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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
Name 4 key personnel involved in the Decontamination process and give a description of each of their roles
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
26
What type of water is used for the final rinse cycle and why use this as opposed to mains water?
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
27
Describe the appearance of dental fluorosis
Diffuse chalky discolouration, symmetrical
28
What percentage of Fluoride is the optimum in drinking Water?
1ppm
29
Name 3 methods of delivering fluoride to an 8 year old and provide the concentrations for each method
Fluoride toothpaste 1450ppm Mouthwash 225ppm Varnish 22,600ppm
30
What is the local action of fluoride in the oral cavity?
Promotes remineralisation of any demineralised enamel and forms fluoroapetite which has a higher erosion resistance Inhibits bacterial metabolism and acid production
31
Give the best treatment option for fluorosis and 2 advantages of this treatment.
Microabrasion Conservative, only removing 100 microns of enamel Results are permanent
32
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?
Pseudomembranous candidosis
33
Name 4 pre-disposing factors for Pseudomembranous candidosis , 2 local and 2 medical.
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
give an advantage and disadvantage of each oral swabs and oral rinses
Swab Site specific Not quantitative Rinse Quantitative Not site specific
35
Name you first-line medication for candidosis, state 2 drugs that it interacts with and the nature of their interaction.
Fluconazole Warfarin will interact to cause an increased risk of bleeding Statins can cause muscle death and rhabdomyolysis
36
Describe the method of how composite bonds to dentine
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
Describe how Porcelain is treated to improve its retention
Sandblasting of fitting surface and hydrofluoric acid to etch the surface and then silane coupling agent applied
38
Name 2 luting cements, other than resin based, that could be used to bond porcelain crowns
RMGIC/GIC Zinc polycarboxylate
39
Describe how a resin based luting cement bonds to porcelain
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
Name one advantage to placing a crown as a posterior restoration.
Cuspal coverage to provide support and protection for the remaining tooth tissue
41
What three questions should you ask mum after her son ingests fluoridated toothpaste?
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
what advice do you give a mother who's son has ingested a toxic dose of toothpaste?
Ingest a large amount of calcium (milk) Take the child to A+E immediately
43
What is the most common cause of fluorosis in the UK?
drinking water
44
If the patient is 10 with fluorosis what would you first line of treatment be?
Microabrasion (provided the patient is wishing for Tx)
45
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
Age 1- 0.25mg per day Age 4- 0.5mg per day Age7- 1mg per day
46
Give 3 diagnostic features of a subluxation.
Tooth has not been displaced in the socket Increased mobility of the tooth Bleeding from the gingival sulcus
47
What type of splint and how long for a subluxation injured tooth?
Flexible splint 2 weeks
48
When would you review a patient following placement of a flexible splint?
2 weeks for splint removal 1 month 3 months 6 months 6 monthly for 2 years
49
Name 2 features you would be assessing radiographically following a sublaxation injury at review?
Forming of any periapical lesion (widening of the PDL) Initiation of inflammatory resorption
50
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?
Clinically there would be a pink discolouration of the tooth Ballooned, irregular shaped canal Non setting calcium hydroxide
51
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?
100 verifiable hours
52
Give three suggested CPD topics and the hours per cycle for each
Decontamination (5 hours) Medical emergencies (10 hours) Radiology and radiographic protection (5 hours)
53
What are the components of Clinical Governance?
Research and development Education and training Clinical effectiveness Risk management Openness Clinical audit
54
What are the dimensions of healthcare quality?
Patient centred Safe Effective Efficient Equitable Timely
55
Name 3 possible complications associated with the extraction of a lone-standing upper molar.
OAC/OAF Tuberosity fracture Root displaced into the maxillary antrum
56
describe how you would diagnose OAC/OAF, Tuberosity fracture, and a displaced root into the maxillary antrum
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
Outline your management of one of these possible complications: OAC/OAF, Tuberosity fracture, and a displaced root into the maxillary antrum
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
Give 3 uses of URA other than tipping and tilting teeth
Habit breaker Retainer Growth modification Overbite reduction
59
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 = roberts retractor 0.5HSSW R = Adams clasps 6s and 5s 0.7HSSW A = appropriate B = self cure PMMA, as OB previously reduced
60
List 6 signs of “good wear” of a URA on visit.
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
Describe 4 inta-oral signs of ANUG
Ulceration and recession of the papilla Greyish slough over ulcers which can be removed Red and puffy gingiva punched out crater like ulcers
62
What 4 risk factors pre-dispose someone to ANUG?
Smoking Poor OH Stress Malnutrition
63
Outline your treatment for ANUG
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
Give three potential reasons why a post and core may have debonded?
Secondary caries Poor moisture control during cementation Root fracture
65
There is a fracture at junction of the post and core, give three reasons why this may have happened?
Biocorrosion Lack of sufficient ferrule Trauma
66
Give an example of a wetting agent use to bond metal to resin within resin based luiting cement.
MDP, 4-META
67
Name 3 ways of retrieving a fractured post.
Ultrasonic tip Eggler forceps Moskito forceps
68
A 28 year-old patient fit and well attended your practice, full mouth peri-apicals reveal severe angular bone loss. What is you diagnosis?
Generalised aggressive periodontitis
69
How would you determine that someone has Generalised Chronic Periodontitis?
Bone loss excessive for the patients age Patient is otherwise fit and well Rapid progression of bone loss
70
What clinical and lab investigations can be done to confirm Generalised Chronic Periodontitis?
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
What determines the prognosis of individual teeth in a patient with Generalised Chronic Periodontitis?
CAL Mobility scores Furcation involvement Pocket depths

4th year (4 decks)

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