Midterm

Objectives:

• 60 total questions (58 multiple choice, choose all that applies, 2 matching, fill in the blank with short answers)

• Infant, Pedo, Ado: 9

• Patient Counseling, Interviewing: 12

• Oral Infection Control: 11

• Dentifrices/Mouthrinses: 18

• Fixed/Removable Appliances: 9

List facts about:

• AAPD (American Academy of Pediatric Dentistry)

  • Definition: advocates policies, guidelines, and oral health care for children

  • 1st dental visit BEFORE 12 months

  • early morning/after nap

  • Recall every 4–6 months or as needed

• ADA (American Dental Association)

  • Recommend soft bristles

  • recommends a minimum of 2x daily

  • List of approved products on the website

• AAPD / ADA  Age Classification

  • Infant: Under 1 year

  • Toddler: 1–3 years

  • Preschooler: 3–5 years

  • School-age: 6–11 years

  • Adolescent: 12–17 years

• ADA Seal of Approval (1931)

  • help make informed decisions about dental products

  • Evaluate OTC products for safety and effectiveness

  • voluntary

  • awarded after full review of effectiveness/safety

  • acceptance is for 5 years

  • use must have an ADA approval statement

  • lack of seal does not mean unsafe or ineffective

• ADHA (American Dental Hygienist Association)

• CDC (Centers for Disease Control and Prevention)

• FDA

  • Cosmetic: Cleans or improves appearance only (whitening, fresh breath).

  • Therapeutic: Prevents or treats disease (caries prevention, gingivitis reduction).

CAMBRA

• What does CAMBRA stand for?

  • Caries management by risk assessment

• What is the purpose of CAMBRA?

  • assessment data to determine caries risk level for children under 6 or adults (over 6+)

  • Identify protective and contributing factors against caries

  • balance between protective and risk factors

  • classify child’s risk levels

Early Childhood Caries (ECC)

• List factors/microbes that contribute to ECC

  • high level of S. mutans in biofilm → risk factor

  • transfer by saliva-sharing behaviors (AVOID)

  • Lactobacilli and Candida contribute

  • Predisposing factors: bottle in bed, prolonged breastfeeding

  • Pattern: maxillary anteriors → primary molars

• List facts about ECC

  • Also known as: Nursing bottle caries, baby bottle caries, or rampant caries.

  • presence of 1 or more decayed, missing, or filled tooth surfaces in any primary tooth in a child under 6

  • S-ECC → child under 3 with any smooth-surface caries

  • Adolescence: One of the highest caries-risk periods, particularly for males

Define:

• Active Listening

  • being fully engaged and demonstrating that you are listening

• Anticipatory Guidance

  • providing parents and caregivers with information about their child’s current and upcoming developmental stages to help them anticipate needs and support development

• Change Talk

  • self-expressed language that is an argument for change

• Motivational Interviewing

  • A tool used to elicit and strengthen patient motivation for positive behavior change

• Sustain Talk

  • individuals’ own arguments for not changing

• List the consequences of thumb sucking

  • narrow maxillary arch

  • anterior open bite

  • posterior crossbite

  • increased overjet

  • decrease overbite

• List facts about biofilm-induced gingivitis in adolescents

  • incidence

  • Severity may increase during puberty

  • clinical and hormonal changes related to increased biofilm

  • exaggerated response to biofilm

fluoride supplement chart:

• What prescription should be written for a 4-year-old child in a non-fluoridated community (0.0mg/L)?

  • 0.50ppm

• What prescription should be written for a 6-year-old child that has naturally occurring fluoride at .45mg/L?

  • 0.50ppm

Home Care:

List considerations when choosing oral health aids for patients:

• anatomy

• ability to perform self-care

• product they use

• time dedicated to oral health

• barriers to self care

Finance and Usage Factors:

• affordability of the product

• product upkeep (battery)

• current product usage (suggest to the appointment)

Anatomy and Access:

• Position of teeth

  • crowding

  • open contact

  • fixed/removable appliances

  • limited opening

  • hard-to-reach areas

• Embrasure type:

  • type I: gingiva fills interproximal area

  • Type II: missing/reduced papilla

  • Type III: extensive recession; may be lost

Biofilm and compliance factors:

• extent and location of biofilm with BFI

Recommendations for home care

• Research shows ____power_____ manual toothbrushes are more effective at biofilm removal by 10-20%

• the ADA recommended ____2_____ manual toothbrushes

  • AM/PM

• What toothbrushes are best for patients in orthodontics?

  • Interdental brushes

• Which teeth are more likely to suffer from toothbrush abrasion?

  • canine, 1st PM, bucco/linguoverted teeth

• List methods to disinfect toothbrushes and intraoral aids.

  • 3% hydrogen peroxide

  • CPC/CHX

  • essential oil rinse

  • microwave or UV light

• When can children start using mouth-rinse?

  • over 6 years

• Under 3 years: Smear (rice-sized amount)

• Ages 3–6 years: Pea-sized amount

List defining properties of each toothbrushing method:

Modified Bass	45° to sulcus, light pressure, vibrate ×10, roll to crown	+ Gingival stimulation− Limited subgingival biofilm removal
Modified Stillman	Filaments partly on gingiva, blanch, vibrate, roll	+ Gingival stimulation− Slippage may cause lacerations
Charters	45° toward occlusal, rotary strokes	+ Marginal gingiva stimulation− No subgingival removal
Fones	Teeth edge-to-edge, circular motion	+ Easy for children− Lower biofilm removal
Leonard	Teeth edge-to-edge, vertical strokes	+ Easy for children− Minimal interproximal/sulcular cleaning
Horizontal Scrub	90° to tooth, back-and-forth	Only for children <7− Cervical abrasion

Special Areas: Anterior linguals: Brush vertically, overlapping strokes

Occlusals: Handle parallel; overlapping strokes and vibration into pits/fissures

List the best interdental aids for:

• Orthodontics

  • floss threader

  • interdental brushes (soft-piks & rubber tips)

  • toothpick holder

  • water-piks

• Bridges   

  • tufted floss (aka superfloss)

  • interdental brushes

  • rubber tips

• Implants

  • tufted floss (aka superfloss)

  • floss threader

  • interdental brushes

  • soft-piks

  • rubber tips

  • water-piks

• Teeth next to edentulous areas

  • gauze strips

• Type I embrasures

  • dental floss

• Type II embrasures

  • interdental brushes

• Type III embrasures

  • Stim-U-Dent

List important dentifrice active ingredients in:

• Therapeutic: Cavity Protection/Remin

  • sodium fluoride

  • stannous fluoride

  • sodium monofluorophosphate

  • Xylitol

  • Amorphous calcium phosphate (ACP)

  • Casein phosphopetide-amorphous calcium phosphate

• Therapeutic: Biofilm/Gingivitis Reduction

  • stannous fluoride

  • zinc citrate

• Therapeutic: Sensitivity Protection

  • 5% potassium nitrate

  • potassium citrate

  • potassium chloride

  • strontium chloride

  • strontium acetate

  • stannous fluoride

  • arginine calcium

  • carbonate

  • novamin

• Therapeutic: Tartar Control

  • sodium hexametaphosphate

  • tetrapotassium pyrophosphate

  • pyrophosphate

  • tetrasodium

  • zinc chloride

  • zinc citrate

• Cosmetic: Malodor Control

  • sodium hexametaphosphate

  • stannous fluoride

  • essential oils

  • chloride dioxide

  • cetylpyridinium chloride

• Cosmetic: Stain Reduction

  • tetrasodium pyrophosphate

  • sodium tripolyphosphate

  • sodium hexametaphosphate

  • hydrogen peroxide

  • carbamide peroxide

List inactive dentifrice ingredients for:

• Detergents/Surfactants

  • sodium lauryl sulfate

  • sodium N-lauryl sacrosinate

• Abrasives

  • silica and silicates

  • calcium carbonate

  • calcium pyrophosphate

  • aluminum oxide

  • bicarbonate

• Humectants

  • glycerol

  • sorbitol

  • synthetic cellulose

  • vegetable oils

• Binders

  • mineral/seaweed colloids

  • xanthan gum

  • carrageenan

  • synthetic cellulose

• Preservatives

  • alcohol

  • benzoates

  • dichlorinated phenols

• Flavoring

  • essential oils (peppermint, cinnamon, wintergreen, and clove)

  • artificial non-cariogenic sweeteners (xylitol, glycerol, and sorbitol)

For mouthrinses, describe the function of:

• Surfactant (detergent)

  • foam and cleanse

  • lower surface tension

  • penetrate/loosen surface deposits

  • suspension of debris

  • emulsify/disperse flavor oil

  • contribute to foaming action

• Humectant

  • moisture stabilizer

  • retain moisture

  • prevent hardening when exposed to air

• Preservatives

  • prevent bacterial growth

  • prolong shelf life

• Dyes

  • adds color

• Flavor/sweetener

  • add pleasantness/freshness

  • contributes to overall flavor perception

• Alcohol

  • enhances flavor impact

  • contributes to cleaning

  • acts as perservative

• Water

  • major vehicle to carry ingredients

List important uses/functions and considerations for these mouthrinse ingredients:

Tips:

• antimicrobial → stannous fluoride, Chlorhexidine, Cetylpyridium chloride, Sanguinarine and Essential oils

• taste alteration → stannous fluoride and Chlorhexidine

• staining → stannous fluoride, Chlorhexidine, and Cetylpyridium chloride

• tissue sloughing → Cetylpyridium chloride and oxygenating agent

• Short-term ONLY: Chlorhexidine and oxidizing agents

• Sodium fluoride

  • decrease demin/increase remin

  • decrease hypersensitivity

• Stannous fluoride

  • decrease demin/increase remin

  • decrease hypersensitivity

  • antimicrobial

  • taste alteration

  • staining

• Chlorhexidine

  • 0.12% prescription only rinse 20z/30sec

  • 8-12 substantivity

  • increase supragingival calculus formation

  • short-term use ONLY

  • do NOT use CHX after brushing w/ SLS product (wait 30 seconds)

  • antimicrobial

  • decrease biofilm and gingivitis

  • taste alteration

  • staining

• Cetylpyridium chloride

  • 0.05%-0.07% OTC rinse

  • low substantivity

  • burning sensation

  • tissue sloughing

  • antimicrobial

  • decrease biofilm and gingivitis

  • staining

• Sanguinarine

  • increase risk of oral leukoplakia

  • potential carcinogen

  • antimicrobial

  • decrease biofilm and gingivitis

• Phenolic-Related Essential oils (thymol, eucalyptol, menthol, and methyl salicylate)

  • burning sensation

  • bitter taste

  • contradicted for recovering alcoholics

  • Good for preprocedural rinse

  • low substantivity

  • antimicrobial

  • decrease biofilm and gingivitis

• Oxygenating agents

  • debriding agent/releases CO2

  • reduce symptoms for NUG/NUP

  • whitening(?)

  • no reduction of SARS-CoV-2

  • anodyne

  • pericornitis

  • tissue sloughing

  • low substantivity

• Oxidizing agents

  • deodorizer (neutralizes VSC)

  • reduction of malodor

  • cosmetic use

  • short term ONLY

  • decrease biofilm and gingivitis

  • low substantivity

Process of Removable Appliances in Clinic

• Place wet paper towels in denture cup.

• Give patient tissue and instruct them to remove appliance.

  • If tight, apply even vertical pressure — avoid pulling on clasp.

• Inspect appliance for defects.

• Place appliance in denture cup to transport for sterilization

• Double-bag:

  • Write patient’s name on outer bag.

  • Put cleaning solution in inner bag with appliance.

• Seal bag and place in ultrasonic cleaner for 10 minutes

• Remove bag and discard.

• Rinse appliance under warm water.

• Clean with denture brush to remove debris.

• Place wet paper towel in denture cup and set appliances on top.

• Allow patient to inspect and reinsert appliance.

• Return empty denture cup and brush to care bag

• After removing ortho brackets, fluoride can remineralize up to:

  • 38-44%

Define: Oral Concerns

• Angular cheilitis

  • inflammation of the corners of the mouth

  • nutrient deficiency, fungal or yeast infection, loss of vertical dimension

• Denture stomatitis

  • inflammation of the oral mucosa under a prosthesis

• Tissue hyperplasia

  • excessive growth of tissue in response to inflammation or trauma

• Traumatic ulceration

  • isolated, red inflamed area surrounding ulcerated lesions

Fixed/Removable Appliances:

• List the purposes for replacing missing teeth

  • preserves alveolar bone

  • enhances oral functions (chewing, swallowing, and speaking)

  • improved psychological impact

• Which teeth are usually not replaced?

  • third molars

  • extractions for ortho

Fixed Appliance Example:
Fixed Partial Prosthesis
Implant Supported Over Denture
Fixed Ortho Appliances
Perio Splint
Space Maintainer

Removable Appliance
Removable Partial Denture
Complete Denture
Root-supported Overdenture
Obturator
Removable Ortho Appliance

• List the best methods to clean around fixed appliances

  • soft toothbrush

  • mouth rinse

  • gum stimulator

  • superfloss

  • waterpik

  • soft pik

  • non-abrasive dentifrice

    

Describe:

• Abutment

  • natural tooth or implant supporting pontic

• Pontic

  • false (floating) teeth

• Bridge

  • fixed partial prosthesis

• Implant

  • prosthetic device placed in the jaw to which a tooth or denture may be anchored

List examples of:

• Verbal/vocal communication

  • spoken language

Verbal/non-vocal communication

• signs or signals: writing, braille, sign language

• Nonverbal/vocal communication

  • based on characteristics of language

  • qualifiers: volume, pitch, tempo, cadence

  • characteristics: crying, laughing

• Nonverbal/non-vocal communication

  • body language, movement of body and eyes, facial expressions

Define barriers to communication:

• Cultural

• Physical

  • noise levels, not positioned face-to-face

• Physiological

  • inability to see, hear, touch, or vocalize to communicate

• Psychosociological

  • emotional factors, pain, or fear

Define:

• Aphasia:

  • loss of power of expression by speech, writing, sign, or comprehension of language

• Dysarthria

  • motor/speech disorder that weakens/paralyzes muscles of face, mouth, larynx, vocal cords that result in difficult speech

• List those who have highest treatment needs and greatest barriers to care

  • older adults

  • immigrants

  • minorities

  • below poverty level

  • little to no english

  • low education

Define the acronym PACE

• Partnership

  • establish a positive environment

  • Patients are experts on themselves

  • avoid communication based on professional experience

• Acceptance

  • Absolute Worth: respect the patient as a human being

  • Accurate Empathy: understand the patient’s perspective

  • Autonomy Support: respect patient choice

  • Affirmation: encourage hope and belief in change

• Compassion

  • Prioritizing the needs of the patient over the agenda

  • establishing trust in the patient

• Evocation

  • elicit patient’s strength, thoughts, and ideas

  • build up on patient’s thoughts

Define the acronym RULE

• Resist the Righting Reflex

  • Avoid the urge to “fix” the patient

• Understand the Patient’s Motivation

  • Identify their reasons for change

  • Restate to confirm understanding

• Listen to the Patient

  • Practice active listening

  • Remain neutral

• Empower the Patient

  • Support autonomy

  • Outcomes improve with patient involvement

Define the acronym OARS

• Open-ended questions

• Affimations

  • to validate or recognize a patient’s effort toward change

• Reflective listening

  • responding with a summary or statement that shows understanding (not just repeating words)

• Summary

List and define the four steps in the Process of MI

• Engaging

  • process of establishing a connection and working relationship

• Focusing

  • process of developing and maintaining a direction in conversation about change

• Evoking

  • process of eliciting the patients’ motivations for change

• Planning

  • process encompasses developing commitment to change and formulating a plan of action

Commitment to Behavior Change

• List statements that represent a high-level commitment to change

  • I will

  • I promise

  • I am ready

  • I intend to

• List statements that represent a low-level commitment to change

  • I’ll think about it

  • I’ll consider it

  • I plan to

  • I hope to

  • I’ll try to