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Need to Know > 2021 > Flashcards

2021 Flashcards

1
Q

What nerves must be anaesthetised to remove tooth 48 safely

A

Inferior Alveolar Nerve
Lingual nerve
Long buccal nerve

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2
Q

What are two different ways to assess anaesthesia has been achieved?

A
  • Probe around the tooth and ask the patient if they feel anything sharp
  • ask if the patients lips and tongue feel numb
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3
Q

What is the dental terminology for pins and needle feeling or partial loss of sensation ?

A

Parasthesia

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4
Q

What is the dental terminology for painful, unpleasant sensation lasting for a fraction of a second ?

A

dysesthesia

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5
Q

What is the dental terminology for total loss of sensation?

A

Anaesthesia

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6
Q

What are 3 clinical reasons that could account for neurological-sensory deficits?

A
  • crushing injury
  • cutting/shredding injury
  • transection of the nerve
  • damage due to LA
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7
Q

What is the correct terminology for dry socket?

A

localised alveolar osteitis

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8
Q

What are predisposing factors of dry socket?

A
  • smoking
  • excessive mouth rinsing after extraction
  • excessive trauma during extraction
  • previous dry socket
  • more common in mandibular extractions
  • More common in posterior extractions
  • More common in females
  • Oral contraceptive pill
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9
Q

What are signs and symptoms of sry socket ?

A

pain disturbing the patients sleep
pain radiating to the ear
dull aching pain
bad breath (halitosis)
bad taste in the mouth
exposed bone that may be sensitive

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10
Q

What is the management for dry socket?

A
  • reassure and support the patient
  • debridement to remove the old clot and encourage new clot formation
  • irrigate the socket with warm saline
  • may give systemic analgesia
  • antiseptic pack (BIP)
  • advice patient on analgesia and hot salty mouthwash
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11
Q

What are risk factors of oral cancer ?

A
  • smoking
  • Alcohol intake
  • HPV
  • sunlight
  • nutritional deficiencies
  • candida infections
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12
Q

What radiation dose increases the risk of osteoradionecrosis?

A

doses over 60 Gy

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13
Q

What are oral complications of radiotherapy?

A
  • osteoradionecrosis
  • radiation caries
  • hypogeusia - loss of taste due to radiation affecting taste buds
  • xerostomia - may be due to damage of salivary glands
  • difficulty wearing dentures
  • more prone to fungal infections
  • trismus may occur due to replacement fibrosis of muscles of mastication
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14
Q

what sites of the teeth are affected by radiation caries?

A
  • gingival margins and incisor edges
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15
Q

what are causes of radiation caries?

A
  • dry mouth
  • loss of taste
  • change in diet
  • hypersensitivity of teeth makes OH difficult
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16
Q

What do you need to know about patients who have had radiotherapy?

A
  • what dose of radiation was given
  • what area of the body was exposed to the radiation
  • duration of treatment
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17
Q

What are preventative measures used for patients who have had radiotherapy?

A
  • OHI
  • higher concentration of fluoride toothpaste
  • fluoride varnish
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18
Q

how do you treat osteoradionecrosis?

A
  • irrigation of necrotic debris
  • remove loose sequestra
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19
Q

What methods help prevent risk of osteoradionecrosis?

A
  • scale teeth near extraction site and use chlorohexidine mouthwash
  • careful extraction technique
  • antibiotics, chlorhexidine mouthwash and review
  • hyperbaric oxygen before and after extraction to increase local tissue oxygenation
  • close soft tissues
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20
Q

What is the most common cause of facial trauma in a female patients?

A

Domestic Abuse

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21
Q

What are the forms of abuse that may be involved in domestic abuse?

A
  • Physical violence
  • Verbal abuse
  • Emotional abuse
  • Sexual abuse
  • Financial Abuse
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22
Q

What process should you follow to ask about the possibility of domestic abuse

A

AVDR

Ask - ask about abuse in a private setting

Validate - show you are concerned about them

Document - be specific and detailed, use patients own words and describe injuries in as much detail as possible

Refer - signpost to appropriate services

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23
Q

What are physical signs you may see in domestic abuse ?

A
  • repeated injuries
  • Bruises at different stages if healing
  • dental/maxillofacial injuries
  • facial bruising, strangle marks around the neck or fingertip bruising
  • TMJ problems
    -Orofacial pain
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24
Q

What are causes of liver cirrhosis

A
  • Alcohol
  • Hepatitis virus
  • fatty liver disease
  • autoimmune causes:primary billary cirrhosis
  • haemochromatosis
  • hepatocellular carcinoma
  • drug induced
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25
Q

what does dentally fit mean

A
  • no active pathology
  • consider removing teeth of poor long-term prognosis
  • establish preventative plan
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26
Q

why should a patient be dentally fit before a transplant

A

the patient will be immunosuppressed for the rest of their life so must reduce the risk of further dental intervention in the future

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27
Q

what teeth can be justified to extract when making a patient dentally fit

A

teeth with periapical periodontitis or other pathology
teeth with poor prognosis - highly restored and secondary caries

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28
Q

what causes thrombocytopenia to occur

A

splenic sequestration

impaired hepatic synthesis

increased degredation of thrombopoeitin by platelets sequestered in the congested spleen

drug related - alcohol, penecillin based drugs or heparin

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29
Q

what platelet level is considered safe to treat in general practise

A

> 100 x 10^9 / L

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30
Q

why might patients with advanced alcoholic liver disease have increased risk of bleeding

A
  • thrombocytopenia
  • medication induced, patient may be taking heparin
  • liver disease may have been caused by hepatitis or HIV which both affect bleeding
  • clotting factors essential for coagulation are formed in the liver. If the liver is not functioning proerly these will not be present and affects coagulation ability
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31
Q

What are the types of dementia

A

Alzheimers
Vascular dementia
Dementia with lewy bodies

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32
Q

what are early stages of dementia?

A

Short term memory loss

confusion

Anxiety, agitation or distress

Communication issues - decline in ability to talk or write

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33
Q

What are middle stages of dementia

A

support required for everyday activites e.g. washing, dressing, using the bathroom

Increasing forgetfulness

Distress, aggrression or anger

Risk of wandering

behaving inappropriately e.g. going out in pyjamas and slippers

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34
Q

what are end stage

A

inability to recognise familiar objects, surroundings or people

Increased physical frailty - may shuffle when walk or become confined to a bed or wheelchair

difficulty eating and swallowing

asphagia

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35
Q

who can provide section 47 AWI certificate for dental treatment

A

dentist who has done additional training

general medical practicioners

consultants in-charge of patient care

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36
Q

What is the antibiotic and dose given for antibiotic prophylaxis

A

amoxicillan 3g

clyndamicin 600mg

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37
Q

how long before a procedure is AB prophylaxis taken and what guidance is this from

A

1 hour

SDCEP guidance

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38
Q

what are indications of child abuse/neglect?

A
  • irregular attenders - only attend when in pain
  • delayed seeking attention/help for injuries
  • injuries to the triangle of safety (ears, neck and side of face)
  • Injuries to the head and neck
  • injuries to both sides of the body
  • untreated injuries
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39
Q

What would you ask if you suspect child abuse

A

ask what caused the injury and see if the story matches clinical finding

Has there been a reason for delay in seeking advice

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40
Q

who could you discuss concerns with about child abuse

A

Child protection adviser
Named safeguarding nurse

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41
Q

what are the stages in managing child neglect?

A

Preventative dental team management - raise concerns with the parents, offer support, set targets and monitor progress

Preventative multi-agency management - liase with other professionals (e.g. health visitor, GMP, school nurse) and agree joint plan of action

Child protection referral - follow local guidelines to refer to social services

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42
Q

how do you refer to child services?

A

initially by telephone
follow up referral in writing

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43
Q

what is the treatment for dentine enamel fracture

A

cover all exposed dentine with glass ionomer or composite

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44
Q

what would you look for clinically when monitoring this patient

A
  • normal mobility
  • no TTP
  • discolouration
  • Infection
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45
Q

what are radiographic signs a tooth is non vital

A

internal inflammatory resorption
External inflammatory resorption
Periapical abscess
Widened PDL
Loss of lamina dura

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46
Q

what appliance might help prevent injury to anterior teeth

A

splint

47
Q

explain the distribution of decay in nursing bottle caries

A

lower incisors protected by the tongue
Maxillary incisors are affected worst as they erupt first
Affects molar teeth
if habit continues teeth will be affected in the sequence of eruption

48
Q

what causes nursing bottle caries

A

going to bed with a bottle of milk or juice

prolonged breastfeeding

baby using bottle as a comforter rather than a dummy

inappropriate use of feeding bottles and cups - should not contain sugar juice or milk

49
Q

fluoride regime for 2 year old with caries

A

1500 ppmF toothpaste 2x daily

50
Q

fluoride regime for 2 year old with caries

A

1500 ppmF toothpaste 2x daily

51
Q

What are recommendations to make for toothbrushing

A
  • brush 2x daily with a smear of toothpaste (state concentration)
  • Parent should be brushing teeth for the child
  • do not rinse mouth after brushing
  • use a small headed toothbrush with soft bristles
52
Q

What are local causes of maloclussion

A
  • variation on tooth number
  • variation in tooth size or form
  • abnomralities of tooth position
  • Local abnormalities of soft tissue
  • Local pathology
53
Q

what are examples of variation in tooth number

A

supernumary teeth
hypodontia
Retained primary teeth
early loss of primary teeth
unschedules loss of permanent teeth

54
Q

what are the types of supernumary teeth

A

conical
tuberculate
supernumary
odontome

55
Q

what are 2 ways to assess AP skeletal pattern

A

Palpate skeletal bases
visual assessment

56
Q

what are possible non-skeletal factors that can because class 2 div 2 occlusion

A
  • lip trap
  • digit sucking
  • crowding
57
Q

what appliance can be used to correct class II div 2 malocclusion

A

functional appliance - twin block

58
Q

how does mandibular growth occur

A

growth occurs at condylar cartilage

growth occurs by surface remodelling ( resorption and deposition of bone)

results in increase in height of the ramus and increase in the length of the dental arch to accomodate teeth

growth is downwards and forwards

59
Q

why might patients with advanced alcoholic liver disease have increased risk of bleeding

A
  • thrombocytopenia
  • medication induced, patient may be taking heparin
  • liver disease may have been caused by hepatitis or HIV which both affect bleeding
  • clotting factors essential for coagulation are formed in the liver. If the liver is not functioning proerly these will not be present and affects coagulation ability
60
Q

What methods help prevent risk of osteoradionecrosis?

A
  • scale teeth near extraction site and use chlorohexidine mouthwash
  • careful extraction technique
  • antibiotics, chlorhexidine mouthwash and review
  • hyperbaric oxygen before and after extraction to increase local tissue oxygenation
  • close soft tissues
61
Q

when does collimation errors occur

A

when the axis is not truly horizontal. The photo receptor is unlevel

62
Q

What leads to overhangs in amalgam restorations

A

poor adaptation of the matrix band

excessive force applied when condensing amalgam

63
Q

what are short and long term complications of an overhang

A
  • difficult to clean
  • causes plaque accumulation
  • secondary caries
  • gingivitis and periodontal disease
64
Q

how do you correct an overhang

A

replace the restoration

use finishing strip

use soft flex files

65
Q

what special tests are used to diagnose NUG/P

A

There are no special tests

would take radiographs to see if there is any bone loss as probing may be extremely painful for the patient and bleeding may make probing difficult

66
Q

What are risk factors for NUG/P

A

Smoking
Stress
Immunocompormised
Malnutrition
Sleep deprivation
Poor oral hygiene

67
Q

With a necrotising gingival condition what is a risk of no treatment

A

The necrotising gingivitis can become necrotising periodontitis. This will lead to bone loss, tooth mobility and eventually tooth loss

68
Q

what is the treatment for necrotising gingivitis

A

Smoking cessation, diet advise, OHI

ultrasonic debridement

Prescribe 0.2% chlorhexidine mouthwash 2x daily as pain may prevent brushing

may prescribe antibiotics

69
Q

what antibiotic and dose is prescribed for NUG/P

A

metronidazole 400mg 3x daily for 3 days

70
Q

State each stage and its number

A

1 - Intercuspal Position
2 - Edge to edge
3 - protrusion
4 - maximum opening
5 - retruded axis position
6 - redruded contact point
7 - mandibular rest position

between 1 and 7 - freeway space

71
Q

what is the measurement for free way space

A

2-4mm

72
Q

what are border movements of the mandible

A

non functionl movements of the mandible

the maximum movement in each direction

73
Q

what is the terminal hinge axis

A

when the condyles of the mandible are in their most superior and posterior position in the glenoid fossa

74
Q

why is the retruded contact position important

A

it is the initial point of tooth contact during mandibular closure

It is used as a reference point for mouting casts on an ariculator

75
Q

What is the average value of the sagittal condylar guidance angle which may be used on an articulator

A

30 degrees

76
Q

what is the value of bennet angle on an average value articulator

A

15 degrees

77
Q

what are the principles of root canal shaping

A
  1. develop a continuously tapering funnel from the canal orifice to the apex
  2. maintain apical foramen in the original position
  3. Keep the apical opening as small as possible
78
Q

what measurement must canal obturation be from the apex

A

within 2 mm of radiographic apex

79
Q

what are objectives of irritant in root canal treatment?

A
  1. disinfection
  2. flush out debris from canal
  3. dissolve tissues in the canal
  4. lubricates root canal instruments
  5. removes the endodontic smear layer
80
Q

what is the primary endodontic irrigant and what concentration range is most effective

A

sodium hypochlorite 3%

concentration ranges from 0.5-5.25%

81
Q

what are factors affecting the function of endodontic irrigants

A
  • have a broad antimicrobial spectrum
  • able to dissolve tissue
  • must be able to prevent formation of the smear layer
  • little potential to because anaphylactic reaction
  • non toxic to periodontal tissues
82
Q

what are the differences between dental ceramic and normal

A
  • more glass in dental ceramics
  • more feldspar in dental ceramics
  • more kaolin in decorative ceramics
83
Q

what does translucent mean

A

the amount of light is can transmit through the substance

want this to be high for dental ceramic

84
Q

What does opalescence mean

A

difference in chroma between the reflected and transmitted colours

want material to be opalescent

85
Q

hoe do you bond composite to porcelain

A

silane coupling agent

86
Q

chemically how does silane coupling agent attach composite to ceramic

A

C=C double bonds in silane attach to the composite
oxide groups in the silance atttach to porcelain

87
Q

what is the function of silane coupling agent in composite

A

prevents moisture developing on the surface of glass ensuring good glass filler bond to the resin

88
Q

characteristics that make biofilm resistant

A

Gram negative

pili/fimbriae - allows bacteria to attach and overcome mechanical forces

capsule - virulence factor
- protects bacteria from immune cells and can mediate adhesion

endotoxins - part of outer cell wall and protects bacteria

exotoxins - gram positive, secreted by lysis to surrounding environment

89
Q

what microorganisms because caries

A

streptococcus mutans
lactobacillus acidophilus

90
Q

what microorganisms are found in the red section of socranskys model

A

p. gingivalis
tannerella forsythia
treponema denticola

91
Q

what aids adhesion and acid tolerance in caries forming microorganisms

A

synthesis of glucans

extrusion of H+ ions through ATPase

92
Q

what are systemic diseases associated with periodontal biofilms

A

periodontitis
Rheumatoid arthritits

93
Q

what are the 5 stages of the washer-disinfector cycle

A

pre-wash
wash
rinse
thermal disinfection
drying

94
Q

what is the purpose of the prewash cycle

A

saturates contamination and removes gross contamination

95
Q

what is the purpose of the wash cycle

A

supplemented by detergent to effectively remove biological mater

96
Q

what is the purpose of the rinse stage

A

removes remaining residue before disinfection

97
Q

what is the purpose f the thermal disinfection stage

A

actively kills microorganisms whith the use of heated water

98
Q

what is the purpose of the drying stage

A

uses hot ait to remove any remaining moisture from the surface of the instruments

99
Q

why is water removed between each stage of the WD

A

to remove the contamination within the machine

removes prions during wash stages as they cannot be deactivated by sterilisation

100
Q

what is a PICO and what does it mean

A

P - patiet/population
I - intervention
C - comparison/control group
O - outcome

101
Q

what is a randomised control trial

A

used for proving effectiveness of treatments

102
Q

what is the function of blinking and masking

A

to eliminate bias

103
Q

what is a cohort study

A

participants are recruited and followed over a period of time

can estimate incidence of disease
can investigate because of disease
determine prognosis

104
Q

how do you calculate absolute risk difference

A

difference in outcome between two groups

if = 0 there is no benefit as = is value of no difference

105
Q

how do you calculate the number needed to treat

A

1/ absolute risk difference

106
Q

what iss the number needed to treat

A

the number of patients you would need to treat to prevent one developing the condition

107
Q

how do you calculate risk

A

number of events of interest / total number of people in obsercation

108
Q

what is the value of no difference for risk ratio

A

1

109
Q

what if the CI overlaps the value of no difference

A

there is notsufficient evidence

110
Q

what are benefits of digital radiography over film radiography

A

doesn’t require chemical processing
easy storage
easy back up of images
easy transfer of images
images can be manipulated
Images can be integrated into patient records

111
Q

what is a benefit of rectangular collimation

A

is can reduce dose of radiation patient is exposed to

112
Q

what chemical property of lead makes it effective at absorbing photons

A

density and has a large number of electrons

113
Q

what does ALARP stand for

A

As low as reasonably possible

114
Q

what is the minimum distance recommended for a dentist o be away from radiographs

A

1.5m

Need to Know (21 decks)

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