Exam 3 Study Guide
CLASS VI Caries
-Cavities on incisal edges of anterior teeth and cusp tips of posterior teeth-Cavities on incisal edges of anterior teeth and cusp tips of posterior teeth
Recognize the factors that influence the accumulation of biofilm, calculus, and stain.
-Dental biofilm accumulates readily around crowded teeth as shown in Figure 17-4. -With effective biofilm control, biofilm accumulation around crowded teeth is not greater than that around well aligned teeth. •Rough surfaces: Biofilm develops more rapidly on rough tooth surfaces, existing calculus, poorly contoured restorations, and removable appliances; thick, dense deposits can be difficult to remove. (any where it can hide) •Occlusion: Deposits may extend over an entire crown of a tooth that is unopposed, out of occlusion, or not actively used during mastication. (biting can help clean the surfaces but not always) •Calculus formation is affected by factors such as salivary flow, salivary supersaturation with calcium phosphate salts, and inhibitors and promoters of calculus formation. -Types of Stains -Extrinsic stains occur on the external (outer) surfaces of the teeth and can be removed by polishing (coffee, wine, tobacco) -Intrinsic stains occur within the enamel and cannot be removed by polishing (bleaching might help)
Mucogingival junction
-Distinct line of color change in the tissue where the alveolar membrane meets with attached gingivae
Proximal
-In between teeth -Probe in area of crater formation. Probing is often deeper on the proximal surface under the contact area than on the facial or lingual surfaces.
Junctional epithelium
-Located at the base of the sulcus Junctional epithelium: attaches the gingiva to the tooth
Attached gingiva
-Part of the gingiva that is tightly connected to the cementum on the root and to the connective tissue cover of the alveolar bone -Wrinkle or Fold Test for a Mucogingival Defect -The periodontal probe is positioned at the mucogingival junction and gently moved coronally against the mucosa. -Blanching or wrinkling of the mucosa at the gingival margin indicates no attached gingiva.
Col Space
-Under the contact of teeth is called the "Col" space. -Used for probing in between contacts of teeth
Unhealthy Gingival Tissue
Dark red, loose, cratered, blunted papillae, spongy, shiny, generalized BOP with localized exudate
What are the markings of a probe with Marquis? UNC? Williams markings? What probes do students at CCD use?
A:Williams (1-1-1-2-2-1-1-1) B:Williams, color-coded C:Goldman-Fox (1-1-1-2-2-1-1-1) D:Michigan O (3-3-2) E:Hu-Friedy or Marquis color-coded(3-3-3-3 or 3-3-2-3) F:Hu-Friedy UNC 15 (each millimeter to 15), color-coded at 5-10-15. At CCD we use the Marquis and the UNC
Supragingival
Above the gum line
What are you looking for when you evaluate the oropharynx? Be able to name landmarks and spell them.
Oral Pharynx •Assess: • Tonsils • Trauma • Lesions • Color •Tonsillar Pillars •Anterior •Posterior •Palatine tonsils •Uvula •Pterygomandibular Raphe •Retromolar pad •Maxillary tuberosity
What are you looking for when you evaluate the palate? Be able to name landmarks and spell them.
Palate •Retract the tongue •Incisive papilla (covers Incisive Foramen) •Median Palatine Suture •Hard/Soft Palate •Torus palatinus ( may not always see or feel them) •Palatal Rugae -Palatine Fovea (Snake eyes) A: View of hard and soft palate. B: View of uvula and oropharynx.
Healthy Gingival Tissue
Pale pink, tight to teeth/knife edged, scalloped, pyramidal papillae, firm, stippled, no BOP
What are the different ways we can use our hands and fingers to assess tissues?
Palpation Digital (one finger) -Mucogingival, maxillary tuberosity) Bidigital (two fingers) -Tongue (one on the dorsal and the other on the Ventral) Bimanual (2 hands) -Floor of the mouth (one E/O, other I/O) Bilateral (Two sides with two hands) -TMJ -Neck Exam
Subgingival
Below the gum line
Identify potential etiologies for mobility.
Bone loss around the tooth from: -Clenching -Grinding -Recession -Trauma -Periodontal disease
What is the impact of tobacco and alcohol on oral cancer?
Both tobacco and alcohol are carcinogenic, which means they contain chemicals that can damage the DNA in cells and lead to cancer. If you drink alcohol or you smoke, this increases your risk of mouth cancer. If you both smoke and drink alcohol, this further increases your risk.
What are you looking for when you evaluate the buccal mucosa? Be able to name landmarks and spell them.
Buccal Mucosa -Evaluating for any abnormalities, lesions, or hard spots •Buccal Mucosa •Stenson's Duct/Parotid gland •Fordyce's Granules (yellow spots) •Labial Mucosa •Frenal Attachments (x7) •Alveolar Mucosa
G.V. Black's Classification system
CLASS I: Cavities in pits and fissures CLASS II: Cavities in proximal surfaces of premolars and molars CLASS III: Cavities in proximal surfaces of incisors and canines that do not involve the incisal angle CLASS IV: Cavities in proximal surfaces of incisors or canines that involve the incisal angle CLASS V: Cavities in the cervical 1/3 of facial or lingual surfaces (not pit or fissure) CLASS VI: Cavities on incisal edges of anterior teeth and cusp tips of posterior teeth
CLASS I Caries
Cavities in pits and fissures A.) Occlusal surfaces of premolars and molars B.) Facial and lingual surfaces of molars C.) Lingual surfaces of maxillary incisors Method of Examination: - Direct or indirect visual - Radiographs not helpful
CLASS III Caries
Cavities in proximal surfaces of incisors and canines that do not involve the incisal angle Method of Examination: -Early caries: by radiographs or transillumination -Moderate caries: not broken through to the facial or lingual~ 1.) Visual by tooth color change 2.) Radiograph -Extensive caries: direct visual
CLASS IV Caries
Cavities in proximal surfaces of incisors or canines that involve the incisal angle Method of Examination: -Visual Transillumination
CLASS II Caries
Cavities in proximal surfaces of premolars and molars Method of Examination: -Early caries: by radiographs only -Moderate caries: not broken through from proximal to occlusal -Extensive caries: involving occlusal, direct visual
CLASS V Caries
Cavities in the cervical 1/3 of facial or lingual surfaces (not pit or fissure) Method of Examination: -Direct vision~ dry surface for vision -Dull probe to distinguish demineralization~ whether rough or hard and unbroken -Areas may be sensitive to touch
What terms are used to describe the gingiva in terms of color, shape, form, consistency/tone, texture, and bleeding points in healthy gingiva?
Color Signs of Health -Pale pink, coral pink, salmon pink: Darker in people with darker complexions due to melanin pigmentation Changes in Disease -In chronic inflammation: dark red, bluish red, magenta, or deep blue. -In acute inflammation: bright red. Size Signs of Health -Free gingiva: flat, not enlarged, tight; fits snugly around the tooth. Changes in Disease -Become enlarged, swollen -May be localized or limited to specific areas or generalized throughout the gingiva. -Enlargement from Drug Therapy Shape (Form or Contour) Signs of Health -Free Gingiva: Follows a curved line around each tooth (Scalloped); may be straighter along wide molar surfaces. -The margin is knife-edged or slightly rounded on facial and lingual gingiva; closely adapted to the tooth surface. -Papillae: Facial and lingual gingiva are pointed or pyramidal papillae with a col area under the contact between adjacent teeth. Changes in Disease -Free gingiva: rounded or rolled margin (turtle neck). -Papillae: blunted, flattened, bulbous, cratered Consistency Signs of Health -Firm when palpated with the side of a blunt instrument (probe). -Attached gingiva is bound down firmly to the underlying bone. Changes in Disease -Soft, spongy gingiva dents readily; firm, hard tissue resists. -Soft, spongy gingiva: Related to acute stages of inflammation with increased infiltration of fluid and inflammatory elements. -The tissue appears red, may be smooth and shiny with loss of stippling. •Tissue may be friable or thin and fragile. •Has marginal enlargement and bleeds readily on probing. Surface Texture Signs of Health -Free gingiva: smooth. -Attached gingiva: stippled (minutely "pebbled" or "orange peel" surface). -Interdental gingiva: The free gingiva is smooth; the center portion of each papilla is stippled. Changes in Disease -Inflammatory changes: may be loss of stippling, with smooth, shiny surface. -Hyperkeratosis: may result in a leathery, hard, or nodular surface. -Chronic disease: Tissue may be hard and fibrotic, with a normal pink color and normal or deep stippling. Position Signs of Health -For the fully erupted tooth in an adult, the apparent position of the gingival margin is at the level of, or slightly below, the enamel contour or prominence of the cervical third of a tooth. Changes in Disease -Effect of gingival enlargement: When the gingiva is enlarged, the gingival margin is coronal to the CEJ, partly or nearly covering the anatomic crown. Medication Bleeding Signs of Health -Healthy gingival tissue does not bleed during periodontal probing. Changes in Disease -Sulcular epithelium becomes a diseased pocket epithelium. -The ulcerated pocket wall bleeds spontaneously or during periodontal probing. Bleeding on probing (BOP) Exudate (Puss) Signs of Health -There is no exudate (puss) in health. Changes in Disease -Increased GCF in presence of inflammation with flow rate increasing as periodontal disease progresses. -Suppuration (or pus) is another indicator of active periodontal breakdown and may be seen in about 25% of patients with chronic periodontitis.
Angles Class II Occlusion
Distoclusion •Class II or distoclusion •Mandibular teeth posterior to normal position in their relation to the maxillary teeth. •Facial profile: Retrognathic; maxilla protrudes; lower lip is full and often rests between the maxillary and mandibular incisors; the mandible appears retruded or weak (retrognathic). •Molar relation: the buccal groove of the mandibular first permanent molar is distal to the mesiobuccal cusp of the maxillary first permanent molar by at least the width of a premolar. •*When the distance is less than the width of a premolar, the relation should be classified as "tendency toward Class II." •Canine relation: the distal surface of the mandibular canine is distal to the mesial surface of the maxillary canine by at least the width of a premolar. 2 DIVISIONS- SEE PICTURE- DIVISION 1 THE MAXILLARY INCISORS ARE PROTRUED. DIVISON 2 THE MAXILLARY INCISORS ARE RETRUDED
Lymph nodes
E/O -Check for Enlarged/tender/mobile •Pre/Post Auricular •Submental •Submandibular •Tonsils •Occipital •Superficial Anterior Cervical •Deep Cervical •Cervical •Use Bimanual Palpation and Bidigital to evaluate •Utilize bimanual & bilateral palpation •Assessing for: •Adenopathy - swelling •Lymphadenopathy - swelling •Induration - hard •Tenderness - pain •Just touching areas should not be painful
Labial zones
E/O -Looking for cancer and herpes
Face and Skin
E/O •Facial asymmetry (stroke or bels palsy) •Lesions •Scars •Expression/paralysis •Skin •Bruises/trauma/swelling (domestic violence potentially, or cosmetic procedures) •Color changes/suspected lesions/ growths
Salivary Glands
E/O •Parotid •Submandibular -Sublingual •Utilize bimanual & bilateral palpation •Assessing for: •Adenopathy - swelling •Lymphadenopathy - swelling •Induration - hard •Tenderness - pain •Just touching areas should not be painful
Thyroid
E/O •Utilize bi digital •Ask the patient to "swallow" to identify where the thyroid is •Swallowing issues •Thyroid gland •Enlarged (size) •Uneven •Lump or bump
TMJ
E/O •Utilizes bilateral palpation •Utilizes auscultation •Gathers subjective information •Assessing for: •Tenderness/discomfort •Limitations or restricted opening •Deviations (left to right) •Crepitation or crepitus (popping and cracking) •Subluxation •We do not pop back into place the jaw if it gets locked (hazard for fingers to bit)
Eye
E/O •color of sclera •pupil size. Are they constricted or dilated? (drug use, and medical issues) •protrusion of eyeballs •presence of glasses/contacts
What are you looking for when you evaluate the floor of the mouth? Be able to name landmarks and spell them.
Floor of the Mouth -Tongue •Assess: •Dorsal surface •Ventral surface •Lateral borders •Base -Lingual Tonsils -Foliate Papilla -Fungiform -Circumvallate -Filiform •Assess for: •Shape/size •Surface characteristics (geographic (looks like a map), fissuring, coating) •Ankyloglossia (tongue tied) •Lesions •Utilize: -digital & bimanual palpation •Assess: •Ventral tongue surface -Taste buds •Base of tongue -Plica fimbriate •Sublingual Folds •Lingual frena •Salivary duct openings •Warton's Duct -Ranula (blocked salivary gland) •Lingual Caruncle •Assess for: •Lesions •Tori •Mandibular Tori •Induration (Hard areas)
What are the furcation grades/classes?
Furcation involvement is usually classified by the amount of bone destroyed in the furcation area. The most common classification is the Glickman furcation grades and include: •Grade I: early, beginning involvement. A probe can enter the concavity of the furcation but the bone between the roots (interradicular) is intact. •Grade II: moderate involvement. Bone has been destroyed to an extent that permits Nabers probe to enter the furcation area between the roots but not extend all the way through to the opposite side. •Grade III: severe involvement. A probe can be passed between the roots through the entire furcation. •Grade IV: Same as grade III, with exposure resulting from gingival recession, especially after periodontal therapy.
Describe what the Dentrix periodontal charting line labels represent (GM,PD,MGJ) Use the homework assignment to study for this one.
GM= Gingival Margin (recession) PD= Pocket Depth FG= Furcation MGJ= Mucogingival Junction Bld=Bleeding upon probing PMB=Mobility
Hard Deposits
Hard Deposits Calculus: Mineralization •Calculus formation is affected by factors such as salivary flow, salivary supersaturation with calcium phosphate salts, and inhibitors and promoters of calculus formation. •Supersaturation of saliva and plaque biofilm is the driving force for mineralization. (some people it's a matter of days) •Calculus inhibitors for supragingival calculus include pyrophosphate and zinc salts. •Calculus promoters include urea and silicon. Structure of Calculus •Calculus forms in layers, parallel with the tooth surface. •The layers are separated by lines that appear to be pellicle deposited over the previously formed calculus, and as mineralization progressed, the pellicle became imbedded. Formation Time •The average time required for the primary soft deposit to change to the mature mineralized stage is about 12 days. •Microorganisms in the biofilm layer covering calculus perpetuate the inflammatory state supragingivally and subgingivally. •With its rough surface, permeable structure, and porosity, calculus acts as a reservoir for endotoxins and tissue breakdown products. •The biofilm in contact with the diseased pocket epithelium promotes gingivitis and periodontitis. •Irritation to the pocket lining stimulates greater flow of gingival sulcus fluid, which contains minerals for subgingival calculus formation. •Calculus is composed of inorganic and organic components and water. •The percentages vary depending on the age, hardness of a deposit, and location of the calculus. •Major Inorganic Components •The main components are calcium (Ca), phosphorus (P), carbonate (CO3), sodium (Na), and magnesium (Mg). •Crystals •At least two-thirds of the inorganic content of calculus is crystalline, principally apatite. •The predominant form is hydroxyapatite, which is the same crystal present in enamel, dentin, cementum, and bone. •Organic Components (pores and a good environment for bacteria) •The organic proportion of calculus consists of various types of microorganisms, desquamated epithelial cells, leukocytes, and mucin from the saliva. •Mature calculus has approximately 70% to 80% inorganic content •The difficulty of distinguishing calculus from cementum or dentin when scaling subgingivally, and the modes of attachment of calculus to the tooth surface.
How does a correct instrument grasp contribute to probe adaptation?
Having the proper instrument grasp allows the clinician to rotate and adapt the probe correctly. Also important to have a very light grasp on the probe. •A pressure exerted with the probe tip against the soft tissue base of the sulcus or pocket should be between 10 and 20 g. •The probe tip is kept in contact with the tooth surface throughout the walking stroke. •Probe is correctly positioned parallel to the long axis of the root surface. "Parallelism" •This probe is correctly positioned parallel to the long axis of the root surface. At contact areas: •Slant the probe slightly so that the tip reaches under the contact area. •In this position, gently press downward to touch the soft tissue base.
List indications for rubber cup polishing. List contraindication for rubber cup polishing.
Indications •Selective Polishing •Polish stained tooth surfaces •Polish biofilm (debridement with instruments and limiting the need for polishing) •Prepare Teeth for Caries Prevention •Sealants (for better bond) •Fluoride application Contraindications -Lack of debris -Polishing is contraindicated for tooth surfaces that either have no stains or biofilm. (only the surfaces that need polishing) -Exposed Cementum or Dentin -Areas of exposed cementum (due to tissue recession) or exposed dentin should not be polished. -Polishing removes significant amounts of these structures. -Polishing should be limited to enamel surfaces. -Restored Tooth Surfaces -Restorative materials are not as hard as enamel and therefore are scratched easily by abrasive pastes. (special pastes or don't polish at all) -Air-powder polishing can scratch, erode, pit, or result in margin leakage.
Angles Class I occlusion (Normal and Malocclusion)
Malocclusion Facial profile. Same as normal occlusion. •Molar relation. Same as normal occlusion. •Canine relation. Same as normal occlusion. Malposition of individual teeth or groups of teeth. •General types of conditions that frequently occur in Class I: •crowded maxillary or mandibular anterior teeth. •Protruded or retruded maxillary incisors. •Anterior crossbite. •Posterior crossbite. •Mesial drift of molars resulting from premature loss of teeth. •To move to the next class the occlusion has to be off by the width of a premolar (that patients)
Angles Class III Occlusion
Mesioclusion -Molar relationship: buccal groove of the mandibular first permanent molar is mesial to the mesiobuccal cusp of the maxillary first permanent molar by at least the width of a premolar.
What is the name of the instrument stroke used when periodontal probing? For exploring?
Probe Walking Stroke -The side of the tip of the probe is held in contact with the tooth. From the base of the pocket, the probe is moved up and down in 1- to 2-mm strokes as it is advanced in the direction indicated by the blue arrow in 1-mm steps. -The attached periodontal tissue at the base of the pocket is contacted on each down stroke to identify probing depth in each area. Explorer Assessment Stroke
When would we postpone a dental appointment?
Recognize a need for postponement of the current appointment because of evidence of communicable disease or in deference to the need for urgent medical consultation.
How is primary dentition occlusion different and the same to adult occlusion?
Normal Occlusion •Same as permanent dentition. •The mesiobuccal cusp of the maxillary second primary molar occludes with the buccal groove of the mandibular second primary molar. Malocclusion of the Primary Teeth •Same as permanent dentition 2nd molars not 1st molars.
FACIAL PROFILES
Retrognathic- Over bite Mesognathic- Normal Prognathic- Under bite
If you want to accurately probe an entire tooth, how many readings will you measure?
Six
Describe the technique for periodontal probing.
Start in Zone 1 Step 1 •Insert at the distofacial line angle. •Keep the side of the probe in contact with the tooth surface. •Gently slide to touch the soft tissue base. Step 2 •Keep the tip in contact with the tooth, pressing down to touch the soft tissue base. •Initiate a series of short, bobbing strokes toward the distal surface. Step 3 •Walk the probe onto the distal surface until it touches the contact area. Step 4 •Tilt the probe so that the tip reaches beneath the contact area. •Gently press downward to touch the soft tissue base of the sulcus/pocket. Step 5 •Technique check: •Tilt the probe so that the tip reaches beneath the contact area. •Press down against the soft tissue and take a reading. Go to Zone 2 Step 6 -Prepare to access zone 2, the facial surface from distofacial line angle to mesiofacial line angle Step 7 •Make a series of tiny walking strokes across zone 2—the facial surface. Locate Zone 3 Step 8 •Reinsert at the mesiofacial line angle in preparation for assessing the mesial surface. Step 9 •Walk the probe onto the mesial surface until it touches the contact area. Step 10 •Take a measurement beneath the contact area. •Tilt the probe and press down gently.
Gingival margin
The rolled border or crest of tissue surrounding the crown portion of each tooth.
Oral cancer is most often found in what sex, age group, location in the mouth?
•(HPV Cancers are high on the charts)#1 Tongue, #2 Floor of the Mouth, #3 Lip -Men at a high risk Severity •floor mouth > tongue > lip •95% of cases > 40 years of age •52%, 5 year survival rate •More than 30,000 cases annually •squamous cell carcinoma most common
What are the most common oral sites to find squamous cell carcinoma?
•A flat or slightly raised whitish discoloration of the lip. •A sore that won't heal (always follow up on this). •Tingling, pain or numbness of the lips or the skin around the mouth To protect your lips, wear lip balm with SPF every day, even on cloudy days!
What is the depth of a healthy gingival sulcus?
•A healthy sulcus is 1 to 3 mm in depth. •The probe tip touches the tooth near the CEJ.
What are the instrument characteristics of a probe? How does it compare with scalers and curettes or to the explorer?
•A probe is a slender instrument with a smooth, rounded tip designed for examination of the depth and topography of a gingival sulcus or periodontal pocket. •A probe has three parts: the handle, angled shank, and working end, which is the probe itself. •Materials •Stainless steel. •Plastic: for screenings and titanium implant probing. •Straight working end: •Tapered, round in cross section with a smooth, rounded end. •Calibrated in millimeters at intervals specific for each kind of probe; some have color coding. •Curved working end: Paired furcation probes have a smooth, rounded end for investigation of the topography and anatomy around roots in a furcation. Examples are the Nabers 1N and 2N probe •Assess the Periodontal Status for Preparation of a Treatment Plan •Determine Clinical Attachment Level •Conduct Mucogingival Examination •Make Other gingival or tooth •Guide Treatment •Evaluate Success and Completeness of Treatment •Evaluation at Continuing Care and Periodontal Maintenance Appointments •Measure oral findings A: Williams (1-1-1-2-2-1-1-1) B: Williams, color-coded C: Goldman-Fox (1-1-1-2-2-1-1-1) D: Michigan O (3-3-2) E: Hu-Friedy or Marquis color-coded (3-3-3-3 or 3-3-2-3) F: Hu-Friedy UNC 15 (each millimeter to 15), color-coded at 5-10-15.
What is the purpose of taking periodontal probe readings?
•Probing: the act of walking the tip of a probe along the base of a sulcus or pocket for the purpose of assessing the health status of the periodontal tissues •In health, the probing depth is between 1 and 3 mm. •In disease, the probing depth is greater than 3 mm.
Identify the changes in patterns in biofilm microorganisms as biofilm matures over time in days. (Prepare for an ordering question).
•Although there is significant variability between individuals in the pattern of dental biofilm development, the changes in oral flora follow a general pattern. The formation of dental biofilm may vary by days of accumulation. (depends on the stage its in) •With undisrupted biofilm for approximately 7 days, negative anaerobic bacteria growth is favored, which increased risk for dental caries and gingivitis, and eventually other inflammatory periodontal diseases causing bacteria increase. (3 to 4 days can cause gingival distruction) Days 1-2 •Early biofilm consists primarily of gram-positive cocci. •Streptococci, which dominate the bacterial population, include Streptococcus mutans (caries) and Streptococcus sanguinis ( bad for infective endocarditis) (heart valve being destroyed). •The best time for oral hygiene! Days 2-4 •The cocci still dominate while increasing numbers of gram-positive filamentous form and slender rods join the surface of the cocci colonies along with more leukocytes. •Gradually, cocci adhere to the filamentous bacteria in a "corn cob" appearance and this is when the bacteria secrete EPS. •Dental biofilm is said to have matured by 72 hours and is capable of initiating the inflammatory process. Days 6-10 •Filaments increase in numbers, and a mixed flora appears comprised of rods, filamentous forms, and fusobacteria with heavy accumulations of leukocytes. •Gram-negative anaerobic bacteria (prefer no O2) such as Porphyromonas gingivalis, spirochetes, and vibrios proliferate. •The EPS secreted by the bacteria lead to development of a well-organized three-dimensional structure of the biofilm. Days 10-21 •Inflammation is clinically evident in 10 to 21 days. •Host Response •Host response refers to the way an individual's immune response interacts with bacteria to resolve inflammation. •Bacteria initiate an inflammatory response in periodontal disease and in susceptible individuals the body's immune response becomes chronic resulting in tissue destruction.
Attached gingiva is bound to what underlying tissues?
•Attached Gingiva is the part of the gingiva that is tightly connected to the cementum on the cervical-third of the root and to the connective tissue cover of the alveolar bone. -Periodontal ligament fibers: surround the root; one end attaches to the alveolar bone, the other to the cementum of the root •The attached gingiva extends from the base of the sulcus or pocket to the mucogingival junction.
Describe how to determine midline deviation
•Based on #8 and 9, #24 and 25 •Midline of MAXILLA and MANDIBLE (which way mandible is going because the maxilla is stationary) •Ask patient to "close teeth and bite normally on your back teeth" •Measure deviation or shift •Normally based on MANDIBLE (which direction did the MANDIBLE shift?) Put your probe between 8/9 at the 12 o'clock position and look. •Example of notation: 2mm to the Right
What are the three Angles Occlusal classification? How do you determine these using the anatomy?
•Class I •Class II -Class III •Principles of Edward H. Angle - 1900's •Normal relations of the occlusal inclined planes of the teeth when the jaws are closed
Gingival Description summary
•Color, size, shape, consistency, surface texture, position, MGJs, bleeding, and exudate.
Soft Deposits
•Dental biofilm •The matrix is composed of polysaccharides, proteins, and other compounds; it acts to protect the biofilm from the host's immune system and antimicrobial agents. •The microcolonies are separated by a network of open water channels that supply nutrients deep within the biofilm community. •The three-dimensional structure of biofilms enhances their ability to communicate with each other, adapt, and respond to their environment. •Adheres to the pellicle coating on all hard and soft oral structures, including teeth, existing calculus, and fixed and removable restorations. •Acquired enamel pellicle -The pellicle begins to form and is fully formed within 30 to 90 minutes. •Pellicle can begin as soon as tooth surface is cleaned. •Composition: •Primarily glycoproteins, selectively adsorbed by the hydroxyapatite of the tooth surface. •Protein components are derived from the saliva, oral mucosal cells, gingival crevicular fluid (GCF), and microorganisms. •Salivary proteins have a high affinity for the hydroxyapatite tooth surface and initiate the process of pellicle formation. •Microbial (bacterial) biofilm •Dental biofilm consists of a complex mixture of microorganisms in microcolonies. The microbial density is very high and increases as biofilm ages and matures. •The potential for the development of dental caries and/or gingivitis increases with more microorganisms, especially as the numbers of pathogenic microorganisms outnumber the nonpathogenic microorganisms. (antibiotics are bad for this reason because everything is wiped away) •Materia alba •Clinical Appearance and Content •Materia alba is a soft, whitish tooth deposit that is clinically visible without application of a disclosing agent. It may have a cottage cheese-like texture and appearance. -Composition: •Materia alba is an unorganized accumulation of living and dead bacteria, desquamated epithelial cells, disintegrating leukocytes, salivary proteins, and food debris. This differentiates it from organized oral biofilms. •Prevention •Materia alba can be removed with a water spray, oral irrigator, or tongue action, whereas only the surface organisms of biofilm can be removed. (better the care the better) •Food debris •Collection at cervical third and proximal embrasures •Vertical food impaction •Contributes to general unsanitary condition and initiation of dental caries and oral malodor.
What terms/descriptors should you be using when evaluating the physical characteristics of a lesion of the head and neck?
•Elevated/depressed/flat •Single/multiple •Location/unilateral or bilateral (where?- use landmarks) •Size (use probe) •Color (uniform color, multiple colors) •Surface characteristics (has a hair sticking out) •Fixed (skin tag)/mobile (swollen lymph node) Crust: An outer layer, covering, or scab that may have formed from coagulation or drying of blood, serum, orpus, or a combination. Erythema: Red area of variable size and shape. Exophytic: Growing outward. Indurated: Hardened. Papillary: Resembling a small, nipple-shaped projection or elevation. Petechiae: Minute hemorrhagic spots of pinhead to pinpoint size. Pseudomembrane: A loose membranous layer of exudate containing organisms, precipitated fibrin, necrotic cells, and inflammatory cells produced during an inflammatory reaction on the surface of a tissue. Polyp: Any mass of tissue that projects outward or upward from the normal surface level. Punctate: Marked with points or dots differentiated from the surrounding surface by color, elevation, or texture. Torus: Bony elevation or prominence usually found on the midline of the hard palate (torus palatinus) and the lingual surface of the mandible (tori) in the premolar area. Verrucous (verrucose): Rough, wartlike. •Elevated Lesions •Blisterform "Fluid filled" •Vesicle •Pustule •Bulla •Nonblisterform "Hard" •Papule •Nodule •Tumor •Plaque -Depressed Lesions •Ulcer •Loss of continuity of epithelium •Erosion •Shallow •Does not extend through epithelium to underlying tissue -Flat Lesions •Macule •Circumscribed •Not elevated above surrounding skin or mucosa •Identified by color and border
Define selective polishing
•Selective Polishing •Polish stained tooth surfaces ONLY •Polish biofilm ONLY (debridement with instruments and limiting the need for polishing) -NO NEED TO POLISH AREAS THAT DON'T HAVE STAIN! •Historically, all teeth were polished at the completion of the oral prophylaxis. •Many adult patients mistakenly believe that the polishing procedure rather than the periodontal instrumentation is the therapeutic part of an oral prophylaxis. •The American Dental Hygienists' Association recommends selective polishing because of risk of enamel removal and lack of documented therapeutic value. Today, researchers agree that coronal polishing is not necessary on a routine basis if not needed. • Over time, polishing can remove tooth structure causing morphological changes in the teeth. (if used incorrectly) (expose dentin and recession) •At best a cosmetic procedure with no health benefits, biofilm removal can be useful. •At worst, it is a procedure that damages the tooth surface.
What is used to classify mobility? What are the stages of Mobility?
•Horizontal mobility is the ability to move the tooth in a facial-lingual direction in its socket. -Using the ends of two handles, gently apply alternating pressure against the tooth, first from the facial and then from the lingual aspect. •Vertical mobility is the ability to depress the tooth in its socket. •Use the end of an instrument to exert gentle pressure against the occlusal surface or incisal edge of the tooth. Class 1 -Slight mobility, up to 1 mm of horizontal displacement in a facial-lingual direction. Class 2 -Greater than 1 mm but less than 2 mm of horizontal displacement in a facial-lingual direction. Class 3 -Greater than 2 mm of horizontal displacement in a facial-lingual direction or vertical mobility. 1.The use of wooden tongue depressors or plastic mirror handles is not recommended because of their flexibility. 2.Testing with the fingers without the metal instruments can be misleading because the soft tissue of the fingertips can move and give an illusion of tooth movement. 3.Apply specific, firm finger rests (fulcrums): A standardized finger rest pressure contributes increased consistency to the determinations. 4.Apply the blunt ends of the instruments to opposite sides of a tooth, and rock the tooth to test horizontal mobility. Keep both instrument ends on the tooth as pressure is applied first from one side and then the other. 5.Test vertical mobility (depression of the tooth into its socket) by applying pressure with one of the mirror handles to the occlusal or incisal surface.
Define acquired pellicle and discuss the significance and role of the pellicle in the mouth. (Possible short written question)
•Immediately upon exposure to saliva after eruption or after all soft and hard deposits have been removed from the tooth surfaces (such as by rubber cup or air polishing), the pellicle begins to form and is fully formed within 30 to 90 minutes. •Composition: •Primarily glycoproteins, selectively adsorbed by the hydroxyapatite of the tooth surface. •Protein components are derived from the saliva, oral mucosal cells, gingival crevicular fluid (GCF), and microorganisms. •Salivary proteins have a high affinity for the hydroxyapatite tooth surface and initiate the process of pellicle formation. Significance •The pellicle plays an important role in the maintenance of oral health: •Pellicle can begin as soon as tooth surface is cleaned. •Protective: •Pellicle appears to provide a barrier against acids, impacting remineralization and demineralization. •Lubrication •Pellicle keeps surfaces moist and prevents drying, which in turn enhances the efficiency of speech and mastication. •Nidus (breeding place) for bacteria •Pellicle participates in biofilm formation by aiding the adherence of microorganisms. •Attachment of calculus •One mode of calculus attachment is to the pellicle.
Describe the 4 methods that can be used to examine the periodontium attachment besides pocket depth?
•Mobility is the loosening of a tooth in its socket. •This may result from loss of bone support around the tooth. 3 Classes of Mobility. -Horizontal Mobility -Vertical Mobility •Fremitus means palpable vibration or movement. •In dentistry, fremitus refers to the vibratory patterns of the teeth. A tooth with fremitus has excess contact, possibly related to a premature contact. Usually, the tooth also demonstrates some degree of mobility because the excess contact forces the tooth to move. •Because fremitus depends on tooth contact, determination is made only on the maxillary teeth. -Gingival Recession •The level of the gingival margin "Recession" can change over time in response to trauma, medications, or disease. •Measure and record the amount of gingival recession. •Remember that if the gingiva is receded in an area, then the alveolar bone in that area has also been lost. •Measure the distance from the gingival margin to the CEJ. 1.Position the tip of the probe at a 45-degree angle to the tooth. 2.Slowly move the probe tip along the tooth until you detect the CEJ. 3.Record the distance between the gingival margin and the CEJ. Attached Gingiva -The part of the gingiva that is tightly connected to the cementum on the cervical-third of the root and to the connective tissue cover of the alveolar bone. -Calculate by: Step 1-Measure the total width of the gingiva from the gingival margin to the mucogingival junction. Step 2-Measure the probing depth. Step 3-Calculate the width of the attached gingiva by subtracting the probing depth from the total width of the gingiva. Furcation •A furcation is the place on a multirooted tooth where the root trunk divides into separate roots. •Furcation involvement is a loss of alveolar bone and periodontal ligament fibers in the space between the roots of a multirooted tooth. •Bone loss in the furcation area may be hidden beneath the gingival margin, or may be visible with recession. •Using knowledge of the anatomy of the multirooted teeth, use a furcation probe, such as the Nabers 1N or 2N probe, to walk around the area sulcus to identify the entrance to the furcation.
How do you describe in words Normal or Ideal occlusion?
•Normal occlusion is the ideal mechanical relationship between the teeth of the maxillary arch and teeth of the mandibular arch with an even bilateral distribution of occlusal forces between maxillary and mandibular arches that is symmetrical. (tooth is out of place and it will get worn down or get extra force) •Facial Profile •Mesognathic: slightly protruded jaws, which give the facial outline a relatively flat appearance (straight profile) (Figure 16-15). •Molar Relation •The mesiobuccal cusp of the maxillary first permanent molar occludes with the buccal groove of the mandibular first permanent molar. •Occlusal force is greater on the posterior teeth than on the anterior teeth. •Canine Relation •The maxillary permanent canine occludes with the distal half of the mandibular canine and the mesial half of the mandibular first premolar.
What is overjet and overbite and how to you determine these? What are the facial profile names associated with occlusion classifications?
•Overjet -Maxillary incisors are labial to the mandibular incisors. Measurable horizontal distance is evident between the incisal edge of the maxillary incisors and the incisal edge of the mandibular incisors. •One way to measure the amount of overjet is to place the tip of a probe on the labial surface of the mandibular incisor and, holding it horizontally against the incisal edge of the maxillary tooth, read the distance in millimeters. •Jets fly horizontal Overbite A: Normal overbite: incisal edges of the Maxillary teeth are within the incisal third of the facial surfaces of the mandibular teeth. B: Moderate overbite: incisal edges of maxillary teeth are within the middle third of the facial surfaces of the mandibular teeth. C: Severe overbite: the incisal edges of the maxillary teeth are within the cervical third of the facial of the mandibular teeth. •When the incisal edges of the mandibular teeth are in contact with the maxillary lingual gingival tissue, the overbite is considered very severe. BOTH GIVE THE FACIAL PROFILE Retrognathic
When does a healthy sulcus become a pocket?
•Periodontal pocket: a gingival sulcus that has been deepened by disease; depth is greater than 3 mm. •Gingival pocket is deepening of gingival sulcus caused by detachment of coronal portion of junctional epithelium and swelling of tissue •Periodontal pocket forms from apical migration of the junctional epithelium and destruction of periodontal fibers and bone •Probing depth is greater than 3 mm
Interdental papilla
•Portion of the gingiva that fills the area between two adjacent teeth apical to the contact area
Lymph Nodes
•Pre/Post Auricular •Submental •Submandibular •Tonsils •Occipital •Superficial Anterior Cervical •Deep Cervical •Cervical
Describe the different stages in biofilm formation. (Prepare for an ordering question)
•Stage 1—Formation •Biofilm formation begins with initial attachment of planktonic bacterial cells to the pellicle on the tooth surface (physicochemical). Happens within 24 hours. (not causing any problems) •Stage 2—Bacterial Multiplication and Colonization •Planktonic microorganisms attach themselves using cell adhesion structures such as fimbriae, pili, flagella, and adhesion proteins. •Microcolonies multiply in layers growing upward and outward, creating the three-dimensional aspect of biofilm structures. •With growth, colonies produce EPS to firmly attach in an irreversible manner; rough surfaces will result in more rapid irreversible attachment. •Stage 3—Matrix Formation •Extracellular polymeric substance (EPS) •Bacteria within the aggregate of cells continue to secrete EPS as bacteria multiply to form a matrix. Components of the EPS are: •Polysaccharides, glucans, and fructans or levans produced by certain bacteria within the community and from dietary sucrose. •EPS provides a scaffold to anchor the bacteria together increasing adherence to dental and other structures and provide protection as the bacterial community continues to grow. •Stage 4—Biofilm Growth •This stage is characterized by further development of the biofilm architecture to enhance the cell-to-cell communication process, also known as quorum sensing: •Activated by specific genes located on the surface of the bacterial cells within the biofilm. •The mass and thickness of biofilm increase as the bacteria multiply; if left undisturbed, bacteria continuously adhere to the biofilm community and surrounding surface area. •Stage 5—Maturation •Bacterial colonies mature and release planktonic cells to spread and colonize other areas within the oral cavity. (free floating bateria) •Bacteria disperse as single cells or in clumps. This causes free floating planktonic bacteria.
Recession
•The level of the gingival margin "Recession" can change over time in response to trauma, medications, or disease. -Common in periodontitis •Remember that if the gingiva is receded in an area, then the alveolar bone in that area has also been lost. •A positive (+) number = gingival recession
How should the probe be angled at the tooth surface?
•The probe tip is kept in contact with the tooth surface throughout the walking stroke. •Probe is correctly positioned parallel to the long axis of the root surface. "Parallelism" -60 to 70 degrees -Allows follow the angle of the tooth •This probe is correctly positioned parallel to the long axis of the root surface. What happens in the contact area •Walk the probe between the teeth until it touches the contact area. •Slant the probe slightly so that the tip reaches under the contact area. •In this position, gently press downward to touch the soft tissue base.
Free gingiva
•The unattached portion of the gingiva that surrounds the tooth •Surrounds the neck of the tooth in a turtleneck manner
How do you properly evaluate the TMJ?
•Utilizes bilateral palpation •Utilizes auscultation •Gathers subjective information Assessing for: •Tenderness/discomfort •Limitations or restricted opening •Deviations (left to right) •Crepitation or crepitus (popping and cracking) •Subluxation Place a hand on each side of the patients head just anterior to the external auditory meatus (using bilateral palpation) and ask the patient to open and close repetitively. Examine any deviations, popping, pain, or limitations of opening.
When periodontal probing, what technique is used to access the area directly beneath the contact area of the teeth?
•Walk the probe between the teeth until it touches the contact area. •Slant the probe slightly so that the tip reaches under the contact area into the Col space. •In this position, gently press downward to touch the soft tissue base. Proximal Surface Probing -A: Probe must be applied more than half way across from facial to overlap with probing from the lingual. -Under the contact is called the "Col" space. -B: Probe in area of crater formation. Probing is often deeper on the proximal surface under the contact area than on the facial or lingual surfaces.
