BDS4 Flashcards
How does an RPI work?
rotation about mesial rest allows for the saddle to sink into denture bearing mucosa.
2 Reasons to use lingual bar?
Depth of sulcus
OH- allow for cleansing
What factors would guide the decision of the length of a post?
4-5mm of GP apical must be present
post must be at least the height of the crown.
Materials which may be used to cement a definitive post and core?
RMGI
GIC
What would bcause gingival recession on the palate?
traumatic OB
What may occur in the mouth if patient is taking bisphophonates?
Oesteonecrosis of the jaw
How would you manage a patient who has oesteonecrosis?
Be conservative Antiseptic MW surgical debidment primary closure monitor
What are the uses of an URA?
tipping and tilting space maintainer retainer habit breaker reduce overbite maxillary expansion
What is the design for a space maintainer?
Adams clasp - 16 and 26, 0.7HSSW
Southend clasp -11 and 21 )0.5 HSSW
What are the types of space maintainer?
Fixed palatal arch
Nance palatal arch
Fixed band and loop
What would the fluoride plan for an 8 year old?
MW- 225ppm
Toothpaste- 1450ppm
Varnish- 22600ppm
Tablets 1ppm
What is involved in a d3mft graph?
D3= decayed deciduous teeth M= missing teeth xla due to decay) Ft= filled teeth
How does a d3mft graph show a difference between 2 areas?
shows socioeconomical status
ethnicity status
individual health board involvement
what does the 3 in d3 mean?
Obv decay into dentine of dentine which can been seen visually
What interventions are carried out in scotland on a population level?
sugar tax
smoking ban
living wage
What is PICO?
Population- who is the studying involving
Intervention- what the thing being studied is
Comparison- what the control is
Outcome- what the final result was
What are confidence intervals?
the range of values the absolute risk difference will take in the population.
if CL overlaps 0 = not enough evidence
if CL does not overlap= sufficient evidence
a narrow CL if better as it implys a larger group
What is relative risk?
is the ratio of incidence in exposed to non-exposed groups
What are tge 5 steps of clinical audits?
identify problem or issue
set criteria or standards
observe practice/data collection
compare performance with criteria and standards
Implementing change
What are other options can you do instead of a clinical audit?
Peer review
quality improvement programme
CPD
What are the 6 dimentions of healthcare and explain each?
Safe – avoiding harm to patients from the care that is intended to help them Effective – providing services based on scientific knowledge to all who could benefit and reframing from providing services to those not likely to benefit
Patient centred – providing care that is respectful of and responsive to individual patient preferences, needs and values Timely – reducing waits and delays for both those who receive and those who give care Efficient – avoiding waste, equipment, supplies, ideas and energy Equitable – providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, location and socioeconomic status.
What head neck and oral features of cocaine use?
Perforation of nasal septum/palate xerostomia erosion and attrition of tooth surfaces TMJD GORD Orofacial pain?
What is the risk of sugar free methadone?
may cause diarrhoea
can be injected due to the fact that it does contain chloroform
Give 3 types of consent?
Implied
Verbal
written
What must be discussed with the patient to gain consent?
Options for treatment with the risks and benefits of all.
The consequences, risks, benefits of the treatment you propose.
The likely prognosis.
The cost of proposed treatment.
Your recommended option.
What will happen if treatment is not carried out.
Patient can change their mind.
How long the treatment options will last for.
What are the 6 factors which make up consent?
Not manipulated. Valid- recnet, specific, remains appropriate. Given with capacity. Informed. Voluntary. No coerced.
Who would carry consent for a 3 year old patient?
Birth mum has automatic right to consent.
What problems would wearing scrubs to practice have?
Infection control.
scrubs may state where the nurse works and can have an impact on reputation.
How would you ensure that correct PPE procedure was carried out?
clinical audits
Regular inspections
Reflections
CPD
Why is manual cleaning carried out?
To remove gross contamination.
To remove materials from the instruments.
to aid disinfection and sterilization.
remove organic material.
Why do we need to test the washer disinfector/sterilizer?
To ensure it is working correctly and to its optimum.
to ensure validity of the machine and the warranty.
Helps to detect errors in the procedure.
To ensure that all areas of the instrument to be sterilised correctly.
What are the 5 stages of the washer disinfector?
- pre-wash/flush- <45 degrees to remove gross contamination.
2.Washing- physical force of water , chemical action of the detergents, thermal heat. - Rinsing- removal of cleansing agents.
- Disinfecting- temp only with holding time of 1-10 mins.
%. Drying circulation of air heated to 90 degrees for 20 mins to clear chamber of remaining moisture.
Who are the 4 key personnel involved in the decontamination process and what are their roles?
Operator/decontamination user- trained in the operation of the equipment, carry out simple housekeeping and maintenance. Keep records and ensure tests.
Manager- person ultimately responsible for decon. Generally the practice owner.
Authorising engineer- provide expertise and performs audits (annually and quarterly), advises on maintenance, testing and validation.
Test person- conducts and reports on validation and periodic tests, must be qualified for 2 years or more.
what are the 7 components of clinical governance?
Audit Risk Management Education and training Service user, carer and public involvement Clinician effectiveness and research Clinical information and IT Staffing and staff management
What is a clinical audit and what is its use?
A process which is used in order to review and assess patient care and its outcomes as a method of improving practices.
It is used to consider the gaps in knowledge, learning, protocols, training and attitudes.
What is the cycle of an audit?
Identify the problem/issue Set criteria and standards Observe practice/data collection. Compare performance with criteria and standards Implementing changes.
What are the stages of significant event analysis?
Step 1- identify the significant event
Step 2- collect and collate as much info possible relating to the event.
Step 3- orginise a meeting with educational focus (no blame).
Step 4- undertake a structured analysis.
Step 5- monitor the progress of that actions/changes which have been decided on.
Step 6- write up event analysis.
Step 7- peer review.
What are the stages of the chain of infection?
infectious agent reservoir portal of exit mode of transmission portal of entry susceptible host
What are the principles of waste disposal?
Segregation
Storage
Disposal
Document
in regards to waste, what document is legally required?
Consignment note which should be kept for 3 years - description of waste quantity of waste origin of waste transport of waste
What are the 3 divisions of NHS Scotland dental services?
Primary care- general dental practices
Public dental services- community settings
Secondary care- hospital services
What are the GDC standards?
Patients intrests are put first
communicate effectively with patients
obtain valid consent
Maintain and protect patients information
Have a clear and effective complaints procedure
Work with colleagues in a way which is in the patients best interests
Maintain, develop and work within your professional knowledge and skills
Raise concerns if patients are at risk
Make sure your personal behaviour maintains patients confidence in you and the dental profession.
what are the 4 aspects of the sinners circle?
Time
Temperature
Chemicals
Energy/mechanics
What are the 10 SICP?
PPE Hand hygiene. patient placement. Safe disposal of waste. Safe management of care environment. Safe management of blood spillages. Safe management of linen. Safe management of care equipment. Respiratory and cough etiquette. Patient placement. Occupational safety.
What are the 4 pillars of ethics?
Respect for autonomity
Non-maleficence
Beneficence
Justice
What is negligence?
The failure to meet standards of care which result in harm. May involve the omission to do something which a reasonable dentist would not do or to not do something a reasonable dentist would do.
What is the criteria for clinical negligence?
the dentist owes a duty of care
that duty of care is breached
the breach caused or materially contributed to damage
The damage was foreseeable and had negative consequences.
What should clinical notes be?
Confidential concise accurate legible current complete retained retrievable
What type of study provides the highest level of evidence?
Cochrane reviews - systemic assessments of all the relevant randomised controlled trials (RCTs) to provide the highest levels of evidence.
What are 4 aspects of cochrane reviews?
randomised double blind test reduces bias
inclusive and exclusive criteria
randomisation facilitates statistical analysis
compares one treatment to a control to show effects
What are 3 other types of study designs?
Cohort studies -prospective study
Case control studies- retrospective study
Case studies- single report
RCT- effectiveness and efficacy of treatments against no treatment
What is incidence?
the number of new disease cases developing over a specific period of time in a defined population
What is prevalence?
is the number of disease cases in a population at any given time
What is SIMD?
Scottish index of multiple deprivation- a postcode based index which uses a range of data to rate areas based on deprivation. 1 being the most deprived to 5-10 which is least deprived.
What 7 factors influence deprivation?
Employment status. Crime. Health and health care services. Geographical access to services. Income. Housing, living and working conditions. Education, skills and training available.
What are the characteristics of split mouth study design?
both control and intervention group are exposed to same environment.
intervention and control are randomly assigned to one half of dentition,
What are the disadvantages of split mouth study design?
patients are not blinded
Adds bias
Incorrect reporting of risk
What are the advantages of split mouth study design?
no carry over effect for intervention or outcome
It removes the variable from the possibility of estimating treatment effect.**
What is a P value?
Used to determine the significance of your results.
If the P value is <0.05 means that you reject the null hypothesis and your results are statistically significant.
What are confidence intervals?
The range of values the absolute risk difference will take in the population..
CI should not over lap 0 = sufficient evidence
if CI overlaps 0 = null hypothesis
A narrow CI is better as it shows show that a larger sample group has been used.
What are the signs and symptoms of Parkinsons?
Aphasia - problems with speech Confusion Memory and cognition problems muddled over daily activities mood swings may become withdrawn lack of confidence communication difficulties mask like face resting tremor rigidity instability on feet and may loose balance shuffling gait loss of protective reflexes
How do the signs and symptoms complicate dental treatment?
reduction in manual dexterity - struggles with OH capacity to consent? reduced self care ability poor communication tremor protective reflexes are lost access to oral cavity may be difficult
what is the incapacity act (2000) and what are its principles?
refers to the capacity and consent issues and allows for people who are able to consent to do so on their own behalf.
Principles-
the benefits to the adult
minimal intervention
take into consideration the patients current and past wishes
consultation with adult and any involved relevant others
encourage the patient to use the skills that they have
What is defined as having capacity?
can retain the memory of a decision They can act (make their decision) Can make a reasoned decision Can coommunicate the decision Can understand the decision - repeate it back in their own words
Who can consent under the AWI2000 act?
Power of attorney- medically and financially decisions can be made by a named person. appointed by a court prior to the person loosing capacity.
Welfare guardian- looks after welfareand make their decisions which are not money based. Appointed by the court.
What is the english equivalent of AWI2000?
Mental capacity act 2005
What is the decontamination cycle?
purchase or loan cleaning disinfection inspection disposal (if not suitable) packaging sterilisation transport storage use transport
4 legislation for decontamination?
the health and safety at work act (1974)
COSHH
The national health service (Scotland ) legislation 2010
Medical device directive
5 common reasons for handpiece faults?
incorrect compressor setting (may involve lack of maintenance) damage to chuck incorrect instrument usage poor or inadequate cleaning incorrect or inadequate lubrication
What is involved in a alcohol brief intervention?
raise the issue if they consume alcohol
screen and give possible risks
listen and gauge rediness for change
suitable referral/information and advice
What are the options for smoking brief intervention?
5As- Ask, advice, assist, assess, arrange
3As- Ask, advise, Act (signpost)
2A1R- Ask, Advice, Refer
What is the primary appraisal in stress?
Assessment of stressor- irrelevant benign harmful/threat harmful/challange
What is the secondary appraisal to stress?
Reaction to primary appraisal-
Harm
Resistance
Exhaustion
4 responses to stress?
Direct action
Seek information
Do nothing
coping
What is burnout?
when a professional disengages from their work due to the stresses and strains which have been experienced during job. Mental and physical exhaustion causing a negative or indifferent attitude towards life/work.
$ examples of coping mechanisms for stress?
keeping a good work/life balance exercise setting personal goals and/or targets knowing personal limits self care
Factors for the aetiology of fear?
previous negative experiences experience and attitude of parent or peers social media influence emotional development delay poor understanding
What is the cycle of behavior change?
pre-contemplation contemplation preparation action maintenance with progress - may relapse at any time
How do ultrasonic baths work?
high frequency sound waves produce micro bubbles which cause the cavition of instruments when the microbubbles implode which helps to remove the debris present on instruments.
What tests should be carried out for an automatic washer disinfector?
daily- carried out on the first cycle of the day
weekly done at the same time on a weekly basis as the daily test
quarterly/annually- carried out and tested again the manufacturers specification carried out by authorised testing personnel
What are the tests carried out for sterilisers?
daily- check door safety, drain and refill, run and print out a cycle run, use a helix or bowie-dick device- chemical change from blue to yellow.
weekly- automatic control test and air detection test
Why is RMGI considered better than GIC?
RMGI has a higher tensile strength, compressive strength, bond stregnth and decreased soluability compared to GIC.
why is RMGI better than GI for ED fractures?
prevents leakage, and has a better seal to the oral cavity.
Why should GCI not be used as a conventional restorative material?
low mechanical properties, low fracture strength , toughness is poor and wears easy. shorter working time.
why is RMGI not a good luting cement?
contains HEMa which absorbs water and expands
What are the ideal properties of a luting cement?
viscosity high compressive strength easy of use radiopaque cariostatic bio compatable low soluability thickness below (25microns)
what luting cement would you use for cementing a fiber?
dual cure composite resin cement
what luting cement would you use for ceramic veneers?
resin luting cement
What luting cement would you use for a MCC adhesive bridge?
RMGI
What are the constitutes of temp bond?
2 parts -
Base = zinc oxide, starch and mineral oils
Accelerator= EBA, eugenol and carnauba wax.
Can you bond to zirconia?
no but it can be etched and thus micromechanical retention occurs.
How do you bone to non-precious metals?
sand blast with aluminium oxide first
What bacteria are involved in denture stomotitis?
candida albicans, candida tropicalias, straphyococcus aueus, strapococcus epideridermidis
what is the drug treatment for denture stomatitis?
Fluconazol caps-50mg
7 caps/ 1 a day
topical miconazole oral gel 20mg/g
send 80g tube
* apply a pea sized amount to fitting surface of upper denture after food 4 times daily after food.
Should be used for one week after cleared up
what denture adjustments would you make to a denture if patient presents with denture stomatitis?
may need a reline, tissue conditioner? if the fungal infection continues- may suggest making a new denture.
Ill fitting denture can be causative to DS.
What 2 topical treatments may be use to treat Denture stomatitis?
Miconazole oralmucosal gel 50mg/g
Nystatin oral suspention 100,000 unit/ml
What may occur orally from steroid inhaler use?
erosion due to acidic nature of inhaler
patient should rinse the mouth out after use
may place fluoride varnish on teeth
what are the methods to improve the fit of a denture?
Reline
Rebase
Remake denture
What is the concept of a shortened dental arch?
3-5 units required not including anteriors
occluding premolars= 1 unit
occluding molar = 2 units
What are the indications for SDA?
enough remaining units which occlude to provide a large enough occlusal table.
prognosis of remaining teeth must be sufficient
patient doesn’t want to have dentures
might be financial issues
What are contraindications for SDA?
poor prognosis of remaining teeth avanced perio or unstable perio preexisting TMD signs of pathological wear sever class II or class III
Why would periodontal disease be contraindicated for SDA?
Drifting or perio comprimised teeth under occlusal load
loss of alveolar bone
loss of space in the neutral zone
may be increase iinterdental spacing due to increase in anterior load and thus distal migration of teeth
What is the definition of retention?
resistance to displacement in a vertical direction -tested by pulling denture
What is the definition of indirect retention?
resistance to the displacement in a rotational manner
Describe how composite bonds to dentine.
dental conditioner (37% phosphoric acid) for 10 seconds - 20 seconds on enamel . this causes micromechanical retention due to having an increased surface area and removal of smear layer (0.5-5microns). Decalcification of the of dentine happens and the exposure of the collagen network allows for bonding agent to penetrate. The hydrophillic end of the DBA adherse to the dentine via penetration the hydrophobic ends bond to the composite which causes a hybrid layer of collagen and resin.
How is porcelain is treated to improve its retention?
treated with hydrofluric acid which causes roughening of the bonding surface of the allowing for the placement of surface wetting agent to create a stronger bond
Other than resin based luting cements, what can be used?
Zinc phosphate cement
GIC
Advantage to placing a crown as a posterior restoration?
reinforces and strengthens the underlying tooth
What are the intraoral signs of ANUG?
halitosis
crater like ulcers
grey necrotic slough which bleed when wiped off
painful ulceration of interdental papilla
reverse gingival architecture
What would your treatment for ANUG be?
LOCALLY- remove supra and sub gingival deposits OHI smoking ceassation 6% hydrogen peroxide or 0.2% CHX mouthwash
SYSTEMICALLY-
Metronidazole tabs 200mg for 3 days
1 x three times daily
REVIEW-
further scaling and HPT
consider the general health of the patient if no improvement- may consider blood tests
What ways would you remove a fractured post which is still visible?
Ultrasonic vibration
miskito forceps
eggler
masseran kit
What are the characteristics of generalised aggressive perio?
Generalised pattern of attachment loss affecting at least 3 teeth except from incisors and 6s
generally under age of 30
vertical boney defects present
rapid progression of bone loss
plaque levels not consistent with the levels of disease
How would you mange periodontal abscess with systemic involvement?
subgingival scaling of pocket (under LA)
drained via incision or through perio pocket if pus is present
analgesics
Antibiotics due to systemic involvement -
AMOXICILLIN 500mg for 5 days
1x 3 times daiy
METRONIDAZOLE 200mg for 5 days
1x 3 times a day
what are the 4 method of obturation?
Cold lateral compaction
Warm vertical compaction
Continual wave compaction
Carried based obturation (themafil)
Give 3 examples of sealers and their brand names?
calcium hydroxide (dycal)
Epoxy resin sealer ( AH plus)
ZOE
What are the 2 factors determining post length?
Post placement- 4-5mm of root filling should be left apically
Sufficient alveolar bone support -at least 1/2 of of the post length must go into the root= at least 1:1 ratio of post legnth/crown height
Post width- no more than 1/3 of the roots width at its narrowest and 1mm of remaining circumferential coronal dentine
Ferrule- at least 1.5mm height and width of remaining coronal dentine.
prior to the placement of an implant, what should be considered?
GENERAL- smoking?, general health, medical history- bisophosphates
LOCAL- alveolar bone level, quality of bone and quantity.
7mm required to place the crown.
What are the interventions for inadequate bone levels?
guided tissue regeneration
bone grafting
Why would a sub alveolar fracture make a tooth unrestorable?
lack of coronal tissue- problems with moisture control and impression taking will be more difficult
may indicate for a post core, however the furrel would not be sufficient
What is a possible out come if only an upper denture is provided?
combination syndrome can occur which can further result in a flabby ridge . caused by rapid and excessive bone loss in maxillary ridge from forces being directed at the anterior region of the denture when it displaces. This causes the ridge to be replaced by excess fibrous tissue.
How would you manage combination syndrome?
mucostatic impression so that tissues are recorded at rest. Ror secondary impression there should be an impression teaken with alteration the the special tray- may have a window cut from it can be done in clinic or in the lab) then a low body impression material would be used. You may also consider taking a chunk of medium body impression material which then would be filled with light body impression material to gain detail of the flabby ridge area.
What are the 4 principles of caries removal and what does each include?
Access- dam, remove overlying enamel with highspeed and follow caries to ADJ
Extent- spread of caries at ADJ determines the outline form of the cavity. Remove all caries and check if any staining is present that it is hard. smooth enamel at cavo-surface margins.
Remove dentinal caries- using sharpe probe check softness of dentine caries. Remove carious dentine from the ADJ before removing from the cativy floor using slow speed or excavator.
Modifications- Carried out in order to prep the tooth for the restoration material.
What materials or alternative preparation techniques would you use is amalgam was not retaining in the cavity?
Undercuts./ dovetails Could use composite dental pins adequate bulk- at least 2mm in depth cavosurface margin angles between 90-120 degrees
What is the Cvek pulpotomy?
Used for partial pulpotomy after traumatic exposures. Pulp below the exposure is removed by 1-3mm untill non-inflamed healthy tissue is reached
Bleeding is controlled by the use of sodium hypochloride or CHX and then calcium hydroxide or MTA is used to cover followed by RMGI
What is the standard pulpotomy?
removal of coronal aspect of the tooth. Heamostatis of the pulp is achievedusing with ferric sulphate. Cover over with calcium hydroxide or MTA and place RMGI or GIC for crown placement.
What are the compents of composite?
resin- bis-GMA Glass- silica or quarts Light activator- camphorquinone Saline couplin agent Low weight dimethacrylate
What are the 4 different types of composite?
microfilled nanofilled hybrid flowable bulk fill
What are the clinical disadvantages of composite and how can they be reduced?
Polymerisation contraction stresses- low configuartion factor when placing (small increment)
Post op sensitivity- correct placement, moisture control, lining, correct bonding
Moisture sensitivity- use of dental dam
soggy bottom- no more than 2mm thickness placed at any time unless with bulk fill.smaller incraments
What is a healthy periodontium response to occlusal trauma compared to physiological and pathological responses?
healthy- widening of the PDL no LOa or imflammation. Returns to normal once occlusion is fixed
Healthy but with reduced periodontium- same as healthy but due to reduced PDL there is an increase in mobility
Periodontitis- Widening of PDL, LOA, mobility may increase BOP and plaque present.
Why might pagents disease cause issues with a denture fitting?
pagets disease causes an increase in bone turnover which can cause the swelling of bones. Thus maxilla or mandible may swell and cause ill fit of denture
What precautions would you take prior to an XLA on a patient who is taking bisphosphates?
Is patient taking oral or IV Bis and for how long have they been taking the medication
may consider speaking with their GP/ bis provider to consider temp stop in medication
CHX daily as pre op, immediatly prior to XLA and post op 2x daily for 2 months
OHI
atraumatic XLa as possible and suture to aid healing
post op follow up at 1 week and 2 months
refer if complications occur .
What is sodium hypochlorite extrusion and what are the signs and symptoms ?
high pressure injkesction causes SH to escape through the apex of the tooth and into surrounding tissues. May also happen if CWL of the tooth has not been determined.
SIGNS and SYMPTOMS-
inflammation around the area and/or hemorrhage of the tissue through the tooth. Both of which can cause necrosis of the tissue. Patient will also experience extreme pain.
What would your immediate action be in the event of a sodium hypochlorite extrusion?
reassurance and explination to patient LA for pain relief Copious amounts of saline dress with non-setting calcium hydroxide make note in patients records and review in 24hrs suggest analgesics
Following initial treatment for a sodium hypochlorite extrusion what would the next steps be?
analgesics
cold compress for first few days (5 times) for swelling followed by warm compress to prevent swelling and heamatoma
review in 24 hours
antibiotics if indicated refer if severe reaction
If a patient is concerned about having amalgam placed, what would you tell them ?
would require 350-400 fillings in order to beconsidered toxic
been used for 150 + years
no evidence based studies- apart from suggestion not to be used in pregnant or breastfeeding patients
what is the distribution of LA?
infiltration- placed around the terminal branches of the nerve
Block - placed around the nerve trunk (mandibular branch of the tri nerve which allows for the lingual branch to be anesthetized also)
What is the mechanism of LA ?
LA binds to the NA channels of nerves block the possible influx of NA and thus preventing action potential and the propagation of the nerve. last as long as as many NA channels are blocked
What fibers are most likely to be affected by LA?
A delta fibers and C fibers due to having less Na gates.
What are the consitutes of LA?
aromatic region- hydrophobic ester/amide bond- anesthetic Basic amine side chain- hydrophillic Preservatives - methyl paraben Buffers
Name one ester and three 3 amide anesthetics?
ester- benzocaine, procaine
amide-lignocaine, prilocaine, articaine
What is the maximum does of lignocaine?
max dose - 4mg per kg.
4.4mg per cart,
What are the clincial signs of erosion?
loss of surface detail
surface become flat and smooth and if leftto continue, dentine will become exposed and lead to cupping of the occulasal surfaces.
typically bilateral concaved lesions without a chalky appearance
increased translucency of the anterior teeth
What are the causative factors of erosion?`
repeated exposure of tooth tissue/ enamel to acidic environment
Instrinsic- GORD, Bulimia,
Extrinsic- fruit, fizzy drinks, fruit drinks
What is the hybrid layer?
the layer of dentine which has been conditioned to remove the smear layer and exposing the collagen matrix, it then has a resin adhesive placed which flows into collagen matrix and creates a hybrid layer.
What are the different types of dentine and how do they affect binding?
primary dentine ( laid down during development)- open tubuals and good for bonding Secondary dentine- (laid that down during function)- allows for sufficient bonding Tertiary dentine( reactionary and laid down due to mild stimuli and reparative to intense stimuli)- poor bonding due to sclerosed and poorly orginised tubules.
What is the content of inorganic matter in dentine?
calcium hydroyapitite (70%)
What percentage of max first molars have a mb2 canal?
93% have 4 canals and 7% have 3 canals`
What are the 3 design objectives of endodontics?
Create a continuously tapering funnel shape
maintain apical foramen in original position
keep apical opening as small as possible
What are 3 of the law of pulpal floor anatomy?
law of colour - always dark
law of symmetry 1 - orifices lie equal distance from MD line through chamber**
Law of symmetry 2 - orifices lie perpendicular on MD line**
** except maxillary molars
3 rules for finding the pulpal floor and locating orifices?
always at the floor and junctional walls
Always at angle in floor and wall junction
always at terminus of developmental fusion lines
Why irrigate during endo treatment?
to disinfect
to remove debris and disolve inorganic matter
to lubricate for instrumentation
to remove smear layer
Why is sodium hypochlorite a good irrigant?
can disolve pulp remenamts and collagen
potent antimicrobial action
dissolves both vital and necrotic tissue * only irrigant to do this*
helps disrupt smear layer
What is the stregnth of NaOCl used in endo?`
3%
What other irrigant is usually used in endo?
EDTA - Ethylenediaminetetraacetic acid
What are the indication for resin retained bridge?
young teeth - less destructive good enamel quality large abutment tooth surface ( at leaste 0.5 mm supra gingival) minimal occlusal load good for single tooth replacement
What are the contraindicators for resin retained bridges?
poor abutment tooth shouldnt be used for replaceing mutiple teeth shouldnt be used in presence of perio heavy occlusal load or bruxism tilted, spaced, or badly aligned teeth perio issues
What are the 5 requirements of occlusal stability?
stable contacts on all teeth with equal intensity in centric relation
anterior guidance in harmony with possels envelop
disclusion of all posterior teeth during mandibular protrusion
disclusion of posterior teeth om non working side during later mandibular movement
What are the signs of occlusal trauma?
fractures/abfraction widening of PDL mobility unexplained pain pronounce lina alba may have scalloping of tongue
What are the causes of tooth discoloration?
Instrinsic- fluorosis, MIH, non-vital, amalgam, CF(grey) porphyria(red)
Extrinsic- Smoking, tea/coffee, red win, iron supplement, chromogenic bacteria, CHX
What percentage of adults have tooth wear?
77% (anterior)
How does vital bleaching with hydrogen peroxide work?
chromgenic bacteria which causes the staining are long organic chains molecules. These chains are oxidised by the Hydrogen peroxide which leads to smaller chains being formed which are usually non- pigmented. Ionic exchange occurs.
What is the common acute ingredient in tooth whitening gel and how is it related to hydrogen peroxide?
Carbamide peroxide which breaks down to form hydrogen peroxide and urea.
4 risks of vital bleaching ?
relapse of shade sensitivity need to replace restoration problems bonding to teeth gingival irritation
What are the key features of a cavity for composite?
no unsupported enamel
no sharp internal line angles
bevel cavosurface angle to increase bonding area
What are the key features of a cavity for amalga?
undercuts for retention lock and key, groves, and dovetails for retention required to be deeper than 2mm flat occlusal floor cavosurface angle of 90 degree no unsupported enamel `
What is the pro taper sequence?
8 or 10 k file - watch winding S1 and SX- 2/3 of canal 8 or 10 k file-CWL S1, S2 -coronal and then middle thirds F1- apical third may go up larger
What advantages do pro tape have over k files?
shape memory decreased likeliness to cause edging due to having a lower lateral pressure less instruments required quicker increased cutting efficiency user friendly
name a rotory endo system?
reciproc
pro taper gold
what are the 4 motions of filing?
Filing
watch winding
reaming
balanced force
name 3 reasons a file may seperate ?
flexural stresses (repeated cyclic fatigue) Torsional stress (binding to canal wall) problems with straight line access/ complicated curved canals.
Name a hereditary white patch?
white sponge naevus- increased production of keratin
How does white sponge naevus appear histologically?
intra-cellular oedema in keratin layer (swelling)
parakeratosis - persistence of the nuclei of keratinocytes as they rise into the horny layer of the skin
How does smokers keratosis appear histologically?
Areas of mild or variable dysplasia
low levels of macrophages and melanocytes in basal layer
hyperkeratosis
What other differential diagnosis would you consider in a patient with denture stomotitis?
leaf fibroma
giant cell granuloma
what factors can result in denture induced hyperplasia?
ill fitting dentures which cause trauma to the tissues
denture flange can cause pressure and thus fiberous tissue forms
Name 2 histological features of denture induced hyperplasia?
hyperplastic rete ridges
pseudo-epithelial hyperplasia
What is the common does of amoxicillin for dental treatment
amoxy 500mg caps
3 x day
for 5 days
What is the common dose of metronidazole?
metro 200mg tablets
3 x day
5 days
the lasrger dose of 400mg requires systemic involvement such as pyrexia
What is the rate of infection in the exposure to HIV, Hep C and Hep B?
HIV- 0.3%
Hep C- 3%
Hep B- 30%
NAme 6 oral lesions associated with HIV?
Candidosis lesions Haory leukoplakia Karposis sarcoma Non-Hodgin Lymphoma Perio- ANUG HErpes outbreaks
What is a fiberous epulis?
a reactive non- neoplastic condition which affects gingivae due to irritation. It presents as a localised fiberous enlargement.
What is the aetiology of fibrous epulis?
long term low grad chronic irritation
How does a fibrous epulis appear histologicaly ?
1granulation tissue
metaplastic bone formation
ulceration
What would fibrous epulis be called if foudn elsewhere in the body?
fibro-epithelial polyp
What is a pyogenic granuloma?
Granulation tissue which can be found at any mucosal site in respose to trauma and requires sampling. Known as vascular epulis is found on gingivae.
How does a vascular epulis ( pyogenic granuloma) appear histologically?
granlulation tissue with a blood supply
What conditions may require patient to be on long term steriods?
Severe asthma COPD addisons disease MS Lupus Crohns disease arthritis
What are the signs and symptoms of adrenal suppresion?
fatigue/low BP/ diziness dehydration hypoglyceamia weight loss disorientation oral pigmentation (buccal)
What emergency can be assosiated with low adrenal levels?
adrenal crisis.
S&S-
suddenpenetrating pain in legs, arms and abdomen
confusion,psychosisand slurring of speech
convulsions
fever
vomiting and diarrhea which result in dehydration
fainting
Why are asthmatics more prone to erosion?
acidity of inhalers which are used orally.
What is the proper name for burning mouth syndrom?
oral dysaethesia
who is most likely to be affected ?
mainly menopausal woman
affects woman more commonly than men
ages around 40-60
What are the causes of burning mouth?
zerostomia, nutritional deficiencies, fungal infections, poor fitted dentures, allergies, parafuntion habits, stress/anxiety/depression, endocrine disorders
What are the signs and sypmotoms of burning mouth syndrome?
ingling or burning inside the mouth
dry mouth -increased thirst?
taste alterations
loss of taste
What are differential diagnosis of burning mouth?
xerostomia,
orofacial pain
lichen planus
denture problems
What investigation may you carry out for a patient who is suffering from burning mouth syndrome?
blood tests- FBC, haematinics psychiatric assessment salivary flow rate parafunction habits? - I/O & E/O exam denture assessment
How do you manage burning mouth syndrome?
- reassurance
- try and find underlying issueand treat that
- conservative advice- hydrate and use a diflam mouthwash
- consider drugs to help - gabapentin
Which benign and malignant tumors affect the salivary glands (in order of incidence).
Pleomorphic adenoma (75%) Warthins tumour (10%) adenoids cystic carcinoma(5%) mucopidermoid carcinoma(3%) acinic cell carcinoma (<1%)
What are the histological features of pleomorphic adenoma?
variable capsual epitilium in ducts and sheets myoepithelial cells chondroid stream myxoid
What histological feautres are related to recurrance in pleomorphic adenoma?
poorly encapsulation leads to harder removal
What are the histological signs of Warthins tumour?
destinctive epilthelium with lymphoid tissue present and cystic spaces
What are the histological signs of an adenoid cystic carcinoma?
cystic spaces, cribiform architecture of malignant cells
no capsual present
tumour may be solid or tubular in shape
How is salivary gland neoplams diagnosed?
fine needle aspiration
core biopsy
incisal biopsy
excisional biopsy- removes the whole thing
What is the mechanical action of CHX?
positive CHX molecules react with the negative clean surface of microoganisms. This this increase permability of the cell membrane. This allows for the leaking out of the cellular fluid and eventually cell death. has around 12 hour substantivity.
What antispetics does CHX belong to?
bisbiguanides
What is substantvity?
prolonged adherance of antiseptic to the oral surface and thus the slow release of the antiseptic allowing for longer contact time.
What solution of CHX would you give to patients?
0.2% OR 0.12% chlorohexidine mouthwash 10ml x2 daily. Rinse for 1 min.
What are the side effects of CHX?
mucosal irritation parotid gland swelling staining loss of taste staining of the oral tissues burning mouth and tissues hypersensitivity and possible anaphylasis
What are the indications for use of CHX?
short term use in candidosis (pseudo and erythematou)
pre and post op for perio and oral surgery
immunocompromised patients
management of ANUG, aphthous ulcers, mucositis
What are the 3 stages of forming a clot?
- vasocontriction
- temp blockage of wound by the formation of a platalet plug
- blood coagulation/formation of fibrin clot
How does aspirin affect clotting?
inhibits platelet aggrigation by altering balance between thromboxane A2 and prostacyclin. This is irreversable for the lifetime of the platelet.
Reduces production of prostaglandins and inhibits COX-1
How does warfarin affect clotting?
Inhibits synthesis of Vit K dependant clotting factors 2, 7 , 9 , 10 and proteins C and S
How does NOAC (new oral anticoaugulant drugs) affect clotting?
Factor X inhibitors that stop conversion of prothrombin to thrombin preventing the production of the fibrin clot.
what are aspirin and clopidogrel used in conjunction for?
duel anti platelet therapy used for the acute treatment of MI but should not be used for longer than 12 months.
How does clopidogrel affect clotting?
specifically and irreversiblyinhibs p2y12 in adp receptor which activates the platelet and fibrin cross linking.
What is the pattern of Von willebrands diease?
autosomal dominant condition which has varying inheritance patterns
TYPE1= deficiiency of normal vWF (von willebrand factor)
TYPE2- defects in vWF where the concentrate is required
TYPE3- deficiency of the vWF molcule in regards to concentration and quality.
Hoe does von Willebrand disease affect bleeding?
the vWB protein stabilises factor 8 (F VIII) and enables platelet interaction with the blood vessel wall so without this factor or in the case of lack of this factor the actions are reduced leading to a higher risk of heamorrhage.
What is a biofilm?
a biofilm is the aggregation of microorganisms which cells adhere to one and other and also to a surface. they then become in-bedded in a self produced matrix of extracellular polymeric substances.
What are the stages of colonisation of a biofilm?
- Adhesion
- colonisation
- accumulation
- complex community
- Dispersal
give 4 methods of identifying organisms?
culture on agar isolate bacteria DNA probes enzyme activity and sugar fermentation testing API
What is lichen planus?
a chronic disease which affects mainly femals in 30-50 age range
it is a chronic imflammatory and immune meditated disease which has no known cause
What are the different types of Lichen planus?
Reticular- lacy/spider web in appearance
atrophic- white/blueish plaques with central superficial atrophy
Papular- white plaques
Bullous- development of fluid filled vesiclesand bullae with skin lesions which project to the surface
Plaque - plaque arranged in lines
erosive- ulcerative apperance
desquamatuve gingivitis
What are the histological findings of lichen planus?
hugging band of imflammatory cells
lymphocytes and macrophages presesnt with destruction of the basal cell layer caused by apoaptosis (programmed celll death)
saw edge rete pegs
loss of inter-cellular attachment
keratinisation, atrophy and sometimes hyper plasia of the tissues
`What is the aietiology of lichen planus?
not overly known idopathic- but can brought on by :
stress
autoimune
drug related - beta blockers, NSAIDS, diuretics
amalgam or gold
SLS allergy
When would you biopsy a lesion?
in smoker
symptomatic/ erosive type in all
when in a high risk area such as floor of mouth , lateral border of the tongue
What is a mucocele?
a recurrent swelling which is most ften found in the lower lip due to a blocked/ damaged minor salivary gland. It may burst and then reoccur or recannulate. May be classed as superficial or deep
How does a mucocele appear histologically?
cystic macrophage lined cavity surrounded by a granulation tissue wall and foam cells
How do you manage a mucoclele ?
excision of the mucocele and the gland to prevent reoccurance
What is the name given for a mucocele which is found on the floor of the mouth?
RANULA- usually sublingual extravasion types.
What is orofacial granulomatosis?
lymphatic obstruction from giant cell grbulomas which causes accumulation of tissue fluid and thus causes oedema. can be linked to crohns (15%) and sarcoidosis disease.
What is the aetiology of OFG?`
Autoimmune condition
allergic reactions to benzoates, cinnamon, sordid acid and chocolate
What is the hisotlogical apperance?
increased tissue fluid retention
formation of granulomas
lymphatic obstruction
dilated lymp and blood vessels
What are the signs and symptoms pf OFG?
lips, cheek and gingivae swelling skin changes angular cheilitis ulceration mucosal tag formation apthous ulcers buccal cobble stoning
how is OFG managed?
allergy testing food avoidance antibiotic therapy- clarithromycin oral steroids - azathioprine intra-lesion steroid injection
give 6 types of canidida infections?
angular cheilitis hyperplastic pseudomembranous erythematous median rhomboid glossitis denture induced stomatitis
Whare does median rhomboid glossitis occur?
central papillary atrophy of the tongue affecting the dorsum of the tongue anterior to the sulcus terminalis.
Give 3 histological feature of rhomboid glassitis?
elongated rete ridges
hyper plastic rete ridges
candida hypae infiltration
Give 3 methods for testing for candida?
swab, oral rince then culture
biopsy lesion- histo
smear- microscopy
Name 5 antifungal agents?`
topicals- miconazol, nstatins, CHX,
systemic- fluconazole, itraconazole
What medications should be contraindcated for the use of Zoles?
warfarin and statins
What percentage of people in scotland are treated for asthma?
6.5% as per 2015/2016
1 in 14 people
What are the histological signs of mild displasia?
architecture changes in the lower third cytology shows mild atypia pleomorphism and hyperchromatism (increase and change in nucli) basal cell hyperplasia drop shaped rete ridges
What are the histological signs of moderate dysplasia?
architecture changes into the middle third
moderate atypia changes in cells
increased area :volume of nucleus:cytoplasm
pleomorphism and hyperchromatism
what are the histological signs of severe dysplasia?
Architechture changes in the upper third portio
enlarged nuclei
abnormal stratification
Abnormal keratinisation
loss of basal cells or altered polarity of basal cells
loss of intercellular adhesion
abnormally high number of mitosis
how is dysplasia graded?
mild
moderate
Severe
hyperplasia also!!!
What is anemia?
reduced heamoglobin within the blood due to reduced production, increased losses or increased demand. Reduces the oxygen carrying capacity throughout the body.
What are the oral signs of anemia?
recurrent ulceration
candida infections
glossitis or smoothing of the tongue (found in iron deficiency)
beefy tongue (vit b12, diabetes, kidney disease)
oral dyseathesia
mucosal pallor
name the different types of anemia and their characterists?
Microcytic(small RBC)-
Iron deficiency
Thalassaemia
Normocystic(normal blood count)- internal bleed pregnancy sickle cell anemia chronic disease :diabetes, kidney disease,
Macrocytic (large RBC)-
B12/Folate dificiency
Retics
What is the clinical appearance of plasma call gingivitis?
generalised oedema and generalised erythema extending down to the gingival margin
gingivae is friable, red and BOP
stippiling is lost
accompanied by cheilitis or glossitis
What is the aetiology of plasma call gingivitis?
hypersensitive reations - SLS, cinnamon, pepper
idopathic
rare!!
What may worsen plasma cell gingivitis?
not removing the cause
poor OH
plaque retentive factors
how do you manage plasma cell gingivitis?
histo sample to diagnose
advise patient of avoiding causitive substances
tarcrolimus (autoimmune drug) has been thought to improve it
List 3 salivary proteins?
salivary IgA
Mucins
Proline-rich proteins
List 3 enzymes in saliva?
amylaze
lipase
lysozyme
name 3 salivary substitutes?
spray- saliva orthana
Pastilles/lozenges-
Oral care system - biotene
What 5 ways do antibiotics work?
cell wall destruction DNA synthesis inhibition DNA replication inhibition cell membrane inhibition protein synthesis inhibition
3 disadvantages of antibiotics?
antiobiotic resistance
gastrointestinal upset
hypersensitivity/anaphylaxis
interactions with other medication
what are the mechanics of antibiotic resistance?
enzyme degradation of antibacterial drugs
alteration of bacterial proteins
changes in membrane permeability to antibiotics altering metabolism and reducing accumulation
what are the 2 most common inhalers?
blue- beta-antagonist (salbutamol)
brown- corticosteriod (betamethasone)
What so asthma ?
reversable obstruction of the airflow characterised by imflammation and swelling of the mucosa, excessive mucous production and smooth muscle airway constriction as a result of a hyper reactive trigger.
What antibiotics would you give for dental abscesses and systemic involvement?
Amoxy 500mg caps
3x daily for 5 days
What antibiotics would you give for ANUG and pericoronitis?
Metro 200mg tablets
3xdaily for 3 days
What antibiotic would you prescribe for spreading cellulitis?
clidamycin 150mg caps
4x daily for 5 days
name 4 situations wich would call for antibiotics?
oral infections which are spreading or have became systemic
ANUG or pericoronitis with repeated cases, swelling or systemic involvement after local measures
as prophylaxis treatment in the case of cariac patients
sinusitis cases which have been persistant for 7 days or if symptoms are severe
What type of person carries consent for a 16 year old patient?
the patient has legal capacity to consent on their own behalf to any surgery, medical or dental procedures. patient must however be able to give consent with the capacity to understand.
What is Hanaus quint?
5 factors which affect occlusal balanced articulation-
- the saggital condylar guidance angle
- the inclination of the occlusal plane
- compensating curve
- the cusp height
- the incisal guidance height
The 4 functions of a face bow?
Used for mounting upper casts only
transfers the relationship between maxillary teeth and the axis of rotation
positions the upper cast vertically
transfers the angulation of the maxially occulusion plane and in relation to a horoizontal reference plane
name 4 types of articulators?
simple hinge
average value
semi-adjustable
fully- adjustable
3 reasons why anterior guidance is preferred?
easy to reproduce
protects the teeth and posterior restorations
easy on muscles
What are the ideal properties of denture bases?
dimentionally accurate high softening temperature high hardness and abrasion resistance biocompatable good thermal conductivity high transverse, fatigue and impact stregnth easy to manufacture and repair
What are the consitutes of PMMA?
POWDER- benzoyl peroxide(initiator) PMMA particles, plasticisers and co-polymers
LIQUID-methacrylate monomer( polymerises), hydroquinone(inhibitor) and co-polymers
Give 4 possible faults during production of the denture base and explain why they occur?
contraction porosity- not enough pressure, not enough material, too much monomer
Gaseous porosity- monomer boiling in bulkier part of denture
Granularity- not enough monomer
Crazing- internal stresses due to cooling too quickly
What are the principles of crown preparations?
Prepartion/conservation of tooth structure- avoid weakening tooth structure and avoid damaging pulp.balance between retention, resistance and structural durability
Retention and resistance- retention prevents the removal of the restoration along the path of insertion or long axis of the tooth prep*limit the the possible number of paths of insertions**. resistance prevents the dislodgement of restoration by forces directed in an apical or oblique direction and prevents any movement under the occlusal forces.
Tapering inclinationof opposing walls (6 degrees)
legnth of walls to prevent the tipping displacement
path of insertion shoudl be set before the prep has begun
In crown preperation what is structural durability?
restoration must contain bulk of material adequate to withstand the forces of occlusion. It must pprovide enough space for a crown to prevent fracture, distortion or perforation. achieved through occlusal reduction, functional cusp bevel and axial reduction
What is marginal integrity in regards to crown preparations?
prepare finish line configurations to accommodate robust margin with close adaption to minimise microleakage (chamfer or shoulder finish)
Preservation of periodontium in crown preps?
shape of the preperation must be such that the crown is not over contoured, smooth and margin is accessible for OH
What are the aesthetic considerations for crown prep?
create sufficient space for aesthetics take into considerations smile line
What are the stages of crown prep?
Occlusal reduction - maintain some occlusal datails
Seperation- remove from adjacent teeth
Buccal reduction- prep on 2 planes 1st sas shoulder and 2nd follows incline of tooth following gingival contour
Palatal or lingual reduction-
shoulder/chamfer finish
check occlusal surface and clearance
What are the reductions for all metal crowns?
thickness- at least >0.5mm
non-functioning cusps - at least .1mm
functioning cusps- at least >1.5mm
chamfer/shoulder with bevel
What are the reductions for MCCs?
Non-functioning cusps- 2mm functional cusps- 2.5mm incisal- 2mm shoulder/chamfer 1.2-1.3mm between 10-20 degree taper
What are the reductions for all ceramic crowns?
non- functional cusp -2mm
functional cusp -2.5mm
incisal 1.5-2mm
shoulder/heavy chamfer
Give 4 advantages of a CoCr denture base?
higher dimentional stability icompared to acrylic so wont loose shape
more stable and retentive
high conductivity which allows patient to feel temp
can be cast thinner whilst maintaining stregnth
more hygienic as no porous
What are the ideal properties of an impression material?
low viscosity
surface wettability - make intimate contact with teeth and mucosa
small contact angle- more covarge of tight areas
setting shrinkage should be low
themal expansion/contraction should be low
good surface reproduction
Name 4 non-elastic impression materials?
impression compound
impression waxes
impression plaster
zinc oxide eugenol
Name 4 elastic impression materials?
polyether- impregum
Adition curing silicone
condensation curing silicone
polysulphides
Name 2 hydrocolloid materials?
Alginate (irreversable)
Agar (reversable)
What are the consitutes of alginate?
c=salt of alginic acid calcium sulphate sodium alginate trisodium phosphate fillers modifiers, flavorings, chemical indicators
State 3 advantages of elastomeric materials over alginate?
higher tear stregnth/resistance greater elastic recovery lower rigidity for easier removal from undercuts greater reproduction of surface detail lower visco-elasticity
What is the composition of GI?
Acid- polyacrylic acid and tartaric acid
Base- Quartz, aluminia, calcium fluoride, aluminium fluoride, aluminium phosphate, sodium fluoride
What is the setting reaction for GI?
glass + acid= salt + silica gel
Dissolution- acid in the solution releases Ca, Al, Na and F ions leaving a gel around unreacted glass
Gelation - calcium crosslinking with polyacid carbonyl groups of chelation (initial setting)caused by the formtion of calcium polyacrylate
Hardening- trivalent aluminium ion crosslink to increase stregnth forming aluminium polyacrylate to improve mechanical properties
how do phemphigoid and pemphigus differ clinically?
phemhigoid- thick walled blisters affecting full epidermis layer usually filled with blood
phemhigus- intre epithelial bullae blisters affecting surfaces which are easily lost
superficial blisters filled with clear liquid which when bust spread
How may phemphigoid and phemhigus be investigated?
direct immunoflourescence using IgG antibodies looking for basket weave or linear pattern - biopsy should be taken from unaffected oral epithelium
indirect immunoflourescense using patients serum and test for IgG levels
how do you manage pemphigoid?
topical - betamethasone mouthwash 0.5mg 3x per day
systemic steroid use- prednisolone
immune modulating drugs - azathioprine
monoclonal antibody there
How would you manage phemphigus?
topical - betamethasone mouthwash 0.5mg 3x per day
systemic steroid use- prednisolone
monoclonal antibody therapy
How does cancer spread?
locally
lympatic spread
through the blood
Qhat is the TNM staging system for cancer?
T- tumour-
TX- no available info on tumour (primary)
To- no evidence of primary tumour
TIS- only carinoma in situ on primary sites
T1- <2cm
T2- 2-4cm
T3>4cm
T4->4cm involvement of antrum, pterygoid muscle, base of tongue or skin
N-Node- NX- cannot be assessed N0- no clinical positive nodes N1 - single ipsilateral <3cm N2a- single, ipsilateral 3-6cm N2b-muliple, ipsilateral <6cm N3a- single/multiple, ipsilateral node >6cm N3b- bilateral N3c-contralateral
M-metastasis-
Mx- not assessed
M0- no evidence
M1-distant metastasis present
Scores are combined to give an overall stage 1-4
What is necrotising sialometaplasia?
is a benign, ulcerative lesion which is usually cause by vascular damage of the palatine vessels causing blockage in flow to minor salivary glands
What is the aetiology of necrotising sialometaplasia?
small vessel ischemeia with resulting infraction due to smoking, trauma, LA, injections, bulimia, infections, ionising radiation
Self healing and painless
How does necrotising sialometaplasia appear histologically?
surface slough of necrotic tissue
hyperplasia
squamous metaplasia of the ducts and acini in affected lobule
necrosis of salivary acini
How is necrotising sialometaplasia managed?
spontaneous healing - over 6-10 weeks
What are other differential diagnosis for necrotising sialometaplasia?
squamous cell carcinoma
salivary gland carcinoma
How is an upper denture retained?
post dam position
adhesion and cohesion
extension to buccal sulcus and peripheral seal
muscular
Other than remaking how can you impove retention of dentures?
relining
rebasing
addition of clasp
addition of flange
how do you check retention clincially?
pull vertically on anterior teeth to see if the denture pulls out
how do you check stability clinically?
place fingers on the occlusal surface and try rocking from side to side
What is the biometric guide for setting upper and lower teeth?
aim to place teeth in pre extraction sites
max teeth placed buccally to the ridge - helps to promote denture stability in lower denture
mandibular teeth placed over the ridge- reduces tongue restriction
What problems can incorrect OVD cause?
clicking of teeth when eating TMJD aggrigation ANgular chelitis Occlusal trauma Pain in muscles of mastication
What is the distal extention of the lower full denture?
2/3rds onto retromolar pads
Why is the buccal shelf used for support?
non resorbable region so preovides reliable and adequate support
what anatomical features help to set the incisors?
face symmetry
have 1-2mm of incisal edge shownig when lips are at rest
1cm anterior to the incisive papilla
/What 4 things make up shade of teeth
Chroma
hue
translucancy
value
.What is a knife edge ridge?
after tooth loss the labial face of the ridge tends to move inwards faster than the heightdeminsihes meaning loss of width without loss of height
This happens due to incresed active bone resoption osteoclastic activity at the labial/buccal and lingual/palatal areas
typically the soft tissues have thickened, replaing the lost bone.
3 reasons for a knife edge ridge?
perio disease prior to XLa
traumatic surgery during XLA
Immediate dentures
How is a knife edge ridge managed for complete dentures?
Soft lining material can be used on fitting surface of the denture
Surgery to remove the sharpest aspect of the bone
Relief of areas on the denture
What is the difference between a soft lining and tissue conditioning?
Soft lining material can be use on a healthy mucosa as a cushion/shock absorber in a recline. Can be used in long term
A tissue conditioner is used on unhealthy or ulcerated mucosa in order to aid healing. It also disipitates forces but it is only used as a short term answer.
What is a functional impression?
The impression teken using a tissue conditioner. The material is applied and the patient wear the denture and impression during function for approx 24 hours. They return and the impression is then sent to the lab for a reline. Used for short term refining.
What are the average horizontal bone loss for each teeth?
Incisors- 6.3mm
Canines- 8.5mm
premolars - 10 mm
Molars- 12.8mm
What is the difference between horizontal and angular bone loss?
bone loss which is angular occurs at medial and diatal apects of 6s and incisors and is v shaped with sharpe lines.
Horizontal bone loss is found between 2 roots - angular can become horizontal if left long enough.
It refers to the loss in height of the bone
the radius of destruction determines the pattern- if bone is wider than 1.5-2mm (the amount of bone which is lost) the the shape will become more angular.
How is angular periodontitiss caused?
The inflammation travels down the PDL, with the lack of control on this, poor OH and other accumulating factors.
What is definded as local and generalised bone loss?
Localised affect <30% of site
F=Generalised affects >30% of sites
Define mild, ,oderate and severe bone loss?
Mild <30%
Moderate 30-50%
Severe >50%
What are the findings for aggresive generalised periodontitis?
generalised pattern of attachment loss affect in 3 other teeth other than the 6s and incisors
patients usually under 30 years
genetic link
rapid progression of bone loss
plaque levels are not consistant with disease seen
What bacteria are commonly seen in agressive perio cases?
P. Gingivalis, A.A., fusli family**
What are the now periodontal classifications?
- Health -
a. intacted periodontium
b. reduced periodontium due to causes other than perio - Plaque induced pgingivitis
a. intact periodontium
b. reduced periodontium due to other causes than perio
c. associated with the biofilm only.
d. meditated by local or systemicrisk factors
e. drug induced gingival enlargement - Non plaque induced gingival disease and conditions
- Periodontitis
a. localised- <30% of areas affected
b. generalised- >30% of sites affected
c. molar-incisor pattern - Necrotising periodontal disease
- periodontitis as a manifestation of a systemic disease
- systemic disease or condition affecting the periodontal tissues
- Periodontal abscesses
- Periodontal-endodontic lesions
- Mucogingival deformities and conditions
How is mobility graded?
0= physiological movement 1-1.2 1= <1mm horizontal movement 2= 1-2mm horizontal movement 3= >2mm horizontal and vertical movement (rotation and drepression)
how is furcation graded?
1= <3mm horizontal
2=>3mm horizontal but not through and through
3= through ad through defect
How is gingival recession graded?
millers classification
Class 1 - maginal tissue recession which does not extend to the mucogingival junction. No bone loss in the interdental area. complete root coverage
Class 2- marginal tissue recession which extends to or past the MGJ no interdental bone loss. complete root coverage is expected
Class3 - marginal tissue recession extends to or beyond the MGJ with some loss of interperoxial tissue and/or rotation of the tooth. Bone is still coronal to the apical extent of the recession. 70% of root coverage is expected
Class 4 - maginal tissue extends to or past the MGJ with severe loss of the interperoximal tissue or tooth rotation, Less than 50% of the root coverage is expected.
What are the modified systemic factors that can cause periodontitis?
smoking stress Poor diet diabetes gingival hyperplasia cause by drugs Hormonal- pregnacy or puberty Cardiovascular disease
What are the defective systemic factors which can cause periodontitis?
monogenetic syndromes?- sickle cell anemia, CF, PKD
Down syndrome
Why is diabetes a risk factor for periodontal disease?
diabetes causes poor wound healing and links with periodontal disease as it has abnormal glucose regulation resulting in advanced glycerin end products being produced. These interact with cell s increasing permeability and adhesion molecules of endothelial cells, increased chemotaxis and releasing IL-6 and TNF-alpha by macrophages. and this decreased production of fibroblasts
**Diabetes causes impaired neutrophil function, heightened imflam response, altered collagen metabolism, microangiopathy and impaired wound healing **
What tests are carried out for the diagnosis of diabetes and diabetic control?
fasting glucose test
random glucose test
HbA1c testing
At home glucose tesing
How does smoking affect the periodontal tissue?
reduced BOP decresed healing pale hyperkeratontic gingivae halrecession perio disease in general is increased due to vasco constriction and inablity to redeploy macrophages to ares
What is interleukin-1?
highly pro-imflammatory cytocines produced by the epithelial cells, macrophages, dendric cells a, endothelial cells and B cells
I works by regulating the immune respose
What drugs are causitive of gingival hyper plasia?
Anti epileptic- Phenytoin
Calcium channel blockers- amlodipine
immunosuppresant - cyclosporine
What is the classical pattern of goingival hyper plasia?
starts tat the interdental papillae and develops to include the entirety of the attached gingivae
How does gingival overgrowth influence periodontal status?
there is no corrolation with overgrowth and the possibility of perio disease however, OH can become more difficult and this can lead to perio
Give 2 examples of developmental bone pathology?
tori
fiborus dysplasia
Give 2 examples of imflammatory bone pathology?
alveolar osteitis
Give 2 examples of neoplasm bone pathologies
osteoma
osteosarcoma
give 2 examples of metabolic bone pathology?
oesteoporosis
pagets disease`
give 4 differential diagnoses for a multilocular radiolucancy?
ameloblastoma
giant cell lesion
keratocyctic odontogenic tumor
odontogenetic myxoma
What would be the reason behind distorted anteriors on a OPT?
patient not in the focal plan which will be projected to continually changing points on the film and thus horizontal distortion occurs
What would be the reason behind a blurry OPT?
patient moving during the image being taken
What would be the reason behind an OPT being too wide?
patients canine is distal to the canine line on opt machine this means they are closer to the xray source. This means the beam will be slower and thus spreads out the radiograph moreso as the receptor will be too fast and magnifies the image horizontally
Give 3 characteristics of ghost images?
always appear higher due to the vertical beam angulation of -8 degrees
horizontally magnified
usually further forward due to the change in anterior-posterior position
Give 3 ways to reduce patient dose?
Give 3 ways to reduce patient exposure?
use faster speed films- E is the quickest thus lower dose
USe KV range from 60-70kV with a focus -skin-distance of >200mm
rectangular collimisation and use of aiming devices
What are the 4 effects of suppernumeraies on the permanent dentition?
displacement
crowding
diastimas
cyst formation
root resorption of the surrounding teeth
Tuberculate’s generally cause impacted 1’s
What is mandibular displacement on closing?
happens when inter-arch width descrepancy causing upper and lower posterior to meet cusp to cusp, which results in the mandible being forced to deviate to find a intercuspal position
Often associated TMJD
What would you use to correct a unilateral posterior crossbite?
Maxillary expansion with - URA Quadhelix ** both have slow dental expansion with tipping movement* rapid maxillary expansion device
What 4 factors make early tooth loss worse?
age of the patient
marked space loss in already crowded patients
Loss of E’s early can cause issues with the errupting 6’s
most space lost in the maxillary than there is in the mandible
When may you consider balancing a primary tooth extraction?
removal of c’s to prevent midline shift in crowded arch
consider balancing lower 6’s if arch is already crowded! ** especially in the case of planned XLA
give 4 reasons for an unerrupted 1?
supernumery (usually tubercules)
Trauma to A(s) - dilaceration of the unerrupted 1’s
crowding
pathology - dentigerous cyst
What is the BSI classifications of a Class II Div 1?
lower incisal edge lies posterior to the cingulum plateau of the upper incisors
Increased overjet
upper incisors are proclined or of normal inclination
What are the dental features of a Class II div 1 patient?
proclined upper incisors
increased OJ
class 2 molars and canines
What soft tissues may occur with class II div 1?
often incompetent lips due to OJ
struggle with oral seal
lip trap/tongue thrust
stripping/trauma of anterior palatal gingivae
What are 6 features of a twin block appliance?
2 seperate bite blocks
has a bow present in anterior region
adams clasps used for retention
removable functional appliance used for 9-18 months to allow for mandibular hrowth
made in acrylic PMMA
has block s on occlusion of the appliance which means patient is unable to occlude as the normally would do
What is dentoalveolar compensation?
a system which attempts to maintain normal inter arch relationships. Normal occlusion can be attained and maintain through dental compensation.
List 8 potential risks of orthodontic treat other than decalification?
root resorption gingival recession relapse loss of vitality mucosal irritation loss of periodontal tissue TMDJ risk compliance ulceration and soft tissue trauma
how wold assess patients skeletal anterior-posterior relationship?
visiual
Palpae skeletal bases
Lateral Cleph SNA-SNB= ANB
describe a class III incisor relationship?
lower incisors sit in front of the cingulum of the upper anteriors
OJ is reduced or reversed
What systemic condition may a patient have if they have if the mandible keeps growing?
acromegaly
how is a Class III managed?
Accept and monitoe in patients with little to no concern
Intercept early with URA
Growth modification with funtional appliance(reverse twin block, chin cup, head gear)
Camoflage - keep the skeletal relationship as is and bring anteriors into Class I
Combined orthognathic and orthodontic treatment for masication, function or profile concerns.
What are the 4 types of CF?
spastic
Ataxic
Athetoid
mixed
How are the 4 ttypes of CF classed?
hemiplegic
diplegic
paraplegic
quadriplegic
What is CF?
autosomal recessive condition caused by a mutation of chromosome 7 which causes thick, excessive mucous in the lungs,pancreas and salivary glands
What are the general signs and symptoms of CF?
recurrent chest infections thick salivary secretions shortness of breath/coughing/wheezing blue lips and fingers due to poor circulation under-development
What are the dental considerations for CF?
Thick saliva- lower caries risk but higher risk of plaque
difficulty brushing due to respiratory problems and dexterity isssues
unable to carry out GA or inhilation sedation
may have have delayed eruption or emnamel defects
be aware of acidic nature of the inhalers which may cause erosion
What type of splint should be used for avulsion?
EADT<60 mins = flexible splint for 2 weeks
EADT>60 mins = flexible splint for 4 weeks
What are the common outcomes of avulsion?
discolouration due to necrosis of the pulp
mobility
ankylosis
root resorbtion
What medical conditions may be significant in the replacement of an advulsed tooth?
Cardiac defects?
medications?
tetanus jag?
where are the fragments of tooth?
What are the 4 types of amelogenesis imperfecta?
Type 1 = hypoplastic
Type 2= hypo-maturational
Type 3 = hypo-calcified
Type 4= mixed with taurodontium
What are the causes of amelogensis imperfecta?
inherited gene mutation of the genes which are responsible for making the proteins needed in the formation of enamels extracellular matrix molecules
What problems may occur with amelogensis imperfecta?
microdontia yellow or brown discolouration susceptability to acid, caries and damage sensitivity oopen bite is common
What are the factors in index of suspicion?
delay in seeking help
vauge story, lacking detail, varies in details and from person to person
account no corralation to story
abnormalmood for perent - defensive /preoccupied / refusal of treatment/ aggressive
patients apperance and interaction with parents seems abnormal
child may say contradition
history of previous history or family violence
What orafacial injuruies are suspicious?
E/O- bruising of face/ears, abrasions and lacerations, burns and bites,Neck markings, fractures
I/O- contusions, bruises, abrasions and lacerations, burns, tooth trauma, frenal trauma
Triangle of concern - behind the neck!! be aware of capability of patient to cause these on themselves. ie a child of 6 months would not be able to pinch themselves
Tooth 11 has a traumatic exposure, what alters the treatment plan?
site of the exposure - <1mm
Time of exposure (24hours)
EDT
What are the advanatges of non vital bleaching?
aesthetics
simple procedure
gingival tissues are not irritated or traumatized by restoration
original tooth morphology is kept
What are the disadvantages of non vital bleaching?
risk of spillage of bleaching agent not always effective can over bleach tooth can cause brittleness gingival irritation if not carried out correctly
When do roots fully form?
from erruption it takes about 3 years for the roots of the permanent dentition to complete apexification
What are the 3 types of dentinogensis imperfecta?
Type 1= associated with oesteogenesis imperfecta
Type 2-= not associated with OI but is autosomal dominant
Type 3= brandyine isolate
What are the clincial signs of Oesteogenesis imperfecta?
loss of enamel
discolouration
both primary and permanent dentition affected
amber appearance of the teeth due to dentine
multiple periapical abscesses due to pulpal strangulation
What are the clincial signs of oesteogenesis imperfecta?
blue sclera
fragile bones prone to breakage
