2019 MSA Flashcards by David Jack

What is a dry socket?

Localised alveolar osteitis - inflammation affecting the lamina dura

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What are the predisposing factors of a dry socket?

More common in the mandible than the maxilla
More common in females
More common in posterior teeth
Smokers due to reduced blood supply
Excessive mouth rinsing post extraction which removes the clot
Excessive trauma during extraction
Oral contraceptive pills

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How is a dry socket managed?

Support and reassure the patient
Give systemic analgesia
Local anaesthetic for pain
Irrigate socket with warm saline
Debridement to allow new clotting
Antiseptic pack eg Alvogyl

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What are the clinical features of sensory deficit for nerves?

Anaesthesia - numbness
Paraesthesia - tingling
Dyaesthesia - unpleasant sensation/pain
Hypoaesthesia - reduced sensation
Hyperaesthesia - increased/heightened sensation

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What are the short term effects of child neglect?

Reduction in physical health, emotional health, social development and congnitive development

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What are the long term effects of child neglect?

Arrest
Suicide attempt
Major depression
Diabetes
Heart Failure

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What are the stages in management of child neglect?

Preventative dental team management
Preventative multi agency management
Child protection referral

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How should an enamel dentine fracture in a child be treated?

If tooth fragment is there, bond the fragment to the tooth
Cover any exposed dentine with GI
Definitive restoration with a bonding agent and composite
3 angulation radiographs to rule out displacement or fracture
If fragment not available, take radiograph of lips or check laceration to search for the tooth fragment

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What does a trauma stamp note?

Sinus
Mobility
Colour
TTP
Percussion note
ECL
EPT
Radiograph

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What can be seen radiographically in a non-vital tooth?

Widening of PDL
Loss of lamina dura
Root resorption
Periapical pathology

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Why does nursing bottle caries only affect certain teeth?

Lower incisors are protected by the tongue
Sequence of eruption - maxillary incisors erupt first
If the habit continues, other teeth will be affected such as the mandibular canines and the first primary molars

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What are the causes of nursing bottle caries?

Poor oral hygiene
Inappropriate use of bottle feeding
Prolonged breastfeeding
Baby not swallowing contents of liquid instead swirling it around their mouth

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What fluoride toothpaste advice should be given for children who are standard risk?

1000-1500ppm toothpaste
If under 3 use a smear, if 3 and over use a pea sized amount

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What fluoride toothpaste advice should be given for children who are enhanced risk?

Use 1350-1500ppm toothpaste
If 10 or over consider 2800ppm toothpaste

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What tooth brushing instruction should be given for children?

Brush thoroughly twice daily, including last thing at night
Use the age-appropriate amount of toothpaste containing 1000-1500ppm fluoride
Spit, don’t rinse
Parental supervision until child has proper dexterity to do it themselves
If under 3 use a smear, 3 or older use a pea size amount

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What is lip competence?

Competent lip - upper and lower lip meet and maintain anterior oral seal with a relaxed mentalis muscle
Incompetent lip - lips don’t meet at rest and can’t maintain oral seal, relaxed mentalis muscle

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What are the problems of an incompetent lip?

Face may not develop properly
Longer face
Impeded speech
Mouth-breathing leading to dry mouth

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What are the circumoral musculature?

Mentalis
Orbicularis oris
Buccinator

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How does lip competence affect the upper and lower incisors?

Upper incisors may be evident
Upper incisors proclined
Retro lined lower incisors
Increased OJ, incomplete overbite
As teeth are apart, posterior teeth may continue to erupt leading to an AOB, crowded incisors and narrowed arch

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What is a strap lower lip?

Hyperactive lower lip that may retrocline lower incisors
Affects position of anterior teeth
Indicates likely instability at end of treatment so relapse is likely

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What are the signs of digit sucking?

Proclination of upper incisors
Retroclination of lower incisors
AOB
Unilateral posterior cross bite

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How can a digit sucking habit be stopped?

Positive reinforcement
Removable habit breaker (URA)
Fixed habit breaker
Elastoplast on digit
Bitter tasting nail varnish

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What effects does a digit sucking habit have on posterior teeth?

The thumb or fingers are held in the mouth causing the mandible to drop open and the tongue to be held in a lower position than normal
The sucking action caused by the cheeks narrows the maxillary dentition and causes a posterior crossbite

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Describe a randomised controlled trial

Considered the gold standard study design for effectiveness and efficacy when comparing the effectiveness of one treatment to another
They provide the strangers evidence on the effectiveness of treatments in clinical trials

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Describe cohort studies?

Prospective studies which recruit groups of people who have not manifested the disease at the time of recruitment and risk factors are assessed Individuals are observed over period of time to measure frequency of occurrence of disease and amount of people exposed to risk factor and people not exposed to risk factor

Describe a case control study

A retrospective study which compares individuals with disease (cases) with those without disease (control) They are traced back to assess risk factors through past histories and exposure to suspected harmful agents compared

What is significance?

When the confidence intervals do not overlap

What are the causes of congestive heart disease?

Coronary artery disease Cardiomyopathy Alcohol abuse Hypertension Valve disease MI Idiopathic

What are the symptoms of congestive heart disease?

Rapid irregular heart beat Fatigue and weakness Swelling of abdomen Swelling of ankles Nausea SoB Cough Chest pain when breathing

How is congestive heart disease treated?

Lifestyle changes - balanced diet, exercising, stop smoking Medication - ACE inhibitors (ramapril), beta blocker (bisoprolol), diuretics (furosemide) Pacemaker Surgery - heart valve surgery, heart transplant

What microorganisms are involved in caries?

S. mutans A.a.

What are the virulence factors involved in carious bacteria?

Adhesins Extracellular polysaccharides

What organisms are involved in periodontal disease?

P. gingivalis T. forsythia T. denticola P. intermedia

What virulence factors are involved in periodontal disease?

Fimbriae Proteases Endotoxins Capsular polysaccharide Tissue toxic metabolic by-products

Why can’t antibiotics penetrate biofilms?

Biofilms can produce a protective barrier, preventing penetration of antimicrobials ECM impairs diffusion of anti microbial agents

What are the reasons for liver cirrhosis?

Alcohol abuse Viral hepatitis - B, C and D Fat accumulating in the liver Cystic fibrosis Autoimmune hepatitis

How should a blood spillage be cleaned?

Cordon off the spillage Put up a wet floor sign or stay by spillage to protect it Wear PPE Pour chlorine releasing granules or solution of 10,000ppm chlorine on the spillage for 3-5 minutes

What are the 2 chlorine releasing granules?

Sodium hypochlorite Sodium dichloroisocyanurate

How long should waste disposable papers be kept?

Minimum of 3 years

What are the 5 principles of the AWI?

Least restrictive option Take account of the wishes of the adult Benefit Encourage the person to use existing skills and develop new skills Consultation with relevant others

What are 2 causes of overhangs?

Poor adaptation of matrix band Excessive force applied when condensing amalgam

What are the short and long term consequences of an overhang?

Short term - plaque trap, difficulty to clean Long term - secondary caries, periodontal disease

In an OPT, what horizontal line should be parallel to the floor?

Frankfort plane

In an OPT, what can cause the anterior teeth to be horizontally wider?

Canine behind the guideline Patient too far back in the machine

In an OPT, what can cause the posterior teeth to be horizontally wider?

Patient is rotated in the machine

What are the features of a ghost image?

Always higher Always horizontally magnified On the opposite side

What maxillary sinus border is found horizontal above molars?

Inferior border

What maxillary sinus border is found vertical to third molars?

Posterior border

What are other names for secondary impressions?

Definitive impression Master impression

What anatomical features are important for denture support and retention?

Border seal Sufficient extension into the sulcus

What anatomical features are important for position of posterior border of upper impressions

Palatine fovea at vibrating line Hamular notches Border of hard palate

What anatomical features are important to include on mandibular impressions?

Residual ridge Buccal shelf Retromolar pad

Which materials can be used for master impressions on lowers?

Alginate Polyether

What is working length?

A measurement from a fixed reference point which will remain unchanged through the treatment and is within the clinician’s field of view to the chosen apical endpoint

How can working length be calculated?

By a radiograph Through an electronic pulp locator (apex locator) Paper point length

How many canals are in an upper first premolar?

What radiograph should be taken before endodontics?

A periapical

Why should non-surgical perio tx be carried out before surgical?

Deep pocket may heal following non-surgical therapy Improve soft tissue consistency for easier surgical management Allow evaluation of patients motivation and plaque control

What are the indications for surgical treatment at re-evaluation of therapy?

Pockets of 5mm or greater persist Furcation Presence of excellent oral hygiene

What is the aim of surgical periodontal therapy?

To arrest the disease by gaining access to complete root surface debridement To regenerate lost periodontal tissue

What can a dentist do to support patients after periodontal therapy?

Review OH and use TIPPS Carry out supra and sub gingival PMPR Re-appraise mechanical plaque control 6PPC carried out annually with oral exam and modified plaque and bleeding scores

When should non-surgical periodontitis patients be re-evaluated?

6-8 weeks after non-surgical therapy

What questions should you ask a patient about quitting smoking?

Have you ever thought about quitting? Have you ever quit in the past? How many attempts have you had? What helped during your attempts?

What services can be used for smoking cessation?

Pharmacy Smoking cessation services - quit your way

What can you do if a patient doesn’t want to quit smoking now?

Record this in the patient notes with a reminder to bring it up again at future appointments

What are the thermal properties of a denture base?

High softening temperature Low thermal conductivity Thermal expansion coefficient similar to artificial tooth

Why are mould liners used?

More comfortable in patients mouth Reduces inflammation of tissues and promotes healing Distributes occlusal forces more evenly

Why should dentures be kept moist?

More comfortable in the patients mouth Prevents infection For retention