Preventive exam 2

• Palliative care: topical solutions such as a mixture of lidocaine, cough syrup, and a coating agent (milk of magnesia).
• Cryotheraphy such as chewing on ice chips, and bland rinses of sodium bicarbonate or salt.
• Systemic prednisone or narcotics such as morphine.

• Patient’s should be counseled to avoid hot, spicy, acidic, and rough-textured foods.
• Mouth rinses containing alcohol and foods and beverages with high sugar content.
• Chlorhexidine, sucralfate, and antimicrobial lozenges.

• Determining the histologic subtype.
• It is accomplished by determining degree of differentiation exhibited by the cells and how closely the cells resemble normal tissue structure.

• Determining the clinical extent.
• It’s based on the size and extent of metastatic spread of the lesion.

• tumor-node-metastasis (TNM).
• Three clinical features specify the stage:
• Size of tumor (T) in centimeters.
• Involvement of local lymph node (N).
• Presence or absence of distant metastasis (M).

• By performing oral cancer screenings annually on all patients. 
• Surgical biopsy is the only definitive method
• available to DIAGNOSE oral carcinomas. Other means have since been used to help
• visual DETECTION of the lesions which include:
• 1. Exfoliative Cytology
• 2. Toluidine Blue
• 3. Chemiluminescence
• 4. Autofluorescencee

Many recommend that primary teeth never be replaced.

• Avulsed PERMANENT teeth should be reimplanted and proper tooth
• preservation should be used.

Damage to the permanent tooth germ.

No treatment is recommended as these teeth will naturally exfoliate.

• Hanks balanced salt solution (HBSS)
• milk
• saline
• the patient’s own saliva
• Viaspan, a storage medium used for transport of transplant organs.

No, air drying rapidly reduces the chance of successful reimplantation.

• Water’s low osmolality results in periodontal ligament death.
• Storage of avulsed teeth on ice is a low alternative if none of theapproved storage media are available.

• Educators
• Parents
• Students

• Anatomic barriers:
• 1.Epithelium and an ideal dentition
• 2. Normal oral flora: Bacteria that discourage colonization
• 3. Immune System: Cellular and humoral components
• 4. Saliva:Immunoglobulins

• Epithelium is a formidable barrier to microbial invasion. It is a anatomic barrier.
• Microbes cannot cause infection without first getting past this barrier.

Enamel, dentin, pulp, cementum, PDL, Crown, root, apex

The mutans Streptococci and lactobacilli

• Cellular immunity is carried out by T cells from the thymus, T cells originate from cells formed in the blood marrow but these cells mature in the thymus.
• T cells migrate from the lymph nodes, spleen, and blood.

Humoral immunity is carried out by B cells from the bone marrow. (Tonsils contain many B-cells).

• Lubrication
• Flushing/rinsing
• Chemical
• Antimicrobial (including antibacterial, antifungal, and antiviral)
• Maintenance of supersaturation of calcium and phosphate ions bathing the enamel, and helping to buffer demineralization and aid remineralization of tooth surfaces.

• Granulocytes are mature granular leukocytes (WBC’s).
• Eosinophils, neutrophils, basophils and macrophages.

• Immunoglobulins are antibodies made of protein.
• There are 5.
• M (IgM), G (IgG), A (IgA), D (IgD), and E (IgE).
• A (IgA) is the most important immunoglobulin in dentistry.

End rounding (bristles filaments ends are sealed and rounded)

• Toe, head, heel, shank, and handle..
• Handles are made of plastic.
• Plastic is water resistant, inexpensive, and easily manipulated for attractive design.

• Removal of plaque biofilm and disturbance of plaque re-formation.
• Removal of food, debris, and stain from the oral cavity.
• Stimulation of the gingival tissues.
• Application of toothpaste containing specific ingredients to prevent demineralization of tooth structure, periodontal diseases, and tooth sensitivity or to attain remineralization of demineralized tooth structures.

• Bristle position at 45° w/ tips in sulcus.
• Brushing motion: vibratory, horizontal jiggle.
• Subgingival cleaning & gingival stimulation.

• Bristles position apically against attached gingiva.
• Brushing motion: swept in arc toward occlusal surface.
• Supragingival cleaning & gingival stimulation.

• Electric toothbrushes literally uses the motion of the bristles to remove the plaque and debris.
• Recommended for parents who brush their child’s teeth, people w/ disabilities or dexerety, and for patients who require a larger handle.

• Disclosing agents.
• Used for evaluating the thoroughness of cleaning the teeth.  Allow patients to see plaque in mouth before and after brushing. Self-evaluation & plaque control.

Splayed, bent, broken bristles. It is influenced by brushing method than by the length of time or # of tooth brushing/day. Brushing habits.

• The tongue.  
• Finding of multiple small furrows or grooves on the dorsal (top) surface of the tongue.

Depends on the inherent hardness of the abrasive, the size of the abrasive. Particle, and the shape of the particle.

Carbonates, phosphates, and silicas.

Small particles (1mm) have a polishing action and larger particles (20mm) have an abrasive action.

Loss of dental tissue caused by hard toothbrush, an abrasive toothpaste and intensive horizontal brushing technique. Appears as v-shaped notches at cervical regions of facial tooth surfaces.

• Humectants are ingredients added to maintain the moisture and prevent hardening of the toothpaste.
• Examples are: sorbitol, mannitol, glycerol, and propylene glycol.

Flavor, smell, color & consistency.

• Brushing w/ baking soda & peroxide.
• Known to reduce plaque, gingivitis, remove extrinsic stains & reduce malodor.

Activity against caries, plaque, and gingivitis.

• Potassium nitrate.
• It reduces the reaction of nerves in the teeth to stimuli such as heat & cold. It is known to desensitize the nerve by penetrating through the length of dentinal tubules & to depolarize sensory nerve endings located at the dentin-pulpal interface.

• An area of the gingival margin that becomes clefted in the middle due to aggressive brushing or improper dental floss technique.
• Gingival cut and cleft.

A bacterial infection of the heart which have been shown to be linked to oral bacteria along with aspiration pneumonia, chronic obstructive pulmonary disease, andgeneralized infection of the respiratory tract.

When the patient has difficulty loading or threading the floss.

• Type I: papilla fills interproximal space.
• Type II: slight to moderate recession of papilla.
• Type III. Extensive recession or complete loss of papilla.

• Type I : Waxed dental floss or unwaxed round floss.
• Types II & III: Waxed dental tape (broad/flat) or tufted super floss (stiff end) variable thickness.

• Use of fluoride trays for 5 min/day.
• Rinse w/ 1 teaspoon baking soda mixed with 8 ounces of water.
• Over-the-counter 0.05% fluoride rinse is helpful in diminishing enamel loss.
• Don't brush the teeth for at least an hour after vomiting. The enamel becomes soft due to stomach acid.
• Using a tongue cleaner to remove acid from the papillae is crucial.
• Limiting nonabrasive dental products for maintenance appointments is important and the use of enamel promoting dentifrices is optimal.

Bad breath. Oral malodor

Professional debridement and irrigation of soft tissue, increase salivary flow, & removal of plaque.

Self-care.

Systemic conditions that causes immunosuppression (diabetes, HIV/Aids), use of bisphosphonates, osteoporosis, etc..

• Peri-implantitis is implant failure irreversible bone loss caused by inflammation.
• Peri-mucositis is precursor to peri-implantitis which is plaque induced reversible inflammation of surroundings soft tissues.

Titanium

• A scratch implant provides a rough surface that can trap plaque biofilm.
• A primary risk factor for peri-implantitis and implant failure is bacteria.
• Also, bacteria can cause erosion of the titanium surface.

Use of abrasive toothpastes, use of flat-ended bristles, flossing aggressively.

• Patches of erythema on the oral mucosa caused by poor hygiene, trauma, physical irritation.
• Irritants, allergies, infections, systemic disorders from failure to adequately clean dentures

• Remove dentures after every meal and rinse denture and mouth.
• Soak dentures daily in an antimicrobial chemical immersion cleansing solution.
• No self-repair
• Visit dentist for examination of dentures & oral tissue.