Dental Hygiene Theory 1 test

Dental hygiene is

science and practice of:

• recognition

• prevention

• treatement

of oral diseases and conditions as integral component of total health

Primary prevention + example

measures carried out so disease does not occur and truly prevented (flouride, cleanings, sealants)

secondary prevention + example

involves treatment of early disease to prevent further progress of potentially irreversible conidtions that can lead ot rehabilitative treatment or loss of teeth (SDF)

Tertiary prevention + example

uses methods to replace lost tissues and to rehabilitate the oral cavity to a level where function is as near normal as possible after secondary prevention is not successful (fillings)

theraputic

arrest or control disease and maintain oral tissue

• periodontal quadrant scaling

• post treatment care - antibiotics

education

oral health education

• help patients understand disease prevention

• community education

• oral systemic link

Process of Care

ADPIED

• Assess

• Diagnose

• Plan

• Implement

• Evaluate

• Document

Assesment

systemic data gathering

• health histories

• intra oral/extra oral exams

• radiographs

• hard tissue charting

• periodontal probing

• calculus detection

• disease determination

• subjective data

Diagnosis

• identify probelm and justify treatment

• Co therapist (working as a team to treat)

• problem realted to risk factor

  • xerostomia (dry mouth) from meds

Planning

develop strategies and creating a care plan

• selection of interventions to be performed by patient, DH, or others

• establish priorities

• establish goals with patient

• informed consent

implementation

active phase of care plan where DH services perfomred and personalized oral hygiene instructions (OHI) given

Evaluation

compare current (new) status to old baseline data

• was there progress or is it the same

• if same should patient be retreated, referred, etc

Documenting

• all assesment data, diagnosis, care plan, treatment, patient education, and eval documented

HHX

health history

TX

treatment

Perio

periodontal

OCS

oral cancer screening

PTED

Post treatment endodontic disease

NX

next visit

ethics core values

• autonomy and respect - informed consent

• confidentiality

• societal trust

• non-malificence - do not harm

• beneficence - promote well being for all

• justice and fairness - access to care

• veracity - honesty

direct supervision

dentist diagnoses and auhtorizes treatment, stays in the office and approves work when completed

Indirect supervision

dentist present in facility and available for communication if needed

general supervision

dentist authroizes treatment for a pt of record, does not have to be present in the office

direct access practice

assesment prodcuedures can be carried out without authroization but agreement needed (public health settings)

remote practice

(teledentistry) communication and collaboration with supervising dentist who isnt onsite

Independent practice

no authorization or supervision by a dentist

True or false beneficence means do no harm

false (non-maaleficence)

standard precautions

assume everyone has everything you dont want, treat every patient the same

Resident bacteria

(staph, MRSA)

• inhabit surface epithelium or deeper areas

• ultimately shed with exfoliated surface cells

• flora may be altered by new pathogens, reduced by washing

• less suseptible to destruction by disinfectant

Trasient bacteria

• reperesent continuous contamination by routine contacts; some are pathogens and may be temprary residents

• may be washed away

• skin breaks can cause autogenous infection

• most can be removed by soap and water washing

sanitation

process by which the number of organisms on inanimate objects in reduced

disinfecction

process intended to kill or remove pathogenic microorganisms, with the exception of bacterial spores

sterilization

process by which all forms of life, included bacterial spores are destoryed by phsycial or chemical means

Chemical disinfectant uses

• as a surface disinfectant

• immersion disinfectant

• immersion sterilant (long time)

• hand antimicrobial

Low level disinfectant

• inactivates vegetative bacteria and certain lipid type viruses

• does not destory spores

• used on floors, walls, sometimes countertops

  • phenolic, quaternary ammonium

Intermediate level disinfectant

• inactivates all forms of microoganisms but doesnt destory spores

• kills M tuberculosis (hallmark microbe for disinfectant, very resistant)

• we use in offices as surface disinfectant

• examples: alcohol, hypochlorites (bleach), iodine, iodophor

High level disinfectants

• inactivates spores and all bacteria, fungi, and viruses

• disinfecctant or sterilant (depends on contact tme/ immersion time)

• ex: hydrogen peroxide, glutaraldehyge, ortho-phthaladehyde, peracetic acid

properties of ideal disinfecant

• broad spectrum

• fast acting

• surface compatible (1 min vs 3 min kill time)

• non toxic

• not affected by physical factors

• residual effect on treated surfaces

• active in presence of organic matter

• easy to use

• odorless

• economical

Intermediate level disinfecctants inactivate all forms of microorganisms but do not destroy spores, true or false

true

sterilization

must destory all forms of life without damaging the material, not all materials can be sterilized in same way

moist heat/steam under pressure (autoclave)

• most common economical method, quick process

• may cause corrosion (syringes)

• not good for temp sensitive materials (plastics)

• room emits slight odor

Dry heat (oven)

• no corrosion

• long process

• not suitable for temp sensitive materials (plastic)

Chemical vapor sterilizer

• no corrosion

• quick process

• ease of operation

• needs ventialtion and cannot be used in sml areas

Autoclave gravity displacement time and temp

15-30 mins at 250 F (121 C)

Autoclave prevaccum time and temp

3.5-10 mins at 270F 132 C

dry heat oven time and temp

120 mins at 320F (160C)

chemical indicators

come in strips or vials

• biological monitor (spore testing) - geobacillus stearothermophilus

Instrument circulation area

clinical use - holding solution - instrument cleaning (ultrasonic) - package - sterilize -

recieving/holding area

• prevent drying of bioburden

• initiate dissolving of organic debris

• begin the microbial kill

• (holding station for our clinic is cassette)

purpose of receiving/holding area

• reduce transmission of bioburden

bioburden

contaminating organisms present on a surface prior to sterilization or disinfection

purpose of cleaning area

• ultrasonic processing (dishwasher) - most effective and safe method

• hand scrubbing not recommended - dangerous

  • need thourough removal of bioburden

purpose of packaging area

• provides instruments with post sterilization protection

• keeps instrument sets all together

• provides chem indicators

• patients know theyre sterile

chem indicators

• external chem indicator tape and strips - color change

Storage area purpose

• keep sterile and non sterile separate

• low dust low traffic area

• open instruments in front of patients not in storage areas

when and how long to flush water lines

• flush for 2 mins first of day and 30 secs between patients

• end of day - turn off main switch and drain air/water

biohazard

• blood saturated gauze

• organic tissue

• sharps container - needles, blades

treatment room policies

no eating drinking, applying cosmetics, contact lens handling

no food storage in areas where blood/saliva may be present

Bloodborne pathogen standard

requires employers to protect employees who are at risk for exposure to blood and body fluid

• vaccination

• training (gen and specific)

• personal protective attire

• exposure control plan

hazard communication standard

aka the “employees right to know” law. the standard requires employers to ensure chemical saftey in the workplace

• training

• personal protective attire

• info for labeling containers of chems

• maintain SDS

Cross contamination

spread of microorganisms from one source to another

• direct

• indirect

• autogenous infection - infection spread from self to self (herpes)

infectious agent

the invading organism

reservoir

where the invading organisms live and multiply (conditions for infectious agent survival) — food, O2, temp, light, pH

port of exit

from various body systems

mode of transmission

direct, indirect, autogenous

suseptible host

depends on immune status of host —- ex: no HBV vaccine, general physical health, nutrition, antibody response, defense cell reaction

Factors that alter normal defenses

1. abnormal physical conditions, ex: heart valve

2. systemic diseases, ex: diabetes, alcoholism, leukemia, AIDS

3. Drug therapy, steroids, chemo, interferon

4. prostheses and transplants, joint replacements, cardiac prosthesis, organ transplants

factors having to do with organisms

• number of organisms

• virulence of organisms; ability to survive

airborne infections

• dust borne organisms

  • clostridium tetani

  • staph aures

  • enteric bacteria (diarrhea)

• aerosols

• spatter

Airborne infections

• particles classified by size (aerosols or spatter)

• in constant production

  • a/w syringe

  • ultrasonic

  • handpieces

aerosols characterisitcs

• <50 um, usually <5um

• organisms, mercury, amalgam

• invisible and remain in air long time

• can move room to room

• if 5 microns or smaller an be breathed deep into lungs

• highest cv 2 ft in front of patient

  • ex: cavitron, a/w, sneezing, coughing, polishing, speaking, breathing

spatter characteristics

• heavier, larger particles >50um

• remain airborne relatively short time

• may be visible on eyewer, op lights, surfaces, clothing

• cover surfaces 3 ft in front of pts mouth

  • ex: prophy past, calculus pieces, oil from handpiece

TB

• resistant and highly contaigous

• upper part of lung, can hold for 30 years before disease manifests

• transmission mode: inhalation of aerosolized droplet

• no cavitrons, polishing, a/w combo with known TB

• not seen in clinic if active

• can pass through standard surgical masks, may reamin suspended in air for hours

• most contaigous just before diagnosis - only transmitted when active

• symptoms: persistent cough, fever, nigh sweats, fatigue, anorexia

TB infectious agent, reservoir, exit, transmission. entry, host

Infectious agent: mycobacterium tuberculosis

reservoir: body fluids

exit: droplets

transmission: airborne

entry: respiration

host: anyone

viral hepatistis

viral liver infetion blood borne versions often asymptomatic —- most common symptoms are diarrhea, fever, muscle/joint pain, nausea, and jaundice

What type of hepatitis are bowel related and what types are blood/bodily fluid borne

Hep A, E bowels vs Hep B,C,D blood

Hepatitis A

fecal-oral

• A is for anal

• infectious

• restaurants, daycare

  • contact with bowel movements of infected person

  • food handled by infected person

  • water that has sewage in it or shellfish taken from contaminated water

• anal sex followed by oral sex

  • gamma-globuiln injection

Hepatitis E

E is for eating

• similar to A but more virulent (harmful)

• only in underdeveloped countries in contaminated H2O suppl

• fecal oral route/sewage disposal issue

• foodborne via watering crops with feces-contaminated water

Hep B

B is for blood/bodily fluids

• highest oral cv in sulcus

• settings for infection:

  • health care delivery (needle sticks, transfusion)

  • sex

  • sharing needles/drug use

  • mom to fetus

  • tattoos, piercings

  • inactivated by intermediate lvl disinfection

Hep C

C is for careful “stealth virus”

• most common bloodborne disease in US

• asymptomatic

• 47 million globally infected

• often co-exsists w/ B

• no vaccine exsists

• treatment very expensive: interferon, ribavirin

Hep D

D is for deadliest

• most severe from hep

• delta virus

• must have hep B first to contract D

• same modes of transmission as B

• VA clinic, prisons

Which hep virus will live up to 6 weeks

hep C

what is the standard for water cfu bacteria per mL of water

less than 500 cfu of bacteria per mL of water

engineering controls (mechanical devices)

sharp containers, transporting containers, instrument cassettes

work controls (behaviors) preventing transmission

no food/drink in clinic areas, hair and nails, hand washing

labeled regulated medical waste preventing transmission

sharps, saturated gauze or tissue

Seroconversion vs incubation period

seroconversion is when antibody level can be detected 6 wks to 6 months post exposure and incubation period is the time of infection until symptoms of AIDS appear (15+ years)

HIV/AIDS

• sexual contact: vaginal, oral, anal

• intravenous drug users

• transfusions and/or transplants (rare now)

• occupational accidental injuries

• periinatal: cross placental and birth canal

• survives only a few hours

HIV/AIDS transsmission

transmission: body fluids, blood, semen, vaginal secretions, breast milk

• found in saliva, tears, urine, bronchial secretions but not yet been found to be transmitted by these fluids

• attacks immune system

• over 1 million infected in US

• no cure or vaccine

HPV

• infect genital area and the mouth

• cause 70% of cervical cancer

• can cause oropharyngeal cancer

• vacciantions recommeded for girls 11 and 12 and for males and females 13 to 26 as well as same gender sex

Kaposi Sarcoma HHV 8

• saliva and genital secretions

• AIDS defining lesion

• fever, rash, lymphadenopathy, bone marrow failure

cytomegalovirus (HHV 5)

• most affected groups 1-2 years and 16-20 years

• in utero, birth canal. breast milk

• can be transmitted thru blood transfusions, transplants, sex, respiratory droplet

• if infected as an infant, prematurity, anemia, retardation, microcephaly, motor disabilites

Epstein-Barr virus (HHV 4) “mono”

• excreted in saliva during infectious mono and for weeks after infection

• transmission most common through oral contact with saliva, less commoly through blood transfusion

• fever, pharyngitis, cervical lymphadenopathy

• long communicable period, carrier state is CFS (chronic fatigue syndrome)

varicella zoster (HHV3)

primary infection chicken pox shingles is latent infection

Herpes simplex virus type 2 (HHV 2)

• manifests as gential herpes

• oral type 2 lesions can occur

• generally transmitted sexually

• 1 and 2 cannot be distinguished clinically

• has been implicated in cervical cancer

herpes simplex virus type 1 (HHV1)

• most significant viral disease affecting the oral mucosa (cold sore, fever blister)

• primary herpetic gingiovostonalitis is an infection in mouth ages 6 months to 6 years

• herpes labialis, conjuctivitis ocular herpetic whitlow

• highly contaigous in vesicle stage post pone treatment

• autogenous infection

• has been implicated in oral cancer

• acyclovir