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Geriatrics > 10. Clinical Consent and ART > Flashcards

10. Clinical Consent and ART Flashcards

1
Q

Rampant caries often begin in elderly when

A
  • once meds begin
  • When they become
    • Frail
    • Dependent
    • Cognitively impaired
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2
Q

T/F Rampant caries happens to most elderly even when they have been caries free for most of adulthood

A

t

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3
Q

T/F Most rampant caries occur after the individual has been placed in long term care facilities

A

F- often happens before then

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4
Q

Material choice for a restoration should be made when

A
  • Caries have been removed

- Field of isolation is evaluated

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5
Q

T/F Survival rate of composite is better than amalgam

A

f

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6
Q

What are the advantages of Fuji IX

A
  • Packable- dough like consistency that is easy to handle
  • Non-sticky
  • High compressive and flextural strength
  • Excellent wear (better than conventional GI not as good as resin)
  • Simple and easy technique
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7
Q

How long is the working time for Fuji IX

A

2 minutes

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8
Q

What material can be used when field of isolation is less than optimal

A

Amalgam (or GI)

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9
Q

Traditional stepwise is a technique that can be used when the pulp is (vital/non-vital)

A

vital (remove decay and leave deepest decay, temp filling then re-visit)

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10
Q

Define ART

A

Dental caries treatment involving removal of soft, demineralized tooth tissue with hand instruments alone followed by restoration with an adhesive restorative material (typically GI)

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11
Q

Advantages of ART

A
  • Use of available and inexpensive hand instruments
  • Biologically “tooth friendly”
  • Limitation of pain, vibration and sound of drill**
  • Simple infection control
  • Chemical adhesion of GI
  • Combination with prevention (ART sealants)
  • Ease of repair
  • Low cost
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12
Q

Disadvantages of ART

A
  • Not well documented long term survival rates
  • Not always accepted by oral health professionals
  • Limited to small and medium cavities
  • Hand fatigue
  • Misconceptions by the public and profession
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13
Q

Longevity of amalgam restorations is roughly - yrs

A

6-10 yr (insurance number- really longer than this)

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14
Q

T/F No longer believe that caries must always be completely removed when lesion is deep

A

t- but it needs to be completely sealed and in order for it to be completely sealed you must make sure the enamel and DEJ and caries free

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15
Q

T/F there is no significant difference in the survival of amalgam compared to ART restorations

A

t (in primary teeth in permanent teeth ART was better than amalgam but only for class I fillings not class II)

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16
Q

T?F The survival rates of single surface ART restorations are not acceptable to meet the ADA specifications for quality restorations

A

f

17
Q

For the studies that were done on the survival rates of ART restorations what were the caveats of these studies

A
  • Conducted in low caries rate populations

- Nursing home and elderly persons may not qualify

18
Q

The AAPD recognizes ART as an acceptable treatment for caries when….

A

traditional dental restorations aren’t possible

19
Q

Limitations to restorative tx in NH

A

0Cooperation

  • Isolation
  • Hyper-reaction to discomfort
  • Reduced toleration to fixed position
  • Narrow window of motivation
  • Multiple meds/safety with LA
20
Q

Why can’t you use amalgam with ARt

A

hand instruments will not give proper bulky and retention

21
Q

Silver Diamine fluoride is used to

A

arrest caries (off label use) and dentin hypersensitivity (FDA approved)

22
Q

Downside of SDF

A

stains lesions black

23
Q

Usefulness of SDF

A
  • Care resistant geriatric population

- Inaccessible lesions (interproximal root caries)

24
Q

T/F Application of SDF 2x/year is more effective at arresting caries than once per year

A

t

25
Q

Clinical signs that SDF was successful at arresting the caries

A

darkening of the lesion

26
Q

T/F SDF applied to a lesions will only prevent caries at the adjacent surfaces

A

F- other tooth surfaces as well (this statement however is true for GIC)

27
Q

Does SDF reduce the bond strength of GI

A

no

28
Q

SDF will lower the bond strnegths for

A

Panavia fluorocement and Super-bond C&B

29
Q

Mechanism of caries arrest for SDF

A
  • Increased mineral density and hardness
  • Inhibition of proteins that break down exposed dentin organic matrix (MMP, cathespins, bacterial collagenases)
  • Inhibition of biofilm layer
  • Silver ions directly act against bacteria
30
Q

How does Silver inhibit bacterial growth

A
  • Break membranes
  • Denature proteins
  • Inhibit DNA replication
  • Kills cariogenic bacteria in dentinal tubules
31
Q

Indications for SDF

A
  • Extreme caries risk
  • Behavioral challenges or medical complexities
  • Patients whose care will likely take too many visits
  • Patients without access to dental care
  • Prevention of secondary caries in high risk pateints
32
Q

Who grants consent for a minor

A

legal guardian (unless emergency)

33
Q

What is needed for informed consent

A

dentist must disclose all relevant information to enable the patient to make an informed decision regarding proposed treatment

34
Q

Disclousure should include

A
  • Dx
  • Nature of proposed tx
  • Anticipated outcome/ benefits
  • Material risks with treatment
  • Alternative treatment or procedure including no treatment
  • Risks of no treatment
  • No guarantee
  • Opportunity for patient to ask questions
35
Q

T/F Practitioner has the primary responsibility and can’t delegate

A

t (meaning the practitioner is responsible for informing the patient so they can give informed consent- can’t delegate that job to others in the office)

36
Q

T/F a patient signature on a consent form constitutes informed consent

A

f

Geriatrics (11 decks)

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