2017 Flashcards
what would be included in a clinical exam when trying to determine an endodontic diagnosis of a tooth?
- facial symmetry
- sinus tract
- soft tissue
- periodontal status (probing, mobiliy)
- caries
- restorations (defective, newly placed)
which clinical tests can be carried out to determine a pulpal diagnosis?
cold- ethyl chloride
heat- GP
electric pulp test
what tests can be carried out to determine a periapical diagnosis?
percussion
palpation
tooth slooth (biting)
what radiographic analysis should be carried out during endodontic diagnosis?
- new periapicals (at least 2)
- bitewing
- cone beam-computed tomography
how would you define a ‘normal pulp’?
- the pulp is symptom free and normally responsive to pulp testing
- mild or transient response to thermal cold testing, lasting no more than 1/2 secs after stimulus removed
define reversible pulpitis
- based upon subjective and objective findings indicating that the inflammation should resolve and the pulp return to normal following management of the aetiology
- discomfort is experienced when a cold stimulus is applied, but stops within a few seconds of removal of the stimulus
- no significant radiographic changes in periapical region
what are the typical aetiologies of reversible pulpitits?
- exposed dentine (dentine sensitivity)
- caries
- deep restoration
define symptomatic irreversible pulpitis
- based on subjective and objective findings that the vital inflamed pulp is incapable of healing anf that root canal treatment is indicated
- charp pain upon stimulus, lingering for 30+ seconds after removal, spontaneous pain, usually keep patient up at night, referred pain
- pain can be made worse by lying down/bending over
- OTC analgesics usually ineffective
*
why are teeth with symptomatic irreversible pulpitis usually not tender to percussion?
infection has not reached the periapcial tissues
define asymptomatic irreversible pulpitis
- based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing and that root canal treatment is indicated
- no clinical symptoms
- usually respond normally to thermal testing
- may have had trauma/deep caries
define pulp necrosis
- death of the pulp- root canal necaessary
- pulp is non-responsive to testing and is asymptomatic
*
describe ‘normal apical tissues’
- not sensitive to percussion or palpation testing
- the lamina dura root is intect
- the PDL space is uniform
describe symptomatic apical periodontitis
- inflammation, usually of apical periodontium, producing clinical symptoms involving painful response to biting and/or percussion or palpation
- there may be a periapical radiolucency, depending on stage of disease
describe asymptomatic apical periodontitis
- inflammation and destruction of apical periodontium that is of pulpal origin
- appears as apical radiolucency
- no clinical symtoms
desribe a chronic apical abscess
- inflammatory reaction to pulpal infection and necrosis
- characterised by by gradual onset, little/no discomfort and an intermittent discharge of pus through an associated sinus tract
- typically signs of osseous destruction such as a radiolucency
how would you identify the source of a draining sinus in a chronic apical abscess?
place a gutta-percha cone through the stoma/opening until it stops and a radiograph is taken
define an acute apical abcess
inflammatory reaction to pulpal infection and necrosis characterised by rapid onset, apontaneous pain, extreme tenderness of the tooth to pressure, pus formation and swelling of associated tissues
may be no radiographic signs of destruction
patient often feels malaise, fever and lymphadenopathy
define condensing osteitis
a diffuse radiopaque lesion representing a localised bony reaction to a low-grade inflammatory stimulus usally seen at the apex of the tooth
- 46 hypersensitive to cold/sweets over past few months
- symptoms now subsided
- no response to thermal testing
- tenderness to biting and pain to percussion
- diffuse radiopacities around the root apices
**endodontically diagnose this tooth **
pulp necrosis
symptomatic apical periodontitis with condensing osteiotis
- 16 sensitive to hot and cold
- spontaneous pain
- pain lingered for 12 seconds after cold stimulus removed
- normal response to percussion and palpation
- no evidence of osseous changes
endodontically, diagnose this tooth
symptomatic irreversible pulpitis
normal apical tissues
- 26 sensitive to cold/sweets
- no discomfort to biting/pecussion
- hyper-responsive to cold stimulus with no lingering pain
**endodontically, diagnose this tooth **
reversible pulpitis
normal apical tissues
- 42 has an apical radiolucency
- history of trauma 10+ years ago
- tooth slightly discoloured
- no response to pulp tests
- no tenderness to percussion or palpation
endodontically, diagnose this tooth
pulp necrosis
asymptomatic apical periodontitis
explain gaseous porosity
- voids in the material occurring when PMMA is cured fast
- monomer boils
- usually happens in a thicker section of the acrylic
what is the role of a mould liner on a denture?
- reduces porosity
- easier for deflasking to be carried out
why can you not leave dentures in a dry environment?
- acrylic may become brittle if over dried
- warping can occur and the altered shape of the denture may be unable to fit the patient
name 2 thermal properties of acrylic dentures
- low thermal conductivity
- high softening temperature of the acrylic
why is low thermal conductivity in acrylic dentures important?
because the denture base would not be able to transmit heat that well to the palate
patient less sensitive to the temperature of fluid/food
advise patient to be careful to not scald the back of their throat
why is high softening temperature of acrylic dentures important?
tolerant to hot food and drinks
must tell patient not to clean denture with boiling water
what radiograph can you take for a pre-cooperative child?
OPT with deciduous dentition setting 4
a child presents with carious 16, 36, 46 that all require extraction.
what is the treatment of 26?
compensating extraction
when is the most appropriate time to extract the 6s in a child?
when you can see the bifurcation of the 7
usually around 8.5-9.5 years
what are the advatanges of extracting 6s at the desired time?
allows for caries free dentition
allows for space closure through mesial drift of 7
what are 2 disadvantages of extracting the 6s at the desired time?
associated risk of GA
extraction of permanent molars can be quite demanding for a child this age and could affect future appointments
what do you need in order to carry out an extraction on a 3 year old?
- GA/inhalation sedation
- ascertain who has parental responsibility
- gain informed consent
- write referral letter for GA
A patient needs tooth 34 extracted
other wise healthy dentition
what common peri-operative complications can occur?
- difficult access- caused by trismus or crowded/malpositioned teeth
- abnormal resistance- thick cortical bone or divergent roots
- tooth/root fracture- usually caused by extensive caries
- jaw fracture- extraction in the mandible
when does fracture of alveolar bone usually occur during extraction?
in the buccal plate
to canines or molars
what do you do if a jaw facture occurs during extraction?
- inform the patient
- post-op radiograph
- refer (phone call)
- ensure analgesia
- stablise
- if delay - prescribe antibiotic
define neurapraxia
contusion of nerve/ continuity of epineural sheath and axons maintained
define axonotmesis
continuity of axons
epineural sheath disrupted
define neurotmesis
complete loss of nerve continuity/nerve transected
what are the aetiological factors of a tuberosity fracture during extraction?
- single standing molar
- inadequate alveolar support
- unknown unerupted wisdom tooth
name the 5 types of nerve deficit
- anaestheisa- numbness
- parasethesia- tingling
- dysthesia- unpleasant sensation/pain
- hypoaesthesia- reduced sensation
- hyperaesthesia- increased/heightened sensation
name the main causes of haemorrhage during extraction
- local factors- mucoperiosteal tear or fracture of alveolar plate/socket wall
- very few due to undiagnosed clotting abnormality
- liver disease (clotting factors made in the liver)
- medication e.g. warfarin
how do you control a soft tissue haemorrage during extraction?
- pressure
- suture
- LA with adrenaline (vasconstrictor)
- diathermy
how do you control a haemorrhage from bone during extraction?
- pressure with swab
- LA injected into socket
- blunt instrument
- bone wax
- pack
how would you manage a TMJ dislocation during extraction?
- relocate immediately
- give analgesia and advise on supported yawning
- if relocation not possible;
1. LA into masseter intra-orally
2. immediate referral
what is an alveolar nerve block (IDB) used for?
- pulp of lower molars and second premolars
what is a mental (incisive) nerve block used for?
- dental pulp of lower premolars and canine
- buccal gingivae of lower first premolar and canine
what is a long buccal infiltration used for?
buccal gingivae of lower molars and second premolar
how do you test that anaesthesia has been achieved?
- ask the patient if they feel numb/tingling
- probe around site and check if pain felt
give possible causes of neuro-sensory deficits
- crushing injury
- cutting/shredding injury
- transection of the nerve
- damage due to LA
what are signs that trauma was non-accidental?
- injuries to both sides of the body
- injuries that follow a certain pattern
- delayed presentation of injuries
- injuries that don’t match description given
- injuries to the triagnle of safety
- injuries to soft tissue
- untreated injury
how can trauma affect the primary dentition?
- delayed exfoliation
- discolouration
- infection
how can trauma affect the permanent dentition?
- enamel defect
- delayed eruption
- arrested formation of the tooth
- abnormal anatomy of tooth
- odontome formation
how do you help a child stop a digit sucking habit?
- positive reinforcement to persuade behaviour change
- identify triggers and provide comfort in other ways
- offer gentle reminders
- provide removable appliance with rake
- nail polish with a bad taste
give occlusal presentations of a digit sucking habit
- proclined upper incisors
- retroclined lower incisors
- anterior open bite/incomplete open bite
- posterior crossbite
- narrower upper arch
how is the posterior dentition affected by a digit sucking habit?
narrow arch created by masster muscle constantly pushing upper posterior teeth palatally
posterior crossbite can then be observed when narrowed upper arch meets lower arch
define SIMD
area based index which ranks zones in Scotland in order of deprivation
based on factors such as housing, income, geographical access to public services, health services, crime, education, employment
give modifiable aetiology of head and neck cancer
- tobacco use
- excessive alcohol intake
- HPV
- sun exposure
- malnutrition- diet low in fruit and veg
what are common causes of an unerupted central incisor?
- trauma
- supernumerary
list steps to help with diagnosis of unerupted central incisor
- take detailed histroy- check for environmental/hereditary factors and history of trauma
- intraoral exam- sequence of eruption, presence of contralateral tooth, rotation/displacement of other teeth in region
- check for presence of labial/palatal swellings which may indicate presence of the tooth
- take a radiograph
what are the 4 principles for an unerputed central incisor?
- remove supernumerary/deciduous if present
- expose incisor
- create space for the tooth
- monitor for at least 18 months
what is the treatment of an unerupted central incisor?
removal of any obstruction with creation of space
removal of obstruction only
surgical intervention- incision
orthodontic traction
what antibiotic is prescribed for ANUG and its dose/duration?
metronidazole
400mg 3x per day for 3 days
what is the specific advice given for metronidazole?
no alcohol
interaction with warfarin
what treatment would you carry out at a follow up appointment for a patient who smokes and presents with ANUG?
- debridement with LA
- smoking cessation advice
- OHI
how do biofilms help with resistance?
- adhesive properties trap antimicrobials which can then be destroyed by enzymes
- extracellular DNA and presence of biofilm specific resistance gene
- impeded diffusion of antimicrobials through biofilm
what microorganisms cause caries?
- streptococcus mutans
- lactobacillus acidophilus
which microorganisms are found in the red section of Socransky’s model?
- porphyromonas ginigivlalis
- tannerella forsythia
- treponema denticola
what aids adhesion and acid tolerance in caries forming microorganisms?
synthesis of glucans
extrusion of H+ ions through ATPase
desribe randomised control tests
- gold standard of study design
- provides strongest evidence on treatment effectiveness
- 4 elements;
1. inclusion/exclusion criteria
2. control
3. randomisation
4. blinding/masking
what is a null hypothesis?
general statement suggesting that there is no statistical significance in a set of data
how do you calculate an odds ratio?
no. time x occurred/no. times x never occurred
DIVIDED BY
no. times y occurred/no. times y never occurred
what are the 2 types of manual washing?
immersion
non-immersion
what instruments are suitable for immersion manual washing?
probe
dental mirror
(most instruments)
what instruments are suitable for non-immersion manual washing?
handpieces
other electrical/electronic devices
what PPE is required for manual washing and why?
- gloves- protect hands from detergent (irritant) and contaminated substances
- mask- prtect against aerosol from washing of contaminated instruments
- full face visor- protect against splash back of contaminated/detergent filled water
- plastic disposable apron- protect clothes and other parts of body from splashes during water
why do we degas the ultrasonic?
oxygen/air inhibits cavitation and resulting bubbles have lower intensity when imploded
this would reduce efficiency of the machine in cleaning
how often do you degas the ultrasonic?
necessary before every cleaning cycle, after filling the machine with clean water but before loading instruments
why can handpieces not be placed in the ultrasonic?
- handpeices should not be immersed in water
- ultrasonic activity can damage the high-speed turbine
why is demileralised water used in the steriliser?
minerals, endotoxins etc. present in normal water would coat the surface of the instruments, making them not sterile
what are the constitutes of gutta-percher?
- 15% GP
- 65% zinc oxide
- 155 radiopacifier
- 5% plasticiser
give reasons for obturating
- entomb remaining surviving microorganisms within the root canal system
- prevent ingress of fluid into root canal space which will promote the growth of surviving microorganisms
- prevent entry of microbes from the oral environment due to coronal leakage
what are the properties of non-setting calcium hydroxide?
- high pH- antimicrobial factors
- hydrolysis pf LPS reduce inflammatory potential
- removal of tissue debris
what are the functions of a sealer during endodontic treatment?
- lubricate the canal
- seal space between dentinal wall and core
- fill voids and irregularities within the canal and between GP cones during lateral compaction
what provides retention for dentures?
- accurate fit - as little space as possible between denture base and mucosa
- border seal- extending flanges to the depth of functional sulcus and incorporation of post dam
what anatomical features healp identify where the posterior border should be placed for the upper denture?
- hanular notch
- vibrating line
- palatine fovea
what impression materials would you use for an edentulous pt on the mandibular arch?
- primary- alginate/impression compund
- definitive- alginate/polyether/silicone
when is a patient classed as dentally fit?
- free of active dental disease
- associated pain
- foci of infection?
what is a multidisciplinary team?
group of healthcare professionals from different disciplines/specialities who share their expertise and work together in a team to provide the best and most holistic care possible for the patient
list possible members of a cancer MDT
- surgeon
- clinical oncologist
- chemotherapy nurse
- special care dentist
- pathologist
list oral implications of radiotherapy
- xerostomia due to damage of salivary glands
- increase risk of osteoradionecrosis
- mucositis
- radiation caries affecting incisal edges and cervical margins
- limited opening due to trismus
- hypogeusia
what features of cerebral palsy would impair your access to the mouth?
- muscle stiffness (hypotonia)
- muscle weakness
- random and uncontrolled body movements
give two ways you can aid a patient who struggles to open their mouth
- mouth rests for opening
- bedi shield
give methods of tilting a patient for access
- wheelchair recliner
- hoist
- portable turntable
- stand aid
- banana board
what can you use for communicating if a patient cannot speal or write?
- makaton
- picture boards
- talking mats
electrical tablet
what are the differences n medical models and social models related to disability?
- social models- disability caused by how society is organised rather than a person’s impairment or difference
- medical models - disability caused by a person’s impairment/differences and should be ‘fixed’ or ‘changed’ by other medical/other treatments
what is xerostomia?
dry mouth caused by reduced salivary flow
clinically diagnosed if unstimulated salivary flow <0.3ml
list oral problems which are exacerbated by xerostomia
- caries
- periodontal disease
- candida infection
- mucositis
what drugs can cause xerostomia?
- tricyclics
- anticholinergic
- benzodiazepines
- diuretics
- opioid
- nicotine
give causes of xerostomia
- radiotherapy/ chemotherapy
- sjrogren’s syndrome
- HIV
- epstein Barr virus
what position fault causes anterior teeth to appear magnified on a radiograph?
canine is positioned behind the canine guidance line
what position fault causes one side of the posterior region to appear wider than the other on a radiograph?
patient’s head rotated slightly in the OPT machine
what plane is horizontal to the floor during an OPT?
frankfort plane
in an OPT, what part of the maxillary sinus is immediately above premolars?
inferior border
in an OPT, what part of the maxillary sinus is immediately above the third molar?
posterior border
draw flap of retained root of lower premolar
