WEEK ONE - THREE

Question 1

define caries

Answer 1

Transmissible disease that destroys tooth tissue
Primarily from Streptococcus Mutans
Metabolises sugars to produce acid = demineralising tooth structure over time

Question 2

state some contraindications for selective polishing

Answer 2

• xerstomic patients [paste needs salivate to activate]
• demineralisation - WSL [prophy can chip structure away]
• exposed root surfaces [sens]

cautions
- mobile teeth
- painful teeth/ inflammed gingiva
- hypersensitivity

Question 3

what is the stroke for a periodontal probe and what are THREE limitations on measurements

Answer 3

vertical walking bobbing stroke at 10-20 grams of pressure

1. position of gingival margin
2. interference of calculus deposits and overhanging restorations
3. amount of pressure applied

Question 4

clinical appearance of gingivitis

Answer 4

edema
erythema
bulbous - loss of knide edge papilla
bleeding
smooth/shiny gingiva

Question 5

describe the two types of intrinsic staining

Answer 5

pre eruptive
- fluorosis
- dentinogenesis + amelogenesis imperfecta
- hypocalcification - WS or brown spots

post eruptive
- caries
- endo tx

Question 6

list the speeds of the three types of handpieces and the types of burs suited for each

Answer 6

slow speed
- 500-5000rpm
- steel burs
- use of lubricant optional
- uses: caries removal, polishing

**intermediate high speed
**- 30,000 - 120,000 rpm
- fine-med grit diamond burs - use of water MANDATORY
- steel burs will NOT cut at this speed
- tungsten carbid burs tend to chatter and cause micro cracks in enamel at this speed

**ultra high speed **
- 250,000 - 450,000 rpm
- tungesten carbide at their most efficient in this range
- diamond also suitable [preferred bur to enter lesion/ remove bulk enamel]
- lubricant MANDATORY

Question 7

Decribe homeostasis in the oral cavity

Answer 7

• resting pH should not fall below 6.3
• saliva neutralises pH –> should lie between 6.7-7.4 [aims to buffer pH back to 7]

Question 8

name 5 variables that influence polishing [effectiveness, risk of tooth structure loss]

Answer 8

• abrasiveness of prophy paste
• contact time w tooth surface
• speed of rubber cup
• applied pressure on tooth
• site being polished

Question 9

describe the stephan curve

Answer 9

illustrates the relationship between carbohydrate intake and oral pH

if intake is too frequent, the mouth pH continues to become more acidic, resulting in acid attacks, at 5.5 pH = deminerlisation starts of occur

spacing periods of sugar/carb intake allows the saliva to buffer the acidity and return to a neutral pH

Question 10

define periodontal disease:

Answer 10

irreversible inflammatory gum disease resulting from poor brushing and OH. causes loss of periodontium [PDL, alveolar, cementum, gingiva]

periodontal pathogens:
fusobacterium nucleateum
tannerella forsythia
porphyromonas gingivalis

Question 11

define scope of practice:

Answer 11

oral health assessment, diagnosis, treatment, management and preventive services from children to adults.

The scope of work includes restorative and fillings treatment, tooth removal, additional oral care and oral health promotion

Question 12

outline clock positions:

Answer 12

seating positions around the patient - for right handed clinician 8-1

anterior towards = 8-10
anterior away = 11-1

posterior towards = 9
posterior away = 10-11

Question 13

what are the FIVE func of PDL

Answer 13

• support
• sensory
• nutritive
• formative
• remodelling

Question 14

general pathogenesis of periodontal disease

Answer 14

• ## mature biofilm accumulation + favours bacteria which induce a stronger host reponse
• periodontium attempts to heal itself [host response - chemical mediators] - healing process creates rich environment for sustaining damage and inflammation

Question 15

risk factors for periodontal disease

Answer 15

site specific
- defective restorations
- calc depos
- tooth morpho, crowding

patient specific
- medications
- genetics
- smoking
- tobacco/alcohol
- prev hx of perio
- bleeding in probing

Question 16

distinguish the WHO probe from the William’s probe

Answer 16

WHO
- 0.5mm ball at tip
- coloured band from 3.5-5.5mm

williams
- marked at 1,2,3,5,7,8,9,10

Question 17

5 moments of hand hygiene

Answer 17

Moment 1 - Before touching a patient.
Moment 2 - Before a procedure.
Moment 3 - After a procedure or body fluid exposure risk.
Moment 4 - After touching a patient.
Moment 5 - After touching a patient’s surroundings.

Question 18

List and describe the 3 most common modes of transmission of infection

Answer 18

(1) direct contact with blood, oral fluids, or other infected materials,

(2) indirect contact with contaminated objects, such as instruments, environmental surfaces, or equipment,

(3) contact of conjunctival, nasal, or oral mucosa - droplets containing microorganisms

Question 19

What armamentarium is required for a prophylaxis?

Answer 19

Triplex
High volume excavator [HVE]
Slow speed handpiece
Prophylaxis paste
Rubber cups
Bristle brushes
is required for a prophylaxis?

Question 20

What is rubber dam and why do we use it?

Answer 20

Latex or latex free sheet of rubber for isolating treatment site

Anchored by dental clamps and secured by a frame

Retracts + protects cheeks, tongues
Ideal isolation and dryness
Aids in cross infection control
Prevents contamination during endo
Limits contact of dental materials on soft tissue
Effective moisture control for hydrophobic dental materials
Improves visibility for operator
Prevents gagging when treating posterior teeth

Question 21

List all the uses for a dental mirror

Answer 21

indirect vision
light reflection
retraction
tissue protection

Question 22

As a CSU graduate, up to what age can dental therapy services be provided to patients?

Answer 22

26

Question 23

What part of the mouth does ‘dental caries’ affect?

Answer 23

Tooth decay starts with the acid from plaque attacking your tooth enamel.

Question 24

define Periodontium

Answer 24

Periodontium, the supporting structure for the teeth

consists of periodontal ligament, cementum, gingiva, and alveolar bone.

Question 25

define Periodontal ligament:

Answer 25

soft connective tissue between the inner wall of the alveolar socket and the roots of the teeth. periodontal ligament connects the cementum of each tooth to the surrounding alveolar bone

Question 26

define Cementum:

Answer 26

the calcified or mineralized tissue layer covering the root of the tooth which sits inside the gum socket.

Question 27

define Alveolar process:

Answer 27

(also known as the alveolar bone) is the structure that holds the roots of your teeth in place

Question 28

define Explorer

Answer 28

a thin and flexible stainless steel instrument, with a sharp tip. examine the surface of patient's teeth, and detect calculus defects or irregularities - Tactile sensitivity is essential to effectively examine the tooth surface and detect calculus.

Question 29

define Calculus

Answer 29

calcified dental plaque, composed primarily of calcium phosphate mineral salts deposited

Question 30

List and describe what the gingiva is made up of (hint – there are 4 things to list)

Answer 30

1. Free gingiva - UNATTACHED portion of gingiva surrounding neck of tooth 2. Gingival sulcus - V shaped space between free gingiva and tooth surface - Periodontal probe inserts here to assess health - base of the sulcus is formed by the JE - NO fluid found in healthy sulcus [fluid flow = plaque = inflammation] - healthy pocket = 1-3mm 3. Interdental gingiva/papilla - Portion of gingiva that fills area between two adjacent teeth apical to the contact area [on top of contact] - col = lies apical to contact 4. Attached Gingiva - attaches to alveolar bone - between the free gingiva and the alveolar mucosa - firm and resilient

Question 31

What is deemed a healthy clinical appearance of the gingival tissues?

Answer 31

Colour = coral pink with or without pigmentation Contour = Scalloped and knife edge variations depending on tooth shape, arch alignment, location and size of IP contact Surface texture = stippled attached gingiva Shape = knife edged interdental papilla Consistency = first and not retractable with air

Question 32

What is the purpose/function of an explorer?

Question 33

What are the advantages of the 11/12 explorer?

Answer 33

used for detection of subgingival and supragingival calculus in anterior and posterior teeth. can be used in healthy pockets and deep periodontla pockets

Question 34

List the types of periodontal probes

Answer 34

who probe williams probe cp11 nabesr probe

Question 35

List and describe the 3 types of dental burs

Answer 35

steel burs - for SS hp under 5000 rpm - each bur has ~ 8 blades and some can cut dentine/ caries removal tungsten carbide burs - for HS hp --> 100,000 rpm [best capacity > 300,000 rpm - bur has 6 blades for cutting edge support - cuts metal and dentine well but prone to micro cracks in enamel --> not indicated for MID - short clinical life diamond burs - abrade tooth surface instead of cutting or chipping - more efficient at HS - mandatory to finish all cacvity margins with fine diamond stone at 25u grit or less at 400,000 rpm

Question 36

define Cutting edge: Functional shank: Lower shank:

Answer 36

Functional shank Portion of shank that allows working end to be adapted to tooth surface Terminal // Lower shank [ closer to tip] Portion of functional shank nearest to working end

Question 37

define Instrument stroke:

Answer 37

Instrumentation strokes made in a coronal direction, away from soft tissue base of sulcus or pocket Calculus removal strokes Exploratory strokes to detect calculus

Question 38

define pit fissure

Answer 38

pit Small pinpoint depression located on junction of developmental grooves or at groove terminals Can be found on ant + post teeth on Palatal, Occlusal, Buccal surfaces fissure Deep invaginations of enamel Defined as deep clefts between adjoining cusps found on posterior teeth

Question 39

why is note taking essential for best practice dental care

Answer 39

protect ourselves patient safety -ensuring everyone is onboard w pt tx providing good dental care - ensuring the next provider is able to continue optimal treatment documenting for future research projects documents baseline health for the progression of caries/diseases

Question 40

What are the different components of a working-end?

Answer 40

Face Back Lateral surfaces Cutting edges [where face and lateral surfaces meet] Most working ends have two cutting edges Toe or tip Working ends = either round toe / sharp tip

Question 41

Describe the significance of the cross-section of an instrument. Explain how the shape of the cross-section affects where an instrument can be used in the mouth

Answer 41

cross sections indicated where the instrument can be used Triangular cross sections = LIMITED to supragingival use Will cause gingival trauma if used subgingivally Eg sickle scalers Semi-circular cross section = supragingival + subgingival use Eg curets

Question 42

Explain the difference between a simple shank and a complex shank

Answer 42

simple shanks are more straight - designed for use on anterior teeth complex shanks and more angled and have more bends to reach posterior teeth

Question 43

List the 3 instrument stroke directions and the 3 types of strokes

Answer 43

vertical horizontal oblique 1. assessment stroke // exploratory stroke - evaluates tooth surace, located calc depo - using explorers 2. calc removal stroke - used to lift calc depo off tooth surface - using curets and sickle scalers 3. root debridement stroke - used to remove residual calc dpo, bacterial plaque - using curets

Question 44

Where in the mouth is a sickle scaler used? What are its uses?

Answer 44

suited for anterior teeth to remove supragingival plaque and calc

Question 45

Where in the mouth is a universal curette used? What are its uses?

Answer 45

used for periodontal scaling, calculus debridement and root planing to remove small / medium size calc depo and can be used both supragingivally and subgingivally. mostly posterior - also suitable for anterior

Question 46

How do you select the correct working-end on a universal curette for use on a tooth surface?

Answer 46

Working end should be facing towards clinician when working on towards surfaces vice versa Working end should be flush with the tooth as to not catch in subgingival space “V” between junction working and terminal end should be facing midline of tooth

Question 47

What are the indications for a fissure sealant?

Answer 47

Plaque retentive pits and fissures in permanent molars in med-high risk children for caries Premolars + posterior teeth should be sealed in children at high risk of caries In low risk children → only deep and plaque retentive fissures usually considered for sealants Not limited to age but tooth history and patient OH

Question 48

List the steps for placement of a fissure sealant

Answer 48

Isolate with rubber dam Clean fissures using bristle brush and pumice/ water Apply etchant [37% phosphoric acid] - 30 seconds Rinse thoroughly [5-10 seconds] Dry until tooth has frosted appearance [matte] Apply Conseal F-white sealant to fissures using Dycal applicator Light cure - 20 secs Wash and wipe tooth Check occlusion with articulating paper

Question 49

How does a fissure protection differ from a fissure sealant?

Answer 49

Fissure protection treatment using GIC allow for a quicker and cheaper application in a moist environment Cheaper and quicker [less instruments required] Less retention than resin but even if material chips away - particles remain and provide barrier to teeth Release fluoride overtime and are recharged with physical fluoride application Lower longevity than resin GIC penetrates deeper into fissures/ pits semi-permeable membrane] Resin fissure sealants are hydrophobic and require complete moisture control for a successful micromechanical adhesion Greater longevity Hardens with UV light curing

Question 51

Why would a fissure protection be selected as a treatment option instead of a fissure sealant?

Answer 51

Fissure protection treatment using GIC allow for a quicker and cheaper application in a moist environment Resin fissure sealants are hydrophobic and require complete moisture control for a successful micromechanical adhesion GIC is advantageous for - young children or in treatments which need to be completed quicker - added benefit of fluoride - cases where patients are not seen frequently [low SES] - hypoplasia/ hypomineralisation has etch in sealants tx not appropriate