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BDS 4 > Exam questions > Flashcards

Exam questions Flashcards

1
Q

Which factor decreases densty in bitewings?

A

Decrease in kVp

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2
Q

What is the most common recepto in the oral cavity?

A

Merkel’s disk for fine discrimination for light touch

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3
Q

What do you do with an angry patient?

A
  1. Aknowledge frustrations
  2. Say sorry
  3. Provide opportunity to ask question and relate their experiences
  4. Discuss the potential consequences of the injury
  5. Discuss the steps that are taken to prevent that injury from reoccuring
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4
Q

What are the difference between the atrophic oral lichen planus and biofilm induced gingivitis?

A
  1. Red buccal gingiva
  2. Pain on brushing
  3. Eating certain foods
  4. Condition does not resolve post debridement
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5
Q

What are the treatment for disquamative gingivitis?

A
  1. Topical steroid - 0.05% betamethasone diproponate 2x daily for about 7-14 days - continue for 7 days after smptom subside
  2. Rinses with 0.2% CHx muhtrinse for 2 weeks seperate to the betamethasone and tooth brushing
  3. Avoid spicy foods
  4. Brush with soft brissle tooth brush
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6
Q

What are the steps for critique of a bitewing?

A
  1. Exposure settings- contrast and density
  2. Orientation of detector- dot to distal
  3. Horizontal detector placement
  4. Vertical detector placement
  5. Horizontal beam angulation
  6. Vertical beam angulation
  7. Central beam position
  8. Collimator alignment
  9. Sharpness of image
    Overall diagnostic quality
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7
Q

What is the result of higher pKA?

A

Slower onset and diffusuion of LA

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8
Q

What medicament would you use for a child’s pulpotomy in student clinic?

A

Ferric Sulfate

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9
Q

What are the bacteria between the first colonisers and late colonisers which binds the bacteria?

A

P.Intermedia, P.Nigrescens and F. Nucleatum

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10
Q

IgG detection and chicken wire appearance. Likely diagnosis?

A

Pemhigus vulgaris

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11
Q

Which nerve fibre is least affected by LA?

A

A alpha

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12
Q

What are the 5 contra indication of pulpotomy?

A
  1. Special needs kids
  2. Tooth close to exfoliation
  3. Immunocompromised kids
  4. Periapical/furcation involvement
  5. Root resorption
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13
Q

What are the main differences between equia forte and fuji II LC?

A

Equia forte: Has better fluoride release and can be placed subgingivally without LC - but has less compressive strength

Fuji II: better compressive strength, better aesthetics and more working time - but can not be cured subgigivally as nice

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14
Q

What are 6 commercial products you could use for a patient with sensativity? How do they work

A

Sensodyne Rapid relief- stannous fluoride; forms a metal precipitate to occlude dentinal tubules

Sensodyne Daily Care,Sensodyne Pronamel- potassium nitrate, desensitises nerves

Sensodyne Repair and Protect- contains Novamin, occludes dentinal tubules

Oral B Pro Health- contains stannous fluoride which forms a metal precipitate to occlude dentinal tubules

Colgate Pro Relief- contains stannous fluoride which forms a metal precipitate to occlude dentinal tubules

Duraphat/Clinpro- contains resin base and fluoride protector polyurethane; forms insoluble Ca f2 globules after application

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15
Q

What are the two groups of populations that are more susceptible to serious infections? Why?

A
  1. Older people - the function of the immune system reduces with age
  2. Taking immunosuppresants - immune suppresant reduce the function of the immune ysstem
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16
Q

When should you recall the patient after completion of the innital phase of dembridment and provision of at home OHI?

A

After around 12 weeks in order to give the periodontium the chance to heal

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17
Q

What is supportive periodontal treatment?

A

It is treatment that plans to maintain already achieved goals with improvement of periodontal health. Patient should come back for assessment every 3-12 months depending on their risk profile )high risk - come every 3 months, low risk - every 12 months)

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18
Q

How can we evaluate risk of periodontal disease progression in the patient?

A

There dirrent matrix you can use to determine the recall frequency - a common one is the PRA (periodontal risk assessment) and it can be accessed online.

Preio-tools.com seems like the website to go to to find different matrix that may assist you.

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19
Q

Shouldyou probe all the teeth at SPT session

A

YES of course you should to understand the health of pockets - but you can choose not to do a brand new perio chart unless you find some findings

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20
Q

What are the steps to treatment planning?

A

1.. Completion of all histories and exams
2. Taking consent for additional testing
3. Diagnosis, presentation of treatment plan and consent
4. Emergency management - aka pain relief
5. Preventativve care/disease control - fluoride, OHI, smoking sessation
6. In chair treatment
7. Close date recall
8. Transition to regular recall
9. Session breakdown

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21
Q

What are the steps to an initial endodontic procedure?

A
  1. Consent, LA, rubber dam isolation
  2. Removal of caries and access to the pulp
  3. Idenitifcation of the appropriate access using radiographs
  4. Identification of canals using endo probe
  5. Using a small size file a few milimeters into a precieved canal in order to confirm that it is actually a canal
  6. Irrigation with a bent needle for safety
  7. Flaring of the coronal protion of each canal using Gate-Glidden burs
  8. Irrigation
  9. Estimationg of working length of each canal.
  10. Determination pf correct working length with appropriate file, raiographs and apex locators
  11. Apical preperation of each canal. Pre-curved files, watch-winding technique performing circumferential filing
  12. Recapitulate with a size 10 file between each file and irrigate well between each file
  13. Work up until file 25 -take radiograph to check the master apical file is at an appropriate length
    • irrigate and try master gutta percha of the the biggest size possible
  15. Place medicaments with lentulo spiral
  16. Resore with cavit and GIC
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22
Q

What are the Kennedy’s classifications of partial edentulous arch?

A

Class I - bilaterla edentulous areas located posterior to the remaining natural teeth

Class II - A unilateral edentulous area located posterior to the remaning natural teeth

Class III - A unilateral edentulous area with natural teeth remaining both anterior and posteror

Class IV - A single, bilaterla edentulous crossing mid line

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23
Q

What is good guide to stages of periodontits?

A
  1. Severity - no tooth loss is Stage I or II, tooth loss of 4 teeth of less Stage III, anything above is Stage 4 - look at radiographic bone loss, if it is upto 15% it is stage I if more stages 2,3,4
  2. Complexity - If there are major need for rehabilitation - it is stage 4. IF maximum probing depth is above or equal to 5mm it is probs stage II and above
  3. Extent - localised if less than 30% of teeth are involved
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24
Q

What is a good guide for grades of periodontitis?

A
  1. Loss over 5 years - if no than A, if less than 2mm than B if more than 2mm than C
  2. If a lot of biofilm deposits - probs gare B or C
  3. If smoking less than 10cig a day grade B if more Grade C
  4. If diabetes are above 7.0 Grade C if below is Grade B
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25
Q

What is the 2017 Periodontits Case definition?

A

1.Interdental CAL detectable at 2 non adjacent teeth

or

  1. Buccal or oral CAL above or equal to 3mm with pocketing equal or more than 3mm at 2 or more teeth

AND

OBSERVED CAL CANNOT BE ASCRIBED TO NON-PERIODONTITIS CAUSES: SUCH AS VERTICAL ROOT FRACTURE/S

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26
Q

How many appointments do you need for a general denture?

A
  1. Denture consult + primary impressions
  2. Secondary impressions
  3. Bite registration + shade mould selection
  4. Denture try on
  5. Denture insert
  6. Review denture
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27
Q

What is a triple wammy?

A

It is a pharmacodynamic problem which occurs with use of ACE inhibitor, diuretic and NSAID and can result in Acute Kidney Injury (AKI)

Process:

  1. ACE inhibitors preserve renal function and also cause relaxation of efferent renal arteriole - reducing the GFR
  2. NSAID are able to increase the vasoconstriction of the afferent arteriole by inhibiting the production of prostoglandins - a potent afferent arteriole dilator - reducing GFR
  3. Dirutetic drive the increase exertion of water through the renal system thus increasing the amount of blood that is carried to the glomerulus through the afferent arteriole - reducing GFR
  4. All three factors compound reduce the GFR significantly to cause kidney injury
  5. Solution - avoid NSAIDs
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28
Q

What are some of the contraindications for extraction for a child?

A
  1. Haemophilia
  2. Von Willebrands disease
  3. Platelet disorder
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29
Q

What are the stes for a pulpotomy of 85?

A
  1. Consent from parent
  2. LA + sedation - IANB with 2% lignocaine, 1:80000 adrenaline, 2.2 mL
  3. Rubber dam isolation with cuff technique
  4. Initial phase - removing disease and bacterially contaminated tissues with use of slow speed handpieces. Previously - acess with high speed bur
  5. Remove entire roof of pulp chamber and remove pulp from the entire chamber and root orifice
  6. Achieve haemostasis
  7. Place medicament over radicular pulp stums - formocresol
  8. Condense IRM into chamber
  9. Restore with GIC/RMGIC following appropriate GIC/RMGIC procedures
  10. Restore tooth with stainless steel crown - coronal sela is essential
  11. Review in 3 months - inform the patient that if pain persists you might need to extract
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30
Q

What framework can be used to assess fissure sealants?

A

CAMST.
Coverage - is the fissure fully covered
Amount - is there enough FS material
Margins - are the margins sealed & flush
Surface - is the surface smooth
Tooth - at future appts check the tooth

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31
Q

What are the 4 basic counselling skills?

A
  1. Open questioning
  2. Affirmations
  3. Reflections
  4. Summaries
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32
Q

What are the four processes of motivational interviewing?

A
  1. Engaging
  2. Focusing
  3. Evoking
  4. Planning
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33
Q

What are some of the barriers to quitting smoking?

A
  1. High nicotine dependence
  2. Lack of knowledge
  3. Not ready to quit
  4. Psychological or emotional concerns
  5. Fear of weight gain
  6. Fear that quit attempt will be unsuccessful
  7. Substance use
  8. Living with other smokers
  9. Giving quitting a low priority due to other circumstances
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34
Q

What is the 5 As framework?

A
  1. Ask - ask if they smoke
  2. Assess - assess their stages of change
  3. Advise - information is the key
  4. Assist - discuss the benefits of quitting
  5. Arrange - arrange for follow-up
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35
Q

What is a good framework to conduct motivational interviewing?

A

Being with OARS

  1. Open questions
  2. Affirmations on progress
  3. Reflections
  4. Summaries

Find point at which the client is in stages of change, gather information and move on to principles of motivational interviewing

  1. Develop discrepancy - change os uncomfortable so it is important to informt he cleint about benefit sof change
  2. Roll with resistance - listen to clients arguments, don’t refute them, make a neutral statement -DONT GIVE SOLUTION, maybe adressing an issue later will help the client to keep the issue at the back of their mind and build a good relationship with you
  3. Build self efficacy - encrouage the client, to benefits of change and affirm general better outcomes - comment that it is good that they thought about the change
  4. Express empathy - again change is hard and for a person who is uner pressure it is evne harder.
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36
Q

What are some of the example of change talk?

A
  1. Desire to change “ I want to”
  2. Ability to change “I think I can”
  3. Reasons to change “My kids wnat me to”
  4. Need “I think I need to do it”
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37
Q

What are the zones of the panoramic imaging assessment?

A

Zone 1 - Nose and sinuses
Zone 2 - Md Body
Zone 3 - Articular Eminence, Condyle, Mx Tuberosities, Pterygo Mx
Fissures, EAM, Cervical Spine
Zone 4 - Epiglottis
Zone 5 - Md Ramus and Spine
Zone 6 - Dentition

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38
Q

What are three most common anaesthetics used in the ADH

A
  1. 2% Lignocaine with 1:80000 adrenaline (Lignospan special)
  2. 3% Mepivicaine (Scandonest Plain)
  3. 4% Articaine with 1:100000 adrenaline (Articadent)
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39
Q

What is TRIM?

A

TRIM is an acronomy for:
Timing
Relevance
Involvment
Method

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40
Q

What is the key differene between the Miller technique and Tube shift technique in localisation?

A
  1. Miller technique - two radiographs are taken at right angles to each other - good at determining the position of an impacted tooth
  2. Tube shift - a slight shift of the tube is needed after the first radiograph (SLOB) to discern which root is which
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41
Q

What is complete denture retention?

A

Complete denture retention is the resistance to displacement of the denture base away from the ridge. It provides psychologic comfort to the patient.

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42
Q

What is denture stability?

A

Stability is the resistance to horizontal and rotational forces. Stability has been cited as the most significant property in providing for physiologic comfort.

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43
Q

What is denture support?

A

Support is the resistance to vertical movement of the denture base towards the ridge.

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44
Q

What are 3 impression material used for rem pros in the ADH?

A
  1. Alginate - halas
  2. PVS - Honigun
  3. Polyether - Impregum duosoft
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45
Q

What are the steps to describing radiographic lesions?

A
  1. Relative radiodensity - mixed, radioopaque or radiolucent - CONSIDER SOFT TISSUE SHADOWS
  2. Site
  3. Size
  4. Shape
  5. Outline or border
  6. Effects on adjacent structures
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46
Q

What is the role of sodium alginate in alginate material?

A

Sodium alginate forms a hydrogel former

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47
Q

What is the role of calcium sulphate dihydrate in alginate material?

A

It provide clcium ions

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48
Q

What is the role of sodium phosphate in alginate material?

A

It controls working time - acts as a retarder of the rapid use of calcium within the reaction

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49
Q

What nerve exerts pressure to anterior palate?

A

Nasopalatine

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50
Q

What are the 3 elements of autoclave sterilisation?

A

Moist hear in the form of saturated steam under pressure in an air tigh vessel.

Heat, steam, pressure and air tight vessel.

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51
Q

How do you help a pregnant patient with gingivitis?

A
  1. Educate the patient about the diagnosis, peform debridmenet and provide OHI
  2. Use soft bristle tooth brush along gingival margins using modified Bass technique
  3. Use CHx for 2 weeks
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52
Q

What are some of the systematic considerations for a patient with diabetets?

A
  1. Consider multidisciplinery care with GP and oral surgeon
  2. Stock dental practice and train personal for hypolglycemic/hyperglycemic situations
  3. Consider oral consequences of diabetes: poor healing, increased infection rate, increase xerostomia
  4. Risk of periodontitis
  5. Consider early appoitments
  6. Remember - these patient are immunosupressed
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53
Q

Who should avoid fluconazole?

A
  1. People who take warfarin - due to increased risk of bleeding
  2. Pregnant ladies - it is a Category C drugs due to risk f foetal damage, decrease growtha dn development of the feutus, potential risk of miscarriage
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54
Q

What is the point of using 20% polyacrylic acid?

A

To remove smere layer to facilitate ion exchange

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55
Q

What does LA do?

A

It is an hibitor that reduces the influx of sodium particles into the nerves thus stopping the genertion of action potential

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56
Q

Why does LA not work in infections?

A
  1. Infection or inflammation in the region causes pH to drop
  2. Concentration of the unionised (lipophilic RN) decreases
  3. Areas of inflammation also jave increase blood supply due to vasodialation - thus increase LA washout
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57
Q

What bacteria is associated with caries?

A

S. mutans

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58
Q

What bacteria is associated with shift from health to perio?

A

P. Gingivalis

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59
Q

What are the two different PCC techniques you can use to present bad news?

A

PREPARED:
1. Prepare for discussion
2. Relate to the person
3. Explore priorities
4. Provide information
5. Acknowldege emotions and concerns
6. Foster realistic hope
7. Encourage questions
8. Document

TRIM:
1. Timing - correct amount and type of info - chunk the information

  1. Relevance - what will help the patient connect to this info? - relate to patients perspective
  2. Involvement - How can patient contribute? - offer suggestions and choices rather than directives
  3. Method - Help patient understand and recall? - use visual methods of conveying - PANFLETS

SPIKES

Setting - Find a quite and private setting

Perception - Estabslih how much the patient knows and his or her perceptions abut the medical situation

Invitation or information - Ask the patient and significant other how much and what kind of information will be helpful

Knowledge - Share bade news with the patient using gentle, nonclinical language is small segments

Empathy - Acknowledge the patient’s emotions and reaction with appropriate responses

Summarise and strategise - summarise in language that the patient can understand. Ask the patient to repeat or summarise the information received and the next steps

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60
Q

What are some of differential diagnosis for a radiolucency in the posterior mandible?

A
  1. Dentigerous cyst
  2. Odontogenic keratocyst
  3. Ameloblastoma
  4. Ameloblastic Fibroma
  5. Odontogenic myxoma
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61
Q

What are the evaluation criteria of Yellowstone study casts of alginate impressions?

A
  1. Yellowstone mix is homogenous and smooth - think streakless mix with minimal airbubles
  2. Yellowstone has set adequately before removal of impression - think smooth surface with no drag lines
  3. Adequate amount of yellowstone - think good anatomy, no airbubles, good thickness
  4. Articulation of models - no soft tissue or air bubble interference
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62
Q

What are some of the common reasons for tooth loss?

A
  1. Decay and periodontal disease
  2. Trauma
  3. Pathological causes
  4. Radiotherapy
  5. Impacted or congenital missing teeth
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63
Q

What are the options for replacement of loss teeth?

A
  1. Removable denture
  2. Implant
  3. Fixed pros
  4. No treatment
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64
Q

What are the contraindications for a partial denture?

A
  1. Lack of suitable abutment teeth
  2. Rampant caries
  3. Perio disease
  4. Poor oral hygiene
  5. Patient can not tolerate them
  6. Post readiotion tratment - osteoradionecrosis
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65
Q

What are the aims of rem pros?

A
  1. Restore dentition to a satisfactory condition
  2. Comfort
  3. Aesthetics
  4. Function
  5. Speech
  6. Preservation of remaining soft and hard tissues
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66
Q

What is OVD?

A

Occlusal vertical dimension.

The distance between two selected anatomic or marked points (usually one on the tip of the nose and the other on the chin) when in maximal intercuspal position; syn, VERTICAL DIMENSION OF OCCLUSION

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67
Q

What is MIP?

A

Maximal intercuspal position.

The complete intercuspation of the opposing teeth independent of condylar position, sometimes referred to as the best fit of the teeth regardless of the condylar position; comp, CENTRIC OCCLUSION

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68
Q

What is RVD?

A

Rest vertical dimension.

The postural position of the mandible when an individual is resting comfortably in an upright position and the associated muscles are in a state of minimal contractual activity syn, PHYSIOLOGIC REST POSITION, VERTICAL DIMENSION OF REST.

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69
Q

What is free way space?

A

freeway space obs, slang: syn, INTEROCCLUSAL REST DISTANCE, INTEROCCLUSAL REST SPACE

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70
Q

What are the appointments for a conventional acrylic denture?

A
  1. Consult + alginates
  2. Secondary impressions
  3. Bite reg + shade, mould selection
  4. Try-in
  5. Insert
  6. Reviews

Book all with 2 weeks gap

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71
Q

What are the appointments for a cobalt chrome denture?

A
  1. Consult + alginates
  2. Secondary impressions
  3. Frame try-in, bite reg + shade, mould selection
  4. Try-in
  5. Insert
  6. Reviews

Book session 2 a fortnight after 1, appointment 3 4 weeks after that

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72
Q

What are the appointments for a valplast denture?

A
  1. Consult + alginates + shade, mould selection
  2. Try-in
  3. Insert
  4. Review if required
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73
Q

What code do we used for a denture fabrication stage?

A

799

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74
Q

What code do we use for a denture review?

A

741_NEW

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75
Q

What code do we use for a denture rest?

A

731

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76
Q

What code do we use for a retainer?

A

732

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77
Q

What code do we use for a denture tooth?

A

733

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78
Q

How do you calculate the new OVD during the examination?

A

Resting dimension minus freeway space. Think about it if OVD is between 2 point at occlusion, rResting vertical dimension minus freeway space will give you that!

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79
Q

What is the definition of dental impression?

A

Dental impression creates a negative imprint of hard and soft tissues in order to create a positive cast or model.

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80
Q

What are the steps for chrome denture design?

A
  1. Saddle
  2. Support
  3. Retention
  4. Connectors
  5. Simplification
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81
Q

In which Kennedy’s class would you use exclusively tooth support?

A

Kennedy 3 and 4

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82
Q

In which Kennedy class do you use exclusivley soft tissue support?

A

Not Kennedy but complete denture

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83
Q

In which Kennedy’s class would you use both soft tissue and tooth support?

A

Kennedy 1 and 2

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84
Q

What kind of clasps do you use for molars and premolars?

A

Occlusal approaching

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85
Q

What kind of clasps do you use for anteriors?

A

Gingival approaching

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86
Q

What is the minimal length for clasps?

A

15 mm for cast clasps

7 mm for wrought clasp

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87
Q

What are the signs of lost of OVD?

A

Flat filtrum

Hollowing of the cheeks

Collapsed appearance of the jaws

The distance between the tip of the nose and tip of the chin reduced

Increased naso-labial grooves

Increased marionette lines

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88
Q

What is the vertical jaw relationship?

A

It is OVD.

You can calculate it by taking the Resting vertical dimension - 2-4 mm of free way space.

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89
Q

What is a denture review code?

A

741_New

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90
Q

What should you put on a lab form?

A

Describe saddles, cross teeth which are not restored

Describe support and draw rests, major connector/plat

Specify abutment tooth/teeth

Specify clasps: rest, retentive, reciprocal

Specify flanges gum fitted vs buccal flange

Specify the extensions

Fill lab form and draw design

Obtain tutor signature

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91
Q

What are the codes for a valplast denture?

A

721/722

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92
Q

What are some of the effective major connectors for a maxilla?

A

Posterior palatal strap

Anterior palatal strap

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93
Q

What are the ideal dimensions for a rest?

A

1.5mmx1.5mm with 1.5mm occlusal depth. Meaning if the occlusal is 1.5mm no prep is needed

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94
Q

WHat is a code to replace a broken tooth?

A

071+766

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95
Q

What is a code for adding a tooth ona denture?

A

768+071

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96
Q

What is a code for a broken clasp replacement?

A

762+071

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97
Q

What are the two different saddle design for a cobalt chrome denture?

A

Free-end Saddle design

Bounded saddle

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98
Q

What are the benefits and limitations of immediate dentures?

A

Benefits: aesthetics, preservation of OVD

Limitations: Unpredictable, painful, number of appointment and cost

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99
Q

What can you do to reline the denture to new OVD?

A

You can use CCA stopper or a wax compound + border molding + taking impression of upper and lower dentures with Upper first.

So the wax compound needs to increase the OVD and ned reline will ensure that soft tissue retention and supprot can be achieved.

Always use adhesive

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100
Q

What are the 5 moments of hand hygiene?

A
  1. Before touching a patient
  2. Before a procedure
  3. After a procedure or body fluid exposure
  4. After touching a patient
  5. After touching a patient surroundings
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101
Q

What are the standard precautions?

A
  1. Hand hygiene, as consistent with 5 moments for hand hygiene
  2. The use of appropriate personal protective equipment
  3. Safe use and disposal of sharps
  4. Routine environmental cleaning
  5. Reprocessing of reusable medical equipment and instruments
  6. Respiratory hygiene and cough etiquette
  7. Aseptic technique – standard or surgical technique
  8. Waste management
  9. Appropriate handling of linen
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102
Q

What is spaulding classification?

A

It is a classification of instruments depending on their level of causing infection during their use, example is:

  1. Critical – using a perio-probe for surgical procedures – anything that pierces the mucosa must be sterilized and recorded (ideally)
  2. Semi-critical – single use items such as micro-brushes or curing light with a sleeve – you need to clean it but you might not need to sterilize it
  3. Non-critical – example is bib chains – they come in contact with intact ski
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103
Q

What are the steps for reprocessing of Reusable medical devises (RMDs)?

A
  1. Pre-cleaning at the chairside
  2. Mechanical cleaning using ultrasonic
  3. Manual cleaning using of professional cleaning machines
  4. Thermal disinfection
  5. Thermal disinfection using washer-disinfection
  6. Inspection
  7. Choice of packaging material and sealing of packages
  8. Labelling packages of reuseable medical devices
  9. Run a Bowie-Dick type tests for air removal and steam
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104
Q

What is a gold standard indicator for sterilization?

A

Class 6 – measuring time, steam and temperature.

Class 1 – not great because it only shows temperature.

Class 4 – used in SAD

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105
Q

What is the goal of drug therapy treatment?

A

1.Prevent disease

2.Cure disease

3.Decrease mortality

4.Decrease illness

5.Descrease symptoms of illness

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106
Q

What is the rational drug prescribing?

A

1.Right drug

2.Right dose

3.Right frequency

4.Right duration

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107
Q

What are the 3 most important parts of pharmacokinetics?

A

1.Absorption

2.Distribution

3.Elimination – metabolism and excretion

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108
Q

What is the pathway of gastrointestinal absorption?

A

1.Lumen

2.Enterocytes

3.Portal vein

4.Systemic circulation

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109
Q

How much water can we drink to empty a stomach?

A

200mL as it will make the stomach empty into the small intestine

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110
Q

What are some of aspect that effect variability?

A

1.Disease – kidney disease (lover dose), liver disease (no paracetamol)

2.Age – children (hihg clearance) Elderly (lover excretion, polypharmacy, Start Low & Go up slow & don’t stay low)

3.Pragnancy – all drugs no, contact GP to prescribe especially first trimeste, no ibuprofen, floconazole and oral isotretinoin – reduced GI motility

4.Genetic

5.Smoking

6.Food – grapefruit juice Drug-drug interaction

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111
Q

What are different type of drug-drug interaction (pharmakokynetic)?

A

Drug induction – Drug A induced Drug B increasing the sites of binding

Enzyme inhibition – Drug A blocks metabolism of Drug B resulting in accumulation of Drug B (miconazole)

Changes in renal clearance – Ace inhibitors, Nsaids and Diuretics (triple whammy)

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112
Q

What are major types adver drug responses?

A

Type A – augmented or increase effect - usually okay

Type B – Bizarre and unpredictable – high risk of death

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113
Q

What neurotransmitter is used for cholinergic receptros?

A

Acetylcholine. Store in cells in vesicles and can be released in the systemic circulation (synaptic cleft) by calcium channels. There is 3 such receptors called muscarinic M1, M2, M3 (M3 is one is for glands).

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114
Q

What drugs are use as cholinergic agonists?

A

1.Direct acting – bind to activate muscarinic receptors – nicotine, lobeline and muscarine (aka magic mucshroom compound)

2.Indirect acting – inducing acetylcholinesterase (breakdown of acetycholine)

Blocking cholinergic pathway result in:

Red as a beet

Blind as a bat

Dry as a bone

Full as a flask

Stuffed as a pepper

Mad as a hatter

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115
Q

Which drugs are used as cholinergic agonists (specific)?

A

1.Drugs for Urinary Incontienence

2.Parkinson’s disease

3.Gut motility disorders

4.Motion isckness

5.Pre-anaesthetics

6.Astham: inhalers

7.Antidepressants: Tricyclic antidepressant (not logner used much for depression but used for pain), serotonin selective reuptake inhibitors - important

8.Antipsychotics: Olanzapine, droperidol NOT CLOZAPINE that one cause hypersalivation - important

9.Antihistamines: sedating group is more common - improtant

10.Anxioklytic: anxiety drug

11.Antihypertensive

12.Benign prostatis hyper plasia

13.Appetite suppressants

14.Cytotoxic agents: radiotherapy

15.Diuretics

16Opiods

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116
Q

How can we help with xerostomia?

A

Efficacy in unproven:

  1. Saliva substitutes – Aqueae
  2. Salivary peroxidase
  3. Mouth washes

4.M3 receptor agonists - slaframine

5.Check prescriptions and maybe stop taking the over counter medications

6.Sip water

  1. Ice blocks

8.Spray bottle

  1. Suagrless lollies or sugar-free gum
  2. Limit caffein & alchohol
  3. Adhere to preventative dental program
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117
Q

What should be included on a prescriptions script?

A

Remember ePrescriptions are preferred

  1. Patient’s name, address and DOB
  2. Name & address of practitioner, phone number, qualifications, AHPRA reg
  3. Drug name – GENERIC
  4. Drug form – e.g. tablets
  5. Drug strength- e.g 15 mg
  6. Drug quantity in pills (word, symbol e.g Ten,10)
  7. Dose & frequency of administration
  8. Duration of days
  9. Instruction clearly
  10. Write (For dental treatment only)
  11. A line to signify no other prescriptions
  12. Signature of prescriber
  13. Date of prescription
  14. Signature
  15. PBS number for prescribers
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118
Q

What is released during the brekadown of cellular wall?

A

Prostoglandins – long chains of fatty acids which cause vasodilation, swelling and pain. Additionally, bradykinin is released which causes intense pain.

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119
Q

What do non-steroidal anti-inflammatory drugs target?

A

They block the work of COX1 and COX2 enzymes which prevents the creation of prostoglandins

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120
Q

What is important to remember about the cyclooxygenase enzymes?

A

COX enzymes are present throughout the body. COX1 is abundant and it maints our function. COX2 is in very low amount and lead to inflammation & pain because it is inducible. By inhibiting COX2, we can lower inflammation.

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121
Q

What is important to understand about ibuprofen?

A

It is an reversible drug. It is a non-selective COX 1 & 2 inhibitor. But is an effective analgesics in presence of inflammation. It reduce the production of psotoglandisnas and make receptors less sensative to bradykinin.

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122
Q

Do NSAIDS have adverse effects?

A

1.Gastrointestinal ulcers

2.Reduce platelet aggregation

3.Respiratory problems: increase asthma attack

4.Kidney: renal failure and water retention leading to heart failure and hypertension

5.Cardiovascular – uncommon BUT BAD

6.Neurological – headaches

7.Hematological – rare

8.Hepatic – rare

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123
Q

When should you not prescribe NSAID?

A

1.Kidney impairment

2.Heart failure or arterial fibrilation

3.Active GI ulcer

4.Bleeding disorder and their drugs

5.Corticosteroid or anticoagulation use

6.Multiple risk factors for increase NSAID toxicity

7.If unsure contact GP

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124
Q

What questions should you ask particularly an elderly before prescribing an NSAID?

A
  1. Have you experience recent changes in your bowel habits, such as black or tarry stools?
  2. Any episodes or recent nausea, vomiting or abdominal pain?
  3. Have you noticed any changes in your urine output or color?
  4. have you experienced any shortness of breath, chest pain or swelling?
  5. Do you have a care giver or support group that may aid you or remind you about taking the medication?
  6. Do you take any over the counter medications recently that are beyond the once in your medical history?
  7. Do you take a deuretic or an ACE inhibitor?
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125
Q

What can we use an NSAID for?

A

Mild-moderate acute inflammatory pain. Usually 1200mg/day, 400 mg per 6 hours for 2-3 days if pain persists you should go to GP.

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126
Q

What can be used in temporary relief of painful inflmmatory oral mucosal conditions like mucositis?

A

Benzydamine, an NSAID in a spray form.

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127
Q

What is the most important side effect of opioids?

A

Respiratory depression. Additionally, sedation, nausea, euphoria, constipation and dry mouth.

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128
Q

What can dentist prescribe?

A
  1. Morphine – not recommended in dentistry as it is not for acute pain
  2. Codeine – less potent for gram then morphine about 1/10 - not good for dental pain
  3. Oxycodone - not that good
  4. Tramadol – not a drug of dependence – a lot of tummy aches - go with this first!
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129
Q

What can you use to reverse the effects of an opioid?

A

Naloxone

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130
Q

What are the tree major drug groups use for sedetation?

A

1.Sedatives/hypnotics - IV – most important is brain concentration and elimination of the drug – diazepam (very fast 1-2minutes, half-life of 4-8hours), nidazolam(fast onset 4minutes, half-life 90 minutes)

2.Analgesiscs

3.Muscles relaxants

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131
Q

What are the profiles of benzodiazapines?

A
  1. Relatively fast onset
  2. Offset can be slow with diazepam
  3. Dose-response relationship is very variable
  4. CNS – cause convetional sedation, amnesia and anxiolysis
  5. Respiratory – ventilatory depression and airway obstruction
  6. CVS – mild hypotentison
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132
Q

When do you give a second doze of benzodiazepines if does not work?

A

Give it 10-15 minutes and then reassess after the first dose.

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133
Q

What are the profiles of phenols (like propofol)?

A

1.Slow onset

2.Offset is fast due to redistribution but then is slow for full clearance

3.Dose-dependent relationship is less variable

4.CNS sedation and anxiolysis

5.Ventilation depression and airway obstruction

6.Moderate-sever hypotension

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134
Q

When do we use antibitotics?

A
  1. Only use when there are demonstrated benefits
  2. In general, the narrower the spectrum you can use the better
  3. Single agents unless combination has been proven superior
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135
Q

What are the major classses of antobiotics in dentistry?

A

1.Beta-lactams – inhibit bacterial walls and interference of bacterial wall synthesis. Beta lactamase can build resistance to beta lactams. Good spectrum of action, safe and wide therapeutic index. Generics: benzyl penicillin or phempxymethyl penicillin. Act on gram positive cocci thus can affect oral flora. Could be short spectrum or moderate spectrum (amoxycyllin). Can be used with clavulanate (inhibitor of beta lactamase) making it target anaerobes, good for elderly. Main side effects: allergy, GI issues and hepatoxicity.

  1. Cephalsporins – also beta lactam but not pencillins. Broader spectrum. Not very much used.
  2. Nitromidazole – metronidozole. Inhibits DNA synthesis and covers anaerobes. Adverse reactions: GI problems, dizziness, bitter and metalic tase. No alcohol as metronidozole inhibits the brekdown of alchohol. Need to wai 72 hours after finishing a script
  3. Lincosamides – clindamycin. Inhibits bacteria protein synthesis. Good for Gram positive and anearobic bacteria. Adverse reactions: GI problems (bad ones), allergy
  4. Macrolieds – erythromycin. Good for gram positive but not for anaerobes. Adverse effects: GI issues, a lot of drug interactions
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136
Q

What is the use of sedative and hypnotics in dentistry?

A

Majority will be used to reduce anxiety before/during dental procedures

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137
Q

What is effect of benzodiazapines?

A

1.Anxiolytic

2.Sedative

3.Hypnotic

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138
Q

What are adverse effects of benzodiazapines?

A

1.Drowsiness

2.Impaired performance

3.Respiratory depression ESPECIALLY WITH OPIODS

4.Paradoxical excitation

5.Retrograde amnesia

6.Fantasy

7.Dependence – give 1-2 tablets only

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139
Q

What are the benzodiazepines avaliable for dentist?

A

1.Oxazepam

2.Temzepam

3.Nitrazepam

4.Diazepam – please only prescribe 1-3 tablets

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140
Q

What is serotoninergic syndrome?

A

It is when mutliple drugs that increase serotonin are used.

This features:

Bahvioural changes

Altered muscle tone

Autonomic isntability

Hyperpyrexia and diarrhoea

Death

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141
Q

What are usualy drugs of inflammation?

A

Corticosteroids.

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142
Q

If a patient is on steroid, what would be some of the side effects?

A
  1. Delayed wound healing
  2. Increased susceptibility to infection
  3. Masking of signs of infection
  4. Adrenal suppression
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143
Q

What are small moluce immunosupressants?

A

Cyclosporine and tacrolimu for example. They can potentially interfere with healing and immunity. Can also cause gingival hyperplasia.

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144
Q

What are biological immunomodulators?

A

Something like monoclonal antibodies like interferon. Patient will receive an infusion or an injection periodically.

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145
Q

What are some medication that can be used for herpes simplex and varicella??

A

Aciclovir available orally, IV and topically. Or vallaciclovir or famciclovir.

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146
Q

What are some topical antifungals?

A

Amphotericin B. Not obsorbed orally so very good. Nystatin. Not absorbed orally so also very good. Miconazole. Non-pbs but cheap as a cream. Anything azole is a antifungal

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147
Q

What are the 2 different types of bronchodialators?

A

1.B2 adrenoreceptors agonist

2.Anticholinergic drugs

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148
Q

What are beta 2 agonists?

A

1.They relax smooth msucles in airways

2.And stop the mediation factors from wrecking the place up

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149
Q

What are the symport relievers available?

A

1.Salbutamol

2.Tobuterol

They are short acting and there duration is 3-6 hours or can be made into long acting for upto 12 hours.

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150
Q

What are the actions of corticosteroid in lung disease?

A
  1. Anti-inflammatory
  2. Reduce bronchial hyperactivity
  3. Increase number of beta 2 adrenpreceptors
  4. Increase responsiveness to beta 2 agonsits

Example: Beclomethasone

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151
Q

What are the side effect of topical corticosteroids?

A

1.Oral candida

2.Hoarse voice

3.Rash

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152
Q

What are anticholinergic bronchodilators used for?

A

Ipratropium or Tiotropium are used in treatment of chronic COPD or acute asthma. Remember, dry mouth

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153
Q

What equipment shpudl you have at your practice for dental emergencies?

A

1.Oxygen source

2.Disposable plastic airways

3.Adrenaline 1in 1000 injection

4.Pulse oximeter

5.Glucose

6.Glyceryl trinitrate spray 600 mcg

7.Short-acting bronchodialator and space

8.Aspirin

9.Blood pressure monitor

10.Blood glusode monitor

11.Automated external defibrillator

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154
Q

What are some allergic reactin that may occur in chair?

A
  1. Urticaria – red itchy patches – stop administration of any allergens and administer a less sedating oral antihistamine like cetirizine or fexofenadine (not on PBS but good to have around and they are cheap)
  2. Anaphylaxis – cardiovascular collapse and bronchoconstriction – stop administration of any allergens, call 000 and lie patient flat and give intramuscular injection of adrenaline, start supplemental oxygen, support airway, start CPR if needed. Do proper documentation.
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155
Q

What to do if a patient has chest pain or angian?

A

1.Stop treatment

2.Pulse oximeter on, see if patient is concious, check heart rate and blood pressure – if no pulse, CPR - ask patient if they used viagra, as it can make GTN way more potent

3.Use glyceryl trinitrate spray 400 micrograms sublinguallt, repeat 5 minutes if pain persists, for total of 3 dosease if tolerated

4.If pain continues, call 000

5.Give 300mg of aspirin orally chewede before swallowing

6.Strat supplemetan oxygen and maintain oxygen between 90-96% saturation

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156
Q

What are two types of hypoglycemia?

A
  1. Adrenergic – release of adrenaline
  2. Neuroglycopenic – damage to neural cell - common in diabetics
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157
Q

What to do in a hypoglycemic event?

A
  1. Stop treatment
  2. Give 15 g of glucose and measure glucose level in 15 minutes
  3. If still low, administer 3 or more portions
  4. f symptoms persist, seek medical advise and call 000 if patient is unconcious
  5. IF all is good after a few protions, no dental treatment today, get some longer acting carbohydrates like a sandrwich or yogurt and observe the patient until they feel okay
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158
Q

What to do if a patient has an asthma attack?

A
  1. Stop treatment
  2. Oximeter is placed straight away moderate is above 94%, sever 90-94%, life threatening below 90%
  3. f mild – give 4 puffs of salbutamor via spacer 1 puff at a time with patietbreathing in 4 times
  4. Wait 4 minutes, if not imrpoving treat as sever or lifethretening
  5. Call 000
  6. Maximum of 12 puffs but if it is bad even after just keep giving salbutamo with 4 breaths in between before ambulance arrives
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159
Q

What should you cover in penicillin allergy history?

A
  1. What did patient react to?
  2. What was the type of rection? Is it really sever, did it limit their function or made them die? Did it have it for mono, that one can create a fake reaction to antibiotic
  3. How long after start of treatment did it occur eg after a few hours or many days?
  4. How long ago was the reaction?
  5. How was it treated?
  6. Have they had similar antibiotics since?
160
Q

What are considered to be low risk reactions to penicilin?

A
  1. Uknown reaction more than 10 years ago
  2. Childhood exanthem, unlear details with no evidence of hospitalisation
  3. Diffuse or localise rash with no other symptoms after 24 hours after strating the antibiotic more than 10 years ago. This make the risk of rash on re-exposing about 5%.
161
Q

What are considere high risk reaction to penicillin?

A
  1. Any previous respiratory disressm, swelling of mouth or throat
  2. Any history of diffuse rash which comes immediately after starting treatment
  3. Diffuse or localised rash which is delayed but occurred less than 10 yearsago

Re-exposure may cause anaphylaxis, so non-beta lactam

162
Q

What are considered sever cutaneous reactions to penicillin?

A

1.Rash with mucosal ulceration

2.Oustules, blister, desquamation

3.More

These features show that the next ras could be fatal. Non-beta lactam antibiotic should be usd.

163
Q

What is the use antiplatelets/anticoagulants?

A

Primarily for management of cardiac conditions, secondayr prevention of IHD, cerebrovascular, peripheral vascular disease particularly with procedure such as stents. Multiple agents are used I.e. an antiplatelet and an anticoagulant. Used fo artrial fibrilation or if a patient has a history of clots.

164
Q

What are dental implications of aspirin?

A

Prevent clotes forming at low dosage. Irreversible inhibition of platelet aggregation for 7 days. Need to stop 7 days before surgery for platelet to be replaced with new ones.

165
Q

What are clopidegrel and prasugerla?

A

Anitplatelets. More effective then aspirin thus more bleeding may occur. Irreversible. Needs 7 days to regenerate. Check with GP/cardiologist before asking patient to stop taking it. Usually used together with aspirin. Greate risk of thrombosis.

166
Q

What is ticagrelor?

A

Reversible inhibitor. Anti-platelet. Given in high risk situtations. Check with GP/cardiologist before asking patient to stop taking it. Usually used together with aspirin. Greate risk of thrombosis.

167
Q

What is warfarin?

A

Vitamin K antagonist inhibits the clotting factors II, VII, IX, X. Anti-coagulant. Bleeding risk can be measured with INR. 2-3 is manageable and is the therapeutic range. If taken off, restarting takes some time. Warfarin has a lot of drug interactions.

168
Q

What are direct oral anticoagulants or new oral anti coagulants?

A

Apixaban, dabigatran, rivaroxaban. Directly acting agent which generally require a single stable dose, and do not need to monitor for effect. Can not measure the effect with INR. Patient may not know they are on anticoagulants. When to stop: dabigatran 1-4 days depending on renal function, apixaban and rivaroxaban: 1-2 days

169
Q

What is ischemic heart disease?

A

Less oxygen to the heart then requires, lead to pain (angina) and infarction because of the plaque. Therapeutic objective: rebalance supply of oxygen. Acutely reduce myocardial need for oxygen and chronically: improve coronary blood flow

170
Q

What are angiotensin II blockers?

A

End in sartan. Similar to ACE inhibotrs but do not cause cough or angiodema.

171
Q

What are diuretics?

A

End in thiazide. Have a diuretic and vasodilator effects. Have a risk of postural hypotension after prologned supine rest or with nitrates.

172
Q

What is heart failure?

A

Heart incapable of pumping sufficient output for needs of the peripheral tissues at usual filling pressure. Result in fluid accumulation, shortness of breath (pulpmonary oedema) from lying down and ankle swelling. Do not take NSAID’s please (remember tripple whammy).

173
Q

What are loop diuretics?

A

Furosemide. Very effective diuretic with repid onset. IF taken in the morning, may need to stop the procedure so they can take a toilet break.

174
Q

What is important to remember about spironolactone?

A

No NSAIDs. Very common cause of renal failure. Very bad very sad. Contraindications.

175
Q

What is the action of glucocorticoids?

A
  1. Regulation of metabolism
  2. Response to physical stress eg surgery
  3. Suppress immune function (block formation of different immune responses)
176
Q

What are therapeutic roles of glucocorticoids?

A
  1. Replacement in hypoadrenalism eg Addison’s disease (Addisonian crisis hehehe)
  2. Immune suppression (arthitis, skin conditions or even prevention of organ transplant rejection)
177
Q

What happens if you use high doses of exogenous corticosteroids for a perio of time?

A

The cells within the cortex are not stimulated to grow by ACTH from petuitary gland. This mean when the exogenous source is depleted, there is no support coming from an endogenous source (ie natural source, self-produced by the body). For example in stress. The usual amount is more than 5mg/day of prednisolone for more than 2 weeks will require more corticosteroid.

178
Q

How to manage a patient with corticosteroids?

A
  1. Find out how long they have been on steroids
  2. Reduce stresses
  3. If extraction or other steroids, to prevent an Addisonia crisis start teatment in the morning and get more steroids the day before (double the dose) and the day of treatment (double the dose) - contact GP prior.
179
Q

What are sulphonylureas?

A

They stimulate the release of insulin from pancrease. Can cause hypoglycemia. Abuse pancrease so no good. Causes weight gain.

180
Q

What are SGLT inhibitors?

A

Gliflozins. Inhibits glucose transported in renal tubules. Associated with weight loss. Can cause dehydration and infection in the urinary tract.

181
Q

What are the proton pump inhibitors?

A

Omeprazole or other. Irreversibly inhibit the proton pump stopping the production of gastric acid. Very rare adverse effect.

182
Q

What transmitters help to induce vomiting?

A

Aceetylcholine and histamine 1 at the vomiting center. Also, drugs and toxins are detected by chemoreceptor trigger zone in the brain which use dopamine 2, 5ht3 (seratonin), neurokanine 1 so you need to block the chemoreceptor trigger zone.

183
Q

What are good antiemetics?

A
  1. Metoclopramide – dopamine antagonist (please don’t use in Parkinson’s disease) - may cause extrapyramidal effects – use 10mg 6-8 hour;y oral
  2. Prochlorperazine – dopamine antagonists, also anthistamine, alpha blocker and anticholinergic – problems: drowsiness, hypotentsion, dry mouth also cardiac effect
184
Q

What are the indications of RA?

A
  1. Anxious patient
  2. Older children with poor dental experiences
  3. Complex or long procedures
  4. Child with special needs
  5. Fear of needles
  6. To aid analgesia
  7. Increased gage reflex
  8. AND MEDICALLY FIT ASA I AND ASA II
185
Q

What are the pharmacology of nitrous oxide?

A

It has very low solubility in blood. It is absorbed rapidly through the pulmonary alveoli and enters the serum. It acts on the cental nervous system through crossing blood brain barrier. Peak effect achieved within 3-5 minutes. Rapid and complete recovery.

186
Q

What are physiological effects of nitrous oxide?

A
  1. CNS euphoric and depressant effect
  2. Still responds to instruction
  3. Children are more relaxed and feel happier
187
Q

What is the theory behind the work of the RA?

A

Maybe the GABAA receptors or opioid receptors f the CNS.

188
Q

What are the adverse effects of RA?

A

Mostly associated with overdose! Following:

  1. Nausea or vomiting
  2. Sleep
  3. Visual disturbance
  4. Excessive laughing
  5. Sweating
189
Q

What are the signs of over-sedation?

A
  1. Detachment/dissociation
  2. Dreaming, hallcination or fantasizing
  3. Out of body experiences
  4. Floating or flying
  5. Inability to move
  6. Humming
190
Q

What to do if you feel like you overdoing the RA?

A
  1. Slow induction
  2. Keep N2O concentration below 50%
  3. Reduce N2O concentration slowly
  4. Monitor patent closely
191
Q

What the 3 purposes of reservoir bag?

A
  1. Provide a source of additional gas should the patient inspire more gas than is being supplied ◦
  2. Provides a mechanism for monitoring the patient’s respiration (watch the expansion and contraction of the bag) and for adjusting the flow (not too stretched or collapsed)
  3. Functions in an emergency as a method of providing positive pressure oxygen
192
Q

What do you need to do before RA?

A
  1. Parents must sign a consent form
  2. Make sure equipment is set up properly BEFORE the patient comes in
  3. Patient must cooperate
193
Q

What is the difference between slow vs rapid induction?

A

Slow – best suited for inexperienced operators. Increase from 0-30% in 10% intervals every 1 minutes

Rapid – better for young children – jump to higher concertation

194
Q

What do you put in a patient record for RA?

A
  1. Signed consent form
  2. Indication of use
  3. Nitrous oxide dosage
  4. Patient response
195
Q

Why do we start in the waiting room to meet the child?

A
  1. First impression matter
  2. Assessment of the child’s behaviour
  3. To greet the child
  4. To compliment a child in order to build rapport
196
Q

How to talk to a child?

A
  1. Act natural
  2. Make an effort
  3. Find the point of ice breaking such as compliments, pets or school
197
Q

What are contraindication for RA

A

Pulmonary heart disease

Sever asthma

Blocked nose

Refusal to breathe through nose

CNS disease

Otitis media or middle year disturbance/surgery - only active

Claustrophobia

GI issues

Cystic fibrosis

198
Q

How do you administer RA?

A

Use slow induction technique – from zero to desired 10% at a time per minute

Keep N2O concentration below 50%

Reduce concentration N2O

If patient falls asleep, turn O2 to 100%

Avoid fluctuations

Monitor patient closely

Use 100% of oxygen for 5 minutes at the end of the session

199
Q

What is the equipment for the nitrous oxide machine?

A
  1. Gas delivery machine – continuous flow of O2 and N2O, minimum 2.5L/minute, for children 4-5/L
  2. Nasal hood – various sizes and flavours
  3. Inflatable bag – provide source of additional gas, mechanisms for patient respiration, in emergency used as a method of providing positive pressure oxygen
  4. Scavenging system – to trap experied gas by the patient
  5. O2 flush valve – in emergency to provide jet ventilation, can cause barotrauma
200
Q

What sould we record in RA notes?

A
  1. Signed informed consent
  2. Indications of Use
  3. Nitrous oxide dosage in percent of N2O and O2 with flow rates and duration of the procedure
  4. Patient response
201
Q

Is it a legal requirement for a dentist to report child abuse?

A

Yes

202
Q

When would you not report abuse?

A
  1. IF there is a reasonable belief that another person has reported abuse
  2. IF the suspecion was due soley to being informed of the abuse by a police officer or child protection officer
203
Q

What are the eruptions times for deciduous teeth?

A
  1. Lower central incisors – 6-10 months
  2. Upper Central inicsor – 8-12 months
  3. Upper Lateral inicsor – 9-13 months
  4. Lower lateral incosr – 10-16
  5. Upper First molar – 13-19 months
  6. Lower First Molar – 14-18
  7. Upper Canine – 16-22 months
  8. Lower canine – 17-23 months
  9. Lower seond molar – 23-31 months
  10. Upper Second molar 25-33 months
204
Q

What are the eruption times for permanent teeth?

A

1.Lower central incisors – 6-7 years

2.Upper First molar – 6-7 years

3.Lower First molar – 6-7 years

4.Upper Central Incisors – 7-8 years

5.Lower Lateral Incisors – 7-8 years

6.Upper Lateral Incisors – 8-9 years

7.Lower canine – 9-10 years old

8.Upper first premolar – 10-11 years

9.Lower first premolar – 10-12 years

10.Upper second premolar – 10-12 years

11.Upper cannines – 11-12 years old

12.Lower second molar – 11-13 years old

13.Upper second molar – 12-13 years old

14.All third molars 17-21 years old

205
Q

What are some learning theories?

A
  1. Classic: stimulus resposnse ie white coat = needle
  2. Operant: action reenforced with a rewards or punishment .
  3. Social: modeling – very good, monkey see monkey do
206
Q

What is one of the best way to influence a child?

A

Positive reinforcement – all adults and children are influenced by reinforcement. This is also very relevant for small children. The more consistent the reinforcement, the more likely a desired behaviour is reached. ALWAYS BE PRAISING. PLEASE SAY PLEASE AND THANK YOU. Be specific and consistent with your praise

207
Q

What are some of the positive reinforcements?

A
  1. Motivational advice
  2. Verbal praise, non-verbal such as smile or STICKERS
208
Q

What is the Frankl scale?

A

It is a scale of co-operation and fears. Please put it into notes. Uses ++, +, -, – scale for general idea.

209
Q

What are some aspects of child management?

A

1.Time efficiency – kids do not like to sit in the chair for too long

2.Behaviour management techniques: Modelling for the first visit, Tell-Show-Do to reduce anxiety, Voice control do not yell, Use of appropriate language to the kid like euphemism (sleep juice from a magic wand), monitoring the child for sense of control, distractions with triplex or wrigling the toes, positive reinfocement, systemic desensitazantion (a bit advanced and for older children because they realise that fear is irrational), behaviours shaping where you slowly shape the child behaviour from non-cooperative to cooperative with ability to retrace your steps

3.If the kids is dangerous, you can use aversie conditioning BUT NOT IN AUSTRALIA you can just do GA

4.Do not do the treatment if child does not cope with it, it is about quality treatment and overall positive treatment outcomes

210
Q

What do you do if during tell-show-do exercise a child retracks their hand fromt eh prophy brush?

A

1.Retrace your steps. The show componenet needs to be modified

2.Ask the child how they are feeling, if they are withdrawn they are probably just anxious

3.Maybe to give them a more sense of control, do it on your fingernail first

4.Then let a child hold a hand mirror next to your finger to give them a sense of control

5.After do it on their finger

6.And finally on their tooth

7.Praise the child for being brave

8.Promise a sticker if you can do it on al teeth – children love stickers

211
Q

What are factors to consider for pharmacological intervention for behaviour management?

A

1.Patient age

2.Patienet behaviour

3.Treatment required

4.Medical condiitons

5.Distance travelled

6.Language barrier

7.Risk and benefits

8.Practitioner experience

9.Informed consent

212
Q

What is the recommended dose of lignocaine in children?

A

4.4. mg/kg and one carpule has 44mg. So per every 10 kg you can have 1 carpule max. So for a 25 kg child you can have 2-3 carpule with some interspacing. Also remember about topical.0.1g has about 5 mg!

213
Q

What are the most common complicationa fter LA for a child?

A

1.Soft tissue trauma

2.Overdose – CNS depression, seizures, decrease cardiac output and cardiovascular collapse

214
Q

What is the recommended dose of articaine 4%?

A

It is half of that of lignocaine, so if you use 3 carpules for ligno, use 1.5 for articaine.

215
Q

How do we administer local to a kid?

A

1.Tell them about the taste

2.Supraperiosteal infiltration for upper only

3.Inferior alveolar block with long buccal

4.How is the syringe passed is important – under the chair

5.Inject slowly

6.Use behavior management in conuction with pharmacological one

216
Q

What is the etiology of early childhood caries?

A

Mutants streptococci are associated with early childhood caries. These mutants stretococci do not appear in the childrens mouth from birth, rather they are transmitted vertically (by parebnt via saliva) or horizontally (byu siblings or other kids via saliva). If a child does not have mutants streptococci before the age of 2, they will only develop caries in about 25% of the situations.

217
Q

What are risk factors for early childhood caries?

A

1.Previous carious experience – but not when super young lol

2.Visible plaque – remember to screen all children

3.Dietary factors – especially sleeping with a bottle of something sugary and free sugars

4.Breast feeding IS NOT assoicated with ECC – because lactoferin kills MS

5.Enamel developmental defects

6.Low socioeconomic and sociocultural factors

7.Children with medical conditions – such the ones that need to use meidcations causing xerostomia or that predispose them to enamel hyperplasia

218
Q

What are clinical features of ECC?

A

1.Follows the pattern of eruption – starts with lagial, gingival and lingual surfaces of maxillary incisors and spread to molars

2.Rapid progression – DO NOT OBSERVE MAY LEAD TO DISASTER

219
Q

What are the consequences of untreated early childhood caries?

A

1.Pain

2.Sepsis

3.Space loss

4.Disruption to quality of life

5.Disruption of growth and development

6.Possible disruption of intellectual development

7.Hospitalisation

8.Greater risk of caries

9.Death

220
Q

What is a great solution for early childhood caries?

A

Composite resin strip crowns. 80% success rate! Also early screening, prevention or use of silver diamine fluoride, dietary changes, behaviour change, habbit change, fissure sealants and constant use of fluoride.

221
Q

What can you say about caries trend?

A

We getting more caries, oh no 🙁. There is a theory that this occurs due to consumption of non-fluoridated bottled water.

222
Q

What the most common site of caries?

A

Occlusal pit and fissures followed by interproximal. Usually caries are bilateral especially in molars and anterior.

223
Q

What is the problem with adolescence?

A

1.Challenging age group

2.Unique oral health problems

3.Less parental influence

4.Increase in independence

5.Caries susceptibility

6.Erosion risk

7.Smoking

8.Need to update medical history regularly

9.Increase carbohydrate

224
Q

What kind of caries risk tool can you use for children?

A

CAMBRA – caries management by risk assessment. It is a questionnaire that recommends tratment. Not good for idnividuals treatment.

Bad caries progression – WREC – whites spots, restorations past 3 years, enamel lesions and cavities

At risk – BAD – bad bacteria, absence of saliva, dietary habits

Protective factors – SAFE – saliva & sealants, antibacterials, fluoride, effective diet

225
Q

What is the Australian fluoride guide?

A

6-17 months – no fluoride

18 months – 6 years – childrens toothpaste (400-550ppm) 2x per day spit no rinse

6+ years – normal tooth paste 1000ppms x2 a day spit no rinse

6+ years + high risk of caries – 5000ppm tooth paste 2x times a day spit no rinse

226
Q

When do you use fluoride gel/foam?

A

Every 6 months for 4 minutes at 12300 ppm. Not recommended to less than 10 year old.

227
Q

What is the maximum does of fluoride roxicity?

A

3-5mg of fluoride/Kg. Toospase has 1mg/g. Meaning a 10kg baby needs about 30mg or 30 grams.

228
Q

What are some tricky extraction in deciduous teeth?

A

1.Second deciduous molars with roots

2.Broken down crowns with limited amount for forceps application

3.Complete loss of crown structure

4.Molar teeth with complete lost of the crown

5.Previously pulp[otemised teeth

6.Full rooted deciduous canines

7.Asnkylosed teeth

229
Q

What kind of LA should youy give for an extraction?

A

A IANB and a buccal infiltration

230
Q

What are the mechanisms of exodontia?

A

Stop if the kid says ouch, especially if they are cooperative and top up

1.Expansion of the bony socket to permit removal of its contained tooth.

2.Use elevators with utmost caution

3.Use three basic mations: wheel and axle (screwdriver), wedge and lever. Alvaolar bone is the fulcrum

4.Support jaw bone with your other hand

5.Use of level and fulcrum principle to force tooth or root out of socket along the path of least resistance

6.Always use the forceps as sungingivally as possible

7.Push buccaly for 3 seconds, then move to figure of 8

8.Repeate until the tooth is out

231
Q

Up until which point can you perform a pulpotomy?

A

Up until reversible pulpitis as after, according to the continuum of Pulp Status, an extraction or a pulpectomy is recommended. Followign symptoms are bad:

1.Spontaneous pain kept awake at nigh

2.TTP

3.Abscess

4.Mobility

5.Facial swelling celulitis

232
Q

What is a good treatment plan set up?

A

Session 1:First impression, history, examination, X-rays, consent and tretament plan debridment, improvement in OHI and diet, Prophylaxis and fissure sealants if possible. If too much suggest GA.

Session 2: RA + Q1

Session 3: RA + Q2

Session 4: RA + Q3

Session 5: RA + Q4

3 months recall, more treatment if need

233
Q

What are the most common enamel defects in primary dentition?

A
  1. Hypoplasia – quantitative – deficiency in tooth substance due to ameloblast desruption
  2. Hypomineralisation – qualitative – disturbance in the initial enamel calcification and/or maturation leading to lower mineral content
234
Q

What is molar-incisor hypomineralisation?

A

It is a qualitative enamel defects of systemic origin, affecting one to four first permanent molars and frequently associated with affected incisors

235
Q

What is HSPM?

A

Hypomiralisaed second primary molars is a condition where the second primary molar is hypomineralised. There is association between that and Molar hypomineralisation (MH)

236
Q

What is the aetiology of developmental defects of enamel?

A

Ameloblast are exteremly sensetive to any systemic, local or genetic factors. But the insult intesity and timing are important.

Usually:

In primary dention, the insult occurs prenatally or before first eyar of life

Permanent incisors and permanent first molar are more suscpetible in peri-natal and first 3 years of life – consitent with MIH

Permanent canines and second molars around pre-school years

Insults could be cause by:

1.Disease

2.Medications

3.Fluoride

4.Trauma

237
Q

How would you diagnose DDE?

A

1.Describe the distinct border

2.Describe the type

3.Resulting enamel – smooth or soft and pourus

4.If there is any unprotected dentine

5.If there is any caries

6.Is there post-eruptive breakdown of the dental hard tissue

7.ALWAYS perform examination on wet teeth as drying teeth may result in pain

238
Q

What is the problem with hypomineralised enamel?

A

1.It has an increased instance of enamel fractures

2.It has a decreased ability for retention of adhesive materials

239
Q

What are the objective of treatment for a patient with DDE?

A

1.Reduce pain & sensitivity

2.Provide adequate restoration

3.Eliminate need for multiple repeat restorative procedures

4.Minimise dental anxiety and fear

5.Maintain occlusion and minimise cplexity of any furutre ortho treatment

6.Aesthetic rehabilitation

240
Q

What is the 6 step approach?

A

1.Risk identification – assess medical history

2.Early diagnosis – examine at-risk molars on radiographs if available

3.Remineralisation and desensitisation – before breakdown, as soon as erupted

4.Prevention of dental caries & post-eruptive breakdown – F/S

5.Restoration or extraction – SSC can be used even for initial stage even in permanent dentition, but especially in deciduous if there is severe-moderate MIH. GIC good for interim

6.Maintanance

241
Q

What is the first line of treatment for mildly affected MIH teeth?

A

1.Remineralisation

2.Fissure sealant

242
Q

What is the first line of treatment for severely impacted MIH teeth?

A

1.Immediate treatment – desensitising

2.Intermediate treatment – SSC

3.Long-term treatment – extraction or complex restoration

4.Always consider extraction in young patient as it prevent need of life-long maintanance

243
Q

What is a syndrome?

A

A pattern of malformations resulting from the action of a single cause on more than one developmental field.

244
Q

Why should we care about dental anomalies associated with syndromes?

A

1.Significant oral implications

2.Malocclusion

3.Increase instances of oral diseases

4.Pain and sensitivity

5.Disfiguring

6.Genetic implications

245
Q

What is hypodontia?

A

It is the agenesis of less than 6 teeth

246
Q

What is oligodontia?

A

It is the agenesis of more than 6 teeth

247
Q

What is anodontia?

A

When you have 0 teeth

248
Q

What are non-sendromic conditons associated with hypodontia?

A

1.Trauma

2.Infection

3.Radiation

4.Chemotherapy

5.Endocrine disturbances

6.Sever intrauterine disturbances

249
Q

What is hypodntia associated with?

A

Impacted maxillary canines and peg-shaped lateral

250
Q

What is concrescence?

A

Joining teeth by cementum. Usually occurs in second molar fused to third, impacted molar

251
Q

What is fusion?

A

Joining of teeth by dentine and or pulp

252
Q

What gemination?

A

Budding of a second tooth from a single tooth germ

253
Q

What is a good measure for double teeth?

A

1.Fissure sealing

2.Surgical separation

3.Ortho, implants, autotransplants or prosthesis

254
Q

What are Dens Evanginatus?

A

They are cusp-like elevations of enamel located in central groove or lingual of premolars and molars. They are prone to fractures so early diagnosis is essential. Partial pulpotomy might be beneficial. Can occur in anterior teeth as “talon cusp”, and it should be removed.

255
Q

What are Dens Invaginatus?

A

They are deep surface invaginations of inner enamel. Most common in lateral incisors. Needs fissure sealing and maintenance of clean fissures as they are at generally higher risk of pulpal necrosis and abscess.

256
Q

What is amelogenesis imperfecta?

A

A group of inherited conditions that adversely affect the development of dental enamel causing anomalies in it’s amount, structure and composition. Distinguished by dental abnormalities + pattern of inheritance. Results from mutation of AMELX, ENAM, and MMP20 gene

257
Q

How do we diagnose emalogenesis imperfecta?

A

1.Clinical exam – visual and flaking

2.Family history

3.Radiographic assessment

4.Scanning with electron microscope

258
Q

What are two different types of ankylosis?

A

1.With replacement resorption – bone is replacing dentine

2.Without replacement resorption - no bone replacing den

259
Q

What are the steps of pathology for a transverse root fracture?

A

1.Facial trauma, frontal force

2.Transverse fracture – occurs if dentine, cementum and pulp involved, if enamel is also involved – it is a crown root fracture

3.Take radiograph and do all of the test

4.Reparative tissue in a form of tertiary dentine is laied down in the fracture area

5.Over time – root canal stenosis may occur – pulpal tissue will be replaced with deposited hard tissue through “buldging hard tissue” with prior joining of fracture line with fibrous connective tissue - this is done primarily by the pulp - the reparative capacity of dental hard tissue should not be underestimated

260
Q

What the three different types of healing following transverse root fracture?

A
  1. Through deposition of reparative hard tissue
  2. Fibrous hard tissue
  3. Bone and periodontal ligament
  4. No healing and pulp necrosis of the coronal portion (trick question) - this one is pretty rare
261
Q

What are the stages of tooth socket healing?

A
  1. haemostasis and coagulation - this is where suturing in warfarin is important
  2. Inflammation
  3. Proliferation
  4. Modeling and remodeling
262
Q

Why does tranexamic acid work on warfarin but not apixaban?

A

Tranexamic acid is antifibrinolytic which means it prevents breakdown of already created clots.

Apixaban inhibits factor Xa which revents fromation of thrombin and consequently fibrin clots, which means is stop coagulation before tranexamic acid can safe the clot, by not creating a clot to begin with.

Warfarin works on vitamin K as an antagonist (affecting factors II, VII, IX and X). Which means, it reduces reduces the clotting factors but does not eliminate the. This means that tranexamic acid can work on small amoutn of forming clots.

263
Q

What antibiotic interacts with warfarin?

A

Metronidozole

264
Q

What are the steps to assisting a patient with facial trauma?

A

1.ABC – airway, breathing consciousness

2.Neurological symptoms

3.Stability - is patient stable

4.Full secondary survey with primary care pshycision at the hospital. Head to toe with all histories taken if the patient is awake.

5.Diplopia – eye movement exams. Up,down, side to side

6.Nose, upper and lower jaw examination

7.Assessment of cranial nerves especially 5 + 7 but also all other nerves

8.Intra-oral examination - find all teeth, order chest x-ray if one is missing

9.Radiology order – plain x-rays first with OPG, PA skull, submentovortex and Lat ceph

  1. Treatment planning for surgery including history
  2. Consent from patient
265
Q

What is pre-opertaive set up for a facial traum surgery?

A
  1. Order of toxicology report for recent drug use
  2. Order a blood cell count (full blood count test)
  3. Order blood glucose level test if they have diabetes
  4. Order IV antibiotics to reduce the chance of infection as well as IV fluids and alagesia
  5. Order 1 bag of blood if need, tho not very common for facial fracutre surgery
  6. Contact naethetis and book an operating room
266
Q

What is the treatment for a mandbiular and condyle fracture?

A
  1. Direct epihpyseal fracture of the mandible, single, closed
  2. Indirect fracture of the RHD condular head

Treatment for 1 - exposure of the fracture at site at the mandible and placement of direct plating of the fracture (ORIF)

Treatment for 2 - intermaxillary fixation with use of arch bars to allow the condyle to heal if it is not displaced, comminuted or severely damage in other way. This will manage the occlusion. TMJ ficxation with direct bars may be possible.

Remember:
Soft food, and wire shut jaw for the next 3 months at least.

After the surgery, patient needs to be observed until reasching 12 hour stability.

Review 24 hours, a week, a month and 3 months after. If any complications occur, review.

Remove arch bars when the condyle is healed. A period of physiotherapy might be needed.

267
Q

What is the root canal procedure steps?

A

Prerprocedural checks

Chief concern and history taking

Taking the PA

Consultation with the patient and tutor

EPI calculation

Procedural

Step 1: Initial acess

Apply anaesthetic and isolate the appropriate tooth using single clamp

Using a high speed, end cutting bur such as 838 to gain initial access to the pulp chamber – always refer back to the PA

Switch to the non-end cutting endo-z bur in order to expand the access cavity

Use endoprobe to locate the canal

Pre-curve size 10 file and insert it a few mm into the canal

Take a PA

Irrigate the canal with a pre-bent hypochlore 1%

Step 2: Expansion of the coronal aspect

Using size 2 and 3 gate glitten bur, brush it a few mm into the canal coronally to expand the access

Irrigate

Step 3: Working length determination

Determine the working length using electronic apex locator, attach the device, advance to 1mm away from apex and have a good refrence point, take a PA to confirm

When confirmed chart as correct working length

Irrigate

Step 4:

Pre-cruve files and set them to the correct working length

Starting with the smallest file (size 10) instrument using clokc winding technique

Irrigate

Ensure canal is very loose for the smallest file – move to file that is 1 size larger

Irrigate and recapitulate and irrigate again

Ensure canal is very loose for the size up file – move to the file that is 1 size larger

Continue until you reach file 30 – take a PA of master apical file at 25 to confirm

Step 5: Step back

Pre-cruve file 30 and 35, set to correct working length

Create a stepback of 1mm with file 30

Irrigate

Create a stepback of 2mm with file 35

Irrigate

Step 6: Medicaments

Use calcium hydroxide for non-symptomatic and odontopaste for symptomatic

Apply using a file or a lentulo spiral at low rpm

Step 7. Interim restoration

  1. Put a nice layer of cavit in the pulp chamber – use a small cotton pallet with water to engae it

Use RMGIC to restore – check occlusion and recall the patient in 4 weeks

268
Q

How do you write a diagnostic statement in endodontics?

A

1.Pulp and root canal condition – necrotic pulp/irreversible pulpitis

2.Periapical status – chronic/acute apical periodontitis evident radiographically

269
Q

What aspects should we consider for endodontic treatment?

A

1.Strategic value of the tooth

2.Periodontal factor – if the tooth is grade III mobility what si the point of endodontically treating it?

3.Patient factors – MHx, motivation, age, compliance with treatments

4.Restorability options – consider the entire mouth

270
Q

What clinical test should you do during endo examination?

A

1.Percussion of tooth

2.Palpation around the soft tissue

3.Periodontal examination – cracks and fractures

4.Pulp sensibility tests – cold, hot or electric

5.Radiographs – PAs and BWs with or without use of GP with fistula

6.Special test – removal of restoration, selective LA, transillumination oe fracture finder on each cusp

7.Full data analysis and appropriate diagnosis presented to patient with options – two component diagnosis pulp+root canal AND periapical status – IT IS SEEN ON MY UNI REMMEBER IT

8.Patient need to be informed about the time, cost, step-by-step of each procedure, risks and need to consider a crown restoration

9.Ask the patient “is there anything you want to ask me, your opinion is essential for your own wellbeing”

10.Accurate record keeping

271
Q

What is considered to be moderate diffuclty in the AAE classifications?

A

One or two of the following:
1. ASA class 3 patient
2. Vasoconstrictors intolerance
3. Anxiety
4. Limitation in opening
5. Gagging
6. Moderate pain or swelling
7. extensive differential diagnosis
8. Difficulty in obtaining radiographs
9. 1st molar
10. Moderate inclination - 10-30 degress
11. Soem trouble with rubber dam
12. Coronal distruction or complex restoration
13. Canal morphology is slightly more complex
14. Pulp stones
15. 3-5 mm near the IAN
16. Minimal apical resorption
17. Crown fracture
18. Previous access without complications
19. Endo-perio lesion

272
Q

What is considered to be high diffuclty in the AAE classifications?

A

3 or more in moderate difficulty and at least one in the high diffuculty such as?
1. ASA 4
2. Can’t get anaesthesia
3. Uncooperative
4. Significant limitation in opening
5. Extreme gaggin
6. Sever pain
7. History of orofacial pain
8.2nd or 3rd molar
9. Extreme inclanation
10. Extreme rotation
11. Significant deviation from normal tooth/root form
12. C-shape morphology, extreme curvature or S-shape curve, rare root morphology, very long teeth
13. Pulp chaber not visible
14. extremly close to IAN (<3mm)
15. Extreme resopriton
14. Root fractures
15. Previous endo

273
Q

What is the classification of cracked teeth according to severity from low to high?

A

1.Craze line – very common and only in enamel – use transillumination

2.Fracture cusp – usually from insufficient cusp support from deepest point of restorative material – sharp pain on biting usually on non-funcitonal cusps

3.Cracked tooth – centered, vertical crack that has pulpal symptoms and can be in none restored teeth – typically mandibular second mollars

4.Split tooth – progression of cracked tooth – hopeless prognosis

5.Veritcal root fracture – a longitudinally oriented fracture extending from the root canal to the periodontium – hopeless prognosis

274
Q

What are pre-disposing factors from cracked teeth?

A

1.Occlusal factors – posterior buccal crossbites, anterior open bites, steep cusps

2.Parafunction

3.Age

4.Width and depth of cavity

5.Use of rotary instrumental – common in vertical root fractures

275
Q

How do we diagnose coronal cracks?

A

1.Patient symptomatology

2.Vision enhancers

3.Symptom reproducers – Very important

4.Radiographs

276
Q

What is the mechanisms of pain in cracked teeth?

A

Due to peripheral location and low excitability threshold of A-beta and A-delta fibers, rapid sharp pain is generated. In cracked teeth, the increased rapid movement of dentine fluid in dentinal tubules during relaxation after prolonged biting result in such symptom. When bacterial toxins infiltrate the pulp, hyperalgesia can result. This is a state of pulpal inflammation, which lowers the threshold of stimulation of A-delta fibers. Thus patient feels pain easier. A second type of pulpal stimulation is occurs through activation of C-fibers. C-fibers have a higher threshold of excitability thus only respond to prolonged inflammation of pulpal tissues. C-fibers activation means more than likely, pulp treatment is needed.

277
Q

What is the treatment of cracked tooth + symptoms of reversible pulpitis?

A

1.Removal of restoration + invastigate crack + remove or reduce any cracked cusps + restore

2.Provisional restoration and review in 3 months to confirm diagnosis

3.Consider crown

4.Reduce caueses of the crack

278
Q

What is the treatment of a cracked tooth + symptoms of irreversible pulpitis?

A

1.Endodontic access + investigate crack

2.Temporize with ortho band and proceed with RCT or extract

3.Consider causes of this and try to reduce them

279
Q

What is the prognosis from poor-to-good for cracked teeth?

A

1.Poor – segment separation, crack crossing pulpal floor, periodontal pocketing at fracture line, damaging habits not amenable to change

2.Guarded – crack extends to the floor of the pulp chamber

3.Good – crack into roof of the pulp chamber, does not reach pulpal floor

280
Q

What is a clinical presentation of a vertical root fracture?

A

1.Broad-based soft tissue swelling in the mid-root

2.Sinus tract bilaterally on 2 aspects

3.Depp pockets on 2 bilateraly surface (eg buccal-lingual)

4.J-shapped lesion/defect on the radiographs

5.Presents of isolated horizontal/angular bone loss

6.Visual confirmation through raising the flap

281
Q

What are the 3 main avenues of communication between periodontium and the pulp?

A

1.Dentinal tubules – only through patent dentinal tubules due to loss of cementum

2.Lateral and accessory canals – seen in 30-40% of the teeth usually around the apical 1/3 of the tooth

3.Apical foramen – possibly the main avenue – acts as entry and exit

282
Q

How does pulpal pathothis effect the periodontal ligament?

A

1.Pulpal pathosiis occur

2.The bi-products of pulpal pathosis are release in proximity to the preidontal ligament through accessory canals/apical foramen, eliciting an inflammatory response from PDL

3.Increase in vascularity and creation of temporary periodontal pocket – know as retrograde periodontitis

4.In addition – use of endodontic macterials or procedural errors could create moderate to sever periodontal consequences

283
Q

What is the classification of endo-perio lesions?

A

1.Primary endo – secondary perio – drainage through sulcus – treatment: root canal

2.Primary perio – secondary endo – treatment: non-surgical periodontal therapy, control of local factors, control of systemic facots and endo-treatment if needed

3.True combined lesion – primary endo treatment then perio then finish treatment with obturation, also remedicate canal if periodontal treatment is not finished

284
Q

What procedures comprise endodontic microsurgery?

A

1.Periapical curettage

2.Apicectomy

3.Retrograde endodontic treatment

285
Q

What are indication for periapical microsurgery?

A

1.Presen of disease after treamenet/re-treatment

2.Re-treatment not viable

3.Adjunct to re-treatment – re-treatment and surgery

4.Preservation of adequate coronal restoration

5.Costs

286
Q

What are contraindications of periapical microsurgery?

A

1.Re-treatment viable

2.Poor coronal restoration

3.Medical contraindication – radiotherapy or bisphosphonates

4.Anatomical contraindication – sinus or IAN

5.Other patient factors – fear factor

287
Q

What are the steps of a microsurgery procedure?

A

1.Incision at the gingiva – submarginal or full thickness flap

2.Periosteal elevator to raise the flap

3.Retract the flap with retractor

4.Osteotomy using a round or flat fissure bur to create a window in bone to access the lesion

5.Endo-curette is use to remove the soft tissues of the lesion and resection is performed

6.Micro-mirrors are used to observe the resected root

7.Preparation of the root end with ultrasonic tip

8.Use haemostatic agent to control contamination of prepare root end tip

9.MTA is used with sterile water and inserted to the root end

10.Suturing is performed

288
Q

What intra-operative factors are associated to negative outcome in endo?

A

1.Iatrogenic perforation

2.Patency at apical terminus

3.Extrusion of root fillings

289
Q

How do we state perforations?

A

1.With or without communication with the oral cavity

2.Corona/apical

3.Size

4.Delay in treatment – need for repair

290
Q

What are signs and symptoms of reversible pulpitis?

A

1.Pain is not spontaneous

2.Short duration

3.Localised

4.Sharp

5.Disappears immediately upon withdrawal of stimulus

6.Stimulated by: cld and occlusal interference

291
Q

What are the signs of symptomatic irreversible pulpitis?

A

1.Pain keeps patient at night and is lengthy

2.Localised

3.Aggravated by heat, spontaneous, when removed pain persists

4.Throbbing or dull pain

5.Analgesics do not word

292
Q

What materials are used in internal bleaching?

A
  1. Sodium perborate – in SADS – available in powder form
  2. Hydrogen peroxied – can burn tissues
  3. Carbamide peroxide – ususally used for external bleaching
293
Q

What is the SADS protocol for internal bleaching?

A

1.Patient need to be elidgible – no EMERINT PROSGENINT OR EMERREPAIR COCs

2.Consent – multiple appoitments, replacemen of restoration, upredictable, not stable and retreatment may be possible. Cervical resorption may occur

3.Titanium – 117- application of internal bleaching, 990-subsequent application of internal bleaching

4.Remove extrinsic staining

5.Record pre-op shade

6.Rubber dam

7.Remove restorative mamterial from access cavity, keep stained dentine

8.Remove endodontic filling 1-2mm below CEJ

9.Seal the access to the endodontic filling wit 2mm of GIC or cavit

10.Etch pulp chamber, rinse and dry

11.Mix sodium perborate with water until stiff paste is formed

12.Place into the labila surface of the access cavity

13.Cover the bleach with cotton pellet and seal with cavit or GIC

14.Repeate steps of bleaching every 7 days untile desired colour is achieved

15.Remove all bleaching material an rinse throughly

16.Record post-op shade

17.No definite resoration for 7 days because enamel might have been weakened

294
Q

What are the problems with Cone beam CT?

A

1.Movement artifact – shown as multiple lines– patient need to be very still

2.No soft tissue resolution – use convetional CT

295
Q

How much of the radiation does CBCT produce?

A

75 uSv (microSieverts)

296
Q

What is another machine that can be used to observe soft tissues as well?

A

MDCT – multi detector computer tomography – 200 microSieverts

297
Q

Do you need a radiologist?

A

Yes because:

1.It provides a provider number to allow Medicare rebates

2.Review of all areas of the scan

3.Removes much of the legal responsibility

298
Q

What are the medicolegal responsibilities of dentist in terms of radiology?

A

Dentists who record OPG radiographs must take responsibility for all non-dental diagnosis from such images or alternatively have them assessed on referral by an oral radiologist or medical radiologist and include this cost in their estimate of fees to the patient.

299
Q

What is the DOT DAM principle of radiology?

A

Don’t Order Tests that Don’t Affect Management

300
Q

What is the ALARA principle of radiology?

A

As Low As Reasonably Achievable

301
Q

What are the different types of artifact available on CBCT?

A

1.Beam hardening – streaks arising from very dense objects

2.Scatter – soft streaking

3.Motion – blurry or double vision

4.Poor machine care – multiple artifacts

5.Faulty detector – rind around the jaw

302
Q

How do you view a CBCT?

A

1.From down to up

2.From outside to inside

3.From Left to right

303
Q

What are the common accidental findings on CBCT?

A

1.Dense bone Islands

2.Torus

3.Osteomas

4.Degenerative Joint Disease

5.Chondrocalcinosis

6.Synovial osteochondromatosis

7.TMJ Dysfunction

8.Sinus pathology

9.Nasal septum pathology – including different sinusitis, and mucucoel

10.Nasal cycles

304
Q

What is a good rule of thumb when understanding where the pathogloy comes from?

A

1.If above the mandibular canal – possibly dental origin because only non-dental related pathology occurs bellow the mandibular canal

2.Non-dental lesions are move common in tooth bearing areas

305
Q

How do you examine at radiographic boney lesions?

A

1.Location

2.Margin – well-defined or illdefined

3.Zone of transition – short or long

4.Periosteal reaction

5.Internal matrix

6.Single vs multiple

7.Relationships to the joints

8.Effect on soft tissue

306
Q

What are the features of non-aggressive lesions?

A

1.Well-defined margin

2.Often schlerotic border

3.Short zone of transition

4.Little or no periosteal reaction

5.Bone often thinned and/or expanded

6.Minimal effect on soft tissues

307
Q

What are the feature of aggressive lesions?

A

1.Poorly-defined margin

2.Long zone of transition

3.Periosteal reaction may be extensive

4.Bone often destroyed

5.Permeative appearance

6.Soft tissue involvement is common

308
Q

What is the common appearance of the radicular cyst?

A

Lesion consists of a lucent centre and a thin, well-defined sclerotic rim. Cortical bone destruction may occur if cyst becomes too big.

309
Q

What is the common appearance of the dentigerous cyst?

A

Lesion uniformly lucent with a thin, well-defined sclerotic rim attached to the cemento-enamel junction.

310
Q

What is a common appearance of a odontogenic keratocyst?

A

Odontogenic keratocyst is a well-defined sclerotic which causes less jaw expansion and grows along the jaw bone.

311
Q

What is a common appearance of an ameloblastoma?

A

Has aggressive growth characteristics. Typically well-defined and radiolucent. Cause root resorption, tooth displacement and bone expansion. Floating tooth appearance.

312
Q

What is a common appearance of an adenomatoid odontogenic tumour?

A

Anterior mandible, well defined with corticaed border. Tooth displacement is common, root resorption is uncommon.

313
Q

What is a common appearance of cemento-ossifying fibroma?

A

Mandible, fibrous capsule gives a thin raiolucent halo. Rapid expansion and tooth displacement. May contain abnormal bone and cementum like tissue.

314
Q

What is a common appearance of cementoblastoma?

A

Slow growing lesion full of cementum like tissue. Attached to root apex. Well-defined with cortical border.

315
Q

What are giant cell lesions?

A

Anterior to first molar. Slow growing with well-defined margin. Some cortical expansion can occur.

316
Q

What is nasopalatine cyst?

A

A defined radiolucency that occurs in the palate

317
Q

What is a Stafni’s bone defect?

A

It is a salivary inclusion cyst. A well-defined oval lucencies anterior to angle of mandible.

318
Q

What is the common appearance of eosinophilic granuloma?

A

Solitary lesion, well-defined bu non-corticated with irregular margins. DESTROYS BONE AND LEAVES THE FLOATING TOOTH APPEARANCE. Periosteal new bone formation is common.

319
Q

What is common appearance of periapical cemental dysplasia?

A

At apex bone is replaced with fibrous material. Lesion persistent after extraction.

320
Q

What is a common radiographical appearance of squamous cell carcinoma?

A

Smoking adults. Ill-defined, permeative lesion. Spread localy and lymph nodes. Destroys bone.

321
Q

What is a common appearance of mucoepidermoid carcinoma?

A

Well-defined border in posterior body or angle of mandible.

322
Q

What is a common appearance of osteogenic sarcoma?

A

Posterior mandible. Painless swelling. Ill-defined borderd\s. “Sun-ray” spiculation appearance. Breaks bone.

323
Q

What is the common appearance of metastases to the jaw?

A

Usually from renal, breast, lung, colon and prostate. Affect posterior mandible. Ill-defined, lytic lesions with clear bone destruction.

324
Q

What is the common appearance of osteomyelitis?

A

PAIn _ subtle changes in bone density. Bone destruction with sequestration formation.

325
Q

What is the common appearance of MRONJ?

A

Pains, swelling and draining sinuses. Bone destruction. Periosteal reaction is common.

326
Q

What are the 7 signs of IAN involvement?

A

1.Darkening of the roots

2.Interruption of the white line

3.Diversion of the mandibular canal

4.Deflection of the roots

5.Narrowing of the roots

6.Dark and bifid roots

7.Narrowing of mandibular canal

327
Q

What is the common appearance of fibrous dysplasia?

A

Genetic disorder resultin in replacing of bone with fibrous tissue. Ill-defined margin and grounnd-glass appearance. Only condition that can displace the mandibular canal superiorly.

328
Q

What is the most important part of pre-implant assessment?

A

7-10 mm of crestal bone need to be available to withstand stresses.

329
Q

What are the three optical properties of dental sctructures?

A

Opalascence – the ability of the body to look different in reflected or transmitted light

Fluorescence – the ability of the body to emit light that is a wavelength less then incident radiation e.g. crime scene fluoresent lights

Translucence – the ability of the body to appear to transmit light and reflect little of it back

330
Q

What are the three factors of tooth colour?

A

Hue – base pigment – red, pink, green, blue and other

Value – most important – quantity of light reflected – how bright is the object can be shown with black and white images

Saturation – chroma – intensity or vividness – how much of base pigment is there within tooth structure

331
Q

What shade guide do we use in SADS?

A

Vita classical – used commonly in many aspects of dentistry – does not sit in the tooth banana nicely thus covers it inconsistently, with some fall outside of the banana, really incosistent value

Vita 3D Master Shade Guide – amazing for dentistry – sit nicely in the shade banana, amazing value when shown in black and white when going from 1-5 (5 is darkest thus lowest value) - Number 1 is value, Letter 1 is hue, Last number is chroma A3 and 3m2 is nearly the same colour. Infinitely compatible.

332
Q

What is incisal configuration?

A

It is the V shaped area between the incisors. It needs to be at 90 degrees to both of the teeth making up the incisal configuration

333
Q

What is a gingival zenith?

A

It is the line drawn at the terminus of the gingival margin at each incisors. Low gingival zenith in central and high in laterals will result in poor aesthetics. It central incisor and canine should coincide.

334
Q

When do we say a person has a gummy smile?

A

When we see more then 3mm of gingiva past the gingival margin in a person.

335
Q

What is a buccal corridor?

A

It is a negative space in the corners of the smile that is not filled by tooth structure. 15.-2.5 mm is ideal.

336
Q

How can we construct a rough prototype for restoration?

A

You can you putty or isolating material like PTFE tape and old, out of date composite just to get a nice 3D, functional structure. Do not bond as you need to remove it. Check with patient. Create a clear PVS bite reg material to register the prototype restoration so you can replace with permanent one – key guide.

337
Q

What is the best bonding technique?

A

4th generation ethc-prime-bond-composite.

338
Q

What are the steps of build up?

A

1.Build up of palatal wall with dentine shade

2.Apply the needed maverick colours with use of bonding resin and stains. Separate the two and use with probe to dip into both and apply to the needed translucent halo area.

3.Layer with body shade

4.Layer the most superficial layer with enamel shade

339
Q

What is at of extreme importance when you have an aesthetic case?

A

For signs of erosion, attrition and abrasion. Parafunctional wear = poor longevity of a restoration. Patient will need a night guard.

340
Q

How does peiodontal abscess form?

A

1.As an acute exacerbation of untreated perio

2.During periodontal therpay or immediatley after scaling

3.In refractory periodontitis (low response to treatment)

4.Due to dislodgement of calculus

5.Treatment with antibiotics but without debridement – change in subgignival microbiota leading to superinfection

341
Q

What are predisposing factor to periodontal abcess?

A

1.FUrcation areas

2.Patients with diabetes – impaired cellular immunited, decreased leukocyte chemotaxis and bactericidal activity

342
Q

How come periodontal abscess occur in patient without periodontitis?

A

1.Impaction of foreign bodies like orthodontic elastics or popcorn

2.Local factors affecting tooth morphology

343
Q

What is the presentation of periodontal abcess?

A

1.Ovoid elevation of the gingival along lateral aspect of the root

2.Oedematous, red gingiva with calculus usually present

3.Pus coming out of the gingival margin

4.Increased tooth mobility

5.Pain on plapation

6.Some systemic symptoms may be observed

344
Q

What is treatment for peridontal abscess?

A

1.Fully debried the area with or without use of surgery, under LA with saline irrigation

2.Analgesia in form of panadol

I3.f systemic symptoms exist – amoxicillin 500mgs tds+ metronidozole 400 mgs bs x 5-days

345
Q

What are the features of necrotising gingivtis?

A

1.Necrosis of interdental papillae

2.Bleedin, halitosis and pain in the site

3.Punched-out and cratered depression/lesions in interdental sites covered with greay or grey-yellowish pseoudomembrane

4.Patient complains of metallic taste

346
Q

What is the treatment of necrotising periodontitis?

A

Referral to specialist – IMMEDIATE

347
Q

What is pericoronitis?

A

It is a localised infection in gingival tissue and mucosa surrounding a partially erupted tooth. Patient complain of a sore tooth. Explain to patient that pain actually arises from infection and inflammation in the soft tissues surrounding the tooth and not the tooth itself.

348
Q

What are the the symptoms of pericoronitis?

A

1.Difficulty swallowing

2.Limited opening

3.Enlarged lymph nodes

4.Fever

5.Facial cellulitis

6.Pain

7.Localised swelling

8.Pus discharge

349
Q

What is treatment for pericoronitis?

A

1.Debride area under operculum using monoject

2.Place patient on chlorexidine for a week

3.If major or systemic symptoms give amoxicillin in combination with metronidazole for one week

4.If it is recurring and tooth has a terrible position – extraction or operculectomy

350
Q

What is the purpose of periodontal surgical therapy?

A

The goal and purpose can only be considered in conjuction with complete periodontal treatment. SO first initial closed surgical root debridement and then open surgical root debridement.

351
Q

What is the reasons for carrying out periodontal surgery?

A

1.Improve access to root surfaces

2.Removal of diseased tissues

3.Pocket elimination

4.Regenerative techniques

5.Removal of severely hyperplastic gingival tissues

6.Exploration of defects

7.Restorative-crown lengthening

8.Remove excess tissues

352
Q

What are some of the types of periodontal surgery?

A

1.Resective surgery – pocket depth reduction and removal of hyperplastic tissues

2.Access Flap Surgery

3.Periodontal regeneration

4.Mucogingival surgery

5.Implant surgery

353
Q

What are the types of resective surgery?

A
  1. Gingivectomy – removal of pocket epithelium, connective tissue and mucosal epithelium
  2. Modified Widman flap – removal of pocket epithelium and connective tissue +/- osseous, leacing behind mucosal epithelium
354
Q

What is the difference between post operative treament of gingivectomy and flap surgery?

A

1.Gingivectomy – sites can be probed 2-3 weeks after surgery

2.Flap surgery – need to wait 3-4 months

355
Q

What can you do to improve bone levels after periodontal surgery?

A

You can add a boney material for regeneration. But remember, no probing for at least this much for each material:

Perioglas – 6-12 months

Bio-Oss – 12-18 months

Emdogain – 2-3 years

356
Q

What are the most commonly used material in periodontal regenerations?

A

1.Bone grafts

2.Membranes

3.Growth factors

357
Q

What does periodontal regeneration involve?

A

Regeneration involved the placmenet of a physical/biological barrier to ensure that the root surface becomes repopulated with cementum, PDL and bone. The placment of the physical/barrier permits the growth of bone and PDL cells rather than epithelial or gingival connective tissue into the periodontal defect.

358
Q

What are the different types of bone grafts?

A

1.Autogenous – harvested from the patient

2.Autollogus – harvested from same species I.e. dead man bone

3.Alloplastic – bioactive glassis like Perioglass

4.Xenografts – harvested from different species I.e. Bio-Oss which is bovine bone

359
Q

What are some of the membranes that can be used in regenerative surgery?

A

1.Xenografts – from different species like Bio-gide

2.Synthetic – Polyglyclolic

360
Q

What is guided bone regeneration?

A

GBR involves the placement of a physical/biological barrier to ensure that the hard tissue deficiency becomes repopulated with bone.

361
Q

What are the different types of alveolar bone defects?

A

Class 1 – Bucco-lingual deficiency

Class 2 – vertical deficiency

Class 3 – combination

362
Q

What is osteoinduction?

A

Recruitment of immature cells and stimulation of these cells to develop into pre-osteoblast e.g. bone healing situations

363
Q

What is osteoconduction?

A

It permits bone growth on surface or pores. This occurs in bone implants.

364
Q

What are the steps for crown lengthening?

A

1.Soft tissue resection if there is an overgrowth of tissues

2.Soft and hard tissue resection if bone level is incorrect height

365
Q

What are the Miller Classification of gingival recession?

A

Class I – recession that does not extend to the mucogingival junction with no periodontal bone loss

Class II – recession that extends to or beyond mucogingival junction with no bone loss

Class III - recession that extend to or beyond mucogingival junction with loss of bone in the interdental area

Class IV - recession that extend to or beyond mucogingival junction with loss of bone in the interdental area with exposure of interproximal root surface

366
Q

What kind of grafts can you do for recession?

A

Sub-epithelial connective tissue graft

Coronally repositioned flap

Lateral sliding flap

367
Q

What is the management of seizures?

A

If history of epilepsy or seisures is present - please use a bite block on the patient

  1. Stop dental treatment
  2. Ensure patient is not in danger
  3. Turn the patient to the side
  4. Avoid restrainning
  5. Wait until seizure stops
  6. Maintain airways
  7. Assess the patient
  8. If still unconscious, call 000 and maintain airways
368
Q

What are the oral consequences of kidney disease?

A
  1. Greater bleeding tendency due to reduction in platalets
  2. Hypertension due to extra blood volume

3.Anaemia

4.Drug intolerance - antibiotic and analgesics

  1. Increased susceptibility to infections
  2. Halitosis, burning sensation int eh mouth, uremic stomatitis, periodontal disease
  3. Xerostomia
  4. Impared healing

Please consider collaborating with a nephrologis

369
Q

Wht should be your general approach of managing a person of a general medical complication in the dental chair?

A

Consider

  1. Time of day for appointment
  2. Duration of the appointment
  3. Positioning of the patient
  4. Pre-procedure preparation/action plan - e.g. ask the patient to bring their medication
  5. Use of local anaesthetics
  6. Medications - contraindications, toxicities, interaction
  7. Caries risk
  8. Perio risk
  9. Xerostomia
370
Q

How would you quickly assess the patients severity of COPD asthma?

A
  1. If they are managed situational by an inhaler - they are probably okay
  2. If they take medication - this may be a little more sus
  3. If they have been hospitalised - maybe consult with tutor
371
Q

How does the diabetes damage the body?

A

Higher Blood glucose leads to advanced glycosylated end products (AGE) and free radicals which damage tissues - mostly on two levels

Microvascular damage - think perio

Macrovascular - think coronary artery disease and renal disease

372
Q

Give 5 differential diagnosis for a white lesion

A
  1. Leukodema
  2. Leukoplakia
  3. Lichen Planus
  4. Frictional keratosis
  5. Oral squamous cell carcinoma
373
Q

Give 5 differential diagnosis for red lesions

A
  1. Pyogenic granuloma
  2. Haemangioma
  3. Peripheral Giant Cell Granuloma
  4. Erythroplakia
  5. Oral squamous cell carcinoma
374
Q

Give 5 differential diagnosis for a pigmented lesion?

A
  1. Oral melanotic macule
  2. Mucosal melanocytic naevus
  3. Amalgam tattoo
  4. Malignant melanoma
  5. Smokers melanosis
375
Q

FheFGive 5 differential diagnosis for a gum lump?

A
  1. Haemangioma

2.Fibroepithelial epulis

  1. Pyogenic granuloma
  2. Peripheral giant cell granuloma
  3. Calcifying fibroblastic granuloma
376
Q

Give 5 differential diagnosis for an ulcer?

A
  1. Herpetiform ampthous ulcer
  2. Mild amthous ulcer
  3. Major ampthous ulcer
  4. Traumatic acute ulcer
  5. Traumatic chronic ulcer
377
Q

Why are 5th and 7th generation of adhesive system kinda mid?

A
  1. Because they are known to leave moisture bubles at the surface as well as water tress that impare bonding
  2. Because there is an issue with the acid that is used with self etching. Essentially a special compound is used to neutraulise the acid over time so that self etching does not continue to destroy tooth structure - but unfortunaley that compound affect may be delayed thus the created resin tags are not formed properly - this reduced their effectiveness thus making the restoration last less time :(
378
Q

How do we treat hypersensitivity?

A
  1. Block dentinal tubules - using restorations or protective coverings
  2. Block nerve activity - stanous fluoride and potassium nitrate
  3. Remove the cause - erosion and toothbrushing technique change
379
Q

What is the systematic way to examine a lesion?

A
  1. Site - using anatomical terminology
  2. Size - measure with a probe
  3. Morphology - elevated, flat or depressed
  4. Colour - compare to adjacent normal tissue
  5. Consistency - how it feels (ONLY CLINICAL DO NOT SAY THIS IN EXAM), texture - how the surface looks like (PHOTOS ARE APPROPRIATE :))
380
Q

What is the prescription of amoxicillin + clavulanate for spreading odontogenic infection?

A

Amoxicillin 875 + clavulanate 125mg) orally, 12 hourly for 5 days

381
Q

What is the prescription of intravenous antibiotics for spreading odontogenic infection?

A

Benzylpencilli aintravenously in intensive care 2.4g 4 hourly

382
Q

What is a prescription of anaelgisics for mild-to-moderate acute dental pain if NSAIDs are contra indicated?

A

Paracetamol 1000mg 4-6 hourly for shortest duration possible

383
Q

What is the prescritpion of analgesia for a post extraction patient for mild to moderate acute pain?

A

ibuprofen 400mg orally, 6-8 hourly for 5 days if pain persists please seek review with GP
PLUS
Paracetamol 1000mg orally 4-6 hourly to a maximum of 2g for the shortes duration possible

384
Q

What is the prescritpion of analgesia for a post extraction patient for for severe acute pain?

A

ibuprofen 400mg orally, 6-8 hourly for 5 days if pain persists please seek review with GP
PLUS
Paracetamol 1000mg orally 4-6 hourly to a maximum of 2g for the shortes duration possible
PLUS
oxycodone immediate-release 5mg orally, 4 to 6 hourly, for 3 days. PRESCRIBE small quantities

385
Q

What is the antifungal therapy for oral candidiasis?

A

Miconazole 2% gel 2.5 mL topically then swallowed, 4 times a day after food, 7 to 14 days, continue treatment for at least 7 days after symptoms resolve

OR

Nystatin liquid 100000 units/mL 1 mL topically after food, 7 to 14 days, continue treatment for at least 2-3 days after symptoms resolve

386
Q

What is the antifungal therapy for angular cheilitis?

A

Miconazole 2% cream topically then swallowed, 2 times a day after food, 14 days, continue treatment for at least 14 days after symptoms resolve

387
Q

What is MRONJ?

A

Medication-related osteonecrosis of the jaw (MRONJ) is an area of exposed bone in the jaw persisting for more than 8 weeks in a patient currently or previously treated with an antiresorptive drug, an antiangiogenic drug or romosozumab, who has not received radiation therapy to the craniofacial region. Antiresorptive drugs include bisphosphonates and denosumab. Antiangiogenic drugs (eg bevacizumab, cabozantinib, lenvatinib, sunitinib) interfere with the formation of new blood vessels, and are used in the treatment of some malignancies. Romosozumab, a sclerostin antibody inhibitor, increases bone formation and bone mineral density.

388
Q

What is the treatment for MRONJ?

A

For patients receiving antiresorptive drugs or romosozumab for osteoporosis, the benefits of continued therapy outweigh the low risk of medication-related osteonecrosis of the jaw in most patients—consider the following points:

Although stopping bisphosphonates for a short period is unlikely to cause harm in a patient at low risk of fracture, there is no evidence that this approach reduces the risk of medication-related osteonecrosis of the jaw.
Denosumab is a reversible antiresorptive administered every 6 months for osteoporosis. If it is possible to delay a bone-invasive dental procedure in a patient taking denosumab for osteoporosis, ideally schedule the procedure just before the next dose of denosumab. It is never appropriate to interrupt or delay the dose of denosumab; withdrawal of denosumab has been associated with an increased risk of spontaneous vertebral fractures.
Interrupting treatment with romosozumab results in a loss of bone mineral density and potential risk of fracture.

389
Q

In what instances shoudl you have antibiotic prophylaxis?

A
  1. Prosthetic cardiac valve
  2. prosthetic material for valve repair
  3. previous infective endocarditis
  4. Congenetive heart disease but only if it involved: unrepaired cyanotic residual defect and repaired defect with residual defects
  5. Rheumatic heart disease
390
Q

What medications should you use for a person with indications for prophylaxis?

A

amoxicillin 2g for 60 minutes before a procedure

OR

clindamycin 600mg orally 60 -120 minutes before the proceudre

391
Q
A
392
Q

How to set up a provisional treatment plan for perio?

A
  1. Emergency phase - e.g. exo
  2. Systemic phase - e.g. control systemic diseases
  3. Initial phase - e.g. testing and debridement
  4. Surgical phase - regenerative surgery
  5. Restorative phase - temporary crowns
  6. Maintenance phase - depending on risk close recall or normal recall
393
Q

How do you write a diagnostic statement for periodontist modified by diabetes?

A
  1. Type of periodontal disease
  2. Disease extent
  3. Stage
  4. Grade
  5. Current disease status
  6. Risk factor profile

E.g.
Periodontitis: generalized (65%), Stage III (CAL <10 mm), Grade C (HbA1c 8.9%), currently unstable (PPD <8mm, BOP 45%).
Risk factors: uncontrolled diabetes (HbA1c 8.9%), smoking 20 cig/day, high strss levels (change in work)

394
Q

What kind of surgery could you perform for recession?

A
  1. Lateral sliddding flap
  2. Coronally repositioned flap
  3. Free gingival flap
  4. Subepithelial connective tissue graft
395
Q

What is the contect of odontopaste?

A

Clindamycin and triamcinolone

BDS 4 (21 decks)

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