Regulated biohazard waste
Sharps, items that drip of saturated blood and saliva, hard and soft tissues
Direct transmission
Occurs through direct touching of an infectious agent ex: air wat water syringbe tip
Indirect transmission
Occurs through a contaminated object
Ex: hand mirror
Gluteraldehydes
Should not ne used as a surface disinfectant bc of toxic effects of fumes also corrosive
Sterilization
Kills all life even spores, unlike a disinfectant
Chemical sterilization
274'F for 20 min 25 psi, goebacillus sterothermophillus
Dry Heat sterilization
340' for 1 hr
320' for 2 hrs
Bacillus atropheous
Metal instruments only
Steam heat
250' with 15-20lbs per sq inch for 30 min
Dulls inst.,ok for some plastics, ok for cloth goods
Geobacillus sterothermophillus
Tachycardia
Rapid pulse, over 100 beats min
Bradycardia
Slow pulse 50 beats a min
Radial artery
Located thums side of wrist
Brachial artery
Located on upper inside of arm, best point for i fant amd toddlers
Carotid artery
Located outer edge of trachea often used in emergency situations
Well trained athletes pulse
45-60 it will be low
Palpate radial artery
Adolescent to adult pulse
Radial, 60-1001
Children (1-10yrs)
70-120 brachial or carotid
Infants pulse
100-160, brachial
Normal ranges of respirations
Infant 30-60
Children 14-26
Adults 12-20
Tachypnea
Rapid respirations, hyperventilations
Bradypnea
Slow respirations
ASA II
Pt. with mild system disease, asthma, stageh 1 hypertension, healthy pregnancy, well controlled non insulin diabetes
ASAIII
Pt. with mod to severe systemic disease. Well controlled imsulin dependant diabetes, stage 2 hypertension, congestive heart failure, AIDS, chronic copd
ASA IV
Pt with life threateninng disease sever cong. Heart failure, or copd, kidney, or liver failure
Normal blood pressure
120/80
Prehypertension blood pressure
120/80-139/89
ASA1
Stage 1 hypertension
140/90-159/99
Stage 2 hypertension
160/100+
Who are usually prone to high blood pressure?
Elderly and african americans
Example of medical history
Is the pt. under the care of a physician or ha e they beem hospitalized in last. 5 yrs
Blacks class 1
Pits and fissure caries posterior, lingual of anteriors
Blacks class 2
Proximals of posteriors
Blacks class 3
Proximals of anteriors
Blacks clAss 4 ant.
Proximals amd inc. edge
Class 5
CervicAl 3rd
Blacks class 6
Incisive edge of anterioe and cusp tips pf posterior teeth
Class 2 division two occlusion
Remember! The mandible will be retruded. The anteriors will recline lingually. So class 2 is to the tongue!
Nutrient source for supra gingival calculus
Saliva
Nutrient source for sub gingival calculus
Crevicular fluid and inflammatory exudate
How can you detect calculus?
Posteriors-pigtail
Anterior-orban
Dry teeth
RadiogrAphs
Extrinsic stain
(Exogenous))
Removable. Caused by food source, tobacco, bacteria.
Black line
Brown - poor OH, drinkingg colored beverages, tea coffee fruit juoces and red wine
Dark brown-tobacco
Orange-chromogenic bact.
Yellow- CHX and stannous fl. These stain result from the tin ion
Intrinsic endogenous stain
Non removable, pink tooth, pulp necrosis and tetracycline, excessive systemic Fluoride
Class 1 furcation
Early evidence of bone loss, instrument can enter fircation leading to the furcation
Class 2 furcation
Moderate bone loss instrument can enter the furcation but can not pass between the roots
What probe do you use to assess furcations?
nabors probe
Class 3 furcation
Sever bone loss instrument can pass between the roots
Class 4 furcations
Same as class three but also has recession
Critical ph for enamel
4.5-5.5
Critical ph for cementum
6.0-6.7
High concentrations of fluoride
Can be bactericidal
Low concentrations daily fluoride
Is better, and is bacteriostatic
How is systemic fluoride metabolised
Circulates blood, rapidly absorbed in the stomach, and whatever isn't used excreted through the kidneys
Can you recommend fl supplements to a preg patient?
No, never!
What is the most effective way to receive fl?
Water fluoridation, it cost $.13-$5.48 day/year
Optimal fl level in warm- cold climate
0.7-1.2 ppm, .7 is for warm climates
What compounds are used in water fl?
NaFl, NaFl silicofluoride, hydrofluorosilic acid
Fluoride supplement dosage for and infant
NONE
Fluoride supplement dosage for a 3-6 yr old
25 mg
0.3-0.6 ppm
What foods contain fluoride?
Tea
Fish ( large amounts)
When would you use sodium fl?
Presence of tooth colored restoration
, 4 min tray, and recommended for bulimics
Sodium fl varnishes
22,600 ppm ( has the most ppm)
Desensitizes exposed roots and caries prevention,
Use small dose .3-.5 mL application 2-4x a year. Not for home use, can use on infants and children with less ingestion that gel!
Would you recommend a fl rinse to a 5 year old?
No, they should be a little older 6 is better. That way they don't swallow.
Acidulated phosphate fluoride
Causes staining of tooth colored and porcelain restorations as well as pitting over time.. Comes in thixotropic gel and foam
Safely tolerated dose
1/4 the certain lethal dose (cld)
Stannous Fluoride
Unstable, must be mixed, stains demin areas and margins of tooth colored restorations, causes gingival sloughing
Acute fl toxicity
Flu like symptoms that occur within 30 mims of ingestion...increased salivation and thirsts
If a pt has hypersensitivity due to recession, what will you do?
Administer a NaFl (9,050 ppm) varnish
Emergency tx for acute fl toxicity<5mg
Administer calcium binding agent
Who are powered toothbrushes good for
Everyone. Kids-elderly, arthritic pts, poorly motivated individuals, implant care
If a person swallows a toxic dose of fl?>5mg
Induce vomiting, administer fl, seek med tx.
What if someone swallows a lethal dose? >15mg
Seek medical tx, induce vomiting, cardiac monitoring
Bass method
45 degrees and bristles into sulcas
Stillmans
45 degrees, and half on gingiva
Interdental brushes are good for
Open embrasures, exposed clads 3 furcations, ortho, fixed prosthesis, and if plastic coated on implants
Tufted brushes are good for?
Open proximal spaces
Hard to access areas
such as third molars
Fixed prothesis such as a fixed partial dentures pontics and ortho
Tooth Pick holder (perio aid) is good for?
Exposed 3 furcations
Interdental cleaning
Concave proximals
Gingival margins above ortho
Wooden wedge stimulator is good for?
Interdental areas with exposed root (recession)
Tufted floss is good for?
Can use under pontics, or ortho
Floss holders are good for?
Those who are physically challenged, and care givers
Oral irrigators are good for?
Disrupting loosely adherent plaque, flushes ortho appliances
What therapeutic agent is recommended for tartar?
Pyrophophates
What therapeutic agent is used for anti hypersensitivity?
Potassium nitrate
Strontium chloride
Sodium citrate
What agent is dentifrice is used as an antibacterial?
Triclosan
What agent in dentifrice is used for whitening?
Carbamide peroxide, or hydrogen peroxide
Gracey 1-2
All anteriors
Gracey 15-16
Mesial of post
Gracey 17-18
Distal of post
Implant safe curet and scaler
Plastic, nylon, graphite and gold tipped
Ultrasonics
Produce elliptical motion, all sides of tip are active, operates 18,000-45,000 cps,
Uses a stack of metal strips in hand piece
Work through cavitation
Sonic
Compressed air, 2500-7,000 cps
Ultrasonic piezoelectric
25,000-50,000
Ceramic rod
Linear
Systemic health considerations for ultrasonic
Communicable disease
Resp conditions, diff swallowing, susceptible to infection like chemo, immune suppressed, organ transplant
Indications for air polishing
Stain, root detox, sealant prep, debris removal, ortho
Contraindications for air polish
Sodium restricted diets, spongy gingiva, resp cond, porcelin veneers, restorative materials, exposed root surface, immunocomprised,
Pts taking potassium, anti diuretics, or steroid therapy
How do you apply pulp tester?
Middle or gingival 1/3 with no pRessure, avoid contact with soft tissue, and metallic restorations
Dysguesia
Altered taste, disguised taste
Why should you wait 30 mins after brushing before rinsing with Chx
Bc it becomes i activated by sodium lauryl sulfate
Cancer pt with oral mucositis?
Rinse with baking soda, saline solution water rinse. Never alcohol product.
Viscous lidocaine
What would best recommend rinse for a pt with NUG, gingivitis, and perio?
CHX 2x day
Age and mouth rinse
Always note pt. age before recommending any mouth rinse
Quanternary ammonia compounds
Cetlpyridi chloride CPC, scope, cepacol, crest pro health-- cause staining, burns, increases supr calculas formation
Dentigerous cyst
Smooth unilocular radiolucency that originates from reduced enamel epithelium. It is associated with tooth
Remember in a radiograph it is around the crown
Stone
Beta hemi hydrate that needs little water when mixing, regular particles
Perimylosis
Erosion of tooth by gastric acid
Which tooth hAs an oblique ridge
Max 1st molar
Drugs to tx schizophrenia
Chlorpromazine
Haloperidol
Resperidone
Triflupromazine
Cachexia
Wasting of body due to severe illness
Carcinoma in situ is best described as
Encapsulated high grade epithelium that is hyper cellular with no cell maturation at the surface and an intact basement membrane
Melasma
Brown lesion on upper lip at vermillion border that looks like a mole
Caused by hormone changes
Acetominophen
Effects kidneys and liver, analgesic, antipyretic..... It does not have anti inflammatory properties
Immune system defense that actually breaks down connective tissue
Cytokines
Ectomesynchyme
The enamel organ,dental papilla, and dental sac are derived from..
Cheiliosis
Deficiency of riboflavin, niacin, pyridoxine, biotin
Days 4-7 plaque maturation
Plaque spreads more coronally more mixed flora rods, filamentous forms and fusobacteria
What cranial bone does foreman rotd and foreman ovale pass thru?
Sphenoid
Hepatitis b vaccine is what type of immunization, "HBIG
Artificial passive
What mandibular tooth can present with a bifurcated root
Mand. Canine
Acidulated phosphate ph
...
Best way to tx. A patient with chronic periodontal disease and remove endotoxins
Ultrasonic, bc you remove tartar and irrigate.
What is tue most abundant type of connective tissue
Collagen fibers
What type of probe do we use at school?
PCPUNC
Sa node
Electrical activity that initiates a heartbeat
Latent form of chicken pox
Varicella zoster
Two antibiotics that cause photosensitivity
Doxycylcine and minocycline