OSCE Dental Hygiene With Correct Solutions

OSCE Dental Hygiene Bass Method - ANS Most widely used method. Bristles are angled at a 45 degree angel towards the gingiva. Stillman's Method - ANS Bristles are positioned on the gums rather than into the pockets and directed at a 45 degree angle. Charter's Method - ANS Bristles are directed occlusally, away from the gingiva. Useful for cleaning orthodontic brackets, prosthesis, and areas treated with surgeries. Fone's Method - ANS Bristles are moved in large circular motion on the buccal and lingual surfaces. Useful for children, those physically impaired, or adults who lack manual dexterity. Fluoride Varnish - ANS -Dries immediately upon contact with saliva. -Does not require a professional prophylaxis before hand. -Can eat and drink immediately after. -Avoid brushing, rigorous rinsing, or hard foods for 3 to 4 hours. -Easier and more effective method Fluoride is recommended for patients who: - ANS -Have xerostomia -High caries risk -Undergoing cancer therapy -Orthodontics Fluoride Gel or Foam (office application) - ANS -Applied onto tray and placed in patient's mouth usually for 4 minutes (Read manufactures label). -Do not eat, drink, or smoke for 30 minutes. -Most popular types are 1.23% APF and 2% Neutral sodium fluoride. Stannous Fluoride - ANS -0.4% available for non-prescription use. -1% neutral sodium fluoride gels available for prescription use. -Can cause extrinsic staining (especially in patient's with inadequate plaque control). Acidulated Phosphate Fluoride (APF) - ANS -Do NOT use of composites, porcelain, or sealant materials as it causing pitting and roughening. -Also avoid on root surfaces. Neutral Sodium Fluoride - ANS Agent of choice on root caries, implants, cosmetic restorations, and reduced salivary flow. Second trimester - ANS safest trimester for dental treatment. Pregnancy gingivitis - ANS -Caused by an elevation of hormones estrogen and progesterone. Hormones increase can cause exaggerated gingival response to microorganisms. Pyrogenic granuloma (Pregnancy tumor) - ANS localized area of gingival enlargement, typically involving interdental papilla, usually diminishes after delivery of baby. What category of LA can use administer to a pregnant patient? - ANS Category B (lidocaine and prilocaine) Can you use Nitrous oxide sedation and general sedation on a pregnant patient? - ANS relative contraindication (gas interferes with the absorption of B-12 and other nutrients). Early Childhood Caries (ECC) index - ANS -presence of 1 or more areas of decay on a child younger than 6 years of age Severe-Early Childhood Caries (S-ECC) index - ANS -Presence of decay in a child younger than 3 years old. When should a child's first dental appointment occur? - ANS -Within 6 months of the eruption of the first tooth or before 1-year of age. When should you first start brushing a child's teeth? - ANS -When the first tooth appears. Erosion causes - ANS -Anorexia Nervosa -Bulimia Nervosa Anorexia Nervosa - ANS extreme weight loss caused by self-starvation, excessive exercise, use of laxatives, self-induced vomiting. Bulimia Nervosa - ANS compulsive disorder that involves periods of starvation, binging, and purging. Signs and Symptoms of erosion - ANS -dental caries from vomiting -Perimolysis: erosion from vomiting mostly on the maxillary lingual surfaces. Raised appearance of restoration margins. Abrasion - ANS -V-shaped notch in the gingival portion of the facial aspect of the tooth. -Results from forces of friction between the teeth or external objects. -Can happen from improper brushing technique or the use of a toothpick or pipe. Attrition - ANS -Results from forces between the teeth. -Wear on the incised and occlusal surfaces from grinding. Abfraction - ANS -Biomechanical destruction related to fatigue, flexure, and deformation of tooth structure. -Can appear as a wedge-shaped lesion at the cervical third of the tooth. What is the most effective public health measure to prevent tooth decay? - ANS Community Water Fluoridation New recommended level of fluoride is? - ANS 0.7 ppm Old level of fluoride is? - ANS 0.7-1.2 ppm HIV can cause: - ANS -Linear gingival erythema -Kaposi Sarcoma -Delayed healing -Larger than usual ulcers -Candidiasis -Etc. Diabetes can cause: - ANS -Delayed healing -Periodontal disease -Candidiasis -Etc. ASA 1 - ANS Normal, Healthy ASA 2 - ANS Pt. with mild systemic diseases. -Allergies -Controlled hypertension -Asthma -Mild obesity -Pregnancy -Cigarette smoking without COPD -Diabetes without systemic effects ASA 3 - ANS Pt. with severe systemic disease and some functional limitation. -Controlled disease of more than one body system -Controlled CHF -Poorly controlled hypertension -Morbid obesity -Respiratory Problems (COPD) -Stable angina ASA 4 - ANS Pt with severe systemic disease that is a constant threat to life. -Possible risk of death -Unstable angina -Symptomatic COPD and CHF ASA 5 - ANS Moribund patient not expected to survive for more than 24 hours without surgery. ASA 6 - ANS Brain dead pt. Radiolucency - ANS Dark areas on the film. Produced by less dense structures that allows the passage of x-rays. (i.e. cysts) Radiopaque - ANS Light areas on the film. Produced by denser structures. (i.e. Lamina Dura) Overlap - ANS inappropriate horizontal angulation Foreshortening - ANS too much vertical angulation Elongation - ANS not enough vertical angulation Mark across film - ANS bent film Circular white boarder on film - ANS Cone cut Herringbone or waffle pattern on film - ANS backwards film Darker film with outlines of many teeth - ANS double exposure Film too dark - ANS too much development time; temperature too high Film too light - ANS not enough development time; temperature too low Cracked emulsion - ANS sudden temperature change between developer and fixer. Darker areas - ANS developing solution touches film before processing procedure. Lighter areas - ANS fixer solution touches film before processing procedure. Yellow/brown stains on film - ANS exhausted solutions or insufficient washing. Straight white border on film - ANS developer cutoff caused by incomplete immersion of film into developer. Straight black border - ANS fixer cutoff caused by incomplete immersion of film into fixer. Outline border of another film - ANS Films stuck together in solutions. White spots on film - ANS air bubbles trapped during processing. Thin, black, branchlike lines on film - ANS Static lines caused by low humidity and opening film packet too quickly. Fogged films - ANS improper safelight, light leaking into dark room, outdated film. "V" or "Sharks fin" on pano - ANS caused by lead collar. Exaggerated smile on pano - ANS chin tipped down too far Flat smile on pano - ANS chin tipped too far up Mandibular incisors roots blurred on pano - ANS chin tipped too far down Maxillary incisors roots blurred on pano - ANS chin tipped too far up One side shows larger teeth/condyle - ANS patient head is twisted (the larger side is the distant side) White straight opacity - ANS slumping causing ghost image of spine Shadow over maxillary teeth - ANS tongue not touching rough of the mouth Airway shadow in an arch shape - ANS tongue not touching rough of the mouth Anterior teeth thicker and wider - ANS chin placed behind the focal trough. Enlarged incisors (head too far back). Skinny anterior teeth - ANS chin placed too far forward. Small incisors (head too far forward). Dark shadow on anteriors - ANS Patient not closing lips around biting blocks. Ghost image - ANS Jewelry not removed Incisive foramen on film - ANS -Passageway for nasopalatine nerves. -Small radiolucent oval between roots of maxillary central incisors. median palatine suture - ANS vertical radiolucent thin line in the middle of the palate. Nasal septum - ANS -Thin wall that divides the nasal cavity into two. -Radiopaque vertical strip. Nasal Spine - ANS -Projection of bone anteriorly. -Radiopaque triangle shape at medical palatal suture where nasal septum and fosse meet. Nasal cavity (Nasal fossae) - ANS -Large air-filled space above and behind the nose in the middle of the face. -Radiolucent oval shapes superior to central incisors. Maxillary sinus - ANS -Hollow spaces in bone superior to molar and premolar. Inverted Y - ANS -Junction where the nasal fossa and the maxillary sinus. -Most commonly superior to the maxillary canine apex. Maxillary Tuberosity - ANS -Distal portion of the alveolar process. -Rounded, radiopaque elevation distal to third molar regions. Hamulus - ANS -Extension of medial pterygoid plate of sphenoid bone. Radiopaque hook-like protrusion posterior to maxillary tuberosity. Zygomatic process - ANS -Slender profusion of the temporal bone that serves to strengthen the zygomatic arch. -U-shaped radiopaque band superior to molar apices. Coronoid Process - ANS -Anterior portion of ramus. -Radiopaque triangular projection usually superimposed over maxillary tuberosity. Genial tubercles - ANS -Four bony spines used for muscle attachment of the genioglossus and geniohyoid muscles. -Circular rap opacities inferior to central incisor apices. Lingual foramen - ANS -Exit for incisive vessel branches. -Radiolucent circle inside the radiopaque genial tubercles on the mandibular anteriors. Mental Foramen - ANS -Opening for mental nerve and vessels inferior to mandibular premolar apices. -Round radiolucent area sometimes mistaken for periodical disease. Mental ridge - ANS -Ridge of bone located on the anterior surface of the mandible. -Bilateral radiopaque lines, starting inferior to premolar apices and extending anteriorly to the midline. External oblique ridge - ANS -Linear area of bone on external surface of mandible. -Radiopaque line running anterior from the ramus across the molars. Internal oblique ridge (mylohyoid) - ANS -Elevated long area on the internal surface of mandible. -Radiopaque line running along the premolar and molar apices. -Usually positioned below the external oblique ridge on radiographs. Nutrient canals - ANS -Veritcal thin radiolucent lines near the teeth, may be mistaken for bone fractures. Mandibular canal - ANS -Radiolucent horizontal band outlined with a thin line of cortical bone. -Inferior alveolar nerve and arteries pass inside the canal. Stretches from the mandibular foramen to the mental foramen. Panoramic exposure - ANS -Useful for evaluating impacted teeth, eruption patterns, TMJ problems, etc. -Usually not clear and detailed enough to assess caries and periodontal disease. Periapical (PA) - ANS -Captures the crown, CEJ, root, and surrounding areas. -Used mainly for diagnosis of periodontal disease, pathology, endodontic therapy, and implants. Bitewing (BW) - ANS -Captures crowns, contacts, and height of alveolar bone. -Used mainly for the diagnosis of dental caries (interproximally) -Vertical bitewings can detect early periodontal disease because the bone level is visible. Occlusal - ANS -Captures bone surrounding the teeth, floor of the mouth, sialolith (stone), supernumerary teeth, etc. Full-mouth series (FMX) - ANS -Represent the entire dentition using a combination of PAs and BWs. Incipient caries - ANS Lesion that extends less than halfway through the enamel. Moderate carious lesion - ANS Lesion that extends more than halfway through the enamel but does not involve the DEJ. Advanced carious lesion - ANS Lesion that extends to or through the DEJ but does not extend more than half the distance to the pulp. Severe carious lesion - ANS Lesion that extends through enamel, through dentin, and more than half the distance to the pulp. Recurrent caries - ANS Appear under restorations Slight bone loss - ANS loss of 20% of normal supporting bone. Moderate bone loss - ANS loss of 20%-50% of normal supporting bone. Severe bone loss - ANS loss of over 50% of normal supporting bone. Widening of PDL can be caused by what two factors? - ANS -Periodontal disease -Trauma Traumatic Responses include: - ANS -Hypercementosis -External Resportion -Root Fracture Hypercementosis - ANS root deposited more cementum to compensate for trauma. External resorption - ANS root surface can be lost with trauma such as orthodontic therapy. Root fracture - ANS Horizontal or vertical crack. Periapical abscess - ANS Radiolucent area located at the end of a symptomatic tooth with infected pulp. Periapical granuloma - ANS radiolucent area at the apex of a non-vital, usually asymptomatic tooth. Periodontal abscess - ANS Radiolucent area located at the end or lateral part of the root. Ankylosis - ANS Tooth is fused with adjacent bone which prevent the tooth from erupting fully. Concrescence - ANS Two adjacent teeth are united by cementum only. Dilaceration - ANS Distortion of root. Supernumerary tooth - ANS Usually food between the maxillary central incisors (mesiodens) and behind the third molars. Enamel Peral - ANS Round, radiopaque calcifications most commonly seen in furcations of multi-rooted teeth. Cementicle - ANS Round, radiopaque calcifications on the root surface within the PDL space. Condensing osteitis - ANS Radiopaque area attached to apex of a non-vital tooth with a low-grade infection. Dens in dente - ANS Surface of the tooth folds inwards to create a "tooth within a tooth." Mandibular tori - ANS benign bony growth on the lingual surface of the mandible. Overhang - ANS over contouring of dental material beyond the cavity margin. Fluorosis - ANS -Caused by excessive fluoride. Tetracycline stain - ANS -Caused by the ingestion of the antibiotic tetracycline by pregnant or lactating mothers. Minocycline - ANS -A tetracycline derivative that can cause bluish-gray stain. Pulp necrosis - ANS -Creates teeth that are dark. Pulpitis - ANS -Creates pink discoloration caused by inflammation and internal bleeding in the pulp chamber. Extrinsic stain - ANS -Occurred after tooth eruption, the stain is on the outside of the tooth. Yellow stain - ANS caused by plaque buildup. Green Stain - ANS caused by poor oral hygiene or Nasmyth's membrane (thin tissue on newly erupted teeth which will brush off). Black stain - ANS -Caused by iron compounds embedded in dental biofilm. -Found in clean mouths. Brown to black stain - ANS -Caused by tobacco use Orange stain - ANS -Associated with chromogenic bacteria. Tan to dark brown - ANS -Caused by food such as wine, tea, or coffee. Yellow, brown, or gray stain - ANS -Caused by chlorhexidine. Gray-green stain - ANS -Caused by marijuana. Amelogenesis imperfecta - ANS -May show pitting (mottled appearance), smoothness, or roughness. -May appear yellow and is soft in texture, leading to the exposure of dentin. Dentinogenesis imperfecta - ANS -Affected teeth appear opalescent and brownish/blue in color. -Primary teeth are usually affected more severely than permanent teeth. -Radiographically, no pulp chambers or root canals are seen. Anodontia - ANS congenital lack of ALL primary or permanent teeth. Hypodontia - ANS Lack of one or more teeth in the primary or permanent dentition Supernumerary teeth - ANS -Extra teeth found in the dental arches. -Teeth are smaller than normal and often do not erupt. -Most common supernumerary teeth is the mesiodens, located between the maxillary central incisors. Microdontia - ANS -One or more teeth in the dentition are smaller than normal. -The maxillary lateral incisor, called peg lateral, and the maxillary third molars are the teeth most often affected. Macrodontia - ANS -One or more teeth in a dentition are larger than normal. Facial hemihypertrophy - ANS Localized macrodontia affecting one side of the dental arch. Germination - ANS A single tooth germ attempts to divide and results in the incomplete formation of two teeth. (Town crowns, one root) Fusion - ANS -The union of two normally separated adjacent teeth. -The two crowns will appear as a single large crown and the roots are separated and fused. Dilaceration - ANS Abnormal curve or angle in the root Dens evaginatus - ANS -Accessory enamel cusp found on the occlusal tooth surface. -Most often seen on the mandibular premolars. Enamel hypocalcification - ANS -Appears as localized, chalky white or dark spots. -Underlying enamel may be soft and susceptible to caries. Diastema - ANS -Space between two adjacent teeth. Base of the tongue - ANS -Posterior one-third of the tongue Body of the tongue - ANS -Anterior two-thirds of the tongue. Dorsal surface of the tongue - ANS -Top surface of the tongue Filiform papillae - ANS most numerous papillae on the dorsal surface. Fungiform papillae - ANS mushroom-shaped papillae, appear as red dots. Sulcus terminalis - ANS v-shaped groove separating the body and the base of the tongue. Lingual papillae - ANS larger papillae at the base of the tongue. Lingual tonsil - ANS located at the base of the tongue posterior to the circumvallate papillae. Circumvallate papillae - ANS larger papillae lined along the sulcus terminals towards the back of the tongue. 10 to 14 in number. Lateral surface of the tongue - ANS sides of the tongue Foliate papillae - ANS papillae on the sides of the tongue. Ventral surface of the tongue - ANS bottom surface of the tongue. Plica fimbriata - ANS bilateral fold next to the lingual veins. Parotid papilla - ANS small revelation at the opening of the parotid salivary gland duct, opposite of maxillary second molars. Sublingual caruncle - ANS duct opening for the submandibular and sublingual salivary glands. Hard palate - ANS firmer, whiter, anterior part of the palate. Soft palate - ANS yellower, smaller, and softer posterior part of the palate. Palatine raphe - ANS prominent line from the uvula to the incisive papilla. Pterygomandibular fold - ANS fold of tissue from the junction of the hard and soft palate on each side down to the mandible, just posterior to the most distal mandibular molar. Maxillary tuberosity - ANS elevation behind the most posterior maxillary molar. Retromolar pad - ANS dense pad behind the most posterior mandibular. Vestibule - ANS horseshoe-shaped space between the cheek, lips, and teeth. Submandibular gland - ANS -Duct: Wharton -Salivary Secretion: 65% Sublingual gland - ANS -Duct: Bartholin -Salivary secretion: 10% Parotid gland - ANS -Duct: Stenson -Salivary secretion: 25% -Largest encapsulated major salivary gland. Plaque-induced gingivitis exacerbated by systemic conditions: - ANS -Hyperglycemia -Leukemia -Smoking -Malnutrition (Vit. C) Plaque-induced gingivitis exacerbated by oral factor: - ANS -Prominent subgingival restoration margin. -Hyposalivation Peri-implantitis - ANS Pseudopocket - ANS -Caused by gingival inflammation without loss of attachment. Suprabony pocket - ANS -Base if the pocket is above (coronal) the alveolar crest. -Created by horizontal bone loss. Infrabony pocket - ANS -Base of the pocket is below (apical) to the alveolar crest. -Created by vertical bone loss. Recession - ANS free gingival margin is apical to the CEJ exposing the root surface. What factors can cause recession? - ANS -Frenal pull -Improper brushing -Flossing technique Class I tooth mobility - ANS -Up to 1 mm horizontal displacement in a facial lingual direction. Class II tooth mobility - ANS -1-2 mm horizontal displacement in a facial lingual direction. Class III tooth mobility - ANS -Greater than 2 mm horizontal displacement and/or presence of vertical depression. Fremitus - ANS Palpable or visible movement of a tooth when in function. Can be assessed by gently placing a gloved index finger against the facial aspect of the tooth as the patient taps the teeth together. Furcation - ANS Loss of interradicular bone on multiorooted teeth. Nabers probe is used to assess the presence and extent of furcation. Mandibular molars are? - ANS Bifurcated (mesial and distal roots) Maxillary molars are? - ANS Trifurcated (mesiobuccal, distobuccal, and palatal roots) Class 1 furcation - ANS Furcation can be detected with probe but it cannot enter the space. Class 2 furcation - ANS Probe penetrates into the furcation, but does not completely pass through to the other side. Class 3 furcation - ANS Probe passes completely through the furcation. Class 4 furcation - ANS Entrance to the furca is clinically visible because of gingival recession and probe passes through the furcation Normal level of the alveolar crest - ANS located approximately 1-2 mm apical to (below) the CEJ. What radiographs are used to assess bone level and other problems in the periodontium? - ANS -PA and Vertical BW Lamina dura - ANS Sheet of compact bone that lies adjacent to the PDL. Appears as a continuous white (radiopaque) line around the tooth also following the PDL space. -Appears dense and continuous in health and thin in disease. What does CAL stand for? - ANS Clinical Attachment Level or Loss CAL is a more accurate indicator of the periodontal support around a tooth than probing depth. (T/F) - ANS True Ankylosis - ANS Fusion of enamel, dentin, or root cementum with adjacent alveolar bone. Occurs mostly in deciduous teeth. Eruption fails to happen at the proper time and needs to be extracted. Impaction - ANS Tooth is positioned against another striation and fails to erupt. What tooth is most commonly affected by impaction? - ANS Third molars What can cause impaction? - ANS -Dense bone -Tooth malpositioning -Inadequate space for eruption Periodontal abscess - ANS Radiolucency on the lateral side of the tooth Periapical Abscess - ANS radiolucency around the apex of the tooth. Functional shank - ANS portion between the working end and the handle. Allows the working end to be adapted to the tooth surface. Terminal (lower) shank - ANS Portion of the functional shank closest to the working end, between the working end and the first bend. Normally parallel to the tooth surface. Simple shank - ANS -Has only one bend. With the working end tip facing the clinician, the shank is straight. -Used on anterior teeth and on easily accessible areas. Complex shank - ANS -Has multiple bends. With the working end facing the clinician, the shank has a zigzag shape. -Commonly used on posterior teeth, but may be adapted for anteriors. Working end - ANS -Working end refers to the part of the instrument that does the function, such as the explorer tip, a mirror, and also blades. UNC probe black band - ANS -4-5mm -9-10mm No single device has been shown to remove plaque from all surfaces of an implant. (T/F) - ANS True Ultrasonic instruments are generally contraindicated with dental implants. (T/F) - ANS True Sonic scaler - ANS -Uses compressed air to create movements. Two types of ultrasonic scalers - ANS -Magnetostrictive scaler -Piezoelectric scaler Magnetostrictive scaler - ANS Uses magnetic oscillations within metal stack to convert electricity to movement. -Moves in an elliptical motion Piezoelectric scaler - ANS -Uses ceramic discs or quartz plates to convert electricity to movement. -Tip moves in a linear pattern (Front and back) What portion of the ultrasonic tip is the most powerful? - ANS -The last few millimeters and should be placed against the tooth. Contraindications to Ultrasonic scalers - ANS -Respiratory disease (COPD) -Communicable diseases (tuberculosis) -Gag reflex -Cerebral Palsy -Porcelain or composite restorations (may fracture) -Demineralized areas -Newly erupted teeth -Old pacemakers (new pacemakers are shielded and not contraindicated) Type I embrasure - ANS Interdental papillae fill the entire embrasure space with a knife-edge point. According to the AAP, what should be the primary parameter to set thresholds for gingivitis? - ANS BOP Description of alveolar bone in a patient with gingivitis - ANS no changes, infection has not progressed into the alveolar bone. Periodontal remission/control - ANS A period in the course of disease when symptoms become less severe but may not be fully resolved. Periodontal disease stability - ANS A state in which the periodontitis has been successfully treated and clinical signs of the disease do not appear to worsen in extent or severity despite the presence of a reduced periodontium. Stage I Periodontitis - ANS -CAL: 1-2 mm -Bone loss: Coronal third (less the 15%) -No tooth loss -Max PD 4mm Stage II Periodontitis - ANS -CAL: 3-4 mm -Coronal Third ( 15-30%) -No tooth loss -Max PD 5mm Stage III Periodontitis - ANS -CAL greater than 5 mm -Extending to the middle third of the root and beyond -4 or less teeth lost -PD 6mm or greater -Furcation grade II or III Stage IV Periodontitis - ANS -CAL 5 or greater mm -Extending to the middle third or root and beyond -Missing 5 or more teeth -Masticatory dysfunction -Need for complex rehabilitation Grade A Periodontitis (Slow Rate) - ANS -No loss over 5 years -Less than .25 bone loss/age -Heavy biofilm deposits with low levels of destruction -Non smoker -No diagnosis of diabetes Grade B Periodontitis (Moderate Rate) - ANS -Less than 2 mm over 5 years -.25-1.0 % bone loss/age -Destruction comme surate with biofilm deposits -Smokes less than 10 cigarettes/day -A1c less than 7% Grade C Periodontitis (Rapid Rate) - ANS -2mm or greater over 5 years -1.0 or greater -Destruction exceeds expectations given biofilm deposits. -Smokes 10 or more cigarettes per day -A1c 7% or greater Class I Carious Lesion - ANS -Pits and fissures of occlusal, buccal, and lingual surface of posteriors. -Lingual of anteriors Class II Carious Lesion - ANS Proximal surface of posteriors Class III Carious lesion - ANS Proximal surface of anteriors Class IV Carious Lesion - ANS Proximal surface of anteriors, including incised edge Class V Carious Lesion - ANS Gingival third of facial or lingual surface of anteriors and posteriors Class VI Carious Lesion - ANS Cusp tip of molars, premolars, or canines Ankyloglossia - ANS -"Tongue-tied" -Short, tight, lingual frenum Varicosities on tongue - ANS -Dark veins located sublingually. -More common in elderly patients -Considered normal Geographic tongue - ANS -Affected areas are red with white borders. -Lesions can change locations and are considered normal Median Rhomboid Glossitis - ANS -Flat smoothness on the middle dorsal surface of tongue. -Condition is related to candidiasis and is considered normal. Stained/Hairy Tongue - ANS -Elongation of filiform papillae with dark staining. -Caused by lon-term use of metronidazole, tobacco use, hydrogen peroxide, and ingestion of chromogenic food. Herpetic Lesion (Herpes) - ANS -Appears on keratinized mucosa, usually forming a cluster. -Do not treat for at least a week as the virus can spread. Aphthous Ulcer - ANS -Appears on non-keratinized surfaces such as buccal and labial mucosa, ventral surface of the tongue, floor of the mouth, and soft palate. -Lesions are filled with fluid and are surrounded by a red halo. -Postpone treatment until the lesion heals (7-10 days) Linea alba - ANS -Appears as white thin lines paralleling the occlusal plane Amalgam tattoo - ANS -Appears as blue or black macule of varying sizes on soft tissues. Hyperkeratosis - ANS -Thickening of the tissue. -Can be caused by lozenges, drugs, smokeless tobacco, etc. Common in vestibules. Ranula - ANS -Soft, bluish, movable enlarged mass on the floor of the mouth. -Involves major salivary glands Mucocele - ANS -Soft movable, semi-clear or bluish, small swelling present on the lower lip, gums, or palate (mucocele on the floor of the mouth is called ranula. -Involves minor salivary glands Exostosis - ANS -Small benign bone growth of the alveolar process, mostly on maxillary facial surface Torus (tori) - ANS -Benign bone growth on the palate or floor of the mouth. Can be unilateral or bilateral. -Not a concern unless partial or full denture is being constructed. Vesicle - ANS less than 5 mm and contains serum or mucin Bula - ANS greater than 5 mm and contains serum or mucin Pustule - ANS May be greater or lesser than 5 mm and contains yellow pus Papule - ANS less than 5 mm and contains tissue Nodule - ANS greater than 5 mm and contains tissue Macule - ANS flattened skin patch that is altered in color Plaque - ANS -Slightly raised, non-blister-form lesion with a broad flat top. Sessile - ANS Lesion has an attachment larger than the top Pedunculated lesion - ANS has an attachment smaller than the top (base is called a stalk or pedicle) Leukoplakia - ANS -White plaque-like (flat) lesion of the oral mucosa that cannot be diagnosed as a specific disease microscopically. Erythroplakia - ANS indicated by red patches Fordyce Granule - ANS -Clusters of ectopic sebaceous (oil) glands. -Considered normal -Tiny yellow lobules Leukoedema - ANS -Generalized gray opalescence on the oral tissues, especially buccal mucosa. Can not be rubbed off. -Most commonly observed in black adults and smokers . Lingual Thyroid Nodule - ANS When the thyroid gland descends to its normal location in the neck, the tissues can become entrapped in the tongue Aspirin Burn - ANS -Caused by an aspirin tablet placed directly on the pain area instead of being swallowed. -Lesion is painful and usually heals spontaneously in 7 to 21 days. Irritation fibroma - ANS -Most frequently appears on the buccal mucosa because of cheek biting Lichen Planus - ANS -Benign inflammatory condition of the skin. -Characterized by white, lacy lines called Wickham's Striae in the oral cavity Hairy Leukoplakia - ANS -Lesions caused by the Epstein-Barr Virus (EBV). -Most cases of hairy leukoplakia are an oral manifestation of HIV infection. Nicotine Stomatitis - ANS -Benign lesion on the hard palate caused in response to heat. Periapical cyst (radicular cyst) - ANS -Occurs on non-vital tooth and is usually asymptomatic. Periapical Abscess - ANS -Pocket of pus caused by a bacterial infection (caries, periodontal diseases, trauma, etc). -Can cause severe pain Dentigerous Cyst (Follicular cyst) - ANS -Commonly occurs around the crown of an impacted mandibular third molar. Eruption cyst - ANS -Blue/green layer of soft tissue around the crown of an erupting tooth. -Usually around incisors and first molars Lateral Periodontal cyst - ANS Appears as a radiolucent lesion located on the lateral aspect of a tooth root. -If the cyst is located in the bone, it is called a lateral periodontal cyst; if the cyst is located in the soft tissue, it is called a gingival cyst. Candidiasis - ANS -Also known as thrush. -an overgrowth of the fungus candida albicans. -Can be wiped off. -Angular chelititis is associated. Herpes Labialis - ANS Lesions on the vermilion border of the lips. (also called cold sores or fever blisters) Cleft lip - ANS -Failure of the maxillary processes to fuse with the medial nasal process. -Most common on left lip (unilateral) -Increases the risk for oral infection, periodontal disease, dental caries, and malnutrition Cleft Palate - ANS -Failure of the palatal shelves to fuse with each other or with the primary palate. -Malpositioning of the teeth and mouth breathing are common problems. -Increases the risk for oral infection, periodontal disease, dental caries , and malnutrition Hutchinson incisors - ANS -Screwdriver-shaped incisors with a notched incised edge. -Etiology: Congenital Syphilis Mulberry molars - ANS -Multiple tiny globules form on the molars instead of cusps. -Etiology: Congenital Syphilis Chickenpox - ANS Varicella Shingles - ANS Herpes zoster Infectious Mononucleosis (MONO) - ANS -Also known as the "Kissing disease" -Caused by the Epstein-Barr Virus Angina - ANS -Chest pain caused by excessive work of the heart. -Prepare nitroglycerin Myocardial infarction (MI, Heart attack) - ANS -Death in parts of the heart muscle. -Wait 6 months from last attack before dental treatment Hypertension - ANS -Increased pressure on the arteries related to the buildup of plaque in the arteries. -Check BP before and after appointment. -Orthostatic hypotension is possible due to medications (sit patient up slowly) -Angioplasty-stent - ANS -Tiny balloon inserted in the artery to prevent clogging. -Blood thinners can cause heavier and prolonged bleeding Congestive Heart Failure (CHF) - ANS -Inability of the heart to provide enough oxygen, blood, and nutrients to the body, and results in the backing up of blood in various parts. -Avoid cavitron and air polishing if patient has difficulty breathing Arrhythmia - ANS -Abnormal electrical conduction to the heart muscles. -Epi can worsen the condition -Patient have pacemaker so check to see if it is new (shielded) or old (not shielded) to determine is cavitron is safe for use. Artifical (prosthetic) valve - ANS -Patient requires antibiotic premedication before invasive dental procedures. -Patient may be on blood thinners ADHD - ANS -Characterized by inattentiveness, hyperactivity, impulsiveness, and possible learning disability. -Use "tell show do" method Alzheimer's disease - ANS -Progressive disease that destroys memory and other mental functions. -Caregiver educations is important. Parkinson's disease - ANS -Disorder related to lack or impairment of dopamine. -Characterized by rigid moments, tremor, drooling, lack of facial expression etc. -Caregiver education is important -Stabilize instruments Stroke - ANS -Lack of blood supply to the brain. -Characterized by unilateral lack of movements. -Do not treat for 6 months after attack. -Dexterity may be limited Seizure - ANS -Abnormal electrical discharges in the brain. -Dilantin can cause gingival hyperplasia. -Avoid bright lights in patient's eye Depression - ANS -Mood disorder caused by chemical imbalances in the brain. -Avoid mepivacaine with tricyclic antidepressant -Nitrous oxide is contraindicated Alcohol and drug dependency - ANS -Risk for oral cancer is higher. -Avoid mouth rinses with alcohol. -Nitrous oxide is contraindicated Hemophilia and Platelet disorders - ANS -At risk for spontaneous bleeding, prolonged bleeding, and hemorrhages. A1C Normal - ANS Less than 5.7% A1C of prediabetes - ANS 5.7-6.4% A1C of diabetes - ANS 6.5% or higher Renal disease - ANS -Treat the patient the day after dialysis. -Pt. can have poor healing, bleeding abnormalities, and frequent infections. Hypothyroidism - ANS -Patient may not be able to tolerate cold Hyperthyroidism - ANS -Patient may not be able to tolerate heat Spina Bifida - ANS -Latex allergy occurs frequently Asthma - ANS -Late morning or late afternoon appointments are preferred. -Avoid cavitron and air polisher Tuberculosis - ANS -Do not treat patient with active TB. Radiation therapy - ANS -Treat all dental issues before the start of cancer therapy What type of cells do HIV/AIDS affect? - ANS T-lymphocytes How is HIV/AIDS transmitted - ANS -Through blood, semen, rectal fluids, vaginal fluids, and breast milk. NOT in aerosols, saliva, or sweat Autism - ANS -Provide repetitive encounters in a quiet atmosphere, and avoid eye contact. Down syndrome (trisomy 21) - ANS -Patient at higher risk for periodontal disease but usually are at lower risk for caries. -Use "tell show do" method Normal respiration - ANS Adult: 12-20 breaths/min Child 18-22 breaths/min Bradypnea - ANS Slow respiration Tachypnea - ANS Rapid respiration Normal pulse - ANS Adult: 60-100 bpm Child 80-120 bpm Infant 100-160 bpm Bradycardia - ANS Slow heart rate Tachycardia - ANS Fast heart rate Normal BP - ANS less than 120/80 Elevated BP - ANS Systolic between 120-129 and diastolic less than 80 Stage 1 BP - ANS Systolic between 130-139 or diastolic between 80-89 Stage 2 BP - ANS Systolic at least 140 or diastolic at least 90 Seek medical attention but not an emergency Hypertensive crisis - ANS Systolic over 180 and/or diastolic over 120 Patient needs to seek medical treatment immediately Normal body temp - ANS 97-99 (98.6 most accepted temp) Insulin shock - ANS extreme hypoglycemia (low blood sugar) Anaphylaxis - ANS Most severe kind of allergic reaction that can potentially be life threatening. -Usually occurs within seconds or minutes. -Administer epinephrine Allergic reaction treatment - ANS Antihistamine (Benadryl) -Keep patient in supine position BLS sequence - ANS CAB What does CAB stand for? - ANS Circulation, airway, breathing What does CPR stand for? - ANS Cardiopulmonary resuscitation When is an AED used? - ANS Used for patients who are unconscious, without a pulse. Preventative Drug - ANS 2 g amoxicillin 1 hour prior to appointment What would you use is patient is allergic to penicillin? - ANS 600 mg Clindamycin 500 mg Azithromycin 500 mg Clarithromycin Clindamycin - ANS -Choice of premedication if patient is allergic to penicillin ( 20mg/kg for child) Pre med for artificial joints - ANS -No longer require a pre med unless the patient is immunocompromised and/or has an infection. -Old guidelines recommended use of pre med for 2 years after surgery. Heart conditions that require pre med - ANS -Artificial heart valve -History of infective endocarditis. Medications that cause xerostomia - ANS -Anti-hypertensive (hydrochlorothiazide) -Anti-histamine (benadryl) -Anti-depressant (prozac) -Anti-psychotic (clozaril) -Anti-anxiety (Valium) -Anti-emetic (alkaseltzer) -Anti-parkinsons (Levodopa) -Anti-allergic (Claritin) -Chemo and radiation Medication that causes gingival enlargement - ANS -Cyclosporine (anti-organ rejection) -Calcium channel blocker (anti-hypertension) (Procardia) -Phenytoin (anti-seizure) (dilantin) Medications that cause delayed wound healing - ANS -Anti-diabetic (metformin) -Corticosteroids (prednisone) Medications that cause oral candidiasis - ANS -Corticosteroids (prednisone) -Inhaler Medications that cause prolonged bleeding - ANS -Blood thinners (anti-coagulant) (plavix/warfarin) -NSAIDs (aspirin)