2018 MSA Flashcards
Give two aims for raising a flap
Maximal access with minimal trauma
Protection of soft tissues
Give 4 things that influence flap design
Retraction
Location of surgical site
Surgical procedure being carried out
Post-operative aesthetics
What type of handpiece is used for bone removal?
Electric straight handpiece with saline cooled bur
What are the 3 methods of debridement?
Suction - aspirate under flap to remove debris
Irrigation - sterile saline into socket and under flap
Physical - bone file or handpiece to remove sharp bony edges
What is the name for a dry socket?
Localised osteitis/alveolar osteitis
Give 3 disposing factors for a dry socket
Mandibular teeth
Females
Smoking
Give 3 signs and symptoms of a dry socket
Malodour of the socket
Exposed bone is sensitive
Dull, aching pain
How is a dry socket treated? (3 marks)
Reassure patient
Recommend optimal analgesics
LA
Debridement of bone
Pack with alvogyl
What is the drug family of apixaban
DOAC
What does apixaban inhibit?
Factor Xa
What else is apixaban used for? (2 marks)
Prevention of DVT
Prevention of pulmonary embolism
What blood tests should you get before treatment for a patient on abixaban?
aPTT - activated partial thromboplastin time
What should you do with apixaban dosage for surgical tx vs a simple extraction?
Simple extraction is low risk - treat without interrupting medication
Surgical treatment is high risk - ask patient to miss morning dose on day of treatment
Give 3 methods of haemostatic control
Pressure - bite on damp gauze
LA with adrenaline as a vasoconstrictor
Diathermy
Give 4 physical features of Down syndrome
Broad flat face
Short neck
Reduced muscle tone
Upwards slanting of eyes
What is the result of a positive Down syndrome test?
Full trisomy of chromosome 21
Why may patients with Down syndrome have increased levels of periodontal disease?
Systemic immunodeficiency
Inability to carry out good OH practices
Give 2 medical reasons that a patient with Down’s syndrome may lack capacity
Intellectual disability
Dementia
What is the difference between a welfare guardian and power of attorney?
PoA is drawn through a solicitor and granted by the adult before they lose capacity
Welfare guardian is appointed by the courts to a person who does not have capacity
What drug and dosage is used for antibiotic prophylaxis?
Amoxicillin 3g
When should antibiotic prophylaxis be taken?
60 minutes before procedure
Give 3 features of Parkinson’s
Bradykinesia - slow movement
Resting tremors
Posture instability
How does Parkinson’s differ from other cerebellar diseases?
Parkinson’s is caused by loss of dopamine receptors
Others are caused by damage to the cerebellum
For what reason may a patient have a dry mouth?
Medications
How can you prevent a denture from being lost in a care home? (2 marks)
Initial the denture during processing
Store them in a labelled container
Why wouldn’t you extract teeth for denture reasons in a Parkinson’s patient?
The patient won’t tolerate the denture making process
What are the 2 most important things in the provision of future treatment for a Parkinson’s patient?
Mastication function
Relief of pain
What is a local malocclusion?
A local abnormality affecting 1, 2 or several teeth in either arch that produces a malocclusion
Give 4 reasons for abnormality of tooth number
Supernumeraries
Hypodontia
Early loss of primary teeth
Retained primary teeth
What are the 4 types of supernumeraries?
Conical
Tuberculate
Supplemental
Odontome
What 2 ways can you measure antero-posterior skeletal relationship?
Palpate skeletal bases
Visual assessment
What 2 ways can you measure vertical skeletal relationship?
FMPA - if average, planes should meet at external occipital protuberance
LAFH to TAFH ratio - if average should be approximately 55%
What position should a patients head be in for orthodontic assessment?
Frankfort plane parallel to the floor
How is porcelain surface prepped in lab for bonding?
Etch with hydrofluoric acid
What is used to bond porcelain to composite luting resin?
Silane coupling agent
How does a silane coupling agent act chemically?
C=C bonds on one side of silane react with composite composite
Oxide groups on other side of silane form strong bonds with porcelain
When would you use a dual cured material?
For thick porcelain and metal restorations
Why would you still light cure a dual cured material?
Mechanical properties are reduced if not dual cured
What can be used instead of a porcelain veneer?
Composite restoration
What would you do in a lab to prepare a metal?
Sandblast
What chemical agent is used to bond metal?
MDP
What metal can be used for an acid etch retained bridge?
CoCr
What 4 things can you ask a patient about smoking?
How many cigarettes per day
What do they smoke
How many years have they smoked for
What age did they start smoking at
What 3 things should you tell patients about e-cigarettes?
Safer than cigarettes
Safety in long term not known
Contain nicotine but not cancer causing tobacco
What is the methodology for smoking cessation?
Ask
Advise
Assess
Assist
Arrange
What 2 advice services can you refer a smoker to?
Pharmacy
Smoking cessation services - quit your way
What do you do if a patient doesn’t want to quit smoking?
Record this in patient notes with a reminder to bring up again at future appointments
What 3mm spacing material is used for impressions and why?
Alginate
It is mucocompressive and takes an impression of tissues under load
Why isn’t silicone used as a 3mm spacing material?
It is mucostatic and so is better for a smaller spacing impression
What are the 2 support areas for the maxilla?
Hard palate
Residual ridge
What are the primary support areas for the mandible?
Retromolar pad
Buccal shelf
Residual ridge
What part of the mandible interferes during maxillary working impressions?
Retromolar pad
What is absolute risk difference?
The difference in percentage of risk between the exposure group and placebo group
What is the most important thing for preventing HAI?
Hand hygiene
What agents are used for blood spillages?
Sodium dichloroisocyanurate
Sodium hypochlorite
What strength of agent is used in blood spillages and for how long?
10,000ppm
3-5 minutes
How do you break the chain of infection at transmission for dirty forceps?
By cleaning, disinfecting and sterilising prior to use
What 2 features of an ECM make them resistant
LPS protective barrier prevents penetration of anti microbials
ECM impairs diffusion
Name 2 perio microorganisms in red Socransky’s model
P. gingivalis
T. forsythia
Name 2 microorganisms associated with caries
S. mutans
A.a.
Give 2 methods used by S. mutans to survive in high acidic environments
Glucans - adhere to enamel surface
ATPase - controls pH
Name 2 systemic diseases related to periodontal disease?
Down’s syndrome
Chronic granulomatous disease
What are Herb Schilder’s 3 endo principles?
Create a continuous tapering funnel
Maintain apical foramen in original position
Keep apical opening as small as possible
Why is irrigant useful apart from disinfection?
To remove debris from the canal
To lubricate the canal
What is the best irrigant and what is the ideal strength?
Sodium hypochlorite - 0.5-6%
Name 3 variables about NaOCl to be taken into account?
Concentration
Volume
Contact time with root canal
Give 4 indications that a trauma isn’t accidental
History of injuries don’t match clinical findings
Multiple injuries around the mouth
Delay in presentation
Bilateral injuries
Give 2 effects trauma can have on the primary dentition
Discolouration
Infection
Give 4 effects trauma in the primary dentition can have on the permanent dentition
Ectopic eruption
Ankylosis
Dilaceration of root
Delayed eruption
What special investigation should be used for an uncooperative child?
OPT
Give 2 examples of an ideal time to remove 6s?
5s and 8s present
Calcification of bifurcation of 7s
Why is it ideal to remove 6s at a certain time?
Spontaneous space closure
Caries free dentition
What are the disadvantages of removal of 6s?
Traumatic experience could affect child’s view of future dental treatment
Risk of GA
What should you do with upper 6s if removing lower 6s?
Compensating extraction
Give 4 reasons for a child to be anxious
Past negative dental experience
Negative dental attitude of parents
Fear of injections or drilling
Dental experience of friends and siblings
Give 2 ways you can treat an anxious child
If the child has pain, ensure this is managed first
Consider dividing treatment into several stages with a month or two between stages
or
GA
Inhalation sedation
Send help pls Matt McGarva is scaring me
Name 4 behaviour management methods
Behaviour shaping and positive reinforcement
Enhancing control
Tell, show, do
Distraction
Name 2 ways an amalgam overhang can be made
Excessive force used when condensing amalgam
Poor adaptation of matrix band
Give 2 ways you can fix an amalgam restoration
Polishing tooth with long tapered finishing bur
Remove entire restoration and place new one
Give 2 short term and 2 long term problems of an overhang
Short - food trap, difficult to clean
Long - secondary caries, periodontal disease
What line should be horizontal when taking an OPT?
Frankfort plane
Why may anteriors be horizontally magnified in an OPT?
Canine behind the guideline
Patient too far back in the machine
Why may posteriors be horizontally magnified in an OPT?
If patient is rotated in the machine
Name 3 features of a ghost image
Always higher
Always horizontally magnified
On the opposite side
What radiograph should be taken pre-extraction of 48 when there is no sign of the 38?
Right half panoramic
What are the borders of the maxillary sinus?
Mesial - nasal cavity, Inferior - alveolar process of maxilla, Posterior - pterygoid process of sphenoid bone
