The use of fluorides provides the most effective method for dental caries prevention and control.
systemically and topically
Fluoride is made available at the tooth surface by two general means:
Fluoride is rapidly absorbed by passive diffusion from the stomach as hydrogen fluoride (HF)
Most fluoride is absorbed in how many min?
Stomach and small intestine
Fluoride is absorbed by the what most and the what second?
Milk and other foods help absorb fluoride more.
What carries fl for its distribution and elimination through out the body?
How many minutes does it take for max blood levels to be reached?
Approximately 99% of the fluoride in the body is located in the mineralized tissues
By the kidneys in the urine, and a small amt by sweat glands and feces
How is fluoride excreted?
what stage is fluoride deposited during the formation of the enamel , starting at the DEJ, after the enamel matrix has been laid down by the ameloblasts?
Pre-eruptive fluoride results in the development of shallower occlusal grooves, reducing the risk of fissure caries.
when does the first permanent molars began to mineralize?
from the blood plasma to the tissues surrounding the tooth bud
How is fluoride available to the developing teeth?
A form of hypomineralization that results from ingestion of an excess amt of fluoride during tooth development.
the first 2 yrs after eruption
Uptake is most rapid on the enamel surface during..
Fluoride concentration is greatest on the surface next to the source of the fluoride.
pulpal surface until after recession of the pd attachment when the root surface is exposed to the oral cavity.
For the dentin, the highest concentration is at?
Hypomineralized enamel absorbs fluoride in greater quantities than sound enamel
fluoride level is greater in exposed dentin than in?
The level of fluoride in cementum is lLOW and does NOT increase with age
In 1931 a chemist pinpointed fluorine as the specific element related to Colorado Brown stain.
Dr. Frederick McKay
Did extensive studies to find the cause of brown stain, now known as dental fluorosis. He noticed people in Col. Springs had significantly less caries. He associated the condition to the drinking water.
Dr. H. Trendley Dean
Helped determine the safe water levels for fluoride.
40-65% fewer caries in permanent teeth
Continuous use of of fluoridated water from birth can result in:
With fluoridation from birth, the caries incidence is reduced up to _____ in primary teeth
1.23% Acidulated Phosphate Flouride (APF) gel
a 4 min tray application is recommended 4 times per yr for individuals at a high risk for dental caries
5% Neutral Sodium Varnish
Fluoride varnishes are safe and effective, fast and easy to apply, and pt acceptance is good
Distance of tip movement measured in micrometer; determines power output of the instrument
speed of movement; number of cycles per sec the tip moves
Power driven scaling devices convert electrical energy (ultrasonic) or air pressure (sonic) into high-frequency sound waves
agitation in the fluids surrounding a rapidly vibrating ultrasonic tip
action created by the formation and collapse of bubbles in the water by high frequency sound waves surrounding an ultrasonic tip
type of rod with unusually high magnetic permeability used in magnetostrictive ultrasonic unit inserts
a unit of energy equal to 1000 cycles per sec
the therapeutic washing of the pocket and root surface to remove endotoxins and loose debris
space occupied by magnetic lines of force
ultrasonic scaling device that generates a magnetic field and produces tip vibrations by the expansion and contraction of a metal stack or rod
ultrasonic scaling device activated by dimensional changes in crystals housed in the handpiece
type of mechanical power-driven scaler that functions from energy delivered by a vibrating working tip in the frequency of 2500 to7000 cycles per sec
magnetostrictive inserts made of flat metal strips stacked, or sandwiched, together
a device that converts energy to power from one form to another
power-driven scaling instrument that operates in a frequency range between 25,000 to 50,000 cycles per sec to convert a high-frequency electrical current into mechanical vibrations
conventional magnetostrictive units
utilize a longitudinal stack of metal strips in the handpiece;moves in an elliptical pattern, all surfaces of the tip are active
utilize a fragile ferric rod that generates less heat than the conventional metal stack; rotates 360 degrees in three different planes; equal effectiveness
scaler devices feature a ceramic rod in the handpiece; moves in a linear pattern, forward and backward
placement and movement of the tip is specific: use only the terminal 2-3mm of the tip's lateral surface, keep terminal lateral surface of tip adapted at all times around the curvatures and line angles using wrist pivot
to remove supragingival calculus and tenacious stains, subgingival periodontal debridement; initial debridement: NUG patients and other pt's that can be relieved by removal of deposits; debridment of furcation areas following manual instrumentation, prior to oral surgery, removal of ortho cement; removal of overhanging margins of restorations
Why would you use an ultrasonic scaler?
Communicable disease, susceptibility to infection, respiratory risk, swallowing difficulty, cardiac pacemaker, demineralized areas, exposed dentinal surfaces, children.
What are the contraindications for an ultrasonic scaler?
Ultrasonic instrumentation will damage titanium surfaces unless the tip insert if covered with a specially designed plastic sheath
Ultrasonic scalers do not reduce the force needed to remove deposits, and it doesn't reduce the risk of carpal tunnel syndrome and other musculoskeletal disorders
There is no scientific evidence that that cumulative exposure to weak, time varying magnetic fields has caused any biological harm to any dental personnel
constant motion, correct angulation, ample water for cooling
What things are essential to safe operation during ultrasonic scaling?
Conventional or standard tip
traditional ultrasonic and sonic tips, bulkier than most curet tips, aka universal tips; generally used for mod to heavy deposit removal from supra or relatively shallow subg surfaces
Periodontal or Narrow-profile tip
thinner and longer tips provide better access to sub g surfaces; allow superior coverage of deep pockets and furcations; bladed and beveled tips are capable of removing calculus rapidly;
Plastic or carbon composite tip
dentin and titanium surfaces can be safely instrumented with the ______; a light gentle activation is all that is needed to remove soft and mineralizing deposits.
tip slightly curved in only one direction; designed to be used throughout the mouth, aka universal
tips have curvations to left and right designed to adapt to post surfaces of the teeth
used on supragingival surfaces for the removal of heavy calculus, stain, and orthodontic cement
straight or contra-angled tip designed for subg instrumentation
an .8mm sphere found on the tip designed for final flushing in furcations.
delivers water to the tip of the instrument
delivers water from the unit to cool the tip through the internal structure of the insert
not capable of removing calculus completely; will burnish calculus
high to med power
calculus can be removed using higher power settings provided the proper technique is employed; use of anesthesia permits maximum thoroughness while keeping the pt comfortable
feather like overlapping strokes
What type of stroke should you use during ultrasonic scaling?
deactivate power, remove the instrument tip from the embrasure, reposition the instrument and reactivate the power
What do you do when the tip binds in an embrasure?
scratches or gouging on the tooth surface, excessive heat build up, shock-like effect to patient
Keep the instrument tip moving at a moderate to slow pace with a feather light touch at all times to prevent what?
loop the cord and hold it between the ring finger and the little finger, drape the cord over the shoulder
How do you manage cord drag?
Use a light fulcrum or an extra oral or soft tissue fulcrum when using the ultrasonic.
Clinical endpoints for ultrasonic scaling
BOP eliminated, probe depths reduced, attachments levels same or improved, inflammation resolved, gingival appearance, size reduced, color normal;subg microflora: lowered in numbers, delay in repopulation; dental biofilm control record; improvement in scores approaching 100% biofilm free; tooth surface: smooth, no biofilm retentive irregularites; Quality of life factors: oral comfort with freedom from pain
Factors affecting healing
Severity of infection, noncompliance from the patient, tobacco use: smoking; systemic influences; root surface irregularities from incomplete debridement
With out personal daily biofilm control the microorganisms can return to pretreatment levels within an avg of how many days?
the disease producing gram - pocket microorganisms are changed to a health producing gram + flora
a form of antimicrobial agent produced by or obtained from microorganisms that can kill other microorganisms or inhibit their growth
use of specific chemical or pharmaceutical agents for the control or destruction of microorganisms , either systemically or at specific sites
with reference to the clinical attachment level, which is the position of the periodontal attached tissue at the case of a sulcus or pocket as measured from a fixed point
the union of connective tissue or epithelium with a root surface that has been deprived of it's original attachment apparatus
the reunion of epithelial and CT with root surfaces and bone such as occurs after an incision or injury
available for adsorption by the body
susceptible of degradation by biological processes, as by bacterial or other enzymatic action
tubular instrument placed in a cavity to introduce or withdraw fluid
treatment by means of chemical or pharmaceutical agents
local delivery of a chemotherapeutic agent to a site-specific area
a minimally invasive diagnostic procedure used in medicine to examine inaccessible tissues by inserting a fiber-optic tube into the body
invasion and multiplication of microorganisms in body tissues
caused by microorganisms that are part of the normal microbiota of the kin nose mouth and intestinal and urogenital tracts
caused by organisms acquired from outside the oral cavity or the host
open scaling and root planning
instrumentation performed after the area has been exposed by tissue removal or the tissue is separated and laid back as a flap
not responding to usual treament
visualization of the root surface during instrumentation, explore, instrument, and evaluate the root surface using indirect visual observation on the device monitor, increase the effectiveness and thoroughness of root debridement, augment subjective data collection with objective confirmation
What are the objectives of endoscopic root preparation?
adapted to provide fiber-optic imagine with magnification of 24x-48x
to provide a sterile barrier between the patient and the endoscope
to prove irrigation to the working field
to prove illumination to the working field
to capture images of the working field for display
for live viewing of the working field
specialized probes, curets, and retracting instruments
to maximize tissue visualization
Advantages of endoscopic root prep
quality of end product, tactile sensitivity, patient education, provide opportunity for noninvasive, definitive root therapy
treatment using antimicrobials aims to suppress and eliminate pathogenic microorganisms to allow the recolonization of the microbiota that are compatible with health
By arresting the infection using antimicrobial drugs, further loss of periodontal attachment and other periodontal destruction caused by microorganisms can NOT be prevented.
antibiotics are absorbed through the intestine and into the bloodstream, from there the drug is passed to the tissues, the antibiotic enters the pd tissues and passed into the sulcus by the GCF.
How are antibiotics delivered systemically to the pocket?
side effects, development of resistant strains, local concentration diluted by the time the drug reaches the pathogens, superimposed infection can develop as well as candidiasis, low compliance of the pt in following the prescription
What are the limitations of antibiotics?
NUG, NUP, Periodontal abscess formation, pericoronal abscess formation, combined periodontal/endodontic lesions
Systemtic therapy is used in what instances?
irrigation with an antimicrobial agent
what provides a supplemental therapuetic step and results in additional clinical benefits?
pt with sites not responding to traditional care, pt with gingivitis superimposed on periodontitis, pt with areas inaccessible to mechanical instrumentation bc of root contour, furcations, or depth of pocket
During the maintenance phase when would postprocedure irrigation be used?
professional irrigation requires a premedication before treatment in pts susceptible to the effects of bacteremia
medication used to treat the per infection is concentrated at the site of the infection
constant turnover and cleansing going on in the pocket
the action of irrigation is temporary because of the
providing medication over an extended period of time by being held in the pocket and released slowly
informal monitoring, feedback, and modifications in pt care
What does a plan for evaluation of pt care outcomes include?
use evidence based decision making approach to determine any necessary modifications to the ongoing treatment sequence or to plan maintenance care
prevent recurrence of previous infections, prevent new disease from starting, monitor educational and behavioral changes, monitor clinical signs of health and disease, provide specialized instruction for new implants, protheses and ortho appliances, offer motivational encouragement for self care and self eval
What are the purposes of the maintenance program?
mentally/physically disabled, diabetes, CVD or other condition, patient undergoing extensive dental care, rampant dental caries, orthodontic therapy
Special appt requirements (2-3 mo intervals) are needed for?
to prevent the initiation of disease in individuals without perio infection
to provide an interim study period for borderline pts with conditions that must be observed and further evaluated be4 a decision can be made to whether corrective surgery may be necessary
to slow the progress of disease in pts for whom corrective surgery and other advanced treatment are indicated but can't be implemented for reasons of health, economics, etc
to prevent the recurrence of disease and maintain the state of perio health attained during therapy
At every maintenance appt, wheter at 3, 6 or any other number of months, a pt of any age needs a complete reassessment, progress diagnosis, and maintenance care plan
maintenance care plan
OHI/motivation, perio scaling and debridement, dental caries control, supplemental care procedures
Initially- when a pt is new to the practice and they have severe advanced periodontal disease; Later during the reevaluation- after scaling an area that is nonresponsive to treatment; During maintenance
When are the three points during pt care that a hygienist in gen practice may confer with a dentist to determine the need for a referral to a periodontist?
pocket depth prohibits access for complete debridement; furcation involvment and other deep anatomical areas that cant be instrumented; Mucogingival problems; Periodontal disease that is refractory, or not responsive to thorough, usual treatment
A patient will need a referral to a periodontist when...
Inadequate dental biofilm control; lack of compliance with maintenance appts; incomplete professional treatment; tobacco use; systemic disease; genetic factors
What are the contributing factors for recurrence of periodontal disease?
name, address, phone number, instructions concerning appt frequency and available preferred day and time
For any plan, individual file information includes what?