Preventive Procedures - Midterm Learning Objectives Flashcards
1.1 Review definitions and concepts related to an oral prophylaxis (Part 1)
Dental Caries: It is a disease of the hard (calcified) tissues of the tooth, also referred to as a cavity or tooth decay.
Oral: Pertaining to the mouth. Oral health – the health of one’s teeth and mouth.
Periodontal Debridement: Removal of all debris (plaque biofilm, stain, and calculus) from the crowns and roots of the teeth.
Periodontal Disease: It includes a variety of inflammatory and degenerative diseases involving the supporting tissues of the teeth.
Preventive Dentistry. The practice of caring for your teeth to keep them healthy; this can include the use of fluoride, application of dental sealants, proper nutrition, and plaque control to the prevention of disease.
Practice: To perform and/or provide skills or procedures.
Prophylaxis: pertains to the prevention of disease.
Registered: A term used by some provincial dental assisting regulatory bodies. In Alberta registration is mandatory when a person meets the requirements for registration (complete a dental assisting education program, completed National Board requirements or meet labour mobility requirements, have current practice and demonstrates good character) and intends to provide dental assisting services directly to the public
1.1 Review definitions and concepts related to an oral prophylaxis (Part 2)
- Scaling*
It is a procedure in which calculus (hard dental deposits), dental plaque, and some extrinsic (outer) stains are scraped (cleaned) off the teeth with specific dental instruments called scalers and curettes. Only dental assistants who have received additional training may perform scaling.
- Root Planing
It is a procedure done to smooth the tooth root to remove any remaining calculus and bacterial toxins.
- Curettage
Gingival curettage is a surgical procedure designed to remove the soft tissue lining of the periodontal pocket with dental instruments (curettes) to remove the diseased tissue.
The theory behind the use of gingival curettage in the treatment of periodontal disease is that it removes the diseased tissue, reducing the inflamed tissue and allowing the tissue to heal and reattach to the tooth. However, studies have shown that no new attachment occurs and that the results do not differ when only scaling and root planing procedures are done (American Academy of Periodontology, 2002).
Scaling, root planing, and curettage are traditional procedures performed to treat periodontal diseases. In recent years antimicrobial mouth rinses, antibiotics, and the use of lasers have been introduced to supplement these traditional procedures.
- Coronal polishing
Coronal polishing is a cosmetic procedure used to remove extrinsic (outer) stains from the enamel surfaces of the teeth.
Research has shown that coronal polishing is a non-essential cosmetic procedure (Gutkowski, 2001). Instead of polishing the teeth, instruction in oral hygiene techniques can help reduce the buildup of dental plaque biofilm, and dental stains.
Selective coronal polishing is a procedure in which only those teeth or surfaces with visible, extrinsic stains are polished. Selective polishing minimizes enamel being worn away by the abrasives in the polishing paste that is used to remove the stain and allows the patient to realize the importance of maintaining good oral hygiene.
Dental flossing is the best way to ensure that bacterial plaque is removed from between the teeth. Neither the polishing procedure nor a scaling instrument can completely clean the tight contact areas between the teeth.
- Topical fluoride application
Once deposits are removed from the teeth, an optional fluoride treatment can be provided for the patient to help prevent tooth decay and sensitivity.
Fluoride will be discussed in further detail in Outcome 6.
1.2 Compare soft deposits.
- Acquired Pellicle - thin film of protein that quickly forms on teeth. It can be removed by coronal polishing with an abrasive agent such as a prophy paste
- Dental Plaque (often called dental biofilm in current literature) - Dento-biofilm, or simply biofilm, is a thick, sticky layer of bacteria that builds up on the teeth and gums.
- Materia Alba - soft mixture of bacteria and salivary proteins also known as white material. It is visible without the use of a disclosing agent and is common in individuals with poor oral hygiene.
- Food Debris - pieces of food stuck in teeth
1.3 Describe hard tooth deposits.
Calculus, or dental calculus, is a hard, calcified deposit that sticks firmly to teeth, restorations, and dental appliances. It’s a significant cause of periodontal disease because it harbours bacteria. Controlling bacterial plaque is crucial to prevent calculus formation. Once present, calculus provides a surface for more plaque, pellicle, and additional calculus to form, leading to a cycle of buildup, gum inflammation, and the progression of periodontal disease.
Difference Between Dental Plaque Biofilm and Calculus - Dental plaque biofilm is a sticky film of bacteria that constantly forms on teeth. If not removed by regular brushing and flossing, it hardens into calculus. Unlike plaque, calculus cannot be removed with a toothbrush and requires professional cleaning by scaling or root planing.
1.4 Determine classifications of tooth stains.
Stains on teeth happen when coloured materials stick to the surfaces or get absorbed into the tissues of the teeth.
Types of Stains by Location:
Extrinsic Stains:
Found on the surface of the tooth.
Can be removed by brushing, rinsing, or professional cleaning.
Intrinsic Stains:
Located within the tooth.
Hard or impossible to remove with polishing.
Types of Stains by Source:
Exogenous Stains:
Originate from outside the body.
Appear on the external surface of the tooth.
Endogenous Stains:
Originate from inside the body.
Develop within the tooth structure.
Categories of Stains:
Exogenous Extrinsic Stains:
Caused by external factors like food, drink, or smoking.
Appear on the exterior of the tooth and can be removed.
Endogenous Intrinsic Stains:
Caused by factors inside the body, such as certain medications.
Become part of the tooth structure and cannot be removed.
Exogenous Intrinsic Stains:
Caused by external factors but become embedded within the tooth.
Hard to remove and require professional treatment.
2.1 Describe the tissues of the periodontium.
Each tissue plays a vital role in maintaining the health and function of the periodontium.
Gingiva
Provides a protective seal around the neck of the tooth.
Periodontal Ligament
Suspends and holds the tooth in its socket.
Cementum
Anchors the periodontal ligament fibers to the tooth, keeping it in the socket.
Protects the root dentin.
Alveolar Bone
Surrounds and supports the tooth roots.
2.2 Describe the periodontal diseases process.
Periodontal Disease Process:
Dental Plaque (Biofilm):
Bacteria in plaque are necessary for PD to start.
Host Response:
The body’s reaction to bacteria, known as the host response, leads to tissue damage.
The interaction between bacteria and the host response causes tissue destruction.
Understanding the difference between health, gingivitis, and periodontitis is essential.
Types of Periodontal Disease:
Gingivitis:
The mildest form of PD causes gum inflammation without attachment loss.
Symptoms include red, swollen gums that may bleed but usually cause little discomfort.
Gingivitis is reversible with professional care and good oral hygiene.
Periodontitis:
A severe bacterial infection affects the gums, periodontal ligament, bone, and cementum.
The damage is irreversible, leading to periodontal pockets and tooth loss if untreated.
It starts as gingivitis and progresses when toxins from plaque cause a chronic inflammatory response, destroying tissue and bone.
Forms of Periodontitis:
Aggressive Periodontitis:
Occurs in otherwise healthy patients.
Characterized by rapid attachment loss and bone destruction, often seen in families.
Chronic Periodontitis:
The most common form, leading to inflammation, attachment loss, and bone loss.
Prevalent in adults but can occur at any age, with slow but sometimes rapid progression.
Necrotizing Periodontal Disease:
Causes tissue and bone death.
Common in individuals with systemic conditions like HIV, malnutrition, and immunosuppression.
2.3 Identify factors that contribute to the development and progression of periodontal disease.
Systemic Contributing Factors - These are conditions or habits that make a person more prone to periodontal disease:
Tobacco Use: Smoking or chewing tobacco increases the risk of periodontal disease.
Diabetes: People with diabetes are more susceptible to gum infections.
Osteoporosis: This condition weakens bones, which can affect the jawbone supporting the teeth.
Psychosocial Stress: High-stress levels can impact oral health.
AIDS: This condition weakens the immune system, making gum infections more likely.
Systemic Medications: Some medications can affect oral health.
Hormone Changes: Hormonal changes during puberty, pregnancy, and menopause can increase the risk of periodontal disease.
Genetics: Some people may be genetically predisposed to periodontal disease.
Nutritional Deficiencies: Lack of essential vitamins and minerals can weaken the immune system, making it harder to fight infections. Obesity may also be linked to an increased risk of periodontal disease.
Age: Older adults are more likely to have periodontal disease, often due to cumulative damage over time.
Local Contributing Factors - These are conditions within the mouth that increase the risk of periodontal disease:
Dental Calculus: Hardened plaque on teeth can make it harder to maintain good oral hygiene.
Tooth Shape and Surface: Irregularities on teeth can trap plaque.
Untreated Tooth Decay: Cavities can increase the risk of gum disease.
Poor Oral Hygiene: Not brushing and flossing regularly allows plaque to build up.
Trauma from Occlusion: Misaligned bites can cause damage to gums and teeth.
Food Impaction: Food stuck between teeth can contribute to plaque buildup.
Parafunctional Habits: Actions like clenching or grinding teeth can harm the gums and teeth.
Faulty Restorations and Appliances: Poorly fitted dental work can cause irritation and plaque accumulation.
Mouth Breathing: Breathing through the mouth can dry out the gums, making them more prone to infection.
Tongue Thrust: Pressing the tongue against teeth can damage the gums.
2.4 Describe the dental caries process.
How Do Dental Caries Develop?
Dental caries occur when bacteria in plaque produce acids that dissolve the minerals in teeth. This process is influenced by factors like diet, saliva, and fluoride. The balance between harmful factors (bacteria and sugars) and protective factors (saliva, fluoride) changes throughout the day.
Essential Factors for Dental Caries:
Susceptible Tooth: Any tooth can get cavities, but teeth with fluoride are less likely to decay.
Acid-Producing Bacteria: Bacteria like Streptococcus mutans produce acid from sugar and contribute to decay.
Cariogenic Foods: Foods high in sugar that bacteria can ferment into acids increase the risk of cavities.
Other Factors:
Time: Acid from plaque forms quickly after eating and can last for 15-20 minutes, leading to decay if not neutralized by saliva.
pH Levels: Acid lowers the pH in the mouth, starting to damage teeth if it drops below 5.5.
Sticky Compounds: Substances like dextrans and levans in plaque make it stickier and harder to clean.
Patient Education: Regular plaque removal and reducing sugary foods are key to preventing cavities.
Types of Dental Caries:
Pit and Fissure Caries: Found in the grooves of back teeth and on the tongue side of front teeth.
Smooth Surface Caries: Occur on flat tooth surfaces and along the gum line.
Root Surface Caries: Develop on the roots of teeth.
Secondary or Recurrent Caries: Occur around existing dental work.
Early Childhood Caries (ECC): Affects young children’s primary teeth and can lead to severe complications.
Dental Caries vs. Dental Erosion: Dental erosion is different from caries. It’s the loss of tooth tissue caused by acids not produced by bacteria, such as those in certain foods and drinks. Erosion can also be caused by vomiting or acid reflux. Unlike caries, which are influenced by bacterial acids, erosion is caused by dietary acids. Both conditions can lead to significant tooth damage and require careful management.
2.5 Explain the role of saliva in oral health.
How Saliva Protects Your Teeth:
Physical Protection: Saliva helps wash away sugars and food particles from your mouth, which helps reduce the buildup of plaque.
Chemical Protection: It neutralizes and buffers the acids produced by bacteria in plaque, helping to prevent tooth decay.
Antibacterial Protection: Saliva contains substances that kill bacteria, helping to reduce harmful bacteria in the mouth.
Saliva Characteristics Affecting Tooth Decay:
Viscosity (Thickness): Thin, Watery Saliva: This type helps rinse away food debris and reduces plaque formation.
Thick, Mucous Saliva: This type can trap food particles, making it easier for plaque to form on your teeth.
Quantity (Amount):
Low Saliva Flow (Xerostomia): When there isn’t enough saliva, you’re more likely to get cavities because your mouth has less natural protection against acids. Xerostomia can result from things like radiation therapy or certain medications.
High Saliva Flow: More saliva helps maintain a neutral pH in your mouth, which supports the repair of tooth enamel.
2.6 Explain the role of contributing host factors that influence the dental caries process.
Here’s what can increase your risk of getting cavities:
- Tooth Position and Shape:
Crooked Teeth: Teeth that are misaligned can trap food and plaque, making them more prone to decay.
Open Spacing: Teeth with gaps between them are less likely to get cavities.
Surface Types: The chewing surfaces of teeth have grooves and pits that are hard to clean. Areas between teeth are also tough to reach with a toothbrush.
Exposed Roots: When gums recede, the roots of teeth can be exposed and are more vulnerable to decay because they are softer than the enamel. - Fluoride:
Benefits: Fluoride helps prevent cavities by making teeth stronger and more resistant to decay. It works in three main ways:
After Teeth Erupt: Helps repair early signs of decay and prevents bacteria from producing acid.
Before Teeth Erupt: Makes teeth more resistant to acid by incorporating fluoride into the tooth structure.
Silver Diamine Fluoride (SDF): A fluoride solution used to stop cavities and reduce tooth sensitivity. - Oral Hygiene:
Brushing and Flossing: Regular brushing and flossing are crucial. Many people don’t brush or floss consistently or correctly.
Statistics: About 73% of Canadians brush their teeth twice a day, but men and those from lower-income families are less likely to do so. - Genetics:
Family Factors: Family history can influence the risk of decay, but environmental factors like diet and oral hygiene play a bigger role. - Diet:
Sugars and Carbs: Foods high in sugar and carbohydrates can lead to decay. The type of food (e.g., sticky candies vs. liquid sugars) and how long it stays in your mouth affect decay risk.
Frequency of Eating: Frequent eating of sugary or starchy foods increases the risk of cavities. Foods high in calcium and phosphate, like cheese, can help protect teeth. - Socioeconomic Status:
Income and Education: People with lower incomes or less education tend to have more cavities, often due to differences in access to dental care and health education. - Dry Mouth (Xerostomia):
Causes: Dry mouth can be caused by certain medications, medical conditions, or treatments like radiation. This reduces the protective effects of saliva, increasing the risk of decay. - Cariogenic Bacteria:
Bacteria: Certain bacteria, especially streptococcus mutans, are known to cause tooth decay. High levels of these bacteria increase the risk of cavities.
3.1 Discuss the importance of the patient’s medical and dental history in relation to dental probing procedures.
Medical History and Dental Probing: Before performing any oral examination involving periodontal probing, it is essential to review the patient’s medical history. This is because probing involves manipulating the soft tissues around the teeth, and it may not be safe until it is determined if antibiotic premedication is necessary.
Premedication Considerations:
Transient Bacteremia: During dental probing, temporary bacteria in the bloodstream can occur. For patients with certain heart conditions, joint replacements, or weakened immune systems, this can be risky.
Consultation: It may be necessary to consult with the supervising dentist and dental hygienist to assess the risk and decide if premedication is required.
Importance of Medical History:
Pre-medication Needs: Alert the dental team if a patient requires antibiotics before treatment.
Treatment Complications: Identifies any medical conditions or medications that might complicate or affect dental treatment.
Medical Emergencies: Helps in planning for potential medical emergencies.
Special Needs: Highlights any special treatment requirements.
3.2 Differentiate between a normal sulcus and a periodontal pocket.
Healthy Periodontium: In a healthy periodontium, the tooth is surrounded by the gingival sulcus. The junctional epithelium (JE) attaches to the tooth near the cemento-enamel junction (CEJ) and forms the base of the sulcus. The depth of a healthy sulcus ranges from 1–3 mm.
Periodontal Pocket: A periodontal pocket occurs when the gingival sulcus deepens due to periodontal disease. In this case, the JE attaches to the tooth root below the CEJ, resulting from the destruction of the alveolar bone and periodontal ligament fibers that support the tooth.
Measuring Pockets: A pocket is essentially a diseased sulcus. To assess and measure sulcus and pocket depths, a calibrated periodontal probe is used. The measurement is taken from the base of the pocket (or diseased sulcus) to the gingival margin.
Complete Measurement: Since the pocket or sulcus extends around the entire circumference of the tooth, measurements must be taken all around the tooth. Probing depths can vary between different areas of the same tooth.
3.3 Identify characteristics of a calibrated periodontal probe.
What Are Dental Probes? Dental probes are thin, slender instruments with a calibrated tip that allows for precise measurement. They often have a series of markings or bands along their length to measure the depth of the gum pockets around the teeth.
Why Are Dental Probes Used?
Measuring Pocket Depths:
Purpose: To measure the depth of the space (sulcus or pocket) between the gum and the tooth.
Importance: Helps determine if there is gum disease, as deeper pockets can indicate periodontal issues.
Assessing Gum Health:
Purpose: To evaluate the health of the gums and detect signs of inflammation or infection.
Importance: Early detection of gum disease can prevent further damage and tooth loss.
Identifying Periodontal Disease:
Purpose: To help diagnose periodontal disease by measuring changes in gum tissue and bone levels.
Importance: Accurate diagnosis allows for appropriate treatment planning.
Monitoring Treatment Progress:
Purpose: To track the effectiveness of periodontal treatments and observe improvements or worsening conditions.
Importance: Ensures that treatments are working and adjusts care plans as needed.
Detecting Gum Recession:
Purpose: To measure the amount of gum recession from the tooth’s surface.
Importance: Helps in understanding the extent of gum damage and planning corrective treatments.
3.4 Discuss probing depth measurements.
Probe Depth: A probe depth measures how deep a gingival sulcus or periodontal pocket is. To find this, use a calibrated periodontal probe to measure the distance from the gingival margin (where the gum meets the tooth) to the base of the sulcus or pocket.
Recording Probe Depths - Measurement Sites:
Six Sites per Tooth: Measure probing depths at six specific sites around each tooth:
Mesio-facial, Mid-facial, Disto-facial
Mesio-lingual, Mid-lingual, Disto-lingual
One Reading per Site: Record only one depth measurement per site. If there are variations in depth within a site, use the deepest measurement.
Full Millimeter Measurements: Record measurements to the nearest full millimeter. For instance, if you measure 3.5 mm, record it as 4 mm.
How to Read the Probe: Measure from the gingival margin to the base of the pocket.
Count the millimeters visible on the probe above the gingival margin.
Subtract this number from the total millimeters marked on the probe.
If the gingival margin is between two probe markings, use the higher mark for your reading.
