#2 – Understands all client handouts | Dental Practice Coaching

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#2 – Understands all client handouts

People learn in small amounts over short periods of time. Your task is in this section is to help a client learn. The best time to help the client learn is when they want to learn. You’ll know they want to learn when they ask you a question.
When you are asked a question, watch out! You are now a dangerous source of information. You have learned so much that you may flood this poor client with loads of useless (to them) information. It’s one thing to know information; it’s something entirely different to clearly communicate this information to someone else.

Here are some tips:
1. Remember the 3 main functions of the teeth; eating, speech and appearance.
2. Listen to and only answer the direct questions(s) asked.
3. Keep your answer at 30 – 45 seconds.
Examples of questions asked and a response given:
What is a root canal?
A root canal removes the infection in the tooth so it doesn’t need to be extracted.
What all is involved in getting a crown?
The Doctor will reshape your tooth, take impressions, and make a temporary crown. You will return in two weeks to have the permanent crown seated.
What are the advantages and disadvantages of a bridge versus a partial?
The advantages of a bridge are that it’s actually fixed to the teeth, looks and feels more like natural teeth, and could last up to 20 years. The disadvantages are that it is more expensive and requires cutting the teeth down.
The advantages of a plastic partial denture are that it is removable, which makes it easier to clean your teeth. A partial is also quicker to make and is less expensive. The disadvantages are that it can feel bulky and be hard to get use to wearing and break.
What is an implant?
A titanium post is placed into the bone, which grows and locks the post in place over 3 to 4 months. Then an abutment is attached to the implant and a crown is fitted on the abutment. The whole process will take a least 3 appointments over a 4 to 8 month period. Once completed, your implant will look, feel and function like a natural tooth.
4. Use visual aids if you can and offer brochure(s) on the topic of the treatment recommended.
5. Practice what you are going to say over and over. There are only about 2 dozen questions that you will be asked. Memorize a good response for each.
6. Always compare 2 choices – give equal examples of advantages and disadvantages – and include the fee.
7. Record your answers on your phone.  See how smooth and confident you sound.
8. Practice on real clients during your workday.

CROWN OR FILLING?

When you are counseling a client with a broken tooth, how do you decide if s/he needs a crown or just a filling? Here are some general rules.

1. Upper/lower anteriors:
a. If the incisal edge is broken, but the tooth has never had a composite filling recommend a plastic filling.
b. If the tooth has a prior plastic filling that is less than 5 years old recommend a crown.
c. If the tooth has had a root canal – see #5.
d. If the tooth is discolored recommend whitening.
e. If whitening hasn’t worked (dark color returns) recommend a porcelain facing or crown.

2. Upper/lower bicuspids
a. If one cusp is broken off recommend a crown.
b. If a small filling is present, the tooth has darkened due to a silver filling, or the filling shows esthetically recommend a posterior plastic.
c. If the tooth has been endodontically treated – see #5.

3. Upper molars:
a. If mesiobuccal cusp is gone and esthetics are important – posterior composite or PFM
b. If any other one cusp is broken recommend a silver filling. Warn the client that if s/he doesn’t get 10 15 years out of the filling, a crown would be better.
c. If any 2 cusps are missing recommend a crown.
d. If the tooth has had endodontic therapy – see #5.

4. Lower molars:
a. If any one cusp is missing recommend a silver filling.
b. If 2 or more cusps are missing recommend a crown.
c. If the tooth has had endodontic treatment – see #5

5. Endodontically treated teeth
a. Anteriors or posteriors
1. Less than 20% of tooth missing – composite
2. Less than 50% of tooth missing – core/crown
3. More than 50% of tooth missing – post/crown
b. Posts
1. Do not strengthen tooth
2. Only used to help retain crown

Do your teeth fit?
Dental troubles may start from teeth not aligned right. By correcting your bite, dentists can stop trouble before it begins.

“You may need to have your bite corrected,” my dentist told me.

“Isn’t my bark worse than my bite?” I answered flippantly, for we were on friendly terms, despite his having just filled two of my lower molars.

“If I said you had a traumatic occlusion, I suppose you’d take me seriously,” he said smiling. “I’d want to know what you meant.”

“I mean that when you close your teeth, they don’t come together in such a way that all the main pressures are properly distributed. That doesn’t hurt the teeth, but it causes trouble in the supporting tissues.”

“What sort of trouble,” I asked.

“Quite a variety of troubles that until recently were lumped together under the term pyorrhea.”

“Pyorrhea is incurable, isn’t it?” I asked.

“Look,” he replied, “you’re talking the language of a past era. Don’t you know that there’s been a revolution in the practice of dentistry?”

“I’d like to hear about it,” I said, “but I wish you wouldn’t make your gestures with that steam-drill. That’ll make about a thousand revolutions a minute, I judge, and I’d rather think about just one.”

He laid aside the instrument, giving it an affectionate pat. “It’ll be here when you come tomorrow,” he said. Then he rested an arm on his high cabinet and started telling me some things that I think everyone ought to hear.

“Your teeth don’t just sit there in your jaws like pegs in a row of holes, you know. The structure that holds them in place and enables them to chew for a lifetime without wobbling or falling out is delicate and complex. It consists of five different kinds of tissue, all neatly adjusted to each other and to their function. A realization of the primary importance of these supporting tissues and a practice based on it, is what I call the revolution in dentistry.”

“What do you mean by primary importance?” I asked.

“I mean this,” he said. “In adults, more teeth are lost because of disease in the supporting tissues that because of decay or any other trouble in the teeth themselves. That means that dentists ought to direct attention to the supporting structures as well as to the teeth.”

“How many of them do?” I asked.

“Not so many as I wish,” he said. “It is estimated that 90% of dental treatment is still treatment of the teeth only. In times past, the average dentist didn’t even pretend to have expert knowledge about the supporting tissues. He waited until disease in those tissues got so bad that pus formed, and then called it pyorrhea and said it was incurable. Most of these conditions were not incurable even then. In general, when they are diagnosed and properly treated in the early stages, they are among the most easily cured of all human diseases.”

“Why were people indifferent to them for so long?” I asked.

“I’ll tell you one reason – they don’t hurt! At least they don’t hurt until they reach an advanced stage. Another reason is that they are hard to diagnose – it usually requires x-rays and careful clinical inspection. And then, you know, sometimes a word, or a notion, will get stuck in people’s minds and block all progress. The word pyorrhea and the way it has been used has been the roadblock on this particular line of march. Some periodontists have given up using it altogether, but all of them recognize that it’s only a loose general term for a variety of conditions with a variety of causes.”

“What is a periodontist?”

“A periodontist is a specialist in the diseases of the supporting structures of the teeth.”

“Do you have to have specialists for that? Can’t the dentists take care of that? I thought you were talking about a revolution in dentistry?”

“I am, and the revolution consists of the dentists becoming periodontists. At least up to a certain point. There are conditions of these structures too grave for the regular practicing dentist to handle. But he should know how to treat them up to that point, and he should know when that point is reached. Until recently the average graduate of a dental college didn’t know much about the whole subject. The young dentist went into the world unequipped to meet the needs of more than half the patients who came to him. And when teeth which he had repaired, no matter how skillfully, got loose and fell out just the same, he had nothing better to say for himself, or his science, than that pyorrhea is incurable.”

“There must have been some truth, after all, in that toothpaste ad that used to say ‘Four out of every five will have pyorrhea.'” I ventured.

“Yes, but things are changing rapidly. Courses in periodontia are now offered to undergraduates in all our dental schools. Instead of learning about one disease and being told that it is incurable, they learn about a whole set of conditions springing from various causes. And they learn that not one of them is incurable except after years of neglect. They were incurable in the past only because they were neglected until they became so. That’s the simple and sad truth. Many people still neglect them. But if they go to an alert dentist they will learn to take the supporting tissues as seriously as they take the teeth.”

My dentist’s eyes were glowing when he finished this monologue. He has an enthusiasm for dentistry like that of a violinist for his art – sustained, patient, conscientious. I love to hear him talk. And besides, I didn’t want him to pick up that drill again.

“When people take their gums seriously, what do they do about them?”

“That brings us right up into the front line of the modern advance in dentistry,” he said, happy that I had asked the question. “You see, we must not only recognize the importance of diseases in the supporting tissues, but also understand the causes. And then we need the patience and energy and inventive enterprise to treat them properly.”

“That’s where my bite comes in,” I said.

“Of course,” he replied. “Your teeth and jaws are a very delicately adjusted machine. Your jaw muscles are among the most powerful muscles in the body. They bring your teeth together with a tremendous force thousands of times a day, exerting a pressure that can go as high as 300 pounds. That may mean a total of 25 tons in one day. Isn’t it perfectly obvious that if the machine is to stay in order they’ve got to come together, right?”

“Of course, other things may affect your gums – nutritional deficiencies, allergies, infectious diseases, worn fillings and inlays, and tartar deposits. We have to look out for them. But what most commonly injures and gradually breaks down the structures supporting the teeth is the jarring action resulting from improperly adjusted tooth surfaces coming together every time you close your jaws. You laugh at the phrase “correcting your bite.” We can also call it mouth rehabilitation, if you like that better. But there is no doubt that a study of tooth relationships, and a correction of mechanical defects in chewing, is one of the biggest developments in dentistry in many years.”

“I’d like to know how you correct a bite. What do you do?”

“Well, let me give you a simple example. Suppose a tooth is missing, or wanders out of place. The opposite tooth doesn’t get any pressure when you chew. That’s just as bad as pressure in the wrong direction. All teeth need exercise. That’s why we feed bones to a dog. But did it ever occur to you that a single tooth in your mouth might need exercise? Every organ needs to function in order to keep healthy – that is the basic principle. A missing tooth should be replaced immediately, especially in growing children whose entire jaw development, and even facial appearance, may be affected by it. And a migrating tooth should be brought back where it belongs.

“Those are simple cases, and the measures to be taken are obvious. However, suppose all your teeth are there, but some of them don’t come together. They don’t get any exercise either. Or suppose they come together in such a way that, instead of an up and down thrust, some of them get pushed sideways with terrific leverage whenever you chew or grit your teeth. That is just as bad, but the method of correction is a little more complex. It consists of restoring the relationship of the teeth to each other so that they will mesh properly. Sometimes a tooth is centered below the biting plane of its mates and must be raised a bit. This can be done by trimming off the crown and building a new one of gold – or gold and plastic where appearance demands it. This crown is cemented onto the trimmed tooth. It causes no injury to that tooth; on the contrary, if the tooth was subject to decay, a new crown tends to protect it. And, skillfully done, it results in the tooth’s getting exercise, and in the right direction.

“In other cases, the crowns of some teeth may jut up too high above the adjoining teeth, and must be polished down. Sometimes the high points of the chewing surface, what we call the cusps, may hit each other too hard. In such cases we trim them off so they meet evenly.

“That will give you an idea of what I mean by correcting a bite. I regard these new techniques as among the turning points in the whole history of dentistry.”

Its about the same thing movie stars sometimes do for the camera’s sake, isn’t it? I asked.
Not quite, but that’s a part of the general picture.

And doesn’t it take a movie star’s salary to pay for it?

He leaned over toward me, murmuring, “close, please” – a polite way he has of saying “Shut your mouth!” After inspecting my clenched teeth he said: It might be quite an undertaking to correct your bark, but what little I would do to your bite wouldn’t cost you $50.

“Of course, you’re lucky.” he added. “In bad cases a complete mouth rehabilitation may cost quite a lot. It will rarely cost more in a lump sum, however, than the patient will pay out in little driblets over the years, tinkering ineffectually with a chewing machine that is being destroyed by its own operation. That is bad finance as well as bad mechanics.”

Have Missing Teeth Replaced

Problems arising from tooth decay are minor against those from gum and bone changes

Chances are that you and most of your friends have a missing tooth, because statistics show that 70% of people over 21 have had one or more teeth extracted that have not been replaced.

It maybe seems that you can chew as well now as you did before the tooth was extracted; the tooth is probably a back tooth and it doesn’t show anyway. In fact, if the tooth was lost a long time ago, the probability is that the adjacent teeth have shifted so much you can hardly tell where the missing tooth belonged.

Most people, on first consideration, would think of these probabilities as good fortune. A tooth has been extracted without the trouble and expense of having it replaced. But the good fortune is only apparent. By not replacing the missing tooth you have started an insidious process of destruction that will eventually lead to the loss of many more teeth, and to a serious impairment of your chewing apparatus.

Dental scientists have shown that this destruction and impairment happens in every case. In some mouths these debilitating processes start soon after the extraction of a tooth; in others, it may take years. But its as sure as night follows day that when an extracted tooth is not replaced by an artificial tooth, a person can expect to lose other teeth.

Here is how this takes place. Initially all the teeth are present and in proper alignment. The lower teeth meet the uppers exactly; the high, cusp-like parts of the lowers mesh with the indented parts of the upper teeth, and vice versa. There is a natural plan here: the teeth engage each other efficiently at rest and in the chewing processes; the forces of chewing are distributed evenly over each of the teeth, and it can readily be seen that food can be efficiently and comfortably chewed.

Next the lower first molar has been extracted. You will notice how the teeth adjacent to and those above the extraction have shifted out of their normal place. The teeth are not meeting with equal stresses on each individual tooth. Some of the teeth meet obliquely, some meet point to point, and some parts of the teeth do not meet at all. This functioning is similar to walking incorrectly on the heel of your foot instead of using the properly arched sole. If you walk incorrectly in this manner you would expect that the leg, the knee and hip joints and the spine – together with their nerves, muscles and blood vessels – would be affected by the jarring, banging misuse. Also, the arch of the foot and the toes – together with their tissues – would be affected by lack of use. The heel of the foot would accommodate to incorrect usage and would probably be least affected. So it is with the teeth when they do not occlude (mesh) correctly: the gum tissue, the supporting membranes around the teeth and the bones that support the teeth are affected from over-forces and under-forces.

In pyorrhea, as it is commonly known, you have an area of gum tissue that is not snug, as in figure 2, number 5. This gum flap acts as a receptacle for accumulation of food debris, calculus (stone like concretions that are precipitated from the saliva and the blood stream), saliva and bacteria. This accumulation – by virtue of its own bulk and by the infectious matter that it contains – acts as a further irritant to the base of the gum flap and to the bone around the tooth. The effect of these irritations is a deepening of the periodontal pocket and a further loss of supporting bone.
This insidious destruction goes on, too, as you chew. Since the teeth are meeting obliquely, instead of through their long axis, they are further loosened by this improperly directed force. The action and effect is similar to that of removing a post from the ground. To loosen and remove the post you do not pull it straight out. Instead, you rock it obliquely from side to side until its lateral attachments are ineffective. The post finally becomes loose and wobbly and it takes comparatively little effort to remove it. This improperly directed force on teeth, causes a deepening of the lateral, or periodontal pockets, and a further loss of mechanical attachment. Loose and infected teeth are almost invariably teeth that require extraction.

There are other ways too that the remaining teeth are affected. Shifting of the teeth can result in spacing between them. Food collects in these spaces rather easily, and it’s difficult for the toothbrush, the chewing processes, the saliva or the tongue to dislodge these wedged particles. Long-standing food impactions eventually bring decomposition and the liberation of acidic materials. These acidic decompositions will help to start dental caries, or tooth decay. It is obvious; therefore, that you are more prone to tooth decay when you have a missing tooth that remains unreplaced.

The other two effects of unreplaced missing teeth are easily understood. You cannot possibly chew your food as well with unreplaced teeth as you can with a full complement of teeth. You may feel that you are chewing adequately if you have a tooth missing, but that is because you have developed a tolerance and you have become accustomed to the deficiency. Finally, the development of this tolerance usually results in chewing on the side that is most comfortable, the side that has the full complement of teeth. This will eventually lead to over-function and over-development of the one side of the face and the underfuction and underdevelopment of the other side. The effect on the nerves, the joints and the musculature can be serious and profound.

Replacement of a tooth is a measure that has not received enough emphasis. Dentifrice and toothbrush manufacturers have stressed the deleterious effects of tooth decay, yet dentists know, and patients should know, that more teeth are lost from gum and bone damage than from tooth decay. One of the principal harmful changes of gum and bone is periodontoclasia or pyorrhea alveolaris and we have shown that this is caused to a large degree by improper tooth functioning. One of the principal causes of improper functioning is the loss of teeth without proper replacement.

If you have such a condition in your mouth, you should see your dentist, soon.

Guide to Dental Health
Most of the harm we do stems from benign neglect. Dental fitness requires knowledge and commitment to a set of simple guidelines.

1. Two basic dental structures: teeth (the hard tissue) and gums (soft tissue).
2. Two basic types of disease affects the dental structures: the decay process = caries or cavities and gum disease.

Most adults have 32 permanent teeth including 4 wisdom teeth.

Parts of the tooth
Crown – part of the tooth you see when you look into your mouth. Crowns have cusps and recessed areas called depressions.

Roots – portion of the tooth that anchors it into jawbone. About 2/3’s of tooth is made up of the root.

Enamel – Hard white outer covering of the crown of the tooth

Dentin – yellowish bonelike tissue that lies underneath the enamel and supports it. Dentin forms the bulk of the tooth.

Pulp – is a soft tissue that contains nerves, blood vessels, and lymph vessels. Pulp acts as the sensory center for the tooth and also nourishes the tooth.

Cementum – thin bonelike tissue covers the root of the tooth. It serves for attaching the tooth to the bone that surrounds each tooth.

Periodontal ligament – layer of tissue fibers that stretch between the cementum and the bone. These connect the root to the jawbone and help cushion the tooth from pressure and jolts.

Gums – tissues that surround and help hold the tooth in its socket.

Periodontal disease comes from two Greek words that mean around the tooth.

Functions of the teeth
They help your face keep its shape and form, speak clearly, chew and digest food.

Incisors – located front and center of mouth. They cut food and help guide food into the mouth.
Canines – have the longest roots of any teeth so they anchor them firmly in the jaws while they grasp and tear food.
Premolars – crush and tear food.
Molars – grind and chew food.

Mouth rinses and mouthwashes with the ADA’s seal of acceptance use as directed, in conjunction with brushing and flossing, these will help prevent tooth decay.
Porcelain Veneer
Advantages over plastic:
1. Strength
2. Bright and vital
3. Better ability to match shade
4. Less discoloration with aging
5. Longer lasting

Disadvantages over plastic
1. Requires 3/4 mm removal of tooth surface
2. More expensive
3. If it chips has to be done again.

Generally we offer a 2-year guarantee on porcelain facings.

Loss of teeth
When a tooth is lost the following thing can/will happen if left untreated.
1. Other teeth will drift and drop, due to lack of support.
2. The bite will become uneven and bone is lost around.

Once the back teeth are destroyed, the front will go quickly.

Clicking
There are 4 stages in the destruction of jaw joints.
1. The muscles supporting your disk become uncoordinated and the disk bunches up in front of the condyle limiting its movement.
2. The ligaments supporting the disk will stretch and tear until the joint gets loose enough for the condyle to slip over the disk and capture it.
3. Person can open mouth as wide as if they had a healthy joint. By this time the ligaments are torn so badly the disk bunches up and deforms in front of the condyle.
4. Joint degenerates. The condyle wears through the tissues behind the disk and rubs against the skull. Arthritis begins and a scrunching, gravelly sound is heard.

Many reasons that the muscles, teeth and joints can get misaligned.
1. Forceps delivery at birth
2. Thumb sucking after the age of 4
3. Incorrect chewing and swallowing
4. Poor bite caused by crooked teeth
5. Poor fitting dentures

Cold Sores – Herpes
Zilactin is a non-prescription ointment available at drugstores. Good for cold sores.

Structure of the Oral Cavity
1. Hard palate is formed by bone covered with sensitive oral mucosa.
2. Rugae is the wrinkle like folds you feel just behind the anterior teeth.
3. Cleft palate is when during prenatal development the parts that make up the palate don’t join together properly.
4. Soft palate is tissue part of the roof of the mouth.
5. Uvula is in back of the soft palate.
6. Gag reflex when triggered it makes you vomit.

The Tongue
Things that relate to the tongue are often referred to as being lingual. Thing which relate to the lips are often referred to as being labial.

Etched Bridge or Maryland Bridge
This is the newest, still somewhat experimental approach to replacing missing teeth. The metal is bonded with plastics to the sides of the tooth.
1. Requires very little tooth cutting
2. Less expensive than a fixed bridge.
3. Feels as comfortable as a fixed bridge
4. Doesn’t require any shots.

Disadvantages
1. If the bond fails, it can mean redoing the bridge which will be 70% of the cost of the original ridge.
2. Average life is unknown because this is a new technique.

Sealants
Sealants are fluid plastic that is fused onto the biting surface of the back teeth to stop decay. Sealants were developed to be used with fluoride to keep children decay free. The teeth are cleaned, dried, and the plastic is placed. Brown spots, deep grooves, and other small areas of decay can be sealed off and the decay process stopped.

For the best effect, sealants should be applied at ages 6-7 and then reapplied at 12-13 and again 17-18. 75% of these sealants will last at least one year and 50% will last 5 years or more.

Nitrous Oxide
It helps you feel calm, warm, safe and relaxed. You breathe 2-3 times more oxygen than you can from air. It is completely safe. You usually feel like you are floating.

Tension Grind
When your muscles go into spasm, there are a number of things you can do to relieve the spasm and the pain.
1. Temperature pack provide quick relief
2. Medication may be prescribed. Valium will relax you and aspirin will relieve muscle and joint pain.
3. Sleep patterns are important. Use a small pillow and sleep on your back.
4. Diet is important. Cut your food into small pieces.

Denture Diet
Tips on eating.
1. Only put half as much food in your mouth as you normally would.
2. Chew on both sides at the same time.
3. Chew straight up and down.
4. Eat slowly
5. It will take 5-6 weeks to learn to chew well.
Doubling the amount of protein will triple your calcium utilization. 80% of post-menopausal women will notice a taste change or burning in their mouth at the same time. Stress can cause poor nutrition. Men lose .4% bone per year after 50. Women lose 1% per year starting at age 30-35.

Dentures
You should wear your dentures for at least 3 hours before you see the dentist. This allows him to see where the dentures are rubbing against the gums. At first your saliva flow will increase, they will seem bulky, your tongue may feel crowded and you may get a slight gagging sensation. The big secret is to take small bites. Never put dentures in hot water, they will warp. It is best to leave your partial out at least 4-6 hours, each day. Many people leave theirs out overnight. When out, keep it in water to prevent warping.

After surgery instruction
Bite on your gauze for ½ hour. Pressure is the best way to stop bleeding. Tannic acid in the tea is a strong clotting factor = wrap gauze around a damp tea bag and bite on that for ½ hour if bleeding is a problem.

Tips for Taking Medication
If you forget to take medication before meal wait for two hours, food will not allow you to get full value out of antibiotic. Do not take any fruit juice, blue cheese, or antacid within an hour of taking penicillin. They will make it less effective. Also take a multiple vitamin with C with your antibiotic.

Medrol
Medrol stops the body from trying to fight the infection and this usually eliminates the pressure that is causing the pain within a few hours.

Pain Relief
If it has an acid smell – don’t use it; the aspirin is decomposing. Take aspirin with milk, a pinch of baking soda, or a full glass of water to decrease stomach irritation or take a coated tablet.

Empirin Compound 3# or Tylenol #3 (contains Codeine, a narcotic)
The side effects are: light-headedness, sleepiness, nausea, sweating or loss of appetite.

Am I losing my nerve?
Three ways a tooth can be saved:
1. American root canal – it has been used in the US for over 60 years. Over 90% of teeth treated this way will last as long as the adjacent teeth.
2. European root canal – Europeans developed a short cut that is quicker and less expensive. This approach is usually more painful and may be less successful long term. Dr. Smith starts antibiotics and ibuprofen two days before this appointment for his patients.
3. Pulpotomy – seal medication in the tooth. But a root canal will still need to be done in the future.

Choices
Fixed bridges – this is traditionally the best and most trouble free approach.
1. Fixed to teeth
2. Look like, chew like natural teeth
3. Feels like natural teeth quickly

Disadvantages
1. Requires cutting the teeth down
2. Teeth can be sensitive to hot/cold
3. Teeth could need root canal later
4. Most expensive approach
5. Average life is 7-15 years. Decay can ruin it.

Root canal therapy
1. Removing all of the pulp tissue from the tooth
2. Enlarging, cleansing and sterilizing the root canals and pulp chamber
3. Filing these areas with an inert material

Implants
Dentures are a replacement for no teeth not your teeth.
Bony ridges continually melt away from dentures while implants work like teeth to support the bone.
Implants stabilize bone, anchor the tooth replacements, and look as good (or better than your natural teeth).
Insurance companies often pay for the tooth replacement over the implant.
The 10 year survival rate nationally for a bridge is 75% last 10 years, for an implant its 95% for 10 years.

The dentition
Dentition refers to natural teeth in their normal position. Primary dentition consists of 20 teeth. Mixed dentition is when a child has some of his primary teeth and already has some of his permanent teeth. Eruption is the movement of the tooth into its normal working position in the mouth. Permanent dentition consists of 32 teeth, which are designed to last a lifetime. They should be in position between the age of 18-21 years. Occlusion is the relationship between the maxillary (top) and mandibular (bottom) teeth when they meet in normal contact. Malocclusion refers to any irregularities of the teeth. Anterior teeth are the front six teeth. Posterior teeth are the ones towards the sides and back.

Surfaces of the teeth
Mesial means toward the midline of the mouth. Distal means away from the midline of mouth. Lingual refers to the tongue. Facial refers to the surfaces of the teeth that are toward either the lip or the cheek. Incisal edge are the anterior teeth which have a sharp biting and cutting edge. Incisal angle is the corner of an anterior tooth.

Tissues surrounding the teeth
1. Alveolar ridge – supports the teeth in their working position
2. Alveolar socket – each tooth sits in its own socket
3. Alveolectomy – surgical reshaping of the alveolar ridge
a. Aid in the removal of teeth
b. Restore normal contours following the removal of teeth
c. Preparation of the mouth for dentures
4. Periodontal ligament – series of bundles of fibers which support and suspend the tooth within the bony alveolar socket.

Periodontal disease
Tissues which surround and support the tooth. The prefix, peri means around or surrounding. Dental means tooth. Periodontal is caused by: plaque and calculus.

Parts of the teeth
Crown – part of the tooth which is visible in the mouth
Cervix – neck of the tooth, narrow area where the enamel joins the root
Root – they help to hold the tooth in its bony socket
Apex – tip of the root where the nerve and blood supply center and leave.

Tissues of the teeth
Enamel – hardest material in the body. Covers the crown of the tooth.
Cementum – hard, bone like covering of the root. Helps hold the tooth in position.
Dentin – bulk of the tooth
Pulp – is the soft living and very sensitive tissue of the tooth. It is made up of blood vessels and nerves.

Types of Teeth
Incisors are anterior teeth with a thin sharp cutting edge used for cutting and biting. Canines are the heavy pointed anterior teeth, designed to cut and tear those food which are too tough fro the incisors. These teeth are also known as cuspids. Premolars are like the canine in that they have pointed cusps for tearing, grasping. These teeth are also known as bicuspids. There are two maxillary and two mandibular premolars. Molars are posterior teeth used for grinding solid pieces of food. The maxillary molars each have 3 roots. The mandibular molars each have 2 roots. There are 4 maxillary (top) molars and 4 mandibular (bottom) molars for primary teeth. However for permanent there are six for maxillary molars and six for mandibular molars.

To get signed off you must pass a verbal quiz by the dentist or team leader.

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