DH theory

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sthomp88
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34401
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DH theory
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2010-12-14 15:38:19
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Chapters five thirteen
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Quiz on module 3
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  1. What are the 2 main areas that must be recognized when you are preparing for the pt. to come?
    • Operatory
    • Records
  2. What are the requirements for preparation of the treatment area?
    • standard precautions for all patients, whether or not the presence of a communicable disease is known.
    • place barriers on all appropriate areas
  3. What other items along with following standard precautions must be followed in operatory preparations?
    • environmental surfaces: all contact areas must be disinfected or covered to control cross contamination
    • instruments: sterile packaged instruments must remain sealed until the pt. is seated and you are ready to start
    • equipment: prepare and make ready all other materials you may need for the appointment, such as blood pressure cuff, cup for mouth rinse, and cotton rolls etc.
  4. What are the requirments for preparing for the pt. in regards to pt. records?
    • review pt.'s medical and dental history
    • read over previous treatment records
    • anticipate exam procedures and new record making for a new pt.
  5. What is the proper way of introducing yourself to your patient?
    state the pt.s name, and then itroduce yourself as the student hygienist. Be very friendly
  6. Who else of our dental staff might we need to introduce our pt. to?
    our instructor
  7. State the procedure of introducing pt.'s to others.
    • Lady's name always precedes male's
    • older person always precedes younger
    • the pt. name precedes that of the dental personnel
    • call older people by their last name unless they ask you otherwise
  8. Describe the procedure for escorting the pt to the dental chair.
    • invite pt to sit and adjust the chair
    • assist the elderly, infirm, or very small children
    • place hand bag in a safe place and in pt view
    • provide them with protective eye wear and mouth rinse
  9. Name the 4 general pt. chair positions
    • upright
    • semi-upright
    • supine
    • trendelenburg
  10. Upright
    • the initial position from which chair adjustments are made.
    • pust o on the adjustment pad and it will set the chair here
  11. In what cases would we use the semi-upright chair position?
    for pts with certain types of cardiovascular, respiratory, or vertigo problems
  12. Supine
    • flat position where the brain is level with the heart
    • a pt is ideally situated for support of the circulation; rarely could a pt faint in this position
    • used for most treatment procedures
  13. trendelenburg
    the pt is in the supine position and tipped back and down so that the heart is higher than the head
  14. what is postural hypertension?
    when the pt gets dizzy after raising the chair up
  15. describe the general features of the dental chair.
    • provides complete body support for pt. to increase pt. relaxation
    • a comfortable pt is a more compliant pt. which allows procedure efficiency
    • seat and leg support move as a unit, and back and head res move as a unit and are power controlled
    • has a thin back so chair can be lowered close to clinician's elbow height
    • chair base can be lowered and raised as needed
    • chair controls need to be readily available
  16. How should the pt chair be positioned right before the pt is seated?
    • chair at low level with back upright
    • arm raised on side of approach
  17. Describe the adjustment steps for the dental chair once the pt has been seated.
    • first raise the seat and foot portion of chair to help pt. settle back
    • then lower the back to the supine position
    • make sure the pts head is in the middle of the head rest
    • adjust chair so that the pts mouth is level with the clinicians elbow heigth when the shoulder is relaxed
  18. Describe the procedure at the conclusion of the appointment in regards to the pt. chair.
    • move instrument tray away and turn light off
    • slowly raise the back of the chair and tilt chair forward
    • request pt to remain seated in upright position to avoid postural hypotension
  19. what are some contradictions to the supine position?
    • review pt history for indications of need for adaption such as:
    • congestive heart disease, vertigo, breathing difficulty-asthma, emphysema, or sinusitis
    • pt may ask
    • pregnant woman-especially in 3rd trimester
  20. what are the objectives of maintaining neutral working posture?
    • contribute to safety, health, and wellness of clinician
    • contributes to ease and efficiency of performance that encourages pt. coopperation
    • allow endurance for prolonged periods of peak efficiency
    • give pt a sense of well being and confidence
    • accomodate pt with special needs (harder to maintain NWP)
  21. what are the advantages of maintaining neutral working position?
    • reduces the risk of injury
    • includes whole body functional biomechanics
    • habitual neutral posture will translate into all activities even outside of work
    • reduces pain and discomfort
    • extends career
  22. how should your back be positioned in regards to NWP?
    in neutral postural alignment with natural spinal curves
  23. how should your head be positioned in regards to NWP?
    on top of neutral spine with forward neck flexation between 15 and 20 degrees
  24. how should your eyes be positioned in regards to NWP?
    directed downward to prevent neck and eye strain
  25. how should your shoulders be positioned in regards to NWP?
    relaxed and parallel with the hips and floor
  26. how should your elbows be positioned in regards to NWP?
    close to the body
  27. how should your forearms be positioned in regards to NWP?
    parallel with the floor
  28. how should your wrists be positioned in regards to NWP?
    forearm and wrist in a strait line
  29. how should your thighs be positioned in regards to NWP?
    full body weight distributed evenly on seat, parallel to the floor
  30. how should your knees be positioned in regards to NWP?
    slightly apart
  31. how should your feet be positioned in regards to NWP?
    flat on the floor
  32. where is the pts oral cavity in regards to the clinician?
    to the clinician's elbow height
  33. what is the proper distance from the clinicians eyes to the pts oral cavity?
    15-22 inches
  34. define working distance
    the distance between the clinician's eyes and the pts oral cavity (15-22 inches)
  35. what is the best way to learn orientation of clinician to pt?
    designating the hours of the clock around the pts head
  36. what is the treatment area centered around?
    the pts oral cavity
  37. what does the entire 'work area' refer to?
    the dental chair with the pt, the unit and instrument tray
  38. for the clinician, how are the essentials for access and visibility for pt care provided for?
    by flexibility of movement of clinician's stool and appropriate lighting
  39. describe the characteristics of an acceptable base of clinician's stool
    broad and heavy with no fewer than 4 casters
  40. describe the characteristics of an acceptible seat of a clinician's stool.
    seamless upholstery, padded firmly, accomodates requirements for neutral seated position
  41. describe charactersitics for an acceptable height of clinicians chair.
    adjustable for wide personal variability
  42. describe characteristics of an acceptable back of clinician's stool.
    adjustable, lumbar support to accommodate different positions, procedures and clinicians
  43. describe what mobility will be like for an acceptable clinicians stool.
    completely mobile with free rolling casters
  44. describe adjustment of an acceptable clinicians stool
    multiple adjustments for different positions, procedures, and clinicians
  45. how might a clinician's stool be infection control friendly?
    by having surfaces that are able to withstand standard precautions regimen
  46. what do all dental lighting materials need to accomplish?
    directed properly to oral cavity for adequate visualization, optimal pt care, and clinician comfort and safety
  47. What are some suggested features for the dental light?
    • easily adjustable both horizontally and vertically
    • beam of light can be focused
    • set within comfortable arms reach
    • does not require awkward or forceful movement to position it
  48. How should the dental light be adjusted when working on the maxillary arch?
    chin up, and light angle at 60-45 degree angle to the floor
  49. how should the light be adjusted when working on the mandibular arch?
    almost perpendicular to the floor, with pt chin down
  50. describe an ergonomically designed hand piece.
    • light weight
    • fit in contours of clinicians hand
    • reduce fatigue and strain
    • allow maneuverability
    • produce less heat build up
    • are available in cordless options
  51. what is an important procedure in managing dental cords?
    • making sure that they can be sanitized and are not dragging on the floor
    • keeping them lined up properly
    • using straight instead of curly cords
  52. define ergonomic practice
    practice that makes work safe, decrease strain and fatigue, eliminate hazards, improves work process affecting health and well-being of clnician and patient
  53. anthropometry
    the study of human body measurements especially on a comparative basis
  54. body mechanics
    the field of physiology that studies muscular actions and functions in the maintenance of the posture of the body
  55. dynamic postural integrity
    the ability to adapt to needed postural tasks, remain functionally intact, and return to neutral posture when the demand is no longer there. It is a dynamic (changing) process
  56. ergonomics
    the study of human characteristics for the appropriate design of the living and work environment for the achievement of optimal performance with the least amount of negative effects
  57. functional movement
    muscles working together as a unit to complete a movement or task thereby creating the least amount of internal physical stress
  58. movement (somatic) education
    methodology for development of postural habits that improve musculoskeletal efficiency, resulting in less stress and strain in response to physical demands. Based on body mechanics, functional movement, and structural integrity
  59. risk factor
    anything that puts the clinician or patient at risk or increases their risk of exposure to an indentified hazard
  60. safe work practice
    any work practice that improves clinician and patient safety. this includes but is not limited to decreased physical demands, improved layout, enfironmental factors, and work process organization
  61. stress
    a physical, chemical, or emotional factor that causes physical or mental tension and may be a factor in disease cause or fatigue
  62. treatment process organization
    organization of clinician as related to patient, treatment delivered, area of mouth treated
  63. work-related musculoskeletal disorder, repetitive strain injury, cumulative trauma disorder, bioaccumulated stress
    terms used to describe disorders of the musculoskeletal autonomic and peripheral nervous system caused by repeated, forceful, and awkward movements as well as by exposure to mechanical stress, vibration, and cold temperatures. often work-related
  64. work simplification
    application to clinical procedure of time and motion studies, analysis of instruments and equipment and body mechanics to provide the patient with a smooth, systematic simplified approach for comprehesive dental hygiene therapy
  65. what are occupational problems?
    things that will occur if you don't practice ergonomics
  66. carpal tunnel syndrome
    • compresion of the mdian nerve within the carpal tunnel
    • deviations of wrist from neutral. pinch grasp with insufficient rest
    • numbness and tingling in the thumb, index finger and middle fingers
  67. thoracic outlet syndrome
    • painful disorder of the fingers, hand, and/or wrist from compression of the brachial nerve plexus and vessels between the neck and shoulder.
    • tilting head forward, hunched and /or rounded forward shoulders. continuoulsy reaching overhead
    • numbness, tingling, and/or pain in the hand or wrist
  68. bursitis
    • inflammation of the bursa
    • areas of friction or impingement anywhere in the body, usually the shoulder
    • decreased range of motion, aching
  69. tendonitis
    • painful inflammation of the wrist resulting in strain
    • repeated wrist extension or palmer flexion
    • pain in wrist, especially along the outer edges of the hand rather than through the center of wrist
  70. disc herniation
    • displacement of the nucleus of the disc with resultant pressure on the spinal cord or peripheral nerves
    • prolonged static postures of forward flexion, hyperextension, lateral bending, or rotation of the spine.
    • pain, numbness, tingling of the arm, fingers, lower back, hip, or leg
  71. name 4 other occupational problems that we discussed in class.
    • ulnar nerve entrapment
    • pronator syndrome
    • tenosynovitis
    • extensar wad strain
  72. Name and describe the 3 components of the triad of musculoskeltal health.
    • dynamic postural integrity: proper body mechanics
    • physical fitness: to resist negative consequences of the physical challenges of dental hygienist
    • manage and relinquishment of stress: activities to help me relax
  73. Name some procedures to follow to help maintain self care of the dental hygienist.
    • physical fitness: including immunizations, exercise, adequate sleep, and healthy diet
    • standard precautions: PPE
    • clinical practice: clinical/patient positioning
    • nuetral working posture: in all activities, not just clinical practice
    • stress management: reasonable pt scheduling and adequate breaks
  74. What do daily functional movement exercises in the workplace help maintain?
    • muscle health
    • spine support
    • joint range of motion
    • balance
    • flexibility and comfort
    • good postural habits
    • decrease physical and internal stress
    • awareness
  75. What are functional movement exercises?
    sequences that are designed specifically for dental personnel to create functional movement patterns, gently stretch and lengthen muscles, encourage full range of motion, and support the natural curves of the spine.
  76. Work related musculoskeletal disorder
    an injury-affecting the musculoskeletal, peripheral nervous, and neurovascular systems-that is caused or aggravated by prolonged repetetive forceful, or awkward movements, poor posture, ill-fitting chairs and equipment, or a fast-paced work load.
  77. pronatar syndrome
    • painful disorder of the wrist and hand caused by compression of the median nerve between the two heads of the pronator teres muscle
    • holding the lower arm away from the body
    • similar to carpal tunnel, numbness and pain in the fingers
  78. ulnar nerve entrapment
    • a painful disorder of the lower arm and wrist caused by compression of the ulnar nerve of the arm as it passes through the wrist
    • bending the hand up, down, or from side to side at the wrist and holding the little finger a full span away from the hand
    • numbness, tingling, and or loss of strength in th lower arm or wrist
  79. tenosynovitis
    • a painful inflammation of the tendons on the side of the wrist and base of the thumb
    • hand twisting, forcefull gripping, bending the hand back or to the side
    • pain on the side of the wrist and the base of the thumb; sometimes movement of the wrist yields a crackling noise
  80. describe the 8 o'clock position.
    • face pt. with hip inline with pt. upper arm
    • thighs rest agains pt. chair
    • hold arms slightly away from sides, lower right arm over pt. chest
    • rest left hand in area of pt. right cheeck bone, rest fingertips of right hand on anterior max. teeth
    • it's difficult to maintain neutral arm position in this angle.
  81. describe the 9 o'clock position.
    • face side of pt head. midline of torso even with pt. mouth
    • legs straddling pt. chair, or underneath headrest.
    • hold lower half of right arm in alignment with the pt. shoulder. hold left wrist over region of pt. eyes
    • rest left hand by pt right cheeck bone. rest right hand on premolar teeth of mand. right side.
  82. describe the 10-11 o'clock positions
    • sit at top right corner of headrest, midline of torso even with temple region of pt.
    • legs stradle corner of headrest
    • hold right hand directly across corner of pt. mouth. left hand and wrist above pt nose and forhead
    • rest left hand by pt. left cheeck bone. rest right hand on premolar of mandibular left side
  83. describe the 12 o'clock position
    • sit behind pt. head
    • legs straddle head rest
    • hold wrists and hands above region of pt. cheeks and ears
    • place left fingers on ant. teeth in max left. right fingers on ant. mandibular right.
  84. When do you use the 8 o'clock position?
    • for anterior surfaces toward me:
    • medial side of maxillary and mandibular left anterior teeth, and distal side of maxillary and mandibular right ant. teeth
    • mand.: pt. head tured to clinician, and chin down
    • max.: pt. head towark clinician, and chin up
  85. When do you use the 12 o'clock position?
    • for anterior surfaces toward me.
    • the medial side of right maxillary and mandible anterior teeth, and the distal side of left mandibular and maxillary teeth
    • max: pt head turne toward clinician with head up
    • mand: pt. head turned toward clinician, with head down
  86. When do you use the 9:00 position?
    • for posterior teeth facing toward me:
    • buccal side of right max and mand. teeth and lingual side of left mand. and max. teeth
    • for mand. head turned away from clinician with chin down, for max, head turned away from clinician with head up
  87. When do you use the 10-11 o'clock positions?
    • form posterior aspects facing away from me:
    • right lingual of mand and max, and left buccal of mand and max
    • mand. pt head toward clinician with chin down, max. pt head toward clinician with chin up
  88. calibration
    determination of the accuracy of an instrument by measurement of its variation from a standard
  89. clinical attachment level
    probing depth as measured from the cementoenamel junction to the location of the probe tip at the coronal level of attached periodontal tissues
  90. explorer
    a slender stainless steal instrument with a fine flexible, sharp point used for examination of the surfaces of the teeth to detect irregulations
  91. fremitus
    a vibration perceptibel by palpation
  92. periodontomer
    instrument used to measure mobility
  93. probe
    smooth slender instrument usually round in diameter with a rounded tip designed for examination ofthe teeth and soft tissues; except for a few probes made only for blunt examination, probes are calibrated in millimeter increments to facilitate recordings for comparison with periodic assessments
  94. probing depth
    the distance from the gingival margin to the location of the periodontal probe tip at the coronal border of attached periodontal tissues
  95. tactile
    pertaining to the touch
  96. tactile discrimination
    the ability to distinguish relative degrees of roughness and smoothness, for example on a tooth surface, using an explorer or a periodontal probe, also called tactile sensitivity
  97. tension test
    application of tension at the mucogingival junction by retracting cheek, lip, and tongue to thighten the alveolar mucosa and test for the presence of attached gingiva, area of missing attached gingiva is revealed when the alveolar mucosa and frena are connected directly to free gingiva
  98. what is a basic set up for pts with permanent teeth?
    • mouth mirror
    • probes
    • explorers
  99. name the 3 parts of the mouth mirror
    • handle
    • shank
    • working end
  100. name and describe the 3 types of mouth mirror surfaces
    • plane: flat
    • concave: magnifying
    • front surface: eliminates double images
  101. Name the 6 purposes and uses for the mouth mirror
    • indirect vision
    • indirect illumination
    • transillumination
    • retraction
    • grasp and rest
    • maintain clear vision
  102. indirect vision
    surfaces where direct vision is not possible; distal surfaces of posterior teeth and lingual surfaces of anterior teeth
  103. indirect illumination
    reflection of dental light to any area in the mouth
  104. transillumination
    reflection of light through the teeth
  105. retraction
    • mirror is used to prevent interference by the cheeks, tongue or lips
    • move the mirror around for protection, use vaseline if necessary
  106. grasp an rest
    • to provide stability and control
    • to assist in retraction of lips and cheek
    • hold it like a pencil
  107. clear vision
    • warm mirror or rub along cheek, and request pt to breathe through their nose
    • get rid of scratched mirrors
  108. How do you take proper care of your mirror?
    • dismantle all parts
    • check for debris
    • make sure it won't get scratched
  109. What are the purposes and used for using compressed air?
    • improve and facilitate exam procedures
    • improve visability
    • prepare teeth for procedures
  110. what does dried calculus look like?
    chalky and presents a contrast to tooth color
  111. name 3 examples to dry surfaces:
    • application of preventative agents when indicated
    • make impression for study cast
    • apply topical anesthetic
  112. what are some precautions to take when using the air syringe?
    • avoid sharp blasts on sensitive cervical areas
    • aviod applying air directly in pocket
    • avoid forceful applications of air
    • avoid startling the pt.
  113. name 3 types of probes:
    • manual
    • automated
    • furcation (nabor's probe)
  114. what are the objectives for use of probe?
    • accuracy
    • consistency
    • pt. comfort - be gentle
  115. describe assessent/diagnosis in regards to probe uses and purposes
    • classify disease as gingivitis or periodontitis
    • determine the extent of inflammation in conjunction with the overall gingival examination
  116. describe sulcus and pocket survey in regars to probes purposes and uses:
    • examine shape, and dimensions of suci and pockets
    • measure and record probing depths
    • evaluate tooth surface pocket wall
    • chart calculus location and severity
    • redord other root surface irregulataries
  117. describe clinical attachment level in regards to probe use and purposes
    determine the clinical attachment level- CEJ to base of pocket
  118. describe mucogingival examination in regards to probe purpose and procedure
    determine relationship of gingival margin, attachment level, mucogingival junction, and frena
  119. describe bleeding on probing in regards to probe purpose and use
    • evaluate bleeding/infection
    • make 6 measurements around entire tooth
    • determine consistency of gingival tissue
    • measure the extent of visible gingival recession
  120. Describe planning and implementation in regards to probing:
    • determine treatment plan
    • detect root irregularities
    • detect calc
  121. what are signs that the pt is improving and that oral cavity is becoming healthier during probing?
    • no bleeding
    • reduced probing depth
    • tissue is firm
  122. what needs to be done in regards to probe evaluation?
    • re-probe at later appointment to determine treatment outcomes
    • evaluate home care
    • evaluate maintenance interval
  123. describe the desing of the probe:
    • slender, smooth rounded tip
    • handle, angled shank, and working end
    • stainless steel
  124. what is a plastic probe used for?
    screenings, and titanium implant probing
  125. what type of probe has a curved working end?
    Nabor's probe
  126. where is the black marking on the UNC probe that we use?
    4 mm mark
  127. define pocket.
    diseased gingival sulcus
  128. how is a sulcus measured?
    from the base of the pocket (top of attached periodontal tissue) to the gingival margin
  129. true or false. The sulcus is continuous around the entire tooth.
    true
  130. is "spot" probing adequate?
    no, the sulcus must be surveyed around the entire tooth
  131. what are proximal surfaces?
    between the teeth, or col area, where periodontal infections usually begin
  132. what are anatomic features of the tooth-surface wall of the pocket?
    • root concavities
    • cervical thirds
    • furcations
    • anomalies
  133. what factors affect probe readings? and describe each reading.
    • severity and extent of perio
    • normal and healthy: probe is at base of sulcus at coronal end of junctional epithelium
    • gingivitis and early periodontitis: probe tip is within the junctional epithelium
    • advanced periodontitis: probe tip reaches attached connective tissue fibers
  134. what probe features affect probe reading?
    • calibration: must be accurately marked
    • thickness: thinner probes slips through narrow pockets easily
    • readability: aided by marking and color coding
  135. What probe techniques affect probe readings?
    • grasp: hold like a pen
    • finger rest: rest on fulcrum
    • pressure applied: only apply enough pressure to maintain probe against tooth, and to have tactile sensitivity
  136. describe probe placement problems that might affect probe readings:
    • anatomic variations: tooth contours, furcations, contact areas, anomalies
    • interferences: calculus, irregular margins of restorations, fixed dental prostheses
    • accessibility, visibility: obstructed by tissue bleeding, liited opening by pt. macroglossia
  137. describe proper insertion of the probe:
    • grasp probe like a pen
    • rest finger on a neighboring tooth preferably in same arch
    • hold side of instrument tip flat against neighboring tooth near the gingival margin
    • genlty slide tip under margin
  138. is it harder to insert probe in healthy or diseased tissue?
    healthy
  139. how should the probe tip be in comparison to the long axis of the tooth when inserting?
    parallel to it
  140. how should you slide the probe down to the sulcus?
    • vertically down, keeping the contact of the side of the tip of the probe with the tooth
    • in a gingival pocket it will be on the enamel
    • in a perio pocket it will be on the cementum surface
  141. what should you do if calculus blocks your probe?
    lift probe away and move around it til you can go down
  142. how does the base of the pocket feel in comparison with the hard tooth surface?
    soft and elastic
  143. what type of technique is used in circumferential probing?
    a walking stroke
  144. why is it good to use a walking stroke?
    • maintains probe in pocket-efficiency
    • easily records the 6 points- 3 on buccal, 3 on lingual
    • measure all proximal surfaces of tooth
  145. bifurcations
    • on mandible- teeth with 2 roots
    • mandible molars: access from facial and lingual surface
    • maxillary first premolars: access from mesial and distal aspects
    • primary mandibular molar: have widespread roots
  146. trifurcations
    • on maxillary- teeth with 3 roots
    • maxillary molars: palatal root, and 2 buccal roots; access from mesial, buccal, and distal
    • maxillary primary molars: widespread roots
  147. furcation examination
    when pocket extends to furcation area
  148. name and describe some furcation exam methods
    • early furcation
    • measure probe depth
    • examine area by putting probe close to tooth surface and move it over the roots
    • check radiographs
    • traditional probing or nabors probe
  149. what are some complications for furcation exams?
    fused roots, anomalies such as extra roots, or high or low furcations
  150. what is the purpose of the mucogingival tension test?
    • to detect adequacy of width of the attached gingiva
    • to locate frenal attachments
    • to identify promptly the mucogingival junction
  151. what are the general purpose and uses of the explorer?
    • detect texture and character of tooth surface
    • examine supragingival surfaces
    • examine subgingival surfaces
    • determine instrumentation needs
    • caries detection
    • evaluate treatment completeness
  152. describe the working end of the explorer
    • slender, wirelike, metal tip, circular x-section
    • single-ended
    • paired
  153. describe the shank of the explorer
    • straight, curved, or angulated
    • slightly flexible
  154. describe the handle of the explorer
    • light weight
    • wider diameter
  155. describe the subgingival explorer
    • UNC 11/12 is ours
    • adapts along line angles and root curvatures
    • has an angulated shank and short tip
  156. describe the sickle or shephard's hook explorer
    • explores pits, fissures, restoration margins, and caries detection
    • has a wide hook and straight long section so it is dfficult to apply to proximal surfaces
    • not adapted for deep subgingival exams
  157. describe the cowhorn or pigtail explorer
    • used for proximal surfaces to detect calculus, caries, or gingival exam
    • not suited for deep pockets
  158. do you get a more acute sense of tactile stimuli from using a fine/narrow, or thick explorer and probe?
    fine/narrow
  159. Name and describe the 2 basic tactile sensations felt when probing or exploring:
    • normal surfaces: smooth surfaces
    • irregular surfaces:
    • elevations-calculus, enamal, pearl, overcontoured or irregular margins from restorations
    • depressions/grooves-lesions, decalcification, rough surfaces
  160. tactile sensations
    pass through the instrument to the fingers and hand then to the brain
  161. auditory sensations from explorer or probe
    • sounds may be created from irregularity
    • clean smooth emamel is quiet
    • rough areas are scratchy
    • metallic restorations may have a squeak or ring
  162. when is examination and exploration observed visually?
    • if it is supragingival, or on the surface
    • dry the area and use the light
  163. describe the procedure of use for exploring subgingival calculus
    • maintain explorer in contact with tooth
    • use the walking stroke while keeping contact with tooth at all times
    • always lead with the tip
    • especially lead with the tip in proximal surfaces
  164. when recording calculus findings, what do you need to note?
    • type of calc-supra or sub
    • distribution- localized or generalized
    • amound- slight, moderate, or heavy
  165. where is supragingival calc usually found?
    most commonly confined to lingual surfaces of the mandibular anterior teeth and the facial suraces of the maxillary first and second molars - by the salivary ducts
  166. where is subgingival calc usually found?
    it can be localized or generalized
  167. what should be used to test mobility?
    two single ended metal instruments with blunt ends (mirror handle)
  168. what types of mobility are tested for?
    • horizontal: rock tooth
    • vertical: apply pressure on occlusal or incisal surface
    • test abutments
    • move in a systematic order to test teeth
  169. describe the different readings for tooth mobility
    • N= normal tooth mobility
    • 1= slight, but greater than normal
    • 2= moderate mobility
    • 3= severe mobility
    • 4= vertical mobility
  170. fremitus
    • palpable vibration and movement
    • excess contact of teeth
    • usually mobility
    • test during occlusion determination
    • determination made only on maxillary teeth
  171. what type of radiograph is needed for observing evidence of periodontal involvement?
    periapical
  172. How do normal bone levels show on radiographs?
    crest of the interdental bone appears from 1.0 to 1.5 mm from the cementoenamel junction
  173. how do bone levels in periodontal disease show on radiographs?
    the height of the bone is lowered progressively as the inflammation is extended and bone is destroyed
  174. what is horizontal bone loss?
    when the crest of the bone is parallel with a line between the cementoenamel junctions of 2 adjacent teeth
  175. what is generalized horizontal bone loss?
    when the amount of remaining bone is fairly evenly distributed throughout the dentition.
  176. what is localized horizontal bone loss?
    when bone loss is confined to a specific area
  177. what is angular, or vertical bone loss?
    reduction of height of crestal bone that is irregular, the bone level is not parallel with a line joining the adjacent cementoenamel junctions, bone loss is greater on the proximal surface of one tooth than on the adjacent tooth
  178. when inflammation is the sole destructive factor, the bone loss usually appears___________.
    horizontal
  179. vertical bone loss is more commonly____________than _______________.
    • localized
    • generalized
  180. How does normal crestal lamina dura appear on a radiograph?
    white, radioopaque, continuous and connects the lamina dura about the roots of 2 adjacen teeth, covers the interdental bone
  181. how does diseased crestal lamina dura appear on a radiograph?
    indistinct, irregular, radiolucent, and fuzzy
  182. How does normal furcation appear on a radiograph?
    bone fills the area between the roots
  183. how do radiographs of furcation involvement show evidence of disease?
    • radiolucent in the furcation
    • early furcation involvement may appear as a small radiolucent black area or as a slight thickening of the peropdontal ligament space.
  184. what does normal periodontal ligament space look like on a radiograph?
    • it appears radiolucent
    • appears as a fine black line next to the root surface.
  185. what does diseased periodontal ligament space look like on a radiograph?
    wide and thick, there is more space
  186. do early signs of periodontal disease show on radiographs?
    no
  187. where does the initial bone destruction start?
    usually interproximal inflammation moves from gingivitis to periodontitis from inflammed gingival connective tissue to the crest of the interdental bone
  188. where can initial bone destruction be observed most frequently?
    at the crest of the interdental bone in the crestal lamina dura
  189. name 4 other findings that can be seen on radiographs that have relevance to the dental hygienist.
    • calculus
    • overhanging restorations
    • dental caries
    • anomalies and pathology
  190. can pockets be seen on radiographs?
    no, because soft tissue does not show on radiographs, you must use a probe to identify pockets

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