Patient assessment Final

Normal open position: when functioning properly the disc stays in place when the jaw is in use, preventing the bony structures from coming in contact
dysfunctioning: the disc is commonly pulled forward when the jaw is in use, causing the bones of the skull and jaw so grind together

Temporalis, superficial masseter, anterior digastric

deep masseter, lateral pterygoid, medial pterygoid, sternocleidomastoid

opening < 40mm
lateral: <7mm, may indicate anterior disk displacement w/o reduction

1. do you have difficulty and/or pain opening your mouth, chewing or talking?
2. Does your jaw get stuck, locked or go out

B/c tobacco use is a contributing factor in MANY medical conds. it also inc. the risk of periodontal dz

risk factor

lung, mouth, nasal passages/nose, pharynx, larynx, breast, esophagus, stomach, pancreas, bladder, kidney, cervix and possibly colon and rectum

smoking
smokers are 2.6-6X's more likely to exhibit perio destruction that non-smokers
Thus it is the most sign. risk facto in the development and progression and successful treatment of periodontitis

true!

FALSE!
gingival inflammation and bleeding are often reduced or absent. Thus you need to take extra care when performing periodontal screening and examination b/c lack of bleeding on probing does not indicate healthy tissue as it does in non-smokers

false! it is a known human carcinogen that contains more nicotine than cigarettes and tumors often arise at the site of placement of the tobacco

FALSE!
carcinogen is a chemical or other substance that causes cancer
-nicotine is NOT a carcinogen it is the chemical that causes addiction

first part true second part false: ALL tobacco companies inc amt of nicotine to ensure continual use

24 hrs after quitting there is a drop in the risk of heart attack, 2 weeks after quitting there is an inc. in lung function by 30%. 5yrs after quitting your risk of stroke is similar to persons who never smoked

white patch and red sores

so you can see the margins

AMALGAM = very radiopaque while composite can be radiopaque or radiolucent

a composite will look like it has been prepped while sealant has a lake effect

Stainless steel crowns

used when someone is missing a tooth:
teeth holding the missing tooth are the retainers and the missing one is the pontic

all gold, metal and porcelain and all porcelain, or all metal

FALSE
AKA stay plate or flipper. it is just meant for asthetics as a temporary. you take an impression and knock the tooth out of there. it is used so the patient can heal until something permanent can be placed

1. Are portions of the filling fractured or missing? Is everything still there this is important for esthetics and to prevent decay
2. Are there fracture lines or voids present? these can be areas of leakage or plaque collection
3. Do these: weaken the restoration, predispose to further deterioration or recurrent caries

FALSE! you must have marginal ditching WITH:
-recurrent caries at the margin and the accumulation of plaque at the margin indicate replacement
- also correlate with CRA (caries risk assessment

True
amalgam and GI have cariostatic properties while composites do NOT

1. recurrent caries
2. accumulation of plaque
3 tip of explorer can be placed up underneath the crown

-surface roughness of the restoration
- interproximal overhangs
-impingement on the zone of attachment
** food impactation or bulky irritating margins are main reasons for perio problems

hyperocclusion: may cause periodontal pathosis and TMD problems
inraocclusion: restoration that is not occluding with opp. arch. may cause supereruption and subsequent malalignment of teeth

recurrent caries: when you probe these ares you are looking for changes in texture "sticks"

gray color change alone does NOT = caries
often old amalgam will stain the teeth. It is a corrosion prod. from amalgam that inc. caries resistance

you should first try polishing this restoration. It does not need to be replaced

-discoloration or poor shade match
-poor periodontal tissue response
-poor restoration contour
-display of gold or amalgam in esthetic areas: if restorations are in good condition this would be the patient's choice and you would need to explain the differences in materials and get a waiver

hyperocclusion: may cause periodontal pathosis and TMD problems
inraocclusion: restoration that is not occluding with opp. arch. may cause supereruption and subsequent malalignment of teeth

recurrent caries: when you probe these ares you are looking for changes in texture "sticks"

gray color change alone does NOT = caries
often old amalgam will stain the teeth. It is a corrosion prod. from amalgam that inc. caries resistance

you should first try polishing this restoration. It does not need to be replaced

-discoloration or poor shade match
-poor periodontal tissue response
-poor restoration contour
-display of gold or amalgam in esthetic areas: if restorations are in good condition this would be the patient's choice and you would need to explain the differences in materials and get a waiver

true + (TP): caries IS present, and from your examination you determine that it IS present
True neg. (TN) caries is NOT present and from your examination you determine that caries is NOT present
False pos: (FP) caries is NOT present but from you examination you determine that it IS present
false neg. (FN): caries IS present but from your examination you determine that caries IS NOT present

traditionalyy: occlusal caries began in the enamel with demineralization and cavitation
Today: caries begins in dentin through very small openings in enamel fissures, pits and fractures. there is no cavitation

occlusal caries

proximal smooth surface caries

facial/lingual smooth surface caries

root surface (cemental caries)

visual criteria for caries diagnosis

larger lesions may appear black at the base. look for change in occlusal opacity around the pit or fissure

true

no
dry the tooth surfaces
-rough, chalky matte surface = demineralizatino
-smooth, shiny surface = remineralization

true

false: cavitation may be create at the site of a sperficial lesion that might otherwie be remineralized, probing may accelerate the rate of caries progression, pathogenic bacteria may be transferred from one site to another

1. obtain info about the texture of te margins and base of teh cavity in a cavitated lesion
2. detect secondary caries in the presence of restorations
3. evaluate marginal acceptability
4. evaluate discolored cementum for possible root caries
5. explorer should be used to determine the texture of both cavitated and non-cavitated root surface lesions. you need to compare the texture to apparently normal root tiss. b/c you could have someone that has soft cementum naturally

D1

D3

sound no caries

E1

E2

D1

true

facial/lingual: it is usually difficult to differentiate buccal from lingual

root surface

fiberoptic transillumination: intraoral fiberoptic light source placed buccal to the tooth surface: the transmitted light is examined.
a carious lesion has a lowered index of light transmission and will appear as a darkened shadow

quantitative laser fluorescence: may be used on occlusal, facial and lingual surfaces but has a significant # of false positives

if endodontic testing was required: gross caries, broken tooth, traumatic injury, periapical pathology, non-vital tooth
-and/or if there is a lot of subjective or objective info

1. if they all have the same issue: esthetic issues, impacted 3rd's, multiple roots
2. if the subjective or objective info is the same for multiple teeth
3. missing teeth: SOAP all missing teeth from one arch together, usually SOAP missing teeth from max arch separate from mand. arch

caries/defective restorations special problem title under: problems with teeth. you can SOAP multiple teeth together

-E1,E2, D1, D2 lesions or sm. to moderate clinical carious lesions
-teeth WITHOUT suspected pulpal problems
-Deep pits and fissures
-Abrasion
Do NOT use for: teeth with suspected pulpal involvement or problems with fixed partial dentures

when one tooth has multiple problems pick one of the problems and only SOAP once but talk about all of the problems

1. perio
2. caries risk assessment

-high risk patients can be identified before extensive decay occurs
-extent of treatment is appropriate to the indiv. risk
-better allocation of resources
-improves diagnostic decisions

after charting visible and radiographic caries on the odontogram

true

phase 1

phase 2

perio is considered the foundation of dental treatment
urgent: limited treatment can be provided: sedative fillings, temporary crowns, recement of crowns, most extractions

phase 3:
disease control: sealants, endo therapy, amalgams and composits, posts and crown build ups, stainless steel crowns, surgical procedures interim dentures

phase 4

phase 5

1. prophylaxis
2. root planing
*** perio inter eval must occur 1-4 weeks after root planing, it evaluates the completeness of root planing, and will be the last thing in your phase 2

implant placement is also seen here and you will end phase 3 with perio Re-eval: occurs 4-6 wks. after perio interim

assess the results of root planing, determines if surgery is required, determines the prognosis of questionable teeth
*** must ALWAYS occur before phase 5 procedures (crowns, bridges, FPD, porcelain veneers)

complete dentures and removable partial dentures

phase 7