Dentistry Flashcards
Who should have Antibiotic Prophylaxis before dental procedures?
Patients with cardiac conditions such as prosthetic heart valves, who have had previous endocarditis, cardiac transplant patients, or who have congenital heart disease (Either repaired or unrepaired).
When is antibiotic prophylaxis recommended?
Before any dental procedure that involves the manipulation of the gingival (gum) tissue, periapical region of teeth, or oral mucosa.
i.e. extractions, cleanings, fillings, root canals.
When is antibiotic NOT recommended?
Routine anesthetic injection through noninfected tissue
Taking dental x-rays
Placement of removable prosthesis
Adjustment/placement of orthodontic appliances
Bleeding from trauma to lips/oral mucosa
What medication is used for antiobiotic prophylaxsis?
Single oral dose 30-60 minutes prior to appointment of amoxicillin (2g for adult; 50 mg/kg for child).
Can use Clindamyacin, Ampicillin, Cefazolin if patient is allergic to pencillins.
Dental Caries
Infectious microbiological disease of the teeth that results in localized dissolution and destruction of the calcified tissue.
What 3 things are necessary for dental caries to occur?
Teeth
Bacteria
Carbohydrate (sugar)
Also, time for the bacteria to grow and devour the carbs. Brushing disrupts this, so dental caries can be prevented.
What agent is the main cause of Dental Caries?
Strep. mutans: gram positive alpha hemolytic cocci. Facultative anaerobe.
Acid producer and acid tolerant.
Produces glutans from sucrose whcih act as a matrix for the bacteria on enamel surface.
What agent causes root caries?
Actinomyces: gram positive filamentous rod that resembles a fungi.
Dental Plaque
A gelatinous mass of bacteria and its food source adhering to the tooth surface.
The accumulation of plaque on teeth is a highly organized and ordered sequence of events.
Removed during brushing/flossing.
Sequence Leading to Dental Plaque
- Bacteria produce acid
- Acid dissolves the calcium phosphate matrix of enamel.
- Bacteria invade dentin.
- Dentin is dissolved.
- Pulp tissue is invaded (nerves/vessels)
- Irreversible infection of pulp tissue
When does Lactobacillus cause dental carries?
After streptococci invade; allows more organisms to adhere. As the bacteria multiply in the plaque, the flora environment is more adequate for anaerobes: the S. mutans creates and environment for itself via making glutans and acid.
A patient with dental caries was prescribed an antibiotic, which successfully took care of the gram + aerobes causing the cavity. However, a week later, the patient presented with a black tongue described as “hairy”. Why?
Fungi are not affected by long-term penicillin use.
Actinomces
Anaerobic acid producing filamentous bacteria that resembles fungus. It thrives at the gingiva when root surface is exposed (generally in older patients with natural gum regression) and can cause peridontital disease.
Lactobacillus
Rod shaped anerobic acid producing and acid tolerant baccteria present in later stages of caries.
Which layers are most susceptible to dental caries?
The dentin. Enamel is resistant, but once infection reaches the dento-enamel junction, it generally spreads to the pulp.
Treatment of Dental Caries
Remove infected enamel and dentin and replace with synthetic so that it can be cleansed by the patient.
Self-repair of teeth
As acid dissolves calcium phosophate out of enamel, recalcification also occurs. Brushing and flossing allow this to occur because it interrupts dental carry formation.
A patient comes to you complaining that she has been getting cavities ever since starting a depression medication. How do you explain this to her?
A side effect of the meds is dry mouth, which decreases saliva production and interrupts the remineralization process. Advise her to take good care of her teeth.
Prevention of Dental Caries: Fluoride
Topical in toothpaste
Water supply (Easiest/most effective)
Fluoride pills if there is no F in the water.
Action of Fluoride
Absorbed into enamel and aids in recalcification if taken orally. Also makes enamel less soluble in acid.
If internally, becomes part of dentin and enamel matrix.
Xylitol
A sugar alcohol derived mainly from birch and other trees. It is associated with decreased stretopcoccus mutans in saliva and plaque.
Chlorhexidine
Antispetic agent use of rinse in high risk patients decreases bacterial count for hours. Useful in peridontal/gum disease.
Make sure to lift the lip when examining teeth, especially in kids.
Look for inflammation, ulceration, lumps and bumps.
A healthy mouth is:
Pain free
Gums are pink or brown with knife-edged gum triangles
Gums don’t bleed, are firmly attached to bone, and are dimpled like an orange peel
No dark spots or broken teeth
Periodontal Disease
Infection of the gingiva. Gingivitis is milder and reversible because it only affects the gingiva. Use better oral hygiene and teeth cleaning.
Periodontitis is a more serve infection of the gingiva AND bone.
A patient presents with gums that are red, swollen, tender and bleed easily. He also has persistent bad breath. What is your diagnosis?
Gingivitis.
Other Signs of Periodontal Disease
Receding gums, loose/separating permanent teeth.
Risk Factors of Periodontal Disease
Tobacco use, systemic disease (diabetes), medications (steroids, Ca2+ channel blockers, oral contraceptives), defective restorations, crooked teeth, pregnancy (Reversible).
What systemic disease is associated with periodonitis?
15% greater risk of Coronary Heart Disease.
Unhealthy Gums
Inflamed, puffy, red (Gingivitis)
Swollen, shiny red gums and loss of gums and bone (Periodonitis)
May shrink away from teeth
May drain pus
What causes gum disease?
Poor oral hygiene
Oral bacteria
Medicines that cause dry mouth, have high sugar content, or cause gum overgrowth
Treatment of Periodontal Disease
Improved oral hygiene Routine teeth cleaning Med: peridex Periodontal surgery Removal of infected teeth if unsalvageable
Prevention of Periodontal Disease
Oral hygiene: brushing and flossing disturbs dental plaque and decreases acid production
Pit/fissure sealants: prevents plaque formation
Routine dental exams: earl detection, flouride treatment, and restorative intervention
Sources of Bad Breath
Poor oral hygiene, dry mouth, gum disease, frequent sinus infections, digestive problems, diabetes, medicines, fissured tongue.
Dental Pulp Infection
Irreversible infection due to poor blood flow and inability to increase blood flow to the area
A patient presents with swelling, pain without a stimulus or due to a hot stimulus. On x-ray, the dentist sees dark (Radiolucent) portions in the roots. Diagnosis?
Dental pulp infection
Causes of Dental Pulp Infection
Decay (bacterial invasion)
Tooth fracture exposing pulp to oral flora
Trauma (disrupting apical blood supply)
Tx: Dental Pulp Infection
Endodontic (Root Canal) treatment: removal of pulp tissue and replacement with endodontic filling material (gutta percha).
Result of Endodontic Surgery
Get to keep the tooth
Tooth may become discolored/dark
Tooth may need a crown
Dental Abscesses
Swelling usually indicates a necrotic pulp with spread of inflammation to the soft tissue.
Tx: antibiotics
Drainage if severely swollen by incision and extraction of the tooth.
Treatment of Odontogenic Infection
Removal of the cause
Drainage and debridement
Extraction of baby teeth/root canal of permanent teeth
Oral antibiotics if systemic
Extraction of abscessed tooth is often sufficient treatment
A five year old presents to the ER with pain and dehydration along with an abscess from the gums inward to the mandible visible with imaging. What is your concern?
Mandibular infections which can compromise the airway.
If the child has urinated in the last 12 hours. Assess fluid intake.
Temperomandibular Joint
Combination of rotating and translocational when chewing and speaking.
15% of adults in America suffer chronic facial pain.
Symptoms of TMJ Disease
Pain around the ear Tenderness of the jaw Clicking or popping when opening the mouth Chronic headache Chronic neck ache
Diagnosis of TMJ Disease
Complete dental exam is often necessary, but there are clues.
Can be seen on X-ray, CT, or MRI.
A patient presents with painful chewing and ear pain. The jaw pops when moving. Teeth appear smooth. What is your diagnosis?
TMJ Disease.
Treatment of TMJ Disease: Acute pain
Jaw rest: bite guard; soft food Heat and ice therapy Medications: anti-inflammatories (aspirin, ibuprofen), muscle relaxants (Valium), corstisone injections in certain cases. Osteopathic maniuplation PT Stress management Bite guard/splint Correction of bite abnormalities Last resort: surgery
Avulsed (knocked out) Tooth
Hold tooth by crown
Rinse of gently with water ONLY if dirty
Do not scrub or remove attached tissue fragments
Gently insert tooth in socket, but if not possible, place in cup of milk and see a dentist
Cracked Tooth Syndrome Causes
Caused by chewing on a hard object, accident, grinding/clenching teeth, stress on tooth, post endodontic “brittleness”.
A patient presents with pain upon release of pressure and sensitivity to hot and cold, sweets, and sour/sticky food. Dx?
Cracked Tooth Syndrome.
Treatment of Cracked Tooth Syndrome
Resoration (filling or crown)
Bonding agent
Root canal
A patient presents with dry mouth and changes in taste along with difficult swallowing and speech. He has recently been placed on a new medication. DX?
Xerostomia.
Other Causes of Xerostomia
Sjorgen’s (presents with xeropthalmia too)
Rheumatic Disease & radiation tehrapy
Problems Assocaited with Xerostomia
Not enough saliva promotes tooth decay, gum disease, and infections. Can also make swallowing and nutrition more difficult.
Suggestions for Xerostomia Patients
Take sips of water, chew gum, use saliva substitues, try stimulants like pilocarpine.
Maintain oral hygiene and increase fluoride to 1.1% NaF to prevent dental caries.
Diabetes and Periodontitis
3-fold increased risk. No significant risk if glycemic control is monitored.
Chronic infection worsens glucose control. Treating it shows 10-20% improvement in glycemic control.
Elderly patients have risk of inadequate oral care.
Many have chronic disease and many live in poverty.
Most lack insurance and are homebound/institutionalized.
65% are disabled.
Patients with strokes, arthritis, dementia are most at risk.
Swelling
Swelling of gums, lips, tongue and face may be a result of injury or infection. Swelling accompanied by an elevated temperature may signal an infection. Such infections and facial swellings, especially in the lower jaw region, can be serious and can jeopardize breathing. They demand attention right away. Swelling or pain without a fever may signal a facial injury or fracture.
Bleeding
Heavy bleeding from the mouth which doesn’t’t stop by itself could be caused by an injury. You may not be able to see the source of the bleeding.
Avulsions
Avulsion describes when a tooth is knocked out of its socket with the root attached. If a tooth accidentally comes out, root and all, as a result of injury or a fall, don’t scrub or scrape it - place it in any kind of milk or water and bring it and the person to the dentist right away. The best chance of replacing it into the socket is if it is done quickly, within about an hour of its coming out. The goal is to keep the tooth moist, because if the root is allowed to dry out, there is no hope of replacing it in the socket.
Conditions That require attention within 72 hours
Decay on tooth surfaces, overgrown gums, mouth sores, swollen/bleeding gums, oral candidiasis, hairy tongue, fistula/boil, broken tooth.
Discoloration of Teeth
Can occur due to injury; bluish due to bleeding inside tooth. Usually requires a root canal.
