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Class Notes for Primary Preventive Dentistry, 8th Edition

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition UNIT 1 PRIMARY PREVENTIVE DENTAL CONCEPTS Chapter 1 Introduction to Primary Preventive Dentistry OBJECTIVES After studying the chapter, the student should be able to : 1. Define and apply the following key terms: primary , secondary , and tertiary prevention . 2. Describe the historical aspect of preventive dental care. 3. Describe the state of dental health in the U nited S tates. 4. Describe categories that aid in classifying diseases. 5. Describe risk assessment in dental care delivery. LECTURE OUTLINE I. INTRODUCTION A. Historical Aspect of Preventive Dental Care B. Dental Diseases and Systemic Health C. Health Defined and Primary Preventive Care i. Primary Prevention ii. Secondary and Tertiary Prevention iii. Preventive Care

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition D. Categories of Oral Diseases i. Plaque Biolfilm Prevention II. RISK ASSESSMENT III. SUMMARY DISCUSSION ITEMS • Discuss overall dental health by having students write down their thoughts on what dental health means in general and what dental health means to them. • Ask students to bring in articles from the newspaper, magazines, or the Internet about a public health issue that focus on preventive modalities and use these articles to begin the discussion about defining primary preventive dentistry. SIMULATION ACTIVITY • Have the students work in groups of three to four to develop a preventive health program. Choose a setting for the program or have each group come up with a setting. After students have developed and recorded their program, have them present it briefly to the class. Collect the programs and keep them until one of the final class periods, when you have discussed disease and prevention. Return the original programs to the groups and have the students make necessary rev i sions to each program. Students enjoy this activity. The first program tends to be limited about preventive dental health, but by the end of the course, the preventive health programs expand to include many areas. This is a great confidence builder to future dental providers.

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition FIELD EXPERIENCES • Begin the process of literature reviews at the beginning of the course. Assign a preventive topic. The following outline provides a framework for the paper’s progression. By assigning sections of the paper during the semester(s), students have the opportunity to learn about scientific writing and more thoroughly research their topics. • When the students present their preventive literature reviews in class, the following evalu a tion form may be used. It is helpful to have the evaluations completed by the course director, fellow students, and the students themselves. This provides practice at self - assessment and peer - assessment tec h niques. LITERATURE REVIEW ON PREVENTIVE MODALITY GUIDELINES 1. See the course directly when requested throughout the semester to discuss your paper. 2. Topics and groups should be presented to the course director by a set date. 3. Topics may be changed only with the permission of the course director. 4. Papers must be typed, double - spaced, one - sided, and 6 to 8 pages long. TABLE CLINIC GUIDELINES 1. Introduction — 4 pts. a. T o acquaint reader with the topic and intent of the writer. b. B asic overview. c. Major goal of paper. d. Information from the review of the literature can be summarized and presented briefly to document the topic.

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition 2. Statement and significance of the topic — 5 pts. a. Begins with declarative statement of topic . b. Comprehensive document of the significance of the topic in which the student just i fies the topic’s worth. c. Supporting evidence to describe the magnitude and the impact of the topic . d. Include the following: previous (controversial) findings, recommendations for new studies, lack of related published research . 3 . Literature review — 12 pts. a. E nable student to become familiar with what is already known about the problem . b. Cognizant of both the supporting and opposing points of view. c. Guidelines: (1) Begin by developing an outline of the topics related to the problem . (2) Gather resource materials related to the topics on the outline . (3) Tackle each topic on the outline by writing quoted annotated bibliographies and making notes, (4) Research the most current references first because these already incorporate earlier research findings and supply direct source for relevant bibliographies. (5) Save time by scanning abstracts and summaries of past research reports to diff e rentiate between relevant and irrelevant materials. (6) Organize the review into the following sections: introduction, subtopics, and summary . 4. Bibliography — 2 pts a. The bibliography should be formatted according to the professional author

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition guidelines of the Journal of Dental Hygiene. By using these guidelines, students should begin understanding the format for scientific writing, which should also help them understand the articles read in the field .

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition EVALUATION FORM: PRESENTATION Students: ______________________________________________________________________ Topic: ______________________________________________________________________ 1. Appropriate topic for presentation _____ 2. Evidence of research of the topic _____ 3. Prepared for questions and discussion _____ 4. Appropriate time length _____ 5. Appropriate communication skills _____ 6. Utilizes visual aids appropriately _____ 7. Organized, well - prepared handouts _____ TOTAL _____ Comments: ____________________________________________________ ______________________________________________________________ ______________________________________________________________ Score Keys: 3 = Needs no improvement. 2 = Needs minimal improvement. 1 = Needs considerable improvement. 0 = Unacceptable.

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition Chapter 2 Cultural Health Influences OBJECTIVES After studying the chapter, the student should be able to: 1. Define culture and its relevance to the contemporary health care profession. 2. Describe influences of culture on aspects of U.S. society that impact preventive healthcare to underserved populations. 3. Identify health beliefs among different cultural groups. 4. Describe how cultural beliefs influence preventive dental care. 5. Explain the relationship between cultural competence and health outcomes. LECTURE OUTLINE I. INTRODUCTION A. Owning Culture B. Group Cultural Representation C. Moving Beyond Diversity to Inclusiveness D. Cultural Beliefs and Preventive Dental Care E. Cultural Competence and Health Outcomes II. SUMMARY

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition DISCUSSION ITEMS • Ask students to create a list of outcomes that could occur if a patient in a dental setting did not understand post - op instructions, patient education, what to reschedule for, and so on. • Ask students to put themselves in the situation. Imagine you have moved to a new country and, when you seek medical treatment, much of what you have been taught or instructed to do is “thrown out the window” and you are told to practice a new regimen. How would this initially make you feel? Would you demand answers and explanation or just go with it? SIMULATION ACTIVITY • Language Barriers: Ask a student in the class who is fluent in another language to go over brushing/flossing importance, technique, and a brief description of periodontal diseases. Do this without telling the rest of the class exactly what they are speaking about. After the student is finished, ask the class what they think he or she said and use this as an example of how a patient may feel when there is a language barrier. FIELD EXPERIENCES • Have students participate in clinical experiences with a variety of populations. • Have students participate in a group assignment in class . This assignment should entail students working in partners and discussing the oral health values, beliefs of their parents or guardians. Then have them discuss their person beliefs. Each student to report their

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition partner’s “upbringing” in oral health values. • Assign each student a specific ethnic group to research their beliefs, practices, values about oral health. They can use peer reviewed sources, but also they can use personal conversation with individuals from the specific group. Have them discuss with the class.

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition Chapter 3 Dental Hygiene Science OBJECTIVES After studying this chapter, the student should be able to: 1. Describe the dental hygiene process of care. 2. Describe the integration of the dental hygiene process of care into the dental hygiene a p- pointment. 3. Compare and contrast dental hygiene therapy for patients with and without attachment loss. 4. Describe the elements of the dental hygiene appointment. 5. Describe the use of the CDT in creating a dental hygiene care plan. 6. Define dental public health . 7. Describe community programs aimed at preventing diseases. LECTURE OUTLINE I. INTRODUCTION A. Owning Culture B. Group Cultural Representation C. Moving Beyond Diversity to Inclusiveness

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition D. Cultural Beliefs and Preventive Dental Care E. Cultural Competence and Health Outcomes II. SUMMARY DISCUSSION ITEMS • Ask students to discuss patient experiences with process of care. • Ask students to bring in articles from newspaper s , magazines , and/ or the I nternet about a public program that focus es on preventive modalities . Use these articles to begin the di s- cussion about the difference between individualized patient care and public health pr o- grams . SIMULATION ACTIVITY • Have the students , work ing in groups of three or four , explain a patient case and/or a pu b- lic health case that uses the process of care steps. When their work is complete, have the groups pr e sent it briefly to the class. FIELD EXPERIENCES • Have students, using as their basis patients from clinic or public health programs that they are involved with, write up a process of care case study. • Have students develop case study multiple choice test items that focus on the process of care steps for an assignment. Utilize the format of the National Board Dental Hygiene Examination. This will help them with the process of care steps and practice, while pr o viding exper i ence with case study multiple choice test items.

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition UNIT 2 ETIOLOGY OF DENTAL DISEASES AND CONDITIONS Chapter 4 Dental Plaque Biofilm OBJECTIVES After studying this chapter, the student should be able to: 1 . Differentiate between organic coatings of endogenous and exogenous (acquired) origin. 2. Explain why dental plaque is not unique among naturally occurring microbial layers. 3. Describe the mechanisms proposed to explain bacterial adhesion to the acquired pellicle. 4. Distinguish between primary and secondary bacterial colonizers in dental plaque, and cite examples of each. 5. Identify the primary sites of calculus formation, explain how calculus forms, and detail the differences between supragingival and subgingival calculus. 6. Describe the basis for the involvement of the acquired pellicle, bacterial dental plaque, and dental calculus in caries and the inflammatory periodontal diseases. LECTURE OUTLINE I. INTRODUCTION A. Dental Plaque: A Microbial Biofilm

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition B. Bacterial Colonization of the Mouth C. The Acquired Pellicle D. Dental Plaque Formation E. Molecular Mechanisms for Bacterial Adhesion F. Bacteria in the Dental Plaque G. Dental Plaque Matrix H. Dental Plaque Metabolism I. Dental Calculus i. Attachment of Calculus to the Teeth ii. Inhibition of Calculus Formation II. SUMMARY DISCUSSION ITEMS • Discuss clinical patients accumulation and subsequent conditions and/or diseases as a way to begin applying theories of plaque biofilm from the chapter. • Have students research calculus inhibition products that patients have used and be ready to discuss in class. SIMULATION ACTIVITIES • Have the students explain the roles that plaque and calculus play in gingivitis and periodontal diseases in lay terms or in a way that would be easiest for the patient to understand.

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition • Have students practice the Patient Hygiene Performance (PHP) in class on each other. Instructor will need to explain the PHP first and bring gloves and explorer to class. FIELD EXPERIENCES • Have students perform a specific plaque and/or calculu index or indexes in clinic on patients as a requirement. • Have students research the historical aspects of plaque theories and present in class .

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition Chapter 5 Carious Lesions OBJECTIVES After studying this chapter, the student should be able to: 1 . Describe the four types of carious lesions that are found on the different surfaces of teeth. 2. Describe the histologic characteristics of enamel and dentin that facilitate fluid flow throughout a tooth. 3. Describe the four zones of an incipient caries lesion. 4. Describe the conduits (pores) that directly conduct acid from the bacterial plaque to the body of the lesion. 5. List the bacteria most often implicated in the caries process, and indicate when each is present in the greatest numbers during the caries process. 6. Describe the series of events in a cariogenic plaque and subsurface lesion from the time of bacterial exposure to sugar until the pH returns to a resting state. 7. Describe the characteristics of root caries, and explain the differences and similarities to coronal caries. 8. Describe why the profession takes so much time in treating secondary caries. 9. Describe the relationship between pH and the saturation of calcium and phosphorus ions in caries development. 10. Describe the protective relationship of calcium fluoride to hydroxyapatite and fluorhydroxyapatite during an acidogenic attack.

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition LECTURE OUTLINE I. INTRODUCTION A. Multifactorial Disease Process B. Description of Carious Lesions C. Physical and Microscopic Features of Incipient Caries i. Pore Spaces of the Different Zones ii. Direct Connection of the Bacterial Biofilm to the Body of the Lesions D. Cariogenic Bacteria i. Mutans Streptococci and Caries ii. Lactobacilli and Caries E. Adherence of Bacteria to Teeth F. Ecology of Caries Development i. Caries Transmission ii. Coronal Dentin Caries iii. Root Caries iv. Secondary, or Recurrent Caries v. Measuring Plaque pH, the Stephan Curve vi. The Relationship of Mineral Saturation to pH G. Demineralization and Remineralization Principles i. The Relationship between HAP, FHA and CaF 2 ii. Depth of Remineralization II. SUMMARY

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition DISCUSSION ITEMS • Have students arrive to class with one interesting fact on the history of dental caries. This should begin a great discussion on the evolution of dental caries etiology. • Utilize photographs on clinical signs of dental caries from incipient phase to frank decay, to lead a discussion on demineralization. SIMULATION ACTIVITIES • Have students practice exploration for dental carious lesions in clinical rotations. This is an easily applied practice situation for the understanding of demineralization. • Have students watch videos depicting demineralization and remineralization concepts. FIELD EXPERIENCES • Have students present on various modalities used for dental remineralization. • Have students work in groups to present information on the various methods USED TO DIAGNOSE DENTAL DECAY.

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition Chapter 6 Periodontal Diseases OBJECTIVES After studying this chapter, the student should be able to: 1. Name and describe the functions of the four components of the periodontium. 2. Describe the normal gingival sulcus. 3. Differentiate between gingivitis and periodontitis. 4. Describe the role of clinical attachment loss in making the correct diagnosis between gingiv i tis and periodontitis. 5. Describe characteristic microflora associated with periodontal health, gingivitis, and peri o dontitis. 6. Starting with a healthy periodontium and en d ing with advanced periodontitis, describe how periodontal disease progresses. 7. Describe the relationship of supragingival plaque and subgingival plaque biofilm to peri o dontal diseases. 8. Describe the role of the host defenses involved in periodontal disease. 9. Discuss the purposes of a classification system for periodontal diseases. 10. Describe the classification system categories for gingivitis and periodontitis. 11. Define a “risk factor for periodontal diseases.” 12. List the risk factors associated with periodontal diseases.

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition LECTURE OUTLINE I. INTRODUCTION A. The Periodontium B. The Gingival Sulcus C. Periodontal Microflora D. The Developing Gingival Lesion E. The Deepening Pocket F. Cellular Defense in the Periodontal Disease Process G. Classifications of Periodontal Diseases H. Risk Factors I. Primary Prevention of Periodontal Diseases II. SUMMARY DISCUSSION ITEMS • Prior to lecture, briefly discuss the students’ current knowledge on the subject matter. Following the lecture, have a similar discussion in order to evaluate what the students have learned. For further discussion allow students to write down two or three questions for which they may need clarification. Read the questions aloud and determine if class members can answer each other’s questions effectively. • Discuss the three ways that systemic disease and periodontal diseases are related and what this means for health professionals.

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition SIMULATION ACTIVITY • Have the students work in groups of three to four to map out the progression of periodontal disease, starting with a healthy periodontium and end ing with advanced periodontitis. Students should demonstrate their knowledge by including as many steps and risk factors associated with each stage in this process as possible. When students have completed this activity, allow one student to represent his or her group and review what the group members have with the class. Repetition allows the students to hear the material in different ways and continue learning after the lecture is finished. FIELD EXPERIENCES • H ave students go to a periodontal specialist in your community for at least half a day. Engaging the students in the topic of periodontal disease will help to increase their understanding of the subject matter. Students should have the opportunity to speak with the doctor or hygienist in this practice about her or his day - to - day work. • An alternative to the first suggestion in this list is to ask one of the local periodontists to come as a guest speaker. The guest speaker may present the topic in a new way for students. Instruct the students to have questions ready prior to meeting with the guest speaker.

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition Chapter 7 Oral Cancer OBJECTIVES After studying this chapter, the student should be able to: 1. Describe the epidem i ology of oral cancer. 2. Identify risk factors that co n tribute to oral cancer. 3. Identify signs and symptoms of oral cancer. 4. Identify factors to pr e vent oral cancer. 5. Describe the common loc a tions for oropharyngeal cancers. 6. Describe the various scree n ing and diagnostic tools used to detect oral cancer. 7. Describe the steps in a co m plete oral cancer examination. 8. Identify the staging system used for oral cancer. 9. Identify appropriate referral sites. 10. Describe treatment o p tions. 11. Identify resources available to health care providers and patients. 12. Identify practical considerations for health care providers. LECTURE OUTLINE I. INTRODUCTION A. Epidemiology Of Oral Cancer

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition B. Risk Factors i. Tobacco ii. Alcohol iii. Human Papillomavirus iv. Age v. Race and Ethnicity vi. Actinic Radiation (Ultraviolet Light) Exposure vii. Potentially Malignant Oral Epithelial Lesions a. Leukoplakia, Erythroplakia, and Erythroleukoplakia (Speckled Le u koplakia) b. Oral Lichen Planus viii. Immune System Suppression C. Signs and Symptoms Of Oral Cavity Or Oropharyngeal Cancer D. Detection and Diagnosis Of Ora l Cancer i. Health History ii. Oral Cancer Screening/Examination c. Screening and Diagnostic Aids iii. Biopsy Types a. Fine Needle Aspiration Biopsy b. Punch Biopsy c. Scalpel Biopsy iv. Imaging E. Prognosis of Oral Cancer: Staging System

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition F. Treatment Options For Oral Cancer i. Considerations Regarding Treatment Options ii. Surgery iii. Radiation Therapy a. Types of Radiation Therapy iv. Chemotherapy G. Management of Side Effects From Treatment Of Oral Cancer i. Surgical Reconstruction ii. Toxicity and Side Effects of Radiation Therapy iii. Toxicity and Side Effects of Chemotherapy H. Role of The Dental Team i. Education ii. Public Health Screening for Oral and Pharyngeal Cancers iii. Cultural Sensitivity II. SUMMARY DISCUSSION ITEMS • Have the students d escribe one of the screening and diagnostic tools used to detect oral cancer that was presented in the lecture. This may help students to process this information. • Choose real - life patient scenarios from the clinical setting and have students discuss ways to educate their patient in the given situation. • Discuss the overall lecture by having students write down their perceptions about and

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition experiences with oral cancer. Ask students to share their responses either with the class or with a student sitting next to them. SIMULATION ACTIVITIES • In pairs, one student assumes the clinician role and the other the patient role. The clinician should teach the patient how to perform an extraoral cancer screening. The clinician should discuss what he or she is looking for in lay terms and answer any questions the patient may have. • Have the student work in pairs or groups of four. Ask them to consider the role of the dental hygienist in patients with oral cancer. Develop a list of practical considerations for patients and their family members. Collect all lists at the end of the activity and review them for the class. FIELD EXPERIENCES • Visit a clinic or a nursing home in order to teach people how to self - screen . Perform oral cancer screenings on every patient and explain why you are doing an oral cancer examination. Then allow the patient to ask questions and demonstrate a self - screening method in order for the students to help with technique and make appropriate adjustments. • Ask the whole class to develop material for a continuing education program that will educate health professionals on oral cancer and the multiple aspects of the disease. Make sure to include the role of the health professional. • Allow student to break into small groups to develop and d istribute oral cancer

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition educational material s to various facilities. Some of the appropriate facilities are outlined in Chapter 7 and are as follows: o Local health departments o Private practices o Senior centers o Long - term care facilities o Drug abuse treatment centers o Schools for nurses o Physicians and physician a ssistants • Ask the students to go on a rotation to one of the facilities listed in the previous Field Experience and provide oral cancer screenings. The following evaluation form may be used.

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition EVALUATION FORM : ROTATION* Name: ______________________________ Evaluation By: ____________________ Activity: _____________________________ Date: ____________________________ 0 — Failed 1 — Poor P erformance 2 — Fair but N eeds I mprovement 3 — Good Student was on time for event and did not leave until the task was completed . Student performed all task s to the best of her or his ability and asked questions when appropriate . Student demonstrated knowledge on the subject matter and educated patients well and correctly . Student was professional at all times and respectful to patients . *Please justify each score with a detailed response to allow for student improvement.

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition Chapter 8 Dental Trauma OBJECTIVES After studying this chapter, the student should be able to: 1. Define dental trauma . 2. Describe the etiology of dental trauma. 3. Describe the assessment of trauma. 4. List and describe the categories of dental trauma. LECTURE OUTLINE I. INTRODUCTION A. Etiology i. Resorption ii. Inflammatory Resorption B. Initial Examination C. Soft Tissue Injuries D. Categories of Traumatic Dental Injuries E. Injury to Primary Teeth i. Intruded Primary Teeth ii. Avulsed Primary Teeth

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition F. Injury to Permanent Teeth i. Avulsed Secondary Teeth ii. Preservation of Avulsed Teeth iii. Preservation of Periodontal Ligament iv. Clinical Steps for Reimplantation a. Splinting b. Healing of the Pulp v. Fractured Secondary Teeth vi. Displaced Secondary Teeth vii. Intruded Secondary Teeth G. Public Education on Dental Trauma H. Research on Dental Trauma I. SUMMARY DISCUSSION ITEMS • Invite a guest speaker with a lot of experience on dental trauma to develop a practical application or PowerPoint presentation to the students about this subject matter. • Ask students to search for advertisements in magazines, in newspapers, or online that promote mouth guards. Students should bring in articles and use them in class to begin the discussion about prevention or oral trauma.

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition SIMULATION ACTIVITIES • Have the students work in groups of three to four to develop an oral trauma preventive program or a program that details the information needed for post - oral - trauma patients. Choose a setting for the program, such as a school or community sporting event, or have each group come up with a setting. After they have developed and recorded their program have students present it briefly to the class. • Have students rotate through an emergency dental experience with the local dental school, dental residency program, community dental clinic, urgent care center or emergency room to be able to have experience with daily dental emergencies. FIELD EXPERIENCES • Search for resources about oral trauma or develop your own pamphlet on the way to manage oral trauma effectively and what to expect. • Develop an emergency dental presentationfor schools (teachers and nurses), parent groups, and other people. Discuss all aspects and answer any questions the groups may have. This is an important way to reach out to the community and educate community members about oral trauma so that more people will know what to do if they are faced with this scenario. If the students present their information to the community , the following evaluation form may be used. Students may self - assess and may also be assessed by the ir instructor.

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    Harris et al., Instructor's Resource Manual for Primary Preventive Dentistry , 8 th edition E VALUATION FORM : ROTATION* Name: _____________________________ Evaluation By: ______________________ Activity: ___________________________ Date: _____________________________ 0 — Failed 1 — Poor P erformance 2 — Fair but N eeds I mprovement 3 — Good Student was on time for event and did not leave until the task was completed . Student performed all task s to the best of her or his ability and asked questions when appropriate . Student demonstrated knowledge on the subject matter and educated patients well and correctly . Student was professional at all times and respectful to patients . *Please justify each score with a detailed response to allow for student improvement.

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