Clinical Dentistry Daily Reference Guide

Brief Contents

About the Author xix

Preface xxi

Acknowledgments xxiii

List of Abbreviations xxv

How to Read this Book xxix

1 Health History Treatment Modifications 1

2 Extraoral Exam, Intraoral Exam, and Oral Cancer Screening 47

3 Radiographs and Interpretation 67

4 Treatment Planning 103

5 Preventive Dentistry 115

6 Periodontics 151

7 Operative Dentistry 173

8 Endodontics 209

9 Oral Surgery 255

10 Toothaches 307

11 Crown and Bridge 323

12 Complete Dentures 377

13 Removable Partial Dentures 437

14 Implant Crowns 493

15 Occlusal Guards 515

16 Dental Pharmacology 533

17 Pediatric Dentistry 575

18 Nitrous Oxide and Oxygen Sedation 605

Appendix A:: International Association of Dental Traumatology Guidelines 621

Appendix B:: Basic Life Support 651

Appendix C:: Evidence-based Dentistry Pyramid 657

Appendix D:: Ergonomics for the Dentist, Patient, and Dental Assistant 659

Appendix E:: “CAMBRA” CAries Management By Risk Assessment 665

Index 669

Contents

About the Author xix

Preface xxi

Acknowledgments xxiii

List of Abbreviations xxv

How to Read this Book xxix

1 Health History Treatment Modifications 1

Real-Life Clinical Questions 2

Relevance 3

Treatment Planning 3

ADA Health History Form 3

General Guidelines 3

Demographic Data 3

Dental Information 6

Medical History 7

Alphabetized Conditions with Treatment Modifications 7

Medications 33

Lab Values 36

Miscellaneous Terms 36

ASA Physical Status Classification System 36

Medical Consultations 38

Sample Form 38

Charting Template 39

Clinical Pearls 39

Troubleshooting 39

Tips 39

Real-Life Clinical Questions Answered 40

References 42

2 Extraoral Exam, Intraoral Exam, and Oral Cancer Screening 47

Real-Life Questions and Comments 48

Relevance 48

Purpose of the EOE, IOE, and OCS 48

Oral Cancer 49

Risk Factors 49

Signs and Symptoms 49

Prognosis 50

Treatment 50

Risk Reduction 50

Screening Frequency 50

Armamentarium 51

Procedural Steps 51

Detecting Oral Cancer Guide from the National Institute for Dental and Craniofacial Research (NIDCR) 56

Adjunctive Technologies 58

The American Dental Association Evidence-Based Clinical Practice Guideline for the Evaluation of Potentially Malignant Disorders in the Oral Cavity 58

Referral 59

Informed Refusal 60

Clinical Pearls:: Tips 60

Real-Life Questions and Comments Answered 64

References 65

3 Radiographs and Interpretation 67

Real-Life Clinical Questions 68

Relevance 69

Types of Radiographs 69

Bitewing 69

Periapical 69

Panoramic 69

Occlusal 69

Cone Beam Computed Tomography (CBCT) 70

Treatment Planning 70

Recommendations for Prescribing Dental Radiographs 70

Informed Consents 74

Informed Refusal 74

Verbal Consents 74

Procedural Steps 74

Radiographic Interpretation 75

Diagnostic Image Criteria 75

Diagnosis 75

Additional Considerations 77

Panoramic Anatomy 83

Periapical Anatomy 84

Referrals 86

Charting Template 87

Billing Clarifications 87

Clinical Pearls 88

Troubleshooting 88

Tips 92

Real-Life Clinical Questions Answered 96

References 100

4 Treatment Planning 103

Real-Life Clinical Questions 104

Relevance 104

Treatment Planning Phases 105

Special Sequencing Considerations 106

Tooth Replacement Options 107

Pediatric Treatment Planning 108

Referrals 108

Treatment Plan, Refusal, and Informed Consent Forms 109

Charting Template 109

Clinical Pearls 110

Troubleshooting 110

Tips 111

Miscellaneous 112

Real-Life Clinical Questions Answered 112

References 113

5 Preventive Dentistry 115

Real-Life Clinical Questions 116

Relevance 117

Treatment Planning 118

Armamentarium 118

Clinical/Radiographic Exam 118

Caries Management by Risk Assessment (CAMBRA) 119

Background 119

Oral Hygiene Instructions 125

Motivational Interviewing 125

Basics 125

Specific Populations 128

Nutritional Counseling 130

Background 130

Nutritional Counseling for Oral Health 131

Additional Nutritional Counseling for Specific Populations 132

Tobacco Cessation 133

Procedural Steps 133

Infant Prophylaxis 133

Child Prophylaxis 134

Adult Prophylaxis 134

Sealants 135

Preventive Resin Restoration 136

Fluoride Varnish 136

Silver Diamine Fluoride (SDF) 137

Postoperative Instructions 140

Erosion, Abrasion, and Attrition Prevention 140

Xerostomia 141

Thumb-sucking and Pacifiers 141

Sports Injuries 142

Clinical Pearls 142

Tips 142

Real-Life Clinical Questions Answered 144

References 146

6 Periodontics 151

Real-Life Clinical Questions 152

Relevance 153

What is Periodontal Disease? 153

Diagnosis:: New Classification of Periodontitis 153

Chairside Guide to Periodontitis Staging and Grading 154

Periodontal Diagnosis Flowchart 156

Clinical Attachment Level 156

Furcation 156

Mobility 157

Occlusal Trauma 157

Fremitus 157

What Is a Periodontal Abscess? 157

The Periodontal–Systemic Connection 158

Radiographic Findings 159

Treatment Planning 159

Assignment of Periodontal Maintenance Recall Schedule 160

When to Refer to a Periodontist 160

Armamentarium 161

Hand Instrument Advice 162

Prophy Angle and Polishing Paste 162

Ultrasonic Scaler 162

Procedural Steps 163

Comprehensive Periodontal Evaluation 163

Scaling and Root Planing 164

One-Month Reevaluation 165

Periodontal Maintenance 165

Periodontal Abscess Treatment 166

Prognosis 166

Charting Template 167

Clinical Pearls 167

Troubleshooting 167

Tips 167

Miscellaneous 168

Real-Life Clinical Questions Answered 169

References 171

7 Operative Dentistry 173

Real-Life Clinical Questions 174

Relevance 175

Clinical and Radiographic Exam 175

Treatment Planning 176

Informed Consent 176

Armamentarium 177

Procedural Steps 178

Cavity Preparation:: External and Internal Outline Forms 178

Cavity Preparation:: Principles and Tips 183

Cavity Restoration:: Principles and Tips 185

Other Restorative Scenarios 190

Tips for Getting Good Anatomy 193

Postoperative Instructions 194

Clinical Pearls 195

Troubleshooting 195

Tips 200

Real-Life Clinical Questions Answered 202

References 207

8 Endodontics 209

Real-Life Clinical Scenarios 210

Relevance 212

Clinical and Radiographic Exam 212

Diagnostic Testing 213

Pulp Sensitivity Testing 215

Periapical Testing 217

Biting Test 217

Mobility 217

Anesthetic Test 217

Diagnostic Terminology 218

Formulation of Pulpal and Periradicular Diagnoses 219

Types of Tooth Fractures 220

Treatment Type and Indications 221

AAE Endodontic Case Difficulty Assessment Form and Guidelines 222

Treatment Planning 224

Referral to an Endodontist 224

Sample Referral Form 225

Informed Consent 225

Sample Informed Consent Form 226

Armamentarium 227

Dental Materials 230

Endodontic Access 231

Rules of Symmetry 232

Teeth and Relevant Information 232

Endodontic Access Tips 235

Procedural Steps 235

Pulpotomy 236

Pulpectomy 236

Nonsurgical Root Canal Treatment 237

Follow-up 242

Postoperative Instructions 244

Nonsurgical Root Canal Treatment 244

Pulpotomy, Pulpectomy, or Pulpal Debridement 245

Internal Bleaching 245

Procedural Accidents 245

Charting Template 245

Clinical Pearls 246

Troubleshooting 246

Tips 247

Real-Life Clinical Scenarios Answered 247

References 252

9 Oral Surgery 255

Real-Life Clinical Questions 256

Relevance 257

Clinical and Radiographic Exam 257

Treatment Planning 265

Additional Tips 265

Referral to Oral Maxillofacial Surgeon 266

Informed Consent 266

Armamentarium 267

Other Equipment and Materials 268

Extraction Steps 271

Related Surgical Procedures 279

Extraction Postoperative Instructions 288

Charting Template 290

Clinical Pearls 291

Troubleshooting 291

Tips 296

Real-Life Clinical Questions Answered 299

References 304

10 Toothaches 307

Real-Life Questions, Concerns, and Comments 308

Relevance 309

Treatment Planning 309

Dental Trauma Armamentarium 312

Nonodontogenic Toothaches (Referred Pain) 312

Teledentistry and Toothaches 314

Clinical Pearls 315

Troubleshooting 315

Tips 317

Real-Life Questions, Concerns, and Demands Answered 319

References 321

11 Crown and Bridge 323

Real-Life Clinical Scenarios 324

Relevance 326

Clinical and Radiographic Exam 326

Treatment Planning Considerations 328

Terms Used in this Chapter 328

Ferrule 329

Biologic Width 329

Indications and Considerations for Crowns 331

Indications and Considerations for Bridges 333

Author’s Crown Material Decision Tree 334

Crown Material Properties 336

Crown Reduction Guidelines 338

Tripe Tray versus Full Arch Impressions 341

Bite Registration 342

Referrals 342

Consents 343

Shade Selection 343

Background 344

Steps 344

Procedural Steps 344

Crowns 344

Bridges 351

Crown/Bridge Materials and Cement Types 356

Adjusting Crown/Bridge Materials 356

Alternative Steps 357

Removing (“Sectioning”) a Crown 357

Removing (“Sectioning”) a Bridge 359

Seven Scenarios Involving Removable Partial Dentures/Complete Dentures 360

Core Buildup 362

Post and Core 363

Lab Prescriptions 363

Crown 364

Bridge 364

Postoperative Instructions 365

Clinical Pearls 366

Troubleshooting 366

Tips 369

Real-Life Clinical Scenarios Answered 372

References 375

12 Complete Dentures 377

Real-Life Clinical Questions 378

Relevance 379

Setting Realistic Expectations 379

Clinical and Radiographic Exam 380

Evaluation of Existing Dentures for Replacement 380

Evaluation of Edentulous Patient Prior to Denture Fabrication 383

Evaluation of Dentate Patient Prior to Denture Fabrication 387

Treatment Planning 388

Consent Forms 389

Complete Denture Procedural Steps 392

Appointment 1:: Preliminary Impressions 392

Appointment 2:: Final Impression 393

Appointment 3:: Wax Occlusal Rims 399

Teeth Setting Guidelines 406

Appointment 4:: Tooth Try-in 408

Appointment 5:: Denture Delivery 411

Appointment 6:: 24-Hour Follow-up 415

Appointment 7:: One-Week Follow-up 416

Appointment 8+:: Denture Adjustment 416

Periodic Oral Evaluation (Recall Exam) 416

Related Procedural Steps 417

Interim (Temporary) Dentures 417

Immediate Dentures 417

Complete Denture Opposing Cast Metal RPD 419

Complete Denture Opposing Dentition 419

Complete Denture Opposing Existing Complete Denture 419

Duplicate Existing Dentures 420

Repairs, Relines, Repositions, Additions, and What the Lab Needs from You 420

Lab Prescriptions 423

Postoperative Instructions 424

Complete Denture Instructions 424

Troubleshooting 426

Miscellaneous Advice 432

Real-Life Clinical Questions Answered 434

References 436

13 Removable Partial Dentures 437

Real-Life Clinical Scenarios 438

Relevance 440

Setting Patients’ Expectations 441

Clinical and Radiographic Exam 441

Treatment Planning 442

Sequencing 442

Treatment Needs Prior to Fabricating a Partial (if Indicated) 442

Selecting Appliance Type 444

Kennedy Classification and Relevant Terms 445

Procedural Steps 446

Consent Form 446

Cast Metal RPDs 446

Repairs, Relines, Repositions, Additions, and What the Lab Needs from You 467

Stayplates (Also Known as Acrylic Resin Partial, Interim Partial, Treatment Partial, Transitional Partial, Flipper) 474

Flexible Partials 476

Essix Appliances 478

Immediate Partials 480

Complete Dentures Opposing Cast Metal RPDs 481

Lab Prescriptions 481

Cast Metal RPDs 481

Stayplates 482

Flexible Partials 482

Essix Appliances 483

Immediate Partials 483

Postoperative Instructions 483

Clinical Pearls 485

Troubleshooting 485

Tips 486

Real-Life Clinical Scenarios Answered 486

References 491

14 Implant Crowns 493

Real-Life Clinical Questions 494

Relevance 495

Treatment Planning 495

Indications and Contraindications for Dental Implants 495

Clinical and Radiographic Exam 496

Clinical and Radiographic Dimensions for Implants 496

Cement- Versus Screw-Retained Implant Crown 497

Restorative Materials 498

Referral to an Oral and Maxillofacial Surgeon or a Periodontist 498

Discussion with the Oral and Maxillofacial Surgeon or a Periodontist 499

Implant Parts to Order 499

Procedural Steps 499

Surgical Stent 499

Final Impression 500

Soft Tissue Cast 502

Provisional Implant Crown 503

Implant Crown Delivery 504

Lab Prescriptions 507

Diagnostic Tooth Wax-Up and Surgical Stent 507

Soft Tissue Cast 507

Soft Tissue Cast and Screw- or Cement-Retained Provisional Crown 507

Soft Tissue Cast and Screw-Retained PFM Crown 508

Soft Tissue Cast and Cement-Retained PFM Crown 508

Follow-Up 508

Maintenance 510

Clinical Pearls 511

Troubleshooting 511

Tips 511

Real-Life Clinical Questions Answered 512

References 513

15 Occlusal Guards 515

Real-Life Comments and Questions 516

Relevance 516

TMD Terminology 517

Occlusal Guards and TMD 517

The Patient Interview 517

Clinical and Radiographic Exam 518

Extraoral Exam 518

Intraoral Exam 521

Dentition 521

Radiographic Exam 521

Treatment Planning 522

Referrals 522

Informed Consent 522

Oral Appliances:: Indications and Types 523

Maxillary Versus Mandibular Arch 525

Procedural Steps for Occlusal Guards, Dual Flat Plane Occlusal Appliances, Athletic Mouthguards, and QuickSplints 525

Lab Prescriptions 526

Postoperative Instructions 526

TMD Self-Care Tips (Adjunctive Treatment) 527

Clinical Pearls 528

Troubleshooting 528

Tips 529

Real-Life Comments and Questions Answered 529

References 531

16 Dental Pharmacology 533

Real-Life Comments, Demands, and Questions 534

Relevance 535

Clinical and Radiographic Exam 535

Informed Consent 535

Aciid 536

Prescription Writing Advice 536

Adult Medications 538

Preventative 538

Local Anesthetics 539

Antibiotics 543

Analgesics 546

Fungal Infections 554

Viral Infections 554

Anxiolytics 555

Pediatric Medications 556

Preventative 556

Pediatric Local Anesthetics 556

Child Antibiotics 558

Child Analgesics 566

Clinical Pearls 568

Troubleshooting 568

Tips 569

Real-Life Comments, Demands, and Questions Answered 569

References 572

17 Pediatric Dentistry 575

Real-Life Clinical Questions and Scenarios 576

Relevance 577

Pediatric Medical History Form 577

Clinical and Radiographic Exam 578

Clinical Exam 578

Radiographic Exam 578

Teeth Eruption Charts 579

Pediatric Treatment Planning 580

Informed Consent 581

Referrals to Specialists 581

Patient Management 582

Pediatric Local Anesthetic Tips 585

Pediatric Medication Dosages 586

Procedural Steps 586

General Remarks 586

Traumatic Dental Injuries of Primary and Permanent Teeth 586

Preventative Dentistry 587

Nitrous Oxide and Oxygen Sedation 587

Interim Therapeutic Restorations 587

Operative 587

Pulpotomies/Pulpectomies/RCT on immature permanent teeth 588

Stainless Steel Crowns and Strip Crowns 592

Primary Teeth Extractions 594

Space Maintainers 595

Lab Prescriptions for Space Maintainers 598

Postoperative Instructions 598

Documentation 599

Real-Life Clinical Questions and Scenarios Answered 600

References 602

18 Nitrous Oxide and Oxygen Sedation 605

Real-Life Questions and Comments 606

Relevance 606

Introduction 607

Indications and Contraindications 607

Signs and Symptoms of Optimal Sedation 608

Signs and Symptoms of Oversedation 608

Armamentarium 609

Informed Consent 610

Procedural Steps for Nitrous Sedation 610

Unit Set-up 610

Rooming 611

Procedure 611

Unit Shutdown 613

Postoperative Instructions 613

Charting Template 614

Clinical Pearls 614

Troubleshooting 614

Tips 615

Miscellaneous 615

Real-Life Questions and Comments Answered 615

References 618

Appendix A:: International Association of Dental Traumatology Guidelines 621

Appendix B:: Basic Life Support 651

Appendix C:: Evidence-based Dentistry Pyramid 657

Appendix D:: Ergonomics for the Dentist, Patient, and Dental Assistant 659

Appendix E:: “CAMBRA” CAries Management By Risk Assessment 665

Index 669

reface

About the Author

Acknowledgements

How to Read this Book

List of Abbreviations

Chapter 1:: Medical History and Treatment Modifications

Alphabetized Medical Conditions and Treatment Modifications

Dental Treatment and INR Ranges

Chapter 2:: Extraoral exam, Intraoral exam, and Oral Cancer Screening

Evidence-Based Clinical Practice Guideline for the Evaluation of Potentially Malignant         

Disorders in the Oral Cavity

Chapter 3:: Radiographs and Interpretation

Recommendations for Prescribing Dental Radiographs

Panoramic Anatomy

Chapter 4:: Treatment Planning

Treatment Planning Phases

Tooth Replacement Options

Chapter 5:: Preventive Dentistry

Caries Risk Assessments

Silver Diamine Fluoride Informed Consent and Protocol

Procedural Steps

Chapter 6:: Periodontics

Periodontal Diagnosis

Assignment of Periodontal Maintenance Recall Schedule

Procedural Steps

Chapter 7:: Operative Dentistry

Procedural Steps

Chapter 8:: Endodontics

Diagnostic Terminology

Formulation of Pulpal and Periradicular Diagnosis

Types of Tooth fractures

Endodontic Case Difficulty Assessment Form and Guidelines

Teeth and Relevant Information

Procedural Steps

Chapter 9:: Oral Surgery

Extraction Case Difficulty Assessment

Extraction Steps

Chapter 10:: Toothaches

Toothache Checklist

Dental Trauma Checklist

Nonodontogenic Toothaches (Referred Pain)

Teledentistry and Toothaches

Chapter 11:: Crown and Bridge

Crown Material Properties

Crown Reduction Guidelines

Crown Steps

Bridge Steps

Chapter 12:: Complete Dentures

Evaluation of the Existing Dentures, Edentulous Patient, and Dentate Patient

Procedural Steps

Denture Analyzer Chairside Guide

Chapter 13:: Removable Partial Dentures

Removable Appliance Types:: Advantages and Disadvantages

Procedural Steps:: 

Cast Metal RPDs

Stayplates

Flexible Partials

Essix Appliances

Immediate Partials

Repairs, Relines, Repositions, Additions and What the Lab Needs from You

Chapter 14:: Implant Crowns

General Measurement Parameters for Dental Implants

Final Impression Steps

Delivery Steps

Peri-Implant Diseases and Conditions

Chapter 15:: Occlusal Guards

Oral Appliances:: Indications and Types

TMD Self-Care Tips (Adjunctive Treatment)

Chapter 16:: Dental Pharmacology

Local Anesthetics

Antibiotic Selection Algorithm

Antibiotic Premedications

Analgesics

Opioids

Pediatric Antibiotic Dosage Charts

Pediatric Ibuprofen and Acetaminophen Dosage Charts

Pediatric Local Anesthetic Dosage Chart

Chapter 17:: Pediatric Dentistry

Tooth Eruption Charts

Pulpal Treatment for Primary and Immature Permanent Teeth

Space Maintainer Scenarios

Procedural Steps             

Chapter 18:: Nitrous Oxide and Oxygen Sedation

Nitrous Sedation Steps

Appendix A:: International Association of Dental Traumatology Guidelines

Appendix B:: Head and Neck Pain:: Travell & Simon’s Trigger Point Pain Charts

Appendix C:: Basic Life Support

Appendix D:: Evidence Based Dentistry Pyramid

Appendix E:: Ergonomics for the Dentist, Patient, and Dental Assistant

Appendix F:: “CAMBRA” CAries Management By Risk Assessment