Mod 1, 2 Flashcards
What are examples of Temporary special needs
broken arm, heart surgery
In a person with special needs you should focus on the _________ first and the ______ last
person, disability
What is a high functioning s needs pt
complete self care, varying degrees of motivation and supervision
what is a mod functionin s needs pt
partial care
require training, assistance, and direct supervision
what is a low functioning s needs pt
total care dependent
wheelchair confined, bed ridden
can attempt portion of oral care w training
What needs to be established with s needs pts that may take time, and patience
trust
what needs to be emphasized to patients and caregivers
the reasons for good oral infection control therapy
when should prevention be started
early
who are at risk for more oral problems
SHCN patients
What are the parts of prevention for s needs pts
biofilm control fl2 sealants CHX dietary counseling regular exams
What are the steps in biofilm control
- basic info
- disclose and SHOW
- tb demo
- flossing
- dentifrice
why may a pt not be able to use a dentifrice
problems swallowing, can brush w/ H20 or CHX
what should be done to educate caregiver
- establish amt of dependency
- demonstrate and verbilize techniques
- practice and repeat instructions
- include them in the appt
what are some adjunctive therapys for s needs patients
xylitol CHX Fl2 behavior modification home care aids dietary counseling
what are complications of medications
xerostomia
decreased appetite
altered taste
what are barriers experienced by patients
fear of unknown financial lack of knowledge time access to care (transportation)
What should be considered when deciding when to treat or refer pt
-skill and comfort level
-equipment
-time
cost
When treating s needs pts what are some tx considerations
-treat quad by quad- most diseased one first
-chairside assistance
-unbreakable mirrors
tx in hospital
informed consent
chart entries
how can you manage s needs pts
whole team
gain pts trust
restraints
how should you schedule s needs pts
-after hours/weekends
longer appts
frequent recall
when instrumenting what are some thing to consider w s needs pts
patients adapt fulcrum, pt positioning and operator need for assistance and bite block single ended instruments ultrasonic often contraindicated
what is an endosseous implant
within the bone *most common
what is a sub periosteal implant
metal framework
what is a transosteal implant
it extends through the mandible
what are the 3 components of implant
abutment, crown, implant
what is an ASA 1
healthy
What is an asa 2
well controlled systemic disease
what is an asa 3
uncontrolled mult medical problems
ASA 4/5
serious medical problems
what is osseointegration
attachment of the bone to the implant
how much osseointegration has to happen for implant success
35%
what are signs and symptoms of implant failure
exudate, mobility, bleeding, pocketing, inflamed, dull percussion sound, radiolucency, depresses vertically
what is the role of the DH in the maintenance of implants
assess HHX, home care and oral health, educate pt in procedures and home care
Implants placed in which arch take longer to osseointegrate and why
maxilla, because the bone is less dense
when are radiographs advised to eval implants
best way to eval (better than probing)
- at 6 months, 12 mo, and 18 mo
what recall interval for implant pts
6 mo max, 3 mo for first year
what homecare aids for implant pts
superfloss, metal free proxabrush, end tuft brush, perio aid, implant floss, CHX, rubber tip
types of instruments in assessing implants
plastic, CHX dipped, coated ultrasonic tip
what is the titanium oxide surface of implants
exterior coating, stable ceramic, non corrosive, biocompatible SCRATCHES EASILY
implant vs natural tooth- epithelium
sulcus and JE are the same
implant vs natural tooth- conn tissue
implant- more collagen, collagen runs parallel to implant, less fibroblasts and blood vessels NO PDL
Natura- less collagen, run horiz on insert into cementum
peri-implant mucositis
- similar to ging, reversible
- inflammation of cuff of implant
- edema, BOP
- no boneloss
peri-implantitis
advanced, involves tissue around implant, edema, exudate, leads to bone loss
What should every recall appt include in pts with implants
assess of health, OH habits, palpation of implants, probing of implant, deposit removal
at the very first 3 mo appt after implant placement what should be done
debride soft tissue but avoid sub ging instrumentation, eval mobility, tissue condition, probe
can bruxism cause implant failure
yes
what should be done at the second 3 month appt after implant placemtn
x-rays, probe, mobility, occ forces, remove deposit
What is a class I maintenance of implants
healthy, debride of crown and prosthesis
what is a class II maintenance
probe depths above 4 mm, debride around transmucosal portion
what is a class III maintenance of implant
sig pocket depths, bone loss, debride transmucosal portion and implant
what types of instruments should never be used on implants
stainless steel
If a prosthesis can be removed that is attached to implants how often should it be removed for cleaning
every 18-24 months
should pts with implants direct flow of oral irrigator into sulcus
no
when should you probe implants
follow recommendation of practictioner who placed implant, many recommend not probing, eval tissue
what technique should be used to eval implants
paralleling
when should x-rays be taken of implants
baseline, 6 mo, 12, 18
what are absolute contraindications to dental surgery
recent MI (6 to 12 mo) valvular prosthesis (15-18 mo) radiation tx severe renal disorder uncontrolled diabetes osteoporosis hormonal deficiencies drug or alcohol addiction HEAVY SMOKER
What is the bacterial influence on implant success
perio pathogens in other pockets, homecare efficacy
What is the systemic influence on implant success
smoking, medications, systemic disease
what is the occlusions influence on implant success
bruxing malocclusion
what clinical factors influence success of implants
healthy bone, not overheating bone, fibro-osteal integration should NOT take place, pt OH level
Stage one of one step implant
seated in bone w/ cover screw
stage 1 of two step implant
implant submerged under tissue, healing collar placed at later date
stage 2 of two step
abut and crown prep
how long should the load not be placed on implant a
at least 4-6 months
implants are the ______ of care
standard
