2020 MSA Flashcards
What number of canals are found most often in an upper first premolar?
2
Where is the ideal end point of obturation?
The apical constriction
The CEJ
What is the term for maintaining communication between the pulpal space and peri-radicular tissues?
Patency
What is a working length in endodontics?
Distance from the occlusal reference point to the point at which the root canal preparation should stop
What two common intra-operative radiographs can be utilised during endodontic treatment to aid working length determination?
Working length radiograph
Master-cone radiograph
Give 2 potential causes of a corrected working length changing during the course of endodontic shaping
Perforation
Straightening of the canal
Which systemic antimicrobial is prescribed for necrotising gingivitis as well as dose, daily frequency and duration of administration?
Metronidazole 400mg 3x daily for 3 days
What 3 warnings should be given to a patient taking metronidazole?
Don’t consume alcohol
Don’t take if pregnant
Seek medical attention immediately if they experience signs of allergic reaction and stop taking the medication
What follow up care is arranged after necrotising gingivitis?
Review in 2 weeks
HPT therapy after acute symptoms subside
What is the difference between the mandible at rest and ICP?
Freeway space
What is the average freeway space?
2-4mm
What positions is the mandible in retruded axis between?
RCP
Retruded axis position
What is a border position?
A position determined by the anatomy of the TMJ and its musculature
Why is the retruded axis important in clinical dentistry?
It is a reproducible jaw position
What two records are required for mounting casts on a semi adjustable or average value articulator?
Facebow
An interocclusal record
What is the average value of the sagittal condylar guidance angle which may be used on an articulator?
30º
What are the 2 main differences in composition between decorative and dental ceramic?
Decorative ceramic contains more Kaolin
Dental ceramics contain more feldspar
What does translucency mean with regard to optical properties of materials?
The degree of a 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
What does opalescence mean with regard to optical properties of materials?
A translucent materials ability to appear orange in transmitted light and blue in refracted light
How can you modify the ceramic surface to make it more retentive prior to using silane?
Etch with hydrofluoric acid
Chemically how does a silane coupling agent work when bonding composite to ceramic?
C=C on one side of silane reacts to the composite
Oxide groups on other side of silane form strong bonds with the porcelain
What is the function of silane in a composite restorative material?
Improves bond strength between composite resin filler particles
List 4 features of an RCT
Randomisation
Blinding
Inclusion/exclusion criteria
Control group
How can randomisation be implemented in an RCT?
Use a computed generator to decide which participants are put into which group
Name the standards developed to improve the reporting of RCTs
CONSORT
What 4 things can you ask a patient around their tobacco use and to ascertain whether they would be interested in quitting?
- No. of years a smoker
- What do they smoke
- Have you tried to quit before
- How many attempts to quit have you had
What is dependence?
A compulsive psychological and physiological need for something that forms a habit
Name a model/approach that can be used to help a patient quit smoking
5As
- Ask
- Advise
- Assess
- Assist
- Arrange
Give 2 examples of evidence based treatments used to support patients who want to quit smoking
Nicotine replacement therapy
E-cigarettes
What can you do if a patient tells you now is not the right time for them to quit smoking?
Record it in the patient notes with a reminder to bring it up again at a future appointment
What can you do if a patient tells you now is not the right time for them to quit smoking?
Reassure that support is available if they do ever want to quit
Record this in the patient notes
What radiographic view is most suitable for an unerupted central incisor?
Periapical
What are the 4 principles of the orthodontic management of non-eruption of upper central incisors?
- extract deciduous tooth and any supernumeraries to encourage eruption of permanent
- maintain space
- wait 12 months if patient is under 9
- surgically expose, bond gold chain and apply orthodontic traction
Give 2 ways to clinically assess the antero-posterior skeletal relationship
Visual assessment
Palpation of the skeletal bases
Give 2 ways to clinically assess the vertical skeletal relationship
FMPA - if average, lines should meet at external occipital tuberance
LAFH to TAFH ratio - if average should be approximately 55%
How should the patients head be positioned during clinical assessment of skeletal relationship
Frankfort plane parallel to the floor
List 3 causes that may be contributing to continual bleeding of a socket following extraction?
Patient traumatises area with tongue or finger
Undiagnosed bleeding abnormality
Vasoconstrictive effects of LA worn off
How would you manage continual post-operative bleeding from a socket following extraction (5 marks)
Pressure - ask patient to bite on damp gauze
LA with vasoconstrictor
Haemostatic agents
Diathermy
Suture
State 1 pre-extraction blood test that would allow you to test the patients bleeding/clotting status?
FBC
If you cannot stop bleeding post-extraction what should you do?
Refer to local OMFU
List 4 occlusal features due to a prolonged digit sucking habit
Proclined upper incisors
Retroclined lower incisors
Anterior open bite
Unilateral posterior crossbite
Describe 4 methods that could be used to dissuade a digit sucking habit
Positive reinforcement
Elastoplast on finger
Habit breaker device
Bitter tasting nail varnish
Explain the effect that a prolonged digit sucking habit can have on the posterior dentition
The digit sits where the tongue should causing the surrounding musculature to incline the upper arch palatally causing a narrow upper arch
The mandible must displace on closing causing a unilateral posterior crossbite
Give 5 functions of a provisional restoration
Maintain occlusal relationship
Maintain function of the tooth
Maintain aesthetics of the tooth
Test the fit and function of the permanent restoration
Prevent sensitivity by covering exposed dentine/pulp
What variations of preformed anterior provisional crowns are available? (3 marks)
Polycarbonate
Clear-plastic crowns
Preformed composite crowns
Give 2 disadvantages of preformed provisional crowns in comparison to custom provisional crowns
Unlikely to fit accurately
Large bank of crowns needed
Give 4 factors that may contribute to increased tooth mobility
Occlusal trauma
Attachment loss
Root resorption
Periodontal inflammation
Give 2 circumstances in which you would decide to intervene in order to try to reduce the mobility of a tooth or teeth
If mobility is progressively increasing
To facilitate restorative treatment
In a patient with periodontal disease, following successful HPT would tooth mobility be more likely to increase or decrease? Give reasons for your answer. (2 marks)
Decrease
Bacteria causing loss of attachment have been removed which will promote the attachment of long junctional epithelium to the root, increasing stability of the tooth
What are the disadvantages of splinting?
Can cause oral hygiene difficulties
Which type of study would provide the highest level of evidence for the effectiveness of treatment?
Systematic review and meta analyses
List the 4 main features of an RCT?
Blinding
Randomisation
Control group
Inclusion/exclusion criteria
Name the standards developed to improve the reporting of RCTs
CONSORT
Name the standards developed to improve the reporting of RCTs
CONSORT
Which external reference plane of the patient should you position horizontally when setting up for a panoramic radiograph?
Frankfort plane
In an OPT what causes the incisors being horizontally magnified?
Patient too far back in machine
In an OPT what causes posterior teeth on one side being wider than on the other?
Patient rotated in machine
Give 3 important features that apply to all ghost images
Image appears higher
Always horizontally magnified
On the opposite side
What panoramic radiograph would you take for pre-extraction of a partially erupted 48 under local anaesthetic, when there is no evidence of 38 in the mouth?
Right half panoramic radiograph
What panoramic radiograph would you ask to be taken for a child patient with caries, who cannot tolerate bitewings?
Orthogonal projection
Which margins of the maxillary sinus is seen horizontally above the roots of the premolars and molars?
Inferior
Which margins of the maxillary sinus are seen vertically above the third molar region?
Posterior
Who should you first discuss concerns of child abuse with?
Social services
What courses of action may take place after discussing physical abuse with parents?
Child referred directly to lead paediatrician
Child protection ask you to refer directly to social services
Further investigations occur with child protection
What should you do where there is suspected physical abuse and a mother fails to bring their child back to appointments?
Write a letter to the health visitor
What special investigation is appropriate for a poorly cooperative 9 year old child with gross caries?
OPT radiograph
What information are you ideally looking for to establish the suitability of the timing of extraction of 6s?
Calcification of bifurcation of 7s
5s and 8s present
How would you manage a caries free 26 when 16, 36 and 46 are being extracted due to gross caries?
Compensating extraction
List 2 advantages of extraction of first permanent molars of poor prognosis at the correct stage?
Spontaneous closure of space
Caries free dentition
List 2 disadvantages of extraction of first permanent molars of poor prognosis at the correct stage
Risks associated with GA
Traumatic experience now could negatively impact the child’s view of future dental care
What might a child require to enable extractions?
General anaesthetic
Inhalation sedation
What type of drug is warfarin and what is its mechanism of action
Anticoagulant
Vitamin K antagonist
What test must be carried out prior to extractions in a patient on warfarin?
INR
Which guidance document would you refer to for advice on dealing with patients on warfarin and within what timeframe should this test be carried out prior to extractions?
SDCEP
Within 24 hours
Below what level INR is it safe to continue with extractions?
4
Outline options that you could carry out clinically to deal with post-op bleeding?
Bite on damp gauze
LA with adrenaline - vasoconstrictor
Haemostatic agents
Suture
Diathermy
If following intervention, you still cannot stop post-op bleeding, what would you do?
Urgent referral to local oromaxillofacial unit
Anatomically, which nerves must be anaesthetised to remove a 48 safely?
Right long buccal nerve
Right lingual nerve
Right inferior alveolar nerve
List 2 ways you could assess that anaesthesia has been achieved?
Ask patient if right side of chin or lip feels numb
Probe area adjacent to associated tooth - patient should feel pressure but no pain
What word described pins and needles feeling or partial loss of sensation?
Paraesthesia
What word describes painful, unpleasant or neuralgic sensation that lasts for a fraction of a second?
Dyaesthesia
What word describes a total loss of sensation?
Anaesthesia
Give 3 clinical reasons that could account for a neuro-sensory deficit during extraction of the 48
Cutting
Crushing injury
Transection of nerve
Name two adjustments that can be made to a building to improve access for someone using a wheelchair
Elevator
Ramp
Name two relevant acts of law for people with an impairment or disability
Equality Act 2010
Disability Discrimination Act 1995
Describe the difference between the two models of disability
Medical - disability is caused by a persons impairment and should be fixed by medicine
Social - disability is caused by society around a person rather than any difference that person medically has
List two augmentative and alternative communication methods
Makaton
Picture boards
Name two options that are available to allow for the improved positioning of a gentleman in a wheelchair to allow for safe dental examination?
Hoist
Wheelchair recliner
Which particular aspect of cerebral palsy may affect the dentists access to the patients mouth?
Uncontrolled muscle spasm
Name two non-pharmacological adjuncts available to overcome access to the patients mouth
Bedi shield
Open wide mouth rest
List four physical characteristics which are associated with Down’s syndrome
Broad, flat face
Decreased muscle tone
Short neck
Upwards slanting of eyes
What genetic change is responsible for Down’s syndrome?
Full trisomy of chromosome 21
List 2 medical aspects of Down’s syndrome which may result in lack of capacity
Intellectual disability
Dementia
List 2 differences between a Welfare Guardian and a Welfare Power of Attorney
Welfare guardian is court appointed, PoA is drafted through a solicitor
Welfare guardian is for someone who lacks capacity, PoA is chosen by the person before they lose capacity
List 2 features associated with Down’s syndrome that are likely to contributed to periodontal disease
Systemic immunodeficiency
Inability to carry out good oral hygiene practices
What antibiotic and dose should be prescribed for infective endocarditis prophylaxis and when should you provide and observe the antibiotics being taken?
Amoxicillin 3g
1 hour before the procedure
List four risk factors for mouth cancer
Alcohol consumption
Smoking
Diet low in fruit and vegetables
Immunosuppression
What 2 pieces of information do you need to know about radiotherapy treatment a patient has received?
Dosage of radiotherapy
Area of exposure to radiotherapy
What dose of radiotherapy delivered to the primary tumour increases the risk of osteoradionecrosis?
60Gy
Describe the pattern of decay which is unique to radiation caries
Affects cervical margins of teeth
How would you manage teeth needing extraction if a patient is at increased risk of ORN?
Primary orthograde endodontics and decoronate
List two oral complications associated with radiation therapy other than ORN and radiation caries to the head and neck
Trismus
Oral mucositis
List two preventative measures that should be implemented to reduce the risk of future dental disease for patients who have received radiotherapy to the head and neck?
2,800ppm flouride toothpaste
Tooth mousse
List a management strategy for established ORN of the jaw?
Hyperbaric oxygen therapy
Provide 3 examples of PPE to be used during manual washing and describe what each item is protecting you from
Heavy duty gloves - sharps injuries
Apron - splashing
Visor - aerosols to the face
What two methods are used for manual cleaning of instruments? For each of these give an example of an instrument cleaned in this way
Immersion - dental mirror
Non-immersion - handpiece
How often should an ultrasonic cleaner be de-gassed?
Before every production cycle
What is removed by de-gassing an ultrasonic cleaner?
Air bubbles
Why is it important to de-gas an ultrasonic cleaner?
Any bubbles created in the ultrasonic process would collapse into the air bubbles, preventing them from reaching the surfaces of the instruments
Provide one good reason why dental handpieces should not be placed in the ultrasonic cleaner
The ferocious ultrasonic process can damage them
Why is it important to use demineralised water in the steriliser?
Minerals and impurities could leave residue on the instruments, reducing the efficacy of the sterilisation process
What term can be used to describe the collective group of microorganisms within the oral cavity and what are they referred to when attached to a surface?
Oral microbiota
Biofilm
List the 4 key microbial stages of caries plaque formation
Adhesion
Colonisation
Maturation
Production
Name 2 key virulence factors used by S. mutans to influence enamel dissolution
Glucans attach to the enamel
ATPase controls the pH
Name the bacterium associated with secondary endodontic infections
E. faecalis
Name on of the virulence factors used by E. faecalis
Adhesins
Why is it difficult to determine causality from a specific bacteria in endodontic infection?
Integrity of sampling - difficult to ensure no contamination
Which 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?
It is limited to describing what is present rather than what the community is doing
