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3rd year dentistry > BAMS > Flashcards

BAMS Flashcards

1
Q

What is a health care associated infection (HAI)?

A

An infection that occurs as a result of medical care, or treatment in any healthcare setting

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2
Q

What are the ten standard infection control procedures?

A
  • patient placement/assessment for infection risk - hand hygiene - respiratory and cough hygiene - PPE - occupational safety - prevention and exposure management (including sharps) - safe management of care equipment - safe management of care - safe management of linin - safe management of blood and body fluid spillages - safe disposal of waste
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3
Q

What are the five moments for hand hygiene?

A
  • before touching a patient - before an aseptic task - after body fluid exposure risk - after touching a patient - after contact with patient surroundings
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4
Q

How should a spillage of blood be dealt with?

A
  • apply chlorine granules directly to wet blood spillages - for dry blood, place paper towels on top of spillage area - pour a 10,000 ppm chlorine solution on top of the spillage - leave in contact for three minutes - dispose as clinical waste - additionally wash the surface with hot water and detergent if granules have been used
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5
Q

How should a spillage of body fluids be dealt with?

A
  • using paper towels remove spillage contents and discard in clinical waste - clean spillage area with 1,000ppm chlorine solution - chlorine should never be used directly on urine or vomit
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6
Q

What are the immediate first aid steps for a sharps injury?

A
  • squeeze the affected area to encourage bleeding and wash with warm water and soap - splashes to the eyes or mouth should be rinsed out with saline. Remove contact lenses prior to rinsing and seek advice from your optition regarding cleaning
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7
Q

What are the four different types of candidosis?

A

*pseudomembranous (thrush) *Erythematous (denture induced stomatitis; atrophic HIV related and candida leukoplakia) *Angular chelitis (poor OH, dry mouth, anaemia, immunocompromised, malnourished, over closed denture) *Hyperplastic (candida leukoplakia)

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8
Q

How do you treat pseudomembranous candidosis?

A

*nystatin 4x daily for 7 days *chlorhexidine mouthwash 10ml per rinse for 7 days *fluconazole 50mg daily for 7 days

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9
Q

How do you treat erythematous candidosis?

A

*If steriod related use mouthwash after using inhaler *If denture induced stomatitis, ensure thorough cleaning. OHI given. Advise use of milton or chlorhexidine. Ensure denture is removed at night *If drug treatment is required, fluconazole capsules 50mg per day for 7 days, miconazole oromucosal gel on fitting surface of denture

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10
Q

How do you treat hyperplastic candidosis?

A

*confirm diagnosis through microbiology and histopathology *systemic antifungals *Iron, folate or viatamin B12 if patient is deficient

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11
Q

How do you treat angular chelitis?

A

*chlorhexidine mouthwash 3ml per rinse for 7 days *miconozole (2%) apply to affected area twice daily *sodium fusidate ointment (2%) apply 4 x daily *moconozole and hydrocortisone cream

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12
Q

What is the mechanism of action of anti-fungal medication?

A

Azoles mechanism of action is the inhibition of cytochrome P450 dependant enzymes (particularly 14a-demethylase) which is involved in the biosynthesis of erosterol, which is required for fungal cell membrane structure and function. Ensure that miconazole isn’t prescribed to patients taking warfarin or statins

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13
Q

What is azole resistance?

A

*it has been found that candida species such as C.krusei and C.Glabrata are naturally resistant to fluconazole *there have also been some stains of C.Albicans that have formed sensitivity and resistance to fluconazole systmeic treatment *this is why it may be important to carry out sensitivity testing and subtyping to ensure what candida species is causing the candidosis

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14
Q

What factors influence the use of chlorhexidine?

A

*It contains Bisbiguanide (bactericidal) which is the gold standard for active use against gram positive and negative bacteria, fungi, yeasts and viruses. *There is no known bacterial resistance or superinfection reported with its use *It has 12 hour substantively *It is available without prescription

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15
Q

What is the prescribed dose of chlorhexidine?

A

Chlorhexidine digluconate mouthwash 0.2%. 10ml twice daily for 1 - 2 weeks

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16
Q

What is the substantivity of chlorhexidine?

A

Substantivity is usually 12 hours but depends on - the absorption to oral surfaces - maintenance of antimicrobial activity - slow neutralisation of antimicrobial activity -other drugs -some food and drinks

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17
Q

What are the six indications for using chlorhexidine?

A

* short term use for specific problems such as candidosis *used for cleaning dentures that have caused denture stomatitis * Post oral or periodontal surgery * to prevent oral infections when good OH is difficult to maintain (ie poor manual dexterity) * immunocompromised patients, prevent oral infection spreading systemically * ANUG *Used for treatment of gingivitis as an adjunctive for OH *Used for management of mucositis

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18
Q

What side effects are associated with the use of chlorhexidine?

A

Anaphylaxis, hypersensitivity, mucosal irritation, parotid gland swelling, reversible staining of teeth and restorations, taste disturbances, tongue discolouration

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19
Q

What is a biofilm?

A

A biofilm comprises of an aggregate of microorganisms, whose cells adhere to one another and embed in a surface. The adherent cells become embedded within a self-produced matrix of extracellular polymeric substances which allows the adherence to a surface.

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20
Q

What is a niche?

A
  • An ecological niche is the role and position a species has in its environment, how it meets its needs for food and shelter, how it survives and how it reproduces. - A species niche includes all of its interactions with the biotic and abiotic factors of its environment
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21
Q

What are the stages of colonisation in a biofilm?

A
  • Adhesion - Colonisation - Accumulation - Complex community - Dispersal
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22
Q

Give examples of 2 types of Biofilms?

A
  • Streptococcus spp. = produce linking film: — Streptococcus mutans in caries development - Actinomyces spp. = cause coaggregation and re-conditioning of the film: — Actinomyces actimomycetemcomitans (A.a) in periodontitis - Candida albicans in candidiasis
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23
Q

What 3 factors are required for successful colonisation?

A
  • It requires adherence, substrate (energy) and a liveable environment: — Host: i. Mucosa surface, pellicle, acid rich police proteins, minerals and lectins — Saliva: i. Mechanical washing, bactericidal enzymes, buffering and secretor IgA — Bacterial: i. Adhesins, LTA, protease and virulence factors
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24
Q

Name five risk factors for developing oral candidosis

A

*immunocompromised patients *immunosuppressive drugs *advanced HIV infections *Intra-abdominal surgery *central venous catheter *broad spectrum antibiotics *Diabetes *long term corticosteroid use

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25
Q

What is denture induces stomatitis and what are its signs and symptoms?

A

candidal infection that adheres to and colonises acrylic surfaces. *inlammed mucosa, particularly under denture *burning sensation *discomfort *bad taste *in most cases patients are unaware of the problem

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26
Q

name the two most common opportunistic pathogenic yeasts

A

candida albicans and candida glabrata (differential sensitivities to antifungals. candida albicans generally sensitive to fluconozole)

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27
Q

What is the sequence of a biofilm formation?

A

Attachment - early phase - intermediate phase - maturation phase - dispersal

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28
Q

What four key factors account for streptococcus mutans success in causing caries?

A

*sucrose metabolism *adhesions *polysaccharides *low pH

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29
Q

what is sucrose made into to help s.mutans persist, and how does it do it?

A

Glucans, glucosyl-transferase

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30
Q

How does s.mutans adapt to its acidic environment?

A

ATPase, altered cell membrane, protection/repair mechanisms

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31
Q

What stratagies are there for control of s.mutans?

A

*probiotics *vaccination *inhibitors *fluoride

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32
Q

What is the significance of porphyromaonas gingivalis?

A

Gram negative, non motile rod. Strict anaerobe. Black pigmented. Increased numbers in periodontal disease. Suppressed or undetectable in successfully treated lesions. Increased serum of GCF in PD

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33
Q

What are the systemic implications of oral biofilms?

A

Disregulation of the oral mucosal immune system by biofilms. Manifests as destructive inflammation locally and systemically. Increased risk of cardiovascular disease, diabetes, rhematoid arthritis

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34
Q

What is dental plaque?

A

A diverse microbial community (predominantly bacteria) found on the tooth surface, embedded in a matrix of polymers of bacterial and saliva origin

35
Q

Name the three main cariogenic bacteria

A

*streptococcus mutans *Lactobacillus acidophilus *candida albicans

36
Q

What is the significance of streptococcus mutans?

A

Gram positive coccus. Metabolises dietary sucrose from insoluble polymers of glucose - sticks to surface. Survive in low pH environments

37
Q

What are the methods of preventing caries

A

*Reduce carbohydrate in saliva (dietary changes) *reduce tooth susceptibility (fissure sealants) *Reduce or eliminate cariogenic micro-organisms by antimicrobial agents *increase tooth resistance to acid attack (fluoride)

38
Q

What two main bacteria are associated with endodontic infections?

A

*Porphyromonas endodontalis *Fusobaccterium nucleatum

39
Q

Name some advantages of DNA probes and PCR

A

*less time consuming than culture methods *sensitive *can directly detect bacterial DNA within clinical samples *do not require viable cells, samples dont have to be analysed immediately

40
Q

Name some disadvantages of DNA probes and PCR

A

*may detect dead cells *detect only pre-selected species

41
Q

What is a microbiome?

A

A microbiome includes all the micro-organisms in a particular ecosystem (bacterium, fungus, protozoan, or virus.) Sometimes it is used to describe the total of the genetic material of the micro-organisms in a particular ecosystem

42
Q

Describe caries progression

A

Adhesion - survival and growth - biofilm formation - complex plaque - acid - caries

43
Q

What are the four main categories of waste?

A
  • Healthcare (including clinical) waste - Domestic waste - Special (hazardous) waste - Sharps waste
44
Q

What are the waste colour categories?

A
  • Black = domestic waste > landfill - Orange = low risk > heat disinfection > landfill - Yellow = high risk > specialist incineration - Sharps = yellow box (lid colour appropriate) > specialist incineration
45
Q

What is platelet dysfunction?

A

— This may be due to a problem in the platelets themselves or to an external factor that alters the function of normal platelets — Platelet dysfunction can be both inherited or acquired with both increasing the risk of excessive and spontaneous bleeding

46
Q

What is Thrombocytopenia

A

— Is a condition characterised by abnormally low levels of thrombocytes (platelets) in the blood. — Diagnosed when below the normal lower limit of 150x109/L

47
Q

What 3 blood tests can confirm bleeding disorders?

A
  • Full blood count screen – haematology - Coagulation screen – — Prothrombin Time (PT) — partial thromboplastin time (PTT) — Activated partial thromboplastin time (APTT) — APTT ratio — INR — D-dimmer — Fibrinogen - Thrombophilia and haemophilia factor screen
48
Q

What blood test is required for warfarin patients regularly?

A
  • INR screen to determine how long it takes for your blood to clot as warfarin affects vitamin K dependent clotting factors 2,7,9 and 10. - INR 1 = indicates level of coagulation equivalent to an average person not on warfarin but >1 indicates longer clotting time and thus longer bleeding time - INR <4 = allows for treatment to occur without interrupting anticoagulant medication; safest between 1.5-2.5
49
Q

List 4 emergency drugs essential for every dental practice

A
  • Adrenaline IM injections (1:1000, 1mg/ml) - Aspirin dispersible (300mg) - Glucagon IM injection (1mg) - Glyceryl trinitrate (GTN) spray (400ug/dose) - Midazolam IM injection (5mg/ml 2ml ampoules)
50
Q

List 4 emergency pieces of equipment essential for every dental practice

A
  • Oxygen cylinder with bag valve mask - Single use sterile syringes - Automated external defibrillator (AED) - Portable powered suction machine with appropriate suction tips and tubing - Oro-pharyngeal airway adjuvants for adults and children
51
Q

Why do we remove air from the process of ultrasonic washing?

A

— Degassing must occur, if we leave added oxygen/air in the water this inhibits cavitation and a different bubble is formed with less intensity — Without degassing the cleaner would be less effective

52
Q

How often should degassing occur?

A
  • Always run an air purge (degassing) cycle after filling the ultrasonic in the morning to remove air and oxygen from water before cleaning
53
Q

What PPE is required for decon?

A
  • Full face visor, gown, hair mask, marigold gloves and separate shoes that aren’t used for outside.
54
Q

Describe sterilised and sterile

A
  • Sterilised: — When something has went through a process of becoming free from bacteria and all other living microorganisms. - Sterile: — An object that is free from all microorganisms
55
Q

What is sterilisation?

A
  • The use of physical or chemical procedures to destroy all microorganism including large numbers of resistant bacterial spores. - Steam sterilisation: — Is the process used to render reusable medical devices free from viable microorganisms but it does not destroy prions — The aim is to expose the device to steam at a specific temperature for the specific holding time necessary to kill microorganisms — It is ultimately the result of direct contact of medical devices with saturated steam in the absence of air.
56
Q

Define validation

A
  • We consider validation of decontamination equipment when we review if the practice is safe. This related to regulation15 (premises and equipment) and regulation 12 (safe care and treatment). - Maintain and servicing decontamination equipment appropriately is essential to ensure that equipment performs to an optimum standard. This should be done in accordance with the manufacturers instructions.
57
Q

What is the sinner circle?

A
  • It shows the 4 components that are essential for adequate cleaning: — Chemicals — Temperature — Time — Energy (mechanical force) - A reduced parameter is thus compensated by an increase in another or the cycle is inadequate.
58
Q

What’s disinfection?

A
  • The destruction of pathogenic and other kinds of microorganisms by physical or chemical means. - Disinfection is achieved by temperature only known as thermal disinfection - Disinfection is less lethal than sterilisation because it destroys most recognised pathogenic microorganisms but not necessarily all microbial forms such as bacterial spores - Legislation definition: — BS ENO 15883:2006 ad the number of seconds of exposure at 80oC therefore the time heating and cooling while items are above 65oC are taken into account - We disinfect with a washer-disinfector as it makes the load and machine safe for the operator and adds reassurance for the safety of the patient prior to sterilisation
59
Q

What are glycocalyx?

A
  • This is known as a pericellular matrix, which is glycoproteins and glycolipids covering that provides a protected surrounding around the cell membranes of some bacteria, epithelial and other cells. - This allows the bacteria to evade the immune system cells more easily and can incorporate into biofilms. - Bacteria such as staphylococci sp., streptococcus sp., and pseudomonas sp.
60
Q

How do we prevent strep mutans causing caries?

A
  • Reduce carbohydrates in saliva by changing diet habits - Increase tooth resistance to acid attack by addition of fluoride - Reduce tooth susceptibility by fissure sealants - Reduce or eliminate carcinogenic micro-organisms by mechanical removal of the biofilm - Possibility of the use of inhibitors, probiotics, vaccinations and immunisation in the future
61
Q

What is the structure of glucose?

A
  • C6H12O6
62
Q

What are the 3 stages of forming a blood clot?

A
  • Vasoconstriction —> temporary blockage of a break by a platelet plug —> blood coagulation/formation of fibrin clot
63
Q

How do anti platelet drugs interrupt the clotting cascade?

A
  • Anti-platelet drugs: — makes platelets less sticky on atherosclerotic plaques — significantly reduce the chance of a heart attack or stroke in at risk people — they prolong the bleeding time following dental extractions which isn’t a significant problem but drug combinations can increase the risk — Aspirin: i. Inhibits platelet aggregation ii. Altering the balance between Throboxane A2 and prostacyclin iii. Irreversible for the life of the platelet iv. Dental treatment normal without interrupting medication
64
Q

How does warfarin affect the clotting cascade?

A

Warfarin: i. Coumarin based anti-coagulant ii. Inhibits synthesis of vitamin K dependent clotting factors: iii. Factors 2, 7, 9 and 10, protein C and S iv. Initial hyper-coagulation: 1. Anticoagulation takes 2-3 days v. Often heparin used concurrently initially vi. Must be monitored regularly: 1. Drug and food interactions with plasma protein binding and liver metabolism vii. Monitored with INR test: 1. Standardises prothrombin time usually 2-4 viii. Avoid IDB if possible ix. Interactions: 1. All drugs should be assumed 2. Amoxicillin, metronidazole, erythromycin and NSAIDs

65
Q

How do NOACs interrupt the clotting cascade?

A

— rivaroxaban, Apixaban and Dabigatran: i. All new oral anticoagulants ii. Factor X inhibitors that inhibits conversion of prothrombin to thrombin stopping the producing of the fibrin clot iii. Short-life – effect rapidly lost iv. If it is a short course for DVT – postpone dental treatment until stopped especially extractions v. Dental drug interactions: 1. safe with all except macrolides such as erythromycin and clarithromycin 2. safe with antifungals – topical and fluconazole 3. safe with LA 4. safe with antivirals 5. NSAID will prolong action and inhibit platelets – AVOID

66
Q

What oral signs and symptoms might alert a dentist to undiagnosed diabetes mellitus?

A

-Candidal infection -Burning mouth syndrome - xerostomia -Rapidly progressing perio disease

67
Q

What is osteoradionecrosis?

A

-Seen in patients who have received radiotherapy of the head and neck to treat cancer -The bone within the radiation beam becomes virtually non vital -Endarterisis; reduced blood supply -Turnover of any remaining viable bone is slow -Self repair ineffective -Worse in time -Mandible most commonly affected due to poorer blood supply -Routine extraction vs surgical extraction with alveoplasty and primary closure of soft tissue??

68
Q

What are some methods of preventing osteoradionecrosis?

A

-Scaling/chlorhexidine m/wash leading up to extraction -Careful extraction technique -ABs, chlorhexidine and review -Hyperbaric oxygen (to increase local tissue oxygenation and vascular ingrowth to hypoxic areas) before and after extraction -Take advice/refer patient

69
Q

What are some treatment options for osteoradionecrosis?

A

-Irrigation of necrotic debris -ABs not overly helpful unless secondary infection -Loose sequestra removal -Small wounds (<1cm) usually heal over a course of weeks/months -Severe cases; resection of exposed bone, margin of unexposed bone and soft tissue closure -Hyperbaric oxygen

70
Q

What is MRONJ?

A

-Medication related osteonecrosis of the jaw -Bisphosphonates are a class of drugs used to treat osteoperosis, Pagets disease and malignant bone metastases. -They inhibit osteoclast activity and so inhibit bone resorption and therefore bone renewal. -The drugs may remain in the body for years. -Occurs post extraction/following denture trauma/spontaniously -Exclusive to the jaws -Both mandible and maxilla can be affected -Risk is higher in patients receiving IV bisphosphonates but still occurs in patients on oral bisphosphonates

71
Q

How does MRONJ present?

A

-Non healing wound of >8 weeks -Ranges from small asymptomatic areas of exposed bone to extensive bone exposure, dehiscence (wound reopening), pus, pain -

72
Q

What factors contribute to the risk of developing MRONJ?

A

-Length of time the patient has been on drugs -Diabetes -Steroids -Chemotherapy -Smoking

73
Q

What are the treatment options for MRONJ?

A

-Not very successful -Manage symptoms; remove sharp edges of bone, chlorhexidine, antibiotics if suppuration -Debridement, major surgical sequestectomy, resection, hyperbaric oxygen have not proved successful

74
Q

Name some IV bisphosphonates

A

-Clodronate -Pamidronate -Zoledronate

75
Q

Name some oral bisphosphonates

A

-Alendronate -Etidronate -Ibandronate -Risedronate -Tiludronate

76
Q

What medications are linked to MRONJ?

A

-Antiresorptive drugs including bisphosphonates -Receptor Activator of Nuclear factor Kappa-B ligand (RANK-L) inhibitors such as denosumab (stops production of osteoclasts. -Antiangiogenic, two types *Monoclonal antibodies that stop receptor or growth factor (bevacizumab) *Small molecules that determine the block by binding the tyrosine kinase receptor (sunitinib and sorafenib)

77
Q

Describe the clotting cascade

A

Platelets locally activated > increased adherence to eachother and blood vessel endothelium (primary haemostasis) > inactive coagulation factors activated > production of fibrin > fibrin stabilises primary platelet plug by cross linking platelets to eachother and damaged blood vessel (secondary haemostasis)

78
Q

Name some antiplatelet drugs and their mode of action

A

Aspirin, dipyridamol and clopidogrel. -interfere with platelet aggregation by reversibly or irreversibly inhibiting various steps in the platelet activation required for primary haemostasis

79
Q

Name some anticoagulant drugs and their mode of action

A

Warfarin and other vitamin K antagonists -inhibit the production or activity of the factors that are required for the coagulation cascade -Warfarin inhibits the vitamin K dependent modification of prothrombin and other coagulation factors, impairing secondary haemostasis

80
Q

Give some disadvantages of warfarin

A

-Narrow therapeutic range -Diet sensitive -Drug interactions

81
Q

Name some NOACs (novel oral anticoagulants) and their mode of action

A

-Dabigatran; direct inhibitor of the coagulation factor thrombin -Apixaban and rivaroxaban; inhibit factor Xa of the coagulation cascase

82
Q

What are some advantages of NOACs over traditional treatments?

A

-More predictable level of anticoagulation -Do not require monitoring -Easier to manage -Potentially more effective and safer

83
Q

How should a patients prescription of NOACs be altered for dental treatment?

A
84
Q

What is the sinner circle?

A
  • It shows the 4 components that are essential for adequate
    cleaning:
    — Chemicals
    — Temperature
    — Time
    — Energy (mechanical force)
  • A reduced parameter is thus compensated by an increase in
    another or the cycle is inadequate.

3rd year dentistry (16 decks)

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