BDS4 Flashcards
1
Q
what is BSI definition of class 2 div 1
A
lower edges lie posterior to cingulum plateau of upper incisors
increased overjet
upper centrals proclined or of average inclination
2
Q
why do you treat class 2 div 1
A
aesthetics and trauma
3
Q
what is the skeletal pattern for class 2 div 1
A
class 2
4
Q
what are the soft tissues like in class 2 div 1
A
incompetent lips
lower lip trap
mandible postured to allow lips to meet
tongue between incisors
5
Q
what are the dental factors of class 2 div 1
A
increased overjet
variable overbite
variable alignment
dry gingiva
6
Q
what is the aetiology of class 2 div 1
A
sucking habits
skeletal growth
7
Q
what are the consequences of sucking habits
A
procline upper anteriors
retrocline lower anteriors
AOB
incomplete overbite
narrow upper arch
8
Q
how do you stop a sucking habit
A
positive reinforcement
nail polish
glove
habit breaker
9
Q
what are the treatment options for class 2 div 1
A
accept
growth modification
URA only
camouflage
orthognathic surgery
10
Q
why would you accept class 2 div 1
A
mild increased OJ
patient happy
11
Q
what is used for growth modification for class 2 div 1 and what does it do
A
twin block
distalise uppers
mesialise lowers
retrocline uppers
procline lowers
12
Q
when would you use a URA only for class 2 div 1
A
very mild malocclusion
proclined overjet and spaced incisors
13
Q
what is the BSI definition of class 2 div 2
A
lower incisors occlude posterior to the cingulum plateau of the upper incisor
upper incisors are retroclined
overjet reduced
14
Q
what is the skeletal pattern with class 2 div 2
A
mild/moderate class 2
reduced FMPA
prominent chin
15
Q
what are soft tissues like with class 2 div 2
A
high resting lower lip line
marked labio-mental fold
upper 2s trap lower lip
16
Q
what are the dental features of class 2 div 2
A
retroclined upper centrals
upper 2s crowded
reduced arch length
poor cingulum on upper laterals
deep overbite
17
Q
why do you treat class 2 div 2
A
aesthetics and traumatic overbite
18
Q
what are the treatment options for class 2 div 2
A
accept
growth modification
camouflage
orthognathic surgery
19
Q
why would you accept class 2 div 2
A
good aesthetics
patient happy
overbite not an issue
20
Q
what is used for growth modification for class 2 div 2
A
modified twin block
procline upper incisors
21
Q
how do you camouflage class 2 div 2
A
reduce overbite
correct inter-incisal angle
torqueing upper incisors
proclining lower incisors
22
Q
what features of class 2 div 2 have high relapse rate
A
deep overbite
rotated laterals
23
Q
what is the BSI definition of class 3
A
lower incisor edge occludes anterior to the cingulum plateau of the upper central incisor
overjet reduced or reversed
24
Q
what is the skeletal features of class 3
A
AP class 3
bilateral crossbites
retrusive maxilla and wide mandible
25
what are the dental features of class 3
class 3 incisors and molars
reverse overjet
reduced overbite
AOB
crossbites
crowded maxilla and spaced mandible
dentoalveolar compensation
displacement on closing
26
How do the soft tissues influence dental features of class 3
tongue proclines uppers
lip retroclines lowers
27
why do you treat class 3 malocclusions
aesthetics
attrition
recession
displacement
speech
mastication
28
what factors of class 3 can make it harder to treat
facial growth
crossbite
AOB
29
what are the treatment options for class 3
accept
growth modification
camouflage
orthognathic surgery
30
what interceptive treatment for class 3 would a patient receive
URA to procline incisors over the bite
31
what is growth modification used for in class 3
reduce mandibular growth and encourage maxillary growth
32
what appliance is used for growth modification in class 3
reverse twin block
protraction headgear with rapid maxillary expansion
33
when would you camouflage a class 3
when growth stopped
ANB > 0
average or increased overbite
edge-edge
minimal dentoalveolar compensation
34
how do you camouflage a class 3
extract upper 5s and lower 4s
retrocline lowers
procline uppers
correct overjet
35
how do you check for the presence of a canine
palpate buccally and palatally
mobility of c's
angulation of laterals
mobility of lateral
colour of c and lateral
radiography
36
what is the aetiology of unerupted canines
long path of eruption
genetics
class 2 div 2
crowding
ectopic position of tooth germ
37
what are the treatment options for unerupted canine
accept
extract c
expose
surgically remove
autotransplantation
38
when would you accept position of unerupted canine
if canine has not migrated mesially further than midline axis of lateral
39
what could accepting the position of an unerupted canine cause
root resorption
ankylosis of canine
cyst formation
problems for restorative
40
when would you surgically remove an unerupted canine
if good eruption path not possible
if damage to lateral incisor
if good occlusion
41
what is the aetiology of unerupted maxillary incisors
trauma to primaries = dilaceration
tuberculate supernumerary
retained primary
early loss of primary
crowding
ectopic position of tooth germ
42
what are the treatment options for unerupted maxillary incisors
accept
bring into arch
43
what can accepting the position of an unerupted maxillary incisor cause
ankylosis
root resorption
drift of lateral
cyst formation
44
what are the causes of hypodontia
non-syndromic - genetic
syndromic - CLP/ectodermal dysplasia
environmental - trauma/cancer therapy
45
what is the presentation of hypodontia
delayed/asymmetric eruption
retained deciduous/absent deciduous
tooth form
46
what are the associated issues with hypodontia
microdontia
spacing/drifting
over-eruption
aesthetics and function
47
what are the options for missing upper 2s
accept
restorative
orthodontics
combined
48
what are the restorative options for missing upper 2s
retract 3 and create space for RBB for 2
pressure retainer with 2 as pontic
implant
shape canine to be lateral
partial denture
49
what classification is used for cleft lip and palate
LAHSAL
50
what are the dental implications of cleft lip and palate
missing teeth
impacted teeth
crowding
growth
caries
51
what are the functions of fixed appliances
camouflage
alignment
rotations
centreline
overbite and overjet
spaces
vertical movements
52
what are the advantages of NiTI archwire
flexible
light continuous force
shape memory
higher friction than SS
53
name 4 generators of force in orthodontics
elastic power chain
NiTi coils
elastics
active ligature
54
what features have a high chance of relapse
diastema
rotations
palatal ectopic canines
proclined lower incisors
AOB
instanding upper 2s
55
what are the dental health benefits of orthodontics
impaction by missing teeth
trauma risk by overjet
perio support and wear caused by crossbites
caries/perio caused by contact issues
gingival stripping by overbites
56
what are the main risks of orthodontic treatment
decalcification
root resorption
relapse
soft tissue trauma
57
how do you prevent decalcification in orthodontics
case selection
oral hygiene
diet
fluoride
58
what are the risk factors for root resorption
tooth movement - prolonged/intrusion/torque
root form - blunt/pipette
previous trauma
nail biting
59
what are the issues with adult orthodontics
lack of growth
periodontal disease
missing/restored teeth
physiological factors
adult motivation
60
what is the goal of orthodontic treatment aiming to achieve
Andrew's six keys
61
what are Andrew's six keys
tight contacts with no rotations
class 1 incisors
class 1 molars
flat occlusal plane
slight mesial inclination
canines - molars lingually inclined
62
what are the complications of cannulation
venospasm
extravascular injection
intraarterial injection
haematoma
fainting
63
how do you treat venospasm
take time dilating
efficient technique
gloves to keep warm before
64
how do you treat extravascular injection
remove cannula, apply pressure, reassure
65
how do you treat intra-arterial injection
monitor for loss of pulse
leave cannula in for 5 mins post drug then remove if no problems
symptomatic = hospital referral
66
how do you treat haematoma from sedation
time
rest
reassurance
ice pack
67
what are the complications of drug administration in sedation
hyperresponders
hyporesponders
paradoxical reactions
oversedation
allergy
68
how do you manage oversedation
stop
try to rouse
ABC
reverse with flumazenil 200mcg then 100mcg each minute
watch for 1-4hrs
69
how do you manage respiratory depression
check oximeter
stimulate patient
head tilt, chin lift, jaw thrust
supplemental oxygen - nasal cannula 2l/min, hudson mask 5l/min, ambu bag
flumazenil
70
what are the signs and symptoms of N2O2 overdose
patient discomfort
lack of co-operation
mouthbreathing
giggling
nausea
vomiting
LoC
71
what is the treatment of nitrous oxide overdose
decrease concentration by 5-10%
reassure
dont remove nosepiece
72
what does choice of sedation technique depend on
patient co-operation
anxiety and previous experience
dentistry needed
facilities and team skills
73
what are the advantages of IHS
anxiety relief, rapid recovery, flexible duration
74
what are the disadvantages of IHS
nasal hood needs kept in place
less muscle relaxation
need good breathing coordination
75
what are the advantages of IV sedation
good sedation and muscle relaxation with little co-operation
76
what are the disadvantages of IV sedation
baseline readings needed
cannulation
continuously reassess sedation level
77
what is the distribution and elimination half lives of midazolam
distribution = 4-18mins
elimination = 1.5-2hrs
78
what are the causes of dental anxiety
trauma
transference
fear of criticism
fear of dress
lack of communication
helplessness
surgery appearance
staff continuity issues
79
what are the contraindications to sedation in general
severe/uncontrolled systemic disease
severe psychiatric problems
narcolepsy
hypothyroidism
80
what are the contraindications to IV sedation
COPD
hepatic insufficiency
pregnancy
81
what are the contraindications to IHS
blocked nasal airway
COPD
pregnancy
82
what ASA classifications can we treat in primary care and what in secondary care
1 and 2 primary
3 in secondary
83
why do oxygen saturations start to rapidly decrease once they go past 90%
as the affinity of haemoglobin to O2 is decreasing
84
what vital signs are assessed at sedation assessment
heart rate
BP
oxygen sats
BMI
85
what are the effects of benzodiazepines as sedative agents
enhance GABA effects
respiratory depression - CNS and depression and muscle relaxation
decreased cerebral response to increased CO2
decreased BP
increased heart rate
86
what is the concentration of midazolam used
1mg/ml
87
where is midazolam metabolised
liver
88
where can the cannula be put for sedation
dorsum of hand
antecubital fossa
89
what structures do we need to be careful of if using the antecubital fossa for cannulation
brachial artery and median nerve
90
when do you stop administering midazolam
slurred and slow speech
relaxed
willingness to accept treatment
verrils sign
eves sign
91
what are verrills and eves sign in sedation
eyes drooping
finger to nose
92
what is the concentration of flumazenil
500mcg/5ml
93
what are the anxiety assessments that are used
mcdas
mcdasf
94
what is the 5 factor model of CBT
situation
thoughts
moods/emotion
behaviour
body reaction
95
what are the key factors of sedation
remains conscious
retains protective reflexes
understands and responds to verbal commands
96
what are the indications for IHS
anxiety
needle phobia
gagging
traumatic procedures
97
what are the contraindications for IHS
medical issues, cold, large tonsils, COPD, pregnancy, claustrophobia
98
name some safety features of IHS
reservoir bag
colour coding
scavenging system
oxygen flush button
pressure reducing valves
99
what are the signs and symptoms of adequate sedation via IHS
relaxed
slower blinks
reduced gag
awake
still verbal
lethargic
dreaming
100
what are the signs of oversedation via IHS
mouth closing/breathing
vomiting
decreased cooperation
uncontrollable laughter
LoC
incoherent speech
101
what are the pre-op instructions given before a sedation appointment
light meal first
accompanied by adult
sensible clothes
plan to remain in clinic up to 30mins after
102
what is the procedure of IHS
100% O2 5-6l/min for 1 min
reduce O2 by 10%, wait 1 min and repeat
after O2 reaches 80% reduce by 5% per minute
stop titrating when ready
constantly reassure during treatment
gradually increase O2 by 10-20% per minute or turn straight up
100% O2 for 2-3mins
103
what is attrition caused by
tooth to tooth contact
parafunctional habit
104
what are the signs of attrition
facets on occlusal surfaces
reduction in cusp height
105
what is abrasion caused by
wear through abnormal mechanical process independent of occlusion (foreign object)
toothbrushing
106
what are the signs of abrasion on the tooth
labial, cervical v-shape lesions on canines and premolars
107
what is the cause of erosion
chemical process but no bacteria
108
what are the signs of erosion
flat and smooth surfaces
bilateral concave lesions
dark incisal edges
high restorations
109
what is abfraction
biomechanical loading forces resulting in flexure and failure of enamel and dentine at location away from loading which disrupts enamel and dentine by cyclic fatigue
110
what does an abfraction lesion look like
v-shaped
111
how do you start preventing/reducing tooth weae
recognise problem
grade severity
diagnose likely cause
monitor progression
112
what medical history issues can cause erosion
GORD
medications
alcoholism
ED
pregnancy
reumination
113
what social history causes can cause tooth wear
lifestyle stresses
habits
diet
sports
114
what extraoral signs would be indicative of wear
restriction of TMJ movement
hypertrophy
restricted mouth opening and deviation
115
what wear indices are there
smith and knight
bewe
116
apart from wear indices what other special tests are included in tooth wear cases
sensibility tests
radiographs
articulated study models
photos
wax up
diet analysis
117
what are the patterns of wear
localised or generalised
118
what are the 3 types of generalised wear
with OVD loss
without OVD loss but limited space
without OVD loss but no space
119
what is prevention for abrasion
RMGIC in cavities so patient wears this away instead
120
what is prevention for attrition
CBT, hypnosis
splints - soft/hard/michigan
121
what is a michigan splint
splint with canine rise for disclusion and stops which put you in centric occlusion
122
how do you prevent erosion
fluoride
desensitising agents
habit changes
medical - GMP
123
how do you monitor wear
indices
photos
study models
remove cause
124
what factors influence what the treatment of maxillary anterior wear is
pattern
inter-occlusal space
space needed for planned restorations
quality and quantity of tooth left
aesthetic demands
125
why would there be no space left if someone has wear with no loss of OVD
the alveolar bone grows to compensate and maintain mastication
126
what are the methods of creating interocclusal space
increase OVD
reorganise from ICP to RCP
surgical crown lengthening
RCT and post crowns
conventional ortho
127
what is the Dahl technique
composite on anteriors to open bite
posterior disclusion occurs and OVD increase of 2-3mm
occlusion only on canines/incisors
anteriors intrude and posteriors erupt
128
what is the Dahl technique used to treat
localised wear
129
when is the Dahl technique not suitable
active perio
TMJ
after ortho
bisphosphonates
implants
existing conventional bridge
130
what is the first line treatment for anterior wear
composite build ups
131
what is the treatment for localised posterior wear
composite to palatal of upper canines for posterior disclusion to aim for canine guidance
132
what are the methods of composite build ups in wear
alginate, wax, putty matrix
lab made vacuum formed matrix
133
what is the patient information for composite build ups for wear
front teeth have tooth coloured fillings
no/minimal drilling
bite feels strange for a week
back teeth take 3-6 months to touch
lisp for few days
likely need to replace crowns/bridges at back of mouth
will require maintenance
134
what is the treatment for excessive loss of OVD in wear
splint to assess tolerance to face height
increase height with comps
dentures to provide posterior support
135
what is the treatment for wear without OVD loss and limited space still available
re-organisation
splint considered for height
restore to new height
136
what is the treatment for wear without OVD loss but no space
specialist opinion
splints/dentures/crown lengthening/overdentures
137
what is the SDA
sufficient adaptive capacity when 3-5 units left which occlude
138
what does loss of molars mean for SDA
TMJ issues
less occlusal stability
mandibular displacement
reduced masticatory efficiency
139
what are the main conclusions about the SDA
sufficient oral function and comfort
sufficient mandibular stability
sufficient occlusal stability
occlusal attrition not significantly different
alveolar bone decreases at same rate
140
what are the indications for SDA
missing posteriors with 3-5 occluding units
sufficient contacts large enough to get occlusal table
favourable prognosis for remaining teeth
patient not motivated to pursue complex plan
limited money for dental care
141
what are the contraindications for SDA
poor prognosis for remaining dentition
periodontal disease
TMJD
pathological wear
severe class 2 or 3
142
what factors of the patients dentition would make you opt to replace teeth rather than give SDA
problems chewing
appearance concerns
occlusal instability
143
what happens in the SDA if the PDL is not healthy
drifting, loss of alveolar bone
distal tooth migration - increasing anterior load, occlusal contacts and interdental spacing
144
what are the 5 requirements of occlusal stability
stable contacts on all teeth of equal intensity
anterior guidance in harmony with envelope of function
disclusion of posterior teeth during protrusion
disclusion of posteriors on non-working side in lateral movement
disclusion of posteriors on working side in lateral movement
145
what is occlusal stability determined by
absence of pathology
perio support
number of teeth in arches
interdental spacing
occlusal contacts
mandibular stability
146
how can you extend the SDA
RBB
conventional bridge
implants
RPD
147
what are the local indications for bridgework
big teeth
heavily restored
favourable occlusion
favourable abutment angulations
148
what are the contraindications to bridgework
uncooperative
poor OH
high caries
perio disease
large pulps
high chance of further tooth loss
prognosis of abutment poor
length of span too great
tilted teeth
periapical status
bone loss
149
what are the advantages of RRB
minimal prep
quicker
cheaper
used as temporary
150
what are the disadvantages of RRB
metals shine through
porcelain can chip
can debond
has occlusal interference
151
what are the indications for a RRB
young teeth
good enamel
large surface bonding area
minimal occlusal load
single tooth replacement
simplify denture design
152
what is a direct RBB
uses own tooth/acrylic tooth as pontic in emergency situations like trauma or after extraction
153
what is the prep for a RBB
minimal
180 degree wrap around
rest seats
proximal grooves
prep in enamel only
154
what is used to cement RBB
dual cure composite luting cement - panavia
155
what is a fixed-fixed bridge and what are the advantages
retainer at each end
robust, max strength and retention, long spans
156
what are the disadvantages of fixed-fixed bridge
difficult prep
path of insertion
minimal taper
157
what is a cantilever bridge and what is the advantage
pontic support at one end only
conservative design
158
what are the disadvantages of cantilever bridges
short span only
rigid
159
what is a fixed-moveable bridge and what are the advantages
rigid connector distally and moveable connector mesially
no common path of insertion, conserve tooth tissue, allows minor tooth movement
160
what are the disadvantages of fixed-moveable bridges
span limited, complicated, clean beneath moveable joint
161
what is hybrid bidge
one retainer is conventionally prepped and the other is resin-bonded
162
what is a spring cantilever bridge
metal arm from pontic to abutment (usually posterior abutment)
163
what are the requirements of abutments for bridges
withstand forces
free of inflammation
crown to root length needs to be 2:3 or minimum 1:1
164
what is evaluated for abutments for bridges
roots
angulation
perio
bonding surface area
risk of pulp damage
endodontic quality
tooth structure remaining
165
what are the different types of pontics used for bridges
wash through
dome shaped
modified ridge lap
ridge lap
166
what materials are used for bridges
all metal - gold
metal ceramic
zirconia
167
what do you cement conventional bridges with
all metal = aquacem/relyx
metal ceramic = aquacem/relyx
zirconia = nexus
168
what do you cement adhesive bridges with
panavia
169
why should distal cantilevers be avoided on bridges
occlusal forces on the pontic produce leverage forces on abutment meaning it will lift
170
what are the signs of bruxism
significant wear
repeated restoration failure
root fracture
progressive
lack of posterior support
171
why might someone be without posterior support
denture intolerance
denture refusal
supervised neglect
172
what does lack of posterior support mean for the remaining dentition
increased severity of wear
increased rate of wear
occlusal collapse
functional and aesthetic problems
173
what are the advantages of overdentures
correct occlusion and aesthetics
support
tooth wear management
preserve ridge form
proprioception
denture retention
MRONJ
174
what are the disadvantages of overdentures
need good oral health
increased caries and perio
discomfort and infection
175
what is the purpose of transitional dentures
increase OVD and get patient used to this
176
what do you need when you are planning to rehabilitate wear
impressions and facebow
mounted casts
high quality interocclusal record
wax ups
stents
temporary transitional dentures
photos
177
what can you do to increase retention and resistance for wear patients
grooves
inlays
ferrule
crown lengthening
parallel prep
margins and occluding surface
178
what is a failing dentition
deteriorating teeth, restorations or oral health means loss of inadequate basic oral functions such as mastication
179
what model is used to break bad news
SPIKES
180
name the steps of the SPIKES model
set up interview
assess what patient knows
invite them to new information
give medical facts
respond to emotions
negotiate follow up steps with a summary
181
what is osseointegration
direct functional and structural connection between load bearing implant and bone
182
what is primary osseointegration
implant anchored due to frictional forces provided between osteotomy and implant
183
what is secondary osseointegration
living bone grows onto surface of implant
184
what are the supra and sub crestal tissues like with implants compared to tooth
supra - more collagen, less fibroblasts, parallel collagen fibres
sub - rigid connection
185
what are the types of implant
bone level
tissue level
tapered
parallel
186
what factors are important when deciding risk for implants
medical
smoker
aesthetic demand
lip line
biotype
shape of crown
bone level to contact point
local infection
neighbouring restorations
width of space
soft tissues
bone defect
187
what are the bone distance requirements for implant
1.5mm mesial-distal
1mm bone labially
2mm from apical part of implant to gingival margin
188
what are the planning aids for implants
study models
wax up
surgical template
clinical photos
CBCT
surgical guide
189
what are the 2 impression techniques for implants
open tray
closed tray
190
what are the common causes of compromised tissue sites
post XLA defects
trauma
hypodontia
perio
thin biotype
191
what are the determinants of aesthetic outcome for implants
bone volume
space dimensions
3D implant position
biotype
operator skill and experience
192
what is the disinfection temperature, hold time and contact rate of the WD
90-95 degrees
1 min hold
12 secs contact rate
193
what does the SHTMs give you
guidance on design, installation, operation of technology
decon stages and description of each
requirements of machine operation and tests needed
194
what is SHTM 01-01
decontamination of medical devices in a CDU
195
what part of the SHTM01-01 refers to steam sterilisation
C
196
what part of the SHTM01-01 refers to automated cleaning and disinfection
D
197
what part of the SHTM01-01 refers to test equipment and methods
B
198
what part of the SHTM01-01 refers to management
A
199
when would you reference the SHPN
when designing a facility and installing equipment
200
what is the NP143
national procurement
contract for decontamination equipment used in LDUs
201
what document do you look at when procuring decontamination equipment
medical device regulations
202
what should the instruments be marked with when you are procuring them and what does this mean
CE
materials used to make this are of the required grade/standard
203
what does the Labour Standards Assurance System do
ensure that equipment is made in an ethical way
204
what is included in the ACT for the WD
date, operator, cycle start time
cycle number, duration, wash temperature, disinfection temperature, hold time, was detergent added, was cycle complete
205
what is a parametric release
release of a batch of sterilised items based on data from the sterilisation process but all parameters within the process have to be met before the batch can be released for use
206
who ensures that validation of tests are complete in the LDU
CP(D)
207
what daily steriliser information should you take down
date, time, operator
cycle number, sterilisation temperature
daily tests performed, bowie dick, sterilisation machine complete
208
what should be included in the ACT for the steriliser
temp and pressure of each stage
during sterilisation stage record temperature each minute
steam penetration, air leakage, ADFT
209
what are the daily/weekly checks for the WD
spray arms rotate and jets not blocked
door seal for damage or contamination
load carrier condition
no instruments from previous load
strainer/filter clear
sufficient amount of chemical
protein detection test and soil test
disinfection temperature and times
full ACT
210
what are the daily/weekly steriliser checks
door seal for damage
condition of load carrier and chamber
fill and drain feed and used water reservoirs
air leakage
bowie dick
air detector function test
daily sterilisation temperature, pressure and time
full cycle ACT
211
what are the quarterly checks for the steriliser
weekly safety checks
calibration of test instruments
air leakage
ACT and verification of calibration
small load thermometric test
calibration checks
ADFT
bowie dick test
212
what are the top 5 causes of handpiece faults
incorrect compressor settings
damaged or oversized bur fitted
incorrect instrument usage
poor cleaning
incorrect lubrication
213
when is the handpiece lubricated in the decon cycle
after wash but before sterilisation
214
why do we need compressors
incorrect air pressure causes faulty operation
215
what are the treatment options for intrinsic discolouration in permanent anteriors
microabrasion
bleaching
resin infiltration
composite restoration
composite veneers
216
what records are needed before treating discoloured teeth
photos
shade
sensibility testing
diagram of defect
radiographs
217
what are the safety features of microabrasion
PPE
patient bib and gloves
dental dam
sodium bicarbonate guard
218
what is the process of HCl and pumice microabrasion
dental dam and guard
HCl pumice and rotating rubber cup for 5 seconds (x10)
wash after each 5 seconds
fluoride varnish
polish with lightest blue sandpaper disc
final polish with toothpaste
219
why are sandpaper discs used in microabrasion
they change the optical properties of enamel so areas of intrinsic discolouration become less perceptible
220
how much enamel is lost as a result of HCL pumice microabrasion
100microns
221
what are the advantages of microabrasion
easy
conservative
minimal maintenance
effective
permanent results
222
what are the disadvantages of microabrasion
removes enamel
requires protective apparatus
223
what is the patient warning after microbabrasion
avoid highly coloured food and drink due to the fact that teeth are dehydrated
224
what is the home vital bleaching via nightguard technique and what percentage carbamide peroxide is used
10%
brush teeth
gel to tray
set over teeth and press down
remove excess
wear overnight for 3-6 weeks
225
what does 10% carbamide peroxide equate to
3% H2O2 and 7% urea
226
what is the walking bleach non-vital bleaching process
remove GP to below gingival margin
bleaching agent on cotton wool
cover with dry cotton wool
seal with GIC
renew bleach no more than 2 weeks apart
227
what is the inside-out non-vital bleaching process
access cavity open
mouthguard and bleach applied
worn all the time
gel changed every 2 hours
restore with CaOH and GIC then either white GP and resin or cured composite
228
what are the complications of non-vital bleaching
external cervical resorption
spillage of bleaching agents
failure to bleach
brittleness of crown
229
how do you prevent ECR with bleaching
layering cement over GP or non-setting CaOH for 2 weeks before definitive
230
what are the short term soft tissue effects of bleaching
ulceration/irritation
plaque reduction
aids wound healing
231
what are the long term soft tissue effects of bleaching
delayed wound healing
periodontal harm
mutagenic potential
232
how would tooth mousse be used to supplement bleaching and microabrasion
bleaching = 2wks at home application
microabrasion = 4 wks at home application
233
what is resin infiltration
erosion of the surface layer, desiccating the lesion and applying resin infiltrant
234
what teeth are commonly missing with hypodontia
mandibular premolars
maxillary laterals
235
what syndromes are associated with hypodontia
ectodermal dysplasia
Downs
cleft palate
236
what is the management of hypodontia
diagnosis and PREVENTION
removable pros
ortho
composite build ups
porcelain veneer
crowns and bridge
237
what are the problems with hypodontia
abnormal shape
spacing
submergence
deep overbite
reduced LFH
238
what is the prevalence of hyperdontia
1.5-3%
239
what syndrome is associated with hyperdontia
cleidocranial dysplasia
240
what are the 4 types of supernumerary
conical
tuberculate
supplemental
odontome
241
what are the 3 enamel structure anomalies
amelogenesis imperfecta
environmental enamel hypoplasia
localised enamel hypoplasia
242
what are the 4 types of amelogenesis imperfecta
hypoplastic
hypocalcified
hypomaturational
mixed
243
what is the cause of amelogenesis imperfecta
generalised hereditary disease
244
how do you diagnose amelogenesis imperfecta
history
affects both dentitions and all teeth
size, structure and colour are wrong
245
what is hypoplastic amelogenesis imperfecta
crystals not right length
246
what is hypomineralised amelogenesis imperfecta
crystallites fail to grow in thickness and width
247
what is hypomaturational amelogenesis imperfecta
incomplete mineralisation
248
what issues do amelogenesis imperfecta teeth have
sensitivity
caries susceptibility
poor aesthetics
poor OH
delayed eruption
AOB
249
what is the treatment for amelogenesis imperfecta
prevention
composite veneers
fissure sealants
metal onlays
SSCs
250
what systemic disorders are associated with enamel defects of structure
incontinenta pigmentii
downs
prader-willi
prophyria
tuberous sclerosis
251
what are the dentine structure anomlaies
dentinogenesis imperfecta
dentine dysplasia
odontodysplasia
252
what are the signs of dentine dysplasia
pulp obliteration
amber radiolucency
short roots
253
what are the signs of odontodysplasia
thin enamel and dentine and large pulp looking like a ghost tooth
localised arrested development
254
what are the 3 types of dentinogenesis imperfecta
1 = osteogenesis imperfecta
2 = autosomal dominant
brandywine
255
how do you diagnose dentinogenesis imperfecta
appearance, family history
bulbous crowns and obliterated pulps
enamel loss
256
what are the problems with dentinogenesis imperfecta
aesthetics
caries
spontaneous abscess
257
what is the treatment of dentinogenesis imperfecta
prevention
composite veneers
overdentures
removable pros
SSCs
258
what is the overall dental management for structural defects
manage growth and development
removable pros
crown and bridge
interceptive orthodontics
continuous dental care
259
what are the cementum anomalies of structure
cleidocranial dysplasia giving cementum hypoplasia
hypophosphatasia giving hypoplasia of cementum and early loss
260
why would you have premature eruption
high birth weight
neonatal teeth
261
why would you have delayed primary eruption
low birth weight
downs
hypothyroidism
262
why would you have premature exfoliation
trauma
after pulpotomy
hypophosphatasia
immune deficiency
263
why would you have delayed exfoliation
infraocclusion
hypodontia
ectopic permanent successors
after trauma
264
what are the management options for caries in primary teeth in general practice
prevention
biological management
minimally invasive
conventional restorative options
extraction
265
what ages are milestones for monitoring developing dentition
3,6,9,12
266
what aspects of childrens dentistry are we expected to manage in general practice
dental caries
emergencies
developing dentition
MIH
orthodontics
child protection
267
what is motivational interviewing
ask the patient what their own goals are whilst maintaining positive attitude
268
when should we try to start taking bitewings
4yrs old
269
what are the variables when deciding how best to treat caries in paediatrics in general dental practice
caries risk
age and ability to cope
length of time until exfoliation
material choice
minimally invasive considered first
270
what does the site of an abscess depend on
position of tooth in arch
root length
muscle attachments
potential spaces in proximity to lesion
271
where would infection go for there to be a facial swelling on the cheek caused by maxillary tooth
above the insertion of the buccinator into the buccal space
272
where would an infection go if it was to drain into the mouth from a maxillary tooth
below insertion of buccinator
273
what would happen if an infection from a maxillary tooth was to spread upwards
sinusitis
274
why are palatal abscesses less common
palatal bone is denser
275
where would infection spread from a lower tooth if there was a sublingual swelling
above mylohyoid
276
where would infection spread from a lower tooth if there was a submandibular swelling
below mylohyoid
277
where would the infection have spread from a lower tooth if it was draining to the mouth
above buccinator insertion
278
what is the relation of the mylohyoid line to infection spread from premolars and molars
premolars sit above line so more likely to be sublingual
molars sit below line so more likely to be submandibular
279
what spaces make up the masticatory spaces
masseteric
pterygomandibular
infratemporal
deep temporal
superficial temporal
280
what happens to the muscles if infection spreads to the masticatory spaces
the muscles would spasm and cause trismus
281
what symptoms would the patient have if infection spread to the pharyngeal spaces
breathing and swallowing issues
282
once an infection is in the pharyngeal spaces where else would it spread to
retropharyngeal and prevertebral spaces
283
what would be the path of infection spread for an infection to get to the cavernous sinus from the mandible
infratemporal space then pterygoid venous plexus then cavernous sinus
284
what would be the path of infection spread for an infection to get to the cavernous sinus from the maxilla
infraorbital area where veins dont have valves and allow backwards spread of infection to cavernous sinus
285
where can upper anterior teeth infection spread to
lip
nasolabial
lower eyelid
286
where can upper lateral teeth infection spread to and why
palate
palatally placed root
287
where can upper premolars and molars infection spread to
cheek
infratemporal
maxillary sinus
palate
288
where can lower anterior infection spread to
mental and submental space
289
where can lower premolar and molar infection spread to
buccal
submasseteric
sublingual
lateral pharyngeal
submandibular
290
what would be the signs that a patient has a systemic infection
raised temperature
raised heart rate
raised respiratory rate
raised white cells
291
what is the hilton technique
insert closed scissors into infection and open them up to drain infection out
292
when draining an extra-oral submandibular swelling what nerve do you need to be careful to avoid and how do you avoid it
facial nerve
2 finger breadths below inferior border of mandible
293
what is ludwigs angina
bilateral cellulitis of sublingual and submandibular spaces
294
what symptoms would a patient with ludwigs angina have
raised tongue
difficulty breathing and swallowing
drooling
diffuse redness and swelling bilaterally
295
what is SIRS
systemically inflammatory response syndrom
296
what are the SIRS
increased heart rate
increased respiratory rate
increased temperature
increased white cell count
297
what is NEWS
national early warning score
298
what does a CPVU get you on the NEWS score
3
299
what NEWS score should everyone ideally be at
0
300
what are the 2 reasons why bacteria become resistant
intrinsic (genetics)
acquired (mutations)
301
what are the mechanisms of resistance
altered target site
enzymatic inactivation
decreased uptake
302
what bacterial are in a periodontal abscess
anaerobic streptococci
prevotella intermedia
303
what are the oral anaerobes present in pericoronitis
p. intermedia
s. anginosus
304
what bacteria is in osteomyelitis
s. anginosus
s. aureus
305
what is the sepsis 6
high flow O2
blood cultures
IV antibiotics
fluid challenge
measure lactate
measure urine output
306
with regards to antibiotic resistance what is breakpoint
chosen concentration of an antibiotic which defines whether a species of bacteria is susceptible or resistant to antibiotic
307
what is clinical resistance
infection is highly unlikely to respond even to maximum dose
308
what are the confounding variables in antibiotic reistance
pH
phase of growth
biofilm
site of infection
309
what should be the first principle of management of a dental abscess
surgical drainage
310
what is antimicrobial stewardship
team working to reduce antimicrobial use
311
what actions can we take to contribute to antimicrobial stewardship
hand hygiene
team work
data management
reduce prescribing by promoting oral health
312
what is penicillin active against
oral strepotcocci, anaerobes
313
what is amoxicillin active against
resistant flora
it has a broader spectrum
314
what does impaction mean
tooth eruption blocked
315
what can impact a tooth
adjacent tooth
alveolar bone
surrounding mucosal tissue
316
what are the consequences of impacted teeth
caries
pericoronitis
cyst formation
317
what nerves are at risk during third molar surgery
IAN
lingual
nerve to mylohyoid
buccal nerve
318
where does the lingual nerve sit
2.28mm down from top of lingual plate and 0.58mm medial to it
319
what guidelines are published for the extraction of wisdom teeth
NICE guidance on extraction of wisdom teeth 2000
SIGN management of unerupted and impacted third molars
FDS, RCS 2020 parameters of care for patients undergoing mandibular third molar surgery
320
what are the indications for extraction of wisdom teeth
infection (caries/pericoronitis)
cysts
tumours
external resorption of 7/8
fractured mandible
high risk of disease
medical indications
accessibility
patient age
autotransplantation
321
what is pericoronitis
inflammation around crown of PE tooth caused by food/debris trapped under operculum
322
what bacteria is present in pericoronitis
streptococci
actinomyces
prevotella
bacteroides
fusobacterium
323
what are some signs and symptoms of pericoronitis
pain, swelling, bad taste, pus, cheek biting
limited opening, dysphagia, pyrexia, malaise, regional lymphadenopathy
324
what is the treatment for pericoronitis
incision of pericoronal abscess
IDB
irrigate with saline/chlorhexidine
debride under operculum
frequent warm saline or chlorhexidine mouthwash
analgesia
fluids
325
when would you decide to give antibiotics to someone
extra-oral swelling, systemic, immunocompromised,
326
what signs would mean you should be sending someone to hospital with a dental infection
large extra-oral swelling
systemically unwell
trismus
dysphagia
327
what are the predisposing factors for pericoronitis
partially erupted
vertical/distal impaction
opposing molar causing trauma
upper respiratory tract infections
poor OH
full dentition
328
what is important in the history of presenting complaint with pericoronitis
how long, how many episodes
how often
severity
antibiotics before?
329
what does an OPT determine in terms of third molars
presence/absence of disease
anatomy of tooth
depth of impaction
orientation of impaction
working distance
follicular width
periodontal status
how close to maxillary sinus/IAN
other pathology
330
what are the indications that a mandibular third molar is close to the IAN canal
interruption of white liens
darkening of root where canal crosses
diversion/deflection of canal
deflection of root
narrowing of IAN canal
narrowing of root
Dark and bifid root
331
what are the signs on an OPT that means there is a significant risk of nerve injury with M3M removal
interruption of white lines
darkening of root where canal crosses
diversion/deflection of canal
332
how do you measure angulation of a M3M
against the curve of spee from the midpoint of the crown of M3M
333
what are the different angulations that a M3M can have
vertical
mesial
distal
horizontal
transverse
334
what is the most common angulation of a M3M
mesial
335
what does the depth of a M3M give you an idea of
amount of bone removal required
336
what are the different depths of a M3M
superficial - crown of 8 at crown of 7
moderate - crown of 8 at crown and root of 7
deep - crown of 8 at root of 7
337
what are the treatment options for M3M
referral, review, removal
extraction, coronectomy
operculectomy, autotransplantation
338
what are the risks of M3M surgery
risk of 2nd molar restoration fracture
jaw fracture
post-op complications
numbness and altered taste
dysaesthesia/hypoaesthesia
increased sensation
339
what communication system is used to refer patients
SBAR
340
what are the risks of nerve numbness to IAN and lingual (temporary and permanent)
IAN temp - 10-20%
IAN permanent numb - <1%
lingual temp - 0.25-23%
lingual permanent - 0.14-2%
341
what are the steps of surgical removal of a third molar
access
reflection
retraction
remove bone
separate crown and roots
debridement
suture
342
what flap is raised in M3M surgery
mucoperiosteal buccal flap
343
what is used to remove bone
electrical straight handpiece with saline cooled bur
344
name an instrument which retracts tissue during surgery
Minnesota
345
what is the aim of a coronectomy
reduce risk of IAN damage when there is an increased risk of damage with surgical removal
346
what warnings must you give a patient before coronectomy
if root is mobilised during crown removal it must be removed
leaving roots can cause infection
can get slow healing socket
roots may migrate and erupt later on
347
what instruments are used to extract upper third molars
warwcick james and bayonets
348
what is the blood and nerve supply to TMJ
deep auricular artery
auriculotemporal, masseteric and posterior temporal nerve
349
why does it sometimes feel like you have ear pain when you have TMJ pain
as the auriculotemporal nerve also supplies the ear
350
what part of the TMJ feels pain
bilaminar zone
351
what are the causes of TMD
myofascial pain
disc displacement
degenerative disease
chronic recurrent dislocation
ankylosis
hyperplasia
neoplasia
infection
352
what is the pathogenesis of TMD
inflammation of muscles
trauma
stress
psychogenic
occlusal abnormalities
353
what do we look for when doing intra and extra oral exam for TMD
MoM , joint clicks, jaw movement, asymmetry
mouth opening, parafunction,
354
what special investigations are used for TMD
OPT
CT
MRI
nuclear imaging
arthography
ultrasound
355
what are the clinical features of TMD
intermittent pain for several months
muscle pain on waking
trismus
clicking noises
headaches
crepitus
356
what is in the differential diagnoses for TMD
dental pain
sinusitis
ear pathology
salivary gland pathology
referred neck pain
headache
atypical facial pain
trigeminal neuralgia
angina
357
what is the conservative management of TMD
counselling
avoid chewy foods
jaw exercises
medications
physiotherapy, massage, heat, relaxation, acupuncture
splints
358
what is the counselling for TMD
reassure
soft diet
no wide opening
dont incise food
cut into small pieces
support opening mouth
359
what medications are used for TMD
NSAIDs
relaxants
tricyclics
botox
steroids
360
what splints are available for TMD
bite raising
anterior repositioning
361
what surgery is available for TMD
arthroscopy
disc repositioning
replacement
362
why does the TMJ click in disc displacement
lack of coordinated movement between condyle and disc
363
what are the symptoms of TMJ disc displacement with reduction
jaw tightness and deviation
364
what is the function of the maxillary sinus
add resonance
chamber for warming inspired air
reduce the weight of the skull
365
where does the maxillary sinus open into
middle meatus
366
what epithelium lines the maxillary sinus
pseudostratified ciliated columnar epithelium
367
what does the cilia in the maxillary sinus allow
mobilise trapped matter and foreign material to move towards ostium for removal via nasal cavity
368
what issues are associated with the maxillary sinus
OAC, OAF, root in antrum, sinusitis, benign lesions, malignant lesions
369
how do you diagnose an OAC/OAF
look at size of tooth
radiographic position of roots
bone at trifurcation
bubbling of blood
nose holding test
direct vision
light and suction
370
what is the acute management of a small OAC
encourage clot
suture
antibiotics
post-op instructions
minimise pressure in nose and mouth
371
what is the acute management of a large OAC
buccal advancement flap
372
what might someone with a chronic OAF complain of
problems with fluid consumption
problems with speech or singing
wind instruments
smoking
bad taste - post-nasal drip
pain
373
what is the management of an OAF
excising sinus tract
raising flap
antral washout ??
374
what is the aetiology of a maxillary tuberosity fracture
single standing molar
unknown unerupted molar
gemination
extract in wrong order
inadequate alveolar support
375
how do you manage a maxillary tuberosity fracture
reducing and stabilising with splint
OR
dissect out and suture
376
how do you diagnose a maxillary tuberosity fracture
noise
movement
tear in palate
more than the tooth movement
377
how do you retrieve a root in the antrum
through socket
caldwell luc
ENT
378
how is sinusitis precipitated
viral infection
379
what is sinusitis
physiological function is disrupted by cellular damage that occurs to mucosal lining affecting ciliary function
when contents cannot evacuate there is a build up of pressure and is an opportune situation for bacterial overgrowth
380
what are the signs and symptoms of sinusitis
facial pain
pressure
congestion
nasal obstruction
paranasal drainage
fever
headache
dental pain
halitosis
fatigue
cough
ear pain
381
which things point towards a sinusitis diagnosis
discomfort on palpation of infraorbital region
diffuse pain in maxillary teeth
equal TTP in same region
worse with head movements
382
what is the treatment for sinusitis
decongestants - ephedrine drops 0.5% one drop each nostril up to 3x/day maximum 7 days
steam and menthol
only antibiotics if it worsens
383
what antibiotics are used for bacterial sinusitis
amoxicillin 500mg TID 7 days
384
what does aspiration sampling allow
avoid contamination by commensals
protect anaerobic species
can aspirate cystic lesions
385
what are the types of biopsy
excisional
incisional
386
what does an excisional biopsy do and what is it indicated for
remove all abnormal tissue
if confident of provisional diagnosis
for benign/discrete lesions
387
what is an incisional biopsy for
larger lesions and uncertain diagnosis
388
what is a tissue sample sent to the lab in
10% formalin using filter paper
389
what is a fibrous epulis
swelling from gingivae as hyperplastic response to irritation
390
what does a fibrous epulis look like
smooth surface, rounded, pink, pedunculated
391
what is the treatment for fibrous epulis
excisional biopsy
dress with coe pack
remove irritation
392
what causes a fibroepithelial polyp/fibrous overgrowth
due to frictional irritation or trauma
393
what does a fibroepithelial polyp look like
semi-pedunculated or sessile, pink, smooth surface
394
what is the treatment for fibroepithelial polyp
surgical excision
395
what is a giant cell epulis made of
multinucleated giant cells in vascular stroma
396
how do you treat a giant cell epulis
surgical excision and curettage of base and coe pack
397
what is a haemangioma
developmental overgrowth
398
what does a haemangioma look like
exophytic and blue but if you put pressure on it it will lose colour
399
what is the treatment for haemangioma
surgical removal or cryotherapy
400
what is a lipoma
benign neoplasm of fate
401
what does a lipoma look like
soft swelling, pale yellow, sessile
402
what is the treatment of a lipoma
excision
403
what is a pyogenic granuloma
failure of normal healing and overgrowth of granulation tissue
404
how do you treat a pyogenic granuloma
surgical excision and curettage
405
what does a squamous cell papilloma look like
pedunculated
white
cauliflower like
406
what is the treatment of squamous cell papilloma
excision at base
407
what is a leaf fibroma caused by
chronic denture irritation
408
what is a mucocele
mucous extravasation cyst of saliva into the mucosal area
409
what causes mucoceles
damage to minor salivary gland ducts
410
what is the classic description of squamous cell carcinoma
ulcer with rolled margins and that is indurated
411
what are the red flags meaning urgent referral (cancer wise)
persistent unexplained head and neck lumps
unexplained ulceration or swelling/induration of oral mucosa
unexplained red or mixed red and white patches
persistent hoarseness
persistent pain in throat/on swallowing
ALL FOR LONGER THAN 3 WEEKS
412
what are the signs and symptoms of oral cancer
pain on eating
difficulty swallowing
unilateral earache
trismus
dysarthria
sensory loss
loosened teeth
submucosal mass
verrucous lesion
hemi-tongue atrophy
mandible fracture
nasal obstruction
coughing blood
unexplained weight loss
413
what staging system is sued for head and neck cancer
TNM
414
what does TNM mean
T = primary tumour
N = regional lymph nodes
M = distant metastasis
415
what are the treatment options for oral cancer
curative = surgery and chemo/radio
palliative = symptom control and prolonging survival
416
what are the fundamentals of orthognathic surgery
team approach
history taking
clinical exam
investigations
prediction planning
417
when taking a history before orthognathic surgery what should this include to find out what the cause for needing surgery is
congenital causes
hormonal causes
trauma
pathology
racial characteristics
syndromic malformation
418
what diagnostic aids are helpful in orthognathic surgery
OPT
ceph
periapical
occlusal
CBCT
photos
study models
419
what is included in 3D planning for orthognathic surgery
photos
CBCT
intra-oral scanning
420
what are the signs of a definite mandible fracture
sublingual haematoma
2 point vertical mobility
abnormal sensation contralateral to injury
pain contralateral to injury
unexplained numbness
421
what is the treatment for mandible fracture
fast
analgesia
antibiotics if open fracture
liquid diet
speak to OMFS
422
what are the definite signs of midface and zygoma fracture
epistaxis without punch to nose
V2 numbness without blow to nerve
subconjunctival bleed
midface mobility
malocclusion
surgical emphysema around eye
swelling after nose blowing
diplopia
change of appearance
CSF from nose
423
what are the difference between the Le Fort fractures
1 - top teeth move back and forward only
2 - top teeth and nose move
3 - top teeth, nose and eyes move
424
what is the treatment for zygoma fracture
OMFS
no nose blowing for 6 weeks
soft diet
warn about retrobulbar bleed
425
what is the treatment for orbit fracture
document VA and diplopia
OMFS discussion
no nose blowing
retrobulbar bleed warning
426
what is the treatment for a Le Fort fracture
fast
antibiotics
OMFS discussion
liquid diet
no nose blowing
427
what are the 3 most common orthognathic surgeries
Le Fort 1
sagittal split
genioplasty
428
what do you need to assess for eye injuries and trauma
blown pupil
eye movement
pain
chemosis
proptosis
visual acuity
numbness
429
what does a retrobulbar bleed present as
painful proptotic eye
tense globe
ophthalmoplegia
430
what are the signs of an orbit fracture
infra-orbital paraesthesia
diplopia
subconjunctival bleed
431
from front to back , what are the parts of the mandible
synthesis
parasynthesis
body
angle
condyle
432
what are the clinical signs of a malar fracture
periorbital bruising and swelling
subconjunctival ecchymoses
sensory deficit
diplopia
subcutaneous emphysema
epistaxis
step deformity
433
what do you palpate when checking for zygomatic fracture
supraorbital ridge
infraoribtal ridge and zygoma
depression of zygomatic arch
ascertain if maxilla movement
434
what is the initial care of zygomatic fracture
exclude eye injury
prophylactic antibiotics
avoid nose blowing
435
what is the definitive management of zygomatic fracture
review when swelling subsided
further radiographs and CT
informed consent
closed reduction and fixation or ORIF
436
what are some of the consequences of orbito and naso-ethmoidal wall fracture
diplopia, infraorbital anaesthesia
inward displacement, lateral rectus palsy
bridge depression, CSF leak
dural tear and brain damage
blindness
437
what is involved in classifying mandible fractures
involvement in surrounding tissues
number of fractures
side and site of fracture
direction of fracture line
specific fractures
displacement of fracture
438
what factors cause displacement of mandibular fractures
direction of fracture line
opposing occlusion
magnitude of force
mechanism of injury
intact soft tissue
other associated fractures
439
what radiographs are needed for mandibular fractures
OPT and PA mandible
440
when would a condylar fracture be treated by ORIF
bilateral subcondylar with AOB
displaced condylar fracture interfering with opening mouth
displaced fracture causing occlusal derangement/ramus shortening/middle cranial fossa
441
what classification is used for naso-orbital-ethmoidal fractures
markowitz classification
442
what would a NOE fracture look like
blow to nose
bridge pushed in
nose tipped up
increased nasolabial angle
confirm with CT
check for CSF leak
443
what are the characteristic signs of a cyst
egg shell crackling when pressing
tooth mobility/absence of teeth
numbness
discolouration
swelling
444
what radiographs are used for cysts
PA, occlusal, OPT
CBCT, PA mandible, occipitomental
445
what are the radiographic features of cysts that we look for
location
shape
margins
locularity
multiplicity
effect on anatomy
unerupted teeth
446
what are cysts classified by
structure , origin , pathogenesis
epithelium/not , odontogenic/not, developmental/inflammatory
447
what lines odontogenic cysts
epithelium
448
what are the sources of epithelium for odontogenic cysts
rests of malassez
rests of serres
reduced enamel epithelium
449
what type of cyst is a radicular cyst
inflammatory odontogenic
450
where do radicular cysts occur
non-vital tooth
initiated by chronic inflammation at the apex
451
what does a radicular cyst look like on radiographs
well-defined corticated margin continuous with lamina dura
452
what does a radicular cyst look like on histology
epithelial lining incomplete
connective tissue capsule
453
what cells are found in a radicular cysts
mucous metaplasia
cholesterol clefts
rushton bodies
454
what type of cyst is an inflammatory collateral cyst
inflammatory odontogenic
455
where does an inflammatory collateral cyst occur
at vital tooth
456
what is a dentigerous cyst
developmental odontogenic
cystic change of dental follicle
457
where does a dentigerous cyst occur
crown of unerupted tooth
458
what does a dentigerous cyst look like radiologically
corticated margins from CEJ of tooth, symmetrical
459
what lines a dentigerous cyst
thin non-keratinised stratified squamous epithelium
460
what is an eruption cyst and who does it occur in
variant of a dentigerous cyst
occurs in erupting teeth (children)
461
what type of cyst is an odontogenic keratocyst
developmental odontogenic
462
what does an odontogenic keratocyst look like on radiographs
scalloped margjns - can be multilocular
displaces teeth
expands mesio-distally
463
what does a cyst aspirate of an odontogenic keratocyst show
squames
low soluble protein content
464
what is the histology of an odontogenic keratocyst
epithelial lined with parakeratosis, basal palisading and daughter cysts
465
why do odontogenic keratocysts have a high recurrence rate
they have a thin lining so if you dont manage to remove all of the lining it will recur
466
what syndrome is associated with multiple odontogenic keratocysts
basal cell naevus syndrome
467
what type of cyst is a nasopalatine duct cyst
developmental non-odontogenic
468
what is a nasopalatine duct cyst made out of
nasopalatine duct epithelial remains
non-keratinised stratified squamous and modified respiratory
469
what may a patient experience with nasopalatine duct cyst
salty discharge
470
what does a nasopalatine duct cyst look like on radiology
corticated radiolucency between centrals
unilocular
heart shaped
471
what is a solitary bone cyst
non-odontogenic cyst without epithelial lining
472
what is a stafne cavity
depression in bone
473
what is enucleation
removing all of a cyst
474
what does enucleation allow for
whole lining can be examined
allows primary closure
475
what is the risks of enucleation
risk of mandible fracture
can become infected
damage to adjacent structure
476
what is marsupialisation
create surgical window and remove contents and suture cyst wall to surrounding epithelium to encourage decrease in size
477
when is marsupialisation used
when enucleation would damage structures
difficult access
to allow eruption of teeth
elderly/medically compromised
478
what are the disadvantages of marsupialisation
cyst could reform, complete lining not available for histology, hard to keep clean and aftercare needed
479
what are the types of odontogenic tumours
epithelial
mesenchymal
mixed
480
what is an ameloblastoma
benign epithelial tumour
481
what does an ameloblastoma look like radiographically
multicystic (soap bubble)
well defined corticated
potentially scalloped margins
radiolucent
482
what is the effect of an ameloblastoma on adjacent structures
displace adjacent structures
thin bone cortices
knife edge
external root resorption
483
what are the 2 types of ameloblastoma
follicular
plexiform
484
how do you manage an ameloblastoma
surgical resection
485
what type of tumour is an adenomatoid odontogenic tumour
benign epithelial
486
what does an adenomatoid odontogenic tumour look like on radiographs
unilocular radiolucency with internal calcifications around crown of unerupted maxillary canine
well defined corticated margins
487
what are the epithelial cells arranged like in an adenomatoid odontogenic tumour
duct like structure
488
what type of tumour is a calcifying epithelial odontogenic tumour
benign epithelial
489
what are most calcifying epithelial odontogenic tumours associated with
unerupted tooth
490
what does a calcifying epithelial odontogenic tumour look like on radiographs
internal radiopacities
491
what type of tumour is an odontogenic myxoma
benign mesenchymal tumour
492
what does an odontogenic myxoma look like on radiographs
well-defined and thin corticated margin
unilocular or larger multilocular and scalloped
493
what is an odontogenic myxoma made of
loose myxoid tissue with stellate cells
no capsule
494
what type of tumour is an odontoma
benign mixed tumour
495
what are the different types of bone graft
autogenous
xenograft
allograft
alloplastic
bone bioengineering
496
what type of bone graft is deproteinised bone matrix
xenograft
497
what does the upper compartment of the TMD do
translation
498
what does the lower compartment of the TMD do
rotation
499
what happens with inflammatory disease in the TMD
inflammatory disease produces proteases which degrade proteoglycans
500
what are the degenerative changes of the TMD
disc perforation, flattening of condyle and eminence
subchondral cysts
501
what is the conservative management of TMD
counselling, pain management
joint rest, physical therapy
restoring occlusal stability
502
what does a bite raising appliance allow in TMD
eliminate occlusal interference and prevent joint head from rotating
503
what investigations can be used for TMD
OPT
orthogram
MRI
arthroscopy
504
what are arthoscopic procedures used for
diagnosis
biopsy
disc reduction
removing loose bodies
505
what are some complications from arthroscopy
broken instruments
middle ear perforation
extravasation
haemorrhage
infection
trigeminal and facial nerve damage
perforate tympanic membrane
506
what is the post-op management after TMD surgery
joint rest with soft diet
pain management
physical therapy
restoring occlusal stability
507
what are some different types of TMJ surgery
disc plication
menisectomy
reconstructive
eminectomy
508
what is the stages of ankylosis for TMJ
little space
fusion at outer edge
marked fusion
mass of bone
509
what bone tests can you get
calcium
osteoblast activity
PTH
vitamin D assays
510
what syndrome is associated with fibrous dysplasia
Albrights
511
what is fibrous dysplasia/albrights
slow growing asymptomatic bony swelling which grows until growth period stops
can be single bone or many bones
512
what is rarefying osteitis
localised loss of bone in response to inflammation
513
what is sclerosing osteitis and where does it occur
localised increase in bone density responding to low-grade inflammation
apex of tooth with necrotic pulp
514
what is idiopathic osteosclerosis
localised increase in bone density of unknown cause
515
what is osteitis fibrosa cystica
generalised osteoporosis
focal osteolytic lesions
giant cell lesions
516
what is cherubism
rare autosomal dominant inheritance disorder with multilocular lesions in multiple quadrants and can regress after puberty
517
what is the signs of pagets disease and dental signs
bone swelling, pain, nerve compression, increased bone turnover
loss of lamina dura, hypercementosis, migration of teeth
518
what is an osteoma
solitary, slow growing cortical bone
519
when would you not remove retained roots
preserve bone height
near vital anatomical structures
present for a while and no PA pathology
give patient the option
520
what are the 3 main types of skull radiographic views
occipitomental
PA mandible
reverse townes
521
what is occipitomental radiograph for
midface fractures
522
what is PA mandible radiograph for
posterior mandible fractures
523
what is reverse townes radiograph for
mandibular condyles fractures
524
what line is used for patient positioning for skull radiographic views
orbitomeatal line
525
what is the orbitomeatal line based on
outer canthus of eye and centre of EAM
526
what angles of occipitomental radiograph are taken for middle third and coronoid fractures
10 and 40
527
what is the position of the orbitomeatal line for occipitomental radiographs
45 degrees to receptor (nose to chin)
528
what does a PA mandible show
posterior third of body
angles
rami
low condylar necks
529
what is the orbitomeatal line positioned like for PA mandibles
perpendicular to receptor (forehead on receptor)
530
why is the beam projected from the posterior side with skull radiography
reduced magnification of face so less distortion
reduced effective dose
531
what is reverse townes for
condylar head and neck
532
what is the difference between reverse townes and PA mandible
open mouth with reverse townes
533
what is CBCT and what is it used for
cross sectional imaging used for radiodense structures
534
what are the benefits of CBCT
no superimposition
view subject from any angle
no magnification/distortion
allows for 3D reconstruction
535
what are the downsides of CBCT
increased radiation dose
lower spatial resolution
susceptible to artefacts
536
what are the uses of CBCT in dentistry
clarify relationship between impacted mandibular third molar and IAN canal
measure alveolar bone dimensions for implant placement
complex root morphology
investigate external root resorption
cystic lesions
537
what are the imaging variables of CBCT
field of view
voxel size
acquisition time
538
what are the artefacts in CBCT
either movement or streak
539
what are the contraindications to CBCT
if plain is sufficient
pathology requiring soft tissue visualisation
high risk of debilitating artefacts
patient cant stay still
540
what type of margins on radiography suggests malignancy
moth eaten
541
what are radiolucencies caused by
resorption
demineralisation
reduced thickness
replacement of bone with abnormal tissue
542
what are radiopacities caused by
increased thickness
osteosclerosis
presence of abnormal tissue
mineralisation
543
what conditions can show hypercementosis
acromegaly and pagets
544
what does hypercementosis look like on radiographs
homogenous radiopacity continuous with root surface
well defined smooth margins
545
what is an ultrasound good for
salivary glands
546
what criteria must be met for salivary stone removal
mobile
located within lumen on main duct distal to posterior border of mylohyoid
distal to hilum or at anterior border of gland
patent and wide duct
547
what can be seen on glands with sjogrens disease
heterogenous parenchymal pattern
hypoechoic
atrophy
fatty infiltration
548
what are the 2 most common benign salivary tumours
pleomorphic adenoma
warthins
549
what are the 2 most common malignant salivary tumours
adenoid cystic carcinoma
mucoepidermoid carcinoma
550
what is the difference between benign and malignant salivary tumours
irregular margins on malignant (well-defined on benign)
poorly defined margins on malignant (encapsulated on benign)
increased internal vascularity on malignant (peripheral on benign)
lymphadenopathy on malignant (no lymphadenopathy on benign)
551
what is the effect of smoking on periodontitis
vasoconstricts blood vessels and increases gingival keratinisation, impairs antibody production, depresses numbers of Th lymphocytes, impairs PMN function and increases pro-inflammatory cytokines
552
what are the features of chlorhexidine
adsorption to oral surface
long substantivity
broad antimicrobial spectrum
interferes with taste and stains teeth
553
how does scaling increase attachment level
long junctional epithelium formation
554
features of necrotising gingivitis
necrosis and ulcer in interdental papilla
gingival bleeding
pain
pseudomembrane formation
halitosis
lymphadenopathy
555
what bacteria present in ANUG
spirochetes and fusobacterias
556
risk factors for ANUG
stress, sleep deprivation
poor OH
smoking
immunosuppression
557
treatment of ANUG
superficial debridement
avoid brushing - chlorhexidine 0.2% twice daily or 3% H2O2 diluted 1:1 warm water instead
metronidazole 400mg TID 3 days
bring back in 24-48hrs
treat pre-existing condition
558
antibiotics used for ANUG
metronidazole 400mg TID 3 days
amoxicillin 500mg TID 3 days
559
symptoms/signs of periodontal abscess
swelling
pain
TTP
deep periodontal pocket
bleeding
suppuration
enlarged regional lymph nodes
fever
vital tooth
commonly pre-existing periodontal disease
560
treatment of periodontal abscesses
subgingival instrumentation of base of periodontal pocket to avoid iatrogenic damage
drain pus by incision/through pocket
recommend analgesia
chlorhexidine 0.2% until acute symptoms subside
systemic antibiotics if don't resolve
561
antibiotic used for periodontal abscesses
penicillin 250mg 2 tablets QD 5 days
amoxicillin 500mg TID 5 days
metronidazole 400mg TID 5 days
562
signs/symptoms of endo-perio lesion
deep perio pockets reaching apex
negative/altered response to vitality tests
bone resorption in apical/furcation region
spontaneous pain
pain on palpation and percussion
purulent exudate
tooth mobility
sinus tract
563
treatment of endo-perio lesions
endo treatment
analgesia
0.2% chlorhexidine mouthwash
review within 10 days for PMPR
564
how long should you wait until after perio treatment to place a restoration
3-6 months
565
how do crowns and bridges help to damage the periodontium
plaque retention
unfavourable transmission of occlusal forces
pulp damage
566
how do RPDs damage the periodontium
plaque retention
direct trauma from components
unfavourable transmission of forces
567
what are supracrestal attached tissues composed of
junctional epithelium and supracrestal connective tissue attachment
568
what happens if restorations encroach on the junctional or connective tissue
persistent inflammation and loss of attachment
569
what are the keys to periodontally successful indirect restorations
healthy tissue
adequate tooth preparation
precise margin location
excellent provisional restorations
careful tissue handling and impression technique
570
what is Ante's law
combined periodontal area of the abutment teeth should be equal to or greater than the periodontal area of the tooth or teeth to be replaced
571
what does tooth mobility depend on
width and height of PDL, inflammation
number shape and length of roots
572
when can mobility not be accepted
progressively increasing
gives rise to symptoms
creates difficulty with restorative treatment
573
what is therapy to reduce mobility
control of plaque induced inflammation
correction of occlusal relations
splinting
574
what is primary occlusal trauma
injury resulting in tissue changes from excessive occlusal forces applied to a tooth or teeth with normal periodontal support
575
what happens with primary occlusal trauma
PDL width increases until forces can be dissipated
increased mobility
if demand reduced it returns to normal
576
what is secondary occlusal trauma
injury to tissues from normal or excessive forces applied to a tooth with reduced periodontal support
577
what does clinical diagnosis of occlusal trauma show
progressive tooth mobility
fremitus
occlusal discrepancies
wear facets
tooth migration
tooth fracture
thermal sensitivity
root resorption
cemental tear
widening of PDL on radiographs
578
when is splinting for mobile teeth appropriate
mobility is due to attachment loss
mobility is causing discomfort
teeth need to be stabilised for debridement
579
what does tooth migration cause
loss of periodontal attachment
unfavourable occlusal forces and soft tissue profile
580
how do you manage tooth migration
treating periodontitis
accept position and stabilise
moving teeth orthodontically and stabilising
581
stages of clinical audit
set topic
set standards
observe practice and collect data
analyse data
identify areas of change and make changes
582
CPD requirements
100hrs over 5yrs
at least 10 consecutive hours over 2 years
583
what is SHANARRI
safe
healthy
achieving
nurtured
active
respected
responsible
included
