Daleel Daib Flashcards
What teeth erupt from ages 6-8
3
First permanent molars
Central incisors
Lateral incisors
What teeth erupt from ages 11-12
4
First Premolars
Second premolars
Canines
Second molars
How much of the root is complete at eruption
How long between eruption and root formation
2/3
2-3 years
What teeth erupt at dental age 6
2
Mandibular and maxillary first molars
Mandibular central incisors
What teeth erupt at dental age 7
2
Maxillary central incisors
Mandibular lateral incisors
What teeth erupt at dental age 8
1
Maxillary lateral incisors
What teeth erupt at dental age 11
2
Mandibular and maxillary first premolar
Mandibular canine
What teeth erupt at dental age 12
2
Mandibular and maxillary second premolars
Maxillary canine
What teeth erupt at dental age 13-15
1
Second molars
What teeth erupt at dental age 18-21
1
Third molars
What toll like receptor does LPS of gram negative bacteria bind to to induce inflammatory cascade
TLR4
What are the 4 types of hypersensitivity reaction
Type 1: immediate hypersensitivity
Type 2: antibody mediated hypersensitivity
Type 3: immune complex mediated hypersensitivity
Type 4: T cell mediated hypersensitivity
What happens during type 1 hypersensitivity reaction
What are some examples
IgE antibodies sensitise mast cells after they are released from plasma cells in response to allergen, when body comes into contact with allergen again sensitised mast cells trigger complementary cascade
Anaphylaxis
Atopy
What happens during type 2 hypersensitivity reaction
What are some examples
IgG or IgM antibodies coat surface of bodies own cell antigens, opsonising them. This triggers complementary cascade leading to inflammation and destruction of own cells via MAC or NK cells
Rheumatic heart disease
Haemolytic anaemia
Pernicious anaemia
What happens during type 3 hypersensitivity reaction
What are some examples
Insoluble immune complexes of antibodies IgG and IgM form in the blood and are deposited onto tissues activating compliment cascade and destruction and inflammation of host tissues
Rheumatoid arthritis
Serum sickness
Subacute bacterial endocarditis
What happens during type 4 hypersensitivity reaction
What are some examples
CD4 T cells recruit macrophages and neutrophils, CD8 T cells induce cell lysis
Contact dermatitis
Temporal arteritis, transplant rejection, leprosy symptoms, TB symptoms, coeliac disease
What type of hypersensitivity reaction is angioedema
What type of hypersensitivity reaction is a lichenoid reaction to dental materials
What type of hypersensitivity reaction is vesiculobullous oral disease
Type 1
Type 4
Type 2
What are the main antibodies of the primary immune response
IgM
What are the main antibodies of the secondary immune response
IgG
What are the components of a vaccine and what do they do
3
Antigen- part or all of infectious microbe that triggers immune response
Preservatives and stabilisers- Thermosal, MSG
Adjuvants- added to induce stronger immune response often in subunit vaccines such as aluminium or lipid A
What type of vaccines are Hepatitis B vaccine, Pertussis and Influenza vaccine
Subunit
What type of vaccines are diptheria and tetanus vaccines
Toxoid
What type of vaccine in the Hib vaccine
Conjugate vaccine
What type of vaccine is the inactivated polio vaccine and hepatitis A vaccine
Inactivated vaccine
What type of vaccine is Mar, chicken pox, measles and live polio vaccine
Live attenuated
How is polio spread
What percentage of polio cases invade motor neurones leading to paralysis
Faeco oral transmission
0.5%
What are the advantages and disadvantages of the inactivated polio vaccine
No risk of vaccine related polio
Doesn’t stimulate antibody production in the gut so less effective against wild polio
Protects only immunised person as others cannot contract the inactivated strains
What are the advantages and disadvantages of the oral (live) polio vaccine
Replicates wild polio virus as closely as possible
Local mucosal immune response leads to creation of antibodies in the GALT (the area most likely to come into contact with wild polio)
Community benefit- others can pick up weakened strain
Weakened form of pathogen may mutate back to wild type polio and cause disease
What type of vaccine is the HPV vaccine
What strains of HPV does it protect against
4
What strain can infect back of throat, tonsils and base of tongue and cause cancer
Subunit
HPV16, HPV18, HPV6, HPV1
HPV16
Where are non steroid hormone receptors found
Transmembrane receptors on cell surface membrane
What are the amine hormones (non Steroid)
Where are they produces
Are they water or lipid soluble
3
Adrenaline- adrenal medulla- water soluble
Noradrenaline- adrenal medulla- water soluble
Thyroid hormone- thyroid gland- lipid soluble
What are steroid hormones derived from
Are they lipid or water soluble
How are they transported
Where are their receptors
Cholesterol
Lipid soluble
Bind to specific binding proteins in blood
Intracellular
What is the basic steroid hormone structure
3
Four linked hydrocarbon rings
Hydrocarbon tail
Hydroxyl group
What are the types of steroid hormones
6
Glucocorticoids Mineralocorticoids Oestrogen Androgen Progestogen Secosteroid
What are the layers of the adrenal cortex going outwards and what hormones do they produce
3
Zona reticularis- androgens
Zona fasciculata- glucocorticoids
Zona glomerulosa- mineralocorticoids
What is the key glucocorticoid hormone
What does it do
5
Cortisol
Stress response
Increases blood glucose levels through gluconeogenesis and suppression of glucose use by cells
Increases protein breakdown and mobilisation of amino acids
Anti inflammatory and immune suppression
Increases mobilisation of fatty acids from adipose
How is cortisol regulated
Cortisol secretion stimulated by ACTH from anterior pituitary
ACTH release stimulated by CRH from hypothalamus
Release of ACTH and CRH regulated by negative feedback loop of plasma cortisol levels
What disorder is caused by cortisol deficiency
What causes primary hypoadrenocorticism
What causes secondary hypoadrenocorticism
What are the symptoms of this disease
5
Addisons disease
Primary hypoadrenocorticism caused by autoimmune damage
Secondary hypoadrenocorticism caused by long term steroid therapy
Hypotension Fever, muscle weakness and malaise GIT symptoms- nausea or anorexia Weight loss Depression
What is addisonian crisis and why might it occur
A medical emergency that patients with hypoadrenocorticism my be at risk of due to stress associated with dental intervention causing hypotension and hypoglycaemia due to reduced cortisol secretion in time of demand
What disorders are caused by cortisol excess
2
What are the symptoms
Cushings disease- caused by increased ACTH secretion due to tumour in anterior pituitary
Cushings syndrome- excess cortisol due to endogenous or exogenous source
Weight gain (moon face/buffalo hump), hypertension, cardiac disease, secondary diabetes, easily bruising skin, hirsutism, frontal baldness, osteoporosis, muscle weakness, reduced libido, depression
What relevancy does hyperadrenocorticism have in the dental setting
Patients with hyperadrenocorticism are predisposed to opportunistic infections after extraction or candidiasis. They have reduced wound healing
Wha is the main mineralocorticoid hormone
What does it do
3
Aldosterone
Regulates sodium reabsorption and potassium excretion by the kidneys to sustain ECF volume
Promotes sodium reabsorption in distal renal tubes
Stimulates potassium excretion into lumen of distal renal tubules
How is aldosterone regulated
Aldosterone secretion stimulated by angiotensin 2 in the renin angiotensin system
Aldosterone release inhibited by arterial natriuretic peptide (ANP) secreted by atrial myocytes in response to volume expansion
What disorder is caused by excess aldosterone
Conns syndrome- caused by adrenal adenoma (tumour)
Why may a patient be taking hydrocortisone
What would you prescribe Hydrocortisone for
Eczma, asthma, anaphylaxis
Hydrocortisone cream - angular cheilitis
Hydrocortisone oromucosal tablets- used to treat mucosal ulceration and inflammation
What would you prescribe betamethozone for
Betamethasone tablets- dissolved and used as mouthwash for extensive inflammation or ulceration
Why might a patient be taking beclometasone
Why might you prescribe beclometasone
Asthma
Beclometasone inhaler (clenil modulite)- sprayed onto tongue lesions
