Challenging Courses 

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ANAT 1219 Orofacial Anatomy II  

Description of course:  

The course is intended to expand your knowledge of the anatomy and physiology of the head and neck and supporting structures with their functional relationships. Emphasis included recognition of the normal and variations of normal within the assessment of the Dental Hygiene Process of Care. 

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I felt like orofacial anatomy II was a very hard course to learn about in second semester. I found it difficult because there was a lot of new words, information, and spelling to learn. The course includes an abundance of information regarding head and neck anatomy, some information easy and some much more complex. I found the bones easy to learn and memorize but what comes after that, what is the next layer of the human face? It’s the muscles and many muscles that is. When it comes to the muscles of facial expressions and muscles mastication, I felt very comfortable with them at the time, but it did not stick. It was more of memorization in the moment. For instance, I know the general areas of some of the muscles, but I don’t know where they attach to, from and what their main role is. Two areas I would like to learn more about and expand on in regards of orofacial anatomy II would be the muscles of facial expression and the muscles of mastication. I want to educate myself more on these areas because I know they are very important in the dental hygiene field. Having a better understanding of the location and function of the muscles will allow me to recognize any abnormalities a patient may present with. 

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Facial Muscle and Facial Expression(s) 

 

Epicranial - Surprise 

Orbicularis oculi - Closing eyelid & squinting 

Corrugator supercilii - Frowning 

Orbicularis oris - Closing & pursing lips/ pouting & grimacing 

Buccinator - Compresses the cheeks during chewing 

Risorius - Stretching lips 

Levator labii superioris - Raising upper lip 

Levator labii superioris alaeque nasi - Raising upper lip & dilating nares with sneer 

Zygomatic major - Smiling 

Zygomatic minor - Raising upper lip to assist in smiling 

Levator anguli oris - Smiling 

Depressor anguli oris - Frowning 

Depressor labii inferioris - Lowering lower lip 

Mentalis - Raising chin & protruding lower lip 

Platysma - Raising neck skin & grimacing 

(Fehrenbach, M. J., & Herring, S. W., Page 97) 

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Origin: The end of a muscle that is attached to the least movable structure 

Insertion: The other end of the muscle and is attached to the more movable structure

 

Below are some videos I watched: 

Muscles of Facial Expression - Anatomy Tutorial PART 1 

https://www.youtube.com/watch?v=Xmz3oLrnzBw 

Muscles of Facial Expression - Anatomy Tutorial PART 2 

https://www.youtube.com/watch?v=3Z0nbAm2HPw 

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Muscle                                 Mandibular Movement 

Masseter                             Bilateral contraction: elevation of mandible during closing of the jaws 

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Temporalis                          Bilateral contraction of entire muscle: elevation of mandible during closing of the jaws 

                                               Bilateral contraction of only posterior part: retraction of mandible, mandible backward 

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Medial pterygoid              Bilateral contraction: elevation of mandible during closing of the jaws 

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Lateral pterygoid              Unilateral contraction: lateral deviation of mandible, shift mandible to contralateral side 

                                               Bilateral contraction: mainly protrusion of mandible with mandible forward, slight depression                                                   of mandible during opening of the jaws 

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Conclusion: 

During this study session I read the chapter again, watched some informative videos on YouTube, used made some study notes regarding the muscles, their origins and insertion points. I also invested in an anatomy colouring book which was my favourite part of the of the study session. I now have a good refresher on muscle anatomy. Being proficient and having this knowledge will allow me to be more confident when I must clinically find landmarks on the face and neck. 

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DENT 1201 Dental Radiography II 

Description of course: 

Included building and expanding on the knowledge covered in Radiography I. Various radiographic exposure techniques are investigated and/or applied on adult and pedodontic mannequins. Successful completion of both components (preclinic & theory) is required to be promoted in this course. Dental Hygiene students are deemed qualified to operate dental x-ray machines once they have become registered with a provincial regulating body (eg. College of Dental Hygienist of Ontario) 

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The clinical part of this course was very challenging for me and I think could say the entire class was challenged. Since there were many pass or fail assignments in lab with only 3 attempts this put pressure on everyone to practice. In a way I feel like it was a way of the school weeding out the weak. Since the tests were clinical there was no studying that you could really do at home to make your technique better as you don’t have all the equipment. You could read all you want but that doesn’t make ur technique perfect. I would tell my boyfriend every time I was frustrated “it isn't a study thing, it’s a DO thing!!” It allowed me to push myself to sign up for skills to improve my radiography skills. Since I spent a lot of time of worrying about the clinical tests, I definitely put the theoretical part on the lower end of my priorities. I'd like to learn more about panoramic images in terms of indication, advantages, and disadvantages. I would also like to expand my knowledge on occlusal images. When we learned occlusal images, it seemed very fast paced and I haven’t not done one to date on a real patient therefore I will benefit from looking back into the content.  

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Indications for Panoramic Images 

 

• Evaluate the dentition & supporting structures 

• Evaluate impacted teeth 

• Evaluate eruption patterns, growth, & development 

• Detect lesions, diseases, & conditions of the jaws 

• Examine the extent of large lesions 

• Evaluate trauma 

 

***Images are not as well defined/ sharp as the images produced with intraoral projections 

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Panoramic Advantages: 

Convenience, visibility for patient education, short time required, broad coverage of facial bones and teeth, and useful for patients that cannot open their mouths wide (Wilkins, Page 229). 

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Panoramic Disadvantages: 

Proximal caries can go undetected, distortion of structures and findings, and inadequate for examining periodontal structures (Wilkins, Page 230). 

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2 common errors of panoramic images are ghost images and lead apron artifacts 

 

Lead Apron Artifact 

Problem: 

• If the lead apron is incorrectly placed a radiopaque cone-shaped artifact appears that obstructs diagnostic information. 

• An apron with a thyroid collar would leave a bilateral would leave radiopaque artifact that obstructs the mandible.  

 

Solution: 

Use lead apron without the thyroid collar. 

Lead apron without the thyroid collar should be placed low around the neck so it does not block the x-ray beam. 

 

Ghost Images 

Problem: 

• Napkin chains 

• Glasses 

• Earrings, nose rings 

• Hair clips  

• Hearing aids 

• Necklaces 

• Anything removable in the mouth (Dentures, retainers) 

Solution: 

Instruct patient to remove all dense objects in the head and neck region before positioning the client. 

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Occlusal: Chewing surfaces of posterior teeth. 

Occlusal examination: Type of intraoral radiograph examination to inspect large areas of the maxilla or mandible on one image. 

Occlusal technique: Method used to expose a receptor in occlusal examination. 

Occlusal receptor: Size 4 intraoral receptor is used. The patient occludes/ bites on the entire receptor. Size 4 receptors are the largest size of intraoral receptors. In adult size 4 is generally used and in children with primary dentition size 2 is used. (Iannucci, Page 228) 

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Indications for Occlusal Technique 

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• Locate retained roots of extracted teeth 

• Locate supernumerary (extra) teeth, unerupted, or impacted teeth 

• Locate foreign bodies in the maxilla or mandible 

• Locate salivary stones in duct of submandibular gland 

• Locate & evaluate the extent of lesions in maxilla or mandible (eg. Cysts, tumors, malignancies) 

• Evaluate boundaries of the maxilla sinus 

• Evaluate fractures of the maxilla or mandible 

• Aid in examination of patients who cannot open their mouths more than a few millimeters 

• Examine the area of a cleft palate 

• Measure changes in the size & shape of the maxilla or mandible 

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Maxillary Occlusal Projections 

Topographic Occlusal 

Used to examine the palate & the anterior teeth of the maxilla  +65 degrees 

Lateral Occlusal 

Used to examine the palatal roots of molars, or to locate foreign bodies or lesions in the posterior maxilla  +60 degrees 

Pediatric Occlusal 

Used to examine the anterior teeth of maxilla & is recommended for use in children 5 years or younger +60 degrees 

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Mandibular Occlusal Projections 

Topographic Occlusal 

Used to examine the anterior teeth of the mandible -55 degrees 

Cross-Sectional Occlusal 

Used to examine the buccal & lingual aspects of the mandible or to locate foreign bodies or salivary stones in the region of the floor of the mouth  90 degrees 

Pediatric Occlusal 

Used to examine the anterior teeth of the mandible & is recommended for use in children 5 years or younger  

-55 degrees 

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Below are some videos I watched to help brush up on technique: 

Maxillary Standard Occlusal Radiograph 

https://www.youtube.com/watch?v=CWByVRt0kmQ 

Maxillary Lateral Occlusal Radiograph 

https://www.youtube.com/watch?v=wLleYSERNpU 

Mandibular Anterior Occlusal Radiograph 

https://www.youtube.com/watch?v=CM2_4VrMDMo 

Mandibular Lateral Occlusal Radiograph 

https://www.youtube.com/watch?v=zJGlogM2YYg 

 

Conclusion: 

As a dental hygienist radiographic images are a very important assessment tool. They allow for us to do a preliminary assessment (without diagnosis) of what our clients oral cavity looks like beyond what we can see clinically. The dentist will make the diagnosis, but they depend on us to deliver a good quality radiograph that is diagnostic. This little study session was very beneficial and will help me in practice. I understand the indications of both a panoramic and occlusal . radiographs. Some of the indications are similar, for example, both techniques can be used for evaluating eruption patterns, growth, development, to detect lesions, diseases, and conditions of the jaws. Both can also be used to examine the extent of large lesions and evaluate trauma. The main difference between the two techniques is that the panoramic images are not as well defined and/or as sharp as the images produced with intraoral projections. Important points to take away from my panoramic session would be to make sure the client removes all dense objects from their head and neck area as well as making sure to use a lead apron without a thyroid collar during exposures. I chose to learn more about occlusal images because I know not every office has a panoramic machine.  

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DENT 1306 Periodontology 

Description of course: 

This course incorporated the anatomy, histology, microbiology and pathology of the tissues that surround and support the teeth. Disease mechanisms affecting the periodontal tissues, with emphasis on the inflammatory process and its relationship to periodontal diseases/host responses was addressed. The fields of preventive and therapeutic periodontics were also studied, with emphasis on the clinical role of the dental hygienist. Consideration was given to periodontal surgical interventions, and their expected outcomes, Phases of Periodontal Therapy and outcome evaluations of Dental Hygiene treatment.  

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One of the courses I had found challenging was Periodontology. I have a good overall understanding of all the different tissues that support dentition and make up the periodontium. This course has a lot of content that I know will be very important in the career of a Dental Hygienist. By the end of this mini study session I hope to be able to formulate a periodontitis diagnosis while not relying so much on looking at my notes. I choose to focus on chapter 7 of the test book Foundations of Periodontics for the Dental Hygienist.  

 

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Periodontitis Diagnosis: Will include EXTENT, STAGE, GRADE, DISEASE.   

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Extent 

Extent: The distribution of the disease throughout the entire oral cavity. This can be characterized based on a percentage of affected teeth which exhibit periodontal breakdown. 

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Localized: May involve one site on a single tooth, several sites on a tooth, or several teeth. May simultaneously have areas of health adjacent to areas with periodontitis. Localized periodontitis will involve 30% of the teeth or less. 

Generalized: Many teeth or the entire dentition. Generalized periodontitis will involve more than 30% of the teeth. 

Molar/Incisor: Only including molar and incisors. 

****In periodontitis there is no consistent pattern to the numbers and types of teeth involved. 

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Stage

Stage: The stage is defined by the disease severity and complexity. It should be kept in mind that there may be individual complexity or severity factors that may shift the stage to a higher level. 

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Stage I: Characterized by the initial stages of attachment loss. 

Stage II: Represents established periodontitis. 

Stage III: Represents severe periodontitis with significant destruction to the attachment apparatus and potential tooth loss.  

Stage IV: Represents advanced periodontitis with extensive tooth

loss and potential for loss of dentition. 

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Grade:

Grade: An estimate of the future rate of progression of periodontitis. Grade is based on availability of direct or indirect evidence of disease progression. Clinicians should initially assume Grade B and seek specific evidence to shift to Grade A or Grade C. 

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Grade A: Slow Rate of Disease Progression. 

Grade B: Moderate Rate of Disease Progression. 

Grade C: Rapid Rate of Disease Progression. 

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Videos I watched: 

NEW Staging and Grading for Periodontal Disease Explained 

https://www.youtube.com/watch?v=ffq8PyeVUjU 

2018 New Periodontal Disease Classification 

https://www.youtube.com/watch?v=8-mlxPuTkTo 

Periodontal Disease 

https://www.youtube.com/watch?v=xO_sIPTgYf0 

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Conclusion: 

As a dental hygienist understanding the staging and grading classification is essential to create a proper diagnosis statement. This little study session was very beneficial and will help me in practice. I may be able to formulate a diagnosis statement without referring to my cue card pages. I have a better understanding of the terms used throughout the statement which includes extent, stage, and grade of periodontitis. 

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