Exam 2 Flashcards
1
Q
Infant
A
0-1
2
Q
toddlers
A
1-3
3
Q
preschoolers
A
3-5
4
Q
school aged children
A
6-11
5
Q
adolescents
A
12-17
6
Q
Dental home
A
an ongoing relationship between the dentist and patient inclusive of all aspects of oral health in a family centered way
7
Q
when is a dental home recommended
A
no later than 12mnths
8
Q
barriers to care
A
Financial (income/dental insurance).
▶▶ Lack of parental oral health literacy and the importance of oral health.
▶▶ Language.
▶▶ Transportation.
9
Q
American Academy of Pediatric Dentistry recommends
A
6 months or after the eruption of the first primary tooth
no later than age one
10
Q
One year old
recommendations
A
bring in for caries risk assessment, fluoride management, and general information for the parent, opportunity to educate…
Caries = Cavity
11
Q
toddler recommendation
A
Oral Examination: Positioning for Access
Examination Sequence
12
Q
preschooler recommendation
A
Prepare the Child for the Dental Visit
Positioning
Parental Involvement
13
Q
school age
A
▶▶ Can be an active participant in the dental care visit.
▶▶ May still display signs of anxiety or uncooperativeness.
▶▶ Typically, once a child is in school full time having a parent present during their appointments is no longer necessary.
Examine the need for pit and fissure sealants.
▶▶ A periodontal assessment needs to be completed even if there is no bone loss.
14
Q
when is FL TP recommended
A
all children starting at tooth eruption
15
Q
how much FL TP is used until age 3
A
the size of a grain of rice or a smear
16
Q
How much FL TP is recommended for a child 3 and up
A
pea size amount
17
Q
Rules for bottle/sippy cup
A
-never to bed
-only formula or breast milk in the bottle
-never put anything that has been in your mouth in theirs
18
Q
for a toddler you educate the parent on
A
plaque control, diet/feeding, importance of regular dental exams, ECC & bottle rot
19
Q
when do most kids see a dentist
A
at 3 years old
20
Q
white areas or spots start
A
at front teeth on the first teeth to erupt and last protected saliva
21
Q
what happens if white spots go untreated
A
white areas will become yellowish-brown
crowns may be destroyed to the gum line
abscesses may develop
child may suffer severe pain and discomfort
22
Q
Decay information for parents
A
bacteria: strep mutans
-feed off sugar
Sugar turns to acid on teeth
- takes 20 to 40 minutes for the acid to be washed away by saliva
-demineralization of tooth
-sugar
-Carbohydrates = milk, juice, crackers, bread
23
Q
Early Childhood Caries is defined as
A
the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a preschool-age child between birth and 71 months of age.
24
Q
ECC Risk Factors
A
High levels of Streptococcus mutans and dental plaque
-Acidic Oral Environment - pH under 5.5 considered ‘critical’
-Poor Dietary Habits – high levels of acid forming carbohydrates
-Presence of Enamel Defects
25
presence of enamel defects
Maxillary anterior teeth and primary molars are the first to be affected
As the baby falls asleep, pools of sweet liquid can collect around the teeth
Breastfeeding - nipple covers the mandibular anterior teeth, leaving them less effected
26
when is nutrition most important in the life cycle
infant/toddler
27
what is the best source of nutrition for a toddler/infant
Human milk – optimal source of nutrients
Formula – second best
Solid foods introduced around 4-6 mos.
28
feeding 6 months
6 months, introduce child to sippy cups
wean off bottle feeding
between meals sippy cups: water only
as finger foods are introduced,
sugar-containing foods should be limited to mealtimes
have regular pattern of meals and set snacks
Provide healthy snacks from the grain, vegetable, fruit, meat, and milk groups between meals
Rinse the child’s mouth with water immediately after dispensing sweetened medications
29
suckling
: A process developed when the child must open mouth wide, move jaws back and forth, and squeeze with the gingiva to extract milk.
developed well with breast fed babies
encourages maximum development of the genetically defined jaw and chin.
30
food jags
refusing to eat anything except one food for several days.
Normal
Temporary
Limit snacking or provide nutrient-dense snacks
31
Anticipatory Guidance
teaching ahead of time feeding and brushing habit to prevent caries
32
PRESCHOOL CHILD TREATMENT AGE: 4-5 guidance
dental visits every 6 months under normal conditions
child usually more cooperative if parent is not present
parents not allowed in operatory in some offices
encourage “refueling” every 2-4 hours
8-15 exposures for new food acceptance
offer healthy snack choices:
Make the appointment fun: “the sun, Mr. Thirsty, the squirt gun, special toothbrush,” etc.
33
YOUNG CHILDREN: Age 6-10
Nonverbal communication skills are more important with preschoolers than older children. The dental hygienist is advised to make the appointment “game-like” with short simple sentences and explanations.
Parental presence still usually not positive
Be cautious with mask, glasses, gloves
Controlling non-compliant behavior
voice control; who’s the boss?
34
THE GOAL OF BEHAVIOR MANAGEMENT
To help the child establish a positive attitude toward dental health care
To create an atmosphere for the child where dental treatment can be performed effectively and efficiently
35
DEVELOPMENTAL STAGES
Two to eighteen year olds
36
Factors to Teach the Parents
Parent’s oral health affect child’s oral health
Bacteria can be transferred to baby’s mouth from family members
Benefits of fluoride
Methods to prevent dental caries in young child’s mouth
How feeding methods and snacking patterns can contribute to dental caries
How parent can examine child’s mouth and what to look for
37
Treatment Planning and Consent
Dental hygiene diagnosis used to develop care plan
Discuss care plan with dentist
Inform parent/guardian of findings and present care plan orally and in writing
Obtain signed informed consent
Parent/guardian will need to consent to medical clearance
Parent/guardian must approve care plan
38
Documentation
Overall appraisal of physical status and key health history findings.
Existing pathology
Oral hygiene status and caries-risk assessment
Anticipatory guidance provided, parent/guardian recommendation, and any adjunct hygiene aids provided
Procedures completed
Child’s behavior throughout appointment
Treatment planned for next visit
39
Work Related MSDs
An injury affecting the musculoskeletal, peripheral, nervous & neurovascular systems.
Caused or aggravated by prolonged, repetitive forceful or awkward movements, poor posture, ill-fitting chairs & equipment or fast-paced workload [2] . . . and others!
Periodontal Instrumentation:
a repetitive task
more that 50% of time spent using the same fundamental movement and positions.
Clinicians are at a high risk of developing MSD resulting in shortened careers, chronic pain, …
40
Carpal Tunnel Syndrome
compression or entrapment of median nerve in the wrist
-repetitive flexion and extension of the wrist and hand
“pinch gripping” an instrument w/o resting the muscles
symptoms: radiating pain, tingling & numbness in fingers, loss of strength
41
Ulnar Nerve Neuropathy (elbow to wrist nerve
injury, entrapment or compression of ulnar nerve
- continuous or prolonged flexion & extension of wrist/forearm
symptoms:
pain, tingling or numbness in ring/pinky finger
chronic injury results in weakness & loss of strength
42
Tendonitis
Inflammation, irritation , and/or swelling of a tendon
Occurs in wrist/forearm as a result of overuse from repetitive flexion and extension and poor body mechanics
Symptoms; Pain in the wrist esp. on the outer edges of the hand
43
Thoracic Outlet Syndrome
: Compression of the brachial plexus (nerve bundle from neck to shoulder)
- Poor posture, including extending the head and neck in a forward & awkward position with prolonged incorrect postural techniques with shoulders rounded in static position
- Symptoms; radiating pain and numbness into the neck and shoulder, arm, wrists, and hand coupled with weakness and loss of grip strength
44
Musculoskeletal variations: Scoliosis
Usually congenital, can be acquired from prolonged lateral or rotated positioning toward the patient
Predisposes muscles to become shortened on one side, triggering muscle spasm and pain
early symptoms: chronic one-sided pain, esp. in the upper back
45
Kyphosis
Abnormal increase in normal curvature of the thoracic spine
Result of prolonged poor posture
Excessive rounding of the shoulders while working on patients
Results in prominent round back musculoskeletal deformity
Pain, stiffness, and loss of range of motion
46
Lordosis
Increased curvature of the lumbar spine associated with poor posture from prolonged or abnormal positioning
Lower curve is exaggerated inward “swayback”
Too much of a curve puts pressure on the entire back
Low back pain
Sciatica/leg pain
Lack of mobility
Disability
47
Rotator Cuff Tendonitis
A painful inflammation of the muscle tendons in the shoulder region
Caused by:
Holding the elbow above waist level and holding the upper arm away from the body
Symptoms:
Severe pain and impaired function of the shoulder joint
48
Periodontal Assessment
ADA defines assessment as a “collection and analysis of oral health data to establish patient needs
Can be done as full perio chart or PSR and will include perio risk assessment to be discussed later this semester.
49
Signs of Biofilm Induced Gingivitis
Changes in color: dilated capillaries
Bleeding on probing (BOP): ulceration of JE and sulcular epithelium
Swelling or edema: inflammatory and immune cellular infiltrate
Presence of exudate from gingival sulcus
50
Signs of Disease Progression (Periodontitis)
Periodontal pocket
Suprabony periodontal pocket
Intrabony periodontal pocket
Gingival recession
Clinical attachment level (CAL)
Furcation involvement
Tooth mobility
51
determine stage
Utilize radiographs
Calculate with CAL not PD
Determine by site of Greatest loss
52
Stage I
-1-2mm
-coronal 1/3
-No tooth loss
-max probing <4mm
-mostly horizontal bone loss
53
Stage II
-3-4mm
-coronal 1/3
- no tooth loss
-max probing depth <5mm
-mostly horizontal bone loss
54
Stage III
->5mm
-extending to middle third of root and beyond
-<4 teeth loss
- in addition to stage II severity
->6mm probing depth
-vertical bone loss
-furcation involvement class II or III
-moderate ridge defects
55
Stage IV
->5mm
-Extending to middle third of root and beyond
-> 5 teeth lost
in addition to stage III
-needs complex rehabilitation
-masticatory dysfunction
-secondary occ trauma
-tooth mobility
-severe ridge defects
- bite collapse
-<20 teeth remaining
56
Stage descriptors
for each stage describe
-localized <30% of teeth involved
-generalized or localized
-molar and incisor pattern
57
Determine Grade
Based on progression over time
Must have radiographs to determine
Default to B if no ability to verify
58
Grade A
- no bone loss over 5 years
-<0.25 % bone loss/age
-Heavy biofilm deposits with low levels of destruction
-non smoker
- no diabetes
59
Grade B
- <2mm bone loss over 5yrs
-0.25 to 1.0 %bone loss/age
-destruction commensurate with biofilm deposits
-<10 cigarettes/day
-HBA1c <7.0% in patients with diabetes
60
Grade C
- >2mm over 5yrs
->1.0 bone loss/age
- > 10 cigarettes/day
-HbA1c > 7.0% in patients with diabetes
61
Dental Hygiene Human Needs Conceptual Model Developed by
Developed by Michelle Darby and Margaret Walsh
Built upon premise that human behavior is motivated by fulfillment of human needs
62
Maslow’s Hierarchy of Needs
Self-Actualization Needs
-Self-Esteem Needs
-Love & Belonging Needs
-Safety & Security Needs
-Physiological Needs
63
most dominant need above all others
physiological
-sleep/fluids/sleep
64
Dental Hygiene Model: (adopted 4 major paradigms)
ADHA Standard of Care
selected because of its client/pt. centered orientation
concern for whole person
actively involved &ultimately responsible for self care
65
DH HUMAN NEEDS MODEL 8 HUMAN NEEDS
-patients facial image
-medical health risks
-head, neck, or oral pain
-anxiety/stress
-responsibility of oral health
-soft tissue
-understands dental disease and oral care
66
Human Needs Theory as a Standard of Care
-Treat the patient as a whole, show interest in overall systemic health not just oral health
-Take a patient centered approach
-Learn all we can about our patients as a whole to use for education and motivation
-Consider the role of environment in overall wellness
67
Dental Hygiene’s Paradigm Concepts
-client
-environment
-health and oral health
-dental hygiene actions
68
Paradigm Concepts Viewed Through Dental Hygiene Human Needs Model
-Human need fulfillment restores sense of wholeness as human being
-Client is viewed as having eight human needs especially related to dental hygiene care
-Environment influences manner, mode, and level of human need fulfillment
-Concept of health and oral health exists on a continuum
-Dental hygiene actions: behaviors of dental hygienist aimed at assisting clients in meeting their eight human needs
69
Eight Human Needs Related to Dental Hygiene Care
-protection from health risk
-freedom from stress and fear
-freedom from pain
-wholesome facial image
-skin membranes integrity of the head and neck
-biologically and functional dentition
-conceptualization and problem solving
-responsibility of oral health
70
Protection from Health Risks
Assessment
Evaluate client’s verbal and nonverbal behaviors, in addition to clinical, radiographic, and laboratory assessments; watch for things such as:
Evidence that a referral or consultation for a condition is needed, sometimes immediately
Evidence that premedication is needed
Evidence of risk of oral injury
Implications for dental hygiene care
Obtaining initial information related to a client’s general and oral health and updating it at every appointment are essential
71
Freedom from Fear and Stress
Assessment
Evaluate the client’s verbal and nonverbal behaviors
Oral habits related to stress (bruxism or nail-biting)
Excessive perspiration
Implications for dental hygiene care
Initiate fear- or stress-control interventions immediately
Communicate with empathy
Answer any and all questions
72
Freedom from Pain
Assessment
Evaluate verbal and nonverbal behaviors in addition to signs of physical discomfort
Speaks with hesitation
Extraoral or intraoral pain sensitivity
Implications for dental hygiene care
If pain is apparent at the beginning of or during the dental hygiene appointment, the dental hygienist should initiate pain control interventions immediately
73
Wholesome Facial Image
The need to feel satisfied with one’s own oral-facial features and breath
Assessment
Based on information from history, direct observation, and casual conversation
Implications for dental hygiene care
Provide information, reassurance, and referrals as needed
74
Skin and Mucous Membrane Integrity of the Head and Neck
Assessment
Careful observation of the client’s face, head, and neck and examination of the oral cavity and adjacent structures before planning and implementing dental hygiene care
Implications for dental hygiene care
A variety of skin and oral mucosal lesions may be observed that may or may not be symptomatic
Dental hygienists may also recognize poor nutrition
75
Biologically Sound and Functional Dentition
Assessment
Ongoing
Client may report things such as:
Difficulty in chewing
Ill-fitting prosthetic restorations
High daily sugar intake
Implications for dental hygiene care
Document existing conditions and deviations from normal
Signs of disease and/or functional problems should be reported to the dentist
76
Conceptualization and Problem Solving
Assessment
Listen to client’s questions and responses
Implications for dental hygiene care
Present rationale and details of recommended methods for the prevention and control of oral diseases
77
Responsibility for Oral Health
Assessment
Use data collected from direct observation in addition to health, pharmacologic, dental, personal, and cultural histories
Implications for dental hygiene care
Suggest behavior changes
Provide oral health education
Encourage the client
78
THE HUMAN NEEDS THEORY AND THE DH PROCESS OF CARE
A systematic approach to dental hygiene care:
a sequence of actions that are continual in nature.
*Adopted by the ADHA in 1985 as the industry standard.
Hygienists will make clinical decisions based on satisfying their patients’ human need deficits
Human need theory gives the DH process of care a theoretical framework and a philosophy
79
Decision Making and the DH Process of Care
Clarify the problem
Find alternatives
Weighing alternatives
Making the decision
Evaluating the outcome
Recognize your professional, moral & legal accountability
80
The Dental Hygiene Process of Care
ASSESSMENT
DH DIAGNOSIS
PLANNING
IMPLEMENTATION
EVALUATION
DOCUMENTATION
81
The Dental Hygiene Process of Care
Derived from the assessment; focuses on human needs that can be fulfilled through DH care
ex: gingivitis,
caries prevention
Identification of unmet human needs related to DH care and the Cause & Signs and Symptoms
DHDx
82
Carbohydrates
Organic compounds made up of carbon, hydrogen, and oxygen
Provide source of energy
Yield 4 kilocalories/gram
Include monosaccharides, disaccharides, and complex polysaccharides
83
Glucose (dextrose/blood sugar)
Main fuel for brain and needed for WBCs and RBCs
Most abundant carbohydrate found in nature
Found naturally in fruits and vegetables
84
Fructose (levulose/fruit sugar)
Sweetest monosaccharide
Found in many fruits and honey
85
Galactose (component of milk sugar)
Body converts glucose to galactose in mammary tissue during lactation; makes lactose in breast milk
Found in dairy products and some legumes
86
Sucrose (table sugar)
furnishes almost 16% of calorie intake in the average Western diet
Made up of glucose and fructose
Found abundantly in fruits and vegetables
87
Lactose (milk sugar)
Made up of glucose and galactose
Found in milk products
88
Maltose (plant sugar)
Made up of 2 glucose molecules
By-product from the breakdown of polysaccharides
Found in beer and malt beverages
89
Starch (amylase and amylopectin)
plant storage form of glucose
Nutritionally most important carbohydrate
Stores energy
Digestible; breaks down at a slow rate
Sources include rice, potatoes, pasta, and legume
90
Glycogen
Provides a carbohydrate storage form of energy in animals and humans—glycogenesis
Liver regulates blood sugar for the brain
Muscle serves as an energy source for muscle contraction
Not significant as a food source
