BDS4 (2) Flashcards
from page 55 on
What are the radiographic signs of dentinenesis imperfecta?
obliterated canals and pulp chamber from dentine deposits- originally errupt large but become sclerosised
reduced root length with rounded apices
bulbous cron
occult absecesses/periapical rediolucency with the lack of clinical pathology
How would you monitor failure of a pulpotomy?
Clincially - mobility, pain, chronic sinus
Radiographically- radiolucency, external/internal resorption, furcation bone loss
describe primary incisor pulpotomy vs primary molar pulpotomy technique?
usually a pulpectomy and not a pulpotmy carried out due to lack of pulpal tissue. Be aware of using ferric sulphate on the anteriors due to the staining action of it. be aware of aesthetics for the restoration
Primary molars- ferric sulphate can be used and SSC may usually the option for restoration.
Why may a first molar be impacted?
angle of the path of erruption
small arch meaning space may not allow for erruption
ectopic crypt
morphology of surrounding teeth
What are the deleterious effect of impacted teeth?
root resoption bone loss tooth loss tipping and tilting of teeth ectopic teeth
What characteristics of the permanent dentition allows for the replacement of primary teeth without crowding?
mandibular and maxillary growth
slight proclination of perm teeth
leeway space between the primary teeth allowing for space for adult teeth to errupt
What is the leeway space and how does it prevent / stop crowding?
the amount of space that the primary molars occupy with is greater than the space required for the perm premolars - thus extra space allows for the molars to come in behind
space on lower- usually about 2.5mm and on upper around 1.5mm
What is extrusion?
partial displacement of a tooth in its socket which is characteristed by the full or partial loss of PDL. Tooth becomes loose and displaced. tooth will either be protruded or retruded.
How would you splint an extrusion?
flexible splint for 2 weeks which is passive and placed onto tooth with composite.
Flexible stainless steel wire
What would you asses prior to placing or planning implants?
general- perio status, medical cautions!, smoking
Local- OH- bone support (quality and quantity and current position of the existing teeth
What 4 medical conditions are down syndrome patients more predispositioned to?
cardiac defects- ventricular septal defect
leukaemia
epilepsy
alzhimers/dementia
What are 4 extra oral features of a down syndrome patient?
small mouth with a big tongue (may protrude)
flat head and facial features
small nose/flat nasal ridge
slanting upwards and outwards eyes
What are 6 intra oral features of a patient with down syndrome?
maxillary hypoplasia class 3 macroglossia AOB hypodontia/macrodontia common to see perio disaese often bruxism habit
6 ways in which prevention may be altered for these patients?
Fluoride varnish 22,600 ppm 4x yearly fluoride supplimentation radiographs and recall more often increased fluoride tooth paste non foaming toothpaste? CHX mouth wash?
What 8 things are found on a clinical trauma review?
sinus/tender sulcus colour TTP mobility radiograph EPT percussion note
How long should a lateral luxation injury be splinted for?
flexible splint for 4 weeks
What root resorption may occur with lateral luxation trauma?
external inflammatory resorption
What is the cause of external inflammatory resorption?
prolonged stimuli to the damaged root surface which allow the resorption of the root to continue.
What are the treatment options for MIH?
Incisors - micro abrasion
external bleaching
composite veneer/porcelain veneer
composite restoration
Molars- composite/GI restorations
SSC
XLA
What would you do in the case of a subluxation?
flexible splint for 2 weeks OHI and CHX soft diet avoid contact sports review 2w/4w/6-8w/6m? and yearly
What is the age range best suited for interceptive orthodontics
11-13 years of age
How long after XLA of C’s should you review ectopic canines?
6 months
What are the most commonly missing teeth?
8s-lower5-upper2-upper5
What are 2 effects of trauma on primary teeth?
delayed exfoliations - root may not resorb correctly
discolouration
4 effect of trauma on permanent dentition?
enamel defects
delayed erruption
abnornormal tooth/root morphology
ectopic tooth position
What are the fluoride supplement would you give for unfluradate water?
age 1- 0.25mg
age 4- 0.5mg
age - 1mg??
What would be the subluxation injury diagnostic features?
increased mobility and TTP
no displacement of the tooth
bleeding from gingival sulcus `
When taking radiographs for trauma what should you be looking for?
root development- width and length of the canal
internal/external inflammatory resorption
comparing to opposing side
what would indicate a tooth has innternal inflammatory root resorbtion clinically?
may have positive sensibility test
usually asymptomatic
may have acute pulpitis at active stage
sinus tract may present at later stages
What would indicate a tooth has internal inflammatory root resorbtion radiographically?
fairly uniform round-oval radiolucency in pulp canal
oeiginal pulp canal will be distoryed
mottled appearance of the island like mineral tissue which is mineralised in place of pulp
`Name two heamostatic agents?
oxidised cellulose
ferric sulphate
resorbable gelatine sponge
What is the technique for the paralleling with radiographs?
both receptor and object are parallel but not in contact with each other
beam is beam is the perpinducular
long fsd should be used to prevent magnification.
What is the bisecting technique?
image receptor (film) and oject are not parallel but are slightly in contacct with each other
the beam should be perpendicular to the film
can be carried out without film holder ie for occlusals `
What are 5 safety feature advised by IRR99?
controled area with signage warning lights in controlled area exposure stops automatically or when button is not held at least 1m away from the area possible lead lined walls training for alll staff
What are the 3 main principles of radiation protection?
Justification
Optimisation - ALARP
Dose limitation - this applys to workers and members of the public but not to patients
What are the IRMER guidelines?
minimising unintended, excessive or incorrect medical exposures
ensuring benefits outweugh the risks of each exposure
keeping doses as low as reasonablt practicable for their use
How are the IRMER guidelines achieved?
using E film or faster to reduce the ammount of theing required for exposure
us KV rage of 60-70kV with a focus - skin- distance of maximum 20 cm
use aiming devices- collimators (rectangular) and rinn holders
have beam diameter of no more than 60mm at the end of the spacer
How would external inflammatory resorption appear clinically?
positive response to sensibility testing
negative response to EPT
TTP
may be mobile
What are the radiolgraphic signs of external root resobption?
01/*shortening and blunting of root apices
PDL widens with loss of surrounding lamina dura
canal tramlines still intact
/What are the 8 factors of prevention plan
Radiographs Toothbrushing instructions fluoride toothpaste fluoride varnish fluoride suppliment use dietary advice FS sugarfree medincines
What are the tooth paste strengths for the use in children ?
0-3 years- 1000ppm (smear) 0.1ml 3-6- 1000ppm (pea sized) 0.25ml 7 years + -1350-1500ppm 0.25ml (pea size) HIgh risk under 10- 1500 ppm High risk 10-16- 2800ppm High risk 16+ - 5000ppm
What foods naturally contain fluoride?
tea potatos bony fish cuecumber spinach
What are the treatment options for fluorosis?
Microabrasion -easy, conservative , fast acting and permanent
Vital bleaching- allows patients to choose colour simple- but can make white spots whiter
Composite restoration over spot
veneers at later ages
What are the characteristics of pseudomembranous candidosis?
strange taste
white plaques which scrape off to reveal erythematous base
2 local and 2 medical causes of pseudomembranous candidosis?`
local- steroid inhalers, antibiotic use, oral steriod
Medical - immunocomprimised, HIV, diabetes
What is the advantages ad disadvantages of and oral swab?
simple and site spicific, however, uncomfortable and contamination happens easily
What are the advantages ad disadvantages of and oral rinse?
able to seperate healthy and non healthy organisms, recording information from the whole mouth.
Difficult to standardise
not site specific
patients sometimes struggle with the process
What would be you first line of medication for this condition and state what drugs interact withthem?
Fluconazole 50mg - 7 caps - 1x daily for 7 days
Miconazole oromucosal gel 20mg/g for 7 days after lesions have healed. 80mg tube. apply pea sized amount 4 x daily after meals
Nystatin oral suspension 100,000 units/ml for 48 hours after lesions have healed. send 30ml. 1ml 4x daily after food for 7 days + 2 after
These drugs interact with warfarin + statins (simvastatin)
What are the toxic doses for fluoride consumptions and what is the treatment for each?
<5mg/kg give calcium orally and observe (milk)
5-15mg/kg= give calcium orally and admit to hospital (milk, calcium lactate)
>15mg/kg- admit to hospital immediatly for cardiac monitoring and life support and give calcium gluconate
What are the stages of anesthesia?
Induction
Excitement
surgical anaesthesia
respiratory paralysis/ overdose
What needs to be included in a referral letter?
Patient details Gaurdians details GMP and GDP contact details MEdical history Dental history and justification for referral radiographs for justification Treatment plan
What is the definition of conscious sedation?
the technique in which a drug is used to depress the CNS enabling treatmet to be carried out. Verbal communication is held with the patient throughout the sedation.
Patient remains - conscious, maintains the reflexes and is able to communicate and understand verbal commands.
What is GABA and its function?
Gamma-amino butyric acid is an amino acid which acts as a neurotransmitter in CNS which inhibs nerve transmission on the brain calming the nervous activity.
benzodiazepines acct on receptors in the CNS to enhance the affect of GABA in the cerebreal cortex and inhibit the 1CNS neurotransmitters
What is the half life of midazolam?
90- 150 mins
What is postural hypotension?
an excessive fall in blood pressure when an upright position is assumed casued by a failure of the auto regulatory system which normaly maintain BP
What is the order of postural hypotension?
venous pooling in the legs poor venous return fall in stroke volume fall in cardiac output patient continues to lose consciousness
What are 3 things which may cause a patient to collapse?
fainting/syncope fear anxiety hyopoglycemic episode dehydration standing up to quickly
What are the indications for ihnilation inhilation?
medical- epilepsy, hypertension, asthma
Social- phobia, dental anxiety, gag reflex
Dental - past negitive experences, traumatic procedures
what are the contra indicators for inhlation sedation?
unable to nose breathe common cold tonsilitios blcoked nasal airways severe COPD 1st tri of pregnancy must be able to cooperate for brething
What are the advantages and disadvantages of a fixed retainer?
A- good aesthetics, better compliance, no occlusal interfearance, no speach difficultiescheap and easy
D- only retains anteriors, OH must be very good, can debond - high failure rate (~50% in the first 6 months )
What are the advantages and disadvantages in thermoplasitc retainers?
A- good aesthetics, incorperates all teeth, removable, doesnt involve the palate, cheap and easy to make
D- easily lost, requires good coop from patient, not over strong or resilient , occlusal interference, used for wrong reasons
What are the disadvantages and advantages in holly retainers?
A- removable, incoorparate all teeth, no prep, no interferance
D-compliance problems, bulky , poor aesthetics, speech problems
What are the oral signs of thumb sucking ?
proclined upper ants retroclined lower ants AOB or incomplete open bite high palate narrow arch possible incompitent lips `
What 8 questions would you ask a patient regarding an ulcer they have?
When did it appear have you ever had an ulcer like this before have you experieneced any blisters before ? has it gotten worse/better any other associated problems do you have any other skin lesions have you ever been diagnoses with do you ever suffer from cold sores
What are the symptom of primary herpatic gingovostamatis?
Painful eyrthematous swollen gingivae
ulcers in the mouth, on the lips and extra oral mucosal
halitosis
Herpes labbialise is lip only lesion
What are the 5 factors to resist displacement forces in an URA?
- Mastication
- tongue
- talking
- Active components
- Gravity
Name 2 types of mandibular surgery ?
bilateral saggital split osteotomy
vertical subsigmoid osteotomy
Name 2 types of maxiallary surgery ?
Le fort type 1
Anterior maxillary osteotomy
What are the principles of flap design ?
maximum access with minimal trauma (all flaps heal equally )
wide based incision - used to maintain circulation
continual strokes down to bone
no sharp angles
minimal trauma to papilla
ensure flap margins and suturs lie on sound bone
no tension on closing
no crushing tissues
what are two types of cyst removal?
Marsupialation- cut in the cyst wall with the removal of the contents with the aim to reduce the size of the cyst which may be followed by enucleation at a later date
A- simem to perform and can spare vital structers
D- cyst may reform, linging not available for histo sampling, lots of aftercare. `
Enucleation- the complete cystic lesion is removed
A-little after care, allows for primary closure , able to examine whole cyst histo
D- risk for fracture in mandubular, clot filled cavity may become infected, loss of teeth.
how does a radicular cyst form ?
associated with the roots of the teeth and usually has an inflammatory aetiology and sequel to pulpitis and periradicular granuloma develops from epithelium
how does a radicular cyst appear radiographically?
well define radiolucency around the apex of a tooth/teeth
unilocular
corticated and continuous with lamina dura
How would a radicular cyst appear histologically?
often incomplete epithelial lining
may have centralised necrosis chlorestoral clefts
mucosa metaplasia
What are the indications for orthognathic surgery?
complete growth but A?p skeletal pattern discrepancy
in cleft palate patients of 18 or so years of age as part of their treatment
class III malocclusions when there is functional, mastication and profile concerns
What are the risks of orthognathic surgery?
Relapse never damage bleeding unobtainable results with high expectations from patient infection TMJD
What safety feature of the quantaflex MDM machine present with? (inhilation sedation)
O2 flush button reservoir bag scavenger system pin index to prevent mixing up gases min O2 of 30% NO stops when O2 stops one waya experation valve coloured cylinders black -O2 and Blue- NO
What medications can be found in the medicl emergency kit?
ADrenaline IM injection (1:1000 1mg/ml) - Anaphlax
Aspirin dispersions (300mg)- MI
GlucagonIM injection (1mg)- hypo
GTN spray 400 ug/dose) - angina
Midazolam 10mg buccal - extended epileptic fit
What are the maximum doses for lidocaine 2%?
Max dose =4.4mg/kg
What is the max dose for prilocaine 4% plain/315 with felypressin
Max dose= 6mg/KG
What is the max dose for articaine 4% 1:1000000?
5mg/KG
What is the max dose of mepivicaine 3% plain / 2% adren ?
4.4mg/kg
What is used for IV sedation in the uk and what i s the preperation?
midazolam 2mg start followed by 1mg increments every 60 seconds varying from 2-10 mg
what are 3 vital signs you would monitor before, during and after?
heart rate
O2 saturation levels
blood pressure
What drug is used to reverse midazolam ?
flumazenil
What is osteoradionecrosis?
a condition which causes non vital and necrotic bone tissue around the site of radiation injury, This is due to the slow turn over of bone repair
What are the risk factors of osteoradionecrosis?
radiatio of head and neck with mandible being more likely due to limited blood supply.
also more likely when dental treatment hasnt been carried out prior to radio starting
Poor OH
poirritation otrauma to the area within a year
How can osteoradionecrosis prevented?
XLApoor prognosis teeth at least 2 weeks prior
ensure dental fitenss prior to beginning radio
maintaining good OH throughout
CHX usad post and pre op or antibiotic cover
atraumatic XLA
How would you manage osteoradionecrosis?
surgical debridement
- irrigation
-removal of necrotic and infected tissue
-removal of any loose bone
Surgical microvascular reconstructive surgery- to restor blood supply
bone or tissue graft
hyprebaric oxygen therapy
What movements are used for elevators ?
wheele and axle (rotation)
lever
wedge
What are the uses for elevators?
provides a point of application for forceps loosens teeth may XLA without forceps root removal bluntly breaks pdl
What isi the nerve supply for the submandibular gland?
choma tympani branch of the facial nerve and lingual branch of the mandibular never
What is the secretion of the submandibular gland?
mixed- serous and mucous
What is the innervation of the parotid gland?
sensory - auriculotemporal nerve and greater auriciular
parasympathetic -glossopharngeal nerve and auriculotemporal nerve
What is the secretion of the parotid gland?
serous
What is the nerve supply to the lingual nerve?
parasympathetic- facial nerve which unifies with the lingual branch of the submandibular ganglion
What is the secretion of the sublingual gland?
mainly mucous
What are the criteria perimeters for SIRS?
> 2 factors = suspected/confirmed infection.-
temp <36 or >38 degrees
respiratory rate >20 /min
Pulse>90 /min
WCC<4 or >12 - usually longer to check due to sample being required
What would you do if you expect systemic involvement wihich is indicated by sirs?
send straight to a &e or maxfac
What is ludwigs angina?
bilateral infection of the siblingual and submental spaces which compresses the airway-
-raised tongue
-difficulty breathing and swallowing
-drooling or excessive salivation
diffused redness extraorally and bilaterall in submandibular area
Name 4 maxillary spaces and 4 mandibular spaces?
Max- 1.infraorbital
- intra teporal
- palatal
- buccal
Mand-1. buccal
- sub masseteric
- sublingual
- submandibular
What are the use of sutures?
aproximate and reposition the tissues compress the blood vessels prevent wound healing achieve heamostatis cover bone encourage healing less scarring
What may a patient complain of if they have a sialolith ?
swelling associated with meals progressive swelling growing in size xerostomia or thick saliva bad taste lump in mouth which may be painful
What gland/duct is most commonly affected?
submandibular - due to its uphill path to the duct from the gland which is difficult
What investigations may be carried out in order to help diagnose a sialoith?
radiograph- occlusal
ultrasound
palpation of gland and its bi lateral companion in order to find differences
silography
How would you manage it?
surgical removal of the stone
sometimes self fixing
shock wave therapy
potential gland removal
What would you do differently when carrying out an XLA on a patient on warfarin?
Atruamatic technique
extra hemostatic aids -
-suturing
-WHVP
Ensure heamostatis is achieved prior to the patient leaving the surgery
Post op instructions and contact details are essential
review appointment should be made
When should INR be checked prior to XLA?
ideadlly within 24 hours of the XLA but 48 at the very minimum.
should be lower than <4.0 for XLA however should always check the local guidelines
What are bisphoposphonates and what conditions are they used for?
class of drugs used to prevent and treat bone loss by increasing bone density They work by reducing the bone turn over and prevent oesteoclasts recruitment, function and formation. Used to treat- -osteoprosis pagets oesteogenesis imperfecta malignant metastatis multiple myeloma
How is MRONJ diagnosed?
must be on bisphosphonates, anti-angiogenic drugs or RANK-L inhibitors
No history of head or neck radio
exposed bone/lack of healing at XLA site at 8 weeks
How is a patient deemed low risk or high risk for MRONJ?
LR- isolated osteoporosis patients wiith no othe rco-morbidities, oral medication with a treatment of less than 5 years.
HR- cancer patients, past MRONJ, cumulative drug dose, csystemic glucocorticoids, invasive dento-alveolar surgery anf mucosal trauma
higher risk with IV oral meds
How would you manage patient recieving XLA in general practice who are taking bisphophosphates?
advise of risk of MRONJ
must have excellent OH
CHX use post and pre- treatmen t
use heamostatic aids
OPst op instructions and contact given with analgesic advice
review
May disscuss with patients MCT about coming off of medication - DO NOT ADVISE THIS YOuRSELF
How would you manage patient recieving XLA in general practice who are taking bisphophosphates?
advise of risk of MRONJ
must have excellent OH
CHX use post and pre- treatmen t
use heamostatic aids
OPst op instructions and contact given with analgesic advice
review
May disscuss with patients MCT about coming off of medication - DO NOT ADVISE THIS YOURSELF
$ ways to breka a nail biting habit?
positive reinforcement
removable appliance habit breaker
deterrants- nail varnish, glaves , plasters
fixed appliance with a anterior rake
What is the incidence of cleft palate in UK?
1:700 live births more common in males
What are the general health implications?
hearing problems- glue ear (otitis media with effuision resporatory problems congenital cardiac problems - AVD speach and mastication issues aesthetics increased risk of infection nutritional ?
What are the 5 treatment stages for CLP patients?
3 months- lip closure 6-12 months- palate closure 8-10 years - expansion/alveolar graft 12-15 years- definitive orthodontics 18- 20 years - orthognathic surgery
What are the common complication of orthodontics?
relapse
decalcification
gingival ressesion
root reopbtion
How is orthodontic relapse managed?
education and explination explained to the patient at the end of fixed treatment
fixed/removable retainers
explain this is a life long commitment
How would you manage orthodontic decalcifiaction?
educate and give OHI
stress the importance of this and give diet advice, if it worsens removal of appliance
How would you manage orthodontic gingival ressession?
ensure correct OH but advise that this may happen due to tooth movement, may require desensitisatation
How would you manage orthodontic root resorption?
explain the risk and why this may occur (max 1mm move permonth to be expected) pre and post opt to assess
What are SNA, SNB and ANB?
SNA- the projection of the maxialla from the caranial base
SNB- mandible to anterior cranial base
ANB- SNA-SNB= the position of the mandible relative to the maxilla `
What are the average for caucasians?
SNA-81 degrees
SNB- 78 degrees
ANB- 3 degrees
What is the average FMPA angle?
FMPA- 27 degrees
What is the average incisor inclination?
upper - 109 degrees
lower- 93 degrees
What are the ANB values for each class?
Class I- 2-4 degrees
Class II - >4 degrees
Class III- <2 degrees `
What percentages if 6- 18s year olds have a diastima?
98% in 6 yo
49% in 11 yo
7% 12-18 yo
4 reasons for a diastima?
midline supernumeray (tuberculate)
hypodontia
prominent frenulum
proclined upper incisors
What teeth are most commonly infra occluded?
Lower Ds 8-14%
How would an infra occluded tooth appear clinically and radiographically ?
clincially- low and out of occlusion
no mobility
metallic percussion note
radiographically -blurring or absense of PDL
external root resorption
what factors determine the management of infra-occluded teeth?
presense of permanent successor
degree of infra- occlusion
availablility of specialist services
What are the treatment options for infra- occluded teeth ?
if successor is present then monitor for 1 year as it tend to fix itself. if not XLA
If no perm successor - then XLA as it will only worsen
How does tooth movement in orth work?
if external force is applied to the tooth the tooth willl move as the surrounding bone remodels which is mediated b the PDL .
appliances are used to transmit forces to the PDL and bone causing the formation of osteoclasts and oesteoblasts which sets up and breaks down the bone as the movement occurs
Give 4 methods of anchorage?
temporary anchorage devices which are non osseointegrating screws
NAnce palatal arch which uses the palatal vault
baseplates
tanspalatal arch
Define overjet ?
the extent of A- P overlap of maxillary central incisors measures using a ruler flat to the labial surface of the lowers HORIZONTAL
Define overbite?
the extent of the superior-inferior overlap of the maxiallry central incisors over the lowers. average = 1/2 - 1/3
classed as average, increased or decreased
VERTICAL
What foramen does the opthalmic branch pass through?
superior orbital fissure
What for a men does the maxillary branch of the trigeminal pass through?
foramen rotundum
What foramen does the mandibular branch of the trigem nerve pass through?
foramen ovale
Why may a perm first first molar be impacted?
small maxilla/mand
ectopic cyst
morph of the E
erruption angle
What are the treatment options for an impacted molar?
Observe and review - 6 months 66% will disimpact by age 7 requires good OH
XLA of the E- regain space for premolar or treat crowding fat later stage
DIs impact —–
- seperators
- Band the E and backet 6
-discing of E
HOw is orthodontic crowding measured?
space available vs space required mixed dentition anaylisis overlap technique Mild <4mm Moderate 4-8mm Severe >8mm
What factors cause displacement of a mandibular fracture?
- direction of the fracture line
- opposing occlusion
- magnitude of force
- mechanism of injury
- intact soft tissue
- other associated fractures
What does the displacement of fragments depend on?
- pull of attached
- angulation and direction of fracture line
- integraty of the periosteum
- extent of the communication
- displacement of blow
List 3 management options for mandibular fractures?
undisplaced facture - no treatment
displacement or mobile fracture- closed reduction and fixation (IMF) or open internal fixation
What are the signs / symptoms of a mandibular fracture?
pain swelling bruising occlusal derangement losse or mobile teeth facial asym numbess of lower lip limitation of function anterior open bite
Whatare the 6 radiographic signs that the lower 8 is in close proximity to the IAN?
devision/deflection of the IAN canal
darkening of the root where it crosses the canal
interuption of the lamina dura(white lines) of the canal
deflection of the root
narrowing of the IAN canal
JAXta apical area
What are the signs/symptoms of TMD?
clicking and popping of joints pain on opening intermittent pain of several months to years limited mouth opening crepitus signs of wear - linea alba, tongue scalloping, wear facial asym headaches muscle joint/ ear pain
What are the common causes of TMD?
- inflammation of the muscles of mastication or TMJ related to parafunction
- direct or indirect trauma to the joint
- stress
- psychogenic
- occlusal abnormalities
- degerarative disaese- local (oestoarthritis) systmic (RA)
- anterior disc displacement or reduction
- neoplasia
- infection
What nerve supplies the TMJ?
auriculotemporal and massteric branches of the mandibular nerve
What is arthrocentesis?
procedure which allows for the washing out of a joint with sterile saline and anti inflam drugs. This breaks down adhesions and flushes them away
What are 2 possible surgical options for TMD?
arthoscopy - key hole surgery into a joint
disc repositioning or repair
disc removal and replacement
arthrocentesis
What are the signs and symptoms of ZOA fractures which involve the orbit floor?
- Asym of the face - swelling which then becomes flat
- May have altered sensation - infraorbital nerve damage (numb cheek)
- peri -orbbital bruising
- sub - conjunctive haemorrhage
- visual disturbances
- pain on movement of the eye
- excessive watering of the eye
- drop in height of eye
What is the management of ZOA fractures?
- do nothing (monitor)
- Exposure and repair or ORIF (open, reduction and internal fixation)
- CLosed reduction -gillies lift or malar hook
- Post care instructions
- avoid blowing nose
- analgesia
- review
What dimentions are required for the placement of implants and how are they best measured?
1.5mm required around implant
3 mm required between implants
>5mm required between bone crest and contact points
7mm required between crowns
2mm required from other structures (max sinus)
How would you diagnose an OAC?
bubbling of blood from the site pinch nose and air will come through socket visual assesment gental blunt probe checking radiographs echo??
How would you diagnose a mfractured maxillary tuberosity?
hear the noise
visual movement or ability to move with digits
more than 1 tooth movement
visual tear of soft tissue
How would you dianose the loss of a tooth or root in the antrum?
radiographs
visual assesment into socket
CBCT
Describe desquamative gingivitis?
inflammed gingivae which extends beyond the mucogingival margin with srythematous shedding and ulceration the full width of the gingivae - used as a general term to describe various conditions not a diagnosis
Name 3 conditions which you would see desquamative gingivitis? in order of likelihood
lichen planus
phemphigoid
phemphigus
WHat local factors may exacerbate the desquamative gingivitis?
Smoking
OH
plaque and plaque traps
SLS toothpaste partial dentures
How would manage desquamative gingivitis?
carry out further investigations if not known cause SLS removed from use inprove OH use topical steroid - betamethasone mouthwash - CHX
NAme 3 local causes of pigmentation staining?
amalgam tattoo
heamangioma
macule - caused by increased amoints of melanin
Name 3 general causes of pigmentation ?
medications such as contraceptive pill. iron tablets antimalerials
racial
addisons disease
What is haemangioma ?
an abnormal growth of tissue which is unilateral grows with the patient. 60% found in h and n of children
Name 2 types of haemangioma and give 2 differences histologically between the 2 ?
capillary-
-groups of smalll vessels
Cavernous-
-dilated vascular spaces
What cindtions may oresent with similar signs and symptoms to TMD and how would you exclude each?
dental cause- radiographs to check for caries
sinusitis - tilting of head, other symptoms, radiograph of sinus
facial pain syndrome- usually no clicking or crepitus
parotid gland pathology - ultra sound/radio
trigeminal neuralgia- history and increase of pain at night not likely with TMD- very sore
What is bells palsy?
Unknown cause-
- affects the excitability of the facal nerve
- sometime caused by inflammation around facial nerve and pressure causes unilateral paralysis
- most common facial palsy
How would you manage a facial palsy?
reassurance
give eye patch
suggest inflamtory drugs
review in 24 hours
How do you differenciate between upper and lower motor neurons dseas?
UMN- (stroke)
- spasticity
- can wrinkle and move forehead, however cannot move lower half of face
LMN- (facial palsy)
- flaccidity
- cannot wrinkle forehead, cannot lift eyebrows or mover lower portion of face.
HOw does the difference between UMN and LMN occur?
UMN occurs in the supra-nuclear lesion where as LMN affect the neucleus of the facial nerve
UMN interrupts the neural pathway at a level above the anterior horn cell
LMN interrupts the spinal reflex arc to the muscle and why the facial muscles are involved.
What are possiblecauses for LMN disease?
MN - general Polio Bells palsy trauma r infection of ventrical horn Guillain barr syndrome
What are the possible causes of UMN diseas?
stroke
MS
Traumatic brain injury or spinal cord injury
CP
What are the 6 ASA classifications ?
Class 1 = normal healthy patient
Class 2 = mild systemic disease (well controlled) asthma & epilepsy) **
Class 3 = severe systemic disease (stable angina/COPD)**
Class 4 = severe systemic disease that is a constant threat to life (sever COPD/unstable angina)
Class 5 = moribund patient who is not expected to live without an operation
Class 6 = declared brain dead patient whos organs will be removed for donor purpose
**Care should be taken for these
What is the ASA classifciations?
the class of phyisical status used for assessing the fitness of a patient prior to surgery. American socity of anethesiologists
How would you grade histopathical displasia?
Hyperplastic- increased cell numbers with no atypical cells.Regular stratification
Dysplasia-
MILD- changes in lower 1/3 of the architecture. Mild- pleomorphic, hyperchromatism and basal cell hyperplasia **observe and biopsy again **
MODERATE- changes to the middle third of the architecture. moderate atypia wh=ith pleomorphism, hyperchromatism and loss of polarity
SEVERE- changers to the upper 1/3 architecture. numberous mitosis, abnormally high loss of polarity, phleomorphism and hyperchromatism
Carcinoma- malignant but not invasive. abnormal architecture. mitosis abnormalities usually
Other than surgery what are the possible treatment for cancer?
chemo -/+ radiotherapy
immunosupresant drugs
Name one extra oral and one intra oral disease accosiated with crohns?
extra- OFG
intra- oral candidiasis
Why would miconazole presecribed to a patient when micro sampling is not available?
miconazole is effective against both candida and gram positive cocci bacteria such as S. Aureus so prior to being sampled it would be a good suggestion for treatment!
!! statins and warfarin!!! should not be given to these patients.
