Chapter 16 Flashcards
(128 cards)
1
Q
The three divisions of the dentitions are
A
the primary (deciduous) dentition, mixed (transitional) dentition, and permanent dentition.
2
Q
The formation of the primary teeth begins
A
in utero.
3
Q
Mixed or transitional dentition occurs between the ages of
A
6 and 12 years when primary teeth are being exfoliated and permanent teeth erupt.
4
Q
Succedaneous teeth are
A
permanent teeth that erupt into the positions of exfoliated primary teeth.
5
Q
The permanent dentition consists of ___teeth that replace the ____ and serve throughout life.
A
32; primary teeth
6
Q
Mineralization of the permanent teeth starts at
A
“birth” and continues into adolescence.
7
Q
Roots are completely formed about___
A
3 years after eruption into the oral cavity.
8
Q
Clinical crown is the part of the tooth____. It can be considered the part of the tooth that is____
A
above the attached periodontal tissues; visible (not covered with gingiva) when in the mouth and where restorative treatment procedures are performed
9
Q
Clinical root is the part of the tooth______ It is the part of the root to which_____ are attached.
A
not visible because it is below the base of the gingival sulcus or periodontal pocket (is not visible when in the mouth); periodontal fibers
10
Q
______is the part of the tooth covered by enamel.
A
Anatomic crown
11
Q
___is the part of the tooth covered by cementum.
A
Anatomic root
12
Q
The hard tissue examination includes
A
Dental charting of the existing restorations
Assessment of carious lesions and noncarious lesions.
Occlusion
Preparation of study models to aid with treatment planning
13
Q
During the dental charting of existing restorations procedure of the hard tissues exam, what is completed?
A
Charting of missing, supernumerary, unerupted teeth, and existing restorations
14
Q
What are the three types of examination when assessing noncarious and carious lesions during the hard tissues exam?
A
Visual examination, radiographic examination and clinical examination
15
Q
What is the visual examination procedure for assessing noncarious and carious lesions?
A
1.use air to clean and dry tooth surface
- utilize adequate lighting.
- Carefully visually inspect each surface. Transillumination is especially useful for anterior teeth and unrestored posterior teeth.
- Observe changes in the color and translucency of tooth structure
- Changes noted can then be studied in the radiograph or documented for future review.
(Radiology powerpoint: can also use dental instruments like explorers)
16
Q
What is the radiographic examination procedure for assessing noncarious and carious lesions?
A
- Carefully review and interpret radiographic findings to identify areas to investigate during the clinical examination. For example: possible caries lesions, anomalies, impactions, fractures, internal and root resorption, and periapical radiolucencies.
17
Q
What is the clinical examination procedure for assessing noncarious and carious lesions?
A
- If caries cannot be confirmed visually or radiographically, gently use a rounded or ball-end explorer to confirm visual findings.
- Use this time to record intraoral images. They can also document the existing oral condition and provide visual representation of treatment needs both for documentation in the patient record and to educate the patient.
18
Q
What should be documented after finishing the assessment for noncarious and carious lesions part of the hard tissues exam?
A
Existing restorations.
Developmental enamel lesions.
Noncarious cervical lesions (NCCLs).
Carious lesions using a recognized classification system
Any other pathology noted during the radiographic or clinical examination.
19
Q
For the occlusion part of the hard tissues exam, assessment of occlusion will include:
A
Normal occlusion.
Malocclusion.
Malrelations of groups of teeth.
Malpositions of individual teeth.
Dynamic (or functional) occlusion.
Traumatic occlusion.
20
Q
What is the purpose of study models in the hard tissues exam?
A
To assess and document occlusal relationships
Prepare for treatment
21
Q
Name some developmental enamel lesions
A
Enamel hypoplasia, hypomineralization/hypocalcification, and hypomaturation
22
Q
What is enamel hypoplasia?
A
incomplete or defective formation of the enamel of either primary or permanent teeth
23
Q
What are the three types of etiology that can cause enamel hypoplasia?
A
Genetic, systemic conditions, and local injury to developing tooth
24
Q
Give some example of enamel hypoplasia caused by genetics during tooth development
A
Amelogenesis imperfecta is a hereditary enamel defect in which the enamel is either thin or absent. The enamel may also have surface pitting or vertical grooves.
• Other inherited syndromes associated with enamel defects may be associated with dermatologic conditions or defects in mineralization such as hypoparathyroidism.
25
Give some example of enamel hypoplasia caused by systemic conditions during tooth development
• **Metabolic disturbances**such as celiac disease and chronic renal or liver disease.
• **Infections causing fever** such as chicken pox, rubella, measles, or congenital syphilis.
• **Chemicals and drugs** such as fluoride and tetracycline.
• **Nutritional deficiencies** like rickets and hypocalcemia
• **Preterm birth**
26
Give some examples of enamel hypoplasia caused by local insults to developing tooth
• Trauma.
• Periapical infections and inflammation of a primary tooth may injure the developing permanent tooth.
27
What is the appearance of enamel hypoplasia? Include appearance when caused systemically and congenital syphillis
**The teeth may appear yellow or brown, enamel may be thin, have many pits or grooves or may not be present in some part of the tooth**
**Local enamel hypoplasia**: A single tooth with a yellow or brown **intrinsic** stain.
**Systemic enamel hypoplasia**
• Also called **chronologic hypoplasia** because the lesions are found in areas of the teeth where the enamel was forming **during the systemic disturbance**
1. **Single narrow zone** (smooth or pitted): Disturbance lasted a short period of time.
2.**Multiple** (may appear as furrows or horizontal rows of dimples in the enamel): Disturbance to the ameloblast occurred over a period of time or several times
**Hypoplasia of congenital syphilis**
1. **the mulberry molar**
2. **Hutchinson's incisors****
3. **peg lateral incisor**
28
What is hypomineralization?
Deficiency in mineralization of the tooth enamel
29
Hypomineralization occurs during the
maturation stage of enamel mineralization
30
Hypomineralization may result in a higher risk for
hypersensitivity, tooth wear, and dental caries.
31
What is the etiology for hypomineralization?
Systemic disturbances like
1. celiac disease (causes mineral deficiencies)
2. chronic liver or kidney disease
3. childhood illness associated with a high fever
4. Chemicals and drugs such as fluoride and tetracycline.
32
What are the types of hypomineralization?
**Molar incisor hypomineralization (MIH)**
appears as yellow or brownish demarcated areas on one or more permanent molars and incisors. Occasionally the defects may involve the primary second molars along with the permanent canines and premolars.
**Amelogenesis imperfecta**: In the hypomineralized type, enamel is a normal thickness, but opaque and brittle.
**Dental fluorosis** : Exposure of the enamel organ to excessive fluoride during development. Severe forms appear yellow/brown and the enamel is prone to breakdown.
33
Hypomaturation occurs during
the last stages of mineralization from a decrease in deposition of mineral.
34
In hypomaturation, The enamel may appear
opaque or discolored and fracture easily.
35
What are the genetic reasons for developmental defects of dentin?
Current genetic evidence suggests there is just one gene responsible for disturbances in dentin development with a range of severity.
• Dentinogenesis imperfecta (DI)
characteristics vary from mild to severe.
Milder forms were previously named dentin dysplasia.
36
Mild-severity Dentinogenesis imperfecta characteristics:
• Normal to light gray discoloration of the crown.
• Pulp chamber may be thistle-shaped.
37
In moderate to severe Dentinogenesis imperfecta characteristics:
• Crowns may be blue, gray, or brown opalescent in color.
• Shortened, bulbous tooth
crowns.
• Alterations in the pulp from complete obliteration to an enlarged pulp.
• Thin and shortened roots.
• Increased incidence of periapical pathology.
More severe DI may be associated with more fragile bones (osteogenesis imperfecta).
38
Give some examples of noncarious dental lesions
Attrition and erosion
39
What is attrition?
Attrition is the wearing away of a tooth as a result of tooth-to-tooth contact
40
What is the occurrence of attrition?
Location
• May be found on occlusal or incisal, and proximal surfaces.
Impact of age and gender
• Effects of attrition are cumulative over time, so an increase in attrition is often associated with increasing age.
41
What is the etiology of attrition?
1. Bruxism
2. Occlusal interferences
3. Modifying factors such as Ecstasy use causing bruxism, habit of chewing on hard foods like bones., SSRIs (selective serotonin uptake inhibitors) used as an antidepressant may cause bruxism.
42
What is the appearance of attrition?
Initial lesion
• Small shiny, flat, worn spot on the surface of a tooth known as a facet is found on a cusp tip or ridge, or slight flattening of an incisal edge.
Advanced
Gradual reduction in cusp height
Flattening of incisal or occlusal plane
Staining of exposed dentin.
Radiographically the pulp chamber and canals may be narrowed and sometimes obliterated as a result of formation of secondary dentin.
43
What is erosion?
Erosion is the loss of tooth substance by a **chemical process** that does not involve known bacterial action.
44
What is the location of erosion?
Facial or lingual surfaces of multiple teeth are mostly commonly affected.
45
What is the etiology of erosion?
Erosion can result from endogenous and exogenous acid sources.
46
What is the process of erosion?
• Exposure to acid causes loss of the outermost enamel and dentin and softening (demineralization) of the tooth surface.
• This softened surface is easily removed by mechanical forces, such as toothbrushing.
47
What is the appearance of erosion of enamel?
• Smooth, shallow, hard, shiny (in contrast to dental caries, in which appearance is soft and discolored).
• Shape varies from shallow saucer-like depressions of the cusps to deep wedge-shaped grooves; margins are not sharply demarcated
• May progress to involve the dentin and stimulate secondary dentin.
48
What are non carious cervical lesions?
NCCLs are lesions resulting from loss of tooth structure near the
cementoenamel junction not related to dental caries.
49
The lesions typically are wedge-shaped and at least 1 mm deep; near the
cementoenamel junction not related to dental caries.
Noncarious cervical lesions
50
Danger of NCCLs?
They impact the structural integrity of the tooth and esthetics
May retain dental biofilm
Cause dentin hypersensitivity.
51
What are two types of NCCLs?
Abrasion and abfraction
52
What is abrasion?
Abrasion is the mechanical wearing away of tooth substance by forces other than mastication.
53
Where is the location of abrasion?
The cervical areas of exposed root surfaces of teeth are the most commonly affected tooth surface
Typically on exposed cementum, and may extend into the dentin.
54
What is the etiology of abrasion?
abrasiveness of the toothpaste/powder etc. typically worse on area where the patient first begins brushing
stiffness of the toothbrush bristles
Occupational causes: Cement factories and granite workers along with iron miners.
Habits like pipe smoking, chewing pens, betel nut chewing, and pica (eating nonfood items).
55
What is the appearance of abrasion?
V or wedge shaped with hard, smooth, shiny surface and clearly defined margins
56
What is abfraction?
Abfraction means to break away and results from microfractures in the hydroxyapatite crystals of enamel and dentin.
57
Abfraction primarily occurs on
buccal surfaces of teeth; In cases other than incisal biting habits, the lesions will initially be on exposed cementum and eventually will extend into dentin
58
What is the etiology of abfraction?
Multifactorial
Dentin demineralization may increase the risk of abfraction
occlusal forces may increase progression of the lesion.
59
What is the appearance of abfraction?
V or wedge shaped with hard, smooth, shiny surface and clearly defined margins; sharp angles.
60
What are the causes to tooth trauma or injury?
• Automobile, bicycle, and diving accidents.
• Contact sports when mouth protectors are not worn.
• Blows/trauma to the face.
• Falls
61
What are the descriptions of tooth fractures?
May be horizontal, diagonal, or vertical.
62
What are the radiographic signs of tooth trauma?
• Widened periodontal ligament (PDL) space.
• Radiolucent fracture line.
• Radiopaque areas where fracture segments overlap.
• Tooth displacement.
63
What are the classifications for traumatic dental injuries?
**Fracture**
**Luxation**
**Avulsion**
64
What are the recommendations by the International Association of Dental Traumatology for treatment for a tooth that has sustained some sort of trauma or injury?
Emergency examination with radiographs to detect root fracture or injury, as well as pulp vitality testing, testing of mobility and tenderness, location of tooth fragments, clinical diagnosis and immediate emergency treatment.
65
What is the international consensus definition of dental caries?
Dental caries is a biofilm-mediated, diet modulated, multifactorial, non-communicable, dynamic disease resulting in net mineral loss of dental hard tissues. It is determined by biological, behavioral, psychosocial, and environmental factors.
66
Requirements for the development of a carious lesion are
microorganisms, fermentable carbohydrate, and
a susceptible tooth surface.
67
Dental biofilm contains many types of bacteria. Classic theory is that ______are primarily responsible for dental caries; however, research suggests the oral microbiome is much more complex than originally thought and caries results from an imbalance in the oral microbes.
Streptococcus mutans and Lactobacillus
68
What is G.V Blacks Classification?
The standard method for classifying dental caries/restorations according to surfaces of the teeth. developed by Dr. G.V. Black.
69
What is class 1 of GV Blacks classification?
Cavities in pits or fissures
a. Occlusal surfaces of premolars
and molars
b. Facial and lingual surfaces of molars
c. Lingual surfaces of maxillary incisors
70
What is the method of examination for a class 1 in GVBC?
Direct or indirect visual because radiographs are not useful
71
What is Class II of GVBC?
Cavities in proximal surfaces of
premolars and molars
72
What is the method of examination for class 2 of GVBC?
Early caries: by radiographs only
Moderate caries not broken through from proximal to occlusal:
1. Visual by color changes in tooth
and loss of translucency.
2. Radiograph
Extensive caries involving occlusal:
direct visual
73
What is class 3 for GVBC?
Cavities in proximal surfaces of incisors and canines that do not involve the incisal angle
74
What is the method of examination for class 3 of GVBC?
Early caries: by radiographs or transillumination
Moderate caries not broken through to lingual or facial:
1. Visual by tooth color change
2. Radiograph
Extensive caries; direct visual because it has broken through to facial or lingual
75
What is class 4 of GVBC?
Cavities in proximal surfaces of incisors or canines that involve the incisal angle
76
What is the method of examination for class 4 GVBC?
Visual and transillumination
77
What is class 5 of GVBC?
Cavities in the cervical third of facial or lingual surfaces (not pits or fissures)
78
What is the method of examination for class 5 of GVBC?
Direct visual: dry surface for vision, use dull probe to distinguish, area may be sensitive
79
What is class 6 of GVBC?
Cavities on incisal edges of anterior teeth and cusp tips of posterior teeth
80
What is the method of examination for class 6 of GVBC?
Direct visual
May be discolored
81
The International Caries Classification and Management System (ICCMS) approach classifies the tooth surface from
healthy to severe decay and allows for early detection of enamel changes that will benefit from remineralization.
82
The goal of the ICCMS is for
early detection in order to make informed decisions about caries management.
83
Identify all caries categories for ICCMS.
Sound tooth surfaces
Initial stage caries
Moderate stage caries
Extensive stage caries
84
What is the American Dental Association
Caries Classification System?
• The Caries Classification System (CCS) ranges from a healthy or sound tooth to noncavitated lesions to advanced carious lesions.
• Each tooth surface is scored according to the presence or absence of a carious lesion, severity of the lesion, and estimation of activity or progression. This information is then used to determine management or treatment options.
85
According to ICCMS, what qualifies as initial stage caries?
whitish/yellowish (white spot lesion); when dried, the surface may be opaque or dull rather than shiny as in health showing demineralization of the enamel but there is no breakthrough or cavitation of the enamel surface. Surface may become brownish over time or in pits and fissures.
86
• Remineralization: At this stage, the dental hygienist and patient are central to preventing progression of the lesion with meticulous daily oral biofilm removal and remineralization.
ICCMS Initial stage of caries
87
According to ICCMS, what qualifies as moderate stage caries?
A visible white or brown spot lesion showing localized breakdown of the enamel over the demineralized area without visible dentine exposure. Radiographically, the radiolucency extends into the dentin. When viewing cross section of tooth, the lesion is spreading from the dentinoenamel junction continuing along the dentinal tubules.
(To confirm enamel breakdown, a WHO/CPI/PSR ball-end probe can be used during clinical examination portion of hard tissues exam; apply instrument gently across the tooth; area-limited discontinuity is detected if the ball drops into the enamel micro-cavity/discontinuity).
88
According to ICCMS, what qualifies as extensive stage caries?
The cavitation of the lesion is now visibly showing both breakdown of enamel and dentin. (Dentin is exposed)
Radiographically, the radiolucency extends into the inner half of dentin or into the pulp.
(During clinical exam of hard tissues exam, you can use the WHO/CPI/PSR probe to confirm if it dips into the dentin)
89
What is the Nomenclature of cavities by surfaces?
Simple cavity: Involves one tooth surface.
Compound cavity: Involves two tooth surfaces.
Complex cavity: Involves more than two tooth surfaces.
90
What are the types of dental caries?
1. Pit and fissures
2. Smooth surface
3. Primary
4. Recurrent
5. Arrested
6. Rampant
91
Early childhood caries (ECC) is
one or more decayed, missing, or filled primary tooth surface in a child younger than the age of 6 years.
92
Other names for the condition include nursing bottle mouth, baby bottle syndrome, baby bottle tooth decay, and prolonged nursing habit.
ECC
93
Common risk factors for ECC are
developmental enamel lesions, increased consumption of fermentable carbohydrates (e.g., sugary snacks/beverages, bottle at bedtime, prolonged at-will breastfeeding at night), High levels of S. mutans, Candida, low parental education/oral health literacy, and low socioeconomic status.
94
Clinical appearance of ECC
Demineralization begins along the cervical third of the maxillary anterior teeth as white spot lesions which then become cavitated. As the lesions progress, the caries spread to the maxillary and mandibular molars. Eventually, the crown of the tooth may be destroyed to the gingival margin, abscesses may develop, and the child may suffer severe pain and discomfort.
95
Root caries is a
soft, progressive lesion of cementum and dentin that involves bacterial infection, tends to be shallow, and may spread laterally below the CEJ
96
It is also called cemental caries, cervical caries, or radicular caries.
Root caries
97
Multifactorial disease involving the cementum and dentin of roots increasing in prevalence in older adults as they age and retain more natural teeth.
Root caries
98
The ICCMS provides criteria for the stages and activity of root caries. Explain the criteria
**Initial Lesion**
A clearly demarcated discoloration (light/dark brown or black) below the cementoenamel junction with no cavitation.
**Moderate/Extensive Lesion**
Discolored (light/dark brown or black) area on the root surface with cavitation.
May have a leathery texture.
99
What are the factors Associated with Root Caries?
Age: People are retaining their teeth longer and root surfaces become physiologically (aging) or pathologically exposed due to periodontal disease, providing a susceptible root surface.
Lower socioeconomic status
Tobacco users
History of root caries
Gingival recession
Poor oral biofilm removal
Higher levels of S. mutans or lactobacilli
100
Diagnosis of pulp vitality is made with the
patient’s history, clinical and radiographic examinations, and diagnostic testing.
101
Any tooth suspected of being nonvital needs to be
tested for pulpal vitality or degree of vitality.
102
The two basic types of pulp testing are
thermal and electric.
103
The two basic types of pulp testing are
thermal and electric.
104
What are the causes of loss of tooth vitality?
• A tooth may become nonvital from bacterial causes, particularly invasion of the pulp from dental caries or periodontal diseases.
• Physical causes may be mechanical or thermal injuries.
105
What are the indications for need for pulp testing?
• noticing apical radiolucency
• when patient is experiencing oral pain, pulp vitality test can help determine origin
• Prior to dental procedures when pulp health may be questionable, that is, advanced dental caries.
• Assessment following trauma or orthognathic surgery
• Monitoring of orthodontic procedures.
106
Pulp testing is based on the knowledge that
a stimulus can create pain to which a patient will react.
107
The pulp tester determines the conduction of stimuli to the
sensory receptors.
108
• Pulp sensibility to ______stimuli is the most common method used, although there is ongoing research with other pulp vitality tests to also assess blood flow.
thermal or electric
109
The vitality of the pulp depends on the_______; however, recent research suggests a determination of the blood flow may be more accurate in identifying vital and necrotic pulp tissue.
density of the nerve fibers
110
What are the possible outcomes for pulp testing?
• Pulp is normal in response to stimuli of pulp testing.
• Pulpitis is present as indicated by an exaggerated response to pain.
Pulpitis can be reversible or irreversible.
• There is no response because the pulp is necrotic.
111
Cold or hot stimuli may be used.
Thermal pulp testing
112
For all methods, a_____ is performed on a healthy tooth on the opposite side of the arch. A positive response indicates pulpal health.
control test
113
• Cold testing may be accomplished with an
ice, ethyl chloride on a cotton pellet, carbon dioxide, or dry ice. Isolate the test teeth and dry with gauze.
114
Heat testing is done with
gutta-percha or compound material heated to melting and applied directly to the tooth. This is technique sensitive and may result in overheating the pulp.
115
For electric pulp vitality testing, Electric stimuli are used to
stimulate intact nerves in the pulp and identify healthy pulp tissue.
116
Example of endogenous acid sources that cause erosion
Occupational acid exposure, Acidic food, Acidic drugs, and Substance use disorders.
117
Example of endogenous acid sources that cause erosion
Eating disorders: Bulimia and Gastroesophageal reflux disease.
118
What are the different types of fractures?
• Incomplete fracture of enamel without loss of tooth structure.
• Coronal fracture of enamel only.
• Fracture of enamel and dentin with or without pulpal involvement.
• Fracture of enamel, dentin, and cementum with or without pulpal involvement.
• Fracture of root of tooth.
• Fracture involves alveolar bone.
119
What is luxation?
Dislocation of a tooth
120
What are the different types of luxation?
Concussion: Normal mobility with sensitivity to percussion and touch.
Subluxation: Injury to supporting tooth structures with loosening, but no displacement of the tooth.
Extrusive luxation is displacement of the tooth from the socket so it appears elongated with increased mobility.
Lateral luxation is when the tooth is displaced laterally (in a palatal/lingual or facial direction) and usually associated with alveolar bone fracture.
Intrusive luxation is a tooth displaced apically into the alveolar bone.
121
What is avulsion?
is the complete displacement of the tooth out of its socket due to forcible trauma.
122
This classification system applies when completing the dental charting of existing restorations.
G.V Black’s Classification
123
According to the ICCMS, what is considered a sound tooth surface?
show **no evidence of visible caries** (no or questionable change in enamel translucency) when viewed clean and after prolonged air-drying (5 seconds).
(Surfaces with developmental defects such as enamel hypomineralization (including fluorosis), tooth wear (attrition, abrasion and erosion), and extrinsic or intrinsic stains will be recorded as
124
What is the difference between pit and fissure caries and smooth surface caries?
Pit and Fissure caries begins in minute faults (depression) in the enamel and smooth surface caries begin in smooth surfaces where there is no pit, groove, or other defects. It occurs in areas where dental biofilm is protected from removal, such as proximal tooth surfaces, protected areas near a contact, cervical thirds of teeth, and other difficult-to-clean areas.
125
What is the difference between primary and recurrent caries?
Primary caries are caries on a surface not previously affected.
Recurrent caries are caries on a surface adjacent to a restoration where a carious lesion initially was. Meaning that the lesion is back on the same surface that had it previously.
126
What is the difference between arrested and rampant caries?
Arrested caries are caries that have not changed and does not show a tendency to progress further. Frequently has a hard surface and takes on a dark brown or reddish-brown color.
Rampant Caries are rapidly spreading caries resulting in early pulp involvement in which typically 10 or more new lesions occur each year on tooth surfaces not typically affected.
• The three types include early childhood, adolescent, and xerostomia-induced rampant caries.
127
For the electric pulp vitality test, the tooth in question is
isolated (e.g., with a rubber dam) to prevent spread of the stimuli to nearby teeth. Then the pulp tester probe is applied to the tooth in question and the intensity of the electric stimuli is gradually increased to a preselected value. A digital display provides values for when the patient first feels the stimuli.
128
What do we record in a dental chart?
Anomalies in the number of teeth
Anomalies in the dental tissues
Acquired tooth damage
Restorations
Conditions
Occlusion
