Dental Hygiene Board Review

D.H Code of Ethics purpose?
Click the card to flip 👆
1 / 1644
Terms in this set (1644)
What are some Civil law contracts?1. Implied 2. Expressed (Involves PRACTITIONER and PATIENT)What is an Implied contract?an agreement made through inference by sign, inaction, or silenceWhat is an Expressed contract?Oral or written agreementWhen can you terminate a patient?Non-compliant and failure to pay (practitioner)What is abandonment?Dismissal of patient without ample and proper notice (patient)What are the two Civil law torts?1. Intentional tort 2. Unintentional tortWhat are the intentional torts?1. Assault 2. Battery 3. Deceit and misrepresentation 4. Defamation 5. Invasion of property (patients BODY is the property)What is assault?1. Threatening bodily harm Ex- (A person raising his hand to threaten to hit someone but doesn't actually do it)What is battery?1. Causing bodily harm Ex- (Placing sealants on a child's teeth without parental consent or taking radiographs without permission)What is Defamation and what are the two ways of this?1. Damaging a persons reputation 2. Libel- WRITTEN defamation (L=Library) 3. Slander- Verbal defamation (S=SPOKEN)What are the Unintentional torts, what does it include and what is an example?1. Negligence 2. Includes= Standard of Care and Duty 3. Ex- ( Breaking an instrument tip in the periodontal pocket and not telling the patient.What are some of the Regulatory Compliances (agency's)?1. Occupational Safety and Health Administration (OSHA) 2. Health Insurance Portability and Accountability Act (HIPPA) 3. Center for Disease Control (CDC) 4. Consolidated Omnibus Budget Reconciliation Act (COBRA)What is Occupational Safety and Health Administration (OSHA)?1. Responsible for developing universal/standard precautions protocols for EMPLOYEES to prevent them from contracting disease through blood and/or other body fluids a) Protects the EMPLOYEE (worker) b) Pertains to clinics and facilities c) Includes Blood-Born Pathogens and MSDSWhat is Human Insurance Portability and Accountability Act (HIPPA)?1. Maintain patient confidentiality 2. All health care entitles that ELECTRONICALLY process, store, transmits or receives medicalHow often does the HIPPA form need to be signed?ONE TIME... UNLESS... Changes are made (patient wishes to add or remove and individual for previous form) or the government makes changes to the HIPPA formHow often does an office have to provide a copy of the HIPPA policy?every 3 yearsWhat is the Center for Disease Control (CDC)?1. Recommends infection control protocol and conducts research to determine how diseases are transmitted. 2. Provides guidelines for disease prevention and disease transmissionWhere is the Center of Disease Control (CDC) located?Atlanta GAWhat is Consolidated Omnibus Budget Reconciliation Act (COBRA)?1. Gives individuals the right to keep the group health insurance benefit for 18 months after they leave the practice.What is the qualities of an informed consent?1. Presented in understandable languages 2. Nature and need of procedure 3. Benefits/risks of procedure 4. Prognosis 5. Alternatives to procedure 6. Patient is allowed to ask questionsDentist "owns paper on which records are printed, patients "own" information. It is ok for the dentist to charge a reasonable fee to transfer records, even if there is a balance due on the account. (True or False)Both Statements are true!The purpose of a Professional Code of Ethics includes all of the following EXCEPT one. Which one is the EXCEPTION? a) to achieve high levels of practice b) to achieve high levels of integrity c) to achieve high levels of decision making d) to achieve high levels of ethical consciousnessb) to achieve high levels of integrityWhich of the following examples of the Core Values in the Dental Hygiene Code of Ethics deals with the practitioner? a) Autonomy b) Beneficence c) Societal Trust d) Non-maleficenced) Non-maleficenceWhat Core Values states that patients have a right to privacy and freedom of choice?AutonomyProviding dental screenings would be an example of which Core Value?BeneficenceWhat is the best way to avoid a dental lawsuit?Proper documentationPlacing sealants on a child's teeth without getting parental consent is and example of?BatteryWhich of the following is OSHA not responsible for? a) employer b) employee c) clinics and faculties d) Material Safety and Data Sheetsa) EmployerCOBRA (Consolidated Omnibus Budget Reconciliation Act) gives individuals the right to keep group health insurance benefits for?18 monthsAll of the following are true about informed consent EXCEPT one. Which one is the EXCEPTION? a) prognosis b) cost of procedure c) Alternatives to procedure d) benefits/risks of procedure e) presented in understandable languageb) cost of procedureThe Statute of Limitations for dental lawsuits is? (time)No definitive timeA furcation that in which the probe goes entirely through the opening is?Type 3 furcationWhat common emergency situation is characterized by dizziness, paleness, cold sweats, and decreased blood pressure?SyncopeEach of the following is affected by saliva EXCEPT one. Which on is the EXCEPTION? a) Swallowing b) Dental caries c) Oral microflora d) Protein digestion e) Carbohydrate breakdownd) Protein digestionsDemineralization of enamel occurs when the pH of enamel drops below 4.5-5.5. This is know as the "critical pH level. (True or False)Both statements are trueWhat are the signs of infection?I- Increased pulse and respiration N- Nodes are enlarged F- Function is impaired E- Erythema, edema, exudate C- Complaints of discomfort or pain T- Temperature (systemic, local or both)What are the Fat Soluble Vitamins?A - ALL D - Dieters E - Eat K - KilocaloriesWhat are the 12 Cranial Nerves?I - (Olfactory) 1 II - (Optic) 2 III - (Oculomotor) 3 IV - (Trochlear) 4 V - (Trigeminal) 5 VI - (Abducans) 6 VII - (Facial) 7 VIII - (Auditory or Vestibulocochlear) 8 IX - (Glossopharengeal) 9 X - (Vagus) 10 XI - (Spinal Accessory) 11 XII - ( Hypoglossal) 12What type of nerves are the 12 Cranial Nerves? (Sensory, Motor or Both? List all 12 and their Type?I - Sensory (Sense of smell) II - Sensory (Sense of sight) III - Motor (Eye Muscles, Pupil, Lens) IV - Motor (Eye Muscles) V - Both (Ophthalmic, Maxillary, & Mandibular divisions) VI - Motor (eye muscles) VII - Both (Muscle of facial expression, Taste (anterior 2/3 of tongue) Sublingual and Submandibular salivary glands) VIII - Sensory (Sense of balance and hearing aka (Auriculotemporal) IX - Both (posterior 1/3 of tongue, parotid gland) X - Both (smooth muscles and gland of the body, cardiac muscle) XI - Motor (Trapezius, Sternocleidomastoid, pharynx, and larynx) XII- Motor (Muscle of the tongue (EXCEPT palatoglossus, X, XI)Dentin and Pulp arise from the ________?Dental Papilla Remember: both start with D & PIron Deficiency causes what?Burning tongue Remember if you IRON your tongue it will BURN!What are the 3 P's of Diabetes?1. PolyUREA= Much urination 2. PolyDipsea= Much thirst 3. PolyPHAGIA= Much eatingQualities of Disinfectants?1. Rapid, broad-spectrum antimicrobial 2. Odorless, easy to use, fast acting, economical 3. Environmental and surface compatible 4. Residual effect 5. Non toxic to touch or inhalation 6. EPA registered 7. Cleans and disinfects.Types of Disinfectant agents?1. Chlorine-Based compounds- corrosive to metals strong odor. 2. Iodophers- can discolor some surfaces yellow. 3. Phenols (water or alcohol based)- leave a film or residue on surface. 4. Quaternary compounds- not corrosive but has lower kill spectrum; limited efficacy.Why shouldn't Glutaraldehydes be used as a surface disinfectant?because the toxic effects of fumes; also corrosive. OSHA regulates glutaraldehydes.Levels of surface disinfectants?1. High- used in surgical areas 2. Intermediate- used in dental offices; must kill TB organisms. 3. Low- generally used at home; not acceptable for use in a dental office.Methods of sterilization?Chemical, Dry Heat, and Steam.Chemical Sterilization?1. minimum temp.- 273'F for 20 minutes with a pressure of kPa/25 psi. 2. Ventilation is necessary 3. May damage rubber and plastic items 4. Spores test= Geobacillus stearothermophilus.Dry Heat Sterilization?1. 340'F for 1 hour or 320'F for 2 hours 2. Recommended for metal instruments avoid paper 3. may damage rubber and plastic 4. NOT recommended for handpieces 5. Spores Test= Bacillus atrophaeusSteam Sterilization?1. Minimum sterilization parameters 250'F with 15 to 20 lbs per square inch (psi) for 30 mins. 2. Corrodes non-stainless (carbon) steel instruments 3. Dulls instruments and burs 4. Ok for SOME plastics; cotton rolls/gauze (cloth goods) 5. Paper packets come out wet and tear. 6. Spore Test= Geobacillus stearothermophilusPackaging materials?1. cassettes and wrap 2. Plastic/paper pouches. 3. Nylon clear tubing 4. paperExternal Indicators do what?change color only to indicate instruments have been heat processed. Sterilization is NOT guaranteed.Biological Indicators (Spores Test)?1. Conducted weekly 2. Determines if sterilization cycle is reached proper temp, time, and pressure to kill ALL microorganisms.G.V. Black Classification for Caries and Restorations?1. I- ALL Pits and fissures 2. II- Posterior Proximal 3. III- Anterior Proximal; does NOT involve the incisal edge. 4. IV- Anterior Proximal; involves incisal edge. 5. V- Facial and Lingual Cervical third (gingival). (root caries) 6. VI- Cusp tips and/or incisal edgeOcclusal Relationships?1. Cass I (Mesognathic)- Molar Relationship= Normal; Mesiobuccal cusp of the Maxillary first molar is positioned in the buccal groove of the Mandibular first molar. Canine Relationship= Maxillary canine occludes with the Distal half of the Mandibular canine and the Mesial half of the first premolar. 2. Class II (Retrognathic)- Molar relationship= Buccal groove of the Mandibular first molar is Distal to the Mesiobuccal cusp of the Maxillary first molar. Canine Relationship= Distal portion of the Maxillary canine is Mesial to the Mesial portion of the Mandibular canine. Div 1- retrude mandible with one or more Anterior teeth Protrude facially. Div II- retrude mandible with one or more Maxillary Anterior teeth inclined LIngually. 3. Class III (prognathic)- Molar Relationship= Buccal groove of the Mandibular first molar is Mesial to the Mesiobuccal cusp of the Maxillary first molar. Canine Relationship= Mesial portion of the Maxillary canine is distal to the distal surface of the Mandibular canine.Overbite?Verticle overlap of the Maxillary incisors to the Mandibular incisorsOverjet?Horizontal distance between the lingual of the Maxillary anterior incisors and the facial of the mandibular anterior incisors.Openbite?Teeth not in occlusion between the Maxillary and Mandibular teeth or arch.Crossbite?Maxillary teeth are positioned lingual to or totally facial to mandibular teeth.Midline Shift (deviation)?Midline of Maxillary central incisors does NOT align with midline of Mandibular central incisorsEdge-to-Edge?Incisal edge to inciasal edge of the Maxillary anterior to Mandibular anterior teethEnd-to-End?Cusp-to-cusp relationship of Posterior teeth.Calculus?Mineralized plaque; provides an irritant for the gingivaTypes of calculus and the nutrient source?Supragingival- Nutrient source is saliva Subgingival- Nutrient source is cervicular fluid and inflammatory exudateWhat all can you use to detect calculus?1. Explorer- 11/12 and pigtail for posterior, Orban-type for anteriors and cervical 1/3's of posterior teeth. 2. Dry teeth with compressed air 3. RadiographsExtrinisic Stain?1. Exogenous- Removeable, 2. Causes include; certain bacteria, food, beverages and tobacco.Types of Extrinsic stain?1. Black-Line 2. Bluish-green 3. Brown 4. Dark-brown and black 5. Orange 6. Yellow-brown and brown 7. GreenBlack-Line Stain is?gram-positive bacteria; located on cervical 1/3 of facials and lingualBluish-green stain is?inhaling metallic dust, most likely for occupational exposure.Brown Stain is?poor oral hygiene and/or drinking dark colored beverages, tea, coffee, fruit juices, and red wine.Dark Brown and black stain is?tobacco useOrange stain is?chromogenic bacteria in plaque, poor oral hygiene, located on anterior teethYellow-brown and brown stain is?Chlorhexidine use or stannous fluoride; Stannous fluoride results from the reaction of the tin ion in the fluorideGreen stain is?poor oral hygiene, chromogenic bacteria, fungi, and gingival hemorrhage.Intrinsic Stain?Endogenous- not removable, Causes- pulpal necrosis, internal resorption, excessive systemic fluoride and/or tetracycline use during tooth development.Furcation Classifications?1. I= Early evidence of bone loss; instrument can enter the depression leading to the furcation. 2. II= Moderate bone loss; instrument can enter furcation, but can NOT pass between the roots 3. III= severe bone loss; instrument can pass between roots 4. IV= Same as class III, but with evidence of recession.What do you use to assess a furcation?Nabers Probe (always evaluate furcation BEFORE recommending oral physiotherapy aids)Demineralization?process occurs when the PH drops below 4.5 to 5.5 for Enamel and 6.0 to 6.7 for cementum-- known as "critical pH levels"Fluoride interferes with_____?Bacterial metabolismIn high concentrations (professional application) fluoride is _______?Bactericidal (destructive to bacteria)In low concentrations (daily at home application) fluoride is ________?Bacteriostatic (inhibits growth or multiplication of bacteria) most effectiveFluoride has Substantivity which means what?The ability to bind to pellicle, plaque, and tooth surface and be released over a period of time with retention of potency.Pre-Eruptive (systemic) Fluoride Examples?1. Water Fluoridation 2. Dietary Fluoride Supplements 3. FoodsPre-eruptive (systemic) Fluoride characteristics?1. Circulates in the blood and is incorporated into the enamel of developing teeth. 2. Rapidly adsorbed in stomach and small intestines 3. The amount that is not used is excreted through the kidneysAverage cost of water fluoridation in a community is?S0.13-$5.48 per year, per personThe sizes of the community and the cost classification?1. Larger community= Lower cost. 2. Smaller Community= Higher costWhat is the optimal fluoride level?0.7 ppm mg/L (All states)Before January 2011 the optimal fluoride level was?0.7- 1.2 ppm mg/L depending on the climateWarmer Climates equals what? Colder Climates equals what?1. lower concentration level = 0.7 ppm 2. higher concentration level= 1.2 ppmWhat agency monitors the concentration level in community drinking water?Environmental Protective Agency (EPA)What agency sets concentration levels in bottled water?Food and Drug Agency (FDA)Water fluoride is composed of what compounds?1. Sodium Fluoride 2. Sodium silicofluoride 3. Hydrofluorosilicic acidPost-Eruptive (Topical) Fluoride and the types?Professionally applied Topical fluoride 1. Sodium fluoride (tray) 4 mins, no eating drinking smoking for 30 mins (used in presence of tooth colored and porcelain restorations) 2. Sodium fluoride varnish 5% NaF (22,600ppm) Retain 24-48 hours relseased 3. Acidulated Phosphate Fluoride (APF) Tray or painting application, Avoid use on colored restorations and porcelain- acid in the fluoride etches the glass component in the restoration causing surface roughness or pitting over time. 4. Stannous Fluoride- unstable solution, unpleasant taste, stains demineralized areas and margins of tooth colored restorations due to the tin ion, causes possible gingival sloughingCertainly lethal does?CLD- amount of a drug likely to cause death if not intercepted by antidotal agents.Safely tolerated dose?STD= one fourth of CLD. (get sick)Acute Fluoride Toxicity symptoms?30 mins of ingestion can last 24 hours. Gastrointestinal symptoms- fluoride in the stomach reacts with hydrochloric acid to form hydrofluoric acid causing irritation to the stomach lining resulting in: 1. Nausea, Vomiting (emesis), diarrhea 2. Abdominal pain 3. Increased salivation and thirstAmounts of fluoride ingested: less that 5mg/kgAdminister fluoride-binding agentsAmount of fluoride ingested: greater than 5mg/kg (toxic dose)1. Induce vomiting 2. Administer fluoride-binging agent 3. Seek medical treatmentAmount of fluoride ingested: greater than 15mg/kg (lethal dose)1. Seek medical treatment 2. Induce vomiting 3. Cardiac monitoringChronic Fluoride Toxicity results in?1. Skeletal fluorosis- long term exposure (10+ years) water containing 8-10ppm fluoride 2. Dental Fluorosis- Hypomineralization; excessive ingestion during amelogenesis (tooth development). white opacitiesPower-assisted toothbrush indications for use?1. Children 2. Physically and mentally challenged 3. Elderly 4. Arthritic patients 5. poorly motivated individuals 6. Implant careToothbrush methods?1. Bass- angle bristles 45 degrees towards the apex at the gingival 1/3, placing bristles into the sulcus 2. Stillman- angle bristles 45 degrees towards apex with 1/2 of bristles place on tooth, the other half on the gingiva.Additional Oral Physiotherapy Aids?1. Interdental brushes 2. Tufted brush 3. Toothpick holder (perio aid) 4. Wedge Stimulator 5. Floss holder 6. Tufted floss 7. Oral irrigatorWhat is a Interdental brushes used for?Open embrasures, Exposed class IV furcation's, Orthodontic appliances, fixed prostheses, and implantsWhat is a Tufted brushes used for?open proximal surfaces, hard to access areas, fixed prosthesisWhat is a Toothpick holder used for?Exposed call IV furcation's, Interdental Cleaning, Gingival margins above ortho appliances.What is a Wedge Stimulator?interdental areas with exposed root surfaces (recession)Who is recommended to us a floss holder?those who are physically challenged and caregiversTufted floss can be used under what?Pontics of bridges or orthodontic appliancesWhat is an oral irrigator?Disrupts adherent plaque and flushes debris and food particles around ortho appliances.List the Active ingredients in Therapeutic Toothpaste?1. Fluoride- Caries 2. Pyrophosphates- Tarter control 3. Antihypersensitivity- Potassium nitrate, strontium chloiride, sodium citrate. 4. Triclosan- Antinacterial 5. Carbamide peroxide or hydrogen peroxide- WhiteningCaries= (active ingredient)FluorideTater control= (active ingredient)PyrophosphateAntihypersensitivity= (active ingredient)Potassium nitrate, strontium chloiride, sodium citrate.Antinacterial= (active ingredient)TriclosanWhat instruments do you use when scaling implants?1. Plastic 2. Nylon 3. Graphite or gold-tippedUltrasonic Magnetostrictive?1. Operates at 18,000 to 45,000 cycles per second (cps) 2. stack of metal strips in insert to convert energy from handpiece to insert tip. 3. Produces elliptical or orbital strokes. 4. All side of tip are active, most active is the pointUltrasonic Piezoelectric?1. Operates at 25,000 to 50,000 cps 2. Uses ceramic rod to produce mechanical vibrations 3. Produces linear strokes 4. lateral sides of tip are most activeSonic Scaler?1. Operates at 2,500 to 7,000 cps 2. uses compressed air to create vibrations 3. produces elliptical or orbital strokes 4. All sides of tip are activeConsiderations to evaluate before use of an ultrasonic scaler? (oral conditions)1. Demineralized areas 2. exposed dentinal surfaces 3. titanium implants 4. those with communicable dieases (TB) or respiratory conditions (cystic fibrosis, asthma, emphysema) 5. difficulty swallowing 6. susceptible of infections (immunosuppression from disease, organ transplant, chemotherapy. 7. Restorations 8. DenturesConsideration to evaluate before use of an ultrasonic scaler? (Systemic Health Conditions)1. Communicable disease (TB) 2. Respiratory Conditions (cystic fibrosis, asthma, emphysema) 3. Difficulty swallowing 4. Susceptible to infection (Immunosuppresion from disease, organ transplant, chemotherapy)Indicators for rubber cup polishing?1. removes extrinsic stain that doesn't remove by handscaling or with toothbrush and toothpaste 2. always instrument prior to polishingconsiderations for use of a rubber cup?1. Xerostomia 2. Demineralized areas or decay 3. tooth sensitivity 4. newly erupted teeth 5. severe gingivitis 6. lack of extrinsic stain or plaque 7. exposed root surfaces 8. respiratory conditions (asthma, emphysema, cystic fibrosis)What is Air Polishing?1. Slurry formed by forced air, water and powder (sodium bicarbonate, Aluminum trihydroxide - sodium free)Indications for use of an Air polisher?1. Stain and biofilm removal 2. root detoxification 3. sealant preparation 4. Soft debris removal around ortho appliancesContraindications for use of an Air polisher?1. Sodium restricted diets (hypertension) can use sodium free formula (aluminum trihydroxide) 2. spongy gingiva 3. respiratory materials 4. exposed root surfaces 5. immunocompromised patientsChlorhexidine Gluconate mechanism of action?1. 0.12% approved for use in the United Sates 2. Bactericidal a) Active against a wide range of Gram-negative and Gram-positive microorganisms. b) Alters the bacterial cell wall so that lysis occurs (cell is destroyed) 3. High substantivity- rapidly adsorbed into the pellicle and teeth, and then slowly released, prolonging bactericidal effectClinical uses for chlorhexidine gluconate (CHX)?1. Preprocedural rinse 2. Decrease supragingival bacterial plaque formation inhibit development of gingivitis 3. Short-term adjunctive therapy following surgical treatment 4. Implants 5. Patient with high risk for cariesConsiderations for us of Chlorhexidine?1. stains teeth, tongue, and tooth colored restorations (most common side effect) 2. Alters taste sensation (dysgeusia) including bitter taste 3.can irritate or burn mucosa 4. Increases ( slight) supragingival calculus formation due to the dead bacteria that remains.What antimicrobial mouth rinse would you recommend to a patient that uses tobacco?Recommend non-alcoholic mouth rinses.What antimicrobial mouth rinse would you recommend to a patient that has cancer?1. Rinse with baking soda or saline solution followed by plain water rinses 2. Recommend Chlorhexidine to reduce inflammationWhat antimicrobial mouth rinse would you recommend a plaque-induced gingivitis, slight to moderate chronic periodontitis, NUG/NUP and periodontal maintenance?Chlorhexidine 2x/dayWhat antimicrobial mouth rinse would you recommend to a patient that has acute periodontal conditions?1. Rinse with warm water or weak saline solution 2. Recommend Chlorhexidine 2x/dailyWhat antimicrobial mouth rinse would you recommend to a patient that has an alcohol condition?Recommend non-alcohol containing mouth rinsesProcedures in Community Health Practice?1. Needs Assessment 2. Data Analysis 3. Program Planning 4. Program Operation 5. Funding 6. Appraisal or EvaluationProcedures in Private Practice?1. Health History and Examination 2. Diagnosis 3. Treatment Planning 4. Treatment 5. Payment 6. EvaluationWhat are the four governmental levels of community dental health?1. International 2. Federal 3. State 4. LocalInternational level is?1. Coordinates programs for underdeveloped nations 2. Example- Community Periodontal Index of Treatment Needs (CPITN) 3. World Health Organization (WHO) is prime exampleFederal level is?1. Acts on oral health problems of national significance 2. Primarily within the jurisdiction of the Department of Health and Human Services (DHHS) (published Health people 2010)State level is?1. Provides consultation to local departmentsLocal level is?1. Directly administers county and city programs 2. Initiates dental health legislative measures (such as fluoridation)Epidemiology refers to?1. The study of health and disease in populations 2. Requires that disease be measured quantitatively 3. usually report findings in term of either prevalence and incidence.Quantitative Data is?information that can be counted or expressed numerically and is often collected in experiments this type of data can be represented in graph and chartPrevalence refers to?the estimated population of people who are managing a disease at any given time. (Example: Diabetes)Incidence refers to?the annual diagnosis rate or the number of new cases of particular disease diagnosed each year. (Example: Flu)The two statistics (prevalence and incidence) can differ in a way such as?1. a short-lived disease like flu can have high annual incidence but low prevalence 2. While a life-long disease like diabetes has a low annual incidence but high prevalenceUses for Epidemiology include?1. Collecting data to describe normal biological processes. 2. Understanding the natural history of a disease process 3. Measuring the distribution of a disease in a given population 4. identifying determinants of disease 5. testing hypotheses for prevention and control of a disease through studies. 6. Planning and evaluating health care servicesEpidemic refers to?an unexpectedly large number of cases of disease in a particular population at a particular place and time. (Meningitis at a high school during fall course)Endemic refers to?a disease that occurs regularly in a population as a matter of course. (ex: hay fever, AKA sinuses)Pandemic refers to?an outbreak of disease over a wide geographical area; often worldwide. (ex: Ebola Scare)Descriptive studies (correlational or observational) definition?1. A descriptive study is one in which information is collected without changing the environment 2. Describes the extent of a disease or condition within a population 3. Involves surveys or interviews to collect the necessary information 4. KEY: Determines WHO is getting the disease and WHERE and WHEN the disease is occurring** 5. Can involve a one-time interaction with groups of people (cross-sectional study) or a study might follow individuals over time (longitudinal study)Cross-Sectional Study?"snapshot" of the population (picture and time of that day)Longitudinal Study?Refers to ANY type of study that is LONG-TERMAnalytical Studies?1. Tests hypotheses to establish CAUSE 2. The two types of hypothesis is: a) Null hypothesis-a researcher tries to disprove or nullify** Preferred method: easier to disprove hypothesis than eliminate all potential contributing factors. b) Alternative hypothesis is an alternate way to explain the phenomenonExperimental Analytical Studies?1. Carries out under controlled setting (laboratory) 2. Uses control groups (treatment is withheld; Placebo) and treatment groups (receives treatment)What are the two types of Experimental Blindness? (under Experimental Analytical studies)1. Blindness (researcher remains uniformed; prevent bias 2. Double blind (neither the researcher nor the subjects know who is receiving treatment; BEST way to avoid bias**Case-Control or "Retrospective" studies?1. These studies look at the characteristics of one group of subjects who already have a certain health outcome (the case) and compare them to similar group of people who do not have the outcome (the controls) 2. these studies are not ideal in many instances because they gather info from the past and has the potential for inaccuracy and bias.Cohort or Prospective Studies?1. These studies follow large groups of people over a long period of time (longitudinal study) 2. Ex ( oral hygiene techniques, home care frequency, diet, etc) 3. Followed into the future 4. Once a specified amount of time has elapsed, the characteristics of people within the group are compared to test specific hypotheses. 5. Time-consuming and expensive, provides more reliable information KEY: The subject determine whether they are to receive the intervention or not. (intervention=improve a situation)Members of a local dental hygiene component recruited twenty caries-free sixth graders for an on-going study involving flossing habits. After obtaining parental consent, the study participants were surveyed for five years on frequency of flossing. At the end of the study, caries rates were compared between regular flossers and non-flossers. This is an example of what type of study?Cohort or Prospective studyWhat are the 5 Research Samples?1. Random Sample 2. Stratified sample 3. Systematic sample 4. judgment sample 5. convenience sampleWhat is random sample?1. Every one in the population has an EQUAL chance of being selected. 2. Reduces the chance of BIAS**** (Ex: pick names out of a phone book)What is stratified sample?1. Selecting an element according to certain subgroups 2. Proportionate number of participants from each subgroup for the sample 3. EX ( Identify all of the dental hygiene schools attending the boards review and select two members from each schoolWhat is Systematic sample?1. Select every "nth" (number) to participate 2. Ex. (Count off by 6 and then form groups based on like numbers)What is Judgment sample?1. Someone familiar with the population selects the sample 2. HIGH chance of BIAS***** 3. Ex. (your class president selects fellow students to be in one of four table clinic groups)What is Convenience sample?1. sample group is chosen based solely on convenience 2. ex. ( the first 10 people to walk through the door today were asked to fill out a questionnaire) 4. May or may no increase BIASWhat does Variables mean?1. What is being observed or measuredWhat are the two types of Variables?1. Dependent Variable 2. Independent VariableWhat is dependent variable?1. The outcome of interest (bottom line) 2. Should change in response to some intervention (improve a situation, taking action) 3. HINT- DEPENDent variable DEPENDs on the independent variable.What is independent variable?1. The intervention (action) 2. TIP- 'In" is in BOTH INdependent and Intervention 3. The independent variable is manipulated to produce a response to the dependent variableDuring Children's Dental Health Month, four hygienists volunteered to go into two elementary schools in Lewiston, Idaho and provide toothbrushes for all of the first grade students. At the first school the hygienists demonstrated correct tooth brushing techniques to the first grade teachers and students. Students were encouraged to brush their teeth daily after lunch. At the second school, tooth brushes were provided but no tooth brushing instructions was given. At the end of two weeks, a plaque index was taken on all of the first graders at both school. What is the independent Variable? What is the dependent variable?1. Tooth brushing 2. Plaque indexDescriptive Statistics is?Measures of Central Tendency*** distribution of data that best represents the middle (Balanced)Data Matrix does what?Arranges data scores from lowest to highest measurements.What is Frequency of Distribution and what are the three main methods?1. Measures how often each score occurs 2. Ungrouped, Cumulative, or GroupedUngrouped score is?Data is presented in ascending or descending order along with the frequency of each score. ( Hatch marks, Tally Marks)Cumulative Score is?Frequency of occurrence of scores up to and including any given value in the data.Grouped score is?Grouping variables into consecutive intervals. (Grading 91-96, 88-89 etc)What is measures of Central Tendency and what are the three measurements?1. Frequency of distribution is plotted out on an x-y graph. X=Horizontal Y=Vertical 2. Mean, Medial, ModeWhat is Mean?1. Average Score 2. Most Common measure of Central Tendency*** 3. Sensitive to extreme values (range) High low numbers.What is Median?1. Divides the distribution of scores into two equal parts 2. NOT affected by extreme high or low scores. 3. Locate midpoint.What is Mode?1. The MOST frequently occurring score 2. Affects the SkewWhen Data is plotted using a NORMAL curve, the mean, median, and mode are what?EQUAL A Normal Curve is also called (Bell or Gaussian)What is measures of Dispersion and what are the two measures of dispersion?1. Describes how WIDE the scores are around a central point. 2. Range, and Standard DeviationWhat is Range?1. Difference between high and low score. Subtract smallest from the largest. 2. Affected by extremely high or low scoresWhat is Standard Deviation?is the MOST commonly used method of dispersion in oral hygiene research and reflects the range. The bigger the range or standard deviation the wider the distribution curve.When plotted on a normal curve where does the majority of scores fall within? (standard Deviation)within +1 and -1When curves are not uniform graphs demonstrate what?An asymmetrical appearance it is said to be skewed.What is a positive skew?more scores fall in the lower range, so the curve will have a positive skew when plottedWhat is a negative skew?more scores fall in the higher range, so the curve will have a negative skew when plottedInferential statistics?Allows one to generalize findings from the sample study to a larger populationValidity definition?degree that a study or procedure can be conclusive yet sufficiently realistic; Does the test measure what it claims to be measuring?Reliability definition?The extent to which the method of measurement CONSISTENTLY performsWhat are the two Reliability Examiners?1. Intraexaminer reliability 2. Interexaminer reliabilityWhat is Intraexaminer reliability?Consistent performance by the SAME evaluatorWhat is Interexaminer reliability?Consistent performance BETWEEN DIFFERENT examiners (INCREASED calibration)Sensitivity definition?The ability of a test to correctly identify the PRESENCE of a disease (TIP: "EN" is found in both sENsitivity and presENceSpecificity definition?The ability of a test to identify the ABSENCE of a disease. (Tip: "EN" is ABSENT in "specificity"Correlation Co-efficient does what and what are the two correlations?1. Determines the strength of relationship between two variables 2. Shows probably cause and effect 3. Given a number between +1.0 and -1.0 (Tip: The closer the correlation co-efficient is to either +1.0 and -1.0 the STONGER the correlation***) 4. Positive correlation 5. Negative CorrelationWhat is a Positive correlation?The value of X increases, the Value of Y increases and if X decrease Y decreased (reflect a DIRECT Association between the variables) Ex: The more garlic you eat the more halitosis you will haveWhat is a Negative correlation?1. The values of X increase, the Value of Y decreases 2. Predicts an opposite score on the other scale (Ex: the more you brush your tongue the less halitosis you will have)What are the three tests used in Inferential Statistics?1. t-test 2. ANOVA (Analysis of Variance) 3. p-valueWhat is a t-test?statistical measure, the difference between TWO mean scores (TIP: "t" stands for two)What is ANOVA (Analysis of Variance)?Used when comparing the statistical difference between THREE or more mean scores (TIP: there are more than three letters in ANOVA)What is p-value (probability values)?***1. Refers to the probability that a condition or circumstance would happen just by chance without experimental intervention. 2. Standard of acceptability is 1 out of 20 or a p-value od < or = 0.05**** 3. A p-value greater than 0.05 will negatively affect study results!!!What are the types of Preventive services?1. Primary Services 2. Secondary Services 3. Tertiary SercvicesWhat is Primary Services?1. Techniques are designed to prevent, reverse, or arrest a disease process 2. Ex: Mechanical plaque removal, dietary restriction of sucrose, and fluoride treatments. 3. Involves preventive therapiesWhat is secondary services?1. Treating or controlling a disease or condition after it occurs Ex: periodontal therapyWhat is tertiary services?1. Involves replacing lost tissues in order to rehabilitate oral structures Ex: implants and bridgesCharacteristics of an ideal index?1. Simple 2. Valid 3. Reliable 4. Clear 5. Sensitive 6. Quantifiable 7. Objective 8. AcceptedWhat are the general categories of indices?1. Reversible 2. Irreversible 3. Simple 4. CumulativeWhat is a reversible index (indices)?1. Measures condition that can be resolved or reversed 2. gingivitis indices (index) is an exampleWhat is a irreversible index (indices)?1. Measures cumulative conditions that CANNOT be resolved. 2. Caries and periodontal disease indices are exampleWhat is a simple index (indices)?1. Measures the presence or absence of a diseaseWhat is a Cumulative index (indices)?1. Measures all the evidence of a condition (both past and present)What are the common Dental Indices (index)?1. Dental Caries Indices 2. Gingivitis Indices 3. Periodontal Indices 4. Oral Hygiene IndicesWhat type of index's fall under Dental caries Indices?1. DMFT/DMFS (Decayed, Missing, Filled TEETH/Decayed, Missing, Filled SURFACES) 2. deft (decayed, need for extraction, filled teeth) 3. dft/dfs (decayed, filled teeth/ decayed, filled surfaces) 4. RCI (Root Caries Index) 5. CAMBRA (Caries Management by Risk Assessment)What type of Index's fall under Gingivitis Indices?1. GI (Gingival Index) 2. SBI (Sulcular Bleeding Index)What type of Index's fall under Periodontal Indices?1. PDI (Periodontal Disease Index) 2. PI (Periodontal Index) 3. PSR (Periodontal Screening and Recording) 4. CPITN (Community Periodontal Index of Treatment Needs)What type of Index fall under Oral Hygiene Indices?1. OHI-S (Simplified Oral Hygiene Index) 2. PII (Plaque Index) 3. PHP (Patient Hygiene Performance) 4. VMI (Volpe-Manhold Index)DMFT/DMFS (Decayed, Missing, Filled TEETH/ Decayed, Missing, Filled SURFACES) is?1. Irreversible 2. Measures PAST and PRESENT caries experience in populations with adult dentitions.deft (decayed, need extraction, filled teeth) is?1. Irreversible 2. deciduous teeth 3. Does not take into account teeth that have been extracted or exfoliated due to past caries experience**dft/dfs (decayed, filled teeth/decayed, filled surfaces) is?1. Irreversible 2. Measures observable caries experience in deciduous teethRCI (root caries index) is?1. Irreversible 2. Requires recession!!! (only takes into consideration areas of root exposure)CAMBRA (Caries Management by risk assessment)1. Identifying the cause of disease through the assessment of risk factors for each individual patient and then managing those risk factors through behavioral, chemical, and minimally invasive procedures 2. This form lists 24 factors 3. Separate form for pediatric patients 4. easily divide patients into category of low, moderate, high or extreme risk. This is helping each patient prevent caries and manage existing issues.What is GI (gingival Index)?1. Reversible 2. Based on severity versus extent of inflammation 3. can be used in individuals or study participantsWhat is SBI (Sulcular Bleeding Index)?1. Reversible 2. detects EARLY signs of gingivitis 3. useful in short-term trialsWhat is PDI (Periodontal Disease Index)?1. Both irreversible and reversible because is measures gingivitis and periodontitis separately. 2. Developed by Dr. RamfjordWhat is PI (Periodontal Index)?1. Irreversible 2. Developed by Russell 3. Looks at surrounding tissue 4. No clinical attachment loss is included-- LIMITATION**What is PSR (Periodontal Screening and Recording)?1. Assess Periodontal Health 2. Requires a special probe (limitation) 3. Useful in preliminary screening technique and for use in large populationsWhat is CPITN (Community Periodontal Index of treatment Needs)?1. Developed by WHO 2. Determines periodontal NEEDS versus periodontal STATUS 3. Requires special probe (limitation)What is OHI-S (simplified oral hygiene Index)?1. reversible 2. measures oral hygiene status 3. better for groupWhat is PII (Plaque Index)?1. Reversible 2. developed by Silness and Loe 3. used in conjunction with the Gingival Index 4. Scores plaque according to its thickness at the gingival marginWhat is PHP (Patient Hygiene Performance)1. Reversible 2. Measures plaque after toothbrushing (Assesses patients skills)What is VMI (Volpe-Manhold Index)?1. Reversible 2. Used to test agents for plaque control and calculus inhibitionThe FIRST step in planning a program is to conduct a What?Needs assessmentWhat are the reasons for a needs assessment?1. Defines extent and severity of problems 2. Identifies causes of problems 3. Provides a profile of community 4. Collects Baseline Data******What are some ways to conduct a needs assessment?1. Direct observation (time consuming, not cost effective, requires manpower 2. Interview (not time consuming or cost effective, not recommended for large groups) 3. Questionnaire (good for large populations must be understandable for the target population) 4. Survey (Best choice for large populations) 5. epidemiology survey (researched based) 6. Records, documents, charts (access dependent, time consuming)Needs of assessment considerations include?1. Access to care Issues 2. Ways to Observe NeedsAccess to Care issues Includes?1. Need: Type of care available (Ex: one dental office accepting Medicaid patients in a town of 65,000) 2. Demand: Type of care desired (Ex: whitening versus restorative procedures) 3. Utilization: actual use of services available by the public 4. Barriers: obstacles which interfere with care (Ex: lack of financial funding for low cost dental services)Ways to Observe needs include?1. Through the eyes of the PLANNER 2. Through the eyes of the TARGET POPULATIONWhat does it mean when it states through the eyes of the PLANNER?1. Real needs based on health issues 2. ObjectiveWhat does it mean when it states through the eyes of the TARGET POPULATION?1. Perceived needs or wants (what they want not need) 2. Opinion 3. Subjective Ex: The study participants want whitening versus restorative proceduresWhat are the four types of examination methods?1. Type I 2. Type II 3. Type III** 4. Type IV**What is type I (1) Examination method?Comprehensive examination using mouth mirror, explorer, lighting, radiographs, study models, and any other diagnostic test. Not practical for most community programs due to costWhat is type II (2) Examination method?Limited examination including mouth mirror, explorer, light, and limited radiographs; access to radiology equipment limits use in community programsWhat is type III (3) Examination method?Examination using mouth mirror and lighting ONLYWhat is type IV (4) Examination method?Examination using tongue depressor and lighting ONLYTwo dental hygienists employed in the same private practice volunteered to perform oral cancer screenings at a community health fair. The hygienists were told that they would likely screen between 500-800 individuals. While gloves and masks would be provided, the hygienists were asked to supply any other equipment they would require. Comparing the cost of disposable mirrors to tongue depressors, the hygienists elected to use tongue depressors and flashlights for screening. What type of examination method does this represent?Type IVPopulation Profile means?Gathering information about the general publicWhat information is included in the population profile?1. Number of individuals who will be part of the program 2. Geographical distribution of the target population 3. Rate of growth in the community 4. Degree of urbanization 5. Ethic and language profile 6. Nutritional status 7. Standard of living 8. Amount and type of community services and utilities available 9. Profile of school system (private versus public) 10. General health profile (including drug abuse pattern)What are the step for planning a Community program?1. Collection of preliminary information 2. Establishment of priorities 3. Determine goals and objectives*** 4. Consulting and coordinating activities 5. Drafting a planWhat is included when collection of preliminary information?1. Attitudes toward oral health issues by community leaders 2. Funding and resources*** a) Medicare (health care for elderly) b) Medicaid (health insurance for the poor) c) COBRA (employees coverage for 18m after layoff) d) Block grants (lump sum of money given use at their discretion to meet a need) e) Line item grant (Specifies where the money is to goWhat does establishment of priorities mean?Rank the needs of the target populationWhat does Goals mean?1. Broad-based statement of desired outcome of a program Ex. Dental hygiene students are working hard to achieve their goals of becoming a registered dental hygienistWhat does Objective mean?1. Specific statements describing the steps that must be taken to achieve the overall goal; MUST BE MEASURABLE!What is included when consulting and coordinating activities?1. Secure an appropriate facility where the program will be carried out 2. Make sure the necessary manpower is in place 3. Coordinate plan of action between those involved with the programWhat do you need to do when drafting a plan?1. Develop a lesson plan and implementation strategy 2. Choose activities or procedures that have been successful in the PAST!!! No need to re-invent the wheel..What are the six constructs of the HBM ( Health Belief Model)?1. Perceived susceptibility 2. Perceived severity 3. Perceived benefits 4. Perceived barriers 5. Cue to action 6. Self-efficacyWhat are the limitations of Health Belief Model?1. It does not account for a persons attitude, beliefs, or other individuals 2. It does not take into account behaviors that are habitual 3. Is does not account for environmental or economic factors 4. Is assumes that everyone has access to equal amounts of information on the illness or disease 5. It assumes that cues to action are widely prevalent in encouraging people to act and that "health" actions are the main goal in the decision-making process (The most effective use of the model, it should be integrated with other teaching models)What are the Principles of Teaching?1. Teach the way skills are to be used*** 2. Establish goals and objectives*** 3. plan an evaluation (evaluation needs to be ONGOING)What are the Principles of Learning?1. Motivational Factors--- External motivation (promise of a reward) or Internal motivation (change as a result of self awareness; BETTER predictor of behavior change) 2. Learning only progresses as far as learning wantsWhat are the stages of Learning? The learning ladder!1. Unawareness 2. Awareness 3. Self-interest 4. Involvement 5. Action 6. Habit (TIP: Ugly, Apes, Sit, In, A, Hut!)A 53 year old female walks into your office and is worried about halitosis. She states that she gargles with mouth rinse three times a day but does not brush because she "thinks it might stir up the stinky bugs". At what stage of learning is this patient in?UnawarenessEvaluation of a program (or 'Program Appraisal') includes?1. Provides information for future programing revisions 2. Analyses whether or not goals and objectives were met*** 3. may be FORMAL (Ex. Written pre and post- test) or INFORMAL (Ex. questioning audience during a presentation)AS part of their final project for their community Dental Health class, Jamie and Vince decided to give a nutritional presentation on healthy snack alternatives to the fifth grade students at Longmont Elementary School. Prior to their lecture, they gave the students a brief quiz to test their knowledge on healthy snacks. After the presentation the students took the same quiz and Jamie and Vince compared the results. What type of evaluation does this represent?FormalEvaluation must be continuous from the ______ of the program?Beginning (from start to finish) (it is necessary to have baseline data from the needs assessment to determine a groups progress***)Items to be evaluated of a program are?1. Effectiveness and efficiency of the program 2. Appropriateness of the program for target audience 3. Educational and instructional materials 4. Organization/planning of the program 5. Behaviors and attitudes of learning and administrators 6. were the objectives met****What are the types of Evaluations of a program?1. Summative 2. FormativeWhat is Summative?1. Outcome evaluation; measures impact of program/teaching (Ex. Comprehensive final examination)What is Formative?1. Conducted DURING the program; making sure audience is engaged. (Ex. asking learners if they understand a concept before moving on to another topic)What are the steps in the summary of events for a community program?1. Step 1: needs assessment 2. Step 2: Planning a community project 3. Step 3: Implementation of community program 4. Step 4: Program EvaluationThe primary international organization devoted to health issues is the ?World Health Organization (WHO)The two primary federal organizations concerned with health problems in the U.S are the?1.Department of Health and Human Services (DHHS) 2. Centers for Disease Control and Prevention (CDC)Any type of study that is conducted over a long period of time is classified as a ?Longitudinal StudyAdhesion refers to?The chemical attraction between UNLIKE moleculesCohesion refers to?The chemical attraction between LIKE moleculesCoefficient of thermal expansion refers to?An index which indicates how one material reacts to temperature extremes in relation to another.Creep refers to?Slow dimensional change caused by compressionDuctility refers to?The ability to undergo change of form without breakingElasticity refers to?A material's ability to recover its initial shape after undergoing a forceGalvanism refers to?An electrical current generated by dissimilar metals in an acidic environment. (amalgam and gold contact)Gelation refers to?The process of gelling (solidification by cold)Imbibition refers to?Absorption of a solvent by a gelMalleability refers to?A material's capacity to be shaped by force or pressureMicroleakage (percolation) refers to?Passage of oral fluid/bacteria into and out of tooth structure due to marginal gap or failure of marginal (restorative) sealPolymerization refers to?The linking, branching, or cross-linking of smaller molecules.proportional limit refers to?The force at which a material cannot return to its original shapeSyneresis refers to?Contraction of a gel due to the loss of a solventTensile strength refers to?The force needed to stretch a material to the point of fractureViscosity refers to?resistance to flowDesirable features of Amalgam is?1. Durable 2. Similar compressive strength to enamel 3. Relatively inexpensiveUndesirable features of Amalgam is?1. Unattractive 2. High thermal conductivity 3. Dimensionally unstable (creep) 4. Delayed expansion if contaminated by saliva 5. Requires tooth support 6. Fracturable by excessive occlusion 7. Susceptible to galvanism when newFinal polishing in the mouth is what material?Tin oxideAvoid overhand formation by?1. Using a properly placed band and wedges 2. Detect overhang with explorerBonding Agents are?1. Dental Resins (BIS-GMA)\ or Urethane dimethacrylate) which establish micromechanical retention 2. created by conditioning with phosphoric acid.Steps for a bonding agent?1. 15-20 seconds etch 2. Rinse 3. Dry 4. Apply 5. air-thin 5. Polymerize (light cure)What is Phosphoric Acid?an etch application that increases enamel and dentin surface areaPolymerization typically activated by____?Fiber-optic light a) Light-activated polymerization allows flexible working time. b) Polymerization initiators typically benzoyl peroxide or a tertiary amineBonding failures commonly due to contamination by _____?Saliva or oils a) If contamination at any step of the process occurs, RE-ETCHBIS-GMA stands for?Bisphenol a-glycidyl methacrylatePits and fissure sealants is? (low viscosity)Barrier used to protect the occlusal surface of teeth from bacterial assault by sealing anatomically unprotected tooth structure with resinSteps in pits and fissure sealants?a) Pumice, rinse, isolate, etch, rinse, dry, apply, remove excess, polymerize b) re-etch if enamel lacks "frosty" appearanceComposite refers to as? (high viscosity)An esthetic restorative material composed of a bonging agent and tooth-colored filler particles of various sizes. (Shrinks on setting) a) Most common filler particles: silicates, quartz, or glass. b) Barium or strontium usually added for radiopacityLiners are and include what?1. Used to seal dentin or medicate the dental pulp 2. Includes: a) Calcium hydroxide (stimulates reparative dentin formation) b) Zinc-oxide/eugenol (smoothes the pulp, oil, c/I with composite c) Resin-modified glass ionomer ( seals tubules and releases fluoride)Bases are and includes?1. Used to provide thermal insulation or mechanical protection for the dental pulp 2. Includes: all cements, because cements are poor thermal conductors, and have adequate compressive strength. Types of based include: Zinc Phosphate, Zinc (IRM) and Glass ionomer.Cements are and includes?1. Used to affix a restoration to tooth structure, or as a base. a) Zinc Phosphate b) Polycarboxylate c) Glass ionomer d) Resin e) Hybrid f) Zinc-oxide/eugenolZinc Phosphate cement qualities?a) Exothermic (produce heat) reaction on mixing (use cool glass slab) b) Mechanical interlock between tooth and casting c) Neutral pH after 48 hours d) Acidity 3.5 thermal insulator " pulp protection" neededPolycarboxylate cement qualities?a) high chemical affinity for enamel b) powder mixed with polyacrylic acidGlass ionomer cement qualities?a) binds to dentin b) releases fluoride c) Coefficient of thermal expansion approximates tooth structure d) can be used as a Class V restorative materialResin cement qualities?a) tooth colored esthetic restorations like porcelain laminate veneers and tooth colored inlays, onlays, or crowns and clear ortho bracketsHybrid cement qualities?a) resin-modified glass ionomers b) seals dentin effectively to minimize sensitivity c) Releases fluoride (glass ionomer)Zinc-oxide /eugenol cement qualities?a) Commonly used for temporary cementation b) orange solvent typically used to clean ZOE-contaminated instruments c) Do not require a protective varnish or cavity linerLIst the two Aqueous (water-Solube or hydrophilic) Hydrocolloids?1. Reversible hydrocolloid (agar) Irreversible hydrocolloid (alginate) a) both require a quick snap to removeWhat are the qualities of Reversible Hydrocolloid (agar)?1. undergoes a physical reaction only 2. Sol- gel state is temperature dependent 3. Solidification by cold called gelation 4. popular for multiple preparations, but unstable 5. Susceptible to imbition (getting bigger) and syneresis (Shrinking) 6. Must be poured immediatelyWhat are the qualities of irreversible Hydrocolloid (alginate)?1. Undergoes a chemical reaction 2. Not temperature dependent, but setting can be delayed by cold water or accelerated by warm water 3. popular choice for study modelsList the four Non-aqueous (water-insoluble or hydrophobic) Elastomers?1. Polysulfide rubber 2. Polyether rubber 3. Silicone rubber 4. VinylpolysiloxaneWhat are the qualities of Polysulfide Rubber?1. Messy 2. Smelly 3. Must be poured same day 4. Longest working timeWhat are the qualities of Polyether Rubber?1. Relatively rigid, good tissue detail 2. Unstable in presence of moisture (will distort if left wet)What are the qualities of Silicone Rubber?1. Putty-like, rarely usedWhat are the qualities of Vinylpolysiloxane?1. Tasteless, Odorless 2. Stable, strong, accurate 3. Capable of multiple poursGypsum Products and qualities?1. Mineral, Calcium Sulfate di-hydrate 2. heated to refine material, which drives off some of the water, resulting in either: a) Alpha-calcium sulfate hemi-hydrate b) Beta-calcium sulfate hemi-hydrate (plaster of paris) 3. In other words, Alpha (stoner) is superior to Beta (plaster) as a material. 4. The more water needed the greater the setting expansion and lower the compressive strength of the final productPlaster, Type II Gypsum = ?Beta-calcium sulfate hemi-hydrateStone, Type III Gypsum = ?Alpha-calcium sulfate hemi-hydrateDiestone, Type IV Gypsum = ?Alpha-calcium sulfate hemi-hydrate it contains additives to make more durable and wear resistant (also called improved stone)Material selection dependent upon strength and dimensional accuracy desired. What are some of the models and what is the material used for each?1. Orthodontic models: plaster (easy to polish) 2. Study models/working models: stone (more accurate and wear resistant) 3. Crown and bridge die or model: improved stone or Diestone.Modification of working time for gypsum products?1. add potassium sulfate to accelerate set 2. Mix with warm (not hot) water to accelerate set 3. Add borax to slow setGood to knows about gypsum products:1. Model base trimmed perpendicular to midline between central incisors.Dental waxes qualities?1. Multiple use, comprised primarily of paraffin 2. Modified by beeswax, carnauba, rosin, and colorantsWhat are the 6 waxes used in dentistry and there uses?1. Inlay and casting waxes- used for cast restorative patterns 2. Baseplate waxes- useful in removable prosthetic procedures 3. Bite registration wax- useful to obtain occlusal records (low melting point) 4. Boxing wax- used in pouring models 5. Sticky wax- becomes sticky when heated, used to attach models (labs) 6. Utility wax- Used to modify the shape of impression trays and cushion braces.Casting Alloys qualities and uses?1. Used to fabricate inlays, onlays, crowns and bridges 2. Properties determined by components 3. Classified as precious or nonprecious, based upon composition. 1.) Precious alloys contain noble metals a) noble metals resist tarnish and corrosion b) noble metals used in dentistry include: gold, platinum, and palladium 2.) Nonprecious alloys contain base metals a) base metals are subject to tarnish and corrosion. b) may be allergenic (gingival inflammation) c) base materials used in dentistry include: silver, copper, nickel, tin, and zinc 4. Intra-orally, gold may be polished with tin oxide 5. Extra-orally, gold may be polished with rouge 6. Gold foil: small, gold, gum-line, anteriorAbout Implants and what they are?1. Biocompatible titanium alloy prosthesis used to replace missing teeth 2. Prosthesis may be cylindrical 3. Implants are endosteal (within bone)The leading cause of implant failure is ?1. Mobility a) lack of osseo-integration, or inadequate boneContra-indications to implant placement are?1. Inadequate bone 2. Uncontrolled periodontal disease 3. smoking 4. infection 5. BisphosphonatesConsumer products include?1. Tarter control formula toothpastes b) Leading cause of dental hypersensitivity 2. Gum care toothpastes 3. Desensitization toothpastes 4. Vital bleach (home bleach)What is the active ingredient in tarter control formula toothpaste?1. Pyrophosphate a) leading cause of dental hypersensitivityWhat is the active ingredient in gum care toothpastes?1. Triclosan (antimicrobial agent)What is the active ingredients in desensitizing toothpaste?1. Potassium nitrate, sodium citrate, or strontium chlorideWhat is the active ingredient in Vital bleach?1. Carbamide peroxide, or hydrogen peroxide a) Carbamide peroxide breaks down into hydrogen peroxide and urea.A material that is highly ductile, ?Can undergo a change of form without breakingSilver amalgam alloys contain copper to: ?Reduce the rate of corrosionThe liner most commonly used to stimulate the development of secondary dentin in the event of pulp exposure is:?Calcium hydroxideTo slow the set of gypsum and gain more working time in pouring a model, a person would?Add borax to the mixThe best dental was to modify an impression tray is?Utility waxThe primary benefit of using noble metals in restorative allows is?They resist tarnish and corrosionContraindications to implant placement include?1. Inadequate bone 2. Uncontrolled periodontal disease 3. History of bisphosphonate therapyA leading cause of dentinal hypersensitivity is due to the incorporation of what ingredient in toothpaste?PyrophosphatesAccording to G.V black's classification of restorations, an anterior proximal filling would be?Class IIIOne of the benefits of using glass ionomer cements is that?it releases fluorideBacteria are grouped according to their ______ and _____/_______ differences?1. Morphological 2. Metabolic/BiochemicalQualities of bacteria staining?1. Allows clinician to determine shape of organism (round,rod, etc) 2. Necessary because most bacteria are colorless and invisible to light microscopy 3. Most useful microbiological staining technique is the gram staining. 4. Separates organisms into 2 groups. a) Gram + (stain Blue) b) Gram - (stain Red) 5. Different gram stains are a result of differences in CELL WALLSGram + Cell Wall Qualities?1. Very thick 2. Contains teichoic acid 3. Vulnerable to penicillin's and lysozyme 4. Has 2 layers 5. Low lipid content 6. NO periplasmic space/porin channel 7. NO ENDOTOXINSGram - Cell wall qualities?1. Very thin 2. Cell wall has murein lipoprotein 3. Contains 3 layers 4. High lipid content 5. Has periplasmic space and porin channel 6. Outer cell membrane contains ENDOTOXINS (LIPID A) 7. Block diffusion of substances that attack cell walls such as penicillin's and lysozymeThe two organisms that can not be stained by gram positive staining are?1. Mycobacteria (require acid-fast stain) 2. Spirochetes (require dark field microscopy)The causative organisms for tuberculosis is a bacteria called?1. MycobacteriaTuberculosis is acquired via ?Airborne transmissionMost disease causing organisms are?Gram negative rod or gram negative pleomorphicThere are 8 exceptions to the disease causing organisms and they are?1. 2 gram positive cocci (streptococcus and Staphyloccus) 2. 4 gram positive rods (Bacillus, Clostridium, Cornebacterium, and Listeria) 3. 1 gram negative cocci (Neisseria) 4. 1 gram negative spiral shaped organisms (Spirochete)Gram positive Cocci factors?1. Do NOT form spores 2. Non-mobile****In order for most non-mobile microorganisms to invade tissue, the bacteria needs to be able to make a specific enzyme knows as?1. Hyaluronidase. (Ase=Breakdown)Hyaluronidase is referred to as the?Spreading factor and that is necessary for invading tissue during spread of infectionFactors about streptococcus?1. Spherical gram positive cocci usually arranged in chains or pairs 2. All streptococcus are catalase negativeWhat are the three groups in order from there ability to hemolyse Red blood cells (RBCs)1. Beta-hemolytic streptococcus (complete lyse RBCs)** 2. Alpha-hemolytic streptococcus (partially lyse RBCs) 3. Gamma-hemolytic streptococcus (unable to lyse RBCs)Factors Beta-hemolytic streptococcus?1. Arranged in groups A-U (know as Lacefield groups) 2. Group APartially due to their ability to adhere to pharyngeal epithelium, Group A streptococcal are causative for such maladies (disease) as?1. Streptococcal pharyngitis 2. pyogenic infections 3. Tonsillitis 4. Scarlet feverWhat is Rheumatic fever?1. it is an inflammatory disease that may develop after an infection with streptococcus bacteria (such as strep throat or scarlet fever)What is the causative organism for scarlet fever and rheumatic fever?StreptococcusFactors about Viridans group of streptococcus?1. Viridis is Latin for Green 2. Alpha-hemolytic 3. Normal inhabitants of nasopharynx and gingival crevices*****What are the three main types of Viridans infections?1. Dental infections 2. Endocarditis 3. AbscessesSome of the viridans group of dental infections is?S.mutans which can bind teeth by producing dextran polysaccharides in the presence of sucrose; also known as glycans can produce acid and dental caries***Streptococcus mutans process what?SugarS. Mutans metabolizes what?Sucrose to lactic acid which creates an acidic environment which can demineralize enamelSucrose is also used by S.mutans to produce?DEXTRANS (sucrose is the only sugar that can be utilized to form the sticky polysaccharide) which allows the strep to adhere to the tooth and add to the volume of plaque.Many other sugars such as glucose, fructose, lactose can be digested by S. mutans but the end product is?Lactic Acid (not dextrans)It is the combination of _______and _______ that lead to Dental Caries?1. Plaque 2. AcidS. mutans is NOT associated with what?Periodontal diseaseFactors about Endocarditis?Dental manipulations can release viridans into the bloodstream where they implant on the endocardial surface of the heart (damaging heart valves)Most common viridans organisms are?1. S. Mutans **** Caries**** 2. S. sobrinus *(caries)* 3. S. mitis (endocarditis) 4. S. sanguis (plaque colonization and endocarditis) 5. S. salivarius ***(colonizes oral tissue)***Streptococcus Salivarius is a?1. Spherical, gram positive bacteria which colonize the mouth and URT of humans a few hours after birth! 2. ASSOCIATED WITH THE TONGUE!***Viridans streptococcus are among what?1. The most common AEROBIC organisms implicated in facial cellulitis________ ________ can be encapsulated with a _______________ ________ which makes it very resistant and destructive.1. Streptococcus pneumonia 2. Polysaccharide layerStreptococcus Pneumoniae factors?1. Encapsulated with a polysaccharide layer which is very resistant 2, Causes pneumbriaImportant characteristics of staphylococcus1. Non-mobile 2. Non-spore forming 3. Spherical gram + cocci arranged is grapelike clusters 4. Facultative aerobe 5. Lesion formation is abscess formationStaphylococcus qualities?1. GENERALLY harmless 2. Penicillin-G resistant (streptococcus is not)What are important characteristics of staphylococcus?1. Non-mobile 2. Spherical gram positive cocci arranged in grapelike clusters 3. Facultative anaerobe 4. Typical lesion of staphylococcus is abscess formationWhat is an important Staphylococcus pathogen is?Staphylococcus aureus*****Staphylococcus Aureus qualities?1. Significant exotoxins are coagulase and hyaluronidase 2. Major producer of proteins called leukocidins ( Destroy phagocytes) destroyed phagocytes make up much of the material of pus!MRSA is?1. Methicillin Resistant Staphylococcus Aureus 2. ***MRSA is the MOST resistant disease-causing organism*** 3. ***Vancomycin and Bactrim are often the first antibiotic used in treatment of MRSA***What are some GRAM + Rods?1. Bacillus (causative organism for anthrax and food poisoning) 2. Clostridium (causative organism for tetanus, botulism, gangrene, food poisoning and antibiotic-resistant pseudomembranous colitis)Clostridium tetani causes?1. Lock jaw or tetanus; normally inhabits superficial layers of soil------SPORES ARE GENERALLY "DUST BORN"****What are some Gram - Cocci?Neisseria (causative organism for meningitis and gonorrhea)What are some Gram - Spiral shaped organisms?1. Spirochetes (causative for syphilis*** 2. Found in association with NUG/NUPMost other disease-causing bacteria are?1. Gram negative rods or gram negative pleomorphic microbes.Specific Board worthy Microbes are?1. Lactobacillus 2. ActinomycesLactobacillus?1. Can derive lactic acid from glucose which creates an acidic environment (considered ACIDURIC***) 2. Produces LEXAN 3**** Lactobacillus are associated with advanced carious lesions DEEP in enamel AND are aciduric****Actinomyces?1 Gram positive pleomorphic rods which form a large proportion of the oral microflora 2. They (A. Viscosus, A. Naeslundii, and A. Odontolyticus) have been implicated in root cariesMorphology of bacteria 1. Cocci= 2. Bacilli= 3. Spiral forms= 4. Pleomorphic= 5. Appendage bacteria = 6. Filamentous bacteria1. Spherical 2. Rods 3. Comma-shaped, S-shaped, or spiral shaped 4. Lacking distinct shape 5. Arms and legs 6. Has hairGrowth Phases of bacteria?1. Lag Phase 2. Logarithmic ("exponential") phase 3. Stationary phase 4. Death PhaseLag Phase?1. Growth is SLOW at first as bacteria acclimate to their environment 2. ** Cellular metabolic activity was NOT increased during the LAG PHASE**Logarithmic ("Exponential") Phase?1. Growth occurs "exponentially" (very rapidly) 2. Microorganisms are most prone to breakdown by antimicrobial agents!!!!*****Stationary Phase?1. nutrients are used up and waste products build up.Death Phase?1. microbes die offMetabolic characteristics of bacteria is?Can be classified based on; 1. oxygen metabolism*** 2. Carbon and energy sources (the most commonly used source of energy and carbon for humans and bacteria is GLUCOSE!)Oxygen Metabolism Qualities?1. MAJOR FACTOR!!! 2. oxygen is HIGHLY reactive 3. Bacteria posses 3 enzymes to break down oxygen products: a) Catalase (breaks down hydrogen peroxide) b) Peroxidase (breaks down hydrogen peroxide) c) Superoxide dismutase (breaks down superoxide radical)What are some bacteria categories?1. Obligate aerobes 2. Facultative anaerobes 3. Microaerophilic 4. Obligate anaerobesObligate Aerobes?1. Just like us! 2. Have all the enzymes ( catalase, peroxidase, superoxide dismutase) 3. Uses Krebs cycle and glycolysis 4. Examples of obligate aerobes: a) Neisseria b) Pseudomonas c) Legionella d) MycobacteriumFacultative Anaerobes?1. Aerobic 2. Use Oxygen 3. CAN grow in the absence of oxygen by using fermentation 4. Examples: a) Staphylococcus b) Listeria c) Actinomyces (root caries Alert!) d) Most other gram-rodsMicroaerophilic bacteria?1. "Aertolerant anaerobes" 2. Use fermentation 3. Can tolerate low amounts of oxygen (superoxide dismutase) 4. Examples: a) Streptococcus b) Spirochetes c) Camphylobacter (implicated in pregnancy gingivitis)Obligate Anaerobes?1. HATE OXYGEN 2. Examples: a) Prevotella b) Porphyromonas gingivitisPrevotella is Most associated with?Hormonal (Pregnancy) gingivitis, facial cellulitis, and NUP/NUGPorphyromonas gingivalis?1. VERY IMPORTANT PATHOGEN FOR PERIODONTAL DISEASE**** 2. Surface fimbrea which allow the bacteria to adhere to epithelial and tooth surface. 3. Produces COLLAGENASE (an enzyme capable of breaking down collagen in connective tissue and periodontal attachment apparatus); tetracycline's (like doxycycline) have anti-collagenase properties making them ideal treatment options in the treatment of periodontal diseasesOpportunistic Fungi?1. Most fungi are obligate aerobes 3. Normal flora of skin and mucous membranes suppress fungi 4. fungi are EUKARYOTIC organisms and bacteria are PROKARYOTIC a) antibiotic therapy will kill most bacteria but id ineffective against fungal organisms b) when a person is taking antibiotics fungal organisms are unaffected and often overtake the hosts ability to suppress fungal infections.Nystatin is used for what?It is used TOPICALLY to treat oral candidiasisFluconazole is used for?it is used SYSTEMICALLY to treat oral candidiasisCandida Albicans is the?Most common fungus encountered in the dental setting and has several unique characteristics.Candida Albicans Characteristics?1. Can invade tissue of individual's with impaired resistance (immunosuppressed) 2. Can cause candidiasis in debilitated individuals 3. Superficial candidiasis appears as thrush a) patches of creamy white with reddish base on mucous membranes b) membrane may be scraped off to reveal a red ulceration 5. Systemic infections of candida may involve a) Lungs b) Kidneys c) Heart d) Esophagus****Viruses Unique characteristics?1. Energy-less 2. Must have a host cell 3. Composed of protein core (capsid) surrounding genetic material 4. outer lipid bilayer (envelope) or may be naked 5. A complete virus particle called a virion 6. Viruses are generally small (range in size from 0.02-0.3 microns) 7. Host range 8. Helical or "icosahedral" (a symmetrical structure with 20 faces) in shapeVirus background?1. When a virus invades a host cell, if "hijacks" the cells protein- making apparatus in order to self-replicate.Once a host cell has been infected by a virus, there are four possible outcomes:1. Death 2. Transformation 3. Latent Infection 4. Chronic slow infectionsClassifications of viruses is based on:1. Type and structure of viral nucleic acid (RNA or DNA- NEVER BOTH)*****About RNA Viruses?1. RNA genome can be either SIMILAR to mRNA (referred to as positive strand RNA) 2. or a template for production of mRNA (referred to as (negative strand RNA) 3. RNA viruses must provide RNA dependent polymerases (replicase and transcriptase) because host cells cannot replicate RNAExamples of RNA Viruses:1. Hepatitis A 2. Rhino Virus (common cold) 3. Influenza virus (FLU) 4. Mumps 5. Measles 6. Rabies 7. HIV*****About DNA Viruses?1. Has both positive and negative strands 2. Cannot be translated into proteins until it is transcribed into mRNAWhat is the role and function of mRNA?1. The role of mRNA is to move the information contained in DNA to the cells cytoplasm where protein synthesis and viral replication takes place 2.** The primary function of mRNA was TRANSLATION* 3. ** TRANSCRIPTION is from DNA to RNA**Examples of DNA Viruses:1. Human Papilloma Virus (HPV) 2. Herpes simples 1 and 2 3. Varicella-Zoster 4. CMV 5. Epstein-Barr Virus 6. SmallpoxEpstein-Barr Virus?1. EBV it is a member of the herpes virus family the most common human viruses 2. Herpes virus is the causative organism for Epstein-Barr 3. Epstein-Barr Virus is the causative organism for infectious mononucleosis. 4. May also be implicated in malignancies such as Nasopharyngeal carcinoma and Burkitt's lymphoma. 5. Also implicated in oral hairy leukoplakiaMeasles?1. Spread via nasopharyngeal secretions 2. CAN CROSS PLACENTAL BARRIER!!!**** 3. Koplik's spots are small, red-based lesions with blue centers in the mouth.Coxsackie Virus?is causative organism for herpangina (NOT HERPES VIRUS)Varicella-Zoster virus (VZV)?1. causes chickenpox-- and herpes zoster (shingles)Hepatitis qualities?1. 4 RNA hepatitis viruses: a) Hepatitis A (HAV) b) Hepatitis C (HCV) c) Hepatitis D (HDV) d) Hepatitis E (HEV) 2. 1 DNA hepatitis virus: a) Hepatitis B (HBV)****Hepatitis B virus (HBV) Qualities?1. BIG (42nm in Diameter) 2. Intact virus is called the Dane particle 3. Hepatitis B surface antigen (HBsAg) is critical because antibodies against this component (anti-HBsAg) are PROTECTIVE (confers IMMUNITY)**** 4. During active infection and viral growth, a soluble component of the core is released: HBeAg 5. HBeAg is the maker for active disease and a highly contagious state**** 6. HBV vaccine is a recombinant vaccine given as 3 injections (NO risk of developing disease from vaccination!!!)Hepatitis B is an example of?artificial (made up) acquired (nurses give) active (body makes) immunityGamma Globulin is an example of?Passive immunityHBsAg =Disease (acute or chronic)Anti-HBsAg =Immune; NO ACTIVE DISEASE****HBeAg =High infectivity and active infectionImmune system qualities?1. Immunity is less than optimal at either end of life 2. Main function is to prevent or limit infections by microorganisms 3. Protection is provided by 2 systems a) Cell-mediated Immunity b) Antibody-mediated (humoral) ImmunityCell-Mediated Immunity1. T-Cells**** 2. Defense against infections (especially Mycobacterium tuberculosis, Viral*** and Fungal***) 3. Allergic Response (ex: poison oak) 4. Graft and tumor rejections 5. REGULATION of antibody responseAntibody -mediated (Humoral) Immunity1. B-Cells*** 2. Defense against infection (opsonizes bacteria, neutralizes toxins and viruses) 3. Allergic response (Ex: hay fever) 4. AutoimmunitySpecificity of Immune Response1. Involves recognition, activation and response 2. May be natural (innate) or acquired (adaptive)Natural Immunity1. Non-specific 2. NOT acquired from previous antigen exposure 3. Does NOT improve after exposure 4. no memoryHost defense In natural immunity include?1. Barriers (skin, mucosa membranes) 2. Certain cells (natural killer cells) 3. Phagocytosis 4. Inflammation 5. Certain protein (Complement) a) the complement system (also known as "the complement cascade" is a group of 20+ proteins that circulate in the blood and serve to 'complement' or 'assist' other defensive mechanisms (inflammation, phagocytosis, pathogen lysis) b) There are two complement pathways: classical (antibody dependent) and alternative (spontaneous)Acquired Immunity Characteristics?1. after exposure 2. Improves with repeated exposure 3. Mediated by antibodies and tcells 4. Long-term memory 5. Can be passive or activeAntigen Characteristics?1. Foreigness (non-self) 2. (high molecular weight) 3. complexity 4. Antigenic determinants (epitopes) 5. Dosage, route and timing of exposure***Cells of the immune system1. Made up of leukocytes a) Granulocytes (Neutrophils, eosinophils, basophils) b) Lymphocytes (T-Cells, B-Cells, natural killer cells) c) Monocytes (precursor to macrophage) d) Dendritic cells (antigen presenting cells; APC) 2. Produced in the bone marrowT-Cells1. Constitute 65-80% of lymphocytes 2. T lymphocytes arise in the bone marrow and eventually migrate to the thymus to mature 3. During the maturation phase, T cells develop specific receptors that allow then to differentiate (something referred to as "sensitization")Types of T-Cells:1. T-Helper cells ( or CD4 T-cells) 2. T-cytotoxic cellT-Cytotoxic cells are ?the only T Cells that can DIRECTLY attack and kill diseased cells- including cancer cellsT Helper Cells (CD4)1. Produce cytokines that stimulate macrophages, NK cells, dendritic cells, and other t cells 2. Some helper T's turn B-Cells on so they can make antibodies-Which circulate and bind to antigensEffector functions of T-cells:1. Delayed hypersensitivity a) Intracellular organisms (fungi and bacteria) b) Examples: Histoplasma and mycobacteria 2. Cytotoxicity a) Graft rejectionRegulatory function of T cells:1. REGULATES antibody production 2. Cell-mediated immunity 3. Suppression of certain immune responsesB cells 2 important functions?1. plasma cells and produce antibodies**** 2. Are antigen-presenting cells (APCs) 3. memory cellsB cells are involved in the ?Humoral immune responseAntibodies are from?Plasma cellsMacrophages have 3 main functions what are they?1. Phagocytosis 2. Antigen transportation, processing and presentation 3. Cytokine productionMacrophages are responsible for?Transporting and processing antigensNatural Killer (NK) cells1. Kill viruses and tumor infected cells 2. Non-specific 3. Kill without antibody 4. LymphocytePolymorphonuclear Neutophils (PMNs)1. MOST NUMEROUS WBC (60%)******* 2. phagocytosis 3. Migrate in response to chemotactic factor (diapedesis) 4. FIRST LINE OF DEFENSE*******Dendritic cells:1. regulator of the immune system 2. antigen presenting (APC) capable of activating T cells and B cells 3. Found in most tissues of the body and are particularly abundant in those that are interfaces between the external and internal environmentsAntibodies1. Immunoglobulin's that react specifically with antigen 2. Gamma globulins 3. 5 Classes: IgG, IgM, IgA, IgD and IgE 4. Variable (FAB; fragment antibody; where the antibody binds to antigen; highly specific/variable) and constant (Fc; fragment constant; same configuration regardless of antigen) regionsImmunoglobulin Class IgG?1. ONLY ANTIBODY TO CROSS PLACENTA!!!!******** 2. Capable of activating the classical (antibody) complement pathwayImmunoglobulin Class IgM?1. 10 binding stes 2. IgM IS THE LARGEST ANTIBODY******* 3. Capable of activating the classical (antibody) complement pathwayImmunoglobulin Call IgA?1. Main immunoglobulin in secretions (Saliva)******Immunoglobulin Class IgD?1. No known antibody function at this time 2. Present in small amounts in serumImmunoglobulin Class IgE?1. Mediates anaphylactic hypersensitivity 2. Present in trace amounts in serum GENERALLYWhat are the 4 types of hypersensitivity reactions?1. Type I-- Anaphylactic (immediate) 2. Type II-- Cytotoxic 3. Type III-- Immune Complex 4. Type IV-- DelayedHypersensitivity reaction Type I Anaphylactic (immediate)?1. IgE antibody is induced by antigen (allergen) 2. Binds to mast cells and basophils 3. IgE induces degranulation and release of mediators such as histamine 4. Requires previous exposure to allergen 5. Primary antibody is IgEHypersensitivity reaction Type II Cytotoxic?1. Antigens on a cell surface combine with antibody 2. Leads to complement-medicated lysis 3. Examples include Rh and transfusion reactions 4. Primary antibody: IgGHypersensitivity reaction Type III Immune Complex?1. Antibody-antigen complexes are deposited in tissues 2. PMN's are called in 3. tissue destruction 4. Primary antibody: IgGHypersensitivity reaction Type IV Delayed?1. Helper T cells are sensitized by antigens 2. Cell versus antibody Mediated!!!! 3. Example: Tuberculin skin testAutoimmune Disorder Characteristics?1. Most are antibody mediated 2. Genetic predisposition is common 3. Much more common in females 4. Multifactorial 5. Increased incidence with ageExamples of Autoimmune Disorders?1. Insulin-resistant diabetes 2. Myasthemia gravis 3. Grave's disease 4. Systemic lupus erythematosus 5. Rheumatoid arthritis 6. Scleroderma***** (disrupts collagen no facial expression)Scleroderma is?1. An autoimmune disorder 2. Associated with RAYNAUDS PHENOMENON and GENERALIZED widening of the periodontal ligament spaceRough endoplasmic reticulum is?The cellular site for protein synthesisAmino Acids make up _____?ProteinAmino acids are the ?Smallest Unit of PROTEIN!Mycobacterium tuberculosis is to test ______?Intermediated sterilizationBacillus Stearothermophilus is used as a ________ _______ for sterilization equipment.Biological marker________ ______ is a buffer in saliva?Sodium BicarbonateMitochondria are involved with ?Cellular respiration_____ are the primary cell in the periodontal ligament?FibroblastsMovement of cells to the site of inflammation is known as _______?ChemotaxisAll the following characteristics are associated with a gram negative cell wall structure EXCEPT one. Which characteristic is the EXCEPTION? a) Two layers b) high lipid content c) Periplasmic space d) contains endotoxisa) two layersWhat effect do beta-hemolytic streptococcal organisms have on red blood cells?The completely lyse red blood cellsLactobacillus is?1. Aciduric 2. Lexan-producing 3. Associated with deep carious lesionsBacterial organisms capable of producing catalase are able to?Break down hydrogen peroxidePorphyromonas gingivalis adhere to epithelial and gingival surfaces via?Surface fimbraeThe primary function of mRNA is?translationEpstein-Barr is?Causative for mononucleosisA patient presents with a recent bood work-up indicating a positive titer for HBeAg. What is their disease status.Active hepatitis BWhat antibody is the ONLY antibody to cross the placenta barrier?IgGWhat type of immune hypersensitivity reaction is implicated in transfusion reaction?Type 2- Cytotoxic reaction.Nutrients definition?Substances obtained from food and used by the body to promote growth, maintenance, or repair.The six classes of nutrients include:1. Carbohydrates 2. Proteins 3. Lipids 4. Vitamins 5. Minerals 6. WaterCarbohydrates?1. organic compound made up of carbon, hydrogen, and oxygen. 2. Provide most abundant energy during metabolism 3. Yield 4 Kilocalories/gram 4. includes Monosaccharides, disaccharides, and complex polysaccharidesMonosaccharides?1. Single sugar a) Glucose (Blood sugar/Dextrose) b) Fructose (levulose/ fruit sugar) c) Galactose (component of milk sugar)Glucose (blood sugar/Dextrose)?1. Main fuel for brain and needed for RBCs 2. Major carbohydrate found in bloodstreamGalactose (component of milk sugar)1. Body convert glucose to galactose in mammary tissue during lactation; makes lactose in breast milk.Fructose (levulose/ Fruit sugar)1. Sweetest monosaccharideDisaccharides?1. Double Sugars; Made up of two monosaccharides a) Sucrose (table Sugar) b) Lactose (milk sugar) c) Maltose (plant sugar)Sucrose (table sugar)?1. Made up of glucose and galactoseMaltose (plant sugar)?1. Made up of 2 glucose molecules 2. Appears whenever starch is broken downLactose (milk Sugar)?1. Made up of glucose and galactosePolysaccharides (complex)?1. Starch 2. Glycogen 3. FibersStarch?1. Plant storage form of glucose (amylase and amylopectin) 2. Nutritionally most important carbohydrate 3. Stores energy 4. Digestible/breaks down at a slow rateGlycogen?1. Provides 12 to 24 hours of stored energy 2. Animals equivalent of starch 3. Provides a food storage system in animals/humans (glycogenesis) a) In liver, it regulates blood sugar for the brain b) In muscle, it serves as an energy source for muscle contractionDigestion of Polysaccharides (starch)?1. Initial digestion begins in the mouth with enzyme salivary amylase (breaks down into maltose) 2. Continues in small intestines with release of enzyme pancreatic amylase.Fibers?1. Should consume 20-35 grams/day 2. Dietary- e.g., Cellulose/Hemicellulose a) Increases peristalsis 3. Functional a) Added to foods and dissolves in water (soluble) to for a gel b) source- apples and cabbage 4. Total fiber- Sum of dietary and functional fibersDigestion of Disaccharides?1. Sucrose- Sucrase breaks down sucrose into glucose and fructose 2. Lactose- Lactase breaks down lactose into glucose and galactose 3. Maltose- maltase breaks down maltose into 2 molecules of glucose.Carbohydrates Functions?1. Provides energy (4 Kilocalories/gram) 2. Fuels brain and RBC's 3. Spares proteins- protein can supply energy; main function is to build tissue and replace cells 4. Aids in the oxidation (burning) of fats to prevent ketosis 5. Provides fibers for normal peristalsisDairy Requirements and nutritional source of carbohydrates is?130 grams per dayAlternative Sweeteners?1. Sugar alcohol- Nutritive sweeteners; carbohydrate-like, sugar-like compounds that provide calories; do not promote tooth decay because they metabolize at a slower rate; not readily absorbed by small intestine, can cause diarrhea. 20g or more a) Sorbitol b) Mannitol c) XylitolSorbitol, Mannitol, and Xylitol are?1. A 5-carbon sugar alcohol (polyol); sucrose is a 6 carbon sugar 2. Absorbed slowly and completely by the small intestines 3. AntimicrobialArtificial Sweeteners?1. Nonnutritive sweetners; non-carbohydrate and non-caloric. FDA approved the following: a) Saccharin b) Aspartame c) Acesulfame-K d) Sucralose e) NeotameSaccharin?1. Active ingredient is Sweet'N Low 2. soft drinks and table sweetenersAspartame?1. Active ingredient in NutraSweet and Equal 2. Composed of amino acids, Phenylalanine and aspartic acid, and methanol 3. Not stable in heat therefore not suitable for cooking; used in beverages and chewing gum 4. Adverse effects- headaches, dizziness and seizures 5. Must carry PKU warningSucralose?1. Active ingredient is Splenda 2. Stable in heatAcesulfame-K?1. Active ingredient in Sunette and Sweet One 2. Stable in heat 3. chewing gums, nondairy creamers and gelatin puddingsNeotame?1. Approved in 2002 by the FDA; blended with other sweeteners 2. No amino acids are absorbed, therefore does not need to carry PKU warning 3. Stable in heatNutritional management of deficiency of disease, Diabetes Mellitus?1. Metabolic disorder 2. Normal glucose levels are between 70-125 mg/dl)Type 1 Diabetes Mellitus?1. Insulin dependent (IDDM) a) diabetes mellitus case-- 5%-10% b) primarily in children and young adults- usually between 10-14 c) Langerhans in pancreas cannot synthesize insulin d) viral infection or genetics e) weight loss within increased appetiteSign and symptoms of Diabetes Mellitus?1. Hyperglycemia- abnormally high blood glucose concentration 2. Acetone breath- fruity odor on breath (as a result of ketosis) 3. Ketonemia- Ketones in blood 4. Ketonuria- Ketones in urine 5. Polydipsia- Increased thirst 6. Polyuria- Frequent urination 7. Polyphagia- Increased appetite due to need for energyType 2 Diabetes Mellitus?1. Noninsuline dependent (NIDDM) a) Most common type of diabetes- approximately 90% b) people over 40 and is associated with obesity c) insufficient insulin or improper use d) weight gain with increased appetiteChronic Complications of Diabetes Mellitus?1. 3 times more likely to get 2. Xerostomia, increase in decay 3. Loss of sight 4. Poor circulation 5. Loss of kidney function 6. Heart disease- most common cause of diabetes-related deathDiet counseling?1. Motivation 2. Diet Survey 3. ExposuresHypoglycemia?1. Low blood glucose levels ( remember, the brain is fueled entirely by glucose)- less that 70 mg/dlSymptoms of Hypoglycemia are?a) Shakiness b) dizziness c) Sweating d) headaches e) Irritability f) hunger g) lightheadedness h) palpitations (NOT lowered heart rate)Motivation?Motivate the patient by: a) Involving him/her in the decision making process b) allowing him/her to choose what should be eliminated from the diet c) Allowing him/her to be accountable for changing own behaviorDiet Survey?Evaluate: a) Frequently of intake (MOST important)- worse times are between meals b) consistency of food (physical form) c) amount of sugar added to foods d) total intake Remember lactic acid attack begins within the first min of exposureExposure?How many exposures to fermentable carbohydrates.Glucose is also know as?DextroseSucrose is hydrolyzed into?Glucose and fructoseProteins are?1. Organic compounds made up of amino acids 2. Contain the elements carbon, hydrogen, oxygen, and nitrogen (and sometimes sulfur) 3. Main function is to repair/build tissues/cells 4. Yield 4 kilocalories/gramWhat are the four proteins?1. Amino Acids 2. Complete Proteins 3. Incomplete Proteins 4. Complementary ProteinsWhat are the two Amino Acids?1. Essential (Indispensable) Amino Acids 2. Nonessential (Dispensable) Amino AcidsEssential Amino Acids?1. Also known as Indispensable 2. Body cannot synthesize; must obtain from diet 3. 9 are essentialNonessential Amino Acids?1. Also known as Dispensable 2. Body synthesizes as long as nitrogen is present; not required by in the diet 3. 11 are nonessentialWhat are complete proteins?1. High Quality 2. Foods that contain all 9 essential amino acids in sufficient amounts 3. Sources include animal sources (fish, meat, eggs, cheese, milk) and SOYBEANSWhat are incomplete Proteins?1. Low Quality 2. lack one or more essential amino acids (plant proteins)What are complementary Proteins?1. Vegans 2. Need to combine two or more proteins to compensate for deficiencies in amino acids content 3. Use of whole grains is importantWhat is the Physiology of Proteins?Digestion begins in the stomachWhat are some protein deficiency and diseases?1. Phenylketonuria (PKU) 2. Protein-energy (calorie) Malnutrition (PCM) a) Marasmus b) KwashiorkorWhat is Phenylketonuria (PKU) and what should be avoided in the diet if a patient has PKU?1. Inborn error of metabolism 2. Liver cannot metabolize essential amino acid phenylalanine into nonessential amino acid. 3. Must restrict phenylalanine in the diet (need just enough to support normal growth); avoid aspartame (NutraSweet/Equal)What are the two Protein-energy (calorie) Malnutrition (PCM)?1. Marasmus 2. KwashiorkorWhat is Marasmus?1. "to waste away" (chronic condition) [body's adaptation to starvation] 2. Inadequate food intake (protein and calories deficiency) over a long period of time 3. Common in children 6-18 months; impairs brain development and learning 4. Muscles, including heart, waste and weaken (no edema) skin and bones 5. Poor growth if anyWhat is Kwashiorkor?1. "evil spirit that infects the first child when second child is born (acute condition) 2. Severe protein deficiency 3. Begins at approx. 18 months to 2 years of age 4. Edema in legs, abdomen, and face 5. Child fails to grow and gain weight 6. Delayed eruption and hypoplasia of teethWhat are Lipids?(fat) 1. Including triglycerides [95% (fats and oils)], phospholipids, and sterols (cholesterol); organic compounds composed of carbon, hydrogen, and oxygen.What are the four lipid types?1. Saturated fatty acid 2. Monounsaturated fatty acids 3. Polyunsaturated fatty acids 4. Essential (polyunsaturated fatty acidsWhat is Saturated fatty acids?1. Carry maximum number of hydrogen atoms (hydrogenation) 2. Remain solid at room temperature 3. Increased serum cholesterol levels 4. Source include; beef, lard, and animal fatsWhat is Monounsaturated fatty acids?1. Contain a point of unsaturated linkage (double bond) with no hydrogen atoms 2. Viscous in form 3. Maintain serum cholesterol levels 4. Sources include canola and olive oilsWhat is Polyunsaturated fatty acids?1. Contain two more points of unsaturated (double bond) 2. Liquid in consistency 3. Decrease serum cholesterol levels 4. Source includes vegetable oilsWhat is Essential (polyunsaturated) fatty acids?1. Must be obtained for diet 2. Include a) Linoleic fatty acids b) Linolenic fatty acidsWhat are Linoleic fatty acids?1. Omega-6 2. Sources include vegetable oils, such as sunflower and safflowerWhat is Linolenic fatty acids?1. Omega-3 2. Sources include fish, such as mackerel, tuna, and salmon and certain plants oil such as canola, olive and peanutWhat are the functions of lipids?1. Provide concentrated source of energy--9 Kilocalories/Gram 2. Carry fat-soluble Vitamin A,D,E, and K 3. Provide satiety (fullness) 4. Provide flavor and texture to foods 5. Insulation to maintain body temp and protect organsWhat are Vitamins?1. Organic nutrients needed by the body in small quantities 2. Fat-soluble vitamins 3. Water-soluble vitaminsWhat are fat-soluble Vitamins and what vitamins are included?1. Include A,D,E and K 2. Soluble in fats and fat solvents 3. Stored in liver and fatty tissues 4. Not readily excreted and therefore can build up to toxic levelsWhat are the vitamin A Functions?1. Prevent night blindness (forms visual purple=Rhodopsin) Eye pigment in order to see 2. Maintain normal mucous membranes. 3. Impaired tooth formation 4. Keratinized epithelial tissuesSources of Vitamin A?1. Retinols (Preformed Vitamin A)- Animal foods such as liver, fish, and fortified milk 2. Carotenoids (vitamin precursors)- source includes orange-yellow and dark green vegetables and fruitsWhat are the Vitamin D Functions?1. Absorption of calcium and phosphorus 2. Formation and mineralization of teeth and bonesWhat are the sources of Vitamin D?1. Sunlight- body makes its own vitamin D through exposure to sunlight (90%) 2. Fortified milk- human milk has no vitamin D 3. Fish liver OilsWhat are the nutritional deficiency's and Diseases for Vitamin D?1. Rickets- (Children) softening of bones due to failure to calcify normally. 2. Osteomalacia- (Adults) calcium is taken from bones to make up for insufficient absorption in intestines. 3. Osteoporosis 4. Calcium DeficiencyWhat is Rickets and what are the symptoms1. (Children) softening of bones due to failure to calcify normally. 2. Symptoms- bowed legs, enlarged head, joints, and rib cage, and deformed pelvisWhat is Osteomalacia and what are the symptoms?1. (Adults) calcium is taken from bones to make up for insufficient absorption in intestines. 2. Bowed legs, bent posture, and pain in the ribs, pelvis, and legsWhat is the function of Vitamin E (Tocopherol)?1. Antioxidant (Rare)What are the sources of Vitamin E?1. Vegetable oils (corn and safflower oils) green leafy vegetables and whole grains. (Found in many foods including polyunsaturated vegetable oils)What vitamin E toxicity interfere with?1. Blood coagulation (clotting) a function of vitamin KWhat is the function of vitamin K and what is its deficiency ?1. Aids in the formation of blood clotting factor prothrombin and helps increase bone density 2. HemorrhagingWhat are the sources of Vitamin K?1. green leafy vegetables and synthesized by the intestinesWhat are Water-Soluble Vitamins and what is the main function?1. Include all B and C Vitamins 2. Easily absorbed and excreted; therefore it is unlikely to reach toxic levels 3. Main function: metabolism of carbohydrates, fats, proteins and blood formation (hemopoiesis)What is the Deficiency of a Water-Soluble Vitamin?1. Deficiency of these vitamins affect the mouth (Cheilosis and glossitis)What are the 9 water-soluble vitamins?1. Thiamine (B1) 2. Riboflavin (B2) 3. Niacin (B3) 4. Pantothenic Acid 5. Biotin 6. Pyridoxine (B6) 7. Folate (B9) 8. Cobalamin (B12) 9. Vitamin C (Ascorbic Acid)What is the function of Thiamine (B1) Vitamin?1. Helps provide energy to the brain, heart and CNSWhat is the Nutritional Deficiency and Disease of Thiamine (B1) Vitamin?1. Beri Beri (I can't, I can't)- damages nervous and cardiovascular systems?What are the sources of Thiamine (B1) Vitamin?1. Pork, enriched whole grains, milk, legumes, nuts, and peas.What is the function of Riboflavin (B2) Vitamin?1. Essential for growth, repair and production of RBC's; prevents cheilosis and glossitis and anemiaWhat are the deficiencies of Riboflavin (B2) Vitamin?1. cheilosis, glossitis, Fatigue and anemiaWhat are the sources of Riboflavin (B2) Vitamin?1. Milk, green leafy vegetables, nuts, enriched grains, eggs, poultry, fish, and legumesWhat is the properties of Riboflavin (B2)?1. Sensitive to lightWhat is the function of Niacin (B3) Vitamin?1. Needed for RNA and DNA synthesis and MetabolismWhat are the Nutritional Deficiency's and Diseases of Niacin (B3) Vitamin?1. Pellagra, (4 D's- Dementia, Diarrhea, Dermatitis, and Death)What are the sources of Niacin (B3)?1. Meat, Fish, Enriched grains, and green leafy vegetables, legumes, yogurtWhat is the properties for Niacin (B3)?1. Amino Acids tryptophan can be converted to niacin equivalentsWhat is the function of Folate (Folacin , Folic Acid)?1. Assist in forming DNA and RNA. 2. RBC FormationWhat are the Nutritional Deficiency's and Diseases of Folate (Folacin, Folic Acid)?1. Megaloblastic anemia 2. Glossitis 3. Diarrhea 4. Birth Defects (spina bifada)What is the function of Cobalamin (Cyanocobalamin B12)?1. helps build tissue, maintain nerve cells and essential for RBC development; also needed for folate metabolismWhat are the Nutritional Deficiency's and Diseases of Cobalamin (Cyanocobalamin B12)?1. Found in strict vegetarians; pernicious anemia-weakness, sore tongue, and apathyWhat are the sources of Cobalamin (Cyanocobalamin [B12])?1. Animal (organ meats) and fortified foodsWhat are the properties of Cobalamin (Cyanocobalamin [B12])?1. Intrinsic factor- protein made in stomach; needed for absorption of B12 2. Extrinsic factor-must be obtained through foodWhat is the function of Vitamin C (Ascorbic Avid)?Promotes synthesis of protein collagen (connective tissue); acts as an antioxidant (wound healing)What is the Nutritional Deficiency and Diseases of Vitamin C (Ascorbic Avid)?1. Scurvy- ruptured blood vessels; swollen and bleeding gingiva; delayed wound healingWhat are the sources of Vitamin C (Ascorbic Avid)?1. Strawberries, broccoli, cantaloupe, citrus fruit, potatoes, and tomatoesWhat are the properties of Vitamin C (Ascorbic Avid)?1. no extensive storage; smokers have an increased need (140mg)Define Macrominerals?Major minerals present in the amount greater than 5 grams in the bodyWhat are the two macrominerals?1. Calcium 2. SodiumWhat is Calcium?1. Most abundant mineral in body (all cells need calcium)What is the function of Calcium?1. Forms and maintains bones and teeth 2. Coagulates blood (vitamin D helps absorb calcium)What is the nutritional deficiency and Diseases of Calcium?(women are most likely to be at risk) 1. Rickets 2. Osteomalacia 3. OsteoporosisWhat are the sources of calcium?1. Dairy products, broccoli, and soy sourcesWhat are the properties of Sodium?1. Contributes to high blood pressure which can lead to heart disease and stroke; hypertension is not caused by excess sodium, but aggravates it.What is the recommendation for Sodium?1. Reduce sodium intake and increase the use of spices when cookingWeight control means?Calories from food should equal energy needs for bodyWhat are the energy needs of the body (evaluate)1. Basal Metabolism Rate (BMR) 2. Degree of physical activity 3. Specific Dynamic Activity (SDA)What is Basal Metabolism Rate (BMR)?1. Measure of energy needed to maintain life at rest (Breathing, heart beating, circulation, muscle tone, and body temp)What is degree of physical activity?Voluntary component of energy (Varies; sedentary to strenuous activity)What is Specific Dynamic Activity (SDA)?Energy required to digest and absorb foodWhat are the three eating disorders?1. Anorexia Nervosa 2. Bulimia 3. PicaWhat is Anorexia Nervosa?Self starvation due to a distorted body image of being overweightWhat are the behavior profiles of Anorexia Nervosa?1. Usually female; after puberty 2. Highest rate of occurrence ages of 15 and 19 3. Competitive/obsessive behavior 4. Rigid relationship with over-protective parents (cause) 5. Fear of gaining weightWhat are the characteristics of Anorexia Nervosa?1. Dramatic weight loss; 20%-40% below desirable body weight 2. Excessive exercise 3. Aversion to food and altered eating habits; eat 300-600 kcal/day 4. Amenorrhea-absence of menstrual cycle due to hormonal changes 5. Lanugo (Hirsutism) fine, soft hair (unusual hair growth to keep them warm) 6. Decrease heart rate caused by slowing of metabolismWhat is the treatment for Anorexia Nervosa?1. Increase food intake to raise metabolic rate back to normal 2. therapist determines underlying issues for eating disorder 3. About half of those who survive recover within 6 yearsWhat is Bulimia?1. episodes of binge eating followed by purging (vomiting, laxatives, purgatives or diuretic abuse) tp prevent weight gainWhat are the behavior profiles of Bulimia?1. Age of onset is typically 20-24 2. Weight is at or slightly above normal 3. Turns toward food for comfort 4. Aware behavior is abnormal 5. Low self esteem and impulsiveWhat are the characteristics of Bulimia?1. Vomits at least 2 times per week 2. Eats 15,000 or more calories in a binge 3. Calluses on knuckles due to digital purging (vomiting) 4. Often clinically depressedWhat are the oral manifestations for Bulimia?1. Dental Erosion (perimolysis) found on lingual surfaces of maxillary teeth due to constant exposure to acid 2. Erosion (restorative)- restorations appear 'raised' from adjacent teeth 3. Thermal sensitivity 4. Enlarged parotid glands can occur unilaterally or bilaterally 5. Cheilosis associated with loss of moisture and protective qualities of saliva 6. Pharyngeal tears and erythema of the palate, pharynx, and posterior tongue can result from use of objects or fingers to induce gagging/regurgitationWhat is the treatment for Bulimia?1. Dietary- establish regular eating patterns a) sodium fluoride rinses to aid with remineralization b) sodium bicarbonate (baking soda) rinses help neutralize acids caused from vomiting c) chewing sugar-free gum to stimulate saliva flow (don't brush 1 hour after vomiting due to acid being brushed over all surfaces of teeth)What is Pica Characteristics?consumes non-nutritive substances (soil, paper, coal, paint chips) or has an abnormal appetite for some things that may be considered foods (raw potatoes, ice cubes, flour)What is the cause of Pica?Biochemical or iron/zinc deficiencyGlucose is also known as?DextroseSucrose is hydrolyzed into?Glucose and fructoseEach of the following is a sign or symptom of diabetes mellitus EXCEPT one. Which one is the EXCEPTION? a) Ketonemia b) Acetone Breath c) Hyperglycemia d) Decreased appetiteD) Decreased AppetiteGood Example of complete protein include:Meat, Eggs and cheeseAspartame should NOT be consumed by individuals with?PhenylketonuriaWhat fatty acid maintain serum cholesterol level?1. MonounsaturatedWhat Vitamin can interfere with the function of vitamin K?EWhat vitamin is essential for the absorption of calcium and phosphorus?DWhat is NOT a Component of Vitamin B Complex?Ascorbic AcidWhat vitamin promotes the synthesis of collagen?CWhat are the Bones of the Neurocranium?1. Frontal (roof of the orbit) 2. Parietal* 3. Occipital 4. Temporal* 5. Sphenoid (posterior wall of the orbit) 6. Ethmoid (medial wall of the orbit) *= Bialteral bonesWhat does the temporal bone include?1. The mastoid process 2. the styloid process 3. The articular fossa and eminence 4. the stylomastoid foramen (VII) 5. The petrous portion (housing hearing component)What are the bones of the Face?1. Maxilla (medial floor of the orbit)* 2. Mandibular 3. Zygomatic (lateral wall and floor of the orbit)* 4. Palatine* 5. Nasal* 6. Vomer 7. Inferior nasal conchae* 8. Lacrimal (the most medial bone of the orbit)* *= Bilateral BonesWhat is the hyoid bone?Nonarticulated horseshoe shaped bone in the midline; inferior to the mandibleWhat are the Sphenoid Bone Landmarks?1. Greater and Lesser Wings 2. Medial and Lateral Pterygoid Plates (origin of medial and lateral pterygoid muscles, Lateral Pterygoid Plate) 3. HamulusWhat does the Foramina include?1. Superior Orbital Fissure (Trigeminal Nerve (V1) First division (Ophthalmic) 2. Foramen Rotundum (Trigeminal Nerve (V2) Second division (Maxillary) 3. Foramen Ovale (Trigeminal Nerve (V3) Third Division (Mandibular)What are the Landmarks on the Mandible?1. Body= Horizontal portion 2. Angle=Junction of body and ramus 3. Ramus= Vertical portion 4. Condyle=Allows the jaw to rotate 5. Coronoid process= muscle attachment 6. Retro-molar Triangle= soft tissue landmark, behind lower molars 7. Alveolar Process= Bony housing, support the teeth 8. Mental Foramen= mental nerve opening 9. External Oblique Ridge= Radiographic landmark, outside on body 10. Mandibular Foramen= Inferior Alveolar Nerve opening 11. Internal Oblique Ridge= Radiographic landmark, inside on body 12. Genial Tubercles= Muscle attachment, genioglossus muscle.What are the three major Trigeminal nerve branches?1. V1 Ophthalmic (sensory) 2. V2 Maxillary (sensory) 3. V3 Mandibular (both sensory and motor)What does the V1 Ophthalmic trigeminal nerve include?Tip of nose (nasociliary), eyes (lacrimal), and forehead (frontal)Where does the V1 Ophthalmic trigeminal nerve leave the skull?through the Superior Orbital Fissure of the Sphenoid BoneWhat does the V2 Maxillary trigeminal nerve include?the upper teeth, nose, palate, mouth, cheek, and temporal regionWhere does the V2 Maxillary trigeminal nerve leave the skull?through the Foramen Rotundum of the Sphenoid BoneWhat does the V3 Mandibular trigeminal nerve include?muscles of mastication (motor) and lower teeth (sensory)Where does the V3 Mandibular trigeminal nerve leave and enter the skull?1. Leaves through the Foramen Ovale of the Sphenoid Bone 2. Enters the mandible through the mandibular ForamenSuperior refers to?The maxillaInferior refers to?The mandibleAnterior refers to?The incisors and cuspidsMiddle refers to?The bicuspids (premolars)Posterior refers to?The molarsAlveolar refers to?The bony processes which support the teethIn the maxillary, the nerve that innervates the pulp also innervates the?Buccal GingivalThe nasopalatine nerve passes through the incisive foramen under the ?Incisive papillaWhat are the muscles of mastication?1. Temporalis 2. Masseter 3. Medial Pterygoid 5. Lateral PterygoidWhat is the innervation of the muscles of mastication?Mandibular Division of the Trigeminal Nerve (V3)What is the muscle of mastication blood supply?Maxillary artery (branch of the external carotid artery)The Temporalis Origin (O), Insertion (I) movable part, and Function (F) includes?O= Temporal fossa (temple) I= coronoid process (and the mandible posterior to third molars) F= retract and elevate the mandibleThe Masseter Origin (O), Insertion (I) movable part, and Function (F) includes?O= Zygomatic arch (cheekbone) I= outer surface of the mandible (and angle of the mandible) F= elevate the mandibleThe Medial Pterygoid Origin (O), Insertion (I) movable part, and Function (F) includes?O= medial surface of the lateral pterygoid plate (sphenoid bone) and maxillary tuberosity I= inner surface of the angle of the mandible F= elevate and protrude the mandibleThe Lateral Pterygoid Origin (O), Insertion (I) movable part, and Function (F) includes?O= lateral surface of the lateral pterygoid plate (sphenoid bone) and infratemporal surface of the sphenoid bone I= TMJ disc and neck of the mandible condyle F= protrude and/or depress the mandible, and allow side to side (lateral) shift of the mandibleThe medial pterygoid is _____ and the masseter is _______?1. Internal 2. ExternalThe temporalis, medial pterygoid, and masseter muscles all do what for the mouth?They close the mouth (elevate the mandible)The lateral pterygoid does what for the mouth?Opens the mouth (with the hyoid muscle)What are the Temporomandibular Joint parts are?1. Temporal bone 2. Mandible: Condyle 3. Articular disc 4. CapsuleThe temporal bone includes?1. Mandibular fossa, glenoid fossa, or articular fossa (all terms are the same structure)What is the articular disc and what does it do?1. Fibrous pad of dense collagen tissue 2. Prevents bone to bone contact 3.divides joint into upper and lower synovial cavitiesWhat is a capsule?1. Thick, fibrous tissue surrounding joint 2. inner lining secrets synovial fluid (lubricates joint)What are the movements of the Temporomandibular joint?1. Rotation: condyle rotates in the fossa 2. Translation: condyle slides forward along the articular fossa to the articular eminence (disc moves with condyle in health) 3. Trismus: hypomobility from trauma, disease, bruxismThe zygomaticus, levator anguli oris, and risorius does what facial expression?Helps with smilingLevator means?Lift (lever)Depressor means?Pulls downAnguli means?AngleOrbicularis means?circularOculi means?eyeOris means?mouthNasii means?NoseLabii means?lipsSuperioris means?UpperInferioris means?LowerAleque means?SideWhat does the buccinator do?Compresses the cheekWhat cranial nerve does muscles of facial expression innervate?The Facial Nerve (VII)Hyoid Muscles innervate through what cranial nerves?1. Trigeminal Nerve (V) H-Y-O-I-D (5 letters 5th cranial nerve) 2. Facial Nerve (VII) M-U-S-C-L-E-S (7 letters 7th cranial nerve)Hyoid muscles originate from the _______ and are important for what?1. Hyoid bone 2. Chewing, swallowing, and speaking 3. They comprise the floor of the mouthWhat are the infrahyoid muscles (below the hyoid bone)?1. Thyrohyoid* 2. Sternothyroid* 3. Sternohyoid 4. Omohyoid (*common junction, thyroid area*) (Stabilize the hyoid bone)What are the suprahyoid muscles (above the hyoid bone)?1. mylohyoid (make up the floor of the mouth) 2. geniohyoid 3. digastric 4. stylohyoid (open the mouth) depress the mandibleWhat are the muscles of the neck?1. Sternocleidomastoid 2. TrapeziusThe Sternocleidomastoid Origin (O), Insertion (I) movable part, and Function (F) includes?O= sternum (breastbone) and clavicle (collarbone) I= mastoid process of the temporal bone F=tilts and rotates the head (innervation= accessory nerve, XI)The Trapezius Origin (O), Insertion (I) movable part, and Function (F) includes?O= occipital and vertebral bones I= scapula (shoulder blade) and clavicle (collarbone) F= rotate and elevate the shoulder (innervation= accessory nerve, XI)What is the SinoAtrial Node or Sa?1. The hearts natural pacemaker, its located in the right atrial wall (upper right chamber of the heart)Coronary Arteries supply the heart with?BloodVeins carry blood ______ the hear and Arteries carry blood ______ the heart?1. To 2. Away fromChecking a pulse in a emergency for an adult= and a child = what?1. Carotid 2. BrachialChecking a pulse in a nonemergency situation for an adult= and a child=?1. Radial 2. BrachialBlood flow of the heart with Deoxygenated blood?1. Superior and inferior Vena Cavae (from body) 2. Right atrium 3. Tricuspid valve 4. Right ventricle 5. Pulmonary artery (to lungs)Blood flow of the hear with Oxygenated blood?1. (from lungs) pulmonary veins 2. Left atrium 3. Bicuspid (mitral) valve 4. Left ventricle 5. aorta (to body)Blood flow from the heart to the head:?1. Aorta 2. Right side: brachiocephalic artery, branching to the common carotid 3. Left side: common carotidWhat are the right and left common carotids branches are?1. Internal carotid: skull, eye, brain 2. External carotid: everything else (teeth, muscles of mastication, tongue, face, lips)What are the Veins of the head and neck?1. Internal Jugular Vein 2. Facial Vein 3. Pterygoid plexus 4. Superficial temporal vein 5. Common facial vein 6. Cavernous sinusWhat does the Internal Jugular vein do?1. Drains brain, facial vein, and superficial temporal vein (facial v. also empties in cavernous sinus) 2. Runs with the carotid arteryWhat does the facial vein do?1. Drains facial structures (nose, lips, eyes, submental and submandibular areas)What does the Pterygoid plexus do?1. Drains to form the maxillary vein 2. Structure that drain into the plexus include the teeth, muscles of mastication, buccinator, nose, and palate 3. This plexus may be pierced through improper angulation of the needle during the administration of a PSA block. Hematoma may develop as a result.Where can the Pterygoid plexus be found?near the pterygoid muscles, maxillary tuberosity and sphenoid boneWhat does the Superficial temporal vein do?1. Drains areas supplied by maxillary and superficial temporal arteries 2. Superficial temporal vein and maxillary vein are from the retromandibular veinWhat is the Cavernous sinus?A sinus containing venous blood located on each side of the body of the sphenoid bone, near the base of the brain, behind the bridge of the noseFetal pressure on the __________ could cause ________.1. Inferior vena cava 2. Orthostatic hypotensionWhat is orthostatic hypotension?A drop in blood pressure due to a sudden change of posture.How do you prevent orthostatic hypotension?put a pillow under right hip to avoid itWhat is the lymphatic system and what does it do?1. The lymphatic system is a network of tiny channels and nodes 2. It helps the venous circulation return interstitial fluid to the bloodstream from the tissues of the body, and plays a key role in our immune system.What is the lymphatic system composed of?1. Lymphocytes derived from stem cells in the bone marrowTender and/or enlarged lymph nodes can indicates what?1. Infection and/or malignancyWhat are the lymph node groups?1. Parotid Nodes 2. Buccal Nodes 3. Occipital Nodes 4. Superficial cervical Nodes 5. Anterior cervical Nodes 6. Submental Nodes 7. Submandibular Nodes 8. Deep cervical Nodes (superior and inferior)Where does the submental nodes drain fluid?drains from the mandibular incisors, tip of tongue, midline of lip, chin and floor of mouthWhere does the submandibular node drain?1. drains the submental nodes and remaining teeth 2. May (or may not) include 3rd molarsWhere does the Deep cervical nodes drain?1. Drains the submandibular node, 3rd molars and the wall of the throat (including the retropharyngeal nodes) 2. structures of the oropharynx, drained by superior deep cervical nodes 3. Superior deep cervical nodes drained by the inferior deep cervical nodesWhat does it mean when stated Primary nodes?First node affected by a disease processWhat does it mean when stated Secondary nodes?The next set of nodes affected by a disease processWhat does it mean when stated Tertiary nodes?The third nodal set affected by a disease processWhat is the cell?The functional unit of the bodyThe cells components include?1. Membrane 2. Cytoplasm 3. Nucleus 4. Endoplasmic Reticulum (Ribosome-filled membrane network) (RER) Rough ER 5. Golgi Bodies 6. Mitochondria 7. Lysosomes 8. Filaments and tubulesWhat does the Cell membrane do?Controls the passage of materials into and out of the cellWhat is the cytoplasm?watery gel enclosed by the membraneWhat does the nucleus do?stores DNA and directs all cellular activitiesWhat is the Endoplasmic reticulum?site of cellular protein synthesisWhat does the Golgi Bodies do?Packages cellular protein product for secretionWhat is the Mitochondria?Center of energy production (ATP energy) respiration. (power house)What does the Lysosomes do?Responsible for phagocytosis and digestionWhat does the Filaments and Tubules do?provide structural supportMost structures of the oral cavity develop from two embryonic processes which are?1. Frontal Process 2. 1st Brachial ArchThe frontal process includes?1. Forehead and frontal bone 2. Medial nasal process 3. Lateral nasal processWhat does the medial nasal process include?1. center and tip of nose 2. nasal septum 3. globular process (philtrum, premaxillary palate)What does the lateral nasal process include?1. sides of nose 2. infraorbital areaThe 1st brachial arch includes?1. Maxillary process 2. Mandibular processThe maxillary process includes?1. Lateral palatine process (palatal shelves) 2. Upper parts of cheek 3. Sides of upper lipThe mandibular process includes?1. Lower jaw 2. Lower parts of the face and lower lip 3. Anterior 2/3 of the tongueThe posterior (1/3) tongue and hyoid bone develop from what brachial arches?2nd and 3rd brachial archThe development of the face begins about what week?thirdThe upper lip is completed within what weeks?sixth to eighth weekThe palate develops between what weeks?six to twelve weeks (from the fusion of the globular process with the left and right palatal shelves. 1st trimesterWhat is the blood supply to the tongue?Lingual arteryWhat are the innervations of the tongue?1. XII (motor nerve to muscles, except palatoglossus) Hypoglossal 2. V3 (sensory to anterior 2/3) (mandibular division, trigeminal) 3. VII (taste to anterior2/3) (Chorda tympani) Facial nerve 4. IX (taste, sensory to posterior 1/3) glossophyrengealThe tongue contains two types of muscles what are they?1. Intrinsic muscles 2. Extrinsic musclesWhat does the intrinsic muscle do for the tongue?1. Start and end within the tongue 2. Determine the shape of the tongue 3. Superior and inferior longitudinalis, transverse and vertical groupsWhat does the extrinsic muscles do for the tongue?1. Originate elsewhere and insert into the tongue 2. Control the position of the tongue 3. Hyoglossus, styloglossus, and genioglossus 4. Palatoglossus (innervated by X, XI)What are the four papillae on the tongue?1. Filiform 2. Fungiform 3. Foliate 4. CircumvallateWhat is Filiform papillae?1. Keratinized papillae protect the tongue, but contain no taste buds 2. Most numerous papillae 3. Elongation known as "hairy tongue"What is Fungiform Papillae?1. Fewer, larger (appear as red bumps), contain taste budsWhat is Foliate papillae?1. Folds of tissue at the posterior, lateral border (side of tongue) 2. Contain taste budsWhat is Circumvallate papillae?1. 8-12 in number (Mushroom like) largest 2. Contain taste buds & glands of Von Ebner (minor salivary glands, serous)The _________ is the V-shaped line separating the anterior 2/3 and posterior 1/3 of the tongue?Sulcus terminalisThe ________ is found at the center or point of the sulcus terminalis and is the site of the embryonic origin of the thyroid gland?Foramen caecumThe salivary glands are what?Exocrine glands (they have ducts)The ducks of salivary glands are lined by what?Stratified cuboidal epithelial cellsThe flow of saliva is stimulated by the ___________ ?Parasympathetic nervous systemWhat are the three major pairs of the salivary glands?1. Submandibular gland 2. Sublingual gland 3. Parotid glandThe submandibular gland:1. Produces 65% of total saliva 2. Whartons duct empties under the tongue 3. Mixed secretion 4. Located near the angle/body of the mandible (staphne's defect) 5. Parasympathetic innervation by cranial nerve VIIThe Sublingual gland:1. Produces 10% of total saliva 2. Ducts of Rivinus (8-20) empty under the tongue, Open at the sunlingual fold (bartholins duct) 3. Mixed secretion 4. Located in floor of mouth near midline 5. Parasympathetic innervation by cranial nerve VIIThe Parotid gland:1. Produces 25% of total saliva 2. Stenson's duct empties opposite the maxillary molars 3. Serous secretion only (contains amylase to break down starches) 4. Located in front of and below the ears 5. Parasympathetic innervation by cranial nerve IXDevelopment of the face begins at week ?3 with the formation of the primitive oral cavity, or stomodeum, which is lined by ectodermMesoderm underlies ______ and is separated by a __________?1. Ectoderm 2. a basement membraneIn the Stomodeum, the embryonic ectoderm stimulates the ________ to differentiate into ___________.1. Mesoderm 2. EctomesenchymeEnamel derives from _______?EctodermDentin and pulp derive from?EctomesenchymeThe dentino-enamel junction (DEJ) will derive from the?Basement membraneWhat are the 3 stages of tooth formation?1. Initiation (bud stage) START! 2. Proliferation (cap stage) GROWS! 3. Differentiation (bell stage) SPECIALIZES!The initiation (bud stage):1. The dental lamina (ectodermal thickening) grows into the underlying mesenchymal (connective) tissue at 20 places to form the primary teethThe Proliferation (cap stage):The enamel organ develops from the dental lamina, and will produce enamel. 2. The dental papilla arises from specialized connective tissue (ectomesenchyme) and produces pulp and dentin. 3. (Dental Papilla= Dentin and Pulp) 4. The dental sac surrounds the developing tooth, becomes cementum, the PDL and alveolar bone. (PAC = SAC) (Dental Sac Turns into PDL, Cementum, and alveolar bone)The differentiation (Bell Stage):1. The enamel organ develop develops four distinct layers: a) outer enamel epithelium b) stellate reticulum c) stratum intermedium d) inner enamel epitheliumInner enamel becomes _______ which produces enamel _____________ that will create ________________?1. Ameloblasts 2. The outer enamel epithelium 3. Hertwig's Epithelial Root Sheath (HERS)The DEJ develops from the ___________?Basement membraneWhat is the order of Enamel formation?Ectoderm/Dental Lamina---- Enamel Organ---- Inner Enamel Epithelium---- Ameloblasts---- EnamelRemnants of the dental lamina are known as?Rest of SerresRemnants of HERS is known as>MalassezHertwigs Epithelial root sheath (HERS) which his develops form the _______ and _________ it helps determine outline of the ______ and ______?1. Internal Enamel Epithelium 2. External Enamel Epithelium 3. Root 4. DissolvesRoot formation begins after _____ is complete and ends ______ years after eruption?1. Crown 2. 1-4Hydroxyapetite is?Crystalized calcium phosphateThe oral mucosa is composed of?Stratified squamous epithelial layerThe oral mucosa includes what tissues?1. Masticatory 2. Lining 3. Specialized mucosaThe masticatory mucosal tissues is?1. Keratinized and protects the gingiva and hard palate. 2. The keratinization of the attached gingiva ends at the free gingival marginThe lining mucosal tissue is?1. not keratinized and includes the alveolar, vestibular, and buccal mucosa as well as the floor of the mouthThe specialized mucosa refers to the ?Papillae of the tongueEnamel:1. 96% mineralized, hardest tissue of the body 2. Produced by ameloblasts 3. Lines of Retzius are incremental lines from mineralization 4. Enamel spindles are ends of odontoblastic (live in dentinal tubules) process which cross the DEJDentin:1. 70% mineralized, tubular structure, forms greatest bulk of tooth 2. Produced by odontoblasts from the dental papilla 3. Primary dentin is before completion of the root 4. Secondary dentin develops after the tooth is in occlusionCementum:1. 50% mineralized (like bone) found on the root surface 2. Produced by cementoblasts located in the PDL 3. Thinnest at the cervical portion of the tooth, thickest at the apex 4. Acellular found at the CEJ; cellular at the apexPulp:Vital, sensory, responsive portion of the tooth, contains: Blood vessels, nerve fibers, fibroblasts, odontoblasts, histiocytes, pulp stonesPeriodontal Ligament:1. Suspensatory ligament attaching tooth to alveolar socket 2. Composed of dense collagen and fibroblasts 3. Attached to cementum by Sharpey's fibers 4. Oblique fibers most numerous (resist intrusive and rotational forces)Most often missed mesial coronal and root concavity is?Maxillary first premolarPremolar most often having two roots?Maxillary firstTooth with the longest root?Maxillary CanineCuspid with occasionally bifurcated root (facial- lingual)?MandibularTooth which most often fails to develop?third molar or maxillary lateralNon-functional lingual cusp?Mandibular first premolarPremolar which commonly has three cusp?Mandibular secondTooth which frequently has a fifth cusp?1. Mandibular first molar 2. Maxillary first molar (cusp of carabelli)Tooth most often affected by microdontia?Maxillary lateral incisorsTooth most likely to have a root with two canals?Mandibular first molar (mesial root)Tooth most likely to exhibit lingual caries?Maxillary lateral incisorsMaxillary first molar oblique ridge runs from?Distobuccal cusp to mesiolingual cuspWhat root of what molar is the widest and strongest?1. Mesial root 2. Mandibular first molarTooth with tendency to have divergent roots?Maxillary first molarTooth with the most unique anatomy?Primary first mandibular molarPrimary Mandibular Central Incisors erupt between ages?6-10 monthsPrimary Maxillary Central Incisors erupt between age?8-12 monthsPrimary Mandibular Lateral Incisors erupt between age?10-16 monthsPrimary Maxillary Lateral Incisors erupt between age?9-13 monthsPrimary Mandibular First molars erupt between age?14-18 monthsPrimary Maxillary First Molars erupt between age?13-19 monthsPrimary Mandibular Cuspids erupt between age?17-23 monthsPrimary Maxillary Cuspids erupt between age?16-22 monthsPrimary Mandibular second molars erupt between age?23-31 monthsPrimary Maxillary Second molars erupt between age?25-33 monthsPermanent Mandibular first molar erupts between age?6-7 yearsPermanent Maxillary first molar erupts between age?6-7 yearsPermanent Mandibular Central Incisors erupts between age?6-7 yearsPermanent Maxillary Central Incisors erupts between age?7-8 yearsPermanent Mandibular lateral incisors erupt between age?7-8 yearsPermanent Maxillary lateral incisors erupt between age?8-9 yearsPermanent Mandibular cuspids erupt between age?9-10 yearsPermanent Maxillary cuspids erupt between age?11-12 yearsPermanent Mandibular 1st bicuspids erupt between age?10-12 yearsPermanent Maxillary 1st bicuspids erupt between age?10-11 yearsPermanent Mandibular 2nd bicuspids erupt between age?11-12 yearsPermanent Maxillary 2nd bicuspids erupt between age?10-12 yearsPermanent Mandibular 2nd molars erupt between age?11-13 yearsPermanent Maxillary 2nd molars erupt between age?12-13 yearsPermanent Mandibular and Maxillary 3rd molars erupt between age?17-21What tooth is most likely to be impacted?Third molarsThree of the six bones which comprise the orbit include?1. Ethmoid, Sphenoid, ZygomaFour cranial nerves providing innervation to the tongue include?1. V, VII, IX and XIIThe muscle of mastication most responsible for protrusion of the jaw are?Lateral PterygoidsThe articular fossa is provided by what bone?TemporalWhartons duct empties the?Submandibular salivary glandsThe keratinized papillae of the tongue are?FiliformThree developmental processes must fuses to create the upper lip. They are?Globular and the left and right maxillary processesThe primary lymphatic node which drains the lower incisors, tip of tongue, midline of the lip, chin, and floor of the mouth is the?Submental nodeFetal pressure on what structure can cause orthostatic hypotension?Inferior Vena CavaCranial nerve XII (hypoglossal) provides motor innervation to all the muscles of the tongue except?PalatoglossusWhat are the five non-carious loss of tooth structures?1. Attrition 2. Bruxism 3. Erosion 4. Abrasion 5. AbfractionWhat is Attrition?Physiologic loss of tooth structure from tooth to tooth contactWhat is Bruxism?1. Habitual grinding of the teeth (attrition)What is Erosion?1. Pathologic loss of tooth structure due to a chemical process 2. Chronic vomiting, bulimia, acidic foodsWhat is Abrasion?Pathologic loss of tooth structure from a mechanical processWhat is Abfraction?1. Pathologic loss of tooth structure from flexure during mastication 2. Wedge shaped defects to the cervical areaWhat does dilacerations mean?1. Abnormal bend or curve in a tooth 2. Induced from traumaWhat does Gemination (twinning) mean?Single enlarged tooth in which the tooth count is normalWhat does Fusion mean?Enlarged tooth in which the tooth count revels a missing toothWhat does Concrescence mean?Union of teeth by cementum (CC)What does Dens Invaginatus (Dens in dente)?1. Deep surface invagination of the crown or root that is lined by enamel 2. Maxillary lateral incisors most common also most common to have a lingual pit.What does taurodontism (Bulls teeth) mean?1. Large pulp chamber with furcation close to the apex 2. Common in down syndromeWhat does microdont mean?1. Abnormally small tooth 2. Maxillary lateral incisors (peg laterals)What does Macrodont mean?1. Abnormally large tooth (rare)What does Anadontia mean?No teethWhat does Hypodontia mean?1. Fewer than normal teeth 2. Syndrome with hypodontia is ectodermal dysplasiaWhat does Oligodontia mean?missing 6 teeth or moreEnvironmental Hypoplasia of teeth:1. can affect primary or permanent teeth 2. Site of defect based on stage of tooth developmentSystemic Environmental hypoplasia of teeth include?1. Birth related trauma 2. Malnutrition (hypocalcemia- low calcium levels in blood) 3. Chemicals (fluorosis: >0.7ppm of fluoride in drinking water) 4. Systemic infection (congenital syphilis: Hutchinsons incisors & mulberry molars) 5. IdiopathicLocal Environmental hypoplasia of teeth include?1. Local infection or trauma 2. Turners hypoplasia or tooth: enamel defect of permanent tooth from infection in 1' tooth 3. Electrical burn, irradiationWhat are the two Hereditary alterations in tooth structures?1. Amelogenesis Imperfecta 2. Dentinogenesis ImperfectaWhat is Amelogenesis imperfect?Hereditary defect of enamel formationWhat is dentinogenesis imperfect?1. Hereditary defect of dentin 2. Obliderated pulp chambers and canals 3, Associated with osteogenesis imperfect (brittle bone disease)What is tetracycline staining?1. Ingestion of tetracycline during tooth development 2. Endogenous or intrinsic stainWhat is internal resorption?1. Pink tooth of Mummery 2. May occur after tooth trauma 3. If in pulp chamber tooth may look pink 4. Treatment: endodontic therapy before perforation into periodontal membraneWhat are some pigmented lesions?1. Physiologic pigmentation 2. Melanotic macule (oral focal membrane, oral freckle) 3. Amalgam Tattoo (focal argyrosis) 4. Fordyce's granules 5. Addison's disease 6. Cushing's syndromeWhat is Physiologic pigmentation?1. Racial pigmentation or normal pigmentation 2. Dark skin individualsWhat is Melanotic macule?1. Flat, brown lesion 2. Lower lip, intraoralWhat is Amalgam Tattoo?1. (focal argyrosis) 2. Grey, Blue-black, flat lesion 3. Amalgam particles in soft tissueWhat is Fordyce's granules?1. Oral sebaceous oil glands 2. Small, bilateral, yellow nodules of buccal mucosa and vermillion after pubertyWhat is Varicosities (varix, varices)?1. Dilated superficial veins (under tongue) 2. Prominent on ventral tongue (lingual varices)What is Addison's Disease?1. Adrenal cortical insufficiency 2. Pigmentation (bronzing) of skin and mucosaWhat is Cushing's Syndrome?1. (hypercortisolism) 2. Caused from excess pituitary gland ACTH production 3. Weight gain 4. Buffalo Hump- fat accumulation in the upper back 5. Moon face- fat accumulation in the faceWhat are some white lesions?1. Nicotinic Stomatitis (smokers palate) 2. Leukoedema 3. Linea Alba 4. Candida Albicans a) Pseudomembranous candidiasis (thrush) b) Erythematous candidiasis c) central papillary atrophy (median rhomboid glossitis) d) Angular chelitisWhat is Nicotinic Stomatitis?1. White, hyperkeratotic, coarse, nodular, wrinkled appearance to hard palate in smokers 2. Scattered red dots inflamed minor salivary glands 3. Not precancerousWhat is Leukoedema?1. Milky white lesions of buccal mucosa that disappear when stretchedWhat is Linea Alba?1. Hyperkeratotic line of buccal mucosa along plane of occlusionWhat is Candida Albicans?1. Most common fungal infection 2. Local factors: xerostomia, complete dentures/RPD's steroid inhalers 3. Systemic factors: antibiotic therapy, HIV+, uncontrolled diabetesWhat are the 4 Types of Candida Albicans?1. Pseudomembranous candidiasis (thrush) 2. Erythematous candidiasis (Red areas) 3. Central papillary atrophy (median rhomboid glossitis) 4. Angular chelitisWhat is Pseudomembranous candidiasis (thrush)?1. White plaque that wipe off suppressed immune systemWhat is Central papillary atrophy (median rhomboid glossitis)?1. Red, atrophic area, midline dorsal tongue 2. Often seen in immunosuppressed individualsWhat is Angular chelitis?1. Fissured areas at corner of the mouth 2. Can see similar appearance with severe Riboflavon (Vitamin B2) deficiency 3. Treatment: Topical Nystatin, clotrimazole,,, Systemic: Ketoconazole, Fluconazole (diflucan)What are the some tongue lesions?1. Geographic tongue 2. Ankyloglossia (tongue tied) 3. Hairy Tongue 4. Fissured tongue 5. Down syndromeWhat is geographic tongue?1. Erythema migrans, benign migratory glossitisWhat is Ankyloglossia?1. tongue tied 2. thick lingual frenum resulting in limitation of tongue movementWhat is hairy tongue?1. Elongation of the filiform papillae 2. Heavy smoking, antibiotic therapy, poor oral hygieneWhat is fissured tongue?1. Furrowed tongue, scrotal tongue 2. Fissures and grooves on dorsal tongue surfaceWhat are some characteristics of the mouth with down syndrome?1. altered immune system 2. Fissired tongue 3. Macroglossia (acromegaly- excess growth hormone) 4. Mouth breathing 5. Periodontal disease 6. Decrease cariesWhat are the two connective tissue lesions?1. Fibroma 2. PapillomaWhat is a Fibroma?1. Irritation fibroma, traumatic fibroma 2. Smooth, pink, firm, elevated module 3. Most common tumor of the oral cavityWhat is a Papilloma?1. Oral papilloma, Squamous papilloma 2. Pedunculated (on a stalk) wart-like, soft lesion 3. Caused by human papilloma virus (HPV) 4. HPV also causes cutaneous or skin warts, genital warts, cervical cancer, and is a risk factor for oral cancerWhat are some inflammatory soft tissue lesions?1. Epulis Fissuratum 2. Papillary Hyperplasia of the palate 3. Pyogenic granuloma 4. Chronic hyperplastic pulpitis (pulp polyp, pulp granuloma) 5. Peripheral giant cell granuloma 6. Gingival hyperplasiaWhat is Epulis Fissuratum?1. Fibroma around denture flange, especially poor fitting denturesWhat is Papillary Hyperplasia of the palate (pseudopapillomatosis)?1. Papillary lesion under maxillary denture especially if denture is never removedWhat is pyogenic granuloma?1. Exuberant tissue response to local irritation or trauma 2. Vascular appearance 3. Most common in kids and young adults on gingiva 4. Hormonal influence 5. "pregnancy tumor" often seen during pregnancyWhat is Chronic hyperplastic pulpitis?1. Pulp polyp, pulp granuloma 2. Exophytic lesion in carious teeth in childrenWhat is Peripheral giant cell granuloma?1. Looks clinically similar to pyogenic granuloma 2. Multinucleated giant cell presentWhat is gingival hyperplasia?1. Increase in number of cells 2. Most related to medications 3. Phenytoin (Dilantin): Seizure medication 4. Calcium channel blockers (Procardia or nefedipine): hypertension medication 5. Cycosporine: transplant medicationWhat are the two Ulcerative lesions?1. Traumatic ulcer 2. Aphthous ulcerWhat is a traumatic ulcers?1. Painful ulcers at site of traumaWhat is a Aphthous ulceration?1. Painful, recurring, well-circumscribed ulcer 2. Only on movable mucosa 3. Stress is the most commonly reported cause 4. Decrease incidence in smokers 5. Non-keratinized tissueWhat are some Viral Ulcerative lesions?1. Herpes Viruses a) Herpes simplex virus 1 (HSV-1) oral herpes b) Herpes simples virus 2 (HSV-2) genital herpes c) Varicella-zoster virus (VZV) chickenpox & shingles d) Epstein-Barr Virus (EBV) mono, oral hairy leukoplakia, Burkitt's lymphoma e) Human herpes virus 8 (HHV-8) Kaposi sarcoma herpes virus 2. Primary herpes simplex virus 3. Herpes labialis (cold sore, fever blister) 4. Recurrent intraoral HSV 5. Herpetic Whitlow 6. Varicella-zoster virus 7. Infectious mononucleosis 8. Oral hairy leukoplakia 9. Kaposi's sarcoma 10. Herpangina 11. Hand-foot&mouth diseaseWhat is primary herpes simplex virus (primary HSV)?1. Typically occurs at a young age (1-5 years old) 2. Flu-like symptoms fever, lymphadenopathy, malaise 3. Erythema (redness) especially of gingiva (acute herpetic gingivostomatitis)What is herpes labialis?1. Cold sore, fever blister 2. Recurrent lesions of HSV on the lips 3. Prodromal symptoms- burning, tingling, itching, or erythema before a lesionWhat is recurrent intraoral HSV?1. Occurs only on bound-down keratinized mucosa (hard palate and attached gingiva)What is herpes whitlow?1. Recurrent HSV on fingerWhat is Varicella-zoster virus?1. Chickenpox- erythema, vesicles, pustules, crusted lesions 2. Shingles in adults (unilateral erythema, vesicles, ulcers, and painWhat is infectious mononucleosis?1. Etiology: Epstein-Barr virus (EBV) 2. Palate PetechiaeWhat is hairy oral leukoplakia?1. Etiology: Epstein-Barr virus (EBV) 2. White, furrowed lines on lateral surface of tongue (cant wipe off) 3. May be 1st manifestation of HIV infectionWhat is Kaposi's sarcoma?1. Caused by HHV-8 (Kaposi's sarcoma herpes virus) 2. Vascular neoplasm 3. Multiple bluish-purple mascules and plaques 4. Seen with HIV infectionWhat is Herpangina?1. Caused by coxsackie virus (NOT HERPES VIRUS)!!!!!!What is hand-Foot&mouth disease?1. Caused by coxsackie virus 2. Ulcers of mouth, hands, and feethat does it mean when stated a "blistering disease"?1. May be termed vesiculobullous disease 2. Autoimmune disorder (body attacks itself)What are some Blistering Diseases?1. Erythema multiforme 2. Chronic discoid (cutaneous) lupus erythematosis 3. Lichen planusWhat is Erythema multiforme?1. An acute ulcerative condition of skin and mucous membrane 2. An immunologic response to foods, chemicals, drugs, or microbial infections 3. Recurrent HSV is a common trigger for recurrent EM 4. 50% have skin lesions: Bull;s eye or target lesions 5. Steve-Johnson syndromeWhat is Chronic discoid (cutaneous) Lupus erythematosis?1. Mucosa and skin ulcerations 2. "butterfly" rashWhat is Lichen Planus?1. Wickham's striae: fine, lace-like network of white lines 2. Reticular type- lace-like 3. Erosive type- blister and ulcerationWhat are the lesions of the Salivary Glands?1. Mucocele 2. Ranula 3. Sialolithiasis (Salivary stones) 4. Benign mixed tumor (Pleomorphic adenoma) 5. MumpsWhat is a Mucocele?1. Lower lip most common site 2. Bluish/pink fluid-filled nodule 3. Caused by traumatic severance of salivary gland duct 4. treatment: excisionWhat is a Ranula?1. Mucocele of the floor of the mouth 2. Obstruction of Whartons duct (submandibular salivary gland duct)What is a Sialolithiasis (Salivary stone)?1. Calcification within gland or duct 2. Whartons (submandibular) duct most common site 3. Swelling when eating with partial obstructionBenign mixed tumore (Pleomorphic adenoma)?1. Most common tumor of the salivary glands 2. Parotid gland most common location 3. Hard palate (posterior) most common intraoral locationWhat is Mumps (Epidemic parotitis)?1. Bilateral parotid enlargement 2. Inflammation of parotidWhat are the three cancers of the skin?1. Basal Cell Carcinoma- sun exposed skin 2. Squamous cell carcinoma- sun exposed skin 3. Melanoma- pigmented tumorWhat is the most common form of oral cancer?1. Squamous cell carcinoma (Epidermoid carcinoma)What is the major risk factor for squamous cell carcinoma?1. Smoking and alcohol consumption 2. HPV is also risk factor.What is some characteristics of squamous cell carcinoma?1. Often starts off as leukoplakia 2. Dysplasia (premalignant lesion) 3. Lateral tongue, floor of mouth most common site 4. Metastasizes first to cervical lymph nodesWhat is the treatment for squamous cell carcinoma?surgery, chemotherapy, radiation, combinationWhat are some radiation effects from treatment of squamous cell carcinoma?1. Erythema (redness of skin), xerostomia, radiation caries, osteoradionecrosisXerostomia?1. Dry mouth 2. Etiology: Drugs, head and neck radioation, Sjogren syndrome 3 AGING DOES NOT CAUSE DRY MOUTH!!!What is Sjogren syndrome?autoimmune disease with dry eyes, mouth from inflammationWhat are some cysts of the oral cavity?1. Odontogenic cysts 2. Radicular cyst 3. Residual cyst 4. Dentigerous cyst 5. Primordial cyst 6. Odontogenic keratocyst (OKC) 7. Lateral periodontal cyst 8. Non-odontogenic cystWhat is a cyst?Epithelial lined pathologic cavityWhat is a Odontogenic cyst?1. A cyst in which the lining of the lumen is derived from epithelium produced during tooth development 2. Epithelial rest of Serres: remnants of the dental lamina 3. Epithelial rest of Malassez: remnants of Hertwigs root sheathWhat is a Redicular cyst?1. (periapical cyst, apical periodontal cyst) 2. Apex of necrotic tooth 3. Well-circumscribed unilocular radiolucencyWhat is a residual cyst?1. Radicular cyst that was left behindWhat is a Dentigerous cyst (follicular cyst)?1. Cysts around the crown of an impacted tooth 2. Mandibular 3rd molars, maxillary canines 3. Unilocular radiolucencyWhat is a Primordial cyst?1. Occur in place of a tooth 2. Unilocular radiolucencyWhat is a Odontogenic keratocyst (OKC)?1. Multilocular radiolucency 2. Usually posterior mandible 3. High recurrence rateWhat is a lateral periodontal cyst?1. Usually unilocular radiolucency between roots of mandibular premolars 2. Cannot probe as it is a cyst in the boneWhat are the three Non-Odontogenic cyst?1. Globulomaxillary cyst 2. Nasopalatine duct cyst (incisive canal cyst) 3. Nasolabial cyst (Nasolacrimal cyst)What is a Globulomaxillary cyst?1. Unilocular radiolucency 2. Between maxillary lateral incisors and canineWhat is a Nasopalatine duct syst (Incisive canal cyst)?1. Oval Radiolucency od midline anterior maxilla 2. May appear "heart-shaped" due to anterior nasal spineWhat is a Nasolabial cyst (Nasolacrimal cyst)?1. Soft tissue cyst 2. Often lifts ala (wing) of nose-Oma?1. NeoplasmCarcinoma?1. Malignant neoplasm of epithelial tissueSarcoma?1. Malignant neoplasm of mesenchymal tissue (muscle, bone, connective tissue, etc)Adeno-Glandular (glands are epithelialOsteo-BoneChondro-CartilageNeuro-NerveRhabdomyo-Skeletal muscleLeiomyo-Smooth muscleFibro-Connective tissueOsteoma?Bone neoplasmChondroma?Cartilage neoplasmNeuroma?Nerve neoplasmRhabdomyoma?Skeletal muscle neoplasmLeiomyoma?Smooth muscle neoplasmFibroma?Connective tissue neoplasmAdenoma?Gland neoplasmOsteosarcoma?Bone Malignant neoplasmChondrosarcoma?Cartilage Malignant neoplasmNeurosarcoma?Nerve Malignant neoplasmRhabdomyosarcoma?Skeletal muscle Malignant neoplasmLeiomyosarcoma?Smooth muscle Malignant neoplasmFibrosarcoma?Connective tissue Malignant neoplasmAdenocarcinoma?Glands Malignant neoplasmMelanoma is?Malignancy of melanocytesLymphoma?Malignancy of lymph tissues or nodesLeukemia?Malignancy of leukocytes (White Blood Cells)Multiple Myeloma?Malignancy of plasma cells a) Bone pain b) "punched out" RadiolucenciesWhat is a Odontogenic Tumor?a tumor (almost always benign) derived from elements of tooth developmentOdontoma?1. Most common odotogenic tumor 2. Composed of enamel and dentin and can look like little teethAmeloblastoma?1. Usually multilocular radiolucency 2. Usually posterior mandible 3. High recurrent rateWhat are some Bone lesions?1. Palatal Torus 2. Mandibular tori 3. Condensing osteitis 4. Periapical Cemental dysplasia (Periapical cement-osseous dysplasia, False cementoma) 5. Florid Cemento-osseous dysplasia 6. Pagets Diseases (Osteitis deformans)Exostosis definition?Bony protuberancePalatal Torus?1. Bony, Radiopaque mass midline hard palate 2. Female 2:1Mandibular Tori?1. Bony, bilateral, radiopaque mass lingual mandible 2. Females 2:1Condensing Osteitis?1. Focal Sclerosing osteomyelitis 2. Radiopaque lesion at apex of inflamed or necrotic toothPeriapical Cemental Dysplasia (periapical cement-osseous dysplasia, False Cementoma)?1. Middle age black females 2. Lower anterior teeth 3. Involved teeth are vital No-TreatmentFlorid Cemento-osseous dysplasia?1. Multiple quads 4 Quads= bilateral and systemic involvement 2. Middle age black femalesPagets Disease?1. (Osteitis deformans) 2. Thickening and enlargement of the bones 3. Men 2:1 4. Cotton Wool radiopacities 5. Inclrease alkaline phosphatase in blood and increase for osteosarcoma (DENTURES DONT FIT ANYMORE)Bruxism is a pathologic manifestation of what condition?1. AttritionWhat is the most common site for supernumerary tooth?Between the maxillary central incisorsA permanent tooth that displays hypoplasia caused by trauma or infection during development has been termed:Tuners HypoplasiaHairy tongue is characterized by hyperplasia of what papillae?FiliformWhat is the most common location for AIDS-related "oral hairy leukoplakia"?Lateral border of the tongueThe most common location for a mucocele is the?Lower lipA radiograph shows an unerupted mandibular third molar with a 3cm pericoronal radiolucency. The most likely diagnosis is:Dentigerous cystPeriodontology is?The study of the diagnosis, treatment and prevention of disease affecting the periodontiumWhat are the tissues of the periodontium?1. Periodontal ligament 2. Gingiva 3. Cementum 4. Alveolar bonePeriodontal ligament is (PDL)?The PDL is a connective tissue complex made up of fiber bundles and cellsWhat are the functions of the Periodontal Ligament (PDL)?1. Tooth anchorage (attaches teeth to bone) 2. Transmits occlusal forces to the bone and resists impact of these forces 3. Supplies nutrients to periodontal structures 4. Sensory functions include touch, pressure and pain 5. Acts as a shock absorber for the teeth, nerves and blood vessels (All PDL fibers attach to the tooth's cementumWhat is Sharpey's?fibers bundles that are attached and embedded in cementum and boneWhat are the 6 fiber groups?1. Transseptal tibers 2. Alveolar crest fibers 3. Oblique fibers 4. Horizontal fibers 5. Apical Fibers 6. Interradicular fibersWhat are Transseptal Fibers?1. "Interdental ligament" 2. Extend interproximally over the alveolar crest 3. Hold teeth in interpromixal contact with each otherWhat are Alveolar crest fibers?1. MOST NUMEROUS type of fibers 2. Resists "intrusive" or "vertical" masticatory forces 3. Prevents the tooth from being "jammed" into the bony socketWhat are Horizontal fibers?resist horizontal and tilting forcesWhat are Apical fibers?1. Extend from apical area of the tooth to base of the tooth socket. 2. Resist "extrusive" forces 3. Prevents the tooth from being lifted out of the bony socketWhat are Interradicular fibers?1. Found ONLY in multi-rooted teeth 2. Located in tooth furcations 3. Stabilizes tooth rootWhat are the 5 cells of the PDL?1. Fibroblasts 2. Osteoblasts 3. Osteoclasts 4. Cementoblasts 5. CementoclastsWhat are Fibroblasts?1. Most common cell of PDL: Collagen synthesis and fiber production 2. Primary cell of the PDLWhat is the function of Osteoblasts?Production of boneWhat is the function of OSteoclasts?Resorption (break down ) of boneWhat is the function of Cementoblasts?Production of cementumWhat is the function of Cementoclasts?Resorption (break down) of cementumHealthy gingiva features?1. Firm 2. Light pink (coral pink) 3. Fills interproximal space, knife-edge 4. Gingival margin on enamel 5. 1-3mm gingival sulcusUnhealthy gingival features?1. Spongy, Swollen 2. Red' bleeds upon probing 3. Bulbous, festooned 4. Recession. hyperplastic 5. deep pockets or probing depthsWhat is Gingivitis?1. REVERSIBLE inflammation of the gingiva 2. Directly related to the accumulation of plaqueGingivitis results from?Ulceration at the base of the sulcusMost gingivitis is?Chronic plaque associated gingivitisWhat are the features of an Acute gingivitis?1. Develops rapidly 2. Obvious inflammation 3. May be painful 4. Neutrophil is the most prevalent cellWhat are the features of a Chronic Gingivitis?1. Develops slowly 2. May appear normal 3. Not usually painfulErythema is?Redness associated with inflammationCyanosis is?Bluish, highly vascular often found around crownsPallor is?Lighter than normal, associated with anemia, leukemia, fibrotic tissues etcWhat are the three gingival surface tissue textures?1. Stippled 2. Edematous 3. FibroticWhat is Edematous gingival surface tissue texture?1. glossy appearance due to increased fluid 2. Edema is the result of VASODILATION of the peripheral circulationWhat is fibrotic gingival surface tissue texture?Increase in cellular and fibrous components, may present with PALLORWhat are some gingival contours?1. Clefted 2. Bulbous 3. Festoon 4. Recession 5. EnlargementWhat does Clefted gingival contour mean?Stillman's cleft indicated by vertical loss of tissue, caused by improper flossingWhat does Bulbous mean?BluntedWhat does Festoon mean?1. Inner tube-like swelling at gingival margins, due to inflammation and increased cell numberWhat causes recession?1. Caused by age, plaque, iatrogenic (dental treatment), tooth malposition, occlusion, frenum pull, trauma, inadequate attachment, improper flossing techniquesWhat are some drugs that cause Gingival Enlargement?1. Phenytoin (Dilantin)- Anticonvulsant 50% have hyperplasia 2. Nifedipine (Procardiac) Antihypertensive calcium channel blocker 3. Cyclosporin- immunosuppressive drug 30% have hyperplasiaWhat are some causes of gingival enlargement other than medication induced?1. Mouthbreathing 2. Periodontal inflammation 3. Genetic/hereditary factors 4. Systemic conditions including: leukemia, and hormonal imbalanceWhat does hyperplasia mean?Gingival enlargement due to an increase in cell NUMBERSWhat does Hypertrophy mean?Gingival enlargement die to an increase in cell SIZEWhat does Dehiscence mean?1. A loss of alveolar bone 2. Oval shaped root exposure apical to the CEJ 3. Includes gingival recession, alveolar bone loss and root exposureWhat is Dental Plaque?1. Accumulation of microbes on the surface of the teeth 2. Not readily removed by rinsingWhat is the major etiology factor (cause) in the initiation and progression of inflammatory periodontal diseases?PlaquePlaque is a ______ bacteria forming on the tooth surface?BiofilmPlaque formation steps?1. Glycoproteins from saliva are adsorbed to the tooth surface, forming the acquired pellicle 2. Bacteria the adhere (attach) to the acquired pellicle 3. Bacteria multiply to form colonies on the tooth, creating a biofilm 4. As plaque grows, bacteria detach from the biofilm and become "planktonic" bacteria (free) 5. Later, calculus forms from the mineralized plaque biofilmWhat bacteria if found in early plaque formation?Cocci: Round spherical-shaped bacteriaWhat bacteria is the most common type found in periodontal disease?Bacilli: Rod-shaped bacteriaWhat bacteria is often associated with NUG/NUP?Spirochetes: Spiral-shaped bacteriaWhat does Aerobic mean?1. require oxygen to grow 2. Are NOT found in periodontal pocketsWhat does Anaerobic mean?1. Grow in the absence of oxygen 2. Are found in the periodontal pockets and gingival sulcusWhat does Facultative anaerobic mean?can grow in the presence or absence of oxygenWhat are the Early/Healthy bacteria species?1. Streptococcus: S. Mitis, S. Oralis, S. Sanguis, and S. Mutans (gram + bacteria, Healthy) 2. Actinomyces: A. Viscous (gram + bacteria, early colonizer)What are the Bacteria species associated with disease?1. Porphyromonas gingivalis (P. gingivalis) 2. Fusobacterium nucleatum (F. nucleatum) 3. Campylobacter rectus (C. rectus) 4. Prevotella intermedia (P. intermedia) 5. Aggregatibacter actinomycetemcomiytans (A. actinomycetemcomiytans )What bacteria is the most common/most important periodontal pathogen and is an anaerobic, gram - rod shaped bacteria?Porphyromonas gingivalis (p. gingivalis)What bacterial plays a critical role in biofilm formation and is an anaerobic, gram - rod-shaped bacteria?Fusobacterium nucleatum (f. nucleatum)What bacteria is associated with periodontal disease, also gram - and is a facultative anaerobe associated with inflammation during pregnancy?Campylobacter rectus (c. rectus)What bacteria is associated with periodontal disease, also gram - anaerobe and MOST often associated with inflammation during pregnancy?Prevotella intermedia (p. intermedia)What bacteria is a gram - rod-shaped bacteria associated with aggressive periodontal disease?Aggregatibacter actinimycetemcomitans (renamed from Actinobacillus actinimycetemcomitans)What bacteria is associated with NUG/NUP?1. Treponema denticola (t. denticola) 2. Prevotella intermedia (p. intermedia) 3. Porphyromonas gingivalis (p. gingivalis) 4. FusobacteriumTreponema denticola (t. denticola) is a _________ bacteria?SpirochetePlaque retentive zones include?1. pits and fissures 2. irregular tooth surfaces 3. interproximal areasSupragingival plaque:1. Pellicle formation is derived from salivary glycoproteins 2. This pellicle is a sticky matrix that allows for bacterial attachment to the tooth 3. Attachment begins mostly with gram + cocci 4. As plaque matures more facultative anaerobic bacteria are presentSubgingival plaque:1. Accumulates after supragingival plaque 2. Contains MORE motile, gram - anaerobic than supragingival plaque 3. There are also free-floating or loosely adherent plaque in the pocket/sulcusPlaque adherent:1. Densely interconnected 2. non-motile bacteria 3. May mineralize and become CALCULUSPlaque Non-adherent:1. Also known as PLANKTONIC plaque 2. Mostly motile rods and spirochetes 3. Increase during acute infection/inflammation 4. The oral hygiene aid most suited for removal of loose or non-adherent plaque is an oral irrigatorCauses/ local etiology of gingivitis are?1. Plaque 2. Calculus 3. Irritating restorations: poorly fitted crowns, overhang 4. Food impaction: open contactsEndotoxins:1. Associated with GRAM - bacteria 2. Stimulates osteoclasts 3. Inhibits fibroblasts and my harm neutrophils (PMN's)Collagenase:Directly breaks down connective tissueProtease:Directly breaks down tissuesHyaluronidase:breaks down extracellular matrix, allowing bacteria to detach "spreading factor"Exotoxins:1. bacterial waste products that cause direct tissue injury 2. Examples include hydrogen sulfite, uric acid and fatty acidPeriodontitis is?1. inflammation of the periodontal tissue, and loss of connective tissue attachment to the tooth 2. Characterized by bone resorption that usually progresses slowly and horizontally 3. Apical downward migration of the junctional epithelium 4. Is documented by clinical attachment loss (CAL) over timeClinical Assessment of the periodontium include:1. Clinical attachment loss (CAL) 2. Width of attached gingiva 3. Pockets/sulcus depths 4. Occlusal trauma/ wear patterns 5. Position of teeth, edentulous areas 6. Furcarions 7. Radiographs 8. Tooth mobility 9. Restorations status 10. Proximal contactsClinic attachment loss (CAL) characteristics:1. Measures from the CEJ to the base of the pocket 2. CAL is the best indicator of damage to the periodontium 3. An increase in CAL means that there is disease progressionHow to measure the CAL?1. measure the pocket depth first 2. next, measure how much recession is present 3. then, add these two numbers togetherWhat is there is gingival enlargement/ hyperplasia? How do you measure CAL?1. Measure the pocket depth first 2. next, measure how much enlargement is present from CEJ 3. Subtract the amount of enlargement from the pocket depthWidth of the attached gingiva:1. The attached gingiva is connected to the tooth cementum and the periosteum of the alveolar bone 2. Widest is the anterior teeth (max: 3.5-4.5mm Mand: 3.3-3.9) 3. Narrowest is premolar areas (1.8-1.9mm)Radiographs of a healthy gingiva include:1. Crest of the alveolar bone should be 1-2mm apical to the CEJ 2. Contour of the alveolar bone should follow the contour of the CEJ 3. Distinct radiopaque lamina dura should be present 4. PDL space should be visible and uniform in widthRadiographs of a diseased or periodontitis gingiva?1. Lamina dura becomes less distinct 2. May see loss of bone in furcation areas 3.Bone loss may be horizontal or verticle 4. Horizontal bone loss indicated 2mm (+) reduction in bine height from CEJ 5. Vertical bone loss is "angular" 6. Best evaluated on bitewing radiographsTo check for tooth mobility what do you use?Two instruments with hard handles (NOT FINGERS!)Suprabony pocket formation is?Occur ABOVE (coronal to) the alveolar crest boneInfrabony pocket formation is?1. Base of the pocket is BELOW (apical to) the alveolar crest 2. Treated with regenerative proceduresIncreased pocket/probing depths can occur from two possibilities:1. Coronal movement of the gingival margin a) "Pseudopockets" due to inflammation and swelling 2. Deepening of the sulcus/pocket a) due to loss of tissue attachment to the tooth b) Apical migration of the juncitonal epitheliumOcclusal Trauma has two type what are they?1. Primary Occlusal Trauma 2. Secondary Occlusal TraumaPrimary occlusal trauma is?Excessive force on a tooth with normal bone supportSecondary occlusal trauma is?injury as the result of force applied to a tooth that has previously experienced bone or attachment lossRapid bone loss/pocket formation may result from?excessive occlusal force on a tooth that has bone/attachment loss previouslySigns and symptoms of occlusal trauma is?1. Sensitivity 2. Wear facets 3. Tooth migration 4. Increased tooth mobility 5. Widening of the PDL space on a radiographGingival diseases are induced by plaque and non plague what are the differences between the two?1. Plaque induced- dental plaque (bacteria) only can modified by systemic factors, nutrition and medications 2. Non-plaque induced- viruses, fungus, genetic or systemic conditions. May also result from trauma or foreign body reactions.Non-plaque induced gingival diseases, examples include:1. Primary herpes 2. Recurrent herpes (cold sores, fever blister) 3. Aphthous ulcers (canker sores)Primary herpes characteristics:1. Initial infection with herpes simplex virus (6 months to 6 years) with 1 week incubation 2. Characterized by fever, malaise (don't feel good), lymphadenopathy, followed by painful, erythematous, swollen gingival and multiple vesicles. 3. Vesicles ulcerate, crust over and heal within 10-14 daysRecurrent herpes (cold sore fever blister) characteristics:1. Most common is herpes labialis, on vermilion border of the lips 2. My be brought on by sun, stress, fever, menstruation, or unknownAphthous ulcers (canker sores) characteristics:1. Painful yellow/white ulcers surrounded by an erythematous haloCause of Aphthous ulcers?Cause: often unknown may be precipitated by stress or trauma, possibly autoimmune pathogenesisPredisposing factors of aphthous ulcers:HIV infections, nutritional deficiencies (iron, folic acid, vitamin B) smoking cessation, reaction to sodium laurel sulfateTreatment for aphthous ulcers?Topical steroids, or anti-inflammatory meds (Aphthasol) topical anesthetics healing within 1-3 weeksHow to distinguish Herpes from Aphthous ulcers. Herpes are:1. Keratinized mucosa 2. Vesicles first, then ulcers 3. recurrent TX: antiviral drugs Treatment: acyclovir (Zovirax)How to distinguish Herpes from Aphthous ulcers. Aphthous ulcers are:1. Nonkeratinized mucosa 2. NO vesicles 3. Recurrent 4. TX: Topical steroids and anti-inflammatory drugsPeriodontal disease classifications and NOT case type:1. Gingival disease 2. Chronic periodontitis 3. Aggressive periodontitis 4. Periodontitis as a manifestation of systemic disease 5. Periodontitis Associated with genetic disorders 6. Necrotizing periodontal disease 7. Abscesses of the periodontium 8. Periodontics Associated with Endodontics leasions 9. Development or acquired deformities and other conditionsExamples of Periodontitis as a Manifestation of systemic disease are?1. Acquired neutropenia 2. LeukemiaPeriodontitis associated with genetic disorders are:?1. Familial and cyclic neutropenia (Neutropenia- a lack deficiency of neutrophils (PMNs) 2. Down syndrome (NO increase in caries) 3. Papillon-LaFevre syndrome 4. Chediak-Higashi syndrome 5. Aggressive periodontitisPapillon-LaFevre syndrome causes?1. Severe periodontal destruction 2. Hyperkeratosis of the palms of hands and soles of feetChediak-Higashi syndrome causes?1. inherited disease of the immune and nervous systems 2. Impairment of neutrophilsWhat are the two Necrotizing Periodontal Diseases?1. Necrotizing Ulcerative Periodontitis (NUP) 2. Necrotizing Ulcerative Gingivitis (NUG)Necrotizing Ulcerative Periodontitis (NUP) is?Loss of clinical attachment and boneNecrotizing Ulcerative Gingivitis (NUG) is?Affects gingiva onlywhat bacteria are associated with NUG and NUP?Spirochetes Treponema denticola, Prevotella intermedia, Porphyromonas gingivalis and FusobacteriaWhat is the drug of choice for NUG and NUP, also why?1. Tetracycline 2. Because it concentrates in gingival crevicular fluidClinical findings for NUG and NUP?1. Punched out Papillae (NUG) 2. Pseudomembrane 3. Fetid BAD odor 4. Pain and severe inflammationWhat are some abscesses of the periodontium?1. Gingival abscess 2. Periodontal Abscess 3. Pericoronal abscess 4. Periapical AbscessGingival Abscess results in?injury to or infection of the surface gingival tissuePeriodontal Abscess results when?1.infection spread deep into pocket, and drainage is blocked 2. May develop after periodontal debridementPericoronal Abscess develops in?1. Inflamed dental follicular tissue, overlying the crown of a partially erupted tooth (most often mandibular third molars)Periapical Abscess results from?1. infection of the tooth pulp 2. Secondary to deep dental caries 3. Diagnosis often requires a periapical radiographReversible pulpitis is?1. Related to HYPEREMIA of the pulp 2. Mild inflammation from deep restoration 3. Pain improves with the deposition of reparative-dentin after the restoration is placedLocalized tooth related factors that may increase the risk of developing plaque induced gingivitis and periodontitis or exacerbate (make worse) these conditions:1. Gingival recession 2. Lack of attached gingiva 3. Frenum position and "pull" 4. Enlarged/excessive gingiva 5. Occlusal traumaHistopathology of periodontal lesions are:1. stage I = initial lesion (2-4 days) 2. Stage II = Early lesion (4-7 days) 3. Stage III = Established lesion (2-3 weeks) 4. Stage IV = Advanced lesion (3 weeks + to years)Stage I initial lesions:1. NO clinical changes 2. Vasodilation (opening up) of small capillaries 3. Increased number of white blood cells (PMNs/Neutrophils) 4. Increased flow of gingival fluidStage II Early lesion or Gingivitis:1. Clinical sign of gingivitis appear 2. White blood cell (leukocyte) infiltration into connective tissue 3. Rete pegs develop in sulcular lining 4. Collagen destruction (by collagenase) 5. Bleeding occurs due to ulcerated sulcular lining 6. PMNs found in sulcusStage III Established lesion:1. Capillary proliferation (overgrowth) causes erythema (redness) 2. Gingival enlargement may increase probing depths 3. Plasma cells become prominentStage IV advanced lesion:1. Transition from gingivitis to periodontitis 2. Irreversible 3. Junctional epithelium detaches from root surface and migrates apically 4. Osteoclasts and bone lossEvents occurring as periodontal disease progresses:1. Increased probing depths 2. Increased attachment loss 3. Increased bone resorptionHyperemia Definition:Excess of blood in the vessels in the tissueMargination Definition:Movement of WBCs to the periphery of vessel wallsPavementing Definition:WBCs line the wall of the vesselsDiapidesis Definition:Process by which neutrophils squeeze between endothelial cells in the vessel wallsEmigration Definition:Cells move into the tissues from the blood vesselsChemotaxis Definition:The movement of cells to the site of inflammationNeutrophils Definition:1. White blood cells significant to development and progression of disease 2. Most prevalent cell in acute inflammation 3. Most active cell in the periodontal pocket 4. Main function is phagocytosis (engulfing and digesting of foreign bodies)Contributing factors for the development and progression of periodontal disease systemic factors include:1. Diabetes mellitusDiabetes mellitus results in:1. An increase risk of periodontal disease 2. Xerostomia and increased caries risk 3. Candidiasis 4. Delayed wound healingContributing factors for the development and progression of periodontal disease nutritional concerns:1. Scurvy- a vitamin C deficiency, Vitamin C is necessary for collagen production and wound healing 2. Kwashiorkor- A protein deficiency, proteins are necessary for a healthy periodontiumContributing factors for the development and progression of periodontal disease blood cell dyscrasias which are?Erythroblastic anemia, cyclic neutropenia, radiation therapy and acute monocytic leukemia can all affect periodontal tissuesContributing factors for the development and progression of periodontal disease Hormonal effects:1. Pregnancy gingivitis (prevotella intermedia and Camphylobacter rectus) 2. MEdications, puberty, menstruation, and menopause call all affect periodontal tissuesSmokers are at an increased risk of developing _________, due to ___________, but are NOT at an increased risk of developing ________.1. Periodontal disease 2. Vasoconstriction 3. CariesContributing factors for the development and progression of periodontal disease is cancer, cancer patients may present with:1. Xerostomia 2. Mucositis: inflammation of oral tissues 3. Dysgeusia: loss of taste or altered taste 4. Increased risk of fungal and viral infectionsContributing factors for the development and progression of periodontal disease HIV disease, patients who are HIV + may present with:1. Linear gingival erythema (LGE): band of redness of the marginal gingiva 2. Necrotizing ulcerative periodontitis: necrosis of gingiva and alveolar bone 3. Aphthous ulcers 4. Kaposi's sarcoma: malignancy of vessels, present as a blue/purple maculeWhat are the three objectives of periodontal therapy?1. Identify the disease 2. Control inflammation 3. Deal with defects resulting from the diseaseWhat are the three goals of periodontal surgery?1. Allow easier cleaning for the patient ("cleansability") 2. Replace lost tissue 3. Gain new attachmentWhat do you do after periodontal therapy:1. A reevaluation appointment 4-6 weeks after therapy is necessary to determine effectiveness 2. The first factor to asses at this appointment is the degree of inflammation of the tissuesFactors that affect the prognosis after treatment is:1. Tooth mobility 2. Endodontic status (deep restorations, deep caries) 3. Characteristics of the periodontal defect a) depth of pockets, width of defect b) the more bony walls present, the BETTER the prognosis c) A 3-wall defect has a better prognosis than 1-wall defectThe most common surgical procedure to reduce pocket depths is?GingivectomyWhat is a Gingivectomy?1. Removes soft tissue 2. Treatment for gingival hyperplasia and pseudopocketsOsseous surgery:1. Requires a gingival flap (incision) (mucogingival flap) 2. Bone recontoured (osteoplasty) 3. Bone removal (osteoectomy) 4. Sutures are required 5. Sutures maybe bioabsorbable (gut) or non-absorbable (silk)Periodontal dressings:1. Used for comfort, protection, and to maintain tissue contour 2. rarely used 3. periodontal dressing containing eugenol are irritating to tissues 4. White patches 5. Periodontal dressings do NOT prevent build upWhat are some regenerative procedure?1. Guided tissue regeneration (GTR) 2. Osseous grafts 3. Soft tissue graftsWhat is a guided tissue regeneration (GTR)?uses barrier membrane to block migration of epithelial cells.What is the main reason to use regenerative procedure?1to treat infrabony defectsWhat does healing dynamics mean?1. Tissue repair generally involves fibrous repair through the formation of granulation (early tissue formation) tissue.What is granulation tissue?immature tissue with many capillaries (neovascularization) and fibroblastsWhat are the four stages of fibrous repair?1. Blood clotting 2. Wound cleansing 3. Tissue rebuilding 4. Wound remodelingBlood clotting:1. Local tissue injury results in hemorrhage from damaged blood vessels 2. The initial clot is composed of fibrin, fibronectin and platelets 3. The clot fills the wound, serving as a scaffolding for PMN's and macrophagesWound cleaning:1. Macrophages ingest debris and degrade the clot (phagocytosis) 2. PMNs attack bacteria 3. New capillaries and fibroblasts move in as debris is removedTissue Rebuilding:1. Fibroblasts synthesize/deposit fibronectin, collagen and proteoglycans 2. Granulation tissue is formed, and is highly cellular and vascularWound remodeling:1. Granulation tissue is eventually remodeled into a scar, composed of dense collagen interspersed with cells and blood vesselsArachidonic acid is produced when?There is a tissue injury (perio disease)Arachidonic acid is metabolized to produce what?inflammation mediatorsWhat are the two most important mediators for Arachidonic acid?Prostaglandins and leukotrienes (2 inflammatory mediatorsWhat does Prostaglandins do?1. Cause swelling, pain and inflammation (Prostaglandin= Pain) 2. They are inhibited by NSAIDs (ibuprofen) and aspirinWhat does leukotrienes do?1. Cause bronchoconstriction, cellular infiltration, cytokine release and inflammation 2. leukotrienes= LungsWhat are leukotrienes derived from?1. Leukocytes especially mast cellsleukotrienes are inhibited by?1. Asthma drugs, such as Singulair (montelukast)Tobacco use affects the periodontium by:Reduce blood supply to the tissueThe most important type of bacteria on the dorsum of the tongue and other soft tissues in a mouth is?StreptococciPorphyromonas gingivalis are?Pathogenis bacillus bacteria that are prevalent in many chronic periodontal diseasesWhat condition may increase plaque retention?1. Subgingival restorations 2. Faulty crown matgins 3. Unreplaced missing first molarsWhat bacteria species is NOT associated with chronic periodontitis?Streptococcus mutansWhat is a characteristic of the progression of periodontal disease?Motile organismsWhat is Endotoxins:Stimulated osteoclast activityWhat assessment finding indicates that a patients periodontal disease is progressing?attachment loss increases over timeSharpeys fibers are found in?Cementum and alveolar boneDental plaque biofilm associated with severe periodontitis is characterized by?Gram negative bacteriaThe acquired pellicle is formed by?Salivary glycoproteinsPregnancy gingivitis is most closely associated with?p. intermedia and c. rectusControlled substance act is administered by?The DEAWhat is schedule I drugs?High abuse potential, no accepted medical use Ex: heroin and LSDWhat is schedule II drugs?1. High abuse potential, written prescription with signature only, NO refills Ex: morphine, codeine alone, amphetamines, oxycodone and VicodinWhat is schedule III drugs?Moderate abuse potential, may phone in, 5 Rx in 6 months Ex: Tylenol #3 (combination of acetaminophen and codeine)What is schedule IV drugs?Lower abuse potential, may phone in, five Rx in six months Ex: Valium (diazepam) and DarvonWhat is schedule V drugs?Lowest abuse potential, some may be available OTC Ex: Codeine-containing cough medications (not OTC)Log dose-effect curve:A graph of the relationship between dose of a drug and the responseTherapeutic range:Where the dose is increasing sharplyMaximum response:where the curve plateaus (flatten out)Potency:1. The pharmacological activity of a drug, related to DOSE 2. The amount of drug necessary to produce an effect 3. Potency is GREATER when dose is SMALLEREfficacy:Maximum response of a drug, REGARDLESS OF TGHE DOSEOnset:The time is takes for the drug to have an effectDuration:the length of time that a drug has an effectHalf-life:1. One measure of duration 2. The amount of time necessary for a drug to fall to 1/2 of its original blood levelWhat does the route of drug administration affect and what are the two major groups.1. Affects both the onset and duration 2. Enteral and parenteralThe Enteral drug route is?1. Placed directly into the GI tract 2. Oral route 3. Rectal routeThe Parenteral drug route is?1. Bypasses the GI tract 2. IV, IM, SQ, intradermal 3. Inhalation, topical, sublingualOral route of administration:1. Safest, least expensive and most convenient 2. Absorption in Small intestines 3. Less predictable blood level 4. Inactivation by acid, enzymes or first pass effect (by the liver)First pass effect:occurs when orally-administered drugs initially pass through the hepaticportal circulation (liver), which reduces the amount of effect drugRectal route of administration:1. Poor patient acceotance 2. Suppositories, creams, enema 3. Used if patient is vomiting or unconscious 4. poor and irregular absorption rectallyIV (intravascular):1. MOST RADIP drug response, best for emergency situations 2. More predictable blood levels 3. Absorption phase bypasses 4. Disadvantages: phlebitis (inflammation of blood vessel), irretrievability and allergyIM (intramuscular):1. provides sustained effect 2. Absorption due to high blood flow in skeletal muscles 3. Massaging muscles will increase the drugs absorption 4. Deltoid or gluteal muscles common injection sitesSubcutaneous:1. Protein products 2. Insulin is administered subcutaneous- it is inactivated by GI acid/enzymes 3. Local anesthesia in dentistry 4. Side effects: sterile abscess or hematomaIntradermal:1. Injection into epidermis 2. Tuberculin skin test (TB)Inhalation:1. Rapid delivery across large surface area of respiratory mucosa 2. Asthma inhalers and nitrous oxide/oxygen sedationTopical:1. Applied to a body surface: (skin, mucosa) 2. Most effective in no-keratinized areas 3. Used when local effect is desired 4. Topical drugs require an increase concentration of the drug 5. Contraindications in ulcerated, burned or abraded surfacesPharmacokinetics:The study of how a drug enters the body, circulates in the body, and leaves the bodyWhat does ADME stand for?Absorption, Distribution, Metabolism, EliminationAbsorption:1. The transfer of a drug from the site of administration to the blood stream 2. IV administration drugs bypass this step 3, Lipid soluble drugs move across most biological membranes by diffusion, and may bypass the blood-brain barrier 4. SMALL INTESTINES is most important for absorption of oral drugsDistribution:1. The process by which a drug leaves the blood stream and enters the body systems 2. Drugs are distributed to organs with highest blood flow 3. Oral dose to the liver, sublingual dose to the heart 4. Drugs may be bound to protein in the blood, especially plasma albuminMetabolism:The breaking down of a drug for its removal from the body 2. Also known as biotransformation 3. LIVER is the most important site for metabolism of drugsElimination:1. The removal of the drug from the body 2. Drug elimination terminates drug effect 3. KIDNEY is the most important organ (renal excretion) 4. Other routes include: liver, lungs, bile, GI, seat, saliva and crevicular fluid.What are some adverse drug reactions:1. Side effects 2. Toxic effects 3. Allergy 4. Idiosyncrasy 5. Teratogenic effects 6. Local effects 7. Drug interactionsSide effects:dose-related reaction that is NOT a part of the desired therapeutic actionToxic effect:Occurs when the desired effect is excessive (also dose related)Allergy:Hypersensitivity response to a drug NOT dose relatedIdiosyncrasy:an abnormal drug response that is usually genetically determinedTeratogenic effect:causal relationship between the drug use of a mother and congenital abnormalities (congenital defect)Local Effect:1. Effects occurring at the site of administration Ex: pain or irritation at an injection siteDrug interaction:1. occur when the effect of one drug is altered by another drug 2. May result in toxicity OR lack of effectiveness of the drugAutonomic nervous system does what and what does it control?1. functions without conscious effort 2. Controls BP, pulse, respiration, body temp, salivary gland secretion.What are the two forms of Autonomic nervous system?1. Sympathetic (SANS) 2. Parasympathetic (PANS)Sympathetic (SANS):1. "flight or fight" 2. Emergency/crisis situations 3. Increase blood pressure through vasoconstriction 4. Increase heart rate 5. Dilates bronchioles for improved breathing 6. Dilates pupils 7. Preganglionic neurotransmitter: Acetylcholine 8. Postganglionic neurotransmitter: Norepinephrine 9. Adrenergic drugs (sympathomimetic)Parasympathetic (PANS):1. "rest and digest" 2. Normal, resting activity 3. Increased blood flow to digestive organs 4. Accelerate peristalsis 5. Constricts bronchioles 6. Constricts pupils 7. Increase saliva flow 8. Acetylcholine 9. Cholinergic drugs: parasympathomimeticsWhat does Adrenergic drugs do?Effects mimic the sympathetic nervous systemWhat are some examples of Adrenergic drugs:1. Ventolin (albuterol) 2. Epinephrine 3. DopamineWhat is Ventolin (albuterol) use for?inhaler to treat asthma (bronchodilator)What is Epinephrine used for?1. to treat anaphylactic reactions 2. used in local anesthetic solutions as vasoconstrictor 3. Used in cardiac arrest to stimulate heart musclesWhat is Dopamine used for?to treat shock, low blood pressure and Parkinson'sAdverse effects of Adrenergic drugs?1. CNS (anxiety, fear, tremor, headache) 2. Cardiac arrhythmia 3. Hypertension 4. XerostomiaAvoid adrenergic drugs with:Angina, uncontrolled hypertension, uncontrolled hyperthyroidismWhat are Adrenergic-Blocking drugs used for?1. Used to treat cardiac arrhythmia, hypertension, angina pectoris, glaucoma, myocardial infarction 2. May block alpha, beta-1 and beta-2 adrenergic receptorsWhat are some examples of Adrenergic-Blocking drugs?1. Inderal (propranolol) 2. Tenormin (atenolol) 3. Lopressor (metoprolol) 4. Timoptic (timolol)What is Inderal (propranolol)?non-selective beta blocker to treat hypertensionWhat is Tenormin (atenolol)?Selective beta blocker to treat hypertensionWhat is Lopressor (metoprolol)?Selective beta blocker to treat hypertensionWhat is Timoptic (timolol)?To treat glaucomaWhat does Cholinergic drugs do?mimics the parasympathetic nervous systemWhat are some examples of Cholinergic drugs?PilocarpineWhat Pilocarpine used for?1. To increase saliva flow in patients wit Sjogren's syndrome. 2. can also be used to treat glaucomaWhat is glaucoma?A group of eye conditions that can cause blindnessWhat is a contraindication for Pilocarpine drug?Do not use these with asthma, ulcers and cardiac diseaseWhat do Anticholinergic drugs do?These drugs block the parasympathetic nervous systemWhat are examples of Anticholinergic drugs?1. Atropine 2. Imodium 3. Scopolamine 4. DramamineWhat is the use for Atropine?Used to decrease saliva flow for dental proceduresWhat is the use for Imodium?Used to treat diarrheaWhat is the use for Scopolamine?to treat motion sicknessWhat is the use for Dramamine?to treat motion sicknessWhat are some adverse reactions of anticholinergic drugs?1. Blurred vision 2. Bladder retention 3. Constipation 4. Dry mouthWhat does Analgesic mean?Pain medication, Pain relieverWhat are the Analgesic drugs?1. Aspirin 2. Acetaminophen 3. Ibuprofen 4. Narcotics/Opioid drugsAspirin:Nonopioid, Mechanism of action is the inhibition of prostaglandin synthesisWhat the effects of aspirin?1. Analgesic (pain reducer) 2. Antipyretic (fever reducer) through action of hypothalamus 3. Anti-inflammatory 4. Anti-Platelet (blood thinning)What are the adverse effects of aspirin?1. Interferes with clotting 2. GI irritation 3. Hypersensitivity 4. Association with Reye's syndrome 5. TinnitusWhat are some contraindications with the use of aspirin?1. Coumadin (warfarin) use 2. Gastric ulcersWhat percentage of patients has a hypersensitivity to aspirin?1. 15% of patients experience allergic reactions to aspirin 2. Asthma patients at higher riskWhat is Reye Syndrome?A potentially severe reaction in children with either chicken pox of influenza. Avoid Aspirin in children (acetaminophen is drug of choice)What is Tinnitus?ringing in the earsAcetaminophen:Nonopiod, Brand name TylenolWhat are the effects of Acetaminophen?1. Analgesic (pain reducer) 2. Antipyretic (fever reducer) 3. NOT ANTI-INFLAMMATORYWhat are the adverse effects of Acetaminophen?Hepatotoxicity and liver necrosis at high doses/overdoseWhat Analgesic drug is the drug of choice for children, patient on an anticoagulant (Coumadin) or Ulcers is ___________?AcetaminophenWhat Analgesic drug is the drug of choice for post-operative pain after periodontal treatment?AcetaminophenIbuprofen:Nonopiod, NSAID, brand name= Motrin, AdvilWhat is the mechanism of action for Ibuprofen?Is inhibition of prostaglandin synthesis (similar to aspirin)What are the effects of Ibuprofen?1. Analgesic (pain reducer) 2. Antipyretic (fever reducer) 3. Anti-inflammatoryWhat are the adverse effects?1. Interferes with clotting 2. GI irritationWhat are the contraindications for Ibuprofen?1. Patients with gastric ulcers 2. Can decrease the effect of many drugsNarcotics/Opioid drugs do what?Block pain receptors in the brainWhat are the effects of Narcotics/Opioid Drugs?1. Analgesic (pain reducer) 2. Antitussive (cough suppressant) 3. Sedation 4. Euphoria (feeling of well being)What are the adverse effects for Narcotics/Opioid drugs?1. Respiratory depression/Sedation 2. Nausea/Vomiting (emesis) 3. Constipation 4. AddictionExamples of Narcotics/Opioid Drugs?1. Morphine 2. Tylenol #3 (Acetaminophen and codeine) 3. Demerol (meperidine) and Dilaudid (hydromorphone ) 4. VicodinWhat drug is most commonly used in dentistry, in combination with acetaminophen is?CodeineNarcan (naloxone):1. Opioid antagonist that reverses the effects of opioid drugs 2. Used to treat opioid overdose (heroin) 3. Found in dental emergency kitsMethadone:1. Used in the treatment of narcotic dependence and withdraw 2. Taken once daily, it suppresses the need for narcotics for 24-36 hoursBactericidal means?Kills bacteriaBacteriostatic means?Inhibit the growth or multiplication of bacteriaMIC means:1. Minimum inhibition Concentration 2. Lowest concentration needed to inhibit visible growth of an organismResistance means:The ability of an organism to be unaffected by an antimicrobial drugSpectrum means:The range of activity of a drug (narrow or broad)Synergism means:A combination of two antibiotics produces GREATER effects that would be expected if their individual actions were addedAntagonism:when a combination of two antibiotics produce LESS effect than either agent aloneWhat is the most common antibiotic prescribed in dentistry?PenicillinWhat is the most common side effect/Allergy sign for penicillin?RASHIs penicillin Safe for Pregnant women?YesPenicillin is?Bactericidal= Destroys the bacterial cell wallWhat are some examples of Penicillin?1. Penicillin VK and Penicillin G 2. Amoxicillin, Ampicillin 3. Augmentin (Amoxicillin and Clavulanic acid)Macrolide Antibiotics are?1. Bacteriostatic drugs 2. May be used for premedication in dentistryExamples of Macrolide Antibiotics is?1. Erythromycin 2. Azithromycin (Zithromax) 3. Clarithromycin (Biaxin)Tetracycline's is?Broad Spectrum, bacteriostatic antibiotics that inhibit bacterial protein synthesisTetracycline is used in the treatment of?1. Acne and penicillin resistant periodontal infection such as NUGTetracycline shouldn't be used when? And why?1. During pregnancy or Early childhood 2. Due to tooth discolorationTetracycline shouldn't be taken with What? and Why?1. Dairy products 2. Antacids or iron 3. Because they will bind with tetracyclineTetracycline concentrates in _________________ ?Gingival crevicular fluidCephalosporin's action is?Similar to penicillin10% of patients that are allergic to penicillin are also allergic to?Keflex (cross-Allergenicity)What are some examples of Cephalosporin?1. Cephalexin (Keflex) 2. Cefaclor (ceclor) 3. Cefuroxime (Ceftin)What are some Anitbiotics that are used to treat tuberculosis?1. Rifampin 2. Isoniazid 3. Pyrazinamide 4. Ethambutol (RIPE- All four of these are used together to treat active TB)What two drugs are most likely used only for prevention of TB?1. Rifampin 2. IsoniazidClindamycin:1. First alternative for premedication if patient is allergic to amoxicillin 2. Use limited due to rare adverse reaction called Pseudomembranous colitis (600mg 1 hour prior to appointment)Metronidazole (Flagyl):1. Used to treat anaerobic infections 2. DO NOT USED ALCOHOL (antabuse effect will be nauseous)Conditions requiring premedication?1. Artificial heart valve 2. History of infective endocarditis 3. Specific congenital heart defect a) unrepair or incomplete repair of cyanotic heart disease b) Heart defect repair with prosthetic patch or device 4. Cardiac transplant with valve problems 5. Renal dialysis shunt 6. Ventriculoatrial hydrocephalic shunt (NOT STENT!)May require premedication (CONTROVERSY- consult with orthopedic surgeon or physician)?1. Joint replacement less than 2 years ago 2. Previous prosthetic joint infection 3. Multiple joint replacement 4. Immunocompromised patients (IV drug users, uncontrolled diabetes, patients with AIDS)Recommended drug regimens for premedication:1. Amoxicillin 2000mg (2g) one hour prior to the procedure IF PEN/AMOX ALLERGY USE: 1. Cephalexin (Keflex) 2000mg (2g) one hour prior to procedure 2. Clindamycin 600mg one hour prior to procedure 3. Azithromycin or Clarithromycin 500mg one hour prior to procedureWhat does Antiviral medications do?1. Treatment of herpes 2. Treatment of HIV/AIDSOral herpes medications do what?1. Inhibit the DNA synthesisWhat are some examples of Oral herpes medication?1. Acyclovir (Zovirax) 2. Penciclovir (Denavir) 3. Valacyclovir (Valtrex)What are the adverse effects HIV/AIDS medication?1. Bone marrow depression 2. Leading to anemia and thrombocytopenia (lack of blood clotting ability) 3. This results in oral effects of bleeding gingiva and oral ulcersExamples of HIV?AIDS medications?1. Zidovudine (Retrovir, AZT) 2. Didanosine (Videx, ddI) 3. Zalcitabine (ddC)What are some Antifungal Medications?1. Nystatin (mycostatin) 2. Clotrimazole (Mycelex) 3. Fluconazole (Diflucan)Nystatin (mycostatin) is a antifuncal medication for what and what is the dosage given?1. Oral Candidiasis 2. Oral dose is 5ml QID for 2 weeksWhat is the mechanism for action for local anesthetic?Block peripheral nerve conduction by decreasing the sodium ion permeability of the nerve membrane. They "inhibit the influx of sodium ions" by blocking sodium channels in the neuron membrane.The nerves are affected by local anesthetic in this order:1. Autonomic 2. Temperature 3. Pain 4. Touch/pressure 5. Vibration 6. Motor (LAST) (Function is regained in reverse order)Small, unmyelinated fibers affected ________, large myelinated fibers affected ________.1. first 2. lastLocal anesthetic medications are ______ based and work poorly in __________ tissues?1. Weak Based 2. Inflamed tissuesWhat is the best way to reduce the risk of systemic toxicity?AspirationWhat are the two major families of local anesthetic?1. Amide 2. EstersAmide Characteristics?1. Metabolized in the liver 2. Very low allergy potential 3. "I-caines"What is the most common Amide used?Lidocaine (2% lidocaine with Epinephrine 1:100,000)What are some examples of Amides?1. Lidocaine 2. Mepivicaine 3. Prilocaine 4. Bupivicaine 5. ArticaineEster Characteristics?1. Metabolized in the blood plasma 2. Relatively high allergy potential 3. Not used as injection 4. Benzocaine 20% TOPICAL 5. Novicaine (NO I)Lidocaine (Xylocaine):1. also available in topical 2. Safe in pregnancy 3. Medium duration 4. MRD: 3mg/pound, up to a maximum of 500mgMepivicaine (Carbocaine):1. Short duration 2. Comes with vasoconstrictor or as plain solutionPrilocaine (Citanest):1. Avoid prilocaine in patients with anemia and patients taking acetaminophen 2. Medium durationBupivicaine (Marcaine):1. LONGEST DURATIONArticaine (Septocaine):1. 4% solution 2. Increase risk of paresthesia, especially with mandibular block 3. Medium durationVasoconstrictors in local anesthetic solutions do what?1. Prolong and increase the depth of anesthesia 2. Delay absorption, decrease toxicity 3. Decrease hemorrhageWhat are some examples of vasoconstrictors and what is the dosages?1. Epinephrine 2. Levonordefrin 3. .2mg in a healthy patient 3. .04mg in a medically compromised patient (about 2 cartridges)Epinephrine is not contraindicated in a patient with?CONTOLLED hypertension (limited)One cartridge of the local anesthetic lidocaine drug includes how many mg's?1. 36mgOne cartridge of a vasoconstrictor includes how many mg's?1. .018mg 2. Epinephrine is an exampleNystatin (mycostatin) is a antifuncal medication for what?Treatment of oral candidiasis (oral dose is 5ml QID for 2 weeks)What drug it the most common antibiotic likely to produce an anaphylactic allergic reaction?PenicillinWhat are some Antianxiety Drugs?1. Benzodiazepines 2. Nitrous oxide/Oxygen sedationWhat are some examples of Benzodiazepines?1. Diazepam (Valium) 2. Lorazepam (Ativan) 3. Alprazolam (Xanax)What are the characteristics of a Benzodiazepine?1. Short term treatment of anxiety and insomnia 2. CNS depression and sedation 3. Anxiety reduction and sedation 4. Anticonvulsant 5. Muscle relaxant 6. NOT ANALGESIC (Used in dentistry to reduce patient anxiety) (Used in dentistry to treat TMJ disorder)What are the characteristics of Nitrous oxide/Oxygen sedation?1. Colorless, odorless gas used for conscious sedation and anxiety reduction 2. CNS is the major system affected 3. Works by raising the pain threshold 4. Not metabolized in the body 5. Overdose may cause nausea and vomitingWhat are the Contraindications for Nitrous oxide/ Oxygen sedation?1. COPD 2. Upper respiratory tract infection or stuffy nose 3. Pregnancy (especially 1st trimester)(Tarategen Birth defect) 4. Emotional or behavioral instability 5. Communication barriers 6. Abuse potentialProlonged exposure to Nitrous Oxide/ Oxygen sedation may lead to what?1. Tremors and other neurological symptoms 2. Spontaneous abortion/miscarriage 3. Numbness and tingling in the extremitiesWhat are the three Antidepressants?1. Serotonin Reuptake Inhibitors (SRI's) 2. Lithium 3. Tricyclic antidepressantWhat does Serotonin Reuptake Inhibitors (SRI's) do and what are some examples?1. Cause CNS stimulation and Xerostomia 2. Prozac (fluoxetine) 3. Zoloft (sertraline)What is Lithium (antidepressant) used to treat?1. Bipolar DisorderLithium has a drug interaction with _______________?NSAIDs________ is the most contraindication when patient is taking Lithium?MotrinWhat does Tricyclic antidepressant cause?1. Sedation and XerostomiaWhat is an examples of Tricyclic Antidepressants?1. Elavil (amitriptyline)Do Not use what with patient taking Tricyclic antidepressants?1. EpinephrineWhat are some anticonvulsant drugs?1. Dilantin (phenytoin) 2. Phenobarbital 3. Carbamazepine (tegretol)What does Dilantin (phenytoin) do and what do you see occur in 50% of patients?1. Works by depressing the CNS to decrease seizures in patients with Epilepsy 2. Gingival hyperplasia (enlargement)What does Phenobarbital used for and what does it cause?1. AKA Barbiturate used in the management of epilepsy 2. Causes SEDATIONWhat is Carbamazepine (Tegretol) use for?1. Treat partial seizures 2. May also be used in dentistry to treat trigeminal neuralgiaWhat is an Antihistamine drug?1. Diphenhydramine (Benadryl)What are the side effects of Diphenhydramine (Benadryl)1. Sedation 2. XerostomiaWhat is the most common used drug to treat mild allergic reactions?Diphenhydramine (Benadryl)Diphenhydramine (Benadryl) works by doing what?1. Blocking histamine receptors in the bodyDiphenhydramine (Benadryl) has two histamine receptor blockers in it what are they?1. H1 receptor (cause vasodilation, bronchoconstriction, pain and itching when stimulated) 2. H2 receptors (cause gastric acid secretion when stimulatedMedications to treat/manage diabetes mellitus are?1. Insulin 2. Oral hypoglycemic drugsCharacteristics of Insulin?1. Used to treat type 1 ("insulin-dependent" diabetes) 2. Administrated by subcutaneous injection 3. Hypoglycemia is the most common side effectWhat are some oral hypoglycemic drugs?1. Metformin (Glucophage) 2. Glyburide (Micronase, Diabeta)What does Metformin Do?Increases the body's sensitivity to insulinWhat does Glyburide (Micronase, Diabeta) Do?Stimulate the release of insulin from the b-cells of the pancreasDiseases treated with respiratory drugs include:1. Asthma 2. COPD 3. Upper respiratory tract infectionsWhat drug should be avoided in asthma patients?Aspirin (up to 20% of asthmatics are allergic to aspirin)What are some medications used to treat asthma?1. Ventolin (albuterol) 2. Corticosteriod 3. Combination drug: Advair Diskus (combines a corticosteroid and a bronchodilator 4. Theophylline 5. Long lasting bronchodilators (Salmeterol (Serevent)Characteristics of Ventolin (Albuterol)?1. Adrenergic drug (beta-receptor agonist) 2. Bronchodilator (opens air passages) 3. Inhaler can be used for immediate relief of bronchospasm 4. May cause insomniaWhat are some Corticosteriods and what are they used for?1. Fluticasone (Flovent) 2. Triamcinolone acetonide (Azmacort) 3. Budesonide (Pulmicort) 4. Used long term to prevent asthma attacks 5. Not used for immediate reliefTheophylline is used for what and what is the drug interaction?1. Oral medication used to treat asthma, emphysema and chronic bronchitis 2. Erythromycin can cause toxicityMedications used to treat upper respiratory tract infections?1. Nasal decongestants 2. Expectorants 3. AntitussivesWhat is a Nasal Decongestants?1. Adrenergic drug that constricts blood vessels of the nasal mucosaWhat is a Expectorants?1. Drugs that promote the removal of exudate and mucus from airwaysWhat is Antitussives?1. Cough suppressant drugs 2. May be opioids or related drugsWhat are Gastrointestinal (GI) Drugs used for?Treatment of gastric ulcers and GERD (Gastroesophageal Reflux Disease)What are some Gastrointestinal (GI) Drugs?1. Sodium Bicarbonate 2. Proton-Pump inhibitors 3. Histamine Blocking agentsSodium Bicarbonate:1. Systemic Antacid 2. May be contraindicated in cardiovascular patients due to Sodium ContentProton-Pump inhibitors:1. Inhibit gastric acid secretion 2. Used to treat gastric ulcers and GERD 3. Examples: Prilosec (Omeprazole) and Prevacid (Lansoprazole)Histamine blocking agents:1. Block H2 histamine receptors, Which reduces acid secretion 2. Examples: Tagamet (Cimetidine) and Pepcid (Famotidine)Characteristics of Bisphosphonate Drugs:1. These drugs are used to treat cancer, often administration through IV 2. Treat Osteoporosis (Fosamax oral med) 3. Associated with Osteonecrosis of the jaws 4. May result in impaired wound healing after surgery or other invasive treatment 5. The risk remains for many years after administrationEstrogen Characteristics:1. Estrogen is a steroid hormone 2. used for Contraception, Menopause therapy and Menstrual disturbancesConcerns for Estrogenuse?1. May increase (Exacerbate) gingival inflammation 2. Nausea and vomiting possible side effects 3. May promote endometrial cancer and breast cancerExamples of Estrogen:1. Premarin (conjugated estrogen) 2. Estraderm (Estradiol Transdermal)Characteristics of Prednisone:1. Is an intermediate- acting steroid (glucocorticoid) 2. Used in the treatment of autoimmune and inflammatory disorder, Addisons Disease and allergy 3. Reduces the body's inflammatory response and suppresses immunity 4. Increase the risk of infection and delays healing 5. Patients taking prednisone may be at the risk of adrenal crisis during times of stressOral Side effects of drugs?1. Gingival hyperplasia/ overgrowth 2. Gingival bleeding 3. XerostomiaWhat medications cause Gingival Hyperplasia/overgrowth?1. Dilantin (Phenytoin) Anticonvulsant to treat epilepsy 2. Procardia (Nifedipine and other CCBs) Calcium channel blockers to treat hypertension 3. Cyclosporin (used to prevent rejection in organ transplants)What medications cause Gingival Bleeding?1. Coumadin (Warfarin)- Anticoagulant 2. Plavix (Clopidogrel)- Anticoagulant 3. Aspirin- analgesic and blood thinner (Aspirin is CONTRAINDICATED in patients taking Coumadin!)What medications cause Xerostomia?1. Diuretics (water pills) to treat hypertension 2. Calcium channel blockers to treat hypertension 3. AntihistaminesWhat is the drug of choice for Angina pectoris/ Chest pain?NitroglycerinWhat does Nitroglycerin do?1. Vasodilator, opening up vessels to increase blood supply to the heart 2. Smooth muscle relaxantWhat administration is best during an acute angina episode?Sublingually administrationWhat drugs are the main family of drugs to treat CHF (Congestive heart failure)?Cardiac GlycosidesCardiac glycosides do what?Increases the force and strength of heart contraction (positive inotropic effect)What are some examples of Cardiac Glycosides?1. Digitalis 2. Lanoxin (Digoxin)With Congestive heart failure what local anesthetic should you use with caution?1. Vasoconstrictor (Epinephrine) .04 mil (2cart)Anticoagulant therapy characteristics:1. Blood thinners are used prevent stroke and heart attack, especially after initial stroke or MI 2. Therapy attempts to reduce "intravascular clotting) 3. Patients taking these drugs are at increased risk of gingival hemorrhageExamples of Anticoagulant therapy drugs:1. Coumadin (Warfarin) 2. Plavix 3. Aspirin 4. Heparin- Administered to hospitalized patients, administered through injectionCoumadin (Warfarin) does what?1. Prevents the formation of the active form of Vitamin K 2. Aspirin increases the bleeding of patients taking Coumadin 3. Antibiotics may increase the effects of CoumadinHigh Cholesterol Drugs are used for?1. Limit the synthesis of cholesterol in the body 2. Decrease Triglyceride levels as wellDrugs used to control high cholesterol are known as?AntihyperlipidemicsExamples of High Cholesterol Drugs?1. Lipitor (Atrovastatin) 2. Mevacor (Lovastatin) 3. Zocor (Simvastatin) 4. Crestor (Rosuvastatin)Examples of Hypertension medications?1. Diuretics 2. Beta Adrenergic blocking agents 3. Calcium channel blockers 4. ACE InhibitorsDiuretics:1. AKA Water pills 2. Promote the excretion of sodium and water from the body 3. Thiazide diuretics include hydrochlorothiazide 4. Side effects of diuretics include Xerostomia and orthostatic hypotensionBeta-adrenergic blockers:1. Olol medications 2. Reduce blood pressure by decreasing cardiac output 3. Indernal (Propranolol) non-selective beta blocker 4. Tenormin (atenolol) selective beta blocker 5. Lopressor (metoprolol) selective beta blocker 6. Avoid epinephrine with non-selective beta blockersCalcium Channel Blockers:1. Reduce blood pressure by causing systemic vasodilation 2. Gingival enlargement and xerostomia 3. Nifedipine (Procardia, Adalat) 4. Verapamil (Calan, Isoptin) 5. Amlodipine (Norvasc) 6. Diliazem (Cardizem)ACE Inhibitors:1. -Pril medications 2. Block production of antiotensin II resulting in vasodilation 3. Adverse reaction includes altered taste (Dysgeusia) and othostatic hypotension 4. Enalapril (vasotec) 5. Lisinopril (Zestril, Prinivil)Cocaine:1. Is an CNS stimulant 2. Causes vasoconstriction and dilation of pupils 3. Crack-cocaine abusers often present to the office with active dental decayHeroin:1. Is an opioid drug causing CNS and respiratory depression 2. Cause sedation and "pinpoint" pupilsMethamphetamine:1. "meth" is a CNS stimulant 2. Associated with brain damage and severe oral effects 3. Males aged 19-40 most commonly affected group 4. Abusers present rampant caries, xerostomia, and soda consumptionAbbreviation BID stands for?Twice a dayAbbreviation TID stands for?Three times a dayAbbreviation QID stands for?Four times a dayAbbreviation AC stands for?Before mealsAbbreviation PC stands for?After mealsAbbreviation GT stands for?dropAbbreviation HS stands for?at bedtimeAbbreviation PO stands for?by mouthAbbreviation PRN stands for?as needed or if requiredAbbreviation Q3H stands for?Every three hoursAbbreviation QD stands for?everydayAbbreviation SIG stands for?Label, or instructions for useAbbreviation STAT stands for?immediatelyAbbreviation TAB stands for?tabletAbbreviation UD stands for?as directedEmergency drugs include?1. Epinephrine- Anaphylaxis/ severe allergic reactions 2. Diphenhydromine (Benadryl) mild moderate allergic reactions 3. Hydrocortisone Adrenal crisis 4. Albuterol (Ventolin) asthma and respiratory distress 5. Nitroglycerin (Nitrostat) chest pain 6. Oral Carbohydrates/glucose Diabetics complications/ hypoglycemia 7. Diazapam (Valium) Management of seizure 8. Ammonia inhalant syncope/ respiratory depression 9. Naloxone (Narcan) Opioid overdose 10. Oxygen EXCEPT hyperventilation and COPDWhen writing a prescription "PO" is an abbreviation for?By mouthNArcan (Naloxone):Combines with endorphin receptors in the CNS, reversing the effects of opioid drugsPenicillin's mechanism of actions is:Destroys the bacteria cell wallA drug duration is?The length of time that a drug has an effectDuring an emergency, which route of drug administration will result in the fastest onset of a drug action?Intravenous Dose (IV)Each of the following drugs may result in an increased amount of bleeding during scaling and root planing except one. Which one is the EXCEPTION? A. Aspirin B. Warfarin C. Acetaminophen D. HeparinC. AcetaminophenThe maximum amount of epinephrine that may be administered to a patient with cardiovascular disease is?0.04mgWhat organ plays the greatest role in absorption of orally-administered medications?Small intestinesWhat adverse reaction is commonly associated with opioid analgesics?SedationWhat medications is NOT associated with gingival hyperplasia as an adverse effect?Tenormin (Atenolol)Electromagnetic Family:1. The shorter the groups wavelength the stronger the energy 2. KEY: x-rays produce ionization others do notIonization:1. The ejection of an electron from an atom 2. Produce charged ion pairs or free radicalsAC Electricity:1. Movement of electrons (-) along a wire toward a (+) charge which changes direction 60 times per secondConversion to Impulses:1 seconds = 60 impulses of x-rays 1/4 second = 15 impulses of x-raysAmperes:AMPS (mA) describe the number of electrons flowingVoltage:Volts (kVp) the speed or force of the moving electrons toward the (+) chargeQuantity of the beam:Number of X-raysQuality of the beam:Penetrating nature/powerAluminum Filtration:1. Number of photons decrease 2. Removes softer dangerous photons 3. Increase % of hard/soft 4. Safer beam 5. Decrease density 6. Long scale (many grays) 7. Low visual contrast 8. Quantity and QualityMilliamps (mA):1. Number of photons increase 2. Increase density 3. QuantityExposure Times:1. Number of photons increase 2. Increase density 3. QuantityKilovolt Peak (kVp):1. Number of photons increase 2. Increase penetration 3. (Quantity and Quality) 4. Long scale (many grays) 5. Low visual contrastDistance:1. Number of photons decrease as beam spreads 2. Decrease density 3. QuantityWhat two things affect Penetration (Quality)1. kVp 2. FiltrationDensity means what and is affected by what?1. Blackness 2. mA, Exposure time, kVp, Filtration decreases, and distance decrease 3. More photons = more densityA Short scale of contrast means?Mostly blacks and whites (high visual contrast) results from less kVp and AluminumA Long scale of contrast means?Many shades of gray (low visual contrast) Results from more kVp and AluminumPenumbra means?Area of unsharpnessWhat produces the sharpest image with the least magnifications:1. Small focal spot 2. Short object-to-film distance (OFD) 3. Large target-to-film distance (TFD) or (SFD) 4. Film and tooth parallel 5. Beam perpendicular to filmSLOB RULE:1. Same Lingual 2. Opposite Buccal 3. Lingual objects move in same direction as the tube head 4. Buccal objects move in the opposite direction as the tube headIf distance is doubled or halved the original energy changes by a factor of?4Film emulsionSilver halide (Bromide) crystals on both sides of filmDeveloper:(Elon and Hydroquinone) turns only exposed crystals to metallic silverFixer:(Sodium Thiosulfate) removes undeveloped (including unexposed) crystalsDiscolored film:Exhausted fixer or poor replenishment, after tome, problem is poor washDigital Radiography:1. Direct (CCD) vs indirect (PSP Photo-Stimulant-Phosphor) 2. Digital requires less radiation 3. Film has higher resolution than digitalMost common mechanism of damage (radiation) in humans:Hydrolysis, free radicals of waterBiological sensitivity to radiation:1. Rapid turnover or mitosis rate of cells increase tissue damage 2. Undifferentiated cells have increased damageChildren are more sensitive to radiation due to:Rapid cell mitosis associated with child's growthLatent period:Time between x-ray exposure and maximum damage observedHigh Radiation sensitivity includes:1. Reproductive tissues 2. Lymphoid tissue 3. Bone marrow (Hematopoetic) 4. Intestines 5. Mucous membraneMedium Radiation Sensitivity includes:1. Growing cartilage 2. Growing bone 3. Salivary glands 4. Fine blood vessels 5. Lungs 6. Kidneys 7. LiverLow radiation sensitivity includes:1. Nerve tissue 2. Skeletal muscles 3. Heart 4. Optic lens 5. Mature bone 6. Mature cartilageCumulative effect:1. Adverse reactions of the body to x-radiation never return exactly to original state therefore accumulating to some degree over lifetimeGonadal exposure for the average complete mouth series equals to:3 days to one week of normal background whole body radiationFrequency of films:Ordered on an individual basis after a historical and clinical examination of the patientALARA Principle:As Low As Reasonably AchievableFilm Speed:Most effective method of protectionIntensifying screens:Reduce the amount of radiationCollimation:Reduces scatter, No larger than 2.75 inchesRectangular collimator:reduces the area of patients skin surface exposed by 50% to 65% over roundAluminum Filtration?Must have at least 1.5mm of total aluminum filtration for up to and including 70 kVp. Requires 2.5mm above 70 kVpLong vs Short cone:Less volume of tissue is irradiated if long cone is usedBarriers:Wall is mandatory if operator cannot stand at least 6 feet from the scatter source. Walls do not necessarily require lead liningLead Apron:Absorbs 90% of the scatter that would have reached the reproductive tissues. Lead equivalent of 0.25mmIf an Opaque artifact obscures the visualization of the anterior teeth, what is the most likely causative positioning error?The patients spine was angled forwardWhen attempting to localize a foreign object relative to the dental structures:the lingual object moves the same direction (mesial or distal) as the tubeheadThe opaque structure surrounding a tooth root is?The lamina DuraThe radiographic location of the zygomatic arch relative to the other dental structures may be influenced by the beam angulation. (t or f)TrueThe maximum amount of radiation an occupationally exposed person may receive in one week is:1 mSvComposite restorations may appear:Radiopaque and radiolucent both possibleThe radiographic mode which is most accurately and sharply depicts the height of the crest of the alveolar bone is:A bitewing radiographThe coronoid process is most likely to be seen in what intraoral radiographic projection:The maxillary molar periapicalA patient's earring may appear:On the contralateral posterior side of the imageIn a panoramic radiographic image, the hyoid bone may be superimposed:May be projected on either (upon the mandibular bone or below the mandibular bone)General Considerations for Cardiovascular Disease:1. History and severity of the disease 2. Evaluate functional status/extent of limitations 3. If surgery: Date/type 4. Review medications- may be taking anti-platelet (aspirin) or anti-coagulant (warfarin/Coumadin) 5. MD consult may be neededAppointment modifications for Cardiovascular Disease:1. Stress reduction 2. Frequent maintenance appointments 3. Chair position- may not tolerate supine position 4. May need to limit epinephrine** (0.04mg (2 carps 1:100,000 solution)) (Careful with retraction cord) 5. Xerostomia- related medications 6. If condition is uncontrolled, postpone treatment- refer to MD if undiagnosed chest painHypertension (High blood pressure) is also known as?The silent killerNormal BP Range is:Systolic- <120 Diastolic- <80Prehypertension BP range is:Systolic- 120-139 Diastolic- 80-89Stage 1 hypertension range is:Systolic- 140-159 Diastolic- 90-99Stage 2 hypertension range is:Systolic- >160 Diastolic- >100Patients with hypertension has a higher potential for what conditions:1. Stroke 2. MI 3. Renal failurePrimary (essential) hypertension:No identifiable cause, develops over yearsSecondary hypertension:caused by an underlying condition (pregnancy, kidney failure, medications, illegal drugs, etc)Common antihypertensive's and major side-effects:1. Angiotensin converting enzyme (ACE) inhibitors (-prils)- postural hypotension, dry cough 2. Beta Blockers (-olols)- if non-selective, use vasoconstrictors with caution (Epi precaution) 3. Calcium channel blockers- Gingival hyperplasia, xerostomia 4. Diuretics (-thiazides)- postural hypotension, xerostomiaAppointment modification for Hypertension patients?1. Monitor vital signs 2. Stress reduction (nitrous oxide recommended) 3. Xerostomia (medication- related) protocol 4. Limit epinephrine 5. Risk of postural hypotension- slowly raise chair 6. Do NOT use air polisher if power has sodium 7. Do NOT treat if uncontrolled (BP: >180/110, defer elective treatment >210/120, refer for immediate medical evaluationWhat is Myocardial Infarction (MI, Heart attack) and what are the symptoms of acute MI:1. Necrosis of heart muscles from prolonged ischemia (lack of O2 due to decrease flood flow) 2. Pain, nausea, diaphoresis (sweating), dyspnea (shortness of breath), weaknessAppointment modification for MI:1. wait 6 months for elective treatment 2. Stress reduction 3. Monitor vital signs 4. May need oxygen 5. May want to use nitrous (for the stress reduction and supplemental O2) 6. Limit EpiWhat is Angina Pectoris and some characteristics:1. Chest pain from lack of O2 (ischemia) 2. Crushing, pressure, or squeezing 3. Mat radiate to arm, shoulder, neck, and mandible 4. May last 5-15minsAppointment modification for Angina Pectoris:1. Stress reduction 2. Limit Epi 3. Possible nitroglycerin premedication (relaxes blood vessels, increase blood and O2 to heart while reducing cardiac workload)If angina attack during appointment you should administer:1. Sublingual nitroglycerin tablets 2. One tablet ever 5 mins, max 3 tablets in 15 mins 3. Give only if systolic BP is > 100 4. If pain continues activate EMSCerebrovascular Accident (CVA):(STOKE) 1. Supply of O2 to the brain is disrupted (ischemia) 2. Transient ischemic attack (TIA)- mini stroke 3. Risks: Hypertension, Cardiovascular disease, diabetes 4. May be taking warfarin (Coumadin)Appointment modification for Cerebrovascular Accident?1. No elective treatment got 6 months 2. Stress reduction 3. Limit Epi 4. Avoid sensory overload 5. Chair position modifications and assistance for patient transfer 6. Modify home care devices (depends on functional ability)Cardiac Arrythmias:1. Electrical impulses that coordinate heartbeat do not work properly 2. SA node= pace maker, AV node= pace setter 3. fluttering in chest, Tachycardia (fast beat) or Bradycardia (sloe beat)Appointment modifications for Cardiac Arrythmias:1. Stress reduction 2. No Epi 3. Do NOT treat if uncontrolledCongenital Heart Disease:1. Malformations of heart present at birth 2. May have cyanosis (bluish discoloration) and Pulmonary edemaAppointment modifications for Congenital Heart Disease:1. May need antibiotic premed 2. Do NOT use nitrous- possible pulmonary congestionCongenital Heart Failure:1. Heart cannot pump enough blood to meet the body's needs 2. Pulmonary congestion 3. Peripheral edema (swelling) because of inadequate venous return from decrease cardiac output 4. Epi precaution 5. If taking cardiac glycosides (digoxin/Lanoxin) = increase gag reflex and limit epiAppointment modifications for Congenital heart failure:1. Treat sitting up or semi-recline (pulmonary edema) 2. Do NOT use air polisher or ultrasonic scaler 3. Do NOT treat if uncontrolledCoronary Bypass Surgery (Coronary artery bypass graft, CABG):1. Healthy blood vessels from leg, arm, or chest are grafted to the coronary arteries to bypass blood around diseased or blocked coronary vessels 2. How long since surgery/ how are they feelingAppointment modifications for Coronary Bypass Surgery (Coronary artery bypass graft, CABG):1. Wait 6 weeks for elective treatment 2. No antibiotic premedication neededValve replacement:1. Mechanical or tissue replacement of heart valve 2. If mechanical valve, patient will be talking Warfarin (Coumadin)Appointment modifications for Valve replacement:Antibiotic Premedication!!!!!Respiratory appointment modifications:1. Do NOT use air polisher as it can impair breathing 2. Do NOT use nitrous (the exception is asthma)What are some Respiratory disorders:1. Asthma 2. Chronic Obstruction Pulmonary Disease (COPD) 3. Cystic Fibrosis 4. Tuberculosis (TB)Asthma:1. Airway narrow, swell and produce extra mucous 2. May have difficulty breathing and hyperventilation 3. Signs: /unproductive cough, dyspnea, anxiety, wheezing, cyanosisCommon medications for asthma:1. Albuterol (Ventolin)- Short acting bronchodilator 2. Salmeterol (Serevent)- long acting bronchodilator 3. Fluticasone (Flovent)- Corticosteroid, used long term 4. Advair- long acting bronchodilator + corticosteroid (Steriod inhalers cause increase risk for caries and Candida- rinse with water after inhaler use)Appointment modifications for Asthma:1. Bring "rescue" inhaler (Albuterol) 2. Do NOT use aspirin (can precipitate attacks) 3. Do NOT use air polisher or ultrasonic scaler (impairs breathing) 4. Do NOT give anesthesia with epinephrine or Levonordefrin (Bisulfides can precipitate attacks) 5. Nitrous oxide is recommendedChronic Obstruction Pulmonary Disease (COPD):Group of lung diseases that block airflow and make breathing difficultWhat are the two types of Chronic Obstruction Pulmonary Disease (COPD):1. Emphysema (Pink puffers) 2. Chronic Bronchitis (Blue bloaters)Emphysema (Pink Puffers):1. Over inflation of alveoli/air sacs which impairs airflow out of the lungs 2. Increase respiratory rate (puffers) but good oxygenation (Pink) 3. Dry coughChronic Bronchitis (Blue Bloater):1. Inflammation of lining of bronchial tubes which narrows airways 2. Heavy mucous/phlegm 3. Wet cough 4. Cyanosis (Blue) and increased lung volume (Bloaters)Appointment modifications for Chronic Obstruction Pulmonary Disease (COPD):1. Treat patient sitting up 2. May need O2 3. Do NOT use: nitrous, air polish, ultrasonic scaler, rubber dam 4. Increase risk oral cancer if long-term smoking historyCystic Fibrosis:1. Inherited disorder of exocrine glands (Glands that go to surface- tears, seat, saliva, digestive juices) 2. Secretions become thick and stickyAppointment modifications for cystic fibrosis:1. Chair semi-upright to facilitate breathing 2. Do NOT use: nitrous, air polisher, ultrasonic scaler, rubber damTuberculosis (TB):1. Bacteria (mycobacteria) spread through airborne transmission (cough, sneeze, spit)What are Tuberculosis (TB) skin tests:1. PPD (Purified Protein Derivative) 2. Mantoux Skin Test 3. TB skin test 4. Tuberculin Skin Test (All same test different term)What does PPD (Purified Protein Derivative), Mantoux Skin test, TB skin test and Tuberculin skin test do?1. Measure of exposure to TB 2. Type Iv hypersensitivity reaction- delayed, read 48-72 hours after PPD administeredIf a PPD (Purified Protein Derivative), Mantoux Skin test, TB skin test and Tuberculin skin test is positive that means?1. There has been exposure to TB- Does NOT mean active infection (Chest X-ray/Sputum for active TB) 2. Anti-TB drugs (Isoniazid)Appointment modifications for TB:1. Do NOT treat if active disease 2. TB drugs may lead to hepatotoxicity- avoid drugs metabolized in liver (acetaminophen!)Hematopoietic Diseases:1. HIV/AIDS (Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome) 2. Leukemia 3. Sickle Cell AnemiaHIV/AIDS (Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome):1. Infectious disease from human Immunodeficiency Virus 2. Reduced CD4 helper T-Lymphocyte count and functionOral Manifestation of HIV:1. Angular cheilitis (Candida Albicans) 2. Aphthous-like ulcers 3. Candidiasis 4. Increased caries 5. Kaposi's Sarcoma 6. Linear gingival erythema 7. Lymphoma 8. Necrotizing ulcerative gingivitis (NUG) 9. Necrotizing ulcerative periodontitis (NUP) 10. Oral hairy leukoplakia (Epstein Barr virus) 11. Papilloma Lesions 12. Persistent lymphadenopathy 13. Recurrent herpetic infections 14. XerostomiaAppointment modifications for HIV/AIDS (Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome):1. Respect, kindness, and compassion 2. Standard precautions (treat everyone the same) 3. Avoid creation of aerosols ONLY for patient protection 4. Treat infections as needed 5. MD consult (CD4 count, viral load) 6. Shorten recall intervals (3-months)Leukemia:1. Cancer of white blood cells 2. May cause aplastic anemia (No cells) (crowds out other blood elements- RBC, WBC, Platelets) 3. Possible gingival enlargement from leukemic infiltrates (boggy, edematous)Appointment modifications of Leukemia:1. MD consult- platelet count (>50,000 for surgical procedure)Sickle cell Anemia:1. Hereditary blood disorder 2. Hemoglobin defect that causes red blood cells to become sickle-shaped (crescent moons) and can occlude small vesselsSickle cell trait:1. Carry one of the autosomal recessive genes 2. No symptomsSickle cell disease:1. Carry both of the autosomal recessive genes (both parents have to carry the trait for you to have the disease)Appointment modification for Sickle cell Anemia:1. Possible antibiotic premedication to prevent infection 2. Stress reduction protocolGastrointestinal/Kidney/Liver Disorders:1. Crohn's Disease 2. Chronic Renal Failure 3. HepatitisCrohn's Disease:1. Autoimmune form of inflammation bowel disease 2. Chronic inflammatory disorder of the large/small intestine 3. Abdominal cramping, fever, fatigue, loss of appetite, diarrhea, weight loss 4. May involve any part of GI from MOUTH to ANUS 5. Aphthous-like ulcersChronic Renal Failure:Failure of the kidney to preform essential functionsAppointment modifications for Chronic Renal Failure:1. MD consultant- possible premedication if AV fistula/shunt or kidney transplant 2. Avoid blood pressure cuff in arm with shunt 3. If on dialysis: Increase risk of hepatitis B/C, HIV 4. Best time for appointment: DAY AFTER DIALYSISHepatitis:1. Inflammation of the liver 2. Abnormal bleeding, jaundiceWhat are the two types of hepatitis that are through Fecal/Oral (poor hygiene) and is there a vaccine?1. Hep A (Yes) 2. Hep E (No)What are the three types of Hepatitis that is through Blood/Body fluid (IV drugs, Sex, Needle sticks, Perinatal) and do they have vaccines?1. Hep B (Yes) 2. Hep C (No) 3. Hep D (Hep B vaccine)What Hepatitis can you get only if you have Hepatitis B?1. Hep DAnti-HBsAg=Immune (took vaccine or previous infection)Endocrine Disorders include:1. Addison's Disease (Primary adrenal insufficiency) 2. Cushing's Syndrome (Hypercortisolism) 3. Diabetes Mellitus 4. Thyroid DiseaseAddison's Disease (Primary adrenal insufficiency):1. Adrenal cortical insufficiency- too little steroid production 2. Diffuse pigmentation (Bronzing or Tinting) of the skin or mucosaAppointment modifications of Addison's Disease (Primary adrenal insufficiency):Extra steroids for stressful situations (dental appointments)- MD consultCushing's Syndrome (Hypercortisolism):1. Usually from prescribed corticosteroid therapy 2. Is caused from excess pituitary gland adrenocorticotropic hormone (ACTH) production 3. "Moon facies"- fat accumulation in the face 4. "Buffalo hump"- fat accumulation in the upper backAppointment modifications for Cushing's Syndrome (Hypercortisolism):1. Stress Reduction protocol 2. Extra steroids for stressful situations (dental appt) MD consultDiabetes Mellitus:1. Inadequate production of insulin by pancreas or body cells do not respond to insulin 2. Oral findings: periodontal disease, caries, Candidiasis, poor healing, oral burning 3. Two types: Type 1 and Type 2Type 1 Diabetes Mellitus:1. Insulin Dependent 2. Previously called juvenile diabetes 3. Usually diagnosed in children/young adultsType 2 Diabetes Mellitus:1. >90% of cases 2. Tends to occur later in life 3. Associated with being overweight 4. Oral hypoglycemic to control- Glucophage (Metaformin) and Glyburide (DiaBeta)Hypoglycemia (Insulin shock):1. Most common adverse event 2. Caused by taking too much medication, failing to eat, heavy exercise or emotional factors 3. Symptoms occur suddenly 4. Confusion, anxiety, headache, tachycardia, moist clammy skin, sweating, shakiness, visual problems 5. Administer sugar (Glucose), revival is promptHyperglycemia (Diabetic coma):1. Too little insulin 2. Caused by too much sugar, not taking medications, stress, or infection 3. Symptoms occur more slowly 4. Drowsiness, confusion, deep rapid breathing, polydipsia (increased thirst), polyuria (Increased urination), polyphagia (Increased hunger) dehydration, fever, dry flushed skin, sweet/fruity odor to breath 5. Activate EMS, give fluids, keep warmAppointment modifications for Diabetes:1. Stress reduction 2. Avoid tissue laceration (poor healing) 3. Nutritional counseling and/or referral to dietitian 4. Home fluoride 5. Xerostomia protocolWhat is goiter?1. Enlargement of the thyroid gland 2. Should be referred to MD 3. May be from Graves disease or lack of iodineWhat are the two thyroid diseases?1. Hyperthyroidism 2. HypothyroidismHyperthyroidism:1. Graves disease: Autoimmune disorder 2. Goiter, tachycardia, nervousness, heat intolerant (profuse sweating, moist skin), Exophthalmos (Proptosis) bug eyed,Hypothyroidism:1. Hypotension, bradycardia, dry skin, cold intolerance, obesity, delayed tooth eruption. 2. Cretinism: early onset (children); mental/physical retardation, macroglossia, delayed tooth eruption. 3. Myxedema: Adult onset, long-term undiagnosed hypothyroidismWhat is the medication to treat hypothyroidism?Synthroid (levothyroxine): synthetic thyroid hormone replacement therapyAppointment modifications for Thyroid disease?1. Hyperthyroidism: NO EPINEPHRINEWhat are some Musculoskeletal disorder?1. Cerebral Palsy 2. Muscular Dystrophy 3. Scoliosis 4. Spinal Cord InjuryCerebral Palsy:1. Usually from lack of O2 during birth 2. NOT a disease and NOT contagious 3. Involuntary movements and muscle spasms 4. Inability to swallow (drooling), tongue thrusting, mouth breathing, bruxism, increased gag relexAppointment modifications for Cerebral Palsy:1. Avoid injury by utilizing fulcrumMuscular Dystrophy:1. Progressive, chronic disease causing muscle atrophy (degeneration of tissue) 2. Onset usually 20-40 3. Mouth breathingAppointment modifications for Muscular Dystrophy?1. Protect airway 2. Powered oral hygiene devicesScoliosis:1. Idiopathic, congenital, genetic, or neuromuscular-related 2. Spine is curved: C or S shapedSpinal Injury C-4 Functional level is?Needs ventilation (Need help)Spinal injury C-5 functional level is?Minimal functioning, partial shoulder/biceps (Need help)Spinal injury C-6 Functional level is?Sit, eat with devices, shoulder/biceps/partial wristSpinal injury C-7 functional level is?Personal self-care wit devices, shoulder/biceps/wrist/partial handSpinal injury C8-T1 functional level is?Personal self-care, wheel chair transferAppointment modifications for Spinal injury?1. Short, morning appointments 2. Ask patient if they can transfer by themselvesWhat are some Neurologic disorders?1. Alzheimer's Disease 2. Attention Deficit Disorder (ADD/ADHD) 3. Autism 4. Bell's Palsy 5. Depression 6. Down syndrome 7. Epilepsy/Seizure Disorder 8. Mentally challenged 9. Multiple Sclerosis 10. Parkinson's Disease 11. Schizophrenia 12. Sensory ImpairmentAlzheimer's Disease:1. Progressive irreversible brain disorder, characterized by behavioral change, cognitive disturbances and confusion 2. Brain composition changes: Amyloid plaques, neurofibrillary tangles, loss of cortical neuronsAttention Deficit Disorder (ADD/ADHD):1. Developmental and behavioral disorder 2. Short attention span 3. Often with hyperactivity, inattentive, talkative 4. Deficient in short term memory 5. Common medications: Ritalin and AdderallAppointment modifications for ADD/ADHD:1. Mid morning appointments (after eating, and medications) 2. Tell, show, doAutism:1. Developmental CNS disability that affects brain function 2. Avoid eye contact 3. Self-abusive behavior with intraoral trauma 4. Possible increase caries due to rewards (candy) for behavior modificationAppointment modifications for Autism:1. Short, frequent appointments in a calm environment 2. Positive reinforcement 3. No eye contactBell's Palsy:1. Unilateral facial paralysis (7th cranial nerve) 2. Etiology: Viral, pregnancy, idiopathic 3. Face "droops" smile is one sided, eyes resist closing, drooling 4. Usually temporaryAppointment modifications for Bell's Palsy:1. Protect eye 2. Emphasize home care on affected sideDepression:1. Medical illness that causes persistent sadness, loss of interest and physical symptoms 2. Insomnia, decrease ability to make decisions, various pain response 3. Xerostomia from mediccations 4. Compliance problems- little interest in oral healthAppointment modifications for depression:1. Use positive reinforcement and compassion 2. Avoid guilt techniques 3. Encourage a regular exercise program 4. If taking tricyclic antidepressants, avoid vasoconstrictorsDown Syndrome (Trisomy 21):1. Chromosomal abnormality 2. Fissured tongue, Macroglossia, Mouth breathing, hypodontia 3. Periodontal disease, decrease cariesAppointment modifications for down syndrome (trisomy 21):1. May need antibiotic premedication for heart defects 2. Tell, show , doEpilepsy/Seizure disorder:1. At least 2 unprovoked seizures required for an epilepsy diagnosis 2. Can be categorized by the type of seizure activity a) Petit mal: Mild b) Grand mal: Severe c) Status Epilipticus: continuous convulsion lasting >5minsAppointment modifications for Epilepsy/Seizure disorder:1. May have aura prior to seizure (a sensation) 2. Do NOT sit up during seizure 3. Do NOT place tongue blade between teeth 4. Anticonvulsant phenytoin (Dilantin) can induce gingival hyperplasiaMentally Challenged:1. Periodontal disease and caries, especially if institutionalized 2. Bruxing, mouth breathing, tongue thrustingAppointment modifications for mentally challenged1. Tell, Show, Do 2. Involve caregiverMultiple Sclerosis:1. Chronic degenerative autoimmune disease of CNS, myelin sheaths attacked 2. Young adult women (20-40 years old) 3. Heat sensitive: Exacerbates symptoms 4. Fatigue, leg stiffness, tremor, slurring speech 5. Difficulty swallowingParkinson's Disease:1. Chronic, Progressive disease of neurons that produce dopamine 2. Causes slow movement, tremors, rigid muscles 3. Shuffling, slow gait (bradykinesia), slurred speech, postural instability, dementia, stiffness and rigidity of joints 4. Blank, expressionless face, staring, unblinking eyes, excessive salivation/droolingAppointment modifications for Parkinson's Disease:1. Appointment 2-3 hours after taking medicationsSchizophrenia:1. Mental Disorder 2. Disordered thinking, inappropriate emotional responses, hallucinations, delusions, bizarre behaviorWhat are the two Sensory impairment disorders?1. Visual Impairment: Assess degree of impairment and dependency on caregiver 2. Hearing Impairment: Assess degree of impairmentAppointment modifications for sensory impairment?1. Do NOT wear mask when talking 2. Face the patient when talking 3. Speak in a normal tone of voice (do NOT shout)Skin, Joints and Connective tissue disorders:1. Epidermolysis Bullosa 2. Arthritis 3. Marfan Syndrome 4. Scleroderma (Systemic Sclerosis)Epidermolysis Bullosa:1. Hereditary blistering disorder 2. Slight rubbing or irritation causes large bullaeAppointment modifications for Epidermolysis Bullosa:Use pillows and/or blankets in dental chair for cushionArthritis:1. Joint inflammation that causes pain, stiffness, limited mobility 2. Osteoarthritis: progressive cartilage degeneration and loss of cushioning 3. Rheumatoid arthritis: Chronic autoimmune condition: Rheumatoid nodulesOsteoarthritis:progressive cartilage degeneration and loss of cushioningRheumatoid arthritis:Chronic autoimmune condition: Rheumatoid nodulesAppointment modifications for Arthritis:1. Mid-morning appointments 2. Short appointments, especially if TMJ issues 3. Position chair for comfort 4. Hygiene aids (electric toothbrush)Marfan Syndrome:1. Hereditary condition of connective tissue, joints and skeletal tissues 2. Tall, joint laxity, arachnodactyly (long and slender fingers) 3. May have congenital heart defectAppointment modifications for Marfan Syndrome:Antibiotic premedication if heart defectsScleroderma (Systemic sclerosis):1. Autoimmune disorder causing overproduction of collagen 2. Porcelain doll appearance 3. Raynaud's Phenomenon: Episodic vasoconstriction of digits, white discoloration, related to cold 4. Oral finding: Widening of PDL space all teethAlcohol Addiction:1. Compulsive and uncontrolled consumption of alcoholic beverages 2. Pancreatitis 3. May have poor nutrition 4. Severe liver damage could lead to increase bleeding (oral petechiae)Appointment modifications for Alcohol Addictions:1. Do NOT use narcotics, sedatives, nitrous, or alcohol-containing medications 2. Avoid drugs metabolized in liver- Acetaminophen!Fetal Alcohol Syndrome (FAS):1. Defects in a fetus from high levels alcohol consumption during pregnancy 2. Physical deformities, mentally challenged, learning disorders, vision difficulties, behavioral problems 3, Oral findings: U-shaped or cleft palate, gingivitis, abnormal tooth eruption, tooth malformationAppointment modifications for Fetal Alcohol Syndrome:Tell, Show, DoHeroin Addictions:1. Opioid 2. Snorted, smoked, injected 3. Symptoms; drowsiness, decrease respiratory rate, bradycardia, hypothermia 4. Pinpoint pupils 5. Methadone used to treat withdrawal and dependenceAppointment modifications for Heroin Addictions:1. Narcan (opioid antagonist, reverse effects) to treat overdose (should be in your emergency kit) 2. Do NOT give opioid analgesics 3. Increase risk infective endocarditis, HIV, viral hepatitis if injection drug useCocaine (Blow, coke, crack, rock):1. Stimulant, anesthetic and vasoconstrictor 2. Dilated pupils 3. Oral findings: xerostomia, caries, brusxismAppointment modifications for Cocaine:Delay treatment for 24 hours after use Avoid Epinephrine for at least 24 hours after useMethamphetamine (Crystal meth, meth, glass, ice, poor mans cocaine):1. CNS stimulant 2. Parkinsonian featuresAppointment modifications for Methamphetamine (Crystal meth, meth, glass, ice, poor mans cocaine):1. Delay treatment for 24 hours after use 2. Possible unsafe interactions with EpinephrineTobacco Smoking:1. Smoking is the #1 cause of preventable disease/death 2. Increase risk periodontal disease (decrease vascularity)What are the 5 "A's" the hygienist should provide for Tobacco smokers?1. Ask: Do you smoke? 2. Advise: Importance of quitting 3. Assess: Level of readiness to quit 4. Assist: Let me know when you are ready 5. Arrange: Set quit date for one week from now; arrange for follow-upWhat are some RX quit aids for tobacco users?1. Buproprion (Zyban)- antidepressant (xerostomia, use epinephrine with caution) 2. Chantix- nicotine agonist (xerostomia)The Geriatric patient:1. May see conditions that mimic dementia, such as depression, hearing loss, malnutrition, dehydration 2. Oral finding: Xerostomia from medications, Increase risk oral cancer, caries, periodontal disease, attrition, abrasion, enamel discoloration, cracked teethAppointment modifications for Geriatric patients:Special care for fragility of skin and bonesPregnancy:1. Hormonal changes, nausea, fetal sensitivity to drugs 2. Oral findings: Pregnancy gingivitis, pyogentic granuloma (pregnancy tumor)Appointment modifications for pregnancy:1. Nutritional counseling 2. Provide elective care in 2nd trimester 3. Position on left side with pillow to elevate right hip 4. Do NOT give fluoride supplement (fluoride rinses OK) 5. No not use nitrousEpinephrine for cardiac patients:1. 0.04mg 2. 2 cartridges of anesthetic with Epi 1:100,000Do Not use Epinephrine with what conditions:1. Asthma 2. Hyperthyroidism 3. Cocaine/Methamphetamine useEpinephrine Drug interactions:1. Cardiac Glycosides (Digoxin/Lanoxin) 2. Non-selective beta blockers (Antihypertensive) 3. Tricyclic antidepressant 4. Buproprion (Zyban) Smoking aidDuring dental prophylaxis a patient experiences (1) a sudden loss of breath, (2) labored breathing (3) cold, clammy skin and (4) pain radiating to the left shoulder and arm. What is most likely occurred?1. Coronary OcclusionAntibiotic prophylaxis is recommended for each of the following conditions EXCEPT one. Which one it the EXCEPTIOM? A) Heart Valve Prosthesis B) Congenital cardiac malformations C) Previous coronary artery bypass graft D) Cardiac transplant with valvular dysfunctionC. Previous coronary artery bypass graftIn the emergency treatment of angina pectoris, the mechanism of action of nitroglycerin is:Relaxation of vascular smooth musclesWhat represents the serum marker for HIV infections?HIV antibodyThe etiology of Myxedema is?1. Hyposecretion of the thyroid glandASA I Classifications:A normal, healthy patient, no apparent diseases is evident, requires no dental management modificationsASA II Classifications:1. Patient with mild systemic diseases, may or may not need dental management modifications 2. Examples of conditions: Wellcontrolled NIDDM, Asthma, Epilepsy, Stage I hypertension, healthy pregnancyASA III Classifications:1. A patient with moderate to severe systemic disease, but not incapacitating; may have drug concerns and requires special care will most likely require dental management modifications 2. Examples: Well controlled IDDM, Stage II hypertension, CHF (Congestive heart failure), AIDS, Chronis CODPASA IV Classifications:1. A patient with severe systemic disease that incapacitating and life threatening; requires dental treatment modifications, often in a special facility 2. Examples: Severe CHF or COPD, Kidney or liver failureMaxillary Injections PSA? (27 short)1. Maxillary molars except MB root of 1st permanent molar, facial soft tissue of molars 2. 1/2-3/4 cart. used 3. Contraindications: when risk of hemorrhage is too great (hemophiliac)Maxillary injection MSA?1. Maxillary premolars/ MB root of 1st permanent molar, facial soft tissues of premolars and MB root of #3 2. 1/3-1/2 cart used 3. Contraindications: infection or inflammation in areaMaxillary injection ASA?1. Maxillary centrals, lateral, canines, facial soft tissue of maxillary centrals, laterals, and canines 2. 1/3rd cart used 4. Contraindications: when hemostasis is needed, and when only one or two teeth needed to be anesthetizedMaxillary injection GP (greater palatine)?1. No teeth anesthetized, lingual soft tissues of maxillary molar to canine 2. <1/4 cart used 3. Contraindications: Inflammation or infection in areaMaxillary Injection NP (Nasal Palatine)?1. No teeth anesthetized, lingual soft tissue of maxillary from incisor to canine 2. <1/4 cart used 3. Contraindications: Inflammation or infection in areaMandibular injections IA/Lingual?1. Mandibular molars, premolars, canines, incisors, facial soft tissue if 2nd premolar to central incisor. 2. 3/4 cart used 3. Contraindications: infection in area or acute inflammation, patients who may bite their lip or tongueMandibular injection Buccal?1. No teeth anesthetized, facial soft tissue of mandibular molars to 1st premolars 2. 1/8 cart used 3. Contraindications: infections or inflammation in areaMandibular injection Mental?1. No teeth anesthetized buccal soft tissues of lower lip, chin and buccal soft tissues from 1st premolars forward 2. 1/3 cart used 3. Contraindications: inflammation or infection is areaMandibular injection Incisive?1. All teeth anterior to mental foramen, buccal soft tissues of lower lip, chin buccal soft tissues from 1st premolar forward 2. 1/3-1/2 cart used 3. Contraindications: Inflammation or infection in areaShort acting Amide drugs:1. Lidocaine 2% 2. Mepivacaine 2-3% 3. Prilocaine 4% 4. Articaine 4%Ling acting Amide drugs:1. Bupivicaine .5% 2. EtidocainePotentially risk with use of vasoconstrictors medical problems:1. Allergy 2. Hyperthyroidism 3. Impaired liver or kidney function 4. Malignant hyperthermia 5. Methemoglobinemia 6. Heart failure, heart attack, recent heart surgery, hypertension 7. Hemophilia 8. PregnancyDrug interactions vasoconstrictors:1) Cimetidine 2) Non selective beta blockers 3) Tricyclic antidepressants 4) CocaineProphylactic oral antibiotic drug regimens for the heart if patient isn't allergic to penicillin:1. Amoxicillin 2000mg (2grams) 30 mins to one hour before procedure for adult 2. Children 50mg/kgProphylactic oral antibiotic drug regimens for the heart if patient is allergic to penicillin:1. Cephalexin, cephalosporin 2. Clindamycin 3. Azithromycin 4. ClarithromycinProphylactic oral antibiotic drug regimens for the Joint replacement if patient isn't allergic to penicillin:Amoxicillin 2000mg (2grams) one hour before procedureProphylactic oral antibiotic drug regimens for the Joint Replacement if patient is allergic to penicillin:1. Cephalexin 2000mg (2grams) one hour before procedure 2. Cephradine 2000mg (2grams) one hour before procedure