1Why do we perform EO/IO exams?
To find issues that patients might not be aware of, orofacial structures are very sensitive indicators of oral health, and to screen for oral cancer.
2What percent of the poulation have something unusual or atiypical in their mouth?
10%
3What are the risk factors of oral cancer?
HPV, Sun Exposure, Alcohol Abuse, Tobacco Use
4What percent of oropharyngeal cancers are caused by HPV?
About 70%
5What percent of oral cancer occurs in people without risk factors?
25%
6What percent of head and neck cancers originate in the mouth?
More than 75%
7What percent of head and neck cancers are caused by tobacco and alcohol use?
At least 75%
8What are symptoms of oral cancer?
Lump/nodule or sore that does not heal, sore throat that does not go away, change/hoarseness in the voice, unusual bleeding or pain in the mouth, red or white patch in the mouth
9Where is oral cancer most likely to occur?
Lower lip, lateral border of the tongue, floor of the mouth, and oropharyngeal
10What percent of oral cancer occurs on the lower lip?
38%
11What percent of oral cancer occurs on the lateral border of the tongue?
30%
12What percent of oral cancer occurs on the floor of the mouth?
14%
13What percent of oral cancer occurs in the oropharyngeal area?
11%
14What are the basic client assessment skills?
Observation, palpation, auscultation, and olfaction
15Why is it important to establish an assessment sequence?
To reduce the possibility of overlooking an area
16What type of palpation uses one finger to "poke" an area?
Digital
17What type of palpation uses two fingers to "pinch" an area?
Bidigital
18What type of palpation uses two hands to simultaneously feel both sides of the face?
Bilateral
19What type of palpation uses two hands to feel an area (such as the floor of the mouth)?
Bimanual
20What characteristics are we visually observing during an EO exam?
Symmetry, Color, Lesions, and/or Swelling
21What structures do we palpate in front of the ears?
Anterior Auricula Lymph Nodes
22What structures do we palpate behind the ears?
Retroauricular Lymph Nodes
23What lymph nodes are located deep on the lateral side of the neck?
Deep Cervical Lymph Nodes
24What areas drain into the deep cervical lymph nodes?
Nasal Cavity, Posterior Portion of Hard Palate, Soft Palate, Base of the Tongue, Esophagus, Trachea, Thyroid, and maxillary 3rd molars
25What is the name for the corner of the mouth?
Labial Commissure
26What is the name of the smooth area at the midline of the face, just below the nose?
Philtrum
27What is the name of the "tip" of the upper lip, at the midline?
Tubercle
28What is the name of the line where the color of the lips change?
Vermillion Border
29Which salivary gland located on the floor of the mouth is more anterior?
Sublingual
30Which salivary gland located on the floor of the mouth is more posterior?
Submandibular
31Which salivary gland is in the cheek?
Parotid Salivary Gland
32What areas drain into the submandibular lymph nodes?
Cheeks, Upper Lip, Body of the Tongue, Anterior Portion of Hard Palate, Sublingual Salivary Glands, Submandibular Salivary Glands, All Teeth EXCEPT Max 3rd Molars and Mand Incisors
33What areas drain into the submental lymph nodes?
Both Sides of the Chin, Lower Lip, and Mandibular Incisors
34What areas should be examined during the IO exam?
Palate, Pharynx, Tongue, Floor of the Mouth, Teeth, and Periodontium
35What type of tissue lines the oral cavity?
Nonkeratinized Oral Epithelium
36What is the lining of the inner lip called?
Labial Mucosa
37What is the lining of the inner cheek called?
Buccal Mucosa
38What is the highly vascularized dettached tissue above and below the attached gingiva called?
Alveolar Mucosa
39What is the line that marks the separation of the alveolar mucosa and the attached gingiva called?
Mucogingival Junction
40What gingival structures should be noted during IO exam?
Stippling (or lack of) and Interdental Papilla
41What characteristics should be described when describing a lesion?
Size and Shape, Color, Surface Texture, and Consistency
42What is the term for a lesion that contains fluid?
Blisterform
43What is the term for a lesion that does not contain fluid?
Nonblisterform
44What are the 3 types of blisterform lesions?
Vesicles, Pustules, and Bullae
45What are the 3 types of nonblisterform lesions?
Papules, Nodules, and Tumors
46What is the term for a lesion that is widest at its base? (Looks like a hill)
Sessile
47What is the term for a lesion that is narrowest at its base (looks like a balloon)
Pedunculated
48What is the term for a flat lesion?
Macule
49What is the term for a depressed lesion?
Ulcer or Erosion
50What 3 characteristics are we looking for while evaluating the TMJ?
Tenderness, Crepitus, and Deviation
51What is the term for the articulation of the temporal bone and the mandible on each side of the head?
Temporomandibular Joint (TMJ)
52What is the term for partial dislocation of the jaw that causes it to deviate to the right or the left?
Subluxation
53What order should a tooth be identified in?
Dentition, Arch, Quadrant, Tooth (DAQT)
54Which of black's classification of dental caries occurs on the occlusal depressions of molars?
Class I
55Which of Black's Classification of Dental Caries occurs on the interproximal surfaces of molars?
Class II
56Which of Black's Classifications of Caries occurs on the interproximal surfaces of incisors?
Class III
57Which of Black's Classification of Dental Caries occurs on the interproximal surfaces of incisors AND invloves the incisal angle?
Class IV
58Which of Black's Classification of Dental Caries occurs on the cervical portion of either the lingual or buccal surface of a tooth?
Class V
59Which of Black's Classification of Dental Caries occurs on the cusp tips of molars?
Class VI
60What is the term for the voluntary position of the dentition that allows maximum contact when the teeth occlude?
Centric Occlusion
61Which measurement is a horizontal measurement of the overlap of the maxillary teeth over the mandibular teeth?
Overjet
62Which measurement is a vertical measurement of the overlap of the maxillary teeth over the mandibular teeth?
Overbite
63How is overjet measured?
In mm
64How is overbite measured?
Percentage
65What is the term for when the mandibular teeth are buccal or facial to the maxillary teeth?
Crossbite
66What is the term for when the max and mand posterior teeth are directly on top of each other with no overlap?
End-to-End
67What is the term for when the max and mand anterior teeth are directly on top of each other with no overlap?
Edge-to-Edge
68What is the term for when teeth do not occlude?
Open Bite
69In which bite class is the MB cusp of the maxillary 1st molar occluding with the MB groove of the mandibular 1st molar?
Class I
70In which bite class does the maxillary canine occlude with the distal half of the mandibular canaine and the mesial half of the mandibular 1st premolar?
Class I
71What is the term for the facial profile present in a Class I occlusion?
Mesognathic
72In which bite class does the MB cusp of the maxillary 1st molar occlude (by more than the width of a premolar) mesial to the MB groove of the mandibular 1st molar?
Class II
73In which class II division do the maxillary anterior teeth protrude facially from the mandibular teeth with severe overbite?
Division I
74Which facial profile is present in a class II division I occlusion?
Retrognathic
75In which class II division are the maxillary central incisors either upright or retruded and the lateral incisors are either tipped labially or overlab the central insisors?
Division II
76Which facial profile is present in a class II division II occlusion?
Mesognathic
77In which class of occlusion does the MB cusp of the maxillary 1st molar occlude (by more than the width of a premolar) distal to the MB groove of the mandibular 1st molar?
Class III
78In which class of occlusion distal surface of the mandiublar canine occlude (by more than the width of a premolar) mesial to the mesial surface of the maxillary canine?
Class III
79Which facial profile is associated with a Class III occlusion?
Prognathic
80What is used to assess the severity of gingivitis based on color, consistency, and BOP?
Gingival Index (GI)
81Which teeth are usually assessed for the GI?
#3, #9, #12, #19, #25, and #28
82How many teeth are assessed for GI?
6
83What words might be used to describe the color of healthy gingiva?
Pink, Pale Pink, Coral Pink
84What words might be used to describe the color of diseased gingiva?
Bright Red, Bluish Pink, Bluish Red
85What words might be used to describe the size of healthy gingiva?
Not Enlarged, Fits Snugly Around the Tooth
86What words might be used to describe the size of diseased gingiva?
Enlarged
87What words might be used to describe the shape or contour of healthy marginal gingiva?
Flat, Knife-Edged, Followes Curve of the Tooth
88What words might be used to describe the shape or contour of the healthy gingival papillae of teeth with normal contacts?
Pointed/Pyramidal, Fills Spaces
89What words might be used to describe the shape or contour of the healthy gingival papillae of teeth with diastema?
Flat or Saddle Shaped
90What words might be used to describe the shape or contour of diseased gingival papillae?
Bulbous, Flattened, Blunted, Cratered
91What words might be used to describe the shape or contour of diseased marginal gingiva?
Rounded, Rolled
92What words might be used to describe the consistency of healthy gingiva?
Firm, Attached Gingiva is Firmly Bound Down
93What words might be used to describe the consistency of diseased gingiva?
Soft, Spongy, Dents Readily with probe
94What words might be used to describe the surface texture of healthy free gingiva?
Smooth
95What words might be used to describe the surface texture of healthy attached gingiva?
Stippled
96What words might be used to describe the surface texture of acutely diseased gingiva?
Smooth, Shiny
97What words might be used to describe the surface texture of chronically diseased gingiva?
Hard, Firm, With Stippling
98What words might be used to describe the position of diseased gingiva?
Enlarged Gingiva or Recessed Gingiva
99What words might be used to determine the position of healthy junctional epithelium?
At the CEJ
100What word might be used to describe the position of diseased junctional epithelium?
On Root Surface
101How do you determine which end of the Gracies to used on posterior teeth?
The terminal shank should be parallel to the distal of the tooth and the functional shank should go up an dover the tooth. (V to the D)
102What is the range of elevated blood pressure?
120-129 OR <80
103What is the range for high blood pressure stage 1?
130-139 OR 80-89
104What is the range for high blood pressure stage 2?
>140 OR >90
105What is the bp range for hypertensive crisis?
>160 OR >100
106What do we do in case of elevated blood pressure?
Refer to MD, tx permitted
107What do we do in case of high blood pressure stage 1?
Recheck in 5 minures, refer to MD, tx permitted
108What do we do in case of high blood pressure stage 2?
Recheck in 5 minutes, refer to MD, check with clinic DDS before tx
109What do we do in case of hypertensive crisis?
Do not treat, recheck in 5 minutes, refer to MD
110What is the name of a periodontal instrument used to remove calculus deposits from the enamel of the teeth and should NOT be used on cementum?
Sickle Scaler
111What is the most notable difference between a sickle and a curet?
Pointed Toe
112What angle is the working end of a sickle at to the lower shank?
90 Degrees
113What is the correct face-to-tooth surface angulation for instrumentation?
70-80 degrees
114How is correct angulation of a sickle achieved?
By tilting the lower shank toward the tooth surface
115Where does instrumentation of anterior teeth begin?
The midline
116What portion of the sickle is used during instrumentation?
The tip-third of the working end
117Should the tip of the sickle come off the tooth during strokes?
No
118Are calculus removal strokes long or short?
Short
119What is the name of the sickle with a very small, miniature blade that is used in areas of crowding?
Morse Sickle (AKA Smoo)
120What is the name of the sickle with slight curvature on the shank? (actually looks like a sickle)
Montana Jack
121Where is the Montana Jack used?
Both posterior and anterior
122How do you determine the correct working end of a sickle?
The terminal shank should be parallel to the distal of the tooth and the functional shank should go up an dover the tooth. (V to the D)
123Where are posterior sickles used?
The Distal Surfaces of Posterior Teeth
124How many cutting edges are on each end of a sickle?
2
125How many cutting edges do universal sickles have on each end?
2
126What is the difference between the Coumbia 13/14 and Barnhart 5/6?
Barnhart is larger
127How do you determine if an instrument is balanced?
The working-ends are aligned with the long axis of the handle
128How do you determine the correct working end of an instrument on anterior teeth?
Working end should point in the direction you are working and the face of the instrument should be angled in towards the tooth
129What type of fulcrum should be used on mandibular anterior teeth?
Palm Down and Intraoral
130What type of fulcrum should be used on maxillary anterior teeth?
Palm Up, Intraoral Fulcrum
131What type of fulcrum should be used on mandibular posterior teeth?
Palm Down, Intraoral
132What type of fulcrum should be used on maxillary posterior teeth?
Palm up, Intraoral Fulcrum
133What fulcrums are options instead of intraoral fulcrums?
Extraoral or Finger-on-Finger Fulcrum
134What technique may be used to get more power for tenacious calculus?
Finger-Assist
135What type of stain directly adheres to the tooth within calculus or plaque?
Extrinsic Stains
136What type of stain is located within the tooth structure itself?
Intrinsic Stains
137What is the distinguishing of a particular disese or condition from others that present similar clinical features called?
Differential Diagnosis
138What are the 5 main causes of toothaches?
Decay, Abscess, Clenching, Recession, Broken Teeth
139What causes yellow stain?
Dietary and Poor Oral Homecare
140What type of stain is yellow stain?
Exogenous Extrinsic Stain
141What type of stain often reoccurs, despite adequate oral hygiene?
Green Stain
142What type of stain is green stain?
Exogenous Extrinsic Stain
143What type of black or dark brown stain occurs at the cervical portion of the tooth, but does not usually form directly against the gingiva?
Black-Line Stain
144What type of stain appears as a black or dark brown, tarlike stain that coats the teeth?
Tobacco Stain
145What type of stain is commonly caused by coffee, tea, betel leaf, and other foodstuffs?
Brown Stains
146What type of stain was previously very prevalent in miners and can also be caused by certain drugs?
Metallic Stains
147What are the two most common endogenous intrinsic stains?
Pulpless Teeth and Tetracyclines
148What type of stain, affecting the dentin, may result from amalgam or endodontic therapy and materials?
Exogenous Intrinsic Stain
149What tooth surfaces can be polished?
ONLY Intact Enamel
150What are the 10 possible negative effects of polishing?
Potential for Bacteremia, Aerosol Production, Spatter, Removal of Tooth Structure, Areas of Demineralization, Areas of Thin Enamel Cementum or Dentin, Care of Restorations and Implants, Heat Production, Trauma to Gingiva, Irritation of Diseased lining by abrasives
151What are the characteristics of a polishing agent?
Works by producing scratches in surface, irregular/sharp edges, highly abrasive
152What are the characteristics of cleaning agents?
Do not scratch, Round and Flat, Low Abrasive
153How does the size of the particles in polishing agents affect the polish?
Larger particles are more abrasive. As teeth are polished, the particles break down into smaller particles and become less abrasive, leaving a glossy finish
154Where does cementum fall on Mohs Hardness Scale?
2.5-3
155Where does dentin fall on Mohs Hardness Scale?
3-4
156Where does Enamel fall on Mohs Hardness Scale?
5
157Where does Aluminum Silicates fall on Mohs Hardness Scale?
2
158Where does Calcium Carbonate fall on Mohs Hardness Scale?
3
159Where does Pumice fall on Mohs Hardness Scale?
6-7
160Where does Aluminum Oxide fall on Mohs Hardness Scale?
9
161Where does Silicone Carbine fall on Mohs Hardness Scale?
9.5
162What material is the highest on Mohs Hardness Scale?
Diamond
163What polishing ingredient for sensitivity blocks nerve transmission of pain?
5% Potassium Nitrate (KNO3)
164What polishing ingredient for sensitivity seals dental tubules?
Arginine Bicarbonate
165What polishing ingredient is used for whitening?
35% Hydrogen Peroxide
166What are the 4 main aspects of polishing agents?
Abrasive Particles, Fluoride Calcium and Phosphate, Whitening Agents, and Dentin Hypersensitivity Treatments
167What speed is used for polishing?
Steady, Low Speed
168What should always be placed after polishing?
Fluoride
169What instrument is used for air-powder polishing?
Prophy Jet
170What two forms of fluoride are a gel or foam that is placed using a tray?
2.0% NaF and 1.23% APF
171How long should trays of fluoride be applied for?
4 Minutes
172What form of fluoride is used at NAU?
5% NaF Varnish
173How should fluoride varnish be placed?
Try teeth with 2x2 or air (not completely), Dip brush in varnish and mix well, brush a thin layer over all tooth surfaces
174What instructions should be given to a patient after applying fluoride varnish?
They will feel a coating on their teeth, avoid hard foods, hot liquids, and brushing/flossing for 4-6 hours, drink through a straw for the first few hours after application
175What is a Tx Plan?
What you will being doing with this patient AND what the patient agreed to on signed tx plan and consent
176Where would any additional findings or notes that prepare the clinician for the next visit be put in the clinical notes?
Additional Clinical Findings
177What causes blackline stains?
Chromogenic Bacteria Embedded in a Ferric Matrix with a high Phosphorus-Calcium Content. No definitive etiology
178What gives pulpless teeth their color?
Decomposed Hemoglobin
179What causes tobacco stain?
Tobacco Use (duh)
180What causes Orange and Red Stains?
Possibly chromogenic bacteria and poor oral hygiene
181What causes green stain?
Poor oral hygiene, dental biofilm retention, chromogenic bacteria, gingival hemorrhage chlorophyll, metalic dust, green tea, and marijuana smoke
182What causes brown stain?
Poor oral hygiene, tea, coffee, soy sauce, etc, stannous fluoride, antimicrobial agents (like chlorhexidine and essential oils), betel nuts, and chlorine (swimmer stain)
183What causes metallic stain?
Metals or Metallic Salts from a Metal-Containing Dust Industry
184What causes tetracycline stain?
Tetracycline exposure to developing teeth
185What are the 3 characteristics of instrument handles to consider?
Instrument Weight, Handle Diameter, and Texture
186What are the 3 types of instrumentation strokes?
Assessment Stroke, Calc Removal Stroke, and Root Debridement Stroke
187What type of instrumentation stroke is a feather-light stroke of moderate length that contacts the tooth, but no pressure is applied?
Assessment Stroke
188What type of instrumentation stroke is a brief, tiny stroke where moderate pressure is applied against the tooth?
Calculus Removal Stroke
189What type of instrumentation stroke is a lighter, shaving stroke of moderate length where light pressure is applied?
Root Debridement Stroke
190Why are root debridement strokes used on roots?
To avoid removing cementum
191What is the interdental CAL at the site of greatest loss in stage I periodontitis?
1-2 mm
192What is the interdental CAL at the site of greatest loss in stage II periodontitis?
3-4 mm
193What is the interdental CAL at the site of greatest loss in stage III periodontitis?
5 mm or greater
194What is the interdental CAL at the site of greatest loss in stage IV periodontitis?
5mm or greater
195What RBL is present in stage I periodontitis?
<15%
196What RBL is present in stage II periodontitis?
15%-33%
197What RBL is present in stage III periodontitis?
Extending to middle third of root and beyond
198What RBL is present in stage IV periodontitis?
Extending to middle third of root and beyond
199What tooth loss is present in stage I periodontitis?
None
200What tooth loss is present in stage II periodontitis?
None
201What tooth loss is present in stage III periodontitis?
4 or less
202What tooth loss is present in stage IV periodontitis?
5 or more
203What is the max probing depth for Stage I Periodontitis?
4 mm or less
204What is the max probing depth for Stage II Periodontitis?
5 mm or less
205What is the probing depth for Stage III Periodontitis?
6 mm or more
206What is the max probing depth for Stage IV Periodontitis?
6 mm or more
207What type of bone loss is present in stage I periodontitis?
Mostly Horizontal
208What type of bone loss is present in stage II periodontitis?
Mostly Horizontal
209What type of bone loss is present in stage III periodontitis?
3 mm or more Vertical Bone Loss
210What type of bone loss is present in stage IV periodontitis?
3 mm or more Vertical Bone Loss
211Which stages of periodontitis have class II or III furcation involvement?
Stage III and IV
212What is the difference between stage III and IV periodontitis?
# of teeth lost
213What RBL or CAL is present in Grade A periodontitis?
No loss of 5 years
214What RBL or CAL is present in Grade B periodontitis?
Less than 2mm over 5 years
215What RBL or CAL is present in Grade C periodontitis?
2 mm or more over 5 years
216What calculation is used to determine periodontitis grade?
% bone loss/age
217What % bone loss/age is present in Grade A periodontitis?
Less than 0.25
218What % bone loss/age is present in Grade B periodontitis?
0.25-1.0
219What % bone loss/age is present in Grade C periodontitis?
Greater than 1.0
220What two risk factors increase a patient's periodontitis grade?
Smoking and Diabetes
221What would the periodontitis grade be of a patient who smokes 10 or more cigarettes per day?
Grade C
222What would the periodontitis grade be of a patient who smokes less than 10 cigarettes per day?
Grade B
223Can a patient smoke and still have Grade A Periodontitis?
No