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NBDE II > OPERATIVE Patient Assessment, Examination, Diagnosis, and Treatment Planning > Flashcards

OPERATIVE Patient Assessment, Examination, Diagnosis, and Treatment Planning Flashcards

1
Q

what are 6 aspects of patient assessment?

A
  1. infection control
  2. CC
  3. medical review
  4. sociologic and psychological review
  5. dental history
  6. risk assessment
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2
Q

what are 4 important considerations of the medical review?

A
  1. communicable diseases
  2. allergies and medications
  3. systemic diseases and cardiac abnormalities
  4. physiologic changes associated with aging
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3
Q

what are 4 general considerations for examination and diagnosis?

A
  1. charting and records, preferably electronic
  2. tooth denotation system
  3. preparation for clinical examination
  4. interpretation and use of diagnostic tests
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4
Q

what should be included in the examination of orofacial soft tissues?

A
  • submandibular glands and cervical nodes
  • masticatory muscles
  • cheeks, vestibules, mucosa, lips, lingual and facial alveolar mucosa, palate, tonsillar areas, tongue, and floor of mouth
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5
Q

what are ways we diagnose caries?

A
  • visual changes in tooth surface texture or color
  • tactile sensation when an explorer is used judiciously
  • radiographs
  • transillumination
  • laser fluorescence (DIAGNOdent)
  • digital imaging fiberoptic transillumination (DIFOTI)
  • quantitative light-induced fluorescence (QLF)
  • electrical conductance or impedence measurement
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6
Q

should a dentist rely solely on one test to diagnose caries? why or why not?

A

no, because no test currently available is completely accurate

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7
Q

where are caries most prevalent?

A

pits and fissure

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8
Q

why is the use of an explorer to diagnose fissure caries strongly discouraged?

A

because injudicious use of an explorer may cause fracture of the surface enamel that has been weakened by subsurface demineralization

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9
Q

how are occlusal surfaces examined for caries?

A

visually and radiographically

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10
Q

an occlusal surface of a tooth is visually diagnosed as carious if ___

A

there is chalkiness or apparent softening or cavitation of tooth structure forming the fissure or pit or brown-gray discoloration radiating peripherally from the fissure or pit

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11
Q

how are occlusal surfaces radiographically diagnosed as carious?

A
  • should be made from a bitewing
  • when radiolucency is apparent beneath the occlusal enamel surface emanating from the DEJ
  • in contrast, a noncarious occlusal surface has either grooves or fossae that have shallow, tight fissures that exhibit superficial staining with no radiographic evidence of caries
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12
Q

precarious or carious pits are usually found where? what are they typically a result of?

A
  • cusp tips, occlusal 2/3 of the facial or lingual surface of posterior teeth, and on the lingual surface of maxillary incisors
  • typically the result of developmental enamel defects
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13
Q

how are proximal-surface caries usually diagnosed?

A
  • radiographically

- it can also be detected by careful visual examination either after separation or through fiberoptic transillumination

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14
Q

brown spots on intact, hard proximal-surface enamel adjacent and usually gingival to the contact area are often seen in older patients whose caries activity is low. what are these spots usually a result of? are these spots usually carious?

A
  • extrinsic staining during earlier caries demineralization-remineralization cycles
  • usually not carious and is usually more resistant to caries as a result of fluorohydroxyapatite formation (tx not indicated)
  • they are challenging to diagnose because of faint radiographic evidence of the remineralized lesion
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15
Q

how are proximal surface caries in anterior teeth identified?

A
  • radiographic examination
  • visual inspection (transillumination optional)
  • probing
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16
Q

where do smooth-surface caries occur?

A

facial and lingual surfaces, particularly in gingival areas that are less accessible for cleaning

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17
Q

what is the earliest clinical evidence of incipient smooth-surface caries?

A

white spot that is visually different from the adjacent translucent enamel and, in contrast to enamel hypocalcification white lesions, partially or totally disappears from vision by wetting

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18
Q

why are both incipient white spot lesions and hypocalcification white lesions undetectably tactilely?

A

because the surface is intact, smooth, and hard

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19
Q

what is the treatment for incipient white spot lesions?

A

preventive treatment should be instituted to promote remineralization of the lesion

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20
Q

the presence of several facial (or lingual) smooth-surface caries lesions in the same patient suggest ___

A
  • a high caries rate
  • the gingival third of the facial surfaces of maxillary posterior teeth and the gingival third of the facial and lingual surfaces of mandibular posterior teeth should be evaluated carefully in these patients
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21
Q

how do advanced smooth-surface caries present?

A
  • they exhibit discoloration and demineralization and feels soft to penetration by the explorer
  • discoloration ranges from white to dark brown, with rapidly progressing caries usually being light in color
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22
Q

why does discoloration occur in a smooth-surface lesion in someone with low caries activity?

A
  • darkening occurs over time because of extrinsic staining, and remineralization of decalcified tooth structure occasionally may harden the lesion
  • this lesion may sometimes be rough, although cleanable, and a restoration may not be indicated except for esthetics
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23
Q

the dentin in an arrested remineralized lesion is termed ___

A

sclerotic

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24
Q

how do early root caries present?

A

well-defined discolored area adjacent to the gingival margin, typically near the CEJ

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25
Q

root caries is found to be softer than adjacent sound tissue, and lesions typically spread ___

A

laterally around the CEJ

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26
Q

how are active root caries detected?

A

by the presence of softening and cavitation

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27
Q

although root caries may be detected on radiographic examination, ___ is critical

A
  • a careful, thorough clinical examination

- differentiation of a caries lesion from cervical burnout radiolucency is essential

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28
Q

in root caries lesions, a difficult diagnostic challenge is a patient who has attachment loss with no gingival recession, limiting accessibility for clinical inspection. these rapidly progressing lesions are best diagnosed using ___

A

vertical bitewing radiographs

29
Q

what are 11 distinct conditions that may be encountered when amalgam restorations are evaluated?

A
  • amalgam “blues”
  • proximal overhangs
  • marginal ditching
  • voids
  • fracture lines
  • lines indicating the interface between abutted restoration
  • improper anatomic contours
  • marginal ridge incompatibility
  • improper proximal contacts
  • recurrent caries
  • improper occlusal contacts
30
Q

what do amalgam “blues” result from?

A

either from leaching of corrosion products of amalgam into the dentinal tubules or from the color of underlying amalgam as seen through translucent enamel

31
Q

what can cause the blue hue from amalgam “blues” that is the result of the color of underlying amalgam as seen through translucent enamel?

A

when the enamel has no dentin support, such as undermined cusps, marginal ridges, and regions adjacent to proximal margins

32
Q

what is the treatment for amalgam “blues”?

A
  • when other aspects of the restoration are sound, amalgam blues are not indicative of caries, do not warrant classifying the restoration as defective, and require no further treatment
  • however, replacement may be considered for esthetics or for areas under heavy functional stress that may require a cusp capping restoration to prevent possible tooth fracture
33
Q

how are proximal amalgam overhangs diagnosed?

A

visually, tactilely, and radiographically

34
Q

what is marginal or gap ditching of amalgam restorations? what is the treatment?

A
  • shallow ditching less than 0.5mm deep
  • usually does not require replacement because it usually looks worse than it is
  • self-sealing property of amalgam allows the restoration to continue serving adequately if it can be cleaned and maintained
35
Q

when is the treatment (restoration replacement) for a marginal or gap ditch of an amalgam restoration indicated?

A

if the ditch is too deep to be cleaned or jeopardizes the integrity of the remaining restoration or tooth structure

36
Q

how are voids in amalgam treated?

A

if the voids are accessible and located in marginal areas where the enamel is thicker, they may be corrected by recontouring or repairing with a small restoration

37
Q

how are fracture lines detected?

A

clinical examination

38
Q

T or F:

lines indicating the interface between abutted restorations are detected by clinical examination and are acceptable

A

true

39
Q

what cases of improper anatomic contours of an amalgam restoration warrant replacement of the restoration?

A
  • impinging on the soft tissue
  • present recurrent caries
  • have inadequate occlusal contacts
  • have inadequate embrasure form or proximal contact
  • or prevent the use of dental floss
40
Q

clinical examination of composite and other tooth-colored restorations is similar to amalgam, except more emphasis is given to ___

A

esthetics, especially in anterior regions

41
Q

T or F:

clinical examination of cast restorations is similar to amalgam and composite

A

true

42
Q

what are the most helpful diagnostic radiographs for proximal-surface caries, restoration overhangs, or poorly contoured restorations?

A

posterior bitewings and anterior PAs

43
Q

proximal-surface caries present radiographically as a radiolucency in the proximal enamel at or gingival to the contact of the teeth. the radiolucency is typically triangular and has its apex toward the ___

A

DEJ

44
Q

what are the 4 steps of developing a dental treatment plan for a patient?

A
  1. examination and problem identification
  2. decision to recommend intervention
  3. identification of treatment alternatives
  4. selection of the treatment with the patient’s involvement
45
Q

what is the success of the treatment plan determined by?

A

its suitableness to meet the patient’s initial and long-term needs

46
Q

what is the order of treatment plan sequencing?

A
  1. urgent phase
  2. control phase
  3. reevaluation phase
  4. definitive phase
  5. maintenance phase
47
Q

incipient caries lesions are contained entirely within ___

A

enamel

48
Q

what are the two basic treatment options for incipient caries?

A
  1. remineralization followed by regular monitoring (more preferred treatment)
  2. restoration, with the preparation done as conservatively as possible
49
Q

what are the 6 criteria that warrant restoration?

A
  1. elevated caries risk
  2. low frequency of routine dental care because of lack of motivation
  3. lesions extends to DEJ
  4. esthetic treatment
  5. treatment of abrasion, erosion, attrition, and abfraction
  6. root surface caries
50
Q

___ is mechanical wear secondary to abnormal forces

A

abrasion

51
Q

___ is wear secondary to chemical presence

A

erosion

52
Q

___ is normal tooth wear

A

attrition

53
Q

___ is biochemical loading that causes loss of tooth structure in the cervical area

A
  • abfraction
  • usually due to occlusal forces causing the tooth to bend, making microfractures in the cervical thin enamel, which is removed even more rapidly as a result of additional toothbrushing abrasion
54
Q

what is an important consideration in the restorative treatment planning of significant attrition?

A
  • complete occlusal analysis and an in-depth interview with the pt regarding the etiology should be conducted to reduce contributing factors
  • bite guard therapy should be considered
55
Q

abraded or eroded areas should be considered for restoration only in what cases?

A

if one or more of the following exists:

  • area has caries involvement
  • the defect is sufficiently deep to compromise the structural integrity of the tooth
  • intolerable sensitivity
  • defect contribute to perio problems
  • area is involved in design of RPD
  • too close to the pulp
  • pt desires esthetic improvements
56
Q

in the restoration of root caries lesions, care must be exercised to distinguish the active root-surface caries lesion from the root-surface lesion that was previously active but has become inactive (arrested). how can you distinguish between the two?

A

-the latter lesion shows eburnated dentin (sclerotic dentin) that has darkened from extrinsic staining, is firm to the touch of an explorer, may be rough but is cleanable, and is seen in patient (usually older) whose oral hygiene and diet in recent years are good.

57
Q

the most accepted theory of the cause of root-surface hypersensitivity is the ___ theory

A
  • hydrodynamic
  • the pain results from indirect innervation caused by dentinal fluid movement in the tubules that stimulates mechanoreceptors near the predentin
58
Q

what are some of the causes of fluid shifts described in the hydrodynamic theory of root-surface hypersensitivity?

A
  • temperature change, air drying, and osmotic pressure
  • any treatment that can reduce these fluid shifts by partially or totally occluding the tubules may help reduce the sensitivity
59
Q

how is root-surface hypersentivity treated?

A
  • dentin-bonding agents provide the best rate of success
  • also topical fluoride, fluoride rinses, oxalate solutions, sealants, iontophoresis, and desensitizing agents
  • when these methods fail to provide relief, restorative treatment is indicated
60
Q

T or F:
repairing and resurfacing composite, amalgam, or cast restorations, even when the defect is isolated and removal of all carious tooth structure is confirmed, is never an acceptable treatment

A
  • false

- it is acceptable and often preferable to repair or recontour

61
Q

what are indications for replacing existing restorations?

A
  • significant discrepancies
  • risk of fracture or caries
  • negative etiologic factor to adjacent teeth or tissue
  • marginal void that cannot be repaired
  • proximal contour or gingival overhang that contributes to perio breakdown
  • marginal ridge discrepancy that contributes to food impaction
  • overcontour that results in a plaque trap and inflammation of gingiva
  • proximal contact that is either open or improper in location/size
  • recurrent caries
  • ditching deeper than 0.5mm
  • unacceptable esthetics
  • in many cases, recontouring or resurfacing the existing restoration can delay replacement
62
Q

T or F:

the ADA has indicated that composite restorations should have a clinical longevity similar to amalgam restorations

A

true

63
Q

what are the indications for indirect tooth-colored restorations?

A
  • class I and II restorations
  • good esthetics, strength, and other bonding benefits
  • more costly than direct tooth-colored restorations
64
Q

although processed composite (indirect) restorations possess improved ___ over direct composites, they are indicated primarily for conservative class I and II preparations in areas with low to moderate ___

A
  • wear resistance

- stress

65
Q

feldspathic porcelain inlays and onlays for class I and II restorations are highly ___ but are associated with a relatively high incidence of ___, especially if subjected to ___

A
  • esthetic
  • fracture
  • heavy occlusal forces
  • porcelain restorations also have the potential to wear opposing tooth structure
66
Q

what are the benefits of cast ceramic inlays and onlays for class I and II restorations?

A
  • excellent marginal fit
  • low abrasion to opposing tooth structure
  • superior strength compared with processed composite or feldspathic porcelain
  • excellent esthetic alternative to cast metal restorations
67
Q

what is CAD/CAM?

A
  • computer-aided design (CAD) and computer-aided manufacturing (CAM)
  • inlays, onlays, and crowns
  • fabricated chairside, so only one appointment is required for placement compared with two appointments for other types of indirectly fabricated tooth colored restorations
68
Q

what are the indications for cast metal restorations?

A
  • patients undergoing occlusal rehabilitation
  • teeth with deep subgingival margins (cast metal restorations provide a better opportunity for control of proximal contours and for restoration of the difficult subgingival margin compared with amalgam and composite restorations)

NBDE II (35 decks)

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