Intro To Dh Exam 3

Front 1

What are the uses of phase-contrast microscopy? (5)

Back 1

1. to assess perio activity

2. evaluate success of therapy

3. allow pt to become involved through visualization of microflora

4. to predict which pt's/intraoral sites are most likely to suffer perio

5. determine how frequently pt should recall

Front 2

What is the reasoning of bacterial cell shapes?

Back 2

to tell how long biofilm has been on there.

Front 3

3 types of bacterial cell shapes?

Back 3

1. cocci

2. bacilli

3. spirochetes

Front 4

What are Cocci and what forms do they come in? examples?

Back 4

1. spherical forms ; come in pairs, chains and clusters.

2. examples : Pair = streptococcus pneumoniae, Chains = streptococci, Clusters = staphylococci

Front 5

Cocci in mouth indicates =

Back 5

clean mouth

Front 6

Most common bacteria in mouth?

Back 6

Streptococcus

Front 7

What are bacilli? example?

Back 7

1. rod-shaped; indicated after being in mouth for a few days. (after cocci)

2. example = lactobacilli

Front 8

When do you seen Spirochetes? Name the spiral forms and examples of each.

Back 8

1. seen after a few weeks of residing in pt's mouth (after bacilli)

2. Curved rods = vibrios, Rigid spiral = spirillum, Flexible spirals = spirochetes.

Front 9

Describe the 4 accumulative changes in biofilm bacteria @ the gingival margin:

Back 9

1. epithelial cells and a few cocci appear in a well-cleaned mouth

2. no cleaning for 1-2 days develops masses of cocci and short rods.

3. no cleaning for 4-7 days pt develops filamentous, leukocyte and fusobacteria

4. no cleaning for 1-2 weeks pt develops vibrios and spirochetes.

Front 10

Name the 4 members of the streptococcus viridans group -

Back 10

S. sanguis, S. mitis, S. mutans, and S. salivarius

Front 11

Most common bacteria for decay?

Back 11

strep mutans

Front 12

What are the etiologic factors (bacteria) found in dental carries?

Back 12

strep mutans, s. sanguis, and lactobacillus

Front 13

Most gram - disease?

Back 13

perio disease

Front 14

What is the composition of plaque w/ healthy gingiva?

Back 14

gram + aerobic cocci and rods

Front 15

Bacteria associated w/ gingivitis in the early stage?

Back 15

actinomyces (filaments)

Front 16

Bacteria associated w/ gingivitis in the late stage?

Back 16

actinomyces, fusobacterium w/ spirochetes elevated at infected sites.

Front 17

Necrotizing ulcerative gingivitis (NUG) is also known as? What all bacteria is involved?

Back 17

1. trench mouth

2. spirochetes, prevotella intermedius and fusiforms

Front 18

What is trench mouth caused from?

Back 18

stress / poor nutrition (poor people)

Front 19

Name the differences b/t subgingival plaque from diseased perio sites and subgingival plaque from healthy gingival crevices - (5)

Back 19

1. types of bacteria present

2. # of microorganisms

3. organization and interrelationship b/t cells

4. coordinated dynamic behavior of bacterial populations

5. inflammatory potential (cervicular leukocyte level)

Front 20

Cocci clusters look like -

Back 20

corn cob

Front 21

4 things involved w/ periodontium?

Back 21

1. gingiva

2. periodontal ligament

3. alveolar bone

4. cementum

Front 22

3 things w/ in gingiva?

Back 22

marginal, attached and sulcus

Front 23

What is peridontal ligament?

Back 23

tissue fibers that surround the root of the tooth and attach to alveolar process

Front 24

What is alveolar bone?

Back 24

bone that surrounds tooth

Front 25

What is cementum?

Back 25

calcified structure covering the root of the tooth

Front 26

Etiology of periodontal diseases :

Back 26

1. gingivitis (plaque associated / non-plaque associated)

2. periodontitis (plaque associated / non-plaque assocated)

Front 27

Characteristics of gingivits? (3)

Back 27

- limited to gingival tissues

- reversible

- all ages

Front 28

Systemic factors of plaque-induced or modified gingivitis -

Back 28

hormones, diabetes, and leukemia

Front 29

Hyperplasia =

Back 29

enlarged gingiva

Front 30

Hormone induced gingivitis is exaggerated by hormonal changes like?

Back 30

puberty, oral contriceptives and pregnancy

Front 31

Specific microbial origin of non-plaque induced? (3)

Back 31

bacterial (gonorrhea), fungal (candida) and viral (herpetic)

Front 32

Non-plaque induced involves what? (5)

Back 32

specific microbial origin, genetic (fibromatosis), systemic conditions, trauma, and foreign body reactions.

Front 33

Malnutrion for biofilm/plaque-induced or modified includes?

Back 33

vitamin C deficiency

Front 34

Types of systemic conditions for non-plaque induced?

Back 34

allergies, lupus and lichen planus

Front 35

3 types of perio disease :

Back 35

1. chronic periodontal disease (long term)

2. aggressive perio disease (rare in young pt's)

3. necrotizing perio disease (death caused by spirochetes)

Front 36

How is gingivitis? (what's w/ in it, bacteria, and gram + or -, anerobic or aerobic)

Back 36

gram - anaerobic rods like fusobacterium and provetella species (Ps), an increase in actinomyces species (filaments) and streptococci sanguis / s. milleri (cocci)

Front 37

Which stage of perio is most common?

Back 37

chronic

Front 38

Associated bacteria w/ in chronic perio disease - (4)

Back 38

porphyromonas gingivalis (Pg) *most important pathogen*, aggregatibacter actinomycetemcomitans (Aa), tannerella forsythia, trponema denticola.

- many spirochetes and vibrios

Front 39

Most important pathogen w/ in chronic perio disease?

Back 39

porphyromonas gingivalis (Pg)

Front 40

Which type of perio disease is associated w/ progressive bone loss?

Back 40

aggressive perodontitis

Front 41

Name all bacteria w/ in aggressive periodontitis - (4)

Back 41

1. porphyromonas gingivalis (Pg)****

2. aggregatibacter actinomycetemcomitans (Aa)

3. prevotella species (Ps)

4. capnocytophaga species

Front 42

Associated bacteria w/ in necrotizing ulcerative gingivitis - (3)

Back 42

1. Ps-strong association

2. spirochetes

3. fusobacterium nucleatum - small #'s

Front 43

Fusobacterium nucleatum is linked to?

Back 43

colon cancer

Front 44

4 stages of gingivitis -

Back 44

1. intial lesion

2. early lesion

3. established lesion

4. advanced lesion

Front 45

Initial lesion for gingivitis is how long? and what all does it involve?

Back 45

1. 2-4 days

2. primary biofilm colonizers, gram - cocci and rods, gram + rods, filaments, and fusobacteria

Front 46

What is w/ in primary biofilm colonizers for initial lesion of gingivitis - (5)

Back 46

1. aerobic gram + at CEJ w/ in 6 hours of prophy

2. streptococci / lactobaccilli

3. expand & colonize rapidly

4. begin metabolizing nutrients

5. give off by-products

Front 47

Subclinical changes for initial lesion of gingivitis - (3)

Back 47

- WBC infiltrate junctional epithelium & sulcus

- increased flow of sulcular fluids

- collagen breakdown begins in gingival fibers

Front 48

What is the gingivia made of?

Back 48

collagen

Front 49

How long is the early lesion for gingivitis?

Back 49

7-14 days

Front 50

Secondary plaque colonizers for early lesion of gingivitis : (4)

Back 50

1. increase in anaerobic gram - forms

2. vibrios, spirochetes, filamentous

3. biofilm is thicker w/ less oxygen

4. most rapid change in first 5 days

Front 51

What are the clinical changes in early lesion of gingivitis? (3)

Back 51

1. possible bleeding upon probing

2. further breakdown of collagen

3. epithelium proliferates

Front 52

Early gingivitis signs are _____________.

Back 52

apparent

Front 53

Is gingivitis reversible w/ biofilm control?

Back 53

YES

Front 54

How long is an established lesion for gingivitis?

Back 54

2-3 weeks

Front 55

In an established lesion, what do the bacteria continue to do?

Back 55

colonize and increase in #'s

Front 56

Clinical signs for established lesion of gingivitis? (6)

Back 56

1. inflammation

2. pocket formation

3. collagen destruction

4. connective fiber loss

5. ulceration of lining epithelium

6. BOP evident (bleeding upon probing)

Front 57

How are the collagen fibers for advanced lesions of gingivitis (variable) -

Back 57

at some point the collagen fibers can be quickly destroyed and the lesion moves apically w/ attachment loss and resorbtion of crestal bone

Front 58

The time frame for advanced lesions is _________ for each individual dependent on host factors.

Back 58

variable

Front 59

For advanced lesions, when the bone & PDL are involved, ____________ is diagnosed.

Back 59

peridontitis

Front 60

List the characteristics for advanced lesion of gingivtis (6)

Back 60

1. epithelium migrates down root surface as junctional epithelium is destroyed and detached.

2. exposed cementum is altered by bacterial products.

3. cementum is filled w/ endotoxins from bacteria

4. mobility, pockets, bone less

5. lesion continues to extend

6. periods of inactivity occur = "episotic"

Front 61

Clincial signs for advanced lesion of gingivitis (2)-

Back 61

1. profuse bleeding

2. visual signs of inflammation

Front 62

What are the 2 direct effects of bacteria?

Back 62

1. highly toxic endotoxins stimulate immune response

2. enzymes that affect permeability of membranes and cause direct tissue damage

Front 63

What are the host defense response or indirect effects of bacteria? (4)

Back 63

1. swelling of gingival tissue

2. increased permeability of bv

3. increase in gingival fluids

4. migration of PMN's

Front 64

What all is bacteria producing to the gingiva?

Back 64

endotoxins and enzymes

Front 65

****What has to occur before carries?

Back 65

recession

Front 66

3 types of periodontal pockets?

Back 66

1. gingival pocket (pseudopocket)

2. suprabony pocket

3. infrabony pocket

Front 67

4 types of periodontitis categories -

Back 67

1. chronic

2. aggressive

3. systemic or genetic disorders

4. NUG/NUP

Front 68

Chronic perio is -->

Back 68

most common & can be generalized/localized

Front 69

Aggressive perio -->

Back 69

rapid bone destruction & can be generalized/localized

Front 70

2 kinds of Systemic/genetic disorders -->

Back 70

leukemia and downs syndrome

Front 71

NUG/NUP is associated with -->

Back 71

poor oral hygiene, poor nutrition, stress/fatique and HIV

Front 72

2 main/basic types of periodontal dieases are -

Back 72

gingivitis and periodontitis

Front 73

7 types of controls for peridontal disease?

Back 73

1. plaque controls

2. antimicrobials

3. tobacco cessation

4. diabetes screening

5. dental factors

6. osteoporosis

7. other factors

Front 74

What all does plaque control involve?

Back 74

1. toothbrushing

2. flossing

3. irrigation (water/antimicrobial)

4. inter-dental devices (brushes/floss holders/toothpicks)

Front 75

3 kinds of antimicrobials for control of perio -

Back 75

1. toothpaste

2. rinses

3. locally delivered

Front 76

2 kinds of antimicrobial toothpastes -

Back 76

triclosan and stannous

Front 77

3 kinds of antimicrobial rinses -

Back 77

chlorhexidine (strongest one), essential oils (listerine), and stannous 0.63% (higher percentage)

Front 78

3 kinds of locally delivered antimicrobials for perio control -

Back 78

1. arestin

2. atridox

3. perio chip

Front 79

Arestin (locally delivered antimicrobial for perio control) -->

Back 79

minocycline HCL 1mg

Front 80

Atridox (locally delivered antimicrobial for perio control) -->

Back 80

10% doxycycline

Front 81

Perio chip (locally delivered antimicrobial for perio control) -->

Back 81

2.5 mg CHX

Front 82

Smokers are ____ times more likely than non-smokers to have perio disease.

Back 82

7

Front 83

Pt's w/ _________________ diabetes are not a greater risk for infections such as perio.

Back 83

well-controlled

Front 84

Pt's w/ uncontrolled ____________ diabetes at an early age are at a greater risk for perio.

Back 84

type 1

Front 85

Type ____ diabetes can go undiagnosed for decades.

Back 85

2 (this type can be an indicator for perio)

Front 86

Due to decreased resistance to infection, dental __________ can results in an increased periodontal tissue response.

Back 86

biofilm

Front 87

List the dental factors associated w/ perio control -

Back 87

1. overhanging restorations, broken teeth, dental carries and calculus will retain biofilm.

2. malocclusion is conducive to plaque formation: crowding, rotated teeth, missing opposing tooth, partial eruptionm open bite and defective contact.

3. III fitting partial denture (or bridge)

Front 88

Osteopenia can result in loss of -

Back 88

alveolar bone loss

Front 89

Greater periodontal attachment loss in pt w/ -->

Back 89

osteoporosis

Front 90

What all is osteoporosis associated with?

Back 90

smoking, nutritional deficiencies, corticosteroid use and immune dysfunction.

Front 91

Other factors for perio control - (6)

Back 91

1. mouthbreathing (leads to changes in tissues)

2. soft retentive diet (leads to more biofilm)

3. reduced salivary flow (leads to increased biofilm)

4. receded gums

5. enlarged gums

6. pockets

Front 92

Where do most diseases begin?

Back 92

interproximally

Front 93

If interdental papilla is reduced in height or cratered you should use what kind of floss?

Back 93

tufted floss, tape or alternative

Front 94

If gums are bulbous and inflamed you should use?

Back 94

floss and stimulation (stillmans technique)

Front 95

If food is impacted or rentention is occuring, use -->

Back 95

floss

Front 96

If interdental spaces are large, you should use what kind of floss?

Back 96

tufted (fuzzy) floss, tape or alternative

Front 97

Alternative method may work better if ---> (5)

Back 97

1. faulty or rough restorations are present (use waxed floss/tape)

2. periodontal pockets are present.

3. partials/removal appliances

4. pt not motivated

5. pt doesn't have skill to floss

Front 98

Need to floss due to __________ which leads to gum disease.

Back 98

biofilm

Front 99

What is the 1st step in calculus formation?

Back 99

plaque

Front 100

Floss is about _____% effective in removing interdental plaque.

Back 100

80

Front 101

About how many adults floss?

Back 101

18%

Front 102

Name the types of floss (4)

Back 102

1. waxed

2. teflon coated

3. unwaxed

4. tufted

Front 103

Name the types of tape (2)

Back 103

1. waxed

2. unwaxed

Front 104

When should you floss?

Back 104

before brushing, after brushing, with or without toothpaste (either way is right!)

Front 105

When should you use floss aides? (2)

Back 105

1. pronged-dexterity problems

2. threaders-bridges or orthodontics

Front 106

Technique for flossing -->

Back 106

1. wrap fingers around middle or forefinger of each hand (about 18 inches of floss)

2. leave about 4 inches of space b/t (form C shape around teeth)

3. use combo of thumbs and forefingers to wrap floss w/ a push or pull around tooth (about 4/5 times on each tooth)

Front 107

How do you use the "circle method" of flossing and who is it best used for?

Back 107

- tie floss in circle, move around floss to use, finger placement is the same, no wrapping is needed.

- good for children

Front 108

What are the 2 options for floss holders?

Back 108

1. "Y" shaped, slingshot, forked pronged type having 2 fixed points and floss strung taut b/t struts. (like floss picks)

2. flossAwl --> new patented design having a single independent point (takes place one of your fingers)

Front 109

Pt's w/ limited dexterity should use what for flossing? (3)

Back 109

1. power flossers

2. floss picks

3. floss holders

Front 110

Super floss has a small plastic ________________ on end that is used to place floss underneath artificial teeth or other prosthetic structures in order to use it.

Back 110

floss threader

Front 111

Super floss is the __________________ way to clean missing teeth that were replaced w/ fixed bridges or implants.

Back 111

most effective

Front 112

Technique used for super floss -

Back 112

1. inserted into contact area

2. slide back and forth under pontic to remove dental biofilm and debris

Front 113

Pt's flossing incorrectly is called -->

Back 113

cleft

Front 114

What is a cleft due to flossing?

Back 114

indention created in papilla going up and down cutting gum/papilla causing bleeding.

Front 115

Who regulates toothpastes?

Back 115

FDA

Front 116

FDA classifies ____________ dentrifices as drug products : composition, safety, efficacy and labeling.

Back 116

fluoride

Front 117

Detergents purpose and ingredients w/ in it?

Back 117

- foaming, lowering surface tension

- Sodium lauryl sulfate common

Front 118

Sodium lauryl sulfate common causes __________

Back 118

ulcers

Front 119

Purpose of abrasive systems and ingredients w/ in?

Back 119

- cleaning, removing stained tension

- silicas, calcium pyrophosphates, alumina trihydrate and calcium carbonate

Front 120

Purpose of binders and ingredients w/ in?

Back 120

- prevents sepration

- xanthan gum, carboxyvinyl polymer, cellulose

Front 121

Purpose of humectants and ingredients w/ in?

Back 121

- retain moisture, prevent hardening and transport therapeutic and abrasive ingredients

- sorbitol, glycerin, polyethylene glycol

Front 122

Purpose of water and percentages?

Back 122

- solvent for solids and salts

- 15-50%

Front 123

Purpose of flavoring agents and ingredients w/ in?

Back 123

- sweeten, mask bitter tasting ingredients, refresh mouth

- flavoring oils, sodium saccharin or other artificial sweeteners (non-cariogenic)

Front 124

What all is involved w/ in coloring agents? (3)

Back 124

1. vegetable dyes

2. opacifiers create visual differentation b/t pastes and gels

3. mice provides sparkle

Front 125

Anti caries dentrifice =

Back 125

fluoride

Front 126

Anti-plaque dentrifice =

Back 126

triclosan and stannous

Front 127

Anti-sensitive dentrifice =

Back 127

potassium nitrate & strontium chloride

Front 128

Anti-calculus dentrifice =

Back 128

pyrophosphates and zinc

Front 129

Anti-malodor dentrifice =

Back 129

chlorine dioxide

Front 130

Remineralizing dentrifice =

Back 130

calcium phosphate

Front 131

Goal of dentrifice?

Back 131

lowest level necessary to remove stain and pellicle w/ out damage to tooth

Front 132

Dentrifices have a potential to damage ________ & _________

Back 132

enamel and dentin

Front 133

First fluoride dentrifice was in ________. What type was it?

Back 133

- 1956

- Crest (stannous & calcium pyrophosphates)

Front 134

Research shows that ________ reduces caries, not toothbrushing.

Back 134

fluoride

Front 135

PPmF means -->

Back 135

parts per mili fluoride

Front 136

Fluoride has _______ ppmF

Back 136

1000

Front 137

Mechanisms of fluoride systems? (2)

Back 137

1. reduce enamel solubility

2. promote remineralization

Front 138

What does ADA do?

Back 138

gives seal of approval if it is theropeutic

Front 139

ADA accepted ingredients and/or dentrifices? (3)

Back 139

1. sodium fluoride (NaF)

2. Sodium monoflurophosphate (MFP)

3. Stannous (SnF2)

Front 140

What kind of form does NaF have? (sodium fluoride)

Back 140

ionic

Front 141

2 characteristics for the ionic form of NaF -

Back 141

1. upon contact w/ water or saliva, the fluoride ion separates from sodium ion and is instantly available.

2. highly reactive ion so abrasive must be compatible over shelf-life of product.

Front 142

NaF dentrifice __________ easily.

Back 142

breaks

Front 143

MFP (sodium monoflurophosphate) has what kind of form?

Back 143

covalent

Front 144

3 characteristics of the covalent form for MFP -

Back 144

1. chemical bond b/t fluoride and phosphate that is separated by the acid hydrolysis or enzymes in saliva.

2. MFP breaks down to release fluoride

3. more brushing time required than w/ NaF

Front 145

2 main facts about MFP -

Back 145

hard to break and minimum of 30 seconds to occur (which most people could only brush 30 seconds--> pointless dentrifice then)

Front 146

Characteristics of Stannous dentrifice - (4)

Back 146

1. effective against S. mutans some perio pathogens

2. tends to stain teeth w/ use

3. tastes like tin

4. not stable w/ water

Front 147

If a patient has sensitivity or ulcers, do not recommend them -

Back 147

anti-tarter toothpaste

Front 148

Supra-gingival calculus formation - (5)

Back 148

1. pellicle reforms immediately after cleaning

2. within days, plaque becomes susceptible to precipitation of calcium phosphate that mineralizes into calculus

3. calculus matures and becomes less soluble

4. cycle continues

5. calculus becomes harder and more adherent, 20% as hard as enamel, adhered like cement.

Front 149

What do Calculus inhibitors do? (3)

Back 149

1. reduce amount of calculus formed

2. make calculus softer

3. can results in dentinal hypersensitivity

Front 150

What do pyrophosphates do? (2)

Back 150

1. inhibit supra-gingival calculus

2. break calculus cycle

Front 151

How do pyrophosphates break calculus cycle? (3)

Back 151

1. prevent calcium from combining w/ phosphates and mineralizing

2. coat growing calcium phosphate crystals in plaque and prevent maturation (softer crystals)

3. do not interfere w/ active ingredients

Front 152

What does Zinc chloride do?

Back 152

forms complex w/ phosphates and holds them in solution

Front 153

Agents of anti-plaque and anti-gingivitis dentrifices? Which are ADA seal approved? (3)

Back 153

1. triclosan (ADA seal)

2. Stannous fluoride (ADA seal)

3. Sanguinarine (NO seal)

Front 154

Percentage of dentinal hypersensitivity?

Back 154

25%

Front 155

Exposed dentin is caused from? (2)

Back 155

1. toothbrush abrasion

2. recession and erosion due to acids, prophies, etc

Front 156

Pain (sensitivity) results from - (4)

Back 156

hot/cold, chemical, mechanical and dehydration

Front 157

Name the 2 pain conduction theories

Back 157

1. hydrodynamic theory

2. neurophysiology theory

Front 158

Hydrodynamic theory -

Back 158

most widely accepted, stimuli cause fluid movement within the dentinal tubules. The fluid stimulates nerve endings in the pulp.

Front 159

Neurophysiology theory -

Back 159

based on hydrodynamic mechanism but defines types of pain fibers.

Front 160

2 types of agents used in toothpastes -

Back 160

potassium nitrate and strontium chloride

Front 161

What do dentrifices contain?

Back 161

5% potassium nitrate and either sodium fluoride or sodium monoflourophosphate

Front 162

What kinds of agents are active ingredients in whitening dentrifices?

Back 162

oxygenating (none currently ADA approved)

Front 163

What are the factors for consumer selection (personal preference) - (6)

Back 163

1. therapeutic

2. flavor

3. cost

4. cosmetic benefit

5. texture

6. brand name