Examples of biohazard waste
Sharps, Items that drip of blood and/or saliva, and hard and soft tissues removed from the patient.
PPE protects....
the operator.
Items of PPE include
Mask, gloves, eyeware, protective clothing
What does disinfection kill?
MOST pathogenic microbes, but NOT spores.
Qualities of disinfection...
1. Rapid broad-spectrum antimicrobial- bactericidal, fungicidal, tuberculocidal, virucidal
2. Odorless 3. Environmental and surface compatible 4. Residual effect 5. Non toxic to touch or inhalation 6. EPA registered 6. Disinfects and cleans
Types of disinfection agents
This is a must know
1. Chlorine based compounds
2. Iodophors
3. Phenols
4. Quaternary Compounds
What type of disinfection agent is corrosive to metals and has a strong odor?
Chlorine based compounds
What type of disinfection agent can disclor some surfaces yellow?
Iodophors
What type of disinfection agent may leave a film or residue on surfaces?
Phenols
What type of disinfection agent is not corrosive, but has a lower kill spectrum?
Quaternary Compounds
What disinfection agent should not be used due to toxic effects of fumes and is also corrosive?
Glutaraldehydes
What level of surface disinfectant is used in surgical areas?
HIGH
What level of surface disinfectant is used in dental offices? And must kill TB
INTERMEDIATE
What level of surface disinfectant is used in homes?
LOW
What kills ALL pathogenic microbes, including spores?
Sterilization
If indicator tape is being used, what does it indicate?
Instruments have been heat process, but may not guarantee sterility.
What are the classes of GV BLACK
must know
I. Pits and fissures
II. Proximal surface of posterior teeth
III. Proximal surfaces of anterior teeth
IV. Proximal surfaces of anterior teeth, including incisal edges
V. Cervical (gingival) 1/3 of the facial or lingual surface of any tooth (root caries)
V
Must Know
Molar: Mesiobuccal cusp of the maxillary first molar is positioned in the buccal groove of the mandibular first molar; malposition of individual teeth or groups of teeth.
Canine: Maxillary canine occludes with the distal half of the mandibular c
Class I (Mesognathic)
Must know
Molar: Buccal groove of the mandibular first molar is distal to the mesiobuccal cusp of the maxillary first molar by at least the width of a premolar.
Canine: Distal portion of the maxillary is mesial to the mesial portion of the mandibular cani
Class II (Retrognathic)
Class II (Retrognathic)
Molar: Buccal groove of the mandibular first molar is distal to the mesiobuccal cusp of the maxillary first molar by at least the width of a premolar.
Canine: Distal portion of the maxillary is mesial to the mesial portion of the mandibular canine by at l
must know
Molar: buccal groove of the mandibular first molar is mesial to the mesiobuccal cusp of the maxillary first molar by at least width of premolar
Canine: Mesial protion of the maxillary canine is distal to the distal surface of the mandibular cani
Class III ( Prognathic )
What is vertical overlap of the maxillary incisors to the mandibular incisors?
Overbite
What is horizontal distance between the linguals of the maxillary anteriro incisors and the facials of the mandibular anterior incisors?
Overjet
What is teeth not in occlusion between the maxillary and mandibular arch?
Openbite
What is maxillary teeth are positioned lingual to mandibular teeth?
Crossbite
What is midline of maxillary central incisors do NOT align with midline of mandibular central incisors?
Midline shift (deviation)
What is incisal edge to incisal edge of the maxillary anterior to mandibular anterior teeth respectively?
Edge to edge
What is cusp to cusp relationship of posterior teeth
end to end
What is mineralized plaque?
calculus
From what nutrient source makes SUPRAgingival calc?
Saliva
What color is supragingival calc?
White, yellow, or gray.
Where is supragingival calc most commonly found?
Near opening of salivary ducts
From what nutrient sources makes SUBgingival calc?
Crevicular fluid and inflammatory exudate
What color is subgingival calc?
Dark brown, dark green, or black
What kind of stain is removeable?
Extrinsic (exogenous)
What are some causes of extrinsic stain?
Certain bacteria, food, beverages, tobacco,
How do you remove extrinsic stain?
Instrumentation and polishing
What kind of extrinsic stain is associated with iron, insoluble ferric sulfide and gram positive bacteria and typically located on cervical 1/3 of facials and linguals?
Black
What kind of extrinsic stain is associated from inhaling metallic dust, most likely from an occupational exposure?
Bluish green
What kind of extrinsic stain is associated with poor oral hygiene and/or drinking dark colored beverages?
Brown
What kind of extrinsic stain is associated with tobacco use?
Dark brown and black
What kind of extrinsic stain is associated with chromogenic bacteria in plaque; associated with poor oral hygiene and typically located on anterior teeth?
Orange
What kind of extrinsic stain is associated with chlorhexdine use or stannous fluoride?
Yellow brown and brown
What results from the reaction of the tin ion in the fluoride?
stannous fluoride stain
What kind of extrinsic stain is associated with poor oral hygiene, chromogenic bacteria, fungi, and gingival hemorrhage.
Green
If stain is located on cementum, what is the choice for removal?
Instrumentation
What type of stain is not removable?
Intrinsic (endogenous)
What causes instrinsic stain?
pulpal necrosis, internal resorption, excessive systemic fluoride and/or tetracycline use during tooth development
What is the first sign of gingivitis?
Bleeding on probing
What furcation class is early evidence of bone loss, instrument can enter the depression leading to the furcation
Class I
What furcation class is moderate bone loss, instrument can enter furcation but cannot pass between the roots
class II
What furcation class is severe bone loss, instrument can pass between roots
Class III
What furcation class is severe bone loss, instrument can pass between roots and with evidence of recession.
class IV
What assess furcations
Nabors probe
What class of mobility involves slight horizontal mobility
class I
What class of mobility involves moderate horizontal mobility - greater than 1 mm -with no vertical depression
Class II
What class of mobility involves severe mobility with possible combined horizontal and vertical movement
class III
What process occurs when the pH level drops below 4.5 to 5.5 for enamel and 6.0 to 6.7 for cementum - known as critical pH levels
Demineralization
What process occurs when pH levels rise above critical pH levels?
Remineralization
What does fluoride interfere with?
must know
Bacterial metabolism
In HIGH concentrations, fluoride is...
bactericidal (destructive to bacteria)
In LOW concentrations, fluoride is...
bacteriostatic (inhibits growth or multiplication of bacteria)
What does fluoride have that makes it have the ability to bind to pellicle and tooth and be released over a period of time with retention of potency and DOES NOT need to polish teeth prior to application because it penetrates through pellicle and plaque
Substantivity
Two types of Fluoride therapy are
1. Topical
2. Systemic
What type of fluoride circulates in the bloodstream and is incorporated into the enamel of developing teeth?
Systemic
What type of fluoride is rapidly adsorbed in stomach and small intestine?
Systemic
What type of fluoride is effective from 6 months to 14 years of age?
systemic
What type of fluoride excreted through the kidneys when not used?
systemic
What is the adjustment of the fluoride ion content of a domestic water supply to the optimum physiologic concentration that will provide maximum protection against dental caries and enhance the appearance of the teeth with a minimum possibility of produci
Water Fluoridation
What is the most cost effective method of bringing the benefits of fluoirde to a community?
water fluoridation
What is the average cost of water fluoridation of a community?
$0.13-5.48/ per person, per year depending on the size of the community.
What is the optimal fluoride level?
0.7 ppm mg/L
What agency monitors the concentration level in community drinking water?
EPA (Environmental protection agency)
What agency monitors the concentration level in bottled water?
FDA
What is recommended for children who live in areas with inadequate water fluoridation?
Dietary Fluoride Supplements
Are dietary fluoride supplements recommended for pregnant women?
NO
What type of fluoride is sodium fluoride?
Topical
When is sodium fluoride used?
in the presence of tooth colored and porcelain restorations
The tray method is most effective delivery system for individuals with rampant caries for what type of fluoride?
Sodium fluoride
What type of fluoride is recommended for bulimics?
Sodium Fluoride
What type of fluoride contains 5% NaF?
Sodium fluoride varnish
What type of fluoride is used for desensitizing exposed roots and caries prevention?
sodium fluoride varnish
What type of fluoride therapy is sodium fluoride varnish?
topical
what type of fluoride therapy is stannous fluoride?
Topical
What type of fluoride is acidulated phosphate fluoride?
Topical
What type of fluoride must be fixed fresh because it is unstable solution?
stannous fluoride
what type of fluoride stains deminerazlied areas and margins of tooth colored restorations due to the reaction of the fluoride tin ion in the compound?
Stannous Fluoride
What type of fluoride is contraindicated in the presence of tooth-colored restorations and porcelain because acid in the fluoirde etches the glass components in the restoration.
Acidulated phosphate fluoride
What type of sterilization is...20 minutes at 270 degrees F at 20-40 psi. Ventilation is necessary. May damage rubber and plastic items. Spore test: geobacillus stearothermophilus.
Chemical sterilization
What spore test is geobacillus?
Chemical sterilization
What type of sterilization is ...60-120 minutes at 320 degrees F. Recommended for metal instruments. Avoid paper products. May damage rubber and plastic items. Not recommended for handpieces. Spore test: Bacillus atrophaeus.
Dry sterilization
What spore test is bacillus atrophaeus?
Dry sterilization
What type of sterilization is ... 20-30 minutes at 250 degrees F at 15-30 psi. Corrodes non-stainless steel instruments. Dulls instruments and burs. Ok for SOME plastics; cotton rolls/gauze. Paper packages come out wet and tear. Spore test: Geobacillus st
Steam sterilization
What spore test is geobacillus stearothermophilus?
Steam sterilization
What is normal blood pressure?
<120/80
What is prehypertension?
120/80-139/89
What is stage I hypertension
140/90-159/99
what is Stage II hypertension
60/100+
What asa class is Healthy patient without systemic disease. Blood pressure <140/90
ASA I
What ASA class is Patient with mild systemic disease. Blood pressure 140/90-159/94. Well-controlled noninsulin-dependent diabetes mellitus, asthma, epilepsy, healthy pregnancy. Consult physician if BP exceeds guidelines for 3 consecutive visits.
asa II
what asa class is Patient with sever systemic disease with limited activity. Blood pressure 160/95-199/114. Well-controlled insulin dependent diabetes mellitus, chronic heart failure, AIDS, chronic coronary obstructive pulmonary disease. Consult physician
asa III
what asa class is Patient with incapacitating systemic disease that is a threat to life. Blood pressure >200/115. Severe chronic heart failure or chronic coronary obstructive pulmonary disease, kidney or liver failure.
asa IV
What is tachypnea?
Rapid respirations
What is bradypnea?
Slow respirations
What are the normal respiration ranges?
Infants: 30-60 rpm
Children 14-26 rpm
Adults 12-20 rpm
what is tachycardia?
Rapid pulse rate
What is bradycardia?
Slow pulse rate
What is the main species involved in caries process. Gram-positive microorganisms, adhere well to tooth structure, produce higher amounts of acid from sugars than other bacterial types (mainly lactic acid), have the ability to produce glucans from sucrose
Streptococcus Mutans
What is Gram-positive microorganisms. Incapable of producing the range of pH values required for caries initiation. Found in large numbers after cavitation of tooth has occured.
Lactobacillus species
what is Associated with root caries?
Actinomyces viscosis
What kind of brush do you use around exposed furcations, hard to access 3rds, ortho appliances, and irregular gingival margins of rotated anterior teeth?
Tufted brush
What technique is...Angle bristles 45 degrees to gingival margin; place bristles in gingival sulcus
bass technique
what technique is...Angle bristles 45 degrees to gingival margin; place half of bristles on tooth, the other half on the gingiva
stillman technique
What toothpaste contains pyrophosphates?
Tarter - control
What toothpaste contains potassium nitrate, strontium chloride, or sodium citrate?
Hypersensitivity toothpaste
What toothpaste contains triclosan?
Antibacterial toothpaste
What toothpaste contains carbamide peroxide or hydrogen peroxide?
Whitening
Dietary fluoride supplements
Birth-6 months of age: Never need supplements
6 months-3 years of age: ?0.3 ppm=0.25 mg/day
3-6 years of age: ?0.3 ppm=.05 mg/day
0.3-0.6 ppm=0.25 mm/day
6-16 year of age: ?0.3 ppm=1.0 mm/day
0.3-0.6 ppm=0.5 mg/day
Self-applied
1000 ppm
Caries control and plaque reduction
Ortho and perio patients
Dentinal hypersensitivity
0.4% Stannous fluoride gel
Self-applied
5000 ppm
Porcelain or composite restorations
Those who cannot have acidic fluorides (bulimics)
Rampant caries; ortho patients
Decalcification; home whitening
1.1% Neutral Sodium fluoride
-Bacteriocidal- effective against gram + and - microorganisms
-Lysis of cell
-Absorbed then slowly released
-Decreases supragingival plaque formation; inhibits development of gingivitis
-Controls ulcerative periodontal diseases
-Suppresses S. mutans
-Disc
0.12% Chlohexidine
-Oil alters bacterial cell wall
-Controls plaque and gingivitis
-Burning sensation of oral mucosa
-Slight extrinsic staining
Essential oils
-Use in presence of tooth-colored restorations
-Tray system most effective for rampant decay
Sodium Fluoride Gels (2% NaF)
-Used for desensitizing exposed roots and caries prevention
-Retained for 24-48 hours
Sodium fluoride varnishes (5% NaF)
-Unstable solution, not commonly used
-Unpleasant taste
-Staining of teeth in demineralized areas
-Possible gingival sloughing and discoloration of tooth-colored restorations
Stannous Fluoride
The amount of drug likely to cause death if not intercepted by antidotal therapy; 5-10 gram of NaF at one time for adult
Certainly lethal dose
Gastrointestinal symptoms: Nausea, vomiting, diarrhea, abdominal pain, increased salivation, thirst
Systemic involvement: Symptoms of hypocalcemia, hyperreflexia, convulsions, parathesia, cardiac failure, respiratory paralysis.
Acute fluoride toxicity
>5 mg; induce vomiting, administer fluoride-binding agent, seek medical treatment
Emergency treatment for toxic dose of fluoride
>15 mg; seek medical treatment, induce vomiting, cardiac monitoring
Emergency treatment for lethal dose of fluoride
What gracey is used all anterior surfaces
1/2
What gracey is used direct facial and lingual of posterior teeth
7/8
What gracey is used mesial surface of posterior teeth
11/12
What gracey is used distal surface of posterior teeth
13/14
What gracey is used mesial surface of posterior teeth
15/16
what gracey is used distacl surface of posterior teeth
17/18
to 40,000 cycles per second. Uses stacks of metal sheets in insert to convert energy from handpiece to insert tip. Produces elliptical or orbital strokes. All sides of tip are active, followed by concave face, convex back, then lateral sides.
ultrasonic magnetostrictive
Operates at 25,000 to 50,000 cps. Uses ceramic discs to produce mechanical vibrations. Produces rapid linear strokes; new piezos have elliptical/linear motion. Lateral sides of tip are most active.
Ultrasonic Piezoelectric
Operates at 2,500 to 8,000 cps. Uses compressed air to create vibrations. Produces elliptical or orbital strokes. All sides of tip are active.
Sonic Scaler
Avoid polishing with WHAT in areas with xerostomia, demineralized areas, dental decay, tooth sensitivity, and newly erupted teeth
rubber cup polishing
avoid using the air polisher with patients who have
COPD and other respiratory problems
Why is chlorhexidine gluconate used?
For therapeutic mouth rinse agents
What percent is chlorhexidine gluconate?
.12%
What is active against a wide range of gram positive and gram negative microorganisms?
chlorhexidine gluconate
what alters the bacterial cell wall so that lysis occurs---cell is destroyed
chlorhexidine gluconate
What has a high substantivity which means that it is rapidly adsorbed to the teeth and pellicle, but is released slowly prolonging the bactericidal effect?
chlorhexidine gluconate
What rinse is used pre procedural?
chlorhexidine gluconate
What rinse decreases the supragingival bacterial plaque formation and inhibits development of gingivitis?
chlorhexidine gluconate
What is a short term adjunctive therapy following surgical treatment?
chlorhexidine gluconate
What rinse is used in the presence of implants?
chlorhexidine gluconate
What rinse controls inflammation in necrotizing ulcerative gingivits?
chlorhexidine gluconate
What rinse suppresses streptococcus mutans which have a role in the causing smooth surface carious lesions?
chlorhexidine gluconate
What rinse can cause staining of the teeth
chlorhexidine gluconate
what rinse can cause altered taste sensations
chlorhexidine gluconate
what rinse can cause irritation and burning sensations
chlorhexidine gluconate
what rinse can cause slight increase in supragingival calculus formation?
chlorhexidine gluconate
What is an example of essential oils?
Listerine antiseptic
What is an example of quaternary ammonium compounds (cetylpyridinium chloride)
scope and cepacol
-interacts with the bacterial cell to kill bacteria
-anti gingivitis and anti plaque
quaternary ammonium compounds (cetylpyridinium chloride)
Should you recommend fluoride rinses for children under the age of 6?
NO because they may have difficulty in swishing and expectorating
What type of mouth rinse should you recommend to the tobacco user?
non alcoholic mouth rinses
The tobacco user should avoid using
essential oil mouth rinses such as listerine
What type of mouth rinse should you recommended to the cancer paitent?
Rinse with baking soda/saline followed by plain water or recommend using chlorhexidine to reduce inflammation.
Avoid rinses with high alcohol content if patient has severe mucositis associated with
chemotherapy