extra Flashcards
Give examples of temporary restorations
- Zinc oxide eugenol eg kalzinol
- Self setting zinc oxide cement
- Polycarboxylate cements eg poly F
- GIC eg chemfil
when describing something on a radiograph what would you include
- Size
- Shape
- Radiolucency
- Site
- Outline/ edge
- Effects on adjacent structures
What is the aetiology of recession
Multifactorial
Genetics can play a role
Traumatic tooth brushing
plaque induced marginal inflammation
Traumatic occlusion
What is recession usually accompanied with
Dentine hypersensitivity
When would we surgically intervene to treat gingival recession
Where recession is severe and there is a lack of functional attached gingiva
What are some tx options for severe gingival recession
- Mucogingival surgery to correct recession (unreliable)
- Mucoginigval surgery to provide wider and fictional zone of attached gingiva
- Provision of thin atrophic gingival stent or veneer
What can cause a developmentally absent upper 1
- XLA
- Avulsed
- Displacement due to trauma
- Scar tissue preventing eruption
- Supernumerary preventing eruption
- Insufficient space
- Pathological lesion
What is Sjogrens
An autoimmune disorder in which exocrine glands are destroyed
List some intra articular causes of truisms
- Internal derangement
- Fractured condyle
- Traumatic condyle
- Septic arthritis
- Osteoarthritis
- Inflammatory arthritis
- Ankylosis
- Lesions of condylar head
List some extra articular causes of trismus
- Trauma
- Acute infection
- Post surgical removal of lower impacted third molar
- Myofascial pain
- Disease of masticatory
- Scarring of muscles skin or mucosa
- Inflammatory conditions of the mucosa
- Tetanus
List some causes of pain in the TMJ
- Myofascial pain dysfunction syndrome
- Internal derangement of the TMJ
- Osteoarthritis (degenerative joint disease)
What is the purpose of cavity linings
- Protect the pulp from bacterial infection and diffusion of bacterial acid and toxins
- To seal any layer of caries affected dentine that may be retained
- To stimulate dentine pulp complex to lay down tertiary dentine as a defence response
- To promote pulp from thermal electrical and mechanical stimuli
Give examples of gingival lesions
- Pyogenic granuloma
- Fibrous epulis
- Peripheral giant cell granuloma
- Sinus papilla
- Papilloma
Describe pyogenic granuloma
A localised proliferation of granulation tissue usually caused by an irritant eg poor oH, calculus or margins of restorairtons
Give examples of oral mucosa lesions
- Leukoplakia
- Candidiases
- Lichen planus
- Oral hairy leukoplakia
What is leukoplakia
A precancerous condition repressing hyperplasia of the squamous epithelium
Common in tobacco users
How does leukoplakia present itself
As a white patch or plaque
What is candidiases
White plaques on buccal mucosa, palate tongue or oropharynx
What are the risk factors for oral candidiases
Diabetes meliates
Immunosuppressants
Inhaled corticosteroids
Inhaled corticosteroids
Dentine wearing
What is oral hairy leukoplakia
Characterised by white, corrugated painless plaques
typically develops the lateral border of the tongue in HIV infection
What is the medical term for dry socket
Alveolar osteitis
What can post extraction pain be due to
- Normal physiology
- Dry mouth
- Osteomyelitis
- Fractured mandible
- Retained roots fragment
Give examples of factors which can predispose a pt to dry socket
- Surgical or traumatic XLA
- Mandibular XLAA
- Contraceptive pill
- Smoking
- Periodontal disease or acute necrotising ulcerative gingivitis
- Excessive LA
- Local bone disease
Which nerves supply the lips
Upper: Maxillary division of trigeminal nerve
Lower lip: mental lip
What can cause numbness of lips
- Infections
- Tumour
- Trauma
- Vascular compression of nerve root
- Iatrogenic damage
What is resorption
Process of removal of dental hard tissues by osteoclasts
List the different types of resorption
- Inflammatory
- Replacement
- Internal
- External
What is osteomyelitis
An infection in the medullary cavity of the bone
if persistent can lead to chronic disease and sclerosis of bone
What is osteitis
A superficial inflammation of bone
Give an example of an osteitis
Alveolar osteitis (dry socket)
What is osteonecrosis
Death of bone usually due to blood loss, vascular or Bisphosphonates drugs
what do Bisphosphonates do
They reduce bone turnover by leading to osteoclasts cell death
this result in increased bone resorption, remodelling is slowed and bone density increases
When are Bisphosphonates used
Can be used to:
- Prevent further bone loss in osteoporosis
- To prevent malignant tumours in bone releasing excess calcium into blood stream
- To prevent bony metastases from enlarging by inhibiting bone reposition around them
- To reduce bone turnover in pagets disease of bone
- To increase bone mass in osteogenesis impergecta
Should antibiotic prophylaxis be given for extractions in patients taking bisphosphonates?
no as the disease is not caused by bacteria and drugs do no penetrate the bone because it has no blood supply
What specific features of a denture would you examine if a patient did not like it
- Base extension
- Retention
- Does post dam extend back to vibration line (Upper)
- Is there close adaption of the denture base to mucosa
- OVD and RVD
- Its occlusal position correct
- Are natural teeth affecting the occlusal plan e
- Appearene
- Do teeth lie in the neutral zone (Lower)
When assessing a patient for 3rd molar extraction what features of the intra oral examination are important to note
- Mouth opening
- Condition of rest of dentition
- Oral hygiene
- Position of lower third molars
- Position of upper third molars
- Position of external oblique ridge
- Condition of second molars
- Presence of pericoronitis
- Gag reflex, compliance, anxiety
List some indications for XLA of 3rd molars
- Recurrent pericoronitis and pericoronitis with acute spreading infection
- Unrestorable caries
- Untreatable periapical inflammation
- Periodontal disease
- internal or external resorption
- fracture
- Associated cyst or neoplasm
- For tooth reimplantation.
9 For orthognathic surgery or restorative treatment - Prophylactic removal may be advised in specific medical conditions
What complications are there for 3rd molar XLA that we should warn patients of
- Post surgical pain, bleeding, bruising and swelling
- Alveolar osteitis
- Sensory nerve damage, paraesthesia or anaesthesia
- Acute TMJ pain (muofascial pain)
- Iatrogenic fracture
- Incorrect or complete extraction
- injury to adjacent tooth or periodontium
- OAF
Give examples of extrinsic factors that can lead to staining
- Dietary stains
- chlorhexidine mouth wash
- Turner tooth
What is turner tooth
A infection of the deciduous predecessor causing enamel hypoplasia in the permanent tooth
Give examples of intrinsic factors that can lead to staining
- Dental caries
- Blood pigments
- Tetracycline stainign
- Fluorosis
- Amelogenesis imperfect
- Dentinogenesis imperfect
- Regional odontoplasia
- Chronological hypoplasia
- age change
To which tissue spaces may infection spread from a lower third molar
- Sublingual space
- Submandibular space
- Pharyngeal space
- Infratemporal space
- Submasseteric space
- Buccal space
What is Ludwigs angina
Bilateral infection involving the submandibular and sublingual spaces
can lead to airway obstruction and death
Which antibiotics would you prescribe for speeding odontogenic infections
Amoxicillin or metronidazole
What features might suggest a necrotic pulp
- Extension of caries or fracture into pulp
- Discolouration of the crown
- Swelling or tenderness in the buccal sulcus adjacent to the tooth
- Pus draining from a sinus in the mucosa
- Pus draining form the gingival margins
- Facial swelling
- Well localised pain
How would you assess the possibility of mandibular fracture
Fracture is suggested by:
- Pain, swelling and tenderness at the fracture site
- Bleeding bruising or haemotoma at fracture site
- Displacement or step deformity
- Change in occlusion
- Mobility of fragments or of teeth
- Difficulty opening the mouth or in lateral excursion
- Paraesthesia or anaesthesia in the distraction of nerves involved in the fracture
What features should we examine of teeth following trauma
1, Mobility
2. Percussion
3. Extent of fractures was there pulpal invovlement
4. Occlusion
5. Test vitality
List some indications for anterior veneers
- Discolouration of teeth
- For closure of spaces/ midline diastema
- Hypoplastic teeth
- Fracture of teeth
- Modifying the shape of a tooth
What materials can be used to make veneers
Porcelain or composite
What clinical features use you asses before providing veneers as an option to patients
- Is the discolouration enough to warrant treatment or is it so severe it will not be masked
- Assess smile line which teeth need tx
- Is there enough crown present to support a veneer
- Any occlusal restrictions eg edge to edge occlusion
- Any parafuncitonal activities
- Is there an alternative option eg bleaching
What is the function of a post and core
Provides support and retention for the restoration and distributes stresses along the root
What must we assess prior to placing a post core
The condition of the root filling and the apical condition as it is difficult to re Endo following post core palcemtn
What is the ideal length of a post
Length of the crown and 2/3rd of root leaving at least 3mm of GP
What can cause gingival recession
- Traumatic Tooth brushing
- Incorrect toothbrushing technique
- Abrasive toothpaste
- Traumatic occlusion incisor relationship
- Tooth out of arch
- Orthodontic movement of tooth labially
- Habits such as rubbing of gingival with fingernail or pen
List some clinical features for necrotising ulcerative gingivitis
- Hallitosis
- Ulcerations on gingiva that are painful and yellow
- Pain
- Malaise
- Fever
- Poor OH
- Regional lymphadenopathy
- Metallic taste
What are the risk factors for necrotising ulcerative gingivitis
- Poor OH
- Smoking
- Gingivitis
- Stress
- Malnourishment
- HIV infection
How would you treat necrotising ulcerative gingivitis
- OH
- Prevention
- Metronidazole
- Chlorohexidine mouthwash
- PMPR
What does tenderness to percussion suggest?
Inflammation of the PDL and can indicate very late stage irreversible pulpit its or a necrotic pulp
What can lead to a false positve from a sensitivity test
- Patients anticipation of pain or sensitivity
- Multirooted teeth with canals at different degrees of vitality
- Sensation originating from gingival not tooth
- Sensation originating form adjacent tooth if poor electrical isolation
- C nerve fibres within the pulp tissue can still function for some time after loss of their blood supply
What can lead to a false negative from a sensitivity test
- Poor contact betwen the electrode and tooth
- Inadequate electrical access to tooth tissue because of insulating nonmetallic coverage
- Heavily restored teeth
- High pain threshold
- Advanced age (thicker secondary/ tertiary dentine)
What is the criteria for a successful root canal
- No symptoms
- No tenderness to percussion or increased mobility
- No sinus
- Width and contour of periodontal ligament normal
- Slight radiolucency around excess filling material allowable
What is the criteria for an uncertain root canal
- No symptoms
- No tenderness on percussion or increased mobility
- No sinus
- Residual radiolucency at 4 years that is smaller than seen on
completion of root canal filling.
What is the criteria for an unsuccessful root canal
- Symptoms
- TTP or increased mobility
- Sinus
- Unchanged or enlarged peri radicular radiolucency
- Development of a new radiolucency at another site on the tooth
List instruments that are print to fracture in root canals
- Barbed broach
- Stainless steel hand files
- Nickel titanium rotary files
- Gates gladdens
How can we reduce the risk of fractured files
- Straight lien access cavity
- Down force the instrument in
What types of soft tissue infections arising from teeth cause facial swellings?
oedema
abscess formation
cellulitis
combination.
How should we treat an abscess
Drainage
How do we treat cellulitis
Aggressive antibiotics treatment
How do we treat oedema
Requires no direct treatment but resolved when causative Toth is XLA or pulp treated
How do we treat oedema
Requires no direct treatment but resolved when causative Toth is XLA or pulp treated
List some of the features of oedema
Soft not very red or hot
Not TTP or painful
Compressible with slow continuous pressure
Often accounts for much of the facial swelling in children with odontogenic infection.
List some features of an abscess
Localised collection of pus which feels hard if small or tense
If larger can feel softer and exhibit fluctuant
Let some features of cellulitis
Brawny poorly located swelling with marked tenderness and dusky red appearance
May contain small collections of pus but no large localised abscesses
Speads sometimes rapidly through tissues
Often associated with systemic symptoms
What Is cavernous sinus thrombosis
Thrombosis of the cavernous sinus following spread of odongenic infection along 2 main venous pathways
List some features of cavernous sinus thrombosis
- Marked oedema of the eyelids
- Pulsating exophthalmos caused by venous obstruction
- A dilated facial vein
- Inhibition of movement of the eye
- Papilloedema and retinal haemorrhage
- Rapid pulse
- Marked pyrexia
- Severe malaise
List some features of cavernous sinus thrombosis
- Marked oedema of the eyelids
- Pulsating exophthalmos caused by venous obstruction
- A dilated facial vein
- Inhibition of movement of the eye
- Papilloedema and retinal haemorrhage
- Rapid pulse
- Marked pyrexia
- Severe malaiseWhat are the general principles of treatment for all odontogenic infections of the soft tissues
What are the general principles of treatment for all odontogenic infections of the soft tissues
1, Start treatment fast
2. Pus must be drained ASAP
3. Remove causative tooth
4. Provide antibiotics if indicated
5. provide supportive measures
6. Review progress regularly
When should antibiotics be prescribed for soft tissue infections
- If patient is prone to infection eg immunocompromised or diabetic
- There is spreading infection
- The airway is compromised
- There is significant malaise or pyrexia
- The tooth is to be preserved rather than extracted
- Cavernous sinus thrombosis is possible
What can cause severe localised periodontitis
- Food packing an diastema
- Overhanging and poorly contoured restorations
- Subgingval calculus
- Destructive habits
- Periodontal Endo lesions
- Root fractures
- High renal attachments
What factors affect the timing of paediatric XLA of permanent first molars
- Stage of dental development
- Presence of third molars
- Orthodontic analysis
At what age does research say is favourable to extract first permanetn molars
8.5-10.5
What are the treatment options for permanetn incurs suffering from MIH or molar inscior hypoplasia
- Composite veners
- Enamel micro abrasion
- Localised composite restorations
- Porcelain veneers
- Full crown restorations
List some oral signs assorted with HIV infection
- Candidosis
- Hairy leukoplakia
- Preiotnal disease
- Capos sarcom a
- Lymphoma
What information would you need to gather before carrying out tx on a pt diagnosed with HIV
- Is the pt prone to infections
- Neutrophil count
- platelet count
- Does the pt have any co infection with hep b or C
- What medications is the pt on
What are the possible effects of betel quid chewing?
- Oral sub mucous fibrosis
- Oral and pharyngeal squamous cell carcinoma
- Periodontitis, recession and root erosion at the site of use
- Tooth staining
- Decreased taste sensation
- possible worsening of asthma
- Possible asoscateion with diabetes and malignancy
List some of the features of resorption
- Asymptomatic
- Internal = vital pulp, external can be vital or non vital
- Usually slow and intermittent
- mobility or pathological fracture
- External cervical root resorption
- Ankylosis (continuity of tooth and bone)
What are the signs of ankylosis
