Class Notes for Primary Preventive Dentistry, 8th Edition

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionUNIT 1PRIMARY PREVENTIVE DENTAL CONCEPTSChapter1Introduction to Primary Preventive DentistryOBJECTIVESAfter studying the chapter, the student should be able to:1.Define and apply the following key terms:primary,secondary, andtertiary prevention.2.Describe the historical aspect of preventive dental care.3.Describe the state of dental health in theUnitedStates.4.Describe categories that aid in classifying diseases.5.Describe risk assessment in dental care delivery.LECTURE OUTLINEI.INTRODUCTIONA.Historical Aspect of Preventive Dental CareB.Dental Diseases and Systemic HealthC.Health Defined and Primary Preventive Carei.Primary Preventionii.Secondary and Tertiary Preventioniii.Preventive Care

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionD.Categories of Oral Diseasesi.Plaque Biolfilm PreventionII.RISK ASSESSMENTIII.SUMMARYDISCUSSION ITEMS•Discuss overall dental health by having students write down their thoughts on what dentalhealth means in general and what dental health means to them.•Ask students to bring in articles from the newspaper, magazines, or the Internet about apublic health issue that focus on preventive modalities and use these articles to begin thediscussion 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. Afterstudents have developed and recorded their program, have them present it briefly to theclass. Collect the programs and keep them until one of the final class periods, when youhave discussed disease and prevention. Return the original programs to the groups andhave the students make necessary revisions to each program. Students enjoy this activity.The first program tends to be limited about preventive dental health, but by the end of thecourse, the preventive health programs expand to include many areas. This is a greatconfidence builder to future dental providers.

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionFIELD EXPERIENCES•Begin the process of literature reviews at the beginning of the course. Assign a preventivetopic. The following outline provides a framework for the paper’s progression. Byassigning sections of the paper during the semester(s), students have the opportunity tolearn about scientific writing and more thoroughly research their topics.•When the students present their preventive literature reviews in class, the followingevaluation form may be used. It is helpful to have the evaluations completed by thecourse director, fellow students, and the students themselves. This provides practice atself-assessment and peer-assessment techniques.LITERATURE REVIEW ON PREVENTIVE MODALITYGUIDELINES1.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 GUIDELINES1.Introduction—4 pts.a.To acquaint reader with the topic and intent of the writer.b.Basic overview.c.Major goal of paper.d.Information from the review of the literature can be summarized and presentedbriefly to document the topic.

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8thedition2.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 studentjustifies 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 newstudies, lack of related published research.3.Literature review—12 pts.a.Enable 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 andmaking notes,(4)Research the most current references first because these already incorporateearlier research findings and supply direct source for relevant bibliographies.(5)Save time by scanning abstracts and summaries of past research reports todifferentiate between relevant and irrelevant materials.(6)Organize the review into the following sections: introduction, subtopics, andsummary.4.Bibliography—2 ptsa.The bibliography shouldbe formatted according to the professional author

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionguidelines of theJournal of Dental Hygiene.By using these guidelines, studentsshould begin understanding the format for scientific writing, which should also helpthem understandthearticles readin the field.

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionEVALUATION FORM: PRESENTATIONStudents:______________________________________________________________________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, 8theditionChapter2Cultural Health InfluencesOBJECTIVESAfter studying the chapter, the student should be able to:1.Definecultureand its relevance to the contemporary health care profession.2.Describe influences of culture on aspects of U.S. society that impact preventivehealthcare 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 OUTLINEI.INTRODUCTIONA.Owning CultureB.Group Cultural RepresentationC.Moving Beyond Diversity to InclusivenessD.Cultural Beliefs and Preventive Dental CareE.Cultural Competence and Health OutcomesII.SUMMARY

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionDISCUSSION ITEMS•Ask students to create a list of outcomes that could occur if a patient in a dental settingdid not understand post-op instructions, patient education, what to reschedule for, and soon.•Ask students to put themselves in the situation. Imagine you have moved to a newcountry and, when you seek medical treatment, much of what you have been taught orinstructed 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 orjust go with it?SIMULATION ACTIVITY•Language Barriers: Ask a student in the class who is fluent in another language to go overbrushing/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. Afterthe student is finished, ask the class what they think he or she said and use this as anexample 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 entailstudents working in partners and discussing the oral health values, beliefs of their parentsor guardians. Then have them discusstheir person beliefs. Each student to report their

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionpartner’s “upbringing” in oral health values.•Assign each student a specific ethnic group to research their beliefs, practices, valuesabout oral health.They can use peer reviewed sources, but also they can use personalconversation 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, 8theditionChapter3Dental Hygiene ScienceOBJECTIVESAfter 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 ap-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 theCDTin creating a dental hygiene care plan.6. Definedental public health.7. Describe community programs aimed at preventing diseases.LECTURE OUTLINEI.INTRODUCTIONA.Owning CultureB.Group Cultural RepresentationC.Moving Beyond Diversity to Inclusiveness

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionD.Cultural Beliefs and Preventive Dental CareE.Cultural Competence and Health OutcomesII.SUMMARYDISCUSSION ITEMS•Ask students to discuss patient experiences with process of care.•Ask students to bring in articles from newspapers, magazines, and/or theInternet about apublicprogramthat focuseson preventive modalities. Use these articlesto begin the dis-cussion aboutthe difference between individualized patient care and public health pro-grams.SIMULATION ACTIVITY•Have the students,workingin groups of threeorfour,explain a patient case and/or a pub-lichealth case that uses the process of care steps. When their work is complete, have thegroups present it briefly to the class.FIELD EXPERIENCES•Have students, using as their basis patients from clinic or public health programs thatthey 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 ofcare steps for an assignment. Utilize the format of the National Board Dental HygieneExamination. This will help them with the process of care steps and practice, whileproviding experience with case study multiple choice test items.

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionUNIT 2ETIOLOGY OF DENTAL DISEASES AND CONDITIONSChapter4Dental Plaque BiofilmOBJECTIVESAfter studying this chapter, the student should be able to:1.Differentiate between organic coatings of endogenous and exogenous (acquired) origin.2.Explainwhy 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 citeexamples of each.5.Identify the primary sites of calculus formation, explain how calculus forms, and detail thedifferences between supragingival and subgingival calculus.6.Describe the basis for the involvement of the acquired pellicle, bacterial dental plaque, anddental calculus in caries and the inflammatory periodontal diseases.LECTURE OUTLINEI.INTRODUCTIONA.Dental Plaque: A Microbial Biofilm

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionB.Bacterial Colonization of the MouthC.The Acquired PellicleD.Dental Plaque FormationE.Molecular Mechanisms for Bacterial AdhesionF.Bacteria in the Dental PlaqueG.Dental Plaque MatrixH.Dental Plaque MetabolismI.Dental Calculusi.Attachment of Calculus to the Teethii.Inhibition of Calculus FormationII.SUMMARYDISCUSSION ITEMS•Discuss clinical patients accumulation and subsequent conditions and/or diseases as away to begin applying theories of plaque biofilm from the chapter.•Have students research calculus inhibition products that patients have used and be readyto discuss in class.SIMULATION ACTIVITIES•Have the students explain the roles that plaque and calculus play in gingivitis andperiodontaldiseases in lay terms or in a way that would be easiest for the patient tounderstand.

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8thedition•Have students practice the Patient Hygiene Performance (PHP) in class on each other.Instructorwill 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 onpatients 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, 8theditionChapter5Carious LesionsOBJECTIVESAfter 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 flowthroughout 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 bodyof the lesion.5.List the bacteria most often implicated in the caries process, and indicate when each ispresent in the greatest numbers during the caries process.6.Describe the series of events in a cariogenic plaque and subsurface lesion from the time ofbacterial exposure to sugar until the pH returns to a resting state.7.Describe the characteristics of root caries, and explain the differences and similarities tocoronal caries.8.Describe whythe profession takesso much timein treating secondary caries.9.Describe the relationship between pH and the saturation of calcium and phosphorus ions incaries development.10.Describe the protective relationship of calcium fluoride to hydroxyapatite andfluorhydroxyapatite during an acidogenic attack.

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionLECTURE OUTLINEI.INTRODUCTIONA.Multifactorial Disease ProcessB.Description of Carious LesionsC.Physical and Microscopic Features of Incipient Cariesi.Pore Spaces of the Different Zonesii.Direct Connection of the Bacterial Biofilm to the Body of the LesionsD.Cariogenic Bacteriai.Mutans Streptococciand Cariesii.Lactobacilli and CariesE.Adherence of Bacteria to TeethF.Ecology of Caries Developmenti.Caries Transmissionii.Coronal Dentin Cariesiii.Root Cariesiv.Secondary, or Recurrent Cariesv.Measuring Plaque pH, the Stephan Curvevi.The Relationship of Mineral Saturation to pHG.Demineralization and Remineralization Principlesi.The Relationship between HAP, FHA and CaF2ii.Depth of RemineralizationII.SUMMARY

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

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionChapter6Periodontal DiseasesOBJECTIVESAfter 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 betweengingivitis and periodontitis.5.Describe characteristic microflora associated with periodontal health, gingivitis, andperiodontitis.6.Starting with a healthy periodontium and ending with advanced periodontitis, describe howperiodontal disease progresses.7.Describe the relationship of supragingival plaque and subgingival plaque biofilm toperiodontal 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, 8theditionLECTURE OUTLINEI.INTRODUCTIONA.The PeriodontiumB.The Gingival SulcusC.Periodontal MicrofloraD.The Developing Gingival LesionE.The Deepening PocketF.Cellular Defense in the Periodontal Disease ProcessG.Classifications of Periodontal DiseasesH.Risk FactorsI.Primary Prevention of Periodontal DiseasesII.SUMMARYDISCUSSION 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 studentshave learned. For further discussion allow students to write down two or three questionsfor which they may need clarification. Read the questions aloud and determine if classmembers can answer each other’s questions effectively.•Discuss thethree ways that systemic disease and periodontal diseases are relatedand whatthis means for health professionals.

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionSIMULATION ACTIVITY•Have the students work in groups of three to four to map out the progression ofperiodontal disease,starting with a healthy periodontium and ending with advancedperiodontitis. Students should demonstrate their knowledge by including as many stepsand risk factors associated with each stage in this process as possible. When studentshave completed this activity, allow one student to represent his or her group and reviewwhat the group members have with the class. Repetition allows the students to hear thematerialin different ways and continue learning after the lecture is finished.FIELD EXPERIENCES•Have students go to a periodontal specialist in your communityfor at least half a day.Engaging the students in the topic of periodontal disease will help to increase theirunderstanding of the subject matter. Students should have the opportunity to speak withthe doctor or hygienistin this practiceabouther or hisday-to-day work.•An alternative to the first suggestion in this list is to ask one of the local periodontists tocome as a guest speaker. The guest speaker may present the topic in a new way forstudents. Instruct the students to have questions ready prior to meeting with the guestspeaker.

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionChapter7Oral CancerOBJECTIVESAfter studying this chapter, the student should be able to:1.Describe the epidemiology of oral cancer.2.Identify risk factors that contribute to oral cancer.3.Identify signs and symptoms of oral cancer.4.Identify factors to prevent oral cancer.5.Describe the common locations for oropharyngeal cancers.6.Describe the various screening and diagnostic tools used to detect oral cancer.7.Describe the steps in a complete oral cancer examination.8.Identify the staging system used for oral cancer.9.Identify appropriate referral sites.10.Describe treatment options.11.Identify resources available to health care providers and patients.12.Identify practical considerations for health care providers.LECTURE OUTLINEI.INTRODUCTIONA.Epidemiology Of Oral Cancer

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionB.Risk Factorsi.Tobaccoii.Alcoholiii.Human Papillomavirusiv.Agev.Race and Ethnicityvi.Actinic Radiation (Ultraviolet Light) Exposurevii.Potentially Malignant Oral Epithelial Lesionsa.Leukoplakia, Erythroplakia, and Erythroleukoplakia(SpeckledLeukoplakia)b.Oral Lichen Planusviii.Immune System SuppressionC.Signs and Symptoms Of Oral Cavity Or Oropharyngeal CancerD.Detection and Diagnosis Of Oral Canceri.Health Historyii.Oral Cancer Screening/Examinationc.Screening and Diagnostic Aidsiii.Biopsy Typesa.FineNeedle Aspiration Biopsyb.Punch Biopsyc.Scalpel Biopsyiv.ImagingE.Prognosis of Oral Cancer: Staging System

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionF.Treatment Options For Oral Canceri.ConsiderationsRegarding Treatment Optionsii.Surgeryiii.Radiation Therapya.Types of Radiation Therapyiv.ChemotherapyG.Management of Side Effects From Treatment Of Oral Canceri.Surgical Reconstructionii.Toxicity and Side Effects of Radiation Therapyiii.Toxicity and Side Effects of ChemotherapyH.Role of The Dental Teami.Educationii.Public Health Screening for Oral and Pharyngeal Cancersiii.Cultural SensitivityII.SUMMARYDISCUSSION ITEMS•Have the students describeone of thescreening and diagnostic tools used to detect oralcancerthat was presented in the lecture. This may help students to process thisinformation.•Choose real-life patient scenarios from the clinical setting and have students discuss waysto 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, 8theditionexperiences with oral cancer. Ask students to share their responses either with the class orwith a student sitting next to them.SIMULATION ACTIVITIES•In pairs, one student assumes the clinician role and the other the patient role. Theclinician should teach the patient how to perform an extraoral cancerscreening.Theclinician should discuss what he or she is looking for in lay terms and answer anyquestions the patient may have.•Have the student work in pairs or groups of four. Ask them to consider the role of thedental hygienist in patients with oral cancer. Develop a list of practical considerations forpatients and their family members. Collect all lists at the end of the activity and reviewthem for the class.FIELD EXPERIENCES•Visit a clinic or anursing homein order toteach people how to self-screen.Perform oralcancer screenings on every patientand explain whyyou are doing an oral cancerexamination.Then allow the patient to ask questions and demonstrate a self-screeningmethod in order for the students to help with technique and make appropriateadjustments.•Ask the whole class to develop material for acontinuing education program that willeducate health professionals on oral cancer and the multiple aspects of the disease. Makesure to include the role of the health professional.•Allow student to break into small groups to develop and distributeoral cancer

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditioneducationalmaterials to various facilities. Some of the appropriate facilities are outlinedin Chapter 7 and are as follows:oLocal health departmentsoPrivate practicesoSenior centersoLong-term care facilitiesoDrug abuse treatment centersoSchools for nursesoPhysiciansand physician assistants•Ask the students to go on a rotation to one of the facilities listed in the previous FieldExperience and provide oral cancer screenings. The following evaluation form may beused.

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionEVALUATION FORM: ROTATION*Name:______________________________Evaluation By:____________________Activity:_____________________________Date:____________________________0—Failed1—PoorPerformance2—Fair butNeedsImprovement3—GoodStudent was on time forevent and did not leaveuntil the task wascompleted.Student performed all tasksto the best ofher or hisability and asked questionswhen appropriate.Student demonstratedknowledge on the subjectmatter and educatedpatients well and correctly.Student was professional atall times and respectful topatients.*Pleasejustify each score with a detailed responseto allowforstudentimprovement.

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionChapter8Dental TraumaOBJECTIVESAfter studying this chapter, the student should be able to:1.Definedental trauma.2.Describe the etiology of dental trauma.3.Describe the assessment of trauma.4.List and describe the categories of dental trauma.LECTURE OUTLINEI.INTRODUCTIONA.Etiologyi.Resorptionii.Inflammatory ResorptionB.Initial ExaminationC.Soft Tissue InjuriesD.Categories of Traumatic Dental InjuriesE.Injury to Primary Teethi.Intruded Primary Teethii.Avulsed Primary Teeth

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionF.Injury to Permanent Teethi.Avulsed Secondary Teethii.Preservation of Avulsed Teethiii.Preservation of Periodontal Ligamentiv.Clinical Steps for Reimplantationa.Splintingb.Healing of the Pulpv.Fractured Secondary Teethvi.Displaced Secondary Teethvii.Intruded Secondary TeethG.Public Education on Dental TraumaH.Research on Dental TraumaI.SUMMARYDISCUSSION ITEMS•Invite a guest speaker with a lot of experience on dental trauma to develop a practicalapplication or PowerPoint presentation to the students about this subject matter.•Ask students to search for advertisements in magazines, in newspapers, or online thatpromote mouth guards. Students should bring in articles and use them in class to beginthe discussion about prevention or oral trauma.

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionSIMULATION ACTIVITIES•Have the students work in groupsof three to four to develop an oral trauma preventiveprogram 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 haveeach group come up with a setting. After they have developed and recorded their programhave students present it briefly to the class.•Have students rotate through an emergency dental experience with the local dentalschool, dental residency program, community dental clinic, urgent care center oremergency 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 tomanage oral trauma effectively and what to expect.•Develop an emergency dental presentationfor schools (teachers and nurses), parentgroups, and other people. Discuss all aspects and answer any questions the groups mayhave. This is an important way to reach out to the community and educate communitymembers about oral trauma so that more people will know what to do if they are facedwith this scenario.If the students present their information to the community,thefollowing evaluation form may be used. Students may self-assess and may also beassessed by theirinstructor.

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Harris et al.,Instructor's Resource Manual for Primary Preventive Dentistry, 8theditionEVALUATION FORM: ROTATION*Name:_____________________________Evaluation By:______________________Activity:___________________________Date:_____________________________0—Failed1—PoorPerformance2—Fair butNeedsImprovement3—GoodStudent was on time forevent and did not leaveuntil the task wascompleted.Student performed alltasksto the best ofher orhisability and askedquestions whenappropriate.Student demonstratedknowledge on thesubject matter andeducated patients welland correctly.Student was professionalat all times andrespectful to patients.*Please justifyeach score with a detailed response to allow for student improvement.

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