24 Flashcards
tests to confirm cracked tooth syndrome
transillumination
tooth sleuth
management for cracked tooth syndrome
full coverage crown
RCT
xla
factors which affect prognosis of cracked tooth syndrome tooth
pulpal involvement
extent/direction of crack
properties of acrylic which make it suitable material as denture base
biocompatible
good aesthetics
dimensionally stable
ease of repair/modification
thermal expansion similar to Pontic teeth
property of acrylic that makes it prone to breakage
brittleness
significant stress/impact = breakage
most common breakages in complete dentures
midline fracture
loss of Pontic
loss of flange
3 faults of denture construction
incorrect OVD/RVD
insufficient flange
insufficient post dam
3 faults relating to denture finishing of acrylic
gaseous porosity
granularity
crazing
how to know if new impression when denture fractures
can you relocate all pieces together
if missing any or cannot = new impression
denture fracturing and being repaired repeatedly
what to do
strengthener
reinforce palate with wire mesh, glass-fibre mesh or stainless steel wire
use of ductile material in brittle material to increase strength
denture fractures again after use of strengthener
if you were making new denture, what would you do to prevent
reevaluate occlusion
may have incorrect OVD
advantages of non y2 amalgam
increased corrosion resistance
less creep
increase wear resistance
longer lasting rest
higher compressive/durability
how does technician reduce y2
use of copper >=12%
allows tin to preferentially react with copper rather than mercury
creating Cu5Sn6
eliminating y2
minimata convention 2013
what was discussed, what is conclusion
global agreement to phase down mercury use
health/environmental concerns
promote alternatives
which 4 groups are amalgam contraindicated in
<15 y/o
pregnant
breastfeeding
known allergy/hypersensitivity
severe renal
neurological impairment
adv + disadv of amalgam compared to composite
adv =
higher compressive strength
increased wear resistance
less technique sensitive
cheaper
disadv =
poor aesthetics
more destructive prep required
toxic
what would be favourable outcome following pads trauma on radiograph
intact lamina dura and PDL
no root fracture
no pathology
you assess pt one day post trauma
when will you see them again
2 weeks
likely commence RCT to prevent external inflammatory RR
what cells and structures are present in an MIH affected pulp
increased immune cells
increased vascularity
increased neural density
odontoblasts, fibroblasts, neutrophils, macrophages
what is the significance of pulp horn proximity in MIH
more reactive odontoblasts
altered sensitivity of nerve fibres
increased risk pulpal irritation
increased immune cell and inflammatory response due to porous enamel and dentine exposure
restorative challenges
3 proposed pain theory for MIH
hydrodynamic theory =
dentine hypersensitivity due to exposed dentinal tubules allowing rapid fluid movement stimulating nerve endings
peripheral sensitisation = underlying pulpal inflammation lead to sensitisation of c-fibres
central sensitisation -
continued nociceptive input
tx for MIH
fluoride
fs
crowns
composite
resin filtration
xla
4 diagnostic factors of autoimmune mucous membrane disorders
vesicle/bullous formation on mucous membranes - oral, nasal, anogenital, scalp, nails, nasal
H+E staining
DIF
IIF
what is DIF
detects autoantibody presence on tissues
what is indirect immunofluorsence
detects circulating autoantibodies
histopathology and DIF findings of pemphigus vulgaris
H+E =
intraepithelial splitting
DIF =
linear deposition of IgG + C3, chicken wire appearance
loss of cell cell contact, acantholysis
differentials of MMP
pemphigus vulgaris
erythema multuforme
linear IgA
erosive lichen planus
antigens on MMP
BP180, BP230
antigens of PV
dsg 1 + 3
mucous membranes affected in MMP
anogenital
scalp
nasal
pharyngeal
laryngeal
oral
risk factors for malignant change in leukoplakia
asymmetry
high risk site
verrucous leukoplakia
smoker, drinker, previous
heterozygosity
non-homogenous
dysplasia
4 types of oral lichenoid lesions according to van Der Waals classification
oral lichen planus
oral lichenoid drug reactions
oral lichenoid lesion contact hypersensitivty
oral lichenoid lesion in GVDH
histopathology of lichen planus
acanthosis
hyperparakeratosis
band like lymphatic infiltrate
destruction of basal keratinocytes
saw tooth rete pegs
strains of HPV related to tumours
HPV 16
HPV 18
mainstay tx for lichen planus and its side effect
topical steroids
betamethasone
beclamethasne
candidiasis
prednisolone
steroid dependancy
systemic immune modulators used in OLP
azathioprine
mycophenalone
hydrochloroquine
what medication are you required to sit up and drink a whole glass of water with
bisphosphonates
what questions would you ask re bisphosphonates
how long
any concurrent medications e.g. systemic glucocorticoid
oral/IV
is it for cancer
low risk MRONJ pt
how to manage xla
ensure education, prevention
no prophylaxis, atraumatic technique
review healing 8 weeks
pt to contact if unexpected pain, tingling, numbness, altered sensation, swelling
ensure valid consent
pt asks if she should stop bisphosphonates before xla
what should you say
discuss risk
no evidence MRONJ risk reduced if temporarily or permanently stop medication as can persist for 5 years
don’t tell to stop
preventative measures
name 8 post-op complications
pain
swelling
bruising
bleeding
jaw stiffness
infection
dry socket
altered sensation
delayed healing
MRONJ
trismus
pt returned same day post xla with bleeding
how would you manage
reassure pt, sit upright
MH
assess source of bleeding, check no remaining fragments
apply pressure 20 mins w gauze
LA w adrenaline
suture
surgicel, collagen plug, haemostatic sponge if still bleeding
diathermy, thrombin liquid
POI
pt came back again few days post xla with bleeding
you manage the bleeding
what now
ask if poking/prodding
review MH
assess for bleeding disorder, liver cirrhosis
deep trauma
what is the importance of single-flow process in LDU
prevent cross-infection
3 PPE
gloves
marigold gloves
apron
mask
who is responsible for ensuring AWD is fit for use
user
who is responsible for quarterly testing
competent person
fill in the stages of reusable instrument cycle
cleaning - remove gross
disinfection - remove debris, thermal
packaging - package up
sterilisation - sterile at point of use if B
transport
storage
use
transport
explain components of LASHAL classification of CLP
left - right
lip, alveolus, soft palate, hard palate
looking straight up
CLP ages for tx stage
3-6 months; lip closure
6-12 months; palate closure
8-10 years; alveolar bone graft
12-15 years; ortho
18+; surgery
dental anomalies commonly seen in CLP
delayed eruption
hypodontia
supernumerary
ectopic canine
microdontia
high caries rate
pathogenesis of vertical root resorption
bacterial biofilm dysbiosis triggers immune response
pro inflammatory mediators simulate osteoclasts for resoprtion
anatomy of roots/furcation, thickness, alignment facilitate continued resorption vertically
infrabony defect
initial PMPR doesn’t work for infrabony defect
what now
reinforce OH, motivation, risk factors
repeat PMPR
open flap debridement
guided tissue regeneration
enamel matrix derivative
intraoral signs of toothwear
attrition/erosion/abrasion
linea alba
tongue scalloping
wear facets
soft tissue trauma
worn rests
best management of discoloured 21 that has been RT
non-vital bleaching
technique for localised anterior toothwear
dahl technique
composite shelf added palatal UI,
posterior disclusion, extrude and anterior intrude
increase 2-3mm
8 clinical records taken to monitor and facilitate tx planning
study casts
diagnostic wax up
smith and knight
clinical photos
facebow
bewe
bpe
shade matches
radiographs
what 2 materials is the retainer of an adhesive bridge made from
NiCr or CoCr, Ti
zirconia
cemented w panavia as MDP for etching metal
reasons for adhesive bridge failure
unfavourable occlusion
poorly cemented
parafunction
trauma
poorly aligned teeth
how does panavia cement bond to enamel
micro mechanical and chemical via ca2+ in hydroxyapatite and 10MDP
metal = chemical via oxide layer
what materials could you take impression for indirect
polyether
polysulphide
what to discuss for valid consent
risks
benefits
alternatives
risk of nil
cost
procedure
complications
minimum length of GP left apically for post
4-5mm
function of core
replacing missing coronal toothbstructure
foundation for support and retain definitive restoration
dimension of core
4-5mm height
3-4mm width
what is the purpose of greenstick
extend coverage of special tray to allow extension into sulcus
accurate replication of tuberosity, post dam
palatal stop prevents excess flow
allows for functional depth and width of sulcus via border moulding to ensure good peripheral seal and retention
improves posterior palatal seal
what are you hoping to record in master imp
extension into sulcus for functional depth ad contour
replication
full extension of denture base
accurate mucosal detail in denture bearing area
post dam area for posterior seal
muscle movement and frenal attachment
- full extension denture base
- functional depth of sulcus
- mucosal condition
- muscle movement, frenal attachment
what should extension of special be, how short of sulcus
2mm
what lines are marked on jaw reg
centre line
smile line
canine line
what instrument for jaw reg
what anatomical plane
fox’s bite plane
anterior = inter pupillary line
posterior = alatragus line
explain canal instrumentation, shaping and cleaning
- Access cavity preparation
- Establish Estimated Working Length (EWL)
○ Use pre-operative radiograph for initial estimate. - Initial exploration of canal
○ Use pre-curved K10 or K15 to explore the canal and confirm patency. - Determine Working Length (WL)
○ Once patency is confirmed to the estimated apex with a size 10 or 15, determine actual WL using:
§ Electronic apex locator
§ Confirm if needed with radiograph
○ ⚠️ This is where you go from EWL to WL. - Coronal/orifice enlargement
○ Use Gates Glidden or NiTi orifice shapers to enlarge upper third of canal for straighter access. - Shaping – Modified Double Flare technique
○ Balanced force or hybrid technique with:
§ Coronal flaring first (larger files, short of WL)
§ Then apical enlargement to WL (files 10, 15, 20, 25+ depending on canal)
§ Copious NaOCl irrigation throughout.
§ Recapitulate with K10 between files to maintain patency. - Irrigation sequence
○ Sodium hypochlorite (NaOCl) throughout
○ After shaping: rinse with EDTA (to remove smear layer)
○ Final rinse with NaOCl for disinfection. - Check patency
○ With a K10 beyond WL by 0.5 mm to ensure canal isn’t blocked. - Dry canal
○ Use paper points, ideally matching master apical file size.
- Establish Estimated Working Length (EWL)
faults during endo instrumentation
blockages = debris build up, insufficient irrigation
ledges = internal transportation, working short of length or as canal is straight
apical zipping/transportation = over-enlargement outer curvature and under of inner, don’t rotate
perforation = incorrect WL, excessive pressure
instrument separation = cyclic fatigue
what is recapitulation
periodically re-introduce small hand file to working length
maintains patency
prevent blockage
features of tmd
pain worse in mornings
headaches
neck pain
limited mouth opening
jaw deviation
clicking
popping
crepitus
6 differential diagnoses for tmd
pericoronitis
chronic otitis media
sinusitis
myofascial pain
odontogenic
osteoarthritis
rheumatoid arthritis
trigmeinal neuralgia
tmd reversible tx
educate
don’t incise, bilateral, no gum, avoid caffeine, yawning supported
CBT, hypnotherapy, physiotherapy
splint
acupuncture
botox
NSAIDs
clinical signs of mandibular fracture
step deformity
malocclusion
mobility of segment
unable to open or close
paraesthesia
swelling
malocclusion
bruising
imaging modalities for mandibular fracture
OPT
CT
CBCT
tx for displaced mandibular fracture
restore anatomical alignment for occlusion and function
stabilise for healing
what is a compound mandibular fracture
how does it affect management
open fracture, communicating with external environment
increased risk of infection
urgent tx
adv of surgical exposure and fixation plates
mandibular fracture
[ORIF]
direct visualisation
accurate reduction
stable fixation
decreases risk of malunion
rigid fixation
doesn’t need prolonged wiring shut
how does resin infiltration work
infiltration of enamel with low viscosity light cured resin
surface layer eroded, lesions desiccated, alcohol pulls out water for penetration of lesion by resin then loses discolouration
well demarcated lesions reduce
alternatives to resin infiltration
enamel microabrasion
vital bleaching
adv of resin infiltration
conservative, minimally invasive, quick, aesthetic improvement
disadv resin infiltration
non-cavitated, only white spot lesions, technique sensitive, cost
what is PHG and how does it spread
primary herpetic gingivostomatitis
manifestation of herpes simplex virus 1
spread via direct contact
children
fever, malaise, vesicles rupture to ulcers and inflamed gingiva
advice and tx for PHG
reassure, educate
supportive, analgesia, chx, monitor, difflam, hydrations oft diet
advantages of SDA in elderly people
aesthetics
psychological benefits
function
speech
reduced cost
avoids dentures
e`sier maintenance
preserve remaining teeth
what is success rate of implants in 10 years
90-95%
4 clinical signs of peri-implantitis
increased pocket depths
bleeding on probing
suppuration
gingival recession
inflammation
erythema
bone loss beyond crystal bone level changes from initial bone remodelling
material risks to discuss pre implant
cost
aesthetic outcome
failure
complications
damage to adjacent structures
infection risk
pain
difference in peri-implantitis and implant mucositis
peri-implantitis involves progressive loss of supporting bone
what does bodily movement mean and how does it compare to URA
movement of crown + root as a unit
URA can only achieve tipping
3 elements in bracket prescription for fixed appliance
in / out
torque
tip
if elastics in fixed was
lower 3 - upper 6
what malocclusion
class 3 intraoral elastics
what material of wire is used in fixed appliances
what properties allow its function
NiTi
shape memory, superplasticity, low stiffness
what is GDP role in maintaining fixed appliance
OH monitoring, diet advice
prevention
check up
check integirty
manage emergencies
motivation
soft tissue lesions
what is the difference in recurrent oral ulceration and RAS
ROU - any cause, underlying, varied appearance, behcet, crohns
RAS - idiopathic, triggers, grey w erythematous halo
triggers of RAS
immunosuppression
trauma
haematinic deficiency
stress
hormones
infections
what info to confirm minor aphthous ulcers
where are the ulcers
= non-keratinised
how big
= <1cm
scar
= no
how long healing
= 7-10 days
clinical features of minor RAS
no scarring
<1cm
non-keratinised tissue
heals 7-10 days
grey/yellow void base erythematous halo
clinical features of behcet’s
oral ulceration
genital ulcers
skin lesions
ocular lesions
uveitis
allele associated with behcet’s
HLA B51
non steroidal tx for ulcers
chx
benztdamine spray/mw
intra-oral features of OFG
buccal cobblestoning
submandibular stag horning
mucosal tags
ulcers
gingival ulceration
lip swelling
lip fissures
peri-oral dermatitis
angular cheilitis
3 granulomatous disease of H+N
OFG
TB
sarcoidosis
syphilis
granulomatous polyangiitis
behcet
churg-strauss
why lip oedema in OFG
chronic inflammation
vascular permeability
fluid leakage into tissues causing persistent oedema
lymphatic obstruction or impairment
why faecal calprotectin for child with OFG
non-invasive marker of GI inflammation
crohns screening
differentiate
why growth of child needs monitored in OFG
poor growth is crohns indicator
chronic inflammation can lead to nutritional deficiencies
may impact growth hormones, puberty
3 socio-economic determinants of cancer and which is worst determinant
income = low
education = low
occupation = low
modifiable risk factors of oral cancer
smoking
alcohol consumption
betel/pan use
poor diet
obesity
name 2 interventions of upstream, midstream and downstream prevention of oral cancer
upstream = society
- smoking cessation adverts
- public health campaigns
midstream =
- screening in high risk
- health eduction
downstream =
- education
- regular check ups
what is inverse care law
how should it work in setting up oral cancer tx services
most in need of care is where there is the least or poorest quzlity
equitable access, high risk populations gain screenings access, education
