Lisa Mayo, RDH, BSDH Concorde Career College Board Review DH227 Infection Control, Tooth Avulsion,...

Lisa Mayo, RDH, BSDH Concorde Career College Board Review DH227 Infection Control, Tooth Avulsion, Dental Caries, Occlusion

DENTAL CARIES

Class II

DENTAL CARIES

Class III

DENTAL CARIES

Board Question Clinically, the dentist finds evidence of decay on the cervical 1/3 of the facial of tooth #8. The G.V. Black Classification of this decay is A.I B.V C.II D.IV E.VI F.III

Dental Caries Dental caries is a transmissible bacterial infection that is preventable and sometimes reversible Dental caries is the most common dental disease affecting children and adults in the USA

DENTAL CARIES

Board Question Bacteria found in deep carious lesion are: a.Spirochetes b.Lactobacilli species c.Streptococcus mutans d.Actinomyces viscosus

DENTAL CARIES

Dental Caries Risk Assessment for Children 0 to 5 Years of Age The protocol for a comprehensive CAMBRA 0 to 5 years oral care visit includes the following components: Completion of the caries risk assessment form Parent interview Examination of the child Assignment of caries risk level

25 Types of Dental Caries These terms communicate the urgency with which restorative therapy should be delivered: Rampant caries Early childhood caries Chronic caries Arrested caries Recurrent caries

Rampant Caries Signifies advanced or severe decay on multiple surfaces of many teeth Problems can also be caused by the self- destruction of roots and whole tooth resorption when new teeth erupt or later from unknown causes

Rampant Caries High risk groups Xerostomia Poor oral hygiene Heavy alcohol intake = dry mouth Drug use: due to drug-induced dry mouth and lifestyle Large sugar intake: sodas throughout the day If rampant caries is a result of previous radiation to the head and neck = may be described as radiation-induced caries

METH ADDICT

Early Childhood Caries "Baby bottle caries" Baby bottle tooth decay" "Bottle Rot" Pattern of decay found in deciduous teeth The teeth most likely affected are the maxillary anterior teeth, but all teeth can be affected Causes Allowing children to fall asleep with sweetened liquids in their bottles Feeding children sweetened liquids multiple times during the day

Chronic Caries Form of caries that occurs over time and demands regular dental intervention Difficult to control the caries Causes: multiple and many unknown Genetics Salivary content Lack of early preventive interventions

Arrested Caries State existing when the progress of the decay process has halted It is noted by its dark staining without any breakdown of tooth tissues

Recurrent Caries Extension of the carious process beyond the margin of a restoration. Also called Secondary caries

35 Copyright 2010 by Saunders, an imprint of Elsevier Inc. Types of Caries by Location This descriptive mechanism may be best suited for describing the dental problem to the client Pit and fissure caries Approximal caries Smooth surface caries Root caries

Interproximal/Approximal Caries

DENTAL CARIES

Remineralization Fluoride mechanisms of action Inhibits demineralization When fluoride is present in the fluid of the biofilm around the enamel crystals (or dentin of the root) Pass through the diffusion channels with the acid Increase the fluoride of the subsurface lesion Prevent the continued dissolution of the minerals

Remineralization Fluoride mechanisms of action Enhances remineralization As the saliva flows over the biofilm, its buffering properties neutralize the acid produced by the bacteria The pH rises toward neutral and prevents further dissolution of the minerals Minerals in the saliva can go back into the tooth for remineralization

Remineralization Fluoride mechanisms of action Inhibits bacteria in the biofilm Fluoride can change to HF (hydrogen fluoride) when it is contacted by the acid produced by the bacteria from the carbohydrates in the patients diet In the HF form it can then diffuse over the cell membrane of the acidogenic bacteria Inside it dissociates again and the fluoride ions interfere with essential enzyme activity within the bacterial cell

Occlusion A: Class I B: Class II, D.I C: Class II, D.II D: Class III

Class I: normal neutrocclusion MB cusp of max 1 st molar occludes with the MB groove of mand 1 st molar Class II: retrognathic or distocclusion Pt has small chin MB cusp max 1 st molar is M to MB groove mand 1 st molar Max canine M to mand canine by at least the width of itself Division I: molars are in Class II relationship but incisors normally slightly protruded Division II: molars Class II relationship with max central incisors retruded and inclined L Class III: prognathic or mesiocclusal. Bulldog MB cusp of max 1 st molar is D to MB groove mand 1 st molar by at least width of a pm Max canine D to mand canine

Board Question In Angles classification for occlusion for the permanent dentition, a Class II Division II denotes a a.Prognathic profile b.Mesognathic profile c.Retrognathic profile, with one or more teeth protruded facially d.Retrognathic profile, with one or more anterior teeth inclined lingually

Occlusion

Interarch Relationships Curve of Spee: anterior to post curve Curve of Wilson: medial to lateral curve Centric Occlusion Where max. intercuspation occurs Characteristics: 1. Overjet: max teeth to overlap mand by 1-2mm 2. Overbite: characteristic of max ant teeth in a vert. direction by a third of the lower crown height

Interarch Relationships Contd 3. Crossbite: maxillary teeth are positioned lingual to mand teeth 4. Openbite: teeth not in occlusion between max and mand arch 5. Midline Shift (Deviation): midline of max central incisors do NOT align with midline of mand central incisors 6. Edge-To-Edge: incisal edge to incisal edge of max ant to mand ant teeth 7. End-To-End: cusp-to-cusp relationship of post teeth

Occlusal Relationships Intercuspation: post teeth to intermesh in a faciolingual direction Mand F and Max L cusps are centric cusps that contact interocclusally in the opposing arch Interdigitation: each tooth to articulate with 2 opposing teeth Mand tooth occludes with the same tooth in the upper arch and the ones mesial to it Maxillary tooth occludes with the same tooth in the mand arch and the one distal to it.

Overjet or Overbite?

Overbite: lower teeth not visible

Tooth Avulsion

Treatment of Avulsed Tooth Tooth will need to heal following re- implantation healing more likely if tooth handled by crown only and if tooth remains moist and not debrided in any way The sooner the tooth is re-implanted the better the prognosis for retention without root resorption 1-13

Treatment of Avulsed Tooth If the apical end incompletely formed good chance of pulp vitality returning after re- implantation If apical end completely developed endodontic treatment necessary Best method is to replace tooth in alveolus and hold gently until patient transported to oral healthcare setting aids in nutrition of PDL cells 1-13

Sealants 80-90% total caries in kids occur on occ. surface of molars Fluoride better at preventing smooth surface caries Mechanical retention Mechanism of Action 1.Occludes pit and fissure surfaces to prevent plaque and bacterial penetrating the areas 2.Bacteria already in fissure and incipient lesion has formed: sealant blocks substrate to the bacteria that may already lie below the sealant. Bacteria cannot produce sufficient acid to cause min. loss abd further destruction 3.Sealant layer forms a smooth non-porous surface which improves the pts self care

Sealants: Types Almost all are composed of BIS_GMA (bisphenol A-glycidyl methacrylate) 1. Chemical Cured-Autopolymerized Polymerization: mix equal drops of activator (5% organic amine+BIS-GMA) + initiator(Benzoly peroxide +BIS-GMA) Hardens 1.5-2min Low cost, ample working time Cannot control set time once mixed, mixing can create air bubbles, polymerization takes longer and can get contaminated easier, lower cost

Sealants: Types 2.Visible Light Cured: Photoploymerization Polymerization: camphoraquinonne+BIS-GMA Not activated until illuminated by a blue-light source, visible or halogen light Eliminates mixing, min. air bubbles, longer work time, cures 40sec, surfaces slightly harder, high cost, eye safety Resin is a dimethacrylate monomer, activator is a diketone in presence of organic amine

Sealants Selecting Teeth 1. Newly erupted with pits and fissures: deep occlusal fissures/pits/fossa, buccal pits molars, lingual pits max. incisors, cusp carabelli max 1 st molars 2. Incipient caries lesions 3. Kids at high risk: Low-SES 4. Those with limited access dental care 5. Special needs 6. Medically compromised

Sealants Contraindications 1. Operculum remaining on newly erupted tooth 2. Occ decay with caries completely through enamel 3. Tooth with proximal decay 4. Restoration already present 5. Pt behavior does not permit use of adequate dry field 6. Life expectancy of tooth is short

Sealants Modes of Failure 1.Contamination = decreased bond strength a.Saliva during placement b.Microscopic calcium phosphate reaction as a result of phosphoric acid etch interacting with enamel over etching not thorough rinsing c.Presence of Fluoride: block micro pores in enamel which need to be opened to increase the bond 2.Wear that uncovers terminal ends of fissures 3.Direct loss of sealant 4.Absence of bonding within otherwise intact sealant

Sealant IndicatedPossibly Indicated (Clinical Judgment) Contraindicated Deep, narrow pits and fissures OCC, L, B The fossa selected is well isolated from another fossa with a restoration There is an open occlusal lesion Deep sticky occlusal fissure is present Are selected is confined to a fully erupted fossa, even through the D pit not fully erupted Caries exist on other surfaces of tooth Sound occ surfaces are present where the contralateral surfaces R carious or restored Incipient lesion in a pit or fissure confined to enamel Pt behavior does not permit use of adequate dry field Sound teeth in a mouth that already has many occ lesions or restorations Restoration already present Broad, well-coalesced pit and fissures

INFECTION CONTROL

Infection Control PPE Mask, Gloves, Eyewear, Gown Min. exposure to Aerosols Spatter Direct transmission (directly touching infectious agents) Indirect transmission (through contaminated instruments) MSDS Info regarding hazards of chemicals & how to protect themselves

Sterilization

INDICATOR TAPE Just because turned brown, does not mean sterilized only means reached a certain temperature Does NOT guarantee sterility BIOLOGICAL INDICATORS Should be conducted weekly Determine is the sterilization cycle is reaching proper temp and pressure to kill ALL microorg.

Moist HeatDry HeatChemical Vapor Ethylene OxideGlutaral- dehyde AdvantageGood Penetration Short cycle time No dull No rust No dull No rust Short cycle time Good penetration No residue Use if cannot do use moisture/heat sen. Instrum. DisadvantageCorrosion Dull instrum. Not dry well Destroy heat sensitive items Poor pentration Long cycle Destroy heat-sen. items Instrum need to be dry Destroy heat-sen items odor Slow Tissue irritation Explosive Long time Toxic to skin Toxic to mucous membrane 121 degrees 15lbs 15min 160/2HRS 170/1HR 127-132 20-40lbs 20min 2-12HRS7-10HRS

Disinfection

Board Question Which of the following is an example of a high- level disinfectant? a.Iodophor b.Simple phenol c.Glutaraldehyde d.Complex phenol

Agent, usually a chemical, that destroys microorganisms but may not kill bacterial spores Used on inanimate surfaces Kills Tuberculosis in 10min (NBQ) TB kill time is how disinfectants are ranked low, intermediate or high (only low does NOT kill TB) High: Glutaraldehyde (can be used as a sterilant if equipment immersed for certain length of time) Disinfection

From Mosbys Board Book

High-level disinfectants inactivate spores and all forms of bacteria, fungi and viruses. Intermediate- level disinfectants inactivate all forms of microorganisms but do not destroy spores. a.Both statements are TRUE b.Both statements are FALSE c.The first statement is FALSE, the second is TRUE d.The first statement is TRUE, the second is FALSE NBQ

Board Question All the following are properties of a good disinfectant EXCEPT one. a.Has a residual effect b.Kills ALL microorganisms c.Environmentally compatible d.Broad-spectrum antimicrobial

Sanitization

Asepsis

Communicable Diseases Proper sterilization, disinfection, hand washing, PPE helps controls spread C.D. Goal = break cycle of transmission PPE: mandated by OSHA. Purpose is to protect clinician not patient from splash or splatter

PATIENT APPOINTMENT

Patient Assessment Review med/dent hx ASA Classification Record Vitals Temp Resp Pulse BP Important areas: under card MD, hospitalized in last 5 years, meds, smokes, tobacco use, pregnant, med/social history, CC Social Hx/CC: helps determine appropriate care

OBJECTIVE #8: Premed

94 Prophylactic Antibiotic Premedication Antibiotic premedication is also known as antibiotic prophylaxis Infective endocarditis is a life-threatening infection of the tissue lining the heart and the underlying connective tissue, sometimes also called bacterial endocarditis

Prophylactic Antibiotic Premedication The regimen intended to prevent Infective endocarditis has been developed by the American Heart Association Infection in a total joint replacement has been developed by the American Dental Association and American Association of Orthopedic Surgeons

Prophylactic Premedication Risk for infectious endocarditis/bacteremia Risk factors with invasive procedures Routine use of antibiotics not indicated Timing of ingestion of oral antibiotics 1hour prior

AHA Guidelines Rationale for 2007 revision Exposure to bacteremias more likely to occur in daily activities than in dental procedures Antibiotic prophylaxis prevents only small # of cases of IE Risks of antibiotic-associated adverse events outweigh benefits of prophylaxis Maintenance of oral health with daily biofilm removal reduces risk for IE No evidence-based method to decide which procedures require prophylaxis Low incidence of IE, wide variety of types of cardiac diseases and invasive dental procedures Antibiotic premedication does not always prevent IE Most current guidelines: www.americanheart.org

Medical Conditions Requiring Antibiotic Premedication Prosthetic cardiac valve Previous endocarditis Congenital heart disease Cardiac transplantation recipients with cardiac valvular disease

Procedures Requiring IE Prophylaxis for At-Risk Patients Dental & dental hygiene procedures involving Manipulation of gingival tissue The periapical region of teeth Perforation of the oral mucosa

Procedures NOT Requiring IE Prophylaxis for At-Risk Patients Routine anesthetic injections Taking dental radiographs Placement of removable appliances Adjustment of orthodontic appliances Placement of orthodontic brackets Shedding of primary teeth Bleeding from trauma to lips or oral mucosa

Clinical Procedures Medical Hx Pre-Med Needs Assessment Cardiac conditions: artificial heart valves, previous hx endocarditis, serious congenital heart defects, repair heart defect w/in 6mo, cardiac transplant with valve issues Other: immunocompromised, organ transplants, joint replacement (2yrs), uncontrolled diabetes, hx IV drug use Review Regimens in handout Dental Hx

7. Prevention of Infective Endocarditis SITUATIONDRUGDOSE ADULTSDOSE KIDS OralAMOX2.0g50mg Unable to take oral meds Ampicillin Cephalosporins (cefazolin, ceftriaxone) 2.0g parental 1g parental 50mg Allergic to pen/ampicillin Cephalexin(Keflex) Clindamycin Azithromycin or clarithromycin 2g 600mg 500mg 50mg 20mg 15mg Allergic to pen/ampicillin & unable to take oral meds Cephalosporins (cefazolin, ceftriaxone) Clindamycin 1g 600mg 50mg 2-mg HAVE TO KNOW EVERYTHING ON THIS GRAPH!!

BODY TEMPERATURE

Body Temperature No single temperature is normal for all people Table 11-2 in DARBY lists the factors that may affect body temperature, including: Hormonal imbalances Time of day or environment Age Smoking Exercise Stress Ovulation and menopause

Maintenance of Body Temperature Normal values Need to know ranges for adults, children Temperature variations Pyrexia: Fever, over 37.5 0 C or 99.5 0 F Hyperthermia: over 41.0 0 C or 105.8 0 F Hypothermia: below 35.5 0 C or 96.0 0 F

Body Temperature Factors that alter body temperature Time of day: highest afternoon/early PM. Lowest sleeping/early AM Exercise Beverages/food Smoking Temperature outside Pathologic States: Infection, Dehydration, Hyperthyroidism, Myocardial infarction, Starvation, Hemorrhage, Physiologic shock

RESPIRATIONS

Respiration Function: To supply oxygen to the tissues and to eliminate carbon dioxide Variations in normal respirations may be shown by such characteristics as the rate, rhythm, depth, and quality and may be symptomatic of disease or emergency states. Normal respirations: a respiration is one breath taken in and let out

Respiration Normal respiratory rate: DARBY Table 11-5 Adults = 14 to 20 per minute, slightly higher for women Children = The rate decreases steadily during childhood 1 st year: 30 per minute 2 nd year: 25 per minute 8 th year: 20 per minute 15 th year: 18 per minute

Respiration Factors that influence respirations Many of the same factors that influence pulse rate 12 per minute subnormal for an adult 28 is accelerated 60 are extremely rapid and dangerous Increased respiration: Caused by work and exercise, excitement, nervousness, strong emotions, pain, hemorrhage, shock Decreased respiration: Caused by sleep, certain drugs, pulmonary insufficiency Emergency situations: Listed in Tables 69-4 and 69-5 WILKINS

Procedures for Observing Respirations Factors to observe 1.Depth: shallow, normal, deep 2.Rhythm: regular (evenly spaced) or irregular (with pauses of irregular lengths between) 3.Quality: strong, easy, weak, or labored (noisy) 4.Sounds: deviant sounds made during inspiration, expiration, or both Record: record all findings in the patients record

Increased pulse ExerciseStrong emotions StimulantsExtremes in heat/cold EatingHeart Disease Decreased pulse SleepDepressants FastingQuieting emotions Low vitality from prolonged illness Emergency situations Listed in Tables 69-4 and 69-5 in WILKINS Pulse

Pulse: Have to know Ranges for Assessment Normal pulse rates Adults. There is no absolute normal. 60-100bpm. Slightly higher for women than for men Children. The pulse or heart rate falls steadily during childhood In utero: 150 bpm Birth: 130 bpm 2 nd year: 105 bpm 4 th year: 90 bpm 10 th year: 70 bpm

Procedures for Determining Pulse Rate Sites 1.Radial pulse: at the wrist (see figure on next slide). 2.Temporal artery: on the side of the head in front of the ear, or 3.Facial artery: at the border of the mandible 4.Carotid pulse: used during cardiopulmonary resuscitation. 5.Brachial pulse: used for an infant.

BLOOD PRESSURE

Blood Pressure Components of blood pressure: When the left ventricle of the heart contracts Blood is forced out into the aorta Travels through the large arteries Smaller arteries, arterioles, & capillaries The pulsations extend from the heart arteries and disappear in the arterioles. During the course of the cardiac cycle, the blood pressure is changing constantly

Blood Pressure Systolic pressure: peak or the highest pressure. It is caused by ventricular contraction. The normal systolic pressure is less than 120 mmHg Diastolic pressure: lowest pressure. It is the effect of ventricular relaxation. The normal diastolic pressure is less than 80 mmHg Pulse pressure: difference between the systolic and diastolic pressures. The normal or safe difference is less than 40 mmHg.

Blood Pressure Follow-Up Criteria Advise & refer for further evaluation 180/110mmHg Cannot proceed with DH or Dental Tx until pt sees MD Never diagnose or treat based on 1 reading

Lisa Mayo, RDH, BSDH Concorde Career College Board Review DH227 Infection Control, Tooth Avulsion,...

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