Clinic Theory Stains Elderly Pt Care & Prosthetic Devices

Front 1

On the GV Black Classification of carious lesions; describe a Class I & Class II lesion?

Back 1

Class I: Occlusal area & buccal or lingual pits
Class II: Posterior Interproximal

Front 2

What is an extrinsic stain? (Stain by locatin)

Back 2

A stain that is outside the tooth surface

Front 3

What is an intrinsic stain? (Stain by location)

Back 3

A stain from within the tooth surface

Front 4

Where does an Exogenous stain orginate?

Back 4

Outside of the tooth

Front 5

On the GV Black Classification of carious lesions; describe a Class III & Class IV lesion?

Back 5

Class III: Anterior Interproximal
Class IV: Anterior Interproximal w/incisal corner

Front 6

What is an exogenous stain the result of?

Back 6

Exposure to environmental agents..the stain may be on the outside surface of the tooth (extrinsic) or become incorporated within the tooth structure (intrinsic).

Front 7

What is an example of an exogenous stain source?

Back 7

Coffee Tea Wine Smoking

Front 8

Where is an endogenous stain orginate?

Back 8

Comes from within the tooth

Front 9

On the GV Black Classification of carious lesions; describe a Class V & Class VI lesion?

Back 9

Class V: Gingival at facial or lingual
Class VI: Cusp Tip

Front 10

What might be an example of an endogenous stain source?

Back 10

Tetracycline or other medications
Chlorhexidine (Paradex)

Front 11

In terms of location (intrinsic or extrinsic) and by source; what would a metallic stain be classified as?

Back 11

Exogenous (from outside of the body) & Intrinsic (as it can stain dentinal tubules)

Front 12

What causes Orange/Yellow stain?
What would be the classification?

Back 12

Chromogenic Bacteria
Exogenous extrinsic-->comes from outside source & can be cleaned off.

Front 13

Where is Orange/Yellow stain usually located on the tooth surface?

Back 13

Cervical 1/3 of anteriors-->adheres to the gingival margin.

Front 14

What is Orange/Yellow stain associated with?

Back 14

Poor Oral hygiene.
*Remember incisors get "self" cleaned by the act of eating. If this stain is present then Pt isn't cleaning very well.*

Front 15

What are Green Stains usually associated with?

Back 15

An environmental metal-->metallic industry dust, perhaps from the work place

Front 16

Where on the mouth is Green Stain usually found?
What is the classification of green stain?

Back 16

MX anteriors

Exogenous/Extrinsic

Front 17

Teeth with green stain are often ____________ (condition.) In addition to the metallic dust, what is causing the green stain?

Back 17

Demineralized
Chromogenic bacteria, fungi and gingival hemorrhage.

*Fungi has a higher acidity, since teeth become demineralized they are a "magnet" for this type of staining.

Front 18

Where is Black Line Stain usually located?
Which sex is more likely to experience it?

Back 18

Posterior linguals, along the gingival margin…often found in clean mouths.

Females

Front 19

What is often the cause of C. Black line stain?

Back 19

Exposure to iron (ferric sulfide).
Can come from Pre-natal vitamins perhaps, or well water

Front 20

Since Black stain can come from well water or vitamins and can be polished right off, what is the stain classification?

Back 20

Exogenous/ Extrinsic

**Remember the iron is constantly coming throug the saliva so the stain is "always" there.**

Front 21

How difficult is it to remove Black stain?

Back 21

Very Easy-->remove with polishing cup.

**But because it flows through the saliva the stain will return right away.**

Front 22

Tobacco stains are the _________ to remove!

Back 22

Worst!
They are the hardest to get off!

Front 23

Where is Tobacco stain usually located?

Back 23

Mostly on the linguals…keep in mind the AMOUNT of stain is not always related to usage
*Home care is essential!*

Front 24

Tobacco stain is obviously Exogenous in nature.
Is it considered Extrinsic or Intrinsic and why?

Back 24

Both extrinsic & intrinsic.
The tobacco may stain the surface of the teeth and be cleaned off (depending on home care) But it can also become intrinsic due to the Heat of the tobacco smoke penetrating dentinal tubules.
*Bleaching can remove some of the stain...but it doesn't usually remove all of the stain!*

Front 25

What specificially causes the intrinsic stain of smoking tobacco?

Back 25

The HEAT!
The heat is actually baking the enamel causing it to become yellow.

Front 26

What tool is good at removing the tar of tobacco stain?

Back 26

Ultra Sonic!
*Otherwise, keep your instruments sharp!*

Front 27

What are 3 "reasons" to see endogenous intrinsic stains?

Back 27

1) Pulpless teeth
2) Tetracycline Stain (Drug induced in offspring)
3) Developmental imperfections

Front 28

A stain in a pulpless tooth is considered what classification? Why?

Back 28

Endogenous/Intrinsic
Because its from within the tooth, not an outside source and it’s the dentinal tubules being stained…

Front 29

What color does a pulpless tooth usually stain?

Back 29

Yellow hue, grey, brown or black-->results from decomoposed hemoglobin in dentinal tubules, bleeding from trauma.

Front 30

Do all pulpless teeth discolor?

Back 30

No

Front 31

"Pink Tooth" is a form of pulpless tooth stain. What is causing the "pink"?

Back 31

The pulp is being resorbed-->is more common in primary teeth

Front 32

Tetracycline stain is absorbed by ________ & _________.
It crosses the __________ barrier.

Back 32

Bones & Teeth
Placental barier
**Tetracyclne will discolor the babies teeth when ingested in the 3rd trimester.**

Front 33

What is the appearance of tetracycline stain?

Back 33

Light-green, dark yellow, gray/brown…depends on the dosage and time.

Front 34

Amelogenisis Imperfecta is classified as what type of stain?

Back 34

Endogenous Intrinsic-->is genetic in nature.

Front 35

With amelogenisis imperfecta what cells are being impacted?

Back 35

Ameloblasts -->can result in the Pt lacking enamel or having irregular pattern/shape of enamel.

Front 36

What dental "product" can help change the apperance of amelogenisis imperfecta?

Back 36

Veneers and Crowns can change appearance.
Bleach won't!

Front 37

What is dentinogenisis imperfecta?

Back 37

Teeth with enamel but no dentin!
The dentin may be irregular

Front 38

What cells are disturbed in dentinogenis imperfecta? What is the appearance of teeth with this condition?

Back 38

Odontoblasts!
Teeth appear translucent, opalescent or grey.

*Tooth color can't be changed by Pt can use veneers to improve the look.

Front 39

Dentinogenisis imperfecta is considered what classification of stain? Why?

Back 39

Endogenous/Intrinsic
Because its from within the tooth, not an outside source.

Front 40

Dental Fluorosis is caused by the excessive ingestion of fluoride while teeth are forming. What is the classification of stain?

Back 40

Endogenous Intrinsic-->Happens when teeth are forming even though its ingestion of water from outside of the body.

Front 41

What can be the apperance of dental fluorosis?

Back 41

Mottled enamel, white spots to severe dark brown..can be smooth & glossy

Front 42

What can dental fluorosis can be misdiatnosed as _____________.

Back 42

Demineralization…rough and chalky apperance.

Front 43

What types of things would you question when trying to identify a stain?

Back 43

Medical/Dental history
Diet
Oral hygiene habits
*The source of the stain determines how I would treat it…if at all.**

Front 44

What are extrinsic stain removal procedures?

Back 44

Toothbrush Prophy (use a toothbrush to remove the stain) Scaling Polishing Cup.

*Remember if a toothbrush doesn't remove the stain then you need to use a more abrasive means.*

Front 45

What is a good reminder about hanging a fork in your opperatory?

Back 45

Reminds patients to clean in between their teeth the way they would clean a dirty fork before using it!

Front 46

If a Pt presents with heavy or moderate stain, what is a time saving measure to remove the stain?

Back 46

Scale it! (Possibly ultra sonic)

Front 47

If a Pt presents with light or fine stain what is a time saving measure to remove it?

Back 47

Polish stain 1st then scale if needed!

Front 48

Concerning aging, what does ADL stand for?

Back 48

Activities of Daily Living

Front 49

What is Chronologic Age?

Back 49

The actual measure of TIME elapsed since a person's birth.

Front 50

What is Bilolgic Age?

Back 50

The (physiologic) age of a person as determined by changes in organismic structure and function.
(Takes into account posture, skin texture, strength,speed & sensory acuity.)

Front 51

What kind of changes are part of physiologic aging? (Name off a few)

Back 51

Musculoskeletal
Skin
Respiratory
GI
CNS & PNS
Senses Endocrine Immune

Front 52

According to the news 1 in _____ people over 65 has Alzheimer's Disease/

Back 52

3 (1 in 3 people over 65)

Front 53

What factors influence overall health status? (4 items)

Back 53

Biologic
Environmental
Psychosocial (Communication & Socialization)
Lifestyle

Front 54

What are the 5 most comon chronic conditions of the aging?

Back 54

1) Arthritis
2) Visual Impairments
3) Hearing Impairments
4) Hypertension (may not be able to Tx Pt)
5) Caradiovascular Disease

Front 55

What are some Conditions of Significance? (They may determine if or how we Tx a Pt, and we may have to approach Tx differently.)

Back 55

COPD
Depression
Diabetes
Alzheimer's (Dementia)
Osteoarthritis/Osteoporosis
Stroke
Alcoholism (can delay healilng)

Front 56

Alzheimer's Disease is ______________. The etiology is ____________.

Back 56

Non Reversible

Unknown

Front 57

What age is considered early onset of Alzheimer's?

Back 57

30-40 year olds

Front 58

What age is considered late onset of Alzheimer's?

Back 58

Over 65.

Front 59

When working with a Pt who has Alzheimer's, who do you need to involve in the Tx?
How often should recare appts be?

Back 59

The care giver
In the early stages recare should be 3 months.

*Be sure you're getting Fluoride into the Pt.*

Front 60

What may be involved in treating a later stage Pt with Alzheimer's?

Back 60

Possible Sedation, Use of a mouth prop

*The Pt/care giver may need to utilize a power tooth brush. Again, involve the care giver!*

Front 61

What kind of soft tissue changes might you observe in an aging patient?

Back 61

Xerstomia--may be from meds or radiation therapy
Loss of elasticity
Capillary fragility-->more petachia
Sublingual varicosities (more often and more pronounced)
Oral candidiasis--due to antibiotics, radiation or chemo therapy.

Front 62

How do the teeth change in an aging patient?

Back 62

Change color (intrinsic)
Pulpal change (secondary dentin)
Attrition/abraision (due to wear n tear)
Root caries (due to recession)

Front 63

In the periodontium, what chanages might you see in the aging?

Back 63

more Bone Loss
Recession w/sensitivity
minimal attached gingiva (gets fragile)

*Remember some patients can ve very healthy, involved and well maintained.*

Front 64

What are some barriers to care for the aging?

Back 64

Lack of income
Lack of perceived need
No access to transportation. (may be wheelchair bound)

Front 65

What do I as a DH need to take into consideration when making the appointment with someone who is aging?

Back 65

Allow Time-->Pt may want to really talk (due to lonliness) Address the Pt formally Mr. Mrs. Miss
Speak Loudly and Clearly
HH may take a long time to get through due to meds etc.

Front 66

When instructing an elderly Pt, what do I need to consider?

Back 66

*Show sincere interest
* Allow Time
*Assess Pt's ability to perform
*Make changes GRADUALLY & build on what they already know

**Remember-->don't want to be seen as a Young Know it ALL!**

Front 67

OHI/Diatary Advice would be based on what 4 findings?

Back 67

Caries Risk
Periodontal Risk
Plaque Index
IO/EO
*Pt may need to make some dietary changes.*

Front 68

In the edentulous mouth be sure to observe what parts of the Bone and Mucus Membranes?

Back 68

Bone: Residual Ridges
Mucus Membranes: attached tissue, lining mucosa, frenal attachments

Front 69

What part of the mocosa may create a problem with a denture wearer?

Back 69

The frenal attachment…could be pinched by dentures.

Front 70

Anodontia

Back 70

The absense of teeth..could be born this way which is rare,

Front 71

Denture Adhesive

Back 71

material used to adhere a denture to the oral mucosa

Front 72

Denture Characterization

Back 72

modification of the form & color of the denture base & teeth to produce a more life-like appearance.

Front 73

Prosthesis

Back 73

An artificial replacement of an absent part of the body…A therapeutic device to improve or alter function.

Front 74

A prosthesis may be __________ or ___________.

Back 74

Fixed or Removable

Front 75

A denture may be a _____________ or ____________.

Back 75

partial or complete

Front 76

Overdenture

Back 76

A removeable prosthesis that tests on one or more remaining natural teeth, roots and/or dental implants.

Front 77

Immediate Denture

Back 77

A complete denture fabricated for placement immediately following the removal of natural teeth (and/or other surgical preparation of the dental arches.)

Front 78

Obturator

Back 78

A prosthesis used to close a congenital or aquired opening such as for a cleft palate.
(Could also be due to other trauma)

Front 79

Space Maintainer

Back 79

prosthetic replacement for prematurally lost primary teeth..to prevent closure of the space before the eruption of the permanent tooth

Front 80

Hawley (retainer)

Back 80

A removable plastic & wire appliance used to stabilize teeth; may be modified for special applications during/after ortho treatment.

Front 81

What are some causes of denture induced oral lesions?

Back 81

1) ill fitting dentures
2) Lack of oral hygiene
3) Continuous wearing of the dentures
**Pt's often feel DDS exams are no longer needed if they wear dentures…this is not true.**

Front 82

What are 4 different denture irritations/lesions?

Back 82

1)Angular Chelitis--due to saliva moisture and C. albicans 2) Inflammatory lesions
3) Ulcerative lesions--from chronic ill fitting dentures
4) Papillary hyperplasia

Front 83

Why would a patient who has recently gotten dentures expect to have a rebase or a remake of their dentures within the first year?

Back 83

The mouth will change as a result of not having teeth..as such the dentures may need to be re-fitted or re-formed to accommodate and allow for pt comfort.

Front 84

If an ideal Pt w/dentures would make only 1 visit to the DDS per year and a Careless or High risk pt might need 2-4 visits per year; what is causing the difference in these patients?

Back 84

Lack of care in the dentures, perhaps in how they are cleaned and cared for or the PT may not be in the best of health.

Front 85

What does the typical appointment for a denture Pt look like? (describe what you would do)

Back 85

Review HH / Vitals
Inquire on fit of dentures/have Pt remove
Perform IO/EO
Examine dentures in front of PT (don't want to be accused of breaking them)
Cleanse Dentures
Identify homecare needs/education
DDS Tx as needed

Front 86

Why does a denture Pt still need to brush the soft tissues?

Back 86

To remove plaque and stiumlate the tissue.

*Always use a very soft brush.*

Front 87

Why is it important to label or mark dentures?

Back 87

So Pt doesn't get them confused with another person. *Can be confused in close living situations like nursing homes etc.*

Front 88

What is usually including in the ID of dentures?

Back 88

Full Name Birth Date
(may depend on the caregiver)

Front 89

A bridge is a __________ or _________ denture.

Back 89

Fixed or Partial

Front 90

What does the metal framework do with regard to the partial denture or bridge?

Back 90

Makes it more stable

Front 91

What does a "rest" sit on?

Back 91

Existing structure to add support

Front 92

What does a "clasp" do with regard to partials?

Back 92

Wraps around a tooth to add stability

Front 93

What are the 4 parts of a Complete Removable Denture?

Back 93

1) Impression Surface (where the existing soft tissue lies) 2) Denture Border(rests in the vestibule)
3) Polished Surface (the pink polished surface)
4) Occlusal Surface

Front 94

An implant supported denture is a more/less common type of denture?

Back 94

More Common!
It uses actual implants in the edentulous Pt to hold the denture in place

Front 95

An over denture is often used for a patient with….

Back 95

Remaining tooth structure.
(could be existing teeth or roots remaining)

Front 96

If a patient has an over denture what sill needs to be done with the remaining tooth structure?

Back 96

Still needs to be probed and examined for health.
Still need to scale those remaing structures too!

Front 97

Why is a provisional or immediate denture placed immediately after removal of existing teeth?

Back 97

So soft tissue will heal and take the shape of the denture.

Front 98

What is the purpose for cleaning a prosthesis? (4)

Back 98

1) Prevent irritation of oral tissue
2) Control Infection
3) Prevent Mouth Odor
4) Maintain Appearance (they will stain)

Front 99

What 3 deposits will show up on dentures?

Back 99

Plaque, Calculus and Saliva!
(All of this will be on both sides of a denture. Calc especially so on the lower denture.)

Front 100

What types of things do I need to tell a Pt concerning the cleaning of their dentures?

Back 100

Remove and brush after each meal. (if can't brush then rinse off)
Use denture cleaning products--Immersion is best w/denture detergent (avoid abrasives)
Use a specially designed denture brush
There are commercially available ultrasonic devices the Pt can purchase.

Front 101

Denture Cleansers need to be: (5 things)

Back 101

Easy to use
Reasonably priced
Effective at removing deposits
Non-toxic
Harmless to dental materials

Front 102

What can be the purpose of denture adhesive?

Back 102

To fill the space when the tissues shrink as a result of healing.
*Be aware that food & plaque will stick to the adhesive and if not cleaned…will stink!*

Front 103

What is the procedure for a professional cleaning etc of complete/partial dentures?

Back 103

1) Have Pt remove (unless they are unable then I should do it.)
2) Inspect for debris
3) Immerse in an ultrasonic cleaning solution
4) Rinse, inspect & polish-->just like typodont teeth
5) deliver to Pt

Front 104

What should always be done to avoid breakage of dentures when cleaning?

Back 104

Fill the sink with water to avoid breakage in case you drop them. Also, always transport in a cup.

Front 105

What would be the procedure of cleaning a fixed partial (bridge) denture? (For the Patient that is.)

Back 105

1) Regular tooth brushing
2) Floss where contacts are accessible
3) Use a floss threader to access under the pontics.
4) Rinse well
5) Use a water pik

Front 106

If I need to remove a MX denture from the Pt's mouth, what are the procedures?

Back 106

1) Sit at Noon
2) Grasp denture with thumb at height of border under the lip, index finger on palatal side
3) Use other hand to raise lip, expose the border of the denture & break the seal.
4) Gently pull down on denture to remove
5) Ask Patient to blow w/lips closed to assist in breaking the seal.

Front 107

How would I remove the MN complete denture?

Back 107

1) "Righties" sit at 9
2) Grasp denture firmly on facial surface w/index finger
3) Place thumb on the lingual surface
4) Use other hand to support denture as I lift it out of the mouth.

Front 108

If the Pt can't remove the partial denture w/clasps…how would I remove it?

Back 108

1) Exert even pressure on both sides of the denture
2) Use index fingers to lift clasps from teeth
3) Lift vertically and support denture from the mouth.

Front 109

What do I need to provide to the Pt (who wears dentures) during intra oral procedures?

Back 109

A tissue for the patient and place dentures in disposable cup.
(If cleaning of denture is necessary follow immersion instructions)

Front 110

Where should I not ever keep the denture?

Back 110

Do not keep in on the tray set up…will likely tip it over and it could break!

Front 111

What should I be teaching the Pt about the underlying mucosa and its care for the denture wearer?

Back 111

Rince each time the deuture is removed
Bush the mucosa with an ultra soft brush
Massage w/finger, thumb or soft brush to stimulate.
Have Pt remove dentures overnight
Keep denture moist when out of the mouth for periods of time…otherwise the acrylic will dry out.

Front 112

Reline material of dentures is applied by the ____________. Adhesive paste is applied by the ___________.

Back 112

Dentist

Patient

Front 113

What are the advantages of cleaning by immersion? (5)

Back 113

1) Solution reaches all surfaces
2) Minimize danger of dropping the appliance
3) Offers safe storage when not in the mouth
4) Aids person with limited dexterity
5) Immersion involves the least amount of handling or observation when distasteful!

Front 114

If someone is using bleach to immerse clean their denture, what ratio of bleach to water should they be using?
How long should the appliance remain in the solution?

Back 114

1 part bleach : 3 parts water
5 Minutes

*Remember, bleach will "Bleach" the gingiva of the denture and it won't match the pt skin anymore.*

Front 115

The chemical solution of Alkaline Peroxide for cleaning dentures comes in what form?

Back 115

powder or tablet

Front 116

Dilute acids for claning dentures is prepared how?

Back 116

Commercially (Enzymes are too)

Front 117

What is the Process Eval for cleaning dentures by immersion? (9 Steps)

Back 117

1) Examine for breaks/debris
2) Use warm water to disolve cleanser in plastic bag
3) Place appliance inside solution
4) Place bag in sterile beaker cushioned with water (for stability in ultra sonic)
5) Run ultra sonic for 5-10 minutes
6) Remove & evaluate for cleanliness
7) Inspect for additional debris
8) brush/polish if necessary
9) Rinse well after cleansing

Front 118

What is the Process Eval concering Pt information of cleaning etc of dentures?

Back 118

1) Provide cleaning & maintenance info to Pt
2) Explain necessity for annual examination
3) Explain how to store overnight
4) Document in Patient Notes (I in ADPIE "cleaned & advised pt how to clean")
5) Maintain asepesis

Front 119

What shoud I used to clean orthodontic prostesis?

Back 119

Use your polisher with a brush to clean inbetween.
The brush can be gotten from Mrs. D

Front 120

When might I see a space maintainer?

Back 120

In kids who may have lost a tooth prematurly. It holds the space open for the permanent teeth to avoid crowding later

Front 121

When would I usually see the use of a Hawley Retainer?

Back 121

Post Ortho Tx!

Front 122

What do I need to be telling Pt's with fixed Ortho appliances?

Back 122

Brush Regularly (can use a power or sonice TB for excellent care)
Floss with a threader
Use home fluoride
Use and end tuft brush to get between brackets
Use of Water Pik is good.

Front 123

What do I tell a Pt about cleaning a retainer? (removable ortho appliance)

Back 123

Regular Brushing or Power brushing
Immersion in denture cleanser is fine
Rinse appliance if unable to brush