Senior Fall Clinic
Class V
- Caries affecting gingival one-third of facial or lingual surfaces of anterior or posterior teeth
What are the barriers to implement tobacco cessation intervention in the dental setting?
- Fast pace of the dental office/lack of time - Lack of knowledge in tobacco cessation techniques - Limited counseling experience of providers Many dental professionals feel unprepared to implement tobacco cessation interventions for a number of reasons, including lack of time, knowledge, and experience with tobacco cessation intervention techniques
Mandibular anterior crowding is associated with:
- Higher prevalence in root proximity - Increase in dehiscence and fenestrations - Thin bone plate
What are the risks associated with chewing tobacco use?
- Increased risk of nicotine poisonings - Developing recession - Increased risk of heart disease and stroke According to CDC, smokeless tobacco products can increase the risk of oral diseases, certain types of cancer, risk of death from heart disease and stroke, and cause nicotine poisoning in children.
What steps should be taken after an unsuccessful quit attempt?
- Set a new quit date. - Explore different pharmacologic adjuncts. - Recommend different coping strategies. The cessation counselor helps clients to identify what caused the slip or relapse and to think about what they can do to prevent a recurrence. If a full relapse has occurred, a new quit date must be set. Counselor and client should explore different pharmacologic adjuncts and coping strategies.
Nicotine addiction is characterized by
- continuous use despite harmful effects - pleasant (euphoric) effects. - developing tolerance to nicotine dose The hallmarks of nicotine addiction are compulsive use despite harmful effects, pleasant (euphoric) effects, difficulty with quitting, or controlling use.
8 Human Needs for Dental Hygiene.
1. Wholesome facial image 2. Protection from health risks 3. Biologically sound and functional dentition 4. Skin and mucous integrity of the head and neck 5. Freedom from head and neck pain 6. Freedom from stress and anxiety 7. Responsibility for oral health 8. Conceptualizing and problem solving
For how long should the water tubing for a powered device be flushed at the start of the day?
2 minutes
According to Black's classification, occlusal caries on cusp tips is an example of what class of caries?
Class VI
Which of the following definitions best describes the physical status classification of ASA III?
A patient with severe systemic disease
A 23 yo female patient presents with a significant history for a 5 pack-year history of smoking cigarettes, currently smoking half-a-pack per day. What ASA physical status classification is most appropriate for this patient?
ASA II
A 46 yo man presents for dental care. He is 5′11′′ and weighs 120 kg (BMI, 37). He has a history of Crohn's disease, controlled hypertension, and hyperlipidemia. His spouse reports that he snores loudly at night but has not had a sleep study. His vital signs are heart rate 76 beats/min, blood pressure 142/82 mmHg, respiratory rate 16 breaths/min, temperature 37°C. What ASA PS classification is most appropriate for this patient?
ASA II
A 53 yo woman who is 5'4" and 73kg (BMI 28) presents with controlled hypertension on metoprolol, a 20 pack-year smoking history, NIDDM with recent hemoglobin A1c of 10.6% and a blood glucose the day of dental care of 267 mg/dL. What ASA PS classification is most appropriate for this patient?
ASA III
Which of the following can directly harm the periodontal or gingival tissue?
Anterior crossbite
5 A's
Ask Advise Assess Assist Arrange
Missing teeth
Biologically sound and functional dentition
Which of the following is the most reliable indicator of sufficient gingival inflammation to cause pocket wall ulcerations that lead to bacteremia?
Bleeding gums?
Which of the following comorbidities, considered alone, will place the patient in an ASA physical status classification of ASA III?
Body mass index measured at 41 kg/m2
Advanced fulcruming techniques work well for clinicians who cannot master the standard intraoral fulcruming techniques. Advanced fulcruming techniques work well when the clinician is removing supragingival calculus deposits from the crown of a tooth.
Both statements are false.
Furcations are rarely encountered in shallow pockets. Usually the furcation entrance is located at least 7 mm apical to (below) the CEJ.
Both statements are false.
When selecting a powered instrument tip, the location of the calculus deposit is the only factor that needs to be considered. The high power setting is recommended for use with most powered instrument tips.
Both statements are false.
Sealant placement is contraindicated for placement over noncavitated carious lesions. Sealant placement over noncavitated carious lesions will cause the carious lesion to progress.
Both statements are false. Sealant placement is recommended over noncavitated lesions because they can prevent the progression of dental caries
All sealant materials have fluoride-releasing capabilities. The addition of fluoride to sealant materials is beneficial for arresting the progression of dental caries.
Both statements are false. Not all sealant materials release fluoride. The addition of fluoride to sealant materials has not been shown to arrest the progression of dental caries
A preprocedural rinse for the patient is recommended for powered instrumentation to reduce the number of bacteria introduced into the patient's bloodstream during instrumentation. A preprocedural rinse for the patient is recommended for powered instrumentation to reduce the number of bacteria in the airborne aerosols produced by powered instrumentation.
Both statements are true
People with uncontrolled or poorly controlled diabetes mellitus are more susceptible to infections, including periodontal diseases. People with diabetes mellitus whose disease under poor metabolic control have more severe periodontitis compared with those who are medically well controlled.
Both statements are true
A preprocedural rinse for the patient is recommended for powered instrumentation to reduce the number of bacteria introduced into the patient's bloodstream during instrumentation. A preprocedural rinse for the patient is recommended for powered instrumentation to reduce the number of bacteria in the airborne aerosols produced by powered instrumentation
Both statements are true.
Advanced fulcrums should be used selectively in areas of limited access. Advanced fulcruming techniques are not intended to replace the standard intraoral fulcrum.
Both statements are true.
Correct explorer adaptation for a root concavity involves rolling the instrument handle to adapt the leading-third of the explorer tip. This results in the middle- and heel-third of the explorer being rotated toward the adjacent tooth.
Both statements are true.
For calculus removal, a powered instrument is used in a series of tapping motions. For subgingival deplaquing, the lateral surface of a powered instrument is moved in a series of sweeping motions.
Both statements are true.
Periodontal disease is epidemic in the United States and elsewhere. The human need for skin and mucous membrane integrity of the head and neck is usually unmet in clients seeking dental hygiene care.
Both statements are true.
When instrumenting root surfaces, treat each root as a separate tooth. The toe of the curet can be used against the roof of the furcation on a mandibular molar.
Both statements are true.
Cigarette smoking increases the risk for failure of periodontal therapy and implants. Smokeless tobacco use can cause severe recession in the areas where it is placed.
Both statements are true. Oral effects of tobacco use (such as failure of periodontal therapy and implants) are listed in Box 37.2.
What is true about clear aligners (Invisalign)?
Clear aligners may be more convenient for patients to maintain good oral hygiene than conventional orthodontic brackets with wires
Each of the following is true about intensive tobacco cessation treatment programs EXCEPT one. Which is the EXCEPTION?
Counselor encourages clients to set up a quit day within a day or two. Clients should set up a quit day within 2 weeks to start taking medication and get ready (inform family and friends, get rid of tobacco, and stock up on oral substitutes).
Class II
Caires affecting proximal surfaces of molars and premolars
Lingual fixed retainer
Can be maintained clean if patients can brush and floss around it
Class IV
Caries affecting proximal including incisal angles of anterior teeth
Class III
Caries affecting proximal surfaces of central incisors, lateral incisors, and cuspids without involving the incisal angles.
Which mobility classification describes a tooth that can be moved more than 1 mm in any direction but is not despressible in the socket?
Class II
Karen plans to use a curet in a toe-up position to make horizontal strokes to instrument the distal concavity of the maxillary left first molar. Karen establishes her fulcrum on the occlusal surfaces of the maxillary right posterior teeth. What type of advanced fulcrum is Karen using?
Cross-arch fulcrum
One lower incisor is in an anterior crossbite, and therefore, is very proclined. What do you anticipate to see in front of the lower incisor in crossbite?
Dehiscence
What is the best way for the orthodontic patients to keep healthy teeth and gingiva?
Dentist, specialist, and hygienist collaborate to educate and monitor oral hygiene of patients
If a patient is taking biguanides (Glucophage), it is usually an indication that he or she is being treated for
Diabetes
Does self-ligating brackets always provide a better environment for improved oral hygiene as compared to conventional brackets (which requires elatomeric ties)?
No
Which of the following comorbidities, considered alone, will place the patient in an ASA physical status classification of ASA IV
ESRD not undergoing regularly scheduled dialysis
Your patient grinds his teeth at night. Which of the following materials would be indicated for use in this patient?
Filled sealants A filled sealant is better at resisting occlusal wear than an unfilled sealant because the filler particles strengthen the sealant material. Colored sealants enhance the visibility for the operator during placement and at recall appointments.
Halitosis
Freedom from stress
Which of the following sealant materials has the MOST fluoride releasing capability?
Glass ionomer cements All of the above sealant materials release some amount of fluoride but glass ionomer cements continue to release fluoride after the sealant is placed.
When removing calculus deposits with a powered instrument, what type of lateral pressure is recommended?
Light lateral pressure
The following statements are true of dental aerosols except:
Only large particles remain suspended for hours after a procedure
All of the following oral complications may be related to diabetes mellitus (DM) EXCEPT:
Oral cancer
All of the following are benefits from Silver Diamine Fluoride EXCEPT one, which one is the EXCEPTION?
Patient will need local anesthetic and drilling of the tooth structure.
Class I
Pits and fissures on the occlusal thirds of molars and premolars, occlusal two-thirds of molars and premolars, and lingual part of anterior teeth.
Rosa is using an extraoral fulcrum while instrumenting the distal surface of the maxillary first molar from the facial aspect. Rosa can adapt the cutting edge to the distal surface, but finds that she cannot apply sufficient lateral pressure against the distal surface to remove a calculus deposit. Which of the following advanced techniques would be most helpful in obtaining more lateral pressure against the distal surface?
Placing the index finger of her nondominant hand behind the instrument shank
On a powered instrument tip, which of the surfaces should never be adapted to the tooth surface because it could damage the tooth surface?
Point of the tip
After reviewing the complicated medical history and vital signs for your scheduled morning patient, you determine the patient to be ASA PS class IV. Which of the following is the most appropriate next action?
Postpone any dental treatment until medical condition improves to ASA III
The most optimal products for plaque control of orthodontic patients are (Select one)
Powered (electrical) tooth brushes
Transtheoretical Model
Precontemplation Contemplation Determination Planning Maintenance
Which of the following comorbidities, considered alone, will place the patient in an ASA physical status classification of ASA II?
Pregnant patient at 17 weeks since conception
Which of the following is MOST important for successful placement of resin-based sealants?
Prevention of salivary contamination Resin-based sealants are hydrophobic so the tooth must be completely dry when sealant is placed.
What type of dental hygiene care service is the placement of pit and fissure sealants?
Preventive Placement of pit and fissure sealants is a preventive strategy as they are placed to prevent dental caries. None of the other categories apply.
Concern about cost
Responsibility for oral health.
Bleeding on probing
Skin and mucous membrane integrity of the head and neck
Each of the following is a health risk due to hookah smoking EXCEPT one. Which is the EXCEPTION?
Skin cancer/melanoma Hookah smoking is associated with impaired pulmonary function, infertility, increased risk of transmitting infectious diseases, and increased risk of certain types of cancer but not skin cancer/melanoma.
Advanced fulcruming techniques increase tactile information to the clinician's fingers. Advanced fulcruming techniques facilitate access to the maxillary second and third molars
The first statement is false; the second statement is true.
During Gingival Curettage, the curette blade is inserted at a closed angle until contacting the epithelial junction. The instrument is only used in a horizontal direction with the blade open to 90 degrees.
The first statement is true and the second statement is false
Electronic cigarettes liquid has less toxic elements and therefore pose no risk of poisonings.
The first statement is true, the second is false. E-cigarettes are considered less harmful than traditional cigarettes due to fewer toxic elements but can cause poisonings as liquid has high concentration of nicotine and can be absorbed through the skin and cause nicotine overdose/toxicity.
Sealants can be either self-cured or light-cured. Self-cured sealants allow the clinician to have a longer working time because polymerization does not start until after the materials have been mixed.
The first statement is true, the second is false. Sealants can be either self-cured or light-cured depending on the sealant material. Self-cured sealants have a shorter working time as polymerization starts once the materials are mixed
With an intraoral fulcrum the handle is held in a modified pen grasp near the junction of the handle and shank. With an extraoral fulcrum the handle grasp is similar.
The first statement is true; the second statement is false.
Dental hygienists are often asked to explain the potential connection between gum disease and serious medical problems, because emerging evidence implicates periodontal infections as one of several important factors that exert negative effects on overall general health.
The statement is correct but the reason is NOT
What is the most appropriate statement for relationship between malocclusion and gingival health?
There is a significant positive association between mandibular arch crowding and pathologic probing depth and alveolar bone loss
Which of the following is true regarding primary prevention strategies?
They are designed to prevent disease. Primary prevention strategies prevent disease from occurring; secondary prevention strategies prevent disease from progressing.
Why is it important to identify and use non-tobacco oral substitute during the cessation process?
To deal with sensory aspects of addiction Puffing on a cigarette or having a dip of a specific size and texture in one's mouth provides oral gratification, which relates to the sensory aspect of nicotine addiction. Because of the sense this oral gratification provides, the use of nontobacco oral substitutes is important to the quitting process.
Patients being treated with fixed orthodontic appliances (braces) will have increased bleeding on probing, plaque index, gingival index.
True
Many tobacco users prefer quitlines to face-to-face programs because they provide anonymity.
True Many tobacco users prefer quitlines to face-to-face programs, because telephone and online counseling is more convenient and provides anonymity.
Dental hygienists are often asked to explain the potential connection between gum disease and serious medical problems, because emerging evidence implicates periodontal infections as one of several important factors that exert negative effects on overall general health.
Unknown
Which of the following is the BEST way to detect a noncavitated carious lesion?
Visual inspection Visual inspection is the best way to detect a noncavitated carious lesion. Bitewing radiographs detect interproximal decay, use of an explorer is not recommended as the pressure can cause a noncavitated lesion to cavitate, and disclosing solution highlights bacterial biofilm, not a noncavitated lesion
Presence of plaque biofilm and calculus
Wholesome facial image
One effective way to reduce the number of airborne organisms in the aerosols produced by a powered instrument is _____.
asking the patient to use an antimicrobial mouthrinse before treatment
The advanced fulcrum that allows the best instrumentation access in the distal concavity of the mandibular third molar using the curet in a toe-down position is the _____.
cross-arch fulcrum
Before inserting an instrument tip into the handpiece of a magnetostrictive ultrasonic device, the clinician should do all of the following except
drain the water from the water-filled handpiece
Sealants help prevent decay by
providing a physical barrier between the tooth surface, carbohydrates, and bacteria Sealants act as a physical barrier between the tooth surface, carbohydrates, and bacteria. Patients still need to perform effective oral hygiene and receive fluoride to prevent smooth surface caries and occlusal caries on teeth that are not sealed.
The vertical or "probe position" for the powered tip is used
when deplaquing deep periodontal pockets
