mini assessment 4 Flashcards
1
Q
Goals of Isolation of the Operating Field
A
- moisture control
- retraction
- harm prevention
2
Q
Moisture Control
A
- saliva, blood, crevicular fluid, humidity
- necessary for proper restorative material applic
- bonding procedures need moissture controls for optimum results
3
Q
Retraction
A
- access and visibility
- lips, cheek, tongue, gingival tissue
4
Q
harm prevention
A
- prevents aspiration/swallowing of objects
- protexts tissues from instruments
- protects patients from irriating materials/ bad taste
- protexts operator from saliva + aerosol (infection control)
5
Q
1-rubber
2-hole punch
A
1-1864, dr. sanford barnum
2-1882- SS White
6
Q
Rubber Damn isolation
A
- protect patient
- patient comfort
- better visualization
- improve qualit of care
- inc. productivity
- improve retention of bonded restorations
- infection control
- for licensing exam
7
Q
disadv of rubber damn
A
- may not be places where there is insuffiecient eruption of teeth so no clamp stability
- time consuming
- patient objection
8
Q
Materials used for Rubber Dam
A
- non latex
- medium
- darker colors are preferable
9
Q
1-young frame
2-plastic frame
3-clamp forceps
A
1-metal—U shaped w/ open end towards nose
2-endodontics, doesnt interfere w/ radiographs
3-placement/removal of clamb from abutment of tooth—-open jaws of the clamp and carries clamp to tooth
10
Q
1-wingless retainer
2-winged retainer
3-Retainers
A
1-positioned on tooth w/o rubber dam, damn goes over retainer…easier to see placement of retainer
2-damn is placed on wings of retainer and both applied at once
- one step application
- wings give additional retraction from rubber damn
3- 4 pts of retainers contact tooth at line angles
engage tooth cervical to height of contour
not extend past mesial & distal angles of tooth bc it would inferfere w/ matrix/wedge placement
may get gingival trauma
11
Q
1- retainers with points directed gingivally
2-N27
3-13A
4-12A
5-14A
6- anterior retainer
A
1-placement on partially erupted teeth
2-small molars
3-lower left & upper right molars
4-lower right & upper left molars
5-partially erupted molars
6-retainer is placed after rubber damn, gives retraction of gingival tissue & protects gingival tissue
12
Q
other methods to retain rubber damn
A
- wedgets
- rubber damn material
- ligation w/o floss
-usually w/ anterior of mouth
13
Q
1-size 1
2-size 2
3-size 3
4-size 4
5-size 5
A
1-mand incisors
2-max incisors
3-canines & bicuspids
4-molars
5-molars
14
Q
1-extension for the posterior teeth
2-extension for the incisors
3-extension for canine
4- minimum extension for restorative procedures
A
1- 1-2 teeth posterior to the treatment tooth to the contralateral canine
2-from 1st premolar to 1st premolar…may/may not need clamps
3-1st molar to contralateral canine
4-3 teeth: treatment tooth, 1 tooth anterior, 1 tooth posterior
15
Q
Problems w/ holes
A
1-holes punched too close together
stretches the dam too much
causes gaps
2-holes punched too far apart
too much dam material between teeth
causes bunching
—double punch hole w/ the retainer
16
Q
Placement of Retainer
A
- forceps open jaw of retainer and carry retainer to tooth
- bow is towards distal
- seal retainer from lingual then over buccal contour
17
Q
Isolation of Teeth
A
- pull dam over bow
- after posterior tooth isolate, isolate anterior
- secure anterior w/ wedget or clamp or floss
- leave teeth in betwene until frame is in place
- isolate the rest of the teeth
18
Q
Winged Clamp Technique
A
- dam is on retainer
- dam & retainer go at the same time
- winged retainer & damn are placed on posterior abutment at same time
19
Q
Rubber dam removal
A
- remove debris
- cut septa
- remove wedgets
- remove clamps/ dam at same time
20
Q
Other methods of Isolation
A
- cotton rolls
- dry angles
- super clamp—retracts & protects tongue and lip
- optra damn—3D, frame dam all in one
- optragate—retraction of lips and cheeks, doesnt isolate each tooth
- isoprep retractor—bleaching
- isolite system—retracts tissue, suction, & light
21
Q
Enamel
A
- inorganic
- prisms are made of hydroxyapatite crystals
- –parallel to one another
- –from DEJ to outer surface in radial pattern
- in key hole like pattern
22
Q
Etchants
A
- phosphoric acid
- gel so it stays in place
- removed via rinsing
23
Q
Etching Enamel
A
- 30-40% phosphoric
- 15-30 s of demin of surface
- inc surface area for bonding
- inc surface roughness
- dec surface tensions
—frosty white appearance
-addition of bodnign resin makes resin tags in etched enamel= micromechanical retention
24
Q
problems w/ etching
A
- over etching
- etching= decalcification to a big depth—no etch pattern
- dec ability to form resin tags
- lower bond strength
- clinically overetched enamel cant be distinguished
- outer 5 um of enamel= amorphous, if unprepared = more etching time
- if has fluorosis needs more etching time
-bond strength to enamel is reduced when etched enamel= contaminated (blood, saliva, oil) and then etch surface again for 10 s
25
1- enamel
2-dentin
1-more minerals than water, very little organic
2-50% minerals, and then 25% 25% for organic & water
26
Smear Layer
-cavity prep = smear layer
- debris from grinding & organic matter
- smear layer differs depending on instruments
- makes smear plugs in tubules
- loosely adheres to dentin
27
1-dentin
2-bonding to dentin
1-dentin is always wet
smear layer is present
when smear is removed, fluid seeps out of tubules
communicates w/ pulp
2-30-40% phosphoric, 15 s, removes smear, demineralizes surface dentin
28
1-bonding to enamel
2-enamel/dentin bonding systems
1-bonding system
- etchant (30-40% phos)
- adhesive----hydrophobic resin, works bc very little H20
2-etchant (37% phos)
- primer---hydrophillic in solvent (acetone, ethanol, H20)
- adhesive---hydrophobic resin
29
1-enamel bonding
2-dentin bonding
3- what happens when dentin is etched
1-inorganic
can be dried
hydrophobic resin can be applied to dried enamel and cured
2-organic
dentin is wet and stays wet
hydrophyllic primer is needed
3-smear layer is removed
dentin is demineralized
collagen layer remains
30
Dentin cant be dried...
- must be moist to prevent collapse of remaining collagen
- if dried, bond strength to dentin decreases
- if dried then must be rewet to rehydrate
- must be primed, priming removes residual H20 to allow for infiltration of hydrophobic adhesive resin
31
Adhesive
- applied to dentin
- light cured
- making a hybrid layer= collagen surrounded by resin
32
4th generation
etch and rinse
3 steps
- etch---rinse enamel and dentin
- primer application
- adhesive application
33
5th generation
etch and rinse
2 steps
- etch-rinse enamel and dentin
- primer & adhesive bodning resin are applied together
34
6th generation
self etch
2 step
- etch & prime- 1 step, no rinsing
- adhesive bonding
35
7th generation
self etch
1 step
no rinsing
-etch, prime, & adhesive bonding resin all at once
36
1- etch and rinse
2-self etch
1-removes smear layer
demineralizes superficial dentin
remaining collagen & resin= hybrid layer
---technique sensitive, with large amt of enamel left
2-doesnt remove smear and is incorporated into resin (hybrid)
demin & infiltration of adhesive into superficial dentin
---better results, provide more predictable bonding to dentin
37
8th generation
- etchant, primer & hydrophobic resin---like 4th gen
- etchant isnt rinsed---like 6th generation
adv= less sensitivity, dentin is wet w/ etchant that isnt rinsed, after primer cant be dried, can be used w/ all composite materials
disadv= lack of clinical research at this time
38
CDMI uses
-excite f
- 5th generation---etch and rinse
- ---etch & rinse and then solvent (ethanol)
cavity prep= smear layer
39
1-etching enamel
2-etching dentin
1-30-40% phosphoric
demin enamel= irreg inc SA
2-removes smear layer, superficial demin of dentin, opens tubules, collagen layer remains
etchants rinsed w/ H20
dentin needs to stay moist
40
Summary of etching
- etch enamel
- etch dentin
- rinse/leave moist
- primer---adhesive application, air thin, light cure
- after application of primer---adhesive, dentin= shiny hybrid
41
2 factors that control mandibular movement
1-posterior controlling= the condyles
via the sagittal, horizontal, and frontal plane
2-anterior controlling= anterior teeth
42
1- Condylar movement as Vertical Determinants
2-Condylar movement as Horizontal Determinants
1-influence cusp height & fossa depth
2-influence ridge direction & groove position
-define the dimensions the tooth cusps & horizontal paths that the cusps will travel along surfaces to avoid making interfering contacts
43
4 vertical determinants of posterior condylar
1-angle of eminence
2-plane of occlusion
3-curve of spee
4-lateral translation working movement
44
1-angle of eminence
2- 45 degree slope
1-steeper the slope of eminence, the greater the downward movement of the condyles during translation===greater downward movement of mandible
2-45 degree slope for eminence= mandible moving downward at 45 degree rate of inclination
as it goes downward it will then separate the teeth by that same 45 degree
if slope of eminence increases so will separation of teeth
so steeper condylar guidance= taller cusps MAY be and the flatter condylar guidance the shorter cusps MUST be
45
1-the occlusal plane
2-change of angulation of above
1-imaginary line drawn from incisal edges of maxillary anterior teeth along cusp tips of maxillary posterior
2-changes in angulation of plane of occlusion from horizontal plane will effect posterior tooth cusp height
- --occlusal plane that parallels the horizontal = tooth separation at same angle as articular eminence
- --as plane becomes more parallel to angle of eminence= less tooth separation
- --plane becomes more divergent from angle of eminence= greater tooth separation
so more parallel the occlusal plan to angle= shorter cusps MUST be and divergent the occlusal plane is from angle of eminence, taller cusps MAY be
46
Curve of Spee
1-anteroposterior curve extending from tip of mandibular canine along buccal cusp tips of mandibular posterior teeth
-changes in degree of curvature of curve of spee effects cusp height
- greater curvature of curve of spee (more acute arc of curvature) the **shorter** custs MUST BE
- less acute (flatter) the curvature of curve of spee, **taller** cusps MAY be
47
4 horizontal determinants of posterior condylar
1-distance from working side condyle
2-distance from midsagittal plane
3-lateral (working) translational movement
4-intercondylar distance
= movement of opposing cusps in horizontal plane= working & nonworking paths in harmony w/ ridge direction & groove position of tooth
48
1-Mandibular movement guided by condyles---horizontal
2- curvature becomes flatter...
1-greater distance between working condyle and given tooth = greater angle between eccentric
2- as object moves further form center of rotation
so further tooth is away from working condyle= greater angle between working/nonworking
49
Overjet (anterior controlling)
2-overbite (anterior controlling)
1-horizontal relationship between anterior teeth
-anterior-posterior distance between incisal edges of maxillary + mandibular anterior teeth
2- vertical relationship between anterior teeth
-amount that the anterior teeth of 1 arch vertically overlaps teeth of opposing arch
50
Anterior Guidance
- overjet & overbite = disclusion (separation) of posterior teeth during eccentric mandibular movement
- protrusive, right working, and right nonworking
- vertical determinant
- impacts only cusp height & fossa depth
- steeper anterior guidance angle= greater downward movement of mandible= greater separation of posterior teeth
- shallower angle of guidance= less downward movement of mandible= less posterior tooth cusp separation
51
-summary of anterior guidance
- so steeper anterior guidance, the **taller** the cusps MAY BE
- shallower anterior guidance, the **shorter** the cusps MUST BE
- factor of proximity influences posterior tooth anatomy
- is dominant factor both in occlusal anatomy & mandibular movement bc of proximity to posterior teeth
52
1-infection control
2-standard precautions that are preventive
3-infections may be encountered in oral health
4-how are infections transmitted
1- various policies and procedures (Standard Precautions) to prevent the spread of infectious diseases in the health care setting.
2-against exposure too blood, body fluids, non intact skin, mucous membranes, any other tissues
3-HIV, CMV, tuberculosis, Hep B, C, D, Hepes, Staph, Strep
4-open wounds, puncturing of skin, ingesion, inhalation, & mucosal transmission
53
1-bloodborne
2-Hep B
3- Hep C
4-HIV
5-PPE
1-risk of transmission after percutaneous exposure
2-22-31%risk clinical 37-62% HBV serologic
3-1.8%
4-0.3%
5-gowns, masks, eye protection, gloves
54
1-gowns
2-masks
3-eyewear
4-gloves
1-covers arms to wrist & closed at neck...
resistant to liquids
-disposed if soiled and over work clothes
2-over mouth and nose to prevent breathing of infectious---reduces risk of transmission
change between patients
3-prevent injury from airborne or splattering
needs side shields
4-touching patient/materials that come in contact w/ infectious
touch patient, sterilized instruments
once on dont touch anything that cant be disinfected
must remove after
wash hands 15 s, put on, and then wash after
55
Surface Disinfection
- w/in 3 ft radius of patients = contaminated w/ barrier
- disinfect counter tops, hoses, simulator head/torso
- with isopropanol & diisobutyl phenoxyethyl ammonium chloride
- wear clean gloves and wife clean the surface---use second wipe to keep surface wet and then discard and wash hands
56
1-Prevention of early childhood tooth decay
2-disease mangement in kids
3-access to dental care service in kids
4-systems of integration/coordination in kids
1-fluoride, reduction of bacteria that causes tooth decay, guidance for parents
2-risk assessment for tooth decay, spectrum of dental treatment
3-age 1 dental visit, dental home, dental workforce + professional development
4-partnership w/ health & childcare providers, state & local dental public health programs, policiy development
57
1-leading causes of death in the US
2-underlying causes
3- why are dentists involved
4- faces 2 kinds of malnutrition
1-heart disease, cancer, & stroke
2-tobacco, lifestyle, diet
3-bc we see patients on regular basis, spend more time with them, can show them direct effect, treat women, and can be as effective as physicians
4-hunger & dietary excess----obesity, diabetes, CVD, **dental caries **
58
Vitamins for good health
- Fe- cells w/ O2 through HgB---red tongue
- Zn- immune, wound healing, & sexual maturation---poor wound healing
- Ca- nerve, muscle activity, mineralization, membrane transport---osteoporosis
- Vitamin D- inc Ca absorption, reduces hypertension---rickets
- Vitamin B12- synthesis of RBCs and myelin---anemia
59
1-Diet counseling
2- "diet" products
3-saliva
1-asses dietary habits, bod weight, identify changes needed, identify barriers to change, setting goals, finding support, & maintaining changes
2- diet suppresents= acidic
diets detoxify are acidic
diet soda pop is acidic
milk= 6, coffee= 5, tomato juice= 4, redbull= 3.3, poweade= 2.8, lemon= 2
3-buffer---saliva pH is 6-7.5, bicarbonate ion
inc metabolic rate---\> inc flow rate--\> bicarb conc inc--\> raises pH
60
1-sugars
2-development of caries
3-sucrose
1-dietary cause of caries
intake of extrinsic sugars greater than 4x's a day= inc caries
shouldnt excees 60 g/day
2-cariogenic food--\> dental biofilm--\> acid formation--\>demineralization--\>dental caries
3-sucrose is a dimer of glucose & fructose
s. mutans break is down to individual sugars & metabolize fructose intracellularly for energy as part of glycolysis= release lactic acid
61
1-visual examination detection
2-ICDAS
1-primary mode of detection for pit/fissure caries, dry field, good lighting, & magnification
2- 0=sound surface
1= first visual change in enamel
2= distinct visual change in enamel
3= localized enamel breakdown, no visible dentin
4=non cavitated surface w/ underlying dark shadow from dentin
5=visible dentin
6=extensive distinctive cavity w/ visible dentin
62
1-risks for oral health
2- risk indicators
3-protective factors
```
1-physical= genetic, handicapp, arthritis, mental comp
social= drugs, alc, financial, oral health
medical= radiation, Rx meds, chemo
dietary= smacks, carb beverages, balance of diet
```
2-xerostomia, plaque, active caries, hypocalcification, recent fillings= 3 yrs, extractions
3-oral hygiene practices, daily fluoride, sugarless gum (xylitol), saliva, balanced pH, sealants
63
1-low risk
2-moderate risk
3-high risk
4-extreme high
1-no new cavities, no meds affecting saliva, good home, no snacking, chekups
2-few white spots, no new cavities, no meds w/ saliva, limited snacking, ortho work: prevident
3-1 or more cavities, medications affect saliva, bad home care, no checkups, snacking: prevident 2x, xylitol
4-anterior caries, smooth/root caries, dry mouth meds, no checkups, snakcs
prevident 2x, xylitol, otc toothpaste
64
1-early childhood caries
2-chemotherapeutics
3-fluorides
1-bottle caries
2-eliminate, reduce, alter effect of microorganisms in oral cavity: fluorides, chlorhexidine, xylitol, remineralize
3-promote tooth remineralization: make enamel decay resistant, inhibit acid creation: toothpaste, varnish, trays, rinses OTC, water
65
1- office tray range
2-avg toothpaste
3-rx prevident range
4-flouride varnish
5-chlorhexidine gluonate
1-1.23%---\> 12,300
2- 0.20%---\> 900
3- 1.1%---\> 4,950
4- 5%---\>22,500
5-alteration of bacterial adsorption, reduction in pellicle formation, and alter bacterial cell wall lysis
reduction in plaque biofilm and gingivitis= teeth staining, and alteration of taste
66
1-Xylitol
2-remineralizing pastes
1-prevent caries= lower levels of sucrose & free acid in whole saliva, lower plaque. lowest lactobacilli saliva
-caries pathogen suppression & caries reduction in high risk
2-recaldent= milk derived= remineralizes teeth and prevents dental caries, stabilizes Ca, P, and fluoride as water soluble
casein phosphopeptide & amorphous calcium
67
1-green tea
2-nutmeg
3-barley tea
4-lollipop
1-rich in catechin= antioxidants. inhibts s. mutans, kills bacteria, combats plaque
2-macelignan. decrease s mutans levels
3-popular drink, inhibit s. mutans
4-developed safe & effective sugar free herbal pops that kill cavity causing bacteria
68
what are dental sealants
- caries preventive approach to oral health
- plastic coatings applied to chewing surfaces of teeth on noncavitated
- mainly for kids
69
dental sealant process
- isolate/pumice clean/rinse
- etch 15 s/ rinse 10 s/ dry
- apply/cure 20 s
- bond/wipe dry/rinse/check occlusion
70
1-localized hypoplastic enamel
2-demineralization
3-preventive approach
4- most common decay in kids
5-succesful fissure sealing
1-aplastic---areas where no enamel forms
2-varying degrees of surface breakdown
3-low in sugars, brush/floss, toothpaste/rinse, literacy, xylitol gum, dry mouth, dental sealants
4-pit & fissues
5-prevents bacteria from colonizing, cuts off carb supplies, helps with oral hygiene
71
1-resin composites
2-resin portion
3-particle portion
4-resin composite as restorative
5-fluroides vs sealants
6-dental sealants effective
1-combo of inorganic particles surrounded by coupling agent, w/in organic resinous matrix
2-bowens resin---bisphenol
3-inorganic fillers used in resin composites= strengthen + reinforce
4-need to isolated from salivary mositure, they are sensitive to moisture
5-fluoride isnt as preventive on deep grooves of back teeth
6-when sealed=effective, retention= 85%
72
1-risk to chemicals in comp of dental sealants
2- risks w/ dental sealants selling in decay
1-sealants have monomers from BPA (bisphenol A)
2-effect of sealing caries: pulp not endangered when placed over small pit & fissure lesions
73
1-ergonomics
2- ergonomics risk factors
3-mitigating risk factors
1-assesses work related factors that may pose musculoskeletal disorders to help alleviate them
involves positioning of patient + provider w/ proper illumination
2-repetitive, forceful, prolonged exertion of hands
prolong awkward postures
vibration + cold
multiple risk factors
3-breaks, stretching, and use of ergonomics
74
1-ergonomic stats
2- ergonomics
1- 2/3= occupation related pain
1/3 retire early because of musculoskeletal disease
out of 271 students---by 3rd year 71% = pain in neck/shoulder (female) and lower back (male)
2-postioning of provider/staff/patient, illumination, and use of mirror for safe care
75
1-provider posture
2-ergonomics & loupes
3-loupes
4-patient positioning
1-back straight, feet flat
height of stool so thighs are parallel to floot
back against backrest
2- taller people= longer working distance than shorter
3-enhance visuality + posture + comfort
working distance, declination angle & frame size
20 degrees or less neck flexion
4-patient lying with back flat
w/ maxillary, put teeth at 25 degree angle to vertical
support head rest so it supports the neck
mandibular arch the toso should be 30-45 angle to floor
adjust height of chair until patients oral cavity is treated at level of elbow w/ arms at your side and forearms perp.
76
1-mandibular posterior occlusal
2-mandibular posterior buccal
3-maxillar posterior occlusal
4-masxillary & mandibular lingual
1-right handed= 7
left handed= 5
```
2-right= 9
left= 3
```
3-right=11
left=1
4-right & left= 12
77
outside illumination
outside switch= on/of
middle switch= intensity
innermost switch= light from full spectrum white light to decreased spectrum yellow light
ideal distance of light is 27 inches---3 by 6 inch area
for mandibular arch= position light from straight above
for maxillary arch= light in front of patient
78
1-direct vision
2-indirect vision
1-anterior arch + mandibular arch...need posture, positioning and illumination
2-use a mirrow, needs good grasp & finger rest and working w/ reversed mirror image
hold mirror as you would a pen, close to head w/ non dom hand
have middle finger extended so pad of finger lies against shank of the mirrow ( **modified pen grasp**)
use ring finger as finger rest
