Subject:  Scientific Basis for Dental Hygiene Practice
Category: Anatomic Sciences
SubCategory:  Anatomy/Head & Neck Anatomy

Frontal region: includes the forehead and the area superior to the eyes
Frontal eminence: prominence of the forehead
Glabella: smooth elevated area between the eyebrows
Tragus: smaller flap of tissue of the auricle anterior to the external acoustic meatus
Philtrum: The groove between the upper lip and the nose

Subject:  Community Health / Research Principles
Category: Analyzing Scientific Literature, Understanding Statistical Concepts,
and Applying Research Results
SubCategory:  Analyzing Scientific Literature, Understanding Statistical Concepts,
and Applying Research Results

Includes plagiarism, copyright or patent infringement, falsifying or fabricating data, misrepresenting data, and conflict of interest

Subject:  Provision of Clinical Dental Hygiene Services
Category: Assessing Patient Characteristics
SubCategory:  Periodontal Evaluation           

Describe in progress note:
-Color (coral pink, erythematous, cyanotic)
-Contour (knife-edge, rolled-margin, bulbous, clefting)
-Consistency (firm, edematous, fibrotic)
-Texture (stippled, smooth/ glossy)
-Distribution (generalized, localized)

Subject:  Provision of Clinical Dental Hygiene Services
Category: Planning and Managing Dental Hygiene Care
SubCategory:  Anxiety and pain control

Structurally, local anesthetics consist of three molecular components:

• a lipophilic part
• an intermediate aliphatic chain
• a hydrophilic (amine) part

The chemical linkage between the lipophilic part and the intermediate chain can be of the amide-type or the ester-type, and is the general basis for the current classification of local anesthetics.

Amino esters, in reference to anesthetic agents, are rapidly metabolized in the plasma by butyricholinesterase to para-aminobenzoic acid derivatives, then excreted in the urine. This suggests their very short half lives. Allergy is more likely to occur with ester-type agents, as opposed to amide-type.

Subject:  Scientific Basis for Dental Hygiene Practice
Category: Pharmacology
SubCategory:   Pharmacology

Drug metabolism is carried out in the body by the liver, kidneys and intestines, but the bulk of the work is done by the liver.

Subject:  Scientific Basis for Dental Hygiene Practice
Category: Pharmacology
SubCategory:   Pharmacology

Tylenol, percocet, vicodin and lorcet all have acetaminophen as an active ingredient.           
*Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). It works by reducing hormones that cause inflammation and pain in the body.
*Ibuprofen is used to reduce fever and treat pain or inflammation caused by many conditions such as headache, toothache, back pain, arthritis, menstrual cramps, or minor injury.

*Ibuprofen is used in adults and children who are at least 6 months old.
Important information
*Ibuprofen can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

Ibuprofen may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using ibuprofen, especially in older adults.

Do not take more than your recommended dose. An ibuprofen overdose can damage your stomach or intestines. Use only the smallest amount of medication needed to get relief from your pain, swelling, or fever.

Subject:  Provision of Clinical Dental Hygiene Services
Category: Planning and Managing Dental Hygiene Care
SubCategory:  Recognitions and management of compromised patients

Leukemia, is a group of cancers that usually begin in the bone marrow and result in high numbers of abnormal white blood cells. These white blood cells are not fully developed and are called blasts or leukemia cells. Symptoms may include bleeding and bruising problems, feeling tired, fever, and an increased risk of infections. These symptoms occur due to a lack of normal  Diagnosis is typically made by blood tests or bone marrow biopsy.

Subject:  Scientific Basis for Dental Hygiene Practice
Category: Anatomic Sciences
SubCategory:  Anatomy/Dental Anatomy/Root Anatomy

The maxillary lateral incisor is smaller than the maxillary central incisor in all dimensions except root length.

Subject:  Provision of Clinical Dental Hygiene Services
Category: Planning and Managing Dental Hygiene Care
SubCategory:  Recognition of emergency situations and provisions of appropriate care 

Storage media
There are many storage media available for knocked-out tooth storage. The most often recommended are: saliva, physiologic saline, milk and pH balanced cell preserving fluids. Water and ice have been shown to damage the tooth root cells, and as such, avulsed teeth should never be stored in them. The osmolality and pH of water and ice is very low (7-17mOs) compared to normal cell pressure (280 mOs). When a knocked-out tooth is placed in water, the cells attempt to equalize with the surrounding environment, the cell fluid tries to move to the outside pressure environment and burst. Water with table salt in it is damaging to the knocked out teeth.

Saliva, that is placing the tooth under the accident victim’s tongue or in the cheek, has been recommended. Saliva, as a storage media, causes twice damage as water. Its osmolality is very low, causing bursting of the tooth root cells, but additionally, because saliva is filled with its normal flora of microorganisms, it will severely infect the tooth root cells. When the tooth is replanted, not only will the cells be necrotic but they will also infect the bone socket.  Physiologic saline has a fairly compatible osmolality and will not cause cell swelling but it lacks the metabolites and glucose necessary for maintenance of normal cell metabolism.

Milk has been also recommended as a storage medium for avulsed teeth. Its advantage is the high availability of fresh whole milk. Only whole milk can be used for tooth preservation. Skim milk and heavy cream do not have the correct fluid pressure and will cause damage to the root cells. Milk has no observed regenerative properties for cells on knocked out teeth.

It was discovered 30 years ago that milk was less damaging to knocked out teeth than water or saliva. It was recommended because it has a compatible osmolality (fluid pressure) to tooth root cells and it is thought to be readily available. However, like physiologic saline, milk lacks the necessary metabolites and glucose necessary to maintain normal cell metabolism of the tooth root cells. The cells on knocked-out tooth roots in milk do not die immediately but are unable to replicate (mitosis) and so are less able to reform new cells when replanted.

The most optimum storage media that are available have been shown to be pH balanced cell preserving solutions. The best known and most extensively tested is called Hank’s Balanced Salt Solution (HBSS).  It has all of the metabolites such as Ca, phosphate ions, K+ and glucose that are necessary to maintain normal cell metabolism for long periods of time. HBSS has been extensively tested in dental and medical research for the past twenty years. This research has shown that 90% of cells stored in HBSS for 24 hours maintain their normal viability and after four days, still have 70%viable. In research studies, extracted dog’s teeth that have been placed in HBSS for four days can still be replanted with little signs of resorption. Hank’s Balanced Salt Solution is found in a Save-A-Tooth, a storage device for the storage, preservation, and regeneration of tooth root cells.

HBSS also has been shown to be capable of replacing lost cell metabolites. Since a cell that has been cut off from its blood supply depletes its stored metabolites after fifteen minutes, a tooth that has been extra-oral for one hour has less vital cells to reconnect with the bone ligament cells. Some studies in dental research have shown that knocked out teeth that have been dry for up to one hour will have less resorption if they are soaked in a HBSS for 30 minutes prior to replantation. In these studies, dog’s teeth were extracted and left dry for 30, 45 and 60 minutes and then soaked in HBSS for 30 minutes and then reimplanted. These teeth showed 50% less replacement resorption following reimplantation. It has also been shown that keeping the teeth cold while in the HBSS does not affect success.

Many other types of storage liquids have been tested such as powdered milk, Enfamil, Gatorade, and contact lens solution. All of them have been shown to either be ineffective or damaging to avulsed tooth.

Subject:  Provision of Clinical Dental Hygiene Services
Category: Planning and Managing Dental Hygiene Care
SubCategory:  Recognitions and management of compromised patients

Subject:  Provision of Clinical Dental Hygiene Services
Category: Using Preventive Agents
SubCategory:  Fluorides – systemic and topicals/Mechanisms of action
           
Possible mechanisms of action of Fluoride
• reduced acid solubility
• improved morphology
• enzyme inhibition
• polysaccharide synthesis
• lower free surface energy
• promotion of remineralization

Subject:  Community Health / Research Principles
Category: Promoting Health and Preventing Disease within Groups
SubCategory:  Promoting Health and Preventing Disease within Groups

Toothbrush prophylaxis in young children is a gentle, non-invasive method to remove plaque and is particularly effective because it does not intimidate the young patient. This approach not only aids in maintaining oral health by removing plaque but also serves an educational purpose. By demonstrating the proper technique of brushing in a real-time, interactive manner, dental professionals can effectively communicate and teach caregivers the correct way to brush their child’s teeth. This dual benefit of toothbrush prophylaxis—plaque removal and educational opportunity—makes it an essential practice in pediatric dental care. It encourages the development of positive oral hygiene habits early on, setting the foundation for a lifetime of healthy oral care practices.

Subject:  Scientific Basis for Dental Hygiene Practice
Category: Pathology
SubCategory:  General

Lethal to Cell
Necrosis is characterized by cytoplasmic swelling, irreversible damage to the plasma membrane, and organelle breakdown leading to cell death. The stages of cellular necrosis include pyknosis; clumping of chromosomes and shrinking of the nucleus of the cell, karyorrhexis; fragmentation of the nucleus and break up of the chromatin into unstructured granules, and karyolysis; dissolution of the cell nucleus.Cytosolic components that leak through the damaged plasma membrane into the extracellular space can incur an inflammatory response.

There are six types of necrosis:
–   Coagulative necrosis
–   Liquefactive necrosis
–   Caseous necrosis

• Fat necrosis
• Fibroid necrosis
• Gangrenous necrosis

Subject:  Scientific Basis for Dental Hygiene Practice
Category: Physiology
SubCategory:  Physiology

Bachmann’s bundle (BB), also known as the interatrial bundle, is well recognized as a muscular bundle comprising of parallel aligned myocardial strands connecting the right and left atrial walls and is considered to be the main pathway of interatrial conduction. Disruption of the bundle’s structure causes interatrial conduction block (IAB), which is associated with development of various atrial tachyarrhythmias and with electromechanical dysfunction of the left atrium. Technological progress providing sophisticated mapping and imaging techniques in the past decade has increased our knowledge of specific anatomic structures and their role in development of both atrial brady- and tachyarrhythmias. This review outlines the current knowledge of the relation between anatomic and electrophysiological properties of BB and its possible role in initiation and perpetuation of atrial fibrillation (AF)

Subject:  Provision of Clinical Dental Hygiene Services
Category: Using Preventive Agents
SubCategory:  Fluorides – systemic and topicals/Methods of administration/Self-administered

Indications for fluoride therapy
The individual’s risk factors and the reason for treatment will determine which method of fluoride delivery is used. Consult with a dentist before starting any treatment. Reasons for fluoride therapy include:

• White spots
• Moderate to high risk patients for developing decay
• Active decay
• Orthodontic treatment
• Additional protection if necessary for children in areas without fluoridated drinking water
• To reduce tooth sensitivity
• Protect root surface
• Decreased salivary flow
• Institutionalized patients

Subject:  Scientific Basis for Dental Hygiene Practice
Category: Physiology
SubCategory:  Physiology

Subject:  Scientific Basis for Dental Hygiene Practice
Category: Pathology
SubCategory:  Oral

Koplik spots (also Koplik’s sign) are a prodromic viral enanthem of measles manifesting two to three days before the measles rash itself. They are characterized as clustered, white lesions on the buccal mucosa (opposite the upper 1st & 2nd molars) and are pathognomonic for measles.  The textbook description of Koplik spots is ulcerated mucosal lesions marked by necrosis, neutrophilic exudate, and neovascularization.  They are described as appearing like “grains of salt on a wet background”, and often fade as the maculopapular rash develops. As well as their diagnostic significance they are important in the control of outbreaks. Their appearance, in contacts of a diagnosed case, before they reach maximum infectivity, permits isolation of the contacts and greatly aids control of this highly infectious disease.

Subject:  Scientific Basis for Dental Hygiene Practice
Category: Physiology
SubCategory:  Physiology

Subject:  Provision of Clinical Dental Hygiene Services
Category: Using Preventive Agents
SubCategory:  Fluorides – systemic and topicals/Mechanisms of action

Systemic fluoride’s role in dental health extends beyond the development and eruption of teeth. Once ingested and absorbed into the body, fluoride can be excreted in saliva, continuously providing a topical source of fluoride for erupted teeth. This salivary fluoride is crucial for ongoing enamel protection as it aids in the remineralization of enamel surfaces and helps inhibit the demineralization process, thereby reducing the risk of dental caries. This process demonstrates the dual benefits of fluoride: systemic ingestion contributes to the fluoride reservoir in the body, which in turn supports the topical protection of teeth via saliva. This understanding underscores the importance of fluoride throughout life for maintaining dental health, not just during the development of teeth.

Subject:  Scientific Basis for Dental Hygiene Practice
Category: Biochemistry & Nutrition
SubCategory:  Biochemistry & Nutrition

Factors affecting Enzyme Activity
*The activity of an Enzyme is affected by its environmental conditions. Changing these alter the rate of reaction caused by the enzyme. In nature, organisms adjust the conditions of their enzymes to produce an Optimum rate of reaction, where necessary, or they may have enzymes which are adapted to function well in extreme conditions where they live.

Temperature
*Increasing temperature increases the Kinetic Energy that molecules possess. In a fluid, this means that there are more random collisions between molecules per unit time.
*Since enzymes catalyze reactions by randomly colliding with Substrate molecules, increasing temperature increases the rate of reaction, forming more product.
*However, increasing temperature also increases the Vibrational Energy that molecules have, specifically in this case enzyme molecules, which puts strain on the bonds that hold them together.
*As temperature increases, more bonds, especially the weaker Hydrogen and Ionic bonds, will break as a result of this strain. Breaking bonds within the enzyme will cause the Active Site to change shape.
*This change in shape means that the Active Site is less Complementary to the shape of the Substrate, so that it is less likely to catalyze the reaction. Eventually, the enzyme will become Denatured and will no longer function.
*As temperature increases, more enzymes’ molecules’ Active Sites’ shapes will be less complementary to the shape of their Substrate, and more enzymes will be Denatured. This will decrease the rate of reaction.
*In summary, as temperature increases, initially the rate of reaction will increase, because of increased Kinetic Energy. However, the effect of bond breaking will become greater and greater, and the rate of reaction will begin to decrease.
*The temperature at which the maximum rate of reaction occurs is called the enzyme’s Optimum temperature. This is different for different enzymes. Most enzymes in the human body have an optimum temperature of around 37.0 °C.

pH – Acidity and Basicity
*pH measures the Acidity and Basicity of a solution. It is a measure of the Hydrogen Ion (H⁺) concentration, and therefore a good indicator of the Hydroxide Ion (OH^–) concentration. It ranges from pH1 to pH14. Lower pH values mean higher H⁺ concentrations and lower OH^– concentrations.
*Acid solutions have pH values below 7, and Basic solutions (alkalis are bases) have pH values above 7. Deionized water is pH7, which is termed ‘neutral’.
*H⁺ and OH^– Ions are charged and therefore interfere with Hydrogen and Ionic bonds that hold together an enzyme, since they will be attracted or repelled by the charges created by the bonds. *This interference causes a change in shape of the enzyme, and importantly, its Active Site.
*Different enzymes have different Optimum pH values. This is the pH value at which the bonds within them are influenced by H⁺ and OH^– Ions in such a way that the shape of their Active Site is the most Complementary to the shape of their Substrate. At the Optimum pH, the rate of reaction is at an optimum.
*Any change in pH above or below the Optimum will quickly cause a decrease in the rate of reaction, since more of the enzyme molecules will have Active Sites whose shapes are not (or at least are less) Complementary to the shape of their Substrate.
*Small changes in pH above or below the Optimum do not cause a permanent change to the enzyme, since the bonds can be reformed. However, extreme changes in pH can cause enzymes to Denature and permanently lose their function.
*Enzymes in different locations have different Optimum pH values since their environmental conditions may be different. For example, the enzyme Pepsin functions best at around pH2 and is found in the stomach, which contains Hydrochloric Acid (pH2).

Concentration
*Changing the Enzyme and Substrate concentrations affect the rate of reaction of an enzyme-catalyzed reaction. Controlling these factors in a cell is one way that an organism regulates its enzyme activity and so its Metabolism.
*Changing the concentration of a substance only affects the rate of reaction if it is the limiting factor: that is, it the factor that is stopping a reaction from preceding at a higher rate.
If it is the limiting factor, increasing concentration will increase the rate of reaction up to a point, after which any increase will not affect the rate of reaction. This is because it will no longer be the limiting factor and another factor will be limiting the maximum rate of reaction.
*As a reaction proceeds, the rate of reaction will decrease, since the Substrate will get used up. The highest rate of reaction, known as the Initial Reaction Rate is the maximum reaction rate for an enzyme in an experimental situation.

Substrate Concentration
Increasing Substrate Concentration increases the rate of reaction. This is because more substrate molecules will be colliding with enzyme molecules, so more product will be formed.
However, after a certain concentration, any increase will have no effect on the rate of reaction, since Substrate Concentration will no longer be the limiting factor. The enzymes will effectively become saturated, and will be working at their maximum possible rate.

Enzyme Concentration
*Increasing Enzyme Concentration will increase the rate of reaction, as more enzymes will be colliding with substrate molecules.
*However, this too will only have an effect up to a certain concentration, where the Enzyme Concentration is no longer the limiting factor.

Subject:  Provision of Clinical Dental Hygiene Services
Category: Planning and Managing Dental Hygiene Care
SubCategory:  Recognition of emergency situations and provisions of appropriate care

Syncope is the most common medical emergency to occur with in the dental office, more specifically neurocariogenic syncope. The dental professional should work hard to alleviate the patients stress as well as administer oxygen if needed. In the future the patient can be medicated with nitrous oxide during appointment or premeditate with an oral sedative such as Benzodiazepine.

Subject:  Provision of Clinical Dental Hygiene Services
Category: Assessing Patient Characteristics
SubCategory:  Head & Neck Examination

Contralateral
Pertaining to, situated on, or coordinated with the opposite side.

Ipsilateral
Pertaining to, situated on, or affecting the same side of the body.

Subject:  Scientific Basis for Dental Hygiene Practice
Category: Anatomic Sciences
SubCategory:  Anatomy/Dental Anatomy/Root Anatomy

The cusp of Carabelli is a small additional cusp at the mesiopalatal line angle of maxillary first molars. This extra cusp is usually found on the first molar, and becomes progressively less likely in the second, third molars

Subject:  Scientific Basis for Dental Hygiene Practice
Category: Biochemistry & Nutrition
SubCategory:  Biochemistry & Nutrition

The fat soluble vitamins are vitamin A, vitamin D, vitamin E, and vitamin K. They may also go by the name lipid soluble vitamins. These vitamins are stored in your body and are dissolved in the stored fat in your body. In turn, they are released when fat is broken down to access the vitamins or for other nutritional or energy needs. These vitamins are absorbed in your intestines, and are structurally related. Without these four vitamins, your body could not perform the critical job of repairing daily damage or help your organs function efficiently. Because they are stored in the fat, these vitamins can build up. Fish liver oil and essential omega 3 fatty acids are very rich in both vitamin D and vitamin A, and these vitamins can be stored in your liver until it is needed by your body. The good part about these vitamins is, they do not have to be consumed every single day because they can be stored until needed by your body.

There are a number of different water soluble vitamins, and these are all eight B vitamins and the sunshine vitamin, vitamin C. These vitamins are not stored in your body, and because of this you must eat these vitamins every single day to ensure your body has all the nutrients required for proper maintenance and function. Because these vitamins dissolve in water and are excreted through your urine every day, there isn’t any danger from a buildup in your body. However, they are required to be consumed daily. Your intestines will absorb these vitamins and they are then sent directly into your bloodstream, where they are used. Excess vitamins are then sent via the body’s urine or excretion process. The eight B vitamins are B1, B2, B3, B5, B6, B7, B9, and B12.

Subject:  Provision of Clinical Dental Hygiene Services
Category: Performing Periodontal Procedures
SubCategory:  Etiology and pathogenesis of periodontal diseases

Five stages of the formation of dental plaque biofilm
1. Acquired Pellicle Formation
2. Attachment
3. Young Supragingival Plaque Formation
4. Mature Plaque Formation
5. Subgingival Plaque Formation

Subject:  Provision of Clinical Dental Hygiene Services
Category: Performing Periodontal Procedures
SubCategory:  General

Osteoplasty: the surgical procedure which only involves removal of body ledges or nonsupporting bone is called.

Ostectomy: surgical procedure where the bone is removed also contains supporting periodontal ligament fibers.

Apicoectomy: surgery that removes the apex of the tooth for access to the root canal for endodontic treatment.

Osteotomy: an osteotomy is a surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture. It is also used to correct a coxa vara, genu valgum, and genu varum.

Subject:  Community Health / Research Principles
Category:  Participating in Community Programs
SubCategory:  Assessing populations and defining objectives

1. Life Expectancy
2. Well-being
3. Overweight & obesity
4. Addictive Behavior
5. Unintended pregnancy
6. Healthy Communities
7. Preventive Services
8. Access to Care
9. Patient Safety
10. Evidence-based Care
11. Care that matches patient goals
12. Personal spending burden
13. Population spending burden
14. Individual engagement

15. Community engagement

Subject:  Provision of Clinical Dental Hygiene Services
Category: Providing Supportive Treatment Services
SubCategory:  Other supportive services (e.g., tooth desensitization)
           
Treating dentinal hypersensitivity can be challenging for the dental professional because of the difficulty related to measuring the pain response as the response can often vary from patient to patient.  In addition if the dentin exposure is due to personal habits, it may be difficult for patients to change their behavior(s).  If the diagnosis confirms dentinal hypersensitivity in the absence of underlying diseases or structural problems, then the following steps can be initiated:  (1) remove the risk factors by educating the patient about dietary acids and other oral care habits; (2) recommend different toothbrushing methods, if appropriate; (3) initiate treatment by recommending a desensitizing agent for home use; and/or (4) applying topical desensitizing agents in-office.

In 1935, Grossman addressed the requirements for an ideal desensitizing agent as:  rapidly acting with long-term effects, non-irritating to the pulp, painless and easy to apply without staining the tooth surface.  These requirements still exist today when considering an ideal solution to dentinal hypersensitivity.  There are various ways to classify treatments:  first, they can be categorized based on their ingredients and/or mechanism of action. There are two common approaches to treating dentinal hypersensitivity, nerve stabilization and tubule occlusion.  Furthermore, treatment options can be classified as either invasive or non-invasive in nature.  Examples of invasive procedures administered in-office include gingival surgery, application of resin adhesive materials such as dentin bonding agents, or a pulpectomy.  Dentifrices and other products for home use are non-invasive.  Finally, treatments can be categorized based on whether they can be applied by the patient (over-the-counter) or require professional application.  For the purposes of this CE course, the focus is on first line over-the-counter products as well as popular in-office treatments.

Subject:  Community Health / Research Principles
Category: Promoting Health and Preventing Disease within Groups
SubCategory:  Promoting Health and Preventing Disease within Groups

Health Belief Model
1) they are susceptible vulnerable
2) disease has serious consequences
3) behavior change is good
4) change is important
5) ready to act
6) able to demonstrate self- efficacy

Subject:  Provision of Clinical Dental Hygiene Services
Category: Planning and Managing Dental Hygiene Care
SubCategory:  Recognition of emergency situations and provisions of appropriate care

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Subject:  Provision of Clinical Dental Hygiene Services
Category: Performing Periodontal Procedures
SubCategory:  Prescribed therapy/Periodontal debridement

Angle between face of curet and the tooth surface

• Insertion – 0 degrees
• Scaling/Root Planing – 45-90 degrees

• OPTIMAL angulation for scaling and root planing is 60 – 80 degrees

Subject: Provision of Clinical Dental Hygiene Services
Category: Planning and Managing Dental Hygiene Care
SubCategory:  Infection control (application)

Exogenous: disease that originates from outside of the person’s body caused by either pathogenic organisms that invade the body, radiation, chemical agents, trauma, electric shock, or temp extremes.

Endogenous: disease that originates w/in the person’s body and are not transmitted from another infected individual.

Nosocomial: Infection acquired from germs transmitted from hospital worker or environment.

Iatrogenic: Infections caused from body’s response to medical procedure.

Opportunistic: when bod’s immune system is compromised and incapable of resisting even minor infection (generally would not infect a healthy person with intact immune system).

Subject:  Scientific Basis for Dental Hygiene Practice
Category: Pathology
SubCategory:  General

Aplasia is defined in general as “defective development or congenital complete absence of an organ or tissue.” In the field of hematology, the term refers to “incomplete, retarded, or defective development, or cessation of the usual regenerative process

Subject:  Provision of Clinical Dental Hygiene Services
Category: Using Preventive Agents
SubCategory:  Fluorides – systemic and topicals/Toxicology

4 possible effects of chronic fluoride toxicity on bones
-exostosis
-sclerosis
-osteoporosis
-spontaneous fractures

Subject:  Scientific Basis for Dental Hygiene Practice
Category: Microbiology & Immunology
SubCategory:  Microbiology & Immunology

Mycoplasma is a genus of bacteria that lack a cell wall around their cell membrane. Without a cell wall, they are unaffected by many common antibiotics such as penicillin or other beta-lactam antibiotics that target cell wall synthesis. They can be parasitic or saprotrophic. Several species are pathogenic in humans, including M. pneumoniae, which is an important cause of atypical pneumonia and other respiratory disorders, and M. genitalium, which is believed to be involved in pelvic inflammatory diseases. Mycoplasma species are the smallest bacterial cells yet discovered, can survive without oxygen, and come in various shapes. For example, M. genitalium is flask-shaped (about 300 x 600 nm), while M. pneumoniae is more elongated (about 100 x 1000 nm). Hundreds of mycoplasmae infect animals.

Subject:  Provision of Clinical Dental Hygiene Services
Category: Assessing Patient Characteristics
SubCategory:  Head & Neck Examination

This plexus communicates freely with the anterior facial vein; it also communicates with the cavernous sinus, by branches through the foramen Vesalii, foramen ovale, and foramen lacerum. Due to its communication with the cavernous sinus, infection of the superficial face may spread to the cavernous sinus, causing cavernous sinus thrombosis. Complications may include edema of the eyelids, conjunctivae of the eyes, and subsequent paralysis of cranial nerves which course through the cavernous sinus.

The pterygoid plexus of veins becomes the maxillary vein. The maxillary vein and the superficial temporal vein later join to become the retromandibular vein. The posterior branch of the retromandibular vein and posterior auricular vein then form the external jugular vein, which empties into the subclavian vein.

Subject: Scientific Basis for Dental Hygiene Practice
Category: Biochemistry & Nutrition
SubCategory: Biochemistry & Nutrition

Stress Hormones:
When the body experiences acute or chronic stress, there are two major stress hormones that are released:

•    Cortisol
•    Norepinephrine

Cortisol is the hormone that is responsible for increased blood pressure, blood sugar, and suppressing the immune system. It provides that extra boost of energy when needed for a quick get away. When this hormone is released frequently or for long periods of time, its effects can be dangerous. High blood pressure and diabetes are common health problems that can occur.

Norepinephrine is the hormone that causes the heart rate to increase, stored glucose(simple sugar) to be released, and increased blood flow to the muscles. This hormone like Cortisol, plays a major part in helping you to escape dangerous situations. It’s effects from long or frequent exposure are very similar to Cortisol. The increased heart rate can cause high blood pressure, and the stored glucose(simple sugar) that’s released can also cause diabetes. Back and body muscle pain can occur due to the tension in the muscles caused by this hormone.

Subject:  Provision of Clinical Dental Hygiene Services
Category: Planning and Managing Dental Hygiene Care
SubCategory:  Individualized patient education/Provision of instruction for prevention and management of oral diseases/Dental caries

Radiographs are helpful in diagnosing dental caries but do nothing as an intervention to stop dental caries.

Subject:  Provision of Clinical Dental Hygiene Services
Category: Obtaining and Interpreting Radiographs
SubCategory:  Recognition of normalities and abnormalities

Subject:  Provision of Clinical Dental Hygiene Services
Category: Providing Supportive Treatment Services
SubCategory:  Properties and manipulation of materials

Impression Plaster
AKA Type I gypsum product;
(for edentulous patients; usually mint flavored)

Plaster defined
AKA Type II gypsum product; beta-hemihydrate; model or lab plaster

Stone
AKA Type III gypsum product; alpha-hemihydrate; Trade names: Hydro cal, Capstone (also called Class I stone) Lab stone

Die Stone
AKA Type IV gypsum product;
modified alpha-hemihydrate;
improved stone; TM Density; Die keen (also called Class II stone) Die stone

Subject:  Scientific Basis for Dental Hygiene Practice
Category: Microbiology & Immunology
SubCategory:  Microbiology & Immunology

Spirochetes belong to a phylum of distinctive diderm (double-membrane) bacteria, most of which have long, helically coiled (corkscrew-shaped or spiraled, hence the name) cells. Spirochetes are chemoheterotrophic in nature, with lengths between 3 and 500 µm and diameters around 0.09 to at least 3 µm.

Spirochetes are distinguished from other bacterial phyla by the location of their flagella, sometimes called axial filaments, which run lengthwise between the bacterial inner membrane and outer membrane in periplasmic space. These cause a twisting motion which allows the spirochaete to move about. When reproducing, a spirochaete will undergo asexual transverse binary fission.

Subject:  Community Health / Research Principles
Category:  Participating in Community Programs
SubCategory:  Assessing populations and defining objectives

Guiding principles

Objectives should be defined in relation to the priority health problems and risks identified in the situation analysis and within the overall framework of reducing excess mortality, morbidity, malnutrition and disability and restoring the delivery and access to health care. They must address the main causes of death and illness and the major constraints to delivery of and access to health care.

Objectives may include improving information as well as achieving direct health outcomes. While many will concern aspects that are the responsibility of the MoH (and the Health Cluster/sector coordination group), some may relate to aspects that are the responsibility of other ministries (and other cluster/sector coordination groups).

Objectives must be “SMART” – specific, measurable, accurate, realistic and time-bound (e.g. “the risk of diarrhea reduced by 50% in the target population in 6 months”).

Subject:  Provision of Clinical Dental Hygiene Services
Category: Assessing Patient Characteristics
SubCategory:  Oral Evaluation

Subject:  Scientific Basis for Dental Hygiene Practice
Category: Pathology
SubCategory:  Oral

Subject:  Provision of Clinical Dental Hygiene Services
Category: Planning and Managing Dental Hygiene Care
SubCategory:  Recognitions and management of compromised patients
           
Dental Management for Patients with Bronchial Asthma
*Avoid anxiety which may precipitate an asthmatic attack.
*Patients are advised to bring their regular medication with them.
*Elective dental care should be deferred in severe asthmatics until they are in a better phase.
*Patient should not be treated during sickness e.g.  u-like symptoms.
*Allergy to penicillin may be more frequent.
*Epinephrine, erythromycin, clindamycin and azithromycin are contraindicated for patients on theophylline.
*Avoid the use of LA containing vasoconstrictor because some asthmatic patients may react to sulfites present as preservatives in it.
*Aspirin and NSAIDs should be avoided as they are considered asthma precipitating drugs.
*Patients on steroid inhalers are prone to oral and pharyngeal thrush and those on ipratroium bromide may have dry mouth.
*Avoid antihistamines such as promethazine and diphenhydramine because of their drying effect that can exacerbate the formation of tenacious mucus in acute attack.

Subject:  Scientific Basis for Dental Hygiene Practice
Category: Microbiology & Immunology
SubCategory:  Microbiology & Immunology

Cytokines are a broad and loose category of small proteins (~5–20 kDa) that are important in cell signaling. They are released by cells and affect the behavior of other cells. Cytokines can also be involved in autocrine signaling. Cytokines include chemokines, interferons, interleukins, lymphokines, tumour necrosis factor but generally not hormones or growth factors (despite some overlap in the terminology). Cytokines are produced by a broad range of cells, including immune cells like macrophages, B lymphocytes, T lymphocytes and mast cells, as well as endothelial cells, fibroblasts, and various stromal cells; a given cytokine may be produced by more than one type of cell.

Subject:  Scientific Basis for Dental Hygiene Practice
Category: Microbiology & Immunology
SubCategory:  Microbiology & Immunology

Many species in the gut have not been studied outside of their hosts because most cannot be cultured. While there are a small number of core species of microbes shared by most individuals, populations of microbes can vary widely among different individuals. Within an individual, microbe populations stay fairly constant over time, even though some alterations may occur with changes in lifestyle, diet and age. The Human microbiome project has set out to better describe the microflora of the human gut and other body locations.

The four dominant phyla in the human gut are Firmicutes, Bacteroidetes, Actinobacteria, and Proteobacteria.  Most bacteria belong to the genera Bacteroides, Clostridium, Faecalibacterium, Eubacterium, Ruminococcus, Peptococcus, Peptostreptococcus, and Bifidobacterium. Other genera, such as Escherichia and Lactobacillus, are present to a lesser extent. Species from the genus Bacteroides alone constitute about 30% of all bacteria in the gut, suggesting that this genus is especially important in the functioning of the host.

The currently known genera of fungi of the gut flora include Candida, Saccharomyces, Aspergillus, and Penicillium.

Archaea constitute another large class of gut flora which are important in the metabolism of the bacterial products of fermentation.

Subject:  Community Health / Research Principles
Category: Promoting Health and Preventing Disease within Groups
SubCategory:  Promoting Health and Preventing Disease within Groups

Despite a patients oral health priority, their lack of dental acumen wouldn’t prohibit them from care.

Subject:  Provision of Clinical Dental Hygiene Services
Category: Planning and Managing Dental Hygiene Care
SubCategory:  Anxiety and pain control

In order for any topical anesthetic to achieve soft tissue anesthesia for scaling and root planing or prior to a local anesthetic injection, it needs to be placed on the mucosa for 1-2 minutes.

Subject:  Provision of Clinical Dental Hygiene Services
Category: Obtaining and Interpreting Radiographs
SubCategory:  Technique

The Buccal Object Rule is a localization technique applied to radiographs. This rule determines whether an object that is seen on a radiograph is on the buccal or lingual side of the tooth. It cannot be determined by a single PA radiograph. According to the Buccal/Object Rule, the buccal object will always move in the same direction in which the x-ray beam is traveling. If the object is lingual, the object will move in the opposite direction the x-ray beam is traveling.

The Buccal Object Rule
Begin with a standard PA radiograph. Take a second radiograph altering the vertical or horizontal angulation of the x-ray beam slightly. Comparing the second radiograph with the first, if the object moves in the same direction the x-ray beam is flowing, the object is buccal.  If the object moves the opposite direction of the flow of the x-ray beam, the object is lingual.

SLOB Rule (Same Lingual Opposite Buccal)
The SLOB Rule is exactly the same technique as the Buccal/Object Rule. Take 2 radiographs and change the horizontal tube angle slightly on the second radiograph. The SLOB rule states: same lingual. The object is lingual if the object movement on the second radiograph is on the “same” side as the position of the x-ray tube head. “Same” is referring to the position of the x-ray machine tube head and not the flow of the x-ray beam as in the Buccal/Object Rule.

Both the SLOB and Buccal/Object Rule end up with the same results; determining where an object is located. Only the phrasing is different between the two. One is referring to the flow of the x-ray beam and the other is referring to the position of the x-ray tube head, in relationship to the object movement on the second radiograph taken.