DENTIN™ | NBDHE 2017
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2017 EDITION
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DENTIN™ | NBDHE 2017 IMPORTANT MESSAGE FOR HYGIENISTS PREPARING FOR THE NBDHE: DENTIN thanks you for confiding in us to help you prepare and pass the challenging NBDHE. You worked extremely hard to get into and complete hygiene school, and passing the NBDHE is your last major hurdle before entering into one of the top 10 professions as ranked by U.S. News and World Report. With that said, DENTIN finds that most students prepare 4-8 weeks in advance from the actual NBDHE test date. If you know the information in this study guide, you will confidently be able to answer any type of question (including testlets), and you WILL PASS THE NBDHE. Be positive, confident, and calm during the NBDHE, and you will pass! This DENTIN NBDHE study guide GUARANTEES comprehensive, clear, and concise information in that thoroughly provides the dental hygiene student with a SOLID FOUNDATION upon which to confidently answer any type of question format presented on the NBDHE. DENTIN backs this statement up with our 100% pass guarantee because we know the DENTIN NBDHE AND 1,001+ HIGH SPEED DRILLS are simply the best resources to pass the NBDHE. Your score is determined by two criteria (number of correct answers and a pre-determined conversion scale). A STANDARD SCORE of 75 is required to pass the NBDHE. Scores are mailed to you within 3-4 weeks after taking the exam, and will also be mailed to your program director and state licensing boards you indicate.
2017 NBDHE SUMMARY The NBDHE consists of 350 multiple-choice examination items broken down as follows: COMPONENT A ANATOMY, HISTOLOGY & EMBRYOLOGY PHYSIOLOGY BIOCHEMISTRY & NUTRITION MICROBIOLOGY & IMMUNOLOGY ORAL & GENERAL PATHOLOGY PHARMACOLOGY ASSESSING PATIENTS RADIOLOGY PLANNING & MANAGING DENTAL HYGIENE CARE PERFORMING PERIODONTAL PROCEDURES USING PREVENTIVE AGENTS SUPPORTIVE TREATMENT SERVICES PROFESSIONAL RESPONSIBILITY COMMUNITY HEALTH & RESEARCH COMPONENT B (TESTLETS) *TESTS ABILITY TO APPLY COMPONENT A CONCEPTS *10-15 Dental Hygiene Patient Cases
NUMBER OF QUESTIONS 16 5 6 10 13 10 17 13 34 18 9 7 18 24 150 QUESTIONS
NBDHE scores range from 49-99, with a MINIMUM PASSING SCORE of 75. Results are available within 3-4 weeks from the date the computerized exam is completed. Preparing with this study guide and DENTIN’s 1,000+ HIGH SPEED DRILLS GUARANTEES THAT YOU WILL PASS THE NBDHE.
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DENTIN™ | NBDHE 2017 For each TESTLET on the NBDHE, perform a thorough PATIENT ASSESSMENT: 1. Chief Complaint: always obtain this FIRST from the patient. 2. Social History: tobacco, drugs, weight loss, gain, occupational, recreational. 3. Dental History: OHI, gingival and periodontal health, frequency of prior dental visits. 4. Medical History: under physical care, last hospitalization, pregnancy status, existing medications (including any history of oral or IV bisphosphonates). 5. Patient Status: age, sex, height, weight, vitals (BP, RR, Pulse). 6. Clinical Exam: Examine presented intra-oral photographs and radiographs for dental implants, restorations, crown and bridge, and endondontically treated teeth. Restorations are NOT charted, carious lesions may be charted, but typically are not. Missing teeth are charted as “x” •
Class I and II furcations are charted as
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Class III and IV furcations are charted as
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DENTINâ„¢ | NBDHE 2017
TABLE OF CONTENTS ANATOMY AND PHYSIOLOGY Tongue and Salivary Glands ................................................................................................................ 9 Hard Palate, Soft Plate, Throat .......................................................................................................... 14 Muscles of Mastication ...................................................................................................................... 16 Muscles of Facial Expression ............................................................................................................. 18 Hyoid Muscles .................................................................................................................................... 20 Neck Muscles and Neck Triangles ..................................................................................................... 21 Cranial Nerves .................................................................................................................................... 24 Osteology ........................................................................................................................................... 37 TMJ .................................................................................................................................................... 43 Heart and Blood Supply to Head and Neck ....................................................................................... 45 Veins (Head and Neck) ....................................................................................................................... 49 Lymphatic System .............................................................................................................................. 52 DENTIN 1,001+ High-Speed Drills Anatomy and Physiology Preview ......................................... 57
MICROBIOLOGY AND IMMUNOLOGY Cellular vs. Humoral Immunity ........................................................................................................... 58 Natural vs. Acquired Immunity ........................................................................................................... 59 Cellular Immunology........................................................................................................................... 61 Immunoglobulins (Antibodies) ............................................................................................................ 63 Hypersensitivity Reactions ................................................................................................................. 65 Bacteria .............................................................................................................................................. 67 Fungi................................................................................................................................................... 76 RNA and DNA Viruses ........................................................................................................................ 78 DENTIN 1,001+ High-Speed Drills Microbiology and Immunology Preview ............................... 84
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DENTINâ„¢ | NBDHE 2017
BIOCHEMISTRY AND NUTRITION Cells and Organelles .......................................................................................................................... 85 Carbohydrates, Sugars, Glucose Metabolism ................................................................................... 87 Nutritive and Non-Nutritive Sweeteners ............................................................................................. 91 Amino Acids, Proteins, Lipids (Fats) .................................................................................................. 93 Vitamins and Vitamin Deficiencies ..................................................................................................... 98 Microminerals and Macrominerals ................................................................................................... 102 Weight Control and Eating Disorders ............................................................................................... 106 DENTIN 1,001+ High-Speed Drills Biochemistry and Nutrition Preview ................................... 108
EMBRYOLOGY AND HISTOLOGY Facial Development .......................................................................................................................... 109 Tissues ............................................................................................................................................. 112 Odontogenesis ................................................................................................................................. 115 Enamel and Dentin ........................................................................................................................... 119 Cementum and Pulp ........................................................................................................................ 123 DENTIN 1,001+ High Speed Drills Embryology and Histology Preview .................................... 126
DENTAL ANATOMY AND OCCLUSION Tooth Eruption and Exfoliation ......................................................................................................... 127 Dental Occlusion .............................................................................................................................. 129 Primary Tooth Anatomy ................................................................................................................... 133 Permenant Tooth Anatomy .............................................................................................................. 134 DENTIN 1,001+ High Speed Drills Dental Anatomy and Occlusion Preview............................. 140
ANATOMY OF THE PERIODONTIUM AND PROVISION OF DENTAL HYGIENE CARE Free and Attached Gingiva ............................................................................................................... 141 Periodontal Ligament (PDL) Fibers and Alveolar Bone .................................................................... 143 Oral Mucosa ..................................................................................................................................... 146 Classification of Periodontal Disease and Provision of Dental Hygiene Care .................................. 148 Dental Plaque ................................................................................................................................... 155 Dental Calculus ................................................................................................................................ 158 Gingival Conditions and Treatment .................................................................................................. 160
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DENTIN™ | NBDHE 2017 Periodontal Disease and Treatment ................................................................................................. 165 CAL, Mobility, and Osseous Defects ............................................................................................... 167 Scaling and Root Planing and Gross Debridement ......................................................................... 168 Periodontal Surgery, Grafting, Wound Healing ................................................................................ 169 Osseous Defects and Root Furcations ............................................................................................ 174 Dental Implants ................................................................................................................................ 177 DENTIN 1,001+ High Speed Drills Periodontology Preview ....................................................... 180 Hygiene Instrumentation .................................................................................................................. 181 Instrument Sharpening ..................................................................................................................... 188 Polishing and Tooth Discoloration ................................................................................................... 189 Preventative Agents (Fluoride, Dentrifices, Antimicrobials).............................................................. 191 Preventative Services and OHI ........................................................................................................ 200 Oral Health Indices ........................................................................................................................... 205 DENTIN 1,001+ High Speed Drills Provision of Dental Hygiene Services Preview .................. 209
PHARMACOLOGY Drug Potency, Efficacy, and Adverse Reactions ............................................................................. 210 Pharmacokinetics ............................................................................................................................. 212 Routes of Administration .................................................................................................................. 213 Autonomic Nervous System (SANS and PANS) .............................................................................. 215 PANS Drugs (Anti-cholinergics, Cholinergics, Muscarinics) ............................................................ 216 SANS Drugs (Adrenergics) ............................................................................................................... 217 Respiratory Drugs ............................................................................................................................ 219 Cardiovascular Drugs (Anti-Coagulants, Anti-Arrhythmics, Anti-Hypertensives) ............................ 223 Cardiovascular Drugs (Beta-Blockers, Cardiac Glycosides, Anti-Anginals, Statins) ....................... 229 Antihistamines and Gastrointestinal Drugs ...................................................................................... 234 Non-Opioid and Opioid Analgesics .................................................................................................. 236 Anti-Anxiety Drugs, Anti-Depressants, and Anti-Convulsants ......................................................... 239 Hypoglycemics and Endocrine Imbalance Drugs ............................................................................ 243 Antibiotics and Prophylaxis Guidelines ............................................................................................ 249 Antivirals and Antifungals ................................................................................................................. 257 General and Local Anesthetics ........................................................................................................ 260 Nitrous Oxide (N2O) .......................................................................................................................... 268 DEA Controlled Substances and Prescriptions ............................................................................... 270 DENTIN 1,001+ High Speed Drills Pharmacology Preview ......................................................... 272
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ORAL AND GENERAL PATHOLOGY Pathology Terminology .................................................................................................................... 273 Squamous Cells Carcinoma and Basal Cell Carcinoma .................................................................. 275 Tongue Lesions ................................................................................................................................ 277 White Lesions ................................................................................................................................... 281 Pigmented Lesions ........................................................................................................................... 286 Connective Tissue Lesions .............................................................................................................. 290 Inflammatory Soft Tissue Lesions .................................................................................................... 292 Bone Lesions .................................................................................................................................... 295 Ulcerative Lesions ............................................................................................................................ 296 Viral-Induced Ulcerative Lesions (Herpes) ....................................................................................... 301 Odontogenic Tumors ....................................................................................................................... 306 Odontogenic Cysts .......................................................................................................................... 310 Non-Odontogenic Cysts .................................................................................................................. 312 Salivary Gland Lesions ..................................................................................................................... 313 Odontogenic Abnormalities .............................................................................................................. 315 DENTIN 1,001+ High Speed Drill Pathology Preview .................................................................. 325
SPECIAL NEEDS AND MEDICALLY COMPROMISED DENTAL TREATMENT MODIFICATIONS Asthma and COPD ........................................................................................................................... 326 Cardiac Disorders ............................................................................................................................ 329 Blood Disorders .............................................................................................................................. 333 Cancer Treatment and Dental Management .................................................................................... 336 Developmental and Behavioral Disorders ........................................................................................ 339 Mental Health and Addiction Disorders (Tobacco, Alcohol, Substance Abuse) .............................. 341 Pregnancy ........................................................................................................................................ 347 Sensory Impairment and Geriatric Care ........................................................................................... 348 Musculoskeletal and Skin Disorders ................................................................................................ 349 Neurological Disorders ..................................................................................................................... 354 DENTIN 1,001+ High Speed Drills Special Needs Preview ......................................................... 357
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DENTINâ„¢ | NBDHE 2017
DENTAL BIOMATERIALS Terminology ...................................................................................................................................... 358 Amalgam, Composite, Whitening, and Sealants .............................................................................. 360 Dental Adhesives, Cavity Liners and Bases, and Dental Cements .................................................. 363 Impression Materials ........................................................................................................................ 366 Gypsum, Waxes, and Casting Alloys ............................................................................................... 369 Radiographic Material Interpretation ............................................................................................... 371 DENTIN 1,001+ High Speed Drills Dental Biomaterials Preview ................................................ 372
DENTAL RADIOLOGY Radiation Biology ............................................................................................................................. 373 ALARA Techniques to Minimize Radiation Exposure....................................................................... 375 X-Ray Tube Components ................................................................................................................. 378 kVp, Density, Contrast, and mA ....................................................................................................... 379 Inverse Square Law, Half-Value Layer ............................................................................................. 380 Image Quality (Sharpness, Magnification, Distortion) ...................................................................... 381 Dental Radiograph Film Processing and Errors ............................................................................... 382 Radiographic Techniques and Errors ............................................................................................... 383 Panoramic Errors.............................................................................................................................. 388 Anatomical Landmarks on Radiographs .......................................................................................... 390 DENTIN 1,001+ High Speed Drills Radiology Preview ................................................................ 396
PROFESSIONAL RESPONSIBILITY OSHA and Infection Control ............................................................................................................. 397 Ethical and Legal Principles, Professional Responsibility, and Informed Consent .......................... 404 Community Dental Health and Research ......................................................................................... 408 Epidemiology .................................................................................................................................... 413 Research Methods, Variables, Statistics, Measures of Central Tendency ...................................... 415 DENTIN 1,001+ High Speed Drills Professional Responsibility Preview ................................... 426
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HEAD AND NECK ANATOMY AND PHYSIOLOGY TONGUE AND SALIVARY GLANDS TONGUE-all tongue muscles (intrinsic & extrinsic) are innervated by Hypoglossal nerve (CN XII) EXCEPT palatoglossus muscle (innervated by pharyngeal plexus of CN X). Blood supply is from the LINGUAL ARTERY. Dorsum = top of tongue. Ventral = underneath the tongue. Paired Extrinsic Tongue Muscles: originate on structures away from the tongue and insert onto the tongue, causing tongue movements or positions during speaking, food manipulation, cleaning teeth, and swallowing (CN-XII). Are named based on their ORIGIN. 1. Genioglossus-PROTRUDES the tongue apex through mouth (sticks out tongue). Origin superior genial spine of mandible. Insertion tongue dorsum. Innervation: hypoglossal nerve.
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2. Hyoglossus-DEPRESSES the tongue sides during contraction Origin hyoid bone. Inserts tongue lateral border. CN XII. 3. Styloglossus-ELEVATES and RETRACTS the tongue. Origin is styloid process of temporal bone. Insertion: lateral side and dorsum of tongue. Innervation: hypoglossal nerve. 4. Palatoglossus-ELEVATES the tongue base and DEPRESSES the soft palate. Origin: palatine aponeuroses. Insertion: side of tongue. Innervation: PHARYNGEAL PLEXUS of Vagus (X, XI). Intrinsic Tongue Muscles: superior and inferior longitudinals, transverse, and vertical muscles determine tongue shape, are confined to the tongue and are NOT attached to bone (intrinsic muscles begin and end within the tongue). All intrinsic tongue muscles are innervated by the HYPOGLOSSAL NERVE (CN-XII). Intrinsic muscles are named based on the 3 spatial planes that they occupy.
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TONGUE BLOOD SUPPLY: 1. Lingual artery (from facial artery’s tonsilar branch) is the TONGUE’S MAIN BLOOD SUPPLY. 2. Ascending pharyngeal artery 3. Veins from tongue drain into the internal jugular vein. TONGUE LYMPHATIC DRAINAGE: 1. Tip of tongue-drains into SUBMENTAL lymph nodes. 2. Remaining anterior 2/3-bilaterally drains into submandibular and deep cervical lymph nodes. 3. Posterior 1/3-drains bilaterally into deep cervical lymph nodes.
TONGUE INNERVATION: ! Posterior 1/3 of tongue & circumvallate papillae receive sensory and taste sensation from glossopharyngeal nerve (CN IX). !
Anterior 2/3 of tongue receives general sensory innervation from LINGUAL NERVE (CN V3 the trigeminal mandibular division) and taste sensation from CHORDA TYMPANI (CN VII).
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SUBMANDIBULAR GLANDS (Submaxillary Glands)-large MIXED salivary glands beneath the FLOOR OF THE MOUTH that produce between 60-65% of total saliva. Lies next to a Stafne defect, the cortical bone depression on the lingual surface of the angle of the mandible. •
Submandibular gland is located SUPERIOR to the DIGASTRICS and INFERIOR to the MYLOHYOID muscle (divides the glands superficial and deep lobes).
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WHARTON’S DUCT (Submandibular Duct)-passes forward along side of the tongue, below the mucous membrane of the floor of the mouth. It is crossed by the LINGUAL NERVE and then lies between the sublingual gland and genioglossus muscle. It opens at the base of the frenulum of the tongue.
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Sublingual Caruncle-the site on either side of the lingual frenum where the submandibular (Wharton’s duct) and sublingual salivary glands empty into the oral cavity.
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Innervation: parasympathetic secretomotor from FACIAL NERVE (CN VII), which runs in the chroda tympani and lingual nerve (V3 branch). Same innervation as sublingual gland.
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Blood Supply: FACIAL & LINGUAL ARTERIES.
SUBLINGUAL GLANDS- SMALLEST SALIVERY GLAND that produces 10% of total saliva. Located in mouth floor under the tongue, close to the midline, and supported by the mylohyoid muscle. •
Sublingual glands have 8-20 small ducts (ducts of Rivinus) that empty onto the floor of the mouth at the sublingual fold (Bartholin’s Duct—not gland, which is the major sublingual gland duct that drains the sublingual gland and opens in the sublingual papilla in the mouth floor. Sublingual gland is a MIXED GLAND secreting mostly MUCOUS and some SEROUS ACINI.
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Innervation: parasympathetic secretomotor from FACIAL NERVE (CN-VII) that runs in the chorda tympani and lingual nerve (V3 branch). Same innervation as submandibular gland.
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Blood Supply: sublingual artery (a lingual artery branch, a branch of external carotid).
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Lymphatic Drainage: drain into submandibular and deep cervical lymph nodes.
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MUSCLES OF MASTICATION MUSCLES OF MASTICATION-four pairs of muscles responsible for biting, grinding, and mandibular movement during mastication. All muscles of mastication are innervated by TRIGEMINAL NERVE (V3-mandibular division). Blood supply comes from the MAXILLARY ARTERY (external carotid artery branch). 1. TEMPORALIS-fan-shaped, originates from the temporal fossa floor (temple) and deep surface of the temporal fascia. It passes medially (downward and deep) to the zygomatic arch as a thick tendon before inserting on CORONOID PROCESS of mandible and anterior border of ramus-posterior to 3rd molars). •
Anterior & superior fibers ELEVATE THE MANDIBLE. Temporalis posterior fibers RETRACT the MANDIBLE. Maintains resting position during when the mouth is closed. ELEVATES & RETRACTS the mandible.
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Inserts into the coronoid process of mandible and anterior border of the ramus.
2. MASSETER-paired muscle that originates from the ZYGOMATIC ARCH (cheekbone) that inserts and COVERS THE LATERAL SURFACE OF THE RAMUS (ANGLE OF MANDIBLE). ELEVATES MANDIBLE to occlude teeth. Forms a sling around the angle of the mandible. The stretch reflex maintains masseter muscle tone. MASSETER IS THE MOST POWERFUL MASTICATORY MUSCLE. The masseter is overworked, becomes prominent, and hypertrophies with chronic bruxism. 3. MEDIAL PTERYGOID-origin is the medial surface of the lateral pterygoid plate (sphenoid bone) and maxillary tuberosity. Inserts on medial surface of angle of mandible. ELEVATES (CLOSES) & slightly PROTRUDES MANDIBLE, & MOVES IT LATERALLY. Forms a sling around the angle of the mandible. • During an inferior alveolar block injection, the needle passes through the mucous membrane and buccinator muscle, and lies LATERAL to the medial pterygoid. If the anesthetic needle passes through the MEDIAL PTERYGOID MUSCLE OR BUCCINATOR during an inferior alveolar nerve block, trismus can result. •
Can cause TRISMUS if needle passes through the MEDIAL PTERYGOID during IA nerve block with anesthesia. TRISMUS (LOCKJAW)-limited mandibular opening due to SPASMS of a muscle of mastication.
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The MOST definite clinical sign indicating extension of an odontogenic infection into the masticator space is TRISMUS (difficulty opening the mouth due to a tonic spasm of mastication muscles).
4. LATERAL PTERYGOID (2 Heads)-mainly contained in the INFRATEMPORAL FOSSA (along with the maxillary artery and vein). Its origin is lateral pterygoid plate (inferior head) and infratemporal crest (superior head) greater wing of the sphenoid bone. BOTH HEADS INSERT into the neck of the mandibular condyle and TMJ articular disc to DEPRESS (OPEN) & PROTRUDE THE MANDIBLE & MOVE THE MANDIBLE LATERALLY (SIDE-TOSIDE) when one side contracts. Works with the hyoid muscles to OPEN THE MOUTH. Temporalis, Medial Pterygoid, & Masseter all CLOSE (ELEVATE) THE MANDIBLE.
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DENTIN™ | NBDHE 2017 All 4 muscles of mastication receive blood from MAXILLARY ARTERY’s PTERYGOID BRANCH (larger terminal branch of the external carotid artery). MUSCLES OF MASTICATION
MUSCLE OF MASTICATION MOVEMENT SUMMARY MOVEMENT MASTICATION MUSCLE ELEVATES MANDIBLE Masseter, Temporalis, Medial Pterygoid DEPRESSES MANDIBLE Lateral Pterygoid with Hyoid Muscles PROTRUDES & LATERAL MANDIBLE Lateral Pterygoid RETRUSION Temporalis
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MUSCLES OF FACIAL EXPRESSION Most of the 10 muscles of facial expression are motor innervated by the FACIAL NERVE (CN VII) and blood supply comes from the FACIAL ARTERY (external carotid artery branch). 3 Smile Muscles: Zygomaticus (major and minor), Levator anguli oris, and Risorius. 1. Levator Anguli Oris-elevates (lifts) the corners of the mouth. 2. Zygomatic Major (laughing) and Zygomatic Minor (smiling)-draws the angle of the mouth up and back. 3. Risorius-retracts the angle of the mouth to produce a SMILE. Arises in the parotid gland fascia. •
If the facial expression muscle inserts into the mouth, an origin above the mouth contributes to smiling, while an origin below the mouth causes frowning.
6 Additional Muscles of Facial Expression: 1. Depressor Labii Inferioris-pulls down (depresses) the lower lip by working with platsyma. 2. Depressor Anguli Oris-pulls down the corners of mouth and depresses the lower lip. 3. PLATSYMA-draws the lower lip and corner of the mouth inferiolaterally. Tenses neck skin (overlaps SCM). Gives expression of GRIMACE. 4. MENTALIS-lower lip muscle that pulls chin skin upward to raise the central portion of the lips (allows the lips to POUT). Hyperactivity can make lower lip retraction difficult. The best way to examine the mentalis muscle is DIGITAL PALPATION. 5. FRONTALIS-elevates the eyebrows and wrinkles the forehead. 6. OCCIPITALIS-assists frontalis to wrinkle the forehead. 7. ORBICULARIS ORIS-enclose the opening to the oral cavity; contracts (closes) and protrudes the lips. KISSING or PUCKER MUSCLE. 8. ORBICULARIS OCULI-surrounds the eye socket. sphincter muscle that closes the eyelids. THE ONLY MUSCLE THAT CLOSES THE EYE. 9. Levator Palpebrae Superioris-raises the upper EYELID. 10. Levator labii superioris alaeque nasi (Elvis Muscle)-raises and protrudes the upper lip upper and wing of nose (dilates the nares). Enables a SNARL expression (ELVIS PRESLEY used this muscle a lot in his facial expressions). 11. BUCCINATOR MUSCLE (muscle of facial expression) innervated by buccal branch of facial nerve (CN VII). Originates from ALVEOLAR PROCESS of maxilla and mandible and PTERYGOMANDIBULAR RAPHE. Buccinator muscle COMPRESSES THE CHEEKS and LIPS AGAINST THE TEETH. and hypertrophies with bruxism. • Blood supply from facial and maxillary arteries. •
ORIGIN: outer surface of alveolar processes of maxilla and mandible opposite the molar teeth and from the pterygomandibular raphe (thin, fibrous band from the hamulus of the medial pterygoid plate down to the mandible that contains a portion of the IA nerve).
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POSTERIOR TRIANGLE-boundaries are sternocleidomastoid, trapezius muscles, & clavicle. Contains nerves and vessels, and 2 lesser triangles: 1.
Occipital triangle-bound by sternocleidomastoid, trapezius, and omohyoid muscles. Contains cervical plexus and accessory nerve.
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Omoclavicular triangle-bound by sternocleidomastoid and omohyoid muscles; clavicle. Contains brachial plexus and subclavian artery.
NECK TRIANGLES
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TOTAL SENSORY I, II, VIII
CRANIAL NERVE FUNCTION SUMMARY TOTAL MOTOR BOTH (SENSORY & MOTOR) III, IV, VI, XI, XII V, VII, IX, X
CRANIAL NERVE INNERVATION OF TEETH & TISSUES MANDIBULAR & MAXILLARY TEETH NERVE INNERVATION & ANESTHESIA MANDIBULAR PULP BUCCAL/FACIAL LINGUAL GINGIVA TOOTH GINGIVA Molars Inferior Alveolar Buccal Nerve Lingual Nerve Nerve Premolars Inferior Alveolar Buccal & Mental Nerves Lingual Nerve Nerve (Mental if anterior to the mental foramen) Canines & Incisors IA Nerve (Incisive Mental Nerve (if anterior to Lingual Nerve Nerve anterior to the mental foramen) Mental Foramen) MAXILLARY PULP BUCCAL/FACIAL PALATAL GINGIVA TOOTH GINGIVA 1st, 2nd & 3rd Molars PSA Nerve PSA Nerve Greater Palatine st (except MB of 1 ) 1st Molar PSA Nerve & MSA PSA Nerve Greater Palatine (MB root) Premolars MSA Nerve MSA & Infraorbital Greater Palatine Canines & ASA Nerve ASA & Infraorbital Nasopalatine (anterior Incisors gingiva) & Greater Palatine (posterior gingiva) *For maxillary anesthesia, all nerves are V2 branches. For mandibular anesthesia, all nerves are V3 branches of the trigeminal. Inferior alveolar nerve anesthetizes ALL mandibular teeth. The PSA anesthetizes all maxillary molars (except MB root of 1st molar), MSA (premolars), and ASA (canines and incisors).
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SCC of the tongue metastasizes fast, and the prognosis is not as good as lower lip SCC.
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More common on the LOWER LIP than intra-orally (some consider the lower lip extra-oral, however sun exposure is the primary risk factor). The most common intra-oral site is the lateral border & ventral surface of the TONGUE (from this site, SCC often metastasizes to cervical lymph nodes). Dorsal tongue surface is almost never affected.
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Treatment of choice for ORAL CANCER (SCC) IS SURGERY.
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Mostly effects men > 60yrs. on the posterior lateral border and middle 1/3 of the tongue. Presents as a painless ulcer with leukoplakia and erythroplakia. SCC OF MOUTH FLOOR AND LOWER LIP
BASAL CELL CARCINOMA–a MALIGNANT epithelial cell tumor that begins as a papule that enlarges peripherally, forming a central crater that erodes, crusts, and bleeds. Only found on the skin, and NEVER orally due to EXCESSIVE SUN EXPOSURE (UV radiation) or to x-rays. Metastasis is rare, but the local invasion by direct extension destroys underlying and adjacent tissues. Often develops on exposed skin surfaces, face (nose), and scalp in middle-aged or elderly people. Treatment: eradicate the lesion by electrodessication or cryotherapy. BASAL CELL CARCINOMA IS THE MOST COMMON SKIN CANCER, that usually appears as an ulcerated, crateriform lesion. It may look exactly like SCC, but RARELY produces metastasis with a much better prognosis than SCC. • •
BASAL CELL CARCINOMASA ARE NEVER FOUND IN THE MOUTH (INTRA-ORALLY). MAY BE ASSOCIATED WITH ODONTOGENIC KERATOCYST (OKC).
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MEASURES OF CENTRAL TENDENCY MEASURE OF CENTRAL TENDENCY (AVERAGES)-a central or typical value of a probability distribution. The frequency of distribution is plotted on an x-y graph to create a pictorial representation of the data. The most common measures of central tendency are MEAN, MEDIAN, & MODE. •
MEAN-arithmetic average of scores, and most common measure of central tendency. Mean is the sum of a collection of numbers DIVIDED by the number or numbers in the collection. Add all the scores together and divide by the number of scores. The mean is sensitive to extreme values (outliers). Ex: If 10 hygienists scored a total of 950 points out of 1000 possible points on the NBDE after using the DENTIN study guide, then the mean score is 950/10 = 95%.
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MEDIAN-the MIDDLE value of a finite data set (list of numbers) that separates the higher half of a data sample from the lower half (50% of the scores fall above the median, 50% fall below). The advantage of the median (compared to the mean) is the median is NOT SKEWED by extremely small or large values. Ex: 92,94,94,95,96,97,98. The median is 95 (the middle number in the data set).
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MODE-the score (value) that occurs MOST FREQUENTLY in a data set (data matrix). Mode is the number repeated more often than any other number in the data set and affects a graph’s skew. Ex: 92,92,95,95,95,98,99. The mode is 95.
BELL CURVE-a normal (Gaussian) symmetrical distribution “bell shaped” curve that represents plotted data distributed EQUALLY distributed around the mean, median, and mode. • The larger the standard deviation, the more spread out the curve. • Bell curve has 1 mode that coincides with the mean and median. • Bell curve follows the 68-95-99.7 rule, meaning ~68% of data fall within 1 standard deviation of the mean, ~95% of all data within 2 standard deviations of the mean, and ~99.7% of all data falls within 3 standard deviations of the mean. When sample data is plotted on a NORMAL BELL CURVE, the MEAN, MEDIAN, & MODE are EQUAL. NORMAL BELL CURVE
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DENTIN™ | NBDHE 2017 NBDHE TESTLET: the entire second year dental hygiene class of 25 students was asked to brush and floss by their hygiene instructor and then apply plaque disclosing solution to determine their plaque-free scores. Upon compiling the class data, their plaque-free scores were plotted and on a normal distribution Bell-Curve. The most commonly occurring plaque score was 83. This measure of central tendency best represents the MEAN.
NBDHE TESTLET: of the second year dental hygiene class plaque-free scores, 17 of the 25 scores in the data matrix were 84. This measure of central tendency best represents the MODE.
MEASURES OF DISPERSION (SPREAD): describes how WIDE or VARIED the scores are around a central point (in a normal bell curve, the central point is the MEAN, MEDIAN, and MODE). •
VARIANCE-the average of the squared difference from the MEAN. A measure of how the data distributes itself about the mean. CONSIDERS ALL DATA POINTS AND THEN DETERMINES THEIR DISTRIBUTION.
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RANGE-the difference between the highest and lowest scores of a data matrix. Affected by OUTLIERS (extremely high or low scores). Ex: (90 high score) – (80 low score) = 10. Range = 10. Range only looks at EXTREMES.
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STANDARD DEVIATION (s): measures how “spread out” the data is using the SQUARE ROOT of the sample variance. The MOST common method of DISPERSION (SPREAD) in research that reflects the RANGE of data in the data matrix. Standard deviation is a VARIABLE measure based on the calculations of the analyzed data. The LARGER the range (standard deviation), the WIDER the distribution curve:
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DENTIN™ | NBDHE 2017
From the bell curve above, 68.2% of the results lie between +1 and -1 of the standard deviation (the majority of results) when plotted on a normal bell curve. Important: most scores in a NORMAL BELL CURVE fall within +1 and -1 from the STANDARD DEVIATION.
SKEWED CURVE: an ASSYMETRICAL and NON-UNIFORM “tailed-curve” due to OUTLIERS. The graphed data is not normally distributed. Important: BELL CURVE IS SYMMETRICAL AND IS NOT A SKEWED CURVE. POSITIVE SKEW: the curve has a positive skew when more scores fall in the LOWER RANGE, so that the curve “tail” on the right side is longer (fatter) than the left side (Ex: if the majority of oral pathology test scores were below 60% except for one student who aced the exam and scored a 95%, the plotted test data who show a positive skewed curve). NEGATIVE SKEW: the curve has a negative skew when the score plotted fell more into the HIGHER RANGE. (Ex: 25 of the 30 dental hygiene students at Old Dominion University prepared for the NBDHE using this DENTIN study guide. The 25 hygiene students who used the DENTIN study guide outscored the 5 who did not prepare with DENTIN by an average of 25%). A negative skew occurs when the majority of scores are high and there are a few extremely low scores. When plotted on a graph, the scores the curve leans to the right and the “tail” to the left.
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DENTINâ„¢ | NBDHE 2017
DENTIN 1,001+ HIGH SPEED DRILLS PROFESSIONAL RESPONSIBILITY PREVIEW 1. The measure of central tendency that would locate the midpoint of sample data using a DATA MATRIX is the MEDIAN. 2. The DIFFERENCE between high and low scores on a data matrix that is affected by OUTLIERS is the RANGE. 3. Steam Under Pressure Autoclaves and Chemical Vapor Autoclaves: used for sterilization should be BIOLOGICALLY MONITORED/tested AT LEAST WEEKLY. 4. An expected level of certain diseases found regularly in a certain populations in particular areas or during particular time periods like the INFLUENZA during winter, or Malaria in tropical regions, is an ENDEMIC. 5. The PERCENTAGE of people in a population suffering from a particular disease or condition at a given point in time is PREVALANCE. 6. The research sample that yields the GREATEST BIAS POTENTIAL is a JUDGEMENT SAMPLE. 7. The extent that a test measures what it is intended to measure is VALIDITY. 8. The CLOSER the CORRELATION CO-EFFICIENT to +1 or -1, the STRONGER CORRELATION and more probable the CAUSE & EFFECT. 9. An evidence-based approach to prevent and manage CARIES by assessing risk levels that form intervention guidelines before irreversible tooth damage occurs is CAMBRA. 10. PERSONAL PROTECTIVE EQUIPMENT includes GLOVES, GOWNS, EYE PROTECTION, FACE SHIELD, and MASKS. 11. ALCOHOLS, CHLORHEXIDINE, IODOPHORS, PHENOLS, and QUATERNARY AMMONIUM are all examples of DISINFECTANTS. 12. Opportunistic pathogens that inhabit biofilm inside dental unit water lines are PSEUDOMONAS AERUGINOSA & LEGIONELLA PNEUMOPHILIA. 13. BIOLOGICAL INDICATORS (BI) test the proper functioning of sterilization cycles AT LEAST WEEKLY. 14. UNIVERSAL PRECAUTIONS applies to contact with SKIN, MUCOUS MEMBRANES, AND ALL BODILY FLUIDS (except sweat). 15. Dental charts are legal documents, thus should be recorded legibly and written in only BLUE or BLACK INK. 16. Mistakes made in the dental chart are corrected by DRAWING A SINGLE LINE THROUGH THE ERROR and WRITING THE CORRECT INFORMATION IMMEDIATELY AFTER AND SIGNING THE ENTRY (the original entry must remain legible).
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DENTIN™ | NBDHE 2017
YOU ARE PREPARED FOR THE NBDHE WITH DENTIN™
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