Anatomy and physiology Flashcards
what are normal BP readings, elevated BP, high BP etc?
In congenital heart defects, what are cyanotic defects?
When the blood travels from the body to the lungs.
The 5 Ts are examples (don’t have to know!)
Tetralogy of Fallot, Truncus arteriosus, Transposition of great vessels, Tricuspid atresia, Total anomalour pulmonary vascular return
In congenital heart defects, what are Acyonotic?
When the blood returns from the lungs to the body.
5 defects that have 3 letter abbreviations (don’t have to remember).
Atrial septal defect, Ventricular septal defect, Hypertrophic cardiomyopathy, Patent ductus arteriosus, Coarctation of arota
What is systolic pressure?
Pressure against the vessel walls when the heart beats
What is Diastolic pressure?
Pressure against vessel walls when the heart relaxes.
What is acute hypertension?
Occurs on physical exertion, anxiety and stress
What is chronic hypertension?
Remains higher than normal with or without stimulus
What do SDCEP guidelines recommend on the use of antibiotic prophylaxis?
Antibiotic prophylaxis is not recommended routinely for people undergoing dental procedures
What prescription should be given to patients requiring antibiotic prophylaxis?
Amoxicillin 3g oral powder sachet one hour before procedure.
In patients who are allergic to penicillin, 600mg clindamycin capsules one hour before procedure
What is considered normal blood pressure?
Systolic <120, diastolic <80
What is considered elevated blood pressure?
Systolic 120-129, diastolic <80
What is considered high blood pressure?
Systolic 130-139, diastolic 80-89
What are some causative factors in high blood pressure?
Obesity, smoking, lack of physical activity, diet/alcohol, age, familial history/genetics, pain, medications (stimulants, decongestants, immunosuppressants), diseases (chronic kidney disease, hyperthyroid, acromegaly, sleep apneoa)
What are some oral side effects caused by HPB medication?
Dry mouth, taste changes, and ulcerations. Gingival hyperplasia related to calcium channel blockers. Angioedema related to ACE inhibitors and renin-angiotensin-aldosterone system blockers.
Gingival bleeding related to direct vasodialators
A 68 year old female with a history of a fractured neck of femur has been given medication to prevent her getting another fracture.
What two drugs is she likely to be taking?
Bisphosphonates
Calcium and vitamin D
What oral condition may arise from a patient taking bisphosphonates?
Osteonecrosis of the jaw
How can MRONJ be managed?
*Conservative approach
* Antiseptic mouthwash
* Antibiotics
* Surgical debridement
* Primary closure
How can MRONJ best be avoided in the first place?
* Avoid extractions
* Avoid trauma
* Good OH
* Aid healing by packing/suturing post ext
Briefly explain the main features of Stage 1 oral transportation in the context of food ingestion and mastication
Food gathered on tongue tip. Tongue retracts taking food back to the level of the posterior teeth
Briefly explain the main features of stage 2 oral transport in the context of food ingestion and mastication
Sufficiently masticated food is transferred to the oropharynx by a squeeze back mechanism in which the bolus is squeezed between the tongue and the palate
What are the 4 stages of swallowing?
- Oral phase; move food posteriorly. Some can pass onto pharyngeal surface of tongue. Liquid remains in the mouth in front of pillars.
- Pharyngeal phase. Bolus passes into pharynx. Misdirection of bolus is prevented by tongue blocking oral cavity, soft palate blocking nasal cavity and epiglottis blocking larynx.
- Oesophageal phase. Upper oesophageal sphincter constricts and bolus passes downwards.
- Lower oesophageal sphincter relaxes to admit bolus to stomach
Name two biological factors that can affect masticatory performance of a human being?
Number of occluding teeth.
Biting force
To which group of chemicals does chlorhexidine digluconate belong?
Bisbiguanides
Describe the mechanism of action of chlorhexidine digluconate
Chlorhexidine binds to the microbial cell walls causing cell wall damage and interfering with cell wall permiability. Leakage of cel contents leads to cell death. Dicationic; one ion binds to the oral surfaces and one ion to the bacterial cell membrane
The activity of an oral antiseptic depends on its substantivity. How is substantivity defined and provide two examples of factors that may influence the substantivity of chlorhexidine in the oral cavity
* Defined as the capacity of a chemical agent to continue its therapeutic effect for a prolonged period after its initial application.
* Adsorption to the oral surfaces
* Maintenence of antimicrobial activity
* Slow neutralisation of antimicrobial activity
* Concentration of chlorhexidine
* Presence/levels of anionic neutralising agents
What is the general advice for all patients taking an anticoagulant/antiplatelet?
* Plan treatment early in the day and early in the week.
* Provide pre treatment instructions
* Treat atraumatically, only discharge when haemostasis is achieved.
* If travel time to emergency care is a concern, place emphasis on preventive measures
* Provide patient with post op advice and emergency contact details
Name 2 DOACs and the advice on dental procedures
Direct oral anticoagulants. Apixaban, Dabigatran, Rivaroxaban, Edoxaban.
Low bleeding risk procedure; treat without interrupting medication.
Higher risk procedure; advise patient to delay or miss morning dose.
Treat patient early in the day, limit treatment area and assess bleeding. Consider sutures and packing
Name a vitamin k antagonist and the advice on dental treatment
Warfarin, Acenocolimarol, Phenindione
Check INR ideally not more than 24 hours before dental treatment (up to 72 hours if patient is stable)
INR < 4 treat without interrupting medication
INR of 4 or over delay treatment or refer if urgent
Name an injectable anticoagulant and the advice on dental treatment
Dalteparin, enoxaparin, tinzaparin.
If low (prophylactic dose) treat without interrupting medication (consider sutrures and packing)
If higher dose or uncertain, consult prescribing clinician
What classification of drug is aspirin and what is the advice regarding dental treatment?
Antiplatelet drug. Treat without interrupting medication. Use local haemostatic measures
Besides aspirin, name another antiplatelet drug and the advice regarding dental treatment
Clopidogrel, dipyridamole, prasligrel, ticagrelor (taken on its own or with aspirin)
Treat without interrupting medication. Expect prolonged bleeding. Limit initial treatment and consider staging treatment. Strongly consider suturing and packing
What is the advice regarding dental treatment for a patient who is on a combination of anticoagulant and antiplatelet therapy
Consult with patients prescribing clinician
For what patients should anticoagulant/antiplatelet therapy not be stopped?
* Patients with prosthetic metal heart valves or coronary stents
* Patients who have had a pulmanory embolism or DVT in the past 3 months
* Patients on anticoagulant therapy for cardioversion
Name some bisphosphonate drugs
Alendronic acid
Risedronate sodium
Ibandronic acid
Name a RANKL inhibitor
Denosumab
Name an anti-angiogenic
Bevacizumab
Sunitinib
What 3 factors put a patient at high risk of developing MRONJ?
* Previous diagnosis of MRONJ
* Pt is taking anti-resorptive or anti-angiogenic drugs for management of cancer
* Pt has taken bisphosphonate drug for more than 5 years
What foramen does the opthalamic branch of the trigeminal nerve pass through?
Superior orbital fissure
What foramen does the maxillary branch of the trigeminal nerve pass through
Foramen rotundum
What foramen does the mandibular branch of the trigeminal nerve pass through
Foramen ovale
List the cranial nerves and how you would test each one
Olfactory - can patient smell, ie hand sanitiser
Optic - check field of vision with fingers, left to right up and down
Occulomotor - ask pt to follow finger with eyes
Trochlear - ask pt to follow finger with eyes
Trigeminal - light touch to both sides, forehead, cheeks, chin
Abducense - ask pt to follow fingers with eyes
Facial - ask patient to smile, wiggle eyebrows, blow out cheeks, scrunch eyelids and try to open against resistance
Vestibulocochlear - hearing both sides, observe pts balance
Glossopharyngeal - ask pt to say ‘ahhh’ and observe soft tissues moving equally both sides
Vagus - ask pt to say ‘ahh and observe soft tissues moving equally both sides. Ask pt to shrug shoulders
Accessory - ask pt to say ‘ahh’ and observe soft tissues moving equally both sides.
Hypoglossal - ask pt to stick out tongue, wiggle from side to side
What is the nerve supply for the submandibular glad?
Chorda tympani and submandibular ganglion
What is the secretion of the submandibular gland?
Mixed serous and mucous
What is the nerve supply for the parotid gland?
Glossopharyngeal nerve
What is the secretion of the parotid gland?
Serous
What is the nerve supply for the sublingual gland?
Chorda typani
What is the secretion of the sublingual gland?
mixed but mostly mucous
What are the intrinsic muscles of the tongue?
Transverse
Vertical
Superior longditudinal
Inferior longditudinal
What are the extrinsic muscles of the tongue?
Palatoglossus
Genioglossus
Hyoglossus
Styloglossus
What is the motor nerve supply to the muscles of the tongue?
Hypoglossal except the palatoglossus which is supplied by the vagus
What is the sensory nerve supply to the tongue?
Anterior two thirds taste; chorda tympani
Posterior third glossopharyngeal
What is the
origin
insertion
innervation
function
the masseter
Inferior border of zygomatic arch
Angle of mandible
Masseteric branch of V3
Elevate and protrude the mandible
What is the
origin
insertion
innervation
function
of the temporalis
Temporal fossa
Coronoid process and anterior border of ramus
Temporal branch of v3
Elevate and retrude the mandible
What is the
origin
insertion
innervation
function
of the lateral pterygoid
Superior head; greater wing of spenoid
Inferior head; lateral surface of lateral pterygoid plate
Insertion; anterior surface of neck of mandibular condyle
Lateral pterygoid branch of V3
Depress, protrude and lateral deviation of mandible
What is the
origin
insertion
innervation
function
of the medial pterygoid muscle
Deep; medial surface of lateral pterygoid plate
Superficial; Maxillary tuberosity
Insertion; angle of mandible
Medial pterygoid branch of v3
Elevate and protrude the mandible
