DH 340 Quiz

What are the five psychological therapies discussed in lecture?

1. Cognitive behavior therapy 2. Group therapy 3. Dialectical behavior therapy & family 4. Counseling interventions 5. Specific therapy programs for certain disorders

What are the four causes of mental illness as discussed in lecture?

1. Consequence of biological and environmental interactions 2. Environmental factor may create biological vulnerabilities 3. High chaos, low security and safety 4. Often associated with gender, age, family dynamics and socioeconomic status

List the five major chemicals found in tobacco.

1. Nicotine 2. Pesticides 3. Aldehydes 4. Ketones 5. amines

What are the three imported tobacco products mentioned in lecture, and how are they different?

1. Shisha- flavored tobaccos used in hookah 2. Kretek - clove cigarettes from Indonesia 3. Bidis - clove cigarettes from India a. Contain more nicotine, tar and carbon monoxide than regular cigarettes

Approximately what percentage of children ages 5-16 years have a recognizable mental disorder?

10%

According to the CDC, in 2010, how many adults smoked?

45.3 million

Mental Health disorders affect 1 in every ____ young people in the United States.

5

What are the two most prevalent disorders among adolescents?

Anxiety disorders and depression disorders

List the criteria for Major Depression:

At least FIVE of the following during the same 2 week period: • Depressed mood most of the day • Loss of interest or pleasure • Significant weight gain or loss • Insomnia or hypersomnia • Fatigue nearly every day • Feelings of worthlessness of excessive guild • Inability to concentrate or indecisive • Recurrent thoughts of death An organic factor did not trigger disturbance (such as family death) No delusions or hallucinations Not schizophrenic, delusional or psychotic

What potential damage can result from cheek piercings?

Damage to parotid duct May become injured through piercing process or through embedded jewelry over time Duct may begin to secret saliva that runs out of the piercing Damage is irreversible and decreases the amount of saliva Damage to facial nerve Leads to symptoms like bell's palsy, which can be irreversible

List the criteria for Dysthymia:

Depressed mood for at least 2 years Presence, while depressed, of two or more of the following: • Poor appetite • Insomnia or hypersomnia • Low energy or fatigure • Low self-esteem • Poor concentration • Feelings of hoplessness During the period the person has never been w/o symptoms for more than 2 months

What is ETS and what are other terms used in place of ETS?

Environmental Tobacco Smoke, Passive smoke, Second hand smoke, Secondary smoke

What is the healing time and placement if a tongue piercing?

Healing time: 4-8weeks Placement: confined to central groove of tongue and anterior to the lingual frenum

What is the healing time and placement of a labret or lip piercing?

Healing time: 6-8 weeks Placement: should be positioned so that the jewelry rests at a neutral angle to avoid recession and bone loss

What can happen if the piercing isn't located in the central groove of the tongue?

If placed too far laterally muscle damage may result

What are the risks associated with oral piercings?

Infection, prolonged bleeding, pain and swelling, chipped or cracked teeth, injury to gingiva, interference with normal oral function, blood-borne disease, endocarditis

Briefly discuss the following healing phases: Inflammatory, Proliferative, Maturation & Wound Remodeling

Inflammatory- differs from standard wound healing, success depend on maintain opening, instead of filling the wound the basal cells line the piercing canal to create a thick lining (4-6 weeks to form), to ensure lining forms leave jewelry in for 8 week Proliferative- epithelium in piercing canal begins to grown and thicken, canal become fully lined and sealed Maturation & Wound Remodeling- collagen come together to form scar tissue, canal isn't fully healed, may take months or years for canal to completely stabilize, hygiene is key component, quality jewelry can also help prevent infection

Briefly explain the metabolism of nicotine by smokeless tobacco.

Nicotine is directly absorbed through the gingiva and oral mucous membranes. Once the quid is placed in the mouth, the amount of nicotine absorbed is two to three times the amount delivered by a cigarette. Nicotine concentration declines over 2 hours. Smokeless tobacco users experience nicotine blood plasma levels similar to the nicotine blood levels of smokers. Most juice produced by smokeless tobacco is spit out. Juice that is intentionally and/or accidentally swallowed by the user is absorbed through the blood vessels lining the small intestine.

Please describe the role that each of the following plays in tobacco use:

Please describe the role that each of the following plays in tobacco use: • Tolerance o Physiologic adaptation  Refers to the user's need for more smoking or chewing as the build up a tolerance o Amount of use  Becomes less effective over time  To sustain positive feelings associated with use, more and more has to be taken in over time • Dependence o As increased amounts are needed, loss of control over amount and frequency reflects dependence o Nicotine intensifies the release of dopamine by the brain  Increases feeling of pleasure and compulsion to use tobacco o Positive reinforcement is produced with tobacco use o Withdrawal symptoms are produced by abrupt stopping • Addiction o Chronic, progressive, relapsing disease characterized by compulsive use of a substance o Effects results in physical, psychological and social harm to user o Smoking is more addictive than alcohol and drugs o Pattern of relapse is identical for tobacco, alcohol and heroin o Factos affecting development of addiction: family, peers, social acceptance, psychiatric disorders • Withdrawal o Effects of cessation of nicotine use by an individual who is dependent o If users stop abruptly, within 24 hours they will experience maximum withdrawal symptoms o Relapse within a week is not uncommon o Most symptoms decrease over a few weeks when a relapse does not occur o Cravings for tobacco, increased appetite, and weight gain may persis for months or years

Mental health is a term used to describe and discuss what?

Refers to psychological and emotional state used to discuss the following: • A positive state of psychological and emotional well-being and the conditions that foster it • The absence of mental illness • The presence of mental imbalance that affect psychological well-being

What are the two types of jewelry worn for lip piercings?

Ring-style or fishtail

What techniques are used for tongue splitting?

Scalpel used followed by a cauterizing pen

According to the "targeted activities" chart in the PowerPoint, what works and what doesn't work for the following? Self-esteem, coping, depression, ADHD, anxiety, conduct disorder, drug and alcohol abuse, and Multiple Internalizing and Externalizing Problems

Self-esteem: Promote connections between adolescents and their teachers and peers Don't use tricyclic antidepressants Coping: Teach general coping techniques and stress management Depression: Cognitive behavior therapy - don't use tricyclic antidepressants ADHD: Medication and psychological or behavioral therapy Anxiety: Cognitive behavior therapy and SSRI Conduct Disorder: Target prevention programs, prevent maternal smoking during pregnancy, encourage parents to be involve, teach youth to interpret social cues correctly, promote peer relationships that are positive Drug and Alcohol Abuse: School-based drug prevention programs, community-based family programs, alcohol-free activities outside of school, programs that use resistance strategies through peer leaders and adult encouragement Multiple Internalizing and Externalizing Problems: Promote school bonds and involvement of parents, help families move from high-poverty to low-poverty, promote healthy family functioning, intervene early

In Europe and North America, how have tattoos evolved?

Since 1960s changes in social status of tattoo art has led to considerable experimentation. Tattooing in women has quadrupled

Why does smoking cigars increase a person's risk of developing oral and esophageal cancers?

Smokers directly expose their lips, mouth, tongues, throat and larynges to tobacco, and cigars contain higher levels of toxins

Briefly describe tobacco's effects on developing Cancer.

Smoking is responsible for 87% of lung cancers in the United States and is the chief neoplastic cause of death in the United Kingdom. Lung cancer is the leading cause of death for both black and white men and women. Approximately 75% of oral cancers are related to smoking and the use of smokeless tobacco.

Which country meets the World Health Organization's goal of a 20% prevalence of smokers?

Sweden

What are the three piercing sites discussed in class?

Tongue, labret, cheek

What clinical considerations exist for each of the following piercing sites? (Tongue, Lip, Cheek)

Tongue- bone loss checks in man and max ant regions, periapical radiographs may be necessary, perio probing to determine any attachment loss Lip - difficult piercing to perform, abrasion and recession may occur on facial surfaces of man ant teeth Cheek- damage to facial structures

Briefly describe the toxicity of tobacco.

many chemicals are contained in passive smoke, including the same carcinogenic compounds as those in mainstream smoke. Some toxic components are actually in higher concentrations in sidestream smoke than in mainstream smoke. Chemicals present in ETS include irritants and systemic toxicants (hydrogen cyanide and sulfur dioxide), mutagens and carcinogens (benzopyrene and formaldehyde), and reproductive toxicants (nicotine, cadmium, and carbon monoxide)

Briefly explain the metabolism of nicotine by smoking.

nicotine enters the lungs and quickly passes into arterial circulation by way of blood vessels lining the sacs of the bronchi. Nicotine is delivered efficiently to the brain by the bloodstream in less than 20 seconds. It is metabolized in the liver into cotinine. Cotinine concentrations in the blood, urine, and saliva are used to assess (a) whether a person uses tobacco, (b) if so, to what extent, and (c) the level of exposure of nonsmokers to passive or environmental smoke. Peak plasma concentration of nicotine occurs approximately 10 minutes after the onset of smoking and rapidly declines over the next 20 to 30 minutes. Nicotine is spread to all body tissues. The smallest amounts of nicotine from tobacco smoke (one puff) will remain in the body for 8 to 12 hours.

List the aftercare consideration for oral piercings:

• Alcohol-free, anti-microbial rinse, multiple time daily for 30-60sec • Saline rinse • Ongoing home care instruction o Brush and floss o Gently clean tongue ring after eating

What risks are associated with tattoos?

• Allergic reactions to dye • Skin infections • Granulomas and keloid • Bloodborne disease • MRI complications

List and briefly describe the four aspects of appointment interventions.

• Assessment o Monitore medical and medication histories o Review consultations with medical/psychiatric specialists o Check for xerostomia • Approach o Provide positive reinforcement and reassurance - avoid negative and guild-inducing words o Show genuine interest • Preventive instruction o Dental biofilm control o Xerstomia  Fluoride  Saliva substitute  Alcohol-free OTC fluoride rinse • Implementation of care o Some medications may make patients photosensitive o Use local anesthesia o Provide FL after instrumentation o Use care to prevent postural hypotension

List the other disorder that may affect youth:

• Bipolar • Conduct disorder • Eating disorder • Attention-deficit/hyperactivity disorder • Childhood-onset schizophrenia • Autism • Learning disorders

What complications may occur from tongue splitting?

• Bleeding • Pain • Swelling • Nerve damage • Numbness • Increased salivary flow • Loss of taste

What factors should be considered when selecting the appropriate mental health therapy?

• Boys and young men prefer activity based support • Depend on developmental status and specific wishes of the parents and/or child • Medication should never be used as sole therapy

Name the four new smokeless tobacco products mentioned in the lecture. What do they resemble and what is the mechanism by which nicotine is absorbed.

• Camel sticks • Camel orbs • Camel strips • Camel snus • Nicotine is absorbed through the oral mucosa without chewing or spitting

Compare the levels of nicotine in smokeless tobacco, cigarettes, and cigars.

• Cigarettes 1.2mg-1.4mg nicotine • Cigars 5.9mg-335.2mg • Smokeless 4.4mg-25mg

What are the components of ADHD therapy?

• Combination of medication and psychotherapy • More effective than a single intervention method • Multi-component strategies that address family, peer, individual, neighborhood and school factors are best • Promoting strong family bonds, teaching social skills, and using social services

Describe externalizing disorders.

• Conduct disorder, ADHA, and alcohol and drug abuse • Expressions of overt deviant behavior over time • Include persistent aggressive or other deviant acts, constant inability to sit still and pay attention, or regular and frequent abuse of alcohol or drugs • Teen who begin early are at a greater risk • Stress, difficulty coping, deviance-prone attitude, lack of parental support, family dynamic, socioeconomic status and environments, and media all play a role

What are additional tips for patients to consider?

• Contact dentist or physician if signs of infection • Keep site clean and free of debris • Avoid clicking jewelry against teeth • Check tightness of jewelry • When playing sports, remove jewelry • Maintain good oral hygiene habits

Describe internalizing disorders.

• Expressed internally and reflect a troubled emotional state • Appear to have a genetic component • Females have a higher incidence • Negative self0esteem and introversion also increase likelihood • Parents are controlling

What should you consider when providing dental hygiene care?

• Goals should be to maintain oral health, comfort and function • Diet of a person with disorder often contains cariogenic foods • The plan must take into consideration the severity of the disorder

How does ETS influence...

• In utero - nicotine and carbon monoxide cross the placenta and enter the fetus. Adverse pregnancy risks include: o Miscarriage o placenta previa o low birth weight o increased perinatal mortality o Cleft lip, cleft palate, and delayed tooth formation have been associated with maternal smoking. • Infancy - chemicals are passed to the baby in the breast milk of mothers who smoke. Acute effects include: o increased incidence of lower respiratory tract illness o Postnatal ETS exposure is an independent cause of sudden infant death syndrome. • Young children - ETS affects lung development with symptoms of: o coughing, phlegm, and wheezing o Children are at higher risk for asthma; asthma sufferers have additional episodes and worsened condition. o Children have an increased incidence of middle ear infections. o Behavioral problems and lower academic achievement in school may be related to missing school during illnesses.

Who are at greater risk of developing a mental illness?

• Learning disabilities • Under local authorities, like DHS • Physical disabilities • LBGT

How does tobacco use influence the following?

• Periodontal infections o Tobacco is a major risk factor for perio disease o Users are at a high risk for developing more severe perio at younger ages o Direct impact on perio disease  Reduced blood flow  Altered neutrophil function  Increased cytokine production  Inhibitions of fibroblast growth and attachment  Reduced vascularity • Effects on the periodontal tissues o Gingivitis  Inflammatory response is reduced  Nicotine masks the signs of inflammation o Perio  Increased rate of severity of destruction  Increased bone loss, attachment loss, and pocket depths  Gingival recession may exist on anterior teeth  Increased tooth loss from perio causes • Mechanisms of periodontal destruction o No effects on the rate of biofilm accumulation o Lowered immune factors o Impaired neutrophils = decrease of chemotaxis, phagocytosis and adherence o Altered antibody production o Impairment of revascularization which impacts healing o Negative effect on bone metabolism o Smoking can influence osteoporosis • Response to treatment o Resistance to conventional therapy o Decrease in biofilm can control the effects o Implant failure is greater due to implantitis o Delayed healing after surgical and nonsurgical procedures

If a patient is considering a piercing, splitting, or a tattoo, what helpful information can you share?

• Research! o Tour o View sterile equipment o Check rating online o Make sure tech is wearing gloves, wiping down equip, and using sterile instruments • Discuss risks and potential complications • Oral implications: increase in bacteria, chance for fracture and wear of enamel, and potential for jewelry to embed in tissue • Direct pt to reading material on potential side effects, health risks, and complications

Although regular and "light" cigarettes both contain tar, nicotine, and nitrosamines, why do smoking "light" cigarettes increase the risk of developing cancer?

• Smokers inhale more smoke per puff • Inhale more often • Smoke cigarettes to a shorter butt length

Describe the effects of tobacco...

• Systemically - use of tobacco products influences every system of the body. The diseases that affect each system have consequences ranging from mild to deadly. About half of today's smokers will die of a smoking-related disease. • Cardiovascular - smoking aggravates and accelerates the development of atherosclerosis and is a major risk factor for coronary heart disease. Smokers who are over 50, who have used oral contraceptives, or who have a family history of coronary heart disease are at even greater risk. • Pulmonary - smoking is the major cause of chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. Emphysema slowly destroys a person's ability to breathe. Chronic bronchitis is a condition in which the airways produce excess mucus, which forces the smoker to cough frequently.

Briefly discuss the cultural significance associated with tattoos

• artistic expression • status symbol • declaration of love • signs of religious belief • adornments • status • rank • ancestry • abilities