Hygiene Atlas

Atlas · Plate XVI · Clinical Services

Supportive Treatment Services

Supportive treatment services are the procedures that surround restorative and periodontal care: knowing how dental materials behave, polishing restorations safely, taking alginate impressions and pouring study models, managing dentin hypersensitivity and guiding tooth whitening. A hygienist works around these materials every day, even when someone else placed them.

On the NBDHE, supportive treatment is its own clinical services subarea. Questions favor practical handling: which material releases fluoride, why alginate must be poured quickly, which gypsum type makes a study model, how water temperature changes setting time, how potassium nitrate differs from tubule blockers, and what carbamide peroxide breaks down into.

Blueprint Provision of Clinical Dental Hygiene Services · Providing supportive treatment services · 31 facts

Radiograph of a molar with a large, completely radiopaque amalgam restoration
Plate XVI · LeadAmalgam restoration on a radiographBernard bill5~commonswiki (Wikimedia Commons uploader) · CC BY-SA 3.0

In this plate, we cover

  1. 01 Restorative materials 9 facts
  2. 02 Impressions and study models 10 facts
  3. 03 Desensitization and whitening 7 facts
  4. 04 Other supportive services 5 facts

01 · 9 facts

Restorative materials

Amalgam combines about 50% mercury with a silver, tin and copper alloy and can be polished after 24 hours. Composite is a resin matrix, filler and silane coupling agent that shrinks as it cures in about 2 mm layers. Glass ionomer bonds chemically and releases fluoride. Zinc oxide-eugenol soothes the pulp but blocks composite curing.

  1. Dental amalgam is about 50% mercury combined with a silver, tin and copper alloy; high-copper alloys resist corrosion and creep.T2
  2. Amalgam can be polished 24 hours or more after placement.T2
  3. Composite resin = resin matrix (e.g., Bis-GMA), inorganic filler, and a silane coupling agent; it shrinks as it polymerizes.T2
  4. Composites are light cured in increments of about 2 mm.T2
All 9 facts on restorative materials
Radiograph of a molar with a large, completely radiopaque amalgam restoration
Fig. XVI.1Amalgam restoration on a radiographBernard bill5~commonswiki (Wikimedia Commons uploader) · CC BY-SA 3.0

02 · 10 facts

Impressions and study models

Alginate is mixed for about 30-60 seconds and sets faster in warm water. Because it loses and gains water, rinse, disinfect and pour it within about 15 minutes. Take the mandibular impression first. Study models use Type II model plaster, and extra water makes a weaker cast. Polyvinyl siloxane is the most dimensionally stable elastomer.

  1. Alginate (irreversible hydrocolloid) mix time about 30-60 s; working time about 1-2 min; regular set 2-4.5 min, fast set 1-2 min.T2
  2. Cold water slows alginate setting; warm water speeds it.T2
  3. Alginate loses water (syneresis) and gains water (imbibition), so pour it as soon as possible (within about 15 minutes).T2
  4. Take the mandibular impression first (less gag); seat the maxillary tray from posterior to anterior with the patient leaning forward.T2
All 10 facts on impressions and study models

03 · 7 facts

Desensitization and whitening

Dentin hypersensitivity is short, sharp pain from exposed dentin, diagnosed by ruling out caries and cracks. Potassium nitrate calms the nerve over 2-4 weeks, while stannous fluoride, arginine, oxalates and varnishes block tubules. In whitening, 10% carbamide peroxide yields about 3.5% hydrogen peroxide; sensitivity and gingival irritation are the usual side effects, and restorations do not lighten.

  1. Dentin hypersensitivity: short, sharp pain from exposed dentin, triggered by cold, air, touch or sweets; diagnose by ruling out caries, cracks and leaks.T2
  2. Potassium nitrate 5% (toothpaste) depolarizes nerve fibers; it takes about 2-4 weeks of use.T2
  3. Tubule blockers: stannous fluoride, arginine with calcium carbonate, oxalates, strontium, fluoride varnish, resin sealers, GLUMA (glutaraldehyde/HEMA).T2
  4. Abrasive toothpaste plus aggressive brushing can worsen sensitivity; recommend a soft brush and low-abrasion paste.T2
All 7 facts on desensitization and whitening
An opened tube of sodium fluoride varnish with a drop of the yellow varnish at the nozzle; varnish is one of the agents used to block exposed dentin tubules
Fig. XVI.3Fluoride varnishAwvh · CC BY-SA 4.0

04 · 5 facts

Other supportive services

Other supportive tasks include digital impressions with intraoral scanners, suture removal at about 7-10 days (cut close to the tissue so the contaminated part never passes through it), and custom fluoride trays and mouthguards made on study casts. Teach denture wearers to remove the appliance at night, clean it daily with a nonabrasive cleaner and store it in water.

  1. Intraoral scanners make digital impressions without trays or gypsum.T2
  2. Remove sutures usually 7-10 days postop; cut close to the tissue and pull through so the contaminated part does not pass through tissue.T3
  3. Mouthguards and fluoride trays are made on study casts; custom fluoride trays are used for radiation patients.T2
  4. Denture care: remove nightly, clean daily with a denture brush and nonabrasive cleaner, store in water; examine tissues annually.T2
All 5 facts on other supportive services
A custom-made mouthguard, formed on a cast of the maxillary arch, held in an open hand
Fig. XVI.4Custom mouthguardLee Haywood from Wollaton, Nottingham, England · CC BY-SA 2.0