Clinical Dental Hygiene

OSHA

organization concerned with clinics being compliance with the Bloodborne Pathogen Standard

MSDS

contain information about each product used in the clinic

High

Level of surface disinfection commonly used in surgical areas

Intermediate

Level of surface disinfection commonly used in dental offices

NO

Is a Low level of surface disinfection acceptable in the dental office?

Disinfection

kills MOST microorganisms

Sterilization

designed to kill ALL microorganisms including spores

Spores

What is the hardest form of life to kill?

Bacillus stearothermaphilus

Type of spore, used for autoclave & chemical vapor

Bacillus subtilis

Type of spore, used for dry heat & ethylene oxide

Steam Autoclave

Corrosion of non-stainless steel may occur, don't use closed containers, 20 min at 250 degrees & 15-30psi

Unsaturated Chemical Vapor

Do not use closed containers, may damage plastic & rubber items, provide adequate ventilation

does not corrode instruments, affective for oils & powders, any instrument that cannot be autoclaved.

Advantages of Dry Heat

long sterilization cycle, not good for plastics or hand pieces, do not stay sterile b/c instruments are not wrapped

Disadvantages of Dry Heat

Sterilizes by oxidation. Substances combine with oxygen. Timing starts when contents reach peak temperature

How does dry heat work?

Unsuitable for oils & powders & waxes, can corrode instruments.

What are the disadvantages of moist heat?

very economical, useful for all instruments that are able to stand high temperatures

What are the advantages of moist heat: .

ASA Classification I

Notmal healthy patient, no dental management alterations required

ASA Classification II

A patient with mild systemic disease; may or may not need dental management alterations

ASA Classification III

A patient with moderate to severe systemic disease; would generally require dental managment alterations

ASA Classification IV

A patient with severe systemic disease; requires dental management alterations, best treated in special facility

Blood Pressure

The force exerted by blood against arterial walls when the heart contracts

Primary Hypertension

Most common form of hypertension, no obvious cause

Secondary Hypertension

Hypertension that is secondary to another disease

Malignant Hypertension

Most severe form of hypertension

Radial Artery

Most common point to take pulse

Brachial Artery

Best place to take pulse on a toddler or infant

Carotid Artery

Point to take pulse in emergency situations; unconscious patient

Tachycardia

Rapid pulse: 100+ beats/min

Brachycardia

Slow pulse: below 50 beats/min

60-100

Normal adult pulse rate

Tachypnea

Rapid respiration (hyperventilation)

Bradypnea

Slow respiration

12-20

Normal adult respiration rate

Attrition

Tooth to tooth wear

Abrasion

Pathologic wear due to a foreign substance

Erosion

Loss of tooth structure due to a chemical agent

Hypoplasia

Caused by a disturbance of ameloblasts during enamel formation; pitted enamel, striations, white spots

Class I

GV Black Class I--Pits and fissures of anterior & posterior teeth

Class II

GV Black Class--Proximal surface of posterior teeth, commonly involves occlusal surface

Class III

GV Black Class--Proximal surface of anterior teeth NOT involving the incisal edge

Class IV

GV Black Class --Proximal surface of anterior teeth involving the incisal edge

Class V

GV Black Class--Cervical 1/3 of facial or lingual surface

Class VI

GV Black Class--Incisal edge of anterior teeth or cusp tips of posterior teeth

Angle's Class I

The mesiobuccal cusp of the maxillary first molar is aligned with the buccal groove of the mandibular first molar. There is alignment of the teeth, normal overbite and overjet and coincident maxillary and mandibular midlines

Angle's Class II

A malocclusion where the molar relationship shows the buccal groove of the mandibular first molar distally positioned when in occlusion with the mesiobuccal cusp of the maxillary first molar

Angle's Class II Div. I

__________ is when the maxillary anterior teeth are proclined and a large overjet is present

Angle's Class II Div. II

__________ is where the maxillary anterior teeth are retroclined and a deep overbite exists

Angle's Class III

A malocclusion where the molar relationship shows the buccal groove of the mandibular first molar mesially positioned to the mesiobuccal cusp of the maxillary first molar when the teeth are in occlusion

Openbite

MX and MN teeth do not occluse

Crossbite

MX teeth are positioned lingual to the MN teeth

Overbite

Vertical overlap of MX and MN incisors

Overjet

Horizontal overlap of MX and MN incisors

Class I Furcation

Evidence of early bone loss in furca area; instrument can enter

Class II Furcation

Evidence of moderate bone loss in furca; instrument can enter but not pass between roots

Class III Furcation

Evidence of severe bone loss in furca; intstrument can pass through entire furca

Class IV Furcation

Same as Class III with exposure resulting from gingival recession

Nabors

Probe used to measure furcation involvement

Marginal Gingiva

Marks opening into sulcus

1.5 to 2.0mm

In health gingival margin is ________ coronal to crest of bone

Keratinized Gingiva

The gingiva from GM to MGJ

Attached Gingiva

The gingiva from the base of the gingival sulcus to MGJ

Interdental Gingiva

Located between adjacent teeth

(1) Presence of Bacterial Plaque (2) Ingestion of certain drugs

2 causes of gingival enlargment

Aquired Pellicle

1st stage of Plaque Formation

Selective Bacterial Adhesion

2nd stage of Plaque Formation

Bacterial Colonization

3rd stage of Plaque Formation

Gram Positive, Streptococcus

Dominant bacteria in Inital Plaque

Gram Negative, motile rods & spirochetes

Dominant bacteria in Established Plaque

Saliva

Source of nutrition of Supragingival Plaque and Calculus

Crevicular Fluid (pl & cal), Gingival Crevicular Fluid (cal)

Source of nutrition of Supragingival Plaque and Calculus

Provides a rough, irritating surface for bacteria to exist; a physical irritant for gingiva

Function of Calculus

Pyrophosphates

_______ from saliva affect calculus formation

Bacterial Plaque

a non-mineralied mass, that is attached firmly to acquired pellicle

Proximal or Gingival 1/3

What tooth surfaces have the most involvement in plaque formation?

Palatal Surfaces of MX teeth

What tooth surfaces have the least involvement in plaque formation?

4.5-5.5

pH for enamel demineralization

6.0-6.7

pH for root surface demineralization

Increased

People with heavy calculus have (increased or decreased) levels of calcium phosphorous in their saliva.

Smooth bottom layer of calculus

What is burnished calculus?

Incorrect Angulation or Dull Instruments

2 causes of burnished calculus

Change it immediately!

What if your mast gets moist?

Lingual of MN anteriors & Buccal of MX molars

Most common site for supragingival calculus

Proximal Surfaces (when plaque is left undisturbed)

Most common site for subgingival calculus

Chlorhexidine

Active ingredient in Peridex

Essential Oils

Active ingredient in Listerine

Quaternary Ammonium Compounds

Active ingredient in Scope & Cepacol

True

True/False- Indicator tape indicates temperature has been reached, NOT sterility

80

Plaque is ________% water

Yes

Does subgingival calculus have more inorganic compound than dentin?

Intrinsic

_____(location) stain within the tooth surface (Meds)

Extrinsic

_____(location) stain that occurs from an outside source (Tea, Coffee)

Endogenous

Stain originating from within the tooth (Trauma, Tetracycline)

Exogenous

Stain that originates from sources outside the tooth (Cigarettes)

Yes

Can some extrinsic stains (green or tobacco) become embedded & become intrinsic?

Black Line Stain

Usually teeth are clean, iron compounds in saliva

Green, Yellow, Orange

Chromogenic bacteria can cause stains in what 3 colors?

Yellow-Brown

What color stain does Chlorhexidine cause?

Blue/Green; Copper

An industrial worker may have what color stain on his teeth? What causes this stain?

True

True/False- The amount of sugar is not as important as the frequency & form.

Adaptation

Rolling the explorer between the thumb & index finger will promote better ________

Tissue Trauma

Scaling with greater than 90� angulation may cause:

Tufted Brush

_______would be used on: rotated teeth, hard to access 3rd molars, Type III & IV furcations

Interdental Brush

_______would be used on: open embrasures, root concavities, proximal surfaces, III & IV furcations

Periostat

An example of a Collagenase Inhibitor

Arestin

Minocycline in the form of a powder, controlled delivery system

Periochip

Subgingival sustained release delivery system, containing Chlorhexidine

Atridox

Doxycycline subgingival treatment

20 min @ 121�C/250� & 15-30 psi

Cycle for Steam Autoclave

20 min @ 132�C/270� & 20-40 psi

Cycle for Unsaturated Chemical Vapor

60-120 min @ 160�C/320�

Cycle for Dry Heat

10-16 hours @ 61�C

Cycle for Ethylene Oxide

Chief Complaint

Always address the pt's ___________ first.

Pseudopocket

Produced by edematous gingival, no migration of JE

Periodontal Pocket

Produced by apical migration of JE

Bleeding on Probing

1st sign of gingivitis; microulcerations of sulcular epithelium

Direct Facial, Distofacial, Mesiolingual

Access MX Molars furcations from ______, ______, & ______

Bass Method

Most commonly accepted brushing technique; bristles directed apically into sulcus @ 45�

Toothpick

Indications for _______ use is: accessible furcations, shallow pockets & normal sulcus depths

Pyrophosphate

Active ingredient in anti-calculus toothpaste

Sensitivity

Potassium nitrate, strontium chloride, or sodium citrate are all added to toothpastes to treat what?

Dentinal Hypersensitivity

Caused by movement of fluid within dentinal tubules

Effervescent

Oxygenating agents cleanse via what kind of action?

Hydrogen Peroxide

Continued use of __________ can lead to: sponginess of gingiva, hairy tongue, root hypersensitivity, & demineralization

Streptococcus mutans

0.12% Chlorhexidine suppresses growth of ________

No

Should an ultrasonic scaler be used on implants, dentures or in areas of demineralization?

True

True/False-Gracey curets are designed as "finishing" curets

2

Universal curets have ________ cutting edges per working end

during Instrumentation

When should stain be removed ideally?

False

The size of the polishing cup influences the ability of the polishing agent.

Occlusal

Polishing is LEAST effective on _________ surfaces.

Moist Heat

Sterilizes by coagulation of proteins

No

Are standard precautions patient specific?

Clinician

The purpose of PPE is to protect the clinician or the patient?

10 Hours

To sterilize instruments through liquid chemical solutions, the recommended immersion time is _______

HIPAA

Who is concerned with patient confidentiality?

Yes

Is a toothpick in holder effective in furcation plaque removal?

Therapeutic

If a mouthrinse is _________, it has the ability to kill all bacteria in the mouth

True

True/False- The type of subgingival bacteria most likely to be found at the base of a 7mm pocket would be RODS.

No

Does a classification of II for mobility involve vertical movement?

Angle's Class I

Canine relationship: the MX canine occludes with the distal 1/2 of the MN canine & mesial 1/2 of MN 1st premolar

True

True/False- The facial profile of Class I Occlusion is mesognathic.

Angle's Class II

Canine relationship: Distal of MN canine is distal to mesial surface of MX canine by at least the width of a premolar.

1

Class II, Div ______ is often associated with deep overbite, excessive overjet, abnormal lip muscle function, short mandible &/or short upper lip.

Retrognathic

The facial profile of Class II occlusion is ________

Angle's Class III

Canine relationship: distal of MN canine is mesial to the mesial surface of the MX canine

Prognathic

The facial profile of Class III occlusion is ________

2

Class II, Div ______: one or more MX incisors are retruded

Within Minutes

How long does it take acquired pellicle to form after polishing?

1-2 Days

How long does it take Gram Positive cocci to enter bacterial biofilm?

<120 / <80

What is normal blood pressure?

120-139

Systolic for "Prehypertension

80-89

Diastolic for "Prehypertension

140-159

Systolic for "Stage I Hypertension

90-99

Disastolic for "Stage I Hypertension

160 or above

Systolic for "Stage II Hypertension

100 or above

Diastolic for "Stage II Hypertension

Stage II Hypertension

Mr. Thats Whatshesaid came in with BP of 190/102. What stage hypertension is that?

True

True/False- Definitive emergency care only if blood pressure is <180/110.

Morning

Patients who are ASA Class II should be scheduled for appointments when?

No

Ms. Ophelia Dingdong presents with blood glucose level of 248. Should she be treated?

I/E Exam

The purpose of _______ is to assess & recognize deviations from normal conditions significant to the patient's health.

Stage I Hypertension

A blood pressure of 162/95 would be considered_________.

Class II

An MOD on #4 would best be described as a __________ restoration.