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37 Cards in this Set

  • Front
  • Back
normal flora of the oral cavity
aerobic gram + (strep)
actinomyces
anaerobes (prevotella melaninogenicus)
candida
normal flora of nasal cavity
aerobic gram + (strep)
haemophilus (children)
staph aureus
normal flora below clavicles that you know shouldn't be in mouth
gram - aerobes (E. coli, klebsiella, proteus)
enteric gram - anaerobes (bacteroides fragilis), also staph epidermidus & corynebacterium diptheriae
pathogen that is most serious risk of transmission for dentist/staff/pts
hep B. virus excreted in blood and saliva. may enter thru any moist mucosal surface or epithelial skin wound. good news- there's a vaccine for hep B (no vaccine for C)
universal precautions ***
tx all pts as if they had a communicable disease since you are unable to identify all pts who may be infective. treat all surfaces exposed to blood or secretions as potentially infectious. wear barriers for all pt contacts. avoid touching and contamination of surfaces w/ contaminated gloves or instruments
what is sepsis?
breakdown of living tissue by action of microorganisms. (not just the presence of microorg)
what is sterility? ***
freedom from viable organisms. absolute state. no degrees of sterility.
what is sanitization
reduction in # of viable organisms to levels judged safe by public health standards
how do you monitor sterility? ***
bacterial endospores eg Bacillus stearothermophilus is extremely resistant to heat and is used in sterilization monitoring services. required monthly test
necessary sterility in the dental environment**
most materials & drugs sterilized by manufacturer with double wrapping. absolute sterility in oral procedures is impossible. goal is to eliminate cross contamination from surgeons or other pts to surgical wound. **any surface patient contacts is potential carrier of infectious organisms and must be wrapped or disinfected btwn pts. contaminated supplies must be discarded in labeled bags by waste company.
"clean" technique ***
office based that doesn't require sterile tech. gown or long sleeved coat over street clothes. gloves over washed & dried hands. eye protection. mask. may prep mouth w/ CHx or EtOH mouthwash. drape patient w/ optional eye protection for pt. irrigate only w/ sterile water or saline in open wounds
"sterile" technique
skin treated w/ antiseptic. implant placement, office or hospital. goal to minimize # of organisms that enter wounds created by surgeon. surgical hand scrub. sterile gloves placed in sterile fashion. sterile gown. meticulous attn to detail & cooperation among staff
how do you elevate mucoperiosteum?
after incision elevate mucosa & periosteum in one layer. students have problem getting cleanly subperiosteal. should see bone. #9 Molt periosteal elevator: use sharp end to get started at papilla. use broad end to slide under flap separating periosteum from bone. can also be used as a retractor
are needle holders & hemostats the same?
NO! hemostats control hemorrhage by clamping vessels, pick up root tips/toothfrag/granulation tissue. needle holder has a locking handle, flat surface to stabilize triangular needle.
characteristics of suture needles
curved 1/2 or 2/8 circle, triangular tip is "cutting", tapered tip is "noncutting". swaged on tip or load your own. hold 2/3 from tip
suture sizes**
size designated by # of zeros. the more zeros, the smaller the suture. 3.0 most commonly used.
extraction forceps & their shapes
remove teeth from alveolar bone. beaks adapt to root structure of tooth and NOT crown. should parallel long axis of tooth w/ handle in a comfortable position. 2 basic shapes of maxillary forceps: 1) #150 universal forceps 2) #150A parallel beaks. #23 cowhorns for mandibular teeth only- pointed heavy beaks to enter furcation of lower molar. MD-3 (Ashe) forceps are for anterior teeth (bird beak).
characteristics of proper incisions
sharp blade, firm continuous stroke, avoid vital structures, blade perpendicular to epith surfaces, make incisions over intact healthy bone in attached gingiva when possible
characteristic of proper flaps
apex never wider than base. keep blood supply in base of flap- dont cut off blood source. don't twist or stretch falp. tearing sign of insufficient access. use vertical release to avoid tearing
3 things required to make blood clot
1) clotting factors made in liver that make fibrin 2) platelet adhesion 3) vessels constrict locally
5 methods of obtaining hemostasis
pressure, heat (electrocautery), ligation w/ hemostat, vasconstriction (epi), procoagulation (gelatin sponge, thrombin topical, collagen, cellulose)
purpose of irrigation
removes necrotic, foreign or ischemic material w/ sterile saline
monofilament vs multifilament sutures
monofilament is weaker, no wicking, looser knot, less inflam
multifiliment is stronger, wicks, holds knot better, more inflam
basic suturing technique
suture loose tissue first to tight tissue. gently approx edges (excessive tightness compromises vascularity). excessive # of sutures traps foreign material and incr tissue injury. no need to suture average extraction socket (only if loose tissue & exposed bone)
what is epithelialization & how is it important for dentistry?
free edge of epith migrates across injured (but vascularized) wound tissue bed. contact inhibition = stops when reaches another epith margin. contact inhibition may be detrimental if sinus epith heals to oral epith leaving a fistula in a sinus perf. 2e epithelialization is useful for vestibuloplasites
3 stages of wound healing
1) inflammatory
2) fibroplastic
3) remodeling
importance of inflammatory stage of wound healing
3-5 days. get edema to dilute contaminants. lag phase (no incr in wound strength occuring). but get PMNs, macrophages, B and T lymphocytes in to clear body of foreign substances
importance of fibroplastic phase of wound healing
2-3 weeks. get fibrin lattice and fibroblasts come in and lay down ground substance and tropocollagen (crosslinks to form collagen). new capillaries follow fibrin network. 70% strength. wound stiff and erythematous.
importance of remodeling phase of wound healing
strength never greater than 85%. collagen fibers realign to resist tensile forces. scar softens, vascularity decr, erythema decr. flexibility less due to lack of elastin. contraction slowly diminishes size of wound. remodeling continues indefinitely
what type of wound healing do extraction sockets undergo?
healing by secondary intention (gap in wound requires epithelial migration, collagen deposition and remodeling, slower healing, more scarring compared to primary intention).
types of healing in bone
primary and secondary intention apply to bone healing as well. gap btwn free ends of bone results in fibroblast/osteoblast matrix (callus) which ossifies more slowly & must be extensively remodeled.. vascularity & immobility are required
purpose of doing a medical history
to perform a medical risk assessment. (allows you to predict how well a pt will tolerate a proposed tx, predict & prepare for medical emergencies, prepare & modify planned tx based on medical status, predict complications and prepare strategies to avoid them)
stress reaction
complex state of physiologic rsns. reflex withdrawal. central stimulation (amygdala, hypothalamus, pituitary), ACTH, thyroid stimulating hormones, cortisol release, autonomic NS activation. **catecholamine production w/ alpha and beta effects, incr BP and cardiac work, blood flow shunting to facilitate fight or flight, form of exercise that may be a challenge to some pts. cortisol generates fight or flight by having adrenal medulla produce epi & norepi.
when is tx a pt considered "unsafe" & must be medically worked up and cleared before tx
"heart disease" checked on med history. hx of unstable angina, no current medical monitering, poorly compliant w/ medications, dental plan is for multiple extractions
definition of angina
chest pain caused by cardiac ischemia
definition of fibrillation
chaotic electrical activity w/ no effective pumping action
definition of defibrillation
depolarizes all cells at once so dominant pacemaker takes over