2017 Oregon Dental Conference Course Handout

Transcription

1 2017 Oregon Dental Conference Course Handout Natalie Carrier Denis, RDH, Shannon Carroll, RDH, Ljiljana Hinton, RDH, Grethe Whitman, RDH Course F9012: Excellence in Dental Hygiene (Workshop) Saturday, April 8 1 pm - 4 pm

2 Straight Talk about Crooked Teeth

3 Classes of Occlusion Class I Class II Class III 2

4 Overjet Reverse Overjet Overbite 3

5 Anterior Guidance in Harmony with the Envelope of Function 4

6 Patient education

7 Patient education 83% of what we learn is what we see!

8 Patient education Educational Tools: Intraoral camera Brochures PCS Education Model: Problem Consequence Solution

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13 Pre-Clinical Conversations What do you see? Can I tell you what I see? What would you like to see? Can I tell you what you would like to see?

14 Patient education Before & After Intraoral Photos

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16 Troubleshooting Photographic Records Avoid canted photographs by sitting knee-to-knee with the patient and holding the camera parallel to the floor. Buccal photos are taken with the Y end of the retractor (opposite end). Have the patient pull the retractor back toward their ear. Encourage the patient to smile big and wide - large enough to see all the teeth. Make sure hair is pulled back to see the ear and full profile of the face. Buccal views need both retractors, not just one. Holding only one will cause the lips to collapse in the anterior. Occlusal views require using wire retractors to get lips out of the frame and a better view of the teeth. Always use translucent retractors. Color attracts the eye drawing attention away from the teeth. Never use patterned wallpaper or distracting colors as the background. Invest in a good digital SLR (DSLR) camera. Have a battery charger with extra rechargeable batteries on hand. Never use an iphone or ipad for taking photographic records. This is considered a HIPPA violation. Patient s permission is necessary. You must have a signed consent or photo release form in order to share patient images with anyone including the aligner company. A photo consent form is available for your use at our website, Keep our photography guide in each operatory to remember the number and sequence of photographs along with camera settings. This will maintain record consistency for everyone taking photographs. Proper retractors and intraoral mirrors are critical with taking good photos. Both double-ended wire and double-ended plastic retractors are needed for the retracted view and buccal views. Always use wire retractors for all photographs that require the intra-oral mirror. Wire retractors are important to keep the lip from touching the teeth. During autoclave sterilization, make sure the water is clean or the translucent plastic retractors may turn opaque. Prevent intra-oral mirrors from fogging by using a heating pad, a defogging agent, hot water, or simply move fast. Patient positioning is the key to taking great photographic records: The three full face views, should have the patient is standing tall with hands at their side. For full smile and retracted views, have the patient sit on bend of the dental chair facing you, while you sit on the doctor s chair at eye level, knee-to-knee with the patient. For the maxillary occlusal view, always stand behind the patient with the chair laid back to your waist. Have the patient raise their chin as high as possible. The higher they lift their chin the further the tongue falls back. Place the intraoral mirror flat against the maxillary teeth. Make sure you are not positioning the mirror at an angle that will create a double image. Always use a intra-oral mirror with a handle. The length allows more control with intra-oral mirror shots. DSLR cameras can be heavy - use a neck strap to lighten the load. We hear many complaints about how heavy cameras can be, which indicates the need to practice more shots with the help of the neck strap. A camera card reader will be needed to transfer image files to the computer. A Wi-Fi card can be used to wirelessly transfer image files to your computer. Maxillary images are the hardest to achieve. Have the patient chair laying back with the top of the chair even with your waist. Come from behind the patient. When taking occlusal views always wear gloves and retractors are necessary. Try to focus on the center of the palate and remove the nose from the frame. Follow us on Guidelines for Good Photo Records

17 Guidelines for Good Photo Records notes full face repose, smile, profile Use a non-distracting background: white, black, blues or greys all work well. Have the patient stand with hands at their sides. Long hair should be pulled back or tucked behind ears. HINT: Use the interpupillary line and long axis of the face to align the camera. Camera angle should be at the same level as the patient s nose. FULL FACE - REPOSE FULL FACE - SMILE FULL FACE - PROFILE anterior smile and retracted Patient is seated knee to knee facing the assistant. Both patient s and photographer s chair are the same level allowing the photo lens to be parallel. HINT: Use buccal retractors without a mirror for retracted shot; focus is on the central teeth. ANTERIOR - SMILE ANTERIOR - RETRACTED buccal left and right Same seating position - knee to knee with patient. Have the patient place retractors, pulling further back the retractor side you are capturing. HINT: Upper and lower teeth should be together; focus are on the cuspids (right and left) and should be in the center of the frame. RIGHT BUCCAL LEFT BUCCAL upper and lower occlusal Try not to leave any teeth out of the photo the wider the patient opens, the more teeth will be in the frame. Keep nose out of the picture. Keep mirror warm to avoid fogging. HINT: Place retractors and mirror then stand behind the patient and lower the chair to waist level. Ask patient to lift their head as high as they can, again encourage them to open wide. The full arch mirror should rest flat against the opposing arch teeth. UPPER OCCLUSAL LOWER OCCLUSAL

18 MALOCCLUSION & PATIENT HEALTH Consequences from malocclusion seen everyday: Plaque and tartar buildup Periodontal disease (inflamed, receding, bleeding gums) Bone loss, tooth mobility Pre-mature wear, abfractions, fractured teeth While these problems can be treated the root cause may not have been addressed

19 The Hygienist is the first person who can identify these patients established relationship established trust

20 Conversation with photos: First I want us to pay attention to what is healthy and what you like about your mouth Second, we can then explore what you may want, or what could be different The purpose of using photos is simply to see where you are, then to see where you might want to go Every choice is yours, and my job is to make sure that you understand the benefits and consequences of those choices What do you see? Can I tell you what I see? What would you like to see? Can I tell you what you could see?

21 Patient education PCS Model PROBLEM CONSEQUENCE SOLUTION Malocclusion: Crowding Difficulty cleaning Plaque & bacteria accumulation Gum disease Cavities Inflamed & bleeding gums Gum recession Poor root support Bone and tooth loss Straight teeth

22 Deep Bite POTENTIAL MALOCCLUSION ISSUES Improper function of anterior teeth Occlusal trauma Premature wear, chipping Lower anterior incisors can over-erupt and damage palate behind upper incisors

23 Crossbite BACTERIA & PLAQUE ISSUES Possible loose teeth and bone loss POTENTIAL MALOCCLUSION ISSUES Improper occlusal function Uneven wear, chipping Abfraction

24 Excessive Overjet BACTERIA & PLAQUE ISSUES High risk of trauma to anterior incisors, which leads to chipping or fractures High risk Posterior tooth trauma due to lack of canine guidance

25 Insufficient Overjet / Edge-to-Edge Bite BACTERIA & PLAQUE ISSUES Deep pocketing of posterior teeth. Gum recession, bone loss, poor root support POTENTIAL MALOCCLUSION ISSUES Risk of anterior teeth chipping and fracture Shortened or worn down anterior teeth

26 Spacing BACTERIA & PLAQUE ISSUES POTENTIAL MALOCCLUSION ISSUES Possible food impaction Can lead to gum problems, periodontal pockets Insufficient anterior support Flared anterior teeth Premature posterior wear Periodontal problems

27 Anterior Open Bite BACTERIA & PLAQUE ISSUES POTENTIAL MALOCCLUSION ISSUES Deep pocketing of posterior teeth Gum recession, bone loss, poor root support Improper occlusal function Lack of anterior contact, posterior contact overload Premature wear on posterior teeth Abfraction

28 Troubleshooting Photographic Records Avoid canted photographs by sitting knee-to-knee with the patient and holding the camera parallel to the floor. Buccal photos are taken with the Y end of the retractor (opposite end). Have the patient pull the retractor back toward their ear. Encourage the patient to smile big and wide - large enough to see all the teeth. Make sure hair is pulled back to see the ear and full profile of the face. Buccal views need both retractors, not just one. Holding only one will cause the lips to collapse in the anterior. Occlusal views require using wire retractors to get lips out of the frame and a better view of the teeth. Always use translucent retractors. Color attracts the eye drawing attention away from the teeth. Never use patterned wallpaper or distracting colors as the background. Invest in a good digital SLR (DSLR) camera. Have a battery charger with extra rechargeable batteries on hand. Never use an iphone or ipad for taking photographic records. This is considered a HIPPA violation. Patient s permission is necessary. You must have a signed consent or photo release form in order to share patient images with anyone including the aligner company. A photo consent form is available for your use at our website, Keep our photography guide in each operatory to remember the number and sequence of photographs along with camera settings. This will maintain record consistency for everyone taking photographs. Proper retractors and intraoral mirrors are critical with taking good photos. Both double-ended wire and double-ended plastic retractors are needed for the retracted view and buccal views. Always use wire retractors for all photographs that require the intra-oral mirror. Wire retractors are important to keep the lip from touching the teeth. During autoclave sterilization, make sure the water is clean or the translucent plastic retractors may turn opaque. Prevent intra-oral mirrors from fogging by using a heating pad, a defogging agent, hot water, or simply move fast. Patient positioning is the key to taking great photographic records: The three full face views, should have the patient is standing tall with hands at their side. For full smile and retracted views, have the patient sit on bend of the dental chair facing you, while you sit on the doctor s chair at eye level, knee-to-knee with the patient. For the maxillary occlusal view, always stand behind the patient with the chair laid back to your waist. Have the patient raise their chin as high as possible. The higher they lift their chin the further the tongue falls back. Place the intraoral mirror flat against the maxillary teeth. Make sure you are not positioning the mirror at an angle that will create a double image. Always use a intra-oral mirror with a handle. The length allows more control with intra-oral mirror shots. DSLR cameras can be heavy - use a neck strap to lighten the load. We hear many complaints about how heavy cameras can be, which indicates the need to practice more shots with the help of the neck strap. A camera card reader will be needed to transfer image files to the computer. A Wi-Fi card can be used to wirelessly transfer image files to your computer. Maxillary images are the hardest to achieve. Have the patient chair laying back with the top of the chair even with your waist. Come from behind the patient. When taking occlusal views always wear gloves and retractors are necessary. Try to focus on the center of the palate and remove the nose from the frame. Follow us on Guidelines for Good Photo Records

29 Guidelines for Good Photo Records notes full face repose, smile, profile Use a non-distracting background: white, black, blues or greys all work well. Have the patient stand with hands at their sides. Long hair should be pulled back or tucked behind ears. HINT: Use the interpupillary line and long axis of the face to align the camera. Camera angle should be at the same level as the patient s nose. FULL FACE - REPOSE FULL FACE - SMILE FULL FACE - PROFILE anterior smile and retracted Patient is seated knee to knee facing the assistant. Both patient s and photographer s chair are the same level allowing the photo lens to be parallel. HINT: Use buccal retractors without a mirror for retracted shot; focus is on the central teeth. ANTERIOR - SMILE ANTERIOR - RETRACTED buccal left and right Same seating position - knee to knee with patient. Have the patient place retractors, pulling further back the retractor side you are capturing. HINT: Upper and lower teeth should be together; focus are on the cuspids (right and left) and should be in the center of the frame. RIGHT BUCCAL LEFT BUCCAL upper and lower occlusal Try not to leave any teeth out of the photo the wider the patient opens, the more teeth will be in the frame. Keep nose out of the picture. Keep mirror warm to avoid fogging. HINT: Place retractors and mirror then stand behind the patient and lower the chair to waist level. Ask patient to lift their head as high as they can, again encourage them to open wide. The full arch mirror should rest flat against the opposing arch teeth. UPPER OCCLUSAL LOWER OCCLUSAL

30 Whitening Analysis Form Patient Name: Patient s Last Recall: Interviewer Name Dentist: Interview Medical History: YES NO YES NO YES NO YES NO Dental History: Allergic to plastics or peroxides? History of Tetracycline Antibiotics Do you routinely use tobacco? Pregnant or nursing mother? Onset of discoloration? YES NO History of trauma? Reason: YES NO YES NO YES NO YES NO YES NO YES NO YES NO Radiographs: Previous treatment for discoloration? What product did you use? Were you happy with the results? Did you get any sensitivity? Have you ever had ortho or Invisalign? Do you wear night guard Do you wear retainers? Are they wire or Vivera? Pull up and review radiographs for pulp size. Any Periapical, pulp size difference or internal resorption concerns? Restorations/Prosthesis? YES NO Discolored restorations needing replacement & shade q Crowns, Veneers, Bridges q Bonding q Partial, Bridge, Denture Soft Tissue Morphology / Characteristics: YES NO YES NO Photographs: q Full face and smile soft tissue lessons/attached gingivae periodontal conditions q Retracted and shade tab (Take before and after photos with same camera, magnifications and shade tab system) Starting shade of natural teeth Shade of Existing Restorations Tooth Morphology / Characteristics: YES NO Fluorosis YES NO Tetracycline YES NO Amelogenesis YES NO Devitalized Tooth YES NO Defective Restoration YES NO Tooth Aging YES NO Exposed dentin YES NO Caries YES NO Wear Facets / Cracks YES NO Abfractions YES NO Recession YES NO Wear facets YES NO Intrinsic Stain YES NO Extrinsic Whitening Procedure Selected q Go q Custom Tray q Boost and Go q Boost and Custom Tray q Internal Whiting and Custom Tray Notes: Follow us on

31 Opalescence Whitening System Congratulations! You ve just experienced a revolutionary tooth whitening procedure. The next 48 hours are important to enhance and maximize your whitening results for a long lasting, bright and healthy smile. For the next 48 hours, dark staining substances should be avoided, such as: Tobacco Beets Coffee Curry Tea Sports Drinks Frozen Fruit Bars and Popsicles Texas Pete Sauces Soy Sauce Carrots Wine Candy Tomato and Pasta Sauce Barbeque Sauce Blue Berries Soft Drinks It is normal for some people to experience minor tooth sensitivity for 1-3 days after the procedure. To minimize this, you may want to avoid excessively hot or cold foods and beverages. With the approval of you doctor, you may want to take 2 to 4 Advil (up to 800mg) every 4 to 6 hours as need for any discomfort. If you experience any severe or prolonged sensitivity, you should contact our office. All whitening procedures do have some relapse due to tobacco, foods and beverages. This is why we recommend a follow-up home tray system to maintain the whitening results. Seek regular professional dental hygiene care to maintain oral health, keep staining to a minimum and determine the need for whitening touch-ups. In addition, continue to practice good oral Hygiene including thorough tooth brushing, flossing, and tongue cleaning. Your dental professionalwill assist you in selecting the products to maintain not onlt a white smile, but a healthy one as well! Follow us on

32 Informed Consent for Teeth Whitening (In-Office and Home Treatments) This information read and given to me so that I can make an informed decision on teeth whitening (in-office or home treatments). I have been examined by my dentist and told I am a good candidate for whitening. I have the choice of home or in-office whitening treatment. I have been given all the details of whitening treatments by my dental professional and explained the procedure in detail. Power Bleaching Photoreactive Drug Information The following medications are commonly considered to be photoreactive and may cause an adverse condition if used in conjunction with the Power Bleaching solutions. If you are currently taking any of these medications, please consult with your physician before going through with bleaching procedure. To check photoreactive properties of any medications not listed below, please consult the most recent edition of the Physician s Drug Reference (PDR). Generic Name experience Hydrochlorothiazide Aldacteride, Aldoril, Capozide Chlorthalidone Naprosyn Oxaprozin Nabumetone Piroxicam Doxycycline Ciprofloxacin Ofloxacin Psoralens Democlocyline Norfloxacin Sparfloxacin Sulindac Tetracycline St. John s Wart Trade Name Aldoclor, Diupres, Diuril Dyazide, Hydrodiuril, Lopressor, Orotic, Moduretic Combipres, Tenoretic, Hgroton Naproxen Daypro Relafen Feldene Vibramycin, Doryx Cipro Floxin Methoxsalen, Trisoralen Declomycin Chibroxin, Noroxin Zagen Clinorilm, Sulindac Achromycin Patient Acknowledgement By signing this document in the space provided I indicate that I have read and understand the entire document and that I give my permission for any of these whitening treatments to be performed on me. I have read the list above and understand that the medications listed, if taken, can have an adverse reaction when used with the in-office or home bleaching treatments. I also acknowledge that I do not currently take any of these prescribed medication. Patient Signature Date Witness Signature Date Follow us on