Flashcards in Study Guide Deck (131):
What is the depression in the gingival tissue under a contact area between the lingual (palatal) papilla and the facial papilla called?
What is the V-shaped spillway space next to the contact area of adjacent teeth, narrowest at the contact and widening towards the facial, lingual (palatal), and occlusal contacts?
What is it called when a cleft in the gingival margin usually at the mesial or distal line angle of a tooth where dental floss was repeatedly applied incorrectly and the line of the cleft can be completely lined with epithelium?
What is the use of forced intermittent or steady stream of water for a cleansing or therapeutic purpose?
What is the flushing of a specific area or site with a stream of fluid; application of a continuous or pulsated stream of fluid to a part of the body for a cleansing or therapeutic purpose?
What is the point of the delivery of the irrigation is placed in the sulcus of the pocket and may reach the base of the pocket depending on its probing depth?
What is Acidogenic?
A chemical that is used for therapeutic reasons?
What is it called when an agent has the ability to bind to the pellicle, tooth surface, and soft tissue and be released over an extended period of time with the retention of its potency?
What is Synergistic Effect?
Coordinated action; acting jointly.
Example: One drug might enhance the effect of another drug.
A chemical with Therapeutic properties that us delivered by rinsing or irrigation device?
Acidulated Phosphate Fluoride
What is a group of minerals of the general formula Ca10(PO4) X2 wherein the X might include Hydroxyl (OH), Carbonate(CO), fluoride(F), Or oxygen (O); Crystalline mineral component of hard tissues (bone and teeth)?
What is Demineralization?
The breakdown of the tooth structure with the loss of mineral content, primarily calcium and phosphorus.
Decayed, missing and filled teeth.
DMFT: Permanent Dentition
dmft: Primary Dentition
What is the form of hydroxyapatite in which fluoride ions have replaced some of the hydroxyl ions; with fluoride, the apatite is less soluble and therefore more resistant to the acids formed from carbohydrate intake?
What is Fluorosis?
Form of enamel hypomineralization due to excessive ingestion of fluoride during the development and mineralization of the teeth; depending on the length of exposure and the concentration of the fluoride, the fluorosed area may appear as a small white spot or as severe brown staining with pitting.
What occurs when foods and beverages processed in a fluoridated community are imported and consumed in a nonfluoridated community and can result in increased fluoride intake by individuals living in non fluoridated communities providing them with protection against caries?
Halo or Diffusion effect
Neutral sodium Fluoride
What is ppm?
Parts per million; measure used to designate the amount of fluoride used for optimum level in fluoridated water, dentifrice, and other fluoride-containing preparations.
What is Remineralization?
restoration of mineral elements in a tooth surface; enhanced by the presence of fluoride; remineralized lesions are more resistant to initiation of dental caries then is normal tooth structure.
in sealant placement, the enamel surface is prepared by the application of phosphoric acid, which etches the surface to provide mechanical retention for the sealant.
bisphenol A-glycidyl methylacrylate; plastic material used for dental sealants.
What is the physical adherence of one substance to another; the adherence of a sealant to the enamel surface is accomplished by an acid-etching technique that leaves microspaces between the enamel rods; the sealant becomes mechanically locked (bonded) in these microspaces
What is Viscosity?
The resistance to flow or alteration of shape by any substance as a result of molecular cohesion.
Fluoride is made available at the tooth surface by what two general means?
Systemically and Topically
By the way of the circulation to developing teeth (preeruptive exposure)
Directly to the exposed surfaces of erupted teeth (posteruptive exposure).
Maximum caries inhibiting effect occurs when what?
there is systemic exposure before tooth eruption and frequent topical fluoride exposure throughout life.
Fluoride is a systemic nutrient taken into the body by the way of
Fluoridated water, dietary supplements, and found in small amounts of food. Varying amounts ingested from toothpaste and mouth rinses.
Fluoride is absorbed by diffusion from where?
the stomach as hydrogen fluoride.
What distributed the fluoride to the tissues and organs?
Fluoride has a strong affinity to which kinds of tissues?
99% of the fluoride in the body is located where?
Concentrations of fluoride are at what surfaces?
surfaces next to the tissue fluid supplying the fluoride.
Which layer of enamel is where most fluoride is distributed?
most outer layer.
Most fluoride is secreted through what?
Pre-eruptive Fluoride is deposited during when?
the formation of the enamel after the enamel matrix has been laid down by ameloblasts.
What does hard tissue formation occur during utero?
How is Fluorapatite formed?
when the fluoride ion replaces some of the hydroxyl ions of the hydroxyapatite.
This is less soluble and more resistant to acids?
Preeruptive fluoride also results in what?
Shallower occlusal pits and grooves which reduces the risk of pits and fissure cavities.
Excessive fluoride during enamel formation results in what?
Dental Fluorosis (the enamel is hypomineralized)
After Mineralization is complete and before eruption fluoride depositions do what?
continue in the surface of the enamel
Children who are exposed to fluoride for the first time within the two years prior to eruption have what?
the greatest amount of fluoride acquired during the preeruptive stage.
During post eruptive exposure to fluoride, the uptake is more rapid on the enamel surface during when?
the first year after eruption where fluoride concentration is the greatest.
What type of enamel absorbs fluoride in greater quantities?
Hypomineralized or decalcified
What are the 5 basic topical effects of fluoride to prevent dental caries?
1. Inhibits demineralization
2. Enhances remineralization
3. Inhibits bacterial activity by inhibiting enolase, an enzyme needed by bacteria to metabolize carbohydrates.
4. Works as desensitizer
5. Inhibits erosion
Fluoridation has been established as the most?
efficient, effective, reliable, and inexpensive means for improving and maintaining oral health.
Fluoride is measured in
In 2015 the US Department of Health and Human Services updated the recommendation for the optimal concentration of water fluoridation to _________ppm for ALL communities.
What did they use to think the fluoride concentration for colder communities should be?
What did they use to think the fluoride concentration for warmer communities should be?
Which fluoride is better for kids due the lesser chance to ingest?
2.0% Sodium Fluoride (NaF) Gel/ Foam is also called
Neutral sodium fluoride due to its neutral pH of 7.0
Which fluoride is the most common for pt. on regular hygiene recall intervals?
1.23% Acidulated Phosphate Fluoride (APF) Gel/Foam is not good for pt. with porcelain, composite restorations, and sealants because
it etches them
APF in recommended to patients with what?
High risk for caries
APF has a pH of what?
3.5 which enhances fluoride uptake
Varnish can be used as what?
Which Fluoride is better for children due to caries inhibiting effect and great diffusibility?
Acute toxicity to fluoride refers to what?
the rapid intake of an excess dose over a short time.
Chronic toxicity to fluoride
applies to long term ingestion of the fluoride in amounts that exceed the approved therapeutic levels.
Acute fluoride poisoning is what?
Adult fluoride Lethal Dose
5-10g of NaF taken at. one time
Child Fluoride Lethal Dose
0.5-1.0g, variable with size and weight
Signs and Symptoms of Acute toxic dose
Nausea, vomiting, diarrhea, abdominal pain, increased salvation, and thirst.
When are the symptoms of fluoride acute toxic dose produced?
when the fluoride in the stomach binds with stomach acid, producing hydrofluoric acid, which is a stomach irritant.
When do the symptoms of fluoride acute toxicity usually begin?
Within 30 minutes of ingestion.
Who shall we not give fluoride to?
Who shall we give fluoride to?
Children at risk for caries
Who shall we give varnish to?
Best for kids
Adults showing root caries
Who shall we give APF fluoride to?
6 years old and older and adult root caries.
What are the emergency treatments for fluoride toxicity?
-Administer fluoride binding liquid when pt. is not vomitting
-Milk of Magnesium
Fluoride is used to protect__________ surfaces, while sealants protect____________.
Smooth; Pits and fissures to prevent occlusal caries
Incidence of new pit and fissure caries can be lowered by _____% if the sealants are retained at 1 year.
Incidence of new pit and fissure caries can be lowered by _____% if the sealants are retained at 2 year.
Incidence of new pit and fissure caries can be lowered by _____% if the sealants are retained at 4 year.
What are the purposes for Sealants?
- To provide a physical barrier to "seal off" the pit and fissure.
-To prevent oral bacteria and their nutrients from collecting within the pits and fissures to create a acidic environment.
What is the purpose of acid etch?
-To produce irregularities or micropores in the enamel to give the sealant a better place to stick to.
-To allow the liquid resin to penetrate into the micropores and create a bond or mechanical locking.
What is the criteria for an ideal sealant?
1. Achieve prolonged bonding to the enamel
2. Biocompatable with oral tissues
3.Simple application procedure
4. Free-flowing, low-viscosity material capable of entering narrow fissures.
5. Low solubility in the oral environment
What pt. are at risk for dental caries and would need sealant placement?
- Incipient pit and fissure caries ( only in enamel and no evidence of adjacent interproximal decay)
-Low socioeconomic status
-diet high in sugars
-inadequate daily oral health care
What teeth should you place sealants on?
-Newly erupted teeth as soon as they are completely grown in.
-Deep, irregular pits and fissures
-other restorations or carious lesions
What are the contraindications of sealant placements?
-Adjacent proximal caries
-Shallow pits and fissures
-Low caries risk
-Tooth not completely erupted
-Primary tooth near exfoliation
The bacteria in incipient dental caries at the base of a well-sealed pit or fissure has no what?
access to nutrients required for survival.
Majority of sealant material is made with what?
Filled sealant content
Increases bond strength and resistance to abrasion and wear. increased viscosity.
Unfilled sealant content
No particles(clear). Less resistant to wear. May not require occlusal adjustment after placement.
Fluoride releasing Sealant content
Enhances caries resistance. Helps remineralize incipient caries at base of pit or fissure.
Type I Embrasure
Interdental Papilla fills the gingivalembrasure
Type II Embrasure
Slight to moderate recession of the interdental papilla
Type III Embrasure
Extensive recession or complete loss of the interdental papilla.
Microorganisms can be harbored in this concave area.
Most gingival disease starts in this area.
The incidence of gingivitis is greatest in what tissue?
With bacteria infection and loss of gingival attachment, the interdental papillae are what?
reduced in height
-Aids in removing interdental Biofilm
-Minimizes tissue trauma
-Wax gives strength and durability and can minimize breakage.
-Helpful with tighter contacts bc it is thinner.
-Pressure against tooth surface spreads the nylon fibers and gives a wider surface for biofilm removal.
-Requires special attention to prevent injury to tissue.
Research has shown no difference in the effectiveness of waxed and unwaxed floss for boifilm removal. It depends on what?
How the floss is applied.
When do you need to floss and why?
Floss before you brush you teeth bc when proximal tooth surfaces are flossed first and biofilm is removed, the fluoride from a tooth paste used while brushing reaches the proximal surface for prevention of dental caries.
Tufted Dental Floss (Super Floss)
-Usually for type 2 Embrasures.
-Used for fixed dentures, bridge abutments, implants and ortho.
Aids for Flossing
Recommend to pts. with disabilities
-Used under fixed partial or bridges
-Used for large diastemas, isolated teeth, distal surfaces of posterior teeth.
Used for proximal surfaces of widely spaced teeth, surfaces next to edentulous areas, outer surfaces of abutment teeth on bridges.
-Nylon filaments twisted into a fine stainless steel wire. can get plastic coated wires for implants.
-Can use for ortho, fixed prosthesis, implants, per splints, any area hard to reach with toothbrush, exposed class IV furcations, apply chemotherapeutic agents.
In Pt. with open embrasures and moderate to severe attachment loss, which is more effective for flossing?
B. Interdental Brush
B. Interdental Brush
End-Tuft Brush (Single-Tuft Brush)
-open interproximal areas
-fixed dental prosthesis
-difficult to reach areas
- use a circular brushing stroke
-Rubber tip that is inserted just below the gingival margin
-Used for cleaning debris from the interdental area and removing biofilm by rubbing the exposed tooth surface.
-Toothpick is inserted into a handle with contra angled ends for adaptation to the tooth surface at the gingival margin for biofilm removal. Tell pt. to use a fulcrum. placed just under gingival margin.
-Used for pt. with periodontitis for interdental cleaning and exposed furcations.
Wooden Interdental Cleaner
-For exposed proximal surfaces where interdental gingiva is missing.
-teach pt. to use fulcrum
-soften the tip with saliva or water before use.
Oral Irrigation purpose
- to reduce the bacteria and inflammatory mediators that lead to period infection.
-results in reduction of bleeding even with water as the irrigant.
-reduced gingivitis and bleeding
-subgingival delivery of antimicrobial agents
-the standard jet tip is placed subgingivally can penetrate below the gingival margin 44-71% of the pocket depth.
What is Chlorhexadine(CHX)?
A broad spectrum antibacterial and antigingivitis
Purposes and uses of mouth rinses
-To reduce the numbers of microorganisms in aerosol.
-Post treatment therapy-deep scaling, root planing, period surgery, tooth removal.
What is CHX mechanisms of action?
-Binds to oral hard and soft tissue
-causes cell lysis (pops cells open
-binds to pellicle to prevent biofilm accumulation
-Substantivity 8-12 hours
What is the most effective antimicrobial and antigingivitis agent available for clinical use?
-Use before, during, and after period debridement
-good for pt. with high risk of caries
-Immunocompromised pt. who are more susceptible to infection
-post surgery for advanced wound healing
-Can work towards streptococcus mutans.
-Casues brown staining that comes off by polishing
-heavier calculus formation
-produces altered taste sensation (metallic)
What is Hydrodynamic Theory?
Currently accepted mechanism for pain impulse transmission to the pulp as a result of fluid movement within the dentinal tubule, which stimulates the nerve endings at the dentinopulpal interface.
What are the 3 parts of a toothbrush?
How often should you change your toothbrush?
-At least every 2-3 months
-Need to be replaced before filaments become splayed out.
-Replace after being sick or having an infection
Toothbrush Cleaning Care
-Toothbrushes need to be cleaned thoroughly after each use. (run under hot water)
-You can use another toothbrush to clean another.
-Always rinse completely and tap out water.
Where and how should toothbrushes be stored?
In open air with head in upright position not touching any other toothbrushes.
Always put portable ones in a container with open holes so air can get to the toothbrush to dry.
Power Tooth Brushes
-Current power toothbrushes move at speeds and motions that cannot be duplicated by a manual brush.
-Rotating oscillating action toothbrushes have been shown to be the most effective powered toothbrush for reducing plaque and gingivitis.
What are the indications for power toothbrushes?
-People who cannot brush properly with a manual
-Those undergoing orthodontic treatment
-Those undergoing complex restorative and prosthodontics treatment
-those with dental implants
-Pt. with disabilities
What toothbrush method do we recommend?
The Bass Method
-Direct filaments apically so filaments are parallel to the along axis of the tooth.
-Angle approx. 45 degrees and direct filaments into the gingival sulcus and press lightly.