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4th year > 2016 M > Flashcards

2016 M Flashcards

1
Q

2 differential diagnosis for painful swelling pertaining to 11 with associated lympadenopathy

A

Periodontal abscess
Periradicular/periapical abscess

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2
Q

2 special investigations for painful swelling pertaining to 11 with associated lympadenopathy

A

Radiograph (PA)
Sensibility testing (EPT, ECL)

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3
Q

2 ways of draining painful swelling pertaining to 11 with associated lympadenopathy

A

Incise and drain
Drain through periodontal pocket

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4
Q

Initial management painful swelling pertaining to 11 with associated lympadenopathy, providing not endodontically involved (5 marks)

A

LA and drain the abscess through the pocket
Gentle irrigation and RSI of the pocket, careful not to traumatise the pocket base
Antibiotics due to lymphadenopathy (metronidazole 400mg 3 times daily 3 days)
Advise pt on CHX/saline mouthwash
Review to ensure resolution and complete RSI

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5
Q

What are 4 potential reasons for the debonding of a bridge clinically?

A

Unfavourable occlusion
Insufficient coverage with adhesive wing for bonding
Poor enamel quality of abutments
Inadequate moisture control during cementation
Caries

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6
Q

Cite 4 methods of checking of bridge debonding clinically?

A

Pressing on the pontic and looking for movement of adhesive wings
Pressing on the adhesive wings and looking for bubbling of saliva at the wing/tooth interface
Explore the margins with a probe looking for defects, and place probe under pontic and apply coronal pressure, looking for movement in adhesive wings
Try and pass floss underneath the adhesive wings
Radiograph

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7
Q

What factors should be checked by a dentist before the placement of implants?
Give 2 general and 2 local

A

General -
Any head and neck cancer treatment (radiotherapy), any bisphosphonates, diabetes
Local -
Bone height, space available between existing teeth, any rotations or drifting of teeth, smoking status, OH

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8
Q

Name 4 features that indicated close proximity of a lower 8 to the Inferior alveolar canal

A

Deflection of canal
Interruption of IAC lamina dura
Juxt apical area
Darkening of the root where IAC crosses it

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9
Q

If you were suspicious of a lower 8’s proximity to the canal what imaging could you use?

A

CBCT

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10
Q

State 2 potential complications of extracting a tooth that is in close proximity to the Inferior alveolar canal

A

IAN paraesthesia
IAN dysaesthesia

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11
Q

What procedure, excluding XLA of a lower 8, could be done to reduce the risk of damaging the IAN?

A

Coronectomy

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12
Q

Name 2 scenarios where there would be an increased risk of bleeding for a patient and 2 post- operative methods of achieving haemostasis.

A

Anticoagulant/antiplatelet therapy
Alcoholic liver disease
Damp gauze and pressure
Surgicel and suturing margins
LA with vasoconstrictor
Diathermy

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13
Q

List 6 signs/symptoms of TMD

A

Pain
MoM hypertrophy
MoM tenderness
Clicking, popping, crepitus at TMJ
Linea alba
Tongue scalloping
Tooth wear (attrition)

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14
Q

What two muscles would you palpate when examining for TMD?

A

Temporalis and masseter

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15
Q

List 5 points of conservative advice you would give someone with TMD

A

Stop any parafunctional habits
No chewing gum
Cut foods into small pieces
Do not incise foods
Avoid hard and sticky foods
Chew bilaterally

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16
Q

What are the different edentulous classifications?

A

Class 1 = tooth in alveolus
Class 2 = immediate post XLA
Class 3 = broad ridge
Class 4 = knife edge
Class 5 = flat
Class 6 = Submerged

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17
Q

define retention in prosthodontics

A

Resistance to vertical dislodging forces

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18
Q

Define indirect retention

A

Use of supportive components to resist rotational forces, components are placed at 90º to the clasp axis and on opposite side from dislodging force

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19
Q

Describe Desquamative gingivitis

A

A clinically descriptive term to describe severely erythematous and ulcerated gingiva caused a number of conditions or allergies, inflammation can extend beyond the mucogingival junction

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20
Q

Name three conditions that you would see Desquamative gingivitis (in order of likelihood)?

A

Lichen planus
Pemphigus
Pemphigoid

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21
Q

Describe how you would manage Desquamative gingivitis

A

Biopsy an area of mucosa and use immunofluorescence and histological analysis to determine the cause
PGI, FMPC where indicated, OHI
Diet advice and SLS free toothpaste
Betamethasone mouth rinse
Tacrolimus ointment
Systemic corticosteroids to prevent any new lesions from forming (prednisalone)

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22
Q

Name one other gingival disease that is typically painful on presentation other than desquamative gingivitis

A

ANUG

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23
Q

Name 3 local and 3 generalised causes of pigmentation.

A

Local
Malignant melanoma
Melanocytic neavus
Amalgam tattoo
Haemangioma

Generalised
Racial pigmentation
Addison’s disease
Smoking

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24
Q

Name 2 types of haemangioma and give 2 histological differences between the two. (4 marks)

A

Types
Capillary
Cavernous
Cavernous is encapsulated and capillary is not
Cavernous is dilated vascular space and capillary is thin walled capillaries

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25
Q

Name 4 key personnel involved in the Decontamination process and give a description of each of their roles

A

Operator
Responsible for day to day operations, recording machine readings
User
Responsible for daily testing and maintenance of records
Manager
Ultimately responsible for running of LDU and release of instruments fit for use
Engineer
Annual and quarterly testing of the machines and any maintenance

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26
Q

What type of water is used for the final rinse cycle and why use this as opposed to mains water?

A

RO
Mains water has minerals present in it which can
Damage instruments
Cause limescale build up
Give a roughened surface for bacteria to adhere to

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27
Q

Describe the appearance of dental fluorosis

A

Diffuse chalky discolouration, symmetrical

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28
Q

What percentage of Fluoride is the optimum in drinking Water?

A

1ppm

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29
Q

Name 3 methods of delivering fluoride to an 8 year old and provide the concentrations for each method

A

Fluoride toothpaste 1450ppm
Mouthwash 225ppm
Varnish 22,600ppm

30
Q

What is the local action of fluoride in the oral cavity?

A

Promotes remineralisation of any demineralised enamel and forms fluoroapetite which has a higher erosion resistance
Inhibits bacterial metabolism and acid production

31
Q

Give the best treatment option for fluorosis and 2 advantages of this treatment.

A

Microabrasion
Conservative, only removing 100 microns of enamel
Results are permanent

32
Q

A 10 year old boy presents at your surgery with his mother. His only complaint is a bad taste in his mouth. On examination you note generalised white plaque that scrapes off easily and leave an erythematous base. What is your diagnosis?

A

Pseudomembranous candidosis

33
Q

Name 4 pre-disposing factors for Pseudomembranous candidosis , 2 local and 2 medical.

A

Local
Use of a corticosteroid inhaler
Removable prosthesis (ie URA for this patient)

Systemic
Diabetes
Systemic immunosuppressive treatment
Immunosuppression side effect of treatment (ie chemotherapy)

34
Q

give an advantage and disadvantage of each oral swabs and oral rinses

A

Swab
Site specific
Not quantitative

Rinse
Quantitative
Not site specific

35
Q

Name you first-line medication for candidosis, state 2 drugs that it interacts with and the nature of their interaction.

A

Fluconazole
Warfarin will interact to cause an increased risk of bleeding
Statins can cause muscle death and rhabdomyolysis

36
Q

Describe the method of how composite bonds to dentine

A

Etch is used to remove any smear layer present and open up the dentinal tubules and expose collagen fibres
Primer (HEMA) is them applied to aid in changing the surface from hydrophilic to hydrophobic
A resin adhesive agent is then applied and when polymerising it flows into dentine tubules to form resin tags, and the polymer chains will also become entangled with the exposed collagen fibres to give micromechanical retention (called the hybrid layer)
Composite resin can bond to the hydrophic adhesive surface

37
Q

Describe how Porcelain is treated to improve its retention

A

Sandblasting of fitting surface and hydrofluoric acid to etch the surface and then silane coupling agent applied

38
Q

Name 2 luting cements, other than resin based, that could be used to bond porcelain crowns

A

RMGIC/GIC
Zinc polycarboxylate

39
Q

Describe how a resin based luting cement bonds to porcelain

A

Silane coupling agent bonds with the oxides present in the porcelain, it also has a C=C end of the molecule, rendering the surface hydrophobic and allowing the resin based agent to bond to the surface

40
Q

Name one advantage to placing a crown as a posterior restoration.

A

Cuspal coverage to provide support and protection for the remaining tooth tissue

41
Q

What three questions should you ask mum after her son ingests fluoridated toothpaste?

A

What is the fluoride strength of the toothpaste?
How much of the toothpaste did the child ingest?
What is the weight of the child?

42
Q

what advice do you give a mother who’s son has ingested a toxic dose of toothpaste?

A

Ingest a large amount of calcium (milk)
Take the child to A+E immediately

43
Q

What is the most common cause of fluorosis in the UK?

A

drinking water

44
Q

If the patient is 10 with fluorosis what would you first line of treatment be?

A

Microabrasion (provided the patient is wishing for Tx)

45
Q

Please provide the fluoride supplement values for the following patients, all living in an area of <0.3ppm fluoridated water.
Age 1
Age 4
Age 7

A

Age 1- 0.25mg per day

Age 4- 0.5mg per day

Age7- 1mg per day

46
Q

Give 3 diagnostic features of a subluxation.

A

Tooth has not been displaced in the socket
Increased mobility of the tooth
Bleeding from the gingival sulcus

47
Q

What type of splint and how long for a subluxation injured tooth?

A

Flexible splint
2 weeks

48
Q

When would you review a patient following placement of a flexible splint?

A

2 weeks for splint removal
1 month
3 months
6 months
6 monthly for 2 years

49
Q

Name 2 features you would be assessing radiographically following a sublaxation injury at review?

A

Forming of any periapical lesion (widening of the PDL)
Initiation of inflammatory resorption

50
Q

How would internal inflammatory root resorption present both clinically, radiographically, what would it indicate about the tooth, what medicament would you place to attempt to halt resorption?

A

Clinically there would be a pink discolouration of the tooth
Ballooned, irregular shaped canal
Non setting calcium hydroxide

51
Q

As a member of the dental profession, CPD is one of the standards of practice.
Under clinical Governance, how many hours of CPD are to be done in a 5 year cycle?
How many are to be verifiable?

A

100 verifiable hours

52
Q

Give three suggested CPD topics and the hours per cycle for each

A

Decontamination (5 hours)
Medical emergencies (10 hours)
Radiology and radiographic protection (5 hours)

53
Q

What are the components of Clinical Governance?

A

Research and development
Education and training
Clinical effectiveness
Risk management
Openness
Clinical audit

54
Q

What are the dimensions of healthcare quality?

A

Patient centred
Safe
Effective
Efficient
Equitable
Timely

55
Q

Name 3 possible complications associated with the extraction of a lone-standing upper molar.

A

OAC/OAF
Tuberosity fracture
Root displaced into the maxillary antrum

56
Q

describe how you would diagnose OAC/OAF, Tuberosity fracture, and a displaced root into the maxillary antrum

A

OAC
Bubbling of blood in the socket
Good light and suction, direct vision (echoing of the suction)
Nose holding and explore with blunt probe (may cause OAC)
Bone present at the trifurcation of the roots post XLA

Fractured tuberosity
Crack felt/heard during mobilisation of the tooth
Tear in the palate
Mobility of the ridge and tuberosity palpable

Root in antrum
Good suction and irrigation and visually assess
Radiograph may show root placed in the antrum
CBCT

57
Q

Outline your management of one of these possible complications:
OAC/OAF, Tuberosity fracture, and a displaced root into the maxillary antrum

A

OAC
If small then encourage clotting in the area, surgicel and suture the margins
Prescribe antibiotics and give post op advice including
no nose blowing
avoid playing wind/brass and drinking through a straw
do not inhibit any sneezes
Review to ensure the communication has healed and no symptoms present
If larger communication then raise a buccal advancement flap, surgicel to encourage clotting and suture the buccal advancement flap to the palatal mucosa to close the wound, then manage the same as small

58
Q

Give 3 uses of URA other than tipping and tilting teeth

A

Habit breaker
Retainer
Growth modification
Overbite reduction

59
Q

Describe a URA to reduce 8mm OJ. First premolars have previously been extracted and previous URA retracted canines and reduced the overbite. Pt. has permanent dentition. The resulting design should be described in sufficient detail to allow a technician to produce the appliance

A

A = roberts retractor 0.5HSSW
R = Adams clasps 6s and 5s 0.7HSSW
A = appropriate
B = self cure PMMA, as OB previously reduced

60
Q

List 6 signs of “good wear” of a URA on visit.

A

Active component become passive
Patient can insert/remove the appliance competently
Post dam mark present on the palate
Patient can speak normally with appliance in
No hypersalivation when the appliance is in situ
Signs of wear on the appliance
Patient is wearing the appliance when they come in

61
Q

Describe 4 inta-oral signs of ANUG

A

Ulceration and recession of the papilla
Greyish slough over ulcers which can be removed
Red and puffy gingiva
punched out crater like ulcers

62
Q

What 4 risk factors pre-dispose someone to ANUG?

A

Smoking
Poor OH
Stress
Malnutrition

63
Q

Outline your treatment for ANUG

A

PGI, FMPC where indicated
OHI
recommend a soft bristled toothbrush to try and combat pain on brushing
Diet advice
HPT - supra and subgingival scaling to remove any causative plaque
Metronidazole 400mg 3 times daily for 3 days
CHX mouthwash
Refer to specialist if no improvement

64
Q

Give three potential reasons why a post and core may have debonded?

A

Secondary caries
Poor moisture control during cementation
Root fracture

65
Q

There is a fracture at junction of the post and core, give three reasons why this may have happened?

A

Biocorrosion
Lack of sufficient ferrule
Trauma

66
Q

Give an example of a wetting agent use to bond metal to resin within resin based luiting cement.

A

MDP, 4-META

67
Q

Name 3 ways of retrieving a fractured post.

A

Ultrasonic tip
Eggler forceps
Moskito forceps

68
Q

A 28 year-old patient fit and well attended your practice, full mouth peri-apicals reveal severe angular bone loss.

What is you diagnosis?

A

Generalised aggressive periodontitis

69
Q

How would you determine that someone has Generalised Chronic Periodontitis?

A

Bone loss excessive for the patients age
Patient is otherwise fit and well
Rapid progression of bone loss

70
Q

What clinical and lab investigations can be done to confirm Generalised Chronic Periodontitis?

A

Oral rinse to check for Aa presence
FMPC to assess CAL of affected teeth
PGI to assess OH
Thorough history including FH to see if older relatives have the same symptoms

71
Q

What determines the prognosis of individual teeth in a patient with Generalised Chronic Periodontitis?

A

CAL
Mobility scores
Furcation involvement
Pocket depths

4th year (4 decks)

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