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DH III - Test 1

DH-DH III/1-Care Plan, PerioProbing, Ultra/Sonic Scaling, instruments

Maxillary roots are 3 roots. MB, DB, P Mesiobucal, distobuccal and palatal
Mandibular roots are 2 roots. M, D Mesial and distal
Probing the furcations using using a Nabor’s probe which has 3mm markings
Maxillary molars - PROBE probe from MB, B, DB mesiobuccal, direct facial, distobuccal
Mandibular roots - PROBE probe from B direct buccal only
Who has a (PL) - Palatolingual or (PG) palatogingival groove The maxillary lateral incisor has ..... groove
Mandibular central incisors - Roots are the roots are close to each other (proximity), scaling can be difficult if pockets are present.
Maxillary canine longest strongest root of all roots. Use a posterior explorer to feel calculusaround the distoincisal angle. The distal prominence of crown creates a concavity at the CEJ at distal.
Maxillary 1st Premolar can have can have 2 roots, BP. buccal/palatal. Most extracted for Ortho
As you progress posteriorly from Central incisors roots have roots have more depressions
Diamond instruments are for roots. Advanced use, very specific. They can damage the root if too long on it.
15 Principles of Instrumentation (1-7) 1. Fulcrum Finger Pressure: 2. Fulcrum Finger and Middle Finger Together: 3. Fulcrum Location: 4. Middle Finger for Lateral Pressure: 5. Thumb Position and Lateral Pressure: 6. Index Finger Position: 7. Middle Finger Slightly Bent:
15 Principles of Instrumentation (8-11) 8. Middle and Index Finger Together: 9. Handle Position: 10. Wrist Motion and Finger-Flexing Motion: 11. Wrist Motion with Lateral Pressure:
15 Principles of Instrumentation (11-15) 12. Middle of Thumb Pad on Handle: 13. Adjustment of Index Finger Position: 14. Pivoting on the Fulcrum: 15. Grasp Position on Instrument:
1. Fulcrum Finger Pressure: 15 Principles of Instrumentation There is a direct relationship between the pressure on the fulcrum finger and the pressure on the instrument blade against the tooth. Keep pressures equal.
2. Fulcrum Finger and Middle Finger Together: 15 Principles of Instrumentation Keep the fulcrum finger and the middle finger together. (Built up fulcrum)
3. Fulcrum Location: 15 Principles of Instrumentation The fulcrum must be established close to the working area to position the instrument so that the lower shank is parallel with the surface of the tooth being instrumented.
4. Middle Finger for Lateral Pressure: 15 Principles of Instrumentation With all curettes, the handle and the shank of the instrument should rest on the bony side of the middle finger, right next to the fingernail.
5. Thumb Position and Lateral Pressure: The thumb position should be parallel with the curette blade, providing the operator with direct pressure through the blade onto the tooth.
6. Index Finger Position: The index finger should be bent at the first joint next to the knuckle and cocked back on the handle of the instrument.
7. Middle Finger Slightly Bent: The middle finger should be slightly bent at the first joint next to the knuckle, but not bent as much as the index finger.
8. Middle and Index Finger Together: Keep your middle and index fingers together to increase strength and stability.
9. Handle Position: Positioning the handle parallel with the long axis of the tooth is a key to proper orientation of the curette blade.
10. Wrist Motion and Finger-Flexing Motion: Flexing Motion: The most effective strokes should combine both wrist motion and finger flexing motion. Pure wrist motion makes the stroke too short and Pure finger-flexing causes fatigue.
11. Wrist Motion with Lateral Pressure: The effectiveness of the working stroke depends on combining wrist motion with adequate lateral pressure against the tooth.
12. Middle of Thumb Pad on Handle: Position the middle of the thumb pad on the instrument handle to achieve optimum pressure and control.
13. Adjustment of Index Finger Position: Lighten the pressure on the index finger and carefully readjust it so that it does not fall off the instrument as the operator rolls the handle with the thumb.
14. Pivoting on the Fulcrum: When scaling around any line angle or curvature of any tooth the operator must not only rotate the instrument in his/her fingers but also pivots on the fulcrum.
S 204 SD9 Location Used: Area Specific (Universal) Posterior sickle, double ended for use in posterior proximal region.
S 204 SD9 This sickle is a bit smaller than your original posterior sickle. It is great for premolars and can be used in the anterior if you adapt the lower shank parallel to the surface you are working on.
SMO/009 Location Used: Area Specific tiny sickle for anterior
SMO/009 This tiny sickle is made for tiny areas in the anterior. It is extremely area specific.
SMO/009 It is extremely area specific sickle.
SC NEVI 2 Location Used: Area Specific Super thin posterior curved sickle scaler.
SC NEVI 2 Contra angle design great for interproximal reach and ergonomic hand positioning.
SC NEVI 4 Location Used: Area Specific Super thin anterior/posterior sickle scaler.
SC NEVI 4 sickle scaler provides the MUSCLE you need to take on the toughest scaling tasks!
SC NEVI 4 Tapered, super thin blades and increased rigidity coupled with curves providing access and reach into the most challenging areas gives you the EDGE you need to tackle deposits!
11/129 Gracey Location Used: Area Specific This instrument is used on mesial surfaces. It is similar to the 15/16 gracey except the shank is not as curved.
5/6 Langer Location Used: Universal Instrument Langer curettes are designed with the same shank design of a Gracey but they have a universal blade.
5/6 Langer These instruments scale all surfaces. has a straighter shank and I like to use it on premolars.
13/14 Columbia Curette Not all ............. are intended for universal use. Some are meant for posterior or anterior. Great for just about anywhere.
13/14 Columbia Curette Location Used: Universal Instrument The ....... is intended for universal application. It is used exactly like the Barnharts. Notice this instrument has a shorter terminal shank.
Hoe 1-Single straight cutting edge. Blade: 99' / 100' angle. Shank angled/ adaptation of cutting edge Some are paired
Chisel 1-Single straight cutting edge. Blade continuous with slightly curved shank. End of blade is flat and beveled at 45'.
Chisel Supragingival calculus removal from exposed proximal surfaces of anterior teeth where interdental gingival is missing. Heavy proximal calculus. dislodge bridges of calculus on anterior mandibular teeth. Full width of cutting edge is used.
File Multiple cutting edges, mini hoes lined up on a rectangular, oval or round base. Blades at 90' or 105' Angulated shanks May be paired
Implacare _ For implant maintenance. Used to remove plaque and calculus without damaging titanium abutments. _ Made of Plasteel, a high grade resin that doesn’t scratch titanium. _ Should be autoclaved before and after use. _ Are disposable
File Supplemental instrument. Crushes or fragments heavy calculus; smoothing of tooth at CEJ; root debridement, especially on exposed root surfaces, after periodontal surgery; smoothing rough or overextended amalgam restorations.
Debridement Curettes/Furcation Curettes _ Used after ultrasonic scaling for gentle removal of residual deposits and for smoothing root surfaces. _ Ideal for furcations, developmental grooves and line angles. _ Push or pull stroke
File Helps fracture burnished, tenacious calculus. Always finish with a curette. Burnishing calculus if placement and pressure are not constant. Entire working surface is placed flat against treatment area. Apply pressure so cutting edges can grasp surface.
File Helps fracture burnished, tenacious calculus. Always finish with a curette. Burnishing calculus if placement and pressure are not constant. Entire working surface is placed flat against treatment area. Apply pressure so cutting edges can grasp surface.
Vision Curvettes _ Designed to adapt to a specific area or tooth surface. _ 5mm and 10mm shank markings
File Decreased tactile sensitivity due to size and shape / wide and bulky.
Turgeon / Modified Gracey Curettes _ Blade designed to produce a different cross section of blade angulations _ Sharper blade _ Easy to sharpen _ Narrow and easy to insert
Chisel Proximal surfaces of premolars with/lip and cheek flexibility. Nicking cemental surface with edge. Sharp corners should be rounded when sharpening to reduce chance of nicking tooth surface.
Graceys (Implacare) _ Designed to adapt to a specific area of tooth surface. _ Standard, Rigid, Extra Rigid (greater strength)
Graceys (Implacare) After Five (terminal shank elongated by 3mm for access in 5mm or greater periodontal pockets) _ Mini Five (terminal shank elongated by 3mm and blade half the length of all other Gracey instruments)
Chisel Stroke is push stroke - horizontal only, from facial to lingual on proximal surfaces of anterior teeth (mandibular teeth).
Hoe For large, tenacious, accessible supragingival/supramarginal pieces of calculus. 2-3mm below the GM, tissue must be spongy and easily displaced. Pull stroke, full width of cutting edge is in contact with calculus.
Hoe If used subgingivally, thick blade will cause distention of pocket wall; lack of adaptability of wide straight cutting edge to curved root surface; will easily gouge cemental surfaces, should round sharp corners when sharpening;
Hoe lack of sensitivity due to largeness of instrument (reduced tactile sensitivity); impossible to reach base of pocket without stretching/tearing pocket wall due to size, shape and angulation of blade.
Magnetostrictive(Ultrasonic) Scaling Ultrasonic scalers involve a power-unit box that sits on the counter. They must be connected to a water source and they plug into an electrical wall outlet.
Magnetostrictive(Ultrasonic) Scaling vibrate Ultrasonics vibrate at much higher frequencies than sonic scalers (25,000 cycles per second or higher.) The pattern of vibration is much more linear than the sonic scaler, tracing the letter “I” or a very narrow ellipse as it vibrates.
Swivel Direct Flow Design _ SWIVEL inserts allow for single-handed adjustment – No need to stop scaling or to reach with your free hand to adjust the insert.
Swivel Direct Flow Design Less hand fatigue* - An 18% larger handle diameter reduces finger pinching for a light touch and enhanced tactile sensitivity.
Swivel Direct Flow Design The through-tip water delivery of SWIVEL Direct Flow focuses the water flow directly to the tip – reducing excess spray for improved visibility and enhanced patient comfort.
Piezo Scaling The PIEZO is powered by vibrating quartz plates in the handpiece instead of a vibrating metal stacks on the back of the insert. The oscillation is provided by vibrating quartz plates built into the handpiece
Piezo Scaling As a result, the PIEZO is quieter and generates less heat than the traditional magnetostrictive design. You can use the piezo with minimal water flow, or even no water flow at all.
Sonic Scaling scalers, like the Titan®, are small handpiece-size devices. They sit conveniently in the delivery unit and hook up to a conventional air/water handpiece connector.
Sonic Scaling the tip of a sonic scaler moves in an orbital pattern, tracing the letter “O” as it vibrates at approximately 3000-9000 cycles per second.
15. Grasp Position on Instrument The grasp should be spread out on the handle of the instrument to provide the best stability and control. This also allows consistent, even pressure and avoids finger flexing. Periodontal Instrumentation: Anna Pattison
The stroke for piezo ultrasonic scaler is linear
SATELEC-NEWTRON - piezoelectric ultrasonic - Color Coding System (CCS tips) • Low power and amplitude green n.H3,
Color Coding System (CCS tips) • Medium power and amplitude yellow ET20, ET20D, SO4 tips, four K15/21mm files, four K25/25mm files The Endo mini-tips are used during root canal preparations and irrigation. They include specific instruments for endodontic retreatment.
Color Coding System (CCS tips) • High power and amplitude blue n.1, n.10Z, supra- and sub-gingival scaling tips are ideal for treating commonly encountered cases (pockets <3-4mm)
Color Coding System (CCS tips) • Very high power and maximum amplitude orange
The dental hygiene Process Of Care 1. 2. 3. 4. 5. Assess Diagnose Plan Implement Evaluate
Assessment Findings -Planning for Dental Hygiene Care- Chief complaint, risk factors, patient's overall health status, oral healthcare knowledge level of the patient, the patient's ability to perform oral care procedures, documentation of assessment data
Periodontal Diagnosis -Planning for Dental Hygiene Care- Current periodontal status, case type, classification of periodontal disease, parameters of care: clinical diagnosis, therapeutic goals, treatment considerations, and outcomes assessment for periodontal disease
Dental Hygiene Diagnosis -Planning for Dental Hygiene Care- Basis for diagnosis, diagnostic statements, diagnostic models
The Dental Hygiene Prognosis -Planning for Dental Hygiene Care- Factors that determine outcome, expected outcomes
Considerations For Providing Care -Planning for Dental Hygiene Care- Role of the patient, tissue conditioning, preprocedural antimicrobial rinsing, pain and anxiety control, maintenance during therapy, four-handed dental hygiene *Gather health status details of the patient; analyze and synthesize the data.
What is Mucogingival involvement? when there is NO attached gingival.
What is attached gingiva? The portion of gingiva between the free gingival groove and mucogingival junction.
How do you probe interproximally? Under the contact. ( not sure )
What are the measurements of the PERIO probe? Perio probe: 1 2 3 5 7 8 9 10
How you calculate attached gingiva. From Gingival Margin to Mucogingival Junction (total width of gingival minus the Pocket depth (GM to JEA)
When do you record MGI? when there is no attached gingiva.
Probe PCP 10/11587 $ measurements are Our Probe (the periodontal end) PCP - Periodontal Color Probe 1,2,3,5,7,8,9,10 = 10 mm in total length 3.5,5.5,8.5,11.5 = 11.5 mm in total length 1,2,3,_,5,_,7,8,9,10 _,_,3.5,_,5.5,_,_,8.5,_,_,11.5
Probe stroke probe is walked with an oblique bobbing stroke around the whole tooth. six (6) general areas - recorded. greatest detected depth should be rounded to the next integer (5 1/2 mm rounded to 6mm)
Attached Gingiva (Measuring Amount that is left) min AG noted if the measurement 2mm or less. To measure place the tip of the probe on the line of the MJ, measure to the GM and record the reading.("outside" reading) Take the reading from the base of the pocket to the GM and subtract =attached gingiva.
When mucogingival problem exist? if probe can be inserted apically beyond the mucogingival line into the attached gingiva, a mucogingival problem exists
CP Probe CP = Qulix Color Coded Probe. has a black marking that is smooth and accurate
What areas/how many do we probe? 6 areas around the tooth. If 6 is not an answer in multiple we choose number 4.
Normal Gingiva Pink, firm, no bleeding, stippling
Gingivitis Red, soft, bleeding, smooth. No structural damage (fibers intact, bone intact, pocket formation is due to swollen gingiva) \- is reversible with proper homecare - if not arrested, can lead to structural destruction
Periodontal Disease Progressive destruction of structural elements (fibers lost, bone lost, pocket formation due to actual destruction of supporting structures)
I not treated Periodontal Disease ... - not reversible but may be arrested with NSPT or surgery - if not arrested, will progressively move to more advanced disease stages
Plaque is the culprit. It is colorless and sticky. It is a live bacteria that is composed of microorganisms, food and saliva. It forms continuously. It feed on food and debris. It excretes by-products (waste), plaque's wastes are endotoxins.
Plaque's wastes are plaque's wastes are endotoxins. These toxins erode gingival tissue by creating small ulcers in the gingiva. These ulcers cause bleeding. If left untouched, plaque calcifies (calculus -rough surface) and attracts more live bacteria.
Which direction we hand scale? Coronal-apical and Apical-coronal.
What does calculus to gingiva calculus grows larger and pushes the gingiva away from the tooth allowing the live plaque to get closer to the attachment fibers and ultimately bone
Who is the father/inventor of Gracey curette? invented by Dr Clayton Gracey with the help of Hugo Friedman of Hu-Friedy Manufacturing company in the early 1940's
Know the lower shank. has to be parallel to surface you work on.
factors that can lead to increased susceptibility to gingivitis are mouth breathing, diet, medications,and systemic diseases
Chisle- stroke & use used for anterior teeth, push stroke.
File- stroke & use horizontal strokes, multiple cutting edges, use a Gracey after you smoothed the calculus.
Calculus removal —Power-driven instrumentation- Power-driven instrumentation is as effective as hand instrumentation in shallow pockets, and significantly more effective in pockets > 4 mm.
Removal of oral biofilm with Power-driven instruments —Power-driven instrumentation- is extremely effective in disrupting and removing subgingival plaque biofilm from root surfaces and pocket areas, especially helpful for patients on frequent recare appointments whose primary need is deplaquing for maintenance of periodontal health
Furcation access —Power-driven instrumentation- Power-driven instrument tips with slim diameters are more effective in treating class II and III furcations in the hands of experienced clinicians.
Conservation of tooth structure —Power-driven instrumentation- use on low or medium power settings remove less root surface than hand instrumentation,
Penetration into deep periodontal pockets —Power-driven instrumentation- Power-driven instruments with slim-diameter tips penetrate more deeply into periodontal pockets than hand instruments
Lavage or irrigation —Power-driven instrumentation- therapeutic washing of the periodontal pocket and cemental surface from the constant stream of water exiting the point of the instrument tip.
Bacteriocidal effect —Power-driven instrumentation- Cavitation and acoustic turbulence allow power-driven tips to disrupt plaque biofilms even slightly beyond the tip of the activated instrument
Power-driven compared with hand instrumentation has —Power-driven instrumentation- - Shorter instrumentation time (scaling) - reduced operator fatigue - Effective as hand instrumentation
Benefits to the pt. —Power-driven instrumentation- Tissue distention is a primary factor in patient discomfort. Power-driven devices require very little lateral pressure and a slim-diameter tip allows less tissue distention, resulting in increased patient comfort
Increased tactile sensitivity during longer appointments —Power-driven instrumentation- no decline in tactile sensitivity. lost tactile sensitivity after hand scaling for 45 minutes.
methods of decreasing aerosol production - - —Power-driven instrumentation- adjusting water flow - mist is produced will greatly decrease aerosol production. Adjusting the frequency and power setting is another method of decreasing aerosol production
Effect on cardiac pacemakers —Power-driven instrumentation- all modern pacemakers are shielded, but if magnetostrictive ultrasonics or ultrasonic instrument cleaning devices generate a magnetic field that might interfere with certain types of cardiac pacemakers
Infection control —Power-driven instrumentation- Not all components of electronically powered devices can be sterilized
Water production and visibility —Power-driven instrumentation- Position the patient in a supine position with the head turned to the side and chin pointed down.
Primary or newly erupted teeth with large pulp chambers —Power-driven instrumentation- recommended low to medium power settings and adequate water flow are used because the amount of heat generated will not be sufficient to harm the pulp.
Oral conditions —Power-driven instrumentation- Ultrasonic or sonic use is contraindicated for patients with hypersensitivity, demineralized areas, porcelain or composite resin restorations, and titanium implants (unless a specially designed tip for this purpose is used)
Cavitation the action created by the formation and collapse of bubbles in the water or fluid exiting the tip, creating shock waves that lyse or tear the bacterial cell walls.
powered scalers effectiveness all types of powered scalers are as effective as hand instrumentation,
Frequency is the number of times an instrument tip vibrates per second. A hertz (kHz) is a unit of energy that measures the cycles per second. Frequency varies from 2500 Hz to 8000 Hz for sonic scalers and from 18,000 Hz to 50,000 Hz for ultrasonic scalers.
Amplitude or stroke refers to the distance the instrument tip moves during one cycle. Stroke length, which ranges from 10 µm to 100 µm, is controlled by the power setting
High power settings produce ... strokes lower power settings produce ... strokes High power settings produce longer, more forceful strokes; (more uncomfortable for the pt, more likely to cause tooth surface damage, and are no more effective than medium power settings) Lower power settings produce shorter, less forceful strokes.
Acoustic streaming or turbulence the agitation of this discharged fluid in the confined space of the periodontal pocket produced by the continuously vibrating tip. This intense swirling effect will disrupt bacterial biofilms.
Purpose of Lavage or irrigation To wash away toxic bacterial by-products and provides a cleaner working area by removing blood from the treatment area.
Stroke motion is the motion in which the operator moves the instrument tip. Multidirectional, light, overlapping strokes are recommended
How effectiveness of electronically powered instruments is determined by by the instrument tip's frequency, stroke length, stroke motion, and the tip surfaces in contact with the tooth. The high vibrational energy crushes and removes calculus with a cooling water lavage.
What is used produce rapid vibrations of the instrument tip Electrical currents
main action of the power-driven scalers is mechanical vibration; however, cavitation, acoustic turbulence, and lavage all have positive roles in periodontal debridement.
Advantages of Power-driven Scalers best results for nonsurgical periodontal therapy are achieved by a blended approach: the combined use of power-driven devices and hand instrumentation. effective as hand instrumentation
What kind tips of Power-driven instrument best is for class II and III furcations slim diameters
amount of root surface removed by (which is the most) - ultrasonics - sonics - hand instruments - diamond burs amount of root surface removed depends on the specific power scaler type used. - ultrasonics removed 11.6 µm, - sonics removed 93.5 µm, - hand instruments removed 108.0 µm, - diamond burs removed 118.7 µm.
Advantage of Lavage rrigation improves vision and helps speed healing by removing toxic bacterial by-products
Limitations and Concerns with Power-driven Scalers • Aerosol production • Effect on cardiac pacemakers • Infection control • Water production and visibility • Primary or newly erupted teeth with large pulp chambers • Oral conditions
Standard-diameter tips should be used for for heavy or medium calculus deposits and orthodontic cement removal.
Slim-diameter tips should be for light calculus deposits and biofilm disruption in pockets > 4 mm. Using a slim-diameter tip to remove medium to heavy calculus is ineffective, causes excessive tip wear, and may result in tip breakage and burnishing of calculus.
Straight or universal tips to be used in pockets < 4 mm
Curved tips with right and left access are designed for deeper pockets, using the back of the instrument against the curved root surface in the same manner as using a periodontal probe.
The primary factor in selection of an instrument tip the type of deposits to be removed (biofilm; light, medium, or heavy calculus) and the location of these deposits
Who should not be treated with power-driven scalers Patients with communicable diseases or at high risk for infection because of the high production of potentially infective aerosols.
using preprocedural mouthrinse before Powered instruments can can reduce bacterial counts in aerosols by more than 90%
additional safety measures for aerosol production personal protective equipment, effective surface disinfection and barriers, high-velocity evacuation systems, and air-filtration systems
Diamond-coated tips used for for tenacious calculus can increase clinician e3ffectiveness; however, they are only indicated for use with an endoscope or during open-flap surgery.
Plastic-covered tips can be used for safely debride implants.
Power-driven tips features to increase operator comfort, such as cushioned grips, swivel mechanisms, and fiber-optic lights.
hand instrumentation depends on strong lateral pressure and adaptation of the instrument below the calculus deposit (bottom-up)
Technique that requires Power scaling light pressure to allow the vibrations to break up the deposit, and adaptation at the most coronal portion of the deposit (top-down)
Subgingival deplaquing is effectively accomplished by .... strokes/motions gentle sweeping movements and short, multidirectional, overlapping strokes that cover every millimeter of root surface
Power instrumentation angulation less that hand instruments. From 0 no more than 15
Power instrumentation activation More finger motion than hand instruments. (light grasp as probing. Firm will reduce effectiveness)
NEVI 2 differs from Nevi 4 that Lower shank is .... more contra-angle
Preparation of a Dental Hygiene Care Plan Parts of a Care Plan: Periodontal/Gingival Health, Dental Caries Control, Prevention, Description, Rational, Objective
Components of a Written Care Plan Demographic Data Assessment Findings and Risk Factors Periodontal Diagnosis/Case Type and Status Diagnostic Statements Planned Interventions Expected Outcomes The Appointment Plan Reevaluation
Sequencing and Prioritizing Patient Care -provide evidenced-based indv. pt care disease factors -eliminate signs/symptoms of disease To promote oral health and prevent recurrence of disease Factors affecting sequence of care: urgency, existing etiologic factors, severity condition, indv pt re
classification systems of Periodontal Disease ADA/AAP (Insurance Purposes)
ADA/AAP (Insurance Purposes) The system developed by the American Dental Association classification system is primarily based on the severity of attachment loss. (Insurance Purposes)
Classification of Periodontal Disease Case Type I Gingivitis: Inflammation of the gingiva. No bone loss.
Classification of Periodontal Disease Case Type II: Early Periodontitis: Early bone loss and formatin of periodontal pockets of 4-6mm in depth.
Classification of Periodontal Disease Case Type III: Moderate Periodontitis: Increased destruction, mobility and furcation evident.
Classification of Periodontal Disease Case Type IV: Advanced Periodontitis: Further destruction, mobility and furcation.
Classification of Periodontal Disease Case Type V: Refractory Periodontitis: Occurs after treatment - do not respond to therapy.
Most common types of drugs that have been associated with hyperplasia are 1. Phenytoin (Dilantin), 2. Cyclosporin A (Sandimmun), 3. Nifedipine (Adalat),
Phenytoin (Dilantin) an anticonvulsant drug used in the management of epilepsy.
Cyclosporin A (Sandimmun) used to prevent rejection in organ transplantation, and for treatment of some aut~immune diseases.
Nifedipine (Adalat) a calciumchannel blocker used in the prophylaxis and treatment of angina, and in the control of mild hypertension.
hyperplasia is increased cell production in a normal tissue or organ. side effect of medications (dilantin, cyclosporines, calcium channel blockers and even birth control pills). Can also be a sign of leukemia and some blood dyscrasias.
gingivectomy removal of the excessive gum tissue (gingival hyperplasia)
Frequency of Periodontal Charting dependent upon the diagnosed periodontal case type
Furcations Class I: incipient, only slight penetration (slight)
Furcations Class II: definately in furca, but not through (moderate)
Furcations Class III: through and through (severe)
Furcations Class IV: same as III except clinical exposure resulting from gingival recession (severe)
Evaluation of Tooth Mobility may be present due to hyperfunction or loss of attachment Check for mobility with the handles of two instruments
Mobility Class I (slight, greater than normal physiologic) 0.5 to 1.0 mm facial-lingual tooth movement
Mobility Class II (moderate, greater than 1mm) 1 mm to 2 mm facial-lingual tooth movement
Mobility Class III (severe tooth can be depressed into socket) Over 2 mm facial-lingual tooth movement and apical coronal depressibility
Mucogingival Involvement areas with less than or equal to 1 mm of attached gingiva.
Clinical Attachment Level (CAL) is the distance from the CEJ to the most apical extent of the periodontal probe or where resistance is met. (Normal sulcus depths are .5-2mm coronal to the CEJ)
Clinical Attachment Loss is defined as pathologic detachment of the gingival collagen fibers from the root surface with the concomitant apical migration of the JE along the root surface.
AAP AAP: Gingivitis - Periodontitis (Verbally descriptive) AAP - American Academy of Periodontology
ADA/AAP I – V (Insurance)
Purposes -Assess the periodontal status for preparation of a treatment plan (PSR) -Make a sulcus and pocket survey -Make a mucogingival examination -Make other gingival determinations -Guide treatment -Evaluate success and completeness of treatment
probe is A probe is a slender instrument with a smooth, rounded tip designed for examination of the depth and topography of an area. It has three parts: the handle, the angled shank, and the working end, which is the probe itself.
more frequently Gingival and periodontal infections begin in the in col area
Probing depth may be deepest in ... directly under the contact area because of crater formation under contact area.
Who influence direction of probing Anatomic features of the tooth wall
Circumferential Probing Walking Stroke
Bifurcation maxillary first molars, mandibular molars, primary mandibular molars,
Trifurcation Maxillary molars, maxillary primary molars.
Furcation Grades F1 just able to probe root indentation
Furcation Grades F2 Probe penetrates into furcation
Furcation Grades F3 Probe penetrates through furcation filled with soft tissue
Furcation Grades F4 Furcation is open and void of soft tissue
AREA SPECIFIC - designed and angled to adapt to a specific anatomic area of the dentition. - designed with only one cutting edge
UNIVERSAL CURETTE designed to adapt to most areas of the dentition by altering and adapting the finger rest, fulcrum, and hand position. Two parallel cutting edges are formed, one on either side of the face. Either cutting edge can be used
When do you know you reach the bottom of a pocket? when you meet resistance
Largest and longest ROOT of Max. molars Lingual
Least likely to have proximal root concavities? Max. Central incisor
Proximal surfaces is more easy reach from lingual aspect Max. insisors & Mndbl. pre-molars
Surface that do not have concavity Max. 1st molar - (L) lingual root
for Max. 2d molar furcation must be probed froms Prox. surfaces & midfasial
tooth that has mesial furcation and the longest root trunk Max. 1st pre-molar
Typical this permanent teeth has 2 roots Max. 1st pre-molar
Permanent anterior more likely has bifurcated root Mnd. canine
permanent teeth that has two pulp canals Max. 1st pre-molar
permanent teeth that most likely has palatolingual grove Max. lateral incisor
which furcation area can be better maintained tooth with roots that diverge
Dilaceration rotated root
Concrescence roots fused together
Color Coding System (CCS tips) Are ... • Low power and amplitude: green. • Medium power and amplitude: yellow. • High power and amplitude: blue. • Very high power and maximum amplitude: orange. The color marking resists.
Created by: Redabj