Dental Technique Exam 2 PDF

Probing Depths Obtain the deepest reading from the six areas around each tooth (1) Holding the probe too tight or not letting it slide can lead to inaccurate readings (1) The most difficult part of probing is the proper grasp, fulcrum, and technique (1) Recessio...

Probing Depths Obtain the deepest reading from the six areas around each tooth (1) Holding the probe too tight or not letting it slide can lead to inaccurate readings (1) The most difficult part of probing is the proper grasp, fulcrum, and technique (1) Recession Measured from the cementoenamel junction (CEJ) to the margin of the gingiva (1) Need to be familiar with the anatomical/clinical crown (1) Both direct facial recession and interproximal recession can occur (1) Charting Recession Example charting: o #24 - 0.3 mm o #25 - 0.3 mm 030 030 Do not overmark recession on teeth where it is not present (e.g., #23 and #26) (1) Causes of Recession Can have many causes: o Toothbrush abrasion o Clenching/grinding o Frenal attachments o Trauma o Calculus/biofilm Gingival o Dental appliances facial Need to investigate the cause and how to stop recession progression (1)  Gingival Margin Probing Depth vs. Clinical Attachment Loss (CAL) If the gingival margin is at the correct level, the probing depth = the CAL (1) If there is swelling, subtract that from the probing depth (1) If there is recession, add that to the probing depth (1) Probing Depth vs. CAL Examples Tooth A: Probing Depth = ___ mm, CAL = ___ mmTooth B: Probing Depth = ___ mm, CAL = ___ mm Tooth C: Probing Depth = ___ mm, CAL = ___ mm Eaglesoft Charting Eaglesoft will automatically add recession to probing depth to calculate CAL (1) It will also subtract inflammation from probing depth (1) Just need to enter recession or inflammation values: o GM = recession (auto +) o GM & "-" = inflammation o Lock button will lock + or - Bleeding Points gingivitis is the first stage of periodontal Gingivitis is the first stage of periodontal disease and disease is reversible (1) and it is Mark bleeding points with a red circle in the corresponding box (1) reversible Even slight bleeding is considered bleeding (1) Need to communicate this effectively with patients (1) Can mark 'ALL' in cases of severe gingivitis (1) Assess whether the bleeding is due to the patient or your technique (1) Adaptation  Consistent bleeding on posterior mesial surfaces may indicate poor adaptation Gingival Bleeding Index Bleeding Index = Total number of tooth surfaces bleeding ÷ (6 × number of teeth present) = _______Multiply answer by 100 = % score 0% is ideal, but less than 10% is realistic (1) Example: Patient has 25 teeth, you count 33 areas of bleeding. What is the plaque score? (1) Inefficient Probing 33 6 25 25 Factors that can affect accurate probing: 1. Extent of disease: o Inflammation o Bleeding o Patient sensitivity (1) 2. The probe markings: o Can wear off o Operator needs to be able to read (1) 3. Placement: o Tooth contour, furcations, crowding o Calculus buildup o Dental prostheses o Obstructed view o Limited opening o Macroglossia (enlarged tongue) (1) Air/Water Syringe Use water to rinse the mouth Water Use air to detect calculus Air Press both together to push away blood or biofilm (1) Pressure Air Saliva Ejector Bendable, everyone has their own preferred bend Helps with ergonomics (1) Patient can hold if responsible (1) Intraoral Camera Important tool for documentation and patient education (1) Minimum 5 photos per patient, but should capture all significant findings (1) Before/after photos help patients see the work done (1) Take pictures of "watch" areas (1) Set up at the beginning of the day, wipe down cord and cover at the end (1) Explorers - Design Features (Section on Assessment 11 12 super flexible fight Instrument) 6 AND Flexible shank provides tactile sensitivity Fine, wire-like working end Tgtifivity Flexible metal conducts vibrations from the working end to the clinician's fingers Sharp point sharp pointircular Circular in cross-section cross section Tip should remain on tooth surface at all times (1-2 mm) be Tip should adapted Explorers - Uses to the teeth 1. Detection of surface irregularitiesTextureandBumps 2. Calculus detection (used on clinical board exam) 1,112Explorer 3. Caries detection 6 Explorer 4. Helps create a map of the mouth 5. Checks work throughout treatment Common Calculus Formations Exploratory or assessment stroke must cover the entire tooth surface to accurately assess where calculus lies Explorers - Types Shepherd's Hook BoardsExam Used only supragingivally (above the gumline) Uses: Poke at caries spots o Caries detection o Checks margins of restorations o Assesses sealant retention Shepherds Right Angle #6/Straight Hook and In your kit! For use on skills test only 6 Straight Used only supragingivally (above the gumline) Uses: is used for o Caries detection caries o Examination of tooth surfaces detection o Checks margins of restorations o Sealant retention Orban Type Primarily for calculus detection and tooth surface irregularities on anterior teeth Can be used on direct facial and lingual surfaces in posterior Can be used subgingivally (under the gumline) 90-degree bend at end of tip Pigtail or Cowhorn Orban Type  Used only on normal or shallow pockets subgingivally for calculus detection Could damage soft tissue in deep pockets BelgTmline Curved Used only on normal or shallow pockets subgingivally for calculus detection Could damage soft tissue in deep pockets 11/12 All tooth surfaces In your kit Primarily for calculus detection and tooth surface irregularities Used subgingivally to the base of pockets Below gumline Long, complex shank makes it advantageous for anterior or posterior use Must use on board exam Design of 11/12 Explorer Tip is curved and bent at a 90-degree angle Terminal shank is the shank closest to the bend Tip will remain adapted to the tooth surface Selecting the Working End tea Posterior Teeth Visual check: Terminal shank at the distal of the premolar will be parallel to the long axis of the tooth Tip "V" is directed towards the "D" of the tooth "P" stands on 1 foot = 1 end Anterior Teeth Use 1 end for all teeth surfaces of posterior V to the D  Visual check: Working-end curves around the tooth surface you are working towards Tip should wrap Terminal shank will be slightly oblique to the long axis offend of the tooth tooth Tip "V" is directed towards the tooth "A" stands on 2 legs = 2 ends for each tooth Two ends used for Tips! each tooth on the Anteriors The end correct for the facial aspect of the posterior quadrant is also correct for the anterior facial surfaces away from that quadrant The opposite end is correct for the lingual aspect and the opposing arch on the same surfaces (e.g., Q1 facial; Q4 facial) Explore the entire coronal surface and follow through the entire tooth General Technique Adapt tip (1-2 mm side of instrument) to tooth surface Tip points in the direction of exploring Light grasp - the lightest of all instruments Subgingival stroke in vertical or oblique direction Lots of overlapping Exploratory stroke is the length of the sulcus/pocket Interproximal is most important; shank should always be touching the contact to ensure you are interproximal enough Technique - Posterior One working end for all tooth surfaces Tip of instrument on tooth at all times Insert at the distal line angle, travel distally into the distal aspect of the tooth 7 Come out, reinsert at distal line angle, travel mesially all the way into the mesial aspect of the tooth Posterior Sequence 1. How it looks on the distal 2. How it looks across the facial 3. How it looks across the mesial Horizontal/Oblique Strokes Can be used to explore direct facial or lingual surfaces of anterior or posterior teeth Practice when you get more comfortable Most Common Mistake Leaning the instrument back instead of standing it up Keep the terminal shank parallel Don't get lazy and lay the instrument down Should always be looking at the back of the terminal shank Technique - Anterior One working end for surfaces toward and the opposite working end for surfaces away Tip of instrument on tooth at all times Must overlap at the midline to ensure the entire surface is covered Insert tip at base of sulcus at midline Roll handle at line angle Use small, overlapping strokes Explore all surfaces toward, then flip instrument to do surfaces away Overlap at midline using horizontal strokes Rough Restoration  Shank Terminal intent Where Do I Sit? Same as for a probe Keep all clock positions the same, except anterior surfaces can be done from one area as long as you remain neutral Example: Lower anteriors o Right: 11:00 or 8:00 o Left: 1:00 or 4:00 You can move for each, you won't be penalized for not moving*** ***Unless you start to look ergonomically incorrect! Dental Calculus and Tartar Definition and Occurrence Big.fi cBEimserekatahns andaitcii's Dental calculus is a mineralized dental biofilm composed of calcium phosphate crystals deposited between living organisms (1) It forms a hard, tenacious mass on teeth, dental appliances, and restorations, and can extend over the gingiva (1) Calculus can develop in anyone, regardless of dentition or age (1) Location and Distribution Frequentlyfoundin Supragingival calculus is most commonly found: o On the lingual surfaces of mandibular anterior Linguals Mandible APE teeth o On the buccal surfaces of maxillary molars aces o Due to the openings of the submandibular Maxiteg.EE and parotid salivary ducts (1) o On teeth that are out of occlusion, hard to reach, or in crowded areas (1)  o On dentures, partial dentures, and oral piercings/jewelry (1) Subgingival calculus is most commonly found: o In interproximal areas, but can be found anywhere in (1) o The importance of using an explorer to check interproximal areas (1) Appearance and Consistency Supragingival calculus: o White to yellow in color, may be stained by food, drink, or smoke o Moderately hard in consistency (1) Subgingival calculus: o Brown to black in color due to blood pigments o More brittle in consistency (1) Detection Supragingival calculus: o Can be detected visually and tactilely using a light, mirror, and air (1) o Can be felt with an explorer or probe (1) Subgingival calculus: o Can be detected visually and tactilely o May be visible as a dark deposit, but air can help deflect loose tissue for a better view (1) o Transillumination and observation for tissue color changes can also aid in detection (1) o Can be felt with an explorer or probe, which will feel rough or bumpy (1) across the tooth Formation a Protective layer 1. Pellicle forms on the tooth surface (2) 2. Biofilm matures on the pellicle (2)  3. Mineralization of the biofilm occurs, forming calculus (2) Begins as early as 24 hours after plaque formation (2) Minerals (calcium and phosphorus) from saliva (for supragingival) and sulcular fluid (for subgingival) connect and continue to be deposited in the biofilm matrix (2) Crystals form using the cell walls of dead microorganisms as a foundation (2) The process repeats, forming calculus in layers (2) Takes an average of 12 days to form, with a range of 10-20 days (2) Attachment Relates to the ease of calculus removal: Eat ant o Pellicle attachment: just on the surface, easier to remove (2) o Attachment to minute irregularities: subsurface Subsurfaq cracks and grooves, harder to ensure complete removal (2) o Direct attachment: unusual, may cause cemental removal (2) RARE Composition Inorganic (70-90%): o Calcium and phosphorus are the primary minerals (2) o Crystalline forms include brushite, octocalcium phosphate, hydroxyapatite, and whitlockite (2) Organic/water (10-30%): o Living and dead microorganisms, nutrients, fats, carbohydrates, proteins, and cells (epithelial cells and leukocytes) (2)  Significance Cause PeriodontalDisease Contributes to the development of periodontal disease (2) Predisposes to pocket formation due to the rough, porous surface that harbors biofilm, especially in protected subgingival areas (2) Aesthetic consideration (2) Prevention Personal biofilm control through effective oral hygiene (2) Educate Patients Recomend ORALCareProducts Professional removal of rough, bacteria-laden calculus to provide a smooth, easy-to-clean surface (2) Professional Use of tartar control toothpaste and rinses to inhibit Removal crystal formation and prevent new calculus, but not remove existing calculus (2) Calculus on Radiographs Radiographic detection of calculus is discussed in the text, but not covered in these notes. Curettes: Comprehensive Study Notes Usedsubgingival andsupra gingival Universal Curettes Semi curclecrosssestion Doubleendedwith 2cuttingedges Can be used both supragingivally and subgingivally, and in all areas where designated (Universal Curettes) Have rounded "toes" (semi-circular cross-sections) to access pockets without traumatizing tissue Curets subgingivally (Universal Curettes) Double-ended with two mirror-image ends, each with two cutting edges (Universal Curettes) BOARDSEXAM Types of Universal Curettes  Columbia, Younger-Good Langer series - more "site-specific" but with universal ends (1/2, 3/4, 5/6, 17/18) Universal Curette Design Features Rounded "toes" for subgingival access 60980 Ideal Working Double-ended with two cutting edges per end Degree Beginning Scaling with Universal Curettes Goes angetereated Angulation for insertion and scaling strokes o Get completely under the deposit o Open the face to begin scaling o Apply pressure against the tooth Tighten grasp when o Use short, biting strokes upward to bring the deposit out of the pocket pulling 7 o Pressure only on the upstroke Application of Cutting Edge o Same process as an explorer o Posterior: Use one cutting edge from distal line angle to interproximal, then turn and use the opposite cutting edge from distal to mesial o Anterior: Start at midline and overlap, turning the toe in the direction you are scaling Gracey Curettes belowgumline Site-specific - used on specific surfaces, both sub- and supra-gingivally Abovegumline Need a full set to complete a full prophy Have rounded "toes" like universal curettes, but are pre-angulated so the operator doesn't have to angle the instrument manually Double-ended with two mirror-image ends, but each end has only one cutting edge (the lower edge) Gracey Curette Design Features Pre-angulated shanks for easier access to specific surfaces One cutting edge per end Finding the Correct Cutting Edge on Gracey Curettes Hold the instrument facing you with the terminal shank completely parallel to the floor to help determine the lower (cutting) edge Gracey Curette Variations i VariationDescription RigidThicker shank for removing heavy calculus After FiveElongated terminal shanks to reach deeper pockets (>5mm) MiniShorter/smaller working ends for small areas or crowding Gracey 1/2 For anterior teeth, all surfaces Simple, straight shank One end/cutting edge for surfaces towards, one for surfaces away; overlap at midline Must determine correct cutting edge by finding the lower edge Gracey 11/12 & 15/16 For posterior teeth, direct facial/lingual and mesial surfaces only More complex shank to access posterior teeth  One end/cutting edge per posterior region; start at distal line angle, only move across direct surface and into mesial aspect Must determine correct cutting edge by finding the lower edge Inter proximal Rollhandle foradaptationtothetooth Gracey 13/14 & 17/18 For posterior teeth, distal surfaces only More complex shank to access posterior teeth One end/cutting edge per posterior region; start at distal line angle, only move to distal aspect Must determine correct cutting edge by finding the lower edge Gracey Curette Instrumentation Insertion (13/14 or 17/18): At distal line angle, toe pointing into distal surface, 0° angulation, light grasp, slide to base of sulcus Working Angulation: Less than 90° Concepts of Channel Scaling Alternate exploratory and scaling strokes Exploratory strokes feel the tooth surface to find the base of the deposit o Lighter grasp and stroke Scaling strokes utilize lateral pressure against the tooth and pulling upward (lateral) or across (oblique) in small, biting movements o Tighten grasp o Listen for the sound of the blade on the tooth to ensure correct adaptation Supragingival Scaling with Sickle Scalers & Disc  Sickles curved sealers EEE.EE view Sickle Scalers: Design Features Jacquettes straightscaler Straightblade Function: aight filmthree Remove calculus from crowns of teeth Should not be used on root surfaces Anatomical crown is ideally 1-2mm subgingival Features: Sickle Gracey Barnhart Pointed back Pointed tip Triangle cross-section 2 Cutting edges per end Face is perpendicular to lower shank – like universal curettes; must be tilted to tooth for scaling angulation Grasp Recap Types of Sickles Anterior Sickles IEND ended Often single-ended Anterior is single Common to combine 2 onto one instrument Posterior Sickles Usually double-ended Posterior double ended Can be used on all areas of posterior teeth Be very careful adapting a pointed tip! Can be used on anterior teeth, but we will not use them there this year Comparisons: Sickles that are Comparable to Each Other Anterior Sickles:  H5 – does not require finding the correct cutting edge H6/7 – must find the correct end Posterior Sickles: Nevi 1 Anteriorscaler Rigid terminal 2workingends SIU 204 smallthinsickle Etc angulation 204S Other end Nevi 2, 3, & 4 is an ovaldisc Fte Instrumentation SequenceNeuit115Anterior NEVIING Elongated disk for Anteriorlingual Anterior: a thin curvedblade Ickle Same sequence as anterior curette for interpretical Interior Surfaces towards and away, beginning just before areas midline in both directions to overlap University Posterior: 204 SIU Posterior Sickle Indiana Universal posterior sickle Eg Same sequence as posterior curette D line angle into interprox, turn and D line angle across direct (vertical or oblique/horizontal strokes) to mesial interprox Adaptation & Angulation Must tilt lower shank towards the tooth to establish a 70-80 degree scaling angulation Light Rolling the instrument is most important Remember all steps before you start scaling grasp Keep your eye on the Anterior 1/3 of tip! Adaptedto the Incorrect Angulation - PosteriorCorrect Angulation - tooth PosteriorImage 1Image 2 Incorrect Angulation - AnteriorCorrect Angulation - AnteriorImage 3Image 4 Disc and Hoe Scalers Disc/Disk Stain on anterior linguals Cutting edge is the entire circumference of the working end Used only on linguals of anterior teeth Multidirectional strokes – Vertical, Horizontal and Oblique Hoe Cutting edge on flat-front side of working end Used only on linguals of anterior teeth