Test 1 Flashcards
What is the intended purpose of the office emergency manual?
For dental office staff preparedness training, as well as for during times of crisis
What does the office emergency manual contain?
Protocols, procedures, and training for management of potential emergencies, responsibilities and roles of staff
The office emergency manual addresses specific dental office medial emergency situations which are defined by
Symptom analysis
What is the most common dental emergency?
Syncope
Other then syncope, what are the common dental emergencies?
Allergic reations
Angina
Myocardial infarction
Cardiac arrest
Hypotenseion
Seziures
Bronchospasm
Diabetic episodes
What is the dental hygienist’s responsibilities in an emergency in accordance with the Regulated Health Professions, Act 1991?
They are to be able to ensure the provision of aid in medical emergency situations. They can administer drugs orally, by injection, or inhalation even though it is not within their scope of practice.
What first aid and CPR training does a dental hygienist need?
Current CPR level C and basic first aid.
The components of a sound medical emergency plan for the dental office should include:
Medical emergency prevention
Development of an action plan
Recognizing a client’s distress and management of medical emergencies
Emergency drugs and equipment
What is a low blood sugar level reading?
Less than 70mg/dl (3.9 mmol/L)
What are the signs/symptoms of hypoglycemia?
Confusion
Dizziness
Nausea
Feeling hungry/shaky
Nervousness
Irritable or anxious
Sweating
Chills
Pale, clammy skin
Rapid heartbeat
Weakness/tiredness
Tingling in the mouth area
Headaches
Seizures
Coma or loss of conciousness
Weight loss
What does the dental hygienist do during a hypoglycemic episode?
Prove client with one of the following:
A glucose tablet
A sweet juice
A candy
Sugar
Sweet syrup on gums if unable to eat
What are the signs/symptoms of hypergylcemia?
Increased thirst
Frequent urination
Headaches
Blurry vision
Fatigue
What is hyperosmolar syndrome?
Blood glucose high for too long causing dehydration and confusion.
What is ketoacidosis?
High blood sugar complication of body breaking down fat too fast, keytones produced from the liver causes blood to become acidic.
What does the dental hygienist do during a hyperglycemic episode?
Provide client with fluids, electrolytes. Client should take their insulin. If symptoms worsen, they have difficulty breathing, a very dry mouth or fruit smell on their breath they need to see a doctor ASAP.
When seeing a diabetic client, was does the hygienist need to ask and record?
The client’s blood glucose level that day and record it in the ROC
When is dental hygiene care contraindicated requiring medical clearance to proceed with a diabetic client?
When blood glucose levels are less than 3.9mmol/L or greater than 11.1 mmol/L
What does the dental hygienist do during client’s grand mal seizure?
Terminate clinical procedure
Position the client supine with legs elevated, turn client to the side, loosen tight clothing
Time the seizure
Summon medical assistance (call 911 if the seizure lasts longer than 3 minutes or if client becomes cyanotic)
Assess and perform as necessary basic life support
After seizure reassure client and allow them to recover.
Assess oral cavity for injury
Discharge client to the hospital, physician, or home with a responsible adult
Angina signs and symptoms
Sharp, bruning, or cramping pain that starts in the cental chest and then radiates to the left arm, neck, back, throat or jaw
Pressure, tightness, squeezing and or achng feeling in the chest or arms
Retrosternal burning sensation similar to persistant sever gastroesophageal reflux
Ache that starts in the neck, jaw, throat, shoulder, back, or arms
Discomfort in the neck or upper back
Numbness in the arms, shoulder, or wrists
What is the most common allergy related emergency in dental offices?
Latex
Signs of a mild allergy
Itching
Hives
Rash
Signs and symptoms and a severe allergy
Respiratory or cardiovascular compromise
Loss of conciousness
The final decision to proceed or not with dental hygiene treatment is the responsibility of who according to the CDHO?
The registrant
Ideally medical clearance is to be done in writing either by fax or email. If done over the phone, what must the hygienist record?
The substance, time, and date of the conversation.
Where would you find information about if care is contraindicated?
CDHO knowledge network
CDHO Contraindications Regulation
Dental Hygiene Act, 1991
Best Practice Guidlines, CDHO
Under the Dental Hygiene Act, 1991 and CDHO best practice guidelines, when should dental hygiene care not be provided?
- Any cardiac condition for which an antibiotic prophylaxis is recommended in the guidelines set by the Amercian Heart Association
- Any condition for which antibiotic prophylaxis is recommended or required
- An unstable medical or oral health condition when the condition may affect the appropriateness or safety of scaling and root planing
- Active chemotherapy or radiation therapy
- Significant immunosuppreision caused by disease, medications, or treatment modalities
- Any blood disorders
7, Active TB - Drug or alcohol dependency of a type or extent that it may affect the appropriateness or safety of scaling and root planing
- High risk infective endocarditis
- A medical condition or oral health condition with which the member is unfamiliar or that could affect the appropriateness, efficiacy or safety of the procedure
- A drug combination of drugs with which the member is unfamiliar or which could affect the appropriateness, efficiacy, or safety of the procedure
What can be done while awaiting medical clearance?
Non-invasive care (paperwork). NO probe or explorer, do not disturb plaque
Where are you going to look up medications to determine their side effects?
DC Library - CPS link under dental resources
What are the 8 fundamental assessment questions regarding medications?
- Why are they taking it?
- Are reported symptoms from the drug side effects or from the medical condition?
- What are the adverse effects of the drug?
- Are there potential drug interactions?
- Do these findings suggest a problem with drug dosage?
- How is this client managing medications?
- Will any oral side effects of this medication require intervention?
- What are the risks of treating the client?
What are some common oral side effects of medications?
Xerostomia
Caries
Change in taste
Difficulty with mastication
Difficulty wearing applicances
Oral ulcerations
Atrophic mucosa
Hairy tongue
Infection
Mucositis or stomatitis
Burning mouth or tongue
Difficulty with speech
Difficulty with swallowing
Increased periodontal disease progression
Opportunistic infections
Bleeding
Gingival enlargement
What act broadly describes the scope of practice of what each regulated profession does and sets out the framework for the regulation of the entire health sector, Minister of HLTC?
Regulated Health Professions Act, 1991
What act deals specifically with the issues pertaining to the regulation of dental hygienists?
Dental Hygiene Act, 1991
True or False: Regulations can be made under both the Regulated Health Professions Act and the Dental Hygiene Act
True
What regulations made under the Dental Hygiene Act are specific to the profession of dental hygiene?
Registration
Examination
Profesional misconduct
Quality Assurance
Containdications
Advertising
Notice of meetings/hearings
Records
What regulates the practice of dental hygiene in the interest of the overall health and safety of the public of Ontario?
CDHO
What are health care actions that are considered potentially harmful if performed by untrained persons called?
Controlled acts
Can a dental hygienist communicate a formal diagnosis to a client?
No
What controlled acts can a hygienist do?
2. Performing a procedure on tissue below the dermis, below the surface of a mucous membrane, in or below the surface of the cornea, or in or below the surface of the teeth, including the scaling of teeth.
What are the exceptions to the Regulated Health Professions Act in performing controlled acts?
- Rendering first aid or temporary assistance in an emergency
- Fulling requirements while in school
- Treating a person by prayer or spiritual means in accordance with the tenets of the religion
- Treating a member of the person’s household and the act is a controlled act set out in paragraph 1, 5, 6, of subsection 27 (2)
- Assisting a person with his or her routine activities of living and the act is a controlled act set out in paragraph 5 or 6 of subsection 27 (2)
What is the scope of practice statement Dental Hygiene Act 1991?
The practice of dental hygiene is the assessment of teeth and adjacent tissues and treatment by preventative and therapeutic means and the provision of restorative and orthodontic procedures and services.
What is the purpose of the scope of practice statement?
To educate dental hygienists and the public about the focus of the dental hygiene profession.
The most signifcant legal implication of the scope of practice statement is the impact on the:
Harm clause
What is the harm clause?
Stating that no one shall work outside their scope of practice or shall treat or advise a person with respect to their health if it may reasonably be forseen that serious bodily harm may be the result of the advice.
Can an RDH self-initiate immediately upon graduation?
Yes
When is an “order” required for a dental hygienist?
Always reuired for orthodontic and restorative procedures
Can a dental hygienist treat a client without a dentist in the office?
Yes
What guidelines do x-rays fall under?
HARP
When is medical clearance required?
1.When the client has a condition from the Prescribed Contraindications List - CDHO
2. If it is about a joint replacement, this should only be obtained from the ortho surgeron
What is INR?
International Normalized Ratio - blood clotting level
What does a higher INR mean
Takes more time to clot, risk of bleeding and bleeding related events increases
On an anti-coagulent, what shoudl the INR range be?
Between 2-3
What is a process by which two or more people work together to realize or achieve something successfully?
Collaboration
What is a meeting in which someone (like an MD) talks to a person about a client’s problem?1
Consultation
What is the process to ensure adequate informed consent is obtained and couments in the DC Dental Hygiene Clinic?
Obtain informed consent
Explain risks
Eplain benefits
Explain side effects
Explain consequences
Address specific questions or concerns
Is a signed consent the same as obtained an informed consent?
No
What do you record in your ROC when treatment is declined?
Risks of completing treatment are explained
Possible alternatives are suggested
What is the gingival colour for children compared to adults?
More reddish
What is the ginigval contour for children?
Rounded free marginal gingiva
What is the gingival consistancy for children?
Flabby due to less connective tissue density and lack of organized fiber bundles
What is the surface texture of gingiva in children?
Stippling absent in infnacy; may be seen by age 6
Interdental gingiva in children is
Saddle-shaped
Children’s attach gingiva increases with
Age
Where should the bony crests be on a BW of a child?
Within 2mm of the CEJ
True or False: During radiographic assessment the periodontal ligament in children is wider and has less dense fibers compared to adults.
True
True or False: in radiographic assessment the alveolar bone in the primary dentition has less trabeculae and clcification with larger marrow spaces.
True
True or False: in radiographic assessment, the lamina dura is not prominent in the primary dentition with a narrower periodontal ligament space than in the permanent dentition.
False. The lamina dura IS prominent in the primary dentition with a WIDER periodontal ligament space than in the permanent dentition.
True or False: in radiographic assessment, the interdental septa of children are generally broader and flatter than the interdental septa seen in healthy adults, with bony crests within 1-2 mm of the CEJ.
True
A thorough examination of a child patient inculdes the assessment of:
General health
Chief complaint
E/O
I/O
OH
Periodontal health
Developing occlusion
Caries Risk
Behaviour
How does oral responsiblity shift as a child grows?
Starts with parents, then jointly child and parent, and finally just child
Is family history relevant to the patient’s oral condition?
Yes
Why would family history be important to the patient’s oral condition?
May provide important diagnostic information in some hereditary disorders
When is plaque record performed?
Every appointment
When does a client start getting periodontal probing?
Age 16
Are mobilites and open contacts recorded for children?
No
When is terminal plane recorded?
Until the eruption of the 1st permanent molars
In a child, “primate spaces”, the primary mandibular canine should align with
The space between the primary maxillary lateral and canine
According to Leeway Space, the combined mesio-distal width of the permanent canines and the premolars is usually
Less than that of the primary canines and molars
What kid of terminal plane is this?
Straight/flush
What occlusion does a straight/flush terminal plane usually end up?
Usally a Class I
What kind of terminal plane is this?
Mesial step
What kind of occlusion does a mesial step usually lead to?
Class III
What kind of occlusion does a mesial step sometimes lead to?
Class I
Can other factors affect a straight/flush terminal plane to create a class II or III occlusion?
Yes
What type of terminal plane is this?
Distal step
What type of an occlusion does a distal step terminal plane lead to?
Class II
What should be considered when creating goals for children?
Consider age and ability of client, goals should include parent/guardian
Do you need to consult with a parent/guardian before planning or proceeding with x-rays, fluroide, polish, and PFS?
Yes
True or False: Prevalence of gingivitis in children is low.
False: prevalence of gingivitis is high.
How many children exhibit attachment loss and alveolar bone loss?
A small percent
Failure to identify periodontal conditions early on can lead to
Unnecessary tooth loss
Gingivitis is nearly __________ in children and adolescents.
Universal
In children, does the amount of plaque biofirm correlate with the level of inflammation?
Not necessarily
Loss of periodontal attachment/bone is uncommon from the ages
5-11
What percentage of children/adolescents present with severe attachment loss on multiple teeth?
0.2% - 0.5%
What is primary herpetic gingivostomatitis?
Severe reaction to the initial viral infection (HSV-1)
Sometimes initial infection of primary herpetic gingivostomatitis presents with painful gingival inflammation and multiple vesicles that rupture into
Painful ulcers
What is a cold sore?
Reactivation of the HSV-1
How long does a cold sore take to resolve?
10-14 days
OTC medication for cold sores
Abreva
Wht is a recurrent apthous ulcer?
A canker sore
Peak age of canker sores is
10-19
Possible causes of canker sores
Toothpase with sodium lauryl sulfate
Foods - acidic, spicy, strawberries, eggs, cheese
Lack of B12, zinc, folate, iron
Stress
Injury
What is inflammation of the gingival margin that is clinically evident around the erupting teeth of a child called?
Eruption gingivitis
What are the characterisitics of eruption gingivitis?
Short lived
Observered in children during tooth eruption
Caused by the plaque accumulation where the tooth is shedding
JE migrates under the resorbing tooth crreating a pocket for plaque to accumulate
Treatment of eruption gingivitits
Managed with improved OH
Condition is reversed after the tooth has completely erupted
What is a localized infection within the soft tissue (operculum) surround the crown of a partially erupted tooth called?
Periocoronitis - Pericoronal Abscess
Which teeth have the highest occurance of periocoronitis?
1st and 2nd molars
Characterisitics of periocoronitis
Bad taste
Bad smell
Pain upon occlusion
Pain with also prevent proper plaque removal
Treatment of periocoronitis
Irrigation, gentle debridment or
Removal of operculum + antibiotics
If periocoronitis is left untreated, infection can spread and cause
Trimus
Dysphagia
Dyspnea
Ludwig angina
What is plaque-induced gingival disease?
Presence of inflammation limited to the marginal gingiva with no loss of clinical attachemnt or alveolar bone
Plaque-induced gingival disease characteristics
Very common
Occurance increases as children age
Peaks between 9-14 years old
Related to hormonal changes
60% of teeagers have BOP
Less intense reaction from body to plaque vs adults
Treatment of plaque-induced gingival disease
Professional care
Daily plaque removal
Calculus percentage in children 4-6 years
9%
Calculus percentage in children 7-9 years
18%
Calculus percentage in children 10-15 years
33-43%
Phenytoin-Influenced Gingival Overgrowth is a severe enlargement of the gingiva assosicated with a medication for a client with epilepsy. What type of gingival disease is it?
Gingival disease modified by medications
What type of gingivitis results from any systemic mediation that causes exaggerated inflammatory response to plaque?
Drug influenced gingivitis
True or False: when periodontitis occurs in pediatric patients, characterisitics are similar to the characterisitics in adults.
True
Necrotizing periodontal disease occur with a low frequency in North American and Eurpopean children at what percent?
Less than 1%
What factors predispose a child to necrotizing periodontal disease?
Viral infections
Malnutrition
Emotional stress
Lack of sleep
Systemic diseases
