2018 Flashcards
state aims for raising a flap
- allows better access to the tooth if finding any difficulty to extract e.g. due to abnormal resistance, ankylosis etc.
- helps with closure of an OAF
state aims of retracting a flap
- protection of the soft tissue
- better access and vision
state factors which influence flap design
- design may be influenced if the tooth is in an area of aesthetics
- narrow ridge- bone augmentation may be required so wide flap desisgns should be utilised
- the anatomy surrounding the tooth being treated e.g. nerves and muscles (lingual nerve can be damaged during surgical removal of lower 3rd molars)
- the treatment which is being carried out
- ability to access/visualise and ability to suture it back
name 3 types of flap design
- semi-lunar
- triangular
- rectangular
what type of handpiece is used for bone removal?
- electric straight handpiece with saline cooled bur
- round or fissure yungsten carbide burs
- air driven handpieces may lead to surgical emphysema
what are the 3 methods of debridement?
- physical
- aspiration
- irrigation
describe physical debridement
using bone file or handpiece to remove sharp bony edges
mitchell’s trimmer/Victoria curette to remove soft tissue debris
describe debridement by irrigation
sterile saline/water placed into the socket and under flap
describe debridement by aspiration
aspirate under the flap to remove debris
check the socket for retained apices
what is the clinical term for a dry socket?
alveolar osteitis
(inflammation of the lamina dura)
what are the predisposing factors of a dry socket?
- female
- young
- previous dry socket
- smoker
- trauma during extraction
- excessive swishing in the mouth post extraction (damage to blood clot)
- more common on the mandible
- oral contraceptive pill
what are the signs and symptoms of a dry socket?
- dull aching pain
- exposed, sensitive bone
- patient will be kept up at night
- pain can radiate to the ears
- bad breathe
- bad taste in the pts mouth
what are the treatment options for dry socket?
- remove the blood clot to encourage new clotting
- irrigate the socket with warm saline
- support and reassure the patient
- antiseptic pack e.g. BIP
what family of drugs does apixiban belong to?
NOAC
novel oral anticoagulant
what does apixiban inhibit?
factor Xa
stops conversion of prothrombin to thrombin, stopping the production of a fibrin clot
what are the uses of apixiban?
- inhibits conversion of prothrombin to thrombin
- prevention of DVT
- prevention of pulmonary embolism
- can prevent stroke and reduce risk in pts with AF
what blood tests do you carry out on a patient who is on apixiban before treatment?
APTT
activated partial thromboplatin time assay
what do you do for a patient who is taking a NOAC before a low risk procedure?
- do not disrupt the medication
- treat the patient according to general advice for managing bleeding risk
- plan treatment early in the day
- limit the intial treatment area
- actively consider suturing and packing
give examples of low risk procedures
- simple extraction (1-3 teeth)
- incision and drainage
- 6PPC
- RSD and subgingival scaling
- direct or indirect restorations with subgingival margins
how should a pt alter their NOAC before a high risk procedure?
miss morning dose for apixiban or dabigatran
delay morning dose until after procedure- rivaroxaban
give examples of high risk procedures
- extraction >3 teeth
- biopsies
- surgical procedure (perio surgery, periradicular, crown lengthening etc.)
how do you manage a patient who is taking a NOAC and receiving a high risk procedure?
- Treat the patient according to the general advice for managing bleeding risk
- Plan treatment for early in the day.
- Consider carrying out the treatments in a staged manner.
- Actively consider suturing and packing
- Advise the patient when to restart their medication.
give methods of haemostatic control
apply pressure by biting on damp gauze
LA with vasoconstrictor
Suture
Surgicel
Bone wax
Diathermy
give physical features of downs syndrome
- broad flat face, flat nasal bridge
- short neck
- short nose
- small arched palate
- macroglossia- big tongue and protruding tongue. Fissured tongue
- upslanting palpebral fissure
- open bite
- class 3 malocclusion
- hypodontia
- abnormal ears
what is the result of a genetic tesgt for down’s syndrome?
extra copy of chromosome 21
why are people with Down’s syndrome at increased risk of perio disease?
- immunocompromised
- poor oral hygiene
- less saliva
what are 2 reasons for a patient with down’s syndrome not having capacity?
learning difficulty
dementia
what are the two types of power of attorney and the difference between them?
- welfare- matters relating to health and personal welfare
- continuing - financial affairs and property
describe a power of attorney
- granted by the adult while they still have capacity
- certified bu a lawyer or medical practitioner
- powers only come into effect when the adult is incapable fo decision making
describe a welfare guardian
- appointed by the court after the adult has lost capacoty
- requires 2 medical reports
- continuous management of welface and financial matters
- usually appointed for 3 years
when should antibiotic prophylaxis be taken?
1 hour before the procedure
gives features of parkinson’s
- bradykinesia – slow movement
- rigidity – increase motor tone
- mask like face
- resting tremors
- posture instability – impaired use of upper limbs; impaired gait and falls
how does Parkinson’s disease differ from other cerebellar diseases?
Parkinson’s- resting tremors
other cerebellar diseases- intentional active tremors
why might a patient with Parkinson’s suffer from dry mouth?
medication due to antichollinergic effects of drug treatment (Benztropine)
how do you prevent a denture getting lost in a care home?
initial it during processing
if already constructed, can mark using sandpaprer or a sealant
store them in a labelled container
why would you avoid extracting teeth in.a denture wearing patient with Parkinson’s?
- tremor can make extraction difficult
- poor motuh opening due to rigidity
- will require new prostheses to replace missing teeth- won’t be able to tolerate it
define local malocclusion
a localised problem or abnormality within either arch, usually confused to one, two or several teeth producing a malocclusion
tends to get worse with time
gives reasons for abnormalities of tooth number
- supernumerary teeth
- hypodontia
- retained primary teeth
- early loss of primary teeth
- unscheduled loss of permanent teeth
- variation of timing
state 4 types of supernumerary
conical
tuberculate
supplemental
odontome
how do you measure anterio-posterio skeletal relationship?
visual assessment
palpate skeletal bases
measure the ANB angle on a lateral cephalogram
how do you measure vertica skeletal relationship?
- Frankfort Mandibular Plane Angles (FMPA)
- LAFH to TAFH ratio
who sets the classifications for incisor relationships?
British Standards Institute
describe a class I incisor relationship
The lower incisor edges occlude with or lie immediately below the cingulum plateau of the upper central incisors
describe a class II incisor relationship
The lower incisor edges lie posterior to the cingulum plateau of the upper incisors
what is the difference between a clas II division 1 and class II division 2 incisor relationship?
divison 1- upper incisors are proclined or of average inclination and there is an increase in overjet
division 2- upper central inciors are retroclined- overjet is usually minimal or may be increased
describe a class III incisor relationship
The lower incisor edges lie anterior to the cingulum plateau of the upper incisors. The overjet is reduced or reversed.
how is porcelain surface prepped in the lab for bonding?
hydrofluoric acid is applied to produce a retentive surface
what do you use to bond porcelain to composite luting resin?
silane coupling agent
how does silane coupling agent act chemically?
double carbon C=C bonds attach to composite luting agent
oxide groups in the silane coupling agent attach to the porcelain
what metal can be used for an acid-etch retained bridge?
CoCr or NiCr
what chemical agent do you use to bond to metal?
MDP, 4-META
give 4 examples of questions you would ask a patient about their smoking habits
- what do you smoke?
- how many cigarettes a day?
- how long have you been smoking?
- are you thinking of quitting?
what would you tell patients about e-cigarettes?
- suggest use of research backed product e.g. patches
- they are not harmless but considerably safer than conventional cigs if used in moderation
- dont use them in public spaces
- can cause dry mouth, soft tissue damage due to battery overheating
what is the methodology for smoking cessation?
- Ask
- Advise
- Assess
- Assist
- Arrange a referral
give advice services you could refer a smoker to
- community clinics
- hospital advisor
- mental health in-patient service
- specialist pregnancy service
- prison serive
- community pharmacy setting
what do you do if a patient tells you they do not currently wish to quit smoking?
- provide a leaflet and emphasise that when they do want to stop, support is available
- record advice given in notes
why is alginate a more suitable impression material than silicone for 3mm spacing?
- alginate is a mucostatic and will take an accurate record of the tissue without displacement
- silicone is a mucocompressive and is likely to tear- also not effective if undercuts are present
name 2 support areas for the maxilla (dentures)
residual ridge
hard palate
name the primary support for the mandible (dentures)
- residual ridge
- retromolar pad
- buccal shelf
which part of the mandible can interfere during maxillary working impression?
coronoid process
how is PICO used in study design?
- Population- can only be one group of people
- intervention- represents the intervention of interest
- comparison- a standard deviation
- outcome- expected result
how do you reduce bias during a study design?
randomising
double blinding
what is the absoulte risk difference?
the difference in risk between groups
what is a confidence interval?
- the range of values the ARD witll take in the population
- 95 times out of 100 the CI will contain the TRUE population ARD
what is the most important thing for preventing healthcare associated infection?
PPE- gloves, apron, visors, face masks
name SICPs
standard Infection Control Precautions
* hand hygiene
* respiratory and cough etiquette
* ppe
* safe management of care equipment
* safe management of blood and bodily fluid spillages
* safe disposal of waste including sharps
* occupational safety
name 2 agesnt which can be used to clean a blood spillage
- sodium dichloroisocyanurate
- sodium hypochlorite
how do you break the chain of infection at transmission for dirty forceps?
the chain is broken at the reservoir wherethere are dirty contaminated forceps- break by cleaning, disinfecting, sterilising prior to use
what features of extracellular matrixs make them resistant?
- the biofilm impairs diffusion
- it causes binding of antibiotics
- extracellular DNA persists
name microorganisms that cause caries
- lactobacillus acidophilus
- streptococcus mutans
- candida albican
- actinomyces viscosus
name systemic diseases related to periodontal disease
- diabetes
- rheumatoid arthritis
describe Herb Schilder’s endodontic principle
- create a continuously tapering funnel shape
- maintain apical foramen in original position
- keep apical opening as small as possible
why is irrigant a useful (apart from disinfection)?
- dissolves organic materials
- flushes out debris
- lubricate root canal instruments
- removes the endodontic smear layer
what is the best irrigant and ideal strength?
sodium hypochlorite
3%
what features should you take into account whilst using irrigant?
NAoCl can damage the soft tissues
can discolour fabric
opthalmic injuries if contact with eyes is made
allergic reactions
indications that trauma is NOT accidental
- injuries to both sides of the body
- injuries to soft tissue
- injuroes with particular patterns
- any injury that doesn’t fit the explaination
- delay in presentation
- untreated injury
what are the effects of trauma on the primary dentition?
discolouration
delayed exfoliation
infection
what are the effects of trauma on permanent teeth?
- fails to form
- ectopic eruption
- dilaceration
- hypomineralisation
- odontoma formation
- delayed eruption
- enamel defects
- abnormal tooth/root morphology
- delayed eruption
- ectopic tooth position
- arrest in tooth formation
- complete failure of tooth to form
- odontome formation
when is the ideal time to extract permenant first molars in children?
- when bifurcation of 7s is visible
- when permanent premolars and wisdom teeth present
- class 1 incisor relationship
why might a child be nervous at the dentist?
- media coverage prior to dental experience
- family experience
- poor knowledge of treatment
- expectation of pain
- past negative medical/dental experience
- dental experince of friends and siblings
- the attitude of the parents
how woul dyou treat an anxious child?
- positive reinforcement
- tell-show-do
- acclimatisation
- desensitisation
- voice control
- distraction
- role modelling
- relaxtion technique/hypnosis
how do overhangs occur?
- poor adaptation of the matrix band
- excessive force applied when condensing amalgam
how do you fix an overhang?
you can remove and replace the restoration
use of finishing strips/soft flex files
give features of a ghost image
- image is always higher
- the image is horizontally magnified
- on theopposite side
- can interfere with diagnosis
