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Perio Test 3
| Question | Answer |
|---|---|
| Disease sites definition: | Individual tooth or specific surfaces of a tooth that are experiencing periodontal disease. |
| What are local contributing factors? | Oral conditions that increase an individual's susceptibility to periodontal infection in specific sites. |
| What are some local contributing factor examples? | Dental calculus, faulty dental restorations, developmental defects, dental decay patient habits, and occlusal trauma |
| Does local contributing factors initiate disease? | No |
| What are the 3 ways local contributing factors increase risk of disease? | 1. Increase plaque retention 2. Increase plaque pathogenicity 3. Cause direct damage to periodontium |
| What factors increase plaque retention? | Dental calculus and tooth morphology |
| When does mineralization of plaque begin? | From 48 hours up to 2 weeks after plaque initiation |
| What is the inorganic component of calculus? | **Calcium phosphate**, calcium carbonate, magnesium phosphate |
| What is the organic component of calculus? | Materials derived from plaque, dead epi cells, and dead WBC |
| Newly formed calculus: | Brushite |
| Less than 6 months calculus: | Octocalcium phosphate |
| More than 6 months calculus: | Hydroxyapatite |
| What forms calculus supragingivally and what is the shape of the calculus? | Saliva; irregular, large deposits |
| What forms calculus subgingivally and what is the shape of the calculus? | Crevicular fluid; flatten from pressure of pocket wall |
| What are the 3 modes of calculus attachment to tooth surface? | Acquired pellicle, tooth irregularities, and direct contact to the tooth |
| What is pathogenicity? | The ability of the bacteria in a biofilm to produce periodontal disease |
| What are some local factors that cause direct damage? | Occlusal forces, food impaction, patient habits, faulty restorations, faulty appliances and fremitus |
| What are some signs of trauma form occlusion? | Tooth mobility, sensitivity to pressure, migration of teeth, enlarged, funnel-shaped PDL space; alveolar bone resorption |
| When does local factors must be identified so they can be eliminated or minimized? | During nonsurgical periodontal therapy |
| Smoking may be responsible for more than how much of cases of perio disease among adults in the US? | 50% |
| What bacteria is likely to be found in a smoker's biofilm? | Porphyromonas gingivalis (Pg) |
| Smokers have a decrease in what? | Signs of inflammation and gingival crevicular blood flow |
| What is one of the tissues that is most affected by smoking? | Bone |
| Nicotine increases the secretion of what 2 pro-inflammatory mediators? | IL-6 and TNF-alpha |
| What gingival signs are absent on smokers? | Gingival inflammation and gingival bleeding |
| What is peri-implant mucositis? | Is plaque-induced gingivitis with edema, bleeding/purulence on probing, probing depths 4mm or greater |
| T/F Smoker patients may notice inflammation and bleeding that lasts for several months. | True |
| Tobacco smoking may have any of the effects on the periodontium listed below, EXCEPT which one: | Increased effectiveness of PMN and monocyte/macrophage defensive functions |
| Which risk factor most affects the progression of periodontal disease? | Tobacco use |
| Is mature biofilm more pathogenic than initial deposition of plaque? | Yes |
| What is triangulation? | Widening of the PDL space caused by bone resorption on either the mesial or distal of interdental crestal bone also called funneling |
| It is difficult to detect bone loss on a radiograph if it is less than ___mm. | 3 |
| T/F Radiographs show disease activity. | False |
| To determine if the bone is healthy on a radiograph, what lines are drawn on the 2 different structures? | CEJ and Alveolar Crest |
| Interdental septa between incisors.... | thin and pointed |
| Interdental septa between posteriors.... | Rounded or flat |
| What are the 3 signs of early bone changes on a radiograph? | Fuzziness in the crest of the interdental bone, widening of the PDLs, and radiolucent lines in the interseptal bone |
| If there is extensive bone loss, what type of BW should be taken? | Vertical BW |
| Characteristics of white (visible) light: | Multiple wavelengths, non-directional, non-focused |
| What does the acronym LASER stand for? | Light Amplification by Stimulated Emission of Radiation |
| What is wavelength? | The distance from wave crest (peak) to wave crest (peak) |
| Characteristics of laser light: | Collimated (wavelengths can be focused, very directional); Monochromatic (very precise color or wavelength, one color); Coherency (wavelengths are superimposed on one another, synchronized in phase) |
| Where in the spectrum do most lasers operate? | In both the visible and infrared portions |
| What is a photon? | The elemental quantity, or quantum of radiant energy |
| When using a laser, power density is measured in what? | watts/cm^2 |
| Laser power is expressed as: | Watts (W) |
| Dental laser beams are conducted by all of the following except: | Platinum cable |
| Assuming both beams have equal power, the smaller fiber (smaller spot size) will have: | Higher power density |
| Which of the following are examples of ionizing radiation? | X-rays, Gamma rays and Ultra violet rays |
| Does the lasers we use, use ionizing radiation? | No |
| Diode lasers seek what tissue targets? | Melanin and hemoglobin |
| T/F A 400 micron fiber would have a higher power density than a 600 micron fiber if both lasers were set at the same power setting. | True |
| Optical pumping is used to achieve which step in laser creation? | Emission of photons |
| What laser do we use in clinic? | Diode 810nm, .6 watts power, continuous wave |
| When laser energy interacts with biologic tissue, the effect is influenced by: | Emission wavelength, tissue optical properties, time of exposure and laser energy |
| Which is better: pulsed or continuous mode? | Different settings for different applications |
| Which of the following is the most important type of interaction in terms of the laser's ability to alter the target tissue? | Absorption |
| Pulsing a laser gives the tissue a thermal relaxation period between energy pulses. | True |
| The emission mode that has true pulsed bursts of laser energy is: | Free running pulsed |
| A laser running in continuous mode's peak power is: | The same as its average power |
| Thermal relaxation refers to: | The tissues ability to absorb and dissipate heat to help minimize thermal damage with pulsed laser usage |
| What is dental hygienist's thermal threshold range? | Hyperthermia: below 50 degrees C (98.6 degrees F)-laser bacterial reduction |
| What thermal thresholds cause irreversible changes and pain? | Coagulation and protein denaturation: 60 degrees + C (140 degrees F); Carbonization: 200 degrees + C (392 degrees F) |
| At approximately 100 degrees C (212 degrees F), which of the following effects occur? | Tissue vaporization |
| T/F Charring and browning of tissues results in a biological bandage and is an advantage in healing. | False |
| Fluorescence of tissue stimulated by laser light is mostly important in: | Caries diagnosis |
| The primary biological effect of lasers when performing soft tissue procedures is: | Photothermal |
| The diode laser operates at: | 810nm |
| T/F The diode laser's wavelength is visible to the human eye | False |
| Which of the following are procedures that you can perform with a diode laser? | Herpetic lesion treatment, apthous ulcer treatment, desensitizing teeth--uninitiated tip; fibroma removals--initiated tip |
| Ebrium lasers are.... | hard and soft tissue capable |
| When cutting hard tissue with an erbium laser: | minimal thermal effects are observed in adjacent tissue when use properly |
| Nd: YAG lasers are what wavelength? | 1064nm |
| What do diode lasers use to produce laser light? | A semiconductor stimulated b electricity |
| T/F Water is the primary chromophore for diode laser wavelengths. Diode lasers run in free running pulsed mode. | Both statements are false |
| T/F You should always use the minimum power setting necessary in order to perform a procedure. | True |
| The tissue effects in a contact application of laser energy are determined by: | Color of tissue, duration of exposure, rate of movement of the fiber tip across the target tissue, and energy per pulse of laser |
| Which is not a desired effect of laser interaction on soft tissue? | Edema |
| What do you accomplish with biostimulation? | Increase collagen formation, increase circulation, increase fibroblastic activity and increase osteoblastic activity |
| Reasons to perform Laser Bacterial Reduction (LBR) are: | Reduce or eliminate bacteremias, reduce or eliminate cross contamination, and kill perio infections before loss of attachment |
| T/F A laser safety office should be assigned in every dental office that has a laser. | True |
| What is critical before performing any laser treatment on a patient? | Place safety glasses on the patient and the clinician, ensure your laser is properly prepared and in ready mode, and have proper training in laser |
| Specific safety equipment needed for laser use include: | Laser-specific protective eye ware, high volume evacuation and laser safety sing |
| Why would we prefer to regenerate the periodontium over the formation of a long junctional epithelium? | Epithelium is not an effective barrier |
| After gingivitis is gone, do we have a long junctional epithelium? | No, because there is no bone loss in gingivitis |
| The client's sensitivity in the maxillary canine is most likely related to: | Fluid entering the dentinal tubules |
| The tissue(s) that have nerve innervation are: | Pulp and periodontal ligament |
| The free unmyelinated nerve endings of the pulp can sense: | Pain |
| The tooth anomaly of the molar, ex., the root curved at an angle, is best referred to as: | Dilacerations |
| The root form is dictated by Hertwig's epithelial root sheath. This sheath is derived form the: | Reduced enamel epithelium |
| A globulomaxillary cyst is a pear-shaped radiolucency in the palatal area where the derivative of the globular process fuses w/the derivatives of the max. process. Between which teeth is the alveolar ridge area that marks the fusion of these processes? | Lateral incisor and canine |
| A gloulomaxillary cyst arises form odontogenic epithelium. From which part of the tooth germ does this epithelium originate? | Enamel organ |
| This client has healthy gingival tissue; the tissue lining of a healthy sulcus consists of: | Nonkeratinized epithelium without rete pegs |
| What are the 5 phases of perio treatment plan? | Assessment phase and preliminary therapy (Phase 0); Nonsurgical Therapy (Phase I); Surgical Therapy (Phase II); Restorative Therapy (Phase III); Periodontal Maintenance (Phase IV) |
| Which perio phases of perio treatment plan are dental hygienists involved in? | Assessment phase and preliminary therapy (Phase 0), Nonsurgical therapy (Phase I) and Periodontal Maintenance (Phase IV) |
| What is the old term for nonsurgical periodontal therapy? | Root planning and scaling |
| What is included in NSPT? | All nonsurgical treatment and educational measures used to help control gingivitis and periodontitis (pt. self care, perio debridement, and chemical plaque control) |
| Philosophy for developing a plan is a plan treatment that controls or eliminates what? | Bacteria, local risk factors and systemic risk factors |
| T/F Nonsurgical Periodontal Therapy is not the best therapy for aggressive periodontitis. | True |
| What is the primary risk factor in etiology of periodontal disease? | Dental plaque biofilm |
| What is the primary goal of NSPT? | To stabilize the attachment level |
| What is the most effective mechanism to control perio disease? | Physical removal of bacterial plaque |
| What does periodontal debridement remove? | Removes or disrupts bacterial plaque, byproducts, and calculus form crown and root within pocket space |
| What is deplaquing? | Removal of subgingival microbial plaque |
| All dental treatment codes use what coding system? | ADA Insurance Coding system |
| Is "gross debridement to enable an examination and diagnosis" the same as the term periodontal debridement? | No |
| T/F Periodontal debridement is a recognized ADA procedure name. | False |
| What is the end point for instrumentation? | To return the periodontium to a state of soft tissue health and a periodontium that is free of inflammation. |
| What is the primary pattern of healing after instrumentation? | Formation of a long junctional epithelium |
| What is the complete resolution of healing after instrumentation? | Shrinkage of the soft tissue resulting in a shallow pocket depth |
| What is re-adaptation with long JE? | Re-adaptation of the tissues to the root forming a long JE |
| What is a residual pocket? | Little change in the level of soft tissues (refer to periodontist for gingivoectomy) |
| Re-evaluation should be scheduled in how long after completion of instrumentation? | 4-6 weeks |
| What is dental hypersensitivity? | Short, sharp, painful reaction that occurs when an area of exposed dentin is subjected to mechanical, thermal, or chemical stimuli |
| What creates hydrodynamic forces in fluid-filled tubules that stimulate nerve endings? | Changes in temperature |
| Hypersensitivity is associated with what? | Exposed dentin, but all exposed dentin is not sensitive |
| Hypersensitivity pain is: | Sporadic, localized or generalized |
| What layer prevents sensitivity? | Smear layer |
| What are strategies for management of hypersensitivity? | Chemical management, patient education, treating exposed dentin surfaces with lasers, and blocking dentinal tubules with restorative materials |
| What chemicals can be used to seal tubules? | Fluoride, calcium phosphate, cavity varnish, dentinal bonding agents |
| Toothpaste for sensitive teeth contain what? | Potassium nitrate or strontium chloride |
| What are the steps in re-evaluation appointment? | 4-6 weeks after completion of NSPT: Medical status update, thorough PA, compare results with initial assessment, decide on the next step in therapy, additional nonsurgical therapy, periodontal maintenance, and possible referral for perio surgery |
| Should all patients with chronic periodontitis be placed on a maintenance program after NSPT? | Yes |
| Indications to refer a patient to a periodontist: | Moderate or sever chronic periodontitis or surgery, aggressive perio, need for IV sedation, continued perio breakdown |
| T/F Following perio instrumentation, there normally is NO formation of new alveolar bone, new cementum, or new PDL. | True |
| When is a plan for periodontal maintenance developed? | At the re-evaluation appointment |
| What are we lacking when healing occurs in the formation of a long JE? | Formation of alveolar bone, cementum and PDL fibers |
| What is the objective of supragingival irrigation? | To diminish gingival inflammation by disrupting biofilms coronal tot he gingival margin |
| What is the goal of subgingival irrigation? | To reduce the number of bacteria in the periodontal pocket space |
| What is a dental water flosser? | Device that delivers pulsed irrigation of water or other solutions supragingivally and subgingivally |
| Dental water flosser delivers a pulsating fluid that incorporates what phases? | Compression and decompression phase |
| A compression and decompression phase of a dental water flosser creates two zones of fluid movement called what? | Hydrokinetic activity |
| What are the two zones of fluid movement? | Impact and flushing zone |
| Impact Zone: | Initial fluid contact with an area of the mouth |
| Flushing zone: | Depth of fluid penetration within a subgingival sulcus or perio pocket |
| What are benefits of home irrigation? | Biofilm removal, bleeding reduction, gingival inflammation reduction, periodontal pathogens reduction up to 6mm, and reduction in inflammatory and destructive host response |
| What are the indications for recommending the dental water flosser? | Pt. on perio maintenance, pt. who are noncompliant with dental floss, pts. with special needs, pts. w/ dental implants, pts. w/ diabetes, pts w/ orthodontic appliances, and pts. w/ prosthetic bridgework and crowns |
| Subgingival irrigation with water provides as much of a benefit as other antimicrobial agents. Why? | Readily available, cost-effective, and no side effects |
| How is chlorhexidine used at home and how is it available to the patient? | Should be diluted with water and it's available by prescription ONLY |
| What is the dilution we recommend with CHX? | .04%=3 parts water to 1 part CHX |
| What is an example of essential oils as irrigants? | Listerine-only effective when used at full strength, over-the-counter, and flush unit with water after use |
| Standard Irrigation Tip: | Plastic material; The water penetrates at a depth of 50% or more of the pocket |
| Subgingival Irrigation Tip: | Has soft rubber-tip end; 6mm or less, the water penetrates up to 90% of the pocket depth; 7mm or more, the water penetrates at 64% of the pocket depth |
| Orthodontic and Filament Irrigation Tips: | Have soft tapered brush that facilitates biofilm removal around orthodontic wires, brackets, or implants |
| What is the placement of the standard irrigating tip? | Place tip at 90 degree angle at the neck of the tooth; use the water spray to trace along the gingival margin |
| What is the placement of the subgingival irrigating tip? | Adjust water pressure to lowest setting; Slide rubber tip beneath the gingival margin; Direct tip at 45 degree angle |
| What is the placement of the orthodontic and filament irrigating tip? | Place tip at a 90 degree angle and trace the gingival margin; Start at the lowest setting and increase it to the medium setting |
| What 3 systems do dental hygienist or dentist use for in-office flushing of pockets? | Handheld syringe with blunt-tipped cannula; Ultrasonic with reservoir; Air-driven hand piece |
| What is the goal of professional irrigation? | Disruption and dilution of bacteria and their products from within the perio pockets |
| What are some irrigant solutions? | Water, chlorhexidine gluconate (full strength), povidone iodine and water (1:9), stannous fluoride (1:1), tetracycline, and Listerine (full strength) |
| T/F Single application of in-office subgingival irrigation w/ an antimicrobial agent has been shown to have only limited or no beneficial effects over perio instrumentation alone. | True |
| Is substantivity of antimicrobial agent in pockets long-termed? | No |
| What can reduce the incidence of bacteremia and the number of microorganisms in aerosols? | Subgingival irrigation performed before periodontal instrumentation |
| Water flosser used in combination with manual tooth brushing removes how much more biofilm than traditional brushing and flossing? | 29% |
| What is significantly better for reduced marginal bleeding and bleeding on probing, daily irrigation with water or rinsing with CHX? | Daily irrigation with water |
| Water irrigation reduces bleeding in how long? | 14 days |
Created by:
Chava102693