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125 Exam 1
Terms in this set (126)
What is a method of creating mechanical movement using a high voltage electrical signal?
The handpiece of the Piezoelectric contains _____that change dimensionally to create vibrations in the tip
What is the tip direction of the Piezo?
What is a method of creating mechanical movement using a low voltage magnetic signal?
The handpiece contains ______ that create a magnetic field and produces ____ by the expansion and contraction of a metal stack or rod of the interchangeable inserts
T or F
Magnetostrictive does not produce heat.
produces heat and is cooled by a water system
Which direction is the tip for magnetostrictive?
Using ____ ultrasonics may alter electrocardiogram patterns in pace maker placed prior to ____
What is an absolute contraindication for ultrasonic?
Highly infectious disease, AIDS or hepatitis
The working end of the ultrasonic should be ___ to ____ degrees to the surface of the tooth when scaling
What is the number of times per second the insert tip moves back and forth during one cycle?
What is the optimum frequency?
18KHz and 32 KHz
Devised that are attached to permanent structures and cannot be removed by the patient
Dentures are ___% as effective as a natural bite
For implants we check for (MCCS)
Composite placed inter proximally to hold teeth down
Alkaline hypochlorite is _____
Bleach and water
Loosen debris and light stain
Dont soak, just few drops of clorox
Alkaline peroxide is
loosen debris and light stain
Will no remove heavy stain or calculus
Enzymes will breakdown
mucoproteins of less adhesive molecules
Straight into a bag with denture.
Who fills out the forms when there is a sharps injury?
How long do we have to take the forms to school?
When do we get tested?
What are post op instructions we give to the patient after given anesthesia?
Wait to eat before anesthesia wears off
Or eat soft foods
Nothing hot or spicy
Take the medication normally take for a headache
What type of pain med should the patient not take after given anesthesia?
What rinse may cause black hairy tongue?
Sonic scalers: operates at _______ to ________ cycles per second (Hz)
3,000 to 8,000
Sonic scaler: Tip direction is ______
Sonic scaler: transducer: driven by_____________
Piezo: transducer: _________
Magneto: transducer: _________
metal rod, stack of metal sheets
what does bleed the line mean?
activate foot control to fill handpiece with water for 2 minutes to clear stagnant water and air
what is the number of times per second the insert tip moves back and forth during one cycle (excursion) called?
what is one complete linear or elliptical stroke path called?
what is a unit of energy equal to 1000 hertz or 1000 cycles per second (cps) called?
what is a range between 18 kHz and 32 kHz that is above the audible frequency called? It is within a range to allow greater patient comfort and maximum life of the insert.
What is affected by frequency?
Active tip area
In the 25 to 30 kHz ranges the active tip area is approximately_______ . In the 40 to 50 kHz ranges the active tip area is generally less than _______.
what is it called when the tip frequency is controlled automatically by the system?
what is it called when the tip frequency is adjusted using the tuning knob. This term is often mistaken for power.
what is the electrical energy in the handpiece used to generate the movement of the insert called?
T/F: Increasing the power increases the distance the insert tip moves (stroke) without changing the frequency.
What is the maximum distance the insert tip moves during one cycle? What adjusts it?
the power knob
What is equal to one half the stroke?
What is the resistance on an insert when placed against the deposit on the tooth surface?
What is the ability to remove deposits under load called? The stroke, frequency and type of motion (elliptical or linear), and the angulation of the motion against the tooth surface are factors that determine it.
what is energy associated with sound waves called?
what is unidirectional fluid flow caused by ultrasonic waves called?
T/F: Acoustic streaming occurs at higher acoustic pressures than cavitation.
what is it called when the tip stroke causes coolant to accelerate, producing an intensified swirling or agitation effect which disrupts the bacterial matrix. This effect is increased as the power knob is adjusted to higher power settings.
what is the formation of bubbles in liquids by rapid changes such as those induced by ultrasound called? When bubbles implode, they produce shock waves in the liquid.
what is it called when water spray penetrates to the base of the pocket to provide a continuous flushing of debris, bacteria, and endotoxins called? Oscillation of the ultrasonic tip causes hydrodynamic waves to surround the tip. This acoustic turbulence is believed to disrupt bacteria.
Three E's and the three A's of hand, sonic, and ultrasonic instrumentation techniques:
E's effectiveness, efficiency, and ergonomics;
A's -Adaptation, angulation and activation
Patients with systemic conditions that are significantly affected by oral inflammation
Diabetes, CVD, and Pregnancy
Progressive Treatment Planning: 4 Part Plan
o Oral hygiene
o Smoking cessation
o Laser Therapy
o Bacterial load
o Antimicrobial or host modulation therapy
o Nutritional Supplements
T/F: for an ultrasonic, angulation similar to the probe, but activation is not like the probe
Medical and Dental considerations for using an ultrasonic:
Terminal _____________ mm's adapted during ultrasonic instrumentation
Terminal ______ mm's are best utilized during activation of the stroke
For Vertical Adaptation:
Positioned like a probe
Facilitates access of active area to depth of pocket
Predominantly horizontal strokes on buccal/lingual surfaces
Oblique strokes on interproximal surfaces
For Horizontal/Transverse Adaptation:
Positioned like a hand instrument
Predominantly oblique strokes
Vertical strokes thru contact area
Dental charting: GREEN Color indicates:
Gold material Restoration
Dental charting: BLUE Color indicates:
Dental charting: RED Color indicates:
Dental caries: tissue registration, fractures
Dental charting: GREY/Black indicates:
Dental charting: For erupting teeth place a ___________ ________ above the tooth and draw the tissue line accordingly
Dental charting: For Impacted teeth: _____ in __________ and write "________" over tooth
circle in black
Class I Cavity:
Pits and fissures
use x rays
use Careful Exploration
Class II Cavity:
Proximal surfaces of posterior teeth
use x rays
Class III Cavity:
Proximal surfaces of anterior teeth
Class IV Cavity:
Proximal surfaces of anterior teeth and the incisal angle
Class V Cavity:
Cervical 1/3 of the facial or lingual surface
use Careful Exploration
Class VI Cavity:
Tips of cusps or incisal edges on incisors
**Not one of G.V. Black's original classifications
Types of Dental Restorative Materials
•Stainless Steel Crowns (pedo)
•Includes all the pertinent information that is presented to you by the patient or responsible person
•This information may change at subsequent appointments
S, of SOAP notes
•ANY patient complaint
•Medical Alerts that may require altering normal treatment
•Lifestyle information that may affect care
•Emotions and/or attitudes
•Patient's response to previous or current treatment
•Information relevant to the patient's case or present condition
•Note any premedication the patient has taken & when
Information that May be Included in "S"
•Medical History findings and all medications patient is taking if not listed under"S"or in computerized pre-note summary
•Vital signs measurements
•Intra/extra oral examination findings
•Range of pocket readings and which teeth or quadrant probed that day
•Any significant findings or pathologies
•Findings that are of any concern
•Results of appropriate consults
Information that May be Included in "O"
•Amount (light, moderate, heavy) of calculus, plaque & stain
•Statement regarding discussion of the DH Diagnosis and treatment plan with the patient or guardian
•Statement that the patient agrees to the treatment plan
Information that May be Included in "A"
•Progress notes or Services provided. •It should include all procedures performed on this patient
•Quadrant or teeth scale
•Type and amount of anesthesia/if used /or indicate "No anesthesia"
•Nitrous oxide sedation - preoxygenate with O2 for how long, ratio of nitrous oxide to oxygen or % delivered, length of time pt on Nitrous. Post oxygenate with O2 for how long.•Post op vitals•Indicate if patient tolerated it well.
•FM polished or selective polish #'s 22-26.
•Topical Fluoride treatment
•Oral Hygiene Instruction given
•Post-operative Instructions given
•Always end with "Patient tolerated procedure well and left in good condition" or an appropriate brief statement of their condition
•IF the appointment is a quadrant scale- indicate what quadrant in the sequence was done.•EG. Scale and root plane URQ (2 of 4)...........•SC/RP Full mouth with ultrasonic and hand scaling
Information that May be Included in "P"
Dilute acids: organic or inorganic acids•Examples are vinegar, commercially prepared ultrasonic solutions•Dissolves inorganic deposits•Corrosion of chrome alloys (hydrochloric acids)
Grasp firmly with one hand-Thumb in facial at the height of the boarder of the denture and under the lip-Index finger on the palatal surface•Other hand will lift the lip to expose the boarder to break the seal•Remove gently in a downward & forward direction
Removing a Maxillary full denture
Grasp firmly with the thumb in facial at the boarder of the denture and under the lip and index finger on the lingual surface•Other hand will retract the lip to expose the boarder to break the seal•Remove gently in an upward & forward direction
Removing a Mandibular full denture
Exert even pressure on both sides of the appliance•Place thumbs on the occlusal and finger tip under clasp •Then lift the clasps on both sides simultaneously over the abutment teeth vertically
Removing a Partial appliance with clasps
Fill the ultrasonic cleaner bath with a general cleaning solution
Place new zip lock bag containing 1/2 water, 1/2 stain and tartar remover solution, and removable appliance into the ultrasonic bath
Set the time for one to 10 minutes: varies with the type of unit and material being removed
Scrub appliance with sterile denture/tooth/clasp brush and rinse thoroughly
•Place in a denture bath with dilute mouth rinse on a solid counter
•Rinse thoroughly prior to returning to the patient•Allow the patient to replace the appliance in their mouth
•Give them a paper towel or Kleenx to wipe their hands and mouth
Ultrasonic cleaning procedure: Dentures
T/F: Ultrasonic Bath is the Preferred method of cleaning appliances
•Less chance of distortion or damage to appliance•Less time required•Must be sure chemicals will not damage the appliance (titanium)
T/F you can polish obturators and implants
If the appliance is very dirty you may have the Lab Technicians clean the appliance for you at the beginning of the appointment.-At the VA you must spray the appliance on all surfaces with the disinfectant in the spray bottle with the red writing-This solution must stay on the appliance for 2 minutes prior to carrying it to the lab in a paper towel or headrest cover with the patient's name on the bag-Make sure you tell the Lab Technician you have left the appliance.The appliance will be on the counter when it is finished-The appliance must be sprayed and set in the solution for 2 minutes again -Rinse the appliance well prior to returning it to the patient at the end of the appointment.
VA- SPRAY 2MIN-SCRUB-SPRAY 2MIN
Procedure for the Long Beach VA: Dentures
2 modes of action to Desensitize
VARNISHES (tubular occlusion) % Fl
5% Sodium Fluoride (22,600 PPM)
Advantages of Varnishes:
Higher concentration of fluoride than in fluoride gels, foams, rinses and pastes. (Toothpaste has 1,000-14,000 ppm of fluoride)
Available in child friendly flavors.Easily tolerated by infants, toddlers and developmentally disabled children.
Fast and easy to apply.
Sets within one minute of contact.
Safe, less risk of adverse reaction because only a small amount is used and less is swallowed.
It can be applied in any setting.
POST OPERATIVE INSTRUCTIONS: Varnishes
The patient may drink water immediately after application and may eat soft foods but it is best effective if there if eating can be avoided for as long as possible 30 min. minimum
If the patient must eat, advise soft foods and water to drink
It is recommended to also wait as long as possible before brushing. (minimum of 3 hours, it is suggested that if it is possible have the patient not brush until the next day
Types of Fluorides in office
Varnish: ____% Sodium
Rinse: ____% Neutral Sodium Fl-
Trays: ____% Acidulated Phosphate Fl
Fluoride Rinse: Time
1 min rinse total time
2 x 30 sec rinse
Post Operative Instructions: Fl: Varnish, Rinse, Trays
Varnish: NO eating hard foods/hot liquids for 3 hours. No brushing till next morning
Rinse: NO eat/drink for 30 minutes
Trays: NO eat/drink for 30 minutes
Chlorhexidine Gluconate (CHX): _____%
Used to treat gingivitis, red, swollen, inflamed, bleeding gingiva
Broad spectrum antisepticBacteriostatic (gram negative and gram positive bacteria). Causes cell membrane disruption.
Needs prescription- it is not an over the counter product.
Taste sensations are altered
Increased supragingival calculus formation
Patients may experience all or none or some of these side effects
Best effect if avoid food, drink, smoking and mouth rinses for at least one hour after CHX delivery
Disadvantages of CHX
T/F CHX should not be used with fluoride products
they may bind to each other and be less effective
brush and floss and then wait 30-60 minutes before using a CHX rinse or gel followed by no eating or drinking
CHX at home
If you are using the ultrasonic with water and CHX in the reservoir, best to wait at least ___________ before fluoride use. You may use that time to hand scale, give OHI and give post
CDT code for: Periodic Oral Evaluation - established pt
CDT code for: Limited Oral Evaluation - problem focused
CDT code for: Comprehensive Oral Evaluation - new or established pt
(new pts. or estab. ones absent from active treatment 3+ yrs.)
CDT code for: Comprehensive Periodontal Evaluation - new or established pt
For pt showing signs or symptoms of periodontal disease and for patients with risk factors such as smoking or diabetes
CDT CODE: Prophylaxis - adult
CDT CODE: Prophylaxis - child under 14 years
CDT CODE: Scaling/Root Planing- four or more teeth per quadrant
CDT CODE: Scaling/Root Planing: one to three teeth per quadrant
CDT CODE: Full mouth debridement
CDT CODE: Periodontal Maintenance
This procedure is instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacements.
CDT CODE: Topical application of fluoride - adult
CDT CODE: Topical fluoride varnish; therapeutic for moderate to high caries risk patients.
CDT CODE: Application of desensitizing medicament
CDT CODE: Oral hygiene Instructions
CDT CODE: Analgesia- Nitrous Oxide Delivery
CDT CODE: Scaling in the presence of generalized moderate or severe gingival inflammation. FM after oral evaluation.
CDT CODE: FMX
NO Bone Loss
BOP- bleeding upon
1-3 MM probe depths
-Inflammatory changes into
-Slight bone loss
-Probing depths: 4-5 mm
-Slight loss of
-Slight bone loss
-Visible bone loss on radiographs
-Can see loss of crestal bone
AAP II: Slight Periodontitis
Loss of bone support
Furcation involvement is likely
AAP III: Moderate Periodontitis
Major loss of bone
Bone loss half the length of the root
AAP IV: Advanced Periodontitis
-Several unclassified types of periodontal diseases
-Rapid bone and attachment loss or slow but continuous
bone and attachment loss
-Resistance to normal therapy
AAP V (THE WORST): Refractory Progressive Periodontitis
A normal healthy patient without systemic disease, with
little or no anxiety
Non-smoking, no or minimal alcohol use
No organic, physiologic or psychiatric disturbance
Excludes the very young and very old
No treatment modifications
Not taking any meds
ASA I: HEALTHY
A patient with mild systemic disease without substantive
Exhibits extreme anxiety
Less stress tolerant...employ stress-reduction strategies
Controlled disease such as epilepsy, asthma
Patients with allergies, especially to drugs
Healthy patients over 60
Adults with controlled hypertension
Non-insulin dependent diabetes (Type II)
Cigarette smoking without chronic obstructive pulmonary
Social alcohol drinker
ASA II: MILD DISEASE
A patient with severe systemic disease that limits activity but
Has substantive functional limitation: Wheelchair, cant care for self (mentally challenged, etc)
One or more moderate to severe diseases
At rest these patients appear OK, but may experience
symptoms while under stress
Employ stress-reduction strategies
Well-controlled insulin dependent diabetes (Type I)
Exercise induced asthma
Less well controlled epilepsy
Adults with stage 2 hypertension
Old heart attack
Poorly controlled hypertension
Controlled congestive heart failure (CHF)
Chronic renal failure
Alcohol dependence or abuse
ASA III: SEVERE DISEASE
Hard to choose btw ASA II/III so whichever you pick, say why
II more controlled than III
A patient with systemic disease that is a constant threat to
Risk is too great for elective dental care
ONLY DO IF REALLY NEED DENTAL CARE
Emergency treatment should be as noninvasive as possible
Should receive dental care in a hospital
Unstable angina -
Myocardial infarction CVA, TIA or CAD/stents within the past 3 months
Ongoing cardiac ischemia or severe valve dysfun
Adult blood pressure greater than 160 and/or 100
Uncontrolled epilepsy -
Uncontrolled insulin dependent diabetes (Type I) -
Symptomatic chronic obstructive pulmonary disease (COPD)
Symptomatic CHF -
ASA IV: THREATENING DISEASE
Ruptured abdominal/thoracic aneurysm
Intracranial bleed with mass effects
Multiple organ/system failure
ASA V: NEAR DEATH
A declared brain-dead patient who will have their organs
removed for donor purposes
ASA VI: BRAIN DEAD
Classification of Mobility
Class 1 - Slight mobility, up to ______ of horizontal displacement
Class 2 - Greater than 1mm but less than _____ horizontal displacement
Class 3 - Greater than 2mm horizontal displacement OR ______ mobility
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