DHYG 259 LO1-LO4

what design characteristics make a gracey area specific

curved cutting edge, only one cutting edge is used, self angulating

what cross section does a gracey have

semicircular cross section

what is the angulation of a gracey in relation to the lower shank

70 degrees

where is therminal shank with the tooth surface with a self angulating instrument

parallel with the tooth surface

what is the design features of a rigid instrament

has a thicker terminal shank used for moderate to heavy calculus removal

what is the design features of a A5 instrament

has a 3mm longer terminal shank, working end width is 10% thinner, used to access deep pockeets

what are the design features of a mini instrament

working end length is 50% shorter and 10% thinner, used for furcation areas and narrow root surfaces

what are the design features of a micro instrament

a thick functional shank, tapered terminal shank, working end length decreased by 50% and width 20%

what anterior gracey do we use

gracey 1/2

what posterior mesial and straight gracey do we use

gracey 11/12, gracey 15/16

what posterior distal gracey do we use

gracey 13/14, gracey 17/18

what should you consider when using choosing a gracey

type of deposit, size of calculus, tenacity of deposit, location of deposit, location of teeth, limited openings

why are graceys good for pockets

the angulation of working cutting edge is easy to maintain subgingivally, non working cutting edge is angled away from soft tissues, long functional shank provides good access to deep pockets, rounded toe provides good access to depressions in the root surface

what advantages does a rounded toe have

it can adapt to root, concavities and furcation areas that a sickle cant adapt to

what do we need to consider when selecting an area specific curet

type of deposit, size of calc, tenacity of deposits, location of deposits, location of teeth, limited openings

what is the purpose of the assessment stroke

to assess tooth anatomy, detect calculuc, or other plaque retenetive factors

what is the purpose of calculus removal stroke

to left calculus deposits off of the tooth surface

what is the purpose of root debridement stroke

to remove all residual calculus deposits, disrupt biofilm from root surfaces within pockets

where is the functional shank if using the correct end

up and over the occlusal surface

what is the angluation of an area specific curet when inserting

cutting edge of 0-40 degrees

what is the angulation of an area specific curet during an assessment stroke

strokes are 50-70 degrees with light lateral pressure

what is the angulation of an area specific curet during a calculus removal stroke

terminal shank is parallel ot 70 degrees and use firm lateral pressure

what are the design features differences in a rigid instrument

shank is 3mm longer, diameter of shank is thicker, working end width decreased by 10%

define the term area specific curets

that each instrument is specific to tooth surfaces, the shank design determines the specific area

describe the design features of area specific curets

long complex shank, rounded back, rounded toe, semicircular cross section, face is self angulating (70 degrees)

differentiate between universal and area specific curets

universals have two working cutting edges and blade is perpendicular to the shank

decribe the indications for using area specific curets

to perform nonsurgical periodontal therapy for supragingival and subgingival debridement of hard and soft deposits by using assessment, calculus removal, and root debridement strokes in various directions

describe the design characteristics of area specific curents that make them good tools for subgingival debridement

rounded back allows safe and comfortable subgingival debridement, rounded toe adapts to root concavities and furcations, complex shank angles allows acces to posterior interproximal surfaces, long shank can reach pocket depths

describe stroke directions used with an area specific curets

vertical, oblique, and horizontal strokes

what is the objective of sharpening our area specific curets

preserve the internal angle of 70-80, preserve original contour, maintain the strength of the instrument

where is the face positioned when we sharpen

parallel to the floor

how do we do stone care while chairside

using a wet gauze

how do we properly clean and disinfect a stone

use scrub/ultrasonic/hydrim, dry and bag to be sterilized

describe dentin hypersensitivity

short, sharp pain that arises from exposed dentin in response to stimuli typically thermal, evaporative, tactical, osmotic, or chemical and cannot be ascribed to any other form of dental defect or pathologic condition

describe the pain that would be associated with dentin hypersensitivity

sharp and rapid onset, arises from a stimulus, short duration, chronic condition with acute episodes, not due to any other dental defect or disease

what area are most common to have dentin hypersensitivity

buccal cervical regions of teeth

why does prevalence decreases with age

with the increase of secondary dentin, and reduction in pulpal chamber size, vascularity and pulpal nerve fibers

what is the etiology of hypersensitive dentin

tubules are open to the oral cavity

what teeth and surfaces are most common

bicuspids and cuspids, buccal cervical tooth surface

why does sensitivity often go unreported

people think it is normal, dental professionals may not screen for it, difficult to dianose

which tooth structure causes sensitivity

dentin

what are the three classifications of dentin

primary, secondary, sclerosis of dentin

what are the three type of sensory nerve fibers

a-delta fibers, a-beta fibers, unmyelinated C-fibers

where do the dental tubules run from

from the pulp to the surface of dentin

what is the dental hypersensitivity pain impulse therapy that we use

hydrodynamic theory

what is the hydrodynamic theory

stimuli on the surface of exposed dentin causes fluid movement within tubules

what are the different tyles of stimuli that can trigger pain

tactile, thermal, evaporative, osmotic, chemical

what are the contributing factors for dentin hypersensitivity

loss of gingiva, loss of cementum, loss of enamel, additional causes

what are reasons for loss of gingiva

age, anatomic factors, pathological factors, tissue trauma

how do anatomic factors contribute to loss of gingiva

prominent teeth in an arch, narrow zone of attached gingiva, frenum pull

how does pathological/other factors contribute to loss of gingiva

periodontal disease related, poor self care, smoking, extractions, occlusal trauma, ortho, restorations

how can tissue trauma contribute to loss of gingiva

oral piercings, excessive debridement, toothbrushing factors

what are types of loss enamel and cementum

erosion, attrition, noncarious cervical lesions

how is erosion a contributing factor in loss of enamel and cementum

dissolution of enamel by acids/chemical agents from dietary acids, medications, substance use, GERD, bulimia

what is mostly responsible for enamel loss

erosion

what are risk factors for erosion

low pH, dietary habits, Bulimia, GERD, whitening products, xerostomia

how is attrition a contributing factor to loss of enamel and cementum

wearing down on the occlusal or incisal edge caused by masticatory forces, parafunctional habits, occlusal interferences

how is abrasion a contributing factor to loss of enamel and cementum

loss of hard tissue due to mechanical process using force when toothbrushing or occupational causes

how much faster does dentin abrade than enamel

25 times faster than enamel

how much faster does cementum abrade than enamel

35 times faster than enamel

how is an abfraction a contributing factor to loss of enamel and cementum

wedge at cervical areas caused by occusal forces bruxism, mastication, and occlusal trauma

what are other factors for loss of enamel and cememtum

ortho, tooth preps, instrumentation, incorrect stain remoal techniques, root surface carious lesions

what are natural desensitization

sclerosis of dentin, secondary dentin, smear layer, calculus

what condition can tooth whitening cause

reverse pulpitis

why can dental hypersensitivity be difficult to diagnose

many dental conditions have similar triggers such as hot, cold, sweet, and sour stimuli

what are some dental conditions that can mimic dental hypersensitivity

caries, fractured restorations, cracked tooth, chipped teeth, pulpitis, sinus infection, gingival inflammation, post op sensitivity, occlusal trauma

what diagnostic techniques can you use to rule out other conditions

interview the client, visually inspect tooth, and use marking paper, bite stick, thermal testing, air/water, or dental explorer

why should clients can be asked about sinus problems

sinus infections can cause referred tooth pain

what tooth structure must be exposed for dental hypersensitivity

dentin

what clinical criteria must be there in order to diagnose hypersensitive dentin

sensitivity associated with stimulus, exposed dentin, no signs of caries, no fracture lines in tooth, restorations intact

what radiographic criteria must be there in order to diagnose hypersensitive dentin

no dental caries, no fracture lines, restorations intract, no pulpal pathology, radiolucency at cervical 1/3

what is the main goal and first step of planning care for dentinal hypersensitivity

pain relief

when should we evaluate the professionally applied products that we place

after debridement, and after application at later appointments

what is the second step to planning care of someone with dentin hypersensitivity

address risk factors/cause

what are risk factors or causes of sensitivity

oral self care, parafunctional habits, diet, tooth whitening, instrumentation

what are preventive techniques to prevent loss of gingiva and tooth structure

review toothbrush techniques, nutritional counselling, educate on periodontal surgery, at home whitening, instrumentation

what are ways that sensitivity will treat itself with no treatment required

following calculus removal and periodontal surgery, dentinal tubules go through crystallization and occlusion, odontoblasts create secondary dentin, a smear layer is formed, saliva enters dentin tubules and block external stimuli

in therapeutic care what are the self care and behavioural changes that we should educate on

reduce the stimuli that cause pain, reduce risk for loss of gingiva and tooth structure, recommended home care products

what are ways that we can reduce the stimuli that cause pain

communicate habits that allow tubules to remain occluded such as sensitivity toothpastes and daily fluoride or mouthrinses, and reducing stimuli that cause pain such as parafunctional habits, toothbrushing techniques, whitening, diet, avoiding stimulants

what are ways that we can reduce risk for loss of tooth structure and gingiva

educate on bulimia/reflux/medications, diet modifications, reduce clenching behaviours, toothbrushing modifications

when do we recommend self care desensitizing products

mild to moderate sensitivity

what ingredient do we look for in a desensitizing mouthrinse

stannous fluoride 0.63%

what ingredient do we look for in a desensitizing gel

5000ppm fluoride

what are the two modes of action to self applied desensitizing products

occlusion of tubules and nerve desensitization

what ingredients are common in nerve desensitization

potassium nitrate, potassium citrate, potassium chloride, potassium oxalate (potassium salts)

what ingredients are common in occlusion of tubules

strontium chloride, strontium acetate, calcium phosphate compounds, arginine, fluoride, oxalates

how does occlusion of tubules work

a physical and chemical reaction that works due to particles blocking stimulus to pulp tissue or precipitation of minerals or proteins

how does nerve desensitization

reduce nerve depolarization, pulpal nerves becomes unresponsive to excitatory stimuli

what self applied product ingredients are arginine and calcium carbonate

colgate sensitive pro relief

how does stannous fluoride 0.454% desensitize

occlusion of tubules

what is the most widely available desensitizing ingredient

potassium nitrate

how does fluoride 5000ppm or 1.1% sodium fluoride desensitize

occlude tubules

what is the active ingredient in MI Paste

Recaldent

what product uses NovaMin for sensitivity

sensodyne repair and protect

what are qualities of a desensitizing agent

accetable to oral tissues, ease of application, good rapidity of action, long lasting results, no side effects

what are common ingredients for professionally applied products that occlusion of tubules

sodium fluoride varnish, arginine and calcium carbonate, silver diamine fluoride, oxalates, calcium compounds, HEMA, Gluma

what are common ingredients for professionally applied products that nerve desensitize

potassium salt compounds, HEMA, Gluma

what is the application of sodium fluoride varnish

remove debris, dry surface, leave undisturbed up to 4 hours, post op instructions

what is a product with sodium fluoride and calcium phosphate

embrace varnish 5% sodium fluoride with CXP

what are the active ingredients of bifluorid 10

calcium fluoride and sodium fluoride