DH 2017

particulate matter generated from burning tobacco which appears as a sticky brown substance.

found in tobacco leaves, addictive, processed in the liver (80%) excreted in the kidneys.

competes with oxygen. Reduces O2 carrying ability. Crosses the placenta and reduces O2 to the fetus. increases the risk of cardiovacular disease.

• Nitrosamines-organic, cancer causeing.
• Aromatic Hydrocarbon- benzoapyrene. Found in the smoke.
• Polonium 210-natural. radioactive in leaves. 
• Formaldehydes
• Other inorganic: Arsenic, beryllium, cadmium, lead and nickel
• Other Organic: benezene, Vinyl Chloride.

Tar & carcinogenic compounds affect the oral and resp. tissue prior to absorption, once nicotine is in the lungs it passes quickly to circulatory system.

once absorbed, nicotine, tar and carcinogens are processed in the liver, sent to brain, and excreted in the kidney. Once nicotine is in the liver, converts to cotinin. Once in the brain, triggers release of dopamine, noreip, endorphins, and serotonin.

directly thru mucosa. 2-3 X more absorb. into circulatory than cigarettes.  Secondary absorption is in the intestinal tract if swallowed.

circulatory to brain, liver, kidneys. High levels of free nicotine, (ionized) results in greater addiction.

• Cardio: Increase of athero, CAD, peri arterial disease, hypertension and stroke. 
• Resp: COPD, emphysema, chronic bronchitis, lung cancer.
• GI: ulcers and cancers
• Pregnancy:miscarriage, pre-term, SIDS
• Other: osteoporosis, ulcers, impotence, other cancers. stomach esoph pancrease

• tooth staining
• perio_ (50% of perio pts) 2-6X more likely 
• oral cancers
• Lung cancer
• stomatitis
• Increased CAL 
• neg. effect on bone metabolism 
• delayed healing
• resistant to DH therapy

xerostomia, hairy tongue, halitosis, impaired taste, attrition and recession

A physiologic adaptation- neuroadaptation,  to a substance/chemical. Over time more tobacco is needed for the desired response.

Physical need. withdrawals.

• ASK
• ADVISE
• ASSESS
• ASSIST
• ARRANGE

irritability, anxiety, depression, restlessness, increased appetite, intestinal distress, loss of concentration, and or loss of sleep.

• Nicotine Replacement therrapy
• 1.) the Patch
• 2.) Transmucosal (gum, lozenges, inhaler, spray)
• 3.) NonNicotine prescr. drugs: Bupropion HCL, Varenicline.
• Contains 1/3 to 1/2 nicotine as cigs.
• No Cancer causing ingredients found in tobacco products. 
• Not to be used for more than 6 months. Can become addicting.

40 million

12 million

10 years.

80-90%

75%

• areca nut and betel leaf. 
• add tobacco and it is Gutka.
• Sucked or chewed. Highly addictive. mild stimulant with relaxation effects.

• stain
• erythroplakia, leukoplakia, oral cancers, lip and tongue, oropharyns, and esopoageal.

• Marijuana
• Hookah
• Beedies and cloves
• E-cigs

dried plant, resin, oil, powder, tinctures.

• THC 
• Cannabidiol- sedative
• Terpenes- antiInflam. anagesic, (distint aroma)

• smoking
• water pipe
• vaporizers
• oral
• sublingual
• rectal
• transdermal

• Cancer
• Neoropathy
• chronic pain
• pain assoc. with chemo
• osteoarthritis
• PTSD
• Alzheimers
• (migraines, IBS, Fibromyalgia, arthritis, epilepsy, leukemia, tourettes)

• rapid heart rate
• increased BP
• Increase breathing
• Increased appetite
• xerostomia

• hallucinogenic (reality distortions)
• mood alteration
• impaired memory
• impaired concentration
• Reduced psychomotor coordination

• Eyes: reddening, decreased intraoccular pressure
• Mouth: xerostomia
• Skin: sensation of heat or cold
• Heart: increased HR
• Muscles: relaxed

• stain
• xero
• malodor
• increase caries risk
• chronic irritation of tissues
• increased risk of perio
• Delayed wound healing

Device used to smoke flavored tobacco, (shisha) ( hubble-bubble, Goza, ghalyn or Nargile)

• India
• originally for opium or hashish (17th cent)
• 1990 rapid pop. in US

• HEAD: tobacco bowl. 
• WATER BOWL: vase. water filled
• HOSE & MOUTH piece: draws the smoke from the bowl for inhalation.

• same as cigarettes
• along with communicative risks from sharing the mouthpiece: TB, Hep, HSV, Mono)
• Low birthweight babies
• similar second hand smoke effects.

• (bedis) Unfiltered cigs. leaves from the temburni plant.
• Flavored
• 3X nicotine as cigs
• 5X the tar
• increased risk of oral, lung, liver, and stomach cancer.

• aka: kreteks
• filtered or unfiltered
• 2/3 tobacco and 1/3 cloves
• Indonesia
• may have clove oil
• 2-3X the tar and nicotine of cigarettes
• Increased risk of lung and respiratory condtitions

• battery powered device attached to a vaporizer, and then to a cartridge of synthetic nicotine dissolved in propylene glycol. up to 20 mg of nicotine
• Device heats up and then vaporizes
• User puffs on the mouth piece and inhales the voporized nicotine.

• Carcinogenic potential from Diethylene Gylcol and nitrosamines found in the cartridges. 
• Can be used for cessation.
• Second hand arosol: propylene glycol, a volitile organic compound. 
• No relation to carbon dioxide or tar.

• Bupropion HCL
• Valernicline

• OTC
• transdermal
• self adhesive
• chg every 18-24 hours.

• nicorette)
• Polacrilex
• sweetened with xylitol, mint, or orange flavor.
• chew then park
• oral mucosa
• lasts 30 min
• otc

• (committ, nicorette)
• polacrilex 2mg or 4 mg
• Sweetened with manitol or aspartame
• 30 min to dissolve
• oral mucosa
• OTC
•  "candy"

• reduces cravings
• nicotine receptor agonist
• use for 12 weeks. If successful use for 12 more. 
• prevents release of dopamine.
• Can be used with nicotine replacement therapies.
• Rx only

• Serious, chronic, life threatening eating disorder defined by a refusal to maintian minimal body weight within 15% of an individuals normal weight. 
• SUBtypes:

Restricting: excessive exercise, dieting, starvation to control wieght.

Binge-purging: vomit, diuretics, laxitives, diet pills, and enemas

• Intense fear of gaining weight
• distorted body image
• obsessive/excessive exercise
• low self worth
• introverted shy
• high achiever
• withdrawn
• avoids public eating
• avoids specific foods
• lethargic

A serious eating disorder marked by a destructive pattern of binge-eating and recurrent inappropriate behavior to control one's weight. Can occur with other psych. disorders. Depression, OCD, Substance dependence (80-90%), exhibit vomiting behaviors.

Purging: vomit, laxitive, diuretics, diet pills, enemas

Non-purging: diet and exercise

• Dry lips
• puffy cheeks (swollen parotid)
• chronic sore throat
• irritated palate
• esophageal tears and GI problems
• laxitive dependent
• cardiac problems
• arrhythmias
• depression and calluses on the semicircles of the dom. hand.

• Freq. bathroom use
• self induced vomiting
• laxative abuse
• diuretics
• enemas.
• Non purging: fasting, execes. exercise
• inconspicuous eating
• ritual eating
• excessive use of breathfresheners
• Normal body wieght, low self esteem, depression, mood swings, extroverted

Eating Disorder Not Otherwise Specified

Binge eating disorder: compulsive eating. A chronic eating disorder characterized by obsessive, uncontrolled, compulsive eating beyond feeling full. No purging. Obese and have difficulty losing weight. Any eating disorder not defined as anorexia or bulimia.

eating disorder coupled with one or more psychiatric disorders, increasing morbidity.

• enamel erosion (permylolysis) 
• thinning and chipped enamel
• dentinal sensitivity
• increase in caries, iron & B complex def., xero,sore throat, swollen parotid, gingival disease.

• Approach the pt.
• Notify parents/guardian
• Refer to counselor etc
• Dev. a dental tx plan.

• soft tissue can be fragile-provide pain control
• give OHI
• recommend neutral sodium fluoride application in office
• encourage sodium bicarbonate rinses if xero
• discourage pt from brushing immed. after purging.

approx. 10 million

• Biological influence
• Psychological/emotional health
• Cultural and societal

• possible genetic link
• serotonin (5-HT) may influence
• possible hormonal influences

• Depression, anxiety, drug/substance abuse
• OCD, self-harming behaviors.

• Gender
• Age
• Family 
• Excessive/frequent dieting
• Life changes/Transitions
• Sports, work and artistic activities

10%

• May dev. pre-adolescent thru older adults.
• most commonly teens and early 20s

• Yes
• Signif. more likely to occur in people who have parents or a sibling who have had a eating disorder.
• Family attitude toward physical appearance and dieting.

ballerinas, gymnasts, runners, and wrestlers

fearful of weight gain, sad, moody, fainting, change in brain chemistry, depression

thin and brittle

low BP, low HR, fluttering, heart failure

anemia & other blood problems

weak muscles, swollen joints, bone loss, easily fracture, osteoporosis

kidney stones, kidney failure,

low K, Na, magnesium

Constipation, bloating

difficult to concieve, low birthweight, c-section, increase rate of miscarriage and increase in post partum depression.

Bruise easy, dry skin, fuzz like hair all over the body,yellow skin

maxillary anteriors

(L, O, I ) due to low gastric pH (vomiting)

• Assessment
• identification
• Setting of goals
• Implementation
• evaluation

• Med Hx
• Dental Hx
• Social Hx

• economic resources
• Ethnic/religious considerations
• Eating alone/dining out
• Motivational level
• Education level
• Physical/mental challenges

• Inflamed gingiva 
• Cheilosis
• Glossitis
• Ulcerations

• 24 hour recall. 
• Food questionnaire
• Food diary

• Evaluate balance of diet
• Determine cariogenic potential
• Determine inadequacies

• Prevention and mgmt of perio. disease
• prevention and control of caries
• incorporation of client goals 
• consider medical, dental and social needs

• Plan a menu
• provide firm, nutritional knowledge
• focus on established guidelines
• set realistic goals-behavior changes

• have the goals been met/achieved?
• can they be maintained?
• What modification are needed?
• What are the barriers?

• Main source of fuel for the body
• provides heat and energy
• ground substance for the foundation of collagen; excess is stored as fat

• concentrated source of energy
• protects vital organs and nerves

• Solid at room temp.
• Can be hydrogenated: solidifying a liquid

liquid at room temp and always derived from vegetable sources

• Maintain and repair body tissue
• Makes hemoglobin (carries O2)
• Forms antibodies in the bloodstream
• produces enzymes and hormones

• C
• B1 (Thiamin)
• B2 (Riboflavin)
• B3 (Niacin)
• B6 ( Pyridoxine)
• Folate
• Panothenic Acid
• B12
• Biotin

ADEK

biochemical substance that can only be only be supplied from an outside source (food)

• water
• carbs
• fats
• proteins
• vitamins
• minerals

Provide energy, build and maintain tissue, regulate

• sorbitol (most common)
• mannitol (mannos/legumes)
• xylitol
• Do not cause sudden change in glucose levels
• Non-cariogenic
• Slowly absorbed and metabolized
• possible laxative effect

• glucose + fructose
• Glucose + galactose
• gluctose + gluctose

• table sugar
• from sugar beets and sugar cane
• found in some fruits and veg
• tree sugars

milk sugar

malt sugar

• amylose, amylopectin
• grains, cereals, legumes, potatoes, unripe fruit

• cellulose (hemicellulose)
• promotes GI function
• gums, pectin

• Inorganic elements found in the body that maintain functions. 
• 4% of body weight
• Calcium, Phosphorus, sodium, potassium, magnesium, chlorine, sulfur.

Iron, iodine, copper, zinc, manganese, selenium, chromium

• Most abund. mineral in body.
• Formation of thrombin
• aids in synthes. of neurotransmitters
• muscle and nerve activity
• bone health
• Vit C and D enhance absorption
• (milk, spinach, broccoli, soy)

• 2nd most abund.
• 85% in teeth and bone
• metabolism (dna-rna)
• muscle contraction and nerve activity
• (meat and dairy)

• supports physical and mental function
• req for form. of thyroxine
• (seafood, iodized salt)

• Bone cell func. 
• nerve transmission
• Muscle contraction
• energy metabolism
• (whole grains, nuts, beans, green leafy)

• supports integrity of bone health
• (seafood, brewed tea)

• water balance
• reg. acids/bases
• Muscle contraction
• Nutrient absorp.
• (animal sources, some veg, processed, canned, and processed food.)

• Protein and glycogen synthesis
• pH balance
• Nerve transmission
• muscle contraction (heart)
• (meat, dairy, grain fruit, and veg)

• component of hemoglobin
• cofactor for many enzymes
• immune function and production of antibodies
• synthesis of collagen
• removal of lipids from blood
• (meat, esp beef, yolks, dark green veg, enriched foods)

maintain electrolyte balance and osmotic equilibrium

(salt Nacl)

• DNA/RNA and protein synthesis
•  (lamb, crustaceans, eggs, peanuts)

• Absorbic acid
• collagen form
• hormone synthesis
• wound healing
• resist. to infection
• enhances iron absorption
• (citrus, bell peppers, strawberry and kiwi)

• Thiamin
• Metabol. of carbs, proteins, and fats
• normal brain func, nerves, muscles, heart
• reg. appetite
• DNA RNA formation
• (whole grains, cereals, pasta)

• (riboflavin)
• cellular growth
• metab. of carbs, proteins, and fats 
• healthy eyes and mucous membrane
• aids in syn. of niacin (B3)
• (milk, dairy, meat, poultry and fish)

• Niacin
• all cell func.
• release of energy from carbs, protein, fat
• co-enzyme of ATP
• (meats, cereals, nuts, seeds, legumes)

• Pyridoxine
• coenzyme in protein synthesis
• energy from glycogen
• nervous system function
• (meat poultry fish)

• Folic acid, folacin
• maturation of RBC
• func. with B12 and C
• DNA/RNA synthesis
•  (liver, green leafy, fort. foods)

• syn of vit D
• aid in release of energy from carb, fat, protein
• (animal products and whole grains)

• cobalamin
• form of mature RBC
• DNA/RNA synth.
•  (meat and animal products)

DNA/RNA synth. 

(egg yolk and liver)

• Retinol
• bone and tooth dev
• healthy skin and mucous membranes
• immune system func.
• vision in dim light
• (dairy, eggs,meat(liver) fortified food)

• Calceferol
• Absorption of calcium and phosphorus
• mineralization of bone
• (sunlight, seafood)

• Tocopherol
• most important fat sol, anti-ox
• protects RBCs
• (whole grains, nuts, seeds, green leafies)

• Formation of prothrombin 
• activiates proteins for bone form. 
• (green leafies, meat, dairy)

• most abund, component of body
• primary component of blood and lymph
• medium for secretions and excretions
• acts as a solvent
• maintains fluid stability
• enables chemical reactions
• aids in cell lubrication
• transport for nutrients
• regulate body temp.

• Magnetostrictive
• Peizoelectric
• Sonic

• high freq.electrical energy converted to rapid vibration. tip=elliptical pattern
• ultrasonic technology
• 25 or 30K units

• energy is created by ceramic crystal or quartz transducers in the handpiece.
• tip=linear
• less heat, less water than Magento
• No magnetic field created

• lower freq than magneto. pressure sensitve
• energy levels range form 2000-6300 cps. 
• tip=elliptical 
• little heat is gen.

vibration energy of water resulting in the lyses of the bacterial cell wall. ( minute bubbles implode)

ultrasonic action created by high freq electrical current converted to ellipitical movemt of the tip

amt of power in the tip related to the length of the tip movement.  longer the stroke, the more energy and greater ability to remove more tenacious deposits

number of cycles of tip movement or vibration in one second.

magneto units that have a pre-set freq. have adj water and power controls. The freq automatically adjusts with adaptation of the tip and as conditions change during instrumentation

magneto units that have adj freq. in addition to adj water and power controls.

• The tip=Most power 2-4mm
• Face (concave) of tip= next highest power
• Back of tip (convex)
• Lateral sides of tip (least powerful)

• the cooling effect and hydrodynamic movmt of water around the elliptical tip that moves subgingival debris and disrupts bacteria. 
• AKA microstreaming

• pt with pacemakers
• pt with communicable/ infect. diseases that are tramissable through aerosols
• pt with COPD, asthma, CF
• Pt with strong gag reflex/diff swallowing
• implants

insert tip, grip, O ring, stack

• Do not submerge in glutaraldehyde or spray with birex.
• Rinse and place in indiv. pkg
• Do not run thru ultrasonic
• Ck periodically for wear
• Replace )-ring if water leaks from handpiece or feels loose.
• Bag so that the tip can be viewed. Tip down. 
• Autoclave paper side down. 
• Check "born on" date
• replace if stack is bent or splayed
• use an efficience indicator template to check the wear in the tip length.

• decrease power-length of stroke
• decrease freq. 
• increase water flow
• avoid sensitive teeth
• keep the tip moving at all times and maintain constant water  flow.

• seat the client as upright as possible
• provide adequate suction
• avoid continuous use.

• PPE, face shield, mask, gloves, gown
• Client: protective lenses and cloth towel/prerinse 
• Ultrasonic unit: drape with plastic
• Ultrasonic handpiece: sterilize . Bleed 1 minute
• Water evac. - use high volume if working with an assistant. 
• water spray: water flow should be on low

• water lavage
• lyses bacterial cell wall
• removes plaque
• gram - most suseptible
• less tissue trauma
• increased pt comfort
• decreased operator fatigue
• MAY req less tx time
• Better access to deep pockets
• no sharpening, less lateral pressure, less tissue distention

• water flushes debris
• removes endotoxins
• removes plaque
• can add a antimicrobial

• decrease tactile sense
• req water evac
• produces aerosol
• potential for damaging restoratives
• visibility is increased by clearing blood

yes

internal or external

use to remove mod to heavy calculus ABOVE the gingival margin and in shallow pockets.

• chisel
• beaver tail
• furcation tips ( .8mm ball on the end)
• diamond coated

access tight contacts and increase client comfort when light dep are subgingival.

• use for healthy maintenance 
• 4mm or less pockets

• Right or left curved. 
• perio case type III IV

• the thinner the tip the lower the power setting
• the lighter the dep. the lower the power setting
• Low power should always be used wht the patient in NOT anesthetized for debridement. 

• Do not use on HIGH power
• finish with hand scaling