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Introduction to Periodontics and Prevention > Lecture 18 > Flashcards

Lecture 18 Flashcards

1
Q

Order of instrumentation for calculus removal:

A

ultrasonics, scalers (Towner/Jacquette, McCalls) then use curettes (Gracey’s)

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2
Q

TF? 30 Jacquette is used to shave off calculus.

A

F. big chunks

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3
Q

For breaking big chunks of calculus:

A

U15 Towner/ 30 Jacquette

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4
Q

Best instrument for bicuspids:

A

McCalls #13/14

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5
Q

Best instrument for molars:

A

McCalls#17/18

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6
Q

Ultrasonics were first proposed for use for:

A

cavity prep, early 50’s

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7
Q

When did the ultrasonic become an alternative to hand instrumentation?

A

60’s

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8
Q

Todays use of ultrasonic:

A

plaque and calculus

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9
Q

Indications for Ultrasonic Scaling:

A

calculus, soft tissue debridement (NUG), overhanging resto, excess cement, stain

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10
Q

Is there more or less trauma with ultrasonic scaling?

A

less

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11
Q

TF? The ultrasonic is a complete substitute for scaling.

A

F

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12
Q

Benefits to using ultrasonic:

A

faster, less effort, less discomfort

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13
Q

When to use ultrasonic for soft tissue debridement:

A

NUG

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14
Q

Types of Powered Scalers:

A

Sonic, ultrasonic

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15
Q

Hz for Sonic, ultrasonic:

A

up to 6,000, 20,000-50,000

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16
Q

cycles per s for ultrasonic:

A

18,000: beyond hearing range

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17
Q

Types of ultrasonic devices:

A

Magnetostrictive and Piezoelectric

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18
Q

Drives rotor of sonic scalers:

A

compressed air

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19
Q

cycles per s for sonic scalers:

A

2.5-7K cycles/s

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20
Q

Tip motion of sonic/ ultrasonic scaler:

A

elliptical

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21
Q

TF? Sonic scalers req cooling.

A

T, heat tissues

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22
Q

TF? Sonic scalers are good for removing heavy, hard deposits.

A

F. Can’t remove

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23
Q

Tip motion of piezoelectric scaler:

A

linear

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24
Q

What powers the piezoelectric scaler?

A

piezoelectric transducer

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25
Q

How many sides of piezoelectric scaler are active?

A

2

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26
Q

Type of current used for piezoelectric scalers:

A

alternating, AC

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27
Q

TF? The tip of piezoelectric scalers are separate from the transducer.

A

T

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28
Q

Transduceer is aka:

A

handpiece

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29
Q

TF? piezoelectric scalers do not produce heat.

A

F. little heat Linear, Less heat

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30
Q

Adaptation is more critical for this type of scaler:

A

piezoelectric (WHY?)

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31
Q

What type of scalers are ultrasonics?

A

magnetostricitve and piezoelectric

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32
Q

How does an ultrasonic work?

A

oscillating magnetic field (25-30 kHz) across ferromagnetic stack

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33
Q

Which sides of the ultrasonic are active?

A

all

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34
Q

Is heat generated with an ultrasonic?

A

yes, water cools and flushes debris

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35
Q

Optimal freq of magnetostrictive, piezoelectric and sonic:

A

20-40 kHz, 29-50kHz, 2,500 to 7,000 cycles per s

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36
Q

Part that converts energy to vibration:

A

transducer

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37
Q

transducer for magnetostrictive, piezoelectric and sonic:

A

metal rod/ stack of metal sheets, ceramic, compressed air

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38
Q

Stroke patter for magnetostrictive, piezoelectric and sonic:

A

elliptical, linear, elliptical or orbital

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39
Q

Power dispersion on tip of magnetostrictive, piezoelectric and sonic:

A

all surfaces, lateral surfaces (more), all surfaces

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40
Q

Which 2 types have all tip surfaces active?

A

magnetostrictive and sonic:

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41
Q

2 MOA’s for ultrasonic scalers:

A

vibrating tip, cavitation bubbles

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42
Q

disruption of biofilm is aka:

A

deplaquing

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43
Q

How do cavitation bubbles work?

A

bubble expands then collapses, -OH and H- radicals formed.

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44
Q

TF? Both -OH and H+ radicals are formed.

A

F. -OH and H-

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45
Q

Effect of free radicals on biofilm:

A

kills bacteria in biofilm

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46
Q

Which is more technically demanding, hand scaling or ultrasonic?

A

hand

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47
Q

When to sharpen ultrasonic tip:

A

never

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48
Q

__% prefer ultrasonic over hand instruments:

A

74%, may influence compliance w PM (perio maintenance)

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49
Q

Benefits of hand scaling over ultrasonic:

A

better subgingivally, no irrigation, no infectious aerosols, good tactile sensitivity, good visibility, hard to damage roots

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50
Q

What type of therapy is irrigation considered?

A

chemotherapy (check)

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51
Q

Possible damage that may occur to roots w ultraonic scaler:

A

root gouging

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52
Q

How many positions does the foot pedal of the ultrasonic provide?

A

2, half/ fully depressed

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53
Q

Steps to setting up ultrasonic:

A

Convenient location, water, flush tubing, fill with water, lubricate O-ring, seat insert in handpiece, adjust water spray

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54
Q

Dental unit waterlines bc infected w:

A

microorganisms

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55
Q

Options to control contamination:

A

Self-contained reservoirs, point-of-use filters, flushing of water tubing

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56
Q

How long to flush ultrasonic handpiece:

A

2 min at start of each day, 30s bw pts

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57
Q

Why add water to hand piece before inserting tip:

A

expel bubbles from hand piece, prevent overheating

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58
Q

Bubbles in an ultrasonic hand piece can cause:

A

over heating

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59
Q

Lubricate the O-ring with:

A

water

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60
Q

Do you need to twist the ultrasonic tip into place?

A

yes

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61
Q

Where to adjust water spray:

A

unit or handpiece

62
Q

This passes thru instrument tip:

A

water coolant

63
Q

Adjust water flow at this power setting:

A

lowest

64
Q

More aerosol for __, less for ___.

A

moderate-heavy calculus, light calculus, plaque

65
Q

The ultrasonic is __ _ __ (3 words) when using for light debris and deplaquing (plaque, not calculus!)

A

“out of phase”

66
Q

When to readjust water spray:

A

When changing power level or tips

67
Q

Why wrap cord of handpiece around pinky or arm?

A

weighs down, may cause handpiece to twist during instrumentation

68
Q

Power =

A

freq X amp

69
Q

Freq =

A

number of vibrations

70
Q

Amplitude =

A

length of vibration

71
Q

When to use low power, low frequency, low amplitude

A

light calculus, staining, deplaquing

72
Q

When to use med power, med frequency, med amplitude

A

mod to heavy calculus, stain

73
Q

Power rarely goes above:

A

medium

74
Q

most comfortable power range zone:

A

Blue zone

75
Q

Fully depressed foot control

A

Boost mode

76
Q

% increased power w fully depressed foot control:

A

25%

77
Q

1/2 depressed pedal:

A

tip activated, irrigating water flows

78
Q

How to get to “boost” mode:

A

fully depress pedal

79
Q

Type of strokes dentists should use for ultrasonic:

A

short, light

80
Q

What will happen if ultrasonic is used at 90d angle to tooth?

A

gouging

81
Q

How to reduce aerosol effect of ultrasonic:

A

high speed evacuation

82
Q

This happens with heavy pressure of the ultrasonic:

A

oscillation dampening

83
Q

9 groupings of ultrasonic tips:

A

scaling, resto, maintenance, perio, V-tip restorative, V-tip endo, endo, retrograde endo, and prosthetics

84
Q

All perio tips for ultrasonics are used:

A

subgingivally

85
Q

TF? Heavy deposits require more tactile sense.

A

F. less

86
Q

There are special tips for:

A

subgingival, furcations, implants

87
Q

Thin tips for ultrasonics are used for:

A

light deposits

88
Q

When to use standard diameter insert:

A

general debridement

89
Q

Tip to access subgingival area:

A

subgingival insert

90
Q

2 types of irrigation with ultrasonic:

A

External, Internal (Dr. Culotta: external, align both tips, internal seems less likely to break)

91
Q

Use implant tips for:

A

Debridement of implants, cosmetic restorations

92
Q

Are the ultrasonic tips and/or point adapted to tooth surface?

A

No

93
Q

Covers for ultrasonic for implants:

A

carbon composite or plastic

94
Q

Parts of ultrasonic that should not be directly adapted to tooth:

A

point or face

95
Q

Parts of ultrasonic that should be directly adapted to tooth:

A

back, lateral surfaces

96
Q

Surfaces of ultrasonic for deposit removal:

A

back and lateral

97
Q

Surface(s) most effective for tenacious calculus:

A

lateral

98
Q

Highest to lowest power dispersion of magnetostrictive insert tip:

A

point, face/ concave, back/ convex, lateral

99
Q

When to use ultrasonic tip:

A

fracture large calculus ledges, rings

100
Q

TF? Brief contact of tip to sound enamel is probably harmful.

A

F. probably not

101
Q

Active portion of ultrasonic tip:

A

last 2-3mm of the back or lateral surface

102
Q

tip-to-tooth surface angulation should be close to:

A

0d

103
Q

Lateral surfaces of an ultrasonic is adapted in a similar fashion to a:

A

curet working-end

104
Q

Lateral surface adapted to the facial surface in a similar manner to a:

A

periodontal probe

105
Q

How does the approach to calculus removal differ bw ultrasonic and hand instruments?

A

top-down vs pocket base to CEJ

106
Q

Work in this direction in a pocket with an ultrasonic:

A

apical

107
Q

Two techniques for orientation of tip to tooth:

A

Transverse / vertical tip orientation

108
Q

vertical tip orientation:

A

back or lateral surface positioned similar to probe

109
Q

transverse tip orientation:

A

back or lateral surface positioned similar to curet, R angle to long axis

110
Q

Powered instrument tips break up heavy calculus deposits by creating:

A

microfractures

111
Q

When to leave the tip of ultrasonic in one spot for a few seconds:

A

never, keep it moving

112
Q

Motion/ stroke used against large calculus deposits:

A

tapping

113
Q

Motion/ stroke used on light calculus deposits and deplaquing:

A

sweeping

114
Q

How to make sure all calculus is removed with ultrasonic:

A

Overlapping, multidirectional strokes

115
Q

Most common mistake in using ultrasonic:

A

heavy or moderate pressure, stops vibrations

116
Q

Standard diameter tips are used for:

A

med to heavy calculus, coronal surface, subg deposits easily accessed

117
Q

HVE stands for:

A

high volume evacuation

118
Q

Magnetostrictive scalers operate at either:

A

25kHz or 30kHz

119
Q

How to reduce bacteria in aerosols while using ultrasonic:

A

Pre-procedural rinse (chlorhexidine) (ask, does this also reduce bacteremia?)

120
Q

Is hearing protection recommended during US use?

A

yes

121
Q

How much of a difference in effectiveness are high and medium power settings for US?

A

NO DIFFERENCE

122
Q

Too little water will lead to:

A

pulp damage

123
Q

Difference in calculus removal between 25kHz and 30kHz scalers:

A

No substantial difference

124
Q

Main difference bw 25kHz and 30kHz units:

A

less noise

125
Q

Are the inserts bw 25 and 30kHz interchangeable?

A

No

126
Q

Will a 25kHz vibrate a 30kHz insert?

A

no

127
Q

Occupational risks with ultrasonic scalers:

A

Neurological, musculoskeletal, tinnitus (ringing/ buzzing in ear)

128
Q

Possible neurological, musculoskeletal problems assoc w vibrating devices:

A

Loss of strength, tactile sense, sensory perception, hearing

129
Q

Patient contraindications for US:

A

Unshielded (define) cardiac pacemakers / defibrillators (except piezoelectric, no electric field), communicable diseases (TB), at risk of respiratory disease, primary/ newly erupted perm teeth, large pulp chambers, difficulty swallowing, prone to gagging

130
Q

Pts at risk of respiratory disease:

A

immunosuppressed, chronic pulmonary disease, asthma

131
Q

How long can aerosols stay in the air after US use?

A

many hours

132
Q

Pts prone to difficulty swallowing or prone to gagging:

A

MS, ALS, muscular dystrophy, Parkinson’s, paralysis (MMAPP)

133
Q

Tooth Contraindications for US:

A

demineralization, sensitivity, implants (wo special tip), restorative materials (ask)

134
Q

1 mm tip wear = __% loss calculus removal ability. (Markings on tips?)

A

25

135
Q

2 mm tip wear = __% loss calculus removal ability.

A

50

136
Q

When should US tips be discarded?

A

2mm of wear

137
Q

power is localized here in US insert:

A

last 2 to 4 mm of tip

138
Q

Slim-Diameter straight tip work well on these roots:

A

anterior, straight roots, shallow pockets of posteriors

139
Q

Part of curved slim tips that adapts best:

A

Back of working-end

140
Q

Curved slim tip w ball end, ideal for use in:

A

furcation area

141
Q

technique to contain water during US use:

A

cupping

142
Q

Pt pos during US use:

A

supine, side, down

143
Q

Is there a sig. difference between manual and ultrasonic?

A

No

144
Q

To clean furcations:

A

Roll ball of working-end across furcation roof

145
Q

Should the US be on or off when locating the furcation?

A

off

146
Q

Stroke type to use to locate furcation:

A

oblique

147
Q

What fits into a furcation better, ball tip or curette?

A

ball tip

148
Q

To get best tactile sense with US:

A

release pedal

149
Q

When to use transverse technique:

A

above or slightly below gingival margin

150
Q

When to use vertical technique:

A

below gingival margin

151
Q

Tip for posterior tooth surfaces more than 4 mm apical to CEJ:

A

curved

152
Q

Tip for anterior teeth even in deep pockets, posterior tooth surfaces 4 mm or less apical to CEJ:

A

straight

Introduction to Periodontics and Prevention (8 decks)

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