Module 1 Flashcards
What can ignoring someones culture lead to?
negave health concequences or poor clinical outcomes
how is cross culture communication enhanced
when the DH develops a knowledge about adn aviods stereotyping
What are some successful nonverbal communication examples
- follow pts lead about touching or personal space
- use hand gestures with caution
- be careful interpreting facial expressions
- follow pt. lead for eye contact
The DH who strives to become adept to providing culturally effecive care:
- values diversity
- actively aquires knowledge
- nonjudgemental
- avoids sterotypes
What does periodontal debridement include?
scaling, root planing, root debridement
what is scaling?
manual and power driven to remove calc and all soft deposits sub and supra
what is root planing?
to elimiate subgingival calculus and smooth the tooth surface
what is root debridement
to elimiate subgingival biofilm and mineralized deposits
gingival inflammation and periodontal destruction result from what
the action of pathogenic microorganisms in dental biofilm
What is another name for an endotoxin?
lipopolysachcharides
what are endotoxins derived from?
the cell walls of gram negative organisms
What is an endotoxin?
toxic to human tissue and leas to inflammation and destruction of perio attachment
where do endotoxins exist?
in the biofilm
Removal of cementum during instrumentation is
inevitable
Is calculus a direct cause of gingival inflammation
no
what does calculus provide in inflammation
a nidus for bacteria
what must be removed to create a healing environment for perio tissue
calculus
what are the aims and expected outcomes of perio therapy?
- interrupt of stop the progress of disease
- create an environment that encourages healing
- induce changes in quantity and quality of bacteria
- tissue conditioning for advanced disease
- educate and motivate patient
when is a single appointment adequate for a patient
gingivitis or ealy perio with small deposits, reasonable personal care, few teeth present
When may you need multiple appointments for a patient?
extent of deposits, probe measurements,lack of oral care
When would you schedule patients for quadrant scaling appointments?
in a patient who is severely diseased, at 1 week intervals with anesthesia
In quadrant scaling when can you scale 2 quads in the same appointment?
when they have less severe perio
after quadrant scaling is completed what will be needed?
a follow up appt for evaluation
what is introduced after quadrant scaling is completed?
periodic maintenance
how long should you wait to evaluate a paitent after the scaling series?
2 weeks
What is full mouth disinfection?
scaling in 2 long appointments completed within a 24 hour period
what is the rationale for full mouth disinfection
perio disease are infections ridding the mouth of as many pathogens at one time can encourage healing and no reinfection
what are the limitations of full mouth disinfection?
- pt cant stand such intense tx
- not as may opportunities for pt instruction
- revaluation
what is preliminary partial scaling?
“inital full mouth debridement” “gross scaling”
what is usually used in partial scaling?
an ultrasonic
what are potential problems for imcomplete scaling?
Healing at the margin:limited access potential for abcess formation patient instruction roughened calculus patient misunderstanding
What happens to gingival tissues in gross scaling?
- tightens around tooth
- tissue appears normal
- probing and bleeding hasnt changed
- makes instrumentation difficult
What is the potential for abcess formation?
predisposing factors
sequence: tissue tightens, pocket closes, microorganisms multiply abcess develops
What are the problems of incomplete scaling in the category of patient instruction?
- visible lesson taken away
- swelling and discomfort taken away, less motivation
- when you scale quads the patient cant compare them
What are the problems of incomplete scaling as far as roughened calculus?
calculus is roughened thus providing more areas for infection
What are the probems of incomplete scaling as far as patient misunderstanding?
it looks and feels good so they may not see need to return for appointments, if perio develops they may claim incomplete tx was given
In scaling to completion what is the segmental approach?
quad or sextant treatments and reevaluating quads each time the patient comes back for the remaining quads
What are factors to consider in scaling to completion?
access, deposit on tooth surface, root anatomy, patient factors (LA, n20, limited opening)
What do you do to prepare for instrumentation?
Review patients assessment record review radiographic findings review care plan and tx records patient preparation supra and sub gingival exam formulate a strategy
What factors are included in patient preparation?
premedication, preprocedural bactericial Rinse, prep for anesthesia
What factors are included in a suprogingival visual examination?
- gross deposits and irregularites
- dry off teeth observe calculus
What factors are included in a tacile supragingival examination?
- look for smooth surface
- explorer meets resistance to calc
what sound is heard when an explorer encounters a deposit?
scratchy or audible click
What factors are involved in a visual subgingival examination of the gingiva?
- spongy, red tissue over proximal calc
- dark color beneath translucent marginal gingiva
what factors are involved in a visual subgingival examination of calculus?
- loose resilient pocket wall deflected
- dark calc can be seen within the pocket
what factors are involved in a tactile subgingival exam with perio charting?
- depths recorded as a baseline
- study soft tissue attach for effective procedures
what factors are involved in a tactile subgingival exam with identifying shallow pockets
- scaling in pockets less than 3 mm can lead to loss of attachment
- repeated use of curet when no calc is present can result in loss of attachment
what factors are involved in a tactile subgingival exam with determining the extent of the pockets?
use an explorer for distinction of fine hard deposits
what is involved in tactile subgingival exam with examining tooth topography?
detect grooves and furcations using a horizontal stroke
what factors are involved in a tactile subgingival exam when evaluating restorative margins?
- detect overhangs
- detect marginal irregularities
How do you formulate a strategy for instrumentation?
- combine clinical findings with info in chart
- check tx objectives
- formulate a strategy
WHat are the 3 prerequisites for calculus removal?
- position of clinician to prevent trauma
- visibility and lighting
- sharp instruments
What is periodontal debridement?
removal of all residual calc and toxic materials from the root to produce a clean smooth surface
what are the other names for periodontal debridement?
root planing, root detoxification, root preparation
What is the instrumentation zone?
areas where instrumentation is preformed for scaling and root planing
where is the instrumentation zone?
above the clinical attachment of perio fibers, extends the height and width of the deposits to be removed
What are the steps in systematic deposit removal?
1-tooth to tooth 2-section to section of deposit 3-strokes overlap 4-instrument in instrumentation zone 5-nature of the deposit
What is the nature of a deposit?
the oldest calc is located next to the tooth and is the hardest
What are some special subgingival anatomy considerations?
- tooth surface pocket wall- thin or no cementum
- soft tissue pocket wall- bleeding inevitable
- variations in probing depths- guides insertion
What is instrumentation dependent on?
almost entirely on tactile sensitivity
what limits the freedom of movement of an instrument?
soft tissue pocket wall
What is the location of subgingival calc?
enamel root or both
how does calculus attach to the cementum?
in minute irregularities and in areas of enamel resorbtion
calculus is more______ than on enamel and requires a different technique for removal
tenacious
What forms does subgingival calc occur in?
nodules, ledge, smooth veneer, and other forms
What are the steps in manual subgingival scaling?
- instrument grasp
- stabilization: establish finger rest
- select correct cutting edge
- adaptation of cutting edge
- angulation
- lateral pressure
- activation stroke
- channels of strokes
- plane the root surface
- evaluation
What do you do during an activation stroke?
- tighten grasp
- maintain cutting edge evenly
- control motion
- overlapping strokes
- stay in instrumentation zone
What are channels of strokes?
moving the instrument slightly laterally to ensure overlap
What is the purpose of the finishing techniques in root planing?
to smooth the surface to lesson the immediate recolonization of bacteria
Where do do plane the root surface
only where deemed necessary after exploration
What strokes should be used in the finishing techniques of root planing?
multidirectional, vertical then oblique, be careful with horizontal
How should the explorer be applied in evaluation?
vertical and diagonal strokes
