Final Flashcards
(410 cards)
1
Q
Why do an EIO?
A
- base line
- oral cancer screening
- detect from normal
2
Q
oral cancer
A
- Oral cancer accounts for 3-4 percent of cancers
- With early detection the cure rate can exceed 90 percent
- Observation by the dental professional is the principle method for detection of oral cancer
- Early detection is going to reduce the risk of death
- location: Lateral border of the tongue, Oropharynx, hard and soft palate, Lower lip (chew Tabacoo, sun), Floor of the mouth
- malpractice: failure to detect oral cancer (top 10 reasons for malpractice)
3
Q
observation/inspection
A
The act of viewing and watching the client to collect data
4
Q
palpation
A
The act of using the sense of touch to collect data
5
Q
auscultation
A
The act of listening to and detecting body sounds in order to determine variations from normal
6
Q
olfaction
A
The act of sensing body odors to detect variations from normal and potential disease
7
Q
When does the EIO start?
A
when you get them out of the waiting room
8
Q
fruity breath indicates what?
A
diabetes
9
Q
digital palpation
A
Use of a single finger to move or press against tissue
10
Q
bidigital palpation
A
Use of one or more fingers and thumb to move or compress tissue
11
Q
bimanual palpation
A
Use finger of one hand and fingers and thumb of other hand simultaneously to move or compress tissue
12
Q
bilateral palpation
A
Use fingers of both hands simultaneously to move or press on contralateral sides of the head/neck
13
Q
Thyroid gland -location -shape -what does it do enlarges?
A
- Secretes thyroid hormone that controls the body’s metabolic rate
- Middle of lower neck over trachea
- Shaped like a bow tie
- Check for nodules during examination
- Goiter is an enlarged thyroid gland: graves disease, hyperthyroid
- hypothyroid: hashimoto’s
14
Q
lymphatic system
A
- Network of lymph nodes connected by vessels, which plays a role in defense against infection
- Lymph fluid carries nutrients and waste between body tissues and bloodstream
- Lymph nodes are bean-shaped structures that filter and trap bacteria, fungi, and waste
- 400-700 in the body
- 170–300 in neck
- Major chains in anterior and posterior of neck and under chin
- Vary in size from head of pin to baked bean
- Enlarge when infected, if there is an inflammatory condition, or cancer (idiopathic-no cause, infection, cancers)
15
Q
when doing EIO what are you looking or
A
lump, swelling, raised knob, freely movable node, fixed nodule, asymmetry, irregular shape, firm or hard consistency, tender areas, red or discolored area, wound, bruise, scar
16
Q
exostosis
A
extra bone growth on buccal, normal unless it is causing issues
17
Q
leukoedema
A
white film, common on darker skin
18
Q
toris palatine
A
extra bone on the palate
19
Q
nicotine stomatitis
A
minor glands that are irrupted, dry heat causing altered tissue, educate the pt
20
Q
tonsilloliths
A
tonsil stones
21
Q
geographic tongue
A
bengin migratory glossitis
22
Q
scalloped tongue
A
wave like tongue on the borders
23
Q
ankyloglossia
A
tongue tied
24
Q
macule
A
A circumscribed, nonraised area of epidermis altered in color from its surroundings
25
patch
A circumscribed pigmented or textured area larger than a macule
26
erosion
A denudation of epithelium above the basal cell layer
27
ulcer
A loss of epithelium that extends below the basal cell layer
28
scar
A permanent mark indicating previous wound healing
29
fissure
A linear crack in the epidermis
30
papule
An elevated, solid lesion less than 1 cm in diameter
31
plaque
A flat, raised area larger than 1 cm in diameter
32
nodule
A raised, solid mass that has the dimension of depth and is less than 1 cm in diameter
33
tumor
A solid, raised benign or malignant mass that has the dimension of depth and is larger than 1 cm in diameter
34
vesicle
A circumscribed, fluid-filled skin elevation less than 1 cm in diameter
35
pustule
A vesicle filled with purulent exudate
36
bulla
A fluid-filled mucocutaneous elevation greater than 1 cm in diameter
37
when documenting EIO finding ask theses questions about the history
- Is the patient aware of the lesion
- How long has it been present
- Changes in size and appearance
- Symptoms
- 7 to 10 days
38
when documenting EIO findings, be specific about location and document if it is
Localized
Generalized
Single lesion
Multiple lesion
39
when documenting EIO findings, document physical characteristics
Size and shape
Color
Surface texture
Consistency
40
when documenting EIO findings, document Attachment of lesion
sessile or pedunculated
41
excisional
entire lesion is removed
42
incisional
section of the lesion is removed
43
cancer screening adjuncts
- vizilite: abnormal tissue will reflect light and appear white
- velscope: abnormal tissue will appear dark and irregular
44
What is the most common dental emergencies?
syncope: pt has anxiety, psychogenic reaction
male: men don't express that anxiety, more common to faint.
45
what are the risk factors in medical emergencies?
- Increased number of elderly patients in society with natural teeth and dental diseases that require invasive procedures
- Medical advances (more dental history, implants)
- More complex dental procedures require longer appointments
- Increased use of pharmacological agents for systemic conditions (more medicine)
46
what are preventative actions for an emergency
A. Medical History Assessment (allergies)
B. Physical Observation (nervous, not communicating, seems rude, holding onto chair, arms crossed, you can ask them if they are nervous)
C. Psychological Assessment
D. Medical Consultation (resent cardiac event 3-6 months)
47
what are preventative actions for an emergency
- Medical History Assessment (allergies)
- Physical Observation (nervous, not communicating, seems rude, holding onto chair, arms crossed, you can ask them if they are nervous)
- Psychological Assessment
- Medical Consultation (resent cardiac event 3-6 months)
48
compensation
pt vitals increase above base line
49
decompensation
pt vitals decrease below base line
50
what are the 8 vital signs
blood pressure, pulse, respiration, temperature, height, weight, age, medical alert tag
51
is it better to be compensation or decompensation?
compensation
52
why do we take vital signs?
- baseline
- consult if not WNL
- monitor during medical emergency
53
temperature; normal ranges and not normal ranges, what reduces a fever
35.5°C – 37.5°C
96.0°F – 99.5° F
Fever (pyrexia) greater than 99.5°F
Anti- pyrexia: reduces fever
Hyperthermia greater than 105.8°F
Hypothermia less than 96.0°F
54
pulse; normal ranges and not normal ranges
```
Normal adult rate 60-100 bpm
Normal child rate 90-120 bpm
Bradycardia: less than 50 bpm
Lower than normal
Tachycardia: more than 100 bpm
Higher than normal
```
55
blood pressure; normal ranges, Factors to observe during respiration
```
Adult 14 – 20 respirations per minute
Child 20 – 25 respirations per minute
Factors to observe during respiration
Depth: shallow/deep
Rhythm: regular/irregular
Quality: strong/weak/labored
Sounds: gasping/wheezing
```
56
respiration; normal ranges and not normal ranges
normal: 160/>100
57
systolic pressure
The peak or highest pressure, caused by ventricular contraction
58
diastolic pressure
The lowest pressure, caused by ventricular relaxation
59
pulse pressure
The difference between the systolic and diastolic pressures
60
hypertension
- primary
- secondary
- primary
* 90%
* etiology: idiopathic
* predisposing risk factors: heredity, overweight, race, sex, age, environment, smoking
- secondary
* 10%
* major underlying disease, i.e. kidney disease
61
hypertension
| -clinical symptoms
headache, dizziness, shortness of breath, fainting
62
hypertension
| -long term effect
hypertensive heart disease (heart attack)
cerebral vascular accident (stroke)
hypertensive renal disease (kidney failure)
ischemic heart disease (angina or heart attack)
63
hypertension
| -treatment
- life style changes: diet, exercise, smoking cessation
| - antihypertensive drug therapy
64
how to minimize stress
- Heightened anxiety can lead to acute exacerbation of medical problems
- Identify anxious patients through health history questionnaire and observation
- Take steps to reduce stress by developing a rapport and making the patient feel secure
- talk to pt, ask what they would like
- calm voice
65
when should pt with anxiety, diabetes, physical or mental handicaps have appointments
- what works best for the pt
| - shorter morning appointments
66
ASA stands for
american society of anesthesiologist
67
what does ASA physical status classification system do
- estimates the risk for a pt to receive anesthesia
| - valuable method
68
ASA I
normal healthy pt without disease and without stress
69
ASA II
pt with mild systemic disease, anxiety, fear of dental tx, smoker, age, taking medication
70
ASA III
pt with severe systemic disease, disease that isn't well controlled
71
ASA IV
pt with incapacitating systemic disease that is constant threat to life, inhaler multiple times a day, oxygen, not a great time for a cleaning (talk with dr) but if it is emergency that needs to be addressed it can be addressed
72
ASA V
morbid pt not expected to survive with or without an operation, terminally ill pt, palliative tx only, 24 hours left
73
What is the most important thing that most be done prior to a medical consultation
obtain consent from pt to contact physician
74
What is C-A-B
Chest compressions, airway, breathing
75
CPR for an adult
Compression Rate: At least 100 per minute
Depth: At least 2 inches
Compression to Breath Ratio: 30:2 for 1 or 2 rescuer
76
Oxygen is useful in all medical emergencies except
hyperventilation
77
oxygen
- Easily administered
- (E) size cylinder, provides enough oxygen for 30 min, portable
- Tanks are green, nitrogen is blue
- Begin supplemental oxygen at 4-6 liters per minute
78
Epinephrine
- Has a vasoconstrictor effect on the capillary which counteracts the vasodilation produced by histamine in an allergic reaction
- allergic reactions/ anaphylatic shock
- severe life-threatening asthma attacks
- administration: intramuscular into arm or thigh
79
Benadryl (diphenhydramine)
- An antihistamine with anticholinergic (drying) and sedative side effects. In the injectable form benadryl has a rapid onset
- As an adjunct to epinephrine after the acute symptoms have been controlled
- For uncomplicated allergic conditions
- Administration: Intramuscular into arm or thigh
80
Diazepam
-Anticonvulsant that
produces CNS depression
-Treatment of overdose reactions to local anesthetic, epileptic seizures, and anxiety
-Administration: Intravenous or intramuscular into arm or thigh
seizure: let it take its course and if doesn't go away then the pt needs this
81
Nitroglycerine
- Produces relaxation of smooth muscle
- Management of chest pain associated with angina pectoris and acute myocardial infarction
- Administration: Place tablet or spray under the tongue, nitroglycerine increases blood flow, dosage: up to 3 doses in 15 minutes, usually every 5 minutes
82
Glutose (glucose)
- Concentrated sugar
- Used to control hypoglycemic reactions in patients with diabetes
- Administration: Orally
83
Bronchodilator (albuterol)
- An agent used with asthmatic patients and allergic reactions that manifest as respiratory difficulty
- For asthma and for bronchospasm that may occur in association with bronchitis or emphysema
- Administration: 1-2 inhalations, have at appt on counter, and not expired
84
Aromatic ammonia inhalants
- Produces respiratory stimulation. It acts by irritating the mucous membrane of the upper respiratory tract which stimulates respiration
- Vasodepressor Syncope
- Administration: Crush and pass under patients nose
85
sialolith
salivary stone
86
diabetes (what do you smell)
fruity breath
87
Anaphylaxis
severe, sometimes fatal, allergic reaction that results in shock
88
angina pectoris
chest pain caused by a lack of oxygen to the heart muscles; common in individuals with blocked arteries; may or may not result in heart attack; treat with nitroglycerin
89
angioedema
localized, large swellings without the well-defined borders of hived, an allergic reaction to a food or medicine, affects the tissues of the hands, face, and genitals
90
antigen
foreign substance that causes an immune response
91
arterlosclerosis
hardening of the arteries caused by an accumulation of plaque
92
atherosclerosis
arteriosclerosis of the coronary arteries
93
avulsion
traumatic removal of a tooth from its socket
94
bradycardia
slower than normal pulse rate; less than 60 beats per minute (adult)
95
cerebrovascular accident (CVA)
a stroke caused by cerebral hemorrhage, embolism, thrombosis, or infarction
96
clonic
convulsive movements characterized by the contraction and relation of muscles
97
cyanosis
blue coloration of an area, particularly the lips, caused by a lack of oxygenated blood
98
dyspnea
difficult or labored breathing
99
embolism
blood clot, unattached to a blood vessel, carried through the blood stream
100
EMS
emergency medical system within a community; consists of trained personnel and communication, transportation, and medical facilities to provide emergency medical care; is activated in most communicated by telephoning 911; sometimes is referred to as phone first
101
gingival hyperplasia
an over growth of connective tissue component of the gingiva, occurs in direct response to medication use (dilantin) and plaque accumulation
102
hemorrhage
uncontrolled bleeding
103
hyperglycemia
high blood sugar
104
hypoxia
deficiency of oxygen in the air being breathed
105
ictal
relating to convulsion
106
insulin shock
low blood sugar
107
ketones
excess amounts of acetone and acetonic acid in the blood and urine of individuals with diabetes; contributes to an increased frequency of urination
108
kussmaul breathing
heavy, labored breathing that may be either rapid or slow, occurs during a hypoglycemic incident
109
myocardial infarction (MI)
heart attack
110
orthostatic hypotension
low blood pressure that results from remaining in one position for a significant length of time; may be characterized by dizziness, light-headedness, loss of balance, or syncope
111
Pericoronitis
inflammation of the soft tissue that surrounds an erupting tooth
112
postictal
relating to the final stage of a seizure, often involves extreme exhaustion and sleep
113
prodromal
relating to an initial phase of a seizure, during which an aura may be sensed
114
pruritus
itching, typically associated with allergy
115
syncope
fainting, caused by decreased blood flow to the brain
116
tachycardia
faster than normal pulse rate; more than 100 beats per minute for an adult
117
thrombosis
a blood clot attached to a blood vessel
118
tonic
stiff and rigid movements caused by muscle contraction
119
tonic-clonic
describes the sudden muscle contractions followed by convulsive movements during a seizure
120
transient ischemic attack
TIA, a temporary stroke, also termed incipient stroke, does not result in permanent neurological damage, although its occurrence indicates the presence of cerebrovascular disease
121
trismus
difficulty in opening the mouth
122
urticaria
hives, appear as raised areas of edema and erythema and are accompanied by prutius
123
vasodilator
a medication or drug that causes the arteries to dilate (nitroglycerin)
124
coronal polishing
cosmetic procedure designed to remove extrinsic stains from the enamel surfaces of the teeth
125
therapeutic procedure
dental procedure used to maintain health or treat disease to restore health.
126
effects of polishing
```
Environmental contamination
Bacteremia
Iatrogenic damage to tooth structure
Gingiva
Restorations
```
127
dental aerosols
invisible airborne particles dispersed into the surrounding environment by dental equipment such as dental handpieces and electronically powered instruments.
128
how long do microorganisms in dental aerosols survive
24 hours
129
Splatter
consists of airborne particles that land on people and objects.
polishing paste, microorganisms, and saliva
130
What do the patients and clinicians need to wear during polishing and why
glasses, to prevent eyes from splatter
Constituents of prophylaxis pastes may include various chemicals that can cause a severe inflammatory response in the eye.
131
Examples of individuals who are susceptible to bacteremia include those with:
Damaged or abnormal heart valves,
Prosthetic heart valve,
Congenital heart disease,
Cardiac bypass surgery within the last 6 months,
Prosthetic joint replacement, and Dialysis patients
132
if patients need an antibiotic prior to a prophylaxis does that patient need to be pre med for coronal polishing
yes
133
iatrogenic
term used to describe a problem brought on by something that a clinician does.
134
what does polishing generate that should be taken in consideration when polishing?
heat, Care must be taken to use a wet polishing agent with minimal pressure at a low speed to prevent overheating the tooth.
135
what do primary teeth have that gets affected when polishing
large pulp chambers that make these teeth particularly vulnerable to the heat
136
can gingival margin get injured during polishing? if so, how?
yes, incorrect polishing technique
137
What are some dental contraindications for polishing?
Lack of stain, sensitive teeth, exposed cementum or dentin, restored tooth surfaces, newly erupted teeth, implant abutments, areas of demineralization, and gingiva that is inflamed
138
Why is lack of stain a dental contraindication for polishing
Polishing is contraindicated for tooth surfaces that either have no stains or have stains that are not visible when the patient smiles or engages in conversation.
139
Why is sensitive teeth a dental contraindication for polishing
Sensitive teeth should not be polished with traditional prophy paste.
140
Why is exposed cementum or dentin a dental contraindication for polishing
Polishing removes significant amounts of these structures.
| Polishing should be limited to enamel surfaces
141
Why is restored tooth surfaces a dental contraindication for polishing
Restorative materials are not as hard as enamel and therefore may be scratched by abrasive pastes.
Air-powder polishing can scratch, erode, pit, or result in margin leakage.
Special polishing agents should be used when polishing these structures is indicated
142
Why is newly erupted teeth a dental contraindication for polishing
Because the mineralization of newly erupted teeth is incomplete, polishing should be avoided.
143
Why is implant abutements a dental contraindication for polishing
Titanium abutments should not be polished.
| The implant superstructure--prosthetic crown or denture--can be polished if needed for stain removal
144
Why is areas of demineralization a dental contraindication for polishing
Conservation of demineralized enamel surfaces is indicated.
145
why is gingiva that is inflamed a dental contraindication for polishing
Polishing is not recommended for a patient with inflamed, enlarged, soft, spongy, or bleeding tissue.
If needed, polishing should be scheduled for a separate appointment after tissue healing has occurred.
146
What are some systemic contraindications for polishing?
Communicable disease, susceptibility to infection
147
Why is communicable disease a systemic contraindication for polishing
Patients with communicable disease that could be spread by the aerosols created by polishing
148
Why is susceptibility to infection a systemic contraindication for polishing
Patients with high susceptibility to infection that can be transmitted by contaminated aerosols
Examples: those with respiratory or pulmonary disease or debilitated or immunosuppressed individuals
149
What are some special consideration for polishing?
restricted sodium diet, respiratory disease, renal disease
150
Why is restricted sodium diet a special contraindication for polishing
Contraindicated because of the high sodium content of most polishing powders
151
Why is respiratoy disease a special contraindication for polishing
Respiratory disease or other condition that limits swallowing
152
Why is renal disease a special contraindication for polishing
Renal disease or metabolic disorders and in individuals on diuretics or long-term steroid therapy--because the high sodium content of the powder could cause an electrolyte imbalance in these individuals.
153
what are indications for stain removal?
To remove extrinsic stains not removed during tooth brushing and scaling
To prepare teeth for caries preventive agents
To contribute to patient motivation
154
What is the sequence for rubber cup polishing
Identify biofilm/stain (disclose)
Apply polishing agent
Activate the cup
Apply intermittent light pressure for 1-2 seconds
Work from posterior to anterior
Activate the cup from the cervical third to the incisal third
Irrigate and floss
155
What is the rubber cup adaptation and lateral pressure for polishing
The rubber cup should be applied using just enough pressure to make the rim of the cup flare slightly
156
If the pt has tooth color restorations what polishing agent should be used?
soft shine
157
if the patient has demineralization or is sensitive what polishing agent?
sensitive
158
If the patient has no sensitivity and not tooth colored restorations what polishing agent should be used?
fine grit
159
What are the indications for the porte polisher?
Patients with infectious diseases
To apply desensitizing agents
For homebound or bedridden patients
160
aesthetic prodcedure
Stain removal is a nonessential aesthetic procedure undertaken for cosmetic reasons—to
improve the appearance of the anterior teeth
161
extrinsic stain
occur on the external (outer) surfaces of the teeth and can be removed by polishing.
162
chlorhexidine stain
is caused by the use of antimicrobial mouth rinses that contain chlorhexidine. Chlorhexidine causes a yellowish brown stain on
the cervical and proximal tooth surfaces, restorations, and the surface of the tongue.
163
tobacco stain
is a tenacious dark brown or black stain that results from cigarette or cigar smoking or the use of chewing tobacco.
164
intrinsic stain
occur within the enamel of the tooth and cannot be removed by polishing
165
endogenous
occurring during tooth development, tetracycline, dental fluorosis
166
exogenous
acquired after tooth eruption, silver amalgams, non-vital teeth, endodontic tx
167
air-powder polishing
This technique uses a mixture of warm water, a polishing powder, and air for extrinsic stain removal. Other terms for air-powder polishing include airbrasive polishing and air polishing
168
GV black classification I
pits and fissures, using Shepherd's hook
169
GV black classification II
interproximal posterior, bitewings
170
GV black classification III
interproximal anterior, transillumination
171
GV black classification IV
anterior incisal edge, transillumination
172
GV black classification V
cervical third anterior or posterior
173
GV black classification VI
incisal edges of anterior and cusp tips of the posterior, discolored, not common, griding
174
Congenitally missing
circle in blue
175
impacted molar
circle in red
176
MOD amalgam
color in area in blue
177
gold inlay/onlay
Blue diagonals
178
corwns
out line in blue, black diagonals where metal is located
179
Composite restoration
outline in blue
180
temporary restoration
color in area in black
181
Nonprecious metal
green diagonals
182
Sealants
has: outline in blue and write PF in blue
needs: in red write PF
183
caries
red where located
184
Root canal
blue line down root, can only chart with x-ray
185
Overhang
restoration is not flush with tooth
186
fistula
opening to a draining abscess
187
supernumerary/ hyperdontia
extra teeth
188
pontic
fake tooth that is filling a space where a tooth should have been
189
abutment
supporting structure for the pontic
190
cantilever
when there is only 1 side of the pontic that has an abutment
191
crossbite
when the mandibular teeth are in front of the maxillary teeth
192
edge to edge
incisal (anterior) surfaces occlude
193
end to end
cusp to cusp (posterior) surfaces occlude
194
overjet
measurement horizontally between max incisors and mandible incisors
195
underject
maxillary incisors are lingual to the mandibular incisors
196
open bite
lack of incisal contact
197
overbite
incisal edge of maxillary tooth on the facial surface on the mandibular anterior tooth (slight, moderate, severe)
198
Malocclusion class I
mesiobuccal cusp of maxillary first permanent molar occludes with the buccal grove of the mandibular first permanent molar
199
Malocclusion Class II
mesiobuccal cusp of maxillary first permanent molar occludes mesial (by the width of a premolar) with the buccal grove of the mandibular first permanent molar
200
Malocclusion Class II
| division 1
mandible is retruded and all maxillary incisors are protruded
201
Malocclusion Class II
| division 2
mandible is retruded and 1 or more maxillary incisors are retruded and some protruded
202
Malocclusion Class III
mesiobuccal cusp of maxillary first permanent molar occludes distal (by the width of a premolar) with the buccal grove of the mandibular first permanent molar
203
attrition
grinding and wearing down the insical and occulsal edges
204
wear facets
caused by attrition
205
craze lines
chewing on ice, parafunctional habit
206
abrasion
brushing too hard, at gum line
207
abfraction
deep v-shaped
occlusal forces
at gum line
208
erosion
Lemons, eating disorders take involved vomiting, acid reflex
209
ankylosis
rigid fixation of a tooth to the surrounding alveolus as a result of ossification of the periodontal ligament
210
bruxism
grinding
211
static occlusion
contacts between the teeth when the jaw is not moving
212
functional occlusion
consists of all contacts during chewing, swallowing, or other normal actions
213
functional contacts
normal contacts that are made between the maxillary teeth and the mandibular teeth during chewing and swallowing
214
parafunctional contacts
those made outside the normal range of function
215
tongue thrust
infantile pattern of suckle-swallow movement in which the tongue is placed between the incisor teeth or alveolar ridges; may result in an anterior open bite, deformation of the jaws and abnormal function
216
labioversion
a tooth that has assumed a position labial to normal
217
linguoversion
position lingual to normal
218
buccoversion
position buccal to normal
219
supraversion
elongated above the line of occlusion
220
incipient caires
beginning caries or beginning of decay
221
tooth avulsion
The tooth is completely displaced out of its socket. Clinically the socket is found empty or filled with a coagulum.
222
hashimoto's disease
- thyroid is hypoactive.
- Thyroid gland cant make enough thyroid hormone T3 and T4. These keep the the body’s metabolism normal.
- There are many causes to the disease most of which are unknown.
- Symptoms include becoming tired easily, dry skin, or depression.
- Signs include weight gain from an increase in eating, low blood pressure, and a slow pulse rate.
223
high cholesterol
-caused from a buildup of lipids in the heart.
-Excess cholesterol can form plaque between the layers of artery walls.
-Blocking an artery that feeds to the brain can cause a stroke.
It can cause ischemic heart disease because it can case less blood flow to the heart, which will cause less oxygen transportation.
-High cholesterol can be hereditary, or it can be caused by poor diet.
-Many people are not aware they have high cholesterol because there are no symptoms.
-A sign of high cholesterol is high blood pressure.
224
Chemical dependency (alcoholism)
- Alcohol dependency may run in families; passed though your genes.
- It can also be influenced by the environment you grow up in.
- Signs of alcoholism include: Heavy drinking,Easily agitated, Drinking more than one drink daily, Always intoxicated
- Symptoms include: Depression, Withdrawal, Loss of control
225
Simvastatin (20mg)
Use along with proper diet and exercise.
Helps lower “bad” cholesterol (HDL) in the blood.
It reduces the amount of cholesterol from the liver.
226
Synthroid (100 mg)
Used to treat and underactive, deficient thyroid.
| Provides thyroid hormones that would normally be produced by the thyroid gland.
227
Allergies
anaphylaxis
| epinephrine (epi pen)
228
Diabetes
~Type 1 Diabetes:
Insulin dependent
The beta-cells of the pancreas, secreting insulin for lowering blood sugar, are destroyed by the immune system.
Once blood sugar is raised, it cannot be lowered, resulting in hyperglycemia
To control blood sugar, insulin is injected.
~Type 2
Body continues to produce insulin but does not produce enough or is unable to recognize insulin and use properly.
Lack of insulin, or improper use of insulin results in glucose not able to get into the body’s cells to be used as energy
Glucose builds up in the blood
229
Humulin N
treat type 1 diabetes mellitus (insulin dependent, IDDM) and type 2 diabetes mellitus (noninsulin dependent, NIDDM) to improve glycemic control.
230
Lantus
Treatment of type 1 diabetes mellitus (insulin dependent, IDDM) and type 2 diabetes mellitus (noninsulin dependent, NIDDM) to improve glycemic control.
231
Depression
Takes antidepressant Zoloft
Affects physical and metal health
Symptoms:
Depressed mood most of day, nearly every day
Significant weight change or change in appetite
Sleep disturbance
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive guilt
Diminished ability to think or concentrate
Recurrent thoughts of death or dying
232
Zoloft
Treatment of major depressive disorder (MDD) in adults)
| Xerostomia
233
cerebrovascular accident (stroke)
an interruption in blood supply to the brain1
Patient experienced CVA (stroke) in 2004
Patient takes 2.5 mg daily
Effected Psychomotor function on right side, has improved with therapy
234
osteoporosis
porous bones as a result of loss of calcium and minerals, causing weak bones that are susceptible to fractures
Patient takes 150 mg once monthly
235
Coumadin
```
Anticoagulant (blood thinner)
Reduces risk of systemic embolism
Mouth ulcers and taste disturbance
Bleeding from gingival tissue
Increase risk of bleeding during dental surgery
```
236
Boniva
Treatment and prevention of osteoporosis in postmenopausal females
Tooth disorder (cavities, pulpitis, periapical abscess, impacted teeth)
Osteonecrosis of the Jaw (ONJ)
Severe bone disease that effects the jaw
Delayed healing of extraction socket or exposed jawbone
237
hemorrhage
Uncontrolled bleeding, From tooth socket
238
xerastomia
reduction of salvia production
239
dilantin
gingival hyperplasia and increased bleed
| medication used to manage convulsing disorders and for the prevention of seizures.
240
Klonopin
medication that is prescribed to control seizures and to relieve panic attacks or anxiety.
241
benadryl
(antihistamine)- is used to relieve allergic symptoms such as nasal, dermatitis, and other allergic symptoms.
242
clindamycin
used as a pre med for treatment of Mitral Valve Prolapse. Mother is allergic to amoxicillin so this is the safer route even if patient is not allergic to it.
243
mitral valve prolapse
medical clearance from cardiologist
| pre med
244
Hepatitis B
- Is a DNA virus that attacks the cells within the liver.
- Transmitted through blood or bloody fluid, percutaneous or permucosal transmission.
- Hepatitis B can be expressed as acute or chronic with no symptoms.
- Treatment includes: Short term treatment – Interferons, Chronic treatment – - antiviral medications such as Lamivuding and Adefovir
- Severe cases involving liver damage require a liver transplant
- Vaccine is available for Hepatitis B.
245
Arrhythmia
- An abnormal heart rhythm. Such as Bradycardia and Tachycardia.
- It can feel like a fluttering in the chest or neck.
- Severe arrhythmia can cause the heart to be unable to pump enough blood to the body. This condition can be fatal.
- Treatment includes:Pacemaker to stabilize the heart beat, Digitalis medication to make the heart beat stronger with a more regular pattern, Heart valve replacement in sever cases
246
Pacemaker
- This artificial device uses electrical impulses to help the heart pump properly.
- Most pacemakers having a sensing mode that allows the pacemaker to control the heart beat.
- Diagnostic radiation such as dental radiographs is believed to not have an effect on these devices
247
Pneumonia
- Common pulmonary infection which can be caused by bacteria, virus or fungi.
- Inflammation of the alveoli, lung sacs, resulting in a buildup of fluid in the lungs and respiratory complications.
- Treatments Include: Fluid, rest, anti-inflammatory (Naproxen), antiviral medication (viral strand), antibiotics (bacterial strand) (azithromycin, clarithromycin, or erythromycin), oxygen therapy
248
Digitek
- A digitalis medication that is used to make the heart beat stronger and with a more regular pattern. Used to treat arrhythmia.
- Dental Implications: This medication may cause a sensitive gag reflex which could create difficulty during dental impressions.
- Also, a vasoconstrictor should be avoided if possible because there is a risk of cardiac arrhythmia.
249
Aspirin
- An anti-inflammatory used to treat moderate pain, inflammation, or fever.
- Dental Implications: Patient has potential risk of increased bleeding during treatments such as probing and debridement.
- Physician consultation for medical clearance if the patient is taking more than 325mg or greater of aspirin daily.
250
Cardiac arrest
- A sudden, unexpected stop of the heart
- Symptoms include: sudden loss of responsiveness/consciousness, no breathing or pulse.
- Management requires: Activate EMS and initiate BLS
251
Myocardial infarction
- Damage of death of heart muscle due to a blockage of blood flow through a coronary artery.
- Symptoms include: chest pain that can include arms, neck and back, nausea, fatigue, dizziness, anxiety, shortness of breath, palpations and sweating.
- Management: Stop treatment and activate EMS, keep in the patient in an upright position, administer aspirin if not allergic, monitor vital signs, administer oxygen, initiate BLS as needed.
252
Syncope
- A brief loss of consciousness due to inadequate blood flow to the brain
- Symptoms include: pale skin, dizziness, weakness, blurred vision, nausea, trembling or shaking, loss of consciousness.
- Management: Stop treatment, put patient in a supine position, maintain airway, loosen clothing, place a cool damp cloth on their forehead, wave aromatic ammonia under their nose, monitor vitals.
253
Crohn's disease
- Chronic inflammatory disease of the gastrointestinal tract
- Etiology is unknown, but hereditary and immune dysfunction are associate with development
- abdominal pain, diarrhea, fever, rectal bleeding, and weight loss
- Gingival inflammation, dental caries, and most commonly oral lesions
- Iron deficiency anemia
- Affects patients in symptomatic flare-ups, and they are at a higher risk for infection and oral problems
- Oral hygiene is very important and frequent recall appointments
- Corticosteroid therapy can suppress the adrenal function and reduce the ability of the patient to withstand stress.2
- increases the patient’s risk for infection and adrenal insufficiency
- consultation with physician (drug interactions and adverse effects, adrenal insufficiency, infection, bleeding problems and impaired wound- healing)
254
Human papillomavirus (HPV)
- Viral infection spread by skin to skin sexual contact
- Signs and symptoms can take up to a year to appear
- Currently no cure
- Medications taken for Crohn’s disease can cause suppression of the immune system, which prevents the body from fighting HPV
255
Anemia
- Condition where body does not have enough healthy red blood cells
- People with Crohn’s disease are at higher risk for anemia
- Anemia occurs with Crohn’s due to poor absorption of vitamins and minerals because of inflammation or diarrhea
- Limits body’s ability to make more red blood cells
- signs and symptoms: Fatigue, Dizziness, Irritability, Numbness/coldness in hands or feet, Pale skin, Shortness of breath and rapid heartbeat with mild exertion, Weakness, Chest pain
256
Iron 65g
anemia
(Ferrous Fumarate)
Iron is a mineral
supplements taken to treat iron-deficiency anemia
Patients taking iron should not be prescribed tetracycline because the gastrointestinal tract
Iron increases risk of teeth staining
257
Cyclosporine 2.5mg
crohn's disease
(Sandimmune)
Immunosuppressant drug used to help decrease inflammation in the digestive tract
Can cause: gingival hyperplasia, mouth sores, swallowing difficulty, gingivitis, gum hyperplasia, xerostomia, abnormal taste, tongue disorder, tooth disorder, and gingival bleeding
**need consultation because patient is at risk for infection due to side effects of immunosuppressant
258
Imuran 2mg
Crohn's disease
(Azathioprine)
Immunosuppressant drug used with cyclosporine
Weakens the immune system in order to decrease inflammation of digestive tract
No dental side effects, but does increase risk of infection
259
Systemic lupus erythematos (SLE)
- chronic autoimmune disease which occurs when your body's immune system mistakenly attacks healthy tissue and organs in your body.
- inflammation that is associated with pain and swelling and it can affect many different body systems which include the joints, skin, brain, lungs, kidneys, nervous system, heart, blood cells, and other organs of the body.
- range from mild to serious
- genetics and your environment
- The actual cause of lupus in most cases, however is unknown but things that trigger lupus include: sunlight, certain drugs, and infections.
- difficult to diagnose
- facial rash (butterfly)
- lab testing
- no cure, reduce inflammation
260
arthritis
-Arthritis is inflammation of one or more joints.
It is a complex family of musculoskeletal disorders which is made of more than 100 different diseases.
-Arthritis is the leading cause of disability in the United States.
-Arthritis involves the breakdown of cartilage which causes swelling, and stiffness.
-Arthritis can affect people of all ages, races and genders
-Osteoarthritis, rheumatoid arthritis, juvenile arthritis
261
cortisone-aristospan
adjunct treatment and temporary relief of symptoms from inflammatory/ulcer oral wounds. Oral wounds due to trauma to systemic lupus erythematosus (SLE), intra-articular (soft-tissue), and other diseases that involve immunosuppression and anti-inflammatory effects.
262
Aspirin
increased bleeding, hemostasis, or hemorrhage. Patients with ischemic stroke prevention are safe to treat. Aspirin used with other antiplatelet medications like: clopidogrel (Plavix), ticagrelor (Brilinta), or prasugrel (Effient) are main preventive measures to stent thrombosis after placement of drug-eluting stent in coronary patients. Early delay or interruptions of the combination anti platelet therapy can cause increased risk of a tragic incident of stent thrombosis leading to myocardial infarcation and/or death.
263
latex allergy
- reaction to the protein in rubber latex
- symptoms: Pruritus, Erythema, Hive/rash, Sneezing, Runny nose, Scratchy throat, Difficulty breathing, Wheezing/ coughing
- treatment: avoiding latex products, anti-itch cream, epi-pen
264
Asthma
- respiratory disease of the lungs
- irreversible
- may be fatal
- symptoms: Swollen airways, Coughing, Trouble sleeping, Wheezing, Tightness in chest, Shortness of breath
- possible causes: Genetics, Childhood respiratory issues, Viral infections
265
GERD
- GER is when stomach acid backs up to esophagus
- GER is experienced by everyone, GERD is not
- Symptoms vary: Heartburn / chest pain, Sour taste in mouth, Difficulty swallowing / dry cough, Sore throat / something stuck in throat, regurgitation
- Treatment: Anti-inflammatory drugs, Bronchodilators / inhalers
- Causes: Stomach acid in the esophagus, Weakened esophageal sphincter, Irritation and inflammation of esophagus from acid
- Treatment: Avoiding foods high in spice and acid content. Neutralizing substances. Early intervention to prevent cancerous conditions
266
link between asthma and GERD
Occasionally asthma attacks can affect the lower esophageal sphincter (between esophagus and stomach) to relax and then causing stomach acid to go into the esophagus.
Asthma medications may increase GERD symptoms.
If GERD occurs during an asthma attack symptoms may worsen.
If GERD is well managed then asthma symptoms tend to be more controlled as well
267
albuterol inhaler
known as a bronchodilator that opens the airways during an asthma attack. Associated dental implication is xerostomia.
268
singulair
prevention and relief of inflammation of the airways to help minimize and reduce asthma attacks. Associated dental implications include dental pain and increased bleeding.
269
pepcid AC
minimize the buildup of acid within the gastrointestinal tract, aids in the prevention of heart burn and ulcers. No dental implications
270
tetralogy of fallot
- more commonly known as blue baby syndrome
- It is a congenital heart defect (present at birth), that results in low oxygenation of blood, due to the mixing of oxygenated and deoxygenated, leads to cyanosis.
271
seizures
likely when someone is not getting enough oxygen.
Signs/symptoms: Aura, loss of consciousness, epileptic cry, involuntarily tonic-clonic, muscle contractions, altered breathing, involuntary urination and/or defecation.
272
endocarditis
An infection of the heart chambers, and heart valves that is caused by bacteria formed by other infectious substances. Usually result of blood infection that happens during a medical procedure.
pre med
contact dr for inr (need to be between 2-3), med clerance
273
plavix
taken for Infective Endocarditis
-anticoagulant; will thin the blood to prevent blood from clotting.
Dental implications: bleeding during treatment, and scheduling morning appointments due to anxious tendencies.
274
paxil
taken for anxiety (20 mg daily)
-antidepressant agent that selectively blocks uptake of neurotransmitter serotonin.
Dental implications: Causes xerostomia and bruxism which causes a higher risk for caries, attrition, and TMJ pain.
275
history of heart attack (myocardial infarction)
-occurs when the blood flow that brings oxygen to the muscle of the heart is severely reduced or completely cut off. This happens when the patient build up plaque in the coronary arteries (atherosclerosis).
276
Angina pectoris
Chest pain or discomfort due to coronary heart disease
Happens when the heart muscle doesn’t get as much blood as it needs
Usually because one or more of the heart’s arteries is narrow or blocked
Patient may be pale and also experiencing faintness, sweating, difficulty in breathing, anxiety, or fear
stable vs unstable
nitroglycerin
277
nitroglycerin
vasodilator
| administered subgingivally
278
lotrel
Fewer reports of gingival hyperplasia with Amlodipine and consult with the physician
279
hydrochlorothiazide (HCTZ)
For management of mild-to-moderate hypertension
| Effects on dental treatment: Orthostatic hypotension and hypotension
280
high blood pressure
High blood pressure is a common and dangerous condition.
Having high blood pressure means the pressure of the blood in your blood vessels is higher than it should be.
Generally established guidelines are valves exceeding 140mmHg systolic or exceeding 90-mmHg diastolic blood pressures.
High blood pressure is also called the "silent killer" because it often has no warning signs or symptoms , and many people do not know they have it.
That's why it is important to check your blood pressure regularly.
281
factors to consider when selecting oral physiotherapeutic aids
Hard tissue variables include:
tooth position
root anatomy
restorations
```
Client variables include:
level of dexterity
adherence/compliance
skill development
personal preferences
```
282
single - tufted brushed
Used to remove dental biofilm from surfaces not accessible with larger brushes, including areas of crowded or malpositioned teeth, distal surfaces of terminal molars, around pontics, in furcations, and on lingual surfaces of molars; also useful for cleaning fixed orthodontic appliances
283
orthodontic brushes
used for pt with braces
284
Factors to Consider when Selecting Interdental Cleaning Methods
Soft-tissue variables include the level of health or disease and the position and architecture of the gingiva and attachment
type of embrasure
285
type I embrasures
occupied by the interdental papillae
286
type II embrasures
have slight to moderate recession of the interdental papillae
287
type III embrasures
have extensive recession or complete loss of interdental papillae
288
unwaxed floss
unbound filaments spread on the tooth and have more friction for cleaning; filaments hold plaque and debris for easier removal; floss, being less bulky, slips through contacts more easily
289
waxed floss
resists tearing and shredding on faulty restorations or when moved through very tight contacts
290
polytetrafluoroethylene (PTFE) floss
slides through contacts easily; does not fray; equally effective when compared with waxed floss; may enhance client adherence because of high preference ratings
291
powered flossing
Design-powered interdental cleaning devices use a multi-tufted nylon tip, designed for a single use, that extrudes and rotates on interproxirnal surfaces
Technique-requires only one hand to operate; tip is aimed into the interproximal space
Suggested use-alternative to hand-held floss; studies have demonstrated safety and effectiveness in removal of interproximal plaque, reduction of gingival inflammation and bleeding on probing
292
floss holders
plastic device onto which the floss is threaded and held, forming a span between the prongs
holder is positioned for insertion, then adapted and activated in much the same manner as hand-held floss; special care should be taken not to snap the floss through contacts
Indicated for use-when an individual lacks the dexterity to floss properly, and client preference
293
floss threader
Firm, flexible, blunt-ended device for moving floss through closed contacts or under pontics or orthodontic wires
position the floss in the threader with even lengths on each side; pass the threader through the embrasure, from the buccal to the lingual aspect, leaving sufficient length on the buccal aspect, floss in a normal manner, slide floss through space to remove
294
interdental brushes
Soft nylon filaments are twisted onto a stainless steel wire to form either a tapered or nontapered small brush
Brushes can be attached to a special handle; or are attached small handles
Provide good access to root concavities, furcation areas, proximal surfaces where papillae do not fill interdental spaces, as in type II and type III embrasures and under orthodontic wires
295
interdental brushes technnique
Choose a brush of appropriate size, insert interproximally, and use an in-and-out motion from the buccal to the lingual aspect and from the lingual to the buccal aspect
Brushes may be aimed into furcation areas in a similar manner
Filaments compress when moving through constricted areas and flare out to adapt to larger spaces
296
interdental brush precautions
Avoid forcing through tight, tissue-filled areas to prevent trauma
Do not aim wire into tissue
Discard the tip when filaments lose their original shape
Do not use brush with a stainless steel wire on an implant; brush must have a plastic- coated wire to prevent damage to implant
297
gauze strips
Used on proximal surfaces when large diastemas are present, teeth are isolated, or there is no adjacent tooth; type II embrasures‘
Use one 1-inch width of bandage gauze cut into a 6-inch length and folded the long way into thirds; adapt to the open proximal surface and move back and forth several times
Limitation: no subgingival plaque disruption
298
knitting yarn
Used on proximal surfaces with type II embrasures, diastemas, and isolated teeth
Use synthetic yarn, not wool; wrap in a C shape against the tooth and move it up and down, like floss
Limitations: no subgingival access; seldom used because a variety of flosses and interdental brushes are available
299
pipe cleaners
Used to remove bacterial plaque from exposed furcation areas and open inter- dental areas
Cut the pipe cleaner to a manageable length, approximately 2 inches; round off the sharp wire edges and adapt the end to the space; move back and forth several times
Precautions: if not properly adapted, wire can cause trauma to soft tissues
Limitations: less effective than interdental brushes, but cost may be lower
Do not use pipe cleaners on a dental implant; wire can damage the implant
300
toothpicks
Used for proximal surfaces and concavities, furcation areas, type II embrasures, just under the gingival margin, and around fixed orthodontic bands
toothpicks can be used alone or inserted into special holders (periodontal aids); moisten the tip and adapt it to the surface to be cleaned; subgingivally (submarginally) use a 45-degree angle to the tooth; move it in and out several times for interproximal surfaces, and follow the tooth contour on facial or lingual surfaces
Ridged pointed tips can cause injury if forced into tight tissue areas; over time papillae will abrade if toothpicks are used improperly
301
interdental wedge (stimudents)
Used for proximal surfaces or just under the gingival margin; triangular in cross sections; should be used interproximally only when there is adequate space for insertion (e.g., type II embrasures)
Moisten the tip, position the flat base of the triangle at the gingival margin, insert with the tip angled slightly toward the occlusal surface, and move the wedge in and out, with moderate pressure against the surface
302
interdental wedge (stimudents) precaustions
discard tips as soon as splaying occurs; using a fulcrum position in- creases control and reduces the risk of inserting the wedge with too much pressure; repeated insertion with tip perpendicular to long axis of tooth may cause blunting of interdental papillae
303
rubber tip
Used for proximal surfaces, in exposed furcations, and under gingival margins; authors differ on the rubber tip's ability to remove plaque; may be used to maintain interproximal gingival contours or recontour papillae following periodontal surgery
304
rubber tip technique
Bacterial plaque removal: trace gingival margin with tip aimed into sulcus
Contouring gingiva: place but do not force the tip into the interdental contour with the tip angled occlusally, press the side of the tip against the gingiva, and use a firm rotary motion to apply intermittent pressure
305
rubber tip precaution
inserting the tip perpendicularly to the long axis of the tooth can result in flattened interdental papillae
306
denture care
Remove and rinse dentures after eating. Place a towel on the counter or in the sink so that the dentures won't break if you drop them.
Clean mouth after removing your dentures. Use a soft-bristled toothbrush on natural teeth and gauze or a soft toothbrush to clean tongue and palate.
Scrub dentures at least daily. Gently scrub dentures using a denture cleaner, mild soap or dishwashing liquid and a denture brush or soft toothbrush to remove food, biofilm and other deposits. Avoid stiff-bristled brushes, strong cleansers and harsh toothpaste, as these are too abrasive and can damage dentures. Toothpastes advertised as whitening pastes are especially abrasive and should be avoided with removable dentures.
Handle dentures carefully. Be sure not to bend or damage the plastic or the clasps when cleaning
Soak dentures overnight. Most types of dentures need to remain moist to keep their shape. Place the dentures in water or a mild denture-soaking solution overnight. Don't soak dentures with metal attachments in solutions that contain chlorine because it can tarnish the metal.
Rinse dentures before putting them back in the mouth, especially if using a denture-soaking solution. These solutions can contain harmful chemicals that cause vomiting, pain or burns if swallowed.
Schedule regular dental checkups. The dentist can help ensure a proper fit to prevent slippage and discomfort. See the dentist promptly if dentures become loose. Loose dentures can cause irritation, sores and infection.
307
dental caries
An infectious disease of the dental calcified structures (enamel, dentin and cementum) that is characterized by demineralization of the mineral components and dissolution of the organic matrix
Bacterially-based
Chronic
Infectious/Communicable
308
dental caries incidence
In the United States, dental caries is the most common chronic disease in childhood, with 41% of children between the ages of 2 and 11 having caries in primary teeth
Among dentate adults aged 20 to 64, 92% have caries in permanent teeth
309
essentials for dental caries
```
-Susceptible tooth surface (Host)
Less than optimum fluoride exposure
-Microorganisms
Streptococcus mutans
Streptococcus sobrinus
Lactobacillus
-Cariogenic food source
Sucrose, glucose, fructose
Carbohydrates (starch)
```
310
contributing factors for dental caries
-Time
The longer the pH is lowered the greater the risk for caries to form
The response after exposure of dental plaque to a fermentable carbohydrate is that pH decreases rapidly, reaching a minimum in approximately 5 to 20 minutes.
This is followed by a gradual recovery to its starting value, usually over 30 to 60 minutes
-Plaque pH
Critical pH for enamel 4.5-5.5
Critical pH for root surface 6.0-6.7
-Frequency of carbohydrate intake
The more frequent the exposure the greater the risk for caries to form
311
lymphadenopathy
- enlarged lymph nodes
- Nodes swell in area of infection
- Usually enlarge to ½ to 1 inch across with virus
- Will enlarge over 1 inch with bacterial infection
- Painless with cancer
- Lymphatic system can transport cancer cells throughout the body
- firm, tender, enlarged, freely movable, swollen grape
312
hydroxyapatite
An inorganic crystallized structure comprised of calcium, phosphorus, and hydroxide
313
demineralization
is the breakdown of the tooth structure with a loss of mineral content, primarily calcium, phosphorus, and fluoride
314
remineralization
is the process by which minerals are restored to the tooth structure and tooth destruction is arrested
315
calcium and phosphate in remineralization
Calcium and phosphate diffuse into the tooth via saliva
Results in crystal formation
Hydroxyapatite: the principle crystalline mineral component of the teeth
316
formation of enamel caries
Phase I
| Phase II
317
Phase I
incipient lesion
Subsurface demineralization (not visible)
Vizualization (not visible)
First clinical evidence (visible)
318
Phase II
untreated incipient lesion
Breakdown of enamel
Progression of carious lesion
Spread of carious lesion
319
white spot lesions
Active lesions feel rough when the tip of the explorer is moved gently across their surface.
Inactive lesions feel hard and smooth when the tip of the explorer is moved gently across their surface.
320
types of dental caries by location
1. Pit and Fissure
2. Smooth Surface
3. Root surface
- Cemental
- Cervical
- Radicular
321
Early childhood caries
- Baby bottle caries
- First effects maxillary anterior teeth followed by molars
- Least evident on mandibular anterior teeth
322
primary caries
occurs on surfaces not previously effected; also called initial caries; early lesion may be referred to as incipient
323
arrested caries
carious lesion that has become stationary and does not show a tendency to progress further; frequently has a hard surface and takes on a dark brown or reddish-brown color
324
rampant caries
widespread formation of chalky white areas and incipient lesions that may increase in size over a short time
325
recurrent caries
occurs on a surface adjacent to a restoration; also called secondary caries
326
tx as an infectious disease
Change from “surgical” approach to a “medical” approach
Surgical: focuses on restoring symptoms of the disease
Medical: focuses on treating/managing causes of the disease
Goal: prevent the need for restorative Tx.
327
CAMBRA stands for
Caries Management by Risk Assessment
328
Caries Management by Risk Assessment
Treat patients by risk
Identify patients with higher risk
Treat higher risk patients more aggressively
Identify risk factors and disease indicators
Manage risk factors to alter the caries balance in favor of health
329
key protective factors
Saliva
Fluoride, calcium, phosphate
Antibacterial agents
330
Key Pathological (Risk) Factors
```
Cariogenic bacteria
Fermentable Carbohydrate
Decreased salivary flow
Poor oral Hygiene
Smoking
Ortho
```
331
disease indicators
White spot lesions
Cavity in past 3 years
Radiographic lesions
Visible cavitations
332
Pathologic factors (bad)
bacterial infection
absence of saliva (xerostomia)
dietary habits poor
333
Protective factors (safe)
saliva and sealants
antimicrobials
fluoride
effective diet
adequate saliva flow
fluoridated water/rinse
xylitol gums/mints
334
disease indicators
visible cavitations
radiographic lesions
white spot lesions
cavity in last 3 years
335
risk factors
visible plaque
inadequate saliva
acidic beverages
deep pits/fissures
336
Fluoride
Inhibits demineralization
Enhances remineralization process
Inhibits bacteria
Structure is less soluble than original
337
Fluorapatite
the crystalline structure that forms when fluoride ions are incorporated during the remineralization process
338
counseling for dental caries control
```
Biofilm control
Pit and fissure sealants
Dietary assessment
Fluoride therapy
Antimicrobial therapy
Remineralization
```
339
antibacterial therapy
| Chlorhexidine
-0.12% Chlorhexidine
-Indicated for high risk patients
-Protocol for use:
Reduces MS; not effective against LB
10ml for 1min at bedtime for 1week/month
Follow with 3 weeks of NaF rinse
340
antibacterial therapy
| povidone iodine
-Povidone iodine
-Indicated for high risk patients
-Protocol for use:
Reduces MS and LB in children
Professional application only
Swish 10ml for 1min or swab 1-2ml for 2min
341
fruity breath indicates what?
diabetes
342
digital palpation
Use of a single finger to move or press against tissue
343
bidigital palpation
Use of one or more fingers and thumb to move or compress tissue
344
bimanual palpation
Use finger of one hand and fingers and thumb of other hand simultaneously to move or compress tissue
345
bilateral palpation
Use fingers of both hands simultaneously to move or press on contralateral sides of the head/neck
346
```
Thyroid gland
-location
-shape
-what does it do
enlarges?
```
- Secretes thyroid hormone that controls the body’s metabolic rate
- Middle of lower neck over trachea
- Shaped like a bow tie
- Check for nodules during examination
- Goiter is an enlarged thyroid gland: graves disease, hyperthyroid
- hypothyroid: hashimoto's
347
lymphatic system
- Network of lymph nodes connected by vessels, which plays a role in defense against infection
- Lymph fluid carries nutrients and waste between body tissues and bloodstream
- Lymph nodes are bean-shaped structures that filter and trap bacteria, fungi, and waste
- 400-700 in the body
- 170–300 in neck
- Major chains in anterior and posterior of neck and under chin
- Vary in size from head of pin to baked bean
- Enlarge when infected, if there is an inflammatory condition, or cancer (idiopathic-no cause, infection, cancers)
348
lymphadenopathy
- enlarged lymph nodes
- Nodes swell in area of infection
- Usually enlarge to ½ to 1 inch across with virus
- Will enlarge over 1 inch with bacterial infection
- Painless with cancer
- Lymphatic system can transport cancer cells throughout the body
- firm, tender, enlarged, freely movable, swollen grape
349
when doing EIO what are you looking for
lump, swelling, raised knob, freely movable node, fixed nodule, asymmetry, irregular shape, firm or hard consistency, tender areas, red or discolored area, wound, bruise, scar
350
exostosis
extra bone growth on buccal, normal unless it is causing issues
351
leukoedema
white film, common on darker skin
352
toris palatine
extra bone on the palate
353
nicotine stomatitis
minor glands that are irrupted, dry heat causing altered tissue, educate the pt
354
tonsilloliths
tonsil stones
355
geographic tongue
bengin migratory glossitis
356
scalloped tongue
wave like tongue on the borders
357
ankyloglossia
tongue tied
358
macule
A circumscribed, nonraised area of epidermis altered in color from its surroundings
359
patch
A circumscribed pigmented or textured area larger than a macule
360
erosion
A denudation of epithelium above the basal cell layer
361
ulcer
A loss of epithelium that extends below the basal cell layer
362
scar
A permanent mark indicating previous wound healing
363
fissure
A linear crack in the epidermis
364
papule
An elevated, solid lesion less than 1 cm in diameter
365
plaque
A flat, raised area larger than 1 cm in diameter
366
nodule
A raised, solid mass that has the dimension of depth and is less than 1 cm in diameter
367
tumor
A solid, raised benign or malignant mass that has the dimension of depth and is larger than 1 cm in diameter
368
vesicle
A circumscribed, fluid-filled skin elevation less than 1 cm in diameter
369
pustule
A vesicle filled with purulent exudate
370
bulla
A fluid-filled mucocutaneous elevation greater than 1 cm in diameter
371
when documenting EIO finding ask theses questions about the history
- Is the patient aware of the lesion
- How long has it been present
- Changes in size and appearance
- Symptoms
- 7 to 10 days
372
when documenting EIO findings, be specific about location and document if it is
Localized
Generalized
Single lesion
Multiple lesion
373
when documenting EIO findings, document physical characteristics
Size and shape
Color
Surface texture
Consistency
374
when documenting EIO findings, document Attachment of lesion
sessile or pedunculated
375
excisional
entire lesion is removed
376
incisional
section of the lesion is removed
377
cancer screening adjuncts
- vizilite: abnormal tissue will reflect light and appear white
- velscope: abnormal tissue will appear dark and irregular
378
What is the most common dental emergencies?
syncope: pt has anxiety, psychogenic reaction
male: men don't express that anxiety, more common to faint.
379
what are the risk factors in medical emergencies?
- Increased number of elderly patients in society with natural teeth and dental diseases that require invasive procedures
- Medical advances (more dental history, implants)
- More complex dental procedures require longer appointments
- Increased use of pharmacological agents for systemic conditions (more medicine)
380
what are preventative actions for an emergency
- Medical History Assessment (allergies)
- Physical Observation (nervous, not communicating, seems rude, holding onto chair, arms crossed, you can ask them if they are nervous)
- Psychological Assessment
- Medical Consultation (resent cardiac event 3-6 months)
381
compensation
pt vitals increase above base line
382
decompensation
pt vitals decrease below base line
383
what are the 8 vital signs
blood pressure, pulse, respiration, temperature, height, weight, age, medical alert tag
384
is it better to be compensation or decompensation?
compensation
385
why do we take vital signs?
- baseline
- consult if not WNL
- monitor during medical emergency
386
temperature; normal ranges and not normal ranges, what reduces a fever
35.5°C – 37.5°C
96.0°F – 99.5° F
Fever (pyrexia) greater than 99.5°F
Anti- pyrexia: reduces fever
Hyperthermia greater than 105.8°F
Hypothermia less than 96.0°F
387
pulse; normal ranges and not normal ranges
```
Normal adult rate 60-100 bpm
Normal child rate 90-120 bpm
Bradycardia: less than 50 bpm
Lower than normal
Tachycardia: more than 100 bpm
Higher than normal
```
388
respiration; normal ranges, Factors to observe during respiration
```
Adult 14 – 20 respirations per minute
Child 20 – 25 respirations per minute
Factors to observe during respiration
Depth: shallow/deep
Rhythm: regular/irregular
Quality: strong/weak/labored
Sounds: gasping/wheezing
```
389
blood pressure; normal ranges and not normal ranges
normal: 160/>100
390
systolic pressure
The peak or highest pressure, caused by ventricular contraction
391
diastolic pressure
The lowest pressure, caused by ventricular relaxation
392
pulse pressure
The difference between the systolic and diastolic pressures
393
hypertension
- primary
- secondary
- primary
* 90%
* etiology: idiopathic
* predisposing risk factors: heredity, overweight, race, sex, age, environment, smoking
- secondary
* 10%
* major underlying disease, i.e. kidney disease
394
antibacterial therapy
| povidone iodine
-Povidone iodine
-Indicated for high risk patients
-Protocol for use:
Reduces MS and LB in children
Professional application only
Swish 10ml for 1min or swab 1-2ml for 2min
395
antibacterial therapy
| xylitol
Xylitol is a 5 carbon “sugar alcohol”
It looks like sucrose and has about the same sweetness by weight
It is used in some foods, chewing gum, candies, lozenges, and dental products as a sweetener
Cariogenic bacteria can not metabolize it
Humans can metabolize it and use it as an energy source
Decreases level of S. Mutans
1gram xylitol per stick
Chew 5-10 sticks per day for 5 min/stick
396
Remineralization
| calcium phosphate technologies
-ACP (amorphous calcium phosphate)
-CPP-ACP (milk protein casein phosphopeptide as carrier for ACP)
Avoid in patients with milk allergy
397
Dietary assessment for dental caries
To provide an opportunity for the patient to assess their dietary habits
To obtain an overall picture of the types of foods in the patients diet
To assess snaking patterns
To determine the overall consistency of the diet
To identify the nutritional status of the individual
To provide a basis for making recommendations for changes in the diet important to oral health
398
Salivary assessment
| unstimulated normal
0.3-0.4 ml/min
399
Salivary assessment
| unstimulated abnormal
400
Salivary assessment
| stimulated normal
1-2 ml/min
401
Salivary assessment
| stimulated abnormal
402
stimulated salivary flow rate
| normal, low, dry
1. 0 ml/min or greater = Normal
0. 6 - 0.9 ml/min = Low
0. 5 ml/min or less = Dry
403
Which of the following physical traits of food presents the highest potential for dental caries?
a. Soft and mushy
b. Liquid
c. Sticky
d. Hard and brittle
sticky
404
Once exposed to fermentable carbohydrates,
how long does it take on average for plaque
pH to reach its minimum?
a. 5 to 20 minutes
b. 1 to 3 minutes
c. 30 to 60 minutes
d. There is no average; it depends entirely on the individual.
5 to 20 minutes
405
Why does cheese have a beneficial effect on saliva?
a. Cheese has the advantage of raising the plaque
concentrations of calcium and phosphate, increasing
the chance of remineralizing teeth.
b. Cheese is a strong sialogogue (causing salivation), an agent that increases
the flow of saliva.
c. The chewing of cheeses rich in nitrogenous
compounds gives rise to pH increases, despite the
cheese itself being acidic.
d. All of the above.
all of the above
406
At what pH does tooth enamel begin to demineralize?
a. 8.3
b. 7.5
c. 5.5
d. 3.2
5.5
407
What is the clinical appearance of the initial stage of a carious lesion?
a. A large cavitation that extends into the dentin.
b. A chalky white spot on the tooth surface.
c. Evidence of tooth erosion caused by acid
attack.
d. Completely demineralized tissue.
A chalky white spot on the tooth surface.
408
```
Which of the following should be avoided if
the patient is allergic to milk?
a. ACP
b. MI Paste ™
c. Recaldent™
d. Fluoride
```
Recaldent™
409
Which sugar substitute can promote remineralization?
a. Sorbitol
b. Xylitol
c. Sucralose
d. Aspartame
xylitol
410
fluoride
Fluoride is a salt of hydrofluoric acid
| It is found in all tissue but has an affinity for calcified tissue (bones and teeth)
