2018 MSA Flashcards
What are two aims for raising a flap in oral surgery?
- better access
- better vision/view
- protection of soft tissues
What 4 things influence flap design in oral surgery?
- the type of surgery being carried out
- proximity of important structures such as nerves & muscles
- area of the mouth (aesthetics may play a part)
- how much access needed
- personal preference of clinician
What type of handpiece is used for bone removal in oral surgery?
- electrical straight handpiece with saline cooled burs
- round or fissure tungsten carbide burs
- air driven handpiece may lead to surgical emphysema
what are the three methods of debridement in oral surgery?
- Physical
- bone file or handpiece to remove sharp bony edges
- mitchell’s trimmer or victory curette to remove soft tissue debridement - Irrigation
- sterile saline into socket and under flap - Suction
- aspirate under flap to remove debris
- check socket for retained apices
What is the clinical name of dry socket?
Alveolar Osteitis
- inflammation of lamina dura
What are 3 predisposing factors for development of dry socket?
- smoking
- female
- molars more common
- oral contraceptive pill
- previous experience
- excessive rinsing
- female
What are 3 signs & symptoms of dry socket?
- dull aching pain
- pain radiates to ear & is continuous
- being kept up at night
- bad smell/bad breath/ bad taste
what are 3 treatment options for patients with dry socket?
- supportive reassurance with systemic analgesia
- irrigate socket with warm saline to remove any debris
- curettage/debridement to encourage formation of new clot
- pack the socket with antiseptic alvogyl
- LA to help with pain
What drug family does Apixaban belong to?
NOAC
- novel oral anticoagulant
What does Apixiban inhibit to work?
Factor Xa (10a)
- inhibits conversion of prothrombin to thrombin stopping the production of the fibrin clot
What else is apixaban used for?
- treatment or secondary prevention of DVT
- prevention of pulmonary embolism
- prevention of stroke
- treatment of AF
- heart valve disease
What blood tests should be done before treating a patient taking Apixaban?
APTT (activated partial thromboplastin time)
What would you do in terms of dosage for surgical dental treatment vs simple extraction with a person taking apixaban?
Surgical dental treatment = miss morning dose for apixaban
Simple extraction = treat without interrupting (if they are very high risk of bleeding you would also miss morning dose)
What are 3 methods used for achieving haemostatic control?
- bite on damp gauze
- LA with vasoconstrictor
- suture
- diathermy
- bone wax
What are 4 physical features of Down’s Syndrome?
- broad flat face
- short nose
- small arched palate
- macroglossia
- abnormal ears
- dental abnormalities
- hypodontia
What genetic test result would confirm a patient has Down’s Syndrome?
extra copy of chromosome 21
Give 2 reasons a patient with Down’s Syndrome may have increased incidence of periodontal disease?
- poor OH due to mental retardation
- immunocompromised (impaired neutrophils)
- less saliva/of a poorer quality
What would be 2 examples of things that result in a patient not having capacity?
- end stage dementia
- severe learning disability
What is the difference between a welfare guardian and a welfare power of attorney?
Welfare guardian has responsibility over persons health and financial status (property, finance & even marital affairs), has to be court appointed.
Welfare POA only has responsibility for health & wellbeing NOT financial decisions.
What antibiotic could be prescribed for antibiotic prophylaxis & what dosage?
Amoxicillin 3g oral powder sachet 60 mins before procedure
OR
2 Clindamycin capsules (300g each, 600g total) 60 mins before procedure
When should antibiotic prophylaxis be given? (timescale)
60 mins before procedure
What are 3 clinical features of Parkinson’s?
- bradykinesia (slow movement)
- rigidity (increased muscle tone)
- tremor
- mask like face
How does Parkinson’s differ from other cerebellar diseases?
Parkinson’s = resting tremor
Other cerebellar diseases = intentional active tremors
Why might Parkinson’s patients have dry mouth?
Anticholinergic effects of drug treatment (benztropine)
How could you help prevent dentures being lost in the care home?
- mark initials on denture during development
- store in a labelled container
Why might you choose not to extract teeth of a Parkinson’s patient to make dentures?
Tremor could make extraction difficult
Poor mouth opening due to rigidity
What would be the 2 most important things in the provision of a Parkinson’s patients future treatment?
- prevention (OH may get compromised due to poor motor function, disease will progress)
- relief of pain
What is local malocclusion?
A localised problem or abnormality within either arch, usually confined to one, two or several teeth producing a malocclusion.
Tends to get worse with time, can be caused by variation of tooth number
What are 4 reasons for abnormalities of tooth number?
- supernumerary teeth
- hypodontia
- retained primary teeth
- early loss of primary teeth
- unscheduled loss of permanent teeth
What are the 4 types of supernumerary teeth?
- conical
- tuberculate
- supplemental
- odontome
Give 2 ways to measure anterio-posterio skeletal relationship?
- palpating the maxilla and mandible with 2 fingers and assessing if the maxilla is infront etc
- take a lateral cephalogram and check the ANB angle
Give 2 ways to measure the vertical skeletal relationship?
- assess FMPA (Frankfort mandibular plane angles)
- LAFH to TAFH ratio
What position should their head be in when taking a cephalogram?
frankfort plane parallel to floor
How is porcelain surface prepped in the lab for bonding?
Hydrofluoric acid used to produce retentive surface on porcelain
What do you use to bond porcelain to composite luting resin?
Silane coupling agents
How does silane coupling agent act chemically?
Silane molecule has C=C bond which reacts with the composite resin luting agent
Oxide groups on the porcelain bond with the silane
When would you use a dual cured?
when using metal restorations as light will not penetrate metal
What would you do in the lab to prepare metal?
Sandblast it
What chemical agent is used to bond metal?
MDP and 4-META
what metal can be used for an acid-etch retained bridge?
CoCr
What 4 things would you ask the patient about smoking?
- why do they smoke?
- how many cigarettes a day?
- how long have they been smoking?
- are they thinking of quitting smoking?
what 3 things would you tell a patient that uses E-cigarettes?
- not harmless but safer than conventional cigarettes
- can still cause dry mouth
- can help patients to quit
what is the methodology used for helping patients to quit smoking?
5 As
1. Ask
2. Advise
3. Assess
4. Assist
5. Arrange
Give 2 advice services you could refer a patient to?
- local pharmacy
- community smoking support group
What should you do if a patient does not want to quite smoking now?
- provide information/leaflet and explain if they ever think about quitting in the future we can support them
- record advice given in notes
What 3mm spacing material is used & why?
Alginate
- it is mucostatic & will take accurate record of tissues without displacement
Why is silicone not used?
- not effective for undercuts
- mucocompressive
what are the 2 support areas on the maxillary arch?
- hard palate
- ridge crest
What is the primary support area of the mandible?
buccal shelf & pear shaped pad
What part of the mandible interferes during a maxillary working impression?
Coronoid process
How does PICO relate to study design?
Population
Intervention
Comparison
Outcome
How can bias be reduced in study designs?
- randomising
- double blinding
What is absolute risk difference?
difference between the observed risks in the two groups
what is the most important thing in prevention of healthcare associated infections?
PPE
- gloves
- aprons
- visors
- masks
what are the 10 SICPs?
- patient placement
- hand hygiene
- respiratory and cough hygiene
- PPE
- safe management of care equipment
- safe management of care environment
- safe management of linen
- safe management of blood & bodily fluid spillages
- safe disposal of waste
- occupational safety prevention and exposure management including sharps
What is used to clean blood spillages?
- sodium hypochlorite
- sodium dichloroisocyanurate
What strength of cleaning agent is used to clean blood spillage?
10,000ppm
What time should cleaning agent be used to clean blood spillage?
3-5 mins
How to break the chain of infection at transmission for use of dirty forceps?
Cleaning, disinfecting and sterilising before use
What are the Herb Schilder’s endodontic principles?
- create a continuously tapering funnel shape
- maintain apical foramen in original position
- keep apical opening as small as possible
Why is irrigation useful in endodontics apart from disinfection?
- dissolves organic materials
- flushes out debris
- lubricates root canal instruments
- remove the endodontic smear layer
what is the best endodontic irrigant?
sodium hypochlorite
what is the ideal strength of sodium hypochlorite in endo procedures?
3% sodium hypochlorite (2.5-5.25 acceptable)
Give 3 features to take into account when using sodium hypochlorite:
- allergic reaction
- irritate soft tissues
- apical extrusion leading to tissue necrosis
- discolouration of patients fabric/top
Give 4 indications that trauma isn’t accidental:
- delay in presentation of trauma
- presentation not compatible with story
- bilateral injury
- vague story
- injury untreated
- previous history of violence
What are 2 effects that trauma has on the primary dentition?
- discolouration
- delayed exfoliation
What are 4 effects that trauma has on the permanent dentition?
- failure of permanent successor to form
- dilaceration
- enamel defects
- abnormal tooth/root morphology
What special investigation could be used for a child that is totally unco-operative?
OPT
When would be the ideal time to remove a child’s carious 6s? why is this?
- bifurcation of the 7s on radiograph
- 5 & 8 are present
- mild buccal segment crowding
- prevents 7s erupting late/early
- caries free dentition
What would be the disadvantage of extracting a child’s carious 6?
- loss of permanent tooth
- risk of GA
- bad experience could affect patients future visits
Give 4 reasons that a child may be anxious when attending the dentist:
- past negative medical/dental experience
- influence of friends & family
- media representation of dentists
- expectation of pain
