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Dental Hygiene Theory Quiz #3 Prep
Terms in this set (487)
_____ is a new term for dental plaque.
Biofilm always ____ and ____ immediately.
It takes how long for biofilm to develop after brushing or professional prophy?
Dense, noncalcified, highly organized bacterial mass, firmly adherent to the teeth or other hard materials within the mouth. What is it?
Dental Biofilm can not be washed off by ______ or ________.
saliva; water flow
What 6 things affect the formation of biofilm?
3. Salivary flow
4. Oral hygiene
5. Tooth alignment
6. Systemic disease
What are the liquids and fluids, (such as gingival crevicular fluid and polysaccharides bacterial waste products), that make-up the biofilm?
Biofilm Matrix (intracellular)
What is stage 1 of the formation of Biofilm?
What is stage 2 of the formation of Biofilm?
Bacterial Adherence and Colonization
What does acellular mean?
There are no cells present
The acquired pellicle can form on the tooth surface within _____ to _____ minutes.
What are the 5 characteristics of an acquired pellicle?
3. Tenacious amorphous membrane
4. Its very sticky and suction cups to the tooth
What are the 2 types of acquired pellicle?
supragingival and subgingival
What are the 2 types of supragingival pellicle?
Stained and Unstained
Where do stains come from in supragingival pellicle?
The most common is tobacco, beverages, and food
Where is subgingival pellicle located?
It's embedded into the tooth structure, particularly where there are pits and fissures, rough surfaces and demineralization.
How does the Acquired Pellicle attach to the teeth?
A large coat of saliva that covers the teeth have glycoproteins trying to attach to the rough surface of enamel.
Pellicle forms on the tooth surface by ________ of protein components from _________.
selective absorption; the saliva
The _______ has finger-like projections that attach to the rough surfaces and slide into rough areas mixing with the __________ that are found inside the enamel fluid. At this time, the acquired pellicle becomes ______________.
subgingival pellicle; hydroxyapatite crystals; highly insoluble
Name the 4 significances of the Acquired Pellicle.
3. helps in colonization of bacterial plaque
4. Adheres to dentures, restorative dentistry, braces, tongue, tissue, etc.
_______ in the saliva that are involved in developing biofilm come in contact with _________ and attach.
All bacteria; acquired pellicle
The first bacteria to become established in biofilm formation is ____________.
streptococcus and actinomyces
These bacterial masses will set up ______ and adhere __________.
colonies; all over the teeth
Bacteria cells are _______ charged.
Calcium ions are _______ charged.
Acquired pellicle is _________ charged.
_______ catches a ride with _______ and brings it to the ________.
Negatively charged bacteria; positively charged calcium ion; negatively charged acquired pellicle
When the bacteria adheres to the teeth using appendages, it's ________ with the ________.
bonding; acquired pellicle
What days do most changes occur for bacterial colonization?
What 3 things happen by day 2-4 for bacterial colonization?
1. Quantity of bacteria increases
2. Gram positive cocci are still present
3. Filamentous gram negative cocci and rods can be found
What 3 things are happening by day 4-7 for bacterial colonization?
1. Filaments increase and more mixed flora with gram negative rods, filamentous forms and fusobacteria.
2. Biofilm thickens by gingival margin and develops mature bacteria w/ spirochetes and vibrios.
3. Oxygen supply has decreased and anaerobic bacteria appear.
When is clinical gingivitis evident?
What day does inflammation (Gingiva) BOP occur?
Mature plaque has ______ and _______.
Where do nutrients for these microorganisms come from and what increases it?
The gingival crevicular fluid. The nutrients increase when the pocket is infected.
On day 7-14, white blood cells __________ to fight the infection and diseased tissue. Large number of _______ and ____________ microorganism appearing.
increase; gram negative; anaerobic
On day 4-7, oxygen supply __________ greatly and __________ (_____) bacteria appear.
decreased; anaerobic (O2 intolerant)
On day 4-7, filaments __________ and more ______ with gram negative ________, _______ forms, and _________.
increase; flora; rods; filamentous; fusobacteria
What is the base composition of dental biofilm?
8. epithelial cells, leukocytes, and macrophages
What percentage of biofilm is water and what percentage is inorganic and organic solids?
80% water; 20% organic and inorganic solids
The composition and bacteria found in dental biofilm can _______________.
vary from person to person
_______ biofilm is coronal to the gingival margin and is associated with gingivitis and dental caries.
Formation of biofilm starts at the ______________ and increases _______ when left undisturbed and spreads over the _______________ toward the _______ and onto the top of the crown.
gingival margin; rapidly; gingival third; middle third
Supragingival biofilm is mainly ______ and ______.
aerobic and streptococcus
Supragingival biofilm creates an environment that permits ____________.
the development of subgingival biofilm
Subgingival Biofilm results from ______________________.
apical progression of microorganisms in the supragingival biofilm
Subgingival biofilm attaches to ______, ______, and even the ____________.
tooth; root; pockets epithelial lining
At times subgingival biofilm will just ________________.
float around in the pocket
________ biofilm is mainly anaerobic.
Subgingival biofilm receives nutrition from _______________.
the gingival crevicular fluid
What are the 3 organizations of Subgingival Biofilm?
1. Tooth-surface Attached
3. Epithelium Associated
The "fluid" biofilm contains many ________.
white blood cells
What is Tooth-surface attached subgingival biofilm? And what is associated with it?
Over top the pellicle, which covers the tooth surface, is a layer of densely packed microorganisms.
- calculus formation
- root caries
- root resorption
______ focuses on keeping unattached subgingival biofilm rinsed out of the pocket.
Between the layers of attached biofilm are many ______________.
motile gram-negative organisms
Epithelium associated subgingival biofilm is associated with what?
the advancement of periodontal infection
Loosely attached to the pocket lining are many __________ and numerous ____________.
gram-negative microorganisms; numerous white blood cells
Epithelium associated subgingival biofilm causes _______ which breaks down the connective tissue and advances toward ______.
inflammatory response; bone
_______ is the 1st step for dental calculus formation.
Dental calculus is the last stage in __________.
the maturation of dental biofilm
Calculus is derived from the Latin word meaning ________.
pebble or stone
______ itself is not harmful, rather the rough surface is ___________, which causes irritation.
Calculus; collecting bacteria
Calculus has to be _____________.
When mature calculus is _______ if not _______ bone or ___________.
just as hard; harder than; porous
Define dental calculus.
mineralized dental biofilm that is a hard mass that forms on the crown and root, it also can form on dentures and other prostheses.
addition of mineral elements, such as calcium and phosphate, to the organic tissue which results in hardening of these substances.
process by which organic tissue becomes hardened by a deposit of calcium and other inorganic salts within its substance.
intercellular or intermicrobial substance of cells and tissue, or tissue from which a structure develops, gains support, and is held together.
Calculus results from _____ that is saturated with high concentrations of _______ and ______. The ions become entrapped into the _____.
saliva; calcium; phosphate ions; biofilm
Dental calculus is ______ mineralized.
What are the 6 steps in calculus formation?
1. Pellicle formation
2. Biofilm maturation. Microorganisms settle into the pellicle layer.
3. Mineralization starts at the center of the tooth outward.
4. Mineralization starts within the intermicrobial matrix and occurs within the body of the bacteria with age.
5. Not all plaque will mineralize, it depends on the amount of calcium and phosphate ions found within the saliva.
6. Several crystals are involved in the mineralization.
What are the 4 main crystals involved with the mineralization of dental calculus?
2. Octacalcium phosphate
Mineralization (undisturbed biofilm) occurs withing _________ hours.
The average time is about ________ for the mineralization of biofilm to be complete. Which is about _______ days.
2 weeks; 10-20
Calculus formation depends on what 6 factors? These factors can lead to ______ calculus within ______ days or less.
3. Disabled patients unable to practice good oral hygiene
5. Heredity factors
6. Saliva high in calcium and phosphate
Attachment of calculus to the teeth can be accomplished by what 3 modes of action?
1. acquired pellicle
2. irregularities in the tooth surface
3. direct contact between calcified intercellular matrix and tooth surface.
Acquired pellicle is between ______________.
the calculus and the tooth
What mode is calculus easy to remove?
What mode is calculus difficult to remove?
Irregularities in the tooth surface
Acquired pellicle has no _______ or ______ with enamel or _______.
interlocking; penetration; cementum
What irregularities in the tooth surface does calculus attach to?
cracks, pits and fissures, or rough root structure
It's easy to tell that all the calculus has been removed when it's attached to tooth surface irregularities. T or F
False; it's difficult
Biofilm can slip into _______________ where it will mix with the __________ of the cementum and these two ______ together.
spaces in the enamel and cementum; intercellular matrix; mineralize
Direct contact between calcified intercellular matrix and tooth surface results in what?
an interlocking of organic crystals
Direct contact between calcified intercellular matrix and tooth surface makes it _______ to distinguish between calculus and ______ when assessing the tooth.
Hydroxyapatite make up what 4 things?
_______% of mineralized dental biofilm is inorganic.
What 6 components make up mineralized dental biofilm?
Enamel is ____% inorganic (_________).
Dentin is _____% inorganic.
Cementum and bone is ____% inorganic.
What % of dental calculus is organic?
What is the composition of calculus?
Mineralized biofilm, microorganisms epithelial cells, leukocytes from saliva, fats, sugars, and carbohydrates.
What are the 2 types of calculus?
supragingival and subgingival
How is supragingival calculus formed?
Calcifies on the clinical crown coronal to the gingival margin and develops coronally.
Where does supragingival calculus get its nutrition and minerals from?
What are the 9 clinical characteristics of supragingival calculus?
1. See directly or with mirror
2. located on clinical crown
3. use of air for detection
4. stained by tobacco or coffee
5. white, yellow, or grey color
6. Hard surface covered with plaque
7. most frequent sites are md ant. lingual incisors, mx buccal surface
8. commonly seen in children
9. signs of gingival inflammation
How is subgingival calculus formed? And what does it not develop from?
On the clinical crown, apical, the gingival margin and it develops apically. Does not develop from supragingival calculus.
Where does subgingival calculus get its nutrition from?
gingival sulcular fluid
As _____ increases in the pocket, the ______ will increase, making minerals needed for mineralization available.
What are the 8 clinical characteristics of subgingival calculus?
1. extend to base of pocket
2. more difficult to detect
3. seen below gingival margin when using air
4. feel roughness and hit when probing - false readings
5. heavier in proximal areas
6. not common in children
7. transillumination see shadows
8. gingival changes present
What 4-5 things do you use to detect calculus?
1. Direct vision
3/4. 11/12 explorer or probe
5. disclosant which is for biofilm only
In some populations ____% of the people older than 30 years old have dental calculus and everyone has dental plaque.
What 8 factors affect biofilm and calculus accumulation?
1. crowded teeth
2. rough surfaces
3. hard to reach areas: 3rd molars
6. poor oral hygiene
7. saliva - pyrophosphate vs. calcium and phosphorous
The occurrence of biofilm and calculus increases with ____.
Biofilm and calculus can be at _______, localized or ______, in primary or _______.
any age; generalized; permanent
Calculus without bacteria present is not harmful. T or F
Subgingival biofilm develops as a result of ____________ of _________ plaque.
downward growth; supragingival
Subgingival calculus can be present without supragingival calculus and does not develop from supragingival calculus. T or F
Where does subgingival calculus get its nutrition from?
The oral cavity has a unique environment and facilitates growth of microorganisms such as _________, __________, and ___________.
bacteria; fungi; viral
The oral cavity is a __________ environment due to temperature along with ________ and other factors.
_____________ periodontal disease is a bacterial infection.
Inflamed tissue is referred to as ___________, which can usually _________.
gingivitis; be reversed
When bacteria affect deeper structures of the tooth. Connective tissue and bone is included.
Functional unit of tissue surrounding and supporting the tooth.
What is the function of the Alveolar Bone?
To support the teeth and provide attachment for the periodontal ligaments.
What is the function of periodontal ligaments?
To attach the root of the tooth to the alveolar bone, acting as shock absorbers and keeps the tooth within the socket.
What is cementum and what is its function?
It's bone-like connective tissue that covers the tooth from the CEJ and around the apical foramen, providing attachment for the periodontal ligaments.
What is the function of the gingiva?
It acts as a protective covering shield.
This is the space between the free gingiva and the tooth; measured with the probe.
____________________ seeps from the connective tissue through the _____________ of the sulcus or pocket.
Gingival crevicular fluid; epithelial lining
A healthy sulcus produces __________ fluid.
slight to no
Gingival crevicular fluid tries to do what?
Keep the bacteria washed out of the sulcus
When ______ is present, the gingival crevicular fluid will increase; therefore, when gingivitis or periodontitis is present, the gingival crevicular fluid will ________.
For the gingival sulcus to be considered healthy, the probe depth needs to be _______ mm with ________.
1-3; no bleeding
Periodontal disease is a generic term for all types of pathological involvement of periodontal tissue; including gingivitis. T or F
Studies conducted in ______ and _________ concluded that _________ is not caused by any specific bacterium, but a variety of bacteria participate in the disease.
the late 1800's; early 1900's; "pyorrhea"
Gingivitis is when _________and when it affects the __________________ it is referred to as periodontitis.
soft tissue is inflamed; connective tissue and bone
Periodontal disease develops from what? And what does this contrast and why?
A combination of microbes. This contrasts the classical definition of a disease in which the host deals with only one disease.
Periodontal disease is a ________ infection because ___________ are present.
mixed; several different types of bacteria microbes
What were the two past Plaque Hypotheses? And what is the current theory today?
Non-Specific Hypothesis and Specific Hypothesis. The current one today is Host-Bacterial Interaction Theory.
What year was the non-specific hypothesis popular?
1965 - 1975
What year was the specific hypothesis popular?
1975 - 1985
According to non-specific hypothesis, plaque/biofilm leads to __________ and that leads to ___________.
What is non-specific hypothesis?
The progression of disease relates to the overall amount/quality of plaque present rather than composition; the more plaque and calculus, the more disease.
Research for non-specific hypothesis demonstrated that if ______ is allowed to accumulate, _______ results and with plaque removal, normal oral hygiene health will resume in ________ days.
plaque/biofilm; gingivitis; 7-10
Why did some practitioners disagree with non-specific hypothesis? And what 3 reasons do they have for believing this?
They questioned that plaque leads to periodontitis.
1. Patients would have gingivitis for years and never develop periodontitis
2. Patients with little plaque experience severe periodontitis destruction
3. Patients with excellent oral hygiene habits would develop periodontitis
What is specific hypothesis?
only "specific" bacteria attribute to the various periodontal diseases
Over ______ bacterial species are found in the oral cavity; only ________ cause periodontal diseases.
700; a few (20)
According to specific hypothesis, bacteria found among healthy sites, _________ sites and _______ sites all differ.
The 7 "Specific" bacterial populations that have been identified for periodontal diseases are:
2. Adult periodontitis
3. Acute Necrotizing Gingivitis
4. Juvenile periodontitis
5. Rapidly progressive periodontitis
6. Prepubertal periodontitis
7. Other gingivitis associated with hormonal changes
What hormonal changes are associated with forms of gingivitis?
2. Oral contraceptive use
What is Host-Bacterial Interaction Theory?
Interaction of the host with the pathogenic bacteria that controls whether or not periodontal disease is present.
Everyone is equally susceptible to periodontitis. T or F
False, everyone is not equally susceptible
What are risk factors to periodontitis according to the current theory?
1. Local oral conditions
2. Systemic disease
4. Genetic factors
What microorganisms are found in healthy sulcus?
Biofilm harbors simple bacteria that are gram positive cocci and rods, predominantly aerobic
What microorganisms are found in severe gingivitis?
Biofilm is characterized by a gram-positive and filaments (actinomyces), however, gram-negative and anaerobic organisms are nearly as numerous (fluoctobacterium). Large amounts of plasma cells, lymphocytes and macrophages are present.
What microorganisms are found in periodontitis?
biofilm characterized by gram-negative and anaerobic bacteria
study of the cause of disease
Dental biofilm is the single most _______________ in the developmental of periodontal diseases.
Dental biofilm and saliva allows the perfect environment by supplying _____, _________, and _________ for the bacteria associated with these infections to multiply and live.
water; nutrition; air
________ are a favorable environment for the production and growth of microorganisms.
Biofilm microorganisms invade the ________ and cause inflammation by their production of ________, ________, or __________.
gingival tissues; toxins; enzymes; antigens
Soft deposit when mineralized become _______, which harbor bacteria causing irritation.
Dental Calculus is a _________ in the development of periodontal disease because it provides a haven for the collection of ________ masses on the rough surfaces, which results in greater ________ of the periodontal tissues.
predisposing factor; bacterial; irritation
_______ of the gingiva is the most common form of gingival disease.
Inflammation is the response of living tissue to _____ or ______ and is the _____ response of periodontal tissue to fight infection.
injury; infection; primary
The inflammation caused by the biofilm gives rise and is associated with __________ and increases _______ sometimes resulting in changes in the gingival tissue.
degenerative (breakdown) destruction; blood flow
An initial gingival lesion occurs in ______ days.
What are the 2 main characteristics of an initial lesion?
1. An increase in the # of WBC in the sulcus, and the gingival crevicular fluid increases
2. There is no clinical evidence of change
An early gingival lesion occurs in ______ days.
Is an early lesion reversible?
Yes, it can be totally reversed
What are the 3 characteristics of early lesions?
1. Biofilm becomes older and thicker
2. Breakdown of the collagen fibers supporting the gingival margin
3. Clinically there is slight gingival enlargement and possible bleeding upon probing, if left undisturbed gingivitis will develop
When does an established gingival lesion occur?
After 14 days
What increases with an established lesion?
The gingival crevicular fluid and plasma cells are predominant.
What cells are related to areas of chronic inflammation?
What are the 3 characteristics of an established lesion?
1. Ulceration of epithelial lining; BoP
2. Formation of gingival pocket
3. Clear evidence of inflammation is present with marginal redness, BoP, spongy marginal gingiva, this is reversible
In an established legion, if ________ destruction continues to connective tissue, ______ support is lost. Can the damage be reversed?
collagen; fiber; It cannot be totally reversed
An established gingivitis lesion may ______________________, or it may
remain stable for several years and never get worse
Not all gingivitis will lead to periodontitis. T or F
When progressing to periodontal disease, the extension of inflammation will spread through the connective tissue and enter the _________. Is this reversible?
alveolar bone; this is not reversible
Inflammation spreads through the ________, weakening the ______, and into the periodontal ________.
bone marrow; bone; ligaments
When the bone is weakened what happens next in periodontitis?
Periodontal ligaments will be destroyed and bone loss results.
Without treatment to periodontitis, the ______ and __________ will increase, which results in losing teeth.
pocket; bone loss
A diagnosis of gingivitis implies what?
That the actual level of soft tissue attached to the tooth's root is at or above the CEJ (hyperplastic tissue)
Define gingival pocket.
A pocket formed by gingival enlargement without apical migration of the junctional epithelium.
What makes up a gingival pocket?
The tooth wall makes up one side and the epithelial lining makes up the other side.
A diagnosis of periodontal disease implies what? What is this called?
That an apical migration of the epithelial attachment has taken place, creating a deeper sulcus between the tooth and epithelium. A periodontal pocket.
Define periodontal pocket.
A pocket formed as a result of disease or degeneration that caused the JE to migrate apically.
What makes up a periodontal pocket?
Cementum of the root is one side of the pocket and the epithelial lining makes up the other side.
Inflammation is a disturbance in _________.
What attempts to destroy the irritant and return the tissue to normal?
What are the 5 cardinal signs of inflammation?
heat, redness, swelling, pain, loss of function
Define predisposing factor.
A factor that renders a person susceptible to a disease or condition.
What are the 8 predisposing factors related to periodontal disease?
1. Personal oral care
2. Diet and eating factors
3. Dental stains
7. Tooth position
What is a materia alba?
A visible soft deposit consisting of microorganisms, leukocytes, salivary proteins, epithelial cells and food particles. It's white in color and and be rinsed pff.
What causes a materia alba?
Poor oral hygiene
How can personal oral care make a person susceptible to disease?
Faulty biofilm control techniques or a lack of motivation
How can diet and eating make a person susceptible to disease?
Food debris consists of particles of food retained in the oral cavity. It doesn't appear to cause gingival irritation even though it contains bacteria.
What makes food debris a risk?
1. Contains bacteria
2. Can leave odor
3. cariogenic food selection
4. soft foods
How can dental stains make a person susceptible to disease?
May lead to tissue irritation by creating a rough surface and it contributes to biofilm accumulation and retention
What are dental stains?
Pigmented deposits on the tooth surface
______ do not cause periodontal disease.
Caries act as a what?
Favorable environment for the accumulation and retention of soft deposits.
How can tobacco make a person susceptible to disease? (4 Reasons)
1. Stains, heat, and smoke can lead to gingival changes
2. Chewing tobacco can produce destruction of the teeth and gingival tissue.
3. Increased prevalence and severity of perio disease in people who smoke or chew tobacco.
________ must be present for calculus to form.
Controlling calculus deposits begin with ______________.
What 4 things relate to tooth position that contributes to accumulation and retention of biofilm?
What factors make the gingiva a risk factor for periodontitis?
1. Position; receded, enlarged, flapped - provides retention areas for biofilm
2. Size and contour-deviation of shape
3. Effects of mouth breathing
_________ leads to changes in size, shape, texture, and consistency of gingiva.
What are 5 strategies for the prevention of periodontal disease?
1. Biofilm control
2. Good home-care, brushing 2-3 x a day, flossing and mouth rinses
3. Increase the patient's awareness
4. Formation time of biofilm and calculus so recommend short recall appointments
5. Educate that gingivitis can lead to periodontitis
Proteins that facilitate bacterial tissue penetration by breaking down structural barriers.
cellular components of gram-negative bacteria which contribute to the inflammatory process
What are the steps of the Dental Hygiene Process of Care?
2. Diagnosis and Prognosis
3. Care Plan
What are the 4 assessments made in the assessment phase?
1. General A
2. Periodontal A
3. Hard and Soft Tissue A
What is the DH prognosis? What are the range of possibilities?
Evaluation of the results expected to be achieved from oral treatment provided by the dental hygienist.
Good, fair, guarded, and poor
_______ can be modified from time to time to reflect changes in patient attitudes, habits, new systemic diseases, targeted microorganisms, etc.
What is a differential diagnosis? Give an ex.
Determination of which condition or disease may be producing the symptoms. Is the diabetes causing the severe gingival inflammation to be worse than normal?
Define DH Diagnosis
identification of an existing or a potential oral health problem that a DH is qualified and licensed to treat
What are the 2 periodontal diagnoses?
Maintained and unmaintained
A maintained perio condition usually have what 5 characteristics?
1. Pockets have not changed since last visit
2. Little calculus/biofilm
3. 5mm pocket with no bleeding and little biofilm/calculus
4. Little bleeding
5. Not changed in 3 years
An unmaintained perio condition has what 4 characteristics?
1. Its localized or generalized
2. Slight moderate to severe inflammation and BoP
3. deep pockets
4. generalized moderate-heavy calculus and biofilm
What is the total care plan?
A sequential outline of the essential services and procedures carried out by the Dentist, DH, and patient to eliminate disease and restore oral cavity to normal and functional health.
What does the total care plan include?
NSPT, periodontal surgery, restorative, prosthetic, orthodontic, and includes referral to help with hypertension, diabetes, oral cancer, etc
What is the DH care plan?
A written blueprint that directs the DH and patient to work together to meet patient's goals using data from the assessment to prioritize and decide sequence of patient care.
_______ is within scope of practice as defined by the _____ practice act.
The DH care plan is incorporated in the patient's _________________.
total care plan
The DH care plan must include what 5 things?
1. individualized care for each patient
2. focus care on patient's needs
3. facilitate communication and collaboration among providers and patient
4. establish patient centered goals
5. foundation on which evaluation of dental hygiene intervention can be based
Have __________ by patient for treatment.
Define informed consent
The patient must be knowledgeable about what the healthcare provider plans and the patient must give permission before the plan is carried out and they understand they can change their mind at any time.
During the implementation phase you provide _________ to patient.
What may be included in the implementation phase? (7 things)
1. case presentation
2. motivation and OH education
5. fluoride treatment
6. antimicrobial therapy
What 4 things happen during the evaluation?
1. judge the outcome of provided therapy/procedures
2. Re-evaluation schedule about 4-6 weeks later to check progress
3. Need for referral
4. Decide recall appointment for periodontal maintenance.
What are the phases of care planning and what phases do DH do?
Phase I, Phase II, Phase III, and Phase IV
DH do only phase I and IV
What is involved in Phase I care planning? (5 things)
1. Biofilm control
2. Dietary counseling
3. Removal of biofilm and calculus
4. antimicrobial therapy
5. restorative caries control
What is involved in Phase II care planning? (3 things)
1. Perio surgery
3. root canal therapy
What is involved in Phase III care planning? (4 things)
1. Final restorations (crown)
2. Fixed or removable prosthodontics
4. Evaluation of restorative work
What is involved in Phase IV care planning? (6 things)
1. Appointments for continuing care and re-evaluation
2. Refining biofilm control techniques
3. gingival conditions
4. occlusion, tooth mobility, furcations
5. other pathologic changes
6. Oral hygiene instruction
What should a DH do before they start care planning?
What are the DH 4 objectives?
1. Eliminate and control etiological factors
2. Eliminate signs and symptoms of disease
3. Restore normal function
4. Maintain health
What are the 9 patient risk factors?
1. Periodontal disease
2. Enamel or root caries
3. Systemic condition
4. Behavioral: noncompliance w/ home care
5. Tobacco use
6. Hormonal consideration
7. Genetic factors
8. Nutritional status
9. Overall health
What factors should be considered before writing a care plan?
1. Patient risk factors
2. Assess patient's oral health knowledge
3. Patient is willing to participate in treatment and take responsibility
Establish priorities of care
Emergency or 6 month recall ask and even record patient's chief complaint
What is the preliminary phase? (4 things)
1. treatment of dental emergencies
2. treat severe abscess, severe decay/extraction, oral cancers, tumors, etc.
3. Anything causing severe infection or pain to patient
4. This may be the patient's reason for the patient's visit
When setting goals, keep in mind what 3 things?
1. Evaluate success or failure of treatment
2. Know if patient is compliant to OHI
3. Care plans and procedures; working for the patient
Identify ______ that will be addressed to meet the patient's ______ in their oral health care or address risk factors.
What are the 3 steps to a successful health care plan?
1. Discuss the importance of patient involvement
2. Discuss the role of the DH
3. Discuss the role of the dentist
The DH can provide appointments every ____ months, but the patient must know how to __________ between these appointments.
3; take care of their teeth.
Combine ____ with _____ development at each appointment. Always discuss patient's ______ or diseases.
theory; skill; conditions
Pockets greater than _____ mm _____ be cleaned adequately with any aid.
Consider what ______ patient already uses and ________or _________
aids/techniques; modify; supplement
_________ number aids recommended. If ____ will do the job, select it over _____ aids that will accomplish the same thing. ________ appointments may be needed before _______ to a second aid.
Minimize; one; two; multiple; progressing
Consider patient's ______________ when presenting techniques. And consider their _________ when determining frequency and selection of OPT aids.
When care planning for instrumentation what 6 things should be kept in mind?
1. Determine degree of involvement
2. Determine # of appointments
3. Determine approach or sequence
4. Circuit vs Segmental Debridement
5. Circuit Fine Scale/Debridement
6. Segmental Periodontal Debridement
When determining the degree involvement, what do you take in consideration?
1. Gingivitis/Advanced Perio, maintained/unmaintained, etc.
2. Perio assessment findings
3. Location and extent of deposits
4. Patient cooperation
5. Type of instruments needed
What do you take into consideration when determining the # of appointments?
1. Based on involvement
2. Evaluate your own abilities
3. Consider PPD and type of calculus
4. What else is planned for the appointment
With ________ scales you are treating a ______, try to complete the patient as soon as possible, don't stretch treatment out over ________ months.
quad; disease; 2-3
Define circuit scaling.
Making a complete circle during one visit
Define segmental scaling.
Breaking the treatment into sections
What should be taken in consideration when determining the approach or sequence?
1. Specify extent of instrumentation
2. Sextant or quadrant
3. Need for pre-medication
4. Degree of involvement
5. Need for LA
6. Half mouth approach
What would permit taking one sextant at a time?
If the patient had moderate to advanced periodontitis with moderate calculus
Why is it not recommended to do arch by arch when scaling?
1. Need for local anesthetic
2. Compare healing
3. Comfort of patient
4. Patient education
5. Cleaning one arch can result in the patient never returning for the other arch; clean the top, no one sees the bottom
Define circuit initial scale.
Scaling as much calculus off as possible; the clinician is not fine scaling at this time. The patient will need to return to complete treatment.
_______ is no longer recommended as patient may never return and tissue heals around __________ calculus ________mm down in PPD, which causes ________ in the future for patient and clinician.
Circuit initial scale; subgingival; 5-8; problems
Circuit initial scale is for who?
1. Acute Necrotizing Ulcerative Gingivitis generalized; generalized acute/painful or hemorrhagic gingival inflammation.
2. Just for emergency
Circuit initial scale must be followed up with what?
periodontal debridement by quadrant
What is circuit fine scale
Complete the circle when scaling/periodontal debridement of the mouth in one appointment.
Class ____ gingivitis, class _____ early, moderate or advance; maintained perio patient should have the circuit fine scale/debridement.
What is recommended for most periodontal involved cases?
Segmental Periodontal Debridement
What are 6 advantages of segmental periodontal debridement?
1. complete healing
2. easier instrumentation
3. opportunity for re-evaluation
4. sense of accomplishment
5. comparison of tissues for patient
6. clinician fatigue
Probing can be _______. Patient's that are _____ may need local _______ for treatment. Clinician can probe the areas before ________.
segmental; sensitive anesthetic; scaling
What are 5 advantages of multiple appointments?
1. Patient's education and motivation
2. Re-evaluation of treated areas, clinician can check healing and areas for residual calculus
3. Confines discomfort
4. Comparison of treated vs untreated areas when educating
5. Completion of healing
Areas of the mouth having problems should be ____________________.
treated right away
When to plan for anesthesia?
Sensitive patients, moderate to heavy calculus with deep pockets needing periodontal debridement
How would you present anesthesia to a patient?
Discuss the condition of gingiva (biofilm and calculus are causing the tissue to be infected, causing bleeding and tenderness). They don't have to be uncomfortable.
What should be specified about the anesthetic?
1. The type of anesthetic
2. Specify injections at each appointment
Patient's with certain health conditions may need _________ or no epinephrine. They may need an anesthetic that is _________ by the _____ and not the liver.
a lower dosage; broken down; lungs
What is the purpose of case presentation?
1. Communicates with patient and discusses treatment and various options
2. Satisfy legal responsibilities for care
3. Encourage collaborative treatment efforts between the patient and clinician.
"Provide patient's with ___________ to make _________ about their oral health and encourage their full ________ in treatment decisions and goals." This is part of the what?
the information necessary; informed decisions; participation; ADHA's Code of Ethics
What can be the MOST difficult part of case presentation?
Addressing the specifics of time and money requirements for treatment.
Never let the patient what?
Take control of their treatment. You have the final say in the patient's treatment because you are a licensed provider and you know what is best.
Make sure the clinician has the patient's ________ before beginning treatment. ______ is the best way and this will cover you ________. When the patient gives this, it becomes a _______ between the DH, the Dentist, and the patient.
informed consent; Written; legally; contract
What 4 things do you keep in mind concerning informed refusal of treatment?
1. Make sure they understand the consequences
2. This is the patient's right and we must understand this
3. Always document in patient's chart or have a form the patient must complete
4. You can dismiss the patient from practice if refusal interferes with the well-fare of the patient or is against the practices beliefs or standards of care
What is the most common to be refused by the patient?
Define "Oral Health Education":
Provision of health information and instruction to people in such a way individuals can apply the information to everyday life and improve their oral health.
What is included in oral health education? (7 things)
1. Educate patient of existing conditions
2. Possible future outcomes if nothing is done
3. Educate oral health conditions
4. Instruction for daily biofilm
5. Motivate patient to have an inner drive to accomplish a particular goal to improve their oral health
6. Introduce new dental products and procedures available to patient
7. Available treatment to patient
What is the goal of OHI?
Improve the quality of health for the patient
The main focus for the DH is regular ___________ from the teeth and adjacent oral tissue to prevent the accumulation of biofilm and ____ which can lead to ______________ and place the patient at risk for ____________________.
removal of dental biofilm; bacteria; gingival inflammation; periodontal destruction
Information can be given to the patient in what 4 ways?
1. Instruction from the DH
2. Self-instruction manual
What 6 steps can a DH use to give instructions to their patient?
1. Watch the patient
2. Make modifications
3. Supervise the patient doing the skill correctly
4. Encourage the patient to practice at home
5. Next appointment evaluate at-home care success
6. Observe for incorrect or correct methods and modify as needed
Extent to which a person's health behaviors coincide with dental/medical health advice
Acquiring knowledge or skills through study, instruction or experience, true learning means that knowledge acquired is used in everyday living
Inner driving force that prompts an individual to act to satisfy a need or desire or accomplish a particular goal
Define preventative dental hygiene.
Efforts to promote, restore, and maintain the oral/overall health of the individual; primary focus of dental hygiene
Define OPT Aids
(oral physiotherapeutic aids) devices such as the proxy brush, end-tuft brush, suprafloss, etc. used for biofilm control. Physical therapy tools for the oral cavity
When assessing the patient's individual needs, take into consideration what 4 things?
1. Review all information gathered
2. Identify the severity of the condition and possible risk factors
3. Use indices for baseline and comparisons
4. Patient's attitudes and beliefs
How to do you plan for intervention? (7 steps)
1. Education level of patient
2. Occupation and social background
3. Factors affecting physical ability
4. Age and mental health
5. Determine current oral health procedures
6. Outline your goals and the patient's goals
7. Explain outcomes expected
What might you have to plan for patient education? (15)
1. Selection of toothbrush
2. Toothbrushing method
4. Mouth rinses
5. Other OPT aids
6. Removable prosthetics
7. Fixed prosthetics
12. Hard to reach areas
13. Disclosing tables
14. Tobacco awareness
15. Interdental care
What 4 steps can you help a patient formulate goals?
1. Show patient conditions
2. Explain the changes and benefits of treatment and daily home care
3. Show patient successful cases: before and after photos
4. Work together to meet goals
In what 3 ways can we implement education in preventative care?
1. Provide a demonstration
2. Show methods for self-evaluation
3. Spread out instruction over several visits
Why must you spread out instruction over several visits?
Learning takes time, too much at once can be overwhelming, and patient's need reinforcement and positive feedback.
Oral hygiene ______ and _________ always come before biofilm and calculus removal and application of caries-preventive agents such as ______ and _______.
education; preventive aids; fluoride; sealants
What 4 things should be taken into consideration during evaluation changes?
1. Is the patient following home care instruction
2. Evaluate gingival conditions and PPD's
3. Use indices and compare to baseline or initial visit
4. Provide counseling for corrective methods when goal is not met
What intervals are appointments?
3, 4, 6, or 12 months
What helps to plan maintenance?
Patient's conditions will decide and reevaluation of home care at each appointment using corrective methods or introducing new products
Tell the patient _______ NOT __________. Be honest and help them improve their condition, when possible.
the truth; what they want to hear
Document _____________ during patient education and any items given.
Learning is more effective when the individual is ______________. _________ is essential for successful learning.
ready and willing to learn; Motivation
What 5 things may interfere with motivation level?
1. Not understanding the importance
2. Fear of disapproval or rejection
3. Addiction to a substance and overcoming the addiction
4. Physical, emotional, and social needs
5. Stress, finances, not knowing
Learning takes place when the individual has _________________.
feelings of satisfaction
Define motivational interviewing
Patient- centered, goal directed methods of communication for eliciting and strengthening intrinsic motivation for positive. This helps the clinician when the patient elicits their own understanding of current oral health status and ideas about needed behavior change without the DH pushing their own ideals.
What are the 4 elements of the "MI Spirit?"
Establish a positive _______________ that is not intimidating Don't _____________ to patient and ________ your ideals.
interpersonal environment; talk down; push
How should DH's show acceptance?
Accept what the patient brings, without approving the conditions
Define absolute worth.
Respecting the patient as an individual who has worth in their own right.
Define accurate empathy
Showing interest in understanding the patient's perspective
Define autonomy support
Allows patients to have independence to choose for themselves.
Confirmation that the patient can change provides support and encouragement
How does a DH show compassion?
Commitment to promoting the welfare and prioritizing the needs of the patient
How does a DH show evocation?
Commitment to elicit patients' assessment of their own strengths and weaknesses in order to draw the motivation for change out of them.
Resist Righting Reflex. What does this mean?
Resist the urge to simply fix the patient's problem but instead maintain a partnership.
How can we understand the patient's motivation?
Determine the patient's own reasons for change rather than focus on the clinician's reasons about why the patient needs change.
What are the 4 main guiding principles to evocate the patients?
1. Resist Righting Reflex
2. Understand the Patient's Motivation
4. Empower the patient
Prior to presentation of OHI and education, question the patient about the ________, ____, frequency of _______, __________ of toothbrushing and replacement. (This should be done with the ______________)
type of toothbrush; toothpaste; toothbrushing; duration; dental history
The ideal place to give patient education is at the ___________, and the ideal time is before ____________, usually during or after _________ has been completed.
dental unit; instrumentation; assessment
Why is patient education before treatment?
Teaching is more effective when you can see biofilm, calculus, and bleeding. But the emphasis is on self-care or home care.
What are the 5 toothbrushing methods?
3. Modified Stillman's
4. Powered Toothbrush
5. Generalized Bass with one area needing Stillman's
What methods help with the delivery of information?
3. Disclosing solution to visualize biofilm
4. Intraoral camera
5. Relate illustrations to patient's condition
6. Demonstration and simple instructions
7. Set goals for the patient
What do you tell the patient when talking about gingivitis?
Discuss biofilm and calculus causing gingival inflammation and that can lead to periodontitis.
What do you tell the patient when talking about periodontitis?
Discuss and show pockets, furcations, bone loss and mobility. Let the patient see and know where these areas are.
What do you tell the patient when talking about dental caries?
Discuss bacterial biofilm breaking down enamel, question the patient's diet and about snacking; may need a nutritional counseling appointment.
What 10 things decide the interdental aid needed?
1. Presence/Absence of interdental papilla
2. Alignment of teeth
3. Shape of teeth
4. Tissue contour
5. Condition of restorations
6. Tightness of contact area
7. Presence of bridges, implants, or orthodontic appliances
8. Patient motivation
9. Effectiveness of patient's self-care and dexterity
10. Size of gingival embrasure
What is a type I gingival embrasure?
An embrasure filled w/ gingiva
What is a type II gingival embrasure?
Slight to moderate recession of the interdental papilla
What is a type III gingival embrasure?
No papilla or extensive loss of the interdental papilla
Anterior crowding or hard to reach 3rd molars need what oral aid?
The end-tuft brush
Open contacts need what oral aid?
Proxybrush or suprafloss
Furcations need what oral aid?
Oral irrigator, Class IV suprafloss, or perio aid
Brushing, flossing, mouth rinse, and other home care aids will reach no more than _______ mm subgingivally.
___________ are materials used to make the presence of the pellicle and bacterial biofilm visible to the patient.
_____________ will not absorb dye. However, disclosing solution adheres to _______________, rough restorations, ___________, and cementum.
Clean tooth surfaces; rough tooth surfaces; decalcification
Disclosing agent is available in liquid tablet form. T or F
What are the 3 types of disclosing agents?
1. Erythrosine dye
2. Florescent dye
3. Two-tone solution
What is the most commonly used disclosing agent? What does it contain and what color does it make the biofilm?
Erythrosine dye; Red #3; pink
What disclosing agent does not stain the teeth and needs a special ultraviolet light to make visible? What color does it make the biofilm?
Florescent dye; bright yellow
What disclosing agent stains older, thicker biofilm one color and thinner, younger biofilm another color? What are those colors?
Two-tone solution. Older = blue; Younger = pink/red
What 6 steps must you take to disclose your patient's teeth?
1. Explain the purpose of the solution
2. Have patient rinse to remove food particles
3. Apply non-petroleum jelly to the patients lips to prevent staining.
4. Dry the patient's teeth
5. Apply the disclosing solution with a cotton swab
6. Have the patient swish with water to remove the solution and then suction
What 3 steps are taken after applying disclosing agent?
1. With a hand mirror, the patient can observe the colored biofilm on anterior and posterior teeth.
2. Explain/Review what biofilm is and what its made of and how fast it can develop
3. Explain/Review how bacterial biofilm can lead to periodontitis or dental caries
What are the 3 main types of open-ended questions to ask the patient?
1. Current self-care practice
2. Knowledge Level
3. Long-term goals
According to the Principle of Ethics of the ADHA, the DH has the _______________________ to "provide oral care using the _____________ of professional knowledge, ___________ and ability to increase the patient's awareness of oral health conditions.
ethical responsibility; highest level; judgement
DH must use _________________ to select appropriate biofilm control devices and methods for each individual patient.
It is a lifelong commitment of the DH to ________________________________ to prevent disease.
keep up on new products and information
The _________________________________ outlines that treatment plans should include the evaluation of biofilm and calculus, plans for education, consideration of the ____________________ aids and assessment, reinstruction and evaluation of the patient's ________________.
American Academy of Periodontology; chemotherapeutic; home care
At the end of each appointment it is the DH responsibility to __________ what has been covered, the education given, and the patient's current home care.
What are the 3 types of floss?
Unwaxed, waxed, and dental tape
What are the 6 characteristics of unwaxed floss?
1. round in shape
2. Thinner than waxed
3. Sharper than waxed
4. Frays when passed over an irregular surface
5. Shreds easily
6. Difficult to work with
What are the 5 characteristics of waxed floss?
1. Round in shape
2. Very smooth surface
3. Helps prevent trauma to tissue
4. Slides easily
5. Strength, durability, and some resistance to shredding
What are the 6 characteristics of dental tape?
1. Flat like tape
3. Great for tight contacts
4. More resistance to shredding than waxed floss
5. Most common "Glide" and "Satin Floss"
6. Most common type of floss used
Sonicare does what?
Oral B does what?
Sonicare - Brush head vibrates
Oral B - Pulsates/rotates back and forth
Sonicare's bristles move against tooth at ________ brush strokes per minute using a wide ______ motion.
Oral B _______ back and forth _______ times per minute. Its pulsating action creates movement in and out __________ times per minute.
30,000; sweeping; oscillates; 7,600; 40,000
Oral B has a ______ brush head.
Sonicare's brush profile is ______ and it's _________ compared to a standard toothbrush.
round; rippled; smaller
What toothbrush creates dynamic fluid action that can agitate oral fluids and dislodge biofilm in contact areas?
What toothbrush can agitate oral fluid and dislodge biofilm in contact areas with a head that allows better adaptation and cleaning of interproximal areas?
What are the 5 Sonicare models?
Sonicare Elite - 7500, 7300
Sonicare Advance - 4700, 4300, 4100
What are the 7 Oral B models?
AdvancePower 400 or 900 series
Advance Power Kids
3D Excel Pulsating Tooth Brush
ProfessionalCare 7000 or 8000 series
Pro-Health 5000 Smart series
What are the features in a Sonicare toothbrush? (5)
2. Extra-soft bristles
3. Quadpacer encourages proper time for each quadrant
4. Large or ergonomic tapered handle
5. Built in pressure sensor, makes a loud noise
What are the features in a Oral B toothbrush? (6)
2. Soft bristles
3. Quadpacer encourages proper time for each quadrant
4. Green interdental tips reach deep between teeth
5. Indicator bristles fade halfway when time to replace
6. Built in pressure sensor, stops pulsations when pressure too hard
No pressure or scrubbing on either Sonicare or Oral B. T or F
Oral B brush is held over ______ at a time at a _______ degree angle to the incisal plane. Move slowly around each tooth for _________ seconds
one tooth; 45-90; 3-5
Sonicare is held over _______ at a time and needs to be angled around ________ or in anterior region. Placement of bristles will depend on __________________.
2-3 teeth; distals; the toothbrushing method
What are the 2 types of mouth rinses given?
1. Plax mouthrinse
2. Scope Mouthrinse
What are some of the ingredients of Plax mouthrinse? (7-8)
3. Alcohol 8.7%
4. Sodium saccharins, sodium benzoate
5. Xanthan gum
6. Tetrasodium Pyrosphosphahte
7. Red #40
What are some of the ingredients of Scope mouthrinse? (7-8)
3. Alcohol 14.3%
4. Sodium saccharins, sodium benzoate
5. Cetylpyridinium chloride
6. Domiphen bromie
7. Blue #1
What is Plax mouthrinse's claim? And what are its 3 flavors?
"Refreshing way to remove more plaque/biofilm than brushing alone." Mint, original, and softmint
What is Scope mouthrinse's claim? And what are its 3 flavors?
"Kills millions of bad germs. Its minty tingle gets breath clean and fresh" Peppermint, smooth mint, and original mint.
What do you do with Plax mouthrinse?
Rinse for 30-60 seconds with 1 Tbs before brushing to loosen and detach biofilm.
What do you do with Scope mouthrinse?
Rinse 30-60 seconds after brushing
Sodium is a surfactant pre-brushing rinse that has research to support the claim. T or F
False. It has no research to support the claim.
What is Tetrasodium pyrophosphate?
an anti-calculus compound that inhibits crystal growth and retards calculus formation
What is Cetylpyridinium Chloride and Domiphen bromie?
They are quaternary ammonium compounds which are to aid in the reduction of biofilm.
What are 3-5 fluoride rinses and fluoride gels for home use?
2. Gel-Kam (Colgate)/Stop (Oral B)
3. Prevident (Colgate)/NeutraCare (Oral B)
What fluoride rinse and gels are over the counter?
What fluoride gels are perscribed?
ACT is ____% sodium fluoride and its ____________. You must rinse with it for ____________ and use it ____ times a day. This is for ____ years and up. Do not eat or drink for _______ after rinsing.
0.05%; alcohol free; 1 minute; 1-2; 6; 30 minutes
Gel-Kam/Stop is ____% stannous fluoride and it has a ____________. You must apply a _______ to the toothbrush and brush for ____________. This is for ____ years and up. Do not eat or drink for _______ afterward.
0.4%; gel-consistency; small ribbon; 2 minutes; 12; 30 minutes
Prevident/NeutraCare is ____% sodium fluoride and it has a ____________. You must apply a _______ to the toothbrush and brush for ____________. This is for ____ years and up. Do not eat or drink for _______ afterward.
1.1%; gel-consistency; small ribbon; 2 minutes; 6; 30 minutes
ACT helps _____ caries and is commonly used in _______, ________, and teens, anyone at a ____ risk for caries.
prevent; children; ortho patients; low
Gel-Kam/Stop help prevent dental caries, ________, and _____ biofilm count.
dentin sensitivity; high
Prevident/NeutraCare help prevent dental caries, ________ or other systemic conditions that cause dry mouth. It's also good for ______ surfaces and patients going through _______ or ______.
xerostomia; exposed root; radiation; chemotherapy
A coated tongue may cause __________. And what bacteria is associated with this?
Halitosis. T. denticola and P. gingivalis
________ bacteria combined with _____ found on the tongue produce volatile __________, which are the primary cause of ___________.
Anaerobic; debris; sulfur compounds; bad breath
What do mouth rinses do for halitosis?
It only hides or covers up halitosis
What 4 reasons are there for tongue cleaning?
1. Retards bacterial and biofilm formation and accumulation on the tongue surface
2. Reduces number of microorganisms
3. Reduces potential for halitosis
4. Contributes to overall cleanliness
Who would need a tongue cleaner?
1. Everyone should brush their tongue
2. Xerostomia, reduces saliva flow which increases bacterial growth
What devices can be used to clean your tongue?
1. Tooth brush
2. Tongue brush
3. Tongue razor/cleaner
4. Always new items to try
How do you clean your tongue?
1. Start on the posterior dorsal region
2. Flatten device against tongue
3. Gently pull the cleaner forward against the tongue
4. Repeat several times covering entire surface, always rinse the tongue scraper under water
What are 3 flossing aids for interdental cleaning?
1. Sper Floss or Tufted floss
2. Floss threaders
3. Floss holders
Super floss/tufted floss is ____ in length with a ____ in. tufted portion adjacent to a ____ in. stiff end.
2 feet; 5; 3
Floss threaders are __________ devices made of stiff yet flexible plastic. Used to carry _____ through the ______ or under the _______.
blunt needle-like; floss; embrasure; appliance
Floss holders are ___-shaped, ___-shaped, or ___-shaped with a handle. With an inch space between two _____ for the floss. It is ____ or single used.
C; Y; U; prongs; reusable
How do you use the super floss/tufted floss?
1. Thread the stiff end of floss under or between the area
2. Wrap tufted portion around tooth or appliance
3. Similar technique as flossing
4. Use thinner portion of floss to go subgingivally
How do you use the floss threaders?
1. Place correct floss length through eye of threader
2. Direct into proximal area, under bridge or appliance and pull threader and floss through and use same technique as flossing when finished pull floss directly out.
How do you use the super floss holders?
1. Grasp handle guide floss to interproximal
2. Push or wiggle floss into contact area
3. Clean mesial and distal with the same technique when flossing
What is super floss/tufted floss best for?
1. Implant abutment
2. open contacts
3. wide embrasures
4. Clas IV furcations
5. Thread under fixed bridge or other fixed appliances
6. Between orthodontic bands/wires
7. Type II embrasure
What is floss threaders best for?
1. Fixed appliances or fixed bridge
3. Lingual bars
What is super floss holders best for?
1. Large hands
2. hates to floss because it hurts fingers
3. Poor dexterity
4. Strong gag reflex
5. Caregivers or parents to use when flossing
6. Type I embrasure
What oral aids are made of wood?
1. Toothpick-in-holder (perio-aide)
2. Wooden Interdental Cleaner (stimudent)
What is the toothpick-in-holder's purpose?
To increase the effectiveness of the traditional toothpick by holding it securely at the proper angle. Inset the toothpick into the plastic handle. Push at least halfway through and then break off the toothpick.
What does the toothpick-in-holder help with?
Helps with biofilm removal at gingival margin, interproximal, Class I, II, or IV furcatons, and ortho patients around fixed appliances.
What technique is used with toothpick-in-holders?
At a right angle, trace the GM around each tooth. To remove biofilm below the GM apply the end at less than a 45 degree angle and keep the toothpick adapted around the sulcus. For interdental cleaning, keep the tip adapted to the tooth and rub the tip against the tooth moving in and out of the embrasure and under contact areas.
Do NOT press too hard with the toothpick-in-holder or what will happen?
It will flatten the interdental papilla or puncture the junction epithelium.
What is a wooden interdental cleaner?
2 inch long device made of bass wood, or plastic
What is the wooden interdental cleaner made for?
Proximal surfaces, when interdental papilla is missing, Orthodontics, fixed bridges, and other appliances
What technique is used with the wooden interdental cleaner?
Patient needs to find a fulcrum on the chin. Hold the base of the triangular wedge toward the gingival border of interdental area and insert the tip slightly toward the occlusal or incisal surface to follow the contour of the embrasure. Move the wedge in and out 3-4 strokes for each area.
When held ________ the wooden interdental cleaner can damage or flatten ___________.
horizontally; interdental papilla
What are 2-4 different Interdental Brushes?
1. Proxy brush or Interdental brush
2. End-tuft brush / Single-tuft brush
End-tuft or single-tuft brushes have group of ____________ and may be flat or tapered. They can be straight or ____________.
small tufts 3-6 mm; contra-angled
What are the indications for an end-tuft or single-tuft brush? (6)oioisten
1. Fixed partial
2. Fixed bridge
5. Hard to reach distal areas on molars
6. Crowding teeth
How do you use the end-tuft or single-tuft brush?
1. Moisten the brush or apply agent
2. Guide brush into area and along the GM
3. Use a rotating motion with intermitted pressure at a 45 degree angle position, the filament tips into the gingival sulcus.
Proxy or interdental brushes come in different sizes ______ or ______ and also _______. Bending of bristles occur from undue force, _________ or the _______ is too small. These brushes do not ________________.
tapered; cylindrical; sponges; wrong angle; space; last very long.
What are the indications for a proxy or interdental brush?
1. Clean interdental areas where papilla is missing or under and around appliances
3. Under fixed bridge
4. Stimulate gingival tissue
5. Used to delivery chemotherapeutic agents between teeth or to root surfaces
6. Great for concave proximal surfaces
7. Class IV furcations, depend on how much you can see
How do you use the proxy or interdental brush?
1. Moisten the brush or apply agent
2. Insert to angle that follows the gingva and move the brush in and out 8-10 times
What are 2 antiseptic mouth rinses? Which is the most effective but needs a perscription?
2. Chlorohexidine - most effective, but needs to be prescribed
What are the ingredients in Listerine?
1. Active ingredients - essential oils: thymol, eucolyntol, Methyl Salicylate and menthol
2. 21.6% alcohol
What are the ingredients in Chlorohexidine?
1. 0.12% Chlorohexidine gluconate
2. 11.6% alcohol with pH near neutral. Used for supra and subgingival irrigation
Listerine and Chlorohexidine is not recommended for who?
Patient's that are sensitive to alcohol or has a history of alcoholism
What is the mechanism in action in Listerine?
Reduction of pathogenic cell wall; breaks down outside of cell, slowing the growth of bacteria.
What is the method action in Chlorohexidine at both high and low concentrations?
At high concentrations, there is cellular penetration that disrupts the cytoplasm proteins of bacteria.
At low concentrations, the membranes are destroyed and there is dispersion of the cytoplasmic content of the bacteria.
You need to wait __________ after brushing to use the Chlorohexidine otherwise the ________ will make the rinse ineffective. This is only used _________________ as it can mask _________ and breakdown ___________ when used for a long time. DO NOT _________ with water as it will wash the agent away.
30-60 minutes; toothpaste; short-term; periodontitis; subgingiva; rinse
What are the 4 adverse reactions of Listerine?
1. Burning sensation
3. Sloughing of tissue
4. Dry mouth due to alcohol
What are the 7 adverse reactions of Chlorohexidine?
1. Temporary loss of taste
2. Bitter taste
3. Burning sensation
4. Long term dry mouth
5. Epithelia sloughing
6. Discoloration of teeth, tongue, and restorations
7. Slight increase of supragingival calculus
What is the efficiency of Listerine? (3 things)
1. Decrease of biofilm and gingivitis by 25-40%
2. No change in the balance of oral flora
3. Substantively is slight
What is the efficiency of Chlorohexidine? (3 things)
1. Biofilm reduction is decreased by 50-60%
2. Reduction of gingivitis by 45-50%
3. Substantively is high
ability of an agent to bind to the pellicle and tooth surface and to be released over an extended time with retention of potency
What factors affect mouth rinse effectiveness? (6 things)
1. Non-toxic and not damaging to tissue
2. No or limited absoprtion
4. Bacterial specifity
5. Broad Spectrum antimicrobial
6. Interfere with bacterial attachment to matrix
Mouth rinses can be considered ________ or __________. What are the 3 important items to consider when recommending a mouth rinse? Mouth rinses are a supragingival procedure as the flid only reaches ______mm into the sulcus.
Cosmetic or therapeutic
1. Alcohol content
2. Sodium content
3. Flavoring agents or coloring
Chlorohexidine and ________ products such as Gel-Kam and Prevident should not be used at the same time.
What is a xerostomia patient?
Somone who has a decrease in normal salivary flow or changes in saliva composition
What characteristics might someone have that has xerostomia? (21 things)
1. Mouth feels sticky
2. Trouble speaking and masticating
3. Painful, burning feeling in the mouth
4. Dry throat
5. Cracked lips
6. Increased sensitivity
7. Thirst all the time
8. Damage to glands: radiation or chemo
9. Sjrogens syndrome: autoimmune disorders
10. Nerve damage to head or neck
14. Immunosuppressed patient
17. Cancer patients
18. Parkinson's Disease
19. Mouth breathers
20. Certain diets and anorexia
21. Blocked salivary gland
What is the clinical or oral effects of xerostomia? (7 things)
1. Heavy/thick biofilm, material alba and debris accumulation that can increase periodontal infection and dental caries
2. Recession high risk for root caries
3. Problems wearing dentures or partials
4. Diet changes because of discomfort
6. Increased gingival inflammation or tender gingiva
7. Difficult swallowing
Have a xerostomia patient avoid _____ and _______ and chew sugarfree hum or gum with ______.
caffeine; alcohol; xylitol
What type of therapeutic agents can a xerostomia patient use? And what is the most common? (8 things)
1. Biotene - most common
2. Non-alcoholic rinses
3. Moisturizing Spray
4. Oral Irrigation
6. Adjunct to perio therapy
7. Alter Micro floral
8. Removal of unattached biofilm
Daily irrigation is effective for ______mm subgingivally.
What are the 6 toothbrushing methods?
1. Sulcular: Modified Bass
2. Roll: Modified Stillman's
3. Vibratory: Stillman, Charters, Bass
4. Horizontal (or scrub)
5. Circular: Fones
6. Vertical: Leonard
What is sulcular brushing? And what methods uses this?
a method in which the end round filament tips are directed into the sulcus at 45 degree angle for the purpose of loosening and removing biofilm. Bass/modified Bass, and Sillman/modified stillman
Stillman is the _________ of Charter. Both are at a _______ angle, but aimed in _________ directions.
opposite; 45 degree; different
Who is the "father of dental hygiene?"
Alfred E. Fones
Who coined the term dental hygiene?
Alfred E. Fones
What did Alfred E. Fones believe and opposed to what?
Dental hygienists should be positioned in dental public health, as opposed to working just in private practice dental settings.
What roles did Alfred E. Fones emphasize?
Education, prevention, and service, with particular focus on mass pediatric prevention.
Who was the first dental hygienist and when was she licensed?
Irene Newman; 1917
Where did Irene Newman work and who was she trained by?
Fones School of Dental Hygiene; Dr. Fones
What was the first dental hygiene program, where, and when?
Fones School of Dental Hygiene; Bridgeport Connecticut; 1913
What 3 things are involved in infection control in the steri-center?
Ultrasonic, meile, and autoclaves
What does the ultrasonic cleaner do?
Removal of debris by cavitation or waves of acoustic energy, they produce cavitation bubbles within the chemical bath and disrupt the bonds that hold particles and bacteria to a surface.
What is the meile?
Automatic unit that cleans and thermally disinfects instruments, uses high temperature high temperature cycle rather than a chemical bath.
What does the autoclave do? How long does it take, the pounds, and pressure?
Sterilization is achieved by heat and moisture and all microbes are destroyed; 15-30 minutes; 250 F or 121 C; 15 pounds per pressure
Where is biofilm thickest?
Around the gingival third
The acquired pellicle can protect the tooth from what?
Biofilm formation depends on what?
The character of the tooth, OHI habits, and types of bacteria
What is the most highly mineralized tissue in the body?
Define dental caries.
Post eruptive transmissible disease involving the demineralization of the dental hard tissue by bacterial metabolism producing acid.
Define extrinsic stains
Occurs on the external surface of the teeth; removed by instrumentation
Define intrinsic stains
Occurs within the tooth surfaces; cannot be removed by scaling and may be acquired during tooth development or after eruption
Develop or originate from sources outside of the tooth
Originate from within the tooth; endogenous stains are always intrinsic.
Where is a green stain? And where is it most frequently found?
Yellow-green to dark green; labial cervical 1/3 of anterior teeth
What is the green stain's bacteria and what is it more specifically?
chromogenic bacteria; It's extrinsic and exogenous
What is dental fluorosis stains? And what is it considered?
White opacities to brown molting; endogenous
What is black line stains? Where is it found? And what is it considered?
Highly retentive black or dark brown stain; Cervical 1/3 of teeth; Etiology is unknown, but it is considered extrinsic
production of smooth glossy mirror-like surface
Coronal polishing is done on the __________ of the tooth.
Define air-powder polisher.
air powered device using air and water pressure to deliver a controlled stream of specially processed sodium bicarbonate or glycine slurry through the handpiece nozzle
material composed of particles of sufficient hardness and sharpness to cut or scratch a softer material when drawn across the surface
microorganisms in the bloodstream that can lead to the development of infective endocarditis.
thin, semifluid suspension of a solid in a liquid
capable of inhibiting bacterial growth and multiplication of bacteria; fluoride is considered bacteriostatic
What are the 4 benefits of polishing?
1. Removes stains
2. Improves esthetics and psychology
3. Pit and fissure sealant preparation
4. Before cementation of ortho bands
What is grit?
Refers to the various degrees of coarseness of an abrasive polishing agent.
Fine grit still removes enamel surface T or F.
What are flour and powder polishes good for?
Very fine and less abrasive, great for gold, porcelain, composites, sensitive or recession area, and sealants.
More pressure, quantity, and dryness, and the faster rotary speeds equal ___________________.
more abrasion and heat-pulpal thermal damage
___________ is used for tobacco stains.
____________ is recommended to use as a non-abrasive "cleaning agent" only.
____________ is the most common polishing method.
You should NEVER polish if the patient has:
4. Hepatitis (A, B, C...)
5. Staph or Strep infection
Dental Hygiene care plans are individualized and always include what 3 things?
prevention, educational and therapeutic treatment
What are the 2 ways to receive fluoride?
Systemically and topically
What fluoride is used for patients with gold, composite, and porcelain restorations?
Sodium Fluoride (neutral)
The sickle is used on ____________________________________.
Supragingival calculus on anterior teeth
Professional topical fluorides are recommended for ____________________.
Primary teeth, incipient decay, ortho, decreased saliva, teeth supporting overdenture
Day 1-2 biofilm
early/young gram positive cocci
Day 2-4 biofilm
Quantity of bacteria increases
Day 4-7 biofilm
Oxygen supply has decreased greatly and anaerobic bacteria appear
day 7-14 biofilm
Inflammation (gingiva) BoP
Clinical gingivitis evident
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