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DA (Can) > Preventive Procedures 1 (Midterm Review: Outcome 1-4.4) > Flashcards

Preventive Procedures 1 (Midterm Review: Outcome 1-4.4) Flashcards

1
Q

Preventive Dentistry

A

The practice of caring for your teeth to keep them healthy
- Includes: use of fluorides, application of dental sealants, proper nutrition, and plaque control

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2
Q

Oral Prophylaxis

A

The complete removal of calculus (a hard-mineralized deposited attached to the teeth), debris, stain, and plaque from the teeth with the use of hand instruments (exploring), ultrasonic scaling, and coronal polishing.

  • Commonly known as prophy or cleaning
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3
Q

Why is prevention important?

A

A partnership must be formed between patient and dental healthcare team.

There are several steps in helping patients obtain their optimal oral health.
1. Helping patient understand what causes dental disease and how to prevent it.
2. Motivating patients to change their behaviours and educating them on recognizing and preventing dental disease in themselves and their families

  • Oral health does affect the overall body system (direct correlation with oral cavity and overall health)
  • If calculus is not removed, can lead to bone loss
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4
Q

What is the primary treatment for gingivitis?

A

Dental Prophylaxis

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5
Q

What are the different types of oral prophylaxis procedures?

A
  1. Scaling (non-surgical)
  2. Root planing (non-surgical)
  3. Gingival curettage (surgical)
  4. Coronal polishing (non-surgical)
  5. Fluoride
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6
Q

What is scaling?

A

The removal of calculus deposits (supragingival - above the gum line) from the teeth with the use of suitable instruments

  • Non-surgical
  • Can only be performed by D.H. Dentist, or DA (who has taken additional education - PDM)
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7
Q

What is root planing?

A

Follows scaling procedures to remove any remaining particles of calculus and necrotic cementum embedded in the root surface

  • non-surgical
  • Can only be completed by D.H. or dentist
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8
Q

What is gingival curettage?

A

Scraping or cleaning of the gingival lining of the pocket with a sharp curette to remove necrotic (diseased) tissue from the pocket wall

  • Subgingival (below gum line)
  • Surgical
  • can only be completed by DH or dentist
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9
Q

What is coronal polishing?

A

A procedure that removes plaque and stains from the coronal surfaces of the teeth
- strictly limited to the clinical crown (visible within oral cavity)
- can be performed by DA, DH, dentist

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10
Q

What is fluoride in preventive dentistry?

A

Naturally occurring minerals help prevent cavities
- Fluoride can be prescribed and then delegated to the DA who can apply fluoride

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11
Q

What procedures can be done by Registered Dental Assistants with supervision from RDH or dentist?

A
  1. Fluoride
  2. Coronal polishing
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12
Q

What are dental deposits?

A
  1. Calculus (hard deposits - mineralized)
  2. Plaque (soft deposits)
  3. Stain on supragingival and unattached subgingival tooth surfaces
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13
Q

What are soft deposits?

A

Oral Biofilm (also known as plaque, dental plaque biofilm, microbial biofilm)
- a colourless, soft, sticky coating made up of communities of microorganisms that adheres to tooth surfaces, dental appliances, restorations of teeth, oral mucosa, tongue, and alveolar bone

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14
Q

What is the significance of soft deposits?

A
  • Dental caries, gingival and periodontal infections are caused by microorganisms from a person’s dental plaque
  • Dental biofilm is a primary risk for gingivitis, inflammatory periodontal diseases and dental caries
  • Severe periodontal disease: once plaque gets removed, the bone loss is irreversible
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15
Q

What are the different types of tooth deposits?

A
  1. Acquired pellicle
  2. Materia alba
  3. Food debris
  4. Dental biofilm
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16
Q

Acquire Pellicle

A

A thin film of salivary proteins (glycoproteins) that quickly forms on teeth
- can be removed by coronal polishing with an abrasive agent (e.g. prophy paste)

  • Pellicle begins to form and is fully formed within 30-90 minutes
  • immediate upon exposure to saliva after eruption or after all soft/hard deposits have been removed from tooth surfaces
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17
Q

What is the significance of Pellicle?

A

Plays an important role in the maintenance of oral health:

  1. Protective
    - provide a barrier against acids, impacting remineralization and demineralization
  2. Lubrications
    - keeps surfaces moist and prevents drying, which enhances the efficiency of speech and mastication
  3. Nidus (place) for bacteria
    - participates in biofilm formation by aiding the adherence of microorganisms
  4. Attachment of calculus
    - one mode of calculus attachment
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18
Q

How do you remove pellicle?

A

Pellicle is not resilient (strong) enough to withstand rigorous patient oral self-care

Extrinsic factors that may interfere with pellicle formation and maturation:
1. Abrasive toothpastes
2. Whitening products
3. Intake of acidic foods and beverages

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19
Q

What is materia alba?

A

A soft, whitish tooth deposit that is clinically visible without the application of a disclosing agent.

  • Resembles cottage cheese
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20
Q

What is the composition of materia alba?

A

Materia alba is an unorganized accumulation of:
1. Living and dead bacteria
2. Desquamated (peels of) epithelial cells
3. Disintegrating leukocytes
4. Salivary proteins
5. Food debris

*This differentiates it from organized oral biofilms

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21
Q

How do you remove materia alba?

A

Can be easily removed by the patient or:
- Water spray
- Oral irrigator
- Tongue action

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22
Q

What is food debris?

A

Food remnants after food consumption collected about the cervical third and proximal embrasures of the teeth

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23
Q

What is Dental Biofilm?

A

A dynamic, structured community of microorganisms, encapsulated in a self-produced extracellular polymeric (repeating) substance (EPS) forming a matric around microcolonies

The mouth has a number of environments (teeth, gingival sulcus, attached gingiva, tongue, oral mucosa, lips, hard/soft palate) with their own microbial inhabitants

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24
Q

What are the 5 stages in the formation of biofilm?

A

It begins with the initial attachment of bacterial cells to the pellicle on the tooth surface.

Stage 1 - Formation
Stage 2 - Bacterial Multiplication and colonization
Stage 3 - Matrix formation
Stage 4 - Biofilm growth
Stage 5 - Maturation

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25
Q

What is the composition of dental biofilm?

A

20% - microorganisms and EPS (organic and inorganic solids)
80% - water

Inorganic elements: calcium & phosphorus
Organic elements: carbohydrates, protein

EPS = extracellular polymeric substance

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26
Q

How do you detect dental plaque biofilm?

A
  1. Direct Vision
  2. Use of an explorer or probe
  3. Use of a disclosing agent
  4. Clinical record
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27
Q

What is a calculus?

A

A mineralized dental biofilm

  • Hard, tenacious mass forms on the clinical crowns of natural teeth, dental implants, dentures, and other dental prostheses
  • CANNOT be removed by patient and must be removed by dentist with the use of scaling instruments
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28
Q

Where is supragingival calculus mostly found?

A
  • Lingual surfaces of mandibular anterior teeth
  • Facial surfaces of maxillary 1st & 2nd molars
  • Opposite the opening of the ducts of the submandibular & parotid salivary glands
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29
Q

Where is subgingival calculus located?

A

On the clinical crown apical to the margin of the gingival and extends toward the clinical attachment on the root surface

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30
Q

What is the significance of dental calculus?

A

The surface of calculus is porous and rough and provides an excellent surface on which additional plaque can grow
- Calculus can penetrate into the cementum on root surfaces
- contributing to periodontal disease

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31
Q

What is a dental stain and the significance of it?

A
  • A discolored deposit or area on a tooth that is in contrast with the rest of the tooth colour.
  • Classified as:
    i. Exogenous or endogenous (depending on their source)
    ii. Intrinsic or extrinsic (based on their location)

Identification of the stain origins and locations are needed to develop an appropriate treatment plan.

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32
Q

What is exogenous in dental stain?

A

Stains developed from external sources

i.e. food, beverages, tobacco products, chromogenic bacteria (color-producing bacteria)

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33
Q

What is endogenous in dental stain?

A

Stains developed from within the structure of the tooth

i.e. excessive amount of fluoride during formation of teeth, medications taken (e.g. Tetracycline)

  • cannot be removed by polishing
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34
Q

What is extrinsic stain?

A
  • Stain that occurs on external surface of the tooth
  • May be removed by toothbrushing, scaling, and/or polishing
  • Developed because of the presence of chromogenic bacteria and substances such as tobacco, red wine, tea, coffee, certain drugs, exposure to metallic compounds

*Over time, extrinsic stains may become intrinsic

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35
Q

What is intrinsic stain?

A
  • Stain incorporated within the tooth structure
  • Cannot be removed by scaling or polishing; alternative methods can be used to improve the appearance
  • Result of alteration during tooth development
  • associated with antibiotic use, fever, trauma, infection, ingestion of high amounts of systemic fluoride
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36
Q

What are the different types of extrinsic tooth stains?

A
  1. Green
    - Source: chromogenic bacteria and fungi from poor oral hygiene (often seen in children with enamel irregularities
    - Removal: toothbrushing or lightly polishing (should not be scaled because of underlying demineralized enamel)
  2. Black Stain
    - Source: iron in saliva, iron-containing oral solutions, industrial exposure to iron, manganese, and silver
    - Removal: should be scaled because of its calculus like nature and selectively polish
  3. Black-line stain
    - Source: associated with bacteria and iron in the saliva
    - Removal: scale and polish selectively
  4. Orange stain
    - Source: chromogenic bacteria from poor oral hygiene
    - Removal: scale and polish selectively
  5. Brown stain
    - Source: Tobacco (tars from smoking, chewing, hookah), food, beverage pigments
    - Removal: scale and polishing selectively
  6. Brown stain (chemotherapeutic agents)
    - Removal: scale and polish selectively
  7. Gray/brown-green stain
    - Source: marijuana
    - Removal: scale and polish selectively
  8. Yellow stain
    - Source: oral biofilm
    - Removal: have patient remove stains during toothbrush
  9. Blue-green stain
    - Source: mercury and lead dust
    - Removal: scale and polish selectively
  10. Red-black stain
    - Source: chewing betel nut, betel leaf (found in Western Pacific and South Asian cultures)
    - Removal: scale and polish selectively
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37
Q

What are the different types of intrinsic stains?

A
  1. Dental fluorosis (white-spotted to brown-pitted enamel)
    - Source: excessive fluoride ingestion during enamel development
    - Removal: cannot be removed by scaling or polishing
  2. Hypocalcification (white spots on enamel)
    - Source: high fever during enamel formation
    - Removal: cannot be removed by scaling or polishing
  3. Demineralization (white or brown spots on enamel, may be smooth or rough)
    - Source: Acid erosion of enamel caused by oral biofilm
    - Removal: cannot be removed by scaling or polishing. Recommend daily 0.05% sodium fluoride rinses for remineralization
  4. Tetracycline (grayish brown discoloration)
    - Source: use of tetracyclines during tooth development
    - Removal: cannot be removed by scaling or polishing
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38
Q

What are the uses of a dental mirror?

A
  1. Indirect vision
    - to view tooth surface or intraoral structure that cannot be seen directly
    - e.g. lingual teeth on lower anterior)
  2. Retraction
    - use of mirror to hold patient’s cheek, lip, or tongue so that clinician can view tooth surfaces hidden from view by soft tissue structures
  3. Indirect illumination
    - reflecting surface of the mirror is used to direct light onto tooth surface
  4. Transillumination
    - technique of directing light off of the mirror surface and through the anterior teeth
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39
Q

What is the difference between dental plaque biofilm and calculus?

A

Dental plaque biofilm is the sticky film of bacterial colonies that constantly form on the teeth.

  • If not removed from teeth through regular toothbrushing and flossing, it hardens to create calculus.
  • Calculus cannot be removed by a toothbrush, only by scaling or root planing.
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40
Q

What is the Periodontium?

A

Made up of structures that surround, support, and are attached to the teeth

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41
Q

What is the Periodontium?

A

Made up of structures that surround, support, and are attached to the teeth

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42
Q

What are the structures of the periodontium?

A
  1. Gingivae (gums)
    - covers the alveolar process of jaws and surrounds the necks of teeth
  2. Epithelial attachment
    - tissue is at the base of the sulcus where the gingiva attaches to the tooth
  3. Sulcus
    - space between the tooth and the free gingiva
  4. Periodontal ligaments
    - dense connective fibres that connect the cementum with the alveolar bone of the socket wall
  5. Cementum
    - covers the root of the tooth
    - primary function: anchor tooth to the bony socket with attachments of the PDL
  6. Alveolar bone
    - bone that supports the tooth in its position within the jaw
    - the alveolar socket is the cavity in the bone that surrounds the tooth
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43
Q

What is periodontal disease?

A

An infectious disease process that involves a chronic inflammation of the structures of the periodontium
- initiated by microorganisms in dental biofilm plaque

  • most common dental problem and can progress quite painlessly until you have a real problem
  • over time, bone loss occurs, causing pockets (spaces around teeth, below gumline) to appear that need professional cleaning
  • loss of bone leads to loosening and possible loss of teeth
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44
Q

What are the signs and symptoms of periodontal disease?

A
  1. Red, swollen, or tender gingiva
  2. Bleeding gingiva while brushing or flossing
  3. Loos or separating teeth
  4. Pain or pressure when chewing
  5. Pus around the teeth or gingival tissues
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45
Q

What are the factors that could cause periodontal disease?

A
  • The type of bacteria
  • Length of time bacteria are left undisturbed on the teeth
  • Patient response to bacteria

*Bacteria in biofilm cause inflammation by producing enzymes and toxins that destroy periodontal tissues and lower host defenses

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46
Q

Risk factors for Periodontal disease

A
  1. Smoking
    - smokers have greater loss of attachment, bone loss, tooth loss, calculus formation
  2. Diabetes Mellitus
    - individuals with diabetes are 3x more likely to have attachment and bone loss
  3. Poor oral hygiene
    - lack of good oral hygiene increases the risk for periodontal disease in all age groups
  4. Osteoporosis
    - increased alveolar bone resorption, attachment loss, and tooth loss
  5. HIV/AIDS
    - increased gingival inflammation is noted around margins of all teeth
    - develop necrotizing ulcerative periodontitis
  6. Stress
    - psychological stress is associated with depression of the immune system - link between stress and periodontal attachment loss
  7. Medications
    - decreased salivary flow (xerostomia) can be caused by more than 400 medications
  8. Local factors
    - overhanging restorations, subgingival placement of crown margins, orthodontic appliances, and removal dentures may contribute to the progression of periodontal disease
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47
Q

What are the local contributing factors for periodontal disease?

A

Oral condition that increase an individual’s susceptibility to periodontal disease:

  1. Calculus
  2. Tooth position
  3. Tooth morphology
  4. Occlusion
  5. Poor oral hygiene
  6. Habits
  7. Food impaction
  8. Faulty restorations and appliances
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48
Q

What are the different types of periodontal disease?

A

Periodontal disease includes both gingivitis and periodontitis
- these two basic forms of periodontal disease each has a variety of forms

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49
Q

What are the stages of periodontal disease?

A
  1. Healthy tissues
    - gum is firm, fits tightly to the teeth and does not bleed
  2. Gingivitis
    - gum tissue may be inflamed, swollen, and bleeds easily during brushing, flossing or examination by dentist
    - REVERSIBLE, no bone loss
  3. Early Periodontitis
    - Continued inflammation, loss of gum attachment and bone support
    - Not reversible, bone loss
  4. Moderate periodontitis
    - Supporting gum and bone tissue have deteriorated and tooth loosens
    - Not reversible, bone loss
  5. Advanced periodontitis
    - severe destruction of tissue and bone, causing tooth loss
    - Not reversible, bone loss
50
Q

What are the modifiable risk factors for periodontal disease?

A
  1. Tobacco use
    - greater bone loss and calculus formation
  2. Hyperglycemia (undiagnosed or uncontrolled diabetes)
    - high blood glucose levels can increase susceptibility to infections, including periodontitis or periodontal abscesses
  3. Bacterial plaque biofilm, clinical attachment loss, and age
    - age is also a factor because periodontal attachment loss is cumulative over time
  4. Leukemia
    - significant bleeding attributable to clotting deficiencies
  5. Hyposalivation (Xerostomia) dry mouth
    - associated with more than 500 medications
  6. Malnutrition
    - Vitamin C deficiency (Scurvy) - without adequate foot supply or those with restricted diets
  7. Drug-induced gingival enlargement
    - several categories of drugs (e.g. calcium channel blockers), immunosuppressive drugs, and antiseizure drugs can cause drug-influenced gingival enlargement
51
Q

What are the non-modifiable risk factors?

A
  • Past history of periodontal disease
  • Gender and race
  • Age
52
Q

What is the connection between periodontal disease and cardiovascular disease?

A

Individuals with periodontal disease have a greater incidence of coronary heart disease.

  1. Increased risk of strokes and heart disease
  2. Patients with periodontal disease have 3x the risk for stroke and 3.6x the risk for coronary heart disease
  3. Oral bacteria can easily spread into the bloodstream, attach to fatty plaques in coronary arteries and contribute to clot formation and heart attacks
53
Q

What is the connection between periodontal disease and Preterm/low birth weight?

A
  1. Women with severe periodontal disease have 7x the risk for preterm/low-weight babies (PLBW)
  2. Other risk factions (smoking, alcohol use, drug use) also contribute to PLBW infants
54
Q

What is the connection between periodontal disease and respiratory disease?

A
  1. Individuals with periodontal disease may be at risk for respiratory infection
  2. Bacteria that have colonized in the oral cavity may alter respiratory epithelium, leaving it more susceptible to pneumonia
  3. For patients who already have chronic bronchitis, emphysema, or COPD, existing conditions may be aggravated by inhalation of bacteria from the mouth into the lungs
  4. These bacteria multiply in the respiratory tract and cause infection
55
Q

What are Dental Caries?

A

Tooth decay
- An infectious and communicable disease (worldwide health concern, affecting humans of all ages)

  • The single most common chronic disease in children
56
Q

What are the 2 specific groups of bacteria found in the mouth that are responsible for caries?

A

Caries is a transmissible bacterial that can be passed from parent to child & human to another.

2 groups of bacteria responsible for caries:
1. Streptococcus mutans: disease-producing bacteria found in large numbers within dental plaque

  1. Lactobacilli (LB): typically found in patients with high sugar intake

*Separate of together, they are the primary cause of dental caries

57
Q

What are the stages of caries development?

A

It can take months or years for cavities to develop.

Stages:
1. Incipient caries or incipient lesions occurs when caries begins to demineralize the enamel
2. The overt lesion or frank lesion, is characterized by cavitation (the development of a cavity or a hole)
3. Development of cavitation, with multiple lesions through the mouth = rampant caries

58
Q

Explain the Dental Caries Process

A
  1. The tooth is attacked by acids in plaque and saliva
  2. Calcium and phosphate dissolve from the enamel in the process of demineralization
    - tooth surface will appear opaque, dull, and chalky-white
  3. Fluoride, phosphate and calcium re-enter the enamel in a process called remineralization
    - overtime, the dental caries will continue to a dark brown or black appearance
    - this results in the breakdown or collapse of enamel
59
Q

How to control tooth decay?

A
  1. Diet
    - Limit quantities of sugary and starchy foods, snacks, drinks, and candy (3 snacks per day)
  2. Fluorides
    - help make the tooth resistant to being dissolved by acids
  3. Remove plaque
    - perform thorough brushing and flossing to remove plaque from all tooth surfaces
  4. Saliva
    - neutralizes acids and provides minerals and proteins that protect the tooth
    - after a snack, chew some sugar-free gum to increase the flow of saliva and neutralize acids
  5. Dental sealants
    - an excellent preventive measure to be placed on children and young adults who are at risk for decay
60
Q

What are the different types of tooth surface caries?

A
  1. Pit and fissure caries
    - primarily on occlusal surfaces
  2. Smooth surface caries
    - mesial, distal, facial, lingual
  3. Root surface caries
    - any surface of the exposed root
  4. Secondary or recurrent caries
    - on the tooth structure that surrounds a restoration
61
Q

How do you prevent root caries?

A
  1. Thorough plaque removal with brushing and flossing
  2. Nutritional counseling
  3. Patient education
  4. In-office and/or prescription fluoride products (containing 5000 ppm). Remineralization products that contain calcium phosphate
  5. For patients with xerostomia, stimulate saliva with use of sugarless chewing gum or sugarless candies, or apply saliva substitutes (e.g. gels, sprays, or liquids)

*No one method will be ideal for all patients, so recommendations should be based on the individual patient’s needs and caries risk assessment

62
Q

What is Early Childhood Caries (ECC)?

A
  • An infectious disease that can happen in any family.
  • Many children live with the constant pain of decayed teeth and swollen gums
  • Tooth decay is the single most prevalent disease of childhood
  • Untreated tooth decay in children results in pain and infection
63
Q

Risk Factors for Early Childhood Caries

A
  1. Families of lower socioeconomic status
  2. More common among particular ethnic groups
  3. Families with limited access to care
  4. Areas where there is no water fluoridation
  5. More common among children with special needs
64
Q

What are the contributing factors for Early Childhood Caries?

A
  1. Mother to the child, important for parents to keep their teeth healthy
  2. Allowing a child to sleep with a bottle, there is an increased risk
  3. Avoid sugary and starchy foods
65
Q

List the antibacterial protection from saliva

A
  1. Provides calcium and phosphate for remineralization
  2. Carries topical fluoride around the mouth for remineralization
  3. Neutralizes organic acids produced in plaque biofilm. Discourages the growth of bacteria, inhibiting infection
  4. Recycles ingested fluoride into the mouth
  5. Protects hard and soft tissues from drying
  6. Facilitates chewing and swallowing
  7. Speeds oral clearance of food
66
Q

Erosion

A

Loss of tooth structure by a chemical process that does not include bacterial involvement

  • Chemical dissolution of the tooth by:
    i. chronic vomiting
    ii. diet
    iii. idiopathic
  • Tooth surface appears smooth, shallow, hard and shiny
67
Q

What increases an individual’s risk for dental caries?

A

Risk factors:

  1. Tooth position and morphology
  2. Fluoride
  3. Oral hygiene
  4. Genetics
  5. Diet
  6. Socioeconomic status
  7. Xerostomia
  8. High counts of cariogenic bacteria
68
Q

What are the methods used to detect caries?

A
  1. Dental explorer
  2. Radiographs
  3. Clinical observation (visually apparent)
  4. Indicator dyes
  5. Caries laser detectors
69
Q

How to prevent dental caries?

A
  1. Fluoride
  2. Antibacterial rinses
  3. Decrease fermentable carbohydrates
  4. Increase salivary flow
  5. Oral hygiene
70
Q

What is the Dental Equation?

A

Cariogenic Food Source Ingested + Acidogenic Microorganisms = Acid, Dextrans, Levans

Acid + Susceptible Tooth Surface = Decalcification (1st stage of dental caries process)

71
Q

Dental Probing

A

A technique used to detect periodontal disease by assessing the periodontal tissues

72
Q

Why is it important to review the medical history of patients?

A
  1. Prevent medical emergencies
  2. Treatment planning
  3. Assess if premedication is required
  • A thorough medical history is taken from every patient before dental treatment can proceed
  • Responsibility of the dental team to review medical history, initiate conversation and ask questions to gain greater insight into the patient’s well-being
73
Q

Bacteremia

A

Microorganisms have gained access to the bloodstream

Caused by:
- numerous dental procedures
- including flossing and dental probing

Premedication:
- patients at risk receive antibiotics before any oral tissue manipulation that could cause bacteremia

  • use of subgingival instruments is avoided until level of risk has been assessed and condition has been discussed with patient’s primary care
  • Premedication is required 1 hour before instrumentation begins to ensure adequate blood concentration during and immediately following instrumentation
74
Q

Infective Endocarditis

A

A severe inflammation of the heart valves and supporting structures (the inner lining of the heart (endocardium))
- if not treated quickly, it can lead to life-threatening complications
- Cause: blood borne pathogens that enter into bloodstream (from mouth)

75
Q

Free gingiva

A

The unattached portion of the gingiva that surrounds the tooth

76
Q

Attached gingiva

A

Part of the gingiva that is tightly connected to the cementum on the root and to the connective tissue cover of the alveolar bone

77
Q

Gingival sulcus

A

The space between the free gingiva and the tooth surface

  • A periodontal probe is inserted into this space to access the health of the periodontium
78
Q

What is a pocket?

A

A diseased sulcus

  • Divided into gingival and periodontal pockets to clarify the degree of anatomical involvement
79
Q

Gingival pocket

A

A pocket formed by gingival enlargement without apical migration of the junctional epithelium

  • Also referred to as “pseudo pocket”
80
Q

Periodontal Pocket

A

A pocket formed as a result of disease or degeneration that causes junctional epithelium to migrate apically along the cementum

  • the connective tissue attachment at the base of a periodontal pocket is destroyed
81
Q

What is a calibrated periodontal probe and the functions of it?

A

Periodontal probes are used to determine the health of periodontal tissues

  • Used like a miniature ruler for making intraoral measurements
  • Functions:
    i. Determine the sulcus topography
    ii. Identify gingival bleeding
    iii. Measure the size of an oral lesion
    iv. Aid in the detection of calculus
    v. Identification of root morphology
82
Q

Millimeter Markings on a Periodontal probe

A
  • Working end of a probe is marked in mm intervals
  • There are many different patterns of mm markings
  • Do not assume that all probes have the same pattern of mm markings
83
Q

Williams Probe

A
  • Millimeter markings only at certain intervals
  • Marks are found at:
    1, 2, 3, 5, 7, 8, 9, 10mm intervals
    (missing 4 & 6mm)
84
Q

Colour-coded Probe

A
  • Marked in bands with each band being several mm in width
  • Ex. 3, 6, 9, 12mm
85
Q

Computer Assisted Probe

A

The “Florida Probe” is an example.

86
Q

What should the probing depth be for a healthy sulcus?

A

Between 1 and 3mm

87
Q

What is the probing depth of a diseased sulcus?

A

Deeper than 3mm indicates a periodontal pocket

88
Q

How many sites on a tooth are measured when probing?

A

Measurements are recorded at 6 specific sites around EACH tooth

  • This is because probing depths may vary in a single area (may find a deeper pocket depth in an isolated area)
89
Q

Dental Implants

A

A non-biologic (artificial) device surgically inserted into the jawbone to:
1. Replace a missing tooth
2. Provide support for a prosthetic denture

90
Q

What are the components of a dental implant?

A
  1. Abutment post
    - Titanium post that protrudes through the tissue into the mouth
  2. Implant fixture
    - Portion that is surgically implanted into the bone
  3. The implant abutment post is covered by a prosthetic crown
    - Clinically, it is difficult to recognize that it is an implant
91
Q

Probing Dental Implants

A
  • Location of dental implant should be clearly indicated in the patient chart
  • Implants are made of titanium –> plastic probe should be used so it doesn’t scratch the metal
  • Light probing techniques are used
92
Q

What is a Periodontal Screening and Recording (PSR)?

A

The PSR probe measures 0.5, 3.5, 5.5, 8.5 and 11.5mm intervals

  • This probe is used to complete a periodontal screening in comparison to a comprehensive periodontal examination
93
Q

How many sites on the tooth are recorded for PSR probing?

A

1 code is recorded per SEXTANT

94
Q

PSR Index (Code and Criteria)

A

Code:
0 = healthy periodontal tissues
1 = bleeding after gentle probing; entire colored band of probe is visible
2 = supragingival or subgingival calculus is present; entire colored band of probe is visible
3 = 4-5mm pocket; colored band of probe is partially obscured
4 = 6mm or deeper; colored band on the probe is not visible

  • is placed next to the code given to indicate an abnormality (i.e. bleeding, calculus, restoration overhang, mobility, furcation involvement or recession over 3.5mm)
95
Q

How can we meet the patient’s needs in preventing oral diseases?

A
  • Individualized self-care education is essential in improving and preventing oral diseases
  • Oral hygiene aids and techniques must be considered before providing a treatment plan to our patients
  • Dental assistants must have a comprehensive understanding of oral hygiene education in order to ensure a high quality of patient care
96
Q

What is a disclosing agent and why do we use it?

A

A type of dye that allows patients to see the plaque present on their teeth
- Plaque is not always visible on teeth and therefore patients may not know they have it

  • Available in tablet or liquid form
97
Q

Purposes of Disclosing Agents

A
  1. Provides individualized instruction in self-care in the locations of soft deposits and the techniques for its removal
  2. Assists the patient in evaluation of their plaque biofilm removal skills
  3. It allows clinicians to also evaluate their plaque control procedure techniques (coronal polishing)
98
Q

What are the procedures of disclosing agents?

A
  1. Review medical history to ensure no contraindications are present (allergies to flavors or dyes)
  2. Follow manufactures instructions for application
  3. Dry teeth with gauze or air (air/water syringe)
  4. Place Vaseline on lips, labial mucosa and white or porcelain restorations
  5. For liquid: paint teeth with cotton tip applicator
  6. For tablets (teeth not dried before): have patient chew tablet, swish and spit. Rinse
  7. Record findings
99
Q

What is an Oral Hygiene Index?

A

A record of the presence of plaque on the surfaces of the patient’s teeth

  • An index is a way to measure a clinical condition/observation in numerical values
  • Plaque Biofilm Control Record (PCR)
  • Simplified Oral Hygiene Index (OHI-S)
100
Q

Plaque Control Record (PCR)

A
  • Draw a line through missing teeth
  • Place disclosing agent or explore
  • Assess surfaces and record which surfaces have plaque
  • Calculate plaque score
101
Q

How do you calculate Plaque Control Record score (PCR)?

A
  • Count total number of plaque containing surfaces
  • Count total number of available surfaces (4 per tooth - do not include occlusal)
  • Multiply by 100 to get plaque score percentage

# of surfaces with plaque / # of total surfaces x 100

102
Q

Simplified Oral Hygiene Index (OHI-S)

A
  • 6 teeth are scored (1 per sextant)
  • Scoring is from 0-3 based on tooth surfaces covered by debris
103
Q

How do you calculate Simplified Oral Hygiene Index (OHI-S)?

A

Add up the scores on the tooth surface and divide by 4 or total number of teeth measured.

e.g.
Scores are 2, 1, 1, 2 for buccal, lingual, mesial, distal respectively (4 tooth surfaces were measured)
2 + 1 + 1 + 2 / 4 = 1.5

104
Q

Purpose of Toothbrush

A
  • Toothbrushing is the most recommended and performed oral hygiene behavior
  • Helps to prevent oral disease, maintain esthetics, and prevent halitosis (bad breath)
  • Primary action: involves mechanical removal of plaque biofilm
  • Delivers chemotherapeutic agents to the tooth surfaces (ex. fluoride in toothpaste)
105
Q

Manual Toothbrushes

A
  • Soft-bristled brushes are recommended
  • Nylon bristles are preferred because their ends are rounded
  • Should be replaced 8-12 weeks or when bristles are worn
106
Q

General design of manual toothbrushes

A
  1. Handle
    - part grasped in the hand
    - durable, impervious to moisture, low cost, east to grasp, variety of sizes
  2. Shank
    - section that connects the handle and head
    - a twist, curve, or offset angle may help with adaptation
  3. Head
    - working end; consisting of tufts of bristles or filaments (synthetic, rounded ends)
    - adjusted to size of patient’s mouth
107
Q

How do we want our manual toothbrush?

A
  1. Conform to individual patient requirements
  2. Be easily and efficiently manipulated
  3. Be readily cleaned and impervious to moisture
  4. Be durable and inexpensive
  5. Have prime functional properties of flexibility and softness of bristles and strength and rigidity of the handle
  6. Have round-ended bristles
108
Q

Bristles and Filaments Characteristics

A

i. Bristle length (proper amount of flexibility)
- too long = inadequate cleaning
- too short = stiffer and less flexibility

ii. Diameter of bristle
- greater than 0.075mm = medium to hard range
- thinner filaments are softer and more resilient

iii. Number of filaments in a tuft
- increased density = added support = increased feeling of stiffness

iv. Angle of filaments
- angled may be more flexible and less stiff

109
Q

Benefits of Soft Nylon Brush

A
  • More effective in cleaning cervical areas
  • Less traumatic to tissue
  • Can be directed into the sulcus
  • Toothbrush abrasion and/or recession prevented or lessened
  • More effective for sensitive gingiva
110
Q

What are the different types of specialty toothbrushes?

A
  1. Orthodontics brush
    - brushes for use over orthodontic appliances
  2. Post-operative brush
    - ideal for post operative cleaning after extractions, implants or grafts
  3. Colis Curve
    - Brushes 3 sides at once
  4. Children’s toothbrushes
    - variety of sizes and colours
111
Q

Power Toothbrushes Benefits

A
  • Equivalence between manual and power toothbrushes in plaque biofilm removal
  • Rotating oscillating power toothbrushes are most effective
  • Recommended for all patients (but cost may have impact)
  • Useful for patients with oral health challenges:
    i. failed attempts at traditional brushing methods
    ii. orthodontic treatment
    iii. complex restorative treatment
    iv. dental implants
    v. aggressive brushers
    vi. patient’s with disabilities or limited dexterity
    vi. patient’s that require a caregiver to brush for them
112
Q

How do you select toothbrushes?

A

Depends on:
- patient ability
- gingival health and anatomical morphology
- position of teeth
- patient compliance

113
Q

Explain improper brushing

A
  • Every patient should be cautioned about damage that may be caused by vigorously scrubbing teeth with any toothbrush
  • Over time, this may cause abnormal abrasion (wear) of tooth structure, gingival recession and exposure of root surface
114
Q

List the different types of toothbrushing methods

A
  1. Fones
  2. Rolling Stroke
  3. Modified Bass
  4. Modified Stillman
  5. Charters
115
Q

Why do we have different toothbrushing methods?

A
  • Individualize treatment
  • Patient specific techniques
  • Dexterity
  • Age
  • Motivation
  • General oral condition
116
Q

Fones Toothbrushing Method

A
  • Circular method
  • Usually for young children, toddlers and for patients with decreased dexterity
  • Circular motion
  • Bring anterior teeth end to end emphasizing to get all teeth (with children)
  • For lingual surfaces, we do an “in-and-out” stroke
117
Q

Rolling Stroke Toothbrushing Method

A
  • Cleaning gingiva, removal of dental plaque, materia alba and food debris from teeth without focusing on sulcus
  • Place brush apically close to attached gingiva and apply slight pressure and roll down or up
  • Usually used in combination with another technique
118
Q

Modified Bass Toothbrushing Method

A
  • Most widely accepted method for plaque removal adjacent and directly below gingival margin
  • Removal of dental plaque at cervical third
  • Brush is placed at 45 degrees apically with 1-2 bristle rows directed into the sulcus very gently
  • Vibrate brush back-and-forth for 5-10 strokes without removing the brush tips from sulcus
  • Roll down or up after vibration
119
Q

Modified Stillman Toothbrushing Method

A
  • Ideal for individuals that have recession
  • Removes plaque and massages gingiva
  • Bristles help at 45 degrees apically and partly on the attached gingiva
  • Flex bristles so tissues blanch slightly
  • Vibrate gently, keeping tips of bristles in position
  • Roll down or up after vibration
120
Q

Charters Toothbrushing Method

A

Used for:
- Patients receiving orthodontic treatment
- Patients with prosthetic appliances
- Individuals with severe loss of interdental papillae height

121
Q

What are some unusual conditions that could impact toothbrushing?

A
  1. Acute inflammation or a traumatic lesion
    - patients should be instructed to brush all areas of mouth that are not affected; resume regular oral hygiene asap
  2. After periodontal surgery
    - patients may be instructed to brush only the occlusal surfaces and to use very light strokes over the dressing
  3. After dental extractions
    - patients are usually instructed to avoid the surgical site, but to brush the other teeth as per usual
  4. After dental restorations
    - most often, patients are instructed to brush all areas of their mouth normally
122
Q

Benefits of Tongue cleaning/brushing

A
  • Many organisms are present on our tongues
  • Brushing the tongue:
    i. slows formation of biofilm
    ii. reduces the number of microorganisms
    iii. reduces halitosis
    iv. contributes to overall cleanliness
    v. helps improve issues with: xerostomia, coated tongue issues, deep fissures, tobacco product use

DA (Can) (21 decks)

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