- not used with pts who have pacemakers or other electronic life-supporting devices > must be place on non-restored tooth - false positive on metalic restorations > placed in middle of tooth

Dental Examination and Charting Flashcards by a l

Development of dental caries

Development of carious lesions require:

1.Miroorganisms
Streptococcus mutans
Streptococcus sobrimus
Acidogenic lactobacilli
Nonmutans streptococci
Actinomyces

2.Carbohydrates (sucrose)

3.Susceptible tooth surface
>partially weakened
>difficult to keep clean > pits and fissures, interprox

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Steps in formation of dental caries

Phase I & Phase II

›Phase I incipient lesion
»remineralization can occur if treated in this phase

›Phase II untreated incipient lesion
>> breakdown of enamel
>> see and feel irregularities
>> spread to DEJ
>> subsurface demineralization - biofilm can seep thru pores to dentin

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GV Black’s Classification of dental caries

›Class I - pits and fissures
›Class II - prox of post
›Class III - prox of ant.
›Class IV - prox of ant involving incisal edge
›Class V - facial / lingual of cerv. 3rd
›Class VI - incisal edge of cusp

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Early childhood caries

›Microbiology
high levels of Streptococcus
mutans and Lactobacilli in biofilm

Risk factors
teaching parents
Significant risk factors: nursing bottle containing sugary fluid, including milk.
Pacifier sugar-dipped. Prolonged at-will breast feeding.

Effects
›max ant teeth and primary molars first to be affected

›children need should be seen for an examination no later than 6 months after eruption of first tooth

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Root caries

Steps in formation
recession must occur first to expose cemental surf.
start near CEJ where cementum is thinnest

Effects

Clinical recognition
active lesion = soft or leathery
inactive / arrested lesion = hard
color = yellow to brown black

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pH of mouth, cementum and enamel

mouth = 6.2

cementum = 6.2 - 6.7

enamel = 4.5 - 5

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Types of pulp vitality testing

Thermal

Electric

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Thermal testing

Cold test
›Materials - air blast, cold drink, ice stick, ethyl chloride in a spray or on a cotton swab, or a carbon dioxide dry-ice stick
›Isolate test teeth and dry with gauze

Heat test
›Temporary stopping (gutta percha) - Apply to tooth dried with gauze
›Water - Isolate tooth and bathe in very warm water

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Electric testing

not used with pts who have pacemakers or other electronic life-supporting devices
> must be place on non-restored tooth - false positive on metalic restorations
> placed in middle of tooth

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Causes of loss of pulp vitality

›Baterial – invasion of pulp from caries or perio

›Physical – mechanical or thermal injuries

Vitality depends on blood supply not nerve

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Clinical obs of loss of pulp vitality

›Clinical – intrinsic discoloration, fracture, large caries or restoration, fistula

›Radiographic – bone loss w/widening PDL extending to apex, fractured root, large caries or restoration close to pulp chamber

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Noncarious Dental Lesions (4)

Enamel hypoplasia

Attrition

Erosion

Abrasion

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Enamel hypoplasia

Defect that occurs as result of disturbance in formation of organic enamel matrix

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Types of Enamel hypoplasia

Hereditary
Systemic - nutrition deficiency, chicken pox, disease
Local - usually due to trauma, occurs while tooth is forming

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Attrition

Wearing away of tooth as result of tooth-to-tooth contact

Bruxism

 with age, more seen on men than women

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Appearance of attrition

Clinical and Radiographic

Initial lesion.
›Small polished facet on a cusp tip or ridge, or slight flattening of an incisal edge

Advanced
›Gradual reduction in cusp height; flattening of incisal or occlusal plane
›Staining of exposed dentin, usually is brown

Radiographic
›Pulp chamber and canals may be narrowed and sometimes obliterated as result of formation of secondary dentin

Erosion

Loss of tooth substance by chemical process that doesn’t involve known bacterial action

Facial, lingual, or occlusal depending on cause

Cause  may be idiopathic, chronic vomiting, atmospheric/dietary acid

Abrasion

Wearing away of tooth substance by mechanical forces other than mastication

Occurs @ exposed root surfaces or @ incisal edge

Abfraction

Theoretical, still unproven

Deep, V-shaped lesions 1 or 2 teeth

Occlusal interferences

Tooth fractures causes

›Automobile, bicycle, and diving accidents

›Contact sports when mouth protectors are not worn

›Blows incurred while fighting

›Falls

Tooth fracture description

Line of fracture

May be horizontal, diagonal, or vertical

Radiographic signs of recent trauma

Widened periodontal ligament space

Radiolucent fracture line

Radiopaque areas where fracture segments overlap

Tooth displacement

Types of facial profiles

›Orthoognathic - normal

›Mesognathic -

›Retrognathic -overbite

›Prognathic - underbite

Malocclusion examples

Crossbites
Edge-to-edge
End-to-end
Open bite
Overjet
Underjet
Overbite

Overbite classification

Normal - incisal 3rd Moderate - middle 3rd Deep, severe - cerical 3rd

Malposition of teeth

Labioversion: a tooth that has assumed a position labial to normal. Linguoversion: position lingual to normal. Buccoversion: position buccal to normal. Supraversion: elongated above the line of occlusion. Torsiversion: turned or rotated. Infraversion: depressed below the line of occlusion, for example, primary tooth that is submerged or ankylosed.

Occlusion classes

``` Angle’s Classification: ›Normal (ideal) ›Class I ›Class II -Division 1 - max ant flared out -Division 2 - max ant retruded ›Class III ```

Functional occlusion

Occlusion consists of all contacts during chewing, swallowing, or other normal action Types of occlusal contacts ›Functional – normal contacts made ›Parafunctional – contacts outside normal range of function, result of occlusal habits/neuroses

Proximal contacts - purpose

›Stabalize position of teeth

Migration

›Drifting – natural tendency for mesial migration ›Pathologic migration – occurs when disease present

Trauma from occlusion

Perio tissue injury caused by repeated occlusal forces that exceed the physiologic limits of tissue tolerance

Types of occlusion trauma

›Primary trauma – excessive occlusal force with normal bone support ›Secondary trauma – excessive occlusal force with bone loss

Effects of occlusion trauma

›Excessive forces Circulatory disturbances, tissue destruction from crushing under pressure, bone resorption, and other pathologic processes are initiated ›Relation to inflammatory factors Does not cause gingivitis, perio, or pocket formation***

Clinical Signs of occlusion trauma

- Tooth mobility. Fremitus. - Sensitivity of teeth to pressure and/or percussion. - Pathologic migration. - Wear facets or atypical incisal or occlusal wear. - Open contacts related to food impaction. - Neuromuscular disturbances in the muscles of mastication. - muscle spasm can occur. - TMJ symptoms.

Radiographic findings of occlusion trauma

-Widened PDL spaces, particularly angular thickening (triangulation). -Angular (vertical) bone loss in localized areas. -Root resorption. - Furcation involvement.