Restorative Procedures 1 (Midterm Review: Outcomes 1-5) Flashcards
1
Q
What is Restorative Dentistry?
A
Type of dentistry that restores teeth to their ideal structure through the use of direct and indirect restorative material.
2
Q
What role do DAs play in restorative dentistry?
A
- Be familiar with procedure & anticipate need of dentist
- Set up for procedure
- Provide moisture control
- Transfer instruments
- Provide proper mix of materials
- Perform any legal expanded functions
- Maintain patient comfort
- Maintain IPC
3
Q
What are the procedures/methods used for diagnosing decay (dental caries)? Briefly describe each method
A
- Dental explorer
- When the sharp tip of an explorer is pressed into an area of suspected caries, it will “stick” when being removed - Radiographs
- A dark “shadow” will appear on radiographs when decay is present (often 2x deeper & more widespread than it appears on radiographs) - Visual appearance
- Gray shadowing underneath enamel can indicate decay - Indicator dyes
- Dye applied to the inside of a cavity preparation can indicate through colour change whether decay remains - Caries detection devices
- Detects bacterial by-products and quantify sound signals to aid in caries detection - Laser caries detector
- Reveals bacterial activity underneath the enamel surface. (Does not detect interproximal, subgingival, secondary caries or decay under restorations)
4
Q
What is anxiety and pain control?
A
The practice of various psychological, physical, and chemical approaches to prevent and treat pre-operative, operative, and post-operative anxiety and pain
5
Q
Anesthesia
A
Administration of a medication to provide a temporary loss of feeling or sensation
6
Q
Anesthetics
A
Medication that produces a temporary loss of feeling or sensation
7
Q
Methods to alleviate/reduce anxiety and pain
A
- Topical anesthesia
- Local anesthesia
- Inhalation sedation
- Anti-anxiety agents
- Intravenous (IV) sedation
- General anesthesia
- Mind-body medicine
8
Q
Topical Anesthesia
A
A gel, liquid (rinse), or spray that provide a temporary numbing effect on nerve endings located on the surface of the oral mucosa (a specific area where an injection is to take place)
9
Q
Local Anesthesia
A
Temporarily blocks the normal generation and conduction action of the nerve impulses
10
Q
Characteristics of local anesthetics
A
- Non-irritating to the tissues in the area of the injection
- Associated with minimal toxicity
- Rapid onset
- Able to provide profound anesthesia
- Sufficient duration of action
- Completely reversible
- Sterile or capable of being sterilized by heat without deterioration
11
Q
What are needle gauges and the different types?
A
- Gauge = needle thickness
- # 30 gauge = used to anesthetize maxillary arch. The needle is very thin and short
- # 27 gauge = used to anesthetize mandibular arch. The needle is very thick and long
The larger the gauge number, the thinner and shorter the needle
12
Q
List 4 steps to safely operate a dental syringe.
A
- Always use new needle, new anesthetic carpule, sterile syringe
- Point needle away from you when loading and unloading syringe
- Never touch needle with your hands
- Ensure anesthetic carpule is appropriate for your patients medical history
13
Q
How is local anesthetic administered to the patient?
A
Subgingival (below the gumline; enters the blood stream)
*Note: the opposite of subgingival is supragingival (above the gumline; does not enter blood stream)
14
Q
What is the purpose of a vasoconstrictor in anesthetic?
A
To slow down the intake of an aesthetic agent and increase the duration of action
15
Q
What type of patient should a vasoconstrictor not be used on?
A
Patients who have:
- Heart disease
- High blood pressure
- Medications that have contra-indications
- Anxiety or fears
- Previous negative reactions
16
Q
Which cartridge contains the most epinephrine: 1:200,000; 1:100,000; or 1:50,000?
A
1:50,000 (for longer duration because it contains twice as much epinephrine)
1 part (drop) of epinephrine per 50,000 parts of anesthetic solutions
17
Q
Side effects of epinephrine
A
- Nervousness
- Excitement
- Muscular twitching
- High blood pressure
- Increase heart rate & respiration
18
Q
List the guidelines for handling anesthetic cartridges.
A
- Should be stored at room temperature and protected from direct sunlight
- Never use a cartridge that has been frozen
- Do not use a cartridge if it is cracked, chipped, or damaged in any way
- Never use a solution that is discoloured or cloudy or expired
- Do not leave syringe preloaded with the needle attached for an extended period
- Never save a cartridge for reuse
19
Q
The area in the mouth where topical and local anesthetic is placed.
A
Mucobuccal Fold
20
Q
List all the maxillary anesthesia location and briefly describe them.
A
- Local infiltration = completed by injecting into a small, isolated area
- Field block = when the injection is placed near a larger terminal nerve branch
- Nerve block = when local anesthetic is deposited close to a main nerve trunk (indicated for quadrant dentistry)
21
Q
3 different types of nerve blocks
A
- Anterior superior alveolar (ASA)
- Middle superior alveolar (MSA)
- Posterior superior alveolar (PSA)
22
Q
Where are the Greater Palatine and Nasopalatine Blocks located?
A
5-10mm from the free gingival margin of the operative tooth
Greater palatine = posterior portion of the hard palate
Nasopalatine = anterior hard palate
23
Q
List all the mandibular anesthesia location and briefly describe them.
A
- Inferior alveolar nerve block (or mandibular nerve block) = anesthetic is injected near, but not into the branches of the inferior alveolar nerve
- Buccal nerve block (or long buccal nerve block) = provides anesthesia to the buccal soft tissues of the mandibular molars
- Incisive nerve block = injection is given at the mental foramen, only given when the mandibular premolar or anterior teeth require anesthesia
24
Q
Post-operative instructions to inform the patient
A
- Avoid hot and cold foods
- Chew on other side of mouth
- Avoid biting cheek or tongue
- Let them know how long topical and local anesthetics will last
- Go for a casual walk (get heart rate up = wears anesthesia quicker)
25
How long will topical anesthetics last?
15 minutes
26
How long will local anesthetics last?
2-4 hours (depending on epinephrine content)
27
Induction time vs. Duration time
Induction time = the length of time from the injection of the anesthetic solution to complete an effective conduction blockage
Duration time = the length of time from induction to complete reversal of anesthesia
28
Chemical composition of local anesthetics
1. Amides (local anesthetics) = metabolized in liver
2. Esters (topical anesthetics) = metabolized in the plasma
29
Types of time spans of anesthetics
1. Short acting = last approximately 30 minutes
2. Intermediate acting = approximately 60 minutes (most commonly used)
3. Long acting = 90 minutes
30
Factors that impact anesthetic duration
1. Type of injection
2. Amount of anesthetic injected
3. Location of injection
31
List the complications and precautions for anesthetics.
1. Injecting into a blood vessel
- Can alter function of vital organs, mainly heart. The DDS will aspirate the syringe before injection
2. Infection
- Anesthetic agents may be delayed or prevented if injected into infection
- Inflammatory infection LOWERS the pH, which interferes with anesthetic penetration.
- It can also possibly diffuse the infection
3. Toxic reactions
- Localized reactions (contact dermatitis)
- Systemic reactions (systemic toxicity can manifest in the central nervous system)
4. Temporary numbness
- Patient feels that their lip/tongue/cheek feels "fat", may bite tissue inadvertently
5. Paresthesia (Can be temporary or permanent; most cases are resolved in ~ 8 weeks)
- Condition where numbness lasts after the local anesthetic has worn off
- This can be caused by the following:
□ Trauma to the nerve sheath during injection
□ Bleeding into or around the nerve sheath
□ Use of contaminated anesthetic solution
32
Electronic anesthesia and the benefits of it.
A non-invasive method to block pain electronically with the use of a low-level current of electricity through contact pads that target a specific electronic waveform directly to the nerve bundle at the root of the tooth
Benefits:
- No needles
- No post-op numbness or swelling
- Chemical free
- No cross contamination risk
- Reduced fear and anxiety in patients
- Patient control over own comfort level
33
Types of Dental Sedation
1.Intravenous (IV) sedation
2. Unconscious Sedation
3. Inhalation Sedation
4. Oral Sedation
34
Inhalation Sedation & its effects
- Nitrous oxide/oxygen (N2O/O2)
□ Combination of gases inhaled to help eliminate fear and to aid relaxation
- Effects:
□ Non-addictive
□ Onset is easy, effects are minimal, rapid recovery
□ Stage 1 anesthesia
□ Dulls the perception of pain
35
Advantages & Disadvantages of Inhalation Sedation
1. Advantages
- Administration is simple and easily managed
- Services of anesthetist or other special personnel not required
- Excellent safety record
- Patient is awake
- Can be used with patients of all ages
- Minimal side effects
- Rapid recovery
2. Disadvantages
- Some patients may experience nausea or vertigo
- Patients who have behavioural problems may react in negative way and act out those behaviour issues
36
Contraindications for Inhalation Sedation
- Pulmonary disorders
- Respiratory disorders
- Pregnancy
- Psychiatric
- Immune compromised
- Multiple sclerosis
- Middle ear blockage
- Nasal obstruction
- Emphysema
- Emotional instability
37
Inhalation Sedation Administration
- Ask patient to refrain from speaking or mouth breathing while nitrous is being administered
- No set dosage regimen as patients can react differently to treatment from one appt. to next
- Assess patient for dizziness, headache or lethargy once nitrous has been removed
38
Safe Practices for Inhalation Sedation
1. Scavenger System:
- reduces nitrous oxide released into the treatment room
2. Venting exhaust fumes outside
- exposure overtime has proven adverse health effects
- ventilation should not be close to fresh-air intake vent
3. Testing pressure conditions
- soap solution is applied to lines to test for leaks
4. Inspection of equipment
- look for wear, tear, cracks, holes, & replace any damaged parts
5. Properly fitting mask
38
Safe Practices for Inhalation Sedation
1. Scavenger System:
- reduces nitrous oxide released into the treatment room
2. Venting exhaust fumes outside
- exposure overtime has proven adverse health effects
- ventilation should not be close to fresh-air intake vent
3. Testing pressure conditions
- soap solution is applied to lines to test for leaks
4. Inspection of equipment
- look for wear, tear, cracks, holes, & replace any damaged parts
5. Properly fitting mask
39
Anti-anxiety Agents
Drug of choice for physicians and dentists seeking to relieve anxiety in their patients
40
What is the criteria for the use of Anti-anxiety agents?
- Patient is very nervous about a procedure
- Procedure is long or difficult
- Patient is mentally challenged
- Patient is very young child requiring extensive treatment
41
Intravenous (IV) Sedation
Anti-anxiety drugs administered IV throughout a procedure at a slower pace, providing a deeper Stage 1 analgesia
42
Explain the procedures that must occur during IV Sedation administration.
Prior to administration a health exam (including patient weight) and a signed consent
- Baseline vitals are taken, blood O2 levels recorded
- IV line should be continuously monitored to make sure that there is no inflammation or pain at the insertion site or that the needle has not become dislodged, leaking, clotted or cracked
- Physiologic measurements should be recorded at least every 15 minutes
- Supplemental oxygen and a defibrillator must be available for immediate use in case of emergency
43
General Anesthesia
A controlled state of unconsciousness with a loss of protective reflexes - including the ability to maintain an airway independently and to respond appropriately to physical stimulation or verbal command - that produces Stage III general anesthesia
44
Explain the 4 stages of Anesthesia
i. Stage 1:
□ Patient is relaxed and fully conscious
- Patient experiences a sense of euphoria and reduction in pain
- Vital signs are normal
ii. Stage 2:
□ Excitement stage
□ Patient is less aware
- Patient may lose consciousness, vomit, or become unmanageable
□ Undesirable stage
iii. Stage 3:
□ General anesthesia
□ Patient feels no pain or sensation
- Patient becomes unconscious
- Can be achieved only under the guidance of an anesthesiologist in a controlled environment
iv. Stage 4:
□ Respiratory failure or cardiac arrest
□ If not quickly reversed, it can result in death
45
What do you document for anesthesia and pain control?
Always document the following measures and observations:
- Review of patient's medical history
- Pre-operative and post-operative vital signs
□ Vitals should be documented every 15 mins. in patient chart during IV, general and oral sedation
- Patient's tidal volume if inhalation sedation is being used
- Times at which anesthesia began and ended
- Peak concentration administered
- Post-operative time (in minutes) required for patient recovery
- Adverse events and patient complaints
46
How do you prepare the patient for anesthesia?
- Patient undergoes a pre-operative physical exam and signed consent is completed
- Most appointments are scheduled in the early morning as the patient cannot eat or drink for 8-12 hours before the procedure
- Patient must have someone to drive them home
- Once the procedure is completed, the patient is monitored closely until normal reflexes return
(Patient should NOT be left alone while regaining consciousness)
47
Mind-Body Medicine & the techniques
Methods of reducing anxiety and pain through different non-pharmacologic techniques
Common techniques used:
- Distraction (e.g. listening to music, watching iPad)
- Relaxation (e.g. guided techniques, deep breathing, biofeedback, hypnosis, acupuncture)
48
Black's Classification
The standard classification system for notating carious lesions
49
Class I Lesions
- Occurs on pits and/or fissures
- Can also appear on buccal or lingual
- Examples: 4.5 occlusal pit, 4.6 occlusal pit, 1.1 lingual pit
50
Class II Lesions
- Occurs on posterior teeth only
- Involves the interproximal surface
* Two-surface restoration of posterior teeth
* Three-surface restoration of posterior teeth
* Multi-surface, four-surface (or more) restoration of posterior
- Examples: MOD, MODB
51
Class III Lesions
- Anterior teeth only
- Involves interproximal surface only
- Examples: 1.1 M, 1.2 D, 3.3 M
52
Class IV Lesions
- Interproximal surface and incisal edge of anterior teeth only
- Examples: 1.1 MIL, 1.2 DIL
53
Class V Lesions
- Gingival third of lingual or buccal (facial) surface on any tooth
- Examples: 1.1 F, 1.1 B,1.2 F, 1.2 B, 1.2 L
54
Class VI Lesions
- Physical or chemical wear on the incisal or occlusal edge on any tooth
- Examples: 4.6 pit wear, 2.5 cusps wear
55
Types of Dental Caries & Where they occur
1. Primary caries = cavities or dental caries
- Occur on unrestored teeth
2. Recurrent or Secondary caries
- Occur around restorations
- Require replacement
3. Rampant caries
- Widespread areas of caries occurring simultaneously
56
Classifications of cavities involving surfaces
1. Simple Carious Lesions
- Involves only 1 tooth surface
- Examples: 4.6 O, 3.5 B
2. Compound Carious Lesions
- Involves 2 tooth surfaces
- Examples: 4.5 MO, 4.6 DO
3. Complex Carious Lesions
- Involves 3 or more tooth surfaces
- Examples: 4.7 MOD, 2.1 MIL
57
Explain cavity preparation and the knowledge needed in preparing a permanent restoration.
Cavity preparation = the process of removing diseased tooth structure
When preparing a tooth for a permanent restoration, the dentist has required knowledge about:
- Direction of enamel rods
- Thickness of enamel
- Body of dentin
- Size and position of the pulp
- Crown of tooth as it relates to the gingival tissues
58
Describe the steps in initial cavity preparations.
1. Outline form
□ Design and initial depth of sound tooth structure
□ Overall size/shape of the restoration
□ Related to the size of the tooth
□ Amount of decay
2. Resistance form
□ The primary shape and placement of the cavity walls is determined
3. Retention form
□ Designed to prevent the tooth and the restoration from fracturing from biting forces
4. Convenience form
□ Describes modifications necessary to enable proper instrumentation (size)
□ Accessibility in preparing and restoring the tooth
59
Describe the steps in final cavity preparations.
Slow speed handpiece and hand cutting instruments
1. Removing any enamel, diseased dentin or old restorative material (or a combination)
2. Inserting additional resistance and retention notches, grooves, and coves
3. Placing protective dental materials (lining agents, bases, desensitizing, or bonding agents)
60
Dental Dam
A thin, stretchable material that becomes a barrier when it is appropriately applied to selected teeth.
- When in place, only selected teeth are visible through the dam
- Routinely placed after local anesthetic has been placed (placed in ~ 2 minutes)
61
Indications for Dental Dam
1. Serves as an infection control barrier
2. Safeguards the patients mouth against contact with debris, dental materials or other liquids
3. Protects patient from aspirating or swallowing debris
4. Protects tooth from contamination by saliva or debris if pulpal exposure accidentally occurs
5. Protects oral cavity from exposure to an infected tooth opened during endo treatment
6. Provides moisture control essential for restorative material placement
7. Improves access by retracting lips, tongue, and gingiva from the field of operation
8. Provides better visibility because of contrasting colours between the dam and tooth
9. Increase efficiency by discouraging patient conversation and reducing the time required for treatment
62
Contraindications for Dental Dam
1. Patient concerns (i.e. claustrophobia)
2. Physical conditions, asthma, nasal congestions or lesions around the area of treatment
3. Condition in the mouth (i.e. mobile teeth, partially erupted teeth or severe misalignment)
63
Characteristics of a Dental Dam
- Made of either latex or latex-free material
- Available in continuous roll or in two precut sizes (6x6 or 5x5)
- Available in wide range of colours from light to dark
- Available in scented or flavours
- Dam thickness (gauges): thin (light), medium, and heavy
64
Instruments & materials used for Dental Dam preparation
1. Dental Dam
2. Dental Dam Punch
3. Dental Dam Frame
4. Dental Dam Forceps
5. Dental Dam Clamp
6. Dental Dam Ligature
7. Dental Dam Napkin
65
What is a Dental Dam Punch? Explain the characteristics.
- Creates the holes in the dental dam that are needed to expose the teeth to be isolated
- Characteristics:
□ 5 largest hole: clamped
□ 4 large hole: molars
□ 3 medium hole: premolars
□ 2 small hole: maxillary anteriors
□ 1 smallest hole: mandibular anteriors
66
What is a Dental Dam Frame?
Stabilizes and stretches the dam so it fits tightly around the teeth and out of operators way
- Available in plastic and metal frames
- 3 different types of dental frames:
Plastic U-shaped, Young frame, Ostby frame
67
Plastic U-Shaped Dental Dam Frame
- Frame is placed under the dam (next to patient's face)
- Radiolucent (does not block x-rays); not necessary to remove when radiographs are required during treatment
68
Young Dental Dam Frame
- Stainless steel U-shaped holder
- Placed on the outside of the dam
- Increases patient comfort by holding the dam away from patient's face
69
Ostby Dental Dam Frame
- Round plastic frame with sharp projections on its outer margin
- Dam is stretched over the outside of the frame
70
How do you use a Dental Dam Forceps?
- Used in the placement and removal of dental dam clamp
- Beaks of the forceps fit into holes on the jaws of the clamp
- Sliding bar keeps the handles of forceps in a fixed position
- Handles are squeezed to release clamp
- Beaks of forceps are turned toward the arch being isolated
71
Function & Components of Dental Dam Clamps
- The primary means of anchoring and stabilizing the dental dam
- Made of chrome or nickel plated steel
- Designed to hold dental dam securely at the end nearest the tooth being treated
Components of dental dam clamp:
□ Bow - rounded portion of clamp
□ Jaws - seat around tooth, creates extension and balance necessary to stabilize the clamp
□ Holes - where forcep prongs enter and retract jaw
□ Prongs - make contact with tooth
□ Winged clamps - extra extensions to help retain the dental dam
72
Anterior Clamp Sizes (Dental Dam)
9, W9
73
Premolar Clamp Sizes (Dental Dam)
00, W00, 2, W2, 2A
74
Molar Clamp Sizes (Dental Dam)
7, W7, 8, W8, 14A, W14A
75
Dental Dam Clamp 13
Used for Quadrant 1 & 3
76
Dental Dam Clamp 12
Used for Quadrant 2 & 4
77
Dental Dam Ligature
A piece of floss tied to the clamp, to allow the clamp to be retrieved should it accidentally become dislodged and/or inhaled by patient
78
Dental Dam Napkin
- Disposable dental dam napkin can be used and is placed between patient's face and dam
- Primary purpose: increase patient comfort by absorbing moisture
- Protects patient's face from direct contact with dam, reducing risk that they may develop a latex sensitivity (if using latex dam)
79
What should be considered when preparing a Dental Dam?
- Each application of dental dam is pre-planned to accommodate the dentists preferences, the tooth or teeth involved, and the procedure to be performed.
- When punching a dam, these should be considered:
□ Maxillary or mandibular arch
□ Shape of arch
□ Any irregularities, missing teeth, fixed prosthesis, or mal-positioned teeth
□ Size and spacing of other holes to be punched
80
How do you apply the Dental Dam on the maxillary arch?
- Punch dental dam 1 inch down from upper edge of dam
- If patient has a mustache or very thick upper lip, it is necessary to allow slightly more than 1 inch margin from edge
81
How do you apply the Dental Dam on the mandibular arch?
- Punch dental dam 2 inch from the bottom edge
- Due to smaller size of mandibular anterior teeth, holes are punched closer together than for posterior teeth
82
How do you apply the Dental Dam on the Anterior dentition?
- Isolation of anterior teeth typically occurs from canine to canine
- When isolation is complete, a dental dam clamp is not required
- Dam is secured using a piece of dental dam or floss
83
What are some problems that could occur with Dental Dam?
a. Holes are too large:
- dam will not fit tightly around tooth
- May allow saliva to leak through
b. Holes are too small:
- Dam will not slip easily over tooth
- May cause dam to stretch or tear and leave gingiva exposed
c. Holes are too close:
- Dam may tear or stretch
- May cause leakage
d. Holes are too far apart:
- Excess material will be present between teeth
- May block dentists vision or catch instrumentation
e. Fixed bridge:
A prosthetic device that is cemented in place that replaces one or more missing teeth
- Because the units of bridge are joined together, it is not possible to place dental dam septum between each tooth
- When punching dam, punch a hole for each crowned tooth, do not punch holes for teeth that are "missing"
84
Why can we not always use the standard template for a Dental Dam?
- Crowding
- Loose teeth
- Missing teeth
- Misaligned teeth
- Narrow or wider arch
85
Explain the pre-operations for Dental Dam procedures to educate the patients.
1. Like a rubber "raincoat" that fits over your tooth
2. Prevents water and debris from getting in your mouth
3. Helps keep the working area dry
4. A small "ring" fits around your tooth to hold the rubber in place
86
Explain the post-operative instructions for Dental Dam procedures to educate the patients.
1. Warm salt water rinses will help any gingiva tenderness in the area worked on today
2. How long local anesthetic will last (if used)
3. Any other post-op relating to the treatment performed that appointment
- i.e. occlusion (chew on other side of mouth, avoiding drinking or eating hot/cold, avoid biting on cheek/tongue)
87
Types of Isolation
1. Cotton Roll
2. Dry Angle
3. Isolite
88
Cotton Roll Isolation
Tightly formed absorbent cotton that is pre-shaped to be positioned close to the salivary gland ducts to absorb flow of saliva and close to working filed to absorb excess water
89
Advantages & Disadvantages of Cotton Roll Isolation
Advantages:
□ Easy application
□ Variety of sizes
Disadvantages:
□ Does not provide complete isolation
□ Does not protect against patient aspiration
□ If removed improperly, it may stick to oral mucosa
90
Cotton Roll Holders (Garmers)
- Designed to hold multiple cotton rolls in a more secure manner for the mandibular quadrant
- Especially important when operator is working alone without an extra pair of hands to maintain isolation
91
Dry Angle Isolation
- Triangular absorbent pads
- Helps isolate posterior areas in maxillary and mandibular arches
- Placed on the buccal mucosa over the Stensen's duct
92
Isolite Isolation
Intraoral suction and retraction
