What are the 2 main areas that must be recognized when you are preparing for the pt. to come?
Operatory
Records
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
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.
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.
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
Who else of our dental staff might we need to introduce our pt. to?
our instructor
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
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
Name the 4 general pt. chair positions
upright
semi-upright
supine
trendelenburg
Upright
the initial position from which chair adjustments are made.
pust o on the adjustment pad and it will set the chair here
In what cases would we use the semi-upright chair position?
for pts with certain types of cardiovascular, respiratory, or vertigo problems
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
trendelenburg
the pt is in the supine position and tipped back and down so that the heart is higher than the head
what is postural hypertension?
when the pt gets dizzy after raising the chair up
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
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
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
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
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
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)
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
how should your back be positioned in regards to NWP?
in neutral postural alignment with natural spinal curves
how should your head be positioned in regards to NWP?
on top of neutral spine with forward neck flexation between 15 and 20 degrees
how should your eyes be positioned in regards to NWP?
directed downward to prevent neck and eye strain
how should your shoulders be positioned in regards to NWP?
relaxed and parallel with the hips and floor
how should your elbows be positioned in regards to NWP?
close to the body
how should your forearms be positioned in regards to NWP?
parallel with the floor
how should your wrists be positioned in regards to NWP?
forearm and wrist in a strait line
how should your thighs be positioned in regards to NWP?
full body weight distributed evenly on seat, parallel to the floor
how should your knees be positioned in regards to NWP?
slightly apart
how should your feet be positioned in regards to NWP?
flat on the floor
where is the pts oral cavity in regards to the clinician?
to the clinician's elbow height
what is the proper distance from the clinicians eyes to the pts oral cavity?
15-22 inches
define working distance
the distance between the clinician's eyes and the pts oral cavity (15-22 inches)
what is the best way to learn orientation of clinician to pt?
designating the hours of the clock around the pts head
what is the treatment area centered around?
the pts oral cavity
what does the entire 'work area' refer to?
the dental chair with the pt, the unit and instrument tray
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
describe the characteristics of an acceptable base of clinician's stool
broad and heavy with no fewer than 4 casters
describe the characteristics of an acceptible seat of a clinician's stool.
seamless upholstery, padded firmly, accomodates requirements for neutral seated position
describe charactersitics for an acceptable height of clinicians chair.
adjustable for wide personal variability
describe characteristics of an acceptable back of clinician's stool.
adjustable, lumbar support to accommodate different positions, procedures and clinicians
describe what mobility will be like for an acceptable clinicians stool.
completely mobile with free rolling casters
describe adjustment of an acceptable clinicians stool
multiple adjustments for different positions, procedures, and clinicians
how might a clinician's stool be infection control friendly?
by having surfaces that are able to withstand standard precautions regimen
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
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
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
how should the light be adjusted when working on the mandibular arch?
almost perpendicular to the floor, with pt chin down
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
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
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
anthropometry
the study of human body measurements especially on a comparative basis
body mechanics
the field of physiology that studies muscular actions and functions in the maintenance of the posture of the body
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
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
functional movement
muscles working together as a unit to complete a movement or task thereby creating the least amount of internal physical stress
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
risk factor
anything that puts the clinician or patient at risk or increases their risk of exposure to an indentified hazard
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
stress
a physical, chemical, or emotional factor that causes physical or mental tension and may be a factor in disease cause or fatigue
treatment process organization
organization of clinician as related to patient, treatment delivered, area of mouth treated
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
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
what are occupational problems?
things that will occur if you don't practice ergonomics
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
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
bursitis
inflammation of the bursa
areas of friction or impingement anywhere in the body, usually the shoulder
decreased range of motion, aching
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
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
name 4 other occupational problems that we discussed in class.
ulnar nerve entrapment
pronator syndrome
tenosynovitis
extensar wad strain
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
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
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
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.
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.
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
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
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
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.
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.
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
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.
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
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
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
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
calibration
determination of the accuracy of an instrument by measurement of its variation from a standard
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
explorer
a slender stainless steal instrument with a fine flexible, sharp point used for examination of the surfaces of the teeth to detect irregulations
fremitus
a vibration perceptibel by palpation
periodontomer
instrument used to measure mobility
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
probing depth
the distance from the gingival margin to the location of the periodontal probe tip at the coronal border of attached periodontal tissues
tactile
pertaining to the touch
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
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
what is a basic set up for pts with permanent teeth?
mouth mirror
probes
explorers
name the 3 parts of the mouth mirror
handle
shank
working end
name and describe the 3 types of mouth mirror surfaces
plane: flat
concave: magnifying
front surface: eliminates double images
Name the 6 purposes and uses for the mouth mirror
indirect vision
indirect illumination
transillumination
retraction
grasp and rest
maintain clear vision
indirect vision
surfaces where direct vision is not possible; distal surfaces of posterior teeth and lingual surfaces of anterior teeth
indirect illumination
reflection of dental light to any area in the mouth
transillumination
reflection of light through the teeth
retraction
mirror is used to prevent interference by the cheeks, tongue or lips
move the mirror around for protection, use vaseline if necessary
grasp an rest
to provide stability and control
to assist in retraction of lips and cheek
hold it like a pencil
clear vision
warm mirror or rub along cheek, and request pt to breathe through their nose
get rid of scratched mirrors
How do you take proper care of your mirror?
dismantle all parts
check for debris
make sure it won't get scratched
What are the purposes and used for using compressed air?
improve and facilitate exam procedures
improve visability
prepare teeth for procedures
what does dried calculus look like?
chalky and presents a contrast to tooth color
name 3 examples to dry surfaces:
application of preventative agents when indicated
make impression for study cast
apply topical anesthetic
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.
name 3 types of probes:
manual
automated
furcation (nabor's probe)
what are the objectives for use of probe?
accuracy
consistency
pt. comfort - be gentle
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
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
describe clinical attachment level in regards to probe use and purposes
determine the clinical attachment level- CEJ to base of pocket
describe mucogingival examination in regards to probe purpose and procedure
determine relationship of gingival margin, attachment level, mucogingival junction, and frena
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
Describe planning and implementation in regards to probing:
determine treatment plan
detect root irregularities
detect calc
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
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
describe the desing of the probe:
slender, smooth rounded tip
handle, angled shank, and working end
stainless steel
what is a plastic probe used for?
screenings, and titanium implant probing
what type of probe has a curved working end?
Nabor's probe
where is the black marking on the UNC probe that we use?
4 mm mark
define pocket.
diseased gingival sulcus
how is a sulcus measured?
from the base of the pocket (top of attached periodontal tissue) to the gingival margin
true or false. The sulcus is continuous around the entire tooth.
true
is "spot" probing adequate?
no, the sulcus must be surveyed around the entire tooth
what are proximal surfaces?
between the teeth, or col area, where periodontal infections usually begin
what are anatomic features of the tooth-surface wall of the pocket?
root concavities
cervical thirds
furcations
anomalies
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
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
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
describe probe placement problems that might affect probe readings:
pass through the instrument to the fingers and hand then to the brain
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
when is examination and exploration observed visually?
if it is supragingival, or on the surface
dry the area and use the light
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
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
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
where is subgingival calc usually found?
it can be localized or generalized
what should be used to test mobility?
two single ended metal instruments with blunt ends (mirror handle)
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
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
fremitus
palpable vibration and movement
excess contact of teeth
usually mobility
test during occlusion determination
determination made only on maxillary teeth
what type of radiograph is needed for observing evidence of periodontal involvement?
periapical
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
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
what is horizontal bone loss?
when the crest of the bone is parallel with a line between the cementoenamel junctions of 2 adjacent teeth
what is generalized horizontal bone loss?
when the amount of remaining bone is fairly evenly distributed throughout the dentition.
what is localized horizontal bone loss?
when bone loss is confined to a specific area
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
when inflammation is the sole destructive factor, the bone loss usually appears___________.
horizontal
vertical bone loss is more commonly____________than _______________.
localized
generalized
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
how does diseased crestal lamina dura appear on a radiograph?
indistinct, irregular, radiolucent, and fuzzy
How does normal furcation appear on a radiograph?
bone fills the area between the roots
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.
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.
what does diseased periodontal ligament space look like on a radiograph?
wide and thick, there is more space
do early signs of periodontal disease show on radiographs?
no
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
where can initial bone destruction be observed most frequently?
at the crest of the interdental bone in the crestal lamina dura
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
can pockets be seen on radiographs?
no, because soft tissue does not show on radiographs, you must use a probe to identify pockets
