Patient Management / Fluoride / Public Health Flashcards
pre-Rx for general anesthesia for PEDO
Versed
- A barbiturate may cause paradoxical excitement
- Gen anesthesia is best for children too young to reason (
Frankly Behavioral Scale
Class 1: uncooperative, cry, v. difficult
Class 2: uncooperative, but listens. Progress is possible.
Class 3: cooperative, but is shy
Class 4: completely cooperative, enjoys the visit
Always permit the child to express fear, even by crying
Angry = separate parent Fearful = keep parent in room
This causes abnormal behavior
Always inform the insurance carrier of any incident with a patient
always
OSHA Regulation
H is for HEALTH
Keep records:
- Sharps Incident log: 5 years
- Employee Training Record (Attendance): 3 years
- Medical records: 30 years (even part time employees)
Review an Exposure Control Plan and Employee Training every year
MSDS are not required for common household products used as intended in a workplace
CDC Regulation
Flush lines in the AM and between patients for 30 sec
HBV titers
- No booster (Another vaccine as seen with Tb and Diphtheria every 10 years) is required, but titers are
- Titers (Blood test for antibodies) needed 1-2 months post vaccine
- Vaccine itself requires 3 shots:
If the series was interrupted after dose 1, continue to dose 2
Dose 1 and 3 should be administered 16 week apart
Dose 2 and 3 should be administered 8 weeks apart
If dose 3 is delayed, it should be administered ASAP - If the titer shows negative ab’s:
Repeat the vaccine series and re-titer 1-2 months post dose 3 –> If person is still negative, they are labeled a non-responder and may have chronic HBV infection –> If no chronic HBC infection, they must be counseled on how to receive Immunoglobulin PROPHYLAXIS for at risk exposures.
Hep B vaccines are mandated by OSHA.
disinfect surfaces between patients with what level of disinfectant?
Intermediate level (EPA approved, use PPE)
Hand gels vs soap/water
soap/water causes more dryness
use hand gels for 10 sec, soap/water for 15 sec
Heat sterilization methods
All heat inactivation of proteins/enzymes:
- Moist Heat kills via denaturation (Autoclave 250F, 15 PSI, 20 minutes OR 270F, 30 PSI, 8 minutes) = short cycle = risk erosion of metal and dulling products
- Dry Heat kills via protein coagulation (Dry Heat Oven 320F for 120 minutes OR 340F for 60 minutes) = long cycle time = not suitable for handpieces = protects against corrosion and dulling (endo files/broaches, burs)
- Chemical vapor sterilization (270F, 20 PSI, 20-40 minutes)
- Utilizes organic solvents (acetone, ketone, alcohol formaldehyde) for vapor, not water (instruments must be completely dry prior to process)
- PROs: leads to NO corrosion or NO dulling of instruments!
- CONs: heat sensitive products will be damaged, can’t sterilize liquids) - Glass Bead sterilizer (15 sec, 220 C or 428 F)
- Endo files
- NOTE: gp endo points in 5.25% NaOCl, 1 min
2% Glutaraldehyde requires ___ hrs to work
10 hours (is a liquid, but can kill spores although not considered appropriate in dentistry)
- AKA cold sterlization
- most potent of the chemicals used
- Its a chemical sterilant
- BUT its allergenic
Most common organism for a spore test
Bacillus
- Spore tests must occur weekly
Define:
- Disinfection
- Pasteurization
- Sanitation
- Sterilization
- Antiseptic
- A chemical that causes inhibition or killing of pathogens (not spores)
- expose food to high temps to destroy some pathogens (M. tuberculosis)
- treat water supplies to reduce microbe levels to “safe” public health levels
- killing of all forms of life
- antimicrobial agent that can be safely applied to living tissue (EtOH) which inhibits, not necessarily destroys, bacteria
Anything put into the patients mouth must be sterilized or disposable.
Parenteral exposure
Exposure to blood or other material that results from punter of the skin barrier
Levels of Disinfectant
Disinfectant = destroys most, but not all (spores)
Low Level = HIV and HBC
Intermediate Level = Tuberculocidal
Hospital Level = Salmonella, S. aureus, P. aeruginosa
Contact Dermatitis Types
- Irritant = won’t have a rash, just itchy and dry.
- Allergic = Type IV delayed. Will have a rash.
Latex Allergy = Type I immediate = begins within minutes (unlike allergic contact dermatitis which begins in Hours) = Has systemic conditions
Laundry and OSHA
A dentist who is the owner and in unincorporated is not subject to OSHA and may take contaminated laundry home.
Instrument Classification
- Critical = penetrate ST or bone = sterilized! (forceps)
- Semi-Critical = contact but no penetration = sterilized! (burs, mirror, x-ray instruments)
- Non-critical = do not touch mucuous membranes = intermediate to low level disinfectant
Fluoride
Supplements
- via Rx only
- Meant only for non-fluoridated areas with children aged 6 months to 16 years
- Mouthrinse (popular in school) = 0.2% NaF > 0.05% NaF
- Chew (30 sec chew, 30 sec swish, then swallow = systemic + topical fluoride)
Gel
- 1.23 % Acidulated Phosphate Fluoride is most common form (pH = 3.0, NaF + Orthophosphoric acid)
- 0.4% stannous fluoride
- 1.0% NaF
Water
- Community: 0.7-1.2 ppm
- School Water: 4.5 times that (balances time children are not in school)
Reduces caries 20-30% over 12 years
(1pp means 1 mg go Fl in 1 Liter of H20)
American Disabilities Act
- 1990
- federal civil rights protection
- work or public entry access
- Must have a record of disability (impairment that substantially limits major life activities)
- ADA protects individuals whom are ASSOCIATED with HIV people
ADA Code of Ethics
- Veracity = truth
- Autonomy = self governance = confidentiality
- Justice = fairness
- Non-malfecience = to do no harm
- Beneficence = to do good = ideal tx.
Dependent vs Independent variable
X = 2y + 3z
X is dependent (value depends on others)
Y and Z are independent (values will determine others)
Public Health Goal
Most important concept is community organization, NOT prevention of disease.
Public Health rates
Growth rate = birth:death ratio
Birth rate = natality
Death rate = mortality
Attack rate = number of cases developing in a population hat is exposed to an infection
Index case = patient zero
Incidence vs Prevalence
Incidence = number of new cases with disease = rate
Prevalence = proportion with disease at a given time = %
*prevalence is most important in assessing need and impact
Non-Communicable disease = normal oral flora causing harm to someone (via reservoir)
Child Abuse
- most common under 3 y/o
Face 68%
Eyes 45%
Neck 12%
Prevention Levels
Primary = before it occurs (sealants) Secondary = controlling disease after it occurs Tertiary = limiting disability from the disease or rehab (dentures)
Specificity vs Sensitivity
Sensitivity = WITH disease who are correctly classified as having the disease = TP, FN Specificity = without disease who are correctly classified as having the disease = TN, FP
Define:
- p value
- correlation of coefficient
- multiple regression
- chi square
- t-test
- P-value = validity of the hypothesis = 0.05
- Correlation coefficient = quantifies the relationship between values
- Multiple regression = linear relationship between a dependent and 2+ independent variables
- Chi square = compare observed data with expected data
- T-test = statistical difference between two means
- Caries Index
- Plaque Index
- Gingival Index (GI)
- Periodontal Index (PI) / Periodontal Disease Index (PDI)
- Community Periodontal Index of Treatment Needs (CPITN)
- Simplified Oral Hygiene Index (OHI-S)
- DMFT / DMFS / deft (pedo) = caries index
- irreversible index
- DISADVANT: not related to # of teeth at risk; teeth may be lost due to other reasons than decay; not used for root caries or sealed teeth
The following are reversible: BOP, plaque
- Must be used with the gingival index
- 0-3 scale (0 has no plaque)
- Scores dependent on thickness of plaque at FGM, not coronal aspect of tooth
- SCORE: Total (B,L,M,D) / 4 - Gingival Index = Measures only gingival inflammation
- PI/PDI = Gingivitis + periodontitis (into 1 score)
PI measures 2 levels of each gingivitis and perio
PDI measures 3 levels of gingivitis (extent/severity) and perio - CPITN = incidence and treatment needs of the community
- OHI-S = Debris index + Calculus index
Dental fear vs anxiety
Fear = specific stimulus = most occur during childhood = not anticipating, but occurs when the stimulus is present = response to imminent danger Anxiety = not specific (apprehension) = response to no danger Phobia = occurs with intense anxiety Stress = Body's response to danger
Behavior is determined, purposeful activity
To change attitude, one must first change behavior
Health Belief Model
- individuals act to prevent disease only when they are susceptible to it
- Predicts health behaviors by focusing on attitudes and beliefs of people
- Developed when people did not use free TB screenings
Types of Fluoride
- 4% SnF2
- pH = 2.1
- radiation patients
- RISK: staining, mucosal burn
Acidulated Fluoride (APF)
- 1.23% NaF + ortho acid
- pH = 3.5
- most common in office use
SnF2 and APF remove glaze from resin, porcelain and GI which causes stains. Use neutral NaF.
- 5% NaF
- pH = 9.2 (only basic one)
- Most common OTC (toothpaste)
- Best for porcelain, resin, GI
Social Cognitive Theory
Behaviors learned through observation and motivation through positive reinforcement
Behavior Theory (ABC model)
A = trigger antecedents
B = behavior
C = consequences
Behavior is preceded by antecedents and followed by consequence
Stages of Change Model (SCM)
change occurs in progressive steps
- pre-contemplation
- contemplation
- preparation
- action/will power/change
- maintenance
- relapse
Types of conditioning for behavior modification
AKA behavior therapy = psychotherapy to modify observable, maladjusted patterns of behavior by the substitution of a new response to a given stimulus
Techniques for modifying Behavior
- Classical conditioning = one stimulus leads to a response = Ex: Pavlovian Dog, white coat syndrome
- Operant conditioning = instrumental conditioning = rewards and punishment = positive or negative reinforcement, punishment or extinction
- Aversive conditioning = using punishment to stop unwanted behavior = Ex: HOME
- Modeling = individuals ascertain how to act by observing another person
- Systemic desensitization = Used for phobias and aversions = teachers a person to replace anxiety with relaxation when the stimulus is present.
Most realistic approach to manage a difficult child is through re-conditioning.
Insurance
PPO = reduced fee for service = pre-negotiated fees to be a preferred provider HMO = capitation plan = dentist paid on a fixed, monthly income Fee-for-service = out of pocket = main payment for dentistry = 56% of all dental expenses paid this way
Deductible = out of pocket before insurance kicks in
Co-payment = cost share for every office visit
Co-insurance = fixed percentage of a co-payment
Coordination of benefits = used when more than 1 insurance plan is used
Balance billing = illegal = fills in the gap as to what insurance covers
Study types
Cross section = exposure + disease outcome at same point in time
Case control = disease present and results
Cohort = group followed over time to see if association exists between exposure and disease development
Quality assurance vs assessment
Assessment = measurement of quality of care Assurance = measurement, action and implementation of the quality of care
