Preventive Exam Ch 26-28
In your own words, outline at least six of the dental hygienist roles in planning patient care for caries management
1.Determine restorative needs 2.Determine areas requiring remineralization 3.Define a remineralization program 4.Assess and identify individual patient's risk factors 5.Determine protocols for patient education, remineralization, and prevention based on patient need 6.Interventions include oral hygiene instruction and biofilm elimination, placement of dental sealants, use of home and office fluorides, and education/counseling regarding dietary modifications
There has been a reduction in caries in the United States since 1945, attributed to the fluoridation of the water supplies in certain communities. Which of the following is the percentage reduction in caries found?
40%
Describe a tuft in the head of a toothbrush
A tuft is a cluster of bristles or filaments secured together in one hole in the head of the toothbrush
What 3 factors in tooth brushing are most likely to contribute to gingival recession or tooth abrasion?
Abrasive dentifrice Hard toothbrush bristles or filaments Use of any vigorous back and forth method of toothbrushing
Identify the acids produced during the metabolic process of the bacteria in dental biofilm
Acetic, lactic, formic, and propionic
The bacteria in the dental biofilm capable of metabolizing fermentable carbohydrates into acids
Acidogenic bacteria
List 4 specific situations that the dental hygienist would recommend an end tuft brush
Adaptable around and under prosthesis Can reach the lingual surfaces of the molars Can reach the distal surfaces of the most posterior teeth Teeth that are crowded together
When is toothbrush trauma most likely going to occur?
After the initial instruction in a new method of brushing
In your own words, describe an effective toothbrush handle
An effective toothbrush handle should be easy to grasp, light weight, and have strength. It should not slip or rotate during use and should not have sharp corners or projections
Your patient presents with a definitive carious lesion diagnosed by the dentist. What is the treatment plan for a definitive carious lesion?
Appoint for a restoration
A patient has asked you for advice in using a particular model of power toothbrush given to her as a gift. You have never heard of this type of power toothbrush. She has an appointment with the doctor for restorative work the following week. What should you recommend to this patient?
Ask the patient to bring the brush in at her next visit and research the manufactures's instructions prior to her return
What is the most widely accepted method of toothbrushing intended to remove dental biofilm adjacent to and directly beneath the gingival margin?
Bass method
CASE STUDY: When a patient presents with no dental caries, which of the following treatment options would not be recommended?
Be glad that the patient is caries free and leave well enough alone
Which of the following radiographs is the best choice to detect caries on proximal tooth surfaces?
Bitewing radiographs
When making suggestion regarding toothbrush selection, the dental hygienist should consider all of the following except one. Which is the exception?
Bleeding of the gingiva during brushing
Remineralizing tooth surfaces should not be scratched or altered in any way, Which of the following techniques would be the most acceptable way to detect coronal caries on a demineralized surface?
Blunt probe
Floss cuts and cleft can occur in the col area or on facial or lingual surfaces in the middle or side of a papilla. The cuts are caused by snapping floss through the contact area, by flossing with undue pressure against the attachment area, or from not curving the floss sufficiently around the tooth
Both statements are true
Which one of the following characteristics would be least desirable in a toothbrush?
Bristle or filament height of 21 mm
Saliva has many protective functions in the oral cavity. Which of the following is the most important protective property of saliva in the caries procesS?
Buffering of acids
How can you best gather data assess your patient's individual caries risk factors?
By your patients social and medical/dental history, oral health values, and success in changing habits. You can also assess your patients caries risk factors by interviewing the patient to gain information and food diaries
List 4 limitations of unwaxed floss
Can break more easily Frays easily More care is needed to prevent injury Can cut into the fingers during use
All of the following statements regarding dental caries are true except one. Which is incorrect?
Caries is an eradicated disease
Which of the following is not an effect of cleaning the tongue?
Contributes to increases xerostomia
The major stage in the dental caries process when minerals, primarily calcium and phosphorus, are removed from tooth structures by acids formed by acidogenic bacteria
Demineralization
An infectious disease of teeth caused by acidogenic bacteria with dissolution of enamel and dentin, which lead to coronal caries, and cementum and dentin, which lead to root caries
Dental caries
CASE STUDY: You have been asked by your employer to develop a caries management strategy that covers all of the patient's needs. Which of the following is not an objective for this caries management strategy?
Determine the patients' financial situation
List four factors that affect the stiffness or firmness of toothbrush filaments
Diameter Length Number in a tuft Angle of filaments
Who was issued the first patent for a toothbrush in the United States around the middle of the 19th century?
E.H.N. Wadsworth
Outline a protocol for remineralization that you can initiate when your patient has evidence of early carious lesion that do not yet require restorative treatment.
Eliminate all potential sources of bacterial infection-restore all cavities, place dental sealants, and control biofilm Encourage all family members to attain and maintain optimum oral health Identify and account for systemic diseases and medications that affect oral health Initiate daily personal decay prevention measures, fluoride use, and dietary modifications Include professional applications of chlorhexidine and fluoride treatments. Plan for appropriate maintenance to monitor caries control
The sequence in brushing for any method used should:
Ensure complete coverage for each tooth surface
The concave center of the col is easily accessible for toothbrushing and harbors very few microorganisms
False
Writing in 300 B.C. include description of diseases gums related to calculus and of complex preparation for the treatment on unhealthy mouths. Who was the author of these writing?
Hippocrates
Dental floss is most effective when a patient has:
Interdental papillae and no loss of attachment
List the 4 CAMBRA risk levels
Low Moderate High Extreme Risk
In a patient with advanced periodontitis, which teeth may have furcation areas on the proximal surface, making interdental biofilm removal difficult?
Maxillary first premolars
List 3 alterations in the appearance of gingival tissues that require you to recommend a different tooth brushing technique
McCall's festoon Gingival cleft Gingival recession
All of the following are mechanism of action of fluoride in the prevention of caries except one. Which of the following actions of fluoride is not associated with the prevention of caries?
Passes through diffusion channels to increase acid level
Acids are byproducts of metabolic processes. Which acid is not a byproduct of metabolic processes?
Phosphoric acid
All of the following are uses for a toothbrush except one. Which of the following is not an accepted use of the toothbrush for oral health care?
Polishing of restorations
An individual can be in the "high-risk" or "low-risk" category for development of dental caries. All of the following are low-risk factors in the development of dental caries for adults except one. Which one of the following is not low risk?
Poor manual dexterity
All of the following statements regarding power toothbrushes are true except one. Which is the exception?
Power brushes do not offer a great variety in the manner in which the bristles/head moves
List the four prevention interventions that are identified in the CAMBRA management guidelines
Radiographs Recall exam frequency Chemotherapy management Sealants
The rapidly progressive caries that occur in many teeth simultaneously. They are also called acute caries in contrast to chronic
Rampant caries
The healing process when minerals are redeposited in the demineralized tooth structure. This is accomplished by the protective factors of the saliva and the action of fluoride to inhibit demineralization and interfere with the enzymatic requirements of bacteria
Remineralization
Which of the following reasons for occlusal brushing would be the least desirable reason for this technique?
Remove biofilm deposits from the maxillary tuberosity
A habit, behavior, lifestyle, or condition that when present increases the probability of a disease occurring is a term often used in medical research. What fits this definition?
Risk factor
In what ways does the present of adequate saliva protect your patient against dental decay?
Saliva buffers acids and supplies calcium and phosphate ions to replace those dissolved from the tooth surface. Saliva is the source of fluoride transport to tooth surfaces.
List 5 benefits of waxed or expanded PTFE floss
Smooth surface to help prevent trauma Slides through contact areas easily Resists breakage or shredding Gives strength and durability
CASE STUDY: The reason the straight-line cuts appear are because Mr. Larsen:
Snaps floss through the contact area
List the 5 risk factor categories associated with CAMBRA guidelines for caries management.
Social history Medical history Use of fluoride Dietary habits Clinical/oral observations
Which of the following bacteria are the infectious organisms that colonize the teeth, help to form biofilm, and are responsible for the dental caries process?
Streptococcus mutans
List the types of fermentable carbohydrates
Sucrose Glucose Fructose Cooked starch
Which of the following recommendations would you least likely give to a patient experiencing toothbrush abrasion?
Suggest that the patient spend a longer time brushing his or her teeth
CASE STUDY: In order to better remove biofilm around the abutments, Mr. Larsen should use what interdental aid?
Super floss
List and define the three delivery method categories for oral irrigation
Supragingival irrigation is the delivery of the irrigation is at, or coronal to, the free gingival margin Marginal irrigation is the delivery of the irrigation is angled at, or apically to, the gingival margin Subgingival irrigation is the delivery of the irrigation is placed in the sulcus or pocket and may reach the base of the pocket, depending on its probing depth
Which of the following statements is true about the interdental anatomy?
The papillae are connected by a col
List 4 factors that influence the type of toothbrush selected for an individual patient
The patients ability and motivation The shape and status of the gingiva The position of the teeth The personal preferences of the clinician and patient
The use of nylon for toothbrush bristles began in 1938. World War 1 complications prevented Australian export of wild boar bristles so synthetic materials were substituted.
The statement is true, and the reason is false
In your own words, describe how the metabolic action of Streptococcus mutans and Lactobacillus bacteria contributes to the destruction of tooth structure and causes dental caries
These bacteria metabolize acid from the fermentable carbohydrates ingested by an individual. The acid passes into channels between enamel rods and dissolves calcium and phosphate minerals in the tooth structure. Streptococcus mutans are the most active in initial stages of demineralization and lactobacilli are more active during progression of the cavity
List 3 benefits of unwaxed floss
Thinner, which helps when contact areas are tight Nylon fibers spread and gives a wider surface for biofilm removal Makes squeaking sound to indicate thorough cleaning
The horizontal brushing method is not recommended for all of the following reasons except one. What is the exception?
This method allows greater coverage in a short amount of time
What is the purpose of discussing individualized caries risk assessment with each patient?
To provide information regarding individual oral problems To relate individual behaviors and lifestyles to caries control To encourage patient to apply knowledge and preventive methods to family To serve as a guide during management or a prevention plan
The loss of a tooth structure produced by a mechanical cause using excessive pressure with a hard-bristled toothbrush and an abrasive dentifrice
Toothbrush abrasion
A child can be at risk for dental caries as soon as tooth eruption begins, why?
Transmission of the streptococci can occur to the child from a close family member, primarily the mother, when the child is ingesting carbohydrates from the acid
An interdental brush is a better choice than dental floss when there are root concavities and floss cannot be curved to touch the concaved surface
True
Anatomically the epithelial covering in col area is thin, not keratinized, and therefore less resistant to infection
True
Changes in gingival height, irregularities of tooth position, concavities and grooves, and root surface morphology of the proximal surfaces make biofilm removal difficult
True
Interdental brushes are similar to bottle-brushes, with a wire in the middle to enhance insertion, and the brush head can be cylindrical or shaped like a Christmas tree with a point on one end
True
There are no limitations listed as to the effectiveness of waxed floss
True
When large proximal surface dental caries are present the use of a radiograph is necessary, not for detection, but for determining extension to pulp involvement.
True
When radiographic (Proximal surface) early dental caries are present, the lesion does not extend into dentin and the radiograph cannot reveal true depth because of tooth density
True
Flossing aid used when wide proximal spaces or around orthodontic appliances or fixed prothesis
Tufted floss
Posterior teeth have ___ papilla with a col, and anterior teeth have ______ papilla that forms a col under the contact area
Two, one
Describe the embrasure spaces
Type 1- interdental papilla fills the gingival embrasure Type 2- with slight to moderate recession of the interdental papilla Typer 3- with extensive recession or complete loss of the interdental papilla
Which of the following is not a suggestion to tell your patient regarding the care of toothbrushes?
Use only one brush for home and work to prevent cross-contamination
In your own words, describe how fluoride protects your patient against dental decay
When fluoride is present in the biofilm, it will pass through with the acid and increase fluoride on the lesion, preventing the dissolution of minerals. When the saliva flows over the biofilm, it neutralizes the acid. When the fluoride is contacted by the acid in the patient's diet, it changes to hydrogen fluoride. The fluoride interferes with the enzyme activity in the bacterial cell.
All of the following are considered fermentable carbohydrates except one. Which of the following is not a fermentable carbohydrate?
Xylitol
CASE STUDY: Your employer has decided to send the caries risk "Oral Health Check Sheet" to his patients and ask that they fill it out and bring it to their next appointment. This checkoff lists 10 questions associated with a patients caries risk. Is this a good choice by your employer and why?
Yes, this will be convenient for patients to complete at home and bring in
An interdental tip is indicated for a patient who has:
a biofilm accumulation at the gingival margin
When _________ is present an open cavity can be easily and directly observed, especially with air blast to clear loose biofilm and debris. Proximal areas may need radiograph for confirmation.
cavitation
The surface of the _______ white spot lesion is still smooth with a blunt instrument but will scratch or break with pressure or a sharp instrument
early
CASE STUDY: What are straight-line cuts n Mr. Larsen's gingiva?
floss cuts
A person with disability would use what flossing aid
floss holder
A patient with orthodontic or fixed prothesis would use what flossing aid
floss threader
The _________ of carbohydrates ingestion in your patients diet has a strong influence on the amount of acid produced and the extent of tooth destruction
frequency
____________ is the use of forced intermittent or steady stream of water for a cleansing or therapeutic purpose
hydrotherapy
The col area becomes deeper when:
inflammation lead to edema
The incidence of gingivitis is greatest in what area?
interdental tissues
During the initial caries infection the clinician will most likely observe dental biofilm and lesion is _______?
invisible
Flossing aid used with wide proximal spaces, mesial or distal of tooth with no contacting tooth
knitting yarn and gauze strip
The _______ white spot lesion shows white; may feel rough with blunt instrument
later
Planning patient interdental care begins with patient assessment, which provides all of the following information except:
motivation to perform the patients oral care routine
Toothbrushing adequately removes biofilm from all surfaces of the teeth except:
proximal
When teaching a patient to use floss, all of the following instructions should be given except:
snap floss through the contact area
Properties of unwaxed floss include:
squeaking sound when floss moves over clean tooth surface
The early ________ lesion is generally invisible
subsurface
Which interdental aid would be best to recommend to a patient with orthodontic appliances?
toothpick in holder
CASE STUDY: Mr.Larsen asks Eric what type of floss he should use to prevent further floss cuts. Eric should recommend:
waxed floss
When dried, the early white spot lesion will shop up ______ under a bright light
white
Floss is made of the following materials except:
wood filaments
