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Bone that surrounds or supports teeth.
Toward the front of the body.
Toward the rear of the body.
Uppermost, above or toward the head.
Lowermost, below or toward the feet.
Projection or prominence on a bone.
Large, rounded process.
Jagged line where bones articulate and for a joint that does not move.
Bony passage of the outer ear.
External auditory meatus
Natural opening in a bone through which blood vessels, nerves and ligaments pass.
Depression on a bony surface.
Area where bones are joined together.
Opening in bone that is long, narrow or tube-like.
Tubercle or rounded elevation on bony surface.
Opening in bone that is narrow and cleft-like.
What are the 2 sections of the human skull?
Name the 8 cranial bones.
- Parietal (2)
- Temporal (2)
Which bones form a hard protective covering for the brain and provide the site of head and neck muscle attachments?
Which bones form the visible framework for the face, sensory organs and teeth?
Name the 14 facial bones.
- Inferior nasal conchae (2)
- Lacrimal (2)
- Zygoma (2)
- Palatine (2)
- Nasal (2)
- Maxillae (2)
- Vomer (1)
- Mandible (1)
What is the most constantly used joint in the body? What part of this joint is made of cartilage, is a stress absorber, and acts as a condylar cushion?
- Temporal Mandibular Joint (TMJ)
- Articular disc
What type of joint is the TMJ?
- Hinge: rotation down and backwards; lower compartment only
- Gliding: translation forward, upper compartment along eminence
Which muscle of mastication elevates the mandible and closes the mouth, and spans the temporal bone to the body of the mandible?
Which muscle of mastication elevates the mandible and closes the mouth, and spans the zygomatic arch to the angle of the mandible?
Which muscle of mastication allows protrustion of the mandible, closure of the mouth, and spans the sphenoid bone to the mandibular ramus?
Which muscle of mastication allows protrusion/retrusion/depression, opening of the mouth, and spans the pterygoid plate and sphenoid bone to the articular disc?
Lateral pterygoid muscle
How does constant crushing, grinding, and clenching of the jaw affect the parotid gland?
Hypertrophy of muscles of mastication can affect the parotid gland.
What is the innervation and blood supply to the muscles of mastication?
- Trigeminal nerve (V3 branch)
- Maxillary artery of external carotid artery
Which muscle of mastication depresses, protrudes, retrudes and provides lateral movement to the mandible?
Which two muscles serve as a contractile "hammock" in which the mandible rests?
Soft, vascular tissue that covers bone; tissue between the teeth is called the interproximal papilla.
Hard, vascular bone that encases a tooth.
What is the anatomic crown of a tooth? What is the clinical crown?
- Entire tooth
- Visible tooth
What is the cementoenamel junction (CEJ)?
Area where the anatomic crown meets cementum.
What is the periodontal ligament (PDL)?
Fibers that anchor the tooth cementum to bone.
What part of a tooth is seated in bone and covered by cementum?
What is the term used for the end of the tooth root?
The outermost layer of a tooth, considered the hardest substance in the human body with a surface able to withstand 100K psi, and thins over time as we age (becomes translucent).
Why is tooth enamel incapable of regeneration?
Ameloblasts become inactive after eruption.
The 2nd layer of a tooth that runs through the crown and root, is pale, yellow and softer than enamel, acts as a thermal conductor, transmits pain via tiny tubules.
How does dentin continuously repair and regenerate?
Odontoblasts respond to chemical, thermal or mechanical stimuli.
The part of the tooth that covers the root when the enamel ends, is the surface where the PDL fibers attach the tooth to the alveolar bone.
Where should the cementum overlap or meet the enamel?
At the CEJ
Gaps in the cementum can lead to what?
External root resorption
Soft tissue at the center of the tooth, made of blood vessels, cells, nerves and nutrients, supplies dentin with moisture, receives stimuli and transmits pain via the apex.
Canal walls in the pulp that cannot expand due to inflammation can cause what?
Necrosis of pulpal tissues
What are some of the characteristics of deciduous (milk) teeth?
- 20 primary teeth
- Identified with letters
- No premolars
What are some of the characteristics of permanent teeth?
- 32 adult teeth
- 2 premolars
Explain the universal numbering system (USA) for maxillary and mandibular teeth.
- Maxillary: pt's top right to left #1-16
- Mandibular: pt's bottom left to right #17-32
Explain the FDI World Dental Federation numbering system for teeth.
- Mouth is divided into quadrants, 2-digit notation
- All teeth are numbered 1-8
At what age does our first permanent molar erupt?
What lip landmark is where the facial skin meets the lips?
What lip landmark is at the junction of the upper and lower lips?
Commissure/corner of the mouth
What lip landmark is a depression between the upper lip and the nose?
Thin, vertical bands of oral mucosa stretching from alveolar mucosa to other areas.
What are the landmarks present in the vestibule?
- Labial frenum
- Lingual frenum
These tongue papillae are fine, hair-like and cover the anterior 2/3 of the tongue.
These tongue papillae are mushroom-like and cover the anterior 2/3 of the tongue.
These tongue papillae make up a V-shaped row on the posterior aspect of the tongue.
These tongue papillae are located on the lateral, posterior aspect of the tongue.
These tongue papillae are round and cover the posterior 3rd of the tongue.
The opening of the submandibular gland is known as what?
The openings of the sublingual gland are known as what?
Ducts of Rivinus
What are the 3 major salivary glands?
What are the functions of saliva?
- Begins digestion
- Lubricates food
- Cleans oral cavity
- Buffers bacterial acid (bicarb)
- Protects enamel
- Creates biofilm (pellicle) where bacteria adhere to enamel
What can impact the production of saliva?
Secretory duct of the parotid gland adjacent to the maxillary 2nd molars.
Openings of the sublingual glands found on either side of the lingual frenum.
Ducts of Rivinus
Secretory duct of the submandibular gland, opens in the floor of the mouth, midline near lingual frenum.
What covers the incisive nerve and canal on the roof of the mouth (hard & soft palate)?
What feature on the roof of the mouth (hard & soft palate) marks the midline (suture)?
Median palatine raphe
What is the term used to describe the prominent ridges of alveolar mucosa on the roof of the mouth (hard & soft palate)?
Movable fold suspended from hard palate that elevates during swallowing to protect the nasal cavity.
Depresses to protect the larynx and respiratory system; directs food to the esophagus.
What part of the gingiva lies around the neck of a tooth and forms the sulcus?
What part of the gingiva is bound to bone, and has a stippled appearance (healthy)?
What area of the gingiva is where attached gingiva meets the alveolar mucosa?
What are the 3 branches of the trigeminal (CN 5) nerve?
- Opthalmic nerve
- Maxillary nerve
- Mandibular nerve (also Lingual nerve)
What nerve is responsible for motor and sensory function to the oral cavity?
Facial (CN 7)
Inflammation limited to the soft tissues that surround the teeth, AKA "early gum disease", and is a precursor of advanced gum disease (periodontal disease).
Gingival inflammation extended into the alveolar processes, PDL, or cementum.
What is the etiology of gingivitis?
Bacterial biofilm (plaque).
How can gingivitis be reversed?
With good oral hygiene and professional cleanings every 6 months.
Does gingivitis result in tooth loss?
What are the signs and symptoms of gingivitis?
- Loss of stippling appearance, shiny
- Bleeding on probing
- Receding gingival margin
What are the different types of gingivitis?
- Necrotizing ulcerative gingivitis (NUG)
What type of gingivitis results from poor oral healthcare allowing pathogenic bacteria (gram +/- aerobes/anarobes) to adhere to the salivary pellicle, forming a "biofilm" within interproximal spaces that induces inflammation with plaque and calculus?
Plaque associated gingivitis
What type of gingivitis can occur due to physiologic stress & smoking, causing the interproximal papillae to appear blunted and punched-out with a gray pseudomembrane that gives off a fetid odor and causes severe pain?
Necrotizing Ulcerative Gingivitis (NUG/ trench mouth/ meth mouth)
What patient population is at higher risk for developing NUG?
Immunosuppressed, nutrition/sleep deprived.
What is the treatment for NUG/ trench mouth/ meth mouth?
- Hydrogen peroxide
What type of gingivitis occurs due to gingival hyperplasia (overgrowth), causing the accumulation of excess collagen (decreased degradation)?
What types of medications cause medication-influenced gingivitis? What are the top 3? How is it treated?
- Types: Immunosuppressants, anticonvulsants, CCB
- Top 3: cyclosporine, phenytoin, nifedipine
- Tx: change meds
What type of gingivitis can be caused by herbs (typically cinnamon), mouthwash, mint candy, chewing gum, peppers and presents with bright erythema and loss of stippling in the gingiva?
What is the treatment for allergic gingivitis?
- Avoiding spicy foods.
- Identify irritant.
- Apply topical steroids if needed.
What are the systemic factors that can cause gingivitis?
- Hormones (puberty, pregnancy, BCP)
- Drugs, stress
- Poor nutrition (Vit C deficiency)
What are physical local factors that can cause gingivitis?
- Crowded, overlapped teeth
- Dental caries/decay
- Frenum attachments
- Overhanging restorations, ortho
What is the difference between gingivitis and periodontal disease?
- Gingivitis: only involves SOFT tissue around the teeth
- Periodontal disease: involves HARD tissue around the teeth (bone & PDL)
What is the first step in plaque formation?
Formation of the salivary pellicle.
What are the reversible and irreversible states of dental caries?
- 1-bacteria acids demineralize enamel (pH 5.3)
- 2-dentin is infected by bacteria
- 3-bacteria penetrate the pulp chamber; pulp is inflamed
- 4-pulpal tissue becomes necrotic; pain ends
- 5-periapical abscess forms at root apex (possible sepsis or seeding or prosthetic heart valves)
What are some foods that cause dental caries?
- Fruit juices
- Energy drinks
- Sticky foods
Describe the process of the development of dental caries.
- Salivary pellicle adheres to enamel
- Colonies of bacteria attach to pellicle (biofilm=plaque)
- Decalcification of enamel (white spot lesion)
- Cavitation into the enamel
- Penetration into dentin
- Penetration into the pulp (pulpitis)
- Periapical abscess
Pits and fissures of occlusal surfaces, interproximal areas, areas with crowding, and improperly fitted contoured restorations (fillings) are what type of areas?
High caries areas
What is typically used to aide in the prevention of caries?
- Fluoride foam
- Fluoride varnish
How does fluoride work to prevent dental caries?
It binds to enamel and increases remineralization which helps enamel resist bacterial attack.
Name 5 sources of fluoride.
- Toothpaste enhanced w/ fluoride
- Fluoride supplements
- Fluoridated water supplies
- Food processed with fluoridated water
- Mouthwash enhanced with fluoride
The father of preventive dentistry, physician, studied the activity of microorganisms in human saliva, developed technique for proper use of a toothbrush and dental floss, and was the first to describe daily removal of oral bacteria.
Dr. Charles Bass
Describe the modified Bass Technique toothbrush.
- Soft bristles, rounded ends
- Long, wide handle for a firm grip
- Small toothbrush head for easy access to all areas of the mouth, teeth and gums
What are the Modified Bass Techniques for brushing teeth?
- 45° toward gumline
- Press lightly
- Circular motions
- 2-3 teeth at a time
What are tooth brushing recommendations for oral health and care and use of the toothbrush?
- Clean the brush
- Change brush every 3-4 months
- Sick ppl should replace brush after illness
- Discuss proper brushing
- Brush at least 2 min 2x/day
- Brush before going to bed
What is the purpose of flossing?
- Removal of plaque and material alba from interproximal surfaces
- Disrupts bacterial biofilm
What are the different types of dental floss?
- Lightly waxed
- Several flavors
What type of floss should be used on a diastema (space/gap between two teeth), baby and children's teeth, and adult teeth?
What type of floss should be used on teeth with interproximal contacts?
What type of floss should be used on misaligned teeth (crooked), and crowded teeth?
Waxed/ lightly waxed
Describe the technique for flossing.
- 1. cut off @ least 18" of floss, wrap loosely around middle fingers leaving @ least 2-3" free from finger to finger
- 2. grasp free floss between middle fingers w/ index fingers and thumbs, ensure floss is not cutting circulation to middle finger
- 3. place floss along the side of the tooth making a "C" shape either mesially or distally (may have to adjust amount of floss held for control)
- 4. glide floss facial to lingual as you move along the interproximal surface of the tooth down into the sulcus, avoid injuring the interproximal papilla
What does plaque disclosing solution do?
- Detects plaque & areas of neglect
- Plaque is colorless and invisible otherwise
- **erythrosine tar dye can be used (also used in food coloring)**
Describe the procedure for plaque disclosing.
- Dry teeth
- Put 5-6 drops of disclosing solution under the tongue or in a cup
- Have pt swish it for about 30 seconds
What are alternate methods to using drops for plaque disclosing?
- Disclosing tablets: chew and swish mixture around in mouth w/ tongue for 30 seconds and then spit
- Disclosing swabs: swab all tooth surfaces in mouth
What are the process and oral hygiene instructions you need to give a patient after plaque disclosing?
- Rinse after swish (of disclosing agent)
- Observe stained area
- Discuss bacterial plaque and periodontal disease
- Discuss and show pt consequences of not controlling plaque
- Instruct pt to brush & floss
- Evaluate for proper brushing & flossing
- Explain advantages
Inflammation of the gingival tissues combined with a loss of PDL attachment and adjacent alveolar bone; apical migration of the marginal (free) gingiva; formation of periodontal pockets (depth >3mm); leading cause of tooth loss in adults; cannot be cured, only managed.
What are the signs of periodontal disease?
- Loose teeth
- Mouth sores & Purulence
- Radiographic evidence of bone loss
- Blunted interproximal papillae
What are the causes of periodontal disease?
- Plaque and calculus formation
- Traumatic occlusion
- Poor oral health
- Smoking/tobacco products
- Pregnancy and Menopause in women
- Clenching/grinding teeth
- Systemic disorders
- Poor nutrition
What is the treatment for periodontal disease?
- Initiate non-surgical therapy: supra and sub-gingival scaling & root planing every 3 months, may prescribe antibiotics to be placed directly into the periodontal pocket (sulcus), proper rest, diet and exercise, eliminate smoking and carbonated/alcoholic beverages
- Surgical intervention: pocket defects >5mm, 2-6 months after non-surgical therapy, refer to periodontist for long-term follow up
Who can treat periodontal disease? Who makes the initial diagnosis? Who does the assessment?
- Treatment: periodontist, registered dental hygienist
- Initial Dx: general dentist
- Assessment: physician assistant, medic
What DoD dental classifcation system needs no treatment?
What DoD dental classification system shows that there are treatment needs, but they are not predicted to cause a dental emergency within 12 months?
What DoD dental classification system shows that treatment needs indicate a dental emergency will occur within 12 months, making the Soldier non-deployable?
What DoD dental classification shows that dental status is unknown (exam required annually)?
What things are looked at during the periodic oral evaluation that would indicate the need for restorations?
- Caries on bitewing x-ray?
- Any clinically visible decay?
- Any old or fractured restorations that need replacing?
What things are looked at during the periodic oral evaluation that would indicate the need for periodontics?
- Pocket depths 1-3mm?
- Knife-edged papillae?
- Scalloped, uniform color?
- Firmly attached to bone?
- Healthy bone around all teeth on x-ray?
What things are looked at during the periodic oral evaluation that would indicate the need for prosthodontics?
- Need teeth replaced?
- Crown, veneers, bridges, dentures, implants?
What things are looked at during the periodic oral evaluation that would indicate the need for endodontics?
- Any sensitive or throbbing teeth?
- Any irreversible caries?
- Any non-vital teeth with sinus tract present?
- Any teeth need root canals?
What things are looked at during the periodic oral evaluation that would indicate the need for orthodontics?
- Are the teeth aligned properly?
- Is there an overjet, overbite, crossbite?
- Severe crowding or rotations?
- Narrow palate?
- Skeletal malalignment?
What things are looked at during the periodic oral evaluation that would indicate the need for oral surgery?
- Any extractions indicated?
- Impacted teeth present?
- Bone fractures?
What things are looked at during the periodic oral evaluation that would indicate the need for oral pathology consult?
- Any pigmented soft tissue lesions?
- Buccal mucosa or palate?
- Boney defects on x-ray?
- Salivary glands blocked?
- Changing moles?
What are some common dental emergencies?
- Periapical abscess
- Periodontal abscess
- Alveolar osteitis
Acute inflammation at the apex of a non-vital tooth, causing intense pain to palpation, extreme sensitivity to percussion, localized edema, no response to cold tests, and fever & chills (if systemic infx).
What is the etiology for periapical abscess?
- Large filling
What dental emergency shows localized PARL; widened PDL; poorly defined radiolucency on a radiograph?
What is the treatment for periapical abscess?
- Local anesthesia
- Incision & drainage
- Refer to dentist for root canal therapy
Acute inflammation in the sulcus of a periodontal pocket causing throbbing pain, edema that's localized to attached gingiva but involves bone and PDL attachment, gingival enlargement lateral to tooth, pus extruded upon probing, mobile tooth, and foul taste.
What is the etiology for periodontal abscess?
Pre-existing periodontal lesion.
What dental emergency shows bone loss associated with the previous periodontal pocket on radiograph?
What is the treatment for periodontal abscess?
- Incision through mucosa or drainage through the sulcus
- If fever present, prescribe antibiotics
- Soft diet
- Salt water rinses
- Refer to dentist for scaling & root planing (every 3 months)
Acute inflammation in the tissues surrounding the crown of a partially erupted tooth causing throbbing pain radiating to ear, throat, or floor of the mouth, foul taste, inability to close the jaws, facial edema, and NUG-like necrosis may develop.
What is the etiology for pericoronitis?
Trapped food/bacteria beneath gingival flap.
What dental emergency shows impacted, erupting mandibular third molar on radiograph?
What is the treatment for pericoronitis?
- Local anesthesia
- Antiseptic (saline) lavage to remove trapped debris
- Analgesics, antibiotics if fever present
- Refer to dentist for removal of gingival flap or extraction
Post-extraction inflammation of an exposed, sensitive alveolar process 3-4 days post extraction, exposed unprotected bone, usually a mandibular third molar, severe pain, foul odor, and swelling & lymphadenopathy.
Alveolar osteitis (dry socket)
What is the etiology for alveolar osteitis (dry socket)?
Loss of the initial blood clot which protected the socket and enabled appropriate healing (by negative suction, smoking, trauma, bacteria, BCP).
What dental emergency shows a recent extraction socket on radiograph?
Alveolar osteitis (dry socket)
What is the treatment for alveolar osteitis (dry socket)?
- Local anesthesia
- Remove all sutures & irrigate with warm saline
- Place Peridex (chlorhexidine) oral antimicrobial rinse in syringe for patient's home irrigation
- Analgesics x 2 weeks
- If dry socket paste or gauze is used, it must be changed every 24 hours
When will a non-compliant patient following an extraction typically present to sick call when he experiences alveolar osteitis?
What kind of soft tissue laceration leaves more visible scars?
If using the 2 layer closure, how do you suture?
Fromm the inner muscle layer outwards.
Where do you suture a soft tissue laceration of the mouth first?
Vermillion border first, approximating the tissue for primary closure.
Describe the treatment and closure of a facial laceration.
- Clean with saline and treat within 24 hours
- Apply pressure to stop bleeding
- Begin closure at mucocutaneous junction (MCJ) known as the vermillion border
Describe examination and debridement of facial lacerations.
- Clean out foreign matter
- Treat hard tissue injuries first
- Anesthetize the facial skin
How are facial lacerations managed?
- Remove obviously contused & devitalized tissue
- Be conservative (face a rich blood supply)
- Manage hard tissue trauma before soft tissue trauma
- Know anatomy, be aware of the labial artery
What are the 3 classes of sutures?
- Synthetic absorbable
What does suture size refer to?
- Diameter of the suture strand (denoted by zeroes).
- Dentists use 3-0 and 4-0 absorbable in the mouth.
What suture size should you use in the muscle layer?
3-0 or 4-0 (absorbable)
What size suture should you use in the subcutaneous layer?
4-0 or 5-0 (absorbable)
What size and type of suture should you use in the epithelium? Why would you not want to use silk on the skin?
- 6-0 nylon (nonabsorbable)
- Avoid silk (nonabsorbable) on skin because the braided fiber causes acute inflammation and scarring
What questions should you ask yourself when determining whether or not you should close a facial laceration?
- Will casualty be evacuated soon?
- Are you comfortable with the procedure?
When should avulsed teeth be reimplanted? What is required?
- Within 1 hour
- Root canal is required
What are the storage mediums that can be used for avulsed teeth from dental trauma?
- Saliva (vestibule, under tongue)
- Milk (superior due to compatible pH, osmolality and fewer bacteria)
- NEVER wrap in tissue
- NEVER leave in open air
Why should the root surface never be scrubbed?
PDL cells will be injured and cementum will not reattach to the alveolar bone
What are the factors that affect the possible success of reimplanting avulsed teeth?
- Time >60 min=poor prognosis (incr PDL & cementum necrosis, ankylosis/root resorption)
- Damage to root surface
- Stoarge medium
What are different forms or causes of dental trauma?
- Blunt trauma
- Motor vehicle accident
- Stabbing victim
- Bar fight
What signs are inspected for during physical evaluation of maxillofacial trauma?
- Contour deformity
- Continuity defects
What things are looked for during a facial examination of maxillofacial trauma, particularly the orbits?
- Periorbital edema and ecchymosis
- Gross visual acuity determined
- Pupillary size & shape
- Subconjunctival hemorrhage
- Palpate for unknown fractures
What are you looking for when palpating the face during evaluation of maxillofacial trauma?
Crepitus-crackling (bony segments, mobility)
What is the LeFort I fracture?
Transverse maxillary fracture
What is the LeFort II fracture?
What is the LeFort III fracture?
Craniofacial dysjunction fracture
What are the common midface fractures?
- Lefort I (transverse maxillary)
- Lefort II (pyramidal)
- Lefort III (craniofacial dysjunction)
- Zygomatic complex
- Orbital floor
- Nasal fractures
What is the level of a Lefort I fracture (transverse maxillary)?
Above the level of the teeth
What is the level of a Lefort II fracture (pyramidal)?
Level of nasal bones
What is the level of a Lefort III fracture (craniofacial dysjunction)?
What are the weakest areas of the midfacial complex when assaulted from a frontal direction at different levels referred to as?
What is the most common facial fracture?
What are the signs and symptoms of a zygomaticomaxillary complex?
- Lateral blow over the cheek
- Depressed cheek bone (dimple)
- Bleeding into cornea of fractured side eye (eye bright red)
- Restricted movement or deviation of mandible toward affected side
What are some sites of isolated facial fractures?
- nasal bone
- orbital rim
- orbital floor (blow out- common in baseball)
What are the signs and symptoms of isolated facial fractures?
- Palatable step defect along inferior orbital rim
- Double vision
- Lowered globe
- Restricted movement of involved eye
What is the second most common fractured facial bone?
50% of mandibular fractures are also what?
What are the different mandibular fracture classifications?
- Condylar Process
- Coronoid Process
- Alveolar Process
What is Class I occlusion?
Normal (maxillary and mandibular alignment)
What is Class II occlusion?
Retrognathic (manibular molar/canine is DISTAL to maxillary counterparts)
What is Class III occlusion?
Prognathic (mandibular molar/canine is MESIAL to maxillary counterparts)
What are some long term treatments for TMJ/TMD?
- Drugs: anti-inflammatory/analgesics, muscle relaxants, tranquilizers
- Physiotherapy: moist heat, exercises/massage, cold spray (relieve muscle spasms), ultrasound, electrical, laser
What is the most frequently avulsed (knocked out) tooth?
Maxillary central incisor
Maxillofacial trauma is not life threatening unless what?
The airway is obstructed
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