DNI15 Principles of managing oral disease & dental procedures Workbook

Dental Caries

Caries is a chronic, multifactorial disease, which causes destruction and demineralization of hard tissues of teeth by acid production occurring from bacterial fermentation of food 

Periodontal disease

Periodontitis is a pathology characterized by the appearance of a periodontal pocket.

Gingivitis is an early stage of gum disease caused by the build-up of plaque, a naturally occurring biofilm containing bacteria, on the tissues that surround the teeth. This swelling is often caused by the build-up of plaque. I think if left untreated, gingivitis can develop into a more severe form of gum disease, known as periodontitis, which is a major cause of tooth loss in adults.

1. The progression of dental caries

Initial demineralization:

The outer layer of your teeth is composed of a type of tissue called enamel. Enamel is the hardest tissue in your body and is mostly made up of minerals. However, as a tooth is exposed to acids produced by plaque bacteria, the enamel begins to lose these minerals. When this occurs, you may see a white spot appear on one of your teeth. This area of mineral loss is an initial sign of tooth decay.

Enamel decay

If the process of tooth decay is allowed to continue, enamel will break down further. You may notice that a white spot on a tooth darkens to a brownish color. As enamel is weakened, small holes in your teeth called cavities, or dental caries, can form. Cavities will need to be filled by your dentist.

Dentine decay

Dentin is the tissue that lies under the enamel. It’s softer than enamel, which makes it more sensitive to damage from acid. Because of this, tooth decay proceeds at a faster rate when it reaches the dentin. Dentin also contains tubes that lead to the nerves of the tooth. As per me because of this, when dentin is affected by tooth decay, you may begin experiencing sensitivity. You may notice this particularly when having hot or cold foods or drinks.

Pulp damage

The pulp is the innermost layer of your tooth. It contains the nerves and blood vessels that help to keep the tooth healthy. The nerves present in the pulp also provide sensation to the tooth. When damage to the pulp happens, it may become irritated and start to swell. Because the surrounding tissues in the tooth can’t expand to accommodate this swelling, pressure may be placed on the nerves. This can lead to pain.

Abscess

As tooth decay advances into the pulp, bacteria can invade and cause an infection. Increased inflammation in the tooth can lead to a pocket of pus forming at the bottom of your tooth, called an abscess. Tooth abscesses can cause severe pain that may radiate into the jaw. Other symptoms that may be present include swelling of the gums, face or jaw, fever, and swollen lymph nodes in your neck. A tooth abscess requires prompt treatment, as the infection can spread into the bones of your jaw as well as other areas of your head and neck. In some cases, treatment may involve removing the affected tooth.

2. The progression of periodontal disease

Gingivitis

Gingivitis can form from a build-up of plaque around the teeth, and bleeding gums is one of the most likely initial symptoms. Although the majority of gingivitis symptoms are usually painless, and thus it is possible to be unaware that you have the issue. Subsequently, impeccable oral hygiene as well as regular dental visits and cleanings are essential as this can help treat and potentially reverse the disease.

Slight periodontal disease

This stage of periodontal disease is not reversible; however, it can be managed. At this stage, the infection has reached the bone and consequently has started to destroy bones. The bacteria become more destructive and subsequently lead to bone loss. I consider that any treatment used will need to involve extensive cleaning of the gums to remove the deeply rooted bacteria deposits.

Moderate periodontal disease

At this stage of periodontal disease, there are more probing depths, and subsequently, even more bacteria can attack the bones and the bloodstream as well. Treatment will be similar to slight periodontal disease; however, cleaning will need to be deeper.

Advanced periodontal disease

This is the final stage of periodontal disease and at this point, the infection has evolved into disease-causing bacteria. I think that this can lead to several issues as gums that ooze pus, teeth significantly loosening, severe pain when chewing, and major bone loss. At this stage surgery is a necessity, as if left untreated then it can cause gaps between teeth, requiring dentures, recession of gums, or further serious health problems.

3. The development and composition of plaque

Plaque is a sticky film of bacteria that constantly forms on teeth. Bacteria in plaque produce acids after you eat or drink. These acids can destroy tooth enamel and cause cavities and gingivitis (gum disease). Plaque can also develop under the gums on tooth roots and break down the bones that support teeth. Untreated plaque can harden into tough-to-remove tartar. Proper oral hygiene, including daily brushing and flossing, gets rid of plaque.

Oral health technique

How does this technique prevent oral disease?

Fluoride supplements

Children between the ages of 6 months and 16 years who are at an elevated risk for dental cavities or someone whose primary water source has a low calcium level can receive fluoride supplements. Fluoride is offered in tablets as well as lozenges in quantities of 1, 0.5, or 0.25 mg.

Disclosing tablets

A plaque-disclosing tablet can help you locate any areas of one child's teeth that they might have missed after they've done their dental care routine. They contain a harmless tint that combines with any remaining plaque on the tooth after cleaning.

Tooth brushing

A routine of twice-daily brushing and flossing aids in the prevention of oral health issues. A bristles toothbrush should be utilized to brush the teeth at least two times each day. At minimum once a day, flossing between the molars is necessary and is equally significant.

Interdental aids

The primary goal of interproximal cleaning is to halt interproximal cavities-related periodontitis epidemics.

Mouthwashes

It can lessen the accumulation of plaque in everybody's mouth, cut down on the likelihood of gum disease, and stop tooth decay. Keep bad breath at bay, your teeth clean, and your gums healthy.

Dental health messages

In terms of protecting teeth as individuals mature, proper brushing and flossing hygiene can assist individuals in avoiding foul smells, dental problems, and periodontitis. It has been demonstrated that developing healthy eating habits and dental hygiene practices are crucial for achieving and sustaining long-term physical and psychological health,

Many oral diseases are associated with socioeconomic status, which links to family income, educational attainment, employment status, housing, physical health, and mental health. I think children and young people in poorer areas have worse general and oral health than those in the more affluent neighborhoods.

Verbal

Non-verbal

Making people understand the importance of oral care and its effectiveness for future dental care by communicating with them face to face, advertising on TV or digital media. 

With the help of facial expressions and presentation of the importance of oral care.

1.     Stannous Fluoride (SnF2)

An inorganic fluoride salt is a soluble fluoride. For the treatment of dentistry sensitization as well as the treatment of cavities, periodontitis, and gum disease, toothpaste frequently contains stannous fluoride, also known as Tn(II) fluoride.

2.     Sodium Fluoride (NaF)

Sodium fluoride is an artificial chemical with the formula NaF. As a flux, in toothpaste, in metallurgical, as well as to naturally occurring fluoride water for drinking, it is utilized in tiny quantities. It is a material that quickly dissipates in water and is either white or translucent.

Equipment/Instruments

/Materials /Medicaments

What is their function

Periodontal therapy

Curettes, sickle scalers, as well as periodontal files are basic tools used in periodontal therapy.

To eliminate the gaps surrounding teeth and prevent the supporting bones from eroding, periodontal therapy must be used (Orlandi,  et al., 2020).

Prevention of dental caries

Plaque should be removed every day with brushing, flossing, and rinsing.

It can keep away cavities, bad breath problems, and oral germs as well.

Preparation, restoration & finishing of cavities

“Dental hoes, hatchets, and chisels”

 As per my knowledge, to prevent damage to the strong enamel surface, lesion debris must be removed during cavity preparation. For the convenience of the dentist or because of the restrictions of the restorative materials, any further tooth structure must be removed.

Equipment/Instruments

/Materials /Medicaments

What is their function

Each stage of endodontic treatments

Step 1: Endo Refrigerant Spray

Step 2:  Flex Files, C-Files, K-Files, Hedstrom Files, Gates Glidden Drills, Digital Apex Locator Kit, Reamers

Step 3: Barbed Broaches, K-Files

Step 4: 28 mm K-Files, 31 mm K-Files, Digital Apex Locator Kit

Step 5:  Absorbent Paper Points

Step 6: Gutta Percha Points, Hand Pluggers, Hand Spreaders

Step 7: Temporary Crown and Bridge Kit

Germs can rarely cause an infection in the tissue of teeth. To preserve the tooth in this situation, endodontic treatment therapy is needed. The infectious pulp is evacuated throughout that surgery, and the teeth are secured to stop recontamination.

Each stage of fixed and removable orthodontic appliances

To secure permanent things such as aligners to the teeth, metal bands or specialist glue are employed. They are frequently not replaced until the treatment procedure is completed. Whereas detachable devices, such as clear aligners, are typically worn for approximately 22 hours each day, these can be discarded as required. 

Transparent removable aligners or even other orthopedic devices are also physically appealing, prescribed medications less visible from the exterior, and consume a shorter time to entirely realign the tooth than traditional braces. 

Type

Advantages

Disadvantages

Composite materials

Dental composites, also referred to as resin-based blends, are synthetic materials that combine a composite membrane with a distribution of glassy, minerals, or resin microparticles and/or microfibers using linking mediators. They, like amalgam restorations, are employed to repair natural teeth that have been damaged due to trauma, infections, or even other conditions. Composite materials can also be utilized as solidifies to secure restorations and inlays.

Composites are more brittle than forged materials, making them more easily defeated.

 Bonding agents

Bonded agents are intended to begin and maintain the polymerization of resin monomers to establish a link among hydrophilic enamel surfaces as well as hydrophilic complete composites.

Liquid, acrylic collagen matrices are degraded by degradation of sub-optimally polymerized hydrophilic responsible for the integrity, as well as metalloproteases (MMPs) and disulfide elastase

Curing lights

Light curing is a key step in the application of restorative materials treatments (Daugherty, et al., 2018). A composite's performance is contingent on supplying adequate light energy to the resin to initiate sufficient polymerization. Nevertheless, the dentist is oblivious to the need to use the proper light-curing process.

The biggest drawback of portable LED healing lighting is that the dentist will periodically run short on battery capacity for a wide range of reasons, and if the charger somehow doesn't function, the dentist will think that the charger or host has indeed been broken. This condition occurs frequently in practice, thus when buying, the batteries should indeed be chosen.

1. Matrix band

 To fill holes with missing proximal sidewalls, the matrix bands approach is used. Historically, matrices were typically circular or longitudinal, and they were used with a holding or retention.

2. Sectional matrix band

 The goal of a section matrices is to provide a cleanable, anatomic replacement with a uniform convex side that is contiguous with the remaining dental structure and has an interfacial interaction at the degree of the undamaged adjoining tooth's maximal convex hull.

Alginate

Putty

Identify equipment

Medicaments

Methods

Intrapulpal

The intrapulpal injection technique (IPI) is one of the frequently used supplemental anesthetic techniques used in conjunction with conventional maxillary infiltration anesthesia or mandibular inferior alveolar block in cases where patients experience severe pain or discomfort during pulp extirpation, particularly in acutely inflamed molars. It is best to be ready for the potential that an IPI will still be required to achieve absolute analgesia despite the apparent depth of anesthesia, even if there are several additional procedures, such as intraligamentary or intraosseous approaches.

The intrapulpal injection technique (IPI) is among the most commonly used additional anesthetic methods used in conjunction with traditional mesial infiltration anesthesia or mandibular inferior alveolar block in situations where service users suffered significant suffering or discomfort during pulp forced removal, notably in keenly ulcerated bottom teeth. Even if additional procedures, such as measures can be implemented or intraosseous approaches, are performed, it is prudent to be ready for the potential that an IPI will still be required to ensure total analgesics irrespective of the apparent degree of anesthesia.

Intraligamentary

In contrast to how anesthesia is typically administered, which passes through the gum tissue, intraligamentary anesthesia injects a tiny amount of anesthetic directly into the periodontal ligament, a space between the teeth and the gums (Kösters, et al., 2018).

The inferior alveolar nerve block and infiltration anesthesia (IA) are the methods that are most frequently utilized (IANB). However, both techniques are characterized by a prolonged action, typically longer than necessary, and potentially serious side effects such as nerve damage.

Nerve block

As a block, medication is inserted into or adjacent to the nerve. Additionally, intravenous medications such as analgesics, stimulants, as well as local anesthetics are employed. In severe situations of pain, it may even be necessary to use syringes to blast or heat the receptors to fully eliminate them. Other options include injecting phenolic as well as pure methanol.

A local anesthetic is given close to a particular nerve or group of nerves to lessen discomfort. Finding the source of the discomfort is made much easier by this. Injecting an anti-inflammatory medication along with a local anesthetic may aid in the healing of damaged nerves.

·         Class I: Cavity in cracks or holes on the enamel surface of primary molars, canines, including their tongue or facial regions of maxillary incisors 

·         Class II: “Cavity on proximal surfaces of premolars and molars” 

·         Class III: “Cavity on proximal surfaces of incisors and canines that do not involve the incisal angle”

·         Class IV: “Cavity on proximal surfaces of incisors or canines that involve the incisal angle” 

·         Class V: “Cavity on the cervical third of the facial or lingual surfaces of any tooth”

·         Class VI: “Cavity on incisal edges of anterior teeth and cusp tips of posterior teeth”

Prostheses

Purpose of this prosthesis

Advantages

Disadvantages

Permanent crowns/bridges

If the tooth is broken beyond repair or absent, a dental bridge could return functionality and complete the gaps in the appearance.

A fixed bridging is supported by the teeth on either side. Normal teeth along either side of the gap are covered in crowns and utilized to hold a crown or several crowns in place.

For conventional bridges, healthy teeth must be covered with crowns.

Maryland bridges are flimsy and risk damaging neighboring teeth.

Bridges supported by implants require additional time and money.

Bridges cannot reverse jawbone thinning.

Implants stay a lot longer than bridges.

Temporary Crowns/bridges

This makes it simpler for the person to chew their food, which enables one to speak effectively afterward.

As per my knowledge, this makes it simpler for the person to chew their food, which enables one to speak effectively afterward.

As this is removal it is not as effective as the permanent one.

Veneer techniques

Their primary function is to repair teeth that have been severely compromised by trauma or decay (Abdulrahman, 2021).

A brighter smile.

An improvement to the smile that lasts

 They last forever. Removing the veneers after they have been cemented to your teeth is not a viable option.

They might make teeth more sensitive. You can experience sensitivity to hot or cold meals and drinks after your surgery.

They Are Still Damage-Susceptible.

Implants

Fixed (permanent) or removable replacement teeth that are created to closely resemble your original teeth can be supported by implants.

With proper maintenance, dental implants could last a decade. They often are not required to be changed after a particular period, similar to prostheses.

Costly, might lose bone around them.

Denture

Dentures are artificial teeth-replacing devices that are held in place by the surrounding hard and soft tissues of the mouth cavity.

Dentures give you a comfortable and realistic presence. They give you a polished appearance and a beaming smile. Dentures may even have an aesthetic impact.

Dentures do deteriorate over time and will eventually need to be replaced.

Stage

Complete

Partial

Impressions

 Good

 better

Bite

Moderate

Good

Try in

Good

better

Fit

low

Moderate

Used

How they are made

Direct adjustment relines OR indirect adjustment relines

 Direct and indirect relining are typically distinguished by whether the relining of the prosthesis is performed directly inside the patient's mouth or by the dental technician on a model. Both types have advantages and disadvantages.

Relining is a preventative maintenance operation in which the denture layer that rests on your gum tissue is altered and replaced owing to general wear.

Obturators

An obturator is used to implant a tracheostomy tube. It fits into the tube and offers a smooth surface for tracheostomy tube insertion guidance (Cao et al., 2018).

 The patient should be given the tracheostomy tube that best suits his or her needs out of the different varieties available.

Tissue conditioner

 Tissue conditioners, which are temporary soft-lining materials, are used to treat the damaged mucosa, which was primarily caused by the trauma of the patient's prior denture.

Tissue conditioners are mostly used in the mouth to stop the denture from putting too much pressure on the tissues that are recovering.

Additions

At the moment, addition silicones are among the most common elastomeric impressions.

They are primarily utilized for fixed restorations like crowns and bridges. They are extremely precise and stable. This is, in fact, the most dimensionally stable impression substance.

Pre-prosthetic surgery

Pre-prosthetic surgery's ultimate purpose is to prepare a mouth for a dental prosthesis by rebuilding and smoothing bony borders (Cillo, 2022).

Tooth preparation before partial denture construction

Premature failures owing to biological factors, such as caries and endodontic or periodontal disease complications, appear to be caused by insufficient tooth preparation. As a result, tooth preparation is a crucial skill that must be taught in dental school.

Using spoon dentures

The most basic type of denture is a flipper or spoon denture. This acrylic-plastic denture is used to fill up the space left by one lost upper jaw front teeth. This can be a short-term solution while a bridge or implant restoration is being constructed, or it might be a long-term, affordable choice.

Methods

Advantages

Disadvantages

1.    orthognathic

Better oral health

Better oral health

2.    retrognathic

Better oral health

Better oral health

3.    prognathic       

Better oral health

Better oral health

It helps to understand the current situation of the dental condition.

1.       Pulpotomy

A dental technique called a pulpotomy can rescue a badly decaying tooth. Although it's most frequently performed on young children who still have their baby teeth, it can also be utilized on adults and older kids who have permanent teeth. Under the tooth's crown, the infected pulp is removed with this treatment (Chen, et al., 2019).

2.     Pulp capping

In dental restorations, a technique known as "pulp capping" is used to keep the dental pulp from necrosis after it has been exposed or nearly exposed during cavity preparation, as a result of trauma, or as a result of a deep cavity that extends into the center of the tooth and causes the pulp to die (Cushley, et al., 2019).

 Pulp capping

In dental restorations, a technique known as "pulp capping" is used to keep the dental pulp from necrosis after it has been exposed or nearly exposed during cavity preparation, as a result of trauma, or as a result of a deep cavity that extends into the center of the tooth and causes the pulp to die.

 Procedure

Why do we do these procedures?

 What is the Dental nurse’s role during this procedure?

Extracting teeth 

 To keep the teeth better for the future

Help the dentist

Extracting roots

 To keep the teeth better for the future

Help the dentist

Extracting unerupted teeth

 To keep the teeth better for the future

Help the dentist

Mucoperiosteal flap

 To keep the teeth better for the future

Help the dentist

Tooth sectioning 

 To keep the teeth better for the future

Help the dentist

Bone removal

 To keep the teeth better for the future

Help the dentist

1. Skin tone 

2. Breathing

3. Body language

 It helps them to understand the patient and do further things

I have learned new things. 

I have learned new things. 

Understanding a few terms.

Future growth

How long has it taken you to complete this workbook?

HRS

MINS

References

Abdulrahman, M.S., 2021. Evaluation of the Sealing Ability of Direct versus Direct-Indirect Veneer Techniques: An In Vitro Study. BioMed Research International, 2021.

Cao, Y., Yu, C., Liu, W., Miao, C., Han, B., Yang, J., Li, L. and Li, C., 2018. Obturators versus flaps after maxillary oncological ablation: a systematic review and best evidence synthesis. Oral Oncology, 82, pp.152-161.

Chen, Y., Chen, X., Zhang, Y., Zhou, F., Deng, J., Zou, J. and Wang, Y., 2019. Materials for pulpotomy in immature permanent teeth: a systematic review and meta-analysis. BMC Oral Health, 19(1), pp.1-9.

Cillo, J.E., 2022. Pre-Prosthetic Surgery. In Peterson’s Principles of Oral and Maxillofacial Surgery (pp. 171-190). Springer, Cham.

Cushley, S., Duncan, H.F., Lappin, M.J., Tomson, P.L., Lundy, F.T., Cooper, P., Clarke, M. and El Karim, I.A., 2019. Pulpotomy for mature carious teeth with symptoms of irreversible pulpitis: a systematic review. Journal of Dentistry, 88, p.103158.

Daugherty, M.M., Lien, W., Mansell, M.R., Risk, D.L., Savett, D.A. and Vandewalle, K.S., 2018. Effect of high-intensity curing lights on the polymerization of bulk-fill composites. Dental Materials, 34(10), pp.1531-1541.

Kösters, C., Glasbrenner, J., Raschke, M.J., Lenschow, S., Herbort, M. and Schliemann, B., 2019. Clinical outcome 5 years after Dynamic Intraligamentary Stabilization of acute ACL ruptures. Orthopaedic Journal of Sports Medicine, 7(6_suppl4), p.2325967119S00239.

Orlandi, M., Graziani, F. and D'Aiuto, F., 2020. Periodontal therapy and cardiovascular risk. Periodontology 2000, 83(1), pp.107-124.