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2024 Flashcards

1
Q

what clinical investigations can confirm a candida diagnosis?

A

Smear, biopsy, swab, oral rinse

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2
Q

treatment options/advice for chronic hyperplastic candidosis?

A

smoking cessation
Improve OH
Systemic fluconazole - 1 50mg tablet a day for 7 days

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3
Q

a. List 4 factors causing endo-perio lesion

A

i. Root fracture due to trauma
ii. Root /pulp/ furcation perforation
iii. Pulpal necrosis due to caries which secondarily affects periodontium
iv. Periodontal destruction secondarily affecting root canal

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4
Q

List 3 special investigation before determine fixed option

A

i. sensibility test of abutments
ii. Radiographs to assess periapical status and periodontal status.crown to root ratio, min should be 1:1. (length of tooth coronal to alveolar crest compared to length of root embedded * Alveolar bone levels
* Width and completeness of periodontal membrane space
* Root form and length
* Extent & adequacy of coronal restorations
* Periradicular status
* Pre-existing endodontic treatment
iii. Impressions to form cast to assess POI

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5
Q

List 2 non-periodontal challenges to decide fixed replacement

A

?

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6
Q

What is facebow used in dentistry

A

i.Transfers position and angulation of maxillary plane in relation to three bony reference points of the patient : EAM, nasion and infraorbitale.
It transfers this to a mandibular hinge axis on the articulator
Allows mounting of upper cast on an articulator such that the relation of the occlusal plane to the axis of rotation approximated that in the patient

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7
Q

List 4 materials/method to record ICP and aid articulation of lower cast analysis

A

i. Wax
ii. Registration paste
iii. Natural occlusal stops / index teeth
iv. Record blocks – free end saddles

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8
Q

Which 2 types of articulator suitable for facebow

A

i. Average value articulator
ii. Semi-adjustable

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9
Q

List 4 requirements for minimizing bias in RCT (2)

A

i. Randomisation
ii. Inclusion/exclusion criteria
iii. Control group
iv. Blinding/masking

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10
Q

What clinical features/symptoms to diagnose trigeminal neuralgia

A

i. Severe stabbing pain, electric shock like pain, mask like face, 5-10 seconds, paroxysmal, concomitant continuous pain.

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11
Q

b. List 2 other drugs for TN besides carbamazepine

A

oxycarbazipine
lamotrigine
pregalin
gabapentin
phenytoin

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12
Q

Why is TN pain worst in the morning ?

A

i. Medication used to treat TN wears off overnight, so by morning time symptoms re appear

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13
Q

how can TN pain be alleviated other than mediciation?

A

avoiding known triggers such as cold air/water.
?

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14
Q

List 3 factors can be seen on MRI of the nerves for the aetiology of TGN

A

i. Vascular compression of the nerve
ii. Space occupying lesion
iii. Multiple sclerosis

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15
Q

other than burnign sensation, What 2 other intraoral symptoms patient complains of in BMS?

A

i. Dry mouth
ii. Altered sensation

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16
Q

What psychological disease can this be associated with BMS (1) and what can you do about it (1)

A

i. Anxiety /cancerphobia
ii. Reassure of benign nature

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17
Q

Patient doesn’t want medical treatment for BMS and decides to just have symptomatic therapy, give 2 advices to the patient

A

sucking on ice, sipping cold water
avoiding acidic/spicy foods/drinks

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18
Q

tests for BMS?

A

blood tests - haematinics, FBC
Allergy tests

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19
Q

investigations to be carried out for a discoloured tooth?

A

i. Sensibility tests
ii. Radiographic if indicated
iii. Trauma stamp

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20
Q

causes of tooth discolouration

A

extrinsic - smoking, tannins, CHX, iron supps, chromogenic bacteria
Intrinsic - fluorosis, tetracycline, amalgam, gp, porphyria, hyperbilirubinemia, physiological aging, anaemia

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21
Q

treatment options for discolouration and disadvantages.

A

HCl pumice microabrasion - HCl is caustic, must be in surgery, cannot be delegated, protective apparatus required for all parties.
internal bleaching - failure to bleach, overbleaching, leaking bleach, external cervical root resorption, brittleness of tooth crown
external bleaching - sensitivity, wears off, gingival irritation
resin infil - durability of long term aesthetics unknown
composite veneers - destructive
crowning

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22
Q

what is the advantage of using a temporary achorage device?

A

gain absolute anchorage

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23
Q

factors in caries risk assessment

A

fluoride
clinical evidence
plaque control
saliva
social history
medical history
diet

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24
Q

4 non pharmacological way to manage his anxiety (4)

A

i. Psycho education
ii. CBT
iii. Stop go signals
iv. Breathing techniques

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25
Q

List medications that dentist can prescribe and do for his anxiety

A

i. Diazepam – orally - 1 5mg tablet 2 hours before procedure
ii. Midazolam – IV – 2mg then 1mg every 60 seconds, max ~7.5mg
iii. Nitrous oxide – inhalation – up to 10L/min

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26
Q

List 2 advantages and disadvantages of implant

A

i. Advantages
1. Withstand high occlusal forces
2. Maintains bone levels in jaw
ii. Disadvantages
1. Costly
2. Invasive
3. Not appropriate if patient looking for short term fix

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27
Q

List 4 things you’d cover when asking about smoking cessation

A

when did you start?
how many?
what do you smoke?
every tried quitting?
anything helped whilst you tried quitting?
use of any smoking cessation methods such as nicotine patches or vape?

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28
Q

define attrition, erosion, ,abrasion and abfraction.

A

attrition - physiological tooth wear as a result of tooth to tooth contact
erosion - wear attributed to a chemical stimulus and not from bacterial cause
abrasion - wear attributed to a repeated external stimulus contacting tooth surface
abfraction - wear as a result of eccentric occlusal forces, leading to compressive and tensile stresses at the cervical fulcrum area

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29
Q

List 4 factors causing combination of erosion + attrition (2)

A

acidic drinks
GORD
Bullimia
bruxism

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30
Q

Decide to place composite on anterior teeth. Describe dahl technique for this case

A

placement of composite or CoCr on the palatal aspect of upper anterior teeth for lower incisors to occlude with, this creates posterior disclusion and encourages posterior eruption. this would increase the patietns OVD and create space for anterior restorative work

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31
Q

How many mm minimum for composite in anterior teeth (1)

A

2mm?

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32
Q

e. What do you suggest to do before restorative treatment on tooth wear case, list 4

A

deal with caries
deal with active perioidentify aetiological cause and remove/create plan to remove habit
take preoperative records such as casts,photographs

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33
Q

What could be the reasons for the fractured filling (3)

A

biting on hard objects
bruxism
large restoration

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34
Q

perio outcomes to determine success?

A

<=4mm pockets
<10%BOP
no BOP in 4mm pockets

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35
Q

The dental hygienist will be performing subgingival PMPR for this patient. What should you specify to the dental hygienist in the notes about the local anaesthesia? (3)

A

type of anaesthesia (i.e. brand or generic name, strength);
* maximum dosage (i.e. maximum number of cartridges);
* frequency (e.g. as required);
* route of administration (e.g. by injection).

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36
Q

List 3 features more likely to create OAC (3)

A

increasing pressure - valsalva manouvre, playing wind instruments, sea diving.
when probing a suspected OAC, not being gentle enough

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37
Q

List 6 clinical signs of OAC (3)

A

bubbling of socket
direct vision - unable to see bottom of socket/light not reflected
bone at furcation of roots
gentle probing for feel of atral lining
nose holding test and asking pt to gently blow as to see any blood/air coming out
suction - echo

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38
Q

Small OAC so manage conservatively. List 4 post-op instructions specifically for OAC (4)

A

avoid wind instruments
avoid deep diving
dont try to hold in sneeze
avoid blowing nose hard

39
Q

List 4 factors causing spread of infection (4)

A

size of root
root in relation to muscle attachments
position in arch
path of least resistance ?

40
Q

4 signs of SIRS (4)

A

temp <36 and >38
HR >90bpm
Resp rate >20bpm
WCC >4 <12g/L

41
Q

SEPSIS red flags?

A

HR >130bmp
resp rate >=25pm
systolic BP <90 or drop of >40
not passed urine in last 18 hours
only responsive to voice or unresponsive
requires oxygen to keep SpO2 >=92%

42
Q

Patient wants implant treatment in the future. What 4 things would you want to plan before that?

A

reduce/quit smoking
control diabetes
manage active perio
?

43
Q

What 4 things would you discuss with patient about implant treatment?

A

cost
risks associated such as implant failure to osseointegrate, periimplant mucositis, periimplantitis,
the procedure itself being long winded and invasive.
alternative treatment options

44
Q

List 2 main features of the modified lap pontic and their benefits

A

pontic continues down to the ridge buccally - increased aesthetic
pontic has lingual aspect removed - can reduce less likely to cause blanching of tissues

45
Q

2 post op instructions for any patients receiving bridgework (1)

A

use of superfloss and interdental brushes to clean in hard to reach areas

46
Q

What does Oxyguard do and what is the purpose? (

A

?

47
Q

3 dental features of this malocclusion, class 3, that are difficult to correct with orthodontic appliances alone in an adult

A

> number of teeth in anterior crossbite
A-P discrepancey
AOB

48
Q

4 features of good posterior restoration

A

functional cusps contacting fossa of opposing tooth
no interproximal voids
no overhangs
restores tooths original morphology

49
Q

8 factors you would discuss with patient to obtain valid consent for extraction

A

what the treatment involves - LA, pushing and pulling using different instruments to remove the tooth
the risks involved with the treatment - they may experience pain,infection,bleeding,bruising, temporary or permanent nerve damage, damage to adjacent structures, failure to remove whole tooth and thus requiring surgical removal.
the benefits of treatment - pain relief, removal of infection
Alternative options to the treatment - doing nothing
Patient must have the capacity in order to make their decision - this would be based on the clinicians assessment of the patient.

50
Q

4 main causes of stress in dentistry (4)

A

trying to keep up with patient expectations
time pressure
difficult procedures
sit in same position for hours

51
Q

3 main sociodemographic risk factors for oral cancer and state which one is highest risk (3)

A

smoke and drink (x5)
betel quid paan (x3)
socioeconomic (x2)

52
Q

4 modifiable risk factors for OC (4)

A

stopping smoking
limit alcohol consumption
improve diet - eating fruit and veg
improving OH - reduce candida in mouth

53
Q

c. What recently rising risk factor means its important to differentiate between oral cavity cancer and oropharyngeal cancer? (1)

A

Number of sexual partners?

54
Q

a. 3 clinical or investigational features to confirm autoimmune bullous disease MMP? (3)

A

Nickolskys sign - Postive in MMP, this is where the outer layer can be removed by rubbing the skin/mucous membrane of the bulla.
DIF - Linear IgG or C3 staining along the basement membrane
IIF - circulating autoantibodies BP180/230
Histopathology - full thickness separation of epithelium from lamina propria

55
Q

2 types of investigations that can be done from patient’s blood sample (VB)

A

IIF
DIF

56
Q

2 other differential diagnoses for subepithelial bullous disease apart from mucous membrane pemphigoid

A

Angina Bullosa Haemorhagica

57
Q

First line drug is prednisolone for MMP. What other systemic drug can oral med prescribe?

A

Immune modulating drugs - azathioprine, mycophenolate

58
Q

What other mucosal area can you get pemphigoid?

A

eyes
genitals

59
Q

What type of antigen detected in MMP?

A

BP 180 or 230

60
Q

3 histological features of reticular lichen planus (3)

A

patchy acanthosis
parakeratosis
basal cell damage
T lymphocyte infiltration into the lamina propria
elongated rete ridges

61
Q

2 tx management strategies for pericoronitis?

A

extraction of M3M
coronectomy
extraction of maxillary 3M
Operculectomy

62
Q

3 signs of close proximity to IAN canal (3)

A

deflection of the roots near the canal
defelction of the canal
darkening of the roots crossing the canal
interuption of the lamina dura of the canal
narrowing of root
narrowing of canal

63
Q

6 warnings to give pt before doing surgical extraction of 38

A

risk of nerve damage - temporary, or permanent. altered sensation, reduced, loss of sensation
damage to adjacent tooth and its restoration
pain, bleeding, bruising swelling,
mandibular fracture if lone standing molar at border of mandible
dry socket
trismus

64
Q

2 nerves likely to be at risk for coronectomy (2)

A

lingual nerve
long bucal nerve

65
Q

How does bisphosphonate work and what can it cause in patient

A

reduce bone resorption by inhibiting enzymes essential to the formation, recruitment and function of osteoclasts

66
Q

Target INR for patient taking Warfarin?

A

2-3

67
Q

INR for safe treatment?

A

<4

68
Q

How would you manage patient taking Apixaban (4)

A

dependant on bleeding risk:
Low risk where for example 1-3 extractions with restricted wound size/ 6PPC/ Subgingival scaling/ incision and drainage of swellings then no change is required.
high risk where >3 teeth being removed or they are adjacent to eachother/flap raising procedures/biopsies then apixaban users should miss their morning dose and take thier evening dose as per usual

69
Q

Other than using an apex locator, describe 2 ways that can be used to determine the working length. (2

A

working length radiograph with small K file in situ
paper point method where moist/blood at bottom of paper point indicates apical foramen

70
Q

What can affect accuracy of apex locator. (2)

A

residual caries
previous restorations not removed fully
improperly dried canal
faulty apex locator

71
Q

What can you do for MIH of 6s besides extraction

A

FS
composite/gic restorations
SS crowns
desensitising agents - FV

72
Q

Talk to the mum about extraction of MIH 6s and when?

A

if prognosis very poor, interceptive removal at the correct time can prevent the need for orthodontics in the future
bifurcation of 7s and presence of 8s is the indicator for ideal time of removal

73
Q

3 questions to ask mom regarding MIH.

A

Prenatal - 3rd trimester pre eclampsia, gestational diabetes
peri natal - low birth weight, cessarian section,
post natal - first 4 years of life: antibiotic use, asthma, meales, rubella, pneumonia, dioxins in breast milk

74
Q

Effects of severe asthma on mouth, advise to be given after inhaler use (8)

A

Severe asthma - colophony allergy and FV contraindicated
inhaled steroids causing candida
increased mouthbreathing = dry mouth - gingivitis and caries
use spacer device when using inhaler
rinse mouth after steoird inhaler use

75
Q

8 ulcer questions

A

where do you get ulcers?
how many ulcers do you get?
how long do they last?
are they painful?
how big are they?
do they recur?/how often do you get them?
do you have any medical/family history which may predispose you to ulcers?
are you taking any medications for your heart? (nicorandil)

76
Q

How would you inform the mother about the condition (primary herpetic gingivostomatitis) and it’s aetiology (5)

A

i would suspect based on symptmoms that they have PHGS, this is a condition caused by a viral infection from a group of conditions called human herpes virus, this specifically is from Herpes simplex virus type 1. it is likely that your child came into direct contact with someone with the virus. this virus is very common and typically presents with blistering that become ulcers and can be quite painful for the child, the virus usualy clearly up on its own within 10 days. it is possible due to the nature of the virus that it can reactivate and reoccur and present differently in what is called secondary infection.

77
Q

Management for Primary herpetic gingivostomatitis(4)

A

local measures - nutritious diet, plenty of fluid intake, bed rest.
medications - Antiseptic m/w CHX 0.5% 10ml 2x daily.
for severe infection/immunocompromised patient then systemic aciclovir 200mg 5x daily for 5 days and referral to specialist

78
Q

what 4 methods of prevention are there for MIH (4)

A

OHI
FV
FS
2800ppmf toothpaste

79
Q

if the sterilisation temperature of a cycle acheives a temperature of 135.2 degrees what is the corresponding pressure randge in bar and the minimum hold time?

A

3.05 - 3.35
minimum hold 3 minutes

80
Q

if instruments need to be sterile at the point o fuse, how should they be prepared for processing and what equipemnt must be used?

A

instruments must be wrapped prior to processing
a type B or vacuum capable machine must be used

81
Q

on a daily basis, what 4 bits of information must be recorded from the first production cycle of the day?

A

cycle number
sterilisation temperature
hold time
pressure

82
Q

4 types of purified water that can be used in a steriliser?

A

distilled
deionised
reverse-osmosis
sterile

83
Q

what part of the SHTM-01 provides guidelines for operating and testing sterilisers?

A

Part C

84
Q

apart from space maintenance, list three uses of a passive URA.

A

OB reduction
habit breaker
retainer

85
Q

name types of space maintainers

A

URA
Fixed palatal arch
band and loop

86
Q

name four active components of a URA

A

Z spring
palatal finger spring
buccal canine retractor
roberts retractor
Hyrax Screw

87
Q

how would you judge if a patient has been using their URA?

A

walk into appointment wearing it
active components are now passive
no diffciulty with speech with appliance in
no excess salivation
signs of wear on the acrylic
indentation marks on the palate
able to remove and insert proficiently
signs of tooth movement

88
Q

assuming there is no relevant medical history, suggest 3 general factors which need to be considered before referring patient for consideration for implants

A

discussion with patient regarding what implants are and the process of recieving them (invasiveness/surgical aspect)
cost
periodontal history
smoking
good OHI
lack of viable bone

89
Q

list factors local to site of the proposed implant which will be assess for the implant treatment

A

bone width between adjacent teeth
thickness of bone bucco palatal
root position of adjacent teeth
soft tissue adequacy
smile line
gingival biotype
plaque control/perio health

90
Q

3 potential complications when consenting patient for implant retained bridge

A

implant failure
peri-implantitis
periimplant mucositis
crown fracture
screw fracture
recession

91
Q

why are lower incisors more at risk of recession in the traumatic OB patient

A

thin gingival biotype
thin buccal bone

92
Q

what signs and symptoms of recession

A

cervical caries
sensitivity
poor aesthetics

93
Q
A

PP (1 decks)

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