WEEK ONE - THREE Flashcards
define caries
Transmissible disease that destroys tooth tissue
Primarily from Streptococcus Mutans
Metabolises sugars to produce acid = demineralising tooth structure over time
state some contraindications for selective polishing
- xerstomic patients [paste needs salivate to activate]
- demineralisation - WSL [prophy can chip structure away]
- exposed root surfaces [sens]
cautions
- mobile teeth
- painful teeth/ inflammed gingiva
- hypersensitivity
what is the stroke for a periodontal probe and what are THREE limitations on measurements
vertical walking bobbing stroke at 10-20 grams of pressure
- position of gingival margin
- interference of calculus deposits and overhanging restorations
- amount of pressure applied
clinical appearance of gingivitis
edema
erythema
bulbous - loss of knide edge papilla
bleeding
smooth/shiny gingiva
describe the two types of intrinsic staining
pre eruptive
- fluorosis
- dentinogenesis + amelogenesis imperfecta
- hypocalcification - WS or brown spots
post eruptive
- caries
- endo tx
list the speeds of the three types of handpieces and the types of burs suited for each
slow speed
- 500-5000rpm
- steel burs
- use of lubricant optional
- uses: caries removal, polishing
**intermediate high speed
**- 30,000 - 120,000 rpm
- fine-med grit diamond burs - use of water MANDATORY
- steel burs will NOT cut at this speed
- tungsten carbid burs tend to chatter and cause micro cracks in enamel at this speed
**ultra high speed **
- 250,000 - 450,000 rpm
- tungesten carbide at their most efficient in this range
- diamond also suitable [preferred bur to enter lesion/ remove bulk enamel]
- lubricant MANDATORY
Decribe homeostasis in the oral cavity
- resting pH should not fall below 6.3
- saliva neutralises pH –> should lie between 6.7-7.4 [aims to buffer pH back to 7]
name 5 variables that influence polishing [effectiveness, risk of tooth structure loss]
- abrasiveness of prophy paste
- contact time w tooth surface
- speed of rubber cup
- applied pressure on tooth
- site being polished
describe the stephan curve
illustrates the relationship between carbohydrate intake and oral pH
if intake is too frequent, the mouth pH continues to become more acidic, resulting in acid attacks, at 5.5 pH = deminerlisation starts of occur
spacing periods of sugar/carb intake allows the saliva to buffer the acidity and return to a neutral pH
define periodontal disease:
irreversible inflammatory gum disease resulting from poor brushing and OH. causes loss of periodontium [PDL, alveolar, cementum, gingiva]
periodontal pathogens:
fusobacterium nucleateum
tannerella forsythia
porphyromonas gingivalis
define scope of practice:
oral health assessment, diagnosis, treatment, management and preventive services from children to adults.
The scope of work includes restorative and fillings treatment, tooth removal, additional oral care and oral health promotion
outline clock positions:
seating positions around the patient - for right handed clinician 8-1
anterior towards = 8-10
anterior away = 11-1
posterior towards = 9
posterior away = 10-11
what are the FIVE func of PDL
- support
- sensory
- nutritive
- formative
- remodelling
general pathogenesis of periodontal disease
- ## mature biofilm accumulation + favours bacteria which induce a stronger host reponse
- periodontium attempts to heal itself [host response - chemical mediators] - healing process creates rich environment for sustaining damage and inflammation
risk factors for periodontal disease
site specific
- defective restorations
- calc depos
- tooth morpho, crowding
patient specific
- medications
- genetics
- smoking
- tobacco/alcohol
- prev hx of perio
- bleeding in probing
distinguish the WHO probe from the William’s probe
WHO
- 0.5mm ball at tip
- coloured band from 3.5-5.5mm
williams
- marked at 1,2,3,5,7,8,9,10
5 moments of hand hygiene
Moment 1 - Before touching a patient.
Moment 2 - Before a procedure.
Moment 3 - After a procedure or body fluid exposure risk.
Moment 4 - After touching a patient.
Moment 5 - After touching a patient’s surroundings.
List and describe the 3 most common modes of transmission of infection
(1) direct contact with blood, oral fluids, or other infected materials,
(2) indirect contact with contaminated objects, such as instruments, environmental surfaces, or equipment,
(3) contact of conjunctival, nasal, or oral mucosa - droplets containing microorganisms
What armamentarium is required for a prophylaxis?
Triplex
High volume excavator [HVE]
Slow speed handpiece
Prophylaxis paste
Rubber cups
Bristle brushes
is required for a prophylaxis?
What is rubber dam and why do we use it?
Latex or latex free sheet of rubber for isolating treatment site
Anchored by dental clamps and secured by a frame
Retracts + protects cheeks, tongues
Ideal isolation and dryness
Aids in cross infection control
Prevents contamination during endo
Limits contact of dental materials on soft tissue
Effective moisture control for hydrophobic dental materials
Improves visibility for operator
Prevents gagging when treating posterior teeth
List all the uses for a dental mirror
indirect vision
light reflection
retraction
tissue protection
As a CSU graduate, up to what age can dental therapy services be provided to patients?
26
What part of the mouth does ‘dental caries’ affect?
Tooth decay starts with the acid from plaque attacking your tooth enamel.
define Periodontium
Periodontium, the supporting structure for the teeth
consists of periodontal ligament, cementum, gingiva, and alveolar bone.
define Periodontal ligament:
soft connective tissue between the inner wall of the alveolar socket and the roots of the teeth.
periodontal ligament connects the cementum of each tooth to the surrounding alveolar bone
define Cementum:
the calcified or mineralized tissue layer covering the root of the tooth which sits inside the gum socket.
define Alveolar process:
(also known as the alveolar bone) is the structure that holds the roots of your teeth in place
define Explorer
a thin and flexible stainless steel instrument, with a sharp tip.
examine the surface of patient’s teeth, and detect calculus defects or irregularities - Tactile sensitivity is essential to effectively examine the tooth surface and detect calculus.
define Calculus
calcified dental plaque, composed primarily of calcium phosphate mineral salts deposited
List and describe what the gingiva is made up of (hint – there are 4 things to list)
- Free gingiva
- UNATTACHED portion of gingiva surrounding neck of tooth - Gingival sulcus
- V shaped space between free gingiva and tooth surface
- Periodontal probe inserts here to assess health
- base of the sulcus is formed by the JE
- NO fluid found in healthy sulcus [fluid flow = plaque = inflammation]
- healthy pocket = 1-3mm - Interdental gingiva/papilla
- Portion of gingiva that fills area between two adjacent teeth apical to the contact area [on top of contact]
- col = lies apical to contact - Attached Gingiva
- attaches to alveolar bone
- between the free gingiva and the alveolar mucosa
- firm and resilient
What is deemed a healthy clinical appearance of the gingival tissues?
Colour = coral pink with or without pigmentation
Contour = Scalloped and knife edge variations depending on tooth shape, arch alignment, location and size of IP contact
Surface texture = stippled attached gingiva
Shape = knife edged interdental papilla
Consistency = first and not retractable with air
What is the purpose/function of an explorer?
What are the advantages of the 11/12 explorer?
used for detection of subgingival and supragingival calculus in anterior and posterior teeth.
can be used in healthy pockets and deep periodontla pockets
List the types of periodontal probes
who probe
williams probe
cp11
nabesr probe
List and describe the 3 types of dental burs
steel burs
- for SS hp under 5000 rpm
- each bur has ~ 8 blades and some can cut dentine/ caries removal
tungsten carbide burs
- for HS hp –> 100,000 rpm [best capacity > 300,000 rpm
- bur has 6 blades for cutting edge support
- cuts metal and dentine well but prone to micro cracks in enamel –> not indicated for MID
- short clinical life
diamond burs
- abrade tooth surface instead of cutting or chipping
- more efficient at HS
- mandatory to finish all cacvity margins with fine diamond stone at 25u grit or less at 400,000 rpm
define
Cutting edge:
Functional shank:
Lower shank:
Functional shank
Portion of shank that allows working end to be adapted to tooth surface
Terminal // Lower shank [ closer to tip]
Portion of functional shank nearest to working end
define Instrument stroke:
Instrumentation strokes made in a coronal direction, away from soft tissue base of sulcus or pocket
Calculus removal strokes
Exploratory strokes to detect calculus
define
pit
fissure
pit
Small pinpoint depression located on junction of developmental grooves or at groove terminals
Can be found on ant + post teeth on Palatal, Occlusal, Buccal surfaces
fissure
Deep invaginations of enamel
Defined as deep clefts between adjoining cusps found on posterior teeth
why is note taking essential for best practice dental care
protect ourselves
patient safety -ensuring everyone is onboard w pt tx
providing good dental care - ensuring the next provider is able to continue optimal treatment
documenting for future research projects
documents baseline health for the progression of caries/diseases
What are the different components of a working-end?
Face
Back
Lateral surfaces
Cutting edges [where face and lateral surfaces meet]
Most working ends have two cutting edges
Toe or tip
Working ends = either round toe / sharp tip
Describe the significance of the cross-section of an instrument. Explain how the shape of the cross-section
affects where an instrument can be used in the mouth
cross sections indicated where the instrument can be used
Triangular cross sections = LIMITED to supragingival use
Will cause gingival trauma if used subgingivally
Eg sickle scalers
Semi-circular cross section = supragingival + subgingival use
Eg curets
Explain the difference between a simple shank and a complex shank
simple shanks are more straight - designed for use on anterior teeth
complex shanks and more angled and have more bends to reach posterior teeth
List the 3 instrument stroke directions and the 3 types of strokes
vertical
horizontal
oblique
- assessment stroke // exploratory stroke
- evaluates tooth surace, located calc depo
- using explorers - calc removal stroke
- used to lift calc depo off tooth surface
- using curets and sickle scalers - root debridement stroke
- used to remove residual calc dpo, bacterial plaque
- using curets
Where in the mouth is a sickle scaler used? What are its uses?
suited for anterior teeth to remove supragingival plaque and calc
Where in the mouth is a universal curette used? What are its uses?
used for periodontal scaling, calculus debridement and root planing to remove small / medium size calc depo and can be used both supragingivally and subgingivally.
mostly posterior - also suitable for anterior
How do you select the correct working-end on a universal curette for use on a tooth surface?
Working end should be facing towards clinician when working on towards surfaces vice versa
Working end should be flush with the tooth as to not catch in subgingival space
“V” between junction working and terminal end should be facing midline of tooth
What are the indications for a fissure sealant?
Plaque retentive pits and fissures in permanent molars in med-high risk children for caries
Premolars + posterior teeth should be sealed in children at high risk of caries
In low risk children → only deep and plaque retentive fissures usually considered for sealants
Not limited to age but tooth history and patient OH
List the steps for placement of a fissure sealant
Isolate with rubber dam
Clean fissures using bristle brush and pumice/ water
Apply etchant [37% phosphoric acid] - 30 seconds
Rinse thoroughly [5-10 seconds]
Dry until tooth has frosted appearance [matte]
Apply Conseal F-white sealant to fissures using Dycal applicator
Light cure - 20 secs
Wash and wipe tooth
Check occlusion with articulating paper
How does a fissure protection differ from a fissure sealant?
Fissure protection treatment using GIC allow for a quicker and cheaper application in a moist environment
Cheaper and quicker [less instruments required]
Less retention than resin but even if material chips away - particles remain and provide barrier to teeth
Release fluoride overtime and are recharged with physical fluoride application
Lower longevity than resin
GIC penetrates deeper into fissures/ pits
semi-permeable membrane]
Resin fissure sealants are hydrophobic and require complete moisture control for a successful micromechanical adhesion
Greater longevity
Hardens with UV light curing
Why would a fissure protection be selected as a treatment option instead of a fissure sealant?
Fissure protection treatment using GIC allow for a quicker and cheaper application in a moist environment
Resin fissure sealants are hydrophobic and require complete moisture control for a successful micromechanical adhesion
GIC is advantageous for
- young children or in treatments which need to be completed quicker
- added benefit of fluoride - cases where patients are not seen frequently [low SES]
- hypoplasia/ hypomineralisation has etch in sealants tx not appropriate
