PatientCare2 – Flashcards
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CaviWipes contact time?
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1 minute
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How long to flush water lines?
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30 seconds
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What volume is used from oxygen tank for adult?
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6 liters/min
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What are the 2 vales on oxygen tank?
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Tank reserve; flow rate
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Medical/dental hx should be updated how many times?
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At least once per year (legal standard); UMKC & most offices do it every 6 months
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Prn
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As needed
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Bid
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Twice a day
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Tid
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3 times a day
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Qid
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4 times a day
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UCHD
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Unusual childhood diseases
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TB
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Tuberculosis
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Symptoms
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Patient's own words; indicates severity
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Signs
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Your findings; can reveal asymptomatic diseases
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Most frequent alleged dental malpractice error due to:
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Failure to diagnose
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Vivadent Test Strips test what bacteria
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Mutans step; Lactobacilli
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What to check in saliva?
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Flow, consistency, pH
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Normal saliva flow rate is
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Greater than 1 mL/min [(that is stimulated; unstimulated (normal) is 0.3 mL/min]
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In xerostomia, stimulated flow rate is:
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less than 0.7 mL/min
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In xerostomia, nominal flow rate is:
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less than 0.5 mL/min
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Xerostomia products include:
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Biotene (mouthwash, tooth paste, gum, mouth rinse) Oasis rinse (alcohol-free)
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Xerostomia saliva is:
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Thick, stringy, frothy
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Caries disease indicators:
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Visible caries present Caries restored in laste 3 years Interproximal lesions White spot lesion = 1st sign
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CAMBRA stands for:
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Caries Management by Risk Assessment
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Less surgical intervention (CAMBRA) needs to be coupled with:
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Antibacterial & Fl therapies
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Fl toothpaste should be used how many times per day?
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2 times
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Frequency of APF treatment per year?
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1x-2x/year; APF works better, unless if there are a lot of porcelain restorations, then in that case use neutral
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Fl gel should be used when & how long?
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After brushing, brush on gel for 1-2 minutes, don't rinse
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Fl creme (Prevident 5000 +)
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Use for brushing, once a day, don't rinse
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Fl varnish is:
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Resin-modified glass ionomer Releases Fl, Ca, phosphate Best preventative method for large groups of caries-prone school-age children
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For high risk caries therapy, use
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Fl varnish, 5000 ppm Fl toothpaste bid, xylitol gum/mints qid, 6 months recall, AB therapy? Chlorohexadine (stains teeth, tastes bad; good for perio ds)?
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Types of caries (4):
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Pit & fissure (most common) Smooth surface (interproximal (starts just below contact area), Facial/lingual) Root (cervical) Secondary (recurrent)
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Smooth surface caries is dependent on both:
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Strep mutans + sucrose
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Pit & fissure caries is dependent on neither ___ , but is augmented by both
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Step mutans + sucrose
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Location of interproximal caries
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Below contact area
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Root caries characteristics:
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Gingival recession, cementum/dentin (more soluble than enamel), no "white spots", need stronger Fl
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Order of Caries Susceptibility of Teeth
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1. Mandibular 1st molars 2. Maxillary 1st molars, all 2nd molars 3. All premolars & max incisors 4. Mandibular incisors & all canines
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Caries severity, dental caries: stages
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Subclinical (progression/regression (=demin-remin)) Enamel (closed & open) Dentin (closed & open) Pulp
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Hemiplegia
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Paralysis one side (usually from stroke)
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Paraplegia
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Paralysis both sides
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Hemiparesis
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Weakness one side
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Paraparesis
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Weakness on both sides
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Ataxic:
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Gross incoordination of muscle movements
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Parkinsonian
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Tremor, rigidity, postural instability, hypokinesia
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Cranial Nerve V:
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Clenching of teeth (Masseter symmetry)
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Cranial Nerve V & VII:
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Wrinkle forehead, close eyes, smiling
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Cranial Nerve IX & X:
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Gag reflex, say "ahh"
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Cranial Nerve XI:
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Shoulder shrug
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Cranial Nerve XII:
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Tongue range of motion
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Stature:
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Short, Tall
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Habitus:
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Thin, Obese
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Marfan's Syndrome
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Tall, thin, arachnodactily, wingspan > height, heart murmur?
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Scoliosis
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Side curvature
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Kyphosis
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Round back (hunchback)
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Types of tremors (3):
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Resting (Parkinson's), intentional (when they're moving), essential (all the time)
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Outer canthus
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Outside of eye
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Inner canthus
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Inner of eye
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Ala
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Outside of nose
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Philtrum
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Under the nose
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Tragus
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Flap of ear
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Nasion
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Inbetween the eyes
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HEENT
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Head, eyes, ears, nose, throat
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Frontal bossing
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Enlargement of head
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Prognathic
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Sticking out, from the chin
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Retrognathic
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Sticking in, from the chin
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Basal Cell
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Most common, middle 2/3 of face, "rat bite", won't heal, usually benign
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Stabismus
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Eyes crossed
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Ptosis
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Lid lag, sometimes sign of past stroke (eyes)
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Ocular hypertelorism
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Excess space between eyes
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Expothalmos
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Bulging eyes, sign of hyperthryoidism
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Yellow sclera
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Hepatotoxicity
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Most common frequency of lymphadenopathy is:
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Cervical
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Mumps is an infection of:
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Parotid gland
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Angular chelitis
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Inflammation that affects extra oral corners of mouth
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TMD is:
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(Temporomandibular disorder) Collection of disorders, with orofacial pain &/or masticatory dysfunction"
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TMD stats
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20% of U.S. 2:1, or 3:1 females Mostly < 45 yrs 85.4% of women
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TMD symptoms
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Joint pain (76%), headaches (82%), Tinnitus (ringing ears), insomnia, neck ache, dizziness, teeth sensitivity to H & C
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TMD 3 broad diagnostic classes
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Muscles, soft tissue of joint, hard tissues of joint
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Causes of TMD
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Bruxism, clenching, stress, malocclusion, arthritis, trauma, ergonomics
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Backrest recline should be ____ degrees from the floor
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15
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___% of time, oral cancer is squamous cell; it is ___% of all cancers
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90; 3
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High risk areas for oral cancer is:
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Floor mouth, lateral border of tongue, ventral surface of tongue, oropharynx
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Risk factors for oral cancer:
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Tobacco (#1), alcohol (#2), viruses (HIV+, HPV), sun exposure, inadequate nutrition, genetic predisposition, chronic inflammation, radiation exposure, carcinogen exposure
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Signs/symptoms of oral cancer
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Non-healing ulcer, bleeding, lymphadenopathy, attachment, induration, pain, paresthesia (abnormal sensation, tingling), drooling
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Torus (Pal term)
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Bony, hard
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Induration (Pal term)
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Firm (solid rubber ball); ex: cancerous lymph node
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Firm (Pal term)
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Yields to pressure but keeps its shape; ex: fibroma
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Compressible (Pal term)
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Pressure alters its shape; Ex: lymph node
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Doughy (Pal term)
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Returns slowly to original shape; Ex: cysts
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Spongy (Pal term)
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Returns quickly to original shape; Ex: vascular tumor
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Pitting (Pal term)
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Soft & leaves indentation; Ex: edema
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Collapsing (Pal term)
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Contents expressed; ex: abscess
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Blanching (Pal term)
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Color change; ex: freckle
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Discrete (les description)
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Separate, not running together or blending
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Confluent (les description)
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Running together, blended; originally separate, but now formed into one
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Papillary (les description)
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Having small bump-like elevations or projections
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Verrucose, aka verrucous lesions (les description)
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Covered with or full of wart-like growths; cauliflower-like surface
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Sessile (les description)
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Attached to the surface on a broad base
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Pedunculated lesion (les description)
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Elevated tissue having a narrow stem which acts as a base
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Erythema (les description)
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Red area of variable size & shape
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Leukoplakia (les description)
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White keratotic patch-like lesion on the mucosa which can't be rubbed off
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Petechia(e) (les description)
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Minute round red spot
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Macule (les description)
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Small (<1 cm) circumscribed area of color change, brown, black, blue, red; not elevated or depressed; Ex: Freckle = ephelis
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Ephelis
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Freckle
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Eschar (les description)
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A sloughing (shedding) of epithelium caused by disease, trauma, or chemical burn; i.e. aspirin burn
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Torus (les description)
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Bony elevation or prominence
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Patch (les description)
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Large (> 1 cm) circumscribed area of color or texture change (or both); not elevated or depressed; Ex: port wine stain
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Erosion (les description)
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A denuded area above the basal layer, gradual tissue disintegration, usually painful; ex: aphthous or herpes simplex
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Crust (les description)
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An outer layer, covering, or scab, from a coagulation of blood, serum, pus, or any combination
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Papule (les description)
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A superficial, elevated, solid lesion <1 cm., any color, solid base or pedunculated; ex: parulis ("gum boil") (a bump)
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Plaque (les description)
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A solid, flat, raised area > 1 cm; often keratinized (white); Ex: Snuff dipper's lesion (from spit tobacco/chewing tobacco)
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Nodule (les description)
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An elevated, deep solid lesion 0.5 - 2.0 cm., overlying mucosa not fixed; Ex: fibroma
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Tumor (les description)
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Elevated, deep solid mass > 1 cm., any color, or any neoplasm (benign or malignant), Ex: Kaposi's sarcoma (associated w/HIV)
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Vesicle (les description)
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Small (<1 cm) fluid filled, elevated lesion w/a thin surface covering, = small blister filled w/lymph or serum; Ex: herpres simplex
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Pustule (les description)
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Small (<1 cm) vesicular-type lesion containing purulent material rather than clear fluid, creamy white or yellow; Ex: dental abscess
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Bulla (les description)
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Large vesicle, > 1 cm., = large blister, = contains serum, usually at the mucosal - submucosal junction; Ex: pemphigus (skin ds, watery blisters form on skin), 2nd degree burn
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Cysts (les description)
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Epithelial lined, fluid-filled mass, may range from mm - cm., = submucosal or subcutaneous; Ex: epidermal cyst
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Stenson's duct
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Parotid duct
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Wharton's duct
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Submandibular duct
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Fordyce granules
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Sulfur-colored granules
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Buccal mucosa leukoedema
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Common in African-American's, "milky" white surface, doesn't rub off, is normal
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Lichen Planus
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White lace-like lines, asymptomatic
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Nicotine stomatitis
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Red dots, observed in pipe & reverse cigarette smokers, & less often in cigarette & cigar smokers
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Benign Migratory Glossitis
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Geographic tongue
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Hairy tongue
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Glossitis, filiform papillae, trapped debris (bacteria, fungus, coffee, tobacco)
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Lingual varicosities
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Veins on lingual side of tongue
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___% are found in stage I or II in oral cancer; ____ have 3 year survival
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40%; 80-90%
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___% are found in stage III or IV; ___% 3 year survival; ___% = recurrence in 2 yrs.
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60%; 33%; 67%
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Symptoms of xerostomia:
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Candidiasis, angular chelitis, burning tongue, root & cervical caries, stomatitis, dysphagia
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Possible causes of xerostomia:
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Medications (#1), Sjogren's syndrome, sialolithiasis
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Sialolithiasis:
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Stone in salivary gland (usually in submandibular gland)
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Candidiasis (thrush) fungus is:
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C. albicans
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C. albicans is normal flora (yeast) found in:
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Mouth, esophagus, GI tract, vagina
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3 types of Candidiasis:
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Atrophic Candidiasis Acute Pseudomembranous Candidiasis Chronic Hyperplastic Candidiasis
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Atrophic Candidiasis
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Under dentures Red on palate or tongue Burn w/spicy foods & alcohol
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Acute Pseudomembranous Candidiasis
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Most common Tongue, bucal mucosa, floor Creamy white patches Easily wipes off Pain w/spicy/acidic foods Xerostomia Dysphagia
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Chronic Hyperplastic Candidiasis
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White plaque Looks like hyperkeratosis, but rubs off Inside corners, buccal mucosa, lateral tongue
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Candidiasis Risk Factors
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Birth control pills, long term antibiotics, diabetes, dentures that don't fit, xerostomia, iron & B12 deficiency, immunocompromised, pregnancy, poor oral hygiene, smoking, stress, depression
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Candidiasis Tx
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Oral hygiene Yogurt Avoid alcohol, simple sugars
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Medications for Candidiasis
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Nystatin (rinse & tablets) Ketaconozole & fluconozole
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Other names for fever blisters:
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Cold sores, herpes simplex type I
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Tx for cold sores:
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Topicals: --antiviral cream --> Penciclovir (Denavir); docosnaol (abreva) Lysine Zinc oxide cream
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Aphthous ulcers, aka
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Canker sores
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Herpetiform:
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Aphthous ulcers that are more numerous & vesicular
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Aphthous ulcers vs. cold sores
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No blister Generally larger Rarely merge Moveable intraoral tissue Tongue, buccal mucosa, soft palate, inner lip
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Aphthous ulcer tx
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Viscous benzocaine (e.g. Oragel, Anbesol) Kenalog in Orabase (local anti-inflammatory) Ameseal (sealing agent) Aphthasol (prodromal stage)
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Types of biopsies (4)
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Exfoliative (brush) Fine needle aspiration Incisional (best for LARGE intraoral lesions) Excisional (best for SMALL intraoral lesions)
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What is Toluidine Blue Stain?
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Simple dye A "litmus test" for suspicious lesions
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What is lateral excursion?
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Moving teeth side to side, see which teeth guide
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What is protrusive?
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Moving teeth forward and back, see which teeth slide
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Bruxism evidence:
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Flattened incisal edges, bony ridges, recession, periodontal ds, abfraction (loss of cervical area due to bruxism), broken teeth, broken fillings, excessive attrition, TMJ problems, headaches, sore muscles, cheek irritation, scalloped tongue
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Sources of TMD:
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Occlusion Trauma Emotional stress Referred pain form CV disease
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Referred pain in TMD, at the temporalis, it is generally:
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Anterior Teeth
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Referred pain in TMD, at the masseter, it is generally:
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Posterior Teeth
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Bruxism (TMD) Tx:
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Meds: NSAIDs Diathermy of heat packs Occlusal splint Physical therapy Surgery in extreme cases Splints
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Attrition
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(Action of gradually decreasing strength/effectiveness of someone/something through sustained attack/pressure) Normal mastication Diet related Age related Occlusal or incisal BRuxism accelerates
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Abfraction
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Bruxism results in cervical loss
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Abrasions
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Abnormal mechanical (toothpicks, nails, pipes, toothbrushing)
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Erosion
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Abnormal chemical (lemons, chlorine (from swimming)), bulimia)
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Signs of bulimia:
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Lingual erosion "Raised amalgams" Thermal sensitivity Thinning, chipping of incisal edges Anterior open bite Loss of vertical dimension Enlarged salivary glands
