2012 U of T Flashcards
give 4 presenting features of irreversible pulpitis
a) pain restricted to a single tooth
b) pain relieved by a diagnostic LA block
c) prolonged sensitivity to cold, sensitivity to hot
d) tooth associated with trauma or dental caries or recent dental treatment
give 4 presenting features of migrane
unilateral, pulsating, moderate to severe headaches lasting from two to 72 hours
2) nausea, vomiting, photophobia (increased sensitivity to light) and phonophobia (increased sensitivity to sound)
3) three times more common in women than in men
4) one-third of people who suffer from migraine headaches perceive an aura—transient visual, sensory, language, or motor disturbances signaling the migraine will soon occur
give 4 presenting features of dentin hypersensitivity
a) pain not always restricted to a single tooth
b) pain relieved by a diagnostic LA block
c) sensitivity to cold that is not prolonged
d) pain relieved by use of desensitizing agent or restoration to cover exposed site
give 4 presenting features of trigemnial neuralgia
a) severe shooting electric-like pain which lasts for a few seconds (10 % bilateral)
b) trigger points often found
c) not relieved by diagnostic LA block unless trigger point is frozen
d) normal thermal tests of teeth
extra: not always restricted to tooth
give 4 presenting features of temporal arteritis
a) Throbbing headache on one side of the head or the back of the head
b) Fever, malaise and Excessive sweating, loss of appetite and weight loss
c) Jaw pain or painful jaw muscles
d) Vision difficulties: Blurred vision, Double vision, Reduced vision and hearing difficulties
e) temples sore to touch
d) diagnosed by biopsy (giant cells)
give 4 presenting features of TMD
1) Pain or tenderness in the face, TMJ area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide
2) Limited ability to open the mouth very wide
3) Clicking, or grating sounds in the TMJ when opening or closing the mouth (+/- pain)
4) Aching pain in the face, Ear ache or Headache (particularly in the morning)
give 4 presenting features of acute sinusitis
Headache/facial pain, toothache, pain behind the eyes or pressure of constant, or aching sort
2) Pain is localized to the sinus and may worsen when the person bends over or lying down, may cross with time.
3) Precipitated by an earlier upper respiratory tract infection
4) Fatigue and generally not feeling well +/- Fever
5) Nasal stuffiness and discharge
give 4 presenting features of shingles
1) headache, fever, and malaise
2) painful skin or paresthesia
3) unilateral (does not cross midline), dermatome pattern
4) rash with blisters
What is the most common age group affected by shingles?
60+
List 5 indications for antibiotics use in endodontics.
a) AHA Prophylaxis
b) Diffuse swelling (Cellulitis)
c) Localized swelling without drainage
d) Rapidly increasing swelling
e) Systemic signs (Fever, Lymphadenopathy, unexplained trismus)
g) Trauma
h) Regeneration
List 4 cardiac conditions that need prophylactic antibiotics.
a) Artificial heart valves
b) History of infective endocarditis
c) Cardiac transplant that develops a valve problem
d) Certain congenital heart conditions:
i. Unrepaired cyanotic congenital heart disease
ii. Repaired congenital heart disease with prosthetic material within the last 6 months
iii. Repaired congenital heart disease with residual defects
a) Artificial heart valves
b) History of infective endocarditis
c) Cardiac transplant that develops a valve problem
d) Certain congenital heart conditions:
i. Unrepaired cyanotic congenital heart disease
ii. Repaired congenital heart disease with prosthetic material within the last 6 months
iii. Repaired congenital heart disease with residual defects
What is normally prescribed for an adult as a prophylactic antibiotic, give name and dose.
Oral Amoxicillin 2 grams (adults) or 50 mg/kg (children) 1 hour prior to dental treatment.
If the patient has pen allergy, give 3 antibiotics (and their dose) that can be prescribed for prophylaxis.
a) Clindamycin 600mg (adults) or 20 mg/kg (children)
b) Azithromycin (preg b) or Clarithromycin (preg C) 500 mg (adults) or 15 mg/kg
(children)
c) Cephalexin 2 grams (adults) or 50 mg/kg (children)
We don’t use erythromycin because Azithromycin and clarithromycin have better pharmacokinetic properties than erythromycin. They also have a higher bioavailability, less drug-drug interaction and a longer duration of effect. They also have less gastrointestinal effects than erythromycin and less likely to cause arrhythmias and ototoxicity. Erythromycin is arrhythmogeninc.
An instrument is rotating in a canal and the tip binds, but the motor continues to rotate. As a results the instrument fractures – what is this type of fracture called?
Torsion stress is the stress on the instrument when it is bound at the tip and rotated about its axis.
An instrument is rotating in a curved canal and the tensile and compressive stresses that occur as a result cause fracture – what is this type of fracture called?
Cyclic fatigue fracture occurs when an endodontic instrument rotates in a curved canal. In this condition, the instrument under elastic deformation is subjected to a mechanical load represented by alternating tensile and compressive stresses. The cyclical repetition of the load leads to instrument fracture through low-cycle fatigue. The cyclic fatigue resistance comprises the number of cycles that an instrument can endure under a specific loading condition until fracture occurs. Because the number of cycles to fracture is cumulative, it can be calculated by multiplying the rotation speed by the time elapsed until fatigue fracture occurs. (Lopes 2010)
Does the risk of cyclic fatigue fractures increase or decrease when the degree of curvature increases?
Increases
Does the fracture resistance to cyclic fatigue increase or decrease when the diameter of the file is increased?
decrease
Which part of the triple antibiotic paste results in potential discoloration?
Minocycline
What are 3 things that can be done to reduce the risk of discoloration?
a) Place paste to maximum height of CEJ
b) Placed bonded flowable composite over inside of access cavity sealing dentinal tubules before placing paste
c) Place bonded restoration for temporary
d) Advise patient of possible discoloration and to contact office if begins to discolor
e) Do not use Minocycline or use alternative
How does dentin demineralize?
Dentin demineralization and destruction-oral microbes produce acids such as lactate, acetate and propionate, which dissolve inorganic minerals, hydroxyapatite crystallites, first from the enamel, and then from dentin (Hojo et al. 1991, van Houte 1994). As a consequence of an acidic environment, the collagenous matrix of dentin is demineralized, leading to a caries lesion. However, bacterial acids are not able to hydrolyze fibrous collagens, therefore fail to degrade the dentin organic matrix (Katz et al. 1987, van Strijp et al. 1997). Host enzymes, matrix metalloproteinases, degrade the dentin matrix during or after demineralization by bacterial acids (Tjäderhane et al. 1998a, Sulkala et al. 2001). Such host proteases, either from odontoblasts or pulp tissue may be responsible for collagen matrix destruction, and in combination with additional hydrolytic enzymes such as lactate dehydrogenase (LDH) and glycoproteases, may catalyze dentin connective tissue degradation in caries progression. In physiological conditions, proteolytic enzymes may in turn model calcified matrix. (Larmas 2001.)
Lido 2% 1:100,000 epi – how much epi is there in 2 carps?
1: 100,000=1000g/100000ml=0.001g/100mL=0.01mg/mL
0. 01mg/mL X 3.6mL =0.036 mg
Lido 2% 1:100,000 epi – how much lido is there in 1 carp?
2% lidocaine is 20mg/ml
20mg/ml x 1.8 = 36mg
Max dose of lidocaine?
7mg/kg
Max dose of articaine?
7mg/kg
Max dose of Bupivicaine
2mg/kg
Max dose of Prilocaine
8mg/kg
Max dose of Mepivicaine
6.6mg/kg
Calculate the maximum number of cartridges for a 60 kg non-pregnant patient of 2% lidocaine local anaesthetics. Show your calculations.
Maximum dose of lidocaine is 7mg/kg 60kg x 7mg/kg = 420mg (maximum amount of lidcaine) 2% lidocaine = 20mg/ml they can have 420mg / 20mg/ml=21ml 21/1.8 = 11.6 carpules
What is the maximum number of carpules of 4% prilocaine?
) 4 grams prilocaine per 100mL=40g/1000mL=40mg/mL
40mg/mL X 1.8mL = 72 mg of prilocaine/cartridge
60kg X 8mg/kg (max dose prilocaine) = 480mg prilocaine
480mg/72 mg prilocaine = 6.7 cartridges max
What are 2 purposes of electropolishing an endodontic instrument?
a) Reduce microfracture by reducing surface irregularities
b) Reduce corrosion
List 5 reasons for coronal leakage.
a) Inadequate temporary seal between and after treatment
b) Inadequate timeliness of the final restoration
c) Choice and integrity of the final restoration material
d) Pre-endodontic tooth preparation
e) Traumatic occlusion
List 6 properties of an ideal intracanal irrigant.
a) Antimicrobial
b) Substantivity
c) Removes smear layer
d) Penetrates into dental tubules
e) Water soluble
f) Low cytotoxicity
g) Allergy is rare
e) Cheap
What are 4 components of 2% Lidocaine 1:100,000 epi local anaesthetic carpule?
Carpule: glass cartridge, rubber stopper, Metal Cap & Rubber Diaphragm
Lidocaine, epinephrine, sodium bisulfite, distilled water, sodium chloride
Goals of revascularization?
a. treating and preventing apical periodontitis
b. triggering continued root development
c. restoring functional competence of the pulp tissue
How long would you expect it to take to get a positive sensibility test after revascularization?
6 months (Torabinejad & Turman, 2011)
How would you determine if your revascularization procedure was successful?
Radiological exam, absence of symptoms, sensibility
Clotting mechanism fill in the blanks (6) such as the end result of the intrinsic pathway? Coagulation – platelet function – COX2 involvement.
The crucial step in both clotting mechanisms is the conversion of fibrinogen to fibrin. The fibrinogen is a plasma protein formed by the liver that is constantly in circulation in the blood. The polymerization and linkage of these molecules into interconnecting strands forms a thread-like network entrapping serum fractions and formed elements. This forms a hydrated, gelated aggregete termed the fibrin clot that strengthen the platelet plug and form the initial seal between the oral environment and the wound edges.
What are the percentages of organic to inorganic dentin matrix?
by weight, 70% inorganic, 20% organic, 10% water (and 45%, 33%, and 22% by volume).
- phosphophoryn (dentin phosphoprotein) a highly phosphorylated, tissue specific molecule that is unique to the odontoblast cell lineage, thought to bind to calcium and play a role in mineralization.
What is the principle type of collagen in dentin
91% of the organic, is collagen, type 1, minor component type V
What is the principle inorganic component of dentin?
Ca10(P04)6(OH)2 (hydroxyapatite).
What are the principle inorganic (non-collagenous) components of dentin?
Noncollagenous matrix components include phosphoproteins, proteoglycans (dermatan sulfate, heparan sulfate, hyaluronate, keratan sulfate, chondroitin 4 sulfate, chondroitin 6 sulfate), gamma carboxyglutamate containing proteins, acidic glycoproteins, growth factors, and lipids.
What is the precipitate called when mixing sodium hypochlorite and chlorhexidine and why is of concern?
Parachloroaniline
Does EDTA have strong antimicrobial properties?
No, Torabinejad, 2003?
