DEN 150 - Dental Specialties Proc & Exp Funct- FINAL EXAM

Includes 54, 55, 56, 57, 58, 59, 60

What is the main focus of oral and maxillofacial surgery?

It involves the diagnosis and surgical treatment of diseases, injuries, and defects in the oral and maxillofacial region.

What are the indications for maxillofacial surgery?

Indications include extractions of decayed or impacted teeth, treatment of jaw fractures, reconstructive surgery, and more.

What advanced training does an oral and maxillofacial surgeon (OMFS) receive?

An OMFS completes 4 to 6 years of postgraduate training in a hospital residency after dental school.

Why is the chain of asepsis important during surgery?

It helps prevent infection by ensuring that sterile techniques are followed during the surgical procedure.

What is the role of a surgical assistant in oral surgery?

The surgical assistant must have knowledge in patient assessment, surgical asepsis, and handling specialized instruments.

What are some specialized instruments used in oral surgery?

Instruments include surgical curettes, scalpels, hemostats, and various types of forceps.

What should be included in patient preparation before surgery?

Update medical history, confirm premedication intake, check vital signs, and position the patient appropriately.

What postoperative care instructions are important for patients?

Patients should be instructed on bleeding control, swelling management, diet, and when to return for suture removal.

What is alveolitis and how can it be prevented?

Alveolitis, or dry socket, can occur due to improper care of the extraction site and can be prevented by following postoperative instructions.

What types of sutures are commonly used in oral surgery?

Absorbable sutures such as plain catgut, chromic catgut, and synthetic materials like Vicryl; nonabsorbable sutures include silk and nylon.

Orthodontic Treatment

Provides the following types of treatment:

Straightens teeth that are rotated, tilted, or otherwise improperly aligned

Corrects crowded or unevenly spaced teeth

Corrects bite problems

Aligns the upper and lower jaws

Benefits of Orthodontic Treatment

Psychosocial problems

Severe malocclusion and dental facial deformities can be a social handicap

Oral malfunction

Malocclusion can compromise all aspects of oral function

Dental disease

Malocclusion can contribute to dental decay and periodontal disease

The Orthodontic Assistant

Depending on the expanded functions that are legally permitted in the state in which you practice, the clinical assistant can participate in various procedures that involve

diagnostic records

preliminary appointments

adjustment visits

The Orthodontic Office

The orthodontic office is designed to accommodate many patients at a time

The patient care area of the office can be sectioned off to serve three functions

• Obtain records and create a more private setting

• Take radiographic images

• Provide clinical care at all stages of treatment

Open Bay concept

In larger practices, it is common to see up to 30 patients a day

Environmental Causes of Malocclusion

Injuries can occur at birth in two major categories

• Fetal molding, when an arm or leg of the fetus is pressed against another part of the body

• Trauma during birth, such as an injury to the jaw

Injury throughout life

• Dental trauma can lead to the development of malocclusion in three ways

• Damage to permanent tooth buds when an injury to primary teeth has occurred

• Movement of a tooth or teeth as a result of premature loss of a primary tooth

• Direct injury to permanent teeth

Habits

• Tongue thrusting

• Tongue-thrust swallowing

• Thumb and finger sucking (beyond the age of 5 will affect facial structure development and growth.

• Bruxism (excessive grinding of the teeth or clenching of the jaw)

• Mouth breathing

Malocclusion

Angle’s classification

Class I malocclusion

Class II malocclusion

Class III malocclusion

Class I Malocclusion

For class I malocclusion, there is a normal relationship with the molars, but the anterior teeth will be out of alignment with malpositioned or rotated teeth

The mesiobuccal cusp of the maxillary first molar occludes with the mesiobuccal groove of the mandibular first molar.

Class II Malocclusion

This condition is also referred to as distoclusion

The body of the mandible is in an abnormal distal relationship to the maxilla

The mesiobuccal cusp of the maxillary first molar occludes in the interdental space between the mandibular second premolar and the mesial cusp of the mandibular first molar

Class III Malocclusion

This condition is also referred to as mesioclusion

The body of the mandible is in an abnormal mesial (outward appearance) relationship to the maxilla

Class III malocclusion causes the mandibular anterior teeth to protrude in front of the maxillary anterior teeth

Malaligned Teeth

Crowding

• In this, the most common contributor to malocclusion, one or many teeth are involved in misplacement

Overjet

• An excessive protrusion of the maxillary incisors results in space or distance between the facial surfaces of the mandibular incisors and the lingual surface of the maxillary incisors

Overbite

• This is an increased vertical overlap of the maxillary incisors

Open bite

• A lack of vertical overlap of the maxillary incisors results in an opening of the anterior teeth when occluded

Cross-bite

• A tooth is not properly aligned with its opposing tooth

Photographs

Two standard extraoral photographs are taken as follows:

. The frontal view

. A profile view

Three standard intraoral photographs are also routinely taken

. Full direct view

. Maxillary occlusal view

. Right buccal view

Craniofacial Images

Panoramic projection

• Used to view the eruption process of the primary and permanent teeth as well as to evaluate the amount of space available for the eruption process

Cephalometric projection (Most Commonly Used)

• Extraoral radiographs make it possible to evaluate the anatomic basis for malocclusion, as well as the skull, bones, and soft tissue

Computed Tomography (CT)

Orthodontist can gain specific information like:

Accurate measurements

Localization of impacted teeth

Asymmetry

Periodontal structures

Placement sites for anchorage devices

Views of condylar joint and TMJ

Specialized Instruments and Accessories

Intraoral instruments

Orthodontic scaler

Used in bracket placement, removal of elastomeric rings, and removal of excess cement or bonding material

Ligature director

Used to guide the elastic or wire ligature tie around the bracket and to tuck the twisted and cut ligature tie under the arch wire

Band plugger

Used to help seat a molar band for a fixed appliance

Bite stick

Used to help seat a molar band for a fixed appliance

Bracket placement tweezers

Used to carry and place the bonded bracket on the tooth

Bird‑beak pliers

Used to form and bend wires

Weingart utility pliers

Used in placing arch wires

Contouring pliers

Used in fitting bands

Three‑prong pliers

Used to close and adjust clasps

Posterior band remover pliers

Used to remove bands

Wire-bending pliers

Used to hold, bend, and adjust arch wires to create movement

Pin and ligature cutter

Cuts the ligature wire for removal

Ligature‑tying pliers

Used for ease in ligature tying

Howe (110) pliers

Allow for placement and removal of, and the making of adjustment bends in, the arch wire

Sequence of Appointments for Fixed Appliances

1.Placement of separators

2.Cementation of molar bands

3.Bonding of brackets

4.Insertion of arch wire and tying in with ligature ties or elastomeric ties

5.Adjustment checks

6.Removal of appliance

7.Retention of teeth

Auxiliary Attachments

Headgear tubes

These round tubes, routinely placed on maxillary first molar bands, are used for the insertion of the inner bow of a facebow appliance

Edgewise tubes

Rectangular tubes are placed on the buccal surfaces of the upper and lower first molar bands to receive the arch wire

Labial hooks

Located on the facial surfaces of the first and second molar bands for both arches, these hooks hold the interarch elastics

Lingual arch attachment

This button or bracket, located on the lingual portion of the bands, stabilizes the arch and reinforces anchorage and tooth movement

Types of Arch Wires

Nickel titanium (NiTi)

For movement (initial stage) because of its flexibility

Stainless steel wire

Stiffer and stronger (gives more force and better stability to control the teeth)

Beta titanium (TMA)

Provides a combination of strength, flexibility, and memory

Optiflex

Used for light force and its esthetics

Shapes of Arch Wires

Round wires

Used in the initial and intermediate stages of treatment to correct crowding, level the arch, open a bite, and close spaces

Square or rectangular wires

Used during the final stages of treatment to position the crown and root in the correct maxillary and mandibular relationship

Ligating the Arch Wire

Ligature ties

Elastic ligature tie or stainless steel wire ligature is used to “tie” in arch wires

Kobayashi hooks

Ligature ties that have been spot-welded at the tip form hooks for the attachment of elastics

Power Products

Elastic chain ties

These ties, continuous “Os” that form a chain, are used to close space between teeth or to correct rotated teeth

Elastics

Commonly referred to as rubber bands, elastics are placed from one tooth to another in the same arch or from one tooth to another tooth in the opposing arch

Elastics help close spaces between teeth and correct occlusal relationships

Elastic thread

A type of tubing used to close space or aid in the eruption of impacted teeth

Comfort tubing

Aids in patient comfort by covering an arch wire that may be causing discomfort

Retention

Retention is necessary to:

Allow gingival and periodontal tissues the required time for reorganization

Support the teeth that are in an unstable position

Control changes caused by growth

Different types of appliances for retention include:

Orthodontic positioner

Hawley retainer

Lingual retainer

Lingual Retainer

A fixed lingual wire bonded canine-to-canine on the lingual surfaces

This provides lower incisor position during late growth

The fabrication consists of light steel wiring that is bent so that it rests against the flat portion of the lingual surface of the incisors with a long loop over the cingulum of the canines

What is pediatric dentistry?

A specialized area of dentistry focused on the care of children from birth through adolescence.

How long does a pediatric dentist continue their education after dental school?

An additional 2 to 3 years.

What is the role of a pediatric dental assistant?

To provide preventive procedures and assist in the clinical practice environment in pediatric dentistry.

What is an important characteristic of a pediatric dental office's environment?

Cheerfulness with a nonthreatening décor.

What are Erikson’s stages of development related to trust?

Learning basic trust occurs during infancy when a child is nurtured and develops security.

What is an important factor to consider when managing child behavior in a dental office?

Always consider the child’s point of view and practice honesty.

What are the common IQ ranges for mild intellectual disability?

IQs ranging from 50 to 70.

Describe Down Syndrome.

A chromosomal aberration resulting in abnormal physical characteristics and potentially mild to moderate mental impairment.

What is the main challenge of treating patients with autism?

They may exhibit behavioral problems and management difficulties.

What should be reviewed in preventive dentistry for children?

Oral hygiene, fluoride intake, and dietary nutrients.

What type of procedures might a pediatric dentist perform?

Restorative, endodontic, and prosthodontic procedures.

What happens in a traumatic intrusion injury?

The tooth is driven into the alveolus with only a portion of the crown visible.

What should be done if a tooth is avulsed?

Recover the tooth immediately, wrap it in moistened gauze, and go to the dentist.

What signs might indicate child abuse in a dental setting?

Injuries in various stages of healing, chipped teeth, and inconsistent injuries relative to explanations.

What information is required when reporting suspected child abuse?

Details about the child and adult custodian, descriptions of abuse or neglect, and any evidence of previous injuries.

What is the purpose of dental sealants?

To prevent dental caries in the pits and fissures of teeth.

How do dental sealants work?

Sealants act as a physical barrier that prevents bacteria and food particles from entering pits and fissures.

What age group is indicated for sealant placement?

Patients between the ages of 6 to 15 years.

What are contraindications for sealant placement?

Lack of pits and fissures, apparent occlusal or interproximal decay, insufficient eruption, soon-to-be-lost primary teeth, and poor patient cooperation.

What are the two types of polymerization methods for sealants?

Self-cured materials and light-cured materials.

What is an advantage of light-cured sealants?

No mixing required and allows the operator to place and cure the material at their discretion.

Why is etching important before sealant application?

Etching with phosphoric acid helps achieve retention of the sealant.

What can lead to the failure of sealants?

Moisture contamination and inadequate etching.

What is a potential benefit of sealants that release fluoride?

They create a fluoride-rich layer at the base of the sealed groove.

What precautions should be taken when using etching agents?

Wear protective eyewear and avoid contact with skin, eyes, and oral soft tissue.

How long do most sealant products last at room temperature?

Shelf lives range from 18 to 36 months.

What should be checked during recall visits regarding sealants?

To ensure that the sealant material has not been partially or totally lost.

Coronal Polishing

A procedure that removes plaque and stains from the coronal surfaces of the teeth.

Selective Polishing

A procedure in which only stained teeth or surfaces are polished to avoid removing surface enamel.

Extrinsic Stains

Stains on the exterior of the tooth caused by environmental sources, which may be removed.

Intrinsic Stains

Stains that cannot be removed as they have become incorporated into the structure of the tooth.

Dental Abrasives

Polishing materials used to remove stains and polish teeth, available in extra-coarse, coarse, medium, fine, and extra-fine.

Fulcrum

A point of support on which the handpiece is stabilized to allow movement during polishing.

Prophy Angle

A reusable or disposable attachment that holds the polishing cup or brush for coronal polishing.

Fluoride Application

A treatment performed after polishing, historically thought to be enhanced by prior polishing.

Rheostat

A foot pedal used to control the speed of the handpiece during dental procedures.

Patient Preparation

The process of checking medical history, seating the patient, and explaining the polishing procedure.

What can the dental assistant assist with during periodontal procedures?

periodontal charting

periodontal surgeries

provide home care instructions to the patient

The Periodontal Practice

Patients are referred by the general dentist or dental hygienist for treatment of a periodontal condition

*After the periodontal treatment, the patient will return to the general dentist for routine dental care

*Frequently, periodontal patients will alternate periodontal maintenance (cleaning) appointments between the periodontist’s office and the general dentist’s office

The Periodontal Examination

A periodontal examination includes:

Medical and dental history

Radiographic evaluations

Examination of the teeth

Examination of the oral tissues

Supporting structures

Periodontal charting

Periodontal charting includes pocket readings, furcation's,*tooth mobility, exudate (pus), and gingival recession

Medical and Dental History

Systemic diseases such as acquired immunodeficiency syndrome, human immunodeficiency virus infection, and diabetes can decrease resistance of the tissue to infection

Dental history used to gather information about conditions that could indicate periodontal disease

For example, patients with periodontal disease often complain

* of bleeding gums

* loose teeth

* bad taste in the mouth

Dental Examination

Mobility

• It is normal for teeth to have a slight amount of mobility (tooth movement) because of the cushioning effect of the periodontal membranes

• Excessive mobility important sign of periodontal disease

Oral Tissues and Supporting Structures

The periodontal examination includes:

• Assessment of the amounts of plaque and calculus

• Changes in gingival health and bleeding

• Assessment of the level of bone

• Detection of periodontal pockets

Supporting Structures

Periodontal Probing

A periodontal pocket results when the gingival sulcus becomes deeper than normal (<3 mm)

Periodontal probing measures how much epithelial attachment has been lost to disease

The greater the depth of the periodontal pocket results in

* the greater the loss of epithelial attachment

*the greater loss of bone

*more serious the periodontal disease

Periodontal pockets are very difficult, and sometimes impossible, for the patient to clean

Early Signs of Periodontal Disease

Changes in the gingiva (color, size, shape, texture)

Gingival inflammation

Gingival bleeding

Evidence of exudates

Development of periodontal pockets

Bleeding Index

The severity of gingival inflammation can be measured by the bleeding index

Several different systems of recording bleeding scores are used

Occlusal Adjustment

Patient’s bite is evaluated for areas of unequal pressure

Occlusal trauma can result if excessive biting pressure is noted in a specific area

Occlusal adjustment: Procedure that adjusts patient’s bite so that occlusal forces are equally distributed over all the teeth

Radiographic Analysis

Radiographs are a valuable aid for evaluating periodontal disease

Bitewing radiograph: Can accurately depict bone height along the root surface

Vertical bitewing radiographs are excellent for determining the extent of crestal bone loss

Periodontal Instruments

Periodontal therapy requires the use of specialized instruments

*to remove calculus,

*smooth root surfaces

* measure periodontal pockets,

*perform periodontal surgery

In general, the dentist or registered dental hygienist who uses these instruments takes responsibility for maintaining their sharpness

Periodontal Probes

Used to locate and measure the depth of periodontal pockets

On some types of probes, the tip is color-coded to make the measurements easier to read

Periodontal probe

* tapered to fit into the gingival sulcus

* shape is blunt or rounded tip

Six measurements are taken and recorded for each tooth

Scalers and Files

Sickle scalers are used primarily to remove large deposits of supragingival calculus

Chisel scalers are used to remove supragingival calculus in the contact area of anterior teeth

The blade on the chisel scaler is curved slightly to adapt to the tooth surfaces

Hoe Scalers are used to remove heavy supragingival calculus

Hoe Scalers are most effective when used on buccal and lingual surfaces of the posterior teeth

Curettes

Curettes are used to remove

*subgingival calculus,

*smooth rough root surfaces (root planning),

*remove the diseased soft tissue lining of the periodontal pocket (soft tissue curettage)

A curette has a rounded end, unlike a scaler, which has a pointed end

Two basic designs of curettes

• Universal

• Gracey

Types of Curettes

Universal curettes are designed so that one instrument can be used on all tooth surfaces

Gracey curettes have only one cutting edge and are area-specific

• They are designed for use on specific tooth surfaces (mesial or distal)

• Treatment of the entire dentition requires the use of several curettes

Pocket Markers

These perforations, which are referred to as bleeding points, are used to outline the area for an incision on the gingivae

Ultrasonic Scaler

Allows for rapid calculus removal and reduces hand fatigue for the operator

Works by converting very-high-frequency sound waves into mechanical energy in the form of very rapid vibrations

A spray of water at the tip prevents the buildup of heat and provides a continuous flushing of debris and bacteria from the base of the pocket

• Because of the spray of water at the tip, there is a large amount of potentially contaminated aerosol spray

• Highly desirable for the operator of an ultrasonic scaler to have the dental assistant help with using the high-volume evacuator to minimize aerosol contamination.

Indications for Use of the Ultrasonic Scaler

Removal of supragingival calculus and difficult stains

Removal of subgingival calculus, attached plaque, and endotoxins from the root surface

Cleaning of furcation areas

Removal of deposits before periodontal surgery

Removal of orthodontic cements; debonding

Removal of overhanging margins of restorations

Contraindications to Use of the Ultrasonic Scaler

Communicable disease: transmitted by aerosols, such as tuberculosis, poses a risk to the operator

Immunocompromised: A compromised patient is open to infection

Respiratory problems: Materials can be aspirated into the lungs of a patient with respiratory problems

Swallowing difficulty: Problems with swallowing or a severe gag reflex

Cardiac pacemaker: Consultation with the patient’s cardiologist is necessary

Precautions for Children

Young tissues are very sensitive to ultrasonic vibrations

These vibrations and heat may damage the pulp tissue of primary and newly erupted permanent teeth

Nonsurgical Periodontal Treatment

Dental prophylaxis

Prophylaxis is the complete removal of

*calculus

* soft deposits

* plaque

*stains from all supragingival

* unattached subgingival tooth surfaces

Dentist and dental hygienist are licensed to perform this procedure

Scaling, Root Planing, and Gingival Curettage

Scaling and root planing are done as part of a periodontal debridement

In some cases, gingival curettage, a nonsurgical technique, may also be indicated

A local anesthetic is usually administered before these procedures

Scaling

Scalers

*supragingival calculus from the tooth surface

Curettes

*remove supragingival and subgingival calculus

Root Planing

Root planing is performed after scaling procedures to remove any remaining particles of calculus and necrotic cementum embedded in the root surface

After root planing, the surfaces of the root are smooth and glasslike

Anesthetic is usually required for this procedure

Gingival Curettage

Curettage means scraping or cleaning with a curette

Some patients also require gingival curettage in addition to scaling and root planing

Gingival curettage, also known as subgingival curettage, is the scraping of the gingival lining of a periodontal pocket

This is performed to remove necrotic (dead) tissue from the pocket wall

Antimicrobial and Antibiotic Agents

Tetracycline is an antibiotic that is particularly useful for the treatment of periodontitis

Penicillin

Fluoride mouth rinses

A twice-daily chlorhexidine rinse (Peridex) is the most effective means available for reducing plaque and gingivitis

Locally Delivered Antibiotics

New methods can be used to apply antibiotics directly into the periodontal pockets

In one technique, a fiber that contains tetracycline is packed into periodontal pockets

Other methods include using a syringe to insert dissolvable materials such as a gel into the pocket

A dissolvable chip that releases chlorhexidine is inserted into deep pockets

Surgical Periodontal Treatment

When nonsurgical treatment is ineffective in stopping the disease process, periodontal surgery is indicated to control the progress of periodontal destruction and loss of attachment.

Advantages of Periodontal Surgery

*Allows access to the root surface for scaling and root planing

*Makes it easier for the patient to clean difficult areas

*Results in better access to furcations and other areas that are very difficult to reach during traditional scaling and root planing