2018

Question 1

What are the aims for raising a flap?

Answer 1

• better access to the tooth
• ## for protection of soft tissue

Question 2

What are the aims for retracting a flap?

Answer 2

• protection of soft tissues
• better access
• better vision

Question 3

What is dry socket?

Answer 3

• localised alveolar osteitis - inflammation of the lamina dura

Question 4

What are predisposing factors of dry socket?

Answer 4

• excessive trauma during extraction
• Excessive mouth rinsing which removes the clotting
• smoking
• previous experience of dry socket
• oral contraceptive pills

Most common in mandibular molars

Question 5

What are symptoms of dry socket?

Answer 5

• Dull aching pain
• Sharp pain that radiates to the ear
• Pain disturbing sleep
• bad breath
• Bad taste in the mouth

Question 6

What are treatment options for dry socket?

Answer 6

• support and reassure the patient
• irrigate the socket with warm saline
• debridement to remove the old clot and allow new clotting
• systemic analgesia
• Antiseptic pack or Alvogyl

could give LA block for pain

Question 7

What drug family is apixaban from?

Answer 7

DOAC (direct otal anticoagulant)

Question 8

What does apixaban inhibit?

Answer 8

• Factor 10A, it inhibits conversion of prothrombin to thrombin stopping the producing of the fibrin clot

Question 9

What is apixiban used for?

Answer 9

• treatment or prevention of DVT
• treatment or prevention of pulmonary embolism
• prevention of stroke
• reduce risks if patients have AF

Question 10

What is the SDCEP guidance for treating patients on DOACs?

Answer 10

• for low bleeding risk procedures - treat without interruption of medication
• for high bleeding risk procedures - discuss with cardiologist- may advice patient to miss or delay morning dose before treatment
  REMEMBER to advice them when to restart medication

Always treat early in the day and limit initial treatment area
Consider suturing and packing

Question 11

Give examples of procedures unlikely/low to cause bleeding?

Answer 11

• local anaesthesia by infiltration or block
• BPE
• PMPR - supra gingival
• restorations with supra gingival margins
• simple extractions
• detailed 6 point pocket charts

Question 12

Give examples of procedures with high risk of bleeding?

Answer 12

• Complex extractions (adjacent extractions causing large wounds)
• Flap raising procedures
• Periodontal surgery
• Crown lengthening
• Dental implant surgery
• Biopsies

Question 13

What are the methods of haemostat control?

Answer 13

• Apply pressure by biting on damp gauze
• Use LA with vasoconstrictor
• Pack with oxidised regenerated cellulose (surgicel)
• Suture
• Diathermy

Question 14

What is a contraindication of surgicel?

Answer 14

Avoid use on lower 8 regions as it is acidic and may damage the Inferior Alveolar Nerve

Question 15

What are physical features of downs syndrome?

Answer 15

• Broad flat face, especially flat nasal bridge
• Short neck
• Small arched palate
• Short nose
• Small head and abnormal ears
• Slanting eyes
• Class III malocclusion
• Hypodontia

Question 16

What genetic difference causes Down’s syndrome?

Answer 16

• an additional copy of chromosome 21

extra chromosome may be full or partial

Question 17

What are factors of Down’s syndrome that increase risk of periodontal disease?

Answer 17

• Patients are immunocompromised (impaired neutrophils)
• Poorer oral hygiene
• saliva - quality is altered

Question 18

What are reasons for patients with Down’s syndrome lacking capacity?

Answer 18

May have:
- Learning difficulty
- Alzheimer’s
- Intellectual impairment

Question 19

What is the difference between welfare guardian and welfare power of attorney?

Answer 19

Power of Attorney is granted by the adult while they still have capacity
It is certified by a lawyer
It is only in effect once the person loses capacity

Welfare guardians are appointed by the courts and require 2 medical reports
They can make financial and welfare decisions
They are usually appointed for 3 years