2024 Flashcards
What 2 intra-oral radiographs would you want to take for a patient who is in pain in teeth 45 and 46?
Right bite wings
Lower right periapicals
What are you looking to assess from the radiograph of a patient presenting with pain on tooth 46 and 45?
- periapical pathology
- Caries
- Fractures in teeth
- overhanging or defective restoration margins
What other tests to do?
- sensibility testing
- percussion (TTP)
- tooth slooth test
What are the radiographic signs of cracked tooth syndrome?
- periapical pathology secondary to crack
- PDL widening
- radiolucencies within the tooth suggesting a crack
What are the treatment options for cracked tooth syndrome?
- do nothing
- Extract (if the crack is subgingival and tooth not restorable)
- If restorable and extends to pulp = RCT + crown
- If does not extend to pulp = restore and review
What to consider for the long term prognosis of the tooth?
- Site of fracture and extent
- Remaining tooth structure
- tooth vitality (pulpal involvement)
3 things about acrylic that makes it good for a denture?
- easy to repair
- high hardness and high fatigue strength
- cost effective
What property of acrylic makes it more prone to fracture on impact?
Brittleness as it has low impact resistance
What are 3 common fracture features if an acrylic denture dropped?
- midline fracture
- tooth detaches from denture base
- loss of flange
features of CoCr denture fracture?
Acrylic detaches from CoCr plate
Clasp fractures or bends
Other than impact or acrylic properties why would it break?
Parafunctional habits
Occlusion such as deep overbite
Problems with bonding between tooth and acrylic base
Denture processing problems
Woud you need to take an impression of the current denture?
no
denture breakes from midline twice again what else would you do to enhance the palate?
- Enhance to palate with metal mesh or fibre
If the denture breaks again after rebasing or religning what would you include in the new design?
- Cocr Palatal coverage with acrylic post dam
- Acrylic crosslinking of denture teeth
- Cocr Backing of teeth
Other than erosion, abrasion and attrition, give 4 other intra-oral signs of wear?
- polished restorations
- sensitivity
- Cracks or fractures in enamel
- abfraction
- Flattened occlusal surfaces
If 21 is discoloured and non vital, what is the best treatment option?
Internal bleaching using the walking bleach technique
What is the least invasive rehabilitation technique for localised anterior wear?
DAHL technique
Why does the DAHL technique makes posterior support better?
- gain space for anterior build ups
- no need for occlusal reduction
- posteriors erupt into place and gain support leading to more balanced distribution of occlusal forces
What 6 clinical records would you need for tooth-wear rehabilitation?
- Sensibility testing
- Radiographs
- Articulated study models
- Diagnostic wax ups
- Occlusion - RVD, OVD, freeway space
- Facebow registration
- Clinical photos
What things about non-y2 amalgam that makes it better than normal amalgam?
- high corrosion resistance
- higher compressive strength
- less creep
- higher early strength
How is non-y2 amalgam made?
by mixing silver copper particles with silver tin lathe cut particles to produce high copper y-2 free amalgam
What are the aims of the minimata convention?
- Promote mercury free alternatives
- Phase down dental amalgam use
- Raise awareness about the risks of mercury
- Monitor mercury exposure and provide health advice
What are the decisions made by the minimata convention?
- designate a special waste stream for mercury
- phase down the use of dental amalgam
- control measures on mercury emissions to air water and land
- restrict amalgam use to its encapsulated form
- educate dental professionals and dental student on using other amalgam free alternatives
What other investigations would you need for a vertical bone loss on 46 ( PA , MPBS and BPE is given)
6PPC
OPT
How does vertical bone loss occur?
- Plaque accumulation on one side of the tooth in deep areas (scalloping) , this makes it hard for access for cleaning
What is the initial treatment for a patient presenting with a vertical bony defect?
step 1 according to S3 guidelines (BSP)
- OHI advice
- Supra and sub gingival PMPR
- Education about periodontal disease and risk factors
- Risk factor control and behavioural management
What are the treatment options after Step 1 and Step 2 if symptoms of vertical bony defect persists?
step 3
- Targeted subgingival PMPR
- Open flap surgical instrumentation
- pocket elimination with osseos resection where the flap is repositioned apically
- regenerative surgery such as bone, PDL and cementum grafting
Comment on the appropriateness of a splint for a subluxation trauma on tooth 21 and 22 ( photographs show big composite and splint only includes 21 and 22 )
- Not appropriate
- Splint is not extending to adjacent teeth
- Composite restorations are very big
- Composite restorations are not placed in the middle of the teeth
When would you review a subluxation trauma after providing a splint?
- After 2 weeks , remove splint and do a trauma stamp to monitor progress and ask about any symptoms
Give 3 cellular pulpal changes that may cause sensitivity in MIH?
- increase in neural density in the pulp horn and subodontoplastic region - more sensitive to stimuli due to high neural density
- Significant increase in immune cells accumulation - more inflammatory response
- high vascularity - higher blood flow therefore higher pain and sensitivity
Give three dental theories for pain by MIH?
- Dentine hypersensitivity - porous enamel or exposed dentine facilitates fluid flow within dentine tubules to activate A- alpha nerve fibres (hydrodynamic theory)
- Peripheral sensitisation - underlying pulpal inflammation lead to sensitisation of C fibres
- Central sensitisation - from continued nociceptive input
Apart from temporary dressing what other treatment options are available for MIH?
- Extraction
- Stainless steel crowns
- composite restorations
What drug is taken one week and the patient is standing up while taking it?
Alendronic acid
What do you want to know about the drug and MH for a patient taking alendronic acid?
- If they take this drug for a bone condition
- when have they started taking the drug and what dose?
- have they ever been given a drug through blood infusion?
- why are they prescribed this drug?
- if they have or had cancer before?
What to tell patient if ask that they should stop taking their their bisphosphonates drug
- it is not advisable to stop the drug as it is important for the treatment
- risks of stopping the drug and it may worsen their condition
- The risks and dental treatment is low and may not require stopping treatment
- It is best to discuss this decision with the prescribing clinician
- keeping good oral hygiene and stopping smoking after the procedure can reduce the risk of developing MRONJ
Give 8 post op extraction complications?
- bleeding
- bruising
- pain
- infection
- nerve damage
- swelling
- sequestrum
- trismus
- infection
- dry socket
If pt comes back bleeding the next day after extraction what would you do to the patient?
- Apply pressure with cotton wool
- Reassure patient
- take a history (ask if they are on blood thinners)
- sutures
- use floseal
- use haemocollagen sponge
If patient comes back bleeding for the second time and you manage to stop it what would you do?
- refer to specialist and consult general practitioner for any underlying condition , transexamic acid can be prescribed if suspected bleeding disorder
What are 5 ways to know that you are treating the correct tooth?
- mark the tooth with a pen
- check patient notes and charting
- compare with radiographs
- ask patient about their complaint and symptoms
- Count the teeth
give three predictable factors of malignancy in oral leukoplakia?
- location of the lesion in the oral cavity (floor of the mouth and lateral border of the tongue higher rate )
- if the patient is a smoker it is a higher risk
- the appearance of the lesion (non-homogenous)
- duration of the lesion
What are 4 types of oral lichenoid reactions according to van der waal 2009?
- Amalgam restoration OLL
- Drug related OLL
- Chronic graft verses host disease
- lichen planus-like lesions that lack one or more clinical characteristics of LP
Give 3 histopathological signs of lichen planus?
- band of lymphocytic infiltrate
- Civatte bodies
- elongated rete pegs
- orthokeratosis
What are the short term effects radiation therapy?
Xerostomia
Mucositis
Increased caries risk
difficulty swallowing
infection
erosion
What 2 strains of HPV are associated with oropharyngeal tumerigenosis
16 and 18
Give 3 diagnostic factors of autoimmune membrane blistering diseases?
- nikolsky’s sign
- direct immunoflusence
- histopathological analysis
Describe the histology and direct immunofluresence of pemphigus vulgaris?
-Histological it can present with acantholysis, supra-basal split and tzank cells are present
- Direct immunofluorescence shows basket weave pattern with IgG and C3 deposits
What antibodies are involved in pemphigus vulgaris?
- Desmoglein 1 and 3
Immunosuppressants that can be used for pemphigus?
Azathioprine and mycophenolate
What is the lahsal classification for unilateral upper cleft lip and palate?
LAHS
Give the careway pathway with dates and stages of cleft lip and palate children
3 months - lip closure
6-12 months - palate closure
8-10 years - alveolar bone graft
12-15 years - definitive orthodontics
18-20 years - surgery
What dental anomalies that can be associated with cleft lip and palate?
hypodontia
impacted teeth
malocclusion
supernumerary teeth
microdontia
Good thing about single flowline in LDU?
helps to show how to manage the path of instrumentation through the LDU
Give a primary way to stop infection spread?
Hand hygiene
3PPE in LDU
Rubber gloves
Visor
Apron
Who is the person who ensures that the equipments are working in the decontamination unit?
Decontamination user
who caries out quarterly and annual testing?
Competent Person (D)
Explain each stage of the decontamination cycle
- Acquisition - purchasing or loaning the device
- Cleaning - manual cleaning of instruments or using the ultrasonic bath
- Disinfection - disinfect instruments using washer disinfector
- inspection - inspect instruments using magnification and light
- packaging - if instrument is damaged it is packed and disposed or sent for repair
- Sterilisation - sterilize instruments using type B and N sterilizer
- Transport - transport instruments to designated area using transport box
- Storage - label and store
- Use - use instrument by dentist or dental nurse
- transport using transport box (red lid box) back to decontamination unit
Tooth 11 root canal treated and affected by trauma and has been extracted due to pain , give Kennedy classification of the arch?
Kennedy class 3
What other options are available apart from a bridge for extracted 11?
- implant
What would be the best bridge design for an extracted central incisor? and why?
adhesive cantilever design
* there are divergent guidance paths on the anterior teeth and a fixed fixed design is not suitable
* It is the least destructive option and if it debonds it is less likely to act as a plaque trap
What is the bond between acid etched enamel and the wing of a bridge?
micro-mechanical bond - using panavia cement
Give 4 reasons why an adhesive bridge might fail?
- poor oral hygiene
- poor moisture control while cementation
- high occlusal load due to parafunctional habits
- poor bridge design such as inadequate wing dimensions and poor Pontic shape
Give three reasons why might a root treated central incisor may be extracted that presents with pain and has been traumatised?
- loss of periodontal attachment due to trauma
- Unrestorable tooth as there is insufficient tooth structure
- Caries
- Periapical pathology
What material is used to take an impression for a bridge?
- polyvinyl siloxane
- polyether
What metals can be used for the wing retainer of a bridge?
- CoCr
- NiCr
Why do we add green stick to the palatine rugae?
- provides relief at the denture bearing area to the patient by adding the green stick to the rugae area
Why do we add green stick to the post dam area?
- to enhance the posterior seal of the denture
What os the depth that should be left between the special tray and the sulcus?
2mm
What should a maxillary master impression include?
- Arch form and size - capture the entire maxillary arch extending from the distal of one tuberosity to the distal of the other tuberosity
- Denture bearing areas - including residual ridge, maxillary tuberosity and palatal tissues
- Peripheral borders - including buccal, labial and palatal vestibules
- Anatomical landmarks - frenulum, incisive papilla and tuberosities
What device during jaw registration is used is used for posterior occlusion analysis and what plane does it lie on?
- Fox’s occlusal plane guide and lies on ala-tragus line plane
Record block is given with 3 marked lines , what are they?
- centre line
- canine line
- smile line
What would you want the dental technician to do before adding teeth on for try in based on your prescription?
Put the registered blocks in holding casts and mount on articulator (semi-adjustable)
Wha are 4 differential diagnosis from a tooth with 10mm pocket and pus + failed RCT in an upper anterior tooth?
- periapical periodontitis
- Apical periodontitis
- Periapical abscess
- perio-endo lesion
What special tests would you take for tooth presenting with 10mm pocket with pus discharge and a failed RCT?
6PPC
TTP (percussion )
PA radiograph
What 5 things to tell a patient about re-rct to gain consent ?
- explain the procedure -> explain why retreatment is necessary such as persistent infection or inadequate previous treatment ( removal of current root filling and replacing it with a new one)
- Discuss potential benefits - such as resolution of symptoms and preservation of tooth
- Discuss risks and complications such as instrument fracture , perforation , failure to resolve infection and post treatment discomfort
- Discuss success rate and prognosis - 75% approximately
- Provide post operative care - such as oral hygiene and pain management using analgesics
How much GP would you remove for post placement ?
4-5mm GP
What is the function of a core?
- provides structural support to the tooth
-provides retention for indirect restorations
What are the ideal dimensions of a core?
- 5.5 mm height
- 6 degree taper
- 2mm clearance for MCC crown
List 3 issues that can rise from iso files and explain how?
- File fracture: excessive torisional stress and inadequate lubrication of the canal
- Ledge formation: curved canals and excessive force applied
- Canal blockage - dentine debris getting packed into the canal
Describe the endodontic process of shaping and filing the root canal system using reciproc files R25 ?
- Choose correct instrument
- Prepare 2/3 of the working length with R25 using pecking movements and ensure to clean the instrument and irrigate the canal between every 3 pecks
- Use iso size 10 to determine corrected working length through diagnostic radiograph
- If size iso 10 goes to working length without being precurved, finish apical preparation using R25
- If it needs to be pre-curved, create glide path with iso 15 and if it goes to working length without being precurved, finish apical preparation using R25
- If it needs to be precurved then finish preparation using hand instruments
Types of file movements in endodontics
- Filing
- Reaming
- watch winding
- balanced force
How many units are there in 2 occluding pre-molar and one molar?
4 units
Give 3 advantages of SDA in older patients?
- patient does not need to go through complex treatment
- Patient does not need to spend money on RPD
- Good oral function is maintained
- Easier to perform oral hygiene as RPD require more comprehensive approach to oral hygiene
What is the implant success rate past 10 years?
95%
5 material risks of the implant you would tell the patient?
- The implant material may corrode
- May cause allergy or sensitivity so ensure to take good history
- May fracture
- infection
- may cause peri-implantitis if no adequate oral hygiene
Give 4 signs clinically and radiographically of peri-implantitis?
- inflammation and infection
- Poor oral hygiene
- resorbed alveolar bone around the implant
- increased probing depth around the implant
- Bleeding around the implant
What is the difference between peri-implantitis and peri-mucositis?
Peri-implant mucositis is an inflammation that affect the soft tissues around the implant only while peri-implantitis affect the soft tissue and bone surrounding the implant leading to bone loss
What 8 things to ask a patient from history who is presenting with TMD?
- occupation
- if they are stressed
- home circumstances
- sleeping pattern
- recent bereavement
- relationships
7.If they take any medications such as SSRI - Any parafunctional habits
- Any degenerative disease
What are 5 reversible treatment advice for patients presenting with TMD?
- Patient education about TMD disease and counseling
- Splints such as bite raising appliance and anterior repositioning splint
- Physical therapy: relaxation and acupuncture
- Medications for pain control: NSAIDS , triccyclic antidepressants and botox
- Jaw exercises such as physiotherapy
Give 6 differential diagnosis of TMD?
- Dental pain
- Sinusitis
- ear pathology
- salivary gland pathology
- neoplasm
- infection
- trigeminal neuralgia
- Angina
- condylar fracture
Give 4 clinical features of TMD?
- muscle, joint and ear pain particularly on waking up
- headaches
- clicking and popping of joints (TMJ)
- limited mouth opening
- crepitus (can indicate late regenerative disease)
- Intermittent pain in the area of TMJ of several months or years duration
EXTRA : most common between the ages of 18-30
Apart from pain and swelling give 6 other signs of mandibular fracture?
- pain, swelling and limitation of function
- occlusal derangement
- numbness of the lower lip
- loose or mobile teeth
- bleeding
- Anterior open bite
- Facial asymmetry
- Deviation of the mandible to the opposite side
What imaging are helpful in the diagnosis of mandibular fracture?
- 2 radiographs at right angle to each other - (OPT and PA mandible)
- Occlusal
- lateral oblique
- CT scans
- town’s view
What is the aim when diagnosing a mandibular fracture?
- to assess the extent of the fracture and check displacement and therefore choose the best treatment option
What is a compound fracture and how does that affect the treatment of it?
It is a mandibular fracture that communicates with the external environment through a laceration in the skin or mucous membranes it can cause bone exposure leading to increased risk of infection and a more complex treatment
Describe resin infiltration?
It is when low viscosity resin is infiltrated into enamel by capillary forces after the enamel is eroded and desiccated, this leads to an appearance that is close to enamel as the resin has a similar infraction index as enamel.
Give two other treatment options for tooth discolourations other than resin infiltration
- enamel micro-abrasion
- bleaching (internal or external depending on vitality)
What is the advantage of resin infiltration compared to other treatment options?
- no tooth tissue removal
- simple to perform
- does not cause sensitivity as other options
What are 4 things a patient with primary herpatic gingivostomatitis might be feeling?
- pain
- fatigue
- irritable
- headaches
- dysphagia
other than ulceration and thick gingival give 4 other clinical signs of herpetic gingivostomatitis?
- swollen lymph nodes
- bad breath
- xerostomia
- fever (pyrexia)
How does primary herpetic gingivostomatitis occur?
by transmission of herpes simplex virus type 1 through droplets to the child causing the rise of signs and symptoms
Mum asks how long will it take for primary gingivostomatitis to get better and if it can happen again, what would you say?
- It can take two weeks to go away on its own with conservative measures
- It can happen again but with a different presentation if the virus is activated in the future as the current presentation is the primary infection and the secondary infection of this virus presents as what is called ‘cold sores’
NOTE : almost 100% of the populations are carriers of herpes simplex virus
What are the advantages of metal plate and surgical exposure?
- leads to accurate reduction and stabilisation of fracture
- faster recovery and maintains occlusion
- better aesthetics and reduced scarring and restored facial contours
What are the treatment options for primary herpetic gingivostomatisis?
- Hydration
- Bed rest
- Pain management such as paracetamol
- antimicrobial gel or mouthwash
What is the difference between recurrent aphthous ulcers and oral ulceration?and recurrent apthous ulcers?
- Recurrent apthous stomatitis only affect non keratinised mucosa while oral ulceration can affect keratinised and non keratinised
- RAS us a condition that occur with no specific aetiology while recurrent oral ulceration is a reaction to a known cause such as trauma or infections
if asked about comparison with recurrent apthous ulcers : RAS is a broad name of recurrent apthous ulcers describing a condition where multiple recurrent ulcers appear in the non keratinised mucosa while RAU refers to isolated recurrent ulcers
What are the 3 clinical signs of minor apthous ulcers?
- less than 1cm in diameter
- last up to two weeks
- only affect non keratinised mucosa
- heals without scarring
Apart from haematology’s, give 3 other triggers of aphthous ulcers?
- food additives
- coeliac disease
- autoimmune disease
- medications such as NSAIDS
Apart from oral ulceration, give 2 other signs of behcet’s disease?
- eye inflammation
- genital sores
- skin ulcers
Give 2 non steroid medications for moderate RAU
tetracycline mouthwash
hydrogen peroxide mouthwashes
chlorhexidine mouthwash
Steroid treatment: beclometasone , betamethasone , hydrocortisone
Give 4 signs of orofacial granulomatosis?
- oedema in the oral and facial soft tissues that is persistent
- angular cheilitis
- facial erythema
- mucosal tags and oral ulcers
Angioedema is not a sign as it appears quickly and goes away quickly (24
Why does OFG cause internal swelling?
Due to an immune reaction causing blockage of lymphatic drainage in the tissues affected
Give other granulomatosis disease than can be found in the head and neck other than OFG?
- sarcoidosis
- tuberculosis
- crohn’s disease
- Granulomatosis with poly angitis
What is the function of calprotectin in testing children with OFG?
- it can detect if OFG is related to a Crohn’s disease
- It detects Crohn’s disease activity and monitors it
Why is it important to monitor a growing young child with OFG?
- to gain accurate diagnosis
- to address any psychological impacts such as depression and issues related to self esteem
- to assess the effectiveness of treatment and manage symptoms as soon as possible to improve the child life quality
What is bodily movement and what are the advantages compared to removable appliances?
- movement of whole tooth including root
- removable appliances does not offer precise movements and complex corrections as it only causes the tipping of teeth
What three things should you include in orthodontics bracket prescription?
Tip
Torque
in and out control
What is your duty as a GDP with a patient whi have fixed appliances?
- ensure adequate oral hygiene and give instructions
- educate patient about the risks and benefits of fixed appliance
- monitor the development of caries and treat it
- monitor the appliance and detect any complications and faults in the appliance such as debonded brackets, root resorption , trauma and other possible complications
- Give patient diet advice such as to avoid sticky, sugary and hard food
- Answer any question a patient may have about their appliance
- Refer to orthodontic department in case of emergency
What is the archwire material in the fixed appliance showed in the photo? (a wire that is attached to an ectopic canine for traction)
- Ni-Ti (nickel titnanium)
What is good about it and what is its properties?
- Flexible and have good shape memory
- cannot be bent
- exerts light continuous force
What are elastic bands used for in orthodontics?
- these are force generating components and are intra-oral elastics, teeth move by utilising the energy stored in the elastics
- they aid in intermaxillary anchorage
- they get damaged by time
What 3 sociodemographic groups who are at more risk of oral cancer and which group within them is highest?
- Age - older population
- Sex - more in males
- socioeconomic status - more in poor socioeconomic status
What 4 factors contribute to oral cancer?
- smoking
- drinking
- socioeconomic status
- oral health
- sexual activity (especially HPV related cancers)
- paan usage
Give down, mid and upstream interventions for oral cancer (2 examples of each)
Upstream
* HPV vaccination for young population
* public health campaigns about oral cancer awareness
Midstream
* education about risks of oral cancer in schools, work places and community centres
* improve access to regular dental check-ups and oral health screening in community health centres
Upstream
* patient education and follow up
* regularly screen high risk people for early signs of cancer (smokers, heavy drinkers)
How does the inverse care law affect planning for oral health prevention?
By making access to health care easier for those who need it and making preventive services free or affordable for low income population (maximising access to health care services for people with low income and people with disabilities )
