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What are the recommendations for patients with cancer with mucositis?
- 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.
What are things patients with mucositis should avoid?
- 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.
What is grading?
- 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.
What is staging?
- Determining the clinical extent.
- It’s based on the size and extent of metastatic spread of the lesion.
How is the stage of cancer determined?
- 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).
How do health care providers diagnose oral cancers?
- 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
How do we treat primary avulsed detention?
Many recommend that primary teeth never be replaced.
How should we tx permanent avulsed
- Avulsed PERMANENT teeth should be reimplanted and proper tooth
- preservation should be used.
Discolored primary teeth is caused by?
Damage to the permanent tooth germ.
What are possible recommended treatments for primary discolored teeth?
No treatment is recommended as these teeth will naturally exfoliate.
Where should you store avulsed teeth in?
- Hanks balanced salt solution (HBSS)
- the patient’s own saliva
- Viaspan, a storage medium used for transport of transplant organs.
Is dry media as good as wet media?
No, air drying rapidly reduces the chance of successful reimplantation.
Why is water not the best media to store avulsed teeth?
- 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.
Who should be knowledgeable about handling avulsed teeth?
What are the defense system of the human body? What is the function of each
- 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
What is the epithelium and what is its function?
- Epithelium is a formidable barrier to microbial invasion. It is a anatomic barrier.
- Microbes cannot cause infection without first getting past this barrier.
What are the components of a tooth?
Enamel, dentin, pulp, cementum, PDL, Crown, root, apex
Which bacteria causes dental decay?
The mutans Streptococci and lactobacilli
What is cellular immunity and its components?
- 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.
What is humoral immunity and its components?
Humoral immunity is carried out by B cells from the bone marrow. (Tonsils contain many B-cells).
What does saliva provide?
- 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.
What are granulocytes and what are some examples of them?
- Granulocytes are mature granular leukocytes (WBC’s).
- Eosinophils, neutrophils, basophils and macrophages.
What are immunoglobulins? How many are there? Which are most important in dentistry?
- 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.
What is it called when toothbrushes are heated?
End rounding (bristles filaments ends are sealed and rounded)
What are the components of a toothbrush? What are most brush handles made of? What are advantages of such materials used nowadays?
- Toe, head, heel, shank, and handle..
- Handles are made of plastic.
- Plastic is water resistant, inexpensive, and easily manipulated for attractive design.
What is the purpose of brushing?
- 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.
What is the Bass method?
- Bristle position at 45° w/ tips in sulcus.
- Brushing motion: vibratory, horizontal jiggle.
- Subgingival cleaning & gingival stimulation.
What is the rolling technique for brushing?
- Bristles position apically against attached gingiva.
- Brushing motion: swept in arc toward occlusal surface.
- Supragingival cleaning & gingival stimulation.
What are some benefits of an electric toothbrush? Who is it typically recommended for?
- 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.
What are disclosing tablets and what are they used for?
- 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.
What is toothbrush wear? What is it caused by? What influences its progress?
Splayed, bent, broken bristles. It is influenced by brushing method than by the length of time or # of tooth brushing/day. Brushing habits.
What anatomy in the mouth harbors the most bacteria? What is fissure tongue?
- The tongue.
- Finding of multiple small furrows or grooves on the dorsal (top) surface of the tongue.
Dentifrice abrasives are influenced by what factors?
Depends on the inherent hardness of the abrasive, the size of the abrasive. Particle, and the shape of the particle.
What are the most common dentifrice abrasives?
Carbonates, phosphates, and silicas.
What is the difference between particle size of abrasive and polishing particles?
Small particles (1mm) have a polishing action and larger particles (20mm) have an abrasive action.
What is abrasion? What does it typically appear like on a tooth?
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.
What are humectants? What are common examples of humectants?
- Humectants are ingredients added to maintain the moisture and prevent hardening of the toothpaste.
- Examples are: sorbitol, mannitol, glycerol, and propylene glycol.
What are characteristics of dentifrice for public acceptance?
Flavor, smell, color & consistency.
How is baking soda used in dentistry? What does it do for oral hygiene?
- Brushing w/ baking soda & peroxide.
- Known to reduce plaque, gingivitis, remove extrinsic stains & reduce malodor.
What is an activity of stannous fluoride?
Activity against caries, plaque, and gingivitis.
What are examples of desensitizing agents? What is their mechanism?
- 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.
What is clefting? How does it appear in the gingiva?
- 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.
What is bacterial endocarditis?
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 are floss holders NOT recommended?
When the patient has difficulty loading or threading the floss.
What are the different embrasure types?
- Type I: papilla fills interproximal space.
- Type II: slight to moderate recession of papilla.
- Type III. Extensive recession or complete loss of papilla.
What are recommendations for hygiene of each type of embrasure?
- 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.
What is a recommendation for bulimics for oral hygiene?
- 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.
What is halitosis?
Bad breath. Oral malodor
How does someone address halitosis?
Professional debridement and irrigation of soft tissue, increase salivary flow, & removal of plaque.
What are implant success rate dependent on?
What are some contraindications for patient’s health history prior to any surgery?
Systemic conditions that causes immunosuppression (diabetes, HIV/Aids), use of bisphosphonates, osteoporosis, etc..
What is the difference between peri-implantitis and peri-mucositis?
- 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.
What are implants made of?
Why is it important to keep implants clean and not scratch their surface?
- 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.
What are some contraindications for implant hygiene?
Use of abrasive toothpastes, use of flat-ended bristles, flossing aggressively.
What is stomatitis? What is it caused by?
- 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
What are some hygiene care for denture wearers and their overall health?
- 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.