DOCONUT MOSE
ED 183 960 CB 024 027
.TITLE Military Curricula for Vocational.8 Technical Education. Dental Specialist, 10-1. INSTITUTION ,kir Univ., Gunter AFS,Ala.s.Extension Course Inst.: Ohio State_Univ., Columbus. National Center for Research in Vocational Education. SPONS AGENCY Bureau'of Occupational and Adult Education (DHEW/OE), Washington, D.C. P313 DATE -r74]- NOTE 434p.;' Not available in paper copy due to small, light type.
EDRS PRICE MF01 Plus Postage. P: Not Available from EDRS. DESCRIPTORS *Allied Health'Occupations Education; Behavioral Objectives:. *Dental Assistants; *Dentistry; High Schools; Postsecondary Education: *Vocational Education IDENTIFIERS Dental Equipment: Dental Therapy Assistants; Military Zurricului Project
ABSTRACT Designed to provide entry level apprentice skills to persons who wish to become skilled, specialist level workers as dental assistants, these course materials supplement laboratory or on-the-job learning situations. One of a number of military-developed curriculum packages selected for adaptation to civilian vocational curriculum and instruction, the course contains a considerable aiount of review material and is stated to be suitable for beginning students with background in the basic sciences. Each chapter in the four-volume set is organized around learning objectives, accompanied by text with criterion exercises and answers keyed to the text for self-evaluation. Each volume also has a review examination containing questions keyed to the objectives: no answers are provided. Volaie I, Administration, Safety, and Maintenance, discusses the professional-client relationship and general safety practices. Volume 2, Basic Dental Sciences, covers oral anatomy, physiology, and pathology; dental therapeutics: and basic microbiology and sterilization. Volume 3, Dental Instruments and Materials, describes the uses of general, restorative, and specialty instruments; and dental materials. It is accompanied by supplementary foldout charts. Volume-4, Clinical Procedures, describes preventative dentistry programs, dental radiology, general assistingprocedures, and specialties. (MEK)
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asl-m 4 -, MILITARY CURRICULUM MATERIALS The military-developed curriculummaterials in this course package were selected by the NationalCenter for Research in Vocational Education Military Curriculum'Project for dissem- ination to the six regional CurriculumCoordination Centers and other instructional materialsagencies.The purpose of disseminating these courses was to make curriculummaterials eeveloped by the military rrore accessible tovocational educators in the civilian setting. The course materials were aopired, evaluatedby project staff and practitioners in the field, arylprepared for dissemination.Materials which vmre specific to the rcilitary There deleted, oppyrightedmaterials were either adtted or appro- val for their use was obtained.These oairse packages contain curriculum resource.materials which can beadaptea to support vocational instruction and curriculum development.
4 Military Curriculum Materials for The National Center Vocational and Mission Statement Technical Education -.A A 0, 'AA -Nore,./ ,,
The National Center for Research in Information and Field Vocational Education's mission is to increase Services Division the ability of diverse agencies, institutions, and organizations to solve educational prob- lems relating to individual career planning, preparation, and progression. The National The National Center for Research Center fulfills its mission by: in Vocational Education
Generating knowledge through research
Developing educational programs and products
Evaluating individual program needs and outcomes
Installing educational programs and products
Operating information systems and services
Conducting leadership development and training programs
FOR FURTHER INFORMATION ABOUT Military Curriculum Materials WRITE OR CALL Program Information Office The National Center for Research in Vocational Education The Ohio State University 1960 Kenny Road, Columbus, Ohio 43210 Telephone: 614/486-3655 or Toll Free 800/ 848.4815 within the continental U.S. (except Ohio) Military Curriculum Materials What Materials How Can These Dissemination Is. . . Are Available? Materials Be Obtained? tizsearevxr. et .g714 417,
an activity to increase the accessibility of One hundred twenty courses on microfiche Contact the Curriculum Coordination Center military-developed curriculum materials to (thirteen in paper form) and descriptions of in your region for information on obtaining vocational and technical educators. each have been provided to the vocational materials (e.g., availability and cost). They Curriculum Coordination Centers and other will rispond to your request directly or refer This project, funded by the U.S. Office of instructional materials agencies for dissemi- you to an instructional materials agency Education, includes the identification and nation. closer to you. acquisition of curriculum materials in pri.lt form from the Coast Guard, Air Force, Coursematerialsinclude programmed Army, Marine Corps and Navy. instruction, curriculum outlines, instructor CURRICULUM COORDINATION CENTERS guides, student workbooks and technical Access to military curriculum materials is manuals. EAST CENTRAL NORTHWEST provided through a "Joint Memorandum of Rebecca S. Douglass William Daniels Understanding" between the U.S. Office of The 120 courses represent the following Director Director Education and the Department of Defense. sixteen vocational subject areas: 100 North First Street Building 17 Springfield, I L 62777 Airdustrial Park The acquired materials are reviewed by staff Agriculture Food Service 217/782.0759 Olympia, WA 98504 and subject matter specialists, and courses Aviation Health 206/753-0879 deemed applicable to vocational and tech- Building & Heating & Air SOUTHEAST nical education are selected for dissemination. Construction Conditioning MIDWEST Trades Machine Shop Robert Patton James F. Shill, Ph.D." The National Center for Research in Clerical Management & Director Director Mississippi State University Vocational Education is the U.S. Office of Occupations Supervision 1515 West Sixth Ave. Education's designated representative to Communications Meteorology & Stillwater, OK 74704 Drawer DX Mississippi State, MS 39762 acquire the materials and conduct the project Drafting Navigation 405/377-2000 activities. Electronics Photography 601/325-2510 Engine Mechanics Public Service WESTERN Project Staff: NORTHEAST The number of courses and the subject areas Joseph F. Kelly, Ph.D. Lawrence F. H. Zane, Ph.D. Wesley E. Budke, Ph.D., Director represented will expand as additional mate- Director Director National Center Clearinghouse rials with application to vocational and 225 West State Street 1776 University Ave. Honolulu, HI 96822 Shirley A. Chase, Ph.D. technical education are identified and selected Trenton, NJ 08625 Project Director for dissemination. 609/292-6562 808/948-7834 9 8
.) 7 Correspondence CoUrst 104
DENTAL SPEC/ALIST Table of Contents
Course Description Page 1
Volume 1 Administration, Safety, and Maintenance - page 3 Text Material Volume Review Exercise Page 51
Volume 2 Basic Dental Sciences - Text Material Page 60 Volume Review Exercise Page 158
Volume 3 Dental /nstruments and Materials - Text Page 172 Materials Volume Review Exercise Page 235 Supplementary Material - Diagrams Page 247
Volume 4 Clinical Procedures - Text Materials Page 294 Volume Review Exercise Page 428
9 WAL.SPECIALIST Conespondenco Coune
IllksselPsdby: Omspistleasi Ane: United States Air Force Hoot* Development and 401: Print Page& Review Dow WOO 444 Unknown Militery Curriculum Project. The Center for Vocations, Education. 1990 Kenny Rd., Columbus, ON 43210
Suggested Background:
Chemistry. biology
Target Audiences:
Grades 10-odult
Organization of Materiels:
Criterion objectives. Mt, Cfiterioll exercises. anwrers,supplementary charts, volume review exercises
Type of Instruction:
Individualized, self-pecod
No. of Pages: Awe. Type of Materiels: Completion Time: Flexible Volume 1 Administration, Safety, and Mointonanca 43
Volume Review Exorcises 15 Flexible Volume 2 Basic Dental Sciences 94
Volume Review Exercises 14 Flexible Volume 3 Dente/ Instruments and Materials 59
Volume Review Exercises 12
Supplementary Materials Fold-out Charts 1-8 45
Flexible Volume 4 OIrdcal Prot...dorm 131
Volume Review Exercises 14
Supplementary Materiels Required:
None
Expires July 1, 1978 001111"14r(AltillgrLif An. ours. Description: workers in this Gamy. who wish to becomelipeeleilist lekilled) level (mmi-skilied) Wei people the look sciences. Thecourse nis course is designed toprovide training for Apprentice for beginning studentswith beckgrounds in considerable *mount of reviewmaterial and is suitable no course contains a laboratory or on-thejob leiwningsituetiorts. designed to supplement angel's...word chewers WsWeil* provided. The fine volume motorists %Stich are four volumes accompaniedby supplementary far vocationaltraining. ha course is divided into meterials wore deletediii adopting the course Mtn procedures, formsand organization. These reletionship and generalsafety practises. The CheelWrs discusses the professioneldient Safety, end Maintenance Volume 1 AdminIstradon, and training weredeleted. on administration,management, supervision therapeutics; end basicmicrobiology and oral anatomy, physiology,and pethology; dental Volume 2 Dark Dental Sciences covers sterilization. end specialtyinstruments:and dental materiels. Materials describes the usesof general, restOrative, Dental instruments end . Volume3 charts. lt is accompenied bysupplementary fold-out assisting procedures, andsPecielities. preventive dentistry proerame,dental Wicket, general Clinical Procedures describes Program vies deleted. Volume 4 Force preventive dentistry A section dealingwith the specific Air acCOMPunied be teat, CriteriOn learning objectives.These learning objectives are but no chapters and each chapteris organized around containing questions keyedtO the objectives, `23ch voturne is divided into self-evaluation. Each volumehas a review examination keyed to the tsxt for on-theiob instruction. exorcises and answers be suitable as a supplementto laboratory and ar.swers are provided.This material would
1 1
.4 .1...ns*ot 90150 01 7501 CDC 96150
DENTAL SPEcunser
(AFSC 98130)
Volume 1
Administration, Sa,foty, and Mainiaassece
Extension Course Institute 16-/ Air University 1384 12
Pro-fail YOU HAVE NOW progressed in the dental career field to the pointwhere you are qualified to enroll in the 98160CDC. The basic knowledge you have already obtained, either through formal training or on-the-jobtraining, will prov e to be invaluable as you progress upward.If you apply younelf, there are unlimited possibilities. Right now you areprimarily interested in where to go from your present status. The material you willfind in this volume has been compiled in an effort to assist you in attaining your goal. As you study this volume, it will be quite apparent thatit has been prepared for two distinct purposes. One purpose, of course, is to prepare you for upgrading to the 5-level AFSC. The other purpoee is to create asingle self-contained text that provides the study matter for the SKTportion of the Weighted Airman Promotion System. To adequately supportthese purposes, we have included new materialthat supports upgrade training and have repeated or reviewed previously taught material that is neededto prepare a comprehensive skill knowledge test. This volume contains the first five chapters of yourupgrade training. It begins with a discussion of the organization and missionof the Air Force Dental Service, the requirements for progression in thedental career field, and the duties of the various dental skill levels. The nexttwo chapters are devoted to the administrative procedures required in theoperation of a base dental service. Chapter 4 introduces you to thebasic fundamentals of supervision and training The concluding chapter ofthis volume reviews the principles and procedures involved in safety,housekeeping, and equipment maintenance. Foldouts 1 and 2 are included at the back of thisvolume. Whenever you are referred to one of these, turn tothe back of the volume and locate it. If you have questions on the accuracy Or currencyof the subject matter of this text, or recommendations for its improvement,send them to USAF SHCS/MST, Sheppard AFB TX 76311. If you have questions on course enrollment oradministration, or on any of ECI's instructional aids (Your Key to CareerDevelopment, Behavioral Objective Exercises, Volume Review Exercise, andCourse Examination), consult your education officer, training officer, orNCO, as appropriate. If he can't answer your questions, send them toECI, Gunter AFS AL 36118, preferably on ECI Form 17, Student Request forAssistance. This volume is valued at 36 hours (12 points). Material in this volume is technically accurate,adequate, and current as of August 1974. - Contents
PM*
iii Preface
Chapter 1 1 The Air Force DentalService 14 2 General AdministrativeProcedures 48 3 Administrative Support 86 4 Supervision and Training Equipment 6 Safety, Housekeeping, and 95 Maintenance
121 Answers for Exercises
1.5
1364 10 MODIFICATIONS
/-43of this publication has (have) been deleted in allapting this material for inclusion in the"Trial Implementation of a
Model System to Provide Military CurriculumMaterials for Use in Vocational
of and Technical Education."Deleted material involves extensive use military forms, procedures, systems, etc. and was not considered appropriate
fi,r use in vocational and technicaleducation.
16 CHAPTER 2
General Administrative Procedures
THE DENTAL SERVICE, like other services principles of patient psychology In receiving in the Armed Forces, maintains records that patients, and identify as true or false selected are primarily for its own use. There are several statements about the reception of patients. reasons for keeping these dental records. The most important reason is to improve patient Receiving Patients. The manner in which moralethroughanefficientsystemof you receive the dental patient may have a appointments. Records provide an more profound impact upon him than the opportunity to determine the quantity of actual treatment Whatever the quality of the tzeatment provided for a given number of professional care, the patient may be resentful personnel.Informationisobtained from anddissatisfiedifclinicpersonnelare records for the preparation of the budget. inattentive, indifferent, or abrupt. Frequently, records are employed for their Consequently, you should make favorable legal value in supplying required information. patientreactionaprimaryobjective. A Records also provide the information for pleasant disposition, coupled with tact, and a reports,andthereportshelphigher calm, courteous, and efficient manner are headquarters plan and act. For these reasons, essentialif the patient is to feel at ease. records should be prepared with care.so that Althoughtheactual procedures used to they will be accurate and factual. process .patients through dental facilities may The schedulingof patientsfor dental vary in accordance with local requirements, treatment includes receiving and directing the principles of patient psychology remain patients and answering inquiries about clinical the same. policies and procedures. You must not only Human relation& Whatarehuman be knowledgeable about administrationbut relations? Simply put, human relations are you must alsobe ableto communicate how you relate to other individuals. In many efficiently with dental patients. This requires areas of endeavor, human relations aremainly a basic understanding of patientpsychology. restricted to getting along with coworkers. The material discussed in this chapter will You are involved with treating people, and be valuable to you regardless of where you are treating people consists of much more than assigned in the dental clinic. This chapter curing their physical ailments. The good discusses the reception and administration of dental assistant never loses the awareness that patients,dental treatment records, dental patients are human beings. The needs of reporting system, and miscellaneous forms humans may be divided into the categories of and reports. physical and psychological requirements. Among the major physical needs that must be satisfied are food, water, shelter, rest, 2-1. Reception/Records Section exercise, sex, and physical well-being. Since The reception/records section is the first the Air Force satisfies most of the physical point of contact between patients and dental needs of its airmen, we will concentrate our personnel. The basic functions of this section discussion on how you can deal with the aretoreceivepatients,determinetheir psychological needs of the dental patient in treatment eligibility, schedule dental receiving him. The psychological appointments,and prepare and maintain needssometimes referred to as social or dental patient records. personality needsinclude security, recognition, affection, and achievement. 006. List desirable and undesirable ways of a.Security. People desire regularity and receiving patients, identify ways of applying stability in their lives. Too much uncertainty 14 1364
1 7 as to how they standcreates a very unsettled provides the patient with his firstimpression Ifapatient's of the type of treatment he isgoing to conditionfor them. important appointmentmustbe delayed pastits receive. This first impression is an scheduled time, you shouldinform him. one. Often, the finestprofessional care in the Failure to do so may cause him tofeel undue world cannot erase the tarnishedimage that a anxiety. He doesn't, know wherehe stands. lackadaisical receptionist has created.The Has he been forgotten? Is yourappointment dentalreceptionistshouldbe.acalm, schedule in error? Did someone fail totell the well-groomed,articulateindividualwho dentist he was here for his aPpointment?All strives to present a good firstimpression of of these questions flutter throughhis mind. the dental service to each.patient Keep him informed; this helpssatisfy his The very heart of the term"dental service desire for security. team"istheword"service."When b. Recognition.Everyindividual wants performingyourservicesasadental recognition and attention. We allhave a desire receptionist, keep in mind that the patientis to be looked upon favorablyby othersto unaware of. the proceduresrequired for feel important We crave the esteemof the treatment. You must listen to eachpatient's people we come in contact with.Your patient problems, and determine how sand .whereto does not want to be just anotherpatient; he route him for professional care.You should desires your recognition. How can wesatisfy explain this routing to him so that heknows this psychological need? Well, agood start is where he stands and what to expect.Listening to address your patient byhis name and rank. to the patient and explaining theprocedures Generally, just calling someone byhis lastfor his individual case can eliminate many name has a tendencyto turn him off. It future misunderstandings and problems. makes him feel that you thinkhe is just When misunderstandings do occur, you another "fish in the barrel"and does not must take positive action to resolvethem with provide him with the recognitionhe wants. as little commotion aspossible. You must use c. Affection. Everyone wants tobe able to tact and diplomacy when dealingwith an upset patient. Normally, thistype of patient have a relationship of reciprocal warm regard is with his fellow man. The good dental assistant is acting under abnormal stress,and it difficult to rationalize with him. Inhandling is one who genuinely likes his patients. The remember best way to meet this psychological need is to the upset patient, it pays you to show a sincere interest in your patient. The the expression: "When fire blazes in thebody, first thing you must do to have affection for sparks often come out of the mouth."You your patient is to like him. Youdo this at the must guard against this happeningto you. outset by developing in interest in him. For Losing your temper gains nothing. If youfind every dental assistant who hopes torise above that you cannot satisfy the patient, coup yourself and have a senior NCO or anofficer the amateur grade, this sincere interest in the will be patient is the law and gospel. speak with him. Usually, the patient d. Achievement. Everyone wants to do more receptive to someonein a position of something worthwhile. This desire is closely greater authority. Above all, do notget related to the need for recognition. Normal yourself involved in an argument withthe individualsarehappiest when theyare patient. contributing something. By informing your patient of his progress toward improved oral Exercises (006): health, you help satisfy his psychological need 1. What three attitudes should youavoid for achievement. This sssurance normally when receiving a patient if you want to see resultsinthe patient displaying an ever that he does NOT becomeresentful or greater interest and prowess thanbefore. dissatisfied? The code of ethics of the American Dental Assistants'Asaociationisbased on the principle of the Golden Rule, DO UNTO 2. What qualities should you displaywhen OTHERS AS YOU WOULD HAVE THEM receiving patients if you want tomake DO UNTO YOU. Place yourself inthe them feel at ease? patient's position. Imagine his anxietyand fear toward dental treatment Haveempathy toward him. Seldom does an individual have too much security, recognition,achievement, 3. Into what two categories may theneeds of or affection. individuals be divided? The re :eption area of the dental service li 1364 1 8 4. List seven major physical needs which must _16. It is well to be ram with an upset be satisfied. patient, even to the point of showing temper; argue your point effectively if you are right and, above all, keep- him in his place. 5. What are four psychological needs that must be dealt with in the reception of 007. Given a series of statements about the dental patients? general principles of telephone communication, indicate which are true and which are false.
In the next four exercises, identify ways you Telephone manners. Other than can apply, the principles of patient psychology face-to-face conversation, the telephone is the in the reception of patients by matching the most frequently used method of personal letters of desirable actions in column B with communication.Itisone of the most the psychological needs they best fulfill in the important pieces of equipment in the clinic. proper blank of column A. (One action All of the elements of good human relations cannot be matched correctly.) already discussed apply also to telephone conversations; however, since the person to Column A Column B whom you speak on the telephone cannot see. _6. Achievement. a. Addreu patient by you, this can lead to certaindifficulties. Here _7. Affection, name and rank to make are some generalprinciples to remember _8. Recognition. him feel important. _9. Security. b. Address all patients by whichwillbe helpfulin overcoming or last names only. preventing these difficulties: c. Keep patient informed a. You are the Dental Clinic when you in cue his appointment speak on the telephone. The opinion the is delayed beyond the scheduled time. patient has of the entire hospital may often d. Inform patient of his depend on this first telephone contact. Use progresstoward im- the telephone as a representative of a dental proved oral health. service eager for the opportunity to help e. Show a sincere interest someone. inpatientfromthe b. Use a sincere, pleasant, outset. easy-to-understand voice. Since the person on th e other end cannot see you smile, you must Indicate which of the next seven statements put the smile in your voice. Develop thishabit arepsychologicallytrue and whichare to the point that you do it unconsciously. psychologically false by inserting a T or an F c. Answer promptly. A good rule isto try in the blanks provided. to answer by the third ring. d. Be clear,concise,andaccurate. 10. Having empathy for your patients Doublecheck all specific information given or helps achieve the Golden Rule of the taken on the telephone. If you initiate the American D ental Assistants' call, plan what you have to say ahead of time. Association. The other person's time is also valuable. 11.. The ideal receptionist is concerned e. Stateyourname,rank, and duty _ with providing the patient with a section,such as: "Good morning, Dental good first impression of the dental Clinic, Sgt Smith speaking. May I helpyou?" service. f. Know the local ground rules. Most _12. Sex, shelter, rest, recognition, and clinics have specific ways of answering the exercise are all physical needs. telephone. They also have certain limitationr 13. The very heart of the term "dental as to the information that canbe given over _ service team" is the word "service." the telephone. Be sure you knowthe rules 14. Most individuals have too much and have all the necessary information at your security,recognition, achievement, fingertips, especially informationabout and affection. appointments. 15. Part of the service you can render as g. Neverdiagnoseonthetelephone. _ a receptionist is to listen to each Diagnosis is not your function. The patient, patient's problems, determine how however, does not know your qualifications; andwheretoroutehhnfor if the information required by the caller is out professionalcare, and make any of your area of responsibility, call the proper necessary explanations to him. authorityorsetupanappropriate 1364 appointment in accordance with the local lothescametoyourclinicrequesting rules. eatment, what would you do? How could h. Neverprescribeonthetelephone. y determine his eligibility for txeatent9 Obtain accurate information if the dentist is Th easiest way is to look at his identific tion busy, and determine whether the nature of card. You can then determine whethe he is the call is administrative or professional. on ave duty, a reservist, a re or a i.Record calls. If the telephone message is civilia All of these categories are au orized for someone who is not available at the time, some pe of treatment. To de -a. ine a or if it requires information that needs further patient' treatment eligibility, you t know investigation, be certain that the inforination the type of dental attendance av:4ble and isaccurately and completely recorded. A the categes of patients that are uthorized convenient form (SF 63, Memorandum of treatment. Call) is available for this purpose. These forms Types o dental attendance. I" ere are two come in pads, and if you need to keep a typesof entalattendanc eneral and record of calls, slip in a piece of carbon paper. emergency. e types of atten ance indicate the scope of tatment provid . Exercises (007): a. Generalntal attendan. This includes Indicate which of the following statements allthe medi , surgical, d restorative are true and which are false by inserting a T treatmentof raldi injuries,and or an F in the blanks provided. deficiencies thacome wiin the field of _1. There are no special problems connected dentalando surge u commonly with telephone mannerisms, since the practiced by thdentalprofession. This person to whom you are speaking cannot service ispreve tivea dcorrective.It see you. includes: _2. When you speak on the telephone, you (1) Dental exina ons and advice on should speak as a representative of a dental heal dentalservice whoiseager for the (2) Restoration of ost tooth structure. opportunity to help. (3) Treatment o p riodontal conditions. _3. It is important that your telephone voice (4) Surgical procurea. be businesslikenever give a hint of a (5) Replacement of missing teeth smile by the tone of your voice. essential to nal appearance, the _4. Concentrate on the task you are doing; if performance military duty, or the the phone rings, the caller can call back proper mastS a ion of food. after you finish. _5. A caller's tune it too valuable for you to b. Emergency dtalattendance. This is ever doublecheck specific information the dental care ren for humane reasons given or taken on the telephone. torelievepain,to eatacuteseptic _6. Therearelocalgroundrulesand conditions, or toare fpainful injuries to limitations as to information you should the oral structure. Emency dental care is give on the telephone. authorized worlide fpersonnel of all _7. Itisyourfunctiontodiagnose; categories. therefore, there are times when it is both diplomaticandproperfor you to Patient cateriesautrized treatment. diagnose over the telephone. Dentalcare sauthori edforvarious _8. You should never diagnose nor prescribe categories of rsons atir Force dental on the telephone. facilities subje t to the folioing limitations: _9. In some cases, you should keep a record a. Active utymilitarypersonnel.Air and a duplicate of certain telephone Force persoel and otherembers of the messages. uniformed cesonac vedutyare authorizedeneral dental atdance in Air Force den facilities.Unif ed service 00 Given a list of types of care membersust use the facilitiesf the parent need match each with th per type of organizati n or service if theacilities are dental andance in er list. Designate availablend capable of provid g the care the correctrder o nority for the dental required Personnel of one service assigned to attendance individuals inspecific duty wianother service are given outpatient categories. treatmt on the same basis as sonnel of the .ce rendering the txeatment. De ming Trea t Eligibility. Who is b. etiredmembers of the ormed aurized dental care? person in civilian servi es. Retired members of the u iformed
17 1364 21) MODIFICATIONS
(have) been deleted in /g- 0-72(7 of this publication has Implementation of a adapting this material forinclusion in the "Trial in Vocational Model System to Provide MilitaryCurriculum Materials for Use extensive use of and Technical Education." Deleted material involves appropriate military forms, procedures, systems,etc. and was not.considered
for use in vocational andtechnical education. 0
i- , 12 13 14 15 16 2 3 4 5 D 7 8 9 1001 rn, r ' -n 0 19 18 17-4 a 32 31 3029 28 27 26 25 2423 22 21 20
011. Nee.hletelNe Pest Crewn. 01. Teeth Misslag. #12. Open face Chad Crown. #2. MesierOulvseDistePodel Amalgam. end 013. Gold Crown with Pien-Metoltic Peeing. 03. Consbinetien Restsratien, Amelgens 014. Oschisel Amble's% Geld. Cans* *13. Mese.Ocevse-linguel Gold inlay. if& Three.Ouerter Omen end Root *15 end 011. Teets missing, replaced sy fining. remissible pertiel denture. 04. Deciduous #4 present in piece el #20. Mesits-OccluseDistel Ansolgens. petameneet 04. (Fer inspected perrnanont *22, #23, end #24. fined Partial Denture. 044 circle es shown fro teeth 032, Threeirverter gold crown on #22 end tiger* 2, on theft, "Diseeses end 24, supporting pentk replacing Abownselities.") percelein, 023 with non.rnetellk facing. 07. Ildwaend Crown. Feting vney be 11124. Unreel Nen.Meteltic Restoration. Root acrylic. *r silicate filling motorist. Canal filling end Apkrtectorny. Pest end Root Cosa filling. 0211. full Geld Crown. 05. Distal Non.Metalic Rest...Ken. 020. 030. end 031. Teeth reining,replaced 01. lesa-Metellic Jecket Crown. by rtnnevable ascii& denture. 010. Retained Deciduous Cuspid between permanent teeth #10 end 011. #32. Teeth missing.
Figure 2-1. Charting of missing teeth and existingrestorations.
tment consisted of rem g the old mists m the tooth. Regional red. reration and replac' t with a new sut was ad amal restoration
35. Thepent is suring from an acute and severe periap abscess of the 017. Given a chart showing the surfaces and ary right central r. Treatment roots of various teeth, and a list ofdental 28' 1364 22 conditions, mark the chart with the symbols defect or a restoration. Such double use of a used to depict these conditions. single symbol will not, however, result in confusion on SF 603, as separate charts are ChartingSymbols.Although you are provided for defects and restorations. Any probably familiar with the frequently used attempt to use the symbols to chart dental charting symbols, a comprehensive review of records that have only a single chart will make them is in order. Figure 2-1 shows tharting itimpossibletodetermine whether the symbols that are used to depict missing teeth symbol is intended to show a defect or a and existing restoration, while figure 2-2 restoration. shows charting symbols that illustrate diseases Charting missing teeth. The guidelines for and abnormalities. charting missing teeth are as f3llows: If you compare the entries in figures 2-1 a. Edentulous Arch or Mouth. Inscribe two and 2-2, you will find that certain of these crossiiiiThiis, iIII ruNiuirgfromthe symbols may be used to indicate either a uppermost aspect of one third molar to the
11 12 13 14 15 16 1 2 3 4 5 6 7 8 9 10 rn,
32 31 30 29 28 27 26 25 24 23 22 2120 19 18 17 Illosillaggi, .mil MASI CM: SO a ei a & A AOle 0tab0 IsmlaW0011OY 10 "111."P i II tiljn I1 1 WI 02. MesioOctiosol Cosies. 016. Cyst lavalviog 01$ sad *16. 03. OioulCarist. 017. IloesupIed Toork. (If oot visible in oral 04. fabooion indicated. cavity, on "X" world oppose or 06. MesioI Cosies. corresponding Mork ow owl "Missing Took 07. Abscess Periopod. sodfoisting ResIsprOksos.") OS.frolores1 Crown. 020. Itesidool Root impairing removal. #11. fre(ured Reolfalrectisso intuited. 023 tkeeogh 026. Giftgivol CreaContinu. 010. Oboes' sod TWO. urscierfaleri roof ors WOO. Olveslor CrstCootiassors con& (Ming. 011 Rooked Roo. 032. Impeded TeNk with osesiol 014. Defooice ItestorolionOroIkse incksdes Direction ef rrow will itidicore degree ef oo ef restecorien o be replocol end defective ores.
Figure 2-2. Charting of diseases and abnormalities.
29 1364
9r) lowermost aspect of the third molar on the denture base material. In chrome-cobalt cases, give the type for possiblefuture repair opposite side. the restoration is b.Individual Missinj Teeth. Draw an X on purposes. State whether the root or roots o eacWatural tooththat serviceable or unserviceable. does not appear in the mouth at the timeof i.Fixed Partial Dentures. Outline each tounerupted, aspect,inclaiig atrM'rients and pontics. examination.Thisapplies materials and extracted,orcongenitallyabsentteeth, Show partition at junction of regardless of whether they have been replaced show each material used, exceptgold, as indicated above; show gold byinscribing by fixed or removable partial dentures. diagonal parallel lines instead ofhorizontal c.Deciduous Teeth. If only the deciduous toothiliT?resent, inscribe a block letter D parallel lines. Note defective fixedpartial around the number of the corresponding dentures under Remerks. Example:Defective permanent tooth. If both the deciduoustooth pontic *10 or defective artificial crown=11. and the permanent tooth are present, show J.Remarks. Under Remarks, add any other their relative positions on the chart. Indicate pertinent remarks relating to missingteeth the position of the deciduous toothby and existing restorations. placing the number of the permanent tooth in the relative position that the deciduous tooth Charting diseases and abnormalities. 'The occupies; inscribe a block letter D aroundit. following guidelines indicate the authorized method for charting diseases and Charting restorations.In the diagram of the abnormalities. Care is necessary to insure that tooth, draw the restoration and showthe you do not enter thesesymbols in record approximatesize,location,andshape. areasdesignatedformissingteethand Identify restorative procedures and prostheses restorations. Entering these symbols in the in accordance with the instructionsbelow. wrong area would preventdifferentiation a. AmalgamRestoration.Outlineand between the caries and the restorations. block in solidly.haZ-Tt-iiiitimal restorations a. Caries. On the diagramof the tooth inposterior teeth on facial and lingual affecOTaraw an outline of the carious surfaces only when the restorationextends portion, showing approximate size,location, onto these surfaces to a greaterextent than is and shape; block in solidly. neceuary for theprevention of recurrence of b.Extraction (Removal) Indicated. Draw decay. two pWriniiiticiiiiies throuah all aspects applies b.Gold Restoration. Outline and inscribe of the tooth and roots involved. This horizar parallel lines within the outline of also to unerupted teeth whenremoval is indicated. In case of a retained root,draw two the restoration. long axis c.Nonmetallic (Sake*, Porcelain, Am parallel lines in the direction of the Restorations, ArtiaisiTiowns, and Fdacshmgs ). of the root through the part that isretained. 1:51Varriy outirrie-ErstzTlerratiOran ape Indicate the missing portion of the tooth with of restoration and each aspect of the crown or an X. facing. c. Abscess or Cyst.Outline approximate d.Combination Restoration. Outline area, size, form, andTocitiBit. showing approximate size, location, (I.Fistula. Draw a straight line from the and shape; partition at junction ofmaterials abscess area, ending in asmall circle in a position on the chart corresponding tothe used. Show each type of material used. the e.Post Crown. Outline each nonmetallic location of the fistulous opening into restorativemetallic mouth. materM an-aihow Unerupted Tooth. Outline all aspectsof materials.Outlineapproximatesize and e. the tooth with amlkoval. position of the post or posts. fracture f.Root Canal Fitng. Outline each canal f.Fractured Tooth. Trace a jagged line alErigatliiTTosition onthe crown or broCrin so dIy. indicated, chart is g. Apicoectomy. Draw asmall triangle, roots. When removal is apex away from the crownand base line at outlined inbabove. g.Periodontitis and/or Alveolar the approximate line of the rootamputation. extentofgmgival Placeahorizontalline Resorption.Indicate h.Dentures. recession lath acontinuous line drawn across betweetilleciutline of the teeth and the involved. In the case of replacedby the roots in the areas numeralsdesignatingteeth active periodontal disease, place anX in the removablepartialdenturesonly.Under partial proper box under"B. Periodontoclasia." Remarks, deacribe full and removable Indicate the extent ofalveolar resorption by dentures,indicating whether maxillary or line across the mandibular; the type of restoration; andthe drawing another continuous 1364 30 9 4 ARNORMAirms MISSING TEETH 4 EX1STiNG RESTORATIONS DISEASES 1 AlII el Oa 1111100 Ilkikkossam illipAson.1 TeAgroMA cot voNip vs isivOir I II I letv *1 4 4. II II q 414: 2 q of : VI I, IsIVIIII7141111, es a s a t /0 VP IIr. I I,ft PO II arlyMitirkin ayskismiasflayikolus 1. A ,ereigtten ft I e 410 WU I ITTI'Vtiv
Figure 2-3. Clout* maths (objective017, exacta 1). roots of the teeth at the properkW, based ElTooth missing. *2 Mesiolicclustkingual gold inlay. on etnical and radiographkfindinp. h. Reso tion of Root. Draw an even line *3 Defective distel-occluml reetotation. *3 Distal-occhisal amalgam. showing omen ns--Tiption of root. Note charting of fractured tooth as givenin f *4 Extraction indicated. *5 Openpfaced gold clown. above. *6 Nonmetallic jacket crown. 1. Defective Restoration.Outlinethe. defective rntoratii;Iiiiraing the carious or *7 Medal nonmetallic restoration. otherwise defective area, and block insolidly. *7 Distal caries. *6 *9, *10Fixedpartialdenture. I. Inclination of Impacted Teeth. Place an Thrsequarter crown on $11 and 010 snow Th.-CIRC.townportion of the tooth form, of the supporting a pontic replacing missing showinc Ike direction of the long axis tooth *9 with a nonmetallic facing. tooth. *11 Retained deciduous cuspid between k. Abnormalities of Occlusion and and any permanent teeth 010 end *11. Remarks. Describe m-Roccrusiciri *12 Cyst involving *12 and *11. remarks petaining to diseases oKet *14 Full gold crown. and abnormalities that are found. Comments oral or *15 Tooth missing. about therapeutic radiation to the $16 Unerupted tooth. when considering perioral structures *17 Mesio-occlusal amalgam. treatment are particularly prosthetic *16 Abscess periapical. noteworthy. *19 Occlusal amalgam. 1. Special Entries for Identification. as *20 and *21 Teeth missin& replaced by a Recad underiWarkr-findmga removable partial denture. abrasion, mottled enamel, erosion, *22 Lingual nonmetallic restoration. hypoplasia,Hutchinton'steeth,rotation, of alignment, driftingor Root canal filling and apicoectomy. irregularity *23 ?Maid caries. malocclusion of teeth, pretence of supernumerazy teeth, abnormalinterdental *24 and *25 Teeth miming, replaced by a removable partial denture. space*, mucosal pigmentation,leukoplakia, diastema, torus palatinus ormandibularis, *27 Residual root requiring removal. bodies,andunusial *28 Mesio-occluso-distal caries. embedded foreign *29 and *30 Teeth missing, replaced by a restorations or appliances. Theseentries are important for diagnostic andideatification removable pa:fibs denture. *32 Impacted toothwith 45' medal imposes. IL Fit in in state= Exercises (017): and conditions by placing with DD 1. Record th following th Recotd. the propet symbols on figure2-3. 1364 31 MODIFICATIONS
IPLof this publication has (have) been deleted ln
"Trial Implemettation of a adapting this materialfor inclusion in the Ser-Use-in-Vocational-- ModelSystem to Provide MilitaryCurriculum Materials xtensive ust of mut Technical Education." Deleted material involves appropriate military norms, procedures,systems, etc. and was not considered for use In vocational andtechnical education. CHAPTER li
Safety, Housekeeping, andEquipment Maintenance
speeds, operating controls,and guards may AN IMPORTANT aspectof your job is to do is to reed the safe environment differ, the wise thing to provide a neat, clean, and operating instructions for the newequipment for your patients and fellowworkers. To safety must very carefully.This first principle of furnish this type of. environment, you demands that you know yourequipment and maintaina tidy work area,keep your safely! Be sure to ask irigoodrepair,and conduct know how to operate it equipment your supervisor forinstructions or reed the yourself in a safe manner.We begin this operate any chapter with a discussion ofthe principles of operating instructions before you safety. By following theseprinciples, you'll be new or unfamiliarequipment. able to protect yourself, yourcoworkers, and your patients fromneedless injury. Exercises (070): 1. Who teaches thetraining you should 5-1. General Safety Ptinciples receive before you operateequipment? We all know that everyonemakes mistakes. Some mistakes are of littlesignificance, but others have led to lou of limband to loss of ofnine 2. Whatisthefirstprincipleof safety life.Therefore,thediscussion familiar principles of safety that follows isoffered in .regarding the use of either new or an attempt toward making you equipment? safety-conscious while you work. 070. State who teaches thetraining you need for you to equipment,thefirst 3. What isan alternate way beforeoperating familiarize yourself with newequipment principle of safety when using new orfamiliar solely on your equipment, and a way to familiarizeyourself other than by relying with new equipment without relyingsolely on supervisor? your supervisor. Preoperational Training. Naturally, a man must know theproper way tooperate equipmentifheistodoitsafely. it relates to Preoperational training, as the nameimplies, 071. Defme "self-discipline" as andstate who hasthe primary is the training a man shouldreceive before he safety safety check operates equipment. It is necessarybefore responsibility for performing a operating any. Air Force equipment,whether of equipment in yourwork area. itis a handpiece, powersaw,forklift,or either in a Discipline. The secondmajor principle of screwdriver. You are taught this inbasic formal technical course or bY yoursupervisor safetyisdiscipline. You learned howimportantgood in on-the-job treblingperhapsboth, as time militarytraining disciplineisinthe classroom and inthe goes on. drill. It is even more Preoperation al training is especially execution of close-order important if you acquire newequipment. important whenever thereis a threat to your Don't assume that because you are askilled personal safety. operator of the oldequipment. you can Forconvenience,let'sdefinegood proceed immediatelyto operate the new observance. Now, equipment. Since such things asoperating discipline simply as law 1364 r 96
...,9 ^-y f thereisanother kindof disciplinelaw that occur outside of you and distractions enforcement. Law observance comes from that occur inside of you, either mentally or within yourself; in contrast, law enforcement physically. You must do your best to keep comes from the outside. Being arrested for from being sidetracked by every distraction speeding is an example of outside discipline. that comes your way. However, if you observe the speed limits, you have exercised self-discipline, another name Exercises (072): for law observance. Mark each of the following statements with a Of course, self-discipline is best. For one T or an F in the blanks provided to show thing,it means that you are thinking for whether it is true or false, yourself.Ontheotherhand,outside _1. Alertnessisof minor importance in discipline, -or- lair-enforcement, -means that avoiding aCcidents. someone else is doing your thinking for you. _2. The principal enemies of alertness are So, for our purposes, the meaning of good external and internal distractions. discipline is self-discipline. To illustrate the point of self-discipline, let's consider electrically powered equipment. 073. Given a list of unsafe working practices In anyfacility,thesupervisorandthe that should be avoided and another list of personnel working under him should check work situations, match each unsafe practice electrically powered equipment for frayed with the work situation to wh" ti it applies. wiring, looseconnections,.andproper grounding.Butwhohastheprimary Avoiding Unsafe Practices. Th.- three major responsibility for checking the equipment in principles of safety you have studied so far your work area? The answer, of course, is are preoperationaltraining,discipline, and you. This is because the supervisor simply alertness. A fourth major principle involves cannot check all equipment each time before avoiding unsafe practices.Ofcourse, itisused. Consequently, you must use preoperational training, discipline, and self-discipline in this area unless you wish to alertnesswillhelp you toavoidunsafe risk your life. practices; but, at the same time, it's well to know just what unsafe practices are. While it Exercises (071): would not be practicable to discuss every kind 1. What is meant by the term "self-discipline" of unsafe practice, we can ct,nsider some of as it relates to safety? the most common types of unsafe practices thatoccur inoperating equipment, using tools, and handling materials, along with the general safety principles that apply. 2. Who has the primary responsibility for According to the National Safety Council, performing a safety check of equipment in faulty handling of material is the major source your work ales'? of injuries on the job. Most of these injuries are back injuries caused by improper lifting of heavy objects. When lifting heavy objects, the main point to remember is don't bend your back if you can avoid it. Keep your back as 072. Givenstatements about thegeneral straight as possible. The idea is to -lift with safety principle of alertness, indivite which your legs, not your back." Squat down, get a are true and which are false. good grip underneath the object, then lift slowly with your legs. Alertness. So far, you've learned about two Another unsafe practiceis working too major principles of safety:preoperational fast. You can work too fast at any job you do training and discipline. A third principle of in the Air Force. However, you shouldwork very great importance is alertness. Constant ata moderate,consistent pace whenever alertnessisa prime requisiteinavoiding possible. Undue haste may cause a mistake in accidents. judgement, resulting in an accident. Fundamentally, alertness means "paying Stillanother unsafe practiceisusing a attention"to what you're doingnot just handtool or instrument for a purpose other "now and then" but all the time. Unless you than that for which it was designed. For pay close attention, you may do something example, it is unsafe to use a dental chisel as a wrong that will cause an accident. screwdriver. Its cutting edge is likely to slip The principalenemies of alertness are off the screw and lacerate some part of your external and internal distrac.ionsdistractions body, and you will also ruin the chisel. 96 28 The way you use knives can also be an each day's work, eat balanced meals, and unsafe practice. It is always unsafe to cutparticipate routinely in a physical exercise toward yourself. A slight -lip can cause you to program. Faulty sight or hearingis a prime cut yourself severely. Thus, always cut away'cause of accidents.If you notice blurred from yourself after making sure no one else is vision or a decrease in hearing, arrange for a in the curling path. medical appointment so the defect can receive attention. Always do all you can to stay as Exercises (073): healthyas possible. Thiswill reduce the probability of accidents as a result of physical Match each unsafe practice listed in column B deficiencies; it will also relieve you of worries that should be avoided by placing a letter about your physical conditionand worrying from this column beside the work situation to accidents. which this unsafe practice applies in column can decrease alertneu and cause A. Match one blank twice. Three practices in column B are safe, so do not enter their Exercises (074): . letters. Insert a T or an F besides each of the following statements to indicate whether it is Column .4 Column B true or false. 1. Lifting objects. a.Cut away from your- _1. Poor mental fitness and poor physical 2. Workingatcorrect self and others. fitness are NEVER causes of accidents. pace. b.Bend your back but 3. Usinghandtoolsor not your lep. _2. Mental fitness includes the following: instrumentsforap- C.Get a good grip on using only prescribed drugs, engaging in proved p u rp oses the top of the object; well-balancedmentalactivities,and only. liftsuddenly,with getting appropriate rest. 4. Using knives. the back serving as a fulcrum. _3. Staying as healthy as possible will reduce d. Use a handy dental mental worriesthatcould cause chiseltoloosen a accidents. !Crew. e. Performing a task so rapidly that a mis- 075. Completetheblanksinstatements takeinjudgement dealing with avoiding physical hazards. occurs. f. Lift with your legs, not your back. Hazard Avoidance. The sixth major safety g. Work at a moderate, principle is to eliminate, minimize, or avoid consistent rate. physical hazards. Now, every job situation has h. Keep thecutting edge toward you. its own peculiar physical hazards. Since there are thousands of jobs in the Air Force, we can about thegeneral consider only a few representative examples. 074. Given statements Equipment and instrument hazards. Among safetyprincipleof mental and physical the important physical hazards you may fitness, identify each true statement with a T expect to encounter in the dental clinic are and each false statement with an F. the dangers imposed by the moving parts on Mental and Physical Fitness. Maintaining equipment and the hazards associated with mentalandphysicalfitnessisthefifth dental instruments. However, proper handling principle involved in avoiding accidents and and precautions on your part can either eliminate or minimize the hazards involved. promoting safety on the job that we shall Most dental equipment hazards can be dealt discuss. Mental fitness. The mental fitness aspect is with by making maximum use of the guards :omplex, to say the least. Much has been and shields that are provided. The hazards written about the subject, and there are many associated with dental instruments can be different views about it. Generally speaking, minimized bypositive instrument control mental fitness may be approached in a similar (proper instrument-passing techniques and way as physical fitness. Just as your physical proper instrument grasps). body needs proper nutrition, exercise, and Fire hazards. A major physical hazardis rest, so does your brain. Make sure that you fire. Many different factors can cause afire, use only properly prescribed drugs, engage in which is the common name for thechemical well-balancedmentalactivities,andget reaction known as combustion. Fire is really a appropriate rest. chemicalreactionbetween two or more Physical fitness.Just as impaired mental substances. Three elements are necessaryin fitness can result in accidents, so can impaired order for the chemical reaction of combustion physical fitness. Get plenty of rest before to take place: fuel, oxygen, andheat. the following Before you can have a fire, you musthave condition,one or both of mayoccur:(1)lossof job something that will burn. Thatsomething is situations be able to turn called fuel. In order for combustion to occur, efficiency, since you won't out as much work; (2) asafety hazard. you must also have oxygen,which is usually that o supplied from the oxygen in theearth's Regardless of the piece of equipment alone are you may be operating,watch out for any atmosphere. But fuel and oxygen such conditions not enoughthe thirdrequirement is heat. "play" that may result from as nuts becomingloose, parts becoming worn. Therefore, if you have fuel that is hotenough getting out of adjustment. and sufficient oxygen is present, youwill have or working parts Any of these conditions cancause play to combustionor fire. develop, and this couldbecome a safety This leads us to the main point concerning off, for combustionif you take away any one ofthe hazard (because of partsfalling instance). three things necessary for combustion, you cutting tool or will not have a fire. Thus, oxygenand heat are If you're using any kind of are operating amachine used as a drill, the not enoughthere's no fuel toburn. Likewise, sharp. Any tool or with just oxygen and cutting edges should be you will have no fire machine cutting edge that isdull may slip, fuelif the fuel isn't hot enough toburn. The ant" cause an secret of extinguishing afire is to remove any break, or otherwise malfunction one of the threeelements, and the fire will die injury. keep all three of these On.electrically operate achines, switches out. But better still, should be in top condition.defective switch elements from getting together resulting in a simultaneously and you will prevent afire might be an electrical haze.' shock, or it might keep youfrom stopping a from starting. machine when you want itstopped, and thus cause an accident. Exercises (075): Before operating any machine orpiece of Enter an appropriate wordinthe blanks equipment, become thoroughlyfamiliar with provided to complete each of thefollowing its parts and becomeespecially familia' with statements. the safety hazards that maydevelop as a 1. Eliminate, minimize, or the peculiar result of defective or worn parts.Know what physical hazards associated with yourjob hazards tolookfor and look for them situation. frequently. Equipment maintenance is discussed in more detail laterin this chapter. 2. Most dental equipmenthazards can be dealt with by making use of the Exercises (076): provided. guards and shields that are Mark each of the followingstatements with a T or an F in the blanksprovided. 3. Positive instrumentcontrol, as reflected by tool is more techniques and _1. A sharp cutting edge cn a proper instrument-passing likely to malfunction and cause aninjury proper grasp of theinstruments, can with dental than a dull edge. thehazards associated _2. "Play" caused by nutsbecoming loose instruments. (or by worn orout-of-adjustment parts) of equipment to of the three elements cancause a piece 4. Eliminate any one become a safety hazard. necessary forcombustion and you will an existing fire.Prevent all three elements (fuel,oxygen, and heat)from 077. Given a list ofdescriptions of working getting together simultaneouslyand you conditions, select those that aredesirable for will a fire. a safety-orientedenvironment by matching each desirable conditionwith the applicable environment item given inanother list. 076. Given statements concerningthe general Theighth properequipment Satety-Oriented Environment. safetyprinciple of major principle of safetyis that the operating maintenance, identify each truestatement environment should beconducive with a T and each false statementwith an F. or working tosafety.Your immediatesurroundings (environment) can help orhinder you from a Equipment Maintenance.The of Proper safetystandpoint.Underthetopics seventh major principle ofsafety is to keep physical hazards, we have good operating physical fitness and machines and equipment in severalelementsofthetotal condition.If any machine is not ingood discussed 98 3 0 environment. Now, let's look at certairiother Column B elements. withoutcreatinghaz- One of these elements is good ards. it e. Position equipment so housekeeping. Just as youfind that operator faces advantageous to live in a well-kept household, doorways, halls,and so you will fmd it equally desirable towork in windows, and can be a well-kept working environment.Both are alert to what is happen- conducive to safety. ing around him. One of the elements a good housekeeping is disposal of waste and scrap. If floors or 078. State the factor that determines the workbenches are cluttered by such material, amount of preoperational planning that is the chances of an accident occurring are necessary in order to observe proper safety definitely increased. It is important to keep precautions, and specify what items your floors and workbenches clean, especially from check of safety Instructions may include such*matter as oil, _grease, paints, chemicals, before you start a job. radioactive materials, and any thing else that may pose a safety hazard. Youshould also Preoperation Planning. The ninth and last keep handtools and machine tools clean. If principle we shall discuss is this: Proper they are greasy, for example, they may slip planning must precede operation. No matter and cause an accident. Aside from keeping what you are getting ready to do, you should itemsclean,goodhousekeepingmeans think about it and plan your activity properly keeping tools, materials, and other items you sothatyouobservenecessarysafety use properly stored in goodorder. A working precautions. The amount of advance planning environment that is cluttered with tools and you do depends, of course, on the natureof materials poses a safety hazard. the task. Some jobs require more advance Thelayout. ofequipmentisanother planning than others. But all tasks warrant a important safety factor. Equipment should be certain amount of planning ahead. positioned so that the operator will have Doubtless, the most important thing to sufficient space to handle stock (the materials bear in mind when planning to begin a job is he's working on) without creating a hazard to to check any pertinent safety instructions. himself orothers. The equipment layout These may concern the materials yoti will should also be such that the operator will not workwith,protectiveclothing, machine face doorways,halls,windows, or other guards, and the type of machine or equipment distracting areas. As you learned earlier, onethat you will use. Be sure to study safety majorprincipleofsafetyis"constant instructions carefully, especially if the job or alertness." Facing any distracting area may equipment is new. As you begin each day's tend to diminish alertness and divert attention work, even on comparatively simple tasks that you are familiar with, it's agood idea to plan from the job. ahead to be sure that all pertinent safety being observed.If guards, Exercises (077): principlesare protectiveclothing,andother protective Match each desirable conditionlistedin items are called for, are they available to you? column B with the appropriate reference to a In brief,is everything "shipshape" for the safety-oriented environment listed in column day's work? A in the blanks provided. Do not match the Whatever the job you are assigned to, look two undesirable conditions listed in column for the nine principles o f safety you have just B. studied. If your unit is "safety conscious," you'll find them. If not, it's up to you to help Column A Column B make the unit safety conscious. Remember, _1.Good house-a. Floors or workbenches keeping. clutteredwith waste "The life you save may be your own." In 2. Layout of equip- and scrap. everything you do, "always be careful." ment not directlyb. Keep floor and work- involving house- benches free of grease. Exercises (078): keeping. oil, chemicals, or radio- active materials. c. Keep hand or machine 1. What determines the amount of toolsclean,properly stored,andingood preoperational planning that is necessary in working order. order to observe proper safety precaution? d. Position equipment so thatthe operator has sufficient working space 3/99 lighter or 2. Before you begin a job, youshould check thoughtless lighting of a cigarette What may match in a gas-filled room is certainto cause pertinent safety instructions. (explosion). To, prevent these instructions deal with? LI instantaneous fire this type of fire hazard, followthe procedures that were given for preventingthe hazards of breathing gas vapors, but go one stepfurther. Make sure that you spread thealarm quickly to prevent lighting of thelethal fuse. 5-2. Items Requiring Safety Electrical Wiring. Electrical wiring is often Precautions a source of tragedyusually inthe form of The nine general safety principles wehave fire or electrocution. Moreover, thispotential discussed may be applied (at leastin part) to danger is present in Air Force dental clinics. any environment.But in the dental clinic As is true of most potential hazards, thekey environment, there are specificitems that to handling the electrical wiringhazard is require special attention forsafety purposes. prevention. Among theseitemsaregasses,electrical Preventing electrical wiring hazardsinvolves wiring, burn hazards, slipperyfloors, and detecting potential trouble areas andhaving adverse personal behavior. corrections made. You must havefrayed makesurethat to factors in wiringreplacedand 079. Given a list of references overloadedcircuitsarecorrected.Have the dental clinicenvironment which may abnormally warm electrical cords andwiring involve safety hazards andgiven another list checked for potential hszards. of descriptions of safetyprecautions against dental clinic is also a these hazards, match eachreference in one list Burn Hazards. The in the other list. place where burnsocdur frequently. Most to the applicable precaution bums are received frombunsen burners, and hot Gasses. Commonly, gasses are usedfor two alcoholtorches, hot equipment, instruments. Most of thesebums can be different purposes in Air Forcedental clinics. For dental prevented ,byusingcommonsense. Oneistheoxygenusedfor burners and snuff emergencies, and the other is eithernatural orexample, shut off bunsen in burners andout alcohol torchflames after each use. In prepared gas used for fuel to hot equipmentitems (such as heating systems. regard assuming that they As mentioned earlier, oxygenis one of the sterilizers), form a habit of Therefore, you are hot and reactaccordingly. Finally, make three items necessary for fire. instruments are either left in must be extremelycareful in handling oxygen sure that all hot respect, never handlethe sterilizer until theycool, or dip them in a equipment.Inthis for cooling before oxygen equipment insuch a reckless mannercold disinfectant solution as to producesparks. This means that youyou attempt tohandle them. must store oxygentanks in a secure, upright Slippery Floors. Another commonsafety position and that you must not usewrenches hazard in dental clinics is aslippery floor. on oxygen controlmechanisms. Sparks caused This condition exists duringfloor-cleaning by falling oxygencylinders or by wrenches operations and sometimesfollowing waxing slipping from oxygen controlshave started operations. As a warningagainst this hazard, tragic fires. post signs duringcleaning operations (they Naturally, you should respectnatural or mayread"WetFloors")and usea propane gas as youwould oxygen; sparks can skid-resistant wax. Always besafety-conscious ignite this gas also. Even asmall leak could when you are near a slipperyfloor. soon fill a roomand present danger in two Another breathing of gas vapors Adverse Personal Behavior. ways. First, prolonged potential hazard in the dentalclinic results causes the gas to enterthe bloodstream and attitudes. For eventually reach the brain.This can result in from individual actions and and may lead to example,horseplayandalackadaisical impairing one's judgment canlead to keep this from attitude toward safety unconsciousness. To unwarranted safety violations.To eliminate happening, you mustrespond quickly and behavior, adopt a is, you must this type of undesirable decisively to gas leaks. That professional attitude and practicebeing safety make sure that the smallestleak (detectable practice of safety and adequate fresh air conscious at all times. The by smell) is reported in the dental clinic adds upto preventing ventilation is established. life (maybe your The second danger posedby a natural or injuries and possibly saving propane gas leak is apotential fire. Careless or own). 100 3 2 Exercises (079): 080. Given specific statementsabout housekeeping procedures applicable to dental Match each of the statements relating to equipment, identify which are true and which safety precautions in column B with the are false. factor associated with that safety precaution in column A by inserting the appropriate Equipment Cleaning. The big problem letter from column B in the blank provided in behind improperly cleaned equipment is not column A. "how to clean it" as much as it is failure to Column A Column B carry out the cleaning responsibility. All too 1. Oxygen used for den-a. Replace frayed wir- often, the dental assistantfallsinto the tal emergencies. ing. correct over- "seeing is believing" group. That is, if the 2. Naturalor propane loaded circuits, and gas used for fuel. check abnormally equipment looks clean, he believes that it is 3. Electrical wiring. warm cords and wir- clean. Of course, we know that this is not ._ 4. Burnhazards. ing. alwaystrue,sincemicro-organismsare 5. Slippery floors. b. Shut bunsen burners invisible to the naked eye. Therefore, the key 6. Adverse personal be- oft and extinguish regardingdental havior. alcohol torch flames togoodhousekeeping after each use. equipment is to form a habit of cleaning at c. Report smell that in- prescribed intervals and to accept cleanliness dicates even a small as an absolute must in the dental clinic. leakandestablish fresh air ventilation. Mostly, the cleaning of dental equipment d. Avoidhandlingin- involvescleaningchrome-plated,painted, struments too stainless-steel, and upholstery. surfaces. As a quicklyafterthey general rule, wipe the chrome-plated, painted, havebeen leftin and stainless-steel surfaces daily. Occasionally sterilizer. e. Careless or thought- (at least twice weekly), wash these same less light:4 of a cig- surfaces with a damp cloth and mild soap. arettein a room Further, apply a quality automobile paste where leakage exists. wax to chrome-plated and painted surfaces, f. Storetanksin up- stainless-steel right position; avoid and apply metal polishto handling in a manner surfacesmonthly. Tocleanupholstery thatwill produce surfaces, use lukewarm water and mild soap. sparks. Apply only a thin layer of suds to the surface g. Use a skid-resistant with a sponge. Then, use a cloth dampened wax and post signs during cleaning oper- with clear water to remove the suds. To fmish ations. the job, dry the surface with a soft cloth. h. Avoid horseplay and Beforeattemptingtoremovestainsor lackadaisical safety deposits from any equipment surface, consult attitudes. i. Adopt a professional the applicable service manual. attitude toward indi- vidual actions. Exercises (080): Enter a T or an F in the blank provided with 5-3. Housekeeping Duties each of the following statements to indicate As a chairside dental assistant, you have a whether the statement is true or false. continuing responsibility to maintain a clean _1. The problemof improperly cleaned work area. Failure to do so can cause patients equipment is not so much the problem tobecomeinfectedbymicro-organisms of "how to clean it" as it is failure to (bacteria)whichflourish inadirty carry out cleaning responsibilities. environment. Your job includes preventing _2. The keyto good dental equipment these harmful microbes from infecting dental housekeeping isto make a habit of patients. One preventive measure is realized cleaning at prescribed intervals and to through good housekeeping. Thatis, the accept dental clinic cleanliness as an equipment and facility must be kept in a absolute must. sanitary condition at all times. Naturally, this _3. Thecleaningofdentalequipment means that you must clean theequipment and involves only the cleaning and waxing of facility at prescribed intervals. Additionally, chrome and stainless-steel surfaces. many dental patients are knownto prejudge _4. Metal polish is applied to stainless-steel the quality of a dental service by what they surfaces monthly. see. A soiled uniform, a dustycabinet top, _5. To clean upholstery surfaces, apply a dirty floors, and a dirty bathroom can give quality automobile paste wax, then wash patients an adverse impression of a clinic. with a damp cloth and mild soap. 101 33 081. Supply important information relating solution sparingly and follow up by rinsing tohousekeepingpracticesinvolved with with clear water. Clean acoustical tile walls by facility cleaning by answering a series of key dusting themwitha dry clothor by questions. vacuuming. Don't forget to include doors, baseboards, and framework as you clean the Facility Cleaning. The two goals in cleaning walls. a dental facility are to keep dirt and filth at Windows. Another significant requirement the lowest possible level and to keep the in cleaning a dental facility is window clean- facility in a presentable condition. For the ing. Most Air Force dental facilities have most part, these two requirements are met alarge number of windows, which soon simultaneously. That is, when the facility is become "eyesores" because of neglect. A dental patient will frequently associate the clean, it is usually presentable, and vice versa. the Cleaning a dental facility involves cleaning its cleanlinessofa dentalclinicwith floors, walls, windows, furniture, plumbing cleanliness of the windows. Therefore, we fixtures, and light fixtures. must do our utmost to keep all clinic areas Floors. Various floor coverings are used in cleaninorder to eliminatedistrust and health care facilities. Among the more widely uneasiness on the part of patients. used ones are concrete, terrazzo, ceramic tile, Whenever possible, use clean water as a asphalt and asbestos-vinyl tile, and caipeting. cleaning agent on window surfaces. Clean Most AirForce dentalfacilities have a water is removed easier and streaks less than carpeting,asphaltor most commercial window cleaners. If water combinationof will not sufficiently clean a window, you may asbestos-vinyl tile, ceramic tile, and use a stocklisted window cleaner or add a sometimesconcrete as floorsurfaces. small amount of ammonia to water. Apply Normally, all of these floors require daily these agents with a soft, clean cloth and dry attention. by the windows with a clean, dry, lintfree cloth. Carpeting is usually maintained You can further diminish the prominence of vacuuming and spot removal. You should dryingcloth vacuum all carpeting in the dental clinic atthe streaks bymovingthe end of each duty day. This daily action is horizontally across the window, necessary to remove dust and Plumbing .fixtures. The primary micro;organisms. Try to remove unsightly requirements in cleaning plumbing fixtures spots by shampooing. If shampooing fails to involve two different types of remove a spot, consult with yourNCOIC su rf aceschrome-plated and porcelain. before using solvents. Normally,chrome-platedfucturescanbe Asphalt andasbestos-vinyltilerequire cleaned with a damp cloth and then polished sweeping, scrubbing, mopping, waxing, and with a soft, dry cloth. If you must clean buffing. The idea in maintaining this type of corroded, chrome-plated fixtures, use a sbft floor is to keep it polished and looking clean. cloth and apply stocklisted metal polish. Then To meet this standard, you must sweep, damp use another soft, dry cloth toshine the mop, and buff these floors at leastdaily. Also, fixture. Porcelain surfaces may be cleaned this standard requires you to scrub floors with scouring powder or porcelain cleaner coated with water emulsion wax at least liquid.Normally, scouring powder isthe weekly. Scrubbing is necessary to remove the choice for cleaning porcelainsinks, while soiled old wax and scuff marks before you porcelain cleaner liquid is used for cleaning add new wax. Resin-emulsion wax is more other porcelain bathroom fixtures. Be sure resistanttosoilandstainsthanthe you read the label concerningthe proper use water-emulsion type. For this reason, you of porcelain cleaner liquid, since it is caustic may wait for as long as 3 weeks or more to human tissues.If,for no other reason, before floors coated with resin-emulsion wax clean plumbing fixtures daily to maintain need scrubbing and rewaxing. Do not use their characteristic luster. waxes containing inflammablesolvents Lighting fixtures. Some Air Force dental gettingapprovalfromthe clinics have light fixtures suspended fromthe withoutfirst and installatAon engineer. ceiling.Becauseoftheirstructure Walls. Most walls in Air Force dental clinics location, such fixtures become dust collectors are either painted,tiled,or covered with and must be cleaned periodically (about once wood paneling. All of these surfaces collect each quarter). Before cleaning these fixtures, dust and must be cleaned periodically. The make sure that the electrical switch is in the exact interim between cleanings is determined OFF position. Then dismantle the fixture as by local conditions. To clean painted and much as you can without using tools.The wood-paneledwalls,applyamildsoap dismantling normally provides access to all 102 3 4 areas .of the fixture. Next, clean thefixture 6. Although clean water is preferred as a with a damp cloth. CAUTION: Be sure that cleaning agent on window surfaces, name you do not apply the damp cloth to hotlight two alternate ways to clean windows bulbs or lamps as this might cause the bulb or when water will not do the job. lamp to shatter. To reassemble a fixture, reverse the step-by-step procedure youused to dismantle it. Furnishings.The furnishings in Air Force 7. How often should plumbing fixtures be dentalclinicsincludepictures,window cleanedsotheywillmaintain their shades, drapes, tables, chairs, couches, and characteristic luster? desks. As a general rule, you should dust these items with a soft, dry cloth daily. However, if dusting does not remove the toil and stain, you may need to use mild soap and water or 8. What precautionary step should be taken shampoo. Milk soap and water are appropriate before the periodic cleaning of dental for cleaning painted and plastic surfaces. Use clinic lighting fixtures by the dismantling shampoo tocleanfabric-type upholstery process? found on some chairs and couches. Have drapes dryclesned. By keepingthese furnishings clean, you help the dental service put its best foot forward. This is especially 9. As a general rule, how and when aro true in connection with furnishings, since dental clinic furnishings dusted? most of them are located in the waiting room for all to see. Exercises (081): 10. How are drapes cleaned? 1. Whattwogoalsartusuallymet simultaneouslyincleaningadental facility?
082. Complete blanks in statements 2. How often do thevarietyof floor concerning housekeeping procedures required coverings used in most Air Force dental in areas outside the dental clink. facilities normally require attention? Outside Areas. Among the outside dental clinicitems that need attention are the building exterior, lawn, and parking lot. To 3. State briefly how carpeting is usually maintain the building exterior in a presentable condition, you should keep the windows and maintained. entrance ways clean and keep cobwebs removed from the exterior. Maintaining the lawn means that you should keep the grass 4. How often should you scrub and rewax: and hedges neatly trimmed, the walks and a. Floors coated with wateremulsion steps free of debris, and all litter picked up (particularlyaroundtrashreceptacles). wax? Normally, parking lot maintenance means keeping the lot free of litter.
b. Floorscoated withresin-emulsion Exercises (082): wax? Fill in the blanks in each of the following statements with the most appropriate word. 1. Among the dental clinic items that need attention are the building exterior, 5. Whatdeterminestheexactinterim lawn, and between cleanings of Air Force dental clinic walls? 2. Keep the windows and entrance ways and keep removed from the building exterior.
103 minor exterior 3. Maintaining the lawn, parkinglot, and area daily inspections, cleaning, and around trash receptacles includespicking repairs. All of these maintenanceactions are up theresponsibilityof you, the apprentice dental specialist. 54. Maintenance of Dental Treatment Organizational maintenance. Organizational Room Equipment maintenance is adefmitiveformof and Two men bought identicalhouses next maintenance that is the responsibility of, that is performed by, a using organization on door to each other. At the end of a year,each of sold his house and moved from the city.One itsassignedequipment.Itconsists .man received $1000 morethan the other for inspecting,servicing, lubricating, adjusting, intheprices repairing, modifying, and replacing parts or hishouse. The difference Organizational received wasduetothemaintenance assemblies and subassemblies. The maintenance requires the services ofqualified performed by each man on his house. maintenance personnel and the useof tools man who received themost had routinely to the made minor repairs and adjustments.The and test equipment notavailable other had made no repairs or adjustmentsof operator of the equipment. Itshould be any kind. From thisexample, you should be performed only by, or under the direct able to see the importance ofperforming supervisionof,afullyqualifiedmedical necessary maintenance.This section discusses equipment repairman. of maintenance of dental Field maintenance. Field maintenanceis theprinciples the maintenance performed by adesignated treatment room equipment and somespecific support of using functionsthatyoushould maintenanceactivityin maintenance organizations. This maintenance is normally perform. limitedto major repairs,inspections, and specific replacement of parts or assemblies.For Air 083. Giiren statements concerning is types of maintenance in onelist, match each Force medical facilities, field maintenance which it limited tothe services ofprecision with the type of maintenance to laboratories most closely relates inanother list. measurement equipment (PMELs) and the Atlanta Army Depot. Overall, Area maintenance. Area maintenanceis Types or Kinds of Maintenance. that maintenance performed by amedical themaintenance of medicalanddental medical equipment repair center (MERC)functioning equipment is the responsibility of the MERCs may be used to organizationthat usesit. To make this on a geographic basis. types provideprimaryorganizationalorfield responsibility easier to apply, these four existing havebeenestablished: maintenance support, or to augment ofmaintenance organizational maintenance capabilities. preventive maintenance, organizational maintenance,fieldmaintenance, and area maintenance. Exercises (083): maintenance. Preventive Preventive regarding maintenanceisthe care and servicingof Match each statement in column B equipment for the purpose ofretaining it in athe scope of responsibility withthe type or includes proper kind of maintenance to which it mostclosely serviceable condition. This the operation anduse,systematicinspection, relates as listed in column A by inserting detection, and correction ofincipient failures appropriateletterincolumn Binthe either before they occur orbefore they appropriate blank in column A. developintomajordefects.Preventive responsibility of the Column A Column B maintenance is a joint mainte-a. Performed by a using andthe 1.Preventive its medicalequipmentrepairman nance. organization on operator or user of theequipment. This level 2. Organizational main- assigned equipment; of maintenance is anextremely important tenance. consists of inspect- Proper 3. Field maintenance. ing,servicing, lubri- function of any maintenance program. 4. Area maintenance. eating, adjusting, re- care and use bythe operator and scheduled pairing, modifying, preventivemaintenance bymaintenance and replacingparts reliability, orstaembi4,sand personnelwill insure maximum subassemblies. How- prolong the useful life of theitem, and reduce ever. it requires the the time that the equipmentis inoperative. services of qualified Preventive maintenance includesthe following maintenance person- actions relating to the nel(performedby, routine maintenance or directly supervised proper operationand use of equipment: by, qualified medical maintenance of oil levels,simple lubrication, 104 36 Column B Probablythebestapproachtoward equipment repair- preventive maintenance of dental equipment am); it also requires is to begin each duty day by making a visual use of tools and test inspection, followed by an operational check. equipoised not avail- able to the operator During the inspection, rust look for obvious of the equipment. problemareas,suchasfrayed electrical b. The care and ser- wiring, missing screws, oil leaks, water leaks, vicing of equipment and the like. Then make an operational check .1 to retain it in a KV* viceeMe condition; I. of each of the four systems mentioned in the the joint responsibil- above paragraph. For example, try working ity of the medical the water syringe and saliva ejector to check equipment repairman the water system. Try operating air-driven and the operator or user of the equip- handpiects and air syringes to check the air ment; includes system. Try lighting the gas burner to check routine maintenance the gu system. (Be sure to turn the burner off items such u mainte- after the check.) Activate the engine to check nance of oil levels, out the electrical system. simple lubrication, and minor exterior Water system.A malfunctioning water repairs. system affects the operation of the water c. Those major repairs, syringe, cuspidor, saliva ejector, cup filler, and etc., performed only headpiece water spray hookup. If any of the by PMELs and the Atlanta Army Depot above items fail to work, first make sure that designatedto sup the necessary valves and switches have been port using organisa- activated. Then turn the main water valve off tions (Air Force and check the associated altars and screens. If medical facilities). you have not solved to problem at this point, d. That maintenance performed by a med- besuretowad themanuhicturer's ical equipment repair instructions before proceeding further. More center functioning often than not, water leaks are a result of on a geographic loose connections or defective washers and basis. e. May be used to pro- valves. When necessary, simply tighten the vide primary organi- connection or have medical equipment repair zational or field personnel replace the defective part. main tenant* sup . the advent of air-driven port, or to augment Air system. With existing organisa- handpieces, dentalunitair systems have tional maintenance become more elaborate and complex. On capabilities. some dental units, air is used to operate upto three air-driven handpieces, an air syringe, a 084. Give significant details about spray syringe, and the handpiecelubricating user-maintenance procedures required for the system. In addition, the air supplied mustbe dental operating unit by answering a series of as cleanas possiblein order to prevent key questions. contaminating dental patients and to protect expensive handpieces. One problem is that of DentalOperatingUnit.Manydental having excessive moisture iri the air system. operating units are in use in the Air Force M oistu te.-laden air passing through DentalService.Theyareonlyslightly precision-engineered handpieces tends to ruin standardizedsincetheyare of different theminrapidorder. To eliminatethe design,shape,andmanufacture. This moisture problem, you must drain the air equipment is necessary so that the dentist will tankandpurgetheairlinesdaily. be able to complete a wide variety of dental Another problem often encountered in the air treatment procedures. Most dental operating systemisincorrect air pressure at critical units are equipped with water, air, gas, and points. Most air-deven handpieces operate on electricalsystems.For thereason given air pressure falling within the 20- to 60-psi earlier, the maintenance instructions given range, with a specific pressurerecommended here are necessarily general in nature. Specific for each handpiece. By following instructions maintenanceproceduresareavailablein furnished by the manufacturer, you can make manuals preparedbytheequipment fairly simple adjustments to meet the air manufacturers.Ifthesemanualsaren't pressure requirements. Either correctall air available in your clinic, ask your NCOIC to leaks or have them corrected as soon as obtain the necessary copies. possible. 105 3; Gas system. Usually, the dental unit gas system is used less than the other systems. However., all systems mutt be "go" at all times within resew. The most critical aspect \''' of the gas system is the hazard it presents. Be sure to take precautionary', action when you firstsmellescaping psthen corrective action! Replace or have defective gas valves replaced without delay. Also, make sure that leaksinother areas of the system are promptly repaired by the medical equipment repairsectionor bycivilengineers,as applicable. Electricalsystem.Probablythemost complex system on a dental operating unit is the electrical system. In moet cues, other systems are also affected by the electrical system. Unless you have had special training and have special electrical test equipment, electrical system problems should be turned over to the medicalequipment repairman. Among the items affected by a dental unit electricalsystemare the dental engines, reservoir heaters (water and air), pulp testers, cautery devices, and solenoids (electrically operated switches) which help control other dental unit systems. Dental envie assembly.Many dental operating units are equipped with oneof severalsmall, electricpowered engines. By way of a belt hookup, theseengines operate Figure 54. The dental engine. conventionalhandpieces.Because of the engine, the belt, and a series of guidepulleys for the belt, this assembly can be a sourceof sound is heard. At the highest pitchpoint, the preferable for maintenanceills,However, by completing belt is properly adjusted. (it is daily inspections and scheduled maintenance the belt to be adjusted a little tootight than procedures, the dental engine assemblyis too loose.) seldom a cause for alarm. Lubricate the pulleys on the engine arm The engine itself should be lubricated once about every 3 months, making surethat you monthly, on the average. A good gradeof don't overlubricate. Excess oil on thepulleys lightweight engine oilisthe lubricant of is a dust collector. In general, removeand choice. On some of the newer units, you may clean the pulleys and lightlyrelubricate the need to first remove engine covers togain bearing or pulley shaft area with a lightweight sccess to the oilholes. Normally, you will engineoil. Then reassemble the pulleys, find oil holes at the top andbottom of the making sure the retaining screws aretight. engine shaft. Place two to three drops ineach The adjusting am mechanism seldomneeds oil hole monthly. Then replace theengine lubrication.Whenitdoes,usealittle cover. (See fig. 5-1.) handpiece grease. You should replace the engine beltwhen Syringes. Dental operating unitsusually fraying, To do this, have an air syringe and a water syringe,and you first notice sips of equipped with remove the engine arm coverstf present), many of the newer models are engine a third, combinationsyringe (air, water, and loosen the belt tension by turnsAf the the inner arm adjusting screwcounterclockwise, and spray). If you have problems with remove the old belt. Thenplace the new belt workings of any of these syringes, it is best to in position on all pulleys andtighten the belt have a qualified medical equipment repairman After repair or replace them. But if noqualified adjustment screw. (Turn if clockwise.) perform the the belt slack has been removed, activatethe helpisavailable, you can engine necessary maintenance yourselfby following engine. While it is running, adjust the the arm adjustment screwboth clockwise and gep-by-step procedures available from counterclockwise until the highest pitchof manufacturer. Problems in conjunctionwith 106 38 binding syringe hoses an usually solved easily. 5. Name two problems often encountered First, remove the back unit penal. Then locate withtheair system of the dental the offending hose. In most cams, simply operating unit, and state bow each may wedging the binding hose or lubricating the be corrected. guide slides is ell that is nice/easy. Lubricate lightly with lightweight machine oil unless nylon or plastic surfaces ue kwolved. If they ate, use a silicone spray (dry) lubricant. 6. Because of the complexityof the Sdw. *clot Neglected salvia ejectors= electrical system and its interaction with become a perpetual peoblem wee. PPM this other systems, what should en Mingo' ream, doily preventive maintenutce is of usuallydo aboutelect:lentsystem prime impedance. The maintenance problems? procedure consists of cleaning the screen and running a cup of water through the system. Do this at the end of the day and more often if necessary. 7. When should you replece the engine belt Cuspidor. As is true of the saliva ejector, of the engine assembly of the dental the neelected cuspidor may also become a °Mating unit? perpetualproblem.It too requires daily maintenance. This maintenance consists of cleaning the entire bowl and the gold or amalgam imp.Failureto do so cams 8. Describe the sound that tells when the cOffOliOn and may eventually clog the entire engine arm adjustment screw has been draZtel system. positioned so that enoperating new belt youshould be aware of your is properlyadusted j. limitations regarding maintenance of dental equipment. To be mum, you will be faced with maintenance problems tor which there are no answers. In most of them situations, you can 9. What lubricant is used for nylon or solve the problem by using allavailable plastic surfaces of guide slides when there mourceeincluding experienced coworkers, ere problems in conjunction with bindkg medical equipment repairmen, manufacturer's syringe hoses of dental opetating units? inenuctions, and commonsense. In some cam. you may need tosolicitfactory usistance. 10. What is a likely result of neglecting to Exercises (084): clean the entire bowl end the gold or amalgam trap of the dental operating unit 1. To what degree are dente operating units as a part of daily ma'mtenance? standardized?
11. What preventive maintenance is made 2. Whatisthe beet source of specific daily,oroftenerifnecessary,that maintenance procedures concerning COCICelri the saliva ejector of dental dental operating units? operating units?
3. Summarize the preventive maintenance ofdentaloperatingunitsthatis recommended at the beginning of each duty day. 065. Complete the blanks in a aeries of statements concerning the usemaintenance proceduresrequiredfordental operating drain. 4. What are two causes of water leaks that youormedicalequipmentrepair Dental Operating Chair. As is true of dental personnel can correct? operating units, the US Air Force Dental Service has a number of different makes and models of operating chairs. All of them have 10? 39 ARMREST TILT LEVER 4s-- LOCKING LEVER
ROTARY LOCK FOOT SPEED CONTROL OPERATING LEVER
RELEASE-0P LEVER
taw
Figure 5.2. Th. doge certain things in common. We are able to rake In the manually operated chair pump, the or lower the operating chairmanually or foot-operating lever should move freely and electrically. The back, headrest, armrests, and smoothly and should return to the UP footrest may be adjustable. Before attempting position when released. The chair should any maintenance of the dentalchair, first remain at any desired height. Each stroke of determine any problem you have with it. This the operating lever should caule the chair to can be don* by performing asimultaneous rise. When the release liver is pushed, the inspection and operational check. chair should lower evenly and smoothly. If There are certain things that you shouldthe chair has a speed control, it should vary ascertain when inspecting the chew. (See fig. the speed of descent. When the chaik is raised 5-2.) The exterior surface must be clean and to its maximum height, there should be no well-polished. There should be no oil leaks. wobble or play. You should look for broken or missing parts. All adjustments of the chair frame should The upholstery should be in good repeir, with be included in the operational check. The no team or other damage. For theoperational headrest,backrest,armrest, andfootrest check, we shall consider the chair in its two should move freely and smoothly and lock in basic partsthe chair pump and the chair any position. The chaiMilt levershould allow frame. the chair to be tilted and locked firmly in any 108 4 0 2-
position. The base of the chair is not normally faster movements. On newer electric-powered moved for each patient. There are, however, chairs, not only the up and down movements chairs equipped witha track that allows are hydraulically controlled but the forward forward and backward movement of the chair and backward tilt of the backrest and entire base. seat are also hydraulically controlled. To gain Hydraulic system. The dental operating accesstothese adjusting screws, read the chair hydraulic system is activated by either manufacturer's instructions. an electric motor or a foot-operated lever. For Other chair adjustmentdevices.Dental the most part, this system is seldom a source chair adjusting devices besides those already of trouble. With proper preventive discussed are mostly the friction-control type. maintenanceandabsenceofabuse,the That is, a type of lever is loosened (usually hydraulic systemwillfunction well for a tumedcounterclockwise),thenecessary number of years. adjustments made, and then the leveris However, like many other things, some tightened again. Thus, the adjusted position is hydraulic systems turn out to be "lemons." maintained by friction. Little lubrication is When this is the case, the associated problems needed for these friction-control devices. At may range from abnormal oil leaks to broken the most, apply only one drop of lightweight chairs. In such cases, you should call in the oil on the device every 6 months. Some of the medical equipment repairman and perhaps a older headrest adjustment devices have an factoryrepresentativeforanynecessary additional adjustment to control the degree of assistance. tightness when the lever is in the tightened Some of thethings that you may be position. directly concerned with axe the reservoir fluid level, air or oil leaks, plus the travel rate of Exercises (085): hydraulicallycontrolled chairparts. As a Completethefollowingstatementsby general rule, you should not attempt to repair inserting the most appropriate word in each or replace the inner workings of the hydraulic blank. system. This is a job for a qualified medical 1. Although the Air Force Dental Service equipment repairman. has many makes and models of operating The exact way to add oil to a dental chair chairs, each chair can be raised or hydraulic system varies with the different manually or models and different manufacturers. Thus, you mustconsultthe manufacturer's 2. When performing the inspection part of instructions for the correct fluid level and an inspection and operational check of procedures for adding needed oil. Most dental dental operating chairs, ascertain that the chair hydraulic systems use S.A.E. 20-weight surfaceiscleanandwell motor oil for the hydraulic fluid. polished; there should be no In order for a hydraulic system to work leaks, or broken or missing parts; and the properly, the oil in it must be free from air. upholstery should be in repair, Oil leaks eventually permit air to mix with the with no or other oil and cause sluggish operation. Extremely low levels of oil (also a broken chain) may 3. In the manually operated chair pump, the prevent the system from working altogether. foot operating lever should move freely To expel air from the system, you must first and smoothly and should return to the lower the chair to its lowest position. Then position when released; each remove the seat cushion to gain access to the stroke of the operating lever should cause airventscrew.(Seethemanufacturer's the chair to ; when raised to instructions.) Next, loosen the screw (turn it maximum height,there should be no counterclockwise) about one turn and operate or play. the foot lever or activate the motor for a few seconds. While still working the foot lever or 4. The dental operating chair's hydraulic still running the motor, tighten the screw. system is activated by either an Attimes,therateoftravelfor the motorora motorora hydraulically controlled parts of a chair may -operated lever. be too fast or too slow. On older chairs, only the up and down movements are hydraulically 5. As a generalrule, do not attempt to controlled. The rate of travel 1r, these older repair or replace the workings chairscanbeadjustedbyturningthe of the hydraulic system, since this is a job adjusting screw (seefig.5-2) clockwise for fora medicalequipment slower movements and counterclockwise for repairman. 11.09 6. Most dental chair hydraulic systems use _1. Dental handpiecesareprecision-built S.A.E. 20-weight oil for the mechanical devices designed to rotate 4 hydraulicfluid,although you should the burs, stones, wheels, and discs used consult the manufacturer's for in dental treatment. specific instructions about adding oil. 2. High-speed handpieces are air-driven and rotate at speeds up to 12,000 revolutions 7. The oilin the dental chair hydraulic per minute. system must be free from in .....3. Ultra-speedhandpiecesareair-driven order for the system to work properly. handpieces that operate at speeds up to 300,000 rpm. 8. To expelairfromadentalchair's hydraulicsystem,you must first 087. Citespecific maintenance procedures the chairtoits that applyto conventional-speed, straight position. handpieces. 9. A subsequent step in freeing the system Conventional-speed handpieces. The first from air is to the air vent screw conventional-speed handpiece we shall discuss by turning it about one turn isthestraighthandpiece. You must use before operating the foot lever or motor. meticulous care when performing maintenance on this handpiece. Itis to be 10. The rate of travel of older hydraulically cleaned and lubricated after every 10 hours of controlledchairs can be adjusted by general useorwheneveritoverheats turning the adjusting screw for (whichever comes first). You must completely slower movements and for disassemble the handpiece before you can faster movements. clean and lubricate it properly. Complete the disassembly, cleaning, lubrication, and 11. Friction-controltype devices used in reassembly as follows. adjusting dental chairs are lubricated by The disassembly is necessary so that you applying one of lightweight oil may clean and lubricate theinaccessible parts. on the device every 6 Figure 5-3 is an illustration of this handpiece: I refertoitoftenduringthefollowing 086. Givenaseriesof statements about discussion. Disassemble the handpiece by first dental handpieces, indicate which statementis unscrewing the tightening rod and removing true and which is false. it, along with the collet nut. Next, remove the drive pulley. Unscrew the sheath nut, and Handpieces. What is a handpiece? What is remove the sheath and spindle.Remove the itspurpose? Adentalhandpieceisa spindle from the sheath. Finally, remove the precision-built mechanical device designed to bur chuck and chuck lock plunger from the rotate the burs, stones, wheels, anddiscs used spindle. This is done by inserting the chuck indentaltreatment.Handpieces may be removal rod into the nose of the spindle and classifiedinaccordancewiththeirrpm forcing the bur chuck and chuck lock plunger (revolutions per minute). Conventional-speed to the rear of the spindle. handpieces rotate at speeds up to12,000 rpm. Thorough cleaning to remove gummy oil, High-speedhandpiecesattainspeedsof saliva, and tooth debris is the nextprocedure. rotation upto 100,000 rpm. Ultra-speed As you disassemble the handpiece,place the handpieces are air-driven and rotate atspeeds smallpartsinacontainer of handpiece up to 300,000 rpm.Handpieces are also cleaner. Shake the containervigorously to classified as air- or belt-driven and straight or thoroughly flush each part. Next, insert a contra-angle. Constant preventive attentionis handpiecebrushintothesheath.After anabsolutenecessity inthecareand immersing the small end of thesheath in maintenance of handpieces. If they are not handpiececleaner,useanup-and-down properly cleaned and lubricated. motion to clean the inside of thesheath. abrasivessuch as finely ground tooth,metal, Follow the same procedure when cleaningthe and other particleswill cause excessive wear. spindle. After all parts have beencleaned, dry The result of this wear is undue vibration. them with paper towels andpipe cleaners. Never use cotton-tipped applicators toclean a Exercises (086): handpiece. They leave small strandsof cotton ., handpiece. Write y in each blank beside each statement fibers on the inner surfaces of the beside each After you nave thoroughlycleaned the belowthatistrueandF for lubrication and statement that is false. handpiece,itisready
110 4..: 94. i SPINDLE
1 r M1111111 41I 11 411111 I I MItC1:01;;;;5
CHUCK/ LOCK BUR CHUCK/ \ PLUNGER END PLAY{ ADJUSTING WRIST JOINT NUT PULLEY REAR SPINDLE BEARING WRIST JOINT WRIST LATCH I ASSEMBLY
I i
IMINEINO J r L / / TIGHTENING ROD DRIVE PULLEY COLLET\ NUT
Figure 5-3. Conventional-speed, belt-driven, straight handpiece.
in 43 reassembly is Occasionally, an adjustment is necessaryto reassembly. The procedure for eliminate undesirable end play in thestraight in reverseorderofdisassembly.The in this order so handpiece. If proper cleaning and lubrication lubrication will be explained followed, this that you may reassemblethe handpiece as procedures have been adjustmentisseldom needed becauseof you lubricate it.First, coat the bur chuck because lightly with a handpiece lubricantand replace excessive wear. It is usually required Follow this by of loosening of certain parts.To make this it in the spindle from the rear. rod and lubricating the chuck lock plungerand placing adjustment, loosen the tightening the outer rear turn the collet nut clockwise,using fmger it in the spindle. Next, coat has bee." removed. section of the spindle andinsert it into the pressure until the end play rearsectionbearing.Lubricatethe nose section of the spindle whereit comes in Exercises (087): contact with the sheath.Lightly lubricate the 1. How often should theconventional-speed, outside of the rear sectionbearing. Insert the straight handpiece be cleaned and drive pulley, insuring thatit engages the slots lubricated? in the spindle. Lastly,lightly lubricate the threads of the tightening rodand screw it into the barrel of the spindle.This completes the assembly and lubricationof the handpiece 2. Statethesequence of the foursteps exc ept for thewrist joint pulley and guard. involvedin cleaning and lubricatingthe Disassemblethewrist joint pulley and handpiece's inaccessible parts. guard. Immerse the pulleyshaft and hinge body in the cleaner. Wipe offthe cleaner and place a light coat of dental engineoil on the pulley shaft and hinges.Reassemble the parts 3. Summarize the first andlast steps involved in reverse order, and yourhandpiece is ready in disassembly. for operation. OIL TUBE HEAD .. BUR LAICH
BEARING ASSEMBLY BUR TUBE /
CAVE SHAE
DRIVE SHAFT HOUSING
KNEE HOt i!;ING OI L TUBE
.
-144r.---0,10,,,F.Pz.ok.stio.vezyot
Figure 5-4. Conventiondl-speed.conira-angle handpiece. 112 .14 4. Afterallpartsofthedisassembled and head will insure proper relationship. Care handpiece have been thoroughly cleaned, for the right-angle prophylaxis handpiece in a what takes place next? similar fashion, with one major exception: Be iure to disasseinble, clean, relubricate, and reassemble it after each use. 5. State briefly how undesirable end play in Exercises (088): the straight handpiece is removed. Identify each of the following statements as either true (T) or false (F). _1. Lubricate the convential-speed, contra-angle handpiece attachment after each 5 hours of use. , _2. Insert the tip of a tube of handpiece 088. Given a series of statements concerning grease into each of the two lubrication themaintenance procedures for the points and squeeze untilthe grease conventional-speed,contra-anglehpndpiece begins to escape. attachment, indicate which are true and _3. Thoroueily clean and lubricate the angle which are false. handpieceaftereach10 hoursof operation, but do NOT disassemble it The next handpiece we shall discuss is the while performing this maintenance. conventional-speed, contra-angle attachment. 4. As a part of proper maintenance, and This handpiece should be lubricated after after the disassembled parts have been each 5 hours of use. There are two lubrication cleaned and dried, they are lubricated points on this attachment. See figure 54 for and reassembled in the following order:. the location of these holes. Using handpiece (1) knee housing to drive shaft housing, .grease, insert the tip of the grease tube into (2) bearing assembly to knee housing, the hole in the elbow and squeeze until the (3) head assembly to bearing assembly, grease begins to escape at the junction of the (4) cap to bur tube. tube tip and hole. The other lubrication point is under the bur lock latch. Open this latch 5. The toolsusedindisassembly and and repeat the procedure. reassembly are so constzucted that you The angle handpiiiishould be thoroughly cannot mar the plated finish. cleaned and lubricated after each 10 hours of 6. Maintenance of the above handpiece and operation. The handpiece must be the right-angle prophylaxis handpiece are disassembled in order to do this. Refer to identical in every respect. figure5-4 duringthisdiscussion of the disassembly of the handpiece. Using two pairs 089. Fill in the blanks in statements about ofplierswithfriction tape-covered jaws, the maintenance procedures for high-speed disassemble it in the following order: handpieces. 1. Remove the cap from the bur tube. 2. Remove theheadassemblyfrom the High-speed handpieces. The maintenance of adjoining bearing assembly. the belt-driven, high-speed, straight handpiece 3. Remove the bearing assembly from the is less complex than that of the slower speed knee housing. handpiece, but itis just as important. The 4. Remove the knee housing from the drive disassembly of this handpiece involves only shaft housing. the removal of the sheath. After removal, clean the inside and outside of the sheath Place these parts in a container of handpiece support. Since you do not disassemble the cleaner and flush thoroughly. After they have handpiece completely, clean the chuck by been cleaned, dry them with paper towels. passing a pipe cleaner through the front end The handpiece is now ready to be lubricated. of the spindle. After these areas have been Carefully pack geesse into the elbow and the cleaned, dry them with a paper towel. Since head assembly as the component sections are this handpiece operates at a high speed, use a reassembled. The reassembly procedure is the lightweight engine oil for lubrication. Figure reverseof the disassembly procedure. To 5-5 illustrates the points to lubricate. prevent marring the plated fmish, be careful in your use of tools. It is important that the Place two drops of oil on the drive knurled end of the bearing section and the pulley. head be properlyalignedtothe elbow. Place two drops of oil on the sheath Aligning the lubrication holes in the elbow support. 113 1 15 Figure 5-5. High-speed, beltdriven, straight handpiece.
Place one drop of oil in the end of the 1. The maintenance of the -driven, spindle to lubricate the chuck. high4peed, straight handpiece is Place one drop of oil on the sheath lock. complex than the maintenance of the Place two drops of oil between the slower speed handpiece, but it is just as spindle and the sheath support. litplace the sheath, which was the only part 2. The disassembly of this handpiece involves removed for cleaning and lubrication. The only the removal of the wrist joint of this handpiece has sealed ball bearings, which require no maintenance other 3. Clean the by passing a pipe than placing two drops of oil on the pulley cleaner through the front end of the shaft. Thehigh-speed,contra-angle handpiece 4. Since this handpiece operates at a high attachment is maintained in the following speed,usea engineoilfor way. Operate the handpiece in the cleaner for lubrication. 15 seconds in each direction at slow speed. Repeat this procedure in lubricating oil. Do 5. The wrist jointof this handpiece has not disassemble this handpiece. ball bearings; therefore, the only maintenance required is to place Exercises (089): drops of oil on the pulley shaft. Completethefollowingstatementsby inserting the most appropriate word in each 090. Given alistof air-driven handpiece blank. systems and components, match each with 114 46 -e) the most appropriate statement in another may also be performed by the air system. The list. water system also emits a fine ipray mist, whichaidsinrinsingdebris from the Ultra-speed handpieces. In addition to the operating site. belt-driven handpieces, there are ultra-speed The electrical system function in operating handpieces that are operated by air preuure. theultra-speedhandpieceistoactivate Do not attempt to operate any of the solenoids, which control the other systems. ultra-speed handpieces without first To' start the action, the operator activates a consultingtheappropriate manufacturer's foot switch. The switch may be a separate instructions. All models of the ultraopeed mechanism or it may be built into the dental handpieces work on the same basic principle. operating unit. The built-in type may also be The bur is held in the handpiece by either a used to operate a separate dental engine. friction grip chuck or by a chuck that requires Usually, a switch is provided on the foot manual tightening. These chucks are a part of controller to enable the operator to change the bur tube and should be changed in from operating the dental engine to the accordance with the manufacturer's air-drive system, and vice versa. instructions. The bur is rotated when air is Proper lubrication of ultra-speed forced through the air ports into the head of handpieces is of utmost importance and is one the handpiece and to the air turbine. of our continuing maintenance problems. The Ultra-speed handpieces are operated in part importance of this requirement cannot be by the air system, inpart by the water overstressed. Most ultraepeed handpieces art system, and in put by the electrical system of lubricated by the air-forced system today. a dental operating unit. Controls for operating Such a system requires you to check the oil the handpieces are found either in a control supply frequently to determine whether the cabinet mounted on the dental operating unit correct amount is reaching the handpiece and or are built into the unit itself. whether the reservoir level is adequate. To be The air system helps to operate several safe,read and rereadthe manufacturer's parts of the ultra-speed handpiece. The main instructions to make sure that you understand function of the air is to rotate the air turbine. the lubricating requirements. Then take the In other words, the air system is the main necessary measures immediately. It takes only power source for ultra-speed handpieces. On afew secondstoruinanultra-speed some theairsystemalso handpiece that has improper or insufficient handpieces, lu brication. functions to keep the handpiece cool. Still Slow-speed, air-driven handpieces. Some of another function of the air system is that of the newer dental units are now equipped with moving the handpiece lubricant from the a slowepeed handpiece powered by the air lubricant reservoir to the handpiece. But this is system. These handpieces are also activated not requiredforallof theultra-speed by working the foot controller. Most of these handpieces,since youmus.:personally handpieces are lubricated by the air forced lubricate some of them. Be sure that you read system just as the ultra-speed handpieces are. instructionsforthe themanufacturer's The biggest difference between the lubrication requirements for eich handpiece. slow-speed, air-driven handpieces Further still, the air system may supply air to manufactured by various companies is in the the handpiece for blowing :hips of tooth amount of oilrequired for each type of structures from cavity preparntions. For each handpiece. Someoftheseslow-speed, of these air system functions, there is a handpieces mayalsorequire separate air line. Normally, these lines merge air-powered at some point on the unit an 1 are connected additional lubrication in certain areas, so be by amultiple-line,flexibkhosetothe sure to read the lubrication instructions. handpiece. As a precautionaiy measure, the main air lineis equipped with a filter to Exercises (090): prevent moistureinthe air system from Match each statement in column B with the reaching the handpiece bearink s. Some units most applicable system or component in also have a purging valve fcr eliminating column A by inserting a letter from column B excess moisture. Change these filters as the in the appropriate blank in column A. manufacturer directs. The water system plays a smaller role than Column A Column 1. Ultra-speed hand-a. Each separate air system the air system on ultra-speed hat dpieces. The pieces. has one,all of which prime function of the water system on these 2. Bur of ultra-speed normallymergeata handpieces is to keep the handp ece cool. As handpieces. point on the unit (and mentioned earlier, this cooling requirement 3. Air system of are connectedtothe
nell V
Column A Co(umn B tungsten carbide bun in 70 percent solution of isopropyl alcohol. Do not place them in ultra-speedhand- handpiece by a benzalkonium chloride. This will cause them I pieces. multiple4ine, flexible 4. Separate airline. hose). to corrode and will shorten their usefulness. 5. Purging valve. b. Operated in part by the Diamond-coatedinstruments donot 6. Water system of air system, in part by become as clogged at higher speeds as they do ultratpeedhand- the water system, and in pieces. part by the electrical at lower speeds. This is because of the light 7. Electricalsystem system of a dental oper- pressure used in cutting at high speeds. If of ultra-speed ating unit. debris does collect in the diamond grit, soak handpieces. c. Held in handpiece either the instrument in soapy water for about 5 by a friction grip chuck or a chuck that requires minutes and then scrub it with a bristle brush. manual tightening; is ro- A rubber-impregnated disk or ink eraser can tated when air is forced also be used for cleaning. You may clean with through theairports a rubber eraser by applying it against the intotheheadpiece's head and on to the air instrument while itis slowly turned in the turbine. handpiece. Old amalgam may be removed by .d. Main power source for soaking the diamond instrumentin pure ultra-speedhandpieces; mercury and then using a brush or an eraser sometimes another function is to move the to remove thepartlyloosened amalgam. h a nd pi eat lubricant Avoidboilingandautoclavingdiamond from the lubricant reser- instruments. Doing so causes deterioration of voir to the handpiece; the bonding material. may also clear cavity of chips. e. Some units havethis Exercises (091): component as a means Match each of the maintenance procedures ofeliminatingexcess moisture. listed in column B with the applicable items f. Its prime function is to listed in column A by inserting a letter from keep the handpiece column B in a blank in column A. Some cool; also aids in rinsing blanks in column A may be matched more debris. than once. g. Ittakesonlyafew secondstoruinthis Column B type of hanripieceif Column A 1. Carbon steel bum.a. Requirelittlemainte- there is improper or in- 2. Tungstencarbide nance, because coolants sufficient lubrication. bum. preventdebris from 3. Diamond-coated clogging theirgrooves. instruments. b. Cleanwithstiffwire 091. Match specific maintenance procedures brush. in one list with the rotary instruments to c. Normally clean by which they apply in another list. scrubbing with a bristle brush after soaking it in Rotary Instruments. There are two types of soapy water for 5 min- utes. bursthose used with the straight handpieces d. Whennecessary,soak andthoseusedwiththecontra-angle thisrotary-cuttingin- handpieces. These burs are made of tungsten strument in pure mer- carbideandcarbonsteel.We alsouse curyto partly loosen diamond-coated rotary instruments, and we old amalgamthen re- move the loosened am- shall discuss their care. algam with a brush or The care of carbon steel burs is simple. If an eraser. the bur is serviceable after use, it is cleaned, disinfected, and replaced inits holder. To clean the bur, use a stiff wire brush. If the bur 092. State whichtaskconnectedwith is not serviceable, throw it away and replace it maintaining dental lights is performed most with a new one. All types and sizes of burs are often, where the most common type of dental always available. lightmounts,andageneralrulefor Tungstencarbidebursrequirelittle lubricating the joints of movable parts of maintenance, since the coolants used with dental operating lights. themprevent debris from cloggingtheir grooves. Should they become clogged, clean DentalOperatingLights. Most of the them withastiffwirebrush.Although maintenancerequiredfordentallights tungsten carbide burs last well, they wear out. consists of changing burned out bulbs. Of the Discardburswhichareworn.Disinfect two types of lights, the most common one 116 mounts onto the dental operating unit, and the drawers. Dust the exterior surface of the the other one mounts on the ceiling. Some of cabinets daily and wipe the top with a the newer types are equipped with bulbs 70-percent solution of isopropyl alcohol as which require special handling. Read the part of the cleanup between patients. Clean required literature before you attempt to and wax the exterior of the cabinets at least change a bulb. When changing any light bulb, monthly, or as needed. you should use a dry towel to help prevent The following maintenance variations apply injury, since the bulb could shatter. The only to the two types of cabinets. In the 24-drawer lubrication required is rather infrequent and type, lightly oil the hinges monthly and coat inminuteamounts. Ingeneral,this the drawer slides with petrolatum twice a lubrication (with lightweight machine oil) is year. The modular cabinets usually have required about every 6 months for the joints nylon drawer guides which do not need of the movable parts of the operating lights. lubrication. If the modular-type cabinets are mobile, keep the casters clean by scraping Exercises (092): them with the back edge of a knife. The 1. What task connected withmaintaining wheel bearings require lubrication monthly; dental lights is performed most often? use one drop of oil. Exercises (093): Identify each of the following statements as 2. Where does the most common type o f either true (T) or false (F). dental light mount? 1. Drawers of the older basic type dental instrument cabinets (24-drawers) have drawer slides that need lubrication. _2. Inthe24-drawer type of cabinet, 3. What should you use when changing a light lubrication consists of heavily oiling the bulb? hinges daily and coating the drawer slides with pertrolatum daily. 3. Mobile modular-type cabinet lubrication includes scraping casters clean with the 4. Give a general rule for lubricating the joints back edge of a knife and applying one of movable parts of dental operating lights. drop of oil monthy to wheel bearints. _4. The nylon drawer guides used on the newer cabinets(1-12drawers) need frequent lubrication.
SUCTION REGULATING VALVE 093. Given a series of statements about the SAFETY OVERFLOW VALVE user-maintenance required for dental OIL RESERVOIR instrument cabinets, indicate which are true MUFFLER and which are false. OIL CUPS Dental Instrument Cabinets. There are two \ basic types of dental instrument cabinets. One type (the older) has 24 drawers, equally divided into two vertical rows. The other type has from 1to 12 drawers. These newer (modular)cabinetsmaybemobileor 112 wall-mounted. Normally, the wall-mounted modular cabinets consist of one to several differing cabinets arranged in a functional sequence with a single, solid cabinet top. The maintenance for both types is the same, except for the two areas we shall mention. The glass tray inserts, used in the draw :trsofthecabinetsforinstrument storage, must be washed frequently. Protect these inserts from breakage by placing a foam rubber strip between them and the back of Figure 5-6. Aspirator. 117 094. Fill in blanks in statements concerning evacuation of fluids and debris. They will not aspiratormaintenance,andanswer key injuretheoraltissues.Theseunits are questions about user-maintenance procedures supplied as table models, portable units, or required for oral-suction apparatus. units which may be attached to the light arm or the wall. The units attached tothe light Aspirators. These sze vacuum devices used arm are usually equipped with anautomatic to keep the operating field clear. An aspirator drain into the cuspidor. The other unitshave is illustrated in figure 5-6. Refer to this figure aself-containedcanisterwhich must be frequentlyduringthisdiscussion.The emptied periodically. All units are equipped aspirator has an electric motor that operates a with a filter, which may be either a bag or a vacuum pump. A bottle connected to the wire screen. Clean ot change the filter at the vacuum pump holdsaspiratedmaterial. end of each day. Clean and polish theoral Leading from this bottle is a rubber tube, to evacuator weekly. which a handle is attached. This handle has tips of various sizes. A valve located on top of Exercises (094): the vacuum bottle is used to adjust the Complete each of the following statements by amount of suction at this tip. There Is asafety inserting the appropriate word in each blank. overflow valve between the bottle and the 1. Inspect the aspirator each .Its vacuum pump. This valvecontains a chamois electric cord must be sufficiently long, in disk. This disk must be dry. When it is wet, it good repair, and equipped with a stops the flow of air and cuts off the suction. plug. The motor and pump must vary the The dry disk protects the pump from fluids pressure from 0 to pounds and that may overflow from the bottle. operate with no excessive .The Inspect the aspirator each morning before cotton muffler and oil reservoirrequire a starting the day's work. Inspect the electric check, but the electric motor cord to see if it is long enough and if itneeds requires lubrication. repair. The cord must be equipped with a pounded plug. The motor and pump mounts 2. Aspirator maitenance includes: (1) must be secure. You must beable to vary the Maintaining the levelin the pressure from 0 to 20 pounds.The motor and reservoir. (2) Changing the cotton in the pump must start operating as soon asthey are when it becomes moistened with turned on. They must operate with no .(3) Placing drops of excessive vibration. Certain items, including oilin each oil cup at each end ofthe the cotton muffler and the oilreservoir, motor. (4) After each use (toprevent require a weekly check. The electric motor ), flushing a generous amount of requires lubrication monthly. through the suction. You must maintain the oil level in the reservoir. Change the cotton in the muffler 3. If the aspirator bottle overflows,what do when it becomes moistened with oil. There you do with the chamoisdisk? are two oil cups, one on eachend of the motor. Place two drops of oil in each ofthese. After each use, flush a generous amountof water throughthesuctionsystem. This 4. After each operation, whatprocedure is prevents clogging. If the bottleoverflows, you necessaryformaintainingthe aspirator must replace the chamois diskwith a dry one. bottle? After each operation, empty the bottle and put an inch of water in it. Thehandles and tips must be removed and autoclaved; the rest of the unit is cleaned with a70-percent 5. What must be doneperiodically with the solution of isopropyl alcohol. self-containedcanistersofsomeoral Oral Evacuators. The ultra-speed evacuator units? handpieces, using water as a coolant, have come into general use. This watermust be removed from the patient's mouth.Neither the saliva ejector nor the aspirator can remove 6. How often is the filter (bag orwire screen) it rapidly enough. The high-speed turbineoral of an oral evacuator cleaned orchanged? evacuator is a more efficient way to remove it. The principle of this evacuator islow pressure and high volume.Larger tips may be attached to these units to allow forfaster 118 5 9 tik
7. How often is the oral evacuator. cleaned Although the Air Force has many different and polished? types of steriliserssuch as those using gm, chemicals, and heatdental clinks use only othose which use heat. The most popular ones include the autoclave, dry-heat steriliser, and the heat-transfor steriliser, which is often referred to as the "bead" or "flash" steriliser. 095. Complete statements about significant The autoclave uses heat to convert water features of maintenance peocedures for dental into steam under premium. Distilled weter operating stook. should be used. This keeps mineral &polite from accumulating. gads autoclave has a Operating Stools. More and more, dental mark to indicate the correct water level. Make operating stools are playing an impottant role we that water is up to this level before each in the practice of dentistry. This is due largely use. Completely dean the interior weekly. to new techniques which require the dentist The light acak that may form can be removed andhis assistantto work from seated with soap, water, and a stiff brush. If you fail positions. Several types of these stools are to use distilled water, heavier scale may available. The type of stool most often used form. To remove this scak, odd 1/2 co of in sit-down dentistryis the mobile type. vinegar to the required amount of water, and Another type of stool that is frequently used operate the autoclave through a rootlet in Air Force dental clinics is the single-shaft, sterilising cycle. Remove the vinegar water solid-base type. and rinse the inside thoroughly. Refill the Maintenance on the mobile stools consists unit to the correct level with distilled water. of making adjustments and lubricating the The autoclave must be on a solid surface, with cuter bearings. These adjustments involve the the electric cord out of the traffic area. The seatheightandthebackrestposition. cord must be in good repair with a grounded Lubricate the caster bearings with lightweight Plug- machine oil monthly. Maintenance on the Another method of sterilisation uses the singlershaft stool involves making seat-height chy-heat oven. This is a nnall electric oven. adjustments and keeping the stool clean. There islittle maintenance that you can - Never lubricate the shaft on these stools, since perform on theseovens.. Maintaintheir doing so would keep the locking mechanism appearance by frequent dusting. If they prove from holding in its adjusted position. to be ineffective, have medical maintenance personnel check them. Exercises (095): Heat-transfer sterilisation uses intense heat Complete each of the following statements by applied for a abort time. The steriliser using inserting the appro priats word in each blank. the "flash" principle is a small unit used to 1. Maintenance on mobile stools *consists of sterilise small instruments, such as root canal adjusting the height and the files(usedtoamoothrootcanalsin backrest ,and of lubricating the endodontics). This electrically heated bearings with lightweight steriliser uses glass beads, salt, or molten machine oil metal u a heat-transfer metgium. The transfer medium is heated to intense heat (424° F. to 2. Maintenance on single-shaft stools includes 532° F.), and the instrument is inserted into making seat-height adjustmentsand the medium for 3 to 10 seconds. Little keepingthestool . Never maintenance is required for flash sterilisers. lubricatethe ,since doing so The electric cord and plug must be pounded would keep the mechanism from and in good condition. Because of the intense holding. heat, be extremely careful when moving these sterilisers. The heat-transfer media may spill on you, causing a severe burn. 096. Given a list of maintenance procedures for sterilizers, match each procedure with the appropriate sterilizer in another list. Exercises (096): Match each statement in column B with the Sterilizers.In another volume of this applicable sterilizer in column A by placing course, you will study the use of the different the appropriate letter from column B in the types of sterilizers. In this section, however, blank provided in column A. Some blanks will we will discuss the maintenance of sterilizers. be matched more than once. loiga
Calms A Column II Amalgamaton. An amalgamator is a device 1. Autoclave. This steriliser is a mail used to prepare a mix of dental amalgam. It 2. Dry-kest Meriliser. electric oven, upon 2 3. Heat-transfer steri- whichyouperform has a small electric motor which rotates an liser. littlemaistenaace ex- eccentric cam. A forked prong is attached to empt frequent dusting. this cam. The capsule with alloy and mercury This steriliser uses heet isplaced in the forked prong. The cam to convert distilled wa- rotates, causing the prong to move in a figure terinto maim uoder pressure. It has a mark "8." The amalgamator is equipped with a to indicate the correct timer to adjust the mixing time. water level. Usermaintenanceofthisequipment On %hie steriliser, you consists of keeping it clean and polished. You remove heavy scale by addim 1/2 cup of vine- must remove objects which fall through the gar to water sad opera- case at the opening for the prong.To remove ting the steriliser these objects, unplug the amalgamator and throughregular eyrie; turn it upside down. Gently rotate it backand remove the miter, rinse the unit, and refill with forth until the object falls out. Do not remove distilled water. the case from thia equipment. Incorrect This "Auk" steriliser replacement can demisethewiring or applies intense beet for bearings short durations, but lit- tie *maintenance is necessary. Exercises (097): Remove light mole from Identify each of the following statements as this steriliser with soap, water, and a stiff brush. either true (T) or false (F). This "flash" steriliser's _I. When the small electric motor of an electric cord sad plug amalgametor operates, a rotating cam must be grounded and causes the prong to mon in a figure"8" kept in good condition. pattern. Ilecareful when you move the steriliser as _2. Remove objects which fall through the you mightreceive a case at the opening for the prong by severe burn if you spill reversing the motor. its hest-transfer medium _3. Remove the case from this equipment at (glambeads,mit,or any desired time, as the wiringand molten metal). bearings are constructed so as to be tamperproof. 097. Given a series of statements concerning 4. The amalgamator timer can be adjusted dental amalgamators, indicate which are true to vary the number of seconds of mixing and which are false. before cu to ff. ANSWERS FOR EXERCISES
currza 111, 90150 MSC. 001 4. 962X0, DowdLabyt4,AVIC. Itellsesmos: 000 -I. WO MAP P &twit Cahles 001 1. a. on. S. t5330 001 2. b. 000 T. As a liketwal duty 001 3. b. toomal oboe foalleato. tad job sualkisaa, twin- 1 4. a. I. Jib 1 5. a. ON 0. the 00 I. The base dental surgeon. Of IN di* A1CT (or 002 2. T. lessee pew staadfinist prefemlenal 04111. patient am 10. Cooled** et a rassaasawas soma: 002 Ma &mid not &legate reef easibility *aim any dr...miaow. MARI* 2 002 4. The vane.. revens nod by dm bow talsVlsss. 114sosasel 002 5. settlag up coma ;denies km and 001.1. Yea Shield not be isatteative, ladiffenal, eliak awl filmdom to Orabmpt. fit mods of the organisations. 004 2. A Oleasaat diepasidea, tact, and a calm, 002 1. H. up sa CMT by appointing outman, and raciest mason. and peon: for training 11911. 006 3. Physkal and parebelogital. 002. 7. The r ks.fh4 ant mrgeoft. 006 -4. Feat, WOK, alielter, rot, csereise, am, and physical welibeing. 003 I. Th. Air tal Seek. provides Ak 006 5. amity, reeeig.ition, affection, and Fore* and memlims of Mbar anikeement. unit m mquired, oral hmith ON -6. 1. service w in support of the amain 006 7. e. Air Fore* kal mission. ON t a. 003 -2. Tha Airr Desist Sink. supports 006 9. e. oihm p dine tad. 006 - 10. T. 003 -3. a. 006 - 11. T. 003 4. b. 00612. It. 003 .5. b. 006 13. T. 003 6. b. 00114. F. 003 7. a. 006 15. T. 003 -6. I. 006 - It F. 003 -9. IN reception, a ntmsiu schedulin& and th word main 007 -I. P. 007 -2. T. 004 -1. Airone Manual 39-1,Inman Clessifics- 007 3. F. PioManual. 007 4. F. 004 2. A e 3 Is..1 and the6 lev 007 -5. F. 004 3. of the duties may p; however, 007 6. T. 170 duties have a iisanL iaelination 007 -7. F. ward more management .54supervision. 007 -8. T. 004 -4. e 93191 AFSC. 007 9. T. 004 5. d. 004 -6 b. -1. Look at his I tficatioa card. 004 7 k b. 2. a. 004 - a. 00 3. b. 004 - .d. 008 - 004 -O. c. 008 - 008 - 006 1. 90010,Medical Helper. 008 7, a, 00 2. Upon graduation from the medical 8. a. menials ccurse. 9. b.
121 53 MODIFICATIONS
46 A:Q. of this publication has (have) beendeleted in adapting this material for inclusion inthe "Trial Implementation of a Vocational Model System to Provide MilitaryCurriculum Materials for Use in of nod Technical Education." Deleted material involves extensive use military Corms, procedures, systems, etc. and was not considered appropriate
for 'me In vocational and technicaleducation.
54 Missing Teeth and Existing Restorations Diseases and Abnormalities
Figure 1. Answer for Objective 017.exercise 1.
rendered is available in subsection1 017 -1. SF 603A is initiated. red in 020 -9. Major identifying features are en 018 -1. Member; active. item 15: current treatment req ments 18 -2. Blue. 16. 0 8 -3. Manila. are entered in item - 4. Typing:ink. 01 rate record 018 5. Closed. 021 -1. A Form 528 provides an 018 6. Capital. ofe presence and locatioof any gingival 018 -". Pencil. or riodontal proble requiring treat- ment: also gives a gen estimate of the health the tooth-s porting structures. 019 - 1. on and pgress of gingival and 2. 021 -2. The ince 019 - periodonta isease. 019 -3. The Periodontal Screening 4. 021 -3. AFM 162-3, 019 - Procedure. 020 -1.Itis chronologi record of a person's dentalconditionduringhisperiodof 022 -1. T. military rvice. t is used as a means of 022 -2.F. verifying ni ividual's dental condition 022 -3. F. andtreat . anditisan important 022 -4. T. sourceof nformationforidentifying 022 -5. T. deceased p nnel. 022 -6. F. 020 -2. The indiv dento-oral condition upon his entry nto litary service. 1. T. 3. A dentofficer. 023 - 020 - 023 -2.F. 020 -4. They e made iblack or blue-black ink withfine-point p form provides inform ion necessary 020 -5. The ime of the origal examination. 024 -1. ange. and penciled maintaining a patient's in -vidual dental 020 -6. Be ause they may ealth records: it provides stistical data eries are easy to cha e. orthedental servicerepo thereby 020 -7. ubsection 15.Restotions and Treat- dental sequent Diseases informing higher headquarters o the ents: subsection 16. S procedures performed by the clin andAbnormalities: an subsection17. 024 -2. Becausetheformisusedtoprovide Services Rendered. information for keypunching. 020 -8. When no space for enterinthe treatment
5 123 MODIFICATIONS
deleted in )a.5/ it.47 of this publication has (have) been adapting this material for inclusionin the "Trial Implementation of a
Model System to Provide Military CurriculumMaterials for Use in Vocational
of and Technical Education."Deleted material involves extensive use military forms, procedures, systems, etc. and was not considered appropriate
for use in vocational and technicaleducation.
56 " 4
060 -2. Thismeansthatasupervisorcannot 067 -3.F. property supervise too many people and 067 -4. T. that he should not oversupetwise too few. 067 -5. F. 3. This term means that a peaon should ha 067 -6. T. only one boss. 067 -7. T. 4. Because he can't do everything himself. 068 -1. Before the scheduled training time. 06 1.( 1) Determine how the task is being e, 068 -2. Inadequate p/anning. (2) evaluate each step of the task, (3) pply 068 -3. Vary the pitch, rate, and force work simplification principles, (4)t any voice to emphasize points and to k your necessary approval, (5) impleme your voice from becoming monoton improvements, and (6) make a owup 068 -4. Use natural hand and body ures and evaluation. avoid physical distractions, ch as coin 061 -2. "mime* unnecessary work; bine de- jingling, pacing, and had tching. when practical; rearrange for better 068 -5. It shows them you aretoasted in them uence;simplifythe through and allows you to checfor signs of doubt, m on economy. confusion, or boredo 068 -6. To the desired ob" 062 -1. To personnel to the t skill level and giveinstruction changes in 069 1.To determine it was effective and if it tee ue, equipment, and tenets. accomplished titwas intended to 062 -2. Info accomplish. 062 -3. F 069 -2.Short answr or multiple choice types are 062 -4. It is a tic, repo Is application of preferred 0-false tests and essay testa self-stud andthe c -apprentice should avoided. principle. 069 -3.If yotraining was intended to teach the studt how to perform, you should, of 063 -1. Through use ofis record, the Air co , check to seethat he can perform to Force insu that i airmen have been r standard; by means of a performance trained to a cula standard so that they .If you intended for him to acquire can performredibly, effectively, and rote knowledge; or if specific knowledge is efficiently. important to his performance, you should 063 -2. The supervisor a use this record to select use a written test. airmen for dut gnments, positions, and 069 4. The lesson objectives. upgrade actions. 063 -3.b. 063 -4.a. 063 -5.c. CHAPTER 5 063 -6. b. 063 -7. c. R.efteence: 063 -*8.a_ 070 -1. An instructor in a formal technical course, 063 -9. The trainee d theupervisor enter the your OJT supervisor, or both. date and thr initialsext to the STS/JPG 070 -2. Know the equipment and how to operate it task elemen to indicaits completion. safely. 070 -3. Read its operating instructions very care- 064 -1. In the trea nt rooms. fully. 064 -2. Onetha hasadequ lightingand ventilatioand that is atively free of 071 1. Law observance. (It comes from within distracti you.) 064 -3. From thbase film library. 071 -2. You do. 064 -4. You m order them fromhe list of rilms main ed by thr squadroOJT monitor 072 -1.F. or frosuppliers of dental terials. 072 -2. T.
065 -1. &tab your objectivesselecting an 073- 1.b.c. instctional method. pre g the lesson 073 -2.e. plan presenting the lesson, measuring 073 -3.d. the Its. 073 .4.h. 065 2. Wt you expect the student know or orm as a result of your traing. 074 1.F. 074 .2.T. 066 -1. c. 074 3.T. 066 -2. e 066 3. 075 .1. Avoid 066 4. 075 -2. Maximum. 066 5. 075 .3. Minimize. 066 6.e. 075 .4. Extinguish: prevent. 066 -7a. 066 a. 076 .I.F. 066 .c. 076 .2. T.
067 1. T. 077 .1. b.c. 06/.2. T. 077 2.d. 5 7128 a 078 -L. The nature of the task. 084 - 11. Clean the screen and nan a cup of water 078 -2. Thew instructions may deal with the through the system. materials,protectiveclothing,machine guards, and type of machine or equipment 085 -1. Lowered; electrically. that you will use to do the job. 085 -2. Exterior; oil; good; team; climate. 085 -3. UP; rise; wobble. 079 -1. e, f. 085 -4. Electric; foot: 079 -2. c,t, f. 085 -5. Innec'qualified. 079 -3. a. 085 -6. Motor; instructions. 079 -4. b, d. 085 -7. Air. 079 -5. g, h. 085 -8. Lower; lowest. 079 -6. h,i. 085 -9. Loosen; counterclockwise. 085 - 10. Clockwise; counterclockwise. 085 - 11. Drop; months. 080 -1. T. 080 -2. T. 086 -1. T. 080 -3. F. 086 -2. F. 080 -4. T. 086 -3. T. 080 -5. F. 087 -1. Whenever it overheats or after every 10 081 -1. (a) Keeping dirt and filth at the lowest level hours of generaluse-whichever comes posaible, and (b) keeping the facility in a rust. presentable condition. 087 -2. Disassembly,cleaning,lubrication,and 081 -9.Daily. reassembly. 081 -3.Removedustandmicro-organismsby 087 -3. First, unscrew the tightening rod; remove it vacuuming carpeting at the end of each and the collet nut. Lastly, remove the bur duty day. Remove spots by shampooing, if chuck and chuck lock plunger from the possible. Do not use solvents without spindle. consulting your NCOIC. 087 -4. After all parts are dried, they are lubricated 081 -4.(a) At least weekly; (b) about every 3 and reassembled. The procedure for reas- weeks. sembly is in the reverse order of disassem- 081 -5.Local conditions. bly. You may reassemble the handpiece as 081 -6.(a) Use a stocklisted window cleaner; (b) you lubricate it. add a small amount of ammonia to water. 087 -5. Loosen the tightening rod, turn the collet 081 -7.Daily. nut clockwise, and use finger pressure until 081 -8.Make certain that the electrical switch is in the end play is removed. the OFF position. 081 -9.With a soft, dry cloth-daily. 088 1. T. 081 - 10.They are drycleaned. 088 -2. T. 088 -3. F. 082 -1.Outside; parking lot. 088 -4. T. 082 -2.Clean; cobwebs. 088 -5. F. 088 6. F. 082 -3.Litter. .. 089 -1. Belt; less; important. 083 -1.b. 089.-2. Sheath. 083 -2.a. 089 -3. Chuck: spindle. 083 -3. c. 089 -4. Lightweight. 083 -4.d, e. 089 -5. Sealed; two.
084 - 1.Only slightly since they differ in design, 090 - 1.b. shape, and manufacture. 090 -2.c. 084 -2.Manuals prepared by the equipment manu- 090 -3.d. facturers. 090 -4.a. 084 -3.Make a visualinspectionforobvious 090 -5. e. problemareasandfollowitwithan 090 -6.f. operational check of the water, air, gas, and 090 -7. g. electrical systems. 084 -4. Loose connections, and defective washers 091 -1.b. and valves. 091 2.a, b. 084 -5. (a) Excessive moisture in the air system; it 091 -3.c. d. can be corrected by draining the air tank and purging the air lines daily. (b) Incorrect air pressure at criticalpoints; it can be 092 1. Changing burned out bulbs. adjusted by following the manufacturer's 092 2. Onto the dental operating unit. instructions. 092 -3. Use a dry towel. 084 6. Turn them over to the medical equipment 092 4. About every 6 months, apply lightweight repairman. machineoiltothejointsinminute 084 7. When you first notice signs of fraying. amounts. 084 -8. The screw is turneduntilthe highest possible pitch of sound is heard. 093 1. T. 084 9. Use a silicone spray (dry) lubricant. 093 -2.F. 08410. Conrosion, with eventual clogging of the 093 -3. T. entire drainage system. 093 -4. F.
129 56 . 4
094-1. Morning; grounded; 20; vibration; weekly; 095 -2. Clean; shaft; locking. monthly. !. 094-2. Oil; !nuttier; oil; two; clogging; water. 096-1. b, c, e. 094-3. Replace it with a dry one. 096-2. a. 034-4. Empty it, then put an inch of water in it. 096-3. d, f. 094-5. They must be emptied. 094-6. At the end of each day. 097-1. T. 094-7. Weekly. 007- 2. F. 097- 3. F. 095 -1. Seat; position; cuter; monthly. 097-4. T. *U.$ .i.GOVUNUENTPRINTING OFTNX:1974 640-058/304 AUGAPS. ALA (751365) Jan 75-2900
e
5,9 130 7-
I. MATCH ANSWER 2. USE NUMBER 1 OR SHEET TO THIS NUMBER 2 PENCIL. STOP- EXERCISE NUM- BER. 98150 01 24 EXTENSION COURSE INSTITUiE VOLUME REVIEW EXERCISE ADMINISTRATION, SAFETY, AND MAINTIIIANCE Carefully read the following: DO'S:
1. Check the "course," "volume," and "form" numbers from the answer sheet address tab against the "VRE answer sheet identification number" in the righthand column of the shipping list. If numbers do not match, take action to return the answer sheet and the shipping list to ECI immediately with a note of explanation. 2.Note that numerical sequence on answer sheet alternates across from column to column.
3. Use a medium sharp #1 or #2 black lead pencil for marking answer sheet. 4.Circle the correct answer in this test booklet. After you are sure of your answers, transfer them to the answer sheet. If youhave tochange an answer on the answer sheet, be sure that the erasure is complete. Use a clean eraser. But try to avoid any erasure on the answer sheet if at all possible.
5.Take action to return entire answer sheet to ECI. 6.Keep VoluMe Review Exercise booklet for review and reference. 7.Ifmandatorilyenrolled student, process questions or comments through your unit trainer or OJT supervisor. Ifvoluntarilyenrolled student, send questions or comments to ECI on ECI Form17. DON'TS: I.Don't use answer sheets other than one furnished specificallyfor each review exercise. 2.Don't mark on the answer sheet except to fill in marking blocks.Double marks or excessive markings which ovierflow marking blocks willregister as errors.
3.Don't fold, spindle, staple, tape, or mutilate the answer sheet 4. Don't use ink or any marking otherthan a #1or #2 black lead pencil. NOTE:NUMBERED LEARNING OBJECTIVE REFERENCES AREUSED ON THE VOLUME REVIEW EXERCISE. Inparenthesis after each itemnumber ontheVRE isthe Learning Objective Numberwhere the answer to thatitem can belocated.Whenanswering the items on the VRE, refer to theLearning Objectivesindicated by theseNumbers.The VRE results will be sent to you on a postcardwhich will list the actual VREitems you missed.Go totheVRE booklet and locate theLearning Objective Numbersfor the items missed. Go to the text andcarefully review the areas covered by these references.Review the entire VRE again before you take the closed-book Course Examination.
1
6i) Multiple Choice
clearinghouse for (001) Which individual in the AF Dental Service serves as a USAF directives, receives "feedback" from his fieldorganizations, and insures hat USAF and command policies are being implemented?
a. case dental surgeon. b. mmand dental surgeon. C. S eon General of the Air Force. d. Ass tant Surgeon General for Dental Services.
e base dental 2. (002) Wha is the primary professional responsibility of surgeon?
a. Insure prop r standards of professional patient b. Maintain pror functioning of USAF Preventive tistry Program. c. Act as chief a inistrator of all base dental grams and training. d. Establish train g standards for upgrade tra ing of dental personnel.
h services worldwide in support 3. (003) Providing Air F ce personnel oral hea of the overall Air Forceedical mission is e dental service's
a. primary mission. c. primary responsibility. b. secondary mission. d professional responsibility.
4. (003) Within a base dental cli o is directly responsible for the supervision, training, work assl nts, and evaluation of the enlisted dental personnel?
a. NCOIC. c. Base dental surgeon. b. Clinic 0/C. . Chief of Professional Services. between perso nel holding a 98130 AFSC and those 5. (004) The major differenc holding a 98160 AFSC is
a. type of duties per armed. b. tasks performed. c. variety of duti s performed. d. depth of knowdge and proficiency expected.
to entry into the 6. (005) What AFSmust a dental specialist attain prl preventive de lstry specialty?
a. 98130. c. 98150. b. 98131. d. 98250.
with the 98150 AFSC Dental 7. (005) at rank is usually held by those Speci 1st?
E-1 or E-2. c. E-3 or E-4. E-2 or E-3. d. E-4 or E-5.
applying the principles of 8. (006) Which is the most important reason for patient psychology when you are receivingpatients?
will help assure you have a. Addressing a patient by both his name and rank the right patient. achieve the best actual patient b. Using patient psychology is necessary to treatment procedures. patient may have a more profound c. The manner in which you reQ4ive the impact than the actual treatment. totally incumbent upon the way in d. The quality of the professional care is which the patient is received. 61 A ;4 6 3- 9. (006) Which general principle below identifies a desirable telephone mannerism for a dental receptionist?
a. Avoid letting your voice show a smile. b. Be extremely firm and businesslike in allsituations. the diagnosis of the c. Offer complete help on the telephone including patient's condition. d Speak as a representative of thedental clinic and reflect an eagerness to help.
with the Air Force receive (008) Army or Navy personnel assigned to duty outpatient dental treatment on what basis?
a. They receive emergency care only. b. ey are treated after all membersof the Air Force are cared for. space-available basis c. Th may receive routine dental treatment on a d. The receive treatment on the same basis as Air Forcepersonnel.
AF Form 1223a, Dental A ointment 11. (009) By ing both the front and back of Register, y can schedule appointments for
a. eight oper tors for 1 day or one operator for 8days. b. six operato for 1 day or one operator for 6 days. c. four operato for 1 day or one operator for 4 days. d. two operators or 1 day or one operator for2 days. months, what type 12. (010) If bitewing riographs were taken during the ast 12 of examination may beiven to fulfill the annual emination requirement?
a. Type 2. C. Type 4 b. Type 3. d. Type of a mouth mirror and explorer 13. (011) What type of dental e amination cons sts examination with adequate art :cial ill nation and posterior bitewing radiographs?
a. Type 1. Type 3. b. Type 2. Type 4.
d apply to a patient who hasminor or 14. (012) What dental classificati wo incipient caries that do not danger the pulp?
a. Class 1. Class 3. b. Class 2. Class 4. r including on dental records an (013) Who has the ge eral responsibility 15. rofes$ional service that has been accurate and appropate entry for a dental rendered?
a. The recordclerk. b. The dent clinic NCOIC. c. The den officer who performed the service ved. d. The d tal assistant or dental technicianinv
than a permanent, content 16. (014) ich of the following is a temporary, rathe of a ental record?
AF Form 696, Dental Patient History. Original SF 603, Dental Health Record.
. AF Form 528, Periodontal Scoring Chart. AF Form 644, Record of Dental Attendance.
3 17.7)]...5%.,When available, you should use cardboa unts for which of the followin types of radiographs?
a. Periapical. c. Occlusal. b. Exal-oral. d. Eitewing.
18. (016) How would ndibular righ e second bicuspid with facial lingual surfaces be ab lated in a dental reco
a . #4 c. #20-LB. 3-FL. d. #29-FL.
19. (017) To correctly chart an apicoectomy, you would
a. outline the defective area and block in solidly. b. trace a jagged fracture line in therelative position on the root. c. draw a small triangle at the approximate line of the rootamputation. d. circle the missing portion of the root and place a small "X"in the circle.
ed by 20. Dental treatment folders of flying personnel areident
their distinctive blue color. b. writing "flying personnel" in blue ink across the ont of the cover. c. acing a blue tab on the top right-hand side of he cover. square and the "AD" d. da ening in with blue the space between the " squa on the cover.
21. (019) When s uld negative dental patient htories (AF Forms 696) be destroyed?
a. Never. D. After 90 days. c. After 2 years. d. As soon as a new histo is cc leted.
ction I, Dental Examination, of the SF 603 22. (020) What are the entries in (Health Record--Dental) intend d o reflect?
a. The patient's general h lth dat b. The patient's dental h alth histo prior to entry into the service. c. The patient's dental ondition uponntry into the service. military service. d. The restorations co..leted during the atient's
Chart, is used to record data, 23. (021) If an AF Form28, Periodontal Scorin where and for how 1 g is it kept?
a. It is permRne ly filed with the patient's m dical records. b. It is retain d for 1 year in the patient's mecal records. c. It is retai ed for 1 year in the patient's den1 records. in the dental treatment d. It and sub equent charts are kept permanently folder.
using an SF 513, 24. (022) If medical officer requests a dental consultati when is tr etment ziven to the patient if a dentalproblem is discovered?
uest for the a. Not less authorized by the medical officer making the . con ultation. medical o icer. b. No before an SF 515 is returned to the requesting c. ,ly if authorized by the base dental officer. d. determined necessary by the consultant.
4 63 'ow
nducted in the dental clinic? 71. (064) I ere is most train
a. In the 0 office. b. In th nce room. c. I tal treatment rooms. endent's office.
uld perform when developing atraining 72. (065) program o
a. Establish t jectives. b. Develop less an. c. Prep measurement t d. S ect the instructional me
employ h " and tell" principle? 73. 066) What lesson presentation method e method. Lecture method. c. Performa tion method. Discussion method. d. Demons develop relationships in the 74. (06 ) Which of the following is a good way t body f a lesson plan?
a. F present to past. b. From complex to simple. c. From own to unknown. fr:equently used. d. From 1 s frequently used to mos presentation interesting, youshould do 75. (068) In ord to make your less all of the folling except
a. vary the pitch f your vo e. b. keep your voice a mon one. voice to emphasize keypoints. c. change the force d. vary the rate of yo peech. training program, what should yourphase test 76. (069) Upon completionf measure?
a. The lesson obj ives e. b. The students' epth of knowle gained through outside reading. c. The knowled the students hall ep above those of thestudents. d. The skill vel requirements a undesirable action concerning general 77. (070) Which statement below describes an safety pr iples related to preoperatiarEfeiranir
t operate the equipment. a. Ope ors should know the proper way onal training. b. Fo 1 technical courses teach preoperat preoperatioal training ofoperating c. Y OJT supervisor will give uipment. normally have no need toread instruc- d. killed operators of old equipment tions for new or unfamiliarequipment.
general safety principle ofdiscipline, the 78. (071) In accordance with the person having the primaryresponsibility -to safety check equipment in your work area is the ground safety officer. a. you. c. the medical equipment repairNCO. b. your supervisor. d.
11
6 4 safety principle of alertness, 79. (072) In order to conform with the general you must do your best to keepfro? being ?entail* or physically
a. aware. c. disciplined. b. alert. d. sidetracked. safety practice? 80. (073) Which action listed below is not z
a. Cut away from yourself. b. Work at a moderate, consistent pact. legs. c. Lift with your beck, not with your arms or d. Use tools or instruments only fartheir designed purpose. safety principle of mental and 81. (074) Which statement concerning the general physical fitness is correct?
a. Sight or hearing difficulties rarely causeaccidents. alertness and accidents. b. Mental worries are unrelated to effect on accident reduction. c. Physical exercise programs normally have no similar manner to physical fitness. d. Mental fitness should be approached in a elements is tht secret to 82. (078) Elimination of which of the following extinguishing fires?
a. Fuel. c. Neat. Any of the above elements. b. Oxygen. d. principles is incorrectly,stated 83. (076) Which of the following general safety as it concerns propertquipment maintenance? hazardous even if it works. a. A defective electric switch is of adjustment are all hazardous. b. Worn or loose parts and parts out constitutes a safety hazard. c. Any michine not in good condition be kept dull or sesisharp toavoid d.The cutting edge of tools should serious accidents. environment that is not safety 84. (077) Which statement below describes an oriented? working spece. a. Equipment layout that provides ample easily see a hallway, window, b. Equipment arranged so that the operator can or doorway. clean and free from unnecessary grease. c. Handtools and machine tools kept and clean. d. Workbenches and floors that are uncluttered planning that should precede the 85. (078) The amount of safety preoperational beginning of your operations depends uponthe
a. amount of supervision available. b. nature of the tasks to beaccomplished. c. attitude of your supervisory personnel. imposed upon you. d. number of regulatory publications should you follow if you smell a 86. (079) Which of the following procedures small propane gas leak?
hazards, and establish fresh air a. Report the leak, eliminate fire ventilation. ventilation, and light a Bunsenburner to b. Report the leak, establish dissipate the gas. and then call the firedepartment. c. Remove oxygen equipmerr from the Irea and windows, and call the fire d. Evacuate the clinic, close all c:ors department.
12 65 1
housekeeping is to 87. (080) With regard to dental equipment, the key to good
a. clean it only when it appears dirty. b. always wait to be directed to perform thecleaning. c. make a habit of cleaning at prescribed intervals. microorganism are visible. 4. thoroughly clean any equipment on which
18. (081) Prior to dismantling lighting fixtures fortheir periodic cleaning, you should
a. dieconnect and remove the light switch. b. ground the light witch with a safety wire. provisions so it cennot c. place the switch in the OFF position and make inadvertently be turned ON. electrical switch to the Orr d. turn the fuse box switch connected to the position and lock the door of the fuse box.
of a dental clinic 89. (082) Normally, good housekeeping for the outside area includes keeping the parking lot free from
a. cars. c. litter. b. weeds. 4. rodents. equipment repair center (Nen) 90. (083)The maintenance performed by a medical functioning on a geographic basis is
a. area maintenance. c. preventive maintenance. b. field maintenance. d. organisational maintenance. maintenance of dental 91. (084) Probably the best approach to preventive equipment consists of a visual inspectionfollowed by an operational check at the
a. cicee of each duty day. b. beginning of each duty day. repairman. c. time of inspection by a medical equipment equipment and at monthly intervals. d. time of the installation of the new with dental operating unitsis 92. (084) What air system problem encountered correctable by draining the air tank andpurging the air lines daily?
a. Air is too dry. b. Air pressure is too low. c. Air pressure is too high. d. Air contains excessive moisture, of a dental operating chair,the 93. (OW To expel air from the hydraulic system first step is to
cushion, and the air vent screw. a. remove the electric motor, the seat cushion, and the air vent screw. b. remove the hand lever, the seat the seat cushion, and c. lower the chair to its lowest position, remove locate the air vent screw. the seat cover, and remove d. raise the chair to its highest position, remove the air vent screw.
with most dental operatingchairs? 94. (085) What type of hydraulic fluid is used
a. SAE 20-weight motor oil. b. SAE 10W40-weight motor oil. c. Lightweight automotive-type hydraulic fluid. d. Heavyweight automotive-type hydraulic fluid.
13 66 95.(086) The range of speed of all three classifications (conventional-speed, high-speed, and ultra-speed) of dental handpieces is from a law of
a. 12,000 rpm to a high of 100,000 rpm. b. 12,000 rpm to a high of 300,000 rpm. c. 6,000 rpm to a high of 500,000 rpm. d. 100,000 rpm to a high of 500,000 rpm.
96.(066) If dental handpiecss are not given constant preventive attention consisting of cleaning and lubricating, a likely malfunction due to abrasives would be
a. lowered operating speeds. b. excessive oil consumption. c. wavering speeds and excessive noise. d. undue vibration resulting in excessive wear.
97. (087) How often should the conventional-speed straight handpiece be lubricated?
a. Only when it malfunctions. b. After 20 hours of general use. c. Only when overheating is noticed. d. Whenever it overheats or after every 10 hours of general use.
98. (087) Which of the following items should never be used when cleaning dental handpieces?
a. Cotton-tipped applicators. c. Paper toweling. b. Handpiece cleaner. d. Pipe cleaners.
99. (088) The conventional-speed, contra-angle handpiece should be lubricated after every
a. hour of use. c. 10 hours of use. b. 5 hours of use. d. 15 hours of use.
100. (.4)89) The disassembly of the belt-driven, high-speed straight handpiece for cleaning and lubrication
a. involves only the removal of the sheath. b. involves the complete breakdown of all component parts. z. is much more complex than that of the slower handpieces. d. is of no importance, as oil-impregnated bearings require no ldbrication or cleaning.
101. (090) The best rule to follow concerning the lubrication of the ultra-speed handpiece is to
a. lubricate after every 5 hours of general use. b. clean and lubricate after every 10 hours of general use. c. read and closely follow the manufacturer's instructicns. d. lubricate only when directed to do so by a dental officer.
67 102. (091) Which one practice listed below should be avoided in themaintenance 41, of diamond-coated rotary instruments ieCauer itcaTeiThuterioration of the bonding material?
debris away with a. Soaking the instrument in soapy water and then scrubbing a bristle brush. b. Using an ink eraser for cleaning debris free the instrument'sgrit. removal. c. Soaking the instrument in pure mercury as a part of amalgam d. Soiling and.autoclaving the instrument.
the bulb in 103. (092) Which of the following items should you use when changing the dental operating light?
a. A voltmeter. c. A pair of pliers. b. .A dry towel. d. A wet gauze sponge.
cabinet usually has 104. (093) The newer (modular) type of dental instrument nylon drawer guides which require
a. no lubrication. b. lubrication daily. c. one drop of oil monthly. d. coating with petrolatum weekly.
105. (094) If the bottle of the dental aspirator overflows, you must
a. adjust the valve located on top of the vacuum bottle. b. replace the rubber tube leading from the bottle. c. replace the chamois disk with a dry one. d. change the cotton in the muffler.
shaft of dental 106. (095) What is a normal result of lubricating the single operating mobile stools?
a. The stool base will malfunction. b. The castor bearing will deteriorate. c. The shaft will attract dirt and clog thesliding mechanism. d. The locking mechanism will nct hold in itsadjusted position.
from the inside of 107. (096) What action should you take to remove heavy scale an autoclave?
a. Lightly sand the inner chamber with "wet-and-dry" sandpaper. b. Scrub with mild soap and water solution using a pieceof steel wool. the deposits c. Use the wide blade of the ultrasonic tooth cleaner to remove through its vibrating action. and operate the d. Add one-half cup vinegar to the required amount of water autoclave through its regular cycle.
a rotating 108. (097) When the small electric motor of an amalgamator operates, cam causes the prong to move in whatkind of pattern?
a. Oval. c. Figure "8." b. Circular. d. Up and down.
15 S 9
i
PREPARED BY SCHOOL OF HEALTH CARE SOENCES. USAF(ATC) SHEPPARD AiR FCRCE BASE, TEXAS
EXTENSION (XURSE INSTITUrE. GUNTER AIRFORCE STATION. ALABAMA
THIS PUBLICATION HAS BEEN REVIEWEDAND APPROVED BY COMPETENT PERSONNEL OF THE PREPARING COMMAND INACCORDANCE WITH CURRENT DIRECTIVES ON COCTRINE. POLICY. ESSENTIALITY.PROPRIETY. AND DUALITY.
7 r) THIS SECOND volume of your career development course (CDC) presents the basic dental sciences that are of concern to your job proficiency. These knowledges are beneficial in several ways. For example, they allow you to conununicate with the den- tal officers in the terminology native to your vocation; they enable you to present a more profeuional image to the patients; and they allow you to perform better in your job, because they have given you the background knowledge you need to understand your job. As in the other volumes of this CDC, we review the material necessary to prepare you for your promotion testing (SKT), and we present new information to ad- vance your knowledge in dental technology. Chapter 1 presents a comprehensive study of oral anatomy and physiology. The sec- ond chapter is concerned with the diseases and conditions common to dental patients. The next chapter discusses the various therapeutic agents and aids used in dentistry. Chapter 4 presents the subjects of basic microbiology and sterilization. Foldouts 1 through 4 are included at the back of this volume. Whenever you are referred to one of these, turn to the back of the volume and locate it. If you have questions on the accuracy or currency of the subject matter of this text, or recommendations for its improvement, send them to School of Health Care Sciences/MST, Sheppard AFB TX 76311. If you have questions on course enrollment or administration, or on any of ECI's instructional aids (Your Key to Career Development, Behavioral Objective Exercises, Volume Review Exercise, and Course Examination), consult your education officer, training officer, or NCO, as appropriate. If he can't answer your questions, send them to ECI, Gunter AFS AL 36118, preferably on ECI Form 17, Student Request for Assistance. This volume is valued at 39 hours (13 pcints). Material in this volume is technically accurate, adequate, and current as of Septem- ber 1974. Contonts
Page iii Preface
Owprer
1 1 Oral Anatomy and Physiology 30 2 Oral P atho logy 53 3 Dental Therapeutics 69 4 Basic Microbiology and Sterilization
81 Answers for Exercises 4 x Lot
CHAPTER 1
NOTE: In this volume, the subject matter is developed by a series of Learning Objectives. Each of these carries a 3-digit number and is in boldface type. Each sets a learning goal for you. The text that follows the objective gives you the information you need to reach that goal. The exercises following the information give you a check on your achievement. When you complete them, see if your answers match those in the back of this volume. If your response to an exercise is incorrect, review the objective and its text.
Oral Anatomy and Physiology
THE SUCCESSFUL dental specialist must obtain a Cranial Bones of the Skull.Cranial bones are thorough knowledge of oral anatomy and either single or paired. Single bones are always physiology. This knowledge is necessary when you found in the midline plane of the skull. Paired are completing dental treatment records and other bones are found on either side of this plane and are related forms and when you are discussing mirror images of each other. There are eight treatment procedures with the dentists. Although cerebral cranial bones: the frontal (single), parietal you have already received extensive training in the (paired), occipital (single), temporal (paired), oral anatomy and physiology areas, we feel this sphenoid (single), and ethmoid (single). chapter is needed to reinforce your past training. Frontal. The frontal forms the forehead, the In this chapter, we discuss the cranial and facial anterior part of the floor of the cranium, the roof of bones of the skull, the structure and innervation of the eye sockets, and the nasal cavity. Inside the the oral cavity, the deciduous and permanent heavy roll of bone above the eye and posterior to dentition, the structures of the teeth, and the oral the eyebrows are two airspaces called the frontal mucosa and its function. We begin our discussion sinuses. These sinuses drain into the nose. Their with the bones of the skull. purpose is thought to be that of maintaining even temperature ranges within the bone. 1-1. Bones of tbe Skull Parietal. The two parietal bones form the roof and the upper sides of the cranium. These bones As a dental specialist, your main concern with extend from the frontal bone to the occipital bone. anatomy involves those bones and bony landmarks The sagittal suture is formed where the two bones that most closely relate to the teeth. While we meet at the top of the cranium. From this suture, the discuss all the bones of the skull, we do place parietal bones extend outward and downward to a special emphasis on the maxilla (upper jaw) and point at about the top of the external ear, where mandible (lower jaw), since they are the boncs that they meet the temporal bones. contain the teeth. Occipital. The occipital bone forms the back and the base of the skull. It is commonly referred to as 200. Name, locate, and identify the facial and the back of the head. This is the bone that supports cranial bones of the skull that do not directly the head upon the spinal column. When a patient is support the teeth. properly seated in the dental chair, the headrest should be positioned to support.the occipital bone. The skullis composed of 22 flattened or If thisis done properly, the entire head will be irregular bones. With one exception (the mandible), supported. The spinal cord passes through a large they are immovably joined together. The bones of hole in the base of the occipital bone to the the skull are divided into two groups: the cerebral vertebral canal. This large hole is called the cranial bones, which enclose and protect the brain, foramen magnum. and the facial bones, which make up the skeleton of Temporal. The two temporal boncs form the the face. There are eight cerebral cranial bones and lower part of each side and a part of the base of the 14 facial cranial bones. All 22 bones are shown in cranium. These bones contain the mential organs foldout 1, located in the back of this volume. Only of hearing and balance. The zygoma:ic process of the facial bones are discussed in detail. each temporal bone extends forward f...om the top
I P7I0 1 0 1.
cavity, and it forms of the external opening of the ear tojoin the lower andback-Part of the nasal forms a part of the septum of thenasal cavity. It is thin and zygomatic bone of the face. This process it is bent to one cheek bone. varies in individuals. Frequently, part of the zygomatic arch or the nasal chambers of Sphenoid. The sphenoid bone makes up partof side or the other, thus making the floor of the cranial cavity. Italso forms the different size. posterior one-third of the lateral wallsof the nasal Exercises (200): cavity and the back of the orbits,permitting the locate, and identify brain. The Display your ability to name, transmission of the optic nerve from the matching the deicriptive which drain the bones of the skull by sphenoid bone also contains sinuses statements in column B tothe elements listed in into the nose. Edvnoid. The ethmoid bone is locatedbetween column A. the eyes and extends from the roof ofthe nose and CohunnA Column B sphenoid bone to the frontal bone. Itforms the _ I.22. a. Total number of facial anterior part of the skull base, themedial wall of 2.Zygoma. bones. 3.Vomer. b. Paired bones that form both eye sockcts, and the roof ofthe nasal cavity. the roof and upper sides transmitted _ 4.Ethmoid. The olfactory nerves to the nose are S.14. of the cranium and con- through the ethmoid bone. The ethmoidsinuses are 6.Inferior conchae. tain the sagittal suture. Paired bones that form located in this bone and they, too,drain into the 7.Palatine. c. Parietal. the lower part of each nose. _ 8. side and a pan of the the area with Sphenoid. Tbe Face. Since the face lies within Lacrimal. base of the cranium. which the dentist is concerned, let'slook at its Temporal. They also contain the es- stnicture. Its importance is paramountin that it Frontal. sential organs of hearing affects appearance and expression,and itis the Nasal. and balance. Occipital. d.Total number of bones in gateway to the alimentarycanal. Damage to the face the skull. can result in serioussocial and psychological e. Paired bones that form problems. The 14 facial bonescomplete the the lower and outer edges Included in these are two of the eye socket and the anatomy of the skull. prominent portion of the lacrimal, maxillary, two zygoma, two nasal, two cheekbones. one vomer, two inferiorconchae, two palatine, and These paired bones by one mandible. Sincethe bones of the jawsthe their junction form the maxilla and mandibloare ofspecial interest, we upper pan of the bridge detail. of the nose. will discuss them last and in more g. This bone forms the back Zygoma. The zygomatic bones formthe lower and and base of the skull and outer edge of the eyesockets and the prominent contains the foramen portion of the cheekbone. Theanterior edge of the magnum. and is called the h.This bone forms the zygomatic bone joins the maxilla forehead and contains zygomatic process of the maxilla. sinuses that drain into Lacrimal. The lacrimal bones aresmall fragile the nose. bones of the face. They aresituated at the front of i. Situated at the front of orbits. They contain part the medial wall of the eye the medial wall of the eye orbits, these small fragile of the canal through which the tearducts pass. bones contain part of the Nasal. The nasal bones are twosmall, thin, canal through which tear oblong, bones located side byside at the middle and ducts pass. upper part of the face.These bones, by their J. The honzontal portion bridge of the of these bones play a ma- junction, form the upper part of the jor role in forming the nose. The lower partof the nose is formed by nasal roof of the mouth. carti lages. k. This bone is located be- Inferior conchae. The inferior conchae arecurved tween the eyes, and it ex- bones lying horizontally along thelateral walls of tends from the roof of located directly the nose and sphenoid the nasal cavity. These bones are bone to the frontal bone. is a layer of above the roof of the mouth. Each bone I These curved, scroll-like thin, cancellous tissue cvrled like ascroll. bones are located along Palatine. The palatine bones aresituated at the the lateral walls of the back part of the nasal cavity between themaxilla nasal cavity. m.This bone makes up part and the pterygoid process of the sphenoid.They are of the floor of the cranial L-shaped; the horizontal part helps toform the cavity and also forms the floor of the nasal cavity and the roofof the mouth; posterior one-third of the orbit and forms a lateral walls of the nasal the vertical part extends to the cavity and the back of thc very small portion of theorbit's floor. the orbits. Vomer. The vomer is a single bone located at 74 2 Cee
Column B The body and the four processes are shown in figure n. This single bone forms 1-1. During this discussion, you should refer to this pan of the septum of the figure frequently. nasal cavity. Frequently. itis bent to one side. The alveolar processes are the ones with which making nasal chambers you will most often come into contact. These of different sizes. processes are extensions of the lower maxillae body surfaces. They fuse together between the central 201. Describe, locate, and identify the anatomi- incisors and appear as one processthe maxillary cal features of the maxilla and mandible. alveolar process. The function of this maxillary process is to hold and support the maxillary teeth. The Maxilla and Mandible. As stated earlier, However, when the teeth are removed, this holding the maxilla and mandible are of special interest to function is no longer necessary. Then the body, the dental profession, since they are the bones in through natural resorption, removes a large portion which the teeth are embedded. For this reason, we of the structure. For this reason, the dentist tries to have elected to discuss them in more detail than we maintain the natural teeth as long as possible. The did the other facial bones. anatomy of the maxillae is particularly important to the dental profession, especially in prosthetic Maxilla. The maxillae (plural) form the upper dentistry and roentgenology. Of particular interest jaw. They are two irregular-shaped bones that to prosthetic dentistry is the maxillary tuberosity, the small, rough prominence behind each maxillary contribute to the formation of the boundaries of the roof of the mouth, the floor and outer walls of the third molar area. Just behind the maxillary nasal cavity, and the floor of each orbit. Within the tuberosity, where the maxilla and the pterygoid thin walls of each maxilla is the maxillary sinus. process unite, is a notch or groove known as the Each maxilla consists of a body and four processes. hamular notch. This notch is used to determine the The body of the maxilla is the base for these posterior extent of a maxillary denture. processes and gives shape to the face in general. The There are three paired foramina and one four processes and their purposes are as follows: unpaired foramen in each maxilla. These foramina allow blood vessels and nerves to pass in and out of The frontal processes give shape to the nose. the maxilla. The unpaired foramen lies just The zygomatic processes join the zygomatic posterior to the central incisors at the midline of the bones and form the cheeks just below the hard palate. It is called the incisal foramen or the orbits. incisive palatine foramen. One set of the paired The alveolar processes hold and support the foramina lie medial to the third molars at the suture maxillary teeth. line of the palatal processes of the maxillary and the The palatal processes join to form most of the palatine bones. They are called the major palatine hard palate. foramina or the posterior palatine foramina. The
Frontal Process,, Maxillary Zygornatic Sinus Process Nasal Process
1 Maxillary Palatine Tuberosity Process
Alveolar Process
LATERAL MEDIAL Figure The maxilla.
3 second group of paired foramina are found on the is the largest and the only movable bone in the distal border of the maxillary tuberosity. Usually, skull. The mandible consists of a body, two rami, they consist of three to five openings and are called and the mandibular alveolar process. the posterior superior alveolar foramina. The last The body of the mandible is a strong, hard piece group of paired foramina are located onthe of bone that curves somewhat like a horseshoe. At zygomatie process of the maxillary bone, superior the posterior of the mandible, the bone turns to the apex of the cuspids, and just below the eye upward and slightly backward to form the rami. orbit ring. These foramina are called the The alveolar process is on the superior borderof infraorbital foramina. the body of the mandible. Figure 1-2 showsthe Mandible.The mandible forms the lower jaw. It mandible and the anatomy important to you as a
Mandibular Notch Condyloid Process
Neck Of Condyle Alveolar Process
Oblique Line
Mental Foramen
Coronoid Process
Mandibular Foramen
Mylohyoid Ridge
Genial Tubercle Figure 1-2 The mandible. -76 4 , 0,
dental technician. Therefore, during this discussion Exercises (211k of the mandible you should make frequent 1. What anatomical formations are contributed to references to the figure. by the maxillae? On each side of the mandible, approximately 2 inches distal from the midline and on the lateral surfaces of the mandible, are the mental foramina. Describe the function or anatomical formation of They are looted about halfway between the top and the processes of the maxilla by matching the bottom edges of the mandible. Their function is to function or formation in column B to the process in allow blood vessels and nerves to exit to the soft column A. tissues of the chin. On the internal surface of the mandible, opposite the chin and on the midline, is the genial tubercle or mental spine. These are sharp Colwnn A Colony, 8 2. Palatal. a. Holds and supports the spines that serve as attachments for the genioglossus 3. Zysomatic. maxillary teeth. muscle. These tubercles are used as landmarks in 4.Alveolar. b. Forms most of the bard dental roentgenology. The bony ridge that starts 5 Frontal, palate. just below the genial tubercules and extends C. Gives shape to the nose. d.Forms the cheeks just backward and upward on each inner side of the below the orbits. mandible, ending in the area of the third molar, is known as .mylohyoid ridge. This serves as an 6. Describe and tell where the maxillary tuberosi- attachment for the mylohyoid muscle that forms the ty is located. floor of the mouth. On the external surface of the mandible is the oblique line. This line starts near the mental foramina and extends upward and backward until it disappears into the anterior edge of the ramus. These landmarks are used in 7. What notch or groove is located just behind the prosthetic dentistry. The dental officer insures that maxillary tuberosity, where the maxilla and the he does not overextend his impression, which pterygoid process unite? would cause the denture to impinge on the tissue, thus causing an irritation or a denture that does not properly seat. 41 The rami are the vertical extensions of the 8. What is the purpose of the foramina located in mandible. The posterior of the ramus and the lower the maxilla? border of the body of the mandible meet at what is called the angle of the mandible. The front edge of the ramus meets the body and forms the retromolar triangle. This junction is located just behind the last Indicate the anatomical position of the foramina tooth. The ramus divides into a "Y" at the top to located in the maxilla by matching the location form the coronoid and condyloid proceaes. The given in column B to the foramen or foramina in anterior part, or coronoid process, serves as an column A. attachment for muscles of mastication. The posterior process, or condyloid process, has a knob Colwnn A Column B on top called the head. This head fits into a -9. Incisive palatine a. On the zygomatic process foramen. of the maxillary bone, depression in the temporal bone to form the 10. Major palatine supenor to the apex of temporomandibular joint. The space between the foramen. the cuspids. and just coronoid and condyloid processes is the _ II. Infraorbital fora- below the eye orbitring. men. b. On the distal border of mandibular notch. The mandibular foramina are _ 12. Posterior superior the maxillary tuberosity. located almost in the center of the inside surface of alveolar foramen. c. Medial to the third the rami. Through these foramina, the blood vessels molars at the suture line and nerves enter and leave the mandibular body. of the palatal processes of the maxilla and the These foramina are protected superiorly by a bony palatine bona. ridge called the lingula. d. Posterior to the central The alveolar process of the mandible is of the incisors at the midline of same type of bone structure and serves the same the hard palate. function as that of the maxillary alveolar process. In an X-ray film view of the posterior teeth, the 13. What is the only movable bone of the skull? oblique line superimposed over the alveolar process gives the impression that this portion of the process is much thicker. Behind the last tooth, thc alveolar process becomes continuous with the ramus in the 14. Where is the alveolar process of the mandible retromolar area. located? TABLE 1-1 MUSCLES OF MASTICATION
Action Muscle Origin ^ Insertion Coronoid process. To raise the mandible Temporalis Side of head and close the mouth.
Zygomatic process Facial surface of To raise the mandible Masseter the angle of the and close the mouth. mandible. The simultaneous Medial pterygoid Sphenoid bone Lingual surface of the angle of tits mandible. action of both medial pletygoid muscles moves the mandible upward and forward. When one medial pterygoid contracts, it moves the mandible to the side opposite that muscle. The simultaneous Lateral pterygoid Sphenoid bone Condyloid process of the mandible. action of both lateral pterygoid muscles moves the mandibl downward and forward. When one lateral pterygoid contracts, it moves the mandible forward and to the side opposite that muscle.
15. What anatomical feature is located on eachside 20. What joint is formed when the head of the of the mandible approximately 2 inches distal condyloid process fits into the depression in the from the midline about halfway on the temporal bone? mandible lateral surface? What is the function of this feature? 21. What is the space between the coronoid and condyloid processes called? 16. Where is the genial tuberclelocated, and for what does it serve as an attachment? 22. Where is the retromolar area located?
17. Describe the path of the mylohyoid ridge,and state what attaches to this ridge.
1-2. Muscles of Mastication and Teinpora mandible 18. What is the vertical extension of the mandibular Articulation called? Now that you have an understanding of the bones of the skull, with particular emphasis placed on the maxillae andmandible, it is necessary to of the review the muscles of mastication and howthey 19. What is the anterior process at the top There are rami called? What purpose does it serve? effect the movements of the mandible. four primary muscles of mastication. Table 1-1 identifies these muscles and states their origin, insertion, and action. 6 78 .4
Pterygoid
Figwe 1-3. Muscks of mastkation.
7 7-I
the head of the mandibleforward and inward. 202. identify the fenctions, location, origin, and function of this illStreiell of swedes of mastication. Thus, you can visualize the primary muscle as one of grinding. Prior to studying these muscles, there are a few Auxiliary Muscles of Mastkation. Inaddition terms that you must remember.These terms are to these primary muscles ofmastication, there are the chewing listed below. several additional muscles that assist in a. MasticationThe grinding andcrushing of of food and the formation of the lips,cheeks, and which can be food with the teeth. the floor of the mouth. These muscles, b. Muscle originThe more fixed, central, or seen in figure 1-4, never actindependently but larger attachment of a muscle. always in unison with their related muscles. c. Muscle insertionThe part ofthe muscle that Buccinator. The buccinator muscle must be attaches to the bone to be moved. considered in any discussion of the musclesof Masseter Mode. The masseter muscle is the most powerful mastication muscle.It acts to raise the lower jaw, thereby exerting pressure on the teeth, particularly in the posterior region. Figure 1-3 shows that its origin is the entire lengthof the outer surface of the zygomatic processof the maxilla and zygomatic bone. From this origin,the muscle fibers have a general downwardand backward direction to their insertion on the lower border of the ramus, mandible, and facial surfaceof the ramus. If you will clench your teeth, you can feel the movement of the masseter muscle around the angle of the mandible. Temporalis Muscle. The temporalisis a muscle whose origin is a wide area on theside of the head. Obicularts Oris This area includes the lower partof the parietal A bone, the greater pan of thetemporal -bone, the outer wing of the sphenoidbone, and the lateral surface of the frontal bone.The area of insertion of this muscle is on the entirecoronoid process and / part of the anteriorborder of the mandible. The "' origin and insertion can be seenin figure 1-3. The fibers of the temporal muscles arequite long and spread over a large area.For this reason, the Iluceirtotor temporalis is mainly used for movementrather than power. Thus, it is used toraise the mandible., and because of the oblique directionof the fibers, it can also retract the mandible. If youplace your hand over the temporalbone, you can feel the actionof this muscle when you openand close your mouth. Medial Pterygoid Muscle.The medial pterygoid, as seen in figure 1-3, acts,in a way, as a counterpart of the massetermuscle. Its fibers follow the same general planes, andits function of raising the mandible is the same. It islocated on the medial side of the ramus, with its originbeing the medial surface of the lateral pterygoidplate. Its insertion is at the angular portionof the mandible. Lateral Pterygoid Muscle.The lateral pterygoid is seen in figure 1-3. It hasits origin from two separate heads: the superiorhead arises from the lower part of the lateral surface of the greatwing of the sphenoid, and the inferiorhead from the lateral surface of the lateral pterygoidplate. The fibers from both heads convergein front of the temporomandibular joint and on the neckof the of masucatton. condyle. The action of the lateralpterygoid pulls Ftgure 1-4. Auxtliary muscles 8 8 07, mastication, although it has little, if any, effect on Cokes. A the movement of the mandible. The buccinator outer surface of zygomatic process forms the lateral walls of the mouth. Its primary of the martins and action is to compress the cheeks; tins. it keeps the wink bone. food between the teeth during masticat:on. Its 11. Primary action is origin is the alveolar processes of both the maxillae to compreu the and mandible. The fibers ate directed forwatd to cheeks. thereby keeping food be- the angle of the mouth where they blend with the teem theme!u der. orbicularis oris. The fibers divide at the angle of the ing mastionion. mouth so that the upper fibers insert into the 9. Primary action is muscles of the lower lip, and the lower fibers insert one of grinding. since it pulls the into the muscles of the upper lip. hesd of the mandi- Orbicularis oris. The orbicularis oris isa ble forward and in. sphincter muscle, which has no definite originor ward. insertion. It completely encircles the outerentrance of the mouth and forms the fleshy portion of the lips. It functions to perform the actions of opening 203. Given a series of statements that describe and closing the outer entrance of the mouth and the the saatonticti features of temporomandibeito protrusion of the lips. articulation sad *sir fonctions, indicate *Ida Mylohyvid. The mylokoid muscle hu its origin are true and Wadi see false. on the mylohyoid ridge. Its posterior fibers are directed downward and medially, with their Teasporomandibular Articulation. Now that insertion on the superior border of the hyoid bone. you have an undentanding tbe primary muscles The middle and anterior fibers are united along the of mastication and those other major muscles that midline with the same fibers e: the opposite support the mastication process, let us discuss the mylohyoid muscle. Thus, they form the muscular rotational center of the mandiblethe floor of the mouth. temporomandibular joint, This joint derives its name from the two bones that enter into its makeupthe condylar process of the mandible and Exercises (202) the mandibular fosse of the temporal bone. The Complete the following exercise by matching the mandibular foss* is somewhat cup-shaped and is muscles in column B to the appropriate statements limitud anteriorly by the anicular eminence. This in column A. Some muscles can be matchedto aids the liptnents of the joint in keeping the jaw more than one statement. from becoming dislocated. The articular surface of the condyle is oblong with the long diameter in a Column A Column 8 transverse plane. This joint allows for a I A sphincter muscle a. Orbicularts ens. combination of movements such ss hinge, bilateral, that forms the b. Muuter. and protusive. To prevent the bony surfaces of the fle.ln portions of C. Temporalis. the lips. d.Mylohyoui two principal bones in this joint from rubbing and 2. Inserts onthe e. Buccinatnr. wearing their surfaces, an articular disk lies hyoid bone and f. Medial pternioad. between the condyle and the mandibular fosse. The forms the floor of g. Lateral pterygotd. upper surface of the thin, oval, fibrocartilage plate the mouth. is convex to conform to the mandibular fosse. The 3Acts to raise the lower jaw; in so undersurface is concave to conform to the head of doing, it exerts the condyle. On its circumference, the articular disk pressure in the is connected to the articular capsule or capsular posterior region. ligament and, in front, to the lateral pterygoid 4. Its long fibers are used mainly for muscle. The disk divides the joint into two cavities. movement rather Each of these cavities has a synovial membrane than power: it aids surrounding it, which secretes a fluid that acts as a in raising the man. lubricant for the joint. To seal in this lubricant, the cilble but can also joint is enclosed in the capsular ligament. This retract it. 5. Forms the lateral protects the joint linings from wear and allows the walls of the mouth. temporomandibular joint to absorb normal blows 6. Acts as a counter- to the jaw. The four ligaments in the temporoman- part of the masseter dibular joint help prevent excessive movement and muscle in the func. tion of raising the aid in supporting the mandible. Individually, they mandible. are the capsular. temporomandibular, sphenoman- 7. Has origin along dibular, and the stylomandibular ligaments. Refer entire length of to figure 1-5 as we discuss each of these.
9 Si TomporeftertdIlvtior ligemoot Maude. Cipswito
Sphrmameo4Iltyler ligoirmet
StyrIttottodlltwIrli.01110111...... \ MEDI A ASPECT 'LATERAL ASPECT
Syetniel Cirri tim
I..1111kptali. Olidiwg (\i'''' StetIqrs
MOVEMENTS Opttolo. / CIstio Art levir DWI Orladkre
SAGITAt. SECTION
Elegy 1.5, The wmporomandibutar temporomandibular joint derives ligament is often called the I. The a. The capsular its name from the twobones that enter articular capsule. It is a thin,shertlike ligtment that into its makeup: thecondylar process of surrounds the temporomandibularjoint and mandibular fosse above and to the neck the mandible and the attaches to the temporal bone of the temporal bone. of the condyle below. eminence aids the ligament attaches 2. The articular b. The temporomandibular ligaments of the joint inkeeping the jaw above to the zygomatic processof the temporal attach to tts.- outer from becoming dislocated. bone and extends downward to tunporomandibular jointallows and posterior surface of theneck of the condyle. 3. The sphasomandibular ligament is a flat,thin only for a hinge-typemovement. c. The disk divides the jointinto band that attaches above to aprojection on the 4. The articular under surface of the sphenoidbone. It then paws three cavities. downward and attaches to theinner surface of the 5. The four ligamentsin the temporoman- prevent excess ramus in the regionof the mandibular foramen. dibular joint help in supporting the d The stylomanditederligament attaches near the movement and aid end of the styloid peocess. Itthen passes downward mandible. and forward and attaches tothe posterior border of 6. The fourligaments involved in tan- _ the the mandibular angle. poromandibular articulation are condyloid, temporomandibular, sphenomandibular, and mylomsndibu- Exercises (23k lar. by indicating Complete the following exercises 7. Tle s)novial membranesecretes a fluid concerning temporomandi- _ whether the statements that lubricates the joint. baler articulation are true (T) orfalse (F). 10 32 8.The articular disk lies between the cross-section of the mucosa would reveal a thick condyle and the mandibular fossa. epithelium, thick connective tissue (lamina 9. To seal in the lubricant, the joint is propria), and definite rete pegs. Masticatory enclosed in the capsular ligament. mucosa is stippled and tightly bound downthat is, upon application of pressure there is no irdication of elastic fibers that permit tissue to stretch or 1-3. The Oral Cavity expand, and the tissue is obviously keratinized (of a It is in the oral cavity that you and the dental hornlike composition). officer perform most of your tasks. In this section, Specialized mucosa. Mucosa that has been we discuss the structure of the oral cavity. We begin developed for the purpose of taste perception is our discussion with the functions and general called specialized mucosa. There are four divisions anatomy of the oral cavity. Next, we discus.: the of specialized mucosa: the filiform, the fungifornt, mucous membrane. Then we cover the two major the foliate, and the circumvallate. portions of the mouth, the vestibule and the mouth a.The filiform are thread-shaped papillae on the proper. We finish this section with the salivary dorsal surface of the tongue. They are the smallest glands. and most numerous. Taste buds are located at the base of these papillae and art the main source of 204. State the functions and locate the structures taste sensation. of the oral cavity. b.Fungiform are mushroom-shaped papillae located on the tip and along the sides of the tongue. Functions and General Anatomy of the Oral Those located on the tip of the tongue are Cavity. The oral cavity, or mouth, is the entrance to responsible for the sensation of sweet. The the alimentary can..1. It is, therefore, the first fungiform located along the sides of the tongue are subdivision of the digestive system. The oral cavity partially responsible for the sensation of sour. contains the elements of mastication, helps perform c. Foliate papillae also are partially responsible the functions of speech, and provides a spccial sense for detecting the sensation of sour. The mucous of taste. The mouth is bounded in front by the lips, membrane is very thin along the margins of the laterally by the cheeks, above by the hard and soft tongue, but on the posterior part of each margin can palates, and below by the floor of the mouth. It be found a variable number of vertical folds. These contains the teeth and tongue. Anteriorly, the folds are collectively called foliate papillae. mouth opens through the lips, and posteriorly, d. Circumvallate papillae are large mushroom- through the fauces into the pharynx. The mouth is shaped papillae located on the posterior dorsum of divided into two parts: (1) the vestibule, which lies the tongue. These papillae are usually arranged in between the lips, cheeks, and teeth; and (2) the an inverted "V" formation, and they number from mouth proper, which lies internally to the teeth. 8 to 12. These taste buds are responsible for the The bony framework of the mouth is formed by the sensation of bitterness. maxilla, palatine bones, and the mandible. The Mucous Membrane. The mucous Lining mucosa. Lining mucosa is found on the membrane lining the mouth is continuous floor of the mouth, the lining of the cheeks, the posteriorly with the mucous membrane of the covering of the lips, and the soft palate. It has a thin pharynx; anteriorly it blends with the skin of the epithelium and connective tissue. There is no stip- face. Many mucous glands are distributed pling nor isit keratinized. This mucosa has an throughout this mucous membrane. While this abundant supply of elastic fibers, thus allowing for membrane is similar in composition to the skin, it is free movement and elasticity. softer and less tough. It is made up of two layers: the The Vestibule. The vestibule is the space that is epithelium and an underlying connective tissue. A bounded above and below by the reflection of the loose submucosa containing many fat cells lies mucous membrane from the lips and cheeks onto beneath the two layers. In addition to fat cells, te the gingiva of the maxillae and mandible. This submucosa contains a series of glands to bathe the reflection of tissue, which is known as the mucous membrane with serous or mucous mucobuccal fold, can be seen in figure 1-6. To secretions. In the hard palate, these glands are to be explore the vestibule limits, place your teeth found at the base of the epithelial layer, since there together and push your index finger along the outer is no submucosa on the hard palate. Healthy surfaces of the teeth; move your finger upward and mucous membrane is pink in color. However, when downward as far as possible. diseased, it may vary in color from a bright red to a We must consider both the upper and the lower pale pink. Oral mucosa is divided into three types: labial frena (singularfrenum) when discussing the masticatory, specialized, and lining. vestibule. These are sickle-shaped extensions of Masticatory mucosa.Masticatory mucosa is connective tissue that connect the lips to the tightly bound to the underlying bone, such as the alveolar ridges. This connection tends to restrict the hard palate and attached gingiva. A microscopic lip movement.
II 83 LABIAL FRENUM MAXILLARY
LABIAL FRENUM 0 MUCOBUCCAL MANDI BULAR FOLD
Rgure 1-6. The vestibule of the mouth.
the mouth is formed bythe around the soft palates. The floor of The lips are the fleshy folds of tissue mylohyoid muscles and the tongue. opening of the mouth. The orbicularisoris muscle The anterior two-thirdsof the arch-shaped roof encircles the mouth and is a majorcontributor to the hard palate, as shown the lip formation. The lip borders arethe points of the mouth is formed by in figure 1-7, and isreferred to as the palatal area. where the mucous membrane ofthe oral cavity of The arch shape is formedby the palatal process meets the skin of the face. the maxilla. The hardpalate is covered with a The cheeks are made upof muscles and that adheres closely tothe fibroelastic tissue, with thc outer surfac.;covered by mucous membrane maxilla. The incisive papillais located just behind skin and lined internally with mucousmembrane. the central incisor in theanterior region of the hard Three pairs of masticatory musclesthemasseters the incisive palatine ptcrygoidscontribute palate. The papilla covers and the medial and lateral foramen through whichthe nerves and blood to the cheek formation.However, the buccinator this area, the mucosa is muscles form the innermost muscularlayer of thc vessels pass. Posterior to drawn into irregularlyshaped elevations called cheeks and force the food betweenthe teeth from The rugae, which extendlaterally from the midline. the facial side duringmastication. The cheeks with the hard palate. It is extend both upward and downward tothe line soft palate is continuous chiefly composed of musclescovered with mucous where the mucous membrane turnsback on thc membrane. Behind themaxillary third molar arc alveolar process. and the The Mouth Proper. The mouth properis two landmarks:the maxillary tuberosity hamular notch. Theconical-shaped mass oftissue enclosed by the teeth. Its front and sideboundaries border of the soft palate the lingual surfaces of the teeth. that extends from the free are the gingivae and uvula does not touch thesurface of At the back, it opens into thepharynx. The arched is the uvula. The the tongue until a swallowingeffort is made. When roof of the mouth is composed of boththe hard and I 2 84 swallowing, the uvulain combination with the tongue. Both the intrinsic (fig. 1-8,A)and extrinsic muscles of the neckcloses off the passageway muscles (fig.l -8,B) are illustrated. Use this figure between the nasal cavity and the throat. Also, it in conjunction with tables 1-2 and 1-3, whichshow vibrates during speaking. the origin, insertion, and action on the tongue of The tongue almost covers the entire floor ofthe these muscles. mouth. Only when the tip of the tongue is raised are During the mastication process, the tongue you able to see the portionformed by the assists in positioning the food between the teeth. mylohyoid muscle. Too, when the tip of the tongue After the food has been sufficiently chewed,the is in its raised position, you can see the lingual frena tongue forms it into a ball so thatit can be that connects the undersurface of the tongue tothe swallowed. After eating, the tongue helps to clean floor of the mouth. On each side of the lingual frena the surfaces of the teeth; and, of course, withoutthe are the sublingual papillae(nipple-shaped tongue there would be no speech. projections). The submandibular salivary glands papillae. secrete into the oral cavity through these The Salivary Glands. Althoughnot a part of the The tongue itself is a muscular organ covered vestibule or the mouth proper, there are three pairs with mucous membrane. It is divided into the tip, of major salivary glands that empty their salivainto the body, and the root. The tip lies almost free, and the oral cavity. They are the parotid, the submandi- the body is attached to the mandible at the side. The bular, and the sublingual. The parotid glands body is movable but to a lesser extent than the tip. If (which are the largest of the salivary glands) you look posteriorly alongthe dorsum of the lie in the cheeks just in front of the ear. They empty tongue, you will notice that the root becomesless their secretion into the oral cavity throughthe defined until it finally becomes continuous with the parotid or Stensen's duct. The opening of the ducts soft tissue structure of the mouth. are opposite themaxillary second molars. The The muscles that control movement of the opening of a parotid duct is usually marked by the tongue are both intrinsic and extrinsic.The parotid papilla. The submandibular glands intrinsic muscles have both their origin and (sometimes called submaxillary glands) are located the insertion in the tongue. The extrinsic muscles have below the mandible, medial and inferior to their origin outside the tongue but insert into the parotid gland. These glands discharge their
FOLD
MAXILLA HARD PALATE SOFT PALATE UVULA tA
TONGUE VESTIBULE (ANTERIOR PART)
MUCOBUCCAL FOLD MANDIBLE
Figure 1.7 Cross.section of the oral cavity
1 3 35 ,'l-q
SUPERIOR TRANSVERSE MUSCLE- LONGITUDINAL MUSCLE
VERTICAL MUSCLE INFERIOR LONGITUDINAL MUSCLE
DORSUM OF TONGUE
7
STYLOGLOSSUS GENIOGLOSSUS
HYOGLOSSUS
Figure 1.8. Muscles of the tongue
14 86 TABLE 1-2 INTRINSIC MUSCLES OF THE TONGUE
Origin 1n3ertion Action on Mot le Tongue _ ... _ Near thc epi= Runs for.:ard Shortens. Superior turns tip longitudinal glottk and to edges of median septum the tongue. and edges up.
Inferior Root of thc Tip of the Shortens. turns tip and longitudinal tongue tongue. edges down. Narrows and Transverse Median septum Sides of the tongue. elongates.
Vertical Upper surface Under surface. Flattens and broadens.
(1) the secretion through the submandibular or Wharton's 2. The oral cavity is divided into two parts: ducts into the floor of the mouth on each side of the mouth proper and (2) the lingual frenum. The sublingual glands are located beneath the tongue. They are the smallest of the 3. Where is the vestibule located? three major saliva glands. Many small sublingual ducts empty the secretions from the sublingual glands onto the floor of the mouth. Refer to figure 1-9 for the location of the major salivary glands. 4. What skull boncs form the bony framework of Exercises (204 the mouth? In exercises1 through 9, which follow, state the functions and locate the structures of the oral cavity by writing short answers to the following exercises in the spaces provided; or complete statements by writing appropriate words in the spaces provided. 5. a. Where in the mouth is the palate? b. What are its two parts? I. What are thc four functions of the oral cavity?
TABLE 1-3 EXTRINSIC MUSCLES OF THE TONGUE
Muscle Origin Insertion Action on Tongue ------_ _ Genioglossos Superior genial Under surface Protrudes and tubercle of tongue depresses. from apex to root.
Styloglossus Styloid process Postcrior Upward and dorsum of backward. the tongue. Depresses and Hyoglossus Greater cornu Side of the and body of tongue. turns edges the hyoid down.
15 S 11
/
Pa rot id
---Submaxillary
Sublingual \
1
Figure 1-9. Major salivary glands.
6. What is a good way for you to differentiate 9. What special property does an abundant supply between healthy and diseased mucous of elastic fibers allow the lining mucosa to membrane? possess?
In exercises 10 through 14 which follow, match the 7. The filiform, thread-shaped papillae, including terms in column A with the most appropriate the tastc buds, are specialized mucosa located statement in column B by writing the correct letter on the surface of thc in the blank provided. A statement may be used once only or not at ali. One term may be matched twice.
8. Specialized mucosa provide the following taste Column A Column B sensations: ___ 10. Vestibule limits. a. Amuscularorgan 1 I.Labial frena. covered with mucous _ 12. Floor of mouth membrane, whose move. a. Fungiform papillae _ 13Tongue. ment is controlled by in. and ._ 14. Salivary glands innsic and extrinsic mus- cles b. Foliate papillae, b Formed by the mylohyoid muscles and thc tongue c. Circumvallate papillae, c. Sickle-shaped extensions of connective tissue that d. Filiform papillae, connect the lip6to the
16 S8 Column H the foramen rotundum and enters the zygomatic alveolar ridges. thereby fossa. In this fossa, it gives off the posterior superior restricting lip movement. alveolar branch. This branch innervates the third d. Can be explored when molar, the second molar, and the lingual and the teeth are together by pushing index finger distofacial roots of the first molar. The remainder along the outer surface of of the maxillary division passes forward into the teeth and moving finger orbital canal. While in the canal, two important upward and downward. branchesthe middle superior alveolar and the e. Used to empty secretions into mouth. anterior superior alveolarare given off. The f. Not apart of the middle superior alveolar branch supplies vestibule or mouth innervation to the maxillary bicuspid teeth and.the proper but are made up mesiofacial root of the first molar. The anterior of the parotid. subman- superior alveolar branch serves the cuspid, the dibular. and sublingual. g. Conical-shaped mass of lateral incisor, and the central incisor. The last tissue that extends from branching from the maxillary division of the free border of the soft trigeminal nerve is the point where it separates into palate. three networks: the greater palatine, thelesser h. Used as an aid in speech. to help clean surfaces of palatine, and the nasopalatine. All three palatine teeth, and in the mastica- branches innervate the mucosa of the maxillary arch tion process. and the palate. Space bounded by reflec- tion of the mucous The mandibular division is a mixed nerve that membrane from lips and has both sensory and motor functions. It supplies cheeks onto the gingiva sensory innervation to all of the mandibular teeth, of thc maxillae and the the mandibular gingiva, the inside of the cheek, and mandible. the tongue. In addition, it supplies motor impulses to all the primary muscles of mastication as well as to other muscles not a part of this discussion. It leaves the cranium through the foramen ovale 1-4. Nerve and Blood Systems ofthe Oral where it gives off the motor branch that innervates Cavity the muscle of mastication. Thesensory branches to the tongue are also given off at this point. The As with other cells, -tissues, and organs ofthe remainder of the nerve enters the maridibular canal body, the oral cavity also has a nerve, blood,and and innervates the mandibular teeth. lymph systems. In this section, wediscuss the The facial nerve. You should have an portions of these systems that are of importance to understanding of one other cranial nerve, the facial the dental specialist. nerve, shown in foldout 2,B. This is the seventh cranial nerve, and like the mandibular branch of 205. Locate, identify, and state the function of the the trigeminal, it is a mixed nerve. It supplies motor nerves that innervate the oralcavity. sensation to all the muscles of facial expression and sensory sensation to the tongue. The facial nerve Innervation of the Oral Cavity. There are a leaves the skull through the internal auditory total of1 2 pairs of cranial nerves. Eachpair meatus. The sensation of taste is supplied to the originates in the brain and supplies definite areas of tongue by a branch of the facial nerve called the the body. Of these we are concerned with only two, chorda tympani. However, the main trunk of the tht. trigeminal and the facial. Afterleaving the nerve innervates the muscles of facial expression. cranium, both the trigeminal and the facial nerves This is accomplished when the facial nerve split into branches and have a wide distribution. subdivides into its five terminal branches. These The trigeminal nerve. The trigeminal, or fifth branches are the temporal, zygomatic, buccal, cranial nerve, is the main nerve supply of the oral mandibular, and cervical. Each of these provides cavity. Its major divisions are shown in foldout 2,A motor sensations in the region for which the branch (in the back of this volume). Notice how, afterthe is named. trigeminal nerve arises from the brain, it separatm into three main divisions called the ophthalmic, the Exercises (205): maxillary, and the mandibular. The ophthalmic division is entirely sensoryand Locate, identify, and state the function of nerves passes forward to enter the orbitalcavity.Within that innervate the oral cavity by writing short the orbital cavity, it subdivides intobranches that answers to the following exercises or by writing one supply sensation to the tissues around the eyeand word in each space provided. the adjacent parts of the nose and forehead. I. What is the name and oral cavity function of The maxillary division leaves the skull through fifth cranial nerve?
1 7
3.9 2. Into what three main divisions does the trigeminal nerve separate after it arises from the brain? Here the exchange of oxygen and carbon dioxide takes place. Arterial system. The arteries cany blood from the heart to the tissues of the body. This arterial 3. Afterenteringthezygomaticfossa,the distribution is shown in foldout 3,A. The principal maxillary divisiongives off theposterior arteries that supply the head and neck are the superior branch to common carotid arteries. These consist of both a innervate the molar, the right and a left carotid artery, ascending within the molar, and the lin- tissues of the neck. At about the level of the hyoid gualanddistofacialrootsofthefirst bone, each common carotid divides into internal and external carotids. Refer again to foldout 3,A, and locate this division. The internal carotids enter the base of the skull and supply the structures of the 4. What nerve branch innervates the maxillary cranium. The external carotids, with their many bicuspids? branches, supply the structures on the outside of the bony cranium. The external carotids, just above their division from the common carotids, give off the lingual artery that supplies the tongue. The 5. The cuspids, the lateral external maxillary arteries are given off superior to and the incisors are the lingual arteries and supply the soft tissues of the innervated by the side of the face and nose, the lip tissues, and the superior alveolar branch of the trigeminal muscles. At about the level of the lower part of the nerve. ear, the external carotids divide into their twomain terminal branchesthe internal maxillary artery 6. Which trigeminal branch supplies motor and the superficial temporal artery. impulses for mastication? The internal maxillary branch supplies the bones of the jaws and the teeth and their supporting soft tissues. This artery is divided into four branches called the inferior alveolar artery, the posterior 7. A major nerve that supplies taste sensation to superior alveolar artery, the descending palatine the tongue and motor sensation to all the artery, and the infraorbital artery. muscles of facial expression is known as the a. The inferior alveolar artery is the firstbranch seventh cranial nerve, or nerve. given off by the internal maxillary artery. It passes downward and enters the mandible through the 8. Name the five terminal branches of the facial mandibular foramina to supply the lower teeth and nerve that provide motor sensations in that the substance of the bone. The mental artery, a region for which the branch is named. branch of the inferior alveolar artery, exits through the mental foramen and supplies the chin. b. The posterior superior alveolar artery is the next branch given off. It enters the maxillary bone posterior to the roots of the upper third molar. It passes through the bone to supply the molarand bicuspid teeth, the maxillary sinus, and the gingiva. 206. Locate, identify, and state the function of the c. The descending palatine artery entersthe vessels associated with the blood supply of tbe palate by way of the palatine foramina. This artery oral cavity. supplies the soft tissues of the hard palate. d. The infraorbital artery is the last branch of the Blood System of the Oral Cavity. The internal maxillary artery. Just prior to coming out circulation of blood to the oral cavity is through the infraorbital foramina onto the face, it accomplished through a network of arteries, veins, gives off the anterior superior alveolar branch. This and capillaries. Through this vascular nctwork, the branch artery supplies the incisors and cuspids as tissues are nourished, and the metabolic products well as thc maxillary bone. are eliminated. The arteries, exceptfor the Venous system. The veins return the blood to the pulmonary artery, are the vessels that carry heart. They begin as small branches, which unite oxygenated blood to the tissues. The veins, except and thus increase in size, as shown in foldout 3,B. for the pulmonary vein, carry blood containing The venous blood from the brain and internal carbon dioxide. The capillaries are those minute structures of the cran'am drain into venous vessels located between the arteries and thc veins. channels called sinuses. These sinuses then empty
18 91) 4. In what direction does lymph always flow? 207. State and describe tbe components of the lymph system, and list the essential functions of the system and its components. 5. Briefly describe the lymph vessels. Lymph System of the Oral Cavity. The head and neck are well supplied with a lymphatic system. The basic component parts of this system are the lymph, the lymph vessels, and the lymph nodes. 6. Briefly describe the lymph nodes and their Lymph is an almost colorless liquid similar in composition to blood plasma. The lymph fluid is function. derived from the blood plasma as it leaks into the spaces between the tissue cells. The essential functions of this system are to combat bacterial infections by transporting disease-producing organisms to the lymph nodes, to carry off excessive fluid from the body tissues, and to act as a supplement to the venous system. 1-S. Human Dentition The flow of lymph through the network of lymph You must become familiar with the terms vessels is influenced by three factors: (1) the generally used in describing the external difference in pressure at the two ends of the system; appearance of the teeth. You will usethis (2) the valves in the lymph vessels, which prevent knowledge when completing dental records and backflow of the lymph; and (3) the contraction and other related forms. You should realize that the relaxation of the muscles. The flow of the lymph is characteristic shape, size, and arrangement of the always toward the heart. teeth are factors enabling them to efficiently The lymph vessels resemble the veins in thatthey perform their three major functionsthat is, mastication, speaking, and esthetics. You must keep start as small vessels and havethe same type of duct linings as veins. The lymph vessels collectthe lymph in mind that while this discussion covers the normal from the tissue spaces and then unite toform larger conditions, each patient's mouth may vary from the vessels. With the increase in size, the wallsbecome norm. stronger until they are verysimilar in structure to the venous vessels. The tributaries of theright side 208. Given a series of statements concerning the of the head and neck drain into the rightlymphatic arches and the surfaces of the teeth, determine duct, which, in turn, empties intothe right which are true and which are false. subclavian vein. The tributaries from theleft side of the head and neck drain into thethoracic duct, The Teeth. Normally, each person gets two sets which empties into the left subclavianvein. of teeth during his lifetime. The first, or deciduous set, consists of 20 teeth. The second, or permanent set, usually consists of 32 teeth. Withthe mouth The lymph nodes are small, oval-shaped bodies open, the teeth are seen to bearranged in two that lie along the course of the lymph vessels. opposing arches. The teeth in the upper arch are Usually, they occur in groups and act as filters to called maxillary teeth, and those in the lower arch remove bacteria and other particles fromthe lymph also has origin of are called mandibular teeth. Each tooth system. The lymph nodes are also the five surfaces, and each surface is named according manufacture of lymphocytes. Figure 1-10 is a diagrammatic illustration showing the lymph to the direction it faces. Divisions of the arches. As has already been system of the head and neck. stated, the teeth are embedded into the two opposing jaws, the maxilla and the mandible. Since Exercises (207): the arrangement of the teeth in these bones I. What are the components of the lymphatic resembles an arch, the teeth form the maxillary and system? mandibular arches. In addition to being located in either the maxilla or the mandible, the teeth can also be located in one of four quadrants. To divide the two arches into 2. Briefly describe lymph. quadrants, draw a vertical line between the two front teeth and extend it backward until it divides each arch into halves. The two quadrants in each arch are mirror images ceach other and conform 3. List the essential functions of the lymph system. to the right and left sides of the body.
20 9 1 6. At about the level ofthe into the internal jugular vein.The venous biuod is divides into the facial structurcz. 4 (Wt. bone, each common carotid returned from the oral and internal and carotids. principal vessels. The superficialtissues are drained a. by the anterior facialvein, and the deep facial tissues are drained by theposterior facial vein. 7. The artery supplies the The anterior facial veinfollows the same general tongue. course as the externalmaxillary artery. It runs at an of angle downward andbackward across the border the mandible to a point atthe anterior border ofthe this point, the anteriorfacial masseter muscle. At 8. At about the levelof the lower part of the vein and the posteriorfacial vein unite to form the the patient's external vein. The common facialvein, in main common facial carotidsdivideintotheir two turn, empties into theinternal jugular vein. branchesthe internal artery and thesuperficial The pterygoid venous plexusis a mass of veins constituting a dense networkaround and between artery. the lateral pterygoidmuscle and the temporal muscle. The plexusreceives blood from veins of the internalmaxillary by the internal 9. The four branches the draining the areas supplied artery collectivelysupply the bones of maxillary artery branches.The blood is led away and the and their wide trunk known as the from the plexus by a short, supporting soft internal maxillary vein. Theinternal maxillary vein connects with theposterior facial vein which,in external jugular vein.Study is the first turn, becomes the 10. The inferior foldout 3,B, closely so that youwill be thoroughly the internal maxillary these veins. branch given off by familiar with the location of artery. As it passesdownward to supply the lower teeth and thesubstance of the bones, Exercises (206): it enters the mandiblethrough the mandibular One of the inferior In the followingexercises, locate, identify, or alveolar's branches, the concerning vessels complete a functional statement artery, suppliesthe chin. that carry blood to orfrom the oral cavity by writing the appropriate missingword in the blanks the provided. 11. The posteriorsuperior alveolar artery, internal maxillary artery, that carry second branch of the I. With one exception, vessels enters the maxillarybones near the upperthird oxygenated blood from the heart to thetissue and molar and supplies the molar are called teeth, the maxillary
,and the
2. With one exception,vessels that carry blood containing carbon dioxide arecalled 12. The descending palatine artery,the third branch of the internal maxillary artery,supplies the soft tissues of the palate.
in exercises 1 and 2 arethe 3. The "exceptions" artery is the last arteries and veins. 13. The branch of the internalmaxillary artery.
4. The exchange of oxygenand carbon dioxide minute vessels that are the takes place in those 14. Justpriorto coming ontotheface, called infraorbital artery gives off the superior alveolar branch the head and that supplies the incisors and arteries that supply maxillary 5. The principal are the common as well as the arteries. 0 Figure 1.10 Lymphatic system of the head and neck. ANTERIORS
st 2nd ) 1 QUADRANT QUADRANT
POSTERIORS POSTERIORS
UP PERS RIGHT LEFT LOWERS
POSTERIOR POSTERIORS 3rd . 4"I 9UADRANT QUADRANT...
7
ANTERIORS
Figure I .1 I. Division of teeth in the arches.
Thereis yet another descriptive division made in as surfaces, and they receive their namesfrom the the oral cavity. This is to divide the oral cavity into directions in which they face. an anterior and a posterior region. Indentistry, this The five surfaces of any one tooth are the same as is the most frequently used reference. Anterior the five surfaces of another, except for one major means toward the front. Thus, the firstthree teeth differencethat being the name of the working on either side of the midline of eachnormal arch surface of the anterior and posterior teeth. The are called the anterior teeth. Posterior means biting (working) surface of the anterior teeth is toward the rear, so all the teeth behind the anterior called the incisal surface. whereas the chewing teeth are called posterior. Refer to figure 1-II, and (working) surface of the posterior teeth is called the you can see how the arches are dividedinto both occlusal surface. The four remaining surfaces of all quadrants and anterior-posterior regions. teeth have common names, whether that tooth is xiterior or posterior. Surfaces of the teeth.There is really only one surface on the crown of a tooth, the coronal Now let us consider two common surfaces of surface. However, because of the bending over of each tooth, the distal and mesial. When you are this surface, other areas appear, which face in determining the mesial and distal surfaces of a several directions. These latter areas are also known tooth. you must think of these surfaces as being on a 22 94 flat plane. The relationship of the teeth in their Interdental Papilla Interproximal Space normal arch shape and a flat plane is shown in figure 1-12. Notice that there is an imaginary line which equally divides both the upper and the lower arches between the central incisors. This line is called the midline. If we consider the place where the line divides the ce..rzal incisors as our starting point, the tooth surfaces nearest this point are Avit,1011 Interproximal called the mesial, whereas those which face away Contact Area from it are known as the distal surfaces. Thus, the Embrasure mesial and distal surfaces of two adjoining teeth are Proximal Surfaces always adjacent. The remaining two surfaces common to all teeth Figure 1.13. Proximal surfaces sod contact anse of the teeth. are the facial and the lingual. The facia/ surface is toward the lips in the anterior region and toward the cheeks in the posterior region. The tooth surface wear area widens outward from the contact area toward the tongue in both regions is the lingual both facially and lingually. Part of the interproxi- surface. mal space below the wear arta is filled by inter- The mesial and distal surfaces of adjacent teeth dental papilla. That part not filled by this papilla is are known as proximal surfaces, as shown in figure called the interproximal embrasure. 1-13. The space between the proximal surfaces is Exercises (20Sk called the interproximal space. The area where proximal surfaces of adjacent teeth make contact is In the following exercises, identify descriptive at Mil greatest contour of the adjoining tooth terms related to divisions and surfaces of teeth by crown. These areas are called contact areas. In this determining whether each statement is true or false. way, teeth help to support each other. As age Circle the T or F to indicate your answer. increases, wearing occurs at these contact areas due T F1. The deciduous set of teeth usually to the movement of the teeth. The imerproximal consists of 32 teeth.
A OCCLUSAL // N) 4AV I LINGUAL DISTAL !)/ MESIAL
1/ // ea I FACIAL .).,;..,.,, ltI I AS
INCISAL
MIDLINE
Figure 1-12 Surfaces of the teeth
23 95 T F2. The teeth in the lower arch are called ANTERIOR maxillary teeth. T F3. Each tooth has five descriptive surfaces, and each surface is named according to INCISORS the direction it faces. T F4. Since the arrangement of the teeth as they CUSPIDS are embedded in the maxilla and the mandible resembles an arch, the teeth BICUSPIDS form the maxillary and the mandibular arches. T F6. The six front teeth of each normal arch of MOLARS ft ;44 permanent teeth are described as anterior teeth. T F7. All of the teeth behind the anterior teeth MAXILLAE are described as being in thefourth quadrant. T F8. The surface on the crown of any tooth can be accurately described asthe *POSTERIOR,* corona! surface. I F9. All five surfaces, including the working surface of an anterior tooth, are the same MANDIBLE as those corresponding surfacesof a posterior to3th. MOLARS T F 10. The biting surface of an anterior tooth is called Its incisel surface, but the chewing surface of a posterior tooth is called its occlusal surface. T F 11. The mesial and distal surfaces of two JSPIDS adjoining teeth are never adjacent. T 12. In either an anterior or a posterior tooth, ySPIQ the tooth's surface toward the tongue is its I N \SOR lingual surface. T F 13. The mesial and distal surfaces of adjacent ANTERIOR teeth are known as proximal surfaces. Figure 1.14 Positions of the teeth in the arches
209. Given statements about the names ofteeth, The full complement of 32 permanent teethis their identifying characteristics, andtheir divided by position, shape, and function into eight associated anatomical landmarks, indicate incisors, four cuspids, eight bicuspids, and 12 whether each statement is true or false. molars. The position of the teeth in the two motes is shown in figure 1.14. Occasionally, thethird Names and Anatomical Landmarksa the molars do not erupt, because they areeither Teeth. Du; ng the discussion. youshould impacted or were never formed. Fohowingis a remember tI all teeth are in pairs; the right and brief discussion of each type of tooth. nirror images of each other. You left sides ar The anterior teethThe frunt teeth are the should be asmcerned with the roots of the teeth as Also ',:eep in mind that anterior teeth. These are the teeth that are seen most you are with the crowns. have sharp shape, and other while one is smiling. The anterior teeth teeth vary considerably in size, these teeth in another. To cutting edges; there are usually six of characteristics from one person to constitute the descriptions of each arch. The incisors Ind cuspids make it easier for you 4.s. understand anterior teeth, and all have single roots. the teeth, the mouth has been dividedinto anterior and posterior regions. Within ',hesediscussions, we There are four incisors in each arch. The first of shall consider comparisons betweenthe various these anterior teeth to be found on either side ofthe types of teeth. midline of both the maxilla and mandible are the An individual tooth may beidentified by its central incisors. Those teeth located adjacentand positionfor example, maxillary leftcentral distally to these are the lateral Incisors. The word incisor. It may also be identified by itsanatomical "incisor" describes their function of incising or form, since each tooth has its o'./1particular cutting food. Important features of these teeth are as characteristics that set it apart from any othertooth. follows-
24 96 Maxillary incisors are larger than the Molars are the largest teeth in the dental arches mandibular incisors. and lie directly behind the bicuspids. There are 12 Maxillary central incisors are larger than molars in the oral cavity when they are all present, maxillary lateral incisors, whereas all three in each quadrant. They are called the first, mandibular incisors are approximately the second, and third molars. Their function is same size. grinding the food into a pulp during mastication. Incisors are very important, both esthetically Important features of these teeth are as follows: and for correct enunciation of certain speech Molars are the largest teeth in the mouth and sounds. normally decrease in size from anterior to posterior. The next teeth, located distally to the incisors, Maxillary molars have two facial and two are the cuspids. There are two cuspids in each arch. lingual cusps. The maxillary first molar The cuspids are so named because each possesses a sometimes has a small fifth cusp on the lingual sharp elevation or cusp on its cutting edge. The aspect of its mesiolingual cusp. major difference between incisors and cuspids is Mandibular first molars have three facial and that cuspids have a more sharply pointed cusp, a two lingual cusps. Mandibular second molars greater facial curvature, and a more pronounced have twp facial and two lingual cusps. cingulum on the lingual aspect. The cuspids are Mandibular third molars usually have four or used to seize and tear food. Additional important five cusps. . features of these teeth are as follows: Each cuspid has a rounded elevation of The deciduous teeth. Deciduous teeth have certain enamel (a cusp) on its incisal surface, wliiCh dermite characteristics that set them apart from the gives the tooth a pointed appearance. permanent teeth. The deciduous teeth are smaller. The single cusp gives the cuspid its name and Their roots are proportionately longer and more makes possible its function of tearing food. slender. The pulp chamber is larger, making it more Because of their location at the corner of the susceptible to carious exposure. The deciduous dental arches, the cuspids play an important teeth have a greater constriction at the necks, giving role in characterizing facial expression. the czowns more prominence. The enamel is whiter, Maxillary cuspids have the longest roots of and its color is more uniform. The texture of the enamel is poorer and coarser in quality. The buccal any teeth in the mouth. and lingual surfaces converge toward the occlusal, making the teeth appear wide mesio-distally at the The posterior teeth. The posterior, or back teeth. gingival area. The roots diverge greatly on the are the grinding teeth. They are locatedbehind the molars to accommodate the crowns of the anterior teeth along the dental arches. Bicuspids bicuspids. which are developing in the jaws. The and molars constitute the posterior teeth. All have roots of these deciduous molars Surround the cusps on their occlusal surfaces, with thenumber of five on developing bicuspid crowns. The upper deciduous cusps varying from two on bicuspids to anteriors closely resemble the permanent anteriors: certain molars. The-number of roots varies from their general contour and the roots are about the one on mandibular bicuspids to three onmaxillary same. molars. Occlusion. All of this section has led up to this The bicuspids are located posterior to the one final thoughtocclusiop, Occlusion may be cuspids and anterior to the molars. They are called defined as the relationship of the inclines of the bicuspids because they possess two cusps on their tooth cusps when the jaws are closed. When chewing surfaces. There are eight bicuspids in the occlusion of a well-informed dentition is such that oral cavity. Two bicuspids are found in each the cusps and depressions of the teeth interdigitate quadrant of the maxillary and mandibular arches. well and the greatest amount of contact between Important features of these teeth are as follows: opposing arches has been established, centric occlusion is normal. Each bicuspid has two cusps on its occlusal surface, a facial and a lingual cusp. Cusps of the maxillary bicuspids are Exercises (209): approximately one-half as long as the facial Identify whether the statements that follow cusp. regarding the teeth and their landmarks are true or Mandibular bicuspids have single roots. false by circling the T or F. Maxillary bicuspids may have one or two T FI. There are eight incisors, four cuspids, roots. eight bicuspids, and 12 molars in a Bicuspids are sometimes called premolars. normal permanent set of teeth. When two roots are present, they are a facial T F2. Incisors have single roots, but cuspids root and a lingual root. have double roots.
25 9 7 T F3.. limit are foitr incisors in each arch. Tissues of the Teeth. Each tooth has a crown T F4. Mandibular incisors are larger than are and a root portion. The crown is that part of the .the maxillary incisors. tooth that may be seen in the normal, healthy T F5. As a general rule, all mandibular incisors mouth, protruding from the gingivs. The root is (either central or lateral) are that part of the tooth that is normally present in the approximately the same size, but gingiva and alveolar bo6e structures. The narrow maxillarycentralincisors are normally portion of the tooth, where the crown and root larger than are corresponding maxillary meet, is called the neck or cervix. The tip of the !afoulincisors. root is its apex. If you were to section a tooth in a T F6. Since the two cuspids in each arch are longitudinal plane, you would see that both the used to seize and tear food, their incisal crown and the root consist of two layers of hard surfaces give each a pointed appearance. substance surrounding the dental pulp. The outer T F7. Cuspids, bicuspids, and molars constitute layer of the root is covered by a substance called the posterior teetheach of which has cementum, and its inner layer is dentin. In the two roots and two cusps. innermost portion of the tooth, there is a chamber T F8. Each bicuspid has a facial and a lingual that contains the nerves and blood vessels. This cusp; each is sometimes called a chamber is known as the pulp chambei. The premolar, each lower bicuspid has _one anatomical structures of. a tooth can be seen in root, but an upper bicuspid may have one foldout 4,A. When a tooth erupts into the mouth, or two roots. the entire crown is coveted by a membrane called T F9. Molars are the next to largest teeth, lie the enamel cuticle or primar/ cuticle. Mastication directly in front of the bicuspids, and of food and brushing of the teeth soon wear this there are normally six of them in the oral cuticle away on the exposed surfaces. cavity. Enamel.Enamel is the hardest calcified tissue in T F 10. The first, second, and third molars grind the human body. It covers the entire crown and food into a pulp during mastication; they protects the underlying structures. It is composed of decrease in size from anterior to 96 to 98 percent inorganic materials, principally posterior. 'calcium and phosphorus, and from 2 to 4 percent T F I 1. In general, most maxillary molars have organic material. As seen in foldout 4,8. the two facial and two lingual -asps, but the structural composition of 'enamel consists of rods, maxillary first molar sometimes has an or prisms, which are bound together by an additional small fifth cusp. intercementing substance. Each enamel rod extends T F 12. Mandibular molars have the same num- fromttv:junction of the enamel and dentin to the . ber of cusps as do their maxillary coun- outcr surface of the tooth. As the enamel is formed, terparts. brief pauses in its development cause areas of 13. Compared to permanent teeth, deciduous dirn;nished calcification. These appear as narrow, teeth have the following characteristics: bri_wn lines when viewed under a microscope. The T F a. They are smaller. lines are comparable to growth rings in a tree trunk. T F b. Their roots are proportionally shorter They are called lines of Retzius, after the man who and blunter. discovered them. Narrow cracks may develop in the T F c. Their pulp chambers are larger and enamel in planes of tension, either during more subject to exposure by decay. development or after the enamel is formed. These T F d. Their enamel is darker, less uniform in cracks become filled with organic materials and are color, and of finer and better texture. known as enamel lamellae. The lamellae extend T F 14. Balanced occlusion occurs when the from the outer surface of the enamel toward the occlusal contact of the teeth on the dento-enamel junction. In some instances, they may working side of the jaw is accompanied reach the junction or even penetrate the dentin. by the harmonious contact of the teeth of the opposite (balancing) side. The enamel is formed by specialized cells called ameloblasts. After the ameloblasts have formed the enamel, they degenerate and disappear. Therefore, 1-6. Dental Histology after the enamel has been formed, it has no further Histology is the microscopic study of the power of growth or repair. structural elements of an organism or of its parts. Dentin.Dentin is the next hardest calcified tissue Thus, dental histology deals with the microscopic in the human body, and it forms the major portion study of dental tissues. In this section, the teeth and of a tooth. Itis composed of approximately 70 their supporting structures are discussed. percent inorganic material and 30 percent organic material. Just as with enamel, the main constituents 210. Locate and identify the tissues that compose of the inorganic material are calcium and the teeth. phosphorus.
26 98 q0 Dentin consists of dentinal tubules held together cellular layer because it contains the remains of the by a calcified matrix. The structures of dentin can cementoblasts. Removal of the cellular layer by be seen in foldout 4,C. Study this figure as the mechanical means. such as tooth scaling, will result discussion of the dentin is presented. The dentinal in a loss of cement= that will not be replaced. tubules appear as hollow tubes. They extend from The principal function of cementum is to serve the dento-enamel junction to the surface of the pulp as an attachment for thc periodontal fibers that chamber. Odontoblasts, cells which produced the anchor the teeth to the bony walls of their sockets. dentinal tubules, are found at the pulp chamber The cementum is formed throughout the life of the surface (see foldout 4,E). They are active cells, tooth. This continuing formation compensates for since they still receive nourishment from the blood growth of the tooth into the oral cavity and vessels in the pulp tissue. On occasion, the tubules movement of the tooth by external forces. The may extend past the dento-enamel junr , n and process allows the periodontal fibers to terminate in the enamel. Each of these tubules continuously reattach to the root surface so that the contains a cytoplasmic extension of the odon- teeth may be moved and still remain firmly seated toblasts. These extensions are known as Tome's in the alveolar bone. fibers. It is theorized that Tome's fibers transmit pain impulses from the dentin to the pulpal nerves Exercises (210): located adjacent to the odontoblasts. since nerve Complete the following exercise by matching the fibers have never been identified within the dentin. tooth tissue in column B to the appropriate Mechanical stimuli, such as is produced by dental statement in column A. Some tissues may be burrs. produce pain at the dento-enamel junction matched more than once. but not in the dentin proper. except near the pulpal chamber. Thermal and chemical stimuli may cause Columnel Column 8 pain at any level within the dentin. Continuous I. Functions to form a. Neck or cervix. - b. Enamel. stimuli from any of these may cause the odon- enamel. c. Root. toblasts to again become active and thereby recom- 2. Each has a crown - d. Pulp chamber. and a root portion. mence producing dentin. 3. That part of a tooth e. Crown. - f. Enamel cuticle. The formation of the dentin starts in the tips of normally present the cusp and proceeds inward toward the pulp in the gingiva and g. Dentin. alveolar bone h. Tooth chamber. The initially formed dentin is called structure. i. Lines of Retzius. primary dentin, while later deposits are called 4. The narrow por j. Apex. - k. Dental pulp. secondary dentin. The formation of secondary tion of a tooth dentin is possible because The odontoblasts remain where the crown I. Cementum. and root meet. m.Odontoblans. along the pulpal, wall. The formation of secondary 5. The harekst calci. n. Ameloblasts. dentin usually occurs in response to an external - 0.Tome's fibers. tied tissue where irritation, such as dental caries or thermal stimuli. thc crown and root P. Secondary dentin. The layer of secondary dentin is produced in an meet. attempt to protect the vital pulp tissues. -6. Functions to form dentin. Cernen rum. Cementum is a thin layer of bonelike -7. Composed of 96 tissue covering the roots of the teeth. The structures percent to 98 per. of the cementum can be seen in foldout 4,D. Its centinorganic material. composition is approximately 55 percent organic -8. Transmits pain im material and 45 percent inorganic material. The pulses from the organic material is primarily composed of collagen. dentin to the pulpal This collagen is present in all connective tissue and nerves. 9. Usually is formed dissolves into gelatin when boiled. The cementum - in response to an and enamel meet each other at the cervix of the external irrkation. tooth at what is called the cemento-enamel -10. when viewed mi junction. croscopically. these resemble narrow Cementum is produced by cells called brown rings of a cementoblasts. These cells begin to form cementum tree trunk. at the surface of the dentin of the roots. Then, as -11. The tip of the rout. 12. The nextto the they produce the cementum. they imprison - hardest calcified connective tissues in the cementum. These tissue in the human extensions are called periodontal membrane or body: forms the ligaments. Normally, there are two layers of major portion of a tooth and appears cementum present on the root. The inner layer, or to be light yellow. the layer next to the dentin, is called the acellular -13. The vital center of layer since it contains no cells. The outer layer is a a tooth.
27 99 Column A tooth. The list below identifies the principal fiber -14. A membrane that groups comprising the periodontal membrane. covers the entire a. Gingival fiber groupExtends from the crown of a newly cementum to the gingiva. aupted tooth. _...... * 15. A thin bonelike tis- b. Transeptal fiber groupConnects the sue that covas the cementum of adjacent teeth by running from one outer layer of the tooth over the alveolar crest to the adjacent teeth. root. c. Alveolar fiber groupConnects tooth to 16. Covers a tooth's - alveolar bone, as shown in figure 1-15. This group entire crown and protects its wsder- is further broken into its principal fibers: (1) bins structure. alveolar crest fibers extend from the cervical -17. The layer beneath cement= to the crest of the alveolar bone., (2) the enamel. horizontallibers extend from the cementum to the 18. That innermost - alveolar bone at tight angles to the tooth root; (3) part of the tooth that provides space oblique fibers extend obliquely from the cementum for nerves and of the apical two-thirds of the root to the alveolar blood vessels. bone; (4).apical fibers extend from the cementum -19. That part of the surrounding the apex of the root to the alveolar tooth that pro- trudes from the bone, and (5) interradicular fibers extend from one gingiva- root to another in multirooted teeth. Alveolar process. Tbe alveolar process is that bony portion of the maxillae and mandible that 211. Name and ideatify the tissues surrounding supports the teeth. The alveolar process is the teeth and state their functions. composed of two parts: the cortical bone and the cancellous bone. Tissues Surrounding the Teeth. The tissues that The outer portion on both the lingual and the surround and support the teeth are known as the facial surfaces of the alveolar processes is 'covered periodontium and include the following: the by cortical bone. Cortical bone is dense, compact periondontal ligament, the alveolar process, and the bone. It covers the alveolar processes ind is gingiva- continuous with the body of the jaws. The cortical Periodontal ligament. The teeth are imbedded in bone gives the alveolar process its shape and the bony sockets of the alveolar processes, the entire protects the softer bone and tissues inside. function of which is to support the teeth. The Cancellous bone is a porous, spongy type of periodontal ligament is composed of fibers that bone, often called spongiosa. In composition, attach to both the cementum of the tooth and the =odious bone is a network of narrow spaces and alveolar process. Their function is to hold the teeth spicules called trabeculae. Blood and lymph vessels in place in a semirigid state. The gingivae consist of course through this cancellous bone to the the free gingiva and the attached gingiva. The periodontal ligament. After a tooth has been following descriptions of the individual tissues will removed, this network of vessels applies the more fully explain the relationships of the tissues to nourishment needed to heal the socket. the teeth. The alveolar process undergoes continuous The periodontal fibers completely surround the change due to growth:stress, advancing age, and root of the toothexcept for the apical tooth loss. Since the principal function of the foramenand attach the root to the wall of the alveolar process is to support the teeth, the entire bony socket. The functions of the periodontal alveolar process undergoes partial atrophy, or ligament are support, sensation, nutrition, and decreases in size, when the teeth are lost. formation. The fibers support the tooth within the The gingiva. The gingival tissue surrounding the socket. The nerves and blood vessels provide teeth consists of the free gingiva and the attached sensation and nutrition to the cells of the ligaments. gingiva. The free gingiva lies relatively close against The main tissue elements of the periodontal the crown just above tne cervix. The edge of the free ligament are connective tissue fibers. gingiva that is towards the occlusal and incisal As the tooth erupts, the periodontal fibers form surfaces of the teeth is called the gingival margin. bundles to support the tooth. The bundles are The V-shaped space reaching from the free gingival arranged in such a manner as to withstand the margin to the depth where the gingiva attaches to functional stresses of the tooth after it reaches the the tooth is called the gingival sulcus. The occlusal plane. These fibers are somewhat elastic triangular fold of tissue that fills.the space between and permit a certain amount of tooth movement. adjacent teeth is the interdental papillae. The principal fibers are30arranged that they apply The attached gingiva is that portion covering the a pulling force on both the cementum and the alveolar bone. Itis mainly connective tissue. alveolar process when a force is applied to the covered by epithelium. which is held snugly against
28 100 Alveolar crest Horizontal nterradicular Oblique
1.7.1
Apical
Figure I-IS. Apical fiber group. the alveolar cortical plate. The attached gingiva 4. What structure undagoes continuous growth closely follows the outline of the supporting or Change, supports the teeth, but undergoes alveolar bone, rising over root eminences and partial atrophy when the teeth are lost? developing into valleys between these eminences. The entire gingiva contains a very rich nerve and blood vessel supply, and when healthy, this tissue has a stippled appearance.- 5. What is the function of the dense, compact, Exercises (211): cortical bone that covers the lingual and facial I. a. What is the general name for those tissues surfaces of the alveolar process& that surround and support the teeth? b. Name its three parts.
6. What is cancellous bone? 2. Name four functions of thc periodontal ligament.
3. Why are the periodontal fibers somewhat 7. Name and locate the two parts of the gingival elastic? tissue.
29 101 CHAPTER. 2
Oral Pathology
PATHOLOGY IS the study of any abnormal tissue cells, and different types of bacteria.If we disclosing phrical condition. This chapter provides youwith paint the teeth with a dye, such as a fundamental knowledge of the most common solution, the plaque will become stained and will be surface pathology of oral structures. Although it is not your easily visible. However, an area of the tooth will duty to diagnose oral conditions,basic knowledge that is really clean and not covered with plaque performance not retain the dye color.Tooth decay most of these conditions is essential in the and of your duties. For example, if yourecognize an commonly occurs in the pits, fissures, grooves, abnormal condition, you can call it to theattention interproximal and gingival areasthose locations formed. of the dental officer. In addition, youwill use where bacterial plaques are most readily entries on since they are not easily cleaned. Both neglectand knowledge gained here when making of dental records and other dental forms. lack of oral hygiene contribute to the process dental caries: so does a diet high incarbohydrates entirely free 2-1. Pathologies ofthe Teeth and refined sugars. No age group is from the disease, but caries activity is highest up to The primary effort in Air Force dentalclinics is about 28 to 30 years of age. Basically, there are two directed at treating pathologies of teethand theories as to the etiology of dental caries. periodontal diseases. In this section, we willreview The first is the acidogenic theory. Thistheory the common pathologiei of the teeth.These include states that dental caries is theresultof the combined dental caries, pulpitis, abscesses.pericoronitis, action of acids and bacteria. The carbohydratesand cysts, and granulomas. Since the treatmentof these refined sugars are ingested as food by the bacteria pathologies is the reason for your employment, you Lactobacillus acidophilus and streptococci to produce should be thoroughly familiar with them. Webegin lactic acid. Lactic acid first disiolves the inorganic our discussion with theetiology, signs, symptoms. material of the enamel and dentin.theteby and treatment of dental aims. permitting the bacteria and their products to amth related to the dissolve the remaining organic material of the 212. Indicate basic aspects substance. etiology, signs, symptoms, and treatmentof The second is the proteolytic theory. Thistheory dental caries. explains the process of dental caries,in the following manner: Bacteria first penetratesmall Dental Caries. The most common of alldental fissures of the enamel. The bacteria inthe plaque decay diseases is dental caries. The possibility of can produce proteolytic enzymesand then are able begins with the eruption of the deciduousteeth and to destroy the matrix orcementing media of the continues throughout life, with certainpeak enamel and also decalcify thetooth. The periods. Decay starts in the enameland. if mechanism of caries development canbe unchecked, progresses into the dentin.It begins summarized as follows: Enamel caries isprimarily a when bacterial actions start a gradualdissolution of process of decalcificationand proteolysis tooth substance. (proteolytic theory). The important point to Etiology. As was mentioned, the etiology, or remember is that neglect causes the plaque toform. the cause, of dental caries is bacteria.Normally, these Fundamentally, in both of the above theories, bacteria are present in the mouth of every plaque supplies the bacteria needed to causedental individual. All dental caries begin when plaque caries. is an deposit on the tooth surfaces becomes laden with Signs and symptoms. A 'sign of a disease bacteria. Dental plaque is a filmlike covering thatis objective manifestation. The examiner can often difficult to see. The plaque is firmly adherent positively determine a sign; swelling is anexample. to the tooth surface and iscomposed of mucus, A symptom of a disease is asubjective 30 102 manifestation. Only the patient can positively 3. What is the composition of dental plaque? identify a symptom; pain is an example. Sometimes What role does it play in tooth decay? the very early signs of dental caries can be detected by a thorough examination, including radiographs of the teeth. The appearance-of a carious lesion 4. Which theory of tooth decay involves the depends upon the rapidity of the process as well as dissolving of tooth structures by lactic acid? upon other influencing factors. In some instances, you will find indications of small areas of decalcification of the enamel. Sometimes, even after dental caries has begun in the 5. What supplies the bacteria needed to cause enamel, decalcification stops for reasons unknown; tooth decay in both theories of dental caries? such caries are called arrested caries. However, the process of dental caries usually continues through the enamel toward the dentin. As the carious 6. What is the difference between a sign and a process continues, you may see a discoloration of symptom? the tooth structure, an increase in the translucency of the tooth structure, and the formation of a cavity which varies in color from light yellow to dark brown or black. 7. What are arrested caries? In caries of the dentin, either a leathery substance or a spongy mass is formed as the result of decalcification. Either variety can easily be removed with an excavator. However, should some 8. Describe how caries of the dentin appear. change take place along the pulpal wall excited by the decay process, a hardened layer called secondary dentin is laid down within the pulpal chamber adjacent to the decay. This secondary 9. What is the purpose of the secondary dentin dentin acts as a protective lining or insulator for the that is the result of the cellular stimulation pulp tissue. caused by the caries? Quite often, dental caries presents a combination of signs and symptoms. which must be evaluated in order to arrrive at a correct diagnosis. Generally. 10. What are generally the first symptoms of tooth the tooth first becomes sensitive to cold foods and decay? liquids and then to foods and liquids containing high concentrations of sugars. Pain may also occur as a result of local irritations from food particles that have become trapped between the decayed 11. What is the only way dental caries can be tooth and the adjacent tooth and thereby exert repaired? pressure upon the interdental papillae. Pain, resulting from the above stimuli, is a symptom of what is normally termed simple tooth decay. If no treatment is given for this condition, the carious lesion continues to get larger; this, in turn, creates 213. Indicate basic aspects related to the additional complicating factors. etiology, signs, symptoms, and treatment of Treatment.Since dental caries is a disease of a pulpitis. tissue that cannot regenerate or repair itself, the lesion is progressive. Sometimes it may be self- Pulpitis. The term "pulpitis" simply means an limiting, a condition known as arrested caries, but inflammation of the pulpal tissue. Two types of the destroyed area is never self-repaired. Repair can pulp inflammation are possible: primary and only be accomplished by dental restorations secondary: Primary pulpitis is the condition that (filling). results from direct injury to the pulpal tissue by formation of dental caries or by other traumatic Exercises (212): causes. Secondary pulpitis is usually due to the 1. What is the most common of all dental patient's general health conditions. diseases? Etiology of primary pfdpitis.The most common cause of primary pulpitis is extensive tooth decay. The more severe the caries, the greater will be the damage to the pulp. .-rt"S type of pulpitis may also 2. What is the cause of dental caries? be the result of im:sition by chemical substances, TABLE 2-1 STAGES OF PRIMARY PULPITIS
Atages Etiology igns and Sp *tow Tooth sensitive to: 1 Heperemia irritants to pulp I. Decay close but not into pulp I. Coldheat feels better. chamber. 2. Touchsmarts while 2. F.xposed dentinechipped. chewing. Pain is short 1. Small pulp exposure. and sharp. 4. High restoration or heat from 3. Pulp tester reads veil dental drilling. sensitive (low reading t. . ------2. Acute pulpitic' I. Decay into pulp chamber. Tooth sensitive to: 2. Beginning of infection in I. Heat and cold. chambers. 2. Pulp tester reads like 3. Progresses from untreated hyperemia. hyperemia. 3. Severe painsshole side and head aches. _ . I. Usually no pain. 3. Chronic pulpitis . Infection progresses from un- treated acute pulpitis. 2. May feel itchy and elongated due to forma- lion of abscess. 3. Heat hurtscold feels better. 4. Very high reading cn tester.
4. Necrosk Entite pulp chamber is necrotic I. Usually very painful or suppurative from progres- with throbbing. boring sion of chronic pulpitis. Forms pain due to pressure of abscess. suppuration. 2. Cold relieses pain a bit. 3. Swelling - toothache. 4. No reading on pulp tester. pidpitis. . fromastyncralbodyConclatmn with the, awn.:r.}mptom, prsm.r S.Arontlar) pirIpm% cumuli: thermal changes, or trauma sufficient to injure the within the pulp chamber and apical bone. Chronic cells of the pulp.. pulpitis is the result of bacterial acids causing minor inflammation of the pulp chamber. Also, in chronic Etiology of secondary pulpitis.Secondary pulpitis is an inflammatory condition of the pulpchamber pulpitis, there is only dull, obscure painusually no pain with percussion and verylittle pain with due to a systemic disease; it is a secondaryeffect of a heatand the pulp is still vital. Normally, this stage more prominent disease of thebody. It is exhibited by swelling of the blood vessels withinthe pulp of pulpitis precedes acute pulpitis. In some cases, chamber. Sometimes a sinus irritation causesthe however, even before any bacteria enter the pulp, blood vessels that course through the maxillary their products may reach it and induce such changes sinus to become enlarged within the pulp chamber. in the pulp tissue as edema, hyperemia,. and other inflammatory processes. Since the pulp is contained More frequently, however, the protectivesheath in hard, unyielding walls, the svelling produced by for the nerves that course through the infected sinus processes like edema (accumulation of serousfluid) membrane becomes irritated and causes the patient blood) rather than and hyperemia (excessive accumulank.,, of to believe his pain stems from his teeth death of the his sinus. Such a sensation is known asreferred pain. causes pressure that may soon result in pulp. Refer to table 2- I to see the stages of primary Signs and symptoms.In the condition of acute pulpitis. etiology, and the signs and symptoms of pulpitis, we generally find that the tooth is each stage. extremely sensitive to heat but is relieved by cold applications. A person experiences a piercing and Treatment.Treatment of pulpitis in its early pulsating pain when lying klf.s.wn and, thus, the pain stages is usually performed in the restorativesection is more severe while he is to bed at night. Also, the of a dental clinic. This treatment may consistof pain may be increased by pressure or percussion. removing the irritant and inserting a sedative Pain experienced with acutc pulpitis is more severe filling. In the later stages of pulpitis, treatment is than that of simple dental caries of chronic pulpitis normally performed in the endodontic section. The because of the inflammation of the pulp tissue treatment at this stage may be what iscalled a 32 104 4'o pulpotomy (removal of the coronal portion of the and organisms that identify the type of abscess. pulp). Should pulpitis lead to necrosis of a tooth, Disintegration is the decay or separation into the tooth is said to be nonvital. A nonvital tooth is fragments. Thus, an abscess is a collection of cells, treated in either the endodontic section or the oral liquor purls, and organisms in an area limited to surgery section. Treatment in the endodontic one region with one or more spots formed by the section essentially entails the removing of the decomposition or decay of tissue. necrotic pulp and replacing it with a suitable root Periapkal abscess.The most common condition canal restorative material. In oral surgery, a following untreated acute pulpitis is a periapical nonvital tooth that cannot be treated is usually abscess. A periapical abscess is the localized extracted. collection of pus at the apex of a tooth and may Exercises (213): classified as either acute or chronic. An acute periapical abscess is a rapidly I. What is pulpitis? progressive inflammatory process, in that the surrounding tissues become swollen and red. Usually, distressful quantities of pus form within 24 hours. The area becomes extremely painful, and the 2. What is the most coinmon cause of primary abscess rapidly increases in size, with the pus pulpitis? searching for an outlet. The tooth may be extruded slightly from its socket. The periodontal membrane breakdown, due to the abscess, may cause the tooth 3. What is secondary pulpitis? What is its cause? to become loose. The tooth is very sensitive to percussion, and the body temperature is elevated. When heat is applied to the offending tooth, the 4. What agents or factors increase the pain pain is increased: however, when cold is applied, experienced by a patient with acute pulpitis? the pain is decreased. When the red, swollen tiuue covering the gingiVa at the apex of the tooth is depressed, a blanching ,ffect can be seen. If a pulp 5. What type of pain is usually experienced with tester is used, no reading will be recorded, chronic pulpitis? indicating the necrotic (dead) condition of the pulp. The chronic periapical abscess is a condition that ( is of much longer duration than the acute type but is 6. What may happen to the pulp as a result of the less painful and has little tendency to spread. As a pressure produced by swelling caused by edema rule. the pain occurs only when pressure is placed and hyperemia? on the tooth in a certain direction. When a pulp tester is used to check this condition, normally no reading is obtained. In most instances, the abscess is walled off; however, the membrane is usually 7. How is pulpitis treated during its early stages? attached more firmly to the bone than to the root of the tooth. There is very little redness or swelling involved. If an abscess remains untreated, it will continue 8. What treatment would be performed on a tooth to progress in the direction offering the least that has become nonvital as a result of pulpitis? resistance. The accumulated pus eventually penetrates the cortical plate to emerge into the gingival tissue and forms a parulis (gum boil)see figure 2-1. Eventually, a fistula will form and allow the pus to drain. In most cases, there is a swelling of the face in the area of the abscess. If the infection 214. Indicate basic aspects related to the types of does not localize, then a hard, boardlike swelling dental abscesses, their etiology, signs, symptoms, called cellulitis spreads through the tissues of wide and treatment. areas of the face and neck. Usuaily, a constant. pulsating pain is experienced while the abscess is Abscesses. By definition, an abscess is a forming. However, when drainage is established, localized collection of pus in a cavity formed by the the pain is almost instantly relieved. Treatment may disintegration of tissue. To understand this more involve root canal therapy or the removal of the clearly, let's break this definition down to its infected tooth. simplest meaning. To localize something. we limit Parietal (periodontal) abscess. This is an abscess or confine it to a particular place, area. or locality. that more often develops alongside the tooth. It Pus is an inflammation product, consisting of cells. locates between the gingiva aixl the tooth and it leukocytes. liquor purls (the liquid portion of pus). involves the periodontal membrane and the 33 195 develops, the central area may assume ared, shiny appearance. A high feveris associated with cellulitis (104° F. to 105° F.), along with arapid pulse and headaches. Trismus (spasm)of the involved masticatory muscles also occurs.In some cases, rather than the typicalabscess production, a chronic cellulitis follows the acute phase,with persistent deep swelling. In other instances, severe extensive inflammation is apparent fromthe onset.
Exercises (214): 1. Define an abscess.
Figure2.1. Periapical abscess. 2. Name the types of periapicalabscesses and state their location. supporting alveolar bone. Theparietal abscess may undergo both acute and chronicchanges in its progress toward resolution,and it has to be treated according to the stage of tissueinflammation. 3. Differentiate briefly betwesn an acuteand a Usually, the etiology of a parietalabscess stems chronic periapical abscess as to pain,redness, from a foreign body 'rritantthat becomes and welling. embedded in the space between thetooth and the soft tissue, or completely withinthe soft tissue adjacent to the tooth. The most common causesof parietal abscesses are calculusformation, 4. State two recognized treatmentsfor a periapical impacted overhanging fillings, fractured fillings, abscess. food particles, popcorn husks,and toothpicks, which become wedged in theinterproximal areas. Another cause may be a deepgingival or periodontal inflammation that becomeswalled off. 5. Summarize the usual diology(causes) of a This prevents drainage andresults in acute swelling. parietal abscess. In the acute stage of aparietal abscess, a typical inflammatory reaction occurswithin :he tissue. Ordinarily, the gingiva aroundthe abscess is very swollen. Too, there may beswelling of the face and, occasionally, enlargement of theregional lymph nodes coupled with a slightelevation of body temperature. Pain associatedwith the lesion may vary from mild toquite severe. The tooth israrely sensitive to percussion;however, pressure on the inflamed gingiva is quite painful.Application of heat or cold to the inflamedarea causes no particular increase in the pain.The mucous membrane appears red, swollen,and inflamed, and is quite tender. The degreeof swelling depends the upon the extensivenessof the infection. When irritant is removed and drainageis established, the pain or discomfort willdisappear. Cellulitis. Cellulitis is an inflammationof the soft tissue structures. It may occur as acomplication from a dento-alveolar abscess or as apostoperative complication following extensivesurgical procedures in the mouth. In either event,the signs and symptoms are quitesimilar. The onset of a cellulitis of the oral structuresis manifested by edema of the soft structures,quite often extensive and throbbing, (see fig. 2-2). Pain is usually severe Figure2-2. Cellulitis of the jaw. and it increases with pressure.As the inflammation 106 34 q4
6. State the usual elk*. in regard to pain, of the There we many signs and symptoms associated application of hest or cold to a parietal abscess. with pericotonitis. The *siva wound the tooth is inflamed. Swelling occurs in the infected glegival tissue, and it may emend into the a4jacent dose. There mer be an accumulation of pus, dog with 7. State, in summarized form, the signs and severe throbbing pain and dismus of the muscles in symptoms of cellulitis. the affected area. Fever and nesteralind Caliendo may develop in chronic cases. In most cases. pericoronitis lasts about a week if: it doss not Wcome extensive and W the infection is not of an extremely vindent type. In some cases, it may then slowly disappear only to recur spin in 3 or 4 weeks unless the dental officer gives defInitiw trestment. Treatment of pericoronids varies according to the condition. If the tooth involved is erupting into 2IS. Indicate basic factors related to the etiology, a normal and functional position, the dentist will signs, symptoms, and treatment of periceronites. probably elect a treatment procedure designed to saw the tooth. Such a procedure weld involw Periceroultis. This is an inflammation around flushies out the pocket area and instrecdng the the crown of the tooth. Most frequently, it occurs patient bow to kap the area clean. In somecases, around the crowns of partially erupted teeth, the dentist may have to remove the opsriehtm by especially the third molars or wisdom teeth. surgical excision. In caw where the tooth cannot Pericoronitis of the third molar can be seen in erupt into a normal and functional position, it is figure 2-3. However, any partiilly erupted tooth wually removed. may be affected. In this condition, a flap of gingMl (gum) tissue called anOperculum emends over the unerupted portion of the tooth., and, just as in a parietal abscess, it establishes an ideal pocket for Exwelses (215)i the accumulation of food debris. The environment is warm, dark, and moist; consequently, such an I. An inflammation occurring around the crown area is ideal for the growth of bacteria. As the of a partially erupted third molar would be bacteria multiply under these conditions, rn called infectious process is initiawd. It causes pain, pus formation, swelling, and, at times, trismus of the muscles of mastication in that particular area. With 2. The pain, pus formation, and swelling trismus, the patient has difficulty in opening his associated with pericoronitis often result from the growth of in food mouth. Sometimes, he is unable to open it more than one-half inch. Although this condition is debris that hae accumulated in an area where growth conditions are ideal. frequently brought about as the result of a partially erupted tooth, it nm be aggravated by mechanical trauma and, as we have mentioned, by secondary bacterial infection. 3. If a patient with pericoronitis of a partially erupted tooth has difficulty in opening his mouth, the difficulty results from of the affected muscles of masticaiton.
4. The involved tooth is erupting into a normal and functional position', but. so far, flushing and oral sanitation have not proven effective in the treatment of pericoronitis. In this cue, the dentist should continue treatment by removing the by surgical excision.
5. In cases of pericoronitis where conditions are such that the tooth cannot erupt into a normal and functional position, the best treatment is to Havre 2.3. Pericoronitis. the tooth.
35 197 216. heat* lay bes eeneenigg the edelem 3. Colson form around or sips, symptoms, and treatment et the meet y. thst may be bored in cammet types or cysts eseenntered I.the the tissue. treatment et dental paean& 4. When the epithelial sac of a cystcompletely Coen While there an meny type of crm, the surrounds& periapical abeam, the pus will tern two most common types you will enconster in the ism a treatment of dental patients are inflammatory and develoceental get. Treatment normally comets 5. A developmental cystis cared by the lima of the surgical excision of the cyst, combined with a the formed the during thorough curettage anise area to eliminate est cells tooth the could, lead to iis reoccurrence. normally consists of the Inflammatory cyss.An inflammatory cyst is 6. Treatment of cysts caused by some irritant that can usually be of the cyst, combined with a thorough of the identified. Epithelial rest cells may have been left that behiad after the tooth was formed. A chronic area to eliminate perispical &bees may cause the cells to proliferate could Wad to its reoccurrence. (to reproduce in quick succession) and surround the abscess. If this epithelial sac successfully surrounds 217. Describe a gresalems, sod stale Its etielegy, the chronic abeam, it will prevent further bacterial vowth by cutting off the source of nutrient. The dos, irsd symptoms. pus will gradually turn to a clear liquid. This sac or grantdOma is a cyst may continue to enlarge by increating the fluid Dotal Grantham. A dental mass of ventilation tissue, usually surroundedby a inside the sac due to an exchange of fluids through fibrous sec. It is a sequel to chronic inflammation the cyst wall. Cysts can form around retained roots of the paispical tissues. This chronic inflammation or any foreign chronic irritant that may be buried in may be the result of necrosis of thepulp cells Of the tissue. A cyst is usually asymptomatic to pain or bacteria. The sensitivity. This condition is usually caused by a may be caused by nonpyogenic granuloma is located at the apex of the root, and the pathology ot' the teeth. membrane that surrounds the granuloma often Developmental cysts.Developmental cysts are remains attached to the tooth as it is extracted. The usually composed of cells that were left behind after tooth may be sensitive to percussion and feel performing a particular function. One good slightly elonpted: also, there may be a dull gnawing example a a developmental cyst is the follicular pain. However, in other instances, this condition cyst. 'Ibis fluid.filled sac is caused by the tissue that may be present and offer no symptoms. formed the developmental sac during tooth formation. Usually this sac disappears after itsjob is Exercises (217)t finished. However, in some cases, parts c: it remain embedded in bone or attached to the tooth. Years I. Describe a granuloma. later, theepithelial cells of the follicle begin to multiply and cause the follicular cyst. Additionally, of this sac may be left behind during third renmants 2. To what condition is a granuloma sequel? molar extraction. Since the third molar erupts comparatively late in life, it may still have some of the follicle attached. Although healing appears normal at thetime,the cyst can appear some years 3. Where are granulomas usually located? later.
Exercises (216): Indicate the etiology of the signs, symptoms, and 4. What symptoms maybe noticedby a patient treatment of the most common types of cysts having a granuloma? encountered in thetreatmentof dental patients by placing the appropriate words in the blank spaces.
1. An inflammatorycyst is usually causedby a ofthe teeth. 2-2. Periodoatal Diseases Periodontal diseases cause the loss of moreteeth 2.A cyst isusually topain than anyotherfactor.Although the diseases more orsensitivity. commonly affect people over 35 years of age. they 36 198 are a serious threat to the dental health of patients become grossly enlarged. The papilla may grow like of all ages. You can compare advanced periodontal stubby fingers, and the condition may not recede diseases to a strong house with a weak foundation. after treatment. The gingiva is neither red nor A patient may have teeth that are free from painful. The cause is probably some low grade decaybut they may be supported by weak, irritant of long standing. It may be caused by the diseased, degenerated tissue. This section discusses patient's partial dentures, an overhanging filling, or gingivitis, periodontitis, and periodontosis. a child's orthodontic clasps; or, ptrhaps, some drug like dilatin his been taken. Some mouth breathers have hyperplastic gingivitisthe breathing being 218. Define gingivitis and differentiate between the low grade irritant This condition sometimes the types of gingivitis. runs in families. The dental officer's treatment may be surgical excision. Gingivitis. The tcrm "gingivitis" refers to an Hormonal gingivitis. A hormone imbalance is inflammation of the gingiva. This is themost responsible for this type of gingivitis. The disease common periodontal ailment that_ you treat in the occurs during the phases of life when there is a dental clinic. You sbiuld knOw the types,causes, change in the hormones. With this condition, the and treatment of gingivitis. Also, you must be able gingiva will be enlarged, puffy, red to bluish red to explain the disease to your patients in terms that with short, fat, purplish papilla. It will bleed easily. they can understandthey may not even know what This type of gingivitis appears between the teeth the term "gingiva" means. Also, your patients need first, then it spreads from the interdental papilla to simple instructions that they can follow on how to the marginal gingiva. The condition may involve a improve their oral conditions. few or many teeth; it usually is not generalized Simple gingivitis. The inflammation of the throughout the mouth-. Good oral hygiene helps gingiva may be caused by local irritants. Simple alleviate this condition because this type of gingivitis usually is caused by inadequate oral gingivitis, like the other types, is precipitated by a hygiene; however, it may be caused byan local irritant. overhanging filling or other local irritant. Usually, Necrotizing gingivitis. This disease has been the gingiva around only a.few teeth is involved. The called many namesfrom oral fusospirochetosis to gingiva becomes swollen and red in varying degrees necrotizing ulcerative gingivitis (NUG). It may be around the margins. The most common typecan referred to as Vincent's infection, and during develop in 3 or 4 days if the teeth are not cleaned. World War I our doughboys who contracted this Simple gingivitis is easily treatable by both the mouth disease had "trenchmouth." The-Air Force dentist and the patient. The treatment is toremove uses the shortened term NUG. But whatever it is the local irritant. When the teeth are cleaned, the called scientifically, vernacularly it is "bad news." inflammation disappears. A person can have simple In this type of gingivitis, the tissue is either dead or gingivitis one day, not have it 2 days later, and have dying. The gingiva is swollen, red, and bleeding; the it again a week later. It is almost a "turn-it-off-and- dead or dying interdental papilla is covered with a on" type of disease. It is especially common in grey-white pseudomembrane (false membrane). If children, who get careless with their oral healthcare you squirt water on the membrane, it peels off and if not closely supervised. leaves a raw bleeding surface. There is always a fetid odor present. This odor has been described u Infective gingivitis. This is caused by an invasion a "very stale, tomato-juice-can smell." With the of micro-organisms, such as streptococci. It differs acute stage, the patient has fever, his gums are from simple gingivitis in the intensity of the painful, and he may be unable to eat because of inflammation. There may be no local irritant. The them. His cervical lymph glands in the neck are gingiva and the adjacent mucosa are very red and swollenyou may feel pea-sized lumps below the swollen. The gingiva actually looks painfulwhich mandible that are tender to the touch. He suffers it is. Few patients come in with pain from gingivitis, from malaise. The symptoms and signs may vary in but if they do and if the redness and swelling extend intensity, but all are there. onto the mucosa, the condition can be diagnosed as Necrotizing gingivitis is caused by the vibrio infective gingivitis. This type of gingivitis is treated (comma-shaped bacillus), bacillus (rod-shaped with antibiotics. It is the only type treated in this bacillus), and spirochete (spiral-shaped manner. bacillus)anacrobic bacteria that get deep down Hyperplastic gingivitis. This type starts out as into the tissues. From the patient's physical simple gingivitis (usually chronic), but you seldom standpoint, the causes of NUG are usually poor oral see it in its simple form. You usually see the patient hygiene, rundown physical condition, fatigue, and after the tissues have overgrown. There is an emotional and physiological stress. There are enlargement of the gingiva that is not due to several definite steps in the treatment of NUG. swelling but to tissue growth. Actually, there isa Treatment should be performed by the dental fibrous replacement of tissue: this growth can officer or preventive dentistry technician. 37 109 . 16/
Geherally, treatment consists of local debridement Column B (cleanup). f. Caused by anaerobic bac- Desquainative gingivitis. This type is linked with teria penetrating deeply a the hormonal type; however, it does have different into patient's tissues because patient's physical characteristics. The epithelium lifts off numerous condition is rundown, areas of the gingiva. Somethingattacks the fatigued, or because he is epithelium, and it, lifts off leaving large, raw under emotional or patches. Sometimes there are blisters, especially physiological stress. Characterized by with a patient experiencing menopause. The blisters swollen, red, and bleed- may rupture, leaving a rawsurface and a painful ing gingiva, covered with condition. It may require a topical anesthetic before a grey-whitefalse the patient can eat. The treatment is membrane: fetid odor: symptomatiokeep the patient comfortable, and fever: painful gums: swollen cervical lymph stress the need for improved oral hygiene.. glands: and malaise.
Exercises (218): I. Define the condition of the gums referred to as gingivitis. 219. Define periodontitis and periodontosis, describe their clinical appearance, and state the In exercises 2 through 7 that follow, match the type treatment .for each.. of gingivitis listed in column A with the letter of the Periodontitis (Pedoni). This is inflammation of appropriate statement listed in column B. Write the the periodontia, including both the gingiva andthe letter of the selected statement in the blanks supporting bone. The definition sounds much like provided. Use every letter once, and only once. the definition for gingivitis. Once theinflammation passes the periodontal ligamentfibers and the Column ei Column B supporting structures of the tooth break down, the 2. Desquamative a:Although linked with thc gingivitis, hormonaltypeof condition is no longer gingivitis but is 3. Hyperplastic gingivitis, it has different periodontitis. If gingivitis is properly treated, it gingivitis. characteristics:the should not progress to periodontitis. 4. Neerotizing epithelium may lift off. Periodontitis is caused by irritants in general. gingivitis. leavinglarge.raw 5. Infective gingivitis. patches: ,or sometimes These irritants may be materia alba, plaque, 6. Simple gingivitis. there are blisters. which calculus, food impaction, malocclusion, or faulty 7. Hormonal may rupture. restorations. The condition may also be caused by gingivitis. b. The only type treated systemic factors, such as low resistance, stress. with antibiotics: caused by an invasion of micro. diabetes, blood problems, or hormone imbalance. organisms: gingiva is If a patient has uncontrolled diabetes,dramatic very red and swollen. healing should not be expected. and looksand The patient's breath will'usually be foul. Irritants ispainful. may or may not be present. There maybe exudate in c. Characterized by enlargement of the the depth of the pocket. The dental officerwill most gingiva due to fibrous likely use X-rays and a periodontal probe when replacement of tissue and making a diagnosis. If he finds that the not to swelling. Gingiva interproximal bone shows slight blunting, the is neither red nor pain. ful. Surgical excision disease is in the beginning stages. In advanced may be a required treat. cases, there is a horizontal loss ofbone and a ment. cupping-out of interdental bone. d. Usually caused by inade. The treatment consists of educatingtile patient quate oral hygiene. but toward better oral hygiene and removing thelocal may also bc caused try an overhanging filling or irritant when it can be found. Then the pocket other local irritant. should be removed, and possibly the dentalofficer Gingiva becomes swollen will recontour the gingiva and bone. If there are and red in varying systemic factors, the patient will he sent to a degrees around the margin of the few lerah physician. Actually. you may think of the treatment involved. for periodontitis as having four possible e. The gingiva will bleed procedures: easily and be enlarged. (I) Education of the patient. puffy. and :ed to bluish and redl'he papilla %ill be (2)A conservative treatmentscaling sh,rt. at. and purplish curettage.
38 11 0 (3) Gingival surgery and possibly osteosurgery. 4. Under what condition does the inflammation (4) Postsurgical treatment which may include of the gingiva progreu from gingivitis to occlusal equilibration. periodontitis? Periodontosis (Pedono). This is an abnormal condition in which the peridontia shows degeneration. There is initially no inflammatory reaction. The disease is specifically defined as "an 5. Define periodontosis. uncommon occurrence of a nonspecific noninflammatory degeneration of the periodontia." No one is sure as to the cause of the disease. It may be a systemic factor, such as diabetes; it may be 6. Describe the clinical appearance of the result of early childhood malnutrition or periodontosis. infectious disease; it could be a defect in collagen metabolism; or a genetic factor may be involved. Dramatic bone loss is first noticed in the region of the first molars and incisor teeth. The rest of the 7. Describe the treatment for periodontosis. teeth may be in good condition. This disease initially occurs most often in the 15- to 25-year age group. It has a high incidence in die middle, near, and far eastern parts of the world. The clinical appearance of periodontosis in the early stage is Widening of periodontal spaces and 2-3. Systemic and Locally Originating Diseases migration of teeth. The first signs of inflammatory Many pathological conditions, other elan those involvement, local irritation and bone loss leading already discussed, may be seen in dental treatment. to periodontitis, are seen in the second stage. The Generally, the diseases will be grouped according third stage is characterized by progressive gingival to the conditions that cause them. Disorders inflammation, trauma from occlusion, deeper associated directly with the teeth and supporting periodontal pockets, and increased bone loss. structures are omitted, since they were discussed Another clinical appearance of periodonto3is is the earlier. Diseases of the oral mucosa may be divided loosening and drifting of teeth. As these occlusal primarily into those related to systemic diseases and stresses become more traumatic, the patient has those of local origin. Diseases of systemic origin more bone loss. Neither pocket formation nor bone usually affect the entire body and produce some loss is part of the beginning process of clinical pictures in the oral cavity. The infectious periodontosis but is seen in the later stages. diseases of syphilis and tuberculosis are examples of The patient should be educated toward good oral this type of oral lesion. Locally originating diseases hygiene: then his mouth should be thoroughly are due to conditions that are present only in the cleaned. The dental officer then treats the patient mouth. They include physical irritants, such as according to his needs. This treatment may include dentures, restorations, habits, and chemicals, that equilibrating, splinting, or extracting those teeth may be taken orally. These factors may be beyond hope of saving. Prognosis for teeth involved introduced into the oral cavity by the dentist, the in periodontosis is very poor. technician, or the patient himself. Certain other Although caries cause some extractions, common local infections will also be included. periodontal disease accounts for approximately 90 percent of tooth loss. Good oral hygiene helps the 220, Identify the etiology, signs, symptoms, and patient keep his teeth. Remember that periodontal treatment of herpes simplex and aphthous disease is usually the end result of poor oral stomatitis. hygiene! Infectious Conditions of Systemic Origin, The Exercises (219): specific diseases discussed here are oral lesions 1. Define periodontitis. from infections caused by a particular bacteria or virus. Herpes simplex. Herpes simplex is a common infection usually occurring on or about the 2. Describe the clinical appearance of lipsoften referred to as a cold sore or fever periodontitis. blister. The cause of this lesion is not definite. It sometimes appears as a corollary of a common cold, upper respiratory tract infection, allergy, gastrointestinal disturbance, overexposure to 3. Describe the treatment for periodontitis. sunlight, fatigue, or emotional tension. Whether
39 ,1 these factors actually cause the disease, or just and heals in 10 to 14 days without contribute to it, is not definitely known. At times, it scarring. appears without obvious cause. The herpes simplex T F 4.Gastrointestinal disturbances and virus has been identified as the primary causative emotional tensions (or stresses) often organism. precede or are associated with either The patient may feel an itching or burning herpes simplex or aphthous stomatitis. sensation prior to the eruption of one to several T F 5.The lesions 'of aphthous stomatitis are water blisters (vesicles). These vesicles break and preceded by vesicles which rupture to crust over. The area is usually surrounded by produce cold sores. redness and is slightly swollen. Normally, the T F 6. When aphthous stomatitis lesions lesions are painless but will become sore if the rupture, they almost always result in the vesicles break and leave a raw surface. Herpes formation of herpes simplex. simplex is usually-self-limiting and heals in ID to-14 T F 7.Palliative treaunent -will-keep either the days without scarring. herpes simplex or the aphthous stomatitis Keep irritating drugs and spicy foods away from patient comfortable, since both the the lesions by coating the lips with vaseline or some infection and the sore normally are self- other preparation. This is palliative treatment. healing. Aphthous swmatitis. This is a bothersome ulcer, sometimes called a canker sore, found in the mouth 221. Identify factors associated with the on the mucous membrane. The exact cause of this transmission and oral manifestations of syphilis. lesion is unknown, but a certain type of Syphilis.This highly contagious disease can be a streptococcus may be a causative factor. It appears threat to the technicians who touch infected patients to be associated with gastrointestinal disturbances with their bare hands. It is a venereal disease which in individuals whose resistance is low and in may manifest itself in the mouth. Though it is not persons who are suffering from physical or common, transmission can occur to the hands from emotional stress. The term "stomatitis" refers to lesions in the mouth. Syphilis is caused by a specific any inflammation of the mucous membrane ofthe bacteria, the Treponema pallidum spirochete. it can mouth, while "aphthous" refers to vesicles which enter the body through any break in the skin,such tend to form and then break down and produce as hangnails, blisters, cuts, and abrasions.Syphilis ulcers. is characterized by three stages. These ulccrs appear as depressions on the The first stage of syphilis is characterized by mucous membrane and are coveredby a grayish- appearance of the lesion called the chancre. The white or light yellowish membrane. Each such chancre may appear anywhere on the body, but the lesion is preceded by a vesicle, which normally most common sites are on the genitals, on thelips, persists for only a few hours before rupturing and or in the mouth. Clinically, in the oral cavity it is producing the ulcer. The ulcers vary in size from characterized by an ulcer formation with a hard that of a small pinhead to one-half inch at their border. Because it is.usually painless, the patient is greatest dimension. Aphthae may occurin various often unaware of its existence. The chancre is parts of the mouth but are most common onthe lip, normally a single lesion, although rare cases of two cheek, floor of the mouth, and tongue. or more have been reported. Any single, painless, Once again, palliative treatment will keep the untreated lesion appearing on the lips or in the patient comfortable until the ulcers subside. mouth should be called to the dental officer's Soothing rinses and application of surface attention at once and should be viewed with anesthetics may be of some value. The patient is in- suspicion until steps are taken to secure structed to stay away from spicy or irritating foods. confirmation by laboratory procedures. The A dental officer should always be notified when chancre is highly infectious, and although it is most lesions of any type are noticed in the mouth. commonly found on the genitals, its appearance in the mouth is not rare. The dentist and the dental Exercises (220): technician should never overlook the possibility of Indicate whether each of the following statements is its presence. The chancre goes away in about 10 true or false by circling the appropriate T (true) or days, leaving no scar. F (false). A dangerous secondary lesion appears from 2 T F 1.The exact causes of herpes simplex and of months to1 year after the primary chancre aphthous stomatitis are very definite and disappears. It is the result of a generalized can usually be identified. involvement of the blood and the lymphatic T F 2.Herpes simplex, sometimes called a circulation. The causative organism enters the canker sore, is found in the mouth on the bloodstream at the site of the primary lesion, mucous membrane. multiplies, and is carried throughout the body by T F 3.Herpes simplex is usually self-limiting the circulatory system. The secondary lesions may 40 112 appear anywhere on the body and in large numbers. appears from 2 months to 1 year after the The lesions that appear on the mucous membrane primary lesion has disappeared. are known as mucous patches. These are probably T F8. The lesion of the second stage of syphilis the most contagious of all the syphilitic lesions and is called a gumma; that of the third stage are seldom absent from the oral mucosa during the is called a chancre. secondary stage of syphilis. The true mucous patch T F9. The dentist and technician should view is usually oval in shape with a moist, glistening, any painless lesion of the mouth or throat grayish-white, slightly raised surface. Other with suspicion of being possibly related secondary lesions, however, may have radically to syphilis. differmit appearances; it is this fact which makes the T F 10. Treatment of syphilis, regardless of stage, clinical diagnosis of secondary syphilis difficult. As is a medical problem. in the case of the single piimary lesion, the dentist and his technician should view any painless lesions 222. State specific factors concerning the oral of the mucous_membranes of the mouth and throat manifestation of tuberculosis, and indicate the with suspicion. The dental officer will take the patient management procedures rewired when necessary steps for proper laboratory diagnosis. treating infected patient& The third and terminal stage of syphilis produces a lesion called a gumma. It may appear at any time Tuberculosis. The oral lesions in this disease are from several months to several years after the initial usually associated with pulmonary (lung) infection. Usually, there are not very many tuberculosis. The primary causative agent is the lesionsoften just one. The lesions in this stage are bacillus Mycobacterium tuberculosis. The spread of not considered very contagious, since they rarely the oral cavity occurs either through the blood contain the causative organisms. They appear in the stream or by direct contamination of an abruion or mouth but not with the same frequency as do the wound in the mucosa. The most common site for secondary lesions. The gummas normally appear as this secondary tuberculous lesion is on the tongue. nodules and slowly increase in size, becoming If the oral lesion is a primary site, it may be caused softer and less dense. Eventually, the center of the by the direct contact of the tissue with an infected nodule becomes eroded and a definite ulcer results. instrument. The soft tissue and underlying bone are destroyed. Oral lesions, especially those of the lips, Perforations of the palate often result. frequently begin as a small tubercle or pimple, The treatment of syphilis, regardless of stage, is a which breaks down to form painful, ulcers. medical problem. The patient's dental requirements Additional tubercles form in the same mannerthe will be met through close cooperation with the process repeats over and over and the lesions grow physician treating the systemic infection. in size. The tongue lesions are particularly painful as they develop along the lateral borders of the Exercises (221): tongue where it rubs against rough, sharp, or Indicate whether each of the following statements is broken down teeth and restorations. The pain is true or false by circling the appropriate T (true) or severe and continuous, and it interferes with eating. F (false). The patient suffering from this disease is in serious trouble. Management is a medical problem. T F1. Though it is not common, transmission The oral lesions are treated in the closest of syphilis can occur from the oral lesion cooperation with a physician. The maintenance of of an infected patient to the hand of a good oral hygiene and the elimination of all areas technician. that might be a source of irritation to the tissues is T F2. Syphilis is caused by a specific bacteria the primary dental concern. During the dental called Treponema pallidum. portion of treatment of diseases such as this, where T F3. The chancre, which characterizes the first contact with the lesion could spread the infection to stage of syphilis, very rarely appears in the operator, rubber gloves and the strictest aseptic the mouth; however, when it does, it techniques aremandatory. leaves a telltale scar. T F4. Normally, multiple lesions (chancres) Exercises (222 appear in the mouth during the first stage 1. What is the primary causative agent of of syphilis. tuberculosis? T F5. Clinical diagnosis of secondary syphilis is difficult, because secondary lesions often have different appearances. T F6. The lesions which appear during the third 2. Indicate three methods by which the stage of syphilis are usually the most tuberculosis bacilli can be spread to or in the contagious. oral cavity. T F7. The secondary lesion of syphilis normally n 3. What is the most common site for the statement in column B that is appropriate to that secondary tuberculous lesion? term. Some statements are applicable to both terms.
Column .4 Column B 1. Measles. a. A viral contagious dis- 4. Breifly explain hots the painful tuberculous 2. Measles. eme. ulcers develop and spiead. I Measles. b. Runs its course in 14-21 4. Measles. days. 5. Mumps. c. Usually imparts lasting 6. Mumps. immunity. 5. What is the dental primary concern in the 7. Mumps. d.May also affect the testi- treatment of the tuberculosis patient? 8. Mumps. cles, ovaries, pancreas. and brain. e. Accompanied with swell- ing at angle of mandible 6. What precautions should 'oe observed by dental and possible with ir- personnel who are involved with the treatment ritability. feVer, andiur of a tuberculosis patient? headache. f. Pinhead size, white or bluish-white Koplik's spots. surrounded by a red halo, appear on the soft palate as an earl) sign 223. Differentiate betweer the etiology and oral manifestations of measles and mumps. 224. Identify specific factors related to patients with diabetes.. Measles. Measles is seldom dangerous but is highly contagious. If you have not already had this Diabetes Mellitus. This disease is due to disease, then you arc not immune, and you should insufficient secretion of insulin by the pancreas. stay completely away from an infected patient. Insulin is needed by the body for the digestion and Measles is a viral infection that usually produces use of carbohydrates. The cause is unknown,but lasting immunity once a person has had the disease. patients who eat too much sugar and fat. are One of the earliest signs of rubeola (measles) is overweight, get little or no exercise, or have some Koplik's spots, an important diagnostic sign of the disease of the pancreas itself, have a greater disease. They appear 1 or 2 days before the rash. tendency to develop diabetes. The spots are pinhead size and white or bluish- Patientsusually experience xerostomia(dry white. surrounded by a red halo, usually found mouth) and sweetish odor to the breath. Diabetes early on the soft palate, and later, during the acute mellitus impairs the body's healing ability. This stages of the disease, on the cheek mucosa along the factor causes diabetics to have increased tendency line of closure in the molar region. to develop periodontitis, glossitis, and gingivitis. The disease will run its course in 14 to 21 days. They also develop infections easily. If oral surgery Unless there are oral complications, measles is is performed, the patients usually exhibit healing treated 'as 'a medical problem by a physician. difficulties and are often predisposed to alveolar Mumps. Mumps, although primarily a viral osteitis. infection of the parotid salivary gland, is Diabetes is a medical problem. It is not curable considered a systemic disease because it also may but can be controlled in most cases by oral affect the testicles, ovaries, pancreas, and brain. medication or insulin injection. If a patient is a This acute, highly contagious disease should be controlled diabetic, his reactions to surgery and his viewed with suspicion by those who have never had healing functions are about the same as that of a the disease. Mumps must be differentiated from normal patient. acute oral infections and cellulitis. Mumps is a highly contagious viral disease that usually imparts Exercises (224): a lasting immunity to those who have beeninfected. Indicate whether each of the following statements is Patients with swellings located at the angle of the true or false by circling the appropriate T (true) or mandible may be infected by this virus. F (false). Accompanying symptoms include irritability, fever, T F1. Diabetes mellitus is a disease due to the and headache. The swollen area is extremely insufficient secretion of insulin by the sensitive to palpation. The medical clinic manages parotid gland. this condition. T F2. Patients who eat too much sugar and fat, are overweight, get little exercise, or have Exercises (223): some disease of the pancreas have a Match each term in column A with the letter of any greater tendency to develop diabetes.
42 114 T F3. Diabetics usually exhibit healing Exercises (225): difficulties and are often predisposed to alveolar osteitis following surgical Match the descriptive statements in column B to the conditions listed in column A. Procedures. T F4. Diabetics have a greater resistance to Column A Column periodontitis, glossitis, and gingivitis. I. Vitamin B com- a. A prolonged deficiency T F5. Diabetes is not curable, but in most cases plex malnutrition. produces scurvy. it can be controlled by oral medication-or 2. Vitamin B com- b.Deficiency may remit in insulin injection. plex malnutrition. anplardseiloeis with ac- 3. Vitamin C defi- companying pain due to (dewy. irritation. 225. oiffereatiate between the clinicalsigns, 4. VitaminC defi- c. 'Fragment is the admin- symptoms, and treatment of vitamin B complex ciency. istntion of ascorbic acid. 5. VitaminC deft d.Most significant oral malnutrition sad vitamin C *Beim". ciency. mpect is impaired heal- ing ability and some Oral Manifestations of Nutritional gingival bleeding. -Deficiencies. Oral lesions dueto poor diet are e. A prolonged deficiency relatively rare in the military patient. Patients with causes the tongue to enlarge and appear fiery diets that are deficient inone or more vitamins still red and glossy. appear in the clinic. However, most of these deficiencies are due to the omission of certain foods 226. Name two classes of burns, Indicate their from their diet because of habitor personal taste. likely causes, and tell whet precautions alight The avitaminoses (conditions dueto the lack of prevent thew. specific vitamins) can produce acute problemsin the oral cavity. For the dental technician,it is a Oral Lotions of Local Origia. Considering the matter of recognition of abnormal textures and number of functions performed by the mouth and color. Nutritional disturbancesare best managed by associated structures, the mouth is a magnificent the medical facility. Only a brief representative part of the body. The oral cavity is abused with group of these disturbances will be discussed. pencils, fingernails, caustic drugs, and hot and cold .Vitamin B wmplex malmarition.Several lesions foods. It often inflicts wounds upon itself with lip can appear in the oral cavity froma diet deficient in and cheek biting. It is evident that all this abuse this group of vitamins. Angularcheilosis is the sometimes causes damage. The damage may be cracking of the corners of themouth with reparable or may cause permanent defects. Some of accompanying pain due to irritationfrom foods the agents of abuse can lead to serious problems and and saliva. This conditionmust be differentiated even loss of life. The most common oral lesions will from angular cheilitis, which ischapping due to be discussed according to cause. Most of these increased salivationor secondary infection of problems can be avoided, since they are nearly all cracks in the corners of the mouth.Overclosure of manmade. the bite due to loss invertical dimension of Thermal bums. Severe burns are rare in a dental dentures can be a contributingfactor to cheilitis. clinic. The oral cavity is relatively inaccessible to Cheilitis is a lesion dueto local irritation, whereas heat hazards. The mucosa also has some built-in cheilosis is due to the vitaminB complex protection by virtue of its moist surface. Combat nutritional disturbance. personnel occasionally receive flash burns, and a Prolonged deficiency ofcomplex vitamins resultant severe sloughing of tissue°CCM.Minor causes the tongue to enlarge, resulting ina glossy or burns occasionally occur from hot foods on the smooth texture. The fiery redappearance is also labial and palatal mucosa. Most burns due to hest due to insufficient vitamin B.Medical management are avoidable. usually includes incxeasing thedaily intake of the B Burns may be caused by careleu handling of complex vitamin group. heated dental materials and instruments. If a Vitamin C deficiency. Aprolonged vitamin C technician uses instrument forceps to hand an deficiency producesscurvy. This once common instrument directly from a hot sterilizer to a doctor condition is now foundonly in patients with who is wearing rubber gloves, the patient may be restricted diets. Unless thecondition persists fora injured before the doctor detects the temperature long period of time, themost signficant oral aspect of the instrument. It is also likely that the patient of vitamin C deficiency isthe impaired ability to will be anesthetized and therefore not be able to heal and some gingivalbleeding. Detectable give a warning. changes in the periodontalstructures supporting the Careless manipulation of hot dental materials, teeth occur only afterextended vitamin C such as impression waxes and endodontic deficiency. Treatment isthe administration of instruments, constitutes a hazard. All such ascorbic acid (synthetic vitaminC). materials and instruments should be kept away
43 115 from the patient and not brought to the operating Exercises (226): area until they are within safe temperature range. 1. Name the two classes of burns. Oral mucosa reacts the same, regardless of the source of heat-4iquid, metal, or gas.The tissue protein of the mucosa coagulates and usually turns 2. Which class of burn may be caused bythe white and sloughs off, leaving an ugly raw wound careless handling of heated dental materials that heals with difficulty and pein. and instruments? Chemical burns. The use of chemicals in dentistry is widespread. Many chemicals in the dental office are designed to be used on the hardtissue of the teeth and are quite caustic in soft tissues. These 3. How can you help to avoidthermal burns? chemicals must be handled with extreme caution. Patients sometimes self-inflict chemical burns by placing an aspirin tablet in the mucobuccal fold next to the tooth that hurts. This does not curethe 4. How do patients often receive self-inflicted toothache but does cause a severe chemical burn. chemical burns? This burn often becomes a greater problem than the toothache itself. The aspirir burn may be severe enough in cases to expose bone and open a pathway 5. When aspirin is prescribed, whatinstructions for a painful infection. Some of the common agents should you give to the patient to avoid chemical that cause chemical burns are given below. bums? a. Aspirin. Moisture changesacetylsalicylic acid into acetic acid and salicylic acid. The result of placing aspirin against the mucous membrane of the oral cavity is a severe chemical burn. The mucosa 6. Restate the instructions that should beadhered turns white in the area covered by the tabletand to by each dental technicianwho handles usually sloughs off, leaving an ulcer difficult to caustics. treat. The patient must be questioned todetermine the cause of the lesion. To avoid being part of this problem, when aspirin is prescribed for a patient, it should be emphasized that the tablet must be 2-4. Bone Lesions swallowed to give the beneficial effect intended. Bone lesions are divided into two b. Eugenol. This chemical is refined oil of cloves categoriesthose that result from trauma and those and is quite valuable in dentistry. Used properly, it that are pathological. Because the bony framework is most beneficial, but it will burn soft of the head contains the brain and the food andair tissuealthough not as severely as aspirin. passages, it is important that anybone lesion be c. Phenolic compounds.There are many compounds of phenol (carbolic acid) used in promptly identified and treated. dentistry. Many of them have the same name but concerning with 227. Given a series of statements different strengths. They should be handled traumatic bone lesions, determine which are true extreme care, since they are verycaustic. d. Other caustics. Most dentists will have a aad which are false. selection of compounds that are needed to support Traumatic Lesions. Traumatic lesions are the operations they perform. No attempt will be actually fractures induced by trauma.Dental made here to anticipate all of these requirements. with the be management of fractures deals primarily The following general instructions should facial bones. Steps must be taken toheal the adhered to by each dental technician who handles fracture and restore the proper function. Fractures caustics: of the jaw are the most common reasonfor Know the contents of all the medicament bot- hospitalization of dental patients. tles in the operatory. Other than the circumstances of emergency first Be able to describe the properties ofthese aid, the dental technician's primary involvement substances and precautions necessary forhandling, with facial fractures is in the capacity of assistant to neutralizing, and storing them; for example, some the dentist who is treating the patient in order to require refrigeration, others the absence ofsunlight, identify the fact that a fracture exists; specific signs and symptoms can be noticed. Patients whoexhibit etc. be Label all containers. the characteristics discussed below should Make positive identification of all drugs and considered fracture patients until determined chemicals. otherwise. Be very careful in handling all chemicals. Tratuna. Wounds, swellings, and discoloration 44 116 of the face, with a history of trauma to the site, the normal appearance of the patient is should suggest the possibility that bones may be changed, indicate complete fracture& broken. Necessary precautions should be taken to T F8. Malocclusion may be quite noticeable to prevent further injury. Bruising and the escape of the patient with a fractured jaw. blood under the skin is indicative of blows that may T F9. The most noticeable movement indicative be severe enough to break bones. Sometimes the of a fracture is deviation of the jaw to one broken bones can be seen or felt. side when the patient opens or closes his Pain.Pain, severe tenderness, and grating under mouth. the skin are good indications that a mobile bone fragment is present in that area. 2211. State why early stabilization of fractures is Abnormal appearance.Facial asymmetry and desired, indicate stabilizatiom method of choice, luxation (dislocation), in which the normal amd briefly describe the wiring, head-bandage appearance of the patient is changed, indicate technigme. complete fractures. Diplopia (double vision) may occur if the bones forming the floor of the orbit are Immobilization of-fracture patients. involved. Sunken areas or abiiormal projections Immobilization of fractured elements has vital should also increase the suspicion of fractures. therapeutic implications. Although the dental Abnormal movement.Abnormal mandibular technician will probably not be required to stabilize movements occur when muscles displace fragments facial fractures, he should be able to anticipate the of the bone fracture, or the continuity of the jaw is needs of the dentist and give prompt, accurate broken so that it does not swing from the auistance. temporomandibular joint but from the fracture site. Early temporary stabilization aids in the control The most noticeable movement indicative of a of shock, infection, pain, swelling, trismis, and fracture is deviation of the jaw to one side or hemorrhage. It also has a direct bearing on the another when the patient opens and closes his reestablishment of a normally functioning mouth. masticatory system and on the esthetic result. Since many maxillofacial Cases are not seen by an oral Malocclusion.Malocclusion may be quite surgeon until they arrive at a major treatment noticeable to the patient with I fractured jaw. The center, other medical personnel are therefore bite will correspond to the deviation of the responsible for applying early temporary mandible. Since the mandible will swing toward the stabilization. A simplified technique of side of the fracture, the teeth will usually strike on intermaxillary fixation (stabilizing the maxilla and that side first when closing. Sometimes, all of these the mandible by wiring them together), signs and symptoms are present. Regardless of how supplemented by a head bandage for support of the many conditions are noticed, they should be noted mandible, is the method of choice for attaining and brought to the attention of the dentist, who will temporary stabilization. confirm the fracture with further examination and The wiring, head-bandage technique is X-rays. accomplished as follows: pus a 2-inch length of stainless steel wire around the neck of a tooth that Exercises (227): has been selected for wiring (see fig. 2-4). In Traumatic lesions are actually fractures maxillary fractures, the intact mandible is used as a induced by trauma. splint, against which the segments of the maxilla are Fractures of the jaw are the most common repositioned and immobilized. In mandibular reason for hospitalization of dental fractures, the intact maxilla is used as the splint. At patients. least two posterior teeth in each quadrant are T F3.A patient should never be considered as a selected for wiring. Each of these teeth should be fracture patient until the fracture has firm and have an opponent in the opposite arch: positively been verified. that is, the biting surface of the upper tooth selected T F4.Bruising and the escape of blood under for wiring should contact the biting surface of the the skin is not generally indicative of lower tooth when the jaws are brought together. blows severe enough to break bones. Twist the ends together tightly with a hemostat to T F5.Pain, severe tenderness, and grating prevent its slipping over the crown. Cut the twisted under the skin are good indications that a wire one-half inch from the tooth and fold it back mobile bone fragment is present in that against itself to form a tight loop. Bend the loop area. back toward the gingiva to form a hook to attach the T F6.Diplopia (double vision) usually occurs elastics. Form similar loops on all of the teeth withfractures of the body of the selected for wiring, and anchor small intermaxillary mandible. elastic bands on these curved loops so that the T F 7.Facial asymmetry and luxation, in which forces tend to bring the upper and lower jaws 45 11 7 .t 641
Steel Wire Hemostat Elastic Band
Fiiure 24. Wiringhead.handage wchniqut together. Apply the supplemental bandage as shown vs. Given a series of statements concerning the in figure 2-5. If a limited armamentarium precludes transportation of fracture patients determine stabilization by intermaxillary traction, a head which are true and which are false. bandage alone may be employed. The head bandage by itself is less effective than when combined with Tran.sportatum of fracture patients.The air the intermaxillary elastic traction, but itis evacuation of patients with facial trauma is an beneficial in providing gross stabilization, important aspect of aerospace medicine. Dental especially when both maxilla and mandible are technicians may be called upon to assist in fractured. preparing and receiving patients with fractured facial bones that require stabilization. Exercises (228): If the fracture patient is to be transported. I. Why is the early temporary stabilization of precautions must be taken to protect him against fractures desired? motion sickness. This is important, since such a patient could easily suffocate from his oml vomitus.Preparationsincludepreparingthe patient psychologically for the trip to alleviate his 2. What is the method of choice for attaining apprehension or fear. prescribing antimotion temporary stabilization? sickness drugs. and preparing for the removal of the fracture fixation if vomiting should occur. Regulations prohibit transporting patients with axed intermaxillary %%king. The arches must be 3. Midi; describe the wiring. head bandaee ti.ed together with elastm. which are much easier techMque. to ie.nove. Scissors suitable for cutting mternimillary elastics are attached to the patient so that the are readily availabie if needed A quick rdease mechanism tor jaw tka,it.n 46 118 . 1(0 for 2 or 3 days. Pain normally becomes increasingly acute after the third day and MAW severe for several days without treatment and medication. Examination of the socket usually indicates that a portion of the alveolar bone is exposed and infected: hence, the name "dry socket." The socket usually has a foul odor, and the surrounding tissue is inflamed. Although the treatment of a dry socket may vary, it often consists of irrigating the socket with warm saline and packing the socket with iodofoftn gauze saturated in eugenol. The gauze is packed lightly into the socket to provide sedative action without interfering with healing. Sedatives and/or analgesics may be prescribed to relieve pain andpossible insomnia.
Exercises (230): I. Under what conditions is alveolar osteitis likely Figure 2-5. Head bandage for stabilization. to occur?
shouldbe constructed from wire or dental floss as shown in figure 2-4. Simpi) loop the wire or floss 2. When does the pain from alveolar osteitis through the elastic fixation hanks and tape the end become increasingly acute? to the patient's cheek. W'..en immediate release from fixation is needed, either the patient or attendant can pull the wire and free the elastic bands. 3. During alveolar osteitis, what does an examination of the socket usually reveal? Exercises (229): 'IF1. Regulations require that patients being transported have fixed intermaxillary 4. What treatment is often used to treat a "dry wiring. socket"? T F2. Scissors suitable for cutting intermaxillail elastics should be kept in the emergency kit. T F3. Precautions must be taken to protect 24. Other Oral Diseases aad Coadltloas fracture patients who are about to be transported from motion sickness. There are certain other oral conditions of which I F4. A quick release mechanism for jaw you should be aware. Some result from trauma or fixation can be constructed by looping wearing, while others result from disease. In this wire or dental floss through the elastic section we discuss tumors. hypoplasia. erosion. fixation banks and taping the end to the resorption, abrasion, and attrition. patient's cheek.
230. Delineate the etiology, sips, symptoms, and treatment of the alveolar osteltis boae lesion.
Pathological Lesioas. Pathological bone lesions are any lesions that affect thebone. We have already discussed many of these, such as inflammatoryand developmentai cysts, abscesses, and granulomas. A pathological bone lesion, which is frequently seen in the dental clinic, is alveolar osteitis. Alveolar osteitis is an extremely painful condition that results when a normal blood clot fails to form or is dislodged. Pain may occur immediately after the extraction or may be delayed Figure 2.6. Quick release mechanism. 47 119 231. Given a series or dsocriptive dellaitleas, of the parotid gland. A benign lesion of the palate !denary the various types or tumors sad the may be described a bit further as a popilloma, terminology which applies to than. meaning that it is raised and resembles a watt. Warts are epithelial papillomas. Tamers. The word "tumor," which means a b. Supporting tissue neoplasmsare abnormal swelling, ii used to describe an abnormal growth of growths of tissue of mesodermal embryonic origin. tissue. The terms "non-neoplasms" and Neoplasms of the bony skeletal system and cartilage "neoplums," meaning new formations, can, are included in this group. Cancers of the bone are however, more accurately describe the pathological termed "osteosarcomas" ("osteo" or conditions. "bone""sarcana" or "malignant neoplasm of). Non-neoplasms. Non-neoplasms are different Benign growths of supporting tissue are named by from tnie neoplasms in that the etiological factor the same system %act in the epithelial tumors. The can be identified. We have already discussed many benign tumor or bone is an osteoma. Two common overgrowths that are classified as non-neoplasms. bony tumors of the mouth are the "torus These include the overgrowth of ORO VS due to mandibularis" and the "torus palatinus." These mechanical or bacterial irritants, granulomas, terms arc examples of older nomenclature still in dental abscesses, and cysu. use and often given to benign laions. Twos means Neoplasms.Neoplasms are uncontrolled new "a bulging." These neoplasms- are actually growths without an immediate cause. They possess osteomas. They are quite benign and need only be the potential for unlimited growth and are of no use removed if they interfere with prosthetic appliances to the body. The simplest way to discuss them is to or bother the patient. classify them as either epithelial neoplasms or supporting tissue neoplasm Within both groups Exercises (231); aremalignant and benigntypes.Malignant In the following; exercises, match the type of tumor neoplasms are referred to as cancers. Look at table listed in column A with its most appropriate 2-2, and compare the characteristics of benign and descriptive definition in column B by writing the malignant neoplasms. letter you choose in the blanks provided. Use every a. Epithelia neoplasms are abnormal growths of descriptive definition once, and once only. Match epidermal embryonic origin. Neoplasms of the skin every term in column A but once. and associated structures, including most glands, are in this stoup. Cancers of the skin are referred to Column A Cohere I .110I. UMW. 3. Uncontrolled new u carcinomas; cancers of the glands are referred to vowed without an ha- as adenocarcinomas. A malignant lesion of the .....111M 2. Noaplaam. .1110M=ND 3. Ncenesplaams. mediate cause. parotid gland would be called an adenocarcinoma 4. Epithelial b. A malignant lesion (can- of the parotid gland. A similar lesion affecting the neoplmme. cer) of the glands. mucosa of the palate would be called a carcinoma 11.S. Carcinomas. C. Abnormal po wild of t is. sue of mesodermal or epidermoid carcinoma of the palate. Benign VIIINISMI 6. Adenocercinomm 7. The suffix "oma" embryonic origin. overgrowths may hive descriptive names but added to a &scrip d.A new formation where usually conta:n the suffix "oma." A benign tive name. the etiological factor can neoplasm of the parotA gland is called an adenoma be identified.
TABLE 2.2 COMPARISON OF BENIGN AND MALIGNANT NEOPLASMS
&nip Malignant Grows slowly by enlargement. Grows rapidly by invasion. Confined orencapsulated. Not confined; borders ill defined. Does not metastasize (the Metastasizes through the circu- transfer of disease from one latory s)stens to form a 'yew foci o(gan or pan to another not of the disease. directly connected with it). Not likely to recur after May recur after temo.al. removal. Resemblesparent tissue. Does notresembleparent tissue. Usually doesnot cause death. Cancause death if not treated early., .)
48 121) I 2-
Gems A Gam I *we armed*, e fewm. The acme eruptive dimes 5. Sectoring tines e.Antonini sr.. -ths usually ocaw during childhood when doe math we esenanno. epidermal embryonic bang formed, mod affect their development. The 011111011M wine. toxins produced in these diseases attack *Mid 10. Toros mandiba. I. Word terniestioe mese. tissue, and since enamel is of spithdiel derindon, lark& Jos "tumor" or "nem. 11. Ilseip. plans" of the pan to meny of the enameiformimg cells (modoblasts) 12. bkilipmet. which it is attach. case to function. Therefore, areas of the meth thst .4amUyusm.uaia. develop during dse course of the disease are dime a bet* grow& defective. The affected cells do not mow, but Mems a noollies. de. scribes an abaormal after the diesels is awed, new ameloblests develop now* aUMW adjacent to them. When the new celk begin to form h.A baling booty tumor of enamel, the defective nue thet developed during the mouth (specilleally, tbe disease are pallidly cowed end repaired, but on the limed Woe of bypoplestic defeat will usually be visible when the the amedible). I. A hard tenor of Wen tooth snaps. Enamel pie, varying in size, may be like snows doyennes visible on tbs mho ci *be enamel, or them may be oe a Wee. ridges on tbe enemel. The SOW defects mey be seas j. Malisnast neoplasm inbypOpilleill caused by vitamin Of mineral k.Toadies to berme no. sroodyny tom deficiencies. Not fiV0116k numb deficiencies. Rickets is a nutritional for reewery. disease armed by lock of Amin D. Slaw *mils D regulates calcium-phosphorus Metabolism isdkvaly, throe. the persdryroid glade, Mom 232. Given a series el statements eencerning Woo the development of the tele, as well as dm definition, severity, and etiology of bypepleskt, of the bolos. When rickets occur determine which are true ad *bleb we Ms. widesvinierbsiltere developisg, enema *parboil frequently rads, and inviplerdwitis is formed. It Hypopialia. A temporary disturtance in the the condition is very 8041110, none of/the emeloblese formation of enamel matrix Multi in hypoplasie develop, sad the crown or the tooth is compost of ("hypo." means "under" and "-plasia" means dentin only. The tooth 'nolo, may be Ms*. "formation"). This condition results from Vitamin A deficiency eifoom orldisi tissue. A disturbances during the formation of the calcified wire deficiency therefore interfere with the thsuesii period extending from die sixth week a formation of ousel mid dentin in the woe mdmer embryonic life until about the fifteenth yew of age. as do the mute muptive fevers. Occalionally, a distwbancs affects a single tooth, Vitamin C deficiency daring the sadism sups of but usually it affects several. The position addicts tooth formation prevents the differentiation °Me on esch tooth indicates the stage of development of odontoblests. If the deficiency occurs shot the that tooth at the time the disturbance occurred. odoneoblems have foamed, it causes them to atrophy The deems of hypoplasia varies from mild to and desesersti. Inigulw dentin formatioe results. severe, depending upon the character and severity When the deficiency is 'were, it also mums the of the disturbance. In mild cues, there are small ameloblasts to depurate, end Noonday enamel patches of poorly calcified enamel ead as biasesa hypoplesie results. in wicakilied areas of the dentin, la severe cams, Mineral deficiencia. Whitt actual deficiencies of all or a part ci the enamel fails to develop. Between calcium and phosphome exist, conneaive tissue these extremes, there is a wide mese of fomu. cella in the &mina papillae proliferate (geow by Systemic causes of hypoplastic disturbances rapid reproduction) between the sauloblass. This include the following: may produce small areas of Nypocalcification (1) Acute eruptive fevers, such as smallpox, (deficient calcification of the matrix) between diphtheria, measles, and scarlet fever. enamel rods dist appear only m one or more small (2) Vitamin deficiencies, principally of vitamin whitish spots on the tooth surface. The meeloblass D. and'aleo of vitamins A and C. may also degenerme. In addition, tbb dentin may be (3) Mineral deficiencies, especially of calcium poorly calcified.- and phosphonw. A deficient amount of magnesium causes (4) Excess of fty_oride. degeneration of the epithelial tissue. Normal (5) Disturbaw in endocrine gland function. calcification of the teeth also requires small (6) Congenital defects. quantities of sodium, potassium, chlorine, and' (7) Local disturbances. fluoride. Excess of fluoride. Excessive amounts of fluoride Some local disturbances also cause hypopimia: in drinking water cause disturbances in the these include traumas, kali:alone, mid MIMI. processes of meths formation andcalcification that 49 may result in large arm of poorly formed =mei. or they may be t.edge.shaped, with the base of the The condition is called dente 1 Names. It hes also wedge at the cervkal line. Look at fore 2.7 to see been called enamel fluorosis or mottkd enamel. a comparison of two maxillary incisors. One has o Chalky or pitted arm, or opaque white, brown, or been affected by congenital syphiliis (Hutchinson's even black mottling may appear on the tooth disease), while the other is a norrnisl tooth. In some surfaces. The symptoms may range from a few small instances, the cusps of the first permanent molar white spots on one or more teeth to extensive may be mulbeny.like in form. However, it MIK disfigurement of nearly all tooth surfaces, and some also be determined that other syphilitic (lumic) teeth may not form a all. The severity of the symptoms are peesent before making a definite condition depends upon the amount of fluoride in diagnosis of congenital syphilis. the drinking water. As link as two parts per million Load distwbances. Local listurbances that may of fluoride in the drinking water of an area cauees produce forms of hypoplasia are traumas, mild symptoms in about half the population. infections, and tumor Trauma. such as would Laboratory experiments have shown that result from a blow or .1 fall, might kill or displace noncarious teeth contain more fluoride than some of the ameloblasts or odontoblasts during carious teeth. Teeth affected by even minimum tooth formation. Then, absence of part of the degrees of fluorosis that do not change their clinical enamel and dentin mm result. A microscopical appearance are less sutceptible to caries. Persons change in the appearance of the dentin :an follow. whose drinking water during the period from birth caraed by an altered p.oition and course of the until after the permanent teeth have erupted detainal tubule*, or a change in the character of the contains a very small quantity of fluoride calcified matrix. In infections, the bacteria may (approximately one pan per million) have from 50 cause the death of some or mai:. of these cells and to 65 percent less dental caries than persons whose produce the same defects we have been discussing. drinking water is fret from fluoride during the same Tumor MINUS, such as cysts. interfere with normal period. Since fluoride continues to be deposited on calcification processes, and pa;ts of the teeth may the outer surfaces of the teeth for a time after they not form. have erupted, topical application of fluoride to children's teeth also reduces the incidence of caries. Disturbances in endocrine gland function. Exercises (232)c Sometimes dysfunction of the thyroid, parathyroid, T FI. Hypoplasia means overformation. and pituitary 1014.103 setiously interferes with tooth T F2. Disturbances in the formation of development. Dysfunction of the adrenal and sex calcified tissues may occitr from the sixth glands may influence such development to a lesser week of embryonic life to 15 years of age. desree. Retarded eruption, malposition of the T F3. In severe awes of hypoplasia. all of the teeth, dwarfed teeth, malocclusion, and defects in tooth's enamel may fail to form. the attachment apparatus may be caused by T F4. Acute eruptive fevers can cause dysfunction of the endocrine glands. Dysfunction hypoplasia when the toxins of the disease of the parathyroid glands may produce an alteration of calcium and phosphorus metabolism, even when the body has an adequate supply of those minerals and of vitamin D. Congenital defects. Disturbances occurring during the embryonic or fetal stages of development are called congenital disturbances. Tooth development is seldom affected before birth except by a very serious disease, and when it is, the defects usually appear on the deciduous teeth. It has been found that when the mother has rubella (commonly called German measles) during pregnancy, the child's deciduous teeth may be hypoplastic when they erupt. If the disease occurs during the first 3 months of embryonic life, some teeth may fail to develop. Congenital hypoplasia may result from activity of the causative organism of syphilis, TrePonema pallidunt. When a mother has syphilis during pregnancy, she may transmit the disease to her child. In particular, the teeth show the effects of this transmission. The maxillary incisors appear notched at the incisal edge and are barrel-shapte: Figure 2-7. Hutuunum's incisors. 50 122 attack the epithelial tissues and ce the on the hardness of the enamel, as well as on the diet. function of many of the ameloblisr*s A regular diet of coarse, rough foods requires long T F5. Rickets result from a lack of vitamin A and forceful chewing and, therefore, causes more and may cause the formation of irregular extensive attrition than a diet of soft, well-cooked foods. In normal attrition, the cusps and contact T F6. Vitamin C deficiency during the early points of all teeth show uniform wear. stages of tooth formation. prevent% the In both abrasion and attrition, the dentin under differentiation of the odontoblasts, and tht worn areas may become xkrosed; that is, the when severe may also cause the dentinal tubules become calcified, and secondary ameloblast to degenerate. or irregular dentin may be deposited in the pulp T F7. Small whitish spots on the tooth's surface immediately below the area. The pulp is more often may result from hypocalcification caused damaged by abrasion than by attrition. A possible by deficiencies of calcium and explanation is that the foreign body or other cause phosphonts. of abrasion wears down the tooth structure so T F8. Cnalky or pitted areas, or opaque white, -rapidly-in.certain.areas that-the.tooth is. unable to brown, or even black mottling (mottled provide a suitable defense. In attrition, slower and enamel) are often the result of mineral more equally distributed wear takes place. This deficiencies. enables the pulp to act by calcifying the dentinal T F9. As little as one part per million of tubules and depositing secondary dentin at a rate fluoride in the drinking water causes mild equivalent to the destructive process. In both symptoms of dental fluorosis in about abrasion and attrition, secondary cement= may be half the population. laid down about the roots of the teeth. In abrasion, T F 10. Retarded eruption, malposition of the the deposition may be uneven because abnormal teeth, dwarfed teeth, malocclusion, and forces are brought to bear upon the tooth; whereas defects in the attachment apparatus may in attrition, it will be uniform unless the teeth are becausedbydysfunctionofthe maloccluded. endocrine glands. When teeth show normal attrition, the T F 11. Disturbances occurring during the periodontium is stronger and wider. Also, the teeth embryonic or fetal stages of development are less susceptible to pit and fissure caries because are called congenital disturbances. the pits and fissures become shallow, and debris T F 12. If a mother has German measles during cannot accumulate in them. her first 3 months of pregnancy, the child's deciduous teeth may be Exercises (233): hyperplastic, and soine teeth may fail to Differentiate between abrasion or attrition by form. matching the statement in column B to the T F 13. Congenital hypoplasia may result in a appropriate terms in column A. Some statements child whose mother had syphilis during may be matched to both terms. pregnancy; however, this condition Column A Column B - causes malformation of the palatal bone I. Abrasion. The loss of tooth and not the teeth. 2. Abrasion. ambiance from the inur- T F 14. TraumS, such as would result from a 3. Abrasion. ing process. blow or fall, could cause hypoplasia by 4. Abrasion. The dentin under the 5. Abrasion. worn arms may become killing or displacing some of the 6. Attrition. sclerossd. ameloblasts or odontoblasts during tooth 7. Attrition. The condition that most formation. S. Attrition. oftencausespulp 9. Attrition. damage. 10. Attrition. Normally the cusps and I I. Attrition. contact points show 233. Differentiate between abrasion and uniform wear. attrition. May result in accondary dentin being laid down Abrasion and Attrition. Both abrasion and about the roots of the teeth. attrition mean the loss of substance of a tooth from When normal. the pea- wearing processes. In abrasion, one or more teeth dontium is stronger and may show wear, generally brought about by biting wider, and the teeth are foreign objects, such as a pipestem thread, or len susceptible to decay. bobbypins Wrong use of the toothbrush or nervous A normal loss of tooth structure due to the biting habits will also cause abrasion. In attrition, mastication of food. the wear involves all the teeth and is considered a May be caused by biting normal loss of tooth substance due to the on foreign objects or im- mastication of food. The extent of attrition depends proper toothbrushing.
123 234. Given statements concerning the T F 6. Relief of pain caused by erosion can be characteristics, etiology, and treatment of achieved through topical applications of erosion, determine which are tree and which me sodium fluoride paste. false.
Erosion. Erosion is a loss of tooth substances 235. Define resorption, and differentiate between from areas not subject to attrition, usually the facial normal and pathologic resorption. surfaces of teeth. This wedge-shaped defect occurs most often on the gingival third of the crown, Resorption. Although there are many varieties usually at the cemento-enamel junction. The of resorption inyolving different body structures, enamel and dentin at the base of the lesion are this discussion is concerne:1 only with resorption of smooth, hard, and glistening, and the enamel is not the teeth roots. Resorption is a process of undennined as it is in dental caries. The area looks dissolution of tissue by body fluids or cellular as if it has been cut with a file or burand then activity. -Those-cells- which-are active. in -the polished. Although improper toothbrushing is resorption of bone and dentin are calledosteociasu. suspected, this type of erosion is called idiopathic Resorption and decalcification through osteoclastic, action and rebuilding through osteoblastic action erosion because the exact cause is not known. with subsequent calcification are continuous Acid erosion results from the therapeutic use of proceises in all bones of the body. In tooth acid for gastric diseases. The defects occur on any structure, however, after resorption has taken place, surfaces of the teeth that are in frequent contact there is no natural repair. with the acid. The acid decalcifies the enamel, and Some resorption processes may be normal. Such when the dentin is exposed, it wears rapidly. Those an event occurs when the roots of the deciduous who suck lemons .frequently may develop acid teeth are resorbed in order that their crowns may be erosion on the facial surfaces of the incisors. shed to make room for the permanent teeth. During the early stages of erosion, the eroded Pathologic resorption sometimes occurs on the areas are very sensitive to heat and cold, to acid roots of permanent teeth. It results from trauma; foods, and to brushing, but sensitivity decreases from orthodontic appliances used to move teeth if when secondary dentin is formed. Relief of pain the movement of the, teeth is too rapid; from ihe can be achieved through topical applications of attempted eruption of retained or impeded teetii; or sodium fluoride paste. from improperly designed prosthetic appliances. Infection, with or without cystic formation, may Exercises (234): cause resorption of the teeth roots and of their surrounding structures. T FI. Erosion is the loss of tooth substances Exercises (235): from areas not subject to attrition. T F2. Erosion usually occurs on the occlusal 1. What is resorption? two-thirds of the tooth. T F3. The enamel and dentin at the base of an erosion lesion are soft and highly susceptible to decay. 2. Give an example of normal resorption. T F4. Patients who suck highly acid fruit, such as lemons, may develop acid erosion on the facial surfaces of their incisors. T F5. The exact cause of idiopathic erosion is 3. What processes could cause pathologic tooth decay. resorption?
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52 CHAPTER 3
Dental Therapeutics
IN THE FIELD of dentistry, several drugs are used Common Methods of Drag Administration. in caring for the dental patient. While you do not There are several common methods of preacribe drugs, you may be called upon to prepare administering drugs. Those Commonly encountered medications and to aid the dental officer in in the dental clinic are listed below: administering drugs. In either instance, knowledge Topical. of drugs enables you to perform your duties with Oral. desired expertise and self-confidence. Further, Inhalation. having knowledge of drugs and drug actions helps Injection. you render aid to the dental patient during Topical.The topicil method of administering a emergency situationsnot to mention being able to drug refers to applying the drug to Me surface of the protect yourself, your family, and friends against -skin or mucous membrane to produce a local effect. drug abuse. Such drugs are in the form of ointment, lotion, or Properly used drugs can aid in rendering a cream. A good example is the topical anesthetic diagnosis, in treating or preventing a disease or ointment. other abnormal condition, in relieving pain or Oral.Oral administration of a drug is probably suffering, and in controlling or improving any the simplest and easiest method. It is painless, physiological or pathological condition. Improper requires no special apparatus, and produces a application of drugs has been known to cause systemic effect in a short period of time. Drugs for physical and mental impairment and even death. oral administration may be prepared either in solid Therefore, it behooves us to recognize our personal or liquid form. The solid forms are pills, tablets, limitations in regard to drugs and to make rational troches, lozenges, and capsules. Although these application accordingly. In the interest of human terms are sometimes used interchangeably, there are life, experimenting with drugs should be left to the differences in their meanings. scientists in drug research laboratories, where a. Apillis a small, globular, or oval dosage term experiments are carried out under highly controlled used for medicinal purposes. conditions. In this chapter, we begin with the b. A tabletis a compressed or molded solid methods of drug administration. Next, we discuss dosage, which may be coated or uncoated. the actions of drugs, and fmally we discuss specific c. Troches and lozengesare molded, uncoated categories of theripeutic agents and aids. tablets, which are usually mixed with flavoring agents. They are dissolved in the mouth for their emollient (soothing) effect They come in various 3-1. Drug Athol:titration sizes and shapes. d. Capsulesare solid dosage forms enclosed in Your job as a dental specialist requires you to either a hard or soft soluble container of a suitable assist the professional dental officer in all phases of form of gelatin. patient treannent procedures. One phase of patient treatment involves the administration of drugs. In The liquid forms used for oral drug this phase, the dentist prescribes the specific drug administration are solutions, ermirs, and syrups. A and the dosage of the drug, but you are normally solution uses water as a vehicle (carrying agent) for a required to prepare the drug for administration. drug. An elixir is a clear, sweetened liquid usually containing water and alcohol. A syrup is an aqueous 236. Name and give specific facts about the solution of sugar that is used as a vehicle for a drug. common methods of drug administration, and Inhalation. Drugs administered by inhalation are given definitions of oral dosage forms, associate relatively few in number. Included in the highly each with the form to which it relates. volatile (easily vaporized) group are ether, nitrous
53 oxide, and oxygen. An inhalant often used in the while the dentist is performing closed-chest cardiac dental clinic to revive patients experiencing massage or other lifesaving procedures. syncope is aromatic ammonia inhalant. Some Choice of the Administration Method. The o inhalants are supplied in cylinders equipped with choice of drug administration is determined by the regulators ,that are used to adjust the flow of the dentist. The method he selects for the drug and with a face mask that aids in the administration of a drug depends on several factors. administration. These inhalants are, of course, in Basically these factors are: gas form. Other inhalants, such as aromatic The effect desired. ammonia, are supplied in liquid form in a cloth- The rapidity of action needed. covered vial that can easily be crushed to release the The nature and amount of the drug to be liquid vapors. given. Injection. Drugs to be injected are usually The physical condition of the patient. prepared with normal saline as the vehicle. However, some drugs that are rapidly absorbed and Exercit (?36): excreted by the body, such as penicillin, may be 1. Name the four common methods of drug suspended in medicinal oils. To say that drugs are administration. administered by injection is not very descriptive, since there are many methods of injecting drugs. The injection methods used in the dental clinic are the intramuscular and intravenous methods. 2. What method of drug administration is used Obviously, to inject a drug intramuscularly means with ointments, lotions, or creams to provide a to inject into a muscle; and to inject intravenously local drug effect? means to inject into a vein. When the intramuscular injection methcd is used, the onset of the drug's action is slow, and the duration of the action is prolonged. This longer 3. Why is oral administration of a drug the activity occurs since a pool of the medicament is simplest and easiest method? deposited in the muscle, by injection, and the medicament is slowly absorbed into the tissues. The use of oils as a vehicle, or the addition of a vasoconstrictor may delay absorption and further Complete items 4 through 10 by matching the prolong the drug's action. Care should be taken to descriptive statement in column B to the prevent injection into any of the small blood vessels appropriate oral dosage form in column A. located in the muscle. After the needle has been inserted into the muscle, the syringe should be Column A Column B aspirated by pulling its plunger slightly back. If the 4. Capsule. A small globular or oval needle has been inserted into a blood vessel, there _ S. Elixir. dosage. will be blood visible in the barrel of the syringe. If 6. Solution. Liquid dosage that uses _ 7. Pill. water as a vehicle. this occurs, the syringe and its needle should be _ 8. Troches and loz- Molded, uncoated tablets removed and reinserted into the muscle in another enge& usually mixed with a fla- location. Injecting the medicament into the blood _ 9. Syrup. voring agent. They are dis- vessel will result in a more rapid absorption of the _ 10Tablet. solved in the mouth for their emollient action. drug than is desired for intramuscular injections. A clear, sweetened liquid This, of course, could be dangerous to the patient, usually containing water since the planned dosage was intended for slow and alcohol. absorption. The more rapid absorption may place An aqueous solution of sugar that is used as a vehi- too much of the drug into the patient's system at one cle for a drug. time. A solid dosage form en- Intravenous injections produce a very rapid closed in either a hard or response, since the drug is instantly carried to the soft soluble gelatin con- tissue upon which it is to act. This injection method tainer. A compressed or molded is used when a quick response to the drug is desired, solid dosage which may be as in emergency situations. Intravenous injections coated or uncoated. ,generally should be made slowly. Normally, the dental officer administers any injections (both intramuscular and intravenous) that are given in the 11. What type of drug administration method is dental clinic, and your job is concerned with used for highly volatile drugs? preparing the drug for administration. This, however, does not rule out emergency situations where you may be called upon to give the injection 126 54 4
12. What is usually used as the vehicle for drugs on the hands before putting on rubber gloves, serves that are to be injected? as a protective agent for the skin. Systemic Action. This is the action of a drug on some tissue or organ remote from thesite of introduction. Such action occurs only after the drug 13. Why is the drug action slow and prolonged has been absorbed or after it has entered the when the intramuscular injection method is vascular system. Before a drug is accepted for um as employed? a systemic medication by the medical profession, it must first meet certain criteria. It must, for instance, be capable of the following: 14. What is accomplished by the addition of a a. Be administered so that it is introduced vasoconstrictor or the use of oil as the vehicle advantageously into the body. in medicaments to be injected intramuscularly? b. Be absorbed. (This presuppoem its solubility in one or more of the body fluids and its ability to permeate cell membranes.) modify an IS. Why is it imporsznt not to inject into a blood c. Reach specific cells of the body to vessel when givins an intramuscular injection? already existing function. d. Be excreted by the body or destroyed within the body. (It may be eliminated unchanged or in combination with other waste products o( ths body, 16. What injection method is used when a quick chiefly through the intestime, kidneys, Junp,or response to') a drug is desired? skin.)
17. What factors does the dentist considerwhen he Exercises (237k is determining the method ofdrug 1. What is local drug action? administration?
2. What is systemic drug action?
- 3.2. Actiomof Drugs Complete items 3 through 6 by indicating whether To understand how all drugs actually work the descriptive statements concerning the desired inside humans is one of the challenges of modern capability for a systemic medication are true (T) or medicine. It is true that we can easily explain the false (F). actions of certain drugs. For example, we know that T F3. Systemic medications should produce an magnesium sulfate causes water to be retained equal local and systemic effect. within the lumen of the bowel and that diarrhea T F4. Systemic medications should be results. But the reason for the actions of many other nonabsorbable in muscle tissues. drugs remains obscure to us. Nevertheless, we can T F5. Systemic medications should reach profit here from a discussion of the actions of drugs specific cells of the body to modify an that we do understand. In this discussion, we will already existing function. cover local and systemic drug actions. T F6. Systemic medications should be excreted or destroyed by the body. 237. Define local aad systemic drug actioas,and indicate tbe criteria that mint be met by systemic medications. 2311. Given a series of statements concerning the systemic action of drugs, indicate whether they Local Action. A local action is the effect that a are tree or false. drug or medication produces upon tissue at the point or area of application or introduction. Such Types of Systemic Drag Adios,. The action of effects, however, are confined to the site or area of drugs cannot change the function of a cell, or cause application only if the medication is dispensed in any cell to produce a new response thatdoes not reasonable doses. Included in medications with already exist. Drugs can, however, alter the local action are emollients and demulcents. productivity of a normal or diseased cell, tissue, or Emollients, which are fats or oils, are usually used organ through their stimulation, depression, as protective or softening agents for the skin. irritation, or replacement effect. Drugs may also Demulcents are used to protect irritated or abraded function to attenuate (weaken) or destroy micro- tissue. Dusting powder, for instance, which is used organisms. Let's look a little closer at the
55
1 2 7 fI9 simulation, depression, irritation, and replaczment Dreg Toxicity. Any drug, medicinal actions of drugs. preparation, or compound may have a toxic Stimulation. The activity of a tissue or organ is (poisonous) effect upon the human body. The o increased by stimulation. Theophylline, undesirable effects of some drugs are trivial in the aminophylline, and caffeine stimulate central average person; but in others, these effects can be nervous tissue. There are many other drugs that very serious and produce effects ranging from tisue stimulate selected tissue within the body. However, damage to the death of the patient. Some of these it is significant to remember that overstimulation of undesirable effects appear early; others appear only cells actually results in depression. after a prolonged adminisration of a drug. In some Depression. This action of a drug decreues the cases, the toxic reaction can be alleviated by power of the cell to function. A drug that decreases adjusdng the dosage; in other cases, the patient must the ability of the respiratory center is called a be taken off the drug. In some severe cases, another respiratory center depressant. The barbiturates drug must be administered to counteract the drug (phenobarbital, mepobarbital, and seconal) are that is pi oducing the toxic effect. Let's look at some central nervous system (CNS) depressants. of the undesirable effects that may be produced by Irritation. This action produces slight temporary drugs. . damage to tissue. Mild irritation usually results in Side effects. This is an effect or action of a drug stimulation of cells, but prolonged irratation causes other than the one for which it is given or intended. depression of cellular activity. Marked irritation The action of a drug may be therapeutic for-one may initiate an inflammatory reaction and possible condition and become a side effect when it is used death of tissue. Castor oil is a mild irritant. A for a different purpose. Antihistamines, which are strong acid is a marked irritant. administered for their decongestant action, can also Replacement. Replacement therapy is a term used cause drowsiness. This drowsiness is a side effect of to indicate the use of organs or gland secretions in the drug. the treatment of deficiency diseases in human Untoward effects. When a side effect is, or can be, beings. In general, it is a therapy of substitution. harmful, itis known as an untoward effect. This type of therapy represents one of the greatest Morphine at times causes nausea, vomiting, and triumphs in modern medicine. For. example, habituation. Prolonged administration of the estrogens and androgens are a form of replacement antibiotic streptomycin causes destruction of the therapy for nonavailable normal hormones, as are eighth cranial nerve. Aspirin day cause gastric thyroid, insulin, etc. upset or bleeding in the lining of the stomach. These are not the only drugs with untoward effects. Exercises (2311)t Instead, there are literally hundreds of drugs that Indicate whether the following statements can have untoward effects if used improperly or aincerning the systemic action of drugs are true (r) without caution. or false (F). Antagonistic effects. When two or more drugs are T F1. Drugs function systematically to change administered to a patient and each drug has an the function of a cell or to produce a opposite effect on an organ, the tissues, or the other response that presently does not exist. drug, they are said to be antagonistic toward one T F2. Overstimulation of a cell actually results another. Some drugs are highly valuable for their in depression. antagonistic effects. For example, a doctor may use T F3. The action of a drug that decreases the sodium amytal (a barbiturate) to counteract power of a cell to function is called poisoning by strychnine. depression. Synergistic effects. This is the "working together" T F4. Mild irritation usually results in effect, the enhancing effect one drug has on depression of cells, but prolonged another. In the treatment of certain types of irritation causes stimulation of cellular infections, the combined effects of penicillin and activity. streptomycin are far greater than the effects T F5. Replacement therapy is a term used to afforded by either. Naturally, any combination of indicate the use of organ or glanddrugs is effective only when an organism is secretions in the treatment of deficiency susceptible to their combined action. diseases in human beings. Cumulative effects. Some drugs are excreted so slowly that one dose has not been completely eliminated by the body before the next dose is given. In this way, the drug accumulates in certain 239. State the methods that may be used to body tissues. Then, if administration is continued. alleviate toxic reactioas ard identify the specific it is possible for toxic effects to occur. Drugs such reactions that may result from drug as mercufy,.ipiides. and digitalis can have this administration. cumulathk 56 a (P
Idiosyncrasy.This effect refers to an unexpected response to a drug, an effect that differs from that The mythological crav- normally seen. For example, occasionally a patient ing for the dim dist a becomes excited after an injectionofmorphine. drug /as on the body. Tolerance.This is an acquired resistance to a llis is the effeu or ac- tion of a drug other dun drug in which the effective dosage level has to be the one for which the progressively increased to attain the same result as drug wee given or intend- that produced by the original dose. A drug addict, ed. for instance, must keep increasing the amount of This is the "working together" effect, the the narcotic he takes to obtain the same result that enhancing effect one he obtained with the original dose. drug has on another. Habituation.This is the psychological craving for This is the acquired the effect that a drug has on the body. Some people renitence to a drug, in develop a habituation to almost anything.Aspirin, which the dose" mum be increased to obtain the coffee, alcohol, amphetamines, and tranquilizers desired effect. are common examples. This occun *tat adrug Addiction.This effect refers to a drug's Ability to his become essential to alter the physiological process within the body. The the maintenance of or- dinary cellular activky. drughas become essential to the maintenanceof These are the effects ordinary cellular activity. Morphine is well known &up have on the un- for its addicting ability. born, causing fetal ab- Hypersensitivity.This is an unusuai or normalities. This is an unwed or tx- exaggerated reaction of the body to a drug. merited reaction of the Hypersensitivity in its most obvious and severe body to a drvg. form is known as anaphylaxis. The precise reason Effects such as&peening for this occurrence is not fully understood. tbe bone Mallow. Blood dyscrasias (abnormal blood conditions). Certain drugs have a direct effect upon blood; others have an indirect eftect, by depressing the 3.3. Therapeutic Agents bone marrow, which decreases the production of Therapeutics is the science and art of healing. red blood cells. Chloramphenicol is known to Therapeutic agents are those drugs that are used to produce blood dyscrasiss if itis improperly or treat diseases. These agents may be known by more inadequately administered. than one name. They may be identified by a trade Tetragenic effects.These are the effects drugs name (proprietary name) or by a generic name have on the unborn, causing fetal abnormalities. (nonproprietary name), or by both. In this section, we discuss these names and the msjor classifications Exercises (239): of drugs. There are several war to classify drugs. I. What methods may be employed to alleviate They can be classified according to their use, toxic reactions to drugs? source, or chemical similarities. Sometimes they are not classified at all, just described therapeutically. For our purpose, we will classify them by their use. There are many sources available to help you find a Complete items 2 through 12 by matching the particular drug. The Council on Dental descriptive statements concerning toxic reactions in Therapeutics of the American Dental Association column B to the appropriate reaction listed in annually publishes the book,Accepted Dental column A. Therapeutics (ADP.formerly calledAccepted Dental Remedies (ADR).The ADT is a compilation of Column A Column B drugs useful in dentistry. Drugs listed must have 2. Habituation. a. An unexpected response first met the criteria of the council. The ADT 3. Tetragenic effects. to a drug that differs contains the description, dosage, pharmacological 4. Untoward effects. from that normally seen: 5. Tolerance. for eump4e. a patient's action, and therapeutic use of each drug. It is not 6. Blood dyscrasiu. becoming excited after a the intent of this CDC to cover all the drugs listed in 7. Side effects. morphine injection. the ADT. Instead, we will cover only the major 8. Hypersensitivity. b. This effects means that classifications of drugs and a few representative 9 Idiosyncrasy. the drug's side effects are. drup of each class. _ 10. Addiction. or can be. harmful. _ I ISynetgistic effects. c. When two or more drugs _ 12. Antagonistic administered to a patient 240. Given a series of statements concerning the effects. have opposite eftects on an organ, tiisue, or the names of drugs, indicate which are true and which the other drug. are false.
57
1 2,9 igl
Trade Names. Trade, or proprietary, names are Narcotic analgesics. Analgesics are drugs that given to drugs by the manufacturer of the drugs. reduce pain. Some analgesics are narcotics, some These names distinguish the drugs produced by one are not. The narcotic analgesics are used to relieve 4 manufacturer from like drugs produced by another severe pain. They do, however, produce side effects manufacturer. For example, tetracycline, which that preclude their continued use. Morhpine sulfate is an antibiotic,is produced by various drug falls into this category. There is probably no drug manufacturers under the names of Achromycin, superior to morphine for the relief of pain. It not Panmycin, Polycycline, Stec lin, and Tetracyn. only relieves pain but acts swiftly. However, These drugs are the sameonly their names are morphine is habit-forming, depresses !teething, different. Manufacturers of drugs advertise their and contracts the pupils of the eyes. These adverse products by the trade name they have given the side conditions limit the use of morphine. Codeine product in an attempt to influence dentists and is another narcotic analgesic that has much the same physicians into prescribing that drug under its trade action as morphine. It does, however, have some name. Once the drug has been prescribed under the distinct advantages over morphine. Codeine is leis trade name, a civilian pharmacist cannot legally habit-forming; it depresses respiration less than substitute another like drug bearing a different morphine; and, when administered with other trade name. In military pharmacies, however, the drugs. it increases their effectiveness. Still another pharmacist may dispense the prescribed drug under narcotic analgesic is meperidine (Demerol). a different trade name. Meperidine is almost ideally suited for the relief of Generic Names. The official name of a drug is pain or for cough supression. Although, its generic name. For example, tetracycline is the meperidine's side effects may include dizziness, official name for Achromycin, Panmycin, sweating, nausea, and vomiting, such side effects Polycycline, Stec lin, and Tetracyn. The United are experienced less with meperidine than with States Pharmacopeia (U.S.P.) and the National codeine or morphine. Formulary (N.F.), which are the pharmaceutical Non-narcvtic analgesics. Non-narcotic analgesics standards made official by the Food, Drug, and produce a loss of pain without the loss of Cosmetic Act, refer to all drugs by their generic consciousness that may be produced by narcotic name. Further, the Air Force encourages its dentists analgesics. In addition to their pain-reducing and physicians to prescribe drugs by their generic (analgesic) action, most of the drugs in this group name. also function as an antipyretic (fever-reducing Exercises (240): agent). These agents are most effective when used for pain that is not of the deep-seated type. Deep- Complete the following exercises by indicating seated pain usually requires administration of a whether the statements concerning drug names are narcotic analgesic, but for most dental pain, true (T) or false (F). narcotic analgesics are not really necessary and T FI. Trade names distinguish the drugs should be avoided. Salicylates are the most produced by one manufacturer from like representative members of the non-narcotic drugs produced by another manufacturer. analgesic group. They relieve pain and reduce T F2. The official name for a drug is its trade abnormally high body temperature in febrile name. (feverish) patients. As an analgesic, aspirin is most T F3. Manufacturers usually advertise drugs by popular and effective against pain that is not of a their generic name. deep-seated origin. Aspirin is also combined with T F 4. If a drug has been prescribed by its trade other agents, such as'caffeine and phenacetin, and name, any pharmacist may substitute a in some cases amphetamines, to relieve pain and like drug bearing a different trade name. produce a feeling of well-being. Frequent, large T F5. The official pharmaceutical standards doses of aspirin are likely to produce a condition refer to all drugs by their generic name. known as salicylism. This condition is characterized by ringing in the ears, mental confusion, and profuse sweating. Idiosyncrasies to 241. Name the functions and groups of aspirin are quite common and usually occur in the analgesics, and indicate the representative form of urticaria (raised patches and itching of the actions of specific analgesic drugs. skin); edema (swelling); bleeding of the stomach lining; andoften anaphylactoid-like (hy- Analgesics.Analgesics are drugs that relieve persensitive) reactions. As with other drugs, care pain without acting to depress consciousness. Some must be taken when dispensing aspirin. Ulcer of the drugs used as analgesics have an added patients, in particular. should not be administered function: they also relieve or reduce fever. aspirin. Normally, analgesics are divided into two groups Acetaminophen (Tempra, Tylenol) is a synthetic for discussion purposesnarcotic and non- agent. In the treatment of musculoskeletal narcotic analgesics. conditions, acetaminophen relaxes the skeletal 58 131) MIMICS better than the salicylata and is las toxic 12. When would aceaminophen be the drag of an analgesic. It is useful where patients are allergic choice over aspirin? to aspirin. Propoxyphene hydrochloride (Darvon) is a synthetic, non-narcotic drug. It is usually combined with other analgesics, such as aspirin, to provide 13. Which non-narcotic analgesic does not have an relief from mild to moderate pain. Like the narcotic antipyretic effect? anallesics, it does not reduce fever when used by itself.
Exercises (241k I. What is the function of analgesia? 242. Idestify the drag =ties, se, and ciaalifien 2. Which group of analgesia is used to relieve don of specifk sedatives sad hypnotic& severe pain? Sedatives assi Hypastia. Often in the treatment of various disorders and diseases, it becomes necessary to relax the patient or produce sleep. 3. What drug is probably most superior for the Agents that are employed for this purpose are relief of pain? termed "sedatives" and "hypnotics." Sodetives allay excitement and activity but do not produce sleep. Hypnotic& also called soporifics or somnifecients, an drugs that produce sleep. With few exeptions, a 4. What adverse side conditions limit the use of drug that produces sedation in mall therapeutic morphine? doses acts as a hypnotic in larger therapeutic doses. Similarly, a hypnotic drug functions as a sedative In smaller therapeutic dose& 5. How does codeine compare to morphine in The barbiturates are the most commonly used regard to its addictive powers? sedative and hypnotic drugs. These agents produce all levels of central nervous system depression, from mild sedation to coma. As we briefly discus the barbiturates, you should be familiar with some 6. Which narcotic analgesic is almost ideally terms that compare the actions of the various suited for the relief of pain or cough agents. These terms refer to the onset and length of suppression? action of the drus. Barbiturates are classified rather arbitrarily by the duration of their clinical effects into "ultruhoH," "short," "intermediate," and "long" acting compounds. The speed of onset of 7. Which group of analgesics are most effective their therapeutic effects generally parallels their for pain that is not of a deep-seated origin? duration of action. For example, a long-acting drug, such as phenobarbital, may requite 30 to 60 minutes for induction followins the oral 8. What group of drugs is most representative of administration of a sleep-producing dose. The sleep the non-narcotic analgesic group? may last 4 to 6 hours longer and leave a moderate "drug hangover." Those drugs of short duration, such as pentobarbital, usually produce their effects in from 15 to 30 minutes and cause a sleep of from 9. In addition to relieving pain, what other 2 to 4 hours, often without any "drug hangover." beneficial effect is provided by salicylates? Side effects of the barbiturates include skin eruptions, photosensizivity, muscle and joint pain, vertigo, headache, nausea, and voiniting. 10. What condition is likely to be produced by Intravenous administration of the barbiturates may frequent large doses of aspirin? lead to shock and severe respiratory depression, especially if the injection is too rapid. Many drugs, such as alcohol, tranquilizers, antihistamines, and narcotic analgesics, will increase the action of 11. For what type of patients is the use of aspirin barbiturates and could seriously endanger or claim contraindicated? the life of the patient_ Therefore, no barbiturate 59 1 at 1;-3- should ever be gives in normal dosage in (attenuation) sesd in some Islam= dearoy dum. conjunction with these drew There are literally hundreds of antibiotics, but some are too toxic for use on MIMI. Some effects are Enerdess (242h not beneficial to man. Each hes its ovm possible o Complete the following exercises regarding drug side or untoward effect and can, in certain action, sedatives, or hypnotics by writing thc circumetances, cause a disturbanee in the normal appropriate miming words in the blanks provided. physiological functions within the body. To be an I. Sedatives and hypnotics are agents employed in ideal antibiotic, a substance should: cases where it becomes seaway to a. Exhibit selective and effective antimicrobial the patient or to activity, preferably against several micro °maims. & Have little or no aids or untoward effect. 2. Drugs used as agents to produce sleep am c. Not disturb say vital organ or its function. called (also soporifics or d Not have its effect reduced by the body's somnifacients). fluid, plasm, protein, or engraft e.Be water soluble and stable. 3. Drugs used as agents to allay excitement and f Be manufactured at a reasonable cost to the activity (but not to produce sleep) are known a patient. Penicillin and its somisyntbetic derivatives ate still the moot important of the available antibiotics. 4. An increased dosage of a sedative drug might It is by far tbe most common drug of choice for cause it to act as a dental infections. Dramatic results have been obtained from its use, even within its narrow S. The most commonly used sedative and spectrum. On a weight basis, penicillin 0 is one of hypnotic drup am the the molt potent antibiotic agents in use today. Some bacteria have become resistant to almost all forms 6. Barbiturates produce all levels of central of penicillin; yet, others have remained just as nervous system depression from sensitive to penicillin a with their first exposure. to For example,Treponenta pallidunt(syphilis spirochete) is one of the most sensitive organisms to 7. Barbiturates are classified by the penicillin 0. The pneumococci is another organism of their clinical effects. that is very anceptible to penicillin. Organisms that are sensitive to penicillin are not only inhibited S. The of from further growth, but in some cases are actually of the therapeutic effect killed in adequate concentration of the penicillins. of barbiturates generally parallels their It has beet proved that bactericidal (killing) action duration of action. is a relatively slow but continuous process. Increasing the doer or concentration of penicillin 9. Intravenous administration of barbiturates may does not accelerate its bactericidal effect. One essential requirement for the bactericidal action of lead tc; and severe penicillin is that the bacteria be actively ,especially if the injection is too rapid. multiplying. Penicillin causes a lysis (decomposition) of the bacterium's cell wall and 10. Many drugs, such u interferes with its auimilation of necessary elements to build a new cell wall. and The penicillins are no exception to the rule that will increase the action of barbiturates and any drug can provoke a variety of side and could seriously endanger the life of the patient. untoward effects. Hypersensitivity is the most common reaction to penicillin. Other reactions include pain, sterile inflammatory reactions, and phlebitis (mflammation of the vein) at the site of the 243. Gives a series of statemests caucusing the injection. Injections of penicillin G into a blood &Actium, characteristics, me, aid ',steward venel can prove fatal to a patient because penicillin effects of antibiotics, determine which are tree G is insoluble and, consequently, is transported to and which are false. the lungs where it acts as a pulmonary obstruction. If the obstruction becomes extensive enough, death Antibiotics. Antibiotics are substances results. When a person is known to be allergic to produced from or by various bacteria and fungi. penicillin, erythromycin is normally the drug used Antibiotics suppress the growth of other organisms as a substitute.
60 132 When it was observed that certain pethogenic T F b. Predictably disturb the function of a organisms were developing resistance 'to the vi orgen. penicillin., a systematic search vas started for an F C. Be musufactured at a reasonable cost antibiotic that would be effective against the to the pkient. resistant organisms. This search led to the T F d. Have its effect reduced by the body's development of streptomycin. In high fluid, plasma, protein, or =yew concentrations, streptomycin is bactericidal; T F e. Be water insoluble aml unstable. whereas, in low concentrations, it is bacseriostatic. T F f. Have little or no vile or untoward Bactericidal agents destroy bacteria, and effect. bacteriostatic agents inhibit the growth and T F4. In mos imams, sonromycia is the multiplication of bec4ria. Some of the organisms drug of choice for desist infectioes. that were originally sensitive to streptomycin are T F5. Tetracyclines are contraindicased during now partially or totally resistant to its effect. periods of tooth developmem, because Streptomycin is poorly absorbed in the they may produce &flowing stains on pstrointestinal tract, and when it is given orally, it the teeth. is almost totally eliminated unchanged in the feces. T F6. The theory of the action of Consequently, intravenous or intramuscular cbloramphenkol on bacteria is that it injections are the preferred routes. invades the cell walls and destroys the nucleus. Streptomycin, too, is no exception to the rule T F7. Oral administration of streptomycin is that all drugs are potentially harmful to man. It has preferred, since tkis antibiotic is highly produced a wide variety of side and untoward solubie in gescic ju:ces. effects in man. The most important toxic effect of T FS. Inc:suing the docias or concentration of streptomycin is that involving part of the central penicillin accelerates its bactericidal nervous system, particularly the eighth cranial effect. nerve. Deafness has developed in many individuals T F9. One essential requirement for the when the drig has been administered for more than bactericidal action of penicillin is that the I week. Blurred vision was noted in a few instances bacteria be actively multiplying. when the drug was continued for over 25 days. T F10. To produce the most desired effect, penicillin 0 should be injected into a Tetracyclines are like penicillin and blood vessel. streptomycin in their side and untoward effects. T FI 1. Bacteriostatic agents deetroy bacteriasand They, too, are potentially harmful to man. Burning bactericidal agents inhibit the growth and of the eyes, black coating of the tongue, multiplication of bacteria. hypersensitivity, nausea, vomiting, diarrhea, blood T F12. The most important toxic effect of dyscrasia, and superinfections are a few of the streptomycin is that Involving part of the possible complications that have resulted from the central nervous srtem, patticularly the use of tetracyclines. Their use is contraindicated eighth cranial nerve. during periods of tooth development, because they T F13. Chloramphenicol has a fairly broad may produce disfiguring stains on teeth. spectrum effect anti is mainly tatteriostatic in the normal dose range. You may hear chloramphenicol called T F14. When a penon is known to be allergic to chloromycetin. Chlorarnphenicol has a fairly broad penicillin, erythromycin is usually the spectrum effect and is mainly becteriostatic in the drug of choice. normal dose range. The theory of the action of chloramphenicol on bacteria is that it inhibits protein synthesis. In effect, we can say that the bacteria starve to death. 244. State the purpose sakes* of hemostatic:, aad same the types of hemostatic mean used in deatistry. Exercises (243): T F1. Antibiotics are substances produced from various bacteria or fungi. Iteasootatics. When we think of hemostatics, T F2. Antibiotic suppress the growth of other what comes to mind? If we take the wordapart and organisms and in some instances destroy look at it, we arrive at hemo- (blood) and -static them. (not moving). So, it means the blood is not moving. 3. To be an ideal antibiotic, a substance In the case of a hemostatic agent, it wouldbe should: something to stop the blood from moving. Themost T F a. Exhibit selective and effective common dental problems with hemorrhage occur antimicrobial activity. following a tooth extraction. When hemorrhaging
61 1 33 occurs, the bemotatics commonly vsed wethe 24S. Indicate the purpose, types, and iibsocbent type and the vitamin K therapy type. ainlaksratlen SeehnInnes el diesel anesthetic& Among the more common absorbable hemostatics are gelatin sponge. (LIP.. oxidized Lead Ansostsetke. Anesthetics we dnms that esiktime, U.S.P., and oxidized reeinerstfd Million. diminish or eliminate the seneation of pain. While The gelatin spouse, U.S.P. (Gelfoam), is a pliable, analgesics are admiaimered to relieve pain from an surgical sponse material that &soft and retains existing condition, anesthetics me administered to blood until it coagulates and fonns a firm clot. Sods eliminate sensation to pain that might be produced the oxidized cellulose (Ozycel, Novoceil) and the by the operative or surgical treatment of a oxidized regenerated cellulose (Surgical) feed condition. Local anesthetics eliminate sensation by chemically with the blood, which ;aids so tepid blocking pathways of pain impulses (the nent). coagulation. The basic difference between the two product is in the method of their manufacture. All Topical anesthetics, Topical anesthetics are of these products are used in dentistry in about the usually applied with a cottontipped applicator or same way. That is, they are mad to pack socket aerosol spray. When they are applied so the area, following tooth extractions and as a sutured they produce only superficial anesthesia and are implant in oral soft tissues. Absorbable gelatin often used prior to injecting the local anesthetic. sponge is normally absorbed in 4 to 6weeks. Small They also have other uses in dentisuy, such as for amounts of the oxidized cellulose types aft application prior to scaling the teeth, for making absorbed in 2 to 7 days, but lune amounts may take impeessions, or for radioaraphs. up to 6 weeks before total absorptionis complete. LOcal infection anestitnies. Local injection Normally, vitamin K is derived from bacterial anesthetics are uesd more by the dental profession action upon certain ingredients in one's diet. than by any other profession. The intended result of HOW/Va, when the diet is inadequate or when there using local anesthetics is to produce anesthesia in a is an imbalance of the required bacteria, a person's specific area. There are many brands of local ability to produce vitamin K is impaired. Since anesthetics available and most of them work in the vitamin K is necessary to help the human body in injects these the blood coagulation process, it follows that same way. As a neneral rule, the dentist anesthetics as close as possible to the area netve supplements of vitamin K are sometimes necessary. Patients having a.history of blood.deficient fibers. coagulation properties are sometimes given vitamin Teo types of injecion procedures wed by the K befOre surgical operations. dentist are the regional block and regional infiltration. In regional block anesthesia, he injects Exercises (244)c the anesthetic solution around a nerve trunk I. For what purpose is a hemostatic agent between the area to be anesthetized and the brain. commonly used in dentistry following a tooth An example of this technique is the mandibular block. The dentistusing a 27gauge, 1 VIIinch, or extraction? 25.gauge, l'h-inch (long) needledeposits the anesthetic gent over the mandibular nerve trunk as it enters the mandibular canal. This injection 2. Name three of the more commonabsorbable blocks all the impulses of the mandibular nerve hemostadcs used in dentistry. originating forward of the injection site. Tbe effect does not cross the midline of the mouth. The dentist gives regional.infiltrationanesthesia when it is necessary to anesthetizeonly a small area 3. What is the basic difference between the tigel, when a types of absorbable hemostatics that rr,.. oltissue and minimal number of teeth, or chemically with the blood? nerve block is notdesirable. Regionalinfiltration anesthesia enables the dentist to limit the areaof numbness to a specific area or a specifictooth if he so desires. Maxillary teethand tissues Ire usually of the 4. Summarize the two waysabsorbable anesthetized by regional-infiltration because extreme porosity of themaxilla. The dentist uses a hemostatics ateused indentistry. 25-gauge, I-inchor 13/4-inch(short), needle to inject just above the periosteum asclose to the possible. condition might a dental patient be position of the apex of the tooth as S. Under what anesthetics given a vitamin K therapy type of hemostatic Ordinarily, two &laic kinds of injectable are used in the Air ForceDental Servicelidocaine prior to surgical operations? hydrochloride (HC1 ) and mepivacaine hydrocrlicli (HC1).
62 I* Lida:sine HC1 is also mimed to in xylocaim. amenhetice led reader the area lees henorrhegic. It is mails* is two formsointment for topical The vasoconstricting action &mess the blood use and liquid for injection purposes. The supply ia the injection area which, in turn, injectable foem is available in 1.11 cc ampules (Ow decreases the absorption rate of ths anesthetic type amid.) containing a 2-penem solution of Thee, the slower the anuthetic is absorbed, the lidocaine HC1 and varying amounts of longer its effect. The ammo of vasocomeimor is vesocoastricsor. Vasoconstrictoss are dimmed in demised by the procedure to be accomplished detail lmer. and by the patient's remiremeat. Some operations Mepivacaine hydrochloride (carbocaine) is require more time thee others, and a proloaged available is carpules of 2-percent merivacaine with effect is desirable. Levonordefrin is another the vasoconstricsor, or in 3.percent carpels with vssocoastricsor that is commoaly used ia dotal no vasoconstricsors. The 1.11 cc standard carpels is tessthetic solutions. used for all Air Force injection anesthetics to fit the syrhtess designed for this purpose. Enereisse (240
Exereless 1240 I. Vasoconstrictors are drugs that blood vessels and ace Indicate whether the statements reprding dental particularly effectim for ometricting the blood anesthetics are tme of false by circling the Tor F. T F I. Roth mudessics and anesthetics are drugs 2. The vasoconstrictor most widely used in that diminish or eliminate the sensation dentistry is---...----- , and when of pain. applied to a local area, it acts at T F2. Topical anesthetics are often applied a prior to injection of local anesthetics, prior to scaling the teeth, for making 3. The ilower the local anesthetic used with impressions, and for radiographs. epinetshrineisabsorbed,the T F3. Roth basic kinds of injectable anesthetics, is its effect; so, the lidocaine hydrochloride and mepivacaine amount of vesoconetricior need is determined hydrochloride, are available in 11cc by the dmired prolonged effect. cupos. T F 4. Local injection anesthetics are widely used by the dental profession to produce anesthesia in a specified area, so they are 247. Identify the adios sad me of sadslala. therefore injected as closely at possible to ppm in dentistry. that area's nerve fibers. T FS. A regional Mock anesthesia would be the Andslalagegues. Antisialsgogues are drugs type of injection procedure used by a which reduce the flow of saliva. Then *up are dentist if he desired to limit the area of sometimes used on patients who secrete an numbness to a specific maxillary tooth. excessive amouat of saliva. This enables the dentitt T F 6. Anesthetics are administered to relieve -) complete dental operations without the problem pain from an existing condition. of moisture contamination from saliva. T F7. The usual method of application of a Antisialagogues are used only on patients having topical anesthetic is by iekaion in an area severe salivary problems, since in addition to adjacent to nerve fibers. making the mouth dry, they cause dryness of the throat and make speaking difficult. Atropine sulfate and scopolamine are representative of the antisialagogues used in demistry.
20. Della. vasmonstricton and tell when they Exercises I247h are used is deaden,. 1. What drugs are useful in dentistry to reduce Vasoconstrictors. As their name implies, excessive amounts of saliva secreted by vasoconstrictors are drugs that constrict blood patients? vessels. They are particularly effective for constricting the blood capillaries. Epinephrine is the most widely used 2. Give two reasons why antisialagogues are used vasoconstrictor in dentistry. When it is applied to a only on dental patients having severe salivary local area, it acts as a hemostatic. Its action is problems. similar to that of a ligature wire tied on a blood vessel. Epinephrine as a local vasoconstrictor is also 3. Name two representative antisialagogues used used in dentistry to prolong the effect of local in dentistry.
- 63 135 . ig.i-
US, Deiseneise *Whet siamentsameerning Antihistamines. Antihistamines are used to Ms seam sad ones of astiseptiesand gennieldiss combat the body's allergic reaction to certain Medically, are wee or N. writs, such as polkas and drum. antihistamines may be prescribed to counteract 1 Aneiseptke and Cennkides. Antiseptics and conditions such as him, mewl hay fever, and germicides have my broad ass in dentistry. The dmMI:600S. rust is for the disinfection of inamments that do In dentistry, they are generally used to not come in contact with Mood. The other is for counteract the body's alit:tic reaction to a drys that topical application so the oral mucosa so prevent Of has been used during dental treatment. For control minor infections. Antiseptics slop or inhibit exampk, a patient having a mild reaction so a local the growth of micro.orpnisms without necessarily anesthetic would probably be administered an deetroying them. They are applied to the mouth by antihistamine drug. spray bottles, syringe!, etc., to help clean an Beryl is the most frequentlyused infected aria or to clean the mouth m a whole. They antihistamine for such allergic reactions.In can also be plated in cavities, in sockets, end under addition to Semidry!, the antihistamines withbrand ainaival tissue flaps. names "Chlor-Trimeton"and "P)ribenzsenine" in The ideal antiseptic is one that does little damage representative of the group. Antihistamines may to the skin and has the most harmful effect possible produce side effects of sleep, drowsiness,dizziness, on bacteria. Chemical action is the Kimsey means and disturbance of body coordination. by which an antiseptic prevents the growth of bacteria. Typical antiseptics are alcohol, tincture of Exercises (249)1 iodine, and preparations containinn mercury. Write one word in each space thatfollows to Germicides are substances that destroy micro. identify the action and use of antihistamines. organisms. They are used to swab the mucous 1. Antihistamines are used to combatthe body's membrane prior to injection and to treat inflamed reaction to certain areas. The difference between antiseptics and germicides is difficult to delineate. Many agents, such as pollens and dna.. antiseptics in strong solution become germicides, 2. In dentistry, a patient having a mild reaction to and when germicides are diluted, they act as a local anesthetic would mostfrequently be antiseptics. administered the antihistamine ,although "Odor. Runless (244k Trimeton" and "Pyribenzamine" are also Indicate whether the statements below concerning frequently used. the actions and uses of antiseptics and germicides in dentistry are true or false by circling the T or F. 3. Antihistamines may produce T F1. Antiseptics are used solely for the effects of sleep, disinfection of instruments, while drowsiness, dizziness, and disturbance of body germicides are used exclusively for coordination. topical application. T F2. Germicides stop or inhibit the growth of micro.organisms without necessarily destroying than, but must be in strong solution before they act as-antiseptics. T F3. The ideal antiseptic does little damage to 2M. State the purpose, guideline, anddosage the skin, and yet has the most harmful limits of the Air Force fleoridatios program,and effect possible on bacteria. indicate the methods of administeringfluoride T F4. Alcohol, tincture of iodine, and eourponads. preparations containing mercury are typical antiseptics whose chamical Fluoride Compounds. More than 50million actions prevent growth of bacteria. people drink water that containscontrolled I F5. An agent that destroys pathogenic micro- amounts of fluoride. Researchhas shown that when organisms is defined as a germicide, but fluoride dosages are applied in thecontrolled when diluted acts as an antiseptic. amount of about 1.0 pan permillion (ppm) to the water supply, caries in childrenis greatly reduced. Currently, water is the most effectiveand economical means through which tracequantities of fluoride can be made available. 249. Identify the action and use of The condition called fluorosis (mottledenamel) of fluoride in the artikistamines. is caused by excessive amounts 64136 ,
water supply. Fluorosis can be prevented, of c :ie, 5. What is the alternative method of administering by reducing the amount of fluoride parts per fluoride in those areas where it is not feasible to million parts of water. Any fluoride reaysval add fluoride to drinking water? program should not reduce the fluoride content below established standards. The USAF Surgeon General prescribes the fluoride residual in the distribution for each 6. Summarize the method of application currently installation. Because of the greater average intakc approved by the Air Force to apply fluoride to of water in warm climates, the prescribed fluoride is the teeth after their eruption. maintained at a lower level than in cool climates. To determine the dosage that gives the desired residual, the natural fluoride content of the raw water must be considered. The desired spread is 7. What regulation specifically covers the Air from 0.6 to 1.7 ppm of fluoride in the finished Force policy on fluoridation and water supply with the optimum about 1.0 ppm. The defluoridation? specific regulation that covers the US Air Force policy on fluoridation and defluoridation of base water supplies is AFR 161-9,Fluoridation und Defluoridation of Water Supplies. 251. Identify the uses of oxidizing agents in In areas where it it not feasible to add fluoride to dentistry. drinking water, we can give dietary supplements of fluoride tablets. Administration of fluoride by Oxidizing Agents.Oxidizing agents are used in either the drinking water or tablet route is called dentistry to bleach teeth and to treat certain gingival systemic fluoridation, meaning that its action is in diseases. The oxidizing agent used to bleach teeth is the body systems. Another method of using fluoride a 30-percent solution of hydrogen peroxide is the topical application. (Superoxol). The bleaching is usually done in The topical method of applying fluoride is conjunction with root canal therapy. The oxidizing helpful to the teeth after they have erupted. This agent used to treat inflamed soft tissues is normally method employs stannous fluoride in a 10-percent a 3-percent solution of hydrogen peroxide. The benefit derived is from the resultant cleansing i aqueous solution. Application of this solution to all exposed areas of the teeth tends to make them decay rather than the oxidizing action, however. To be resistant. The solution is to contact the teeth for 30 more specific, the bubbling action tends to loosen seconds, and the application is to be repeated at 6- debris, so that it can be rinsed away to leave clean to I 2-month intervals. Other variations of applying tissues. fluoride topically are used, but the above described method is the only topical application method Exercises (251): current approved by the Air Force. Complete the following statements regarding the use of oxidizing agents in dentistry by writing the Exercises (250): word of your choice in the blanks provided. I. Anoxidizing agent used in varying percent 1. Through what means are fluoride compounds solutions to bleach teeth and treat gums is in trace quantities currently made available for hydrogen 50 million people so that caries in children is greatly reduced? 2. A percent solution of Superoxol is used to bleach teeth.
2. What condition results from excessiveamounts 3. Inflamed soft tissue is normally treated with a of fluoride in the water supply? percent solution of hydrogen peroxide, but the benefit derived is frora the resultant action. 3. Why is the prescribed concentration of fluoride in the water supply of southern bases lower than that of northern bases? 252. Name the types and uses of solvents in dentistry. 4. In terms of parts per million, what is the Solvents. Solvents are substances that are used to desired spread of fluoride concentration in m ..-,olve other substances. In dentistry, solvents are base water supply systems? used for cleaning purposes and for helping with
1 65 137 treatments. Common solvents used for cleaning in items I through 3 by writing their use or uses in purposes in dental clinics arc orange oil, U.S.P.; the spaces provided. alcohol, U.S.P.(ethylalcohol); and isopropyl I. Thymol: alcohol, N.F. The orange oil is very effective in dis- a. solving zinc oxide and eugenol materials from the hands and face. Alcohols are effective in dissolving a variety of substances found on instruments, b. cabinet tops, etc. Alcohols, of course, are also used as disinfectants. Chloroform and eucalyptol are solvents 2. Creosote: sometimes used to aid in treating root canals, Both substances are effective in partially dissolving and softening guna-percha points before they are 3. Camphorated paramonochlorophmol: inserted as root canal-filling materials. Chloroform containing dissolved gutta-percha is called chloropercha, and eucalyptol containing dissolved gutta-percha becomes euCapercha, 4. What should you have available as a neutralizer when you are using phenol? Exercises (252); I. For what two general purposes are solvents used in dentistry? 3:4. Therapeutic Mds 2. Name three common solvents used for cleaning Throughout the fields of medicine and dentistry, purposes in dental clinics. substances are used as aids in the art and science of treating patients. Such substances have little or no medicinal value but simply aid in rendering 3. Name two solvents suitable for partially treatment. This section deals with a few of these dissolving and softening gutta-percha points therapeutic aids: dentifrices, mouthwashes, and before their insertion as root canal-filling selected physical aids. materials. 254. Given a series of statements concerning the types and the therapeutic value ofdentifrices and mouthwashes, determine which are true and which are false. 253. Indieate the usts of phenolic compounds in dentistry and specify what precautions should be Dentifrices. Dentifrices are mostly therapeutic taken when using phenol. aids used in conjunction with a toothbrush to clean the dentition. Dentifrices are available in the form Phenolic Compounds. Phenolic compounds are of powder, paste, and semiliquid. Most dentifrices used in dentistry for' their antiseptic and consist of abrasives, flavoring, detergents, and a disinfecting qualities. Camphorated base vehicle (such as glycerin). Some dentifrices paramonochlorophenol is the most commonly used have had fluoride compounds added with clinically phenolic compound. It is used during endodontic proven benefits realized. Tests haveshown that procedures to sterilize root canals. Also some (not all) fluoride toothpastesused on a regular representative of this group are creosote and basis actually aid in reducing the incidence of tooth thymol. Creosote is also used to sterilize root canals decay. in endodontic procedures. Thymol is sometimes While some dentifrices aid in cleaning the teeth, mixed with camphor and used as a desensitizing some produce undesirableresults. These paste. It is furthcr mixed with zinc oxideand used undesirable results are directly related tothe as a pulp-capping material. Phenol(carbolic acid), abrasive quality of the dentifrice in most cases.For itself, is a very caustic material. When it is used in example, the abrasiveness of some available any strength, you should have a50-percent solution dentifrices is so high that they scratch tooth enamel of alcohol available to neutralize itin case an and erode the dcntin rather severely. Although most accident occurs, since misplaced or spilled phenol people desire white and clean teeth, maintaining could cause severe acid burns to soft tissues. them by using highly abrasive toothpastes isunwise. It is not possible to name a single dentifricethat Exercises (253); is suitable for all patie is, butrecommendations Indicate the uses of the phenolic compounds listed should be based on individual cases. Becauseof its
66 .138 .1 1'p
cleansing ability and reltively low abrasiveness, Toothbrushes. Toothbrushes fall into one of two common baking soda is sometimes recommended categoriesmanual or mechanical. That is, they are for regular use. Also, two brand name dentifrices, either the type used solely by hand or the type Senosodyne and Thermodent, are recommended powered by a small electric motor. There have been for patients with hypersensitive teeth. The dental many arguments presented as to which category is officer usually prescribes usage of the sensitivity better. Suffice it to say that the toothbrush to be type dentifrices for limited periods of time. Thus, recommended for dental patients depends upon the dentifrices should be carefully selected to meet.the merits of individual cases. The type of toothbrush particular needs of each patient. frequently recommended has bristles that are of soft Mouthwash.In spite of claims of medicinal to medium rigidity. This recommended toothbrush value, most mouthwashes are little more than a also has a multiplicity of tufts equal in length to pleasant tasting rinse. Claims of "bacterial killing form a flat brushing surface. Overall, the entire power" and "breath sweetener" qualities have been head of the brush is from small to medium in size. largely refuted in the laboratory. Mouthwashes Should you be in a position to decide which fitting this description are of value, however, toothbrush is best for a particular patient, be sure because they add to the patient's feeling of having you have considered these points. received the full treatment. Thus, due to this Type of treatment patient is receiving psychological benefit (if for no other reason), such (surgical, periodontal, etc.). mouthwashes are likely to remain a part of dental Patient's present dental condition (normal, treatment routines. Some other mouthwashes, such gingivitis, etc.). as the oxidizing agents discussed earlier, provide Relative size of patient's mouth. limited therapeutic benefit. Patient's ability to manipulate a toothbrush.
Exercises (254): Dental flosses. A general description of dental In the following exercises, circle the T or F to floss might read "a strong thin string or tape of indicate whether the statements concerning nylon, which is sometimes waxed and is used to dentifrices and mouthwashes are true or false. clean areas between the teeth." Quite often, the T FI. Most dentifrices consist of a base vehicle, nylon, unwaxed type is the floss recommended. abrasives, detergents, and.flavoring. Although dental floss is used to clean plaque T F2. Not all fluoride toothpastes aid in from only a small portion of the total exposed tooth reducing the incidence of tooth decay. surfaces, these surfaces are important. In fact, the T F3. Since highly abrasive dentifrices produce area cleaned by dental floss is more suspectible to white and clean teeth, they are to be decay and periodontal disease than other areas of recommended because they produce the mouth. Stress the importance of using dental desirable results. floss when you are counseling a patient on effective T F4. Common baking soda is never a home care, but be sure to caution against snapping recommended dentifrice, because its the floss between the teeth. Such action can injure cleansing ability is low and its gingival tissues. Disclosing agents. abrasiveness is high. Disclosing agents are dyes T F5. Laboratory tests conclusively prove that suitable for staining bacterial plaques found on the mouthwashes "kill bacteria" and teeth. For effective cleansing of the entire mouth, it "sweeten the breath." is important to know the areas where bacterial plaques are most likely to persist. The easiest way to do this is to stain the bacterial plaques so that they can be seen. Chewable tablets (called disclosing tablets or wafers) contain a dye and are suitable for this purpose. When chewed and swished between 255. Specify the types, use, and value of the the teeth for about 30 seconds, the dye in disclosing physical therapeutic aids. agents stains any plaque on the teeth. The dye does not stain clean tooth surfaces or fillings, but it will Physical Aids. Under the heading of physical stain the tongue and lips for up to 2 hours. Staining aids, we add a few of the other items that aid in the of the lips can be prevented by coating them lightly treatment of dental patients. Again, we are not with a lubricant such as vaseline. attempting to include all physical aids in this To assure complete cleansing of the teeth, they discussion. Instead, the items that follow were should be inspected in a mirror with a good light to selected because of their tendency to be see where the areas of plaque are located. A mouth misunderstood and because of their relative mirror used in conjunction with a regular mirror importance. We begin with toothbrushes, then makes It possible for the patient to see the inside follow with dental flosses, disclosing agents,water surfaces of his teeth. Until one has thoroughly irrigating devices, and interdental stimulators. mastered the methods for plaque removal, the 67 139 , , .1 3-1
disclosing dye should be used again after brushing 2. Give briefly four points you should Consider in and flossing to check on the success of the cleaning. deciding which toothbrush is best for a patient. Water-irrigating devices. Water-irrigating 1 mechanisms or hydrodevices are useful in rinsing away dislodged or loose oral debris.Their intended use is primarily as an adjunct to normal mouth 3. When briefing a patient concerning the use of cleaning devices. Following normal brushing and dental floss, why should you caution him flossing, these devices may be of value to some against snapping the floss between the teeth? individuals. But irrigators are of particular value in helping to clean areas sheltered by orthodontic appliances, fracture and peridontal wiring, and splints. A variety of these mechanisms is available. 4. What two types of mirrors should a patient use Interdental stimulators. Interdental stimulators to assure complete cleansing of bacterial are gingival massaging devices. There are two types plaques when he uses the disclosing agent (dye) availablerubber and wood. The rubber type is method without technical assistance? sometimes attached to the handle end of a toothbrush. The wood type is a thin triangular wedge. Interdental stimulators should be used with caution. The normal healthy adult obtains the 5. What type of physical aid would be of necessary gingival massaging while brushing his particular value in helping to clean areas teeth. sheltered by orthodontic appliances, etc.?
Exercises (255): 1. Although the type of toothbrush recommended depends upon the individual case, summarize a 6. Are interdental stimulatorsrecommended for typical recommendation for an average patient. all normal healthy adults? Why?
J
68 CHAPTER 4 (
Bab PAlcrobio and SterMandon
WE LIVE IN A world that is generously supplied Bacteria. Bacteria are one-celled micro- with minute organisms referred to as micro- organisms. Unlike the typical cell, a bacterial cell organisms. Since it has been established that these does not have an organized nucleus. The nucleus is micro-organisms play definite roles in the health diffused throughout the cell. Bacterial cells occur in status of mankind, it is important that we consider a number of shapes: spherical, called cocci; rod- some basics regarding them. As with many living shaped, calledbacilli;coil-shaped, called spirochetes things, we have generally divided micro-organisms orspirilla.The shape of a particular bacteria is one into two groupsthose we consider to be good for of the criteria used in its identification. Another mankind and those we consider bad for mankind. factor in the identification of bacteria is the way the In this study, we are primarily concerned with the cells are arranged or grouped together. An "bad" (disease-producing or harmful) group, since arrangement grouped in clusters like grapes is it is definitely related to general health as well as called staphylococci. Some cocci arrange dental health. From the dental health standpoint, themselves into pairs. Paired organisms are called you are directly involved because you have a major diplo;thus, the term "diplococci." Still another role to play in destroying these harmful micro. group of cocci form into long chains; these ( organisms found in the dental environment. This is organisms are known as streptococci. The bacillus especially true in your role of caring for dental organisms, or rod-shaped bacteria, may align instruments. In this chapter we consider, in order, themselves into chains or pairs, and these may be basic microbiology, sharpening dental instruments, called streptobacilli or diplobacillibut these sterilization and disinfection of instruments, and terms are not often used. The spirochetes will vary finally storage of instruments. from a loose spiral to a tightly coiled spring. They may be short or very long, They always appear as 4.1. Microbiology individual cells and do not form clusters or chains. The pairing, chaining, or clustering of bacterial Microbiology may be defined by looking at the cells is a result of the organism's method of root words from which itis formed: reproduction. The cells multiply by a process called "micro""small", or in this instance, "too small to binary fission (fission is "to split"; binary means be seen by the naked eye"; "biology""the study of "two"); thus, the splitting of one organism into two living things." Thus, the definition of microbiology organisms just like the parent cell. If fission is is "the study of living organisms (micro-organisms) complete, the cells may be found individually or in too small to be seen with the naked eye." clusters; but if the fission is incomplete, the cells may remain in pairs or in long chains. The 256. Identify micro-organisms by classification, polymorphic bacteria are just what the name structural makeup, characteristics, behavior, implies, many shapes. They appear as nodular functions, and diseases duly are associated with. filaments, short, clumpy rods, or possibly even Y- shaped organisms. Throughout the world, there are many hundreds In addition to different shapes and groupings, of micro-organisms. There are many ways to some bacteria have special structures that aid them classify micro-organisms. We will divide our study in motility or survival in nature. All bacteria into five areas: bacteria, viruses, rickettsiae, possess ars outer coating known as a capsule. Some protozoa, and fungi. We have neither the time nor may have a capsule so thin that it is undetectable. space to treat these organisms extensively. We will Others have a very thick, sticky capsule composed discuss the main points and differentiate between of a complex sugar-fatty-protein substance. It is each area to give a general overview of each believed that this capsule aids in the organism's organism. survival against the white blood cells in the body.
69 .141 To enable them to move about, some of the bacilli still a mystery to people outside the field of have special structures called flagella. A flagellum virology. They are so different from the other is a hairlike appendage that whips beck and forth diseue-causing agents that they cannot be and either pulls or pushes the organism about. compared with any of them. They belong to neither Some cells have only a single flagellum, while the plant nor animal kingdom, and only a few can others may have several or may even be completely be seen without the aid of an electron microscope. covered with flagella. The sole purpose of the They do not fit our present biological definition of flagella is for movement. "living" organisms. They do not die. They merely Another special structure that develops in some inactivate or disaasociate themselves. They do not of the bacteria is the spore. Any time certain reproduce themselves but cause a living cell to organisms find themselves in an unfavorable replicate or reproduce them. They do, however, environment, they concentrate their protoplasm cause a wide variety of diseases in plants and into a little round ball and become extremely animals. We, therefore, only mention them here resistant to the unfavorable condition. When the and leave the study of viruses to the virologist. spore is formed, you can clearly see the rigid cell Examples of virus-caused diseases are smallpox, wall with the little ball inside. This dormant form measles, poliomyelitis, yellow fever, and the common cold. enables the organism to survive adverse conditions Rickettsiae. Rickettsiae are a group of that normaly destroy bacteria. One species,Bacillus organisms intermediate in many characteristics anthracis(anthrax), has been known to live for u between the bacteria and viruses. Rickettsiae will long as 40 years outside of the animal body. Some not reproduce outside of a host cell. In other words, organisms can withstand boiling for as long as 2 they require the presence of a living cell for growth. hours. Rickeusiae are primarily parasites of insects and are One thing must be kept in mind here. In order transmitted to man by fleas, lice, mites, or ticks. for bacteria to cause disease, they must have the The most common rickettsial diseases are Rocky proper environment to survive. Bacteria have no Mountain spotted fever and typhus. mouth and absorb their food directly through their Protozoa. Protozoa is the lowest division of the cell membranes. Their food or nutrients must be micro-organisms of animal life, and is composed of. part of their environment, and there must be one-celled organisms. There are many species of sufficient moisture to sustain life. Temperature is a protozoa, but the majority are harmless to man. A 0 very critical requirement for bacteria. Most bacteria protozoa differs from the "typical cell" in that it is a (disease-producing) can survive only at body true member of the animal kingdom and does not temperature. Therefore, when this temperature is have a pell wall. Its outer covering is the cell lowered or elevated, they will cease to grow and membrane, which is flexible like a plastic bag. It sometimes die. Basically, wecan say that a does possess all the other parts of a typical cell, particularbacteria, in order to reproduce or grow, including an organized nucleus, vacuoles, and must have the proper temperature, nutritional cytoplasm. Some of these one-celled animals have requirements, and moisture (environment). parts not included in the typical cell. Some have As thebacteria grow, they produce waste flagella or cilia, which are organs of locomotion, products and sometimes excrete other substances and some have a cytostome, which is a kind of used in their digestion. These products may be toxic primitive mouth. These organisms are as different or poisonous to us, and we call them bacterial as day and night. There are four classes of protozoa, toxins. Exotoxins are toxins which diffuse out of and we will only mention them here. You will note the bacterial cell into the surrounding media. that the first two are the causes of diseases familiar Endotoxins do not diffuse out normally but are to you: liberated by autolysis or physical disintegration. In (1) Sarcodina (amoeba), the type that causes either case, these are the substances that make amebic dysentery. bacteria harmful. Can you see that bacteria in their (2) Sporozoa, the type that causes malaria. simple one-celled form are actually very complex (3) Mastigophora (flagellates). little organisms? (4) Infusoria (ciliates). Another method of classifying bacteria is on the Fungi. The fungi are small members of the plant basis of their reaction to the gram stain. In this kingdom commonly referred to as yeasts and classification, bacteria are divided into two broad molds. They have no roots, stems, or leaves, and groups, the gram-positive and gram-negative. We possess no chlorophyll. Chlorophyll is the will discuss this staining process and talk more substance used by members of the plant kingdom to about bacterialater inthis chapter. convert carbon dioxide, water, and sunlightinto Viruses. Viruses are a group of sugars. Therefore, the fungi, lacking chlorophyll, ultramicroscopic, disease-causing agents. In the must depend upon some other source for their ,,, past few years,vast amounts of knowledge have livelihood. This other "source" concerns us; it is been attained aboutthese little "bugs,"but they are the living organism. We normally refer to an 70 1 1 2 infection caused by the fungi as a fungus infection. 6. What is the process by which cells multiply Most of the pathogenic fungi produce superficial called? infections and pow on the skin. The condition referred to as ringworm is an example of this type of infection. Other fungi are responsible for more serious infections, where the fungus invades the 7. What is the outer coating of a bacteria called? lunp and other tissues of the body. Fungi do not look at elflike typical cells. They are round, oval, or filamentous, and much larger than the bacteria cell. 'They have a large vacuole, 11. What is a flagellum? taking up a good portion of the cell and usually a few large granules between the vacuole and cell wall. Identification is based almost entirely on the 9. When certain organisms find themselves in an type of colony the fungi produce. Like bacteria, unfavorable environment, they concentrate fungi are ever-present in our environment. Some their protoplaem into a little round protective are harmful to us, while others are beneficial. There ball. What is an organism in this sate called? are many industrial uses of fungi. Penicillium and several other fungi are used in the production of antibiotics. The undesirable fungi are pathogenic to plants and animals and are very difficult to control. 10. What must pathogenic bacteria have in order to Spores are found on everything. They blow around cause disease? in the air and can grow on anything that hints at being a nutrient. Because of their prevalence in nature and their association with disease, they are of prime concern to the field of medicine. 11. Whatare viruses? Exercises (256)t 1. Name the five categories of micro-organisms. 12. What micro-organisms are associated with diseases such as smallpox, measles, poliomyelitis, yellow fever, and the common 2. Name three factors that play a role in the cold? identification of bacteria.
13. By what means are rickettsiae usually transmitted to man? 3. What names apply to the following shapes of bacteria? a. Spherical. 14. Name the two most common rickettsial diseases. b. Rod-shaped.
15. What is the lowest division of the micro- organisms of animal life, composed of one-cell c. Coil-shaped. organisms?
4. What name would apply to coccal bacteria that 16. Which group of micro-organisms is responsible arrange themselves into pairs? for malaria and amebic dysentery?
5. What name would apply to coccal bacteria that 17. Which group of micro-organisms is commonly arrange themselves into long chains? referred to as yeasts and molds?
71 18. What types of conditions may be produced by with tbe r.r4periiiii of both. Early bacteriologists pathogenic fungi? arced to classify bacteria as plants. Bacteria abound everywhere; you name a placeany place around youand you can correctly say that bacteria are found there. Bacteria 19. Why must fungi depend on other livin3 are usually thought of as something that makes us organisms for their livelihood? sick, and very often they do; however, many kinds of bacteria are so useful that we could not live without them. As a result of years of scientific experimentation, many diseases can be cured by killing harmful bacteria; at the same time, many other types of bacteria ate beneficial to mankind. Categories of Bacteria. There are several 4-2. Oral Flora different ways to catesorize bacteria. Some are Although men had been familiar with some of termed saprophytes and derive their nourishment the effects caused by becteria for some time, it was from dead or decaying matter. These organisms for in Holland in 1663, that Anton Van Leeuwenhoek the most part do not cause disease. Other becteria (pronounced Loo-vahn-hoke) invented the first are categorized as parasites. These organisms live scientific microscope. He was an amateur lens on or in other organisms, deriving their grinder, cutting and polishing quartz. He ground nourishment at the expense of the living host. some of the pieces in concave form and others in Parasitic bacteria thet live in or on a host but do convex. When he looked through some of these not cause serious damage are termed nonpathogens. lenses, objects looked larger than they really were. Those that severely &male their host by destroying One day while lookins through one of the the host's tissues or causing serious infections are magnifying glasses (he actually made a crude called pathogens. A pathogen that causes infection microscope) at some saliva from his mouth, Van so severe that the host is permanently damaged, or Leeuwenhoek became the first person to see a that results in death of the host, is called a virulent micro-organism. He saw bacteriaor oral flora. pathogen. Nonvirulent pathogens damage the host, Since oral flora are minute unicellular (one cell) but damage is usually not permanent and rarely plantlike organisms and since they are colorless. results in death of the host unless other underlying 6 one may wonder how Van Leeuwenhoek could debilitating (weakening) conditions are present. have seen them through his crude microscope. It is Bacteria are further categorized into three probable that he was chewing tobacco and the groups, based upon their need for oxygen. tobacco juice acted as a disclosing agent and stained Anaerobic bacteria grow only in the absence of the flora. At any rate, he was the first to see oxygen and, in the human mouth, are usually deep bacteriaand they were rod-shaped. Since the in the sulcus. Aerobic bacteria grow only in the Latin word bacteria means rod shape, the scientists presence of oxygen; that is, they must have oxygen simply called these rod-shaped organisms bacteria. to live. Facultative bacteria are the micro- Later this word became a general term, taking in all organisms that can live under either aerobic or of the different forms. anaerobic conditions. These can be found deep in the sulcus or on the tongue. Each of these types of 237. Ideality the characteristics of the bacteria bacteria is found in infectious areas. Most bacteria that are comma to tbe oral cavity. cannot live in direct sunshine. Bacteria arealso distinguished as being either Oral flora are the bacteria found in the mouth. gram-negative or gratn-positive. This refers to the There are over a hundred types of bacteria found in staining method devised by Gram in 1884. When the mouth alone. However, in this discussion only you use a phase microscope, you have no need for five of the most common types are included. Gram stain. Although you will probably not use it, Bacteria are micro-organisms andmaybe calledby you should know in general what its terminology many names: microbes, micro-organisms, means, since it is frequently used. Stain is useful in microflora, germs, and possibly "bup." The term the differentiation ofbacteria. A smearis prepared, "oral flora" best describes the bacteriafound in the air-dried, and then stained with a primary violet mouth. Each bacterium (bacteria) is much likea stain, followed in order by a mordant (fixing agent), tiny bit of living jelly surrounded by a clear, thin decolorizer, and counterstain. Some bacteria have covering called a membrane. Are these bacteria the property of retaining the violet dye after having animals or plants? The answer is that some bacteria been treated with decolorizer and exhibit a are branched and sheathed like plants, but some pronouncedpurple or bluecolor throughout the have locomotive (movement) organs like animals. process.These bacteria are called gram-positive. Thus,in thescheme oflifethey occupy an Those bacteria thatlose theirpurple or blue color intermediary position between animals and plants, after decolorization are a pinkishred andare called
72 1 1 i mouth and respiratory tract. They are nonmodle Spirochetes (spl'-ro-Cits).These anaerobic 1vi and aerobic, and are arranged in pain with their °monism, are pam-septive. Their name, which adjacent walls compressed. - shown in figure 4-1. means "coiled hair," is very descriptive of their The Neisseria group is primarily composed of two form, as shown in figure 4-1. They are extremely parasitic types of bacteriathe gonococci (which motile and move in a corkscrew fashion. There are cause gonorrhea) and the meningococci (which two types: came meningitis). a. Dardia(bo-re-k-als) Wncentii are found in d.Veillonella (va"-yon-el'-ah) are gram- necrodzing ulcerative gingivitis (NUG) with the positivc cocci. They are strict anaerobes that fusiform beelike. They are competitively small. physically resemble the Neisseria. It is not clear b. Treponema (trep"-o-ne"-msh) arelarger whether these organisms should be called opirochetes and are rather rate. They ate extremely pathogens. They have been frequently isolated from motile. The invasion ofthe Treponetnaminden abscesses on teeth. spirochete results in syphilis. Bacilli(bak-str-i).These are a form of bacteria that you will see much of in your clinic. Tbey are Now that you have a general introduction to the rod-shaped, about 3 or 4 microns long, and I scientific facts about oral flora, consider some micron in diameter. They can be srirore-forming, pertinent statisticsboth numerical and otherwise. gram-positive or nonspore-forming, eram-negative. Modem* of Oral lloctodo. Only once during Some are motile; some nonmotitc. They are your existence is your mouth without oral flora. aerobic, anaerobic, or facultative. There are several The oral cavity of a fetus is steeilebut not for types of bacilli; but' the types of most hnportance long. Shortly after birth, the oral cavity of a beby are fusiform types (see fig. 4-1). Fusiforms are shows signs of oral flora. Soon the bacteria are gram-negative, anaerobic bacilli, which inhabit the flourishing. Hove? gingival sulcus and increase to large numbers when Bacteria do not have seed, give birth, or lay egp. NUG (necrotizing ulcerative gingivitis) is present. Instead, each bacterium increases rapidly by They are very susceptible to antibiotics. dividing into two bacteria. Under proper Spirit la (spi-ril-olaThe most common spiral& conditions, some bacteria dheide evocy 15 minutes. oral flora are the vibrios (vib'-re-os). These are This means that, theoretically, in less than 1 day, short, bent rods (see fig. 4-1). Each has a single one single bacterium can become more then 100 polar flagellum (titi). They are either gram-positive million bacteria! Actually, there ate 40,000,000 to or gram-negadve and are anaerobic. They are 5,500,000,000 organisms per ec of salivaand we found in severe diseisoin deep gingival sulci and have about 10 cc of saliva in our mouths during our in pockets. They are extremely mobile. This little waking hours. In addition, there are many, many comma-shaped organism will be most helpful to more organisms in contact with the teeth and soft you in motivating your patient toward better oral tissues. The saliva is both an aid and a deterrent to hygiene, because it will flip across the microscope the growth of becteria. It aids in providing warm field of vision like a speedboat, spinning and moisture, but some secretions in saliva provide a turning in every direction. mechanical means of removing bactesia from the Filamentous (fil-ah-men'-tus) branching mouth, either by expoztorating or swallowing. organisms.These are gram-positive, anaerobic, The bacteria in an infant's mouth before tooth nonmotile, branching organisms. They are found eruption are predominantly aerobic cocci and around the teeth, in plaque, and in calculus. You short-rod forms. With the eruption of teeth, the will probably see two types of filamentous bacteria are able to work deep down into the Was. organisms. An illustration of filamentous During this stage, the oral flora are predominantly branching organisms is shown in figure 4-1. anaerobic cocci and short-rod forms. When a a.Leptothrix (lepl-to-thriks) are gram-positive, person loses his teeth (becomes edentulous), he anaerobic, nonmotile, long-rod forms. The loses the deep crevices of the sulcus, and once more distinguishing feature between the Leptothrix and the bacteria are predominantly aerobic cocci and the rod-shaped bacilli is that the Leixothrix usually rod forms. has a long branch from the end. Its shape resembles Other than the presence or absence of teeth, what a bent twig. else influence% the predominance of either aerobic b.Actinomyces (ar-ti-no-mi'-az) are gram- or anaerobic bacteria in one's mouth? Aerobic positive,anaerobic,nonmotile, multibranching bacteria are prevalent with good oral hygiene; forms, and they are Jassified between fungus and anaerobic bacteria are prevalent in areas of poor bacteria. They most nearly resemble a small branch oral hygiene. The greatest number of oral flora are from a tree which has smaller branches from it. present just before the morning and evening meals. Actinomyces israelii (one of three pathogenic Rapid eating and drinking, expectorating, and species of actinomyces) is the one found in the using a mouthwashtemporarilyreduce oral flora, human mouth. but remember how quickly they reproduce! (e 74 Streptococci Staphylococci Sarcinae
CArin op.,,G0
6) es) 09 CV Filamentous Neisseria Branching Organisms oe'd7-2'11--cz..3 Bacilli (Fusiform) Spirilla Spi:ochetes
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Spirochetes Spirochetes (Born lia) (Treponema Pallidum)
nflare 4-1. %aerial forms. gram-negative. The staining process kills the clusters of varied shapes). You should be able to bacteria, and they cannot be as effectively used in recognize the following types of cocci: motivating your patient to keep a clean mouth u a. Streptococci (strep" -to-kok'-i),the most live specimens, which perform all sorts of antics common of all the oral bacteria, is pam-positive under a microscope. For this reason, the phase and facultative. Figure 4-1 shows that it grows in microscopewhich permits viewing of live chains. It does not usually cause disease unleu it bacteriais effectively used in preventive dentistry settles on abnormal heart valves (causing subacute counselings. bacterial endocarditis), in urinary tracts, or in the Forms of Bacteria. Bacteria have many different meninges (one of the membranes enveloping the shapes and forms, as shown in figure 4-1. However, brain and spinal cord). But varieties of streptococci oral bacteria (normal flora) are reduced to five have recently been implicated in the caries process. forms for discussion here. This discussion is a b. Staphylococci (star' -i-lo-kok'-i) are gram- superficial explanation of bacteria found in the oral positive, facultative, and grow in clusters. They are cavityit presents only that information that may nonmotile and are often found on the epidermal be useful to you in motivating your patients toward surfaces oftuman beings. They cause osteomyelitis, better oral health. boils, abscesses, and ulcers. Some food poisoning is Cocci (kock'-sigh). The cocci forms are usually caused by staphylococci. However, they produce gram-positive, nonmotile, and facultative. They are various enzymes that are necessary for some normal spherical or oval-shaped and are about 1 micron body functions. (1/1000 mm) in diameter. The cocci forms exist c.Neisseria (ni-se'-re-ah) are gram-positive singly or in aggregate (in chains or in colonies with cocci, usually occurring in pairs. They occur in the -, 73 1 1 G To prevent uneven war of the sone, the sides as stones aria to use. This addition is called a dental well as the middle should be used for shsrpening instrument sharpening guide. It consists of a shads inanimate. The instrument should be drawn over which fits a roundaose dental headpiece and the stone with a long, firm stroke. Be sure to accommodates a mandrel-mounted sharpening maintain the correct bevel of the instrument. stone. It also features & T-shaped dental hutment Instruments used for cutting soft structures usually rest, an adjustable chuck for positioning this T. have long, thin bevels, end those used for awing shaped rat, and a swiveling arm which connects the hard ammo have short beveis. Always draw the chuck to the sheath. This guide can be a tremendous instnunent toward the bevel of the cutting edge. aid to you in keepine irregular-surfaced The mining edge is produced when the instrument is instruments sharp. The dentist depends upon you to drawn across the stone st an angle. The edge has keep all cutting instruments sharp. Thus, any and length but no thiclmess. all available sharpening aids may, and perhaps Instrumeat Sharpealeg. You can divide dental should, be used. cutting instruments into groups for sharpening. Emden (250 These groups are the instruments with flat, beveled working edge, those with curved working edges, Complete the following exercisa by circling either and finally those with irregular working edges. It is the T or the F to indicate whether the statement is very important that put be 'accurate in sharpening true or false. dental instruments. That is, the instrument cutting T FI. The sharp edge of an instrument will surface should be restored ss.nearly as possible so reflect light. the original cutting edae. Inaccurate sharpening can T F2. Before sharpening instruments, it is ruin an instrument. The correct bevel or aarVentre important to oil the surface of the on an instrument makes it ttlOst effective. Exercise Arkansas stone to prevent its pores from extra WC tO Mare that the correct bevel or becoming embedded with metal filing. curvature is maintained. T F3. You can restore the surface of a glazed Arkansas stone by soaking it in hydrogen The instruments with flat, beveled working edges peroxide. should be sharpened on a flat Arkansas stone. Place T F4. When sharpening instruments on a flat the blade on the stone so that it forms Arkansas itone, you should always draw approximately a 45° angle. Pull the blade beck and theinstrument away from the bevel of the forth across the stone with a firm, even stroke until cutting edge. it is sharp. T F5. Instruments with a curved working edge Some instruments with a curved working edge should be sharpened on a flat Arkansas may be sharpened on a grooved Arkansas stone. stone. The spoon excavators, elevators with sPooh-shsPed T F6. Mandrel-mounted stones are effectively working edges, and some scalers are included in used to sharpen instruments with this group. The grooves in the stone are rounded irregular working edges. and of different sizes. Be sure to use the groove of T F7. When sharpening instruments with a the proper size. To sharpen these instruments, place mandrel-mounted stone, you should run the working end in the proper groove and draw the the handpiece slowly. instrument away from the cutting edge. When you check these instruments for sharpness, make sure that the curved working edge is smooth and perfectly shaped. 4-4. SterilizationandDisinfectionofIn. The final group of instruments to be discussed struments are those with irregular working edges. The explorers, curettes, extraction forceps, some One of your greatest responsibilities to the dental elevators, and most of the scalers are included in patient is to maintain proper cleanliness, this group. Use the shape of the old cutting edge as sterilization, and disinfection of dental your guide. To sharpen them, you must use instruments. As you have already learned, mandrel-mounted stones. These stones come in instruments of various designs and materials are various sizes to make it easier to reach the almost used in the dental clinic. Each has characteristics inaccessible areas of the cutting edge. You should different from the others. These characteristics select the size that fits the working edge of the make it impossible to use any one particular instrument and place it in the handpiece. Then hold method of sterilization. In this section, we discuss the instrument with the working edge toward you. the various types of sterilization and disinfection. Rotate the stone slowly in a clockwise direction. With practice, the tuk becomes much easier. 259. Define sterilization and identify the A fairly recent addition to the Federal Supply procedures, methods, and egdpment involved in Catalog has made mandrel-mounted sharpening the sterilization of dental instruments. 76 1 I 7 Eisen:lees WU mote time. When dating wish dents1 instruments, howfter, the regainment is critical because they Complete the following exercises by circling either are veld on hums beinp. A sharp instrument the T or the F to indicate whether the statement is makes tbe dental officer's work mist and Wens, ( true Of false. by fre, tbe tfillfall that is nendlmely inflicted with I. Early bacteriologists agreed to dassify T F *all instruments. bacteria - animals. T F 2. Some bacteria are a benefit to mankind. T F3. Saprophytes derive their nourishment 2$11. Idestify the peeedures nod equipment from deed or decaying matter and for the imbed la shsepesing dental head IMMININS. most part do not cause disease. T F 4. Parasitic bacteria that live in or on a host To compile the shaping of sa hususant and severely damage their host by require that you IOW etch instrument a *berms destroying tissues or causing serious test. One way o( testing the sherries is to look at infections are called pathogens. . each instrument's cutting edge through a T FS. Notwirulent pathogens usually cane a magnifying Ow (1./se ow/mho-shoulder lighting.) permanent damage to the hog and often A sharp edge *owe as a fine line rather then a result in death. surface. Also, tbe sharp edge reflects no light, T F6. Anaerobic becteria are those that mug Another *win to slide the cutting edge over your have oxygen to survive and pow. fingernail. A dull instrument will not cut the nail 7. Facultative bacteria are those that can live T F and needs sharpening. under either aerobic or anaerobic Care f the Sharpening Stones. Before condons. sharpening inetrumentn, rsu mutt properly prepare T FIL Betted& that lose their purpk or blue the shorpsning sone by coating its surfact with a color after the discoloration step of the light machine oil. If you neglect this Sep, metal gram-staining Irocess and become a filings from the inetrumens boom embedded in pinkish red are called gram-positive. the dry pots of the sone. This foam a glue that T F 9. Streptococci are the most common of all make the Ma ineffective. Alm, when you finish oral bacteria. sharpening instruments, be sure to NOM the oil T F 10. Staphylococci have been recently film and meal Ow, or they will be absorbed and implicated in the caries process. cane the sone to become glued. The sone should T F 11. Members of the Neisseria group of never be permitted to become gland; however, if bacteria are responsible for gonorrhea you do lave a glazed sone, you can restore its and meningitis. abrasive surface by soaking it in an ammonia.weter T F 12. Fusiforms are pam-negative, anaerobic solution. If the stone is tIat, you an restore its bacilli which inhabit the gingival sulcus abrasive surface by rubbing it with a fine grade of and increase to large numbers when NUG emery cloth on a wooden block. is present. Sharpening stones are available in two T F 13. The most common spirilla oral flora are typesthe Maness stones and the carborundum the comma-shaped vibrios. stones. There are two styles of Arksues stones. One T F 14. The Leptothrix and the Borrelia are is a flat 2. by 1.inch sone, and the other is a examples of filamentous branching gromed stone. The grooved stone is particularly organisms. useful when sharpening instruments having curved T F 15. Invasion of theTreponema pallidum or disc.shsped cutting odes. The carborundum spirochete results in syphilis. stones rue usually mandrel.mounted for use with T F 16. Bacteria reproduce by laying egp. the conventional speed headpiece. T F 17. Bacteria found in edentulous mouths are The hard Arkansas same as an oibione, with a: predominantly aerobic cocci and rod surface that permits free bor4ng movements. Close forms. examination of the stone reveals a surface consisting of a mass of tiny crystals. These crystals act as little, sharp cutting points. When we sharpen' 4-3. Sharpening Metal !strenuous an instrument, we are actually recutting it into Just as a pocketknife or a paring knife requires shape. The hard Arkansas stone is preferred fcir the sharpening from time to time, so it is with dental following reasons: cutting instruments. In fact, this requirement is even (i) The point of the instrument may catch in the more critical with dental cutting instruments. You carborundum stone and ruin both may use a dull pocketknife to carve a piece of wood instrument and stone. with little consequence. About the only difference (2) The surface of the Arkansas stone is not in using a dull pocketknife or dull paring knife is easily grooved and will remain an effective that a dull knife makes the carving harder and takes sharpener for a longer period of time. 75 118 Before bananas are sterilized, they should be 400 dossed. The end denims procedure is to scrub the iaannents, ming a sends biush and soapy inset They must then be rinsed with dem wmer Ind dried n prevent wow spottiag. Owe clan, the inanimate we then ready to sterilise. The methods Of sterilizatiOn include the MMUS pressure aueodeve, thy heat, and heat walk, awilizatios. Swrilization is the &sweeties of miao-orsenins. Micro-orgesins ostaminating *wins objecos con be killed by exposure to high temperatures. Reliance of beans to ninon of tanpseawee depends upon the species, the powth slap, and whether or not the baceeria produce spores. Bacterial sporeo have a much greater resistant to high temperatures don do %Isolative forms. There we bacterial mat packs and indicators available which we used to confirm that proper sterilize** temperatures ban been reached. Wien supplies or inservments we so be **Wised in packs, they we usually wrapped in muslin or specialty prepared ppm Always um a piece of material large enough to completely cover the contents. The muslin should be dont* thickness. Place the wrapper on the table with ate point toward you. Center the items on the wrapper. Fold over the corner neweet you, then the right and left mew 4.2. Sueitlasdes Wismar. corners, and finally the corner opposite you. Always turn the tips of the cocoon back so that the pack may be unwrapped without touching the corona. steam under preosure, ths temperature rises se the Try to make firm, (=pally *upped packeen. pressure increases. Ordinaeily, susoclavins at 121' Place a sterilization tempwature indicator in the C. (250° F.) at IS pounds primers for IS to 20 middle of the pecker, label the package, and minutes will suffice. Follow the maeufacturer's SWUM it with pressure-sensitive tape. See figure 4-2 instructions if there is a variance on the high side for a sterilization indicator. Many times, the with respect to time or temperature. These labeling is done on the tape. Roller, pressure- autoclaves must be placed on a solid surface, with sensitive tape has light marks which turn dark when the electric cord out of the traffic area. Each subjected to heat under pressure. It provides autoclave has a mark inscribed to indicate the another way to confirm that the pack his been correct water level. Distilled water must be added to autoclaved. Thc larsea pack for the floor-moumed brins the fluid up to this lova prior to each use of autoclave should be not more than 12 by 12 by 20 the autoclave. inches. Carefully follow the instructions printed on the Autoclave method. Steam under pressure equipmat data plate when you start the aueoclave (autoclaving) is the most effective and practical and also later when ru opts the autoclave deer the method for sterilisation of dental instruments. sterilising period. The interior must be completely Normally, autoclaving is done in dental treatment cleaned at weekly intervals. If you fail to use rooms, where a rapid and sure method is routinely distilled water, a scale will form on the interior required. The autoclaves used in treatment rooms surface. Light scale may be removed with soap and are usually fairly small, portable types. A larger, s stiff brush. Removal of healer scale requires the floor-mounted type is frequently used in the oral addition of one-half cup of vinegar to the water. surgery section. The autoclave is basically a Operate the empty autoclave through a regular pressure cooker. It is a cylinder with a door sterilizing cycle and then remove the vinegar water. attached, through which instruments can be passed. Ventilate sufficiently to remove the offensive odor. It is equipped with valves to control the entry and Rinse and refill to the correct level with distilled exit of steam and with monitoring and timing water. devices that allow ru to observe the autoclave in In an autoclave, steam saves as a medium for the operation. Steam for the autoclave may be supplied transmission of moist heat from a source of energy from a central point, or by water heated to boiling tc. the objects to be sterilized. When it touches these by electric coils within the chamber itself. cooler objects, the steam condenses to moisture as When the cylinder of an autoclave is filled with its heat enagy is absorbed. More and more steam
77 1 19 enters, and the temperature of objects risa until commonsense. CAUTION: Cottca, paper, plank, they are as hot as the mum. Mkro-orpnisms are and rubber may melt, scorch, or bens at sterilizing killed by this beat. temperatures. Be careful what you piece in these Cleaned instromeets or sets of instruments may ovens. Omas and illitedaVel dsould be cloaked for be individually wrapped in muslin, Of they may be effectivenets by using indicators that amp color placed in paper begs or polyethylene tubing prior to et sterilizing temperatures. These indicators come amoclaving. They may be autoclaved in covered in the form of bap, tape% and small Ilan vials. if pans or trays is which they are also stored. Do not any of these indicason fail to turn to the proper crowd the autoclave. Leave space between packs for color, the medical equipment repairman should be circulation of steam. Containers that might retain called to theck the equipment. condensed 'WNW should be placed on their sides Remember, an instrument is bot enough at with their lids alongside them. The lids can then be sterilizing temperatures to give a seven burn if picked up and replaced without contamination touched. Allow sufficient time for the sterilizer to after sterilization is completed. return to room temperature before removing To remove materials from the autoclave, turn the instruments. operating valve to exhaust at the end of the timed Heat transfer serffization. Many dentists sterilize period. When the chamber gauge shows zero small instruments, such a root canal instruments, pressure, unlock the door, but do not openit wide. at the dental chair with a small, heat transfer Loosen it just enough to permit vapor to escape. sterilizer, usually called a "bead steriliser." This Leave the door cracked for a minimum of 10 sterilizer uses the principle of "flash" sterilization, minutes to allow the load to dry. Once the door is subjecting the item being sterilized to intense hest cracked, a sign reading STERILE should be hung (424*F. to 532' F.) for between 3 and 10 secoris. on the door while the materials finishdrying. After This electrically heated sterilizer uses glass buds, the 10 minutes have elapsed, you may open the salt, or molten metal as the heat transfer medium. door and remove the load. Set the packs on a rack Be cautious when moving these sterilizers so that to dry. Do not place warm packs on a flat,solid you will not be burned. surface or on a metal surface, because condensation will wet the pack and cause contamination. Exercises (259): Sterilization indicators can be used to indicate I. How should you glean dental instruments prior whether the machine is operating correctly. On a to sterilization? day-to-day basis, you may use pellet indicstors in the center of the sterilizing chamber and in each pack. The color of the pellets changes if there is sufficient heat. You may bind packs and paper 2. Define sterilization. envelopes with pressure-sensitive tape that changes color after proper exposure to heat. At least once each month, you should use becterial culture tests or "spore strips" for positive checking of the 3. What factors have a bearing on a bacteria's autoclave. These strips are impregnated with spores resistance to temperature extremes? that require a minimum exposure of 250° F. and 15 pounds of pressure for 12 minutes to kill them. You send the strips to the laboratory after autoclaving for a culture and microscopic examination. A 4. When wrapping instruments in a sterilization negative report of bacterial growth shows effective pack, why should you turn the corner tips of the autoclaving. wrapper back? Dry heat method. Dry heat sterilization is a clinically approved method that effectively sterilizes all instnunents used in dentistry. It should be substituted for the steam pressure sterilizing 5. What is the most effective and practical method method when it is essential to preserve cutting edges for the sterilization of dental instruments? or to sterilize instruments where rust is a factor. This method is not used under normal circumstances, because it takes approximately four times as long to sterilize by the dry heat method u it 6. What is normally -onsidered sufficient does by the steam method. temperature. pressure, and time for A small electric oven is used to sterilize with dry autoclaving? heat. The standard for a dry heat oven is 180° C. (350° F.) for 1 hour. There is little maintenance for these ovens other than normal dustingand using
78 150 7. Why should you use distilled water in the Physical method. Physical disinfection is autoclave? accomplished with boiling water. This technique should not be used except as a temporary expedient. While disinfection by this method will destroy all vegetative micro-organisms, the spore-forming 8. When placing packs in an autoclave, why is it bacteria 'are usually not destroyed. You should important not to czowd the autoclave? never rely on this method as a sterilizing process. The boiling water technique requires heating some type of vessel filled with water. The temperature of the water is regulated by the amount 9. Why should you not place warm (recently of applied heat. The maximum temperature that can sterilized) packs on a flat, solid surface or on a be reached is the boiling point, 100 C. (212 F.). metal surface? Thirty minutes of continuous boiling is necessary to disinfect the instruments. Then, if you add a group of instruments to a partly disinfected group, you contaminate both groups. You must restart the 10. How often should spore strips be used for timed period when you add the new group. Another positive checking of the autoclave? point to remember is that instruments having sharp cutting edges or delicate mechanical parts should not be placed in boiling water. Prolonged exposure to heat will destroy the temper in cutting 11. Why isn't the dry heat method of sterilization instruments and make it impossible to keep a sharp used under normal circumstances? Qating edge- Chemical method. Chemical disinfection is used for those articles that may be damaged by heat. When disinfecting with chemicals, the article 12. Why must you be careful of the items you place surface must be absolutely clean. If it is not, the in the dry heat sterilizer? chemical agent will not be effective. Thorough cleaning of the article reduces the number of bacteria and removes the material that affords the bacteria protection. 13. Give three examples of transfer media that may The use of chemical disinfectants should be kept be used in the heat transfer sterilizer. to a minimum. The most commonly used substance is a solution of zephiran chloride 1:1000 (with antirust). Bathe the instruments in this solution for at least 30 minutes. 14. Which sterilizer uses the principle of "flash" Alcohol is another chemical agent sometimes sterilization? used. However, pure alcohol has very little value as a disinfectant. When itis diluted with distilled water, it will inhibit the growth of bacteria. This may seem strange, but it can be easily explained. Alcohol stops the growth of bacteria cells by a process of coagulation of the vital material of the 260. Identify the disinfection process, media, and cell. When it is applied in full strength, it coagulates procedures used by the dental service. the cell wall first. This prevents the alcohol from Disinfection. There are times when sterilization penetrating into the vital center of the cell. Diluted may not be possible. For example, during alcohol does not coagulate the cell wall as battlefield conditions, electricity may not be completely, thus permitting the alcohol to penetrate available to operate sterilizers. Even when into the vital center of the cell and destroy it. The sterilizers are operable, there are some articles that ideal concentration of alcohol is a 70-percent would be damaged by heat and therefore cannot be solution. A solution of less than 50 percent or sterilized. When such cases occur, disinfection must greater than 80 percent is of little value as a be used in lieu of sterilization. disinfectant. Disinfection is a procedure in which all but There are numerous other chemical preparations spore-forming micro-organisms are destroyed. that may be used for disinfection, such as Disinfection may be achieved by either physical or merthiolate, metaphen, mercresin, mercurochrome, chemical means. In choosing the method of and various iodine solutions. There are still others, disinfection for various types of equipment, you but they require an extended period of time to kill must consider the composition of the article vegetative bacteria and are not routinely used since (9 concerned. there are more acceptable chemical agents. The
79 1 5i 4-P3t final consideration we give to maintaining article can be considered sterile depends primarily instruments is the storage requirement. on its wrapping. Some wrappings provide freedom from contamination for as much as 6 months, while Exercises (260): other provide as little as 2 weeks' protection. Check Complete the following exercises by circling either with your dental officer or the hospital central the T or the F to indicate whether the statement is supply service to determine the sterilization expiration dates for your particular type of packs. true or false. Place all sterilized packs in their proper locations. T FI. Disinfection is a process that kills all They should be clean, diy, and free from dust. micro-organisms. 2. It is safe to rely on boiling water as a Place like items together and arrange them T F according to expiration date, placing items with sterilizing process. later dates toward the rear. Check supplies T F3. Instruments submerged in boiling water periodically to determine any necessity for for a period of 30 minutes can be reautoclaving. Items must be resterilized if the considered adequately disinfected. T F4. Boiling water is the best method of wrapper becomes wet, if the pack touches the floor, disinfection for instruments with sharp if there is any question of contamination, or if the safe storage period has expired. cutting. edges. T F5. Instruments being disinfected in zephiran Instrument Cabinets. Instruments not kept in chloride should remain in the solution packs are normally stored in dental instrument for 10 to 15 minutes. cabinets. Due to the wide variety of cabinets found T F6. The ideal concentration of alcohol for in dental clinics, there is no standard storage use as a disinfectant is 90 percent. procedure established. The general practice is to follow the storage procedures already in effect at a given base or arrange the cabinet to meet the desires of your dental officer. Ordinarily, all instrumcnts 4-5. Storage of Instruments are to be cleaned, sterilized, and placed in a specified drawer or tray of the instrument cabinet at Because of the variation of treatments rendered the close of each duty day. You are to assure that in a dental treatment room, it is necessary to have these drawers and trays are disinfected at least many dental instruments available. In turn, this weekly and more often if needed. If in doubt, ask large number of instruments requires that a system your NCOIC or the dental officer you assist. be established to group some and store others where they can be easily identified and accessible. Exercises (261): 261. State the safeguards and procedures I. When should sterile packs be dated? involved in storing dental instruments. Instrument Packs. One way of grouping instruments is to place them in packs or on trays, 2. What is of primary concern when determining which are then wrapped. Surgical instruments are how long an article can be considered sterile? frequently sterilized and stored in packs. There is no standard system for storing packs. However, all instruments are usually stored in some type of an instrument cabinet. 3. What should you do if the wrapper of a Date the sterile packs after they are removed sterilized pack becomes wet? from the autoclave by marking the outside wrapper with a washable marker. Never date a pack before it is autoclaved. Supplies should be marked to show the date when the sterilized article is no longer 4. How often should you disinfect the drawers considered safe to use. The time span for which an and trays of the instrument cabinet?
1.52
80 ANSWERS FOR EXERCISES
CHAPTER 1 201 - 21.Tbe mandibular notch. 201 - 22.Behind the loot tooth. Reference: 200I. d. 202 - I. 2002. C. 2022. 200 - 3. n. 202 - 3. 200 - 4. k. 202 4. 2005. a. 202 - 5. 2006. I. 202 - 6. 200 - 7. j. 202 - 7. 2008. b. 202 - 8. 200 - 9. m. 202 - 9. 20010.i. 200I I. C. 20012.h. 203 - 1. T. 200 - 13. L 203 - 2. T. 200 - 14.g. 203 - 3. F. 203 - 4. F. 203 - 5. T. 201 -I . The boundaries of the roof of the mouth, the floor. and outer walls of the nasal cavity and the floor o( 203 - 6. F. each orbit. 203 - 7. T. 203 - 8. T. 201 - 2. b. 201 - 3. d. 203 - 9. T. 201 - 4. a. 201 - 5. c. 204 - 1. Provides a special sense Of taste, helps perform 201 - 6. The maxillary tuberosity is a small, rough (unctions of speech, contains elements of prominence located just behind each maxillary mastication, and saves as tbc entrance to the third molar ma. alimentary canal. 201 - 7. The hamular notch. 204 - 2. Varibule. 201 - 8. They allow naves and blood yawls to pais in and 204 - 3. The vatibule lies betweat the lips, cheeks, and out of the maxilla. teeth. 201 - 9. d. 204 - 4. The maxilla, mandible, and palatine bones. 201 - 10.c. 204 - 5. a. The palate forms the roo( of the mouth. 201 - 11.a. b. It includes both the hard and soft palate. 201 - 12.b. 204 - 6. Look at its color-healthy mucous membrane is 201 - 13.The mandible. pink; diseased mucous manbrane varies from a 201 - 14.On the superior border of the body of the mandible. bright red to a pale pink. 201 15. 'Mae are the mental foramina that allow nerves 204 - 7. Dorset tongue. and blood vowels to exit to the soft tames o( the 204 - 8. a. Sweet; sour. chin. b. Sour. 201 - 16.The genial tubercle is located on the internal c. Bittanas. surface of the mandible, opposite the chin, and at d. Main source of taste rmsation. the midline. It serves as an attachment for 204 - 9. The property o( free movanern and elasticity. genioglosan muscle. 204 - 10.d. 201 - 17.The mylohyoid ridge is a bony ridge thst starts just 204 - II.c. behind the genial tubercles and extends backwards 204 - 12.b. and upward on each inner side o( be mandible 204 - 13.a and h. aiding in the third molar area. It serves as an 204 14. (. attachment for the mylohyoid muscle that forms the floor o( the mouth. 201 - 18.The rami. 205 -I . The trigeminal nave (filth cranial) is the main 201 - 19.This is the coronoid process.It saves as an nave supply of the oral cavity. madam for the muscles of mastication. 205 - 2. The ophthalmic, maxillary, and mandibular. 201 - 20.The tanporomandibular joint. 205 - 3. Alvailar; third; second; molar.
81 153 205 - 4. The middle superior alveolar branch of the 210 - 1. n. trigetninal nave. 210 - 2. h. 205 - 5. Inciaors; central; anterior. 210 - 3. c. 205 - 6. The mandibular. 210 - 4. a. 205 - 7. Facial. 7.10 5. b. 205 - 8. The five terminal branches of the facial nerve are as 210 - 6. m. follows: temporal, zygomatic, buccal, mandibular, 210 - 7. b. and cervical. 210 - 8. o. 210 - 9. p. 206 - 1. Arteries. 210 - 10.i. 206 - 2. Veins. 210 - II.j. 206 - 3. Pulmonary. 210 - 12.g. 206 - 4. Capillaries. 210 - 13.k. 20-5. Neck; carotid. 210 - 14.f. 206 - 6. Hyoid; external. 210 - 15. I. 206 - 7. Lingual. 210 - 16.b. 206 - S. Ear; maxillary; temporal. 210 - 17.g. 206 - 9. Jaw; teeth; tissues. 2l0 - 18.d. 206 - 10.Alveolar; foramina; mental. 210 - 19. e. 206 - 11.Bicuspid; sinus; gingiva. 206 - 12.Hard. 211 I. a. Periodontium. 206 - 13.Infraorbital. b. The periodontal ligament, the alveolar process, 206 - 14.Anterior; cuspids; bone. and the gingiva. 211 - 2. Formation, nutrition, sensation, and support. 207 - I. Lymph, lymph vessels, and lymph nodes. 211 - 3. To support the teeth and yet permit a attain 207 - 2. It is an almost colorless liquid that is derived from amount of tooth movement. blood plasma as it leaks into spaces between the 211 - 4. Alveolar proms. tissue cells. It is similar in composition to blood 211 - S. It gives the alveolar process shape, yet protects the plasma. softer bones and tissues inside. 207 - 3. To combat baterial infection by transporting 211 - 6. It is a porous, spongy type of bone composed of a disesse-pcoducing organistts to the lymph nodes, to network of narrow spaces, spicule*, blood and carry off excessive fluid from the body tissues, and lymph vessels. to act as a supplement to the venous system. 211 - 7. Free gingiva lies close to the crown just above the 207 - 4. Toward the heart. cervix; the attached gingiva covers the alveolar 207 - 5. They resemble veins in that they sart as snail bone. vessels and have the same type of duct lininp. 207 - 6. They are snail oval-shaped bodies that lie along the course of the lymph vessels. Usually, they °caw as groups and act as filters to remove bacteria and other particles from the lymph system. CHAPTER 2
208 - I. F. References 208 - 2. F. 212I. Dental caries. 2083. T. 2122. Bacteria. 208 - 4. T. 212 - 3.. Dental plaque is a filmlike covering on teeth 208 - 5. F. surfaces that is composed of mums, sloughed-off 208 - 6. T. tissue cells, and different types of bacteria. All 208 - 7. F. dental caries begin when plaque deposits on tooth 208 - 8. T. surfaces become laden with bacteria. 208 - 9. F. 212 - 4. The acidogenic theory. 208 - 10.T. 212 - 5. Dental plaque. 208 - 11. F. 212 - 6. A sign of a disease is an objective manifestarion. 208 - 12.T. The examiner can positively determine a sign: 208 - 13.T. swelling is an example. A symptom of a disease is a subjective manifestation. Only the patient can 209 - I. T. positively identify a symptom; pain is an example. 209 - 2. F. 212 - 7. These are caries that begin in the enamel and then 209 - 3. T. stop for some unknown reason. 209 - 4. F. 2l2.it. As a leathery or spongy mass. 209 - 5. T. 212 - 9 The secondary dentin acts as a protective lining or 209 - 6. T. insulator for the pulp tissue. 209 - 7. F. 212 10. Sensitivity to cold foods or liquids. 209 - 8. T. 212 I I.By dental restorations. 209 - 9. F. 209 - 10.T. 213 -I Inflammation of the pulpal tissue. 209 - II.T. 213 - 2. Extensive dental caries. 209 -12. F. 213 - 3. Itis an inflammatory condition of the pulp 209 . 13.a. T. chamber due to a systemic disease, and itis a b.F. secondary effect of a more prominent disease of the c. T. body. d. F. 213 - 4 Pain is increased by heat, preasure, and percuarion: 209 - 14.T. It Is also greater when the patient is lying down.
82 1 5 r 10-(e 2133. Dull, obscure pain; usually, no pain with depth of the pocket. In tbe beginning stages, the peransioa, vary little pain with heat. interproximal bone shows slight bhutting. In 213 - 6. The pulp may die. advanced cases, there is a horizontal loss of bone 213 - 7. It is molly treated by removing the irritant and and a awing-out of the interdental bona insetting a temporary filling. 219 - 3. Trastment for periodondtis consists of oft, or more 213 - 8. In some cases, the necrotic pulp may be removed of the folios/inn (a) (ideation of the patient, (b) and replaced with a suitable root canal filling conservative scaling and curettage, (c) gingival material. In other cases, the tooth must be surgery and possibly osteosurgerY, and enennelleal extracted. treatment which may include occlusal equilibration. 214 - 1. An abscess is a condition in which pus, caused by 219 - 4. When these two events occur, the inflammation tissue disintegration, collects locally in a body peas the periodontal ligament fibers, and tbe cavity and is surrounded by resulting inflamed supporting structures of the tooth begin to break tissue. down. 214 - 2. Either an acute or a dtronic periapical abeam is 219 - S. Periodontosis is an abnormal condition formed what there is a localized collection of pus (degeneration) of the periodonda, but initially at tbe apes of a tooth. there is no inflammatory reaction involved. 214 - 3. The acute periapical absceu area becomes 219 - 6. Widening of tbe periodontal mules and migration maw* psinful; this pain increases when hest is of the teeth is apparent in the early stages. The first applied but decreases when cold is applied. sign of inflammatory involvement is seen in the Generally, the chronic periapical abeam is les second star. The third stage is charaderiaed by painful, occurring only what pressure (in a certain progressive gingival inflammation, deeper direction) is applied. With the aaste periapical periodontal pockets, incnssed bone low and the abscess, tbe surrounding tissues become swollen or loosening and drifting of teeth. Neither pocket red; but with the chronic periapicul abscess, there is formation nor bone loss is part of the hennaing little redness or swelling. stages but is seen in the later stages. 214 - 4. Fat, root canal therapy; second, removal of the 219 - 7. Treatment for periodontosis consists of 'dyads' infected tooth. the psdent toward good oral hygiene and cleaning 214 - 5. Such foreign body irritants as calculus formation, his mouth thoroughly; then the dental offica treats overhanging or fracture fillings, impacted food, or the patient according to his needs. broken toothpicks become embedded between the tooth and the soft tissue, or completely within 220I. F. adjacent soft tissue. 220 - 2. F. 214 - 6. No appreciable change in the pain. 220 - 3. T. 214 - 7. Normally, the onset of cellulitis is signified by 220 . 4. T. edema of the soft structure (often extensive), severe 220 - 5. F. pain and throbbing, high fever (around 105° F.), 220 - 6. F. rapid pulse and headaches, and spasm of the 220 - 7. T. involved muticatory minds. 221 - I. 215 - 1. Pericoron 221 - 2. 215 - 2. Bacteria. 221 - 3. 215 - 3. Trismus. 221 - 4. 2154. Operculum. 221 - 5. 215 - 5. Remove. 221 - 6. 221 - 7. 216 1. Pathology. 221 - 8. 216 - 2. Asymptomatic. 221 - 9. 216 - 3. Retained roots: foreign chronic irritant. 221 - 10. 216 - 4. Clear liquid. 216 - S. Developmental sac; formations. 222 - Die Manua bfrobacterium tubercubsis. 216 - 6. Surgical excision; curretage; rat cells. 222 - 2. It may be spread through the bloodstram or by diren contamination of an abrasion or wound in 217 - 1. It is a mass of granulation tissue that is usually the mucosa. If the oral lesion is the primary site, it surrounded by a fibrous sac. may be caused by direct contact of the tissue with an 217 - 2. A chronic inflammation. infected instrument. 217 - 3. At the tooth's apex. 222 - 3. On the lateral borders of the tongue. 217 - 4. The tooth may be sensitive to percussion, fed 222 - 4. Oral lesions frequently begin as a Ma tuberde or slightly elongated, and cause a dull gnawing pain. pimple which breaks down to form painful ulcers. Additional tubercles form in the same manner; the 218 - 1. Inflammation involving the gingival tissue. proem repeats over and over, and the lesions grow 218 - 2. a. in Wt. 218 - 3. C. 222 - 5. The maintenance of good oral hygiene and the 218 - 4. f. elimination of all areas that might be a source of ir- 218S. b. ritation to the tissues. 218 - 6. d. 222 - 6. Rubber gloves and the strictest aseptic techniques 218 - 7. e. are mandatory.
219 I. An inflammatory reaction of the cisme surrounding 223 -I. a. and supporting a tooth, including the penodontal 2232. b. membrane, the alveolar bone, and the gingiva. 2233. 219 - 2. The patient's breath is usually foul. Irritants may or 223 - 4. f. may not be present. There may be caudate in the 223 - 5. a.
83 155 10-
2236. C. 230 - 4. kriptieg the pocket with wenn aline and pecking 223 - 7. d. tbe pocket with iodoform gauze saturated in 2238. e. eugenol. Sedadyes and/or anallesies maY be prescribed to reilem pain and posible insomnia. 224 - 1. F. 224 - 2: T. 231 - 1. 224 - 3. T. 231 - 2. 2244. F. 2313. 2245. T. 231 - 4. 2315. 225 - 1. b. 2316. 225 2. e. 2317. 2253. a. 231 - 8. 225 - 4. c. 231 - 9. 2255. d. 231 10. 231 - 11. 226 - I. Thermal and chunicel. 231 12. 2262. Thermal. 226 - 3. By keeping hosted materials and teammate out of 232 - I. the operating area until they are in a safe tem- 2322. permute range. 2323. 2264. By placing an aspirin tablet in the mucobuccal fold 2324. next to a tooth that buns. 232 - 5. 226 - 5. That it should be swallowed to give the beneficial 2326. effect intended. 232 - 7. 226 - 6. i(now the contents Of all the medicament bottles in 232 - 8. the operatory; be able to desaibe the properties and 232 - 9. precautions necarry for handling, neutralizing, 232 10. and storing these substances; label all containerr, 23211. make positive identification of all drugs and themi- 232 - 12. cab; be very careful in handling all chemicals. 232 - 13. 232 - 14. 227 - I . 2272. 233 - 1. a. 227 - 3. 2332. b. 2274. 233 - 3. c. 2275. 2334. C. 2276. 2335. h. 227 - 7. 2336. a. 227 8. 233 - 7. b. 227 9. 233 - 8. d. 233 - 9. e. 228 - I. Early stabilization aids in the control of shock, 233 - 10. f. pain, swelling, trixnus, and hemorrhage. It also has 233 -I I . 1. a direct bearing on the reestablishment of a nor- mally functioning masticatory system and on the 234 I . T. esthetic results. 234 2. F. 228 - 2. A simplified technique of intermaxillary fixation 234 - 3. F. supplemented by a head bandage for the support of 234 - 4. T. the mandible. 234 - 5. F. 228 - 3. Select at least two suitable posterior teeth in each 234 - 6. T. quadrant for wiring. Pam a 2-inch length of stain- less steel wire around the neck of each of these 235 -I . Resorption is the dissolution of tissues by body teeth. Using a hemostat, twist the aids of each of fluids or cellular activity. these wires together. Cut the twisted wire one-half 235 - 2. The resorption of the root of deciduous teeth so inch from the tooth it encircles and bend it back to that their crown may Ix shed to make room for the form a tight loop. Bend the loop back toward the permanent teeth. gingiva so that it forms a hook. Anchor mall 235 - 3. Trauma; orthodontic appliances used to move teeth elastic bands between the =vett loops of the max- too rapidly, attempted eruption of retained or im- illary and mandibular teeth 30 that their forces peded teeth, improperly designed prosthesis, or in- bring the jaws together. fection.
229 I . F. 229 = 2, F. 229 - 3. T. 229 - 4. T. CHAPTER 3
230 - I. After in extraction if a normal blood clot fails to Reference: form or is dislodged. 236 I . Topical, oral, inhalation, and injection. 230 - 2. After the third day. 236 - 2. Topical. 230 - 3. That a portion of the alveolar bone is exposed and 236 - 3. Because it is painless, requires no special apparatus. infected. The socket usually has a foul odor, and the and produces a systemic effea in a short period of surrounding tissue is inflamed. time.
84 r C *
236 - 4. 1. 241 - 8. Selicyiatm. 236 - 5. d. 241 - 9. They reduce fever. 236 - 6. b. 241 - 10.Salicyliem. 236 - 7. a. 241 - I I.Ulcer. 236 - 8. c. 24112.In the treatment of auseculoekaimal conditions nod 236 - 9. e. *ism the patient is allergic to aspirin. 236 - 10.g. 241 13.Propoityphene hydrochloside (Damn). 236 - 11.Inhalation. 236 12.Normal saline. 242 - I. Relam produce. 236 - 13.Because in this method a pool of mediamest is 242 - 2. Hypnotic. deposited in the muscle and is then slowiy absorbed 2423. Sidmives. into the tissues 242 - 4. Hypnotic. 236 - 14.This delays absorption and further prolonp the 242 - 5. Harbiturams. drug's action. 242 - 6. Mild iodation; coma. 236 - 15.Injecting into a blood vessel would result in a more 242 - 7. Duration. rapid absorption of the medicament than &eked Of 242 IL Speed; onset. intended. This could be dangerous, since the rapid 2429. Shocig respiratory depreesioa. absorption would place too much of the drug in the 242 - 10.Alcohol; uanquilizees; antihistamines; narcotic patient's system at one time. analgesics. 236 16.Intravenoin. 243 1. T. 236 - 17.The effect desired; the rapidity of action needed: 2432. T. the nature and amount of the drug to be given; sad 243 - 3. a. T. the physical condition of the pedant. b. F. C. T. 237 -1. The local action is the effect that a drug or d. F. medication produces at the point or area of e. F. applicetion or introduction. f. T. 237 - 2. This is the action of a dnig on some tissue or organ 243 - 4. F. remote from the the of introduction. Such action 243 - 5. T. occurs only after the drug has been absorbed or hes 2436. F. entered the vascular mum. 243 - 7. F. 237 - 3. F. 243 - II. F. 237 - 4. F. 2439. T. 237 - 5. T. 243 - 10. F. 287 - 6. T. 24311. F. 24312.T. 238 - I. F. 243 - 13.T. 2382. T. 24314.T. 238 - 3. T. 238 - 4. F. 244I. To stop the hemorrhage of blood. 238 - 5. T. 2442. Gelatin sponge, oxidized cellulose, and oxidized regenerated cellulose. 239 - 1. Toxic reactions may be alleviated by adjtiting the 244 - 3. Their method of manufacture. dosagr, taking the patient off the dn( ; or in severe 2444. To pack sockets and as a sutured implant in soft cases, administering another drug to counteract the th one that is producing a toxic effect. 244 - 5. When there is a history of blood coagulation 239 - 2. d. problems. 239 - 3. 1 239 - 4. b. 245 - I. T. 239 - 5. g. 2432. T. 239 - 6. k. 245 - 3. T. 239 - 7. e. 245 - 4. T. 239 - 8. j. 2455. F. 239 - 9. a. 243 - 6. F. 239 - 10. h. 245 - 7. F. 239 -I I. f. 239 - 12. c. 246 - 1. Constrict; capillarie& 246 - 2. Epinephrine; hemostatic. 240 - I. T. 2463. Longer. 240 - 2. F. 240 - 3. F. 247 - I. Antisialagogues reduce the excessive Bow of saliva. 240 - 4. F. 247 - 2. They cause dryness of the throat and speech 240 - 5. T. difficulty. 247 - 3. Atropine sulfate and scopolamine. 241 -I. Analgetics are drup which relieve pain without acting to depress consciousness. 248 - I. F. 241 - 2. Narcotic analgesics. 248 - 2. F. 241 - 3. Morphine. 248 - 3. T. 241 - 4. Itis habit-forming. depresses breathing, and 248 - 4. T. contracts the pupils of the eyes. 248 - 5. T. 241 - 5. It is les habit-forming. 241 - 6. Meperidine. 249 - I. Allergic. 241 - 7. Non-narootic analgesics. 249 - 2. Benadryl.
85 157 249 -3. %be. 256 - 15.Protozoa. 256 - 16.Protozoa. 250 - I. Through the water supply. 256 - 17.The boll 250 - 2. Fluorosis. 25618.Superficial infections that grow on the skin and 250 - 3. The averap daily water intake in warm climates is more serious infections, where the fungus invades greater. the limp and other tissues of the body. 250 - 4. 0.6 to 1.7 ppm. 256 - 19.Becauee they lack chlorophyll, and therefore the 250 - 5. Giving dietary supplements of fluoride tablets. ability to convert carbon dioxide, water, and 250 - 6. Contact the surface of tbe erupted tooth with a 10- sunlit* intoWINS. percent stannous fluoride aqueous solution for 30 seconds: repeat at 6- to 12-month intervals. 257I. F. 250 - 7. AFR 161-9, fluoridation and Deflatoridation of 257 - 2. T. Water Supplies. 257 - 3. T. 257 - 4. T. 251 . I. Peroxide. 257 - 5. F. 251 . 2. 30. 2576. F. 251 - 3. 3: cleansing. 257 . 7. T. 2578. F. 252 - I. Cleansing purposes: to aid in rendering treatment. 2579. T. 252 - 2. Orange oil, ethyl alcohol, and isopropyl alcohol. 257 - 10. F. 252 - 3. Chloroform and eucalyptol. 257 - II.T. 257 . 12.T. 253 - I. a. As adensitizingpaste wino mixedwith 257 - 13.F. camphor. 257 - 14.F. b. As a pulp-capping material when mixed with 257 - 15.T. zinc oxide. 257 . 16.F. 253 - 2. To stdilize root canals. 257 . 17.T. 253 - 3. To sterilize root canals. 2534. A 50-percent solution of alcohol. 258 - I. F. 258 - 2. T. 254I. T. 258 - 3. F. 254 . 2. T. 258 - 4. F. 2543. F. 258 - 5. F. 254 . 4. F. 2586. T. 2545. F. 258 - 7. T.
255 - I. Bristles-soft to medium: flat brushing surface 259I. Clean the instruments with a scrub bnnh and soapy formed by multiple tufts; head size-small to water, rinse in clean water, and dry them to prevent medium. spotting. 255 - 2. Type of treatment, dental condition, size of mouth, 259 - 2. Sterilization is the destruction of micro-organisms. patient's manipulative ability. 259 - 3. Its species, growth stage, and whether or not it 255 - 3. It can prevent him from injuring his gingival produces spores. tissues. 259 . 4. So that the pack can be unwrapped without 255 . 4. He will need a regular mirror and a mouth mirror touching the contents. to insure that the inside surfaces are clean. 2595. The autoclave method. 2555. Irrigators. 2596. 121' C. (250' F.) at 15 pounds preasure for 15 to 255 - 6. No. Brushing the teeth normally gives the necessary 20 minutes. massaging. 259 - 7. Failure to use distilled water will cause a scale to form on the autoclave's inner surface. 259 - 8. There must be mace Idt between the packs to allow CHAPTER 4 for the circulation of steam. 259 - 9. Because condonation will wet the pack and cause Reference: contamination. 256 I. Bacteria, viruses. rickettsiae, protozoa, and fungi. 259 - 10.At least once each month. 256 - 2. The shape of the bacteria, the way the cells are 259 -I I . Because it takes approximately four times as long as arranged or grouped together, and their reaction to with the steam method. the gram stain. 259 - 12.Because the high temperature produced by the dry 256 - 3. a. Cocci. heat sterilizer could cause cotton, paper, plastic, or b. Bacillus. rubber items to melt, scorch, or burn. c. Spirochetes or spirilla. 259 - 13.Glass beads, salt, and molten metal. 2564. Diplococci. 259 - 14.The heat transfer sterilizer. 256 - 5. Streptococci. 256 - 6. Binary fission. 260 - I. F. 256 - 7. A capsule. 260 - 2. F. 256 - 8. It is a hairlike appendage that whips back and forth 260 - 3. T. to create the movement of some bacteria. 260 - 4. F 256 - 9. A spore. 260 - 5. F. 256 - 10.The proper environment to survive. 260 - 6. F. 256 - 11.A group of ultramicrotcopic. disease-causing agents. 261 - I. After they are removed from the autoclave. 256 - 12. Viruses. 261 - 2. How it is wrapped. 256 - 13.By insects such as fleas, lice, mites, or ticks. 261 - 3. Resterihze the pack. 256 - 14.Rocky Mountain spotted fever and typhus. 261 - 4. At least once a week.
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159 Fddout 1. Cranial and facial bones of tbeikulL TRIGEMINAL
-.1-
SEMILUNAR GANGUON FRONTAL MAXILLARY7
POSTERIOR SUPERIOR OTHALMICT: ALVEOLAR TRIGEMINAL (5)
A MIDDLE SUPERIOR ALVEOLAR MAADALAli
ANTERIOR SUPERIOR', ALVEOLAR
INFRAORBITAL PITA
AURICULOTEMPORAL
SPHENOPALATINE
BUCCINATOR LINGUAL
MENTAL INFERIOR ALVEOLAR
Foldout 2. Trigeminal and facial nerves ( 1 6f e A0014 167`
FACIAL
CHORDA TYMPANI
INFRAORBITAL-
POSTAURICULAR ZYGOMATIC
MENTAL \ BUCCAL MANDIBULAR CERVICAL
Foldout 2. Trigentinal and facial nerves. 161 i0-
A ARTERIES
DESCENDING PALATINE
POSTERIOR SUPERIOR ALVEOLAR IIVERNAL MAXILLARY SUPERFICIAL TEMPORAL
% 'c. INFRA.ORBITAL 1 .. .i
OCCIPITAL
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EXTERNAL MAXILLARY INTERNAL CAROTID so4bp.011'wz. .N, -._%,
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MENTAL LINGUAL
INFERIOR ALVEOLAR COM MON CAROTI D IP
Foldout 3. Arteries and veins of the head.
162 Ame
E3 VEINS
CAVERNOUS SINUS
FRONTAL INTERNAL MAXILLARY
RTERY(iOR) PLEXUS
POSTERIOR FACIAL
SUPERIOR ALVEOLAR
ANTERIOR FACIAL
INFERIOR ALVEOLAR
.9INTERNAL JUGULAR SUBMENTAL COMMON FACIAL LINGUAL
EXTERNAL JUGULAR
Foldout 3. Arteries and veins of the head.
1S3 11111111111111111111111111111111,1111
111II, 16A0
ENAMEL DENTIN PULP-
PERIODONTAL MEMBRANE
ALVEOLAR BONE
( AkoCROSSSECTION OF A TOOTH
Foldout 4.Anatomical structues of the teeth 1S4 IIMMW
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. 1. MA.TCH ANSWER 2. USE NUMBER 1 OR SEIx:ET TO THIS NUMBER 2 PENCIL. STOP- EXERCISE NUM. BER. 98150 02 23 EXTENSION COURSE INSTITUTE VOLUME REVIEW EXERCISE BASIC DENTAL SCIENCES Carefully read the following: DO'S: I.Check the "course." "volume," and "form" numbers from the answer sheet address tab against the "VRE answer sheet identification number" in the righthand column of the shipping list. If numbers do not match, take action to return the answer sheet and the shipping list to ECI immediately with a note of explanation. 2.Note that numerical sequence on answer sheet alternates across from column to column.
3. Use a medium sharp #1 or #2 black lead pencil for marking answer sheet. 4.Circle the correct answer in thistest booklet. After you are sure of your answers, transfer them to the answer sheet. If youhaveto change an answer on the answer sheet, be sure that the erasure is complete. Use aclean eraser. But try to avoid any erasure on the answer sheet if at all possible.
5.Take action to return entire answer sheet to ECL
6. Keep Volume Review Exercise booklet for review and reference. 7. If mandarorilyenrolled student, process questions or comments through your unit trainer or OJT supervisor. If voluntarilyenrolled student, send questions or comments to ECI on ECI Form 17. DON'TS: I.Don't usc answer sheets other than one furnished specificallyfor each review exercise. Don't mark on the answer sheet except to fillin marking blocks. Double marks or excessive markings which overflow marking blocks willregister as errors.
3. Don't fold, spindle, staple, tape, or mutilate the answer sheet. 4.Don't usc ink or any marking other than a #1 or #2black lead pencil. NOTE:NUMBERED LEARNING OBJECTIVE REFERENCESARE USED ON THE VOLUME REVIEW EXERCISE. Inparenthesis after each item number on the VRE is theLearning Objective Numberwhere the answer to that item can be located.When answering the items on the VRE, refer to theLearning Objectivesindicated by theseNumbers.The VRE results will be sent to you on a postcard whichwill list theactual VREitems you missed.Go to the VRE booklet and locate theLearning Objective Numbersfor the itcms missed. Go to the text andcarefully review the areas covered by thesereferences. Review the entireVRE again before you take the closed-book CourseExamination.
1 i S 7 Multiple Choice
1. (200) Which facial bone forms the lower and outer edges of the eye socket and the prominent portion of the cheekbone?
a. Vomer. c. Concha. b. Zygoma. d. Lacrimal.
2. (200) Through which of the following facial bones do the tear ducts pass?
a. Vomer. c. Lacrimal. b. Zygoma. d. Inferior conchae.
3. (201) All of the following are processes of the maxilla except the
a. frontal process. c. zygomatic process. b. alveolar process. d. condyloid process.
u. (201) Into which process of the maxilla and mandible are the teeth embedded?
a. Alveolar. c, Palatine. b. Coronoid, d. Condyloid.
5. (201) The anterior process located at the top of the ramus of the mandible is called the
a. coronoid. c. zygomatic. b. condyloid. d. alveolar.
6. (202) Which definition of "muscle insertion" is correct?
a. The place where the muscle articulates with another muscle. b. The part of the muscle that attaches to the Sone to be moved. c. The more fixed, more central, or larger attachment of the muscle. d, The part of the muscle that inserts into the bone.
7. (202) Which muscle forms the floor-of the mouth?
a. Mylohyoid. c. Buccinator, b. Temporalis. d. Orbicularis oris.
8. (203) What is the function of the synovial membrane lc.:ated in the temporomandibular joint?
a. It helps prevent excessive movement of the mandible. b. It aids the ligaments in supporting the mandible. c. It secretes a fluid that acts as a lubricant for the joint. d. It provides an attachment for the muscles of mastication.
9. (204) The mouth opens anteriorly through the lips, and posteriorly through the fauces into the
a. pharynx. c. intestines, b. trachea, d. larynx.
10. (204) Which type of oral mucosa is tightly bound to underlying bone, such as the hard palate and attached gingiva?
a. Lining. c, Masticatory. b. Specialized. d. Epithelium. 11. (204) Which of the tongue's papillae are responsible for the taste sensation of bitterness?
a. Foliate. c. Fungiform. b. Filiform. d. Circumvallate.
U. (204) Which name applie to Co: sickl--qhaned extensions of connective tissut that connect the lips to the alveolar ridges?
a. Labial frena. c. Foramina. b. Muscle. 1. Papillae.
13, (204) Which anatomical structure, in combination with the muscles of the neck, closes off the passageway between the nasal cavity and the throat during swallowing?
a. Hyoid. c. Pharynx. b. Uvula. d. Trachea.
14. (204) :dentify the large salivary gland that lies in the cheek just in front of the ear.
a. Parotid, c. Sublingual. b. Wharton's, d. Submaxillary,
15. (215) Which division of the trigeminal nerve is entirely sensory and divides into branches that supply sensation to the tissues around the eye and the adjacent parts of the nese and forehead?
a. Maxillary. c. Mandibulary. t. Ophthalmic. d. Superior alveolar.
15, (205) '::hich branch of the fifth cranial nerve's maxillary division supplies innervation to the maxillary bicuspid teeth and the mesiofacial root of the first molar?,
a. Nascpalatine. c, Anterior superior alveolar. b. :.;reater a1atine. d. Middle supericr alveolar,
17, (205) Which cranial nerve supplies motor sensations to all of the muscles of facial expression and sensory sensation to the tongue?
a. First. c. Seventh. Fifth. d. Ninth.
IS. (206) ..ihich branch cf the intermaxillary artery supplies the incisors and cuspids as well as the maxillary bone?
a. Infraorbital. c. Inferior alveolar. t. Descending palatine. d. Posterior superior alveolar.
I?. (206) Into which vein does the common facial vein empty?
a. Anterior facial. c. Internal jugular. b. ?osterior facial. d. Pterygoid venous plexus.
2). (207) '..ymoh fluid is derived from blood plasma when it
a. is regenerated by the heart. b. leaks int: spaces between the tissue cells. c. becomes overabundant in carbon dioxide. d. is manufactured by the many circulating lymphocytes.
3 1 99 Vto
21. (207) All of the following are functions of the lymph system except to
a. transport disease-producing organisms to the lymph nodes. b. carry off excessive fluids from the body. c. serve as an auxiliary nerve supply. d. act as a supplement to the venous system.
22. (208) How many teeth are normally present in the deciduous dentition?
a. 20. c. 28. b. 24. d. 32.
23. (208) Which term refers to the working surface of posterior teeth?
a. Mesial. c. Incisal. b. Distal. d. Occlusal.
24. (209) In a full set of permanent dentition, there are
a. 12 molars. c. 4 incisors. b. 6 bicuspids. d. 2 cuspids.
25. (209) Which of the following statements concerning the incisor tceth is correct?
a. Incisors function to grind food into small portions. b. Mandibular central incisors are significantly larger than the lateral incisors. c. Maxillary central incisors are smaller than the lateral incisors. d. Incisors are important for correct enunciation sf certain speech sounds.
26. (209) Compared to permanent teeth, deciduous teeth have
a, less constriction at their neck. b. stronger and smoother textured enamel. c. whiter and more uniformly colored enamel. d. a smaller pulp chamber.
27. (210) What is the name of the narrow portion of the tooth where the crown root meet?
a. Apex, c. Occlusal. b. Cervix. d. Contact roint,
28, (210) What is the hardest calcified tissue in the human body?
a. Bone. c. Enamel. b. Dentin. d. Cementum.
29. (210) What is the name of the specialized cells that produce dentin?
a. Odontoblasts. c. Odontoclasts. b. Ameloblasts.
30. (210) What is the Primary function of tne tooth's pulp?
a. Transmitting stimuli. b. Producing dentin. c. tourishing the apical fibers. d. Combating bacteria.
1 79 431. Ict°2. (211) Which periodontal fiber group connects the cementum of adjacent teeth by running from onc tooth over the alveolar crest to the adjacent teeth?
a. Gingival. c. Horizontal. b. Transeptal. d. Alveolar crest.
32. (211) The V-shaped space reaching from the free gingival margin to the depth where the gingiva attaches 70 the tooth is called the
a. gingival sulcus. c. periodontal relief. b. contact area. d. interproximal space.
3?. (.:12) What is the most common of all dental diseases?
a. Gingivitis. c. Pericoronitis. Pulpitis. d. Dental caries.
1.. (212) All of the following contribute to the process of dental caries except
a. a diet high in carbohydrates. c. a diet high in calcium. diet high in refined sugars. d. neglect or lack of oral hygiene.
35. (2:2) Which bacteria are associated with the acidogenic theory of tooth decay?
a. Sarcinae and neisseria. b. Spirochetes and bacilli. Streptococci and Treponema callidum. c. Lactobacillus acidophiius and streptccocci.
:6. (212) In both the acidogenic and proteolytic theories, what is the supplier of tne bacteria needed to cause dental caries?
a. Plaque. c. Carbohydrate.:. 1.nz:ras. d. Food debris.
37. (212) 5enerally the first symptom cf tooth decay is
a. pain from foods and liquids containing high concentrations of sugar. 1. the spontaneous production of secondary dentin, c. the inflammation of the pulpal tissues. d. sensitivity to cold foods and liquids,
(:13) What is the most common cause of secondary pulpitis?
a. Trauma. c. Thermal change. b. Systemic disease. d. Extensive tooth decay.
19. (213) In the condition of ac.ate pulpitis, the pain may be somewhat relieved by
a. applying heat. c. lying down in bed. o. cold applications, d, putting pressure on the tooth.
LO (21u) In comparison with an acute periapical abscess, a chronic periapical abscess
a. is less painful. b. is of much snorter duration. c. has greater tendency to spread. d. does not cause pain when pressure is pla-ed on the tooth.
5
-1 7 41. (214) Which of the following conditions is Characterized by high fever (104° F. to 105° F.), rapid pulse, headaches, and trismus of the involved masticatory muscles?
a. Cellulitis. c. Periodontal abscess. b. Periodontitis. d. Acute periapical abscess.
42. (215) In which of the following locations does pericoronitis occur most frequently?
a. On the hard palate. b. In the area of the labial frenum. c. Around the crowns of partially erupted teeth. d. In the maxillary incisor and cuspid area.
43. (215) In some cases of pericoronitis, the dentist may have to surgically excise and remove the involved
a. operculum. c. retromolar pad. b. tooth crown. d. labial frenum.
44. (216) Why is a thorough curettage of the area where a cyst has been removed important to the success of the procedure?
a. Curettage stimulates the tissue to regenerate. b. Curettage removes bacteria that could lead to an abscess. c. Curettage eliminates rest cells that could lead to the cyst's reoccurrence d. Curettage delays the reformation of tissue and causes the wound to heal from the inside out.
45. (217) A dental granuloma is considered to be
a. an acute infection. c. an acute inflammation. b. a chronic infection. d. a chronic inflammation.
46. (218) Which type of gingivitis is characterized by swollen, red, andbleeding gingiva, covered with a grey-white false membrane, fetid odor, fever,painful gums, swollen cervical lymph glands, and malaise?
a. Hormonal. c. Necrotizing. b. Infective. d. Desquamative.
47. (218) Which type of gingivitis is characterized by an enlargement of the gingiva that is not due to swelling but to tissue growth?
a. Hyperplastic. c. Hormonal. b. Necrotizing, d. Simple.
48. (219) Which disease may be described as an uncommon occurrence of a nonspecific, noninflammatory degeneration of the periodontia?
a. Gingivitis. c. Periodontosis. b. Periodontitis, d, Pericoronitis.
49. (220) Which of the following terms refers to aphthous stomatitis?
a. Cold sore. c. Fever blister. b. Canker sore. d. Koplik's spots.
6 50. (220) The treatment for both aphthous stomatitis and herpes simplex is
a. chemotherapy. c. surgical incision. b. surgical excision. d. palliative in nature.
51. (221) Which disease is caused by the Treponema pallidum bacteria?
a. Syphilis. c. Herpes simplex. b. Periodontosis. d. Aphthous stomatitis.
52. (221) Which stage of syphilis produces a lesion called a gumma?
a. First stage. c. Third stage. b. Second stage. d. Fourth stage.
53. (222) Patients suffering from tuberculosis develop painful oral lesions that form
a. outside the lips. b. along the lateral borders of the tongue. c. in the area of the maxillary tuberosity. d. on and around the zygomatic process of the maxilla.
54. (223) What is an early sign of rubeola?
a. Fever blisters. c. Koplik's spots. b. Cold sores. d. Oral chancres.
55. (223) Which disease is caused by a viral infection of the parotid salivary gland:
a. Mumps. c. Herpes simplex. b. Measles. d. Aphthous stomatitis.
56. (224) Why is it important to identify diabetic patients prior to their dental treatment?
a. Diabetes is a highly contagious disease that requires special sterilization techniques. b. Diabetes impairs the body's healing ability and increases the chances of infection. c. 'iabetes affects the body's coagulation process and hemorrhage control measures must be instituted. d. Diabetes is associated with congenital heart defects and appropriate precautions must be taken.
57 (225) Angular cheilosis is a condition that results from a diet deficient in vitamin
a. E. c. C. b. D. d. B complex.
58. (225) Which agent would be administered to combat a vitamin C deficiency?
a. Penicillin. c. Ascorbic acid. b. Chloromycetin. d. Paramonochlorophenol.
7 1 59. (226) Chemical burns are often self-inflicted by patients who
a. eat hot pizza. b. drink scalding coffee. c. gargle with commercial mouthwashes too frequently. d. place an aspirin tablet on the tissue next to an aching tooth.
60. (227) All of the following are signs and symptoms of a maxiofacial fracture except
a. malocclusion. c. lack of pain. b. abnormal movement. d. history of trauma.
61. (228) Teeth selected for intermaxillary wiring in the immobilization of oral fractures should
a: not be vital to mastication. b. be the ones that may be lost to periodontal disease. c. have opposing teeth in the opposite arch. d. be anterior teeth whenever possible.
62. (229) Regulations prohibit transporting facial fracture patients who
a. are under sedation. b. have fixed intermaxillary wiring. c. could suffer from motion sickness. d. have elastic fixation devices.
63. (230) Which condition results when a normal blood clot fails to form or is ,dislodged after a tooth removal?
a. Pericoronitis. c. Alveolar osteitis. b. Periapical abscess. d. Dental granuloma.
64. (231) Which of the following is a common bony tumor of the mouth?
a.. Canine eminence. c. Maxillary tuberosity. b. Genial tubercle. d. Torus mandibularis.
65. (232) Which of the following systemic causes could result in hypoplastic disturbances?
a. Fluoride deficiency. c. Excessive salivary excretion. b. Periapical abscess. d. Acute eruptive fever.
66. (232) The congenital hypoplasia that results in Hutchinson's incisor is a result of the causative organism of
a. rickets. c. scarlet fever. b. syphilis. d. epidemic parotitis.
67. (233) Select the normal condition in which all the teetn show wear due to the mastication of food.
a, Abrasion. c. Hypoplasia, b, Attrition, d. Erosion.
171 Rs, 68. (234)Which tooth area is most subject to erosion?
3. The tooth's apex. b. The occlusal surface. c. The incisal surface. d. The area near the cemento -enamel junction.
69. (235) The cells that are active in the resorption of bone and dentin are called
a. ameloclasts. c. osteoclasts. b. cementoblasts. d. odontoblasts.
70. (236) All of the following are common methods of drug administration in the dental clinic excepl
a. oral. c. injection. b. rectal. d. inhalation.
71. (236)Which is considered the simplest and easiest method of drug administration?
a. Oral. c. Injection. b. Topical. d. Inhalation.
72. (236) What administration method is usually employe, ) administer aromatic ammonia?
a. Oral. c. Inhalation. b. Topical. d. Injection.
73. (236) What vehicle is usually used with drugs that are to be injected?
a. Sugar. C. Medicinal oil. b. Eugenol. d. Normal saline.
74. (236)Why must extreme care be taken not to inject into a blood vessel when giving an intramuscular injection?
a. Injection into a blood vessel will result in collapse of the vessel and will severely impair circulation. b. Injection into a blood vessel will result in the drug being absorbed too rapidly, thereby putting too much of the drug in the patient's system at one time. c. Injection into a blood vessel can result in internal tissue bleeding that could result in loss of life or limb. d. Injection into a blood vessel delays the systemic effect of the drug since its normal absorption into the muscle does not occur.
75. (237) Systemic drug action produces a response
a. at the site of application. b. that cannot be predetermined. c. that always depresses the action of a gland. d. on an organ or tissue remote from the application site.
76. (238) Which type of drug therapy uses organ or gland secretions in the treatment of deficiency diseases in human beings?
a. )1acement. c. Irritation. b. mulation. d. Depression.
9 ) 77. (239) When the side effect of a drug is, or can be, harmful, it is known as
a. an antagonistic effect. c. an untoward effect. b. a synergistic effect, d. a cumulative effect.
78. (239) Which term refers to the psychological craving for the effect that a drug has on the body?
a. Addiction. c. Tolerance. b. Habituation. d. Idiosyncrasy.
79. (240) The generic name of a drug is the
a. official name for the drug. b. name that was given by the manufacturer. c. name by which the drug must be prescribed. d. name by which a manufacturer distinguishes his drug from like drugs of other manufacturers.
80. (241) Which drug is considered superior for the relief of deep-seated pain?
a. Aspirin. c. Codeine. b. Baryon. d. Morphine.
81. (241) In addition to their pain-reducing action, most non-narcotic analgesics also function as an antipyretic.This means that they
a, kill bacteria. c. induce sleep. b. reduce fever. d. prevent vomiting.
82. (241) Which of the following drugs is likely tp produce a condition known as salicylism if it is taken in frequent large doses?
a. Aspirin. c. Penicillin. b. Codeine. d. Pentobarbital.
83. (242) Antihistamines should never be given in conjunction with a normal dosage of
a. barbiturates. c. hemostatics. b. antibiotics. d. non-narcotic analgesics.
84. (243) Which of the following characteristics is desirable for an antibiotic substance?
a. Have predictable untoward effects. b. Be water insoluble and stable. c. Be able to disturb the function of any vital organ. d. Have selective and effective antimicrobial activity against several microorganisms.
85. (243) An essential requirement for the bactericidal action of penicillinis that the bacteria must
a. have a uniform cell wall. b. be actively multiplying. c. be in a dormant or near dormant stage. d. be comprised of cells having a double nucleus.
PG
10 86. (243) What Ls usually the antibiotic of choice for patients having a known allergy to penicillin?
a. Streptomycin. c. Erythromycin. b. Tetracycline. d. Chloromycetin.
97. (244) What is the function of hemostatics?
a. To relieve tension. c. To kill bacteria. b. To reduce pain. d. To stop bleeding.
88. (244) Which of the following vitamins is most closely associated with the coagulation process?
a. K. c. C. b. D. d. A.
39. (245) What type of injection would a dentist give if he only wanted to anesthetize a small area of tissue and a minimal number of teeth?
a. Topical. c. Regional block. b. General. d. Regional infiltration.
90. (246) What is the purpose of including epinephrine in dentalanesthetic solutions?
a, It speeds the onset of the anesthetic. b. It prevents the possibility of allergic reactilms. c. It prolongs the effect of the anesthesia. d. It eliminates all bleeding during the procedure.
patient? 91. (247) Why would an antisialagogue be administered to a dental
a. To prevent bleeding. b. To reduce the flow of saliva. c. To disinfect tissue at the operative site. d. To combat an allergic reaction tc the anestheticsolution.
destroy microorganisms? 92. (248) What name applies to an agent that functions to
a. Germicide. c. Analgesic. b. Antiseptic. d. Antisialagogue.
93. (249) What purpose do antihistamines serve?
a. They relieve postoperative pain. b. They stimulate the production of secondary dentin. c. They combat the body's allergic reaction to certain agents. d. They speed the onset of othvr dental drugs.
94. (250) The fluoride content of drinking water in southern states ascompared to that in northern states should be
a. the same. c. significantly higher. b. slightly higher. d. somewhat lower.
teeth? 95. (251) What concentration of hydrogen peroxide is used to bleach
a. 3 percent. c. 15 percent. b. 10 percent. d. 30 percent.
11 96. (252) What solvent is effective for partially dissolving and softening gutta-percha points before they are inserted as root canal-filling materials?
a. Chloroform. c. Ethyl alcohol. b. Crange oil. d. Isopropyl alcohol.
97. (253) What solution should you keep available as a neutralizer whenever you art using phenol?
a. Watar. b. Orange oil. c. 50-percent solution of alcohol. d. 3-percent solution of hydrogen peroxide.
98. (254) The value realized through the use of most mouthwashes is
a. psychological. c. bactericidal in nature. b. highly therapeutic. d. destruction of plaque.
99. (255) The removal of plaque from the interproximal surfaces of the teeth is best accomplished with
a. a toothbrush. c. interdental stimulators. b. dental floss. d. a water-irrigating device.
100. (255) Disclosing agents are dyes that are used to stain
a. contrasting areas. c. incipient caries. b. infected gingiva. d. bacterial plaques.
101. (256) The spherical-shaped bacteria are called
a. cocci. c. spirilla. b.bacilli. d. spirochetes.
102. (256) The hairlike appendages that whip back and forth to provide for the movement of some microorganisms are called
a. tails. c. flagella. b. filaments d. spirochetes.
103. (256) What is the dormant form that enables some microorganisms to survive adverse conditions that would normally cause their destruction?
a. Diplo. c. Flagellum. b. Spore. d. Polymorphic.
104. (256) Which listed disease is an example of a virus-caused disease?
a. Measles. c. Ringworm. b. Typhus. d. Rocky Mountain spotted fever.
105. (256) Which microorganisms are primarily ?arasites of insects and art transmitted to man by fleas, lice, mi:es, cr ticks?
a. Viruses. c. Bacteria. b. Protozoa. d. Rickettsiae.
106. (257) Which bacteria derive their nourishment from dead or decaying matter?
a. Fungi. c. Pathov-..ns. b. Parasites. d. Sapr4hv:es.
12
17 S 107. (257) Bacteria that are classified as virulent pathogens are those that
a. do not damage their host's tissue. b, derive their nourishment from dead or decaying matter. c. cause infection so severe that the host is permanently damaged. d. live on the host but do not cause serious damage.
108. (257) Which of the following bacteria grow only in the absence of oxygen?
a. Aerobic. c. Pathogenic. b. Anaerobic. d. Facultative.
109. (257) Bacteria that retain a pinkish-red color at the completion of a gram- staining process are called
a. mordant. c. gram-negative. b. facultative. d. gram-positive.
110. (257) Which of the following coccal forms of bacteria are implicated in the process of dental caries?
a. Streptococci. c. Veillonella. b. Staphylococci. d. Neisseria.
Ill. (257) Which of the following bacteria appear in large numbers when necrotizing ulcerative gingivitis is present?
a. Spirilla. c. Staphylococci. b, Streptococci. d. Fusiform bacilli.
112. (257) Which of the following, when viewed with a phase microscope, appear as comma-shaped bacteria that are extremely mobile?
a. Vibrios. c. Stmptococci. b, Leptothrix. d. veillonella.
113. (257) Which bacteria are predominant in an edentulous mouth?
a. Facultative coccal forms. b. Aerobic filamentous forms. c.. Aerobic cocci and short-rod forms. d. Anaerobic cocci and filamentous forms.
114. (258) The cutting edge of a properly sharpened dental instrument will
a. show as a surface when viewed through a magnifying glass. b,not reflect light. c. not cut a fingernail. d. retain its sharpness when disinfected in boiling water.
115. (258) What action should you take if the surface of your Arkansas stone becomes glazed?
a. Discard the stone and order new one. b, Soak the stone in an ammonia-water solution. c. Place the stone in the autoclave and run it through a sterilizing cycle. d. Run a mandrel-mounted sharpening stone over the surface until the glaze is removed.
13 1 116. (258) Which of the following instruments should you sharpen with a mandrel- mounted sharpening stone?
a. Chisel. c. Hatchet. b. Curette. d. Spoon excavator.
117. (259) Which of the following autoclaving cycles would normally suffice for the sterilization of dental instruments?
a. 10pounds pressure at 200°F.for 10 mirutes. b, 15pounds pressure at 200°F. for 10 minutes. c. 15pounds pressure at 225°F.for 15 minutes. d. 15pounds pressure at 250°F.for 20 minutes.
118. (259) Which of the following actions should you take to remove heavy scale deposit from the inside of an autoclave?
a. Wash with soap and a soft brush. b. Scour the inner surfaces with steel wool and pumice. c. Add 1/2-cup vinegar to the water and run the autoclave through a sterilizing cycle. d. Replace the autoclave's water with a solution of ammohia and hydrogen peroxide and run the autoclave through a sterilizing cycle.
119. (259) Bacterial spore strips should be employed to verify the effectiveness of the autoclave at least
a. weekly. c. quarterly. b. monthly . d. annually.
120. (259J Sterilization in the dry heat sterilizer requires the exposure of instruments to a temperature of.350° F. for a period of
a. 10 minutes. c. 30 minutes. b. 20 minutes. d. 60 minutes.
121. (260) When you disinfect an instrument with boiling water, how long must you expose the instrument to continuous boiling?
a. 5 minutes. c. 20 minutes. b. 10 minutes. d. 30 minutes,
122. (260) What is the ideal concentration of alcohol for use as a disinfectant?
a. 50 percent, c. 90 percent. b. 70 percent. d. 100 percent.
123, (261) How and when should you date a sterilization pack?
a. ?lace the dare you will sterilize the pack on the outside wrapper prior to sterilization. b. ?lace the date you sterilized the pack on the outside wrapper after the pack is sterilized. c. ?lace the date that the pack will no longer be considered sterile on the outside wrapper prior to sterilization. d. Place the date that the pack will no longer be considered sterile on the outside wrapper after the pack is sterilized.
124. (261) You should disinfect the trays of the dental instrument cabinet et least
a. daily. c. monthly. b. weekly. d. quarterly.
14 1 0
1. T
Pre fac
THIS THIRD VOLUME of your Career Development Course (CDC) is designed to provide you with a knowledge of the materials and instruments employed in the prac- tice of modern dentistry. The first three chapters of this volume are concerned with dental instruments. Each chapter has been carefully planned to cover a particular seg- ment of the many instruments available through Air Force supplychannels. In the first chapter are what are termed the -general" dental instruments, the instruments that are commonly used in more than one section of the dental service. To be specific, these are the diagnostic and rotary instrument groups, plus somemiscellaneous instruments that are common to many sections. Chapter 2 concentrates on the restorativeinstru- ment group. These are the instruments that areused in preparing carious teeth to receive restorations and in manipulating. placing. and finishing therestorations. As you study the instruments in Chapters 2 and 3.remember that many of the instruments discussed in Chapter Iare used in conjunction with theseinstruments. The third chapter focuses attention on the specialty instruments, theinstruments used in oral surgery and in the periodontic. endodontic.and prosthodontic sections. Much time. effort. and expense have been expended to provide several foldouts thatillustrate the whole realm of dental instruments. These foldouts present one of the mostcomprehen- sive coverages of dental instruments ever published(printed in a supplementary volume). Make it a routine practice to study theseillustrations aeyou read the text that concerns them. The last chapter isdevoted to the many materials used throughout various sections of the dental service. For the most part, this volume revievs the relatedmaterial you studied in your 3- level training. This review should reinforce yourknowledge of instruments and materials and help you make a smooth transition from onepatient treatment specialty to another. Further, it should better prepare youfor your promotion (SKT) testing. If you have questions on the accuracy or currency of thesubject matter of this text, or recommendations for its improvement,send them to School of Health Care Sciences/MSTW. Sheppard AFB TX 76311. If you have questions on course enrollment oradministration, or on any of ECI*s instructional aids (Your Key to Career Development.Behavioral Objective Exercises. Volume Review Exercise. and Course Examination), consult youreducation officer, training officer. or NCO. as appropriate. If he can't answer yourquestions, send them to ECI, Gunter AFS AL 36118.preferably on ECI Form 17, Student Request for Assistance. This volume is valued at 30 hours (10 points). Material in this volume is technically accurate, adequate. and current asof October 1974.
i i i
1 S2 Contents
Page
Preface iii
Chapter
General Dental Instruments
2 Restorative Instruments 10
3 Specialty Instruments 17
4 Dental Materials 33
Answers fur Lrercises 57
QA CHAPTER 1 Me
liOTE: In this volume, the subject matter is developed by a series of LearningObjectives. Each of these carries a 3-digit number and is in boldface type. Each sets a learning goalfor you. The text that follows the objective gives you the information you need to reach thatgoal. The exercises following the information give yuu a check on your achievement. When youcomplete them, set if your answers match those in the back of this volume.If your response to an exercise is incorrect, review the objective and its text.
General Dental Instruments
TEAMWORK IS THE kcy in thc Air Forcc Dental whereas thc nib is thc working part of condensing Health Servicc. Nonc of your duties is morc instrumcnts. Figurc I-1 illustratcs thc parts of important than carrying your sharc of thc tcam dental hand instruments. load. Thc dcntist relies upon you. as his assistant, to Classification Names. Thc name of thc dcntal aid him in many ways. Onc of these ways is in thc hand instrumcnt is derived from its association with proper handling of dental instrumcnts. You must one, or a combination, of thc following classifica- havc a sound knowlcdgc of the great varicty of these tion factors: instruments and be able to anticipate thc needs of Thc purpose of the instrumentexcavating, the dcntist. Dentists vary in thc techniques thcy use scaling, and condcnsing. for a givcn dental proccdurc. Thcy may use Thc positionormanner of use---hand different instruments, and you must havc thc right condcnscr, automatic mallet, and push scaler. instrumcnt rcady at the right time. In this chaptcr. Thc shape of thc working endfile, chisel, you will begin to learn thc instrumcnts that arc used spoon, and hatchet. for thc trcatmcnt of dcntal conditions. Thc angle of thc working cnd in relation to the handlebiangle. I-I. Classification of Instruments An cxamplc of a combination of thc abovc Whcn you considcr thc largc number of classification factors is thc bianglc chisel. instruments nccdcd to trcat various dental Instrument Numbers. In addition to the conditions, it is apparent that thcre must be a way to classification names, instrumcnts arc also distinguish onc instrumentfrom anothcr. numbcrcd. Normally, there arc two diffcrcnt Instruments arc classified or idcntified by a numbcrs on thc handle of most dcntal hand combination of several factors. instrumcnts. Onc is an idcntification number: thc othcr is a formula number. Also, the instrumcnts 400. Name the parts of specific dental hand may carry an abbreviation (BI, Wds,Hol). These instruments and state how the instruments are abbreviations arc rcfcrcnccs to thc instrument's identified. designer (Black. Woodson. Hollcnbcck.) Thcsc references also hclp to idcntify thc instrument. Instrument Parts. Thcrc arc three main parts of Identification numbers. Thcsc numbcrs arc a dental hand instrument, the handlc, the shank. normally on thc portion of thc handle farthest from and thc working cnd. Thc handlc is thc part hcld in thc working end of singlc-cnded instrumcnts and thc operator's hand. Some instruments, such as near the ccntcr of double-ended instrumcnts. As mouth mirrors and Morse scalers, havc dctachablc thcir namc implics, thcy idcntify thc instrumcnt. handles. This allows you to replace the shank and For instancc. therc arc fivc Black's condensers of thc working cnd without purchasing a ncw handlc. various sizes and shapcs. The identification number Thc shank is thc tapered conncction between thc makes it possible to distinguish one from another handlc and thc working cnd. The working cnd, of whcn thc dentist requests an instrumcnt or whcn course, is thc part designcd to perform a certain you arc ordcring one from supply. operation. It can be cithcr a blade or a nib Thc Formula numbers.Formula numbcrs fully bladc is thc cutting cnd of cutting instruments. dcscribc thc instrumcnt, and bccausc of thcir
I
1 81 HANDLE it SHANK ---)IBLADE o le
CUTTING EDGE
0 FACE HANDLE SHANK --0 1(
( \ NIB
Figure I .1. Parts of dental handInstruments. length, are not primarily used for identification In discussing diagnostic instruments,we should purposes. The rormula number isa group of point out that they often have functions other than numbers, which is normally locatedon the handle. diagnosis. Normally the diagnosticgroup is a near the working end, of most dental hand mouth mirror, an explorer, and dressing forceps. instruments. They describe the width,length, angle, These three instruments are placed on the bracket and sometimes the angle ofcurvature of the table before almost all dental procedures. instrument's blade. Diagnostic aids help in making or confirming the dental officer's diagnosis. Refer to foldout I. Exercises (400):
I. Name the three main parts ofa dental hand 401. Given an illustration of diagnostic insb.u- instrument. ments and aids used in dentistry, identify each by use and name.
Mouth Mirrors.Mouth mirrors (illustrated in 2. What name appliesto the working end of FO 1) are used to view hard-to-seeareas in the condensing instruments? mouth, to retract tissues, and to reflect light into dark areas of the mouth. Since mouth mirrors often become scratchcd and clouded, you must inspect them often and take corrective action. Aswe 3. What factors arc associated with an instru- mentioned earlier, the mouth mirror hasa mcnt's classification name? detachable handle. Simply unscrew the shank and mirror portion and screw a new one into the handle. The Air Force stocks three types of mouth 4. Where on an instrument's handle does the mirrors: the plane glass with a front reflective identification number usually appear? surface, the plane glass with a glass-covered reflective surface, and thc magnifying mouth Mirror. (1) The mirror with the front reflective surface 5. What numbers on the instrument'shandle produces the most accurate imagc of the nem being describe the width, length, and angle ofthe reflected. Handle these mirrors with extracare instrument's blade? because thc reflective surface is on top of the glass and is easily marred and scratchcd. (2) The glass-covered r-gective surface mirror is thc most common m Air Force dental clinics. However, since the reflective surface is glass covered, the "ghost" image it produccs isa 1-2. Diagnostic Instruments and Aids disadvantage.
2 1 S 5 11i (3) The magnifying mirror produces an are equipped with a handle for each diagnostic aid. enlarged image. This mirror is used when minute The vitalometer is also known as the pulp tester, and detail is required in a dental treatment procedure. is used to determine the vitality of pulp-nerve tissues in teeth. It actually passes electrical current Another diagnostic instrument is the explorer. to the tooth. With the vitalometer the operator can Explorers. The explorer is another dental start at zero and gradually increase the amount of instrument used in many dental procedures. current until there is a mild reaction from the Explorers have sharp-pointed working ends called patient. The sensation produced by the vitalometer tines. This instrument is usually considered a on a tooth has been described as a "tingling diagnostic instrument because itis used to detect feeling." The vitalometer is shown in foldoutI. small cavities and to check the depth of cavities. Like the transilluminator, the vitalometer tip must The dental officer also uses explorers to probe for be disinfected with a chemical solutionnot with foreign bodies, to determine the margin quality of heat-type sterilization. A different type of fillings, and to detect fractured tooth enamel. diagnostic aid is the dental radiograph. Explorers are available in various sizes and shapes. Dental Radiographs. Dental radiographs, also You may find one each of several kinds or all of known as dental X-rays, are very valuable as one kind in the dental treatment room you are diagnostic aids. They are similar to small assigned to maintain. Be sure to replace explorers photographic negatives. (A periapical dental with broken or bent tines (see FO 1). A third radiograph is shown in FO 1.) In this respect, a instrument usually placed in the diagnostic group is radiograph is a shadow image of a substance or the dressing forceps. body projected on radiographic film. The dentist Dressing Forceps. Dressing forceps are curved, looks at a dental radiograph as a negative image of tweezerlike instruments (see FO 1). They are used the tissues of the mouth, and is able to diagnose, in many dental treatment operations. In the with the use of dental radiographs, oral conditions examination section, the dental officer uses that would otherwise have been invisible. Dental dressing forceps to carry cotton pellets for drying radiology will be covered in greater detail in a teeth or cavities. Used inthis way, they are subsequent chapter. One other aid frequently used diagnostic instruments. Since they are used to carry by the dentist is the clinical thermometer. cotton pellets, they are frequently referred to as Clinical Thermometer. The clinical cotton pliers or cotton forceps. Dressing forceps are thermometer has proved to be very valuable at times sometimes used to apply medicaments and to help the dental officer determine the correct dressings. You should place a pair of dressing diagnosis. A clinical thermometer is shown in forceps along with a mouth mirror and explorer on foldout I. Sometimes, infections in the oral cavity the bracket table for almost every dental procedure. increase body temperature. Whenever the dentist Other items the dentist uses to make a proper suspects that infection is present, he can usethe diagnosis are called diagnostic aids, and include the thermometer to verify his tentative diagnosis. Keep transilluminator, vitalometer, radiograph; and thermometers disinfected in a cold, chemical clinical thermometer. solution. Some authors might include other items as Transilluminator. The transilluminator may diagnostic aids, but those we have presented are the also be referred to as a diagnostic lamp (see FO I). primary ones used in the Air Force dental service. Itis a small mouth lamp found in some dental operating units. By directing this light through the Exercises (401): gingival tissues, the dentist can detect certain I. Identify the diagnostic instruments and aids gingival fluids, calculus, and foreign bodies. There illustrated in foldout 8, exercise 401, by is also a battery-operated transillummator which is placing their name in the space provided sometimes made available when dental operating below: units are not equipped with one. Maintain these a. lamps by keeping them clean and disinfected. Do not try to sterilize transillummatorswith any heating rype of sterilization. The outer case is made of plastic and is deformed at heat sterilization b temperatures. Disinfect them with a 70-percent Isopropyl alcohol solution or other approved disinfecting chemical agent. Another diagnostis: aid
operated by electrical power is the vitalometer. C. Vitalometer. The vitalometer (shown in F01) is another device found on some dental operating units and is available as a portable ktt. Some of those found on a dental operating unit operate from d. I the same handle as the transit luminator Other units e. procedures. Your responsibility with thisgroup ranges from maintaining an adequate number in the treatment room to changing them in the handpiece. Rotary instruments may be categorizedas burs, disks, wheels and points, and polishers. Theyare used in three different handpieces. 402. Identify the types and uses of the burs employed in dentistry.
Types of Handpieces. You have already learned that there are several types of handpieces used in Complete exercises 2 through 6 by placing the dentistry. Each rotary instrument is designed fora appropriate letter from foldout 8, exercise 401, in particular handpiece. To indicate the handpiece in the space provided. which a rotary instrument functions, handpieces 2.This instrument is used to detect small have been categorized as friction grip, straight cavities and to check the depth of handpiece, and angle (latch) types. The cavities. It is also used to determine the abbreviation for friction grip instruments is FG and marginal qualities of fillings and to they are used in ultraspeed handpieces. These detect fractured tooth enamel. instruments have a small shank and are held in the handpiece by friction against a metalor plastic chuck. The abbreviation for straight handpiece rotary instruments is SHP. SHP instruments are 3.This instrument is used to direct light used in conventional straight handpieces and slow- through the gingival tissues to detect speed, air-driven straight handpieces. The shankon certain gingival fluids, calculus, and SHPs is larger in diameter than the FG shank and at foreign bodies. least twice as long. The angle handpiece instrument (AHP) is used in conventional contra-angle handpieces. Common AHP rotary instruments have the same diameter as SHP instruments but are about 4.This instrument is used to carry cotton half the length. However, some AHP instruments pellets to dry teeth and to apply are made with a short shank. Foldout Iillustrates medicaments and dressing. the latch-type, the straight handpiece, and types of friction grip burs. Let us consider one family of the rotary instrument group, the burs. Dental Burs. Dental burs are available in many 5.This instrument is used to view hard-to- sizes and shapes and are made of either steel or see areas of the mouth, retract soft tissue tungsten carbide. They are used in nearly all of the mouth, and reflect light into dark sections of the dental clinic. Dental burs are further areas. classified as excavating, finishing, denture trimming, and dental surgery burs. Excavatmg burs. The dental burs used by the dental officer to prepare cavities are known as 6.This instrument is used to determine the excavating burs. They are designed for specific vitality of pulp-nerve tissues in teeth. functions ranging from removing decay to making undercuts. The excavating bur designs are round, inverted cone, straight fissure, tapered fissure, and end cutting. Foldout I shows the various excavating bur designs: 1-3. Rotary Instruments a. Round burs are, as the name implies, in the shape of a sphere on a shank. They are numbered The rotary instrument group includesa great 1/4,112, 2. 4, 6, and 8, with the largest number number of small separate items. These instruments being the largest (as in all groups of burs). (See FO are made from many materials and combinations I, bur sizes.) They are also available in steel and of materials ranging from diamonds tovery finely tungsten carbide for some numbers and used in detailed steel. Rotary instruments have many uses, contra-angle, friction grip, and straight handpieces. among which are preparing cavities, finishing One exception isthat all numbers may not be restorations, trimming dentures, polishing teeth, available for each handpiece. Round burs are and removing bone in oral surgery cases. The rotary designed to gain entrance into tooth structure and instruments are a vital part of most dental treatment to remove decayed tooth substance.
4 b. Inverted cone burs are shaped like small smooth and shape tooth-restoring materials. These cones inverted on the shank. In the Federal Supply burs are available in various shapes to enable the Catalog, these burs are numbered 33%, 35, 37, and dentist to recreate, as closely as possible, the 39, with number 39 the largest There may be original shape of the tooth. Finishing burs are made variations in the metal quality and sizes available of steel and are used in contra-angle and straight for each handpiece. Inverted cone burs are used to handpieces. These burs are easily differentiated make undercuts in the cavity preparation. These from excavating burs by the fineness of the cutting undercuts are necessary for the proper retention of blades on the working ends. The finishing burs for filling materials. Otherwise, the filling materials use in contra-angle handpieces are numbered 6, might fall out of the prepared cavities. 200, 218, 224, and 242 in the Federal Supply c. Straight fissure burs are small cylinders with Catalog. Those for use in the straight hand pieces are grooves machined into their outer walls. These numbers 200 and 224. The shapes of these finishing grooves are either plain or crosscut. The plain burs are easily described. The #6 bur is a rounded- fissures have semispiral grooves running generally spear shape: the #200 is round and often mistaken lengthwise on the small cylindrical working end of for a round excavating bur. Bur #218 is oval the bur. Crosscut fissures have lengthwise grooves shaped, #224 is bud (flower bud) shaped, and that have been further cut crosswise on the working #242 is sugarloaf or flame shaped. Another end of the bur. The straight crosscut fissure burs are category of burs is the denture trimming variety. numbered 557, 558. and 559 in the Federal Supply Foldout 1 shows three of them. Catalog. Most of the crosscut fissure burs are made Denture trimming burs. The dentist uses denture from tungsten carbide. The straight plain fissure trimming burs to trim acrylic resin denture base bur is number 57 in the Federal Supply Cat Wog and materials. For hand use, these burs are available for is available in the friction grip style only. The main only the straight handpiece. Denture trimming burs use of straight fissure burs is to smooth and shape are also used in lathes in the dental laboratory. cavity walls. Denture trimming burs are made of steel, and the d. Tapered fissure burs are small tapering working end is nearly as large as the crown of a cylinders with grooves machined into their outer tooth. The Federal Supply Catalog lists these bur walls. Like the straight fissure burs, the grooves on shapes as flame, pear, and round. The last examples tapered fissure burs are available in plain or of dental burs are the dental surgery burs. crosscut patterns. The Federal Supply Catalog lists Dental surgery burs. Dental surgery burs are used the crosscut tapered fissure burs as numbers 699. either to cut bone or to cut tooth structure. Foldout
700, 701. 702, and 703. Most tapered fissure burs 1 illustrates the surgical burs: are made from tungsten carbide, and some numbers (I) The Henahan #41 bur is used to cut bone. It are not available for all three handpieces. The plain is sometimes used to remove the bone covering an fissure tapered burs are also made of tungsten impacted third molar. The Henahan #4 1is a steel carbide and are used in friction grip handpieces bur and is available for either the contra-angle (ultraspeed handpieces). Two plain tapered fissure (AHP) or the straight handpiece (SHP). burs are listed in the Federal Supply Catalog. (2) The #703 straight handpiece bur is listed in numbers 169L and 170L. Tapered fissure burs are the Federal Supply Catalog as a dental surgery bur. It used to smooth and shape the walls of a cavity is made of tungsten carbide, which makes it suitable preparation, as are straight fissure burs. However,. for cutting either bone or the harder tooth tapered fissure burs are particularly useful in structures. The oral surgeon sometimes uses this bur preparing teeth for inlay and full crown to completely or partially section a tooth for easier restorations. removal. e. End cutting burs are small cylinders with the tip designed to cut tooth structure. The number 901 Exercises (402): identifies this style of bur in the Federal Supply Catalog. It is available in both the friction grip and In exercises 1 through 8, identify the types and uses contra-angle types. The end cutting burs are used to of dental burs by placing the appropriate letter or shape and finish the gingival floor for crown and letters from foldout 8, exercise 402, in the space fixed partial denture preparations without the risk provided below each question. of removing more tooth structure from prepared 1. Which burs are designed for use in the: cavity walls. The chief use of all of the burs we have a. Latch-type handpiece? discussed thus far is to remove P^oth structures. Other types of burs are used to perform other functions and are divided accordingly. One of these is the finishing bur. b. Straight handpiece?
Finishing burs. Finishing burs (F0 1) are used
5
1 S c.Ultraspeed handpiece? wide variety of sizes, shapes, and abrasive grit. They are designed for contra-angle and straight lyndpieces. (See FO 1.) Manufacturers' provide abrasive disks either mandrel-mounted or unmounted. A mandrel isthe 2. Which burs are classified as finishing burs? shaft upon which a disk is mountedat one end while the other end inserts into the handpiece. Mandrels are available for contra-angle and straight handpieces. Some mandrelsare designed to 3. Which burs are used to cut boneor tooth hold disks in place by spring tension: othersare structures during oral surgery procedures? designed with a small screw inone end. Other mandrels are permanently mountedto the disk, such as certain types of diamond disks. Small diamond chips are one of the cutting 4. Which bur is designed to make undercuts in the materials used on abrasive disks. These diamond cavity preparation? chips, bonded to a metal base, make avery effective enamel-cutting material. The surface planeon diamond disks ranges from flat toconcave to convex and usually one side is covered with 5. Which bur is used to trim acrylic resin denture abrasive chips while the other side is freeof base materials? abrasives. Such disks are called safe-sided disks. Other abrasives used in the fabrication of abrasive disks are aluminum oxide, flint, garnet, and silicon carbide. Aluminum oxide abrasivesare 6. Which burs are classified as excavating burs? available on either metal or plastic-backed disks. Flint, garnet, and silicon carbide abrasivesare bonded to paper or plastic-backed disks. Some disks, such as the separating variety, are made only 7. Which excavating bur is designed to gain of silicon carbide and are pressed into the form of a entrance into tooth structure and to remove double-sided abrasive disk held together by a decayed tooth substance? bonding material..Another of the rotary instruments is the abrasive wheel. Abrasive Wheels and Points. Abrasive wheels and points are very similar to abrasive disks. Their 8. Which bur is called an end cutting bur? primary use is to reduce and smooth high spotson restorations and prosthetic devices. Like disks, wheels and points are either mandrei-mounted or unmounted, and use some of the same abrasives. 9. In the spaces provided, enter the number(s) (See FO 1.) The greatest difference is in the shape of used to identify the following excavating burs: the working end. Generally speaking, disks are a. End cutting thinner and usually the abrasive is on onlyone side. b. Inverted cone In wheels and points, the abrasive is usually on both c. Tapered fissure sides and on the outer edge as well. Furthermore, d. Round wheels and points are sometimes made with e.Straight fissure different types of abrasives. For example, rubber f Plain tapered fissure impregnated with pumice or silicon carbide and g. Plain straight fissure glass is used to fabricate abrasive wheels. Still another difference is that some wheels and points can be used in ultraspeed handpieces, whereas disks are used in conventional speed contra-angle or straight handpieces The last type of rotary instruments is the polisher type. 403. Answer key questions about the abrasive Polishing Instruments. Polishing instruments disks, wheels, and polishing instruments are usually used with an abrasive to remove stains employed in dentistry. or to polish teeth, restorations, and dental appliances. These polishers come in three Abrasive Disks. Abrasive disks are circular- formscup, brush, or buffing wheel. (See FO.) shaped cutting instruments. They are used by the The polishing cup is made of rubber and is used to dental officer to cut tooth structures and to smooth polish teeth and restorations. These cups screw into and polish restorations. Disks are available in a a slow speed.right -an tge(prophylaxis) handpiece or
6 139 into a contra-angle mandrel. An abrasive, 7. For what tasks are polishing instruments zirconium silicate, is used with the polishing cup to usually employed? polish natural teeth. The polishing brush screws into the right-angle handpiece like the polishing cup. It is made of natural bristles (swinehair) mounted on a screw stem. The polishing brush is 8. How are the polishing caps and brushes used used to remove stains from tooth fissures and other for prophylaxis secured in the right-angle areas that the polishing cup cannot reach.The handpiece? wheel-type polishers are used primarily in the dental laboratory for polishing dentures and other prosthodontic appliances. They range in diameter from three-fourths of an inch to 4 inches. Some of 9. For what use would a 3-inch diameter chamois the materials used to fabricate these wheels are polishing wheel be employed? chamois, felt, cloth, and fiber bristles. You must have the necessary rotary instruments available in your assigned dental treatment room. You must also properly clean, disinfect, sterilize, 10. Why must some rotary instruments be and store all dental instruments. Generally disinfected rather than sterilized? speaking, you should clean the excavating burs with a scratch brush and sterilize them in theautoclave. Discard paper- and plastic-backed abrasive disks after one use. Some steel burs should also be discarded after one use. Disinfect other abrasive disks and wheels in a chemical solution rather than 1-4. Miscellaneous Dental Instriments in the autoclave. Autoclaving temperatures can affect the abrasive bond (glue). Sterilize all Whenever attempts are made to divide a large instruments to be placed in the patient's mouth by group of associated items into logicalsubdivisions, autoclaving or by using dry heat, if at all possible. it is practically inevitable that some problems arise. This, of course, occurs with dental instruments. Most dental items can be directly or primarily Exercises (403): associated with a particular dental specialty; some, I. What is a mandrel? however, cannot. We can, however, combine such items in a "miscellaneous section." In this section we will discuss anesthetic syringes,rubber dam instruments, the vernier caliper, cotton roll holders, 2. What name applies to a disk that has one side the saliva ejector mouthpiece, and the napkin covered with abrasives and the other side free holder. Refer to foldout 1 as we discuss these of abrasives? instruments. 404. Indicate, as true or false, statements about the items classified as miscellaneous dental 3. For what purposes would a dental officer use instruments. abrasive disks? Anesthetic Syringes. Anesthetic syringes are used in dentistry to inject a local anesthetic. These syringes differ from most syringes because they are 4. What are the primary uses of abrasivewheels? designed to inject anesthetic from a carpule. There are basically two types ofsyringesthe aspirating and the nonaspirating. They look similar, but the aspirating syringe has a small "harpoon" on the 5. What is the general difference between abrasive plunger that embeds itself into the rubber stopper of disks and wheels? the carpule. This enables the dental officer to asp:rate and see if he has entered a blood vessel. These syringes use disposable needles that are available in different gauges and lengths. Normally, 6. What types of handpieces can be usedwith you fit the syringe with a short needle (I3/I6-inch length) for maxillary injections, and a long needle abrasive disks? (I Va-inch length) for mandibular injections.
Rubber Dam Instruments. The rubber dam
7
1 go instrument set includes the rubber dIn punch, used mostly on the mandibular arch. They are rubber dam clamps, rubber dam clamp forceps, and designed in right and left types for the right and left rubber dam holder. These instrumentsprepare and sides of the arch. This instrument maintains the maintain the position of thin sheets of latex rubber. cotton rolls in position on both the lingual and The rubber dam itself is used to isolatea designated facial sides of a tooth (or teeth). Cotton rolls held in tooth or teeth in the mouth before certain such a position isolate or dam saliva from the area restorative or endodontic procedures. The rubber under treatment. Some cotton roll holders also have dam actually keeps mouth fluids, tissues, and the a metal plate to restrict tongue movement and a tongue away from the operation site. Refer to built-in saliva ejector. foldout I. Saliva Ejector Mouthpieces. Saliva ejector Rubber dam punch.The rubber dam punch is mouthpieces are connected to the saliva ejector used to make the necessary spaced holes in the hoses on dental operating units. This combination rubber dam. On the working end is a plunger on removes excessive saliva and small particles of one side and a wheel on the other side, with holes of debris from the patient's mouth. In this way, the different sizes on the flat surface facing the plunger. area treated remains fairly free of obstructing fluids These features enable the operator to select and to provide the dental officer with needed adjust the wheel to punch a hole of the desired continuous working time. Saliva ejector diameter in the rubber dam. mouthpieces are available in two typesmetal and Rubber awn clamps.After the required number plastic. The metal type can be cleaned, resterilized. of holes are punched in the rubber dam, it is then and reused, but most dental clinics now use the stretched tofit over each designated tooth. To disposable plastic type. The plastic type offers maintain a snug fit around the neck of the tooth, a several advantages over the metal type. Plastic saliva rubber dam clamp is used. These clamps are made ejector mouthpieces are conveniently discarded of spring steel in various sizes to fit the general after use, they can be easily bent to the desired contours of the different teeth. The space between shape, and because of their softer and fle,tible the gripping edges is narrower than the diameter of quality, they are more comfortable for the patient. the corresponding tooth. Thus, to place the clamp The last item in the miscellaneous group is the around the tooth, the gripping edges must be spread napkin holder. wider than the tooth diameter. To spread the Napkin Holder. The napkin holder is com- gripping edges, a rubber dam clamp forceps is used. monly called a towel chain. It holds a towel or Rubber dam clamp forceps.The rubber dam paper napkin around a patient's neck during dental clamp forceps spreads the two working ends apart treatment. The chain is similar to the one that holds when the handles are squee2ed together. On the your identification tag around your neck .. however. working end are small projections that fit into two it has a small alligator clip on each end. corresponding holes on the rubber dam clamp. The Exercises (404): area between the working end and the handle is equipped with a sliding lock device. This locks the Indicate whether the statements beloware true or handles in position while the rubber dam clamp is false by circling the T or F located to the left of the being maneuvered around the tooth. statement. Rubber darn holder.To place and clamp a rubber T F I The anesthetic syringes used in dam around the tooth is not enough. The loose dentistry are designed to inject outer edges of the rubber dam sheets must be held to anesthesia from a carpule. provide visible access to the tooth being treated. This is done with an instrument called the rubber dam holder. Most of the rubber dam holders used today are U-shaped. One of the more popular ones T F2. Short anesthetic needles are usually is called the Young's frame. When the edges are used for maxillary injections connected to the small, sharp projections on this U- frame, the dentist h.....s adequate access and visibility to the area of trntment. Vernier liper.Cr. The vernier caliper is T F3. You can easily distinguish the non- frequently called the Boley gauge, and is calibrated aspirating syringe from the aspirating in millimeters. It is used for precision measurement syringe because the plunger of the in the endodontic and prosthodontic treatment nonaspirating syringe has a small, har- rooms and the dental laboratory. You can measure poon-type tip. with the vernier caliper, whether you are using the side with points marked A and B or the opposing side marked with points Y and Z. (See FO I.) Cotton Roll Holders. Cotton roll holders are T F4. Rubber dam clamps are made of T FS. The vernier caliperwould never be spring steel in various sizes to nt the section. general contours of the different teeth. used in the endodontic
T F9. The vernier caliperis commonly T F5. The rubber dam punch producesthe called a tioley gauge. same size hok in therubber dam for each tooth.
T F 10. Cotton roll holdershold cotton rolls in such a position as toisolate or dam T F6. The rubber dam isprimarily used in saliva from tt'A area under yeoman. the oral surgery section.
T F 11. The salivaejector mouthpieces holders used preferred by most clEnics are T F7. Most of the rubber dam constructed of plastic. today have an X-shape.
e 9 1 9,2 CHAPTER 2
Restorative Instruments
THE RESTORATIVE instrument group ends. Basically, three types of chisels are used in" encompasses the largest portion of the entire dental restorative dentistry. instrument inventory. This group is composed of Wedelstaedt chisels.The Wedelstaedt chisels the instruments needed to prepare the teeth to carry the identification numbers 41 and 42. They receive restorations, to form matrices around cavity are a paired set. The bevel of the cutting tip on the preparations, and to manipulate, carry, condense, #41 chisel is in the opposite direction from the and finish restorations. These are not, of course, the bevel on the #42 chisel. The Wedelstaedts have only instruments needed in the restorative section. slightly curved shanks rad are used primarily on Many of the diagnostic, rotary, and miscellaneous anterior teeth. Foldout 2 displays the Wedelstaedts. instruments already discussed are also employed in Slightly modified versions of this instrument design the restorative dentistry section. are the double-ended Black #3, *4, and #5, #6 chisels. Another type of restorative chisel is the 2-1. Cutting Instruments straight chisel. Straight chisels. The straight chisel group Many dental procedures require the use of consists of the #48 and the Black #84, #85, and instruments with sharp cutting edges. Because of the #86. As their names imply, they have straight many hard-to-reach areas in the human mouth and shanks. You can see in foldout 2 that the #48 chisel the various functions required, cutting instruments has a broad triangular-shaped working end, while are made in a wide variety of sizes and shapes. The the #84, *85. and #86 chisels have straight cutting instruments we will discuss in this section working ends. The difference within this group of are those that are primarily used in restorative chisels is in their blade width. The #84 chisel is the dentistry. This cutting instrument group includes broadest and the #86 the narrowest. chisels, hatchets, hoes, gingival margin trimmers. Biangle chisels.The biangle chisels carry the and excavators. Other dental instruments have instrument identification numbers of 81 and 83. cutting edges but are usually included in a different (See FO 2.) They have two distinct angles in their group, such as the oral surgery or periodontic design, one at the shank and one at the working group. Refer to foldout 2 as you study the end. This design allows access to tooth structures restorative cutting instrument group. that would not be possible with a straight chisel. A double-ended version of the biangle chisel is the 405. Identify the type and use of the cutting Black #40 and #41. instruments la restorative dentistry. Excavators. Among the dental hand instruments is the excavator group. In this Chisels. Dental chisels are frequently described instrument group are the hatchets, hoes, spoons, as miniature wood chisels. The cutting edge is and other variations (claw, disk, and gouge) of the usually at a right angle to the axis of the blade. The spoon-shaped working end. shank width on _a chisel is also constricted, Hatchets.A dental hatchet resembles a camper's compared to the blade width in most cases. Chisels hatchet in miniature. Like dental chisels, some have are used to cleave (split) tooth enamel, to smooth single cutting ends, and others have cutting edges cavity walls, and to sharpen line and point angles. on both ends of the handle. Hatchet blades are set at Each chisel is designed to reach specific areas of the a 450 to 90° angle from the handle and shank. mouth. You need to be careful in handling chisels These instruments have different lengths and widths because the cutting edges are dulled very easily. of blade. Hatchets are used on the walls of the Even though a dental instrument is made from the cavity preparation to cleave enamel and cut dentin finest metal available, a slight blow of its cutting in order to help establish a sharp cavity outline. edge against a metal object greatly reduces its There are basically two types of hatchets: the bi- cutting ability. Some dental chisels are single- bevel and the single bevel. ended, whereas others have cutting edges on both u. Bi-bevel hatchets. The bi-bevel hatchets carry 10 1 93 ; cavity preparation. the instrument identification numbers of8, I 7, and shape the gingiva floor of a cutting end is bi- These instruments are available inboth single- 23. As the name implies, their There are four beveled (see FO 2). The difference betweenthese ended and double-ended styles. double-ended gingiva margin trimmers:the Black three instruments is in the size of *heirworking Gingiva margin ends. The #8 hatchet has the largestworking end #26, #27, #28, and #29. trimmers are also used to sharpenline angles on the and the #23, the smallest. retention and to b. Single-bevel hatchets. There are two pairsof gingiva fioor for better amalgam preparations. single-bevel hatchets, and they are supplied asfour level the gingiva floor on inlay single-ended instruments. The identification- numbers of these instruments are 51. 52, 53,and Exercise (405): 54. Numbers 51 and 52 are thelarger pair and Foldout 8, exercise 405, shows the shankand numbers 53 and 54 are the smallerpair. In working end of several cuttinginstruments. Each addition, two double-ended hatchets areavailable: instrument is identified by a letter. In exercises 1 the Black #15. #16, and the Black#17. #18. In through 10 place the identification letterof each this case, the two working ends com pose apair. The cutting instrument shown in foldout 8,exercise instruments that comprise pairs are the samesize, 405, in the appropriate space providedbelow. but their cutting edges have oppositebevels to permit access to different areas of the mouth.(See 1. Biangle chisel. FO 2.) Another type of cuttinginstrument is the hoe.
Hoes. As you may have guessed,dental hoes 2.Disk-shaped excavator. miniature. Like the dental _ look like a garden hoe in hatchets, dental hoes are alsoincluded in the dental excavator group. They canbe used very_effectively to smooth andshape the floor of cavity 3.Spoon-shaped excavator. preparations and to actentuate groovesand _ retention points. The identificationnumbers are 29 afid 34. Spoon-we excavators. This portion ofthe dental _4.Gouge-shaped excavator. excavator family is made upof spoon-, claw-, disk-, and gouge-shaped blades. (SeeFO 2.) Their primary use is to remove cariousdebris from tooth cavities. Their tips and sides aredesigned for _5.Claw-shaped excavator. cutting action. These instruments areoften referred to as spoons becausetheir blades somewhat resemble miniature spoons.Excavators are occasionally used in carving waxinlay patterns and _6.Wedelstaedt chisel. amalgam restorations. Those mostresembling spoons are the pairedBlack #63 and #64, and the paired Black #65 and #66. These aresingle-ended instruments. Each instrument of thepair is designed _7.Gingiva margin trimmer. for different areas of theteeth. Double-ended versions of this type of spoon arethe Black #36, #37 and the Black #38,#39. The Darby-Perry (DP) #5, #6, #21, and #22 areexcavators with _8.Hoe-shaped excavator. gouge-shaped blades. These arealso paired single- ended instruments. The DP #5and #6 are the smaller pair, and the DP #21and #22 are the larger pair. The last instrumentsin this family are _9.Hatchet-shaped excavator. the single-ended Black #89and the single-ended Black #92. The #89 has adisk-shaped blade, and the #92 has a claw-shapedblade. Gingiva Margin Trimmers.There are two _10.Straight chisel. pairs of single-ended gingivamargin trimmers in the Air Force inventory theBlack #77, #78 and #79, #80. The two instrumentscomposing a pair have 11. Which letters in foldout 8,exercise 405, are the samesize; however, their working ends used to (See FO 2.) Gingiva identify instruments that are primarily opposite curvatures and bevels. remove carious debris fromtooth cavities? margin trimmers are used totrim, smooth, and
11
1 94 f3,1-
12. Which letters in foldout 8, exercise 405, Matrix Bands. Matrix bands are very thin, identify instruments that are used on the floor flexible, stainless-steel bands that either partially or of a cavity preparation? totally enclose a tooth. The bands used with the Tofflemire retainers completely encircle the tooth. S. The bands used with the #1 retainer partially encircle a tooth in a hoiseshoe or U-shape. Matrix 13. Which letters in foldout 8, exercise 405, bands come in assorted sizes and shapes in small identify instruments that are used on the walls envelope-type packages. A dentist usually prefers of a cavity preparation? certain types of these bands over others. With practice, you should become very proficient in having the preferred band on the appropriate retainer. Matrix bands are also shown in foldout 2. Wedges. Wedges are small tapering, triangular 2-2. Dental Matrices pieces of wood about 1/2 inch in length. Since the If the walls of a tooth have been destroyed by general shape of tooth crowns varies, the band decay or removed during the course of cavity around the tooth may not always produce a snug fit. preparation, they must be restored with restorative This leaves space through which packed amalgam material. To do this, the dentist uses a matrix to can extrude to create an undesirable overhanging approximate the original walls and to hold the restoration. The dental officer uses wedges to force filling material in proper form and position until it the matrix band tightly against irregular tooth has time to harden. This matrix is similar to the surfaces to eliminate these spaces. This snugly -forms" a builder uses to hold setniliquid concrete fitting band then restricts the firmly condensed in proper form and place until it hardens. Whereas amalgam to the confines of the prepared cavity the builder uses plywood, 2 x 4s, and nails to make margins and the band itself Many dental officers his forms, the dental officer uses matrix retainers use an instrument called a wedge holder to place the and materials to obtain the same effect. These wedge-in proper-position. Another instrument matrices include matrix retainers, metal bands, sometimes used in positioning the matrix is the wedges, matrix strips, and plastic crown forms. Re- matrix contouring instrument *FP 2A. It is fer to foldout 2 as we discuss the matrices. particularly useful for contouring the matrix during amalgam pin reinforcenient procedures. (See- FO 2.) Other matrices which the dental officer uses are 406. From a list of statements, select those that called strips. are true concerning the types and uses of the Matrix Strips. Matrix strips are manufactured matrices employed in dentistry. in roll form. They are available in plastic and metal. Matrix Retainers. Matrix retainers are the The plastic type is clear polyethylene in a 45-foot devices that hold the matrices (metal bands or roll. The metal type is available in three different strips) firmly in place around a tooth. Matrix kinds of metalcopper (20-foot roll), copper- nickel alloy (10-foot roll), and stainless steel (20.- retainers and metal bands are used in combination foot roll). The dental officer uses the plastic as a to.form a temporary mold while the filling material is being packed into place. These retainers have matrix for silicate and resin filling.materials, and the metal as the base material from which he can cut either small hooks or retaining screws at one end to hold the matrix band. On the other end of the the appropriate length to form a special matrix retainer is an adjusting screw. When the adjusting band. At times, the standard packaged matrix bands screw is turned clockwise, the band loop is do not provide the necessary length, width, or shape constricted. When the adjusting screw is turned for a particular cavity preparation. When this is the case, he can cut the metal matrixstrips to form the counterclockwise, the loop is loosened. The Federal needed band. Another type of matrix is available in Supply Catalog lists two different types of matrix retainersthe Tofflemire, and the #1. (See FO 2.) crown form. The Tofflemire retainer is available in three Matrix Crowns. Temporary matrix crowns are different designsthe universal straight, the available in both clear plastic and corrosion- contra-angle, and the contra-angled junior size. resistant steel construction. They are used to hold These retainers are practically maintenance free. temporary or sedative filling materials inplace on They can be heat-sterilized along with other dental badly broken down or fractured teeth or to function instruments. Your part in maintaining matrix as temporary crowns when permanent crownsare retainers is to check them periodicaily and replace being fabricated by the dental laboratory. The clear those with badly worn screw threads. You are also plastic matrix crowns are available in the incisor, expected to attach the correct matrix band to the cuspid, and bicuspid shapes. These crowns are appropriate retainer in anticipation of the dental removed when the filling material sets, or are left in officer's needs. place to lend additional strength. Corrosion
. 12 1.95 resistant steel crowns are available in the incisor, T F7. Toffletnire matrix retainers should not cuspid, bicuspid, and molar shapes. Because of be heat-sterilized. their poor esthetic quality in anterior regions, they are primarily used on posterior teeth. There are other matrices used less frequently than those we have already mentioned. We will group them as "other matrices." -Other Matrices. These are the copper bands 2-3. Amalgam Instruments and the cerifical types. Cervical (neck) matrices are While many instruments are involied in the made of plastic and are available in assortecrsizes. restoratiun of' tooth structure, certain instruments The dentist uses cervical matrices to hold filling relate directly to amalgam filling material. materials firmly in place on the facial necks of Amalgam instruments are those that carry, anterior teeth. Copper bands are not usually used condense, carve, and finish amalgam restorations. with a filling material. Instead, they are used to Study foldouts 2 and 3 in the supplement as we hold an impression material until it is set. These discuss this instrument_group. copper bands are small cylinders open at-both ends and available in several sizes. The dental officer 407. Identify amalgam instramems by their use may use them when making an impression for an inlay or a crown. and by their visible features. Carriers. Amalgam carriers transport the Exercises (406): freshly prepared amalgam filling material to the Indicate whether the following statements cavity preparation. These carriers have hollow concerning matrices are true or false by circling the working ends, called barrels, into which the T or F. amalgam is packed for transportation. Both regular T FI. The item used to force the matrix band and large barrel carriers are available. When tne tightly against irregular tooth surfaces lever located on the top of the carrier is depressed, is called a wedge. the amalgam is ejected into the cavity preparation. Normally two or more carriers are used during the amalgam placement procedure This saves time for the dentist who is ejecting or condensing a carrier T F2. The #1 matrix retainer should be used load while you are refilling the carriers. when the tooth must be coinpletely Condensers. Amalgam condensersarein- encircled. suuments used to pack or condense the amalgam filling material into the cavity preparation. They are often called pluggers. The hammerlike working end is large enough to compress the soft amalgam without sinking into it. They are available in single- T F3. Plastic matrix crowns are available in the incisor, cuspid, bicuspid, and and double-ended designs. Condensers also have variously shaped and sized working ends. They may molar shapes. be smooth or serrated. Normally the dental officer favors certain condensers, which he uses routinely. You should be aware of his preference and have the condenser he wants available at the itart of the T F 4. Copper band matrices are usually used in conjunction with filling materials. condensing procedure. The condensers available through Air Force supply channels are listed below and are pictured in foldout 2:
T F5. Corrosion-resistant steel matrix Singk-ended condensers crowns are primarily used on anterior Black #1. #2, #3. #4, and #5 teeth. Double-ended condensers Sweeney # ,#2.#3.#4,#5,#6. and #7 Tanner #0T.#2T,St3T, and #4T Modified Mortonson #2 T F6. Plastic strip matrix material Is usually used as a matrix for silicate or resin Carvers. After the amalgam is condensed, it filling material. must then be carved to approximate the original tooth structure. Carvers are available in an assortment of shapes and sizes and in single- or double-ended designs. They have sharp cutting
13
1 Q0 edges to shape, form, or cut tooth anatomy into instrument and the back disk surface of the other. amalgam restoration. Some Qrvers are alsoused to This permits access to any area of the mouth. They carve wax patterns for crown and inlayfabrication. are used to smooth and finish themargins of As with condensers, dental officers alsohave metallic restorations and to remove excess favorite carvers which they use routinely. Know the hardened amalgam (overhang) that extends beyond dental officer's preference so that you can have the the intended boundaries of the prepared cavity. desired instrument ready when it is needed. The Pin Amalgam Set. Extensive decay or a cusp carvers available through Air Forcesupply fracture results in the loss of a major portionof the channels are listed below (see FOs 2 and 3): tooth structure. To restore such a tooth to itsformer healthy condition, the dental officer may Choose to Single-ended amalgam carvers rebuild the tooth. If the tooth is a posterior one,the Tanner #6TA and #6113 dental officer may use the pin amalgamtechnique. For a pin amalgam, the dentist usesspecific Double-ended amalgam carvers instruments. Many times these pin amalgam Cleoid, Discoid 089-92 instruments are kept together as a set (see FO3), Hollenback #14 or "H" which includes pinhole drills, pin drivers, pins, and Tanner #5T perhaps grooved or threaded wire. The setavailable in theFederal Supply Catalogincludes drills of two Single-ended amalgam and wax carvers different lengths, pins of two different lengths, and Frahm #1. #2. and #3 one package of grooved wire. Pinhole drills.The dentist uses the pinhole drills Double-ended amalgam and wax carvers to drill holes in the dentin portionof the tooth to Hollenback #1, #2. and #3 size. The Walls #3 receive pins or wire of corresponding pinhole drills closely resemble dentalburs, and are Burnishers. When the carving has been made for use in conventional speedhandpieces. completed, burnishers can be used to smooth and The actual drilling part of these drillsvaries from polish the restoration and remove scratches left on .021 inch to .027 inch in diameter.They are the surface of the amalgam by thecarving available in lengths of either 55/64 inch or1 V9 instruments. Single- and double-ended burnishers inches. The shorter drills are used incontra-angle have smooth rounded working ends. These handpieces on posterior teeth. The longerdrills are burnishers are listed below and pictured infoldout used in straight handpieces on anteriorteeth. 3: Pin drivers. Pin drivers hold, place, and drive or screw the pins into the dentin part of a tooth. These Single-ended burnishers drivers are of two different typesfriction-lock Ovoid, large 428 and thread-forming. The friction-lock type drives Ovoid, medium #29 grooved pins and grooved wire into the prepared Round, large #25 Round. small #27 holes. The thread-forming type screws thread- forming pins and wire into place. The friction-lock Double-ended burnishers driver is available in straight or bayonet shapes. *15 or "I Pins.The pins used in the pin amalgam technique are very small. For example, some are Finishing Instruments. Finishing instruments less than 1/4 iru.:1 long and .022 inch indiameter. are sometimes used tocomplete or put the These pins are available in grooved andthreaded "finishing touches" on a restoration. Thefinishing forms. The grooved type actually locks in placein instruments most often used in Air Force dental the tooth dentin by friction, with the spiral grooves clinics are the margin-finishing knivesand margin- providing retention for the amalgamfilling finishing files. material. The threaded type is screwed into place or Margin-finishing knives.The Black #8 margin- cemented with zinc phosphate cement. Thethreads finishing knife is often called the gold knife. It has a on this type of pin alsohelp retain the filling large sickle-shaped blade and is used to remove material. Each type can be obtained indifferent excess filling material fromthe margins of lengths and diameters. Although pins areused in restoration-. Another finishing knife is theBaird amalgam restorations for the most part, they canbe, knife. It is quite similar to the Blackfinishing knife, and are. used to reinforce other fillingmaterials. but has a detachable handle. (See FO 3.) Wire.Although designed specially for the same The most commonly used purpose as the precutpins above, some retention Margin-finishing files. material is in wire form. Like the pins,retention margin-finishing files are the Rhein #31 and #32 threaded form. files. The working end of these files is smalland wire is also available in grooved or filing Most of these wires are madeof a corrosion- disk-shaped, as illustrated in foldout 3. The lengths. surface is on the front disk surfaceof one resisting steel and are in 43/4- and 6-inch 14 197 ; 7.Ovoid large burnisher. Also like the pins, different diameters areavailable. _ One advantage of the grooved retentionwire is that #8 finishing knife. needed. This Pin driver. _ it can be cut at the precise length feature is particularly helpful when the precutpin _10.Black condenser. lengths would be either too short or too long.The 11.Rhein file. pin length can be critical in the success orfailure of 12. #15 or "3" burnisher. Amalgam carrier. large pin aMalgams. 13. 14.Cleoid, discoid carver. Condensers.Becauseof thedifficultyex- 15. Hollenback #3 carver. periencedinpacking amalgam aroundpins, special condensers have been designedfor this 16. Sweeney condenser. purpose. These are thedouble-ended Markley #1 , 42, #3, #4, and #5 condensers. Theirfunction is the same as that of the amalgamcondensers previously discussed. The contlensers designedfor however, have much narrower use with pins do, 2-4: Resin and Cement Instruments working ends. This instrument group consistsof thein- Exercises (407): struments for mixing andhandling restorative Answer exercisesI through 6 by placing the resin, silicate cement, and various temporary identification letter or letters of theinstruments filling, insulating, and pulp-cappingmaterials. pictured in foldout 8. exercise 407in the spaces provided. 408. Answer key questions about theinstruments employed to mix and handle the resinand cement I.Which letters identify instrumentsused _ materials. to condense amalgam? Spatulas. There are three differentspatulas available for mixing restorative materials.(See FO produce a slight Which letters identify instrumentsthat 3.) Some of these spatulas can discoloration in the material beingmixed. The are used to carve anatomyinto amalgam selection of a mixing spatula is notcritical except restorations? when a permanent anteriorrestoration is being prepared. Silicate cement, inparticular, has a tendency to discolor easily. Therefore,when you are preparing thismaterial, it is extremely 3.Which letter identifies theinstrument spatula to prevent used to drive pins into thedentin? important to use the proper ruining the esthetic value of therestoration. The spatula designed for mixingsilicate is the double- ended #142 plastic spatula. The twoother spatulas available are the #313 and the #324.Each of these Which letters identify instrumentsused 4. has a single semiflexible workingend and is suitable to remove scratchesleft on the surface for mixing materials other thansilicate. The #313 of an amalgam by carvinginstruments? spatula is a smaller version of the#324 and is used for mixing small quantitiesof cement. Thoroughly clean \and disinfect the spatulasafter each use. instrument _5.Which letter identifies the Plastic Filling Pluggers. A varietyof single- freshly mixed that is used to transport and double-ended instruments composethis amalgam to the cavity preparation? instrument voup. They are used to transportand place dental cements, resin, and temporary, insulating, and pulp-capping materials.The working ends on plastic filling pluggers rangefrom Which letters identify instrumentsused _6. varying small cylinders to assortedangled, paddle- to remove "overhangs"from amalgam like shapes. These instruments arelisted below and restorations? are pictured on foldout 3.All of these instruments are constructed ofcorrosion-resistant steel, except for #1-2 and 5-7, which areconstructed of listed below byplacing the chromium alloy. The chromium alloyinstruments Identify the instruments 407 in handling restorative resins identification letter fromfoldout 8, exercise are more suitable for and silicate cement. Since theseinstnunents are the space provided: 15
1 98 used in the mouth, they should be sterilized after equipped with a spring catch, which releases when a each use: certain amount of pressure is applied. In turn, this produces a light, adjustable, hammerlike tap that Single-ended plastic filling pluggen condenses the gold foil. The mallet is used with the Gregg sir, #2. and #3. gold foil plugger points. Interchangeable Points. The tips of the seven Double-ended plastic filling pluggas interchangeable gold foil plugger points are serrated, The Federal Supply Catalog lists them as #1-2 #1, #2, #3, #4, #5, #6, and #10. Since each *5-7 Woodson.#1, #2, and #3 point has a different shape, a point is available to fill almost any conceivable cavity preparation. These threaded points screw into either end of the Exercises (408): automatic gold plugging mallet. Gold Foil Carrier. The gold foil carrier looks 1. Which spatula should be used to mix silicate like a #23 explorer. Only with a close examination cement? Why? of the small working tip can you distinguish a significant difference. The tip of the gold foil carrier has a tiny, flat, serrated surface. The instrument is used to transport gold foil pellets or 2. How does the #313 spatula differ from the cylinders from the annealing tray to the cavity *324 spatula? preparation. Annealing Tray. The annealing tray holds gold foil pellets or cylinders for heating. This tray is designed to slip over the Bunsen burner tube found 3. 'Whit should be done with a spatula after it has on most dental units. When it is properlyplaced, been used? the tray lies horizontally and immediately over the Bunsen burner. The heating (to burn off the gas coating) and proper cooling of the gold before it is condensed into the cavity is called annealing. 4. What is the purpose of plastic filling pluggers? Annealing allows the gold foil to adhere (autoweld) to itself and contributes to a well-bonded restoration. 5. Which plastic filling pluggers are constructed Exercises (409): of chromium alloy? I. Why are the interchangeable points of the gold foil condenser set constructed in different shapes?
2-5. Gold Foil Condenser Set The gold foil condenser set (FO 3) includes an 2. What instrument does the gold foilcarrier automatic gold plugging mallet, interchangeable closely resemble? How does it differ? points for the mallet, the gold foil carrier, and an annealing tray. These instruments are used to fill selected and prepared cavities with gold foil. 3. Where on the dental unit is the annealing tray 409. Furnish specific facts about the instruments mounted? in the gold foil condenser set.
Gold Foil Mallet. The automatic gold plugging mallet is hand-operated. Itis double-ended and 4. What is the purpose of the annealingtray? -
199
16 CHAPTER 3
Specialty Instruments
principles. The forceps consist ofthiee partsthe DENTISTRY IS a highly specialized profession. In of tooth- addition to the general dentists. in many AirForce beaks, the neck, and the handle. The beaks dental clinics, oral surgeons. periodontists. extracting forceps are designed to grasp the tooth endodontists, and prosthodontists are assigned to with maximum contact on thefacial-lingual The serve the base population.For each of these surfaces of the root(s) just below the cervix. specialists, instruments have been designed tohelp inner surf3ce of each of the two beaks is concave Tooth-extracting him in the performance of his specialty.In this and the outer surface is convex. forceps are designed to be used in specific areasof chapter we will discuss these specialtyinstruments. the mouth. The beak is always shaped toconform snugly to the contour of the tooth. For example. 3-1. Surgical instruments both beaks of maxillary forceps areusually angled The instruments used to remove teeth or to treat away from the curvature ofthe handles. Thew the oral conditions that requirecutting and bone varying angles facilitate access to various parts of removal are called oral surgery instruments.These the arch. The beaks of mandibularforceps are instruments are constructed of high-gradestrel, usually at a much sharper angle andin the same either stainless or chrome-plated.Each instrument direction as the curvature of the handles,This is designed for a particular pupose andshould be makes it easier to reach different parts ofthe lower handkd with extreme care. Theinstruments with arch. The notches on the beaks serve as aguide to cutting edges must be kept sharp to preventslippage the region of the mouth where thatparticular and possible injury to the patient.Hinged forceps is to be used. instruments should be lubricated tokeep them in To identify the forceps, picture to yourselfthe good operating condition and to prevent rust. number of roots on the tooth to be removed.All Although some 80 oral surgery instruments are anterior teeth have single roots and need forceps available through supply channels,these with a single curve on the end of each beak. If you instruments can be separated into groupsfor easy examine the tips of anterior forceps "headon," you reference. Keep in mind, as we discuss these groups. will find that they resemble a set of parentheses, as that most surgical proceduresrequire several illustrated in figure 3-1. Forceps for removing different instruments. Our discussionof surgical bicuspids are similar to those for anterior teeth. instruments begins with the tooth-extractingand with the beaks resembling a set of parentheses.But miscellaneous forceps group. they are generally wider than those used foranterior With the exception .of the Rongeur forceps. teeth. When you remember that lowermolars have forceps arc two roots. situated mesially anddistally, you can which is used to cut bone. most follow the grasping-type instruments. They are used to grasp easily see that any instrument designed to lower molars must be teeth for extraction, secure patientdrapes, hold curve of the root of the tissues. transfer notched. The beaks of lower molarforceps are suture needles, grasp oral soft resemble instruments and dressing materials, andcontrol notched and, when examined head on, hemorrhage. The bulk of the forceps groupis two sets of parentheses arrangedin the manner shown in figure 3-1. The exception tothis is the composed of those used for extracting teeth. mandibular "cowhorn" forceps whosebeaks forceps used in resemble cowhorns. These beaks enterinto the 410. Identify the tooth extraction bifurcation facially and 1,..zually to lift the tooth the oral surgery section. out of the socket. Tooth-Extracting Forceps. There areseveral Upper molaf teeth have three rootstwofacial the and one lingual. To be effective on these teeth,the variations of tooth extracting forceps on side market. but except for those made for somespecific forceps must have a notched beak on the facial operation, they generally followcertain basic and an unnotched beak on the lingual side (except
1 7 20 9 Anterior Arrangement Mandibular Posterior Maxillary Posterior Arrangement Arrangement
Figure 3.1. Beak arrangement of tooth extracting forceps. for the 88 R and L, maxillary cowhorn forceps, shaped so that a maximum amount of force can be which are just the opposite). You can, therefore, see applied to the beaks and the handles are still in a why upper molar forceps are manufactured as comfortable position for the oral surgeon. The "right" and "left" forceps. Some manufacturers beaks are also shaped so that a force on the handles stamp theletters "R" and "L" on the handle, but tends to extrude the tooth out of its socket. even without this identificationitis easy to Since more than one forceps design is available determine which side of the mouth they are for the extraction of any tooth, the dental officer designed for if you remember the position of the usually chooses the one that he feels is most notches in relation to the roots. By relating the comfortable and gets the best results. Consequently, parentheses to the upper molar forceps, you will different dentists elect to use different forceps. You find that, for the right and left sides, the parentheses should know the basic principles of determining are arranged to oppose each other. This where a forceps is designed to be used. You can arrangement is shown in figure 3- I. then adapt these principles to the needs of the Another way of telling the general area of the individual dental officer. Let's examine the various mouth in which a tooth-extracting forcep should be tooth extraction forceps in the Air Force inventory. used is by its neck. The neck is shaped so that the Refer to foldout 4 as we discuss these instruments. beak can be placed on the tooth and still be parallel Tooth-extracting forceps #I.The Iextracting with the long axis of the tooth. The handles are forceps is designed to remove maxillary anterior 18 201 1272 cuspids. The beaks posite is true with the #53R forcepsand the maxill- i4/ teeth and in particular maxillary molar. Such a design ena- (grasping pans) are in line with thehandle. Because ary right first or second the tooth securely for of this straight line design, much leverage canbe bles the dental officer to grasp exerted with the #1 forceps. the rocking and elevating movements. Tooth-extracting forceps #150. The *150 Tooth-extracting firceps #881. and #88R.The forceps is sometimes referred to as the maxillary #88L and #88R forceps are often calledmaxillary "universal" forceps. The beaks are set at an angle in cowhorns. Like the #53L and #53R, they are designed for the maxillary first and second MOUS. relation to the handles, which makes them in accessible to any part of the maxillary arch. When They differ slightly from the #53L and #53R *150 the way they function to remove a tooth.The the handles are closed, the beaks on the is to forceps are noticeably close together at the tips and primary use of the #53L and #53R forceps portion of a tooth so that curve opposite each other to resembleparentheses. grasp thecrown and root slight the dentist can rock the tooth from its socket.The Notice also that the handles themselves have a wedging curvature. Even though the #150forceps can be #88L and #88R forceps operate on a principle. They are actually inserted betweenthe used in any region of the maxillary arch,itis This specifically designed to remove maxillary incisors. tooth roots and the surrounding bone. wedging action tends to lift the tooth fromits cuspids, bicuspids. and residual roots. There are long, two other types of #150 forcepsthat possess certain socket. The #88L forceps is designed with a modifications. One is a scaled-down version slender, pointed right beak and a forked ordeeply (150S) for use in removing maxillary deciduous notched left beak for grasping the root structures on teeth. The third version is the #150AS.This maxillary left first and second molars. The exact forceps has slightly thicker beaks with less curvature opposite applies for the #88R forceps and and more space between the beaktips when the maxillary right first and second molars. The #88L handles are closed. The #150AS isused on and #88R forceps have straight handles. maxillary incisors. cuspids, and bicuspids, asis the Tooth-extracting forceps #210. The *210 forceps is designed to extract maxillarythtsd #150. molars. The short beaks on theseforceps have Tooth-extracting forceps #65. The handles of the inner #65 forceps are straight and the beaks areoffset. smooth rounded tips and wide concave position, it surfaces. When these forceps are heldin the When the forceps is in the closed handle is resembles a bayonet. The beaks areshort, very operating position, the end of the left forceps is used on noticeably curled to form a finger rest.These narrow, and slender. The #65 the maxillary anteriors, bicuspids, and roottips. characteristics make the *210 different from tooth- other maxillary molar forceps. Thewide inner Tooth-extracting forceps #286. The beaks make the *210 extracting forceps #286 is very similar toforcePs concave surfaces on the short forceps particularly effective in graspingthe #65. The biggest differences arethat the *286 between generally underdeveloped maxillarythird molar beaks are wider and there is a wider space has a slightly wider the beaks neatest the handles when they areclosed. crowns. The *2 l OS forceps little more beak than the #210, and thefinger rest curl is These characteristics make the #286 a maxillary third suitable than the #65 for removingmaxillary absent. It is also used tr extract bicuspids. The *286 is also used to remove molars. Tooth-extracting forceps #101. Thisforceps is maxillary anterior teeth and residual roots. mandibular arches. Tooth-extracting jioceps #53L and#53R. The used on both the maxillary and designed to extract More specifically. the #101 forcepsis to be used .r.-53L and #53R forceps are for removing maxillary andmandibular cuspids, maxillary first and second molars.The letters L and for use on the left bicuspids, and any remaining roots. R indicate that the forceps are Hawkbill-type forceps. Three differentforceps and right sides of themaxillary arch. They have fall into the "hawkbill" category. theMead #MD3, straight handles with offsetbayonet-type beaks. beaks are When you view the #53L forcepswith the handles the *13. and the #22. Their from you. a pointed perpendicular to the working action of the handles. toward you and the beaks away This design permits a great deal of leverage tobe projection is visible on the rightbeak tip, whereas exerted with a minimum amount ofeffort. The the left beak tip is rounded.The opposite is true on from your stu- major physical difference between these forcepsis the *53R forceps. As you remember the width of their beaks. This, as you mayhave dy of dental anatomy inVolume 2, maxillary first Two of these surmised, is because they are designed to extract and second molars have three roots. different teeth. The Mead #MD3forceps is three roots are toward the facialsurface, while the the right beak ot' designed for the extraction of mandibular anteriors other is a single lingual root. Thus, and bicuspids: the #13 forceps is formandibular the #53L forceps engages themaxillary left first or between the two first and second bicuspids: and the #22forceps is , second molar crown and enters second, and facial roots while the concave leftbeak engages the for the extraction of 'mandibular first, lingual part of the crown and root.The exact op- third molars. 19
2 92 46 Tooth-extracting forceps *151. The *15 1 Exercise:1411h extracting forceps is similar to the *150 forceps I. Name the three pans of the extraction forceps. except that the beaks art set at an angle opposite to the slightly curved handles. Another similarity between these forceps is that as the *150 is known o as the "maxillary universal" forceps. the *151 is 2. How arc the beaks of extraction forceps known as the "mandibular universal" forceps. The shaped? *151 is used primarily to extract mandibular anterior:, bicuspids, end roots. There is still a third similarity between the *150 and *151 forceps. Each has two additional versions to the basic 3. When you are viewing lower molar forceps forceps. The #151AS is smaller and is used to head on (with the exception of the mandibular extract mandibular deciduous teeth. The #151A cowhorns), what do their beaks resemble? has slightly thicker beaks, with more space between them than between the beaks of the basic *151 forceps. The #151A is used in the same way as the *151 forceps. 4. With the exception o( the SIR and 88L Tooth-extracting forceps *203. The *203 forceps, what is the beak configuration of forceps is used on mandibular anterior, bicuspids, upper molar forceps? and roots. These forceps are like the *101, except that the beaks are more sharply angled from the handles. Like the *101 handles, the *203 handles are straight. 5. How are the necks of extraction forceps Tooth-extracting forceps *15. Forceps #15 is designed to remove mandibular first and second shaPed? molars. The beaks on these forceps have concave inner surfaces with pointed projections on the tips. These work well in grasping the crown with the two Foldout 8, exercise 410, shows several extraction Projecting tips extending to the bifurcation between forceps. Each is identified by a letter, Complete the two roots on mandibular third molars. The left exercises 6.16 by placing the appropriate letter in. handle on the *15 has a finger rest. the space provided. Tooth-extracting forceps *16. The *16 forceps is nicknamed "mandibular cowhorns," because the 6.Identify the three forceps that are beaks actually resemble cowhorns. This is designed exclusively for use in the especially true when the beaks are viewed in an maxillary arch. open position. The *16 forceps is used to remove mandibular molars. The long, slender, curved beaks function on the same principle as the #88L and #88R forceps. The *16 forceps wedges 7.Identify the four forceps that are designed exclusively for use in the between the toothroots and the surrounding bone and, with pressure and a rocking motion, lifts the mandibular arch. tooth from its-socket. The left handle on the *16 forceps has a finger rest. Tooth-extracting forceps *17. The beaks of the *17 forceps are similar to beaks of the *15 8.Which forceps may be used to extract forceps. The handle of the *15 forceps is straight either maxillary or mandibular cuspids, without a curled finger rest. Like the #15 and #16 bicuspids, or roots? forceps, it is used on lower first and second molars. Tooth-extracting forceps *217.The #217 forceps is used primarily for removing mandibular to as the third molars. The beaks have inner concave 9. Which forceps is referred surfaces and pointed projections much like those of hawkbillforceps? the #15 forceps. The handles,however, have a slight curvature andresemble those on the *151 forceps. Which forceps is referred to as a Tooth-extracting forceps *222. The beaks on the 10. *222 forceps are rounded with concave inner maxillary cowhorn forceps? surfaces, and angle sharply from the handle. Like the #217, it is also used to extract lower third molars. 293 20 The hemostatic MEM.= I I Which forceps is referred to as the Ifemosemic forme. forceps mandibular cow/hots looks ory web like the needle.holdiag forceps. forosps? The main difference is that the beeki of the hemostatic forceps am low and maw slender. The hemostatic (*reeve are supOied with both Which is used for curved and straieht beaks.' The Maas at these .12. forceps extracting a so interiors and in particular forceps we also equipped with locking device maxillary are used in anpids? keep the beaks closed. They mend surgery. to control hassorrhege by dopes' or constricting blood vessels. Howemr, in oral mpg they are more cognac* used so remove bite of is used for debris, such se bone chips or pars dies*, from die Which forceps extracting we a anterior& and root oral cavity. Hemostatic forceps nearing pert maxillary him**, You should ham tips? of all surgical setups you prepare. them ready during all procedures *het invohe the removal of teeth or bone. TosWcheep forceps. As the name implies, the is used to maintain surgical 11.1MMIM Which forceps is designed specifically towel.clamp forceps for a left first or towels and drapes in *praline position dudes extracting maxillary has second molar? sulk& operations. The soniel.damp forceps beadles and a locking device similar so those= the needle holder and hemostatic forceps. The workiag ends have sharp points thee overlap in the dosed of 13 Which (other than the hawkbill position. The ezwel.clemp forceps is a pan every forceps in the is designed for instrument setup ussd hosphal operating type) extracting more and more in dental mandibular interiors, bicuspids. and room and is being teed roots? satiny operstions. Goau forceps. The gauze forceps is used to grasp Mine emu spongse. h is long handled and has two ring.shaped beaks. which permit you to at once. In some aim .16. Which forceps (other than the secure semral gauze sponses is used for where extensive surouy is being performed, the cowhorns) extracting is in mandibular molars? aspirator is only partially effective. The patient such a position that the blood drains towerd his throat. If so, you should be ready with sponges, locked in the gauze forceps, to absorb the blood at every opportunity. The saute forceps is also used when the surgeon is performing multiple 411. Match the type of mistellaneons focceps extractions under pent anesthetic. fie may soak the correct in the with used in the oral surgery section with several sponges (locked same forceps) and swab the oral for descriptive statement. metaphen cavity preorrative disinfection, or with epinephrine to staunch blood Miscellantoos Forceps. As we mentioned flow. to the oral The ends on earlier, many forceps common surgery Surgkal dressing *ceps. working area are not used to extract teeth, and we have the surgical dreuing forceps used in oral surgery are This instrument rather arbitrarily placed them in a "miscellaneous" straight extensions of the handle. hs inner surfaces group. Let's take a closer look at these forceps. resembles large straight tweezers. Needle-holder forceps. The needle-holder are serrated. The forceps is used to transport gauze forceps is used, as the name indicates, for holding sponges, towels, and patient drapes. Using surgical these items needles during suturing procedures. The typical dressing forceps to transport prevents needle holder has two short. rather blunt, serrated contamination. at firsi beaks, which hold the curved suture needles very Tissueforceps. The tissue forceps, glance, device is to be a with securely. A graduated, notched, locking appears surgical dressing forceps located near the end of the handles. This locking straight working ends. Upon closer examination of a is device enables the oral surgeon to lock the suture the working end, however, marked difference end hss needle in the suturing position as if the needle were easily detected. One side of the working an extension of the needle holder. In turn, the two very small, sharp, pointed extensions, which to the a The other side of the end operator can devote his full attention suturing form W-shape. working that meshes in process and not be overly concerned about has a single, sharp, pointed extension on the needle. the middle of the when the maintaining a secure grip opposing! W-shape 21 2 91 instrument is in the closed position. Although the 412. Describe tbe cutting instruments used in the tissue forceps is used in oral surgery to grasp and oralsurgery section by type,features, and stabilize loose tissue ends during suturing purpose. 110 procedures, it is mainly used to hold tissues being Surgical knives. The surgical knife handles and excised. blades are used to incise or excise soft tissues, and Instrument forceps. The instrument forceps is come in various sizes and shapes. The use of each designed to handle instruments. It is used. type depends upon the type and accessibility of the primarily, to transfer instruments from surgical tissue to be cut. Knife blades are supplied in cabinets to surgical operating trays or to other areas presterilized packagcs and should be discarded as needed. The handles look like those on after one use. The reason is that a nicked blade will hemostatic forceps, but the instrument forceps do not make a clean cut and thus would delay the not have the locking device. The working end is proper healing of the tissue. Attach and remove the such that it can be manipulated to hold nearly any blades from the knife handles with hemostatic instrument securely, regardless of its shape. One forceps. The use of the forceps prevents accidental side of the working end is basically a curved fork. cuts and possible infection. The knives used in oral The other side is a curved arm that meshes between surgery are usually referred to as scalpels or -Bard- the two opposing fork tines. Instrument forceps Parkers. should be stored in an upright instrument forceps canister containing fresh disinfectant solution. There are two surgical knife handles commonly usedthe #3 and the #9. The #3 handle is short Exercises (411): and wide, whereas the #9 is fairly long and slightly thicker but narrower than the #3. The four blades Complete exercises 1 through 7 by matching the used most often in oral surgery are #10, #1 I . #I2, statement in column B to the appropriate and #15. instrument in column A. Each statement should be a. Blades #10 and #I5 have similar working used only once. ends. The greatest difference is that the #10 blade is larger. The cutting edge on both of the blades is Column A Colwnn B I. Gauze forceps. a. This forceps resembles on the curved part of the blade. Thus, they cut in 2. Instrument forceps. large straight tweezers. either a straight or rocking fashion. 3. Tissue forceps. b.Used primarily in oral b. Blade #Il has a straight cutting edge and is 4. Hemostaticfor. surgery to remove bone ceps. chips or other debris from used for lancing. 5. Dressing forceps. the oral cavity. c. The 012 blade has a concave cutting edge, is 6. Needk-holder c.This forceps has lor.g shaped like a hawkbill. and is used in a ripping forceps. straight handles with ring- 7. Towel-clamp for- shaped beaks. motion. d.This forceps has a locking device, and its beaks have Rongeur forceps. The Rongeur forceps is used sharp points that overlap for trimming projecting, uneven, or overhanging when in the closed posi- tion. bone (alveolectomy), usually after multiple e.One side of this forceps' extractions and before tissue suturing. Since these working end has small. sharpbonyprojectionsresultingfromthe pointed extensions that extraction would be a constant source of pain to the form a W-shape. patient and would make the wearing of a denture f One side of this forceps' working end is basically a impossible, they must be trimmed. The Rongeur curved fork. forceps function like large toenail clippers and snip g.This forceps has short. off the bony projections. Some Rongeur forceps are blunt. serrated beaks that so shaped that they cut on only one side. Others are are used to hold a suture needle securnly. designed to cut on the ends of the beaks. The cutting edges are sharp and should be examined for nicks after each use. Note that these forceps are Cutting Instruments. When most people hear similarinsize and appearance tothetooth the word "surgery," the first thing they think about extracting forceps. but each Rongeur has a steel is the cutting of the body with knives. But knives are spring spreader. which opens the beaks when the not the only cutting instruments used in surgery, pressure is released from the handles. particularly oral surgery. Although knives are used Bonefile.Althoughmostofthebony in oral surgery, there are many other projections are removed with the Rongeur forceps. instrumentsbone files, surgical scissors, and some rough edges usually remain. The bone file is curettesthat perform some type of cutting now used to further shape and smooth the alveolar function. Refer to foldout 4 as we discuss these bone. The Seldin #1 I bone file is used in most Air instruments. Force dental clinics.Itis a double-ended
22205 blade or blades have: instrument, with both a large and a smallworking 3. Which surgical knife end. a. A hawkbill shape? Surgkal scissors.Scissors are used in Oral surgery to cut tissues andinures. The scissors with saw- toothed cutting edges are used to trim excess or b.A curved cutting edge? irregular soft tissues, while those withsmooth blades are normally used for cutting sutures or edge? other fabric material. The surgical scissorslisted in c. A straight cutting the Federal Supply Catalog include asmooth-blade, blunt-ended pair, and the angular.saw-toothed Dean scissors. 4. Which cutting instrumentfunctions like large Surgical bias. Surgical burs are rotating cutting toenail clippers to snip off unevenbony instruments used by many surgeons to removebone projections? or -cut through teeth.They are made for both straight and contra-angle handpieces.The burs are shaped much like regular toothcuttingburs. but the blades of the surgical burs are farther apart sothat used after tbe it. They 5. What instrument is usually they can cut hard tissue without burnishing Rongeur forceps has been used? must be thoroughly scrubbedafter each use to remove bone particles andblood from between the blades. These burs were discussed inChapter 1 of this volume. surgical chisels Surgical chisels may also be 6. For what purposes are Surgical chisels. employed? classified as cutting instruments. Likesurgical burs. chisels are used to remove bone.They are also used to split teeth and aredesigned to be used 'with a mallet. Their cutting edges areeasily dulled: has the widest blade? therefore, you must sharpen them after each use, 7. Which surgical chisel becausesharpchiselsreducethetrauma experienced by the patient. The chiselsused in oral Federal Supply Catalog are surgery and listed in the 8. What cutting instruments areused to clean out the Stout #1. #2. and #3.Surgical chisels are debris chisels used in infected cavities in bone and to remove 410 much larger than the enamel from tooth sockets? restorative dentistry. The #1 Stoutchisel has the widest blade, and the #3 has the narrowestblade. Curettes.While surgical curettes are noEstrictly cutting instruments, they must do somecutting in the performance of theirfunction. Curettes are sharp, spoon-shaped instrumentsused to clean out Elevators. Three different typesof elevators are infected cavities in bone and to removedebris from available for use in oral surgeryproceduresthe tooth sockets. They come in manysizes and in malar, periosteal, and root (seeF05). Two of these, used depends on straight or angled shapes. The type theperiostealandroottypes,arefurther the nature of the socket, curvatureof the roots that categorized by their variousshapes. As the name were in the socket,and the location of the cavity in implies, each of these elevatorsis des4ned to usually stocked in most the mouth. The curenes elevate something. dental clinics are the Moltnumbers 1, 2, and 4. which are straight curettes,and the Molt numbers 413. Identify the elevatorsused in the oral which are paired, angled 5L, 6R, 9L, and 10R, surgery section bydass and use. Curette& Malar elevator. As you recall,the facial bone called zygoma or rnalar Exercises (412): that forms the cheek is bone. Traumatic injury ofthis bone often results in I. What names are usuallyused for surgical a depressed fracture.If this occurs, the bone must knives? be elevated toits normal position.The malai elevator, which resembles abent table knife, is used by the oral surgeon tolift or elevate a fractured surgical knife blade zygoma. 2. What should you do with a The fibrous membrane after it has been used? Periosreal elevators. covering a bone is calledthe periosteum. The
23 29 6 3
working end and the working ends of the #9L and periostealelevatorisusedtoseparatethe periosteum and other tissues from the bone. It can the #9R are set at left and right angles, respectively, gingival to the handles. also be used to separate the periosteum and Federal tissues from around impacted teeth, in areaswhere f The last group of elevators listed in the also Supply Catalog are commonly calledCross-Bar the bone needs trimming (alveolectomy), and elevators. The handles are set at 90° in relation to in areas where there are retained roots. There are listed in the the shank. This handle position allows the operator three different periosteal elevators Cross-Bar elevator Federal Supply Catalog: the Molt #9, the Seldin to exert great pressure. The group consists of two sets of pairedelevators. The #22, and the Seldin #23. The Molt #9 and the Winter *IL and the #1R set have working ends Seldin #22 are used exclusively as periosteal eleva- somewhat like the Miller #73 and *74, exceptthat tors, but the Se !din #23 has wide working ends and the Winter elevator working end tips aresharply can also be used as a retractor. pointed. Also, the Miller elevator working ends are Root elevators. Root elevators are available in more curved than those ofthe Winter *IL and more are.a part of everytooth extraction setup. **IR. The Winter #I22 and #I23 make a setand Which elevator or elevators are used depends upon their working ends almost-duplicate the Seldin #1L have the desire of the oral surgeon. Root elevators and #1R working ends. three functions: to loosen the teeth in theirsockets. to remove parts of teeth(broken root tips or retained roots), and sometimes to remove a Exercises (413): complete tooth. In the last case, the tooth isusually Several elevators are pictured on foldout 8.exercise an underdeveloped thirdmolar. The elevators are 413. Each is identified by a letter. Answereach of actually levers. The fulcrum (support point)for the the following exercises by placing theappropriate elevator is usually the support bone inwhich the letter from this foldout in the spaceprovided. tooth to be removed is located. I.Which elevator is commonly referred to straight working _ a. The elevators composing the as the Cross-Bar elevator? end group are the #301 and the#34S. The working ends are in line with the handle anct have a concave surface. The #301 hasthe smallest group working end, and the #34S has the largest working _2.Which elevator belongs to a end. called the root picks? b. There are two elevators with spade- or wedge- type working ends. They are the StoutA and the Cogswell A elevators. The greatest difference between these two elevators is in the handles. The _3.Select the two elevators that are Cogswell A handle is grooved, whereas the Stout A classified as periosteal elevators? handle is plain. c. The Federal SupplyCatalog lists one pick- shaped root elevator, the Cogswell B,whose working end is shaped somewhat like a rounded _4.Which elevator belongs to a set that is toothpick tip. referred to as the East-West elevators? d. In two sets of elevators, the handles are in line with the shank but the working ends are set at an angle. They are the Miller #73 and #74 set andthe Seldin #IL and #1R set. The Miller #73 and #74 _5.Which elevator is classified as a straight elevators have curved, thin, working endswith elevator? smooth, rounded tips. The Seldin #IL and#1R have very abrupt, sharp-tipped, working ends. The Seldins are sometimes referred to as "East-West" Which elevator would be used toelevate elevators. _6. e. One group of theelevators is designed to a depressed zygoma? remove fractured root tips that arelodged deep in the tooth socket. These are frequentlycalled root picks. Three elevators make up this group:the West #9, the West#9L, and the West #9R.The working thin, sharply ends on these elevators are very Surgical Instruments.In pointed, and small. The handles are alsosmall in Miscellaneous addition to the instruments we havediscussed, there diameter but longer than those on theelevators we has a straight are some others neededin the oral surgery section. have considered thus far. The #9 Among these are the aspirating,irrigating, suturing. 24 2 7 and retracting instruments, and the surgical mallets. Suture materials. Suture materials are usually Our discussion begins wiih asphating instruments. classified as either absorbable or nonabsorbable. Refer to foldout 5 as we discuss nine iastruments. Almost all sutures used in oral surgery are nonabsorbable. Absorbable sutures are dissolved 414. Describe the miscellaneous instruments and absorbed in the body. Examples of absorbable used in tbe oral surgery section by features, type, sutures are the "catgut" .(made from sheep's and function. intestine) and "tendon" types. Many materials are used to make nonabsorbable sutures. Some of these Dental aspirator.The dental aspirator itself is are silk, cotton, nylon, and even corrosion-resistant not an instrument but is classified as anitem of steel wire. Probably the most common suture used equipment. We mention it here because there are in oral surgery is hisde of silk. All of these sutures parts of it that are usually considered as surgical are available in different diameters. The oral instruments. These parts are the hose, handle, and surgeon uses the suture material with a suture tips. The hose used to connect the handle to the needle to close wounds in the oral cavity. Since aspirator is simply latex rubber tubing. and is almost all of the suture material is nonabsorbable, usually from 30 to 36 inches in length. The handle these sutures must be removed after the wound has a bulbous portion on one end and a chuck on heals enough to hold together. the other end. The bulbous portion is slipped into Tissue retractors. As the name implies, tissue one end of the hose, and the chuck endsholds the retractors are used to retract tissue. In oral surgery tips. There are two tips availab;e#2, and #4.. The they are used to hold tissue flaps away from the #2 tip is smaller and is suitable for use in a tooth operative site to provide better visibility. These socket. When these parts are properly joined and retractors have forklike prongs, which permit the loose end of the hose is connected to the handling the tissue without causing excessive aspirator, they function as a single suction unit. damage. Your job is to connect the parts, operate the aspirator, and manipulate the handle and tip. With Exercises (414): experience, you should be able to perform these I.Which of the two aspirator tips is the larger? tasks quickly and efficiently to keep the surgical site clear for the oral surgeon. Irrigating syringes. There are two types of syringes for irrigating the orkl cavity. One is the 2. Name the two types of irrigating syringes. bulb-type syringe. It ig' a rubber bulb with a small tube extension and a metal tip, which fits into the tube on the bulb. The other syringe (Luer type) is composed of a glass barrel and a glass piston. The 3. What surgical instruments2eused to flush pus barrel portion is fully open at one end with a and debris from tooth sockets and bone constricted opening at the other end. The glass cavities, or from under inflamed gingival flaps; piston has a handle on one end, while the remaining and are also used to direct sterile water onto a part acts as a plunger in the barrel.Irrigating surgical bur during tooth-sectioning syringes are used to flush pus and debris from tooth procedures? sockets and bone cavities, and from under inflamed gingival flaps (pericoronitis). They are also used to direct sterile water onto a surgical bur to flush bone chips' and blood from the dentist's field of vision. 4. What surgical instrument is often used with Surgical mallets. Basically, all mallet are surgical chisels to split teeth or reduce alveolar/ designed to produce a hammering type of action. bone? The oral surgery mallet is no exception. It is a small hand type that resembles a gavel. It is used in oral surgery with the surgical chisels. The mallet along with the selected chisel is used to split teeth or 5. What is the usual shape of the surgical needles reduce alveolar bone. used in oral surgery? Suture needles. Most suture needles used by the oral surgeon are semicircular. These needles are available with either smooth sides or cutting sides. They vary greatlyastothe diameter of the 6. Give the most common type of oral surgery semicircle. The smaller sizes are most often used in suture material. oral surgery because of the limited space in the oral cavity. Some needles are already attached to the sutures and arrive in sterile vials orfoil packets. Others are available separately. 25
2 98 DP\
7. Describe the working end of a tissue retractor. this reason, you should refrain from using it until you have become skilled in using the other scalers we shall mention. You should also establish a finger rest or "fulcrum" before attempting to use any scaler. Be sure to use a finger on the same hand holding the instrument to establish a support point. 3-2. Periodontal Instruments This support point can be anywhere on a tooth or teeth but should always be on the arch you are When you break down the word "periodontal," treating. you have an insight into the general purpose of b. The Younger-Good #15 and B-scalers are these instruments. Periodontal instruments are not sickle-shaped. They are designed for primary use in designed to be used on or in teeth but are used anterior teeth areas. They are also effective on the around the teeth. To be a little more specific, facial, lingual, and interproximal surfaces. Use the periodontal instruments are designed primarily to Younger-Good #I5, and the B-scalers with a pull- treat the structurei surrounding the teeth. You may type motion. remember from your study of the preceding volume c.The Jacquette scalers are among those most that the greatest cause of tooth loss is periodontal common in the dental clinic. There are three of disease. Thus, it is an understatement to say that them, numbered 1, 2, and 3. The #1 Jacquette periodontal instruments are very important. The scaler is used on anterior teeth, while the #2 and periodontal instrument group includes scalers, #3 are used on posterior teeth. The Jacquette #2 is files, curettes, probes, hoes, pocket-marking for scaling the maxillary right facial, the maxillary forceps, and knives. left lingual, the mandibular left facial, and the mandibular right lingual surfaces. The Jacquette 415. Identify by features, type, and function the #3 scaler is used in scaling the remaining posterior scaling instruments used to prevent or treat teeth areas. Thus, the three Jacquette scalers may be periodontal disease. used in combination to scale the entire dentition (full set of teeth). Scalers. It has long been the practice of the medical and dental professions to follow a pattern Morse scalers.Morse scalers are a set of scaler in rendering treatment. First, the signs and points used. with a separate chuck-type handle. The symptoms concerning the patient are evaluated to Federal Supply Cataloglists the handle as a "Dental form a diagnosis. With the diagnosis established, Instrument Point Handle" and the Morse scalers as treatment begins, if needed. A principle commonly "Dental Scaler Points." There are six different , applied to any treatment series is to remove the points, which are numbered 2, 3, 4, 5, 6, and7: irritant that causes the disease or condition. One a.Morse scaler point #2 is a small hook which common source of irritation to periodontal resembles the Younger-Good #15. The #2 is used structures is calculus. Calculus is a hard, calcified to scale anterior teeth. substance composed of calcium carbonate, calcium b.The Morse #3 point is a modified hook-type phosphate, and organic matter. This calculus is similar to the Jacquette #1 scaler. The #3 point is found on the exposed crown parts of teeth and often also used to scale anterior teeth. extends beneath the 'gum tissues. The texture of c.Morse point #4 is similar to Jacquette scaler calculus is generally rough. Scalers are used to #3 and is used in the same posterior areas of the remove calculus found on the root and crown mouth. portions of the teeth. Refer to foldout 5 as we dis- d.The #5 Morse scaler point resembles the #2 cuss these scalers. Jacquette scaler and is used on the same posterior Fixed-tip scalers.Although preventive dentistry teeth. technicians normally scale teeth, you may be e.The Morse #6 has a sickle-shaped point. It is assigned where there aren't any preventive dentistry a modified version of the B-scaler. Use the #6 technicians. In such a case, you may be called upon point on anterior teeth. to scale teeth under the supervision of a dental f.Morse scaler point #7 is another sickle- officer. This requirement makes it necessary that shaped instrument. It more closely resembles the B- you be familiar with fixed-tip scalers. scaler than the #6 point. The #7 point is also a.The Zerfing scaler functions when used with a designed foruse onanterior teeth. pu3h -type motion. This scaler has a single cutting edge and is used to remove calculus from between There is still a third set of instruments used to scale anterior teeth. Since the Zerfing scaler is difficult to teeth. This third set is the ultrasonic handpiece control, only experienced personnel should be insert cm. The ultrasonic permitted touse it.As is the case with most scalers, Ultrasonic handpiece inserts. careless use can severely lacerate oral soft tissues. handpiece inserts are used in conjunction with the This is especially true with the Zerfmg scaler.For ultrasonic prophylaxis unit, which converts 26 299 electrical energy into sound waves. There are three 416. Identify by class and functionthe essential parts involvedthe unit, thehandpiece, instruments used in treating subgingival and the handpiece insert. Theunit transmits pniodontal conditions. electrical energy to the handpicce. The handpiece insert then converts the electrical energy into sound Periodontal Curettes. We have already waves or vibrations atthe insert tip. These described one type of curette, the surgical type. vibrations move the insert tips 1/1000 inch.When Surgical curettes and periodontal curettes are properly tuned, the tip vibrates from20,000 to similar in name only. Periodontal curettes are 25,000 times per minute. The vibrating tipaction is different in size and shape and are designed for very effective in removing calculus.To prevent different purposes. Periodontal curettes are more overheating the insert, a small stream of water closely related to scalers than to any other continually flows onto the tip. You must adjust the instrument. They are, in fact, used to remove water flow until a fine mist (with afew droplets) is calculus just as scalers are, but the main difference emitted from the tip. There are eight different between the scalers and the periodontal curettesis handpiece inserts listed in the Federal Supply in the areas in which they are used. While scalers Catalog. They are the curette type, the flat-hoe are used to remove calculusmainly on the exposed crown parts of the teeth, theperiodontal curettes chisel type, the left hatchet type, the righthatchet deposits of type, the left Jacquette type, theright Jacquette type. are used primarily to remove straight subgingival (below the gum line) calculus. A the small universal hook type, and the number of investigations have shown that scaler type. periodontal curettes are less traumatic to the hard structures, cementum, and supporting structuresof Exercises (415): the teeth than scalers. The Federal SupplyCatalog Foldout 8, exercise 415, shows severalscaling lists the Gracey and McCall curettes. TheGraceys instruments. Each is identified by a letter.Answer listed are #1 through #14. The Mc Callslisted are each of the following questions byplacing the # 13S- # 14S and #17S-#18S.Some commonly appropriate letter in the space provided. used Gracey curettes are #3, #4, #11,and #12. and I.Which scaler is used only with apush- See foldout 6 for Gracey and McCall curettes type motion? the other periodontal instruments: a. The Gracey #3 and #4 curettesare single- ended instruments that together Make a pair.You use these curettes on anteriorteeth. also single- 2.Whatare the two scalersprimarily b. The Gracey #11 and #12 are _ ended instruments that together make a secondpair designed to scale posterior teeth? of curettes. Since t#1 Iand #12 Graceys are designed for use in all areas of the mouth,they are called the universal curettes. is a double-ended 3.What are the three sickle-shapedscalers c. The McCall #13S-#14S _ curette. Use this instrumentfor scaling bicuspid designed for scaling anterior teeth? teeth. d. The McCall #17S-#18S is a seconddouble- ended curette, specially designed forscaling molar _4.Which instrument functionsthrough a teeth. vibrating action? Periodontal Hoes. Periodontal hoes areused to remove subgingival calculus.Their working ends have small projections, whichform the cutting What three instruments composethe edges. The cutting edge appears to beperpendicular 5. edge on the periodontal Jacquette scalers? to the shank, but the cutting hoe is actually placed at somewhere close to a450 angle from the shank of the instrument.There are four periodontal hoes listed in theFederal Supply Which instrument is the Zerflngscaler? CatalogOrban types #5, #6, #7, and #8. 6. Periodontal Files. Periodontal files are instruments used to smooth roughened root surfaces. There are four periodontal files inthe Air 10. 11, and Identify in this order the "B" scaler,and Force inventory: the Orban numbers 9, 7. 12. The Orban files have flat,wide, rounded the Younger-Good #15. working ends. The Orban #9 and #10 are a setof paired periodontal files that areused to smooth
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2.10 roughened cementum on mesial and distal root each exercise by placing the appropriate letter in the surfaces. The Orban #11 and #12.compose a set space provided. that is used on the facial and lingual root surfaces of 1. Which instrument is designed to remove posterior teeth. Let's consider next a noncutting gingival tissue (gingivectomy)? type of periodontal instrumentthe periodontal probe. Periodontal Probes. Periodontal probes are used to determine accurately the presence, depth, 2.Which instrument perforates gingival and form of periodontal pockets. An angled shank tissues to provide a reference line for the places -the working end at about a 450 angle in excision of excess gingival tissue? relation to the handle. The thin, narrow working end is easily inserted to the depth of the periodontal pocket. These working ends are scored at millimeter intervals. The scored marks make it easy 3.Identify the three instruments that are to determine the depth of the pocket. Some probes designed to removed subgingival have a mark for every millimeter from I through calculus deposits. 10. Others have a mark for every millimeter from 1 through 3, then marks for every 2 millimeters from 3 through 7, and finally marks for every millimeter from 7 through 10. The Federal Supply Catalog lists 4.Which instrument can accurately the Fox and Merritt "B" periodontal probes. Both determine the presence, depth, and form of these probes have scored marks as in the of periodontal pockets? description above. The Fox and Merritt "B" probes appear much alike, except that the Merritt "B" has a round working end while the Fox has a flat working end. 5.Which instrument is used to smooth Periodontal Pocket-Marking Forceps. The roughened cementum on root surfaces? periodontal pocket-marking forceps are listed in the Federal Supply Catalog as the Goldman-Fox #1, and the Goldman-Fox #2. At first glance, periodontal pocket-marking forceps appear to be 6:Which instrument is a periodontal hoe? dressing forceps. When you examine the working ends, however, you can see that one tip has a perpendicular blade projection. They are used to. mark the depth of periodontal pockets so that the 7. Which instrument is an Orban file? mark is visible on the exposed gingiva before periodontal surgery. The smooth tip is inserted between the tooth and gums to the bottom of the periodontal pocket, and the instrument ends are 8.Identify the two periodontal curettes. then closed. This causes the tip with the blade to perforate (penetrate) the gingival tissue. Several of these perforations provide the operator with a reference line for the excision of excess gingival 9.Which instrument is a periodontal tissue and the elimination of periodontal pockets. knife? The final family of periodontal instruments is the periodontal knives. Periodontal Knives. The periodontist uses periodontal knives to remove gingival tissue 10. Which instrument is the pocket-marking (gingivectomy) during periodontal treatment. There forceps? are several knives manufactured for this purpose. They are the Kirkland #K-15; the Kirkland #K-16; and the Orban knives #19, #20, #21, and #22. The Kirkland knives are used to make the 11. Which instrument is the periodontal initial incisions, and the Orban knives are used to hoe? complete the dissecting procedure.
Exercises (416): 12. Which instrument is the periodontal Foldout 8, exercise 416, shows several periodontal probe? instruments. Each is identified by a letter. Complete 28 211 3-3. Eitiodontic Instruments workiniends. The working ends of one set are 21 mm long, and the ends of the other are 25 mm long. If the pulp of a tooth has become necrotic Root Canal Pluggers. Root canal pluggers are (dead), endodontic treatment may be considered. used to pack root canal filling materials into Endodontics is described as root canal therapy. It prepared root canals. The working ends of these includes removing the tooth pulp, sterilizing the pluggers are cylic :.1-shaped with flat tips. There root canal, and filling the root canal with a root are two different types available. One type has canal filling material. Endodontics is sometimes contra-angled working ends, whereas the other has performed in conjunction with the surgical removal straight working ends. The contra-angled types are of the tooth root apex and the surrounding numbers 7.9, and I 1 , with number 7 the smallest. infectious debris; this procedure is called an Numbers 1, 3, and 5 make up the straight working apicoectomy. The instruments specifically designed end type. The dontra-angled types are convenient IP for root canal procedures are called endodontic for bicuspid teeth, and the straight types are suitable instruments. They include root canal broaches. for anterior teeth. Another instrument, sometimes reamers, files, and pluggers. Refer to foldout 6 as considered a root canal plugger, is the gutta-percha we discuss these instruments. spreader #3. The spreader has a contra-angled point. . 417. Describe the instruments used for Endodontic Explorers. In addition to the other endodoatic procedures by function, features, and endodontic instruments, there are two explorers type. that have been designed especially for endodontic Root Canal Broaches. A root canal broach is purposes: the #DG1 6A and #16B. The one of the first instruments used in the pulp canal endodontic explorers have long, narrow working during endodontic treatment procedures. Before ends, angled from their shank in such a way that broaches are used, however, the dental officer uses they provide easy access to the pulp canal. The a bur to gain entrance into the pulp chamber. endodontic explorers are used for the exploration Broaches are then used to clear the canal of soft and debridement of pulp chambers and canals. tissues. These broaches are shaped like needles covered with small barbed projections. The Federal Exercises (417): Supply Catalog lists three sizescoarse, fine, and I. Which endodontic instrument is used toclear extra fine. The usual procedure is to start with the the pulp canal of soft tissues? smallest broach. The chunk-type handle, called a broach holder, helps to control the broach during use. Discard each broach after it has been used. Root Canal Reamers. Root canal reamers are used to enlarge the pulp canal after the broaches 2. Which endodontic instrument is used to have been used. The reamers are available with enlarge the pulp canal? either short or long handles. They are also available in many sizes. The Federal Supply Catalog list begins with size 10 and continues in intervals of 5 to size 60. Beginning with size 60, they are also available 3. What endodontic instrument is used, after the in intervals of 10 through size 100. The working reamers, to smooth the root canal? ends on reamers look like a needle with screwlike graduated threads. The dental officer may use several reamers in one operation. He usually begins with a relatively small size, then uses the next larger 4. How do the threads of the files and the reamers size each time, untii the canal has been reamed to differ? the desired diameter. Root Canal Files. Root canal files are used to smooth the root canal following the use of the reamers. The working ends of the files look much 5. Describe the two types of root canal pluggers. like those of the reamers. The difference is in the threaded part. The file threads are much finer and closer together. Like the reamers, the files are available with either a long or a short handle and in the same sizes. Files are also available in two other 3-4. Prosthodontic Instruments sets called the Hedstrom files. Both of the Hedstrom file sets, like the regular files and A prosthodontic appliance is a replacement for a reamers, are in sizes beginning with size 15 and missing portion of the normal dentition. Full continuing through size 100. The difference dentures, removable partial dentures, fixed partial between the two sets is in the length of their dentures (bridges), and crowns are prosthodontic 29
212 appliances. The instruments used by the dental mixing imprmsion materials. The spatula used to officer in the prosthodontic treatment rooms are mix the vanous impression materials is called a those we are going to discuss. Prosthodontic laboratory spatula. It has a 2 1/2-inch flexible blade, instruments, in the true sense, include all the which is about 1 inch wide with a rounded end. The instruments used to fabricate dental appliances. handle is =ally made of wood or plastic. The wax Some prosthodontic instruments are used only in spatulas commonly used are the Beale #7 and the the dental laboratory. Others are used only in the Gritman #f31. The #7 spatula is much shorter and prosthodontic treatment room. Still others are used has small. spoon-shaped, double working ends for in both places. You, as the chairside assistant, are detailed viax work. The #31 spatula is also double- primarily concerned with the instruments used in ended with one large rounded, spoon-shapedend the prosthodontic treatment room. This group in- and one large sharp-pointed, spoon-shaped end. cludes impression trays, spatulas, mixing bowls, Spatula #31 is used on the less delicate wax work knives, pliers, scissors, the alcohol torch, the crown where detail is not a requirement. Both wax remover, and the roach carver. Refer to foldout 7 as spatulas are used to hold small bits of wax over a we discuss these instruments. Bunsen burner flame. Once the wax melts, it may then be flowed onto an occlusion rim or perhaps 418. Aiwer key questions about the instruments added to a wax denture base. At times, wax spatulas used in tbe prosthodontic section. are simplyheated over aflame and used while they are still hot to smooth or adjust wax patterns, Impression Trays. Impression trays hold occlusion rims, and baseplates. impression materials to obtain a negative reproduction. The impression may include a Mixing Bowl. The item needed te hold portion of the arch or the entire arch. The tray alginate-type impression material and water for holds the impression material in place while it sets mixing is the mixing bowl. This flexible bowl is or becomes elastic. Generally, the impression tray made from either rubber or flexible plastic, and is shaped to match the natural contour of the arch. available in small, medium, large, and extra large They are available in many sizes for both the sizes. All sizes are used in the dental laboratory, but maxillary and mandibular arches. The trays used the one often used in the prosthodontic treatment for making mandibular impressions are easily room is the medium sin. The spatulaused to distinguished from the maxillary tray by the area incorporate the powdered alginate into the water is left open for free tongue movement. Impression normally the 2 V2-inch blade spatula we mentioned trays can be further divided into two groups, as they earlier. You may also find that a regular, dining- are found in theFederal Supply Catalogthose hall, tableknifeis used as a mixing spatula. In made of aluminum and those made of brass. either case, the rounded ends on the spatula or the table knife pretty well match the contour ofthe Aluminum impression trays.The aluminum mixing bowl. impression tray group is used for making Prosthodontic Knives. Usually two kinds of edentulous (without teeth) arch impressions. (See knives are used in the prosthodontic treatment FO 7.) Your responsibility with aluminum trays is plaster knife. As to keep them clean and to learn the onei your dental room: the compoundknifeandthe officer prefers. In this way, you can anticipate his the names imply, one is used with compound, and needs and be more effective as a chairside assistant. the other isusedwith plaster. The compound knife has a Brass impression trays.Brass impression trays do Compound knife. not appear to be made of brass because they are fairly large red plastic handle and detachable plated with a nickel-colored metal. These trays are blades. Routinely, the #25 blade is used to trim impression compound, wax, and other materials easily identified, however, by their rim-locking This characteristic. This rim resembles a metal wire that require an extremely sharp cutting edge. the soldered along the inner part of the tray at the edge blade is almost identical to a larger version of #11surgical blade we talked about earlier. Your of the outer borders. Also, the maxillary brass knife isto impression tray has a U-shaped wire soldered to the primary concern withthecompound palatal area of the tray. These trays are called rim- replace broken or dull blades. lock impression trays. Semiliquid impression Plaster knife.The plaster knife is a heavy-duty material flows into the undercuts (ledges) formed model used to trim and chisel plaster of paris and by the rim and sets (hardens); this locks the material impression compound. It has a large flat blade at in the tray. The dental officer can then remove the one end with a wide, screwdriver-appearing impression without fear of separating the impres- projection at the other end. The handle is made of sion material from the tray. Rim-lock trays areused wood and riveted in place. You must keep the blade for hydrocolloid impression materials. of this knife sharpened. Prosthodontic Spatulas. Spatulas are used in Dental Pliers. Dental pliers haveseveral prosthodontics for handling dental waxes and functions. Those listed in theFederal Supply Catalog
30 include the pin amalgam type. the matrix type, and Crow., Remover. At times, the dental officer several others designed for use in the prosthodontic must remove a gold crown from a tooth to gain section. Some of the more common ones found access to a dental problem. This can present quite a there are the clasp bending, contouring, and clasp problem if the neceuary instrument is not available. adjusting types. This group generally includes, but In fact, it is next to impouible to remove some gold is not limited to, pliers #47, #I22. #134, #137, crowns without a crown remover instrument.The and #noo. This group provides theprosthodontist handle on a crown remover is encircled with a with a variety of working jaw shapes for adjusting, heavy steel weight which slides from one end of the bending, and contouring prosthodontic appliances. handle to the other. Two interchangeable points Once again, your responsibility is toidentify the make up the working end. One of these points is pliers by function and learn which pliers the dental contra-angled and the other is straight. Both points officer prefers. If you do these things, you will have have a right angle projection at the tip. When the the desired instrument available when it is needed. crown remover is used properly, the tipis placed Collar and Crown Scissors. The primary use of over the margin or junction of the crownand tooth first. Then the sliding weight on the handle is the collar and crown scissors in the prosthodontic section is shaping copper bands. These same tapped against the bottom part of the handle. scissors are used in restorative dentistry to cut and Usually, one or two taps of the sliding handle are all contour matrix bands. Collar and crown scissors that is needed to separate the crown from the tooth. are listed in three different typesthestraight Roach Carver. The roach carver is a double- universal, the Beebee curved, and the Quimby ended instrument used to cut, smooth, and carve curved. All of these are heavy-duty scissors because dental waxes. At first glance, it appears to be a wax they must cut the metal matrix bands and strips as spatula. A closer examination reveals a spear- well as copper bands. These scissors are fairly shaped blade at one end with a deep-welled, very maintenance free. They measure from 41/4 to 43/4 small spoon at the other end. Both ends have very inches in length. sharp edges. Alcohol Blowtorch. The alcohol blowtorch is designed to provide directional control of an Exercises (413): alcohol flame. Basically, it is a small alcohol burner 1. Which type of impression tray is usually used (wick type) with a hand pump that operates a for the impression of an edentulous arch? bellows. The bellows forces air through a small air jet on top of the blowtorch. The air jet is set to direct the air across the flame. This design allows the prosthodontist to direct the flame in any 2. Which prosthodontic knife has afairly large, direction. The alcohol blowtorch is frequently used blades? to partially melt and smooth roughened wax on red plastic handle and uses detachable denture wax-ups and to soften baseplates for adapting to stone models. Your duties with the blowtorch are to keep it free of wax and to keep the fuel reservoir filled with the proper fuel. 3. Which prosthodonticinstrument has a heavy and down its handle? The proper fuel for the alcohol blowtorch is, as steel weight that slides up the name indicates, alcohol. However, notjust any alcohol will do. For example, dental clinics frequently use isopropyl alcohol as a disinfectant. Used as a disinfectant. isopropyl alcoholis in a 4. What is the beg fuelchoice for the alcohol solution:containing about 70 percent alcohol and blowtorch? 30 percent distilled water by volume.The diluted alcohol produces a flame of very poorquality. Further, 100 percent isopropyl alcohol tends to smoke badly while burning, whichmakes it somewhat undesirable as a blowtorch fuel. Ethyl 5. What double-ended prosthodontic instrument alcohol produces a clear blue flame butis is used to cut, smooth, and carve dental waxes? undesirable because it is a security item. Also the denatured and rubbing alcohol types are unsuitable as fuels. The best fuel choicefor the alcohol blowtorch is methyl (wood) alcohol. Methyl for internally. It 6. Which prosthodontic instrument is used alcohol is highly poisonous if taken clasp bending, contouring, or adjusting? burns with a reddish-yellow flame, which is not as hot as the ethyl alcohol flame, but is hot enough for use in the prosthodontic section.
31 r
7. Which prosthodontic spatulas are used with 9. What prosthodontic item is used for the shaping of copper bands? dental waxes? 6 8. In addition to a spatula, what other equipment item is required in mixing alginate-type 10. What is another name for the brass impression impression material? trays?
e
, 32 215 1272
_ CHAPTER 4
Dental Meistisile
THE SUCCESS OF dental procedures depends Another way to improperly handle a dental upon many people, one of whom is you. Starting at material is to proportion and mix the material the manufacturing plant, several people are without first reading and heeding the involvtd in the production of dental materials. manufacturer's instructions. We sentrally conclude From the manufacturer, some of these MN:vials that the manufacturer knows his 111110fial best. enter the Ftileral supply system and eventually end Along with each unit (package, box, etc.), the up in the dental clinic where you are assigned. manufacturer sends a small brochure that briefly There, the responsibility for using a portion of these and basically opines the dental materiel. This materials rests upon you and the dental officer rim brochure provides information on the uses, Wain assist. While the dental officer has the overall procedures, mixine time, setting time, and handling responsibility, he does depend directly upon you to characteristics of the material involved. Therefore, properly prepare filline materials for insertion in a it is important that you read and follow the patient's tooth. The dental officer looks upon you manufacturer's instructions. We will begin our as his semiprofessional assistant. He expects you to discussion of dental ITIWAtiale with dental amaleent. have the knowledge and ability to proportion, mix, and sometimes help insert the mix in the prepared 4.1. Dental Maoism tooth. A blunder in any one of these steps can mean the failure of the restoration. Dental amalgam is the most widely used restorative material. It is our beet filling material The dental materials found in Air Force dental for many restorative procedures. To achieve the clinics are supplied by many manufacturing firms. best possible results, the assistant must know how to Each of these materials has been through many mix and handle amalgam properly. Every asp in quality control inspections to assure that it is of the handling of engem, from the proportioning high quality. The standards that those niaffila of alloy and mercury to the final polishing of the must meet are established by the American Dental restoration, has some effect, upon its properties. Association and Federal Government Often, while an amalgam meets the American specifications. Thus, we can be reasonably sure that Dental Meociation specifications, it results in a the dental materials arrive in Air Force dental very poor filling because of some faulty technique clinics as high-quality products. in mixing. You must try, therefore, to set up a Although dental materials arrive as high-quality standard method of working with amalgam to products. they are of little or no value unless they eliminate any variation in any step of the are handled properly. One way to handle dental manipulation. materials improperly is to mix put of one material from a certain iot number with a like material with a 419. Given a series et ssasesenes easesesing die different lot number. We can compare this problem uses, cheraderissies, eleareassse, and progenies with a similar problem encountered with paint. of *mai amalgam, Wks.* which are arms aid Two cans of paint may have the same brand name. which are else. the same ingredients, and the same color listed on the label, but have different 10t of batch numbers. Uses. Basically, dental amalgam hes two uses. It The professional painter knows that it is next to is sometimes used as a die material. (In dentistry, a impossible to obtain an exact color match. Further. die is a positive reproduction of a tooth prepared to there may be slight differences in the ingredient receive a restoration.) More often, however, dental percentages that affect the drying (setting) time and amalgam is used as a restorative material. Usually, the resultant texture. This same principle applies to amaleam is used to restore posterior teeth because intermixing dental materials that are alike except its characteristic color makes it esthetically for having different lot numbers. undesirable in anterior teeth.
33
21 6 Clamseeeristles. The word "amaleam," as it is next metal, silver, makes up the highest percentage used in dentistry, is defined as a combination of of the alloy that is mixed with mercury. mercury with other metals. In contrast, the avenge Silver. The American Dental Association dental patient rekrs to dental amalgam as a "silver tADAS has established either the maximum or the filling.Although silver is ope ingredient and an minimum percentage for each of the metals found amalgam restoration does reveal a silver-gray in dental amalgam alloy. For silver, the ADA hes colored filling, the dental amalgam is a true specified a minimum of 65 percent. Silver provides amalgam, and is a combination of mercury with strength, durability, and color to dental amalgam. In addition, silver gives ROWS= a desirable setting other metals. . The mercury is supplied as a separate item, but upansion, decreases now, and decreases the setting the other metals arrive combined as a single alloy in time. . the form of pellets. This alloy is frequently referred Tin. Tin is a soft metal that is highly malleable to a "silver alloy." Each component of dental (ean be hammered into a metal sheet) and ductile melon is very important, so we should consider (can be drawn into a wire) at ordinary them further. temperatures. For tin. the ADA has determined 29 Components. In addition to the mercury percent to be the maximum amount allowed. The already mentioned, the other metals that mike up softness quality of tin makes the amalgam more dental amalgam ere silver, tin, copper, and zinc. workable. Tin also combines easily with the Each of these five metals contributes certain mercury. Further, tin helps control expansion and qualities or values to the combined lmalsam. That increases both the flow and setting time of the is to soy, :.-hen all five metals arecombined, each amalsam. ream chemically to produce a certainreaction or Copper. The ADA specifies 6 percent to be the effect. Let's examine esch metal and see how each maximum amount of copper permitted in dental affects the final product. amalgam alloy. The copper increases hardness sad Mercury. Mercury is a metal in liquid form at causes expansion of the amalgam duties the setting room temperature. When mercury is placedin process. Copper also reduces the flow and shortens the setting time. contact with certain other metals, it acts to bond or adhere to the other metals. An exarnple of this Zinc. The last of the five metals is zinc. The action is seen when mercury is placed on a silver maximum amount allowed in dental amalgam alloy coin. In the similar way, mercury reacts chemically is 2 percent. Zinc increases the workability of the with the partidn of silver in the alloy to bond the amalgam and prevents the formation of oxides with !articles together. To help speed up this chemical the other metals. action, the alloy and mercury are usually pieced in a You have noticed, no doubt, that the capsule and mechanically triturated (mixed or descriptions of the above metals reveal that the thrown together). Mixing the amalgam will be chemical action of one metal is often counteracted discussed in more detail later. For now, we will by the action of another metal. The resulting turn to some precautions involved in handling product is a restorative material with properties that mercury. meet the exacting requirements of modern Mercury left uncovered at room temperature dentistry. volatilizes (converts into vapor) into the air. Since Properties. The ideal restorative material is one mercury vapors can be a health hazard, youshould that duplicates original tooth structures. Of course, continually observe the following practices: modern science has been unable to accomplish such Store mercury in a closed container, a feat to date. Dental amalgam, however, does Always sweep up spitted mercury with a possess many of the desirable qualities while having broom and never with a vacuum cleaner unless it is few unisesirable ones. one especiaHy designed for mercurypickup. Desirable properties. A properly proportioned Household vacuum cleaners increase mercury and properly mixed amalgam has the following volatilization. desirable properties: Discard the spilled mercury in the scrap Is easily adapted to prepared cavity. amalgam container. Is dimensionally stable. Store unused portions (scrap) of dental Has adequate strength whet: At. amalgam in a vessel containing enough water to Resists discoloration. cover the amalgam. Has sukable setting time. Notice that the label on a bottle of mercury Undesirobk propenks. As we stated earlier, there shows the contents to be poisonous. Naturally, is no perfect filling material. The two main mercury in its pure state is harmful,but the mercury undesirable properties of dental aMalgam are its 11 found in medichr I compounds and in dental high thermal conductivity and its poor color. ) amalgans is not harmful when properly applied.The Because of its high thermal conductivity, dental 34 21 7 amalgam restorations are often placed over an T F9. "The meal that provides unapt. color. insulating bee material that helps prow the tooth and durability to the simipm is silver. pulp from temperature change irritation. The metallic or silver-gray color of dental amalgam also makes it undesirable a a filling in asterkw teeth. You can avoid adding other undesirable %slides T F10 Copper furctions. to increase.the by mixing the amalgam in correct proportions. hardness. UAW evasion, reduce the flow, and shorten the setting time of Lung** (40k =Wpm. Indicate whether the following statements concerning dental amalgam are true (T) or false (F) by Cirdini the appropriate T or F. T FI I . Tbe two maja undeskable characteristics of amalgam are its high thermal .);roductivity sad its poor color.
T FI. Dental amalgam is best suited for anterior restorations.
429. Explain specified maidens aides T F2. Dental amalgam is sometimes used a a die material. Mixing Amalgam. Normally, dental amalpm is easily prepared. Very little equipment ad time are needed to produce a satisfactory restoration. T F3. Silver alloy is usually supplied in pellet However, you must follow certain stops and form. precautions to produce desired MAI Alkylmercwy poponimigg. The tint sop in preparing a mixture of amalgam is proportioning the alloy and the mercury, and the tint sup ki T F4. The word "amalgam" as it is used in proportioning dental amalpm is to make sure you dentistry is defined as a combination of understand the manufacturer's instructions. Each mercury with other metals. alloy manufacturer provides a brochure that gives the alloy composition, dearee of coarseness, mixing time, and alloy-mercury NAO. it is importam that you follow the manufacturer's instructions madly. T FS. Scrap amalpm should be stored in a dry Th adition to knowing the alloymercury ratio, open container. you must also know how much to mix. Since Air Force dental clinics use the pellet type of silver alloy, the amount to be mixed is stated in numbers of pellets. You may be asked to mix a "2-pellet T F6. The best way to clean up spilled mercury mix." This means that you should place 2 silver is with a household vacuum cleaner. alloy pellets in the mixing capsule and add the amount of mercury the manufacturer recommends to reach the proper alloy-mercury ratio. There are two methods of proportioning the T F7. The ADA% allowable percentages for the mercury. In the "manual" method, because pellets metals comprising silver alloy are a are ecefotmed in a set amount of silver alloy, you minimum of 65 percent silver and a must measure the mercury by using an eyedropper ntaximum of 29 percent tin, 6 percent and counting the drops. However, a faster and more copper, and 2 percent zinc. accurate method is to use a mercury dispenser specially made for the purpose. This unit, shown in figure4-1, comes withfourinterchangeable plungers, each of which dispenses a specific T F8. Tin functions in an amalgam restoration quantity of mercury when the plunger is depressed. to prevent the formation of oxides with You canvarythealloy-mercuryratioby the other metals. interchanging the plungers. You operate the device by placing the requited number of alloy pellets in the mixing veuel. Then you add mercury by 35
2.1 1
the alloy and mercury in the clean capsule along with the pestle. Now place the cap on the capsule and load the capsule between the forklike prongs on the electrical amalgamator. See figure 4-2. Set the mixing time as the manufacturer suggests and activate the amalgamator. The forklike mechanism vibrates the capsule at a very high speed to produce a smooth, homogeneous mix ofamalgam. The dental officer you assist may want you to mull the amalgam after mixing. To do this, remove the pestle. Replace the capsule on the amalgamator and operate the machine for 1 or 2 seconds. Another way you can mull the amalgam is to place it in a piece of rubber dam, a cotton squeeze cloth, or a fingerstallto protectit from moisture contaminition from your fingers. Then knead the amalgam until it rcaches the desired consistency. You use this latter method when you mix the amalgam manually. After trituration and mulling, the amalpm may contain excess mcrcury. You remove this excess by squeming. Place the mix in a squeeze cloth (a circular piece of white cotton cloth about 3 inches in diameter). Fold it over the mix and twist with finger pressuie. The dental officer will tell you how much mercury to remove. Always squeeze the excess mercury into a container and neverlet it spill on the floor. As we mentionedearlier, the container should then be covered to avoid the volatilization of the mercury. After the excess Figure 4-1. Mercury dispenser. , mercury has been removed, the mixis ready for depressing the plunger on the mercury container. Be sure to use the plunger that produces the desired mix consistency. PRONGS -Trituration. . Now that you have proportioned the alloy and mercury, you must mix the two together. Mixing (triturating) amalgam can be done in two different ways. One way is the older method of manually using a mortar and pestle. The other method is using an electrical amalgamator that mixes the alloy and mercury mechanically. In the 1 first method, you place the alloy and mercury in the mortar and mix them together bymanually manipulating them with the pestle. The results are usually good in the hands of a skilled chairside assistant. But in the hands of the unskilled assistant, the mix is frequently undesirable because of variations in consistency and shortened working time. The mechanical method is usually the better of the two because it eliminates the human variable and reduces the mixing time. Also, the mechanical method produces more consistent mixes from one mix to the next. The first step in the mechanical method is to inspect the capsule to make sure that it ON-OFF SWITCH TIMER is clean and that it has a pestle (small plastic or metal cylinder that helps mix the amalgam). Place Figure 4.2. Amulgamatfir. ..) I:. 1 36 Le y e ..'insertion into the cavity preparation. Open the 421. Point out specific procedures that insure an squeeze cloth and load the amalgam carrier. adequate quality control in dental amalgam Packing the amalgam into the cavity preparation preparation. is known ascondensation.Time and pressure are important factors in achieying the best results. The Quality Control Measures. To assure high- dentist must pack or condense the amalgam in the quality amalgam fillings, quality control measures cavity preparation before the chemical setting must be continually applied. These control action begins forming crystals. Therefore, it is measures must begin with the development ofthe important that you do not waste time in handling amalgam materials and end only after a missing part the amalgam after you have it. Too much delay can of a tooth has beeri successfully restored. Quality weaken the amalgam. As you may have already control measurer may be divided along three lines noticed, there are several areas where the wrong of responsibility. The first control measures are the action can adversely affect the quality of an responsibility of the manufacturv: second, several amalgam filling. control measures are in your hands: and finally, the dental officer himself is solely responsible for some Exercises (420): of these quality control measures. Manufacturer control measures.The I.If the dentist calls for a "2-pellet mix," what manufacturer is responsible for the purity of the should you place in the mixing capsule? ingredients in his products. With reference to alloy specifically, the manufacturer must also exercise proper controls to produce an alloywith the metals in the correct proportions. We also depend upon 2. What is the purpose of the interchangeable the manufacturer to provide an alloy withthe plunger that comes with the mercury dispenser? proper particle size. The particlesize affects the consistency of the mix for a given alloy-mercury ratio. Still another process controlled by the manufacturer is the heat treatment given to the alloy 3. What term applies to mixing the alloy and metals. This is the controlled heating and cooling of mercury together? the metals to bring out the best combination of the strength, condensing ability, and chemical bonding ability of the alloy. 4. Why is thc amalgam that is mixed manually Assistant dantrol mantra.Although the dental with a mortar and pestle frequently officer has the overall resporsibility for any restoration, he depends upon you to exercise undesirable? certain control measures in handling dental amalgam. Among these areas under your control are the proportioning, mixing, andmanipulating of 5. State the first step in the mechanical method of the amalgam. triturating amalgam. a.Proportioning. Proportioning the amalgam can be vital to the SUCCOM or failure of a filling. Especially is this true when there is too little mercury, which produces a "dry mix." If any 6. Describe the process of mulling the amalgam portion of a mix is too dry, it should be replaced with the amalgamator. with a mix of proper consistency. You should never add mercury to a mix that is too dry. If I drop of mercury is added to a partially set mixof average size, the resulting compressive strength of the mix 7.Why is the squeeze cloth used before loading will be about one-tenth of its normal strength. After the amalgam carriers? your dental officer has told youwhat mix consistency he wants, refer to the manufacturer's instructions to find the proportions that will
a* produce the desired mix. 8. What name applies to the process of packing b.Mixing. Mixing the amalgam properly is also the amalgam into the cavity preparation? vital to producing a quality restoration. Some improper quality control measures are faulty timing, overtrituration, and undertrituration: (1 ) Timing ir important as it relates to the 9. Why must you work rapidly with the amalgam moment when the mixing process shouldbegin. If after it has been mixed? you begin a mix too soon, theamalgam may begin s 3 7 .0 to set before it can be used. Ask the dental officer to interference also weakens the amalgam. We notify you when he will be .eady for the mix. mention these possible problems in condensing (2) Overtrituration is undesirable because it ralgam only because the dental officer condenses decreases the setting time and increases the the amalgam that you prepare. Therefore, shrinkage of the amalgam. condensing problems encountered by the 'dental (3) Undertrituration is also undesirable because officer are many times the result of improper action it increases the setting time, increases the on your part. As you may have already concluded, expansion, and weakens the amalgam. Once again, teamwork is essential in handling dental amalgam. to prevent overtrituration or undertrituration of amalgam, consult the manufacturer's instructions. Exercises (421): C. Manipulation errors. Your manipulation of I. Who is responsible for the purity of amalgam, as the assistant, is important. If proper ingredients. correct proportions of rrietals. controls are not exercised, the results can be proper particle size. and the heat treatment of discomfort and inconvenience for the dental the silver alloy? patient. The most common error in manipulating amalgam is contaminating the mix with moisture or other impurities. These contaminants are usually introduced during the mixing, mulling, or 2. What should you do if your amalgam mixture is squeezing of the amalgam. too drl? Why? (I) Moisture. If moisture in any form contacts freshly triturated amalgam,the result can be painful and injurious to the dental patient. The undesirable effects are delayed and excessive 3. Why is overtrituration or undertrituration of an expansion, lowered crushing strength, blister amalgam undesirable? formation on the amalgam surface, and pain shortly after the- fillingis inserted. You can introduce moisture into amalgam by mulling it in a moist palm, touching or handling it with moist fingers, or 4. What is the most common error in triturating it at a temperature below the dewpoint (the temperature at which moisture from the manipulating amalgam? atmosphere begins to form on an item). You can help control the introduction of moisture into 0 amalgam by making sure that it does not directly 5. List the undesirable effects caused by the touch your bare skin and that the temperature of the moisture contamination of amalgam. amalgam doesn't fall below the dewpoint. (2) Other oontarninants. These are any foreign materials that enter the amalgam. If soil from an unclean squeeze cloth or debris on an instrument is 6. List three ways that moisture can be introduced introduced into an amalgam, it can interfere with into amalgam. the chemical bonding action. Even a small fragment of amalgam lodged in a capsule can act as foreign matter. To remove a small fragment of lodged amalgam, place a few drops of mercury in the 7. How can you eliminate small fragments of capsule and place it on the amalgamator for a few amalgam that have lodged in the capsule from a seconds. This process usually dislodges the previous mix? fragment of amalgam and it can then be emptied with the rest of the contents. To prevent contaminating amalgam with foreign matter, make sure that you use only clean squeeze cloths. instruments, and capsules. As a further measure. 4-2. Silicate Cement \ you may store the alloy and mercury in covered containers to guard against dust contamination. Silicate cement, like amalgam, is a tooth restorative material. However, this is about the only Dental officer control measures. The dental thing the two materials have in common. Amalgam officer is solely responsible for condensing the is uscd to restore posterior teeth and silicate cement amalgam. If he does not condense the amalgam isprimarily uscd to restore anterior teeth. enough, the results are an increase in expansion and a weakened amalgam. Further, the chemical setting 422. Specify the use, components, properties, and action can be interrupted if the dental officer takes mixing and placement procedures involved with too long in condensing the amalgam. This silicate cement. ) 38 221 1 1 improperly. A cap that ?4 Silicate cement is used to restore anterior teeth can make the bottle cap fit mainly because of its esthetic value (pleasing fits improperly does not protect the liquid and can appearance). It is supplied in a variety of shades to cause it to gain or lose water. match the tooth color of each patient. Many If silicate cement is supplied to you by different dentists now prefer composite filling materials over manufacturers, their dispensing bottles sometimes silicate cement, but silicate cement has certain look much alike. Since these liquids must not be anticariogenic properties that still make it the used interchangeably, you should store each material of choice for many patients, particularly powder and liquid set together to avoid those with rampant caries. To achieve the best mismatching the liquids and powders. results with silicate cement, the mixing time and the Combined Properties. As with all dental mixing technique are very critical. Any variation materials, silicate cement has some desirable from the established mixing time and mixing qualities and some undesirable qualities. If you technique can produce an improper mix recall, amalgam has a number of desirable qualities consistency, an improper shade match, and a and very few undesirable qualities. In comparison, weakened filling. First of all, we will describe the silicate cement has very critical desirable qualities, components of silicate cement. but its undesirable qualities are just as critical. Components. A powder and a liquid are mixed Desirable properties. Silicate cement has some together to form silicate cement. The powder is advantages over metallic restorative materials. The supplied in a small bottle. The liquid arrives in a major desirable property of silicate cement is its small ampule, which is heremetically sealed. Both natural appearance. As we said earlier, it is the powder and the liquid, along with a dispensing manufactured in many shades to match the shade of bottle for the liquid, arrive packed together in a the tooth being restored. Silicate cement is also small box. The box label gives the Federal stock translucent (transmits light) to about the same number, the shade of the powder, and the manufac- degree as natural tooth enamel, which contributes turer's lot number. to its natural appearance. As we mentioned earlier, Powder.The powder component of silicate one of silicate cement's most important properties cement is silica (the main constituent),alumina, is its anticariogenic action. The fluorine and various fluxes, including fluorine. The powder concentration in the average silicate cement powder is so finely ground that it resembles talcum powder. is from 12 to 15 percent. The clinical significance The manufacturer has very carefully produced these of the fluorine is quite important because the powders to assure precise shades. It is important, fluorine passes from the silicate restoration to the therefore, that you do not let foreign matter get into tooth's enamel. As a result, there is a low incidence the powder. Even dust from the air can enter an of recurrent caries at the margin of a silicate uncovered bottle of powder and upset the delicate restoration. Since marginal caries are the most color balance. Certainly, unclean instruments or an frequent cause of the failure of most dental unclean mixing surface would significantly affect restorative materials, silicate cement is notably the color of the mix. Be sure that you maintain the superior from this standpoint. Another of its cleanliness of everything you use in handling desirable properties is its very low rate of thermal silicate cement powder to avoid any color change. conductivity. Silicate cement is also relatively easy Liquid. The primary ingredients of the liquid to mix and can be manipulated more easilythan phosphoric acid part of silicate cement are usually metals and alloys. and water. The percentage of each ingredient varies is important Undesirable properties.Even though silicate a little from brand to brand. Thus, it material, that you do not interchange the components of cement is classified as a permanent filling it is one of the least permanent. It is brittle, it is different brands. Ideally, the powder and liquid has a low crushing should be of the same lot number as well as of the soluble in mouth fluids,it same brand. It is also important that youkeep the strength, and it contracts somewhat upon setting. All of these undesirable properties reduce the life bottle closed, except when dispensing the liquid. If thereby silicate cement liquid is exposed to a high-humidity expectancy of a silicate cement filling and atmosphere, it will absorb water. If it is exposed to limits its use. low humidity, it will lose water. Excess water in the Mixing Procedure. As we stated earlier, silicate silicate cement liquid causes rapid setting, and a cement is relatively easy to mix. There are, loss of water from the liquid causes slow setting. however, definite steps to be taken and definite time For the same reason (possible water content limits in the mixing procedure. These steps are imbalance), you must not place the liquid on the preparing the equipment, preparing the materials, mixing surface prematurely. Ask the dental officer and using an approved mixing technique. to notify you when to begin mixing thematerials. Equipment preparation. Tomix silicate cement, It is a good idea to wipe the neck of thebottle you need the following items ofequipment: containing the liquid every 2 or 3 days. Phosphoric (1) A clean, cool, dry glass slab. This should be acid crystals form around the neck of the bottle and used only for mixing silicate cement. If the glass 39
224 0 .%A.1t"
scratched, you should that matches the patient's tooth.After he gives you slab becomes chipped or the shade number, you can measureout and replace it. proportion the correct shade ofpowder on the glass (2) The #142 plasticspatula. Be sure that the Never use the metal slab. For a normal-sized mix, usethe large end of 4 spatula is clean and dry. the measuring stick and measure outfour to five spatulas (#313 and #324)for mixing silicate as (approximately 1/6 they will stain the mix. portions of the powder stick. This is an teaspoon). Then, using thespatula, divide the (3) The powder measuring of the halves optional item. It is about 4inches long and is powder into halves. Further divide one diameter. At each into quarters, which makes ahalf and two quarter slightly larger than a pencil in portions depression used to portions. Now, divide one of the quarter end of the stick is a cup-shaped with a half, a quarter, powder. into eights, so that you end up measure the volume of and two eighth portions ofpowder. Do not place laid out for use, you the liquid on the glass slabuntil the dental officer After you have the above items indicates that he is ready for you tobegin mixing. may need to run cold waterover the glass slaband between 65° and 75° F. Place 2 to 3 drops of liquidclose to the divided spatula to cool them to portions of powder and begin mixingthe materials. CAUTION: Be sure you don'tcool them below the dry them thoroughly, Mixing technique. To mixthe liquid and dewpoint. Next, you should powder, be sure you use the #142spatula. To start using a clean towel. You are nowready to prepare mixing, incorporate the firstportion of the powder the materials for mixing. (the half portion) into the liquid.Remember always Materials preparation. Thedental officer uses a to mix silicate cementwith a folding motion. using shade guide to determinethe number of the shade
0
Figure 4-3. Mixing silicate =lent. hilte 23 only,a small area of the glass slab. When you have S. What is the effect on the cement's setting time if mixed the first powder portion until it appears the silicate cement liquid loses wales? completely wet, then bring the quarter portion into the mix. Continue adding the portions of powder until the mix is of puttylike consistency. The entire mixing time should not exceed I minute. Briefly 6. List the desirable Properties of silicate cement. stated, mix silicate thickly and quickly. (See fig. 4-3.) When you have completed the mixing of the silicate cement, discard any excess powder. Then 7. List the undesirable properties of silicate leave the mix on the slab and quickly place it within cement. easy reach of the dental officer. The average setting time for most brands of silicate cements is from 4 to 6 minutes. Considering this short setting time, you can see why you must prepare the mix and have it 8. Name the items needed to mix silicate cement ready quickly in order for the dental officer to have and briefly comment about their proper enough time to insert the mix. temperature. Placement procedures.The dental officer ;ties a clear plastic strip matrix to partially form and hold the silicate cement in place until the initial set is complete. He condenses your mixture into the 9. How does the dentist determine the number of cavity preparation with one of the stellite plastic the shade of silicate cement needed to match filling instruments. After the silicate has set, he the patient's natural teeth? trims and smooths the material until it assumes the contour of the natural tooth. Next, the dental officer places a protective coating on it to prevent a gain or loss of moisture. If the newly.placed filling 10. How should you divide the silicate cement is prematurely exposed to oral fluids, it will stain powder after you have placed it on the glass more easily. The premature exposure of a new slab? silicate cement mixture to air can also cause the restoration to stain more easily. To prevent the exposure of silicate cement to air and mouth fluids prematurely, the dental officer coats the cement 11. Describe the proper mixing motion, final with silicate lubricant. As with dental amalgam, the consistency, and mixing time for silicate key to quality silicate cement fillings is the cement. teamwork between you and the dental officer you
Exercises (422): 12. What is the average setting time for most brands 1. Which teeth are normally restored with silicate of silicate cement? cement?
13. When the dental officer is placing a silicate restoration, what does he use to partially form 2. Name the main constituent of silicate cement and hold the silicate cement in place until the powder. initial set is complete?
introduce any 3. Why isit important not tt 14. What instrument does he use to carry and place foreign matter into the silicate cement powder? the silicate cement into the cavity preparation?
4. Name the primary ingredients of the silicate 15. How is a newly placed silicate restoration cement liquid. protected from premature exposure to oral fluids?
41
2 94 I1
43. Composite Filling Materials composite filling materials are many. Like silicate cement, they closely resemble the naturaltooth Composite restorative materials are now the structure and, like silicate, these materials arealso material of choice for some tooth surfaces and for (ranslucent. The marginal shrinkage of composite certain areas of the mouth. Like the other fillings is minimal, and this factor reduces the i restorative materials, they have both desirable and possibility of marginal leakage and recurring caries. undesirable properties. The composite restorative Unlike silicate cement, the composite fillings are materials are available from many different resistant to water sorption andsolubility. manufacturers. Some examples are Adaptic, Therefore, they are not susceptible to washing out, Addent, Smile, and Dakor. Each of these materials and they resist staining. Also, thecomposites are is somewhat different from the others, and stronger and harder than silicatesand resist therefore requires special handling. For this reason abrasion. Because of their strength, thecomposites we will not discuss the mixing procedures for com- are better used for incisalrestorations than silicate. posite filling materials. You should be thoroughly Probably the most interesting desirable propertyof fatniliar with the manufacturer's instructions con- this material is its ability to assume the colorof the cerning the composite restorative material used in natural tooth. Because of this property,matching your clinic. the natural tooth's shade or color is not ascritical as it is with silicate cement. Undesirable propernes. Primarily the composite 423. State the uses and comments of composite filling material has two undesirable properties. We !Whig materials and identify their properties. have mentioned the first of these previously. As you recall, silicate cement has an anticariogenic action Uses. Composite 'restorative materials are used that is produced when the fluorine from thesilicate primarily for anterior restorative procedures. They powder is absorbed by the tooth's enamel. The can be used in any of the areas inwhich silicate composite restorative materials do not havethis cement can be used. Because of their increased property. Although the compositesdisplay little crushing strength, they are more suitable for incisel marginal shrinkage and a low incident of recurring restorations than is silicate. caries, they do provide a greater possibilityfor caries recurrence than does silicate. Thesecond Components. Basically, all composite undesirable property is the extremely short shelflife restorative material sets consist of a composite of composite resins. Some composite's havesuch a material and a catalyst. The exact ingredients of the brief shelf life that the manufacturer's instructions I various composite materials and their catalysts call for the materials to be destroyed 30days after remain closely guarded secrets of their they have been opened. Unopened, mostof the manufacturer. "Composite materials" consist of composites can be safely stored for severalmonths, organic binders and inorganic fillers. The function and if refrigerated, their shelf life can beextended of the binders, as their name implies, is to bind the further. mix together during setting. These binders are Placement Procedures. The placement modified acrylates that become highly crosslinked procedures used with composite filling materials during setting. The inorganic fillers comprise the are practically the same asthose used with silicate bulk (probably 70 percent) of the composite cement. The dentist uses theclear plastic matrix material. Various inorganic materials are strip to partially form and hold the compositein associated with the fillers of the different place until the initial set is complete.He condenses manufacturers. Some of these fillers are fiber glass. the composite material into the cavitypreparation natural quartz, glass beads, and other translucent with a stellite plastic restorative plugger. Afterthe spherical, fibrous, and powdered mineral fillers. material is set, he trims and smooths ituntil it These fillers provide a light transmission system for assumes the contour of thenatural tooth. He then adapting the color of the composite material to the places a protective coating over the restoration to surrounding tooth structure. The composite protect it from premature exposure tooral fluids. material is usually supplied in the paste form. Depending on the manufacturer, the composite Exercises (423): material comes in jars, tubes, or individual units. I. What teeth are compositefilling materials The catalyst is the agent that, when mixed with the primarily used to restore? composite material, causes it to set or harden. These catalysts, depending on their manufacturer, are supplied in either paste or liquid form. Combined Properties. As stated earlier, 2. Name the basic components of acomposite composite filling materials have both desirable and filling material set. ID undesirable properties. 1 Desirable properties.The desirable properties of 42225 3. Name the basic ingredients and describe the Uses. Zinc phosphate cement is used as a function of the composite filling materials' cementing agent for crowns, inlays, fixed partial organic binders and inorganic fillers. dentures, and other dental appliances. Zinc phosphate cement is also used as a temporary restoration, and as an insulating base under amalgam fillings. It might seem that the 4. In what form are composite restorative components of zinc phosphate cement would be materials usually supplied? rather complex because of its wide range of application and the complicated sound of its name. Although its chemical makeup is not altogether simple, neither is it overly complex, as you shall see. 5. What is the function of the composite filling Components. Zinc phosphate cement is materials' catalyst? composed of a powder and liquid, as is silicate cement. Also, like silicate cement, each component is contained in a small bottle. The two bottles arrive in the dental clinic packed in- a small box. When 6. Identify the desirable and undesirable you open the zinc phosphate cement box, you find a properties by indicating which of the following small corkscrew and a dropper in addition to the properties apply to composite restorative two bottles. After you have fitted the rubber part of material. Indicate those that apply by placing the dropper into the opening provided in the lid of an "X" in the spaces provided. the bottle, use the corkscrew to remove the stopper from the bottle containing the liquid and close the Resembles tooth structure. a. bottle with the plastic lid. As you examine further, Is translucent. b. you see that the zinc phosphate cement powder and C. Provides anticariogenic action. liquid look much like the components of silicate d. Is water soluble. cement. For this reason, they are sometimes e. Has a long shelf life. mistaken for each other. Until you can differentiate f: Not susceptible to washing out. between the two cement components by sight, it is t.Resists abrasion. best to identify them by reading the labels. Suitable for incisal restorations. Powder. The exact ingredients of zinc phosphate i. Highly susceptible to marginal powder vary from manufacturer to manufacturer, leakage. but the chief ingredient in all brands of the powder Resists staining. is zinc oxide. In some instances, the powder also Assumes the natural tooth's color. contains magnesium oxide, silica, bismuth, trioxide, and certain pigments. The different pigments, of course, produce different shades of powder. Air Force dental clinics use light grey and light yellow shades primarily. If you have any doubt 7. How do the placement procedures for as to which shade you should mix,always ask the composite restorative materials compare with dental officer you assist. Now consider the liquid those used for silicate cement? component. Liquid. The liquid used with zinc phosphate cement powder is composed of phosphoric acid and water. If you remember, these same two ingredients are found in silicate cement liquid.However, the 4-4. Zinc Phosphate Cement percentages of these constituents are different in the In recent years, a large variety of new dental two liquids. Zinc phosphate cement liquid mayalso materials has been introduced to the dental contain aluminum hydroxide and zinc hydroxide. profession. Many of these new materials have been When the liquid and powder are mixed, the widely accepted. Some new materials have phosphoric acid combines with the zinc oxide to generally replaced some of the older materials. form zinc phosphate. The manufacturer adjusts the Although zinc phosphate cement is among the older water content to provide a suitable setting time. dental materials, it is still widely used. One reason Too much water in the liquid causes the mix to set for its continued use isits wide range of rapidly, while too little water causes the mix to set application. slowly. When the powder and liquid are mixed, they yield cettain properties that we call combined 424. List the uses of zinc phosphate cement, properties. specify its composents, and mixing procedures Combined Properties. Zinc phosphate cement used with zinc phosphate cement, and identify its in its combined state possesses some desirable and proPerties some undesirable properties. In this respect, itis 43 22 6 You need the following like silicate cement and amalgam. However,the Equipment preparation. properties of zinc phosphate cement make it more items of equipment to mix zinc phosphate cement: suitable as a cementing agent than as a filling (1) A clean, cool, dry glass slab. (2) A clean, cool, dry spatula. The spatulas material. designed for mixing zinc phosphate cement are the Desirable properties.The shades of zinc #313 and #324 stainless steel types. The above phosphate cement allow it to be used almost items may need cooling under cold running water inconspicuously, which is definitely a desirable before they are used. The temperature of the mixing property. This cement is also fairlyeasily mixed and slab and spatula affects the setting time of the mix. is easily manipulated after mixing. Another desirable property of zinc phosphate cement is that Materials preparation.When the dental officer it can be mixed and used in a fairly thin indicates that he will use zinc phosphate cement, consistency. This gives the cement sufficient flow to select a matching set of powder and liquid and form a very thin layer for cementing crowns,inlays, measure out the powder. To do this, removethe cap and fixed partial dentures. Zinc phosphate cement and roll the neck of the powder bottle on the glass is also desirable because it has low thermal slab until you have dispensed from 1/6 to1 /4 conductivity. For this reason zinc phosphate teaspoon of powder. The amount of powder cement is used under metallic restorations as an depends upon the type of mix desired. (We'll insulator, protecting the pulp from the rapid discuss this a little later.) The powder is then temperature changes that are characteristicof metal divided into portionsgenerally fourths. Then one restorations. The undesirable properties ofzinc of the fourth portions is divided into eighths, and phosphate cement are similar to those ofsilicate sometimes one of the eighth portions is divided into cement. sixteenths. Such a dividing procedure gives you a eighth Undesirable properties. Probably the most total of 6 portions-3 fourth portions, 1 significant clinical property of zinc phosphate portion, and 2 sixteenth portions. It is best to wait cement is its solubility and disintegration.Cement until the dental officer signals that he is ready for solubility is the main factor leading to recurrent you to mix the material before you measure outthe decay (caries) around crowns and inlays. When it is liquid. Exposing the liquid to air prematurely can used as an intermediary base for deep cavity affect the water content and in turn affect the setting preparations, the acidity of the cement irritates the time of the cement. With the signal to mix, dispense tooth pulp. The relatively low crnshing strength of from 3 to 5 drops of liquid and you're ready to the cement is also undesirable. The crushing begin the mixing procedure. (The amount of powder dispensed governs the amount of liquid e strength of a zinc phosphate cement mix of medium consistency is about 12,000 pounds per square inch needed.) or about half that of silicate cement. The strength of There are two types of zinc photphate cement the mix is directly proportional to the amount of mixes. The first mix might be described as having a powder it contains. Therefore, incorporate the thin to medium consistency. It is used as a maximum amount of powder that still yields the cementing agent for inlays, crowns, and other desired mix consistency. Zinc phosphate cement dental appliances. The second type of mix is athick shrinks during setting, which is also undesirable. mix, which is used as a base material underfillings All of these undesirable properties limit its use to and sometimes as a temporary filling. some extent. It is still, however, universally accepted and used as one of the basic dental Mixing technique.The type of zinc phosphate materials. As with amalgam and silicate cement, the cement mix depends largely uponthe amount of method of mixing zinc phosphate cement is very powder incorporated. For a cementing-typemix, important. incorporate one of the sixteenthportions and Mixing Procedure. The mixing of zinc spatulate over a large portion ofthe slab; then sixteenth phosphate cement is similar in some respects to the follow the same pattern with the next portion, the eighth portion, and so onuntil the mixing of silicate cement. The differences are medium significant, however, so be sure you have these desired consistency is reached. A thin to differences well established in your mind. If you mix should be completed inapproximately 11/2 minutes. The consistency of the mixshould appear confuse the exact mixing requirements for silicate spatula. To cement with those for zinc phosphate cement, you somewhat creamy and flow from the add more powder and will usually have an unusable mix, and have wasted prepare a thick mix, simply complete the mix within13/4minutes to a time and material. The best source of information the mix is on the proper mixing proceduresis, as we have maximum of 2 minutes. Be sure homogeneous (of uniform consistencythroughout). stated time and again, the manufacturer's instruc- phosphate cement tions. Generally, the steps include equipment prep- (See fig. 4-4.) Always mix zinc over a large area of the slab.This dissipates the heat aration, materials preparation, and the approved ingredients. If 0 mixing technique. created by the chemical action of the ) 44 . 0 41, i." ...,1
'II 4 5. What equipment should you use for mixing zinc phosphate cement?
6. What is the mixing time for a thin to medium mix of zinc phosphate eement?
7. What is the mixing time for a thick mix of zinc phosphate cement?
Figure 4.4. Mining zinc phosphate cansot. .. 8. Why is it important to mix zitic phosphate cement over a large area of the slab? the heat is not dissipated it would injure the tooth Pull). Several factors can influence the setting time of zinc phosphate cement. Factors that shorten the 9. Indicate the factors that prolong the setting setting time are: time of zinc phosphate cement by placing an a.A warm mixing slab and spatula. "X" in the appropriate spaces. b.A moist mixing slab. Water evaporation from liquid. c. Rapid mixing. Cool slab. d.Dilution of the liquid with moisture from the Rapid mixing. air. Warm slab. Factors that prolong the setting time are: Slow spatulation. a.A cool, dry slab. Dilution of the liquid by moisture. b.Evaporation of water from the liquid. Mixing over a large area of the slab. c.Mixing over a large area of the slab and slow spatulation. 4.5. Insulating Materials Exercises (420 Even though the dental profession has developed many dental materials that have proven to be highly I. List the uses of zinc phosphate cement. desirable, it has not yet developed the perfect restorative (filling) material. Such a material would provide all the qualities of natural tooth structures. To date, one of the problems with these dental 2. What is the chief ingredient of the zinc materials has been that many possess very poor phosphate cement powder? insulating qualities. Those that insulate against some and possibly all irritants are usually deficient in other restorative properties. The result has been the need for separate 3. How do the ingredients of the zinc phosphate insulating materials. cement liquid compare with those of the silicate cement liquid? 425. State the purpose of insulating materials, sad describe their mes and mixing procedures.
Insulating materials are used to protect the vital 4. Identify the following properties that apply tO dental pulp from thermal, chemical, electrical, and zinc phosphate cement by placing an "X" in the any other possible sources of irritation. .Though spaces provided. researchers have been unable to find the perfect Insoluble in oral fluids. insulating material for the dental pulp, several Shrinks during setting. products are considered valuable. While some Irritating to tooth pulp. provide a nearly adequate strength, they are Easily mixed and manipulated. inadequate as thermal insulators. Others may be Has a high thermal conductivity. adequate as thermal, electrical, and chemical Can be used in thick or thin insulators but inadequate in crushing strength. As a consistency. result, the dental officer has a variety of insulating 45
228 materials to choose from, and he selects the minutes, which makes it usable as a base material insulator best suited for each insulating under restorations. requirement. The most common insulators, in Zinc oxide and eugenol cement. You will have addition to zinc phosphate cement, are variations of many opportunities to mix the zincoxide powder calcium hydroxide and zinc oxide mixed with with eugenol to form a cement. Zinc oxide and eugenol (oil of cloves). eugenol cement is one of the most popular materials for sedative or temporary fillinp. Calcium Hydroxide. Pure calcium hydroxide is Vety little equipment is needed to prepare a mix a fine white powder. It is relatively nontoxic and is of zinc oxide and eugenol cement. While you can used by both the medical and dental professions as a use a glass slab, it is usually Moreconvenient to use protective material. In dentistry, it is widely used as plastic or a pulp-capping material because it seems to a paper pad with disposable sheets. Use a stainless steel spatula, or a tongue depressor. When stimulate the production of secondary dentin, and you prepare .a mix of zinc oxideand eugenol, the is also used as a bue under permanent restorations. dentist may want to accelerate the setting time. This insulating materisl is available in powder and There are a number of materials that you can use paste forms. The powder is sometimes mixed with for that purpose. However, the one most frequently either sterile water or a local anesthetic to form a used is zinc acetate. Because water also acts as an paste. The Federal Supply Catalog also lists calcium accelerator, this cement sets rapidly when saliva hydroxide in two different paste types. contacts it after insertion. If the prepared cementis Hard setting type. This type arrives in two stored in a dry atmosphere without an accelerator, tubesone tube of base paste, one tube of catalyst it may be kept for a week or longer. There is no (accelerates chemical setting action)--and a mixing definite mixing technique for this cement, but pad. To 'mix them, you simply -place small equal incorporate as much powder as possible into the portions of base and catalyst on the pad and mix liquid. You want to form a smooth, homogeneous them together. When mixed together, the hard mass. Of all the cements wehave discussed, this is setting type is used as a rigid base under the only one to which you, can odd more powder or restorations. The brand most often supplied to Air liquid after mixing without adversely affectins the Force dental clinics is "Dycal." material. Soft setting type. The soft setting type arrives in a Cavity Liners and Varnishes. Cavity liners and paste form and is used for pulp capping, in varnishes are the least effective oflhe actualdental pulpotomy procedures, and as a cavity liner under insulating materials. In fact, they are usually not cement bases. This material comes in a tube and classified as insulators at all. In spite of their there is no mixing involved. The soft setting inefficiency as thermal insulators, cavity liners and material most often supplied to Air Force dental varnishes do serve to partially insulate tooth clinics is "Pulpdent." structures from certain materials. For example,they Zinc Oxide and Eugenol. A combination of are used under zinc phosphate cementbases, silicate these two ingredients is used in surgical dressings, cement, and composite restorations toinsulate the in impression materials, in root canal sealing tooth structures from the acids found in such materials, as a base material under restorations, as a materials. They also serve for a short time as sealers cementing agent, and as a temporary or sedative around the margins of restorations. For this reason, filling material. Itis used in surgical dressings cavity liners and varnishes are better known as because of its soothing effect on tissues and sealers than as insulators. because it possesses mild antiseptic qualities. The Cavity liners are primarily resins in solutionin a major disadvantages of this combination are its low solvent, whereas cavity varnishes areactually crushing strength and its solubility in mouth fluids. varnishes in solution in a solvent. The solventsused Zinc oxide and eugenol, which is frequently in these solutions are highly volatile and evaporate classified as a dental cement, is also a very good rather readily. Because of this property,the insulating material. solutions become thick after a time and athinner must be added to returnthem to a usable Zinc oxide and eugenol paste. The 6520 Federal liners Supply Catalog lists zinc oxide and eugenol in paste consistency. The manufacturer supplies the and varnishes in sets, each containing abottle of the form for use as a pulp protector or, we might say, as is no mixing an insulating Material. The brand most commonly sealer and a bottle of thinner. There required with this material. The dentistsimply supplied is "Cavitec." Like the hard setting type of varnish and calcium hydroxide, zinc oxide and eugenol pulp moistens a cotton pledget in cavity protective paste arrives in two tubesone tube of applies it to the cavity preparation. base material and one tube of catalyst. To prepare a zinc oxide and eugenol paste mix, use equal lengths Exercises (42S): of material from both tubes. You may mix the two 1. State the purpose for insulatingmaterials. on the small parchment pad supplied. This cement will set to a very hard ,-Insistency in 33/4 to 4'/4 46 229 2. Why if calcium hydroxide widely used as apulp confider eaylk resits, gypsum prod." dowel in the capping meserist? waxes, and the metals and alloys used proshodomic section.
436. Aimee "edge IFINGINIB sheaf the wee mud 3. Describe the mix* proceduresinv.:lived with eempessme ef'tbe dead rads. the hard setting type of calcineshydroxide Mad Rolm The me of dental reins hes paste. been seedily increasing since the lase 1930s.Since then, a considerable amount of refinement and improvement have been msde in both the Medlin, 4. What should you mix with calciumhydroxide and processing of dental ram. TreeNAN are powder to form a pastel derived from plant secretions, but those used in dentisay are synthetic ruins. Tbe synthetic reds, methyl methacrylase, is the most widely used type. It is also refer/3d to es acrylic resin and is avsliablein S. How do you mix the paste form ofzinc oxide two different formsbeim:wingand selfcwieg. Heat Mgt be applied so the best-caring form before and nuSinol? it will harden. The self-curing form hordes at room temperature. &MUM base material. Damn base maid* 6. What is frequently used as anaccelerator for are available in gel form orin a est wmiWiag * The zinc oxide and eugenol cement? powder (polymer) and a liquid (mosonser). powder and liquid set is the most widely used in Air Force dental clinics. The heavan resins arevend to comma the base of fitll andpedal domes heat- 7. When you are mixing zinc oxideand eugenol The Falerel *ply Casa* lies dm following cement, how much powdershould you cure denture bete materials: incorporate into the liquid? a. Clear. b. Pink. c. Fibeted, light pink. The self.cured denture basematerials used for 8. Can you add more liquid to amixture of zinc making denture repairs are: oxide and eugenol without adverselyaffecting a. Pink repair. b. Fibered, light pink repair. the mixture? Resin crown material. Although most anterior crowns fabricated in the dentallaboratory are 9 State the uses of cavity line?: andvarnishes. constructed of porcelain, occasionally an acrylic crown is desired. Acrylic resin crownsare fabricated in the dental laboratory, using a heat . curing process. These crowns are made from resins that are shaded to match closely the shade ofthe 10. What action should you takeif the cavity liner patient's natural teeth. Resin crowns are usually or varnish solution getstoo thick to use? made for anterior teeth. Acrylic resin material can also be used for acrylic veneer crowns.The resins used as the veneer (outward layer visible inthe patient's mouth) on acrylic veneer crowns are also shaded to match tooth shades. These resins are applied to a metal crown (usually a gold alloy crown) to give the crown a natural appearance.The 4.6. Dental Prosthodontic Materials resins used on these crowns are usually theheat. minor repairs are made All the materials used in the osthodontic cure type, but sometimes section are incidental to the mak_agof artificial with shaded, self.curing resins. Impression tray resins. During the fabrication of dental appliances, crowns.inlays, and other dental full dentures, the prosthodontist may want tomake prostheses. We have already discussedthe resins a final, detailed impressionby using a customized used in prosthodontics and cannotinclude all of them under this heading. Wewill discuss impression tray. Such customized trays are made impression materials in a separatesection because with a special self.curing acrylic resin. This tray resin material is usually light blue or white in color. they are so numerous. In thissection we will 47 23 combine as an ingredient in certain high-heat tandem (436k investments. and (5) to make certain impressions. 1. Width form of acrylic rains is most often used The initial setting time for most dental plastersis for making denture repairs? from 5 to 12 minutes. The final setting is complete in afproximately 45 minutes. ifsfroosi. Chemically, hydrocal (dental stone) is very similar to plaster of park, butthe method of 2. What terms apply to the powder and the liquid manufacturing dental stone is somewhat different used to make denture base material? and the two differ in their physical properties. If you compare hydrocal and piasterparticles under a microscope, you will see that the plaster particle is long, needlelike, and quite porous. The hydrocal 3. How are resin crown materials used in particle is smaller, much more dense, and relatively dentistry? nonporous. For this reason. hydtocalrequires less water in mixing, and sets more slowly:When it is set, it is harder, denser, and has ahigher crushing strength. These properties make hydrocal 4. How are impression ttay resins used in preferable to plaster as a muter cast in complete dentistry? and partial denture construction, since it can withstand mve pressure in finking and packing and is less apt to be scratched or damaged in the laboratory. Hydrocs1 has many dental uses. The mote common omit are pouring castsand din, and 427. Chersetetke the mut predicts and their nuking dentures for processing. Hydrocal is colored yellow by the manufacturer to make it easily distinguishable from plaster. The initial set of Gypsum Predates. The gypsum products are a typical hydrocal mix is from 7 to15 minutia. The supplied m powders. When it is mixed with water in final set is completed in apptoximately 43 Minutes. the right proportions, the powder forms a paste that gradually hardens to a solid. This setting, or Eureka (427)/ hardening, process takes place over a period of is several minutes, during which time the mixture is 1. As final solidification takes place. what "given off" by all gypsum products? soft and pliable and can be formed into the desirNI shape. The setting process accelerates as it piogrestes. As it finally solidifies, the Outer gives off an appreciable amount of heat, which is 2. List the dental uses of plaster of paris. characteristic of all gypsum prorlwcts. Each of the materials in the gypsum group is carefully compounded to give it the particular combination of physical properties needed to do a particular job. 3. What are the initial and final settingtimes for The gypsum products you will use most are plaster plaster of paris? of pads and hydrocal (artificial stone). Plaster of park. Under a microscope, gypsum appears to be made up of tiny costal:, andeach crystal contains a definite amount of water. It is hydrocal or converted into plaster by grinding it into small 4. Is more water needed for mixing for mixing plaster of paris? particles and heating it slowly to remove the water. The amount of water that is removed by heating determines the behavior of the plaster when it is apin mixed with water. Plasters made for dental S. What are the most frequentdental uses of use are speeially processed to providehigh purity hydrocal? and suitable working properfies. These properties must be uniform within each batch andfrom one batch of material to another. One of the most important requirements is that it must set within a 6. Give the initial and final settingtimes for definite time limit. The amount of its setting hydrocal. expansion must also be within reasonable limits. Plaster has many uses. Among them arethe following: (1 ) to form casts. (2) to conttruct matrices, (3) to attach casts to the articulator, (4) to 48 231 119 4211. Given a lisi of *Mal waxes, identify their propery makes it useful for holding the parts of a saes aad eharaderisties. broken denture together 30 that it can ba Utility sox. Utility wax is a red wax that is Dental Wanes. Dental waxes are used at some supplied in round rope form. It is extremely pliable stage in the consteuction of all dentures, inlays. and somewhat tacky at room temperature, which crowns, and other maxillofacial appliances. The makes it usable without heating. The most waxes are supplied in many different forms, each important use A utility wax is in beading (otioAt with specific properties necessary for an intended trimming) impe4sions before boxing and pouring purpose. It is important to use the proper wax. the model. It has various other uses, ooeof which is lineplare mac Baseplate wax is supplied in two to provide a rimlock for imptesion trays. typeshard (type 1) and medium (type 11). The Disclosing ma. Ditclosing wax is an ivory hard type is better for warm temperatures because it colored wax that comes in a paste form. It is resists flow at higher temperature, but it may be too extremely low fusiAg, melting at mouth brittle and have a tendency to crack at lower temperature. Disclosing wax is used to determine temperatures. The medium type is satisfactory for the fit of full and partial dentures. colder tempemures, but it may exhibit tO0 much flow in a warmer environment. Baseplate wax is Exercises (421Ih used for occlusal rims, as a boxing matrix, and for Identify the uses and characteristics of the waxes in many miscellaneous purposes. This wax is pink and column A by matching them with the statements in is available in both sheet form and in the 11/1.inch colomn B. wide ribbon form, which is rolled in a dispenser carton. Colfew A Cutronn IMMO.1.NOting %flu. aA nwist.impreessest wax Bite mix. Bite wax is a metal.impregnated wax 2.Utility wee. used to transfer the cc- used by the dentist to transfer the occlusal 3.Inlay wax. cIt rolatioltaip of the relationship of the teeth from the patient to the 4.Ilauplate wax. lash from the patient to fIIMINEN. 3.Sticky was. the came. casts. This permits the dental laboratory specialist 6.Indicator wax. ftA wet supplied ie a wip or technician to set the tech in the proper position. 7.Disciosing twos. about I Vs hubs wide It &sine wax. Boxing wax is a red, specially. 8.Bite woe. is wed to eking the int- /motion with a matria prepared wax, which is supplied in strips about P/s Met powing a ea. inches wide and 12 inches long. Its principal use is c.Composed of beeswax. to box impressions. (Boxing is the act of enclosing paraffin, sad rein. this the impression with a matrix when pouring a cast.) wax will brae rather then It is alio used in making a plaster matrix when a bend wee Fame. It is used so hold the parts ofa complete denture is duplicated. broken denture together Indkator mu. Indicator wax is coated with a so that it cao be repakod. water soluble adhesive on one side. It is usually d The mo carefully oom. pounded of all the vexes. green and is used for registering occlusal contact on it is mil to make wax pat- natural teeth, individual restorations, fixed partial terns for Comte dentures, removable partial dentures, and complete and pointer. dentures. It is sometimes used by the dentist to eUsed to bead intrusions determine premature contact (high spots) on and provide a timlock for improssion trays. this wax restorations. is pliabk and somewhat Inlay mix. Inlay wax is one of the most carefully tacky at room tem- compounded of all the denta: waxes, and is used to perature. Ivory-wlored low fusieg make wax patterns for crowns, inlays, and pontics. mix that comes iii * 9ssie Inlay wax is supplied in sticks, in both hard (dark form. ft is used to doer- blue) and medium (blue) grades (the dark colors mote the fit of dentures. contrast with the color of the teeth) and also in R.Available in hard and ivory or white with no color pigment. This last type medium typo for use in different climates, this is used for waxing the pattern for acrylic jackets wax is wed for occlusal because it does not leave a colored residue in the rims plaster mold, which might discolor the resin of the Coated wtth a water WA- Me adhestve on one side, jacket crown. this wax is used for Sticky wax. Sticky wax is made of beeswax.' registenng occlusal con- piraffin. and resin. It is dark blue, dark red. or dark tact on teeth. restorations. vio.et in color. The resin gives the wax its and demo* adhesiveness and hardness. An important requirement of sticky wax is that it must break 429. Ideatify the propetties or characteristics of under pressure rather than bend or distort. This metals. 49 Dental Metals and Alloys. There is no Column 8 satisfactory, all-inclusive definition for metals. f.The areas of temperature However, they do have certain characteristicsthat in which a cuticular alloy distinguish them from nonmetals. They possess a will melt. o metallic luster, are good conductors of heat and electricity, and are usually solids atordinary 430. Given a list of dental metals,identify the use temperatures. Each metal possessesphysical of each. properties peculiar to it alone, which distinguishit of from all other metals. It has a melting range, a Dental gold. Gold possesses a combination specific gravity, a certain degree of hardness, physical properties that is unique amongmetals. malleability, and ductility. By knowing these Although too soft to be used alone for mostdental physical properties, you can predict with a fair purposes, it can becombined with other metals in almost any degree of accuracy the way in which the metalwill varying proportions to produce alloys of combination and degree of the desiredproperties. behave under different conditions. fluids. It is Metal properties. The different types of alloys It is entirely unaffected by mouth the extremely malleable and ductile, and canbe used in dentistry are scientifically prepared by tooth to refiners to give them the exact properties needed for burnished tightly to the surface of a of produce a margin that is sealed againstsaliva and special dental purposes. This careful balancing enough to the properties of the alloy is of value only whenthe other fluids. It can be made . hard properties withstand heavy occlusal wear, or softenough to alloy is properly handled. The physical the opposing teeth. that make metals and alloys useful indentistry are wear at about the same rate as Properly alloyed with other metals, it canbe used to listed below: Hardnem. This is the ability of an alloy to fabricate every type of dentalrestoration or prosthesis where metal is indicated. Thegold alloys resist indentation or scratching. of three main Ductility. This is the property of a metal that used in US Air Force dentistry are gold, and gold solders. permits it to be drawn or stretched without types: casting gold, wrought Pure gold is used in the form offoil, powdered breaking. wrapped in gold Malleability. Its malleability indicates the gold, mat foil, and powdered gold amount of bending and shaping h metal can foil. casting golds are alloyed sustain without breaking. a. Casting gold. The Specific gravity. This is the weight of a and madeinto ingots which aresuitable for melting and casting into molds during thefabrication of volume unit of metal compared with an equal appliances. volume of water at the same temperature. individual tooth restorations and cast Melting range. This is the range of Different types of restorations requirealloys with alloy used temperatures that can melt a particularalloy. slightly different physical properties. The Melting point. This is the point at which a for an inlay must havesomewhat different characteristics from one that is to be used for a pure metal melts. partial denture. Similarly, a one-surfaceinlay does large inlay that is to be Exercises (429): not need the hardness of a the abutment for a bridge. The goldused for the In items 1 thru 6, identify the propertiesof metals clasp on a partial denture needs astill different by matching the statement in columnB to the combination of properties. For these reasons, the related property in column A. casting golds are further classified intofour types: (1) Type A or 1(soft). This type of gold alloy is Column A Column B used for inlays that will not be subjected tomuch a. The weight of a volume I Malleability. stress. It is relatively soft andmalleable and is easily 2 Melting range. unit of metal compared 3 Hardness. with an equal volume of burn ished. 4Specific gravity. water at the same tem- (2) Type B or 2 (medium). This typeof gold is 5 Melting point. perature. used for inlays that will be subjected to more stress. 6 Ductility. b.The exact temperature at Three-quarter gold crowns can also be castfrom which a pure metal will melt. this type of gold. c. The indication of the (3) Type C or 3 (hard). This typeis used for amount of bending and crowns and fixed partialdenture abutments. shaping a metal can sus- (4) Type D or 4 (extra hard). This typeof gold tain without breaking. for saddles. d.The ability of an alloy to alloy is used in prosthetic appliances resist indentation or clasps, bars, and one-piece, removablepartial scratrhing. dentures. r.The property of a metal b. Wrought gold. Wrought gold alloys arein the which permits itto be form of wires and bars that can bcused to make drawn or stretched with gold is out breaking. prosthetic or orthodontic appliances. The
5°2 3 3 '4 alloyed to give it the properties needed so that it can Column B be bent and shaped into a desired form and so that e Used for crowns and fixed several different units can be joined by dental partial denture abutments. solder. The manufacturer makes wrought gold from t Used tomake prosthetic gold alloy, which has been rolled, swaged, and or orthodonticappliaaces. It is supplialin wire or drawn through die plates into the desired shape and bar forms which are bent gage. It must have a higitmelting range sothat each into shape. part of the appliance can be solderedwithout overheating or melting the wire. c. Gold solders. Dental goldsolders (brazing alloys) are alloyed so that they can be melted and 47. Impressiom Materials flowed onto the parts tobejoined without Much of the work done in making overheating them. The ideal solder is similar in prosthodontic, orthodontic, oral surgery splints, color and physical properties to the metal being and other dental appliances, crowns, and inlays is joined. The solder must melt and flow at a done outside the mouth on stone casts. Casts temperature at least 100 F. below the lower limit facilitate access to the work area and prevent of the melting range of the parts being joined. injuries to oral soft tissues from hot waxes and d.Gold foil. Gold foil is unusual among other harmful material. Such procedures as casting restorative materials because it is one of the few and soldering cannot bt done in the patient's metalsusedin a pure state. Gold foil is supplied in mouth. two, forms, cohesive and noncohesive.Unless cohesive foil is protected from air, its cohesiveness 431. State the use of dental impression 'materials, will diminish. Noncohesive foil is different. Certain and identify their characteristics. impurities from moisture or gas residues" condense on its surface. These prevent thegold particles from To make a stone cast, there must first be a coming into actual contact with, and adhering to negative reproduction of a patient's mouth. A each other. Usually, these impurities can be negative reproduction is obtained with impression removed by converting them into a vapor. The material. It is then poured up with a gypsum common practice is to heat the foil to ared color product, producing a positive reproduction called a before condensation, which also softens the foil. cast. Though there are many types ofimpression This process is called annealing. The foil is then materials usable for this purpose, no one material mechanically condensed into a prepared cavity. The fulfills all the ,requirements for making .a perfect cohesiveness of the gold foil with the mechanical negative reproduction of the oral structures. condensation produces a well-bonded restoration. Therefore, because clinical situations and dentists' Chrome-cobalt alloys.Chrome-cobalt alloys are techniques vary, so will the Choice of the material to considerably harder than gold alloys and have a be used. There are several ways in which the much higher melting range. Special equipmentand impression material may be classifiedaccording training are needed to manipulate these metals. to its rigidity, plasticity, chemicalreaction, Chrome-cobalt castings are stronger, lighter, and elasticity, and use. less expensive than gold. They are used for all types Plastic Compounds. Plastic impression of cast removable partial dentures but are not compounds soften when heated and harden when cooled, with no chemical action taking place. The suitable for crowns, inlays, or fixed dentures. exact composition of a plasticimpression compound varies with the type and the Exercises (430): manufacturer. These plastic compounds come in several colors (red, green, black), and in stick or Identify the use of the various dental metals by cake(wafer) form. These materials are used to make matching the use in column B to the appropriate personalized impression trays and impressions. The metal in column A. plastic compounds must be heated in a water bath before they are placed in impression trays. They are Columnet Co lunar 8 divided into two types. Type I compound is a low- I Gold foil. a.Used for inlays which arc temperature fusing material. It is used with copper 2 Chrome-cobalt not subjected to much alloys. urea. bands for inlay and crown impressions, andfor 3 Type C casting b.Used for cast ranovable recording "functional" or "preliminary" gold. partial danures. but not impressions. Type I compound softens between 4 Type A casting suitable for crowns. In- 126° F. and 144° F., and is compatible with the gold. lays. or fixed partial den high- 5 Wrought gold. tures. oral tissues. Type II compound is a 6 Gold soldax. c. Used in its pure state for temperature fusing material, relatively tough,and restorations. strong enough to act as a tray to supportother types d.Used to join metal parts of impression materials. Materials of this type together.
5 I 231 soften at a temperature above 158° F., and are not Rubber-base impression materials should be compatible with oral tissue because of this higher mixed in 45 to 60 seconds. Using a stirring motion. temperature. Be careful when you soften this mix the base and hardener until the mix is free of material because overheating makes it so sticky that color streaks and is uniform in shade. After the mix it is extremely difficult to handle. When it cools, is prepared, load the syringe or the impression tray. plastic impression compound becomes hard and Hydrocoltoid Compounds. Hydrocolloid brittle. Trimming an impression correctly requires impression materials are primarily used for partial a sharp knife to reduce the possibilityof breakage. denture impressions because of their elasticity. As a Wax Compounds. Impression wax is a low. consequence of this elasticity, they have the ability temperature fusing material that can be used as a to spring over undercuts without breaking or "wash" to correct defects or deficiencies in other distorting. There are two types of impressions. It is especially compounded so that it hydrocolloidsagar(reversible)andalginate flows at mouth temperature. After this wax is (irreversible). They differ chemically and physically melted in a water bath,itis painted in the and require different handling, but the purposes for individual impression tray to serve as a corrective which they are used are very similar. liner for final impressions. If you rinse the Agar hydrocolloid is a thermoplastic material impression, do so very carefully with cool water. that solidifies upon cooling. Since this procedure Also avoid touching the wax areas with your fingers can be repeated again and again with the same agar. because they may cause the wax to flow and distort it is said to be reversible. You need water-cooled the impression surface. trays when you use this material. Pour the Impression Paste Compounds. Impression impressions immediately to prevent shrinkage and paste is also used as a corrective "wash." This paste distortion due to dehydration. contains zinc oxide and eugenol and is supplied in Alginate hydrocolloid is supplied in the form of two tubes. One tube contains the base material:the a fine powder. With a prescribed amountof other the hardener. Equal lengths of material from distilled water at a controlled temperature. you mix each tube are used. Because cleaning up after the powder to a thick, creamy consistency. preparing this material is difficult, you will save Impression Plaster Compound. Impression time by mixing it on a parchment pad. using a plaster has been specially compounded by the tongue depressor for a spatula. You can discard manufacturer for use in the oral cavity. The both the parchment sheet and the tongue depicssor behavior of plaster that is to be used for an when you have finished. If you want to increase the impression must be different in several respects setting time of this material, decrease the amount of from ordinary dental plaster. A prime requirement hardener. To decrease the setting time. increase the is that it must set much faster, to reduce the time it amount of hardener. As with all the materials we must be held in place in the patient'smouth. have discussed previously, you should read and Various accelerators and retarders are added to follow the manufacturer's instructions. give the plaster these required properties. Rubber-Base Compounds. The rubber-base compounds are soft, synthetic, rubberlike Exercises (431): materials, supplied in two collapsible tubes. One I. State the use of dental impressionmaterials. tube contains a base, and the other a hardener. When the two are mixed together in the proper proportions, the resulting mixture sets in a Identify the characteristics of dental impression semihard, rubbery state. These materials have a materials by matching each statement in column B short shelf life because of their unstable polysulfide to the correct material in column A. base. Rubber-base impression materials can be used Column A Column B 2 Rubbcr-basc com a.Flows at mouth tem for almost any type of impression. They come in mature and is used as a three consistencies: pounds. 3 Wax compounds. corrective liner for final (1) Light bodied, to be used ejected with a 4 Impression plaster impressions. syringe onto preparations for inlays, crowns, and compounds. bAvailable in the agar and types.this fixed partial dentures. 5 Impression paste alginate - °Impounds. material is highly elastic. (2) Regular bodied. to be used in an impression 6 Hydrocolloid r.A material that is he2ted tray for inlays, crowns, arid fixed partial dentures. - compounds. in a water bath before st is and as "wash- impressions for full dentures, 7 Plastic compounds. placed in thc impression relinings, and removable partial dentures. Its high tray. Some types. whcn softened. arc too hot for degree of flow registers the finest details. oral tissues. force (3) Heavy bodied, to be used in a tray to d.Used as a °affective. this light bodied impression material onto the cavity matcnal consists of zinc preparation. or with a copper band for impressions oxtcle and cugenol and is 0 ') supphed in two tubes. of single teeth. 4. u0 5 2 Cuimout inserted into the root canal. You prepare gutta- perchxpoints for insertion by disinfecting them in rThis material is availabk in three consistencies.It tincture of metaphen or by washing them in sets in a semihard rubbery alcohol. They are then air-driód and cemented into state.It can be used for the root canal with root canal cement. almost any type of impres- Silver points. The dental, officer may also use sion. j: A apsum product that is silver points to fill the root canal. They share the specially compounded for many advantages' mentioned for gutta-percha. use in the mouth. It sets Silver points, however, are easier to insertand come much faster than other in the same sizes and tapers as standard root canal gypsum products. files and reamers:The main disadvantage in the use of silver points is that they are hard to remove from 4-8. Endodontic Materials the root canal. The dental officer first selects the The main materials used in root canal therapy silver point, fits it to the-canal, and prepares it for are various liquid antiseptics, paper points, gutta- insertion by' sterilizing it in an open flame or in a percha points, and silver points. The dental officer bead sterilizer. He passes the point through a thin uses these to treat and fill a properly prepared root mix of a special silver point cement. He then inserts canal from which he has removed the pulp. itinto the root canal, which he has previously coated with the cementing medium. 432. Characterize tie uses and properties of Root Canal Stakes. The root canal sealers or endodontic materials. cements most commonly used in American dentistry are in cement and paste forms. The zinc Paper Points. Paper points are used during the oxide and eugenol type is the one most often used. treatment phase of endodontics. They are usually The liquid is, of course, the eugenol. A typical zinc saturated with an antiseptic (ethyl alcohol, oxide powder formula may contain the following camphorated parachlorophenol, and sometimes ingredients: creosote) and inserted into the prepared canal to act a. Zinc oxidemain ingredient. as antiseptics (bacterial growth inhibitor) and b. Rainsoleo or Staybelite types. bactericidals (bacterial destructions agents). Paper c. Thymol iodidea bactericide. points are never used as a permanent root canal d. Bismuth subcarbonatean antacid. filling material. Root Canal Restorative Materials. Root canal In addition to the above ingredients, some formulas restorative materials are used to fill the previously contain silver particles or barium sulfate, which add prepared root canals, as part of root canal or radiopaque (ability to stop radiant energy, such as endodontic therapy. Root canal restorative X-rays) qualities. These ingredients are mixed in materials consist of tapered gutta-percha or silver much the same way as is zinc phosphate cement. points in a variety of standard sizes, and root canal Using a glass slab and a noncorroding spatula, sealers or cements. A good root canal restorative incorporate the powder into the liquid until a thick, material is insoluble in tissue fluids, opaque to the creamy consistency is reached. The pastes passage of X-rays, reasonably easy to remove, sometimes used as sealers are chloropercha and nonirritating to periapical tissues, nonabsorbent, eucapercha, made by dissolving gutta-percha in and dimensionally stable after its insertion into a chloroform or eucalyptol. The cements are used to root canal. cement both silver and guaa-percha points in place, but the pastes are usually used with gutta-percha Gutta-percha. Gutta-percha is used for points only. temporary restorations as well as for a root canal restorative material. Gutta-percha is the refined, coagulated, milky exudate of certain trees in the Exercises (432): Malay Peninsula in Southeast Asia. It is pink or gray in color, softens when heated, and easily I. How are paper points used during endodontic molded. When it is cool, it maintains its shape fairly treatment? well. Guna-percha points have been a choice for root canal restorative material for many years. The material has many advantages: it has a high thermal expansion, does not shrink unless used with a 2. What characteristics should a good root canal solvent, is radiopaque, can be kept sterile in an filling material possess? antiseptic solution, is resistant to moisture, is bacteriostatic, and is a poor conductor of heat. On the disadvantage side, gutta-percha shrinks when it is used with a solvent and is not always easily 53 236 3. How is gutta-percha used as an endodomic Local Formulation. Many dental officers material? prefer to use,a powdered mixture from the hospital pharmacy with which you must mix the desired 4iquid. One preferred dressing is Glickman's formula. The formula for this powder mixture. 4. What are the disadvantages when gutta-percha blended at the pharmacy, contains the following is used as an endodontic material? ingredients in the amounts shown: Zinc oxide 63 grams Rosin 30 grams Asbestos fibers 5 grams 5. State the main disadvantage of using silver Zinc acetate 2 grams points as the root canal restorative material. To use all of this powdered mixture,the liquids
. necessary for the proper consistency are:
6. Name the type of root canal cement most often Eugenol 80cc 20cc used. Olive oil The eugenol and zinc oxide are both agents that soothe pain. The powdered rosin and asbestos it can 7. Describe the manufacture of the root canal fibers give strength to the dressing so that pastes that are used as sealers. remain in the mouth for the required timeusually 5 to 7 days. The dental officer may vary theabove formula. He may want to add thymol orother aromatic oils to give a more desirable flavor to the dressing, and coloring agents to make the dressing less noticeable in the patient's mouth. Tannicacid 4.9. Surgical Dressings can be added to checkbleeding. He may use foil between the tissues and the dressing so that no During the course of oral and periodontal sutures become embedded in thepekiodontal surgery, the dental officer exposesoral soft tissues dressing as it hardens. and sometimes bone, leaving raw wounds. Surgical dressing materials are usually applied to the wounds Exercises (433): as a protective barrier. They aresometimes referred to as "surgical packs." I. Why are surgical packs used? 433. Cite the uses of surgical packs and identify the purpose of each of their ingredients. 2. On what patients would the noneugenol typeof Surgical packs are placed on soft tissue or bony surgical pack be used? wounds as both a protective barrier and a soothing and healing agent. They are primarily used to treat "dry socket" and to act as a gingival bandageafter periodontal surgery. These packs not only protect Identify the purpose of each ingredient inthe the area by preventing food from touching the surgical pack by matching its action in column B to excised margins but also soothe and aid in healing the ingredient in column A. the tissues. Your main duty will be to mix the ingredients and form the packs that the dental Column A Column B 3 Tannic acid. a Esthetics officer places in the patient's mouth. 4Thymol. h Strength. Types. There are essentially two types of 5 Rosin and asbestos C. Flavor. surgical dressingsthose that contain eugenol and fibers. dCheck bleeding. 6 Zinc oxide and e Soothing effect those that do not. The dressings containing eugenol eugenol. are more widely used. Any of fivecommercial 7Coloring agents. brands of surgical dressings may be used in your dental clinic. Dressings with eugenol are made by Kirk lands, Wards, Schleins, and Professional Products Company. Thf:. noneugenol type is the Coe-Pack. This type is usually used on patients whose surgery left some exposed bone or who are allergic to eugenol. 4-10. Miscellaneous Dental Materials 54 237 In addition to the materials we have already and gold. It is mainly composed of complex discussed, there are other materials that have an silicates of aluminum, potassium, and sodium. The important place in dentistry. For lack of a better Federal Supply Catalog lists two gradesflour of classification, we call these miscellaneous dental pumice and coarse pumice. Flour of pumice is used materials. for putting the final shine on appliances and for polishing restorations. Coarse pumice is primarily 434. Given a list of miscellaneous dental used in the dental laboratory as an initial rough materials, select the correct use of each. polish fOr dentures. Pumice should never be used in the.patient's mouth. Temporary Stopping. Temporary stopping is a Zircvniurn silicate. A material that has replaced temporary restorative material. It is usually pumice for polishing teeth is zirconium silicate. composed of gutta-percha, waxes, zinc oxide, and Zirconium silicate is mixed with water or a fatty acids, and possibly powdered feldspar or silex. stannous fluoride solution for caries prevention This material dissolves in the mouth fluids to some treatment. extent. It is easier to handle and manufacture than Tin oxide. Another material used to polish teeth gutta-percha, but does not wear as well. It can be and restorations is tin oxide. It is a fine, white made plastic by heat or can be dissolved in powder, which is made into paste form by mixing it chloroform or eucalyptol. with water or glycerin. Dental Porcelain. Dental porcelain is Chalk. Chalk (whiting) is used as a polishing manufactured in the form of a powder. When it is agent for both acrylic resins and metals. Its main heated to a very high temperature in a special oven component is calcium carbonate. (called baking), it fuses into a homogeneous mass. Rouge. This is a polishing agent, not used in the When it cools, the mass is hard and dense. Dental mouth, that imparts a high luster to gold. It is porcelain is manufactured in a variety of shades to composed of iron oxide and is usually supplied in match most tooth colors. The translucency of baked cake or stick form. porcelain is like that of dental enamel, so that Tripoli. This polishing agent is used in the porcelain crowns, pontics, and inlays of a highly dental laboratory for gold and other metals. It is pleasing appearance can be made. made from certain porous rocks found near Tripoli Baseplate Materials. Baseplate materials are in North Africa and is supplied in cake form. used in constructing full and partial dentures, bite- Tripoli is slightly more abrasive than rouge and is rim foundations, and impression trays. Baseplates usually used just before the rouge is used. are usually softened over an open flameand.then Abrasive paste. The final material in this group is molded over a cast and trimmed. Most baseplates dental abrasive paste. This is made of very finely are composed of resins and shellac, withvarious ground silicon carbide particles incorporated in a powders used as fillers. greaseless base. Its primary use is to "mill-in" Impression Adhesive. Impression adhesive is a complete dentures, but it can be used to increase the special gluing agent for bonding rubber base abrasive action of the carborundum stones used in impression materials (polysulfide) to impression cavity preparation. trays. It can bond the polysulfide to metal,acrylic, or compound impression trays.Impression trays are Exercises (434): coated with this adhesive before they are filled with Identify the use of each of the miscellaneous dental rubber base impression material, insuring thatthe materials by matching the use in column B to the impression material stays in the tray whenit is material in column A. removed from the mouth. Dental Abrasives. Unless the surfaceof the Column A Colunut B restorations and appliances are smooth andhighly I. Baseplate o To impart a high luster to polished, they cannot be kept clean. Food, debris, materials. sold. surface, 2. Coarse pumice. b For polishing teeth. and salivary deposits collect on a rough 3. Rouge. c.As a temporary restoratWe producing calculus. If all the surfaces of the 1_4 Temporary stop- material. restorative materials and the natural teeth are ping. d. To make crowns and poll- smooth and polished, the cleansing action of the 5. Impression tics. denture adhesive. e. For making bite-rim foun- tongue, assisted by proper toothbrushing or 6. Tripoli. dation. cleansing, should prevent the formation of any 7. Zirconium silicate. f A polishing agent usually permanent deposits. In dentistry, a groupof 8. Abrasive paste. used just prior to rouge. materials, called dental abrasives, are used for 9. Dental porcelain. g. To "mill-in" complete dentures. smoothing and polishing the restorations and k As an initial rough polish appliances that are placed in the mouth. for dentures. Pumice. The first of these materials is pumice, a I.To hold rubber base im- finely ground. sandlike material used as an abrasive pression material in the and polishing agent for acrylic resins, amalgams, tray. 55 23,9 Maws for Exorcises
403 7. They are usually used with abeasives to remove CHAPTER I stains and to polish teeth, rolliorationz. and dental appliance. Rehresee: 4038. They are screwed into the handpece. 400I. Handle, shank, and working end. 4039. For polishing dentures or other prosthodontic ap 400 2. Nib. pliances. 4003. The purpse of the instrument; the position or man- 403 - 10.Sterilization can affect the abrasive bond. ner of use: the shape of the working end;and the angle of the working end in relation to the handle. 404I. T. 400 4. Normally on the portion of the handle farthest 404 2. T. from the working end of single-ended instruments 404 - 3. F. and near the :enter of double-ended instruments. 4044. T. 4005. The formula number. 404 - 5. T. 4046. F. 401 I. a. Vitalometer. 404 7. F. b. Dressing forceps. 4048. F. c. Transilluminator. 404 9. T. d. Clinical thermometer. 404 10.T. e. Dental radiograph. 404 - II.T. f Mouth mirror. g. Explorer. 401 - 2. g. CHAPTER 2 401 3. C. 401 - 4. b. 401 5. 1. 405 I. 401 6. a. 405 - 2. I. 405 - 3. e. 402I. a. A, C. D, F, G. 4054. a. b. H. I, and J. 4055. b. c. B and E. 4056. C. 402 - 2. D and F. 4057. h. 402 - 3. A and H. 405 8. f. 402 - 4. E. 405 - 9. j. 402 - 5. 405 10. d. 402 - 6. B, C. E, G, and J. 405I I.a. b. c. g. 402 - 7. G. 405 12. f. h. 402 - 8. C. 405 - 13. d. e. i.j. 4029. a. 901. b. 33'h, 35. 37. and 39. 406 - 1. T. c. 699, 700, 701, 702, and 703. 406 - 2. F. d.114, 1/2, 2, 4. 6, and 8. 406 3. F. e. 55'7, 558. and 559. 4064. F. f169L and I70L. 406 - 5. F. g. 57. 406 - 6. T. 4067. F. The shaft upon which an abrasive disk orwheel is 403 - I. A, C. mounted. 407 - I. 407 2. B. I. 403 - 2. Safesided disk. 407 . 3. F. 403 - 3. To cut tooth structures and to smoothand polish 4074. E. H. restorations. 407 - 5. D. 403 - 4. To smooth and reduce high spots on restorations or 4076. G, J. prosthetic devices on 407 - 7 E. 4035. Disks are thinner and -usually have abrasives only one side. Wheels usually have abrasives on 4078. G. F. both sides and on the outer edges as well. 4079. 40710 A. 403 - 6. Conventional speed angle or straighthandpieces. 239 0
407 . J. 414 . I. The *4. 40712. H. 414 - 2. Bulb type and Luer type. 407 . 13, D. 414 - 3. Irrigating syringes. 407 - 14. I. 414 - 4. The surgical mallet. 4071$. 414 - 5. Small, semicircvlar.shaped. 407 - 16.c. 414 - 6. Silk. 414 - 7. It has forklike prongs. 40SI. The *142. Other spatulas can discolor the mix. 40B2. It is a smaller version for mixing email quantities of 415 I. B. OMNI 415 - 2. D, E. 4083. It should be thoroughly cleaned and disinfected. 415 - 3. A, C, F. 408 4. To transport and place dental MIMI', resin, and 415 - 4. G. temporary, insulating, and pulp-capping materials. 415 - 5. D, E. 4085t The #1 - 2 snd *5 - 7. 4156. N. 415 - 7. F, A. 409I. To fit almost any conceivable cavity preperation. 4092. The *23 explorer. It has a tiny, flat. serrated tip. 416 - I. B. 4093. Over the Bunsen burner tube. 4162. E. 4094. Annealing bums off the gasses and allows the gold 416 - 3. C. D. F. foil to adhere to itself and contributes to a well. 416 - 4. A. bonded restoration. 416 - 5. G. 416 - 6. C. 416 - 7. G. CHAPTER 3 416 S. D, F. 416 - 9. B. 410I. The beaks, the neck, and the handles. 416 10. E. 4102. They have a concave inner surface and a convex 416 - 11.C. outer surface, and are shaped to conform snugly to 416 12.A. the contour of the tooth. 4103. Two sets of parentheset. 417 1. Root canal broach. 410 . 4. They have a notched beak for the facial side and an 417 2. Root canal reamer. unnotched beak for the lingual side of the tooth. 417 3. Root canal file. 4105. They are shaped so that the beaks may be placed on 417 - 4. The file thrseds are finer and closer together. the tooth and still be parallel with the long axis of 417 5. One type has contraangled working ends and the the tooth. other has straight working ends. 4106. E, F. 4107. A, C. G, H. 418I. The aluminum tray. 4108. D. 4111 2. The compound knife. 4109. A. 41k 3. The crown remover. 41010. F. 4111 4. Methyl (wood) alcohol. 410 I I . G. 418 5. The roach carver. 410 - 12. B. 41 k - 6. The dental pliers. 410 13. E. 418 7. The Beale *7 and the Gritman *31. 410 14. F. 418 - 8. A rubber mixing bowl. 410 15. C. 418 9. Collar and crown scissors. 410 16. H. 418 10. Rim-lock impression trays.
411 I. C. 411 - 2. 4113. e. CHAPTER 4 411 - 4. b. 4115. a. 419I. F. 411 6. t. 419 - 2. T. 4117. d. 419 - 3. T. 419 - 4. T. 412 - 1. Scalpels or BardParkers. 419 - 5. F. 4122. Discard it. 419 - 6. F. 412 3. a.#I 2. 419 . 7. T. b. #10 and #I5. 419 - 8. F. C. #11. 419 - 9. T. 4124. Rongeur forceps. 419 - 10.T. 412 - S. The bone file. 419 - 11.T. 412 - 6. To remove bone or to split toeth. 412 - 7. The Stout #1. 420 -I . Two silver alloy pellets and the amount of mercury 412 - 8. Surgical curettes. recommended by the manufacturer. 420 - 2. You can vary the alloy-mercury ratio by in- 413 - I. B. terchanging the plungers. 413 - 2. A. 420 - 3. Trituration. 413 - 3. C and E. 420 - 4. Because of variations in consistency and shonened 413 - 4. F. working time. 413 - 5. D. 420 - 5. Inspect the capsule to make sure that it is clean and 413 - 6. G. that it has a pestle. 420 - 6. Remove the pestle, replace the capsule on the amalgamator, and operate the machine for I or2 used as a temporary filling and as an insulating base under amalgam restorations. seconds. 420 7. To remove excess mercury from the amalgam. 424 - 2. Zinc oxide. 4,24 - 3. They are both composed of phosphoric add and 420 8. Condensation. water, bathe percentages of these constituents are 420 9. The amalgam should be condensed beforethe chemical setting action begins to form crystals. Too different in the two liquids. much delay can produce a weakened amalgam. 424 - 4. b.c.d,andf 424 - 5. A clean, cool, dry glan slab and a *313 or*324 stainless steel spatula. 421 . 1. The manufacturer. 4246. Approximately 1 Ve minutes. 4212. Discard the dry mix and replace it with a proper From 13/4 to 2 minutes. mix. Adding mercury to a dry mix drastically 424 - 7. 424 - 8. The heat created by the chemical actionof the reduces its compressive strength. material can injure the tooth pulp if it is not dissi. 4213. Overtrituration decreases the setting time and in- Undertrit ura pared. creases the shrinkage of the amalgam. 424 - 9. a.b,e.andr don increases the setting time, increasesexpansion, and weakens the alloy. 425 I. To pot= the dental pulp from thermal,chemical, 421 - 4. Contaminating the mix with moisture or other im- electrical, and any other possible sources ofirrita- purities. tion. Delayed and excessive expansion, lowered crushing 421S. 425 - 2. Because it seems to stimulate the productionof sec- strength, blister formation on the amalgam's sur- ondary dentin. face, pain shortly after the filling is inserted. 425 - 3. Simply place small, equal portions of the'base and 4216. Mulling in a moist palm, touching or handling catalyst on the mixing pad and mix themtogether. amalgam with moist fingers, and triturating at tem- 4254. Sterile water or local anesthetic. peratures below the dew point. Place equal portions of the base material and the drops of 4255. 421 - 7. Remove the fragments by placing a few catalyst on the mixing pad and mix together. mercury in the capsule andplace it on the 4256. Zinc acetate. amalgamator for a few seconds. 4257. As much as possible. 4258. Yes. 422 - I. Anterior teeth. 4259. To partially insulate the tooth structuresfrom cer- 4222. Silica. tain chemicals and to temporsrily seal the margins 422 - 3. To avoid any color change. of restorations. with the 422 - 4. Phosphoric acid and water. 425 10. Add some of the thinner that is supplied 4225. Loss of liquid causes slow setting. liners and varnishes. This will return them to a usa- 422 6. Natural appearance, translucence,anticariogenic ble consistency. action, low thermal conductivity,and easy manipulation. 426I. The self-curing form. fluids, has a low 422 . 7. It is brittle, soluble in mouth 4262. The powder is polymer and the liquid is monomer. crushing strength, and contracts upon setting.Tfiese 426 . 3. To fabricate acrylic resin crowns or veneer crowns. properties reduce its life expectancy. 426 - 4. To construct "customized" impression traysfor and #142 spatula. 422S. A clean, dry, cool, gla* slab final, detailed impressions. The plastic measuring stick is optional.The tem. should aot be below perature of the slab and spatula 427 1. Heat. the dew point. 427 2. To form casts: construct matrices: attach casts to ar- 4229. He uses a shade guide. ticulators:to be combined as a ingredient in certain quarter, 42210.Divide it so that you end up with a half, a high heat investments: and to make certain impres- and two eighth portions of powder. sions. of the slab. and the 422 11.Using a folding motion and a small area 427 - 3. The initial setting time is 5 to 12 minutes you should incorporatethe powder into the liquid final set occurs in approximately 45 minutes. until the mixture has a putry-likeconsistency. Mix. 427 . 4.. plaster of paris. ing time should not exceed I minute. 427 - 5. For pouring casts and dies, and (taskingdentures 42212.4 to 6 minutes. for processing. 422 - 13. A clear plastic matrix strip. 427 - 6. The initial set of a typical hydrocal mix isfrom 7 to 422 - 14.One of the stellite plastic fillinginstruments. 15 minutes. The final set is completed in approx- 422 - 15.It is coated with a silicate lubticant. imately 45 minutes.
423 - I. They are primarily used to restoreanterior teeth 428 - I. b. and are particularly suitable for incisalrestorations 428 - 2. because of their crushing strength. 4283. d. 423 - 2. The composite maienal and a catalyst. 428 - 4. b. bind the 423 - 3. The binders are modified acrylates that 428 - 5. c. mix together during setting.The fillers are 428 - 6. h. translucent mineral fibers thatprovide a light 428 - 7. 1. transmission system for adapting the colorof ihe 428 - 8. a. filling material to the surrounding tooth structure. 423 - 4. Paste. 429 -I. C. 423 - 5. It causes the composite restorative material to set or 429 - 2. harden. 429 - 3. 423 - 6. b. f. g. h. j. and A. 429 . 4. 423 - They are practically the same. 129 - 5 429 - 6. e. 424 - I. Zinc phosphate cement is used as a cementing agent for crowns, inlays, fixed partial dentures. It isalso 430 -I . C. 58 0 4 4234-
430 : 2. ways easily inserted into the root canal. 4303. 4325. They are hard to remove from the canal. 430 - 4. a. 432 - 6. The zinc oxide and eugenol type. 430 - 5. 4327. Gutta.percha is dissolved in chloroform or 430 - 6. eucalyptol.
431 . 1, To make a negative reproduction of the patient's 433I. As a protective barrier and a soothing and healing mouth. This negative reproduction is poured up agent, they treat dry sockets and act as a gingival with a gypsum product to make a positive reproduc- bendage after periodontal surgery. tion called a cast. 433 - 2. On patients whose surgery left some tweed booe 431 - 2. e. or who are allergic so olgenol. 431 - 3. a. 4333. d. 431 - 4. 433 - 4. c. 431 - S. 433 - 5. b. 431 - 6. b. 433 - 6. e. 431 - 7. C. 4337. a.
432 - 1. They are saturated with antiseptic and inserted 434I. into the canal. They are never us& as permanent 4342. root canal material. 434 - 3. 432 . 2. It should be insoluble in tissue fluids, opaque to X 434 4. rays, reasonably easy to remove, nonirritating to 4345. periapical tissues, nonabsorbent, and dimen- 4346. sionally stable after insertion. 434 - 7. 4323. As a root canal restorative materiel. 434I. 432 . 4. It shrinks when used with a solvent and is not al- 434 9 . *La GOVERNM(NT PMIITHIG OFFICE:1,74- 143-059/312 AUGATS, A1A. (75127)) Jan 7S-2900
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1. MATCH ANSWER 2. U S E NUMBER 1 OR SHEET TO THIS NUMBER 2 PENCIL. STOP- EXERCISE NUM. ERR. 98150 03 23 EXTENSION COURSE INSTITUTE VOLUME REVIEW EXERCISE DENTAL INSTRUMENTS AND MATERIALS Carefully read tbe following: DO'S: 1.Chock dm "Mune," "volume," and "form" numbers from the answer sheet address tab against the "VRE answer :beet identificition number" in tbe righthand column of the shipping list. If numbers do not match, take action to return the answer sheet and the shipping list to ECI immediately with a note of explanation. 2.Note that numerical sequence on answer sheet alternates across .from column to column. 3.Use a medium sharp #1 or #2 black lead pencil for marking answer sheet. 4.Circle the correct answer in this test booklet. Atter you are sure of your answers, transfer them to the answer sheet. If you have to change an answer on the answer sheet, be sure that the erasure is complete. Use a dean eraser. But try to avoid any erasure on the answer sheet if at all possible.
S.Take action to return entire answer sheet to ECL 6.Keep Volume Review Exercise booklet for review ana reference. 7.If mandatorily enrolled student, process questions or comments through your unit trainer or OJT supervisor. If voluntarily enrolled student, send questions or comments to Ea on ECI Form 17. DON'TS:
1. Don't use answer sheets other than one furnished specifically for each review exercise. 2.Don't mark on the answer sheet except to fill in marking blocks. Double marks or excessive markings which overflow marking blocks will register as MOM 3.Don't fold, spindle, staple, tape, or mutilate the answer sheet. 4.Don't use ink or any marking other than a #1 or #2 black lead pencil. NOTE: NUMBERED LEARNING OBJECTIVE REFERENCES ARE USED ON THE VOLUME REVIEW EXERCISE. In parenthesis after each item number on the VRE is the Learning Objective Number wherethe answer to that item can be located. When answering theitems on the VRE. refer to the Learning Objectives indicated by these Numbers. The VRE results will be sent to you on a postcard which will list the actual VRE items you missed. Go to the VRE booklet and locate theLearning Objective Numbers for the items missed. Go to the text andcarefully review the areas covered by these references. Review the entire VREagain before you take the closed-book Course Examination.
1 Multiple Choice
instrument is called the 1. (400) The working part of a condensing
a. shank. C. nib. b. blade. d. bead. single-ended dental instrument is 2. (400) The identificatice number of a usually found on the
a. inner portion of the instrument's shank. b.portion of the handle nearest the workingend. working end. c. portion of the handl* farthest from the d. dorsal aspect of the lastrument'sworking end. tie most accurate image of the item 3. (401)Which type of mouth nirror produces being reflected?
Mack reflective surfaos. a. Magnifying surface. c. Front reflective surface. b. Polished steel surface. d. cavities and to determine 4. (401)Which instrument is designed to detect smell the margin quality of restorations?
c. Transilluninator. a. Explorer. Periodontal probe. b. Vitalcmster. d. electric current to a tooth? 5. (401)Which diagnostic aid actually passes an
Transilluainator. a. Explorer. c. Dental X-ray unit. b. latalometer. d. headpiece by 6. (402) Friction grip burs are secured in the
a. screwing them into the headpiece. headpiece. b. tightening the expansion walls of the of the headpiece. c. friction created against the latch top chuck located in the headpiece. d. friction against the setal or plastic gain entrance into the tooth and 7. (402) which shape of bur is designed to remove decayed toothsubstance?
c. Tapered fissure. a. Round. d. Straight fissure. b. Inverted cone. undercuts in the cavity preparation? S. (402) Which bur is best suited to make Tapered fissure. a. Round. c. Straight fissure. b. Inverted cone. d. shapes which.apply tofinishinW hwts aeathe 9. (402) All of the following are
round. a. bud. c. d. inverted cone. b. oval. disk that only has one side covered 10. (403) What name applies to en abrasive with an ebrasive? One-surfaced disk. a. Safe-sided disk. c. Slick-surfaced disk. b. Plain-sided disk. d. c) 4t
2 arr,
11. (403) The 1Serg wheel-type Chamois polishers are Primarily designed far use
a. on cavity preparations. c. on amalgam restorations. b. during oral prophylaxis. d.in the dental laboratory.
12. (404) A small "harpoon" located on theplunger of a syringe identifies the syringe as
a. an aspirating syringe. c. a Luer lok syringe. b. an irrigating syringe. d. a bulb-type syringe.
13. (404)The instrument commonly referredto as a Doley gauge is the
a. dentimeter. c. vernier caliper. b. endedontic probe. d. periodontal probe.
14. (405) WhiCh restorative chisels have slightly curved shanks?
a. Mangles. c. Wedelstaedts. b. Straight. d. Delta-shaped.
15. (405)The instrument used on the walls of a cavity preparation to help establish a sharp cavity outline is the
a. hoe. c. spoon excavator. b. hatchet. d. gingival margin trimmer.
16. (405) Which of the following instruments ham a bi -beveled cuttingend?
a. Hoe. c. Ratchet. b. Chisel. d. Gingival margin trimmer.
17. (405) The instruments which carry theidentification'numbers 29 and 34 ars the
a. hoes. c. hatchets. b. chisels. d. spoon excavators.
16. (405) Spoon-type excavators are primarily used to
a. carve wax inlay patterns. b. carve amalgam restorations. c. smooth the floor of a cavity preparation. d. remove carious debris Pros toothcavities.
19. (406)Devices which are used to hold metal bands firmly around a tooth, thereby foraing a temporary mold for filling materials, arecalled
a. wedges. c. band formers. b. templates. d. matrix retainers.
20. (406) Which item is used to force a matrix band tightly against irregular tooth surfaces to eliminate spaces that could result in an overhanging restoration?
a. Wedge. C. Cotton pellet. b. Crown former. d. Matrix retainer.
with silicate 21. (406)Which type of strip matriA material is used in conjunction or resin filling materials?
a. Copper. c. Copper nickel. b. Plastic. d. Stainless steel.
3 215
MOP filling materials firmly in place 22. (406)Which type of matrix is used to hold on the facial necks of anteriorteeth?
Plastic crowns. a. Cervical matrices. c. b. Ivory retainers. 4. Copper bands. conjunction with an 23. (406)Which type of dental matrices would be used impression material?
a. Copper bands. c. Plastic strips. b. Matrix crowns. d. Ivory retainers. pack amalgam into cavity 24. (407) What name applies to instruments used to preparations?
a. Spatulas. c. Condensers. b. Carriers. d. Burnishers. and to smooth and polish 25. (407)What instrument is used to remove scratches a freshly packed amalgam restoration?
a. Carver. c. Finishing file. b. Burnisher. d. Finishing knife.
overhang of a hardened 26. (407) Which instrument would be used to remove the metallic restoration?
a. Carver. c. Periodontal scaler. Margin finishing file. b. Burnisher. d. drive amalgam pins into the 27. (407) The instrument used to hold, place, and tooth's dentin is called a
a. pin driver. c. pinhole drill. b. wedge holder. d. restorative mallet.
cement? 28. (408) Which spatula is suitable for mixing silicate
a. 431. c. #313. b. 0142. d. 0324.
suited for handling restorative 29. (408)Which plastic filling plugger is best resins and silicate cement?
a. #1--2. c. Woodson #1. b. Gregg #2. d. Ladmore #3.
closely resemble? 30. (409) Which instrument does the gold-foil carrier most
a. Rhein file. c. 415 burnisher. b. 423 explorer. d. Amalgam carrier.
tooth extracting forceps? 31. (410) Which of the following is not a part of a
a. Nib. c. Beaks. b. Neck. d. Handle.
32. (410) What tooth extracting forceps is particularly effective forremoving maxillary cuspids?
MD 43. a. 41. c. b. #88L. d. 4217.
4r; 42 33. (410) What teeth are the tooth extracting forceps #BBL and088R designed to remove?
a. Mandibular bicuspids. c. Maxillary molars. b. Mandibular molars. d. Maxillary cuspids.
34. (410) Identify the mandibular tooth extracting forceps that are oftenreferred to as the "cowhcrns."
a. 01. c. 053R. b. 016. MD 03.
locking 35. (411) Which forceps used in oral surgery have a graduated, notched, device located near the ends of the handles?
a. Tissue. c. Instrument. b. Dressing. d. Needle holder.
36. (411) Which forceps are designed to control hemorrhage byzlamping or constricting blood vessels?
a. Gauze. c. Hemostatic. b. Tissue. d. Towel-clamp.
37. (411) Which forceps used in the oral surgery section have tworing-shaped beaks?
a. Gauze. c. Dressing. b. Tissue. d. Hemostatic. overhanzing 38, (412) What instrument is used to trim the projecting, uneven, or alveolar bone that is often the result of a multipleextraction procedure?
a. Tissue forceps. c. Surgical scissors. b. Rongeur forceps. d. Hemostatic forceps.
designed to cut 39. (412) Surgical scissors with a saw-toothed cutting edge are
a. gauze sponges. c. suture material. b. alveolar bone. d. soft oral tissues. instrument would you 40. (412) If the oral surgeon called for a Seldin 011, what pass him?
a. Curette. c. Crossbar elevator. b. Bone file. d. Periosteal elevator. infected cavities in 41. (412) What surgical instruments are used to clean out bone and to remove debris from tooth sockets?
a. Curettes. c. Bone files. b. Elevators. d. Rongeur forceps. lift or elevate 42. (413) Which surgical elevator would the oral surgeon use to a fractured zygcma?
a. Root, C. Crossbar. b. Malar. d. Periosteal.
43. (413) What type of elevator is the Seldin023?
a. Root. c. Crossbar. b. Malar. d. Periosteal.
5 2 4 44. (413) Which elevator has a handle that is set at 900 in relation to its shank?
a. Malar. c. Crossbar. b. Stout A. d. Pericsteal.
45. (414) The Luer syringe is used during oral surgery procedures to
a. inject the anesthetic. b. aspirate the surgical site. c. flush bone chips and blood from the field of vision. d. apply disinfectant solution post-operatively to the surgical site.
46. (414) The shape of suture needles used by most oral surgeons is
a. hooked. c. straight. b. circular.. d. semicircular.
47. (414) What type of suture material is most commonly used in oral surgery procedures?
a. Silk. c. Catgut. b. Nylon. d. Cotton.
48. (t'15) Which type of scaler is designed to function when used with a push-type motion?
a. c. Jacquette #3. b. Zerfing. d. Younger-Good #15.
49. (415) Which of the following scalers is designed primarilyfor use on posterior teeth?
a. "B." c. Jacquette #3. b. Zerfing. d. Younger-Good #15.
handpiece inserts 50. (415) What action produced in the ultrasonic prophylaxis is effective for removing calculus erom tooth surfaces?
a. Heating. c. Rotating. b. Flushing. d. Vibrating.
removal of 51. (416) The primary purpose of periodontal curettes is the
a. subgingival calculus. c. debris erom tooth sockets. b. supragingival calculus. d. stains erom coronal tooth surfaces.
roughened cementum on 52. (416) Which type of files are designed to smooth root surfaces?
a. Bone. c. Periodontal. b. °..ot canal. d. Margin-finishing.
the presence, depth, 53. (416) What instruments are used to accurately determine and form of periodontal pockets?
a. Probes. c. Explorers. Pocket-marking forceps. b. Curettes. d.
gingival tissue .and thereby provide 54. (416) The instruments used to perforate a reference line for the excisionof excess gingival tissue are periodontal
a. probes. c. curettes. pocket-marking forceps. b. knives. d.
6 the pulp canal of soft tissuoa 55. (417) The endodontic instrument used to clear is the root canal
a. file. c. broach. d. plugger. 4111 b. reamer. indicates the order in which 56. (417) Which sequence of root canal instrumente they would normally be used?
a. File, reamer, broach, plugger. b. Broach, plugger, reamer, file. c. Reamer, broach, file, plugger. d. Broach, reamer, file, plugger.
select for making use of 57. (418) Which type of impression tray should you hydrocolloid impression materials?
a. Stainless steel. c. Aluminum. b. Rim-lock. d. Sectional.
red-plastic handle and 58. (418) Which proethodontic knife has a fairly large uses detachable blades?
Denture trimming. a. Plaster. c. b. Compound. d. Margin finishing.
examples of 59. (418) The Betbee curved and Quimby curved are
c. periodontic scissors. a. fabric SCiSSOWS. d. collar and crown scissors. b. surgical scissors.
60. (418) The roach carver is primarily designed to carve
plaster. a. wax. c. resin materials. b. acrylic. d. posterior teeth? 61. (419) Why is amalgam primarily used to restore
teeth. a. It is too soluble for use on anterior b. Its crushing strength is not adequatefor anterior teeth. estheigilly undesirable for anterior teeth. c. Its color makes it consuming for anterior teeth. d. Its mixing procedure is too time should be stored in 62. (419) Unused portions (scrap) of dental amalgam
a. a lead-lined box. b. a nonmetallic container. c. an area of tha clinichaving adequate ventilation. enough water to cover the amalgam. d. a vessel containing
The American Dental Associationestablished the maximum or minimum 63. (419) than percentages for the metalsin a silver alloy as not less
than 35 percent tin, 20 percent copper, a. 50 percent silver, and ma more and 5 percent zinc. tin, and ngt more than 8 percentcopper and b. 60 percent silver and 30 percent 2 percent zinc. than 29 percent tin, 6 percent copper,and c. 65 percent silver, and nos more 2 percent zinc. tin, and n21 more than 5 percentcopper d. 70 percent silver and 20 percent and 3 percent zinc.
7
2 49 64. (419) Which of the following is an undesirable property ofmnalgam?
a. Slew setting.time. b. High thermal conductivity. c. Poor dimensional stability. d. Poor discoloration resistance.
dispenser to 65. (420) Interchangeable plungers are supplied with the mercury
a. allow you to change the alloy-mercury ratio. b. provide a backup plunger in case one malfunctions. damaged by the c. permit periodic replacement of plungers that have been mercury. d. provide a means of changing the size of the mixture.
66. (420) Which of the following methods of mulling amalgam isacceptable?
a. Retriturate the mix for 10 seconds. b. Roll the mix in your bare fingers for 5seconds. c. Roll the mix in the palm of your hand for 10 seconds. for 2 seconds. d. Remove the pestle and revibrate the amalgam filled capsule
preparation is known as 67. (420) The process of packing an amalgam into the cavity
a. filling. c. trituration. b. building. d. condensation.
partially set mix of amalgam, it 68. (421) If you add a drop of mercury to a
a. makes the mixture more homogenous. b. adversely affects the colar. a. drastically reduces the crushing strength. d. improves the marginal adaptation of themix. undertrituration of an amalgam? 69. (421) Which of the following is a result of
a. Increased crushing strength. b. Decreased setting time. c. Increased expansion. d. Increased shrinkage.
of the moisture contamination 70. (421) All of the following may be the result of an amalgam except
decreased expansion. a. pain. c. lowered crushing strength. b. blister formation. d.
silicate cement powder? 71. (422) What is the main constituent of
Fluorine. a. Silica. c. Zinc oxide. b. Alumina. d. silicate cement liquid will 72. (422) An excess of moisture absorbed by the affect the setting time of a silicate restorationby
a, preventing its setting. b. causing faster setting. c. causing a slightly slower setting. d. causing a notable delay in setting. 25 9
8 p1-3-
73. (422) The most important property of silicate cement is that it
a. is insoluble in oral fluids. b. has an anticariogenic action. c. has a high crushing strength. d. has a rate of thermal conductivity.
74. (422) Which spatula should be used to mix silicate cement?
a. #31. c. #313. b. #142. d. #324.
75. (422) Silicate cement should be mixed
a. slowly over a large area of the slab. b. with a rapid stirring motion over a small area of the slab. c. rapidly with a folding motion over a large area of the slab. d. quickly to a thick consistency with a folding motion.
76. (422) The entire mixing time for silicate cement should not exceed .
a. 1 minute. c. 45 seconds. b. 2 minutes. d. 1 1/2 minutes.
77. (423) Which filling material is best suited (both esthetically and functionally) for an incisal restoration?
a. Amalgam. c. Zinc phosphate cement. b. Silicate cement. d. Composite filling material.
78. (423) An undesirable property of composite filling material is its
.a. short shelf life. c. tendency for staining. b. anticariogenic action. d. solubility in oral fluids.
79. (424) Zinc phosphate cement may be used for all of the following purposes except as
a. a pulp capping material. c. a cementing agent for crowns. b. an insulating base material. d. a temporary filling material.
80. (424) The chief ingredient of zinc phosphate cement is
a. silica. c. magnesium. b. phosphate. d. zinc oxide.
81. (424) A desirable property of zinc phosphate cement is its
a. insolubility in oral fluids. c. low thermal conductivity. b. expansion during setting. d. high crushing strength.
82. (424) Which spatula is designed to mix zinc phosphate cement?
a. #7. c. #142. b. #31. d. #324.
83. (424) Zinc phosphate cement should be mixed over a large area of the slab to
a. accelerate its normally slowsetting time. b. dissipate heat that could beinjurious to the tooth's pulp. C. increase the powder's liquidconsumption for added strength. d. provide the necessary liquidevaporation needed for settings
9 .251 84 (425) Calcium hydroxide powder is often mixed with sterile water and used as a pulp capping agent because of its ability to
a. achieve a cementing bond between the restoration and the tooth. b. provide increased translucency to anterior restorations. c. stimulate the production of secondary dentin. d. seal the margins of the restoration.
85. (425) When you mix hard setting calcium hydroxide or zinc oxide pastes, you should use
a. equal portions of the base and catalyst together. b. two portions of the catalyst to one portion of the base. c. two portions of the base to one portion of the catalyst. d. three portions of the base to one portion of the catalyst.
86. (425) Cavity liners and varnishes can best be classified as
a. bases. c. insulators. b. sealers. d. restorations.
87. (426) Which term is used to identify the acrylic resin liquid?
a. Polymer. c. Merrimac. b. Monomer. d. Methyl methacrylate.
materials is for making 88. (426) The primary use of self-curing denture base
a. temporary crowns. b. veneer facings for metallic crowns. c. the base material for full dentures. d. repairs on broken full or partial dentures.
resin? 89. (426) What is the usual color of impression tray
a. Pink. c. Light blue or white. b. Clear. d. Light pink or white. plaster gives 90. (427) During the final solidification of gypsum products, the off an appreciable amount of
a. heat. c. vapor. b. odor. d. moisture.
91. (427) As compared to hydrocal, plaster ofparis is
a. harder. c. quite porous. b. denser. d. relatively nonporous.
92. (427) The initial set of a typical hydrocal mixis
a. from 1 to 3 minutes. c. about 30 minutes. b. from 7 to 15 minutes. d. about 45 minutes.
rims? 93 (428) Which dental wax is used to construct occlusal
a. Bite. c. Utility. b. Inlay. d. Baseplate.
patterns for 94. (428) Ivory inlay wax is used in preparing the wax
c. acrylic jac!.ers. a. gold crowns. d. full dentures. h. gold inlays. 2o 10 95. (428)WhiCh wax is used to bead impressions and provide a rimlock for impression trays?
a. Boxing. c. Baseplate. b. Utility. d. Impression.
96. (429) Which term refers to the amount of bending and shaping a metal can sustain without breaking?
a. Hardness. c. Malleability. b. Ductility. d. Specific gravity.
97. (430) Which type of gold is supplied in a particular gage?
a. Type 1. c. Wrought. b. Type 3. d. Casting.
98. (430) Gold solders should melt and flow at
a. the same temperatures as the parts being joined. b. slightly below the melting range of the parts being joined. c. least 500 F. below the melting range of the parts being joined. d. least 1000 F. below the melting range of the parts being joined.
99. (430) Which of the following dental metals is used in its pure form?
a. Gold foil. C. Wrought gold. b. Gold solder. d. Casting gold.
100. (431) Which type of impression material has a relatively short shelf life because of its unstable polysulfide base?
a. Impression wax. c. Rubber-base compound. b. Impression paste. d. Alginate hydrocolloid.
101. (431) What is the proper mixing time for rubber-base impression material?
a. 15 to 30 seconds. c. 60 to 90 seconds. b. 45 to 60 seconds. d. 90 to 120 seconds.
102. (431) Which of the following impression materials is a reversible material?
a. Impression paste. c. Impression plaster. b. Agar hydrocolloid. d. Rubber-base compound.
103. (432) During root canal therapy, antiseptics are usually introduced into the canal by
a. the gutta percha points. c. the rool canal cement. b. a saturated paper point. d. a Luer syringe.
104. (432) A desirable characteristic of a good root canal filling material is that it be
a. difficult to remove. b. radiolucent to X-rays. c. soluble in oral fluids. d. nonirritating to periapical tissues.
105. (432) An acceptable root canal paste for use as a sealer can bemade by dissolving gutta percha in
a. creosote. c. ethyl alcohol. chloroform. d. parachlorophenol. b. 11
253 4P-4(0,
106. (433) Surgical dressing is often used after periodontal surgery to serve as
a. a sterilizing agent. c. a gingival bandage. b. a cauterizing agent. d. an anticoagulant.
107. (433) The zinc oxide and eugenol Lngredients of a surgical pack serve to
a. soothe pain. c. provide strength. b. check bleeding. d. provide esthetics.
108. (433) What function would be served by adding tannic acid to theingredients of a surgical pack?
a. Harder setting. c. Checked bleeding. b. Better flavor. d. nore strength.
109. (434) What fabrication procedure requires the use of baseplate material?
a. Gold crown construction. b. Porcelain crown construction. c. Acrylic tray construction. d. Bite-rim foundation construction.
.110. (434) Which dental abrasive should be used to polish natural teeth?
a. Rouge. C. ts:11-3 pumice. b. Tripoli. d. Zirconium silicate.
25
17 98150 03 S01 7501
SUPPLEMENTARY MATERIAL
CDC 98150
.DENTAL SPECIALIST
(AFSC 98150)
Volume 3
AU UFS.A1A.(73t274)211 Foldouts 1-8
AMSVNAWINVAVVIVKNANIAVIMWA VIM* AIMPAIMMAIIANWWWW~WVIAMVIMIMWINNIANIAMMWANMAWAMAWAWINIMMMAAWA*
Extension Course Institute Air University MOUTH MIRRORS
#6,1i
#17 ""'4...--
1 19.,#23 111111111111.
EXPLORERS
MERIAM
#17
RESTORATIVE RETENTION PIN
ACTUAL SIZE
DRESSING FORCEPS 61/2 inch } 256 Foldout 1.Dental Instruments
MEMEL. - 4116400. -4
CLINICAL THERMOMETER "nap" ammilemp fr'Ar
RADIOGRAPHS
fong=== =16.FLAME-SHAPED FRICTION GRIP ===M PEAR.SHAPED ROUND LATCH TYPE ===2310 DENTURE STRAIGHT HANDPIECE TRIMMING BURS SHAPES &
LENGTHS OF Round BURS Invrted Cone
Straight Fissure
Tapered Fissure
4 6 8 End Cutting BUR SIZES EXCAVATING BUR DESIGNS
259 Foldout 1. Dental Instruments. .
2.5 ii- 6 200 210 224 242 EE1 FINISHING BURS SURGERY BURS
ABRASIVE DISKS ABRASIVE WHEELS & POINTS
POLISHING INSTRUMENTS
Foldout I. Dental Instrumento (cont'd) 259 -
5% inch ANESTHETIC SYRINGES
RUBBER DAM EQUIPMENT
CLAMP FORCEPS 7 Inch
e
2,61) Foldout 1.Dental Instruments (contld) Foldout 1. Dental Instruments (coned). 4
#41 IL
#42 4 WEDELSTAEDT CHISELS
#3 BLACK #4 ecol---""'"Ilwasmumsmialer #5 BLACK #6
#40 BLACK #41
%DOUBLE ENDED CHISELS
BLACK #84
BLACK #85
BLACK #86
#48 J STRAIGHT CHISELS
BLACK #81 1 BLACK #83
BI-ANGLE CHISELS ACTUAL SIZE
2 Foldout 2.Dental Instruments - \15
BLACK #8 , T BLACK #17 gr 311mim... 17 ) BLACK #23 --4;--) BIBEVEL HATCHETS
BLACK #51 \-----z it 1 BLACK #52 c.4...... th.-21 BLACK #53 \. S3 BLACK #54 , vi...)
SINGLE BEVEL HATCHETS -
#17 BLACK #18 % , ±.5 BLACK #16
DOUBLE ENDED HATCHETS
C. BLACK #29
BLACK #34 io .i HOES
2 s 3 Foldout 2.Dental Instruments BLACK #63
BLACK #664 J BLACK #65
BLACK #66 64 SPOON TYPEEXCAVATCRS
# 3 6 BLACK #37
#38 BLACK#39
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DARBYPERRY #22 22 BLACK #89 et.) BLACK #92 " GOUGESHAPED BLADES
BLACK'S #77.THRU 804single end designs
BLACK'S #26 THRU 294double end designs
GINGIVA MARGINTRIMERS
Foldout 2. Dental 1n3truments. .2 SI DENTAL MATRICES TOFFILEMIRE
CONTRA ANGLE
UNIVERSAL CONTRA STRAIGHT ANGLE JR.
MATRIX BANDS
#FP 2A
MATRIX CONTOURINGINSTRUMENT
MATRIX WEDGE HOLDER
MATRIX WEDGES MATRIX STRIPS
COPPER BANDS MATRIX CROWNS CERVICAL MATRICES
Foldout 2,Dental Ins trutnentscont d AMALGAM INSTRUMENTS ill
CARRIERACTUAL SIZE BLACK #1
4=== BLACK #2
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0 SWEENEY #6
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TANNER-1r-
TANNER #2T 0 TANNER #31 0
TANNER #4T
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MODIFIED MORTONSON #2 /71-
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TANNER #6TB r-000Ngli ACTUAL SIZE SINGLE ENDED AMALGAM CARVERS
Foldout 2. Dental Instruments (coned). 2 S #89 CLEOID, DISCOID #92 rdr----- HOLLENBACK #1/2
#14 OR "H" q ,) TANNER #5T d P DOUBLE-ENDED AMALGAM CARVERS
FRAHM #1
FRAHM #2
FRAHM #3 AMALGAM & WAX CARVERS
#1 % HOLLENBACK fliTz171:inrt 2
HOLLENBACK #3
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OVOID MEDIUM #29
ROUND LARGE #25
ROUND SMALL #27
DOUBLEENDED15 OR "1"
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RHEIN #31
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MARGIN FINISHING FILES
Foldout 3.Dental Instruments
269 DOUBLEENDED AMALGAM CONDENSERS
MARKLEY #1
MARKLEY #3
MARKLEY #4
PIN AMALGAM EQUIPMENT
APPLICATOR SET PIN RETENTION
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Foldout 3.Dental Instruments 2 '7 o GROVED PIN
GROVED PIN DRIVER ACTUAL SIZE
PLASTIC FILLINGPLUGGERS
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#1 I WOODSON
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#3 WOODSON ACTUAL SIZ,
Foldout 3.Dental Instruments SPATULAS
. #313
$ #324
PLASTIC #142
GOLD FOILCONDENSER SET ciZt PLUGGING MALLET II *pi 11. 0 ; 7
2 3 4 5
GOLD FOIL PLUGGERPOINTS
BLACK
GOLD FOIL CARRIER
ANNEALING TRAY
Foldout 3. DentAl Instruments. 272 ft.
EXTRACTION FORCEPS
BEAK
NECK HANDLE #1 cz:zp
#150#150S
#150AS #151AS
#65
614 to 71A inches ACTUAL SIZE
Po 1atA34.Dental. Instruments
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INSTRUMENT FORCEPS
ACTUAL SIZE
TOWEL FORCEPS 3 inch
.2'75 Foldout 4. Dental Instruments. HEMOSTATIC FORCEPS ACTUAL SIZE
KELLY CURVED
NEEDLE FORCEPS ACTUAL SIZE
STRAIGHT 51/2 & 7 inch
DRESSING FORCEPS
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ACTUAL SIZE TISSUE FORCEPS
Foldoti?t7 Dental Instruments (contld) #3 ME=
ACTUAL SIZES
SURGICALANIVES &BLADES
c#10 #15
RONGEURFORCEPS
#1A
# 4 A 7 inch ACTUAL SIZE
/ (cont,d) Foldout 4. DentalInstruments 210
DEAN ANGULAR 63/4inch
SURGICAL SCISSORS
CURVED
both points blunt4 inch
BONE FILE SELDIN #11 ACTUAL SIZE
DENTAL SURGERYBURS
Foldout 4, Dental Instruments (contld) 2 4 / Foldout 4. Dental Instruments (con(d). ELEVATORS
MOLT # 9
OV1/410VAMAN.WW,VVV%W.;%\
SELDIN #22
PERIOSTEAL
# 301
#34 -S
COGSWELL A
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ROOTELEVATORS ACTUAL SIZE
2S/
Foldout 5.Dontal Instruments COGSWELL B
1L1ER 7 3
.
WEST #9
WEST # 9L
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CDC 98150
DENTAL SPECIALIST .0
_ (AFSC 98150)
Volume 4
- Clinical Procedures 0
-
4
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Extension Course Institute Air University
302 Pre face
YOU ARENOW starting your studies of the fourth and final volume of the 98150 Career Development Course. This volume, like the preceding volumes, is designed to present the information you need to perform your job and to prepare you for your pro- motion (SKT) testing. Chapter 1 concerns the USAF Preventive Dentistry Program. The scope df the program along with prophylaxis technique, preventive dentistry phase microscopy, and dietary needs are discussed in detail. The second chapter provides information on radiographic principles, safety, film exposure technique, and the processing of radiographic film. Chapter 3 pertains to the basic assisting principks. Discussed in this chapter are the professional standards of your vocation, the fundamental assisting pro- cedures, the concepts and techniques of four-handed dentistry, and the management of emergency situations. The fmal chapter, Chapter 4, discusses the procedures and assisting techniques associated with the dental specialty sectlops. . If you have questions on the accuracy or currency of the subject matter of the text, or recommendations for its improvement, send them to USAF School of Health Care Sciences/MSTW, Sheppard AFB TX 76311. If you have questions on course enrollment or administration, or on any of ECI's instructional aids (Your Key to Career Development, Behavioral Objective Exercises,. Volume Review Exercise. and Course Examination), consult your education officer, training officer, or NCO, asappropriate. If he can't answer your questions, send them to ECI, Gunter AFS AL 36118, preferably on -ECI-Form 17, Student Request for Assistance. This volume is valued at 48 hours (16 points). Material in this volume is technically accurate, adequate, and current as of October 1974. Contents
Pare Preface iii
Chapter
1 USAF Preventive Dentistry Program 1
2 Dental Radiology 31
3 General Assisting Procedures 72
4 The Specialty Sections 100
Answers for Exercises 121
_
39,1
1 V MODIFICATIONS
6c/f.6 ).---.: of this publication has (have) been deleted in adapting this material for inclusion in the "Trial Implementationof a
Model System to Provide Military Curriculum Materials for Use inVocational and Technical Education." Deleted material involves extensive use of
and was not considered appropriate military forms, procedures, systems, etc. _ for use in vocational and technical education.
305 What oral hygiene items sold by the se You will also need to advise him on the use of change should be given prom onal toothbrushes, methods of brushing, dentifrices, asis? floss and tape, interdental stimulators, and imgating devices. Toothbrushes.There are two groups of toothbrushesmanual and mechanical. While the 11. When shouspecial-emasis be placed on the manual toothbrush has been used for years, recently Air Force ndt School Oral Health the mechanical toothbrush has proven its Programs? effectiveness. Tests show that mechanical brushes, operated by a type of motor, clean and massage oral tissues as effectively as manual brushes if used an equal amount of time. The recommended 12. Would iIpient caries o mild gingivitis be a toothbrush is a small multituft brush with soft or disqlifying factofor Air Force medium bristles. Before you can explain the fooandlers? method to a patient, you must master it yourself. Manual toothbrushes vary greatly in their angled handles. The heads vary in size, shape, and texture. The shape of the heads may be straight, concave, convex, sloping, or tufted end. The texture of the bristles may be hard, medium, or soft. The sizes of 1-4. Oral Hygiene and Diet the heads vary greatly. The brush recommended for most patients has a small, flat, bristle head and a Oral hygiene is the total effort a patient expends straight handle. Tne.dental officer often prescribes to keep the hard and soft structures of the mouth in a specific type of manual brush for a patient to a state of health. Close cooperation among the useas indicated by the patient's oral condition. dental officer, you, and the patient is necessary to Mechanical toothbrushes are also available with the maintain effective patient oral hygiene. The teeth following different types of strokes: must be cleaned properly if correct oral hygiene is The vertical stroke. The brush travels in an up to be maintained, and toothbrushing is the most and down arc. important single factor in this maintenance. As you The horizontal stroke. The brush head moves know, you brush your teeth to clean them of all in a back and forth motion. bacterial plaque that accumulates and to stimulate The circular stroke. The brush moves in a the soft structures. If the patient does not remove circular motion. the plaque by brushing, ,calculus forms. Then, you, or other dental personnel must remove the calculus Toothbrushing methods.Exceptfor normal, by scaling the teeth with instruments. Even with a healthy adults, brushing techniques vary according good oral hygiene program the patient's oral to the type of treatment the patient is condition could be adversely affected if his diet is receivingsuch as orthodontic, periodontal, or not adequate. Therefore, we have included dietary surgical. There are a number of toothbrushing information in this section. methods that the dental officer may recommend. Most methods bear the name of the individual who 603. State the need for home oral care, name the originally described them in dental literature. items that are required, and explain how they The current concept of tooth cleaning should be med. incorporates the use of a disclosing tablet. The Home Care. Home care is best defined as the disclosing tablet is a small tablet containing a dye total oral hygiene effort the patient accomplishes. that gives a red color, to the normally invisible This, of course, does not restrict home care to the deposits of plaque. Chew a disclosing tablet and home. This definition makes inclusive in the term swish it around in your mouth. Rinse gently and "home care" those oral hygiene efforts the patient examine your mouth to determine the areas of makes in his home, on his job, or elsewhere. plaque accumulation. Take your toothbrush and One of your most important duties is to instruct point it at the teeth at a 450 angle. Lay the bristles in the patient in proper home care. If you can make a the sulcus area and use a "jiggling," scrubbing patient understand the reasons and need for correct motion. Repeat this procedure in other areas of the mouth cleansing, he will usually cooperate. Explain mouth and clean until all the red color is removed to the patient that periodontal disease starts with the from the teeth. After the red color is removed, run a accumulation of trapped food and plaques from piece of unwaxed dental floss between each contact around the teethand that the chief purpose of a point. Be careful not to snap the floss between the good oral hygiene program is to remove these teeth: to do so could cause damage to the gingiva. If accumulations. Warn him of the diseases and you experience pain during use of the brush or explain the possible consequences of these diseases. floss, you, too, should consult a dental officer.
6 3 alo.., Tell your patients to include their tongue in the tooth surface. The remaining 25 percent of the maintenance of oral hygiene. If they have deep tooth is the area most susceptible to caries arid gum grooves-or fissures-on the surface of-the -tongue,disease._Encourage the patient_to use dentatfloss to caution them to examine their tongues frequently so clean this area. that they can brush away any coating. or Interdental stimulators.Although interdental discoloration. A coating may vary in color from stimulators are not recommended routinely, light yellow to deep brown, depending upon what patients receive some benefit from using them. the patient has been eating or drinking. Small Interdental stimulators are gingiva massaging particles of food lodge in these grooves or cling to devices. Two common types are rubber and wood. the papilla. This creates a coating. Since everything The dental officer may recommend a toothbrush that is swallowed passes over the surface of the with a rubber tip on it for normal use and may stress tongue, it should be brushed regularly. The tongue use of the rubber tip for stimulation. Some should be protruded and brushed lengthwise as well periodontal patients may use wood stimulators. as from side to side. The patient may readily These are usually triangular wedges of wood. The remove the coating by using this brushing periodontal patients may require massage of the technique. interdental spaces (where the toothbrush bristles cannot reach). The normal healthy adult usually Dentifrice.Mostdentifrices(toothpasteor toothpowder) are composed of a flavoring, a obtains the necessary massage from the bristles of his toothbrush. detergent, and a polishing agent. Some dentifrices Irrigatingdevices.These are sometimes contain fluoride and are believed to be better recommended as an adjunct to normal because of the benefits derived from fluoride. In toothbrushing. Irrigating devices use a small forced most cases, it is best to recommend a dentifrice that stream of water to clean and massage the oral contains fluoride. A dentifrice may be supplied in tissues. The advantage of water-irrigating devices is either a paste or a powder. Pastes are composed of that they remove debris that has been loosened with the same ingredients as powders. However, a binder brush or floss from the gingival sulcus. (usually glycerin) and a lubricant are added to the powder to make a paste. The lubricant makes the Exercises (603): paste easily squeezed from the tube. Patients who have sensitive, exposed root surfaces may need a 1. What is the purpose of a good (home care) oral desensi.izing toothpaste. The effects of hygiene program? desensitizing toothpastes are usually temporary. Dental floss and tape.Dental floss, or tape, is a strong, thin string of cotton or nylon, sometimes waxed for added strength and ease of use. Unwaxed 2. Give the definition of home care. dental floss is recommended because it does not leave a wax residue on the proximal surfaces of the teeth. Dental floss is necessary for removing plaque from between the teeth where a brush does not 3. List the items that may be used in the home care reach. Tell the patient to exercise care in the use of program. floss to avoid injuring the tissue between his teeth. Show the patient how to use the floss. When preparing to use it, cut a piece long enough to be wrapped around the index finger of each hand, 4. What type of toothbrush is recommended for leaving 1 or 2 inches extending between the fingers. most dental patients? Guide the piece of floss with the thumb of one hand and the index and middle fingers of the opposite hand. Hold the floss at such an angle that you can apply force against one tooth from the facial side. 5. What is the purpose of using disclosing tablets? The floss is able to slide through the contact area but not against the tissue. Once the floss has passed through the contact area, press it against one tooth for and move it gently down into the gingival 6. What type of motion is recommended creviceform the letter "U" with the floss against brushing your teeth? the tooth and slide the floss up and down to clean the-tooth's proximal surface. Follow the same procedure for the adjacent tooth. Then remove the 7. Besides the teeth and gingiva, what other oral floss by releasing the lingual end and pulling it brushing through the embrasure. Explain to the patient that a structure should be included in your toothbrush cleans only about 75 percent of the routine?
7
3 9 3 ,1)
8. In most cases, what type of dentifrices should it. you can get the nutrients needed from the variety you recommend7 of everyday foods. I tiiiiiiiitlie-fOOdluide:-you select-the-mainpart of your diet from four broad food groups. To this, you add other foods as needed to make your meals 9. What is the primary purpose of using dental more appealing and satisfying. When using this floss? guide. you choose at least the minimum number of servings from each of the broad food groups. Serving sizes may differsmall for young children. extra large (or seconds) tbr very active adults or 10. Why is unwaxed floss recommended? teenagers. Pregnant or nursing women also require more food from these groups. Make choices within each group according to suggestions given later. Foods within each group are similar, but not I I. After the floss has been slid through the contact identical. in food value. Choose the additional area, how should it be positioned and used to foods to round out your meals both from foods in clean the proximal tooth surface? the four groups and- from foods not iisted in these groups. These additional foods should add enough calories to complete your food energy needs for the day. Children need enough food energy to support 12. What is the function of interdental stimulators? normal growth; adults need enough to maintain body weight at a level most favorable to health and well-being. Try to have some meat, poultry. fish. eggs, or milk at each meal. 13. What type of patient would be the most likely to need the use of an interdental stimulator? Exercises (604): I. List the four basic food groups.
14. What is the advantage of the water-irrigating devices? 2. What nutrients are needed in the daily diet, and 604, List the four basic food groups, state the how does each serve the body? nutrient requirements of the body and indicate the variance in caloric nee&s. Dietthe Basic Four Food Groups. Another 3. Place the following categories of people in way the patient can limit the number of decay- order from those who need the most daily causing microorganisms in his mouth is to have a calories to those who need the least. nutritionally sound diet. You have heard the saying, a. Pregnant or nursing women. "You are what you eat." Studies show that there is Small children. much truth in the saying; in a year's time 98 percent Active 'teenagers or adults. of our body atoms are replaced. This constant rebuilding indicates that adults as well as children need the nutrients found in a diet containing the basic four food groups. These groups are vegetable- fruit, milk, meat, and bread-cereal. Each day our food should supply us with many 605. State the body requirement for specific different nutrients: nutrients, name the available food sources, and Protein for growth and for repair of the body. indicate what association they have with tooth Minerals and vitamins for growth and to keep decay. the body functioning properly. Vegetable-fruit group. The foods included in this Fats and carbohydrates for energy. group are all vegetables and fruits. Thisguide emphasizes those that are valuable as sources of Most foods contain more than one nutrient. But vitamin C and vitamin A. Good sources of vitamin no single food contains all the nutrients inthe C are grapefruit orgrapefruit juice. orange or amounts we need. Therefore, choosing foods wisely orange juice, cantaloupe. raw strawberries. means selecting kinds that together supplynutrients broccoli. Brussels sprout. green pepper. sweet red in the amounts needed. The following daily food pepper. guava, mango. and papaya.Fair sources of guide indicates the way to choose food wisely. With vitamin C are honeydew melon, lemon. tangerine
8 3 or tangerine juice. waterniehm. asparagus. raw equivalents in calcium are these: 1-inch-cube cabbage. collards. garden cress, kale. mustard cheddar-type cheese = 1/2-cup milk: I/2-cup cot- greens, potatoes or sweet potatoes cooked in the tage cheese = 1/3-cup milk; 2-tablespoons cream jacket. spinach, tomatoes or tomato juice. and cheese = 1-tablespoon milk; and 1/2-cup ice cream
_ _ _ _ = 1/4-cup milk._ Rich sources of vitamin A in the vegetable-fruit Meat group. The foods Included in this group are group are dark green and deep-yellow vegetv.bles beef; veal; lamb: pork: variety meats such as liver, and a few fruits: apricots, broccoli. cantaloupe. heart, and kidney: poultry and eggs; and fish and carrots, chard, collards. cress. kale. mango. shellfish. As alternates you can use dry beans, dry persimmon. pumpkin, spinach, sweet potatoes. peas. lentils, nuts. peanuts, and peanut butter. turnip greens and other dark green leaves, and Foods in this groyp are valued for their protein, winter squash. Fruits and vegetables are valuable which is needed for growth and repair of body chiefly because of the vitamins and minerals they tissues--muscle, organs. blood, skin, and hair. contain. In this plan. this group is counted on to These foods also provide iron, thiamine, riboflavin, supply nearly all the vitamin C needed and over half and niacin. The amounts recommended are two or of the vitamin A. Vitamin C is needed for healthy more servings every day. Count as a serving: 2 to 3 gums and body tissues. Vitamin A .is needed for ounces of lean cooked meat, poultry, or fishall growth, normal vision, and a healthy condition of without bone: 2 eggs: 1 cup cooked dry beans, dry the skin and other body surfaces. peas. or lentils; and 4 tablespoons of peanut better. It is recommended that you choose four or more Bread-cereal group. This food group is our servings .every day to include the following: cheapest and most abundant source of One serving of a good source of vitamin C or carbohydrates. The foods included in this group are two servings of a fair source. all breads and cereals that are whole or restored One serving, at least every other day, of a grain (check labels). Specifically, this group good source of vitamin A. If.the food chosen includes breads, cooked cereals, crackers, flour, for vitamin C is also a good source of vitamin grits, macaroni and spaghetti, noodles, rice, rolled A, the additional serving of vitamin A food oats. and quick breads and other baked goods if may be omitted. made with whole grain or enriched flour. Parboiled The remaining one to three or more servings rice and wheat also may be included in this group. may be of any vegetable or fruit, including Foods in this group furnish worthwhile amounts of those that are valuable for vitamin C and protein. iron, several of the B'vitamins, and food vitamin A. energy. Itis recommertded that you choose four servings or more daily. Count as one serving: 1 slice Count as one serving: one-half cup of vegetable of bread: 1 ounce ready-to-serve cereal; 1 /2 to 3/4 or fruit, or a portion as ordinarily served, such as cup of cyoked cereal, cornmeal. grits, macaroni, one medium apple, banana, orange. or potato: half noodles, rice. or spaghetti. a medium grapefruit or cantaloupe: or the juiceof To round out meals and meet energy needs, one lemon. almost everyone will use some foods not specified Milk group. The foods included in this group are in the four food groups. Such foods include milk (fluid whole, evaporated, skim, dry. or unenriched, refined breads, cereals, and flours.. buttermilk): cheese (cottage. cream, cheddar sugars; butter or margarine: and other foods. These typenatural or processed): and ice cream (made often are ingredients in a recipe or are added to from milk products). Milk is our leading source of other foods during preparation or at the table. Try calcium, which is needed for bones and teeth. It to include some vegetable oil among the fats used. also provides high-quality protein, riboflavin, Regarding diet and dental health. research has vitamin A. and many other nutrients. clearly shown there are "do's" and "don'ts" which It is recommended that everyone have some milk should be observed. It is not our purpose. however, every day. Recommended amounts are given in to tell anyone he cannot eat certain foods or that he terms of whole fluid milk in 8-ounce cups. must eat certain foods. This type of responsibility Children under 9 need 2 to 3 cups. Children 9 to lies with the dietitians and physicians. Nevertheless, 12 and pregnant women need 3 or more cups. we should tactfully point out some of these "do's" teenagers and nursing mothers need 4 or more cups. and "don'ts" in the interest of dental health. and adults need 2 or more cups. Part or all of the When you are conducting a preventive dentistry milk may be fluid skim milk, buttermilk. counseling, offer the following information for the evaporated milk, or dry milk. patient's benefit: Cheese and ice cream ma) replace part of the a. High sucrose (sugar) diet. Research shows that milk. The amount of either necessary to replace a patients who eat a high sugar diet have a high rate of given amount of milk is figured on the basis of tooth decay. Thus, suggcst that the patient limit the calcium content. Common portions of various intake of sugar foods to one meal a day and lower kinds of cheese and of ice cream and their milk the total intake.
9
399 b. Sticky foods. Again, research shows that the 8. If a plpent insists on snacking between meals, use of sticky foods (carbohydrates, such as starch what can you suggest as a substitute for sugar foods and soft candies) increases the rate of tooth and sticky foods? decay. Suggest that the patient reduce his use of such foods. c. Food substitutes. In view of the above suggestion, the patient should use substitute foods. In place of some sugars (not all), suggest the useof saccharides for example. If a patient insists upon 1-5. The Clinical Approach to Prophitaxis snacking between meals, suggest that he eat nuts, This section is designed to provide you the carrot sticks, and fruits as substitutes for sugar and information neceasary to understand and perform sticky foods. Since experts generally agree that the the clinical procedures involved in oral intake of reasonable amounts of sugar and other prophylaxis. We begin by defining prophylaxis and carbohydrates is needed for overall good health, be discussing the deposits that may accumulate on the sure you don't imply that such foods should be teeth. We then discuss the procedures involved in excluded from the diet altogether. Instead, simply preparing for and performing the prophylaxis. relate the research facts pertaining to these.foods and recommend an intake reduction or 606. Define oral prophylaxis, state the purpose substitution. In so doing, you have made the patient for prophylaxis, and identify and answer key diet conscious in relation to dental health and have questions concerning the deposits that accarmukte fulfilled your obligation in this respect. on the tooth's surfaces. Oral Prophylaxis. This term is defined as the use Exercises (605): of preventive measures against diseases of the 1. Why does the body need vitamin C? List five mouth. In our dental clinics, the term usually refers good sources of vitamin C. to scaling, cleaning, and polishing of the teethwhich may include preventive dentistry counseling and topical applications of anticariogenic agents. The removal of the various 2, Why does the body need vitamin A? Which forms of mucinous and bacterial plaques (which vegetables are rich in this vitamin? cover neglected and unclean surfaces of the teeth) is of prime importance. It is in these plaques that dental calculus and stains first become impregnated and attach to the surface of the tooth. Acid that is 3. Why are milk or milk products unportant to produced by the bacteria within a plaque may be our diet? sufficient to decalcify the enamel and form the initial lesion of caries. Other organisms exert a toxic and irritative effect upon the gingival tissues. It is essential that you, the dental technician, 4. Place the following categories of people in remove all plaques and calculus from the patient's order from those who need the most milk to teeth by prophylactic measures, and (as previously those who need the least. mentioned) that you teach the patient to prevent the a. Children under age 9. recurrence of these deposits by personal oral b. Children age 9 to 12. hygiene measures. c. .Nursing mothers. Irritants in the form of foreign matter (plaque, 5. What is the nutrient for which the meat group is calculus) are the most common causes of most valued? periodontal diseases. However, many other factors may cause one to be susceptible to the disease. Some of these factors are the use of certain drugs, nutritional or endocrine disturbances, blood 6. What food group is the cheapest and most diseases (such as leukemia), overhanging abundant source of carbohydrates? restorations, open contacts, bacteria and their products, malocclusion, missing teeth, habits, and psychosomatic factors. You need only to recognize that these predisposing conditions do exist so that 7. What type of diet is associated with a high rate you may watch for them. Your job may require you of tooth deoay? to remove some of the local irritants; therefore, the following discussion is given to insure that you can identify the more common gingival irritants. Some form of deposits can be found on the teeth of most people. The importance of deposits such as intrinsic stain is an irregular brownish-yellow plaque, calculus, stains, and materia alba in the discoloration of mottled enamel. This is most etiology of periodontal disease is well established. probably caused by too high a fluoride content in As you study 'the following material and increase the water supply. your knowledge of these deposits, you will develop improved, techniques for removing them and for Calculus. Calculus is divided into two classes. preventing their recurrence. The first is a hard, calcified substance called Materia alba and inucinous plaque. Materia alba is supragingival or salivary calculus. It accumulates a soft, white deposit that forms around the necks of on the exposed portions of the teeth. This type of the teeth. It is composed of food debris, dead tissue calculus is composed of a mixture of calcium salts elements, and purulent matter. Bacteria find these and organic matter. It is thought to be deposited deposits an ideal place to grow. Mucinous plaques from the saliva. When first deposited, it is soft and consist of a sticky substance that accumulates on the sticky. The color is cream or graynot much teeth. These plaques are composed of mucin darker than enamel. The color may be modified by precipitated from the saliva and of bacteria and food and smoking. It is readily removed by their waste products. Both types of plaque cause brushing during the first few dap of accumulation. gingival irritations. Mucinous plaques (when they The deposits become harder, more dense, and become bacterial plaques) may form areas for the adherent to the tooth surface if they are not start of decay. removed during ibis early period. The second type is subgingival calculus and is Stains. Discolorations in the mouth can be also believed to be deposited from the Saliva. It is simply unsightly or contributing factors to the cause the chief cause of gingival inflammation that of periodontal disease. Stains can bcst be described progresses into periodontitis. As its name implies, it according to their formation. There are basically is located under 'the free gingiva. Subgingival, two types of stainsextrinsic (external) and calculus is usually much darker and harder than intrinsic (internal): supragingival calculus and is gritty and sharp in a. EXtrinsiC stains. TCh.: extrinsic stain that texture. This accounts for the ability of the calculus tobacco smoking causes is a dark diffuse to cause inflammation and bone loss. discoloration on the surface of the teeth. The tar Calculus accumulates more in certain areas than products of the burning tobacco are responsible for in others. The salivary glands empty their contents the condition rather than nicotine. Two additional into the mouth as do the small mucous glands which types of dark brown or black stains are known. are distriwted throughout the mucous membranes. These are not associated with tobacco. They occur The combined secretions of all the glands form the in both sexes at all ages. They appear as a saliva. The duct opening of the patotid gland is continuous line around the neck of the tooth near located just opposite the maxillary second molar. the gingival margin. The exact cause of this The sublingual and submandibular glands empty extrinsic stain is not known. It is presumed to be their secretions onto the floor of the mouth just due to chromogenic bacteria (color-producing lingual to the mandibular incisor teeth. bacteria). The other type of black or brown stain is Consequently, the facial surfaces of maxillary due to silver nitrate, a chemical that is sometimes molars and lingual surfaces of mandibular incisors used to prevent dental caries in children. are prime areas for the accumulation of calculus. b. Chrornogenic bacteria. Chromogenie bacteria In the earliest stages, calculus is deposited in the can also cause a green stain on teeth. This condition form of small flakes.It gradually forms a line may be found on the neck or apical half of the around the tooth just above the free margin of the crowns of anterior teeth. It is frequently found in gingiva. This inflames the margin of the gingiva. children, and its contributing cause is poor oral Then the calculus deposit and the bacteria that have hygiene. Orange and red stains are rare compared been incorporated into the mass at the gingival to brown or black stains. The orange and red stains margin contribute to the inflammation. As the are believed to be associated with chromogenic deposits increase in size, they form a framework for bacteria, also. They are more common among an increasingly rapid buildup of calculus. The children than adults. deposit of calculus becomes so large that it strangles c. Intrinsic stains. These are internal stains most the blood supply to the interdental papillaeand often caused by blood pigments. When there is gingival recession begins. The epithelial attachment hemorrhage in the pulp chamber due to trauma or begins to migrate down the root surface. death of the pulp, the blood seeps into the dentinal Destruction of the periodontal membrane and tubules. The hemoglobin in the red blood cells alveolar bone proceeds until the tooth becomes breaks down, and its high content of iron is mobile. Finally, unless adequate treatment is deposited in the tubules. This discoloration can be instituted, the tooth is lost. Performing routine seen through the translucent enamel of the teeth: it prophylaxis can, of course, help prevent the appears as shades of slate gray to black. Another development of severe periodontal conditions.
I I 312 Exercises (606): discussion with the evaluation of the patient's dental health record. 1. Define the term "oral prophylaxis." Etuluation of reafids. Before the patient enters the operators% evaluate his record. Check it for o äliIThfoldrshould -contain his dental 2. What is prevented by performing a routine oral record; current X-rays; AF Form 696, Dental prophylaxis? Patient History: and other applicable forms as discussed previously. Check his past medical history and his past history of periodontal disease. Complete items 3 through 8 by matching the Check the recommendations that were made during description that appears in column B to the previous preventive dentistry counseling. If the appropriate deposit in column A. patient has had a class 5 examination, evaluate the panoramic X-rays kr subgingival calculus and Co lwfm A Column R irritation. The few minutes that you spend 3.Mucinous plaque. a.Black, brown, or green evaluating his records tell you much about your 4 Subgingival deposits caused by tobacco patient. They help you evaluate his home care calculus. or chromogenic bacteria. habits and possibly his attitude toward the care of 5. Extrinsic stain. b. A soft, white deposit corn his teeth. After you evaluate the record and perform 6.Intrinsic stain. posed of food debris, dead 7.Supragingival tissue elements, and all between-patient housekeeping, you are ready to calculus. purulent matter that forms seat the patient. B. Materia around the necks of teeth. Seating the patient. Seat the patient in the chair in c. A sticky substance cum. posed of mucin a position that affords you the best view of the oral tated by saliva and bac. cavity. You can work either seated or standing. If teria and their waste pro. you prefer to work standing, raise the chair so that ducts. the patient's mouth is approximately at your elbow. d. A condition due to For the sitting position, adjust the stool and chair so hemorrhage in the pulp chamber or too high a that you are comfortable and so that your posture is fluoride concentration in correct. Check the patient for comfort. Be sure that drinking water. the chair position is within the limits of operation. e. A hard calcified deposit (The patient should not have to stretch to reach the that accumulatn on the exposed surfaces of the cuspidor: nor should you have to lean over the teeth. patient to reach the water and air syringes.) If (.Dark. hard. grin) deposits possible, position the bracket tray out of the located under the free patient's direct vision. You should have thoroughly gingiva. scrubbed your hands before the patient entered. After the patient is seated. wash your hands in full 9. Name the teeth and their surfaces that are view of the patient so that he will know that your considered the prime areas for the hands are clean. Now you are ready to examine the accumulation of calculus. patient's mouth. lactrament examination. Before you begin any calling procedures. make a thorough appraisal of the condition of the patient's mouth. This 10. What process begins when buildups of calculus examination serves three purposesit determines strangle the blood supply to the interdental the needs of the patient. determines the sequence in papillae? which these needs must he met, and provides you with useful information for conducting the preventive dentistry counseling. Be sure that the dental light is properly adjusted so that you can adequately view the oral structures. 607. Given a series of statements concerning the This examination has two phasesobservation preparatory procedures for oral prophylaxis, of the entire oral mucosa. and examination of the determine which are true and which are false. teeth and gingival sulcus. In the first phase. inspect the lips; then move intra-orally to the labial. buccal. Preparation for Oral Prophylaxis. Prior to and vestibular mucosa. Examine the oral pharynx. performing an oral prophylaxis, you must perform retromolar area, maxillary tuberosity. soft palate, several preparatory functions. Our discussion of the and hard palate. Pay particular attention to the preparatory phase includes evaluation of records. tongue and the sublingual mucosa. In the second seating the patient, instrument examinations, and phase. examine the gingival sulci to determine their contraindications to prophylaxis. Let's begin our depth. Examine the teeth below the gingiva for the
12 3 Ye presence of subgingival calculus. You can do this or kidney damage. local anesthetics should not be with a mouth mirror and explorer. A blast of air given. Check with the dental officer. directed into the gingival sukus also aids in the d. Rhes.inatk fryer. Question these patients - to detection of subgingival calculus. Examine the teeth when, where, and how affected. Fifty percent of for stains. soft and hard deposits. defects, and these patients have had some damage to the heart dental caries. The use of disclosing tablets will aid valves. Their treatment is the dentist's you greatly in detecting the soft deposits on the responsibility. Call his attention to any history of teeth and is a valuable aid when you conduct your rheumatic fever. These patients must be preventive dentistry counseling. Disclosing tablets premedicated with penicillin Of other antibiotics. and preventive dentistry counseling are discussed in Failure to premedicate these patients can be other parts of this volume. grounds for a malpracticeluit. Don't try to make a diagnosis. but recognize e. Prolonged bleeding. Ask the patient the deviations from the normalespecially those which following questions about bleeding. why? How relate to the oral prophylaxis technique. The first much? How long? Is he a slow bleeder or oozy? phase of the examination may reveal such These patients may be on anticoagulants. If the conditions u lesions and manifestations of virus patient is on anticoagulants and if the dosage must infection that prohibit the continuation of the be reduced for dental treatment, it must be done by appointment. Be alert (or all of the types of oral a physician. pathology we discussed in Volume 2. Bring any j: Reaction to local anesthetic. There are various condition that might be a contraindication to types of reactions to local anesthetic. Neurogenic prophylaxis to the attention of the dental officer. (nerve) reaction is the most common. Epinephrine Contraindications to prophylaxis. MI dental in the anesthetic causes the veins to constrict, and patients must be evaluated for medical history this increapes the blood pressure. Toxic (poison) before a course of treatment begins. AF Form 696. reactions are rare and usually result from a large Dental Patient History. must be completed for all dose. An allergic reaction to local anesthetic is rare. patients. The purpose of this form is to find out if Local anesthetic is considered a very safe den. there are any medical problems that can affect ir.Allergies. If the patient has a history of dental treatment. In addition to oral pathology. allergia, find out what he is allergic to. Ask what there are maw,: medical problems that are type of reaction he has had, and hoW long after the contraindications to prophylaxis as well as to other injection it occurred. Record all information that types of dental treatmtnt. Many of these conditions the patient gives you. If he is IlltfliC to dnap, such require special precautions. as penicillin Of novocaine, be sure to make the You are responsible for reviewing each patient's appropriate entries on his dental records. medical history. Any medical history. no matter h. Under the rare ole physicist. If the patient has how complete, is only as good as the person who been under the care of a physician during the past uses it. There are a number of questions on the year, ask him for what, when, and where? Is he form. Discuss each question. All "yes- answers taking medication? What kind? Has he taken must be further questioned as to what, when, where. cortisone? If the patient is being treated for a how much. and how long. We will discuss each condition that may be a contraindication to question on AF Form 696. Expand each "yes" prophylaxis, check with the dental officer. It may .O1Met in the following was: also be necessary to check with the physician before a. Hean condition'. lithe patient has a history ot you render dental treatment.. angina pectoris. he probably carries his own i.kfertions. For patients with a history of recent nitroglycerin tablets. CAUTION: Nitroglycerin infections. ask them what infection, when, how must be available at the time of treatment. If it is long, how often, and what treatment they received. needed, place the tablet under the patient's tongue. If a patient has a history of existing infection or You should avoid stre3s for patients who have numerous infections in the pest, he probably has suffered a coronary occlusion. Many of these lowered resistance, increased susceptibility, and patients are on anticoagulants. If the patient has slower postoperative recovery. DisCUL. ,he patient's high blood pressure :hypertension). avoid anything history with the dental officer. that may raise hi,' blood pressure. Always check j. Compikations following dental treatment. If a A:al the dental officer before treating these patient indicates that he has had complications patients. following dental treatment, find out what, when. b. Diabetes isaear diabetes). Patients with a and why. Try to uncover the complications that the history of diabete.; are slow healers and are sublect patient relates to dentistry, such as infection. to infection. Antit.iotic; may be necessary. Check nausea, fainting, and bleeding. This relates the with the dental officer before treatment. patient's pasz history to the complications you can c. Kidney and lire: disease. Ask these patients expect in the future. what, when, and how lone it there has been liver k. Condition of present health. Have the patient
13
31 3 301* indicate what be feek is the audition of his present of the patient, determine the sequence in heakh. If the p&Izat has mewed all previous which these needs must be met, and to questions with a "eo," aad then states that the provide beefy1 information for condition of his present health is "fair" or conducting the preventive de-`stry "poor"qession him about this. counseling. T F7.The preprophyluis examination hes two Disdain; thendeek. You apply disclosing phasesobservation of :he entire oral agents to the teeth before prophylaxis procedures. mucosa, and examined** of the teeth and These agents reveal the presence of deposits and gingival aka. stains. They are especially useful for staining T FI.A blast of air directed ix* the gieliVel plaque, which is impossible to see widow these MICIls is useful in determining the assns. You also use disclosing chemicals* mist presence of suprasingival calculus. in patient education techniqees. These agents color T F9.If the patient has a himory of angina the deposit or stain, but they do DOI CO1Of clean pectoris, nitroglycerin must be available tooth surfaces. The disclosing tablets are an at the time of treatment. indispensable part of the recommended method of T F 10.Patients with a history of rheumatic fever cleaning discussed later in this volume. must be premedicated with an satibiotic The coloring agent used in disclosiis tablets is drug. an erythrosin dye, a harming red food coloring. T F 11.Patients with an existing infection or The disclosing tablets are listed in the 6505 dass in numerous pat infections probably have a the Federal Stork Cote*. You may also use a 4. lowered resistance, and you should percent solution of basic fuchein as a disclosing discuss such histories with a dental sohnion. officer. To use basic fucbsin, dry the tads with T F 12.Disclosins spats should be applied to compressed air, and apply the solution with a the teeth before prophylaxis to reveal the cotton applicator or a cotton pellet in cotton pliers. presence of deposits and steins. During the application of the solution, retract the T F 13.The coloring tient in disdains tablets is patient's tongue, lips, and cheeks to provide scam basic fuchsin, which serves to color the to the teeth and to avoid stsinins the oral mucosa. deposits while not affecting the clean nstruct the patient to rinse thoroqhly after the tooth surfaces. solution has been applied. The use of disclosing T F 14.To use disclosing tablets, have the patient tablets is much mote convenient. Have the patient chew the tablet and then rinse chew the tabkt and then rinse thoroushly. Inspect thoroughly, the teeth with a mouth mirror, using completed air to move the papilla for better viewing of the sulcus 41111. State the purpose of teoth.seallog area. Give the patient a hand mirror to obsera his own mouth while you are performing the procedures, cite the factors that influence harms* selectee*, some the lasteument wasps, examination. and indicate the proper procedures for Burden (Mb establIshies a Name. Indicate whether the following statements Oral Prophylaxis, As you probably recall, we concerning the preparatory procedures for oral earlier defined oral prophylaxis as the clinical prophylaxis are true (r) or false (F) by circling the procedures, relating to the prevention of oral appropriate T or F. diseases, that you perform for the patient. T FI. Before the patient enters the operators+, Tooth.scaling procedures are- used to remove you should evaluate his dental records. calculus from the tooth surfaces. Basically, this T F 2.0f prime concern during a consists of using various scaling instruments to preprophylaxis records evaluation is the mechanically fracture the calculus deposits from the dental health record chart of "Diseases tooth's surface. It is relatively simple to remove sad Abnormalities." large deposits of supragingival calculus, but the T F3. Panographic radiographs can aid you in removal of small pieces of subgingival calculus in locating subgingival calculus. deep periodontal pockets is exceedingly difficult. I F 4. Once the seating egrocedure is completed, Calculus deposits can extend down the root to the you should wash your hands in full view depth of the sulcus or pocket. You must remove all of the patients. of the calculus from the teeth in order to eliminate T FS. When performing an oral prophylaxis, the SOW= of irritation to the periodentium. you should always work from a standing When you remove the source of irritation, the position. existing inflammatory response subsides. In the case T F6. The purposes of the instrument of simple gingivitis, the gingiva usually heals com- examination are to determine the needs pletely and no further treatment is needed. When
14 314 a
via
Figure I-I. The pat grasp. deep periodontal pockets remain, pocket elimina- or heavy stain, you would probably bewise to start tion procedures are usually indicated. The surgical your scaling procedure with the cavitron. After you eradication of pockets should be done by the dental have removed the gross supragingival calculus, you officer. may choose to complete the entire procedureusing Instrument selection. Primarily, your choice of the manual hand instruments. The cavitron may be instruments is determined by the amount of used only to remove supragingival calculus, calculus present in the patient's mouth. If the whereas the manual hand instruments are effective patient has a large amount of supragingival calculus for removing both supragingival and subgingival
. ,* ..... '.I a*, .!:.1.' . .-...;
4C-. .4 ;I. t ,''' y 4''-'-' ii- x **--C . t f A. ; ...7 i , r of...ti.,,,..' S t13.41f..Y:".i 1,'a .... .; :f r:a' .1 f ... 4.: '.'I- tJ '1G1. 2 f0t. /tiii,-zii.,...
...izivecig,e," ' :
Figure 1.2. The modified pcn grasp.
I 5 calculus. The scaling instruments wcrc discussed in Volume 2 of this CDC. You would probably be wise to review them at this point in your study of oral prophylaxis procedures. Instrument grasps. Using a correctinstrumcnt grasp is an important part of instrumentation. It has a direct bearing upon your ability to manipulate instruments. There arc three instrument gasps that you may use during oral prophylaxis procedures: (1) Withthc pen grasp,hold the instrumcnt thc way you hold a pen in writing. This grasp is shown in figure 1-1. Activate the instrument with a rolling motion. (2) With thcmodified pen grasp.hold thc instrument ip basically thc samc way as in thc pen grasp. cxccpt that you move your middle finger onto thc shank of thc instrument. This grasp is Figure I The palm grasp. shown in figure 1-2. 9) Inthe palm grasp. placethc instrument 5.Which instrumcnts arc effective for removing across thc first phalange of your fingers. Thcn flex both supragingival and subgingival calculus? your fingers over thc handle into the palm of your hand. Leave your thumb free. Thc palm grasp is shown in figure 1-3. This grasp is useful whcn you nccd exceptional forcc. 6. Name the three instrument grasps? Use a fulcrum to maintain control of thc instrument. A fulcrum may be defined as a firm finger rest. You should use a fulcrum in thc same arch as thc working area and asclose to thc 7. What instrument grasp is useful whcn you need working area as possible. In the modified pen grasp, excepfional force? thc middle fingcr is most oftcn uscd as a fulcrum. Thc finger used for a fulcrum can rcst on thc teeth, thc gingiva, anothcr finger. or a combination of these. Do not use soft movable tissue for a fulcrum. When you arc holding the instrument in the pen Items 8 through 11 arc statements that relate to grasp. use your third (or ring) finger ai the fulcrum. establishing a fulcrum: indicate whcthcr each When using the palm grasp, usc your thumb for the statement is truc (T) or false (F) by circling the fulcrum. appropriate T )r F. T F8. A fulcrum is used to maintain control ot Exercises (608): the instrument. T F9. A fulcrum should be established in the 1. What is the purpose of woth-scaling arch directly ,,pposite the working area. procedures? T F 10. Whcn using the palm grasp. use the ring finger for the fulcrum. T F 11. A fulcrum should always be established on hard tissues such as the teeth. 2. Why must all calculus be removed from thc teeth? 609. Given a series of statements concerning the systematizing of the periodontal scaling routine. indkate which are true and which are false. 3. What is thc primary factor in instrument Periodontal Scaling Procedure. You should selection? approach cach patient with a spccific plan of treatment. This plan will, of course, vary with the individual patient's needs. Most paticnts who have frequent prophylaxis treatment and adequate oral 4. What instrument would be a wise choice to hygicnc need only one appointment. Paticnts who have bccn neglectful of their oral health. such as start the scaling procedure on a patient who has a large amount of calculus and heavy stain? those with periodontios. usually rcquirc several appointmentsRegardless of whether the scaling can he completed in one %ming ur in SeveNd
16 ) , t0 sittings, you should approach the scaling task segmentation approach is accomplished systematically. by dividing the mouth into quadrants. .Systentaticing the procethireIf tht. patient has T F5. When scaling the teeth. you should gross supragingival calculus deposits. you should remove the deposits from all the aspects first remove them. 'These deposits are easy to locate of one tooth before you start to scale and are usually relatively easy to remove. The another tooth. cavitron is particularly useful for performing the gross scaling. The cavitron is recommended only 610. Gil en IAseries of incomplete pertinent for the removal- of supragingival calculus.The statements concerning the operating position of o:ainique is similar to that used with other hand the technician during oral prophylaxis, sapid) instruments except that application must be in a key words that complete the statements. contindously wet field. Apply the tip in a gentle. Positions uf time tecimician. After seating the short, rapid, massaging stroke. Overlap the strokcs patient, adjust the chair so that both you and the and repeat as necessary until all the deposits are patient are comfortable. Try to work from a removed. Keep the tip moving constantly while it is position where your working area is lower than touching the teeth. The use of a light touch your heart. This will help prevent your hand and produces satisfactory results. arm from becoming fatigued. You may work from As you begin your hand scaling with the curettes. either a standing or a sitting position. Most you should divide the mouth Into work segments. technicians. however, prefer a sitting position as The most widely used segmentation method is to they find that it leaves them less tired at the end of divide the mouth into quadrants. Each quadrant the work day. Operating from the seated position begins with a central incisor and extends posteriorly has another advantage as it allows you to view most to include the third molar. When scaling patients areas without having to look in the mouth mirror. with advanced perindontitis. you may be able to Most technicians find that the scaling procedure scale only one quadrant during the first can be performed faster and more efficiently if they appointment and one quadrant during each have a direct view of the operating area. If you do subsequent appointment. When more than one choose to stand, distribute your body weight appointment is needed. reevaluate the areas equally on both legs.Whetheryou stand or sit, previously scaled during each subsequent maintain a good posture by keeping your back appointment. You may find calculus deposits that straight. were left and must be removed at this time. If the entire scaling is to be performed during one Exercises (610): appointment. you should still complete an entire O. quadrant before you begin the next quadrant. I.To prevent ynur hand and arm from becoming Skipping haphazardly from one area of the mouth fatigued, you should work from a position to another may cause you to miss some areas and where the working area is than your usually results in wasted time. As you begin your work within each quadrant. try,to use each 2. Working from the seated position is less tiring instrument in all the places indicated by its design and allows you to view most oral structures before changing to another instrument. without having to use the 3. If you work from the standing position, you Exercises (609): should distribute your _equally on both
Indicate whether the following statements 4. Whether you stand or sit, maintain a concerning systematizing the periodontal scaling by keeping your routine are true (I) or false (F) by circling the _ appropriate T or F. T F I. Systematizing of m.p.: periodontal scaline 611. Indicate the actions and the purposes of the procedure provides for the same actions that both directly and indirectly show treatment plan for each patient. thoughtfulness to the patient by answering a series T F /. If the patient has gross calculus deposits. of key questions. periodontal curettes are usually thc first instrument used in the scaling routine. Thoughtfidness to the patient. As you perform the T F1. The use of long. slov.. medium to heavy prophylaxis procedure. remember that you are strokes with the cavitron is an effective working on a living, breathing human being. You way to remove subgingival calculus after must accomplish your tasks in a manner thatdoes the gross scaling has been completed. not psychologically irritate the patient. Remember. T F4. Prior to beginning your hand scaling, you your job is not tu chastise the patient torhis past should divide the mouth into work neglect. but to rehabilitate and educate him toward segments. The most widely used improved oral hygiene. Be as gentle as possible
I I 7
,-)., C)t"-f -0.,. / during the scaling procedure so that you don't Exercises (611): needlessly injure the tooth or its surrounding tissues. Frequently irrigate the scaling site to I. What should you consider as your job in an prevent particles of calculus from becoming effort not to psychologically irritate the implanted in the gingival tissues. Be careful when patient? you retract tissue with the mouth mirror, because too vigorous a retraction can be extremely uncomfortable to the patient. 2. Why should you beas gentle ai possible during Studies show that periodontal scalings the scaling procedure? performed with sharp curettes produce smoother root surfaces than do other scaling methods. You cannot do a good job unless you use sharp instruments. The use of dull instruments not only 3. How can you prevent calculus particles from results in an inadequate procedure but is a waste of becoming implanted in the gingival tissues? time and effort. Additionally, dull instruments are hard to control. They could easily slip off the scaling surface-and cause an unnecessary laceration or puncture-type wound in the patient's lips, 4. Why should you be careful when you retract cheeks, or palate. So, after use on each patient, tissues with the mouth mirror? check your instruments and sharpen them if necessary.
As you place your instruments on-the bracket 5. Give three reasons for using sharp instruments table, place them in the order they are going to be for the scaling procedure. used. For instance, if you are going to scale the anterior area first, place the curette you will need in the first position on the bracket table. This prevents you from having to search through your instrument 6. When placing instruments on the bracket table, setup to find the one you need. Color coding tape what action can you take to make it easier to can also aid you in quickly finding the instrument find the instrument you will want to use at the you need. Since the curettes are paired, you can time you want to use it? identify both instruments of the pair with the same color of tape. When you wish to change from one instrument of the pair to the other, you can select it readily by the color of the tape you have placed on 7. How can you code paired instruments to make its handle. Patients can easily lose confidence in a them easier to identify? technician Who must frequently change instruments in an effort to find the right one to sdale a particular area. No matter how well organized your instrument setup is, occasionally you will pick up 8. Why should you make an overt effort not to the wrong instrument. When this occurs, it is a good change instruments frequently when trying to idea to go ahead and briefly use the instrument find a suitable instrument to scale a particular rather than indicating your error to the patient by area? immediately changing instruments. You must consistently do everything in your power to gain and maintain your patient's confidence. 9. Why should you clean your instrument tip on a When you are scaling, you will occasionally need gauze sponge or in a dappen dish containing to remove calculus and debris from the working hydrogen peroxide rather than wipe it on the end of your instrument. This can be accomplished patient towel? in one of several war. You can place a dappen dish containing hydrogen peroxide on the bracket table and simply dip the instrument tip into the solution. You could also wipe the instrument off on a gauze sponge that can either be attached to the towel chain 612. Relate the various methods employed to or held in your nonscaling hand. Avoid wiping the locate calculm, and indicate in which oral area instrument directly on the patient towel as blood or calculm is most difficult to locate. debris from your hands or the instrument could stain the patient's clothing. Locating the calculus.The actual scaling process 18 31 1 root surface just below the cervix. Figure 1-4 illustrates typical furcation grooves.
CONCAVE AREA Exercises (612) 1. What chemicals can assist you in locating supragingival calculus?
2. Into what area should you direct a stream of air to locate subgingival calculus?
3. What must you depend upon to locate calculus Figure 1-4. Furcatien grooves. deposits in the periodontal pocket?
begins after the deposits of calculus are located. Drying the teeth with a stream of warm air helps to 4. What texture do the calculus deposits in expose supragingival calculus. Disclosing chemicals periodontal pockets characteristically have? can also assist you in locating the supragingival calculus deposits. Some subgingival deposits can be seen if you direct the air stream intothe gingival sulcus. Pay particular attention to areas where 5. What is the most difficult area in which to gingival inflammation is apparent. Deposits in the locate and remove calculus deposits? periodontal pocket cannot usually be seen. To locate these deposits, you must depend on your sense of touch. By inserting an explorer or afine curette into the pocket area, you can usually feel the calculus deposits as they characteristically have a 613. Given a series of statements concerming the rough flintlike texture. The most difficult areas for instrumentation involved for calculus removal, the location and removal of calculus deposits are indicate which are true and which are false. the concave grooves leading into the furcation areas of multirooted teeth. These areas are located on the Instrumentation. Once you have located the
e Figure 1-5. Basic scaling strokes. 19 V? a
B c Figure 1-6. Phases of the venical stroke. calculus deposits, you are ready to perform the gingival margin. Grasp the curette lightly and move instrumentation necessary to remove them. There it down toward the base of the gingival sulcus. Keep are two basic scaling strokes. The first is the vertical the curette's tip in light contact with the calculus or . stroke which parallels the long axis of the tooth. tooth surface and continue the downward The vertical stroke is usually used to remove movement until you feel the tension of the soft 0 calculus from the proximal surfaces of the teeth. tissue attachment. The other stroke is the horizontal stroke which Once you reach the base of the sulcus. you are parallels the cervical line. This stroke is used to ready for the positioning phase. This phase is remove deposit from the facial and lingual surfaces illustrated in figure 1-6.B. The blade should he of the teeth. The vertical stroke is considered the positioned at the apical aspect of the deposit and safest scaling stroke to use as the instrument's should form a 45° to 90° angle with the tooth. If the cutting edge does not come in contact with the angle is less than 450. yourworking stroke will epithelial attachment. Do not use the horizontal probably slip over the deposits. If it is more than stroke in cases where probe measurements show 900. there is a danger of gouging the root surface. that the sulcus depth is uneven, as the curette will be After the instrument is properly positioned, you are dragged into the epithelial attachment at the higher ready to initiate the working phase of the stroke. areas. Even in cases where the sulcus depth is uniform. you should exercise extreme care when Prior to initiating the working phase of the using the horizontal stroke. The vertiol and stroke you should tighten your grip on the horizontal strokes are illustrated in figure 1-5. instrument. Your hand, wrist, and arm should be These strokes must often be altered slightly to an used to activate the instrument. Avoid scaling with oblique or diagonal direction in order to scale all of independent finger movements as this technique is the tooth's surfaces. extremely fatiguing. Your working stroke should be short, controlled, decisive, and directed in a There are three distinct phases to each scaling manner to protect the tissues from trauma. The stroke. the exploratory phase, the positioning short stroke helps to maintain control of the phase. and the working phase. Refer to figure 1-6 as instrument and permit adaptation of the cutting we discuss these phases. Figure 1-6,A, shows the edge to variations in the tooth's surface. The exact exploratory phase of the stroke. Prior to beginning length of the stroke is dependent on the height of this stroke, establish your finger rest on a dry, firm the deposits. During the working stroke, you should tooth structure as close as possible to the tooth slightly increase the pressure on the fulcrum to being scaled. Gently insert the curette under the balance the pressure of the instrument on the tooth ! 20 3711 Figure 1-7. Maxillary right pisterwr. i.mal andpr.iximal poo two Figure 1-9. Maxillary anterior. 14021 andproximal position. being scaled. The working stroke is shown in figure I -b.C. a nucleu& for new plaque andcalculus formations. Try to work within the boundaries of the pocket Frequently irrigate the pocket and sulcus areas to or sulcus to eliminate the need forrepeated prevent implantation of calculusdeposits into the ithdrawal and reinsertion of the curette. Doing underlying tissues. FiguresI .7 through 1.18 this not only saves time but also reduces thc number illustrate the suggested instrument and finger rest of times that the instrument must he passed over the positions for scaling in different areas of the mouth. tooth's highly sensitive neck and gingival margin. After you have completed the scaling procedure, where the enamel and cenwntum is thinnest. you are ready to polish the teeth. Whenever possible. remove the whole thickness of calculus in one piece. Never remove calculus b. Exercises (6131: shaving it off in layers. Shaving often leaves a thin I F 1 . The horizontal scaling stroke shouldbe layer of calculus which is difficult to distinguish used in areas where the sulcusdepth is from the tooth's surface. This thin layer can serve as uneven. T F2. The vertical scaling stroke parallelsthe long axis of the tooth and is usually used
Figure 14. Maxillaryright posterior, lingual position. Figure 1-10. Maxillary anterior, lingual position.
21
322 a
Figure 1.13Mandibular lett posterior. tacial And proximal Figure 1.1 I .Maxillary left posterior. facial and proximal posi. posnuin non
to remove calculus from the proximal gingival margin, and keeping the surfaces of the teeth. curettes's tip against the tooth surface, T F3. The scaling stroke that is used to remove move it down until you feel the tension of calculus from the facial and lingual the soft tissue attachment. surfaces of the teethis the horizontal T F 7.Prior to beginning the working phase of stroke. the stroke. position the instrument blade T F4. The first phase of the scaling stroke is the so that it forms a 45° to 90° angle with the positioning phase. tooth. T F5. Prior to beginning the scaling stroke you T F8. You should attempt to use independent should establish a finger rest on a soft- finger movement when scaling to avoid tissue structure. becoming fatigued. T F6. In the first phase of the scaling stroke, T F9. Your working stroke should be short, you should insert the curette under the controlled, decisive, and directed in a
Figure 1-12Maxillary lett posterior, lingual position Figure 1.14 Mandibular kft posterior. lingual position
223 22 Figure 1.15. Mandibular anterior. facial and proximalpost Figure 1.17. Mandibular right posterior. facial and proalsal tion. position.
manner to protect the tissues from answer key questions concerning the onsterials trauma. and procedures involved I. the polishing sem. T F 10. During the working stroke, you should slightly increase the pressure on the ?oilskins Teeth. After you have completed the fulcrum to balance the pressure of the scaling procedures. you must polish the teeth. The instrument on the tooth being scaled. purpose of polishing is to remove stains and plaque, T F 11. When you scale the teeth, you should and to smooth the enamel. Remove gross deposits make an effort to reduce the number of of stain with hand instruments. Zircate or some times the instrument must be passed over other fine abrasive agent is best for polishing. the neck of the tooth. Zircate is mixed with 3 percent hydrogen peroxide T F 12. The best method for eliminating calculus or is mixed with stannous fluoride, as we will involves shaving if off layer by layer. discuss later in this section. Studies using the electron microscope have shown that the enamel of 614. State the reasons for polishing the teeth, and teeth polished with zikate is much smoother than
Figure 1-16 Mandibular anterior. lingual position. Figure 1-18. Mandibular rightposterior, lingual position.
23
323 ..
that of teeth polished with flour of pumice. The 3. Name two agents that may be mixed with secondary cuticle (a factor in the formation and zircate to make the polishing paste. attachment of plaque and calculus) doesnot reattach as fast when the teeth are polished with zircate. a Apply the polishing agent to the teeth witha 4. What is used to apply the polishing agent to the rubber cup attached to a prophyleads headpieceor teeth? to a conventional speed contra-angle headpiece. You may use a mounted bristle brushon the occlusal surfaces. Use slow speed and lightpressure to reduce the amount of heat generated. Be careful 5. List three things you should do to reduce the not to damage the soft tissues. Keep the cup moving heat generated during the polishing procedure. over the tooth surfaces to reduce heat. Use a systematic routine to assure that all areasare polished: The rotation of the cup or brushcan sling 6. Why should you wear protective glasses when polishing material out of the patient's mouth. For polishing a patient's teeth? this reason, you should wear protective glasses and mask and the patient should be adequately draped to protect his clothing. You may not be able to reach all of the 7. What type of dental floss should you use in interproximal areas with the polishing cup. To conjunction with zircate to polish the proximal polish these areas, place zircate in the facial and tooth surfaces? lingual embrasures and carry it into the interproximal space with waxed dental flossor dental tape. Waxed dental floss or tape is used for this procedure since the chemical and abrasive 8. Why should you recommend unwaxed floss for agents in zircate will rapidly break down the fibers the patient's home care program? in unwaxed floss. The patient should be informed of this, and instructed to use unwaxed floss for his home care. Unwaxed floss does not leavean undesirable wax residue on the tooth surfaces and 9. What should you do if you notice an generally does a better job since its fiberscan overhanging restoration when you are spread and cover more of the tooth's surface. polishing the teeth? why? Remember that the primary purpose of polishing is to produce a smooth surface. Plaque and calculus do not form as quickly on smooth polished tooth surfaces; therefore, it is essential that all surfaces be polished. 615. Supply the necessary word Polish amalgam restorations witha rubber or words to polishing cup filled with zircate or tin oxide. Run complete pertinent statements concerning the preparation and topical application of mansions the handpiece slowly, using lightpreuure. If you fluoride. discover an overhanging restoration, besure to call it to the attention of a dental officer or makea note Topical Anticariogenic Agents. After you of this finding in the remarks section of the patient's complete the scaling and polishing procedure,you dental record. Overhanging restorations are a prime should administer a topical application ofan source of gingival irritation, and they should be approved anticariogenic agent to the teeth. Theuse promptly corrected. of topical stannous fluoride for the Air Force Preventive Dentistry Program is currently Exercises (614 recommended in a 30-second application of a 10- percent aqueous solution as the preferred method. 1. State the purpose of polishing the teeth. The 30.second method described below involvesa meticulous procedure. Prepare the application in the following manner: Dissolve 100 g SnE, (stannous fluoride) in 2. What should you use to remove gross deposits approximately 300-ml distilled water in of stain? a 500-ml volumetric flask. Add 50-ml glycerin and mix well. Bring flask to volume with distilled water and add I ml flavoring oil, such as oil of peppermint, oil of spearmint, oil of anise, or oil of orange. Mix well.
24 32.1 Allow to stand at room temperature for 2 to 3 how done by isolating and drying the teeth arid then and decant any excess oil. Store in tightly sealed moistening them with the fluoride solution for plastic bottle. The identification legend for the bottle should be: -Stannous Fluoride-20 percent 9. Patients should be advised not to . stock solution." Date. The prescription legend or for 30 should be: "For use in dental clinic under minutes after the application of the fluoride professional supervision. Not to be dispensed to solution. patient for self-use." 10. Repeated applications of fluoride are rec- The following directions are for use of the ommended at to month intervals. topical application via the prophylaxis paste. Thorough prophylaxis must precede topical 14. Preventive Dentistry Coesseling application. Mix stock solution with zirconium The preventive dentistry counseling is one of silicate (zircate) to prepare fresh prophylaxis paste. your most important duties, as its impact can A fluid. slurry mix will yield the highest percentage motivate the patient to improve oral hygiene. In of stannous fluoride, and a thick paste will yield the lowest percentage of stannous fluoride. Other performing these counselings, you will be amazed abrasives, such as flour pumice. may be used to to learn the misconceptions many people have concerning oral health. These misconceptions are deliver stannous fluoride to the demition. For topical application in aqueous solution. normally formed because the patients have not dilute a small portion of stock solution with an previously received the good, sound, professional advice that you can provide. Instead they have been equal volume of distilled water in a dappen dish to influenced by misleading advertising and the provide a 10.percent solution. Isolate the teeth with unprofessional oral health trainieg they received cotton rolls, dry the teeth with compressed air, and from their parents. It is your job to correct such keep the teeth moist with the 10-percent solution misconceptions and further educate your patients throughout a 30-second period. Advise the patient into an adequate oral health program. not to eat. drink, or rinse his mouth for 30 minutes following treatment. Repeated applications are recommended at 6- to 12-month intervals. 616. Identify factors necessary I. creating a good counseling atmosphere by matching the factors to CAUTION: Do not apply fluoride if the patient's gingiva is extremely irritated. Reschedule such their beneficial impact. patients so that you can evaluate the therapy. If The Counseling Atmosphere. The: atmosphere healing is satisfactory at the time of the evaluation. you create for your counseling session is of vital you should then apply the fluoride. importance to the success of the counseling. Position yourself so that you can look the patient in the eye and observe his responses to the various Exercises (613k portions of your counseling. You may have to I. The amount of fluoride needed to mix a 20- repeat or further clarify points if the patient's percent stock solution of fluoride in a 500-ml responses show that he does not understand or volumetric flask is believe what you have said. In most cases. sitting on 2. Oil of peppermint, spearmint, anise, or orange the operating stool and facing the patient provides a is added to the fluoride mixture to serve as a good counseling position. This position allGws you _oil. to view the patient's facial expression. Addi- 3. A freshly mixed fluoride solution should be tionally, being at the same eye level as the patient allowed to stand at room temperature for helps to establish rapport, since you are not talking to _ hours .. then decant any excess oils. down to him like a ruling monarch. 4. The prescription legend on the 20-percent Talk directly to your patient. If you stare at the stock solution of stannous fluoride should wall, desk, or some other inanimate object during read: "For use in the dental clinic under your counseling, the patient will tet the impression Not to be dispensed to that you are not sincerely interested in him. Use patient for simple words, and explain any complex scientific or S. Topical applications of fluoride must be technical terms with which the patient may not be preceded by a thorough familiar. After all, your patient probably doesn't 6. A fluid, slurry mix of stannous fluoride and know that "gingiva" is the technical term for zircate will yield the percentage of "gums," and he probably thinks calculus is a form fluoride. of mathematics. You cannot motivate a person to 7. To prepare for a topical application of fluoride improve his oral health if you talk in terms he in an aqueous solution, you should dilute the doesn't understand. 20-percent solution with an volume of Another important aspect in establishing the proper counseling atmosphere is explaining, or 8. The application of SnF: in aqueous solution is better yet, showing and explaining why good oral
25
325 health care is needed. The phase microscope ii. of great benefit in convincing the patient that he needs a good oral health program by showing him live A-2/ microorganisms. Additionally, charts and literature that pictorially illustrate the progresion of caries and periodontal diseases are also fine motivational tools. Don't forget the disclosing tablets as they can ArArk have the greatest impact on the patient. By using these tablets prior to your counseling session you can actually show the patient the areas his cleansing techniques are missing. Again we repeat a point previously mentionedyour job is not to chastise the patient for his past neglect but to educate and encourage him to improve his oral hygiene.
Exercises ([6): Fipre 140. Placing saline on the slide.
Complete the followins exercises by matching the beneficial impact listed in column B to the 627. Statethe impose of the phase microscope, appropriate factor in column A. sad describe the preparation procedures for viewing specimen. Cohort A Colwyn B Use of the Masse Microscope. Areyour verbal powers of persuasion good? Can you tell a patient Disclosing tablets. a.Allows you to determine about bacteria and convince him that what you say 2.Talking in simple if the patient underrands term your counseling efforts is true just because you say it is true? You have _3.Pictorial charts and helps establish rap. already learned that the use of training aids in and literature. Port teaching is a most desirable method of imparting _4.The phase micro- b.Helps your motivation information. Perhaps the best training aid you can scope. efforts by allowing the ps. use is a microscopic slide. (Naturally, you need a _5.Sitting a the same tient to understand your eye level as the pa. counseling. microscope to view die slide.) A slide can show the tient. C.Convinces the patient he patient exactly what is living inhismouth! needs an oral health Thinking as a "nonscientist," we can say that the program by showing him way the phase microscope makes it possible to see live microorganism from colorless, live bacteria is by using changes in the his own mouth. d.Provide insight to the pa- intensity of light. As the light goes through the tient on how dental dis. bacteria, the phase of the light waves is altered. The eases progress. optical design of the phase microscope converts the e.Actually shows the patient phase variations into visible changes in light where his cleansing tech. niques ire missing. intensity and permits one to set the outline of the microorganisms clearly. Recently, phase microscopes have been taken out of the luxury price range;scientists have found Ins costly ways to incorporate the phase principle into the microscope. In the phase microscope, the specimen requires almost no special preparation for use. The phase microscope makes the details of the specimen visible by "optical staining." Slide preparation materials.To prepare a slide for a patient to view, you must have certain materials. Normally, the sterile pack or the required number of sterile packs is made up in advance. You need the following items: a. Glass slide on which to put the specimen. b.Glass side coverslip to put over the specimen so that it is isolated from other organisms and so ..4401 P°r that it can be seen. c. Solution to put the specimen in. Use one drop of a solution akin to what is found in the moutha Figure 1.19. Slide preparation materials. normal saline solution.
26 3 9 ° handed). Fipre 1-22 *owe the covenlip k makes contact with the glem 1. Gently lower the cowslip over the drop of Wine until it makes contact. g. Let the cowslip fall on the *op of Wine and pros it gemly down wink the *op with the cotton rolls. In fore 1-23 tau cotton tolls am being used to press the coverslip apinst the slide. 4 h. Slot the excess solution from 'roved the cowslip with a cotton rojl or gauge sponge. t 1. Hold the covenlip as slow in figure /44 end seal it with lacquer on all four sides.
:;,;.44.zik; Viewing the sinew. Now that the slide is 4 :it" prepared, it mtet be mounted inthe miaoscopefor roue 141. Illnaldes up die sereOs. viewing. Sianmany breads of phase microscopes ate used thcouOtout the Air Force, it would be too d. Sterile instrument or dental flom so take the lengthy so provide mounting instructions for each specimen from the mouth. brand. You should follow the manufacturer's e. Cotton 1.010 10 UN to peas down the slide instructions for the microscope used in your cover over the specimen. particular clinic. Figure 1.23 ilhoesiss the Unities I Gauze sponse to blot excess solution from miamcope. which is used in many clinim. The around the slide. patiem doss not nesd to know all the details of the ff. Covenlip cement to seal the slide sothesmear microscope so view his meet. You should focus the will be isolated. (A clear fingernail lacquer will do.) microscope for normal viewing and thenshow the prier how to °perste thefine-timing otljnottwneSty hooting Ar the WNW Prior to obtaining a Ise can focus k to hiseyes. Most patients will be specimen from the patient's, mouth you should lay antated at the quantity of Wade that have bean out the materials you will need to fix the smear. living in their mouths. Emotional's this sight wiU Thew preparations shoGld be made as follows: normally make a patient mote receptive of your a. Open the sterile wrap. counseling efforts. b. Place the contents at the upper right corner of the wrap. Left-handed persons use the left side. runless .(417lt c. Remove the glass slide and the glass c Iverslip from the gauze wrapping. Place the slide in the I. What purpose does the phase microscope serve center of the opened wrapper and put the cowslip during a preventive dentistry counseling? beside it. d. Affinip the bottles of saline and slide cement or lacquer m shown in figure 1-19 if ru are right- handed or at the left side if you are left-handed. 2. List the items needed for slide preparation.
Preprint the sneer. Now you are ready to get a specimen from each patient's mouth. Look for a red area in the mouth and take the scrapinp from the sulcus area to get anaerobic bacteria. Place the 4.4 instrument on the wrapper artfully so as not to ' dislodge the scrapings. The instrument may be "propped" on the cotton roll. Fax the smear as fo !lows: a Place a small drop of saline on the center of the glass slide, as shown in figure 1-20. b. Pick up the instrument with the smear on it. c. Immerse the tip of the instrument in saline drop. break up scraping, and let it float free (see fig. 1-21). d. Grasp the cover glass with the thumb and index finger in vertical position. e. Touch the bottom edge of the coverslip at the right side of the drop (or the left side, if left- Sore 1-22. %mafiosi.' dis covedip.
27
3 5. What should you show the patient concerning the operation of the microscope?
5o Ih2 6111 ideality sabjects that should hie dimmed derby a peeenaive destistry cesaseling. Oral Health Edecation. Preventive dentistr) ..14 vf3PfiLt4 counseling and/or oral health education is dependent upon achieving the patient's / participation and cooperation. To accomplish this. not only must you provide patients with the knowledge of what they can do to prevent oral disease. but you must also impress upon them the I. importance of doing it. in these preventive dentistry Figure 1.23. timing the uumslip against the counselings. stress the following by using simple words the patient will understand: u. Prevalence of bacteria. Explain that 3. Which area of the mouth will yield a specimen mkroorganisms are ever present in our of anaerobic bacteria? environment and that all people are continually infested with them from shortly after birth throughout lift. h. lkroontanismc and donut health. Explain 4. Briefly outline the steps required for preparing that there is overwhelming evidence that the smear. microorganisms play a definite role in tooth decay and periodontal disease.
: t , t 14;:rtlf t4t641 . .1811.11.1141141114211411 .0fP I, i ...Os, " A I t ,i3
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-; , .1.5:Y21r- rit 4:2 . -W S a e WT. .'41.41A0 . ,
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Figure I-24. Sealing the covershp.
28 323 Body Tube
Coarse Adjustor
Revolving Nosspiec
Fine Adjustor
Arm bjectives Stog
Mchanical Stag. Condenser Adjustment Diaphrapm Condenser Adjustor
Phos Level Adjustor
NMI Illuminator Illuminator Control
Figure 1-25. A phase microscope.
c. Home care. Emphasize to each patient that he patient is prior to the oral prophylaxisafter he has can help himself by exercising proper care at home. chewed a disclosing tablet and you have pointed out Explain that this includes the thorough removal of stained areas of the mouth. You have already all bacterial plaque at least once every 24 hours and gained most of the knowledge needed to give a eating a Alitable diet. (Show what is to be used and preventive dentistry counseling; however, you how it is to be used to cleanse the mouth.) should establish a close contact with your local preventive dentistry section to stay abreast of the d. Recommended items for proper home care. latest recommended brushing and flossing Urge the use of a small multituft brush with soft or medium bristles; urge the use of unwaxed dental techniques. floss or tape: and if the patient desires to use a dentifrice (toothpaste or powder). suggest he use one which contains fluoride.(Avoid Exercise (618): recommending brand names.) r. Professional care. Leave no doubt in the I. Identify the subjects that should be routinely patient's mind that while proper home care is a must discussedwithpatientsduringpreventive in maintaining dental health. it does not guarantee dentistry counselings by placing a checkmark exemption from dental disease. For this reason. in the spaces provided: regular (at least annual) professional care is also a necessity. a Dental therapeutics. b Need for professional care. An ideal time to have this discussion with the c The proper home care program.
29 329 *
Recommended brand name items for g The prevalence of bacteria. the home care program. h Slide preparation for the phase The role microorganisms play in microscope. dental disease. The proper use of items required in i The requirement for, and the . diet the home care prbgram. needed for, adequate nutrition.
I
3 3 0 , 30 CHAPTER 2
Dental Radiology
THE X-RAY was discovered by Wilhelm Konrad indicate the location of root tips that have frachired Roentgen in November 1895 in Wurzburg, off during an extraction procedure. They also may Bavaria. The use of X-rays in the field of dentistry be used to verify the complete removal of such root was first advocated by Dr. Edmund Kells in 1896. tips. Since then the use of X-rays in dentistry has gradually increased until an X-ray examination now plays a prominent part in most diagnoses of Exercises (619): dental disorders. This. naturally, demands much of I. What oral areas may dental officers employ X- you in the field of radiography. rays to view? 2-1. Radiology Principles
Quality radiographs must be produced 2; How may a dental officer employ radiographs consistently for the dental officer to have the best to aid himself in cases involving periodontal diagnostic film possible. You must have a thorough understanding of the principles of radiology to disease? perform the various X-ray exposure examination techniques accurately and carefully. Additionally, since X-radiation can be dangerous, it is important 3. How may the dental officer employ that a good diagnostic radiograph be produced each radiographs in the endodontic section as a time to avoid unnecessary (additional) exposure of treatment aid? the patient.
619. State various ways in which radiographs are employed in tbe practice of dentistry. 4. How may the oral surgeon use radiographs u a Use of Dental Radiographs. Radiographs play treatment aid? an important role in diagiosing dental ailments. The radiograph allows the dental officer to view areas of the teeth and the surrounding structure that cannot be seen in a mouth mirror and explorer examination. Through the use of radiographs the 620. Given a list of statetnents that relate to the dental officer can both diagnose caries and various properties of X-rays, match them to the determine how far they have progressed. Cysts, appropriate property. abscesses, and impacted teeth can also be identified on radiographs. Periodontal disease involving bone Properties of X-Rays. The exact nature of X- loss can be seen, and the progression of this disease rays is not totally known. X-rays are thought to be can be closely followed. Radiographs also are used discrete units of energy called quanta or photons. as a preoperative or postoperative record. They travel with a wave motion similar to light or In some treatment areas, radiographs are used as radio waves and at about the same speed (186,000 a treatment aid. For instance, in the endodontic miles per second). The wavelength of X-ray, section the dentist often requests radiographs to however, is extremely short, as it is only about one help him determine if he has reamed and filed the ten-thousandth that of visible light. In units that you root canal to the proper length. Additionally. he can visualize easier, the X-ray wavelength is normally requests a postoperative radiograph to appoximately one-billionth of an inch. Itis this assure that he has properly filled the root canal. In extremely short wavelength that enables X-rays to oral surgery radiographs are sometimes used to penetrate many substances. Let's discuss this
31 332 GLASS ENVELOPE FILAMENT \ ANODE CATHODE a
WINDOWTUNGSTEN TARGET FOCUSING CUP
ELECTRON CUP
.. .111... .41 TARGET e::::..11...... 111.-- i - 4. .111 ANODE(+) CATHODE(-)
.. X-RAYS Figure 2.1. Production of X.rays. qt penetrating effect plus a few more of the effects of the visible spectrum, and the crystals are said to X-rays. fluoresce. This property is used in diagnostic work Penetrating effects. When X-rays pass through to give a rapid X-ray examination with the use of a different substances, they penetrate in varying photographic plate. The degree of fluorescence is amounts and degrees, depending upon the dependent upon the amount of X-rays striking the wavelength of X-ray employed, the density of the crystals. This is the principle used in the substance being radiated, and the distance from the fluoroscopic apparatus. target to the substance. Scientists have found that Biological effects. Living cells are sometimes the penetrating quality of X-ray will vary inversely destroyed when subjected to X-radiation. This with the wavelengththe shorter the wavelength, the biological effect may be employed to destroy greater the degree of penetration. undesirable cell growths in the human body: for Photographic effects. When X-rays are allowed to example, cancer. X-radiation is also used in the fall on a photographic film, the film chemicals will treatment of certain skin diseases. Germ cells may be changed. Upon developing, the film will appear also be altered, which can cause birth defects. This in varying shades of gray, depending upon the fact is the main concern in safety practices in using amount of X-rays reaching it. Since X-rays travel in X-radiation. straight diverging lines, they can be used to record Ionization effects. When X-rays pass through air the densities of various parts of the human body on or matter, ionization takes place. Ionization means a photographic film in the form of a shadowpicture the atoms are altered to become either negatively or or a radiograph. These densities arefrequently positively charged. This property enables experts to varied due to pathosis, and therefore, some measure the quantity of radiation producedby pathological conditions can be detected with the aid measuring the ionization (electrical charge) of the of the radiograph. air through which the radiation passes. Fluorescent effects. When X-rays are allowed to Exercises (620): fall on certain chemical crystals, such as calcium tungstate, the X-rays are changed to light waves of Identify the properties of X-rays by matching the
32 332, r items in column B to the appropriate term in During this transition from cathode to anode, column A. high speed and kinetic energy are imparted to the - electrons. Upon reaching the anode, the electrons Column .4 (Wiunn H are suddenly stopped as they impact against the tungsten target. During the stopping period, the I Speed of 'Ways. a.Tbe special effect X.rays 2 Fluroescent effect. have on certain chemical electrons must give up the kinetic energy. The 3. Biological effect. crystals. such as CalCIUM energy reappears, or is converted to X-rays and 4 Penetrating effect. tungstate. heat. The bulk of the energy liberated at the anode 5. Photographic h.The property that enables is heat, with the remainder (about I. percent) effect. experts to measure the appearing as X-rays. The tungsten target is set in the 6 Ionization effect. quantity of radiation. C. The degree of this effect is copper head at an angle that directs the X-rays out determined by the the glass window of the X-ray tube. wavelength of the "Ways. To permit maximum acceleration of the dAbout the same as that of electrons, the glass enclosure of the X-ray tube is isible light. 'e.The effect X.rays have on under a high degree of vacuum. If a good vacuum is 'radiographic film not present. unwanted atoms and electrons move IThe main concern tor around within the glass tubing. This will cause safety practices when using sparking: a gas discharge will take place inside the X.radiation. tube when current is passed through it, snd few, if any, X-rays will be produced. The electron stream across the X-ray tube constitutes the tube current. This current, which is small in magnitude, is generally expressed in 621. Name the components of the X-ray tube, milliamperes (mA). One milliampere is 1/1000 and by answering a series of key questions, tell ampere. CUITaltS upward to 1,000 mA are used how they function to produce X-rays. with modern X-ray tubes. The voltage across the anode and cathode is relatively high and is Production of X-Rays. The production of X- measured in kilovolts (kV). One kilovolt is 1,000 rays occurs when high-speed electrons strike volts. matter. In order to effectively produce X-rays, an The X-ray wavelength of the emitted radiation electric current of high voltage must be applied and varies from a certain minimum to very long. The passed through the X-ray tube. The tube consists of wavelength is governed by the amount of voltage two terminals, one positive and one negative. The applied to the X-ray tube. X-rays produced by low cathode or negative terminal has two principal voltage are of longer wavelength and have low parts: (1) a tungsten filament. around which is penetration. They are often referred to as soft placed a (2) molybdenum cup that focuses the radiation. X-rays produced by high voltage are of cathode rays on the anode. The anode or positive shorter wavelength and, therefore, have high (1 ) the tungsten target terminal has three parts: penetration power. These rays are referred to as upon which is located the focal spot where the hard radiation. cathode rays are directed. (2) a copper head into which the tungsten target is set. and (3) a copper Exercises (621): stem that extends to the outer end of the anode arm. The copper head and stem serve to dissipate the 1. Name the two terminals of the X-ray tube. heat created during X-ray production. These components are encased in a glass envelope, which forms the outer shell of the X-ray tube. (See fig. 2- 1 .) The tube itself is located inside the X-ray tube 2. Name the parts of the X-ray tube's positive head. In addition to containing the X-ray tube. the terminal. tube head also contains an oil or a gas that serves as an insulator for the heat created during X-ray production. Although the production of X-rays is as rapid a 3. Name the parts of the X-ray tube's negative process as turning on a table lamp, there are two terminal. independent actions that occur. First, low voltage current heats the tungsten filament of the cathode terminal to incandescence; as this occurs, a cloud of 4. When does a cloud of electrons form around electrons forms around the tungsten filament. Next. high-potential (voltage) current is passed through the tungsten filament? the X-ray tube. This propels the electrons toward the tungsten target at a very high rate of speed.
33
333 5. When are the electrons propelled toward the cellular change in tissues and organs exposed to tungsten target at a high rate of speed? even safe quantities of radiation. As long as the b9dy is functioning properly, most cells will regenerate themselves and become normal again. This regeneration does, however, take time, and if 6. What occurs as the electrons impact upon the another dose of radiation is applied shortly after the tungsten target? first dose, more cellular change (cumulative) will occur, If this additional cellular change is great enough to impair the function of the organ or tissue, repair or regeneration may not be possible. 7. What condition inside the X-ray tube permits Though the cumulative effects present a danger to the maximum acceleration of electrons? the patient, they probably present a greater danger to the technician because he spends day after day in the exposure room. It is always wise, however, to question the patient and find out if he has recently 8. What current is measured in kilovolts? been exposed to any type of radiation about the head and neck area. If quite a few exposures have been made within the preceding 30-day period, it would be best to consult the dental officer before 9. Describe the X-rays produced by high voltage. proceeding with any further dental X-ray exposures. For you to understand the need for proper safeguards against radiation, it is necessary that you understand the types of radiation produced by the X-ray equipment and the factors that 622. Given a series of statements concerning the influence the dose. The types of radiation produced hazards and types of X-radiation determine during a radiographic examination are: This radiation is the which are true and which are false. (I )Primary radiation. useful beam; it comes directly from the focal spot Hazards of Radiation. The most important on the anode target of the X-ray tube. consideration in the field of dental radiography is (2)Indirect radiation.This is radiation coming adequate protection for the operator and patient from parts of the X-ray machine other than the from the hazards of radiation. X-radiation is an focal spot. It may come from the tube housing and invisible, odorless, and soundless form of energy head assembly of the machine. Itis sometimes that can inflict injury and death to body tissues if referred to as leakage radiation. the proper precautions are not observed. While we (3)Secondary radiation.This is radiation would exercise expeditious action to remove emitted by any substance through which X-rays are ourselves from the path of a speeding locomotive, passing. It consists of longer wavelengths coming this self-protective instinct is not always observed from the X-ray tube and housing and from the soft with X-radiation. Since X-rays are not apparent to tissues of the area being radiographed. It may the senses, inexperienced technicians have a sometimes be referred to as a scattered radiation. tendency to overlook their potential hazard. This tendency is extremely dangerous, since X-rays Exercises (622): possess the same potential hazard as that speeding locomotive. X-rays, if improperly used, can Identify factors concerning the hazards and types of severely and irreparably damage vital body organs, radiation by circling either the T or F to indicate cause genetic mutations, and result in the loss of whether the following statements are true or false. human life. Many of the early pioneers of T FI. The most important consideration in the radiography lost their lives learning the hazards of field of dental radiography is obtaining X-rays. Some modern day radiologists and high-quality diagnostic radiographs. technicians have lost their limbs or their lives T F2. Massive overdoses of X-ray produce because they were irresponsible and didn't bother about the same harmful effects as to follow the proper safety practices. Carelessness sunburn. and indifference on the part of the technician is the T F3. Carelessness and indifference on the part most common cause of overexposure to X-rays. of the technician is the most common -In theaveragedental radiographic examination. cause of overexposure to X-rays. the amount of radiation received by the patient is T F4. Inexperienced technicians have a quite small and only a fraction of the harmful dose. tendency to overlook the potential The effects of radiation are. however,cumulative. hazards of X-rays because the X-rays are This cumulative effect of X-rays can be extremely not apparent to their senses. harmful. For example, there is a certain amount of T 5. The cumulative effects of radiation are 34 331 important since two normally safe doses (9) Care must be exercised in moving the tube of radiation applied within a short time head to and from the working area. Avoid striking span can together equal a harmful dose. the tube head against the dental unit, wall, or other T F6. The type of Kadiation emitted by structures. Damage to the tube head could result in substances through which X-rays are leakage of radiation. passing is called indirect radiation. T F7. The useful beam is classified as primary As mentioned in the preceding paragraphs, the radiation. film badge must always be worn (at chest level) by personnel working in the radiography section. The badge is worn at chest level to measure whole body 623. Explain the safety practices and equipment radiation. This film badge is part ofa radiation ,features related to protection from overexposure monitoring program designed to protect personnel by X-radiation. working in certain radiation areas. The badge worn Protection from Overexposure by X-Ray. in the dental radiography section contains special There are certain safety practices that must be films that provide a permanent record of X- observed by the operator to insure proper radiation received by personnel working there. If protection from overexposure by X-rays. The you are assigned to the radioaraphy section, be sure recommendations for proper protection against all to wear the provided film badge became it is for types of radiation should be followed closely. xner protection. Certain protective measures are built into exposure The film badge consists of a plastic case (usually rooms, such as the adequate shielding of the walls blue in color), which is slightly larger and thicker and doors to prevent X-rays from passing through than a book of matches. The badge contains one or them and exposing personnel in adjacent areas. The two film packets that are approximately the size of safety measures we discuss in this section are those dental periapical film packets. An alligator-type over which the operator has control: clip is provided on the back of the film badge. This (I) The operator must be in the proper position clip makes it easy for you to attach the film be* to during exposures. This includes standing away from the outer part of your uniform. the tube head, out of the line of the useful beam, Personnel from the environmental health section and behind an adequately shielded protective collect these film packets at predetermined intervals barrier. (usually monthly) and forward them to the USAF (2) Personnel working in the dental radiography section must wear a film badge (at chest level). Each film badge is issued by the environmental health TUNGSTEN section. and each film badge is for use only by the TARGET individual in whose name it was issued. (3) Protective clothing, such as a leaded rubber apron, should be worn by patients receiving multiple exposures. (4) The X-ray film should be held by the patient LEAD or a mechanical film holder while the exposure is DIAPHRAGM beina made. The film should never be held by the dentist or the technician. A parent or guardian should hold the film for small children who are unable to hold the film in place themselves. (5) The tube and head assembly of the machine should not be held by hand during exposures. (6) The door of the exposure room should be closed when radiographs are being exposed. This is done to protect patients and coworkers in areas near the exposure room from unnecessary exposure to radiation. (7) The number of exposures of a particular patient should be held to a minimum, consistent with the diagnostic requirements. In other words. SKIN don't take exposures that are not necessary. SURFACE (8) Repeated radiographic exposures using human patients to develop a technique or for practice must be avoided. Commercially available shields, such as the Dexter IL should be used for LI this purpose. Figure 2-2. Collimation.
35 Radiological Health Laboratory, Wright-Patterson radiation, which would normally be absorbed by AFB, Ohio, for evaluation. There, the films are the patient's soft tissues and which is not of any developed under carefully controlled conditions diagnostic value. Be sure not to remove the and evaluated. If abnormally hies radiation dosages aluminum filter as it serves to protect the patient are detected, a message so stating is hurriedly from useless radiation. i dispatched to the originating environmental health Collimation. Collimation serves to limit the area section. Such a message usually triggers a of exposure on the patient. It is accomplished by comprehensive investigation. Dosages considered use of the lead diaphragm, which is usually located to be normal are recorded and forwarded quarterly. just in front of the aluminum filtration disk. The film badge should be worn at all times when Without this diaphragm, radiation emerging you are working in the radiognphy section. You directly from the tube head would expose an area should not, however, wear the badge outside the approximately 6 inches in diameter at the patient's dental clinic. Instead, you should always place your skin surface. This must be reduced, by collimation, badge in the designated safe-storage area. This is an to an area not more than 23/4 inches. Through area located in the dental clinic that is free from collimation, the X-ray beam is restricted to cover exposure to direct sunlight, radiant heat, or other only the area of interest. Resultantly, unnecessary types of radiation. Exposing a film badge to direct exposure to the patient's throat and eye areas is sunlight, radiant heat, or other types of radiation drastically reduced. (See fig. 2-2.) A recently could affect the highly sensitive films used in the developed lead-lined rectangularly shaped pointer film badge. Therefore, it is to your advantage to tube is also available to further reduce the area of wear and store the film badge as we have indicated. exposure at the patient's skin surface. Carelessness on your part may result in a waste of time and expense in an investip,ation, not to mention possible endangerment to your own health Exercises (6231: because of an undetected overdose of X-radiation. In addition to the safety precautions you must 1. What safety feature is built into the exposure observe when exposing radiographs, the room? manufacturers of modern X-ray equipment provide some built-In safety features. These features offer additional protection by means of filtration and collimation. Although most modern X-ray units are 2. Where should the operator stand during X-ray adequately equipped with these built-in devices, exposures? 4) often they are removed by technicians who are not familiar with them. Let's discuss filtration and collimation and see how they provide protection. Filtration.Filtration is an important element in 3. What protective clothing should be fitted to the control of the emerging radiation. Inherent patients receiving multiple exposures? filtration is the amount produced by the X-ray tube enclosure itself and is expressed as an equivalent thickness of aluminum. An additional aluminum disk is usually located where the rays exit the tube 4. When, if ever, is it permissable for the X-ray head. This is done to increase the total filtration of mchnician to hold the film in position, for the the useful beam to at least 2.5 mm of aluminum. patient, during an exposure? The inherent filtration along with the aluminum disk serve to absorb poor quality long wavelength 5. Why should the door of the X-ray room be closed during exposures?
6. What should be used. in place of human patients, to develop or practice radiographic ; techniques?
OM. 7,*-1! : \ szido""-.-" 7. Why must you avoid striking the X-ray tube head against the dental unit, walls, or other 0 Figure 2-3. Types of radiographic film objects?
36 8. Why is the X-ray film badge worn at chest ;. k level? 1"-tt .1 >rt.*
. ..se4 9. What action occurs if the USAF Radiological Health Laboratory detects abnormally high radiation dosages on a packet from a film badge? Fore 24. Comma of the film peek.
10. Why shouldn't you wear the film badge outside commonly used. It is used to radiograph the the dental clinic? crowns. roots, and supporting structures. The periapical X-ray film has an embossed dot on the tube side of the film to permit identification of the lingual aspect of the image. There is a printed dot II. How does filtration protect the patient from on the film packet which corresponds with the useless radiation? embossed dot on the film. When you make an exposure. be sure that this printed dot is toward the occlusal or incisal surface of the teeth. This is to insure that the embossed dot is not superimposed 12. How does collimation protect the patient from over the apical region of the teeth. unnecessary radiation? Ditewins film. The interpzoximal, or bkewing, film is used principally to locate cavities on the interproximal surfaces of the teeth. It permits viewing of the crown portion of the tooth and a small area of the root. To hold the film in position, the patient's teeth close on a tab which is attached to 24 Dental Radiographic Film the film packet. Oahu& film. The occlusal film is a larger film Radiographic films are available that have the that is placed horizontally between the occlusal characteristics needed to produce a diagnostic surfaces of the upper and lower teeth. The occlusal radiograph. The inherent characteristics of the film is occasionally used to obtain a general view of films include satisfactory speed. desirable contrast. the maxillary or mandibular arch. This type of film and convenient size. In addition, the films allow is especially useful in aiding the dentist to locate sufficient latitude to compensate for small errors foreign bodies in the floor of the oral cavity and made in exposure time and the X-ray absorption of impacted teeth, cysts, etc, in the palate. There are the area being radiographed. The film also permits usually two films in the occlusal packet, which unavoidable fluctuations in the current to the X-ray allow for different developing times. By using machine without affecting the completed different developing times you can provide the radiograph. Because of the various oral structures dentist with two different film contrasts: one for to be viewed, different types of radiographic film hard oral structures and one for soft oral tissues. must be used. Pedodontic film. Pedodontic or "Pedo film," as it is commonly referred to, is a smaller version of the 624. Name the types of dental X-ray filo aad periapical film. It is used to obtain periapical-type state their chancteristies. radiographs of children or adults with an extremely small mouth. Types. Radiographic films are made in different Extra-oral films. Extra-oral films are used to sizes to be used in making the two general classes of obtain a panoramic view of the oral structures and dental radiographs: intra-oral and extra-oral. Intra- to view specific facial bones, sinuses, or the oral radiographs are made by placing the film temporomandibular joint. Extra-oral films must be packets inside the mouth: these require small films. loaded into cassettes prior to use. A cassette is a Extra-oral radiographs are made by placing film hinged. lightproof aluminum box that contains two holders or cassettes adjacent to the head or face and intensifying screens, which fluoresce when exposed directing the X-says through the area being to X-rays. The screens light up and produce a more radiographed. Larger films are used in making intense exposure of the film without requiring an extra-oral radiographs. Refer to figure 2-3 as we increase of exposure time. Extra-oral films may be discuss the individual film types. used to supplement the finding of periapical and Periapical film. Periapical film is the film most occlusal radiographs. They are valuable in the
37
33 7 diagnosis of dislocations of the Mandible, impacted backing in the film packet prevents secondary teeth, malignancies, foreign bodies, sinus radiation (which scatters from the oral tissues) from involvements, and fractures. fogging the film. Geseral asarseterissles. Radiographic film Unlike intra-oral film. extra-oral film is not consists of a transparent, cellulose base coated on picketed in individual lightproof and waterproof one or both sides with an emulsion. The emulsion is packets. Therefore, the individual sheets of film composed of silver halides in gelatin and is very must be removed from the packaging container and sensitive to both X-rays and light. When the film is loaded into cassettes in the darkroom. exposed to X-rays, the energy from this exposure is X-ray films must be protected by proper storage. stored in the emulsion. This produces what is called These films must be kept in a cool, dry place. or a latent image. However, this image cannot be they will deteriorate rapidly. X-ray film should detected by ordinary physical methods and must be never be kept near steam lines or radiators. An ideal immersed in certain chemicals to produce a visible place for the bulk storage of X-ray film is in a image. The image becomes visible when the refrigerator. Additionally, many chemicals affect developer solution causes a chemical reaction and films adversely. Therefore, never store the films transforms the exposed silver halides into a black near areas where drugs are kept. because exposure metallic silver. The amount of silver suspended in to the vapors usually present in such places may the emulsion produces different shades on the result in decomposition of the film. Since films are processed radiograph. These shades may vary from sensitive to X-rays, they must be kept in lead-lined gray to black. Areas not exposed to X-rays will contairiers if stored in or near the exposure room. appear dear. When several films areto be exposed, they should The various types of film have different speeds. be taken one at a time from the dispenser. exposed. This means that they vary in their sensitivity to X- and dropped into a lead-lined receptacle. This rays. This sensitivity affects the amount of exposure protects them from being affecrA by secondary time and the detail of the completed radiograph. radiation. The two speeds of film used by the Air Force are Boxes containing extra-oral Alms should be intermediate (medium fast type B) and ultraspeed stored so that the films are standing on edge and not (super type D). The manufacturers of the different lying flat. This method of storage will prevent them films use their own trade names to identify each from being pressed together. A minimum film stock sPeed should be maintained. The oldest film should be Film used for intra-oral radiographs is supplied used first so that the film stock will always be fresh in packets of different sizes. The outside of these and will not exceed the exposure limit date. packets is both lightproof and waterproof. Inside the packet, the film is sandwiched between black Exercises (624): protective paper, and this in turn is backed by lead foil. (See fig. 2-4.) The packet is pliable enough to IWhat type of dental X-ray filmis most be contoured to the correct position in the mouth, commonly used to view the crowns, roots, and yet firm enough to resist excessive bending that supporting structures of the teeth? would distort the radiographic image. The lead foil
Illsacting Plan* 2. How should the embossed dot on the periapical film packet be positioned when you are making Central Rays an exposure? Why?
4. 3. What type of film is used principally to locate cavities on the interproximal surfaces of the teeth?
4. What type of view is the occlusal film used to obtain?
Short Con* tschniqua 5. Why are there usually two films in the occlusal Figure 2-5. Short cone technique. film packet?
38 3 / S 6. What name applies to the smaller version of the '01° periapical film?
7. What may extra-oral films be employed to viev4
8. How do the intensifying screens in a X-ray cassette function? ^ rim 24. The data X4sy oak. 9. What is used to coat the transparent cellulose base of the X-ray film? 24 Exposing the Radiographs There are two techniques for exposing intra-oral 10. What is produced when X-rays strike the film's radiographsthe long cone technique and the shon emulsion? cone technique. This section disarm both of these techniques plus tbe techniques used to obtain extra. oral radiographs. Our discussion begins with the short cone technique. 1 I . What must be done to make the latent image on the X-ray film visible? i2S. State the principle f the short cone radiographic techoicie and Wks** the target- film dietaace it employs. 12. What are the two speeds of dental X-ray film Short Cone Technique. The short cone stocked by the Air Force? technique is often referred to as the Wading angle technique. The principle of the short cone technique is to direct the X-ray beam perpendicular to an imaginary plane that bisects the angle formed 13. Describe the construction of an intra-oral film by the recording plane of the film and the long axis packet. of the tooth. This principle is shown in figure 2-5. As the name implies, when you are using the short cone technique, the short noes cone must be in place on the X-ray tube head. This nose cone serves 14. What is the purpose of the lead foil backing in as a pointer, and its tip is positioned against the the film packet? patient's skin surface during exposures. Some manufacturers supply a short tube in place of the cone. When properly positioned, the tube head establishes a target-film distance of about 8 inches. 15. Why must extra-oral film be removed from the This means that the distance between the tungsten packaging container and loaded into cassettes target located in the tube head to the film in the patient's mouth should be approximately 8 inches. in the darkroom? Maintaining proper target-film distance is important because variations will alter the X-ray unit's collimation and will also change the required 16. Where should X-ray film be stored? exposure time. Exercises (625k 1. What is the principle of the short cone 17. In what position should boxes containing radiographic technique? extra-oral film be stored?
39 33,9 2. What is the targetfihn distance employed with electromechanical. and electronic) are employed the short cone technique? for this important function. Follow the instructions for setting kVP, mA, and exposure time as prescribed by the manufacturer of the specific film 4 you are using. 3. How is the proper target-film distance established? !Undies (626k I. When should you set the unit adjustments and check its operation?
4211. Name the unit adjustinests needed to proem short cone radiesraphs, indicate who 2. What machine adjustments govern the quantity hese adjustments tootrol, and state when the of radiation produced? adjustments should be made.
Unit Adkjustments. There are a number of steps used in producing radiographs with the short cone 3. What machine adjustment controls the-quality technique. Let's begin by adjusting the X-ray unit. of the radiation produced? You should set the unit adjustments and check its operation prior to patient entry. This machine adjustment includes those items that are checked to insure proper operation of the Xray 4. What guidance should you follow when setting unitkilovoltage, milliamperage, and timer the kVP, mA, and exposure time? controls. (Ste fig. 2-6.) As you check your unit, make sure that itis plugged into the electrical outlet, that it is turned on, and that the kilovoltage and milliarnperage are at the settings required by the technique. Kilovoltage and milliamperage control the quality and quantity of the radiation. 627. Ideality the planes dream. and describe the proper patient position for short come Kilotokage. Kilovoltsge (KVP) is the pressure rildloirtaPh that forces the electric current through the circuit much like the pressure in a garden hose. It governs Patient Position. To produce a diagnostic the speed at which the electrons travel between the tsdiolseph.'you must require the patient to use a cathode and anode. This speed determines the fixed head position. In order to achieve the correct impact velocity of the electrons and therefore the head position for the patient, you must be familiar wavelength of the resulting radiation. Because the with the three planes of references which are listed shorter wavelength radiation (as produced by high below: kilovoltage) has more penetrating power, it is Median sagittal plane: an imaginary vertical considered to be high-quality radiation. line through the center of the body which divides it Milliamperage. Milliamperage (mA) is the into right and left halves. amount of electricity tbs.: is applied, much like the Ala-tragus line: an imaginary straight line amount of water carried by a garden hose. With from the als (or wing) of the nose to the tragus (the higher milliamperage, more electrons impact upon lobe in front of the opening of the ear). the tungsten target of the anoae. This, of course, Tragus-corner of the mouth line: an imaginary governs the quantity of the radiation. Another straight line from the tragus of the ear to the corner machine setting that controls the quantity of of the mouth while the teeth are in a closed radiation is the exposure time. position. Exposure time.Thetimingof the period during For bitewing exposures, and for periapica! which the X-ray tube emits X-rays is accompfished exposures of the maxillary arch, the patient should by special timing and switching circuits. In dental be seated so that themedian sagittal planeis vertical radiography, exposures rangt from a fraction of a and theala-tragus lineis parallel to the floor. For second to several seconds. The timers on some X- periapical exposures of the mandibular arch, the ray equipment are calibrated in impulses. These median sagittal planeshould be vertical and the impulses represent fractions of seconds; usually I tragus-corner of the mouth lineparallel to the floor. impulse equals one-sixtieth of a second. The When you position the patient in this way, the modern trend is to reduce exposures to a minimum occlusal plane of the arch being X-rayed is parallel time. Timers of various types (mechanical, to the floor when the patient's mouth is open.
40 3 4 I) Enerdses MU of the film packet is necasary if distortion Of the40 images is to be prevented. Because of the variation Identify the planes of references in items I thru 3 by in the anatomic structure of the patient's mouth, it matching the description in cohimn B to the correct term in column A. is often necessary to flex or mold the film pocket to make it easier to position. Do not crisnp or bend the Gloom A cohann tt film sharply as this could crack the film's emulsion or distort the radiographic imp. In placing the I. Tragus-corner of a. An imaginary line from film packet in the patient's mouth, you must the Mouth line. the wing of the note to the consider several points. Place the film in.poskion. 2. Mediae sagittal lobe in front of the ear One. °MOM Do not slide it oar the macs membrane into 3. Alamipis We. b. An imaginary vertical line position, since this may cause the patient to gag. that divide the body into Center the packet behind the teeth to be ribbt and left halm radiographed. The long axis of the film packet C. An imaginary line fmm the corner of the mouth to should be in the vertical position when the lobe in front of the eat radiographing anterior teeth and horizontal when 01Polilli. radiographing posterior teeth. Extend the film's edge about one.fourth inch beyond the biting surfaces of the teeth. This insures recording the whole crown on the radiograph and creates a slight 4. How should the patient be positioned for short border that allows the film to be mounted without cone periapical exposures of the mandibular obstructing the dentist's view. Ptevent movement by arch? retaining the film in position through use of the patient's finger or thumb. Have the patient press the film packet firmly against the teeth being radiographed. The operator must never hold the 5. How should the patient be positioned for short film in place himself. Before milking the exposure, cone bitewing exposures or exposures of the instruct the patient to relax as much se poesible maxillary arch? without changing the position of the film pocket or the patient's head. Relaxation of the patient will prevent movement during the exposure. There is no way that the finished radiograph will show what you wanted it to show unless you place WA Answer a series of key **aloft that serve the film in the correct area of the mouth. You just to describe procedures Involved in the placement can't place the film behind the molars to expose the of data radiographic film. bicuspids. The following teeth should be shown by these individual exposures: Periapial IFIlm Placement. Proper placement Molarshows the second and third molars. Bicuspidshows the first bicuspid, second --0 bicuspid, and tht first molar. Cuspidshows the cuspid and the lateral incisor. . Incisorshows the central incisors and lateral incisor.
If you place the film correctly, most of the teeth will appear on two different exposures. Don't bend the film excereively because this causes distortion of the image. /0 / Even if you are assigned to the dental / radiography section for only a brief period of time, you will undoubtedly encounter a gagging patient. Although such patients can present quite a problem, they need not always cause undue alarm. A few counteractions have proved to be at least partially effective in reducing the severity of the gag reflex. In some cases, counteractions have completely eliminateft the tendency to pg. Without suuesting Figure 2.7. Vertical angulation. the most or least effective, we offer the following
41
312 CORRECT HORIZONTAL ANGLE
Fiore24. Horizontal ansulatton. counteractions for your possible use when making 2. Why shouldn't you bend the film packet radiographs on the gagging patient: sharply? (I) Before you attempt to position the film in the patient's mouth, try coating the patient's uvula and soft palate with a spray-type anesthetic. (2) Simply ask the patient to breathe through his 3. Wlty is it important to place rather than to slide nose instead of his mouth. You might also ask the the Mm into position? patient to hold his breath during the exposure time for each film, (3) Placeaninteresting(noncontroversial) painting, photograph, or other object in view of the 4. How should the film's long axis be positioned patient and ask him to concentrate intensively upon for radiographs of posterior teeth? the object during film exposures. (4) Ask the patient to close his eyes and concentrate upon a pleasant subject. (5) Suggest the patient mentally count 5. How is the periapical film packet retained in backwards by staining at 100. position during exposures?
A gag reflex is a psychological defense mechanism. Do not add to this by telling the patient, "You are a easier," or "I'll try not to pg you." Just try one of 6. Why should you extend the film's edge about the ideas we have given you above and don't give one-fourth inch beyond the biting surface of the patient a suggestion that may trigger his gag the teeth? reflex. Mewing Flits Placement. Like the periapical film packet placement the bitewing film packet is also centered behind the teeth being radiographed. 7. List the teeth which should be shown in each of As you place the film in the patient's mouth, direct the following radiographic views: the wing or tab toward the patient's cheeks. Once a. Molar. b. Bicuspid. c. Cuspid. d. Incisor. the film is in position, have the patient bite down firmly on the tab to hold the film in position during the exposure. Caution the patient to keep his teeth closed together until after the exposure has been 8. List five counteractions that may be effective in made. reducing or eliminating a gag reflex.
Exercises (6211
I. Why is it often necessary to moldor flex the 9. Why shouldn't you tell the patient, "You are a film packet? gagger," or, "I'll try not to gag you"? 421 4 0 .A./ 10. How is the bitewing film packet retained in position during the exposure? (I 629. State the effects of vertical and horizontal angulation and indicate where the central ray should be projected.
Tube Positioning. The X-ray tube and film must be aligned in such a way that the positioning will !it .: .. 4.____.41L fA
. .-
s1... I 'is,
., `'is,'
SONGS T US o S. Z OS OP TOOTS . I I , 111$11C TINGIP tSII / *:`,.....-
SSIII OP MAXILLARY do ... 001411.P I SZe CUSPID VI1110111 AN1111.11 OPP SO /ICS ION AS. 45. OCC AAAAA tPoll \. Figure 2-10. Maxillary cuspid.
preclude or at least reduce distortion that would otherwise occur in the image. Three factors are involved in the tube positioning. They are the vertical angulation, horizontal angulation, and projection of the central ray. Let's first discuss the vertical angulation. t ClooGotoo0o oot A 1 0 SOP Toot. Vertical angulation. The greatest difficulty the Io SIC Shooot 1.1 Air operator will have is producing a film image that is -.AA.... the same length as the teeth involved. This is controlled by the vertical angulation. Probably the easiest way for you to understand the effects of vertical angulation is to compare it with a shadow MAX IL LAR Y that the sun casts or projects onto the ground as it toot co DONT s s sr CENTRAL strikes an upright object. If the sun is low in the sky, INCISOR the object's shadow is considerably longer than the AAAAA GO PO Ott 0 z0 o IC fop.' object; this effect is called elongation If the sun is OCCIAISt 1. oof high in the sky, such as at noon, the object's shadow is much shorter than the object; this effect is called foreshortening. (See fig. 2-7.) Similar to the shadows 41 Figure 2.9Maxillary central incisor projected by the sun, in radiography we are faced 43
313 elongated imagewill be produced on the film. To overcome this difficulty, project the rays at the imaginary line which bisects the angle formed by the long axis of the tooth and the recording plane of the film. (See fig. 2-5.) Horizontal angulation. Projecting therays parallel with the interproximal spaces of theteeth and at right angles to the film will prevent overlapping and will show a distinct image of each tooth on the film. This principle is illustrated in figure 2-8. Notice that the diagram shows how the -Ali:40i 114 central ray (CR) is to be aimed. Two methods may be employed on each patient to obtain proper :e horizontal angulation. For the anterior teeth, use V. the sighting method by standing behind the tube head and sighting down the cone. For posterior teeth, use the paralleling method. Align the face of the tube head so that it is parallel with the edge of the film.
tO.Groveaot 1111 OP tOOIN
/Da
Figure 2-11. Muilluy bicuspid. trst., with the task of projecting the tooth's image onto ; the film. And, furthermore, we must project it in such a way that the size of our radiogaphic image is the same size as the tooth. This, as we said earlier, is controlled by vertical angulation. Too much verti- cal angulation and we have a foreshortened im- agecoo little, an elongated image. Ideally, the film should be parallel to the tooth, and the rays should be directed at a right angle to the long axis of the tooth. In the 8-inch, short cone technique, however, the tissue structure and the shape of the oral cavity cause the film to be farther from the tooth root than it is from the crown. This produces an angle between the tooth and the recording plane of the filmmuch like the angle between the upright object and the ground (recording plane) we used in discussing the sun as the projecting force. If the rays are then projected at a right angle to the long axis of the tooth, an Figure 2.12. Maxillary molar. Projection of the central ray. Even when you centered on the ala-tragus line below the know the angulation to apply to the cone, it is outer angle of the eye and below the zygoma. difficult to know exactly where to center the cone. For the bicuspids, the cone is centered below The projection is a problem because the film packet the pupil of the eye. and the teeth are covered by the cheeks and lips. For the lateral incisor and cuspid, the cone is For this reason, imaginary lines are projectedon centered at the ala of the nose. the face of the patient to help you in positioning the For the central incisors, the cone is centered cone. through the tip of the nose. For the upper jaw, the ala-tragus line5 used. Points are laid out on this line below anatomical For the lower jaw, an imaginary line is projected landmarks to aid you in projecting the central ray. one-fourth inch above the lower border of the The following points are for use on the upper teeth: mandible from the angle to the symphysis. The For the upper molars, the tip of the cone is points at which the cone is directed on the lower jaw are immediately below those described for the corresponding teeth of the upper jaw. After the film and cone are properly positioned, the exposure is made by simpl depressing the exposure button.
:rigid,: Exercises (629) I. What is the result of too much vertical .449:i angulation?
2. What is the result of too little vertical angulation?
3. How should the central ray be projected to obtain a radiographic image that is the same size as the tooth?
.. 4. What results from improper horizontal angulation?
5. On what imaginary line should the cone tip be _./ positioned for maxillary exposures?
OCC t I 6. On what imaginary line should the cone tip be
GI ..G%1 positioned for mandibular exposures? 0/ 011C
PtP. IOP In items 7 through 10 indicate what anatomical 010*% PI, we point in column B is used as the reference point for the radiographic view listed in column A by MA NDISUL A I matching the point in column B to the view in CENT NAL column A.
INCISOR (;dumn CIwnn 8 seC .0 I 7Bicuspids. a.The outer edge of thc eye. I Oro*" I $ O 001. 8.Central incisors. bThe pupil of the cyc. 9Lateral incisors c The tip of the nose and cuspids. d.Thc ala of the nose. Figure 2.13. Mandibular central inctsors. _ 10Molars.
45 two mouths are exactlyalike. Let us begin our 630, Given a series of factors related to the incisors: exposure of short cone radiographs, matcheach to discussion with the maxillary central its appropriate specific exposure. it. Maxillary central incisors.Refer to figure 2-9 as we explain the procedurefor taking periapical 11 X-rays of the maxillary central incisors.Position Specific Short Cone Exposares. Normally 16 the patient's head so that the median sagittalplane is radiographic exposures constitute a full mouth vertical and the ala-tragus line is horizontal. Gently series. This series is composed of 14 periapical and flex the upper corners of the film packet andplace 2 bitewing views. The technique for each specific the film in the mouth with the long axis of thefilm exposure is presented to be used only as aguide. in the median sagittal plane. The lower edgeof the Each exposure discussed is also illustrated to give packet must be parallel to and about one-fourth you a better understanding of theprinciples inch below the incisal surfaces of the teeth.Have involved. The vertical angulations we suggest are the patient hold the packet with his thumbagainst based on the angulations that are appropriate for its upper third. Direct the central ray throughthe tip the average patient. You may, however, findit of the nose at the root tips (apices) ofthe central necessary to alter this technique because of the incisors. The pointer should read about 450 below various types of equipment used throughout the Air the centerline for proper vertical angulation.To Force and also because of the difference in insure correct horizontal angulation, sight downthe anatomical structures of the oral cavity, since no cone to line up with :he proximal spaces. b. Maxillary lateral incisor and cuspid. Refer to figure 2-10 as we discuss the procedure for taking a periapical X-ray of the maxillary lateral incisor and cuspid. The median sagittal plane must bevertical and the ala-tragus line horizontal. Flexthe mesial corner of the film packet slightlyand place it in the mouth with the long axis of the packet in avertical plane coinciding with the lateral incisor andcuspid contact area. The lower edge ofthe packet must be parallel to and about one-fourth inchbelow the incisal surfaces of the teeth. The patient'sthumb should hold the packet by pressure against its upper mesial corner. Direct the central raythrough the I canine fossa at the ala. The pointershould read about 45° below the centerline for propervertical angulation. Sight down the cone to line upwith the proximal spaces to achieve the properhorizontal angulation. c.Maxillary bicuspids and first molar. The procedure for taking a periapical X-rayof the maxillary bicuspids and first molar is illustratedin figure 2-11. The median sagittal plane mustbe vertical and the ala-tragus line horizontal. Flexthe mesial corner of the packet slightly andplace the film in the mouth perpendicular to the longaxis of the second bicuspid. The lower edge of thepacket must be parallel to andabout one-fourth inch The A vi sA0e "Note `-..... below the occlusal surfaces of the teeth. op ,1011CfrOr. ..,.. patient's thumb should hold the film bylight 20. Pt^.1 OP of the DINTAL ?UM pressure against the upper third portion packet. Direct the central ray at the ala-tragusline , tip (apex) MANDIBULAR through a point slightly distal to the root of the second bicuspid tooth. The pointershould CUSPID read about 350 below the centerline for proper vertical angulation. Sight through thesecond bicuspid-first molar contact area for proper
IIISICTINO Pt^.1 horizontal angulation. lONOITUDJNAI *US OP 100,. d Vfaxilhiry second and thir(l molars.The procedure for taking a periapical X-ray of the in I Figure 2.14Mandibular cuspid maxillary second and third molars is illustrated
46 ,-) 0 , 1) figure 2-12. The median sagittal plane must be vertical: The ala-tragus line must be horizontal. The patient's thumb should hold the packet by light pressure against the upper third of the film. Place the film with its long axis in a horizontal plane. The shorter center axis of the packet must coincide with the long axis of the second molar tooth. The lower edge of the packet is parallel to and about one- fourth inch below the occlusal surfaces of the teeth. A Direct the central ray at the ala-tragus line below the outer corner of the eye and at a point between the facial root tips of the second molar. The pointer should read about 25° below center for proper vertical angulation. The face of the X-ray head should parallel the film packet. e. Mandibular central incisors. The procedure for taking a periapical X-ray of the mandibular central incisors is illustrated in figure 2-13. The median sagittal plane must be vertical. The ala corner of the mouth line must be horizontal. Flex the lower corners of the packet slightly and place the film in
etlisA1 KANO
01 ANOtel OP PaGiletleir 0 Ptoll OP OINIAt
MANDISUl AR MOI. AR
ISSICIING tlASII"".... IONGITUINAL ZIS OP 1001N
Figure 2-16. Mandibular molar.
the mouth with its long axis parallel to the central incisors. The lower edge of film must lie underthe tip of the tongue, and the upper edge mustbe parallel to and about one-fourth inch below the incisal surfaces of the teeth. The patient's forefinger must hold the packet by light pressureagainst its center. The central ray shouldbe directed in the OCCLUSAL PlAut median sagittal plane at just about the tip of thechin PLPII OP and between the root tips of the central incisors. L Pula vISACII *NOLO The pointer should read about 150 above centerfor OPP110/11C100.4 proper vertical angulation. Horizontalangulation is obtainable by paralleling the face of the X-ray head with the film packet. MANI/111UL AR I:Mandibular lateral incisor and cuspid. The IIIC USPI procedure for taking a periapical X-ray of the mandibular lateral incisor and cuspid is illustrated PLAse tON011U01NAI AioS OP fOOTA in figure 2-14 The median sagittal plane must be vertical. The ala corner of the mouth line must be Figure 2-15Mandibular bicuspid horizontal. Flex the lower mesial corner of the
47
34 ..-4-1 packet slightly and place the film in the mouth with figure 2-16. The median sagittal plane must be the long center axis of the packet coinciding with vertical. The ala corner of the mouth line must be the long axis of the cuspid tooth. The upper edge of horizontal. Flex the mesial corner of the packet the film must be parallel to and about one-fourth slightly and plate it in the mouth with its long axis inch above the incisal and occlusal surfaces of the in the horizontal plane. The short axis of the packet a teeth. Have the patient use his forefinger to hold the should coincide with the long axis of the second film by exerting light pressure against the center of molar. Again, the upper edge of the film must be the packet. Direct the central ray through the root parallel to and about one-fourth inch above the tip of the cuspid tooth to the center of the packet at occlusal surfaces of the teeth. The patient's a point about one-fourth inch above the lower forefinger is used to hold the film by applying light border of the mandible. The pointer should be pressure against the center of the packet. You about 200 above center for proper vertical should then direct the central ray through the root angulation. Parallel the face of the X-ray head with tips of the second molar to the center of the packet the film packet for proper horizornal angulation. at a point about one-fourth inch above the lower g. Mandibular bicuspids and first molar.The border of the mandible. The pointer should read procedure for taking a periapical X-ray of the near 0° for proper vertical angulation. For proper mandibular bicuspids and first molar is illustrated horizontal angulation, the head of the X-ray in figure 2-15. The median sagittal plane must be machine should be placed parallel with the film vertical. The ala corner of the mouth line must be packet. horizontal. Flex the lower mesial corner of the packet slightly and place it in the mouth with its Exercises (630 long axis in the horizontal plane. The short axis of the packet must coincide with the long axis of the Indicate the factors related to the exposure of second bicuspid tooth. The upper edge of the film specific radiographs by matching the appropriate must be parallel to and about one-fourth inch above items in column B to the specific exposure listed in the occlusal surface of the teeth. The patient's column A. Item (1) of each exposure listed in forefinger holds the film by light pressure against column A should be matched with a response from the upper center of the packet. Direct the central ray group I in column B, item (2) with a response from through the root tips of the second bicuspid tooth to group 11, and item (3) with a response from group the center of the packet at a point about one-fourth III. inch above the lower border of the mandible. The Column A Column B pointer should read about 10° above center for Group I proper vertical angulation. Parallel the lower edge 1.Mandibular central incisors: a.25' below centerline. (1) Vertical angulation b.35° below centerline. of the head of the X-ray machine with the film (2) Film position. c. 40' below centerline. packet. (3) Entry point of centrald. 450 below centerline. h. Mandibular second and third molars.The ray e.0' angulation. procedure for taking a periapical X-ray of the 2. Maxillary molars. f.10' above centerline. (1) Vertical angulation. g.IP above centerline mandibular second and third molars is illustrated in (2) Film position. h.200 above centerline.
Biscting Plan Long Axis of Tooth7 Central Rays 7 Cntral Rays / 1 .."1......
Short Con Tchniqu long Con Tchniqu
Figure 2.17. Comparison of die short and long cone principle5
48 '4 el ;3, is) Focal Spot
8 inch Focal.filmDistance
Film.--e ak
I., 1mag Focal Spot
.' . .
16 inch Focal.Film Distance
Figure 2-18. Comparison of focal.film disance.
(3) Entry point of centralGroup II (3) Entry point of centralf.At the ala of the nose. say. a.Long axis of the film ray. s.One-fourth inch above 3.Mandibular bicuspids: packet in the vertical 7.Maxillary central incisors: the lower border of the (I) Vertical angulation. position. (I) Vertical angulation. mandible and below (2) Film position. b.Long axis of the film (2) Film position. the pupil of the eye. (3) Entry point for central packet in the horizon. (3) Entry point of centralh. iDne.fourth inch above ray. tal position. ray. the lower border of the 8.Mandibular lateral incisors mandible and below Group III 4.Maxillary lateral incisors and and cuspids. the ala of the nose. cuspids: a.Ala.tragus line below (I) Vertical angulation. (I) Vertical angulatton. the corner of the eye. (2) Film position. (2) Film position. b. Tip of the nose. (3) Entry point of central Ala.tragus line below (3) Entry point of centralc. point. ray. the pupil of the eye. 5.Mandibular molars d. One.fourth inch above (I) Vertical angulation. the lower border of the 631. State the principle of the long cone (2) Film position. mandible and below radiographic technique and tell how it differs (3) Entry point of central the corner of the eye. from the short cone technique. ray. e One.fourth inch above 6.Maxillary bicuspids: the lower border of the short mandible and below Long Cone Periapical Technique. The (I) Vertical angulation undesirable results. (2) Film position. the tip of the nose. cone technique produces some
49
319 The most objectionable one is dimensional C-one P-arallefing (X-C-P) instrument (shown in distortion, which cannot be completely avoided fig. 2-19). When you use this instrument, it is not even by the most skilled technician. In this section necraary to maintain the patient in the standard we discuss the long cone technique. which dental radiographic position. By rotating or tipping minimizes dimensional distortion and presents the the patient's head, or by adjusting the dental chair a objects being radiographed in their true anatomical to a convenient position, it is usually possible to relationthip and size. align the extension tube with the X-C-P instrument Principle of the long cone technique. The principle regardless of space limitations or restricted mobility of the long cone technique is to direct the X-ray of the X-ray unit. Alignment of the extension tube beam perpendicular to the recording plane of the with the X-C-P instrument can also be film, which has been positioned parallel to the long accomplished with the patient in a supine position. axis of the tooth. A comparison of the long and This requires minimal maneuvering of the X-ray short cone principles is illustrated in figure 2-17. unit, with the final alignment being made by The long axis requires use of extension cones adjusting the patient's head. Placement of the film is supplied by the manufacturer of the X-ray machine. simplified and well tolerated by the patient in this The extension cone increases the focal (target) film position. distance from approximately 8 inches (with the There are two X-C-P instruments used to assist short cone) to 16 to 20 inches. With the longer in the taking of long cone radiographs. One is for focal-film distance, enlargement of the image is anterior exposures: the other is for posterior reduced. (See fig. 2-18.) Additionally, with the exposttres. Both the anterior and posterior increased target-film distance the exposure time instruments consist of a bite-block, an indicator must be increased. Read the film manufacturer's rod, and a locator ring. (See fig. 2-19.) The anterior instructions for the recommended exposure time. bite-block back support is designed to hold the Normally, long cone radiographs are exposed' at film's long axis in the vertical position while the 90kV, 15mA. posterior bite-block back support holds the film in the horizontal position. You can easily distinguish Exercises (631): between the indicator rods as the posterior rod has L State the principle of the long cone a long, straight extension that bends off the main radiographic technique. shaft at a 90° angle to attach to the bite-block. The extension off the main shaft of the anterior 'rod consists of a series (3) of short 900 bends. The plastic locator rings differ in that the anterior ring's 2. What advantage does the long cone technique neck is considerably shorter than that of the have over the short cone technique? posterior ring. For anterior exposures (fig. 2-19.A), place the shielded (printed) side of the film packet agaitht the backing support of the bite-block. Insert the film 3. What target-film distance is employed with the vertically into the slot by using a downward motion, long cone technique? Why? and at the same time place slight pressure against the backing support to open the slot. Hold the offset portion of the indicator rod away from the biting surface of the block. Insert the pins into the proper 4. What adjustment in the exposure time must be holes. Slide the plastic locator ring onto the accomplished when you go from the short cone indicator rod so that it is in front of the film packet. to the long cone technique? The instrument is now ready to position in the mouth. For posterior exposures (fig. 2- I9,B), place the shielded (printed) side of the film packet against the backing support of the bite-block. Insert the film 632. State the purpose of the X-C-P instrument, horizontally into the slot by using a downward identify its components, and describe their motion and at the same time place slight pressure assembly. against the back support to open the slot. Hold the right-angle portion of the indicator rod anterior to The X-C-P Instrument.The variety of the block and away from the film. Insert the pins anatomical conditions of individual mouths into the proper holes. There are three holes in the presents problems in obtaining a parallel bite-block, which allow a choice for lingual relationship between the film packet, the structures positioning of the film. Slide the locator ring onto to be radiographed, and the tube head. These the indicator rod so that it is in front of the film difficulties usually can be overcome by the use of packet. The instrument is ready to position in the intra-oral film holders such as the Rinn X-tension mouth.
50 r BITESLOCK Exercises (fans LOCATOR RING 1. What is the purpose of the X-C-P instrument?
2. Must the patient be maintained in the standard PIN HOLES radiographic position when you use the X-C-P A INDICATOR RO instrument? Anterior Instrument
Distinguish between the parts of the anterior and posterior X-C-P instruments by matching the description in column B to the part listed in column A. Column A Co Isonn
PIN 3. Anterior locator a. Designed to hold the film ring, in a horizontal position. 4. Posterior indicator b. Hasa long, straight extel rod. sion that bends off its 5. Posterior bite. main shaft at a 90° angle. block. C. Designed to hold the film 6. Anterior indicator in a vertical position. Posterior Instrument rod. d. A plastic. ring.shaped oh- 7. Anteriorbite. ject, having a *on no:k. block. e. A plaetic. ring-shaped ob. 8. Posterior locator joct, having a long neck. ring. f.Its tstiniOn consists of a series of short 90° bends. Figure 2.19. X.C.Pinerumenu.
LOCATOR RING
LONG CONE FILM
NOTE: THE TIP OF THE LONG CONE, LOCATOR RING, AND THE FILM ARE ALL PARALLEL
Fisure 2-20. Paralleling in the long cone technique.
51 351 34 understand the principles involved. When placing the fi'm in the patient's mouth for long cone exposures, do not attempt to place the film directly against the teeth. The film must be positioned somewhat towards the midline if the proper a joill parallelism is to be achieved. (See fig. 2-20.) With this in mind, let's see how we set up for the specific exposures: a. Maxillary incisor region. For the maxillary incisor region, assemble the anterior instrument. Center the film packet with the midline, and parallel it with the long axis of the incisors. The entire length of the block should be utilized to position the film in the region of the first molar. Rest the block on the incisal edges of the teeth to be radiographed. Insert a cotton roll between the mandibular incisors and the block. Instruct the patient to close firmly to retain established position of the film. Slide the locator ring down the indicator rod to approximate the skin surface and alivt the extension tube of the X-ray unit with the rod and ring on vertical and horizontal planes. This LOCATOR RING IXTENSION TURE procedure is shown in figure 2-21. b. Maxillary cuspid region. To radiograph the maxillary cuspid region, assemble the anterior FILAL
0111111111 ..): ' COTTON ROLL
Figure 2.21. Maxillary central incisors.
9. When you place the film packet in the X-C-P instrument, which side of the packet should be I against the backing support of the bite-block? agrA/ - 10. Briefly describe how the posterior X-C-P instrument is assembled. (Omit the film placement.)
633. Indicate the positioning procedures involved in taking long cone radiographs by stating the proper longitudinal film position, the alignment, the X-C-P instrument, and the procedure employed for edentulous patients, and by identifying the teeth upon which the film should be centered. Specific Periapical Radiograph Expo- suresLong Cone. The techniques presented in the following paragraphs are to be used only as a guide. Each procedure is illustrated to help you Figure 2-22Maxillary cuspid incisors. "ili:)(41647 instrument with the film inserted vertically. Center the film on the cuspid. and parallel it with the long axis of the tooth. Rest the block on the maxillary - cuspid. Insert a cotton roll between the mandibular teeth and the block. Instruct the patientto close firmly on the block to retain the established position of the film. Slide the locator ring down the indicator rod to approximate the skin surface. Align the extension tube of the X-ray unit with the rod and ring on vertical and horizontal planes. (See fig. 2-22.)
c. Maxillary bicuspid region. For the maxillary bicuspid region, assemble the posterior instrument with the film inserted horizontally in the bite-block. Position the film in the mouth with the second bicuspid centered on the film. Parallel the film with the long axis of the bicuspids. Hold the bite-block on the occlusal surfaces of the maxillary bicuspid. Insert a cotton roll between the bite-block and the LOCATOR MHO mandibular teeth. Instruct the patient to close firmly to retain the established position of the film. IRTINSIONTillS Slide the locator ring down the indicator rod to TIM approximate the skin surface, and align the extension tube of the X-ray unit with both the rod and ring on horizontal and vertical planes. (See fig. 2-23.) COTTON ROLt...,-
Figure 2.24 Maxillary molar incisors.
d. Maxillary molar region. To radiograph the maxillary molar region, assemble the posterior instrument with the film inserted horizontally in the bite-block. Position the film in the mouth with the , anterior edge of the film in the vicinity of the first molar-second bicuspid contact point. Parallel the film with the long axes of the molars. Place a cotton roll between the underside of the bite-block and the mandibular molars. Have the patient close firmly to -.3 :7 retain the established position of the film. Slide the t 1,1"- -;44sr locator ring down the rod to approximate the skin surface, and align the extension tube of the X-ray unit with both the red and ring on horizontal and vertical planes. (See fig. 2-24.) e. Mandibular incisor region. For the mandibular incisor region, assemble the anterior instrument tocAroa RING IXTINSION tuse and insert the film vertically in the bite-block. Center the film with the midline, and parallel it with the long axes of the incisors. Lingual placement of the film packet to the region of the FUN second bicuspid will accomplish this. Rest the block on the incisal edges of the teeth to be radiographed. Insert a cotton roll between the top COTTON 101t--/ of the block and the maxillary incisors. Instruct the patient to close firmly to retain the established position of the film. Slide the locator ring down the Figure 2-23Maxillary bicuspid incisors. indicator rod to approximate the skin surface.
53 353 34 align the extension tube with the rod and ring on horizontal and vertical planes. (See fig. 2-27.) h Mandibular molar region. To radiograph the mandibular molar region, assemble the posterior instrument with the film inserted horizontally in the bite-block. Position the film in the mouth with the anterior edge of the film in the vicinity of the first molar-second bicuspid contact point. Parallel the film with the long axes of the molars. Place a cotton roll between the block and the opposing maxillary teeth. Have the patient close firmly to retain the established position of the film. Slide the locator ring down the indicator rod to approximate the skin surface. Align the extension tube with the rod to approximate the skin surface. Align the extension tube with the rod and ring on horizontal and vertical planes. (See fig. 2-28.) i.Edematous patients.To radiograph partially edentulous patients, place a cotton roll in the space normally occupied by the crowns of the missing COTTON OLL teeth and then follow the standard procedure. For completely edentulous patients, cotton rolls may be taped to the bite-block to fill the space normally flifINSION TUSI filled by the crowns of the teeth. Parallel the film PIM with the ridge area being examined. Have the patient close down to hold the film in the desired
LOCATOR RING position. It may also be necessary for you to vary the standard technique for patients with variations
Figure 2-25. Mandibular central tncisors
Align the extension tube of the X-ra:, unit with the rod and ring on vertical and horizontal planes. (See fig. 2-25.) f Mandibular cuspid region. To radiograph the mandibular cuspid region, assemble the anterior instrument with the film inserted vertically in the bite-block. Center the film on the cuspid and parallel it with the long axis of the tooth. Rest the block on the mandibular cuspid and insert a cotton roll between the block and the maxillary teeth. Instruct the patient to close firmly to maintain the established position of the film. glide the locator ring down the indicator rod to approximate the skin surface. Align the extension tube with the rod and ring on vertical and horizontal planes. (See fig. 2-26.) g. Mandibular bicuspid region. With the posterior instrument assembled and the film inserted horizontally in the block, position the film in the mouth with the second bicuspid centered on the film. Parallel the film with the long axes of the bicuspids. Place the block on the occlusal surfaces RZTENRION TUft of the mandibular bicuspids. Insert a cotton roll between the block and the maxillary teeth. Have the LOCATOR RING patient close firmly to retain the established position of the film. Slide the locator ring down the indicator rod to approximate the skin surface and Figure 2.2(1Mandibular cuspid incisors
54 3 5 1 in the shape of the oral structures. such as low palates and malpositioned teeth. 7,1 Allpr's;
Ezerciws (433k ,err 4.4 I. In what position should the k)ng axis ofthe film packet be positioned forexposures of the incisors and cuspids? ,
Identify the proper position of the film packetin relationship to the teeth being radiographedby matching the film position in column Bto the radiograph in column A. (;)hunn A Ohorter ',1st 2Incisor regions a. The anterior edge ot the . 3Bicuspid regions, Ulm should he in the 4. Cuspid regions. %until) of the first molar. 5. Molar regions. second bicuspid contact pont. h. The second bi:uspid is centered on the film. c.The midline is awned on COTTON toil tht film. d The film is centered lansimOts TUGS behind the cuspid. PIM
lOCATOS SING 6. When you use the long cone technique with the Figure 2.21. Mandibular molar incisors.
X.C.1) instrument, what aPproxiMates the patient's skin surface?
41111Nat, 7. What is aligned to the ?C.C.!' locator ring when Zith. you take long cone radiographs?
8. When you radiograph edentulous or partially edentulous patients, what should you do prior to taking the exposure?
634. State the purpose of hitewing radiographs and detcribe the proper patient, fibs, and central ray pcSitiGnine needed for their exposure. Skewing Technique. The interproximal or bitewing examination is primarily used to reveal the resence of caries in the crowns of the teeth. pArticularly early lesions on the interproximal surfaces. During this examination we are also able to observe certain changes in the pulp chambers and Figure 2.27 Mandibular bicuspid inasors. pulp canals, the presence of everhanging fillings,
55 35,5 .341 improperly fitting, crowns and fixed partial 2. Describe the position in which you should dentures, and resorption or destruction of the crest place the patient for the exposure of bitewing of the alveolar bone. radiographs. The posterior interproximal exposure is the a standard procedure for taking a posterior bitewing radiograph. The median sagittal plane must be vertical and the ala-tragus line horizontal. Have the 3. How should the film be positioned for bitewing patient close hit teeth firmly on the bite tab. Place radiographs? the film packet so that its greatest dimension lies in a horizontal plane, parallel with the longaxis of the crown of the teeth. The forward edgeof the film packet should be placed behind the distal one-third 4. How should the central ray be directed for the of the cuspid teeth. This insures that the entire exposure of bitewing radiographs? crown of the first bicuspid appears onthe radiograph. Do not permit the film to rotate as the patient closes his mouth. Direct the cen:ral ray toward the occlusal plane at the center of the packet. (See t3g. 2-29.) The pointer should read about IP below the centerline for proper vertical angulation. Sight straight through the maxillary i3$. State the purpose of the oeclutil second bicuspid-first molar contact area for proper eumination and identify the condition in which horizontal angulation. Accuracy is essential to the occlusal radiograph could have great avoid overlapping of structures. diagnostic valve. Occlusal Radiographic Examination. The Exercises (WO occlusal examination is so called because thefilm I. For what purpose are bitewing radiographs packet is placed in the occlusal plane for exposure. primarily used? It is a supplementary procedure that allowsthe dental officer to view many oral conditionsfrom a
, It .,..t I r MO*
1., '
1!.. - '
1
c..,..- - / Ati....t.aibk I ,. l .2
5.-.4...--4 -.....110-
r , t
Figure 2-29 Helot/mg tychntquc 56 356 1
4
EXPOSED HIM
FILM PLACEMENT
CENTRAL. RAY PROJECTION Figure 2.30 Maxillary topographical occlusal
cross sectional aspect that cannot be achieved with examination would prove to be of great diagnostic other types of intra-oral film These radiographs are value. of great value in the diagnosis of antral involvements, the relationship of foreign bodies in 2 Periapical abscess 3 Max, Ilary bone fracture the jaw or maxdlary sinuses, bone fractures. 4 Sal:vary stones presence of salivary calculi (stones). the location of 5 Dental granuloma areas of bone involvement, cysts. impacted teeth. _ 6 Foreign bodtes in a sinus. and malignancies. 7 Periodontitis ____ 8 Impacted teeth ____ 9 Gingivitis Exercises (635): I. Generally speaking. what does the occlusal examination allow the dental officer to view'' 636. Given a series of statements concerning the occlusal exposure technique, indicate which are true and which are fa/se. Items 2 through 8 list several oral conditions Place a checkmark next to those in which an occlusal Occlusal Exposure Techniques.The cclusal
57 361 film packets, previously discussed, are normally have him bite down firmly, but gently. on the packet used to record occlusal radiographs. In the cases of to retain it in position. children, or adults with extremely small mouths a periapical film packet may be substituted for the Exircises (636): occlusal packet. For both maxillary and Indicate whether the following statements mandibular exposures, the patient's median sagittal concerning the occlusal exposure technique are true line should be kept in the vertical plane. Position or false by circling the appropriate T orF. the patient's ala-tragus line parallel to the floor for maxillary exposupes. During mandibular exposures the patient's head should be tiited back until his ala- traps line is perpendicular with the floor. T F I.In the cases of children, or adults with Position the film packet so that its recording extremely small mouths, a periapical film plane is facing the structures to be radiographed. packet may be substituted for the occlusal Insert the film packet into the patient's mouth and packet.
;-;
W*:
EXPOSED FILM CENTRAL RAY PROJECTION
3 5 3 FILM PLACEMENT Figure 2.31Maxillary antcnor occlusal.
58 .1. .1 I.-
"1"111., '' EXPOSED FILM CENTRAL RAY PROJECTION
FILM PLACEMENT Flgurc 2.32Maxillar . postcrior occlusal.
T F 2.During occlusal exposures thc patient's match each procedure with the specific median sagittal linc should be kcpt in thc radiograph to which it would apply. vcrtical planc. T F 3.Thc patient's ala-tragus linc should be Specific Occlusal Exposures.Thc following positioncd parallcl to thc floor for paragraphs describc thc proccdurcs involvcd in thc mandibular exposures. setup for scvcral specific occlusal examinations. T F 4.The film packct should be positioned so These sctups arc illustrated in figures 2.30 through that its rccording plane is facing thc 2.35. Use thc exposure time. kVp. and mA settings structures to bc radiographed. recommended by thc fllms manufacturcr. T F 5. Thc film packct :s retained in position by Maxillary topographical occlusal As with all having thc paticnt prcss on it firmly with maxillary exposures. thc patient's ala-tragus linc his thumb or forefinger. should parallcl with thc floor. Placc thc film packct in thc mouth with its long dimension cxtcnding 637. Given procedures necessary for the across thc mouth. Bc surc thc film is placcd far production of various occlusal radiographs. enough distally to include all thc teeth. thcn havc
59 35!) 3-S3 the patient bite down gently on the film packet. floor. Position the film in the mouth on the side to Adjust the tube head so that the central ray enters be radiographed with its long axis parallel to the along the median line at the top of the head. When median plane. The lone aspect of the film packet viewed from the side, the path of the central ray that lies toward the cheek should be parallel with should be aligned with the outer corner of the and should extend at least one-fourth inch beyond a patient's eye. The cone tip should be directed the facial cusps of the posterior teeth. Have the straight down (90°) toward the film packet. See patient hold the film packet in position by gently figure 2-30. closing his teeth together. Adjust the tube to a Maxillaryanterior occlusal.Again, position the vertical angulation of 600 downward. Direct the patient so that his ala-tragus line is parallel with the central ray to pass through the ala of the nose floor. Place the film in the mouth with its short toward the apical region of the cuspid and first dimension extending across the mouth, and have bicuspid to the plane of the film packet. (See fig. the patient bite down gently on the film packet. 2-32). Direct the central ray to enter at 65° downward in Mandibular topographical occlusal. Tilt the the midsagittal plane, at the interior border of the patient's head back so that the ala-tragus line and nasal bones. (See fig. 2-31.) Sight between the occlusal plane of the teeth are perpendicular to the central incisors to establish proper horizontal floor. Keep the median facial plane in a vertical angulation. position. Place the film packet in the mouth with its Maxillary posterior occlusal.Thepatient's ala- long axis extending across the mouth. Be sure the tragus line should once more be parallelwith the film is placed far enough distally to include all the
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FILM PLACEMENT e Figurc 2.33Mandibular topographical occlusal
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FILM PLACEMENT Ftgur, iNlandlhula cJuNal teeth and has.e the patkm hue eenti on the him in the mouth with its lesser dimension extending packetThe central ra should be direoed across the mouth and have the patient bite doss n on perpendicular to the re,ordine plane ol the tilm the tilm packet. .Adiust the tube to a vertical packet. this 1.1:ourse mean) thing ifsertical anguiation 35: downward. Position the tube so angulation The tube pointer shiukl he positioned that the central raenters at the median line ot the under the chin on the median line at a spot betsseen chin lust beloss the apices of the mandibular centnl the mandibular tirst mu Jars The n, should pas) incisors 1See fig2.:1-1) through the floor ot the mouth to the ,:enter uit the 11,1mIt1',rlar pmtertt,r ,,«.1usur/Tilt the patient's him ISee iig 233t head hack so that the ala.tragus line and the teeth t/widibidor wito tri%alTilt the patient's are perpendicular to the floor Keep the median head back so that the ala.tragu) line and the teeth facial.plane in the %,ertiejl positionPlace the film .ire perpendicular to the floorKeep the median in the mouth on the side to be radiographed ssith its tactal plane in the sertical position Place the tilm long axis parallel :0 the median plane The long
6 I
361 aspect of the film packet that lies toward the cheek to the procedures in column A that are required in should be parallel with and extend one-fourth inch the production of a particular radiograph. Each beyond the facial cusps of the posterior teeth. Have radiograph can be matched to more than one the patient hold the film in position by gently biting p'roduction procedure. on the film packet. Adjust the vertical angulation so ( ohm; .4 ( doom B that the central ray is directed perpendicular to the film packet. If the film packet is perfectly I ertical angula. a.Maxillary topographical perpendicular to the floor. 00 vertical angulation non of 60 down- h.Maxillary antertor 4 ssard. Maxillary posterior would be used. Direct the central ray so that it will 2 L.,ng axis ot the Mandibular topographi. pass from below the mandible and through the Win positioned cal second molar to the center of the film packet. (See across the mouth Mandibular anterior fig. 2-35). 1 Film positioned to Mandibular posterior he parallel %kith aid emend a: least Exercises (637): onefourth inch Match the specific radiographs listed in column B beyond the tacial
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62 (7..)2 X-RAY HEAD
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Figure2.36 Panographic X-ray unit.
Coliunn Column cusps toward the chin on the median line at a spot be. cheeks tween the first -1 Short axis of the film positioned across the mouth 8 niD(i'rclearstthe central ray 35° downward 5 Central ray directed 6 down. through the median voard atinterior lone of the chin Just border of the nasal below the apices of Nones the mandibular n Central ray direct central incisors. 90, downward 9 When the head is through the top of properlyposi. the head tioned the vettical Position the tube angulation is 0° head under the 10 The central ray is
63
363 361
Column A describing a multitude of extra-oral techniques. are available for reference should you need to expose projected 60' unit. downward at the extra-oral radiographs with a dental X-ray ala of the nose toward the apical Exercises (638): a regionofthe cuspid and first 1. How are extra-oral radiographs employedin bicuspid. dentistry?
638. State the uses of extra-oral radiographs in 2. How does the panographic unit perform to dentistry and basically describe how they are provide a complete view of the patient's oral ... produced. structure? Extra-Oral Radiographs. Extra-oral radiographs may be used to obtain a panoramic view of the patient's teeth and their surrounding 3. Why is the panographic technique primarily structure or to view a specific bony area where an abnormality is suspected. The extra-oral limited to full mouth surveys? radiographs that are most often used in the dental clinic are the panographic radiographs. As the name implies, they provide a panoramic view of 4. How are extra-oral radiographs of specific oral structures. bony areas obtained? Panographic radiographs.The production of panographic radiographs requires special equipment (fig. 2-36 illustrates a panographic unit). The X-ray head and cassette of this unit rotate around the patient, obtaining a complete view of his 2-4. Processing X-Ray Films oral structure. Panographic equipment is useful for obtaining a comprehensive survey of Ihe patient's Precise methods in processing X-ray films are oral condition. With use of the panographic just as essential as the use of precise exposure procedure, the patient receives only about one- techniques. If the correct procedures are followed, tenth the amount of radiaticn as in a conventional the resulting radiograph leaves nothing tobe full mouth series. Since the need to place individual desired, and you can perform your work with every film packets in the patient's mouth is eliminated, assurance that you are providingradiographs of the the panographic technique is also much faster. highest quality. If, on the other hand, the processing There is, however, some degree of distortion with procedures are carelessly done and directions are - all panographic radiographs. Usually the dental not carefully followed, all the carethat was officer will order periapical films of any questionable areas he notices on the panographic radiograph. Because of this distortion factor, the OVERFLOW VALVE panographic technique is fairly limited to obtaining full mouth surveys. Because there are variations in the operation of panographic equipment supplied by different manufacturers, you should read the applicable instructions before attempting any exposures. Other extra-oral radiographs.The other extra-oral radiographs are used to view a specific part of the anatomy. They may be requested if a fracture is suspected or if the patient is experiencing TMJ problems, sinus pain, etc. These radiographs are obtained by having the patient hold the cassette against the structure to be radiographed and by directing the central ray toward the cassette from the opposite side of the patient's head. Although FIXER dental X-ray units may be used to expose these DEVELOPER RUNNING radiographs, better results are usually obtained by RINSING WATER having them exposed and processed by the medical X-ray section. Many dental radiography textbooks, Figure 2.37X.ra film processing tank
64 3q4 64
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Figure 2.38Automatic film processor. exercised during the exposure of the films will be packet under safelight illurniaation. Place the film time lost. The processing procedure, using various on the worktable beneath the safelight. Place a coin processing techniques. is carried out in a or paper clip on the open film. Expose it to the photographic darkroom. safelight forI minute and process the film. If you can see the profile of the object, thesafelight 639. State the need and factors necessary for a illumination is not safe. properly constructed darkroom, describe the Processing tank. A suitable tank for processing darkroom's contents, and tell how they function. films is an important part of the darkroom equipment. (See fig. 2-37 ) The tank should be The Darkroom.Since the films used in X-ray constructed of corrosion-resistant and rust-resistant work are extremely sensitive to white light, it is very material. Compartments or divisions are provided important to have a good darkroom. It need not be for the developing and fixing solutions, plus a a large room, but it must be constructed so that no larger section for water. Since itis essential to light can enter through cracks. In addition, the door process film at the predetermined temperature.the should have an inside lock so that no one can tank must be equipped with a thermometer that will accidentally open it or enter while films are being register the exact temperature of the developer processed. Another type of construction plan for solution. This developing temperature can be partly entering the darkroom is a maze that has enough controlled with hot and cold water supply Most turns to keep out light. Because of its construction. tanks are equipped with refrigeration units that adequate ventilation of the darkroom must not be maintain the proper temperature. If the processing overlooked. The use of some forced change of air tank is not equipped with a refrigeration unit. the employing a ventilation fan is advisable. incoming pipes should lead to a mixingvalve so that Darkroom illumination For the illumination of the temperature of the water flow can be regulated the darkroom. a light that is photographically safe Automatic processor Many Air Force darkrooms must be used. There are numerous types of are now equipped with automatic processors(See safelights available. The safety of the safelight fig. 2-38.) Operation of this equipment is relatively illumination in the darkroom can be tested easily simple. You unwrap the film and feed it into a slot Darken the room and open the radiographic film on the automatic processor A conveyor system
65 .35-g transports the film through the automatic 2. List the factors that are necessary for an developer's chemicals, and the processed film is adequately constructed darkroom. turned out in about 5 minutes. This equipment is available through several manufacturers, and you should be thoroughly familiar with the operating and maintenance instructions furnished by the 3. How can you determine if your darkroom particular manufacturer of your equipment. The illumination is adequate? processing tank, interval time, and film holders we discuss in this section all relate to the manual processing method. So do not confuse them with the automatic processing method. 4. Describe the radiographic processing tank. Interval timer.Because of the direct relationship between temperature and time in the processing procedure, it is necessary to know the exact time that any given film is to be left in each solution. For 5. How may the temperature of the processing this purpose, an interval timer is needed in the solution be controlled? darkroom. This gives the time in minutes and fractions of minutes and is equipped with an alarm, which smids to indicate the expiration of the time selected. 6. Briefly describe how film is developed in the Film holders.Two types offilmholders or automatic developer. hangers should be available in the darkroom. (See fig. 2-39.) One type is for intra-oral film, and the other for extra-oral film. Film should be handled carefully when placing it on the hangers to avoid 7. What is used to indicate the amount of time the fingerprints on the film. film has spent in the processing solutions?
Exercises (639): 1. Why isit necessary to develop radiographic film in a darkroom?
640. Indicate specific factors and procedures in
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Figure 2-40. Mounted radiographs. the processing of dental radiographic film by packet and securely 'attach it to the film rack. If the answering a series of key questiom. film is not setured on the rack, it may fall off and sink to the bottom of the processing tank. Needless Time-Temperature Processing Technique. The to say, retrieving film from the bottom of the tank is procedures we discuu in this section apply to the a difficult and meuy task. Now the film is ready to manual processing tank and not the automatic be placed in the first processing solutionthe processor. If you are using the automatic processor, developer. follow the manufacturer's instructions. Several steps are necessary for processing radiographs using Developing. Generally speaking, when the time-temperature processing technique. The radiographic films are placed in a developing first step entails providing for the identification of solution, the surface tension of the film preventi the the film. solution from fully contacting the film. You can see the results of this phenomenon in the form of tiny Film identification. Since there are usually several air bubbles, which appear to be attached to the film. processing racks in use in the darkroom at any given When left uncorrected, portions of the film go time, it is necessary to have some way of identifying undeveloped, which produces an inferior quality which patient's films are on which rack. One way of radiograph. To eliminate the bubbles and increase doing this is to number each rack and assign a rack the quality of the radiograph, agitate the rack for a number to each X-ray patient. The patient's name few seconds immediately after you place it in the and rack number may be recorded in an X-ray log developing solution. book, or the number may be recorded onto the patient's AF Form 644, Record of Dental The amount of time required for the developing Attendance. After the films have been processed, of X-ray film depends on the temperature of the they can be identified by matching the rack number developer solution. The ideal time-temperature to the patient number. ratio of the developer used by the US Air Force is a Film placement on racks. After you have provided developing time of 4 1/2 minutes with the developer for the identi" -ation of the film you are ready to solution at a temperature of 68° F. However, start processi the film. The processing must, of variations are allowed. The following table course, be dc iside the darkroom. To begin the indicates the amount of time that a film must be left processing p. lure, remove the film from its in the developer solution at a certain temperature: 67
367 31P1
Temperener Time unaffected halide salts and hardens the emulsion. Owes Fahrenheit) Mimeo) Films should be briskly agitated when they are placed in the fixer solution and left there for 60 6 'It 65 5 approximately 10 minutes. All of the foregoing 60Ideel 4 Vs steps are accomplished in the darkroom with no a 70 4 light except the safelight. 75 3 Washing. From the fixer solution the films are placed in the water in the center rinsing section of Since the time-temperature ratio is so critical when the processing tank for washing. They must be you process radiographic film, it isadvisable to post washed for at least 20 minutes in running water. the processing table in a conspicuous place in the This will prevent a discolored film and also keep darkroom for the convenience of all persons who the fixer solution from dropping on the floor, may process film. When fresh developer solutionis where it forms an unsightly white spot. being used, it may be necessary to reduce the Drying. Films must be thoroughly dried after developing time by a minute or more. When the they have been processed. The time involved developer solution has been used for a period of depends on the humidity and circulation of air. time, it may be necessary to extend the developing Films should never be dried in a temperature time by a minute or more. exceeding 100° F, or near a source of heat such as a The developer solution is kept in the left-hand radiator, because such a practice results in curled section of the processing tank. When films are film. placed in this solution, the silver halides in the film emulsion that were affected by the X-rays are Exercises (640): converted to a black metallic silver. The unexposed silver halides are not affected by the developer 1. What is the purpose of numbering the X-ray solution. Since developing time is most critical, a film racks? floating thermometer should be kept in this section of the tank. Be sure to check the temperature of the developer before you begin film processing. Developer that is too old, too exhausted, or too 2. What is the first step of the processing cold will not properly develop a film. The procedure that must be done entirely in the chemicals in a developing solution are gradually darkroom? exhausted by use. Also, exposure of the solution to 4) air, heat, or light will cause deterioration by oxidation. Therefore, keep the tank filled at all times, keep the solution cool, and keep the solution 3. What processing difficulty can result from the covered to protect it from light. New solution may surface tension of the film and what should you be added to the tank from time t.o time to avoid an do to eliminate this problem? abrupt change in potency. However, depending upon the number of films developed, itwill be necessary to renew the solution at intervals. Ifthe developer has become a dark brown color, it should 4. What is the ideal time-temperature ratio for be discarded and replaced with fresh solution.The developing dental radiographic film? average length of time thatthe solution is effective in the dental clinic is about 2 weeks.Mix new solutions in accordance with their manufacturer's contains instructions.. 5. What portion of the processing tank Rinsing. The running water in the center section the developer solution? of the processing tank should be approximately the same temperature as the developer solution and the fixer solution. After the developing is complete, the should film should be moved into the center rinsing section 6. In what portion of the processing tank of the processing tank and agitated from 15 to 30 the floating thermometer be kept? Why? seconds for the purpose of rinsing off ail traces of the developer solution. The water should be shaken from the film. Next the film must be placed in the the fixer solution. The developer solution must not be 7. How does the developing solution affect carried into the fixer solution. Likewise. the fixer film? solution must not get into the developer solution. Fixing. The fixer solution is kept in the right- hand section of the proctaing tank. Itremovesthe 3(-3 68 8. When should the developing solution be dot lzcated on one corner of the film. This dot discarded and replued with fresh solution? appears as a bump on one side of tInx film and as a depression on the other side of the film. To properly mount the radiogsaphs, you should be looking into the depression. Viewing into the 9. What should ou do immediately after the depression provides the lingual aspect of the interval timer has signaled that the film has radiograph. spent its allotted time in the developer Next, we determine whether the radiographs are solution? maxillary or mandibular views and which teeth are shown. Several anatomical features can aid us in making this detertninatioh. We have listed many of these features below: 10. What portion of the processing tank contains a. The maxillary sinus is usually quite prominent the fixer solution? on the maxillary cuspid. bicuspid, and molar vieWS. It appears as a large darkened area above the root tips and is often inscribed by thin white lines. h: The nasal spine can usually be seen on 11. How long should the films remain in the fixer radiographs of maxillary central incisors. It appears solution? as a white line, about one-fourth inch thick, which descends from the top of the film down to about the root tips. Darkened areas appear on each side of the nasal spine. These areas are the nasal passages. 12. After the fixing of the film has been completed. c. The maxillary tuberosity can usually be seen how long should the film be washed? on maxillary molar views. This tuberosity appears as a bulge of bone located distal to the maxillary third molar. d. The mandibular canal can sometimes be seen 13. What is the maximum temperature at which on the mandibular molar and bicuspid views. This films can be dried without danger of curling? canal, when visible, appears as a dark line that begins in the third molar area and travels horizontally just below the root tips. Quite often small vertical extensions from this line to the apex of the tooth can be seen. r. The mentaUbramen can usually be viewed on 641. State the procedure for mounting radiographs ot the mandibular bicuspids. This radiographs, and given a list of anatomical natural opening in the bone appears as a dark dot, landmarks, identify the radiographs on which which is located slightly below the bicuspid teeth. they may be seen. : The anterior portion of the ramus of the mandible can often be seen on mandibular molar Mounting Periapical Radiographs. A full radiographs. Normally, you can see the inner angle mouth radiographic series consists of 14 periapical of the mandible and a portion of the ramus as it and 2 bitewing films. which are usuak mounted in ascends toward the temporomandibular joint. a cardboard folder called an X-ray mount (See fig. g. In addition to the anatomical features we have 2-40.) This permits convenient handling of the mentioned, the teeth themselves often offer clues to radiographs while viewing, and it facilitates filing. the identity of the radiograph. For example: You should always mount the films tbr viewing (I) Maxillary incisors and cuspids appear larger from the lingual aspect. as though the viewer were than their mandibular counterparts. sitting on the patient's tongue looking out of the (2) Maxillary molars have three roots, whereas mouth. The mounts have slots into which you slide mandibular molars have only two. the film. Place the film into the mount in the same (3) The shape and position of the teeth differ. sequence that the teeth appear in the mouth. You place the central incisor view in the center of the After you have identified the radiographic view, mount, a cuspid view on each side of the central your last determination is whether it belongs on the incisor view, a bicuspid view distal to each cuspid right or left side of the mount. This is a simple view, and a molar view distal to each bicuspid view. procedure. First. make sure you are viewing the Now that we know how the films are placed in the film from the lingual aspect. Then arrange the films mount, let's see how we identify the various views. so that the teeth appear as they do in the mouth. For rite first step in mounting radiographs is example. the bicuspid view also shows the first determining the aspect from which you are viewing molar: this film should be placed in the mount so the film. As you should recall, there is an embossed
69
369 that the bicuspids are the closest teeth to the exist. The quality of the radiornipl: is determined midline. by the sharpness of the image (detail} the degree of blackening of the film (density); and the difference Lurches (1641): between the black,: wiite, and various shades of gray on the film (contrast), I. In what sequence and aspect should films be Causes of faulty radiographs. Faulty radiographs mounted for viewing? result from many types of errors. Sixteen common classes of faults thut can occur when you art exposing and processing radiographs are listed below: 2. How can you determine if you are viewing the a. Thin image, caused by: radiograph from the lingual aspect? (1) Insufficient exposure or developing time. (2) Use of excessively cold or exhausted developer solution. (3) Use of diluted developer solution. In the exercise below swim the anatomical feature b. Dense image, caused by: or features listed in column B under the radiograph in column A on which they may be seen. Some (I) Too long exposure time or too long developing time. items may be used more than once. (2) Use of a too warm developer solution. Column A ColumnI (3) Use of a concentrated developer solution. 3. Mandibular bicuspids: a.Nasal spine. c. Partial image, caused by: (1) b.Maxillary sinus. (I) Rim not completely immersed in the C.Maxillary tuberosity. developer solution. 4. Maxillary(2)- central incisors: d.Mental foramen. (2) Film in contact with another film in the (I) C.Mandibular canal. 5. Maxillary molars: 1. Ramus of the mandible. developer solution. (I) (3) The center beam of the X-ray focused off (2) the film in periapical films or off center 6. Mandibular molars: in bitewing films so that it only exposes a (I ) (2) - portion of the film.The unexposed .7. Maxillary cuspid: portion of the film is clear when it is (I ) processed. This error is called cone cutting. d.Foreign image, caused by: (1) Eyeglasses, rubber dam clamps, 8. List the characteristio of the teeth that can removable partial dentures, amalgam in offer clues to the identity of a radiograph. tooth sockets, metal'in tissues. (2) Radiopaque objects in the X-ray unit cone. (3) Fingers interposed between the film packet and the cone. 642. List the terms that relate to the visual e. Blurred image, caused Ly: quality of radiographs, and identity the causes of (1) Movement of the patient, film, or X-ray faulty radiographs. unit head. (2) Double exposure. Evaluation of Diagnostic X-Rays. You must be f Distorted image, caused by: able to evaluate the radiographs that you take and (1) Film packet bent daring exposure. determine whether they are of diagnostic quality or (2) Improper angulation. not. This does not mean that you willmake a g. Fogged image, caused by: diagnosis.it means that you must determine (1) Unintentional exposlre of film to whether the radiographs are of acceptable quality to radiation because of improper storage. aid the dentist in making a diagnosis. There are a (2) Use of overage film that has been exposed number of things that you must consider when to heat or chemical fumes. making your evaluation. Consider the visual quality (3) Improperly mixed or contaminated of the image, and whether correct techniques were developer solution. used for film placement, vertical angulation, (4) Safelight scr...en bleached, thin, or horizontal angulation, projection of the central ray, cracked. exposure, and processing. Visual quality of the image.Radiograph quality requires clear definition and maximum accuracy in NOTE: Fog may be described as a dark gray the portrayal of the dental structures as they actually appearance on the film, with a loss .4detail and an
70 3.--; 1 ) absence of the contrasting light elements of the contact with electric current supply due v-A picture. (The radiograph lacks contrast or sparkle.) to loose locking collar. h. Stained or streaked film, caused by: (1) Dirty solutions. Exercises (642): (2) Unclean film holders or hangers. (3) Insufficient fixing or washing. L. List the terms and their meanings that relate to the visual quality of a radiographic image. i.Black spots, caused by bending the film packet to the extent that the packet cracks open and admits light. j.Fingerprinted films, caused by handling the films by flat surfaces instead of placing Identify the causes of faulty radiographs by fingertips on the edges. matching the cause in column B to the fault listed in k. Reticulation, caused by carrying the film from column A. a warmer to a colder solution or use of processing solution of over 75° F. Column A Column B Reticulation is a netlike appearance of the 2. Distorted image. a.Insufficient exposure or film. The film may appear to be covered with 3. Herringbone im- developing time. little globules. age. b. Film left too long in 4. Dense image. freshly mixed fixer solu- 1. Herringbone image, caused by placing the iNo image. tion. wrong side of the film packet toward the 6.Bleacherl image. c.Improper angulation or source of the X-rays. Instead of a herringbone 7.Partial image. excessive bending of the image, some film will show the words 8. Reticulaiion. film packet. WRONG SIDE EXPOSED" when, ;n fact, 9. Foreign image. t!.Unintentional exposure of 10. Thin image. film to radiation because the wrong side has been exposed. I I. Blurred image. of improper storay. m. Bleached image, caused by leaving film in a 1 2. Black areas on the e. Insufficient fixing or freshly mixed fixer solution for too long a film washing. time, especially at elevated temperatures. 13. Fogged image. f.Using a solution over 75* 14. Stained or streaked F. or carrying the film n. Black areas on film, caused by discharge of film. from a wanner to a colder static electricity, due to pulling a film from its solution. paper wrapping too rapidly in a dry s.Placing the wrong side of atmosphere. the film packet toward the v. Crescent-shaped lines, caused by damage to source of the X-rays. h.Pulling the film from its the emulsion resulting from sharp bending of paper wrapping too the film packet. rapidly. p.No image obtained on the processed i.Placing the film in the fix- radiograph, caused by: er solution prior to the de- (1) Electric plug not in, circuit breaker veloper solution. J. Movement of the patient, switch off, timer not lifted from hook, film, or X-ray unit heed. timer button not pushed down hard, or k.Not completely immersing the voltage compensator indicator not on the film in the developer solution. a contact point. I.Radiopaque objeas in the (2) Film placed in fixer solution before being X-ray unit's cone. placed in developer solution. m. Too long a developing or (3) X-ray unit head not making proper exposure time.
71 3 71 CHAPTER 3
General Assisting Procedures
THE SAYING"It's not whether you win or lose obtain these relations by fulfilling the psychological that counts, but how you play the game" is one that needs of your patients and coworkers. As you should be remembered by all dental personnel. recall, these needs include security, recognition. Since most patients do not have the educational affection, and achievement. Having good relations background to judge the professional merit of the with your coworkers and patients promotes a dental treatment, it is obvious that they must draw feeling of harmony. It makes your job more their conclusions from other factors. These factors enjoyable and results in a smoother running, more are, fundamentally, how you and the other reputable dental service. members of the dental staff participate to make Behavior. Certainly behavior relates to their visits to the dental clinic as pleasant as professional standards. You are working in a possible. professional atmosphere, and anything you do to As a member of the dental career field you are distract from that atmosphere degrades your well aware that one of the prime responsibilities is profession. Patients come to the dental clinic for providing assistance to the dental officer. To treatment by professionalsdon't let them think effectively provide this assistance. you must be you are anything less. Even witnessing harmless knowledgeable of the fundamental assisting "horseplay" can have a negative effect on a patient procedures. This chapter is devoted to professional who is in pain or who is apprehensive. Abusive or standards and the fundamental assisting offensive language has the same effect. Always procedures. refrain from any unprofessional actions in patient areas. This includes the reception area and waiting 34. Professional Standards room since this is where the patient forms his first impression. Also remember the white uniform you Strangely enough, most people do not wear differs from fatigues as it identifies you with acknowledge that members of the health care the medical services. Your behavior when in whites sciences possess human weaknesses. Instead, they should be such as to make your profession proud. consider them as rather sacred and associate them Professional Ethics. Just as physicians and with the great television healers like Ben Casey, Joe dentists have a code of ethics so do dental assistants. Gannon, or Marcus We lby. They admire and The following code of ethics was formulated by the respect the members of health care sciences, and American Dental Assistants Association (ADAA). rightfully so, as health care science is an admirable It applies to both military and civilian dental and respectable profession. The general public assistants. Study it carefully. didn't get this impression by accident. It was earned The spirit of (he Golden Rule should bc the guiding through our observance of the standards set by our principle of conduct for the dental asistant. In all your profession. These standards include our contacts with the dental profession and socicty you professional relations, behavior, and ethics. This should maintain honesty. loyalty, and desire to serve to section discusses these standards and the legal the best of your ability. your dentist, your organization. and our patients implications of the dental health team. You should give to your dentist and your organization the cooperation they need to serve our patients capably and efficiently You will hold in confidence the details of professional service rendered 643. State the purpose for the professional by your dentists You should refrain from performing standards required within the dental service and any service for patients which requires the professional given a list of actions, identify those that could competence of the dentist. or which may be prohtbtied by result in legal implicatious. applicable dental practice acts of the state in which employed. You should 2void making any disparaging remarks Professional Relationships. Basically about the conduct of the profession you serve or your professional relations are no different than the dentist's treatment of his patients human relations we have already discussed. You You have the obligation of increasing your skill and
72 '3 ') etfkiency hy availutg yourselt of the educational Which one., is right? Thc patient could feel the opportunities provided by the American Dental dcntist is cxtracting a tooth that could be saved and Assistants Assooation and its component societies. You should take part an the efforts of ths3e groups to improve bring legal action against him. For this reason you the educational status of the dental assivant and should should refrain from telling the patient too much. support this Code of Ethuz. Refer him to the dental officer for the cxact treatmcnt plan. Legal Implications. Laws established by the Equipment maintenance. If a patient is injured American Dental Association and the Statc Dental because of faulty equipment. thc dentist may be Practice Acts provide for thc legal practicc of chargcd with negligence. Since thc maintenance of dentistry. Since the dentist is licensed and you arc equipment is your responsibility, you must be sure not, he is legally responsible for patient treatment. everything is working properly. Pay particular This,, however, does not relieve you of your attention to X-ray units and operating lights which responsibility. You must be awarc of these legalities could fall and injurc the patient. to prevent compromise of the cxisting laws. Lct's Sterilization. The use of unsterile technique can look at somc legal complications in which you resultinliability. The dentist relies on you to could be involved. properly sterilize his instruments and to help him Perfbrming unauthorized services. Each statc has a avoid patient contamination. There is no excuse for Dental Practicc Act, which authorizes the allowable shortcutting sterile techniques. You must observe duties of civilian dental auxiliaries. Thcsc duties thc proper sterilization procedures and frequently vary from statc to state. For instancc, auxiliaries check your sterilizers to makc sure they are may not be allowed to expose radiographs by one operating properly. statc but may be authorized to by another statc. Drug administration. Use of a wrong drug which Military dental assistants are not limited by thc results in injury ii also negligence. This could result Dental Practicc Act while performing duties on a if you give the dentist the wrong drug or have drugs military installation. Your duties are, however, without labels or with improper labels in the summarizcd in AFM 39-1, Airman Classification treatment room. When passing a drug to the dentist, Manual. These dutics as they appear in AFM 39-1 you should tell him what drug you are giving him. can be found in Volume I. Chaptcr 1, of this CDC. This final check helps prevent thc administration of You must know your legal restrictions and not wrong drugs. There is no excuse for unlabeled surpass thcm, regardless of how qualified you feel. drugs. It takes only a few minutes to make a label Leaving patients unattended. You have probably for medication bottles, and these few minutes could seen paticnts experience syncope or drug reactions prevent injury to a patient. and fully realize why paticnts shouldn't be left unattended. Nevertheless, this cannot bc Exercises (643): overemphasized. If the dcntist leaves the treatment room, be surc you stay with the patient. Paticnts I. What is accomplished by establishing good who arc injured by falls or medication rcactions professional relationships with patients and while unattended could file and probably win a coworkers? lawsuit. Privileged communications. In your work you arc exposed to much information that is considered 2. How can you obtain good professional privileged communication. Thc best way to avoid relationships? violating privileged communication is to simply refrain from talking about your patients. Health histories may reveal that Mrs. X has had a breast removed or Sergeant Y has had a venereal disease. 3. Why should you rcfrain from horseplay in thc This is nobody's business but yours, the dentist's. patient areas of thc dental clinic? and thc patient's. Don't sprcad it around, as itis privilegedcommunication.Evendiscussinga , patient's routinc treatment with someone without a need to know must be avoided. Kccp thc business of 4. What should be used as the guiding principle of thc trcatmcnt room in thc trcatmcnt room. conduct for thc dental assistant? Prescribing ,reatment. Many times paticnts will ask you what trcatmcnt the dentistis going to perform. Although it seems harmless enough to tell him, it can result in complications. For instance. 5. Identify each action that could result in legal you tell a patient thc dcntist is going to rcstorc a implications by placing a checkmark ncxt to thc tooth: then thc dentist examincs thc radiograph and action. 'nforms him that thc tooth must be removed. Now a. Seating thc paticnt in an uncomfortable thc patien; has two conflicting treatment plans. position.
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373 -30 when they appear for a dental appointment, they are _b.Leaving a medicated patient unattended. c.Telling the patient what treatment the more acutely aware of the appearance andcleanli- dental officer is going to perform. ness of the treatment room when theyfirst enter. d.Mixing materials according to manufac- Theiefore, in preparing the treatment room, it is turer's instructions. important to carry out certain procedures. Clean e. Shortcutting sterile techniques. and disinfect the dental unit and other dental f. Discussing the patient's health history cabinets, work surfaces. arms of chairs. and lamps with the dentist. with an alcohol sponge. Clean the cuspidor of debris and blood, since this is the area a patient ob- g. Underexposing a radiograph. paperwork should h.Administering the wrong drug. serves when he expectorates. All be stored in cabinets or desks. The medicaments and instruments should also be neatly arranged with as few exhibited as possible. Apprehensivepatients dislike viewing instruments and medications. Make 3-2- Fundamental Assisting Procedures sure that hand towels are clean and neatlyarranged. During your career, you may assist several Place the standard diagnostic instruments (mouth different dental officers. You may further assist in mirror, explorer, and cotton pliers) on the bracket several or all of the dental specialties. In doing so. table along with a clean saliva ejector. you will find dental officers do notalways carry out Once you have the treatment room ready you procedures in the same way. Dentalofficers should review the patient's dental health folder. generally follow a similar pattern, but because of Your review should determine the following: individual preferences and variations in profes- If the record is complete. sional training, each performs somewhat If information is current. differently. Consequently, you must learn the If you have the correct record for the patient favorite instruments, medications, and procedural bcing treated. routines of each dental officer you assist. Even If positive responses on the dental patient though there are variations in treattnent routines, history forms are indicated on the outside of there are fundamental assisting procedures and the folder. knowledgm you need to bc an effective dental assis- tant. This section discusses theseprocedures and Should you find chat the contents of a dentalfolder knowledges. are incomplete or noncurrent or that youhave the wrong record for the patient beingtreated, do what 644. Answer pertinent questions about the pro- you can to correct suchconditions. Should you cedures involved with receiving the patient. further find that there is a positive response to any question of the patient's history form (AFForm Receiving the Patient.The importance of how 696). bring this to the attention ofthe dental you receive the dentalpatient cannot be officer. In fact. all discrepancies noted in adental overemphasized. Your personal actions and reac- folder should be brought to his attention.In doing tions help to create an imprcssion in the mind of the so, however, be sure you point outthese discrepan patient. Creating a good impression aids in patient cies before the patient is seated or in a waythat will treatment, whereas an undesirable impressionhin- not cause the patient undue alarm. ders dental treatment. To be sure, you willin- Greeting. Now that you have made the necessary fluence the dental patient. Naturally, your aim preparations. you are ready to receive thepatient. should be to exert influence toward aiding the treat- Whenever possible. walk to the waiting roomand ment each patient is toreceive. his name and rank. As we mentioned earlier, a few careless words or greet the patient pleasantly by Do your best to call out the correctrank and to actions on the part of the assistant can completely correctly. Failure in destroy a favorable image the dental patient might pronounce the patient's name either instance can irritate thepatient and be hold concerning the Air Force dental service. As a dental specialist you are constantly under the embarrassing to you. inter. scrutiny of the "public's eye." How you talk, walk, Insomedentalclinics a clinical dress, and perform are noticed by the public.It is. communication sound system is used to direct pa- therefore, imperative that you always guard against tients to the treatment rooms. If this systemis used in your clinic, be sure to greet thepatient at the creating possible adverse impressions and publicity, of the especially when you receive patients. There are door of the treatment room. Regardless three functions involved with receiving patients. system used, bc sure to greeteach patient pleasantly notify the First, you must make preparations for the patient: by name and rank. Also, be sure to believe he next, you greet the patient: and,finally, you seat scheduled patient if there is reason to scheduled time. Failure to him in the dental chair. may not he treated at the of patients Preparation.Since patients are apprehensive do so tcnds to irritate thc hcst
74 Should ou walk to the waiting room to call the patient. or should your dental officer refer a patient to another section. Itis good practice for you to escort the patient. In doing so. you c-an use light conversation to good advantage. Such action helps to relieve the patient of possible apprehension concerning the dental treatment he is to receive. The weather or the patient's hobbies arc good subjects for such occasions. Avoid subjects which could cause a controversy between yourself and the patient. Sewing.Immediately preceding the seating of the patient, you should relieve him of anything that might possibly interfere with his treatment. For example, items such as spectacles or a coat should be removed and placed in an out-of-the-way area. Some dental officers prefer to seat the patient and Head Too Far Back adjust the chair at this point. Most, however, expect A you to seat the patient. The main ideais to seat the patient as comfortably as possible, since the comfortable individual makes a better patient. An uncomfortable patient cannot relax. To scat the patient with ease, the chair should be lowered to its lowest position and the engine arm along with the bracket table should be swung out of the way. If the treatment room you work in is equipped with a chair having an adjustable backrest and headrest. you should have previously set them for the average patient before attempting to seat each patient. Further adjustments may then he made much more easily and seemingly more accurately. You should stand behind the chair as the patient is seated and make the necessan adjustments right away. There is no one seated position for the patient that is suitable for all dental operations. The correct patient position varies becauseofthe arch (maxillary or mandibular) being treated. because of Head Too Far Forward the training of the dental officer you assist, and because of the nature of the treatment to be accomplished. A good rule to follow is to nave the occlusal plane of the patient's mandibular teeth parallel with the floor when his mouth is open. If ,ou arc in doubt about the correct patient position. ask your dental officer. Figure 3-1 shows the correct and incorrect positions of a patient in a dental chair. Most or all of the patient seating procedures may be completed before the dental officer enters the treatment room. When this is the case, you should continue to maintain light conversation with the patient. If the patient asks questions about his particular treatment. ou may answer them if they are within your realm of responsibility. Be extremely careful not to commit the dental officer to a treatment plan he cannot fulfill.Do notattempt to impress patients with your knowledge about dental professional matters. Questions about the Correct Position professional aspects of patient treatment are to be referred to and answered only by the professional Figure 3.1Patient positions 75 V dental officer. It is further important that you do not 10. What tooth plane should be parallel to the floor leave the patient unattended at any time during the when you have the patient seated? course of a treatment procedure. Instead, you should observe the patient and bring abnormal responses (pale, flushed, or clammy skin, etc.) to the immediate attention of a dental officer. I I. What should you do after you have seated the patient and are waiting for the dental officer to Exercises (644): enter the treatment room? I. What are the three functions involved with receiving patients?
645. List two procedures for draping dental patients; state the purpose of each, and briefly 2. What should be used to clean and disinfect the describe each procedure. dental unit, cabinet, chair arms, and the dental lamp? Draping the Patknt. After you have the patient in a comfortable preoperative position, he is ready for draping. There are normally two types of patient drapings used in the dental clinic. They are the 3. What instruments should be placed on the routine drape and the surgical drape. The type of bracket table during the preparation phase? drape selected depends on the procedure to be done What should be done with the other and the preference of the dental officer. instruments? Routine drape. The primary purpose of the routine drape is to protect the patient's clothing. It is used for procedures with a low contamination 4. What should you determine by your revie v. of probability. The routine drape is the most commonly used draping procedure. Linen, paper, the patient's dental health folder? and plastic-backed paper towels are cbmmonly used patient drapes. They are held in position by a towel chain, which is put around the back of the 5. When should you bring discrepancies you find patient's neck. When using the plastic-backed paper in a patient's health record to the attention of napkin, be sure the paper side faces outward. This the dental officer? allows spilled liquids to be absorbed rather than to run down the plastic onto the patient's clothing. Some clinics use a plastic apron that covers the anterior surface of the patient's torso to the knees. 6. Whenever possible, how should you greet the This apron is particularly useful for protecting the patient? patient's clothing when the cavitron is being used. Surgical drape. The surgical drape is used when contamination is a prime consideration. It has a threefold purpose. First, it prevents an appre- 7. Where should you greet the patient if you use hensive patient from seeing instruments that might the clinic's intercommunication system to further aggravate his tensions. Secondly, it prevents direct the patient to your treatment room? the bright operating light from shining into the patient's eyes. Finally, since the Mayo or instrument stand is customarily located behind the patient, the surgical drape will prevent the 8. What topics are acceptable for conversation accidental contamination of the instruments with when escorting a patient? the patient's hair. Using sterile towels, apply the surgical drape in the following manner: Have the patientlifthis head from the headrest. 9. How should the dental chair be positioned Lay two hand towels across the headrest, before you attempt to seat each patient? taking care not to contaminate your gloves. Have the patient lay his head back on the towels. Crisscross the top towel across the eyes and head and secure itin place with a towel clamp.
76 IN 3: t) a V° Allow the bottom towel to drape naturally around be performed, you must furnish him with the the neck and shoulders of the patient. Finally, cover necessary instruments. You must, of course, know the patient's chest with a drape and secure it at the what instruments the procedure requires and the back of the neck to the bottom head drape towel ones the dentist prefers. Instruments should be with a pair of towel clamp forceps. When you have arranged in their sequence of use; this eliminates properly draped a patient, everything in the having to search through all the laid out instruments operative field will be covered except the nose, for the one you want. Although many assistants mouth, and chin. merely lay the needed instrument on the bracket table, some dentists prefer that you go a step further and use instrument packs or tray setups. Exercises (645): Packs.Although instrument packs are primarily I. Name the two draping techniques used for used in oral surgery, they are often used in dental patients. periodontic, endodontic, and restorative dentistry. The pack consists of a series of instruments and supplies. which have been wrapped in a cloth wrapper and sterilized as one unit. The contents of 2. What is the primary purpose of the routine the pack are planned so that almost everything drape? needed for a specific operation is available in the pack. Medications and instruments that could be harmed by sterilization cannot, of course, be included in the pack. An example of this wouldbe a 3. What is used to hold the towel in position for dental handpicce. The use of packs results in a the routine drape? saving of time and energy, because you do not have to gather the needed instruments and supplies one at a time.
4. If the plastic-backed paper napkin is used for Setup trays.Trays are similar to packs as they also the routine drape, which way should the contain most of the supplies and instruments for a napkin's paper side be placed? Why? specific operation. Although packs have the advantage of not needing much storage room, setup trays allow you to prearrange instruments in their using sequence. A typical setup tray includes a 5. When is the plastic apron particularly useful? corrosion-resistant and autoclavable tray (sometimes compartmented) in which the instruments and supplies are placed. The contents are usually covered with a cloth towel, surgical 6. When is the surgical drape used? wrapper, or a suitable metal cover or lid. The entire tray, contents, and cover are then autoclaved as a unit. Setup trays are quite popular in the restorative section.
7 What three purposes does the surgical drape When preparing packs or setup trays, write their fulfill? contents on a piece of autoclave tape, and affix this tape on the outside. After sterilization has been completed, write the date that the contents will no longer be considered sterile on the tape. Failure to 8. Briefly describe how the surgical drape is label the packs or setup trays would cause you to applied. have to open each one until you find the instruments you need. Normally, you do not need to list all of the contents on the label. It is sufficient to identify the contents by the procedure they are to perform. For example, silicate setup, amalgam setup, impacted mandibular third molar setup, 646. List two methods of preparing dental gingivectomy setup. etc. Additionally, be sure that instruments for use, state when each method is all instruments you place in the pack or on the setup preferred, and briefly describe the preparation tray are in good condition. Dull chisels, severely procedure for each. scratched mouth mirrors, and forceps or scissors with stiffly operating h, ige joints should be Select and Arrange Instruments.After ;he remedied before you place them in the pack or dental officer has determined what procedure is to setup tray.
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3',---. , Exercises (646): performed without caustrig undue pain or discomfort to the patient. Your role in I. What must youknow in order to select the administering local anesthetics lies primarily in instruments for aspecific procedure? making preparation for the injecuon.This includes preparing the syringe and other items used prior to and during injection. Preinjection items.Before anesthetic injection. 2. List two ways in which you can prepare the dentist usually prepares the injection site. The instruments for use. preinjection items include an antiseptic solution, a topical anesthetic. cotton-tipped applicators. and 2- by 2-inchgauze sponges. A gauze sponge is used to dry the injection site mucosa prior to the 3. How should you arrange instruments if you application of the antiseptic and the topical place them on the bracket table or in setup anesthetic. Afterhe has dried the injection sue. the trays? dental officer uses a cotton-tipped applicator to paint the area with an antiseptic sidution. Metaphen is a topical antiseptic thatts commonly used. Next. he will use another cotton-upped applicator to 4. Where are instrument packs primarily used? apply thetopical anesthetic. The topical anesthetic is usually supplied as an ointment It is applied to reduce thepain associated with the injection of the needle. Your function during these preinjection S. What advantage do setup trays have over proceduresconsists of preparing the materialsfor instrument packs? use and passing them to the dental officer as he requiresthem Injection items. Theinjection items used in administering local anesthetics include a syringe, a 6. Describe the typical setup tray. needle. and an anesthetic carpule. There are different types ofeach ofthese items availablefor use in the dental clinicsTheretore, it is important type anti prepare the desired t.:ays or packs be dated? that you know each 7. How should setup combination for useby your dental officer Thedental injectionsyringes are available in two typesthe aspirating and nonaspirating types.(See fig 3-2.) The aspirating syringe (top of fig. 3-2) is equipped with a small harpoon on the plunger and a 647. State the purpose of local anesthetics and thumb ring handle. These two characteristics make givenalist of specific items and procedures. it easily identifiable and serve to fulfill an aspirating identify their purpose. function. Thisfunction enables the dental offizer to determine whether or not the needle tip is located Preparing the Local Anesthetic. Prior to in a bloodvessel before he injects the anesthetic performing a painful dental procedure the dental solution. officer injects the patient with a local anesthetic. The aspirating function is made possible by the The anesthetic functions to render the operating site harpoon engaging the rubber stopper located in the insensitive to pain. The procedure may then be anesthetic carpule. Once the harpoon is embedded in the rubber stopper. thedental officer may then apply inward or outward pressure on the stopper by placing his thumb in the thumb ring handle and exerung either inward or outw, pressure. Exerting outwardpressure produces L..tspirating (suction) effect whereas inward pressure forces the anesthetic solution through the needle Thisqualuy enables thedental officer to fulfill the requirement ofassunng that anesthetic solutions are notinjected into blood vessels. The aspiratiog syringe is presently more commonly used than the nmiaspirating syringe Loading the carpulc (cartridge) mit) the aspirauns Figurc 3.2ncsththe sytingta syringc is fait ly easy d()Thcm: syringes arc eithcr
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: .. VI
Figure 3.3In Action needles
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379 the side- or top-loading type. The side-loading type is loaded by pulling the plunger against the top part of the syringe body, which-allows the cartridge to be placed into the slot provided in the body part of the syringe. The top-loading type is loaded by turning the top, threaded portion of the syringe in a clounterclockwise direction. This action removes the top and makes the body part of the syringe ready to receive the cartridge. To complete the loading procedure, the threaded top portion is reattached to the syringe. On both the top- and side-loading syringes the harpoon is embedded into the loaded cartridge by holding the body portion of the syringe with one hand while you lightly tap the top of the handle with the other hand. CAUTION: Do not tap the handle with too much force since this might cause the glass cartridge to shatter. Until you gain experience in this regard, it is good policy for you to wrap a towel around the body portion of the syringe to prevent possible injury from shattered glass. Be sure you use a sterile towel. The nonaspirating syringe (bottom of fig. 3-2) is Rgure 3.5Needle destruction unit basically the same as the aspirating type, with two exceptions. These exceptions are that the nonaspirating syringe plunger is absent from the in Air Force dental clinics. They are lidocaine harpoon, and the handle is the crutch type. hydrochloride, 2 percent, with epinephrine Nonaspirating syringes are also designed in the top- 1:100,000; lidocaine hydrochloride, 2 percent with and side-loading types. epinephrine 1:50,000; mepivacaine hydrochloride, Almost all injection needles used by the Air Force 2 percent, with levonordefrin as a vasoconstrictor; dental service are the disposable type. (See fig. 3-3.) and mepivacaine hydrochloride, 3 percent, without For this reason, we limit our discussion to the a vasoconstrictor. Each of the four types is sealed in disposable type. These disposable needles are 1.8 cc glass cartridges or carpules. The needle end available in a variety of gauges and lengths. Those of each cartridge is sealed with a rubber membrane, listed in the Federal Supply Catalog are in either which is held in place by a metal band. The other or 17/e-inch lengths, and both lengths are end is sealed with a rubber stopper. There is a color available in either 25- or 27-gauge openings. All of difference in the rubber stoppers used in each the disposable needles arrive in individual, sealed, different type of anesthetic. As you gain experience, pl:,capsulelike containers and also in a you will be able to distinguish each type of presterilized condition. Further, each of these anesthetic by these color differences. Figure 3-4 needles is equipped with either a plastic or shows an anesthetic carpule. Having considered the aluminum alloy hub designed to screw onto the necessary parts, let's see how they ale assembled to threaded end of the syringe. This hub is positioned make ready for an injection. to permit the needle to extend inward to penetrate The dental officer will notify you as to which the rubber seal portion of a loaded anesthetic type of anesthetic he desires to use, which syringe, cartridge and outward for injection into the patient. which needle he will use, and whether or not he will The plastic that encapsulates the sterile needle is use a topical anesthetic. As a general guide, the easily slipped from both ends of the hub. When you following steps should be observed in preparing for place a needle onto the syringe, remove only the an anesthetic injection: capsule part which covers the syringe portion of the (1) Place on the bracket table, as indicated, the needle. In this manner, you maintain the sterility of antiseptic solution. the topical anesthetic, two the needle portion used to inject the patient until it sterile cotton-tipped applicators, and a sterile 2- by is needed. 2-inch gauze sponge Several different anesthetic cartridges ..-e found (2) Once you know which type of anesthetic, syringe, and needle the dental officer desires to use, you may assemble them for the injection while the dental officer andministers the antiseptic and the topical anesthetic.
To assemble these items, you should, first of all. Figure 3-4. Anesthetic carpule. make all assembling and handling procedures out
83 '3"i 1 of view of the patient. You are expecting to (1 ) (1)honn place the needle on the syringe (usually a short I.Charactemed byautch- needle for maxillary injections and a long needle type handle for mandibular injections), (2) load the cartridge, m. Anesthetic carpules should (3) embed the harpoon in the rubber stopper (when be stored an this. using the aspirating type syringe), and (4) forcea small but visible amount of anesthesia through the needle to assure that all things are in readiness for the injection. Guard against contaminating the patient with infectious microorganisms by using 648. Indicate the knowledges and procedures properly sterilized syringes, needles, and anesthetic required to properly pass instruments and cartridges. The syringes and needles should have materials by answering a series of key questions. been autoclaved or sterilized with dry heat, whereas the anesthetic cartridges should have been stored with the metal-banded end pointed downward in Pass Instruments and Materials. One of the a most important duties of the chairside assistant is 70-percent isopropyl alcohol solution. You should the passing and receiving of instruments and continue to guard against possible contamination materials. To perform this task you must know the by keeping the plastic needle covering in place until you pass the syringe to the dental officer. Naturally. routine of the procedures and the related this cover must be removed to test for proper instruments and materials required. This enables you to anticipate the dentist's needs and allows you operation of the syringe and during the injection but should then be returned to its protective to fulfill these needs without unnecessary delays. The position you work from is dependent on the position. After each patient has been dismissed, you desire of the dentist and the arrangement of the should bend and break or cut the needles to prevent treatment room. further use. A destruction unitis available for disposable syringes and needles. You simply insert Pass and receive instruments. Let's assume that the needle into the unit's small orifice and squeeze you are standing on the left side of a patient who is the handles on the unit with a fast squeezing action. being treated by a right-handed dentist. In most (See fig. 3-5.) This shears the needle off at its hub so cases, you remove one instrument from die dentist's that it may not be reused. right hand and place the next needed instrument in his hand when given a signal. The signal may be a Exercises (647)t spoken word, a slight to monerate movement of his hand away from the patient's mcuth, or only a I. What is the purpose of administering a local pause in using the instrument. As the dentist gives anesthetic? his signal, you should remove the working instrument and pass the next needed instrument with the working end pointed toward the treatment area. In items 2 through 14 identify the purpose of the specific item or procedure listed in column B with To begin the passing routine, you normally hold the item or procedure listed in column A. the instrument with your left hand in the position Column 4 Cidiunn B where the dentist may grasp it with his working hand without movement of his working hand. Do 2Short 13/16-inch a A commonly used topical needle antiseptic not release your grip until the dentist has firmly 3 Nonaspirating Lsed to dry the mucosa at grasped the instrument. The dentist will signal that syringe the injection site he has finished with the working instrument and 4 Gauze sponge. Needle usually used for desires the next instrument. The instrument ex- 5 t 8 cc glass car maxillary injections change and placement differs with various dentists; pules d.Used to apply the antisep. 6. Metaphen. tic or topical anesthesia. therefore, you should ask how the dentist would 7Cotton.tipped ap. Used to reduce the pain like to receive and exchange instruments. When you plicators. associated wuh the mice- assist from the right side and in front of the patient, 8Topical anesthetic tion of the needle you use your right hand in the same manner as 9 The syringe's har. IContains the anesthetic poon g.Makes aspiration possible described for the left hand above. 10 Tappingthe sy- hEmployed to prevent reuse ringe's handle. of the needles Prepare and pass materials. Dental material must II 70-percent Assures that anesthetics be prepared at the proper time. A material mixed isopropyl alcohol arc not injected into the too soon does not allow sufficient handling time. solution blood vessels For example. an impression material mixed before 12. Vasoconstrictors. j Epinephrine and levonor. 13Destruction unit detnn. the dentist is ready for it may harden or set in the 14Aspiration Embeds the harpoon into impression tray before it can be placed in the the rubber stopper patient's mouth. On the other hand. a delay in
8 I 391 mixing an impression material on your pan tends to 649. state the purpose of retraction, list the irritate the dental officer in addition to waning instruments used, and indicate how much pressure time. Similar results occur when there is a pre- should be applied when retracting tissue. mature or delayed mixing of other dental materials. Therefore, knowing when to mix is equally as im- RetractTissue. During many dental procedures. portant as knowing how to mix. As with instru- there is a need to retract oral tissues. Retraction is ments, knowing the routine of the procedure allows normally performed to give the dentist easier you to anticipate when the dental officer willneed operating accessibility, to allow a better view of the the specific materials. You should have the mixing operation site, and to protect the tissues being equipment ready and the material proportioned retracted. The tongue, cheek. lips, and gingiva are slightly prior to the time they are needed. Begin tissues which must often be retracted. As you recall, mixing only when you know the dental officer is the Thoma Iand 2 retractors are helpful in ready. retracting gingival naps and the Seldin #23 and When you are assisting during an amalgam Molt #9 periosteal elevators may be used on restoration, you load the amalgam into the gingival flaps and other oral tissues. The mouth amalgam carrier and pass the loaded carrier to the mirror is very effective and is widely used to retract dental officer. You may sometimes use two or more the tongue, cheeks, and lips. There are several amalgam carriers, which enable you to fill the medical-type retractors and a few of this type are barrel of one while the 'dental officer is using the sometimes used to retract oral tissue. other. Of course, you must also pass condensing The. main idea in retracting oral tissues is to instruments during the amalgam restoration firmly hold the tissue concerned out of the way to process. During the use of silicate andzinc permit better viewing and access to the operation phosphate cements, most dental officers prefer that site, and to protect the tissue being retracted. For you leave the mixed cement on the glass slaband example, the gingival tissues covering an impacted then place the glass slab in an accessible place (on molar must be retracted to give visual and bracket table or on mobile cabinet top) or hold the instrument access to the operation site. For another slab with your hand. He is then able to select the example, the tongue can become very unruly in amount he desires for placement in the patient's some patients and must be protected frompossible mouth. The overall idea in passing and receiving harm by rotating burs and other instruments. dental instruments and materials is to have the Likewise, sometimes the cheeks must be retracted needed item at the right place, in the right position, for protection, as well as to permit access to certain and at the right time. In doing this, the dental areas of the mouth. During surgical operations to officer is then free to concentrate more on the area remove salivary stones from the sublingual glands, of treatment. you may need to retract a flap of the oral mucosa with one hand and manipulate an aspirator tip with Exercises(648): the other. In such cases, the dental officer may also need to retract the tongue with one hand and I . What knowledges must you have in order to perform the operation with the other. Whatever the adequately pass instruments and materials? case may be, remember to retract thetissue firmly enough to prevent slippage but not so firmly as to cause unnecessary tissue bruises and trauma.An unfirmly applied retractor tends to result in 2. What signals might the dental officer use to slippage and unnecessary tissue damage. indicate he needs the next instrument? Exercises(649):
I. State the purposes of retraction. 3. How should you place the working end of the instrument you are passing? 2. List the instruments that are used to retract the various tizsues. 4. What knowledge concerning materials is equally important as knowing how to mix? 3. How much pressure should you apply to the tissue you are retracting? 5. What is the overall idea in passing and receiving dental instruments and materials? 3S, 82 650. State the purpose of irrigation and of fluids that accumulate during cavity preparat.on.-Y4-4° aspiration, list the irrigation medias; and given a Your role in handling the oral evacuazor is series of descriptive statements, diffe12nliale frequently to manipulate the suction tip, to aspirate between the types of irrigation and aspiration the oral fluids, and to assure that a sterile tip is in equipment. place for each patient. You must also clean and maintain the oral evacuator as instructed in the Irrigation and Aspiration. The job of irrigating manufacturer's maintenance pamphlet. the oral cavity is yours for the most part. By Gomco aspirator.The Gomco aspirator is applying water or saline solutions to operating areas primarily used during periodontic and oral surgical in the oral cavity, you bring small tooth particles, procedures. The small aspirating tips are especially dried blood, and other debris into solution so that helpful in removing debris, blood, and fluids from these materials can then be removed by aspiration. tooth sockets during attempts to locate and remove This leaves a clean field of operation for the dental root tips. The suction ability of the Gomco officer. The use of handpietes with a water spray aspirator is better than the saliva ejector but lea system has eliminated much of the need for than that of the oral evacuator. An important part irrigation by the dental assistant during restorative of your role concerning the Gomco aspirator is to procedures. Sometimes, however, the dental officer assure the sterility of the aspirator handle and the may need additional irrigation, or he may elect not aspirator tip for each patient. When operating this to use the water spray system for a particular aspirator, keep a close watch on the reservoir bottle procedure. If this is the case, use the dental unit to make sure it doesn't overflow. After each use, mounted water syringe to irrigate the operative site. empty and clean the reservoir bottle, flush the When you irrigate operation sites during surgical tubing with water, remove and sterilize the procedures, you normally use a sterile saline aspirator handle and tips, and disinfect the latex solution or sterile water as the irrigation medium. tubing. Follow the manufacturer's instruction You may apply these fluids by using either a bulb- concerning other maintenance requiremenu for this type or Luer (piston-barrel) syringe. The main piece of equipment. purpose for irrigation during surgical procedures is to maintain a clean field of operation. The Exercises (650): cleansing is not completed. however, until the I. What is the purpose of irrigation and irrigating solution is aspirated (drawn by suction) aspiration? from the mouth. Aspiration is necessary to remove blood, pus, saliva, and debris from the field of operation and the oral cavity. This is accomplished in one of three 2. What type of irngation media is normally used ways in Air Force dental clinics: by using the saliva for restorative procedures? ejector, the oral evacuator, or the Gomco aspirator. When using any of these aspirators, always place their tip in the upright position before turning them off. This helps prevent the clogging of their hoses by 3. List the irrigation media used for surgical materials that have pawed completely through. procedures. Saliva ejector.Your role in using the saliva ejector is primarily to assure that a sterile saliva ejector tip is in place for each patient. The saliva ejector is used when the aspirating requirement is Differentiate between the types of irrigation and mostly limited to removing saliva from the patient's aspiration equipment by matching the descriptive mouth. The saliva ejector does not have enough statement in column B to the equipment incolumn suction power to remove large volumes of soltPions A. from the oral cavity. This aspirating device is Column el Column8 widely used, however, to remove salivary secretions 4 Gornco aspirator a.Use for irrigation during after the cavity has been prepared and during the - surgical priccdures. S. Saliva ejector. - b.Its low suction power placement of filling materials in the cavity 6. Oral evacuator. - limits its use mostly to preparation. Bulb-type or Luct syringe. removing salivary secre- Oral evacuator.The oral evacuator is generally 8. The unit's water dons. described asahigh-volume, low-pressure suction - c.Usai for irrigauon during syringe or spray apparatus. That is, the oral evacuator is capable of system. restorauve procedures. removing a high volume of fluids from the oral d.Ideal for removing large volumes of solutions from cavity and yet does not exert injurious suction the oral cavity pressure to oral soft tissues. These qualities make ePrimarily used for wira . the oral evacuator almost the ideal suction tion during surgical pro- apparatus for removing the relatively high volume cedures.
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3S3 651. Define the word "culture" and answer a be easily attached to the test tube and provide the Seriesof key aptestions that trace the steps following information is staitable: involved with culture preparation. Patient's name. Date end time of sample taken. Preparing Cultures. The task of preparing Whether it is the first, second, etc., culture cultures is important, even though it is not taken. frequently used in all dental specialties. When the Description of sample (root canal, abscess, word "culture" is used in connection with the work etc.). involved in the medical and dental profeuions, it Type of report desired. means the attempt to gather a sampleof microorganisms from a patient and to promote For endodontic purposes, usually a report stating growth of those microorganisms. In dentistry, positive or negative is sufficient. For dental suritry -.ultures are most frequently associated with reports, however, the dental officer may desire endodontics (root canal therapy) and dental surgery information as to the exact type or types of (oral sutlery and periodontal surgery). microorganisms found. When cultures are To prepare a culture, there are definite steps to forwarded to the medical laboratory, they should be be taken in proper sequence. Basically, these steps accompanied with an SF 557, Miscellaneous Test involve gathering a sample of microorganisms, or Examination, which has been properly filled out. placing the sample in or on a suitable culture Incubation. For the microorganisms to grow media, carefully labeling the sample, incubating the properly. they must be subjected to culture sample, and finally evaluating the culture. Some of incubation temperature (37' C. or 98.6' F.). This these steps are performed by the dental officer, temperature is attained and maintained in special some by you, and some by the medicallaboratory. incubators (small ovens) usually found in Air Force Let'sfurtherconsider these steps one at a time. medical laboratories. Usuallya sample of Microorganism sample. In the endodontic micmorganisms introduced to a suitable culture section, a sample of root canal microorganisms is medium will show signs of growth within 48 hours taken by inacrting a sterile paper point imo the root of subjection to the incubation temperature. canal. The contaminated paper point is placed in a Evuluation. Evaluation of cultures is rendered by culture medium contained in a test tube, and the medical laboratory personnel in nearly all cases. tube is then sealed. Microorganism samples from For endodontic purposes, however, the evaluation dental surgery sites are usually acquired by is not very difficult to make. The only report swabbing the site with a sterile cotton-tipped needed for most endodontic. cases is that there is applicator. The sample is then placed in a test tube (positive) or is not (negative) visible evidence of and sealed to prevent further contamination until microbial growth in/on the culture med:um. A the sample can be placed on a culture media. cloudy ascites solutionispositive, and visible Flame the opening of the test tube upon opening moldlike growth on a gelatin medium is likewise and just before sealing it. To flame the opening of positive. the test tube, tilt itsliglulyand hold it over a lighted Bunsen burner. Flaming destroys microorganisms Exercises (651): that may be found near 'Ne opening of the tube. I. Define the word -culture." This is very importan%ince it helps prevent introducing microormisms other than those obtained in the sample. Culture media.Culture media for promoting 2. Describe how the cultures are obtained. microorganism growth in endodontic cases are usually in solution form. Two common solutions used are penase ascites and glucose ucites. These solutions appear mostly clear with a slightly yellow 3. What should you do upon opening the test tube tint. The glucose ascites is suitable for rapid growth just prio: to sealing the tube? of many types of microorganisms but is more commonly used with root canal samples that have beentreated withcamphorated parachlorophenol. In contrast, the penase ascites is specially 4. What type of culture media is commonly used formulated for ust with samples from root canals with root:anal samples which have been that have been treated with penicillin. Beef broth treated with penicillin? gelatin is sometimes used as a culture medium aiso. Labeling.Once the sample of microorganisms has been sealed in the test tube, you must complete and attach a label to the tube. There is no one 5. What data should be included on thelabel you standard label for this purpose. Any label that can attach to the test tube?
84 6. What type of report is sufficient for endodontic assist at the chairside for the duration of the PurPosee treatment. In such cases, it is best to complete the dental treatment forms after the patient has been dismiesed rather than detain the patient while you write up the forms. Be sure you don't prolong 7. What incubation temperatures are necessary for completing these associated administrative tasks, cultures to grow properlY! since you may forget some of the specifics involved. Thus, making administrative duties a postoperative function assures timely and skurate entries oti treatment forms and records. 8. How soon should growth be apparent after a Store materials dean and sterilize instruments. All mature has been introduced into the incuVation medications and materials used during patient media? treatment should be put back into proper order. Materials and medications that may be reused should be returned to their proper place in the dental cibinet. The dental instruments laid out for 9. How does a positive growth structure appear in the operation must be scrubbed with soap and water the gelatin and ascites mediums? and thoroughly rinsed and dried. The cutting-tyPe instruments should then be sterilized in a dry beat sterilizer, The remaining instruments are usually sterilized in the autoclave. Your role in performing these tasks is critical in preventing possible 652. Give specific facts about the procedures contamination of the next patient. involved whim you are dismissing the patient. Clam and disinfed equipnent. Sometimes the cuspidor and dental unit are splattered with debris Dismiss the Patient. After a dental operation after patients rinse their mouths. Such debris is sure has been completed, -the next procedure is to to be spotted by the next patient if it is not removed. dismiss the patient. Throughout the dismissal To mthntain professional standards, you must not .period, be careful to maintain the same cordial, only remove the debris to provide a clean pleasant mannerisms with which you greeted the appearance, but you must also disinfect the area patient. This kind of personal treatment tends to with a solution such as isopropyl alcohol. In leave the departing patient with the feeling of addition, an alcohol sponge (2- by 2-inch gauze having received the finest treatment possible. sponge dipped in isopropyl alcohol) should be used Careless and rude dismissal of a patient tends to to disinfect all other equipment items used or create a negative attitude about the treatment. For touched during the last treatment session. Items on this reason and many others, your actions help to the dental unit that are frequently used include the create an image of the Air Force dental service. air syringe, the water syringe, handpieces, and the The first step in the dismissal of a patient is to dental operating light handle. remove all debris from his face. Better still, hand Obtain additional needed items. After the patient the patient a hand mirror and a dampened towel has been dismissed and the treatment room is and let him clean his face. You may then remove the restored to its original order, you must obtain any drape. apron, or protective napkin from the patient. additional equipment or supplies needed for the Also, be sure to push the dental operating light and next operation. For example, your dental officer the bracket table to an out-of-the-way position. may be assigned to the restorative dentistry section. Further still, you may need to lower the dental chair Most of the treatment he renders involves placing and move the chair backrest forward, making amalgam and silicate restorations, generally exiting easier. If the patient brought persona; items speaking. However, he may decide to construct a (such as spectacles) and left them in your care, make gold crown or an inlay for professional reasons. it a point to see that he doesn't leave them behind. Normally, all the items necessary for a gold crown Should the patient need a further appointment, be or inlay appointment are not maintained in each sure that he is given one or is given instructions on dental treatment room but are in the prosthodontic how to obtain on: as applicable. Although the section. Under these conditions, you would need to patient treatment is complete, you still have a few obtain the needed Items (impression trays, more tasks to complete. These include completion impression materia6, etc.) as a preoperative duty. of administrative duties and preparation for the next patient. Exercises (652): Complete administrative chafes. In most cases you can complete your administrative tasks during I. Brief:y describe the steps involved in preparing breaks in your chairside assisting routine. However, the patient ta leave the treatment room. some dental treatment procedures require you to
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3 s 5 2. When should you complete the necessary procedures to follow. Exercising good supply administrative tasks? management is important when ordering supplies. Order a working level of supplies. Do not hoard supplies as this may deprive other personnel of the supplies they need. Hoarding also invites thievery. 3. After the patient has departed and the ties up supply dollars needlessly, and may result in administrative procedures have been loss due to supply item deterioration. When completed, what tasks are necessary to restore ordering dental gupplies, consider also what types the treatment room to its original order? of items are needed. When you submit your order. .be sure you have included both the replacement and new items needed for patient treatment. Of course. emergency supply requirements can be filled at any 4. What remains to be done after you have time. restored the treatment room to acceptable Turning in supplies. Aswe implied earlier, order? inventories also determine any supply overages you may have in dental treatment rooms. All overages should be reported to the dental supply personnel or your NCOIC so that further distribution or turn in steps can be taken. As with supply hoarding. 653. List tbe elements invol-ged with dental failure to turn in overages in dental treatment treatment room supply management, state tbeir rooms invites thievery, ties up supplydollars importance, and relate your procedural needlessly, and results in dollar loss because of responsibility. suppiy item deterioration. Storage of supply items is also important. Management of Treatment Room Supply Storing supplies.Once you receive dental supplies Levels. To fully consider the chairside assistant's in the dental treatment room, you have further role in basic assisting procedures we must give some responsibility to properly store the supplies. attention to the supplies used in dental treatment Basically, proper storage entails taking the steps rooms. This requirement includes both patient necessary to protect the supply items. This means treatment supplies and the administrative forms keeping bottles tightly closed, keeping older items needed to record patient treatment. As a general in front so that they will be used first, and storing rule, you must inventory, order, turn in, and store only enough of each supply item to last for a few dental supplies in the dental treatment room similar days. Also remember to keep such items as to managing supplies in the dental supply section. hydrogen peroxide stored in a cool, dark place; Naturally, there is a big difference in the volume of keep certain drugs and precious metals under lock supplies handled in the dental treatment room and and key; and take any other steps necessary to the dental supply section. Let's consider the protect supply items. elements of inventory, ordering, turning-in, and storing functions one at a time. Exercises (653): Inventory.One of the more important elements 1. List the elements involved with dental in maintaining supply levels in dental treatment treatment room supply management. rooms is that of conducting thorough and frequent inventories. Inventories are necessary to be sure that you don't run out of supplies during a patient's treatment, and that you don't have an excess of 2. Why is it important to inventory supplies? materials on hand. For best results, you should conduct adaily inventoryof the supply stock in your treatment room. When you have inventory data available, you may compare it with your estimate of 3. For best results. how often should you the supplies needed to treat the daily schedule of inventory your treatment room supplies? patients and determine the necessary adjustments. To make the adjustments, you may need to turn in or order (requisition) supplies. Ordering supplies.The exact procedures to follow 4. Why is it important not to hoard supplies? when ordering supplies within the dental clinic vary from base to base. Some clinics require you to submit a written list of supplies needed each duty day. Other clinics only require you to submit your 5.Why should you turn in supplies that your requirements verbally. You should check with inventory shows as excess? dental supply personnel for the correct ordering 3S6 86 $ 6. What does the proper storage of supply items statements are true or false, (T or F:). If you answer basically entail? false, state why. T F11 The dentist should keep his hands and eyes in the opetating zone.
3-3. Four-Handed Dentistry Many studies of dental manpower problems have T F2. The assistant should work from a been conducted over the last 30 years. These studies standing position. indicate that the dental profession must increase its productivity to keep up with the dental needs of our growing population. Today's jentists are responsible for treating many more patients than T F3. The operating equipment should be the dentists of the past. In other words, the patient positioned solely for the convenience of population has been increasing faster than the the technician. dentist population. For example, in 1930 there were 58 dentists for every 100,000 people in the United States and in 1965 there were only 45 dentists per 100,000 people. The obvious solution T F4. All routinely performed operation is to produce a greater number of dentists. But this should be routinized. has proven more difficult than it seems. Additional dental schools must be established, existing schools expanded, monies allocated, and more people made interested in a career in dentistry. Another obvious T F5. The patient should be placed in the solution is to increase the productivity of the supine position. dentists currentlyin practice. This solution kindled the birth of four-handed dentistry. Four-handed dentistry, as it has been developed, not only increases productivity but reduces stress and fatigue 655. Given several equipment desips, identify on the operator and his assistant. those that are best suited for four-handed 654. Identify the guidelines suggested for dentistry. implementing the four-handed dentistry concept. Equipment. The selection and positioning of four-handed dentistry equipment is extremely Guidelines of Four-Handed Dentistry. Four- iMportant. Since the operator and assistant are both handed dentistry, as the name implies, uses the working from a sitting position, the equipment hands of the dentist and the assistant to the design must b somewhat different from that for maximum extent. Several guidelines are suggested conventional dentistry. Let's look at some of the for implementing the four-handed dentistry recommended equipment for four-handed concept. They are: dentistry. Both the dentist and assistant should operate Operating stools.Stools for both the dentist and from a seated position, and the patient should assistant should be well padded and comfortable. be placed in the supine position. They must be mobile and have a broad base to give Ope:ating equipment should be selected and them stability. Normally, chairs with at least five positioned for the convenience of the dentist casters are preferred. The stools should have a foot- and assistant. support ring so that the user can keep his feet The dentist should keep his hands and eyes in parallel to the floor, thereby maintaining comfort the operating zone. and posture. Additionally, the stool must have a All routinely performed operations should be body support thac can be used for either the routinized. abdomen or back. Dental operating chair.This chair should have a Although these guidelines are not rules, they do thin, !Jarrow back. Chairs with bulky backs make relate a basic formula for the practice of four- patient positioning difficult and also prevent the handed dentistry. dentist and assistant from getting into a comfortable working position. The chair should provide complete body support for the supine patient and Exercises (654): have independently powered back and seat Identify the guidelines that apply to four-handed controls, which can be conveniently adjusted by dentistry by indicating whether the following either the dentist or the assistant. The chair design
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397, should permit rotation for better patient Exereisei (655): positioning. Additionally, it should have a low base Of the equipment designs listed below identify the so that the chair can be lowered to within 14inches design features best suited for the four-handed of the floor. - dentistry concept by placing a checkmark in the Dental unit. Many modern dental units are space provided. designed with four-handed dentistry in mind. The unit should be designed so that it is compact and 1. Operating stool Equipped with a foot support ring. doesn't occupy space needed by the assistant. Hose- _ a. attached instruments, such as the hartdpieces, _b.Has less than five casters. Is immovable and has a narrow base. syringe, and oral evacuator, should be conveniently c. Has a body support that can be used poeitioned to both the dentist and the assistant. The d. for either the abdomen or back. most noticeable difference between this unit and the 2.Dental operating chair conventional unit is the absence of the cuspidor on _ a.Has a low base so that it can be the four-handed dentistry unit. The syringe should lowered to within 18 inches of the be the multipurpose type, which supplies air, water, floor. and spray. _b.Base permits rotation for better pa- Artificial lighting. A ceiling track-mounted light tient positioning. is considered ideal for four-handed dentistry. It c Provides complete bbdy support for.. should be easily adjusted by either the dentist or the supine patients. assistant. If a track-mounted ceiling lighting is d Has thick, broad, well-padded back- impractical, chair- or unit-mounted lighting may be used. Ceiling track-mounted lighting is preferred, e.Has independent positioning con- however, as it is more flexible and does not have trols that can be operated by either mounting attachments that could get in the way of the dentist or technician. . the dentist or his assistant. 3.Dental unit . Cutting equipment. Ideally, you should have a _ a.Has a multipurpose syringe. slow-speed handpiece and two or more high-speed _b.Has a compact design. handpieces. Having an adequate number of c Has hose-attached instruments con- hanapieces eliminates the loss of time previously veniently positioned for both the. experienced for changing burs. Afl handpieces dentist and technician. should be controlled by a single, variable-speed d Is not equipped with a cuspidor. foot-control. The foot-control should be- the 4.Artificial lighting straight line depression type rather than the rotation _ a. Should be unit mounted. type. This enables the operator to keep his foot in _b.Should be easily adjusted by either one position for better control and more comfort. the dentist or technician. 5.Cutting equipment Cabinets. Avoid overcrowding the treatment _ a.All handpieces controlled by a single room with unneeded cabinets. Normally, afew variable-speed foot control. wall-mounted cabinets are enough to store needed _I? Has a rotation-type foot control. supplies. Two sink-top cabinets should be c Is composed of a slow-speed provided. One is for the dentist to wash his hands, handpiece and two or more high- and the other for the assistant to wash his hands and speed handpieces. clean instruments. This saves time as neither person 6.Cabinets has to wait for the other. A specially designed a Mounted cabinets should provide mobile cabinet is also needed. This cabinet should sink-top cabinets for both the dentist provide easily accessible space for the supplies and and the technician. equipment needed during the patient's treatment. b The mobile cabinet should provide a Additionally, it should provide a working surface working service over the assivant's over the assistant's lap and be of aheight lap. comfortable for the sit-down assistant. 7.Setup trays Setup trays. An adequate number of setup trays _ a.Should never be color coded. are needed. As mentioned before,these trays _b.Should contain prearranged, steri- contain prearranged sterilized instruments and lized instruments arid materials for materials for specific procedures. Storage space for specific procedures. these trays must also be provided. A good idea is to color code these trays with tape; for example, blue for amalgam, red for silicate, yellow for gold, etc. 656. State the operating positions that shouldbe Instruments may also be coded to identify them as a employed in the practice of four-handed part of a particular tray setup dentistry. 883 S3 ' operating Positions. Once the patient has been your feet directed toward the head of the chair. This seated. the dentist and his assistant should place position permits you to reach the field of operation, VP' themselves in the proper positions for treatment. hose-attached instruments, and the instruments and These positions can be best understood by relating materials from the mobile cabinet without leaning, them to A clock (see fig. 3-6). The demist's stool twisting, or overextending your arms. You should should be in the 8- to I I-o'clock position, and the adjust your stool so that your eye level is 4 ,to 6 assistant's stool should be in the 2- to 5-o'clock inches above the dentist's eye level. And, like the position. Instruments and materials are, of course, dentist, you should sit in an erect position. The passed in the transfer zone. The static zone is mobile cabinet should be placed toward the head of basically an area of no activity. the chair and so positioned to allow you easy access The dentist should sit in a poSition with his back to the needed instruments and materials. straight and head relatively erect. This helps prevent curvature of the spine. His shoulders should be Exercises (656): parallel with the floor and his elbows close to his sides. The patient should be lowered to a position I . As related to the face of a cloek, in what zones that pikes the field of operation as close to the should the dentist's and assistant's stools be dentist's elbow level as possible. The dentist should positioned? further position himself so that the patient's mouth is in line with his sagittal body plane. When he is properly positioned, the dentist's eyes should be 14 to 16 inches from the operating site. 2. In what zone are instruments and materials passed? As the assistant, you should sit as close as possible to the backrest of the patient's chair with
STATIC ZONE -
NEW PENATOR'S .tr\ ZONE
-a
/ASSISTANT'S ' ZONE tFT mn..tyw'rw- -
UP'
Figure 3.6. Operating zones.
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3S9 3. To what level should the patient be lowered? with the right hand and transfer instruments with your left hand. /nstrument transfers. Since your right hand is busy aspirating, you must team to transfer 4. When he is properly positioned, how far from instruments with your left hand. The one-hand the operating site should the dentist's eyes be? instrument pass may sound difficult at first, but it is quite easy to master. Let's assume that the dentist is using instrument "A" and you.know that he soon will need instrument "B." You pick up instrument "B" bythe end opposite from the working end, and 5. How should the assistant's eye level be in hold it between your thumb and first two fingers. relation to that of the dentist? Hold the instrument close to the field of operation and parallel to the instrument being used., Thern dentist gives you the signal he is ready for instrument "B" by raising instrument "A" from the tooth. Now you take instrument "A" between third 6. Whereshould you position the mobile cabinet? and small finger of your left hand, remove it from the dentist's hand and replace it with instrument "B." Otner duties. If your unit is equipped with two high-speed handpieces, you should place the first cutting bur the dentist needs in one handpiece and the second bur he needs in the other. This eliminates time lost from having to change burs. 657. State the objective of the four-handed The other assisting duties, such as mixing materials dentistry assisting routine and answer a series of and completing the administrative tasks, remain key questions that serve to describe the assisting basically the same. As you get more involved with technique employed with the four-handed four-handed dentistry, even more ways of dentistry concept. improving your routine become apparent. Keep working on them and improving on them! Assisting Duties. Aswe discuss the assisting duties, keep in mind that the prime objective of Routinizing. To be able to properly anticipate the four-handed dentistry is to increase production dentist's needs, you must have a treatment routine. while reducing stress and fatigue to the operator You must know what the dentist is going to do next. To make four-handed dentistry work for you, you and assistant. This demands that the dentist and his assistant work as a well-knit team. Their two heads must establish a set routine for every operation that and four hands must function together toward a can be rbutinized. Then you must systematically common goal. And, resultingly, you as the assistant follow that routine. Once you have done this, you are more involved in the patient treatment. One of and the dentist can accomplish more procedures the guidelines we previously mentioned stated that and be less fatigued at the end of the workday. the dentist's hands and eyes should not leave the working area. This, of course, mans that you must Exercises (657): fully know the treatment routine and have each instrument and material ready at the proper time. I.What is the prime objecti..e of the four-handed Also, the absence of the cuspidor means that you dentistry concept? must aspirate throughout many phases of the procedure. Let's first discuss aspiration. Aspiration. You might wonder why the cuspidor has been eliminated from the four-handed dentistry unit. Actually the answer is quite simpleit eliminates the time lost when the patient expectorates. This, of course, means that you must aspirate throughout the procedure. You should 2. Why must you spend more time aspirating hold the aspirator tip in a position where it during a four-handed dentistry procedure? adequately evacuates saliva, debris, and water spray from the handpiece. It must be positioned so that it doesn't interfere with the dentist's line of vision or access to the operating site. Normally, you aspirate 3911
90 4 1. Thrust head backward
3. Pinch nostrils 4. Blow into patient's mouth
Figure 3-7. Mouth-to.mouth resuscitation.
3. What is gained by the elimination of the prepared to deal with it effectively. You, cuspidor on the four-handed dentistry unit? personally, should be ready to administer or assist the dental officer in administering lifesaving steps.
658. State how the steps you may take can help 4. How should you position the aspirator tip? prevent emergency situations from occurring. Preparation for Emergencies. A recent task survey showed that only a small percentage of the 5. How does the four-handed dentistry concept dentistry personnel surveyed had ever used a dental alter your instrument-passing technique? emergency kit: This does not reduce the need for training in this area. Although such events are rare, medical emergencies may be and are encountered in dental practice. Medical emergencies pose a threat 6. How can you eliminate much of the time lost in to life in the form of severe reactions, changing burs? complications from drugs and anesthetics, fear, or stress. Since your duties are involved with patient treatment, you must be able to recognize and to administer lifesaving steps if these complications 7. What must you have knowledge of to properly occur. One of your duties is to make sure that anticipate the dentist's needs? proper preparations have been made to cope with emergencies. Naturally, we desire to prevent emergencies from arising whenever possible. Granting that all preventive attempts will not succeed in every case, prevention should still be our goal. Preventive 3-4. Emergency Procedures steps can be taken when dental personnel have Emergencies (life-death situations) in the dental knowledge of the patient's medical history treatment room are rare. However, when a true (allergies, bleeding tendency, etc.) and when we emergency arises, all dental personnel should be recognize emergency signs through observing
91
392 patient actions and responses. For example; a careful check of the dental patient history form(s), AF Form 696, may reveal that the patient is allergic to certain drugs. With this information, the dental officer may use other drugs to treat the patient and, thereby, prevent an emergency. Further, you might observe a patient's response to an injection of lidocaine and detect that he is becoming apprehensive. You may be able to prevent syncope (fainting) in such a situation by allaying the apprehension through casual conversation. Conversation tends to show that you care about the patient and also takes his mind from the present problem. Thus, to be effective in dealing with emergenties, you should.be able to recognize them and react rapidly in a favorable manner.
Exercises (658) I. How can the dental patient history, AF Form 696, help prevent emergency situations?
2. Why should you closely observe the patient's response to an injection of a local anesthetic?
559. Answer a series ofkeyquestions that serve Figure 3.8. Closed.chest cardiac massage. to describe the preparations you must make, and the life saving procedures you must know in case emergency situations occur. indicates that his lungs are filling with air. Repeat 14 to 18 times per minute for adults and 20 times Although prevention is our goal, emergency per minute for children.Useonly gentle puffs on situations do occur. Therefore, you m. 'a make sure children, so as not to rupture their lung sacs. that oxygen and resuscitation ect...pment are Closed chest cardiac massage.You can best carry available, conveniently located, and.. functioning out this massage by placing the heel of one hand on properly. Check the emergency treatntnt kit daily the patient's lower sternum and placing the other to insure that it is supplied with the pit per levels of hand over the first as shown in figure 3-8. If the all drugs and equipment, and that these supplies are patient is a child, one hand is sufficient. Using your in good condition and have not passed their body weight, rapidly force the lower sternum expiration date. Have readily available the sources downward from 1'/2 to 2 inches. Hold for one-half and phone numbers of medical personnel needed second; then rapidly release. Repeat this procedure for assistance in any emergency arising in the dental every second. clinic. Learn how to administer mouth-to-mouth When it is necessary to administer both resuscitation, closed chest cardiac massage, and procedures at the same time, it is best for one cricothyroidotomy as part of your preparation for person to administer mouth-to-mouthresuscitation emergencies. while another administers closed chest heart Mouth-to-mouth resuscitation.This is best massage. The patient must be on a hardsurface for accomplished by lowering the back of the dental cardiac massage to be effective. You may need to chair so that the patient's head is in a hyperextended remove the patient from the dental chairand place position. Grasp the mandible and elevate the chin. him on the floor. In this way, the airway is thrown wide open. Check Emergency airway (cricothyroidotomy).There are for and remove any obstructions (vomitus, blood, two reasons for a pafient to stop breathing.One is mucus, cotton rolls, gauze, removable appliances, systemic respiratory arrest, and the other is an etc.). Once the airway has been cleared, blow obstructionof the air passage. In systemic forcefully into the patient's mouth while pinching respiratory arrest, the patient ceases to breathe his nostrils closed. (See fig. 3-7.) A rise in his chest because of some depression to the nervous system. 92 392 The treatment for this is mouth-to-mouth depression is the'cricothyroid space into whiels the resuscitation as discussed earlier. When the air airway is to be opened (see fig. 3-9). passage becomes blocked by a foreign substance, Make the incision by holding a knife blade attempt to remove the object through the oral between your thumb and forefinger so that no more cavity. If the blockage cannot be cleared, an than one-half inch of the blade protrudes. Insert the emergency airway must be provided below the blade crosswise into the cricothyroid space. Your obstruction. Since rapid treatment and positive fingers will limit the penetration of the blade 30 that results are paramount, the cricothyroidotomy it doesn't reach the esophagus. Widen the incision rather than a tracheotomy is preferred.Only under as required to admit the tube that is to be used as an extreme entergency conditionswhere the patient will airway. The blade may be turned up to hold the die without care should you establish an emergency incision site open for this purpose. Insert the airway airway. It is not conceivable that you will ever into the trachea. If possible, use tubing that cannot perform this procedure in the dental clinic because collapse. If there is no other material available, a there should always be qualified professional ballpoint pen barrel can be used. Be careful not to personnel available immediately. However, in case lose the material used for an airway into the such an emergency ever arises, you should know trachea. Secure the material with tape. Control how to perform a cricothyroidotomy. hemorrhage and keep the airway open. Administer Position the patient flat on his back, maintaining artificial respiration and/or oxygen until the patiers his neck straight and head hyperextended. This is relieved of breathing difficulties. Obtain medic.1 position may be accomplished by using a blanket aid as quickly as possible. roll or other object under the patient's shoulders. Use aseptic technique if possible. To locate the Exercises (639k cricothyroid space, feel the thyroid cartilage (Adam's apple). Slide your finger just downward to I. What check should you make of oxygen and the notch or depression between it and the next ring resuscitation equipment? of cartilage (cricoid cartilage). This almond-shaped
,00.msra,
Posit-ion of ra.-t-iervi.
Crico.thliroidot-onvi
Tracheof.ornm
Figure 3-9. Cncothyroidminy.
93
393 31)1
2. What should your daily check of the emergency 14. When possible, what type of tube should be kit include? used when performing a cricothyroidotomy?
3. What phone numbers should you have rattily available? S. Explainwhy safety precautionsaft necessarywhen dealing with oxygen; and given a SWISS of true and Wee statements, intik* the proper method of mahttaining sadadministering 4. How should you position the patient's head for oxygen. mouth-to-mouth resuscitation? Emergency Equipment and Supplies. Normally, the equipment and supplies needed to handle dental emergencies include oxygen. oxygen 5. When performing mouth-to-mouth equipment, and an emergency kit. The exact makes resuscitation, what actions should you take to and models of the equipment vary from base to base obtain an'open airway? as do the items that make up dental emergency kits. You must know the exact location of the equirtmtnt, be able to use and maintain the equipment, know the contents of the dental 6. When giving mouth-to-mouth resuscitation, emergency kit, maintain the emergency kit, and be what should you do to the patient's nose? able to assist the dental officer in using the emergency kit. Oxygen equipment. Oxygen and oxygen equipment should be available in each dental 7. How often should you inflate the lungs when treatment room. The equipment includes oxygen giving mouth-to-mouth resuscitation? cylinders, a regulator to control the flow of oxygen, a mask, a rebreathing bag (not alwaysincluded), and connecting items. There are some precautions you should strictly adhere to when using oxygen. 8. Briefly describe how to perform closed chest Remember that oxygen supports combustion and cardiac massage to an adult. that an oxygen tank contains stored energy under pressure. Even a small spark will glow much brighter in the presence of oxygen and could be enough to trigger an explosion. For this reason, you 9. What type of surface must the patient be placed should observe the following precautions when on for cardiac massage to be effective? handling oxygen cylinders and regulators: a. Post "No Smoking" signs where oxygen cylinders are stored or in use. b. Store full and empty oxygen cylinders in 10. When would a cricothyroidotomybe separate, designated areas. performed? c. Keep all volatile materials, such as oil, grease, and alcohol, away from oxygen cylinders. Also keep cylinders away from heaters, boilers, radiators, sterilizers, and all electrical equipment. 11. How should the patient's head be positioned d. Never use oil or gm:Le to aid in connecting for a cricothyroidotomy? regulators to the cylinders. e. Label all regulators with a tag whichieads "Do Not Oil or Grease." f Test regulators daily for correct operation. 12. Where is the cricothyroid space located? g. Do not attempt to repair regulators. Turnin defective regulators to supply and obtain a serviceable regulator in return.
13. When performing a cricothyroidotomy, why In addition to the above-listed precautions, you should you hold the blade between your thumb may find the following suggestions useful: and forefinger so that no more than one-half of a. Always maintain an extra, full oxygen the blade protrudes? cylinder on hand in case itis needed. Extra cylinders can be obtained from medical supply.
943 94 PSi GAUGE REGULATOR ;LOW GAUGE INLET VALVE NUT liters of omen So administer par minion UM dme
CYUNDER VALVE not do so, or should you happen so be giving the / owe alone, adjust the flow hawses 4 andlions .Z- per Waite. Oxygen flow between 6 andliters per REGULATOR FLOW ADJUSTING misuse is pure oxygen. Mmy dental officers desire HANDLE the oxygen regulmor be vs at 5 for most oxygen OXYGEN therapy. Keep a careful watch on the rebrembieg CYUNDER bag. The bag should expand when the patient exhales and &flaw when the patient inhales. If the oxygen equipment you are ming dos not have a REGULATOR rebreathing bag, you may observe the patient's OUTLET bnathing effort by wmcbing his chest. In either cese, if the rebreething bag does not expand and CYLINDER dellase properly, or if the patient appears so be OUTLET laboring excessively to get enough air, quickly PROTECTOR (back the equipment for poen* malftinctiom and make corrections and atVuesnents as required. Call for help if nendecl.
nowt 3.10. (him cylindw. After the mask Ma bees used on a patient, disconnect it and remove the sponge rubber disks. You may then scrub the meek with soap and war and rinse it thoroughly. The ask the meek in b. Remember to keep a close watch on the zephiran chloride 1:1,000 for 20 minuses Finally, regulator gauges to determine when you need to rinse the mask and the rubber foam disks under exchange cylinders. running water and allow them to air dty before they c. Before connecting the regulator to a new are remsd. As you may have already concludsd, oxygen cylinder, always "crack" the cylinder valve you should always have MON than one mask first. By "crack" we mean to open and close the cylinder valve rapidly. This "cracking" =OM any available for use. dust or debris that may have collected in the cylinder outlet. Always do the "cracking" in a safe place and point the cylinder outlet away from rm. HEAD STRAPS
After a regulator has been connected to the oxygen cylinder, a face mask must then be connected to the regulator before oxygen can be administered to a PLUG FOR patient. Figure 3-10 shows a cylinder with a SUCTION TUBE regulator in place. There are two types of face masks commonly INHALATION . usedthe nasal and the oronasal. The nasal mask covers only the nose. It cannot be used on EXHALATION VALVE unconscious patients. The oronasal mask covers both the nose and the mouth and is the most commonly used of the two types. Figure 3-11 shows the oronasal mask with the rebreathing bag and connector tubing. Once the oxygen cylinder has been cracked, the regulator is in place, and the facial mask has been connected to the regulator, the equipment assembling is complete. REBREATHING BAG The procedure for administering oxygen is fairly simple. Once the dental officer indicates he desires to administer oxygen, tell the patient. Then make sure that the regulator valve is open and open the cylinder valve. Next, adjust the regulator to release from 6 to 10 liters of oxygen per minute. As you PLUG TO PERMIT apply the mask to the patient's face, ask him to exhale. You may then adjust the mask-retaining /DRAINAGE OF MOISTURE straps and further adjust the oxygen flow. Normally, the dental officer will indicate how many Pilure3-11. °roamed mast
95
395 Siemciasaow, Emergency treatment kit. All dental clinics should set up an emergency treatment kit, tray, or I. Why is it numsary to follow certain safety drawer convenient to all locations where patients precautions whim dealing with oxygen? are being treated. If re use a cabinet drawer, use the some drawer in all dental cabinets to avid confusion. You should be completely familiar with all drugs and equipment in this drawer to that you Identify tbe procedures that should be taken when can properly assist in any emergency and can maintiining oxygen by indicating whether the maintain the equipment and supply levels. The oxygen maintenance procedures described in items following is a list of drugs and materials which 2 through 11 are true or false. should bs inchtded in the dental emergency kit: T F2. Post "No Smoking" signs where oxygen a. Airwayfor mouth-to-mouth cylinders are stored or in use. b. Ammonia carpulesa mild stimulant for .TF 3. Keep cylinders away from heaters, syncope. boilers, radiators, sterilizers, and c. Epinephrine 1:1,000anilallellic drugs. electrical equipment. d. Diphendydramine (benadry1)antiallergic T F 4. Maks sure that all regulators that connect drugs. to the cylinder are well oiled. t. Pentobarbitalorsodiumsecobarbital T F5. test regulators monthly for correct sedative and anticonvulsive. operation. f. Amyl nitrite pearls and nitroglycerin T F 6. Store empty and full oxygen cylinders in tabletscoronary dilators for angina pectoris. secerate designated arm. e. Ephedrine sulfate, injectablevasopressor. T F7. Personally perform the necessary repair Solu-Cortefsevere shock and acute procedures on the regulators. reactions to drugs. T F8. Before connecting the regulator to a new 1. Material$ for administration of these drugs oxygen cylinder, you should always. should include syringes, hypodermic needles, "crack" the cylinder first. sterile isotonic saline, and a tourniquet.
Your role in using an emergency kit is supportive in nature. Mainly, you are to maintain the IdIntify the proper procedures to be used when emergency kit and to insist the dentist as he uses the administering oxygen by indicating whether the kit. In either case, you should apply rurself as if procedures listed in items 9 through 13 are correct human life is directly dependent upon you. or not. Identify the proper procedures by circling T Proper maintenance of an emergency kit is a for true, and the improper procedures by circling F daily affair. That is, you should inspect the kit daily for false. to determine its adequacy and then correct any T F9. If you wish to administer oxygen through deficiencies noted. Inspections have revealed that the nose only, you should select an kits sometimes contain drugs with expired potency oronteal mask. dates and that previously used drugs aren't always T F 10. When administering oxygen, you replaced. Be sure to keep your kit(s) ready for use. normally set the regulator to release from Your proper assistance in the use of emergency 18 to 20 liters per minute. kits increases the dentist's total treatment T F 11. If you wish a flow of pure oxygen, you capability. In other words, the semiprofessional should set the regulator to release from 6 tasks that you complete free the dentist to to 8 liters per minute. concentrate more upon the immediate professional T F 12. When the patient inhales, the rebreathing requirements. Normally, these semiprofessional bag should inflate. tasks include placing needles or syringes, loading T F 13. After the mask has been used, you should syringes with proper drugs, and applying remove the sponge rubber disk, then tourniquets for intravenous injections. In scrub the mask with soap and water, conclusion, the use of dental emergency kits is rinse, and soak the mask in zephiran intended to be a dentist-assistant team effort. chloride 1:1,000 for 20 minutes. Exercises (661) In exercises 1 through 8 identify the purpose of the items kept in the emergency kit by matching the purpose listed in column B to the item listed in 661. Gives a series of statementsthat relate the column A. purpose of emergency kit items, match them to Column A Column the specific item, and describe your role in I.Ephednne sulfate. a. A coild stimular. tyn- maintaining and mingthe kit. - 2. Solu-Conef. cope.
96 396 coahomn.4 (14unvi H hanging over the end of the chair) and adniinister oxygen. . 1 Pentoharhttal. h. An antiallergic drug. V) 4S)ringes. needles. c.For the administration of Anesthetic allergy reactions. There are three types and ttiurniquet. drup. of reaction to local anesthetics: allergic reaction, iIknadryl. d. For mouth-tomouth toxic reaction, and hypersensitivity: I. Ammonia car- resuscitatitm. . pules. -e. A coronary dilator for a. Allergic reaction. The most common allergic op 7. Airway. angina petloris. reaction to local anesthetics appears as a rash, X. Nitroglycerin fTo act as a vasopressor. swelling, or redness. The rash can appear on other tablets. g. A sedative and anticon- parts of thc body. such as the arms. The swelling vulsivc. h. For severe shock and acute and redness are usually around the area of =talons to drugs. injection. These reactions usually occur soon after the- injection; however, swelling may occur at the injection site 12 to 24 hours later. The anaphylactic (allergic) shock is the least common of the reactions 9. Describe your role in maintaining and using from a local anesthetic. This reaction is the emergency kit. characterized by a sudden circulatory and respiratory collapse. The blood pressure drops and respiration is impaired. The dentist usually treats this type of reaction with a subcutaneous injection of 1:1.000 epinephrine. Administer oxygen under 062. Given a verbal description of an emergency pressure or by mouth-to-mouth resuscitation. An situation identify the emergency and the action antihistamine drug may also be given. These that should be taken. reactions should be treated by the dental officer. In mild cases, oral antihistamines may be given. In the Recognition and Correction of Emergencies. If more severe cases. injections of epinephrine or emergencies occur, you must be able to recognize antihistamine may be given. them and assist in their correction. The following b. Toxic reaction. Toxic reactions are the retntlt brief descriptions provide only word pictures of of an overdose of local anesthetic. This type of emergency procedures. There should be regular reaction was discussed earlier. In dentistry, the training sessions in your clinic to make sure that all toxic reaction to a local anesthetic is usually the personnel are qualified to administer appropriate result of injecting the solution directly into a blood lifesaving measures. vessel. Psychogenic reactions. A psychogenic reaction is c. Hypersensitivity. Some patients have a an alarm mechanism, characterized by sudden hypersensitivity to local anesthetics. These patients dilation of peripheral blood vessels resulting in loss develop all of the symptoms of a toxic reaction even of blood to the brain. The causes are usually though only a minimal amount of the drug is given. mental, triggered by fear. The signs and symptoms The diagnoses and treatments are the same as for are dizziness, nausea, cold perspiration, blood- toxic reactions as discussed earlier. pressure drop. dilation of the pupils, loss of consciousness, and occasionally brief convulsion. Penicillin allergy reactions. There are two types of The treatment is to place the patient in a supine reaction to penicillin. The first type is the position with his feet higher than his head. Break an immediate or anaphylactic type, which occurs ammonia carpule and have the patient sniff it. Place within minutes to several hours after a cold towel on his forehead and let it drape over administration. The delayed or serum sickness type the temples. Loosen his collar button, tie, and belt. of reaction occurs several days to 2 weeks after Keep the patient's mouth cleared. Have oxygen administration. This type is characterized by handy and administer it if necessary. Recovery is urticaria, angioneurotic edema, fever. pain in the usually rapid. joints, and swelling. Toxic reactions.A toxic reaction is usually the Penicillin should not be given in the dental result of an overdose (or excessive amount) of a clinic. The dentist should prescribe oral penicillin drug. The toxic reaction takes place only when if conditions permit. If this is not possible, shots there is sufficient concentration of the drug in the should be given in the hospital shot room. blood stream to affect respiration or circulation Angioneurutic edema.This is a form of giant adversely. These reactions are caused by urticaria (hives) characterized by localized painless administering too much of the drug-or swelling of subcutaneous tissue in various parts of administering ittoo fast. The dentist should the body. It may also appear in the mouth. The diagnose and treat toxic reactions. The emergency reactionis an allergic response to food, drugs. treatment is to place the patient in the infections, or emotional stress. This reactionis Trendelenburg position (on his back on a plane common in patients with a history of allergy. Itis inclined approximately 450 with legs and feet also caused by trauma. It must be treated by the 97
39 7 311 doctor. He treats it with an antihistamine drug, such Oxygen must be delivered to the lungs with pressure as benadryl. equipment or by mouth-to-mouth resuscitation. Insulin shock. Insulin shock is czused when the Closed chest cardiac massage must be started in concentration of glucose in the blood drops below conjunction with, the oxygen delivery. Have the normal limit. The signs and symptoms are someone call a phyiician and alert the emergency profuse sweating, nervousness, headache, dizziness, MOM. mental confusion, transient unconsciousness, convulsions, and coma. Insulin shock may be Exercises (662): confused with psychogenic reactions. The early Column A below lists some emergency situations symptoms are not always present, and the attack that could occur in the dental clinic. Column B lists may begin abruptly. Obtaining a good medical actions that should be taken in the event of a history is important. The administration of sugar specific emergency. Immediately following constitutes the treatment for insulin shock. Have columns A and B are descriptions of the patient's the patient swallow 1 or 2 teaspoons of sugar and condition. Next to each emergency description a give him a small glass of orange juice if possible. space is provided for you to identify the emergency Epileptic seizure. An epileptic seizure is defined situation and to show what action should be taken. as an intermittent disorder of the nervous system Identify the situation with a choice from column A believed to be caused by a sudden, excessive and the action with a choice from column B. discharge of cerebral neurons. The result is an Column B (Arnow almost instantaneous disturbance of sensation, loss Column A dituutionl of consciousness, convulsive movements, or some a.Insulin shock. a.Inject 1:I.000 epinephrine combination of these. The cause of epilepsy is b. Cardiac arrest. subcutaneously and ad . c.Anaphylactic shock. minister oxygen. either a hereditary factor or pathologic changes in d. Cerebral-vascular acci- b. Place a nitroglycerin the brain from such disorders as encephalitis, dru. tablet under the patient's meningitis, tumor, hemorrhage, or trauma. The e.Epileptic seizure. tongue and administer ox. signs and symptoms are warning aura (a subjective 1. Angina pectoris. ygen. g.Psychogenic reaction. c.Start closed chest cardiac sensation to lights) and crying, unconsciousness, massage in conjunction convulsions, and coma. with oxygen delivery. The treatment for epileptic seizure is to give Have someone call z oxygen, place a firm pad between the patient's teeth, physician and alert the emergency room. - prevent injury, and loosen his clothing. Dilantin is d. Place patient in thc supine the drug of choice, and it should be on hand when position and loosen his you are treating patients with a history of epilepsy. clothing, have him sniff an Cerebral-vascular accident. A rupture, ammonia carpule. and thrombosis, or embolism occurring in a cerebral place a cold towel on his forehead. Stand by with vessel constitutes the primary, sudden emergency oxygen. that may be seen in the dental office. The symptoms c.Place a pad between the vary with the area of :he brain affected. The patient patient's teeth. Loosen his may have sharp pains, drowsiness, bleeding from clothing and administer the ear, or a numb feeling in any area of the body. dilantin. f.Keep the patient calm, ad. There islittle treatment that you can give these minister oxygen. call a patients. Keep the patient calm, administer oxygen, physician. and alert thc call a physician, and alert the hospital emergency hospital emergency sec- section. tion. s.Have the patient swallow Cardiovascular emergency. Angina pectoris is I or 2 teaspoons of sugar. caused by diminished blood supply to thr cardiac and give him orange juice muscle. The patient has severe pain in ttc chest. if possible. The pain may radiate to the left arm and neck. The blood pressure rises. His pulse remains strong. The Description treatment is to place a nitroglycerin tablet under his Almost instantaneous disturbance of sensation. loss tongue, and administer oxygen. of consciousness, convulsive movements, or a An acute myocardial infarction lasts longer than combination of the above. Unconsciousness is often angina. The patient has severe pain in his chest preceded by a subjective sensation to lights and radiating down his left arm. The treatment is to crying. keep the patient calm, call a physician, and alert the I .Situation. hospital. 2. Action. A patient with cardiac arrest loses consciousness. There is no pulse rate, and respiration stops. When Usually triggered from fear. The signs and this happens, the ultimate emergency is present. symptoms may include dizziness, nausea,cold Action without panic may save the patient's life. perspiration, blood pressure drop. pupil dilation. 98rIno 'loss of consciousness and occasionally brief con- Strong pulse, a rise in blood pressure, severe chest vulsions. pain that radiates to the left ann and neck. 3. Situation. 9. Situation. 4. Action. 10. Action. Sudden respiratory and circulatory collapse im- mediately following the injection of a local Sharp pains, drowsiness, bleeding from the ear, and anesthetic. a numb feeling in any part of the body. 5. Situation. 1 1. Situation. _6. Action. 12. Action. -Profuse sweating, nervousness, headache, dizziness, mental confusion, transient unconsciousness, con- The patient has lost consciousness, hasno pulse vulsions, and coma. rate, and respiration has stopped. 7. Situation. 13. Situation. 8. Action. 14. Action.
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399 CHAPTER- 4
The Specialty Sections
A TYPICAL Air Force dental clinic contains Scheduled annual examination of military several specialty sections. Each of these sections is members. manned and equipped to provide a special kind of Examination of sick call patients and the dental treatment. To illustrate, let's compare a routing of such patients for immediate dental clinic to a modern department store. Unlike treatment when necessary. past "general merchandise stores," where one could Treatment planning for members eligible for obtain all needed articles from one small room or care. building, the modern department store contains Special examinations in support of the several specialty departments or sections. If one medical mission. desires a shovel today, he must go to the hardware department; if he desires shoes, he must go to the Annual Eramination. Probably the most frequent footwear department; if vitamins, to the drug purpose for administering a dentalexamination is department, just to mention a few items. Similarly, to meet the annual examination requirement. To in Air Force dental clinics, examinations are facilitate the accomplishment of these annual .performed in the examination 'and treatment examinations, consolidated base personnel offices planning section, and teeth are extracted in the oral furnish the dental service and organizational units surgery section. You may be assigned to assist in with machine rosters. These rosters are made up any one or all of the specialty sections during your according to organization and birth month. Each Air Force career. unit coordinates the scheduling of the dental To be an effective dental assistant, you must examinations with the dental service and sends an know what procedures are accomplished in each of annotated notification card to the unit members to the specialty sections, and you also must be able to advise them when to report for the examination. perform the proper assisting techniques. Although The records of persons who have transferred should the basic assisting procedures have been discussed be removed from the file and disposed of according in Chapter 3, the various specialty sections have some additional requirements. This chapter to appropriate directives. discusses the individual specialty sections and your Dental sick call. Another important functionof role in these sections. the examination section is the examinationand routing of sick call patients. The purpose of the sick 4-1. Examination Section call examinations is to diagnose the patient'sdental Dental examinations constitute one of the basic problem and to route him to the appropriate professional services provided by the Air Force treatment section. Many of the patientsreporting to dental service. The time, skill, and effort required dental sick call have a painful dentalcondition that to accomplish and record dental examinations are demands immediate treatment, while othershave as important as those for any other dental developed a condition that is not painful but that procedures. should be treated in the near future. Forexample, a painful acute periapical abscess requiresimmediate 663. State the functions of the examination and attention. The patient with this condition is seenby treatment planning section and answer key the examination section, radiographs areordered "lotions which serve to describe the assisting and read, the condition is diagnosed,and the procedures required in this section. patient is referred to either the oral surgery or endodontic section for the appropriateimmediate Examination Section Procedures. There are treatment. Some sick call patientsdo not, however, several different functions or procedures require immediate attention. For example.if the accomplished in the examination section. These patient has lost a restoration and is not in anypain, diagnoses the functions include: the examination section simply
o condition and has the patient scheduled for an the dental clinic. The old adage "The first Appointment with the restorative dentistry section. impression is a lasting impression" is the point in Treatment planning. A treatment plan is question here. By being cheerful, courteous, developed to provide a systematic approach to prompt, and thorough, you help create the desirable clinical dental care. The first step in developing a first image of the dental service on your base. treatment plan is to record the findings of a Exercise extreme care to see that a patient is not thorough examination, including the condition of overlooked when his needs are to be coordinated the oral and adjacent tissues, diagnostic measures, with other sections. Deliberate followups can help and consultations required. The treatment plan may eliminate such problems. Another specialty in the also include the following: emergency treatment: Air Force dental clinic is the restorative section. treatment to prevent early development of emergency conditions; initiation of treatment of Exercises (663): periodontal and other soft tissue disease; individual 1. State the functions of the examination section. instructions and motivation in toothbrushing, diet, eating habits, and other selfcare measures: a thorough prophylaxis, with consideration given to the use of a prophylaxis paste containing stannous 2. What is probably the most frequent purpose of fluoride or a topical application of stannous administering a dental examination? fluoride solution; correction of gross discrepancies of occlusion; exodontia and other necessary oral surgery; restoration of carious tooth structure; and preparation of the mouth to receive prosthetic 3. What is accomplished during sick call appliances. examinations? Special examinations. Dental examinations in conjunction with medical physical examinations may be requested for a number of purposes. These include, but are not limited to, examinations 4. What is the purpose of treatment planning? required for enlistment, commissioning, remote or isolated duty, flying training, enrollment in the Air Force Academy, and assignment as a food handler. Normally the type of dental examination required is 5. To what publication should you refer if you are indicated on the patient's physical examination trying to determine the type of dental form. If it is not indicated, you should find out the examination required by an applicant for flying purpose of the examination and refer to the foldout training? located in the back of AFM 162-1, Administration of USAF Dental Activities. This foldout tells you the type of examination required, the forms involved, the dental standards the patient must meet, and any 6. What do the majority of your tasks in the other special requirements. examination and treatment planning section Examination Assisting Duties. The majority of involve? your tasks performed in the examination and treatment planning section involve the completion of forms. For this reason, you must have thorough knowledge of the types of examinations, charting 7. Why is your behavior in the examination and symbols, diagnostic nomenclature, authorized treatment planning section extremely critical? abbreviations, and dental classifications. You must also perform the basic assisting procedures, such as receiving and seating the patient, selecting and arranging instruments and medications, and coordinating patient needs with other sections. 4.2. Restorative Section It is especially important that you maintain the proper attitude and guard against improper Since the heaviest workload in any dental clinic personal actions while you assist in the examination is restorative dentistry, most dental specialists are and treatment planning action. Naturally, such assigned as restorative assistants. Restorative behavior is desirable in all dental clinic sections, as dentistry (operative) includes the treatment and was mentioned before. However, your behavior is restoration of carious teeth with metallic and very critical in the examination and treatment nonmetallic restorative materials. These materials planning section because this is where a patient is are usually amalgam, silicate, resins, and gold. If first.exposed to the professional treatment area of the dental assistant is well trained and works closely
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4 01 with the dental officer, the patient may receive more After the dental officer has determined which treatment in a shorter length of Cane. Let's first tooth or teeth to restore, the next step is to discuss restorative procedures, followed by administer the anesthesia. Perform your share of restorative assisting duties. these duties out of the patient's view. When the dental officer is ready to proceed with the injection, pass the gauze sponge to wipe the injection site. 664. State the function of the restorative section Receive the sponge and pass the cotton-tipped and answer key questions that serve to describe applicator. While the dental officer is administering the aukting procedures required in this section. the topical anesthetic, loosen the protective cover from the needle. Hold the syringe by the barrel so Restorative Procedures.. The restorative that the handle may be passed to the dentist. dentistry section strives to restore decayed or Receive the cotton applicator and pass the syringe. fractured teeth to their original functional ability As the dentist receives the syringe, remove the and esthetic quality of healthy dentition. In general, protective cover from the needle. After the restorative procedures include the following: injection has been completed, replace the protective Determining the procedure(s) to be covering on the needle in case a second injection is accomplished. needed. Administering anesthesia. After the preliminary preparations, the actual Preparing the cavity or cavities to be filled. treatment begins. If you are well prepared, the Placing filling material(s) into prepared operatfon should proceed smoothly without delay, cavities. and the patient will be more at ease and confident. Carving and finishing restorations. Watch closely during the operation and be prepared Smoothing and polishing restorations. to hand the instruments and medicines to the doctor as they are needed. Immediately remove those All of the above procedures are the primary instruments that are no longer required. Maintain a responsibility of the dental officer. Your role in clear field of vision for the dentist by retracting the restorative dentistry is to help the dental officer cheeks or tongue and irrigating and aspirating as complete each step. required. Restorative Assisting Duties. After you have Mix and pass restorative materials by following seated the patient, don't forget to maintain light the proceduresNke mentioned earliernamely, conversation until the dental officer arrives. You exercising care to mix at the right time and should also check the name, rank, and serial following the manufacturer's instructions. Once the number on the treatment record with the patient. restorative materials have been placed in the cavity. Sometimes patients have identical names and rank, the dental officer then begins the carving and io all that identifies them to the treatment records finishing of the restoration. He does not normally are their serial numbers. After identifying the require assistance at this time. You may then make record with the patient, place it where it will be good use of this -free- time by completing the convenient to the doctor. The radiographs and the forms and records that reflect the treatment the treatment records should be out for viewing by the patient has received. doctor when he arrives. This arrangement reduces Once the operation has been completed. you are errors and saves time. The patient should now be expected to begin your postoperative duties. If comfortable in a preoperative position. future appointments are needed, be sure that the When the doctor arrives, wash your hands and patient knows the procedure to follow to obtain dry them in full view of the patient. The patient is one. Dismiss the patient in the same cordial. then further impressed with the idea of cleanliness pleasant manner that you greeted him, and you can and sterility. Then remove the instruments for the be sure he will leave with a feeling that he has examination or operation from the cabinets and lay received high-quality treatment provided by the them out in the arrangement and location from dental service. You may then remove all which they are used. It is best to set out only the instruments laid out for the operation. These instruments that are going to bc. used on each phase instruments must be washed and then sterilized of the procedure. This reduces a cluttering effect of regardless of whether or not they were used. Return instruments and patient apprehension. If the saliva the medications, materials, and equipment to their ejector is to be used, attach a sterile tip to the dental proper places and prepare the chair and cabinet for unit after the patient has been seated. This assures the next patient. the patient of the cleanliness of the saliva ejector apparatus. Do not hang the instruments over the Exercises (664): edge of the bracket table since they are easily dropped from this position. Turn on the operating 1. What is the function of the restorative dentistry light and adjust it to the operating field as the dental section? officer approaches the patient.
102 4 "e) 2. What should you do after you have seated the not visible in the oral cavity. Retained root tips may- patient and are waiting for the dental officer to be present due to fractured teeth, advanced decay, arrive? or an incomplete postsurgical procedure. They are usually detected on radiographs. c. Surgkal removals. The removal of impacted embedded, or partially erupted teeth involving 3. What procedures should you perform between tissue incision, excision, or bone removal. Removal the time that the dental officer enters the of unerupted third molars is the most commonly treatment room and the time that treatment performed surgical removal. begins? d. Alveolecromies. The removal of the alveolar bone. It is usually performed in conjunction with a surgical removal or multiple extraction (1 ) to eliminate sharp bone edges that could cause 4. Why should you replace the protective covering discomfort to the patient and (2) to provide suitably on the anesthetic needle after the injection has contoured bone structure for denture fabrication been completed? and insertion. At times, however, this may be an independent procedure to prepare past extraction sites for dentures. e.Cystectomies. The removal of cysts and 5. How do you maintain a clear field of vision for periapical granulomas. the dentist during the restorative procedure? f Tori removals. The removal of abnormal, bony growths, which are often found on the lingual surface of the body of the mandible or the center of the hard palate. Usually tori removals are done to 6. When is normally a good time to complete the permit fabrication and insertion of dentures. forms and records that reflect the treatment the g. Frenotonties. The surgical removal of that patient has received? tissue which restricts movement of the tongue (lingual frenum) or lips (labial frenum). The excision of the lingual frenum is done to help correct tongue tie. The labial frenum may be done 7. When you are performing your postoperative to enable better lip moverpent and to help prevent cleanup, what should you do with instruments large diastemas (spaces) between erupting central that were laid out for the procedure but were incisors. not used? h. Biopsy. The removal of a piece of tissue from a living subject for diagnostic and microscopic examination. i. Foreign body removals. The removal of any foreign body, such as a needle, metallic restoration, piece of elevators, piece of forceps, or gunshot. 4-3. Oral Surgery Section Such a removal is considered a surgical operation. Oral surgery is a speciality of dentistry dealing It is not always indicated and ii often left up o the with the surgical treatment or correction of judgment and discretion of the dental officet. diseases, defects, or injuries of the oral cavity, teeth, and adjacent tissues. In this section on oral surgery, Exercises (663): you learn what procedures are commonly accomplished and also how you are expected to Identify the procedures performed in the' oral surgerysectionby matchingtheprocedure perform. description in column B to the appropriate procedure name in column A. 665. Given descriptions of the various Column B procedures performed in the oral surgery section, Column A match each description to the appropriate I. Biopsy. The surgical removal of procedure. 2. Oistectomy. the time that restricts the 3. Surgical removal. tongue's movement. 4. Extraction. Tooth removal that entails Oral Surgery Procedures. To start our S. Frenotomy. tissue incision, excision, discussion of the oral surgery section, let's look at 6. Tori removal. or bone removal. 7. Foreign body The removal of the sharp some of the common oral surgery procedures: bony edges that result a. Extractions. The removal of erupted, diseased, removal. 8. Alveolectomy. from a multiple extrac- or malposed deciduous and permanent teeth. tion. b. Retained root removals. The removal of The removal of abnormal, retained roots that may be buried in the bone and bony growths from the
103 4 3 Column B the introduction of foreign bacteria (cross contamination), either through the use of unsterile body of the mar.dible or instruments or materials or by being careless in the the maxilla. The removal of a piece of preparation of your hands. The procedures to be titsue for ::iagnottic and accomplished before the actual operation begins are microscopic examination. called preoperative procedures or the preoperative The removal of such items as a needle, piece of an in- phase as we mentioned earlier. strument. or buckshot. Patients awaiting oral surgical treatment The removal of erupted, normally remain in the main patient waiting room. diseased, or malposed However, in some facilities a small seating area is teeth. The removal of cysts and located just outside the surgery section. If your neriapical granulomas. clinic has one of these areas, make sure that patients awaiting treatment cannot see into the treatment room. Patients who are waitingfor surgical treatment are usually more apprehensive than those waiting for other dental care. Most treatment is 666. State the correct approach to oral surgery provided on an outpatient basis (treated and procedures, and describe the elements of the released). preoperative, operative, and postoperative Occasionally, a patient will be presedated (given phases. a sedation drug before thescheduled appointment time). In this case, he should either wait in the clinic Oral Surgery Assisting Duties. Dentalpatients recovery room or in a quiet area ofthe clinic. Be requiring oral surgical treatment are often more absolutely sure that presedated patients are not left nervous and more apprehensivethan those alone. Prior to actually seating the patient inthe scheduled for other types of dental treatment. chair, check to make sure that you left no tracesof Consequently, it is very important that you be a the previous operation. After you haveseated the calming influence upon the highly nervous, oral patient and made him comfortable, hive him loosen surgery patient. You may exert acalming influence restricting clothing and make sure that removable by making sure you complete every action with self- prosthetic appliances are taken from his mouth and confidence. Patients (particularly oral surgery stored in an appropriate receptacle. patients) tend to react to dental operations the same If you or the You may be required to perform a full surgical way you and the dental officer react. scrub prior to each operation. In any case, the very dental officer exhibit nervousness, the patient minimum should be a scrubbing with a handbrush becomes more nervous. On the contrary, if you and rinsing the dental officer display calmness, the patient's and soap. Mere hand-to-hand lathering and is simply not enough to satisfy the requirementsof nervousness seems to subside somewhat.Therefore, scrub, assisting task oral surgery. After you have completed your you should perform each oral-surgery dry your hands on one of the sterile towelsthat you in a deliberate, calm, and self-confident manner. placed on top of the instrument setup. When you The key to self-confidence is preparation. When have dried your hands, don the sterilerubber gloves you become thoroughly familiar with each aspectof surgical The that you will be wearing during the your job, self-confidence follows. procedure. All of this is done in view ofthe patient accomplished oral surgery assistant is a stabilizing because it helps to reassure him. With glovedhands, influence to even the most nervous of oral surgery you may then drape thepatient with a sterile drape. patients. don't touch any Preoperative procedures. The actual procedures Be sure to exercise care that you unsterile object during the drapingprocedure. for chairside assisting during oral surgery cannot be have been outlined in any step-by-step sequence. Techniques After these preoperative procedures completed, the operation may begin. vary from oral surgeon to oral surgeon; however, in certain steps are basic to an accomplishment of the Surgical operative procedures. The variations dental officers' techniques make it verydifficult to preoperative procedure in an efficient manner so followed for that it is bearable by the patient and enhances the outline a uniform procedure to be each surgical operation. However,the following final treatment results. know the If possible, you should have previously discussed procedures can be followed until you with the oral surgeon the essentials for each type of desires of the dental officer. oral surgery operation. With such preparation, you First, the majority of oral surgeryprocedures can be sure to have the necessaryinstruments, require two or more injections of localanesthetic. equipment, and materials ready for each patient. For this reason, it is a good practice toinclude two This Also, asepsis and strict cleanliness are essential for aspirating syringes with each instrument setup. all surgical operations. Since it is not possible to will permit you to supply aloaded anesthetic needed with sterilize the oral cavity, you must take steps to avoid syringe to the surgeon for as long as 104 404 minimum loss Of time. Anesthetic solutionsarc Under no circumstances should you make a remark Yr?) hitter, and leakage front injection sites will require on a sudden complication in the procedure. Such you to aspirate the fluids front the patient's mouth remarks tend to exciic and further arouse the after the injection. patient's nervousness. As you might suspect. this To become an effective oral surgery assistant. could lead to even further adverse patient reaction. you must anticipate the needs and desires of the Puswperutire priwedures. Once the surgical surgeon. This is not done overnight .. however, when operation is completed. moisten a 2- by 2-inch or the surgeon's sequence of performing an operation 4- by 4-inch sponge and use it to remove all blood is known, you can form a smooth operatingteam. from the patient's face. It is also a good idea either You should plan ahead and see that the next to remove the blood-stained instruments and instrument is available when itis needed. When aspirator bottle or to cover them with a towel so passing instruments to the surgeon, place them that they are not visible to the patient. You may firmly in his hand because gloves reduce tactile then remove the drape and reposition the chair so feeling, thereby increasing the possibility of his that the patient is able to exit easily. dropping the instrument. This also saves time since Most oral surgeons have instruction sheets for the surgeon doesn't have to reach for the instrument home care of the mouth following oral surgery. he desires. In addition. this procedure contributes Each patient should receive one of these, along with to the smoothness and efficiency of the operation. any medication and gauze recommended by the Aspiration of fluids from the mouth is one of dentist. When the surgeon has finished with the your primary duties during surgical procedures. patient, dismiss him as cordially as he was received The hemorrhage produced by surgical procedures. after making any necessary future appointments. together with the saliva, presents a twofold Closely observe the patient as he is leaving to make problem. First, the use of surgical knives, chisels. sure that he is steady on his feet and shows no signs and rotating instruments makes it imperative that of distress. If he exhibits any signs of dizziness, the oral surgeon be able to see what he is doing. detain him until the oral surgeon can evaluate his Secondly, the accumulation of this blood and saliva condition. in the rear of the patient's mouth tends to excite his gag reflex. For these reasons. the need for constant. Exercises (666): comprehensive aspirating cannot be overemphasized. You must aspirate in all areas of I. Why is it important that you perform each oral the mouth. not just in and around the operative site. -surgery task in a deliberate, calm. and self- By anticipating the oral surgeon's moves., you can confident manner? . aspirate ahead of him. This keeps you from getting in his way. For irrigation, a container of sterile, distilled water or saline solution and an irrigating syringe 2. Considering that it is impossible to sterilize the should be kept on the instrument tray. The oral cavity, why is it important to maintain operative site should be periodically flushed to asepsis and strict cleanliness for each oral remove blood, saliva, and debris. A Luer-Lok surgery patient? syringe with a curved, blunted needle is very helpful when flushing a tooth socket, particularly when attempting to remove a broken or retained root tip. You can also use the irrigating solution tc dampen 3. How can you make sure that you are preparing gauze sponges for moistening the patient's lips all of the necessary instruments, equipment, throughout the surgical procedure. to clean blood and materials needed for each oral surgery and debris from instruments prior to returning patient? them to the instrument tray. and to clean the patient's tongue and lips at the conclusion of the operation. Another of your important duties is the careful 4. If your clinic has a separate oral surgery use of a retractor. The mouth mirror makes an waiting room, what view should be obstructed excellent retractor in addition to instruments from waiting patients? designed as retractors. Make sure that you have a firm hold on retracted tissue, particularly during procedures such as cutting. drilling, or suturing. You must stay constantly aware of the patient's 5. What should be done with presedated patients physical condition during the entire surgical prior to seating them in the treatment room? procedure. If any changes occur, quietly point them out to the oral surgeon at once. Always be prepared to lend immediate assistance during an emergency.
105 4 05 6. What should you do immediatey after seating 4-4. Endodontic Section an oral surgery patient? The endodontic section treats diseases of the &coal pulp. Few dental clinics have a dental officer assigned who limits his practice exclusively to endodontics. Usually. one of the operative dentists 7. What is the very minimum Of acceptable hand spends part of his time seeing patients who require cleaning procedures you should perform in root canal therapy. In our discussion of the preparation for oral surgerY? endodontic section we describe the endodontic procedures that may be performed as well as the basic assisting duties. 8. Should you drape the patient before or after you don your rubber gloves? 667. Supply answers to a series of key mtestions that serve to describe the two types of endodontic procedures, the materials and instruments required, and the assisting knowledge needed. 9. Why should you include two aspirating-type anesthetic syringes in each oral surgery setup? There are two specific types of endodontic operationsconservative root canal therapy and the apicoectomy. Let's take a close look at each of these and set what they entail. 10. When passing instruments to the oral surgeon, Conservative Root Canal Therapy. why must you place them more firmly in his Conservative root canal therapy is normally hand than when passing restorative effective when the disease of the pulp is fairly well confined to the pulp canal. Usually this treatment is instruments?. required as a result of a periapical abscess. In most cases of conservative root canal therapy, there is no need for anesthesia since the pulp tissues are dead. 11. Why is it important to perform constant. The objectives of this therapy are to remove the comprehensive aspiration during the surgical contents of the piilp canal, clear up the infection. and insert a root canal filling material. procedure? Normally, conservative root canal therapy takes two or more appointments. This is because the infection must be completely cleared up before the canal can be filled. Filling the canal while infective 12. What instruments and materials are needed for organisms are still present will result in a surgical irrigation? reoccurrence of the abscess. If the patient is suffering from an acute periapical abscess. he will be experiencing severe pain. The pain is a result of pressure created by the formation of pus and gases 13. What may be used to moisten the patient's lips in the pulp canal. The pressure and therefore the during the surgical procedure? pain are illieved during the first step of the endodontic procedure. This step is to gain entrance into the pulp canal. Entrance into the pulp canal is 14. What should you do if you notice a change in gained by drilling directly into the pulp chamber. the patient's physical conditioh during the oral Once entrance has been accomplished, barbed broaches are used to remove dead Nip tiuues from surgery procedure? the canal. During subsequent appointments root canal reamers and files are used toenlarge, shape, and smooth the pulp canal. During these appointments a IS. After the oral surgery procedure is complete. what should you do prior to removing the rubber dam is used to isolate the tooth and to prevent contamination of the root canal.Paper patient's drape? points saturated with an antiseptic are introduced into the root canal to help clear up the infection. Radiographs are taken to ensure the proper reaming and filing of the canal. Cultures are taken to assure 16. Why should you closely observe the patient that the growth of microorganisms within thecanal when he is leaving? has ceased. If the results of the culture arenegative. then the canal is filled with gutta percha or asilver
106 4 96 point and sealed permanently with root canal 4. Once entrance into the pulp canal is cement. Followup appointments are usually accomplished, what is used to remove the dead scheduled periodically for X-rays of the restored pulp tissues? tooth. As in all efficient assisting you should try to anticipate the dental officer's needs. Your function, in the endodontic section, consists mainly of aiding 5. Whai is used to isolate the tooth and prevent in the placement of the rubber dam and taking contamination of the root canal? cultures, miiing materials, and passing instruments and materials. You should know the exact approach your dentist takes toward root canal therapy in order to effectively anticipate his needs. 6. What instruments are needed to enlarge, shape, Apicoectoey. An apicoectomy is the surgical and smooth the pulp canal? removal of the apex of a tooth. It is sometimes indicated when there is possible cystic involvement. In conjunction with removal of the cystic lesion (cystectomy) the apex of the tooth may also be 7. What is used to introduce an antiseptic into the removed; this is termed an apicoectomy. This pulp canal? procedure is done along with the conservative root canal therapy previously described. The apicoectomy requires teamwork between the dentist and you. Apicoectomies are usually done in the 8. Why are cultures of the root canal taken? surgery section, and you must, of course, follow the surgical assisting procedures. After the patient has been draped and anesthetized. the dentist makes an incision facially near the involved tooth's apex. He 9. When is it safe to fill the root canal? then uses a surgical bur or chisel to remove the overlying alveolar bone. Once the root is exposed. he uses the bur to remove its apex. Curettes are then used to remove infectious material from around the 10. What may be used to fill the root canal? root tip. The canal is then filled and sutures are placed to close the incision. The stiliCal portion of the apicoectomy is done quickly. The longer the patient is subjected to a surgical procedure, the 11. What must you know to be an effective more likely it is that there will be swelling and endodontic assistant? discomfort. Most of the information in this section has been general in nature. Dentists vary a great deal in their techniques. When assigned to assist in endodontics. 12. What endodontic procedure is sometimes take time to ask the dentist to brief you on his indicated when there is possible cystic methods. Then make every effort to learn to fulfill involvement? these requirements.
Exercises (647): I. Why isn't there need for anesthesia in most 13. What is done to the apex of the root during an conservative root canal procedures? apicoectomy?
2. What are the objectives of conservative root 14. During an apicoectomy. how is exposure of the canal therapy? root tip achieved?
3. Why are two or more appointments usually 15. What is used to remove infectious material required for conservative root canal therapy? from around the root tip, OI
16. What assisting procedures shouid you follow periodontal pocket may include scaline and root during the apicoectomy? planing, curettage, gingivectomy, osseous contour- ing, and equilibration. You know that these opera- tions are all performed by the dental officer. Even though you do not actually perform these opera- a tions. you do have certain duties to perform as you 4S. Per Wattle Seeties assist the dental officer. These duties may consist of passing the proper instruments, keeping the arta The periodontic section treats diseases involving clear and clean, or setting up for an anesthetic in- the supportive structures of the teeth. The treatment jection (if used). Therefore, you should be of periodontal disturbances may encompass both knowledgeable about these procedures: the dental and medical professions. The patient will a. Sailing and row planing. When the dental be referred to the medical facility for diagnosis and treatment if it is determined that the cause of his officer performs deep subgingival scaling arid root planing, he occasionally uses local anesthesia. To periodontal disturbance is due to systemic factors. Within the dental clinic, the treatment of a remove deep deposits of calculus, he must slide an periodontal patient may require treatment by the instrument gently along the calculus in the direction of the apex until the termination of the calculus on entire dental team. The periodontist may treat periodontal disease the root is reached, removing the piece of calculus by relieving conditions such as traumatic in its entirety if possible. He then planes the root malocclusion: by eradicating periodontal pockets: surface until it is smooth. In root planing. any softened material must be removed until firm tooth and by assuring that the patient practices proper oral hygiene, as previously discussed. The oral substance is reached and smoothed. surgeon performs his service by removing b. Cannurge. Curettage consists of removing the nonrestorable teeth, by making biopsies, and by necrotic and degenerated tissue lining the gingival removing neoplasms. The prosthodontist exercises wall of the periodontal pocket, This procedure his role by replacing missing teeth with required reduces the periodontal pocket by removing a appliances. The dentist in the restorative section barrier to reattachment of the periodontal ligament alleviates periodontal ailments by removing and to the root surface. The dentist performs the replacing faulty restorations. The services of the curettage by using the curette instruments. Local orthodontist may be required to reposition anesthetic is normally needed for this firocedure. malposed teeth. c. Gingivectomy. This term means excisionof the gingiva. The procedure is a method of periodontal M. Stipulate why the mikado. of periodontal pocket eradication. In practice, the gingivectomy is pockets is important, ideality the periodoatal normally a two-stage operation, consisting of procodures, and compare the assistaat's role I. removal of the diseased gingiva and the scaling and periodoaties to his role is other spocialitks. root planing of the root surface. Thegingivectomy may be used to treat any of the followingcondi- Purpose of Periodoatal Treatmeat. As yot . tions: deep suprabony pockets (between tooth know, periodontal disease affects the supportive crown and alveolar bone crest),infrabony pockets structures of the teeth. The primary purpose of (between alveolar bone crest and apex of tooth), periodontal treatment is to eradicate periodontal periodontal abscesses. furcation involvement (areas pockets. Why is eradication of the pockets so between roots), gingival enlargement, and gingival important? defects. This procedure is usually accomplished on a. A pocket is an area of food and bacterial one quadrant at a time: however, somedental accumulation and infection. officers prefer to treat both quadrants on the same b. A pocket creates conditions which lead to side of the mouth at one visit. caries of the root with subsequent involvement of d ()swum contouring. Osseous contouring is the the Pulp. surgical reshaping of bone to eliminate deformities c. A pocket causes degenerative changes in the and create physiologic bone contours. This gingiva, which increases susceptibility to acute operation is indicated when the dental officer necrotizing ulcerative gingivitis (NUG) believes the bone deformities will interfere with d. Pockets cause degenerative changes in the proper oral hygiene and gingival massage.Osseous periodontal ligament, and the inflammation from contouring is most often performed with diamond the pocket walls is a factor responsible for the bone stones; however, bone files. rongeurs.chisels, and loss in periodontal disease. large round burs may he used. When thedental et These pockets are a source of discomfort to officer uses burs and stones, you usually assist by the patient during mastication. bathing the proper area in a stream of warm water or isotonic saline to minimize injury tothe bone e Perlodoeual Procedures. Eradication of the from frictional heat.
1 08 4 9 53 42- r.hquilibraiimr. An equilibration may he In items 9 through 13 identify the the periadontic indicated when malt icclusion causes any of a variety procedures hy matching the description in column ot periodontal conditions. This procedure 11 to the procedure in column A. normal!) requires that study cuts be made to uhront .4 foforrm ft determine where the occlusion must be adjusted. 40 fiingivectonn a. The prounhire that am- An equilibration is the adjusting of the occlusal _ 10 Staling anti root silts of removing the contact areas between the upper and lower teeth so' planing necrotic and degenerated that each tooth carries its equal share of the occlusal tissue lining the gingival load. Then. the dental officer uses mounted stones Curet ag:. wall of the periodontal ()swims contour. picket. to grind and adjust the contact areas between the ing. h This method of pKket upper and lower teeth. The dental officer may radication is accom. perform an equilibration in conjuction with other ptiiItud hy the eseision of periodontal therapyor as a separate procedure. the gingiva. c. The surgical miuping of hone to eliminate &for. Assistant's Role in Periodmilics. Your duties in mities and create this section are similar to those i)fother sections. in tpoashysiologic bone con particular. oral surgery. Keep in mind that the periodontist has several variations of treatment of J. The adiusting of the oc. chisel contact arm be- periodt:mal disease. To properly dischargeyour tween the upper and hover duties, you have to know which instruments and teeth so that each tooth treatment packs the periodontist desires. You carries its equal than of should have all instruments and supplies needed for the occhual load. e.Performed to remove deep the particular periodontal treatment set up prior to dip nits of cakulas and to the arrival of the patient. Tht method of receiving smooth the noit's sorsa. the patient and adjusting the chair and your duties after dismissal of the patient are the same in the pefiodontal secfion as those discussed in the chapter dealing with basic assisting procedures. 14. To what section arc the duties of the You also arm! Irrigate and aspirate the operation periodontal assistant similar? area during periodontal surgical procedures. Still another important assisting duty is to mix. manipulate. and store surgical dressing materials. Frequently. the periodontic assistant also schedules all appointments for the periodontic section. 44 . Prestbudaatic Seetkuit Exercises (661Ik Prosthodontic dentistry deals with the Some of the facts listed in items I through 8are substitutIon or replacement of oral structures. important reasons why periodontal pockets should Prosthodontic dentistry can include anything from be eradicated: some are not. Stipulate those thatare replacing one missing tooth to the construction of )mportant reasons with a T (true) and those that arc an intricately designed device to replace missing not with a F (false). structures in a cleft palate. Most ptosthodontic mININIMMI. I Periodontal pockets are the primary cause ol treatments are concerned with replacing missing systemic disco". A penotIontal picket is an area of lood and teeth. You will recall from previous chapters that bacterial accumulation and ankaims. teeth art lost for many reasons. The older patient Periodontal pockets Create amdithins that %solid may lose some or all of his teeth because of cause caries of the root and subsequent advanced periodontal disease, whereas the younger involvement 40 the pulp patient is more likely to lose his from advanced 4. Periodontal pockets result in the loss iit nutritional food values and linen lead to caries, contact sports. or a coll. :on with a well- malnutrition. placed fist. The replacement of these missing teeth 3 Periodontal pockets can he a source of requires the skill of the prosthodontist. You form discomfort to the patient durang, mastication part of the -prosthodontic team." In this section A Periodomal pockets convon large quantities of harmful and predominantly aerobic hacteria your assisting duties are very similar to those of 7 Periodontal pockets CUSe degenerative dunces other sections in the dental clinic. The primary in the ginglva which increase sasceptihibty differences are the type of treatment being NUG, performed. tne material that you mix or h. Periodoe al podiets cause degenerauve changes in the periodontal ligament, and the manipulate. and the instruments that are used. inflammation from the pocket walls is a factor responsible for the bore loss In pernidontal 649. Stade the eumination requiremems foe each disease. new prosth Idont:c Fs:tient. iadicate why
109
4 99 radleurctdis are astentery sad speeiry eI ration 4. What are the factors that influence the &at lullenste seludellag. scheduling of prosthodontic patients?
Pe liked Relnleements. Each new prosthzdontic patient requires a type I examination. including complete oral radiographs. The dental officer will 5, How can you help assure that the dental make diagnostic Oats when indicated. He uses the officer's and laboratory technician's time is radiographs to diagnose cysts. residual roots. efficiently utilized? unerupted teeth, impacted teeth. periodontal conditions, caries, bone density, or other conditions requiring operative or surgical correction before prosthodontic treatment is started. The diagnostic casts reveal irregularities of the occlusion that must be corrected before M. Siete the fenctkon eta MI **we. name the prosthodontic treatment is initiated. These casts moterleis trout which it is fekketed, sad specify also reveal irregularities that will be a factor in the precisions aud assisting duties involved determining the type of appliance to be constructed. daring Its falwksika. In planning prosthodontic treatment. all oral surgery, and periodontic, endodontic, and Presthedestic Procedures and Assisting restorative treatment should be completed befeee Duties. Prosthodontic treatment is primarily prosthodontic treatment is initiated. concerned with replacing missing teeth with some Appehatesent &heading. Most prostlwgiontic type of artificial substitute. These substitutes for the cases require a series of appointments. It's usually natural teeth are called prosthodontic appliances. your duty as the prosthodontist's assistant to Normally, there are four groups of prosthetic schedule these appointments. Two basic factors appliances: dentures. crowns, inlays, and special influence the scheduling of prosthodontic patients. maxillofacial appliances. The procedure and These factors are the procedures to be sequence of clinical steps described below are accomplished during the appointment and the general in nature. and these vary with the individual laboratory time required between appointments. dental officers and the specific requirements of the These factors will, of course, dictate the time patient. allocation for which you should schedule the Although the basic clinical steps for patient, and the date on which you schedule the prosthodontic procedures are essentially the same patient. in all clinics, the sequence of steps and of materials You must understand the procedure being required varies with the individual dental officer carried out and know the varying amounts of time and the specific requirements of the patient. Many that must be allowed for laboratory work between dental officers combine or omit steps according to visits of a patient. Never hesitate to ask the dental the needs of each cast. Thus. you must be prepared officer and coordinate with the laboratory to render the required assistance at the proper time concerning time allocation for various procedures and in the desired manner, Although a particular so that the dental officer's and laboratory technique of one prosthodontist may vary from that technician's time is efficiently utilized. of another, variations are easily mastered, provided you are familiar with the general procedures and Exercises (Mk materials used. Complete or li411 demurer. A complete denture is I.What type of examination is required for each an appliance that replaces the full number of teeth new prosthodontic patient? in the arch. This appliance is fabrbated from acrylic with porcelain or acrylic teeth. On the first appointment the dental officer will take maxillary and mandibular preliminary impreuions. He will 2.How are full.mouth radiographs used by the atso :ecord information and directions on AF prosthodontist? Form S19, Dental Prosthetic Case Record. This form was ,liscussed in another volume. Although several imptssion materials are suitabk, the first impression is often taken with cake compound. 3. How are diagnostic casts used by the This softened compound is placed in an impression prosthodontist? tray and pressed against the oral tissues by the dental officer. The bottom of the tray may be sprayed with cool water until the compound hardens. after which the impression is withdrawn. You then take the impression to the laboratory so that the impression
110 ins) may he poured and u custom tray may he (4) Return the occlusion rims to the laboratory constructed for the next appointment. so that the teeth may be set up. Your duties during the first appointment may (5) Fill out AF Form 644. include all or part of the following: (1) Soften the compound in the compound The purpose of the fourth appointment is to try heater, following the manufactureei directions. the waxed-up trial dentures in the patient's mouth. (2) Place petroleum jelly on the patient's lips This is done to check appearanee, functional and around his mouth to prevent materials from relationship, and other measurements. The trial sticking to his skin. dentures are sent to the dental treatment room from (3) Chill the compound in the mouth with cold the laboratory on the master casts toprevent water as the dental officer holds it in place. warpage. Since the teeth are set up in wax for the (4) Perform routine assisting duties and assist try-in, they may be moved about by the dental the dental officer as directed. officer, if necessary, for both esthetics and function. (5) Initiate AF Form 519, and AF Form 644. Your duties during the fourth appointment areas follows: The second appointment is used to obtain a final (I) Obtain the trial dentures from the impression. This impression is taken inan laboratory. individual impression tray constructed in the (2) Assist as directed. laboratory from the preliminary casts. The (3) Add applicable information on the patient's individdal tray may be made of acrylic resin, shellac AF Form 519. baseplate, or special tray material. The impression (4) Fill out AF Form 644. material used is usually one of the "wash" types, (5) Return the trial dentures to the laboratory so usually zinc oxide paste or plaster. The final that the denturei may be processed and finished. impressions are taken to the laboratory, and the master casts are poured. Occlusion rims are then The fifth appointment is the final one in the constructed on a baseplate that the laboratory has production of complete dentures. This appointment adapted to the master casts. Your duties during this is used by the dental officer to insert the completed second appointment are as follows: denture in the mouth and make final corrections. (1) Coat the area around the patient's mouth He also instructs the patient on the proper care and with petroleum jelly so that the impression material wearing of the dentures. Your duties for the final will not adhere to the skin. appointment areas follows: (2) Mix the impression material. If you use zinc (1) Obtain the completed dentures from the oxide paste, mix it on a parchment pad. If you use laboratory. 4) plaster-type impression material, mix it in a rubber (2) Assist as directed. bowl. (3) Make proper entries on AF Form 519; AF (3) Perform routine duties and assist as Form 644: and SF 603, Dental Health Record. directed. (4) Add applicable information to AF Form Exercises (670): 519 and fill out AF Form 644 for the patient's visit. (5) Take the final impression to the laboratory. I. State the function of a full denture and name the materials from which it is fabricated. The third appointment is used for interocclusal relationship. The dental officer establishes and records several measurements of the patient, such as centric relation, vertical dimension, and the 2. What is accomplished during the first full occlusal plane. This is accomplished by placing the denture appointment? baseplate and occlusal rim and using a sharp instrument to mark the relationship on the wax occlusal rim. The baseplates and the occlusal rims are then placed back on the master casts. The case is 3. What are your duties in regards to the now returned to the dental laboratory. Laboratory compound impression material during the first personnel now mount the casts on an articulator, set appointment for a full denture? up the artificial teeth in the wax occlusal rim, and trim the wax until it resembles a denture. Your duties during the third appointment are as follows: (1) Aid the dental officer as required in 4. Why should you place petroleum jelly on the recording interocclusal relationships. patient's lips and around his mouth? (2) Assist as directed. (3) Add applicable information to the patient's AF Form 519.
411 5. What is the purpose of the second appointment The first appointment for a removable partial for full denture fabrication? denture is used to prepare rest preparations in the teeth to be used as abutments (a tooth upon which the clasp is placed to retain, support, or stabilize a removable partial denture). It is also used to take 6. What type of impression is usually used for the impressions of the hard and soft structures of both final full denture impression? arches of the mouth. After the dental officer prepares rest seats on the abutment teeth, the patient's teeth are cleaned and polished (all debris removed) before the impressions are taken. One of 7. What functions are performed by the dental the elastic impression materials (usually alginate laboratory personnel between the second and hydrocolloid) is used for the impression. The third appointment for full denture fabrication? material is placed in a rimlock, perforated, or individual impression tray. After the dental officer withdraws the impressions from the patient's mouth, they should be taken to the laboratory to be 8. What is the purpose of the third appointment poured up as soon as possible to prevent distortions for full denture fabrication? caused when the impression material dries out. A stone (hydrocal) mix is used to pour the impression. and occlusion rim(s) will be constructed on the master cast. The master casts are sent to an area 9. What functions are performed by the dental dental laboratory (ADL) to have the metal laboratory between the third and fourth full framework constructed. Your duties will include denture appointments? the following: (1) Clean and polish the patient's teeth(when required). (2) Mix and prepare the impressionmaterial 10. What is the purpose of the fourth appointment according to the manufacturer's instructions and for full denture fabrication?. place it in the impression tray. - (3) Assist as directed by the dent; I officer. (4) Prepare AF Form 519 and AF Form644. (5) Take the impressions to thelaboratory. 11. What is the purpose of the fifth appointment for full denture construction? The second appointment is used to establishand record the relationship between the maxillary and mandibular arches. The dental officer establishes the centric relationship with the occlusionrim(s) placed in the patient's mouth. In some cases.the 671. State the functionofa removable partial metal framework of the partial denturewill be used denture, name the materials from which itis to construct occlusion rim(s). Thetooth shade and fabricated, and specify the procedures and mold will also be obtained at this time. Yourduties assisting duties involved during fabrication. during the second appointment include the following: Removable partial dentures. A removable partial (1) Obtain the occlusion rimsfrom the denture is an appliance replacing less than the full laboratory. number of teeth in one arch. These appliances are (2) Assist as directed. fabricated from gold, chrome-cobalt, or acrylic, .(3) Make proper entries on AF Form519 and with porcelain or acrylic teeth. A thorough AF Form 644. examination, including a full set of radiographs, is (4) Return the case to the laboratoryfor the performed before the partial denture is started. final fabrication. Study casts are made when indicated. This preliminary examination is made for the same The purpose of the third appointmentis to insert reasons as the preliminary examination for afull the completed removable partialdenture. The denture. Another reason is to determine where the dental officer inserts the completeddenture in the rest preparations must be prepared in the teeth. A mouth and makes necessary adjustments.In making rest preparation is a cut on the surface of atooth adjustments he may contour the framework,clasps. made by the dental officer to 2-..commodate the etc. He will also instructthe patient on proper care occlusal or incisal rest of a rt.movable partial and wearing of the dentures. Yourduties during the denture. insertion appointment include thefollowing:
112 4 2 . 6 (I) (1 ) Assist the dental officer as directed. the entire coronil portion of an anterior tockhand (2) Return the dentut t to the laboratory for is constructed of acrylic or porcelain. polishing after alterations have been made. (2) Partial crown. This crown covers threeor (3) Make proper entries on AF Form 519 and more, but not all, surfaces of the coroneportion of SF 603. a tooth, usually the mesial, lingual, and distal. (3) Veneered metal crown. Theveneer crown is Exercises (671): a gold crown, the facial surfaces of whichare I. State the function of a removable partial covered with a porcelain or acrylic shell. denture and name the materials from which it is (4) Thimble or coping crown. This isa fabricated. porcelain or acrylic crown or jacket that is placed over a gold castittgpr platinum shell. --(5-) Full gold crown.-Thiiis a crown, constructed completely of gold, restoring the 2. What is accomplished during the first coronal portion of a tooth. appointment for the fabrication of a removable partial denture? Inlays are cast restorations that are fabricated, usually in gold, to correspond with the form ofa cavity and then cementedinto the cavity, theymay also be made of porcelain or plastic. In!aysare 3. What type of impression tray shouldyou grouped into five classes which are numbered Ito V choose if an alginate impression is being taken? according to the surfaces of the tooth restored: a. Class I. These restorations include the oc- clusal surface of a bicuspid or molar (and some- times the facial or lingual surface of other teeth) 4. Why should the impression be taken to the b.Class II. These restorations include the laboratory as soon as possible after it has been occlusal surface combined with either the mesialor removed from the patient's mouth? distal surface, or both. c. Class III. These restorations are limited to the mesial or distal surface of an anterior toothnot involving the incisal edge. 5. What procedures are accomplished in the d. ClassIV. These restorations involve the dental laboratory between the patient's first and mesial or distal surface ofan anterior tooth second appointments for a removable partial involving the incisal edge. denture? e. Class V. These restorations are confined to the facial or lingual surface.
The fabrication and placement of gold crown,/ 6. What is accomplished during the second and inlays follow sequential steps. Fast, ofcourse, appointment for a removable partial denture? the tooth is prepared, then the dental officermay construct the wax pattern of the crown or inlay in the mouth; this is called the direct technique. Or he may use the indirect technique and take an 7. What is the purpose of the third appointment impression of the prepared tooth in acopper band for a removable partial denture? or crown and bridge tray filled with a suitable impression material, such as rubber base. If the direct method is used, the wax pattern is used by the laboratory for investing and casting. Ifan impression is taken, the impression is pouredto make a die (positive reproduction), anda wax pattern is constructed on the die. Next, this pattern 672. Identify the types of crowns and inlays,state is placed on a sprue, put in a casting ring, and their purpose, and trace the steps required for imbedded in an investment (heat-resistant gypsum) their fabrication. material (see fig. 4-1). This process is called investing. When the investment material hardens, Crowns and inlays.Artificial crowns replace all the sprue is removed. The casting ring is placed in or part of the coronal portions of a tooth and may an oven and the wax is then burned out to form a be constructed of gold. porcelain, acrylic,or a mold. The casting ring is then placed in the casting combination of these materials. Thereare several machine and molten metal is cast into the moldto types of crowns u described below: form the crown or inlay. A temporary r=toration (1) Complete veneer crown. This crown ccvers or crown is plauxi on the tooth to protect it until
113 4 3 Column A Cokonn 8 4. Thimble or coping mesial or distal surface, or crown. both. 5. Class IV inlay. b.A gold crown, the facial 6. Full gold CfOwn. surface of which has been 7.Complete veneer covered with a porcelain crown. or acrylic shell. 8. Class 1 inlay. c.A cast restoration that is 9. Class III inlay. confined to the facial or 10. Veneered metal lingual surface. crown. d.An acrylic or porcelain crown that covers the en- tire coronal portion of an anterior tooth. e. A cast restoration that is limited to the mesial or distal surface of an an . terior tooth not involving the incisel edge. f.A porcelain or acrylic crown that is placed over a gold casting or platinum shell. s.A crown that covers three or more, but not all sur- faces of the tooth's oar- onal portion. h. A cast restoration that in- cludes the occlusal surface Figure 4-1. Divested crown. of a bicuspid or molar. i.Constructed completely of gold and restoring the coronal portion lif a the permanent restoration is completed.Your tooth. follows: j.A cast restoration includ. duties during the first appointment are as ing the mesial or distal (1) Cool.the tooth with water during the cavity . surface of an anterior or tooth preparation ormanipulate the suction tooth involving the incisel apparatus to keep a clear field. edge. (2) Mix impression materials. (3) Help prepare temporary restorations or crowns. II. Briefly describe the events that occur chairside (4) Take the impressions or wax pattern to the during the first appointment for a crown or laboratory. inlay using the direct technique. (5) Complete appropriate admihistrative work. The second appointment is used to cement or seat the crown or inlay ontothe tooth preparation. 12. Briefly describe the eventsthat occur chairside The dental officer tries the crown or inlayin the during the first appointmentfor a crown or patient's mouth. He then makes any necessary inlay using the indirecttechnique. alterations, after which he cements it into place. He will use the crown and bridge cement that he prefers. Your duties during the insertion appointment include the following: 13. If an impression is taken, uponwhat is the wax (1) Mix the cement. pattern constructed? (2) Assist as directed. (3) Complete appropriate administrative work.
Exercises (672): 14. Briefly describe how the wax patternis In items 1 through 10 identify the typesof crowns converted into a metal crown. and inlays by matching the description in column B to the type of restoration in column A.
Column A Column 8 15. What is accomplished during thesecond crown _ I.Class V inlay. a. A cast restoration that in- 2. Partial crown. cludes the occlusal surface or inlay appointment? _ 3.Class II inlay. combined with either the 114 414 16. State the purpose of crowns and inlays. 4. What procedures are accomplished to properly position and attach the pontic to the abutment castings?
673. State the function of si fixed partial denteire, name tbe materials from which it is fabricated, and answera Wks a key glIaltiatts that sineto 674. Given a series of statements concerning indicate the steps (other than those involved with special mazillolacial appliances, indicate which crowns and inlays) required in its fabrication. are true and which are false.
Fixed partial dentures (bridge).A fixed partial Special rnaxillofacial appliances.In addition to denture is an appliance permanently fixed to the prosthodontic appliances already discussed, abutments (a tooth that supports a fixed partial there are a few others of which you should be denture) with inlays or crowns which cannot be aware. These appliances, while not rare, are removed by the patient. It is usually fabricated from infrequently seen in USAF dental clinics. Since ru gold and may have porcelain or acrylic facinp. The -probably will not be involved in the fabrication missing teeth are replaced by pontics. A pontic isa process of these appliances during your AF career, goid artificial .tooth suspended from one or more we will discuss them only in general tetras:. abutments of a fixed partial denture. Veneered a.Wire-raisers. Bite-raisedareappliances acrylic or porcelain facing may be attached to the designed to increase the vertical dimension of the pontic for esthetics. A fixed partial denture that has occlusion. This type of prosthodontic appliance is an abutment only on one side is called a cantilever generally indicated for patients wbo have padually bridge. lost vertical dimension from wear, loss of teeth, or The fabrication and insertion of a fixed partial temporomandibular joint problems. Because of the denture are also carried out in sequential steps. The difficulties involved in establishing a balanced dental officer prepares the abutment teeth for occlusion with this type of appliance, it is a crown or inlays, and impressions are taken. Dies common practice to first make a temporary are made from the impression. A wax pattern is removable appliance of acrylic resin. After the made on the dies by the dental laboratory patient has worn the temporary appliance long technician or by the dental officer. The wax enough to determine its effectiveness, a permanent patterns are invested, burned out, and cast by the appliance is constructed of metal. laboratory technicians. The inlays or crowns are b. Obturators.Obturators are appliances placed on the teeth, and an impression is taken of designed to close the unnatural opening between the entire arch with the castings in place. The the mouth and nasal cavity of patients having cleft impression is poured up with a special soldering (partially split or divided) palate. Ideally, the investment. The pontic is then stabilized in its obturator should fully restore the functions of the proper position with soldering investment. The tissue it replaces. The palatal portion of the pontic is then attached to the castings with gold prosthesis should also restore the resonance solder, and the castings with the attached pontic are necessary for distinct speech. finished, polished, and cemented into place in the c. Splints.Splints may be used to either provide mouth. This procedure is usually accomplished in anchorage for pressure applied in reducing a three appointments. Your duties are similar to those fracture or to hold the bone in proper alignment of other procedures previously discussed in this after it has been reduced by other means. In chapter. addition to their use in treating fractures, splints are sometimes used during periodontal treatment to Exercises (673): temporarily stabilize mobile teeth during the healing process. Normally, impressions of both I. Briefly describe a fixed partial denture. arches are made so that when the splint is fabricated, it will not interfere with normal occlusion.
2. What is a pontic? Exercises (674): Indicate whether the following statements concerning maxillofacial appliances are true (T) or 3. What is a fixed partial denture called that only false (F) by circling the appropriate T or F. has an abutment on one side? T F1. Appliances used to close unnatural openings between the mouth and the nasal cavity are called bite-raisers.
115 41 5 T F2. An obturator should restore the officer will instruct you as to the type of impression resonance necessary for distinct speech. material required and the type of tray to be used for each case. T F3. When preparing a fracture splint it is only Reliningandrebasing. Mouth tissues that support necessary to take an impression of the dentures undergo a certain amount of shrinkage arch being splinted. over a period of time. This change may be seen as a loss of vertical dimension, a deviation from centric T F4. The function of a bite-raiser is to increase occlusion, or a loosening of the denture. To correct the vertical dimension of occlusion.. these conditions the dental officer may reline or rebase the denture. T F5. In addition to their use in treating A reline is accomplished when the denture fracture, splints may also be used to becomes loose in the mouth and the dental officer 'Stabilize mobile teeth during periodontal decides that the difficulty can be remedied with a dentist makes treatment. new lining or refitting. To do this, the an impression inside the denture.-In-otherwords, he uses the denture as his impression tray. The T F6. Bite.raisers are always constructed from a laboratory then substitutes new acrylic for the dental metal. impression material, and the refined denture is inserted in the patient's mouth. The occlusion is usually adjusted at this time. Rebasing consists of replacing the entire denture base with new material. This procedure is similar to 67$. Name the types of denture repairs and state the reline procedure. If the dental officer decides to the purpose and procedure for relining or rebase the denture, the clinical steps are the same as refusing &mazes. forareline impression. The actual fabrication is done in the laboratory. When it is returned to the clinic for insertion; it is handled much the same as a Repairing, Rellulug, and Rehashes Dintwes. new denture. In addition to the fabrication of new prosthodontic appliances, service must also be provided for appliances that are in use. As with the original Exercises (675X fabrication, the bulk of the work is usually performed in the dental laboratory. We begin our I. Thinking from the clinical viewpoint, what are discussion of these procedures with repairing the two types of denture repairs? dentures. Repairing. Many different types of broken complete dentures, removable partial dentures, or fixed partial dentures may be brought into your clinic. In practically all cases, repair is possible. 2. What type of denture repair procedurewould The dental laboratory has the capability to replace normally require impressions of both the upper fractured or missing artificial teeth, to mend and lower arches? fractures of the acrylic denture base material, and in some cases to restore damaged frameworks to their original condition. From the clinical viewpoint, you may think of the needed rt.,airs u being of two types: (1) repairs that can be made in the laboratory 3. What causes the need for relining orrebating without an impression or (2) repairs that require an dentures? impression. Impressions are not usually needed if an anterior tooth is to be replaced or if the pieces of the fractured denture base material fit firmly and unmistakable into their original position. If a posterior tooth is being replaced, impressions of 4. What is used as the impression trayfor relines both arches are usually necessary so that the or rebases? laboratory can grind the tooth into the proper occlusion. If denture base material" fracturto the extent that it is difficult to establish the exact original relationship of the material, usually an impression of that single arch is taken. An impression permits repair to be made on an 5. Where are the actual relining orrebasing accurate cast of the patient's mouth. Thedental procedures accomplished? 116 416 7
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Figure 4-2. Bozod method of pouring a cast.
676. Name the methods, specify the materials, are a responsibility of dental laboratory personnel, and describe the procedures involved in pouring they are also levied against the dental specialist. casts. There are times when the only dental laboratory specialist is on leave status or has begun a Pouring and Trimming Casts.The tasks of laboratory procedure that requires his full attention pouring and trimming casts are frequently for a few minutes. Since most impressions tend to misconstrued as being solely the responsibility of distort because of dehydration or room temperature dental laboratory personnel. Whereas these tasks variations. you r,-...1st pour them right away. Further,
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Figure 4.3. Upright method of pouring a cast. 4 1S
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A
Figure 4.4. Two step method of pouring a cast
119 419 .LO your dental officer may sometimes give you specific The upright method of pouring impressions is instructions as to how he wants you to trim a cast. commonly used by experienced laboratory Thus, this too may become your responsibility. personnel. For the beginner, this method makes it Pouring casts. One of the keys to producing a difficult to control the thickness and the shape of the final cast. However, in experienced hands, the a desirable cast is using a properly mixed gypsum product. Most impressions are poured with a mix of upright method saves time and produces an plaster of paris, hydrocal (dental stone), or minor accurate cast. As the method name implies, the variations of these. To assure a good cast mix, you impression must remain in an upright position should adhere to the following: throughout the pouring and remain in this position a. Always use a clean mixing bowl and spatula. until the plaster or stone hardens. b. Always add the powder to the water, never the Figure 4-3, parts A, B. and C, shows the usual water to the powder. steps in pouring an edentulous mandibular c. Spatulate thorouahly, incorporating all of the impression. Part A shows dental stone being powder evenly throughout the mix. vibrated into the tooth areas of the mold. Part B d. Avoid whipping the mix, which will cause the shows dental-stone being vibrated into the area that final product to have excessive air bubbles. forms the floor of the mouth. Notice that a tongue e. Help eliminate air bubbles from the mix by spacer has been placed in the inner horseshoe area occasionally jarring the bowl against the bench top, of the impression tray. Wet paper, asbestos, wax or by holding the bowl on the vibrator for a few any other suitable material may be used to construct moments, and by subjecting the final mix to a the tongue spacer. Part C shows that stone has been vacuum, mi xer- investor machine (used to mi x added to build the model to the desired thickness. gypsum products and to eliminate air bubbles). The base is also flattened and smoothed. i Never add water to a mix that is too thick, As we mentioned earlier, the remaining method because this interferes with the setting mechanism. of pouring impressions is the two-step method. As g. Whenever possible, use mechanical the method name states, there are two steps in spatulation in preference to hand mixing. pouring an impression when using the two-step method. Actually, the two-step pouring method Once you have the desired mix, you are then ready requires two mixes of either hydrocal or plaster of to use one of three methods of pouring a castthe paris. boxed, upright, and two-step methods. Figure 4-4, parts A, B, C, and D, illustrates the The boxed method is generally considered the two-step method. Part A shows the impression best method for the inexperienced cast pourer. being poured to a level slightly above the height of However, the boxed method is very difficult to use the impression walls with dental stone. Note also when pouring agar or alginate impressions. The that the surface of the stone is left rough. Part B reason for the difficulty is the beading (bordering shows that the second mix of dental stone has been the outermost limits of the impression with utility formed into a patty. Part C shows thin the wax) requirement. The utility wax does not adhere impression containing the hardened initial mix is very well to agar and alginate materials. inverted onto the patty formed by the second mix. Impressions made with impression compound and The soft second mix is then shaped to form the base custom acrylic trays are comparatively easy to bead of the model, as shown in part D. and box for pouring. For illustrations of the boxed method, see figure Exercises (670: 4-2, parts A, B, C, and D. part A shows a typical maxillary edentulous impression. Part B shows the 1. Why must impressions be poured as soon as impression after the beading has been accomplished possible? with utility wax. The beading is to be applied at about 3 millimeters below the height of the peripheral (outward boundary) roll and extended across the posterior border. Part C shows the 2. What gypsum products are used to pour impression after the beading and boxing wax has impressions? been applied. The boxing is now complete and the impression is ready to pour. Part D shows the boxed impression being poured with dental stone. Note the vibrator which helps to eliminate air bubbles In items 3 through Et. identify the true statements and also aids in making the stone flow to fill in concerning the mixing of gypsum products with a T voids and low spots. and the false statements with an F. The boxed method is the best method to insure _ 3.Whenever possible, use mechanical that all peripheral borders are complete. The next spatulation in preference to hand method for pouring an impression is the upright mixing. method. . Cf itli 14111. 4. Use a dean bowl and mixing spatula.
5. Whip the mix to insure the compkte incorporation of all powder particles.
.6.Always add the water to the powder.
IMIONII 7.Help eliminate air bubbles from the mix by jarring the bowl spinet the bench top or by holding it on the vibrator.
B.If the mix appears too thick. you should add a little water.
9. Name the method of pouring impressions in which you invert the impression containing the hardened initial mix onto the patty formed by the second mix.
10. Name the method of pouring impressions in which you employ dental waxes to form a matrix for the gypsum product.
Apia 44, Co Monolog moths.
1 1. Name the method of pouring impressions in which the impression remains in the upright position throughout the pouring and in which, the stone is added, smoothed, and flattened to trimming, and describe the two metimds of build the model to the desired thickness. trimming.
Trimmint casts. Except for casts produced by the boxed method of pouring, there is a requirement to trim down the rough and excess portions of the cast base. Even some boxed impression casts have a base 12. What materials may be used to construct a that is too thick or has irregular surfaces which need tongue spacer when pouring mandibular smoothing. You may be thinking that minor impressions? irregular surfaces or a cast base that is only slightly too thick should cause little or no concern. Basically this can be true, but the dental profession believes that we should -always put our best foot forward" for psychological advantage. 13. When pouring impressions. what equipment is Consequently. we should always be "neat used to help eliminate air bubbles and to aid in conscious" about everything the patient might see in making the stone flow to fill voids and low the dental treatment room. From this viewpoint spots? then, it is very important that dental casts present a neat, attractive appearance. In practically all cases, you trim dental casts on a machine called a model trimmer. This electrically operated machine is. equipped with a 10-inch abrasive wheel, a small worktable, and a water- dispensing mechanism to keep the abrasive wheel 677. Name the equipmeat used to trim casts, rinsed clean. The worktable is located near the IIIspecify the desired cast coaflgoratioa after access opening to the abrasive wheel. This
121 42i 4. Briefly describe the two methods of trimming alongside the periphery.
4;4 IIS. State the we of costaw impression trays, sad i'VZ!*;41-4411t7r..,, same series hey ipsestioas thst sone to ,S ia 711111111kiL describe the methods mad pneederes limbed *att. the tray's essetreetkra., Fallekaties Cosies lasprealan Trays. Many dental officers (especially prosthodomists) prefer la have custom impression trays mnde for use in taking final (detailed) impressions. These trays maybe fabricated from bueplates (thick shellac sheets), impression compound. or acrylic. Probably the Sim 44. Acrylic !alprosiox tray. most common type of material usedfor fabricating impressions is the self-curing resin (acrylic). See worktabie is usually adjustable to permit trimming a fisure 4-6 for a typical acrylic impression tray. make model at nearly any angle. There are generally two ways used to acrylic impression traysthe dough and the To trim a cut you should probably mark h with sprinkle methods. Before adapting the tray trimming lines beforehand. These lines should be material, you must coat the cast with a suitable made to determine the base thickness.. to align the separating medium, such as tinfoil or alginate bue plane to the occlusal plane of the teeth: and to solution (sodium of potassium alginate in distilled trim the outer boundary alongside the posterior water). When using the dough method, soumix the teeth, the anterior teeth, and the posterior border of acrylic (powder and liquid) until the mix reaches the cast. If the occlusal plane of the teeth is not the dough stage and then mold it with your hinds parallel with the plane of the cast base, you should into a fairly thin wafer. You may then adapt the trim the base until it is parallel. Normally, the base wafer to the cut. Use some of the some.material to should be from 3/8- to 1/2-inch thick. The outer form a handle on the anterior pan of the tray.To boundary alongside the teeth should be trimmed up use the sprinkle method. you mustalso have a to the outermost edge of the peripheral (vestibular model coated with a separating medium. The tray mucosa) roll. There are two general ways of making then begins by first sprinkling the acrylic trimming alongside the periphery. One way is to powder (polymer) over the cast and next adding follow the contour completely around the enough liquid to saturate the powder: This peripheral boundary. The other way is to trim the procedure is continued until the tray is of uniform outer peripheral boundary in four straight lines. and adequate thkkness, Usually custom impression These lines generally run from the third molar area trays are only fabricated for patients needing afull to the cuspid on either side of the model and from denture or full dentures. the cuspid to the midline on either side of the cut. Other factors to consider when fabricating The posterior border should be trimmed so that the custom impression trays are blocking out cast hightst point does not exceed the occlusal plane undercuts, adding spacers, and perforating the level. See figure 4-5 for examples of casts trimmed trays. If the east you are to use has deepundercuts, in these two ways. you must. remember to block them outbefore adapting the acrylic. Failure to do so will result in a Exercises (677): damaged cast or tray when you attempt to remove I. Name the equipment that is usually used to trim the hardened (set) tray. You may block out (fillin) casts. the undercut areas with baseplate wax or modeling clay. Some dental officers prefer to use impression trays which have had spacing provided.By spacing, we essentially mean to provide a traythat is larger 2. Normally, how thick should the base of the than the cast. To meet this requirement, first adapt a trimmed cast be? sheet of baseplate wax to the cast before adapting the acrylic. Some dental officers also prefer to have custom trays perforated. Perforations serveto provide escape areas for the impressionmaterial. 3. How close to the teeth should the outer which minimizes tissue displacement,and to the boundary of the cast be trimmed? provide retention of the impression material to
122 49 a..
A Al
. I )c
Figure 4.7 Main ad adapting but non to basplate. tray. Before fabricating a custom impression tray. it 3. What are the two methods of making acrylic is good policy to ask your dental officer what impression trays? Briefly describe each provisions he desires in the tray and make it method. accordingly. Lurches (elk 4. Why isit necessary to block out undercuts I. How are custom impression trays used? when constructing a custom impression tra??
2. What is the most common material used for 5. How can you block out undercut areas of the custom trer construction? cast?
123 :3) 6. If the deatal officer prefrs to have ass by beetles die wee istil it is is a Mold smie,then immolate tray with maim bow cm you clippies the soaked art in the mix. Tke Mambo is provido this speciae then "sickly rembpsed over the wax. lie meek is a baseplate lined with wax. Final impression materials may also be added so the %NO* and adopted so the cest m °bads the stabilizing effect. 7. What purpose could be achieved by Eke riot. lie rims we weally conetrucIed with perform* a custom tray? beeeplam wax. They may be formed by bend or a tms.piece former may be mid for this purpose. To foem bite rims usiag the former, you *add hest a sheet of basepime wax until it is in a semiliquid slaw, amemble the bite rim former and place it on a 6711. Give the densities el "biting flat surface Wes slab or metal bench top), sad relatioashias," sad answer series of key was ita wax imo the former, a ohm is fifers tprestleas seseendeg tbe promderes embed kr 4.70%. Oace the wu hes cooled so the solid NSW ammerambet liamplases ami bile dos. any MIN *add be removed with a knife, as showa in flows 4-7,1. The formes may then be Baseplates sad Site Rims. After the final disassembled and the bite rim removed. You may impressioo has been glowed and the "maser cast" then adept the formed bite rim to the stabilised has bean separated from the impression, the next .baseplate by using sa alcohol torch, heated wax requirement is to obtain the correct biting spatula, and more beeplate twat to act as a bonding relationships. To get thee biting relationships, the material, as shown in lien 4.7, pans C aad D. If dentist uses baggages and bits rims. fey biting you are formitte the bite rim by hand, heat a sheet of relationships, WO are referring tO the patient's beagle* wee until surface mettleg is merest; vertical biting depth, the OCCittill plane, the then quickly roll the wax into a cylinder shape. midline, the contour and fullness of the lips and Next, bead the wax cylinder into a horseshoe that cheeks, etc. Your wle in this regard is to construct coincides with the occluaal surface of the Weepiest. the bmeplate and bite rim and combine the two. Attach the bite rim in the mate meaner as was The fins step is to construct the beseplate. previously described, and use a compound knife Otteepiare. Before adapting the baseplate 10 the and wax spatula to properly shape the bite rim. cast, immerse the cast it, slurry water (water containing dissolved hydrocs1) for a few minutes. Emden(Mk The slurry water will act as a separating medium. The I:template is then adapted to the cast by first I. What is meant by bid% relationthips? being sure it is centered and then using an alcohol toed or Bunsen burner to apply heat and soften the beeeplate. With sufficient heat, the shellac Man Misplace may be easily adapted to the cam by using 2. What is used to obtain the correct biting light finger pressure. (CAUTION: T prevent relationships? possible burning of your fingen, dip them in water before touching the heated baSeplate.) Excess beseplate material may be trimmed with a pair of crown and bridge scissors. Any remaining rough 3. Why should the cast be immersed in slurry edges may be eliminated * using a heated wax water before the beseplate is adapted to the spatula or by using an arbor band (abrasive band on a rubber wheeled mandrel). At times, baseplates cast? need reinforcement. Paper clips can be easily shaped, heated, and embedded into the baseplate (espcially mandibular baseplatea) for reinforce- ment purposes. 4. Briefly describe how the baseplateis adapted to Most dental officers prefer to have the inside of the cast. these baseplates lined with a material which reproduces a close resemblance of the detail shown on the master cast. Such detail cannot be obtained in adequate quality with the baseplate material. The S. What can easily be used to reinforce quality desired is calledstabilizing.The stabilizing baseplates? quality is acquired by tning baseplate wax or a final impression wax. Once again, the master cast must be soaked in slurry water before the stabilizing 42 .1 material is added. The wax (baseplate wax) is added
124 .. a 6. Briefly describe how you stabilize the baseplate B. What is uied as the bonding materiil for with baseplate wax. attaching the bite rim to the baseplate?
9. Briefly describe how the wax is shaped when you fabricate the bite rim without aid of the 7. What material is used to construct the bite rim? two-piece former.
IP
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ANSWERS FOR EXERCISES
CHAPTER 1 6026, Oral health displays. posters, handouts, military radio and television, blue newspaper article. and Retention: group health talks. 6027. 600 - I. The objective of the USAF Preventive Dentistry Overt or implied endorsement of the commercial Program are to: (1) Prevent the occurrence. product. 6028? progression. and recurrence of oral disease. (2) The American Dental Association. 602 - 9. Assist eligible patient categories to establish The base dental surgeon. a 602 - 10. healthy oral environment. (3) Teach each eligible The principal items required for good oral hygiene member how to maintain a healthy oral environ- namely, the toothbiush and unwaxed demal_floes. 602 ment. 1 1. During Natiorial Children's Dental Health Week. 602 - 12. No. 6002. The clinical and community health phase. 6003. All dental personnel. 600 4. Trained dental hygienists or preventive dentistry 603 - I. It is to remove the accumulations of trapped food technicians. and plaque from around the teeth. 6032. The total oral hygiene effort the patient ac- 601 - I. The elements of the USAF Preventive Dentistry complishes. Program are items b. c. d. e. g and i. 603 - 3. Toothbrushes, dentifrices, dental floss or tape. in- 601 - 2. To insure the currency of dental health classifica- terdental stimulators. and irrigating device. tion, early detection of oral disease, and proper up- 6034. A straight-handled toothbrush that has a small flat dating and maintenance of the dental health bristled head. record. 603 - 5. To disclose the normally invisible deposits of 6013. Plaque control techniques, home care, the use of plaque. adjunctive oral hygiene devices, diet and nutrition. 603 - 6. A 'jiggling scrubbing motion." and the interrelationship of preventive dentistry to 603 7. Your tongue. general dental health. 6038. Those containing fluoride. 601 - 4. A thorough oral prophylaxis should include the 6039. To remove plaque from between the teeth. removal of plaque. polishing of the teeth, applica- 603 10. Because it does not leaves wax residue on the teeth. tion of an anticariogenic agent, and a preventive 603 -I I.Press it against the tooth and move it gently down dentistry counseling. into the gingival crevice. The floss should form the 601 5. AFR 162-2. Preventive Dentistry Program for letter "U" as it adapts to the tooth's contour. Now Children. slide the floss up and down to clean the tooth's 6016. A type 3 dental examination, an oral prophylaxis proximal surface. including the topical application of anticariogenic 603 , 12.To massage the gingiva. agent, an oral hygiene demonstration and lecture. 603 - 13.A periodontal patient. handouts of approved oral health literature, and a 603 14. The removal of debris from the gingival sulcus that preventive dentistry kit. has been loosened with the brush or floss. 601 - 7. When the patient is located outside the United States or in one of the areas inside the United States 604 -I. Vegetablefruit, milk. meat. and bread-cereal. designated as remote for dental care purposes. 604 - 2. Protein for growth and repair of the body: minerals and vitamins for growth and to keep the body func- 602 - I. To complement the clinical phase by promoting tioning properly. Fats and carbohydrates for ener- good oral health habits in the Air Force communi- gy. ty. 604 c. Active teenagers or adults: a. pregnant or nursing 6022. Bases where children are in residence, and where women: and b. small children. approval has been obtained from Headquarters USAF 605 -I. Vitamin C is needed for healthy gums and body 602 - 3. The average daily air temperature in the northern tissues. Good sources of this vitamin are grapefruit. areas is lower and as a result the water intake of the oranges, cantaloupe, raw strawberries. broccoli. inhabitants is also lower. Therefore, a higher con- Brussels sprout. green peppers. sweet red peppers. centration of fluoride is required to provide the guava. mangos. and papaya. desired quantity 605 Vitamin A is needed for growth. normal vision. 602 - 4. To improve the oral health habits of the Air Force and a healthy condition of the skin and other body community through the judicious use of ethical surfaces. The dark erten and deep-yellow vegeta- publicity. bles are usually rich in vitamin A. 602 - 5. It should be repeated at intervals throughout the 605 - 3. Milk is our leading source of calcium, which is year. needed for bones and teeth. It also provides high-
127 4 617 S. liow to operate the fine tuning adjustment so he 623 11.Filtration sews to filter out poor quality long can focus it to his eyes. wavelength radiation thst is not of any dlegnoetic value. 618 - 1. You should have checked items b. c. e. f. g. and i. 623 12.Collimation reduces the sinful beam to a 23/4-inch diameter at skin surface. This dranically reduces unnecessary exposure to the patient's eye and throat VOL CHAPTER 2 624 - I. Periapical film. 6242. Toward the occlusal or incisal ;NNW. io prevent it 619I. Areas of the teeth and surrounding nructure that from obstructing the view of the apical MOON. cannot be seen in a mouth-mirror and explorer ex- 624 3., Skewing film. amination. 624 - 4. A general view of the maxillary or mandibular 6192. The dentist can view the bone loos and follow the ardt. progression of the disease. 6245. To allow for different developing times. 6193. To determine if the canal is reamed and filed to the 6246. Pedodontic. proper length. They ate used postoperatively to in- 6247. They may besot! to obtain a panoramic view of the sure that the canal is properly filled. oral structures and to view meciftc facial bones, 619 - 4. To determine the location of fractured root tips sinuses, or the temporomandibular joint. and to verify the complete removal of such root 624 - 8. The screen fluoresces when exposed to Xrays. This tips. provide a more intense ezposure of the film with- out increasing the exposure time. 620 -I . d. 624 - 9., An emulsion consisting of silver halides in a 6202. a. gelatin. 6203. f. 624 10.A latent image. 6204. C. 624 - I I.The film must be immtesiel in chemicals that CMS 620 - 5. e. a reaction that transforms the exposed silver halides 6206. b. into Week metallic silver. 624 12.Intermediate (medium fast Inv 13) sod ukTailled 621 I. The cathode and the anode. (super type 0). 6212. The tungsten target, copper head, and copper stem. 624 - 13.The film is sandwiched between black protective 621 3. The tungsten filament and molybdenum cup. paper, which in turn is backed by lead foil. These 621 4. When low voltage current heats the tungsten fila- contents are enveloped by a lightproof, waterproof ment to incadescvm. packet. 621 - 5. When high voltale current is passed through the X. 624 14. It prevents secondary radiation from fogging the ray tube. film. 6216. They give up their kinetic energy, which reappears 624 15. Because it is not padtaled in individual lightproof or is converted to Xrays anct, heat. packet. 621 7. A high degree of vacuum. 624 16. In a cool, dry place away from any chemicals. If 6218. The relatively high voltage across the anode and wired in or near the exposure room, it should be cathode. kept in lead-lined containers. 6219. X-rays produced by high voltage are referred to as 624 17. On edge. hard radiation. They have shorter wavelengths and therefore higher penetration power. 625 - I. It is to direct the X-ray barn perpendicular to an imaginary plane that bisects the recording plane of 622 - I. F. the film and theiong axis of the tooth. 622 - 2. F. 6252. Appeoximately 8 inches. 6223. T. 625 3. By placing the tip of the shon oone against the pa- 622 - 4. F. tient's skin surface. 6225. T. 622 - 6. F. 626 I. Prior to patient entry. 622 - 7, T. 626 2. The milliamperage and exposure time. 626 - 3. The kilovoltale. 623 -I . The walls are adequately shielded to prevent X-rays 6264. The manufacturer's instruction on the specific film from passing through them and exposing personnei you are using. in adjacent areas. 623 - 2. Away from the tube head: out of the line of the 627 1. c. uteful beam: and behind an adequately shielded 627 . 2. b. protective barrier. 6273. a. 623 - 3. A leaded rubber apron. 627 - 4. 'The median sagittal plane should be vertical, and 6234. It is never permissible. the tragus oorner of the mouth line should be 623 - 5. To protect personnel in areas near the exposure parallel to the floor. room from unnecessary exposure to X-radiation. 627 - 5. The median sagittal plane should be vertical, and 6236. Commercially available skulls. the alatragus line should be Fennel to the floor. 623 7. Damage to the tube head could result in leakage of radiation. 628 - I. Because of the variations in the anatomical struc- 623 - 8. To measure whole body radiation. 623 - 9. A mange so stating is quickly dispatched to the 628 2. This oould crack the film's emulsion or distort the originating environmental health service. This radiographic image. usually triggers a comprehensive investigation. 628 - 3. Sliding the film over the mucous membrane oould 623 - 10.Exposing a film badge to direct sunlight, radiant cause the patient to gag. heat, or other types of radiation could affect the 628 - 4. Horizontal. highly sensitive film 'lied in the film badge. 628 . 5. By the patient using his thumb or finger to press the
129
4,28 02- film packet firmly against the teeth being radio- 633 I. Vertically. lirlPhed. 633 - 2. C. 628 - 6. This insures recording the whole crown on the 6333. h. radiograph and allows the film to be mounted with- 6334. d. out obstructing the dentist's view. 633 - 5. a. o 628 - 7. a. Second and third molars. 6336. The locator ring. b.First and second bicuspids and the first molars. 633 7. The extension tube of the X-ray unit. c. Cuspid and lateral incisor. 633 - 8. Place a cotton roll in the space normally occupied d. Central and lateral incisors. by the CroVAls of the miming teeth. 628 - S. (1) Coat the patient's soft palate and uvula with a spraytype anesthetic: (2) have the patient breathe 634 . L To reveal the presence of caries in the crowns of through his nose or hold his breath: (3) have him teeth. particularly early lesions on the interproxi- concentrate intently on an object in his vim (4) mal surfaces. have him close his eyes and concentrate on a plea- 6342. The median salinel plane must be vertical and the . sant subject: and (5) suggest he mentally count ale-traps line horizontal. backwards from 100. 634 - 3. The film packet should be placed so that its greatest 628 - 9. Gagging is a psychological defense mechanists. and dimension lies in a horizontal plane, parallel with such a suggestion could trigger the patient's gag the long axis of the crown of the teeth. The forward reflex. edge of the film packet should be placed behind the 628 10. By having the patient bite down firmly on the tab. distal one-third of the cuspid teeth. The patient should have his teeth closed down on the bite tah to hold the film in position. 629 - I. An elongated image. 634 - 4 The central ray should be directed toward the oc- 629 - 2. A foreshortened image. clusal plane at the center of the packet. The pointer 629 - 3. It should be directed at an imaginary line that should read about 8° below the centerline for the bisects the angle formed by the long axis of the proper vertical angulation. Proper horizontal tooth and the recording plane of the film packet. angulation is obtained by sighting through the max- 629 - 4. An overlapping image. illary second bicuspid-first molar contact area. 629 - 5. The alatragus line. 629 - 6. Onefourth inch above the lower border of the 635 I. Many oral conditions from a eross-seetional aspeet. mandible. 6352.8. You should have checked items *3. *4. *6. and 629 - 7. b. *8. 629 8. c. 6299. d. 636 - 1. T. 629 10. a. 6362. T. 636 - 3. F. 636-4. T. 630 - 1. (I)g. (2) a. (3)e. 6365. F. 630 2. (I ) a. (21 b. (3) a. 630 - 3. (1) f. (2) b. (3) g. 637I. c. 630 4. (I) C. (2) a. (3) E 637 2. a. d. 630 - 5. (I ) e. (2) b. (3) d. 637 - 3. c. f. 6306. (I) b. (2) b. (3) C. 6374. b. c. e. f. 630 7. (I) d. (2) a. (3) b. 637 5. b. 630 8. (1) h. (2) a. (3) e. 637 - 6. a. 637 - 7. d. 6378. e. 631 I. To direct the X-ray beam perpendicular to the 637 - 9 d. f. recording plane of the film, which has been posi- 637 - 10. c. tioned parallel to the long axis of the tooth. It minimizes dimenstonal distortion and presents 631 2. 638 -I. They may be used to obtain a panographic view of the objects being radiographed in their anatomical the patient's teeth and their surrounding structure relationship and size. or to view a specific bony area where an abnormali- 631 - 3. 16 to 20 indite. With the longer focal (target) film ty is suspected. distance enlargement of the image is reduced. 638 - 2. The X-ray head and the cassette of the unit rotate 631 - 4. It must be increased. around the patient. 638 - 3. Because there is some degree of distortion with all 632 - I. To establish a parallel relationship between the film panographic radiographs. packet, the structures to be radiographed. and the 638 - 4. By having the patient hold the cassette against the tube head. structure to be radiographed and by directing the central ray toward the cassette from the opposite 632 2. No. 6323. d. side of the patient's head. 632 - 4. b. Because the films used in Xray work are very sensi- 6325. a. 639 - 1. 6326. f, tive to white light. It should be completely lightproof. if the entrance 6327. C. 639 - 2. way is a door, a should have an inside lock, if the 632 8. C. entrance is a maze. it should have enough turns to 6329. The shielded or printed side of the packet. keep out all light, it should have adequate ventila- 63210. Hold the right-angled portion of the indicator rod anterior to the block anct away from the film. Insert tion. the pins into the proper holes. Slide the locator ring 639 - 3 Unwrap a film under the safelight's illumination onto the indicator so that it is in front of the film Put an object on the film and place it beneath the safelight for I minute. then process the film If the packet. 130429 4 petals of doe objem is visible on the processed film. 642 - 11.I. the illwaination is mot isle. 642 - 12. h. 639 - 4. It is a conesIon- and rust-rmisient tank that haa 642 - 13.d. three oompartments. The two smaller compart- 64; - 14. e. ments are provided for the developer and fixer solution: the larger compartment contains water. 6395. It can be partially aintrolfed by the but and ixild CHAPTER 3 wage simply. Alta the aster is in the tank, a refrieeration unit maintains the proper tem- perature. If the processing tank is not equipped with 643 I. It promotes a feelinsof hermony that makes the job a rehtillf116011 unit. the incoming pipes should lead more enjoyable and results in a smoother running. So a mixing valve that will regulage the water flow. more reputable dental service. 6396. You ems, the film and feed it into a slot on the 643 - 2. By fulfilling the psychological needs of your pa- automatic developer. A oonveyor synsm transports tients and coworkers. tbe film through the developing chemicals and turns 643 - 3. Even termites horseplay can have a neptive effect out the promsed film in about 5 minutes. on a lenient who is in pain or who is apprehensive. 6397. The interval timer. 643 - 4. The spirit of the Golden Rule. 643 5. You should have checked items b. c. e, and h. 640I. To provide a way of identifyine which patient's films are on which rack. 644I. First you mint make preparations for the patient. 6402. The unvnappine and placement of the film onto the next you greet the patient. and finally you seat him promising rack. in the *vital chair. 6403. Tiny air bubbles may form on the film's surfaces 644 2. An alcohol sponse. and if left uncorrected, portions of the film go un- 6443.. The basic dispostic group should be placml on the derdevetoped. This problem can be prevented by bracket table. Other instruments shoold be needy *Mins the rack immediately aRet you place it in arranged with as few visible as possible. the developing solution. 6444. If the record is complete and =rent. if it is the cor- 6404. 4,/, minutes at 6r F. rect record, and if positive rapines on the dental 640 a 5. The left-hand section. patient health history are indicated on the outside 6406. The left-hand section since the developing time is of the folder. most critivel. 644 - 5. Before the patient is seated or in a way that will not 6407. The silver halide', in the film's emulsion, that were cause the patient undue alarm. affected by the X-rays are convened to black 6446. Walk to the waiting room and Mit the patient metallic silver by the developer solution. pleasantly by his name and rank. 6408. When it becomes a dark brown color. 644 - 7. At the door of the treatment room. 6409. Move the film to the center (water) section of the 6448. Noncontroversial ',Aiwa like the weather or the processing tank and agitate the film for 15 to 30 patient's hobbies. seconds for the purpose of rinsing off all traces of 6449. It should be placed in its lowest position and the the developer solution. bracket table and engine arm should be swung out 640 10. The right-hand portion. of the way. If the chair has an adjtntable backrat 640I I. l0 minutes. and headrest, they should be positioned for the 640 12. At least 20 minutes. &verses patient. 640 13. 100* F. 644 10. The occlusal plane of the patient's mandibular teeth. 641 I . They should be mounted in the same sequence as 644 1 I. Maintain light conversation with the patient, but be the teeth appear in the mouth and for viewing from extremely careful not to commit the dental officer the lingual aspect. to a treatment plan he cannot fulfill. 641 2. From the embossed dot on the corner of the film. If you are looking into the depression, you are view- 645 I. The routine and the surgical drape. ing the film from its lingual aspect. 645 2. To pmtect the patient's clothing. 641 3. Mental foramen: mandibular canal. 645 - 3. The towel chain. 641 4. Nasal spine. 645 . 4. The paper side should be placed toward the outside. 641 5. Maxillary sinus: maxillary tuberosity. This allows spilled liquids to be absorbed rather 641 6. Mandibular canal: ramus of the mandible. than running down the plastic onto the patient's 641 7. Maxillary sinus. clothing. 641 8. Maxillary incisors and cuspids appear larger than 645 - 5. When the cavitron is being used. their mandibular counterpaot maxillary molars 645 - 6. When contamination is the prime consideration. have three roots, whereas mandibular molars have 645 - 7. It prevents the patient from seeing instruments. pre- only two; the shape and position of the teeth. vents the light from shining in his eyes. and pre- vents the accidental contamination of the instru- 642 - 1. Detail refers to the sharpness of the image: density ments by the patient's hair. refers to the degree of blackening of the film: and 645 8. Have the patient lift his head from the headrest, lay contrast refers to the difference between the black. two sterile towels across the headrest. and have the white, and various shades of gray on the film. patient lay his head back on the towels. Crisscross 642 - 2. c. the top towel across the eyes and secure it with a 642 - 3. g. towel clamp. Allow the bottom towel to drape 642 . 4. m. naturally around the patient's neck and shoulders. 642 - 5. i. Cover the patient's chat with a drape and secure it 6426. b. at the hack of the neck to the bottom head drape 642 - 7. k. with a pair of towel clamp forceps. 642 - 8. f. 642 - 9. I. 646 - I. You must know the instruments the procedure re- 642 - 10. a. quires and the ones the dentist prefers.
131 13 0 4 47:1 646- 2. You can lay them on the bracket table or place them 651 - 7. 37*C. or 98.6' F. 'in setup trays or packs. 6518. Within 48 hours. 646- 3. In their sequence of use. 6519. Ascites solution appears cloudy and gelatin exhibits 6464. In oral surgery. a moldlike growth. 6465. Packs need lees storage space. but trays allowyituto place the instruments in their sequence of use. 652 - I. First, you should remove all debris from the pa- a 646- 6. It is a corrosion-resistant and autoclavable tray in tient's face. You may do this yourself or provide the which instruments and supplies are placed. The patient with a dampened towel and mirror and let . contents aremolly covered with a towel, cloth. him clean his face. Next, remove the patient's drape surgical wrapper, or suitable metal lid. and position the chair. operating light, and bracket 646- 7. After sterilization is completed. write the date that table so that the patient can easily exit the chair. the contents will no longer be considered sterile on Return any personal belongings to the patient and the autoclave tape. arrange for any needed future appointments. 6522. Usually this can be done during breeks in the chair- 647- I. To render the operating site insensitive to pain. side assisting routine. If this isn't possible. you 6472. C. should complete the paperwork right after the pm- 647- 3. I. tient departs rather than detaining him. 647- 4. b. 652 - 3., All medications and materials must be put beck 647- 5. f. into proper order. Instruments must be scrubbed 647- 6. a. and sterilized. The equipment should be cleaned 647- 7. d. . and disinfected. 647- 8. e. 652 - 4. Obtain any additional supplies or equipment that 647- 9. g. will be needed for the next patient. 647- 10. W. 647- I 1.m. 653 I. Inventory. ordering, turning in. and storing. 2. To be sure that you don't run out of supplies during 647- 12.J. 653 647 13. h. a patient's treatment and that you don't have an ex- 647 14. i. au of materials on hand. 653 3. Daily. 648 - I. The routine of the procedures and the related in- 6534. Hoarding may deprive other personnel of the sup- atruments and the materials required. plies they need: it invites thievery, ties up supply 648 - 2. A spoken word, a slight to moderate movement of dollars needlessly. and may result in los due to his hand, or only a pause in using the instrument. deterioration. 648 - 3. It should be pointed toward the treatment area. 6535. Failure to torn in excess supplies has the same ad- 648 - 4. Knowing when to mix. verse effect as hoarding. 6485. To have the needed item at the rieht place, in the 653 - 6. Taking the steps necessary to protect the supply right position, and at the right time. . items. 649 I. To give the dentist easier operating accessibility. to 654 -I. T e allow a better view of the operation site, and to 654 2. F. They should both be seated. protect the tissues being retracted. 6543. F. It should be positioned for the convenience of 649 2. The Thome *I and *2 are helpful for retracting both the operator and the technician. gingiyal flaps. and the Seldin *23 and Molt *9 6544. T. may be used on gingival flaps and other tissues. The 654 5. T. mouth mirror is effective for retracting the tongue. cheeks, and lips. 655I. a. d. 649 3. Pressure firm enoush to prevent slippage, but not 655 - 2. b. c. e. firm enough to cause unnecessary tissue bruises and 655 - 3. a. b. c, d. trauma. 6554. b. 655 5 a. c. 650 I. To maintain a clean field of operation. 655 - 6 a. b. 6502. Water from the unit's spray system or water syringe. 655 - 7. b 650 - 3. Normal saline and sterile water. 650 - 4. e. 656 -I. The dentist should be in the 8- to I I-o'clock posi 650 5. b. tion and the asistam in the 2- to 5-otlock posi- 650 - 6. d. tion. 650 - 7. a. 656 - 2. The transfer zone. 6508. C. 656 - 3. To the level where the dentist's elbow is as close as possible to the field of operation. An attempt to gather microorganisms from a pa- 651 I. 656 - 4. 14 to 16 inches. tient and to promote the growth of those micro- 656 - 5. 4 to 6 inches above tit: dentist's eyes. organisms. Toward the head of the chair and so that you have Endodontic samples are obtained by placing and 656 - 6. 651 2. easy access to the needed instruments and materials. then removing a sterile paper point into the pulp canal Samples from surgical sites .ire obtained by swabbing the site with a sterile (Anton-tipped ap. 657 - 1 fo incluse production mole reducing stress and plicator. fatigue to the operator and assistant. 651 - 3. You should flame the tube. 657 - 2. Because of the absence of the cuspidor. 651 4. The penase ascites. 657 - 3. The time lost when the patient expectorates. 651 - 5. Patient's name. date of the sample. whesher it is the 657 - 4. So that it adequately evanuttes saliva, debris, and first, second. etc.. culture taken, description of the water from the oral cavity and yet does not Inter- sample. and type of report desired. fere with the dentist's view or access to the operat- 651 6. Whether it is positive or negative. ing site , 132 431 - 4 657 - S. Since your right hand is busy aspirating, you must 662 - I. e. learn to pass instruments with your left hand. 662 - 2. e. 657 . 6. By placing the fine cutting bur the dentist needs in 6623. S. one high-speed headpiece and the second bur he 662 4. d. needs in the other highspeed headpiece. 6625. c. 657 - 7. The treatment routine. 662 - 6. a. 662 - 7. a. 658 - 1. It can indicate bleeding tendencies or allergies. 662 - 8. n. which could alter the original treatment plan and 6629. f. therefore prevent an emereency. 662 10. b. 658 - 2. You might detect that he is becoming apprehensive 662 - I I. d. and be able to reduce his apprehension through 662 - 12. f. casual conversation, thereby preventing syncope. 662 - 13. b. 662 14.c. 659 I . You should make sure it is available, conveniently located, and functioning properly. 6592. That it is supplied with the proper levels and that the supplies are in good condition and have not CHAPTER 4 passed their expiration date. 659 - 3. The phone number of medical personnel needed 663I. Schedules annual examinations of military mem- for assistance in any emergency arising in the den bers, examination and routing of sick call patients, tal clinic. treatment planning, and special examination in 659 4. Lower the back of the chair so that his head is hy- support of the medical mission. perextended. 663 1 The annual dental examination. 6595. Grasp the mandible and elevate the chin. then check 6633. The patient's dental problem is diagnosed and he is for and remove any obstructions. routed to the appropriate section for treatment. 659 - 6. Pinch the nostrils dosed. 663 4. To provide a systematic approach to clinical dental 6597. 14 to 18 times per minute for adults and 20 times Cafe. per minute for children. 6635. The foldout located in the back of AFM 162-1. Ad. 6598. Place the heel of one hand on the patient's lower ministration of USAF Dental Actisitits. sternum, then place the other hand over the first. 6636. The completion of forms. Use your body weight to rapidly force the lower 663 - 7. Because it is the first professional treatment area of sternum downward from 1'4 to 2 inches. Hold for the dental clinic to which the patient is exposed. qs second then release rapidly. Repeat this pro cedure every second. 664 - I. To restore decsyed or fractured teeth to their 6599. A hard surface. original functional ability and esthetic quality. 65910.When blockage of the airway cannot be removed 664 2. Maintain light conversation with the patient. check and the patient will die vothout this treatment. his dental records, and place the radiographs and 65911.Place a blanket roll or other object under the pa treatment records so that they will be convenient to tient's shoulders to hyperextend his head. the dental officer. 65912.It is the almondshaped deprezsion tun below the 664 3. Wash and dry your hands in full view of the patient. Adam's apyle. lay out the required instruments, attach the saliva 65913.So that you don't penetrate the esophagus. ejector, and turn on and adjust the dental operating 659 14. One that will not collapte. light as the dentist approaches the patient. 664 4. In case a second injection is required. 660 I . Because oxygen supports combustion and even a 664 5. By retracting the cheeks or tongue and irrigating small spark could trigger an explosion. and aspirating as required. 6602. T. 664 6. When the dental officer is carving and finishing the 6603. T. felltoratioa. 660 4. F. 664 . 7. Wash and sterilize them along with the instruments 6605. F. that were used. 660 6. T. 7. F. 660 665 I. e. 8. 660 T. 665 2. h. 660 - 9. F. 665 - 3. b. 66010. F. 665 - 4. g. 66011. T. 6655. a. 660 12. F. 665 - 6. d 66013. T. 665 7. f. 665 - 8. c. 661 I. f. 661 2. h. 666 - 1. Self-confidence has a calming Wm on a nervous 661 3. 8. patient. 661 - 4. C. 666 - 2. To prevent cross-contamination. 661 5. b. 666 - 3. You should previously discuss the essentials for 6616. a. each type of operation with the oral surgeon. 661 7. d. 666 - 4. The view of the treatment area. 6618. e. 666 - 5. You should place them in a quiet area of the clinic 661 - 9. Your role is basically supportive. You should in- and make sure they are not left alone. spect the kit daily to be sure it is adequate and to 666 - 6. Have him loosen restricting clothing and remove correct any deficiencies. If the kit is needed. you and properly store any prosthetic appliances. assist the dennst by preparing and aiding with the 666 - 7. Scrubbing with a handbrush and soap. administration of the drup. 666 - 8. After.
133 666 9 Mos surgical procalures require two or more in number ot teeth in the arch. The appliance is fabri- **ions and supplying two syringes will allow you cated from acrylic with porcelain or acrylic teeth. to supply the syringes to the dentist with minimum 670 - 2. The preliminary Impressions are taken and the AF time loss. 519 is initiated. 666 - 10. Because his gloves reduce tactile feeling. therchy i n- 670 Soften the o impound. place it in the tray. atter the craning the possibility of his dropping the insult. tray is positioned in the mouth, cool it with wooer Mag. until the compound hardens. 666 - 1 1. Because theorist surgeon mug be able to see what he 670 - 4. TO prevent materials from sticking to hie skin. is doing and the scaumilatIon of blood and saliva 670 - 5. The second applintment is used to take the final in the rear of the patient's mouth have a tendency to impression. excite the patient's gag reflex. 6706. One of the -wash- types. 666 12. A container of sterile distilled water or saline solu- 67(i - 7. The hotplates and uicchnal rims are conionteed. tion and an irrigating syringe. 670 - 8. This appointment is used to record intesegehugl 666 - 1.3. A gauze sponge that has been moistened with ir- relationship and to select the artificial teeth. ripting solution. 670 - 9. The casts are mounted on an articulator, the teeth 666 14. Quietly point it out to the oral surgeon. are setup into the wax occlusal rim, and the wax is 66615. Clean the patient's fsce and remove or MKT the trimmed so that it resembles a dennue. blood stained instruments and aspirator bottle. 670 10 To try the waxed-up denture in the patient's mouth 666 - 16. To make sure that he is steady on his feet and show-. and make whatever adjustments are necessary. no signs of distress. 670 1 1. To insert the denture.
667 1. The pulp is dead. 671 - I. A removable partial denture is an appliance replac- 6672. To remme the contents of the pulp canal, dear up ing less than the full number of teeth in one arch. infection, and insert a root canal filling material. Those appliances may be constructed from gold. 6673. Because the infection mug be oompktely cleared up chromecobalt. or acrylic, with porcelain or acry lic before the pulp canal is filled. OWL 667 .4. A barbed broach. 671 2. The rag of the preparations are cut Into the abut- 6675. Rubber dam. ment teeth and the impressions are taken. 6676. Root-canal reamers and files. 671 - 3. A rimlock tray. 667 - 7. A paper point. 671 - 4. To prevent distortion caused when the impression 6678. To ensure that the growth of microorganisms has material dries out. ceased. 671 - 5. Occlusal rims are ninstructad and the master casts 6679. When you obtain a negative culture. are sent to the ADL to have the metal framework 667 10. Gutta percha or a silver point scaled with root constructed canal cement. 671 6 The occlusal and centric relationships are recorded 667I I. The exact approach your dentist takes toward root and the tooth shade and mold are selected. Canal therapy. 671 7. Inserting the appliance. 66712. Apicoectomy. 667 - 13. It is removed. 672 I C. 667 14. By incising the soft tissue and removing overlaying 672 2. bone with a bur or chisel. 672 - 3. a. 4 f. 667 15. Curettes. 672 66716. The surgical assisting procedures. 672 - 5 672 6 672 7 668I. 672 - 8 668 - 2. T. 677 - 9 668 3. T. 10 b. 6684. F. 672 - II The tooth is prepared. then the dental officer con- 668 - 5. T. structs a wax pattern of the cowls or inlay in the 6686. F. mouth. The wax pattern is thenlent to the laborato- 668 7. T. ry for investing or caging 6688. T. 672 - 12. The tooth is prepared and an impression is taken. 668 - 9. b. The impressIon is then sent to tht dental laborato- 668 - 10. C. ry. 668 -I I.d. 672 - 13. The impression is poured to make a die and a wax 668 12. a. pattern is constructed on the die 668 - 13. C. 672-14 The wax pattern is placed in a casting ring and in- 668 14. Oral surgery. vested in heat.resisong gypsum The casting ring is heated in an oven to eliminate the wax Molten 669 - 1. Type 1. metal is then cast unto the void left from the wax. 669 - 2. To diagnose conditions that mug bc corrected be- thereby forming the crown or inlay. fore he starts prosthodontic treatment. 672-15 The crown or inlay is cemented into place. 669 - 3. To determine irregularities of the occItgion that re- 672-16 They replace all or oan of the ononal tooth stoic. quire correction or that are a favor in determining lures the type of appliance to he constructed. 669 - 4. The procedures to be accomplished during the ap- 673-1. It IS an appliance permanently fixed to abutments pointment and the laboratory time required be- with inlays or crowns which cannot be removed b) tween appointments. the patient. It is usually fabricated from gold and 669 - 5. By closely coordinating the patient scheduling woh has porcelain or acrylic facings. the dental officer and the dental laboratory. 673 2. A pontic is an artificial tooth suspended from "lie or more abutments of a fixed partial denture 670 - I. A full denture is an appliance that replaces the full 67.3 - 3 A cantilever bridge.
134 433 vf-'41/Lte n73 . 4. An impression is Caw of the more arch with the ohm the hiphess point dos non awed the umlaut cir). ocaringt in plat. the impricsion It pineal up on a plane kvd. yortial sokkring invettmou. The gamic is then stabilised in its proper position with sokkring in- vestment and attached to the airings with odd Ns - I. They are used wally on patients needing full dew solder. tures to take the lima *Wall impala's", 67$ - 2. Sdfaring acrylic rain. 674 1. F. 6753. The dough and the wrinkle method. Ila both 674 - 2. T. methods the MI is firn comae with a squeaks 674 . 3. F. 111111trial. Using the dough method you mkt the 674 . 4. T. acrylic powder and liquid uatil it make the dough 674 . 5. T. stage. mold it with your kends Ian a serer, and 674 - 6. F. adapt it to the cast. the some of the material to form a handle. Wig the sprinkle method yos 675 . I . Those that require impressions and those that do sprinkle powder over the cest. saturate it with li not. gad. and repeat this aticedure 1001 yoe reach the 675 - 2. The replacement of a posterior tooth. desired thicknem. 6753. The shrinkage and changes which the thrall that 6754. Failure to ',lockout undercut; will reselt in a stcpoft the dentures undergo. damaged cast or tray what you attempt to remove 675 - 4. The original denture. the hardened tray. 675 - 5. In the dental laboratory, 67$5. Ily filling then in with haespiate wee or modeling i clay. 676 - I. Most imprestions tend to distort because of dehy- 6716. by adapting a sheet of hasspiate wee oter the ast dration or room temperature variation& before yaw adapt the acrylic. 6757. 6762. Plaster of petit. hydrocal. or minor variations of Perforation am help minimise tame displacement thine. and provide remotion of the impunity+ material to 6763. T. the tray. 676 - 4. T. 6765. F. 679I. &lift relationdips refer to the patient's vertical 6766. F. biting depth. occlues1 plase. midline. contour and 6767. T. fullness of t.N lips mtd cheeks. etc. 676 11. F. 6792. A bawler ,..al bite rim. 6769. The twostep method. 6793. The slurry -Ater MS AS 81111/seiling media. 67610.The boxed method. 6794. Center the bawls* on the cast thin use an alcohol 676I I.The upright method. torch or liana burner to lawn the besepiale. 67612.Wet paper. elbows. wax. or any other suitable Using your fingers you then adapt the material to material. the cast. Trim off the ease material and moons 67613.The vibrator. any rough edges. 6795. Papa clips. 677I. The model trimmer. 6796. Soak the Pa in AIM wattle. Dip the ast into a 6772. V.. to Vrineh. melted baseplate was and quickly radial the 6773. To the outermost edge of the peripheral ri.11. bookplate to the oat. 677 - 4. One way is to follow the contour completely 6797. Beseplate wee. around the peripheral boundary. The other way is 679 IL More template was. to trim the outer borderin four straight lines. Those 6799. Hen and roll a dna of bemplate visa into a lines run from the third molar area to the cuspid cylinder shape. Shape it likes horseshoe. adapt it to and from the cuspid to the nodline on either side of the baseplate and shape with a compound knife aad the can. The posterior birder should be trimmed so vita spatula. *It 1 iatteteINT mann OrtiCt:1575- 640 -OS a/334 swan , ALA (731303) fob 75-3000