2013 ppq Flashcards

1
Q

How can you test clinically if a conventional bridge has debonded

A
place probe under pontic and apply pressure coronally
visually look for flex
floss
look for bubbles of saliva
good light
  • may be grossly carious visibly or radiographically
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2
Q

4 design/prep features that could lead to conventional bridge debonding

A

poor crown preparation, insufficient reduction or crown margins finished subgingivally

retainers not prepped to common path of insertion

lack of sufficient ferrule for crown

inadequate root surface area for support- ante’s law

poor moisture control during cementation

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3
Q

2 alternatives to replace conventional bridge pontic

A

implant
denture
space closure- ortho

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4
Q

2 alternative bridge designs to a conventional bridge for 11-21-22 - not RRB as both teeth prepped

A

conventional mesial cantilever bridge- fixed crown on 22

conventional fixed-movable bridge

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5
Q

tooth 15 rct, 9mm pocket, vertical bony defect
diagnoses?
si?
initial tx?

A

periodontal abscess- perio lesion with endo involvement

periapical abscess- endo lesion with perio involvement

true combined lesion-perio-endo lesion

si: PA 15, OPT
sensibility testing EPT EC TTP
6PPC, PGI

if no history perio, tooth non-vital and isolated deep pocket then carry out re-rct

if history perio: tooth vital: pocketing throughout- RSD

if diagnosis uncertain, tooth non vital, perform endodontic therapy and observe

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6
Q

How to classify vertical bone defects?

A
number of walls - 
1 wall defect
2 wall
3 wall
combined osseous defect
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7
Q

Mechanism of vertical bony defect?

factors causing vertical defect

A

the plaque has a zone of destruction surrounding the biofilm - 2mm
if bone is thicker than this and on one tooth only the destruction if angular rather than horizontal

  • thicker cortical bone
  • presence of plaque
  • occlusal trauma leading to widened pdl
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8
Q

How to determine success of HPT clinically

A

<15% plaque
<10% bleeding
<4mm pocket depth

reduced mobility
reduced furcation involvement
bony infill

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9
Q

4 features that indicate proximity to IDC in rad?

imaging you would take

A
tramlines interrupted
darkening of tooth root
diversion roots
deviation id canal
narrowing of tramlines

HALF OPT
CBCT

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10
Q

What feature in IDC are you worried about and list 2 potential complications

A

inferior alveolar nerve

axonotmesis
neurataxia
neurotmesis
paraesthesia
dysaesthesia
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11
Q

3 potential complications in extraction of a lone standing upper molar
of the 3 how would you diagnose 2

how would you manage 1

A

oro-antral communication
fractured maxillary tuberosity
root/tooth in antrum

OAC: bubbling blood from extraction site, direct visual assessment, blunt probe, bone in furcation
rads
mgmt: inform pt, reassure, if small encourage clot, suture, ABs,
if large: close with BAF, ABs 7 days and nose blowing instructions

fractured tuberosity:
sound of fracture, movement, multiple tooth mobility, visual tear
mgmt: dissect out and close wound, reduce and stabilise with forceps
-
fixation with ortho buccal arch wire spot, arch bar of splints. check occlusion, ABs, RCT affected tooth. post op insturctions. XLA tooth 8 weeks later

root in antrum: post op rads/ visual assessment
mgmt:
raise flap, suction, curette, irrigation, endoscopic retrieval, caldwell-luc approach

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12
Q

What tissues could be responsible for prolonged bleeding after xla, how would you manage each?

A

soft tissues- LA use or suturing

bone - WHVP, bone wax

vessels - diathermy

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13
Q

4 risk factors for bleeding

A
  • medical conditions - haemophilia A/B, von willebrand disease, liver disease
  • medications - warfarin, anticoagulants
  • lifestyle - alcoholic
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14
Q

traumatic occlusion, mobile tooth tx

A

HPT

Upper anterior BRA at night

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15
Q

OPT rad in onenote

A

onenote

  • condyle
  • hard palate
  • zygomatic buttress
  • styloid process
  • soft palat
  • hyoid bone
  • nasal septum
  • ear lobe
  • bite peg
  • ghost image opp lower mandible
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16
Q

side effects carbamazepine

A
GI discomfort
dizziness
drowsiness
tardive dyskensia
fatigue
oedema
vomiting
headache
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17
Q

Two objective tests for sjogrens?

A

schirmer test
unstimulated salivary flow- <1.5ml in 15 minutes
autoantibodies- anti-Ro, Anti-La

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18
Q

What gland would you biopsy for sjogrens?

A

labial gland

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19
Q

2 things you would ask histopathologist for when you send the sample for biopsy?

A

how many focal collections of lymphocytes are there with 4mm

does each collection have 50+ lymphocytes?

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20
Q

Features in parotid swelling that would make you suspect malignancy?

A

firm,
attached to underlying structures
rapid growth
unilateral

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21
Q

2 syndromes associated with hypodontia

A

down’s syndrome
cleft lip and palate
ectodermal dysplasia

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22
Q

% missing primary

% missing permanent

A

1% primary

6% permanent

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23
Q

optimum water concentration?

A

1ppm

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24
Q

2 foods that are natural sources of fluoride

A

bony fish

tea

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25
2 actions of fluoride
inhibit bacterial metabolism incorporate into enamel as fluoroapatite, to remineralise
26
what would you see in child with fluorosis
diffuse, mottled appearance pitting yellow/brown discolouration
27
3 tx options fluorosis
microabrasion localised comp restoration porcelain veeners bleaching
28
methods used to locate ectopic canines?
parallax technique 2 periapical views
29
age range ideal for interceptive orthodontics?
10-13 years old
30
4 alternative tx options for ectopic canines for ortho
surgical extraction monitor and do nothing open exposure closed exposure
31
what would you see on occlusal surface of denture teeth of pt with stomatits. what can you do
wear on occlusal surface can add PMMA to these surfaces provide copy dentures
32
3 features of anterior crossbite 21 malocclusion that makes it amenable to tx with removable applaince
21 palatally tipped space available good anchorage as only one tooth being moved favourable overbite- aids stability
33
ura design for correcting anterior crossbite
AIM: please construct URA to correct anterior crossbite 21 A - 21 Z-spring 0.5mm HSSW R- 16,26 Adam's clasps 0.7mm HSSW A - ok B- self cure PMMA, posterior bite plane
34
define clinical governance?
systematic approach to continuously improve quality and standards of care in health care system
35
dimensions of clinical governance?
``` RIsk management clinical audit clinical effectiveness openness research and development education and training ```
36
3 divisions of NHS scotland and their function?
public dental surface- promote oral health of public general- first point of contact for dental tx hospital - consultant advice and tx of referred difficult tx
37
6 dimensions of healthcare quality
``` patient centered safe effective efficient equitable timely ```
38
6 causative factors contributing to tooth wear
``` diet habits- grinding, clenching, GORD xerostomia asthma inhaler bulimia ```
39
3 things to check in dentures at trial stage q about upper denture- feature donated by A
``` stability freeway space tooth shade tooth mould tooth position speech ``` relief area - mylohyoid ridge, genial tubercle, mental foramen, torus mandibularis
40
4 principles of caries removal?
remove enamel to identify extent of carious lesion at ADJ, and SMOOTH enamel margins remove peripheral caries in dentine, first ADJ, then deeper Then remove deep caries over pulp Outline form modification Internal design modification
41
gross caries - if cavity unretentive for amalgam - list 4 alternative techniques or materials 2 things to check in rads at review
``` composite compomer gold inlay glass ionomer ceramic inlay ``` sensibility testing periapical radiolucency on radiograph
42
6 signs and symptoms ZOC fracture imaging? mgmt?
``` periorbital ecchymosis subconjunctival haemorrhage diplopia decrease in visual acuity pain on eye movement assymetry swelling then flattening zygoma ``` OM 10-30 conservative mgmt ORIF CR
43
pseudomembranous candidiasis - two conditions you would see PC in?
HIV | diabetes
44
pros and cons mouth swab and rinse
swab: :) avoids contamination with oral commensal :( less reliable uncomfortable for pt rinse- :) non invasive :( contaminated with oral commensal
45
what 2 drugs does fluconazole interact with and why?
warfarin- increases anticoagulant effect- increased bleeding simvastatin- risk of myopathy midazalom - increased sedation
46
2 neurological disroders that could give rise to TN like plain?
multiple sclerosis | facial palsy
47
trauma stamp review 6 things to assess?
``` TTP EC EPT percussion note Colour sinus rads mobility ```
48
4 medical conditions assoc/w/ downs
``` cardiac heart defect leukaemia epilepsy hypothyroidism autism CLP ```
49
4 extra oral features downs
``` short, broad neck dysplastic ears oblique palpebral fissure single palmar crease small midface rounded skull ```
50
6 intraoral features downs
``` macroglossia hypodontia microdontia AOB class III maxillary hypoplasia high vaulted palate increased caries, perio CLP ```
51
how would you alter prevention and tx plan downs
``` allow extra time longer appts early appts modified tooth brush to help tp high fluoride strength toothpaste diet advice CHX MW FS avoid GA ```
52
5 things to assess when deciding caries rate
``` medical history plaque control saliva flow diet clinical evidence social history ```
53
how often would you take bitewings for high caries rate
every 6 months med: annually low- 12-18months
54
7y/o tooth paste strength for high caries rate time interval between fluoride varnishes most appropriate fluoride supplement what other intervention could you do?
1450ppm tp 4 months between fluoride varnish most app: 225ppm f- MW ``` else: Fissure sealants OHI dietary advice f- tablets ```
55
what is dento alveolar compensation?
system that attempts to maintain normal interarch relationships in class III- upper incisors procline, lower incisors retorcline
56
``` ortho si class 3 tx options class 3 ```
si: study models sensibility testing rads: OPT, lat ceph, PA tx: - -accept - monitor growth - -URA early correct incisal relationship - -growth mod/ functional- reverse twin block - -fixed appliance/ camouflage- extract U5s, L4s, accept underlying skeletal discrepancy and correct incisors to class I - - orthognathic surgery
57
define supernumerary
teeth that appear in addition to regular number of teeth
58
4 types of supernumerary
conical odontome supplemental tuberculate
59
effect of supernumerary
failure of eruption displacement of permanent tooth crowding pathology- dentigerous cysts
60
list stages in chain of infection?
``` infectious agent reservoir portal of exit mode of transmission portal of entry susceptible host ```
61
name a chlorine releasing agent concentation? time left for?
sodium hypochlorite 10,000ppm 3-5minutes sodium dichloroisocyanurate
62
what stream of waste for tooth with extracted amalgam?
red stream special waste
63
what document do you need to keep for waste and how long for?
consignment note - description, quantity, mode of transport, storage, origin, frequency of collection 3 years
64
physiology of faint?
fall in cardiac output poor venous return venous pooling in legs fall in stroke volume
65
what order for physiology of faint - fall in cardiac output - venous pooling in legs - fall in stroke volume - poor venous return
fall in cardiac output poor venous return venous pooling in legs fall in stroke volume 1 4 2 3
66
3 things that could cause pt to collapse
hypoglycaemia shock/anxiety low blood pressure dehydration
67
if postural hypotension how to aid in future-
allow them to sit up slowly- first into upright, and then slowly to standing encourage deep breaths monitor HR, RR if needed make sure they have eaten
68
what are b and c in ABCDE and how would you assess
breathing - count RR through chest movement, listen to noise made during breathing c- circulation- radial artery pulse, two fingers, watch for pulse, volume, character, colour, temperature
69
types of recurrent aphthous stamotitis
minor major herpetiform
70
difference between major minor recurrent apthous stomatitis
``` minor/major <10mm/ >10mm round or oval/ oval or irregular 1-20 in a crop / <5 non-keratinising/ any mucosa 1-2 weeks duration/ 6-12 weeks duration no scar/ maybe scar ```
71
solution make ups of CHX
0. 2% | 0. 12% 10ml bid
72
8 indications for CHX use
1. As an adjunct to oral hygiene 2. Post oral surgery including periodontal surgery or root planing 3. In patients with inter maxillary fixation. 4. For oral hygiene & gingival health in physically & mentally handicapped 5. Medically compromised individuals predisposed to oral infections 6. High caries risk patient 7. Recurrent oral ulceration 8. Removable & fixed orthodontic wearers 9. Treatment of denture stomatitis and dry socket 10. As an immediate prophylactic rinse in the prevention of post-extraction bacteremia
73
mechanism of action CHX
bacteriostatic and at high conc bactericidal dicationic- aids substantivity chx= cationic bacterial cell wall = anionic cationic CHX absorbed to phosphate containing compounds - e.g phospholipids, reducing integrity of cell membrane. leakage of cellular components. here, if conc increases---> intracellular coagulation and cytoplasmic coagulation .:. irreversible cell damage
74
2 ways to check for upper complete retention
pull downwards on anterior teeth region- post dam pull vertically on premolar region
75
OAF mgmt signs and symptoms difference oac oaf
symptoms: - problems with fluid consumption- fluid will come out of nose - problems with speech or singing- nasal sounding - problems wind instrument playing - problems smoking or using a straw - bad taste - halitosis - sinusitis type symptoms ``` mgmt; excise sinus tract/ fistula - buccal advancement flap +/- buccal fat pad or palatal flap - bone graft or collagen membrane - antral washout ``` chronic epithlial lined tract between maxillary sinus and oral cavity. oac is acute communication.
76
avulsion - medium best for storage of tooth in order of preference
saliva milk water/saline blood
77
medical history info significant for paeds avulsion
cardiac defect medications tetanus immunisation account all fragments
78
desquamative gingivitis 3 conditions youd seen it in mgmt clinical signs exacerbated by
conditions: lichen planus pemphigoid pemphigus mgmt: - -confirm diag,, any underlying conditions - blood tests, immunofluorescence assay - -treat underlying cause - -improve OH- plaque aggravates lesions - -topical steroid - -topical tacrolimus immunomodulator rinse of cream - systemic immunosuppressant signs: erythematous shedding, ulceration involving full width exacerbated by: sls smoking plaque
79
smoking intervention
5as ask advise assist assess arrange ask advise refer
80
2 drawbacks pocket chart
- assumes everyone has same root lengths | - subjective depth recording between operators
81
mgmt local recession
address underlying cause - e.g atraumatic brushing instructions/ managing parafunctional habits - minimise risk factors e.g periodontal disease, smoking cessation - treat any areas of sensitivity with desensitising agents- f- varnish, sensodyne, f- MW, seal and bond -surgery - free soft tissue graft from palate or coronal advancement flap
82
oral signs thumb sucking additions to ura to break thumb sucking habit effects prolonged digit sucking? methods to stop NNSH?
``` proclination Upper ants retroclination of lower ants localised AOB incomplete OB narrow upper arch ``` deterrent rake hawley retainer thumb appliance palatal crib bluegrass appliance effect of prolonged: digit help in mouth chronically, causes mandible to drop open and tongue held lower than normal. sucking action of cheeks narrows maxillary dentition, causing posterior crossbite methods to stop: - positive reinforcement - non appliance deterrents - plaster on finger, preventative nail varnish, gloves - removable appliance habit breaker - fixed appliance with anterior rake habit breaker
83
% 6-18 year olds have diastema reasons for diastema mgmt for midline diastema
98% 6 year olds 49% 11 year olds 7% 12-18 year olds ``` reasons: hypodontia midline supernumerary proclined upper incisors prominent frenulum pathological causes generalised spacing ``` ``` mgmt: accept and monitor treat underlying casue - orthodontic +/- restorative input - ura oral surgery/ oral med ```
84
what to note in facial swelling
``` Induration Size Pus Palpation Duration Airway compromise ```
85
what is EADT
time it takes from avulsion to placement in storage medium critical time of survival of pdl as longer eadt more damage extra alveolar dry time
86
histology lichen planus cause features of disease
``` hugging band lymphocytes keratinisation acantholysis saw edge rete pegs apoptosis ``` mainlyF, aged 30-50 1% increased risk of developing oral malignancy in 10 year period ``` cause: autoimmune stress idiopathic medications: beta blockers nsaid diuretics sls allergy ```
87
clinical/ radiographic signs dentinogenesis | and osteogenesis imperfecta
di - loss of enamel - discolouration - both primary and permanent dentine affected - amber in colour - periapical abscess due to pulpal strangulation rads: bublous crown, occult abscesses, obliterated pulp, reduced root length OI - blue sclera - multiple bone fractures
88
tx options dentinogenesis imperfecta
composite/ porcelain veneers SSC in children over dentures removable appliances
89
how would you investigate and manage fractured tuberosity
noise of fracture movement noted visually more than 1 tooth moves visual tear dissect out and close wound, reduce, stabilise fixation: orthodontic buccal arch wire remove tooth 8 weeks later
90
how would you investigate and manage root in antrum?
post op radiographs visual assessment currettes, suction, caldwell-luc approach, irrigation, ribbon gauze buccal advancement flap colours
91
indications for inhalation sedation? what machine used - safety feature? pros over iv sedation?
indications: medical- anything aggrevated by stress epilepsy, hypertension, asthma social - dental anxiety dental- unpleasant or traumatic procedures conta: blocked nasal airway, tonsilitis, severe copd, 1st trimester preggers quantiflex MDM machine - oxygen flush button - scavenger system - coloured cyclinerd - pin index - NO stops when oxygen stops - one way expiratory valve ``` pros: -quicker onset rapid recovery flexible duration of use less post od side effects no amnesia used on <12years ```
92
3 causes of oral vesicles
human herpes simplex group a coxsackie virus ebv varicella zoster
93
2 o.mucosal disease of coxsacchie virus
hand food and mouth | herpangina
94
2 disorders of ebv
infectious mononucleosis | oral hairy leukoplakia