dthy 370 final

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what is mechanical instrumentation?
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what is mechanical instrumentation?
powered instruments use a rapidly vibrating, irrigated working end to dislodge calculus from tooth surface, disrupt plaque biofilm, and flush bacteria from periodontal pockets
-effectiveness is determined by skill of clinician and thoroughness with explorer
sonic scaler energy source
air turbine
how does a sonic scaler work?
convert air pressure into high frequency waves that produce vibrations of the powered working end
sonic scaler frequency
low frequency = 3000-8000 cps
ultrasonic scalers
piezoelectric
magnetostrictive
how does an ultrasonic work?
convert electrical energy into high frequency waves that produce rapid vibrations of powered working end
ultrasonic frequency
high frequency = 18,000-50,000 cps
piezoelectric power source
use electrical energy to activate crystals within handpick to produce vibrations of working end
magnetostrictive power source
transfer electrical energy to metal stacks or ferrous rod to produce vibrations of working end
mechanical action
vibration of working end > micro fractures > deposit removal
what is cavitation?formation of tiny bubbles when water stream contacts vibrating working endhow does cavitation work?bubbles collapse > produce shock waves > destroy bacterial cell wallswhat is acoustic micro streaming?-generated by ultrasound in presence of fluid environment -has potential to destroy or disrupt bacteriawhat is fluid lavage?therapeutic washing of sulcus and root surface to remove endotoxins and loose debriswhy must tips be cooled?to prevent overheating due to vibrations and frictionwhat provides more 'pocket reduction' than water when used as a coolant?chlorhexidine gluconatelower rate of water flow =increased heating of tip and warmer waterhigher rate of water flow =less heating of tip and colder waterwhat is frequency?speed of movement -number of cycles per second (cps)what is amplitude?distance of tip displacement during one cycle -determined by power setting; always begin on lower settingfrequency + amplitude =cleaning efficiencylow frequency + low amplitude =idea for disruption of plaque biofilm (deplaquing)high frequency + high amplitude =idea for removal of tenacious calculus depositsadvantages of powered instrumentation-increased efficient -irrigation/lavage -multiple surfaces of tip are capable of removing deposits -less tissue distention -less chance for repetitive stress injuries -no sharpening -effects produced beyond tipdisadvantages of powered instrumentation-client discomfrot -aerosol/splatter -decreased tactile sensation -reduced visibility -noise -damaging to restorative materials -limited infection controlindications for use of powered instrumentation-light/heavy calculus deposits or biofilm -periodontal surgeries -removal of excess cement and bonding agentsprecautions for powered instrumentation-children: large pulp more susceptible to heat -restorations, demineralization, hypersensitivity: avoid these areas -communicable diseases -immunosuppression -cardiac pacemakers (don't use on these patients)limitations of powered instrumentationclinical skill levelcontraindications of powered instrumentationlung/pulmonary disease, bronchitis or pneuomnialess than 91% oxygen saturationdysphagia (muscular dystrophy, multiple sclerosis, paralysis)clinician prep for powered instrumentationgown mask eyewear face sheildclient prep for powered instrumentationexplain procedure pre-rinse eyewear drape/bib/towel mask (optional)how often to change mask when using powered instruments?every 20min or sooner if neededhow should the powered instrument tip be adapted?keep the terminal 2-3mm against the tooth -work from the TOP down -always keep tip moving -use oblique strokesbecause of COVID, we always want to use _______ when creating aerosolsHIGH VOLUME EVACUATIONsonic scalers-attaches directly to unit (far right) -cools friction tip w/ water -compressed air drives tip in elliptical pattern -all surfaces are active -3000-8000cps -lower frequency = calc removal harder -power setting is pre-determined; you can only adjust water flowuse what knob to adjust water for sonic scalers?4piezoelectric scaler-electric generator; ceramic rods/crystals -tip moves in linear pattern; forward/backward ONLY -only lateral surfaces of tip are active -25,000-50,000cps -green tips = up to 20% -blue tips = up to 70% -tips are diamond coated and site specificknob number to adjust water on piezoelectric scalers?2magnetostrictive scaler-electric generator -interchangeable inserts -tip moves in elliptical pattern; all sides are active -25kHz and 30kHz units available -lower frequency has lower amplitude, higher frequency has higher amplitudewhat does the O-Ring do on MS scalers?seal that keeps water flowing to tip of insertwhat does the metal stack do on the MS scaler?converts electrical power into vibrationsultrathin magnetorestrictive inserts are ideal for?periodontal debridementthin magnetostrcitvie inserts are ideal for?supra and sublingual calculuswhat type of tip do you use for patients with implants?PLASTIC TIP -have them for sonic/ultrasonic -have them for instrumentswill firm pressure reduce the effectiveness of a powered instrument?YES -slow, repetitive strokes -overlapping, vertical, and oblique strokes -gentile pressurerectangular or beveled cross section is effective forcalculus removalround cross section is effective fordeplaquingtobacco-chief avoidable cause of illness and death in the US -450,000 deaths annuallywhat is tobacco cessation?a person stops using tobacco with the goal of achieving permanent abstinence75% of oral and pharyngeal cancer attributed totobacco usecancer risk is 10x higher when mixing tobacco with ?alcoholoral health effects of tobacco usenicotine stomatitis periodontal disease (3-6x more likely) mucosal lesions/recessionhighly addictive drug that creates physical and physiological dependence?nicotinewhat are the five A's for helping a patient quit tobacco?Ask Advise Assess Assist Arrangethe five A's approach: "Ask" entails?systematically identifying all tobacco users at every visitthe five A's approach: "advise" entails?-encouraging all tobacco users to stop to protect current and future health -relate to something immediately relevant to client -teachable momentthe five A's approach: "assess" entails?-what is the clients 'readiness to quit?' -'stages of change theory' determines how ready client is to make changethe five A's approach: "assist" entails?-client centered communication -emphasize clients autonomy, not your own authoritythe five A's approach: "arrange" entails?-follow up contact -review past quitting attempts -set new goalsstages of change theorydetermines how ready client is to make changeprecontemplationno thought of stoppingcontemplationconsidered stopping, not ready nowpreparationwilling to set a quit dateactioncessation up to 6momaintenancecessation over 6mobrief intervention-requires less than 3 minutes to complete -accept clients decision NOT to stop using -provide info about benefits of quittingwhat is motivational interviewing?form of client-centered communication to help clients break free from ambivalence trapping them in tobacco use in order to start change processduring motivational interviewing you shoulddiscover and understand clients' motivations for tobacco use to help promote a change in their behavior4 principles of motivational interviewing1. Express empathy 2. Develop discrepancy 3. Roll with resistance 4. Support self-efficacychange talk-have client voice arguments for change -include reasons of concern and advantages of the changeOARS strategy-open ended question -affirming change talk -reflective responding -summarizing results of dialoguemodel used by Mayo ClinicElicit Provide Elicitsteps of Elicit Provide Elicit*Elicit* information to enhance client's motivation to quit *Provide* education about concept of a "quit date", withdrawal symptoms, pharmacotherapies available, referral information, etc. *Elicit* client's decision about cessation planmodel used by ADHAAsk Advise Refer -quickeststeps to Ask Advise Ask*Ask* each client about tobacco use *Advise* all tobacco using clients to quit *Refer* clients to state or national Quitline and providekey elements of tobacco cessation programs-assess -set quit date -establish plan for quitting -offer coping skills training -encourage enlistment of support -recommend pharmacologic agents -prevent relapse -follow upideal times to set a quit date?-2-4 weeks from initial decision to quit -low stress period (weekend) -on a significant date (bday)Is relapse a definitive failure?NOdoes NRT (nicotine replacement therapy) still contain nicotine?YESoral effects of e-cigarettesnicotine -inhibits osteoblast proliferation -vasoconstriction aerosol -temperature -nicotine stomatitis e-liquid -cytotoxic to fibroblastssystemic effects of e-cigarettes*Bronchiolitis Obliterans (Popcorn Lung)* -inflammation of bronchioles resulting in scar tissue and narrowing -symptoms: dry cough and shortness of breath -caused by inhalation of diacetyl (common flavoring)effects of e-cigarette on adolescent brain development-impact learning -affect memory -decrease attention -increased risk for future --addiction to other drugs -altered serotonin receptor functioncurrent tobacco cessation efforts at WVU SoD-tobacco questionnaire -calculate pack year habit -CTTTPoral snuff, 'Snus'-finely ground tobacco leaf -placed between cheek and gum -expectorate juiceschewing tobacco, 'chaw' or 'plug'-coarsely shredded tobacco leaf -placed in cheek -expectorate juicesnitrosamines-cancer causing chemicals -found in larger quantities in smokeless tobaccofree nicotineionized nicotine that passes rapidly through the oral mucosa into the bloodstream and into the brainbenefits of nicotine replacement therapyprovides a blood level/concentration of nicotine to alleviate withdrawal symptoms without client getting any other adverse effects (tar)contraindications for nicotine replacement therapy-recent myocardial infarction (MI) -life threatening arrhythmia -severe or worsening angina -insomnia -neurological issues1 cigarette =1mg nicotine1 PACK of cigarettes =20mg nicotine (20 cigarettes)how does the NRT patch work?-high level of nicotine -easy use: cutaneous absorption constantly -applied to upper bodydisadvantages of NRT patch-slow onset (6-8 hrs max) -mild skin rashes/irritation -less flexible dosing -nausea, headaches, insomniadosing for NRT patch-initial dose maintained 4-6wk -decrease dose 7-14mg every 2-6wk -comes in 21mg, 14 mg, and 7mg patches ->40CPD = 42mg/day -21-39CPD = 28-35mg/day -10-20CPD = 14-21 mg/day -<10CPD = 7-14mg/day -DO NOT dose more than typical nicotine toleranceNRT gum advantages-immediate + sustained: 15-20min peak -easy use: chew and park method -convenient and flexibleNRT gum disadvantages-frequent use -affected by pH (coffee, juice) -TMD: use w/ caution -upset stomach, nausea/vomitingdosing of NRT gum*no more than 24 pieces/day* -chew about 10 times then park until flavor dissipates & repeat 1 piece every 1-2hrs per day (weeks 1-6) 1 piece every 2-4hrs per day (weeks 7-9) 1 piece every 4-8hrs per day (weeks 10-12) 2mg: desire to smoke >30min after waking; <20CPD 4mg: desire to smoke <30min after waking; >20CPDNRT lozenge advantages-immediate + sustained; 15-20min peak -easy use; dissolve in mucosa -convenient/flexible -provides 25% more nicotine than gumNRT lozenge disadvantages-frequent use -affected by pH (coffee, juice) -hiccups, heartburn, nauseadosing of NRT lozenge-place in cheek to dissolve; limit 20 per day 1 lozenge every 2-4hr (week 1-6) 1 lozenge every 2-4hr (week 7-9) 1 lozenge every 4-8hr (week 10-12) 2mg: desire to smoke >30min after waking; <20CPD 4mg: desire to smoke <30min after waking; >20CPDwhat are the only three OTC NRT that we can recomend?patch gum lozengewhat are the prescription NRTs?oral inhaler sprayNRT spray (Rx)-FASTEST DELIVERY SYSTEM OF ALL NRTS -flexible dosing -absorption peak 5-10min -use up to 8wks then quit - used 1-2 times an hour -do not exceed 5 doses an hour/ 40 doses a day -do not inhale; it is absorbed in the mucosaNRT oral inhaler (Rx)-4mg of nicotine VAPOR in each cartridge -use depends on smoking habits -mimics oral aspects of smoking -6-16 cartridges per day in first 3mo -80 puffs = 1 cig -1 cartridge every 1-2hrs (16 cartridges a day) -Dont use longer than 6moWhat are the non-nicotine replacement therapy options?Zyban Chantixwhat is that active ingredient in Zyban?Bupropionhow does zyban work?anti depressant, increases levels of dopamine and norepinephrinedisadvantages for zyban?dry mouth insomniadosing for zyban?*start med one wk BEFORE quit date* -Days 1-3: take 150mg per day (1tab) -Days 4-7: take 150mg twice a day (2tabs) 8hrs apart -Treat for at least 12 weeks; no need to taper dose! You can stop treatment at any time. -Take evening dose BEFORE 6pm to avoid insomniaprecautions for zyban?-seizure -eating disorder -head injury -bipolar disorder -'other medications'what is the active ingredient in Chantix?Vareniclinehow does Chantix work?-binds to nicotine receptors in brain -blocks neurochemical effects of nicotine -eliminates euphoric feelingprecautions for Chantix?-younger than 18 years old -pregnant/breast feeding -kidney problemshow long can you continue tobacco use with Zyban?7-14 dayshow long can you continue tobacco use with Chantix?1 week onlyChantix dosing*start med one wk BEFORE quit date* -Days 1-3: take 0.5mg per day (1tab) -Days 4-7: take 0.5mg twice a day (2tabs) 8hrs apart -Days 8 to End of Tx: take 1mg 2x/day -Treat for at least 12 weeks; no need to taper dose! You can stop treatment at any time.cigarette smoking ____-suppresses the gingival inflammatory response -suppresses effet on gingival bleedingwhat is periochip?dissolvable chlorhexidine gluconatehow long does periochip last? what part is inserted?7-10 days 40% released during first 24hrs rounded edgewhen should periochip be replaced?if it has been dislodged within the first 48 hrsside effects of periochip?-mild/moderate sensitivity -toothache -upper respiratory tract infection -headachecontraindications of periochip-chlorohexidine gluconate allergy -young children -pregnant/nursingfluoride treatments offered in the clinictopical -APF 1.23% -Neutral 2.0% NaF: composites/restorations varnish -5% NaFif the patients temperature is > 101.1 degrees F we areNOT allowed to treatpre-rinse1.5% hydrogen peroxide (Colgate Peryoxl or similar)your cumulative tally, notes, and codes should be filled out _______ checkoutBEFORESOAP notesS = subjective; chief complaint O = objective; what is done by operator during exam (forms, x-rays, soft tissue exam) A = assessment or findings of the exam P = planned treatmentif your patient is allergic to 2mg Amoxicillin, what can they take as an alternative?600mg Clindamycinhow often do pedo patients get panoramic radiographs?every 3yohow old are the patients seen in pedo?newborns-18yo 50% are medically compromisedmain goals of pediatric dentistryprevention and education FLEXIBILITY HAVE FUNhow early should parents bring in their children?1yo or 6mo after the 1st tooth eruptswhat do you need to bring to a pedo rotation?cassette prophy motor/anglecan you seat your pedo patient without the doctor allowing?NO - always let your dr know before seating your patientwho do you give the tx plan to in pedo?a dental assistantwhat two things do parents need to sign?tx plan informed consentBWX should be taken _____ on pedo patientsif caries present = 1x year no caries = 1.5x yearwhat does ECC mean?early childhood cariesprimary 2nd molar is similar topermanent 1st molarTWO year age-related psychosocial traits-gross motor skills (running/jumping) -likes to see/touch -attached to parent -no sharing -limited vocab -interested in self-help skillsTHREE year age-related psychosocial traits-less egocentric; pleases everyone -active imagination; stories -remains closely attached to parentFOUR year age-related psychosocial traits-tries to impose powers -participates in small groups -reaching out & expanding -independent self-help skills -knows please/thank youFIVE year age-related psychosocial traits-period of consolidation; deliberate -takes pride -relinquishing comfort objects (blanket/thumb) -plays with otherscompensatory cry-whining, steady droning -allow them to cryfearful cry-sobbing/rasping -wailing and profuse tears -allaying the child's fearobstinate cry-siren-like in pitch, accompanied by physical flailing and fighting -firmness tempered with understandingpainful cry-often marked by moaning/grimacing -profound anesthesia and/or removal of pain sourceprinciple fears by age3yo = visual fear 4yo = auditory fear 5yo = not a fearful age 6yo = marked increase in auditory and spatial fear 7yo = deeper, worrisome fears 8yo = fewer fears, less worrying 9yo = fears vary from child-child 10yo = worried from school 11yo = most worried and fearful of all ages 12yo = fewer worrieswhat is the tell-show-do method in pedo?developed by Addelston in 1959 from NYU -tell it -show it -do it -always be honest -never sneak things up on kidshydrodynamic theorystimuli are transmitted to the pulp by fluid materials found within the dentinal tubulescauses of gingival recession- anatomy of the labial plate of the alveolar bone - poor oral hygiene status - acute or chronic trauma - frenal attachment at the gingival margin - occlusal traumacementumthis tooth structure abrades 35x as fast as enameldentinthis tooth structure abrades 25x faster than enamelcauses of enamel loss1. attrition 2. erosion 3. abrasion 4. abfractioncriteria for diagnosing dentinal hypersensitivity-pain when stimulus is applied -no caries -sound restoration -exposed dentin -no fracture lines -no inflammation -around apexnerve hyperpolarizationincreased concentration of extracellular K+ ions, making it harder to excite the nerve dentinal tubules are not occludedstannous fluorideproduce a smear layer and calcium fluoride crystals to occlude dentinal tubulesself-applied dentinal hypersensitivity treatments1. potassium nitrate 2. stannous fluoride 3. arginine and calcium carbonate toothpaste 4. fluoride gels and rinsesprofessionally applied dentinal hypersensitivity treatments1. fluoride varnish 2. precipitates (arginine & calcium carbonate, calcium phosphate compounds) 3. hydroxyethyl methacrylate (HEMA) 4. polymerizing agents (glass ionomers) 5. iontophoresis 6. laser therapy 7. restoration or extraction 8. periodontal plastic surgeryiontophoresisdelivery of sodium fluoride by passing electrical current through cervical dentin requires special equipmentfactors that indicate periodontal disease1. susceptible host 2. pathogenic bacteria 3. environmental factorswhat organizations regulate chemotherapeutics?FDA ADAclassification of oral chemotherapeutics1. local or systemic delivery 2. self or professionally appliedactive ingredients in oral chemotherapeutics1. antiseptics 2. antibiotics 3. antiadhesives 4. modifying agentsarestin (local)*minocycline hydrochloride* -microspheres -effective for 20 days -powder becomes sticky paste once in pocket -new tip used to each diseased sitethings to avoid after application of arestin-flossing for 10 days -hard, crunchy, sticky foods for 7 daysside effects of arestin1. infection 2. headache 3. pain 4. flu-like symptomscannot use arestin or atridox on1. pregnant/nursing patients 2. children <8 yo 3. patients w/ tetracycline allergyActisite (local)*tetracycline fiber* -hard to place -continuous release of tetracycline -hydrochloride for 10-14daysperiochip (local)*biodegradable* -2.5mg CHX -pockets >5mm -40% is released in 24hrs -doeses do not need to be replaced if dislodged -cannot floss for 10 daysside effects of perio chip1. URT 2. headache 3. toothachewhich end of the perio chip is inserted into the pocket?rounded endcannot use perio chip on1. pregnant/nursing patients 2. children 3. patients with CHX allergyatridox (local)*10% doxycycline hyclate* -one syringe can treat up to 14 sites -biodegradable -controlled release of antibiotic for 7 days -solidifies at base of pocket -cannot brush/floss for 10 days -inject syringe A into syringe B 100xside effects of atridox1. common cold 2. headache 3. discomfortmetronidazole gel (local)-peak concentration after 4hrs -not as good as minocycline and tetracycline productsperiowave (local)-photodynamic disinfection therapy -inactive subgingival bacteria and enzymes -2 steps: irrigate and illuminateantibiotic used to treat periodontal diseaseclindamycin penicillin doxycycline metronidazoleperiostat (systemic)doxycycline hyclatewhat percent of oral and pharyngeal cancers are attributed to tobacco use?75%BMI =weight/height^2patients that may need nutritional counseling1. osteoporosis 2. osteopenia 3. undergoing dental surgery 4. caries 5. oral manifestations that indicate nutritional deficiencyevaluation of cariogenic potential of diet*induces oral hygiene habits* liquids = 1 solid & sticky = 2 slow dissolving = 3 -sugar exposure occurs every 20mins -multiple exposures by category, then add -score of >9 indicates need for nutritional counselingprimary nutritional deficiencyinadequate dietary intakesecondary nutritional deficiencycaused by a systemic disorder that interferes with the ingestion, absorption, digestion, transport, and use of nutrientsnutritional needs 1-3 days after surgeryliquid diet high in calorie and high proteinnutritional needs 3-7 days after surgery-8 glasses of fluid -small frequent meals -avoid raw fruits/veggies, nuts, foods with seedsdeficiency of these vitamins and minerals is associated with osteoporosisvitamin D calcium phosphorusosteopenia-loss of mineralized bone tissue -precursor for osteoporosistips for successful nutritional counseling-use separate space in office -use measuring cups/spoons and examples to illustrate portion sizes -use visual aids -have brochures readily availablecategories of motionclass I: fingers only class II: fingers & wrist class III: fingers, wrist, & arm class IV: entire arm & shoulder class V: entire arm and twisting of bodyproper use of fulcrum reduces risk ofrepetitive strain injuriesdistance from patient's mouth to clinician's eyes14-16inchesvibrating instruments may lead toRaynaud's syndrometendon gliding exercisediffuses synovial fluidmost common RSIcarpal tunnel syndromecarpal tunnel syndrome-can be caused by cold temperatures and wearing gloves that are too small -may be treated with anti-inflammatory medicines, corticosteroid injectionstiger finger nerve syndrome-inability to extend fingers after flexing -nodule forms on tendonsthoracic outlet compressioncompression of the brachial artery and plexus nerveguyots canal syndromeentrapment of the ulnar nerve as it passes through a tunnel in the wristDeQuervain's syndromeinflammation of tendon and tendon sheath at base of thumbstrained pronator musclecompression of median nerve as it passes under pronator musclelateral epicondylitisinflammation of wrist extensor tendons on lateral condyleradial tunnel syndromeradial nerve becomes entrapped in radial tunnelcubital tunnel syndromecompression of ulnar nerve as it crosses elbowlumbar joint dysfunctionrepetitive twisting and rotating of the spine (ruptured disc)tension neck syndromeinvolves cervical muscles of trapezius (causes pain and stiffness)cervical spondylolysis and cervical disc diseasedegeneration of cervical spinerapid-eye movement (REM) sleep25% of total sleep -"dreaming sleep" -stage 4non-REM75% of total sleep stages 1-317 inch neck sizerisk factor for OSA in men15.5 inch neck sizerisk factor for OSA in womenOSAobstructive sleep apneaghrelina hormone produced by cells lining the stomach that stimulates hunger increased levels during sleep deprivationleptinneurotransmitter produced by fat cells that degenerate appetite -low levels = increased apptiteinsomniamost common sleep disorder -inability to initate or maintain sleephyponeareduced airflowapneabreathing completely stoppedcentral sleep apneabrain "forgets" to trigger breathing muscles -lack of breaths is not do to obstruction -less common than OSAsleep-related breathing disorders1. primary snoring 2. upper airway resistance syndrome (UARS) 3. obstructive sleep apnea% of oxygen in the air we breath21%OSA increases risk ofheart attacksOSA is more common inmen (24%) compared to women (9%)hypoxemialow oxygen in the bloodsigns/symptoms of OSA-excessive daytime sleepiness -snoring -hypertension -GERD -nocturia -mood swingsrisk factors for OSA-age (loss of muscle tone) -genetics -obesity -gender -neck size/posture -dental manifestations (nocturnal bruxism, hypertrophic/scalloped tongue) -smoking/alcohol consumption -mouth breathingdirection of eyes in NWPdownwardneutral working postureNWPplacement of elbows in NWPclose to body bent @ 90 degrees or moreshoulders in NWPrelaxed at lowest positionpeachcompositeorangegolddark blueporcelainlime greenPFMpurpleamalgamamoxicillin2.0gclindamycin600mgelevated blood pressure120-129 mmHg systolic less than 80 mmHg diastolicstage 1 hypertension130-139 mmHg systolic 80-89 mmHg diastolicstage 2 hypertensionsystolic above 140 mmHg diastolic above 90 mmHg