Final Exam Flashcards
what percent of the US population currently smokes cigarettes?
14% (34 million)
how many people die per year as a result of DIRECT tobacco use? what about INDIRECT tobacco use?
direct - 8 million
indirect - 1.2 million
what is the most common form of tobacco use worldwide? what are other forms of tobacco use?
most common - cigarette smoking
other - smokeless tobacco, cigars, pipe, bidis, and roll-your-own tobacco
disparity in tobacco use remains across groups defined by:
race, ethnicity, educational level/socioeconomic status, and regions of the country
8.2% of Hispanic adults in the US smoke cigarettes. Who are more likely to smoke cigarettes?
those born in the US
in the hospitality industry, who is the most exposed to secondhand smoke?
hispanics
who has the highest prevalence of cigarette smoking compared to other racial/ethnic groups in the US
american indians/alaskans
deaths attributed to smoking
pulmonary disease, cancer, or cardiovascular disease
what are the primary effects of smoking due to?
toxins and chemicals produced by burning of tobacco
what is the most effective mechanism to deliver nicotine to the brain?
inhalation thru the lungs
what are the nicotine addiction mechanisms?
- rewarding experience of smoking (dopamine release)
- increased tolerance and dependence of nicotine (leading to withdrawal symptoms)
- learnt experience of responding to situational and emotional triggers with smoking
what is the tobacco mechanism of action?
nicotine acts on dopaminergic receptors in ventral tegmental area, causing burst firing of dopamine neurons leading to drug reinforcement
increasing dopamine release from ventral tegmental area neurons contribute to addiction
what receptor does nicotine work thru? what part of brain works for drug reinforcement?
- works thru dopamine receptor
- midbrain plays pivotal role in drug reinforcement
dopamine reward pathway
nicotine enters brain > stim nicotine receptors > ventral ttegmental area > nucleus accumbens > prefrontal cortex
how can you approach tobacco cessation?
behavioral intervention or pharmacologic strategies
what is behavioral intervention?
- only 3-5% of smokers who quit on their own succeed
- intervention by HC professional combined with appropriate medication increases success of maintaining abstinent by 30%
- dentists can have significant impact on tobacco quit rates
how do pharmacological agents aid with tobacco cessation?
provides nicotine in various forms to lessen or relieve cravings
examples of pharmacological agents for tobacco cessation
- nicotine replacement therapy (NRT) - gum, lozenge, nicotine patch, inhaler, spray
- varenicline - decreases craving and withdrawal syndrome
- bupropion - antidepressant
how does NRT work
pure nicotine is administered, removes exposure to nitrosamines and toxins while behavior changes are made
by self-dosing, the user has control over amount of nicotine needed for cessation
OTC nicotine gum
doubles odds of successful cessation attempt
can lead to toxicity as many users use it like reg gum
OTC transdermal nicotine patch
- diffuse steady dose nicotine thru skin
- peaks about 4-8 hours, maintains for 15-24 hours
- milk skin irritation experienced
- insomnia may be side effect, so lower dose
prescription nicotine inhaler
- nicotine puffed into mouth where held and diffuse thru oral mucosa
- mimics smoking and meets smokers emotional need
- benefits highly addicted users, results in immediate dose of nicotine
- can cause local irritation and congestion
prescription varenicline - chantix
pill form stimulates nicotine receptors
12 weeks of therapy
prescription bupropion - wellbuttrin
antidepressant pill form
safe, doubles chances of quitting
contraindicated in seizure disorders, alcoholics, and eating disorders
adverse effects of pharmacological agents
agitation, depressed mood, and suicidal tendencies
smoking vs. vaping
smoking: created by open flame, very high temp, tobacco destroyed, produces harmful toxins, tar causes smell to linger, causes secondhand smoking
vaping: does not involve open flame, temp is much lower, liquid is vaporized, devoid of toxins, smell greatly reduced, no secondhand smoking
has any e-cigarette been approved as a cessation device or authorized to make a modified risk claim?
NO!
what is public health?
winslow: science and art of preventing disease, prolonging life, and promoting physical health and efficiency thru organized community efforts
IOM: fulfilling society’s interest in assuring conditions in which people can be healthy
three core PH functions
- assessment
- policy development
- assurance
what are 10 essential PH services?
- assess and monitor population health
- investigate, diagnose, and address health hazards and root causes
- comm. effectively to inform and educate
- strengthen, support, and mobilize communities and partnerships
- create, champion, and implement policies, plans and laws
- utilize legal and regulatory actions
- enable equitable access
- build a diverse and skilled workforce
- improve and innovate thru evaluation, research, and quality improvement
- build and maintain a strong organizational infrastructure for PH
what is dental public health
science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice which serves the community as a patient rather than the individual. It is concerned with the dental education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis”
what is a dental public health specialist (DPH)
- 1 of 9 dental specialties of ADA
- contributes to new knowledge, research, education and services that directly benefit different aspects of clinical pt care
what is clinical care
prevention, tx, and management of illness and preservation of mental and physical well being thru health care services
what is a determinant
factor that contributes to generation of a trait
what is a health outcome
result of a medical condition that directly affects the length or quality of person’s life
what is population health
approach to health that aims to improve health of entire population
what is prevention
action to avoid, forestall, or circumvent a happening, conclusion or phenomenon (e.g. disease)
what is intervention
action or ministration that produces an effect or is intended to alter course of pathological process
what is a target population
group of individuals that the intervention intends to conduct research in and draw conclusions from
why is oral health important
oral health is a key indicator of overall health, well-being and quality of life
what are the core elements of oral health
- disease and condition status
- physiological function
- psycho-social function
core element: disease and condition status
refers to threshold of severity or level of progression of disease which also includes pain and discomfort
core element: physiological function
refers to capacity to reform a set of actions (e.g. speak, smile, chew, and swallow)
core element: psychosocial function
relationship btwn oral health and mental state (e.g. capacity to speak, smile, and interact in social and work situations w/o feeling uncomfortable or embarrassed)
definition moderating factors for oral health
elements that determine or affect how a person scores their oral health
5 main factors that affect oral health
- genetic and biological factors
- social environment
- physical environment
- health behaviors
- access to care
what are SDOH
conditions in the environments where people are born, live, learn, work, play, worship and age that affect wide range of health, functioning, and quality of life outcomes and risks
Social determinants of health
5 domains of SDOH
- economic stability
- education access and quality
- health care access and quality
- neighborhood and built environment
- social and community context
what percent of caries is pit and fissure caries
85%
where are sealants mostly underused
among those at high risk of experiencing caries; children in lower-income and certain racial and ethnic groups
unsealed molars are ___ more likely than sealed molars to receive a caries related service
3x
what group of people should you consider sealants for prevention where there is non lesion but tooth or individual is at risk? which teeth?
children - permanent teeth
adolescents - permanent teeth
what group of people should you consider sealants to limit progression in early non-cavitated lesions? which teeth?
children - all teeth
adolescents - all teeth
young adults - all teeth
sealant indications
- occlusal fissures, pits, and fossa
- lingual pit on incisors and molars
- buccal pits of molars
- anywhere a pit of fissure is deep
when in doubt, seal and monitor
dental sealant placement step by step
- tooth is cleaned and dried
- etching solution applied
- liquid sealant applied
- curing light hardens
where do majority of carious of lesions occur
pits and fissures
what is highly effective when placed over pits and fissures of occlusal, buccal and lingual pits and grooves?
sealants in both primary and permanent teeth
sealants reduce caries up to __%
90%
fluorides are highly effective in reducing number of carious lesions where?
on smooth surfaces of enamel and cementum are arrested and remineralized with fluoride
e.g. proximal surfaces (not equally effective in protecting the occlusal pits and fissures like sealants)
what is a sealant
- liquid resin commonly placed over occlusal surface of the tooth with a pit or fissure that cannot be cleaned with toothbrush
- hard resin is a barrier between tooth and bacteria
- sealing reduces Streptococcus mutans because their habitat is drastically reduced
a one time dental sealant program will decrease caries by __% after 4 years
59%
sealants thru school-based programs are effective and saves more than $11 in tx costs for each tooth
what is an enameloplasty? goals of treatment?
modifying enamel with a bur, more of a treatment procedure than a preventative approach
goals: limit outline form of prep and limit cutting enamel
prophylactic odontomy
early insertion of small restorations in deep pits and fissures before carious lesions had the opportunity to develop
not used anymore- sealants used instead
the do nothing or wait and watch approach violates what principle?
ethical principle of non maleficence, which means to do no harm
sealants more used with what?
with the development of Bis-GMA, UDMA, and TEGDMA
Bis-GMA resin
resin that is the most frequently applied sealant
mixture of Bis-GMA and methyl methacrylate
BPA may be a biproduct
BPA
Bisphenol A - a plastic found in many products that mimic estrogen
blamed for low sperm counts in males and cancer in females
however, amounts of BPA that could be ingested within 24-hour period do not exceed established human exposure limits
filled vs. unfilled sealants
filled - contain microscopic glass beads, quartz particles, and other fillers used in composite resins. coated with products such as silane to facilitate combination with Bis-GMA. more resistant to abrasion and wear
unfilled - more quickly to wear but usually do not need occlusal adjustment
resin matrix + filler (coated with silane) = ?
resin composite/filled sealant
sealants methods of polymerization
light cured with used of visible blue light OR chemical cured (monomer and catalyst are mixed together to induce polymerization without use of light source)
polymerization catalysts
light cured: camphoroquinone
self cured: benzoyl peroxide
which generation of sealants first used visible blue light?
3rd generation
atraumatic restorative technique aka interim therapeutic restoration
removal of soft/demineralized tooth tissue using a hand instrument alone
sealant retention
- resin sealants are retained better on recently erupted teeth than on teeth with a more mature surface
- retained better on first molars than on second molars and on mandibular than maxillary
criteria for selecting teeth for sealant placement
well isolated on fully erupted fossa
teeth on opposite sides of the arches
incipient lesions exist in pit and fissure area
can sealant material be flowed over a conservative class I composite or amalgam?
Yes! used to improve marginal integrity and into remaining pits and fissures to prevent further recurrent decay
sealant contraindications
- patient behavior does not allow for adequate dry-field technique during procedure
- open carious lesion on same tooth
- caries exist on other surface of the same tooth
- large occlusal restoration already present
four commandments for successful sealant placement
- max surface area
- deep, irregular pits and fissures
- be clean
- be absolutely dry
acid etch for sealants
- increases surface area
- liquid or gel is acceptable
- keep acid off oral mucosa
- keep sealant out of interproximal contact
cleaning tooth surface for sealants
- pre clean with oil free pumice
- all heavy stains, deposits, debris, and plaque should be removed
why dry the tooth surface
sealants are hydrophobic
make sure air syringe does not leak fluid
if saliva contacts tooth before sealing, have to re-etch, wash and dry
air inhibited layer
There is an oxygen inhibited layer on all resin surfaces that is sticky and tacky, that faces the air, facilitates adding in increments but final layer will wear off
This unreacted layer should be removed with gauze sponge or cotton roll after light cure (minimize BPA)
sealed lesions over incipient and overt caries become what?
inactive bacteriologically
progression does not occur as long as sealant or interim restoration remain intact
what is the most technique sensitive procedures done in dental office?
placing sealants
remineralization occurs with what?
help of saliva (provides calcium/phosphorus proline-rich polypeptides)
how is saliva a natural defense mechanism?
- function as a buffer to keep pH at favorable levels
- has direct anticariogenic activity
sugar free or xylitol gum
- sitmulates salivation
- enhances remineralization
- has antibacterial effect
- non-cariogenic
criteria for visual examination of pit and fissure caries
seal score 0-1, maybe 2-3
0: slight change in enamel translucency
1: opacity or discoloration hardly visible on wet surface, air-dry visible
2: opacity or discoloration distinctly visible without air-dry
3: enamel breakdown in opaque or discolored enamel
4: cavitation in opaque or discolored enamel, exposing dentin
arrested caries
- white or brown spot with shiny surface
- no soft cavitation, been like this for years
- with age of tooth, don’t need to treat
aka inactive caries
how to treat active lesion? arrested lesion?
active - prevention w/ chemical fill (fluoride) or fill with restorative treatment (sealant or composite/amalgam)
arrested - no tx needed
why do sealants work on enamel?
because 90% or more of enamel is inorganic
how to minimize sealant bubbles
using a brush to apply sealant
how is a sealant retained?
micromechanical retention
other strategies for caries management
diet control
sugar substitutes
remineralizing therapies
what is the characteristic of diet that contributes to its cariogenicity?
frequency of fermentable CHO and timing of fermentable CHO (btwn meals and before sleep)
what is the most effective caries prevention strategy after fluoride?
sealants
T/F: Dental caries is a transmissible, infectious disease.
true
T/F: The prevalence of dental caries increases with
age.
true
T/F: At the early stage, carious lesions are reversible.
true
T/F: Dental caries is the most common chronic disease of childhood.
true
T/F: 85% of carious lesions occur in pits and fissures.
true
T/F: Active caries in root surface is soft and leathery and usually
covered by dental plaque.
true
the critical pH for enamel demineralization is
5.5
what bacterium is the most implicated in dental caries?
s. mutans
T/F: dental caries most often occurs on proximal surfaces
false
T/F: the amount of sugar we eat is more important than frequency of eating sugar
false
who can conduct an oral health screening?
licensed health professional: RN, LPN, NP, Physician, Dentists or Dental hygienists
oral health screenings do not replace what?
do not replace complete in office dental examinations performed by a dentist
dental screening categories
0 = no obvious dental problems/need
1 = early problems/need with teeth in 1-2 quadrants of mouth
2 = urgent needs such as pain, swelling, abscess of observable problems with 3 or more quadrants of the mouth
supragingival plaque
located above gingival margin
associated with caries and gingivitis
subgingival plaque
located below gingival margin
associated with gingivitis and periodontitis
when to replace toothbrushes
every 90-120 days or sooner if bristles splay
bass toothbrushing technique
brushing with fluoridated toothpaste reduces dental caries by 25%
brush for 2 minutes at least twice a day
best toothpaste
- ADA seal with fluoride
- may contain ingredients to help with sensitivity, whitening, gingivitis, tartar buildup, and enamel erosion
tooth brush or floss first?
floss first
target population definition
represents certain segment of population that consists of groups of individuals with similarities of some sort
common oral conditions of pregnancy
pregnancy gingivitis, benign oral gingival lesions, tooth mobility w/o periodontitis, tooth erosion, dental caries, periodontitis
1 in 4 women of childbearing age have what?
untreated caries
pyogenic granuloma
aka pregnancy tumor
- round growth connect to gingiva by thin cord of tissue that may develop due to hormonal changes
- women who have extensive and severe gingivitis during pregnancy are more likely to develop oral pregnancy tumors
what is inversely proportionate to pregnancy gingivitis?
matrix metalloproteinases or MMPS
When the integrity of the gingival epithelium is compromised by periodontal disease,
___ can gain direct access to the systemic blood circulation and
may directly invade tissues located remotely from the oral cavity
virulent subgingival bacteria
The resulting bacteremia together with the bacterial virulence factors provoke the release
of responding host inflammatory mediators, hence increasing the level of ___
systemic inflammation
Infection in the ___ supports an association between preterm birth (PTB) or low birth weight (LBW) and infection during pregnancy
chorion and amniotic apparatus
The presence of amniotic inflammatory factors promotes production of cytokines, which release ___
prostaglandins
Once these prostaglandins have reached a threshold level, they appear to facilitate the onset of preterm labor through ___
cervical dilation
The high rate of infant mortality in the U.S. is a ___
public health crisis
what are the most significant predictors or infant health and survival
pre term birth (PTB) and low birth weight (LBW)
T/F: Oral health care, including having dental radiographs taken and being given local anesthesia, is safe an ANY point during pregnancy
true
what percent of pregnancy related deaths are preventable?
80%
what percent of pregnancy related deaths occurred 7-365 days postpartum
53%
7-42 days: 23.3%
43-365 days: 30%
most frequent causes of 75% of deaths
mental health conditions
cardiac and coronary conditions
therefore must do mental health and cardiovascular screenings
teething
localized: intermittent discomfort
generalized: irritability, low-grade fever, and excessive salivation
many children have no apparent difficulties
treat of symptoms - oral analgesics and teething rings
what is an infectious bacterial disease that occurs in the first three years of a child’s life
early childhood caries (ECC) aka bottle caries
ECC is a multifactorial disease meaning what?
there are many interacting individual, cultural, social and socioeconomic
what is the most common chronic childhood disease
dental caries
what is a dental home
an ongoing relationship between the dentist and patient
should be established no later than 12 months of age
dental home addresses anticipatory guidance and preventative, acute, and comprehensive oral health care
lap exam
method for dentist to safely examine young child’s teeth while allowing them to remain seated on caregiver’s lap
factors that are assessed in caries-risk assessment form for 0-5 year olds
biological
protective
clinical findings
anticipatory guidance
- oral development
- fluoride adequacy
- nonnutritive habits
- diet and nutrition
- oral hygiene
- injury prevention
updated fluoride guidelines
- use a SMEAR of toothpaste from erupion of first tooth to 3 years old
- followed by use of pea sized amount for children aged 3- years
to reduce risk of fluorosis
updated fluoride guidelines
- use a SMEAR of toothpaste from erupion of first tooth to 3 years old
- followed by use of pea sized amount for children aged 3+ years
to reduce risk of fluorosis
what should you instruct caregivers regarding bottled water?
use bottled water without fluoride if using fluoridated formula
T/F: professional fluoride applications are not indicated for adults
false
T/F: fluoride mouth rinse should not be recommended for a child under 6 years of age
true
T/F: maximal effectiveness of fluoride mouth rinse requires rinsing for at least 2 full minutes once per day
false
for dental caries to develop, which conditions must occur simultaneous?
host and teeth, refined carbs, time, microflora
where can carious lesions occur
gingival margin
pit and fissures
what s composed of tooth enamel?
enamel rods
where there is an immediate drop in pH after carbohydrate consumption to a normal pH, this is termed:
stephan curve
T/F: although food types are importanat in producing a cariogenic (low pH) environment, frequent between meals snacks and drinks can maintain a low pH environment throughout the day, which shifts the demineralization/remineralization continum toward caries formation
true
infected dentin vs. affected dentin
infected should be removed unless danger of pulp exposure
affected can leave, does not need to be totally removed
rate of caries progression on smooth surfaces
smooth surface caries progress slower than fissure caries
takes about 18 months +/- 6 months for progression on smooth surfaces
how should teeth restored when the lesion approaches the outer third of dentin
cavitation
what is an inicipient lesion
white lesion on enamel that has not been affected by acid demineralization but has not yet developed a cavity or cavitated thru the outer surface of enamel
what does CAMBRA stand for
caries management by risk assessment
why use CAMBRA
- can be controlled by patient and dentist
- treatment is based on patient’s caries risk
steps of CAMBRA
- detect caries by oral exam
- classify pt as low, moderate or high risk
- recommend different tx based on caries risk
- pathological environment can be changed
Why roughen the surface of the tooth?
To improve surface area
There’s only a _ from the bonding agent to the etched enamel
Micromechanical bond
Composite to bonding agent is what type of bond
Chemical bond
Does bonding agent wet tooth better than sealant?
Yes
There is ___ retention btwn tooth and bonding agent but ___ bond btwn bonding agent and the sealant or flowable resin or composite resin
micromechanical; chemical
primary colonizers, secondary colonizers, and tertiary colonizers
primary: gram +, facultative
secondary: gram -, anaerobic
tertiary: present after 1 week
supragingival plaque
- located above gingival margin
- associated with caries and gingivitis
subgingival plaque
- located below gingival margin
- associated with gingivitis and periodontitis
are damages caused by periodontitis reversible with primary preventative measures?
NOT reversible with primary preventative measures.
Preventative procedures aid in the CONTROL of periodontitis
how to floss
18 inches around middle fingers
floss in “C” shape
what does the clinician identify with CAMBRA?
identifies cause of disease by assessing the patient’s risk factors
methods of disease prevention (what we need to know for exam), percentage of decay it reduces, and its application
fluoride tooth paste; 20-25%; 2x daily for 2 minutes
water fluoridation; 25-30%; drink tap water daily
sealant application process
- prep tooth
- tooth isolation
- acid etching
- rinse and dry
- bond agent application (optional)
- air thin and curing
- sealant application
- curing
- final treatment of surface
- check retention
is dental care safe during pregnancy?
YES! it is safe and essential during pregnancy. diagnostic measures, including taking dental xrays can be provided safely
delay in treatment could cause unforseen harm to mother and baby
what occurs prior to tooth eruption?
permanent s. mutans colonization of the oral cavity occurs prior to tooth eruption
sucrose facilitates adherence of s. mutans to tooth’s surfce
source of s. mutans infection is the primary caregiver
___ months of age is the “window” of infectivity” for caries
6-30 months of age
should infants be put to sleep with bottle
no
ad libitum nocturnal breast feeding should be avoided when?
after the first primary tooth begins to erupt
when should infants drink from a cup? when should infants be weaned from the bottle?
should be encouraged to drink from cup as they approach first birthday. infants should be weaned from bottle at 12-14 months of age
oral hygiene measures should be implemented by the time of eruption of what?
first primary tooth
cariogenic
foods that contain fermentable carbs and when in contact with microorganisms in the mouth, can decrease pH and start the caries process
anticariogenic
foods that prevent plaque from recognizing an acidogenic (cariogenic) food when it’s eaten (e.g. xylitol gum and cheese)
cariostatic
foods that don’t contribute to decay (e.g. proteins like eggs, fish, meat, poultry or non-starch vegetables, fats, sugarless gums)
how can dentists aid in prevention of oral cancer
- in office screenings/examinations
- annual in office screenings with palpation of lymph nodes on all patients is the standard of care
- counsel patients on eliminating or reducing risk factors
special care dentistry
intellectual disability, autism spectrum disorders, cerebral palsy, down syndrome, and geriatrics
what is patient centered care
ongoing active partnership between patient and health provider who is dedicated to providing proactive, preventive and chronic care management throughout all stages of life
what is health education
more than information only, it includes patient involvement
voluntary adaptations of behavior are adopted and maintained
improves knowledge, has positive but temporary effects on plaque levels
has no discernible effect on caries experience but preventive measures such as fluorides and sealants do
what is social learning (cognitive) theory
people can learn by observing; learning can occur without a change in behavior
cognition plays a large role in learning
one’s personal actions will impact outcomes
stages of change
- precontemplative
- contemplative
- determinism
- active change
- maintenance
- relapse
counseling relationship thru motivational interviewing is called what?
a partnership
motivational interviewing
- motivation to change is initiated by patient not provider
- direct persuasion is not effective in changing behavior
- counseling style is quiet and encourages patient participation
- provider must assist patient in examining conflict of ambivilance
- readiness to change is not stagnant or innate but fluctuates
