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BDS4 Exam Revision > BDS4 > Flashcards

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

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2
Q

why do you treat class 2 div 1

A

aesthetics and trauma

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3
Q

what is the skeletal pattern for class 2 div 1

A

class 2

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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

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5
Q

what are the dental factors of class 2 div 1

A

increased overjet
variable overbite
variable alignment
dry gingiva

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6
Q

what is the aetiology of class 2 div 1

A

sucking habits
skeletal growth

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7
Q

what are the consequences of sucking habits

A

procline upper anteriors
retrocline lower anteriors
AOB
incomplete overbite
narrow upper arch

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8
Q

how do you stop a sucking habit

A

positive reinforcement
nail polish
glove
habit breaker

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9
Q

what are the treatment options for class 2 div 1

A

accept
growth modification
URA only
camouflage
orthognathic surgery

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10
Q

why would you accept class 2 div 1

A

mild increased OJ
patient happy

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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

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12
Q

when would you use a URA only for class 2 div 1

A

very mild malocclusion
proclined overjet and spaced incisors

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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

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14
Q

what is the skeletal pattern with class 2 div 2

A

mild/moderate class 2
reduced FMPA
prominent chin

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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

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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

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17
Q

why do you treat class 2 div 2

A

aesthetics and traumatic overbite

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18
Q

what are the treatment options for class 2 div 2

A

accept
growth modification
camouflage
orthognathic surgery

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19
Q

why would you accept class 2 div 2

A

good aesthetics
patient happy
overbite not an issue

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20
Q

what is used for growth modification for class 2 div 2

A

modified twin block
procline upper incisors

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21
Q

how do you camouflage class 2 div 2

A

reduce overbite
correct inter-incisal angle
torqueing upper incisors
proclining lower incisors

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22
Q

what features of class 2 div 2 have high relapse rate

A

deep overbite
rotated laterals

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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

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24
Q

what is the skeletal features of class 3

A

AP class 3
bilateral crossbites
retrusive maxilla and wide mandible

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25
Q

what are the dental features of class 3

A

class 3 incisors and molars
reverse overjet
reduced overbite
AOB
crossbites
crowded maxilla and spaced mandible
dentoalveolar compensation
displacement on closing

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26
Q

How do the soft tissues influence dental features of class 3

A

tongue proclines uppers
lip retroclines lowers

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27
Q

why do you treat class 3 malocclusions

A

aesthetics
attrition
recession
displacement
speech
mastication

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28
Q

what factors of class 3 can make it harder to treat

A

facial growth
crossbite
AOB

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29
Q

what are the treatment options for class 3

A

accept
growth modification
camouflage
orthognathic surgery

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30
Q

what interceptive treatment for class 3 would a patient receive

A

URA to procline incisors over the bite

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31
Q

what is growth modification used for in class 3

A

reduce mandibular growth and encourage maxillary growth

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32
Q

what appliance is used for growth modification in class 3

A

reverse twin block
protraction headgear with rapid maxillary expansion

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33
Q

when would you camouflage a class 3

A

when growth stopped
ANB > 0
average or increased overbite
edge-edge
minimal dentoalveolar compensation

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34
Q

how do you camouflage a class 3

A

extract upper 5s and lower 4s
retrocline lowers
procline uppers
correct overjet

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35
Q

how do you check for the presence of a canine

A

palpate buccally and palatally
mobility of c’s
angulation of laterals
mobility of lateral
colour of c and lateral
radiography

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36
Q

what is the aetiology of unerupted canines

A

long path of eruption
genetics
class 2 div 2
crowding
ectopic position of tooth germ

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37
Q

what are the treatment options for unerupted canine

A

accept
extract c
expose
surgically remove
autotransplantation

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38
Q

when would you accept position of unerupted canine

A

if canine has not migrated mesially further than midline axis of lateral

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39
Q

what could accepting the position of an unerupted canine cause

A

root resorption
ankylosis of canine
cyst formation
problems for restorative

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40
Q

when would you surgically remove an unerupted canine

A

if good eruption path not possible
if damage to lateral incisor
if good occlusion

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41
Q

what is the aetiology of unerupted maxillary incisors

A

trauma to primaries = dilaceration
tuberculate supernumerary
retained primary
early loss of primary
crowding
ectopic position of tooth germ

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42
Q

what are the treatment options for unerupted maxillary incisors

A

accept
bring into arch

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43
Q

what can accepting the position of an unerupted maxillary incisor cause

A

ankylosis
root resorption
drift of lateral
cyst formation

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44
Q

what are the causes of hypodontia

A

non-syndromic - genetic
syndromic - CLP/ectodermal dysplasia
environmental - trauma/cancer therapy

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45
Q

what is the presentation of hypodontia

A

delayed/asymmetric eruption
retained deciduous/absent deciduous
tooth form

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46
Q

what are the associated issues with hypodontia

A

microdontia
spacing/drifting
over-eruption
aesthetics and function

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47
Q

what are the options for missing upper 2s

A

accept
restorative
orthodontics
combined

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48
Q

what are the restorative options for missing upper 2s

A

retract 3 and create space for RBB for 2
pressure retainer with 2 as pontic
implant
shape canine to be lateral
partial denture

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49
Q

what classification is used for cleft lip and palate

A

LAHSAL

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50
Q

what are the dental implications of cleft lip and palate

A

missing teeth
impacted teeth
crowding
growth
caries

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51
Q

what are the functions of fixed appliances

A

camouflage
alignment
rotations
centreline
overbite and overjet
spaces
vertical movements

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52
Q

what are the advantages of NiTI archwire

A

flexible
light continuous force
shape memory
higher friction than SS

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53
Q

name 4 generators of force in orthodontics

A

elastic power chain
NiTi coils
elastics
active ligature

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54
Q

what features have a high chance of relapse

A

diastema
rotations
palatal ectopic canines
proclined lower incisors
AOB
instanding upper 2s

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55
Q

what are the dental health benefits of orthodontics

A

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

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56
Q

what are the main risks of orthodontic treatment

A

decalcification
root resorption
relapse
soft tissue trauma

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57
Q

how do you prevent decalcification in orthodontics

A

case selection
oral hygiene
diet
fluoride

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58
Q

what are the risk factors for root resorption

A

tooth movement - prolonged/intrusion/torque
root form - blunt/pipette
previous trauma
nail biting

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59
Q

what are the issues with adult orthodontics

A

lack of growth
periodontal disease
missing/restored teeth
physiological factors
adult motivation

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60
Q

what is the goal of orthodontic treatment aiming to achieve

A

Andrew’s six keys

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61
Q

what are Andrew’s six keys

A

tight contacts with no rotations
class 1 incisors
class 1 molars
flat occlusal plane
slight mesial inclination
canines - molars lingually inclined

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62
Q

what are the complications of cannulation

A

venospasm
extravascular injection
intraarterial injection
haematoma
fainting

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63
Q

how do you treat venospasm

A

take time dilating
efficient technique
gloves to keep warm before

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64
Q

how do you treat extravascular injection

A

remove cannula, apply pressure, reassure

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65
Q

how do you treat intra-arterial injection

A

monitor for loss of pulse
leave cannula in for 5 mins post drug then remove if no problems
symptomatic = hospital referral

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66
Q

how do you treat haematoma from sedation

A

time
rest
reassurance
ice pack

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67
Q

what are the complications of drug administration in sedation

A

hyperresponders
hyporesponders
paradoxical reactions
oversedation
allergy

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68
Q

how do you manage oversedation

A

stop
try to rouse
ABC
reverse with flumazenil 200mcg then 100mcg each minute
watch for 1-4hrs

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69
Q

how do you manage respiratory depression

A

check oximeter
stimulate patient
head tilt, chin lift, jaw thrust
supplemental oxygen - nasal cannula 2l/min, hudson mask 5l/min, ambu bag
flumazenil

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70
Q

what are the signs and symptoms of N2O2 overdose

A

patient discomfort
lack of co-operation
mouthbreathing
giggling
nausea
vomiting
LoC

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71
Q

what is the treatment of nitrous oxide overdose

A

decrease concentration by 5-10%
reassure
dont remove nosepiece

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72
Q

what does choice of sedation technique depend on

A

patient co-operation
anxiety and previous experience
dentistry needed
facilities and team skills

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73
Q

what are the advantages of IHS

A

anxiety relief, rapid recovery, flexible duration

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74
Q

what are the disadvantages of IHS

A

nasal hood needs kept in place
less muscle relaxation
need good breathing coordination

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75
Q

what are the advantages of IV sedation

A

good sedation and muscle relaxation with little co-operation

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76
Q

what are the disadvantages of IV sedation

A

baseline readings needed
cannulation
continuously reassess sedation level

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77
Q

what is the distribution and elimination half lives of midazolam

A

distribution = 4-18mins
elimination = 1.5-2hrs

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78
Q

what are the causes of dental anxiety

A

trauma
transference
fear of criticism
fear of dress
lack of communication
helplessness
surgery appearance
staff continuity issues

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79
Q

what are the contraindications to sedation in general

A

severe/uncontrolled systemic disease
severe psychiatric problems
narcolepsy
hypothyroidism

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80
Q

what are the contraindications to IV sedation

A

COPD
hepatic insufficiency
pregnancy

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81
Q

what are the contraindications to IHS

A

blocked nasal airway
COPD
pregnancy

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82
Q

what ASA classifications can we treat in primary care and what in secondary care

A

1 and 2 primary
3 in secondary

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83
Q

why do oxygen saturations start to rapidly decrease once they go past 90%

A

as the affinity of haemoglobin to O2 is decreasing

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84
Q

what vital signs are assessed at sedation assessment

A

heart rate
BP
oxygen sats
BMI

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85
Q

what are the effects of benzodiazepines as sedative agents

A

enhance GABA effects
respiratory depression - CNS and depression and muscle relaxation
decreased cerebral response to increased CO2
decreased BP
increased heart rate

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86
Q

what is the concentration of midazolam used

A

1mg/ml

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87
Q

where is midazolam metabolised

A

liver

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88
Q

where can the cannula be put for sedation

A

dorsum of hand
antecubital fossa

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89
Q

what structures do we need to be careful of if using the antecubital fossa for cannulation

A

brachial artery and median nerve

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90
Q

when do you stop administering midazolam

A

slurred and slow speech
relaxed
willingness to accept treatment
verrils sign
eves sign

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91
Q

what are verrills and eves sign in sedation

A

eyes drooping
finger to nose

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92
Q

what is the concentration of flumazenil

A

500mcg/5ml

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93
Q

what are the anxiety assessments that are used

A

mcdas
mcdasf

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94
Q

what is the 5 factor model of CBT

A

situation
thoughts
moods/emotion
behaviour
body reaction

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95
Q

what are the key factors of sedation

A

remains conscious
retains protective reflexes
understands and responds to verbal commands

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96
Q

what are the indications for IHS

A

anxiety
needle phobia
gagging
traumatic procedures

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97
Q

what are the contraindications for IHS

A

medical issues, cold, large tonsils, COPD, pregnancy, claustrophobia

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98
Q

name some safety features of IHS

A

reservoir bag
colour coding
scavenging system
oxygen flush button
pressure reducing valves

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99
Q

what are the signs and symptoms of adequate sedation via IHS

A

relaxed
slower blinks
reduced gag
awake
still verbal
lethargic
dreaming

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100
Q

what are the signs of oversedation via IHS

A

mouth closing/breathing
vomiting
decreased cooperation
uncontrollable laughter
LoC
incoherent speech

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101
Q

what are the pre-op instructions given before a sedation appointment

A

light meal first
accompanied by adult
sensible clothes
plan to remain in clinic up to 30mins after

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102
Q

what is the procedure of IHS

A

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

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103
Q

what is attrition caused by

A

tooth to tooth contact
parafunctional habit

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104
Q

what are the signs of attrition

A

facets on occlusal surfaces
reduction in cusp height

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105
Q

what is abrasion caused by

A

wear through abnormal mechanical process independent of occlusion (foreign object)
toothbrushing

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106
Q

what are the signs of abrasion on the tooth

A

labial, cervical v-shape lesions on canines and premolars

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107
Q

what is the cause of erosion

A

chemical process but no bacteria

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108
Q

what are the signs of erosion

A

flat and smooth surfaces
bilateral concave lesions
dark incisal edges
high restorations

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109
Q

what is abfraction

A

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

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110
Q

what does an abfraction lesion look like

A

v-shaped

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111
Q

how do you start preventing/reducing tooth weae

A

recognise problem
grade severity
diagnose likely cause
monitor progression

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112
Q

what medical history issues can cause erosion

A

GORD
medications
alcoholism
ED
pregnancy
reumination

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113
Q

what social history causes can cause tooth wear

A

lifestyle stresses
habits
diet
sports

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114
Q

what extraoral signs would be indicative of wear

A

restriction of TMJ movement
hypertrophy
restricted mouth opening and deviation

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115
Q

what wear indices are there

A

smith and knight
bewe

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116
Q

apart from wear indices what other special tests are included in tooth wear cases

A

sensibility tests
radiographs
articulated study models
photos
wax up
diet analysis

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117
Q

what are the patterns of wear

A

localised or generalised

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118
Q

what are the 3 types of generalised wear

A

with OVD loss
without OVD loss but limited space
without OVD loss but no space

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119
Q

what is prevention for abrasion

A

RMGIC in cavities so patient wears this away instead

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120
Q

what is prevention for attrition

A

CBT, hypnosis
splints - soft/hard/michigan

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121
Q

what is a michigan splint

A

splint with canine rise for disclusion and stops which put you in centric occlusion

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122
Q

how do you prevent erosion

A

fluoride
desensitising agents
habit changes
medical - GMP

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123
Q

how do you monitor wear

A

indices
photos
study models
remove cause

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124
Q

what factors influence what the treatment of maxillary anterior wear is

A

pattern
inter-occlusal space
space needed for planned restorations
quality and quantity of tooth left
aesthetic demands

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125
Q

why would there be no space left if someone has wear with no loss of OVD

A

the alveolar bone grows to compensate and maintain mastication

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126
Q

what are the methods of creating interocclusal space

A

increase OVD
reorganise from ICP to RCP
surgical crown lengthening
RCT and post crowns
conventional ortho

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127
Q

what is the Dahl technique

A

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

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128
Q

what is the Dahl technique used to treat

A

localised wear

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129
Q

when is the Dahl technique not suitable

A

active perio
TMJ
after ortho
bisphosphonates
implants
existing conventional bridge

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130
Q

what is the first line treatment for anterior wear

A

composite build ups

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131
Q

what is the treatment for localised posterior wear

A

composite to palatal of upper canines for posterior disclusion to aim for canine guidance

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132
Q

what are the methods of composite build ups in wear

A

alginate, wax, putty matrix
lab made vacuum formed matrix

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133
Q

what is the patient information for composite build ups for wear

A

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

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134
Q

what is the treatment for excessive loss of OVD in wear

A

splint to assess tolerance to face height
increase height with comps
dentures to provide posterior support

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135
Q

what is the treatment for wear without OVD loss and limited space still available

A

re-organisation
splint considered for height
restore to new height

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136
Q

what is the treatment for wear without OVD loss but no space

A

specialist opinion
splints/dentures/crown lengthening/overdentures

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137
Q

what is the SDA

A

sufficient adaptive capacity when 3-5 units left which occlude

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138
Q

what does loss of molars mean for SDA

A

TMJ issues
less occlusal stability
mandibular displacement
reduced masticatory efficiency

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139
Q

what are the main conclusions about the SDA

A

sufficient oral function and comfort
sufficient mandibular stability
sufficient occlusal stability
occlusal attrition not significantly different
alveolar bone decreases at same rate

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140
Q

what are the indications for SDA

A

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

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141
Q

what are the contraindications for SDA

A

poor prognosis for remaining dentition
periodontal disease
TMJD
pathological wear
severe class 2 or 3

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142
Q

what factors of the patients dentition would make you opt to replace teeth rather than give SDA

A

problems chewing
appearance concerns
occlusal instability

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143
Q

what happens in the SDA if the PDL is not healthy

A

drifting, loss of alveolar bone
distal tooth migration - increasing anterior load, occlusal contacts and interdental spacing

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144
Q

what are the 5 requirements of occlusal stability

A

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

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145
Q

what is occlusal stability determined by

A

absence of pathology
perio support
number of teeth in arches
interdental spacing
occlusal contacts
mandibular stability

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146
Q

how can you extend the SDA

A

RBB
conventional bridge
implants
RPD

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147
Q

what are the local indications for bridgework

A

big teeth
heavily restored
favourable occlusion
favourable abutment angulations

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148
Q

what are the contraindications to bridgework

A

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

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149
Q

what are the advantages of RRB

A

minimal prep
quicker
cheaper
used as temporary

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150
Q

what are the disadvantages of RRB

A

metals shine through
porcelain can chip
can debond
has occlusal interference

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151
Q

what are the indications for a RRB

A

young teeth
good enamel
large surface bonding area
minimal occlusal load
single tooth replacement
simplify denture design

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152
Q

what is a direct RBB

A

uses own tooth/acrylic tooth as pontic in emergency situations like trauma or after extraction

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153
Q

what is the prep for a RBB

A

minimal
180 degree wrap around
rest seats
proximal grooves
prep in enamel only

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154
Q

what is used to cement RBB

A

dual cure composite luting cement - panavia

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155
Q

what is a fixed-fixed bridge and what are the advantages

A

retainer at each end
robust, max strength and retention, long spans

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156
Q

what are the disadvantages of fixed-fixed bridge

A

difficult prep
path of insertion
minimal taper

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157
Q

what is a cantilever bridge and what is the advantage

A

pontic support at one end only
conservative design

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158
Q

what are the disadvantages of cantilever bridges

A

short span only
rigid

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159
Q

what is a fixed-moveable bridge and what are the advantages

A

rigid connector distally and moveable connector mesially
no common path of insertion, conserve tooth tissue, allows minor tooth movement

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160
Q

what are the disadvantages of fixed-moveable bridges

A

span limited, complicated, clean beneath moveable joint

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161
Q

what is hybrid bidge

A

one retainer is conventionally prepped and the other is resin-bonded

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162
Q

what is a spring cantilever bridge

A

metal arm from pontic to abutment (usually posterior abutment)

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163
Q

what are the requirements of abutments for bridges

A

withstand forces
free of inflammation
crown to root length needs to be 2:3 or minimum 1:1

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164
Q

what is evaluated for abutments for bridges

A

roots
angulation
perio
bonding surface area
risk of pulp damage
endodontic quality
tooth structure remaining

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165
Q

what are the different types of pontics used for bridges

A

wash through
dome shaped
modified ridge lap
ridge lap

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166
Q

what materials are used for bridges

A

all metal - gold
metal ceramic
zirconia

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167
Q

what do you cement conventional bridges with

A

all metal = aquacem/relyx
metal ceramic = aquacem/relyx
zirconia = nexus

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168
Q

what do you cement adhesive bridges with

A

panavia

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169
Q

why should distal cantilevers be avoided on bridges

A

occlusal forces on the pontic produce leverage forces on abutment meaning it will lift

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170
Q

what are the signs of bruxism

A

significant wear
repeated restoration failure
root fracture
progressive
lack of posterior support

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171
Q

why might someone be without posterior support

A

denture intolerance
denture refusal
supervised neglect

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172
Q

what does lack of posterior support mean for the remaining dentition

A

increased severity of wear
increased rate of wear
occlusal collapse
functional and aesthetic problems

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173
Q

what are the advantages of overdentures

A

correct occlusion and aesthetics
support
tooth wear management
preserve ridge form
proprioception
denture retention
MRONJ

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174
Q

what are the disadvantages of overdentures

A

need good oral health
increased caries and perio
discomfort and infection

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175
Q

what is the purpose of transitional dentures

A

increase OVD and get patient used to this

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176
Q

what do you need when you are planning to rehabilitate wear

A

impressions and facebow
mounted casts
high quality interocclusal record
wax ups
stents
temporary transitional dentures
photos

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177
Q

what can you do to increase retention and resistance for wear patients

A

grooves
inlays
ferrule
crown lengthening
parallel prep
margins and occluding surface

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178
Q

what is a failing dentition

A

deteriorating teeth, restorations or oral health means loss of inadequate basic oral functions such as mastication

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179
Q

what model is used to break bad news

A

SPIKES

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180
Q

name the steps of the SPIKES model

A

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

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181
Q

what is osseointegration

A

direct functional and structural connection between load bearing implant and bone

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182
Q

what is primary osseointegration

A

implant anchored due to frictional forces provided between osteotomy and implant

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183
Q

what is secondary osseointegration

A

living bone grows onto surface of implant

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184
Q

what are the supra and sub crestal tissues like with implants compared to tooth

A

supra - more collagen, less fibroblasts, parallel collagen fibres
sub - rigid connection

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185
Q

what are the types of implant

A

bone level
tissue level
tapered
parallel

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186
Q

what factors are important when deciding risk for implants

A

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

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187
Q

what are the bone distance requirements for implant

A

1.5mm mesial-distal
1mm bone labially
2mm from apical part of implant to gingival margin

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188
Q

what are the planning aids for implants

A

study models
wax up
surgical template
clinical photos
CBCT
surgical guide

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189
Q

what are the 2 impression techniques for implants

A

open tray
closed tray

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190
Q

what are the common causes of compromised tissue sites

A

post XLA defects
trauma
hypodontia
perio
thin biotype

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191
Q

what are the determinants of aesthetic outcome for implants

A

bone volume
space dimensions
3D implant position
biotype
operator skill and experience

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192
Q

what is the disinfection temperature, hold time and contact rate of the WD

A

90-95 degrees
1 min hold
12 secs contact rate

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193
Q

what does the SHTMs give you

A

guidance on design, installation, operation of technology
decon stages and description of each
requirements of machine operation and tests needed

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194
Q

what is SHTM 01-01

A

decontamination of medical devices in a CDU

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195
Q

what part of the SHTM01-01 refers to steam sterilisation

A

C

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196
Q

what part of the SHTM01-01 refers to automated cleaning and disinfection

A

D

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197
Q

what part of the SHTM01-01 refers to test equipment and methods

A

B

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198
Q

what part of the SHTM01-01 refers to management

A

A

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199
Q

when would you reference the SHPN

A

when designing a facility and installing equipment

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200
Q

what is the NP143

A

national procurement
contract for decontamination equipment used in LDUs

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201
Q

what document do you look at when procuring decontamination equipment

A

medical device regulations

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202
Q

what should the instruments be marked with when you are procuring them and what does this mean

A

CE
materials used to make this are of the required grade/standard

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203
Q

what does the Labour Standards Assurance System do

A

ensure that equipment is made in an ethical way

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204
Q

what is included in the ACT for the WD

A

date, operator, cycle start time
cycle number, duration, wash temperature, disinfection temperature, hold time, was detergent added, was cycle complete

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205
Q

what is a parametric release

A

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

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206
Q

who ensures that validation of tests are complete in the LDU

A

CP(D)

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207
Q

what daily steriliser information should you take down

A

date, time, operator
cycle number, sterilisation temperature
daily tests performed, bowie dick, sterilisation machine complete

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208
Q

what should be included in the ACT for the steriliser

A

temp and pressure of each stage
during sterilisation stage record temperature each minute
steam penetration, air leakage, ADFT

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209
Q

what are the daily/weekly checks for the WD

A

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

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210
Q

what are the daily/weekly steriliser checks

A

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

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211
Q

what are the quarterly checks for the steriliser

A

weekly safety checks
calibration of test instruments
air leakage
ACT and verification of calibration
small load thermometric test
calibration checks
ADFT
bowie dick test

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212
Q

what are the top 5 causes of handpiece faults

A

incorrect compressor settings
damaged or oversized bur fitted
incorrect instrument usage
poor cleaning
incorrect lubrication

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213
Q

when is the handpiece lubricated in the decon cycle

A

after wash but before sterilisation

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214
Q

why do we need compressors

A

incorrect air pressure causes faulty operation

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215
Q

what are the treatment options for intrinsic discolouration in permanent anteriors

A

microabrasion
bleaching
resin infiltration
composite restoration
composite veneers

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216
Q

what records are needed before treating discoloured teeth

A

photos
shade
sensibility testing
diagram of defect
radiographs

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217
Q

what are the safety features of microabrasion

A

PPE
patient bib and gloves
dental dam
sodium bicarbonate guard

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218
Q

what is the process of HCl and pumice microabrasion

A

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

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219
Q

why are sandpaper discs used in microabrasion

A

they change the optical properties of enamel so areas of intrinsic discolouration become less perceptible

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220
Q

how much enamel is lost as a result of HCL pumice microabrasion

A

100microns

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221
Q

what are the advantages of microabrasion

A

easy
conservative
minimal maintenance
effective
permanent results

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222
Q

what are the disadvantages of microabrasion

A

removes enamel
requires protective apparatus

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223
Q

what is the patient warning after microbabrasion

A

avoid highly coloured food and drink due to the fact that teeth are dehydrated

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224
Q

what is the home vital bleaching via nightguard technique and what percentage carbamide peroxide is used

A

10%
brush teeth
gel to tray
set over teeth and press down
remove excess
wear overnight for 3-6 weeks

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225
Q

what does 10% carbamide peroxide equate to

A

3% H2O2 and 7% urea

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226
Q

what is the walking bleach non-vital bleaching process

A

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

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227
Q

what is the inside-out non-vital bleaching process

A

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

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228
Q

what are the complications of non-vital bleaching

A

external cervical resorption
spillage of bleaching agents
failure to bleach
brittleness of crown

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229
Q

how do you prevent ECR with bleaching

A

layering cement over GP or non-setting CaOH for 2 weeks before definitive

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230
Q

what are the short term soft tissue effects of bleaching

A

ulceration/irritation
plaque reduction
aids wound healing

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231
Q

what are the long term soft tissue effects of bleaching

A

delayed wound healing
periodontal harm
mutagenic potential

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232
Q

how would tooth mousse be used to supplement bleaching and microabrasion

A

bleaching = 2wks at home application
microabrasion = 4 wks at home application

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233
Q

what is resin infiltration

A

erosion of the surface layer, desiccating the lesion and applying resin infiltrant

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234
Q

what teeth are commonly missing with hypodontia

A

mandibular premolars
maxillary laterals

235
Q

what syndromes are associated with hypodontia

A

ectodermal dysplasia
Downs
cleft palate

236
Q

what is the management of hypodontia

A

diagnosis and PREVENTION
removable pros
ortho
composite build ups
porcelain veneer
crowns and bridge

237
Q

what are the problems with hypodontia

A

abnormal shape
spacing
submergence
deep overbite
reduced LFH

238
Q

what is the prevalence of hyperdontia

A

1.5-3%

239
Q

what syndrome is associated with hyperdontia

A

cleidocranial dysplasia

240
Q

what are the 4 types of supernumerary

A

conical
tuberculate
supplemental
odontome

241
Q

what are the 3 enamel structure anomalies

A

amelogenesis imperfecta
environmental enamel hypoplasia
localised enamel hypoplasia

242
Q

what are the 4 types of amelogenesis imperfecta

A

hypoplastic
hypocalcified
hypomaturational
mixed

243
Q

what is the cause of amelogenesis imperfecta

A

generalised hereditary disease

244
Q

how do you diagnose amelogenesis imperfecta

A

history
affects both dentitions and all teeth
size, structure and colour are wrong

245
Q

what is hypoplastic amelogenesis imperfecta

A

crystals not right length

246
Q

what is hypomineralised amelogenesis imperfecta

A

crystallites fail to grow in thickness and width

247
Q

what is hypomaturational amelogenesis imperfecta

A

incomplete mineralisation

248
Q

what issues do amelogenesis imperfecta teeth have

A

sensitivity
caries susceptibility
poor aesthetics
poor OH
delayed eruption
AOB

249
Q

what is the treatment for amelogenesis imperfecta

A

prevention
composite veneers
fissure sealants
metal onlays
SSCs

250
Q

what systemic disorders are associated with enamel defects of structure

A

incontinenta pigmentii
downs
prader-willi
prophyria
tuberous sclerosis

251
Q

what are the dentine structure anomlaies

A

dentinogenesis imperfecta
dentine dysplasia
odontodysplasia

252
Q

what are the signs of dentine dysplasia

A

pulp obliteration
amber radiolucency
short roots

253
Q

what are the signs of odontodysplasia

A

thin enamel and dentine and large pulp looking like a ghost tooth
localised arrested development

254
Q

what are the 3 types of dentinogenesis imperfecta

A

1 = osteogenesis imperfecta
2 = autosomal dominant
brandywine

255
Q

how do you diagnose dentinogenesis imperfecta

A

appearance, family history
bulbous crowns and obliterated pulps
enamel loss

256
Q

what are the problems with dentinogenesis imperfecta

A

aesthetics
caries
spontaneous abscess

257
Q

what is the treatment of dentinogenesis imperfecta

A

prevention
composite veneers
overdentures
removable pros
SSCs

258
Q

what is the overall dental management for structural defects

A

manage growth and development
removable pros
crown and bridge
interceptive orthodontics
continuous dental care

259
Q

what are the cementum anomalies of structure

A

cleidocranial dysplasia giving cementum hypoplasia
hypophosphatasia giving hypoplasia of cementum and early loss

260
Q

why would you have premature eruption

A

high birth weight
neonatal teeth

261
Q

why would you have delayed primary eruption

A

low birth weight
downs
hypothyroidism

262
Q

why would you have premature exfoliation

A

trauma
after pulpotomy
hypophosphatasia
immune deficiency

263
Q

why would you have delayed exfoliation

A

infraocclusion
hypodontia
ectopic permanent successors
after trauma

264
Q

what are the management options for caries in primary teeth in general practice

A

prevention
biological management
minimally invasive
conventional restorative options
extraction

265
Q

what ages are milestones for monitoring developing dentition

A

3,6,9,12

266
Q

what aspects of childrens dentistry are we expected to manage in general practice

A

dental caries
emergencies
developing dentition
MIH
orthodontics
child protection

267
Q

what is motivational interviewing

A

ask the patient what their own goals are whilst maintaining positive attitude

268
Q

when should we try to start taking bitewings

A

4yrs old

269
Q

what are the variables when deciding how best to treat caries in paediatrics in general dental practice

A

caries risk
age and ability to cope
length of time until exfoliation
material choice
minimally invasive considered first

270
Q

what does the site of an abscess depend on

A

position of tooth in arch
root length
muscle attachments
potential spaces in proximity to lesion

271
Q

where would infection go for there to be a facial swelling on the cheek caused by maxillary tooth

A

above the insertion of the buccinator into the buccal space

272
Q

where would an infection go if it was to drain into the mouth from a maxillary tooth

A

below insertion of buccinator

273
Q

what would happen if an infection from a maxillary tooth was to spread upwards

A

sinusitis

274
Q

why are palatal abscesses less common

A

palatal bone is denser

275
Q

where would infection spread from a lower tooth if there was a sublingual swelling

A

above mylohyoid

276
Q

where would infection spread from a lower tooth if there was a submandibular swelling

A

below mylohyoid

277
Q

where would the infection have spread from a lower tooth if it was draining to the mouth

A

above buccinator insertion

278
Q

what is the relation of the mylohyoid line to infection spread from premolars and molars

A

premolars sit above line so more likely to be sublingual
molars sit below line so more likely to be submandibular

279
Q

what spaces make up the masticatory spaces

A

masseteric
pterygomandibular
infratemporal
deep temporal
superficial temporal

280
Q

what happens to the muscles if infection spreads to the masticatory spaces

A

the muscles would spasm and cause trismus

281
Q

what symptoms would the patient have if infection spread to the pharyngeal spaces

A

breathing and swallowing issues

282
Q

once an infection is in the pharyngeal spaces where else would it spread to

A

retropharyngeal and prevertebral spaces

283
Q

what would be the path of infection spread for an infection to get to the cavernous sinus from the mandible

A

infratemporal space then pterygoid venous plexus then cavernous sinus

284
Q

what would be the path of infection spread for an infection to get to the cavernous sinus from the maxilla

A

infraorbital area where veins dont have valves and allow backwards spread of infection to cavernous sinus

285
Q

where can upper anterior teeth infection spread to

A

lip
nasolabial
lower eyelid

286
Q

where can upper lateral teeth infection spread to and why

A

palate
palatally placed root

287
Q

where can upper premolars and molars infection spread to

A

cheek
infratemporal
maxillary sinus
palate

288
Q

where can lower anterior infection spread to

A

mental and submental space

289
Q

where can lower premolar and molar infection spread to

A

buccal
submasseteric
sublingual
lateral pharyngeal
submandibular

290
Q

what would be the signs that a patient has a systemic infection

A

raised temperature
raised heart rate
raised respiratory rate
raised white cells

291
Q

what is the hilton technique

A

insert closed scissors into infection and open them up to drain infection out

292
Q

when draining an extra-oral submandibular swelling what nerve do you need to be careful to avoid and how do you avoid it

A

facial nerve
2 finger breadths below inferior border of mandible

293
Q

what is ludwigs angina

A

bilateral cellulitis of sublingual and submandibular spaces

294
Q

what symptoms would a patient with ludwigs angina have

A

raised tongue
difficulty breathing and swallowing
drooling
diffuse redness and swelling bilaterally

295
Q

what is SIRS

A

systemically inflammatory response syndrom

296
Q

what are the SIRS

A

increased heart rate
increased respiratory rate
increased temperature
increased white cell count

297
Q

what is NEWS

A

national early warning score

298
Q

what does a CPVU get you on the NEWS score

A

3

299
Q

what NEWS score should everyone ideally be at

A

0

300
Q

what are the 2 reasons why bacteria become resistant

A

intrinsic (genetics)
acquired (mutations)

301
Q

what are the mechanisms of resistance

A

altered target site
enzymatic inactivation
decreased uptake

302
Q

what bacterial are in a periodontal abscess

A

anaerobic streptococci
prevotella intermedia

303
Q

what are the oral anaerobes present in pericoronitis

A

p. intermedia
s. anginosus

304
Q

what bacteria is in osteomyelitis

A

s. anginosus
s. aureus

305
Q

what is the sepsis 6

A

high flow O2
blood cultures
IV antibiotics
fluid challenge
measure lactate
measure urine output

306
Q

with regards to antibiotic resistance what is breakpoint

A

chosen concentration of an antibiotic which defines whether a species of bacteria is susceptible or resistant to antibiotic

307
Q

what is clinical resistance

A

infection is highly unlikely to respond even to maximum dose

308
Q

what are the confounding variables in antibiotic reistance

A

pH
phase of growth
biofilm
site of infection

309
Q

what should be the first principle of management of a dental abscess

A

surgical drainage

310
Q

what is antimicrobial stewardship

A

team working to reduce antimicrobial use

311
Q

what actions can we take to contribute to antimicrobial stewardship

A

hand hygiene
team work
data management
reduce prescribing by promoting oral health

312
Q

what is penicillin active against

A

oral strepotcocci, anaerobes

313
Q

what is amoxicillin active against

A

resistant flora
it has a broader spectrum

314
Q

what does impaction mean

A

tooth eruption blocked

315
Q

what can impact a tooth

A

adjacent tooth
alveolar bone
surrounding mucosal tissue

316
Q

what are the consequences of impacted teeth

A

caries
pericoronitis
cyst formation

317
Q

what nerves are at risk during third molar surgery

A

IAN
lingual
nerve to mylohyoid
buccal nerve

318
Q

where does the lingual nerve sit

A

2.28mm down from top of lingual plate and 0.58mm medial to it

319
Q

what guidelines are published for the extraction of wisdom teeth

A

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
Q

what are the indications for extraction of wisdom teeth

A

infection (caries/pericoronitis)
cysts
tumours
external resorption of 7/8
fractured mandible
high risk of disease
medical indications
accessibility
patient age
autotransplantation

321
Q

what is pericoronitis

A

inflammation around crown of PE tooth caused by food/debris trapped under operculum

322
Q

what bacteria is present in pericoronitis

A

streptococci
actinomyces
prevotella
bacteroides
fusobacterium

323
Q

what are some signs and symptoms of pericoronitis

A

pain, swelling, bad taste, pus, cheek biting
limited opening, dysphagia, pyrexia, malaise, regional lymphadenopathy

324
Q

what is the treatment for pericoronitis

A

incision of pericoronal abscess
IDB
irrigate with saline/chlorhexidine
debride under operculum
frequent warm saline or chlorhexidine mouthwash
analgesia
fluids

325
Q

when would you decide to give antibiotics to someone

A

extra-oral swelling, systemic, immunocompromised,

326
Q

what signs would mean you should be sending someone to hospital with a dental infection

A

large extra-oral swelling
systemically unwell
trismus
dysphagia

327
Q

what are the predisposing factors for pericoronitis

A

partially erupted
vertical/distal impaction
opposing molar causing trauma
upper respiratory tract infections
poor OH
full dentition

328
Q

what is important in the history of presenting complaint with pericoronitis

A

how long, how many episodes
how often
severity
antibiotics before?

329
Q

what does an OPT determine in terms of third molars

A

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
Q

what are the indications that a mandibular third molar is close to the IAN canal

A

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
Q

what are the signs on an OPT that means there is a significant risk of nerve injury with M3M removal

A

interruption of white lines
darkening of root where canal crosses
diversion/deflection of canal

332
Q

how do you measure angulation of a M3M

A

against the curve of spee from the midpoint of the crown of M3M

333
Q

what are the different angulations that a M3M can have

A

vertical
mesial
distal
horizontal
transverse

334
Q

what is the most common angulation of a M3M

A

mesial

335
Q

what does the depth of a M3M give you an idea of

A

amount of bone removal required

336
Q

what are the different depths of a M3M

A

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
Q

what are the treatment options for M3M

A

referral, review, removal
extraction, coronectomy
operculectomy, autotransplantation

338
Q

what are the risks of M3M surgery

A

risk of 2nd molar restoration fracture
jaw fracture
post-op complications
numbness and altered taste
dysaesthesia/hypoaesthesia
increased sensation

339
Q

what communication system is used to refer patients

A

SBAR

340
Q

what are the risks of nerve numbness to IAN and lingual (temporary and permanent)

A

IAN temp - 10-20%
IAN permanent numb - <1%
lingual temp - 0.25-23%
lingual permanent - 0.14-2%

341
Q

what are the steps of surgical removal of a third molar

A

access
reflection
retraction
remove bone
separate crown and roots
debridement
suture

342
Q

what flap is raised in M3M surgery

A

mucoperiosteal buccal flap

343
Q

what is used to remove bone

A

electrical straight handpiece with saline cooled bur

344
Q

name an instrument which retracts tissue during surgery

A

Minnesota

345
Q

what is the aim of a coronectomy

A

reduce risk of IAN damage when there is an increased risk of damage with surgical removal

346
Q

what warnings must you give a patient before coronectomy

A

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
Q

what instruments are used to extract upper third molars

A

warwcick james and bayonets

348
Q

what is the blood and nerve supply to TMJ

A

deep auricular artery
auriculotemporal, masseteric and posterior temporal nerve

349
Q

why does it sometimes feel like you have ear pain when you have TMJ pain

A

as the auriculotemporal nerve also supplies the ear

350
Q

what part of the TMJ feels pain

A

bilaminar zone

351
Q

what are the causes of TMD

A

myofascial pain
disc displacement
degenerative disease
chronic recurrent dislocation
ankylosis
hyperplasia
neoplasia
infection

352
Q

what is the pathogenesis of TMD

A

inflammation of muscles
trauma
stress
psychogenic
occlusal abnormalities

353
Q

what do we look for when doing intra and extra oral exam for TMD

A

MoM , joint clicks, jaw movement, asymmetry
mouth opening, parafunction,

354
Q

what special investigations are used for TMD

A

OPT
CT
MRI
nuclear imaging
arthography
ultrasound

355
Q

what are the clinical features of TMD

A

intermittent pain for several months
muscle pain on waking
trismus
clicking noises
headaches
crepitus

356
Q

what is in the differential diagnoses for TMD

A

dental pain
sinusitis
ear pathology
salivary gland pathology
referred neck pain
headache
atypical facial pain
trigeminal neuralgia
angina

357
Q

what is the conservative management of TMD

A

counselling
avoid chewy foods
jaw exercises
medications
physiotherapy, massage, heat, relaxation, acupuncture
splints

358
Q

what is the counselling for TMD

A

reassure
soft diet
no wide opening
dont incise food
cut into small pieces
support opening mouth

359
Q

what medications are used for TMD

A

NSAIDs
relaxants
tricyclics
botox
steroids

360
Q

what splints are available for TMD

A

bite raising
anterior repositioning

361
Q

what surgery is available for TMD

A

arthroscopy
disc repositioning
replacement

362
Q

why does the TMJ click in disc displacement

A

lack of coordinated movement between condyle and disc

363
Q

what are the symptoms of TMJ disc displacement with reduction

A

jaw tightness and deviation

364
Q

what is the function of the maxillary sinus

A

add resonance
chamber for warming inspired air
reduce the weight of the skull

365
Q

where does the maxillary sinus open into

A

middle meatus

366
Q

what epithelium lines the maxillary sinus

A

pseudostratified ciliated columnar epithelium

367
Q

what does the cilia in the maxillary sinus allow

A

mobilise trapped matter and foreign material to move towards ostium for removal via nasal cavity

368
Q

what issues are associated with the maxillary sinus

A

OAC, OAF, root in antrum, sinusitis, benign lesions, malignant lesions

369
Q

how do you diagnose an OAC/OAF

A

look at size of tooth
radiographic position of roots
bone at trifurcation
bubbling of blood
nose holding test
direct vision
light and suction

370
Q

what is the acute management of a small OAC

A

encourage clot
suture
antibiotics
post-op instructions
minimise pressure in nose and mouth

371
Q

what is the acute management of a large OAC

A

buccal advancement flap

372
Q

what might someone with a chronic OAF complain of

A

problems with fluid consumption
problems with speech or singing
wind instruments
smoking
bad taste - post-nasal drip
pain

373
Q

what is the management of an OAF

A

excising sinus tract
raising flap
antral washout ??

374
Q

what is the aetiology of a maxillary tuberosity fracture

A

single standing molar
unknown unerupted molar
gemination
extract in wrong order
inadequate alveolar support

375
Q

how do you manage a maxillary tuberosity fracture

A

reducing and stabilising with splint
OR
dissect out and suture

376
Q

how do you diagnose a maxillary tuberosity fracture

A

noise
movement
tear in palate
more than the tooth movement

377
Q

how do you retrieve a root in the antrum

A

through socket
caldwell luc
ENT

378
Q

how is sinusitis precipitated

A

viral infection

379
Q

what is sinusitis

A

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
Q

what are the signs and symptoms of sinusitis

A

facial pain
pressure
congestion
nasal obstruction
paranasal drainage
fever
headache
dental pain
halitosis
fatigue
cough
ear pain

381
Q

which things point towards a sinusitis diagnosis

A

discomfort on palpation of infraorbital region
diffuse pain in maxillary teeth
equal TTP in same region
worse with head movements

382
Q

what is the treatment for sinusitis

A

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
Q

what antibiotics are used for bacterial sinusitis

A

amoxicillin 500mg TID 7 days

384
Q

what does aspiration sampling allow

A

avoid contamination by commensals
protect anaerobic species
can aspirate cystic lesions

385
Q

what are the types of biopsy

A

excisional
incisional

386
Q

what does an excisional biopsy do and what is it indicated for

A

remove all abnormal tissue
if confident of provisional diagnosis
for benign/discrete lesions

387
Q

what is an incisional biopsy for

A

larger lesions and uncertain diagnosis

388
Q

what is a tissue sample sent to the lab in

A

10% formalin using filter paper

389
Q

what is a fibrous epulis

A

swelling from gingivae as hyperplastic response to irritation

390
Q

what does a fibrous epulis look like

A

smooth surface, rounded, pink, pedunculated

391
Q

what is the treatment for fibrous epulis

A

excisional biopsy
dress with coe pack
remove irritation

392
Q

what causes a fibroepithelial polyp/fibrous overgrowth

A

due to frictional irritation or trauma

393
Q

what does a fibroepithelial polyp look like

A

semi-pedunculated or sessile, pink, smooth surface

394
Q

what is the treatment for fibroepithelial polyp

A

surgical excision

395
Q

what is a giant cell epulis made of

A

multinucleated giant cells in vascular stroma

396
Q

how do you treat a giant cell epulis

A

surgical excision and curettage of base and coe pack

397
Q

what is a haemangioma

A

developmental overgrowth

398
Q

what does a haemangioma look like

A

exophytic and blue but if you put pressure on it it will lose colour

399
Q

what is the treatment for haemangioma

A

surgical removal or cryotherapy

400
Q

what is a lipoma

A

benign neoplasm of fate

401
Q

what does a lipoma look like

A

soft swelling, pale yellow, sessile

402
Q

what is the treatment of a lipoma

A

excision

403
Q

what is a pyogenic granuloma

A

failure of normal healing and overgrowth of granulation tissue

404
Q

how do you treat a pyogenic granuloma

A

surgical excision and curettage

405
Q

what does a squamous cell papilloma look like

A

pedunculated
white
cauliflower like

406
Q

what is the treatment of squamous cell papilloma

A

excision at base

407
Q

what is a leaf fibroma caused by

A

chronic denture irritation

408
Q

what is a mucocele

A

mucous extravasation cyst of saliva into the mucosal area

409
Q

what causes mucoceles

A

damage to minor salivary gland ducts

410
Q

what is the classic description of squamous cell carcinoma

A

ulcer with rolled margins and that is indurated

411
Q

what are the red flags meaning urgent referral (cancer wise)

A

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
Q

what are the signs and symptoms of oral cancer

A

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
Q

what staging system is sued for head and neck cancer

A

TNM

414
Q

what does TNM mean

A

T = primary tumour
N = regional lymph nodes
M = distant metastasis

415
Q

what are the treatment options for oral cancer

A

curative = surgery and chemo/radio
palliative = symptom control and prolonging survival

416
Q

what are the fundamentals of orthognathic surgery

A

team approach
history taking
clinical exam
investigations
prediction planning

417
Q

when taking a history before orthognathic surgery what should this include to find out what the cause for needing surgery is

A

congenital causes
hormonal causes
trauma
pathology
racial characteristics
syndromic malformation

418
Q

what diagnostic aids are helpful in orthognathic surgery

A

OPT
ceph
periapical
occlusal
CBCT
photos
study models

419
Q

what is included in 3D planning for orthognathic surgery

A

photos
CBCT
intra-oral scanning

420
Q

what are the signs of a definite mandible fracture

A

sublingual haematoma
2 point vertical mobility
abnormal sensation contralateral to injury
pain contralateral to injury
unexplained numbness

421
Q

what is the treatment for mandible fracture

A

fast
analgesia
antibiotics if open fracture
liquid diet
speak to OMFS

422
Q

what are the definite signs of midface and zygoma fracture

A

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
Q

what are the difference between the Le Fort fractures

A

1 - top teeth move back and forward only
2 - top teeth and nose move
3 - top teeth, nose and eyes move

424
Q

what is the treatment for zygoma fracture

A

OMFS
no nose blowing for 6 weeks
soft diet
warn about retrobulbar bleed

425
Q

what is the treatment for orbit fracture

A

document VA and diplopia
OMFS discussion
no nose blowing
retrobulbar bleed warning

426
Q

what is the treatment for a Le Fort fracture

A

fast
antibiotics
OMFS discussion
liquid diet
no nose blowing

427
Q

what are the 3 most common orthognathic surgeries

A

Le Fort 1
sagittal split
genioplasty

428
Q

what do you need to assess for eye injuries and trauma

A

blown pupil
eye movement
pain
chemosis
proptosis
visual acuity
numbness

429
Q

what does a retrobulbar bleed present as

A

painful proptotic eye
tense globe
ophthalmoplegia

430
Q

what are the signs of an orbit fracture

A

infra-orbital paraesthesia
diplopia
subconjunctival bleed

431
Q

from front to back , what are the parts of the mandible

A

synthesis
parasynthesis
body
angle
condyle

432
Q

what are the clinical signs of a malar fracture

A

periorbital bruising and swelling
subconjunctival ecchymoses
sensory deficit
diplopia
subcutaneous emphysema
epistaxis
step deformity

433
Q

what do you palpate when checking for zygomatic fracture

A

supraorbital ridge
infraoribtal ridge and zygoma
depression of zygomatic arch
ascertain if maxilla movement

434
Q

what is the initial care of zygomatic fracture

A

exclude eye injury
prophylactic antibiotics
avoid nose blowing

435
Q

what is the definitive management of zygomatic fracture

A

review when swelling subsided
further radiographs and CT
informed consent
closed reduction and fixation or ORIF

436
Q

what are some of the consequences of orbito and naso-ethmoidal wall fracture

A

diplopia, infraorbital anaesthesia
inward displacement, lateral rectus palsy
bridge depression, CSF leak
dural tear and brain damage
blindness

437
Q

what is involved in classifying mandible fractures

A

involvement in surrounding tissues
number of fractures
side and site of fracture
direction of fracture line
specific fractures
displacement of fracture

438
Q

what factors cause displacement of mandibular fractures

A

direction of fracture line
opposing occlusion
magnitude of force
mechanism of injury
intact soft tissue
other associated fractures

439
Q

what radiographs are needed for mandibular fractures

A

OPT and PA mandible

440
Q

when would a condylar fracture be treated by ORIF

A

bilateral subcondylar with AOB
displaced condylar fracture interfering with opening mouth
displaced fracture causing occlusal derangement/ramus shortening/middle cranial fossa

441
Q

what classification is used for naso-orbital-ethmoidal fractures

A

markowitz classification

442
Q

what would a NOE fracture look like

A

blow to nose
bridge pushed in
nose tipped up
increased nasolabial angle
confirm with CT
check for CSF leak

443
Q

what are the characteristic signs of a cyst

A

egg shell crackling when pressing
tooth mobility/absence of teeth
numbness
discolouration
swelling

444
Q

what radiographs are used for cysts

A

PA, occlusal, OPT
CBCT, PA mandible, occipitomental

445
Q

what are the radiographic features of cysts that we look for

A

location
shape
margins
locularity
multiplicity
effect on anatomy
unerupted teeth

446
Q

what are cysts classified by

A

structure , origin , pathogenesis
epithelium/not , odontogenic/not, developmental/inflammatory

447
Q

what lines odontogenic cysts

A

epithelium

448
Q

what are the sources of epithelium for odontogenic cysts

A

rests of malassez
rests of serres
reduced enamel epithelium

449
Q

what type of cyst is a radicular cyst

A

inflammatory odontogenic

450
Q

where do radicular cysts occur

A

non-vital tooth
initiated by chronic inflammation at the apex

451
Q

what does a radicular cyst look like on radiographs

A

well-defined corticated margin continuous with lamina dura

452
Q

what does a radicular cyst look like on histology

A

epithelial lining incomplete
connective tissue capsule

453
Q

what cells are found in a radicular cysts

A

mucous metaplasia
cholesterol clefts
rushton bodies

454
Q

what type of cyst is an inflammatory collateral cyst

A

inflammatory odontogenic

455
Q

where does an inflammatory collateral cyst occur

A

at vital tooth

456
Q

what is a dentigerous cyst

A

developmental odontogenic
cystic change of dental follicle

457
Q

where does a dentigerous cyst occur

A

crown of unerupted tooth

458
Q

what does a dentigerous cyst look like radiologically

A

corticated margins from CEJ of tooth, symmetrical

459
Q

what lines a dentigerous cyst

A

thin non-keratinised stratified squamous epithelium

460
Q

what is an eruption cyst and who does it occur in

A

variant of a dentigerous cyst
occurs in erupting teeth (children)

461
Q

what type of cyst is an odontogenic keratocyst

A

developmental odontogenic

462
Q

what does an odontogenic keratocyst look like on radiographs

A

scalloped margjns - can be multilocular
displaces teeth
expands mesio-distally

463
Q

what does a cyst aspirate of an odontogenic keratocyst show

A

squames
low soluble protein content

464
Q

what is the histology of an odontogenic keratocyst

A

epithelial lined with parakeratosis, basal palisading and daughter cysts

465
Q

why do odontogenic keratocysts have a high recurrence rate

A

they have a thin lining so if you dont manage to remove all of the lining it will recur

466
Q

what syndrome is associated with multiple odontogenic keratocysts

A

basal cell naevus syndrome

467
Q

what type of cyst is a nasopalatine duct cyst

A

developmental non-odontogenic

468
Q

what is a nasopalatine duct cyst made out of

A

nasopalatine duct epithelial remains
non-keratinised stratified squamous and modified respiratory

469
Q

what may a patient experience with nasopalatine duct cyst

A

salty discharge

470
Q

what does a nasopalatine duct cyst look like on radiology

A

corticated radiolucency between centrals
unilocular
heart shaped

471
Q

what is a solitary bone cyst

A

non-odontogenic cyst without epithelial lining

472
Q

what is a stafne cavity

A

depression in bone

473
Q

what is enucleation

A

removing all of a cyst

474
Q

what does enucleation allow for

A

whole lining can be examined
allows primary closure

475
Q

what is the risks of enucleation

A

risk of mandible fracture
can become infected
damage to adjacent structure

476
Q

what is marsupialisation

A

create surgical window and remove contents and suture cyst wall to surrounding epithelium to encourage decrease in size

477
Q

when is marsupialisation used

A

when enucleation would damage structures
difficult access
to allow eruption of teeth
elderly/medically compromised

478
Q

what are the disadvantages of marsupialisation

A

cyst could reform, complete lining not available for histology, hard to keep clean and aftercare needed

479
Q

what are the types of odontogenic tumours

A

epithelial
mesenchymal
mixed

480
Q

what is an ameloblastoma

A

benign epithelial tumour

481
Q

what does an ameloblastoma look like radiographically

A

multicystic (soap bubble)
well defined corticated
potentially scalloped margins
radiolucent

482
Q

what is the effect of an ameloblastoma on adjacent structures

A

displace adjacent structures
thin bone cortices
knife edge
external root resorption

483
Q

what are the 2 types of ameloblastoma

A

follicular
plexiform

484
Q

how do you manage an ameloblastoma

A

surgical resection

485
Q

what type of tumour is an adenomatoid odontogenic tumour

A

benign epithelial

486
Q

what does an adenomatoid odontogenic tumour look like on radiographs

A

unilocular radiolucency with internal calcifications around crown of unerupted maxillary canine
well defined corticated margins

487
Q

what are the epithelial cells arranged like in an adenomatoid odontogenic tumour

A

duct like structure

488
Q

what type of tumour is a calcifying epithelial odontogenic tumour

A

benign epithelial

489
Q

what are most calcifying epithelial odontogenic tumours associated with

A

unerupted tooth

490
Q

what does a calcifying epithelial odontogenic tumour look like on radiographs

A

internal radiopacities

491
Q

what type of tumour is an odontogenic myxoma

A

benign mesenchymal tumour

492
Q

what does an odontogenic myxoma look like on radiographs

A

well-defined and thin corticated margin
unilocular or larger multilocular and scalloped

493
Q

what is an odontogenic myxoma made of

A

loose myxoid tissue with stellate cells
no capsule

494
Q

what type of tumour is an odontoma

A

benign mixed tumour

495
Q

what are the different types of bone graft

A

autogenous
xenograft
allograft
alloplastic
bone bioengineering

496
Q

what type of bone graft is deproteinised bone matrix

A

xenograft

497
Q

what does the upper compartment of the TMD do

A

translation

498
Q

what does the lower compartment of the TMD do

A

rotation

499
Q

what happens with inflammatory disease in the TMD

A

inflammatory disease produces proteases which degrade proteoglycans

500
Q

what are the degenerative changes of the TMD

A

disc perforation, flattening of condyle and eminence
subchondral cysts

501
Q

what is the conservative management of TMD

A

counselling, pain management
joint rest, physical therapy
restoring occlusal stability

502
Q

what does a bite raising appliance allow in TMD

A

eliminate occlusal interference and prevent joint head from rotating

503
Q

what investigations can be used for TMD

A

OPT
orthogram
MRI
arthroscopy

504
Q

what are arthoscopic procedures used for

A

diagnosis
biopsy
disc reduction
removing loose bodies

505
Q

what are some complications from arthroscopy

A

broken instruments
middle ear perforation
extravasation
haemorrhage
infection
trigeminal and facial nerve damage
perforate tympanic membrane

506
Q

what is the post-op management after TMD surgery

A

joint rest with soft diet
pain management
physical therapy
restoring occlusal stability

507
Q

what are some different types of TMJ surgery

A

disc plication
menisectomy
reconstructive
eminectomy

508
Q

what is the stages of ankylosis for TMJ

A

little space
fusion at outer edge
marked fusion
mass of bone

509
Q

what bone tests can you get

A

calcium
osteoblast activity
PTH
vitamin D assays

510
Q

what syndrome is associated with fibrous dysplasia

A

Albrights

511
Q

what is fibrous dysplasia/albrights

A

slow growing asymptomatic bony swelling which grows until growth period stops
can be single bone or many bones

512
Q

what is rarefying osteitis

A

localised loss of bone in response to inflammation

513
Q

what is sclerosing osteitis and where does it occur

A

localised increase in bone density responding to low-grade inflammation
apex of tooth with necrotic pulp

514
Q

what is idiopathic osteosclerosis

A

localised increase in bone density of unknown cause

515
Q

what is osteitis fibrosa cystica

A

generalised osteoporosis
focal osteolytic lesions
giant cell lesions

516
Q

what is cherubism

A

rare autosomal dominant inheritance disorder with multilocular lesions in multiple quadrants and can regress after puberty

517
Q

what is the signs of pagets disease and dental signs

A

bone swelling, pain, nerve compression, increased bone turnover
loss of lamina dura, hypercementosis, migration of teeth

518
Q

what is an osteoma

A

solitary, slow growing cortical bone

519
Q

when would you not remove retained roots

A

preserve bone height
near vital anatomical structures
present for a while and no PA pathology
give patient the option

520
Q

what are the 3 main types of skull radiographic views

A

occipitomental
PA mandible
reverse townes

521
Q

what is occipitomental radiograph for

A

midface fractures

522
Q

what is PA mandible radiograph for

A

posterior mandible fractures

523
Q

what is reverse townes radiograph for

A

mandibular condyles fractures

524
Q

what line is used for patient positioning for skull radiographic views

A

orbitomeatal line

525
Q

what is the orbitomeatal line based on

A

outer canthus of eye and centre of EAM

526
Q

what angles of occipitomental radiograph are taken for middle third and coronoid fractures

A

10 and 40

527
Q

what is the position of the orbitomeatal line for occipitomental radiographs

A

45 degrees to receptor (nose to chin)

528
Q

what does a PA mandible show

A

posterior third of body
angles
rami
low condylar necks

529
Q

what is the orbitomeatal line positioned like for PA mandibles

A

perpendicular to receptor (forehead on receptor)

530
Q

why is the beam projected from the posterior side with skull radiography

A

reduced magnification of face so less distortion
reduced effective dose

531
Q

what is reverse townes for

A

condylar head and neck

532
Q

what is the difference between reverse townes and PA mandible

A

open mouth with reverse townes

533
Q

what is CBCT and what is it used for

A

cross sectional imaging used for radiodense structures

534
Q

what are the benefits of CBCT

A

no superimposition
view subject from any angle
no magnification/distortion
allows for 3D reconstruction

535
Q

what are the downsides of CBCT

A

increased radiation dose
lower spatial resolution
susceptible to artefacts

536
Q

what are the uses of CBCT in dentistry

A

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
Q

what are the imaging variables of CBCT

A

field of view
voxel size
acquisition time

538
Q

what are the artefacts in CBCT

A

either movement or streak

539
Q

what are the contraindications to CBCT

A

if plain is sufficient
pathology requiring soft tissue visualisation
high risk of debilitating artefacts
patient cant stay still

540
Q

what type of margins on radiography suggests malignancy

A

moth eaten

541
Q

what are radiolucencies caused by

A

resorption
demineralisation
reduced thickness
replacement of bone with abnormal tissue

542
Q

what are radiopacities caused by

A

increased thickness
osteosclerosis
presence of abnormal tissue
mineralisation

543
Q

what conditions can show hypercementosis

A

acromegaly and pagets

544
Q

what does hypercementosis look like on radiographs

A

homogenous radiopacity continuous with root surface
well defined smooth margins

545
Q

what is an ultrasound good for

A

salivary glands

546
Q

what criteria must be met for salivary stone removal

A

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
Q

what can be seen on glands with sjogrens disease

A

heterogenous parenchymal pattern
hypoechoic
atrophy
fatty infiltration

548
Q

what are the 2 most common benign salivary tumours

A

pleomorphic adenoma
warthins

549
Q

what are the 2 most common malignant salivary tumours

A

adenoid cystic carcinoma
mucoepidermoid carcinoma

550
Q

what is the difference between benign and malignant salivary tumours

A

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
Q

what is the effect of smoking on periodontitis

A

vasoconstricts blood vessels and increases gingival keratinisation, impairs antibody production, depresses numbers of Th lymphocytes, impairs PMN function and increases pro-inflammatory cytokines

552
Q

what are the features of chlorhexidine

A

adsorption to oral surface
long substantivity
broad antimicrobial spectrum
interferes with taste and stains teeth

553
Q

how does scaling increase attachment level

A

long junctional epithelium formation

554
Q

features of necrotising gingivitis

A

necrosis and ulcer in interdental papilla
gingival bleeding
pain
pseudomembrane formation
halitosis
lymphadenopathy

555
Q

what bacteria present in ANUG

A

spirochetes and fusobacterias

556
Q

risk factors for ANUG

A

stress, sleep deprivation
poor OH
smoking
immunosuppression

557
Q

treatment of ANUG

A

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
Q

antibiotics used for ANUG

A

metronidazole 400mg TID 3 days
amoxicillin 500mg TID 3 days

559
Q

symptoms/signs of periodontal abscess

A

swelling
pain
TTP
deep periodontal pocket
bleeding
suppuration
enlarged regional lymph nodes
fever
vital tooth
commonly pre-existing periodontal disease

560
Q

treatment of periodontal abscesses

A

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
Q

antibiotic used for periodontal abscesses

A

penicillin 250mg 2 tablets QD 5 days
amoxicillin 500mg TID 5 days
metronidazole 400mg TID 5 days

562
Q

signs/symptoms of endo-perio lesion

A

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
Q

treatment of endo-perio lesions

A

endo treatment
analgesia
0.2% chlorhexidine mouthwash
review within 10 days for PMPR

564
Q

how long should you wait until after perio treatment to place a restoration

A

3-6 months

565
Q

how do crowns and bridges help to damage the periodontium

A

plaque retention
unfavourable transmission of occlusal forces
pulp damage

566
Q

how do RPDs damage the periodontium

A

plaque retention
direct trauma from components
unfavourable transmission of forces

567
Q

what are supracrestal attached tissues composed of

A

junctional epithelium and supracrestal connective tissue attachment

568
Q

what happens if restorations encroach on the junctional or connective tissue

A

persistent inflammation and loss of attachment

569
Q

what are the keys to periodontally successful indirect restorations

A

healthy tissue
adequate tooth preparation
precise margin location
excellent provisional restorations
careful tissue handling and impression technique

570
Q

what is Ante’s law

A

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
Q

what does tooth mobility depend on

A

width and height of PDL, inflammation
number shape and length of roots

572
Q

when can mobility not be accepted

A

progressively increasing
gives rise to symptoms
creates difficulty with restorative treatment

573
Q

what is therapy to reduce mobility

A

control of plaque induced inflammation
correction of occlusal relations
splinting

574
Q

what is primary occlusal trauma

A

injury resulting in tissue changes from excessive occlusal forces applied to a tooth or teeth with normal periodontal support

575
Q

what happens with primary occlusal trauma

A

PDL width increases until forces can be dissipated
increased mobility
if demand reduced it returns to normal

576
Q

what is secondary occlusal trauma

A

injury to tissues from normal or excessive forces applied to a tooth with reduced periodontal support

577
Q

what does clinical diagnosis of occlusal trauma show

A

progressive tooth mobility
fremitus
occlusal discrepancies
wear facets
tooth migration
tooth fracture
thermal sensitivity
root resorption
cemental tear
widening of PDL on radiographs

578
Q

when is splinting for mobile teeth appropriate

A

mobility is due to attachment loss
mobility is causing discomfort
teeth need to be stabilised for debridement

579
Q

what does tooth migration cause

A

loss of periodontal attachment
unfavourable occlusal forces and soft tissue profile

580
Q

how do you manage tooth migration

A

treating periodontitis
accept position and stabilise
moving teeth orthodontically and stabilising

581
Q

stages of clinical audit

A

set topic
set standards
observe practice and collect data
analyse data
identify areas of change and make changes

582
Q

CPD requirements

A

100hrs over 5yrs
at least 10 consecutive hours over 2 years

583
Q

what is SHANARRI

A

safe
healthy
achieving
nurtured
active
respected
responsible
included

BDS4 Exam Revision (6 decks)

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