2019 MSA Flashcards
What is a dry socket?
Localised alveolar osteitis - inflammation affecting the lamina dura
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
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
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
What are the short term effects of child neglect?
Reduction in physical health, emotional health, social development and congnitive development
What are the long term effects of child neglect?
Arrest
Suicide attempt
Major depression
Diabetes
Heart Failure
What are the stages in management of child neglect?
Preventative dental team management
Preventative multi agency management
Child protection referral
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
What does a trauma stamp note?
Sinus
Mobility
Colour
TTP
Percussion note
ECL
EPT
Radiograph
What can be seen radiographically in a non-vital tooth?
Widening of PDL
Loss of lamina dura
Root resorption
Periapical pathology
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
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
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
What fluoride toothpaste advice should be given for children who are enhanced risk?
Use 1350-1500ppm toothpaste
If 10 or over consider 2800ppm toothpaste
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
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
What are the problems of an incompetent lip?
Face may not develop properly
Longer face
Impeded speech
Mouth-breathing leading to dry mouth
What are the circumoral musculature?
Mentalis
Orbicularis oris
Buccinator
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
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
What are the signs of digit sucking?
Proclination of upper incisors
Retroclination of lower incisors
AOB
Unilateral posterior cross bite
How can a digit sucking habit be stopped?
Positive reinforcement
Removable habit breaker (URA)
Fixed habit breaker
Elastoplast on digit
Bitter tasting nail varnish
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
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
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?
2
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
