307 - support for control of periodontal disease, caries & restoration of cavities. Flashcards
(202 cards)
1
Q
What is the main microorganism that causes caries?
A
Streptococcus Mutans
2
Q
What does ANUG stand for?
A
Acute Necrotising Ulcerative Gingivitis
3
Q
What is a consequence of advanced periodontal disease?
A
Mobility
4
Q
Main advantage of Calcium Hydroxide lining?
A
Promotes secondary dentine formation
5
Q
What is a push scaler used for?
A
Removal of interproximal calculus
6
Q
What may indicate signs of bruxism?
A
Attrition
7
Q
What is an additional advantage zinc oxide and eugenol cement has over other linings?
A
Chemically calms the tooth
8
Q
What material requires the presence of undercuts to remain in place?
A
Amalgam
9
Q
What instrument carefully removes carious tissue without exposing the pulp?
A
Spoon excavator
10
Q
What is the main component of amalgam?
A
Silver
11
Q
Which material chemically prepares tooth surface for a composite restoration?
A
Phosphoric acid (etch)
12
Q
What lining should not be used under a composite restoration?
A
Zinc oxide and eugenol cement
13
Q
What is used for a class II restoration?
A
Siqveland matrix band
14
Q
What is the most likely classification for abrasion cavities?
A
Class V
15
Q
What advantage does glass ionomer have over composite?
A
Releases fluoride
16
Q
What are harmful sugars known as?
A
Non-milk extrinsic
17
Q
What is the pH level of the mouth during demineralisation?
A
pH 5.5
18
Q
Inflammation of the periodontum is periodontitis. What finding helps to diagnose it as not being gingivitis?
A
True pocket
19
Q
Before periodontitis develops, chronic gingivits occurs. What is most likely to be present?
A
Gingival hyperplasia (inflamed/overgrowth of gums)
20
Q
what are cavities caused by?
A
dental caries attacking hard structure of tooth
21
Q
what is a treatment plan for a cavity based on?
A
cavity size
cavity position
tooth involved
extent of caries
22
Q
who can carry out a filling in line with GDC scope of practice?
A
dentist or dental therapist
23
Q
on what patients are temporary restorations placed on?
A
less co-operative patients
24
Q
what materials are used as temporary restorations?
A
zinc oxide and eugenol cement
zinc phosphate cement
zinc polycarboxylate cement
25
where are amalgam restorations usually placed?
on posterior teeth
26
where are composite restorations placed?
anterior teeth for aesthetics and also in posterior teeth too
27
where are glass ionomer cement restorations placed?
in deciduous teeth and in cavities where retention is difficult
28
why is glass ionomer used in deciduous teeth?
releases fluoride
29
what are the aims of cavity preparation?
remove all caries without pulp exposure
avoid accidental pulp exposure
protect pulp by using linings/bases
30
how many classifications are there for cavities?
5
31
what are cavity classifications based on?
site of original caries attack
32
what is the name of cavity classifications?
Black's classification
33
class I cavity
single surface
in pit/fissure
e.g. occlusal/buccal/lingual
34
class II cavity
at least 2 surfaces of posterior tooth
e.g. mesial/distal and occlusal
molar or premolar
35
class III cavity
mesial or distal surface of incisor or canine
36
class IV cavity
same as class III but extend to involve incisal edge of affected side
e.g. mesial incisal or distal incisal
37
class V cavity
cervical margin of any tooth
e.g. labial cervical filling in upper incisor
38
what does careful cavity prep ensure?
all plaque biofilm and soft carious dentine removed
conserve as much enamel as poss to maintain strength/structure of tooth
reduced chance of micro leakage
39
function of mouth mirror
aid dentist vision
reflect light onto tooth
retract and protect soft tissues
40
function of right angle probe
feel cavity margins
feel softened dentine within cavity
detect overhanging restorations
41
function of excavators
small/large spoon shaped to scoop out softened dentine
42
function of amalgam plugger
push plastic filling material into cavity and adapt them to cavity shape and leave no air space
force excess mercury out
43
function of burnisher
ball/pear shaped to press and adapt restoration margins against cavity for no leakages
44
function of flat plastic
remove excess filling material and create shaped surface
45
function of college tweezers
pick up. hold and carry items
46
function of gingival margin trimmer
trim margin of cavity to ensure no unsupported enamel or soft dentine remains
47
function of enamel chisel
remove unsupported enamel from cavity edges
48
what is a preconstructed restoration called?
inlay
49
what material can inlays be?
gold
porcelain
other ceramic material
50
how is retention for a filling made?
cutting tiny grooves in cavity walls
51
what is done if there can't be an undercut in a restoration?
self tapping dentine pins
acid etching for composite
chemical bonding for glass ionomer
52
how are linings placed?
thin layer on floor of shallow cavity
53
what does a lining do?
protect underlying pulp against chemical irritation
54
name an example of a lining...
calcium hydroxide
55
how are bases placed?
in deeper cavities as thicker layer
56
what do bases do?
protect pulp against chemical irritation and insulate from thermal changes
57
name examples of bases...
zinc oxide and eugenol cements
zinc phosphate cements
zinc polycarboxylate cements
58
how does majority of post-restorative pulp damage occur?
microleakage
small amount of fluid/debris/bacteria leak through microscopic gaps
enter dentinal tubules
contaminate pulp tissue
59
properties of modern lining materials
chemically bond to dentine
physically seal dentine tubules
insoluble once set
radiopaque - can be seen on radiograph
60
why can some modern lining materials not be placed on cavity floor?
may cause pulp damage due to chemical composite
61
why is moisture control important?
protect patient airway from fluid inhalation
ensure patient is comfortable - mouth isn't full of fluid
allow good visibility
allow restorative material to set correctly
62
methods used to control moisture?
high-speed suction with aspirator
low speed suction with saliva ejector
absorbent material e.g. cotton wool rolls
rubber dam
3 in 1 to air dry
63
what does high speed aspiration achieve?
fast removal of moisture during drilling
64
what does low speed aspiration achieve?
continual moisture control without sucking at soft tissues
65
what do absorbent materials do?
placed in buccal or lingual sulcus and absorb saliva
keep soft tissues away from teeth
66
what is a rubber dam?
thin vinyl sheet placed over tooth to isolate it from rest of mouth
67
what are the 2 main uses of rubber dams?
RCT to maintain sterile field and prevent inhalation
during insertion of fillings to avoid failure due to saliva contamination
68
at what speed can air turbine handpieces run?
500,000 revolutions per minute
69
what burs are used to cut through enamel and dentine?
friction grip diamond or tungsten carbide burs
70
advantage of air turbines?
ease and speed of cutting
71
disadvantage of air turbines?
little tactile sensation = excessive tooth removal
72
how fast do slow handpieces run?
40,000 revolutions per minute
73
what motors are slow handpieces driven by?
air or electric
74
what are burs for low speed procedures made of?
steel
75
what do steel burs do?
remove caries, cut dentine, trim dentures
76
what are burs for high speed procedures made of?
diamond or tungsten carbide cutting surface
77
what do the diamond/tungsten carbide burs do?
rapid removal of enamel, dentine and old fillings
78
use of round bur
gain access to cavities
79
use of pear bur
shaping and smoothing cavities
80
use of fissure bur
shaping and outlining cavities
81
what are finishing burs and stones used for?
smoothing cavity margins and trimming fillings
82
what is a mandrel used for?
to attach larger wheels, stones and abrasive discs
83
how are diamond burs cleaned?
in an ultrasonic cleaner and autoclaved
84
do handpieces need to be lubricated regularly?
YES
85
what does air abrasion do?
remove hard tissue, soft carious tissue and surface stains
86
what does air abrasion use?
compressed air and special hand piece to convey jet of abrasive particles
87
why are temporary restorations used?
emergency measure to seal cavity and prevent carious ingress
during endo as need to access tooth repeatedly
during inlay construction to seal prep whilst waiting for permanent inlay
allow symptomatic tooth to settle and become symptom free
88
why are temporary materials not used as permanent restorations?
too soft to chew on
soluble in saliva
wouldn't remain intact for long periods
89
main features of temporary restorations?
quick mixing & placement
cheaper
easily removable
some contain sedative ingredients - settle inflamed pulp
90
how is zinc oxide powder and eugenol liquid mixed?
mixing powder with drop of eugenol liquid
91
what is zinc oxide and eugenol mixed on?
glass slab
92
what is the use of zinc oxide & eugenol?
temporary filling
non-irritant
sedative dressing
main constituent of impressions pastes/periodontal packs/root filling materials
93
what filling material is zinc oxide & eugenol NOT compatible with?
composite
due to oily nature
94
what is zinc phosphate made up of?
zinc powder and phosphoric acid liquid
95
what are the 2 different mixes of zinc phosphate?
thick mix of putty consistency - used as temp fill or base
thin creamy mix for crown/inlay cementation
95
how is zinc phosphate cement mixed?
powder and liquid on glass slab
96
does a warm slab accelerate the setting time of zinc phosphate?
YES
96
which mix of zinc phosphate sets quicker - thin or thick?
thick mix sets quicker
97
why must a dry slab be used when mixing zinc phosphate?
moisture accelerates setting
98
advantage of zinc phosphate?
sets hard within few minutes
more durable material than zinc oxide & eugenol
99
disadvantage of zinc phosphate?
in deep cavities it can irritate pulp
moisture sensitive and won't adhere to damp cavity
100
what is zinc polycarboxylate made up of?
zinc oxide powder and polyacrylic acid liquid
101
what pad can zinc polycarboxylate be mixed on?
glass slab or waxed paper pad
102
what is the use of zinc polycarboxylate?
thin mix as luting cement for fixed restorations and orthodontic bands
thick mix as cavity base
103
advantage of zinc polycarboxylate?
less irritant and more adhesive to dentine
104
disadvantage of polycarboxylate?
sticks easily to instruments so it is difficult to place ..
105
how can calcium hydroxide be presented?
powder and resin - two pastes mixed together
premixed single paste - light cured
106
what are the uses of calcium hydroxide?
cavity lining as it is non-irritant
promotes formation of secondary dentine
promotes remineralisation of hard tooth tissue
pulp capping
pulpotomy
107
what properties do permanent restorations have?
set sufficiently hard
dont dissolve or deteriorate in saliva
biologically safe
reasonable lifespan of years
aesthetically acceptable
108
what are the 3 common permanent restorations?
amalgam
composite
glass ionomer
109
how is amalgam prepared?
mixing powdered ALLOY with liquid MERCURY
110
what are the main constituents of amalgam alloy powder?
silver (up to 74%)
copper (up to 30%)
tin (variable quantities)
zinc (small quantities)
111
what is alloy and mercury mixed in?
an amalgamator
112
what condenses amalgam into the tooth?
an amalgam plugger
113
# fill in the blank
Amalgam contains ____ which is known to be toxic
mercury
114
advantages of amalgam?
easy to use
can be condensed into cavity
cheap
good set strength - allow heavy chewing
excellent longevity
115
disadvantages of amalgam?
mercury is toxic
constant corrosion in oral environment
not retentive to tooth - must have undercuts
can transmit thermal shocks
poor aesthetics
116
on who should amalgam NOT be used on unless strictly necessary?
children under 15
pregnant women
breastfeeding women
117
how can mercury poisoning occur?
inhalation of vapours
absorption
ingestion
118
is mercury vapour released at higher or lower temperatures?
higher
119
what are the symptoms of mercury poisoning?
early symptoms - headache, fatigue, nausea, diarrhoea
later symptoms - hand tremors and visual defects
final stage - kidney failure
120
how to avoid mercury absorption?
wear disposable gloves when handling
no open-toed shoes
no jewellery or wrist watch
121
how to avoid pollution of air by mercury vapour?
preloaded capsules
full PPE
ventilated surgery
mercury spillage kit on site
122
who collects waste amalgam and extracted teeth containing amalgam?
authorised hazardous waste contractors
123
who must a mercury spillage be reported to?
dentist or other senior staff member
124
what to do with mercury spillage globules?
draw up into disposable intravenous syringe or bulb aspirator and transfer into mercury container
125
what steps to take with larger mercury spillage?
stop work and report immediately
put on full PPE
smear globules with mercury absorbent paste
leave to dry and remove with wet disposable towel
risk assess incident
evacuate premises
HSE notified under RIDDOR
126
what is composite?
tooth coloured restorative material in a wide range of shades
127
what does composite material consist of?
inorganic filler in resin binder and a catalyst
128
how is composite set?
with a blue light cure
129
how long should phosphoric acid (33%) be coated on to tooth for?
around 15 seconds
130
what does acid etchant do?
chemically roughen enamel surface
131
what are the risks of acid etchant?
acid burns and permanent scarring of soft tissues
132
what damage can the blue light cure do?
damage the retina of eye if looked at directly
133
what barrier can be used to with a blue light cure?
orange tinted protective shield
134
what is fissure sealing?
caries prevention measure
135
advantages of composite material?
aesthetically pleasing
adhesive to tooth - requires less tooth removal
little marginal leakage
fast set with curing light
136
disadvantages of composite material?
more expensive
can't be condensed into cavity
not as strong/hard-wearing
only use glass ionomer as base
137
what is glass ionomer?
tooth-coloured restorative material adhesive to hard tissues of teeth.
138
what class is glass ionomer usually used on?
class V
139
how do glass ionomers set?
chemically or by exposure to blue curing light
140
advantages of glass ionomer?
adhesive to enamel, dentine and cementum
ideal for class V abrasion cavity
good marginal seal
releases fluoride
more aesthetic than amalgam
141
disadvantages of glass ionomer?
low strength
technique sensitive
requires calcium hydroxide lining in deep cavity
protection from moisture contamination
142
what demineralises dentine and enamel?
acids
143
what bacteria are associated with production of caries?
streptococcus mutans (initial stages)
streptococcus sanguis
some lactobacilli
144
what is plaque biofilm?
combination of bacteria and food forming sticky film
145
what is a stagnation area?
areas where plaque biofilm can easily stick to
146
name examples of stagnation areas?
gingival margins
fissures
edges of dental restorations
147
what is the build up of plaque at gingival margins associated with?
gingivitis and periodontal disease
148
what food type can be turned into acid by bacteria?
carbohydrates
149
what do early acid attacks show as on the teeth?
white spot lesions on enamel
150
when caries enters deep into the enamel what will it reach?
amelodentinal junction
151
will patient feel pain when caries enters the enamel?
no
152
what is it called when there is a hole in the tooth?
cavity
153
what do odontoblasts do at the ADJ?
lay down secondary dentine to protect underlying pulp tissue
154
when will the patient begin to feel sensitivity from caries?
when nerve fibrils in dentine tubules are stimulated
155
what is it called when the pulp settles after a filling?
reversible pulpitis
156
what is it called when the pulp reaches the pulp chamber?
irreversible pulpitis
157
what does saliva contain?
water
inorganic ions and minerals
ptyalin
antiobodies
leucocytes
158
what is ptyalin?
a digestive enzyme which acts on carbohydrates
159
what is the condition of reduced salivary flow called?
xerostomia (dry mouth)
160
what can reduced salivary flow lead to?
reduced self cleaning in oral cavity = likelihood of caries and periodontal disease developing
food debris stagnates
161
what is halitosis?
bad breath
162
what is ptyalism?
excessive saliva production
163
how can a dentist detect smaller carious lesions?
blunt dental probes to detect stickiness
transillumination
caries dyes
bitewing radiographs
164
what probes can detect stickiness on occlusal surfaces?
sickle or right-angle
165
what probe can detect stickiness in interproximal areas?
briault probe
166
how can caries be prevented?
diet - fewer cariogenic foods and drinks
control of bacterial plaque
increase tooth resistance to acid attacks - fluoride
167
what are the types of non-carious tooth loss?
erosion
abrasion
attrition
abfraction
168
how does erosion occur?
extrinsic acids on enamel
169
where are extrinsic acids found?
carbonated fizzy drinks
acidic fruits
pure juices
wines
170
what medical conditions can cause erosion?
bullimia - from vomitting
hiatus hernia
stomach ulcers
reflux oesophagitis
171
what tooth surfaces does erosion usually affect?
labial or palatal of upper incisors
occlusal of lower molars
172
how does abrasion occur?
patient scrubs teeth using excessive side-to-side technique
173
where is abrasion seen on the teeth?
cervical neck of tooth on buccal or labial surface
174
what is attrition?
loss of enamel from biting surface of teeth
175
what surfaces of teeth does attrition affect?
incisal or occlusal
176
what causes attrition?
wear and tear from chewing
occlusion of natural teeth onto ceramic restorations
bruxing
177
what is bruxing?
clenching or grinding of teeth
178
what is abfraction?
specific loss of tooth in cervical region
179
what causes abfraction?
shearing forces that occur by overloading single standing teeth
180
what teeth are usually affected by abfraction?
single standing premolars
181
what is periodontal disease?
bacterial infection of supporting structures of tooth
182
what supporting structures of the teeth does periodontal disease affect?
gingivae
periodontal ligament
cementum
alveolar bone
183
what is the early stage of periodontal disease called?
chronic gingivitis
184
what is visible calculus called?
supragingival calculus
185
what is calculus beneath gingival margins called?
subgingival calculus
186
what is a false pocket?
when inflamed gingivae becomes red and there is swelling of gingivae
187
what is bacteria that can survive without oxygen called?
anaerobic bacteria
188
what is a true pocket?
when bacterial toxins destroy periodontal ligament and attachment of tooth to supporting tissues
189
what can worsen periodontal disease?
smoking
hormonal changes
open lip posture
190
what medical condtions/drugs affect periodontal disease?
diabetes
aids
leukaemia
epilepsy treated with epanutin
vitamin C deficiency
191
what are the clinical signs of periodontal disease?
periodontal probing detects pockets greater than 3mm
supra/sub gingival calculus present
some teeth are mobile
radiographs showing destruction of alveolar bone
192
what probe is used for BPE?
WHO or BPE probes
193
what are the BPE scores?
0-4
194
what BPE scores will need detailed periodontal charting?
3 and 4
195
what is periodontal charting (6ppc)?
mouth is divided into quarters to chart
196
what instruments are used for subgingival scaling and root surface debridement?
gracey curette
periodontal hoe
ultrasonic scaler
197
what instruments are used for supragingival calculus removal?
sickle scaler
push scaler
jacquette scaler
198
what is pericoronitis?
infection of gingival flap lying over partially erupted tooth
199
what is the operculum?
gingival flap over partially erupted tooth
200
what bacteria is involved with ANUG?
bacillus fusiformis
treponema vincenti
