BDS3 Flashcards
what does edentulism do to soft tissues
ridge resorption
reduce face height
soft tissue changes to lip and chin
what are the main reasons for complete dentures
caries
periodontal disease
tooth wear
failing dentitions
occlusal collapse
appearance
what is support
resistance of vertical movement of a denture towards the ridge
what gives support on the upper arch
palate and ridge crest
what gives support on the lower arch
buccal shelf, pear shaped pad, ridge crest, genial tubercles
what is retention
resistance to displacement of a denture away from the ridge
what is stability
ability of a denture to resist displacement by functional stress
what is adaptation in relation to dentures
degree of fit between prosthesis and supporting structures
what impression material do you use for people who gag and why
red compound as it sets faster
what do you look for when assessing if an impression is adequate
are all edentulous areas included
are sulci recorded fully
are deficiencies present
what do special trays allow
accurate peripheral extension
uniform thickness of material
reduced amount of material
records denture area more accurately
what do you aim for with impression taking
well rounded borders
minimal air blows
impression centrally placed
all clinically relevant areas
what is the process of replica dentures
lab putting impression on working side
impression of fit surface
record blocks to record occlusion
impression of fit surface with light body silicone with denture in mouth
shade and mould
try in wax
what is mucocompression
pressure applied so tissues recorded under load
what is mucostasis
minimum pressure so records at rest
what is the steps of jaw registration
upper block for retention
upper block for tooth position
upper block for occlusal planes
lower tooth position and horizontal jaw relationship
OVD and RVD
record registration
shade and mould
what does LIMBO stand for
lip support
incisal level
midline
buccal corridor
occlusal plane
what is the angle for lip support
90 degrees
how much tooth should show with complete dentures
1-2mm
what are the reference lines for the occlusal plane
interpupillary
ala-tragus
what is the neutral zone
space between the lips and cheeks and tongue where forces are equal
what is the freeway space meant to be
2-4mm
what do you measure FWS with
willis bite gauge
what gives retention
adhesion
base shape and adaptation to mucosa
post dam seal
retromylohyoid fossa
labial undercut
when is retention for dentures made difficult
atrophic ridges
cleft palate
flabby ridge
damaged alveolar ridge
gagging
insufficient saliva
what do you check at try in stage
retention and stability
base extensions
LIMBO
tooth position
vertical dimension
even contact
speech
aesthetics
what are the contraindications for immediate dentures
ORN
MRONJ
pre-cancer treatment
large cysts
fractures
dementia
what are the potential contraindications to orthodontics
allergy
epilepsy
drugs
imaging
what is AP 1
maxilla 2-3mm in front of mandible
what is AP 2
maxilla more than 2-3mm in front
what is AP 3
mandible in front of maxilla
what is increased FMPA
lines meet before occiput
what is reduced FMPA
lines meet after occiput
what does a sucking habit give
procline upper
retrocline lowers
localised AOB or incomplete OB
narrow upper arch and unilateral crossbite
what do you look at when the teeth are in occlusion
incisor relationship
overjet
overbite/open bite
molar relationship
canine relationship
cross bites
centre lines
what is class 1 incisors
lower incisor edges occlude with cingulum plateau of upper incisors
what is class 2 div 1 incisors
lower incisors edges lie posterior to cingulum plateau of upper incisors
upper proclined or of average inclination and increased overjet
what is class 2 div 2 incisors
lower incisors edges lie posterior to cingulum plateau of upper incisors
upper centrals retroclined and minimal or increased overjet
what is class 3 incisors
lower incisors edges lie anterior to cingulum plateau of uppers
overjet reduced or reversed
how is cephalometry standardised and reproducible
due to cephalostat
what is SNA
maxilla to anterior cranial base
what is SNB
mandible to anterior cranial base
what is ANB
mandible to maxilla
what would dentoalveolar compensation look like in class 3
proclined uppers
retroclined lowers
what is the frankfort plane
lower orbital rim to superior border of EAM
what is the mandibular plane
lower border of mandible
what can arch width discrepancies cause
crossbites
what is asymmetry caused by
displacement of mandible
or skeletal issues like hemi-mandibular hyperplasia
what are the 4 types of supernumerary
conical
tuberculate
supplemental
odontome
what do tuberculates cause
eruption failure of incisors
what are the 2 types of odontome
compound
complex
what teeth does hypodontia commonly affect
upper 2s and lower 5s
what percentage of the population has hypodontia
4-6%
what are the causes of retained primary teeth
absent permanent
ectopic/dilacerated
ankylosed
delayed development
pathology/supernumerary
what are the options for an absent permanent but retained primary
keep or XLA and space closure
what is early loss of teeth due to
trauma
pathology
caries
resorption
what is the incidence of ectopic canines
1-3%
what are ectopic canines associated with
peg laterals
class 2 div 2
how do you check for ectopic canines
visualise
palpate
inclination of 2
mobility of c/2
colour of c/2
what are the treatment options for ectopic canines
extract c
accept
exposure
extract 3
autotransplant
why would upper centrals be missing
supernumerary
trauma
what happens to bone in areas of compression
resorption
what happens to bone in areas of tension
deposition
what does a functional appliance do
posture mandible away from normal position stretching face muscles generating forces transmitted to teeth
grows mandible
strains maxilla
retroclines uppers
proclines lowers
mesial movement of lowers
distal movement of uppers
what do light forces do
frontal resorption
what do moderate forces do
undermining resorption
what do excessive forces do
pain, necrosis, anchorage loss
when do 6s erupt
6
when do 1s erupt
7
when do 2s erupt
8
when do 4s erupt
10
when do 3s and 5s erupt
11-12
when do 7s erupt
12-13
what are the treatment options for impacted eruption of 6 by the E
if <7yrs wait 6 months
orthodontic separators
distalise first molar
extract E
distal disking of E
what are the treatment options for unerupted central incisor due to supernumerary
remove primaries and supernumeraries
create/maintain space
monitor for 12 months
expose and chain
what does early loss of primaries do
cause localised crowding
what primaries do you balance
c
what primaries do you use a space maintainer for
E
when do you compensate for molars
if taking lowers
what is the management of habits
positive reinforcement
nail varnish
glove/plaster
habit breaker appliance/goal posts
if there is infraocclusion what do you need to check for
percussion
mobility
PA/OPT
presence of successor
ankylosis of primary
root resorption
what do you do for infraocclusion if there is a permanent present
monitor for 6-12 months
extract if below contact/root formed
maintain space
what happens if you do nothing for an infraoccluded tooth
ankylosis
more ectopic
caries
what happens if you do nothing for ectopic canines
become more ectopic
impacted
root resorption
cyst formation
ankylosis
what does low calcium mean for bones
increased bone loss
what does PTH do for calcium
maintains serum calcium levels
what does hypoparathyroidism do for calcium
low
what does hyperparathyroidism do for calcium
high
what is osteomalacia
poorly mineralised bone
what is osteoporosis
reduced bone mass
what are the symptoms of osteomalacia and how do you fix it
bowed legs and vertebral compression
sunlight and vitamin D
who is more at risk for osteoporosis
women
steroids
inactivity
smoking
what does osteoporosis cause
bone fracture
kyphosis
scoliosis
back pain
how do you prevent osteoporosis
building peak bone mass
HRT
what are the symptoms of SLE
butterfly rash
arthritis
raynauds
ulcers, bleeding, impaired drug metabolism, lichenoid reactions
what are the sjogrens antibodies
anti-ro
anti-la
what are the oral complications of sjogrens
dry mouth
oral infection
caries risk
loss of function
denture retention
sialosis
salivary lymphoma
what is systemic sclerosis
loss of elastic tissue and connective tissue fibrosis
what are the dental implications of systemic sclerosis
plan treatment in advance
dental erosion
bad metabolism
widened PDL but no mobility
what can vasculitis present as
ulcers
what is kawasaki disease symptoms
fever and lymphadenopathy, crusted and strawberry tongue
what is wegners granulomatosis oral presentation
spongy and gingival erythema
what is gout
uric acid crystal deposition
what is osteoarthritis
degenerative joint disease on weight bearing joints
what can the oral implications of osteoarthritis be
TMJ involved sometimes
ulcers due to NSAIDs
what are the dental implications of rheumatoid arthritis
reduced dexterity
access to care
sjogrens
bleeding
infection
oral lichenoid
ulcers
pigment
what is rheumatoid arthritis
synovium disease with gradual inflammatory joint destruction
what is epilepsy
reduced GABA levels in brain leading to abnormal cell-cell propagation
what can the oral implications of epilepsy be
gingival hyperplasia
bleeding
tissue injury
what are the complications of stroke
impaired mobility
communication problems
risk of cardiac emergencies
loss of protective reflexes
loss of sensory information
stroke pain
what are the side effects of SSRIs
acute anxiety
sedation
dry mouth
GI issues
what do you need to avoid if your patient is on lithium
metronidazole
NSAIDs
what are the oral implications of anorexia nervosa
ulcers
dry mouth
bleeding
what are the oral implications of bulimia
erosion
what does alloys do to help porcelain
smaller strain on porcelain as the alloy is ductile
what does an alloy which is meant to bond to porcelain need to have
good at bonding
expansion coefficient the same as porcelain
avoid discolouration
high elastic modulus
what is the alloy bond to porcelain due to
mechanical - surface irregularities
stressed skin - difference in thermal contraction
chemical - electron sharing in oxides
what is transverse strength
how well upper denture copes with stresses that cause deflection (dropping on floor)
what is the difference between self cure and heat cure PMMA
self cure has better dimensional accuracy, lower weight and poorer mechanical properties but more unreacted monomer which absorbs water and means expansion
what are the important factors for elastomers
interaction between material and tooth
accuracy
removal and undercuts
dimensional stability
how is interaction between material and tooth measured
viscosity
surface wetting
contact angle
how is accuracy of elastomers measured
surface reproduction
viscoelasticity - shark fin
how is removal and undercuts of elastomers measured
flow under pressure
tear strength
rigidity
how is dimensional stability of elastomers measured
setting shrinkage
thermal expansion
storage
what are the different types of luting agents
zinc phosphate
zinc polycarboxylate
GI
RMGIC
composite
self adhesive composite
self etching composite
what is added to RMGIC to make it resin modified
HEMA
what is the effect of HEMA on RMGIC
short setting
long working
higher strength
better bond strength
decreased solubility
but it swells !
what does bonding to porcelain require
silane coupling agent
what does bonding to metal require
metal agent
what can GIC be used to bond for indirects
MCC
metal post
zirconia
gold
what can light cure composite be used to bond for indirects
veneer
what can dual cure composite be used to bond for indirects
fibre post
composite inlay
porcelain inlay
how is zirconia made hard
ytrria stabilised
what is a LiDiSi crown material
it is a cast and milled ceramic
where would LiDiSi be used
anteriorly
where would zirconia be used
posteriorly
what irrigants are used for endodontics
NaOCl
EDTA
chlorhexidine
what material is used for obturation
GP
what are the types of sealers which can be used
ZOE
GI
resin
calcium silicate
what special investigations are used for fixed pros
sensibility tests
radiographs
study models
facebow
diagnostic wax up
diet diary
MPMB
6PPC
photographs
what are the principles of crown preparation
preserve tooth structure
retention and resistance
structural durability
marginal integrity
preservation of periodontium
aesthetic considerations
what should your crown prep taper be
6-10 degrees
what needs to be spoken about to insure informed consent for fixed pros
invasiveness
longevity and success rates
complications
time involved
cost
alternative options
what are the stages for indirect restorations
preparation
temporisation
impressions and occlusal records
cementation
what are inlays used for
occlusal cavities
interproximal cavities
replace failed directs
what are porcelain inlays cemented with
nexus/relyx
what are gold inlays cemented with
aquacem
what are onlays recommended for
sufficient occlusal tooth substance loss
remaining tooth is weak
RCT teeth
wear cases
fractured cusps
replacing failed directs
what are veneers used for
aesthetics
change teeth shape
correct peg laterals
reduce or close proximal spaces
align labial surface of instanding teeth
what are the contraindications to veneers
high lip lines
poor OH
caries
recession and root exposure
heavy contacts
what are the types of temporary restorations you can use
custom with impressions
preformed
what is the active ingredient in vital external bleaching
carbamide peroxide 10% which gives 3.6% H2O2
what ingredients in tooth whiteners reduces sensitivity
potassium nitrate
calcium phosphate
what affect bleaching
time
cleanliness
concentration
temperature
what do you need to warn patient about with whitening
sensitivity
relapse
colour
allergy
might not work
compliance
what is the in office procedure for vital bleaching
clean
dam
gingival mask
bleaching gel
heat and light
wash and repeat
30mins - 1hr
when would bleaching be indicated
age related discolouration
mild fluorosis
post smoking cessation
tetracycline staining
what are the problems with bleaching
sensitivity
wears off
cytotoxicity
gingival irritation
tooth damage
damage to restorations
problems bonding to tooth
when does sensitivity with bleaching resolve
2-3 days after
what is the procedure with internal non-vital bleaching
dam
remove restoration
remove GP from pulp chamber and 1mm below ACJ
place 1mm RMGIC over GP to seal canal
remove dark dentine
etch with 37% phosphoric acid
10% carbamide gel
then cotton wool and GIC
what does microabrasion do
remove discolouration by acid and abrasion
what is microabrasion good for
fluorosis
orthodeminersalisation
staining
before veneering
what is the procedure for microabrasion
clean
dam
18% HCl and pumice mixed
apply to teeth
rub with prophy cup 5 secs/tooth
wash and repeat up to 10x
remove dam and polish with fluoride prophy paste
fluoride varnish
review after 1 month
what are the 3 mandibular movements
rotation
translation
lateral translation
what is rotation of mandible
small mouth opening occurring around the terminal hinge axis
what is translation of the mandible
when lateral pterygoid contracts and articular disc and condyle move downwards and forward along articular eminence
what does posselts envelope display
border movements of mandible in one sagittal plane
what are the positions in posselts envelope
ICP
edge-edge
protrusion
maximum opening
retruded axis
RCP
what is lateral translation known as
bennet movement
what are functional cusps and name them
cusps which occlude with opposing teeth in ICP
lingual uppers
buccal lowers
what are non-functional cusps and name them
do not occlude with opposing teeth in ICP
buccal uppers
lingual lowers
what are the components of the mutually protected occlusion
canine guidance
posterior disclusion in lateral exclusion
no side contacts
no protrusive interferences
why do you want to avoid posterior contacts during lateral movements
muscles get a rest
teeth are not designed to absorb lateral forces and occlusal trauma can occur
what are the 2 forms of bruxism
eccentric - parafunctional grinding
centric - clenching
what do the signs of bruxism include
wear
fractured restorations
migration
mobility
muscle pain
fatigue
headache
earache
TMJ pain and stiffness
how do you put someone into RCP
bimanual manipulation
chin point guidance
anterior jig
what is the bisecting angle technique
x-ray beam not perpendicular to long axes of tooth or receptor
tooth and receptor tilted at equal and opposite angles
what are the types of upper occlusals
anterior oblique maxillary
lateral oblique
what are the types of lower occlusals
anterior oblique mandibular
true mandibular
what is the focus to skin distance
200mm
what is the ICRP
international commission for radiological protection
what does the ICRP provide
recommendations and guidance on radiation protection
what is should all radiological exposures be
justified
optimised
limited
what does justified, optimised, limited mean for radiology
justified = more good than harm
optimised = ALARP
limited = dose limits
what is IRR17 in relation to
staff and public
what are the implications of IRR17
employer needs registration from HSE
RPA issues certificate and answer questions
controlled are 1.5m
dose limits for staff and public
what is IRMER17 in relation to
exposure of patients
what does IRMER17 involve
carer and comforter
your x-ray and you sheets
referrer, practitioner, operator, employer
training records required
medical physics expert to provide advice
if teeth are lingual to focal trough what size are they
bigger
if teeth are buccal to the focal trough what size are they
smaller
what does orthogonal programme on OPT allow
better interproximal view and bone loss view
what are the patient instructions during OPT
stay still
tongue to palate
no talking or swallowing
what is the photoelectric effect
lower energy photons that are potentially damaging to adjacent tissues
lighter areas on radiographs
what is the compton effect
higher photons which can also damage outer shell electrons/adjacent tissues
what is the dose range for radiology
60-70kV
what do the biological effects of radiation depend on
type of radiation
dose
dose rate
cell irradiated
what is absorbed dose
energy deposited
what is equivalent dose
absorbed dose x weighting factor of tissue
what are the factors for dose optimisation
E speed film
60-70kV
focus to skin 200mm
rectangular collimation
what are the advantages of digital radiography
no chemicals
easy storage
put into digital notes
easy sharing
manipulated
what are the disadvantages of digital radiography
worse resolution
computer needed
data loss
print outs have bad quality
what are the horizontal tube shifts for parallax
2 PAs
2 bitewings
2 occlusals
what are the vertical tube shifts for parallax
panoramic and oblique occlusal
panoramic and lower PA
what are the 3 elements for abuse to be present
significant harm to child
carer has some responsibility for that harm
connections between carers responsibility and harm
what does GIRFEC specifiy
named person for each child
lead professional where complex needs
single child plan
SHANARRI - national practice model
shared approach to sharing information
what are the contributing factors to child abuse
drugs, alcohol, poverty, mental illness
crying, soiling, disability, unwanted pregnancy
violence towards pets, social isolation
what are the big 3 concerns for parenting capacity
domestic violence
drug and alcohol misuse
mental health problems
what children are vulnerable
under 5s
irregular attender
medical problems and disabilities
what are the markers of neglect
nutrition
warmth/shelter
hygiene
stimulation
affection
what is dental neglect
persistent failure to meet childs basic oral health needs likely to result in serious impairment of a childs oral or general health or development
what are the indicators of dental neglect
obvious disease
impact on child
care offered but child not returned
how do you manage dental neglect
preventive dental team
preventive multiagency
child protection referral
what are the intraoral signs of abuse
frenal injuries
intraoral bruises
tooth trauma
abrasions
what should increase your index of suspicion with child abuse
delay seeking help
vague story
story not compatible
parent abnormal mood
previous injury/violence
what is the scale for child axiety
mcdasf
what are the non-pharmacological behavioural management techniques
tell-show-do
enhanced control
positive reinforcement
CBT
motivational interviewing
what pharmacological behaviour management is used for children
topical
wand
LA - chasing
sedation
GA
what is the most common injury in primary dentition
luxation
when someone has trauma what medical things should you watch out for
congenital heart disease
rheumatic fever
immunosuppression
bleeding disorders
allergies
tetanus
what is the homecare after trauma
analgesia
soft diet for 10-14 days
soft toothbrush
topical chlorhexidine 0.12%
warn re signs of infection
what is the treatment of uncomplicated crown fracture of primaries
smooth sharp edges/cover
exposed dentine with GI and restore
what is the treatment of complicated crown fracture of primaries
partial pulpotomy, extract
what is the treatment of crown-root fracture of primaries
remove fragment and determine restorability
what is the treatment of root fracture for primaries
remove loose fragment
what is the treatment of concussion for primaries
observe
what is the treatment of subluxation for primaries
observe
what is the treatment of lateral luxation for primaries
spontaneous reposition/extract/reposition and splint
what is the treatment of intrusion for primaries
allow spontaneous reposition, take PA
what is the treatment of extrusion for primaries
spontaneous reposition, extract if mobile
what is the treatment of avulsion for primaries
no replanting
what is the treatment of alveolar fractur for primaries
reposition and stabilise with splint
what are the complications to primary tooth with trauma
discolouration
infection
delayed exfoliation
what are the complications to permanent tooth from trauma to primary
enamel defects
abnormal morphology
delayed eruption
ectopic position
arrested development
failure to form
odontome formation
what is the most common permanent dentition trauma injury
enamel dentine fracture
what does prognosis of traumatised teeth depend on
root development
injury type
if PDL is damaged
time between injury and treatment
presence of infection
what is treatment for enamel fracture
bond fragments/smooth edges
2PAs
what is treatment for enamel dentine fracture
account for fragment
composite bandage
2PAs
sensibility test
restore
what is treatment for enamel dentine pulp fracture
pulp cap
partial pulpotomy
coronal pulpotomy
why would you do a pulp cap for trauma
tiny exposure
less than 24hrs
why would you do a partial pulpotomy for trauma
> 1mm exposure
greater than 24hrs
what is the process for direct pulp cap
LA and rubber dam
clean with saline and disinfect with NaOCl
calcium hydroxide
composite
non-TTP and positive to sensibility tests
what is the process for partial pulpotomy
LA and dental dam
saline and NaOCl
remove 2mm of pulp with high speed round bur
saline soaked CW for haemostasis
CaOH then GI then comp
why would you proceed to a full coronal pulpotomy instead of partial
if no bleeding OR if bleeding too much
what is the aim of a pulpotomy
keep vital pulp tissue within canal to allow apexogenesis
what is the steps of pulpectomy
rubber dam
access
haemorrhage control
WL radiograph
non-setting CaOH
cotton wool
GI temp
MTA plug and heated GP
definitive restoration
what is treatment for concussion
none
what is treatment of subluxation
none, splint if mobile
what is treatment of extrusion
reposition and splint
what is treatment of lateral luxation
reposition and splint
what is treatment of intrusion
reposition spontaneously and splint
surgically reposition if 3-7+mm
what is treatment of avulsion
reimplant
clean area
splint
tetanus
consider antibiotics
what occurs with delayed reimplantation for avulsion
ankylosis replacement resorption
what is treatment for dentoalveolar fracture
reposition splint suture
soft diet 7 days
no contact sport
what should splints be
flexible and passive
stainless steel wire
what is external surface resorption due to
localised injury
what is external infection related resorption due to
what is treatment
PDL damage with indistinct root surfaces, remove infection and endo
what is ankylosis related replacement resorption due to and what is treatment
when bone cells form faster than PDL fibroblasts and no obvious PDL space
plan for loss
what is infection related internal resorption and what is treatment
progressive pulp necrosis
canal walls balloon
endo treatment CaOH in canal for 4-6 weeks and obturate
what is treatment for paeds primary herpetic gingivostomatitis
bed
hydrate
analgesia
acyclovir
antimicrobials
what is the appearance of OFG
lip swelling
gingival swelling
peri-oral erythema
cobblestoned buccal mucosa
linear ulceration
mucosal tags
fissuring
angular cheilitis
what are bohns nodules
gingival cysts which are made of dental lamina
occur on alveolar ridge
what are epstein pearls
small cystic lesions in palatal midline
what should you do for communication with ASD patients
communication
concrete language
be calm
explain what is happening
check understanding
stick with routine
be compassionate
note special interests and triggers
have as first appointment
what are the features of down syndrome
large tongue
midface hypoplasia
spaced dentition
class 3
perio disease
what are the oral complications of cerebral palsy
malocclusion
trauma
bruxism
drooling
poor OH and calculus
periodontal disease
what can acute lymphocytic leukaemia present like orally
gingival swelling and bleeding
ulceration
unusual mobility
petechiae
mucosal pallor
herpetic infections
candidosis
what is the impact of dental disease in children with disabilities
increased caries
delayed diagnosis
delayed management
multidisciplinary planning
pain/infection hard to manage
who is simplified BPE used for
7-18yr olds
what codes of BPE is used for 7-11yr olds
0-2
what codes of BPE are used from 12yrs upwards
all codes
when do you refer children to periodontology
unexplained premature exfoliation
gross mobility
red oedematous gingivae
suppuration
what is the life cycle of instrument processing
transport
cleaning
disinfection
inspection
packaging
sterilisation
transport
storage
use
what do you need for manual washing
dedicated sink
standard water 30-35 degrees
enzymatic/pH neutral detergent
long handled soft bristle brush below water
what is the cycle of the washer disinfector
flush
wash
rinse
disinfect
dry
what temperature is the washer disinfector at each stage
flush - <35 degrees
rinse - <65 degrees
disinfect - 90-95 degrees
dry - 100 degrees
what are the daily checks for the WD
spray arms
spray jets
filter clear
door seal condition
chemical in reservoir
record disinfection temperature
what are the 4 types of purified water
reverse osmosis
de-ionised
distilled
sterile
what is the temperature and pressure range for steriliser and hold time
134-137 degrees
2.05 - 2.35 bar
3 mins
what is the daily testing for steriliser
door seals
chamber not damaged
condition of load carrier
fill and drain feedwater reservoir daily
drain water reservoir daily
bowie dick
what are the weekly tests for steriliser
air leakage
air detector function
what are the factors which affect decontamination (sinner circle)
time
temperature
chemicals
energy
what does the SHTM guidance tell you
role designations
process definitions and descriptions
links to other guidance
properties of aspirin
analgesic
antipyretic
antiinflammatory
adverse effects of aspirin
GIT problems
allergy
overdose
burns
groups to avoid with aspirin
peptic ulcer
bleeders
pregnancy
asthma
children under 16
max dose of ibuprofen
2.4g
properties of paracetamol
analgesic
antipyretic
max dose of paracetamol
4g
what is the basic surgical technique for surgical access
wide based incision
one continuous stroke
no sharp angles
minimise trauma to papillae
no crushing
flap margins and sutures should lie on sound bone
heal by primary intention
dont close wounds under tension
what retracts soft tissue
howarths periosteal elevator
what do you remove bone with
electric straight handpiece
what do you debride bone with
bone file or mitchells trimmer
what is peri-operative haemostasis
LA vasoconstrictor
artery forceps
diathermy
bone wax
what is post op haemostasis
pressure
LA infiltration
diathermy
surgicel
sutures
tranexamic acid
when is the lingual nerve at risk
incising flap
raising buccal and lingual flaps
retraction of flap
bone removal
extraction with forceps
what nerves are at risk during 3rd molar removal
lingual
mylohyoid
IAN
buccal
what peri-operative complications can occur during extractions
access issues
abnormal resistance
tooth fracture
alveolar bone fracture
jaw fracture
OAC/OAF/root into antrum/tuberosity
why might you get abnormal resistance when trying to extract a tooth
thick bone
root shape
ankylosis
what teeth will more commonly cause alveolar fracture during extraction
canines and molars
what do you do if a patient gets jaw fracture during extraction
inform patient
radiograph
refer via phone
analgesia
stabilise
how do you diagnose an OAC
bubbling
nose hold test
direct vision
suction and echo
blunt probe
what are the risk factors for an OAC
premolars and molars uppers
close to sinus
last standing molars
large root
older patient
previous OAC
recurrent sinusitis
how do you manage an OAC at time of extraction
inform patient
if small = encourage clot, suture, antibiotics
if large = buccal advancement, ABX, nose blowing
why would a tuberosity fracture occur during extraction
single standing molar
inadequate alveolar support
gemination
how do you diagnose a tuberosity fracture
noise
movement
palatal mucosal tear
how do you manage a tuberosity fracture
reduction
splint
dissect loose bone
remove or treat pulp
antibiotics
post-op instructions
extract tooth 8 weeks later surgically
what damage during extraction would start a haemorrhage
mucoperisoteal tears
fractures of the alveolar plate
what can trismus post-op be due to
surgery
LA
haematoma
TMJ damage
how do you treat post op trismus
exercises
trismus screw/lollipop sticks
what is apixaban/dabigatran advice for extractions
miss morning dose
what is rivaroxaban advice for extractions
delay morning dose
what is edoxaban advice for extractions
evening only anyway so take as normal
if you get bleeding 3-7 days after an extraction what is this most likely due to
infection
how common is dry socket
2-3% of all extractions
when does dry socket appear and how long does it last
3-4 days after extraction
7-14 days to resolve
what are the symptoms of dry socket
dull aching pain
throbs to ear
up at night
sensitive bone
bad smell and taste
what are the predisposing factors for dry socket
molars
mandible , posterior
smoker
female
OCP
how do you manage dry socket
analgesia
LA
irrigate with warm saline
curettage
alvogyl
review, advise HSMW
what is infected socket management
irrigate and remove sequestra
antibiotics
how do you manage an OAF
excise sinus tract
buccal advancement flap
palatal advancement flap
graft
how do you retrieve a foreign body from the maxillary antrum
flap and suction/small curettes/irrigate
buccal advancement to close
or use caldwell luc by making a buccal window
what is osteomyelitis
inflammation of bone marrow
what is the progression of osteomyelitis
bacteria - cancellous bone - soft tissue inflammation - oedema in closed marrow spaces - increased hydrostatic pressure - soft tissue necrosis
where is osteomyelitis more likely to be seen
mandible as poorer blood supply
who normally gets osteomyelitis
immunocompromised/infection/mandible fracture
what is osteomyelitis like radiographically
moth eaten bone
what is treatment for osteomyelitis
penicillin for 6wks - 6 months depending on acute or chronic
surgery to remove bone and necrotic bone and teeth affected
referral to OS or OMFS
what causes ORN
endarteritis
how do you prevent ORN
scaling/chlorhexidine mouthwash
careful extraction
antibiotics
hyperbaric oxygen
refer for extraction
how do you treat ORN
irrigation
ABX for infection
loose bone removed
small wounds sutured
resect bone
hyperbaric oxygen
what is the treatment options for MRONJ
manage symptoms - analgesia
smooth sharp edges
Chlorhexidine
antibiotics
debride
surgical removal of sequestra
resection
suture over
irrigate
what is actinomycosis
bacterial infection which erodes tissues
what is the treatment of actinomycosis
incise and rain
excise sinus tracts
excise necrotic bone
high dose antibiotics
long term antibiotics
who gets ABX prophylaxis for IE
congenital heart defects
prosthetic valves
previous IE
what are the 3 antibiotics doses that can be given for IE prophylaxis
amoxicillin 3g oral sachet
clindamycin 600mg
azithromycin 200mg/5ml (12.5ml)
all 60 minutes before
what is an impairment
loss or abnormality of psychological, physiological or anatomical structure or function at organ level
what is disability
restriction or lack of ability to perform an activity in the manner or within the range normal for a human
what is handicap
disadvantage for individual resulting from disability or impairment
what are the 5 key areas of barriers to overcome
accessibility
accommodation
affordability
acceptability
availability
how do we assess capacity
AMCUR
how do we communicate with blind people
identify yourself and others
let them know when people entering and leaving rooms
tell them what you are doing before you do it
alternative information formats
how do we maximise communication with deaf people
loop system
establish communication method and BSL interpreter
clear speech with normal lip pattern
write things down
reduce background noise
allow extra time
what are dental implications of bariatric patients
caries
delayed wound healing
erosion
emergenciesd
what sedation is most appropriate for bariatric patients and why
inhalation sedation as you cannot find vein for IV and respiratory depression can be an issue
what advice do we give for people who have had bariatric surgery
healthy diet
adequate oral hygiene
stimulate salivary flow
fibre foods
lower acidic foods and drinks
fluoride varnish and OHI
what aids are used to help people from wheelchair into dental chair/to get treatment in wheelchair
hoist
banana board
reclining wheelchair
turn table
wheelchair recliner
stand aid
what toothbrush modifications can be made for rheumatology patients
electric
foam handles
putty handles
ball handles
suction to wall
when should the INR be obtained before treatment
ideally 24hrs before but up to 72hrs
what is a UKELD score
prognosis for living with chronic liver disease
if someone has liver disease with LA is more suitable and why
articaine because it is metabolised mostly in the plasma
what are the 5 principles of the AWI act
benefit
minimum necessary intervention
take account of adults wishes
consult relevant others
encourage adult to exercise residual capacity
what proxies are allowed to consent for treatment
welfare guardian
welfare power of attorney
combined power of attorney
what are the signs of pain from someone who cannot verbally communicate
holding face
eating habits
sleeping pattern
behaviour changes
what are the barriers to care in homes
untrained staff
poorly paid
volume of work
own perceptions of health
what adjuncts to communication can we use for intellectually impaired people
makaton
picture boards
letter boards
drawing
what exam aids can we use for intellectually impaired people
bedi shield
toothbrush
mirror and light
what is the link between learning disability and oral disease
higher perio
more missing teeth
higher plaque levels
more unmet needs
what are the risks of general anaesthesia
death
brain damage , nausea, vomiting, lethargy
increased risk with age and co-morbidities
anaphylaxis
waking up during operation
what is our responsibility for cancer patients before they start therapy
toothbrushing instruction and ID brushes
fluoride
tooth mousse
diet
PMPR
chlorhexidine mouthwash and gel
definitively restore
remove trauma
imps for fluoride trays
extract obvious prognosis teeth 10 days prior maximum
remove ortho
what is our responsibility for cancer patients during treatment
oral hygiene
chlorhexidine
diet
fluoride
symptomatic relief
when does mucositis begin and end
1-2 weeks after treatment starts
6 weeks post treatment
how can we relieve mucositis
caphosol
difflam
gelclair
cryotherapy
ice
oral hygiene
lidocaine mouthwash
what are the issues that cancer patients are faced with after treatment
xerostomia
trismus
erosion
caries
perio
ORN
what are the factors of radiotherapy which increase risk of ORN
60Gy
immunodeficient
malnourished
longer treatment
what do eating disorders present like orally
exposed dentine and hypersensitivity
lingual cervical lesions
dry mouth
nutritional deficiency
increased keratin in soft tissues
what advice do we give to people who have had eating disorders
reduce acidic drinks/have with meal
use straw
reduce acidic snacks
chew gum and rinse with water or antacid after sick
desensitising toothpaste and soft brush may help
