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Question 1

Dentine hypersensitivity: cause, symptoms, treatment

Answer 1

Exposed dentine due to lack of enamel or gum recession. A delta fibres stimulated by fluid movement in tubules causing short sharp pain to hot/ cold/ sweet.
-prevent recession, de-sensitisation toothpaste to occlude tubules, adhesive restoration

Question 2

Reversible pulpits: cause, symptoms, exacerbating factors, treatment. what ETP will show

Answer 2

-due to caries and infection reaching pulp
-short sharp pain from A delta fibres
-hot/ cold/ sweet stimulus. Not spontaneous
-ETP will show pulp vitality
-not TTP, no PAP

Question 3

Symptomatic irreversible pulpits: cause, symptoms, exacerbating factors, how long pain lasts. tests. treatment

Answer 3

-dull throbbing pain due to C fibres
-caries where infection has irreversibly damaged the pulp
-persistent (mins-hours)
-hot/sweet/cold stimuli. or spontaneous (wake up night in pain) Worse lying down
-poorly localised
-no TTP usually. delayed response to TTP and 3 in 1. ETP confirms vitality
-in severe cases heat may cause pain and cold cause relief
-radiograph: caries and often widening apical periodontal membrane
-pulpectomy or pulpotomy or extraction

Question 4

Asymptomatic irreversible pulpits: cause, symptoms, tests,

Answer 4

-no symptoms
-previous history of symptoms of reversible and irreversible pulpits
-radiograph shows large caries, pulp exposure, internal inflammatory root resorption
-pulpectomy/pulpotomy/extraction
-necrosis: thermal and electronic testing confirms vitality loss
-may develop signs of apical periodontitis so TTP

Question 5

Symptomatic apical periodontitis: cause, symptoms, tests. What can it be mistaken with

Answer 5

-infection spreading into apex
-very painful when biting. TTP
-severe dull throbbing
-well localised (due to proprioceptive fibres in PDL)
-radiation can occur to jaws, face, ear, neck
-usualy no response to hot/sweet/ETP
-same symptoms as cracked cusp syndrome so use tooth slooth
-xray= apical radiolucency, loss of lamina dura, periodical radiolucency. sometimes not associated with apical radiolucency

Question 6

Asymptomatic apical periodontitis: symptoms, tests, treatment

Answer 6

-no symptoms, no TTP, no response to sensibility tests
-apical radiolucency
-extract

Question 7

Acute apical abscess: cause, symptoms, treatment

Answer 7

-rapid onset, an inflammatory reaction to pulp infection and necrosis
- very painful when biting, TTP, well localised, no response to sensibility tests
-intra or extra oral swelling. no discharging sinus tracts
-perhaps fever
-tooth extruding and catching on bite
-periapical radiolucency, or sometimes none if so rapid and not had time to resorb bone
-drain pus and RCT. or extract

Question 8

Chronic apical abscess: cause, symptoms,

Answer 8

no symptoms, no TTP or mild, no response to sensitivity tests
-gradual onset with little or no discomfort
-intra or extra oral swelling with draining sinus into skin surface or mucosa
-well defined periodical radiolucency

Collection of pus, forms a tract that goes through gingiva and bone and points towards apex of tooth causing the sinus

Question 9

What is condensing osteitis: symptoms, radiograph

Answer 9

localised inflammatory bony disease that results from a reaction to a dental related infection
-usually seen at apex
-no symptoms, little or no TTP
-localised radio density at tooth apex

Question 10

Cracked cusp syndrome: symptoms, what it can mimic, how to diagnose, management

Answer 10

-can mimic teeth with symtomatic apical periodontitis
-sudden sharp pain on eating, usually on release of pressure
-radiograph not likely to see crack
-use tooth slooth for cusp flexure test, dyes, pt history, orthodontic band, transillumination, magnification
-management: bond restoration, cusp coverage with crown, endo, extraction

Question 11

critical pH of enamel and dentine

Answer 11

-enamel = 5.5
dentine = 6
Demineralisation occurs below this.

Question 12

what are the 4 zones of a caries lesion, from in to out. and which layers have de or demineralisation

Answer 12

-translucent zone=remineralisation
-dark zone= demineralisation
- body of lesion - destruction
-surface zone = reminerlisation

Question 13

depth of enamel, enamel surface to pulp, length of pear shaped bur

Answer 13

-2mm
-5mm
-3mm

Question 14

what does etch do

Answer 14

removes surface contaminants, roughness the surface microscopically for micro mechanical retention, removes smear layer and opens the enamel tubules

Question 15

Difference between infected and affected dentine

Answer 15

-Infected= mushy, high conc of bacteria, collagen irreversibly denatured, cannot be remineralised, must be removed, brown, dead, no sensation
-Affected= hard and scratchy, not been infiltrated by bacteria, yellow, vital, sensitive, can be remineralised, should be preserved

Question 16

what is attrition, abrasion and abfraction and erosion

Answer 16

attrition: tooth to tooth contact (grinding)
abrasion: foreign object causing wear
abfraction: at gumline, v-shaped, from chewing or grinding
erosion: chemical dissolution of enamel due to extrinsic acids (not bacterial)

Question 17

the codes for tooth surface loss

Answer 17

0 = no tooth wear
1= initial loss of surface texture
2= distinct defect, tissue loss <50% of surface area
3= >50% loss of surface area

Question 18

ICDAS score classification

Answer 18

0= sound
1=first visual change, still shiny, prisms in tact
2= district change in enamel. first appearance of white spot lesion, frosty, not shiny

3=brown or white spot, localised enamel breakdown, no cavity or dentine exposure
4= underlying dark shadowing from dentine

5=cavity with visible dentine
6=extensive cavity with visible dentine
7=unrestorable

Question 19

management of extra oral sinus

Answer 19

remove cause: endodontics, apicetomy, extraction
drainage
antibiotics if systemic