The relationship between the dental hygienist and patient is defined by the expectations both _________ and __________.
expressed; implied
Standard of care for the profession
a standard we have to meet
Failure to meet the standard of care results in ________.
malpractice
Legal framework
based on the principle that the citizens have a right to be safe and free from harm and if they are harmed, they can be compensated
If the harm is one person or property of another, it is considered a ________ _______.
civil violation
If the harm is one that violates a written law or statue, then is is considered a ______ ________.
criminal violation
Plaintiff
the parties to an offense
i.e. the one who got hurt
Defendant
the one defending themselves
For criminal cases the legal standard from proving a violation is __________.
beyond a reasonable doubt
For civil law the legal standard for proving a violation is
by the preponderance of the evidence or greater than 50%
In criminal cases, the plaintiff is usually the _____.
state
The state
enforces the laws and consist for violations
In civil law causes, the plaintiff is the _________.
wrong individual
Civil law can be broken down into ___ different types of causes
2
Contract law
a legally binding agreement to keep a promise in exchange for a thing of value
A ______ ______ is how the courts view the hygienist/patient relationship
contract law
Breach of contract
failure to meet a contractual obligation
Tort case
harm that results from a breach of a legal duty that exists for performance
Intentional
this is when an act was done on purpose
Unintentional
this is done without intent to harm but causes harm
Unintentional torts
person or property damage
-
Negligence
malpractice is a form
Informed consent
the right of every human of sound mind and legal age to determine what shall be done to his or her body
Humans are _______.
autonomous (allowed to give input)
Breach of informed consent
1) must be a duty
2) must be a breach of that duty
3) the breach must have caused an injury to the patient
The level of _______ is important for costs.
harm
Info in informed consent
1) What do they have
2) proposed treatment
3) risks of the treatment
4) alternative treatment and associated risks
5) risks of receiving no treatment
A breach of informed consent is usually not enough for a ______.
claim
Malpractice
the failure of the clinician to exercise the degree of care, skill and learning expected or a reasonably prudent provider in their class within their state
The level of care is different from state to state because...
-each state has different needs for their population
-state boards vary
-dentists fear their profession & money making
Shared responsibility
the recognition that the patient may play a key role in their own rehabilitation and they have a duty in the relationship as well
Statute
a written law of the legislature that limits the length of time a person has to bring a case against another individual
-varies state to state
-anywhere from 2 to 4 years from the time the malpractice occurred or from the time when reasonable diligence wo
Breach of contract in the medical setting usually has to do with _____.
costs
Risk management
the anticipations of unwanted outcomes and the strategies employed to minimize their occurrence
-includes the identification of risks
-reporting unwanted outcomes to assess the system
-have a quality assessment procedure
The best risk management is.....
-having a good relationship with your patient
-communicating with your patient
-knowing your duties under the law
-writing everything down!
Ethics
assists the health care personnel when making choices
*what is right vs. what is wrong
Ethical dilemma
there are 2 correct courses of action
Nonmaleficence
do no harm
Radiology does not hold true to _______.
nonmaleficence
Beneficence
remove existing harm
Autonomy
the right of a person to make a decision that will effect their bodies/selves
Justice
providing some one with what is owed, due, or deserved
Paternalism
acting as a parent
Paternalism can cause a conflict with ______.
autonomy
Veracity
telling the truth
Confidentiality
a right to privacy concerning health information
ex: HIPPA
Characteristics of a true profession
1) a specialized body of knowledge that has great value to a society
2) intensive academic course of study
3) set of standards of practice
4) recognition by society
5) a code of ethics
6) an organized association
The commercial model
dentistry as commodity or a service
-the "wall street" version of dentistry
-the provider does either what the patient wants or what the greatest profit margin is from him or her
ex: Aspen Dental
Disadvantage of the commercial model
patient may be scammed
Disadvantage of the commercial model to the profession
decreased in the quality of care
Guild model
a model where those who are members control the knowledge, skill, and competency
-the patient has no input
-professional tells the patient the course of action to be taken to treat their needs
Disadvantages of the guild model
less informed as a patient & no trust
Interactive model
a model where the patient determines their need bases on personal values and priorities with input of knowledge from the dental professional
---informed consent & providing the options available
Advantages of the interactive model
more trust & autonomy of the patient
Accreditation
a system developed to protect the public welfare and provide a stand for the evaluation of educational programs and schools
Competency must be attained in:
1) assessment 2) planning 3) implementation 4) evaluation
Skills performance stages
1) novice 2) advanced beginner 3) competency 4) proficiency 5) expertise
Honesty and integrity
are key to building a relationship of trust with the patient
Caring and compassion
are important for demonstrating empathy for your patient
Reliability and responsibility
-all services must meet or exceed the standard of care
-sound judgement must be used to assess and treat each patient
-maintaining current knowledge on theory and techniques
-meeting obligations of time and duty
Maturity and self-analysis
understanding the team nature of the dental setting & being able to analyze the traits you bring to the environment and continue making yourself better
Loyalty
protecting and promoting the interests of a person, group, or organization
Interpersonal communication
using more than just your patient's words to communicate
ex: body language, mannerisms, fostering safety through trust
_____ means that all professional decisions must be unencumbered by conflicting personal interests.
Loyalty
Tolerance for others
treating all patients without discrimination
Odontoma
a tumor of the odontogenic origin that is a developmental malformation of a normal dental follicle (extra bud left on its own)
______ can be either complex or compound.
Odontomas
A benign mixed odontogenic tumor is the most ______ tumor of the jaw. (70%)
common
Hamartoma
is not a neoplasm because of its timely development with its fixed size and location
Complex odontoma
a disorderly mass of dental tissues that lacks recognizable tooth form
Compound odontoma
a collection of small, morphologically atypical teeth
Etiology of odontomas
results from an extraneous bud of odontogenic epithelial cells from the dental lamina during in utero & specific causes are unknown, but possible hypotheses include infections/traumas (most accepted) and inheritance and genetic mutations (very complex and
Complex odontoma demographics
-age of diagnosis=20-30 years oldUn
-occurrences=30% of diagnosed odontomas
-location=1st and 2nd molar of the mandible
Compound odontoma demographics
-age of diagnosis=10-29 years old
-occurrences=60% of diagnosed odontomas
-location=incisor/canine area of maxilla
Complex and compound odontomas with clinical presentation
-most commonly associated with impacted teeth
-usually asymptomatic (occasionally swelling & dull pain present)
-no apparent differentiating characteristics (requires x-rays!)
Complex odontoma radiographic findings
-posterior location
-larger (<5 cm) & unilocular
-undistinguished radiopaque mass
-surrounded by radiolucent zone
-a distinct radiopaque border
Compound odontoma radiographic findings
-anterior location
-smaller (<2 cm) & unilocular
-defined radiolucency
-multiple radiopaque miniteeth
Dentogenesis imperfecta is a genetic condition that affects 1 in every _____________ people.
6,000-8,000
Dentogenesis imperfecta
-a disturbance of dentin formation
-consists of opalescent teeth that have irregularly formed, unmineralized dentin
-obliterated pulp chambers and shortened roots with bulbous crowns
Type I dentinogenesis imperfecta
-occurs in individuals afflicted with osteogenesis imperfect
-increased incidence of bone fractures
-classic sign: blue sclerae
Type II dentinogenesis imperfecta
-not associated with osteogenesis imperfecta
-commonly called hereditary opalescent dentin
-most common type inherited as autosomal dominant
Type III dentinogenesis imperfecta
-also known as Brandywine type
-rare and isolated to an area in the state of Maryland
-clinically the same as types I and II, except that individuals have multiple pulpal exposures in the primary dentition
3 important steps in the diagnosis of dentogenesis imperfecta
family history, clinical examination, & complete mouth radiographs
Opalescent teeth
bluish-gray to brown to yellowish
Clinical diagnosis of DI
1) opalescent teeth
2) abnormally soft dentin, which undergoes rapid and severe functional attrition
Radiographic findings of DI
-enamel is normal but fractures or chips easily
-teeth are not particularly prone to dental caries
Treatment of DI
Past: left untreated until adulthood when treatment was extraction and complete dentures
Now: composite resin restorations, laminate veneers, stainless steel crowns on the molars, and overdentures
Taurodontia
a development anomaly of the teeth that appears radiographically as "Bull" shaped teeth
Ameologenesis imperfecta
-a hereditary enamel deficiency of the teeth
-lack of ameloblasts (believed to be the cause)
-enamel is missing radiographically
Fusion
a condition where the dentin and one other tissue of adjacent tooth is united with another
Concrescence
a condition where the cementum of adjacent teeth is united
Germination
a single tooth bud that divides to form two teeth
Dens in dente
developmental anomaly in which a focal area of the crown of a maxillary lateral incisor is folded inward (invaginated) for various distances; when severe, this results in a conically shaped tooth with a small surface opening that quickly becomes subject t
Uniocular
1 sac
Blue sclera is a classic sign of type _______ dentinogenesis imperfecta.
1
Microdontia
tiny/small tooth
Macrodontia
tooth larger than another
Concrescence won't be seen on an x-ray because ______ isn't visible radiographically.
cementum
_____ will always result in an extra tooth.
Gemination
Mesiodent
an extra tooth placed in between 2 teeth
A _______ is a microdontia with a specific name.
mesiodent
Dilaceration
roots go off & jet out in a direction that isn't normal
A tooth that is _______ may have to be cracked and taken out piece-by-piece.
dilacerated
Restorations come in many different ______ and can look very different radiographically because of the ________ of the restorations.
materials; composition
Common dental materials include:
1) gold
2) stainless steal
3) amalgam
______ and ______ look similar on an x-ray.
Amalgam; gold
The _______ along the restorations are the weakest and if the patient doesn't change the home care, the filling (patch) could come off, causing another restoration to be necessary.
margins
Metallic restorations are very ______. Because of that, they _______ x-rays and very little radiation makes it to the film. This makes the area behind the filling very _______. In other words, these areas are ______.
dense; absorb; radiopaque; unexposed
An _______ is the most common restorative material used in dentistry. It is very ____ and therefore ______.
amalgam; dense; radiopaque
A filling can cover all _____ sides.
5
Sometimes decay can be treated with ______ if they decay hasn't gone through the ______.
fluoride; enamel
Restorations can vary not only in material, but by ____.
size
When you view a radiograph, you ____ dimensions by only seeing in _____ dimension. This is why it is imperative to have the patient in your chair and have a completed accurate dental charting to use as a reference.
lose; one
A tooth that is healthy is ______.
sound
Gold restorations are _______ and comes in a _____.
smooth; sheet
Stainless steel crowns are ______ expensive and used for children usually because teeth are not permanent.
less
An _____ is an extension of amalgam that goes beyond the normal contour of the tooth material it is replacing.
overhang
______ can break due to getting snagged on an overhang.
Floss
______ _______ can be dropped on the tissue or get left inside the tissue. It can appear _________ as well as in your patient's mouth. It appears as a amalgam _______ that is located _______ to an amalgam restoration and appears purple/blue in color.
Amalgam fragments; radiographically; tattoo; adjacent
Bridges are usually a _____ composite material that is placed on a _____ surface.
white; metal
Gold foil restorations are _______ surface only and look the same as a one surface amalgam.
one
Post and core are usually _____ because it is a cast metal on the inside with a crown on the outside of different materials. The _____ resembles the tooth crown and the _____ extends and fills the pulp canal.
radiopaque; core; post
_____ _______ is what goes into a canal.
Gutta percha
Root canals are not as ______ as the post and core.
white
_______ ______ are not as dense as the metal restorations and are about the same density as _____.
Porcelain restorations; dentin
White materials appear _____ radiopaque than metals.
less
Porcelain restorations are ________ created in the lab and put into the mouth. They are _______ common.
indirectly;less
Porcelain fused to mestal is the most common along with _______ . PFM is created _______ of the mouth.
gold; outside
_________ ______ are usually used as a temporary crown and it is the _____ dense and therefore the most ______.
Acrylic restorations; least; radiolucent
_____ _____ hold amalgams in place when large amalgams are placed.
Dental pins
____ ______ are used with root canals to fill the canals. They are metal and appear much like metal restorations.
Silver points
_____ _____ should never be seen on an x-ray.
Removable partials
The ______ _____ ______ is used when you have to determine where in a two dimensional picture something is, this is the rule we use.
Buccal Object Rule
SLOB rule
Same Lingual Opposite Buccal
______ _______ is one of the most common diseases to affect humans.
Dental caries
_______ is the localized destruction of teeth by _______.
Caries; microorganisms
The 2 most common childhood diseases is _______ and _____.
Caries; asthma
______ shows up on x-rays because it is mineralized, so when the tooth is less mineralized, ______ show up.
Calcium; caries
Mineralized tooth structure is ______ and ______.
dense; radiopaque
Caries appear as _________ on x-rays.
radiolucencies
Caries is Latin for ________.
rottenness
To the general public a _______ is the name associated with tooth decay, but to the dentist the term is ______ or ______ in the tooth.
cavity; cavitations; holes
An x-ray provides identifications of _______ lesions and provides information on the _____ and _____ of the infection as well.
interproximal; severity; extent
Two parts of caries detections:
1) clinical examination
2) radiographic examination
The clinical exam should be:
1) Thorough and follow a pattern established by each individual clinician
2) Lead to documentation of all positive and suspicious findings to be re-evaluated with the x-rays
3) Be done using correct procedures (light, air, explorer, mirror)
The loss of _____ allows for greater penetration of the x-rays and therefore a more ________ spot on the final image with caries.
density; radiolucent
Caries is always farther ______ clinically than what is seen on a dental x-ray.
advanced
Factors that can affect interpretation:
1) Exposure factors (KVP-affects quality)
2) Developing factors (temperature)
3) Film speed, placement type (digital/conventional)
4) Lighting
5) Proper mounting of the films
6) Type of x-ray taken (bitewing/P/A)
Caries can be located on the ______, ______, _____ ,_____ and on the ______.
interproximal, occlusal, buccal, lingual, roots
_________ caries are the most common location for caries.
Interproximal
Interproximal caries means between two ______ surfaces that are usually found just ______ the contact point. They start as a ______ discoloration and progresses. It may take _____ years before an inter proximal lesion becomes clinically visible. It assume
adjacent; below; white; 3-4; triangular
As caries continues through the _______, it continues in another triangle with the apex _____ the pulp this time and not the DEJ. It
dentin; towards
Interproximal caries can be classified according to the _____ of the penetration of the lesion.
depth
Incipient Class 1 interproximal decay is the decay that is just ________ and is decay that extends _____ than halfway through the thickness of the enamel. It _____ be remineralized.
beginning; less; can
Moderate Class 2 interproximal decay is decay that extends _____ than halfway through the thickness of the enamel but it does not involve the ____.
more; DEJ
Advanced Class 3 inter proximal caries is decay that extends to or ______ the DEJ and into the ______. It does not extend more than half the distance through the dentin into the pulp. Both ______ and _____ are affected by advanced caries.
through; dentin; enamel; dentin
Severe Class 4 interproximal caries is decay that extends through the enamel and dentin more than half way into the ______ and toward the ______. It involves both dentin and enamel.
dentin; pulp
I "m"a Survivor
Incipient, Moderate, Advanced, Severe
_______ and ______ caries is best detected in the clinical exam. It is difficult to determine where the decay is on an x-ray when the surfaces are _______ over each other.
Buccal; lingual; superimposed
_________ caries are caries that develop beneath a restoration due to improper care.
Recurrent
______ caries is the term used to describe growing or spreading of unchecked ______ and ______ caries in numerous teeth in the mouth. It is usually the result of ______ oral hygiene, baby bottle caries, and _____ of salivary flow.
Rampant; advanced; severe; poor; lack
Conditions that resemble caries on radiographs:
1) Restorative materials
2) Abrasion
3) Attrition
4) Cervical burnout
Restorative materials have ______ defined edges.
well
______ is the mechanical wearing away of tooth structure from ______ with a foreign body. The most common cause is ________. It appears white and hard clinically instead of brown and leathery. It is seen most at the ______ 1/3.
Abrasion; friction; cervical
______ is the mechanical wearing down of teeth due to contact with teeth of the other arch (grinding). This is the wear that you normally see commonly on ___________ ________. On posterior teeth, no cusp tips will be seen. Brown/red ______ will be present
Attrition;mandibular anteriors; stains
_______ ________ is a radiolucent artifact. It can be _______ with caries. It appears as a collar or wedge-shaped radioluceny seen on the ______ and _______ root surfaces near the CEJ.
Cervical burnout; confused; mesial; distal
___________ ________ is the destruction of the tissues around a tooth that can range from superficial (gingivitis) to significant loss of supporting bone structure for the teeth.
Periodontal disease
________ _________ would be the x-ray type used to get enough detail to distinguish if a person has periodontal disease.
Vertical bitewings
Healthy periodontium are the tissues that ______ the tooth. ______ is healthy with knife-like interdental papilla that hugs the teeth, and is coral pink.
support; stippling
With healthy periodontium, the ______ _____ is visible. The alveolar crest is approximately _______mm apical to (below) the CEJ.
lamina dura; 1.5-2.0
The lamina dura is _______ on an x-ray, _______ the tooth.
radiopaque; surrounding
Anterior alveolar crests are _____ and _____. Posterior alveolar crests are ________, ______, and _____ to a line between adjacent CEJ's.
pointed; sharp; flat; smooth; parallel
In periodontal disease, receded bone loss produces root _______.
furcations
With periodontal disease we can _________ evaluate the crestal bone condition, lamina dura, PDL space, furcation involvement, predisposing factors, health/progression of the disease, and a baseline to determine success/failure of perio therapy.
radiographically
The crestal bone conditions depends on the ______. On anteriors, the crestal bone is sharp, pointed, and _____. On posteriors, the crestal bone condition is flat, smooth, and radiopaque, but not as radiopaque as _______.
location; radiopaque; anteriors
Slight mobility is ______, however unlike the abscess, it cannot be detected on an x-ray but a _______ PDL can be seen.
normal; widening
______ and ______ _____ are factors that contribute (but don't cause!) periodontal disease.
Calculus; defective restorations
Bone loss can be _______ or _______.
vertical; horizontal
________ bone loss is when a whole section dips down.
Vertical
_______ bone loss is when bone loss appears "flatter" and straight across.
Horizontal
Bone loss distribution can either be ________ or ________.
localized;generalized
Bone loss can be ______, ______, or ______.
mild; moderate; severe
ADA Case Type I is known as ________. It is the ______ form of periodontal disease. _____ bone loss is associated and no _______ changes are seen.
gingivitis; earliest; no; radiographic
ADA Case Type II is also called ______ ________. Gingivitis is present and _______ may be seen. Radiographic changes begin with ______ of the crestal lamina dura, along with mild to moderate bone loss of _______%.
early periodontitis; exudate; fuzziness; 20-30
ADA Case Type III is ________ periodontitis. This classification shows further destruction of the periodontium with clinical inflammation, bone loss of ______% that is vertical or horizontal, furcation involvement, and tooth ________.
moderate; 30-50; mobility (more than 1 mm)
ADA Case Type IV is __________ periodontitis with _____ tooth mobility and possible ____ of teeth. Bone loss is greater than ______%.
advanced; excessive; loss; 50
________ _________ are destructive lesions that originate in a soft tissue pocket. A ______ collection of ____ is present.
Periodontal abscesses; localized; pus
________ ______ is excessive force that is placed on a tooth. It can be a predisposing factor.
Occlusal trauma