2018 MSA Flashcards by David Jack

Give two aims for raising a flap

Maximal access with minimal trauma
Protection of soft tissues

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Give 4 things that influence flap design

Retraction
Location of surgical site
Surgical procedure being carried out
Post-operative aesthetics

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What type of handpiece is used for bone removal?

Electric straight handpiece with saline cooled bur

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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

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What is the name for a dry socket?

Localised osteitis/alveolar osteitis

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Give 3 disposing factors for a dry socket

Mandibular teeth
Females
Smoking

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Give 3 signs and symptoms of a dry socket

Malodour of the socket
Exposed bone is sensitive
Dull, aching pain

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How is a dry socket treated? (3 marks)

Reassure patient
Recommend optimal analgesics
LA
Debridement of bone
Pack with alvogyl

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What is the drug family of apixaban

DOAC

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What does apixaban inhibit?

Factor Xa

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What else is apixaban used for? (2 marks)

Prevention of DVT
Prevention of pulmonary embolism

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What blood tests should you get before treatment for a patient on abixaban?

aPTT - activated partial thromboplastin time

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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

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Give 3 methods of haemostatic control

Pressure - bite on damp gauze
LA with adrenaline as a vasoconstrictor
Diathermy

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Give 4 physical features of Down syndrome

Broad flat face
Short neck
Reduced muscle tone
Upwards slanting of eyes

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What is the result of a positive Down syndrome test?

Full trisomy of chromosome 21

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Why may patients with Down syndrome have increased levels of periodontal disease?

Systemic immunodeficiency
Inability to carry out good OH practices

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Give 2 medical reasons that a patient with Down’s syndrome may lack capacity

Intellectual disability
Dementia

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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

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What drug and dosage is used for antibiotic prophylaxis?

Amoxicillin 3g

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When should antibiotic prophylaxis be taken?

60 minutes before procedure

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Give 3 features of Parkinson’s

Bradykinesia - slow movement
Resting tremors
Posture instability

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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

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For what reason may a patient have a dry mouth?

Medications

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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