2017 Paper Flashcards
What is reversible pulpits and how do you test for it?
Pulpal inflammation that should resolve following removal of aetiology.
Characterised by short sharp pain on application of cold stimulus which lingers a few seconds after stimulus is removed
- Sensibility test with ethyl chloride
What is irreversible pulpits and how do you test for it?
Pulpal inflammation that is incapable of healing
Characterised by sharp pain upon thermal stimulus, and lingering pain (lasts for more than 30s after stimulus is removed)
spontaneous pain that often keeps patients awake at night and is typically unaffected by OTC analgesia
- Sensibility test with GP
A patient has pain on pressure, what is the possible diagnosis?
- symptomatic apical periodontitis
- if there is pus present - acute apical abscess
What is the treatment for reversible pulpits?
- remove stimulus
- remove caries
- restore the tooth with temporary restoration
- review and check if the pulp has returned to a normal state
may use a lining material
What is the treatment for dentine hypersensitivity?
- fluoride varnish or hypersensitivity toothpaste
What is the treatment for symptomatic apical periodontitis?
- RCT
OR - Extraction
What is the treatment of acute apical abscess?
- Abscess drainage
- decide if antibiotics required
- RCT or extraction
Explain gaseous porosity
voids in the material occurring when PMMA is cured fat; monomer boils (100C)
usually occurs in thicker sections of the acrylic
What are 2 things a mould liner helps with
- reduces porosity
- Easier tor deflasking to be carried out
What are 2 reasons why acrylic dentures can’t be left in a dry environment for too long?
- 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 two thermal properties of acrylic dentures and why it is important?
- Low thermal conductivity - the denture base would not be able to transmit heat that well to the palate, the patient would be less sensitive to the temperature of fluid/food
- high softening temperature of the acrylic - tolerant to hot food and drinks but must inform patient to not clean denture using boiling water
What radiograph can be taken for a child with poor cooperation with caries on 13, 36 and 46 and needs extraction?
- OPT with deciduous dentition setting - set for the right half of dentition only
If you need to extract the 26 of a child, what must be done?
- A compensating extraction of the 36
What are 2 things to check for on the radiograph of an uncooperative child when considering extraction of 6s?
- Bifurcation of the lower 7 forming
- Presence of 5s and 8s and their position
What are the advantages of extraction of FPM at the correct time radiograpically?
- Allows a caries free dentition
- Allows space closure through medial drift of the 7s
What are 2 disadvantages of extraction of FPM at the correct time?
- Associated risk of GA
- Extraction of permanent molar can be demanding for a child at this stage and negative experience may affect future dental visits
What is required for a 3 year old child before carrying out extraction?
- GA or Inhalation sedation
- Ascertain who has parental responsibility
- Gain consent - explain risks and alternative options
- write referral letter for GA
What are peri-operative complications of extracting mandibular premolar?
- pain/swelling/bruising
- haemorrhage
- sequestrum
- trismus
- soft tissue damage
- damage to adjacent teeth/restorations
What 2 types of LA administration is needed for extraction of 34
- Metal nerve block
- Lingual infiltration
How do you test when anaesthesia has been acheived after a mental nerve block?
- ask if the patient feels numbness around the lower lip and chin region
- probe around the tooth and check if the patient feels anything sharp or painful
What are the 3 neuro-sensory deficits?
- Paraesthesia (tingling)
- Anaesthesia (numbness)
- Dysesthesia (unpleasant sensation or pain)
What are 3 possible causes of neuro-sensory deficits?
- Crushing
- Cutting/shredding injury
- Transection of the nerve
- Damage due to LA
What are signs that trauma is non-accidental?
- delayed presentation of injuries
- injuries do not match history/description
- Untreated injury
- injuries to both side of the body
- injuries that follow a certain pattern
- injuries to triangle of safety
- injuries to soft tissue
What are effects of trauma on primary dentition?
- delayed exfoliation
- discolouration
- Infection
What are effects of trauma on the permanent dentition?
- Enamel defect
- Delayed eruption
- Arrested formation of tooth
- Abnormal anatomy of tooth (crown or root)
- Ododntome formation
- Incomplete tooth formation
What are ways to stop a digit sucking habit?
- positive reinforcement to persuade behaviour change
- removable appliance
- fixed appliance - tongue rake
- bitter tasting nail polish
- Plasters on nails
What are dental presentations of digit sucking?
- anterior open bite
- proclaimed upper incisors
- retroclined lower incisors
- Unilateral Posterior cross bite
- Narrow upper arch
What happens to the posterior dentition in a digit sucking habit?
- cheeks are sucked in which will gradually push the upper teeth palatally resulting in narrower upper arch and a posterior cross bite
What is the SIMD?
An area based index which ranks zones within Scotland in order of deprivation based on a range of factors
e.g. housing, income, health services
What are modifiable risk factors of head and neck cancer?
- tobacco use
- alcohol intake
- HPV
- sun exposure
What are common reasons for an unerupted central incisor?
- trauma
- supernumerary teeth
If you suspect an unerupted tooth what would you do to help with clinical diagnosis?
- take a detailed medical and dental history
- intra-oral exam - check sequence of eruption, presence of contralateral tooth, displacement of other teeth in upper incisor region
- check for presence of labial or palatal swellings which indicate presence of unerupted incisor
- take a radiograph
What are the 4 principles to follow for unerupted teeth?
- remove supernumerary or deciduous tooth if present
- expose tooth
- create space
- monitor for >1.5 years
What antibiotic is prescribed for ANUG?
- Metronidazole
what is the dose and duration for metronidazole?
400mg 3 times daily for 3 days
What is specific advice to tell patients for metronidazole ?
- Don’t drink alcohol
- Interaction with warfarin
- Cannot be used if pregnant or breast feeding
What is treatment for NUG?
- Debridement with LA
- smoking cessation advice
- OHI
What are 2 wats biofilms help with resistance ?
- adhesive properties of biofilm traps antimicrobials which can then destroy by enzymes
- Extracellular DNA and presence of biofilm specific resistance gene
- Impeded diffusion of antimicrobials through biofilm
What microorganisms because caries?
- streptococcus mutants
- Lactobacillus acidophilus
What are the periodontal microorganisms (red socransky)?
- P. gingival
- T. forsythia
- T. Denticola
What aids adhesion and acid tolerance in caries forming microorganisms?
- synthesis of gluons
- Extrusion of H+ ions through ATPase
What is a randomised control trial ?
gold standard study of all study designs
used for proving effectiveness of treatments
What is a null hypothesis?
- statement suggesting there is no statistical significance in a set of data
How do you calculate an odds ratio?
no. of times event ‘X’ occurred / No. of times event ‘X’ did not occur
divided by
no. of times event ‘Y’ occurred / No. of times event ‘Y’ did not occur
What are 2 types of manual washing ?
- immersion
- non-immersion
What is an example of an instrument suitable for both types of manual washing?
immersion - probe/ dental mirror
non-immersion - handpick (electronic devices)
What PPE is required for manual washing?
- rubber gloves
- plastic disposable gown
- face shield
Why do you de-gass the ultrasonic?
- oxygen/air inhibits cavitation and resulting bubbles have lower intensity when implode. This will reduce the efficiency of the machine in cleaning
How often do you de-gas the ultrasonic?
necessary for every cleaning cycle
after filling the machine with clean water but before loading instruments
Why are hand pieces not placed in an ultrasonic cleaner?
they should not be immersed in water and the ultrasocnic activity can damage the high-speed turbine of the hand piece
Why do you need to use demineralised water in sterilisation ?
- the substances in mineralised water including minerals and endotoxins will coat the surface of the instruments
What features of cerebral palsy would impair access to the mouth?
- muscle stiffness
- muscle weakness
- random and uncontrolled body movements
What are 2 ways to open the patients mouth
- use bite block
- bedi shield
What are the differences in the medical models and social models relating to disability?
- social model -disability caused by how society is organised rather than a persons impairment or difference
- medical model -diability caused by a person’s impairment and should be fixed or changed by other medical treatments
What is xerostomia?
dry mouth caused by reduced salivary flow
What oral problems are exacerbated by xerostomia ?
- caries
- Periodontal disease
- Candida infection
- Mucositis
What are drugs that could because xerostomia?
- tricyclics
- anticholinergics
- Benzodiazepines
- Diuretics
- Opiods
- Nicotine
What are no medication factors that can because xerostomia?
- radiotherpy/chemotherapy
- Sjogrens syndrome
- HIV
- Epstein Barr virus
What are oral implications of radiotherapy?
- xerostomia due to damage of salivary glands
- Increased risk of osteoradionecrosis
- Mucositis
- Radiation caries - affects incisor edges and cervical margins
- Limited opening due to trismus
- Hypogeusia
What are possible faults that could cause magnified anterior on a radiography ?
canine positioned behind canine guidance lines
What are possible faults that could cause one side of posterior wider on a radiography ?
Patient head slightly rotated in the OPT machine
What plane is horizontal to the floor during OPT?
- Frankfort plane
What kind of OPT do you take for a partially erupted 48 with no sign of the 38?
right hand of the mandible on setting 4
In an OPT what part of the maxillary sinus is immediately above the premolars?
inferior border
In an OPT what part of the maxillary sinus is immediately above the third molars?
Posterior border
What provides retention for dentures ?
- Accurate fit -as little space as possible between the denture base and mucosa
- border seal - extending flanges to the depth of the functional sulcus and incorporation of a post dam
What are anatomical features to help identify where the posterior border should be placed for the upper denture ?
- Hamuler notch
- Vibrating line
