Clinical Textbook of Dental Hygiene and Therapy

Suzanne L. Noble BDS, MFGDP, MDentSci, is Director of the Birmingham School of Dental Hygiene & Therapy, The University of Birmingham

Author biographies ix Preface xv

Acknowledgements xvi

Section 1 Core Basic Science 1

1 Oral embryology, histology and anatomy 3
Sheila Phillips

Introduction 3

Oral embryology 3

Early tooth development 4

Development of the dental tissues 5

Histology of oral tissues 8

Histology of dental tissues 11

Oral anatomy 15

Anatomy of the oral cavity 20

Tooth morphology 26

2 General pathology 32
Henk S. Brand and Arjan Vissink

Introduction 32

Inflammation and immunity 32

Wound healing 38

Hyperplasia, hypertrophy and atrophy 39

Neoplasia 41

Haemostasis 46

Atherosclerosis 48

Cardiac disease 49

Hypertension 51

3 Oral medicine and pathology 53
Paula Farthing

Introduction 53

Viral infections 53

Oral ulceration 54

White patches and premalignant lesions of the oral mucosa 56

Oral cancer 58

Soft tissue swellings of the oral mucosa 60

Cysts of the jaws 62

Conditions of the salivary glands 64

Oral manifestations of systemic disease 65

Common causes of facial pain 66

Disorders of the temporomandibular joint 67

Developmental tooth anomalies 67

Tooth wear 70

4 Dental caries and pulpitis 72
Avijit Banerjee and Naveen Karir

Introduction 72

Aetiology and microbiology of dental caries in relation to dental plaque 72

The epidemiology of caries 79

Features of enamel, dentine and root caries 80

Diagnostic methods for dental caries 83

Non-surgical management of dental caries 86

Surgical management of dental caries 86

The histopathology of pulpitis 88

Abscess formation 88

Section 2 Clinical 91

5 The periodontium, tooth deposits and periodontal diseases 93
Philip R. Greene and Maggie Jackson

Introduction 93

The normal periodontium 93

The classification of periodontal disease 96

Chronic gingivitis 96

Chronic periodontitis 98

Aggressive periodontitis 100

Histopathology of periodontal diseases 101

Gingival recession 102

Acute periodontal conditions 102

Microbiological aspects of periodontal disease 104

Principles of periodontal examination 105

Treatment of chronic periodontitis 111

Conclusion 123

6 Oral health education and promotion 125
Jane M. Pratt

Introduction 125

Meaning of health 126

Defining health education and health promotion 126

Promotion of oral health 127

Considerations while planning health education and health promotion 130

Planning a teaching session 133

Oral health promotion/education examples 136

Conclusion 138

7 Diet and nutrition 139
Suzanne L. Noble

Introduction 139

The relationship between diet and disease 139

The current national dietary

recommendations 140

Dietary requirements of groups with special needs 145

The effect of ethnicity and culture on nutrition 147

Dietary needs in specific states of disease 147

The principles behind the dietary control of dental caries 147

Classification of sugars in relation to dental caries 149

Alternative sweeteners 151

The relationship between diet and erosion 152

The relationship of diet to periodontal diseases 153

The role of the dental hygienist/therapist in dietary advice and counselling 155

8 Microbiology and infection prevention and control 158
Mary J. O’Donnell, Denise MacCarthy and David C. Coleman

Introduction 158

Requirement for a formal infection prevention and control policy 158

Microorganisms 159

Immunisation 161

Standard precautions 162

Hand hygiene 162

Aseptic techniques 164

Protective clothing 164

Processing and handling of dental instruments 166

Surgery design 170

General surface cleaning and disinfection 171

Waste management 171

The dental chair unit as a vehicle for cross-contamination and cross-infection 172

The dental laboratory 176

Diagnostic specimens 177

9 Materials in restorative dentistry 181

Paul Franklin and Paul Brunton
Introduction 181

Amalgam 181

Resin composite 183

Glass ionomer cements 187

Cermets 191

Compomers 191

Materials for the protection of fissures 192

Adhesion to tooth substance 192

Pulp protection regimes 195

Temporary dressing materials 196

Impression materials 197

Key points 198

10 Pharmacology and pain control 199
Margaret Kellett

Introduction 199

Prescribing regulations and the use of the BNF 199

The use of antibiotics and antimicrobials in dentistry 201

The use of analgesics in dentistry 204

The relevance of other drugs that may affect oral health and dental treatment 205

Local analgesic agents 208

Techniques for local analgesia 209

Difficulties, complications and emergencies that can be associated with local analgesia 214

Equipment used in dental local analgesia 216

Conclusions 218

11 Preventive dentistry 219
Sarah Murray and Baldeesh Chana

Introduction 219

Definitions of prevention 219

Prevention of periodontal disease 221

Prevention of caries 224

Fluoride 225

Fissure sealants 229

Life-long prevention 231

Prevention for persons

with special needs 232

Prevention and implantology 233

Oral cancer screening 235

Alcohol abuse 236

Smoking cessation 237

Smoking habits 237

Illegal drug abuse 240

The primary health care team 241

12 Paediatric dentistry 244
Sharon M.G. Lee and George T.R. Lee

Introduction 244

Dental development 244

Tooth notation 244

Tooth eruption 245

Morphological differences between primary and permanent teeth 245

Disruption in the number of teeth 245

Disruption of tooth form 246

Abnormalities of tooth structure 247

Dental caries 248

Tooth wear in children 253

Treatment of dental caries in the primary dentition 254

Soft tissue problems in children 260

Anxiety and pain control 262

Trauma in children 267

13 Adult restorative dentistry 269
Ann C. Shearer

Introduction: the importance of the treatment plan 269

Charting the adult dentition 270

Classification of cavities 270

Preparation of cavities 272

Pulp protection 276

Moisture control 277

Direct restoratives: clinical properties, handling and placement 279

Polishing and finishing restorations 288

Replacing and repairing restorations 288

Temporary restorative materials and their placement 289

Temporary crowns 289

The clinical aspects of taking impressions 290

The management of discoloured teeth 290

The management of tooth wear 291

Management of trauma 293

The principles of advanced restorative care 293

Care of instruments and handpieces 296

The ergonomic environment 297

Management of anxiety 297

14 Exodontia 299
Hazel J. Fraser

Introduction 299

Indications for tooth extraction 299

Contraindications for tooth extraction 300

Relevant anatomical structures 300

Preparation of the patient 300

Obtaining local analgesia 301

Clinical assessment 301

Extraction instruments 302

Extraction technique 304

Postoperative care 307

Complications of exodontia 307

15 Gerodontology 311
Fiona Sandom

Introduction 311

Physiological age changes 311

Pathological change 314

Nutritional disturbance 318

The dentate elderly 318

Domiciliary care 318

Treatment of the terminally ill 321

16 Medical emergencies and their management 325
Lesley Longman and Colette Balmer

Introduction 325

Management considerations 325

The role of the hygienist/therapist 327

Avoidance of a medical emergency 327

Assessment of the sick patient using the ‘ABCDE’ approach 329

Medical emergencies 330

Patient discharge 345

Conclusion 346

17 Health and safety at work 347
Hilary R. Samways

Introduction 347

Working environment 347

Materials 348

Equipment 348

First aid 350

Waste disposal 350

Accident book 351

Fire prevention 352

Radiation protection 353

Personal protection 354

Clinical governance 359

Risk assessment 359

18 Complementary and alternative medicine 361
Philip Wander

Introduction 361

Acupuncture 362

Herbalism 363

Aromatherapy 363

Chiropractic 364

Osteopathy 364

Hypnosis 364

Homeopathy 365

Biological medicine for the twenty-first century 369

Section 3 Non-clinical 371

19 Primary care services 373
Sara Holmes and Leanna Wynne

Introduction 373

The framework of UK primary dental care service provision 374

The provision of NHS dental services 374

The primary dental care team 376

The public health agenda and an introduction to epidemiology 379

Summary 382

20 Law, ethics and professionalism 383
Hew Matthewson

Introduction 383

Regulation of dental practice 383

Professional duties and obligations towards patients 385

Patient consent to treatment 388

Relationships with professional colleagues 390

Relationships with the public 391

Clinical governance 392

Employment law 394

Sources of advice 394

Index 396

Companion Website

This book is accompanied by a website: www.wiley.com/go/noble/dentalhygiene

The website includes:

● Multiple Choice Questions

● Figures from the book