119A final

  1. What are synthetic toothbrush filaments made of and why do we use them?
    • nylon and or polymer.  
    • They are resistant to bacterial growth, more durable and easier to standardize.
  2. What are the mechanical action/mode of action for mechanical toothbrushes? (6)
    • oscillating
    • rotational
    • pulsating
    • side to side
    • sonic/ultrasonic
    • combination
  3. What are the indications for use of mechanical brushes? (7)
    • Ortho
    • Elderly or physically compromised
    • Perio patients
    • implant patients
    • patients with impaired dexterity
    • non-compliant/non-motivated patients
    • children
  4. What are the problems with flossing?
    • Excessive pressure in col area
    • wrapping floss too far buccally or lingually
    • snapping through contacts
    • patients hands too large
    • some patients lack coordination
  5. What are 2 flossing solutions?
    • Tie floss ends together, forming a circle
    • use floss holder or automated flosser.
  6. What are indications for floss threaders?
    • fixed prosthetics
    • orthodontic appliance
  7. What are indications for floss holders?
    • pt with difficult to access areas
    • pt with limited dexterity
    • non-compliant patients
  8. Indications of end tuft/single tuft brushes? (4)
    • open embrasures
    • fixed prosthetics
    • implants
    • difficult to access areas (lingual mandibular anteriors, distal of most posterior tooth, malocclusion)
  9. Indications for interdental brushes? (5)
    • open embrasures (class II, III)
    • Class IV furcations
    • bridges
    • ortho
    • deliver of chemotherapeutic agents
  10. Indications for perio aid? (5)
    • CAL
    • concavities
    • crown margins
    • furcations
    • ortho
  11. What are some tips for showing pts how to use the perio aid?
    • 1. start in a spot the pt can see and that will bleed
    • 2. have the client hold mirror
    • 3. get client's interest before teaching
    • 4. spend time showing how to insert the toothpick
    • 5. demo first then let pt try
    • 6. focus on interproximal areas
    • 7. explain that blunting will occur
    • 8. explain process will take 15-20 min
  12. Indications for use of rubber tip? (4)
    • interproximal biofilm removal
    • subgingival biofilm disruption
    • crown margins
    • delivery of medicaments- (fluoride, baking soda)
  13. Explain the 3 types of embrasures
    • Class I (A)- no gingival recession with papilla filling space
    • Class II (B)- moderate papillary recession
    • Class III (C)- complete loss of papillary gingiva
  14. What are indications for tongue cleaners?
    pt with coated tongue, deep fissures, xerostomia, smokers
  15. What are methods of preventing caries?
    • systemic fluoride
    • topical fluoride
    • pit and fissure sealants
    • nutrition
    • pt education
  16. Methods of arrestion of caries?
    • topical fluoride
    • nutritional assessment
    • oral hygiene modifications
  17. Methods of remineralization?
    • topical fluorides
    • antimicrobials
    • gums and mineral replacement products
    • nutritional counseling
    • oral hygiene modifications
  18. methods of restoring caries?
    • fillings
    • crowns
  19. Define CAMBRA
    • Caries Management by Risk Assessment.
    • The clinician develops a plan to prevent future disease using behavioral, chemical and minimally invasive preventative and therapeutic procedures.
  20. What do you do for the caries risk assessment for ages 6-adult?
    • Review pt medical history
    • review pt dental history
    • assess dentition
    • assess nutritional status
    • determine pt caries risk
    • perform salivary analysis
    • develop and implement a plan
  21. What does a white spot lesion appear as?
    • Areas of intact surface enamel that have become weakened
    • White or opaque compared to enamel
  22. What are the indicators of low caries risk?
    • healthy pt
    • no carious lesions or recently restored teeth w/in past 24 months
    • no demineralization
    • no visible dental biofilm
    • low fermentable carb. exposure
    • optimal fluoride exposure
    • regular dental care
  23. What are the indicators of moderate caries risk?
    • Any 2 of the following:
    • 1 carious lesion w/in past 24 months
    • localized demineralization
    • ortho
    • exposed root surfaces
    • decreased salivary flow
    • visible dental biofilm
    • occassional between meal snacking
    • inadequate fluoride exposure
    • history of irregular dental care
  24. What are the indicators of high caries risk?
    • Any 2 or more of the following:
    • >2 carious lesions w/in past 12 months
    • generalized demineralization and/or smooth surface lesions
    • family history of dental caries
    • past root caries
    • visible dental biofilm
    • frequent between meal snacking
    • inadequate fluoride exposure
    • inadequate salivary flow
    • irregular dental care
    • high MS and LB
  25. What are the 3 caries activity tests?
    • pH test
    • salivary flow test
    • culture test
  26. What is the primary cause of demineralization in infants and toddlers?
    • cariogenic bacteria and diet high in fermentable carbs.
    • mothers and caregivers transmit MS to infants and young children
  27. What should be included in the dental plan?
    • elimination of dental biofilm
    • limit refined carbs and acid exposure
    • suppress MS and LB
    • privision for fluoride exposure
    • reintroduce lost minerals
    • follow up plan
  28. What are the caries risk assessment tools for ages 0-5 years?
    • encourage visit by age 1
    • use a parent survey to evaluate the caries risk indicators
    • perform a clinical dental exam
    • caries susceptibility
    • develop plan based on caries risk- low, moderate, high
    • set management goals with caregiver
    • plan for follow up
  29. What are we evaluating during the caregiver interview and clinical exam?
    • primary caregiver with active decay in past 12 months
    • sleeps with bottle or nurses at will
    • bottle contains fluids other than milk or water
    • frequent between meal snacks
    • low socio-economic status
    • little to no home dental routine
    • access to fluoridate
    • mother who uses xylitol products
    • appliances present
    • developmental problems
    • visually inadequate salivary flow
    • presence of saliva reducing factors
  30. What do the caries susceptibility tests tell us in children?
    • SM is lower in children than adults
    • any presence of LB indicates a high risk
    • parents bacterial evel may be a rough indication of child's risk
  31. What is the recall interval for low caries risk?
    every 12 months
  32. What is the recall interval for moderate caries risks?
    every 6 months
  33. what is the recall interval for high caries risk?
    1-6 month
  34. What are LCC's 2 remineralization protocols?
    • xylitol
    • ACP- amorphous calcium phosphate
  35. Explain the xylitol remineralization protocol
    • emphasizes the use of:
    • professionally applied fluoride
    • home fluoride therapy
    • antimicrobial rinses
    • use of XYLITOL products
  36. Explain the ACP remineralization protocol
    • Emphasizes the use of:
    • professionally applied fluoride
    • home fluoride therapy
    • antimicrobial rinses
    • use of amorphous calcium phosphate (ACP)
  37. What are the caries management products?
    • fluoride varnish
    • antimicrobials- chlorhexidine
    • xylitol
    • baking soda
    • calcium and phosphorous
  38. What is fluoride varnish and it's benefits?
    • 5% NaF (neutral colophonium base)
    • 18-56% reduction in caries
    • approved by FDA for use of: cavity liner, dentinal desensitizer
    • remineralization
  39. What is the process of applying fluoride varnish?
    • 1. Remove excess moisture with cotton roll (complete drying not critical, but helpful)
    • 2. Use unit does or place a small amount from tube into a dappen dish
    • 3. Apply varnish as a thin layer with bendable brush or cotton pellet
    • 4. Cover the entire surface evenly; avoiding the tissue as much as possible
    • 5. Patient can close immediately following application; saliva will help “set” the varnish
    • 6. Instruct the patient to avoid hard foods, but can have fluids or soft food (for the next 4 hours) Instruct patient to not brush for 24 hours to enhance fluoride uptake
  40. Describe characteristics of Chlorhexadine gluconate
    • Caries inhibitory effect- antibacterial effect (14 day regime has been shown to suppress SM from 12-26 weeks
    • Contraindicated in individual sensitive to alcohol containing products
    • unpleasant taste
    • may cause staining
  41. What is xylitol and it's benefits?
    • Natural form- Xylan-extracted from birch trees
    • 5 carbon sugar alcohol
    • 40% less calories than sucrose, but equal to table sugar in sweetness
    • Has the ability to affect metabolism of S. Mutans through the following: Accumulates w/in cell wall of bacteria; cannot be readily metabolized; causes S. Mutans strains to mutate and become less adherent to the tooth surface; inhibits enamel demineralization
    • capable of reversing incipient lesions
    • reduces S. Mutans levels in plaque and saliva after 3 weeks of use
    • promotes salivary flow in pt w/ drug induced xerostomia (may not be effective in individuals w/ salivary gland damage)
  42. What is demineralization?
    • Acid production caused by cariogenic bacteria and fermentable carbs
    • caused by loss of minerals associated w/ acid attack
  43. Why are Calcium and Phosphorus essential?
    C and PH lost in caries process replaced can reverse demineralization
  44. What is the most commonly used instrument in plaque biofilm removal?
  45. Define dentifrice
    Substance used w/ a toothbrush to remove biofilm, may provide a means of delivering an agent to the dentition or oral cavity
  46. What are the modes of delivery of dentifrices?
    • 1. Pastes- easy to dispense, best pt acceptance, several ingredients.
    • 2. Powders- 1st type of dentifrice, easy to manufacture, ingredients separate, more abrasive
    • 3. Liquids- "tooth polishers" usually contain 2 abrasive agents.
  47. What are the purposes of dentifrices?
    • caries inhibition
    • reduction of gingival disease
    • desensitization
    • calculus prevention
    • cosmetic
    • bioavailability
  48. List the basic ingredients of dentifrices?
    • 1. Abrasive system
    • 2. detergent/soap/surfactant
    • 3. sweetener
    • 4. flavoring
    • 5. binder/thickener
    • 6. humectant
    • 7. preservative
    • 8. water
    • 9. coloring
  49. Describe the abrasive system of a dentifrice and what are examples
    • 20-40% of dentifrice
    • polishing agent
    • may have combos of 2 or more agents (must be compatible w/ other ingredients w/ no negative side effects to teeth.
    • examples: sodium bicarbonate, calcium carbonate, calcium pyrophosphate, aluminum oxide, silica
  50. Describe the detergent of dentifrices and examples
    • 1-2% of the dentifrice, foaming action, lowers surface tension, emulsifies
    • examples: sodium lauryl sulfate, sodium n-lauryl sarconsinate
  51. Describe the sweetener ingredient of dentifrices and give examples
    • 2-3%, non-fermentable, non-cariogenic substance, must be appealing to consumer, may also serve as humectant
    • examples: saccharin, sorbitol, glycerin, xylitol
  52. Describe the flavoring ingredient of dentifrice and give examples
    1-1.5% used to cover taste of other ingredients, must be pleasant and appealing.  Non cariogenic, essential oils, menthol, some may be contact allergens
  53. Desribe the binder/thickener ingredient of dentifrices and give examples.
    • 1-2% hold solid and liquid ingredients together, contribute to smooth soft texture.
    • examples: organic hydrophilic colloids, alginates, gums, carboxyl methyl cellulose
  54. Descrbe the humectant of dentifrices and give examples
    • 20-40%, moisture retainer, water may  serve as humectant
    • examples: glycerol, sorbitol, glycol
  55. Describe the preservatives of dentifrices and give examples
    • <1%, prevents bacterial growth
    • examples: alcohol, benzoate, formaldeyde, dichlorinated phenols, clorophyll
  56. Describe the ingredient water in dentifrices
    20-40%, distilled and deionized water
  57. Describe the coloring ingredient of dentifrices
    • 1-2%, attractiveness of product, must not stain the dentition or tissue
    • examples: vegetable dyes
  58. Define active ingredient
    An additive w/ specific purpose of prividing a benefit to the dentition or by targeting a specific oral health condition
  59. Define cosmetic additives and give examples put in dentifrices
    • Agents added to dentifrices to remove stain or whiten teeth
    • 1. whitening: perioxide, non peroxide
    • 2. calculus inhibitors: tartar control
  60. What are the therapeutic agents in dentifrices?
    • fluoride
    • anti-gingivitis
    • plaque inhibitors
    • desensitizers
    • bioavailability
  61. What does fluoride do therapeutically and give examples of types used in dentifrices
    • Caries prevention and remineralization effects, OTC or Rx
    • Types of agents:
    • stannous fluoride: crest pro-health
    • sodium fluoride: colgate, crest, aqua fresh, aim, arm & hammer dental care, prevident 5000 plus (Rx)
    • Monofluorophosphate: colgate gel, toms of maine
  62. What does the anti gingivitis therapeutic ingredient do in dentifrices?
    • antimicrobial effects
    • prevents or reduce gingivitis- cell wall disruption
  63. What do plaque inhibitor therapeutic ingredients do in dentifrices and give examples
    • Inhibit plaque formation and adherence
    • Types of agents:
    • Zinc Citrate: antibacterial effects
    • Triclosan: broad spectrum antimicrobial action, used in OTC products, colgate, Total, ADA acceptance based on ability to reduce gingivitis, plaque, caries, supra calc.
  64. What are the desensitizing ingredients for in dentifrices
    • Minimizes or reduces dentinal hypersensitivity by:
    • occluding or mechanically blocking exposed dentinal tubercles
    • chemically by preventing depolarization of the nerve fiber w/in dentinal tubercle
  65. What does the bioavailability ingredient do in dentifrices
    • property of a therapeutic agent
    • agent is stable during storage and active w/in the mouth to achieve desired effect
    • variation in bioavailability depends on: spedific fluoride, Ph, (if lower than 6 supports incorporation of fluoride ions)
  66. What is dentinal hypersensitivity?
    Thermal hypersensitivity caused by external stimuli of exposed dentinal tubercles.  Seen on areas of gingival recession or in areas where enamel has been worn away and exposed the dentin
  67. What are ideal properties of oral rinses?
    • substantial efficacy
    • acceptable to patient
    • cost effective
    • highly soluble and stable in storage
    • broad spectrum
    • adequate bioavailability and retention
    • minimal side effects
  68. What are function of oral rinses?
    • antibacterial/antimicrobial
    • anti-caries/caries prevention
    • xerostomia
    • cosmetic: removing debris, tartar control, freshen breath, whiten, oral malodor
    • Preprocedural: helps reduce surface tension
  69. What are the commercial product ingredients of oral rinses?
    • 1. flavoring and sweetners: .1-.4%, may double as antimicrobial
    • 2. alcohol- 10-30%, acts as solvent and increases solubility, preservative
    • 3. Water- 70% of product, rinse medium
    • 4. Humectant- 5-20%, adds "body" to rinse
    • 5. Surfactant- <1% of product, lowers surface tension
  70. Describe the therapeutic ingredient Cetylpyrindium Chloride and give examples of products
    • Quarternary ammonium compounds
    • antimicrobial effects: bactericidal, ruptures bacterial membran, rapid leakage of cell contents and cell teath; alters bacterial metabolism and inhibits cell growth; decreases bacterial ability to attach to tooth.
    • Products: scope, cepacol, crest pro health
  71. Describe the antibacterial essential oils of oral rinses and give examples (therapeutic)
    • Anodynes- Essential Oils:
    • Phenolic compounds
    • antimicrobial effects
    • bacteriostatic: non selective and rapid bacterial cell wall disruption, inhibits cell enzyme activity, protein denuration
    • alleviates pain, soothing
    • Eucalyptol- from eucalyptus
    • thymol- from thyme
    • methyl salicylate- from wintergreen
    • menthol- from peppermint
  72. Describe the active ingredient stannous fluoride and give examples of products
    • Antimicrobial effects:
    • Bacteriostatic
    • reduces plaque biofilm
    • alters bacterial cell metabolism
    • inhibits cell adhesion
    • concentrations: .63-.454%
    • Products: Gel-Kam, Crest Po-Health, ADA acceptance due to fluoride addition
  73. What essential oils are in listerine?
    • Menthol- .042%
    • Thymol- .064%
    • Methyl Salicylate- .06%
    • Eucalyptol- .092%
    • Listerine is the only OTC essential oil product with ADA Seal of Acceptance for therapeutic use in treatment of gingivitis
  74. Describe the ingredient chlorhexidine gluconate in oral rinses and give examples of products
    • Therapeutic
    • .12% chlorhexidine gluconate (CHX)
    • bis-biguanides
    • prescription ONLY
    • antimicrobial effects: bactericidal and bacteriostatic, groud spectrum effect against gram + and gram -, suppresses S. Mutans, Interferes w/ bacterial colonization and cell attachment.
    • Products: peridex, periogard, oris
  75. What are indications for use of chlorhexidine rinse?
    • adjunct therapy for surgical procedures
    • patients with ANUG or ANUP
    • patients who have short term oral self care limits
    • patients who have limited manual dexterity
    • patients w/ fixed or removable prosthetics
  76. What are disadvantages of chlorhexidine?
    • Can stain teeth, tongue and restorations
    • bitter taste
    • mucosal burning sensation
    • slight increase in supragingivl calculus formation
  77. Describe the therapeutic ingredient for anti caries and give examples of products
    • Sodium Fluoride (NaF)
    • Stannous Fluoride (SnF2)
    • Products: periomed, listerine smart rinse, listerine tooth defense, ACT rinse, Tom's of Maine anticavity rinse
  78. Describe the therapeutic ingredient for xerostomia and give examples of products
    • Used to restore oral moisture
    • Dry mouth associated w/ salivary gland damage, radiotherapy, prescription drugs, or Sjorgren's Syndrome
    • Products: salivart, biotene
  79. What does the cosmetic ingredient zinc chloride treat, and what products is it in?
    • Treats oral malodor (halitosis)
    • Products: Therabreath, Breath Rx, Tom's of Maine Wicked Fresh
  80. Describe the oxygenating cosmetic ingredient and give examples of products
    • Hydrogen peroxide
    • antimicrobial, if oxygen is being released
    • continued use of hydrogen peroxide rinses may cause: 
    • -sponginess of gingiva
    • -black hairy tongue
    • -dentinal hypersensitivity
    • -demineralization
    • Products: peroxyl, listerine whitening, "self prepared" agents
  81. Describe the cosmetic ingredient oxodizing in oral rinses and products it's in
    • Chlorine Dioxide
    • Often used for halitosis
    • common products: Closys II, Oxyfresh
  82. Describe antiplaque agents in oral rinses and give examples of products
    • 1. Delmopinol .2%
    • contains 1.5% alcohol
    • Product: PerioShield
    • 2. Sodium Benzoate
    • Product: Plax (7.5% alcohol), Listermint (alcohol free)
  83. Describe natural and herbal ingredients in oral rinses.
    • Not often the main active ingredient
    • May have some therapeutic effects
    • Examples: witch hazel, aloe vera, xylitol, tea tree, eucalyptus oil, peppermint oil, medicinal herbs
  84. What causes Halitosis?
    • Extrinsic
    • food, medications, alcohol, tobacco
    • Instrinsic
    • 10% systemic source
    • 90% of odor originates from oral cavity- "fetor oris"
    • Oral based malador caused by volatile sulfur compounds (VSC) which are primarily: hydrogen sulfide and methyl mercaptan
    • VSC's are by products of bacterial metabolism from gram- anaerobes.
  85. What agents help with halitosis?
    • chlorhexidine
    • CPC
    • chlorine dioxide
    • zinc citrate
    • essential oils
    • triclosan
  86. What is a hypertonic solution?
    • 1t salt per 8oz water.
    • solution contains more salt than cells- draws fluid out of the cells
  87. What is a isotonic solution?
    • 1/2t salt per 8oz water
    • same osmotic pressure as cellular fluid; not useful in shrinking tissue-pallative
  88. What are the active ingredients in listerine?
    • Essential oils- menthol, thymol, methyl salicylate, eucalyptol
    • fluoride (listerine smart rinse)
    • hydrogen peroxide (listerine whitening)
  89. What products have chlorhexidine?  Rinse or paste?
    • peridex, periogard, oris.
    • Rinses
  90. What is the active ingredient in Pro-Health rinse?
    • Stannous fluoride- .63-.454% (bacteriostatic)
    • cetylpyrindium chloride (cpc) (bactericidal)
  91. What are the active ingredients in ACT?  Is it a rinse or dentifrice?
    • Sodium fluoride
    • cetylpridinum chloride CPC
    • Sodium benzoate
    • rinse
  92. What is the active ingredient in BreathRx, Is it a rinse or dentifrice?
    • Zinch chloride (halitosis)
    • rinse
  93. What is the active ingredient in Closys?  Is it a rinse or a dentifrice?
    • chlorine dioxide (halitosis)
    • Rinse
  94. What product is triclosan the main ingredient?  Is it a paste or a rinse?
    • Colgate total
    • There is also sodium fluoride
    • paste
  95. What is the active ingredients in Perioshield?  Is it a dentifrice or a rinse?
    • delmoprinol (antiplaque)
    • rinse
  96. What is the main ingredient in Peridex? Is it a dentifrice or rinse?
    • .12% chlorhexidene
    • dentifrice
  97. What does triclosan do and what product is it in?
    • Broad spectrum antimicrobial agent
    • Used in OTC hygiene products
    • Colgate Total
    • ADA acceptance based on ability to reduce gingivitis, plaque, caries, supra calc.
Card Set
119A final
Final for LCC DH 119A