in this video we're going to review everything you need to know or most of the things you need to know for dental materials so let's start with learning about impressions for study cast so study cast is like study models and then custommade oral appliances we as hygienists can make custommade oral appliances and we're going to look at what we can make so some things that um you may remember you might remember from Dental materials is that you probably made a sports card mouth guard Sports guard mouth guard are used are the same thing these words are used interchangeably you may have made a whitening tray you also may have made a study model for your clients so let's start with a question first which is a negative imprint of the teeth and surrounding tissues used to create a reproduction of the teeth and surrounding tissues a die a study model Dental impression or diagnostic cast negative imprint not positive but negative imprint the answer is Dental impression so C dental impression is a negative imprint of the teeth and surrounding tissues and it is used to create an accurate or a 3D um reproduction of the teeth and surrounding tissues everything else is a positive reproduction so a Dye which I'll show you a picture of a study model that's a positive um reproduction a cast is a positive reproduction but Dental impression it's when you take an impression it's a negative imprint cuz it's not the actual um model right when you get the actual model or the die or the cast that is a considered a positive reproduction so these are negative um Impressions and then when you finally get the model that is a positive reproduction so when we're looking at Dental materials um there is something called the preliminary impression a preliminary impression are basically accurate reproductions of the patient's mouth so every this is the actual imprint of the patient's mouth and they're used to to make um study models um if you want to document you know the dental Arc as part of your permanent record you could use the the study model to do that and it's a great way to make a study model for patients education so that the patient knows what their mouth looks like and then you can teach them how to properly brush and floss using the study model final Impressions these are used to make cast and dyes and later I'll show you a picture of what cast and Dy look like but here you're getting exact detail so this is a final impression is when you have exact detail of the tooth structures and its surrounding tissues so you can get cast and dyes from these final Impressions and that's what they use to make crowns or um they could use that to make pel or full dentures or even Restorations um such as implants the place that are on um implants and this what you see here is a bite registration and this is used to record the how the Max and man what the recusal relationships are between the arc between the two arcs so bite registration is good when you want to figure out what the articulation is what the bite looks like of the Max and Man cast here we see whitening trays so these are things that um can be made uh this is a good example of a customade oral appliances because this is a custom fit to the client's mouth now when we're looking at impression trays there's so many different types there's metal there's perforated which means they have holes there's plastic there's even quadrant trayes which only cover half in AR um so there's even disposable ones as well disposable styrofoam ones so lots of different types of impression tws that come in different sizes small medium and large for children and for adults so here is another question for you the impression tray that is most widely used in dentistry for preliminary Impressions is reversible hydrocolloid irreversible hydrocolloid addition silicon or condensation silicone the answer is B irreversible hydroc coloid and what does that mean irreversible means that once the algen has set you can can't get it back to um a liquid setting once it's set it's set so there are reversible hydroc coloid that are out there and there's also irreversible hydroc coloid so um what irreversible hydroc coloid is it's basically algen that's a good example of algen and it's irreversible because um you can't get it back to its liquid state but reversible and there are some reversible like AER and what happens is if you take this imp with thermal factors so with heat you may be able to get it back to its original state um but the one we use in dentistry is the irreversible one the alun they do not change their physical state after it becomes um solid Aline impression material powder should be stored a in the freezer b in a cool refrigerated Place C in a cool non refrigerated place or D at room temperature the answer is C in a cool non-refrigerated place the reason for this is because the power actually deteriorates it doesn't it's um you know the quality isn't as good when it's exposed to elevated temperatur so when it's exposed to something hot um or even when it's exposed to water it's really important to store the powder in a tightly closed container in a cool non-refrigerated place so that it doesn't get the powder doesn't get get detoriated so when you put it in a cold place like a refrigerator place it can detate and same thing with the freezer and at room temperature if it gets too hot it could also detate so the best thing is cool non-refrigerated place now when you take an impression it is really important to wrap it in a slightly moistened paper towel and then you place it in a plastic um biohazard bag and the reason for this is because if you do not wrap it you can get an uptake of water so if there's like moisture around the area when you haven't wrap the impression you can get something called inhibition which is where the alet can expand and now you're not going to get a True Fit the the impression um that came out of the mouth it once it once it expands it's not going to be a proper um replication of the client's exact mouth and CIS is when you get lost of water so if the impression is um left exposed and it's uncovered it can shrink so if you so again it's really important that when you have your impression you disinfect it you wrap it in a slightly moistened towel and you place it in a bag because that is the way you can get the least amount of distortion otherwise you're going to get it to either shrink or expand so it's really important that you follow those step if you leave it exposed to the room environment and it's uncovered the impression can shrink can shrink right and that's what syis is so how many scoops of powder are generally required for a maxillary so the top maxillary algen impression one two three or four how many scoops of powder yeah if you said three you are correct three scoops of powder are needed for a maxillary algen impression the way I remember it is maxillary MERS have three Roots Max M ax have is made up of three letters so three scoops for Max and so it actually needs three scoops of this and also three lines of water okay so three lines of water and three scoops that's one: one ratio now when you're um taking the powder or when you're using the powder be sure to fluff the canisters or turn it upside down a several times um before measuring with the scoop with mandibular so at the bottom Al you need two scoops of powder and two lines of water so two lines of water two scoops of powder and um unless someone has a large mandible then you might need three but otherwise it's two and as we said maxillary is three scoops of powder and three measure lines of water now when you're mixing the algen it that time that you have to mix is known as your working time the time that's needed to mix the impression material the time that's also needed to load your impression tray and to put it inside or seat it inside your patient's mouth so that's known as your working time the setting time is how much time um it it's needs for the impression um to set so we have two types of powders we have regular set powder and fast set powder and you could have used either or in um Clinic the regular set powder if you look at the working time you have two minutes so you have full two minutes to mix the impression load the tray and seat it inside the person's mouth so you have 2 minutes and then when you put it inside the client's mouth for it to set it can take anywhere um it can take up to 4.5 so 4.5 minutes for it to set so it does take a while for it to set but a fast set powder it just takes 1 to two minutes for it to set so if you have a gagger for example the fast set powder might be great because it doesn't stay in their mouth for too long regular set powder can take 4.5 minutes to set bath set powder takes 1 to two minutes to set and remember loading the tray and inserting it it shouldn't take too long it should only take no more than 1 minute if it's taking long practice some more until you get the hang of it because that actual loading of the tray and insertion into the M should take no more than 1 minute there are even color changing algenist that are out there which is really cool so color changing alet in which color is which color when set is it white so when it's set when it's hard when the impression material has become hard does it turn white does it turn pink does it turn red or does it turn purple if you said white you are correct it does turn white so when the algen powder mixes with water okay so let's just look at um all the different colors when the algen powder mixes with water it becomes purple and then as you're mixing once it turns into pink that means okay it's now time to load the tray so when it changes pink you have to load the tray and then you put it inside the person's mouth and then it'll turn white and at White um the white color means that it's now ready for you to take it out it has now set red is not a color we see but color changing algen it there are even some silicone Aline alternative materials and these are really cool they're expensive they're really expensive 6 to eight times more expensive than your regular algen products but the advantage of this is that you can pull and repour the models um for weeks so for example I take an impression on you I take it out and I go to the lb and I pour you know I pour up my model and let's say I want to pour it up again maybe next week I want to use the same impression and pour up again I can do so if I want to Pour It Up four weeks later I could even do that so I have the advantage of pouring and repouring the models the original impression um toay as at any time after this infection to up to weeks later so it's comes with a it's convenient it's flexible it even has a mixing syringe um but they come with the price because they are six to eight times more expensive than the traditional algen products when you put when you load the impression tray into your client's mouth make sure you tell them a few things before before you load that tell them that the material is going to feel a little cool but it will gel quickly um tell them if there's going to be a flavor when they when you put it in their mouth and you can check the canister and that should tell you where the alanet um powder is make sure you tell them to breathe through their nose cuz that will help them relax tell them not to talk if they need to talk they can raise their hand and when you load this in we always load from we seat it anteriorly and then posteriorly we don't see it posterior posteriorly to anteriorly cuz if you do everything's going to go all the way back so seat it anteriorly and then posteriorly um the the very important thing that I always tell my clients is to put their chin down because when you put their chin down all the algen will pull forward as opposed to going back there you know um back in their throat so once you've set the once you put this tray in get them immediately to put their to tilt their chin down so that all the algen can come forward and not down their throat what is the best method to control the setting time of algen impression material should we add more algen powder to the mix should we add more water to the mix should we change the water temperature or should we mix for a longer time than recommended how can we best control the setting time of algen impression material if you said c change the water temperature you are correct so when you change the water temperature you can actually manipulate the setting time for example if you use cold water you now have more time to mix so it increases the working time it also increases the setting time um if you use warm water you will now have less time to mix because it's going to set faster with warm water so you always want to use room temperature water but if you feel like you need more time to mix and more time for it to set then you can use the cold water so warm water decreases the working time and setting time whereas cold water increases the working time and setting time so colder the water the more longer it will take to set the warmer the water the um faster it will set the impression of a mandibular teeth should be taken first or second because gagging is more or less likely in the mandibular area and enhances trust in the clinici for the maxillary impression so what do you think the impression of a mandibular teeth should be taken first so always do the mandibular impression first because gagging is less likely in the mandibular area so you're not scaring them you're starting with an easy area you're starting with the mandible because it's easy because they won't gag if you start with the maxillary they're going to be gagging and by the time you get to the mandibular they're already traumatized so you don't want to you don't want to scare them always start with the mandibular then do the maxillary impression when you take the impression out rinse it with water okay cuz when you rinse it you're removing saliva you're removing blood you could be removing debris Shake excess water from the impression and then there there is a disinfectant spray that you can use to disinfect before you pour um the gypsum into the mold into the mold so this is what a bite registration looks like it recurs to relationship of centric occlusion Centric occlusion refers to um the maxim the maximum stable contact between the Max and theand arches so when the jars are closed it reaches Centric occlusion that's what it would look like and so once the client has left the office at least you know what they what it looks like when they bite down so when you pour up your models and you make your um you know study model or your cast for example you now know what they look what it looks like when they bite down because of this because you took the bite registration now this is a dye and a Dy looks like it's a replica of a prepared too basically and it's constructed from a very dense gypsum product and this is a working cast which is like a stone that's strong enough for fabrication of indirect Restorations or even prosthesis which I will talk about what that means in a bit but this is like a working cast this is a Dy which is just like a a replica of one prepared toot whereas this is a working cast and so gyps and products when you pour it up you're using gyps and products you could be pouring it up with model plaster and that's like a study model this is what we used plaster Stone you could be using a dental Stone which is um a little more stronger and then you could be using the high strength Stone which you need for um cast and dies for crowns Bridges and indirect Restorations indirect Restorations are anything a restoration that's made in a lab so a crown or Bridge would be made in a lab direct Restorations are I'll go I'll get to that slide but direct Restorations are things you can do right then and there where you don't need to send anything to a lab so like amalgam fillings composite fillings those are direct Restorations indirect crowns Bridges where you you probably need to send them to a lab and you would use high strength chips some product high strength Stone so what are things we can do with custommade removable oral appliances well when you take those impressions you could make a fluoride tray you could make a toot whitening tray you can make a mouth guard and then um other things that are done in the lab are orthodontic alignments you can make retainers you could uh the lab could make sleep apnea um appliances as well so many things that can be done from taking an impression and they're all listed here there's something here called par functional accusal forces let's just review this term pair of functional accusal forces well actually the opposite of pair of functional accusal forces is functional accusal forces functional accusal forces is when you just chew so forces in your when you're biting down due to chewing but par of functional accusal forces are any forces that could happen to your teeth that have nothing to do with chewing so for example grinding clenching those are considered par of functional occlusive forces because they are not related to chewing so night guards sleep guards those are great examples of parap functional accusal forces um because they help with grinding and clenching so grinding and clenching are examples of par of functional accusal forces and when you use these appliances they can help reduce the clenching and grinding and then it can also minimize the loss of tooth structures because when you crunch or grind you can damage your tooth structures and they also help with um TMJ these are periodontal splints so when someone has a lot of bone loss and recession and their teeth could be getting wobbly this splint could be put in to stabilize the mobile teeth to stabilize the loose teeth and prolong the or keep the teeth there for a longer period of time all right here's another question how often should a removable oral Appliance be cleaned daily weekly monthly at regular visits so think about like dangerous think about Oro um appliances the ones that are removable How often daily would be correct yes daily is the answer because um watching we'll look at why in a bit but the one of the main reasons why you want to remove it daily is because you need to clean it and so you need to clean it with a soft or extra soft cryistal toothbrush and water and if there is a removable Appliance approv approv cleaner you want to put it into that approved cleaner so that it cleans up so but you're also manually cleaning it with a softer extra soft toothbrush so this is an example of a retainer and you can clean it with soft or extra soft Crystal toothbrush and water or you can clean you can even clean it with an approved cleaner okay let's look at restorative now um Composites are being placed in preference to a amalgams in large part due to what due to patients demands for Aesthetics due to easier placement with amalgams due to Greater long longevity than amalgams or due to fewer incidences of recurrent carries why are Composites placed more than amalgams Aesthetics if you said a Aesthetics you would be correct CU Aesthetics are so important is so important for clients these days I mean everyone wants to look better everyone wants to look presentable look good so Composites are um preferred for patients because of the because of aesthetic reasons amalgum is good because it is actually the long longest lasting material it's not you know technique sensitive it's really easy to do and it's the most resistant to recurrent Decay recurrent Decay means once you have a cavity if you get a cavity again that's recurrent Decay where you get a cavity again in the same spot um or around the filling so amalgams are great however Composites are better because patients want them for Aesthetics reasons so why do people need Restorations what is the rationale for restorative therapy I'm sure you guys know this but to sum it up really quickly if you have a damaged tooth structure so if you have a chip tooth for example you're going to need a restoration if you have a defective restoration so perhaps you got fillings done but they were too big they stick out that's considered an overhang or they're too short they don't fill up the entire area that is considered submarginal or there's a gap there's a margin an open margin Gap it needs to be fixed because otherwise bacteria pla will get in there and it will start to rot or create a cavity right which we don't want so if you have a defective restoration such as these examples here you'll need rest you'll need restorative therapy you'll need to get it fixed sometimes if you have a missing too if you have you know cavities and it doesn't look good you people will come for restorative therapy for aesthetic appearance it could also be for occlusion so if you're not you know when you bite down and it doesn't feel right maybe you need some adjustment maybe you need reduction selective reduction of enamel because when you bite down it doesn't feel normal that is another reason why you would come for restor restorative therapy and then there's also mastication mastication means chewing so if you find that you have a missing tooth and you're not able to chew properly if you have a defective restoration so one of your uh Restorations you know something is wrong with that perhaps you're getting food stuck in in the open margin um perhaps there's an overhang and food is getting stuck in between the two teeth with the overhang it and is affecting your chewing it's affecting your mastication you'll need restorative therapy and of course if you have cavities and you can't bite properly or you're only biting on one side because of cavities you'll need restorative therapy so lots of reasons why people need need Restorations and when you look at types of restorations there's direct Restorations and these are the ones that are um done directly inside the person's mouth you don't need to go to a lab so amalgam composite glass ionm or direct gold where you don't need to go to a lab but indirect is where you do go to a lab so you take an impression and you send it to the lab so that they can make something in the lab such as porcelain um crowns um inlays and I have a chart from Darby so this is from Darby direct Restorations these are all examples of direct restoration I do encourage you to pause this video and look at the advantages and disadvantages so as we said about amalgam it lasts a very long time and it's cheap and it's easy to do but no one likes the color so the patient acceptance is poor composite is good because of Aesthetics patients love it because it it's white but it it does take some it's technique sensitive so you need to make sure there's no it needs isolation no water no saliva should be in that area resin modified glass ioner um material is primarily used for class by fillings which is just right here along the cervical and you can see here what's nice of a gloss ionomer is it releases fluoride so if someone's high risk for carries this would be great cuz fluoride ions are being released and no fluoride helps with cavities it's really easy to do the only thing is it does wear away quite fast we have the stainless steel crowns which is good but people don't like it because of its Aesthetics it it's silver it's not white and it's also temporary for permanent teeth for you can use it for primary teeth but for permanent teeth is temporary then we have performed it's Z conium crowns they look like this it's expensive but it looks nice when you look at indirect Restorations these are ones that you go to the lab to mix a gold alloy a porcelain um even person infused to metal where they have that metal component and then there are even CAD sl- cam Restorations where they scan your teeth and then they make it right then and there with the machine um it's like they can make an inlay or an onlay so this is what an inlay looks like it's inside the crown this is what an onl looks like it's on top of the crown uh you have the crown of the too and this is an entire Crown so lots of things that could be made outside the client's mouth the crowns primarily used for Pediatrics or children are made of stainless steel porcelain gold or tin stainless steel is correct stainless Steels are cost effective so it's cheap it lasts long and you know it does the job to restore primary teeth especially when extensive when you have lots of Decay big decay um so this is a great option 10 crowns are not strong enough to last gold and porcelin crowns are too expensive especially for kids so stainless steel is your number one option okay let's talk about dental isolation I um I think I might have a question about that okay no let's talk about dental isolation so Dental isolation are dams dental dams and they're great because what they do is they um help with Moisture Control it's really important for most buildings to have you have a dry area right essential dryness is extremely important and so some restorative materials when it's exposed to saliva or any moisture it can really uh it can fail the restoration can fail so the dental dam helps with that which of the following classification of restorations requires a matrix to be used so they're all listed here class six class one class five or class three class three is the answer let's look at why so when you look at so actually for Matrix which is this one over here it looks like this um it is the key for a quality restoration especially when you're doing any interproximal um reconstruction or contouring of the inter proximal to Anatomy so if you look at the classifications that are out there they're all listed over here you can tell that class 2 has interproximal um contains interproximal um areas class three also contains interproximal areas and same with class four it does kind of um include the interproximal area so anytime you're doing any interproximal Restorations you need a matrix system you need a matrix band and this prevents overhang so that the material can stay confined in that area and it won't hang out so it prevents overhangs really important and this is a wedge and a wedge is good because what wedges do is they triangular they fit into an interproximal space And they support that Matrix band that we were looking at um without en roaching on the contact area so the wedge is really good it it gives it more support bases and liner materials Aid in which of the following insulation under the restoration work as a bonding agent under Restorations can lead to expansion of the Restorations or are bacterio static bases and liner materials it is a insulation so what bases do is they preserve and they protect the dental pulp so actually bases and liners what they do is they insulate the pulp from um temperatures from anything hot from anything cold instead it won't hurt you because they put bases or liners and I'll show you a picture of that um just to look at the other options they do not Bond the restoration they don't they don't glue it together they um do not cause expansion and they are not bacterio static either they don't help with stopping bacteria what they do do is they insulate or they protect the pulp so this is what a base looks like so before you put in a restoration you can put a base you Al can also put a liner and there are when you look at the the um the product it could be cement based materials or it could be glass ionomer cements and again these glass ionomer are great cuz they release fluoride and we know that anyone who has high risk for carries we kind of like the glass ionomer because it has that feature the fluoride releasing future so when you choose a material it's important that is strong enough to resist accusal forces so if you're grinding or clenching a lot you want to make sure that it's strong material so that it won't um you know get damage and you want it to protect thermal insulation so you want the the pulp to be protected from heat and if you're putting an amalgam restoration and you want it to resist firm condensation this is is a liner which is right here and there are many different types of liners as and and as we mentioned liners are good because what they do is they um protect the pulp so there gloss ioner liners um and that is the material of choice today because it releases fluoride we used to use a lot of calcium hydroxide liner um it was commonly used before but now it has been replaced with glass ion liners it's very thick coating that you put to the very internal portion of the cavity preparation if you're around um Dental if you're doing a dental andalum restoration so if you're assisting the dentist for example or if you're an rrh a restorative registered dental hygienist one thing to note is that Merc just be mindful of Mercury's toxic potential it has come a long way we're using careful handling now we're using pre-encapsulated amalgam um so the pre-encapsulated amalgam because it's safe um it just makes it less toxic so amalgam be mindful cuz it has mercury and it could be toxic but we have come a long way in our Decades of use because we are now careful carefully handling it and we're using pre-encapsulated amalgam Composites like this are tooth colored restorative material and they have resin Matrix and filler particles so it could be macril which is Big filler particles it could be microfil which is Tiny filler uh filler particles or it could be hybrid where you have a mix of macro and um micro filed particles so they have different categories of composite Restorations you do need a curing light for it to set and they are incompatible with moisture so you need a dry area when you use a composite when you apply when you place a composite resin modify glass ionomer this is another type of um restoration that could be used it could be a cavity liner or a restoration the downside was is that when you when you when it um meet when it's exposed to saliva it can dissolve so now they have come up with a modified glass ionomer hence the word modified where they have compensated for the tendency to dissolve and they've actually improved the restorative material so glass ionomers have been modified it's better now it doesn't dissolve when exposed to saliva and one of the excellent things about glassionomer is that it releases fluide ions it has great Aesthetics and the the modified one the in modified one is even stronger than the regular glass ionomer so if you have a root cavity root carries if you have class 5 abrasion class 5 as you know I'm going to show you a picture so we can review our classifications our black classification glass Vibe is right here in the cervical so um gloss ionomer would be great for those type of fillings it's also good for any class one two three and four restorations in primary teeth as well when you place amalgam Restorations it's important to finish and polish these amalgam Restorations because what you do when you finish the restoration you're producing the final shape and Contour of a restoration that's what finishing means producing the final shape and Contour of a restoration polishing is when you um polish it when you make it a shiny um surface so that it doesn't um you can reduce scratches okay so it uh it refers polishing refers to abrading the surface to reduce scratches to make a shiny surface so you're making it shiny and you're reducing any scratches we can also finish and polish composite Restorations which all these different birs that you see is a bir there burs finishing strips and disc there's points there's cusp there's like brushes lots of things you can use to finish the composite restoration there are even gingerful retraction cord which is either one or two strands that is placed into the sulcus and what it does is it pushes the gingerb margins away from the restorative prep so when you want to prep the to it pushes it away and if you wanted to um you know when you take an impression when you put that retraction cord in at least when you take an impression you can capture the gingerb margins as well so that's what a gingival retraction cord is used for it's placed into the gingival celus OR pushes the ginger margins away from the restorative uh prep that you need to do and it um it even when you take an impression it can take it can capture the gingerful margins of the prep Zoe so remember Zoe from Dental materials this is Zoe stands for zinc oxide and E stands for eugenol and what you do is you take the zinc oxide powder and you take the orinal liquid and you mix it with firm pressure until the material is thick and it's like a clay like material and you can roll it with your fingertips and you put it in areas where um so you put it in areas where there's there's a cavity for example it restores in um intermediate Siz cavity really important that it is temporary or interm which means that it's not it's just let's say you have a client that has come in and the dentist is not available you can put this in the area where this cavity is because um they have properties inside the zinc oxide that insulates the pulp and and sorry inside the Zoe there's lots of properties that can protect the vital pulp against anything chemical or thermal um in injuries so hot or cold I'll protect it so it's a temporary measure and they're good for inlays they're good for onlays this is [Music] Zoe okay let's look at Ortho now so we're going to look at Orthodontic Care and anytime someone has malocclusion so malocclusion is abnormal alignment of teeth we um they would benefit from Ortho so if they have psychosocial problem that means they say they have problems because you know their face doesn't look good so poor facial Aesthetics or they're not able to pronounce or speak properly that could all fall under psychosocial problems oral functional problem are like if they have difficulty with chewing with swallowing with speaking um LP falls under there they have rotated teeth of course they're going to have more plaque buildup more debris more stain and then that can contribute to periodontal disease if they let's say their front teeth for example are protruding outward and if they fall what's going to happen to their front teeth it will break right so if they have protruding teeth injury is very likely and so they probably would benefit from Ortho and if they have any TMJ or TMD issues Ortho can um fix their alignment and help with the relaxing their TMJ issues so each of the following is a health professional with whom an orthodontist may work inter interprofessionally to complete Orthodontic Care except one which one is the exception that an orthodontist may not likely work with is it Oral Facial myologist is it a speech pathologist is it a periodontist is it an endodontist or is it an oral surgeon the answer is D endodontist an orthodontist does not work with an endodontist for root canal therapy so root canal therapy and Ortho they don't they don't necessarily go hand in hand but an oral facial myologist could work with an orthodontist if there's any Oro facial um myofunctional disorders so for example they kind of breath so nasal breathing issues if the tongue is not resting properly um if they can't swallow these are all things that the ortho and the oral myofacial biologist can work together and help out that client speech pathologist and orthod orthodontist may send a referral to a speech pathologist or vice versa because if there's anything abnormal in the orofacial function and you if there's any speaking problems speech therapy may help periodontist and orthodontist would work with closely um sometimes an orthodontist would want the client to go see a periodontist before they start treatment because if they think that they have a lot of pero issues lots of bone loss lots of um you know the gums are not healthy a periodontist would work with the orthodontist so that when they start Ortho treatment at least all the the everything's stable the oral health is maintained it's really important that we have good oral hygiene when we're doing Ortho and an oral surgeon can also work with the orthodontist if they need any extractions of teeth if wisdom teeth needs to be EXT raed if any extraction of teeth might be needed if someone has a crowded mouth then we need to extract teeth oral surgeons can help with that here's another question each of the following is a medical history consideration for the orthodontic patient except one which is the exception anti-er medications biop phosphinates asthma arthritis or diabet es which is the exception so the answer is D arthritis so let's look at all the options we need to know an orthodontic patient so an orthodontist would need to know about anti-seizure medications because what do we know about anti-seizure medications well um we know that it can cause gingerb overgrowth so fenin is an antise your medication and it can cause Ginger overgrowth which can negatively affect like the braces espe so if you have overgrowth Ginger overgrowth and then you have braces and you're not taking good care of your oral hygiene just imagine the damage that can happen to your gums the amount of overgrowth can expand can grow bigger so that is important um for us to know when we're looking at an orthodontic patient biop phosphines are also important because if you remember from Farm biop phosphines affect the bone so it affects the osteoblast and ocast um activity so biop phosphinate and bone is important bone and Ortho go hand in hand because when you have ortho your bone is being shifted and you know formed and reformed asthma is also important because with asthma your clients are using a cortical steroid are probably taking a cortical steroid and when you take a cortical steroid you can get candidasis you can get thresh you can get decreased salivary flow you can get increased cus you can get gingivitis you can even you you be you're more prone for getting periodontal disease so it's important um to know when someone has asthma so that you can work with them to maintain their oral hygiene diabetes if someone has uncontrolled or poorly controlled um diabetes they now are at an studies show that they're an increased chance of um having periodontitis or getting any perodontal breakdown so we need to work with them closely but arthritis we don't know of any Rel relationship between arthritis and orthop patient no Studies have showed anything but a b c and e are things we need to keep in mind when we are working with an orthodontic patient