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Flashcards in Week 4 Notes Deck (47):
1

Define highly neoplastic

Highly malignant

2

When to take dental radiographs

**Teeth:

- missing

- fractured

- vitality

- resorptive lesions

- painful or sensitive

**Periodontal Disease (under gum)

**Pockets

**Masses

**Draining tracts

**Nasal discharge (disease of roots)

**Epistaxis

**Evaluation of disease progression

**Pre- and post-extraction

3

What else can a dental x-ray machine be useful for?

Small PT extremities

Birds

Exotic/pocket pets

Nasal radiographs

Phalanges

4

Protecting yourself

Lead aprons (new aprons have barium coating and are much lighter)

Thyroid shields

Gloves, if needed

Maintain safe distance!

Remember, PPE only protects from scatter, NOT the direct beam!!!

5

Traditional X-ray machines can be used, but ...

Hard to position PT

Film-focal distance needs to be modified

Beam needs to be collimated

6

Dental X-ray machines

Have a preset Ma and Kv

Well collimated

Easy to position

Convenient (do not have to move PT)

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7

Dental film

Individually packaged in waterproof packet

Three sizes (0, 2, 4)

Always use largest size possible

Three common speeds (D - best, E, F: read on film which speed it needs)

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8

Chair Side Developer

Develop

Water dip

Fix

Rinse

Water bath

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9

Digital Radiography

Wired sensor (allows image to be viewed within seconds on a computer screen)

Phosphor screen (must be fed through a scanner; rarely used anymore)

10

Digital X-ray system comparison

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11

Correct positioning of PT requires?

Tube angulation

Tube position

Film position

12

Tube angulation - Parallel technique

Used in imaging the lower premolars and molars

Tooth and film are parallel, and the beam is directed perpendicular to them both

Like taking a normal X-ray

13

Tube angulation - Basic (bisecting) angle technique

Required because of anatomy of mouth

Beam is angulated so that it is halfway between perpendicular to film and perpendicular to long axis of tooth (plane of x-ray beam should be 90* to imaginary line that bisects the angle formed by tooth's long axis and the film plane)

14

Tube position

Best to place beam at gingival margin so both crown and root structures are presented in radiograph

Avoid cone cut (to fix: move beam in direction of cone cut)

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15

Film position

White side of film packet toward beam

Place film where image will be projected (tube film must be placed so that you catch the radiographic "shadow")

Place film into mouth as far as possible

16

Complications in dental radiology

Blurred or double images (to fix, stop any movement)

Elongation of image (to make shorter, move tube dorsal)

Foreshortening of image (to make longer, move tube head lateral)

Overlapping dental structures (= carnassial!):

- SLOB rule: Same Lingual Opposite Buccal =

Structure that is more buccal will be shadowed in opposite direction as x-ray beam. Lingual root moves rostrally.

17

How to differentiate maxillary and mandibular films

**Maxillary:

- Nasal passages and sinuses visible

- Radio-dense "white line" across root of canine tooth (palatine process of maxilla)

- Carnassial has 3 roots, w/single root caudally

- Both molars have 3 roots

**Mandibular:

- No sinuses visible

- Mandibular cortex visible on ventral mandible

- Mandibular canal visible

- Mental foramina present (rostral, middle, caudal)

- Molars all have 2 roots

18

Structures seen on oral rads

Enamel

Dentin

Root canal

Periodontal ligament space

Alveolar bone

Mental foramina

Infraorbital foramen

Mandibular canal

Mandibular symphysis

Nasal septum

Nasal turbinates

Furcation

Root apices

19

The mandibular symphysis is what kind of joint?

A cartilagenous joint

20

Looking at a dental rad, how can you tell if it's a senior patient or not?

The pulp space will thin out as the patient gets older!

In other words, the thinner the pulp, the older the patient!

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21

Structures of the periodontium

**Periodontal ligament

- cushions the forces on tooth

- separates dentin from bone

- forms joint: gomphosis

**Gingival connective tissue

- protects periodontal ligament

- epidermal tissue

- attaches bone by epidermal pegs

- gingival sulcus

- attaches tooth at cemento-enamel junction (CEJ) on border between root and crown)

**Alveolar bone

- forms tooth socket

**Cementum

- external portion of dentin

- attaches periodontal ligament to tooth

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22

Diseases of the periodontium

Gingivitis

- inflammation of gingiva

Periodontitis:

- accumulation of plaque/calculus

23

Tooth anatomy

Important pic!!!

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24

Periodontal disease

Attachment loss

Gram-positive aerobic bacteria

Gram-negative bacteria

Immune-response

Destruction of junctional epithelium, periodontal ligament; mobility

Treatment

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25

Periodontal disease stages

**PD0 - Normal

- no gingival inflammation or periodontitis clinically evident

**PD1 - Stage 1

- gingivitis only w/o attachment loss

- height & architecture of alveolar margin are normal

**PD2 - Stage 2

- early periodontitis

- less than 25% of attachment loss or at most, a stage 1 furcation involvement in multirooted teeth

**PD3 - Stage 3

- moderate periodontitis

- 25-50% of attachment loss as measured either by probing, radiographs, or there is stage 2 furcation involvment in multirooted teeth

**PD4 - Stage 4

- advanced periodontitis

- more than 50% of attachment loss as measured either by probing or radiographs

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26

Furcation

**Stage 1 (F1, furcation involvement)

- periodontal probe extends less than half way under crown in any direction of multirooted tooth w/attachment loss

**Stage 2 (F2, furcation involvement)

- periodontal probe extends greater than half way under crown of multirooted tooth w/attachment loss but not through and through

**Stage 3 (F3, furcation exposure)

- periodontal probe extends under the crown of multirooted tooth, through and through from one side of the furcation out the other

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27

Define ATP

Oral Assessment, Treatment, and Prevention

Assessment

- tooth by tooth evaluation for depth, mobility, furcation, fractures, missing teeth ...

Treatment

- root planing, antibiotics, extraction ..

Prevention

- home care

28

Periodontal debridement

w/scaler or power scaler

removes hard and soft deposits from supragingival and subgingival surfaces

prevent or arrest infection, restore to health

remove plaque, scale, root plane, polish

29

Power scaling

Need specific scaler head for subgingival cleaning

Vibrations remove deposits

Rinse mouth

Wear PPE

Lubricate/cover PT's eyes

Intubate PT; ensure cuff is fully inflated

30

Power scaling tip designs

Universal (broad tips)

- medium and heavy deposits

Slim tips

- subgingival pockets and furcation areas

31

Difference between sonic and ultrasonic scalers

Sonic scalers

- use air to create vibration

- less powerful

- last longer

Ultrasonic scalers

- use electricity to create vibration

- more powerful

- don't last as long

32

Knob settings on CAVT's power scaler

Black knob = power knob

White knob = water knob

33

Handscaling

3 parts: handle, shank, working end

Examination instruments: probe, explorers

Scaling instruments: curettes, sickles, files, hoes

34

Sickle scalers

Supragingival instrument

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35

Subgingival curettes

Subgingival scaling

Root planing

Sometimes supragingival scaling (semicircle shape)

Examples: Gracey or Langer curette

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36

Principles of scaling

Adaptation (apply cutting edge against tooth)

Angulation (relationship of face of instrument to tooth)

Stroke (exploratory, working, root-planing)

Sharpening (dull instruments can burnish calculus, manual, mechanical)

Engage effective angle

37

Polishing

Smooth surfaces

Remove extrinsic stains

Two methods:

- electric motor/air compressor (most common)

- air polisher (messy due to more speed)

38

Periodontal Sx grading system

Grade I

- routine cleaning

Grade II

- root debridement, subgingival curettage

Grade III

- root debridement, gingival curettage, Sx

Grade IV

- extraction

39

Deep periodontal pockets

Requires 2 visits

- cleaning, root planing, gingival curettage, doxycycline gel

- pocket depth probe, Sx if needed

40

Bone loss

Vertical

- long axis, easier to treat

Horizontal

- multiple furcations, more difficult to treat

Osteoconductive (new synthetics, bone grafts) and osteoinductive (fake bone) material

41

Home Care

**Essential for reducing bacteria:

- Brushing (Bass or Modified Stillmann technique)

- Diet (hard dental diet, Veterinary Oral Health Council - VOHC's approval, reduce accumulations)

- Toys (client monitoring a must; able to indent w/finger nail, raw hides made in USA, remove when small enough to be swallowed)

42

Regional Nerve Blocks

Benefits:

- preemptive analgesia, prevention of wind-up pain

- postoperative analgesia

- decreased concentration of inhalant anestethic gas

3 basic uses:

- Splash block (similar to anesthetic cotton tip application in human dentistry)

- Local anesthesia (around tooth itself; only maxillary)

- Regional aneshesia (most common in VetMed; injecting into foramina)

43

Infraorbital Nerve Block

Maxillary canine

Tip of needle on ipsilateral maxilla

44

Middle mental nerve block

Ipsilateral rostral lower lip from labial frenulum

45

Inferior alveolar nerve block

Or mandibular nerve block

Insert into soft tissue/bone

Aspirate + rotate 3x before injecting

Use contralateral approach (like in a pool game)

46

Maxillary nerve block

Entire maxillary quadrant on buccal and palatal sides

25-27G needle bent at 90* angle

47

Location of middle mental foramina

Rostral rooth of second premolar