Texas A & M University College of Dentistry Caruth School of Dental Hygiene

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1 Texas A & M University College of Dentistry Caruth School of Dental Hygiene Course Number and Name: 3530 Applied Dental Materials Course Type: Lecture/Laboratory Academic Year and Semester Offered: 2017 Spring semester Course Director(s): Kathleen Muzzin, R.D.H., M.S.; Loulou Moore, D.D.S. MPH Other Participating Faculty: Christine Beninger, D.D.S. Steve Karbowski, D.D.S. Danette McNew, D.D.S. Vonica Chau D.D.S. Stan A. Richardson, LIBST Course Description: Didactic, laboratory, and clinical instruction in the principles of the science of Dental Materials and in the procedures within the scope of dental hygiene practice. Course Objectives: See attached learning objectives for each content of instruction. Course Goal: This Applied Dental Materials course is designed to provide the Dental Hygiene students with the principles of the science of Dental Materials and related technologies and to acquaint them with the materials used in the dental health field. The goal of the Applied Dental Materials Course is to build a foundation that will help the students pursue their goals to be successful dental hygienists. Related Competencies: [as submitted in April 2013] 2.2 Commit to self-assessment and lifelong learning in order to provide contemporary clinical care. 5.1 Identify services and agencies that promote oral health and prevent oral disease and related conditions. 6.2 Perform an extraoral and intraoral examination of the patient including assessment of vital signs and radiographic examination, and distinguish normal from abnormal findings. 6.4 Recognize predisposing, etiologic risk factors, and life style choices that may require intervention to prevent disease. 7.3 Establish a planned sequence of educational and clinical services based on the dental hygiene diagnosis using the problem-based approach. 8.3 Select and administer the appropriate preventive and/or antimicrobial (chemotherapeutic) agents and provide pre- and post-treatment instructions. 1

2 The following procedures are taught to clinical competency: 1) placement and removal of periodontal dressings. 2) placement of pit and fissure sealants. 3) make a maxillary and mandibular alginate impression. 4) place and remove a rubber dam. 5) fabrication of a mouth protector and bleaching tray. The following procedures are taught to laboratory competency in this course. However, they are later performed to clinical competency in Clinical Dental Hygiene I (3830), Clinical Dental Hygiene II (4820), Clinical Dental Hygiene III (4140), and Clinical Dental Hygiene IV (4240): 1) finishing and polishing an amalgam restoration. 2) placement of a temporary restoration. 3) debond orthodontic resin. Evaluation Criteria/Methods: Grading Scale: A (100-90); B (89-80); C(79-75); D (74-70); F (69 and below) Evaluation criteria are as follows: Examinations: 60% Four written examinations valued at 15% each for a total of 60%. Laboratory & Clinical Performance: Quizzes: Laboratory Practical Exam: 10% Attendance and participation in lab is mandatory; complete all laboratory experiments and projects as demonstrated by summary and critique sheets for each laboratory. 15% Quizzes will incorporate material presented in lecture and laboratory. Quizzes will be given only during the first 10 minutes of the class or laboratory session. At the end of the semester, the lowest quiz grade will be dropped. 15% Laboratory practical will encompass performing procedures to clinical competency. 100% Attendance Policy: Attendance at all lecture and laboratory sessions is mandatory. If you find yourself with an acute medical condition in which you need to call in sick, please call Pam Hines at Leave her a voic . DO NOT HER. Pam will notify Ms. Muzzin and/or Dr. Moore if a student is out sick. You have up to 2 days of being out sick before a doctor s note is required. So, consecutive sick day 1 and sick day 2 will not require a note. However, if you are out 3 days or longer, a doctor s note will be required. No make-up exams will be permitted unless it is an excused absence. For university excused absences refer to Student Rule 7 for details. Students who have an excused absence must make-up any examination and/or quiz within SEVEN DAYS after returning to school. If the exam/quiz is not taken within this time 2

3 frame, the student will receive a zero for that exam/quiz. It is the student s responsibility to arrange a day and time to retake the exam/quiz. No make-up will be given for the Laboratory Practical Exam. Students who are absent during the exam will receive a 0 (zero). Quizzes will only be administered during the first 10 minutes of class. Quizzes will not be administered after ten minutes past the hour. It is the student s responsibility to be on time for class. Laboratory/Clinic Policies and Procedures: The laboratory experiments and clinical experiences serve two important functions. They are designed to: 1) provide the student with the opportunity to become familiar with the various materials used in dental health care and 2) emphasize the important variables which can affect the manipulation and ultimate performance of the materials used in common dental procedures. The uses and handling of the materials taught in this course have been closely coordinated with material from other courses. This course should be viewed as an opportunity to experiment with the materials the student will be exposed to throughout his/her dental hygiene career. Appropriate laboratory procedures will be taught during each lab session. Each student will self-evaluate their performance on the laboratory/clinical evaluation form provided in the lab manual and will be graded by the instructor at the end of lab and/or clinic. Laboratory/Clinical Evaluation Sheets must be turned in to the instructors at the end of class. If a student has an excused absence during lab, they must makeup the lab within 30 days after returning to school. Students are expected to READ the laboratory manual before class. It is the student s responsibility to bring their lab manual to every laboratory session. No EXCEPTIONS OR EXCUSES WILL BE ACCEPTED. Students who do not bring their lab manual and/or typodont pole to lab will not be allowed to participate in the lab for that class session and will receive a 0 (zero). Clinic attire is to be worn during all clinical and laboratory sessions. Students should also have their hair tied back and bring safety glasses to lab/clinic. For procedures that produce an aerosol and/or pungent odor, safety masks will be provided by the course directors. Learning Materials: Hatrick CD and Eakle WS. Dental Materials Clinical Applications for Dental Assistants and Dental Hygienists. Third Edition Elsevier (HE) Wilkins E.M.: Clinical Practice of the Dental Hygienist. Wolters Kluwer, 12th edition, (W) Darby M.L. and Walsh M.M.: Dental Hygiene Theory and Practice. 4th edition, W.B. Saunders Company, (DW) Additional readings and handouts may be provided by each lecturer. It will be the students' responsibility to read the material. 3

4 Remediation Policy: A student who earns a grade of F must retake the course in the summer session. A grade of C must be attained in order to pass the remedial course. Special Accommodation for Persons with Disabilities: The Americans with Disabilities Act (ADA) is a federal anti-discrimination statute that provides comprehensive civil rights protection for persons with disabilities. Among other things, this legislation requires that all students with disabilities be guaranteed a learning environment that provides for reasonable accommodation of their disabilities. If you believe you have a disability requiring an accommodation, please contact Dr. Charles Berry, Associate Dean for Academic Affairs, Room 514, or call for additional information. Academic Integrity Statement and Policy: An Aggie does not lie, cheat or steal, or tolerate those who do. Upon accepting admission to Texas A&M University, a student immediately assumes a commitment to uphold the honor Code, to accept responsibility, and to follow the philosophy and rules of the Honor System. Students will be required to state their commitment on examinations, research papers, and other academic work. Ignorance of the rules does not exclude any member of the TAMU community from the requirements or the processes of the Honor System. Date prepared: December

5 COURSE OBJECTIVES: I. Periodontal Dressings and Suture Removal W: pp Gladwin G and Bagby M. Placement of the Periodontal Dressing and Removal of Periodontal Dressing and Sutures. In Clinical Aspects of Dental Materials. Theory, Practice, and Cases. 2013, pp Explain the purpose of using sutures in oral and periodontal surgery. 2. Differentiate between an absorbable and non-absorbable suture and give an example of each type. 3. Discuss the advantages and disadvantages of a monofilament and multifilament suture. 4. Describe the two basic characteristics of suture needles. 5. Explain the following patterns of suturing: interdental, sling, interrupted, and continuous. 6. Summarize the post-operative instructions that are provided to the patient following periodontal surgery. 7. Value the need for the removal of non-absorbable sutures. 8. Explain the purpose of a periodontal dressing. 9. Discuss the characteristics of an acceptable periodontal dressing. 10. Discuss the advantages and disadvantages of periodontal dressings. 11. Compare and contrast the physical properties and the effects on the oral tissues of the eugenol and non-eugenol periodontal dressings. 12. Outline and demonstrate the mixing procedures for the eugenol and noneugenol periodontal dressings. 13. Assess the patient s periodontal health following removal of sutures and a periodontal dressing and provide post-operative instructions. 5

6 II. Introduction to Dental Materials HE: pp. 7-12, Explain how dental materials are classified based on their application and composition. 2. Identify the characteristics of an ideal dental material. 3. Differentiate between a direct and indirect restorative material. 4. Understand the complexity and challenges the oral environment has on the materials that are used in dentistry. 5. Describe the difference between compressive force, tensile force, shearing force, stress, strain and torsion. 6. Define the terms used to describe the reaction that occurs when two or more components are mixed together (mixing time, working time, initial set, final set). 7. Discuss the variables that the clinician must take into consideration when manipulating dental materials. III. Dental Cements and Glass Ionomers HE: pp , 89, Define the terms "cement", "base" and "liner" and give an application for each one. 2. Compare the requirements for a cement and a base. 3. Compare the similarities and differences in the properties of cements, bases and liners. 4. Discuss the differences between the specific cements or bases and explain the advantages of each. 5. Match each specific cement, base and liner with a suitable application. 6

7 IV. Adhesion and Bonding HE: pp , 20-21, Explain the importance of adhesion in dentistry in terms of preparation of teeth for restoratives, durability of the restoration, caries and esthetics. 2. Explain the difference between chemical bonding (including primary and secondary bonding) and mechanical bonding. 3. Differentiate between adhesion and cohesion. 4. Describe the importance of the following factors and how they relate to obtaining and maintaining adhesion in the dental environment: a. wetting-contact angle b. surface properties c. surface energies of the adherent and adhesive d. viscosity of the adhesive e. strength of the adhesive f. dimensional changes in the adhesive g. thickness and continuity of the adhesive h. surface contaminants 5. Describe the role an etchant (acid etch, total etch and surface etch) plays in adhesion and bonding. 6. Describe how the tooth is prepared for bonding and the surface changes that are observed on enamel and dentin. 7. Discuss how a smear layer can affect adhesion and bonding. V. Resin Composite HE: pp Compare and contrast esthetic restorative materials. 2. List the three main components of dental composites. 7

8 3. Compare the different types of composites and discuss advantages and applications for each. 4. Describe some of the properties and limitations of resin composite and discuss why they are technique sensitive. 5. Described the polymerization reaction that occurs with restorative resins and sealants. 6. Explain how the polymerization reaction is initiated by either heat, induced chemically or light activated. 7. Discuss the procedure for placing and curing resin composite that should be followed in order to optimize the properties and marginal seal of the restoration. 8. Explain the effects that polymerization shrinkage and coefficient of thermal expansion has on resin composite. 9. Discuss the other uses of resin composite; ie as a dental cement, restorative material and as temporary restoration. 10. Discuss clinical performance and care of resin composite. 11. Evaluate the integrity of a composite restoration and decide if it needs to be finished and polished or replaced. 12. Outline the sequence that is used to finish and polish a composite restoration. VI. Pit and Fissure Sealants HE: pp. 88, , Compare and contrast pit and fissure sealants to dental composites. 2. Describe the way in which sealants are polymerized. 3. Compare and assess the effectiveness of the different types of sealants. 4. Explain the purpose of sealing incipient caries and the effects on microorganisms. 5. Identify teeth and/or individuals who would benefit from having sealants placed based on their risk for developing dental caries. 8

9 6. Outline the sequence and clinical technique for the application of self-cured and light-cured sealants. 7. Explain the possible causes of sealant failure. 8. Compare the clinical effectiveness between a resin-based and glass ionomer pit and fissure sealant. VII. Dental Amalgam HE: pp , , List the elemental components of dental amalgam. 2. Describe the different particle shapes of amalgam and explain their effect on handling properties. 3. Describe the differences in composition, setting reaction and properties (i.e., creep, strength, corrosion) between low and high-copper amalgams. 4. Describe the effects of mercury/alloy ratio of amalgam on their properties and setting time. 5. Describe the effects that the trituration time and amalgamator speed has on the properties and setting rate of amalgam. 6. Explain the technique that used to condense and carve a class I and V amalgam restoration. 7. List and explain G.V. Black's seven steps to cavity preparation. 8. Discuss the advantages of the amalgam capsule as opposed to hand dispensing by the assistant or operator. 9. List the armamentarium needed for restoring a tooth with a class I and V amalgam restoration. 9

10 VIII. Amalgam Polishing Gladwin G and Bagby M. Purpose of Finishing and Polishing. In Clinical Aspects of Dental Materials. Theory, Practice, and Cases. 2013, pp Discuss the rationale for amalgam finishing and polishing. 2. Define tarnish and corrosion as it relates to amalgam and explain their differences. 3. Identify marginal irregularities that the hygienist should examine for before beginning, finishing, and polishing and amalgam restoration. 4. Differentiate between the terms "finishing" and "polishing" and explain their use. 5. List the armamentarium necessary for finishing and polishing an amalgam restoration. 6. Identify the different shaped finishing burs and the uses of each. 7. Use the mirror and explorer to evaluate the margins and contour of the amalgam restoration before finishing. 8. Outline the sequence and burs that are used to finish a class I, II and V amalgam restoration. 9. Outline the polishing sequence that is used with pumice and tin oxide and Sho-fu polishing points and cups. 10. Recognize the need to incorporate amalgam polishing into the patient's treatment plan. IX. Mercury Hygiene HE: pp DW: pp Describe the three chemical forms of mercury and state which is considered to be the most important in terms of dental exposure. 10

11 2. Compare mercury toxicity to mercury allergy in terms of mechanism of action and symptoms. 3. State the TLV set by NIOSH for mercury exposure in an 8-hour day. 4. Identify proper mercury hygiene and clean-up procedures. X. Margination Procedures 1. Describe an overhanging restoration according to its location, size, and restorative material. 2. Explain the effects that overhanging restorations have on the teeth, periodontium and plaque control. 3. Discuss the microbial flora associated with overhanging restorations and their effect on the periodontium. 4. Identify contraindications for margination procedures. 5. Identify the mechanical and hand instruments that are utilized to remove overhanging margins of amalgam restorations. 6. Outline the procedures utilized to remove overhanging margins of amalgam restorations with mechanical and hand instruments. 7. Accept and value the theory that margination procedures are a beneficial expanded function for the prevention and treatment of oral disease. XI. Temporary Restorations Reading Assignments: HE: pp. 223, (Use of Matrix Bands), DW: pp (Tofflemire Matrix System), (Temporary Interim Restoration) 1. Discuss the reasons temporary restorations are necessary. 2. Recognize the type of temporary restoration suitable for a specific area of the oral cavity. 11

12 3. Explain the purpose for using a Tofflemire retainer, matrix band and wooden wedge during the placement of a class II temporary restoration. 4. Demonstrate the correct placement of the Tofflemire retainer, matrix band and wedge on a class II cavity prep. 5. Mix Intermediate Restorative Material (IRM) to its correct consistency. 6. Properly place, contour, and adjust the occlusion of an IRM restoration. 7. Evaluate the IRM restoration for seal ability. XII. Inelastic and Elastic Impression Materials HE: pp , , List the ideal properties of dental impression materials. 2. Define inelastic vs. elastic impression material. 3. Describe some examples of inelastic impression materials. 4. Differentiate between reversible and irreversible hydrocolloid impression material. 5. List the components that are found in alginate impression material and describe their purpose. 6. Explain sol-gel setting reaction that occurs with hydrocolloid impression material. 7. Explain the effect of water temperature on the setting time of alginate impression material. 8. Describe imbibition and syneresis and their effects on the dimensional stability of hydrocolloid impression materials. 9. Describe hysteresis as it relates to agar impression material. 10. List the use of alginate and agar impression material. 11. Discuss ways to prevent gagging while taking an alginate impression. 12

13 12. Describe the method utilized to determine the proper tray size. 13. Discuss the purpose of applying utility wax to the tray. 14. Describe the proper method for removing an alginate impression. 15. Discuss the rationale for making an interocclusal record. 16. Outline the sequence that is utilized to make an alginate impression on the maxillary and mandibular arches. 17. Describe the procedures that are used to disinfect an impression. XIII. Gypsum/Trimming and Finishing Study Models HE: pp , DW: pp Differentiate between model plaster, dental stone and die stone and give the correct w/p ratios for each. 2. List four possible uses for gypsum products and discuss why they can be used for each application. 3. Explain the setting reaction that occurs when gypsum is mixed with water. 4. Discuss the factors that control the setting time. 5. List the variables that affect setting expansion and their effect. 6. Explain the correlation between strength and porosity and list one variable that influences each property. 7. Outline the procedures for trimming maxillary and mandibular casts. XIV. Rubber Dam: Placement and Removal DW: pp , (Procedure 38-1 and 38-2) 1. Discuss the advantages and disadvantages of using a rubber dam. 2. Identify clinical situations in which the rubber dam would be contraindicated. 13

14 3. List the armamentarium that is used in the placement and removal of the rubber dam. 4. Explain the difference between a winged, wingless and #212 clamps. 5. Select the correct rubber dam material, hole punch and clamp based on the tooth and type of restoration. 6. Outline the sequence that is used to place and remove a rubber dam. 7. Evaluate rubber dam placement and determine what factors can cause incorrect placement. XV. Bleaching HE: pp DW: pp W: pp Explain the difference between intrinsic and extrinsic stain. 2. List the factors that affect the bleaching process. 3. Explain how the bleaching process occurs. 4. Differentiate between patient-applied and professional tooth whitening procedures. 5. Identify indications and contraindications for bleaching. 6. Discuss ways in which dental clinicians can prevent or alleviate the side effects that can occur during bleaching. XVI. Pulp Vitality Testing W: pp DW: pp. 268 (Client Symptom Assessment) 269 (Box 16-6 and Procedure 16-1) Cooper MD, Wiechmam L. In Essentials of Dental Hygiene. Chapter 10, pp ,

15 1. Recognize the clinical and radiographic signs that would indicate the need to perform pulp vitality tests. 2. Outline the technique utilized in testing the vitality of the pulp with an electric pulp tester. 3. Identify the factors that create false positive and negative readings with an electric pulp tester. 4. Outline the technique utilized in testing the vitality of the pulp with a thermal stimulus, percussion, transillumination, selective anesthesia, and test cavity preparation. 5. Verify the clinical and radiographic findings of a tooth that is suspected of being non-vital. 6. Recognize the need to incorporate pulp vitality testing into the patient's treatment plan. XVII. Debonding Orthodontic Brackets Gladwin G and Bagby M. Debonding Orthodontic Resins. In Clinical Aspects of Dental Materials. Theory, Practice, and Cases. 2013, pp Explain the rationale for removing composite adhesive resin from the teeth following orthodontic treatment. 2. Describe damage to tooth surfaces that result from improper debonding tools and techniques. 3. Discuss the clinical objectives for debonding. 4. Explain and demonstrate each step in the debonding procedure. 5. Describe six evaluation mechanisms to assess the effectiveness of the debonding procedure. 6. Identify four follow-up considerations to be discussed with the newly debonded orthodontic patient and explain the rationale for each procedure. 15

16 XVIII. Dental Ceramics HE: pp Contrast ceramic type restorations with direct filling esthetic restorations in terms of esthetics and properties. 2. Describe the composition of dental ceramics and the sequence and function of the layers of a ceramic restoration vs. a ceramo-metal restoration. 3. Discuss the properties of dental ceramics including the mechanisms of failure. 4. Explain the advantages and disadvantages of ceramic vs. ceramo-metal restorations. 5. Contrast ceramics used for crowns vs. ceramics used for denture teeth. 6. Identify the alternatives to traditional ceramic-type restorations. XIX. Color and Esthetics HE: pp List the three major factors which influence color. 2. Define hue, value and chroma and explain the color of natural teeth in terms of the three. 3. Compare additive and subtractive primaries. 4. Explain the manner in which the following factors affect color and esthetics: complementary colors, metamerism, simultaneous contrast, fluorescence and fatigue. 5. Describe the procedures for lowering the value of a restorative. 6. List the factors which may affect color matching in the operatory. 16

17 XX. Elastomeric Impression Materials HE: pp Identify the proper impression material for edentulous and dentulous application. 2. Describe the physical and mechanical properties that are characteristic of impression materials. 3. Identify the equipment needed to make an elastomeric impression. 4. Compare the advantages and disadvantages of polysulfide impression material and other elastomers. 5. Describe the steps involved in making an elastomeric impression. 6. Discuss the importance of gingival refraction on the success of an impression. XXI. Use of the Prophy Jet HE: pp DW: pp W: Describe the mode of action of the air-powder polishing device. 2. Discuss the effect that air-powder polishing has on teeth, gingiva, oraltissue and dental restorations. 3. Recognize contraindications to air-powder polishing. 4. Justify the use of air-powder polishing in specific patient care situations. 5. Describe and demonstrate proper techniques of air-powder polishing. 6. Describe ways in which the hygienist can reduce the amount of contaminated dental aerosol that is produced during air-powder polishing 17

18 XXII. Acrylic Resins/Prosthetic Polymers HE: pp List the components of heat-cured and cold-cured resins and explain the function of each component. 2. Describe the physical and chemical changes which occur in acrylic resins during curing. 3 Identify the physical stage in which the material is easiest to handle. 4. Explain the effect of temperature, time and pressure during curing on the physical appearance and properties of denture resins. 5. Explain the differences between "improved" and conventional PMMA denture resins. 6. Compare and contrast the properties of the various denture resins to those of natural tissue. 7. Compare the composition and properties of denture bases to denture liners and tissue conditioners. 8. Explain the reason why temporary liners and conditioners are only useful for short periods of time. 9. Explain the purpose of a custom tray. XXIII. Placement and Removal of Ligature Wires Gladwin G and Bagby M. Orthodontic Materials. In Clinical Aspects of Dental Materials. Theory, Practice, and Cases. 2013, pp Explain the correct technique used to place ligature wires and elastics without trauma to the soft tissue. 2. Explain the correct technique used to remove ligature wires and elastics without trauma to the soft tissue. 18

19 XXIV. Clinical Use of Elastomeric Impressions Date prepared: December

20 3530 APPLIED DENTAL MATERIALS STUDENT CONTRACT Course Responsibilities Statement I, acknowledge that I have read and understand the Applied Dental Materials course syllabus. I have clarified any questions with the course director(s), Ms. Muzzin and Dr. Moore. Upon signing below, I acknowledge that I will be held responsible for all of the content and conditions of this syllabus. Signature Date Honor Code Statement An Aggie does not lie, cheat or steal or tolerate those who do. I, acknowledge that I have read, understand and will uphold the honor code expected of students at Texas A&M University. Upon signing below, I acknowledge that I will not commit any form of academic dishonesty during this course. Signature Date 20