3rd year Flashcards
Clinical presentation of reversible pulpitis
Hot/cold stimuli
Seconds duration
Clinical presentation of irreversible pulpitis
Spontaneous hot/cold stimuli
Hours/constant duration
Night waking
Clinical presentation of infective periapical periodontitis
Localised
Biting/pressure stimuli
Hours/constant duration
Night waking
Clinical presentation of traumatic periapical periodontitis
Localised
Biting/pressure stimuli
Hours/constant duration
Clinical presentation of TMJ
TMJ dysfunction causing pain in the joint/surrounding muscles, clicking in the jaw joint, limited mouth opening or locking
Clinical presentation of trigeminal neuralgia
Severe pain, lasting seconds, spontaneous or triggered by touch, eating, talking
Clinical presentation of burning mouth syndrome
Burning sensation experienced in the absence of identifiable organic cause
4 clinical presentations of impacted 3rd molars
Pain
Swelling
Bad taste
Number of episodes
2 types of 3rd molar impaction
Soft tissue
Boney: mesioangular, distoangular, vertical, horizontal
What is the white Winters line
Drawn along the occlusal surfaces of the erupted mandibular molars to show the difference in occlusal level of the 1st and 2nd molar and the 3rd molar
What is the amber Winters line
Drawn from the surface of the bone on the distal aspect of the 3rd molar to the crest of the inter-dental septum between 1st and 2nd molars to show the margin of alveolar bone covering the 3rd molar and how much bone will need to be removed
What is the red Winters line
Drawn perpendicular from the amber line to point of application - usually cemento-enamel junction on mesial aspect of the tooth
4 signs that the inferior dental nerve is close to the tooth
Deviation of nerve
Narrowing of nerve
Loss of tram lines
Change in radiodensity of tooth
6 treatment options for impacted 3rd molars
Surgical removal
Coronectomy
Opercolectomy
Remove opposing tooth
Surgical exposure
Monitor
9 indications for removal of 3rd molars NICE guidelines
Pericoronitis: 2 or more episodes
Unrestorable caries
Non-treatable pulpal disease
Resorption of tooth or adjacent tooth
Periodontal disease
Fracture of tooth
Disease of follicle- cyst /tumour
Tooth impeding surgery
Tooth involved in field of tumour resection
4 indications not to remove impacted 3rd molars
No/ minimal symptoms
Because the contralateral tooth is being removed
Because the patient requests it
Close proximity to ID nerve
4 features of informed consent
Written consent
What is involved
Risks of surgery: post op pain, bruising, time off work, risk of infection, damage to adjacent teeth, damage to ID and lingual nerves
Risks of leaving tooth in situ
STALL mnemonic
Swelling
Trismus
Anaesthesia
Labial
Lingual
3 treatment options for impacted maxillary canines
Leave and monitor
Exposure: open or closed with bracket and chain
Surgical removal
Describe impacted tooth positions identified by parallax
Moves with beam: canine palatally ectopic
Moves opposite to beam: canine labially ectopic
Doesn’t move: in line of the arch
4 common impacted teeth
3rd molars
Canines
Mesiodens
Supernumeraries
Define ameloblastoma
Commonest odontogenic tumour
Benign, locally invasive
Clinical features of ameloblastoma
Incidental finding or presents as swelling, pain, UE teeth
Treatment, prognosis and follow up of ameloblastoma
Requires resection at least 10-15mm beyond radiological margins
Recurrence inevitable if removal incomplete
Annual follow-up for 5 years then every 3 years thereafter
Define odontome
Hamartomatous malformation composed of dentine, enamel, pulp and cementum
Commonest odontogenic tumour-like lesion
Clinical features of odontome
Incidental finding or swelling, UE teeth
Treatment and prognosis of odontome
Enucleation
No recurrence
Define dilacerated incisor
Trauma displaces the crown of the developing tooth, root development continues but at an angle
Define turner teeth
Disorders ranging from yellow brown pigmentation of enamel to extensive pitting and irregularity of crown in permenant teeth
Due to local trauma or infection
Define regional odontodysplasia
Ghost like appearance of teeth
Due to a developmental disorder
Define enamel opacities
White, cream, yellow or brown patches on enamel of random distribution
Caused by local factors
Define tetracycline staining
Grey coloured teeth due tetracycline being ingested and incorporated into teeth and bone mineralising at the time
Define systemic disease or malnutrition teeth disorders
Horizontal band of pitting
Due to systemic disease or malnutrition affecting developing teeth
Define fluorosis
Hypomineralised or hypoplastic enamel due to ingestion of Fl- during tooth formation
Define connation
Union of two teeth during development involving enamel, dentine and pulp
Define concrescence
Union of teeth at the roots by disposition of cementum - always affects the roots
Define dens-in-dente
Deeply-penetrating pit extending into the tooth from the crown
Due to local disturbance of tooth development
Treatment of dens-in-dente
Endodontic/restorative or extraction as required
Define amelogenesis imperfecta
Inherited congenital defects of enamel formation
Clinical features of hypoplastic amelogenesis imperfecta
Thin enamel, surface discoloured and rough but of normal hardness
Clinical features of hypomature amelogenesis imperfecta
Abnormal thickness, opaque or discoloured and slightly softer than normal
Clinical features of hypocalcified amelogenesis imperfecta
Abnormal thickness of enamel, normal colour but very soft
Treatment of amelogenesis imperfecta
Complex restorative procedures required
Define dentinogenesis imperfecta
Inherited congenital defects in dentine formation, which may or may not be associated with osteogenesis imperfecta
Treatment of dentinogenesis imperfecta
Complex restorative procedures required
4 reasons to suspect Gardeners syndrome
Multiple odontomes
Supernumerary teeth
Shortened/deformed roots
“Osteomas” or other stigmata
Common additional teeth
Mandibular and maxillary 3rd molars
Common teeth with connation
Incisors and deciduous canines
Common teeth with concrescence
Molars
Common teeth with dens-in-dente
Maxillary lateral incisors
Define cleidocranial dysplasia
Genetic condition that affects teeth and bones
6 clinical features of cleidocranial dysplasia
Short stature
Prominence of frontal, parietal and occipital bones “bossing”
Absent or hypoplastic clavicles
High-arched palate
Delayed shedding of deciduous teeth
Multiple unerupted teeth in both jaws
Define hypohidrotic ectodermal dysplasia
Genetic condition characterised by a developmental failure of ectodermal structures, particularly skin, hair, sweat glands and teeth
Clinical features of hypohidrotic ectodermal dysplasia
Underdeveloped facial and jaw bones
Few teeth, cone-shaped
Define Down’s syndrome
Congenital condition characterised by intellectual, physical disability and trisomy of chromosome 21
6 clinical features of Down’s syndrome
Hypodontia of deciduous and permanent dentitions
Larger deciduous teeth
Small permanent teeth
Conical, shovel-shaped, talon-cusped incisors
Taurodont molars
Active periodontal disease
Define dentoalveolar abscess
Acute lesion characterised by a localised collection of pus in the structures that surround the teeth
4 conditions that may lead to an abscess
Periapical periodontitis
Periodontal disease
Acute pericoronitis
Infection of a cyst
Clinical presentation of abscess following periapical periodontitis
Severe pain
Poorly localised
TTP
Non responsive to vitality test
History of caries/ trauma
Soft fluctuant swelling
Clinical presentation of abscess following periodontal disease
Mobile tooth
TTP
Positive vitality testing
Swelling often nearer gingival margin
Pus may extrude from gingival margin on probing
Radiographical features of an abscess
Loss of periapical lamina dura
Periapical radiolucency
Well defined (infection causes loss of definition of margin)
Management of an abscess
Establish drainage of pus: via root canal – RCT, extraction, incision
Antibiotics not indicated if no evidence of spreading infection
Clinical presentation of spreading infection
Local spread of infection: trismus, cervical lymphadenopathy
Systemic toxicity: pyrexia, tachycardia
Define cellulitis
Rapidly spreading infection of connective tissue
Define Ludwig’s angina
Spreading cellulitis involving submandibular, sublingual and submental spaces bilaterally
Define cavernous sinus thrombosis
Blood clot within the cavernous sinus which can arise from maxillary dentoalveolar infection
Define dental cyst
Inflammatory cyst, causing gradual progressive swelling associated with non vital tooth
Most common jaw cyst
Dental cyst contents
Fluid, pus if infected
High level of soluble protein
Cholesterol crystals
Define apical granuloma
Mass of fibrous/granulation tissue related to apex of non vital tooth
Define residual dental cyst
Dental cyst which failed to resolve after extraction
Define paradental cyst
Inflammatory odontogenic cyst that develops in relation to crown or root of a partially erupted tooth
Define dentigerous cyst
A developmental, epithelial lined cyst which surrounds the crown of an unerupted tooth and is attached to the amelocemental junction
What 3 teeth are dentigerous cysts most often associated with
3rd molars
Canines
Premolars
Dentigerous cyst contents
Fluid, pus if infected
High levels of soluble protein >5mg/100ml
Define keratocyst
Developmental odontogenic cyst with a characteristic epithelial lining and a high tendency to recur
Follow up for keratocyst
Long term clinical and radiographical follow up mandatory
Annually for first 5 years, 3 years thereafter
Recurrence usually presents within first 5 years
Define nasopalatine cyst
Developmental non-odontogenic cyst of the incisive canal in the palate believed to arise from remnants of the nasopalatine duct
Define dermoid cyst
Rare developmental non-odontogenic cyst, involving soft tissues only
Define nasolabial cyst
Developmental non-odontogenic cyst of the soft tissues of the face found within the nasolabial fold
Management of cysts
Enucleation
Marsupialisation
Resection
What is enucleation
Complete removal of cyst lining by primary closure or secondary intention
What is marsupialisation
Partial removal of cyst lining
What is resection
Removal of the whole sac
Define acute alveolar osteitis/dry socket
Post-extraction condition characterised by loss of the clot from the socket
Treatment of dry socket
Wash out socket with warm saline
Place protective obtundent dressing into socket: Alvogyl - Antiseptic and analgesic paste easily adheres to the alveolus containing
Prescribe NSAID for pain
Review patient
Define osteomyelitis
Infection of the bone and bone marrow spaces
Define suppurative osteomyelitis
Infection of the bone and bone marrow spaces resulting in bone necrosis and the production of pus
Treatment of suppurative osteomyelitis
Surgical debridement
Antibiotics
Ultrasound therapy
Define chronis sclerosing osteomyelitis
An infection of the bone characterised by bone sclerosis, without the formation of pus
Treatment of chronis sclerosing osteomyelitis
Requires endodontics or extraction of tooth
Might require debridement or antibiotics
Define osteogenesis imperfecta
Group of genetically-determined disorders of bone characterised by excessive fragility and a tendency to fracture
Treatment of osteogenesis imperfecta
Diet rich in calcium and vitamin D
Physiotherapy
Physical aids
Bisphosphonates
Surgery
Define giant cell granuloma
Benign tumour like lesion of jaw bones characterised by numerous osteoclast like giant cells
Treatment of giant cell granuloma
Curettage
Extraction of loosened teeth
Define torus
Boney hard swelling, occurring either in palate or mandible which may be lobulated
Define fibrous dysplasia
A benign developmental condition characterised by the presence of fibrous connective tissue with irregular trabeculae of bone
Treatment of fibrous dysplasia
None usually
Surgery may be required
Bisphosphonates
Define Paget’s disease (osteitis deformans)
A progressive disorder representing a disturbance of the “coupling” of synthesis and resorption of bone
Treatment of Paget’s disease
Calcitonin
Bisphosphonates
Define at risk stage of osteochemonecrosis
No apparent necrotic bone in patients who have been treated with either oral or IV bisphosphonates
Define stage 0 of osteochemonecrosis
No clinical evidence of necrotic bone, but non-specific clinical findings, radiographic changes and symptoms
Define stage 1 of osteochemonecrosis
Exposed and necrotic bone, or fistulae that probes to bone, in patients who are asymptomatic and have no evidence of infection
Define stage 2 of osteochemonecrosis
Exposed and necrotic bone, or fistulae that probes to bone, associated with infection as evidenced by pain and erythema in the region of the exposed bone with or without purulent drainage
Define stage 3 of osteochemonecrosis
Exposed and necrotic bone or a fistula that probes to bone in patients with pain, infection, and one of the following: exposed and necrotic bone extending beyond the region of alveolar bone, resulting in pathologic fracture, extra-oral fistula, oral antral/oral nasal communication, or osteolysis extending to the inferior border of the mandible of sinus floor
Define osteochemonecrosis
Medical related osteonecrosis of the jaws following treatment with Bisphosphonates, Denosumab, Anti-angiogenic medications
Define osteoradionecrosis
Exposed irradiated bone that fails to heal over a period of 3 months, excluding areas of residual or recurrent tumour
Define Notani classification I of osteoradionecrosis
Confined to dentoalveolar bone
Define Notani classification II of osteoradionecrosis
Limited to dentoalveolar bone or mandible above the inferior dental canal, or both
Define Notani classification III of osteoradionecrosis
Involving the mandible below the inferior dental canal, or pathological fracture, or skin fistula
4 management strategies for osteoradionecrosis
Triple therapy
Local debridement
Ultrasound therapy
Hyperbaric oxygen therapy
Outline triple therapy for osteoradionecrosis
Chlorhexidine mouthwash 10ml bi-daily
Doxycycline 100mg once daily
Pentoxifylline 400mg bi-daily
Tocopherol (Vitamin E) 1000IU (caps) or 1000mg (suspension)
3 ways to prevent osteoradionecrosis
Extract teeth with poor long term prognosis prior to radiotherapy (at least 2 weeks)
Ensure dentures fit well/leave dentures out
Avoid need for further extractions
6 intra-operative complications of exodontia
Root fracture
Fracture of alveolar bone
Fractured tuberosity
Oro-antral communication
Root displaced into antrum
Damage to dento-alveolar nerve
2 post-operative complications of exodontia
Haemorrhage
Dry socket
Radiographic features of ameloblastoma
Usually large
Radiolucent and often multilocular
Expands bone, displaces and reabsorbs teeth, destroys lower border of the mandible
Radiographic features of odontome
Speckled or dense radiopacity with radiolucent areas
Circumscribed mass, well defined periphery
May displace adjacent teeth
Define hypodontia
1-6 teeth missing (excluding 3rd molars)
Define oligodontia
7 or more teeth missing (excluding 8’s)
Name an malignant tumour with an odontogenic epithelium without odontogenic ectomesenchyme
Ameloblastoma
Name an malignant tumour with an odontogenic epithelium with odontogenic ectomesenchyme
Odontome
4 common absent teeth and their prevalence
3rd molars (20-30% of population)
Upper lateral incisors (2%)
Lower second premolars (2%)
Lower central incisor (0.2%)
Prevalence of absent deciduous teeth
Less than 1%
Prevalence of additional permanent teeth
1-3%
Prevalence of dens-in-dente
1-5%
How does ameloblastoma grow
By epithelial proliferation extending between trabeculae of bone
How do dental cysts grow
By fluid accumulation
How do dentigerous cysts grow
By luminal fluid accumulation
What syndrome can be associated with keratocysts
Gorlin syndrome
How do keratocysts grow
By epithelial proliferation, hydrostatic forces
Prevalence of dry socket after extractions
3 – 4 % of extractions
20% of wisdom teeth
What syndrome is fibrous dysplasia associated with
Albright’s syndrome
Describe patients at low risk of osteochemonecrosis
Patients being treated for osteoporosis or other non-malignant diseases of bone with oral/IV Bisphosphonates or Denosumab for less than 5 years who are not concurrently being treated with systemic corticosteroids or other immune-suppressants
Describe patients at high risk of osteochemonecrosis
Patients being treated for osteoporosis or other non-malignant diseases of bone with oral Bisphosphonates or yearly infusions of intravenous bisphosphonates for more than 5 years
Patients being treated for osteoporosis or other non-malignant diseases of bone with Bisphosphonates or Denosumab for any length of time who are being concurrently treated with systemic corticosteroids or other immuno-suppressants
Patients taking an anti-resorptive or anti-angiogenic drug (or both) as part of the management of cancer
Patients with a previous diagnosis of medically related osteonecrosis of the jaw
Prevalence of osteoradionecrosis in irradiated patients
7%
Immediate treatment of periocoronitis
Irrigation below operculum and oral hygiene instruction
Define pericoronitis
Inflammation of the gum tissue around wisdom teeth
When should you suspect osteochemonecrosis
Current or previous treatment with anti-resorptive drugs
Exposed bone that persists for > 8 weeks
What syndrome is associated with odontomes
Gardeners
Define supplemental teeth
Additional teeth that closely resembles a tooth of normal series
Define supernumerary teeth
Additional teeth that do not closely resemble a tooth of normal series
4 reasons keratocysts have a high tendency to recur
Lining thin and friable
Extension into cancellous bone – difficult to remove all lining
Satellite cysts
Vigorous proliferative activity of epithelial lining
Treatment of a patient in the at risk category of osteochemonecrosis
No treatment indicated
Patient education
Treatment of a patient in the stage 0 category of osteochemonecrosis
Pain medication
Treatment of a patient in stage 1 category of osteochemonecrosis
Antibacterial mouth rinse
Clinical follow-up on a quarterly basis
Review of indications for continued bisphosphonate therapy
Treatment of a patient in stage 2 category of osteochemonecrosis
Pain control
Antibacterial mouth rinse
Oral antibiotics
Debridement
Treatment of a patient in stage 3 category of osteochemonecrosis
Pain control
Antibacterial mouth rinse
Oral antibiotics
Debridement/resection
3 things assessed prior to exodontia both clinically and radiographically
Crown integrity
Root size and morphology
Condition of the surrounding bone
Name a haemorrhage that occurs during surgery
Primary
Name a haemorrhage that occurs within 24 hours due to a failure to follow post-op instructions
Reactionary
Name a haemorrhage that occurs days after extraction due to infection
Secondary
