Flashcards in Restorative 2 Deck (106):
what is the 'Gate Control Theory'?
-melzack and wall 1965
-possible explanation of how pain can be modulated in the spinal cord and physiological, pyschological and sociolocultural factors contribute to the experience
What pain index is often used for adults?
-McGill pain index
what pain index is often used for children?
-Wong-Baker pain index
What is a placebo?
-An inert medicine given for its suggested effects, but has no pharmacological benefits but can have psychological benefits
what word should be avoided when doing treatment?
how can anxiety be reduced?
-initial explanation of things
-calm and instruct the patient to be calm
-warn the patient if there is any discomfort to be expected
-give the pt control and help them to cop (eg. breathing exercises)
what is the aim of analgesia?
-elimination of pain
-reduction of haemorrahe
what is the physiology of a nerve?
What are two parts of a nerve that contribute to conduction?
-nodes of ranvier
-end feet synapse
what are 4 pain producing substances that are produced by injured tissue?
what are the 4 phases of physiological conduction?
what happens in the polarisation stage (1st stage) of physiological conduction?
-pottasium inside the cytoplasm and sodium outside
what happens in the depolarisation stage?
-pottasium now higher concentration outside the cell and sodium now higher inside the cell
what stage of physiological conduction is the same as 'resting'?
-polarisation is the same as resting as there is now pain
what are the 6 contents of LA?
(Long Vales Reduce People From Climbing)
what is the gold standard LA?
what is prilocaine less effective at?
-less effective in controlling haemorrhage
what is articaine useful for?
what are 3 advantages of using epinephrine?
-more profound anaesthesia
is felypressin better or worse at haemorrhage than epinephrine?
-felypressin is not as good at haemorrhage as epinephrine
what are some precatutions required for safe analgesic?
-good pt cooperation
-enrolled with GDC
-self aspirating syringe
-MH checked and updated at each dental visit
how may toxicity due to LA occur?
if a pt shows signs/symptoms of allergy to LA who should they be referred to?
what LA is latex free?
how many LA cartridges is max. for cardiac pt's?
what is the dose needed of LA to induce labour?
what nerve are you aiming for when you anaesthatise the apex of 12?
-anterior superior alveolar nerve
can therapists carry out indirect restorations?
-no. therapists can only carry out direct restorations
what does the word 'onlay' mean?
-overlying the cusps of the teeth
what is attrition?
-tooth to tooth surface lost
what is abrasion?
- abrasion from a foreign object in the mouth
what is erosion?
-acid causes tooth loss
what is abfraction?
-loss of tooth due to flexural forces
-stress from occlusal overload
what is micro-preperation?
-hand pieces and burs of reduced size keep cavity to a minimum
what is sonic preperation?
-handpiece's work by vibration rather than rotation
what is 'air abrasion'?
-spray aluminium oxide particles through a fine angled nozzle
what are some advantages of air abrasion?
-no LA required
what are some disadvantages of air abrasion?
-lots of contamination
what can lasers remove?
-soft and hard tissue
what is meant by 'ozone'?
-where bacteria in caries is identified with a laser and it delivers 'active' oxygen molecules through suction cup to desired area
-this kills certain types of cariogenic bacteria
what are some disadvantages to 'ozone'?
-not much scientific research been done about it
what is Atraumatic Restorative Treatment (ART) ?
-hand excavaion, restore with GI
what are some advantages of ART?
-ideal for under developed countries and for very nervous patients
what are some disadvantages of ART?
-often not all the caries is removed
do you take maxillary or mandibular impressions first?
what are the 6 steps to taking impressions?
1-prepare the patient
2-assemble the materials and equipment
3-select and prepare the impression trays
4-take mandibular impression
5-take maxillary impression
6-take the interoclussal record for occluding the casts
to prevent cross contamination of the impressions. what is done to stop this?
what disinfection material is used in DDH?
what is another name used fr the 'interocclusal record'?
-the wax bite
who classified cavity preperations?
-Greene Vardiman Black (GV Black)
what is GV Black class 1?
-occlusal surfaces of molars and premolars, buccal pits of molars
what is GV black class 2?
-approximal surfaces of molars and pre molars
what is GV Black class 3?
-approximal surfaces of incisors/canines
what is GV Black class 4?
-icisal edges of incisors and canines
what is GV Black class 5?
-cervical margins of teeth
what are some disadvantages of blacks classification?
-was used before adhesive materials were available, therefor retentive cavities needed to be cut
-removes more tooth substance than necessary
-does not include root or secondary caries
what are 6 principles relating to cavity preperation?
(what steps do you do...)
1. Outline form
4.tx of residual caries
5.correction of enamel margins
what is outline form?
-gaining access to the caries
what is resistance form?
-to resist occlusal forces
-make sure cavity floor is at right angle to the direction of occlusal forces
what is retention form?
-designs to retain the material in the cavity
what are some forms of retention?
-'grooves' in wall of cavity
-use of undercuts and occlusal key
-use of acid etch and bonding agents
-dentine pins (therapists cannot use these)
what happens in the stage 'treatment of residual caries'?
-removing caries from the enamel-dentine juntion first (peripheries) then moving onto the base of the cavity
when is firm but stained dentine removed?
-only on anterior teeth if it shows through the enamel
what happens in the stage 'correction of enamel margins'?
unsupported enamel is weak and prone to fracture
-sometimes a bevel to increase surface area for bonding
what happens in the stage 'cavity debridement'?
-cavity should be thoroughly washed and dried to remove debris and bacteria
what is line angle?
-where two surfaces meet
what is cavosurface angle?
where the cavity wall meets the surface (90-110 degrees)
what is another name used for hidden occlusal caries?
what is the technique for doing sealant restoration?
(exam Q last year)
-take occlusal registration(outline form)
-add lining if necessary
-acid etch, prime and bond to cavity walls and margins
-build up cavity with comp. resin
-apply acid etch to remaining fissures
-thoroughly wash acid etch of fissures
-apply fissure sealant to remaining fissures
what is technique for conventional restoration?
-occlusal registration (outline form)
-apply lining if necessary
-acid etch, prime and bond
-restore with 2 mm increments of composite
-finish with polishing burs or one gloss
what must always be checked after doing a restoration?
-occlusion must always be checked after doing a restoration
if a cavity is within 2 mm of pulp do you need a lining?
if cavity is 0.5mm or less close to the pulp what do you do?
-dycal and GI
what is dycal?
what are some disadvantages of tunnel preperation?
-marginal ridge is prone to fracture
-not always good access to caries at ADJ
what is root caries usually filled with?
cervical caries is a sign of what?
-high caries risk
what are some risk factors for root caries?
-repeated carbohydrate rate intake
-partial denture wearing
-high caries experience
-high salivary counts of S.mutans and lactobacilli
what are 3 functions of fissure sealant?
what are the 3 different etching patterns?
type 1: -prism core removed, peripheral material left
type 2: -prism core remains intact, peripheral regions removed
type 3: -haphazard effect. does not work very well
what is bruxism?
-involves grinding and clenching of the teeth
what are some signs and symptoms or bruxism?
-abnormal rate of attrition
-hypertrophy of masticatory muscles
-pulpal sensitivity to cold
what are the 4 different types of abrasion?
what are some signs of erosion?
-palatal chipping of incisal edges
-smoothed and polished surfaces
-cupping of lower molar cusps
what are some examples of extrinsic erosion?
-sucking citrus fruits
-swimming in heavy chlorinated water
what are some examples of intrinsic erosion due to reflux?
-gastro oesophageal reflux
-stress reflux syndrome
what are some examples of intrinsic erosion due to vomitting?
what are some clinical signs of bulimia?
-normal body weight
-erosion of palatal surfaces of upper teeth
-lesions on palate, fingers, oral mucosa, lips
-signs of malnutrition
what does NCTTL stand for?
Non-carious tooth tissue loss
what 3 things do you protect the pulp from?
what is galvanic shock?
metal on metal with no insulation. Electrolytes occurs due to saliva
cavity preperation 'insults' the pulp. This results in what?
increased inflammatory cell infiltrate
what does the 'smear layer' do?
occludes the dentinal tubules
what are some features of the ideal pulp protector?
-gives good coronal seal
-strength to withstand restoration placement
what are some features of calcium hydroxide (dycal)?
-high pH initially irritates the pulp causing reactionary dentine to be laid down
-not adhesive so there is no coronal seal
give an example of zinc polycarboxylate cement?
what are some features of zinc polycarboxylate cement?
-high molecular weight reduces penetration to tubules, only mildly irritant to the pulp
-sufficient strength for restoration placement
give an example of zinc oxide eugenol
what are some features of zinc oxide eugenol?
-slight irritancy to the pulp
-very obtundant to the pulp
-zinc oxide eugenol is not compatible with resin composite
what are some features of zinc phosphate?
-not obtundant to the pulp
what is an indirect pulp cap?
when cavity is extended to 0.5mm of pulp and calcium hydroxide placed at the deepest part of the restoration.
what is a direct pulp cap?
-when an exposed pulp is covered by capping materials
what is the criteria for direct pulp capping?
-tooth is vital
-no history of pain in the tooth
-no evidence of periradicular pathology
-pulp is pink and health
when does GI fully set?
not till 24hrs after
what is the treatment plan order?