Restorative Dentistry (Obj 1-3) Flashcards
Restorative dentistry is…
includes all of the operative procedures involved in the restoration of defects in the enamel and/or dentin, in both primary and permanent dentition. The goal of restorative dentistry is to best restore the patient’s bite (occlusion) into a natural function for healthy mastication. Ex: cavity fillings, replacing failed restoration, replace missing teeth, abrasion or wearing away of tooth structure, erosion of tooth structure
Esthetic Dentistry
is devoted to improving the appearance of teeth by repairing imperfections with direct or indirect restorative materials or using whitening techniques. Conditions that result in the need for esthetic treatment examples.. discoloration, anomalies caused by developmental disturbances, abnormal spacing between teeth, trauma
Define Topical Anesthesia
Topical anesthesia has a temporary effect on the sensory nerve endings of the surface of the oral mucosa. The primary objective is to provide a numbing effect in a specific area where an injection is to take place.
Topical Anesthetic can be used to:
Numb tissue prior to injecting a local anesthetic
Provide temporary relief from the pain of ulcers, wounds, or denture sores
Prevent a patients gag reflex from occurring when taking X-rays or a Dental Impression
Analgesia
absence of normal sense of pain
Paresthesia
loss of sensation
Sedation
state of being calm
conscious sedation
is a depressed level of consciousness with the ability to maintain a patient’s airway
Active ingredients in topical anesthesia - what form are they available?
benzocain or lidocain - available in ointments, liquids, sprays, patches
Characteristics of Local Anesthesia
Nonirritating to tissues in area of injection
Minimal toxicity
rapid onset
completely eliminates pain during a procedure
sufficient duration
completely reversible
sterile or capable of being sterilized by heat without deterioration
DA’s role when applying topical anesthesia
The dental assistant checks with the dentist for instructions on the type of anesthetic and needle for the procedure. The dental assistant is then responsible for setting up all required materials and supplies for the procedure, reviewing the patient medical history, explaining the procedure to the patient and then applying topical in the area where treatment is to be performed. The dental assistant is then responsible for monitoring the patient for any concerns or adverse reactions while the topical anesthetic is placed.
Define Local Anesthetic
can be defined as a localized anesthetic that reduces the patient’s pain and provides comfort during dental care.
Method of Action for Local Anesthetic
A liquid anesthetic that is injected close to the nerve and diffuses (spreads) around the nerve and prevents the nerve from releasing its normal pain response. The dentist must inject a sufficient amount of anesthetic to ensure that the nerve fibers are completely permeated. The flow of the bloodstream will create a slow reverse the anesthetic response and the patient with eventually lose the numbed feeling in the area of the mouth that was anesthetized.
Chemical Composition of Local Anesthetic
Amides are used for local anesthetic and are metabolized by the patient’s liver.
Chemical Composition of Topical Anesthetic
Esters are typically used for topical anesthetics and metabolized by a patient’s plasma.
Induction Time
the time it takes for the anesthetic to take effect after the injection
Duration Time
the time it takes for the anesthetic to reverse back to the patient feeling no numbness
It depends on the type of anesthetic used.
Short acting: 30 minutes
Intermediate acting: 60 minutes (most commonly used in restorative dentistry)
Long acting: 90 minutes
Vasoconstrictors
Small quantities of vasoconstrictors can be added to an anesthetic to slow the uptake into the bloodstream to extend the duration time.
Types of vasoconstrictors
Epinephrine
Levonordefrine
Neo-Cobefrin
Types of injections
Maxillary
Palatal
Mandibular
Periodontal Ligament
(See MDA textbook pp. 505-506 Figs 37.3, 37.4, 37.5 for names and pictures of nerves site innervations)
When is local anesthetic used
Local anesthesia is used for dental procedures that have the potential to cause discomfort or pain.
It blocks sensations from teeth, soft tissue, and bone in the area of anesthetization and is used for many dental procedures.
Examples include:
Root planning and scaling
Restorative procedures (restoring teeth into function or esthetics)
Surgical procedures (extractions)
Prosthodontic procedures (crown and bridge)
Endodontic procedures (root canals)
Periodontal procedures (gingival surgery)
Exam (to assist dentist with diagnosing decay)
Use the mirror and explorer to detect cariogenic lesions (decay) decay on accessible tooth surfaces. Existing restorations are also evaluated for stability and integrity.
Clinical Observation/ Visual Evaluation (to assist dentist with diagnosing decay)
Perform a clinical observation to note any suspicious areas for decay for the dentist to follow-up for diagnosis.
X-rays (to assist dentist with diagnosing decay)
Take, process, and mount X-rays for the dentist to interpret and diagnose any conditions.
Indicator Dyes
Apply a carious indicator dye inside of the cavity preparation to indicate any decayed areas. *Dentist places to ensure all decay is removed prior to placing the restoration.
Caries Detection Devices
Several different varieties are available on the market. These devices function through different ways such as through detecting bacterial by-products, measuring differences in tooth structure and lasers which can reveal bacterial activity under the enamel surface.
Role of Dental Assistant
- Describe the Behaviour of Materials
Materials all have specific behaviours once placed into the oral cavity, which can affect the success of a restoration.
When choosing materials to use, the material should:
- Present no harm the patients’ health
- Be easy enough to use
- Be able to withstand the patient’s oral conditions
2. Handle Materials Safely
Dental materials are bio-materials, that are man-made, and used to replace tissues or function in close contact with living tissues.
Understanding the physical, chemical, and mechanical properties of materials are very important, as it influences their handling.
Proper handling of materials is a major factor in its success or failure. If materials are properly stored, mixed, and placed, improved patient care will result.
- Assess and Prepare Materials Prior to Treating the Patient
The dental assistant must be able to identify the use of all dental materials intra-orally to prevent serious errors.
Some materials may have contra-indication with the patient’s medical or dental health status.
Others have very specific instructions to be followed in the preparation and placement, that can affect the outcome of the restoration.
The assistant must be aware of the manufacturer’s instructions and guidelines for the use of all materials used in the practice.
- Educate the Patient
Dental assistants are responsible for educating patients regarding treatment options, including comparing one dental material to another.
Knowledge of dental materials is critical to ensure that the patient is provided with complete, and accurate answers to assist in treatment choices.
Variables affecting choosing a dental material(s) for a procedure
the extent of decay in the tooth, how much tooth structure remains intact to hold the new material in place, the condition of the entire mouth, the location of the restoration, and cost factors.
Restorative and Esthetic dental materials most commonly used today:
Amalgam
Composite Resin
Glass ionomer
Temporary restorative materials
tooth-whitening products
gold alloy
ceramic castings
Properties of Dental Materials
Mechanical - material must have sufficient strength to withstand biting force (28000 lbs of pressure per square inch on a single cusp of a molar tooth) (Tensile stress and strain)
Ductility - is the ability of a material to have its shape changed by being streched or by a pulling of tensile force without losing strength or breaking
Malleability - measure of a material’s ability to be extended in all directions by a compressive force
Thermal Change - withstand contraction and expansion due to temp change (from hot and cold food) and the need to protect the pulp from thermal shock from extreme difference in temp
Electrical - electrical current (or galvanic action or shock) can take place in the oral cavity when two different/dissimilar metals are present. Conditions that can create - salt in saliva is conductor of electricity, or two metallic components used in restoration or a fork placed in mouth can act as a battery.
Corrosive - corrosion of metals when exposed to corrosive factors such as temp, humidity, and saline.
Hardness - permanent restoration must have enough hardness to resist indentation, scratching, or abrasion (Strength and wearability)
Solubility - degree to which a substance will dissolve in a given amount of another substance
Application - Flow , Adhesion, Retention, Curing
Type of Curing
Auto-Cure
Light-Cure
Dual-Cure
Amalgram
Silver fillings - powder metal (mostly silver) are mixed with mercury to form a soft mixture
Contradictions to the Use of Dental Amalgram
- Esthetics (if in anterior teeth and can be seen)
-if patient has history of allergy to mercury or other components
-when large restoration is required (and cost is not a factor)
composition of amalgram
43% mercury & 54% alloy (mix metals - silver, tin, copper, and zinc) powder - although typically a 1:1 ratio is used (Eames technique)
Topical Anesthetic Indications
In preparation of a local anesthetic injection
Prevent gagging in procedures such as radiography or impressions
Temporary pain relief from oral ulcers, wounds or inflammation
Topical Anesthetic Contraindications
Allergy to ingredients (i.e. red food dye in flavored topical anesthetic
Heart conditions or High Blood Pressure (if a vasoconstrictor is on ingredient list)
How long do you leave gel type topical anesthetic on for?
a minimum of 15 seconds to 30 seconds with a maximum of 1 or 2 minutes to have optimum effectiveness
What is spray topical anesthetic useful for?
is useful when applied at the back of the throat in patients that have a strong gag reflex. an appropriate time to use this is when taking impressions of for radiography. Can pose a potential danger if too much is administered - its absorbed into the blood stream an can cause irregular heartbeat and respiratory failure
When/what is local anesthetic used for?
Local anesthesia is used for dental procedures that have the potential to cause discomfort or pain.
It blocks sensations from teeth, soft tissue, and bone in the area of anesthetization and is used for many dental procedures.
Examples include:
Root planning and scaling
Restorative procedures (restoring teeth into function or esthetics)
Surgical procedures (extractions)
Prosthodontic procedures (crown and bridge)
Endodontic procedures (root canals)
Periodontal procedures (gingival surgery)
Anesthetic Carpule
The anesthetic carpule is typically clear glass or plastic and contains the anesthetic solution.
Size of Carpule & info on label
Each carpule typically contains 1.8 ml of anesthetic solution and is labeled with the following information:
- The type of anesthetic solution (generic and common name)
- Percentage of concentration of anesthetic in the solution.
- Type of concentration of vasoconstrictor present
- Expiration date
The following carpule components must be checked and assessed prior to the injection in order to ensure patient safety. (See MDA 14th ed., Fig. 37.8, pp. 507)
- The silicon rubber stopper must be flush with the glass.
- If it is pushed out it may indicate that the solution may have been frozen
- If it is pushed in, it may have already been used. - The carpule must not be chipped, cracked or damaged
-The glass may shatter during the injection and may have been contaminated (IPC breach) - The solution must not be cloudy or discoloured.
- may indicate expired, contaminated and no longer effective
