2013 ppq Flashcards
How can you test clinically if a conventional bridge has debonded
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
4 design/prep features that could lead to conventional bridge debonding
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
2 alternatives to replace conventional bridge pontic
implant
denture
space closure- ortho
2 alternative bridge designs to a conventional bridge for 11-21-22 - not RRB as both teeth prepped
conventional mesial cantilever bridge- fixed crown on 22
conventional fixed-movable bridge
tooth 15 rct, 9mm pocket, vertical bony defect
diagnoses?
si?
initial tx?
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
How to classify vertical bone defects?
number of walls - 1 wall defect 2 wall 3 wall combined osseous defect
Mechanism of vertical bony defect?
factors causing vertical defect
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
How to determine success of HPT clinically
<15% plaque
<10% bleeding
<4mm pocket depth
reduced mobility
reduced furcation involvement
bony infill
4 features that indicate proximity to IDC in rad?
imaging you would take
tramlines interrupted darkening of tooth root diversion roots deviation id canal narrowing of tramlines
HALF OPT
CBCT
What feature in IDC are you worried about and list 2 potential complications
inferior alveolar nerve
axonotmesis neurataxia neurotmesis paraesthesia dysaesthesia
3 potential complications in extraction of a lone standing upper molar
of the 3 how would you diagnose 2
how would you manage 1
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
What tissues could be responsible for prolonged bleeding after xla, how would you manage each?
soft tissues- LA use or suturing
bone - WHVP, bone wax
vessels - diathermy
4 risk factors for bleeding
- medical conditions - haemophilia A/B, von willebrand disease, liver disease
- medications - warfarin, anticoagulants
- lifestyle - alcoholic
traumatic occlusion, mobile tooth tx
HPT
Upper anterior BRA at night
OPT rad in onenote
onenote
- condyle
- hard palate
- zygomatic buttress
- styloid process
- soft palat
- hyoid bone
- nasal septum
- ear lobe
- bite peg
- ghost image opp lower mandible
side effects carbamazepine
GI discomfort dizziness drowsiness tardive dyskensia fatigue oedema vomiting headache
Two objective tests for sjogrens?
schirmer test
unstimulated salivary flow- <1.5ml in 15 minutes
autoantibodies- anti-Ro, Anti-La
What gland would you biopsy for sjogrens?
labial gland
2 things you would ask histopathologist for when you send the sample for biopsy?
how many focal collections of lymphocytes are there with 4mm
does each collection have 50+ lymphocytes?
Features in parotid swelling that would make you suspect malignancy?
firm,
attached to underlying structures
rapid growth
unilateral
2 syndromes associated with hypodontia
down’s syndrome
cleft lip and palate
ectodermal dysplasia
% missing primary
% missing permanent
1% primary
6% permanent
optimum water concentration?
1ppm
2 foods that are natural sources of fluoride
bony fish
tea
2 actions of fluoride
inhibit bacterial metabolism
incorporate into enamel as fluoroapatite, to remineralise
what would you see in child with fluorosis
diffuse, mottled appearance
pitting
yellow/brown discolouration
3 tx options fluorosis
microabrasion
localised comp restoration
porcelain veeners
bleaching
methods used to locate ectopic canines?
parallax technique
2 periapical views
age range ideal for interceptive orthodontics?
10-13 years old
4 alternative tx options for ectopic canines for ortho
surgical extraction
monitor and do nothing
open exposure
closed exposure
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
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
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
define clinical governance?
systematic approach to continuously improve quality and standards of care in health care system
dimensions of clinical governance?
RIsk management clinical audit clinical effectiveness openness research and development education and training
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
6 dimensions of healthcare quality
patient centered safe effective efficient equitable timely
6 causative factors contributing to tooth wear
diet habits- grinding, clenching, GORD xerostomia asthma inhaler bulimia
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
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
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
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
pseudomembranous candidiasis - two conditions you would see PC in?
HIV
diabetes
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
what 2 drugs does fluconazole interact with and why?
warfarin- increases anticoagulant effect- increased bleeding
simvastatin- risk of myopathy
midazalom - increased sedation
2 neurological disroders that could give rise to TN like plain?
multiple sclerosis
facial palsy
trauma stamp review 6 things to assess?
TTP EC EPT percussion note Colour sinus rads mobility
4 medical conditions assoc/w/ downs
cardiac heart defect leukaemia epilepsy hypothyroidism autism CLP
4 extra oral features downs
short, broad neck dysplastic ears oblique palpebral fissure single palmar crease small midface rounded skull
6 intraoral features downs
macroglossia hypodontia microdontia AOB class III maxillary hypoplasia high vaulted palate increased caries, perio CLP
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
5 things to assess when deciding caries rate
medical history plaque control saliva flow diet clinical evidence social history
how often would you take bitewings for high caries rate
every 6 months
med: annually
low- 12-18months
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
what is dento alveolar compensation?
system that attempts to maintain normal interarch relationships
in class III- upper incisors procline, lower incisors retorcline
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
define supernumerary
teeth that appear in addition to regular number of teeth
4 types of supernumerary
conical
odontome
supplemental
tuberculate
effect of supernumerary
failure of eruption
displacement of permanent tooth
crowding
pathology- dentigerous cysts
list stages in chain of infection?
infectious agent reservoir portal of exit mode of transmission portal of entry susceptible host
name a chlorine releasing agent
concentation?
time left for?
sodium hypochlorite
10,000ppm
3-5minutes
sodium dichloroisocyanurate
what stream of waste for tooth with extracted amalgam?
red stream special waste
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
physiology of faint?
fall in cardiac output
poor venous return
venous pooling in legs
fall in stroke volume
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
3 things that could cause pt to collapse
hypoglycaemia
shock/anxiety
low blood pressure
dehydration
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
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
types of recurrent aphthous stamotitis
minor
major
herpetiform
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
solution make ups of CHX
- 2%
0. 12% 10ml bid
8 indications for CHX use
- As an adjunct to oral hygiene
- Post oral surgery including periodontal surgery or root planing
- In patients with inter maxillary fixation.
- For oral hygiene & gingival health in physically & mentally handicapped
- Medically compromised individuals predisposed to oral infections
- High caries risk patient
- Recurrent oral ulceration
- Removable & fixed orthodontic wearers
- Treatment of denture stomatitis and dry socket
- As an immediate prophylactic rinse in the prevention of post-extraction bacteremia
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
2 ways to check for upper complete retention
pull downwards on anterior teeth region- post dam
pull vertically on premolar region
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.
avulsion - medium best for storage of tooth in order of preference
saliva
milk
water/saline
blood
medical history info significant for paeds avulsion
cardiac defect
medications
tetanus immunisation
account all fragments
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
smoking intervention
5as
ask advise assist assess arrange
ask advise refer
2 drawbacks pocket chart
- assumes everyone has same root lengths
- subjective depth recording between operators
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
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
% 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
what to note in facial swelling
Induration Size Pus Palpation Duration Airway compromise
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
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
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
tx options dentinogenesis imperfecta
composite/ porcelain veneers
SSC in children
over dentures
removable appliances
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
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
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
3 causes of oral vesicles
human herpes simplex
group a coxsackie virus
ebv
varicella zoster
2 o.mucosal disease of coxsacchie virus
hand food and mouth
herpangina
2 disorders of ebv
infectious mononucleosis
oral hairy leukoplakia
