Restorative 2 Flashcards
what is the ‘Gate Control Theory’?
- melzack and wall 1965
- possible explanation of how pain can be modulated in the spinal cord and physiological, pyschological and sociolocultural factors contribute to the experience
What pain index is often used for adults?
- McGill pain index
- numbers
what pain index is often used for children?
- Wong-Baker pain index
- smiley faces
What is a placebo?
-An inert medicine given for its suggested effects, but has no pharmacological benefits but can have psychological benefits
what word should be avoided when doing treatment?
-oain
how can anxiety be reduced?
- initial explanation of things
- calm and instruct the patient to be calm
- warn the patient if there is any discomfort to be expected
- give the pt control and help them to cop (eg. breathing exercises)
- distract them
what is the aim of analgesia?
- elimination of pain
- reduction of haemorrahe
what is the physiology of a nerve?
eg. ….-……-……
-dentride-cell body-axon
What are two parts of a nerve that contribute to conduction?
- nodes of ranvier
- end feet synapse
what are 4 pain producing substances that are produced by injured tissue?
- potassium
- sodium
- chloride
- calcium
what are the 4 phases of physiological conduction?
1-polarisation
2-depolarisation
3-action potential
4-repolarisation
what happens in the polarisation stage (1st stage) of physiological conduction?
- NO pain
- pottasium inside the cytoplasm and sodium outside
what happens in the depolarisation stage?
- ionic exchange
- pottasium now higher concentration outside the cell and sodium now higher inside the cell
what stage of physiological conduction is the same as ‘resting’?
-polarisation is the same as resting as there is now pain
what are the 6 contents of LA?
-LA agent
-vasoconstrictor
-reducing agent
-preservative
-fungicide
-climbing
(Long Vales Reduce People From Climbing)
what is the gold standard LA?
-lidocaine
what is prilocaine less effective at?
-less effective in controlling haemorrhage
what is articaine useful for?
-repeat injections
what are 3 advantages of using epinephrine?
- more profound anaesthesia
- longer lasting
- haemostasis
is felypressin better or worse at haemorrhage than epinephrine?
-felypressin is not as good at haemorrhage as epinephrine
what are some precatutions required for safe analgesic?
- good pt cooperation
- enrolled with GDC
- written/signed prescription
- needle guards
- sharps boxes
- self aspirating syringe
- MH checked and updated at each dental visit
how may toxicity due to LA occur?
-IV injection
if a pt shows signs/symptoms of allergy to LA who should they be referred to?
-dermatologist
what LA is latex free?
-citanest
how many LA cartridges is max. for cardiac pt’s?
-3
what is the dose needed of LA to induce labour?
100 cartriges
what nerve are you aiming for when you anaesthatise the apex of 12?
-anterior superior alveolar nerve
can therapists carry out indirect restorations?
-no. therapists can only carry out direct restorations
what does the word ‘onlay’ mean?
-overlying the cusps of the teeth
what is attrition?
-tooth to tooth surface lost
what is abrasion?
- abrasion from a foreign object in the mouth
what is erosion?
-acid causes tooth loss
what is abfraction?
- loss of tooth due to flexural forces
- stress from occlusal overload
what is micro-preperation?
-hand pieces and burs of reduced size keep cavity to a minimum
what is sonic preperation?
-handpiece’s work by vibration rather than rotation
what is ‘air abrasion’?
-spray aluminium oxide particles through a fine angled nozzle
what are some advantages of air abrasion?
- no LA required
- preservative
- quite
what are some disadvantages of air abrasion?
- lots of contamination
- irritates asthma
- expensive
what can lasers remove?
-soft and hard tissue
what is meant by ‘ozone’?
- new concept
- where bacteria in caries is identified with a laser and it delivers ‘active’ oxygen molecules through suction cup to desired area
- this kills certain types of cariogenic bacteria
what are some disadvantages to ‘ozone’?
-not much scientific research been done about it
what is Atraumatic Restorative Treatment (ART) ?
-hand excavaion, restore with GI
what are some advantages of ART?
-ideal for under developed countries and for very nervous patients
what are some disadvantages of ART?
-often not all the caries is removed
do you take maxillary or mandibular impressions first?
-mandibular
what are the 6 steps to taking impressions?
1-prepare the patient
2-assemble the materials and equipment
3-select and prepare the impression trays
4-take mandibular impression
5-take maxillary impression
6-take the interoclussal record for occluding the casts
to prevent cross contamination of the impressions. what is done to stop this?
-disinfection
what disinfection material is used in DDH?
-‘Artichlor’
what is another name used fr the ‘interocclusal record’?
-the wax bite
who classified cavity preperations?
-Greene Vardiman Black (GV Black)
what is GV Black class 1?
-occlusal surfaces of molars and premolars, buccal pits of molars
what is GV black class 2?
-approximal surfaces of molars and pre molars
what is GV Black class 3?
-approximal surfaces of incisors/canines
what is GV Black class 4?
-icisal edges of incisors and canines
what is GV Black class 5?
-cervical margins of teeth
what are some disadvantages of blacks classification?
- was used before adhesive materials were available, therefor retentive cavities needed to be cut
- removes more tooth substance than necessary
- does not include root or secondary caries
what are 6 principles relating to cavity preperation?
what steps do you do…
- Outline form
- resistance form
- retention form
- tx of residual caries
- correction of enamel margins
- cavity debridement
what is outline form?
-gaining access to the caries
what is resistance form?
- to resist occlusal forces
- make sure cavity floor is at right angle to the direction of occlusal forces
what is retention form?
-designs to retain the material in the cavity
what are some forms of retention?
- ‘grooves’ in wall of cavity
- use of undercuts and occlusal key
- use of acid etch and bonding agents
- dentine pins (therapists cannot use these)
what happens in the stage ‘treatment of residual caries’?
-removing caries from the enamel-dentine juntion first (peripheries) then moving onto the base of the cavity
when is firm but stained dentine removed?
-only on anterior teeth if it shows through the enamel
what happens in the stage ‘correction of enamel margins’?
unsupported enamel is weak and prone to fracture
-sometimes a bevel to increase surface area for bonding
what happens in the stage ‘cavity debridement’?
-cavity should be thoroughly washed and dried to remove debris and bacteria
what is line angle?
-where two surfaces meet
what is cavosurface angle?
where the cavity wall meets the surface (90-110 degrees)
what is another name used for hidden occlusal caries?
-occult caries
what is the technique for doing sealant restoration?
exam Q last year
- take occlusal registration(outline form)
- remove caries
- add lining if necessary
- acid etch, prime and bond to cavity walls and margins
- build up cavity with comp. resin
- apply acid etch to remaining fissures
- thoroughly wash acid etch of fissures
- apply fissure sealant to remaining fissures
- check occlusion
what is technique for conventional restoration?
- occlusal registration (outline form)
- remove caries
- apply lining if necessary
- acid etch, prime and bond
- restore with 2 mm increments of composite
- finish with polishing burs or one gloss
- check occlusion
what must always be checked after doing a restoration?
-occlusion must always be checked after doing a restoration
if a cavity is within 2 mm of pulp do you need a lining?
-yes
if cavity is 0.5mm or less close to the pulp what do you do?
-dycal and GI
what is dycal?
-calcium hydroxide
what are some disadvantages of tunnel preperation?
- technically difficult
- marginal ridge is prone to fracture
- not always good access to caries at ADJ
what is root caries usually filled with?
-GI
cervical caries is a sign of what?
-high caries risk
what are some risk factors for root caries?
- xerostomia
- repeated carbohydrate rate intake
- partial denture wearing
- poor OH
- high caries experience
- high salivary counts of S.mutans and lactobacilli
what are 3 functions of fissure sealant?
- prevent caries
- eradicate fissures
- aid cleaning
what are the 3 different etching patterns?
type 1: -prism core removed, peripheral material left
type 2: -prism core remains intact, peripheral regions removed
type 3: -haphazard effect. does not work very well
what is bruxism?
-involves grinding and clenching of the teeth
what are some signs and symptoms or bruxism?
- abnormal rate of attrition
- TMJ pain
- hypertrophy of masticatory muscles
- pulpal sensitivity to cold
what are the 4 different types of abrasion?
1-cervical abrasion
2-habitual abrasion
3-iatrogenic abrasion
4-industrial abrasion
what are some signs of erosion?
- palatal chipping of incisal edges
- smoothed and polished surfaces
- ‘proud’ restorations
- cupping of lower molar cusps
what are some examples of extrinsic erosion?
- acidic foodstuffs
- sucking citrus fruits
- swimming in heavy chlorinated water
what are some examples of intrinsic erosion due to reflux?
- hiatus hernia
- gastric ulceration
- alcohol abuse
- gastro oesophageal reflux
- stress reflux syndrome
what are some examples of intrinsic erosion due to vomitting?
- pregnancy
- bulimia
what are some clinical signs of bulimia?
- normal body weight
- erosion of palatal surfaces of upper teeth
- lesions on palate, fingers, oral mucosa, lips
- signs of malnutrition
what does NCTTL stand for?
Non-carious tooth tissue loss
what 3 things do you protect the pulp from?
- thermal attack
- chemical attack
- galvanic effects
what is galvanic shock?
metal on metal with no insulation. Electrolytes occurs due to saliva
cavity preperation ‘insults’ the pulp. This results in what?
increased inflammatory cell infiltrate
what does the ‘smear layer’ do?
occludes the dentinal tubules
what are some features of the ideal pulp protector?
- non toxic
- non irritant
- bacteriostatic
- gives good coronal seal
- thermal/electrical insulator
- strength to withstand restoration placement
- radiopaque
- obtundant
what are some features of calcium hydroxide (dycal)?
- high pH initially irritates the pulp causing reactionary dentine to be laid down
- bacteriocidal
- electrical/thermal insulator
- radiopaque
- not adhesive so there is no coronal seal
give an example of zinc polycarboxylate cement?
poly F
what are some features of zinc polycarboxylate cement?
- high molecular weight reduces penetration to tubules, only mildly irritant to the pulp
- sufficient strength for restoration placement
give an example of zinc oxide eugenol
kalzinol, sedanol
what are some features of zinc oxide eugenol?
- slight irritancy to the pulp
- thermal/electrical insulator
- very obtundant to the pulp
- zinc oxide eugenol is not compatible with resin composite
what are some features of zinc phosphate?
-not obtundant to the pulp
what is an indirect pulp cap?
when cavity is extended to 0.5mm of pulp and calcium hydroxide placed at the deepest part of the restoration.
what is a direct pulp cap?
-when an exposed pulp is covered by capping materials
what is the criteria for direct pulp capping?
- tooth is vital
- no history of pain in the tooth
- no evidence of periradicular pathology
- pulp is pink and health
- no bop
when does GI fully set?
not till 24hrs after
what is the treatment plan order?
- emergency care
- prevention
- stabilisation
- restorative
- maintenance
- referrals
what are some symptoms of amalgam poisoning?
- headaches
- GI upset
- Dyspepsia
- Salivation/xerostomia
- fatigue
- oedema of face/ankles
- character changes
