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NBDHE Study GUIDE
D.H. Code of Ethics - ✔ To achieve high levels of ethical consciousness, decision making, and practice by members of a profession Core Values - ✔ Veracity, Autonomy, Beneficence, Justinc, Nonmaleficence, Confidentiality, Societal Trust Veracity - ✔ telling the truth Autonomy - ✔ Deals with the patient. Patients have the right to informed consent. (SELF DETERMINATION) Beneficence - ✔ Includes promoting the w2ell-being of individuals and the public (DO GOOD) Justince - ✔ provides everyone access to high-quality, affordable Oral healthcare; demonstrating impartiality (FAIRNESS) Nonmaleficence - ✔ Deals with the practitioner. Providing services that protect all patients from harm. (DO NO HARM) Confidentiality - ✔ patient information and relationships Societal Trust - ✔ Value patient trust. based on our actions and behaviors Civil Offense - ✔ lawsuits where most dental cases involved. The wrongful offense against a person where satisfaction is sought ($). Types of Civil law Contracts - ✔ Implied, Express, Between Practitioner and the Patient Implied contract - ✔ an agreement made through inference by signs, inaction or silence Express contract - ✔ oral or written agreement Contract between practitioner and patient - ✔ Termination & Abandonment Terminating patients - ✔ non-compliance and failure to pay (PRACTITIONER) Abandonment - ✔ dismissal of patient without ample and proper notice (PATIENT)
Civil Law Torts - ✔ Intentional torts & unintentional torts Intentional torts - ✔ Assault, Battery, Deceit and misrepresentation, Defamation, Invasion of property Assault - ✔ Threatening bodily harm Battery - ✔ Causing bodily harm. performing procedure without permission falls into this category Defamation - ✔ damaging a person's reputation. includes libel & slander Libel - ✔ written defamation (L=Library) Slander - ✔ Verbal defamation (S=Spoken) Invasion of property - ✔ Patient's body is the property Unintentional torts - ✔ Negligence, Standard of Care and Duty Negligence - ✔ failure to do what a reasonable person would do. ie) inst. breaks and you don't tell the patient O.S.H.A. - ✔ Occupational Safety and Health Administration OSHA - ✔ Responsible for developing universal/standard precaution protocols for employees to prevent them from contracting disease through blood and/or other body fluids. Protects the employee (worker) H.I.P.A.A. - ✔ Health Insurance Portability and Accountability Act HIPAA - ✔ maintains patient confidentialilty. should be signed once unless changes are made or the govt. makes changes to HIPAA policy. Office gives copy of HIPAA to pt. every 3 years C.D.C. - ✔ Center for disease control CDC - ✔ located in Atlanta, Ga. provides guidelines for disease prevention and disease transmission C.O.B.R.A. - ✔ Consolidated Omnibus Budget Reconciliation Act COBRA - ✔ keep group health insurance for 18 mo. applies if person has reduced work hours, quits, or loses job. provides coverage for spouse & dependent children.
Steps in the Learning Leader - ✔ Unawareness, Awareness, Self-Interest, Involvement, Action, Habit regulated biohazard waste - ✔ must be disposed of properly. ex) sharps, items that drip of saturated blood and saliva, hard and soft tissues removed from the patient's mouth Safety Data Sheets - ✔ provide the employee with information regarding the hazards of chemicals utiliazed in the office and how to protect themselves from these hazards Personal Protective Equipment - ✔ barriers (equipment and clothing) used to protect the operator PPE examples - ✔ Mask, Examination gloves, Protective eyewear, Protective (impervious) clothing PPE Mask - ✔ change when it becomes wet/moist and with every patient Purpose of PPE - ✔ provides barriers to minimize exposure to aerosols, spatter, direct transmission, indirect transmission Aerosol - ✔ invisible airborne particles; remain in the air for awhile spatter - ✔ visible airborne particles of blood and saliva; drop quickly to the floor, countertops, etc. Direct transmission - ✔ occurs through direct touching of an infectious agent, saliva, or blood indirect transmission - ✔ occurs through a contaminated object Disifectant - ✔ kill or inactivate most pathogenic microbes, not spores disinfectant qualities - ✔ bactericidal, fungicidal, tuberculocidal, virucidal, environmentally safe, residual effect, EPA registered, cleans and disinfects Residual effect - ✔ continues to work after it is dried. substantivity Types of disinfectants - ✔ Chlorine, iodophors, phenols, quaternary compounds, glutaraldehydes (but don't use) Chlorine-based compounds - ✔ type of disinfectant, corrosive to metals, strong odor Iodophors - ✔ type of disinfectant, can discolor some surfaces yellow
Phenols - ✔ type of disinfectant, may leave a film or residue on surfaces Quaternary compounds - ✔ type of disinfectant, not corrosive, but have a lower kill spectrum; limited efficacy Glutaraldehydes - ✔ type of disinfectant, should not be used as a surface disinfectant because of toxic effects of fumes; also corrosive. Levels of surface disinfectants - ✔ High, Intermediate, Low High - ✔ level of surface disinfectant that is used in surgical areas Intermediate - ✔ level of surface disinfectant used in dental offices; must kill TB organism Low - ✔ level of surface disinfectant generally used at home; not acceptable for use in a dental office (simple phenols) Sterilization - ✔ Kills ALL pathogenic microbes, including spores; methods include chemical, dry heat, and steam Chemical - ✔ Method of sterilization recommended minimum temp 273F for 20 minutes with a pressure of kPa/25psi. Ventilation necessary. may damage rubber and plastic items. Spore test=Geobacillus stearothermophilus Dry Heat - ✔ Method of sterilization 340F for 1 hour or 320F for 2 hours. Recommended for metal instruments, avoid paper products, may damage rubber and plastic items. not recommended for handpieces. Spore test= bacillus atrophaeus Steam - ✔ method of sterilization recommended minimum sterilzation parameters 250F with 15 or 20 lbs per square inch psi for 30 min. corrodes non-stainless steel instruments. dulls instruments and burs. ok for some plastics; cotton rolls/gauze (cloth goods). paper packages come out wet & tear. Spore test= geobacillus stearothermophilus. External color indicators - ✔ indicate instruments have been heat processed. Sterility is NOT guaranteed. biological indicators - ✔ determine if the sterilization cycle is reaching proper temp, time, and pressure to kill all microorganisms. should be conducted weekly Spore test=Geobacillus stearothermophilus - ✔ used in Chemical and Steam spore testing
corssbite - ✔ maxillary teeth are positioned lingual to or totally facial to mandibular teeth midline shift (deviation) - ✔ midline of maxillary central incisors does NOT align with the midline of mandibular central incisors. Edge-to-edge - ✔ incisal edge to incisal edge of the max anterior to mand anterior teeth respectively end-to-end - ✔ cusp-to-cusp relationship of posteror teeth calculus - ✔ mineralized plaque; provides an irritant for the gingiva supragingival - ✔ type of calculus where nutritent source is saliva subgingival - ✔ type of calculus where nutrient source is crevicular fluid and inflammatory exudate 11/12 - ✔ calculus-detecting explorer for all teeth pigtail - ✔ calculus-detecting explorer for posterior teeth orban-type - ✔ calculus-detecting explorer for anteriors and cervical 1/3s of posteriors Extrinsic - ✔ type of removable stain caused by certain bacteria or other sources such as food, beverages and tobacco. Black Line - ✔ type of extrinsic stain. gram positive bacteria; typicallyl located on cervical 1/3 of facials and linguals Brown - ✔ type of extrinsic stain associated with poor oral hygiene and /or drinking dark-colored beverages like tea, coffee, fruit, juices and red wine. Dark brown and black - ✔ type of extrinsic stain associated with tobacco product use Orange - ✔ type of extrinsic stain associated with chromogenic bacteria in plaque. associated with poor oral hygiene; typically located on anterior teeth Yellow brown and brown - ✔ can be associated with chlorhexidine use or stannous fluoride stannous fluoride - ✔ stain results from the reaction of the tin ion in the fluoride
Green - ✔ type of extrinsic stain associated with poor oral hygiene, chromogenic bacteria, fungi, and gingival hemorrage Intrinsic stain - ✔ stain that is not removable; possible causes include pulpal necrosis, internal resorption excessive systemic fluoride and or tetracycline use during tooth development Furcation Class I - ✔ Early evidence of bone loss; instrument can enter the depression leading to the furcation Furcation Class II - ✔ Moderate bone loss; instrument can enter furcation, but cannot pass between the roots Furcation Class III - ✔ severe bone loss; instrument can pass between roots Furcation Class IV - ✔ severe bone loss; instrument can pass between roots but with evidence of recession. furcation - ✔ assessed with naber's probe Mobility Class I - ✔ involves slight horizontal mobility Mobility Class II - ✔ involves moderate horizontal mobility greater than 1 mm- with no vertical displacement Mobility Class III - ✔ involves severe mobility with possible combined horizontal and vertical movement deminieralization - ✔ process occurs when the pH drops below 4.5 to 5.5 for enamel and 6.0 to 6.7 for cementum-- known as critical pH levels. critical pH levels - ✔ 4.5-5.5 for enamel 6.0 to 6.7 for cementum Fluoride - ✔ interferes with bacterial metabolism and can penetrate through pellicle and plaque bactericidal - ✔ destructive to bacteria in high concentrations (professional application of fluoride) bacteriostatic - ✔ inhibits growth or multiplication of bacteria in low concentrations (daily at home application)
corrosion - ✔ silver is susceptible to this Copper - ✔ this metal is added to minimize corrosion, elimination the gamma II phase. desirable features of amalgam - ✔ durable, compressive strength is similar to enamel, relatively inexpensive undesirable features of amalgam - ✔ unattractive, high thermal conductivity, dimensionally unstable, delayed expansion if contaminated by saliva, requires tooth support, fracturable by excessive occlusion, susceptible to galvansim when new. coarse to fine - ✔ when polishing amalgam, move from ___ to ___ agents to remove surface tarnish, stains, flash, and roughness. corrosion - ✔ polishing amalgam can reduce the rate of this because of less surface area. tin oxide - ✔ final polishing agent used in the mouth for amalgam restorations. odontoblasts - ✔ can be damaged by the heat when not using a light touch or water during polishing. overhangs - ✔ can be avoided by properly placing bands and wedges and detecting with explorer BIS-GMA - ✔ bisphenol a-glycidyl methacrylate dental resins - ✔ establishes mechanical retention with enamel and dentin by adapting to relief areas created by conditioning with phosphoric acid. phosphoric acid - ✔ used in conditioning areas prior to dental resins. increases enamel and dentin surface area. polymerization - ✔ typically activated by fiber-optic light Temporal Bone - ✔ the mastoid process, the styloid process, the articular fossa and eminence, the stylomastoid foramen (VII), the petrous portion petrous portion - ✔ houses hearing components Hyoid bone - ✔ nonarticulated horseshoe shaped bone in the midline, inferior to the mandible
Sphenoid bone - ✔ greater & lesser wings, medial and lateral pterygoid plates, hamulus Superior Orbital Fissure - ✔ foramina in which the trigeminal nerve (V1), first division (opthalmic) passes. Foramen Rotundum - ✔ foramina in which the trigeminal nerve (V2), second division (maxillary) passes. Foramen Ovale - ✔ foramina in which the trigeminal nerve (V3), third division (mandibular) passes. olfactory nerve - ✔ cranial nerve # optic nerve - ✔ cranial nerve # oculomotor - ✔ cranial nerve # Trochlear - ✔ cranial nerve # Trigeminal - ✔ cranial nerve # Abducens - ✔ cranial nerve # Facial - ✔ cranial nerve # Vestibulocochlear - ✔ cranial nerve # Glossopharyngeal - ✔ cranial nerve # Vagus - ✔ cranial nerve # Accessory - ✔ cranial nerve # Hypoglossopharyngeal - ✔ cranial nerve # Motor nerves of the eye - ✔ Oculomotor, Trochlear, Abducens facial nerve - ✔ muscles of facial expression facial nerve - ✔ cranial nerve that controls the sublingual and submandibular salivary glands glossopharyngeal nerve - ✔ cranial nerve that controls the parotid glands
posterior superior alveolar nerve - ✔ innervates the maxillary pulp and buccal gingiva of the 1st, 2nd & 3rd molars greater palatine nerve - ✔ innervates the palatal gingiva of the molars and premolars. middle superior alveolar nerve - ✔ innervates the pulp of the maxillary 1st molar, premolars, and the buccal gingiva of the premolars anterior superior alveolar nerve - ✔ innervates the pulp and facial gingiva of the maxillary cuspids and incisors nasopalatine nerve - ✔ innervates the palatal gingiva of the maxillary cuspids and incisors muscles of mastication - ✔ innervated by the mandibular division of the trigeminal nerve and blood supplied by the maxillary artery (branch of the external carotid artery) muscles of mastication - ✔ temporalis, masseter, medial pterygoid, lateral pterygoid temporalis - ✔ Originates in the temporal fossa, Inserts at the cornoid process, and functions to retract and elevate the mandible masseter - ✔ originates in the zygomatic arch, inserts at the outer surface of the mandible and functions to elevate the mandible. medial pterygoid - ✔ originates in the medial surface of the lateral pterygoid plate and the maxillary tuberosity. inserts at the inner surface of the angle of the mandible and functions to elevate and protrude the mandbile. lateral pterygoid - ✔ originates at the lateral surface of the lateral pterygoid plate and infratemporal surace of the sphenoid bone. inserts at the TMJ disc and neck of the mandibular condyle. functions to protrude and/or depress the mandible and allow side to side shift of the mandible elevate the mandible - ✔ the medial pterygoid, masseter, and the temporalis all have this similar function depresses the mandible - ✔ the lateral pterygoid (with the hyoid muscles) all have this similar function Parts of the TMJ - ✔ temporal bone, mandible, articular disc, capsule articular disc - ✔ fibrous pad of dense collagen tissue prevents bone to bone contact and divides joint into upper and lower synovial cavities. thickest at the posterior, thinner in the center that moves with condyle under normal function
capsule - ✔ thick, fibrous tissue surround joint of TMJ where the inner lining secretes synovial fluid, lubricating the joint. rotation - ✔ the movement of the condyle in the fossa during TMJ movement translation - ✔ the movement of the condyle as it slides forward along the articular fossa trismus - ✔ hypomobility of the TMJ from trauma, disease, bruxism smile muscles - ✔ zygomaticus, levator anguli oris, and risorius hyoid muscles - ✔ muscles important in chewing, swallowing, and speaking. comprise the floor of the mouth. work with the lateral pterygoid m. to open the mouth. trigeminal nerve and facial nerve - ✔ cranial nerves that innervate the hyoid muscles infrahyoid muscles - ✔ thyrohyoid, sternothyroid, sternohyoid, omohyoid suprahyoid muscles - ✔ mylohyoid, geniohyoid, digastric, stylohyoid neck muscles - ✔ sternocleidomastoid and trapezius both innervated by the accessory nerve. carotid - ✔ emergency pulse of an adult brachial - ✔ emergency pulse of a child radial - ✔ non-emergency pulse of an adult brachial - ✔ non-emergency pulse of a child external carotid artery - ✔ three major branches of the ____ that give blood flow to the oral and facial structures are the maxillary a. lingual a. and facial a. maxillary artery - ✔ branch of the e. carotid a. gives blood flow to the teeth, muscles of mastication, ear lingual artery - ✔ branch of the e. carotid a. gives blood flow to the tongue and floor of mouth Facial nerve - ✔ Branch of the e. Carotid a. Gives blood flow to the muscles of facial expression, lips, eyelids, soft palate, and throat.
Causes of gingival inflammation - ✔ Open contacts, sub gingival margins of restorations Periodontitis as a manifestation of systemic diseases - ✔ Associated with hematological disorders such as acquired neutropenia, & leukemia Cementum - ✔ All PDL fibers attach to the tooth's _____. Osteoblast - ✔ Cell the produces bone Osteoclast - ✔ Cell that resorbs bone (break down) Cementoblasts - ✔ Cells that produce cementum Cementoclasts - ✔ Cells that resorbs (breaks down) bone Healthy gingiva - ✔ Firm, light pink (coral pink)' fills interproximal spaces, knife edged, gingival margin on enamel, 1-3 mm gingival sulcus describes ______. Unhealthy gingiva - ✔ Spongy, swollen, red, bop, bulbous, festooned, recession, hyper plastic, deep pockets or probing depths. gingivitis - ✔ reversible inflammation of the gingiva directly related to the accumulation of plaque. most common is "chronic plaque-associated" gingivitis - ✔ results from ulceration at the base of the sulcus acute gingivitis - ✔ reversible inflammation of the gingiva, develops rapidly, obvious inflammation, may be painful, neutrophil is the most prevalent cell chronic gingivitis - ✔ reversible inflammation of the gingiva, develops slowly, may appear normal, not usually painful edematous gingiva - ✔ glossy appearance due to increased fluid. the result of vasodilation of the peripheral circulation fibrotic gingiva - ✔ increase in cellular and fibrous components, may present with pallor clefted gingiva - ✔ indicated by vertical loss of tissue, caused by improper flossing (stillman's) festooned gingiva - ✔ inner tube-like swelling at gingival margin, due to inflammation and an increased cell number
recession - ✔ caused by age, plaque, iatrogenic, tooth malposition, occlusion, frenum pull, trauma, inadequate attachment, improper flossing technique gingival hyperplasia - ✔ these drugs can cause this: phenytoin (dilantin) 50%, nifedipine (procardia), cyclosporin 30% gingival hyperplasia - ✔ mouthbreathing, periodontal inflammation, genetic hereditary factors, systemic conditions, including leukemia and hormonal imbalance are all non- drug causes of this condition. dehiscence - ✔ loss of alveolar bone, usually on the facial aspect of the tooth root. ovalshaped root exposure apical to the CEJ. includes gingival recession, alveolar bone loss and root exposure fenestration - ✔ a window-like opening in the bone covering the root of a tooth bordered by alveolar bone on the coronal aspect of the tooth. dental plaque - ✔ accumulation of microbes on the surface of the teeth. not readily removed by rinsing. the major etiological factor in the initiation and progression of inflammatory periodontal disease. dental plaque - ✔ a "biofilm" - bacteria forming on tooth surfaces acquired pellicle - ✔ first step in plaque formation: formed by glycoproteins from saliva adsorbed onto to the tooth surface calculus - ✔ this forms from the mineralized plaque biofilm cocci - ✔ round/spherical-shaped bacteria found in early plaque formation bacilli - ✔ rod-shaped bacteria, most common type found in periodontal disease spirochetes - ✔ spiral-shaped bacteria, often associated with NUG/NUP aerobic - ✔ requires oxygen to grow. not found in periodontal pockets anaerobic - ✔ grow in the absence of oxygen. found in the periodontal pockets and gingival sulcus facultative anaerobic - ✔ can grow in the presence or absence of oxygen disease progression - ✔ non-motile to motile gram + to gram -
protease - ✔ bacterial product that directly breaks down tissue proteins hyaluronidase - ✔ bacterial products that breaks down the extracellular matrix and allows bacteria to detach causes the spreading factor. exotoxins - ✔ bacterial waste product that causes direct tissue injury such as hydrogen sulfite, uric acid and fatty acids. periodontitis - ✔ inflammation of the periodontal tissues and loss of CT attachment characterized by bone resorption and apical migration of the JE. documented by CAL over time. CAL - ✔ measures from the CEJ to the base of the pocket. best indicator of damage to the periodontium. how to measure CAL - ✔ 1. Measure pocket depth
- Measure recesession
- add these two numbers together Class I Furcation - ✔ early/incipient, probe penetrates furca no more than 1mm Class II Furcation - ✔ moderate, probe penetrates more than 1 mm, but no completely through Class III Furcation - ✔ severe, probe will pass completely through furcation, in maxillary Class IV Furcation - ✔ sever, probe will pass completely and furcation is clearly visible due to loss of attachment and recession. Nabers probe - ✔ the best instrument to detect a furcation anterior teeth - ✔ widest width of attached gingiva 3.5-4.5 in Max & 3.3- 3 .9 in the Mand premolar - ✔ narrowest width of attached gingiva 1.8-1.9 mm palatal surfaces - ✔ width of attached gingiva is not calculated here Healthy alveolar bone - ✔ alveolar crest is 1-2 mm apical to the CEJ, contour should follow contour of CEJ. Distinct radiopaque lamina dura should be present and PDL space should be visible and uniform in width.
alveolar bone in periodontitis - ✔ lamina dura becomes less distinct, you may see loss of bone in furcation areas, bone loss may be horizontal or vertical. *best evaluated on bitewing radiographs vertical bone loss - ✔ type of bone loss described as "angular" Class I mobility - ✔ slight mobility, up to 1 mm horizontally (facial-lingual) class II mobility - ✔ moderate mobility, 1-2 mm horizontally (facial-lingual) class III mobility - ✔ sever mobility, >2mm horizontally or vertical (depression in the socket) suprabony - ✔ pockets that occur above the alveolar crest of bone infrabony - ✔ pockets where the base of the pocket is below the alveolar crest. *treated with regenerative procedures regenerative procedures - ✔ used to treat infrabony pockets primary occlusal trauma - ✔ excessive force on a tooth with normal bone support secondary occlusal trauma - ✔ injury as the result of forces applied to a tooth that has previously experienced bone or attachment loss. occlusal trauma - ✔ signs and symptoms include sensitivity, wear facets, tooth migration, increased tooth mobility, widening of the PDL space primary herpes - ✔ initial infection. 1 week incubation characterized by fever, malaise, lymphadenopathy, followed by painful, erythematous, swollen gingival and multiple vesicles. vesicles ulcerate, crust over and heal within 10-14 days recurrent herpes - ✔ most common is on vermillion border of the lips. may be brought on by sun, stress, fever, menstruation or unknown. apthous ulcers - ✔ painful yellow/white ulcers surrounded by an erythematous halo. cause unknown. predisposing factors are HIV, nutritional deficiencies, smoking cessation, reaction to SLS. Treated with topical steroids, anti-inflammatory meds, healing within 1-3 weeks. Herpes - ✔ occurs on keratinized mucosa, vesicles first - > ulcers, recurent, Tx = antiviral drugs (acyclovir/zovirax)
