Restorative Procedures 1 (Midterm Review: Outcomes 1-5) Flashcards
What is Restorative Dentistry?
Type of dentistry that restores teeth to their ideal structure through the use of direct and indirect restorative material.
What role do DAs play in restorative dentistry?
- Be familiar with procedure & anticipate need of dentist
- Set up for procedure
- Provide moisture control
- Transfer instruments
- Provide proper mix of materials
- Perform any legal expanded functions
- Maintain patient comfort
- Maintain IPC
What are the procedures/methods used for diagnosing decay (dental caries)? Briefly describe each method
- Dental explorer
- When the sharp tip of an explorer is pressed into an area of suspected caries, it will “stick” when being removed - Radiographs
- A dark “shadow” will appear on radiographs when decay is present (often 2x deeper & more widespread than it appears on radiographs) - Visual appearance
- Gray shadowing underneath enamel can indicate decay - Indicator dyes
- Dye applied to the inside of a cavity preparation can indicate through colour change whether decay remains - Caries detection devices
- Detects bacterial by-products and quantify sound signals to aid in caries detection - Laser caries detector
- Reveals bacterial activity underneath the enamel surface. (Does not detect interproximal, subgingival, secondary caries or decay under restorations)
What is anxiety and pain control?
The practice of various psychological, physical, and chemical approaches to prevent and treat pre-operative, operative, and post-operative anxiety and pain
Anesthesia
Administration of a medication to provide a temporary loss of feeling or sensation
Anesthetics
Medication that produces a temporary loss of feeling or sensation
Methods to alleviate/reduce anxiety and pain
- Topical anesthesia
- Local anesthesia
- Inhalation sedation
- Anti-anxiety agents
- Intravenous (IV) sedation
- General anesthesia
- Mind-body medicine
Topical Anesthesia
A gel, liquid (rinse), or spray that provide a temporary numbing effect on nerve endings located on the surface of the oral mucosa (a specific area where an injection is to take place)
Local Anesthesia
Temporarily blocks the normal generation and conduction action of the nerve impulses
Characteristics of local anesthetics
- Non-irritating to the tissues in the area of the injection
- Associated with minimal toxicity
- Rapid onset
- Able to provide profound anesthesia
- Sufficient duration of action
- Completely reversible
- Sterile or capable of being sterilized by heat without deterioration
What are needle gauges and the different types?
- Gauge = needle thickness
- # 30 gauge = used to anesthetize maxillary arch. The needle is very thin and short
- # 27 gauge = used to anesthetize mandibular arch. The needle is very thick and long
The larger the gauge number, the thinner and shorter the needle
List 4 steps to safely operate a dental syringe.
- Always use new needle, new anesthetic carpule, sterile syringe
- Point needle away from you when loading and unloading syringe
- Never touch needle with your hands
- Ensure anesthetic carpule is appropriate for your patients medical history
How is local anesthetic administered to the patient?
Subgingival (below the gumline; enters the blood stream)
*Note: the opposite of subgingival is supragingival (above the gumline; does not enter blood stream)
What is the purpose of a vasoconstrictor in anesthetic?
To slow down the intake of an aesthetic agent and increase the duration of action
What type of patient should a vasoconstrictor not be used on?
Patients who have:
- Heart disease
- High blood pressure
- Medications that have contra-indications
- Anxiety or fears
- Previous negative reactions
Which cartridge contains the most epinephrine: 1:200,000; 1:100,000; or 1:50,000?
1:50,000 (for longer duration because it contains twice as much epinephrine)
1 part (drop) of epinephrine per 50,000 parts of anesthetic solutions
Side effects of epinephrine
- Nervousness
- Excitement
- Muscular twitching
- High blood pressure
- Increase heart rate & respiration
List the guidelines for handling anesthetic cartridges.
- Should be stored at room temperature and protected from direct sunlight
- Never use a cartridge that has been frozen
- Do not use a cartridge if it is cracked, chipped, or damaged in any way
- Never use a solution that is discoloured or cloudy or expired
- Do not leave syringe preloaded with the needle attached for an extended period
- Never save a cartridge for reuse
The area in the mouth where topical and local anesthetic is placed.
Mucobuccal Fold
List all the maxillary anesthesia location and briefly describe them.
- Local infiltration = completed by injecting into a small, isolated area
- Field block = when the injection is placed near a larger terminal nerve branch
- Nerve block = when local anesthetic is deposited close to a main nerve trunk (indicated for quadrant dentistry)
3 different types of nerve blocks
- Anterior superior alveolar (ASA)
- Middle superior alveolar (MSA)
- Posterior superior alveolar (PSA)
Where are the Greater Palatine and Nasopalatine Blocks located?
5-10mm from the free gingival margin of the operative tooth
Greater palatine = posterior portion of the hard palate
Nasopalatine = anterior hard palate
List all the mandibular anesthesia location and briefly describe them.
- Inferior alveolar nerve block (or mandibular nerve block) = anesthetic is injected near, but not into the branches of the inferior alveolar nerve
- Buccal nerve block (or long buccal nerve block) = provides anesthesia to the buccal soft tissues of the mandibular molars
- Incisive nerve block = injection is given at the mental foramen, only given when the mandibular premolar or anterior teeth require anesthesia
Post-operative instructions to inform the patient
- Avoid hot and cold foods
- Chew on other side of mouth
- Avoid biting cheek or tongue
- Let them know how long topical and local anesthetics will last
- Go for a casual walk (get heart rate up = wears anesthesia quicker)
How long will topical anesthetics last?
15 minutes
How long will local anesthetics last?
2-4 hours (depending on epinephrine content)
Induction time vs. Duration time
Induction time = the length of time from the injection of the anesthetic solution to complete an effective conduction blockage
Duration time = the length of time from induction to complete reversal of anesthesia
Chemical composition of local anesthetics
- Amides (local anesthetics) = metabolized in liver
- Esters (topical anesthetics) = metabolized in the plasma
Types of time spans of anesthetics
- Short acting = last approximately 30 minutes
- Intermediate acting = approximately 60 minutes (most commonly used)
- Long acting = 90 minutes
Factors that impact anesthetic duration
- Type of injection
- Amount of anesthetic injected
- Location of injection
List the complications and precautions for anesthetics.
- Injecting into a blood vessel
- Can alter function of vital organs, mainly heart. The DDS will aspirate the syringe before injection - Infection
- Anesthetic agents may be delayed or prevented if injected into infection
- Inflammatory infection LOWERS the pH, which interferes with anesthetic penetration.
- It can also possibly diffuse the infection - Toxic reactions
- Localized reactions (contact dermatitis)
- Systemic reactions (systemic toxicity can manifest in the central nervous system) - Temporary numbness
- Patient feels that their lip/tongue/cheek feels “fat”, may bite tissue inadvertently - Paresthesia (Can be temporary or permanent; most cases are resolved in ~ 8 weeks)
- Condition where numbness lasts after the local anesthetic has worn off
- This can be caused by the following:
□ Trauma to the nerve sheath during injection
□ Bleeding into or around the nerve sheath
□ Use of contaminated anesthetic solution
Electronic anesthesia and the benefits of it.
A non-invasive method to block pain electronically with the use of a low-level current of electricity through contact pads that target a specific electronic waveform directly to the nerve bundle at the root of the tooth
Benefits:
- No needles
- No post-op numbness or swelling
- Chemical free
- No cross contamination risk
- Reduced fear and anxiety in patients
- Patient control over own comfort level
Types of Dental Sedation
1.Intravenous (IV) sedation
2. Unconscious Sedation
3. Inhalation Sedation
4. Oral Sedation
Inhalation Sedation & its effects
- Nitrous oxide/oxygen (N2O/O2)
□ Combination of gases inhaled to help eliminate fear and to aid relaxation - Effects:
□ Non-addictive
□ Onset is easy, effects are minimal, rapid recovery
□ Stage 1 anesthesia
□ Dulls the perception of pain
Advantages & Disadvantages of Inhalation Sedation
- Advantages
- Administration is simple and easily managed
- Services of anesthetist or other special personnel not required
- Excellent safety record
- Patient is awake
- Can be used with patients of all ages
- Minimal side effects
- Rapid recovery - Disadvantages
- Some patients may experience nausea or vertigo
- Patients who have behavioural problems may react in negative way and act out those behaviour issues
Contraindications for Inhalation Sedation
- Pulmonary disorders
- Respiratory disorders
- Pregnancy
- Psychiatric
- Immune compromised
- Multiple sclerosis
- Middle ear blockage
- Nasal obstruction
- Emphysema
- Emotional instability
Inhalation Sedation Administration
- Ask patient to refrain from speaking or mouth breathing while nitrous is being administered
- No set dosage regimen as patients can react differently to treatment from one appt. to next
- Assess patient for dizziness, headache or lethargy once nitrous has been removed