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Oral surgery > 3rd year MCQ exam > Flashcards

3rd year MCQ exam Flashcards

1
Q

Clinical presentation of reversible pulpitis

A

Hot/cold stimuli
Seconds duration

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2
Q

Clinical presentation of irreversible pulpitis

A

Spontaneous hot/cold stimuli
Hours/constant duration
Night waking

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3
Q

Clinical presentation of infective periapical periodontitis

A

Localised
Biting/pressure stimuli
Hours/constant duration
Night waking

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4
Q

Clinical presentation of traumatic periapical periodontitis

A

Localised
Biting/pressure stimuli
Hours/constant duration

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5
Q

Clinical presentation of TMJ

A

TMJ dysfunction causing pain in the joint/surrounding muscles, clicking in the jaw joint, limited mouth opening or locking

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6
Q

Clinical presentation of trigeminal neuralgia

A

Severe pain, lasting seconds, spontaneous or triggered by touch, eating, talking

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7
Q

Clinical presentation of burning mouth syndrome

A

Burning sensation experienced in the absence of identifiable organic cause

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8
Q

4 clinical presentations of impacted 3rd molars

A

Pain
Swelling
Bad taste
Number of episodes

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9
Q

2 types of 3rd molar impaction

A

Soft tissue
Boney: mesioangular, distoangular, vertical, horizontal

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10
Q

What is the white Winters line

A

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

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11
Q

What is the amber Winters line

A

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

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12
Q

What is the red Winters line

A

Drawn perpendicular from the amber line to point of application - usually cemento-enamel junction on mesial aspect of the tooth

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13
Q

4 signs that the inferior dental nerve is close to the tooth

A

Deviation of nerve
Narrowing of nerve
Loss of tram lines
Change in radiodensity of tooth

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14
Q

6 treatment options for impacted 3rd molars

A

Surgical removal
Coronectomy
Opercolectomy
Remove opposing tooth
Surgical exposure
Monitor

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15
Q

9 indications for removal of 3rd molars NICE guidelines

A

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

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16
Q

4 indications not to remove impacted 3rd molars

A

No/ minimal symptoms
Because the contralateral tooth is being removed
Because the patient requests it
Close proximity to ID nerve

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17
Q

4 features of informed consent

A

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

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18
Q

STALL mnemonic

A

Swelling
Trismus
Anaesthesia
Labial
Lingual

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19
Q

3 treatment options for impacted maxillary canines

A

Leave and monitor
Exposure: open or closed with bracket and chain
Surgical removal

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20
Q

Describe impacted tooth positions identified by parallax

A

Moves with beam: canine palatally ectopic
Moves opposite to beam: canine labially ectopic
Doesn’t move: in line of the arch

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21
Q

4 common impacted teeth

A

3rd molars
Canines
Mesiodens
Supernumeraries

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22
Q

Define ameloblastoma

A

Commonest odontogenic tumour
Benign, locally invasive

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23
Q

Clinical features of ameloblastoma

A

Incidental finding or presents as swelling, pain, UE teeth

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24
Q

Treatment, prognosis and follow up of ameloblastoma

A

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

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25
Q

Define odontome

A

Hamartomatous malformation composed of dentine, enamel, pulp and cementum
Commonest odontogenic tumour-like lesion

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26
Q

Clinical features of odontome

A

Incidental finding or swelling, UE teeth

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27
Q

Treatment and prognosis of odontome

A

Enucleation
No recurrence

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28
Q

Define dilacerated incisor

A

Trauma displaces the crown of the developing tooth, root development continues but at an angle

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29
Q

Define turner teeth

A

Disorders ranging from yellow brown pigmentation of enamel to extensive pitting and irregularity of crown in permenant teeth
Due to local trauma or infection

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30
Q

Define regional odontodysplasia

A

Ghost like appearance of teeth
Due to a developmental disorder

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31
Q

Define enamel opacities

A

White, cream, yellow or brown patches on enamel of random distribution
Caused by local factors

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32
Q

Define tetracycline staining

A

Grey coloured teeth due tetracycline being ingested and incorporated into teeth and bone mineralising at the time

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33
Q

Define systemic disease or malnutrition teeth disorders

A

Horizontal band of pitting
Due to systemic disease or malnutrition affecting developing teeth

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34
Q

Define fluorosis

A

Hypomineralised or hypoplastic enamel due to ingestion of Fl- during tooth formation

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35
Q

Define connation

A

Union of two teeth during development involving enamel, dentine and pulp

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36
Q

Define concrescence

A

Union of teeth at the roots by disposition of cementum - always affects the roots

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37
Q

Define dens-in-dente

A

Deeply-penetrating pit extending into the tooth from the crown

Due to local disturbance of tooth development

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38
Q

Treatment of dens-in-dente

A

Endodontic/restorative or extraction as required

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39
Q

Define amelogenesis imperfecta

A

Inherited congenital defects of enamel formation

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40
Q

Clinical features of hypoplastic amelogenesis imperfecta

A

Thin enamel, surface discoloured and rough but of normal hardness

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41
Q

Clinical features of hypomature amelogenesis imperfecta

A

Abnormal thickness, opaque or discoloured and slightly softer than normal

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42
Q

Clinical features of hypocalcified amelogenesis imperfecta

A

Abnormal thickness of enamel, normal colour but very soft

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43
Q

Treatment of amelogenesis imperfecta

A

Complex restorative procedures required

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44
Q

Define dentinogenesis imperfecta

A

Inherited congenital defects in dentine formation, which may or may not be associated with osteogenesis imperfecta

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45
Q

Treatment of dentinogenesis imperfecta

A

Complex restorative procedures required

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46
Q

4 reasons to suspect Gardeners syndrome

A

Multiple odontomes
Supernumerary teeth
Shortened/deformed roots
“Osteomas” or other stigmata

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47
Q

Common additional teeth

A

Mandibular and maxillary 3rd molars

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48
Q

Common teeth with connation

A

Incisors and deciduous canines

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49
Q

Common teeth with concrescence

A

Molars

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50
Q

Common teeth with dens-in-dente

A

Maxillary lateral incisors

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51
Q

Define cleidocranial dysplasia

A

Genetic condition that affects teeth and bones

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52
Q

6 clinical features of cleidocranial dysplasia

A

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

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53
Q

Define hypohidrotic ectodermal dysplasia

A

Genetic condition characterised by a developmental failure of ectodermal structures, particularly skin, hair, sweat glands and teeth

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54
Q

Clinical features of hypohidrotic ectodermal dysplasia

A

Underdeveloped facial and jaw bones
Few teeth, cone-shaped

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55
Q

Define Down’s syndrome

A

Congenital condition characterised by intellectual, physical disability and trisomy of chromosome 21

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56
Q

6 clinical features of Down’s syndrome

A

Hypodontia of deciduous and permanent dentitions
Larger deciduous teeth
Small permanent teeth
Conical, shovel-shaped, talon-cusped incisors
Taurodont molars
Active periodontal disease

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57
Q

Define dentoalveolar abscess

A

Acute lesion characterised by a localised collection of pus in the structures that surround the teeth

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58
Q

4 conditions that may lead to an abscess

A

Periapical periodontitis
Periodontal disease
Acute pericoronitis
Infection of a cyst

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59
Q

Clinical presentation of abscess following periapical periodontitis

A

Severe pain
Poorly localised
TTP
Non responsive to vitality test
History of caries/ trauma
Soft fluctuant swelling

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60
Q

Clinical presentation of abscess following periodontal disease

A

Mobile tooth
TTP
Positive vitality testing
Swelling often nearer gingival margin
Pus may extrude from gingival margin on probing

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61
Q

Radiographical features of an abscess

A

Loss of periapical lamina dura
Periapical radiolucency
Well defined (infection causes loss of definition of margin)

62
Q

Management of an abscess

A

Establish drainage of pus: via root canal – RCT, extraction, incision

Antibiotics not indicated if no evidence of spreading infection

63
Q

Clinical presentation of spreading infection

A

Local spread of infection: trismus, cervical lymphadenopathy

Systemic toxicity: pyrexia, tachycardia

64
Q

Define cellulitis

A

Rapidly spreading infection of connective tissue

65
Q

Define Ludwig’s angina

A

Spreading cellulitis involving submandibular, sublingual and submental spaces bilaterally

66
Q

Define cavernous sinus thrombosis

A

Blood clot within the cavernous sinus which can arise from maxillary dentoalveolar infection

67
Q

Define dental cyst

A

Inflammatory cyst, causing gradual progressive swelling associated with non vital tooth
Most common jaw cyst

68
Q

Dental cyst contents

A

Fluid, pus if infected
High level of soluble protein
Cholesterol crystals

69
Q

Define apical granuloma

A

Mass of fibrous/granulation tissue related to apex of non vital tooth

70
Q

Define residual dental cyst

A

Dental cyst which failed to resolve after extraction

71
Q

Define paradental cyst

A

Inflammatory odontogenic cyst that develops in relation to crown or root of a partially erupted tooth

72
Q

Define dentigerous cyst

A

A developmental, epithelial lined cyst which surrounds the crown of an unerupted tooth and is attached to the amelocemental junction

73
Q

What 3 teeth are dentigerous cysts most often associated with

A

3rd molars
Canines
Premolars

74
Q

Dentigerous cyst contents

A

Fluid, pus if infected
High levels of soluble protein >5mg/100ml

75
Q

Define keratocyst

A

Developmental odontogenic cyst with a characteristic epithelial lining and a high tendency to recur

76
Q

Follow up for keratocyst

A

Long term clinical and radiographical follow up mandatory
Annually for first 5 years, 3 years thereafter
Recurrence usually presents within first 5 years

77
Q

Define nasopalatine cyst

A

Developmental non-odontogenic cyst of the incisive canal in the palate believed to arise from remnants of the nasopalatine duct

78
Q

Define dermoid cyst

A

Rare developmental non-odontogenic cyst, involving soft tissues only

79
Q

Define nasolabial cyst

A

Developmental non-odontogenic cyst of the soft tissues of the face found within the nasolabial fold

80
Q

Management of cysts

A

Enucleation
Marsupialisation
Resection

81
Q

What is enucleation

A

Complete removal of cyst lining by ­primary closure or secondary intention

82
Q

What is marsupialisation

A

Partial removal of cyst lining

83
Q

What is resection

A

Removal of the whole sac

84
Q

Define acute alveolar osteitis/dry socket

A

Post-extraction condition characterised by loss of the clot from the socket

85
Q

Treatment of dry socket

A

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

86
Q

Define osteomyelitis

A

Infection of the bone and bone marrow spaces

87
Q

Define suppurative osteomyelitis

A

Infection of the bone and bone marrow spaces resulting in bone necrosis and the production of pus

88
Q

Treatment of suppurative osteomyelitis

A

Surgical debridement
Antibiotics
Ultrasound therapy

89
Q

Define chronis sclerosing osteomyelitis

A

An infection of the bone characterised by bone sclerosis, without the formation of pus

90
Q

Treatment of chronis sclerosing osteomyelitis

A

Requires endodontics or extraction of tooth
Might require debridement or antibiotics

91
Q

Define osteogenesis imperfecta

A

Group of genetically-determined disorders of bone characterised by excessive fragility and a tendency to fracture

92
Q

Treatment of osteogenesis imperfecta

A

Diet rich in calcium and vitamin D
Physiotherapy
Physical aids
Bisphosphonates
Surgery

93
Q

Define giant cell granuloma

A

Benign tumour like lesion of jaw bones characterised by numerous osteoclast like giant cells

94
Q

Treatment of giant cell granuloma

A

Curettage
Extraction of loosened teeth

95
Q

Define torus

A

Boney hard swelling, occurring either in palate or mandible which may be lobulated

96
Q

Define fibrous dysplasia

A

A benign developmental condition characterised by the presence of fibrous connective tissue with irregular trabeculae of bone

97
Q

Treatment of fibrous dysplasia

A

None usually
Surgery may be required
Bisphosphonates

98
Q

Define Paget’s disease (osteitis deformans)

A

A progressive disorder representing a disturbance of the “coupling” of synthesis and resorption of bone

99
Q

Treatment of Paget’s disease

A

Calcitonin
Bisphosphonates

100
Q

Define at risk stage of osteochemonecrosis

A

No apparent necrotic bone in patients who have been treated with either oral or IV bisphosphonates

101
Q

Define stage 0 of osteochemonecrosis

A

No clinical evidence of necrotic bone, but non-specific clinical findings, radiographic changes and symptoms

102
Q

Define stage 1 of osteochemonecrosis

A

Exposed and necrotic bone, or fistulae that probes to bone, in patients who are asymptomatic and have no evidence of infection

103
Q

Define stage 2 of osteochemonecrosis

A

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

104
Q

Define stage 3 of osteochemonecrosis

A

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

105
Q

Define osteochemonecrosis

A

Medical related osteonecrosis of the jaws following treatment with Bisphosphonates, Denosumab, Anti-angiogenic medications

106
Q

Define osteoradionecrosis

A

Exposed irradiated bone that fails to heal over a period of 3 months, excluding areas of residual or recurrent tumour

107
Q

Define Notani classification I of osteoradionecrosis

A

Confined to dentoalveolar bone

108
Q

Define Notani classification II of osteoradionecrosis

A

Limited to dentoalveolar bone or mandible above the inferior dental canal, or both

109
Q

Define Notani classification III of osteoradionecrosis

A

Involving the mandible below the inferior dental canal, or pathological fracture, or skin fistula

110
Q

4 management strategies for osteoradionecrosis

A

Triple therapy
Local debridement
Ultrasound therapy
Hyperbaric oxygen therapy

111
Q

Outline triple therapy for osteoradionecrosis

A

Chlorhexidine mouthwash 10ml bi-daily
Doxycycline 100mg once daily
Pentoxifylline 400mg bi-daily
Tocopherol (Vitamin E) 1000IU (caps) or 1000mg (suspension)

112
Q

3 ways to prevent osteoradionecrosis

A

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

113
Q

6 intra-operative complications of exodontia

A

Root fracture
Fracture of alveolar bone
Fractured tuberosity
Oro-antral communication
Root displaced into antrum
Damage to dento-alveolar nerve

114
Q

2 post-operative complications of exodontia

A

Haemorrhage
Dry socket

115
Q

Radiographic features of ameloblastoma

A

Usually large
Radiolucent and often multilocular
Expands bone, displaces and reabsorbs teeth, destroys lower border of the mandible

116
Q

Radiographic features of odontome

A

Speckled or dense radiopacity with radiolucent areas
Circumscribed mass, well defined periphery
May displace adjacent teeth

117
Q

Define hypodontia

A

1-6 teeth missing (excluding 3rd molars)

118
Q

Define oligodontia

A

7 or more teeth missing (excluding 8’s)

119
Q

Name an malignant tumour with an odontogenic epithelium without odontogenic ectomesenchyme

A

Ameloblastoma

120
Q

Name an malignant tumour with an odontogenic epithelium with odontogenic ectomesenchyme

A

Odontome

121
Q

4 common absent teeth and their prevalence

A

3rd molars (20-30% of population)
Upper lateral incisors (2%)
Lower second premolars (2%)
Lower central incisor (0.2%)

122
Q

Prevalence of absent deciduous teeth

A

Less than 1%

123
Q

Prevalence of additional permanent teeth

A

1-3%

124
Q

Prevalence of dens-in-dente

A

1-5%

125
Q

How does ameloblastoma grow

A

By epithelial proliferation extending between trabeculae of bone

126
Q

How do dental cysts grow

A

By fluid accumulation

127
Q

How do dentigerous cysts grow

A

By luminal fluid accumulation

128
Q

What syndrome can be associated with keratocysts

A

Gorlin syndrome

129
Q

How do keratocysts grow

A

By epithelial proliferation, hydrostatic forces

130
Q

Prevalence of dry socket after extractions

A

3 – 4 % of extractions
20% of wisdom teeth

131
Q

What syndrome is fibrous dysplasia associated with

A

Albright’s syndrome

132
Q

Describe patients at low risk of osteochemonecrosis

A

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

133
Q

Describe patients at high risk of osteochemonecrosis

A

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

134
Q

Prevalence of osteoradionecrosis in irradiated patients

A

7%

135
Q

Immediate treatment of periocoronitis

A

Irrigation below operculum and oral hygiene instruction

136
Q

Define pericoronitis

A

Inflammation of the gum tissue around wisdom teeth

137
Q

When should you suspect osteochemonecrosis

A

Current or previous treatment with anti-resorptive drugs
Exposed bone that persists for > 8 weeks

138
Q

What syndrome is associated with odontomes

A

Gardeners

139
Q

Define supplemental teeth

A

Additional teeth that closely resembles a tooth of normal series

140
Q

Define supernumerary teeth

A

Additional teeth that do not closely resemble a tooth of normal series

141
Q

4 reasons keratocysts have a high tendency to recur

A

Lining thin and friable
Extension into cancellous bone – difficult to remove all lining
Satellite cysts
Vigorous proliferative activity of epithelial lining

142
Q

Treatment of a patient in the at risk category of osteochemonecrosis

A

No treatment indicated
Patient education

143
Q

Treatment of a patient in the stage 0 category of osteochemonecrosis

A

Pain medication

144
Q

Treatment of a patient in stage 1 category of osteochemonecrosis

A

Antibacterial mouth rinse
Clinical follow-up on a quarterly basis
Review of indications for continued bisphosphonate therapy

145
Q

Treatment of a patient in stage 2 category of osteochemonecrosis

A

Pain control
Antibacterial mouth rinse
Oral antibiotics
Debridement

146
Q

Treatment of a patient in stage 3 category of osteochemonecrosis

A

Pain control
Antibacterial mouth rinse
Oral antibiotics
Debridement/resection

147
Q

3 things assessed prior to exodontia both clinically and radiographically

A

Crown integrity
Root size and morphology
Condition of the surrounding bone

148
Q

Name a haemorrhage that occurs during surgery

A

Primary

149
Q

Name a haemorrhage that occurs within 24 hours due to a failure to follow post-op instructions

A

Reactionary

150
Q

Name a haemorrhage that occurs days after extraction due to infection

A

Secondary

Oral surgery (4 decks)

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