Choosing appropriate instruments for patients
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| CASE A Questions 1-10 Mr. D is 72 with history of well-controlled hypertension, emphysema, occ. migraine headaches if he eats chocolate, & colon surgery in 1999. P: 90 beats per minute, HR: 20 breaths per minute, BP: 118/76 (Cont on reverse) | Mr. D has had no dental care for two years. @ perio assess, you record gen. marg. inflam. & gen. bop on depths > than 3 mm
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| 1. whether to include stain removal as part of Mr. D’s treatment can best be made before perio debridement. Power-driven stain removal is contra. for Mr. D b/c of his history of emphysema. A. Both = t B. Both = f C. 1st = t, 2nd = f D. 1st = f, 2nd = t | 1
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| The mand right post. sextant has gen- moderate supragingival calculus deposits. Which instrument would you select to remove these deposits? A. post. sickle B. Columbia 13/14 C. slim line ultrasonic tip/probe like D. R/L ultrasonic tip /furca probe like | 2
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| The mand right post sextant has probing depths of 4 mm with gen-moderate sub deposits. Which would you select first ? A. Post sickle B. curet l/s shank, such as a Barnhart 1/2 C. Gracey 11/12 curet D. Slim/strt/ultrasonic tip extd shank, like a probe | 3
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| You remove most of the sub from the mand R post sextant. You detect a tenacious sub deposit on the distal of first molar. Which instrument would you select ? A. Post sickle B. curet s/shank like Columbia 13/14 C. Rigid G 11/12 D. Rigid G 13/14 | 4
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| U have tried several times to remove a sub deposit on the mesial of mand R/ 2nd molar. Deposit is burnished & tenacious. Which instrument? A. Post sickle B. Curet like Barnhart 1/2 C. Gr 11/12 mini curet/long shank D. perio files, ie Orban 10/11 & 12/13 | 5
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| The ling. of the mand ant sextant has gen- moderate supra deposits. Which instrument ? A. Ant sickle B. Columbia 13/14 C. Gracey 1/2 or Gracey 3/4 curet D. Rigid Gracey 1/2 or 3/4 curet | 6
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| Mr. D has a history of several medical conditions. Which of the following conditions reported by Mr. Dickson will influence the periodontal debridement procedures? A. Hypertension B. Emphysema C. Migraine headaches D. Colon surgery | 10
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| CASE B 11-20 Mrs. M is 55, history of type 1 diabetes, joint replacement in 2003, hypertension, & latex allergy. Mrs. M has taken antibiotic premed as prescribed. P: 80 bpm, R:16 BP: 110/72 (Con't on reverse) | Her last physician’s visit was two years ago; her last dental appointment was four years ago. Mrs. Marcum tells you that her blood glucose level this morning before breakfast was 300 mg/dL.
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| Which of the following conditions would require you to postpone instrumentation? A. Joint replacement B. Hypertension C. Diabetes D. Latex allergy | 11
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| U detect a small deposit 7 mm below gingival margin on distal of mesial root on mand 1st molar. Which instrument? A. Extended Gracey 11/12 curet B. Extended Gracey 11/12 curet C. Extended Gracey 11/12 mini curet D. Extended Gracey 13/14 mini curet | 15
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| Recession is on the facial aspect of the max centrals. The exposed roots have extrinsic stain. Which instrument ? A. Ant. Sickle B. Gracey 1/2 or Gracey 3/4 curet C. perio files, ie Orban 10/11 and 12/13 D. Power-driven rubber cup polisher | 19
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| Uncontrolled diabetes increases Mrs. M’s risk for severe perio. Untreated perio disease may make it more difficult for Mrs. Marcum to control her blood sugar level. A. Both are true. B. Both are false. C. 1st= true 2nd= false. D. 1st = false 2nd= true. | 20
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| Use Case C to answer questions 21 and 22. CASE C Philip J is 18 & has a history of multiple allergies, asthma, & hay fever. P: 80 bpm, R: 15 BP: 108/68 .Last dental appointment was 6 mos ago. (Con't on reverse) | During the periodontal assessment, you record no inflammation and no bleeding upon probing, with probing depths ranging from 2 to 3 mm throughout the mouth.
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| U detect isolated light sub slightly below the gingival margin on the molars and linguals of the mand ants. Which instrument ? A. ant & post sickles B. Columbia 13/14 & Barnhart 1/2 C. Gracey 11/12&13/14 D. R Gracey 1/2 or 3/4 curet & Gracey 11/12 & 13/14 | 21
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| Philip was struck by a ball at 15. So his max cent incisors are implants. There is light supra on the linguals. Which instrument ? A. Gracey 1/2 or 3/4 curet B. Slim ultrasonic tip long shank C. R/L ultrasonic tips long shank D. Plastic w/ curet-like end | 22
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| Use Case D to answer questions 23-27. CASE D Mrs. W is 45 & has a history of hay fever. P: 60 bpm R: 14 & BP: 108/72 . No dental care for about 3 years. (Con't on reverse) | During the periodontal assessment, you record generalized marginal inflammation and generalized bleeding upon probing, with probing depths greater than 5 mm throughout the mouth.
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| The man R post sextant has gen- moderate supra. Which ultrasonic instrument ? A. Bulky ultrasonic tip w/ s/strt shank; i.e. beavertail B. universal ultrasonic tip w/curved shank C. Slim/strt/ultrasonic tip D. R/L ultrasonic tips | 23
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| The mand R post sextant has light deposits from 5-7 mm under the margin. Which ultrasonic tip is used on deposits more than 4 mm apical to CEJ on post roots? A. Bulky tip i.e. beavertail B. universal tip w/curved shank C. Slimline D. R/L | 24
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| A. Bulky tip i.e. beavertail B. universal tip w/curved shank C. Slimline D. R/L | 26
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