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202 Cards in this Set
- Front
- Back
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Scalers are designed to remove deposits ________
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Submarginally
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Lightweight, rounded and hollow-handled
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Scaler Handle
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Portion between the handle and working end or blade
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Shank
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204 Shank is _____
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Angled
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H 6/7 Shank is ______
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Straight
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Scaler shanks are ___________
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non-flexible
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Portion of the shank closest to the blade that is not sharpened
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Terminal End
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The working End is also called the ______
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Blade
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What forms the point of the scaler?
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The convergence of the face, lateral sufaces, and back
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The point of the scaler is designed for what?
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The removal of interproximal calculus.
the point is sharp and chips off the calculus |
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The top part of the scaler blade between the two cutting edges
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Face
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Which cutting edge is adapted to the tooth for the H6/7 Scaler
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lower cutting edge
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What is adapted to the tooth for deposit removal?
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The tip; lower one third or 2-3mm
Think 1 mm for Ms. Amme's class |
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Why should a scaler not be forced sub marginally?
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The sharp back that is formed from the two lateral surfaces meeting
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Portion of the cutting edge nearest the point or toe.
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Tip
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Where the face, lateral surface, and back converge.
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Point (Scaler) Toe (Curet)
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The portion of the shank closest to the blade that is not sharpened
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Terminal end of the shank
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What should the grasp be like for the scaler when compared to the explorer
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Firm Grasp; can fulcrum towards the facial surface not just the incisal edge
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The four things to remember for a fulcrum are
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1. on occlusal, incisal, buccal, facial surfaces
2. As close to tooth as possible on same arch. 3. Stability maintained throughout exploratory and working strokes. 4. Wrist position in a straight line with the forearm. |
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The curet is designed for what?
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Submarginal deposit removal and root planning
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What part of the H6/7 Scaler is adapted to the tooth?
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The lower cutting edge or the larger outer curve
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What part of the Gracey 11/12 is adapted to the tooth?
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The lower cutting edge or the larger outer curve
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What part of the 204 Scaler is adapted to the tooth?
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Both cutting edges
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What part of the Barnhart 1/2 is adapted to the tooth?
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Both cutting edges
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What part of the Gracey 12/13 is adapted to the tooth?
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The upper cutting edge tip or larger outer curve
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Describe the exploratory stroke for curets
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0-25 closed angulation
Light grasp Insert to the base of the sulcus or to the junctional epithelium |
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What is the angulation of the working stroke?
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80 degrees (never more than 90 and less than 45)
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Where does the working stroke begin for a scaler?
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Base of the deposit
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Where does the working stroke begin for the Curet?
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Base of the sulcus or pocket
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The terminal end of the instrument should be ______ to the long axis of the tooth.
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Parallel at mesial and distal surfaces
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What is necessary around the entire surface of the tooth?
How do you accomplish this? |
Continuous adaptation
Rolling the instrument between finger and thumb |
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What kind of pressure is required in the working stroke
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Firm Pressure
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Define Channel scaling
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Short overlapping strokes that start at the edge of a deposit
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Which direction are working strokes?
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Primarily vertical
Sometimes oblique or horizontal |
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True/False
Activate a Unit with your fingers |
False use Rotary or wrist flexion
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What should you do if your exploratory stroke encounters an obstruction?
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move the blade laterally from the tooth surface and then apically
This will aid in distinguishing between a ledge and calculus |
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In the working stroke of an instrument which way is the curet moved?
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Coronally
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What is the best means of maintaining a clear field of vision?
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Surgical suction
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What are the basic principles for hand instrumentation?
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1. Work Comfortably
2. Follow an orderly sequence for instrumentation 3. Operate with maximum visibility 4. Obtain Maximum Accessibility 5. Maintain complete control of the instrument 6. Maintain a clear field 7. Be certain all instruments are sharp 8. Be gentle and careful 9. Use as few instruments as possible. 10. Know the relation of the instrument to the tooth and periodontal structures before activating it 11. Check for completeness |
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What are two things that are required for maximum visibility
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Good light source and a clean mirror
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You use the cowhorn to check for completeness on what patients?
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Prophy patients
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You use the 11/12 explorer to check for completeness on what patients?
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Periodontitis patients
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H6/7 Scalers are used for what teeth?
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Anterior teeth
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True/False
Mesial and distal surfaces are used with the same working end. |
False
You have to flip the instrument to work the different proximal surfaces |
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Using an H6/7 scaler on Maxillary teeth will require what chair position?
What is the fulcrum? |
12:00 chair position for surfaces towards you, same chair position different working end for surfaces away from you
Palm up Fulcrum |
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Using an H6/7 scaler on Mandibular teeth will require what chair position?
What is the fulcrum? |
All Surfaces towards at 7:00
All Surfaces away at 12:00 Palm Down Fulcrum |
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True/False
The scaler has a non-flexing shank |
True
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The 204 Scaler is used on what teeth?
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Posterior teeth
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What is the chair position and fulcrum for the 204 scaler?
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Chair position remains the same for both arches and both arches are palm down fulcrum
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Why is an Oral prophylaxis performed?
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For the prevention of periodontal disease
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Pathologic alteration of the periodontum including periodontitis and gingevitis
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Periodontal disease
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primary etiology of periodontal disease
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bacterial plaque biofilm
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Calculus
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Mineralized plaque
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What is supra marginal calculus called and whats its color?
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Salivary
Light in color |
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What is Submarginal calculus and whats its color?
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Serumal
Dark in Color |
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What is the significance of Calculus in the role of periodontal disease?
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Its very porous and allows Biofilm to cling to it
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Oral prophylaxis
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Preventative procedure where plaque biofilm, calculus, and stain are removed from the tooth surfaces
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What are the objectives of an Oral Prophylaxis?
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Facilitate effective plaque control
Provide a biologically acceptable tooth surface Reduce gingival inflammation, edema, and bleeding |
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What is the sequence for an oral prophylaxis?
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Take a Plaque index
Provide control instruction Check for deposits with explorer/air Scale and disrupt plaque Rubber cup polish Give Fluoride treatment |
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What are ultrasonic scalers used for?
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Heavy deposit, stain, plaque removal
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What are sonic scalers used for?
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Medium to light deposit, stain, plaque removal
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What are scalers and curets used for?
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Medium to light deposit, stain, plaque removal
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Indications for using the Ultrasonic scaler include
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Heavy deposit removal
Overhang removal heavy Stain and cement removal Treating NUG Lavage has an additional effect in removing plaque |
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Contraindications for using the ultrasonic scaler are
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Using the point on the tooth
Patients with a pacemaker Patients with AIDS/HEP Patients with heart murmur On or adjacent to dental implants |
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What do you do if the tip of the scaler becomes hot
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Stop and check the water and the power settings
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What is a significant disadvantage to using the Ultrasonic scaler?
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The production of contaminated aerosols
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What should you have the patient do before instrumentation?
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Rinse with Peridex
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What inserts does the periodontic department use for the ultra sonic?
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The pink swivel insert or the straight tip blue insert
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What inserts are used universally on all tooth surfaces in the mouth?
What type of removal is it used for? |
Blue or Pink inserts for Heavy calculus removal
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The Ultra sonic is used in the debridgement of what particular cases?
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NUG, periconitis, acute gingivitis
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True/False
There is an absence of tactile sensitivity for the ultra sonic scaler |
True
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What must be done after the use of the Ultra sonic?
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checked with the 11/12 explorer and possible follow up with hand instrumentation
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Ultra sonic scalers vibrate at the range of _______ cycles per second
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25,000-35,000
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Sonic Scalers vibrate at a range of _________ cycles
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2,000-6,500
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What are the advantages of the sonic scaler?
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Tip size is smaller and curet-shaped
Its easy to set up Fits in the high speed hand piece Less expensive than the ultra sonic |
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What protective equipment must the dental team use when operating the ultra sonic and sonic instruments?
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Face shield
Surgical Cap Over Gowns |
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Before inserting the tip of the ultra sonic what do you have to ensure?
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That the hand piece is full of water
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What kind of strokes do you use when operating the ultra sonic ?
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Light vertical strokes and keep the tip in contact with overlapping strokes
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What kind of strokes are used with the ultra sonic to prevent marginal damage?
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Short controlled horizontal strokes
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How are curets used and what do they remove?
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Submarginally and Supramarginally to remove hard and soft deposits
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Describe the Shank of the Curets
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Angled and Straight and is flexible for tactile sense
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Which curets have angled shanks?
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Barnhart and Gracey curets
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What is the shape of the curet as seen from the face
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Spoon shaped
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What is the angle of the Barnhart universal curet?
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90 degrees
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What are the working ends of the Barnhart?
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One end is used for all Lingual surfaces, the other end is used for all facial surfaces
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How do you find the proper working end for the Barnhart?
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If the terminal end is Parallel to the mesial and distal sufaces
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When do you change your fulcrum for the barnhart?
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Lower the fulcrum for the distal, raise the fulcrum for the mesial
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What is the shank angle of the gracey 11/12?
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60-70 degrees
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What are the Gracey curets termed?
Why? |
Area specific
Designed with a longer curved shank and off set blade angulations to adapt to specific areas |
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What is the working end for the Gracey 11/12 curet?
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The larger outer curve and the lower cutting edge
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Where does the stroke begin and end on the Gracey 11/12 curet?
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Begins at the distal line angle and will finish at the mesial interproximal contact.
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What is the angle of the Gracey 13/14 Curet?
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60-70 degrees
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What surfaces does the Gracey 13/14 work on?
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The distal interproximal surfaces of posterior teeth
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What part of the Gracey 13/14 is used on the tooth surface?
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The larger outer curve and the upper cutting edge
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how does the 11/12 explorer differ from the cowhorn explorer?
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It has a longer straighter shank that aids deposit detection in deeper pockets
11/12 is used for periodontitis cowhorn is used for gingivitis |
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Iatrogenic dentistry
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Caused by bad diagnosis and or treatment by a professional
This includes work that causes plaque retention and or hard or soft tissue damage |
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Overhanging restorations and faulty margins on crowns and bridges cause...
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Plaque retentive and sheds or cuts floss
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Over contoured restorations with inadequate embrassures cause...
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Plaque retention, constriction of blood supply to the interdental papilla
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Ill fitting partial dentures and dentures cause...
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Plaque retention and abrasion of soft or hard tissues
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Unremoved orthodontic and dental cement causes...
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Plaque retention
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Improper adaptation with hand instrumentation, ultra sonic, or sonic scalers causes...
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Tissue damage to hard or soft tissue
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Tongue Piercings not done by a professional can cause...
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plaque retention
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How can you determine health from a radiograph?
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lamina Dura is intact
No bone loss is seen |
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What is needed to determine if a patient has disease along with their radiographs
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Probing depths are also needed
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Calculus spurs can be seen on what surface in dental radiographs
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Mesial and distal surfaces not facial or lingual
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How can caries seen in a radiograph help you with prophy?
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Carious lesions can help you to distinguish between calculus and lesions as you work
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What should you do with radiograhs while scaling and root planing?
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They should be mounted on the view box
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True/False
It is often difficult to determine where scaling stops and root planing begins, and frequently, the two procedures cannot be dissociated. |
True
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The initial procedure in which the crown and root surfaces of the teeth are instrumented to remove calculus, plaque, accumulated materila, and stain.
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Scaling
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mechanical procedure using curets, sonic or ultra sonic scalers, where residual calculus, sub-gingival bio-film are removed
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Root planing
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Root planing is also known as ______
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Root detoxification
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What is the top priority in Periodontic treatment?
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eliminate the patients pain
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Phase 1 therapy consists of....
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Controlling or eliminating etiologic factors.
ex: plaque and calculus |
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What is the objective of scaling and root planing?
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create a healthy environment at the dento-gingival interface and initiate the healing response by creating an acute wound in place of a chronic wound
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What are the hand instruments of choice for final root planing?
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Curets are most effective with the least amount of trauma
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How do you start each scaling and root planing appointment?
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With a plaque index
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What are the steps for scaling and root planing?
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1. Disclose for plaque index
2. Mount Radiographs on the view box 3. Use 11/12 explorer to check pockets 4. use the ultra sonic for heavy deposits 5. use the Barnhart and gracey for final root planing 6. Use surgical suction to control hemorrhage and keep a clear field |
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What are the strokes that you use when scaling and root planing?
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Controlled overlapping vertical, oblique and horizontal strokes
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When is a rubber cup polish done on periodontitis patients?
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At phase 1 re-evaluation
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When is a rubber cup polish done on gingivitis patients?
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At the end of an Appointment
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What depth is scaling or root planing done effectively?
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5 mm
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What are some factors that limit access when root planing/
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pocket depth, inflammation, tooth position, tooth mobility, root anatomy
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How many appointments does it usually take to complete a root preparation?
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One to four appointments
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When scaling two quadrants what should you do?
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Scale upper and lower from one side in order to allow the patient one side of the mouth to chew on.
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What are the local anesthetics that can be used for a root planing appointment?
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Topical anesthetics are used for mild soft tissue discomfort
Nitrous Oxide is only used for extremely anxious patients($26 Fee) |
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What is almost always required for submarginal root planing?
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Local Anesthesia
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What can a patient use at home to alleviate pain after an appointment?
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Tylenol or Advil with a warm salt water rinse
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What types of food should a patient avoid after an appointment?
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Spicy foods
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What kind of sensitivity will the patient experience after root planing? When should this pain be abated?
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Cold Sensitivity
Abates with thorough plaque control |
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What is the objective of a root preparation?
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To clean and detoxify the root surface
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What does a healthy environment at the dento-gingival interface entail?
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removed calculus
removed bacterial endotoxins time for re-evaluation replace a chronic wound with an acute wound |
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When is the phase 1 re-evaluation appointment done?
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four to six weeks after completed root preparation
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putting a patient on a three to four month interval recall with a PI of 20% or below
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Periodontal Maintenance Therapy
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Putting the patient on a three month recall when their PI is above 20% but with other factors adverse to Surgery
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Compromise Maintenance Therapy
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What must be the plaque index be for the patient to go into Phase 2 surgical therapy
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PI must be 20% or below
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What are the basic four indications for periodontal surgery?
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1. Inaccesible areas/ severe attachment loss
2. Dilantin Hyperplasia : Tissue overgrowth 3. Furcation Invasions 4. Mucogingival defects |
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What is key to a successful outcome for periodontal surgeries?
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A patients compliance for adequate home care and keeping scheduled appointments
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True/False
Prevention of disease is at a higher level of service than corrective therapy |
True
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Where are intrinsic stains located? How can you remove these stains?
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Found in the surface of the tooth and cannot be removed by scaling and root planing
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Discoloration from pigments from decomposed hemoglobin and pulp tissue
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Intrinsic Stains from non-vital teeth
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Caused by short duration distrubance of ameloblasts. Teeth are pitted and can become stained from food pigments
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Enamel hypoplasia
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Generalized disturbance of ameloblasts. Abnormalitiy causing all or part of the enamel to be missing.
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Hereditary intrinsic Stain
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Varying shades of gray-brown caused by an affinity for mineralized tissue
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tetracycline stain
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Tetracycline stains can occur in children from mothers who take the drug during which trimester?
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3rd
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Enamel alteration due to toxic damage to the ameloblasts. exessive intake of more than two parts per million.
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Fluorosis
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What was fluorosis originally known as?
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The brown stain
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What are extrinsic stains and how can they be removed?
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Stains that occur on the surface of the tooth and removed by scaling polishing or brushing of the teeth
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What causes yellow stains?
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food pigmentation and poor oral hygiene
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What causes green stain?
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chlorophyll or from smoking marijuana
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What causes brown stains?
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tobacco, coffee, tea or betel nuts
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what causes black stains?
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iron medications and vitamins
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What causes red stains?
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chromogenic bacteria / very rare
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Can sheet calculus be removed while polishing the tooth?
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no all calculus including sheet calculus must be removed using scalers and curets
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What must be done before a rubber cup polish begins?
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Disclose the teeth
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The rubber cup has to be filled with a ______ polishing agent.
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moist
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What is the speed of the rheostat when doing a rubber cup polish?
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10,000 rpms
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Describe the strokes of the rheostat
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lifting and dabing motions that are moved slightly into the sulcus and adapted to the entire surface of the tooth
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What are the types of fluoride abrasives that can be used on teeth?
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Flour of pumice and hydrogen peroxide
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What are medium and course pumice used for?
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lab use and amalgam polishing
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Rubber cup polish is contraindicative when...
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1. A lot of tooth surface has been removed
2. Extensive decalcification or defective tooth structure is present 3. Severe inflammation is present after scaling or root planing |
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When there is severe inflammation what should you use to polish instead of prophy paste?
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hydrogen peroxide & baking soda
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What does the prophy jet use for polishing teeth?
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Sodium bicarbonate
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What is the prophy jet used for?
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Used for very heavy stains or peridex
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What patients should you not use the prophy jet on?
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Patients who:
1. wear contact lenses 2. on a restricted sodium diet 3. have a respiratory illness 5. have high blood pressure 6. patient with a heart murmur |
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What must an operator wear when using a prophy jet?
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mask shield, protective eyewear and over gown
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What precautions do you have to take for the patient when using the prophy jet?
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Cover the patients face with a towel and coat their lips with a lubricant
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What can a prophy jet do to polished or composite restorations?
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It may dull or roughen them
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What do you do first when using the prophy jet on a patient?
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Disclose the teeth
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How far from the tooth should the tip of the prophy jet be?
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4-5 mm
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What should the angulation of the prophy tip be in conjunction with the tooth?
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60-80 degrees using circular motions
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How many teeth should you clean at a time using the prophy jet?
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2-3 teeth then disclose and re-evaluate
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What are the two types of fluorides that are used in brown clinic?
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Sodium Fluoride (2% gel)
Acidulated Phosphate-Fluoride (APF) 1.23% |
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Under what circumstances do you not use APF?
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porcelain or ceramic restorations and implants
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Which fluoride tray goes in first and on which arch?
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blue tray goes first on the mandibular arch
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How long do you leave fluoride trays in the patients mouth?
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4 min
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How long should the patient keep from eating after doing a fluoride treatment?
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30 min
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When is a patient a good candidate for self-applied home fluoride treatments?
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Rampant caries
Xerostomia Root surface sensitivity |
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What are the three questions you ask when dealing with a patient that has rampant caries?
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1. Do you drink sugary liquids?
2. Do you suck on hard candies? 3. Do you chew sugary gum? |
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Why are sodas, hard candies and gum the most harmful forms of sugar?
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The sugar is retained in the mouth for a long period of time and the saliva doesn't adequately dilute the acid.
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What is the number one contributor to tooth decay?
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Sugar sodas
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True/False
Drinking soda through a straw has isn't any less harmful than drinking it straight from a can |
False
it is less harmful |
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What are some causes of Xerostomia?
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Radiation therapy
Most narcotics Meth Users |
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What is the saliva replacement which helps with xerostomia?
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Biotene
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What are the examples of home fluorides that can be used by the patients.
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Duraphat or Prevident
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What is the prescribed fluoride that is available in Brown clinic?
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Prevident 5000 brush on gel (mint flavor)
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What is the non-prescribed fluoride that is available in brown clinic?
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Phosflur 500 ml bottle (mint or cherry)
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What are the desensitizing agents available in brown clinic?
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Vanish and Prevident
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How long should a patient avoid brushing flossing and drinking hot beverages after applying a desensitizing agent?
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4-6 hours
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What are the objectives for instrument sharpening?
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1. Remove the least amount of metal as possible
2. retain the original angulation and shape of the instrument 3. Restore a sharp cutting edge |
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What are the two methods for instrument sharpening?
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Mounted and unmounted
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What type of stone is used in the unmounted method?
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Arkansas stone
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What type of stone is used in the mounted method?
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Ticonium Stone
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What must be done after both methods of sharpening?
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removal of the wire edge with a round stone to the face
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What is used as a lubricant on a synthetic stone for sharpening instruments?
|
Water
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What is the angle used to sharpen an instrument?
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100-110 degree between the face and the stone making an inner angle of 70-80 degrees
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What stroke should you finish with when sharpening an instrument?
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Down stroke to remove a wired edge.
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lateral surfaces of an instrument should be _____ after sharpening.
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Shiny
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Test an instruments cutting edge with...
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test stick or saliva ejector
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Why should you wipe an instrument down after sharpening?
|
To remove the sludge of oil and metal shavings
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How does the Nabors Furcation Probe differ from the cowhorn?
|
It is longer and heavier and allows for access to furcation areas
Change working ends at the mesial and distal ends when working on a maxillary molar. |
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What are keys to making an implant last longer?
|
Patients should be treated for periodontal disease before an implant is placed
Smoking is bad Good plaque control is essential |
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What kind of instruments are used on implants?
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Plastic or Nylon only
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