Unit 307 – Provide support for the control of periodontal disease and caries, and the restoration of cavities Assignment Answer

City & Guilds Level 3 Extended Diploma in Dental Nursing 

Unit 307 – Aim

Enable you to gain knowledge and skills required to prepare the clinical environment and assist with various periodontal and restorative procedures to provide appropriate patient care.

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307 - 1.1 - Explain the importance of removing supra-gingival and sub-gingival calculus by a clinician.

Answer: 

The hardened deposits that are formed on the teeth are known as supra-gingival and sub-gingival calculus as a result of mineralization of dental plaque. They are some of the major causes of oral health issues. The following are the reasons their removal by a clinician is essential:

• Gum Diseases Prevention: Gum diseases such as periodontitis and gingivitis can develop due to the accumulation of calculus. Such conditions may lead to inflammation, bleeding of the gums and loss of teeth in the long run unless it is treated.
  
  
• Prevention of Tooth Decay: Bacteria causing acids may be found in calculus causing tooth decay and cavities.
  
  
• Aesthetic Reasons: Supra-gingival calculus which is seen above the gum line may result in the discoloration and staining of the teeth and may influence the aesthetic look of the smile.
  
  
• Bad Breath Prevention: Calculus may be used to entrap food and bacteria to cause halitosis (bad breath).
  
  
• Caring of Overall Health: Studies have also associated stomach illnesses like heart disease and diabetes to poor oral health including the existence of calculus.

307– 1.2 - Describe the equipment, instruments and materials used for removing.

Answer:

A.  Hand Scalers

• Manual instruments are the hand scalers, which are utilized in the removal of the supra-gingival and sub-gingival calculus and the infected cementum.
• Push scaler is aimed at the elimination of heavy supra-gingival deposits. It is applied with a pushing movement against the operator on the tooth plane.
• Periodontal hoe is useful in the removal of large, complicated calculus deposits and especially in the interdental area. It has one cutting edge but it is not used with firm strokes.
• Jacquette (sickle) scaler is majorly applied in supra-gingival scaling. It has a tip which is sharp and two cutting edges which makes it appropriate in removing calculus above the gingival margin particularly in interproximal regions.
• Curette (universal or Gracey) is primarily utilized in the removal of sub-gingival calculus, as well as root planing. It possesses a rounded toe and back, which facilitates a safe penetration under the gingival margin and through which one is able to remove infected cementum with minimal damage to the surrounding tissues.

B.  Ultrasonic Scaler

An ultrasonic scaler is an electric device, which is used to break up and remove the deposits of calculus with the help of high-frequency vibrations and water irrigation. It can be used as a supra-gingival as well as sub-gingival scaling and can be used to flush periodontal pockets full of debris and bacteria.
     
C.  Prophylaxis Paste

Prophylaxis paste is an unpopular material that is applied on the teeth following scaling to polish the teeth. It aids in the elimination of left over plaque and surface stains and also polishes the enamel to impede plaque retention.
 
D.  Prophylaxis Applicator

Prophylaxis paste is evenly applied on the tooth surface through a prophylaxis applicator, which is a rubber polishing cup or a brush attached to a slow-speed handpiece.

307- 1.3 - Explain the term ‘plaque trap’ / ‘stagnation area’- please use examples.

Answer: 

A stagnation area or plaque trap is a place within the mouth that food, bacteria, and other debris are likely to congregate and cannot be easily displaced by the natural cleaning mechanisms of the mouth (i.e. saliva and tongue movement). They are those parts likely to develop dental plaque which is a sticky layer of bacteria capable of causing tooth decay and gum disease.
 
Examples of Plaque Traps

• Between Teeth: Interspersing spaces between your teeth are archetypal traps of the plaque. Flossing should be done regularly to extract plaque in these areas.
  
  
• Gum Line: This is another site where your teeth contact your gums and hence a plaque trap. The reasons behind this are that it is a hard part to access using a toothbrush.
  
  
• Dental Appliances: Braces, dentures, and other dental appliances may provide more traps of plaque or dentin in the mouth. Unusual cleaning methods might be needed to ensure that these places are clean.
  
  
• Rough or Irregular Tooth Surfaces: Rough or irregular part of a tooth may serve as the trap of the plaque. This comprises the pits and fissures of the chewing surfaces of the back teeth, and their decay or damages.
  
  
• Under the Edge of Fillings or Crowns: When a filling or a crown is not a good fit, then it may allow a small gap which plaque may infect.

307 - 2.1 - Describe Black’s Classification of Cavities.

Answer:

G.V. Black, a pioneer in dentistry, developed a classification system for carious lesions (cavities) based on their location on the tooth surface. This system is still widely used today. Here's a brief overview:

• Class I: Class I cavities occur in the pits and fissures of teeth. These areas include the chewing surfaces of the back teeth (molars and premolars), the front teeth's backside, and the molars' sides.
  
  
• Class II: Class II cavities are found on the sides of the molars and premolars. These are typically the areas that are susceptible to decay from food getting stuck between the teeth.
  
  
• Class III: Class III cavities occur on the sides of the front teeth (incisors and canines) that do not include the biting edges.
  
  
• Class IV: Class IV cavities are similar to Class III but also include the biting edges of the front teeth.
  
  
• Class V: Class V cavities are found on the gumline or neck of the tooth, either on the front or back side. This area does not include the biting surface.
  
  
• Class VI: Class VI cavities occur on the edges of the teeth that are used for biting or chewing, including the cusp tips of the back teeth and the incisal edges of the front teeth.

307 – 2.2 - Describe the equipment and instruments used in the preparation of cavities.

Answer:

A) Curing Light

Dental materials such as composites or sealants are hardened or set using a curing light. It has a certain wavelength of light that initiates the process of polymerization of these materials.

B) Handpiece

A handpiece is an instrument that is driven by power to either remove tooth structure or carve restorative materials. There are two types:

• High-speed handpiece: This is utilized in cutting the tooth structure in a rapid manner. It is very fast in its RPM and needs water cooling because of its heat.
• Slow-speed handpiece: This is used to perform a fine job, including caries removal and polishing restorations.

C) Types of Bur

A cutting instrument of a dental handpiece is known as a bur. There are several types:

• Friction grip/Latch grip: These are the terms used to refer to how the bur is gripped in the handpiece.
• Diamond/Steel: Diamond burs are covered with the diamond particles to enable it cut efficiently and the steel burs are composed of stainless steel.
• Cylinder /Tapered /Rose-head: These words signify the shape of the bur and this is determined according to the task at hand.

D) Hand Instruments

Hand instruments are applied in diverse purposes, examination, cleaning and restorative processes.

They include:

• Mirror: This is used when one sees indirectly and reflects light.
• Probes: This is used to detect periodontal pockets or cavities.
• Tweezers: these are used to deal with small items.
• Excavator: This is used in the removal of carious material.
• Flat plastic: It is used to shape and contour restorative materials.
• Wards carver: It is used to cut anatomy into restorative materials.
• Packer/Plugger/Condenser: This is used to compress the filling material in the cavity.
• Burnishers: These are tools utilized to smooth and polish restorations.
• Lining applicators: These are applied in the application of cavity liners.

E) Restorative Material Applicators.

They are employed to deliver and insert restorative materials to the cavity. Examples include:

• Amalgam carrier: This is to be used in transporting and dispensing of amalgam.
• Composite gun: This gun is applied to apply composite resin.
• Glass ionomer dispenser: This is utilized in dispensing the glass ionomer cement.

F) Finishing Items.
These are materials that are utilized to complete and polish restorations. They include:

• Stones: These are applied to mould and smooth restorations.
• Strips: Are utilized in contouring and polishing interproximal.
• Discs: These are applied in contouring and polishing the restorations.
• Articulating paper: This is used to check the occlusion of the restoration.

307 -2.3 - Describe the different types of matrix system and how they are used.

Answer:

Matrix Systems

Dentistry employs the use of matrix systems to offer a temporary wall to the tooth structure in the process of restorative procedures. They assist the anatomy of the tooth in the filling material (such as composite or amalgam) shaping. The various kinds of matrix systems are the following:

A. Tofflemire Matrix band and Holder.
Tofflemire matrix system is the most utilized system of matrices on the posterior teeth. It is made up of a retainer (holder) and a band. The band consists of thin flexible metal which can be shaped to suit the form of the tooth. The stabilizing position and the holder position are occupied by the person performing the procedure.

B. Siqveland Matrix Holder and Band.
Siqveland matrix system is a system specifically tailored in multi-surface restorations. It employs several narrow bands rather than a huge band. A universal retainer holds these bands. The system is especially handy in situations where two or more teeth that are placed side by side require restoration.

C. Wedges
Wedges are added to the use of matrix bands to get a tight seal at the gingival margin and also to pull the teeth apart by a slight margin resulting in a tighter contact once the filling is done. They are usually wooden or plastic and they are available in different sizes.

D.  Transparent Strips
Anterior composite restorations would be performed using transparent strips. They are transparent enabling the dentist to view through the strip to place and cure the composite material. They assist in producing a contoured surface and smooth.

E. Individual-Use Ready cut Matrix System.
Single-use assembled matrix systems are pre-assembled and disposable systems like sectional matrix systems. They are made to produce anatomically correct high-quality tight contacts restorations. They tend to have their own ring and wedges so that they may fit in.

307-2.4 - Explain the advantages, disadvantages and restrictions associated with restorative materials and lining materials.

Answer: 

A. Amalgam
Dental amalgam is a powerful and tough restorative substance, which is normally applied in the back teeth. 

• Its strengths are high compressive strength, a high level of longevity and the ability to withstand moisture contamination when placing. It is also cost-effective. 
• It has such drawbacks as poor aesthetics (it is silver) and the inability to adhere to the tooth tissue (which must be fixed mechanically), as well as possible tooth discolouration. Environmental and safety issues are also involved with regard to mercury content. 
• The UK has restrictions based on the advice of the NHS England and UK regulations which restrict its use in children below the age of 15 and in pregnant or breastfeeding patients unless it is considered absolutely necessary.

B. Composite
Composite resin is tooth-coloured, and it is extensively applied in both anterior and posterior restorations.

• The benefits are superior aesthetics, enamel and dentine adhesive bonding, as well as conservative cavity preparation. 
• The demerits are sensitivity of technique to polymerisation, shrinkage of polymerisation, and low strength relative to amalgam in large load bearing regions. 
• The conditions such as the necessity of appropriate moisture control and sufficient curing are provided.

C. Glass Ionomer
Glass ionomer cement (GIC) has a chemical bond to the tooth structure and releases fluoride.

• It has such advantages as fluoride release, chemical adhesion and applicability to patients with high caries-risk. 
• These have disadvantages of reduced wear resistance and strength. 
• Restrictions include the limitation of application in stress prone locations.

D. Temporary Cement
Provisional restorations are done with temporary cement.

• Pros are that it is easy to place and remove. 
• The demerits are poor strength and dissolvability with time. 
• It can only be used in short term applications restricted.

Lining Materials

E. Zinc-Based Liners
Liners based on zinc oxide help in insulation of the pulp thermally and mildly sedate.

• The benefits are a relaxing effect and convenience. 
• Low-strength and no adhesion are disadvantageous. 
• The limitations are not to use under composite when it contains eugenol, which could prevent the setting.

F. Calcium Hydroxide
Deep cavities and pulp protection are done with calcium hydroxide.

• The benefits party with the stimulation of secondary dentine formation and antibacterial qualities. 
• The drawbacks are low compressive strength and solubility. 
• Limitations The use is limited to thin layers supported by a more powerful base.

G. Glass Ionomer (as a Lining Material)
Glass ionomer has chemical bonding and fluoride release as a lining material.

• Good seal and thermal insulation are its advantages. 
• The drawbacks are sensitivity to moisture in the setting. 
• Contraindications are cautious technique of positioning and contraindication in the locations where there is heavy occlusal load with no support.

307-2.5 - Describe the reasons for the use of: 

Answer:

a. Etchant

Etchant is a substance used in the field of dentistry to prepare the surface of the tooth to be bonded. It's primarily used to:

•    Lay off the smear layer, a thin coat of debris to the tooth that is formed when the tooth is drilled.
•    The higher the better the adhesion, increase the surface area of the tooth.
•    Open the dentinal tubules and the bonding agent will be able to penetrate the tooth more deeply.

b. Bonding Agent

A dental adhesive is referred to as a bonding agent:
•    Establish excellent attachment between the tooth and the restorative substance (such as a filling or a crown).
•    Block the interfaces between restoration and tooth and avoid leakages and secondary caries.
•    Make dentinal tubules insensitive.

c. Curing Light

A curing light is applied in dentistry to:
•    Rigidify or harden light-activated dental products, e.g. sealants or composites.
•    Maintain swift and proper setting of the material, such that the dental procedure may be accomplished within one visit.

d. Dental Amalgamator

The application of a dental amalgamator is a machine that is used to:

•   Prepare dental amalgam, which is a filling medication, to the appropriate consistency.
•   A homogeneous mixture containing the alloy and mercury is essential to the strength and longevity of the filling and is therefore a matter of concern.

307 - 2.6- Describe the purpose and procedure for placing a fissure sealant.

Answer: 

Purpose:

Fissure sealants Fissure sealants are prophylaxis dental intervention that involves the application of a plastic substance in to the pits and fissures of the teeth. The key objective is to avoid dental caries (tooth decay) by closing places in which bacteria can conceal and reproduce.
Procedure:

• Step 1: The tooth is cleaned well, normally by way of a rotating brush and a paste.
  
  
• Step 2: A tooth is dried and a solution (acid etch) is deposited on the surface of the tooth to roughen it (to aid in the bonding of the sealant to the tooth).
  
  
• Step 3: The tooth is again rinsed and dried.
  
  
• Step 4: A sealant material is applied on the tooth surface with the help of a brush.
  
  
• Step 5: The sealant is hardened with the help of a special light (curing light).

307- 2.7- Explain the importance of effective moisture control throughout restorative treatments.

Answer: 

Proper moisture management is essential in the restorative dental operation due to a number of reasons:

• Prevents Contamination: Moisture control prevents dampness of saliva, blood, or other fluids getting into the area under treatment which might interfere with the bonding of the restorative materials.
  
  
• Enhances Vitality: It offers a dry field which enhances the visibility and accessibility of the dentist.
  
  
• Improves the success of Restorative Materials: There are a great number of restorative materials like composites and cements that need to be placed in a dry environment to set and bond well with the tooth structure.
  
  
• Avoids Patient Discomfort: It may also avoid patient discomfort by materials and tools touching soft tissues.

The procedures of moisture management are such as the implementation of the rubber dams, the high volume evacuator, cotton rolls, and saliva ejectors.