Test 2 Flashcards
What is the prevalence of any form of perio in the US?
80%-including gingivitis
What is the prevalence of chronic adult perio?
35%
What are the inflammatory cells?
Lymphocytes
Polymorphonuclear leukocytes (PMN’s)
Macrophages
What is chemotaxis?
Process which attracts inflammatory cells to areas of the body by stimuli such as trauma and microbial presence
What are cytokines?
Substances produced by stimulated immune cells
Stimulate release of the inflammatory cells
What is mechanical treatment?
Root debridement
Effective but 10-20% of bacteria still remain within the sulcus after treatment
What are types of adjunctive chemical therapies?
Systemic and topical
Systemic Antibiotic Therapy
Aggressive perio
Perio that does not respond to treatment
Perio abscess
Disadvantages of systemic antibiotic therapy
allergic reactions
bacterial resistance
contraindication-pregnant, nursing, birth control
What is the drug of choice for systemic antibiotic?
Tetracycline
Stays highly concentrated in crevicular fluid
-careful with this due to photosensitivity
What is enzyme suppression therapy?
Periostat
Low dose systemically delivered antibiotic
Doxycycline 20 mg 2xd
9-12 months
Sub antimicrobial dose produces enzyme inhibition
*inhibits collagenase from activating inflammatory response
what is local antimicrobial therapy?
placement of antibiotic or antimicrobial agent at a periodontal site
very concentrated
What is substantivity?
ability of an agent to be bound to the pellicle and tooth surface.
Released over an extended period of time
retention of potency
Perio Chip
Chlorhexidine
biodegradable gelatin mix
40% of drug released in 24 hours
difficult to place
Atridox
10% doxycycline hylcate
two syringes-mix
can pack with instrument
tx time: 7-10 days
can use the whole syringe for multiple sites
leaves behind fiber-bring pt back 2 weeks later to remove
Arestin
Minocycline hydrochloride 1 mg polymer microspheres in powder form attaches to tooth and sulcus wall antimicrobial tx time: 14 days easy to apply
Advantages of local antimicrobial therapy
concentration up to 100 times higher than systemic
minimal or no systemic involvement
delivered where needed
prolonged release over time
When do we utilize local periodontal medicaments?
initial non-surgical therapy
reveal appointment
non-responsive site
What are three types of fulcrums?
Intraoral
Extraoral
Advanced
What are some elements of an extra oral fulcrum?
broad surface area contact between hand and patients face
extended grasp of instrument
appropriate pressure into skin
Advantages of extra oral fulcrum?
access to deep pockets
access to maxillary molars
neutral wrist position
Disadvantages of extra oral fulcrum?
operator may feel unstable
decreased strength
T/F: Extra oral fulcrums decrease control.
FALSE
Control is dependent on the fulcrum pressure
What is an advanced fulcrum?
Variations of both intramural and extra oral fulcrums to gain access to deep pockets
Disadvantages of advanced fulcrum?
Requires greater amount of muscle coordination and instrumentation skills
greater chance of instrument stick
Split fulcrum
weak fulcrum
finger action rather than wrist action
does not allow for deep access into pockets
What is oral irrigation
The targeted application of water or other irrigation fluid for preventative or therapeutic use
Advantages of patient applied irrigation
Removal of loosely attached biofilm
special needs areas -bridges, implants, ortho
Disadvantages of patient applied irrigation
possible dexterity issues
limited reach sub
possibility of tissue trauma
patient compliance
Uses of professionally delivered irrigation
post root debridement during non surgical perio therapy
during perio maint appt
acute periodontal infections
What are some agents used for irrigation?
CHX Water Stannous Fluoride Listerine Herbal solutions
Uses of mouthrinses
pretreatment biofilm control reduce inflammation caries prevention remineralize
Stannous Fluoride
F ion depositedo n enamel/carious lesion
Tin ion interferes with cell metabolism/antimicrobial effect
Sodium Fluoride
Deposits F ion on the enamel/carious lesion
Chlorhexidine
Broad spectrum antibacterial binds to hard and soft tissues released over time causes cell lysis 8-12 hour substantivity
Phenolic related essential oils-Listerine
Thymol, eucalyptol, menthol
disrupts cell wall, inhibits bacterial enzymes
decreases biofilm effects
low substantivity
Cetylpyridinium Chloride CPC
rupture cell wall
decreases ability of bacteria to attach to pellicle
poor substantivity
Oxygenating agents
alters cell membrane, increases permeability
release of oxygen helps to debride area
questionable efficacy
poor substantivity
What is Xerostomia?
patients perception of oral dryness
1 in 4
increases to 40% in people over 55 years
What are some clinical signs of xerostomia?
inflammation/redness tissue tight and shiny secondary infections increase in caries halitosis painful, cracked lips coated, dry, shiny tongue
What is saliva made up of?
over 99% water buffering agents enzymes minerals electrolytes proteins
What are the functions of saliva?
Lubrication and protection Buffering and cleaning Maintaining tooth integrity Antibacterial action Taste and digestion
What is sialometry?
measurement of salivary flow rate below acceptable clinical levels
What are the normal salivary flow rates?
stimulated: 1-3 mL/minute
unstimulated: .25-.35 mL/minute
abnormal: anything below those
What is the healthy pH of saliva?
6.7-7.4
What is an abnormal pH of saliva?
5.5-4.5
How much saliva do we produce per day?
1-1.5 liters per day
What is dentinal hypersensitivity?
an exaggerated response to a sensory stimulus
1 in 5
What are the clinical symptoms of dentinal hypersensitivity?
mild to extreme pain
short, sharp pain
thermal, evaporative, tactile, osmotic stimuli
What is the most common cause of dentinal hypersensitivity?
toothbrush abrasion!
What is Brannstrom’s hydrodynamic theory?
Fluid flow in dentinal tubules disturbed by thermal, chemical, mechanical, & osmotic stimuli
Fluid flow osmotic changes stimulate the nerve processes in the more pulpal portions of the dentin and dentin itself=pain
What are the desensitizing mechanisms?
nerve desensitization protein precipitating agents tubule occlusion/seal physical laser
How does potassium nitrate work?
penetrates through tubules to the nerve, keeps nerve from firing
How do protein precipitating agents work?
ions precipitate (group together to form blockage in tubules) F varnish
How does tubule occlusion work?
tubules are sealed over to prevent stimuli
gluma
bond/sealer
ACP
What are physical mechanisms for desensitization?
connective tissue graft
composite restoration
Crown
How do lasers work?
fuses dentinal tubules
when used with fluoride effectiveness is increased
What is demineralization?
fermentable carbs get into plaque–bacteria in plaque use these to produce acid–the acids destroy minerals in the enamel
What is remineralization?
Calcium and phosphate ions penetrate into the enamel–crystals fill in the space left by demin.–pH of saliva becomes more neutral
What is ACP?
Amorphous Calcium Phosphate
combines soluble calcium and phosphorus salts
Arm&Hammer tp
Enamel Pro
What is recaldent?
stabilizes the calcium phosphate and increase the level in dental plaque and saliva
casien=byproduct of milk
MI paste
What is novamin?
bioactive glass, compound made of calcium, phosphate, silica and sodium
claims to relieve sensitivity and provide rapid remineralization
NUPRO
What is Pro-Arginine?
Colgate sensitive relief
occludes tubules
applied in office with rubber cup
What is osteonecrosis?
necrosis of the bone due to an obstruction of the blood supply
Osteonecrosis of the jaw ONJ can occur because:
radiation therapy chronic corticosteriod therapy immunocompromised patients uncontrolled infections major trauma
What are bisphosphonates?
class of drug used in the treatment of bone diseases
affects bone metabolism
they bind to the bone surface and are ingested by osteoclasts, osteoclastic function is slowed
new bone made faster than it can be resorbed
What are some diseases most commonly associated with bisphosphonate use?
osteoporosis metastatic bone disease pager's disease hypercalcemia breaste and prostate cancers
Is it more likely to develop ONJ when taking bisphosphonates orally or IV?
IV
greater the length of time using bisphosphonates the greater the risk
What are some symptoms of ONJ?
non healing extraction sites exposed jaw bone radiographically large areas of radiolucency pain in jaw with no trauma mobility of teeth
What are the oral bisphosphonates?
Fosamax
Boniva
Actonel
What are the IV bisphosphonates?
Reclast-1xyear
Aredia
Zometa
What are methamphetamines?
CNS stimulant which acts on the brain
causes increased release of neurotransmitters
euphora
weight loss
Where is decay found in a meth mouth?
anterior ipx
posterior cervical buccal and lingual
How does meth work?
induces high faster than cocaine-absorbed quicker
high lasts longer than cocaine
high is more intense
What are the immediate effects of meth?
intense state of euphoria up to 12 hours
increase wakefulness
rapid heart rate
dilated pupils
What is formication?
most common visual effect of long term meth use
skin lesions
meth mites
result of excessive scratching or picking
What are some long term effects of meth?
stroke, increase BP and heart rate violent behavior confusion paranoia delusions
What are the dental effects of meth?
rampant caries gingivitis/perio xerostomia bruxing tmj symptoms tooth fractures
What is the #1 reason for rampant caries?
lack of home care
drink of choice is mountain dew
What are some effects of oral piercings on oral tissues?
decalcification recession malodor caries abrasion allergic reactions
What can we recommend to patients with oral piercings?
remove frequently thorough dental assessments regular dental visits removable over fixed clean daily good oral hygiene habits fluoride paste or gel
What are the initial dental impacts of oral piercings?
initial inflammation hemorrhage asphyxiation of jewelry nerve damage communicable disease trauma infections altered speech
What teeth are most likely to be broken with oral piercings?
maxillary premolars
What can we instruct our patients with oral piercings to do if they have problems?
daily, mild non-iodized sea salt rinses 4-5 times a day
removal of jewelry
Factors contributing to oral cancer
quantity and frequency of tobacco use quantity and frequency of alcohol consumption tobacco and alcohol combined genetic tendency sun exposure HPV
Tissue changes that may indicate oral cancer
white lesions-filmy to thick red velvety lesions indurated growths in a white lesion papillary masses brown/black pigmented areas
What are the symptoms of oral cancer?
ulcerations that bleed easily and or not resolve within 2 weeks
persistant pain, parasthesia
bleeding
High risk sites for oral cancer
lower lip vermillion border tongue floor of mouth soft palate tonsillar pillars and palatine tonsils
What is dysplasia?
an abnormal growth of cells that begins in the epithelium
can appear as white, red or mixed
can often resolve if stimulus is removed
What is leukoplakia?
a white patch or plaque that cannot be scraped off
What is erythroplakia?
bright red lesions of the oral mucosa that cannot be characterized as any specific disease
more of a concern than leukoplakia
What is a degree 1 lesion?
slight superficial wrinkling
pale white or gray
no thickening and lesions may disappear when stretched
What is a degree 2 lesion?
distinct white gray or red color changes
wrinkling is obvious
mucosa is not thickened
color change remains when mucosa is stretched
What is a degree 3 lesion?
white or grayish color
deep furrows
thickening of the mucosa
lesions persist when tissue is stretched
What is basal cell?
common in areas exposed to the sun open, bleeding crusted lesions red, raised or itchy shiny, pink, red, white, or translucent nodules that don't resolve crusted craters
What is squamous cell?
most common
open, painless lesions that do not resolve in 2 weeks
wart-like
persistent, scaly red patches with irregular borders
may bleed easily
rough surfaces and central depression
What is melanoma?
very often fatal
develop near or from mole
ABC’s
What are the ABC’s for melanoma?
Asymmetry border color diameter evolving
HPV
most common STD
leading cause of oral pharyngeal cancers
HPV 16 and 18
back of the mouth
What are some side effects of cancer therapy?
oral mucositis xerostomia caries candidiasis trismus osteonecrosis
What is an impairment?
an abnormality of structure or function of a limb or body organ
What is a disability?
the inability to perform a task or activity as a result of the impairment
What is a handicap?
disadvantage or limitation that an individual has when compared with others of the same sex, age, background that has resulted from the impairment or disability
T/F: disabilities are always permanent
false
T/F: restraint requires consent from parent or guardian
True
What is protective stabilization?
any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body or head
What is active immobilization?
restraint by another person
What is passive immobilization?
utilizes a restraining device
What are supportive straps?
placed on wrists and ankles tied to chair
What is a pediwrap?
nylon mesh that encloses the patient from neck to ankles
What is a papoose board?
board with padded wraps to enclose a patient
What are some chemical restraints?
xanax adavan versed prpofol valium halcion
What are some adjunctive therapies for special needs patients?
xylitol products fluoride products fluoridated water reduction of fermentable carbs chx rinse
What are the guidelines for informed consent?
nature of oral disease condition reason for recommended care alternatives consequences potential complications
