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Modern Dental Assisting Chapter 58

Exogenous

Stains that developed from external sources and can be extrinsic or intrinsic

Extrinsic

Stains that occur on the external surfaces of the teeth that may be removed by polishing.

Fulcrum

Finger rest used when an instrument or handpiece is held for a specified time.

Intrinsic

Stains that occur within the tooth structure that can not be removed by polishing.

Oral Prophylaxis

The complete removal of calculus, debris, stains, and plaque from teeth.

Prophy Paste

Commercial premixed abrasive paste used for polishing teeth and restorations.

Rubber Cup Polishing

A technique that is used to remove plaque and stains from the coronal surfaces of the teeth.

Calculus

Calcium and phosphate salts in saliva that become mineralized and adhere to tooth surfaces.

Clinical Crown

The portion of the tooth that is visible in the oral cavity.

Coronal Polishing

A technique used to remove plaque and stains from the coronal surfaces of the teeth.

Endogenous

Stains that developed from within the structure of the tooth and can not be removed and are always intrinsic.

Indications

Before placement of dental sealants.

Indications

Before placement of dental dam.

Indications

Before cementation of orthodontic bands.

Indications

Before application of acid etching solution on enamel

Indications

Before cementation of crowns and bridges

Indications

Reasons to perform Coronal Polishing.

Contraindications

Reason to not perform Coronal Polishing.

Contraindications

When no stain is present.

Contraindications

Patients who are at high risk for dental caries such as nursing bottle caries, root caries, or areas of thin demineralized enamel. (Because small amounts of enamel are removed during the polishing procedure)

Contraindications

Sensitive teeth (Because abrasive agents can increase the areas of sensitivity)

Contraindications

Newly erupted teeth (Because mineralization of the surfaces may be incomplete)

Selective Polishing

Only polishing teeth or surfaces with stains. (This is to avoid unneccessary removal of surface enamel.)

Possible tooth surface damage

Newly erupted teeth are incompletely mineralized, and excessive polishing with an abrasive could remove a small amount of surface enamel.

Possible tooth surface damage

Avoid polishing areas of demineralization because of the possibility of loss of surface enamel

Possible tooth surface damage

Avoid polising areas of cementum in areas of recession because cementum is softer than enamel and more easily removed.

Possible gingival tissue damage

Gingival tissue may be damaged if the cup is run at a high speed and or is applied too long.

Possible gingival tissue damage

Fast rotation may force particles of the polishing agent into the sulcus creating a source of irritation.

Possible restoration damage

Abrasive pastes can leave scratches or rough surfaces on gold, composite restorations, acrylic veneers, and porcelain surfaces.

What are benefits of coronal polishing?

Prepars teeth for sealants,orthodontic brackets and bands smooths tooth surface,slows new deposits from forming, patients appreciate the smooth clean feeling and is easier for them to keep clean.

What are three basic ways tooth stains occur?

Adheres directly to the surface of the tooth, embedded in calculus and plaque deposits, incorporated within the tooth structure.

Air-Powder polishing

Technique using a specially designed handpiece with nozzle that delivers a high pressure stream of water and sodium bicarbinate.

Two ways to remove plaque and stains

Air-Powder polishing and Ruber cup Polishing.

Term for polishing agent

Abrasives: are available in various grits; extra coarse, coarse, medium, fine, and extra fine. The coarser the agent the greater the abrasion is to the surface.

Grit

refers to the degree of coarseness of a polishing agent

Prophy Paste

Commercial premixed pates

What are factors that influence the rate of abrasion?

The amount of abrasive agent used, the amount of pressure applied to the polishing cup, the rotation speed of the polishing cup.

What are some commonly used abrasives?

Silex, Pumice, Chalk, Commerical premixed preparations, Fluoride prophylaxis paste, Zirconium silicate.

How much air pressure should be used for stain removal?

usually 20 pounds per square inch.

How much time should be spent polishing a tooth.

Polish each tooth for approximately 3-5 seconds

Pen Grasp

The handpiece and the prophylaxis angle are held in a pen grasp with the handle resting in the U-Shape area of the hand between the thumb and the index finger.

Rheostat

The rheostat is the foot pedal used to control the speed (RPM) of the handpiece.

How many Revolutions Per Minute is recommended for the speed of the handpiece?

A low speed handpiece that operates at a maximum of 20,000 rpm

Which surface should you begin polishing fist?

Begin with the distal surface of the most posterior tooth in the quadrant and work forward toward the anterior.

Which direction should your stroke the cup?

The stroke should occur from the gingival thrid toward the incisal third of the tooth.

What is the difference between a coronal polishing and oral prophylaxis?

Coronal polising is limited to just the clinical crown, and oral prophylaxis is the complete removal of calculus, debris, stains and plaque.

What is the purpose of selective polishing?

To avoid unnecessary removal of surface enamel.

What is an extrinsic stain?

Stains that appear on the exterior of the tooth and can be removed.

What is an intrinsic stain?

Stains that are caused by an enviromental source but cannot be removed because the stain has become incorporated into the tooth structure.

Intrinsic stains

Tobacco stains from smoking, chewing, or dipping, and dental amalgam that have become incorporated into the tooth structure.

Intrinsic stains

Pulpless Teeth

Intrinsic stains

Tetracycline antibiotics

Intrinsic stains

Dental fluorosis

Intrinsic stains

Imperfect tooth development

Intrinsic stains

Silver amalgam

Intrinsic stains

Other systemic causes such as jaundice and erythroblastosis fetalis

Extrinsic stains

Black stains caused by natural tendencies

Extrinsic stains

Brown or yellow stains caused by poor oral hygiene or use of toothpaste with inadequate cleansing action

Extrinsic stains

Green stains caused by poor oral hygiene when bacteria or fungi are retauned in bacterial plaque

Extrinsic stains

Dental plaque agents caused by the use of prescription mouth rinse that contain chlorhexdine.

Extrinsic stains

Food and drink stains caused by tea coffee colas soy sauce berries and other food stuff.

Which is the most common technique for stain removal?

Rubber cup polishing

Which type of grasp is used to hold the handpiece?

Pen grasp

What is the purpose of a fulcrum?

Provide stability and allows movement of the wrist and forearm to decrease fatigue.

What precaution should be taken when esthtic type restorations are polished?

detrimine the type of restoration and then use the appropriate abrasive then continue to polish remaining teeth.

What damage can result from use of the prophy cup at a high speed?

High speeds produce frictional heat that can damage the tooth and burn the gingiva.

How should the patient head be positioned for access to the mandibular arch?

Chin down with the lower jaw parallel to the floor.

How should the patient head be positioned for access to the maxillary arch?

Head should be up with chin up.

Left handed operators should be seated at what time postion to begin?

Operator should start at the 3 or 4 o'clock position.

Right handed operators should be seated at what time postion to begin?

Operator should start at the 8 or 9 o'clock position.

When should flossing be done?

Dental floss should be used after coronal polishing to polish interproximal tooth surfaces and to remove abrasvies or debris that may be lodged in the contact area.

What motion should be used when flossing after prophy?

Back and forth motion.

What evaluation should be done after polishing?

Teeth should be dried with air and no disclosing agents remain. Teeth are glossy and reflect light from mirror, and no evidence of rauma to the gingival margins or to any other soft tissues in the mouth.

Items used in rubber cup polishing?

Prophy angle, bristle brush, prophy paste, saliva ejector, disclosing agent, dental floss, air water syringe, and mirror.

What type of strokes should be used to ensure complete coverage of the tooth?

Overlapping strokes

How to prevent splattering?

Relase rheostat immediately when handpiece is removed from the tooth for longer then a moment.

What should be done before polishing can be performed?

You must reveiw patient medical history to check for any contraindications.

What should be said after patient has been seated?

Assistiant should go over what is being done and answer any questions the patient may have.

What should the dental assistant look for when inspecting oral cavity?

Lesions, missing teeth, tori, and restorations.

What should the patient be wearing during polishing?

Patient should be wearing eye wear and should have water proof napkin.

What should the dental assistant be wearing?

Dental assistant should be wearing protective eye wear, gloves, and mask.

Are dental assistants allowed to perform a prophylaxis?

Dental assistants are not allowed to perform prophylaxis.

Are dental assistants allowed to perform coronal polishing?

Dental assistants are allowed to perform coronal polishing.

What are the attachments used for coronal polishing?

Polishing cup and bristle brush.

How should the dental assistant be positioned?

Dental assistant should be positioned at the patients side with feet flat on the floor thighs paralle to floor and arms should be at waist level even with patients mouth.

Which side should dental assistant fulcurm be placed?

Fulcrum should be on the same side of the dental arch being worked on or as close to the area your polishing.

Disclosing agent.

Coloring agent that makes plaque visible when applied to teeth.

Systemic fluoride

Fluoride that is ingested and then circulated throughout the body.

Topical fluoride

Fluoride that is applied directly to the tooth.

What does fluoride do?

Slows demineralization and enhancing remineralization.

Anatomic crown

The portion of the tooth that is coverd with enamel.

Materia alba

A white cheeselike accumulation of food debris microorganisim desquamated epithelial cells and blood cells around the gumline.

Calculus

Known also as tarter is a form of hardened dental plaque.

Plaque

Is a biofilm usually a pale yellow that devlops naturally on the teeth.

Classification of stains

Extrinsic, intrinsic, exogenous, endogenous

Direct supervision

level of supervision in which the dentist is physically present when the dental assistant performs delegated functions

Indirect supervision

overseeing an assistants work by working in the immediate area

Indirect vision

viewing the object with the use of a mirror

parotid gland

largest of the major 3 salivary glands, 25% volume of saliva

submandibular gland

size of a walnut ,2nd largest ,60-65% volume of saliva

sublingual gland

the smallest of the 3,provides 10% of salivary volume. releases saliva in to the oral cavity thought the sublingual duct

Plaque

Primary cuase of dental diseas

pellicle

Fist step in formation of plaque

Green & Yellow

most common stain found on children's teeth

Enamel Hypoplasia

incomplete or defective formation of the enamel of either primary or permanent teeth; result may be an irregularity of the tooth form, color, or surface

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