Dentistry in a Nutshell Flashcards

1
Q

what things must you talk to the patient about to ensure you are obtaining valid consent (not AMCUR related)

A

why treatment necessary
what might happen if treatment is not carried out
treatment options - risks and benefits
recommended option
cost
duration
likely prognosis
whether treatment is guaranteed

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2
Q

what tests can you do quickly when the patient comes in with toothache

A

visual
air from 3 in 1
palpation
probing
percussion
vitality
mobility
tooth sleuth

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3
Q

apart from the usual endodontic diagnoses for pain, what other reasons may a patient have pain

A

hypersensitivity
dry socket
TMJ pain
oral ulceration
necrotising gingivitis
sinusitis
orthodontic problem
salivary gland infection
ill/loose fitting dentures

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4
Q

what is the immediate management for adults with dental infections

A

establish drainage
extirpate if endodontically involved
debride pockets if periodontally involved
prescribe antibiotics if indicated
recommend analgesia
consider extraction

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5
Q

what are the indications for antibiotics

A

limited mouth opening
facial swelling
systemic infection
immunocompromised patient
elevated temperature >38 degrees

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6
Q

when would you refer to maxfax/a&e

A

difficulty breathing/likely to obstruct airway
involvement of orbital area/closure of eye
difficulty in swallowing/unable to stick tongue out
swelling rapidly increasing in size
evidence of infection in facial spaces (ludwigs angina)

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7
Q

what is the dose of penicillin for dental infections

A

phenoxymethylpenicillin 250mg
2 tablets 4x daily for 5 days

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8
Q

what is the dose of metronidazole for periodontal abscesses

A

metronidazole 400mg
1 tablet three times a day for 5 days

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9
Q

what is the dose of metronidazole for pericoronitis and ANUG

A

metronidazole 400mg
take one tablet three times day for 3 days

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10
Q

when the patient is complaining of post extraction pain what extra oral exam do you do

A

pyrexia
lymphadenopathy
bruising
trismus
step deformity

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11
Q

when the patient is complaining of post extraction pain what intra oral exam do you do

A

visual
tactile
inspect socket for healing status
debris
clot
pus
bone sequestra
necrosis
tender/damaged adjacent tooth

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12
Q

what are the differential diagnoses when a patient is complaining of post extraction pain

A

dry socket
retained root/bone
infection
LA related trauma
haematoma
MRONJ
OAC
ORN
fractured maxillary tuberosity
step deformity
dislocated/fractured mandible

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13
Q

what symptoms may someone have if they have a cracked tooth

A

pain on biting
localised pain/sensitivity to cold

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14
Q

what are the signs of a cracked tooth

A

lymphadenopathy
visible fracture
interferences in occlusion
toothwear
heavily restored dentition
swelling

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15
Q

what are the special investigations for a cracked tooth

A

sensibility testing
radiographs
percussion
tooth sleuth

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16
Q

before deciding that a patient has a cracked tooth, what other diagnoses must you rule out

A

periodontal and periapical issues
dentine sensitivity
facial pain
apical pathology
high restoration

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17
Q

if a cracked tooth does not extend to the pulp chamber floor how do you manage it

A

restore with composite/temp crown with occlusal reduction
assess after 2-3 months
if symptomatic after this time then RCT with crown or extract

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18
Q

if a cracked tooth has cracked subgingivally and there is insufficient coronal tissue what is the treatment

A

extract as this is hopeless

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19
Q

if a tooth is cracked and it extends to the pulp chamber floor and is restorable what is the treatment

A

RCT and crown

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20
Q

what are the symptoms of pericoronitis

A

pain on biting
localised pain
pyrexia
may struggle to open mouth wide

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21
Q

what are the signs of pericoronitis

A

inflamed operculum
signs of trauma
trauma from opposing tooth
swelling
lymphadenopathy

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22
Q

what is the management of pericoronitis

A

debride around inflamed tooth
irrigate with saline and instruct patient how to perform OH
consider adjusting traumatic occlusion/extracting upper tooth
antibiotics if spreading infection/trismus
review

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23
Q

what are the signs and symptoms of dry socket

A

pain 24-48 hours post extraction
inflamed non-healing socket
lost blood clot
trapped food debris or bad taste/odour

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24
Q

what are the risk factors for dry socket

A

smoking
alcohol
immunocompromised
female
oral contraceptive
mandibular
posterior teeth
previous dry socket
poor compliance with post op instructions
traumatic extraction

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25
what is the management of dry socket
curette socket irrigate with saline and instruct OH pack the socket with alvogyl (eugenol based dressing) advise good OH and smoking cessation if available review after 1 week
26
if a patient attends with a swelling what do you look for extra orally
site hard/soft eye affected redness temperature difficulty breathing trismus difficulty swallowing drainage lymph nodes examination
27
if a patient attends with a swelling what do you look for intra orally
associated tooth hard/soft swelling mobility drainage pocket depth percussion test palpation test sensibility test fractured tooth/filling
28
if a patient has a swelling and there is apical pathology on the radiograph what are the differential diagnoses
periapical periodontitis perio-endo lesion periodontal abscess periapical cyst
29
if a patient has a swelling and there is no apical pathology on the radiograph what are the differential diagnoses
salivary gland obstruction/infection pericoronitis fractured jaw fractured tooth malignancy bony diseases tumour tori
30
what are the signs/symptoms of acute apical abscess
localised pain pain increases on chewing/touching tooth quick onset of swelling and pain possible mobility
31
what is the immediate management of acute apical abscess
establish drainage analgesia antimicrobials if indicated consider relieving occlusion
32
what is the long term management of acute apical abscess
review definitive treatment RCT/XLA
33
what are the signs/symptoms of perio-endo abscess
generalised periodontitis with localised pain swelling deep pocketing to root apex
34
what is the immediate management of perio-endo abscess
debride pockets irrigate chemical plaque control establish drainage antibiotics
35
what is the long term management of perio-endo abscess
review OH decide if the cause is initially perio or endo and treat accordingly
36
what are the signs/symptoms of salivary gland obstruction/infection
pain in major salivary gland swelling history of dehydration history of xerostomia
37
what is the immediate management of salivary gland obstruction/infection
analgesia advise patient to increase fluid intake use warm compress on gland massage gland encourage salivary flow consult with GMP to consider changing medication refer to medical centre in severe cases
38
what is the long term management of salivary gland obstruction/infection
saliva substitutes high caries risk prevention protocol
39
what are the signs/symptoms of periodontal abscess
pain/tenderness of gingiva increased mobility gingival swelling suppuration from gingiva systemic symptoms include pyrexia, lymphadenopathy and malaise
40
what is the immediate treatment of a periodontal abscess
LA and supra and subgingival debridement of pockets antibiotics if indicated consider extraction
41
what is the long term treatment of a periodontal abscess
review OH periodontal treatment consider extraction
42
what are the signs of a radicular cyst
apical to non-vital tooth egg shell crackling of bone
43
treatment of radicular cyst
RCT XLA
44
what is the signs of residual cyst
following extraction of tooth with radicular cyst, cyst remains and becomes a residual cyst
45
treatment of residual cyst
no treatment and monitor enucleation
46
signs of dentigerous cyst
cyst that develops around CEJ of teeth and prevents eruption
47
treatment of dentigerous cyst
surgical removal uncover tooth
48
describe a mucocele
fluid filled sack due to trauma of minor salivary gland usually in lower lip
49
treatment of mucocele
monitor enucleation
50
describe a ranula
cyst formed from major salivary gland
51
treatment of ranula
marsupialisation
52
treatment of salivary gland stone/obstruction
no treatment surgical removal basket retrieval lithotripsy
53
what are the special tests in the trauma stamp
sinus colour TTP colour mobility electric pulp test ethyl chloride percussion note radiograph
54
if there is dental trauma with displacement and single tooth mobility what injuries could this be
root fracture and extrusion
55
if there is dental trauma with displacement but no single tooth mobility what injuries could this be
alveolar fracture intrusion lateral luxation
56
treatment of root fracture
reposition and confirm radiographically stabilise for 4 weeks with passive and flexible splint monitor pulp for up to 1 year
57
treatment of extrusion
reposition and splint for 2 weeks monitor pulp
58
treatment of alveolar fracture
reposition and splint for 4 weeks suture lacerations monitor pulp status
59
treatment of intrusion with incomplete root formation
allow for re-eruption without intervention for 4 weeks if no re-eruption then ortho reposition monitor pulp RCT if required
60
treatment of intrusion with complete root formation
<3mm allow for re-eruption 3-7mm ortho/surgical reposition >7mm surgical reposition start RCT at 2 weeks and use corticosteroid paste as intra-canal medicament to prevent external resorption
61
if a tooth has no displacement but is mobile and is TTP what trauma is this
subluxation
62
if a tooth has no displacement but is mobile and not TTP what injury could this be
crown fracture if fracture is present crown-root fracture
63
if a tooth has no displacement and is not mobile what injury is this
concussion
64
what is treatment for subluxation
no treatment monitor pulp for 1 year
65
what is treatment for enamel fracture
bond fragment or restore
66
what is treatment for enamel dentine fracture
bond fragment or restore consider need for pulp cap
67
what is treatment for enamel dentine pulp fracture
partial pulpotomy/pulp cap followed by restoration
68
what is treatment for concussion
no treatment monitor pulp for 1 year if mobile then splint for 2 weeks
69
what is treatment for crown-root fracture
if no pulp exposure then stabilise mobile fragment and monitor if pulp exposure then stabilise or extract fragment, pulpotomy or pulpectomy depending on root maturity. RCT and restore
70
treatment for avulsion
clean tooth administer LA irrigate with saline reposition socket fracture if present and reimplant tooth suture any lacerations radiograph to ensure correct reimplantation flexible splint for 2 weeks antibiotics and tetanus booster RCT after 7-10 days with intracanal medicament 2 week follow up clinical and radiographic follow up 1 month, 3 months, 6 months, 12 months
71
post operative advice for avulsion
avoid contact sports soft diet for 2 weeks brush teeth after every meal with soft toothbrush chlorhexidine 0.1% twice a day for 7 days
72
if an avulsed tooth is immature do you start RCT?
no the aim is to revascularise the pulp no RCT unless necrotic
73
emergency management of avulsion
reassure patient hold by crown DO NOT TOUCH ROOT clean tooth with milk or saliva reimplant if possible or store in saliva
74
treatment for pulp exposure when it is an immature tooth
PARTIAL PULPOTOMY remove 1-3mm of inflamed coronal pulp or until reaching healthy pulp control bleeding using CHX or NaOCl dress with CaOH, biodentine or MTA RMGIC restore with bonded restoration follow up with vitality testing
75
when are direct pulp caps performed
on immediate pinpoint exposures <1mm
76
differential diagnoses for extra oral swellings
trauma dental infection sialosis ranula suppurative/viral sialadenitis Crohns/OFG salivary gland tumour OSCC pagets fibrous dysplasia acromegaly
77
differential diagnoses for intra oral swellings that are pink
fibroepithelial polyp drug induced hyperplasia crohn's disease OFG OSCC salivary gland tumour
78
differential diagnoses for intra oral swellings that are red
pyogenic granuloma giant cell granuloma denture induced hyperplasia scurvy OSCC
79
differential diagnoses for intra oral swellings that are white
squamous papilloma OSCC
80
differential diagnoses for intra oral swellings that are blue
mucoele ranula
81
differential diagnoses for intra oral swellings that are yellow
bone exostosis sialolith
82
differential diagnoses for localised pigmented lesions
amalgam tattoo haemangioma melanotic macula malignant melanoma
83
differential diagnoses for widespread pigmented lesions
drug induced pigmentation addisons disease sturge weber syndrome smoking associated pigmentation
84
differential diagnoses for white patches that are painful
chemical burn lichen planus lichenoid reaction lupus erythematous
85
differential diagnoses for non painful white patches
white sponge naevus leukoplakia candida OSCC keratosis
86
differential diagnoses for painful ulcerative red patches
erosive lichen planus post radiotherapy mucositis contact hypersensitivity
87
differential diagnoses for painful non ulceration red patches
any anaemia angular cheilitis acute erythematous candidiasis geographic tongue
88
differential diagnoses for painless ulcerative red patches
OSCC
89
differential diagnoses for painless non ulcerative red patches
erythroplakia chronic erythematous candidiasis
90
differential diagnoses for single ulceration
trauma RAS behcets OSCC syphilis
91
differential diagnoses for multiple discrete ulcers
ANUG herpetiform RAS behcets
92
differential diagnoses for multiple diffuse ulcers
erosive lichen planus lichenoid reaction GVHD radiotherapy induced mucositis ORN
93
differential diagnoses for blistering conditions in children
chickenpox herpangina primary herpetic gingivostomatitis hand foot and mouth
94
differential diagnoses for blistering conditions in adults
shingles pemphigoid pemphigus erythema multiforme angina bullosa haemorrhagica
95
causes of dry mouth
medications dehydration drinking and smoking mouth breathing anxiety cancer treatment health conditions
96
management of dry mouth
assess to see if lifestyle/medication modifications can be made drink water, suck ice cubes, sugar free sweets, chewing gum regular check ups, caries assessment and fluoride application high strength toothpaste saliva substitues
97
medications causing dry mouth
beta blockers anti-convulsant analgesics anti-emetics parkinsons drugs diuretics antidepressants antihistamines antipsychotics anti-manic drugs
98
management of oral ulceration
make note of appearance soft diet, avoid spicy foods, avoid SLS, anbesol, CHX adjust ill fitting dentures/traumatic areas, prescribe keep ulcer diary and refer for further testing if recurrent review at 3 weeks
99
medications causing ulcers
NSAIDs beta blockers methotrexate penicillin nicorandil allopurinol sulfasalazine gold anti-convulsants
100
systemic conditions causing ulceration
herpetic gingivostomatitis lichen planus vesiculobullous hand foot and mouth haematological malignancy OSCC erythema multiforme haematinic deficiency inflammatory bowel disease
101
management of acute pseudomembranous candidiasis (oral thrush)
identify and address underlying causes improve OH CHX mouthrinse miconazole gel/nystatin mouthrinse/fluconazole
102
management of chronic hyperplastic candidiasis (candidal leukoplakia)
biopsy check vitamin levels smoking cessation 2-4 weeks oral fluconazole
103
management of acute erythematous candidiasis (sore mouth)
spacer device/rinse after inhaler oral thrush treatment
104
management of chronic erythematous candidiasis (denture stomatitis)
denture hygiene advice miconazole gel to fitting surface of denture refer to GMP if unresolving or make new denture
105
management of angular cheilitis
correct the cause topical miconazole
106
who is ANUG commonly found in
smokers immunodeficient stress poor OH
107
what bacteria causes ANUG
spirochetes and fusiform
108
clinical appearance of ANUG
pseudomembranous slough covering ulcerated gingival margin papillae are punched out loss of crestal bone bad breath and metallic taste
109
advice for ANUG
stop smoking use soft toothbrush, toothpaste and ID brushes 0.2% chlorhexidine 10ml 2x daily or diluted 6% hydrogen peroxide 3x daily topical pain relief
110
treatment for ANUG
advice LA and debride advise paracetamol prescribe antibiotics if required (metronidazole) review in 1 week
111
clinical findings of a periodontal abscess
patient has periodontitis loss of alveolar crest mobile and TTP in lateral directions abscess adjacent to periodontal pocket pus drainage fever/malaise tooth is usually vital
112
treatment of periodontal abscess
LA and debride antibiotics if required discuss and make aware of cause
113
what does NaOCl do
dissolves necrotic and vital organic tissue antimicrobial lubricant
114
what does EDTA do
dissolves smear layer, inorganic tissue lubricant chelator decalcifying agent (for sclerosed canals)
115
before commencing RCT what do you analyse on the radiograph
root canal anatomy, number, length, curvature and calcifications
116
what burs are used for access
flat fissure/round bur for initial access safe ended access bur for widening pulp chamber/removing roof
117
how do you ensure that hypochlorite is safe
use side venting needle fill needle up to 3/4 use forefinger to inject label clearly ensure the tip does not bind irrigate using in and out motion pass behind patient's head be mindful of droplets bend needle
118
what are the principles of access cavity design
allow removal of entire contents of pulp chamber allow visualisation of pulp floor and canal orifices allow direct access to apical 1/3 of canal for instrumentation allow retention and support of a temporary filling material - good seal provide reservoir for canal irrigant be as conservative as possible
119
is modified step back a hand filing or a rotary technique for canal preparation
hand filing
120
what are the steps of the modified step back technique
scout canals and coronal pre-flaring with gates gliddens prepare coronal 2/3 with gates gliddens establish working length establish glide path prepare the canal to 3 sizes larger than first file which binds at the apex step back using next file size up and 1mm from that length, keep stepping back until you have joined the apical preparation
121
why would you use a file 3 sizes larger than that which binds at the apex to prepare the canals
remove dead pulp tissue, bacteria and substrates increase capacity of canals to retain a larger amount of irrigant prepare canal for adequate obturation
122
what are the steps of the crown down technique for RCT
scout canals and coronal pre-flaring prepare coronal 2/3 establish working length establish glide path use rotary system to prepare the canal in a brushing motion to working length
123
what are the advantages of using a coronal preparation technique first in endodontics
improves tactile sensation prevents pushing bacteria from infected coronal aspect further into the canal reducing the incidence of flare ups allows more accurate working length determination
124
how do you manage a hypochlorite accident
stop and inform and reassure patient irrigate with saline administer long acting LA and prescribe NSAIDs for pain cold compresses in initial days and warm compresses later review after a few days and place temporary seal clinical photographs for record keeping if the swelling of the affected side is more than 30% compared to the contralateral side consider referral
125
what are the steps for obturation via cold lateral compaction
thorough irrigation select master GP cone and mark working length coat in sealer seat in canal and ensure it goes to length select finger spreader accessory points remove GP with super endo alpha at canal orifice clean access cavity with ultrasonics and cotton pellet seal root canal filling with core
126
what are the types of root canal sealer available
resin GIC ZOE calcium hydroxide bioceramic
127
how do you manage a ledge in RCT
identify location of ledge with hand file enlarge canal space to 1mm short of ledge place shark kink at the end of the hand file file up and down to smooth the ledge once a K8 file can glide smoothly move up to 10, 15, 20 etc continue with preparation as normal
128
how do you avoid ledges
good cavity access with straight line access to canals pre curved hand files with lubricant and watch winding motion never force files
129
risks of root canal treatment
perforation instrument separation continued symptoms hypochlorite accident missed canals trismus
130
alternative options to RCT
accept and monitor extraction surgical RCT other
131
how do you manage perforations in house
achieve haemostasis using heat or pressure plug perforation allow appropriate setting time seal with GIC complete RCT review at 6 months and then annually
132
how do you achieve haemostasis and plug perforations in house
haemostasis = 5mins pressure with cotton pellet OR heated instrument to cauterise plug = use MTA or biodentine for gold standard, can also sue GIC or ZOE
133
if you are going to refer a perforation, what do you need to do before
cotton wool over the perforation with CaOH and dress with ZOE or GIC write letter with information on cause and location of perforation
134
what is the success of perforation repair dependent on and what is the success rate of them
depends on location, size and time coronal perforations have lower prognosis as can develop perio-endo lesions smaller perforations and those treated sooner have better success rate
135
why do perforations normally occur
over instrumentation and poor understanding of anatomy of tooth
136
why would you re-organise an occlusion
when ICP cannot be established reliably it is re-designed
137
when would you use a split dam technique
insufficient coronal tooth structure deep subgingival cavity tight contacts indirect cementation
138
steps of recording a facebow
mould wax around bitefork place in patient mouth until wax hardens mark anterior reference point on face - 43mm above distal of 12 incisal edge assemble transfer jig to earbow and tighten screw securely re-insert bitefork and tighten earbow adjust earbow until locating arm is aligned with anterior reference marked on patient face bitefork and transfer jig sent to lab as one unit
139
when taking a patient history for tooth wear what things are important to establish
parafunction diet gastric issues morning sickness lifestyle recreational drug use eating disorders steroid inhalers medication habits
140
what do you assess with extra oral exam for tooth wear
smile line lip line RVD, OVD, FWS phonetics TMJ
141
what are the wear indices used
BEWE Smith and Knight
142
what special investigations are used for wear
radiographs articulated study models sensibility testing photographs diagnostic wax ups
143
what are the types of wear in relation to severity
1 - wear with loss of OVD 2 - wear without loss of OVD with space 3 - wear without loss of OVD and limited space
144
what is the immediate management of wear
adjust sharp edges desensitising agent GIC over exposed dentine
145
what is prevention advice for wear
modify diet and lifestyle cease bad habits promote good oral hygiene splint refer to GP for medical problems apply fluoride treat dry mouth
146
what are the absolute contraindications to implants
patient not compliant ongoing chemotherapy high dose immunosuppressive therapy incomplete maxillary/mandibular growth allergies to implant materials
147
around the localised site where an implant would be placed, what should we be looking at
distance of bone interproximally between neighbouring teeth bucco-lingual width of bone minimal vertical mouth opening minimal interocclusal distance and soft tissue condition
148
what are the special investigations for implants
clinical photography study models radiographs (PA, OPT, CBCT)
149
what should be discussed in the consent process of implants
risks v benefits costs estimated number of visits likely prognosis importance of maintenance visits
150
when would you use a facebow when planning for a bridge
when replacing upper canines and multi-unit bridges
151
how do we ensure a bridge is cleansable
connectors should be at the contact point to allow adequate embrasure space for cleaning smooth, polished and glazed
152
how do you prep for anterior adhesive bridge
ensure parallel wall of tooth no prep needed if 0.7mm of interocclusal space free for retainer minimal palatal chamfer finish can help with seating and increases resistance form then take impressions with lightbody on teeth, medium/heavy body or lab putty in tray
153
what information is included in the lab card for adhesive bridges
shade pontic design metal wing coverage connector level embrasure space locating peg sandblasted metal wings ask for casts to be articulated to jaw registration provided
154
what is the average longevity of a conventional bridge
10 years
155
what is the incidence of devitalisation in a conventional bridge preparation
1 in 5
156
how do you prep for conventional bridge
outer axial walls have 6-15 degree taper parallel guideplanes non functional cusp reduction of 1.5-2mm functional cusp reduction of 2mm axial reduction dependant on bridge material
157
what special investigations are needed for crowns/onlays
radiographs photographs impressions for study models diagnostic wax ups sensibility testing if needed
158
what is the risk of devitalisation with crown prep
20-30%
159
what is the disadvantage of an MCC (porcelain and metal)
metal cervical area can become visible due to gingival recession
160
what is the advantage and disadvantage of a zirconia crown
adv = good aesthetics disadv = more abrasive than metal
161
what are the advantages of a LiDiSi crown
the flexural strength is similar to tooth tissue (much less than MCC though) good aesthetics
162
what are the advantages of metal crowns (precious and non-precious)
flexural strength very high less abrasive
163
what are the options for crown materials available
porcelain fused to metal (MCC) zirconia lithium disilicate precious metal (gold) non-precious metal (silver)
164
what degree of taper should the internal walls of inlay/onlay/crown prep have
4-6 degree
165
indications for an inlay
occlusal and/or proximal cavities failed direct restoration replacement
166
if you are using a ceramic onlay, what should the cusp reduction be
2mm for functional 1.5mm for non-functional
167
indications for an onlay
cusp fracture toothwear caries weakening tooth structure pre-existing failed restoration with large isthmus restoration of RCT teeth
168
axial reduction for MCC crown
buccal = 1.5mm shoulder porcelain palatal = 1mm chamfer metal palatal = 1.5mm chamfer
169
axial reduction for a ceramic crown
1mm rounded chamfer
170
indications for crown
cusp fracture toothwear caries weakening tooth structure pre-existing failed restoration with large isthmus restoration of RCT teeth high aesthetic demand onlay not possible
171
steps of a crown preparation
LA sectional impression for temp construction and separate impression for reduction matrix occlusal reduction - bevel the functional cusp axial reduction interproximal reduction impressions temporary construction
172
what do you do to finish a crown prep
polish proximal boxes and flare edges prepare rounded shoulder or chamfer margin round off internal sharp angles remove any enamel lips no undercuts
173
what is deep margin elevation
building up a subgingival proximal box with composite to ensure margins are supragingival before beginning crown preparation
174
how much space should you have in the interocclusal space of anterior crown prep
2mm
175
prep dimensions for anterior MCC crown
0.7mm chamfer palatal 0.7mm cingulum reduction 1.5mm labial shoulder
176
prep dimensions for anterior all ceramic crown
1-1.5mm shoulder/chamfer palatal 1mm cingulum reduction 1-1.5mm shoulder/chamfer labial
177
steps of temporary crown construction
fill putty index with protemp allow initial set in mouth and then remove to allow full set out of mouth use burs and discs to remove excess material take final impression of crown prep for lab cement temp crown with temp bond
178
steps for impression taking for crowns/onlays
syringe light body silicone around prep take impression with medium/heavy body silicone or lab putty take opposing arch alginate take bite registration in ICP
179
what information do you include on the lab card for crowns/onlays
shade ask for sandblasting (zirconia/metal) or HF acid treatment (LiDiSi) ask for casts to be articulated
180
consequences of poor marginal fit of crown/bridge
plaque retention secondary caries localised periodontitis cement dissolution poor aesthetics
181
what causes poor marginal fit of a crown/bridge and how do you fix it
inaccurate impression poor gingival retraction inadequate marginal preparation redefine margins and retake impression and communicate issue to lab
182
consequences of crown/bridge not seating properly
patient discomfort plaque retention secondary caries localised periodontitis unnecessary occlusal adjustments
183
what causes a crown/bridge to not seat properly
inaccurate impression undercuts in final prep insufficient taper of axial walls drifting of adjacent teeth
184
how do you fix a crown/bridge not seating properly
retake impression check for undercuts in final preparation 4-6 degree tapered axial walls ensure good contact points on temporary crown minimal interproximal reduction with high speed
185
consequences of occlusal interferences of the crown/bridge
post op pain on biting occlusal trauma indirect fracture opposing tooth cuspal fracture decementation bruxism
186
what would cause occlusal interference with indirects
inaccurate impression insufficient occlusal reduction inaccurate bite registration poor planning and clinical assessment
187
what can glass ionomer cement
MCC metal crown
188
what can RMGI cement and give a brand
MCC metal crown brand = RelyX or RIVA luting cement
189
what can light cured resin cement and give brands
porcelain veneer/inlay/onlay brand = RelyX
190
what can dual cured resin cement and give brand
MCC metal crown porcelain inlay/onlay all ceramic crown brand = nexus/relyX/panavia
191
what are the ideal endodontic/root factors for post placement
good apical and coronal seal obturated within 2mm of apex, well condensed no periapical radiolucency wide width of root 1:1 crown:root ratio minimal curvature no resorption no sinus/abscess/TTP
192
how many millimetres subcrestal should a post extend
4mm
193
what are the restorative and occlusal requirements for post
caries free 2mm ferrule minimum around 3/4 of tooth 2mm interocclusal space after core placement need to have group function no wear or bruxing habits
194
what are the periodontal requirements for post
no bleeding pockets >4mm no pockets >5mm no pus BOP <15% not mobile and no furcations
195
adv and disadv of direct post
adv = same day placement and lower cost disadv = less accurate fit, not suitable for wider canals, need ferrule
196
adv and disadv of indirect post
adv = more accurate fit, wider canals fine, can use when less ferrule remaining disadv = more than 1 appointment, costly
197
materials for a post
metal = gold, stainless steel, titanium ceramic = zirconia, alumina fibre = glass, quartz, carbon
198
adv and disadv of metal posts
adv = radiopaque, retrievable, better fit to crown disadv = poor aesthetics, root fracture, corrosion
199
adv and disadv of ceramic posts
adv = high flexural strength, greater aesthetics disadv = difficult retrievability, technique sensitive
200
adv and disadv of fibre posts
adv = allows light cure, more closely replicates root elasticity disadv = difficult to retrieve, less radiopaque
201
adv and disadv of parallel post
adv = less stress on root, greater retention disadv = less conservative
202
adv and disadv of tapered post
adv = more conservative disadv = greater stress on root, less retentive
203
what is the ideal post
parallel sided non-threaded cement retained
204
what are the risks of post placement
perforation root fracture post fracture infection requiring re-RCT bruxism, class 2 div 2, deep overbite, edge-edge ALL increases post fracture risk
205
what are the steps of direct post preparation and cementation
LA and dam refine crown prep margins calculate working length and post width required use gates gliddens to remove 2mm of GP from entrance of canal prepare post space to correct size for post being used irrigate with NaOCl try in post and radiograph to confirm position cement build composite core incrementally remove remaining post coronally once core has been built up redefine crown margins and do impressions
206
what are the steps of indirect post preparation
LA and dam redefine crown prep margins calculate working length gates gliddens to remove 2mm of GP from canal entrance prepare post space to correct post size irrigate with NaOCl
207
what are the steps of indirect post impression taking once preparation has already taken place
insert retraction cord insert impression post and ensure 2mm interocclusal space present remove retraction cord light body silicone syringed around post and impression with medium/heavy body take opposing alginate bite reg place temp post inside post prep build up core
208
what is on the lab card for cast post
outline only cast post and core are to be constructed shade ask for sandblasting of fit surfaces ask for casts to be articulated send burn out post corresponding with post preparation drill used to lab
209
steps of indirect post cementation (cast post)
LA and dam remove remnant temp cement with ultrasonic scaler irrigate with NaOCl try in post and core and take PA radiograph
210
questions to ask in the denture history
happy with current dentures how old are current dentures how many have you had and which were best what are your main concerns did your denture fit initially are you able to eat with dentures in what are expectations of new dentures how long do you wear your dentures for
211
what do you look at in extra oral exam at denture assessment appointment
face structure centrelines OVD, RVD incisal show lips aesthetics occlusal plane speech
212
how do you check for retention in complete dentures
push on incisal edges of anterior teeth and check for posterior drop
213
how do you check for stability in complete dentures
press unilaterally on the posterior teeth and check for a drop on opposite side
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how do you check for support in complete dentures
press on occlusal surfaces of teeth and check if denture sinks or if it causes patient discomfort
215
what do you check for with primary impressions
full coverage of denture bearing areas no encroachment of impression material on tongue space presence of rolled borders with no drags absence of drags, voids and tears mechanical retention of impression material through tray perforations
216
what depth of undercut does a 15mm cobalt chrome clasp engage
0.25mm
217
define retention
resistance to vertical displacement of the denture
218
define indirect retention
resistance to rotational displacement of the denture
219
what provides indirect retention
connectors rest seats saddles denture base
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how do you decide where indirect retention should be
draw line between most posterior clasp and clasp on opposite side then draw perpendicular line and place indirect retention component here
221
how much space does a lingual bar require from floor of mouth to gingival margin
8mm
222
how short of the sulcus should a special tray be in order to achieve rolled borders
2mm
223
what do you check when trying in CoCr framework
adaption presence of sharp edges are clasps engaging the undercuts lab induced defects on denture bearing areas path of insertion
224
what do you check on partial dentures at the try in stage
adaption flange extensions no lab induced defects balanced occlusion position of denture teeth bucco-lingually compared to natural teeth
225
what plane should the posterior occlusal plane be parallel to
ala-tragus line
226
denture hygiene instructions/denture advice
take denture out at night and leave in bowl of water clean denture after every meal with warm water and soap and soft brush retention and general feel improves over time begin with soft diet if causes irritation return to previous set but wear 24 hours before so we can see traumatised areas
227
what is poor retention of complete record blocks caused by
under/overextension inaccurate fit incorrect post dam
228
how much freeway space is desirable
2-4mm
229
what are the indications for replica dentures
patient requested spare denture set and likes current dentures function and aesthetics staining of current denture worn teeth/overclosure fractured baseplate or denture teeth in an otherwise functional denture
230
what is the technique for replica dentures
select tray larger than denture use heavy body putty to take impression of occlusal surface cut location notches on impression that is set put more heavy body putty on top of this and then seat an impression tray on top send away for wax try in use the fit surface of the wax try in as an impression tray and use light body PVS
231
risks of immediate denture
suboptimal immediate denture fit as secondary impressions are not routinely taken denture fit may worsen with time as socket heals and bone remodels unaesthetic appearance as gingival recession occurs over time
232
what is the technique for immediate dentures with single tooth
alginates light body bite registration shade send above to lab proceed with extraction fit denture
233
what is the advice given with an immediate denture
wear denture for 24 hours to protect clot formed remove denture at night and tore in glass of water after initial 24 hours wash daily
234
risks of additions to dentures
point of addition slightly weaker and prone to breakage denture may not fit satisfactorily unaesthetic appearance possible limitation patient will not have their denture for a short period
235
how do you do impressions for additions to dentures
take impression with denture in situ
236
indications for overdentures
RCT teeth with wear bone preservation necessary over implant abutment
237
requirements of remaining teeth for overdenture success
satisfactory RCT on retained teeth adequate interocclusal space retained tooth periodontally stable
238
adv and disadv of overdenture
adv = maintains bone around teeth, good transition disadv = optimal hygiene required
239
cause and resolution of excessive tooth visible on denture
C = increased OVD, upper anterior teeth set out too far R = reset all teeth and reduce OVD, reset teeth over ridge
240
cause and resolution of teeth looking false on denture
C = no gingival contouring, teeth may all appear to have same shape R = rotate or stagger teeth for natural look, ask lab for anatomical finish
241
cause and resolution of upper lip too bulky on dentures
C = labial flange too bulky, teeth set too anterior R = reduce bulk, reset upper anteriors
242
cause and resolution of upper lip having a sinking appearance with dentures
C = upper anterior teeth are set too far palatally R = reset teeth anteriorly, add more wax to labial aspect and reset teeth
243
cause and resolution of having over-closed appearance with dentures
C = reduced OVD R = remake denture, copy denture with increased vertical dimensions
244
cause and resolution of having a whistle on S sounds with dentures
C = palate too narrow or space between centrals R = remove wax from palate, remove acrylic from palate
245
cause and resolution of lisping sounds on S with denture
C = too much tongue space R = add more wax or add more acrylic
246
cause and resolution of muffled F and V sounds with denture
C = incorrect positioning of upper anteriors vertically and horizontally R = back to try in and reposition teeth
247
cause and resolution of instability of denture but not when chewing
C = extension issue of flange, post dam issue, xerostomia, flabby ridge R = adjust extension and post dam, dry mouth treatment, 2 step impression for flabby ridge
248
cause and resolution of instability of denture when chewing
C = lack of post dam seal, anterior teeth labially, flabby ridge, biting only on anterior teeth, incorrect occlusion R = new masters, reset teeth, 2 step impressions, repeat jaw reg
249
cause and resolution of soreness on ridge of denture
C = premature contact, inaccurate denture base, roughness on fit surface R = new bite registration, reline/rebase, use PIP to identify and adjust
250
cause and resolution of soreness under lingual flange of denture
C = RVD and OVD dont coincide, overextended lingual flange, molars too distal R = recheck vertical dimensions, shorten overextended flange, remove last molars
251
cause and resolution of loose denture
C = extension issues, xerostomia, occlusal errors R = adjust flange, reline denture, articulate denture and remove interferences
252
cause and resolution of tight denture
C = denture not relieved in undercut areas causing pain on insertion and removal, clasps too tight R = check path of insertion and adjust denture, adjust clasps
253
cause and resolution of burning feeling under denture
C = denture not relieved in undercut areas causing pain on insertion, clasps too tight, high pressure area R = check path of insertion and adjust denture with acrylic bur, adjust clasps, PIP and adjust
254
cause and resolution of biting cheek or tongue with denture
C = overclosed, posterior teeth set too lingual or buccal R = denture needs to go back to try in stage to reset teeth
255
cause and resolution of denture making patient gag
C = loose denture, patient has strong gag reflex and post dam too far back R = construct new denture with better retention, CBT for gag reflex or trim post dam
256
cause and resolution of redness over denture bearing areas or cheeks
C = overclosed, posterior teeth set too lingual or buccal, allergic reaction R = go back to try in stage and rearticulate and reset teeth, do a patch test
257
what are the intrinsic causes of discoloured anterior teeth
fluorosis non-vital RCT tetracycline age enamel defects
258
what are the extrinsic causes of discoloured anterior teeth
tea, coffee, alcohol tobacco coloured food spices chlorhexidine chemo and radiotherapy
259
what are the treatment options for discoloured anterior teeth
vital bleaching non-vital bleaching deep resin infiltration microabrasion composite resin bonding veneers crown
260
risks of external vital bleaching
existing restorations not same shade transient sensitivity gingival irritation external cervical resorption reduced bonding strength of composite
261
what are the instruction given to patients on how to use whitening trays and gels
clean and dry whitening trays brush and floss hydrogen peroxide used for 1-2 hours during day or carbamide peroxide used for 6-8 hours over night treatment lasts 12-14 days place a bit of gel at the base of each tooth in the tray avoid coloured foods, drinks and toothpaste
262
what is the instructions to lab for bleaching trays
please cast the impressions and construct a gingivally fitted bleaching tray
263
what is the process for internal non-vital bleaching
PA radiograph open access cavity and remove 2-3mm of GP below CEJ place 1mm of GIC over GP remove stained dentine with round bur etch with 37% phosphoric acid, wash and dry place whitening agent into access cavity and cover with cotton pellet seal access cavity with GIC repeat at weekly intervals and review after 3 sessions
264
what are the indications for ICON deep resin infiltration
opaque white spots fluorosis MIH
265
why is initial whitening before icon resin infiltration essential to treatment
changes the refractive index of the white spot to become more similar to enamel
266
what are the steps for ICON resin infiltration
apply ICON etch (15% hydrochloric acid) for 120seconds apply ICON drying material (99% ethanol) for 30 seconds dry and observe, repeat up to 3 times if necessary apply ICON infiltrant and leave for 3 minutes light cure for 40 seconds polish
267
what does the ICON resin infiltrant do to white spots
alters the refractive index of the opaque white spot such that it becomes similar to that of enamel
268
advantages of microabrasion
conservative cheaper minimal maintenance required permanent results quicker results easy to perform
269
disadvantages of microabrasion
outcome unpredictable removes 25-75 microns of enamel per treatment must be performed chairside requires PPE
270
what is the process of microabrasion
pre-op photos clean the tooth place rubber dam place sodium bicarbonate guard around gingival margin 6-10% HCl pumice with a slowly rotating rubber cup on white spot for 5 seconds wash directly into aspirator dry tooth and place guard again and repeat maximum of 10 times fluoride varnish application (profluorid) polish with fine soflex disc final polish with prophy paste avoid coloured foods and drinks that till stain a white t-shirt review at 4-6 weeks and take photos
271
what are the reductions required for veneer prep
cervical enamel = 0.3mm mid-buccal third = 0.5-0.7mm incisal third = 0.5-0.7mm incisal edge reduction = 1-1.5mm
272
what are the steps of veneer preparation
sectional silicone impression LA and shade diagnostic wax up to create silicone indices for depth guides prepare labial surface in 3 planes consider incisal edge reduction interproximal reduction assess preparation from 3 different views smooth and polish preparation scan or take silicone impressions place temporary veneer
273
how would you go about composite bonding as a temporary trial smile for a patient
take impression of diagnostic wax up and use this as stent spot etch and wash and dry load stent with composite and seat and wait for seat remove stent and excess composite with probe floss contacts and light cure review in 2 weeks
274
diet advice for children
promote balanced diet milk and water only reduce sugar to mealtimes only promote non-cariogenic snacks no eating or drinking after brushing teeth be wary of hidden sugars and acid
275
from what age do you start applying fluoride varnish in practice
3
276
what is the fluoride application frequency for low and high risk
low = 2x per year high = 4x per year
277
what is the fluoride varnish dose for 2-5 years and 6+ years
0.25ml for 2-5 years 0.4ml for 6+ years
278
instructions to patient after fluoride varnish
avoid eating, drinking or rinsing for 30 minutes
279
what are the management options for paediatric caries
complete caries removal and restoration partial caries removal and restoration no caries removal and restoration no caries removal and prevention advice extraction or delay until pain or sepsis
280
what would partial caries removal and restoration be suitable for
all types of restorable carious lesions as long as good marginal seal clear superficial caries and from ADJ
281
when would no caries removal and restoration placement be undertaken
when hall crown used or fissure sealant
282
how would you perform no caries removal and making the lesion self cleansing
remove undermined enamel and apply fluoride good for cavitated lesions
283
steps for fissure sealant
clean teeth isolate and dry etch and rinse and dry fissure sealant application light cure for 30 seconds check integrity with probe
284
steps of vital pulpotomy of a primary molar
assess compliance LA and dam remove caries and access pulp chamber remove roof of pulp chamber large excavator or slow speed to remove coronal pulp rinse chamber and apply gentle pressure with ferric sulphate cotton pellet fill pulp chamber with ZOE/MTA/biodentine remove dam and select preformed metal crown
285
when is vital pulpotomy of a primary molar indicated
when vital restorable tooth has: - large proximal carious lesion - carious/mechanical exposure of vital coronal pulp tissue - no radicular pulpitis - no abscess or when extraction is contraindicated
286
indications for hall crown
interproximal caries caries on 2 or more surfaces pulp treated tooth
287
contraindications to hall crown
pulpal symptoms or caries close to pulp patients at risk of infective endocarditis insufficient tooth remaining to retain crown
288
method for hall crown
place separators into contact points for 3-5 days place gauze to protect airway select appropriate crown size place GIC into crown seat crown with finger pressure and child biting remove excess cement and floss interproximally reassure that high bite will settle and advise post operative pain relief if needed
289
parts of the extra oral assessment for orthodontics
AP vertical LAFH asymmetry TMJ MoM lymph nodes salivary glands soft tissues (lip competence, lip trap, smile line, naso-labial angle)
290
parts of the intra oral assessment for orthodontics
charting, OH, caries, wear degree of crowding (mild, moderate, severe) incisor, molar, canine class proclination of incisors overbite overjet centrelines crossbite
291
risks of orthodontic treatment
relapse decalcification root resorption soft tissue trauma toothwear loss of periodontal support loss of vitality failed treatment
292
what is mild crowding
0-4mm
293
what is moderate crowding
4-8mm
294
what is severe crowding
8mm+
295
define class 1 incisors
lower incisal edges occlude with or lie immediately below the cingulum
296
define class 2 div 1 incisors
lower incisal edges lie posterior to the cingulum plateau of upper incisors, the upper centrals are proclined or of average inclination and there is an increased overjet
297
define class 2 div 2 incisors
lower incisal edges lie posterior to the cingulum plateau of the upper incisors, the upper central incisors are retroclined, overjet is minimal or may be increased
298
define class 3 incisors
lower incisor edges lie anterior to the cingulum plateau of the upper central incisors, overjet is usually reduced or reversed
299
define class 1 molars
mesiobuccal cusp of maxillary first molar aligns with the buccal groove of the mandibular first molar
300
define class 2 molars
mesiobuccal cusp of maxillary first molar occludes anterior to buccal groove of mandibular first molar
301
define class 3 molars
mesiobuccal cusp of maxillary first molar occludes posterior to buccal groove of mandibular first molar
302
define canine class 1
mesial incline of maxillary canine occludes with the distal incline of mandibular canine
303
define canine class 2
mesial incline of the maxillary canine occludes anterior to distal incline of mandibular canine
304
define canine class 3
mesial incline of maxillary canine occludes on mandibular first premolar
305
what are the referral guidelines for non-third molar teeth extractions
unsuccessful initial attempt abnormal tooth morphology requiring surgical removal peri-apical radiolucency requiring histological assessment increased risk of damage to adjacent major anatomical structures reduced access to treatment site medically compromised
306
referral guidelines for third molar extractions
one or more episodes of pericoronitis unrestorable caries in third molar or impaction causing caries in adjacent second molar risk of caries in third molar or adjacent tooth anatomical position of tooth inhibiting proper oral hygiene periapical pathology prior to orthognathic surgery prior to initiating radiotherapy or chemotherapy
307
referral guidelines for MOS
impacted teeth OAC/OAF closure root in maxillary antrum pre-prosthetic surgery
308
what is warfarin
vitamin K inhibitor
309
what is apixaban
factor Xa inhibitor
310
what is dabigatran
direct thrombin inhibitor
311
what is rivaroxaban
factor Xa inhibitor
312
what do you do if patient is on warfarin
check INR 24hrs before
313
what do you do if patient is on apixaban or dabigatran
miss morning dose
314
what do you do if patient is on rivaroxaban or edoxaban
delay daily dose till 4 hours post extraction
315
high risk patients for MRONJ
on oral or IV bisphosphonates for over 5 years concurrent treatment of systemic glucocorticoids patient is being treated for cancer previous MRONJ
316
recommendations for people on bisphosphonates
assess risk category avoid extractions atraumatic extraction technique liaise with physician consider referral consider 8 week review
317
risks of extraction
pain swelling bleeding bruising dry socket jaw stiffness infection OAC root fracture maxillary tuberosity fracture altered sensation damage to adjacent teeth root displacement into sinus need for surgical intervention
318
what are upper straights for
upper incisors and canines
319
what are upper universals for
upper canines and premolars
320
what are upper left and right molar forceps for
upper left and right molars
321
what are upper root forceps for
upper narrow single roots upper retained roots
322
what are upper third molar forceps for
upper third molars
323
what are lower universal forceps for
lower anteriors and premolars
324
what are cowhorns for
lower 6s
325
safe dose of lidocaine
4.4mg/kg
326
safe dose of articaine
7mg/kg
327
safe dose of prilocaine
6mg/kg
328
safe dose of mepivicaine
3mg/kg
329
principles of flap design
gain maximum access with minimum trauma large flaps heal at the same rate as smaller flaps broader base to maintain blood supply cut to bone using a firm continuous incision avoid sharp angles either include or exclude papillae entirely do not crush tissue keep tissue moist with saline
330
post operative instructions
be careful because you are still numb blood stained saliva is normal wear dentures as normal call if any issues dont touch area avoid hot drinks for rest of day soft diet for rest of the day do not smoke or drink alcohol for 24 hours avoid strenuous activity rest of day HSMW 4x/day especially after eating starting from tomorrow damp gauze for bleeding same painkillers as headache before LA wears off