Contacts Phone/E-MailNamePh: e-mail:NamePh: e-mail:NamePh: e-mail:NamePh: e-mail:NamePh: e-mail:NamePh: e-mail:NamePh: e-mail:NamePh: e-mail:NamePh: e-mail:NamePh: e-mail:NamePh: e-mail:NamePh: e-mail:2541_IFC.qxd11/10/103:37 PMPage iNotesNotesDHDHRenee G. Prajer, RDH, MSGwen Grosso, RDH, MSPurchase additional copies of this book atyour health science bookstore or directlyfrom F. A. Davis by shopping online atwww.fadavis.com or by calling 800-323-3555 (US) or 800-665-1148 (CAN)F. A. Daviss Notes BookDental Hygienists Chairside Pocket Guide2541_FM_i-vi.qxd11/9/106:28 PMPage iF. A. Davis Company1915 Arch StreetPhiladelphia, PA 19103www.fadavis.comCopyright 2011 by F. A. Davis CompanyCopyright 2011 by F. A. Davis Company. All rights reserved. This product isprotected by copyright. No part of it may be reproduced, stored in a retrievalsystem,ortransmittedinanyformorbyanymeans,electronic,mechanical,photocopying,recording,orotherwise,withoutwrittenpermissionfromthepublisher.Printed in ChinaLast digit indicates print number: 10 9 8 7 6 5 4 3 2 1Acquisitions Editor: Quincy McDonaldDevelopmental Editor: David PayneManager of Content Development: George W. LangArt and Design Manager: Carolyn OBrienContributors: Tab 5L. Teal Mercer, RDH, MPH; Tab 6Sandra DAmato-Palumbo, RDH, MPS; Tab 7Mark G. Kacerik, RDH, MSReviewers: SusanAlexander,RDH,MEd;LisaBilich,RDH,MS;PatriciaD.Bouman, RDH, BS, MA; Suzanne M. Edeneld, EdD, RDH; Tracy M. Gift, RDH, MS;WandaC.Hayes,CDA,RDH,BSDH;HaroldA.Henson,RDH,MEd;FrancesMcConaugh, RDH, MS; Rosalyn Word, RDH, MPA.Asnewscientificinformationbecomesavailablethroughbasicandclinicalresearch, recommended treatments and drug therapies undergo changes. Theauthor(s) and publisher have done everything possible to make this book accu-rate, up to date, and in accord with accepted standards at the time of publication.The author(s), editors, and publisher are not responsible for errors or omissionsorforconsequencesfromapplicationofthebook,andmakenowarranty,expressedorimplied,inregardtothecontentsofthebook.Anypracticedescribedinthisbookshouldbeappliedbythereaderinaccordancewith professionalstandardsofcareusedinregardtotheuniquecircumstances that may apply in each situation. The reader is advised always to check productinformation(packageinserts)forchangesandnewinformationregardingdoseand contraindications before administering any drug. Caution is especially urgedwhen using new or infrequently ordered drugs.2541_FM_i-vi.qxd11/9/106:28 PMPage iiPlace 278 x 278 Sticky Notes here for a convenient and rellable note pad HIPAA Compliant OSHA CompliantWaterproof and ReusableWipe-Free PagesWrite directly onto any page of DH Notes with a ballpoint pen. Wipe old entries off with an alcohol pad and reuse.BASICS ASSESSMED COMPPATIENTSMEDS PAIN ORAL DIS INSTRUM RESOURCE2541_FM_i-vi.qxd11/9/106:28 PMPage iiiBasicsFundamental Principles of Dental Hygiene, Dental Hygiene Ethics,TheDentalHygieneProcessofCare,EvidenceBasedDecisionMaking,CulturalCompetence,AntibioticProphylaxis,AmericanHeartAssociationAntibioticProphylacticRegimen(2007),BasicLife Support for the Health-care Provider, Occupational Exposureto Blood-Borne Pathogens, Infection Control, Dental EmergenciesPatient AssessmentVitalSigns,Patient/RiskAssessment,Extra-oralExamination,Intra-oral Examination, Documenting Lesions, Dentition, Occlusion,Malocclusion,G.V.BlacksClassicationofCaries,Periodontium,Classication of Periodontal Disease, Radiographic SurveyMedically Compromised Patients Angina Pectoris, Anxiety Disorders, Asthma, Bleeding Disorders,Cancer,CardiacArrhythmias,CardiacPacemaker/ICD,ChronicObstructive Pulmonary Disease (COPD), Congenital Heart Disease,Congestive Heart Disease, Diabetes Mellitus, Hepatitis, HIV/AIDS,Hypertension, Myocardial Infarction, Organ Transplant, Pregnancy,Prosthetic Replacements: Joint, Plates, Screws, Pins; Renal Failure,Seizure Disorder, Substance-Related Disorders, TuberculosisPatient Meds EmergencyDrugs,ClassicationofDrugsandTheirEndings,Commonly Prescribed Drugs by ClassicationPain Management ManagingDentinHypersensitivity,TopicalAnesthesia,LocalAnesthetic Agents, Administration of Local Anesthesia, Comp-lication Associated with the Delivery of Local AnesthesiaOral Diseases RedandPurpleLesions,PigmentedLesions,RaisedPapillaryLesions, Enlargements of Soft Tissue, Ulcerative Lesions, VesicleLesions, White LesionsBASICS ASSESSMED COMPPATIENTSMEDS PAIN ORAL DIS INSTRUM RESOURCE2541_FM_i-vi.qxd11/9/106:28 PMPage ivInstrumentation InstrumentDesignCharacteristics,PeriodontalInstrumentation,Instrument Sharpening, Power-Driven Scaling DevicesResources Glossary,CommonDentalTerminology,SpanishTerminology,Web Resources, Bibliography2541_FM_i-vi.qxd11/9/106:28 PMPage v2541_FM_i-vi.qxd11/9/106:28 PMPage vi1BASICSFundamental Principles of Dental HygieneThe foundation for dental hygiene ethics originates from our fun-damental principles. The American Dental Hygienists AssociationCodeofEthicsforDentalHygienistsdenesthefundamentalprinciples of our profession as follows.Universality Theprincipleofuniversalityassumesthatifoneindividualjudges an action to be right or wrong in a given situation, otherpeople considering the same action in the same situation wouldmake the same judgment.ComplementarityTheprincipleofcomplementarityassumestheexistenceofanobligation to justice and basic human rights. It requires us to acttoward others in the same way they would act toward us if roleswerereversed.Inallrelationships,itmeansconsideringthe valuesandperspectivesofothersbeforemakingdecisionsortaking actions affecting them.EthicsEthicsarethegeneralstandardsofrightandwrongthatguidebehavior within society. As generally accepted actions, they canbejudgedbydeterminingtheextenttowhichtheypromotegood and minimize harm. Ethics compel us to engage in healthpromotion/disease prevention activities.CommunityThisprincipleexpressesourconcernforthebondbetweenindividuals, the community, and society in general. It leads usto preserve natural resources and inspires us to show concernfor the global environment.2541_Tab1_001-013.qxd11/2/109:43 AMPage 12ResponsibilityResponsibility is central to our ethics. We recognize that there areguidelinesformakingethicalchoicesandacceptresponsibilityfor knowing and applying them. We accept the consequences ofouractionsorthefailuretoactandarewillingtomakeethicalchoices and publicly afrm them. Dental Hygiene EthicsEthicswithintheprofessionofdentalhygieneisrelativetoconformingtowhatisprofessionallyrightorwrong.Dentalhygienists are responsible for upholding the code of ethics setforth by the professional membership of which they are affili-ated. The core values of the profession of dental hygiene are asfollows: Autonomy. Guarantee self-determination. Condentiality. Hold in condence privileged information entrusted bythe patient. Societal trust. Ensure the trust that patients and society have in dentalhygienists. Benecence. Doing good/benet the patient. Nonmalecence. Do no harm to the patient. Justice/fairness. Fairness and equality. Veracity. Truthfulness and honesty.BASICS2541_Tab1_001-013.qxd11/2/109:43 AMPage 23BASICSThe Dental Hygiene Process of CareThedentalhygieneprocessofcareprovidestheframeworkofclinical dental hygiene practice and is a continuous cycle.I. Assess.Collection of both subjective and objective patient data.II. Dental Hygiene Diagnosis.Based on the overall assessment of the patient, the dental hygienist will identify the patients oral health concerns. III. Plan.Treatment plan appropriate to meet the patients needs.IV. Implement.Dental hygiene services are rendered.V. Evaluate.Outcomes are evaluated, the patients needs are reassessed, and the process of care begins again.Evidence-Based Decision MakingTo stay current in the profession of dental hygiene and provideoptimum care for patients, clinicians may employ the process ofevidence-based decision making. Create a four-part PICO clinical question based on the need/problem. Patient problem or population (the problem). Intervention (the plan for the patient). Comparison (an alternative option). Outcome (the results you plan to accomplish). Complete a search to compile evidence regarding theneed/problem. Clinical applicability, appraise the evidence for its usefulness.2541_Tab1_001-013.qxd11/2/109:43 AMPage 34 Evaluate reliability of evidence. Incorporate ndings into clinical practice. Evaluate the outcome.Evidence-baseddecisionmakingoffersoralhealth-careproviders a means for supporting clinical decisions.Cultural CompetenceAs oral health-care providers, it is necessary to value the impor-tanceofcultureinthedeliveryofcare.Oralandoverallhealthare inuenced by ones culture and values. When treating patientsof diverse backgrounds, the provider should take the followinginto consideration: Nonverbal communication. Direct eye contact or physical contact may be considered disrespectful to certain cultures. Verbal communication should be nonjudgmental to establishtrust. Diseases/conditions that are inuenced by the patients ethnicbackground. Cultural behaviors that have an impact on oral and overallhealth. Identifying the decision maker when discussing treatmentoptions. Cultural inuences on proposed treatment plans. Beliefs/customs regarding pain management. Willingness to learn about the patients culture and beliefs.Antibiotic ProphylaxisPatientswithcardiacconcernsandpatientswithtotaljointreplacements are at greater risk of developing infections; there-fore, they may require antibiotic prophylaxis. The American HeartAssociation(AHA)andtheAmericanAcademyofOrthopaedicSurgeons (AAOS) have set guidelines for antibiotic prophylaxis. BASICS2541_Tab1_001-013.qxd11/2/109:43 AMPage 45BASICSAAOS Recommendations for AntibioticProphylaxis (2009)Antibioticprophylaxisisrecommendedforallpatientswhohave undergone total joint replacement.AHA Recommendations for Antibiotic Prophylaxis The American Heart Association recommends antibiotic prophy-laxisduringdentalproceduresforpatientswiththefollowingcardiac conditions: Prosthetic cardiac valve. Previous endocarditis. Congenital heart disease only in the following categories: Unrepaired cyanotic congenital heart disease, includingthose with palliative shunts and conduits. Completely repaired congenital heart disease with pros-thetic material or device, whether placed by surgery orcatheter intervention, during the rst 6 months after theprocedure. Repaired congenital heart disease with residual defects atthe site or adjacent to the site of a prosthetic patch orprosthetic device. Cardiac transplantation recipients with cardiac valvular disease. ! For patients who present with a cardiac condition previouslynoted,theAHARECOMMENDS antibioticprophylaxisforthefollowing dental procedures:All dental procedures that involve manipulation of gingival tis-sueortheperiapicalregionofteeth,orperforationoftheoralmucosa. ! For patients who present with a cardiac condition previouslynoted,theAHADOESNOT recommendantibioticprophylaxisfor the following dental procedures:Routineanestheticinjectionsthroughnoninfectedtissue;exposing dental radiographs; placement of removable, prostho-dontic,ororthodonticappliances;adjustmentoforthodontic2541_Tab1_001-013.qxd11/2/109:43 AMPage 56appliances;placementoforthodonticbrackets;sheddingofdeciduousteeth;andbleedingfromtraumatothelipsororalmucosa. Patientswhoarenotpremedicatedmayreceiveantibioticcoverage within a 2-hour period if unexpected bleeding occursand/orifduringtreatmentthepatientdisclosesadditionalmedicalhistoryinformationthatwouldindicatetheneedforpremedication.AHA Antibiotic Prophylactic Regimen (2007)Standard Oral ProphylaxisAmoxicillinAdult dosage: 2.0 g orally 3060 minutes before procedure.Child dosage: 50 mg/kg orally 3060 minutes before procedure.If Patient Is Unable to Take Oral MedicationsAmpicillin Adult dosage: 2.0 g IM*or IV*. Child dosage: 50 mg/kg IM or IV 3060 minutes before procedure.ORCefazolin or CeftriaxoneAdult dosage: 1.0 g IM or IV.Child dosage: 50 mg/kg IM or IV 30-60 minutes before procedure.If Patient Is Allergic to Penicillin or AmpicillinCephalexin**+Adult dosage: 2.0 g orally 3060 minutes before procedure.Child dosage: 50 mg/kg orally 3060 minutes before procedure.BASICS2541_Tab1_001-013.qxd11/2/109:43 AMPage 67BASICSORClindamycinAdult dosage: 600 mg orally 3060 minutes before procedure.Child dosage: 20 mg/kg orally 3060 minutes before procedure.ORAzithromycin or ClarithromycinAdult dosage: 500 mg orally 3060 minutes before procedure.Child dosage: 15 mg/kg orally 3060 minutes before procedure.If Patient Is Allergic to Penicillin and Unable toTake Oral MedicationsCefazolin or ceftriaxone+Adult dosage: 1.0 g IM or IV 3060 minutes before procedure.Child dosage: 50 mg/kg IM or IV 3060 minutes before procedure.ORClindamycinAdult dosage: 600 mg IM or IV 3060 minutes before procedure.Child dosage: 25 mg/kg IM or IV 3060 minutes before procedure.*IM, intramuscular; IV, intravenous.**Orotherrstorsecondgenerationoralcephalosporinsinequivalentadult or pediatric dosage.+Cephalosporins should not be used in an individual with a history of ana-phylaxis, angioedema, or urticaria with penicillin or ampicillin.2541_Tab1_001-013.qxd11/2/109:43 AMPage 78Basic Life Support for the Health-careProviderCheck ResponsivenessCall 911: Activate the emergency medical system and obtain anautomated external debrillator (AED).Airway Open airway using the head-tilt, chin-lift, or jaw thrust intrauma victims.Breathing Assess breathing for 5 to 10 seconds by looking for the chestto rise and fall and listening and feeling for air from the noseand mouth. If the victim is not breathing, give two breaths (1 second each). If the breath does not go in, reopen the airway and attemptto ventilate. (If the breath still does not go in, assume airwayobstruction.)Circulation Assess pulse for 10 seconds. Adult and child: carotid. Infant: brachial. If a pulse is present, but no breathing, provide rescue breaths. Adult: 1 breath every 56 seconds (1012 breaths per minute). Child and infant: 1 breath every 35 seconds(1220 breaths per minute). If no pulse, begin chest compressions/cardiopulmonaryresuscitation (CPR).Adult CPR 30:2 30 compressions, 2 breaths. 11/2 to 2 inches for depth of compressions. 100 compressions per minute.BASICS2541_Tab1_001-013.qxd11/2/109:43 AMPage 89BASICS Allow full chest recoil between compressions. Reassess after ve cycles or approximately 2 minutes.Child/infant CPR 30:2 one rescuer; 15:2 two rescuers 30 compressions, 2 breaths one rescuer. 15 compressions, 2 breaths two rescuers. 1/3 to 1/2 the depth of the chest. 100 compressions per minute. Allow full chest recoil between compressions. Reassess after ve cycles or approximately 2 minutes.Automated External Debrillator (AED)Earlydebrillationisessentialandincreasesthechanceofsur-vival when someone is in cardiac arrest. AED should be turned on and the health-care provider willfollow the prompts of the AED unit. Adhesive pads are placed as instructed. All rescuers should clear the patient. Press the analyze button, allowing the AED to determine if ashock is indicated. Continue with CPR as prompted by the AED until theEmergency Medical Response team arrives.AED Precautions AED may not be indicated or effective for patients less than 1 year of age. Proper pad size must be used. Patient must be dry. AED pads must not be placed over an implanted pacemakeror a transdermal medicated patch. Patients chest may need to be shaved for proper adhesion ofelectrode pads.Obstructed AirwayEarly recognition of an airway obstruction is essential for a suc-cessful outcome. An individual with a severe airway obstructionmayexperiencethefollowingsignsandsymptoms:inabilityto2541_Tab1_001-013.qxd11/2/109:43 AMPage 910BASICSspeak,poorornoairexchange,increasedrespiratorydifculty,cyanosis.Torelievechokinginadultsandchildren,abdominalthrustsare employed using quick upward thrusts. Wrap your arms around the victims waist. Place the thumb of your st in the center of the victimsabdomen above the navel, yet below the breastbone. Using an upward motion, provide quick abdominal thrustsuntil the object is expelled from the airway or the victim goesunconscious. If the victim goes unconscious, begin the steps of CPR.Oxygen AdministrationNasal Cannula Indicated for low-ow supplemental oxygen. 26 liters per minute/25%40% oxygen delivery.Face Mask Indicator for moderate levels of oxygen. 812 liters per minute/60% oxygen delivery.Nonrebreather Mask Indicated for high levels of oxygen. 1015 liters per minute/up to 100% oxygen delivery.Bag Mask Indicated for manual ventilation when patient is notbreathing/CPR. 1015 liters per minute/90%100% oxygen delivery.Occupational Exposure to Blood-Borne Pathogens Inthedentalsetting,anexposuretoblood-bornepathogensmay occur. A percutaneous (needle stick or laceration) or permu-cosal(splatterintotheeyeormucosa)exposuretobloodorbodily uids that are potentially infectious are considered to besignicant and should follow postexposure protocol. 2541_Tab1_001-013.qxd11/2/109:43 AMPage 1011BASICSPostexposure Protocol Express blood if possible. Wash affected area thoroughly with antimicrobial soap, rinsewell. Exposures to eye or mucosa should be irrigated thoroughlywith water or saline. Report the incident to the designated supervisor. Follow up with postexposure prophylaxis within 2 hours ofexposure. With supervisor assistance, complete an incident report. Follow workplace postexposure protocols and procedures. Report any illness or symptoms that occur after the incident.Infection ControlStandardprecautionsappliedinclinicalpracticefollowthetheory that all patients receiving treatment are considered to beinfectious. Sterilization MethodsChemical VaporTime: 20 minutes.Temperature: 270F/132C.Pressure: 2040 psi.Dry HeatTime: 120 minutes; temperature: 320F/160C. ORTime: 60 minutes; temperature: 340F/170C. Moist Heat (Steam Under Pressure)Time: 1530 minutes.Temperature: 250F/121C.Pressure: 15 psi.2541_Tab1_001-013.qxd11/2/109:43 AMPage 11Dental EmergenciesEmergency Symptoms TreatmentAbscessAvulsionFractureLoose tooth due to trauma12Monitoring SterilizationIndicatortapeormarkingsonsterilizationpouchesareindica-tive that instruments have been run through a sterilization cycle.However,theyDONOTindicatethatsterilizationhasbeenachieved. To ensure that sterilization has occurred, biologic mon-itoring should be performed on a regular basis.Biologic MonitoringVials, ampules, or strips are packaged and run through a steriliza-tion cycle. After the cycle is complete, the vial or ampule is placedin an incubator. The ampule or vial will change color during incu-bationindicatingthatsterilizationhasbeenachieved. Thestriporganismsareculturedandindicatesterilizationifnogrowthoccurs.Properdocumentationofsporetestingfrequencyandresults should be recorded and maintained in the dental facility.BASICSPain, swelling, pusdrainage Tooth completelyknocked out of sulcusPain, temperaturesensitivity, painupon percussionMobilityAntibiotics, drainingof infection, rootcanal treatment, orextractionReimplantation andsplinting, do notwash tooth beforereimplantingRestoration, rootcanal treatment/crown, possibleneed for extractionSplinting if tooth issalvageable, possi-ble need for rootcanal treatment/crown, or extractionContinued2541_Tab1_001-013.qxd11/2/109:43 AMPage 12Dental EmergenciescontdEmergency Symptoms TreatmentPericoronitisPulpitis, reversiblePulpitis, irreversibleSinusitis13BASICSSwelling, soft tissue pain, badtaste from the areaPain associatedwith hot, cold, and/or sweet stimuli,spontaneous resolution Spontaneous or lin-gering pain that isdifcult to isolateSensitivity involvingseveral maxillaryposterior teethupon percussion orpostural change,pain is most prominent in themorning and subsides throughout the dayDebridement ofarea, irrigation, possible need forantibiotics, andremoval of tissueapRestorationRoot canal treat-ment/crown or possible extractionSaline nasal irrigation, decongestants, antihistamines, possible need forantibiotics2541_Tab1_001-013.qxd11/2/109:43 AMPage 13Normal Pulse Rate RangesAge Pulse Rate (bpm)Adult (18+ years) 60100Adolescent (1117 years) 60100Children (110 years) 60140Less than 1 year of age 100160Vital SignsPulse, respiration, and blood pressure (BP) are vital signs that arerecorded before dental treatment. The purpose of obtaining vitalsigns in the assessment phase of treatment is to determine base-linereadings,preventemergenciesfromoccurring,andmakeappropriate referrals when deemed necessary. PulseTheoralhealth-careprovidermaychoosetotakethepatientspulse at the following arteries: radial, carotid, or temporal.Pulse rate should be palpated for 1 minute and recorded. Dentalproviders should assess for rate, rhythm, and strength.14ASSESSbpm, beats per minute.Tachycardia: Pulse rate greater than 100 for adults.Bradycardia: Pulse rate less than 60 for adults.2541_Tab2_014-041.qxd11/2/1011:08 AMPage 14Factors Affecting Pulse RateIncreasedDecreased Weak PulsePulse Rate Pulse Rate RateExercisePhysical tness Heart diseaseStimulants Depressants Blood clotStress Sleep AtherosclerosisAlcohol IllnessHeart disease HypothyroidismFeverHyperthyroidismNormal Respiration RangesRespirationsAge (breaths per minute)Adult (18+ years) 1220Adolescent (117 years) 1220Children (110 years) 1630Less than 1 year of age 306015ASSESSRespirationsRespirations should be taken by unannounced observation of thepatients chest rising and falling. One respiration is equivalent tothe inhalation and exhalation of one breath. Respirationsshouldbecountedfor1minuteandrecorded.Dental providers should assess for rate, rhythm, depth, and easeof breaths.2541_Tab2_014-041.qxd11/2/1011:08 AMPage 1516ASSESSPatientswhoexperienceanxietyinthedentalsettingmaypresentwithanincreasedrespiratoryratethatmayleadtohyperventilation or syncope.Hyperventilation Hyperventilation decreases a patients carbon dioxide levels as aresult of excessive intake of oxygen. Signs and symptoms of hyperventilation inlcude the following: Rapid, deep breaths. Dizziness. Lightheadedness. Nausea. Tingling in the ngers and toes.MANAGING HYPERVENTILATION Position patient upright. Reassure the patient. Instruct patient on diaphragmatic breathing. Monitor vital signs. DO NOT administer oxygen. If symptoms persist summon medical assistance. Syncope Syncope is a common dental emergency that involves a sudden,temporary loss of consciousness. Syncope is a result of insuf-cient blood ow to the brain. Factors Affecting RespirationsIncreased Respirations Decreased RespirationsAnxiety Cardiopulmonary diseaseExercise MedicationPainShockMedication2541_Tab2_014-041.qxd11/2/1011:08 AMPage 1617ASSESSSigns and symptoms of syncope include the following: Weakness. Nausea. Pale coloring. Dilated pupils. Cold perspiration. Shallow breathing.MANAGING SYNCOPE Place patient in the Trendelenburg position (toes above thenose). Open airway. Wave ammonia inhalant under patients nose. Monitor vital signs. Administer oxygen. Reassure the patient.Blood PressureBloodpressureistheforceofcirculatingbloodonthewallsofthebloodvessels.Systolicanddiastolicreadingsshouldbeobtained and recorded. The systolic reading reects the pressureduringventricularcontraction. Thediastolicreadingrepresentsthe pressure during ventricular relaxation. !BloodpressureMUSTNOTbetakenonanarmwithanimplanted shunt/catheter or on the same side as a mastectomy.Blood Pressure ClassicationsAdult BP Classication Systolic DiastolicNormal