2020 Flashcards
a patient has a 7mm pocket that is discharging pus on the mid buccal aspect of 26. The tooth is non vital and there is litttle periodontal pocketing elsewhere in the mouth. What is the diagnosis
Lesion of endodontic origin with periodontal involvement
what are anatomical factors that may be responsible for the location of discharging pus from mid buccal root of tooth
furcation
accessory canal
what is the treatment for an endodontic lesion with periodontal involvement
root canal treatment
observe
RSD for residual pocket if required 3 months after RCT
patient has mobility of tooth 34 which is getting worse. There is no attachment loss but there is evidence of moderate tooth wear on a number of teeth. Radiograph shows generalised widening of the PDL space of tooth 34 and tooth responds positively to sensibility test
what is the diagnosis
occlusal trauma
how do you manage occlusal trauma
occlusal analysis with millers forceps and thin articulating paper
occlusal adjustment to remove any interference on 34
preventative management of parafunction/ tooth wear - splint
patient has generalised bleeding gums CPITN scores of 4 in each sextant and 78% bleeding on probing. A panoramic radiograph shows horizontal bone loss with 50% alveolar bone loss at worst sites. What is the diagnosis
generalised periodontitis
What stage and grade is a 60 year old patient with 50% bone loss at worst sites
Stage 3 grade B
what is the most important factor to determine from social history for periodontitis
smoking (past or current)
what other investigations are carried out for periodontitis
plaque and bleeding index
Full mouth pocket chart
a patient has a constant throbbing pain from the right side of the mandible. It has kept them awake at night. On exam the tooth is grossly carious an tender to percussion
what is the diagnosis
periapical periodontitis
what further investigations are done for periapical periodontitis
sensibility test
periapical radiograph or sectional panoramic radiograph
what are the treatment options for periapical periodontitis to remove pain
pulpectomy then RCT
extraction of 46
how many canals are found in the upper first premolar
2
during insturmentation of the canal where is the ideal end point for shaping and obturation
apical constriction
cemental dentinal junction or wet/dry interface
what term is used for maintaining communication between the pulpal space and the peri-radicular tissues
patency
what is working length !!
the extent from the apical terminus of the preparation and a predefined coronal reference point
what two radiographs are taken during endodontic treatment to determine working length
corrected working length radiograph
master-cone radiograph
what are potential causes of corrected working length changing during the course of endodontic shaping
ledges
perforation
straightening of the canal
transportation
zipping
what systemic antimicrobial is most appropriate for necrotising gingivitis
metranidazole
what is the dose, daily frequency and total duration of metranidazole
metronidazole 400mg 3x daily for 3 days
what are warnings to give the patient for metronidazole
avoid alcohol
don’t take if pregnant
stop taking antibiotic if any adverse reactions occur and seek medical advice
increased risk of oral candidosis
what follow up is given for patient with ANUG and antibiotics
hygiene phase therapy
smoking cessation
review 1 or 2 weeks
what is a border movement
movement determined by the anatomy of the TMJ and associated musculature
why is the retruded axis important
it is a reproducible jaw position
what are records required for mounting casts on a semi adjustable or average value articulator
facebow
inter- occlusal record on the retruded axis
what is the value of the sagittal condylar guidance which can be used in an articulator
30 degrees
what is the difference between composition of decorative and dental ceramics
there is more kaolin in decorative
there is more feldspar in dental
define translucency
the ability of the material to allow light to pass through but be scattered at one of the surfaces or internally leading to a blurring of the transmitted light
define opalescence
the ability of a translucent material to appear blue in reflected light and orange/yellow in transmitted light
how can you modify the ceramic surface to make it more retentive prior to using silane
etch with hydrofluoric acid
how does saline coupling agent bond composite to ceramic
hydroxyl group on one end of the saline molecule reacts with oxide groups on the ceramic surface
C=C bonds on the other end reacts with similar groups in the composite material
what is the function of saline coupling agent in composite
chemically bonds the filler particle to the resin matrix
what are 4 features of a randomised control trial
blinding/masking
randomisation
comparison group
allocation concealment
inclusion/exclusion criteria
explain how you would blind in a RCT
make treatment and comparison drug look identical to blind patients
ensure the clinician measuring the outcome in patients is masked to what the patient is on
data analyst masked to the group
how would you ensure randomisation in RCT
use computer based programmes to randomly allocate groups
this means the patient has the same chance of being in the treatment or comparison group
OR
use blocking
how is the comparison group implemented in a RCT
control group only difference to treatment group is the treatment
how is inclusion/extrusion criteria used in RCT
based on:
medical history
age
severity of disease
how is allocation concealment used in RCT
the person allocating treatments to patients is masked to which patient gets which treatment
cannot influence who gets the experimental treatment
what might be a patient factor to consider when considering results
age
medical history
previous condition to beginning treatment
what standards were developed to improve the reporting of RCT
consort - consolidated standards of reporting trials
what questions would you ask a patient who smokes about their tobacco use and to determine if they’re interested in quitting
numbers of years smoked
when they started smoking
what type do they smoke (roll ups or cigarettes)
have they ever tried to quit before
are they interested in quitting now
does anyone else smoke around them at home
what does dependence mean
a compulsive physiological and psychological need for a habit forming substance
what is a model/ approach to helping quit
Ask Advise Act
OR
5A’s ask, advice, assess, assist, arange
what are local services that could be referred to for smoking cessation
local pharmacy
specialist services
what are evidenced based treatments to support quitting smoking
nicotine patches
champix
e cigarettes
what do you do if a patient decides now is not the right time to quit smoking
record the advice given in the notes
make a note to bring it up in the future
give leaflet to patient and let them know advice is available when they want it
a patient with history of trauma complains they do not like the look of their front tooth, what part of the physical exam is important
palpation of the labial sulcus
what radiograph is used for a 8 year old with previous trauma to central incisor
periapical
Anterior occlusal of maxilla
given the history of trauma, what sequence of events have most likely caused non-eruption of the upper central incisor
trauma to deciduous tooth leading to dilacerations of permanent successor
what is a because of non eruption of the upper central incisor
unerupted supernumary tooth preventing eruption
congenital absence
pathology
what are the principles of the orthodontic management of non-eruption of upper central incisors
removal of obstruction (if present)
create space and observe
if non eruption, expose and place gold chain - orthodontic traction
what are ways to assess AP skeletal relationship
direct palpation of the skeletal bases
Visual assessment of relationship between soft tissue A and soft tissue B
what are ways to assess the vertical skeletal relationship
assess relationship of frankfort and mandibular plane angles
lower anterior face height compared to total anterior face height
how should the patients head be positioned during clinical assessment
frankfort plane should be parallel to the floor to avoid error in assessment
what is the definition of Class III malocclusion according to the british standard institute
the lower incisors occlude or would occlude anterior to the cingulum of the upper incisors
how would you describe a patient with class III occlusions skeletal relationship in terms of growth and development
maxillary hypoplasia
mandibular prognathism
which reference point should be positioned horizontally when setting up a panoramic radiograph
frankfort plane
what causes the incisor teeth to be horizontally magnified in a panoramic radiograph
the patient is too far back in the machine
vertical guide light in front of canine
canine behind guide line
what causes the posterior teeth on one side being wider than on the other
patient is rotated in the machine
patient not biting symmetrically between incisors on the bite peg
what are important features of ghost images
horizontally magnified
higher than original image
opposite side of original image
radiopaque
caused by dense objects
further forward than real position
out of focus
what panoramic radiograph is used for pre extraction radiograph of partially erupted 48 when there is no evidence of the 38, 48 to be extracted under LA
right side panoramic radiograph
what panoramic radiograph is used for uncooperative child for caries
panoramic radiograph on setting 4
which marginal walls of the maxillary sinus are seen horizontally above the roots of the premolars and molars
inferior
which marginal walls of the maxillary sinus are seen vertically above third molar region
posterior or distal
what are parts of presentation that may lead you to be concerned about child abuse
late presentation of pain.
multiple injuries to different areas of the face
what questions would you ask if you suspect child abuse or neglect
why was the child not brought in earlier
how did the child sustain injuries
has the child had previous injuries seen by anyone else
who might you discuss suspected child abuse or neglect with
child protection advisor
line manager or senior colleague
child protection officer
social services
what are the stages of response for child neglect
dental team management
multiagency management
referal to social services
what action would you take to child protection issues
child protection advisor does further investigation
child referred to lead paediatrician
child protection advisor asks you to refer directly to social services
what information is important when considering extraction of 6s in a child
bifurcation of the lower 7s just formed
8s present radiographically
second premolars present
what is the guidance for extracting lower 6s
also extract upper 6
what is an advantage of removing the first permanent molar at the ideal time
spontaneous closure of space
caries free dentition
reduces future orthodontic need
what are disadvantages of extracting first permanent molars of poor prognosis
no molars for eating
risk of GA
bad experience may result in loss of cooperation
removes caries free healthy teeth
what may a child need to enable multiple extractions
sedation - inhaled only
GA
what type of drug is warfarin and what is its mechanism of action
anticoagulant
vitamin k antagonist
what test must be carried out for a patient on warfarin before extraction
INR
what guidance document would you refer to for advice on dealing with patients on warfarin and what timefame should the test be carried out before extraction
SDCEP - 24 hours
NICE - 72 hours if INR stable
what INR level is safe for extraction
<4
what options clinically help deal with pos operative bleeding
prolonged pressure with damp guaze
sutures
LA with vasoconstrictor
cellulose matrix - cellulose or surgicel
diathermy
tranexamic acid
where might you refer a patient if you cant control bleeding
urgent referal to OS
OMFS unit
A&E
what nerves are anasthetised for removing tooth 48
right IAN
right lingual nerve
right long buccal nerve
what are ways to assess anaesthesia
ask the patient if the area is numb
check the area by probing and seeing if the patient feels pain
what is the terminology for pins and needle feeling or partial loss of sensation
parasthesia
what is the terminology for unpleasant sensation lasting for a fraction of a second
dysaesthesia
what is the terminology for total loss of sensation
anaesthesia
what are 3 clinical reasons for neuro-sensory deficit
damage to IAN during LA placement
damage to IAN during surgery
transection of the nerve
crushing of the nerve
cutting/shredding
what are adjustments for a person in a wheelchair to gain access to an above level dental practice
lift
ramp
what are relevant acts of law for impairment and disability to have equal access
the disability discrimination act (2005)
The equality act 2010
explain the social and medical models in terms of disability
social model - disability is caused by the way society is organised, rather than the persons impairment or difference
medical model - people are disabled by their impairment or difference. These impairments should be fixed or changed by medical and other treatment
what are other ways to communicate if patient is non verbal
sign language
paper and pen
communication boards
physical cues
eye tracking technology
what options are available to safely treat a patient in a wheelchair in practice
transfer to dental chair by hoist
wheelchair tipper
patient may have reclining wheelchair
why may it be difficult to treat a patient with cerebral palsy
incontrollable muscle spasm
what are ways to aid access to a patients mouth whi has cerebral palsy
bedi mouth prop/ finger guard
bite stick
toothbrush
unbreakable mirror head
what are physical characteristics of downs syndrome
decreased muscle tone
short neck
flattened facial profile and nose
small head and ears
upward slanting eyes
wide short hands with short fingers
a deep groove between the first and second toes
what genetic change causes downs syndrome
trisomy of chromosome 21
what are aspects of downs syndrome which may result in lack of capacity
intellectual or learning disability
dementia
what are differences between welfare guardians and welfare power of attorney
power of attorney is granted by an individual with capacity that can express and understand their wishes whereas a guardianship applies when a person doesn’t have capacity
a guardianship is applied for through courts whereas a power of attorney is drawn up by a solicitor
a guardianship is for a fixed period of time whereas a power of attorney stays in force unless revoked by the person granting the power or by death
what are features of downs syndrome that are likely to contribute to periodontal disease
ability to self care
impaired oral function
impaired migration of gingival fibroblasts
altered tooth morphology
systemic immunodeficiency
impaired phagocytic and chemotactic responses
altered oxidative metabolism related to gene on chromosome 21
what is the antibiotic and dose prescribed for antibiotic prophylaxis
amoxicillin 3g
when is antibiotic prophylaxis given
a single dose is given 30-60 minutes before the procedure
what are risk factors for mouth cancer
smoking tobacco
chewing tobacco
alcohol
diet low in fruit and vegetables
immunosuppression
pre existing premalignant mucosal conditions
genetic conditions
NOT HPV
what are important pieces of information to know about radiotherapy treatment
dose
field
what dose of radiation delivered to primary tumours increases the risk of osteoradionecrosis
50-60 Gy
what pattern of decay is seen in radiation caries
cervical margins
incisal edges
how do you manage teeth is a patient is at risk of osteoradionecrosis
provide primary orthograde endodontics and decoronate
what are oral complications associated with radiotherapy to the head anc neck
trismus
dry mouth
increased risk of oral infection
radiation mucositis
dysgeusia or ageusia
skin burns
what are preventative measures for patients who have had radiotherapy
increased fluoride toothpaste - 2800ppmF
tooth mousse
Fluoride trays
prescribe oral saliva substitutes
what are management strategies of osteoradionecrosis of the jaw
surgical debridement
hyperbaric oxygen therapy
what is a contraindication of glandosane
cannot be used if patient has teeth
what PPE is used for manual washing and what does it protect from
gown - splashing
marigold gloves - sharps
full face visor - aerosols
what are methods for manual cleaning and give an example of an instrument cleaned in this way
immersion - any solid instrument e.g. mirror
non immersion - handpieces
how often should the ultrasonic be de gassed
every time it is filled from empty
what is removed by degassing
air/oxygen
why is it important to degass the ultrasonic
air will prevent ultrasonic bubbles from reaching all surfaces of the instruments
why should dental handpieces not be places in the ultrasonic cleaner
they may be damaged by the ultrasonic activity
they should not be immersed in water as water in the lumens will inhibit sterilisation
why is it important to use demineralised water in the steriliser
to prevent the deposits of minerals on the machine and instruments
what term is used to describe a collective group of microorganisms within the oral cavity and what are they referred to when they attach to a surface
microbiome
attached to surface - biofilm
what are key microbial stages of caries plaque formation
adhesion
collonisation
maturation
acid prodcution
what are virulence factors used by strep. mutans for enamel dissolution
glucans (glucosyltransferase - attach)
ATPAse (control pH)
what is the bacterium associated with secondary endodontic infections
enterococcus faecalis
what are virulence factors of enterococcus faecalis
gelatinase
superoxide
cytolysins
adhesins
collagenase
why is it difficult to determine causality from a specific bacteria in endodontic infection
sterile sampling procedures
active/functional bacteria
what antimicrobial is primarily used to disinfect the root canal
sodium hypochlorite
what culture independent technique could be used to assess changes in the oral microbial populations following antibiotic exposure
next generation sequencing
what is the limitation of next generation sequencing
limited to describing what is present rather than what communities are causing the problem
