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142 Cards in this Set
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Peri 741 - Essential Periodontal Therapy
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Epidemiology - Dr. Craig Ririe
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What is epidemiology?
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Studying the distribution of disease in human populations and the factors that influnce the distribution
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What is (probably) the most successful public health intervention?
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Fluoridation of water to prevent caries
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Why do epidemiological studies matter so much to periodontists?
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Because it is an evidence-based practice
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Define prevalence. How is it calculated?
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The percentage of people in a population who have disease at a given point in time. # of people with the disease / # of people in the population
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Define incidence. How is it calculated?
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The average percentage of unaffected people who will develop disease during a specific period of time, or the measure of how much new disease there is. # of new cases / # of persons at risk when the study began
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Prevalence or incidence: Tells the risk/probability that a person will become a new case.
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Incidence
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Name the two overall types of studies done for prevalence or incidence.
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1 - Observational 2 - Experimental
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Name the three types of observational studies.
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1 - Cross-sectional 2- Cohort 3- Case-control
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Most epidemiological studies are (observational/experimental).
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Observational
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Name the most common type of experimental study.
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Drug trials
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What are two synonyms for Cross-sectional studies?
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1 Disease freqency studies 2 Prevalence studies
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If a cross-sectional study is repeated at regular intervals, what are two advantages?
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1 Gives information on trends in disease over time 2 Shows effectiveness of prevention/treatment programs
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Name two reasons why cross-sectional studies are better than cohort or case-control studies.
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1. Cheaper 2. Quicker to conduct
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What does a cohort study reveal about a population?
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Whether an exposure or characteristic is associated with development of disease
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What kind of study starts off with all subjects free of disease?
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Cohort study
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Name 2 disadvantages to cohort studies.
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1 Requires long observation periods 2 Expensive
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What kind of study starts off with 2 groups; patients with or patients without disease?
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Case-control study
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Name 2 disadvantages to case-control studies.
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1 Can't determine prevalence 2 Can't determine incidence
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If you want to calculate prevalence, what type of study should you do?
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Cross-sectional study
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If you want to calculate incidence, what type of study should you do?
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Cohort study
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If you want to study association between exposure and disease, what type of study should you do?
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Case-control study
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Sensitivity or Specificity: The percentage of people who have the disease who test positive.
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Sensitivity
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Sensitivity or Specificity: The percentage of people who don't have the disease who test negative.
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Specificity
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Define risk. Define risk factor.
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Risk = The likelihood that a patient will get a disease in a specific time period. Risk factor = Characteristics that place a patient at risk for getting a disease
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What are three ways for exposure to occur?
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1 Single point in time 2 Episodic 3 Continuous
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If you eliminate a risk factor, does it prevent new disease? Does it get rid of existing disease?
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Prevents - yes. Eliminates - no.
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Name 2 true risk factors for periodontal disease.
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1 Smoking 2 Diabetes
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Once a patient has periodontal disease, what are two things we must do?
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1 Reduce risk at healthy sites 2 Increase risk for positive prognosis in diseased sites
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What are 2 different definitions of gingivitis?
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1 Inflammation on teeth with no attachment loss 2 Inflammation on tooth with healthy, stable, non-progressing attachment loss
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What is gingival index used for?
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It's used to quantify amount and severity of disease in individuals/populations, over time
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What does a gingival index compare: Prevalence or incidence?
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Prevalence
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Name 4 features of an "ideal index".
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1 Quick to use 2 Accurate 3 Reproducible 4 Quantitative
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Gingival index is (subjective/objective). Gingival bleeding index is (subjective/objective) for diagnosing inflammation.
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Gingival index: Subjective… Gingival bleeding index: objective.
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What happens first in gingiva: bleeding or color change?
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Bleeding always occurs first!
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Describe how you differentiate gingivitis from periodontitis using bleeding index.
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Gingivitis: Drag a perio probe (2 mm) through each sulcus, wait a few seconds, then note bleeding…. Periodontitis: Base of pocket, then note bleeding
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What is the direct cause of gingivitis (that all studies have shown)?
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Bacterial plaque
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When and who performed the "classic" experimental gingivitis study?
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1965 - Loe
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Why have there been no experimental studies on chronic periodontitis?
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Because it is an irreversible destruction of the connective tissue
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Maxillary _________ and mandibular __________ have the most attachment loss of any tooth.
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MOST: Maxillary molars, mandibular incisors
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Maxillary _________ have the least attachment loss of any tooth.
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LEAST: Maxillary incisors
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T/F: Increased pocket depth correlates with age.
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False! It does not!
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Periodontitis becomes clinically significant after age ____.
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30
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According to the 'new paradigm' for the etiology of periodontitis, what determines the clinical extent and severity of the disease?
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Host inflammatory response
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Smokers are ____ times as likely to develop severe periodontitis than non-smokers.
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5
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What is the most important host factor for developing periodontitis?
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Cigarette smoking
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What ist he most important predictor for periodontitis?
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Oral hygiene
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Periodontitis is (more severe with/not affected by) the following risk factors: Low socioeconomic/educational status; osteoporosis; HIV/AIDS; infrequent dental visits.
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Low socioeconomic/educational status - more severe; osteoporosis - not affected; HIV/AIDS - not affected; infrequent dental visits - not affected by.
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Periodontitis is (more severe with/not affected by) the following risk factors: bacteria; bleeding on probing; previous periodontal disease; genetic factors; stress.
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bacteria - more severe; bleeding on probing - more severe; previous periodontal disease - more severe; genetic factors - more severe; stress - more severe.
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Non-Surgical Periodontal Therapy - Dr. Juliana Carvalho
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What is Scaling? What is Root planing?
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Scaling = Removing calculus, food, plaque on enamel AND cementum. Root planing = Removing calculus and contaminated cementum ONLY on root
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With scaling and root planing, the oral flora shifts from Gram (-/+) to Gram (-/+) aerobes.
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From gram - to Gram +
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Name the three classes of bacteria that are bad for oral health.
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1 Motile rods 2 spirochetes 3 Any black pigmented bacteria
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What researchers' study had 3 periodontists scale/cavitron, and found that deep pockets were affected much more than shallow pockets (even had destroyed periodontal fibers)?
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Sherman
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What were the results of Sherman's study?
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Deeper pockets gained attachment with 3 SRP & Cavitrons, but shallow pockets had no change, or even lost attachment
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What researchers' study compared open (surgical) to closed (non-surgical) treatment and found that in deeper pockets, less calculus was left but there was no difference for shallow pockets?
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Buchanan
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What were the results of Buchanan's study?
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Surgical calculus removal has no affect on pockets less than 6 mm, but there is significant change for deeper pockets when surgical SRP is done
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What very important study compared different SRP techniques on furcations?
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Matia
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What were the results of Matia's study?
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Ultrasonics must be used on furcations because the tip is smaller! Also, surgical is more effective
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What were the results of Badersten's study?
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Deeper sites get more recession due to decrease of inflammation, and shallow pockets lose attachment with SRP
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How many days does it take, after SRP, to get bacteria to levels of health?
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3!
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If maintenance of plaque control is absent, it takes __ to ___ weeks to repopulate the pocket with bad bacteria.
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4-8 weeks
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What researchers' study found that SRP was equally effective as surgical therapy?
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Lindhe and Nyman
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What researchers' study found that at pocket depths greater than 7 mm, there was no difference between surgical and non-surgical treatment?
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Ramfjord
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What researchers' study found that RP, and surgical procedures produced similar gains in pockets greater than 7 mm?
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Kaldahl
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What is substantivity?
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The ability of an agent to bind to tissue surfaces and be released over time
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What item in dentistry has high substantivity?
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Chlorhexidine
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Chapters 41 and 42
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Why are gracey curettes the best for subgingival SRP?
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They provide the best adaptation to root anatomy
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What kind of fulcrum is best for using the Gracey 11-12?
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Extraoral or opposite arch
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Ultrasonics vibrate between __,000 and __,000 cycles/second.
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20-45,000
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The ideal angle between the face of the blade and the lateral surface of any curette is __ to ___ degrees.
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70-80
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Power Scalers - Dr. Juliana Carvalho
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What is the name of the author who changed her position from 1985 (ultrasonics no good for light treatment) to 1992 (ultrasonics are first choice in treatment of most patients)?
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Irene Woodall
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What is periodontal debridement?
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The mechanical removal of tooth/root surface irritatnts to return to non-inflamed state
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Name 4 basic ways that ultrasonic debridement is accomplished.
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1 Mechanical 2 Cavitation 3 Irrigation/Submarginal lavage 4 Acoustic turbulence
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What mechanical measurement represents the number of times per second that a tip vibrates back and forth?
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Frequency
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What unit of measurement is used for frequency?
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Kilohertz
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What mechanical measurement represents how great the tip is vibrating side-to-side or round-to-round?
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Tip amplitude
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Frequency or tip amplitude: Can be changed by the power setting on the ultrasonic unit.
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Tip amplitude
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Define cavitation.
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Bursting air bubbles (produced by vibration) cause shock waves in the water, which causes rupture of the cell wall membrane
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What basic component of ultrasonic debridement results in disruption of the bacterial matrix?
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Acoustic turbulence
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How many cps does a sonic instrument use?
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3-8,000
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Sonic, Magnetostrictive Ultrasonic, or Piezoelectric Ultrasonic: Titan Scaler
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Sonic
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Sonic, Magnetostrictive Ultrasonic, or Piezoelectric Ultrasonic: Micro ICS Scaler
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Sonic
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Sonic, Magnetostrictive Ultrasonic, or Piezoelectric Ultrasonic: Cavitron SPS
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Magnetostrictive Ultrasonic
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Sonic, Magnetostrictive Ultrasonic, or Piezoelectric Ultrasonic: Turbo 25K/30K
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Magnetostrictive Ultrasonic
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Sonic, Magnetostrictive Ultrasonic, or Piezoelectric Ultrasonic: Odontosan
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Magnetostrictive Ultrasonic
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Sonic, Magnetostrictive Ultrasonic, or Piezoelectric Ultrasonic: Piezon Master 400/Mini
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Piezoelectric Ultrasonic
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Sonic, Magnetostrictive Ultrasonic, or Piezoelectric Ultrasonic: P-5 Booster
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Piezoelectric Ultrasonic
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Sonic, Magnetostrictive Ultrasonic, or Piezoelectric Ultrasonic: Pro-Select 3 Scaler/Irrigator
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Piezoelectric Ultrasonic
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How many cps does a magnetostrictive ultrasonic instrument use?
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25,000-42,000 cps
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How many cps does a piezoelectric ultrasonic instrument use?
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40,000-50,000 cps
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How does an ultrasonic instrument work?
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Converts electrical energy into mechanical vibrations
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Name the two types of Ultrasonic instruments.
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1 Magnetostrictive 2 Piezoelectric
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What surfaces of a magnetostrictive ultrasonic are active?
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ALL
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Which functions with an elliptical/orbital motion: Magnetostrictive or piezoelectric?
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Magnetostrictive Ultrasonic
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Which functions with a linear motion: Magnetostrictive or piezoelectric?
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Piezoelectric Ultrasonic
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Which surfaces of a Piezoelectric ultrasonic are active?
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Lateral sides only
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T/F: There is more tactile sense with an ultrasonic scaler.
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False - LESS
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Name 5 medical contraindications to using an ultrasonic scaler.
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1 Infectious disease 2 Respiratory disease 3 Predisposition to infection 4 Pacemakers 5 Swallowing defects
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Name 3 dental contraindications to using an ultrasonic scaler.
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1 Sensitivity 2 Areas of demineralization 3 Margins of restorations
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What setting should the water knob on the ultrasonic scaler be set at (%)?
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80-90%!
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Name three types of strokes that can be used with an ultrasonic scaler.
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1 Vertical 2 Oblique 3 Circumferential
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Effects of SRP on the Microbiota of the Periodontal Pocket - Dr Nikola Angelov
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Loe's 1965 demonstrated that in the absence of plaque there (was/was no) disease.
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was NO disease
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T/F: Dental plaque bacteria are strongly influenced by environmental factors that may be host mediated.
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TRUE
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What determines periodontal health?
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Balance between bacteria and the host
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Can dental plaque be removed by water squishing into the pockets?
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No, they are adherent to the tooth surface
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Name the two types of bacteria that accumulate at the tooth surface. Name the two types that are found in the outer surface of the mature plaque mass.
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Tooth surface: Gram + Cocci and short rods. Outer surface: Gram - rods and filaments
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Define Long Junctional Epithelium. What is its function?
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It is the migration of the epithelium following SRP. It replaces the lost CT attachment, but is not as good (debatable)
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What did the 1998 Socransky study show about different-colored oral bacteria complexes?
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Red and orange complexes were associated together, and the red complex showed the strongest relationship to periodontal diagnosis.
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Name the three bacteria that made up the "red complex" in the 1998 Socransky study.
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1 B. Forsythus 2 P.Gingivalis 3 T. Denticola
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In the Brochut study, at six weeks after therapy, the mean total bacterial loads had (no/significant) impact on the bleeding tendency of the subject, six months later.
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SIGNIFICANT
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What did the Brochut study show about the effects of scaling and root planing, which explains why we're required to do 3 OHCs before we can start SRP?
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Perfect oral hygiene is VERY important before non-surgical therapy
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What did the Colombo study show about SRP?
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SRP decreased certain periodontal pathogens, and increased beneficial species for up to 9 months following treatment.
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What did the Haffajee study show about OHC?
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Meticulous removal of suprgingival plaque affects nature of bacteria below and above the gingival margin! (in a good way)
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What did the Fujise study show about P.gingivalis, B.Forsythus, and A.A?
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They are all usefull in assessing treatment outcome!
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What did the Petersilka study demonstrate about intensive subgingival SRP in PPD less than 3 mm?
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This should be avoided, as it will result in AL and traumatize the periodontium.
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What did the Darby study demonstrate about humoral immune response?
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There were no significant post-therapy effects, except reduced antibody avidity to P gingivalis/intermeia (host response may fail to make the antibodies to fight oral flora)
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What did the Cugini studyc conclude about perio maintenance?
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It is essential in maintaining clinical/microbial improvements made by initial treatment.
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What did the Loesche study show about non-invasive treatment?
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It reduced the need for surgery/ext, for at least five years after initial SRP
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Is metronidazole dental gel indicated for an adjunctive treatment for adult periodontitis?
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NO.
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What did the Shiloah study show about microbial pathogens in the oral cavity?
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Their presence negatively affects the outcome of both surgical and non treatment!
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Effect of SRP on Root Surface/Gingival Tissue - Dr Oliver Hoffmann
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Name the 3 changes in cementum that occur with periodontitis
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1 Destruction of collagen fibers in cementum 2 Degeneration of Sharpey's fibers 3 NECROSIS of cementum
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What is the one indirect affect of bacteria?
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Their endotoxins prevent attachment of gingival fibroblasts, in vitro
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Name the major etiologic factor of periodontal disease.
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Plaque, especially bacteria that are embedded in the biofilm
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Name the most common endotoxin released by bacteria to disrupt fibroblasts.
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Lipopolysaccharide
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Name 2 proposed mechanisms for hypersensitivity following SRP.
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1 Hydrodynamic (tubules are exposed) 2 Bacterial sensitization of the pulp
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What is the main goal of removing plaque/calculus?
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Reducing inflammation
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What is the primary goal of SRP treatment itself?
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Reduction of the pocket depth
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In the Experimental Gingivitis study by Loe and Theilade, gingivitis appears after ___ days without plaque control,and returns to gingival health within ___ days after reestablishing oral hygiene.
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3, 7.
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Name the 4 stages of periodontal disease progression, according to Page and Schroeder.
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1 Initial lesion 2 Early lesion 3 Established lesion 4 Advanced lesion
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What stage of disease progression is: subclinical, widening of capillaries, and PMN?
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Initial lesion
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What stage of disease progression is: erythematous, and has intensified inflammatory cell response?
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Early lesio n
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What stage of disease progression is: Deeper, bluish colored, has lots of plasma cells, widened intercellular space, destroyed basal lamina/collagen fibers (periodontal tissue destruction)?
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Established lesion
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What stage of disease progression has: extension into alveolar bone?
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Advanced lesion
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__-___ mm of PPD reduction occurs after SRP.
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2-3 (.5 mm new attachment, 1-.15 junctional epithelium, other from recession of gingiva and decreased inflammation)
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Name the three things that occur with healing after SRP.
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1 Recession 2 Junctional epithelium attachment 3 New attachment
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Which gingival structure is (basically) impossible to restore if you destroy it during SRP?
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Interdental papilla
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