Exam 2 Review (Principles)

Radiographs

Snapshot of patient's periodontal situation.

Parts of periodontal assesment

Bleeding index, probe depths, attachment level/recession, furcation involvement, cementum / abrasion, mobility, gingival description

Gingival disease process

Gingivitis = inflammation limited to soft tissue; reversible with good plaque control.

Periodontitis = progression involving PDL and alveolar bone destruction; irreversible.

The whole process begins with bacterial plaque accumulation, triggering an inflammatory response.

What makes up epitheium?

The epithelium of the gingiva is composed of stratified squamous epithelial cells, which may be keratinized or non-keratinized, depending on the area.

Junctional epithelium

Part of the dental tissues that act as attachment mechanisms.

Gingival connective tissue fibers

Includes dentogingival, dentoalveolar, circular, and transeptal fibers.

Periodontal ligament fibers

Includes alveolar crest, horizontal, oblique, apical, and interradicular fibers.

Cementum

Located at the coronal third of root

- Cellular: found more apically

- CEJ can appear 3 ways

Gingiva

Keratinized tissue that makes up part of the epithelium.

- Prevents trauma from mastication

Color

Coral pink (healthy)

- Diseased or inflamed: erythematous or red color, cyanotic or blue / purple color

Contour

Healthy: thin or scalloped, knife-edged

Unhealthy: thick and flat, enlarged due to inflammation

Festooned / bulbous, rolled margin, stillman's cleft

Consistency

Tissue loses its firmness with disease (due to fiber breakdown)

Papilla or marginal tissues (move easily with air)

Stippling: orange peel appearance

Stippling usually disappears during disease

Alveolar mucosa

Non-keratinized tissue continuous with labial mucosa.

Free (marginal) gingiva

Moveable tissue forming gingival margin and sulcus base.

Attached gingiva

Bound to underlying bone.

Interdental papilla

Pyramidal gingiva in interproximal space.

- Free

Col area

Non-keratinized depression connecting facial and lingual papilla under contact point.

Fiber groups

Includes dentogingival, dentoalveolar, circular, transeptal, and periodontal ligament fibers.

Gingival disease

Characterized by color changes, rolled margins, festooned appearance, and loss of firmness.

Health-history systems

Includes personal history, dental history, and medical history.

Premedication

Administered before tissue manipulation if risk of endocarditis exists.

Other patients at risk of premedication

Joint replacement for at least 2 years, type 1 diabetes, uncontrolled diabetes, previous prosthetic joint infections, shunts, malnourishments, hemophilia, chemotherapy, blood diseases, HIV, renal disorders

Amoxicillin regimen

2 g for adults or 50 mg/kg for children, taken 1 hour before procedure.

Clindamycin regimen

600 mg for adults or 20 mg/kg for children, taken 1 hour before procedure.

Normal vitals

Temp 96 - 99.5 °F,

- Pulse 60 - 100 BPM,

- BP Systolic 120 - 130, Diastolic < 80.

- Older: slightly lower

- Children: slightly higher

Abnormal BP adults

Normal high: 130-139 / 80 - 85

Stage 1: 140 - 159 / 90 - 99

Stage 2: 160 - 179 / 100 - 109

Stage 3: 180 - 209 / 110 - 119

Stage 4: >210 / > 120

Abnormal BP kids

- (3-5): 116 / 76

- (6-9): 122 / 78

- (10-12): 126 / 82

- (13-15) : 136 / 86

Abnormal temperatures

- Fever (pyrexia) > 99.5 degrees F

- Hyperthermia: > 105.8 degrees F

- Hypothermia: < 96.0 degrees F

Abnormal Pulse

- Children and women are higher

- Tachycardia: >100 BPM

- Bradycardia: <50 BPM

Disinfection

Kills all pathogens except spores

Sterilization

Destroys all microorganisms including spores using methods like steam, dry heat, chemical, gas.

Steam sterilization parameters (Autoclave)

250 °F for 30 minutes (may corrode).

Chemical vapor sterilization parameters

260 - 270 °F for 20 minutes (ventilation needed).

Dry heat sterilization parameters

320 - 340 °F for 1 - 2 hours (no corrosion).

Ethylene oxide sterilization parameters

75 °F for 2 - 12 hours (no heat, long cycle).

Chemical immersion sterilization

Glutaraldehyde for 8 - 10 hours (not sterile after air exposure).

Upright patient position

Used for vitals, discussion, and dismissal.

Semi-upright patient position

Recommended for cardiac or respiratory conditions (asthma, CHF, pregnancy 3rd trimester).

Supine patient position

Patient is parallel to the floor for standard treatment.

Trendelenburg position

Heart is above head, used for CPR or emergencies.

Hepatitis A

Transmitted via oral-fecal route with a 30-day incubation; vaccine available.

Hepatitis B

Transmitted through blood/body fluids; survives 7-14 days; vaccine recommended for health-care workers.

- Found in ginivical sulcus

- Most at risk for this one

Hepatitis C

Bloodborne transmission (needles)

- No vaccine available.

Hepatitis D

Co-infection with HBV only; most severe form.

Hepatitis E

Waterborne transmission (not prevalent in U.S.).

Herpes Simplex

Transmitted by saliva, blood, and sexual contact; causes vesicular lesions and herpetic whitlow (finger lesion)

HHV-3 (Varicella Zoster)

Causes chickenpox and shingles; transmitted via airborne or contact.

HHV-4 (Epstein-Barr)

Causes mononucleosis; spread by saliva.

HHV-5 (Cytomegalovirus)

Transmitted through blood/saliva; typically harmless except in immunocompromised individuals.

HIV

HIV: primary infection

AIDS: subsequent latent disease

- Not considered high-risk in dentistry with the use of universal precautions

- Numerous infections may occur (could be HIV)

- Fungal lesions (candidasis): white coating on tongue

- Viral or hairy leukoplakia

- Bacterial (gingivitis or periodontitis)

- Neoplastic (Keaposi's syndrome, lymphoma)

other

Legionella

More severe infection of pneumonia

- Found in biofilm in dental waterlines

Tuberculosis (TB)

Respiratory exposure to mycobacterium tuberculosis

Spread through airborne droplets: coughing, sneezing and singing

- Symptoms: persistent cough, fever night sweats, fatigue or loss of appetite

- Incubation: 4 - 12 weeks

- Clinical illness develops within 6 - 12 months

Tetanus

Infection at site of an open wound, injury induced by the tetanus bacillus, clostridium tetani

- Transmitted through puncture wounds contaminated by soil, dust or feces

- Incubation: 3 - 21 days

Measles

Viral infection which was once considered highly contagious

- Transmission: airborne through water droplets of direct contact with nasal secretions

- Symptoms: fever, conjunctivitis, cough, lesions on buccal mucosa and blotch rash

Candidiasis

Fungal infection characterized by a white coating on the tongue.

Staph / Strep infections

Normal resident flora contain Staph microorganisms

Hands (most common vehicle transmission)

- Usually don't react to antibiotics

- Ex: scarlet fever, sore throat

Direct or intimate contact with carriers

- Caused by S. aureus

Parotitis

Inflammation of the parotid glans. Can also be from mumps, bacterial infection and obstruction of salivary gland

Diseases transmitted via airborne droplets

Influenza, pneumonia, mumps

Ergonomics

The science of proper body mechanics to prevent cumulative trauma.

Clinician positioning

Feet flat, thighs parallel to floor, back straight, shoulders relaxed, elbows close, wrists/forearms aligned, eyes 14-16 inches from mouth.

Patient positioning

Contingent among clinician

- Depends on treatment and comfort (upright, semi-upright, supine, Trendelenburg).

Proper light placement

Reduces fatigue and risk of injury.

What is direct transmission of bloodborne microorganisms?

Transmission through direct contact with blood, blood products, and blood-contaminated saliva.

What is indirect transmission of microorganisms?

Transmission from a host (source) to an object, which can then infect another person.

How are aerosols involved in microorganism transmission?

Aerosols are airborne particles

What is the size of splatter or droplets in microorganism transmission?

Splatter or droplets are visible and greater than 50 microns in size.

What is autogenous transmission?

Self-inflicted transfer of microorganisms from one area of the body to another, which may not be infectious in one part but can be in another.

What is waterborne transmission?

Transmission of microorganisms through contaminated dental unit water lines.

What is biofilm in the context of waterlines?

A film of microorganisms that attaches tenaciously to the inner surface of waterline tubing, with over 40 microorganisms identified in contaminated waterlines.

How can blood or blood products be transmitted through the air?

They can be incorporated into saliva and transferred via aerosol droplet and splatter production.

Direct vision

Viewing areas visible without reflection (anterior teeth).

Indirect vision

Using the mirror to view areas not directly visible (posterior teeth, linguals).

What is the purpose of retraction in dental procedures?

To hold the soft tissues (cheek, tongue, lips) away from the working area, increasing clinician visibility and decreasing patient trauma.

What is reflective illumination used for in dentistry?

To reflect light onto intraoral structures to increase visibility.

What is transillumination in dental practice?

The technique of reflecting light through the anterior teeth to view color changes or alterations in tooth structure integrity.

Benefits of textured (knurled) instrument handles

Decrease slipping and trauma, reduce fatigue and CTD occurrence, and increase tactile sensitivity.

Forms of working ends

Wire-like (flexible), rod-like (periodontal probes), or blade (treatment instruments).

Variety of ends

Instruments can have single-ended, double-ended, or mirrored ends.

Balanced instrument

An instrument designed with ergonomic principles to provide proper rollability and hand comfort.

Benefits of using a balanced instrument

Improved ergonomics and reduced strain for the clinician.

Instruments for examination

Mouth mirror, air-water syringe, probe, and explorer.

Instruments for treatment

Sickle scalers, curettes (universal and area-specific), hoes, files, chisels, ultrasonic scalers, and polishers (motor-driven or air powder).

Design and use of a sickle scaler

Pointed back, triangular cross-section, two cutting edges, and a pointed tip.

- Used to remove medium to large sized calculus deposits from the crowns of teeth.

- Supragingival use

- Universally designed

- N67 is shanked

204S Sickle Scaler

Has a complex shank (for posterior areas, but can also be used anteriorly).

Nevi 1

Only double ended sickle

Jacquette scaler

Similar to the 204S — both are double-ended mirrors with similar complexity and functional shanks.

Design and use of a curette

Has a rounded end; used below the gumline (subgingival).

Periodontal probe

Working end: Long, thin, rod-like with a blunt end; - Markings: Millimeter calibrations for measuring pocket depths and clinical attachment levels; Cross section: Rounded or rectangular depending on design;

- Use: Examination and assessment of sulcus or pocket depth, gingival consistency, and bleeding.

Explorer

Working end: Wire-like, flexible, and fine with a sharp point; Cross section: Circular; Shank: Extremely flexible for tactile sensitivity;

- Use: Detection of calculus, caries, irregularities, and overhanging restorations.

Handle

Where the clinician grasps the instrument.

Shank

Connects the handle to the working end.

Functional shank

From the handle to the working end.

Terminal shank

The last bend of the shank closest to the working end.

Working end

Part that contacts the tooth (e.g., blade, probe tip, explorer point).

Modified pen grasp

A grasp with a stable fulcrum, most stable when intraoral.

- 3 + 1 grasp (thumb and index finger + middle finger (stability) )

- ring finger (fulcrum)

Palm grasp

Used with mirror or air/water syringe.

Intraoral fulcrum

Finger rest on tooth structure within the same arch.

Extraoral fulcrum

Rest on patient's face or chin for stability.

Advanced fulcrums

Cross-arch, opposite arch, or finger-on-finger.

Cross-arch fulcrum

Used for difficult-to-access areas (less control and pressure).