MPOD Midterm Review (based on his guide)

How did 3 Musketeers get its name?

Original packages had three pieces in three flavors: chocolate, strawberry, and vanilla

Lesion management:

Fixing the hole (Ex: doing a restoration)

Risk assessment:

Asking "Why is there a hole?" (Ex: diet or home care analysis)

Risk management:

Behavior-modification strategies to shift oral ecosystem to health (Ex: nutritional counseling or teaching toothbrushing)

Risk factors:

Biological or lifestyle causes driving disease (Ex: dry mouth or lack of fluoride)

Risk indicators:

Signs that show disease has already occurred or is active (Ex: redness, pain, or visual lesions)

Normal Pulse:

60-100 bpm

Tachycardia

Pulse over 100 bpm

Bradycardia

Pulse less than 60 bpm

Factors that affect heart rate/pulse:

Anxiety, caffeine, alcohol, medications, exercise, dehydration, body temp, systemic disease (Hyperthyroidism)

Adverse effects of arrhythmia (abnormal pulse)

Blood clot, stroke, pulmonary embolism, cardiac arrest

Normal Respiration level

12-20 breaths per minute

Indicators of respiratory disease / abnormal breathing:

Hyperventilation (rapid breathing), wheezing (possible asthma), out of breath easily (cardiac disease), labored breathing (emphysema)

Normal Blood Pressure

Systolic < 120 and diastolic < 80

Elevated Blood Pressure

Systolic 120-129 and diastolic < 80

Hypertension Stage 1

Systolic 130-139 or diastolic 80-89

Hypertension Stage 2

Systolic > 140 or diastolic > 90

Hypertension Crisis

Systolic > 180 or diastolic > 120

Four physiological factors that increase BP

Excess fluid (blood volume), hardening of arterial walls, narrowing of arterial lumen, excessively strong heart beat

Risk factors for hypertension (cause unknown)

Smoking, obesity, stress, older age, genetics

Clinical/situational factors that affect BP

Anxiety, patient didn't take meds, exercise, lack of sleep, white coat syndrome, smoking, drugs, dehydration, pain

Factors that cause an elevated body temperature:

Abscessed tooth, microbial infection, malignancy, heat stroke

Is lymph node palpation extraoral or intraoral?

Extraoral exam

Is checking midline neck structures / thyroid extraoral or intraoral?

Extraoral

Is checking the TMJ and muscles of mastication extraoral or intraoral?

Extraoral exam

Benign Lymph Nodes (signs/symptoms)

Enlarged, soft, tender, and moveable

Malignant Lymph Nodes

Enlarged, firm, non-tender, fixed, and rubbery

Healthy Thyroid movement:

Moves upward smoothly when the patient swallows

TMJ Joint Sounds:

Clicking, popping, or a grating/cracking sound (crepitus)

Muscles of Mastication clenching sign

Prominent linea alba (a thick white line of keratinization on the cheek mucosa where the teeth bite together) on the cheek mucosa

Bell's Palsy:

Dysfunction of CN VII (Cranial Nerve) causing sudden facial asymmetry and drooping -- often caused by virus

Hyperthyroidism / Graves' Disease

Midline neck swelling, abnormal swallowing movement, bulging eyes

Temporomandibular Disorder (TMD)

Pre-ear tenderness, clicking/popping, restricted opening, jaw deviation

Jaundice indicator

Yellow sclera (whites of eyes)

Are angular cheilitis, herpes, and mucoceles classified under intraoral or extraoral inspection?

Intraoral

Minor Salivary Glands:

Tiny, normal, palpable bumps felt inside the lower lip

Stenson's Duct:

Normal tissue flap on inside of cheek near upper second molar

Mucocele

Soft, bluish-clear bubble on lip/cheek caused by minor trauma

Sialoliths

Hard, stone-like calcified obstructions in the floor of the mouth

Ranula

Large mucus-pooling swelling in floor of mouth from major duct blockage

Bimanual Palpation

Using two hands to trap and feel soft tissue (one finger inside, one hand outside)

Thrombocytopenia

Widespread red dots (petechiae), spontaneous bleeding/oozing

Squamous Cell Carcinoma

Firm, painless, fixed lump or unhealing ulcer, lateral tongue, floor of mouth

Oral Candidiasis

Wipeable white patches, palate/tongue, linked to corticosteroid inhaler use

Critical pH for demineralization (Stephen's curve)

5.5

Brush before or after breakfast?

Before!

Demineralization reaction mechanism

Enamel hydroxyapatite dissolves when oral pH drops below 5.5

Acid-resistant tooth structure form

Fluoroapatite (formed by fluoride)

Protective factors of caries

Saliva flow, fluoride/calcium/phosphate, good hygiene, healthy microbiome strategies

Diet definition:

Specific foods consumed during a day in a specific manner

Nutrition definition:

Nutrients (micro and macro) as they relate to the body's dietary needs

Number one unmet healthcare need for disabled individuals:

Access to oral healthcare

Strategies to close special needs gaps:

Attitudes, Exposure, Toolbox, Payment Models, Creative Workforce, Continuity, Mortality, Underserved Designation, Education

Rosa's Law:

Replaced the "R-word" with "intellectual disability" 2010

ADA/AWDA:

"Americans with disabilities act" - Prohibits discrimination against individuals with impairments that may be disabling due to societal barriers, May not refuse to accept or treat as a result of an individual's disability, provision of auxiliary aids

CODA

"Commission on Dental Accreditation"

"Graduates must be competent in assessing and managing the treatment needs of patients with special needs"

Individual barriers to special needs care:

Lack of perception of need, difficulty with oral hygiene instructions, traveling access issues, anxiety/fear, financial/insurance issues

Dental profession barriers to special needs care:

Inadequate training, insufficient sensitivity, inadequate geographical distribution

Social barriers to special needs care

Inadequate resources, lack of awareness of oral health significance, lack of service planning, lack of research support, inadequate facilities

Government barriers to special needs care

Lack of awareness, low priority, lack of resources, inability to put planning and policy into practice

SCDA

Special Care Dentistry Association

SAID

Special care Advocates in Dentistry

AADMD

American Academy of Developmental Medicine and Dentistry

Oral Health Center for People with Disabilities Location

8th floor

MARTTI

ASL (American Sign Language) assistant tool

Tools at NYU Oral Health Center for People with Disabilities

Wheelchair tilt, MARTTI, Molini (mouth opener) etc

Chief Complaint:

What the patient came in for

History of Present Illness (HPI)

What happened before seeking care today

Past Medical History

Health issues that may influence choice of care today

MASHITT

Medications, Allergies, Surgeries, Hospitalizations, Illness, Transfusion, Trauma

Culture

A system of shared symbols learned and passed from generation to generation

"Culture influences how people perceive the world around them and helps them make decisions. Further, it helps guide their interactions with each other."

"Culture is not a "thing" as much as it is a "process" that can be slightly different in each individual and can change over time"

Patient-centered care components

Active Listening, Empathy, and Engagement

What are the 10 lymph nodes labeled in the extraoral exam diagram? (Idk if we have to know all, but be familiar with the diagram on the slides)

1) Posterior auricular, 2) Occipital, 3) Jugulodigastric, 4) Superficial cervical, 5) Posterior cervical, 6) Supraclavicular, 7) Preauricular, 8) Submandibular, 9) Submental, 10) Deep cervical chain

Caries Balance: What are the 4 pathological factors that drive demineralization (Caries)?

Acid-producing bacteria, Sub-normal saliva flow and/or function, Frequent eating/drinking of fermentable carbohydrates, Poor oral hygiene

Caries balance: What are the 5 protective factors that drive remineralization (No caries)?

Saliva flow and components; Remineralization (fluoride, calcium, phosphate); Good oral hygiene; Strategies that maintain a healthy microbiome; Strategies that modulate a dysbiotic microbiome

Caries balance: What ingredients maintain a healthy microbiome?

Probiotics, prebiotics (arginine), pH modifiers, erythritol, and xylitol

Caries balance: What ingredients modulate a dysbiotic microbiome?

Silver, peptides, tin, and antimicrobials

What are the 4 Contributing Conditions on the caries risk assessment?

I. Fluoride Exposure

II. Sugary Foods or Drinks

III. Caries Experience of Mother/Caregiver/Siblings (ages 6-14)

IV. Dental Home

What are the 5 General Health Conditions on the caries risk assessment?

I. Special Health Care Needs

II. Chemo/Radiation Therapy

III. Eating Disorders

IV. Medications that Reduce Salivary Flow

V. Drug/Alcohol Abuse

What are the 9 Clinical Conditions evaluated on the caries risk assessment? (Idk if we need to know all but should be familiar with the questionnaire)

I. Cavitated or Non-Cavitated Lesions/Restorations

II. Teeth Missing Due to Caries

III. Visible Plaque

IV. Unusual Tooth Morphology

V. Interproximal Restorations (1 or more)

VI. Exposed Root Surfaces

VII. Restorations with Overhangs/Open Margins/Open Contacts

VIII. Dental/Orthodontic Appliances

IX. Severe Dry Mouth (Xerostomia)