Computer Simulated Clinical Examination-Dental Hygiene

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Methicillin-resistant Staphylococcus aureus-is a strain of the staph
bacteria that lives on 20-30% of the population but does not cause
MRSA infection in all who are colonized with it. MRSA resides on the skin
and in the nasal passage, and once you contract a MRSA staph
infection it can be very difficult to eradicate the bacteria.
Many antibiotics can be used to treat this condition. Look for
MRSA antibiotics any of these: vancomycin, linezolid, bactrim, septra, tetracycline,
minocycline, doxycycline, and clindamycin.
Delayed wound healing, poor healing, with increased risk of infec-
Prednisone
tion. This medication affects the immune response.
Can be used with implants for removal of calculus. Also, titanium
Ultrasonic insert with plastic tips
and plastic hand instruments can be used on implants.
Oraqix duration Approximately 20 minutes.
Congenital syphillus- notched incisal edges on incisors, also mul-
Hutchinson's Incisors berry molars- tiny globules of enamel instead of cusps on first
molars.
(Mesognathic)-normal; mesiobuccal cusp of the maxillary first mo-
lar is positioned in the buccal groove of the mandibular first molar.
Class I Occlusion
Maxillary canine occluded with the distal half of the mandibular
canine and the mesial half of the mandibular first premolar.
(Retrognathic) buccal groove of the mandibular first permanent
molar is distal go the mesiobuccal cusp of the maxillary first
permanent molar by at least the width of a premolar. Distal portion
of the maxillary canine is mesial to the mesial portion of the
mandibular canine by at lease the width of a premolar.
Class II Occlusion
Division I-retruded mandible with one or more maxillary anterior
teeth protruded facially.

Division II- retruded mandible with one or more maxillary anterior

teeth inclined lingually.
(Prognathic) Buccal groove of the mandibular first permanent
molar is mesial to the mesiobuccal cusp of the maxillary first
Class III Occlusion permanent molar by at lease the width of a premolar. Mesial
portion of the maxillary canine is distal to the distal surface of the
mandibular canine by the width of a premolar.
This difference in size, mesiodistally between the two types of
teeth. The contour of the bone covering the narrower roots of the
premolars, in addition to the state of flux of the bone formation
Leeway space in this area, furnishes adjustment for dental arch measurements,
making the middle segment of the arches important architecturally.
Leeway space allows the future forward movement of the perma-
nent molars.
Hairy tongue Elongation of filiform papillae (dorsum) clean tongue.
Lateral border, white, corrugated lesions, associated with HIV,
Hairy leukoplakia
Epstein Barr virus.
Geographic tongue Benign, inflammatory condition, irregular patches look like map.
Impaired O2 delivery, 1st pale tongue, flattening of filiform papillae,
Anemia
finally painful and red.
Fissured tongue Associated with xerostomia, clean tongue.
Raised, red, glossy, slanted rectangular shape on dorsum due to
Median Rhomboid Glossitis
Candida albicans infection.
Swelling due to mucus from accessory salivary glands, common,
Mucocele
most mandibular labial mucosa.
Angular cheilitis
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Red fissures at commissures, C. albicans and Staphylococcus
aureus, nutritional deficiency, denture irritation.
Heat
Pain
4 classic features of infection
Redness
Swelling
Larger localized bruise, black eyes, mistakenly injecting posterior
Hematoma
superior alveolar vein.
Chemicals (aspirin burn), heat (food), mechanical force, ill-fitting
Traumatic ulcer denture, broken tooth, dental injection, kids chewing numb lip after
anesthesia, thumb sucking.
Soft tissue cyst surrounding the crown of an unerupted tooth.
Eruption cyst Small, dome-shaped, translucent swelling filled with blood or
serum and thus is red, brown, or blue-gray.
Human herpes virus 3. Primary infection (chickenpox): rash, face
Varicella Zoster
and trunk, vaccine prevents.
Recurrent infection-herpes zoster or shingles Mostly in elderly, unilateral, immunosuppressed vulnerable.
If you see a photograph of a geriatric patient with one side of the
face appearing to have some bumps and redness by the eye, what Herpes Zoster
would this most likely be?
Blood thinners and chemotherapy agents. The main ones are
antihistamine, anticholinergic, anorexiants, antidepressants, an-
tihypertensives, anti-parkinsons agents, diuretics and sedatives.

Medications:
Which medications cause bleeding? Anticoagulants such as warfarin (coumadin)
Antiplatelet drugs such as aspirin and clopidogrel (plavix)
Certain epilepsy, convulsion and seizure medications
Chemotherapy drugs
Antihistamine drugs
Immunosuppressant drugs
Antiemetics, antianxiety agents, decongestants, analgesics, an-
Drug classes that commonly cause xerostomia
tidiarrheals, bronchodilators and skeletal muscle relaxants.
If you see a picture of fordyce granules and it asks which treatment
No treatment is necessary. It is just a sebaceous gland.
was neccessary
Hypocalcification. Dental fluorosis is a form of enamel hypocalcifi-
cation which results from the ingestion of excessive fluoride during
If you see a question about fluoridated water; a child drinking
the period of enamel formation. To cause mottling, fluoride must
fluoride water and taking supplements is at greater risk for?
be present in concentrations several times that found in controlled
fluoridated water supplies.
After being called to the reception area and seeing an unrespon-
Activate EMS procedures.
sive patient what do you do next?
Which hepatitis shot is given to the dental hygienist employee? All dental staff should be protected from hepatitis B virus.
Which method of fluoride application immediately gets absorbed Varnish has the highest PPM and whichever product has the
into the enamel? highest PPM gets absorbed into the enamel quicker.
1. Re-check BP in 5 minutes.
If you have an elderly patient with BP 153/120mmHG what do you 2. Consult MD immediately.
do? 3. Do NOT perform dental treatment until the elevated pressure
decreases.
The area from the free gingival groove to the top of the top of the
Free gingiva
gingiva (free gingival margin).
What % of alcohol in hand disinfection solution to use in a dental
60%
office?

Mucocele

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A mucous cyst and is painless, thin sac on the inner surface of the
lips. It contains clear fluid. Symptoms: a thin fluid-filled sac appears
on the inside of the lip. The sac is bluish and clear.
A type of mucocele found on the floor of mouth. Ranulas present
as a swelling of connective tissue consisting of collected mucin
Ranula
from a ruptured salivary gland duct, which is usually caused by
local trauma. Only appears UNILATERALLY! Not bilateral.
A radiograph will show a lack of enamel opacity and a pathological
loss of enamel. The crowns of the teeth look just like the root as
far as density. On a normal radiograph the crowns are obviously
more white and radiopaque but on an xray with Amelogenesis im-
Amelogenesis imperfecta perfecta the crowns look just like extensions of the root and there
is an obvious pulp chamber. In a clinical photo- "snow capped"
enamel meaning the incisal edges are a lot whiter than the rest of
the tooth. The teeth are typically more yellow or brownish in color.
Pitting of the enamel is also seen.
Radiographically-bulbous crowns with short and slender roots
and absent pulp chambers and root canal. In a clinical photo-the
teeth may be gray to yellowish brown. They exhibit translucent
Dentinogenesis imperfecta
or opalescent hue. Enamel is usually lost early due to loss of
scalloping at the DEJ. However, the teeth are not more susceptible
to dental caries than normal ones.
-Chipped tooth
If a patient has a tongue piercing, all of the following can happen
-Trigeminal neuralgia
due to the piercing?
-Infective Endocarditis
Toxins from biofilm. Gingivitis is plaque induced and while it does
have some inorganic and organic solids that only composes a
If a patient has gingivitis, the reason for the edema is due to:
small percentage of plaque. Acids from plaque are what causes
caries, not gingivitis.
80% water. Of the 20% remaining- 70-80% of that is bacteria and
Plaque
the other 20% of that is inorganic and organic components.
Phosphorous, Calcium, Magnesium, and Fluoride. Elements IN
Inorganic components
periodic table and are INorganic.
Organic components Lipids, Proteins, and Carbohydrates.
Lipids are derived from: Endotoxins from gram - bacteria.
Proteins are derived from: Saliva into supragingival plaque.
At least 15 seconds. (sometimes 15-20 seconds, so if you don't
Washing hands between patients should be done for how long?
see 15 as a choice, choose 20)
Caused by Candida albicans. Also, by nutritional deficiencies-ri-
boflavin (B2) and iron deficiency anemia, which can be evidence
of poor diets or malnutrition. Zinc deficiency has also been asso-
Angular Cheilitis
ciated with it. Also, it could be a sign of anorexia or bulimia due
to malnutrition and as a side effect of constant vomiting. It affects
corners of lips.
Crepitus When the TMJ pops, clicks, or grinds.
Conditions that CANNOT be wiped away Leukoplakia, Snuff Keratosis, and aspirin burn.
Conditions that CAN be wiped away Pseudomembranous candidiasis
Benign or pre-malignant changes on the lip due to chronic sun
exposure. It is also often called actinic cheilitis, and sometimes,
Solar cheilitis
actinic cheilitis with histological atypia. It affects the vermillion
portion of lip.
Junction of the face and lateral surface. The entire lateral side
What side of the instrument is placed on the stone for sharpening? should be sharpened. Angle between the instrument face and the
stone should be 110 degrees.
The best way to sharpen an instrument to preserve the blade? Water with stone.
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If the patient is in a panoramic machine, can they have a thyroid
They should NOT be wearing a thyroid collar.
collar?
If a patient is not allergic to penicillin and has infectious endo-
Amoxicillin 2 grams.
carditis, what pre-medication should be used?
Carry instruments in a safe container to transport, wear gloves,
use ultrasonic machine.
After you dismiss your patient and are transferring and processing
instruments all would apply:
A mask and safety goggles are not needed for transporting your
instruments to the lab, nor processing them in the lab.
If you see a photograph with inflammation around a porcelain
A poorly fitted restoration.
crown, then the inflammation is most likely due?
An inflammed area on the buccal mucosa directly across from the
Papilla of stensons duct.
maxillary molars. What is inflammed?
Lingual of tooth #19. Why does it have a 6mm pocket? Rough restoration is the best answer.
Can be used on dental implants provided they have a plastic tip
added to the inserts. These single use tips must be used on LOW
Ultrasonic scalers power and is effective in removing plaque and calculus around
titanium implants and abutments. It is not indicated for heavy
calculus.
A circumscribed nodule that lies lingual to the mandibular cuspid
Retrocuspid papilla on the gingival tissue. It is observed more frequently in young
children and seems to regress or disappear with age.
A condition found in the molar teeth of humans whereby the body
of the tooth and pulp chamber is enlarged vertically at the expense
of the roots. The underlying mechanism of taurodontism is the
Taurodontism
failure or late invagination of Hertwig's epithelial root sheath, which
is responsible for root formation and shaping causing an apical
shift of the root furcation.
When is the pH level at its highest in regards to eating meals? Highest right after a meal.
Edentulous patient with big ulcer on palate Apthous ulcer or due to irritation.
Can be done with any film, but mostly seen in the lower anteriors.
Superimposition on a radiograph
Same thing as double exposure.
Results when the receptor is exposed twice and two images
Double exposure
appear superimposed onto each other.
How often do you need to have your patient sign HIPPA form? Just once. But hippa website says sign once every 3 years.
Best answer bacteremia.
What is not caused by a tongue piercing?
Fractured tooth, trigeminal neuralgia, and recession caused by
piercing.
What would you not use for heavy deposits? Graceys-they are considered for fine scaling.
Magnetostrictive Eliptical pattern meaning all sides are active.
Piezo Linear and only lateral sides are active.
How many hours for cold sterilization? 10 hours. But usually given 8 as a choice.
If a patient comes into an office due to gum inflammation issues, First step is always have dentist to a complete evaluation before
what is the right course of action? performating any treatment.
Hypoglycemia Fast pulse, dizziness, and fast heart rate.
Where would you use a gracey instrument with a short shank? Shallow pockets.
Most important component of decay Acid.
(No sugar) can cause more decay than regular soda because of
Diet soda
the acid content.
Contraindication to sealant? Interproximal caries.

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Connective tissue, helps cuts and wounds heal, aids in iron ab-
Vitamin C deals with
sorption, and collagen formation.
Pernicious Anemia Vitamin B12.
Best proof of destruction of tissues Attachment loss.
Columbia blade to terminal shank 90 degrees.
Sensitive toothpastes work by either occluding the exposed denti-
How does desensitizing agent work? nal tubules or by desensitizing the nerve endings in the dentinal
tubules with potassium ions.
Large pulp and pink appearance Internal resorption.
How does sensitivity of teeth reduce over time? Hardening/sclerosis.
Most common side effect of Heparin Hemorrhage.

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