Clinical Practice of the Dental Hygienist

by Wilkins, Esther M.

• ISBN13: 9780683303629
• ISBN10: 0683303627
• Edition: 8th
• Format: Hardcover
• Copyright: 1999-04-01
• Publisher: Lippincott Williams & Wilkins

Summary

The Ninth Edition of the definitive text on dental hygiene is significantly revised and updated to provide even more focused guidance on all aspects of dental hygiene in the clinical environment. Ideal for both students and practitioners, the book reviews the clinical and educational skills needed for successful practice. Six comprehensive sections address orientation, preparation for appointments, patient assessment, treatment, and patients with special needs. New features include a significantly revised art program, case-based exercises to reinforce understanding, procedure boxes to enhance technique, and ethics boxes. New ancillaries include a student workbook (sold separately) and instructor's Website. Visit http: //connection.LWW.com/go/wilkins to view video clips of the authors and for more information.

Table of Contents

PART I ORIENTATION TO CLINICAL DENTAL HYGIENE PRACTICE	1	(10)
The Professional Dental Hygienist	3	(8)
Laura Mueller-Joseph
Esther M. Wilkins
Types of Services	3	(2)
Dental Hygiene Care	5	(1)
Dental Hygiene Process of Care	5	(2)
Assessment	6	(1)
Dental Hygiene Diagnosis	6	(1)
Dental Hygiene Care Planning	7	(1)
Implementation	7	(1)
Evaluation	7	(1)
Factors Influencing Clinical Practice	7	(1)
Legal	7	(1)
Ethical	7	(1)
Personal	8	(1)
Special Practice Areas	8	(1)
Objectives for Professional Practice	9	(1)
Factors to Teach the Patient	9	(2)
PART II PREPARATION FOR DENTAL HYGIENE APPOINTMENTS	11	(70)
Infection Control: Transmissible Diseases	13	(29)
Esther M. Wilkins
Judith E. Romano
Microorganisms of the Oral Cavity	16	(1)
The Infectious Process	16	(1)
Essential Features for Disease Transmission	16	(1)
Factors That Influence the Development of Infection	16	(1)
Factors That Alter Normal Defenses	16	(1)
Airborne Infection	17	(1)
Dust-Borne Organisms	17	(1)
Aerosol Production	18	(1)
Prevention of Transmission	18	(1)
Pathogens Transmissible by the Oral Cavity	18	(3)
Tuberculosis	21	(2)
Transmission	21	(1)
Diseases Process	22	(1)
Clinical Management	22	(1)
Viral Hepatitis	23	(1)
Hepatitis A	23	(1)
Transmission	23	(1)
Disease Process	23	(1)
Immunity	23	(1)
Prevention	23	(1)
Hepatitis B	23	(3)
Transmission	25	(1)
Individuals at Risk or With Risk Behaviors for Hepatitis B	25	(1)
Disease Process	26	(1)
Prevention of Hepatitis B	26	(1)
Comprehensive Preventive Program	26	(1)
Active Immunization: The Vaccines	26	(1)
Postexposure Prophylaxis	27	(1)
Hepatitis C	27	(1)
Transmission	27	(1)
Disease Process	27	(1)
Prevention and Control	28	(1)
Hepatitis D	28	(1)
Transmission	28	(1)
Disease Process	28	(1)
Prevention	28	(1)
Hepatitis E	28	(1)
Transmission	28	(1)
Prevention and Control	28	(1)
Herpesvirus Diseases	28	(1)
Viral Latency	28	(1)
Ganglia	28	(1)
Primary Infection: Sequence of Events	29	(1)
Varicella-Zoster Virus (VZV)	29	(1)
Chickenpox	29	(1)
Shingles	29	(1)
Epstein-Barr Virus (EBV)	30	(1)
Cytomegalovirus (HCMV)	30	(1)
Transmission	30	(1)
Disease Process	30	(1)
Prevention	30	(1)
Herpes Simplex Virus Infections	30	(1)
Primary Herpetic Gingivostomatitis	30	(1)
Herpes Labialis (Cold Sore, Fever Blister)	30	(1)
Herpetic Whitlow	31	(1)
Ocular Herpes	31	(1)
Clinical Management	31	(1)
Patient History	31	(1)
Postpone Appointment With Patient with Active Lesion	31	(1)
HIV-I Infection	31	(1)
Transmission	32	(1)
Routes of Transmission	32	(1)
Individuals at High Risk for Infection	32	(1)
Life Cycle of the HIV-I	33	(1)
Establishment of Infection	33	(1)
Production of New Virus	33	(1)
HIV-I Classification System for Adolescents and Adults	33	(2)
Laboratory Categories	34	(1)
Clinical Categories	34	(1)
Clinical Course of HIV-I Infection	35	(1)
Incubation Period	35	(1)
The Acute Seroconversion Syndrome	35	(1)
Early HIV-I Disease	35	(1)
Intermediate Stage of HIV-I Disease	35	(1)
Late Stage Disease: AIDS	35	(1)
Oral Manifestations of HIV-I Infection	35	(2)
Extraoral Examination	36	(1)
Intraoral Examination	36	(1)
HIV-I Infection in Children	37	(1)
Children at Risk	37	(1)
Classification	37	(1)
Clinical Manifestations	37	(1)
Treatment/Management	38	(1)
Prevention of HIV-I Infection	38	(1)
Technical Hints	38	(1)
Factors to Teach the Patient	39	(3)
Exposure Control: Barriers for Patient and Clinician	42	(13)
Esther M. Wilkins
Kathryn Jean Falcone
Personal Protection of the Dental Team	42	(1)
Immunizations and Periodic Tests	43	(1)
Immunizations	44	(1)
Management Program	44	(1)
Clinical Attire	44	(1)
Gown, Uniform, or Scrub Suit	44	(1)
Hair and Head Covering	45	(1)
Protection of Uniform	45	(1)
Outside Wear	45	(1)
Use of Face Mask: Respiratory Protection	45	(1)
Mask Efficiency	45	(1)
Use of a Mask	45	(1)
Use of Protective Eyewear	46	(1)
Indications for Use of Protective Eyewear	46	(1)
Protective Eyewear	46	(1)
Suggestions for Clinical Application	47	(1)
Hand Care	47	(1)
Bacteriology of the Skin	47	(1)
Hand Care	48	(1)
Hand-Washing Principles	48	(1)
Rationale	48	(1)
Purposes	48	(1)
Facilities	48	(1)
Methods of Handwashing	48	(2)
Short Scrub	49	(1)
Short Standard Handwash	49	(1)
Surgical Scrub	50	(1)
Gloves and Gloving	50	(1)
Criteria for Selection of Treatment/Examination Gloves	50	(1)
Types of Gloves	50	(1)
Procedures for Use of Gloves	50	(1)
Latex Hypersensitivity	51	(1)
Clinical Manifestations	51	(1)
Individuals at High Risk for Latex Sensitivity	52	(1)
Management	52	(1)
Technical Hints	52	(3)
Eye Wash Station	52	(1)
Skin Integrity	52	(1)
Factors Affecting Glove Integrity	52	(1)
Factors to Teach the Patient	53	(2)
Infection Control: Clinical Procedures	55	(18)
Objectives of Infection Control	57	(1)
Basic Considerations for Safe Practice	57	(1)
Treatment Room Features	57	(2)
Instrument Processing Center	59	(1)
Holding Step	59	(1)
Cleaning Step	59	(1)
Ultrasonic Processing	59	(1)
Manual Cleaning	60	(1)
Packaging Step	60	(1)
Purposes	60	(1)
Instrument Arrangement	60	(1)
Preparation	60	(1)
Chemical Indicator for Cycle Monitoring	60	(1)
Sterilization	60	(2)
Approved Methods	60	(1)
Selection of Method	60	(1)
Tests for Sterilization	61	(1)
The Chemical Indicator	61	(1)
Moist Heat: Steam Under Pressure	62	(1)
Use	62	(1)
Principles of Action	62	(1)
Operation	62	(1)
Care of Autoclave	62	(1)
Evaluation of Steam Under Pressure	62	(1)
Dry Heat	62	(1)
Use	62	(1)
Principles of Action	63	(1)
Operation	63	(1)
Evaluation of Dry Heat	63	(1)
Chemical Vapor Sterilizer	63	(1)
Use	63	(1)
Principles of Action	63	(1)
Operation	63	(1)
Care of Sterilizer	63	(1)
Evaluation of Chemical Vapor Sterilizer	63	(1)
Ethylene Oxide	63	(1)
Use	63	(1)
Principles of Action	64	(1)
Operation	64	(1)
Evaluation of Ethylene Oxide	64	(1)
Care of Sterile Instruments	64	(1)
Chemical Disinfectants	64	(1)
Categories	64	(1)
Uses	64	(1)
Principles of Action	64	(1)
Criteria for Selection of a Chemical Agent	65	(1)
Recommended Chemical Disinfectants	65	(1)
Glutaraldehydes	66	(1)
Chlorine Compounds	66	(1)
Iodophors	66	(1)
Combination Phenolics (Synthetic)	66	(1)
Chemical Sterilants (Immersion)	66	(2)
Preparation of the Treatment Room	66	(1)
Objectives	67	(1)
Preliminary Planning	67	(1)
Clean and Disinfect Environmental Surfaces	68	(1)
Unit Water Lines	68	(1)
Procedures for Clinical Use	68	(1)
Water Retraction System	68	(1)
Patient Preparation	68	(1)
Preprocedural Oral Hygiene Measures	68	(1)
Application of a Surface Antiseptic	68	(1)
Summary of Universal Procedures for the Prevention of Disease Transmission	69	(1)
Patient Factors	69	(1)
Clinic Preparation	69	(1)
Factors for the Dental Team	69	(1)
Treatment Factors	69	(1)
Post-Treatment	69	(1)
Occupational Accidental Exposure Management	69	(1)
Disposal of Waste	70	(1)
Regulations	70	(1)
Guidelines	70	(1)
Technical Hints	71	(1)
Cleaning the Face	71	(1)
Smoking and Eating	71	(1)
Toys	71	(1)
Handpiece Maintenance	71	(1)
Sterilization Monitoring	71	(1)
Office Policy Manual	71	(1)
Factors to Teach the Patient	71	(2)
Patient Reception and Positioning	73	(8)
Preparation for the Patient	73	(1)
Patient Reception	74	(1)
The Treatment Area	74	(1)
Position of the Clinician	75	(1)
Objectives	75	(1)
Characteristics of an Acceptable Clinician's Stool	75	(1)
Use of the Clinician's Stool	75	(1)
Position of the Patient	75	(3)
General Positions	75	(1)
Characteristics of a Dental Chair for Efficient Utilization	76	(1)
Use of Dental Chair	77	(1)
Lighting	78	(1)
Dental Light: Suggested Features	78	(1)
Dental Light: Location	78	(1)
Dental Light: Adjustment	79	(1)
Related Occupational Problems	79	(1)
Four-handed Dental Hygiene	79	(1)
Positions	79	(1)
Procedures	79	(1)
Technical Hints	79	(1)
Factors to Teach the Patient	79	(2)
PART III ASSESSMENT	81	(250)
Introduction	82	(1)
Examination Procedures	83	(1)
Tooth Numbering Systems	84	(3)
Personal, Dental, and Medical Histories	87	(19)
Esther M. Wilkins
Lois Rigmont Barber
Carol Jahn
Frieda Atherton Pickett
Significance	87	(1)
Purposes of the History	88	(1)
History Preparation	88	(1)
Systems	88	(1)
Record Forms	89	(1)
Introduction to the Patient	89	(1)
Limitations of a History	89	(1)
The Questionnaire	89	(3)
Types of Questions	89	(3)
Advantages of a Questionnaire	92	(1)
Disadvantages of a Questionnaire (If Used Aolone without a Follow-up Interview)	92	(1)
The Interview	92	(1)
Participants	92	(1)
Setting	92	(1)
Pointers for the Interview	92	(1)
Interview Form	92	(1)
Advantages of the Interview	93	(1)
Disadvantages of Interview	93	(1)
Items Included in the History	93	(8)
Personal History	93	(1)
Dental History	93	(1)
Medical History	93	(8)
Review of History	101	(1)
Immediate Applications of Patient Histories	101	(1)
Medical Consultation	101	(1)
Radiation	101	(1)
Prophylactic Premedication	101	(1)
American Heart Association Guidelines	101	(2)
Cardiac-Related Conditions Where Prophylaxis is Recommended	101	(1)
Cardiac Conditions Where Prophylaxis is Not Recommended	102	(1)
Individuals with Total Joint Replacement	102	(1)
Other Systemic Considerations	103	(1)
Prophylaxis for Dental and Dental Hygiene Procedures	103	(1)
Procedures for Which Prophylaxis is Recommended Procedures for Which Prophylaxis is Not Deemed	103	(1)
Necessary	104	(1)
ASA Determination	104	(1)
Technical Hints	104	(1)
Factors to Teach the Patient	104	(2)
Vital Signs	106	(10)
Body Temperature	106	(4)
Maintenance of Body Temperature	107	(1)
Methods of Determining Temperature	107	(1)
Procedure	108	(1)
Care of Patient with Temperature Elevation	109	(1)
Pulse	110	(1)
Maintenance of Normal Pulse	110	(1)
Procedure for Determining Pulse Rate	110	(1)
Respiration	111	(1)
Maintenance of Normal Respirations	111	(1)
Procedures for Observing Respirations	111	(1)
Blood Pressure	111	(3)
Components of Blood Pressure	111	(1)
Blood Pressure Classification	112	(1)
Factors That Influence Blood Pressure	112	(1)
Equipment for Determining Blood Pressure	112	(1)
Procedure for Determining Blood Pressure	113	(1)
Blood Pressure Follow-up Criteria	114	(1)
Technical Hints	114	(1)
Factors to Teach the Patient	114	(2)
Extraoral and Intraoral Examination	116	(18)
Esther M. Wilkins
Arthur S. Miller
Objectives	116	(2)
Components of Examination	118	(1)
Preparation for Examination	118	(1)
Methods of Examination	118	(1)
Sequence of Examination	118	(3)
Systematic Sequence for Examination	120	(1)
Steps for Thorough Examination	120	(1)
Documentation of Findings	121	(1)
Records	121	(1)
History	121	(1)
Location and Extent	121	(1)
Physical Characteristics	121	(1)
Morphologic Categories	122	(2)
Elevated Lesions	122	(1)
Depressed Lesions	123	(1)
Flat Lesions	123	(1)
Other Descriptive Terms	124	(1)
Oral Cancer	124	(2)
Location	125	(1)
Appearance of Early Cancer	125	(1)
Diagnostic Aid: Toluidine Blue	125	(1)
Procedure for Follow-up of a Suspicious Lesion	126	(1)
Biopsy	126	(1)
Cytologic Smear	126	(1)
Exfoliative Cytology	126	(2)
Procedure	126	(1)
Laboratory Report	127	(1)
Follow-up	127	(1)
Special Applications for the Extraoral and Intraoral Examination	128	(1)
Family Abuse and Neglect	128	(1)
Recognition of Child Abuse	128	(1)
Recognition of Abuse of Elderly Persons	129	(1)
Reporting	129	(1)
Substance Abuse	129	(2)
Definitions	129	(1)
Recognition	130	(1)
Appointment Factors	131	(1)
Technical Hints	131	(1)
Factors to Teach the Patient	131	(3)
Dental Radiographs	134	(37)
Dorathea Foote
Origin and Characteristics of X Rays	135	(1)
History	135	(1)
Definition and Characteristics	135	(1)
How X Rays Are Produced	135	(4)
The X-Ray Tube	135	(2)
Circuits	137	(1)
Transformers	137	(1)
Machine Control Devices	137	(1)
Steps in the Production of X Rays	138	(1)
Computerized Digital Radiography	139	(1)
Characteristics of an Acceptable Radiograph	140	(1)
Parts of the Image	140	(1)
Area to Be Examined	140	(1)
Quality of the Radiograph	140	(1)
Factors That Influence the Finished Radiograph	140	(4)
Collimation	140	(1)
Filtration	141	(1)
Kilovoltage	141	(1)
Milliampere Seconds	142	(1)
Distance	143	(1)
Films	143	(1)
Exposure to Radiation	144	(2)
Ionizing Radiation	144	(1)
Factors That Would Influence the Biologic Effects of Radiation	144	(1)
Exposure	144	(1)
Sensitivity of Cells	145	(1)
Risk of Injury From Radiation	146	(1)
Rules for Radiation Protection	146	(1)
Protection of Clinician	146	(1)
Protection from Primary Radiation	146	(1)
Protection from Leakage Radiation	146	(1)
Protection from Secondary Radiation	146	(1)
Monitoring	147	(1)
Protection of Patient	147	(1)
Films	147	(1)
Collimation	147	(1)
Filtration	147	(1)
Processing	147	(1)
Film Size	147	(1)
Total Exposure	147	(1)
Patient Body Shields	147	(1)
Clinical Applications	148	(1)
Assessment for Need of Radiographs	148	(1)
Preparation of Clinic Facility: Infection Control Routine	148	(1)
Preparation of Clinician	148	(1)
Preparation of Patient	148	(1)
Intraoral Examination	148	(1)
Patient Cooperation: Prevention of Gagging	149	(1)
Procedures for Film Placement and Angulation of Ray	149	(2)
Film Selection for Intraoral Surveys	151	(1)
Periapical Surveys	151	(1)
Bitewing (Interproximal) Surveys	151	(1)
Occlusal Surveys	152	(1)
Definitions and Principles	152	(1)
Planes	152	(1)
Angulation	152	(1)
Long Axis of a Tooth	152	(1)
Periapical Survey: Paralleling Technique	153	(3)
Patient Position	153	(1)
Film Placement	153	(1)
Paralleling Technique: Features	153	(3)
Bitewing Survey	156	(1)
Preparation	156	(1)
Film Placement: Horizontal Bitewing Survey	156	(1)
Film Position: Vertical Bitewing Survey	156	(1)
Horizontal Angulation (for Horizontal and Vertical Bitewings)	156	(1)
Maintain Film Flat During Exposure	156	(1)
Periapical Survey: Bisecting-Angle Technique	157	(1)
Patient Position	157	(1)
Film Placement and Position	157	(1)
Direction of the Central Ray	158	(1)
Occlusal Survey	158	(1)
Uses	158	(1)
Maxillary Midline Projection	158	(1)
Mandibular Midline Projection	159	(1)
Panoramic Radiographs	159	(1)
Panoramic Film and Technique	159	(1)
Uses	159	(1)
Limitations	159	(1)
Procedures	160	(1)
Child Patient Survey	160	(1)
Indications	160	(1)
Primary Dentition	160	(1)
Mixed Dentition (6 to 9 years)	160	(1)
Technique With Children	160	(1)
Edentulous Survey	161	(1)
Indications	161	(1)
Procedures for Survey	161	(1)
Paraclinical Procedures	161	(1)
Infection Control	161	(1)
Practice Policy	161	(1)
Basic Procedures	161	(1)
No Touch Method	161	(1)
Film Immersion Method	162	(1)
Daylight Loader Method	162	(1)
Film Processing	162	(1)
Standard Procedures	162	(1)
Film Sensitivity	162	(1)
The Chemistry of Processing	162	(1)
How the Image is Produced	162	(1)
Essentials of an Adequate Darkroom	162	(1)
Lighting	162	(1)
Darkroom Completely Void of White Light	162	(1)
Safelight	163	(1)
Safelighting Test	163	(1)
Automated Processing	163	(1)
Objectives and Advantages	163	(1)
Principles of Operation	163	(1)
Manual Processing	164	(1)
Manual Processing Equipment	164	(1)
Processing Temperature and Times	164	(1)
Steps for Manual Processing	164	(1)
Analysis of Completed Radiographs	165	(1)
Use of Reference Radiographs	165	(1)
Mounting	165	(1)
Anatomic Landmarks	165	(1)
Identification of Inadequacies in Radiographs	166	(1)
Interpretation	166	(1)
Technical Hints	166	(2)
Check Governmental Radiation Protection Laws	166	(1)
Record in Patient's Permanent Record	166	(2)
Ownership	168	(1)
Film Storage	168	(1)
Disposal of Liquid Chemicals	168	(1)
Factors to Teach the Patient	168	(3)
When the Patient Asks about the Safety of Radiation	168	(1)
Educational Features in Dental Radiographs	168	(3)
Study Casts	171	(15)
Purposes and Uses of Study Casts	171	(1)
Steps in the Preparation of Study Casts	172	(1)
Clinical Preparation	172	(1)
Assemble Materials and Equipment	172	(1)
Clinician Preparation	173	(1)
Prepare the Patient	173	(1)
The Interoclusal Record (Wax Bite)	173	(1)
Purposes	173	(1)
Procedure	173	(1)
Preparation of Impression Trays	174	(2)
Selection of Proper Size and Shape	174	(1)
Maxillary Try Try-in	174	(1)
Mandibular Tray Try-in	175	(1)
Application of Wax Rim Around Borders of Trays (Beading)	175	(1)
The Impression Material	176	(1)
Factors Related to the Impression Material That Contribute to a Satisfactory Impression	176	(1)
Mixing the Impression Material	176	(1)
Tray Preparation	176	(1)
The Mandibular Impression	177	(1)
Precoat Potential Areas of Air Entrapment	177	(1)
Steps for Insertion of Tray	177	(1)
The Completed Impression	177	(1)
The Maxillary Impression	177	(1)
Preparation	177	(1)
Steps for Insertion of Tray	178	(1)
The Completed Impression	178	(1)
Disinfection of Impressions	178	(1)
Disinfectants	178	(1)
Procedure	178	(1)
Paraclinical Procedures	178	(1)
Equipment and Materials	178	(1)
Preparation of the Impressions	179	(1)
Mixing the Stone	179	(1)
Factors Related to Dental Stone That Contribute to the Successful Cast	179	(1)
The Mix	179	(1)
Pouring the Cast	179	(2)
Pouring the Anatomic Portion	179	(1)
One-Step Method for Forming the Base of the Cast	180	(1)
Other Methods for Forming the Base of the Cast	180	(1)
Separation of the Impression and the Cast	180	(1)
Trimming the Casts	181	(3)
Use of Model Trimmer	181	(1)
Objectives: Characteristics of the Finished Casts	181	(1)
Preliminary Steps to Trimming the Cast	181	(1)
Trimming the Bases	182	(1)
Posterior Borders	182	(1)
Sides and Heels	183	(1)
Anterior	183	(1)
Finishing and Polishing	184	(1)
Technical Hints	184	(1)
Factors to Teach the Patient	185	(1)
The Gingiva	186	(15)
Objectives	186	(1)
The Treatment Area	186	(4)
The Teeth	187	(1)
Oral Mucosa	188	(1)
The Periodontium	188	(2)
The Gingiva and Related Structures	190	(3)
Free Gingiva (Marginal Gingiva)	190	(1)
Gingival Sulcus (Crevice)	190	(1)
Junctional Epithelium (Attachment Epithelium)	191	(1)
Interdental Gingiva (Interdental Papilla)	191	(1)
Attached Gingiva	192	(1)
Mucogingival Junction	192	(1)
Alveolar Mucosa	192	(1)
The Recognition of Gingival and Periodontal Infections	193	(1)
The Clinical Examination	193	(1)
Signs and Symptoms	193	(1)
Clinically Normal	193	(1)
Causes of Tissue Changes	193	(1)
Descriptive Terminology	193	(1)
Early Recognition of Tissue Changes	193	(1)
The Gingival Examination	194	(4)
Color	194	(1)
Size	195	(1)
Shape (Form or Contour)	196	(1)
Consistency	196	(1)
Surface Texture	197	(1)
Position	197	(1)
Bleeding	198	(1)
Exudate	198	(1)
The Gingiva of Young Children	198	(1)
Signs of Health	198	(1)
Changes in Disease	198	(1)
The Gingiva After Periodontal Surgery	199	(1)
Factors to Teach the Patient	199	(2)
Examination Procedures	201	(23)
Precaution	202	(1)
Basic Set-Up	202	(1)
The Mouth Mirror	202	(1)
Description	202	(1)
Purposes and Uses	203	(1)
Procedure for Use	203	(1)
Care of Mirrors	203	(1)
Instruments for Application of Air	203	(1)
Purposes and Uses	203	(1)
Compressed Air Syringe	203	(1)
Probe	204	(2)
Purposes and Uses	204	(2)
Description	206	(1)
Guide to Probing	206	(1)
Pocket Characteristics	206	(1)
Evaluation of Tooth Surface	207	(1)
Factors That Affect Probe Determinations	207	(1)
Probing Procedures	207	(2)
Probe Insertion	207	(1)
Advance Probe to Base of Pocket	208	(1)
Read the Probe	208	(1)
Circumferential Probing	208	(1)
Adaptation of Probe for Individual Teeth	209	(1)
Clinical Attachment Level	209	(1)
Rationale	209	(1)
Procedure	210	(1)
Furcations Examination	210	(1)
Anatomic Features	210	(1)
Examination Methods	211	(1)
Mucogingival Examination	211	(1)
Tension Test	211	(1)
Gingival Tissue Examination	211	(1)
Probing	212	(1)
Measure the Amount of Attached Gingiva	212	(1)
Periodontal Charting	212	(1)
Teeth Identification	212	(1)
Draw Gingival Lines	212	(1)
Record Probing Depths	213	(1)
Record Special Disease Problems	213	(1)
Explorers	213	(2)
General Purposes and Uses	213	(1)
Description	214	(1)
Preparation of Explorers	215	(1)
Specific Explorers and Their Uses	215	(1)
Basic Procedures for Use of Explorers	215	(1)
Use of Sensory Stimuli	216	(1)
Tooth Surface Irregularities	216	(1)
Types of Stimuli	216	(1)
Supragingival Procedures	216	(1)
Use of Vision	216	(1)
Facial and Lingual Surfaces	216	(1)
Proximal Surfaces	216	(1)
Subgingival Procedures	217	(1)
Essentials for Detection of Tooth Surface Irregularities	217	(1)
Steps	217	(1)
Record Findings	218	(1)
Supragingival Calculus	218	(1)
Subgingival Calculus	218	(1)
Other Irregularities of Tooth Surface	218	(1)
Mobility Examination	218	(1)
Causes of Mobility	218	(1)
Procedure for Determination of Mobility	218	(1)
Record Degree of Movement	218	(1)
Fremitus	219	(1)
Definition	219	(1)
Procedure for Determination of Fremitus	219	(1)
Radiographic Examination	219	(1)
Radiographic Changes in Periodontal Infections	219	(2)
Bone Level	219	(1)
Shape of Remaining Bone	220	(1)
Crestal Lamina Dura	220	(1)
Furcation Involvement	220	(1)
Periodontal Ligament Space	221	(1)
Early Periodontal Disease	221	(1)
Earliest Signs	221	(1)
Intial Bone Destruction	221	(1)
Radiographic Evidence	221	(1)
Other Radiographic Findings	221	(1)
Calculus	221	(1)
Overhanging Restorations	221	(1)
Dental Caries	222	(1)
Relationship to Pockets	222	(1)
Technical Hints	222	(1)
Factors to Teach the Patient	222	(2)
Disease Development and Contributing Factors	224	(12)
Development of Gingival and Periodontal Infections	225	(2)
The Initial Lesion	225	(1)
The Early Lesion	225	(1)
The Established Lesion	225	(1)
The Advanced Lesion	226	(1)
Classification	227	(1)
Gingival and Periodontal Pockets	227	(1)
Gingival Pocket	227	(1)
Periodontal Pocket	227	(1)
Tooth Surface Pocket Wall	227	(3)
Tooth Structure Involved	227	(1)
Contents of a Pocket	227	(2)
Nature of the Tooth Surface	229	(1)
Complications of Pocket Formation	230	(1)
Furcation Involvement	230	(1)
Mucogingival Involvement	230	(1)
Local Contributing Factors in Disease Development	231	(2)
Factors Involved	231	(1)
Dental Factors	231	(1)
Gingiva	232	(1)
Other Factors	233	(1)
Self-Cleansing Mechanisms	233	(1)
Food Enters the Mouth	233	(1)
The Teeth Are Brought Together for Chewing	233	(1)
Food is Forced Out By Pressure of Bite	233	(1)
Food Particles Are Brought Back by the Tongue to the Occlusal Surfaces for Additional Chewing	233	(1)
Food Particles Remaining on the Teeth are Removed	233	(1)
Risk Factors for Periodontal Diseases	233	(1)
Effect of Certain Drugs	234	(1)
Tobacco	234	(1)
Diabetes	234	(1)
Other Systemic Conditions	234	(1)
Factors to Teach the Patient	234	(2)
The Teeth	236	(18)
The Dentitions	238	(1)
Dental Caries	238	(1)
Development of Dental Caries	238	(1)
Classification of Cavities	238	(1)
Enamel Caries	239	(1)
Steps in the Formation of a Cavity	239	(1)
Types of Dental Caries (Described by Location)	239	(1)
Early Childhood Caries	240	(1)
Etiology	240	(1)
Effects	240	(1)
Recognition	240	(1)
Root Surface Caries	240	(2)
Steps in the Formation of a Cavity	240	(2)
Clinical Recognition	242	(1)
Risk Factors for Root Surface Caries	242	(1)
Noncarious Dental Lesions	242	(1)
Enamel Hypoplasia	242	(1)
Definition	242	(1)
Types and Etiology	242	(1)
Appearance	243	(1)
Attrition	243	(1)
Definition	243	(1)
Occurrence	243	(1)
Etiology	244
Appearance	243	(1)
Erosion	244	(1)
Definition	244	(1)
Occurrence	244	(1)
Etiology	244	(1)
Appearance	244	(1)
Abrasion	244	(1)
Definition	244	(1)
Occurrence	244	(1)
Etilogy	244	(1)
Appearance	245	(1)
Fractures of Teeth	245	(1)
Causes of Tooth Fractures	245	(1)
Description	245	(1)
Classification: World Health Organization	245	(1)
Clinical Examination of the Teeth	246	(2)
General Characteristics	246	(1)
Deposits	246	(2)
Color	248	(1)
Developmental Defects	248	(1)
Regressive Changes	248	(1)
Occlusion	248	(1)
Dental Caries and Demineralization	248	(1)
Vitality of Pulp	248	(1)
Tooth Fractures	248	(1)
Recognition of Carious Lesions	248	(1)
Preparation	248	(1)
Visual Examination: Enamel Caries	248	(1)
Exploratory Examination	248	(1)
Radiographic Examination	248	(1)
Testing for Pulpal Vitality	249	(2)
Observations That Suggest Loss of Vitality	249	(1)
Response to Pulp Testing	249	(1)
Thermal Pulp Testing	250	(1)
Electrical Pulp Tester	250	(1)
Factors to Teach the Patient	251	(3)
The Occlusion	254	(10)
Static Occlusion	254	(4)
Normal (Ideal) Occlusion	254	(1)
Malocclusion	255	(1)
Types of Facial Profiles	255	(1)
Malrelations of Groups of Teeth	255	(1)
Malpositions of Individual Teeth	256	(2)
Determination of the Classification of Malocclusion	258	(1)
Normal (Ideal) Occlusion	258	(1)
Malocclusion	258	(1)
Occlusion of the Primary Teeth	259	(1)
Normal (Ideal)	259	(1)
Malocclusion of the Primary Teeth	260	(1)
Functional Occlusion	260	(1)
Types of Occlusal Contacts	260	(1)
Proximal Contacts	261	(1)
Trauma from Occlusion	261	(1)
Types of Trauma from Occlusion	261	(1)
Effects of Trauma from Occlusion	261	(1)
Methods of Application of Excess Pressure	261	(1)
Recognition of Signs of Trauma from Occlusion	262	(1)
Technical Hints	262	(1)
Factors to Teach the Patient	262	(2)
Bacterial Plaque and Other Soft Deposits	264	(13)
Acquired Pellicle	264	(3)
Formation	264	(2)
Types of Pellicles	266	(1)
Significance of Pellicle	267	(1)
Bacterial Plaque	267	(4)
Stages in the Formation of Plaque	267	(1)
Changes in Plaque Microorganisms	267	(3)
Experimental Gingivitis	270	(1)
Subgingival Microbial Plaque	270	(1)
Composition of Bacterial Plaque	271	(1)
Clinical Aspects	271	(1)
Distribution	271	(1)
Detection	272	(1)
Significance of Bacterial Plaque	272	(1)
Dental Caries	272	(2)
Essentials for Dental Caries	272	(1)
Contributing Factors	273	(1)
The Carious Lesion	273	(1)
Effect of Diet on Plaque	274	(1)
Cariogenic Foods	274	(1)
Food Intake	274	(1)
Texture of Diet	274	(1)
Periodontal Infections	274	(1)
Bacteria of Healthy Gingiva	274	(1)
Periodontal Plaque Pathogens	274	(1)
Materia Alba	274	(1)
Food Debris	275	(1)
Technical Hints	275	(1)
Factors to Teach the Patient	275	(2)
Dental Calculus	277	(8)
Classification and Distribution	277	(3)
Supragingival Calculus	277	(1)
Subgingival Calculus	278	(1)
Occurrence	278	(1)
Clinical Characteristics	279	(1)
Appearance and Consistency	279	(1)
Supragingival Examination	279	(1)
Subgingival Examination	280	(1)
Clinical Record	280	(1)
Calculus Formation	280	(1)
Pellicle Formation	280	(1)
Plaque Maturation	280	(1)
Mineralization	280	(1)
Formation Time	281	(1)
Structure of Calculus	281	(1)
Attachment of Calculus	281	(1)
Attachment by Means of an Acquired Pellicle or Cuticle	281	(1)
Attachment to Minute Irregularities in the Tooth Surface by Mechanical Locking Into Undercuts	281	(1)
Attachment by Direct Contact Between Calcified Intercellular Matrix and the Tooth Surface	281	(1)
Composition	282	(1)
Inorganic	282	(1)
Organic	282	(1)
Significance of Dental Calculus	282	(1)
Relation to Bacterial Plaque	282	(1)
Relation to Attachment Loss and Pocket Formation	282	(1)
Prevention of Calculus	283	(1)
Professional Removal of Calculus	283	(1)
Personal Bacterial Plaque Control	283	(1)
Anticalculus Dentifrice	283	(1)
Factors to Teach the Patient	283	(2)
Dental Stains and Discolorations	285	(8)
Classification of Stains	285	(1)
Recognition and Identification	285	(1)
Application of Procedures for Stain Removal	286	(1)
Extrinsic Stains	286	(3)
Yellow Stain	286	(1)
Green Stain	286	(1)
Black Line Stain	287	(1)
Tobacco Stain	288	(1)
Other Brown Stains	288	(1)
Orange and Red Stains	288	(1)
Metallic Stains	288	(1)
Endogenous Intrinsic Stains	289	(1)
Pulpless Teeth	289	(1)
Tetracyclines	289	(1)
Imperfect Tooth Development	289	(1)
Other Systemic Causes	290	(1)
Exogenous Intrinsic Stains	290	(1)
Restorative Materials	290	(1)
Endodontic Therapy and Restorative Materials	290	(1)
Drugs	290	(1)
Stain in Dentin	290	(1)
Technical Hints	290	(1)
Factors to Teach the Patient	291	(2)
Indices and Scoring Methods	293	(21)
Individual Assessment Score	294	(1)
Clinical Trial	294	(1)
Epidemiologic Survey	295	(1)
Index	295	(1)
Systems Described in This Chapter	295	(1)
Periodontal Screening & Recording (PSR)	295	(3)
Purpose	295	(1)
Selection of Teeth	295	(1)
Procedure	295	(1)
Scoring	296	(2)
Plaque Index (PL I)	298	(1)
Purpose	298	(1)
Selection of Teeth	298	(1)
Procedure	298	(1)
Scoring	298	(1)
Plaque Control Record	298	(1)
Purpose	298	(1)
Selection of Teeth and Surfaces	298	(1)
Procedure	298	(1)
Scoring	299	(1)
Plaque-Free Score	299	(3)
Purpose	299	(1)
Selection of Teeth and Surfaces	300	(1)
Procedure	300	(1)
Scoring	300	(2)
Patient Hygiene Performance (PHP)	302	(1)
Purpose	302	(1)
Selection of Teeth and Surfaces	302	(1)
Procedure	302	(1)
Scoring	302	(1)
Simlified Oral Hygiene Index (OHI-S)	303	(2)
Purpose	303	(1)
Components	303	(1)
Selection of Teeth and Surfaces	303	(1)
Procedure	303	(1)
Scoring	304	(1)
Bleeding Indices	305	(1)
Sulcus Bleeding Index (SBI)	305	(1)
Purpose	305	(1)
Areas Examined	305	(1)
Procedure	305	(1)
Scoring	305	(1)
Gingival Bleeding Index (GBI)	305	(1)
Purpose	305	(1)
Areas Examined	305	(1)
Procedure	306	(1)
Scoring	306	(1)
Eastman Interdental Bleeding Index (EIBI)	306	(1)
Purpose	306	(1)
Areas Examined	306	(1)
Procedure	306	(1)
Gingival/Periodontal Indices	307	(1)
Gingival Index (GI)	307	(1)
Purpose	307	(1)
Selection of Teeth and Gingival Areas	307	(1)
Procedure	307	(1)
Scoring	307	(1)
Community Periodontal Index of Treatment Needs (CPITN)	308	(1)
Purpose	308	(1)
Selection of Teeth	308	(1)
Procedure	308	(1)
Scoring	309	(1)
Dental Caries Indices	309	(1)
Decayed, Missing, and Filled Permanent Teeth (DMFT)	309	(1)
Purpose	309	(1)
Selection of Teeth	309	(1)
Procedures	309	(1)
Scoring	310	(1)
Decayed, Missing, and Filled Permanent Tooth Surfaces (DMFS)	310	(1)
Purpose	310	(1)
Selection of Teeth and Surfaces	310	(1)
Procedures	310	(1)
Scoring	310	(1)
Decayed, Indicated for Extraction, and Filled Teeth or Surfaces (dft and dfs) (deft and defs)	311	(1)
Purpose	311	(1)
Selection of Teeth or Surfaces	311	(1)
Procedure	311	(1)
Scoring	311	(1)
Decayed, Missing, and Filled (dmft or dmfs)	311	(1)
Purpose	311	(1)
Selection of Teeth or Surfaces	312	(1)
Procedure	312	(1)
Scoring	312	(1)
Technical Hints	312	(1)
Factors to Teach the Patient	312	(2)
Records and Charting	314	(6)
Purposes for Charting	314	(1)
Materials for Charting	315	(1)
Clinic Procedures	315	(1)
Patient Preparation	315	(1)
Sequence for Charting	315	(1)
Dental Records and Charting	315	(3)
Before Patient Appointment	316	(1)
Patient Appointment	317	(1)
Periodontal Records and Charting	318	(1)
Clinical Observations of the Gingiva	318	(1)
Items to Be Charted	318	(1)
Deposits	318	(1)
Factors Related to Occlusion	318	(1)
Radiographic Findings	318	(1)
Technical Hints	319	(1)
Factors to Teach the Patient	319	(1)
Planning Dental Hygiene Care	320	(11)
Charlotte J. Wyche
Assessment	320	(1)
Dental Hygiene Diagnosis	320	(1)
Dental Hygiene Prognosis	321	(1)
Dental Hygiene Care Plan	321	(1)
Planning for Dental Hygiene Care	322	(3)
Risk Factors	322	(1)
Patient's Overall Health Risk	323	(1)
Oral Health-Care Knowledge Level of the Patient	324	(1)
Role of the Patient	324	(1)
Tissue Conditioning	324	(1)
The Periodontal Diagnosis	324	(1)
Patient Comfort	325	(1)
Preprocedural Anti-Microbial Rinsing	325	(1)
Maintenance During Therapy	325	(1)
Four-Handed Dental Hygiene	325	(1)
Sequencing and Priortizing Patient Care	325	(2)
Objectives	325	(1)
Criteria for Determining Treatment Sequence	326	(1)
Preparation of a Care Plan	327	(1)
Informed Consent	328	(1)
Informed Consent	328	(1)
Informed Refusal	328	(1)
Technical Hints	328	(1)
Factors to Teach the Patient	328	(3)
PART IV PREVENTION	331	(588)
Health Promotion and Disease Prevention	333	(17)
Steps in a Preventive Program	333	(2)
Assess the Patient's Needs	333	(1)
Plan for Intervention	334	(1)
Implementation	334	(1)
Perform Clinical Preventive Services	335	(1)
Evaluate Progressive Changes	335	(1)
Plan Short-and-Long-Term Maintenance	335	(1)
Patient Counseling	335	(1)
Motivation	335	(1)
The Learning Process	335	(1)
Principles of Learning	335	(1)
The Learning Ladder	335	(1)
Individual Patient Planning	336	(1)
When to Teach	336	(1)
The Setting	336	(1)
Presentation, Demonstration, Practice	337	(2)
First Lesson	337	(1)
Second Lesson	338	(1)
Continous Instruction	339	(1)
Instruction Adaptability	339	(1)
The Preschool Child	339	(2)
Early Plaque Control	339	(1)
Professional Instruction	340	(1)
Instruction for the Parent	340	(1)
Maintenance	341	(1)
The Teaching System	341	(1)
Evaluation of Teaching Aids	341	(1)
General Characteristics	341	(1)
Reading Material for the Patient	341	(1)
Use of Models	341	(1)
Use of Disclosing Agents	342	(2)
Purposes	342	(1)
Properties of an Acceptable Disclosing Agent	342	(1)
Formulae	343	(1)
Methods for Application	344	(1)
Interpretation	344	(1)
Patient Instruction	344	(1)
Technical Hints for Disclosing Agents	344	(1)
Xerostomia	345	(1)
Causes of Xerostomia	345	(1)
Effects of Xerostomia	345	(1)
Management of Xerostomia	346	(1)
Halitosis	346	(1)
Etiology	346	(1)
Assessment	346	(1)
Interventions	347	(1)
Factors to Teach the Patient	347	(3)
Oral Infection Control: Toothbrushes and Toothbrushing	350	(20)
Development of Toothbrushes	351	(1)
Early Toothbrushes	351	(1)
Brushing Methods	352	(1)
Manual Toothbrushes	352	(2)
Characteristics of an Effective Toothbrush	352	(1)
General Description	352	(1)
Handle	352	(1)
Head	353	(1)
Bristles and Filaments	353	(1)
Toothbrush Selection for the Patient	354	(1)
Influencing Factors	354	(1)
Toothbrush Size and Shape	354	(1)
Soft Nylon Brush	354	(1)
Guidelines for Toothbrushing	355	(1)
Grasp of Brush	355	(1)
Sequence	355	(1)
Amount of Brushing	355	(1)
Frequency of Brushing	356	(1)
Methods for Toothbrushing	356	(1)
The Bass Method: Sulcular Brushing	356	(1)
Purposes and Indications	356	(1)
Procedure	356	(1)
Problems	357	(1)
The Collis: Simultaneous Sulcular	357	(1)
Purposes and Indications	357	(1)
Procedure	357	(1)
The Roll or Rolling Stroke Method	358	(1)
Purposes and Indications	358	(1)
Procedure	358	(1)
Problems	359	(1)
The Stillman Method	359	(1)
The Modified Stillman Method	359	(1)
Purpose and Indications	359	(1)
Procedure	359	(1)
Problems	360	(1)
The Charters Method	360	(1)
Purpose and Indications	360	(1)
Procedure	360	(1)
Problems	361	(1)
Other Toothbrushing Methods	361	(1)
Circular: The Fones Method	361	(1)
Vertical: Leonard Method	361	(1)
Horizontal	362	(1)
Physiologic: Smith's Method	362	(1)
Scrub-Brush	362	(1)
Power-Assisted Toothbrushes	362	(1)
Description	362	(1)
Purposes and Indications	362	(1)
Instruction	363	(1)
Methods for Use	363	(1)
Supplemental Brushing	363	(2)
Problem Areas	363	(1)
Occlusal Brushing	363	(2)
Tongue Cleaning	365	(1)
Toothbrushing for Special Conditions	365	(1)
Acute Oral Inflammatory or Traumatic Lesions	365	(1)
Following Periodontal Surgery	365	(1)
Acute Stage of Necrotizing Ulcerative Gingivits	366	(1)
Following Dental Extraction	366	(1)
Following Dental Restorations	366	(1)
Toothbrush Trauma: The Gingiva	366	(1)
Acute Alterations	366	(1)
Chronic Alterations	366	(1)
Toothbrush Trauma: Dental Abrasion	366	(1)
Appearance	366	(1)
Location of Abraded Areas	367	(1)
Contributing Factors	367	(1)
Corrective Measures	367	(1)
Care of Toothbrushes	367	(3)
Supply of Brushes	367	(1)
Brush Replacement	367	(1)
Cleaning Toothbrushes	367	(1)
Brush Storage	367	(3)
Interdental Care and Chemotherapy	370	(24)
Esther M. Wilkins
Deborah Mancinelli Lyle
The Interdental Area	371	(1)
Gingival Anatomy	372	(1)
Proximal Tooth Surfaces	372	(1)
Selective Interdental Plaque Removal	372	(1)
Dental Floss and Tape	372	(2)
Types of Floss	372	(1)
Procedure	373	(1)
Precautions	373	(1)
Tufted Dental Floss	374	(1)
Description	374	(1)
Indications for Use	375	(1)
Procedure	375	(1)
Knitting Yarn	375	(1)
Indications for Use	375	(1)
Procedure	375	(1)
Gauze Strip	375	(1)
Indications for Use	375	(1)
Procedure	376	(1)
Interdental Brushes	376	(2)
Types	376	(1)
Indications for Use	377	(1)
Procedure	377	(1)
Care of Brushes	377	(1)
Single-Tuft Brush (End-Tuft, Unituft)	378	(1)
Description	378	(1)
Indications for Use	378	(1)
Procedure	378	(1)
Interdental Tip	378	(1)
Composition and Design	378	(1)
Indications for Use	378	(1)
Procedure	378	(1)
Pipe Cleaner	379	(1)
Indications for Use	379	(1)
Procedure	379	(1)
Toothpick in Holder	379	(1)
Description	379	(1)
Indications for Use	379	(1)
Procedure	379	(1)
Wooden Interdental Cleaner	380	(1)
Description	380	(1)
Indications for Use	380	(1)
Procedure	380	(1)
Chemotherapy	380	(1)
Oral Irrigation	381	(1)
Description of Irrigators	381	(1)
Power-Driven Device	381	(1)
Non-Power-Driven Device	381	(1)
Delivery Methods	381	(1)
Standard Jet Tip	381	(1)
Specialized Tips	382	(1)
Professionally Administered Subgingival Irrigation	382	(1)
Beneficial Effects from Irrigation	382	(1)
Reduction of Gingivitis	382	(1)
Reduction or Alteration of Microbial Flora	382	(1)
Penetration Into Pocket: Subgingival Access	383	(1)
Delivery of Antimicrobial Agents	383	(1)
Periodontal Maintenance	383	(1)
Applications for Practice	383	(1)
Advantages of Home Irrigation	383	(1)
Contraindication	383	(1)
Mouthrinses	383	(2)
Purposes and Uses	384	(1)
Procedure for Rinsing	384	(1)
Characteristics of an Effective Mouthrinse	384	(1)
Self-prepared Mouthrinses	385	(1)
Water	385	(1)
Isotonic Sodium Chloride Solution	385	(1)
Hypertonic Sodium Chloride Solution	385	(1)
Hypertonic Sodium Chloride Solution	385	(1)
Sodium Bicarbonate Solution	385	(1)
Sodium Chloride---Sodium Bicarbonate Solution (Flavored)	385	(1)
Commercial Mouthrinse Ingredients	385	(1)
Water	385	(1)
Alcohol	385	(1)
Flavoring	385	(1)
Coloring	385	(1)
Sweetening Agent	385	(1)
Active Ingredients	385	(1)
Chlorhexidine	386	(1)
Preparations	386	(1)
Mechanism of Action	386	(1)
Clinical Uses	386	(1)
Side Effects	387	(1)
Dentifrices	387	(1)
Basic Components	387	(1)
Detergents (Foaming Agents or Surfactants)	387	(1)
Cleaning and Polishing Agents	387	(1)
Binders (Thickeners)	387	(1)
Humectants	388	(1)
Preservatives	388	(1)
Sweetening Agents	388	(1)
Flavoring Agents	388	(1)
Coloring Agents	388	(1)
Prophylactic or Therapeutic Dentifrices	388	(1)
Action of Therapeutic Agents	388	(1)
Dentifrice Selection	388	(1)
Factors Affecting Abrasiveness	389	(1)
American Dental Association Acceptance Program	389	(1)
Purposes	389	(1)
Products Considered	389	(1)
Requirements	389	(1)
Technical Hints	389	(1)
Factors to Teach the Patient	390	(4)
Care of Dental Prostheses	394	(17)
Orthodontic Appliances	395	(3)
Complicating Factors	395	(1)
Disease Control	396	(1)
Care of Removable Applicance or Hawley Retainer	397	(1)
Self-Applied Fluride	398	(1)
Space Maintainers	398	(1)
Types of Space Maintainers	398	(1)
Fixed Space Maintainer	399	(1)
Removable Space Maintainer	399	(1)
Fixed Partial Dentures	399	(1)
Description	399	(1)
Characteristics	399	(1)
Care Procedures	400	(1)
Debris Removal	400	(1)
Plaque Removal From Abutment Teeth	400	(1)
The Prosthesis	400	(1)
Removable Partial Dentures	401	(1)
Description	402	(1)
Objectives	402	(1)
Cleaning a Removable Prosthesis	402	(1)
Rinsing	402	(1)
Immersion	402	(1)
Brushing	402	(1)
The Natural Teeth	403	(1)
Plaque Control	403	(1)
Dental Caries Control	403	(1)
Complete Dentures	403	(1)
Components of a Complete Denture	403	(1)
Purposes for Cleaning	404	(1)
Denture Deposits	404	(1)
Cleaning the Complete Denture	404	(1)
Rinsing Under Running Water	404	(1)
Brushing	404	(1)
Immersion	404	(1)
Mechanical Denture Cleansers	404	(1)
Denture Cleansers	404	(1)
General Cleaning Procedures	405	(2)
When to Clean	405	(1)
Selection of Procedure for Cleaning	405	(1)
Preparation for Cleaning	405	(1)
Cleaning by Immersion	405	(1)
Cleaning by Brushing	406	(1)
Additional Instructions	407	(1)
The Underlying Mucosa	407	(1)
Rinsing	407	(1)
Cleaning	407	(1)
Massage	407	(1)
Complete Overdenture	408	(1)
Purposes	408	(1)
Criteria	408	(1)
Preparation of the Teeth	408	(1)
Dental Hygiene Care and Instruction	408	(1)
Denture Care	409	(1)
Gingival Tissue and Natural Teeth	409	(1)
Fluoride	409	(1)
Sealants	409	(1)
Maintenance Appointments	409	(1)
Technical Hints	409	(2)
The Patient With Oral Rehabilitation and Implants	411	(14)
Objectives of Complete Rehabilitation	411	(1)
Components of Treatment	412	(1)
Accomplishment of Treatment	413	(1)
Characteristics of the Rehabilitated Mouth	413	(1)
Periodontal Findings	413	(1)
Single Tooth Restorations	413	(1)
Fixed Prostheses	413	(1)
Removable Prostheses	413	(1)
Self-Care for the Rehabilitated Mouth	414	(3)
Planning the Disease Control Program	414	(1)
Plaque Control: Selection of Methods	414	(1)
Fluorides	415	(1)
Dietary Assessment	416	(1)
Procedure	416	(1)
Sample Procedure	416	(1)
Maintenance Plan	417	(1)
Dental Implants	417	(1)
Types of Dental Implants	417	(1)
Endosseous (Endosteal)	417	(1)
Subperiosteal	418	(1)
Transosteal (Transosseous)	418	(1)
Preparation and Placement	418	(1)
Patient Selection	418	(1)
Information for the Patient	419	(1)
Surgical Steps	419	(1)
Prosthodontic Steps	419	(1)
Implant Interfaces	419	(1)
Implant/Bone Interface	419	(1)
Implant/Soft Tissue Interface	419	(1)
Peri-Implant Hygiene	419	(1)
Care of the Natural Teeth	419	(1)
Bacterial Plaque (Implant Plaque)	419	(1)
Planning the Disease Control Program	420	(1)
Selection of Plaque-Removal Methods	420	(1)
Rinsing and Irrigation	420	(1)
Fluoride Measures for Dental Caries Control	420	(1)
Maintenance	420	(2)
Basic Criteria for Implant Success	420	(1)
Frequency of Appointments	421	(1)
The Maintenance Appointment	421	(1)
Factors to Teach the Patient	422	(3)
Importance of Daily Care	422	(1)
Need for Concentration	422	(1)
Time Requirement	422	(1)
Diligence and Thoroughness	422	(1)
Importance of Maintenance	422	(3)
The Patient Who Uses Tobacco	425	(16)
Nancy L.J. Williams
Health Hazards	425	(1)
Components of Tobacco Products	426	(1)
Metabolism of Nicotine	427	(1)
Nicotine from Smoking	427	(1)
Smokeless Tobacco	427	(1)
Systemic Effects	427	(2)
Cardiovascular	429	(1)
Pulmonary Diseases	429	(1)
Cancer	429	(1)
Tobacco and Use of Other Drugs	429	(1)
Environmental Tobacco Smoke	429	(1)
Toxicity	429	(1)
Lung and Respiratory Effects	429	(1)
Cardiovascular Effects	429	(1)
Prenatal and Children	429	(1)
Oral Manifestations of Tobacco Use	429	(1)
Tobacco and Periodontal Infections	430	(1)
Mechanisms for Periodontal Tissue Destruction	430	(1)
Clinical Effects of Smoking	430	(1)
Nicotine Addiction	430	(2)
Tolerance	430	(1)
Dependence	431	(1)
Addiction	431	(1)
Withdrawal	431	(1)
Treatment	432	(1)
Reasons for Quitting	432	(1)
Self-Help Interventions	432	(1)
Assisted Strategies	432	(1)
Pharmaceuticals Used for Treatment of Nicotine Addiction	432	(2)
Objectives and Rationale	432	(1)
Considerations	433	(1)
Contraindications	433	(1)
Types	433	(1)
Nicotine Free Therapy	434	(1)
Dental Hygiene Care for the Patient Who Uses Tobacco	434	(1)
Assessment	434	(1)
Patient History	434	(1)
Vital Signs	434	(1)
Extraoral Examination	434	(1)
Intraoral Examination	434	(1)
Consultation	435	(1)
Clinical Treatment Procedures	435	(1)
Bacterial Plaque Control	435	(1)
Scaling and Root Planing	435	(1)
Other Patient Instruction	436	(1)
Tobacco Cessation Program	436	(1)
Preparation: Dental Team Organization	436	(1)
Group Agreement	436	(1)
Coordinator	436	(1)
Make Clinic Environment Tobacco Free	436	(1)
Prepare or Obtain Materials	436	(1)
Set Example	436	(1)
The Four A's	436	(2)
Ask	436	(1)
Advise	436	(1)
Assist	437	(1)
Arrange	438	(1)
Advocacy	438	(1)
Public Health Policy	438	(1)
Community Oral Health Educational Programs	438	(1)
Technical Hints	438	(1)
Completion of Training Program	438	(1)
Sources	438	(1)
Factors to Teach the Patient	438	(3)
Diet and Dietary Assessment	441	(14)
Cynthia A. Stegeman
Esther M. Wilkins
Oral Relationships	441	(2)
Periodontal Tissues	441	(2)
Skin and Mucous Membrane	443	(1)
Dental Caries	443	(1)
Daily Food Requirements	443	(1)
Recommended Dietary Allowances	444	(1)
The Food Guide Pyramid	444	(1)
Applications	444	(1)
Counseling for Dental Caries Control	444	(1)
The Dietary Assessment	444	(5)
Objectives of a Dietary Assessment	445	(1)
Components of a Dietary Assessment	445	(2)
Presentation of the Food Record to the Patient	447	(1)
Receiving the Completed Food Record	448	(1)
Summary and Analysis	448	(1)
Preparation for Additional Counseling of Patient	449	(1)
Define Objectives	449	(1)
Planning Factors	450	(1)
Select Appropriate Teaching Aids	450	(1)
Counseling Procedures	450	(2)
Setting	450	(1)
Pointers for Success of a Conference	450	(1)
Presentation	450	(1)
Specific Dietary Recommendations	451	(1)
Evaluation of Progress	452	(1)
Immediate Evaluation	452	(1)
Three-Month Follow-up	453	(1)
Six-Month Follow-up	453	(1)
Overall Evaluation	453	(1)
Factors to Teach the Patient	453	(2)
Medications With Sucrose	453	(1)
Medications With Side Effect of Xerostomia	453	(1)
Cause of Dental Caries	453	(2)
Fluorides	455	(25)
Fluoride Metabolism	456	(1)
Fluoride Intake	456	(1)
Absorption	456	(1)
Distribution and Retention	456	(1)
Excretion	456	(1)
Fluoride and Tooth Development	456	(2)
Pre-Eruptive: Mineralization Stage	456	(1)
Pre-Eruptive: Maturation Stage	456	(2)
Posteruptive	458	(1)
Tooth Surface Fluoride	458	(1)
Fluoride in Enamel	458	(1)
Fluoride in Dentin	459	(1)
Fluoride in Cementum	459	(1)
Demineralization---Remineralization	459	(1)
Demineralization	459	(1)
Remineralization	459	(1)
Fluoride in Bacterial Plaque	459	(1)
Fluoride Action	459	(1)
Fluoridation	460	(1)
Historical Aspects	460	(1)
Water Supply Adjustment	460	(1)
Effects and Benefits of Fluoridation	461	(1)
Appearance of Teeth	461	(1)
Dental Caries: Permanent Teeth	461	(1)
Root Caries	461	(1)
Dental Caries: Primary Teeth	461	(1)
Tooth Loss	462	(1)
Adults	462	(1)
Periodontal Diseases	462	(1)
Partial Defluoridation	462	(1)
School Fluoridation	462	(1)
Discontinued Fluoridation	462	(1)
Economic Benefits	462	(1)
Cost of Fluoridation	462	(1)
Cost of Professional Care	463	(1)
Fluorides in Foods	463	(1)
Foods	463	(1)
Salt	463	(1)
Dietary Fluoride Supplements	463	(2)
Administration	463	(1)
Determine the Need	463	(1)
Available Forms of Supplements	463	(1)
Prescription	464	(1)
Patient Instruction	464	(1)
Topical Fluoride Applications	465	(4)
Indications	465	(1)
Development	465	(1)
Clinical Procedures	465	(1)
Paint-On Technique: Solution or Gel	466	(1)
Tray Technique: Gel or Foam	467	(1)
Varnish	468	(1)
Self-Applied Fluorides	469	(1)
Methods	469	(1)
Indications	469	(1)
Tray Technique: Home Application	469	(1)
Indications for Use	469	(1)
Gel Used	470	(1)
Procedure: Patient Instructions	470	(1)
Fluoride Mouthrinses	470	(1)
Indications	470	(1)
Limitations	470	(1)
Preparations	470	(1)
Benefits	471	(1)
Fluoride Dentifrices	471	(1)
Indications	471	(1)
Preparations	471	(1)
Patient Instruction: Recommended Procedures	471	(1)
Benefits	472	(1)
Brush-On Gel	472	(1)
Preparations	472	(1)
Procedure	472	(1)
Patient Instruction	472	(1)
Combined Fluoride Program	472	(1)
Fluoride Safety	472	(2)
Summary of Fluoride Management	472	(1)
Acute Toxicity	473	(1)
Signs and Symptoms of Acute Toxic Dose	473	(1)
Emergency Treatment	473	(1)
Chronic Toxicity	474	(1)
How to Calculate Amounts of Fluoride	474	(1)
Technical Hints	474	(1)
Alternate Isolation Procedures for Topical Application	474	(1)
Fluoride Application Following Polishing of Restorations	475	(1)
Communities with Fluoridation	475	(1)
Factors to Teach the Patient	475	(5)
Personal Use of fluorides	475	(1)
Need for Parental Supervision	475	(1)
Determining Need for Fluoride Supplements	475	(1)
Preparation for Topical Fluoride Application	475	(1)
Fluorides Are Part of the Total Preventive Program	475	(1)
Fluoridation	475	(1)
Bottled Drinking Water	476	(4)
Sealants	480	(11)
Kathleen Sweeney
Esther M. Wilkins
Development of Sealants	480	(1)
How Sealants Work	480	(1)
Definition	480	(1)
Action	480	(1)
Sealant Materials	481	(1)
Criteria for the Ideal Sealant	481	(1)
Classification of Types of Selants	481	(1)
Indications for Sealant Placement	482	(1)
Patients With Risk for Dental Caries (Any Age)	482	(1)
Teeth	482	(1)
Contraindications	482	(1)
Selection of Teeth	482	(1)
Clinical Procedures	482	(3)
General Rules	482	(1)
Preparation of Tooth	482	(2)
Isolation	484	(1)
Dry the Tooth	485	(1)
Acid Etching	485	(1)
Sealant Application	485	(1)
Occlusion	485	(1)
Penetration of Sealant	485	(2)
Pit and Fissure Anatomy	485	(1)
Contents of a Pit or Fissure	486	(1)
Effect of Cleaning	486	(1)
Amount of Penetration	486	(1)
Maintenance	487	(1)
Re-examination	487	(1)
Retention	487	(1)
Replacement	487	(1)
Technical Hints	487	(1)
Sealants and Dental Caries	487	(1)
Records	487	(1)
Unit Dosing	487	(1)
Eye Protection	487	(1)
Care of Materials	487	(1)
Factors to Teach the Patient	487	(3)
PART V TREATMENT	489	(1)
Introduction	490	(1)
Anxiety and Pain Control	491	(21)
Donna J. Stach
Components of Pain	492	(1)
Pain Perception	492	(1)
Pain Reaction	492	(1)
Pain Control Mechanisms	492	(1)
Remove the Painful Stimulus	492	(1)
Block the Pathway of the Pain Message	492	(1)
Prevent Pain Reaction by Raising Pain Reaction Threshold	492	(1)
Depress Central Nervous System	492	(1)
Use Psychosomatic Methods (Also Called latrosedation)	492	(1)
Nitrous Oxide-Oxygen Sedation	492	(1)
Characteristics of Nitrous Oxide	492	(2)
Anesthetic and Analgesic Properties (Potency)	492	(2)
Chemical and Physical Properties	494	(1)
Blood Solubility	494	(1)
Pharmacology of Nitrous Oxide	494	(1)
Equipment	494	(1)
Compressed Gas Cylinders	494	(1)
Gas Delivery System	494	(1)
Nasal Hood, Nose Piece, Mask	494	(1)
Scavenger System	494	(1)
Safety Features	494	(1)
Equipment Maintenance	495	(1)
Patient Selection	495	(1)
Indications	495	(1)
Contraindications	496	(1)
Clinical Procedures for Nitrous Oxide---Oxygen Administration	496	(2)
Patient Preparation	496	(1)
Equipment Preparation	496	(1)
Technique for Gas Delivery	496	(1)
Completion of Sedation	497	(1)
Potential Hazards of Occupational Exposure	498	(1)
Issues of Occupational Exposure	498	(1)
Methods for Minimizing Occupational Exposure	498	(1)
Advantages and Disadvantages of Conscious Sedation Anesthesia	498	(1)
Advantages	498	(1)
Disadvantages	498	(1)
Local Anesthesia	498	(1)
Pharmacology of Local Anesthetics	498	(2)
Contents of a Local Anesthetic Cartridge	499	(1)
Ester and Amide Anesthetic Drugs	499	(1)
Characteristics of Specific Short-and Medium Acting Amide Drugs	499	(1)
Characteristics of Specific Long-Acting Amide Drugs	499	(1)
Vasoconstrictors	499	(1)
Criteria for Drug Selectio	500	(1)
Indications	500	(1)
Dental Hygiene Procedures	500	(1)
Patient Factors	500	(2)
Patient Assessment	501	(1)
Sources of Information for Complete Preanesthetic Assessment	501	(1)
Treatment Options Based on Assessment Findings	501	(1)
General Medical Considerations	501	(1)
Specific Medical Considerations	502	(1)
Armamentarium	502	(1)
Syringe	502	(1)
Needle	502	(1)
Cartridge or Carpule	503	(1)
Additional Armamentarium	503	(1)
Sequence of Syringe Assembly	503	(1)
Computer-Controlled Anesthesia Delivery (WANDtm)	503	(1)
Clinical Procedures for Local Anesthetic Administration	503	(3)
Injections (s) Selection	503	(1)
Aspiration	504	(1)
Sharps Management	504	(1)
Treatment Record: Anesthesia Entry	504	(2)
Potential Adverse Reactions to Local Anesthesia Procedures	506	(1)
Adverse Drug Reactions	506	(1)
Psychogenic Reactions	506	(1)
Local Complications	506	(1)
Advantages and Disadvantages of Local Anesthesia	507	(1)
Advantages	507	(1)
Disadvantages	507	(1)
Topical Anesthesia	507	(2)
Indications for Use	508	(1)
Action of a Topical Anesthetic	508	(1)
Agents Used in Surface Anesthetic Preparations	508	(1)
Application of Topical Anesthetic	509	(1)
Patient Preparation	509	(1)
Application Techniques	509	(1)
Completion of Topical Anesthetic Application	509	(1)
Technical Hints	509	(1)
Factors to Teach the Patient	510	(2)
Nitrous Oxide---Oxygen Conscious Sedation	510	(1)
Local and Topical Anesthesia	510	(2)
Instruments and Principles for Instrumentation	512
Instrument Features	513	(1)
Recognition of Instruments	513	(1)
Instrument Balance	514	(1)
Instrument Parts	514	(1)
Working End	514	(1)
Shank	514	(1)
Handle	515	(1)
The Instruments	515	(1)
Categories	515	(1)
Instrument Blade Anatomy	515	(1)
Curets	516	(1)
Characteristics	516	(1)
Purposes and Uses	517	(1)
Application	517	(1)
Scalers	517	(3)
Sickle Scaler	517	(1)
Hoe Scaler	518	(1)
Chisel Scaler	519	(1)
File Scaler	519	(1)
Principles for Instrument Use	520	(1)
Instrument Grasp	520	(1)
Functions of the Instrument Grasp	520	(1)
Types	520	(1)
Wrist, Arm, Elbow, Shoulder: Neutral Positions	521	(1)
Wrist	522	(1)
Elbow	522	(1)
Shoulder	522	(1)
Fulcrum: Finger Rest	522	(2)
Definition	522	(1)
Objectives	522	(1)
Conventional Intraoral Rests	522	(1)
Variations of Finger Rest	523	(1)
Touch or Pressure Applied to Finger Rest	523	(1)
Adaptation	524	(1)
Relation to Tooth Surface	524	(1)
Characteristics of a Well-Adapted Instrument	524	(1)
Problem Areas	524	(1)
Angulation	524	(1)
Probe	524	(1)
Explorer	524	(1)
Scalers and Curets	524	(1)
Lateral Pressure	525	(1)
Detection Instruments	525	(1)
Treatment Instruments	525	(1)
Activation: Stroke	525	(1)
Characteristics of Strokes	525	(1)
Factors That Influence Selection of Stroke	526	(1)
Nature of Stroke	526	(1)
Visibility and Accessibility	526	(1)
Effects of Adequate Vision and Accessibility	526	(1)
Contributing Factors	526	(1)
Dexterity Development	526	(2)
Squeezing Therapy Putty or a Soft Ball	527	(1)
Stretching	527	(1)
Writing	527	(1)
Mouth Mirror, Cotton Pliers, and Explorer	528	(1)
Tactile Sensitivity	528	(1)
Prevention of Cumulative Trauma	528	(2)
Anatomy of the Median Nerve	528	(1)
Symptoms	528	(1)
Risk Factors	528	(1)
Prevention	528	(2)
Instrument Sharpening	530	(3)
Benefits from Use of Sharp Manual Instruments	530	(1)
Sharpening Stones	531	(1)
Dynamics of sharpening	532	(1)
Tests for Instrument Sharpness	532	(1)
Some Basic Sharpening Principles	533	(1)
Sterilization of the Sharpening Stone	533	(1)
Instrument Handling	533	(1)
Preparation of Stone for Sharpening	533	(1)
Sharpening	533	(1)
After Sharpening	533	(1)
Sharpening Curets and Sickles	534	(1)
Selection of Cutting Edge to Sharpen	534	(1)
Selection of Sharpening Procedure	534	(1)
Moving Flat Stone: Stationary Instrument	534	(1)
Examine the Cutting Edge to Be Sharpened	534	(1)
Stabilize the Instrument	534	(1)
Apply Sharpening Stone	534	(1)
Activate the Sharpening Stone	534	(1)
Test for Sharpness	535	(1)
Stationary Flat Stone: Moving Instrument	535	(2)
Curet	535	(1)
Sickle Scaler	536	(1)
Sharpening Cone	537	(1)
Description	537	(1)
Sharpening Procedure	537	(1)
The Neivert Whittler	538	(1)
Description	538	(1)
Uses	538	(1)
Sharpening Procedure	538	(1)
Mandrel-Mounted Stones	539	(1)
Description	539	(1)
Sharpening Procedure	539	(1)
Disadvantages of Power-Driven Sharpening	540	(1)
Sharpening the Hoe Scaler	540	(1)
Surface to Be Ground	540	(1)
Sharpening Procedure	540	(1)
Round Corners	540	(1)
Sharpening the Chisel Scaler	540	(1)
Surface to Be Ground	540	(1)
Sharpening Procedure	540	(1)
Round Corners	541	(1)
Sharpening Explorers	541	(1)
Tests for Sharpness	541	(1)
Recontour	541	(1)
Sharpening Procedure	541	(1)
Care of Sharpening stones	541	(1)
Flat Arkansas Stones	541	(1)
Mounted Stones	541	(1)
Manufacture's Directions	542	(1)
Technical Hints	542
Nonsurgical Periodontal Instrumentation	544	(566)
Caren Barnes
Margaret Waring
Esther M Wilkins
The Scope of Nonsurgical Therapy	545	(1)
Preparation of the Clinician	545	(1)
Focus of Treatment	546	(1)
Bacterial Plaque	546	(1)
Endotoxins	546	(1)
Cementum	546	(1)
Calculus	546	(1)
Aims and Expected Outcomes	546	(1)
Interrupt or Stop the Progress of Disease	546	(1)
Create an Environment That Encourages the Tissue to Heal and the Inflammation to be Resolved	546	(1)
Induce Positive Changes in the Quality and Quantity of the Subgingival Bacterial Flora	546	(1)
Delay Repopulation of Microorganisms in the Pocket; Hence Prevent or Postpone Disease Recurrence	546	(1)
Provide Initial Preparation (tissue conditioning) for Complicated Periodontal Therapy required for Advanced Disease	546	(1)
Motivate the Patient	546	(1)
Overall Appointment Systems	547	(1)
When a Single Appointment May Be Adequate	547	(1)
Planned Multiple Appointments	547	(1)
Problems of Incomplete Scaling	547	(1)
Preparation for Instrumentation	548	(1)
Review the Patient's Record	548	(1)
Review Radiographic Findings	548	(1)
Patient Preparation	548	(1)
Supragingival Examination	548	(1)
Subgingival Examination	548	(1)
Calculus Removal	548	(2)
Prerequisites	548	(1)
Location of Instrumentation	549	(1)
The Scaling Process	549	(1)
Special Subgingival Considerations	549	(1)
Manual Scaling Steps	550	(4)
Select Correct Cutting Edge	550	(1)
Instrument Grasp	550	(1)
Stabilization: Establish the Finger Rest	550	(1)
Adaptation of the Cutting Edge	551	(1)
Angulation	551	(1)
Lateral Pressure	551	(1)
Activation: Stroke	551	(2)
Channels of Strokes	553	(1)
Plane the Root Surface	553	(1)
Evaluation	554	(1)
Ultrasonic and Sonic Scaling	554	(1)
Mode of Action	554	(1)
Mechanical Vibration	554	(1)
Cavitation	555	(1)
Irrigation	555	(1)
Types of Power-Driven Scaling Devices	555	(1)
Magnetostrictive Ultrasonic Scalers	555	(1)
Piezoelectric Ultrasonic Scalers	555	(1)
Sonic Scalers	555	(1)
Purposes and Uses	555	(1)
Indications for Use	555	(1)
Contraindications and Precautions	556	(1)
Instrument Tip Design	556	(1)
Shape	556	(1)
Size	557	(1)
Water Deliver	557	(1)
Plastic Tip	557	(1)
Clinical Preparation	557	(1)
Dental Hygiene Care Plan	557	(1)
Infection Control Measures	557	(1)
Ultrasonic Unit Preparation	558	(1)
Sonic Unit Preparation	558	(1)
Patient Preparation	558	(1)
Instrumentation	558	(1)
Ultrasonic Scaling	558	(1)
Water Control	559	(1)
Manual Scaling	559	(1)
Risk Considerations	559	(1)
Clinician	559	(1)
Patient	560	(1)
Damage to the Integrity of Restorations	560	(1)
Titanium Implant Abutments	560	(1)
Completion of Nonsurgical Instrumentation	560	(1)
Immediate Evaluation	560	(1)
Objectives	560	(1)
Examination	560	(1)
Patient Instructions After Scaling and Root Planing	560	(1)
Printed Instructions	560	(1)
Information to Include	560	(1)
Rinsing	560	(1)
Toothbrushing	561	(1)
Eating	561	(1)
Effects of Nonsurgical Instrumentation	561	(1)
Clinical Endpoints	561	(1)
Healing	561	(1)
Effect on Microorganisms	561	(1)
Comparison of Manual and power-Driven Instrumentation	562	(1)
Technical Hints	562	(1)
Preventive Instrumentation	562	(1)
Instrument Maintenance	562	(1)
Broken Instrument	562	(1)
Factors to Teach the Patient	563	(3)
Nonsurgical Periodontal Therapy: Supplemental Care Procedures	566	(10)
Patient Needs	566	(1)
Supplemental Care Procedures	566	(1)
Antimicrobial Treatment	567	(1)
Objectives of Antimicrobial Therapy	567	(1)
Types of Delivery of Antimicrobials	567	(1)
Systemic	568	(1)
Action of Systemically Administered Antibiotic	568	(1)
Selection of Antibiotic	568	(1)
Limitations	568	(1)
Use of Systemic Therapy	568	(1)
Professional Subgingival Irrigation	568	(1)
Delivery Method	568	(1)
Procedure	569	(1)
Recommendations for Use	569	(1)
Antimicrobial Agents	569	(1)
Special Considerations	569	(1)
Local Delivery of Antimicrobials	569	(1)
Requirements	569	(1)
Uses for Slow-Release Local Delivery	569	(1)
Types of Local Delivery Agents	570	(1)
Tetracycline Fiber	570	(1)
Description	570	(1)
Action	570	(1)
Placement Procedures	570	(1)
Chlorhexidine Chip	571	(1)
Description	571	(1)
Placement Procedure	572	(1)
Doxycycline Polymer	572	(1)
Description	572	(1)
Delivery	572	(1)
Metronidazole Gel	573	(1)
Description	573	(1)
Delivery	573	(1)
Minocycline Gel	573	(1)
Description	573	(1)
Delivery	573	(1)
Maintenance	573	(1)
Factors to Teach the Patient	573	(3)
Acute Periodontal Conditions	576	(9)
Necrotizing Ulcerative Gingivitis/Periodontitis	576	(1)
Types of Necrotizing Periodontal Conditions	576	(1)
Necrotizing Ulcerative Gingivitis (NUG)	576	(1)
Necrotizing Ulcerative Periodontitis	576	(1)
Necrotizing Stomatitis	577	(1)
Cancrum Oris (Noma)	577	(1)
Clinical Recognition	577	(1)
Initial Signs and Symptoms	577	(1)
Characteristic Clinical Findings	578	(1)
Risk Factors	578	(1)
Local Factors	578	(1)
Stress Factors	578	(1)
Systemic: Disease-Resistance Factors	579	(1)
Etiology	579	(1)
Microbiology	579	(1)
Course of Development	579	(1)
Dental Hygiene Care	579	(1)
Preparation for Diagnosis	579	(1)
Care Plan	580	(1)
Care for the Acute Stage	580	(2)
Acute Phase: First Appointment	580	(1)
Acute Phase: Second Appointment	581	(1)
Successive Appointments	581	(1)
Periodontal Abscess	582	(2)
Development of a Periodontal Abscess	582	(1)
Etiologic Factors	582	(1)
Clinical Signs and Symptoms	582	(1)
Comparison of Periapical and Periodontal Abscesses	583	(1)
Care Plan	583	(1)
Definitive Therapy	584	(1)
Technical Hints	584	(1)
Factors to Teach the Patient	584	(1)
Sutures and Dressings	585	(10)
Esther M. Wilkins
Marilyn B. Cortell
Sutures	585	(2)
Purposes of Sutures	585	(1)
Suture Characteristics	586	(1)
Classification of Suture Materials	586	(1)
Needles	587	(1)
Needle Components	587	(1)
Needle Characteristics	587	(1)
Knots	588	(1)
Knot Characteristics	588	(1)
Management	588	(1)
Suturing Procedures	588	(1)
Procedure for Removal	589	(1)
Supplies for Suture Removal	589	(1)
Preparation of Patient	589	(1)
Steps for Removal	589	(1)
Precautions	590	(1)
Periodontal Dressings	590	(1)
Purposes and Uses	590	(1)
Characteristics of Acceptable Dressing Material	590	(1)
Types of Dressings	590	(1)
Zinc Oxide With Eugenol Dressing	590	(1)
Chemical-Cured Dressing	591	(1)
Visible-Light-Cured Dressing	591	(1)
Collagen Dressings	591	(1)
Clinical Application	591	(1)
Dressing Placement	591	(1)
Characteristics of a Well-Placed Dressing	591	(1)
Patient Dismissal and Instructions	592	(1)
Dressing Removal and Replacement	592	(1)
Patient Examination	592	(1)
Procedure for Removal	592	(1)
Procedural Suggestions for Dressing Replacement	592	(1)
Bacterial Plaque Control Follow-up	592	(1)
Follow-up	592	(1)
Technical Hints	592	(2)
Factors to Teach the Patient	594	(1)
Dentin Sensitivity	595	(8)
Kathy B. Bassett
Peggy Ellingson
Factors Contributing to Hypersensitivity	595	(2)
Loss of Gingiva	595	(1)
Loss of Cementum	596	(1)
Loss of Enamel	597	(1)
Role of Smear Layer	597	(1)
Other Dental Factors	597	(1)
Dentin Structure	597	(1)
Tubules	597	(1)
Odontoblastic Processes	597	(1)
Types of Pain Stimuli	598	(1)
Tactile (Mechanical)	598	(1)
Chemical	598	(1)
Thermal	598	(1)
Osmotic	598	(1)
Bacterial	598	(1)
Pain Impulse Conduction: Theories	598	(1)
Hydrodynamic Mechanism	598	(1)
Neurophysiology Related to Dental Pain	598	(1)
Desensitization	599	(1)
Untreated: Spontaneous Remission	599	(1)
Selection of Desensitizing Agents	600	(1)
Dental Hygiene Care	600	(1)
Self-Care by the Patient	600	(1)
Professional Applications	600	(1)
Technical Hints	601	(1)
Factors to Teach the Patient	601	(2)
Extrinsic Stain Removal	603	(16)
Esther M. Wilkins
Caren Barnes
Effects of Polishing	603	(3)
Bacteremia	604	(1)
Environmental Factors	604	(1)
Effect on Teeth	604	(1)
Effect on Gingiva	605	(1)
Effect on Restorations	605	(1)
Indications for Stain Removal	606	(1)
To Remove Extrinsic Stains Not Otherwise Removed During Toothbrushing and Scaling	606	(1)
To Prepare the Teeth for Caries-Preventive Agents	606	(1)
To Contribute to Patient Motivation	606	(1)
Clinical Application of Selective Stain Removal	607	(1)
Summary of Contraindications for Polishing	607	(1)
Suggestions for Clinic Procedure	607	(1)
Cleaning and Polishing Agents	608	(1)
Factors Affecting Abrasive Action	608	(1)
Abrasive Agents	608	(1)
Clinical Applications	609	(1)
Preparation of Abrasives	609	(1)
Commercial Preparations	609	(1)
Procedures for Stain Removal (Coronal Polishing)	610	(1)
Patient Preparation for Stain Removal	610	(1)
Environmental Preparation	610	(1)
Instruments	610	(1)
The Instruments	610	(1)
Handpiece	610	(1)
Prophylaxis Angle	610	(1)
Prophylaxis Angle Attachments	610	(1)
Uses for Attachments	611	(1)
Use of the Prophylaxis Angle	611	(1)
Effects on Tissues: Precautions	611	(1)
Prophylaxis Angle Procedure	611	(1)
Polishing Proximal Surfaces	612	(1)
Dental Tape and Floss	612	(1)
Finishing Strips	613	(1)
Air-Powder Polishing	613	(2)
Principles of Application	613	(1)
Uses of Air-Powder Polishing	613	(1)
Technique	614	(1)
Recommendations and Precautions	614	(1)
Risk Patients: Air-Powder Polishing Contraindicated	614	(1)
Cleaning the Removable Denture	615	(1)
Objectives	615	(1)
Removal of Denture	615	(1)
Care of Dentures During Intra-Oral Procedures	615	(1)
Procedure for Cleaning	615	(1)
Factors to Teach the Patient	616	(3)
The Porte Polisher	619	(4)
Purposes and Uses	619	(1)
Characteristics of a Porte Polisher	620	(1)
Selection and Preparation of Wood Points	620	(1)
Use of Porte Polisher	620	(1)
Selective Stain Removal	621	(1)
Evaluation	621	(1)
Clinical Procedures	622	(1)
Technical Hints	622	(1)
Factors to Teach the Patient	622	(1)
Care of Dental Restorations	623	(13)
Susan Anderson
Esther M. Wilkins
Rationale for Finishing and Polishing	623	(1)
Longevity of Restorations	624	(1)
Marginal Irregularities	624	(2)
Overhanging Margin	624	(1)
Flash	624	(1)
Open Margin	624	(1)
Undercontoured	624	(1)
Overcontoured	624	(2)
Ditch or Groove	626	(1)
Overhanging Restorations	626	(1)
Identification	626	(1)
Effects of Overhangs	626	(1)
Indications and Contraindications for Removal of Overhangs	626	(1)
Considerations During Instrumentation	627	(1)
Anatomic	627	(1)
Instrumentation	627	(1)
Composite Resins	627	(1)
Uses	627	(1)
Characteristics	627	(1)
Finishing Composites	627	(1)
Polishing Composites	628	(1)
Porcelain	628	(1)
Types	628	(1)
Uses	628	(1)
Characteristics	628	(1)
Polishing Porcelain	628	(1)
Amalgam Restorations	628	(1)
Properties and Age Changes	629	(1)
Finishing	629	(1)
Margination	629	(2)
Procedures Summarized	629	(1)
Manual Instruments	629	(1)
Power-Driven Instruments	630	(1)
Polishing	631	(1)
General Suggestions	631	(1)
Instruments	631	(1)
Procedures	632	(1)
Fluoride Application	632	(1)
The Maintenance Appointment	632	(1)
Assessment	632	(1)
Patient Counseling	633	(1)
Clinical Procedures	633	(1)
Technical Hints	633	(1)
Concerning Polishing Agents	633	(1)
Fluoride	633	(1)
Mercury Hygiene	633	(1)
Factors to Teach the Patient	633	(3)
Debonding	636	(6)
Comparison of Cemented Bands and Bonded Brackets	636	(1)
Fixed Appliance System	637	(1)
Clinical Procedures for Bonding	638	(1)
Clinical Procedures for Debonding	638	(2)
Research	638	(1)
Bracket Removal	638	(1)
Removal of Residual Adhesive	639	(1)
Final Finish	639	(1)
Post-debonding Evaluation	640	(1)
Enamel Loss	640	(1)
White Spots (Demineralization)	640	(1)
Etched Enamel Not Covered by Adhesive	640	(1)
Post-debonding Preventive Care	640	(1)
Periodontal Evaluation	640	(1)
Dental Caries	640	(1)
Fluoride Therapy	640	(1)
Technical Hints	640	(1)
Factors to Teach the Patient	640	(2)
Maintenance for Oral Health: Dental Hygiene Continuing Care	642	(10)
Esther M. Wilkins
Anna Matsuishi Pattison
Purposes of the Maintenance Program	642	(1)
Appointment Intervals	642	(2)
Maintenance Appointment Procedures	644	(1)
Assessment	644	(1)
Maintenance Care Plan	645	(1)
Criteria for Referral During Maintenance	645	(1)
Recurrence of Periodontal Disease	645	(1)