2016 Flashcards
what are the predisposing factors of oral candidosis?
- prolonged antibiotic use
- poor oral hygiene
- denture wearer
- immunocompromised
- diabetes
- dialysis
- burn unit patient
what are the virulence factors of candida albicans?
- phospholipase contributes to host cell penetration
- haemolysin facilitates hyphal invasion
- proteinase aids in adhesion to epithelial cells
what infections can be caused by candida?
- periodontitis
- denture stomatitis
- UTIs
- endocarditis
what classification of oral candidosis is shown here?
pseudomembranous
what classification of oral candidosis is shown here?
chronic hyperplastic
what classification of oral candidosis is shown here?
angular chelitis
what are the 3 types of erthematous candidosis?
newtons type 1- localised inflammation
newtons type 2- diffuse inflammation
newtons type 3- granular inflammation
what are the signs and symptoms of denture induced stomatitis?
- inflamed mucosa, particularly under upper denture
- burning sensation
- discomfort
- bad taste
name 4 types of candida species
- albicans
- glabrata
- parasilosis
- tropicalis
how is denture stomatitis diagnosed in the lab?
- smear test / microscopy
- swab /culture on sabouraud’s agar / germ tube formation
angular cheilitis and acute pseudomembranous candidosis also the same
what are the 3 types of antifungal therapy?
- echinocandins
- azoles- fluconazole
- polyenes
how would you treat denture stomatitis in an immunocomprosed patient?
- systemic antifungal- fluconazole
- topical antifungal (nystatin)/ chlorhexidine rinse
how would you treat an oral fungal infection in a patient with poor oral hygiene?
- need to improve oral hygiene first
- chlorhexidine rinse
how would you treat an oral fungal infection in a patient with dry mouth?
topical antifungal e.g. nystatin
avoid systemic antifungals
how would you treat an oral fungal infection in a patient with large erosive lesions?
same as an immunocompromised patient
systemic antifungal with either topical antifungal or chlorhexidine rinse
give an example of an azole (antifungal medication)
fluconazole
give an example of a polyene (antifungal medication)
nystatin
give an example of an echinocandin (antifungal medication)
micofungin
what is the drug action of flucanazole?
interupts conversion of lanosterol to ergosterol by interacting with the enzyme which catalyses the conversion which stops formation of fungal membrane
what is the drug action of nystatin?
binds to sterols in plasma membrane of fungi, causing cells to leak
this causes fungal cell death
what are the four key design elements of randomised control trials?
- specification of participants
- control/comparison groups
- randomisation
- blinding/masking
name an advantage of randomised control trials
provide the strongest and most direct epidemiologic evidence for causality
give disadvantages of randomised control trials
- more difficult to design and conduct than oberservational studies
- not suitable for all research questions
- high costs
- still some risk of bias
what is a cross-sectional study?
observational study that analyses data collected from a population, or a representative subset, at a specific point in time
what is a case-series report?
description of the medical history of one or more patients
what is a case-control study?
people with a disease are matched to those without it and earlier exposure to different factors are compared
what is a cohort study?
participants are recruited to a study and followed up over time. Exposures and diseases are measured prospectively
what is a systematic review and meta analysis?
all the evidence for RCTs looking at effectiveness of a particular treatment are synthesised
what are case-series reports used for?
- hypothesis generation
- to identify a new disease outcome
what are the disadvantages of case series reports?
- cannot demostrate valid statistical associations
- lack of control group
what are cross sectional studies used for?
- estimating prevalence of a disease
- to investigate potential risk factors
what are the disadvantages of cross-sectional studies?
- recall bias
- causality
- confounding factors
what are case-control studies used for?
looking at potential causes of a disease
what are the disadvantages of case-control studies?
- confounding factors
- recall/selection bias
- time relationships (did exposure occur before disease)
what are cohort studies used for?
- estimating incidence of disease
- investigating cause of disease
- determining prognosis
- timing and direction of events
what are disadvantages of cohort studies?
- controls are difficult to identify
- confounding factors
- blinding is difficult
- need large samples for rare diseases
- very expensive and time consuming
what does a confidence interval do?
tells us the range of values that a true population treatment effect is likely to lie
what does a confidence interval that overlaps the value of no difference between treatments indicate?
there is insufficient evidence for a difference. between the treatment and control group in the population
what does it mean if the confidence interval overlaps 1?
there is insufficient evidence that there is a difference between the drug and the placebo
what is the absolute risk difference?
the difference in risk between groups
what is the value of no difference?
when there is no absolute risk difference
what is the ‘number needed to treat’ (NNT)?
the number of patients you would need to treat to prevent one patient from developing the disease/condition/outcome
what is the risk ratio?
number of events of interest/
total number of observations
what is the odds ratio?
number of events of interest/
number without the event
what are the principles of waste disposal?
- segregation
- storage
- disposal
- documentation
name 3 regulations for waste disposal
- the controlled waste regulations 2012
- the hazardous waste directive 2011
- the environmental protection act 1990
what procedures can be put in place to keep an amalgam container safe?
- spill proof container
- leak proof container
- mercury vapour suppressant in lid
what chemical would you use to clean blood?
sodium hypochlorite
what concentration of sodium hypochlorite would you use for a blood spillage?
1000ppm
what is the active agent used for blood spillage?
chlorine/chloride
what are causes of an overhang?
- poor adaptation of the matrix band
- excessive force applied when condensing amalgam
what are the short and long term complications of overhangs?
- food trap
- difficulty cleaning
- plaque stagnation
- secondary caries
- gingivitis and periodontal diseae
what is the preferred method for correcting an overhang?
replacement of the restoration
what are all of the treatment options for correcting an overhang?
replace restoration
finishing strips
soft flex files
list functions of a provisional crown for an EDP# and exposed RCT
- improve aesthetics and provide pt with realistic expectations
- improve functions of mastication and speech
- resolve gingival inflammation and provide adequate gingival health prior to fitting the definitive restoration
- to act as a marker for the dentist for tooth prep
- prevents sensitivity
- preserves tooth vitality
- used as isolation for RCT
name 3 types of prefabricated crowns
- polycarbonate crowns
- clear plastic
- metal (aluminium/stainless steel)
give disadvantages of prefabricated crowns
- inaccurate fit ervically, occlusally, interdentally
- if a large bank of crowns is needed it is very expensive
how would you manage an 8 year old boy with an ED#?
- cover exposed dentine with either GI or if fractured tooth piece available, bond it back to the tooth with composite
- sensibility tests
- periapical to ensure no root displacement
what are radiographic signs that a tooth is non-vital?
- internal inflammatory resorption
- external inflammatory resorption
- periapical abscess
- widened pdl
- loss of lamina dura
what is included in a trauma stamp?
- colour
- mobility
- TTP
- radiograph
- sensibility testing
- thermal testing
- displacement
- sinus
explain the distribution of decay in nursing bottle caries
- lower incisors protected by tongue
- maxillary incisors are affected the worst as they eruptic first
- if habit continues, mandibular canines and all 6s will be subjected to cariogenic challenge in sequence with their eruption order
what causes nursing bottle caries?
- going to bed with a bottle
- prolonged breastfeeding
- baby using bottle as a comforter rather than a dummy
- innapropriate use of feeding bottles and cups
how would you manage a 2 year old with high caries risk?
- application of fluoride varnish
- high fluoride toothpaste- 1450ppm
what toothbrushing advice would you give to the parent of a high caries risk 2 year old?
- small headed toothbrush with soft bristles
- brush twice a day for 2 minutes
- adult should be brushing the child’s teeth
- 1450ppm toothpaste
- spit dont rinse
name 4 types of dementia
- alzheimers
- vascular
- frontotemporal
- dementia with lewy bodies
what is the most common form of dementia?
alzheimers
how does alzhemiers affect the brain?
- reduction in size of cortex
- severely affects hippocampus
what causes alzhemiers?
abnormal protein fragments (beta-amyloid) build up in spaces between nerve cells forming plaques and disrupting brain function
what are the features of alzheimers?
- short term memory loss
- aphasia
- communication difficulties
- muddled over everyday activities
- mood swings
- withdrawn
- loss of confidence
what are the risk factors of alzheimers?
- age
- gender
- head injury
- genetic- abnormalities of chromosomes 1,14,21
- lifestyle- smoking, hypertention, low folate, high cholesterol
what is the cause of vascular dementia?
reduced blood flow to the brain
damages and eventually kills the brain cells
what causes vascular dementia to develop?
- narrowing/blockage of small blood vessels into the brain
- single large stroke
- lots of mini-strokes that cause small, but widespread damage
- underlying health conditions
what are the features of vascular dementia?
- memory problems of sudden onset
- visuospatial difficulties
- anxiety
- delusions
- seizures
what causes dementia with lewy bodies?
deposits of abnormal proteins called lewy bodies inside brain cells
what are the features of dementia with lewy bodies?
- short term memory loss
- cognitive ability fluctuates
- visuospatial difficulties
- attentional difficulties
- overlapping motor disorders
- speech and swallowing problems
- sleep disorders and delusions
lewy bodies can be found in patients with what cerebellular disease?
Parkinson’s disease
what are the features of frontotemporal dementia?
- uncontrollable repition of words
- short term memory loss (sometimes)
- personality changes
- decline in personal and social conduct
what are the symptoms of late stage dementia?
- inability to recognise familiar objects, surroundings or people
- difficulty eating and swallowing
- incontinence
- gradual loss of speech
what is the most common way to test for dementia?
the mini mental state examination (MMSE)
name 3 cognitive testing methods for dementia
- MMSE
- blessed dementia scale
- the montreal cognitive assessment (MoCA)
what are the advantages of the mini mental state examination?
- well known
- easy to administer
what are the cons of of the mini-mental state examination?
- not sensitive to mild impairment
- not sensitive in testing frontal lobe
- non-standardised time between registration and recall
what is the treatment for dementia?
- councelling can delay residential care up to 1 year
- aspirin/reducing cardiac risks can halt deterioration of vascular dementia
- NSAIDs may slow progression
- vitamin E can slow progression
- anticholinesterases for mild/moderate alzheimers
- cerebrolysin improves cognitive function for vascular dementia
when would treatment for a patient with dementia be stopped?
- when it is deemed that treatment is no longer working
- the MMSE score falls below 10
what can care homes do to be more dementia friendly?
- make walls, flooring, skirting different colours
- add labels/images to drawers etc. to help pts find things
- bedroom WC should be visible from bed
- position personal pics/items with personal relevance
how can healthcare environments be made more dementia friendly?
- reception desk visible from front door
- no non-essential signs
- staff only doors same colour as walls
- colour of walls different from floor/celing
- signs should be simple, colourful;, eye level
what is meant by a dentally fit patient?
being free from any active dental disease
what is an MDT?
- multi-disciplinary team
- team of individuals from a wide variety of disciplines/specialities who work alongside each other in order to provide the best and hollistic care for the patient
list members of a cancer MDT
- cancer nurse specialist
- oncologist
- special care dentist
- restoartive dentist
- physiotherapist
- speech and language therapist
- social worker
- radiologist
name complications of radiotherapy to the head and neck
- mucositis
- xerostomia
- osteoradionecrosis
- radiation induced caries
name modifiable factors for the aetiology of head and neck cancer
- alcohol
- smoking
- chewing tobacco
- diet
- exposure to UV light
list signs of a digit sucking habit
- proclined upper incisors
- retroclined lower incisors
- anterior open bite
- incomplete open bite
- narrow upper arch
- unilateral posterior cross bite
how do you prevent/stop a digit sucking habit?
- URA
- behavioural management therapy
- sock on hands at night
- dummy
- plaster on thumb
- bad tasting nail polish
describe the local causes of malocclusion
localised problem with either arch (1/2/3 teeth)
can be due number, size/form, position, soft tissue or a pathology
ectopic, impacted, missing, trauma, habits, supernumeracy
what are the types of supernumerary teeth?
- conical
- tuberculate
- supplemental
- odontome
what is meand by ‘SIMD’?
- Scottish Index of Multiple Deprivation
- ranks data zones from most to least deprived
- either a scale of 1-5 or 1-10
- factors of deprivation- unemployment, crime, housing, income, education, health, geographic access to services
give roles of epidemiology
- to assess people’s risk of disease
- to study the causes and determinants of disease
- to develop preventive programmes
- to evaluate interventions e.g.oral cancer screening
define incidence
the amount of new cases in the population in a specific time period
define prevalence
proportion of a population affected by disease at a single point in time
what are the constitutes of stainless steel?
72% iron
18% chromium
8% nickel
1.7% titanium
0.3% carbon
what is work hardening?
- work done on metal below its recrystallisation temperature causes slip
- slip= dislocations collect ar grain boundaries hence stronger, harder material
- the hard wire is made by drawing the metal in a cold state through a series of dies of successively smaller diameter
- this makes it stronger and gives it spring properties
define springiness
can undergo large defelctions without permanent deformation
give disadvantages of self cure PMMA
poor mechanical properties
not suitable for pts w residual monomer allergy
what factors can result in tooth mobility?
- traumatic occlusion (bruxism)
- trauma
- periodontal disease
- dental abscess
when would you intervene a mobile tooth?
- progressively increasing mobility
- gives rise to symptoms
- creates difficulty with restorative treatment
how would you expect a mobile tooth to react to HPT?
- decrease in mobility
- clinical attachment will be gained
*
A patient has mobile lower incisors and refuses XLA. What would you advise him and what are the disadvantages of this?
Splinting may be appropriate when there is tooth mobility caused by advanced LOA/if tooth mobility is causing discomfort or difficulty in chewing.
However, splinting does not influence the rate of periodontal destruction and it may create hygiene difficulties.
It is a Tx of last resort.
list peri-operative complications
- difficult access
- abnormal resistance
- fracture of tooth
- alveolar plate or tuberosity
- jaw fracture
- OAC
- loss of tooth
- soft tissue damage
- haemorrhage
- dislocation of TMJ
- damage to adjacent teeth/restoration
- broken instruments
- wrong tooth
during an extraction, the patient’s root fractures. what radiograph should you take?
periapical
where is the mental foramen?
between apices of lower premolars
what structures does the mental nerve innervate?
chin
lower lip
what analgesic is mostg appropriate post-extraction for a patient who takes warfarin?
paracetemol
what is the mechanism of apixaban?
- a selective inhibitor of FXa
- does not require antithrombin III for antithrombic activity
- inhibits free and clot-bound FXa and prothrombinase activity
- has no direct affect on platelet aggregation, but indirectly inhibits platelet aggregation induced by thrombin
- decreases thrombin generation and thrombus development
how is facial palsy caused during an IDB?
- if the clinician doesn’t hit bone and inserts too far back, LA is deposited in the parotid gland
- facial nerve runs through parotid gland and due to dense fascia around the gland, the LA will remain for a long time anf cause paralysis of the facial muscles that the nerve innervates
how would you initially manage. apatient with facial palsy?
- reassure- tell patient sensation will return after a few hours
- keep eye patch over eye to prevent drying out as pt cannot blink
how do you decomtaminate an impression?
- rinse under cold running water
- place in perform for 10 minutes
- remove and rinse under cold water
- place damp gauze on impression
- place into sealable labelled bag
