Dental Hygiene Board Review: Clinical Hygiene/fluoride And Antimicrobials

Front 1

Biohazard Waste

Back 1

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

Front 2

Personal 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 (occurs through a contaminated object)

Front 3

Ideal qualities of disinfectants:

Back 3

-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?"

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 ranges

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 (max centrals protrude)

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" that provides an irritant for the gingiva

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 of enamel happens at what pH?

Back 44

pH drops below 4.5 to 5.5

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

Do you need to polish teeth before applying fluoride?

Back 49

No- 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

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: can't eat for 30 min after

Recomended for bulimics

2%

Front 56

sodium fluoride varnishes

Back 56

-professionally applied topical fluoride
NOT for home use

-used for desensitizing exposed roots and caries prevention

-retained for 24-48 hours (substantivity)

-repeated 2-4 times a year

-more effective in caries reduction than topical

5%

Front 57

stannous fluoride

Back 57

-unstable solution and must be mixed fresh

-unpleasant taste

-stains demineralized areas and margins of tooth colored restorations due to reaction of fluoride tin ion

-gingival slouging

-8%

Front 58

acidulated phosphate fluoride

Back 58

-contraindicated in the presence of tooth colored restorations and porcelain (etches glass causing surface roughening or pitting)

-1.23%

Front 59

fluoride safety with children

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, hyperflexia

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

-open embrasures

-exposed Class IV furcations

-orthodontic appliances, fixed prothesis, and dental implants

inner wire should be plastic coated

Front 67

tufted brush

Back 67

-open proximal spaces

-hard to access areas such as 3rd molars and crowded teeth

-irregular gingival margins of rotated anterior teeth

-fixed prostheses such as under fixed partial dentures, pontics, and orthodontic aplliances

Front 68

toothpick (holder)

Back 68

-use in exposed furcations!!

-interdental cleaning-concave proximal surfaces

-gingival margins above orthodontic appliances

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

-those who are physically challenged

Front 71

Oral irrigator

Back 71

disrupts *loosely* adherent plaque and flushes debris and food particles around orthodontic appliances

Front 72

Active ingredient in dentifrices for caries

Back 72

fluoride

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

designed to smooth root surfaces

face of blade is 60-70 degrees offset to terminal shank

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

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

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

alters bacteria cell wall

side effects:
burning sensations
slight extrinsic staining possible

Front 88

quaternary ammonium compounds

Back 88

ex: Scope

cetylpyridinium chloride

interacts with bacterial membrane to effectively kill bacteria

reduces biofilm and gingivitus

Front 89

Fluoride Rinses

Back 89

retained in saliva and dental plaque to prevent caries

indicated for:

high caries risk

ortho/prothetic patients

xerostomia

recession/demineralization

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

Front 93

PPE provide barriers to minimize exposure to:

Back 93

-Aerosol: invisible airbone particles that remain in air for awhile

-Spatter: visible airborne particles of blood/saliva that drop quickly to the floor

-Direct transmission: occurs through direct touch

-Indirect transmission: occur through contaminated object

Front 94

Should not be used as a surface disinfectant due to toxic effects of fumes , also corrosive

Back 94

Glutaraldehydes

Front 95

Levels of surface disinfectants

Back 95

-High: used in surgical areas

-Intermediate: used in dental offices

-Low: used at home; not acceptable for use in dental office

Front 96

Kills all pathogenic microbes, including spores.

Back 96

Sterilization

Front 97

Consideration during chemical sterilization:

Back 97

-Ventilation is necessary

-May damage rubber and plastic items

Front 98

Consideration during dry sterilization

Back 98

-Recommended for metal instruments

-avoid paper products

-May damage rubber and plastic items

-Not recomended for handpieces

Front 99

Consideration during steam sterilization

Back 99

-Corrodes non stainless steel instruments

-Dulls instruments and burs

-OK for some plastics; cotton rolls/gauze

-Paper packages come out wet and tear

Front 100

Overbite

Back 100

vertical overlap of the maxillary incisors to the mandibular incisors

Front 101

Overjet

Back 101

horizontal distance between the linguals of the maxillary anterior incisors and the facials of the mandibular anterior incisors

Front 102

openbite

Back 102

teeth not in occlusion between the maxillary and mandibular teeth or arches

Front 103

edge-to-edge

Back 103

incisal edge to incisal edge

Front 104

end-to-end

Back 104

cusp to cusp

Front 105

supra gingival calculus nutrient source is:

Back 105

saliva (found near opening of salivary gland ducts

Front 106

sub gingival nutrient source is:

Back 106

crevicular fluid and inflammatory exudate

Front 107

Black stain

Back 107

-associated with iron, insoluble ferric sulfide and gram positive bacteria

-typically located on cervical 1/3 of facials and linguals

Front 108

Bluish-green stain

Back 108

-associated from inhaling metallic dust

-most likely from an occupational exposure

Front 109

Brown stain

Back 109

-associated with poor oral hygiene and drinking dark colored beverages (tea, coffee, fruit juices, and red wine)

Front 110

Dark-brown stain

Back 110

associated with tobacco product use

Front 111

Orange stain

Back 111

-chromogenic bacteria in plaque

-associated with poor oral hygiene typically located on anterior teeth

Front 112

Yellow-brown and brown

Back 112

-can be associated with chlorhexidine use or stannous fluoride

Front 113

stannous fluoride stain results from the reaction of the _______ in the fluoride

Back 113

tin ion

Front 114

Green Stain

Back 114

associated with poor oral hygiene, chromogenic bacteria, fungi, and gingival hemorrhage

Front 115

Best choice for stain removal on cementum

Back 115

instrumentation

Front 116

Intrinsic (endogenous) stain causes:

Back 116

-pulpal necrosis

-internal resorption

-excessive systemic fluoride or tetracycline use during tooth development

Front 117

Demineralization of cementum occurs at what pH?

Back 117

6.0-6.7

Front 118

EPA monitors concentration level in _____ water
FDA sets limits in ____ water

Back 118

community drinking

bottled

Front 119

Compounds used to fluoridate water include:

Back 119

sodium fluoride
sodium silicofluoride
hydrofluorosilicic acid

Front 120

Rinses contain what percentage of NaF

Back 120

0.05%

225 ppm

Front 121

Dentifrices contain what percent of fluoride

Back 121

400-1500 ppm

Front 122

Gel contains what percent fluoride

Back 122

0.4%

1,000 ppm

pH 2.8- 5.0

Front 123

Wedge stimulator

Back 123

use in interdental areas with exposed root surfaces

moisten before use

Front 124

Chronic fluoride toxicity

Back 124

-skeletal fluorosis

-dental fluorosis

Front 125

Skeletal fluorosis

Back 125

-results after long term exposure (10+ years) of water containing 8-10ppm or industrial exposure

Front 126

Dental Fluorosis

Back 126

-hypomineralization caused by excessive ingestion of fluoride (2 ppm+) during the post secretor maturation phase of amelogenesis (immediate pre eruptive phase)

-indicators for mild= white opacities

Front 127

Active ingredient in dentifrices for tartar control

Back 127

pyrophosphates

Front 128

Active ingredient in dentifrices for antihypersensitivity (3)

Back 128

-potassium nitrate

-strontium chloride

-sodium citrate

Front 129

Active ingredient in dentifrices for antibacterial

Back 129

triclosan

Front 130

Active ingredient in dentifrices for whitening

Back 130

carbamide peroxide or hydrogen peroxide

Front 131

5-6

Back 131

anterior and premolars

Front 132

7-8

Back 132

direct facials and linguals of posterior teeth

Front 133

sonic scalers

Back 133

-Use compressed air; less power

-elliptical or orbital strokes

- 2,500-7,000 cps

-all sides of tip are active

Front 134

Ultrasonic Magnetostritive

Back 134

-uses stack of metal strips in insert to convert energy from handpiece to insert tip

-18,000-45,000 cps

-elliptical or orbital strokes

-all sides of tip active; most active is the point

Front 135

Ultrasonic Piezoelectric

Back 135

-uses ceramic rod to produce mechanical vibrations

-linera strokes

-25,000-50,000 cps

-lateral sides of tip most active

Front 136

Consideration to evaluate before use of cavitron

Back 136

-demineralized surfaces

-exposed dentinal surfaces

-titanium implants

-communicable diseases or respiratory conditions

-susceptible to infection

-restorations

-dentures

Front 137

Considerations for use of polishing

Back 137

-xerostomia

-demeneralized areas or decay

-tooth sensitivity

-newly erupted teeth

-severe gingivitis

-lack of extrinsic stain/plaque

-exposed root surfaces

-respiratory disorders

Front 138

Air polishing

Back 138

slurry formed by forced air and sodium bicarbonate or aluminum trihydroxide mixed with water accomplished by erosion

Front 139

indications for use of air polishing

Back 139

-stain and biofilm removal

-root detoxificaiton

-sealant prep

-soft debris removal around orthodontic appliances

Front 140

At home rinses

Back 140

saline rinses: after nonsurgical periodontal therapy (salt water)

fluoride rinse: to prevent dental caries

Front 141

Clinical uses of Chlorhexidine Gluconate

Back 141

-pre procedural rinse

-decrease supragingival bacterial plaque formation

-short term adjucntive therapy following surgical treatment

-implants

-suppress streptococcus mutans

Front 142

Stains teeth, tongue, and tooth colored restorations as most common side affect

can also cause dysgeusia (altered taste) and irritate/burn oral mucosa

Back 142

Chlorhexidine Gluconate

Front 143

Why shouldn't you recommend alcohol containing rinses

Back 143

if they are being treated with disulfiram can combine and induce nausea and vomiting