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Periodontal debridement, Explorers/Recession, Clinical Features of Gingivitis, Probing, Scalers, Universal Curets, Gracey Curets EXAM II

Terms in this set (304)

Periodontal debridement is also known as...
Nonsurgical Periodontal Instrumentation
What are the two main focuses of periodontal debridement
1. Eliminate cause of infection
2. Promote continuing health in the periodontal tissues
The primary source of infection are periodontal pathogenic microorganisms found in...
Dental BIOFILM
There are also secondary sources involved in infection of the mouth that harbor biofilm....
-Endotoxins
-Other bacterial products
-Calculus
-Cementum
What is instrumentation of crown or root surfaces to remove dental biofilm and dental biofilm byproducts such as calculus and endotoxins
Scaling
How is scaling achieved?
hand instruments or ultrasonic scalers
Meticulous removal of rough, altered cementum and/or dentin embedded with calculus, toxins, microbes (dental biofilm)
Root planing
To achieve a smooth root, some or complete removal of cementum is inevitable, BUT...
It is NO longer necessary to remove excess amounts of cementum BEYOND tactile smoothness
We only remove cementum/dentin if it has...
Calculus embedded on it
Aims and Goals to restore gingival health:
1. Regenerate tissue to a healthy color, contour size, consistency texture
2. Eliminate inflammation (pocket reduction, reattachment, improve integrity of JE)
3. Create a biologically acceptable root surface for healing
4. Eliminate bleeding upon probing
5. Improve biofilm free scores
6. Lower subgingival biofilm numbers
7. Choose proper maintenance interval to maintain health
8. Educate patient to value oral health
Use of friction to produce a smooth, glossy mirror like surface that reflects light. Removes dental biofilm and stain.
Coronal polishing
Only polishing teeth or surfaces with stains. (This is to avoid unnecessary removal of surface enamel.)
Selective polishing
Removal of dental biofilm, endotoxins, supra and subgingival calculus, (foreign objects) and damaged tissue from a wound to prevent infection and promote health.
Debridement
Debridement includes:
1. Scaling
2. Root planing
3. Biofilm removal (Polishing, tooth brushing, flossing, proximal aids, exploring)
RDH terminology: The term "Periodontal debridement" replaces the terms:
Scaling and root planing
What is the first step to improve gingival health/reduce biofilm formation?
Personal oral hygiene
The patient is complete when...
health is restored, not only when deposits are removed
Nonsurgical Periodontal Therapy definition
"Bacterial plaque removal and control, supra and subgingival scaling, root planing, and adjunctive treatment such as the use of chemotherapy; the basic objective are to restore gingival health, arrest or slow the progression of early periodontal disease, or for more advanced disease, to prepare the tissues for more complex periodontal therapy." (Wilkins p. 643, 10th ed.)
Basic objectives of nonsurgical periodontal therapy:
1. Restore gingival health
2. Arrest or slow progression of early periodontal disease
3. For more advanced disease, prepare the tissues for more complex periodontal therapy
Measures to preserve health and prevent disease, protective or preventative treatment
Prophylaxis
Oral prophylaxis:
Prophy
Needed for monitoring of the continued success of patient's self-care and health of tissue.
Maintenance appointments
Reasons for maintenance appointments
1. Prevents disease
2. Detect disease early
3. Preserve restored health
Frequency of appointments are...
Based on patient needs
Patients with...
-Deterioration beyond 5 mm
-Inflammation/ANY bleeding
-Etiology is not apparent
...need to be seen within:
3 months or less
Patients with...
-Migration/ pockets 3-5 mm
-Reversible disease
...need to be seen within:
4 to 6 months
Patients with...
-Health
-Sulcus/migration 1-3 mm
-No inflammation
...need to be seen within:
6 to 9 months
Two types of treatments of Gingiva and Periodontium:
1. Non-surgical therapy
2. Surgical therapy
What is the 1st choice of therapy?
-eliminate the cause of infection
Non-surgical therapy
Examples of non-surgical therapy may include:
1. Patient education and patient biofilm removal
2. Removal of dental biofilm, endotoxins and byproducts, calculus
3. Root planing-->removal of diseased root-->smooth surface
4. Subgingival irrigation with antimicrobial agent or water
5. Chemotherapeutic agents
6. Removal of iatrogenic biofilm traps
7. Correction of occlusion
8. Restore carious lesions
9. Correction of food impaction
Examples of Chemotherapeutic agents:
1. 0.12% Chlorhexidine pre rinse
2. Listerine
3. Fluoride
4. Antibiotics (topical or systemic)
produced by a physician (the unexpected results from a treatment prescribed by a physician)
iatrogenic
Example of iatrogenic biofilm traps
Poor restorations
Each tooth needs to be scaled to:
Completion
DH scales one quadrant to completion at each 1 hour weekly appointment. Allows patient learning and monitors healing of previously scaled quadrant with redebridement at troubled sites
Traditional quadrant scaling
What is the cost for traditional quadrant scaling?
$250-$350+ per quadrant
Full mouth scaling and root planning complete within 24 hours. 1 or 2 long appointments. Use of Chlorhexidine
Full mouth disinfection
The philosophy of full mouth disinfection:
Prevents reinfection from other untreated quadrants
Drawback of full mouth disinfection:
Difficult for patient to endure
Traditional quadrant root planing and scaling in __________________ had better results than full mouth disinfection.
Multi-rooted teeth
Full mouth disinfection had better results with:
Anterior teeth
Dental biofilm control education and evaluation:
-Long term success of NST depends on dental biofilm control by patient
-We must educate and motivate the patient to appreciate the value of a healthy mouth
-Daily personal hygiene!
-Importance of frequent recall maintenance appointments
RDH must avoid Gross Scaling:
Scaling only "large deposits" of calculus on the first appointment and leaving finer subgingival deposits for the seconds appointment.
also known as "partial scaling"
gross scaling
Why must the RDH avoid gross scaling?
1. Patient not returning because they "think" they are completed due to clean feeling (supragingival)
2. Periodontal abscess due to microorganisms left in a "tight pocket"
3. Difficulty for hygienist to instrument subgingivally because the tissue will tighten at gingival margin from partial healing
4. Pain to patient due to RDH trying to "squeeze" instrument into a "tight" pocket.
Why would a patient most likely not return if a RDH practiced gross scaling?
They think they are completed due to supragingival clean feeling
Why might gross scaling lead to a periodontal abscess?
Microorganisms are left in a "tight pocket"
Why might gross scaling make it difficult for a dental hygienist to instrument subgingivally?
The tissue will tighten at the gingival margin from partial healing
Why might gross scaling cause more pain to the patient at the second appointment?
The hygienist will have to try and "squeeze" the instrument into a "tight" pocket
When is Surgical Therapy required for a patient?
When non-surgical treatment is insufficient
Surgical procedure reduces deep pockets to _______ following periodontal debridement and patient oral hygiene instructions.
2-3 mm
a dental specialist who prevents or treats disorders of the tissues surrounding the teeth (The man with the knife)
Periodontist
Brushing/flossing only accesses:
2-3 mm subgingival
What is the average cost of periodontal surgical therapy?
$8,600+ for the whole mouth
What are explorers used for?
Used to determine the health of periodontal tissues, the tooth, and the integrity of margins of restorations
What is the general design of explorers?
-Fine, wire-like metal working end
-Tapered to a sharp point
-Circular cross section
-Shank is curved or angled
-Light weight handle is more tactile
Explorers are used in the detection of:
1. Normal tooth morphology
2. Carious lesions
3. Restoration contours/overhanging margins/ defects
4. Calculus
5. Defects or irregularities
6. Identify appropriate areas for sealant use
Detection can be _______ and ________ (Transmission of vibrations from the tooth surface, to the shank, to the handle, to the fingertips, to the brain)
auditory, tactile
Examples of smooth texture (quiet) surfaces on the tooth
1. Normal tooth enamel surface
2. Metal restorations (gold/amalgam)
3. Correct restorative margin
4. Sealants (somewhat scratchy)
Irregularities created by excess or elevations in the tooth surface
1. Calculus (scratchy)
2. Overhanging restorations (bump)
3. Anomalies
Irregularities caused by depressions in tooth surface:
1. Caries
2. Decalcification
3. Abrasion
4. Erosion
5. Abnormal pits
6. Voids in restorations
Examples of "textured" (scratchy/noisy) surfaces on the tooth
1. Cementum
2. Composites/ porcelain/ resin
3. Decalcification
What is the smoothest restoration?
gold
For caries, use a ________, not sharp explorer tip (DIAGNOdent is preferred)
blunt
What do we need to be careful with when exploring? (Area needs to remineralize)
decalcification
acid induced wearing away of tooth surface.
erosion
What is caused by the mechanical wearing away of tooth surface? (mainly dentin, enamel is too strong)
abrasion
incomplete or defective formation of the enamel of either primary or permanent teeth
Enamel hypoplasia
What is biofilm debridement?
Exploring on tooth surface to disrupt bacterial colonies
What are the types of explorers?
1. Pigtail Cowhorn Explorer
2. Periodontal Explorer
3. 11/12 Explorer
4. Shepherd Hook
What is the use of a Pigtail Cowhorn Explorer?
Universal:
-Proximal surfaces for supra/sub calculus
-Caries
-Margins of restorations
-Biofilm debridement
Use only 1-3 mm subgingival-shallow pockets
What is the use of the Periodontal Explorer (right angle)?
-Calculus (supra and sub)
-Morphology
-Biofilm debridement
Which explorer has a higher tactile sensitivity then other explorers?
Periodontal explorer (right angle)
What is the use of the 11/12 Explorer?
-Calculus (supra and sub)
-Overhangs
-Biofilm debridement
What is the use of the Shepherd hook?
-Examines pits and fissures
-Supragingival surfaces ONLY
-Surfaces and margins of restorations and sealants
When using the shepherd hook, what is the agulation of the shank to the surface being examined?
90 degree angle
When using the shepherd hook, what is the angulation of the shank around restorations to check for leakage?
45 degree angle
Technique for Explorers
1. Know tooth anatomy supra and sub!
2. Light grasp!
3. Do NOT use the point!
4. Overlapping short walking strokes
How much of the explorer should be on the tooth?
Only 1-2 mm of the SIDE TIP of the terminal working end is on the tooth
(Do not use the point)
Describe the stroke, including the length of stroke, when using an explorer:
Gentle, short, light lateral pressure, overlapping short walking strokes to the base of the pocket
2-3 mm long
lead with the tip
Overlap at line angles and col areas
Premolars/Molars exploratory stroke:
-Oblique stroke
-DLA to D
-DLA to M
Anterior exploratory stroke:
-Midline to proximal
-Turn tip toward the tooth, then midline to proximal
(use the curl that goes around the tooth)
How do you keep the terminal 1/3 or 1-2 mm of the working end on the tooth at all times?
Roll the instrument between the thumb and index finger
What may lead to root caries or cervical sensitivity?
Recession
What is recession?
Apical migration of the GM from the CEJ; exposes the root surface
What are all of the possible causes of recession?
1. Toothbrushing method
2. Tooth malposition
3. High frenum attachment
4. Chronic gingivitis/ Perio disease
5. Smokeless tobacco
6. Physiologic (aging)
7. Trauma from occlusion
8. Labial orthodontic movement
What causes cervical sensitivity?
Exposure of dentin, or original CEJ anatomy exposing dentin
What percent of the population has dentin exposed from birth?
5-10%
What causes irritation of dentin?
1. Mechanical
2. Chemical
3. Thermal
Examples of mechanical irritation of dentin:
-Scaling
-Instrumentation
Examples of chemical irritation of dentin:
-Use of "Tartar control" toothpaste
-"Whitening" toothpaste
-Mentadent (hydrogen peroxide)
-Salt
-Sugar
-Acids (citric)
Examples of thermal irritation of dentin:
-Hot
-Cold
-Air
Options to help control recession:
1. Use gauze instead of air to dry teeth
2. Personal oral hygiene needs to be meticulous (Less scraping on root surface)
3. Use of desensitizing agents
Examples of desensitizing agents:
1. Toothpaste containing "Potassium Nitrate"
2. Amorphous calcium phosphate paste or gel ("MI paste", "Relief")
3. Gel Kam Home F2 gel containing Stannous Fluoride
4. Calcium Carbonate/ Arginine desensitizing prophy paste (Colgate)
5. Stannous Fluoride toothpaste
6. Calcium Sodium Phosphosilicate and 2.7% Sodium Fluoride found in "Nupro extra care prophy paste with fluoride and NovaMin"
What can be used for sensitivity and to prevent decay?
Hi-potency fluoride
Examples of Hi-Potency fluoride
1. 5% sodium fluoride varnish (Benco "Iris")
2. Rx Fluoride Mouthrinse
3. Rx F2 toothpaste (prevident)
Exposed root is....
VULNERABLE TO SENSITIVITY AND DECAY
Why should cotton pliers be available in all set-ups?
To retrieve small items in the mouth and back of throat
Gingivitis in itself does not cause periodontitis. It depends on the _______________.
Host response
What is gingivitis?
Bacterial infection confined to the gingiva
How do you recognize gingivitis?
Visually and with a probe
What causes gingivitis?
BIOFILM and contributing factors
How to treat gingivitis?
Removal of biofilm and calculus embedded with biofilm
How to prevent gingivitis?
Education, meticulous oral hygiene, frequent recall/maintenance intervals
Characteristics common to gingival diseases:
1. Inflammation
2. NO attachment loss
3. Dental plaque biofilm initiates or aggravates the inflammation
4. Clinical changes of inflammation
Clinical changes of inflammation including changes in gingival....
1. Color
2. Size
3. Contour
4. Bleeding upon stimulation
5. Increase crevicular fluid flow
An inflammatory exudate that can be collected at the gingival margin or within the gingival crevice.
crevicular fluid
Two types of gingivitis:
1. Dental plaque induced gingival diseases
2. Non-plaque induced gingival lesions
Dental plaque induced gingival diseases (MOST COMMON)
1. No attachment loss
2. Reduced but stable periodontium
3. Altered by systemic factors
4. Altered by medications
5. Altered by malnutrition
6. Bacteria and their byproducts permeate sulcular epithelium
Non-plaque induced gingival lesions
1. Gingival diseases of: Specific bacterial origin, viral origin, fungal origin, genetic origin.
2. Gingival manifestations of systemic conditions
3. Traumatic lesions
4. Foreign body reactions
Gingivitis starts with:
Supragingival plaque
BACTERIAL infection leads to:
Inflammation
Signs of periodontitis
-Hard fibrotic pink gingiva
-Bone loss
-Loss of PDL attachment
-Painless
Gingivitis is ___________ with plaque biofilm removal
Reversible
Three stages of gingivitis
1. Initial lesions
2. Early lesion
3. Established lesion
Stage of gingivitis that develops within 2-4 days in response to biofilm accumulation on contact with the gingiva
Initial lesion
Initial lesions are mostly gram _______ in the sulcus
Positive
Stage of gingivitis where clinical inflammation is detected after 7 days
Early lesion
Early lesions are gram _______ fluorish
Negative
Stage of gingivitis where there is bleeding upon probing.
Established lesion
Established lesions are gram negative ______ and _________.
Rods and Spirochetes
Gingivitis ______ between children and adults, seniors and adults, and adolescents and adults
differs
Local factors such as restorations, tooth anatomy, fractures, and appliances act as a "______________" and may contribute to disease
Plaque trap
What factors cause inflammation?
1. Increased blood flow, vessels engorged
2. Increased permeability of capillaries
3. Increased collection of defense cells and gingival crevicular fluid. (Immune system is triggered)
Clinical signs of gingivitis
1. Redness
2. Swelling
3. Bleeding upon probing
4. Tenderness
Patient symptoms of gingivitis
1. Bleeding while brushing
2. Spontaneous bleeding
3. Bad taste or malodor
4. Possible tenderness
Microscopic changes from gingivitis
1. Dilation of capillaries
2. Ulceration of sulcular epithelium
3. Connective tissue (collagen) compromised
Collagen is destroyed in gingival fiber groups by ______________ and replaced by fluid, lymphocytes, neutrophils, and a few plasma cells
Collagenase
Contributing systemic disorders causing hemorrhage:
1. Malnutrition
2. Blood disorders
3. Prescription drugs
4. Hormonal changes
5. Immune compromised
What do we need to describe when observing gingivitis?
1. Severity
2. Course and duration
3. Distribution
Severity of gingivitis
slight or mild/ moderate/ severe
Course and duration of gingivitis
1. Acute gingivitis
2. Chronic gingivitis
Short duration, patient self-care and professional care return tissue to health
Acute gingivitis
Long lasting, may exist for years without progressing to periodontitis
Chronic gingivitis
Distribution of gingivitis
1. Localized or Generalized
2. Papillary, Marginal, or Diffuse redness
One tooth or less than 30%
-Record exactly where (most gingivitis begins in the col area*
Localized
More than 30% of teeth
Generalized
Descriptor for gingivitis only within the interdental papilla
Papillary
Descriptor for gingivitis only within the marginal gingiva
Marginal
"Slight or mild", "Moderate", "Severe or advanced", "Light", "Heavy"
Severity documentation
Descriptor for gingivitis all over up to the mucogingival junction
Diffuse
A painful infection of the gums with symptoms such as acute pain, bleeding, and foul breath. (Dead tissue)
Acute Necrotizing Ulcerative Gingivitis
Healthy gums....
DO NOT BLEED
The earliest clinical sign of gingivitis
Bleeding upon probing
Bleeding gums upon probing
Hemorrhaging
Increased vascularization from capillary dilation due to increased blood flow causes:
Color changes in the gums
Chronic gingivitis colors
Variations of red and blue
--Anoxemia
--Venous return impaired
--Stagnated blood
--Stained Subgingival calculus
Found in Chronic gingivitis
-Absence of oxygen in the blood, causes blue/purple gums. Vessels are engorged
Anoxemia
Bright red gums found in acute gingivitis
Erythema
Healthy gum color
Coral pink, pale pink, dark pink
Color changes in disease
Red, dark red, bluish red, magenta, deep blue
Color differences due to race
Melanin pigmentation
Healthy gum size
Fills embrasures, flat, fits snugly around tooth
Size changes in disease
Enlarged
Changes in disease causes attached gingiva width to:
Decrease
Contour of healthy free gingiva
Closely adapted to tooth surface, margins are knife like, or slightly rounded
Free gingival contour changes in disease
Rounded, rolled, rolled borders
Contour of healthy papilla
Papilla is pointed and pyramidal or slightly rounded
Papilla contour changes in disease
blunted, flattened, bulbous, cratered, McCall's festoons (life saver shape), Stillman's cleft (apostrophe shaped)
Healthy consistency
Firm when palpated, resilient
Consistency changes in disease
1. acute inflammation
2. chronic inflammation
Acute inflammation
Soft, spongy, leaves a dent when pressed by side of probe, fibrotic, readily displaced
Chronic inflammation
tissue appears pink but fibrotic, hard, usually bleeds in deeper pockets
Surface texture for healthy free gingiva
Smooth
Surface texture for healthy attached gingiva
Stippled (pebbly orange peel)
Surface texture for healthy interdental papilla
Free gingiva is smooth/ center is stippled
Surface texture during changes in disease
-Loss of stippling/Inflammation (smooth/shiny)
-Hyperkeratosis (leathery, hard or nodule pink surfaces)
-Chronic (hard & fibrotic)
CAL
Clinical attachment loss
Level of gingival margin in relation to CEJ determined by direct observation.
Apparent position
Apparent position in health
At or slightly below enamel contour of cervical one-third; Tissue is coronal to CEJ
Apparent position in changes in disease
Level is coronal or apical to normal; Must measure recession
Actual position or CAL
Level of JE from CEJ; determined by measurements of pockets by probing
Actual position in health
JE is at or just coronal to the CEJ
Clinical attachment loss actual position
JE is apical to CEJ
Bleeding with probing, scaling, spontaneous, none, etc. Document if generalized, localized, spontaneous, or none
Hemorrhage
fluid, such as pus, that leaks out due to infection. Document if present, the location and the amount
Exudate
Why do we need to probe?
1. To promote health and prevent disease
2. Detect gingivitis and periodontitis
3. Measure recession
4. Measure attached gingiva
5. Measure clinical attachment loss (area of JE on tooth)
6. Know how deep to explore
7. Know how deep to scale
8. Know what oral hygiene aid is recommended
9. To determine if therapy was a success
10. Know when to refer to the periodontist
What is the first clinical sign of gingivitis?
Bleeding on probing
How many measurements are taken on each tooth?
6 measurements
When recording the measurements found on each surface of the tooth, which measurement do you record?
deepest
How soon does a patient need to be seen if they bleed during probing?
3 months
What happens to the sulcus if therapy was a success?
Pockets will shrink
healthy gums...
do not bleed
epithelium that attaches the gingiva to the tooth
junctional epithelium
In health, the junctional epithelial cells attach to the enamel of the tooth crown at or above the CEJ
Gingival suclus
A deepening of the gingival sulcus as a result of swelling or enlargement of the gingival tissue. more than 3 mm
Gingival pocket
another term for gingival pocket
Pseudopocket
What results from apical migration of the JE and/or destruction of PDL fibers and alveolar bone?
Periodontal pocket
The normal level of the alveolar bone is located approximately...
1.5-2 mm apical to the CEJ
Probe depths in health are between ___-___ mm, without bleeding and without apical migration of JE
0.5-3 mm
In health, the junctional epithelium is attached to the ____ or _____.
CEJ or enamel
The major cause of tooth loss in adult patients is...
periodontal disease
A sulcus measuring more than _______ is a sign of disease and termed a periodontal pocket
3 mm
Any recession is a sign of _________ _______ from the CEJ.
attachment loss
2 mm of recession and 2 mm sulcus equals ______ attachment loss from the CEJ.
4 mm
When measuring a pocket that is between sizes, always ______ ____ to the next mm.
Round up
ANUG
acute necrotizing ulcerative gingivitis
An acronym for Acute Necrotizing Ulcerative Gingivitis, commonly known as trench mouth or Vincent's disease, which can be aggravated by stress and/or smoking.
ANUG
Probing is only to be performed on _______ ______ ______. Permanent only
fully erupted teeth
mm measurements on a williams probe
1, 2, 3, 5, 7, 8, 9, 10
1, 2, 3, 4 (silver), 5 (black), 6, 7, 8, 9 (silver), 10 (black), 11, 12, 13, 14 (silver), 15 (black)
UNC
Periodontal screening and recording system (3.5, 5.5, 8.5, 11.5)
PSR
special periodontal probe used to measure furcations only
Nabor's Probe
Probe needs to be as parallel as possible to the __________________ on the facial and lingual surfaces.
(stand up/lay down)
long axis of the tooth
If the probe is not parallel to the long axis of the tooth, it will stick to the...
Sulcar epithelium
What part of the probe needs to be on the tooth the entire time while probing the facial and lingual surfaces?
(Roll)
Side of the black ball
What part of the probe needs to be on the tooth while probing the proximal surfaces?
Entire side of the probe
What part of the probe is always on the tooth?
1 mm side tip
What motion do we use to keep the 1 mm side tip of the ball always on the tooth?
Roll
While walking the probe around the base of the sulcus, what type of pressure is used?
light even pressure
What controls the pressure while walking or "tiptoeing* around the JE?
Pivot
What keeps the probe parallel to the long axis of the tooth?
Stand up
How high and wide are the steps around the sulcus while probing?
1-2 mm
The probe stays parallel to the tooth up until it reaches the...
contact
What is done when the probe reaches the contact?
Lifted and angled into the col area
Where is the col examined from?
facial and lingual
Where is your grasp for molars?
up on the handle
Where is your grasp for anterior teeth?
down on the color bands
What creates the Big Rock?
Gradual standing up and pivoting around the tooth
What needs to be watched within the "Big Rock"?
little rocks
What is the only thing "in" the mouth?
Fulcrum finger
Why don't we need to lift and angle the probe on the distal surface of the last tooth?
There is no contact
When probing the mandibular anterior facial surfaces, how far apart should the fulcrum finger be from the tooth that is being probed?
3 teeth away
To help see the maxillary left posterior facial surfaces does the commissure need to be retracted with the fulcrum finger staying palm up?
Yes
The inside of the probe faces which surface?
distal
the side of the probe faces which surface(s)?
facial or lingual
the back of the probe faces which surface?
mesial
Which side of the probe faces the anterior lingual surfaces?
inside
You should always rock _______ the sulcus (to the right for lefties)
Toward
canines are probed using the shape of an...
ice cream cone
Where should we fulcrum for the maxillary left posterior lingual surfaces?
(palm up, finger tip resting on tooth)
facial cusp of the first premolar or canine
-Larger
-Thicker
-Heavier
-Longer blade
-Sharp point at working end
How scalers differ from curets
-supragingival biofilm
-slightly subgingival biofilm
-supragingival calculus
-slightly subgingival calculus
(light/moderate/heavy)
Scalers remove or disrupt:
1-2 mm
If a scaler goes subgingival, no more than ____ mm should go subgingival
curet
When a scaler goes subgingival, you must always follow up with a:
Col
Scalers go directly under the contact of two teeth. This area is called what?
pointed tip
Scalers have two parallel cutting edges that form a ______ ____, which is a MUST for under contacts
90
The face of the blade of a scaler is flat and at a ____ degree angle to the terminal shank.
cutting edge
The face and the lateral surface of a curet make up the:
Anterior curved scaler
H6/H7
Posterior sickle scaler
S204
triangular
The scaler's back is pointed. This makes it _______ in its cross section
When placed proximally, the terminal shank of a scaler will be _______ to the long axis of the tooth
parallel
Before checking the end, you must ______
fulcrum
Limitation of scalers:
-Poor adaptation to curves
-doesn't reach base of sulcus
-poor tactile sensitivity
-pain and trauma if used incorrectly
The face of the instrument should be at a _______ angle to the tooth while scaling for the cutting edge to be functional.
70-80 degrees
Operator must tilt lower shank slightly ______ the tooth to be instrumented
toward
For scalers, only use the terminal _____ mm of the working end
1-2
Anterior adaptation for scalers:
Midline to proximal
Position for mandibular anteriors surfaces toward
4-3
Position for mandibular anteriors surfaces away
12-2
Posterior adaption for scalers:
-Distal line angle to distal, and then
-Mesial line angle to mesial
--NOT to be used for facial/lingual
When the thumb pushes the instrument handle toward the tooth so that the working end is forced against the tooth
Lateral pressure
Activation of instrument:
Light exploratory stroke (toward JE), then firm lateral pressure for working pull stroke (away from JE). Push thumb against handle to engage cutting edge against calculus.
Strokes should be overlapping ____ mm in length
0.5-3
Supplemental scalers
-Single straight cutting edge
-Supragingival use only
-Gross calculus removal
-Quick dislodgement of calculus bridge
-Can gorge cementum
-Can tear JE if used subgingivally
(Hoe and Chisel)
Hoe
Use pull stroke
Chisel
Horizontal F/L stroke
Curets uses
1) Scaling
2) Periodontal debridement or Root planing
3) Deplaquing
4) Gingival curettage
Debridement
removal of foreign material and dead or damaged tissue from a wound
Scaling
Using an instrument to remove supra and slightly sub calculus and biofilm on a tooth
Periodontal debridement
Removing of cementum or dentin embedded with calculus, et al. to attain a smooth root surface
Deplaquing
Light lateral pressure against tooth to remove biofilm only
Gingival curettage
Removing dead tissue from the sulcular epithelium
Curets working end face has ___ or ___ blades
1 or 2
Curets have a rounded or flattened ____
toe
Curets have a _____ back
rounded
Curets' lateral surfaces are _____
rounded
Types of curets
1) Universal curets
2) "Gracey" curets
Universal curets
-4R/4L
-2R/2L
Can be used on anterior and posterior
4R/4L
Universal curets are used for
Light or moderate supra and sub calculus
Universal curets have ___ parallel cutting edges
2
When in use, the terminal shank of the universal curet is parallel to the long axis of the tooth, allowing the shank to go:
subgingival
The face of the universal curet will be between ________ degrees to the tooth.
70-80
Universal curets face should be at a ___ degree angle to the shank
90
The universal curets' shank should be between ________ degrees toward the tooth
10-20
Which instrument below has two cutting edges?
a) H6/7
b) 4R/4L
c) S204
d) All
All
Which instrument may go subgingival? (All the way down to the JE)
a) Universal curet
b) H6/7
c) S204
Universal curet
Which instrument is *only* used supragingival and onlyonlyinstrument is *only* used supragingival and *only* up the 2 mm. subgingival is the tissue deflects easily?
a) H6/7
b) S204
c) 4R/4L
d) A and B only
H6/H7 and S204
Which instrument has a 90 degree angle between the face of the instrument to terminal shank?
a) S204
b) H6/7
c) 4R/4L
d) All
All
Which of the following is (are) used only on posterior teeth?
a) S204
b) 4R/4L
c) H6/7
S204 and 4R/4L
You are scaling tooth #3 mesial from the facial aspect. You need to remove light to moderate calculus right under the contact. What is the first instrument you use?
a) H6/7
b) S204
c) 4R/4L
d) Gracey curet
S204
For the cutting edge on an instrument to be functional, the angle between the face of the blade and the tooth should be anywhere between ___ to ___ degree angle
46-89
Fulcrum pressure must be _____ or _____ to the stroke pressure
greater than or equal to
H6/H7 surfaces
-Anterior
-Facial/lingual
-Mesial
-Distal
-Supra
-Sub- 1-2 mm if tissue allows
H6/H7 beginning and end of stroke:
-Midline to proximal
-Overlapping midline to proximal
Nevi 1 surfaces
-Anterior
-Facial/lingual
-Mesial
-Distal
-Supra
-Sub- 1-2 mm if tissue allows
Nevi 1 beginning and end of stroke
-Midline to proximal
-Overlapping midline to proximal
S204 surfaces:
-Premolars
-Molars
-Mesial
-Distal
-Supra
-Sub- 1-2 mm if tissue allows
S204 beginning and end of stroke
-DLA to D
-MLA to M
-Overlapping proximal and line angle
Area specific gracey curets remove of disrupt:
*light* supra and light slight supra and *light* subgingival calculus ONLY!
(FINE calculus)
Types of Gracey curets:
-1/2
-7/8
-11/12
-13/14
Gracey curets have only _____________ with the cutting edge lower when the terminal shank is parallel to the floor.
ONE cutting edge
The outer convex blade is the _______ ______ of the Gracey curets
cutting edge
The face of the blade is at what angle to the shank?
90 degrees
The 60-70 degree angle of the gracey curet is ideal for:
Root planing
What is the LAST instrument on the tooth?
Gracey curet
Terminal shank of Gracey for anterior teeth:
Straight or slightly angled
Terminal shank of Gracey curet for posterior teeth:
Multiple contra angled
Remove all calculus on 1 mm wide section of tooth before moving to the next adjacent section.
Channel strokes
Channels are how wide?
1-2 mm
Exploratory stroke
(Assessment)
-Light grasp
-Light but stable fulcrum
-Light lateral pressure
-Light "push" stroke
-Less than 45 degrees
-"Closed"
Working stroke
(Calculus Removal)
-Firm grasp
-Firm fulcrum
-Firm lateral pressure
-Firm "pull" stroke
-More than 45 degrees
-Less than 90 degrees
-"Open"
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