clinical dent Flashcards
1
Q
What does a primary caries lesion refer to?
A
A primary lesion occurs at the tooth surface due to external bacteria. It is not related to a restoration
2
Q
What does a secondary caries lesion refer to?
A
A secondary lesions occurs at he external or internal interface of the tooth due to external bacteria and is in relation to a restoration
3
Q
What is a recurrent caries lesion?
A
A lesion occurring deep in the tooth, at restoration interface due to internal bacteria left in the cavity.
4
Q
Why is it important to detect caries early?
A
- cavitation is not inevitable with caries
- prevented by simple measures
- small lesions remineralise more readily
- remineralised lesions are more resistant
5
Q
What risk factors should be assessed for caries?
A
- biological factors eg saliva, enamel quality
- medical factors
- dental factors eg multiple restorations
- dietary factors
- social and demographic factors
6
Q
What visual features would indicate enamel demineralisation?
A
- White matte appearance
- brown due to exogenous stain
7
Q
What visual features would indicate caries being spread into dentine?
A
Grey discolouration
8
Q
True or false:
You can determine root caries by visual examination provided you have good lighting and the teeth are clean
A
FALSE = colour is not a good indicator of activity for root caries
9
Q
List the diagnostic methods to determine caries
A
- Visual
- radiography (bitewings)
- fiberoptic transillumination (FOTI)
10
Q
List 5 minimal interventions in the management of dental caries
A
- Modification of oral flora
- patient education
- remineralisation of non cavitated lesions of enamel/dentine
- minimal operative intervention of ‘early’ cavitated lesions
- repair/ replacement of restorations
11
Q
Why should we restore teeth? and when restored, why should preventative measures still be pursued?
A
- eliminates plaque traps formed by cavities
- eliminate pain/ discomfort
- improve appearance
however, no restoration gives the perfect seal therefore preventative measures are still needed
12
Q
What is a retentive cavity?
A
A cavity where tooth tissue can support material
13
Q
True or false;
placing amalgam into a large cavity will lead to cusp fracture
A
TRUE
14
Q
Which statement is false regarding composites?
a) micro-mechanical bonding to acid-etched enamel
b) adheres to dentine via bonding agents
c) stronger than amalgam
A
c) stronger than amalgam
composite is WEAKER than amalgam
15
Q
Why is acid etching necessary to bond composites to enamel?
A
Acid-etching produces micro-porosities to give micro-mechanical retention
16
Q
Which statement regarding GICs is false?
a) inferior aesthetics to composites
b) releases fluoride
c) micro-mechanically bonds to tooth tissue
d) weaker than composites
A
c) micro-mechanically bonds to tooth tissue
GICs form a CHEMICAL bond with tooth tissue and therefore DO NOT require mechanical retention
17
Q
Why is the proportion of acidogenic microorganisms in plaque higher in older people than younger ones?
A
due to decreased salivary secretions and higher prevalence of removable dentures
18
Q
A carious lesion is clinically seen as shiny, smooth, hard and has no microbial deposits. Is it an active, progressive, or arrested lesion?
A
ARRESTED
19
Q
Based on pattern of mineralisation, what are the differences in active and arrested lesions?
A
ACTIVE: soft extensive demineralisation with no evidence of intact surface mineral layer
ARRESTED: hard uniform distribution of mineral throughout lesion
20
Q
True or false:
the critical pH for the dissolution of the root tissue is higher than that of enamel
A
TRUE
Enamel critical pH :5.2-5.7
Root pH: 6.0-6.7
21
Q
What would result from having no commensal microflora in the gut?
A
- Hypoplastic peyer’s patches
- Decreased IgA plasma cells
- Decreased lamina propria CD4+ cells
22
Q
List the physical barrier components in the oral cavity (3 things)
A
- Adherent mucus layer
( sticky, slippery gel that allows transit of nutrients but not bacterial toxins/products. Also taps bacteria for prolonged exposure to host antibacterial agents) - Desquamation
( shedding of cells) - Epithelial antibody receptors
( secretory component receptors found on buccal epithelium - anchor bacterial-antibody complexes, which are then shed with the cell)
23
Q
What is desquamation?
A
The shedding of cells
24
Q
Which one is Keratinised stratified squamous epithelium?
a) floor of mouth
b) gingiva
c) ventral surface of tongue
d) inner lips
e) cheek
A
b) gingiva
25
What is acquired enamel pellicle?
An acellular protein film on the enamel surface
formed from selective adsorption of proteins derived from oral fluid such as
- salivary proteins ( eg amylase, S-IgA, lysozyme)
- Gingival crevicular fluid proteins
- streptococcal enzyme - glycosyltransferase
26
What are granzymes and perforins?
granzymes: proteases that induce apoptosis - released by NK and Tk cells
perforin: protein causing lesion-like pores in cell membranes - released by NK cells
27
how to cells infected with viruses trigger the innate immune response?
Infected cells release interferons which trigger macrophages to release cytokines that stimulate NK cells to release proteins such as granzymes and perforins to trigger apoptosis of infected cell
28
What are the three types of dendritic cells?
- Langerhans
- interdigitating cells
- Follicular dendritic cells
29
What are follicular dendritic cells?
a type of dendritic cell found in specialised areas of lymph nodes.
they present unmodified antigens to B cells
30
What are Toll-like receptors and PAMPs?
Toll-like receptors are found on cell membranes that recognise PAMPs, triggering release of cytokines, chemokines and beta defensins
PAMP - pathogen associated molecular pattern
are NOT found in eukaryotes, therefore the body is able to recognise them as foreign material.
31
Which antimicrobial agent is bacteriostatic-iron binding ?
a) Secretory IgA
b) Lactoferrin
c) myeloperoxidase system
d) complement
e) agglutins
b) Lactoferrin
32
Which antimicrobial agent works by being bacteriocidal in the presence o H2O2?
a) Secretory IgA
b) Lactoferrin
c) myeloperoxidase system
d) complement
e) agglutins
c) myeloperoxidase system
33
Which antimicrobial agent is from gingival crevicular fluid?
a) Secretory IgA
b) Lactoferrin
c) myeloperoxidase system
d) complement
e) agglutins
d) complement
34
Name three ways of compliment activation
- antigen-antibody complex
- lectin binding to pathogen surface
- pathogen surface
35
What does complement activation lead to?
- opsonisation
- recruitment of inflammatory cells
- killing of pathogen
36
Which complements are peptide mediators of inflammation and are involved in phagocyte recruitment?
C3a and C5a
37
Which complement binds to complement receptors on phagocytes to initiate opsonisation of pathogens and removal of immune complexes?
C3b
38
What are the role of terminal complement components?
form membrane-attack complexes, lysis of certain pathogens
39
List the differences between innate and adaptive immunity
INNATE:
- non specific
- no memory
- unchanged magnitude of response
- instructs adaptive immunity
- recognises foreign organisms
ADAPTIVE:
- memory and specificity
- magnitude increases upon second exposure
- activated by components of innate immunity
40
What is the difference between humoral and cellular immunity?
HUMORAL immunity is associated with circulating antibodies produced by B cells specific for an antigen on a microbes surface. triggers activation of complement cascade
CELLULAR immunity is a response to activated, antigen specific T cells . induction of further Th cells = B cell activation, Tk cells and macrophages+NK cells
41
Which antibody plays the most crucial role in mucosal membranes?
SIgA (IgA)
42
Which antibody is found in all secretions?
SIgA (IgA)
43
In enamel apatite structure, what is F- substituted for?
a) Ca
b) PO4
c) OH
d) Mg
e) O2H
c) OH
44
In enamel apatite structure, what is CO3 substituted for?
a) Ca
b) PO4
c) OH
d) Mg
e) O2H
b) PO4
45
What is the enamel crown thickness?
~2mm
46
What are the ways to deliver fluoride?
- water fluoridation
- fluoride drops+tablets
- milk
- salt
- topical fluorides eg varnish, gel, toothpastes, rinsing solutions
47
What are the pre-eruptive effects of fluoride on teeth?
- improve crystallinity
- increase crystal size
- decrease acid solubility
- more rounded cusps
- improve fissure sealant patterns
48
What are the post-eruptive effects of fluoride on teeth?
- inhibit demineralisation
- promote remineralisation of early caries
- increase degree+speed of remineralisation
- inhibit glycolysis un cariogenic bacteria = decreased acid production
- fluoride in plaque inhibit synthesis of extracellular bacteria
49
What are the effects of chronic fluoride toxicity?
- exostoses ( bony growth on bone surface)
| - stiffness and pain of joints
50
What are the effects of acute fluoride toxicity?
- poisoning
- nausea, vomiting
- limb spasms, convulsions
- BP and pulse rate fall
- depressed respiration
- unconsciousness
51
What is fluorosis?
effects of excessive fluoride intake characterised by mottles enamel
52
True or false;
Dentine is harder than bone
TRUE
53
What is the difference between tertiary and sclerotic dentine?
both are formed in response to an external challenge however tertiary dentine is laid down in the PULP whereas sclerotic is laid down in the TUBULES (peritubular dentine) as the odontoblast processes retract forming dead tracts
54
Why is zone of tubular sclerosis translucent on ground section?
due to higher mineralisation
55
What is tubular sclerosis?
the laying down of peritubular dentine in tubules due to an external challenge eg caries.
purpose is to block entry of bacteria through tubules.
odontoblast processes retract from acid stimulus and increase peritubular formation. as processes retract dead tracts are formed.
56
What is reactionary dentine?
tertiary dentine formed as a result of external challenge at the pulp-dentine interface.
serves to increase distance from pulp and noxious stimulus
57
How can the mucosal surfaces of the mouth affect the distribution of microflora?
- keratinised and non keratinised areas affect distribution
- papillary surfaces of dorsal tongue provide habitat for microorganisms that otherwise wouldve been removed by mastication/saliva flow
- tongue crypts have low redox potential and act as a reservoir for gram negative anaerobes
58
Which statement is incorrect?
Streptococcus mutans...
a) have a high isolation frequency
b) are a primary pathogen in enamel caries in children and young adults
c) gram negative cocci
d) have low prevalence on sound enamel
e) primary pathogen in root caries of the elderly
c) gram negative cocci
streptococcus mutans are gram POSITIVE
59
Which Streptococcus group is often isolated from infective endocarditis ?
a) Strep. mutans
b) Strep. salivarius
c) Strep. milleri
d) Strep. oralis
d) Strep. oralis
60
Which Streptococcus group is often isolated from purulent disease?
a) Strep. mutans
b) Strep. salivarius
c) Strep. milleri
d) Strep. oralis
c) Strep. milleri
61
Which bacterium species is involved in root canal infections?
a) Streptococcus
b) Enterococcus
c) Staphylococcus
d) Micrococcus
e) Stomatococcus
b) Enterococcus - specifically E. faecalis
62
Which bacterium are involved in actinomycosis?
a) A. naeslundii
b) A. israelii
c) Eubacterium
d) Lactobacillus casei
e) P. propionicus
b) A. israelii
AND
e) P. propionicus
63
Which bacterium are associated with root surface caries and increase in number with gingivitis?
a) Enterococcus
b) Staphylococcus
c) Actinomyces
d) Eubacterium
e) Lactobacillus
c) Actinomyces
| Lactobacillus also involved in advanced caries lesions of root surface
64
What are the functions of established dental plaque?
a) for the bacteria
b) for the host
FOR BACTERIA
- metabolic efficiency of community is increased
- organisms can persist and grow over a wider habitat range
- maintenance of favourable conditions during periods of unfavourable changes
- enhanced catabolism of endogenous nutrients
- recycling of nutrients
FOR HOST
- bacterial competition for adhesion sites, nutrients
- bacterial production of inhibitory substances
(both help in excluding exogenous organisms from entering and establishing)
65
Briefly describe the process by which plaque is formed
1) pellicle is formed on enamel tooth surface by selective adsorption of proteins from saliva, GCF and bacterial enzymes
2) pioneering species of bacteria (eg streptococci and actinomyces) attach onto pellicle via van der waals/ electrostatic/ hydrogen bonds
3) pioneering species multiply and form a confluent layer + co aggregation occurs via cell-cell interactions (eg actinomyces and fusobacterium)
4) growth of bacteria = decreased O2 = growth of anaerobic bacteria eg fusobacterium
5) plaque matures and is attained at stagnant sites = climax community
66
What contributes to the extent of pH drop AFTER glucose challenge? (5 points)
- type and amount of CHO present
- bacteria present
- salivary composition and flow
- thickness and age of dental plaque
- other food ingested
67
Define acidogenicity and aciduricity
ACIDOGENICITY: the ability of bacteria to produce organic acids from fermentable carbohydrates
ACIDURICITY: the ability of bacteria to live in a low pH environment
68
What is the difference between homofermentative and heterofermentative bacteria?
Homofermentative: produce over 90% lactic acid >>> cariogenic bacteria
heterofermentative: produce a mixture of metabolites eg organic acids, ethanol
69
What is the function of intracellular storage polymers in plaque?
- storage form of carbohydrate
- energy production and acids when dieteary CHO is depleted
- contributes to acidogenicity and aciduricity
- produced by most plaque bacteria
70
What is the function of extracellular polysaccharides in plaque?
- may serve as carbohydrate storage
71
What are the indications of fissure sealing?
- children with special needs
- children with extensive caries in primary dentition
- children with caries in permanent molars
- molars with deep pits and fissures
- incisors with deep cingulum pits
- molars with complex fissure patterns
- molars with stained fissures
72
What are the materials that can be used for fissure sealing?
- filled resin
- unfilled resin
- GIC
73
What is PRR?
preventative resin restoration whereby the pit/fissure decay is removed and restored and the rest of the fissure pattern is also sealed to prevent future decay.
74
Why restore deciduous dentition?
- eradicate disease = restore health and general well being
- to give child the simplest form of treatment and avoid more complex procedures eg root canal treatment
- avoid infection that follows root exposure
- maintain arch length for permanent dentition
- restore function (mastication can be painful of teeth are unhealthy)
- psychological benefits + quality of life
75
Which statement is incorrect regarding the differences between deciduous and permanent teeth
a) deciduous teeth have longer, more slender and splayed out roots
b) deciduous teeth have higher pulpal horns and proportionally larger pulp chambers
c) The enamel rods at the cervix of deciduous teeth slope gingivally whereas for permanent teeth slope occlusally
d) The cervical ridges are more pronounced for deciduous teeth
e) deciduous teeth have comparatively thicker dentine over the pulpal wall at the occlusal fossa
c) The enamel rods at the cervix of deciduous teeth slope gingivally whereas for permanent teeth slope occlusally
it is the other way around
deciduous teeth: enamel rods slope occlusally at cervix
permanent teeth: enamel rods slope gingivally at cervix
76
List some of the indications of using a stainless steel crown in deciduous teeth
- 2 or more carious surfaces or one extensive surface caries
- following pulp therapy
- developmental problems eg amelogenesis imperfecta
- fractured primary molars
- high caries risk patients
- special need patients with reduced oral hygiene/ high risk of intra-coronal breakdown of restoration
-
77
List the contradictions of s stainless steel crown use
- allergy/sensitivity to nickel
| - if primary molars are about to exfoliate
78
List the advantages of using air abrasion to remove carious tissue
- reduced need for anaesthetics
- doesn't produce burning smell
- no vibrations/ noise
- reduced failure rate of bonded sealant/filling (due to surface being dry)
- removes carious tissue without cutting healthy tissue
- reduced risk of micro-fracture
79
What makes up the base of the gingival sulcus?
a) sulcar epithelium
b) junctional epithelium
c) oral epithelium
b) junctional epithelium
80
What are the three components of gingival epithelial tissues?
- oral epithelium
- sulcar epithelium
- junctional epithelium
81
What are the different fibre types in periodontal ligament?
- alveolar crest
- horizontal
- oblique (principal)
- interradicular
- apical
82
Which fibres in the periodontal ligament form Sharpay's fibres as the enter the cementum/alveolar bone?
Oblique fibres
83
Which statement concerning the junctional epithelium in the gingiva is FALSE
a) the junctional epithelium is attached to the enamel and cementum
b) the junctional epithelium makes up the base of the gingival sulcus
c) has three basement membranes
d) permeable to GCF and defence cells
c) has three basement membranes
it has TWO basement membranes
84
What are the functions of the periodontal ligament
- physical (supportive)
- nutritional (highly vascularised)
- sensory
- source of stem cells for bone, cementum and other CT cells (remodelling)
85
What are the types of cementum?
- acellular (on cervical 2/3 of root)
| - cellular ( on apical 1/3 of root)
86
In periodontal disease, what is the sulcus depth?
a) <1mm
b) 1-3mm
c) >3mm
c) >3mm
87
What is the difference between probing depth and attachment loss?
probing depth is the distance between the gingival margin and sulcus base
attachment loss is the distance between the cementoenamel junction and sulcus base
88
What is the difference between chronic and aggressive periodontitis?
CHRONIC:
- common,
- increasing age=increasing prevalence
- slow,
- subgingival calculus present
- mainly generalised distribution but can be localised
AGGRESSIVE
- uncommon,
- under 30yr olds
- often localised to first molar/incisor + two additional teeth (can be generalised )
- rapid rate (episodically)
- often few calculus deposits
89
List some of the local risk factors of periodontitis
anatomical: enamel pearls/ root grooves/ furcations/ recession
tooth position: malalignment/crowding
iatrogenic: restorative margins/ partial dentures/ ortho appliances
90
What is the difference in collagen between dentine and pulp?
dentine has type I
pulp has type I, III and V
91
What is the dentine pulp complex?
a dynamic tissue that responds to mechanical, bacterial and chemical stimuli as a functional unit
92
What two material can be used for pulp capping?
Calcium hydroxide
Mineral trioxide aggregate
93
What are the differences in crack formation between bonded and non-bonded restorations?
bonded restorations have cracks forming within the enamel in contact with the opposing tooth (contact points)
non-bonded restorations will have cracks in the internal line angles and ADJ
94
What is the difference between retention-form and resistance-form in relation to cavity designs?
retention form: the aspects of a cavity design that resists OCCLUSALLY displacing forces
resistance form: aspects of cavity design that resist COMPRESSIVE AND OBLIQUE displacing forces
95
What are GHM articulating foil and millers forceps used for?
To check occlusion prior to restoration
96
What is the difference between abfraction- and abrasion lesions?
ABFRACTION: caused by either chronic forces applied onto tooth eg bruxism or by normal occlusal forces but with misaligned teeth
ABRASION: eg by forces of heavy toothbrushing on the exposed root surfaces
both present as notches at the gumline
97
Why cure composites incrementally?
To minimise shrinkage
98
At which stage of gingivitis does collagen destruction begin?
a) initial stage (4-5 days)
b) early lesion (7-14 days)
c) established gingivitis (2-3 weeks)
d) advanced lesion - periodontitis
b) early lesion (7-14 days)
99
Which immune cell is the predominant defence cell in the gingival crevice during periodontal disease?
PMNs - neutrophils
100
Which statement is false concerning cytokines in periodontal disease
a) released by PMNs and macrophages
b) increase inflammation
c) stimulate bone growth by osteoblasts
d) stimulate collagen breakdown by fibroblast production of MMPs
c) stimulate bone growth by osteoblasts
they stimulate bone RESORPTION by osteoCLASTs
101
Which statement concerning prostaglandins is false in periodontal disease?
a) produced by macrophages
b) cause vasoconstriction
c) stimulate fibroblasts to release MMPs to breakdown collagen
d) stimulate osteoclasts
b) cause vasoconstriction
causes vasoDILATION
102
Which probe is used for a BPE chart?
WHO probe
103
Which probe is used for a six point pocket chart (6PPC)?
Williams probe
104
On the BPE chart, what does a score of 3 signify?
pocket depth between 3.5-5.5mm
requires a 6PPC
105
On the BPE chart, what does a score of 1 and 2 signify?
1 = pocket depth <3.5mm + bleeding on probing
2 = pocket depth <3.5mm + calculus
106
Which measurements are missing on a William's probe?
4mm and 6mm
107
What is the difference between diagnosis and prognosis?
diagnosis: the identification of the nature of an illness by examination of the symptoms
prognosis: a prediction of the probable course and outcome of a disease
108
What is the difference between abfraction and attrition?
attrition occurs due to occlusal forces of opposing teeth leading to loss of tissue at the occlusal/incisal surfaces
abfraction is loss of tooth tissue around the gumline due to occlusal forces
109
What is perimolysis?
a rim of enamel left around the tooth due to erosion
110
What is pica?
a compulsive eating of non-foods often seen in pregnancy
111
Which statement is incorrect? Subgingival calculus is
a) highly mineralised
b) usually dark in colour
c) widely distributed
d) confined to one tooth surface
e) difficult to remove
d) confined to one tooth surface
112
At what stage is increased vascularity seen in gingivitis staging?
a) Initial stage gingivitis
b) Early lesion of gingivitis
c) Established lesion of gingivitis
d) Advanced lesion
b) early lesion of gingivitis
7-14 days after plaque accumulation
113
At what stage is collagen destruction noted in gingivitis?
a) Initial stage gingivitis
b) Early lesion of gingivitis
c) Established lesion of gingivitis
d) Advanced lesion
b) Early lesion of gingivitis
7-10 days of plaque accumulation
114
At what stage do neutrophils begin to migrate to the gingival sulcus in gingivitis?
a) Initial stage gingivitis
b) Early lesion of gingivitis
c) Established lesion of gingivitis
d) Advanced lesion
a) Initial stage gingivitis
4-5 days of plaque accumulation
115
At what stage do plasma cells dominate in the infiltrate of gingivitis?
a) Initial stage gingivitis
b) Early lesion of gingivitis
c) Established lesion of gingivitis
d) Advanced lesion
c) Established lesion of gingivitis
2-3 weeks of plaque accumulation
116
At which stage of gingivitis do clinically gums bleed upon probing?
a) Initial stage gingivitis
b) Early lesion of gingivitis
c) Established lesion of gingivitis
d) Advanced lesion
c) Established lesion of gingivitis
2-3 weeks of plaque accumulation
(but tissue swelling and bleeding occurs at initial stage too... so idk)
