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217 Cards in this Set
- Front
- Back
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Professional Roles of the Dental Hygienist
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Educator
Researcher Administrator / Manager Advocate Clinician |
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Dental Hygiene Care definition:
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Preventive and treatment services that is administered to the patient by the hygienist.
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Preventive Services definition:
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Methods employed by the clinician and or patient to promote and maintain oral health.
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Three Groups of Preventive Services:
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Primary Prevention
Secondary Prevention Tertiary Prevention |
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Primary Preventive Services are:
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Measures carried out so that disease does not occur and is truly prevented.
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Secondary Preventive Services are:
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Involves the treatment of early disease to prevent further progression of potentially irreversible conditions that, if not arrested, can lead eventually to extensive rehab treatment or loss of teeth.
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Tertiary Preventive Services are:
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Methods to replace lost tissues and to rehab the oral cavity to a level where function is as near normal as possible after secondary prevention has not been successful
Ex: Implant |
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Which of the following is secondary prevention
1. When disease does not occur 2. The treatment of early disease 3. Replacement of lost tissues 4. True Prevention |
2. The Treatment of Early Disease
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Dental Hygiene Process of Care:
A Dog Can Influence Each Day |
Assessment
Dental Hygiene Diagnosis Care Self-Planning Implementation Evaluation Documentation |
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Purpose of Dental Hygiene Process of Care:
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To provide a framework within which individualized needs of the patient can be met.
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What is Assessment?
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First component of the dental hygiene process
Data collection |
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What does Subjective mean?
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Patient's Complaint
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What does Objective mean?
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Clinical observations not swayed by opinion.
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What is Diagnosis?
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Problem and Cause of Problem
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What is Care Plan?
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Set goals and establish priorities.
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What is Implementation?
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Active phase of the dental hygiene process of care.
Preventive Services are Provided |
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What is Evaluation?
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Evaluation of patient is completed. Has anything progressed since the last visit?
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What is Documentation?
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Records of Patient and treatment
Blue or black ink only. |
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Applications of D H Process of Care:
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The six components of the Dental Hygiene process of care serves as the foundation for the clinical practice of the DH.
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Purpose of DH Ethics:
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Increase awareness of standards of right or wrong
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Code of Ethics:
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Describes professional conduct
Outlines responsibilities and duties of each member toward patients, colleagues, and society. |
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Core Values in Dental Hygiene
ON TEST |
Individual autonomy and respect for human being
Confidentiality Societal trust Beneficience Nonmaleficence Justice and fairness Veracity |
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The act of doing good to Benefit the patient.
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What is Beneficience?
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Do No Harm
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Nonmaleficience
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Treat every patient fairly?
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What is Justice and Fairness?
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Truthfulness?
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What is Veracity?
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A common problem wherein a solution is readily grounded in the governing practice act, recognized laws, or accepted standards of care based on the standard rules of practice.
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What is Ethical Issue?
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Is Ethical Issue more clearly defined than Ethical Dilemma? Yes or No
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Yes
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A problem that may involve two morally correct choices or courses of action
No single answer. |
What is Ethical Dilemma?
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4 Steps in the Resolution of a Dilemma:
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Step 1: Dental Hygiene Situation--What is the CC
Step 2: Individual Preferences--rights of individuals or has consent been obtained Step 3: Choices versus Alternative Step 4: Case Parameters |
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The final decision of an Ethical Dilemma has to be ?
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Morally defensible.
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DH needs to have good health, both physically, mentally, and orally as well as represent their profession is a positive manner. True or False?
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True
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Nine Dental Specialties:
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Dental Public Healt
Endodontics Oral and Maxillofacial Pathology Oral and Maxillofacial Surgery Orthodontics and Dentofacial Orthopedics Pediatric Dentistry Periodontics Prosthodontics Oral and Maxillofacial Radiology |
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Which of the following are examples of dental specialities?
A. Endodontics, public health, and prosthodontic B. Pediatric dentistry and geriatric dentistry C. Odontics and enamel pathology D. Periodontics and maxillofacial gingival surgery |
A. Endodontics, public health, and prosthodontics
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Cross-contamination refers to the spread of microorganisms from one sourceto another; thi smay include which of the following?
A. Person to person, person to inaminate object, and inanimate object to person B. Person to inanimate object onl C. Inanimate object to person onl D. Person to person onl E. Person to inanimate object and inanimate object to person only. |
A. Person to Person, Person to Inanimate Object, and Inanimate Object to Person
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Tuberculosis infection occurs most commonly in which area?
A. Lymph Node B. Lung C. Kidney D. Liver |
B. Lungs
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The majority of cases of transmission of HIV in adults is due to which of the following
A. Blood transfusion B. Needle sharing C. Sexual contact D. Contact with saliva |
C. Sexual contact
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Which of the following is NOT a basic immunization recommended for all healthcare workers?
A. Typhoid fever B. Influenz C. Hepatitis B D. Measles |
A. Typhoid fever
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The part of the tooth covered by enamel.
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Anatomic Crown
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What provides the standards of right and wrong that guide the behavior of its members?
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Ethics of a profession
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What describes professional conduct and outlines responsibilities and duties of each member toward patients, colleagues, and society as a whole?
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Code of ethics
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Dental Specialties
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Dental Public Health
Endodontics Oral and Maxillofacial Pathology Oral and Maxillofacial Surgery Orthodontics and Dentofacial Orthopedics Pediatric Dentistry Periodontics Prosthodontics Oral and Maxillofacial Radiology |
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Chain of Disease Transmission
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1. Infectious Agent
2. Reservoirs 3. Port of Exit 4. Transmission 5. Port of Entry 6. Susceptible Host |
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HIV
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Route:
Blood & Blood products; Sexual Contact; Transplacental and perinatal |
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Hepatitis B Virus
HBV |
Route:
Blood Saliva and all body fluids Sexual contact Perinatal |
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Herpes Simplex Virus
Type 1 (HSV-1) Type 2 (HSV-2) |
Route:
Saliva Direct Contact (lip, hand) Indirect Contact (on objects. limited survival) Sexual Contact |
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Mycobacterium Tuberculosis
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Route:
Droplet nuclei Goes into lungs |
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Removal of all vegetative bacteria, fungi, & viruses. Depending on time of exposure the process could be considered sterilization or disinfection.
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High Level of Disinfection
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Removal of all forms of vegetative bacteria but no the removal or destruction of all spores.
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Intermediate Level of Disinfection
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Inactivate vegetative bacteria and certain viruses, do not destroy spores, tubercle bacilli, or nonlipid viruses.
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Low Level of Disinfection
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Transmission Routes
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Saliva
Blood Respiratory System Droplets Tears Vomitus Others (non dental) |
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Direct Transmission Routes
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Self
Patients Family Members Coworkers |
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Indirect Transmission Routes
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Airborne: coughing, sneezing, sputum, aerosol from ultrasonic scaler, high speed handpiece
Fomites: Dental instruments contaminated chartes, telephones, pencils, gloves, books, food, etc. Vectors: An organism, such as a mosquito, flea or tick, which caries disease-causing microorganisms from one host to another. |
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Why would you postpone treatment with a HSV active lesion?
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Prodromal stage most transmissible to others.
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Which of the following is NOT a basic immunization recommended for all healthcare worker?
a. Typhoid fever b. Influenza C. Hepatitis B D. Measles |
A. Typhoid Fever
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Which of the following are at high risk of developing a latex allergy?
a. a person with spina bifida b. health care workers c. a person allergic to bananas d. a person allergic to bananas, a person with spina bifida, and healthcare workers |
d. a person allergic to bananas, a person with spina bifida, and healthcare workers
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Which of the following is an autoclave?
a. it is a chemical vapor sterilizer b. it is sterilization achieved by steam under pressure c. it is a dry heat sterilizer d. it is an ethylene oxide sterilizer |
b. it is sterilization achieved by steam under pressure
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A. High-level disinfectants inactivate spores and all forms of bacteria, fungi, and viruses. B. Intermediate-level disinfectants inactivate all forms of micoorganisms but do not destroy spores.
a.) Statement A is correct and statement B is correct b.) Statement A is correct and statement B is incorrect c.) Statement A is incorrect and statement B is correct d.) Statement A is incorrect and statement B is incorrect. |
a.) Statement A is correct and statement B is correct
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A. Preprocedural rinsing and other oral hygiene measures help to prevent the spread of communicable diseases. B. Preprocedural rinsing and other oral hygiene measures decreases the number of microorganisms in the oral cavity.
a.) Statement A is correct and statement B is correct b.) Statement A is correct and statement B is incorrect c.) Statement A is incorrect and statement B is correct d.) Statement A is incorrect and statement B is incorrect. |
a.) Statement A is correct and statement B is correct
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Standard Precautions are used ?
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At all times
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this is the initial position from which chair adjustments are made. When updating and discussing medical history with the patient, it is suggested that the clinician be at eye level with the patient, conversing in the upright position. This is the position from which the patient first sits, then exits from the dental chair.
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Upright:
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patients with certain types of cardiovascular, respiratory, or vertigo problems may need this position. It is between the upright and full supine positions.
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Semi-upright or semi-supine:
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in a supine or flat position the brain is on the same level as the heart. A patient is ideally situated for support of the circulation; rarely could a patient faint while lying in a supine position. This is the position used most for treatment procedures.
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Supine:
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the patient is in the supine position and tipped back and down 35 degrees to 45 degrees so that the heart is higher than the head. This is an emergency position used when the patient is approaching syncope.
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Trendelenburg
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What are these positions?
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Supine, Trendelenburg, Semi-upright and upright.
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Why should the patient remain seated in the upright position for a couple of minutes after being reclined?
A) To allow the patient to receive postoperative instructions B) To allow all the patient’s saliva to flow back into the mouth and be expectorated before the patient leaves the operatory C) To avoid possible postural hypotension D) There is no reason for the patient to remain seated after treatment |
C) To avoid possible postural hypotension
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What is the Clinician's working distance?
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Clinician’s working distance. Acceptable positioning shows the patient at the clinician’s elbow level and the oral cavity of the patient between 15 and 22 inches from the clinician’s eyes.
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Neutral Working Posture:
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Back: in neutral postural alignment with natural spinal curves. Head: on top of neutral spine with forward neck flexion between 15 and 20 degrees or less. Eyes: directed downward to prevent neck and eye strain; it is not necessary to bend the head down more than 15 to 20 degrees for prolonged periods of time. Shoulders: relaxed and parallel with the hips and floor. Elbows: close to the body. Forearms: parallel with the floor. Wrist: forearm and wrist are in a straight line. Thighs: full body weight distributed evenly on seat; comfortable space (about 3 inches) between edge of seat and back of knee. Knees: slightly apart. Feet: flat on the floor.
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Which of the following is not correct positioning for a clinician in neutral position?
A) Shoulders are relaxed and perpendicular with the hips and floor B) Elbows are held close to the body C) Forearms are maintained parallel with the floor D) Feet are flat on the floor, knees slightly apart, and weight evenly distributed |
A) Shoulders are relaxed and perpendicular with the hips and floor
They should be parallel. |
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Clock positions:
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Lighting.
Light does not obstruct clinician, and allows clear illumination of the treatment area. |
(A) Maxillary arch; chin-up position; beam of light often between 60- and 45-degree angle to floor. (B) Mandibular arch; chin-down position; beam of light nearly perpendicular to floor.
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What are loupes?
A) Safety glasses B) Vision magnification eyewear C) A nickname for an ear loop-style mask D) An external light source |
B) Vision magnification eyewear
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Functional Movement Exercises
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Encryption technology pertains to which aspect of HIPAA?
A) Portability B) Security C) Privacy D) Confidentiality |
B) Security is the correct answer.
Security refers to policies, procedures, and tools used to keep individually identifiable patient information private. One such tool is encryption technology. |
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Universal tooth numbering (American Dental Association).
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Above, permanent dentition designated by numbers 1 through 32, starting at the maxillary right with #1 and following around to the maxillary left third molar (#16) to the left mandibular third molar (#17) and around to the right mandibular third molar (#32). Below, primary teeth are designated by letters in the same sequence.
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Using the Universal tooth numbering system, state the tooth number for the permanent maxillary left second premolar.
A) #13 B) #12 C) #14 D) #20 E) #21 |
A) #13 is the correct answer.
The Universal tooth numbering system starts with the right maxillary third molar (#1). Follow around the arch to the left maxillary third molar (#16). Descend to the left mandibular third molar (#17). Follow around to the right mandibular third molar (#32). |
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FDI system is also called the International system
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Each quadrant is numbered 1 through 4, with #1 on the maxillary right, #2 on the maxillary left, #3 on the mandibular left, and #4 on the mandibular right. Each tooth in a quadrant is numbered 1 through 8 from the central incisor. Quadrants of the primary dentition are numbered from 5 through 8. It is a two-digit system.
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Palmer or Set-Square Method
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Permanent teeth: each tooth is designated using the numbers 1 (central incisor) through 8 (third molar). The appropriate quadrant for each tooth is designated using a specific pattern of vertical and horizontal lines.
Primary or deciduous teeth: uppercase letters A through E are used instead of the numbers. |
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Palmer system tooth numbering.
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Each permanent tooth is designated by number 1 through 8, starting at the central incisor of each quadrant. Quadrants are designated by horizontal and vertical lines. Primary teeth are identified by the letters A through E, starting at the central incisor.
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Convert from the Palmer notation system tooth
to the Universal system. A) #27 B) #22 C) #3 D) #R E) #30 |
A) #27
B) #22 C) #3 D) #R E) #30 A) #27 is the correct answer. Each tooth is designated in the Palmer system using the numbers 1 (central incisor) through 8 (third molar). The appropriate quadrant for each tooth is designated using a specific pattern of vertical and horizontal lines as shown in Figure 8-3. |
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The question, “Are you thirsty much of the time?,” is an example of which type of question in the health questionnaire?
A) Symptom oriented B) Disease oriented C) System oriented D) Culture oriented |
A) Symptom oriented is the correct answer.
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What type of questions pertain to disorders of specific body systems, such as the respiratory system.
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System-oriented questions
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What type of questions pertain to specific diseases, such as diabetes or cancer.
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Disease-oriented questions
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What type of questions pertain to aspects of the patient’s cultural background that might impact his or her health or care.
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Culture-oriented questions
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What type of questions pertain to particular signs or symptoms the patient may be experiencing that may indicate disease.
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Symptom-oriented questions
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Which type of patient would require antibiotic coverage during treatment?
A) A patient on antihypertensive drugs B) A patient with latex allergy C) A patient of Native American descent D) A patient at risk for infective endocarditis |
D) A patient at risk for infective endocarditis is the correct answer.
Patients at risk for infective endocarditis must have antibiotic premedication prior to any tissue manipulation that could create a bacteremia. |
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Medical Conditions Requiring Antibiotic Premedication
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Prosthetic cardiac valve
Previous endocarditis Congenital heart disease Cardiac transplantation recipients with cardiac valvular disease Joint replacement within 2 years |
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How much Amoxicillin do you give to premed?
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Adult:
2 grams 800 mg 4 pills usually 1 hour before appointment. Child: 50 mg/kg orally |
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If the patient cannot take Amoxicillin, what do you give them?
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Clindamycin
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How much Clindamycin do you give to premed?
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Adults:
600 mg 1 hour before appt. Child: 25 mg |
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If a patient is ill and currently on medication, do you increase their current dosage?
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No...you have them get a different class or type of antibiotic.
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What is the ASA Determination?
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The American Society of Anesthesiologist. It is a physical status classification system that estimates medical risk.
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a patient without apparent systemic disease: a normal healthy patient.
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ASA I
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a patient with mild systemic disease.
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ASA II
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a patient with severe systemic disease that limits activity but is not incapacitating.
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ASA III
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a patient with an incapacitating systemic disease that is a constant threat to life.
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ASA IV
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a moribund patient not expected to survive 24 hours with or without care.
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ASA V
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A person’s health is not static; therefore, a health history must be updated when or how often?
A) Annually B) At every recall appointment C) At each and every appointment D) At the initial appointment |
C) At each and every appointment is the correct answer.
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What is the category that was added to the vital signs?
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Smoking status
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What is the body temperature?
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98.6 degrees F
37 degrees C |
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What makes the body temperature vacillate?
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Time of day
Temporary increase Pathologic states Decrease |
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A patient with a temperature over 100.8°F shows signs of which of the following?
A) Bradycardia B) Hypothermia C) Pyrexia D) Tachycardia |
C) Pyrexia
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the intermittent throbbing sensation felt when the fingers are pressed against an artery. It is the result of the alternate expansion and contraction of an artery as a wave of blood is forced out from the heart.
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Pulse
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Pulse Rate
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60 to 100 beats
Higher in women |
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Which artery do you use on adults to find the pulse?
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Radial pulse
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Which artery do you use on adults for the blood pressure?
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Brachial artery
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Which artery do you use on a baby to find the pulse?
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Brachial artery / pulse
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Adult respiration?
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14 to 20 breaths per minute
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What is the normal adult respiration rate range?
A) 14 to 20 breaths/min B) 10 to 14 breaths/min C) 20 to 24 breaths/min D) 24 to 26 breaths/min |
A) 14 to 20 breaths/min is the correct answer.
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Blood pressure for an average adult
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120/80 mmHg
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Selection of cuff size. The correct width (W) is 20% greater than the diameter of the arm where applied. (A) Too wide. (B) Correct width. (C) Too narrow.
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Use of a single finger. Example: index finger applied to inner border of the mandible beneath the canine-premolar area to determine the presence of a torus mandibularis.
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Digital Palpation
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Use of finger and thumb of the same hand. Example: palpation of the lips.
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Bidigital Palpation
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Use of finger or fingers and thumb from each hand applied simultaneously in coordination. Example: index finger of one hand palpates on the floor of the mouth inside, while a finger or fingers from the other hand press on the same area from under the chin externally.
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Bimanual Palpation
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The two hands are used at the same time to examine corresponding structures on opposite sides of the body. Comparisons may be made. Example: fingers placed beneath the chin to palpate the submandibular lymph nodes.
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Bilateral Palpation
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A bilateral examination uses two hands at the same time to examine corresponding structures on opposite sides of the body. A bimanual examination uses fingers and thumb from each hand applied simultaneously in coordination.
A) The first statement is true and the second statement is true B) The first statement is true and the second statement is false C) The first statement is false and the second statement is true D) The first statement is false and the second statement is false |
A) The first statement is true and the second statement is true is the correct answer.
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Sequence of Extraoral and Intraoral Examination
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1. Overall Appraisal of patient
2. Face 3. Skin 4. Eyes 5. Nodes a. Pre- & postauricular b. Occipital c. Submental; submandibular d. Cervical chain e. Supraclavicular 6. TMJ 7. Lips a. Observe closed, then open b. Palpate 8. Breath Odor 9. Labial & Buccal Mucosa (L to R) a. Vestibule b. Mucobuccal folds c. Frena d. Opening of Stensen's duct e. Palpate cheeks 10. Tongue a. Vestibule b. Lateral borders c. Base of tongue (retract) d. Deviation on extension 11. Floor of Mouth a. Ventral surface of tongue b. Palpate c. Duct openings d. Mucosa, frena e. Tongue action 12. Saliva 13. Hard Palate 14. Soft Palate, Uvula 15. Tonsillar Region, Throat |
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Lymph Nodes
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A tumor is 1 cm or less in width. A nodule is greater than 5 mm but less than 1 cm in diameter.
A) The first statement is true and the second statement is true B) The first statement is true and the second statement is false C) The first statement is false and the second statement is true D) The first statement is false and the second statement is false |
C) The first statement is false and the second statement is true is the correct answer.
A tumor is 2 cm or greater in width. |
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The lining of the oral cavity, the oral mucosa, is a mucous membrane composed of connective tissue covered with _____?
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stratified squamous epithelium
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What covers the gingiva and the hard palate, the areas used most during the mastication of food. Except for the free margin of the gingiva, the masticatory mucosa is firmly attached to underlying tissues. The epithelial covering is generally keratinized.
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Masticatory mucosa
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What covers the inner surfaces of the lips and cheeks, the floor of the mouth, the underside of the tongue, the soft palate, and the alveolar mucosa. These tissues are not firmly attached to underlying tissue. The epithelial covering is not generally keratinized.
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Lining mucosa
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What covers the dorsum (upper surface) of the tongue. It is composed of many papillae; some contain taste buds.
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Specialized mucosa
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Thread-like keratinized elevations that cover the dorsal surface of the tongue; they are the most numerous of the papillae.
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Filiform.
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Mushroom-shaped papillae interspersed among the filiform papillae on the tip and sides of the tongue. On clinical examination they appear redder than the filiform papillae and contain variable numbers of taste buds. The inset enlargement on the next slide shows the comparative shape and size of the filiform and fungiform papillae.
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Fungiform.
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The 10 to 14 large round papillae arranged in a “V” between the body of the tongue and the base. Taste buds line the walls.
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Circumvallate (vallate).
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Vertical grooves on the lateral posterior sides of the tongue; also contain taste buds.
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Foliate.
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Papillae of the Tongue
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Gingival Fiber Groups
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Dentogingival (free gingival) fibers
Alveologingival (attached gingival) fibers Circumferential (circular) fibers Dentoperiosteal (alveolar crest) fibers |
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Dentogingival fibers (free gingival).
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From the cementum in the cervical region into the free gingiva to give support to the gingival.
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Alveologingival fibers (attached gingival).
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From the alveolar crest into the free and attached gingiva to provide support.
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Circumferential fibers (circular).
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). Continuous around the neck of the tooth to help to maintain the tooth in position.
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Dentoperiosteal fibers (alveolar crest)
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From the cervical cementum over the alveolar crest to blend with fibers of the periosteum of the bone.
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Transseptal fibers
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From the cervical area of one tooth across to an adjacent tooth (on the mesial or distal only) to provide resistance to separation of teeth.
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Principal Fiber Groups
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Apical fibers
Oblique fibers Horizontal fibers Alveolar crest fibers Interradicular fibers |
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From the root apex to adjacent surrounding bone to resist vertical forces.
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Apical fibers
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From the root above the apical fibers obliquely toward the occlusal to resist vertical and unexpected strong forces.
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Oblique fibers
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From the cementum in the middle of each root to adjacent alveolar bone to resist tipping of the tooth.
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Horizontal fibers
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From the alveolar crest to the cementum just below the cementoenamel junction to resist intrusive forces.
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Alveolar crest fibers
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From cementum between the roots of multirooted teeth to the adjacent bone to resist vertical and lateral forces.
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Interradicular fibers
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Periodontal Structures
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All of the following are divisions or categories of oral mucosa except:
A) masticatory mucosa B) lining mucosa C) specialized mucosa D) stratified mucosa |
D) Stratified mucosa is the correct answer.
The three divisions or categories of oral mucosa are masticatory, lining, and specialized mucosa. |
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The free gingival groove is a shallow linear groove that demarcates the free from the detached gingiva. In the absence of inflammation and pocket formation, the gingival groove runs somewhat parallel with and about 0.5 to 1.5 mm from the gingival margin.
A) The first statement is true and the second statement is true B) The first statement is false and the second statement is true C) The first statement is true and the second statement is false D) The first statement is false and the second statement is false |
B) The first statement is false and the second statement is true.
The free gingival groove is a shallow linear groove that demarcates the free from the attached gingiva. The second statement is true. |
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Gingival Sulcus (Crevice) Location
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the crevice or groove between the free gingiva and the tooth.
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Gingival Sulcus (Crevice) Boundaries
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Inner. Tooth surface. May be the enamel, cementum, or part of each, depending on the position of the junctional epithelium. Outer. Sulcular epithelium. Base. Coronal margin of the attached tissues. The base of the sulcus or pocket is also called the “probing depth,” the “depth of the sulcus,” or the “bottom of the pocket.”
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Gingival Sulcus (Crevice) Sulcular epithelium
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the continuation of the oral epithelium covering the free gingiva. Sulcular epithelium is not keratinized.
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Gingival Sulcus (Crevice) Depth of Sulcus
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healthy sulci are shallow and may be only 0.5 mm. The average depth of the healthy sulcus is about 1.8 mm.
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Gingival sulcus fluid (sulcular fluid, crevicular fluid)
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A serum-like fluid that seeps from the connective tissue through the epithelial lining of the sulcus or pocket. Occurrence is slight to none in a normal sulcus; increases with inflammation. It is part of the local defense mechanism and is able to transport many substances, including endotoxins, enzymes, antibodies, and certain systemically administered drugs.
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Junctional Epithelium
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is a cufflike band of stratified squamous epithelium that is continuous with the sulcular epithelium and completely encircles the tooth. It is triangular in cross section, is widest at the junction with the sulcular epithelium, and narrows down to the width of a few cells at the apical end. It is not keratinized. It has two basement membranes: one adjacent to the connective tissue and one adjacent to the tooth surface.
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The junctional epithelium or attachment epithelium provides a seal at the base of the sulcus.
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The attachment, or connecting interface between the tooth and the tissue, is accomplished by hemidesmosomes and the basal lamina of the junctional epithelium.
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Parts of the gingiva.
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Alveolar Mucosa
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Description: movable tissue loosely attached to the underlying bone. It has a smooth, shiny surface with nonkeratinized, thin epithelium. Underlying vessels may be seen through the epithelium.
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Frena (singular: frenum or frenulum)
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Description. A frenum is a narrow fold of mucous membrane that passes from a more fixed to a movable part, for example, from the attached gingiva at the mucogingival junction to the lip, cheek, or undersurface of the tongue. A frenum serves to check undue movement.
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McCall's Festoons
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Hyperkeratosis is a:
A) leathery, hard, or nodular surface B) leathery, smooth surface C) leathery, stippled surface D) leathery, soft surface |
A) Leathery, hard, or nodular surface is the correct answer.
Hyperkeratosis may result in a leathery, hard, nodular surface. |
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How to measure recession
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Clinical Attachment Loss: Take Recession + pocket.
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3 Types of Mirrors
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1. Plane (flat): May produce a double image.
2. Concave: Magnifying 3. Front surface: The reflecting surface is on the front of the lens rather than on the back as with plane or magnifying mirrors. The front surface eliminates "ghost" images. |
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Indirect vision: needed for all surfaces where direct vision is not possible. Examples are the distal surfaces of posterior teeth and lingual surfaces of anterior teeth.
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Indirect vision: needed for all surfaces where direct vision is not possible. Examples are the distal surfaces of posterior teeth and lingual surfaces of anterior teeth.
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Indirect illumination: reflection of light from the dental overhead light or headlight worn by the clinician to any area of the oral cavity can be accomplished by adapting the mirror.
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Indirect illumination: reflection of light from the dental overhead light or headlight worn by the clinician to any area of the oral cavity can be accomplished by adapting the mirror.
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Transillumination refers to reflection of light through the teeth. Mirror is held to reflect light from the lingual aspect while the teeth are examined from the facial. Mirror is held for indirect vision on the lingual while light from the overhead dental light passes through the teeth. Translucency of enamel can be seen clearly, whereas dental caries or calculus deposits appear opaque.
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Transillumination refers to reflection of light through the teeth. Mirror is held to reflect light from the lingual aspect while the teeth are examined from the facial. Mirror is held for indirect vision on the lingual while light from the overhead dental light passes through the teeth. Translucency of enamel can be seen clearly, whereas dental caries or calculus deposits appear opaque.
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Retraction: the mirror is used to protect or prevent interference by the cheeks, tongue, or lips.
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Retraction: the mirror is used to protect or prevent interference by the cheeks, tongue, or lips.
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Grasp and rest: use modified pen grasp with finger rest on a tooth surface wherever possible to provide stability and control and to assist in retraction of lips and cheek.
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Grasp and rest: use modified pen grasp with finger rest on a tooth surface wherever possible to provide stability and control and to assist in retraction of lips and cheek.
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Retraction: use a water-based lubricant on dry or cracked lips and corners of mouth. Adjust the mirror position so that the angles of the mouth are protected from undue pressure of the shank of the mirror. Insert and remove mirror carefully to avoid hitting the teeth because this can be very disturbing to the patient.
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Retraction: use a water-based lubricant on dry or cracked lips and corners of mouth. Adjust the mirror position so that the angles of the mouth are protected from undue pressure of the shank of the mirror. Insert and remove mirror carefully to avoid hitting the teeth because this can be very disturbing to the patient.
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Application of Air
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Purposes and uses:
Improve/facilitate exam procedures Improve visibility during treatment Prepare teeth and/or gingiva for procedures |
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Air:
Improve and facilitate examination procedures: |
make a thorough, more accurate examination. Dry supragingival calculus to facilitate exploring and scaling. Small deposits may be light in color and not visible until they are dried. Dried calculus appears chalky and presents a contrast to tooth color. Deflect the free gingival margin for observation into the subgingival area. Subgingival calculus usually appears darker than supragingival. Make identification of areas of demineralization and carious lesions easier. Recognize location and condition of restorations, particularly tooth-color restorations.
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Bleeding on probing is an early sign of ?
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Inflammation in the gingiva
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A pocket is ____?
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a diseased gingival sulcus
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A probe is a slender instrument with a rough, pointed tip designed for examination of the depth and topography of a gingival sulcus or periodontal pocket. A probe has three parts: the handle, the angled shank, and the working end.
A) The first statement is true and the second statement is true B) The first statement is false and the second statement is true C) The first statement is true and the second statement is false D) The first statement is false and the second statement is false |
B) The first statement is false and the second statement is true.
A probe is a slender instrument with a smooth, rounded tip design. The second statement is true regarding the parts of a probe. |
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How is a pocket measured?
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a pocket is measured from the base of the pocket (top of attached periodontal tissue) to the gingival margin.
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Probing:
Proximal surfaces are approached by entering from both the facial and lingual aspects of a tooth. Gingival and periodontal infections begin in the col area more frequently than in other areas. Probing depth may be deepest directly under the contact area because of crater formation in the alveolar bone. Anatomic features of the tooth-surface wall of the pocket influence the direction of probing. Examples are concave surfaces, anomalies, shape of cervical third, and position of furcations. |
Probing:
Proximal surfaces are approached by entering from both the facial and lingual aspects of a tooth. Gingival and periodontal infections begin in the col area more frequently than in other areas. Probing depth may be deepest directly under the contact area because of crater formation in the alveolar bone. Anatomic features of the tooth-surface wall of the pocket influence the direction of probing. Examples are concave surfaces, anomalies, shape of cervical third, and position of furcations. |
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Probe stroke: maintain the probe in the sulcus or pocket of each tooth as the probe is moved in a walking stroke as shown on the next slide. It is not necessary to remove the probe and reinsert it to make individual readings. Use a continuous probing to avoid missing a deep pocket area. Repeated withdrawal and reinsertion cause unnecessary trauma to the gingival margin and hence increase posttreatment discomfort.
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Probe stroke: maintain the probe in the sulcus or pocket of each tooth as the probe is moved in a walking stroke as shown on the next slide. It is not necessary to remove the probe and reinsert it to make individual readings. Use a continuous probing to avoid missing a deep pocket area. Repeated withdrawal and reinsertion cause unnecessary trauma to the gingival margin and hence increase posttreatment discomfort.
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Walking stroke: hold the side of the tip against the tooth at the base of the pocket. Slide the probe up (coronally) about 1 to 2 mm and back to the attachment in a “touch… touch…touch...” rhythm. Observe probe measurement at the gingival margin at each touch. Advance millimeter by millimeter along the facial and lingual surfaces into the proximal areas.
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Walking stroke: hold the side of the tip against the tooth at the base of the pocket. Slide the probe up (coronally) about 1 to 2 mm and back to the attachment in a “touch… touch…touch...” rhythm. Observe probe measurement at the gingival margin at each touch. Advance millimeter by millimeter along the facial and lingual surfaces into the proximal areas.
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Adaptation of probe for individual teeth: Molars and premolars.
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Molars and premolars. Orient the probe at the distal line angle for both facial and lingual application. Insert the probe at the distal line angle and probe in a distal direction; adapt the probe around the line angle; probe across the distal surface until the side of the probe contacts the contact area, and then slant the probe to continue under the contact area. Note the probing depth and slide the probe back to the distal line angle. Proceed in the mesial direction around the mesial line angle and across the mesial surface. When the side of the probe touches the contact area, the probe is slanted to continue measurements over halfway across the mesial surface.
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Adaptation of probe for individual teeth: Anterior Teeth
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Anterior teeth. Initial insertion may be at the distal line angle or from the midline of the facial or lingual surfaces. Proceed around the distal line angle and across the distal surface; reinsert and probe the other half of the tooth.
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Probe walking stroke. The side of the tip of the probe is held in contact with the tooth. From the base of the pocket, the probe is moved up and down in 1- to 2-mm strokes as it is advanced in 1-mm steps. The attached periodontal tissue at the base of the pocket is contacted on each down stroke to identify probing depth in each area.
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Probe walking stroke. The side of the tip of the probe is held in contact with the tooth. From the base of the pocket, the probe is moved up and down in 1- to 2-mm strokes as it is advanced in 1-mm steps. The attached periodontal tissue at the base of the pocket is contacted on each down stroke to identify probing depth in each area.
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Six measurements are recorded for each tooth, three from the facial and three from the lingual or palatal as shown on the next slide. For each of the six areas, the deepest probing measurement is recorded. Two recordings each are made for proximal areas: Numbers 3 and 6 for the mesial and 1 and 4 for the distal.
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Six measurements are recorded for each tooth, three from the facial and three from the lingual or palatal as shown on the next slide. For each of the six areas, the deepest probing measurement is recorded. Two recordings each are made for proximal areas: Numbers 3 and 6 for the mesial and 1 and 4 for the distal.
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The clinical attachment level refers to:
A) position of gingiva surrounding the teeth B) position of the periodontal attached tissues at the base of a sulcus C) position of the gingival attachment apparatus D) position of alveolar bone in correlation to gingival attachment |
B) Position of the periodontal attached tissues at the base of a sulcus is the correct answer.
The clinical attachment level refers to the position of the periodontal attached tissues at the base of a sulcus or pocket |
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Measuring Clinical Attachment
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An explorer is used to:
Detect, by tactile sense, the texture and character of the tooth surfaces. For calculus, defects or irregularities in the surfaces and margins of restorations, and other irregularities that are not apparent to direct observation. An explorer is used to confirm direct observation. Do not use an explorer on remineralizing potentially dental carious legions. Define the extent of instrumentation needed and guide techniques: for scaling and root planing and removing an overhanging filling. Evaluate the completeness of treatment: for periodontal nonsurgical treatment as shown by the smooth tooth surface and for removal of an overhanging filling by the smooth margins of the restoration. |
An explorer is used to:
Detect, by tactile sense, the texture and character of the tooth surfaces. For calculus, defects or irregularities in the surfaces and margins of restorations, and other irregularities that are not apparent to direct observation. An explorer is used to confirm direct observation. Do not use an explorer on remineralizing potentially dental carious legions. Define the extent of instrumentation needed and guide techniques: for scaling and root planing and removing an overhanging filling. Evaluate the completeness of treatment: for periodontal nonsurgical treatment as shown by the smooth tooth surface and for removal of an overhanging filling by the smooth margins of the restoration. |
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Working end. Slender, wire-like, metal tip that is circular in cross section and tapers to a fine sharp point.
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Working end. Slender, wire-like, metal tip that is circular in cross section and tapers to a fine sharp point.
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Explorer Working End:
Single. A single instrument may be universal and adaptable to any tooth surface, or it may be designed for specific groups of surfaces. A single-ended instrument has one working end on a separate handle. |
Explorer Working End:
Single. A single instrument may be universal and adaptable to any tooth surface, or it may be designed for specific groups of surfaces. A single-ended instrument has one working end on a separate handle. |
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Explorer Working End:
Paired. Paired instruments are mirror images of each other, curved to provide access to contralateral tooth surfaces. Double-ended. A double-ended instrument has two working ends, one on each end of a common handle. Most paired instruments are available double-ended. Other double-ended instruments combine two single instruments, for example, two unpaired explorers or an explorer with a probe. |
Explorer Working End:
Paired. Paired instruments are mirror images of each other, curved to provide access to contralateral tooth surfaces. Double-ended. A double-ended instrument has two working ends, one on each end of a common handle. Most paired instruments are available double-ended. Other double-ended instruments combine two single instruments, for example, two unpaired explorers or an explorer with a probe. |
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Shank. Straight, curved, or angulated. Whether a shank is straight, curved, or angulated depends on the use and adaptation for which the explorer was designed. A curved shank may facilitate application of the instrument to proximal surfaces, particularly of posterior teeth.
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Shank. Straight, curved, or angulated. Whether a shank is straight, curved, or angulated depends on the use and adaptation for which the explorer was designed. A curved shank may facilitate application of the instrument to proximal surfaces, particularly of posterior teeth.
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Explorers for deep pockets and inside furcations: several explorers designed for very deep pockets and inside furcation areas are in current use. Examples: Orban 20; TU-17; Number 3A (shown in Figure 15-12); OD 11/12 designed like the Gracey 11/12 curet.
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Explorers for deep pockets and inside furcations: several explorers designed for very deep pockets and inside furcation areas are in current use. Examples: Orban 20; TU-17; Number 3A (shown in Figure 15-12); OD 11/12 designed like the Gracey 11/12 curet.
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Subgingival explorer: The Pocket Explorer:
Shape. The pocket explorer has an angulated shank with a short tip (Figure 15-13). The tip can be measured to ensure that it is less than 2 mm. A longer tip cannot be adapted to the line angles of narrow roots. |
Subgingival explorer: The Pocket Explorer:
Shape. The pocket explorer has an angulated shank with a short tip (Figure 15-13). The tip can be measured to ensure that it is less than 2 mm. A longer tip cannot be adapted to the line angles of narrow roots. |
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Features for subgingival root examination. Back of tip can be applied directly to the attached periodontal tissue at the base of the pocket without lacerating. When a straight or sickle explorer is directed toward the base of the pocket, the sharp tip can pass into the epithelium without resistance. The short tip can be adapted to rounded tooth surfaces and line angles. Long tips of other explorers have a tangential relationship with the tooth and cause distention and trauma to sulcular or pocket epithelium. Narrow short tip can be adapted at the base where the pocket narrows without undue displacement of the pocket soft tissue wall.
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Features for subgingival root examination. Back of tip can be applied directly to the attached periodontal tissue at the base of the pocket without lacerating. When a straight or sickle explorer is directed toward the base of the pocket, the sharp tip can pass into the epithelium without resistance. The short tip can be adapted to rounded tooth surfaces and line angles. Long tips of other explorers have a tangential relationship with the tooth and cause distention and trauma to sulcular or pocket epithelium. Narrow short tip can be adapted at the base where the pocket narrows without undue displacement of the pocket soft tissue wall.
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Supragingival use of No. TU-17. It may be adapted to all surfaces and is especially useful for proximal surface examination. It is not readily adaptable to pits and fissures.
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Supragingival use of No. TU-17. It may be adapted to all surfaces and is especially useful for proximal surface examination. It is not readily adaptable to pits and fissures.
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All of the following refer to fremitus except:
A) palpable vibration or movement B) dentistry refers to vibratory patterns of teeth C) determination is made only on the mandibular teeth D) a tooth has excess contact, possibly related to a premature contact |
C) Determination is made only on the mandibular teeth is the correct answer.
Determination is made only on the maxillary teeth, not the mandibular teeth, because fremitus depends on tooth contact. |
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Shepherd's Hook
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Use: examining pits & fissures & supragingival smooth surfaces; examining surfaces & margins of restorations & sealants.
Adaptability: Difficult to apply to proximal surfaces and not for deep subgingival exploration. |
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Pigtail or Cowhorn
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Use:
Proximal surfaces for calculus, dental caries, or margins of restorations. Adaptability: as paired, curved tips, they are applied to opposite tooth surfaces. |
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A ____ is a diseased sulcus.
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Pocket
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HIPAA
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Health Information Portability and Accountability Act of 1996
* Privacy *Confidentiality *Security *Storage Systems |
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Three Tooth Numbering Systems
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Universal: 1-32 System
FDI Two Digit System Palmer or Quadrant 1-8 System |
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Gingival Pocket
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It is the presence or absence of infection that distinguishes a pocket from a sulcus.
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Periodontal Pockets
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The level of attachment on the tooth distinguishes a gingival pocket from a periodontal pocket.
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A pocket has an inner wall (which is what?) and an outer wall (which is what?) of the free gingiva. The two walls meet at the base of the _____?
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--the tooth surface
--the sulcular epithelium or pocket epithelium |
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4 Stages of Development of Gingivitis and Periodontitis:
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1. The Initial Lesion
2. The Early Lesion 3. The Established Lesion 4. The Advanced Lesion |
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The Initial Lesion Characteristics
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*Inflammatory response to dental biofilm. *Occurs within 2 to 4 days of irritation from bacterial accumulation.
*Migration and infiltration of white blood cells into the junctional epithelium and gingival sulcus result from the natural body response to infectious agents. *Increased flow of gingival sulcus fluid. *Early breakdown of collagen of the supporting gingival fiber groups. *Fluid fills the spaces in the connective tissue. Clinical appearance. *No clinical evidence of change may appear in the earliest phases. *Slight marginal redness with enlargement due to the fluid collection follows as the infection develops. |
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The Early Lesion Characteristics:
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*Increased inflammatory response.
*Dental biofilm becomes older and thicker (7 to 14 days; time reflects individual differences). *Infiltration of fluid, lymphocytes, and neutrophils with a few plasma cells into the connective tissue. *Breakdown of collagen fiber support to the gingival margin. *Epithelium proliferates: epithelial extensions and rete ridges are formed. Clinical appearance. *Early signs of gingivitis become apparent with slight gingival enlargement; will become an established lesion if undisturbed. *Early gingivitis is reversible when biofilm is controlled and inflammation is reduced. *Healthy tissue may be restored. Susceptibility of individuals varies; time before lesion becomes established varies. |
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The Established Lesion Characteristics:
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Progression from the early lesion:
*Fluid and leukocyte migration into tissues and sulcus increases; *Plasma cells are related to areas of chronic inflammation. *Formation of pocket epithelium. *Proliferation of the junctional and sulcular epithelium continues in an attempt to wall out the inflammation. *Pocket epithelium is more permeable; areas of ulceration of the lining epithelium develop. *Early pocket formation with bleeding on probing. *Collagen destruction continues; connective tissue fiber support lost. *Progression to early periodontal lesion may occur, or some established lesions may remain stable for extended periods of time. Clinical appearance: *Clear evidence of inflammation is present with marginal redness, bleeding on probing, and spongy marginal gingiva. *Later, chronic fibrosis develops. |
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The Advanced Lesion Characteristics:
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Extension of inflammation:
*Bacteria from supragingival biofilm enter the sulcus and provide the source for subgingival biofilm. *Biofilm microorganisms produce irritants. *Alveolar bone destruction. Inflammation spreads through the loose connective tissue along (beside) the blood vessels to the alveolar bone. *Most commonly, the inflammation enters the bone through small vessel channels in the alveolar crest. *Inflammation spreads through the bone marrow and out into the periodontal ligament. Progressive destruction of connective tissue: *Connective tissue fibers below the junctional epithelium are destroyed; the epithelium migrates along the root surface. *Coronal portion of junctional epithelium becomes detached. *Exposed cementum where Sharpey’s fibers were attached becomes altered by inflammatory products of bacteria and the sulcus fluid. *Diseased cementum contains a thin superficial layer of endotoxins from the bacterial breakdown. *Without treatment, the pocket becomes progressively deepened. Characteristics of the advanced lesion: *Pocket formation, mobility, bone loss; all signs of periodontitis. *Persistence of the chronic inflammatory process; plasma cells predominate. *Junctional epithelium continues to migrate; lesion extends through connective tissue. *Periods of inactivity alternating with periods of activity can be expected |
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Definition of Gingival Pocket
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A pocket formed by gingival enlargement without apical migration of the junctional epithelium.
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Characteristics of Gingival Pockets
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Margin of gingiva has moved toward the incisal or occlusal without the deeper perio structures become involved.
Tooth wall is Enamel The base of the sulcus is coronal to the crest of the alveolar bone. Suprabony |
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Characteristics of Periodontal Pockets
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The periodontal deeper structures are involved (Cementum, Perio Ligament, Bone)
Tooth wall is cementum or cementum/enamel The base of the pocket is on cementum at the level of attached periodontal tissue. Both Suprabony and Intrabony. |
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Definition of Periodontal Pockets
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A pocket formed as a result of disease or degeneration that caused the junctional epithelium to migrate apically along the cementum.
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Suprabony definition
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Pocket in which the base of the pocket is coronal to the crest of the alveolar bone.
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Intrabony definition
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Pocket in which the base of the pocket is below or apical to the crest of the alveolar bone.
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Contents of a Pocket:
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Microorganisms and their products
Gingival sulcus fluid Desquamated epithelial cells Leukocytes Purulent exudate |
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A periodontal pocket is a pocket formed by gingival enlargement without apical migration of the junctional epithelium. A gingival pocket is a pocket formed as a result of disease or degeneration that caused the junctional epithelium to migrate along the cementum.
A) The first statement is true and the second statement is true B) The first statement is true and the second statement is false C) The first statement is false and the second statement is true D) The first statement is false and the second statement is false |
D) The first statement is false and the second statement is false is the correct answer.
A gingival pocket is a pocket formed by gingival enlargement without apical migration of the junctional epithelium. A periodontal pocket is a pocket formed as a result of disease or degeneration that caused the junctional epithelium to migrate along the cementum. |
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All of the following are functions of attached gingiva except to:
A) give support to the marginal gingiva B) withstand the frictional stresses of mastication and toothbrushing C) provide attachment or a solid base for the immovable alveolar mucosa D) provide attachment |
C) Provide attachment or a solid base for the immovable alveolar mucosa is the correct answer.
Functions of attached gingiva are to give support to the marginal gingiva, withstand the frictional stresses of mastication and toothbrushing, and provide attachment or a solid base for movable alveolar mucosa. |
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Periodontal treatment improves the metabolic control of diabetes. Diabetic patients have a decreased susceptibility to periodontal infections.
A) The first statement is true and the second statement is true B) The first statement is true and the second statement is false C) The first statement is false and the second statement is true D) The first statement is false and the second statement is false |
B) The first statement is true and the second statement is false is the correct answer.
Diabetic patients have an increased susceptibility to periodontal infections. |
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A risk factor for caries is:
A) tobacco use B) poor oral hygiene C) heavy calculus D) bleeding upon probing |
B) Poor oral hygiene is the correct answer.
Poor oral hygiene due to bacterial plaque is a risk factor for caries. Tobacco use would be a risk factor if it was chewing tobacco only. Heavy calculus and bleeding are risk factors for periodontal disease. |
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The dental hygiene diagnosis serves which function?
A) Provides basis for planning interventions B) States possible outcomes of interventions C) Controls patient’s discomfort D) Outlines specific procedures |
A) Provides basis for planning interventions is the correct answer.
The diagnosis provides the basis for planning effective and appropriate interventions. The other distractors refer to prognosis, pain and anxiety control, and the written dental hygiene care plan. |
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What is the purpose of having the patient perform a preprocedural antimicrobial rinse?
A) To obtain better gingival healing B) To lower the bacterial count in aerosols C) To control pain and discomfort during treatment D) To condition the tissue |
B) To lower the bacterial count in aerosols is the correct answer.
Rinsing with a preprocedural rinse will decrease the potential for bacteremia but will have no effect on pain, gingival healing, or conditioning of the tissue. A topical or local anesthetic is best for treating pain during scaling. |
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Which one of the following is not a component of the demographic data in the care plan?
A) Notation of the patient’s chief complaint B) Patient’s name C) Patient’s date of birth D) None of the above |
D) None of the above is the correct answer.
Data about the patient including the statement indicating the patient’s reason for presenting for treatment are considered demographic data. |
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Which one of the following does not require antibiotic premedication?
A) Exploring B) Probing C) Checking for mobility D) None of the above |
D) None of the above is the correct answer.
All instrumentation, including probing and exploring, and mobility determination are done under antibiotic coverage. |
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Informed consent:
A) Requires a written document B) Is legally binding C) Is proven by having the patient’s signature D) Is every dental hygienist’s right |
C) Is legally binding is the correct answer.
Informed consent is legally binding but is not required to be writing. Simply having the patient’s signature does not prove that the patient was informed. Finally, informed consent is the patient’s right, not the hygienist’s. |
