Lectures 9 & 10 Flashcards
Phase 1 perio therapy:
remove issues that accumulate plaque
Phases of Periodontal Therapy:
Phase I, Reevaluation, Phase II (perio surgery), Phase IIII (restorative), Phase IV (maintenance)
Phase II perio therapy?
perio surgery
Phase III perio therapy:
restorative
Phase IV perio therapy:
maintenance
During maintenance of perio therapy, how often should the recall visits be?
every 3 mo
Why is restorative work after Phase II?
bc the gingival margin location will change
TF? Root planing has to be subgingival.
F. does not need to be
Instruments for root planing:
curettes
what is required to get healing after perio therapy?
eliminate biofilm, calculus, and altered cementum
Microbial Reservoirs:
calculus, biofilm, planktonic plaque, scratches from insturmunets, resorption lacunae, accessory root canals and dentinal tubuli, pocket epithelium, intercellular and intracellular, within and upon cementum
Scaling is instrumentation of:
crown and root surfaces to remove plaque, calculus, and stain
Root planing is instrumentation of:
root surfaces,remove rough cementum or surface dentin impregnated with calculus, toxins or microorganisms. A.k.a. root surface instrumentation or root debridement.
Instrument to remove biofilm, calculus, and infected/contaminated cementum and dentin:
Gracey curette
TF? It is easier to remove plaque from a smooth surface.
T
What is the only clinical indicator of calculus removal?
root smoothness
TF Less plaque accumulates on smooth surfaces.
T
Why Remove Cementum?
Calculus is frequently embedded, Scaling can’t remove it, Root debridement is needed to remove cementum with embedded calculus
Goal of removal of cementum:
creation of a biologically compatible surface
How do we want oral microflora to change after SRP, antibiotics, and flossing?
Shift microflora back to gram positive cocci and rods
Plaque takes about ___ weeks to form to final conclusion
8 weeks
Effects of removing gram negative oral bacteria:
resolve inflammation, reduce pocket depth (2mm on average), increase clinical attachment
TF? Movement (?) of pocket from bottom up is histologic change.
F. Clinical attachment, not histologic, tissue gets tighter and can not push probe as deep
How long does bacteremia last after dental extraction
10 min
What type of immune response is there to bacteremia?
both local and systemic host response
% of pts with bacteremia, dental extraction:
100
% of pts with bacteremia, SRP
70%
% of pts with bacteremia, third molar surgery:
55%
% of pts with bacteremia, endodontic treatment:
20%
% viridans group steptococci, dental extraction:
85%
% viridans group steptococci, SRP:
55%
% viridans group steptococci, third molar surgery:
40%
% viridans group steptococci, endodontic treatment:
20%
% anaerobes, dental extractions:
75%
% anaerobes, SRP:
65%
% anaerobes, third molar extraction:
45%
% anaerobes, endo treatment:
5%
Driving bacteria into __here__ leads to bacteremia.
tissue
TF A pt may have constant bacteremia if they have loose teeth.
T, movement of teeth while chewing
How do you measure the level of bacteremia:
draw blood from arm
When to Rx antibiotics before SRP:
prosthetic heart valves (any prosthesis, right?)
Where is removing calculus harder?
posterior, interproximals, and deeper pockets
If pockets are too deep to clean out effectively during dental cleaning this may need to be done:
Open flap debridement (surgery)
TF? Calculus can form on dentures and fixed bridges
T
What fraction of the surfaces can be cleaned for pockets greater than 8mm?
about half of the surfaces
Where will the biggest reduction in
pocket depth be seen?
deep pockets
Typical Sequence of Instrumentation:
probe, explorer, ultrasonic, scaler, curette, polisher
Scalers are used for:
large supragingival calculus
Curettes are used for:
smaller deposits and subgingival debridement
Stains are removed via this process:
polishing
Instrument to locate calculus and caries:
explorers
__ is a combination of #23 and #17:
5
This is the Old Dominion University explorer:
11/12
Explorer with three angles:
17
Typical looking explorer with a slightly longer tip:
23
Straightest explorer:
11/12
Explorer with a slight curve at end, not a full hook:
3
Angled, hook explorer:
3CH Pigtail
What are ultrasonic and sonic instruments used for?
scaling and root debridement – large deposits
5 scalers for supragingival calculus and stain removal:
curette, sickle, file, chisel, and hoe
Sickle scalers are for:
large calculus deposits, 2 cutting edges
Which aspects of the tooth can sickles be used on?
all aspects
Which instrument is triangular in cross section, double-cutting edge, and pointed tip?
sickle scaler
lateral surface should meet face of the sickle scaler at an internal angle of:
70 to 80 degrees
What type of area is the Jacquette scaler good for reaching?
interproximals, pointed tip, especially mandibular anteriors
3 parts to a perio instrument:
handle, shank, blade
Instruments with 2 cutting edges:
scalers
Instruments with 1 cutting edge:
curettes
TF? The lower shank includes the tip of the explorer.
F. area just proximal to tip
The lower shank is aka:
terminal shank
This scaler is good to flick off big chunks of calculus in the mandibular linguals
Towner scaler, facial of mandibular as well? Yes
Curettes are fine instruments for:
subgingival removal of calcified deposits, altered cementum from root surfaces, and debride soft tissue lining the pocket
Numbers for anterior, posterior, mini anterior, and mini posterior explorer:
5530, 5532, 5534, 5536
These remove tenacious subgingival calculus and altered cementum. Limited to certain situations:
hoe, chisel, and file
Cleansing and polishing instruments:
rubber cups, brushes, and dental tape
Oral (Dental) Prophylaxis:
Procedures to remove plaque, calculus, materia alba and extrinsic stain from the crowns and roots of teeth using hand instruments or ultrasonic instruments or electric polishers.
TF Both adults and children get oral prophylaxis.
T
What kind of a shank does a right-angle have?
a straight shank
What type of right-angles are reusable?
metal
Webbed cups:
flexible, less abrasive paste than ribbed cups
Ribbed interior cup
flexes and follows tooth contour
What is used to remove stains from the pits and fissures of occlusal surfaces?
Bristle brush attachments
TF Bristle brush attachments can be used on facial, lingual, mesial, distal, or occlusal surfaces.
F. only oclusal
What is used to remove extrinsic stains from the crowns of the teeth?
rubber cup filled with polishing agent
Universal curettes:
2 cutting edges, blade 90 degree angle to terminal shank
Degree angulation for curettes:
70 degrees
Numbering for Gracey curettes:
5-6, 7-8, 11-12, 13-14
Scalers are angled at __ d’s and curettes are angled at __ d’s:
90 (remember: double edged, makes sense to be at 90d), 70
Which are narrower, scalers or curettes?
curettes
Flat surface of the curette is called:
the face
Surfaces of a curette starting from the cutting end and working around to the face as the last side:
cutting edge, side, back, non-cutting edge, face
Purpose of the exploratory stroke:
detect calculus and irregularitites
Working stroke:
remove calculus and altered cementum
3 basic strokes:
vertical, oblique, horizontal
TF The cavitron is typically used subgingivally.
F
Gross superficial debridement is done with:
ultrasonic
Are curettes ever used supragingivally or only sub?
can be used for both
Adverse Effects of Scaling and Root Debridement:
Gingival recession (“black triangle”), increased clinical crown length, poor esthetics, root sensitivity, toothbrush abrasion, root surface caries
TF The size of the anatomical crown can increase after SRP.
F. clinical crown, not anatomical
Will root sensitivity go away after SRP?
usually, if they clean
Calculus will be visible as:
chalky deposits, need to dry teeth completely
Subgingival calculus is visible at the gingival margin as:
a dark shadow
What explorer should we use to detect subgingival calculus?
11/12
Most common locations of calculus:
buccal of maxillary molars (Stenson’s duct) and lingual of lower anterior (Wharton’s duct), mineral deposition
Patterns of subgingival calculus:
spicules, ledge, ring, veneer
Start scaling with this type of motion:
vertical motion
What would happen if you use a downward stroke when trying to remove calculus?
Impact gingiva, swollen mouth, calculus lodged subgingivally
Why is subgingival calculus dark?
iron deposits in calculus from blood, tobacco, and red wine
What will happen if you cut off circulation in one area of the mouth?
collateral circulation will form
What is the nutrient base for biofilm to form?
calculus
Which mouthwash should I use?
Look for the ADA seal
What mouthwashes can stain teeth?
chlorhexidine or cetyl pyridinium chloride (CPC – Crest procare mouth rinse, CPC: abbreviation for both)
What instrument should you start with to remove calculus?
Towner/Jacquette, McCalls then Gracey’s
Is Gracey’s a scaler or curette?
most often in reference to curette, but can also be scaler
What is the Towner OR Jacquette used for?
big chunks, supragingivally only
This explorer looks like Cpt. hooks hook:
U15 Towner
McCall 17/18 is used for:
Distal posterior
Where might we remove tooth structure when scaling?
subgingivally
What is McCall 13/14 used for?
Bicuspids, mesial posterior:
Scaler that is in the shape of half of a benzene ring
jacquette
TF We can remove enamel when scaling.
F
TF The Towner U15 can be used for subgingival calculus.
F
What is the pointed tip of the Towner U15 used for?
interproximals
Blade width of the Towner U15:
1mm
Sickle scaler with a straight, flat face and two cutting edges that come to a point, removes calculus supragingivally and interproximally, not for subgingival calculus
30 Jacquette
Scalers are for ___ calculus while curettes are for ____ calculus.
breaking, shaving
This instrument is used for medium to heavy calculus, not for use on root surfaces, 80° angulation fractures calculus from tooth, breaks chunks of calculus, not shaving calculus as when using a curette
U15 Towner / 30 Jacquette
TF. The scaler should be at a 90 degree angle to the long axis of the tooth.
F, 80 degrees
All __ facing surfaces, then all __ facing surfaces
Rt, Lt
Designed for most areas by changing finger rest, fulcrum,and hand position, parallel cutting edges on either side of the face:
McCalls 13/14 and 17/18
McCalls #13/14 bestfor ____and #17/18 best for ___.
bicuspids and mesial surfaces, molars and distal surfaces
Shank parallel to distal surface when correct working-end is selected?
lower shank
What shank goes up and over the tooth?
functional shank
How to know which shank is the lower shank?
ask
