Test 3 Flashcards
What are the effect categories with examples of dentifrices?
Costmetic - stain removal, freshens breath, inhibits formation of supragingival caluclus
Hygienic - removes plaque and food debris
Therapeutic - fluoride prevents/reverses caries, reduces gingivitis
What is the most widely used rinse for over 100 years?
Listerine
Key components to focus on when recommending dentifrices
Bioavailability
Levels of abrasivness
Neutral or basic pH
Individual needs
Amorphous Calcium Phosphate (ACP)
Casein Phosphopeptides + ACP
MI Paste
Novamin
Tri-Calcium Phosphate
What is bioavailabilty?
Proportion of therapeutic agents available in pharmaceutic substance that produces desired effect when used as recommended
Why is levels of abraisveness important?
More than 2% will cause abraison and hypersensitivity
Why is neutral or basic pH important?
To promote remineralization
What does amorphous calicum phosphate (ACP) do?
Aids in remineralization
Reduces sensitivity
Enhances fluoride delivery
Where can you find ACP?
Enamel Pro Fluoride Varnish
Some over the counter dentifrices
What happens when you add ACP with Caesin Phosphopeptides (CPP)?
When added together they have stabilizing properties which increase substantivity - helps to remineralize
What is MI paste?
It stimulates salivary flow and increases calcium/phosphate in saliva. Increased fluoride.
When to use MI paste?
Patients with Xerostomia
What is Novamin?
Combination of calicum, sodium, phosphorous, and silica
What does Novamin do?
Increases remineralization for caries protection
What is tri-calcium phosphate (TCP) for?
Anti-caries
How should an oral rinse or irrigation be used?
As an adjunt to mechanical plaque removal, not a replacement
How deeply should an oral rinse or irrigation penetrate?
Less than 1-2mm subgingivally
Are all types or rinses able to penetrate the protective slime layer of biofilm?
No
When is an oral rinse contraindicated?
For current or recovering alcoholics due to alcohol content
If client is using as a substitute to daily brushing and interdental aid
Children under the age of six, unable to expectorate fully
Mentally challenged who are unable to follow instructions
What are the functions of oral rinses?
Remineralization - restore mineral elements by including fluroide/caries prevention
Anti-microbial - therapeutic, control and reduction of perio disease
Biofilm control - therapeutic, reduces attachment ability of biofilm in early stage: 1-2 days
Reduction of gingivitis - therapeutic
Astringent - shrinks tissues
Alleviate pain
Buffering - reduce oral acidity
Deodorizing - neutralize odor - cosmetic
Oxygenating - cleansing
Uses of rinses
Before professional treatment (PPR) which can reduce micoorganisms by 90%, reduce the amount of micoorganisms avilable to aerosols through handpiece or ultrasonic scaler
Self care - used as part of homecare for specific needs
What is oral irrigation?
Delivery of a soultion via an irrigation tip into the gingival sulcus or periodontal pocket
What are the types of stimuli?
Tactile - contact and friction
Thermal - temp changes
- cold is most common
Evaporative - dehydration
Osmotic - pressure in tubules
- sugar and salt concentrations
Chemical - acids
What is the incidence of hypersensitivity?
Most common in ages 20-40
Experienced by 8-30% of the population
Higher incidence than periodontally involved client
Most common in cervical third of premolar and mandibular anteriors
What type of data collection would be done for hypersensitiviy?
Location
Severity
Onset /duration
Aggravating/relieving factors
Dental history
What are the diagnostic tests for hypersensitivity?
Visual
Palpation
Congestion
Occulsion
Rads
Bite stick
STP
Air water - cold
Endo ice
Transillumination
Mobilty
Thermal/electric pulp
What is hydrodynamic theory?
Movement of fluid within the dentin tubules
Pressure on nerve endings
Larger numbers of widened tubules
Treatments for hypersensitivity applied at home
Sensodyne max strength
Sensodyne pronamel
Sensodyne rapid repair
Colgate sensitive pro-relief
What level of relief are at home treatments?
Mild
Professional applied treatments for hypersensitivity
Restorations
Grafts
What level of relief are professional treatments for hypersensitivity?
Moderate - severe
What are the active ingredients in hypersensitivity treatments?
- Stonium acetate
- Arginine
- Novamin
- Fluroide
- Potassium nitrate
How does hypersensitivity treatment stonium acetate work?
Occludes tubules and prevents fluid flow
How does hypersensitivity treatment arginine work?
Blocks tubules
How does hypersensitivity treatment novamin work?
Mends bones and accelerates growth
Blocks tubules
How does hypersensitivity treatment fluoride work?
Remineralization
How does hypersensitivity treatment potassium nitrate work?
Blocks pain signals
Blocks synapse
How to avoid gingival recession
Soft bristles
No long horizontal stroke
Don’t use too much pressure
Signs of acid erosion
Sensitivity
Transparency
Cracks
Treatment for acid erosion
Health diet - limit acidic food, don’t frequently snack
Regular dental visits
Don’t brush your teeth right after eating something acidic
Natural desensitization types
Sclerosis
Secondary
Smear layer
Calculus
How does sclerosis naturally desensitize?
Mineral deposits in tubules deceases diameter
Mineralized layer of peritubular dentin
How does secondary naturally desensitize?
Gradually deposited on the floor and walls of pulp chamber
Insulation
Accumulates with age, deceased diameter
How does smear layer (inorganic debris) naturally desensitize?
Accumulates after scaling, root planing, use of toothpaste, burr, attrition, abrasion plugs/blocks stimuli
How does calculus naturally densenitize?
Acts as a protective coating for exposed dentin
Techniques for managing clients with sensitivity
Diet modification
Control biofilm
Toothbrush techniques
Burnishing
Eliminate parafunctional habits
How to manage tooth sensitivity with diet modification
Limit acidic foods
Discourage brushing right after eating
Eliminate extreme temps and bad habits
How to manage tooth sensitivity with toothbrushing techniques
Soft bristles
No long horizontal strokes
How to manage tooth sensitivity with burnishing technique
Apply desensitizing pastes to form a smear layer
What parafunctional habits to modify to manage tooth sensitivity
Grinding and clenching
Stress reduction
How to provide denture care instructions
Verbal or written
How often does a client with complete dentures need to be seen?
Every 6-12 months
How often does a client with partial dentures need to be seen?
Depends on the assessment of the remaining teeth
Care instructions for dentures
Attend recall visits
Remove overnight or at least 6-8 hours per day
Clean them at home - brushing or polident
Rinse
Check for remaining debris
Observe soft tissues
Massage tissues with a soft toothbrush or finger before reinserting
Oral manifestations from dentures
Ulcerations
Denture stomatitis
Angular cheilitis
Riboflavin
Hyperplasia
What is denture ulceration caused by and what does it look like?
Ill fitting denture or chemical irritation, looks like a red halo
What causes denture stomatitis?
C. Albicans
Poor oral hygiene
Continuous wear
Systemic conditions
Chemincal irritation
Allergy
Where is denture stomatitis usually located?
Under maxillary denture
What causes angular cheiltitis?
C. Albicans
Staph. Aureus
Pooling saliva
What does riboflavin look like?
Fissures
Encrusted
Is riboflavin painful?
Yes
What causes hyperplasia?
C. Albicans
Low grade trauma
Where is hyperplasia usually located?
Under maxillary denture
Implant brushing instructions
Brush 2-3x daily
45 degrees apically
Soft bristles
Chlorhexidine
Implant interdental aids
Proxy brush
Floss daily (around - crisscrossed)
Dentifrices recommended for implants
Low abraisiveness
Oral irrigation recommended for implants
Limited areas
Water + chlorhexidine
Clinical considerations for care of implant
No stainless steel, only plastic or medical grade titanium
Define determinate for health risk and health promotion counselling
Something that increases the probability of disease
What are the 12 determinats of health listed by the Public Health Agency of Canada?
Income and social status
Social support
Education
Employment/working conditions
Social environment
Physical environment
Child development
Genetics
Health services
Gender
Culture
Personal health
What are examples of social determinats?
Meeting daily needs
Education
Health care access
Quality of education/job training
Resource and activities available
Transportation access
Public safety
Support
What are modifiable risk factors?
Can be changed with intervention such as: smoking, inadequate plaque removal, diet, pathogens, stress, BOP, low fluoride use, tooth morphology, xerostomia, alcohol use, sun exposure
What are non-modifiable risk factors?
Cannot be changed with intervention such as: genetics, age, gender, systemic conditions, medications, osteoporosis, family history, developmental factors
What are the three behaviour theories?
Transtheoretical model (TTM)
Social determination theory (SDT)
Theory of planned behaviour (TPB)
What is the transtheoretical model?
Change is process, not an event -
stages of readiness:
1. precontemplation
2. contemplation
3. preparation
4. actions
5. maintenance
6. relapse
What is the social determination theory?
Focuses on establishing new patterns based on client autonomy, improved self-efficiency
What is the theory of planned behaviour?
Dishtinguishes between stages of contemplation and over action.
Client more likely to adhere to plan if they were already thinking about making changes
How does motivational interviewing work?
Engages with the client
Collaborates with the client
Informs the client
Gives client autonomy
Client does most of the talking with DH listens
What communication skills are needed for motivational interviewing?
Open ended questions
Affirmations
Reflective listening
Summarizing
What does RULE stand for?
Resist the righting reflex
Understand client motivation
Listen
Empower
What are the three communication styles of motivational interviewing?
Guiding
Following
Direction
How does guiding work?
DH listens
Eye contact
Nodding
How does following work?
Listening
Suspend role as expert
Let the client have a say
Find motivator
How does directing work?
Help those who are stuck
Give suggestions
What are the vulnerable populations?
Seniors
Immigrants
Unemployed
What does PACE stand for?
Partnership
Acceptance
Compassion
Evocation
What is the PACE model for?
A philosphy for establishing client-clinican relationships
What does LEARN stand for?
Lsten
Explain
Acknowledge
Recommend treatment
Negotiate on plan
What is LEARN and ETHNIC for?
Culturally sensitive framework for communicating with cross-cultural environments.
What does ETHNIC stand for?
Explanation of illness
Treatment tried
Healers
Negotiate on plan
Interventions
Collaboration
Role of the DH with tobacco or cannibis users
Identify users
Oral cancer screenings
Cessation counselling
Oral manifestations of various tobacco/cannabis products
Oral/pharyngeal cancer
Periodontitis
Nicotine stomatitis
Gingival recession
Implant and therapy failure
Caries
Stain
Calculus
Halitosis
Impaired taste
Dry socket
Delayed healing
Black hairy tongue
Xerostomia
Nicotines neurochemical effects on the brain
Chronic relapsing brain disorder
Decrease appetite
Increase pleasure and relaxation feelings
Releases dopamine, serotonin, norepinephrine, acetylcholine, vasopressin, and beta-endorphins
How long does it take for nicotines effects to hit the brain?
7 seconds
What does chronic exposure mean?
Less of an effect over time, a larger dose needed to get the same feeling
When does withdrawl hit?
Peaks at 12-24 hours, can last 2-4 days
Does recreational cannabis contain more THC?
Yes
Smoking cannabis oral side effects
Xerostomia
Caries
Increased consumption of FC
High frequency side effects from cannabis users
Perio
Caries
Xerostomia
Stomatitis
Gingival hyperplasia
Gingivitis
Low frequency side effects from cannabis users
Bone loss
Papillomas
Squamas cell carcinoma
Lung cancer
Attachment loss
Xerostomia
Staining
Medical cannabis is used to treatY
MS
Epilepsy
Anxiety
Depression
PTSD
HIV
Chemo-induced nausea
Cancer
Autism
Is CBD an inhibitor of cancer growth?
Yes
Types of medical cannabis
Nabilone: capsule, antiemetic
Nabiximols: spray, analgesic (pain management)
How long must a client have been without using cannabis to be seen in an office and our DH clinic?
Office: 4 hours
Clinic: 12 hours
What is the percentage of tobacco users that want to quit?
70%
What are the relapse numbers for those who try to quit tobacco?
60% relapse within the first week
70% within the first month
What are the 3 A’s regarding tobacco cessation for a DH?
Ask
Advise
Act
What are the nicotine therapy replacement options?
Nicotine patch
Nicotine gum
Nicotine nasal spray
Zyban
Nicotine inhaler
Nicotine lozenge
Contrindications for nicotine patch
Contact hypersensitivity
Condtrindications for nicotine gum
TMD or dentures
Contrindications for nicotine inhaler
Bronchospastic disease
