Dental Block 1 Flashcards
What is the health care worker risk when dealing with recurrent herpes
it is possible to develop lesions on the fingers
(Herpangina or Herpetic Whitlow)
if the health care provider isn’t careful with gloving and hand washing
Why would you refer someone for restoration
Caries on bitewing x-rays?
Any clinically visible decay?
Any old or fractured restorations that need to be replaced
What is a lefort I fx
Transverse maxillary fx
What do the minerals contained in the pellicle do
buffer the pH and provide components for
remineralization of enamel
What are the components of the oral cavity proper
hard and soft palates, teeth, cheeks, anterior 2/3 of the tongue, and floor of the mouth.
When adding fluoride, what becomes the critical pH in Stephan curve
4.5
What are the S/s of condyloma acuminatum
Painless; multiple, slightly papillary nodules attached with a broad
base; often in clusters
• occurs most often on lips, tongue, and soft palate; anogenital lesions
may also be present
• Etiology: an STI caused by infection with human papillomavirus
(HPV-6, HPV-11, HPV-16, and HPV-18)
What causes inflammation of the PDL
• Includes: excessive wear; mobility; widened PDL
• Etiology:
Non-bacterial: poor restoration; ill-fitting appliance, occlusal trauma
Bacterial: near apex of root due to inflammation in pulp tissue
• Reversible
Describe lining mucosa
60% of total mucosa.
Covers the floor of the mouth, ventral (underside) tongue, alveolar mucosa, cheeks, lips and tissues covering soft palate.
Does not function in mastication and therefore has minimal attrition.
Non-keratinized; soft and pliable.
What are appropriate storage methods for teeth
- Saliva (vestibule; under the tongue) • Lowfat milk
- Coconut water
- Pedialyte
- NO to water or Gatorade
- NEVER wrap in tissue
- NEVER leave in open air
What is the Tx for primary herpetic gingivostomatitis
- Supportive care
- Soft diet & adequate liquids
- Resolves in 5-7 days; acute cases 2 weeks
- Acetaminophen for discomfort, for severe orofacial infections
Acyclovir may be used
What is a class 3 dental status
The treatment needs indicate that a dental emergency will likely occur within 12 months
What is the sensory supply to the base of the tongue
CNX
General and taste
(Internal laryngeal nerve
What are the S/s of periodontal disease
- Mobile teeth
- Mouth sores & purulence
- Radiographic evidence of bone loss
- Halitosis
- Blunted interproximal papillae
- Destruction of attachment apparatus
Low ph in the mouth leads to
Demineralization
What is the dosing for augmentin
RX: Clavulanic Acid, 125mg, by mouth, every 8 hours for 5-7 days
Plus
RX: Amoxicillin, Loading dose: 1000mg
Maintenance dose: 500mg, by mouth, every 8 hours for 7 days
Are there papillae on the posterior 1/3 of the tongue
no papillae but shows nodular surface because of underlying lymphatic nodules (lingual tonsils)
What is candidiasis
curdy, whitish layer that leaves a red inflamed base when wiped off
• Etiology: Candida albicans; opportunistic fungal infection
• Symptoms: burning, dysgeusia, sensitivity, generalized discomfort;
co-infection with staph may be present
Can be acute or chronic (denture/appliance)
How long can intermediate restorative material remain in place
For up to one year
What is the ratio of powder to liquid for Intermediate restorative material
1:1
Correct mix can be rolled in your gloved fingers without leaving a
residue
Is the damage in Periodontal disease permanent
Can be managed – but damage is permanent
What is post extraction inflammation of an exposed, sensitive alveolar process
Alveolar osteitis
Dry socket
What three bacteria make up the red bacterial complex for periodontal disease
- Tannerella forsythia
- Treponema denticola
- Porphyromonas gingivalis
What is the critical pH in the mouth for tooth decay
Stephan curve
Below 5.5
What is the purpose of I&D
- Removes pus, necrotic debris, and bacteria
- Useful for abscess or cellulitis
- Reduces tissue tension
- Improves local blood supply
- Improves delivery of host defenses and antibiotics
- Decreases pain
- Changes oxygen tension and microenvironment
What is the tx for candidiasis
Nystatin suspension; ointment or Clotrimazole troches. Also Ketoconazole or Fluconazole tablets
What are the three major salivary glands in the mouth
Parotid
Submandibular
Sublingual
What are the 4 types of teeth
Incisor
Canine
Premolar
Molar
What are maxiallary vestibular and palatal abcesses primarily the result of
potential result of any infected maxillary tooth
Periodontal disease is always preceded by
Gingivitis
What are the features of masticatory mucosa
Keratinized and Parakeratinized Stratified Squamous Epithelium (KSS/PKSS)
Variable Lamina Propria
Reteridges(pegs)
Located on the gums
What is the undesurface of the hard palate covered in
Mucoperiosteum
What is the keystone pathogen in periodontal disease
Porphyromonas gingivalis:
• Non-motile, gram-negative, anaerobic rod
• Releases enzymes, collagenases and other substances which initiate the
inflammatory process
• Subverts host immune system
Chiefly responsible for bone loss
What is a class 1 dental classification
No dental needs
What is the oral vestibule
The vestibule is the space between the teeth and the inner mucosal lining of the lips and cheeks.
What is Fordyce granules
benign developmental variation of ectopic sebaceous glands found in normal buccal mucosa or commissures of lip
painless; rice-like, white or yellow-white, asymptomatic papules of 1-2 m
What is the most common type of gingivitis
Plaque associated gingivitis
What is the first layer that forms on the tooth
Dentin
How does a sinus tract present
- Typically non-painful
- Pimple-like bump on the oral mucosa
- Sinus tract may have drainage associated with it
• Tooth has no response to cold tests
Where do most various lesions occur
On the Inter proximal surface of primary teeth
What are the 4 tooth surfaces
Facial
Buccal
Lingual
Palatal
What is the lymph drainage for the anterior 2/3 of the tongue
Submandibular unilaterally & then deep cervical nodes
When does the AAPD (American Academy of Pediatric Dentistry) recommend establishing a dental home routine
Within 6 months of eruption of the first tooth and nlt 12 months of age
Why would you refer someone to a periodontist
Pocket depths 1-3mm? Knife-edged papillae? Scalloped, uniform color? Stippled? Firmly attached to bone? Healthy bone around all teeth on x-rays?
What are the 3 requirements for the formation of dental caries
- Cariogenic bacteria
(Streptococci mutans and Lactobacillus) - Sugar
- Available tooth surfaces
What is the RX for clindamycin
- Loading dose: 600mg
* Maintenance dose: 300mg, by mouth, every 6 hours for 7 days
What is benign migratory glossitis
Geographic tongue
Diffuse multifocal red lesions with white rims or edges that migrate
- Eroded areas due to loss of filiform papillae
- Typically asymptomatic; sometimes mild burning sensation
- Dorsal or lateral surfaces of tongue
What nerve supplies the intrinsic muscles of the tongue
Hypoglossal nerve,
The tongue is attached near CN 9
What is the only non shedding surface in the human body
Enamel
What is pericoronitis
– acute inflammation in the tissues surrounding the crown of a partially erupted tooth
• •
Etiology – trapped food/bacteria beneath gingival flap
What is clindamycin
• Use when patient is allergic to Penicillin • Bacteriostatic (suppresses protein synthesis) • Anaerobic bacteria • Penetrates bone
• Side effect: must instruct patient to stop use with first sign of diarrhea
(eight-fold increased risk of developing Clostridium difficile infection, compared to Penicillin, that can evolve into pseudomembranous colitis)
What is black hairy tongue
Diffuse white, yellow, brown or black pigmentation of tongue
• Elongation of filiform papillae; retention of papillae which grown longer
and don’t shed like normal
• Asymptomatic
Where does recurrent herpes manifest
attached gingiva and hard palate (keritinized tissue); external portions of the lip
What cranial nerve innervates the parotid gland
CN 9
Glossopharyngeal
What does saliva buffer the pH in the mouth to
PH 6-8
What are the three basic food processing functions of the teeth
Cutting
Holding/ Grasping
Grinding
What extrinsic muslce of the tongue does tongue elevation
Styloglossus and Palatoglossus
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Dentin has odontoblasitc processes that do what
responsible for growth and repair of dentin.
What is the last tissue of the tooth to form
Cementum
What does the term occlusion mean
is the relationship of the mandibular and maxillary teeth when closed or during excursive movements of the mandible; when the teeth of the mandibular arch come into contact with the teeth of the maxillary arch in any functional relationship
Where does the cementum receive nutrients from
The periodontal ligament (PDL)
What extrinsic tongue muscle does tongue depression
Hyolgossus and genioglossus
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What are the two prominent structures of the external mouth
Vermillion border (Edge of lip) And Commissures (Corners)
What are the 4 phases of plaque formation
- Pellicle formation
- Bacterial Attachment
- Young supragingival plaque forms
(Mainly gram positive cocci and rods) - Aged supragingivial plaque develops
(increase in the percentage of gram-negative anaerobic bacteria.)
What are the S/s of mucosal allergy
localized discomfort; circumscribed erythematous patches at the site of contact with the allergen
What is leukoplakia
white patch or plaque that cannot be characterized clinically or pathologically as any other disease
- The white patch does not rub off
- It is due to a thickened surface keratin layer
Is considered a precancerous sign
What are the S/s of a traumatic ulcer
rolled white border of hyperkeratosis at area of trauma
What are the S/s of gingivitis
- Edema
- Erythema
- Heat
- Pain
- Bleeding on probing
- Purulence
- Receding gingival margin
- Loss of stippling appearance
- Shiny
What are the three parts of the tongue
Oral (anterior 2/3)
Pharyngeal (posterior 1/3)
Base (throat and epiglottis)
What is support care for infection management
- Monitor/manage airway
- Analgesics
- Hydration
- Nutrition
- Rest
Describe the submandibular salivary glands
- Two lobes: superficial and deep
- Mixed secretions: 10% mucous and 90% serous through the Submandibular duct
- 60% of saliva produced
- Salivary amylase
- Gland that gleeks
What is pathological about subgingival plaque
- Tissue inflammatory factors
* Highly pathogenic factors
What is a Class II malocclusion
Mesiobuccal cusp of Maxillary 1st Molar is anterior to the buccal groove of the Mandibular 1st Molar
Over bite
Retrognathic
What are the Principles of severe infection management
removing the cause,
establishing drainage, and aggressive antibiotic therapy
What is intermediate restorative material made of..
- Zinc oxide (powder) and eugenol (liquid)
- Base or temporary cement
- Mechanical retention is needed to keep temporary restoration in place
What is the progression of Cavernous sinus thrombosis
Canine space infection- infra orbital space- to angular vein- CAVERNOUS SINUS THROMBOSIS
Why would you refer someone to a endodontist
Any sensitive or throbbing teeth? Any irreversible caries?
Any non-vital teeth with sinus tract present?
Any teeth need root canals
All 4 muscles of mastication are innervated by which CN
CN V3
Mandibular branch of CNV
IN the mouth what does the term distal refer to
Away from the midline of the dental arch
What do the sublingual glands produce
- Mostly mucous
- 8-20 ducts of Rivinus
• 5% of saliva produced
What does dental public health encompass/ do
preventing and controlling dental diseases and promoting dental health through organized community efforts.
What is the plaque development timeline
• Few minutes: acquired pellicle formation and bacterial adhesion
• 2 hours: initial plaque formation takes place with irreversible colonization of
aerobic gram positive bacteria
- 6 hours: supragingival plaque is well established
- 2 days: plaque doubles in mass
• 5-7 days: plaque maturation is dominated by and gram negative and
filamentous bacteria
• 21 days: bacterial re plication slows so that plaque accumulation becomes
relatively stable
What is the most common mid facial fx
Zygomatic complex fx
Depressed cheek bone (dimple)
- Bleeding into cornea of fractured side eye – eye will be bright red
- Restricted movement
What is augmentin
•Amoxicillin and Clavulanic Acid combination (Augmentin)
• Use when symptoms don’t improve with Amoxicillin alone
• This combo increases spectrum of amoxicillin in persistent infections
• Expensive
• Cautions: Potential for GI and hepatic toxicity due to severe anaphylactic
allergic reactions
What are the s/s of a periapical abscess
• Intense pain to palpation (as pus accumulates within the alveolus) • Extreme sensitivity to percussion • Localized edema • Tooth has no response to cold tests • Fever & chills (if systemic infection present
Name that disease
Inflamed soft and hard tissues
- Etiology: anaerobic bacteria
- Includes: alveolar bone, gingiva, and periodontal ligament (PDL)
Periodontitis
What are the S/s of alveolar osteitis
3-4 days post-extraction • Exposed, unprotected bone • Usually a mandibular third molar • Severe pain • Foul odor • Swelling & lymphadenopathy
What is a Periapical abscess
acute inflammation at the apex of a non-vital tooth
Etiology – bacteria (due to gross decay, dental trauma, large filling)
How can you reduce your risk of caries
• Teeth are brushed after eating to remove plaque and sticky foods
• Fresh fruit, vegetables, and whole grain snacks are chosen instead of
candy or juice
- Flossing is part of the daily oral hygiene regiment
- Parents maintain good personal oral health
What are the phases of tooth eruption
Pre-eruptive Eruptive -root formation -penetration -movement -occlusal contact
Post- eruptive
What are the characteristics of the intrinsic tongue muscles
Confined to tongue
No bony attachment
Consists of:
• Longitudinal fibers
• Transverse fibers
• Vertical fibers
Which teeth have a facial surface
Incisors and Canines
What is oral and Mario facial pathology
management of diseases affecting the oral and maxillofacial regions
oral pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical, or other examinations.
What is the difference between petechiae
Purpura
Eccymosis
- Petechiae: 1-2 mm
- Purpura: 2 mm -2 cm
- Ecchymosis: > 2 cm
What are the early warning signs of gingivitis
- Clinical signs of gingivitis
- Probing apical to the CEJ
- Radiographic evidence of bone loss
- Tooth mobility
- Pathologic migration of teeth
What is the artery that supplies blood to the tongue
dorsal lingual artery
When does the enamel being to form
6-8 weeks in utero
What is the treatment for a periapical abscess
I&d
Refer to dentist for possible root canal
What is a sinus tract
a pathway from an enclosed area of infection to an epithelial surface
What dental appliance increases the risk of gingivitis
Braces
Describe a orbital rim fx
significant force required due to thickness of bone;
palpable step defect along inferior orbital rim;
potential damage to Optic Nerve
Describe the pulp of the tooth
Pulp: composed of fibroblasts, odontoblasts; vascular, nervous, lymphatic components.
Contains Type I and II collagen
- Unmineralized
- Exits at the apex, but may have accessory canal
What are the S/s of primary hermetic gingivostomatitis
Usually seen in younger children
- Vesicles initially and progresses to ulcers with red halos
- Spreads during asymptomatic viral shedding in the saliva
- May have fever, malaise, and lymphadeopathy
What are the top three medication that cause Medication induced gingivitis
- Cyclosporine: immunosuppressant • Phenytoin: anticonvulsant
- Nifedipine: calcium-channel blocker
The parotid gland sits “on top” of what muscle
The Masseter
What is amoxicillin
- Antibiotic of choice for odontogenic infection
- Broad spectrum
- Bactericidal against gram-positive and gram-negative bacteria
- More readily absorbed from gastrointestinal tract than Pen VK
• Only 20% of absorbed amoxicillin is protein-bound in plasma, making it
more readily available
Why would you refer someone to oral surgery
Any extractions indicated? Impacted teeth present?
Bone fractures?
What is the largest muscle of mastication
The Temporalis
What does the parotid gland produce
- Serous saliva
- Produces ptyalin through the Parotid duct
• 30% of saliva production
What does supragingival plaque metabolize
Sacchorolytic: metabolize carbohydrates
What are the 4 muscles of mastication
Masseter
Temporalis
Medial pterygoid
Lateral pterygoid
When suturing facial lacerations that involve the mouth, where should you begin your suture
Begin closure at the mucocutaneous junction (vermillion border)
How many teeth are in primary dentition
20
Called baby teeth, or milk teeth
Sometimes deciduous teeth
Why would you refer someone to a prosthodontist
Need teeth replaced?
Crowns, veneers, bridges, dentures, implants?
What causes NUG (Necrotizing Ulcerative Gingivitis)
Physiologic stress & smoking
(WWI battlefield trenches)
After the initial infection, where does primary herpetic gingiviostomatisis reside
dormant in the CN5 sensory nerve ganglia of the oral and perioral regions
What is supragingival plaque made up of
- Mostly facultative anaerobes, gram-positive bacteria
* Streptococci and Actinomyces
Why would you refer someon to oral pathology
Any pigmented soft tissue lesions? Lips? Buccal mucosa or palate? Boney defects on x-ray? Salivary glands blocked? Changing moles?
What are the S/s of primary syphillis
- Painless
- Lesion with central depression (chancre) at site of inoculation
• Typically located on the face, tongue, lip, scalp, genitalia and rectal areas
Describe masciatory mucosa
25% of total mucosa.
Gingiva (free, attached and interdental) and tissues covering hard palate.
This is the primary mucosa to be in contact with food during mastication.
Masticatory mucosa is usually keratinized.
What causes glossitis
congenital malformations, vascular abnormalities, muscular
hypertrophy
What is a class 4 dental status
Dental status unknown (examination required annually)
Describe the pellicle
the acellular layer of salivary proteins, mucins and other macromolecules on oral surfaces;
-approximately 10 micrometers thick
What bacteria causes syphillis
Treponema pallidum
What is the most common place for the mandible to be fx
The condyles
What is gingivitis
Inflammation limited to the soft tissues which surround the teeth
- Also called “early gum disease”
- A precursor of advanced gum disease (periodontal disease)
- Inflammation extended into the alveolar process, PDL, and/or cementum
Name that disease:
Inflamed soft tissues in the mouth
- Etiology: bacteria; poor oral hygiene; injury; immunocompromised
- Reversible
Gingivitis
Who would you refer a pt with periodontal disease to
Periodontist
Registered dental hygienist
What is the function of the lateral pterygoid muscle
Protrusion, retrustion, depression, of the mandible
The caries process is reversible all the way up until…
Dentin becomes involved
What does the term eruption refer to
is the movement of the tooth from its developmental position to the occlusal plane
When should a oral health evaluation for an infant occur
Before the 1st bday
What is mixed dentition
occurs when both primary and permanent teeth are present, usually between the ages of 6 to 12 years.
What are the S/s of secondary syphillis
Painless
• Grayish-white plaques covering ulcerated mucosa (mucous patches)
which appear about 4-10 weeks after the primary chancre appeared
• Mucous patches have many forms and may erupt on the skin and/or
mucous membranes
• Rash on palms of hands, feet, body
• Painless lymphadenopathy, sore throat, malaise, headache, weight
loss, fever, and muscloskeletal pain
• Highly infectious
When would antibiotics not be indicated
- Chronic, well-localized abscess or dental sinus tract (fistula)
- Alveolar osteitis (dry socket) without systemic problems
- Pericoronitis without systemic problems
- Vestibular (buccal) abscess without systemic problems
- Routine root canal treatment
NOTE ‘WITHOUT” SYSTEMIC PROBLEMS
What are the key features of lining mucosa
Non-Keratinized Stratified Squamous Epithelium (NKSS)
LaminaPropria-loose connective tissue (CT) with collagen bundles
Mucous and serous glands
Found in the lips and cheeks
What is subgingivcal plaque made up of
• Mixed, facultative and strict anaerobic bacteria
• Gram-negative predominates with some gram-positive species and
spirochetes present
In spacial infections the location of where the abcess forms is dependent on what?
where the muscle attachment is in relationship to the location of the root apex.
Describe healthy gingiva
Uniform color, knife-edge; scalloped, firm, stippled
Which teeth have a lingual surface
The posterior incisors and canines
And the bottom interior premolars and molars
The top premolars/ molars do not have a lingual surface
What does the serous component of the pellicle provide
enzymes and proteins for digestion and antibacterial activity
What are the 5 ranges of taste on the tongue
bitter, sour, salty, sweet, and umami.
Generally found around the anterior 2/3 and along the edges.
How is smokeless tobacco keratosis reversible
reversible within 2 weeks after cessation
What ABX should you use when amoxicillin does not improve the pts condition
Amoxicillin and Clavulanic Acid combination (Augmentin)
What is smokeless tobacco keratosis
mucosal tissues affected by smokeless tobacco and snuff
• Signs & symptoms: whitish, wrinkled, mucosa in mandibular vestibule; exact site of tobacco placement
What is the nerve supply to the anterior 2/3 of the tongue
General sensations (lingual nerve) CNV
Taste (Chorda Tympani)
CNVII
What is the second layer of the tooth to begin forming
The enamel
What is the leas likely place for the mandible to be fx
Coronoid
What is a mucocele
traumatic rupture of a minor salivary duct and accumulation of saliva in the adjacent tissue
• Signs & symptoms: soft; painless; may fluctuate in size
What is the function of the Masseter muscle
Elevates the Mandible
For crushing and grinding and chewing
What does the caries process involve
• Involves demineralization of the enamel, dentin and/or cementum
• Bacteria within dental plaque metabolize fermentable carbohydrates into
organic acids
• Below the critical pH proteolytic enzymes break down the organic component
(dentin/cementum)
What part of the tooth recieves nutrients from the pulp
The dentin
What is hairy leukoplakia
Parallel hair-like, vertical white lesions; may be bilateral on the lateral surface of the tongue
- Surface of lesion is frequently infected with Candida albicans
- Etiology: Epstein-Barr virus
- History/diagnosis: Exposure to HIV
Tx: acyclovir
What are bucal maxillary infections primarily a result of
infected maxillary and mandibular molars and premolars
What is the tx for alveolar osteitis
local anesthesia;
remove all sutures & irrigate with warm saline;
place Peridex (chlorhexidine) oral antimicrobial rinse in syringe for patient’s home irrigation;
analgesics for 1 week.
If dry socket paste is used, it must be changed every 24 hours
What is the most numerous type of papillae on the tongue
Filiform and they lack taste buds
How is enamel formed
Ameloblasts lay down collagenous matrix which is mineralized by alkaline phosphatase.
Enamel proteins are then removed to leave only mineralized tissue.
What is a lefort III fx
Craneofacial dysfunction
Define endodontics
branch of dentistry which is concerned with the morphology, physiology and pathology of the human dental PULP and periradicular tissues.
Patients with the following symptoms should be referred to OMFS as soon as
possible
24 hours of painful and increased swelling, difficulty breathing,
difficulty swallowing, severe trismus, fever
Which teeth have a palatal surface
The top premolars and morals
What extrinsic tongue muscle does tongue protrusion
Genioglossus
Publix’s Gives
What is the hardest tissue in the body
Enamel
What is the nerve supply to the posterior 1/3 of the tongue
General and taste
CN IX
What is a class I occlusion
Mesiobuccal cusp of Maxillary 1st Molar aligns with the buccal groove of the Mandibular 1st Molar
Normal
Which teeth have a buccal surface
Premolars and Molars
What does the term dentition describe
The term dentition is used to describe the natural teeth in the jawbones.
Can be :
• Primary
• Mixed
• Permanent
What is xerostomia
Decrease saliva production
Can be from
• Systemic diseases
• Salivary gland damage from surgery or radiation therapy
• Medication side-effects
What is the progression of submandibular space infection to airway obstruction
Submandibular space- submental space- contralateral submandibular space- sublingual space - ludwigs angina- AIRWAY OBSTRUCTION
What does subgingival plaque metabolize?>
Asacchorolytic
metabolizes peptides
What extrinsic tongue muscle does tongue retraction
Styloglossus
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What is a Class III malocclusion
Mesiobuccal cusp of Maxillary 1st Molar is posterior to the buccal groove of the Mandibular 1st Molar
Under bite
Prognathic
What is specific about attached gingiva
Keratinizedcells
STIPPLED;
separated from the alveolar mucosa by the mucogingival junction (groove).
Attached to the tooth by the junctional epithelium.
What is a fibroma
firm, solitary, circumscribed nodule on buccal mucosa, labial mucosa, tongue, and gingiva
• Etiology: reactive hypersplasia of fibrous connective tissue in response to trauma
What is the function of the Temporalis muscle
Elevates and retracts the mandible
Light chewing forces
How do you treat NUG
Chlorhexidine and ABX
What medication should you use if the pt is allergic to penicillin
• Clindamycin
What is the lymph drainage for the posterior 1/3 of the tongue
Deep cervical nodes
What is hemangioma
vascular anomaly
• Signs & symptoms:
- If superficial the tissue may be red, blue, or purple
- Asymptomatic
- Blanches when touched
What is the trigger that stops tooth erruption
Occlusal contact
What is the function of supragingival plaque
- Sacchorolytic: metabolize carbohydrates
- Acidogenic: excrete acid (lactate and formate)
- Excrete Extracellular Polymeric Substance
- Results in decreasing oxygen tension as plaque matures
HWat is the span of the Temporalis
Temporal fossa to the body of the mandible
What is línea alba
white ridge of raised tissue that appears horizontally and bilaterally
• Etiology: benign hyperkeratosis of the buccal mucosa where the maxillary and mandibular teeth meet
What are the potential spacial infections
Buccal Vestibular Palatal Sublingual Submandibular
Describe the process of pellicle formation
Forms within 30 minutes after brushing
Planktonic bacteria initially attach to sticky surface
a firm anchorage between bacterium and surface will be
established by specific interactions: covalent, ionic, or hydrogen bonding
What are lingual varicosities
• Blue area usually on floor of mouth or ventral side of tongue
- Surface of the tongue
- Asymptomatic
- Blanches upon pressure
- Usually seen in an older population
What is an apthous ulcer
Shallow ulcer with an erythematous halo, occurs singly or multiples
• Very painful; lasting from 10-14 days
• Occurs on non-keratinized oral tissues (oral mucosa and soft palate,
inner surface of the cheeks, tongue, and soft palate)
What can cause Petechiae, Purpura & Ecchymosis
hemorrhages in the tissues; asymptomatic
trauma, systemic disease, platelet/clotting disorders; mononucleosis
What are canine infections primarily a result of
Infected mxiallary canines
What is a ranula
defect/blockage in a major salivary duct causing accumulation of saliva in the tissues
• Etiology: typically caused by sialolith (salivary duct stone) or local trauma
to the salivary gland duct
What are 3 Common dental infections
periapical, periodontal, and pericoronal
What are the 4 types of papillae
• Filiform – anterior 2/3 of tongue; fine hair-like projections
• Fungiform – anterior 2/3 of tongue; appear as round red, raised
spots
• Circumvallate – appear in a “V-shaped” row near posterior part of the
tongue
• Foliate – located on posterior lateral border of the tongue
What is the tx for pericoronitis
local anesthesia;
antiseptic (saline) lavage to remove trapped debris;
analgesics;
antibiotics if fever present;
refer to dentist for removal of gingival flap or extraction
What are the S/s of glossitis
Enlargement of the tongue
- Tongue protruding from mouth; inability to close lips together
- Seen in amyloidosis, Down Syndrome, Beckwith-Wiedemann Syndrome and hypothyroidism
What are the ducts of the sublingual glands called
The ducts of rivinus
What is specific about the marginal/ free gingiva
Keratinized Cells
; NOT STIPPLED;
bound on inner margin by the gingival sulcus, which separates it from the tooth;
bound on its outer margin by the oral cavity; and apically by the free gingival groove.
What is the “life threatening séquelea”
Septicemia
Airway obstruction
Cavernous Sinus Thrmobosis
Ludwigs Angina
What is dentin composed of
Composed of:
• 70% Hydroxyapatite
• 20% Organic
• 10% Water
Define oral and maxillofacial radiology
discipline of radiology concerned with the production and interpretation of images
What are the 4 types of papillae on the tongue
- Filiform
- Fungiform
- Circumvallate
- Foliate
Found on the anterior 2/3 of tongue
What is a melancytic nevus
intraoral mole or freckle
• Signs & symptoms: brown, blue, or black pigmented lesion usually less
than 0.5 cm in diameter; usually raised with a smooth surface
What are common irritants that lead to Allergic gingivitis
Cinnamon or lauryl sulfate
What are the 4 functions of the pellicle
Protective barrier
Lubrication
Preventing Tissue Desiccation
Substrate to which bacteria attaches
Describe canines
located at the corner of the arch.
They are designed for cutting and tearing foods, which require the application of force.
What is non surgical therapy for periodontal disease
- Supra and sub-gingival scaling & root planing every 3 months by licensed RDH
- Antibiotics placed directly into the periodontal pocket (sulcus)
- Proper rest, diet, and exercise
- Elimination of smoking or traumatic occlusion
What are the structures of the gingival tissues
Attached gingiva
Interdental Gingiva
Free or Marginal Gingiva
(Includes gingival sulcus)
What are the 4 extrinsic muscles of the tongue
- Palatoglossus
- Genioglossus
- Hyoglossus
- Styloglossus
Describe the periodontal ligament
Fibrous connective tissue
(Type I collagen) that joins the cementum of a tooth to alveolar bone
- Supportive function
- Remodeling function
- Sensory function
- Nutritive function
What is pyogenic granuloma
a reactive lesion
- Red, elevated, soft, bleeds easily
- Usually located at interproximal papillae
Can be from normal changes, like pregnancy
What is lichen planus
benign developmental variation of normal buccal mucosa
• Signs & symptoms: white or yellow thin lines form a lace-like pattern
bilaterally on buccal mucosa; can involve skin and feet; typically
asymptomatic
• Pathognomonic sign: Wickham’s Striae
• Etiology: considered an auto immune response due to damage to the
basal cells of oral epithelium
Can be asymptomatic for erosive
What is the Tx for malignant melanoma
- Appropriate surgery and chemotherapy
- Extremely aggressive form of cancer
• Patients with oral mucosal lesions generally have poor prognosis (5
year survival rate between 10% - 25%)
Describe Tannerella forsythia
Part of the Red Bacterial Complex in periodontal disease
- Gram-negative, obligate anaerobe, spindle shaped, pleomorphic
- Forms biofilm
- Surface layer protein adhesion to epithelial cells and is tissue invasive
- Produces cysteine proteases
- Subverts host immune system
What are the 3 classes of sutures
Collagen
Synthetic absorbable
Non absorbable
What is angular chelitis
dry cracks in the labial commissures, may be bilateral
• Etiology: Candida albicans fungal infection; excessive sun exposure;
anemia; loss of vertical dimension (denture wearing patients)
Describe molars
much larger than premolars.
The molars have more cusps than other teeth that are used to chew or grind up food.
There are two sets of molars in the primary dentition and three sets of molars in the permanent dentition.
(1st, 2nd, and 3rd Molars)
3rd Molars = Wisdom Teeth
What is epulis fissuratum
painless; excessive nodular tissue that may have a crease where the denture sits
• Etiology: reactive hyperplasia of fibrous connective tissue caused by chronic irritation from a denture flange
What is a periodontal abcess
acute inflammation in the sulcus of a periodontal pocket
• •
Etiology – Pre-existing periodontal lesion, vital tooth
Describe a nasoorbital ethmoid complex fx
displaces the medial canthal ligament and widens the intercanthal distance
Development of what tooth tissue results in the eruption of the tooth
Cementum
What are the primary maxillary spaces for infection
Canine
Buccal
Vestibular Abcesses
Palatal Abscesses
What are the S/S of a periodontal abscess
• Throbbing pain
• Edema localized to attached gingiva but involves bone and PDL
attachment
• Gingival enlargement is typically lateral to tooth
• Pus extruded upon probing
• Mobile tooth
• Foul taste
What causes mediation induced gingivitis
Gingival hyperplasia (overgrowth)
Excess collagen (decreased degradation)
What is the depth for a healthy Periodontal pocket
3.5mm or less
Premolars are also know as
Bicuspids
What should you never do in a tooth avulsion
Never scrub root surface.
This will injure PDL cells and cementum will
not reattach to the alveolar bone
Which salivary gland produces the most percentage of saliva
The submandibular glands
What is the #1 cause of tooth loss in adults
Periodontal disease
Why would you refer someone to a orthodontist
Are the teeth aligned properly? Is there an overjet, overbite, crossbite? Severe crowding or rotations? Narrow palate? Skeletal malalignment?
What is the span of the medial pterygoid
Sphenoid bone to the medial surface of the mandibular ramus
What is the span of the lateral pterygoid
Pterygoid plate, phenolic bone to articular disk
What is candidiasis also known as
Thrush
What are the 4 types of gingivitis
- Plaque-associated gingivitis
- Necrotizing ulcerative gingivitis (NUG)
- Medication-influenced gingivitis
- Allergic gingivitis
What is the most common site for oral cancer
Lateral border of the tongue
What is the pathology associated with the Masseter muscle
Over grinding (bruxism)- leads to hypertrophy, could reduce/ occlude the parotid gland
What is fissured tongue
Numerous shorter fissures radiating out, bilaterally
• Seen in Melkersson-Rosenthal Syndrome, Down Syndrome and
patients with xerostomia
• Etiology: developmental; may be inherited or may occur as a result of underlying condition
What is a class 2 dental class
There are dental treatment needs, but they are not predicted to
cause a dental emergency within 12 months
Describe premolars
are a cross between canines and molars.
The pointed cusps hold and grind food.
They have a broader chewing surface for chewing.
There are two sets of premolars in the permanent dentition and NO premolars in the primary dentition.
(1st and 2nd Premolars)
What is ankyloglossia
Short and thick lingual frenum which is attached too far forward on the tip of the tongue, limiting the movement of the tongue
• This condition can cause speech difficulties
How does allergic gingivitis present
Bright erythema and loss of stippling
What makes up 90 % of all oral cancer
Squamous Cell Carcinoma
(90% of all oral cancer)
flat squamous cells arranged like scales
What is “tori”
variation of normal that is composed of normal bone and covered by normal mucosal tissue
• Location: hard palate of maxilla and/or lingual side of teeth in mandible
What nerve supplies the palatoglossus muscle specifically
The vagus nerve
describe treponema denticola
- Gram-negative; anaerobe
- Motile spirochete, pleomorphic
- Travels in viscous environment
- Produces proteolytic enzymes that degrade collagen
- Subverts host immune system
- Tissue invasive
- Slow growth phase (weeks to months)
- Unable to biosynthesize fatty acids, migrates to fuel rich sites
- Found in periocoronitis sites and NUG
What is the roof of the oral cavity and what are its two parts
The palate
Hard/ soft
How does NUG present
• Blunted, punched-out interproximal papillae
• Gray pseudomembrane;
fetid odor;
severe pain;
spontaneous bleeding
What sutures would you want to use on a laceration closure on the mouth/ face
Start at vermillion border with lips
- Muscle layer 3-0 or 4-0 (absorbable)
- Subcutaneous 4-0 or 5-0 (absorbable)
- Epithelium 6-0 nylon (non-absorbable)
- Avoid silk on skin (non-absorbable)
- Braided fiber causes acute inflammation and scarring
What is the radiography for pericoronitis
impacted or erupting mandibular third molar
Define oral and maxilllofacial surgery
diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
What is a prosthodontist
specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or oral and maxillofacial tissues using biocompatible substitutes.
Describe a blow out fx
orbital rim remains intact but a crack forms in the thin bone in the floor of the socket.
Muscles and other structures can become entrapped and prevent the eyeball from normal movements.
What are the principles of infection management
• Call the oral surgeon • Remove the cause (ie. Extract tooth or begin root canal) • Establish drainage (I & D) • Antibiotic therapy • Follow-up • Supportive care
Describe unhealthy gingiva
Cardinal signs of inflammation
- Dolor (pain)
- Calor (heat)
- Rubor (redness)
- Tumor (swelling)
- Functio laesa (loss of function)
What are the risk fx for candidiasis/ thrush
Local – topical steroids, patients using broad-spectrum antibiotics,
xerostomia, heavy smoking, denture appliances
• Systemic – poorly controlled diabetes mellitus, immunosuppression,
leukemic patients, infants (underdeveloped immune system)
What are the three TMJ dislocation techniques
Hippocrates
Wrist pivot
interdental
What are the S/s of malignant melanoma
Painless; rapidly enlarging pigmented lesion
- Larger than 6 mm in diameter; irregular margins
- Etiology: malignant neoplasm of melanin-producing cells (melanocytes)
What is the nerve that supplies the extrinsic muscles of the tongue
All supplied by the Hypoglossal Nerve (except the Palatoglossus Muscle)
What is vertical transmission of caries
S. mutans is transmitted from the primary caregiver to infant by saliva
Transmission rates increase when parents:
• Share utensils or toothbrushes
• Taste food or drink before serving it
• “Clean” a dropped pacifier with saliva
• Allow a child to place fingers into an adult’s mouth
In what direction does dentin grow
Inwards towards the pulp
What is the span of the Masseter muscle
Zygomatic arch to the angle of the mandible
What does premature contraction of the lateral pterygoid muslce cause
TMJ shifting
What is the function of the medial pterygoid muscle
Elevates, protrudes, and laterally shifts the mandible
What is a lefort II fx
Pyramidal fx
What S/s prompts immediate referral to Oral Maxillofacial Surgeon?
- Difficulty breathing
- Difficulty swallowing
- Severe trismus
- 24 hour painful swelling
- Fever
- Not responding to treatment or antibiotics
What are the S/s associated with a Severe infection
• Loss of function (ie. Trismus, paresthesia) • Regional lymphadenopathy • Febrile • Elevated white blood cell count • Tachycardia • Tachypnea • Dehydration • Malaise
Define oral medicine
Oral Medicine is the discipline of dentistry concerned with the oral health care of MEDICALLY COMPETENT PTS - including the diagnosis and management of medical conditions that affect the oral and maxillofacial region.
Does gingivitis result in tooth loss
No
What is the lymphatic drainage for the tip of the tongue
Submental nodes bilaterally &
then deep cervical nodes
Describe incisors
single-rooted teeth with a relatively sharp thin edge referred to as the incisal edge.
Located in the front of the mouth, they are designed to cut food without the application of heavy forces.
Central incisors are the front teeth on each side of the midline and lateral incisors are distal to the central incisors.
What are the three types of mucosa in the mouth
Masicatory
Lining mucosa
Specialized mucosa
What are the first two colonizers of plaque
non-mutan streptococci and Actinomyces species
What is the 1st choice ABX treatment for odontogenic infections
Amaxocillin
How does saliva protect against caries
- Saliva buffers acid pH 6-8. Enamel begins to demineralize at pH 5.5
- Saliva is bacteriostatic: IgA, lysozyme, lactoferrin, histatins, peroxidase
• Saliva aids in remineralization of teeth; supersaturated with Ca, PO4,
bicarbonate, and F
What are the S/s of a sever oral or peri oral infection
• Difficulty breathing
• Difficulty swallowing
• Severe trismus
• 24 hour painful swelling
• Fever
• Not responding to treatment or antibiotics
***Refer to an Oral Maxillofacial Surgeon immediately
What is possible if a hematoma doesnt heal within two weeks
Possible blood dyscrasia
What is the structure of enamel
Enamel has a rod or crystaline structure
Composed of:
97% Hydroxyapatite
3% Other
What is the vein that drains blood from the tongue
The lingual vein that drains into the internal jugular vein
How do you mange soft tissue injuries to the lip
If using 2 layer closure: use absorbable sutures on inner muscle layer first; close skin second
• Suture at vermillion border first, approximating the tissue for primary closure
What are the 4 steps of an I&D
• Establish anesthesia by nerve block or wide infiltration
(not directly into swelling)
- Incise into area of maximum fluctuance
- Blunt dissection and copious irrigation with saline
- Insert and stabilize a drain (if needed)
What is a squamous papilloma
painless; usually a solitary, white, papillary lesion
attached with a pedunculated (narrow stem) base and fingerlike projections
• Etiology: local trauma and human papillomavirus (HPV-6 and HPV-11)
What are the S/s of a blow out fx
Localized hemorrhaging • Double vision • Lowered globe • Restricted movement of involved eye • Enophthalmos (Posterior displacement of the eye)
What does permanent dentition refer to
Permanent dentition refers to the 32 secondary or “adult” teeth.
What is exostosis
variation of normal that is composed of normal bone and covered by normal mucosal tissue
• Location: buccal side of maxillary and mandibular teeth
What are the two chief cardiogenic bacteria responsible for caries
Streptococci mutans and Lactobacillus
What are canines also known as
Cuspids
What are the spaces for primary mandibular infections
• Submental (mandibular incisors)
• Buccal (primarily as a result of infected maxillary and mandibular molars
and premolars)
• Submandibular (mandibular premolars & molars)
• Sublingual (mandibular premolars & molars)
• Vestibular abscess
How do caries first present
First seen as a chalky white spot, its appearance is due to loss of translucency of subsurface enamel rods due to demineralization
What is the soft palate composed of?
- Muscle fibers
- Lymphoid tissue
- Glands
- Blood vessels
- Nerves
What is the loading and maintenance dosing for Amoxicillin
- Loading dose: 1000mg
* Maintenance dose: 500mg, by mouth, every 8 hours for 7 days
What all is covered by lining mucosa
Vestibule
Ventral side of tongue
Soft palate
What does the term exfoliation mean
is the process by which the root(s) of the primary tooth/teeth are resorbed until so little root remains that the primary tooth falls out
Describe specialized mucosa of the mouth
15% of total mucosa.
Covers dorsal tongue and composed of cornified and non-cornified epithelial papillae.
What are the S/s of squamous cell carcinoma
• Deep-seated ulcerated mass; often firm (indurated) adjacent tissues
to palpation
• Possibility of local pain, referred pain (often to ear), and parasthesia
(often lower lip)
What are the 5 stages in caries development
- healthy tooth with plaque
- Initial demineralization
- Advanced demineralization
- ,decay in dentin (irreversible)
- Decay in pulp
What is verruca vulgaris
painless; usually a solitary, white, papillary lesion attached with a pedunculated or sessile (flat and broad) base
- Often occurs on labial mucosa and tongue
- Contagious
- Etiology: Infection caused by the human papillomavirus (HPV-2 and HPV-4)
What bones form the palate
The palatine process of the maxilla
The horizontal plates of the palatine bone
How do you treat a apthous ulcer
Avoid acidic foods or other known irritants; reduce stress
• Topical steroid (Kenalog or Orabase and/or Decadron elixir rinse qid) applied to affected area
Salivary Ca2+, PO4^3-, and F- lead to what in the mouth
Remineralization
What is nicotinic stomatitis
benign developmental variation of normal buccal mucosa
- Signs & symptoms: rough, white inflamed openings to minor salivary glands on the palate
- Etiology: heat generated from pipe or prolonged tobacco exposure changes the palate
Does a hematoma blanch?
NO
How does enamel remineralize
Caries begins as a subsurface lesion which can be remineralized as long as the surface remains intact
• Supersaturated salivary calcium and phosphates in the presence of fluoride* can slowly remineralize the demineralized enamel
What is the first step in the development of a biofilm
Attachement to the tooth surface
Periodontal disease in the inflammation of what structures
- Gingival tissues
- PDL attachment
- loss of Alveolar bone
Describe the histology of the vermilion border
Junction between the skin and mucous membrane
Stratified squamous epithelium
Epithelium is thin
What is the function of the intrinsic tongue muscles
To alter the shape of the tongue
What are the 4 indications for Antibiotic use in infection
- Diffuse swelling with systemic problems (fever)
- Fascial space infections
- Cellulitis
- Compromised host defenses
What is cementum composed of
50% Hydroxyapatite
50% Organic and Water
What are the smallest salivary glands called
The sublingual glands
What is a melanotic macule
painless; circumscribed tan to brown macule typically less that 0.5 cm in diameter
• Etiology: genetics; solar radiation
Where do the “early colonizers” of plaque form from
(non-mutan streptococci and Actinomyces species)
-use oxygen and lower the reduction-oxidation potential of the environment
which then favors the growth of anaerobic species as the biofilm matures
Define dental anesthesiology
discipline of anesthesiology encompassing the art and science of MANAGING PAIN, anxiety, and overall patient health during dental, oral, maxillofacial and adjunctive surgical or diagnostic procedures throughout the entire perioperative period.
What is the PRIMARY bacterial species in caries development
Streptococcus mutans group
but many other bacteria have also been implicated, including Actinomyces and Lactobacillus
Allow how many days for absorbable sutures
5-7 days
What is the most important muscle for speech articulation
The tongue
When should an avulsed tooth be reimpanted
Within 1 hour or less
What is an amalgam tattoo
blue/purple discoloration of the alveolar soft tissue
• Etiology: accidental implantation of material such as amalgam
What are the S/s of pericoronitis
- Throbbing pain radiating to ear, throat, or floor of the mouth
- Foul taste
- Trismus; facial edema
- NUG-like necrosis may occur
What is the largest salivary gland in the mouth
The parotid gland
What are the S/s of inflammatory papillary hyperplasia
painless; multiple, erythematous nodules on palatal vault
• Etiology: from ill-fitting maxillary denture; poor oral hygiene, with potential of an overlying candidiasis infection
What are “secondary colonizers” in plaque
are the microorganisms that do not initially colonize clean tooth surfaces, including Prevotella intermedia Prevotella loescheii Capnocytophaga spp., Fusobacterium nucleatum, Porphyromonas gingivalis.
What is the second function of the tongue
Taste
What is the function of saliva
- Keeps the mouth moist
- Aids in swallowing
- Aids in speech
- Keeps the mouth and teeth clean
- Antimicrobial action
- Digestive function
- Bicarbonate acts as a buffer
What is a periodontist
dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes
What are the characteristics/ functions of the extrinsic tongue muscles
Function: helps in movements of tongue
Connects the tongue to the surrounding structures:
-soft palate and bones
mandible, hyoid bone, and styloid process
What is surgical intervention of periodontal disease
- Pocket defects > 5mm
- 2-6 months after non-surgical therapy
- Irreversible (regenerative techniques available
How does plaque develop, detach and recolonize?
Quorum sensing
What are 4 risks of antibiotic therapy
- Allergy
- Toxicity
- Clostridium difficile infection
- Development of resistant strains
What is the treatment for a periodontal abcesses
local anesthesia;
incision through mucosa or drainage through the sulcus;
analgesics; if fever present prescribe antibiotics;
soft diet;
warm salt water rinses;
refer to dentist for scaling & root planning (every 3 months)
How do you place IRM in a tooth
• Roll the prepared IRM into a cone-shape
• Place the shaped IRM onto the end of a
dental instrument
• Distribute the IRM by spreading it from
the center to the side
• Remove excess IRM with dental
instrument or wet cotton tip applicator
• Have patient bite down and move
mandible from left to right (while IRM is
still soft)
• Moisture helps the IRM set
Define orthodontics
diagnosis, prevention, interception, and correction of malocclusion, as well as neuromuscular and skeletal abnormalities of the developing or mature orofacial structures.
What is a “caries”
Caries is an infectious transmissible disease process resulting from oral bacteria that metabolize sugars to produce acids which intermittently demineralize tooth structure and, if left untreated, can progress to a cavity (carious lesion)
What are the 4 types of impactions
Angular
Partial eruption
Horizontal
Vertical
What does the term medial refer to
Towards the midline of the dental arch
