Challenging Questions Flashcards
What dies the effect of traumatic forces depend on?
Magnitude
Duration
Direction
What is the pathological response to traumatic occlusion?
Occlusal force is too great meaning that width of PDL and therefore mobility does not stabilise
When is intervention for mobile teeth considered?
If becoming progressively worse
If causing discomfort
If interfering with restorative tx
What are treatment options for traumatic occlusion?
Occlusal management
Break parafunctional habits
Spint
Address tooth symptoms
What is trigeminal neuralgia?
A chronic disorder of trigeminal nerve characterised by sudden/severe onset of sharp, shooting unilateral facial pain
What investigations are done for TN?
Blood tests:
-> FBC
-> Blood glucose
Imaging:
-> MRI
-> CT
-> PET
What are the causes of TN?
MS
Brain tumour
Aneurysm
AV malformation
Epidermoid, dermoid and arachnoid cysts
How do you detect a debonding bridge?
- Visually- with good illumination/magnification
- Using floss and probe
- Movement with pushing
- Saliva bubbles gathering at margin on pressure
- Evidence of secondary caries at margin
What are the reasons for a bridge or post/core debonding?
Issue with cementation- moisture contamination
Unfavourable occlusion
Bruxism
Trauma
Root fracture
Wing fracture- caries under wing
Angulation and parallelism issue
-> divergent guide paths
-> prep being too minimal
What is a perio abscess?
Localised infection of periodontal pocket
-> swelling due to pus accumulation
-> caused by food packing, plaque accumulation, lack of cleansing
How is perio abscess differentiated from PA abscess?
Position of swelling
Tooth is vital in perio abscess
Poor periodontal condition in rest of mouth
No radiolucency of perio
How does vertical bone loss occur?
Plaque induces inflammation which travels from PDL to bone
-> radius of destruction is <2mm meaning only localised area of bone adjacent to affected tooth is lost (some of the septum is still present)
What patients are at high risk of bleeding?
Haemophilia patients
Anticoagulant/Antiplatelet medication
Alcoholics and ALD
Liver disease
Patient with previous history of bleeding
What are the treatment options for unerupted ectopic canine?
Leave and monitor
Remove C or create space and wait for eruption
Open exposure
Close exposure- with gold chain
Autotransplantation
XLA and replace with prostheses
What are the causes of ABs being ineffective in perio?
Bacterial resistance
Failure to penetrate biofilm without mechanical disruption
AB may not be specific to bacteria
Inadequate concentration and retention of AB at required site
Allergy
What are the RFs for Candida infection?
Erythrmatous- ill fitting denture, poor denture hygiene, wearing denture overnight
General:
Anaemia
Diabetes mellitus
HIV
Chemotherapy
Broad spectrum AB use
Inhaler with no spacer or rinsing
What are the indications as per FDS2020 for extraction of M3M?
Infection- 1 or more episodes of pericoronitis
Caries- making tooth unrestorable
Periodontal disease
Radicular or dentigerous cyst formation- if XLA will help prevent expansion or recurrence
What extra post-op complications can happen following extraction in the upper?
Tuberosity fracture
OAC
Root in antrum
What extra post-op complications can happen following extraction in the lower?
Altered/loss of sensation (P/T) to lower lip, cheek and tongue (may affect taste)
What are the primary and secondary HSV 1 and 2 infections?
Primary- PHG
Secondary- Herpes Labialis
What are the primary and secondary infections of Varicella Zoster (HHV3)?
Primary- chicken pox
Secondary- shingles
What are the oral effects of HHV4 (EBV)?
Ulceration
Glandular fever
Hairy leukoplakia
Burkitt’s lymphoma
What conditions can be caused by coxsackie virus?
Herpangina
Hand, foot and mouth disease
What are the symptoms of a coxsackie virus infection?
Pinhead vesicles of back of throat and soft palate
Sore throat
Sore head
Fever
Lymphadenopathy
How is a coxsackie virus condition treated?
Rest
Hydration
Soft diet
Analgesia
What is Fluorosis?
Generalised disorder characterised by hypomineralisation of enamel matrix as a result of excessive fluoride ingestion
-> usually in first 8 years of life
-> Diffuse opacities
-> Brown and yellow pitting
What are the biological factors influencing masticatory performance?
Number occluding units
Number of functional teeth
Maximum bite force
Age
What is the SDA?
3-5 occlusal units remaining
-> Ideally 6 anteriors and 4 premolars
What are 5 conclusions form SDA?
Achieves mandibular stability
Sufficient functions and aesthetics
Achieve occlusal stability
Same rate of attritive wear
Same rate of bone loss
What are the different roles in Decontamination?
Owner- owns practice and LDU (responsible for running LDU)
User- designated person that is responsible for day to day running of LDU
Operator- person with authority to operate equipment and performs simple maintenance
Maintenance engineer- employed to carry out maintenance and repairs when required
What is vitapex?
CaOH and iodoform paste
What are the factors which help relief crowding from primary to permanent dentition?
Further maxillary and mandibular growth
Proclined path of eruption in upper incisors
Leeway space
Primate space
How is composite bonded to dentine?
Dentine conditioner (35% phosphoric acid)
-> removes smear layer, opens tubules and decalcifies surface dentine
DBA is applied- contains primer and adhesive
Primer (bifunctional)- Hydrophilic ends bon to dentine, hydro phobic ends are exposed
Adhesive penetrates dentinal surface by molecular entangled bonding to primer tails by hydrophobic interactions
-> forms hybrid layer (collagen and resin)
Composite can bin d to adhesive surface as both are hydrophobic
What are the causes of pain to biting and thermal stimuli following cavity prep? How is this rectified?
Deep prep (place lining)
Pulp exposure (pulp cap/RCT)
Lack of coolant- reversible pulpitis (use coolant)
Undercure of composite- ingress into pulp causing irritation (cure for longer and place increments <2mm)
Unfavourable contacts (check with articulating paper and adjust)
What are the causes of different discolouration primary teeth?
Pink- bleeding into dentine tubules
Yellow- tertiary dentine being laid down
Grey/dark- necrosis of pulp
What are we looking at when reviewing trauma radiographically?
Apical radiolucency
External or internal inflammatory resorption
Pulp necrosis
Continued root development- height and width
What faults can occur when preparing a canal with SS file?
Canal blockage
Apical zipping
Ledging
Debris extrusion
Perforation
File fracture
What are the different sizes of reciproc and their use?
R25- small canals
R40- medium canals
R50- large canals
What are the steps in using reciproc?
To 2/3rds:
3 pecks with R25, irrigate, recapitulate, patency file
-> repeat
Gain CWL
-> Take 10 to WL- if no pre-curve use R25
-> If pre-curve- create glide path with 15 and then use R25
-> If 15 not possible- finish with hand files
To length- irrigate, recapitulate, latency
Check for apical gauging
Why is copper enriched amalgam preferred?
Corrosion resistance
Strength
Creep resistance
Marginal integrity
What are the signs and symptoms of Albright’s syndrome?
Fibrous dysplasia
Precocious puberty
Hyperthyroidisim
Cushing’s
Cafe au Late spots
What are the features of Paget’s?
Increased alkaline phosphatase
Disturbed balance of bone formation and resorption
Bony swellings
Nerve compression
Ill-fitting dentures
Blindness
What are the phases of Paget’s?
Osteolytic
Mixed
Osteosclerotic
What are the features of Cherubism?
Autosomal dominant inheritance
Fibro-osseus condition
Progressive, painless bilateral joint swelling in childhood
What are the physical forms of Orofacial pain?
TMD
Neuropathic pain- TN
Myofascial pain syndrome
Neurvascular pain disorders- Migraines
What are the psychological forms of Orofacial pain?
Mood and anxiety disorders manifesting as atypical facial pain
What is an RPI systems function?
Relieves stress and prevents traumatic torque
-> on loading, mesial occlusal rest acts and pivot point and I bar/proximal plate move around this going downwards and mesially disengaging from last standing tooth
What are the histological features of Sjogrens?
Lymphocyte infiltrate
Loss of acini
Atrophy
Ductal epithelial hyperplasia
What are the signs of salivary malignancy?
Hard
Fixed
Rapidly growing
Cervical lymphadenopathy
Loss of weight
Facial nerve palsy
What are the causes of post core fracture?
Trauma
Unfavourable occlusion/bruxism
Biocorrosion of metal post
Lack of 1.5mm ferrule
What are the different types of provisionals?
Custom made temporary- pro temp and putty matrix
Prefomed temporary- malleable composite, polycarbonate, transparent crown and composite
Bonding fractured tooth or old indirect restoration
Immediate denture or over denture
What are the medical issues associated with Down’s?
Congenital heart defect
Hypothyroidism
Coeliac
Epilepsy
What are the EO features of down’s?
Oblique palpebral fissures
Almond shaped eyes (epicanthic fold)
Flat nasal bridge
Eyes set wide apart
Brushfields spots
Small head
Short thick neck
Atlanto-axial instability
Palmar crease
Small dysplastic ears
What are the IO features of Down’s?
Hypodontia
Microdontia
Enamel defects
Delayed eruption
Macroglossia
CLO
High vaulted palate
High caries risk and perio risk
What is done in terms of prevention for patient with down’s?
FS
FV
F supplements
Hygienist
Bitewings
What are the features of primary teeth to consider when restoring?
Larger pulp
Thinner enamel and dentine
Shorter distance from occlusal surface to pulpal floor
Ribbon shaped canals
More curved canals
Position of apical foramen changes
What is the function of the twin block? (C2D1)
Retroclination of upper incisors
Proclination of lower incisors
Distal migration of uppers
Mesial migration of lowers
Restrains maxillary growth
Encourgages mandibular growth (postures and muscular forces)
-> most of change is dentoalveolar with minor skeletal change
What are the effects of supernumeraries on permanent dentition?
Root resorption
Mobility
Impaction
Failed eruption
Delayed eruption
Ectopic positon
Crowding
What are the general risk factors for periodontal disease?
Genetics/FH
Smoking
Pregnancy
Diabetes
Immunocomprimised
Drugs
Malnutrition
Stress
What are the treatment options for furcation involvement?
Palliative
Repair
Resective tx
Extraction
Regeneration
What are the functions of splints for TMD?
Diagnostic tool
Cognitive awareness of parafunction
Dentition protection
Reduced TMJ loading
-> postures condylar head forwards in articular fossa
What is bracing in RPDs?
Any rigid components of a denture which provide resistance to lateral movement by contacting afainst vertical anatomical structures (tooth/residual ridge)
What is reciprocation?
Any component which acts to prevent displacement of denture by active retention forces
-> contacts tooth while clasp flexes over bulbosity
What are the different types of impression materials?
Polyether- Impregum (philic)
Silicones- PVS (phobic)
Compound (phobic)
Irreversible hydrocolloid- alginate (philic)
What is the dahl effect?
Loclaised placement of appliance and resotration in anterior region
-> increases inter-occlusal space posteriorly allowing further eruption
-> takes 6 months
-> Increases OVD
What are the contraindications for the Dahl Effect?
Root resorption
Perio
RCT teeth
Implants
Post-ortho
Bisphosphonates
Fixed conventional bridgework
TMD
What are the issues with SDA in perio patients?
Remaining teeth could drift distally
Increased anterior load
Teeth already poor prognosis (not suitable for SDA concept)
Reasons for using Nickel Chrominium alloy in RBB?
Similar thermal expansion to procelain
Corrosion resistant
Can be manufactured in thin cross section and cope with occlusal load
Can be sandblasted and etched with current for extra retention
What are the issues with subgingival or alveolar preparations?
Limited tooth structure to bond to
Limited access and visualisation
Challenging mositure cintrol
Issues with impression
Issues assessing marginal integrity
Issues removing excess cement
What are the different types of preps for resin bonded bridges?
Light- no prep
Moderate- cingulum undercut removal, 0.5mm supragingival chamfer margin
Heavy- cingulum rest seat prepared, 0.5mm palatal reduction, 0.5mm supragingival chamfer margin, proximal grooves
-> 180 wraparound prep
What are the issues with mandibular displacement?
Alters growth and developmetn of jaw musculature
Potential TMJ instabilty
Attritive tooth wear
What may you wabt to find out about if a child patient presents with ulcers?
Medical conditions
Nutirent defieciency
Diet
OH regime
Are there lesions elsewgwre
Systemic symptoms
When they started
Exacerbating and releiving factors
Trauma/biting
Whar are the causes of ROU?
Anaemia
Trauma
Stress
Behcets
How does PHG present?
Painful ulcerative lesiosn on mucosa and gingivae
-> swelling
-> bleeding
-> yellow vascular lesions
What are the sequalae of dental trauma?
Mobility
Root fracture
Root resorption
Pulp necrosis
What may hep you determine the aetiology of discolouration?
Trauma Hx
Dental Hx
Diet diary
MH- porphyria, tetracycine staining etc
Special investigations- radiographs, sensibilty testing, percussion notes
What are the ADV of CoCr as a denture base?
Corrosion Resistance
Rigid
High thermal conductivity
Mechanical retention provided by clasps
One piece casting
Strong in thin section
What are the histological features of malignancy?
Dysplasia
Atrophy
Candida infection
How is HPV infection sampled?
Oral rinse
What are the red flags for parotid malignancy?
Deep fixation
Rapid enlargement
Facial nevre palsy
Cervical Lymphadenopathy
What is a benign and malignant tumour of the parotid gland?
B- Pleomorphic adenoma
M- Mucoepidermoid Carcinoma
What is a benign and malignant tumour of upper lip?
B- Monomorphoc adenoma
M- Adenoid cystic carcinoma
What is a benign and malignant tumour of soft palate?
B- Pleomorphic adenoma
M- Mucoepidermoid carcinoma
What are the indications for a URA?
Malocculusion can be corrected by simple tipping
Only 1/2 teeth to be moved- baseplate provides adequate anchorage
Sufficient space available
What is done prior to carrying out microabrasion?
Radiograph
SHADE recording
Clinical photograph
Diagram of defect
Percussion note
Sensibility testing
What is a risk ratio?
Probability of an increased or reduced risk of an outcome occurring in one group compared to another
What is an odds ratio?
A measure of association between exposure and outcome
How long is a consignment note kept for?
3 years
What is contained in a consignment note?
Quantity and contents of wast e
Waste origin
Transport
Waste destination
What info is required to send to the lab for a bridge?
Putty wash impression
Oclusal registration
Material
Design
Shade
How is a metal post/core cemented?
GIC
How is a porcelain veneer cemented?
Light cure/dual cure composite luting agent with silane coupling agent
How is a fibre post cemented?
Dual cure composite luting cement
How is a prescription written?
Date
Pt name, DOB, age
Pt address
Practice address
Name of drug
Preparation
Strength
Dose and frequency
Total quantity to be supplied
Total length of time for prescription
Signed- draw lines in space underneath
How long does a controlled/uncontrolled drug prescription last?
Controlled- 28 days
Uncontrolled- 6 months
What other conditions is denture stomatitis associated with?
Angular cheilitis
Candida leukoplakia
Media rhomboid glossitis
What medical conditions are associated with Candida infection?
Asthma- inhaler use
Microcytic anaemia
Immunocompromising conditions
-> Diabetes, HIV, chemo/radio
What are the ADV/DIS of oral swab?
ADV:
Site specific
Avoids perioral contamination
DIS:
Invasive
Uncomfortable
Not full mouth representation
What are the ADV/DIS of an oral rinse?
ADV- full mouth representation
DIS- contamination of sample
What instructions are given to the lab on suspected Candida infection?
Please culture sample and assess anti-fungal sensitivity and typing
How does secondary infection of HSV occur?
Following primary infection- HSV enters peripheral trigeminal ganglia neurons
HSV releases viral DNA into nucleus to establish latency
-> HSV1 genomes persist in nucleus
Stimuli results in reactivation of latent virus in infected ganglia
Virus travels to axonal shaft and tip at periphery where they are released to cause blisters and sores
What are the triggers for HSV reactivation?
Stress
Fever
UV
Trauma
What conditions may we test for when investigating recurrent aphthous ulcers?
Neutropenia
Anaemia
Nutrient deficiency
Inflammatory markers
Thyroid autoimmunity
What are the effects of cocaine mixed with adrenaline in LA prep?
Cocaine enhances effect
Increased heart rate
Increased myocardium oxygen demand
Coronal artery vasoconstriction
Increased risk of stable angina, MI, arrhythmia
How is MRONJ treated?
Analgesia
Resect necrotic bone
Irrigate and debride (saline)
Primary closure
CHX
Prophylactic AB
How is MRONJ prevented?
Preventive regime
Avoid extractions
Atraumatic extraction technique
Avoid trauma
What are the uses of URA?
Simple tipping of teeth
Habit breaker
Correction of oB
Retainer
Space maintainer
What other space maintainers are used in ortho?
Fixed palatal arch
Nance button
What is substantivity?
Capacity of a chemical agent to continue its therapeutic effect iver prolonged time
-> dependant on conc and absorption to oral tissues
What are the uses of CHX?
Post extraction
ANUG
Candidiasis
Aphthous ulcers
Vesiculobullous conditions
Endo irrigant
Testing Dam
Pericoronitis irrigation
What is SDA concept reliant on?
Occlusal stability- stable occlusal contacts of equal intensity in centric occlusion
-> not provided by sever class 2 or 3
What is mandibular displacement on closure?
Mandible deviates from initial path of closure to progress from first occlusal contact to RCP when closing on retruded arc of closure
What is herpes labialis?
Manifestation of reactivation of latent HSV1
-> labial sores, blisters, ulcers
When should we biopsy LP?
If symptomatic
If patient is smoker
Red patches
What are the topical/systemic treatments for LP?
Topical- hydrocortisone, betamethasone, beclamethasone
Systemic- Prednisolone, hydroxychloroquine
Which variants of LP have more malignant potential?
Erosive and gingival variants
What is Grinspan’s syndrome?
Oral lichen planus
Hypertension
T2 Diabetes
How is LP distinguished from Oral lichenoid reaction?
Both clinical and histopathological confirmation required
What are the symptoms of Sjogren’s?
Tiredness and fatigue
Dry mouth- issues eating/speaking/swallowing/tatse, caries, fungal infections
Joint pain and aches
Tiredness
Swollen salivary glands
Dryness of skin and digestive tract
Dry and sore eyes
What are the signs/symptoms of Behcet’s?
Oral ulceration- similar to RAS
Genital ulceration
Occular inflammation
Fatigue
Thombosis risk
Joint pain
Headache
What gene is behcets associated with?
HLA-B51
What immune cells are involved in hypersensitivity reactions?
T1- IgE
T2- IgG, IgM, complement
T3- IgG and complement
T4- T cell
What is erythema multiforme?
Acute immuno-mediated inflammatory mucocutaneous disease
-> likely T3/T4 rxn to trigger- infection/drugs
What are the symptoms of EM?
Oral ulceration/skin lesions- target
Lip crusting
Flu-like symptoms prior to oral and skin lesions
How is EM treated?
Antiseptic mouthwash- CHX
Analgesic mouthwash- benzydamine
Topical corticosteroids
Systemic corticosteroids- if persistent or recurrent
Changing medication
AB/AV if infection is cause
Azathioprine- very severe
Types of EM?
Isolated
Recurrent- >6 episodes per year
Persistent- continuous with no interruption
What is SLE?
Autoimmune multi system condition
-> systemic inflammation and tissue damage
-> Broad spectrum of manifestations
What are the signs and symptoms of SLE?
Fatigue
Fever
Splenomegaly
Butterfly rash
Weight loss
Arthritis
OP
Myalgia
Lupus nephritis
Uveitis/scelritis
Pericarditis
Pulmonary disease- lupus pleuritis
GI issues- IBD, coeliac
How is SLE treated?
Prednisolone
Hydroxychloroquine
Methotrexate
Rituximumab (monoclonal antibody)
What is the clinical appearance of OSCC?
Ulceration
Speckled
Exophytic
Easily bleeds
Doesnt heal
Indurated
Fixed
Uneven/rolled margins
What are the symptoms of late stage OSCC?
Ulceration
Pain
Trismus
Decreased tongue mobility
Increased tooth mobility
