Exam 2 Flashcards
Subjective
Can Only be reported by the patients
Symptom
“It hurts”
“ I feel tired”
“keeps me awake at night”
“I have a metallic taste”
Symptom
Objective
Can be observed/ measured
Sign
Increased pulse rate, BP, temp
Radiographic findings
observed swelling
Provocation test results
Sign
Listen to your patients for __ of disease and evaluate your patient for __ of disease
symptoms
signs
If the dentist can observe or measure a reported symptom, the symptom is
also a sign
When would you do a provocation test
unexplained periapical radiolucency
Isolation of diffuse dental pain
Determine vitality of discolored teeth
Determination of perio vs endo origin
What are the 4 types of provocation tests
Percussion
Cold
Heat
Electric pulp test
(ONLY USE if needed)
What are the 4 possible results of provocation tests
Normal pulp
Necrotic pulp (No results)
Reversible pulpitis
Irreversible pulpitis
Reversible pulpitis
Responds quicker to stimulus than control tooth
Pain subsides quickly with removal of stimulus (pain goes away fast)
Irreversible pulpitis
Responds quicker to stimulus than control tooth
Pain lingers
Pain more intense
Pain spontaneous
Heat sensitivity
What are the treatment options for irreversible pulpitis
Endodontic therapy (If tooth is restorable)
Extraction (Non-restorable or finances)
Patient needs endo therapy because there is irreversible pulpitis and tooth is restorable, need to get patient out of pain for today, what do we do
Emergency pulpal debridement (cant charge for endo and pulpal debridement on same day)
Radiographically how do you know if there is necrotic pulp
Possible periapical RL
- Not all periapical RL are associated with necotic pulp (cyst, tumors, cementomas)
Some necrotic pulps do not present with periapical radiolucencies (Bone loss has to be present to show)
Possible signs and symptoms of necrotic pulp
Possible intraoral swelling, extraoral swelling, percussion sensitivity, possible pain, possibly febrile
If pulp is necrotic what are provocation test results
For EPT, cold test and heat test it would all test negative
For percussion test it could test positive or negative (Tap it could hurt)
T/F: If tooth is not restorable we do endo
FALSE if not restorable = no endo
Internal vs external resorption is diagnosed by
evaluating radiographs taken at different angles
(internal resorption will always be in the middle of the pulp, external and look like its in the middle of the pulp or external based on the angles)
Endodontic success rates
Initial Tx: 90%+
Factors that decrease endodontic prognosis
calcified canals
pulp stones
dilacerated roots
Root fracture
Root resorption
Retreatment
T/F: Necrosis does not decrease the endodontic prognosis for that tooth
TRUE
What falls under periodontal disease
Gingivitis and periodontitis (both are forms of periodontal disease)
Localized vs generalized perio is determined by
teeth involved
Localized: <30% of teeth evaluated
Must have __ for a diagnosis of periodontitis
CAL
(Can only do an SRP if they have perio = means they have to have CAL)
What is the difference between the two perio codes
one is 4+ teeth per quad
other is 1-3 teeth per quad
How is perio disease addressed in treatment planning
OHI
Tobacco counseling
SRP
Replace defective restorations
protective restorations (use GI)
Perio re-eval (phase I)
Perio surgery
Preventive review
Perio review
Maintenance schedule
perio is only treatment planned after
all contributing factors are eliminated
Perio re-eval vs perio review
Perio re-eval = following up on perio you have treated
Perio review = looks at whole pt again to see if there are new perio findings since 1st exam (end of phase 1 and phase 2)
What determines restorative surfaces
Line angles
ULSD amalgam uses
Anterior direct restorations (class III distal of canines, lingual class V)
Posterior direct restorations
Cores
ULSD Composite uses
Anterior direct restorations (class III, V, VI and composite veneers)
Posterior direct restorations
Cores
ULSD Class II composite indications
Small/ moderate restorations with enamel margins (doesnt bond well to cementum)
Most premolars and molars
A restoration that does not provide all of the occlusal contact
A restoration that does not have heavy occlusal contacts
Ability to obtain good isolations
Advantages of composite veneers vs porcelain (7)
reversible
test restoration
less expensive
single appointment
shade can be modified
easy to repair
life span 5-8 years
Disadvantages of composite veneers vs procelain
difficult to mask severe staining
thin edges chip and stain
pits/voids tend to stain
become flat looking with wear
relatively short life span
Advantages of glass ionomer
Cosmetics (vs amalgam, but not as esthetic as composite)
Fluoride release
Bonds to dentin and enamel
Minimal prep
Good provisional material
glass Ionomer disadvantage
Esthetics inferior to composites
more prone to fracture than composites
more prone to wear than composites
At ULSD we dont use glass ionomer in any area that is
providing occlusion
(Class v on #20 = yes)
(DO on #20 = no)
Uses for glass ionomer at ULSD
Fuju II LC
Fuji IX GP
Class V restorations
Emergency repair of fractured tooth
Protective restoration after E&E
Provisional during active TX
Margin repairs on indirect restorations
What to know about Dycal
Direct/indirect pulp caps
Pulpal irritant
promotes tertiary dentin formation
does NOT bond to tooth (why we cover GI)
Sets quickly
Easy to place
Highly soluble (why we cover GI)
Poor compressive strength (disadvantage) (why we cover GI)
Patients has irreversible/ reversible pulpitis and is in pain, do we place dycal
NO, because it irritates pulp and will only hurt more (still would promote tertiary dentin but would be more painful)
What to know about Vitrebond LC plus
RM glass ionomer
Used as a liner (not for a direct pulp cap)
Bonds to tooth (but is not a bonding agent)
Thermal insulator
Non-irritating to pulp (doesn’t produce tertiary dentin)
Clinical caries are __ than radiographic decay
larger
Suspected radiographic carious lesions __
must be verified clinically
Clinically detected caries must __
be restored even without radiographic verification
Caries is driven by
frequency of eating
Each time S. Mutan is exposed to __, what is produced
sucrose
lactic acid (this is what dissolves tooth)
After a carious lesion is initiated, __ can utilize __
lactobacillus
any fermentable sugar
If you see a picture of caries, what bacteria is present
lactobacillus
Frequency of sugar is worse than
super high amount of sugar
Step mutans initiates caries because if produces __ plaque from sucrose than other bacteria
It also can survive in an __
more adherent
acidic environment (when others cant)
S. Mutans initiates caries process utilizing __
sucrose
__ becomes the predominant bacteria in a lesion after caries process is initiated
Lactobacillus
Lactobacillus is the most efficient __ bacteria
acid producing (why cavities go bad fast)
Acidophilic
Lactobacillus can utilize
ANY fermentable sugar (avoid carbs)
During mineralization of a tooth, fluoride is circulated via blood plasma to tissues surrounding the __. Fluoride is incorporated into the __ as __
tooth bud
enamel matrix
fluorapatite
After tooth mineralization but pre-eruption: Fluoride is deposited in __ which is beneficial if it occurs within __
surface enamel
2 years of eruption
(Fluoride before tooth eruption is important)
Post eruption: Fluoride is deposited in __ and inhibits __ and enhances __
surface enamel
demineralization
remineralization
Post-eruption:
Demineralized areas have the greatest __
Benefits occur throughout the life of tooth
uptake of topical fluoride
Fluoride protects against caries by
Making enamel more resistant to demineralization
promoting remineralization in areas of demineralization
Inhibiting plaque bacteria from growing and producing acid
Preventive review and restorative review addresses
caries
Always treatment plan a crown foundation as a __
core if an indirect restoration is planned
Core build up includes
Pins
Kentucky medicaid does not pay for
cores
(Instead tx plan these cores for the anticipated restorative material and surfaces)
When may a properly placed core function as a long term restoration
Questionable periodontal prognosis
Patient compliance issues
Financial constraints
Patient health status
The only purpose for a post is for
retention of the core
The General consent form is for __ and does not meet the requirements for __
diagnostic data collection
informed consent
Causes of hard tissue loss:
Decalcification
erosion (non-bacterial)
Abrasion
Attrition
Abfraction
Periodontitis
Endodontic issues
Trauma
Oral cancer
Causes of soft tissue loss:
Toothbrush abrasion
harmful oral habits
periodontitis
endodontic issues
trauma
oral cancer
A posterior tooth that has been endo treated needs
Full cuspal coverage
Crowns make a tooth
weaker
Extraction of hopeless teeth: address on __ or __
limited TP or sequenced early in comprehensive TP
(Want out ASAP)
Extract hopeless teeth before
SRP
adjacent restorations
Categories of service
D0100-D099
D1000-D1999
D2000-D2999
D3000-D3999
D4000-D4999
D5000-D5899
D5900-D5999
D6000-D6199
D6200-D6999
D7000-D7999
D8000-D8999
D9000-D9999
Diagnostic
Preventative
Restorative
Endodontics
Periodontics
Prosthodontics, removable
Maxillofacial Prosthetics
Implant Services
Prosthodontics, fixed
Oral & Maxillofacial surgery
Orthodontics
Adjunctive General Services
