DAY 1

REVIEW
 INTRODUCTION TO DENTISTRY
C O M M O N M E D I C A L C O N D I T I O N S T H AT S H O U L D B E I D E N T I F I E D B Y T H E
ME DI CA L HI STO RY

1. R H E U M AT I C H E A R T D I S E A S E — R E S U LT S F R O M R H E U M AT I C F E V E R
A N D C A U S E S R I G I D I T Y O R D E F O R M I T Y O F T H E H E A R T VA LV E S .

• Patient reports: History of rheumatic fever or heart murmur.

• Significance: Patient may be susceptible to subacute bacterial endocarditis.
• Precautions: Antibiotic premedication may be necessary; be sure patient has
taken antibiotic as prescribed before dental treatment; avoid unnecessary
trauma to tissues during instrumentation.
2 . C O N G E N I TA L H E A RT D E F E C T - R E F E R S T O S T R U C T U R A L D E F E C T S
O F T H E H E A RT T H AT A R E P R E S E N T AT B I RT H . ( E X : A H O L E I N T H E
C O M M O N WA L L B E T W E E N H E A RT C H A M B E R S )

• Patient reports: “History of heart murmur in heart,” or other heart

abnormality, corrective heart surgery, or valve replacement.
• Significance: Patient may be susceptible to subacute bacterial endocarditis.
• Precautions: Antibiotic premedication may be necessary. Physician consult
should be conducted.
3 . S U R G I C A L VA LV E R E P L A C E M E N T - A D I S E A S E D H E A RT VA LV E
D U E T O R H E U M AT I C H E A RT D I S E A S E O R C O N G E N I TA L H E A RT
D E F E C T I S R E P L A C E D W I T H A N A RT I F I C I A L P R O S T H E S I S .

Patient reports: History of heart surgery; may be taking anticoagulant.

Significance: Patient may be susceptible to subacute bacterial endocarditic.
Precautions: Antibiotic premedication may be necessary; patient may be
taking anticoagulant; consult physician; test for bleeding may be necessary
before treatment, or patient may be advised to stop medication for few days
before appointment.
3 . S U R G I C A L VA LV E R E P L A C E M E N T - A D I S E A S E D H E A RT VA LV E
D U E T O R H E U M AT I C H E A RT D I S E A S E O R C O N G E N I TA L H E A RT
D E F E C T I S R E P L A C E D W I T H A N A RT I F I C I A L P R O S T H E S E S

• Patient reports: History of heart surgery; may be taking anticoagulant.

• Significance: Patient may be susceptible to subacute bacterial endocarditic.
• Precautions: Antibiotic premedication may be necessary; patient may be
taking anticoagulant; consult physician; test for bleeding may be necessary
before treatment, or patient may be advised to stop medication for few days
before appointment.
 4 . C O R O N A R Y A RT E RY D I S E A S E - C O R O N A RY C I R C U L AT I O N I S
I N A D E Q U AT E F O R M E TA B O L I C D E M A N D S O F T H E H E A RT; T H I S D I S E A S E
I S S E C O N D A R Y T O H A R D E N I N G O F A RT E R I E S ( A RT E R I O S C L E R O S I S )
WHICH CAUSES BLOCKAGE OF NARROWING OF VESSELS.

• Patient reports: Episodes of substernal pain (angina pectoris), typically

radiating to left arm and jaw. Pain is precipitated by activity and anxiety and is
relieved by rest and certain medications. Patient may be taking vasodilators,
nitroglycerin, or propranolol.
• Significance: Patient may have angina attack in dental office.
• Precautions: Have patient’s vasodilator medication accessible; use local
anesthetic without vasoconstrictor; keep appointments to reasonable length,
avoiding unnecessary stress and anxiety
5 . C O R O N A RY T H R O M B O S I S ( M Y O C A R D I A L I N FA R C T I O N ) - T H E
B L O O D S U P P LY T H R O U G H T H E C O R O N A RY A RT E R I E S I S
I N S U F F I C I E N T T O M E E T T H E M E TA B O L I C D E M A N D S O F T H E
H E A RT; T H I S D I F F E R S F R O M A N G I N A P E C T O R I S I N T H AT D A M A G E
I S I R R E V E R S I B L E ( A P O RT I O N O F T H E H E A RT M U S C L E D I E S ) .

• Patient reports: History of angina pectoris, previous heart attack, taking

vasodilators.
• Significance: Patient may have angina attack or myocardial infarction.
• Precautions: Do not treat patient if heart attack occurred within 6 months;
have vasodilator medication ready; avoid vasoconstrictors in local anesthetic;
keep appointments short; be prepared to resuscitate patient; should cardiac
arrest occur, call emergency rescue team.
6 . C O N G E S T I V E H E A RT FA I L U R E - B L O O D B A C K S U P B E H I N D
A FA I L I N G C H A M B E R , C A U S I N G C O N G E S T I O N O F
C I R C U L AT I O N A N D P O O L I N G O F B L O O D I N O R G A N S .

• Patient reports: Shortness of breath, swollen ankles, sleeping on two or

more pillows; may be taking diuretics and/or digitalis.
• Significance: Patient may have difficulty in breathing when supine in dental
chair.
• Precautions: Keep patient in semi upright position; keep appointments short;
possible need for supplemental oxygen.
 7 . C A R D I A C A R R H Y T H M I A S — D I S T U R B A N C E O F T H E H E A RT ’ S
E L E C T R I C A L C O N D U C T I O N S Y S T E M . T H E H E A RT B E AT S AT
T O O R A P I D O R T O O S L O W A PA C E O R AT A N I R R E G U L A R PA C E
( E I T H E R C O N T I N U O U S LY O R W I T H O C C A S I O N A L O D D B E AT S ) .

• Patient reports: Fast or irregular heartbeat, palpitations (awareness of rapid

heart beats), recurrent fainting, surgical implant of pacemaker; may be taking
digitalis or other antiarrhythmic medication.
• Significance: Patient may faint; a pacemaker device may be affected by
electromagnetic interference. (Dental office equipment such as ultrasonic
scaling devices, pulp testers, electrode sensitizing equipment, electrosurgical
instruments, and motorized dental chairs may adversely affect some devices.)
• Precautions: Avoid use of ultrasonic equipment or proximity to such
equipment being used on other patients. Physician consult may be considered
 • Extraoral Features
• Face, neck, tissue changes, skin abrasions, lips
• Cervical lymph nodes
• Temporomandibular joint
• Oral habits

ORAL EXAM • Intraoral Features

• Interior of the lips
• Oral mucosa
• Tongue
• Floor of the mouth
EXTRAORAL EVALUATION
S P E CI F I C P E R I O D O N TA L F I N D I N G S TO BE R EC O R D E D :

• Overall health condition of gingiva

• Signs and location of inflammation
• Location and amount of plaque and calculus
• Areas of unattached gingiva
• Areas of periodontal pockets measuring greater than 3 mm
• Presence of furcation involvement
• Dental mobility scale
INTRAORAL
EVALUATION
INTRAORAL
EVALUATION
Permanent
Dentition

TOOTH
Deciduous NUMBERING
Dentition SYSTEMS AND
LETTERS
ORTHODONTIC
TOOTH NUMBERS
AND LETTERS
 Tooth Eruption Date Exfoliation Date
Maxillary

Central Incisor 6-10 months 6-7 years

Lateral Incisor 9-12 months 7-8 years

First Molar 12-18 months 9-11 years

DECIDUOUS Canine 16-22 months 10-12 years

TEETH Second Molar 24-32 months 10-12 years
ERUPTION
DATES Mandibular

Central Incisor 6-10 months 6-7 years

Lateral Incisor 7-10 months 7-8 years

First Molar 12-18 months 9-11 years

Canine 16-22 months 9-12 years

Second Molar 20-32 months 10-12 years

 Tooth Eruption Date
Maxillary

First Molar 6-7 years

Central Incisor 7-8 years

Lateral Incisor 8-9 years

First Premolar 10-11 years

Second Premolar 11-12 years

Canine 11-12 years

PERMANENT Second Molar 12-13 years
TEETH ERUPTION Third Molar 17-21years

DATES Mandibular

First Molar 6-7 years

Central Incisor 6-7 years

Lateral Incisor 7-8 years

First Premolar 9-10 years

Second Premolar 10-11 years

Canine 11-12 years

Second Molar 11-13 years

Third Molar 17-21years

DIVISION IN
QUADRANTS
TW O A R CH E S
ANTERIOR AND
POSTERIOR
TEETH
 S U R FA C E S O F T H E T E E T H
INCISAL RIDGE (OR EDGE) – THE
BITING EDGE OF ANTERIOR TEETH.

•INCISAL EDGES
 O C C L U S A L S U R FA C E S
O C C L U S A L – T H E C H E W I N G S U R FA C E O F P O S T E R I O R T E E T H .
 LINGUAL
LINGUAL – THE
S U R FA C E O F A T O O T H
FA C I N G T H E T O N G U E .
 The surface of a tooth
The surface of a tooth
Every tooth has a closest to the midline
away from the midline
mesial and distal of the mouth is referred
of the mouth is referred
surface to as the mesial
to as the distal surface.
surface.

“PROXIMAL” MEAN IN RELATIONSHIP

TO THE TERM MESIAL AND DISTAL
SURFACES
 Midline of
mouth

distal mesial
•Buccal B
•Distal D
•Facial F
•Incisal I
•Lingual L
•Mesial M
•Occlusal O
Occlusobuccal OB
Distincisal DI
Distolingual DL
Disto-occlusal DO
Occlusolingual OL
Mesioincisal MI
Mesio-occlusal MO
Mesio-occlusodistal MOD
Mesio-occlusodistobuccolingual MODBL
 TO O T H S T R U C T U R E

• Enamel (covers crown);

• Dentin (below enamel and located in crown and root
area)
• Pulp chamber (upper part of the root area which leads to
the root canals;  

• Cementum (covers root); and

• Cemento-enamel junction
G EO ME TR I C
CH A RTI N G
ANATOMICA
L
CHARTING
PERIODONTAL
CHARTING
CLASSIFICATION
OF CAVITY
CLASSIFICATIONS
 GV B LACK
C LASS IFI CATI ON OF
CAVITY P REPARATI ONS

Class I – pit & fissure; occlusal; buccal; lingual pit

 GV BLACK
CLASSIFICATIO
N OF
CAVITY
PREPARATIONS

Class II – proximal (mesial

or distal) of molars and
premolars MO; DO; MOD
 GV BL ACK
CL ASSIFI CATI ON OF
CAVI TY
PR EPARAT IONS

• Class III – proximal (medial or

distal) of central; lateral or
canine (ML; MF; MFL; DL;
DF; DFL)
 GV BLACK
CLASSIFICATIO • Class IV – proximal and
N OF incisal edge (MIFL or DIFL)
CAVITY
PREPARATIONS
 GV BLAC K • Class V – Gingival 1/3 of a tooth
CLASSIFIC ATION OF
CAVITY (F or Lingual)
PREPAR ATIONS
 GV BLAC K • Class VI – Cusps of molars;
CLASSIFIC ATION OF
CAVITY premolars; canines
PREPAR ATIONS
ABSCESS
 *IF THE DECAY
REACHES THE PULP
CHAMBER THE
PATIENT WILL NEED
A ROOT CANAL.
 * I F T H E D E C AY
C A N N O T B E R E S TO R E D
WITH A ROOT CANAL
T H E TO O T H M U S T B E
EXTRACTED.

AT T H I S T I M E
REPLACEMENT OF THE
TO O T H S H O U L D B E
DISCUSSED WITH THE
PAT I E N T, I E I M P L A N T.

 
 CHARTING

•  
Existing restoration – work completed at another practice (USE MODEL)
1. Direct: Amalgam – silver filling; Composite – tooth colored
2. Crown – porcelain (tooth colored); porcelain fused to metal gold; full metal
3. Inlay – permanent restoration (cemented in place) MO; DO; MOD
4. Onlay – permanent restoration (cemented in place) MODL; MODB (OVER A CUSP)
5. Veneer – Permanent restoration (bonded in place Facial of anterior teeth)
6. Root canal treatment – dental decay reached the pulp; pulpal tissues are removed (files); disinfect/dry
canal; gutta percha filling – Tooth will become brittle and require a crown
7. Bridge – replaces one or more teeth (pontic) prepared teeth are called (abutment)
8. Dental Implants – Anchors placed in bone (Titanium/Titanium allow) they support the dental
restoration which replace a missing tooth
9. Teeth that are not present
CROWN
AMALGAM RESTORATION
COMPOSITE RESTORATIO
ONLAY
VENEERS
VENEERS
IMPLANT
COMPOSITE
 INDIRECT – IE CROWN, INLAY OR
ONLAY

a. Prepare tooth
b. 2. Take final impression of tooth
c. 3. Opposing model impression
d. 4. Bite registration
e. 5. Shade
f. 6. send to lab
g. 7. Make a temporary covering tooth which stays on until tooth from lab
comes back 8. Remove temp and cement final crown
 CEREC

• 1. Prepare tooth
• 2. take optical images of tooth which converts to a 3D image
• 3. Ceramic block – choose shade and put in milling machine – ready to bond
when completed
 CEREC

• 1. Prepare tooth
• 2. take optical images of tooth which converts to a 3D image
• 3. Ceramic block – choose shade and put in milling machine – ready to bond
when completed
1. What burs are used in a high
speed handpiece? Friction grip
2. What burs are used in a slow
speed handpiece? Latch type
3. Which handpieces does water
flow out? High Speed/use suction
1. What is a spoon excavator? Instrument used to remove soft decay
2. When does a matrix used? Forms the part of the tooth that is missing
3. What is acid etch? Phosphoric acid
4. What is prime/bond? Helps to bond the restoration to the tooth
5. What is a composite? Tooth colored restoration