Clinical Dental Hygiene

Front 1

Biohazard Waste

Back 1

-regulated
- items the drip of blood and/or saliva
- hard and soft tissues removed from patient

Front 2

Peronsl Protective Equipment (PPE)

Back 2

-protect the OPERATOR
ex: mask, examination gloves, protective eyewear (side sheilds), protective impervious clothing
-minimizes exposure to:
aerosol (stay in air)
spatter (heavier)
direct transmission (direct touch of infectious agent)
indirect transmission (occures through a contaminated object)

Front 3

Disinfectants

Back 3

You want a broad-spectrum antimicrobial - bactericidal, fungicidal, tuberculocidal, virucidal

*INTERMEDIATE* is used in the dental offices (tuberculocidal)

Front 4

Types of Disinfectants

Back 4

- Chlorine-based compounds
- Iodophors
- Phenols
- Quanternary compounds

"Can't Ian Play Quietly?"

note- Glutaraldehydes should not be used as a surface disinfectant due to toxic effects of fumes , also corrosive

Front 5

Chlorine-base compounds

Back 5

corrosive , strong odor

Front 6

Iodophors

Back 6

discolor (yellow)

Front 7

Phenols

Back 7

may leave a film

Front 8

Quaternary Compounds

Back 8

not corrosive, lower kill spectrum

Front 9

Chemical Sterilization

Back 9

20 mins @ 270* @ 20-40lbs psi
spore test- Geobacillus stearothermophilus

Front 10

Dry Sterilization

Back 10

60-120 mins @ 320-375*
spore test- bacillus atrophaeus

Front 11

Steam Sterilization

Back 11

20-30 mins @ 250*f / 121*c @ 15-30lbs psi
spore test- geobacillus stearothermophilus

Front 12

Sterilization Prep

Back 12

ultrasonic - 10-12 mins
avoid overloadings
single layer
use proper ventilation

Front 13

packaging materials

Back 13

place in autoclave with paper side up
*indicator tape only indicates HEAT processed...does NOT guarantee sterility

Front 14

biological indicators

Back 14

-spore testing- only way to know sterilization occured
-done weekly

Front 15

Questions regarding medical history?

Back 15

call the physician

Front 16

Blood Pressure

Back 16

normal range- <120/80
prehypertension- 120/80-139/89
stage I hypertension- 140/90-159/99
stage II hypertension- 160^/100^

cuff placement is brachial artery

Front 17

Respiration

Back 17

monitors breathing
infants 30-60
children 14-26
adults 12-20

Front 18

pulse

Back 18

beating of heart
infants 100-160 (brachial artery)
children (1-10) 70-120 (brachial/carotid artery)
adults 11^ - 60- 100 (radial)
well-trained athletes 45-60 (radial)

Front 19

Systolic

Back 19

contract (send blood into circulation)

Front 20

diastolic

Back 20

relax (fill with blood returned by circulation)

Front 21

Pregnant patient

Back 21

-treat in 2nd trimester
-latest month is peak for gingivitits

Front 22

chief complaint

Back 22

always addressed FIRST

Front 23

G.V. Black - Class I

Back 23

pits and fissures

Front 24

G.V. Black - Class II

Back 24

posterior interproximal (commonly involves occlusal)

Front 25

G.V. Black - Class III

Back 25

anterior teeth interproximal NOT incisal edge

Front 26

G.V. Black - Class IV

Back 26

anterior teeth interporximal involves incisal edge

Front 27

G.V. Black - Class V

Back 27

gingival 1/3 of any tooth (cervical)

Front 28

G.V. Black - Class VI

Back 28

Incisal edge of anterior or cusp tips of posterior teeth

Front 29

Class I bite

Back 29

mesiognathic
"normal bite"

Front 30

Class II bite

Back 30

Retrognathic
"buck teeth"

div.1 & div. 2 (max. centrals tip lingually)

Front 31

Class III

Back 31

Prognathic
"bull dog"

Front 32

crossbite

Back 32

maxillary teeth are lingual to mandibular teeth

Front 33

Midline shift deviation

Back 33

midline of maxillary central incisors do NOT align with midline of mandibular central incisors

**mandible moves! NOT maxilla**

Front 34

Calculus

Back 34

"mineralized plaque"

supra- nutrient source is saliva (found near opening of salivary gland ducts
sub- nutrient source is crevicular fluid and inflammatory exudate

Front 35

Stain

Back 35

extrinsic (excogenous) - removable via instrumentation and polishing

Black - gram positive bacteria
bluis-green- inhaling metallic dust (occupational exposure)
brown- poor oral hygiene / drinking dark-colored beverages
dark-brown and black - tobacco
orange- chromogenic bacteria in plaque / poor oral hygiene / typically anterior teeth
yellow-brown and brown - chlorhexidine use or stannous fluoride (results from the reaction of the tin ion in the fluoride)
green - poor oral hygiene , chromogenic bacteria, fungi and gingival hemorrhage

**note: if stain is on cementum, instrumenattions is the choice for removal

intrinsic (endogenous) not removable

Front 36

bleeding on probing

Back 36

1st sign of gingivitis

challenges of probing can be over or under angling -- both resulting in false readings

Front 37

Class I Furcation

Back 37

-early evidence of bone loss
-enter the depression leading to the furcation

nabers probe

Front 38

Class II Furcation

Back 38

-moderate bone loss
- instrument can enter furcation , but cannot pass between the roots

nabers probe

Front 39

Class III Furcation

Back 39

-severe bone loss
- instrument can pass between roots

nabers probe

Front 40

Class IV Furcation

Back 40

same as class three with recession (furcation is visible)

nabers probe

Front 41

Mobility - I

Back 41

slight horizontal mobility

Front 42

Mobility- II

Back 42

moderate horizontal mobility

Front 43

Mobility- III

Back 43

sever mobility with possible combined horizontal and vertical movement

Front 44

Demineralization

Back 44

pH drops below 4.5 to 5.5 for enamel and 6.0-6.7 for cementum

these are known as "critical pH levels"

Front 45

Remineralization

Back 45

occurs when pH rises above "critical" levels
area is *stronger and more acide resistant* than original enamal
fluorapatite has been formed

Front 46

Fluoride interferes with ______

Back 46

bacterial metabolism

Front 47

High concentrations of fluoride are

Back 47

bactericidal

Front 48

Low concentrations of fluoride are

Back 48

bacteriostatic
(when done daily, it is more affective than rarely using high concentration)

Front 49

Polish and fluoride

Back 49

Do NOT have to polish teeth prior to application - fluoride penetrates through pellicle and plaque (has substantivity)

Front 50

Systemic fluoride

Back 50

pre-eruptive -> developing teeth (6mo - 14yrs)
-water
-supplements
-food

circulates in the blood stream/ absorbed in stomach and small intestine / amount not used is secreted through kidneys

Front 51

water fluoridation

Back 51

most cost-effective/efficient for community
larger the community = lower cost
smaller community = higher cost

EPA monitors concentration level in community drinking water
FDA sets limits in bottled water

Compounds used to fluoridate water include:
sodium fluoride
sodium silicofluoride
hydrofluorosilicic acid

Front 52

topical fluoride

Back 52

post-erruptive
-water
-toothpaste
-rinses
-fluoride

Front 53

Optimal fluoride level

Back 53

.7 ppm mg/L

(before 2011 optimal fluoride leveles ranged from .7ppm-1.2ppm mg/L depending on climate
warmer = lower concentration .7
colder = higher concentration 1.2 )

Front 54

fluoride in food

Back 54

tea and fish

Front 55

sodium fluoride

Back 55

professionally applied topical fluoride
(neutral) used in the prersence of tooth-colored and porcelain restorations

4 min application

Front 56

sodium fluoride varnishes

Back 56

professionally applied topical fluoride
NOT for home use

Front 57

stannous fluoride

Back 57

professionally applied topical fluoride
-stains demineralized areas and margins of tooth-colored restorations
-gingival sloughing

Front 58

acidulated phosphate fluoride

Back 58

contraindicated in the presence of tooth colored restorations and porcelain

Front 59

fluoride safety

Back 59

children 6 years of age and under should NOT use fluoride rinses because they may swallow it

Front 60

Certainly lethal dose (CLD)

Back 60

amount of drug likely to cause death

Front 61

Safely tolerated dose (STD)

Back 61

one fourth of CLD

Front 62

Acute Fluoride Toxicity

Back 62

symptoms begin within 30 minutes
(think FLUouride like symptoms) - nausea , vomiting, diarrhea , abdominal pain, increased salivation and thirst
systemic -> convulsions, cardiac failure or respiratory paralysis

Front 63

emergency treatment for fluoride toxicity

Back 63

<5mg/kg
1. administer fluoride-binding agent (milk of magnesia)
>5mg/k (toxic dose)
1. induce emesis (vomiting)
2. administer fluoride-binding agent
3. seek medical treatment
>15mg/kg (lethal dose)
1. seek medical treatment
2. induce vomiting
3. cardiac monitoring

Front 64

Bass tooth brushing method

Back 64

for periodontal patients
45* angel toward apex at gingival 1/3 (pressing bristles into sulcus)

Front 65

Stillman

Back 65

for "regular" patients
45* angel toward apex with 1/2 of bristles places on tooth, other half on gingiva

Front 66

Interdental brush

Back 66

inner wire should be plastic coated

Front 67

tufted brush

Back 67

irregular gingival margins of rotated anterior teeth

Front 68

toothpick (holder)

Back 68

use in exposed furcations!!

Front 69

tufted floss

Back 69

"super floss" under pontic of bridge without a floss threader

Front 70

floss holder

Back 70

for a caregiver providing oral hygiene care

Front 71

Oral irrigator

Back 71

disrupts *loosely* adherent plaque

Front 72

Toothpaste - active ingredients

Back 72

therapeutic
a. fluoride
b. tartar-control
***c. antihypersensitivity - contains potassium nitrate, strontium chloride, or sodium citrate ***
d. triclosan - antibacterial
e. whitening

Front 73

Scaler

Back 73

Triangular cross section
pointed top
face of blade at 90* to terminal shank
removes deposits supragingivally and up to 2mm subgingivally
sharpening - stone -> 100*-110* blade-> internal angel should be 70*-80*

Front 74

curet

Back 74

half-moon cross section
rounded toe
face of blade 90* to terminal shank
removes deposits supra and subgingivally
sharpening - stone -> 100*-110* blade-> internal angel should be 70*-80*

Front 75

area-specific curets (graceys)

Back 75

one cutting edge per working end

stroke- beging coronal to edge of JE

Front 76

1-2

Back 76

all anterior teeth

Front 77

11-12

Back 77

mesial, facial, lingual surface of posterior teeth

Front 78

13-14

Back 78

distal surface of posterior teeth

Front 79

15-16

Back 79

mesial surface of posterior teeth

Front 80

17-18

Back 80

distal surfaces of posterior teeth

Front 81

ultrasonic scalers

Back 81

work through CAVITATION
magnetostrictive- elliptical or orbital stroke
piezoelectric- rapid linear strokes (newer piezos have elliptical/linear motion
sonic- elliptical or orbital strokes

Front 82

implant safe curets and scalers are made out of what materials?

Back 82

plastic, nylon, graphite or gold-tipped

Front 83

Types of polishing

Back 83

rubber cup

air polishing - contraindications for use - sodium-restricted diets (hypertensions) can use a sodium-free formula (aluminum trihydroxide)

Front 84

Pulp Vitality Test

Back 84

place on dry tooth middle to gingival 1/3 with toothpaste as conductor- NO pressure, avoid contact with soft tissue or metallic restorations

Front 85

Nitrous Oxide - cylinders

Back 85

Blue = nitrous oxide
OxyGen = Green

Front 86

Chlorhexidine Gluconate

Back 86

.12% approved for use in the US
bactericidal > gram + and gram -
alters cell wall - so lysis occurs - cell destroyed
high substantivity

side effects:
staining of teeth, tongue, and tooth-colored restorations
increase in supragingival calculus

Front 87

essential oils

Back 87

ex: Listerine
control plaque and gingivitis

side effects:
burning sensations
slight extrinsic staining possible

Front 88

quaternary ammonium compounds

Back 88

ex: Scope

Front 89

Fluoride Rinses

Back 89

good for pts who are experiencing xerostomia, have root exposure, and demineralization
do NOT recomment to children under 6 or those who have difficulty swishing and expectorating

Front 90

best mouthwash recommendations for tobacco users

Back 90

non alcoholic mouth rinse - avoid essential oils (listerine)

Front 91

best mouthwash recommendations for cancer patients

Back 91

baking soda/saline solution followed by plain water rinse
chlorhexidine rinse may help reduce inflammation

avoid rinses with high alcohol content if patient has severe mucositis associated with chemotherapy

Front 92

best mouthwash recommendations for acute periodontal conditions

Back 92

warm water or weak saline solution
use chlorhexidine 2x/day