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Need to Know > 2020 > Flashcards

2020 Flashcards

1
Q

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

A

Lesion of endodontic origin with periodontal involvement

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2
Q

what are anatomical factors that may be responsible for the location of discharging pus from mid buccal root of tooth

A

furcation
accessory canal

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3
Q

what is the treatment for an endodontic lesion with periodontal involvement

A

root canal treatment
observe
RSD for residual pocket if required 3 months after RCT

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4
Q

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

A

occlusal trauma

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5
Q

how do you manage occlusal trauma

A

occlusal analysis with millers forceps and thin articulating paper

occlusal adjustment to remove any interference on 34

preventative management of parafunction/ tooth wear - splint

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6
Q

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

A

generalised periodontitis

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7
Q

What stage and grade is a 60 year old patient with 50% bone loss at worst sites

A

Stage 3 grade B

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8
Q

what is the most important factor to determine from social history for periodontitis

A

smoking (past or current)

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9
Q

what other investigations are carried out for periodontitis

A

plaque and bleeding index
Full mouth pocket chart

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10
Q

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

A

periapical periodontitis

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11
Q

what further investigations are done for periapical periodontitis

A

sensibility test
periapical radiograph or sectional panoramic radiograph

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12
Q

what are the treatment options for periapical periodontitis to remove pain

A

pulpectomy then RCT
extraction of 46

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13
Q

how many canals are found in the upper first premolar

A

2

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14
Q

during insturmentation of the canal where is the ideal end point for shaping and obturation

A

apical constriction

cemental dentinal junction or wet/dry interface

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15
Q

what term is used for maintaining communication between the pulpal space and the peri-radicular tissues

A

patency

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16
Q

what is working length !!

A

the extent from the apical terminus of the preparation and a predefined coronal reference point

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17
Q

what two radiographs are taken during endodontic treatment to determine working length

A

corrected working length radiograph

master-cone radiograph

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18
Q

what are potential causes of corrected working length changing during the course of endodontic shaping

A

ledges
perforation
straightening of the canal
transportation
zipping

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19
Q

what systemic antimicrobial is most appropriate for necrotising gingivitis

A

metranidazole

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20
Q

what is the dose, daily frequency and total duration of metranidazole

A

metronidazole 400mg 3x daily for 3 days

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21
Q

what are warnings to give the patient for metronidazole

A

avoid alcohol
don’t take if pregnant
stop taking antibiotic if any adverse reactions occur and seek medical advice
increased risk of oral candidosis

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22
Q

what follow up is given for patient with ANUG and antibiotics

A

hygiene phase therapy
smoking cessation
review 1 or 2 weeks

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23
Q

what is a border movement

A

movement determined by the anatomy of the TMJ and associated musculature

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24
Q

why is the retruded axis important

A

it is a reproducible jaw position

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25
Q

what are records required for mounting casts on a semi adjustable or average value articulator

A

facebow
inter- occlusal record on the retruded axis

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26
Q

what is the value of the sagittal condylar guidance which can be used in an articulator

A

30 degrees

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27
Q

what is the difference between composition of decorative and dental ceramics

A

there is more kaolin in decorative
there is more feldspar in dental

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28
Q

define translucency

A

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

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29
Q

define opalescence

A

the ability of a translucent material to appear blue in reflected light and orange/yellow in transmitted light

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30
Q

how can you modify the ceramic surface to make it more retentive prior to using silane

A

etch with hydrofluoric acid

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31
Q

how does saline coupling agent bond composite to ceramic

A

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

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32
Q

what is the function of saline coupling agent in composite

A

chemically bonds the filler particle to the resin matrix

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33
Q

what are 4 features of a randomised control trial

A

blinding/masking
randomisation
comparison group
allocation concealment
inclusion/exclusion criteria

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34
Q

explain how you would blind in a RCT

A

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

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35
Q

how would you ensure randomisation in RCT

A

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

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36
Q

how is the comparison group implemented in a RCT

A

control group only difference to treatment group is the treatment

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37
Q

how is inclusion/extrusion criteria used in RCT

A

based on:
medical history
age
severity of disease

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38
Q

how is allocation concealment used in RCT

A

the person allocating treatments to patients is masked to which patient gets which treatment

cannot influence who gets the experimental treatment

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39
Q

what might be a patient factor to consider when considering results

A

age
medical history
previous condition to beginning treatment

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40
Q

what standards were developed to improve the reporting of RCT

A

consort - consolidated standards of reporting trials

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41
Q

what questions would you ask a patient who smokes about their tobacco use and to determine if they’re interested in quitting

A

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

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42
Q

what does dependence mean

A

a compulsive physiological and psychological need for a habit forming substance

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43
Q

what is a model/ approach to helping quit

A

Ask Advise Act

OR

5A’s ask, advice, assess, assist, arange

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44
Q

what are local services that could be referred to for smoking cessation

A

local pharmacy
specialist services

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45
Q

what are evidenced based treatments to support quitting smoking

A

nicotine patches
champix
e cigarettes

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46
Q

what do you do if a patient decides now is not the right time to quit smoking

A

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

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47
Q

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

A

palpation of the labial sulcus

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48
Q

what radiograph is used for a 8 year old with previous trauma to central incisor

A

periapical
Anterior occlusal of maxilla

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49
Q

given the history of trauma, what sequence of events have most likely caused non-eruption of the upper central incisor

A

trauma to deciduous tooth leading to dilacerations of permanent successor

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50
Q

what is a because of non eruption of the upper central incisor

A

unerupted supernumary tooth preventing eruption
congenital absence
pathology

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51
Q

what are the principles of the orthodontic management of non-eruption of upper central incisors

A

removal of obstruction (if present)

create space and observe

if non eruption, expose and place gold chain - orthodontic traction

52
Q

what are ways to assess AP skeletal relationship

A

direct palpation of the skeletal bases

Visual assessment of relationship between soft tissue A and soft tissue B

53
Q

what are ways to assess the vertical skeletal relationship

A

assess relationship of frankfort and mandibular plane angles

lower anterior face height compared to total anterior face height

54
Q

how should the patients head be positioned during clinical assessment

A

frankfort plane should be parallel to the floor to avoid error in assessment

55
Q

what is the definition of Class III malocclusion according to the british standard institute

A

the lower incisors occlude or would occlude anterior to the cingulum of the upper incisors

56
Q

how would you describe a patient with class III occlusions skeletal relationship in terms of growth and development

A

maxillary hypoplasia

mandibular prognathism

57
Q

which reference point should be positioned horizontally when setting up a panoramic radiograph

A

frankfort plane

58
Q

what causes the incisor teeth to be horizontally magnified in a panoramic radiograph

A

the patient is too far back in the machine

vertical guide light in front of canine

canine behind guide line

59
Q

what causes the posterior teeth on one side being wider than on the other

A

patient is rotated in the machine

patient not biting symmetrically between incisors on the bite peg

60
Q

what are important features of ghost images

A

horizontally magnified
higher than original image
opposite side of original image
radiopaque
caused by dense objects
further forward than real position
out of focus

61
Q

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

A

right side panoramic radiograph

62
Q

what panoramic radiograph is used for uncooperative child for caries

A

panoramic radiograph on setting 4

63
Q

which marginal walls of the maxillary sinus are seen horizontally above the roots of the premolars and molars

A

inferior

64
Q

which marginal walls of the maxillary sinus are seen vertically above third molar region

A

posterior or distal

65
Q

what are parts of presentation that may lead you to be concerned about child abuse

A

late presentation of pain.
multiple injuries to different areas of the face

66
Q

what questions would you ask if you suspect child abuse or neglect

A

why was the child not brought in earlier
how did the child sustain injuries
has the child had previous injuries seen by anyone else

67
Q

who might you discuss suspected child abuse or neglect with

A

child protection advisor
line manager or senior colleague
child protection officer
social services

68
Q

what are the stages of response for child neglect

A

dental team management
multiagency management
referal to social services

69
Q

what action would you take to child protection issues

A

child protection advisor does further investigation
child referred to lead paediatrician
child protection advisor asks you to refer directly to social services

70
Q

what information is important when considering extraction of 6s in a child

A

bifurcation of the lower 7s just formed
8s present radiographically
second premolars present

71
Q

what is the guidance for extracting lower 6s

A

also extract upper 6

72
Q

what is an advantage of removing the first permanent molar at the ideal time

A

spontaneous closure of space
caries free dentition
reduces future orthodontic need

73
Q

what are disadvantages of extracting first permanent molars of poor prognosis

A

no molars for eating
risk of GA
bad experience may result in loss of cooperation
removes caries free healthy teeth

74
Q

what may a child need to enable multiple extractions

A

sedation - inhaled only
GA

75
Q

what type of drug is warfarin and what is its mechanism of action

A

anticoagulant

vitamin k antagonist

76
Q

what test must be carried out for a patient on warfarin before extraction

A

INR

77
Q

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

A

SDCEP - 24 hours

NICE - 72 hours if INR stable

78
Q

what INR level is safe for extraction

A

<4

79
Q

what options clinically help deal with pos operative bleeding

A

prolonged pressure with damp guaze
sutures
LA with vasoconstrictor
cellulose matrix - cellulose or surgicel
diathermy
tranexamic acid

80
Q

where might you refer a patient if you cant control bleeding

A

urgent referal to OS
OMFS unit
A&E

81
Q

what nerves are anasthetised for removing tooth 48

A

right IAN
right lingual nerve
right long buccal nerve

82
Q

what are ways to assess anaesthesia

A

ask the patient if the area is numb
check the area by probing and seeing if the patient feels pain

83
Q

what is the terminology for pins and needle feeling or partial loss of sensation

A

parasthesia

84
Q

what is the terminology for unpleasant sensation lasting for a fraction of a second

A

dysaesthesia

85
Q

what is the terminology for total loss of sensation

A

anaesthesia

86
Q

what are 3 clinical reasons for neuro-sensory deficit

A

damage to IAN during LA placement
damage to IAN during surgery
transection of the nerve
crushing of the nerve
cutting/shredding

87
Q

what are adjustments for a person in a wheelchair to gain access to an above level dental practice

A

lift
ramp

88
Q

what are relevant acts of law for impairment and disability to have equal access

A

the disability discrimination act (2005)
The equality act 2010

89
Q

explain the social and medical models in terms of disability

A

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

90
Q

what are other ways to communicate if patient is non verbal

A

sign language
paper and pen
communication boards
physical cues
eye tracking technology

91
Q

what options are available to safely treat a patient in a wheelchair in practice

A

transfer to dental chair by hoist
wheelchair tipper
patient may have reclining wheelchair

92
Q

why may it be difficult to treat a patient with cerebral palsy

A

incontrollable muscle spasm

93
Q

what are ways to aid access to a patients mouth whi has cerebral palsy

A

bedi mouth prop/ finger guard
bite stick
toothbrush
unbreakable mirror head

94
Q

what are physical characteristics of downs syndrome

A

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

95
Q

what genetic change causes downs syndrome

A

trisomy of chromosome 21

96
Q

what are aspects of downs syndrome which may result in lack of capacity

A

intellectual or learning disability
dementia

97
Q

what are differences between welfare guardians and welfare power of attorney

A

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

98
Q

what are features of downs syndrome that are likely to contribute to periodontal disease

A

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

99
Q

what is the antibiotic and dose prescribed for antibiotic prophylaxis

A

amoxicillin 3g

100
Q

when is antibiotic prophylaxis given

A

a single dose is given 30-60 minutes before the procedure

101
Q

what are risk factors for mouth cancer

A

smoking tobacco
chewing tobacco
alcohol
diet low in fruit and vegetables
immunosuppression
pre existing premalignant mucosal conditions
genetic conditions

NOT HPV

102
Q

what are important pieces of information to know about radiotherapy treatment

A

dose
field

103
Q

what dose of radiation delivered to primary tumours increases the risk of osteoradionecrosis

A

50-60 Gy

104
Q

what pattern of decay is seen in radiation caries

A

cervical margins
incisal edges

105
Q

how do you manage teeth is a patient is at risk of osteoradionecrosis

A

provide primary orthograde endodontics and decoronate

106
Q

what are oral complications associated with radiotherapy to the head anc neck

A

trismus
dry mouth
increased risk of oral infection
radiation mucositis
dysgeusia or ageusia
skin burns

107
Q

what are preventative measures for patients who have had radiotherapy

A

increased fluoride toothpaste - 2800ppmF
tooth mousse
Fluoride trays
prescribe oral saliva substitutes

108
Q

what are management strategies of osteoradionecrosis of the jaw

A

surgical debridement
hyperbaric oxygen therapy

109
Q

what is a contraindication of glandosane

A

cannot be used if patient has teeth

110
Q

what PPE is used for manual washing and what does it protect from

A

gown - splashing
marigold gloves - sharps
full face visor - aerosols

111
Q

what are methods for manual cleaning and give an example of an instrument cleaned in this way

A

immersion - any solid instrument e.g. mirror
non immersion - handpieces

112
Q

how often should the ultrasonic be de gassed

A

every time it is filled from empty

113
Q

what is removed by degassing

A

air/oxygen

114
Q

why is it important to degass the ultrasonic

A

air will prevent ultrasonic bubbles from reaching all surfaces of the instruments

115
Q

why should dental handpieces not be places in the ultrasonic cleaner

A

they may be damaged by the ultrasonic activity

they should not be immersed in water as water in the lumens will inhibit sterilisation

116
Q

why is it important to use demineralised water in the steriliser

A

to prevent the deposits of minerals on the machine and instruments

117
Q

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

A

microbiome

attached to surface - biofilm

118
Q

what are key microbial stages of caries plaque formation

A

adhesion
collonisation
maturation
acid prodcution

119
Q

what are virulence factors used by strep. mutans for enamel dissolution

A

glucans (glucosyltransferase - attach)

ATPAse (control pH)

120
Q

what is the bacterium associated with secondary endodontic infections

A

enterococcus faecalis

121
Q

what are virulence factors of enterococcus faecalis

A

gelatinase
superoxide
cytolysins
adhesins
collagenase

122
Q

why is it difficult to determine causality from a specific bacteria in endodontic infection

A

sterile sampling procedures

active/functional bacteria

123
Q

what antimicrobial is primarily used to disinfect the root canal

A

sodium hypochlorite

124
Q

what culture independent technique could be used to assess changes in the oral microbial populations following antibiotic exposure

A

next generation sequencing

125
Q

what is the limitation of next generation sequencing

A

limited to describing what is present rather than what communities are causing the problem

Need to Know (21 decks)

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