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What duct is associated with the parotid gland? - ✔✔Stensons duct What duct is associated with the submandibular gland? - ✔✔Wharton's duct What are the muscles of mastication? - ✔✔masseter, temporalis, medial pterygoid, lateral pterygoid What is the role of the dental hygienist in special patient populations? - ✔✔• Recognize physical, medical, mental, social, dental needs
- Communicate appropriately to patient, caregiver, & other health professionals Know all medical conditions, medications, vital signs
- Adapt an appropriate treatment plan Common appointment modifications for special needs patients - ✔✔Stress reduction Short, morning procedures ¯ time for procedure (may need time for appointment) Good communication & encourage patients to ask questions Use relaxation techniques Make procedures as "pain-free" as possible Xerostomia management - ✔✔Things patients can do (hydrate, humidify bedroom) Saliva substitutes Saliva stimulants (cholinergics such as pilocarpine mimic acetylcholine) Caries prevention (frequent recalls, home fluoride, other products)
- Frequent maintenance appointments
- Modification of chair position (CVA, CHF, COPD, pregnancy)
Where does the mental nerve innervate? - ✔✔Between 1st and 2nd premolar What nerve can easily be damaged near retromolar pad? - ✔✔Lingual nerve What are the fibers shown? - ✔✔ 1 - Aveolar crest fibers 2 - Oblique fibers 3 - 4 - Horizontal fibers 5 - Interradicular fibers 6 - Apical Fibers What muscles protrude the jaw? - ✔✔medial and lateral pterygoid What muscles retract the jaw? - ✔✔temporalis, masseter, geniohyoid and digastric What muscles elevate the mandible? - ✔✔temporalis, masseter, medial pterygoid What muscles depress the mandible? - ✔✔digastric, geniohyoid, mylohyoid What are the papillae of the tongue? - ✔✔filiform, fungiform, circumvallate, foliate Sulcus terminalis - ✔✔V shaped line separating the anterior 2/3 of the tongue from the posterior 1/ Masticatory mucosal tissue - ✔✔Keratinized and protects the attached gingiva and hard palate Lining mucosal tissue - ✔✔Not keratinized, and includes the alveolar, vestibular, and buccal mucosa, as well as the floor of the mouth
Removing PPE - ✔✔Gloves, faceshield, mask, gown When do discard sharps container? - ✔✔When it is 3/4 full What is considered health? - ✔✔Less than 10% of sites Peri- implantitis - ✔✔Loss of implant supporting bone Peri-implant mucositis? - ✔✔Gingivitis around an implant ( no bone loss ) Normal blood pressure - ✔✔less than 120/ Elevated blood pressure - ✔✔ 120 - 129/less than 80 Hypertension Stage 1 - ✔✔ 130 - 139/80- 89 Hypertension stage 2 - ✔✔140 or higher/90 or higher Hypertentitive crisis - ✔✔Higher than 180/ higher than 120 Dehiscence - ✔✔Basically recession Fenestration - ✔✔Window or hole Semi-critical surface category - ✔✔Touch mucous membranes. EX: Bite block, mirror Non- critical surface category - ✔✔Do not touch mucous membranes. EX: Light handles, eyewear, x-ray tube
Environmental surface category - ✔✔No contact with pt. EX: counter tops What makes up the red complex? - ✔✔P. Gingivalis B. Forsythus T. Denticola Plaque Index- 1 - ✔✔No plaque visible to the eye, only with the probe Plaque Index- 2 - ✔✔Moderate - thick amount of plaque visible to the eye Plaque Index- 3 - ✔✔Heavy plaque, fills out niche created by the gingival margin and tooth surface Gingival Index- 1 - ✔✔Mild inflammation, slight change in color, slight edema, no bleeding on probing Gingival Index- 2 - ✔✔Moderate inflammation-redness, edema, and glazing; bleeding on probing evident Gingival Index- 3 - ✔✔Severe inflammation-marked redness and edema, ulceration and spontaneous bleeding Hamp classification degree 1 - ✔✔Horizontal loss of periodontal support <3mm Hamp classification degree 2 - ✔✔Horizontal loss of support exceeding 3mm but not passing the total width of 1 furcation area Hamp classification degree 3 - ✔✔Horizontal through and through destruction of periodontal tissue in the furcation Class 1 recession - ✔✔
What curettes are used on anterior teeth? - ✔✔Gracey 1/2,3/4,5/
- ✔✔ What are the tissues that comprise the tooth? - ✔✔- Enamel ( hardest tissue of the body )
- Dentin ( greatest bulk of the tooth )
- Cementum ( found on the root surface )
- Pulp ( Vital, sensory responsive portion of the tooth )
- PDL ( Attaches tooth to alveolar socket ) When does the first permanent tooth erupt? - ✔✔6 years old- usually the first molar. This marks the beginning of the mixed dentition stage which usually lasts until the age of 12 or 13 with the loss of the last deciduous tooth. What deciduous tooth do you usually lose last at the age of 12 or 13? - ✔✔Maxillary cuspid or mandibular second molar What are the last teeth to usually erupt in the mixed dentition stage? - ✔✔Maxillary cuspid or mandibular second molar What is the tooth most likely to be impacted after the mixed dentition stage? - ✔✔3rd molar At what age is primary dentition complete? - ✔✔1 1/2 years old When do the first deciduous central incisors erupt? - ✔✔6 months old What is the name of the layer that connects the buccal and lingual? Is it keritanized or non keritanized? - ✔✔Cul, non keritanized CEJ to FGM - ✔✔Recession
Where does the parotid gland drain? - ✔✔Above 2nd maxillary molar Loe and Sillness - ✔✔Gingival index Sillness and loe - ✔✔Plaque index Free gingival margin to the base of the pocket - ✔✔Probing depth Probing depth + recession - ✔✔Clinical attachment loss Where do enamel projections happen? - ✔✔Furcation area What are the causes of mobility? - ✔✔Bone loss, occlusal trauma, PA lesions, perio surgery Fremitus - ✔✔Movement of the tooth that you can feel with your finger Soft tissue around an implant - ✔✔Mucosa Primary etiological factor of periodontitis - ✔✔Plaque Secondary etiological factors of periodontitis - ✔✔- calculus
- overhanging restorations
- perio-endo lesions
- open contacts
- occlusal trauma
- smoking
- systemic disease ( diabetes )
Secondary colonizers - ✔✔F. Nucleatum, P. Intermedia Predisposing factors of NUG - ✔✔Smoking, poor oh, stress, trauma. Plaque always has to be present for NUG to form What is the name of the layer that connects the buccal and lingual? Is it keritanized or non keritanized? - ✔✔Cul, non keritanized CEJ to FGM - ✔✔Recession Where does the parotid gland drain? - ✔✔Above 2nd maxillary molar Loe and Sillness - ✔✔Gingival index Sillness and loe - ✔✔Plaque index Free gingival margin to the base of the pocket - ✔✔Probing depth Probing depth + recession - ✔✔Clinical attachment loss Where do enamel projections happen? - ✔✔Furcation area What are the causes of mobility? - ✔✔Bone loss, occlusal trauma, PA lesions, perio surgery Fremitus - ✔✔Movement of the tooth that you can feel with your finger Soft tissue around an implant - ✔✔Mucosa Primary etiological factor of periodontitis - ✔✔Plaque
Secondary etiological factors of periodontitis - ✔✔- calculus
- overhanging restorations
- perio-endo lesions
- open contacts
- occlusal trauma
- smoking
- systemic disease ( diabetes ) Bacteria most commonly found in heath - ✔✔Gram positive cocci Bacteria most commonly found in reduced health - ✔✔Gram negative cocci and rods Where are enamel pearls most commonly found? - ✔✔Distal of maxillary molar Biggest modifiable risk factor of perio - ✔✔Smoking Scaling - ✔✔Process by which plaque, calculus, and stains are removed from both supra and subgingival tooth surfaces Root planning - ✔✔Removing cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms Dental prophylaxis - ✔✔Procedure for prevention of periodontal diseases or other dental diseases by the cleaning of the teeth in the dental office Periodontal maintenance - ✔✔This procedure is instituted following periodontal therapy (non- surgical and/or surgical periodontal therapy) and
Locally derived antibiotics - ✔✔- arestin ( minocycline microspheres )
- actisite ( tertracycine fiber )
- atridox ( doxycycline gel )
- perio chip ( chlorhexidine chip ) What is included in the sterile field? - ✔✔Patient, surgical setup and sterile coverings and handles What is not included in the sterile field? - ✔✔Gown, mask/hair covering, dental chair, safety glasses
- ✔✔High humidity, co2 tension, pH and temperature What are the 4 main components of the periodontium? - ✔✔1. Gingiva
- Bone
- PDL
- Cementum Initial lesion - ✔✔Plaque is located Supra-gingival, gingiva still appears clinically healthy Early lesion - ✔✔Toxins and byproducts start to penetrate the JE, start to see PMN'S and macrophages, tissue is starting to become inflamed, 4-7 days following plaque accumulation Established lesion - ✔✔Plaque extends sub-g, disrupts attachment of the most coronal portion of the JE, large recruitments of PMN,S, macrophages and lymphocytes Periodontitis ( Advanced lesion ) - ✔✔Plaque biofilm grows along the root surface both apically and laterally, tissue destruction, JE begins to migrate apically What are the 8 cranial bones? - ✔✔frontal, parietal, occipital, temporal, sphenoid, ethmoid
What are the 14 facial bones? - ✔✔mandible, maxillary bones, zygomatic bones, nasal bones, lacrimal bones, palatine bones, vomer, inferior nasal conchae What are the 7 bones that make up the orbit? - ✔✔frontal bone, lacrimal bone, ethmoid bone, zygomatic bone, maxillary bone, palatine bone, sphenoid bone What are the smile muscles? - ✔✔Lavator Anguli Oris, risorius, zygomaticus What are the extrinsic muscles of the tongue? - ✔✔genioglossus, hyoglossus, styloglossus, palatoglossus ( control position ) What is the purpose of the intrinsic muscles of the tongue? - ✔✔Determine the shape of the tongue What premolar most often has two roots? - ✔✔Maxillary first Which premolar often has 3 cusps? - ✔✔Mandibular 2nd premolar
- ✔✔
- ✔✔ What is the landmark of the occipital bone? - ✔✔Foramen magnum Which cranial nerve is responsible for motor innervation to the muscles of facial expression? - ✔✔Facial Which cranial nerve is responsible for taste and sensation to the posterior third of the tongue? - ✔✔Glossopharyngeal
Where is recession most commonly found? - ✔✔Buccal surfaces of maxillary molars and mandibular central incisors What are ways that gingival overgrowth is classified? - ✔✔- Plaque inducted ( most common )
- Genetic / Familial related
- Physical irritation
- Systemic disease / idiopathic
- Medication induced What are three forms of acute periodontal conditions? - ✔✔1. NUG
- NUP
- PERICORNITIS What are signs of NUG? - ✔✔Pain, bleeding, interproximal cratering, fetid odor, malaise, fever What two bacterias are most common with NUG? - ✔✔Fusiform and Spriochete What are treatments for NUG? - ✔✔Debridement, ABX, Metronidazole What is the big difference between NUG and NUP? - ✔✔NUP has bone loss and very rapid destruction Treatment for acute STAGE 1 pericornitis - ✔✔- cleanse area, irrigate well, consider ext or bite adjustment of opposing tooth Treatment for acute STAGE 2 pericornitis - ✔✔- Drain with curette, thorough irrigation, prescribe correct abx. Treatment for CHRONIC STAGE 1 pericornitis - ✔✔- Decide wether to retain or ext. tooth, possible surgical excision of pericoronal tissues
Treatment for CHRONIC STAGE 2 pericornitis - ✔✔- Possible gingivectomy of excessive tissues, remove tissue that could harbor any bacteria ASA classification - ✔✔•Physical status classification system developed in 1962 by American Society of Anesthesiologists (ASA)
- method of estimating risk in a patient undergoing a surgical procedure
- MUST have every sedation patient assigned a ASA classification prior to surgery ASA class 1 - ✔✔Normal healthy patient. Little to no difficulty handling treatment ASA class 2 - ✔✔Mild systemic disease. Extreme dental anxiety, pregnant or over age 60 falls into this category ASA class 3 - ✔✔severe systemic disease. Includes pts with COPD, induced asthma, epilepsy and controlled angina ASA class 4 - ✔✔Patient with severe systemic disease, disorders that are life threatening: unstable angina, congestive heart failure, debilitating respiratory disease, hepatorenal failure ASA class 5 - ✔✔Pt is not expected to survive. End stage cancer or renal disease. Normal pulse rate - ✔✔ 60 - 100 bpm Tachycardia - ✔✔greater than 100 bpm Bradycardia - ✔✔slow heart rate (less than 60 bpm) What exactly is blood pressure? - ✔✔Force of blood against arterial walls. Max pressure = diastolic, minimum pressure= systolic
Management of hyperventilation - ✔✔Raise chair back to upright position, have pt breathe into paper bag, or cup hands in front of mouth/nose Asthma - ✔✔❖ Respiratory disease causing reversible airway obstruction & reduced ability to expire. ❖ Symptoms include resp distress, wheezing, use of accessory muscles, diaphoresis, & tachycardia. ❖ One of the most common med emergencies in dental office!! ❖ Pt's typically use corticosteroid spray & inhaled bronchodilator for occasional use/acute attacks Bronchospasm - ✔✔❖ Constriction of bronchial smooth muscle ❖ Most likely to occur following LA administration ❖ May be exacerbated by aerosols such as ultrasonics ❖ Management includes termination of procedure, and position pt in upright position ❖ check ABC's, remove objects from pts mouth ❖ administer bronchodilator (albuterol), or epi IM/SubQ 0.3ml of 1: dilution or IV 0.1ml of 1:10,000 dilution ❖ Prevention includes administration of bronchodilator prior to the procedure myocardial infarction (MI) - ✔✔• Necrosis of heart muscle from prolonged ischemia (lack of O2 due to ¯ blood flow)
- Symptoms of acute MI: Pain, nausea, diaphoresis (sweating), dyspnea (shortness of breath), weakness Appointment modifications for somebody with myocardial infarction - ✔✔Appointment modifications:
- Wait 6 months for elective treatment
- Stress reduction
- Monitor vital signs
- May need oxygen
- May want to use nitrous (for the stress reduction & supplemental O2)
- Limit epinephrine Cardiovascular disease - ✔✔A general term for all diseases of the heart and blood vessels. General considerations:
- History & severity of the disease
- Evaluate functional status/extent of limitations
- If surgery: date/type
- Review medications - may be taking antiplatelet (aspirin) or anticoagulant (warfarin/Coumadin)
- MD consult may be needed Appointment modifications for somebody with cardiovascular disease - ✔✔Appointment modifications:
- Stress reduction
- Frequent maintenance appointments
- Chair position - may not tolerate supine (on back with face up) position
- May need to limit epinephrine 0.04mg (2 carpules 1:100,000 solution) Careful with retraction cord if contains epinephrine
- Xerostomia-related medications
- If condition is uncontrolled, postpone treatment - refer to MD if undiagnosed chest pains Primary hypertension - ✔✔High blood pressure, the cause of which is unknown; also known as essential hypertension Secondary hypertension - ✔✔caused by an underlying condition
