2020 MSA Flashcards by Elli Kirkpatrick

What is the term for maintaining communication between the pulpal space and peri-radicular tissues?

Patency

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During instrumentation of the root canal what is the ideal end of shaping/obturation?

The apical constriction, cemento-dentinal junction or wet/dry interface

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What is the working length in endodontics?

From the apical terminus of the preparation and a predefined coronal reference point

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What 2 intra-operative radiographs can be utilised to aid working length determination?

Corrected working length radiograph
Master cone radiograph

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Name 2 causes of corrected working length during endo shaping?

Ledges
Perforation
Transposition
ZIpping

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What is used to treat necrotising gingivitis?

Metronidazole, 400mg 3x a day for 3 days

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What are some warnings that come with Metronidazole?

Avoid alcohol
Do not take if pregnant
If any adverse effects occur, stop taking immediately
Increased risk of oral candidosis

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What should the FWS be?

2-4mm

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What is a border position?

One determined by the anatomy of the TMJ and associated musculature

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Why is the retruded axis important in dentistry?

It is a reproducible jaw position

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What 2 records are required for mounting casts on semi-adjustable/average value articulator?

Facebow
Inter-occlusal record on the retruded axis

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What is the average value of Sagittal Condylar Guidance Plane?

30 degrees

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What is the follow-up for a patient who has been prescribed antibiotics for necrotising periodontal disease?

Review after 1/2 weeks
Hygiene Phase Therapy
Smoking cessation advice

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What is the difference between decorative and dental ceramics? (name 2)

Decorative ceramics have more Kaolin than dental ceramics
Dental ceramics have more Feldspar than decorative ceramics

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What is Translucency?

The ability 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

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What is Opalescence?

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

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How do you make a ceramic surface more retentive?

Etch with hydrofluoric acid

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Chemically, how do silane coupling agents work when bonding composite to ceramic.

Hydroxyl group on 1 end of the silane coupling agent reacts with oxide groups on the ceramic surface
C=C double bond on the other end reacts with similar groups in composite

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What is the function of silane in a composite restorative material?

It chemically bonds the filler particles to the resin matrix

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What are the 4 main features of study design?

Blinding/masking
Randomisation
Comparison group
Inclusion/Exclusion criteria

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How do you achieve randomisation of randomised controlled trials?

Use computer based program to randomly allocate groups

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How do you achieve blinding of a randomised controlled trial?

Make treatment and comparison drug identical
Ensure that the clinicians involved are masked to what the patient is on

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What standards have been developed to improve randomised controlled trials?

Consort statements

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Define dependence.

A compulsive physiological and psychological need for a habit forming substance

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What are the 3 A's of stopping smoking (Scotland)?

Ask, Advise, Act

A patient tells you they are a smoker, what are the follow-up questions you need to ask?

How many years have you smoked?/When did you start smoking? Have you ever tried to quit/How many times? Are you interested in quitting currently? What do you smoke? How many do you smoke a day?

What is the orthodontic management of non-eruption of upper centrals?

Remove any obstructions (if any present i.e. supernumeraries) Create/maintain space and observe If non eruption: --expose surgically --place gold chain and orthodontic traction

Name 2 clinical ways to assess AP skeletal relationship.

Direct palpation of skeletal bases Simple visual assessment of relationship between soft tissue A and soft tissue B

Name 2 clinical ways to assess the vertical skeletal relationship.

Frankfort mandibular plane angle (FMPA) assesses the relationship, the points should meet at the occiput The lower anterior face height (LAFH) and the total anterior face height (TAFH)

Name 2 reasons that the incisors can appear horizontally magnified in an OPT.

Canines behind the guide line Patient too far back in the machine

Name 2 reasons that the posterior teeth on one side appear wider than the other in an OPT.

Patient is rotated in the machine Patient is not biting symmetrically between incisors on the bite peg

Name 4 important features of ghost images.

Horizontally magnified On opposing side than normal Radiopaque (white) Higher than the original image

What kind of X-rays do you take on a child who can't tolerate bitewings?

Orthogonal projection or P4

What margins or walls of the maxillary sinus are seen horizontal above the roots of the premolars/molars?

Inferior or floor

What margins or walls of the maxillary sinus are seen vertical above the third molar region?

Posterior or distal

What course of action do you take after speaking to the child protection officer about concerns of child abuse?

Further investigations and wait for child protection advisor to get back to you Child referred to the lead paediatrician (line manager) Refer directly to social services

When is the ideal time to take out 6's of poor prognosis in paeds?

When the bifurcation of the 7's has just calcified

What are 2 advantages of XLA of first permanent molar of poor prognosis?

Spontaneous space closure Render the child caries free

What are 2 disadvantages of XLA of the first permanent molar of poor prognosis?

Risk of GA Bad experience- cause negative feelings towards any future treatment

What type of drug is Warfarin and what is its mechanism of action?

Anticoagulant and Vitamin K antagonist

What test must be carried out prior to the extractions of patients on Warfarin? And what must the level be to carry out an extraction?

INR Less than 4 to extract

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 the extractions?

SDCEP- ideally within 24 hours NICE- within 72 hours if INR is stable

What nerves must be anaesthetised to remove the 48 safely?

Right Long buccal nerve Right Inferior alveolar nerve Right Lingual Nerve

What are two different ways to test that anaesthesia has been achieved in an XLA of 48?

Ask the patient if the right half of their tongue/chin is numb Check by probing adjacent to the LR8 buccally and lingually

Give 3 clinical reasons that could account for a neuro-sensory deficit after an extraction.

Crushing of the nerves Damage to the nerve during surgical extraction Transection of the nerves Damage to the IAN during LA Cutting/shredding of the nerves

Legislation in the UK has sought to ensure that all new dental practice premises are built to allow people with an impairment or disability equal access. Name 2 relevant Acts of Law

Equality Act The Disability Discrimination Act 1995

What is the Social Model for disabilities?

Disability is caused by the way society is organised, rather than by a person's impairment or difference Social organisation that takes little or no account of people who have disabilities

What is the Medical Model for disabilities?

The medical model of disability says people are disabled by their impairments or differences, these impairments or differences should be 'fixed' or changed by medical and other treatments

Name 2 non-pharmacological aids to help gain access to the mouth in children with cerebral palsy.

Toothbrush Finger guard Bite stick

List 4 physical characteristics which are associated with Down's Syndrome.

Decreased, poor muscle tone Short neck Small head, ears and mouth Flattened facial profile and nose Wide, short hands with short fingers

To confirm a diagnosis of Down's Syndrome a genetic test is undertaken. What genetic change is responsible for Down's Syndrome?

Trisomy of Chromosome 21

List 2 medical aspects of Down's Syndrome which may have resulted in his lack of capacity.

Intellectual disability Dementia

List 3 features associated with Down's Syndrome that are likely to have contributed to his periodontal disease.

Inability to perform self care- OH and calculus Impaired oral function Systemic immunodeficiency

List 4 risk factors for mouth cancer.

Alcohol Smoking Socio-economic status Immunosuppression Diet low in fruit and veg

What 2 additional pieces of information do you require to know about the radiotherapy treatment a patient received?

Dose and Field of limitation

What dose of radiotherapy delivered to the primary tumour increases the risk of ORN?

60 Gy

Following investigation, the coronal tooth structure of all the remaining teeth is found to be extensively decayed and therefore deemed unrestorable. How do you manage this is the patient is at an increased risk of ORN?

Provide primary orthograde endodontics and decoronate

List 5 oral complications associated with radiation therapy to the head and neck.

ORN- osteoradionecrosis Radiation Caries Trismus Xerostomia Radiation Mucositis

List 1 management strategy for established ORN of the jaw?

Hyperbaric Oxygen

List 2 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.

Prescribe a higher concentration fluoride toothpaste- 2,800ppm or 5000ppm Apply fluoride varnish

How often should an ultrasonic be de-gassed?

Before every cycle

What is removed by de-gassing an ultrasonic bath?

Air bubbles

What is 1 good reason a dental handpieces should not be places in the ultrasonic cleaner.

They should not be immersed in water as water in the lumens inhibits sterilisation

Why is it important to use de-mineralised water in the sterilisation?

Prevents deposit of minerals on the machine and instruments

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?

Microbiome, biofilm (plaque)

List the 4 key microbial stages of caries plaque formation.

Adhesion Colonisation Maturation Acid Production

Name the bacterium associated with secondary endodontic infections.

E. faecalis

Name 2 virulence factors of secondary endodontic infections.

Adhesions Gelatinase

Why is it difficult to determine causality from a specific bacteria in an endodontic infection?

Sterile sampling procedures Active functional bacteria