General Dentistry Lecture Review

Chapter 48: General Dentistry

Learning Objectives

• Key Terms: Define, spell, and pronounce key terms related to general dentistry.

• Role in Treatment: Discuss the role of general dentistry in treating dental conditions.

• Indications for Restorative Dentistry: Describe when restorative treatments are necessary.

  • Restorative Dentistry: Involves restoring a tooth to its original form and shape using direct and indirect restorative materials.

• Indications for Esthetic Dentistry: Describe the situations where esthetic dentistry is utilized.

  • Esthetic Dentistry: Focuses on improving the appearance of teeth by repairing imperfections with restorative materials or whitening techniques.

• Cavity Preparation Principles: Describe the method and principles of preparing a cavity for restoration.

  • Initial Cavity Preparation Forms: Identify forms in cavity preparation.

  • Final Cavity Preparation Steps: Recall the final steps involved in cavity preparation.

Introduction to General Dentistry

• Restorative Dentistry: Restoring teeth to original form and shape using direct and indirect materials.

• Esthetic Dentistry: Enhancing the appearance of teeth through repair or whitening techniques.

Cavity Preparation

• Importance of Preparation: Dentists must consider:

  • Direction of enamel rods

  • Thickness of enamel

  • Body of dentin

  • Size and position of pulp

  • Crown alignment with gingival tissues

Key Terminology

• Cavosurface Margin: The edge of the cavity where the cavity preparation meets the tooth surface.

• Cavity Walls:

  • Buccal (facial) wall

  • Axial wall

  • Pulpal wall

  • Lingual wall

  • Gingival wall

• Line Angle: The angle formed by the junction of two walls of the cavity.

• Point Angle: The angle formed where three walls meet.

Cavity Preparation Steps

1. Outline Form: Design and initial depth of sound tooth structure.

2. Resistance Form: Shape and placement of cavity walls to resist displacement.

3. Retention Form: Creation of features in the cavity to keep the restoration in place.

4. Convenience Form: Ensuring accessibility during preparation and restoration.

Final Cavity Preparation Steps

• Removing any enamel, diseased dentin, or old restorative material.

• Inserting additional resistance and retention features (notches, grooves, coves).

• Placing protective dental materials (lining agents, bases, desensitizing agents, bonding agents).

Standardized Plan of a Restorative Procedure

Dentist's Role

• Patient Communication: Informing the patient about the procedure and expectations.

• Examination: Assessing the tooth to be restored.

• Administering Anesthesia: Local anesthesia for patient comfort.

• Tooth Preparation: Preparing the tooth for restorative materials.

• Applying Restorative Materials: Completing the restoration and shaping it appropriately.

• Evaluating Occlusion: Ensuring proper bite alignment post-restoration.

• Final Polishing: Polishing the restoration for aesthetic quality.

Dental Assistant’s Role

• Familiarity with Procedures: Knowledge about the restorative process.

• Setting Up: Preparing instruments and materials for use.

• Patient Positioning: Ensuring patients are correctly positioned.

• Moisture Control: Using cotton rolls, dry angles, or dental dam.

• Assisting the Dentist: Anticipating needs and providing necessary tools.

Permanent Restorations

• Classification: Five classes (I-V) based on location and extent of decay.

• Terminology Used in Restorations:

  • Cavity well

  • Axial well

  • Pulpal floor

  • Enamel wall

  • Dentinal wall

  • Line angle

  • Point angle

Class I Restorations

• Defined as one surface lesions affecting the pits and fissures of teeth:

  • Involves occlusal pits and fissures of premolars and molars.

  • Special considerations: Evaluate occlusion.

Class II Restorations

• Extends from class I into the proximal surfaces:

  • Involves two-surface or three-surface restorations of posterior teeth.

  • Conservative approach: Two surfaces; Comprehensive: three or more surfaces.

  • Special Consideration: Use of matrix systems.

Class III and IV Restorations

• Class III Lesion: Affects interproximal surfaces of incisors and canines.

• Class IV Lesion: Affects incisal edges and interproximal surfaces of incisors and canines, which is of esthetic concern.

  • Special Considerations: Use of dental dam and mylar matrix systems.

Class V Restorations

• Focus on smooth surface restoration:

  • Affects gingival third of facial or lingual surfaces, and the root of the tooth.

  • Location determines material used.

  • Special Considerations: Address proximity to gingival tissues.

Complex Restorations

• Situations of greater loss of tooth structure where the dentist must choose between direct and indirect restorations.

• Retention Pins: Necessary for supporting restorations in cases with significant tooth structure loss:

  • One pin for each missing cusp.

  • Available in various diameters and styles with deep threads for secure attachment.

Intermediate Restorations

• Short-term solutions for:

  • Monitoring tooth health.

  • Waiting for a permanent restoration.

  • Financial constraints.

Veneers

• Thin layer of tooth-colored material placed on the facial surface of prepared teeth:

  • Used for teeth that are:

  • Abraded

  • Eroded

  • Intrinsically stained

  • Darkened post-endodontic treatment.

  • Techniques: Direct (composite resin) and Indirect (porcelain).

Tooth Whitening

• Non-invasive method to lighten teeth:

  • Vital Bleaching: Chemicals penetrate enamel for whitening.

  • Indications:

  • Extrinsic stains (food, tobacco, beverages).

  • Age-related changes.

  • Intrinsic mild stains.

Treatment Options

• In-Office Treatment: Higher concentration whitening agents, results in about one hour.

• At-home Treatment: Slower results over weeks.

• Over-the-Counter Options: Easily accessible, lesser impact.

Dental Assistant’s Role in Tooth Whitening

• Record medical/dental history.

• Assist with shade selection and intraoral photography.

• Create custom trays and provide instructions.

Patient Instructions for Tooth Whitening

• Brush and floss before using whitening trays.

• Apply gel in limited amounts; less is preferred.

• Wear the tray as instructed; avoid eating/drinking while tray is in place.

Adverse Effects of Tooth Whitening

• Thermal Hypersensitivity: Sensitivity to temperatures post-treatment; recommended use of sensitive toothpaste.

• Tissue Irritation: Possible irritation due to poorly fitted trays allowing gel to contact gingiva.

Questions?

• Open floor for any inquiries or clarifications about the course material and procedures covered.