DH320 Final Review Guide: Key Concepts and Strategies

Assess

data collection

diagnose

identify problems based on assessment data

plan

select, prioritize, and sequence dental hygiene interventions

implementation

activating the plan

evaluation

feedback on effectiveness

document

comprehensive record keeping

Risk factors for Periodontal Disease

Stress, Lifestyle choices (tobacco, alcohol), Gender (more prevalent in men), Cultural, Systemic conditions, Genetic factors, Nutritional status

Risk Factors for Dental Caries

Behavioral factors (inadequate biofilm removal), Dietary factors, Low fluoride, Tooth morphology, Xerostomia, Personal and family history

Risk Factors for Oral Cancer

Tobacco, alcohol, Excessive sun exposure, HPV

Patients Self Care Ability

Ability to manipulate a toothbrush and interdental aid in order to comply with suggested oral care regimens will determine the success of planned interventions

OSCAR Planning Guide

Oral, Systemic: normative age changes, medical diagnoses, pharmacologic agents, interdisciplinary communication, Capability, Autonomy, Reality

Phase II - Surgical - Endo

Parts of a Care Plan: periodontal/gingival health, Goal is to restore and maintain health of the periodontal tissues

Final Diagnosis

Dentist and periodontist can give final diagnosis

Informed Consent

Legal concept that can exist even without a written document

Natural Tooth Supported Dentures

Traditional/bilateral: supported by one or more natural teeth at each end

Cantilever

Pontic supported by one or more teeth at one end only

Implant supported

Most often the endosseous implant is used to support fixed partial dentures and overdentures

Resin retained

Wing like extensions are bonded with resin cement to etched enamel

Overdenture

Removable prosthesis that rests on one or more remaining natural teeth and/or dental implants

Endosseous

Most common implant placed to replace a single tooth

Peri Implant Preventive Care

Key requirement for implant success is disease control program for tissue surrounding implant

Adaptation

About 2-3mm of the toe third of a curet may be adaptable when on a flat surface of the tooth

Periodontal disease systemic connection

Cardiovascular disease and some cancers

SRP outcomes

Reduction in inflammation and infection, Reduction in pocket depth, Gains in clinical attachment

Diet

Patient should be instructed to avoid chewing solid food or drinking hot liquids until anesthetic is worn off

Evaluation

Systematic determination of worth, value, or significance

Visual Examination

Gingival examination looks for changes in tissue color, size, shape, and consistency

Interview Evaluation

Success of factors associated with patient comfort during treatment

ADPIED

Assess - data collection; Diagnose - identify problems based on assessment data; Plan - select, prioritize, and sequence dental hygiene interventions; Implement - activating the plan; Evaluate - feedback on effectiveness; Document - comprehensive record keeping.

Dental Hygiene Diagnosis

Identification of an existing potential oral health problem that a dental hygienist is qualified and licensed to treat.

Evidence Based Information

Scientific evidence that we are using to make our dental hygiene diagnosis.

Periodontal Disease Association with Systemic Conditions

CVD; Infective endocarditis; Diabetes; Obesity; Respiratory; Adverse pregnancy; Osteoporosis.

Partial Dentures

Should be removed at night or for 6-8 hours daily; Not removing it daily may result in inflammation and irritation from exposure to microorganisms.

Removable Partial Prostheses Care

Sodium hypochlorite are most effective at killing pathogens; Can corrode metal; Loosens stains and deposits.

Osseointegration

Direct bone anchorage to an implant body; Reveals direct contact between bone and implant with no intervening connective tissue.

Systemic Health

Tobacco may adversely affect wound healing, and jeopardize the success of dental implants and bone health; Alcohol abuse may cause changes in alveolar bone healing impacting osseointegration and may result in implant failure.

Chlorhexidine Gluconate

Recommended as needed to manage inflammation of soft tissues around the implants; Helpful in gingival inflammation.

Implant Success

Avoid acidulated fluoride preparations due to possible effects on the implant surface.

Peri Implant Mucositis

An inflammatory lesion in the mucosa similar to gingivitis; Bleeding and/or suppuration on gentle probing; Increase in probing depth (due to tissue inflammation and not bone loss); No bone loss; Reversible.

Instrument Design

Textured and lightweight handles; Better stability and increased tactile sensitivity.

Oral Conditions Contraindications

Demineralizes areas; Exposed dentin; Thermal injury; Children; Restorations; Titanium implant abutments.

Sharpening Overview

Objectives for techniques of sharpening emphasize the preservation of the original shape of the blade while restoring a sharp cutting edge.

Visual Glare Test

To examine cutting edge under adequate light; Dull cutting edge presents a flat, rounded shiny surface, which can reflect light.

Plastic Testing Stick

Use a sterile plastic or acrylic ¼ inch rod, 3 inches long.

Unit 3 Periodontal disease systemic connection

Cardiovascular disease and some cancers.

Etiology of Periodontal Disease

Microbiome of gingivitis is NOT the same as periodontitis.

Recognition of Gingival and Periodontal Infections

Gingival infections: confined to the gingival; Periodontal infections: all parts of the periodontium, namely the gingiva, periodontal ligament, bone, and cementum.

Tobacco Products

Nicotine: chief psychoactive ingredient in tobacco that causes addiction, toxic; 60 mg of nicotine causes fatality.

Nicotine Withdrawal

Dysphoric or depressed mood; Insomnia; Irritability, frustration, anger; Anxiety; Difficulty concentrating; Restlessness; Decreased heart rate; Increased appetite; Craving for tobacco.

Periodontal Debridement

Remains the gold standard for initial therapy in inflammatory gingival and periodontal infections.

Antimicrobial Treatment

Arresting of infection using antimicrobial drugs to slow or arrest loss of periodontal attachment and other periodontal tissue destruction caused by microorganisms.

Necrotizing Ulcerative Gingivitis (NUG)

Organisms: Prevotella intermedia, Fusiform bacilli, Spirochetes; Signs and symptoms: Malaise, Lymphadenopathy of glands, Fever.

Periodontal Abscess

Exudate collects in tissue as a result of bacterial infection, fistula.

Evaluation

Systematic determination of worth, value, or significance.

Gingival/Periodontal Health Outcomes

Reduced dental biofilm; Smooth tooth surfaces with calculus removed; Reduced probing depths; No bleeding on probing, exudate, or suppuration; Resolution of erythematous tissue; Reduced swelling and edema; No further loss in attachment level; Decrease or no change in mobility.

Dental Caries Risk Outcomes

No new cavitated lesions; Demineralized areas resolved; Reduced intake of cariogenic foods/beverages; Increased fluoride use.

Phases of Treatment

Phase II - Surgical - Endo

Parts of a Care Plan

Periodontal/gingival health, Goal is to restore and maintain health of the periodontal tissues

Metabolism of Nicotine

Absorption of nicotine occurs through most of the body's membranes (in the liver)

Tobacco Cessation 5 A's

Ask, advise, assess, assist, arrange

Long term SRP success

Control of dental biofilm on daily basis, Management of modifiable periodontal risk factors, Regular periodontal maintenance based on risk factors and disease control

Preventive Services for SRP

Personalized oral hygiene instructions (OHI), Professional oral irrigation

Dental Biofilm Removal for SRP

Lipopolysaccharides or endotoxins: gram negative pathogenic microorganisms that are toxic to human tissue

Lateral Pressure Instrumentation

Light pressure: is needed for exploration to position blade below the calculus deposit and to debride biofilm while preserving cementum

Channeling

Overlap strokes in channels to ensure complete coverage of subgingival surface for thorough removal of deposits

Re-evaluation of SRP

4-6 weeks after treatment

Arestin

1 mg minocycline, does not block flow of subgingival fluid

Periochip

Does not have the potential for the development of bacterial resistance

Signs and symptoms of NUG

Malaise, Lymphadenopathy of glands, Fever

Post treatment for NUG

Liquid diet, Nutritious meals, Avoid alcohol and spicy foods, Rinse with warm water, Hydrogen peroxide and water, Chlorhexidine

Necrotizing Ulcerative Periodontitis (NUP)

Clinical manifested as destructive infection of periodontal issues with ulceration of the interdental papilla, cratering of interdental bone, soft tissues, evidence of CAL

Pericoronal Abscess

Infection of gum tissue surrounding the crown of partially or fully erupted tooth

Herpetic Gingivostomatitis

Mouthrinse containing diphenhydramine hydrochloric acid in combination with other agents

Prevention Outcomes

Elimination of iatrogenic factors, Increased percentage of biofilm free areas

Standard of Care

Opinion of expert witness, Journals, guidelines, or documents from recognized professional associations, Federal, state, or local statutes

Self Assessment and Reflection

Be successfully taught and developed, mainly through reflective writing

Critical Incident Approach

Formal approach used to evaluate dental hygiene practice takes the form of answering questions about a specific situation

Continuing Care

Should always be scheduled to patients needs

Patient as Co-Therapist

Patient is the co therapist

Monitor Risk and Clinical Signs

Monitor Risk and Clinical Signs of Health and Disease

Periodontal Infection

Periodontal infection

Oral Mucosal Lesions

Oral mucosal lesions

Dental Caries

Dental caries

Eruption Patterns and Occlusion

Eruption patterns and occlusion

Periodontal Maintenance

Prevent the recurrence of disease and maintain a state of periodontal health attained during surgical and nonsurgical periodontal therapy

Timely Treatment Identification

Increase timely identification of the need for treatment

Frequency of Periodontal Visits

Seen 4 times a year

Recurrence of Periodontal Disease

Recolonization of a pocket can occur in average of 42 days

Methods for Continuing Care Systems

Prebooking, sending reminder card to schedule an appt, monthly reminders, utilizing electronic media

Preventive Program

Assess the patient needs, Plan for interventions, Implement the plan, Learning and practicing more effective health behaviors, Perform clinical preventive services, Evaluate progressive changes, Plan short and long term continuing care

Patient Learning

Acquires the knowledge or skills through study and/or instruction

Motivational Interviewing

Person centered, goal directed methods of communication for eliciting and strengthening intrinsic motivation for positive change

Elements of MI Spirit

How a clinician relates to the patient through communication and interactions

PACE

Partnership, acceptance, compassion, evocation

Acceptance in MI

An attitude of acceptance of what the patient brings

4 Processes of MI

Engaging, Focusing, Evoking, Planning

Complex Reflection

Adds meaning or emphasis to what the patient said

Sustain Talk

Patient who is happy about current health related behaviors

Change Talk

Preparatory or mobilizing toward changing behaviors

Readiness Ruler

Used to measure how motivated the patient is for change