Describe the motion/pressure when preforming a mechanical polish.
A quick light to moderate pressure should be used. on slow speed pushing gently and overlapped.
What part of the rubber cup does the polishing?
THE OUTER EDGE DOES THE POLISHING
If a line of stain or deposits appear along the gingival margin after polishing, the problem was?
the prophy cup was not flexed or adapted to the tooth.
The stroke used to polish a tooth is from the ---- third to the --- edge.
gingival third to the incisal edge
A mechanical polish removes what deposits and stains?
All soft deposits and extrinsic exogenous stains
List the objectives of a mechanical polish?
Creates smooth surfaces easier for patient cleaning, all soft deposits extrinsic stains removed, contributes to pt. motivation.
What does excessive speed during a mechanical polish cause?
Abrasion and tramuatic frictional heat
List other factors that increase the rate of abrasion?
Dry Coarse Polishing Agent, irregular particles in polish, larger particles, Grit, Number of particles, Amount of pressure and speed
Why is unwaxed floss preferred?
May spread out more
How would you remove heavy stains?
Scaling (and/or) root planing (Cannot be done by LDA)
RDA would use a higher grit polishing paste
Define characteristics of tissue abrasion from an incorrect placement of a rubber cup.
Red tissue and hurting
Describe the movement of the hand to adapt the cup to the tooth when polishing.
Use short overlapping, intermittent motions or stroking, lifting, wiping motion with wrist rotation
Give characteristics or a description of how you would explain a mechanical polish to a new patient that is 3-4 years old.
Show, Tell in a way they will understand, let them Feel like prophy cup on finger, and use imagination
What is used interproximally with an abrasive to remove stains?
Dental Floss, Tape
To polish place abrasive on contact areas between teeth and work floss/tape into contacts
Which stain is being described?
Occurs in patient with poor oral hygiene where plaque collects
Brown and Yellow Stain
Which stain is being described?
Located on the cervical 1/3 of the maxillary anterior labials
Green Stain ( Light to Yellowish)
Which stain is being described?
Follows contour of gingival 1 mm of maxillary anterior labials
Green Stain (Light to yellowish)
Which stain is being described?
Gummy and is found on lingual of anterior teeth
Tobacco Stain
Which stain is being described?
Intrinsic, grayish brown and caused by an antibiotic.
Tetracycline
When is wax floss used?
When stronger floss is needed
Contact prior to RD (Rubber Dam) placement
For flossing and polishing interproximally
What abrasive removes tenacious heavy stain? (tobacco)
Silex
What is pumice used for?
Removes persistent stains (not used on solid/resin) no fluoride is in it
What is zirconium silicate used for?
Cleans/polishes enamel, used on root surfaces, crowns
What is Whiting used for?
Polishes dentures (precipated Chalc)
What is tin oxide used for?
Polishing teeth and metallic restorations (fine white powder)
Which abrasives remove heavy stains?
Silex and Pumice
Which abrasives would be used after flour of pumice to leave the surface smooth and shiny?
Tin Oxide or Zirconium Silicate
A highly retentive stain found along the gingival third of the teeth which is more common in females is?
Black Line Stain
What must be done when positioning a patient for a mechanical polish on the mandibular arch?
patients chin down
lower jaw parallel to the floor
use a mirror to retract the tongue
All of the following principles are true regarding the application of abrasives during a mechanical polish?
apply cup using a low speed
stroke from the gingival third with pressure to cause the cup to flare
use the most abrasive agent first and finish with the finest abrasive
Where does an extrinsic stain occur?
Occurs on the outer surface of a tooth
When should the prophy cup be rotating?
After placement in the mouth, before touching the tooth
During coronal polishing, the rubber cup is applied to the tooth surface using a patting, wiping motion in order to?
minimize frictional heat
can black line stain be removed by a mechanical polish?
Yes!
Which if the following stains causes a reddish brown color and forms more rapidly on exposed root surfaces?
Chlorhexidine
What is the optimum level of fluoride in water?
.7 ppm to 1.2 ppm (.7 ppm is the optimum level)
List the tissues that fluoride is important for?
enamel improves bone density. less chance of bone resorption, periodontal disease lowers.
The level of fluoride in water for warmer climates is?
lower because drink more water in hotter climates
Which topical fluoride must be prepared immediately before using because it is unstable?
Stannous Fluoride
Which topical fluoride is the most commonly used fluoride?
APF
Acidulated Phosphate Fluoride
Which topical fluoride may cause brown stain?
Stannous Fluoride
Which topical fluoride is given at ages 3, 7, 10, and 13?
Sodium fluoride
A pt. is instructed not to eat or drink for --- after a topical fluoride application.
30 minutes
How long is fluoride applied to the teeth?
4 minutes 100%
1 minute 80%
How does the pt. get the excess fluoride out of the mouth after a fluoride treatment?
have pt. spit (exporate) or evacuate excess fluoride after treatment (saliva ejector)
If water fluoride concentration were less than .3ppm, a 2 year old pt. would be prescribed a/an --- fluoride supplement dosage.
.25 ml
how many drops of fluoride are used in a small tray?
3-5 drops or 2 ml (1-3 full) per tray
which topical fluoride should be avoided on composite resin restorations?
APF Acidulated Phosphate Fluoride
List topical anesthetics that may have a toxic reaction
Tetracaine Hydrochloride (cetacaine), Butacaine Sulfate, Cocaine Hydrochloride
Which topical is likely to cause a localized allergic reaction?
Benzocaine (Hurricane)
What is the purpose of topical anesthetic?
To produce the loss of sensation prior to injections of local anesthetic, to prevent gagging, temp relief from localized diseased areas
Define Caustic?
irritating to the tissues, toxic
Which topical medication should the LDA inquire about if a pt. has had prior sensitivity?
Benzocaine
What should the LDA check to see if a pt. has had any adverse reactions?
medical history
Where should topical be placed for a mandibular buccal nerve block injection?
place topical in depression just posterior to retromolar area. this will numb the inferior alveolar nerve which will numb half of the lower arch including the teeth, and tip of tongue.
Where should topical be placed for an injection at the midline behind the central incisors?
place topical in the mucoginigval junction above that root this numbs the anterior superior alveolar nerve
Where should topical be placed for a long buccal injection?
place topical in mucoginigval area distal and buccal to the most posterior tooth in arch. this numbs the buccal nerve
where should topical be placed when injecting for the distobuccal and lingual of 1st molar, 2nd molar and 3rd molars?
place topical in mucoginigval junction above second molar. this numbs the posterior superior alveolar nerve
where should topical be placed if tooth #12 is being prepared for an MOD?
place topical in mucoginigval junction above 2nd biscuspid tooth number 13 this numbs the middle superior alveolar nerve
where should topical be placed if tooth #30 is being prepared for an MO?
place topical in depression just posterior to the retromolar area. this is a mandibular nerve block and numbs the inferior alveolar nerve.
where should topical be placed if periodontal surgery is being preformed on the buccal of tooth #31?
place topical in the mucoginigval area distal and buccal to the most posterior tooth in the arch. long buccal injection numbs the buccal nerve.
How is a topical anesthetic placed?
dry area with gauze, apply topical with cotton tip applicator
What is the most widely used topical anesthetic agent?
Lidocaine
List objectives or characteristics of desensitizing?
Desensitizing = Gluma or Hurriseal
we can apply, effective lasting anesthesia, non caustic, no hypersensitivity, easy to wash off if it creates burning, does not delay healing
List the properties of a copal cavity varnish?
placed on cavity floor, margin and walls of a prep, reduces leakage around a amalgam restoration, SEALS DENTIN TUBLES
The bow of the rubber dam clamp is placed towards the?
Distal
The four points of the clamp are resting below the?
ginigval one third of the tooth
Which side of the tooth is the clamp placed on first?
lingual and the stretch over to buccal
List items used to invert the rubber dam?
wax floss, blunt instrument, air syringe, PFI
The smallest hole of the rubber dam punch is used for?
mandibular incisors
The largest hole of the rubber dam punch is used for?
anchor tooth
when is the heavier rubber dam used?
For excellent retraction
Why is the rubber dam clamp ligated with floss?
to prevent pt. aspiration
Where is the rubber dam clamp floss secured?
in the forceps hole or around the bow
what part of the clamp is the rubber dam stretched over first?
the bow stretch down buccal lingually
List the steps for removal of the rubber dam?
Remove ligature and saliva ejector, slide finger under dam and stretch facially, cut dam interproximally, remove clamp, remove dam and frame, check dam for pieces, floss to remove pieces, massage tissue to increase pt. circulation, rinse pt mouth
what is the function of the rubber dam forceps?
places and removes the dental dam clamp
list the uses/advantages of using the rubber dam?
visibility in operating field, pt. management, protection, controls moisture, decreased operating time (no talking), Infection control barrier for pt. and operator
If tooth #21 is to be treated, the clamp would be placed on #19 and the operating field would extend to tooth #?
23 or 24 (have 6 to 8 teeth isolated to counteract the pull of the dam)
The primary purpose of the dental dam napkin is to?
absorb moisture
some dentists prefer darker color of the dental dam because it?
provides more contrast against the teeth
which side of the rubber dam clamp is seated first?
Lingual
When placing the rubber dam clamp it is positioned?
below the height of contour
when removing the rubber dam clamp, the rubber dam septum is stretched and cut toward the?
facial
the heavy weight rubber dam is utilized for?
greater tissue retraction
A double bowed rubber dam clamp is used?
on class V restorations, to retract the gingival on facial surfaces of anterior teeth, and to isolate #8 during endodontic treatment
When punching the rubber dam, the rubber dam will develop folds or bunching interproximally if the holes are?
punched to far apart
What is the light weight rubber dam used for?
root canal treatment
Which instruments are used to remove a periodontal dressing?
plastic instrument, scaler, surgical hoe, or spoon excavator
How is the periodontal dressing contoured when it is placed?
press interproximally and with a plastic instrument adapt around ginigval surface and interproximal areas
Describe the mixing technique of the paste and the powder/liquid form of periodontal dressing?
soft pack mixing technique- extrude equal lengths and quickly mix together with tongue blade until blended
-powder liquid can be prepared and stored in work size pieces
Describe characteristics of a well placed periodontal dressing?
Do NOT COVER OCCLUSAL SURFACE, a well placed perio dressing is secured, nonmovable, rigid, as little bulk as possible, locked interdentally, covers all surgical wounds and interdental areas, has a smooth surface
describe the technique used to remove a periodontal dressing?
remove facial portion first, insert instrument under disto apical border and exert gentle lateral pressure, maintain fulcrum, if sutures are visible cut and remove, check interproximal areas for debris, remove extra and rinse area
when is a periodontal dressing usually removed?
one week to ten days
After the periodontal dressing is removed, the area may be rinsed with?
warm water, warm diluted mouth rinse, warm saline solution or warm antiseptic solution
What instrument is used to cut sutures?
Suture Scissors
When is a periodontal dressing removed from the buccal first?
always because the facial or buccal side is the side the knots are on where the suture is placed
List the steps in removing sutures?
inform pt. may feel tugging, check the number of sutures placed and the locations, swab the area with antiseptic, have dentist inspect, use cotton pliers to grasp knot, cut the suture not the knot, (cut near the tissue) slide the suture by the knot out of
How are sutures removed?
Grasp the knot and raise 2 mm above tissue, cut suture near tissue on the opposite side of knot, pull knot to slide tissue out
Where is the suture cut?
Near the tissue away from the knot side
How should the scaler be held when removing cement?
Develop finger rest, use ring finger (may use pinky too), (use a pen grasp to hold U 15 or H6-H7)
List the sequence of instruments used when removing cement?
U-15 Scaler (H6-H7), Basic 3, Floss, bridge threaders (if remove under pontics), Aspirator tip, Articulating Paper, Burs
list the objectives of the area after the cement is removed?
all surfaces smooth, clean, no particles in interproximal areas, no trauma to tissue, normal occlusion, no damaged or scratched restorations
In what direction is the scaler moved when removing cement?
A horizontal movement using overlapping strokes
When debonding an orthodontic resin, the tooth surfaces appear?
Dull/ Opaque, chalky
What periodontal dressing could cause an allergic reaction?
Zinc-Oxide Eugenol
What kind of pressure should be used to remove a periodontal dressing?
Lateral Pressure
A periodontal pack is placed?
Directly over sutures at the surgical site
The appearance of a healing surgical site includes?
slightly red with granulation tissue, dark pink with granulation tissue or red with granulation tissue NO bleeding
the approximate time frame for removable sutures is?
5-7 days
excess cement is removed interproximally by what item or instrument?
dental floss
what item or instrument is used to ensure the dental cement has hardened?
an explorer
to remove excess cement which movement should the instrument be directed to avoid weakening of the marginal cement?
Horizontally
What color is the nitrous oxide tank?
Blue
What color is the oxygen tank?
Green
List the contra indications for the use of nitrous oxide.
Nasal obstructions, COPD, Chemical dependency, antidepressants, psychotrophic drugs, pregnancy, cystic fibrosis, clastrophobia, morbid obesity, increased intracrainal pressure
The oxygen level should be at least --- when using nitrous oxide inhalation.
30%
the maximum total liter of combined gases of N2o2 and O2 is?
max is 8 LPM for adult and NO more
normal 6-7 LPM for an adult
and 3-4 LPM for a child
A pt. should be instructed to breath 100% oxygen after treatment for --- minutes.
5 minutes
Under nitrous oxide, if the pt. is returned directly to room air rather than 100% oxygen, the pt. may expierence?
Diffusion Hypoxia causing a Headache, Lethargy and Nausea
What is the average adult rate, when establishing the volume of gas flow for nitrous oxide administration?
6.7 LPM
For about 70% of the patients, the ideal optimum N2O sedation dose is?
4-5 L/Min
30-40%
N2O/O2 analgesia should end with the administration of 100% Oxygen for?
6-8 minutes Because 5 minutes is the MINIMUM can not only have 3 minutes!
List the armentarium for sealant applications?
Basic set up, prophy brush, flour of pumice, burs, hydrogen peroxide, rubber dam or cotton rolls, cotton roll holder, dry angle, etching agent, sealant, dappen dish, applicator brush or sponge, explorer, syringe, articulating paper
Prior to the application of sealants, the teeth are cleaned with?
prophy brush and flouride free pumice (flour of pumice)
Which are etched longer, permanent or primary teeth?
primary teeth (they are more resistant to acid)
What is the composition of etching material?
35-50% Phosphoric acid (we use 37%)
What is the preferred isolation technique when applying sealants?
Dental Dam
What must be done is there is saliva contamination during the etching procedure?
reisolate, rinse, cry, repeat etch FOR ONLY 10 SECONDS (etch for less time)
Describe characteristics of an etched surface?
Dull, Frosted, Chalky, Whitish, Satiny
List contra-indications for sealant placement?
well coalesced occlusal surfaces, Occlusal surface decayed, proximal surface decayed, restoration already in place, insufficient tooth eruption,
How is gel etching agent applied?
according to manufacturer directions
Dabbing only for liquids!
List the indications for sealant placement?
Occlusal surfaces with pits and grooves, buccal pits of mandibular molars, lingual groove by cusp of carabelli, cingulum pits
How is a liquid etching agent applied? Why?
Continously dabbed over the surface to open enamel pores and create enamel tags sealant can stick too.
If an unfilled sealant feels to high to the pt. after it has been placed then inform the pt. that?
it will wear down in a few days
Describe the characteristics of sealants?
-a resin material used to prevent cavities
-a physical barrier between the teeth and the oral environment
-prevent acids from causing tooth decay
after a tooth is etched, what is the contaminant that causes failure?
moisture
the material most commonly used for sealants is?
BIS-GMA
Sealants are applied to what surfaces?
deep pits and fissures
What material should be used prior to sealant placement?
flour of pumice
Which of the following agents is NOT recommended prior to the application of an etchant? pumice, OR fluoride, OR silex
Fluoride
Colored sealants are?
easier to see
The most common reason for sealant failure is?
contamination of the etched surface
What is used to evaluate the completed sealant?
explorer
List required structures on a maxillary impression?
Labial frenum, Buccal muscle attachemnts (buccal frenum), muccobuccal fold (vestibule), tuberosity, rugae, hamular notch, hamular process, palatine fovea
List required structures on a mandibular impression?
Labial and Lingual frenum, lingual flange, muccobuccal fold (vestibule), buccal muscle attachments, retromolar pad
List objectives in adding to a wax tray?
protect pt. from injury and provide pt. comfort, extend tray length, add to palate for high vault, extend tray borders
What is the correct operator position when taking a maxillary impression?
Right handed - 11:00 - 12:00
Left Handed- 12:00 - 1:00
What is the correct operator position when taking a mandibular impression?
Right handed - 07:30 - 8:00
Left Handed- 4:00 - 5:00
How do you avoid excess material from going down a pt throat when taking a maxillary impression.
Load tray from posterior first, load majority in anterior, seat posterior to anterior to force material forward, tip head forward
give instructions for a pt. who is gagging?
Breath through nose, wiggle toes, tilt head forward
If a pt. has mandibular tori, what should be done to the tray?
Wax trimming or get a smaller tray
Why is the pt. instructed to lift and extrude their tongue when taking a mandibular impression?
to muscle trim the lingual frenum and lingual flange
On a maxillary impression tray, it should extend posteriorly 2-3 mm beyond the?
last molar
Is it better to choose an impression tray that is too large or one that is too small?
Too large is better
How should alginate impression be disinfected?
rinse, spray, put in plastic bag, leave in bag at least ten minutes!!
An accurate impression of the anterior mucobuccal fold (Vestibule) can be best obtained by?
Muscle Trimming
How is an alginate impression removed?
Hold tray handle with thumb and finger, remove with snap, NO ROCKING
How is the setting time of alginate lengthened?
use Cooler water
How is the setting time of alginate shortened?
use Warmer water
What is the cause of drags?
premature setting, movement while setting
What is the cause of folds?
alginate painted on before setting
What is the cause of fine bubbles throughout an impression?
air trapped in saliva, under air lip, incorporated air into mix, and gagging
What is the cause of a buccal surface protruding on both sides of the tray?
overfilling the tray and not muscle trimming
What is the cause of a mandibular retro molar pad not being visible on an impression?
the tray is seated to far anteriorly and did not go far enough back or the tray is too small
What is the cause of air voids on an occlusal surface of an impression?
improper tray loading, improper tray seating, ropey saliva, premature setting of alginate
What is mouthwash before taking an impression used for?
Removes food and debris, helps prevent air bubbles, has astrigent properties, thins saliva, helps prevent gagging on maxillary impressions
What is the purpose of a bite registration?
to record the alignment of the teeth
to relate the mandibular cast to maxillary cast correctly
List the materials that can be used to obtain a bite registration?
wax or paste type
The pt. is instructed to bite down in which type of occlusion?
Bite on back teeth, Centric Occlusion
When loading a tray for a mandibular alginate impression. the alginate is placed in the tray?
in two increments from the lingual
When loading the tray for a maxillary alginate impression the alginate is placed in the tray?
in one large increment from the posterior
When seating an alginate impression tray in the mouth it is centered over the teeth and then?
the posterior is seated and then the anterior
After taking an alginate impression how should it be stored unitl it can be poured?
keep moist in a plastic bag
If the maxillary tray needs to be extended 2-3 mm posteriorly which of the following would be used?
utility wax
The purpose of the perforations in the alginate impression tray is?
to allow the material to come through to create a mechanical retention of the material with the tray
The most convenient method of shortening the set time of alginate impression material is to?
increase the water temp.
When selecting a tray for an alginate impression, how much space would be sufficient between the tray and occlusal surface?
2-3 mm
A bite registration is useful for?
establishing a relationship between the maxillary and mandibular teeth
trimming diagnostic casts
What instrument is used to remove excess bonding from a bucket?
U-15 end of a schure scaler, explorer
What instrument is used to place elastic orthodontic separators?
elastic seperating pliers, floss, or mathieu pliers
Describe how elastic separators are placed?
Through the interproximal area gently using a see saw motion similar to floss
Orthodontic bands should fit approximately on the --- of the tooth.
middle 1/3 of the clinical crown
the instrument used to measure the position of the bracket on the tooth is the?
BOONE GAUGE
how are O rings placed?
incisal to gingival ?
how are wire ligatures placed?
hold wire with mathieu pliers and place under all four wings of the bracket, slide around bracket over arch wire, twist ends making pig tail, cut 3-5 mm long, use suture instrument or ligature director to tuck pigtail toward gingival embrasure space
the wire ligature is cut --- mm before it is tucked
3-5 mm
After a ligature is tied and cut, where is it tucked?
Under arch wire, toward gingiva, into embrasure space
The use of orthodontic separators is necessary before placing?
bands
if the band is placed beyond the marginal ridge with finger pressure it is?
maxillary band (may be too big)
What instrument is used to remove elastic separators?
scaler
where are seating lugs located on a band?
on the lingual of a band
provides a fulcrum when seating the band
How are wire ligatures removed?
Untwisting and pulling the pigtail from the embrasure, remove it carefully
What instrument is used to adapt bands and seat them after they are placed?
crescent contouring pliers or pesso pliers
Which angle classification is referred to as mesio-occlusion/disto-occlusion?
Class III = mesio-occlusion
Class II = Disto-occlusion
An abnormal horizontal distance between the labial surface of the mandibular anterior teeth and the labial surface of the maxillary anterior teeth is?
Overjet
What bur is a recommended bur to use to remove excess bonding material?
Finishing Bur ( example #1172 finishing bur)
What are the two categories of temporary (provisional) materials?
Prefabricated and Custom Made