Testtwo-theory
About this set
Created by:
jenn_m_2003 on October 15, 2011
Subjects:
Log in to favorite or report as inappropriate.
Order by
119 terms
Terms | Definitions |
|---|---|
 then - mechanical irritants cause of perio, treat by scaling to remove depositsnow- bacterial pathogens overwhelm host's immune response, now control pathogenic bacteria | Etiology: |
| then- complete calculus removal is necessary for healing now - remove all clinically detectable deposits | Calculus removal |
| then - deeply imbedded in cementum, had to root plan to glassy smooth now - toxins loosely associated with outer layers of cementum, easily removed with light instrumentation or ultrasonic acoustic turbulence | Bacterial endotoxins |
| then- subgingival instrumentation limited to roots now - instrument the entire pocket =root, pocket space, soft tissue wall, adherent plaque removed from tooth, unattached plaque removed from pocket space, ultrasonic instruments of choice for unattached plaque, lavage beneficial | Treatment of pocket environment - |
| then skilled clinician can detect all now - skilled clinician effective 50% on residual calculus | Detection of residual calculus |
| then - too technically difficult beyond 5 mm now - closed debridement as successful as surgical debridement at all levels of disease | Closed debridement |
| then- limited to supra use now- as effective as hand scaling, detoxify root surface | Ultrasonic instrumentation |
| then- all root surfaces within a pocket MUST be root planed now-extent of instrumentation necessary to achieve tissue health varies, when tissue does not respond then root plane | Extent of subgingival instrumentation |
| >Instrument tooth surface - clean and smooth -Remove calculus - explorer detection, smooth -Biologically acceptable root surface -Soft tissue response >Disrupt plaque -Reduce microorganisms below the client's threshold >Restore gingival health -Monitor plaque control -Decrease inflammation -Clinician maintain healthy microbial environment -Create environment client can maintain -Create maintainable pockets -Sufficient time for healing >Create an environment client can maintain -Inform client of treatment limitations | Goals of Instrumentation |
| - mechanical instrumentation of the crown & root surface of the teeth to remove plaque, calculus, and stains Outcome assessment - all clinically detectable calculus removed | Scaling |
| - definitive treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus Rationale Smooth root surface so as to decrease surface where plaque & calculus may attach Outcome - instrument all of root surface, NOT glassy smooth "Rifled" roots | Root planing |
| - supra/subgingival debridement & deplaquing with minimum of tooth structure removal Removal of foreign material including biofilm, its by-products, toxins, calculus, Crown, root, pocket space, pocket wall, underlying tissue Conserve tooth & root surface Combination of hand & ultrasonic instrumentation | Debridement |
| - preventive procedure to remove local irritants Biofilm, calculus, stain | Prophylaxis |
| - polishing agents to remove stains & plaque Selective polishing | Coronal polishing |
| Mechanical disruption of non-attached subg. Biofilm & by-products from sulcus Re-evaluation appt & MTX | Deplaquing |
| -Arresting progress of periodontal disease by removing: Biofilm Biofilm retentive calculus -Create an environment that assists in maintaining tissue health Increase the effectiveness of patient self-care Eliminate areas of biofilm retention -For a periodontally involved tooth, the primary pattern of healing is through the formation of a long junctional epithelium Maybe also gingival recession | Rationale for Periodontal Debridement |
| - gross scaling leaves behind partially removed deposits that are rough, irregular and covered with bacteria As the marginal tissue shrinks, it closes off the entrance to the pocket, providing a protected environment and the microorganisms continue to grow | Proliferation of microorganisms |
| - incomplete calculus removal allows the gingival margin to tighten around the tooth, prevents drainage of bacterial toxins = can develop into perio abscess. Medically compromised and clients with deep infraboney pockets are at risk | Abscess formation |
| -Tight marginal tissue at subsequent appointments | Difficult instrumentation |
| - removable of visible deposits combined with improved appearance of gingiva may influence the client to forego future treatment "What they can't see can hurt them" | Decreased client motivation |
| -Multiple appointments in which the entire mouth is instrumented ... "I thought you cleaned all of my teeth at the last appt.?" | Client frustration |
| incomplete calculus removal/healing at the margin present problems: proliferation of microorganisms abscess formation difficult instrumentation decrease client motivation client frustration | Gross Scaling |
| -treat as many teeth as you can treat thoroughly at one appointment -complete one sextant/quadrant same side of mouth -start with sextant and then move to quad *Start most infected quad OR area of client's chief complaint | Sextant/Quadrant |
| 1. Treat as much as you can in posterior sextant before moving on to the anterior teeth 2. Always scale one side of the mouth - increased client comfort, they can eat in comfort 3. Start in area with deeper pockets unless client has chief complaint concentrate another area 4. Divide posterior and anterior - different instruments instrument facial and lingual surfaces of posterior sextant before moving on | Sextant/Quadrant |
| Scale entire mouth in 2 appointments scheduled 24 hours apart (medical model) 2 week use of CHX mouth rinse Microorganisms do not have time to repopulate areas -Sextant scaling modified plan >>> clean sextant by sextant and then at the last appointment use ultrasonic on entire mouth | Full Mouth Disinfection |
| Instrument selection determined by: type and location of deposits probe =extent. Location and characteristics of clinical attachment loss explorer = determine amount, location and distribution calculus use curette for calculus detection to avoid switching back and forth supragingival calculus first with sickle subgingival next with curette OR ultrasonic = instrument entire pocket, begin coronally, ADAPT tip into interproximal areas | Sequence |
| healthy tissue biologically acceptable root surface | Goal |
| probing, clinical attachment levels, bleeding, PI tissue tone, contour, color | Reevaluation |
| Re-evaluate for residual calculus root surface rough? - root plane deplaque with ultrasonic additional factors - host factors, dental factors supportive factors - antibiotics ..... | Non-responsive? |
| Requires good instrument control patience knowledge of root morphology sense of dimensions of subgingival space | Root Planing |
| close the angulation if all calculus removed lighter grasp lighter shaving stroke light lateral pressure smooth strokes systematically overlap longer strokes with reduced pressure to help remove small scratches vertical then oblique strokes adaptation to unique root surfaces, convex and concave instrument becomes quiet as surface smoothes | Root Planing Instrumentation |
| Secure biologically acceptable root surface Resolve inflammation Reduce probing depth Facilitate patient's self-care Maintain attachment Prepare tissue for surgery | RPS: Indications-Goal |
| Anatomy of root Depth of pocket Position of teeth Inadequate diagnosis Inadequate instrumentation-deposit remains May cause recession as tissue heals | RPS: Limitations |
| Don't bite cheek/lip/tongue (anesthesia) Motrin for discomfort Rinse with warm salt water Meticulous home care - improve healing Sensitivity possible Avoid chewing "numb" side Call office with your concerns | Post Op Instructions |
| OHI is inadequate diagnostic testing systemic antibiotics refer to periodontist | At Re-Eval: Decreasing generalized probing depths with bleeding |
| OHI is inadequate diagnostic testing systemic antibiotics refer to periodontist surgery | At Re-Eval: Generalized pockets with bleeding status quo +/- 1 mm |
| diagnostic testing systemic antibiotics surgery refer to periodontist | At Re-Eval: Generalized pockets with increasing depths of =2 mm and bleeding |
| Single cutting edge Blade turned 99 degrees to shank Cutting edge beveled 45 degrees Anterior - straight shank Posterior - angled shank | HOE-Characteristics |
| Remove large tenacious supragingival calculus Ledges of calculus | HOE-Purpose: |
| In sulcus Gouges Lack of adaptability Lack of tactile sense Can not reach depth of pocket | HOE-Contraindicated: |
| Vertical PULL strokes -full width of cutting edge in contact with calculus -apply cutting edge and side of shank to tooth (diagram) - do NOT use on interproximal surfaces -pull stroke toward occlusal or incisal surface | HOE-Application: |
| Single, straight cutting edge Blade continuous with shank Cutting edge beveled at 45 degrees | Chisel-Characteristics |
| Supragingival exposed proximal anterior calculus Anterior teeth and some premolars Large "walls" of or ledges of calculus | Chisel-Purpose |
| Horizontal push stroke Facial to lingual -full width of cutting edge should be applied -do not nick or groove tooth surface -horizontal stroke only from facial to lingual -good for bridge of calculus | Chisel-Application |
| Multiple cutting edges lined up on a round, oval or rectangular base Blades 90-105 degrees to shank Shanks angulated for anterior/posterior Reduced tactile sensitivity Does not adapt well to curved surfaces Subgingival use if inserts easily beneath gingival margin | File-Characteristics |
| Removes calculus by crushing Smooth tooth at CEJ Hoe followed by curet to root plane root Smooth overhanging amalgam | File-Purpose |
| 2 point contact Entire file's surface against deposit Lower shank against tooth PULL stroke only Adaptation to curved tooth surface difficult Pressure permits the cutting edges to grasp surface root planing - must follow with curette | File-Application |
| Area specific curette Disc shaped Continuous cutting edge | O'Hehir-Characteristics |
| Remove light residual calculus Remove bacterial root contaminants | O'Hehir-Purpose |
| Gentle push or pull in vertical, oblique, or horizontal | O'Hehir-Application |
| -anterior scaler; has two distinct working ends. -small thin sickle end paired with an oval disk-shaped end. The rigid terminal shank and the acute angulation of the disk end provide great access for anterior lingual surfaces. -disc removes heavy lingual calculus -pull stroke; can be used with horizontal, vertical and oblique strokes | Nevi 1 Scaler |
| -posterior scaler; a super thin posterior curved sickle with a pronounced contra angle. -interproximal reach and ergonomic hand positioning. | Nevi 2 Scaler |
| THIN TIP DESIGNS GIVE YOU ACCESS WHERE TRADITIONAL CURETTE BLADES WILL NOT FIT. AND THE DIAMOND COATING GIVES YOU THE CAPABILITY TO USE MULTIDIRECTIONAL STROKES. -mesial/distal -like nabers probe for furcations | DiamondTec |
| -used for curved root surfaces -pockets greater than 4mm -a + indicates lower cutting edge | Curvette |
| Point of support Stabilize the hand during instrumentation Most stable Controls stroke pressure and length Precise stroke control Provided leverage and power for instrumentation Excellent tactile transfer to fingers Allows forceful stroke pressure with least amt. of stress to hand/fingers Decrease the likelihood on injury to the patient if they move during treatment Fulcrum same arch On tooth near the tooth being worked on Most desirable | Basic Intraoral Fulcrum |
| May be difficult to obtain parallelism of the lower shank to the tooth surface for access to deep pockets May not be practical to try to fulcrum on edentulous areas | Intraoral Fulcrum Disadvantages |
| Require greater clinician skill & stroke control Helpful in areas of limited access Use selectively Master fundamentals first NOT intended to replace basic intraoral Variations of the basic fulcrum to aid in access to Posterior teeth Root surfaces with pockets | Advanced Fulcrum Techniques |
| Easier access to maxillary 2nd & 3rd molars Easier access to deep pockets on molars Improve parallelism of lower shank to molars Facilitate neutral wrist position for molars | Advanced Fulcrum Advantages |
| Greater degree of muscle coordination & instrument skill Greater risk for instrument stick Reduced tactile information May cause muscle strain Difficult for clients with TMJ problems | Advanced Fulcrums Disadvantages |
| - middle and ring finger contact one another near middle knuckle Standard modified pen grasp - middle and ring finger contact one another near the tips of the fingers Advantages -good stable support for clinician's hand while improving access to difficult to reach proximal root surfaces of max molars -provides leverage, strength, and good stroke control -provides good tactile sensitivity -improves parallelism of lower shank to proximal surfaces Disadvantages -more muscle control than standard intraoral | Altered modified pen grasp |
| Stack middle finger on top of ring finger Improves access to man posterior Advantages: -improves access to man posterior aspects away from the clinician -enhances the whole hand working together as a unit Disadvantages -Difficult for clients with limited opening | Piggy Back |
| Resting ring finger on a tooth on the opposite side of the same arch Advantage Improved access to lingual of man posterior Disadvantages Grasp middle of instrument handle Stroke control more difficult Decreases tactile sense | Cross Arch |
| Rest ring finger on opposite arch from treatment area Advantages: Facilitate access to deep pockets, max post Facilitate parallelism Disadvantages: requires clinician to grasp near midpoint of handle makes stroke control more difficult decrease tactile sense may be uncomfortable for clients with TMJ problems | Opposite Arch |
| Place ring finger of dominant hand on index finger of non-dominant hand Advantage Fulcrum in line with long axis of tooth Stable rest for fulcrum Improves access to deep pockets Disadvantages Possible instr. stick | Finger on Finger |
| Knuckle rest - clinician rests the knuckles against the client's chin or cheek Chin-cup - clinician cups the client's chin with palm of hand Advantage Facilitates instrumentation of proximal root surface of max molars Disadvantages -requires clinician to grasp near the midpoint of handle -stroke control more difficult -decrease tactile sense -least effective of all fulcrum | Basic extraoral Fulcrum |
| Use thumb or index finger of non-dominant hand against instrument shank Concentrates stroke pressure against tooth surface Control working end throughout instrument stroke Advantages -concentrated stroke pressure for removal of tenacious subgingival deposits -creates a well controlled instrument stroke -reduces muscle strain and workload for the non-dominant hand Disadvantages Non-dominant hand cannot hold mirror | Stabilize Finger Assist |
| Abnormal condition that occurs when vital dentin is exposed to the environment Painful stimuli reach pulp and cause pain | Dental Hypersensitivity |
| Rapid onset ... Sharp, short, or transient pain Sharp pain ... Presents as chronic condition with acute episodes Short duration ... Cessation from pain upon removal of stimulus Respond to stimuli Discomfort that cannot be ascribed to any other dental problem Pain from something that would normally not cause pain | Characteristics of Dental Hypersensitivity |
| Contact with TB, eating utensil, scaling instr | Tactile or mechanical Stimuli |
| Hot or cold foods or beverages; cold air | Thermal Stimuli |
| Air syringe | Evaporation-dehydration of oral fluids Stimuli |
| Alteration of osmotic pressure in tubules due to isotonic solutions of sugar and salt | Osmotic Stimuli |
| Acidic foods, fruit drinks, sport drinks | Chemical Stimuli |
| -Primary cause are exposed dentin and open tubules -10% of developing teeth Cementum does not meet enamel -Abrasion, erosion, abfraction, dental caries, over instrumentation -Less common is loss of enamel exposing dentin -Soft tissue loss Gingival recession Periodontal surgery Aggressive tooth brushing -Stage is set by: Recession Loss of cementum Dentin exposure | Etilology of Dental Hypersensitivity |
| -Covered by enamel on crown and cementum on root -Composed of fluid filled tubules, which become narrower in diameter as they extend from the pulp to the DEJ -Portals through which stimuli are transmitted to the pulp -Innervated with nerve fibers from the pulp chamber | Biology of Dentin |
| -Innervated with nerve fiber endings that extend just beyond the dentinopulpal interface of the dentinal tubules -Odontoblasts extend their processes from the dentinopulpal interface about 1/3 through dentinal tubules -Nerves exhibit excitability like any other nerve to a stimulus | Biology of Pulp |
| Effects of OH Use of medium -->hard brush Aggressive toothbrushing Narrow band of attached gingiva Tight and short frenum Periodontal surgery Aging process Oral piercing Tooth fracture Facial orientation of tooth Excessive instrumentation in shallow sulcus NUG Perio surgery - crown lengthening Ortho movement Restorative procedures .... Crown preparation Metal oral jewelry, oral piercings Attrition, abrasion Dietary erosion from acids Brushing immediately after consumption of acids Gastric acids from morning sickness, self induced Abfraction Frequent use of abrasive stain removal products Root surface caries | Factors Contributing to Gingival Recession & Root Exposure |
| -Cementum at cervical area is thin and subject to wear -Enamel and cementum do not meet -10% -Attrition, abrasion and erosion -Abfraction-Occlusal forces cause enamel rod fracture -Over-instrumentation - Improper stain removal | Loss of Enamel and Cementum |
| Calculus formation: "protective" covering Sclerosis of Dentin: Mineral deposition within tubules as a result of traumatic stimuli (attrition or caries) Thicker highly mineralized layer of peritubular dentin (deposited within periphery of tubules) Sclerosis results in a smaller diameter tubule that is less able to transmit stimuli through tubule fluid | Natural Desensitizers |
| -Odontoblasts deposit dentin on the floor and roof of the pulp chamber, which decreases the size of pulp tissue over time Occurs only after teeth fully developed -Creates a "walling off" effect between the dentinal tubules and the pulp to insulate the pulp from dentin fluid disturbances caused by a stimulus -As aging occurs, secondary dentin accumulates, resulting in smaller pulp chamber | Secondary Dentin |
| Formed in area where exposed dentin has been traumatized by a stimulus such as dental caries Similar to secondary dentin Insulates the pulp from dentinal tubule fluid disturbances | Tertiary Dentin/Reparative Dentin |
| Consists of organic and inorganic microcrystalline shavings of cementum, dentin Also contains tissue debris, odontoblastic processes and other microbial elements Temporary desensitization of teeth Teeth may become sensitive appx. 2-3 days after the appt. Plugs dentinal tubule orifice Smear plug, "bandage" Can dissolve by acids, disruption by ultrasonic, self-care Positive / negative effect - neg. may interfere with reattachment of periodontal tissues | Smear Layer |
| Stimulus at the outer aspect of dentin will cause fluid movement within the dentinal tubules, which signals the nerves in the pulp Dentinal tubules exposed Pain-producing stimuli present Initiate flow of lymphatic fluid within tubule Odontoblast and their processes act as receptor and transmit sensory stimuli Movement of tubular fluid cause nerve endings at pulpal wall to be stimulated and produce pain | Hydrodynamic Theory |
| 8-30% of adult population experiences hypersensitivity 20-30 years of age, peek Peek again @ 50 years Recession more prevalent among aged but dentin hypersensitivity is not-natural desensitization occur with aging Women report more pain then men Higher prevalence in perio patients Incidence and severity declines with advancing age due to the effects of sclerosis and secondary dentin Equally present in men and women BUT women report more frequently | The Sensitive Patient |
| Visual exam Radiographs Occlusal exam using marking paper Thermal testing Palpation/Percussion Evaluation of nasal congestion Mobility? Pain from biting pressure - Bite stick Transillumination Pulpal pathology | Diagnostic techniques and testing |
| Which teeth are sens.? On a scale form 1-10 what is your pain intensity How long does the pain last? What is the work that best describes the pain: sharp, dull, shooting, throbbing, persistent, constant, pressure, burning, intermittent Does it hurt when you bite down On a scale from 1-10 how much does the pain impact your daily life Is the pain stimulated by certain foods? Sweet, sour acidic Does sensitivity result from hot or cold Does discomfort stop immediately upon removal of the stimuli or does it linger How effectively are you managing the stress in your life? | Interview questions: |
| Carious lesions Caries into dentin Pulpal caries Recent restorative treatment Open or defective margins Recurrent caries Fractured restorations Fractured tooth Occlusal trauma Recent periodontal debridement Sinusitis Pulpal necrosis Cracked tooth Bruxism TMJ disorder Endodontic problems Abfraction Recent tooth whitening Periodontal ligament inflammation Galvanic pain Sudden sharp pain upon tooth to tooth contact | Differential Diagnosis |
| Dentin immediately surrounding the dentinal tubules | peritubular dentin |
| Dentin surrounding and in between adjacent dentinal tubules and their associated peritubular dentin | intertubular dentin |
| The space in dentin that contains or at one time contained an odontoblastic process. | dentinal tubule |
| -is the primary ingredient in OTC sensitivity reducing dentifrices ADA and FDA approval Acts to block the synapse between nerve cells reducing the excitation thus reducing pain Crest Sensitivity Protection Colgate Sensitive Maximum Strength Sensodyne Maximum Strength Tartar Control and Whitening | 5% potassium nitrate |
| - Acts to block the synapse between nerve cells reducing the excitation thus reducing pain | Potassium chloride |
| - Occlude or sclerosis of tubules thus reduce the flow into the tubules | Potassium or ferric oxalates |
| Stains dentin Sodium, stannous, and monofluorophosphate Occlude or sclerosis of tubules thus reduce the flow into the tubules | Stannous fluoride |
| also precipitates calcium fluoride crystals to decrease lumen size | Sodium fluoride |
| Fluoride varnish approved by FDA in 1994 Stannous Fluoride 5% Glutaraldehyde preparation Dibasic calcium phosphate and calcium hydroxide create calcium crystals or reparative dentin | Sclerosing Agents |
| Stannous Fluoride Strontium chloride Oxalates such as ferric oxalate and potassium oxalate | Occluding Agents |
| Iontophoresis Low voltage electric current is used to impregnate the tooth with ions from fluoride | Iotophoresis |
| Not FDA approved Expensive equipment Long-term studies needed to determine pulpal effects | Laser applied fluoride |
| FDA approved Sensi Stat Contains amino acid arginine in conjunction with bicarbonate and calcium carbonate Proclude used during professional prophylaxis Denclude is self-care patient product | Denclude and Proclude |
| New product by Omni NovaMin (calcium sodium phosphosilicate) NovaMin rapidly releases mineral-building ions to form a calcium phosphate mineral level which occludes dentin tublules | Soothe RX |
| Office Procedures: desensitizing toothpaste, Fl varnish, Fl Tx, Oxalates Re-eval in 3-4 wks: if symptomatic-retreat, change toothpaste, bonding if asymptomatic-reinforce proper OH | Localized sensitivity treatment |
| At Home Procedures: desensitizing toothpaste, sodium fl mouthrinses, stannous fl gels Re-eval in 3-4 wks: if symptomatic-modify toothpaste, in-office procedures if asymptomatic-reinforce OH | Generalized sensitivity treatment |
| meant for deeper pockets and smaller root surfaces | After Five Mini |
| finger rest can be further away doesn't hit opposing teeth has longer, more angles lower shank easier to position lower shank parallel | Gracey 15/16 and 17/18 |
| larger shank stronger shank less flexible shank remove medium deposits limits tactile sensitivity | Rigid Graceys |
| longer terminal shank +3mm reach deeper into pockets | After Five |
| 50% shorter working end allow a more vertical stroke | Mini |
| Anterior teeth all surfaces | Gracey 1/2; 3/4 |
| Anterior teeth: all surfaces Premolar teeth: all surfaces Molar teeth: facial, lingual, mesial surfaces | Gracey 5/6 |
| Anterior teeth: all surfaces Premolar teeth: all surfaces Molar teeth: facial and lingual surfaces | Gracey 7/8; 9/10 |
| Anterior teeth: mesial and distal surfaces Posterior teeth: facial, lingual, and mesial surfaces | Gracey 11/12 |
| Anterior teeth: mesial and distal surfaces Posterior teeth: distal surfaces | Gracey 13/14 |
| Posterior teeth: facial, lingual, and mesial surfaces | Gracey 15/16 |
| Posterior teeth: distal surfaces | Gracey 17/18 |
| Easier calculus removal -Sharp instr. Bites into calculus -Dull instrument burnishes calculus Improved stroke control -Dull cutting edge requires more lateral pressure to remove calculus -Excessive force with dull cutting edge increases likelihood of losing control of the stroke Reduced number of strokes -Fewer strokes with Sharp edge -Reduce overall treatment time Increased patient comfort & satisfaction -Sharp instrument requires less force, thus instrumentation is more comfortable -Sharp edge requires fewer, better-controlled strokes, shorter appointment Reduced clinician fatigue -Dull instrument requires more pressure & more strokes -Dull instrument increases stress and strain on clinician's musculoskeletal system | Advantages of Sharp Instruments |
| Dull edge: Slides over surface Sharp edge: Scratches the surface *Listen for the ping | Tactile evaluation of Sharp Instrument |
| Dull edge: reflects light, Rounded, Thick Sharp edge: does NOT reflect light, Edge has no thickness | Visual evaluation of a sharp instrument |
| (lido and prilocaine periodontal gel) 2.5% / 2.5% Liquid at room temperature, gel in pocket To be applied with Oraqix™ Dispenser 20 cartridges of 1.7 g and 20 blunt-tipped applicators (max. dose 5 cartridges per appt.) Onset—1 minute Duration—average 20 minutes Low toxicity, metabolized in liver, lungs, kidneys, excreted through kidneys | Oraqix |
First Time Here?
Welcome to Quizlet, a fun, free place to study. Try these flashcards, find others to study, or make your own.