Brief Contents
About the Author xix
Preface xxi
Acknowledgments xxiii
List of Abbreviations xxv
How to Read this Book xxix
1 Health History Treatment Modifications 1
2 Extraoral Exam, Intraoral Exam, and Oral Cancer Screening 47
3 Radiographs and Interpretation 67
4 Treatment Planning 103
5 Preventive Dentistry 115
6 Periodontics 151
7 Operative Dentistry 173
8 Endodontics 209
9 Oral Surgery 255
10 Toothaches 307
11 Crown and Bridge 323
12 Complete Dentures 377
13 Removable Partial Dentures 437
14 Implant Crowns 493
15 Occlusal Guards 515
16 Dental Pharmacology 533
17 Pediatric Dentistry 575
18 Nitrous Oxide and Oxygen Sedation 605
Appendix A: International Association of Dental Traumatology Guidelines 621
Appendix B: Basic Life Support 651
Appendix C: Evidence-based Dentistry Pyramid 657
Appendix D: Ergonomics for the Dentist, Patient, and Dental Assistant 659
Appendix E: “CAMBRA” CAries Management By Risk Assessment 665
Index 669
Contents
About the Author xix
Preface xxi
Acknowledgments xxiii
List of Abbreviations xxv
How to Read this Book xxix
1 Health History Treatment Modifications 1
Real-Life Clinical Questions 2
Relevance 3
Treatment Planning 3
ADA Health History Form 3
General Guidelines 3
Demographic Data 3
Dental Information 6
Medical History 7
Alphabetized Conditions with Treatment Modifications 7
Medications 33
Lab Values 36
Miscellaneous Terms 36
ASA Physical Status Classification System 36
Medical Consultations 38
Sample Form 38
Charting Template 39
Clinical Pearls 39
Troubleshooting 39
Tips 39
Real-Life Clinical Questions Answered 40
References 42
2 Extraoral Exam, Intraoral Exam, and Oral Cancer Screening 47
Real-Life Questions and Comments 48
Relevance 48
Purpose of the EOE, IOE, and OCS 48
Oral Cancer 49
Risk Factors 49
Signs and Symptoms 49
Prognosis 50
Treatment 50
Risk Reduction 50
Screening Frequency 50
Armamentarium 51
Procedural Steps 51
Detecting Oral Cancer Guide from the National Institute for Dental and Craniofacial Research (NIDCR) 56
Adjunctive Technologies 58
The American Dental Association Evidence-Based Clinical Practice Guideline for the Evaluation of Potentially Malignant Disorders in the Oral Cavity 58
Referral 59
Informed Refusal 60
Clinical Pearls: Tips 60
Real-Life Questions and Comments Answered 64
References 65
3 Radiographs and Interpretation 67
Real-Life Clinical Questions 68
Relevance 69
Types of Radiographs 69
Bitewing 69
Periapical 69
Panoramic 69
Occlusal 69
Cone Beam Computed Tomography (CBCT) 70
Treatment Planning 70
Recommendations for Prescribing Dental Radiographs 70
Informed Consents 74
Informed Refusal 74
Verbal Consents 74
Procedural Steps 74
Radiographic Interpretation 75
Diagnostic Image Criteria 75
Diagnosis 75
Additional Considerations 77
Panoramic Anatomy 83
Periapical Anatomy 84
Referrals 86
Charting Template 87
Billing Clarifications 87
Clinical Pearls 88
Troubleshooting 88
Tips 92
Real-Life Clinical Questions Answered 96
References 100
4 Treatment Planning 103
Real-Life Clinical Questions 104
Relevance 104
Treatment Planning Phases 105
Special Sequencing Considerations 106
Tooth Replacement Options 107
Pediatric Treatment Planning 108
Referrals 108
Treatment Plan, Refusal, and Informed Consent Forms 109
Charting Template 109
Clinical Pearls 110
Troubleshooting 110
Tips 111
Miscellaneous 112
Real-Life Clinical Questions Answered 112
References 113
5 Preventive Dentistry 115
Real-Life Clinical Questions 116
Relevance 117
Treatment Planning 118
Armamentarium 118
Clinical/Radiographic Exam 118
Caries Management by Risk Assessment (CAMBRA) 119
Background 119
Oral Hygiene Instructions 125
Motivational Interviewing 125
Basics 125
Specific Populations 128
Nutritional Counseling 130
Background 130
Nutritional Counseling for Oral Health 131
Additional Nutritional Counseling for Specific Populations 132
Tobacco Cessation 133
Procedural Steps 133
Infant Prophylaxis 133
Child Prophylaxis 134
Adult Prophylaxis 134
Sealants 135
Preventive Resin Restoration 136
Fluoride Varnish 136
Silver Diamine Fluoride (SDF) 137
Postoperative Instructions 140
Erosion, Abrasion, and Attrition Prevention 140
Xerostomia 141
Thumb-sucking and Pacifiers 141
Sports Injuries 142
Clinical Pearls 142
Tips 142
Real-Life Clinical Questions Answered 144
References 146
6 Periodontics 151
Real-Life Clinical Questions 152
Relevance 153
What is Periodontal Disease? 153
Diagnosis: New Classification of Periodontitis 153
Chairside Guide to Periodontitis Staging and Grading 154
Periodontal Diagnosis Flowchart 156
Clinical Attachment Level 156
Furcation 156
Mobility 157
Occlusal Trauma 157
Fremitus 157
What Is a Periodontal Abscess? 157
The Periodontal–Systemic Connection 158
Radiographic Findings 159
Treatment Planning 159
Assignment of Periodontal Maintenance Recall Schedule 160
When to Refer to a Periodontist 160
Armamentarium 161
Hand Instrument Advice 162
Prophy Angle and Polishing Paste 162
Ultrasonic Scaler 162
Procedural Steps 163
Comprehensive Periodontal Evaluation 163
Scaling and Root Planing 164
One-Month Reevaluation 165
Periodontal Maintenance 165
Periodontal Abscess Treatment 166
Prognosis 166
Charting Template 167
Clinical Pearls 167
Troubleshooting 167
Tips 167
Miscellaneous 168
Real-Life Clinical Questions Answered 169
References 171
7 Operative Dentistry 173
Real-Life Clinical Questions 174
Relevance 175
Clinical and Radiographic Exam 175
Treatment Planning 176
Informed Consent 176
Armamentarium 177
Procedural Steps 178
Cavity Preparation: External and Internal Outline Forms 178
Cavity Preparation: Principles and Tips 183
Cavity Restoration: Principles and Tips 185
Other Restorative Scenarios 190
Tips for Getting Good Anatomy 193
Postoperative Instructions 194
Clinical Pearls 195
Troubleshooting 195
Tips 200
Real-Life Clinical Questions Answered 202
References 207
8 Endodontics 209
Real-Life Clinical Scenarios 210
Relevance 212
Clinical and Radiographic Exam 212
Diagnostic Testing 213
Pulp Sensitivity Testing 215
Periapical Testing 217
Biting Test 217
Mobility 217
Anesthetic Test 217
Diagnostic Terminology 218
Formulation of Pulpal and Periradicular Diagnoses 219
Types of Tooth Fractures 220
Treatment Type and Indications 221
AAE Endodontic Case Difficulty Assessment Form and Guidelines 222
Treatment Planning 224
Referral to an Endodontist 224
Sample Referral Form 225
Informed Consent 225
Sample Informed Consent Form 226
Armamentarium 227
Dental Materials 230
Endodontic Access 231
Rules of Symmetry 232
Teeth and Relevant Information 232
Endodontic Access Tips 235
Procedural Steps 235
Pulpotomy 236
Pulpectomy 236
Nonsurgical Root Canal Treatment 237
Follow-up 242
Postoperative Instructions 244
Nonsurgical Root Canal Treatment 244
Pulpotomy, Pulpectomy, or Pulpal Debridement 245
Internal Bleaching 245
Procedural Accidents 245
Charting Template 245
Clinical Pearls 246
Troubleshooting 246
Tips 247
Real-Life Clinical Scenarios Answered 247
References 252
9 Oral Surgery 255
Real-Life Clinical Questions 256
Relevance 257
Clinical and Radiographic Exam 257
Treatment Planning 265
Additional Tips 265
Referral to Oral Maxillofacial Surgeon 266
Informed Consent 266
Armamentarium 267
Other Equipment and Materials 268
Extraction Steps 271
Related Surgical Procedures 279
Extraction Postoperative Instructions 288
Charting Template 290
Clinical Pearls 291
Troubleshooting 291
Tips 296
Real-Life Clinical Questions Answered 299
References 304
10 Toothaches 307
Real-Life Questions, Concerns, and Comments 308
Relevance 309
Treatment Planning 309
Dental Trauma Armamentarium 312
Nonodontogenic Toothaches (Referred Pain) 312
Teledentistry and Toothaches 314
Clinical Pearls 315
Troubleshooting 315
Tips 317
Real-Life Questions, Concerns, and Demands Answered 319
References 321
11 Crown and Bridge 323
Real-Life Clinical Scenarios 324
Relevance 326
Clinical and Radiographic Exam 326
Treatment Planning Considerations 328
Terms Used in this Chapter 328
Ferrule 329
Biologic Width 329
Indications and Considerations for Crowns 331
Indications and Considerations for Bridges 333
Author’s Crown Material Decision Tree 334
Crown Material Properties 336
Crown Reduction Guidelines 338
Tripe Tray versus Full Arch Impressions 341
Bite Registration 342
Referrals 342
Consents 343
Shade Selection 343
Background 344
Steps 344
Procedural Steps 344
Crowns 344
Bridges 351
Crown/Bridge Materials and Cement Types 356
Adjusting Crown/Bridge Materials 356
Alternative Steps 357
Removing (“Sectioning”) a Crown 357
Removing (“Sectioning”) a Bridge 359
Seven Scenarios Involving Removable Partial Dentures/Complete Dentures 360
Core Buildup 362
Post and Core 363
Lab Prescriptions 363
Crown 364
Bridge 364
Postoperative Instructions 365
Clinical Pearls 366
Troubleshooting 366
Tips 369
Real-Life Clinical Scenarios Answered 372
References 375
12 Complete Dentures 377
Real-Life Clinical Questions 378
Relevance 379
Setting Realistic Expectations 379
Clinical and Radiographic Exam 380
Evaluation of Existing Dentures for Replacement 380
Evaluation of Edentulous Patient Prior to Denture Fabrication 383
Evaluation of Dentate Patient Prior to Denture Fabrication 387
Treatment Planning 388
Consent Forms 389
Complete Denture Procedural Steps 392
Appointment 1: Preliminary Impressions 392
Appointment 2: Final Impression 393
Appointment 3: Wax Occlusal Rims 399
Teeth Setting Guidelines 406
Appointment 4: Tooth Try-in 408
Appointment 5: Denture Delivery 411
Appointment 6: 24-Hour Follow-up 415
Appointment 7: One-Week Follow-up 416
Appointment 8+: Denture Adjustment 416
Periodic Oral Evaluation (Recall Exam) 416
Related Procedural Steps 417
Interim (Temporary) Dentures 417
Immediate Dentures 417
Complete Denture Opposing Cast Metal RPD 419
Complete Denture Opposing Dentition 419
Complete Denture Opposing Existing Complete Denture 419
Duplicate Existing Dentures 420
Repairs, Relines, Repositions, Additions, and What the Lab Needs from You 420
Lab Prescriptions 423
Postoperative Instructions 424
Complete Denture Instructions 424
Troubleshooting 426
Miscellaneous Advice 432
Real-Life Clinical Questions Answered 434
References 436
13 Removable Partial Dentures 437
Real-Life Clinical Scenarios 438
Relevance 440
Setting Patients’ Expectations 441
Clinical and Radiographic Exam 441
Treatment Planning 442
Sequencing 442
Treatment Needs Prior to Fabricating a Partial (if Indicated) 442
Selecting Appliance Type 444
Kennedy Classification and Relevant Terms 445
Procedural Steps 446
Consent Form 446
Cast Metal RPDs 446
Repairs, Relines, Repositions, Additions, and What the Lab Needs from You 467
Stayplates (Also Known as Acrylic Resin Partial, Interim Partial, Treatment Partial, Transitional Partial, Flipper) 474
Flexible Partials 476
Essix Appliances 478
Immediate Partials 480
Complete Dentures Opposing Cast Metal RPDs 481
Lab Prescriptions 481
Cast Metal RPDs 481
Stayplates 482
Flexible Partials 482
Essix Appliances 483
Immediate Partials 483
Postoperative Instructions 483
Clinical Pearls 485
Troubleshooting 485
Tips 486
Real-Life Clinical Scenarios Answered 486
References 491
14 Implant Crowns 493
Real-Life Clinical Questions 494
Relevance 495
Treatment Planning 495
Indications and Contraindications for Dental Implants 495
Clinical and Radiographic Exam 496
Clinical and Radiographic Dimensions for Implants 496
Cement- Versus Screw-Retained Implant Crown 497
Restorative Materials 498
Referral to an Oral and Maxillofacial Surgeon or a Periodontist 498
Discussion with the Oral and Maxillofacial Surgeon or a Periodontist 499
Implant Parts to Order 499
Procedural Steps 499
Surgical Stent 499
Final Impression 500
Soft Tissue Cast 502
Provisional Implant Crown 503
Implant Crown Delivery 504
Lab Prescriptions 507
Diagnostic Tooth Wax-Up and Surgical Stent 507
Soft Tissue Cast 507
Soft Tissue Cast and Screw- or Cement-Retained Provisional Crown 507
Soft Tissue Cast and Screw-Retained PFM Crown 508
Soft Tissue Cast and Cement-Retained PFM Crown 508
Follow-Up 508
Maintenance 510
Clinical Pearls 511
Troubleshooting 511
Tips 511
Real-Life Clinical Questions Answered 512
References 513
15 Occlusal Guards 515
Real-Life Comments and Questions 516
Relevance 516
TMD Terminology 517
Occlusal Guards and TMD 517
The Patient Interview 517
Clinical and Radiographic Exam 518
Extraoral Exam 518
Intraoral Exam 521
Dentition 521
Radiographic Exam 521
Treatment Planning 522
Referrals 522
Informed Consent 522
Oral Appliances: Indications and Types 523
Maxillary Versus Mandibular Arch 525
Procedural Steps for Occlusal Guards, Dual Flat Plane Occlusal Appliances, Athletic Mouthguards, and QuickSplints 525
Lab Prescriptions 526
Postoperative Instructions 526
TMD Self-Care Tips (Adjunctive Treatment) 527
Clinical Pearls 528
Troubleshooting 528
Tips 529
Real-Life Comments and Questions Answered 529
References 531
16 Dental Pharmacology 533
Real-Life Comments, Demands, and Questions 534
Relevance 535
Clinical and Radiographic Exam 535
Informed Consent 535
Aciid 536
Prescription Writing Advice 536
Adult Medications 538
Preventative 538
Local Anesthetics 539
Antibiotics 543
Analgesics 546
Fungal Infections 554
Viral Infections 554
Anxiolytics 555
Pediatric Medications 556
Preventative 556
Pediatric Local Anesthetics 556
Child Antibiotics 558
Child Analgesics 566
Clinical Pearls 568
Troubleshooting 568
Tips 569
Real-Life Comments, Demands, and Questions Answered 569
References 572
17 Pediatric Dentistry 575
Real-Life Clinical Questions and Scenarios 576
Relevance 577
Pediatric Medical History Form 577
Clinical and Radiographic Exam 578
Clinical Exam 578
Radiographic Exam 578
Teeth Eruption Charts 579
Pediatric Treatment Planning 580
Informed Consent 581
Referrals to Specialists 581
Patient Management 582
Pediatric Local Anesthetic Tips 585
Pediatric Medication Dosages 586
Procedural Steps 586
General Remarks 586
Traumatic Dental Injuries of Primary and Permanent Teeth 586
Preventative Dentistry 587
Nitrous Oxide and Oxygen Sedation 587
Interim Therapeutic Restorations 587
Operative 587
Pulpotomies/Pulpectomies/RCT on immature permanent teeth 588
Stainless Steel Crowns and Strip Crowns 592
Primary Teeth Extractions 594
Space Maintainers 595
Lab Prescriptions for Space Maintainers 598
Postoperative Instructions 598
Documentation 599
Real-Life Clinical Questions and Scenarios Answered 600
References 602
18 Nitrous Oxide and Oxygen Sedation 605
Real-Life Questions and Comments 606
Relevance 606
Introduction 607
Indications and Contraindications 607
Signs and Symptoms of Optimal Sedation 608
Signs and Symptoms of Oversedation 608
Armamentarium 609
Informed Consent 610
Procedural Steps for Nitrous Sedation 610
Unit Set-up 610
Rooming 611
Procedure 611
Unit Shutdown 613
Postoperative Instructions 613
Charting Template 614
Clinical Pearls 614
Troubleshooting 614
Tips 615
Miscellaneous 615
Real-Life Questions and Comments Answered 615
References 618
Appendix A: International Association of Dental Traumatology Guidelines 621
Appendix B: Basic Life Support 651
Appendix C: Evidence-based Dentistry Pyramid 657
Appendix D: Ergonomics for the Dentist, Patient, and Dental Assistant 659
Appendix E: “CAMBRA” CAries Management By Risk Assessment 665
Index 669
reface
About the Author
Acknowledgements
How to Read this Book
List of Abbreviations
Chapter 1: Medical History and Treatment Modifications
Alphabetized Medical Conditions and Treatment Modifications
Dental Treatment and INR Ranges
Chapter 2: Extraoral exam, Intraoral exam, and Oral Cancer Screening
Evidence-Based Clinical Practice Guideline for the Evaluation of Potentially Malignant
Disorders in the Oral Cavity
Chapter 3: Radiographs and Interpretation
Recommendations for Prescribing Dental Radiographs
Panoramic Anatomy
Chapter 4: Treatment Planning
Treatment Planning Phases
Tooth Replacement Options
Chapter 5: Preventive Dentistry
Caries Risk Assessments
Silver Diamine Fluoride Informed Consent and Protocol
Procedural Steps
Chapter 6: Periodontics
Periodontal Diagnosis
Assignment of Periodontal Maintenance Recall Schedule
Procedural Steps
Chapter 7: Operative Dentistry
Procedural Steps
Chapter 8: Endodontics
Diagnostic Terminology
Formulation of Pulpal and Periradicular Diagnosis
Types of Tooth fractures
Endodontic Case Difficulty Assessment Form and Guidelines
Teeth and Relevant Information
Procedural Steps
Chapter 9: Oral Surgery
Extraction Case Difficulty Assessment
Extraction Steps
Chapter 10: Toothaches
Toothache Checklist
Dental Trauma Checklist
Nonodontogenic Toothaches (Referred Pain)
Teledentistry and Toothaches
Chapter 11: Crown and Bridge
Crown Material Properties
Crown Reduction Guidelines
Crown Steps
Bridge Steps
Chapter 12: Complete Dentures
Evaluation of the Existing Dentures, Edentulous Patient, and Dentate Patient
Procedural Steps
Denture Analyzer Chairside Guide
Chapter 13: Removable Partial Dentures
Removable Appliance Types: Advantages and Disadvantages
Procedural Steps:
Cast Metal RPDs
Stayplates
Flexible Partials
Essix Appliances
Immediate Partials
Repairs, Relines, Repositions, Additions and What the Lab Needs from You
Chapter 14: Implant Crowns
General Measurement Parameters for Dental Implants
Final Impression Steps
Delivery Steps
Peri-Implant Diseases and Conditions
Chapter 15: Occlusal Guards
Oral Appliances: Indications and Types
TMD Self-Care Tips (Adjunctive Treatment)
Chapter 16: Dental Pharmacology
Local Anesthetics
Antibiotic Selection Algorithm
Antibiotic Premedications
Analgesics
Opioids
Pediatric Antibiotic Dosage Charts
Pediatric Ibuprofen and Acetaminophen Dosage Charts
Pediatric Local Anesthetic Dosage Chart
Chapter 17: Pediatric Dentistry
Tooth Eruption Charts
Pulpal Treatment for Primary and Immature Permanent Teeth
Space Maintainer Scenarios
Procedural Steps
Chapter 18: Nitrous Oxide and Oxygen Sedation
Nitrous Sedation Steps
Appendix A: International Association of Dental Traumatology Guidelines
Appendix B: Head and Neck Pain: Travell & Simon’s Trigger Point Pain Charts
Appendix C: Basic Life Support
Appendix D: Evidence Based Dentistry Pyramid
Appendix E: Ergonomics for the Dentist, Patient, and Dental Assistant
Appendix F: “CAMBRA” CAries Management By Risk Assessment
