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DH Theory 1 > test 6 > Flashcards

test 6 Flashcards

1
Q

what are all sickles used for and where should they not be used

A

A periodontal instrument used to remove calculus deposits from the CROWNS of the teeth

Should NOT be used on root surfaces

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2
Q

what are the 4 unique design characteristics of a sickle

A
  • pointed tip and back
  • triangular in cross section
  • two cutting edges per working end
  • the face is perpendicular to the lower shank (90 degrees)
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3
Q

anterior sickle design

A
  • often single ended
  • may have two different sickles on a double ended instrument
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4
Q

posterior sickle design

A
  • usually two sickles paired on a double ended instrument
  • working ends are mirror images
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5
Q

what is the ideal angulation for calculus removal

A

60-80 is ideal

if you go less than 45 the shank will slip; if you go over 90 there will be no bite and cause tissue trauma

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6
Q

what happens if you position the lower shank parallel to the tooth

A

creates an incorrect face to tooth angulation of 90 degrees

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7
Q

describe how to obtain correct angulation

A
  • tilt the lower shank toward the tooth
  • correct = 60-80 degrees
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8
Q

what are the 6 calculus removal steps

A
  1. stabilization
  2. adaptation
  3. angulation
  4. lateral pressure
  5. controlled, short strokes
  6. various stroke directions
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9
Q

how to achieve the correct working end for anterior teeth with the SH6/7

A
  1. place the working end interproximal on an anterior surface away
  2. make the handle parallel to the tooth
  3. the terminal shank should slightly cross the surface away
  4. for surfaces toward do the same thing, the terminal shank should slightly cross the surface toward
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10
Q

what sequence should we always remember

A

me, my patient, my light, my mirror, my grasp, my finger rest, my adaptation

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11
Q

what are the steps for anterior sickle scaling

A
  1. Position the tip-third of the working-end near the midline of the tooth.
  2. Tilt the terminal shank toward the tooth surface to establish correct angulation
  3. make strokes across the facial surface toward the mesial/distal
  4. roll the instrument at the line angle to maintain adaptation of the tip third (60-80)
  5. go at least halfway across the mesial/distal surface
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12
Q

how to chose the correct working end of a posterior sickle that is double ended

A
  1. use the terminal shank
    - establish a finger rest
    - place the working end interproximal
    - terminal shank should go up and over the tooth (parallel to the distal surface)
    * incorrect is down and around
  2. inner and outer cutting edges
    - hold the instrument to look down at the face
    - determine which cutting edge is closer to the handle
    - inner cutting edge is closer, outer cutting edge is farther
    - inner is used for distal surfaces
    - outer is used for facial, lingual, and mesial surfaces
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13
Q

for posterior sickles, what is the correct angulation

design alert

A
  • still 60-80
  • the face is still perpendicular to the terminal shank
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14
Q

what creates an incorrect angulation for posterior sickles

A

positing the terminal shank parallel to the tooth, creates a 90 degree incorrect angle

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15
Q

steps of using a posterior sickle

A
  1. select correct working end
  2. position tip third at the distobuccal line angle and work toward the distal
  3. check your angulation (60-80), tilt the lower shank toward the tooth surface
  4. reposition at the distobuccal line angle with the tip facing forward, tilt the shank toward the tooth
  5. go across the buccal
  6. roll to adapt to the interproximal
  7. go atleast half way
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16
Q

universal curet design

A
  • used in anterior and posterior
  • can remove supragingival and subgingival calculus deposits
  • rounded back
  • rounded toe
  • semi-circle cross section
  • face is perpendicular to the lower shank (90)
  • two cutting edges are level with one another
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17
Q

universal curet, how to determine the correct working end in the posterior

A
  • lower shank should be parallel to the distal surface
  • functional shank goes up and over the tooth
  • INCORRECT: lower shank is not parallel, functional shank goes down and around
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18
Q

steps of using a universal curet in a posterior sextant

A
  • distofacial line angle back and halfway across the distal surface
  1. Place the working-end toe third in the “Get Ready Zone” near the distofacial line angle; Toe of working-end “points” toward the distal surface
  2. Lower handle; Gently insert beneath the gingival margin, Face should hug the tooth surface
  3. Establish angulation; Lock the toe-third to the tooth surface; Make strokes around the line angle and halfway across the distal surface (SHOULD BE 70-80 DEGREE ANGLE)
  • distofacial line angle forward and across the mesial surface
  1. Place the working-end in the Get Ready Zone near the line angle on the facial surface; Toe “points” forward
  2. Make sure that the face hugs the tooth surface; Gently insert the working- end beneath the gingival margin.
  3. Work across the facial surface; Roll the handle as you approach the mesiofacial line angle
    (SHOULD EXTEND PAST THE MIDLINE OF THE MESIAL)
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19
Q

how to determine the correct working end of a universal curet in the anterior

A

For anterior teeth, the lower shank of a universal curet should be ACROSS the tooth surface; use visual cues

incorrect: cutting edge is not properly adapted to the tooth and the lower shank is NOT crossing the tooth

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20
Q

true/false: only the inner cutting edges are used on anterior teeth with a universal curet

A

FALSE: Only the outer cutting edges of a universal curet are used on the anterior teeth.

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21
Q

how to insert a universal curet under the gingival margin

A
  1. Establish 0-Degree Angulation
    - Position the working-end so that the face is hugging the tooth surface. (closed angle)
  2. Gently insert beneath the gingival margin.
    - Imagine the face sliding along the root surface.
  3. Then establish angulation for exploratory strokes (50-70 degrees) or root debridement strokes (60-70 degrees)
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22
Q

steps of using the universal curet in the anterior

A
  1. place the working-end in the Get Ready Zone near the midline; Toe of working-end “points” toward the mesial surface
  2. Establish 0-degree angulation with face hugging the tooth surface; Gently insert beneath the gingival margin
  3. Adapt the toe-third to the root surface; instrument from the midline of the facial toward the mesial surface
  4. Roll the instrument handle as you approach the mesiofacial line angle to maintain adaptation.
  5. continue at least half way across the mesial
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23
Q

EXPLORATORY STROKE/ ASSESSMENT STROKE DETAILS (4)

A
  • angulation is 50-70
  • fingers are relaxed in modified pen grasp
  • flowing, feather light strokes of moderate length
  • contacts the tooth, but no pressure is applied against the tooth
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24
Q

DETAILS OF ROOT DEBRIDMENT STROKES (2)

A
  • used to removed subgingival biofilm, residual calculus, or surface irregularities
  • angulation is 60-70
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25
Q

assessment stroke

  • purpose
  • used with
  • lateral pressure
  • character
  • number
A

purpose: assess tooth anatomy, detect calculus/plaque retentive factors

used with: probes, explorers, curets

lateral pressure: contact with tooth, light pressure

character: flowing, feather light stroke, moderate length

number: many overlapping strokes to evaluate the entire root surface

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26
Q

calculus removal stroke

  • purpose
  • used with
  • lateral pressure
  • character
  • number
A

purpose: to lift calculus deposits off of the tooth surface

used with: sickle scalers, curets

lateral pressure: firm pressure

character: brief, short, tiny biting strokes

number: limited to areas with calculus deposits

27
Q

root debridement strokes

  • purpose
  • used with
  • lateral pressure
  • character
  • number
A

purpose: to completly remove all residual/remaining calculus deposits; disrupt plaque biofilm from root surfaces within deep periodontal pockets

used with: area specific curets only

lateral pressure: moderate pressure

character: moderate length shaving strokes

number: many, multidirectional strokes; covering the entire subgingival root surface

28
Q

SUBGINGIVAL INSTRUMENTATION (5)

A

A series of overlapping strokes produced by a
sequence of vertical, oblique, and horizontal
strokes

Clinician can use all three types of strokes in
succession to instrument all aspects of the root surface, sometimes called a “crosshatch pattern”

Working-end contacts the tooth surface in narrow 1- to 2-mm strips

Root convexities and concavities only permit
adaptation of the toe-third of a cutting edge to
root surface

For successful instrumentation visualize the root surface covered in series of narrow strips

29
Q

INSTRUMENTATION ZONES (3)

A

Visualize dividing the root surface into narrow
strips

Each narrow strip is an “instrumentation zone”

Start with zone 1, then zone 2, finally zone 3

30
Q

steps for calculus removal (8)

A
  1. get ready, place working end in correct spot
  2. insert curet working end (hug the tooth with the face)
  3. assess, use assessment strokes first
  4. position the working end just apical to calculus deposit
  5. cup the working end (calculus deposit with the curet)
  6. lock the toe third and open the face (open to 80 degrees)
  7. activate calculus removal stroke, keep toe third cutting edge against root surface, make a short biting stroke AWAY from the base of the pocket
  8. pause briefly between strokes, relax fingers in the grasp, use a relaxed grasp to reposition
31
Q

what are the differences between the barnhart 1/2 and barnhart 5/6

A

barnhart 1/2: longer lower shank, ideal for deeper pockets, allows extended reach around posterior teeth

barnhart 5/6: shorter lower shank

32
Q

ORAL HYGIENE INDICES

USED IN ______ AND ______

DETERMINES AND RECORDS _________ OF INDIVIDUALS AND ______

A

used in CLINICAL PRACTICE and COMMUNITY PROGRAMS

determines and records ORAL HEALTH STATUS of individuals and GROUPS

33
Q

what are the types of scoring methods (4)

A
  1. Individual Assessment Score
  2. Clinical Trial
  3. Epidemiologic Survey
  4. Community Surveillance
34
Q

what is the purpose of an individual score assessment

A
  1. education
  2. motivation
  3. evaluation
    - evaluates progress of healing after treatment
    - measures effects of patients oral care efforts
35
Q

what are the uses of the individual assessment score

A
  • helps patient recognize oral problem
  • determine the effectiveness of a treatment
  • motivate the patient
  • evaluate succuss of oral self care over a period of time
36
Q

purpose and uses of CLINICAL TRIAL oral health indices

A

PURPOSE
- comparing experimental/control groups
- EX: gingival index and patient hygiene performance

USES
- determines baseline data before the experiment is introduced
- measures specific agents for biofilm control
- measures the effectiveness of toothbrushes, interdental aids, etc.

37
Q

purpose and uses of EPIDEMIOLOGIC SURVERYS

A

PURPOSE
- study of disease in a population
- trends/patterns of oral health and disease within a population
- EX: DMFT

USES
- determine prevalence/incidence of condition within a population
- provide baseline data
- provide data to support public health interventions

38
Q

purpose and uses of COMMUNITY SURVEILLANCE

A

PURPOSE
- oral health screenings by government agencies, community based services, and professional associations

USES
- assess the needs of the community
- help plan community based health promotion
- compare the results of community based programs

39
Q

what oral health indices are used for ORAL HYGIENE STATUS (5)

A
  1. Biofilm Index (Plaque Index)
  2. Biofilm Control Record (Plaque Control Record)
  3. Biofilm-Free Score
  4. Patient Hygiene Performance (PHP)
  5. Simplified Oral Hygiene Index (OHI-S)
40
Q

what oral health indices are used for GINGIVAL AND PERIODONTAL HEALTH (3)

A
  1. Periodontal screening and recording (PSR)
  2. Eastman interdental bleeding
  3. Gingival Index (GI)
41
Q

what oral health indices are used for DENTAL CARIES (3)

A
  1. Decayed, Missing, and Filled Teeth (DMFT)
  2. Early Childhood Caries (ECC)
  3. Root caries index (RCI)
42
Q

what oral health indices are used for FLUOROSIS

A
  1. Dean’s Fluorosis Index
43
Q

BIOFILM INDEX:

purpose
procedure
scoring methods

A

PURPOSE
- assess the thickness of biofilm at the gingival margin

PROCEDURE
- evaluate biofilm at the cervical 1/3
- apply disclosing agent and use explorer
- assess mesial, distal, lingual, and buccal surfaces

SCORING
- assign a score for each SURFACE
- score by tooth: add scores for each surface and divide by 4
- score for individual: add scores for all teeth, divide by # of teeth examined

44
Q

BIOFILM CONTROL RECORD

purpose
procedure
scoring
goals/ ideal level

A

PURPOSE
- record the presence of biofilm

PROCEDURE
- assess facial, lingual, mesial & distal surfaces of ALL teeth
- Disclosing agent if needed
- Determine presence of biofilm at gingival margin
- Record by making dash (none) or coloring in appropriate spaces
- not attempting to determine the quantity

SCORING
- total number of teeth X 4 = total surfaces
- divide surfaces with biofilm by total surfaces
- multiply by 100 to make it a %

GOAL
- good goal is to decrease by 10%
- IDEAL LEVEL OF BIOFILM IS 10% OR LESS

45
Q

PATIENT HYGIENE PERFORMANCE (USED IN CLINIC)

purpose
teeth selection
procedure
scoring

A

PURPOSE
- assess the EXTENT of biofilm/debris over the tooth surface

TEETH SELECTION
- posterior: 3B, 14B, 19L, 30L
- anterior: 8F, 24F
- first first molars are missing, evaluate a second
- if 8/24 are missing, evaluate adjacent incisors

PROCEDURE
- disclosing agent
- divide each surface into 5 sections
- record PHP score

SCORING
single tooth: add scores for all five sections
score for individual: add score for all teeth and divide by # of teeth examined (6)

46
Q

SIMPLIFIED ORAL HYGIENE INDEX (OHI-S)

can be split into:
purpose
teeth selection
procedure
scoring

A
  • can be split into SIMPLIFIED DEBRIS INDEX (DI-S) and SIMPLIFIED CALCULUS INDEX (CI-S)

PURPOSE
- assess oral cleanliness by estimating teeth with calculus and/or debris

TEETH SELECTION
- buccal of maxillary first molars
- lingual of mandibular first molars
- facials of 8 and 24
- (same teeth as PHP)

PROCEDURE
- determine simplified debris index score
- determine simplified calculus index score
- use explorer to assess calculus

SCORING
- determine the DI-S and CI-S separately by add the scores of all teeth and dividing by 6
- determine OHI-S by adding the scores of DI-S and CI-S

47
Q

what is the criteria for calculus index

A

0 - no calculus present

1 - supragingival calc covering NO MORE than 1/3 of the tooth surface

2 - supragingival calc covering MORE than 1/3 of the tooth but less than 2/3; or presence of subgingival FLECKS

3- supragingival calc covering MORE THAN 2/3 of the tooth; heavy band of subgingival calc

48
Q

what is the criteria for debris

A

0 - no debris or stain

1 - soft debris covering no more than 1/3 OR presence of extrinsic stains w/o debris

2 - soft debris covering more than 1/3, no more than 2/3

  1. soft debris covering more than 2/3
49
Q

PERIODONTAL SCREENING AND RECORDING (PSR)

purpose
procedure
codes

A

PURPOSE
- assess the state of periodontal health in a rapid and effective manner and motivate the patient to seek treatment

PROCEDURE
- divide mouth into sextants
- use the WHO probe
- assign a CODE per sextant regarding DEEPEST probe reading
- add an asterisk for furcation, mobility, or mucogingival problems

CODES
0- pockets are less than 3.5 mm, no calculus/overhangs, no bleeding after probing (black band completely visible)

1- pockets are less than 3.5 mm, no calculus/overhangs, has bleeding after probing (black band completely visible)

2- pockets are less than 3.5 mm, there are supra or subgingival calculus/overhangs (black band completely visible)

3- probing depths between 3.5-5.5 (black band partially visible

4- probing depth greater than 5.5 (black band is entirely covered)

50
Q

how to interpret PSR sextant scores

A

code 0- no need for periodontal treatment

code 1- oral hygiene instruction

code 2- OHI, removal of plaque retentive factors including all supra/subgingival calculus

code 3- OHI, root surface debridement

code 4- OHI, RSD, assess the need for more complex treatment, referral to a specialist may be indicated

51
Q

EASTMAN INTERDENTAL BLEEDING INDEX (EIBI)

purpose
procedure
scoring

A

PURPOSE
- assess the presence of inflammation in interdental areas as indicated by bleeding

PROCEDURE
- use a triangular wooden interdental cleaner
- gently insert interproximally (horizontally)
- slightly depress the papilla
- insert and remove 4 times
- record presence of bleeding within 15 min

SCORING
- record the number of bleeding interdental areas
- # of bleeding sites / total # of areas scored X 100

52
Q

GINGIVAL INDEX (GI) USED IN CLINIC

purpose
procedure
scoring

A

PURPOSE
- assess the severity of gingivitis based on color, consistency, and bleeding on probing

PROCEDURE
- can be done on a single tooth/ full dentition
- assess four gingival areas per tooth (M,D, B, L)
- gingiva and teeth must be dry; do this BEFORE applying disclosing solution
- insert probe near entrance of gingival sulcus (NOT TO THE BASE)
- SLIDE in a circumferential direction (NOT a walking stroke) use light pressure

SCORING
for a surface: each surface is given a score of 0-3

for a tooth: add scores for each surface and divide by 4

group of teeth: total the score for individual teeth and divide by number of teeth

for an individual: total scores for each tooth and divide by # of teeth OR add scores for all surfaces and divide by total # of surfaces

53
Q

how to we calculate GI in axium

A
  • groups of teeth that are already given to us (3, 9, 12, 19, 25, 28)
  • total scores for each tooth and divide by 6
54
Q

DECAYED, MISSING, AND FILLED TEETH (DMFT) OR SURFACES (DMFS)

purpose
selection of teeth/surfaces
procedure
scoring

A

PURPOSE
- determine total caries experience, past and present

SELECTION OF TEETH/SURFACES
- DMFT based on 28 teeth
- DMFS based on surfaces of 28 teeth (128)
- posterior surface: B, L, M, D, O
- anterior surfaces: F, L, M, D
- excluded teeth: 3molars, unerupted teeth, teeth that were restored/removed for reasons other than caries
- retained primary teeth

PROCEDURE
- decayed: visible caries or both caries and restorations
- missing: tooth extracted because of caries or non restorable
- filled: permanent or temporary restoration present (due to caries)

SCORING:
- Individual: total D, M, F separately then add

  • group: total DMFs for each individual; divide by # of people in the group; DMF average represents the accumulate dental caries experience for the group
55
Q

how to calculate % of decayed teeth and % of missing teeth due to caries

A
  1. Calculating percentage of teeth needing restorations:
    __D___ = % of decayed teeth
    DMF
  2. Calculating percentage of missing teeth due to caries
    _____M_____ = % of missing teeth due to caries
    Total # of teeth (28 if calculating for an individual)
56
Q

PRIMARY: DECAYED, MISSING, AND FILLED TEETH (dmft) OR SURFACES (dmfs)

purpose
selection of teeth/surfaces
procedure

A

PURPOSE
- determine dental caries experience for children

SELECTION OF TEETH/SURFACES
- dmft: 12 teeth evaluated (8 primary molars, 4 primary canines)
- dmfs: 56 surfaces total (8 molars X 5; 4 canines X 4)

PROCEDURE
- same for DMFT
- if decay and fillings are present, record decay
- if mixed dentition is present, evaluate separately (dmft and DMFT)

57
Q

EARLY CHILDHOOD CARIES (ECC) AND SEVERE EARLY CHILDHOOD CARIES (S-ECC)

purpose
selection of teeth
procedure

A

PURPOSE
- to provide case definitions that determine dental caries of children 5 years of age or younger

SELECTION OF TEETH
- only primary teeth are evaluated
- evaluate dentition as a whole

PROCEDURE
- assign either ECC or S-ECC
- community based surveys: identify percentage of children with ECC or S-ECC

58
Q

ECC Case Definition

what determines ECC for 0-3 years; 3-4 years, 4-5 years, and 5-5 years and 11 months

A

ECC: one or more teeth with decayed (either cavitated or non-cavitated), missing, or filled surfaces

59
Q

ECC case definition

S-ECC for:
0-3
3-4
4-5
5-6*

A

birth-3 years (0-35 months): one or more teeth with decay (cavitated or non cavitated), or fillings present on smooth surface enamel OR one or more teeth missing due to caries

3-4 years (36-47 months): one or more cavitated or filled smooth surfaces in primary maxiallary anterior teeth; AND one or more missing missing due to caries OR dmfs score of 4 or greater

4-5 years (48-59 months): one or more cavitated/filled smooth surfaces in primary maxillary anterior teeth, AND one or more missing teeth due to caries OR dmfs score of 5 or greater

5-6 years (60-71 months): one or more cavitated/filled smooth surfaces in primary maxillary anterior teeth; AND one or more missing teeth due to caries OR dmfs score of 6 or greater

60
Q

ROOT CARIES INDEX (RCI)

purpose
selection of teeth
procedure
scoring

A

PURPOSE
- determine total root caries experience for individuals and groups
- make comparisons

SELECTION OF TEETH
- up to four surfaces for each tooth (MDBL)
- only surface WITH recession are recorded

PROCEDURE
- adequate lighting and retraction
- identify root recession and carious lesions

SCORING
- RCI = ___(R-D)+(R-F)____ X 100
(R-D) + (R-F) + (R-N)

61
Q

DEANS FLUOROSIS INDEX

purpose
selection of teeth
procedure
scoring

A

PURPOSE
- measure prevalence and severity of dental fluorosis

SELECTION OF TEETH
- smooth surface enamel of all teeth

PROCEDURE
- assign score to each tooth depending on descriptive categories in scoring system

SCORING
- individual score: use highest score recording for 2 or more teeth
- community score: determine percentage of individuals in a population that receive scores in each category

62
Q

DEANS FLUOROSIS INDEX SCORING SYSTEM

normal
questionable
very mild
mild
moderate
severe

A

normal (0): smooth, creamy white tooth surface

questionable (1): slight changes from normal transparency

very mild (2): small, scattered opaque areas, less than 25% of surface

mild (3): opaque areas, less than 50% of surface

moderate (4): significant opaque and/or worn areas, may have brown stains

severe (5): widespread, significant hypoplasia, pitting, brown staining, worn areas, and/or a corroded appearance

63
Q

what do we document

A
  1. name of index/indices used
  2. score for calculated index (number)
  3. interpretation of index score (poor/fair/etc.)
  4. follow up instructions for the patient

DH Theory 1 (9 decks)

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