2021 Flashcards
What nerves must be anaesthetised to remove tooth 48 safely
Inferior Alveolar Nerve
Lingual nerve
Long buccal nerve
What are two different ways to assess anaesthesia has been achieved?
- Probe around the tooth and ask the patient if they feel anything sharp
- ask if the patients lips and tongue feel numb
What is the dental terminology for pins and needle feeling or partial loss of sensation ?
Parasthesia
What is the dental terminology for painful, unpleasant sensation lasting for a fraction of a second ?
dysesthesia
What is the dental terminology for total loss of sensation?
Anaesthesia
What are 3 clinical reasons that could account for neurological-sensory deficits?
- crushing injury
- cutting/shredding injury
- transection of the nerve
- damage due to LA
What is the correct terminology for dry socket?
localised alveolar osteitis
What are predisposing factors of dry socket?
- 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
What are signs and symptoms of sry socket ?
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
What is the management for dry socket?
- 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
What are risk factors of oral cancer ?
- smoking
- Alcohol intake
- HPV
- sunlight
- nutritional deficiencies
- candida infections
What radiation dose increases the risk of osteoradionecrosis?
doses over 60 Gy
What are oral complications of radiotherapy?
- 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
what sites of the teeth are affected by radiation caries?
- gingival margins and incisor edges
what are causes of radiation caries?
- dry mouth
- loss of taste
- change in diet
- hypersensitivity of teeth makes OH difficult
What do you need to know about patients who have had radiotherapy?
- what dose of radiation was given
- what area of the body was exposed to the radiation
- duration of treatment
What are preventative measures used for patients who have had radiotherapy?
- OHI
- higher concentration of fluoride toothpaste
- fluoride varnish
how do you treat osteoradionecrosis?
- irrigation of necrotic debris
- remove loose sequestra
What methods help prevent risk of osteoradionecrosis?
- 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
What is the most common cause of facial trauma in a female patients?
Domestic Abuse
What are the forms of abuse that may be involved in domestic abuse?
- Physical violence
- Verbal abuse
- Emotional abuse
- Sexual abuse
- Financial Abuse
What process should you follow to ask about the possibility of domestic abuse
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
What are physical signs you may see in domestic abuse ?
- 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
What are causes of liver cirrhosis
- Alcohol
- Hepatitis virus
- fatty liver disease
- autoimmune causes:primary billary cirrhosis
- haemochromatosis
- hepatocellular carcinoma
- drug induced
what does dentally fit mean
- no active pathology
- consider removing teeth of poor long-term prognosis
- establish preventative plan
why should a patient be dentally fit before a transplant
the patient will be immunosuppressed for the rest of their life so must reduce the risk of further dental intervention in the future
what teeth can be justified to extract when making a patient dentally fit
teeth with periapical periodontitis or other pathology
teeth with poor prognosis - highly restored and secondary caries
what causes thrombocytopenia to occur
splenic sequestration
impaired hepatic synthesis
increased degredation of thrombopoeitin by platelets sequestered in the congested spleen
drug related - alcohol, penecillin based drugs or heparin
what platelet level is considered safe to treat in general practise
> 100 x 10^9 / L
why might patients with advanced alcoholic liver disease have increased risk of bleeding
- 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
What are the types of dementia
Alzheimers
Vascular dementia
Dementia with lewy bodies
what are early stages of dementia?
Short term memory loss
confusion
Anxiety, agitation or distress
Communication issues - decline in ability to talk or write
What are middle stages of dementia
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
what are end stage
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
who can provide section 47 AWI certificate for dental treatment
dentist who has done additional training
general medical practicioners
consultants in-charge of patient care
What is the antibiotic and dose given for antibiotic prophylaxis
amoxicillan 3g
clyndamicin 600mg
how long before a procedure is AB prophylaxis taken and what guidance is this from
1 hour
SDCEP guidance
what are indications of child abuse/neglect?
- 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
What would you ask if you suspect child abuse
ask what caused the injury and see if the story matches clinical finding
Has there been a reason for delay in seeking advice
who could you discuss concerns with about child abuse
Child protection adviser
Named safeguarding nurse
what are the stages in managing child neglect?
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
how do you refer to child services?
initially by telephone
follow up referral in writing
what is the treatment for dentine enamel fracture
cover all exposed dentine with glass ionomer or composite
what would you look for clinically when monitoring this patient
- normal mobility
- no TTP
- discolouration
- Infection
what are radiographic signs a tooth is non vital
internal inflammatory resorption
External inflammatory resorption
Periapical abscess
Widened PDL
Loss of lamina dura
what appliance might help prevent injury to anterior teeth
splint
explain the distribution of decay in nursing bottle caries
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
what causes nursing bottle caries
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
fluoride regime for 2 year old with caries
1500 ppmF toothpaste 2x daily
fluoride regime for 2 year old with caries
1500 ppmF toothpaste 2x daily
What are recommendations to make for toothbrushing
- 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
What are local causes of maloclussion
- variation on tooth number
- variation in tooth size or form
- abnomralities of tooth position
- Local abnormalities of soft tissue
- Local pathology
what are examples of variation in tooth number
supernumary teeth
hypodontia
Retained primary teeth
early loss of primary teeth
unschedules loss of permanent teeth
what are the types of supernumary teeth
conical
tuberculate
supernumary
odontome
what are 2 ways to assess AP skeletal pattern
Palpate skeletal bases
visual assessment
what are possible non-skeletal factors that can because class 2 div 2 occlusion
- lip trap
- digit sucking
- crowding
what appliance can be used to correct class II div 2 malocclusion
functional appliance - twin block
how does mandibular growth occur
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
why might patients with advanced alcoholic liver disease have increased risk of bleeding
- 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
What methods help prevent risk of osteoradionecrosis?
- 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
when does collimation errors occur
when the axis is not truly horizontal. The photo receptor is unlevel
What leads to overhangs in amalgam restorations
poor adaptation of the matrix band
excessive force applied when condensing amalgam
what are short and long term complications of an overhang
- difficult to clean
- causes plaque accumulation
- secondary caries
- gingivitis and periodontal disease
how do you correct an overhang
replace the restoration
use finishing strip
use soft flex files
what special tests are used to diagnose NUG/P
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
What are risk factors for NUG/P
Smoking
Stress
Immunocompormised
Malnutrition
Sleep deprivation
Poor oral hygiene
With a necrotising gingival condition what is a risk of no treatment
The necrotising gingivitis can become necrotising periodontitis. This will lead to bone loss, tooth mobility and eventually tooth loss
what is the treatment for necrotising gingivitis
Smoking cessation, diet advise, OHI
ultrasonic debridement
Prescribe 0.2% chlorhexidine mouthwash 2x daily as pain may prevent brushing
may prescribe antibiotics
what antibiotic and dose is prescribed for NUG/P
metronidazole 400mg 3x daily for 3 days
State each stage and its number
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
what is the measurement for free way space
2-4mm
what are border movements of the mandible
non functionl movements of the mandible
the maximum movement in each direction
what is the terminal hinge axis
when the condyles of the mandible are in their most superior and posterior position in the glenoid fossa
why is the retruded contact position important
it is the initial point of tooth contact during mandibular closure
It is used as a reference point for mouting casts on an ariculator
What is the average value of the sagittal condylar guidance angle which may be used on an articulator
30 degrees
what is the value of bennet angle on an average value articulator
15 degrees
what are the principles of root canal shaping
- develop a continuously tapering funnel from the canal orifice to the apex
- maintain apical foramen in the original position
- Keep the apical opening as small as possible
what measurement must canal obturation be from the apex
within 2 mm of radiographic apex
what are objectives of irritant in root canal treatment?
- disinfection
- flush out debris from canal
- dissolve tissues in the canal
- lubricates root canal instruments
- removes the endodontic smear layer
what is the primary endodontic irrigant and what concentration range is most effective
sodium hypochlorite 3%
concentration ranges from 0.5-5.25%
what are factors affecting the function of endodontic irrigants
- 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
what are the differences between dental ceramic and normal
- more glass in dental ceramics
- more feldspar in dental ceramics
- more kaolin in decorative ceramics
what does translucent mean
the amount of light is can transmit through the substance
want this to be high for dental ceramic
What does opalescence mean
difference in chroma between the reflected and transmitted colours
want material to be opalescent
hoe do you bond composite to porcelain
silane coupling agent
chemically how does silane coupling agent attach composite to ceramic
C=C double bonds in silane attach to the composite
oxide groups in the silance atttach to porcelain
what is the function of silane coupling agent in composite
prevents moisture developing on the surface of glass ensuring good glass filler bond to the resin
characteristics that make biofilm resistant
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
what microorganisms because caries
streptococcus mutans
lactobacillus acidophilus
what microorganisms are found in the red section of socranskys model
p. gingivalis
tannerella forsythia
treponema denticola
what aids adhesion and acid tolerance in caries forming microorganisms
synthesis of glucans
extrusion of H+ ions through ATPase
what are systemic diseases associated with periodontal biofilms
periodontitis
Rheumatoid arthritits
what are the 5 stages of the washer-disinfector cycle
pre-wash
wash
rinse
thermal disinfection
drying
what is the purpose of the prewash cycle
saturates contamination and removes gross contamination
what is the purpose of the wash cycle
supplemented by detergent to effectively remove biological mater
what is the purpose of the rinse stage
removes remaining residue before disinfection
what is the purpose f the thermal disinfection stage
actively kills microorganisms whith the use of heated water
what is the purpose of the drying stage
uses hot ait to remove any remaining moisture from the surface of the instruments
why is water removed between each stage of the WD
to remove the contamination within the machine
removes prions during wash stages as they cannot be deactivated by sterilisation
what is a PICO and what does it mean
P - patiet/population
I - intervention
C - comparison/control group
O - outcome
what is a randomised control trial
used for proving effectiveness of treatments
what is the function of blinking and masking
to eliminate bias
what is a cohort study
participants are recruited and followed over a period of time
can estimate incidence of disease
can investigate because of disease
determine prognosis
how do you calculate absolute risk difference
difference in outcome between two groups
if = 0 there is no benefit as = is value of no difference
how do you calculate the number needed to treat
1/ absolute risk difference
what iss the number needed to treat
the number of patients you would need to treat to prevent one developing the condition
how do you calculate risk
number of events of interest / total number of people in obsercation
what is the value of no difference for risk ratio
1
what if the CI overlaps the value of no difference
there is notsufficient evidence
what are benefits of digital radiography over film radiography
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
what is a benefit of rectangular collimation
is can reduce dose of radiation patient is exposed to
what chemical property of lead makes it effective at absorbing photons
density and has a large number of electrons
what does ALARP stand for
As low as reasonably possible
what is the minimum distance recommended for a dentist o be away from radiographs
1.5m
