Final Sem 2 Xam Questions Flashcards
What is the management of seizures?
If history of epilepsy or seisures is present - please use a bite block on the patient
- Stop dental treatment
- Ensure patient is not in danger
- Turn the patient to the side
- Avoid restrainning
- Wait until seizure stops
- Maintain airways
- Assess the patient
- If still unconscious, call 000 and maintain airways
What are the oral consequences of kidney disease?
- Greater bleeding tendency due to reduction in platalets
- Hypertension due to extra blood volume
3.Anaemia
4.Drug intolerance - antibiotic and analgesics
- Increased susceptibility to infections
- Halitosis, burning sensation int eh mouth, uremic stomatitis, periodontal disease
- Xerostomia
- Impared healing
Please consider collaborating with a nephrologis
Wht should be your general approach of managing a person of a general medical complication in the dental chair?
Consider
- Time of day for appointment
- Duration of the appointment
- Positioning of the patient
- Pre-procedure preparation/action plan - e.g. ask the patient to bring their medication
- Use of local anaesthetics
- Medications - contraindications, toxicities, interaction
- Caries risk
- Perio risk
- Xerostomia
How would you quickly assess the patients severity of COPD asthma?
- If they are managed situational by an inhaler - they are probably okay
- If they take medication - this may be a little more sus
- If they have been hospitalised - maybe consult with tutor
How does the diabetes damage the body?
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
What would you mention to a patient who has periodontitis?
- Periodontitis - a disease that destroys the bone underneath the tooth
- Usually occurs from bacteria aggrevating the gums
- Aggrevating the gums leads to inflammatory condition - gingivitis
- When gingivitis is present with some underlying risk factors such as smoking, diabetes or immunuesupressed organism - periodontitis is caused
- Periodontitis is caused by the immune system trying to fight off the bacteria in the plaque - but not bring very mindful of the surrounding tissue
- Unfortunatley periodontitis is irreverisble - but if proper treatment - it can be slowed down or even arrested - thus we need to collaborate on this issure
What are the Koch’s Postulates?
1) The microorganism must be found in diseased but not healthy individuals;
2) The microorganism must be cultured from the diseased individual;
3) Inoculation of a healthy individual with the cultured microorganism must recapitulated the disease;
4) The microorganism must be re-isolated from the inoculated, diseased individual and matched to the original microorganism.
Give 5 differential diagnosis for a white lesion
- Leukodema
- Leukoplakia
- Lichen Planus
- Frictional keratosis
- Oral squamous cell carcinoma
Give 5 differential diagnosis for red lesions
- Pyogenic granuloma
- Haemangioma
- Peripheral Giant Cell Granuloma
- Erythroplakia
- Oral squamous cell carcinoma
Give 5 differential diagnosis for a pigmented lesion?
- Oral melanotic macule
- Mucosal melanocytic naevus
- Amalgam tattoo
- Malignant melanoma
- Smokers melanosis
FheFGive 5 differential diagnosis for a gum lump?
- Haemangioma
2.Fibroepithelial epulis
- Pyogenic granuloma
- Peripheral giant cell granuloma
- Calcifying fibroblastic granuloma
Give 5 differential diagnosis for an ulcer?
- Herpetiform ampthous ulcer
- Mild amthous ulcer
- Major ampthous ulcer
- Traumatic acute ulcer
- Traumatic chronic ulcer
Why are 5th and 7th generation of adhesive system kinda mid?
- Because they are known to leave moisture bubles at the surface as well as water tress that impare bonding
- 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 :(
What is the process of activation and initiation of dental composite material?
- Photo-initiator - in a form of specific frequency of light (light cure or UV light) initiates the creation of free radicals within the composite material
- The free radicals with an extra electron will bind with monomers in order to create a polymer - at the end of this process an electron is loss thus another free radical can be initiated
- This continues when around 80% of resin is polymerised and 20% is not - this is important to allow addition of other composite resin
- Over time, free radicals will combine - creating a stable compound
How would you explain to the patient the CR survival?
An average composite may last around 3-8 years but only if it is maintained. Give car analogy.
Why do amalgams last more than composites?
Amalgams last longer due to the hardness of the material - but if they fail they fail spectacularly
How do we treat hypersensitivity?
- Block dentinal tubules - using restorations or protective coverings
- Block nerve activity - stanous fluoride and potassium nitrate
- Remove the cause - erosion and toothbrushing technique change
How do we manage dentine hypersensitivity?
- Occlude dentinal tubules to reduce impact of stimuli on fluid movement - can be done through chemical occlusion (fluorides) or physical occlusion (sealed resorations)
- Reduce sensitivity of nerves - using potassium nitrate
What are indications for indirect pulp capping?
- Deep cavity
- No pulpal exposure
- Removal of all infected dentine may result in pulpal exposure
- No signs or symptoms of irreversible pulpits
What is the most important aspect of indirect pulp capping?
CORONAL SEAL IS VITAL.
What happens to the pulp during direct pulp capping?
The varnish that is used is able to neutralise necrotic tissue and cause the deposition of tertiary dentine
What are the three common reflexes in the jaw?
- Jaw opening
- Jaw closing
- Periodontal
How to write a pulpal diagnosis?
- PULPAL diagnosis - pulpitis, necrosis or absent pulp
- PERIAPICAL DIAGNOSIS - Symptomatic/Asymptomatic Periodontitis/Abscess
- CAUSATIVE AGENT -caries, trauma, idiopathic
Please refer to the radiograph if you looking at one
Observe this patient - they are very fucked - what additiona testing would you do to them?
- Ask question about oral hygine - relevant history taking
- Diet diary
- Saliva tets
- OPG and other readiographic test
- Risk matrix or Traffic Light Matrix
How to write a treatment plan?
1.Completion of all histories and exams
2. Taking consent for additional testing - TRI-PLAQUE GEL
3. Diagnosis, presentation of treatment plan and consent
4. Chief Concern
5. Preventative care
6. In chair treatment
7. Close date recall
8. Transition to regular recall
Describe in detail how an OPG can make an object to appear smaller?
OPG: when the object is outside of the focal trough (closer to the film).
The calibration
of the horizontal film plate produces an approximate 1:1 ratio to offset the inherent
magnification. However this only works for objects in the focal trough. If you are too
anterior, then you will have minimization of the actual object. This only occurs in the
horizontal plane as there is only horizontal movement of the plate, and not vertical.
What is the systematic way to examine a lesion?
- Site - using anatomical terminology
- Size - measure with a probe
- Morphology - elevated, flat or depressed
- Colour - compare to adjacent normal tissue
- Consistency - how it feels (ONLY CLINICAL DO NOT SAY THIS IN EXAM), texture - how the surface looks like (PHOTOS ARE APPROPRIATE :))
What are the the different types of dysplasia?
- Mild (grade I) - dysplasia is in the first third of the pithelium
- Moderate (grade II) - dysplasia entering the middle third of the epithelium
- Severe (grade III) - dysplasia near the basal layer
What is the definitions of dyskeratosis?
An abnormal keratinization occurring prematurely within individual cells or groups of cells below the stratum granulosum.
What is the definition of hyperchromasia?
It is an increased capacity of a cell to stain with dye; usually refers to staining of cell nuclei with hematoxylin.
What is the definition of suprabasal mitoses?
Mitoses of cells that are just above the basal layer
What are some of histological features of squamous cell carcinoma that needs to be talked about to the surgeon
- If there is any invasion of malignant epithelial cells - what is the nature of invasion
- Any local tissue destruction
- Potential spread to lymph nodes
- Any distant metastasis
- Any deeper structures involved
What are the 6 reasons have a deficient margins?
- Poor resistance
- Overcarving
- Underpacking
- Condensation error
- Inappropriate use of burs on the material post restoration during polishing
- Using the burs for gross reduction before the amlgam set
What are the test we can do to determine pulpal status of the tooth?
- Electric pulp teest
- COld test
- Pariapical radiograph
- DPR
- Thermal test with hot water
- Periodontal probing
- Mobility
- Tenderness on pulpation
- Percussion
- Local anaesthetic
What structure is under number 1?
LHS inferior border of the orbit
What structure in under number 2?
LHS Condyle
What is structure under number 3?
Superimposed over the sinus, malar process
What is structure under number 4?
Pterygo-maxillary fissure
What is the structure number 5?
Condesnsing osteotitis around the 35
What structure is under number 6?
Zygomatic arch
What structure in under number 7?
Ear lobe
What is structure under number 8?
LHS Inferior Alveolar Nerve Canal
What is structure under number 9?
Central Hyoid bone
What is the structure number 10?
RHS Styloid Process
What structure is under number 11?
RHS Maxillary Sinus
What structure in under number 12?
RHS Zygomatic Arch
What is structure under number 13?
Primary image of RHS hard palate
What is structure under number 14?
Secondary image of RHS palate
What is the structure number 15a?
LHS External Acoustic Meatus
What structure is under number 15b?
Genial tubuciles
What structure in under number 16?
Mandibular notch/oro-pheryngeal space
What is structure under number 17?
Nasal septum
What is structure under number 18?
Infra-orbital fissure
What is structure under number 19?
Nasal cavity/sinus
What is structure under number 20?
RHS Maxillary tuberosity
What are the six features are wrong with this OPG and what are the error on effect on final image?
- Unnecessary artefacts i.e. the glasses - Results in unnecessary object being presented on the DPR, the glasses
- Patient positioned forward - Anterior teeth blury and too small - spine sen on the film
- Failure to position the tongue against the palate - large, dark, shadow over the maxillary teeth between palate and dorsum of tongue
- Head is tilted to the side in the horizontal direction - condyles are not equal in height, nasal structure is distorted
- Head is turned to one side - seems like the RHS was closer to the detector than LHS - resulting in LHS ramus appearing larger
- Exposure factors have not been selected properly - the image appears to be blur overall
- Chin up - the V shape - joker brain
- Chon down - fraun
What is a ghost image and give a ghost image example on this OPG?
A ghost image occurs when the object or anatomic structure located between the X-ray source and the center of rotation and has a density that is sufficient to ettenuate the X-ray beams.
This image subsequently presents the same morphology as the object, but with distortion, it appears on the opposite side and at a higher point than the corresponding real object and larger.
An example is that maxillary sinus on the LHS a little above the the trueLHS sinus - which is actually the ghost image of the RHS sinus
Why don’t teeth generate ghost images?
In order to generate a ghost image - the object needs to be between the source of radiation and centre of rotation.
The teeth re usually rotated between the centre of rotation and the rcepting plate at all times (that’s how most of OPGs are designed and programmed)
What are some of the causes of false negatives during pulpal sensibility testing?
- Calcified canals
- Immature apex
- trauma
- Premedication of the patient
How to maintain staff safety during the OPG?
- Distance
- Position
- SHielding
What is the clinical importance of the focal trough?
- Structures within the trough are relativley well defined int he final image
- The closer a structure is to the centre of the trough the more sharply defined is the final image. The further, the blurrier.
What are the zones of the panoramic imaging assessment?
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
What type of framework are you going to use to access hard tissue or soft tissue abnormalities?
Site
Size
Morphology
Colour
Cosnistency
Texture
Describe the setting process of alginate.
- When mixed with water, a cross-link polymer chain is formed, resulting in a three-dimensional network structure
- Calcium sulphate dihydrate provides the Ca ions for the cross-linking reaction that the sol to a gel
- In order to decrease the setting time, sodium phosphate is added, which acts as a retarder, decreasing the number of Ca ions available for cross linking
- When a certain threshold of Ca ions have been achieved, the cross linking reaction fully sets
What is syneresis?
It is the loss of fluid within the alginate gel - this causes shrinkage
What is evaporation?
It is the loss of water from the surface of the alginate gel - this causes shrinkage
What is imbibition?
It is swelling of the alginate if immersed in water - this causes distortion
What are the criteria to assess alginate impresion?
- Alginate mix is homogenous and smooth - is it mixed well, is it too runny
- Tray appropriate size - are all teeth included and past the tuberocity area
- Alginate has had adequate time to be inserted into the mouth, seated onto the teeth and set prior to removal - is it seated on teeth correctly, has it set, has the material flown past the CEJ
- Adequate amount of alginate in tray and the treay has been seated and muscled trimmed correctly - has muscle been trimmed, have the tongue been placed properly
- Tray has been removed correctly
What are three most common anaesthetics used in the ADH
- 2% Lignocaine with 1:80000 adrenaline (Lignospan special)
- 3% Mepivicaine (Scandonest Plain)
- 4% Articaine with 1:100000 adrenaline (Articadent)
What are the three important aspects of performing an appropriate inferior alveolar block?
- Level - coronoid notch, 1 cm above lower occlusal plane, midway between arches with mouth wide open
- Angle - opposite premoalrs
- Entry point - pterygotempora depression - but this may be missing so rely on the palpation of the coronoid notch
What to do in SADS if a patient shows symptoms of syncope?
- Stop dental treatment
- Elevate patient’s legs to achieve a position where their head is lower than the heart. If patient is in dental chair, tilt the chair back to a horizontal angulation
- Allow patient to recover slowly
- Measure patient’s blood pressure & heart rate
What are the steps to gingival assessment?
C - colour
C - contour
C - consistency
T - texture
E - exudate
What are the steps to ILA?
- Patient
- CC
- MHx
- SHx
- DHx
- Exam
What is TRIM?
TRIM is an acronomy for:
Timing
Relevance
Involvment
Method
How would you assess the teeth on the radiograph?
- State what radigraph and side you are looking at
- FDI: notatation with restorations and radioopacities
- Pathology: radiolucencies, extent and causes
What are the steps to occlusal analysis?
1.Teeth present/missing
2.Morphology of teeth
3.Wear - mild, moderate, sever
4.Crowding,spacingrotations
5.Axail inclanations
6.Shape of dental arch
7.Cruve of spee and wilsons curve
8.Angle molar classification/canine classification
9.Overbite (%) / overjet (mm)
10.Mediolateral
During odontogenic infection, what is the path of least resistance in the mandible?
- If above the mylohyoid line, the infection would progress lingually, eroding the lingual cortical plate and entering the sublingual space. This will elevate the tongue and create diffuculties with breathing
- If below the mylohyoid line, the infection would progress down into the submandibular space. This may causes swelling near the angle of the ,and able to potentially causing trismus and therefore diffuculties chewing..
How to write a diagnostic statement for gingivitis?
- Extend - localised or generalised depending on the BOP
- Disease - gingivitis
- Specification - biofilm induced, mediated by pregnancy or leukemia
How do we treat necrotising gingivitis?
- Debridment under LA (removal of biofilm, calculus and necrotic tissues)
- Local irrigation with chlorhexidine 0.2%
- Antibiotic therapy - Metronidazole 400 mg orally, 12-hourly, 3-5days
- Review and reffer when needed
How to write a diagnostic statement for periodontitis?
- Type of periodontal disease - periodontitis
- Disease extent - generalised or localised
- Stage - I, II, III, IV
- Grade - A, B, C
- Current disease status - stable, remission, unstable
- Risk profile smoking, diabetes, etc
- Current condition - stbale/unstable
E.g. Periodontitis; generalised, Stage III, Grade C, currently unstable. Risk factors: smoking 20cig/day
What is the most important aspect of indirect pulp capping?
CORONAL SEAL IS VITAL.
Why can facial paralysis occur during IANB administration?
Cause: needle was positioned too far posteriorly & LA administered instead in the body of the parotid gland where facial and tympanic nerve run through
Signs + sympotms: Facial paralysis, unilateral, drooping of eyelid and upper lip / corner of mouth
Managment:
1. Tell patient this is temporary
2. Tell patient to not rub their eye
3. Cover the affected eye with eye patch
4. Keep under observation until better
5. No driving back home
6. IF not recovered in 12 hours - will need a medical review
Why can truisms occur during IANB application?
Causes: Trauma to the muscles or blood vessels, often caused by withdrawing the needle through tissue distension
Signs + symptoms: may present as a prologned spasm of the jaw muscles with limited or complete inability to open the mouth, or pain associated with mouth opening
Managment: Usual improvement within 48-72 hurs with up to 6 weeks for complete recovery. Patient may seek heat therapy, wamr saline rinse, soft diet & jaw exercises.
Why can soft tissue damage occur during IANB administration?
Cause: It is usually self-inflicted injury by the aptient themselves; induced trauma or burn
Sings + symptoms: May present as a soft tissue lesion, accompanied by localised pain and swelling. More noticeable once LA has worn off.
Managment: Provide appropriate post-operative insructions. If sever, antibiotics may be prescribed to void infection. Warm saline rinses.
Why can temporary blidness occur during the IANB administration?
Cause: Intravascular administaton. Pathway: Inferior alveolar nerve into middle meningeal artery into opthalmic artery causing loss of vision
Signs + Symptoms: Loss of vision a few minutes post IANB administration.
Managment: Stop dental treaatment. Call 000 because patient needs to go to the emergency department. CPR if patient is unconcious.
Why can persisten anaesthesia occur when administering IANB?
Cause: Direct sensory nerve damage caused by the needle. Injecting too much LA at high concentrations. Haemorrhage from around/near the neural sheath put pressure on the nerve
Signs + symptoms: paraesthesia will vary depending on structures involved - usually drooling, numbness, pins & needles. If damage to lingual nerve there can be altered taste sensation.
Management: Paraesthesia resolves within approx 8 weeks, if above 8 weeks refer to oral surgeons. Reassure patient and reassess
Why can heart palpitations occur during administration of IANB?
Cause: Intravascular injection may cause an excitation of the cardiovascular system
Signs + symptoms: Tachycardia, palpitations and headache
Management: Typically only short in duration. Ensure to stop procedure and monitor the patient.
Why can oedema occur during IANB administration?
Cause: May be caused by physical trauma, an allergic response, haemorrhage or irritation
Signs + symptoms: Present as a swelling tissues on the medial side of the ramus after deposition of LA
Managment: Pressure and cold compress applied to the area for 3-5 minutes, acoompanied by warm saline rinse
Why can tingly in the trap and throat happen during IANB administration?
Causes: 1) LA travelling down the brachial plexus (unlikely)
2) LA deposited too far back into the fascia surrounding pharyngeal muscles -> anaesthetised supraclavicular branch of cervical plexus that innervates ur traps -> arm numbness (more likely)
Sing + symptoms: Tingling in the throat and trap
Managment: Reassure patient it is temporary. Monitor. If the paraesthesia is persistent, need to get medical care.
What is the key differene between the Miller technique and Tube shift technique in localisation?
- Miller technique - two radiographs are taken at right angles to each other - good at determining the position of an impacted tooth
- Tube shift - a slight shift of the tube is needed after the first radiograph (SLOB) to discern which root is which
What is the purpose of a facebow?
It relates a patients maxillary arch to the intercondylar axis and the point orbital and enable these relationships to be transferred to an artiulator where this can be reproduced
How do you perform a cold test?
- Identify a tooth in question
- Dry the tooth thoroughly and also try a tooth that you would use a base reading (maybe two)
- Explain to the patient to indicate if they feel pain using their hand
- Ask the DA to apply endofrost on a cotton bud while you retract the tissue over the tooth you going to use as base reading
- Carefully, without touching soft tissue, place the cotton bud with endo frost on the tooth that is used as baseline
- When the patient reacts, remove the cotton bud and ask how they feel - it should be “It felt cold but it went aaway fast”
- Now move on to the tooth in question and repeat the procedure
How do you perform and Electric pulp test?
- Ensure the patient understands what the procedures entitles
- identify the tooth of interest
- Dry the tooth thoroughly and also try a tooth that you would use a base reading (maybe two)
- Ask the patient to hold on to the lip clip for you
- Ask the patient to indicate when they feel something by raising their hand up
- Make sure that the light on the Electric pulp test is visible by operator, apply tooth paste to the tip of the EPT pen for conduction and begin conduction on the baseline tooth - carefully without touching the soft tissue and maintaining appropriate moisture control
- When patient reacts, record the reading and move onto the tooth in question
How to manage a gagging patient?
- Let them know in advance
- Use fast set alginate
- Use warmer water
- Use salt on the roof of the mouth
- Add wax to the posterior of the tray
- Ask the patient to lean forward to reduce flow to the back of the mouth
- Get a vomit bag for the patient
- TRY NOT TO REMOVE THE TRAY
What are some of common conditions should we worry about in terms of the cardiovascular disease section of the medical history?
- Heart failure
- Acute Myocardial Infraction
- Hypertension - high blood pressure
- Congenital Heart Disease - bacterial endocarditis
- Arrhythmias - related to heart failure and blood thinners
What is important aspects to assist a patient with general stress?
- Open communication about fears and concerns
- Short appoitment
- Mornign appoitment
- Ensure profound local anaesthesia
- Need to provide adequate post-operative pain control
- Post-procedure telephone call
What are some of common conditions should we worry about in terms of the blood disorders section of the medical history?
- Inherited bleeding disorders - haemophilia
- Anaemia
- Leukemia or blood dyscrasias
- Blood thinners
What are some of common conditions should we worry about in terms of the respiratory tract disease section of the medical history?
- Asthma
- Chronic obstructive airways disease
- Tuberculosis
- Sleep apnea or sleep disordered breathing
What are some of common conditions should we worry about in terms of the neurological disorders disease section of the medical history?
- Stroke
- Epilepsy, seizures and convulsions
- Behavioral/psychiatric disorders
What are some of common conditions should we worry about in terms of the endocrine disease section of the medical history?
- Diabetes - type I and type II
- Thyroid disease - uncontrolled hyperthyroidism and stress sensativity
What are some of common conditions should we worry about in terms of the genitourinary tract disease section of the medical history?
- Kidney disease - abnormal drug metabolism
- Sexually transmitted disease - HIV, Hep b and C
What are some of common conditions should we worry about in terms of the muscuskeletal disease section of the medical history?
- Arthritis - relating to TMJ and use of NSAIDS
- Prosthetic joints
What are some of the other conditions to look out for when conducting a thorough medical history?
- Tobacco and alcohol use
- Drug addiction and substance abuse
- Cancer treatment
- Use of steroids
- Pregnancy
- Previous operations or hospitalisations
What is the protocol of action if you suspect the patient having coronary ischaemia syndromes in chair?
- Stop treatment
- Measure: blood pressure, heart rate and pulse oximetry
- Assess consciousness
- To relieve symptoms use glyceryl as instructed, call the registered nurse
If patient reports pain to be THE WORST EVER DO:
1. Call 000
2. Give glyceryl to a patient with previous history of angina
3. Give aspiring 300 mg orally
4. Measure: blood pressure, heart rate and pulse oximetry
5. Start supplemental oxygen - call registered nurse
6. Provide reassurance
7. If patient loses consciousness - start DRSABCD protocol
What is cardiac arrest, what are signs and causes, what is the management of the patient?
Cardiac arrest is the stop of heart function.
Signs: no pulse, loss of consciousnes and respiration
Causes: ventricular tachycardia, ventricular fibrillation, asystole
Managment:
1. Stop dental treatment
2. Call 000
3. DRSABCD
What is the management of mild or moderate asthma?
- 4 puffs of slabutamol inhaler, 1 puff at a time, shaken before each puff
- Ask the patient to take 4 breaths in and out of the spacer after each puff
- Wait 4 minutes
- If no imporvement - repeate
- If no improvement again - define this as a sever or life-threatening attack
What is the management of sever or life threatening asthma attack?
- Call 000
- Start oxygen and airway support
- Salbutamol - 12 puffs for 6+ years, 6 puffs for less than 6 year olds
- 1 puff at a time, 4 breaths in between
- When waiting for help - perform the protocol every 20 minutes
- If patient is worsening - continuously administer salbutamol
What are the steps of management if the patient is conscious with signs of airway obstruction?
- Call 000
- Reassure the patient and ask them to relax, breete deeply and try to dislodge the object by coughing
- If coughing is ineffective - give upto 5 back blows between the shoulder blades - check between each hit
- If the back blows dont work, do 5 chest thrust similar to CPR
- Continue until assistance arrives
What are the steps of management if the patient is unconscious with signs of airway obstruction?
- Call 000
- Inspect the back of the throat for foreign object
- Start DRSABCD
- Consider performing cricothyroidotomy
- DO NOT DO THE HEIMLICH MANOEURVE
What are the steps to managing a patient with a stroke?
- Stop dental treatment
- Call 000
- Measure: blood pressure, heart rate and pulse oximetry
- Start oxygen and airway support
- Monitor vital signs
What is the management of seizures?
If history of epilepsy or seisures is present - please use a bite block on the patient
- Stop dental treatment
- Ensure patient is not in danger
- Turn the patient to the side
- Avoid restrainning
- Wait until seizure stops
- Maintain airways
- Assess the patient
- If still unconscious, call 000 and maintain airways
How to manage a person with hypoglycaemia?
- Stop dental treatment
- Give 15 g of glucose or a similar drink or food
- Measure blood glucose - if does not return to normal - repeat the dose
- If after 3 doses normal blood sugar not returned - call for help
- If unconscious call 000 than DRSABCD
How to manage a person with hyperglycaemia?
Call 000
When does an addisonian crisis occur and how to manage it?
Usually occurs in patient with hyperthyroidism or use of corticosteroids 6-12 hours after surgica; stress
Managment:
1. Call 000
2. Give hydrocortisone 200 mg
3. Think about GIVING MORE STEROID BEFORE PROCEDURES
What is step by step management of extensive urticaria or angiodema ro swelling involving eyelids, lips or tongue?
- Stop dental treatment
- Remove or stop administarion of the allergen
- Refer for urgent medical attention; systemic corticosteroids may be indicated
What is step by step urticaria or angiodema with associated hypotension and evidence of anaphylaxis?
- Stop dental treatment
- Remove or stop administration of the allergen
- Call 000
- Give intramuscular injection of adrenaline
What is the step by step management of a patient with anaphylaxis?
- Stop dental treatment
- Remove or stop administration of the allergen
- Lie patient flat
- Give an intramuscular injection of adrenaline
- Call 000
- Start supplemental oxygen and airway support if needed
- DRABCD
- Repeat adrenaline every 5 minutes
What are some of the important information that needs to be considered when treating a patient with COPD?
- Avoid treating if upper respiratory infection is present
- Treat in upright chair position
- Avoid rubber dam in sever disease
- Use pulse oximetry in severe disease
- Avoid nitrous oxide/oxygen inhalation sedation with sever COPD - in order to not reduce the respiratory drive
- Avoid using narcoticts - in order to not reduce the respiratory drive
- Consider using steroids before the appoitment
What treatment can we give to a patient with previous history of tuberculosis?
Thorough history is important - contact their respiratory physician about the stage of their disease and procautions that they need.
If patient is confirmed free of disease than patient is safe to be treated as normal.
What are the two main types of sleep apnoe?
- Obstructive sleep apnea
- Central Sleep Apnea - lack of breathing as a result of lack of CNS respiratory drive
What is the purpose of the mandible advancement device?
The main purpose is to protrude the mandible forward (and the tongue) in order to reduce the airway restriction.
Some association with TMD.
What is the difference between a cancerous lymph-node and a node during an infection?
Cancerous
1. Fixed
2. Enlarged
3. Rubbery and hard
4. None-tender
During an infection:
1. Can be rolled
2. Enlarged
3. Kinda soft
What are the oral consequences of kidney disease?
- Greater bleeding tendency due to reduction in platalets
- Hypertension due to extra blood volume
3.Anaemia
4.Drug intolerance - antibiotic and analgesics
- Increased susceptibility to infections
- Halitosis, burning sensation int eh mouth, uremic stomatitis, periodontal disease
- Xerostomia
- Impared healing
Please consider collaborating with a nephrologis
What are the steps to the dental management of a person who is on haemodialysis?
- Consultation with nephrologist
- Platelet dysfunction and anaemia resulting in bleeding tendency should be discussed
- Heparin anticoagulation can be given to patient who is on haemodialysis - thus maybe try to do a procedure on another day
- Avoid compression on the arm with the vascular access
- Do not presribe some drugs - check with MIMS or consult with the renal specialist
- Look out for renal osteodystrophy - there is weaker bone with those patients so extra care need to be taken care when performing surgery
What are the steps to the dental management of a person who had a kidney transplant?
- Consultation with nephrologist
- Platelet dysfunction and anaemia resulting in bleeding tendency should be discussed
- Risk of adrenal crisis if they are teated with long standing corticosteroid therapy: morning appoitment and consider the need of supplemental steroids
- Immunosuppression may require antibiotic prophylaxis prior to invasive dental procedures
- Disturbances in removal of drugs: care is needed prior to prescribing analgesia or antibiotics
- Gingival overgrowth as result of immunosuppressive drugs such as cyclosporin - also consider medication interactions
If anything beyond a clean is needed - please consider sending them to a specialist such a special needs dentist or a OMFS.
What are the 4 main types of adhesion in dentistry with examples?
- Macromechanical (Amalgam)
- Micromechanical (Resin)
- Interfacial / chemical (Resin composite to ceramic)
- Chemical (GIC)
What are some of the factors that influence the adhesion to tooth structure?
- Factors associated with the type and quality of the tooth structure (e.g. prismatic vs aprismatic enamel or secondary vs tertiary dentine)
- Factors associated with cavity preparation (moisture, cavity size, smear layer, foundation of the bonding substrate)
- Factors associated with restorative materials (etch concentration, patient factors, polymerisation shrinkage)
What is the main problem with self-etch adhesives that affect the formation of appropriate hybrid layer?
- Formation of water blisters at the resin/dentine interface
- Semi-permeable membranes
- Greater failure rates and poorer bonding strengths than etch-and-rinse adhesives
What is dentinal sensitivity?
It is a condition characterised by short, sharp pain arising from exposed dentine in response to stimuli.
Rapid onset of pain - can persist as dull, throbbing pain.
Usually associated with deeper dentine because deeper dentine wider and more dense dentinal tubules.
Which fibres within the dentine are responsible to certain pain sensations?
Alpha fibres - short and sharp pain
C fibres - dull, lingering pain
What are the steps for differential diganosis of caused of dentinal hypersensitivity?
- Carious dentine
- Tooth fracture exposing dentine
- Cracked tooth syndrome
- Postoperative sensitibity
- Traumatic occlusion
- Marginal leakage with exposed dentine around the margins
- Irreversible pulpitis
- Vital bleaching
What is the main treatment for dentinal hypersensitivity?
Desensitisation of the tooth with blocking of the dentinal tubules or reducing sensitivity of the pulp to stimulus.
What are the two main stretagies for tooth desensitisation?
- Prevention - removing cuasative factors, address relevant histories
- Management - tubule occlusion by adhesion of exogenous materials, modification of nerve excitability
What are some of the good applicable solution for topical application for dentinal sensitivity?
- Potassium Nitrate
- Fuji bond LC
- CPP-ACP, F or Stanous fluoride
How does potassium nitrate works?
Potassium nitrate is able to over-saturate the space outside the nerve cell membrane with positive potassium ions (K+) thus blocking the re-polarisation phase of the action potential, thereby blocking pain impulses.
Why are 5th and 7th generation of adhesive system kinda mid?
- Because they are known to leave moisture bubles at the surface as well as water tress that impare bonding
- 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 :(
What is the process of activation and initiation of dental composite material?
- Photo-initiator - in a form of specific frequency of light (light cure or UV light) initiates the creation of free radicals within the composite material
- The free radicals with an extra electron will bind with monomers in order to create a polymer - at the end of this process an electron is loss thus another free radical can be initiated
- This continues when around 80% of resin is polymerised and 20% is not - this is important to allow addition of other composite resin
- Over time, free radicals will combine - creating a stable compound
How do we treat hypersensitivity?
- Block dentinal tubules - using restorations or protective coverings
- Block nerve activity - stanous fluoride and potassium nitrate
- Remove the cause - erosion and toothbrushing technique change
What are some of exteroceptors located in the oral cavity?
- Receptors in the PDL
- Receptors in alveolar mucosa
- Receptors in gingiva
- Receptors in periosteum of the jaw bone
They inform about the external loading when for example we chew
What are some of the proprioceptors in the oral cavity?
- Muscle spindles in mastictory muscles
- TMJ spindles
What is the importance of periodontal mechanoreceptors in clinical prectice?
They enable patients to detect new restoration which are high in occlusion
What is the purpose of TMJ receptors?
They function as pain receptors and proprioceptors. They may act as velocity detectors and static-position of the TMJ detectors.
How do we know that the tongue is so sensitive?
Because during two-point discrimination test, the tongue can detect 2 distinct points at around 1.4mm distance between them.
This sensitivity is related to tongue function and can be damped with local anaesthetics.
Tongue is also very very sensitive to temperature changes especially o n the dorsum area.
What is osseoperception?
It is a type of perception that occurs int eh absence of a functional periodontal mechanoreceptive input.
The mechanoreceptors are derived from TMJ, muscles or periosteal mechanoreceptors.
They provide mechanosensory infromation for oral kinaesthetic sensibility in relation to the jaw function and the contacts of artificial teeth.
What is oral stereognosis?
It is the ability to recognise and discriminate forms. Oral stereognosis is the ability to feel depth and understanding of 3 dimentions of objects.
Oral stereognosis can be used to measure oral functions.
Oral stereognosis is influences by forms, size and surface characteristics of the test piece.
Oral steregnosis is associated with health.
Oral stergnosis is HIGHLY DEPENDENT ON PERIODONTAL MECHANO RECEPTORS.
PULP IS NOT INVOLVED
What are the two different types of pain and WHAT FIBRES are responsible for them?
- Fast pain - sharp pain that is well localised and has a short duration - facilitate by A-delta fibres
- Slow pain - aching, burning pain that is poorly localised and is long in duration - involves unmyelinated C fibres
What is antidromic activation of nociceptors? Explain how it relates to the ‘hot pulp’ syndrome.
it is belied that in some cases, injury that is detected by the receptor through orhodromic means, meaning due to the injury itself, may cause propogation of the action potential to other receptors thus causing the pain to intensify through Substance P release.
Hot pulps:
- In ‘hot pulps’ the pain from the lesion is able to causes antidromic activation though the stimulus thus releasing substance P and Calcitonin gene related peptide (CGRP)
- Substance P is able to induce oedema formation through plasma extravasation
and also cause mast cells degranulation, releasing histamines which activate more nociceptors - CGRP are able to cause aditional oedema through dilation of peripheral blood vessels
- The increase in oedema causes an additional release of bradykinin which activates more nociceptors
- Through this multi step process, patient has a large number of nociceptors released thus causing hyperlgesia meaning the action potential threshold is considerably lower
How does some patient adapt so quickly to dental occlusal change or rehabilitative procedures?
It relates to central sensitisation and neuroplasticity.
Central sensitisation is process of shifting of the sensation by the central nervous system due to new stimuli.
Neuroplasticity is a process in which the central nervous system may change it’s ability to detect different stimuli.
The adaptation to the new stimuli occurs first to central sensitisation and lead to the changes to the face sensorimotor cortex due to neuroplastic changes.
What conditions must the chemical meet in order to become detected and cause an olfactory stimulus?
- Must be volatile
- Must have sufficient water solubility
- Must be lipid soluble
]4. Must have a minimal concentration and minimal time of exposure to be detected
What are peridontal mechanoreceptors, what is their function and what is their make up and ability?
Periodontal mechanoreceptors are ruffini type receptors that are within periodontal ligament.
They regulate the forces applied by the teeth in occlusion and mastication.
Response of the receptors vary ith the force applied to the tooth, but there is greater sensativity at low force levels.
This allows the mechanoreceptors to aid patient with finding high spots on restorations
What is the step by step process to understand the arisal of a certain oral lesion?
Use this scheme
- Developmental origin
- Inflammatory origin
- Hyperplastic origin
- Degenerative origin
- Hormonal origin
- Neoplastic origin
- Idiopathic origin
DIHDHNI
How do we take history about a lesion?
- Duration when the patient first started seeing the lesion
- Variations in site and character of the lesion
- Symptoms - related to the lesion and any systemic symptoms
- Onset - any associated hsitorical events related to the lesion
What is the systematic way to examine a lesion?
- Site - using anatomical terminology
- Size - measure with a probe
- Morphology - elevated, flat or depressed
- Colour - compare to adjacent normal tissue
- Consistency - how it feels (ONLY CLINICAL DO NOT SAY THIS IN EXAM), texture - how the surface looks like (PHOTOS ARE APPROPRIATE :))
What are some of the terminology in a lesion with elevated morpholoy?
Blisters - Fuild filled masses:
- Vesicle - upto 0.5cm
- Bulla - more than 0.5cm
- Pustule - pus of any size
Non-blisters - not fluid filled elevations
- Papule - upto 0.5cm
- Nodule - from 0.5cm to 2 cm
- Tumour - more than 2 cm
- Plaque - more than 0.5cm but it is only clightly raised
What are some of the terminology of a lesion with depressed or flat morphology?
Depressed:
1. Ulcer (epithelium lost) - if it is yellow tissue more likely to be an ulcer
- Erosion (epithelium lost)/atrophy - if it is redness tissue more likely to be an erosion/atrophy
Flat:
1. Macule - discoloration (freckel)
- Patch - big discolouration
What should you do with some of the lesions that you may encounter to understant if they are vascular?
Use a small, transparent plate and apply pressure - if the lesion stars to blanch, it is most likely to be vascular
What are some common stains in oral pathology?
- Haematoxylin and eosin
- Periodic Acid-Shiff - used for fungal infection
What are the four layer of the epithelium?
- stratum basale (D)
- stratum spinosum (C)
- stratum granulosum (B)
- stratum corneum (A)
E and F and the papillary and reticular layer accordingly
What are some the benign lesion of epithelial layer with idiopathic or developmental origin?
- Leukoedema
- White Sponge Nevus
- Epidermolysis Bullosa
What is a leukoedema?
It is a common developmental lesion of the oral mucosa. It is a variation of normal mucosa and it is more common in individuals with dark skin. Mainly in buccal mucosa
It can be implicated by the use of tobacco or alcohol.
They are asymptomatic, bilateral, poorly defined and it disappears when the mucosa is stretched or whipped with a gauze. Please consider not to stretched the attached gingiva!
What is the histology of leukoedema?
It appears in the supperficial half of the epithelium.
There are large vacuolated cells present with some Pyknotic nuclei.
Epithelial hyperplasia present as well as long elongated rete pegs
What is the White Sponge Naevus?
It is a rare inherited condition. It is autosomal dominants trait and it is early onset. Majority of cases present with oral lesion, other mucosal surface may be affected.
It is asymptomatic, diffuse, with white thickening and if irregular thickening
What is the histology of White Sponge Naevus?
It appears in the superficial layer of the epithelium.
Large vacuolated cells.
Pyknotic nuclei and thickened parakeratin layer
No dysplasia present
What is benign migratory glossitis?
It is also known as geographic tongue - it is quite common and the aetiology is well known
It is a result of loss (atrophy) of filiform papillae. Sometimes it can be sore but again not much can be done - if concerning please refer for biopsy
What can be commonly seen int eh benign migratory glossitis histologically?
Numerous microabscesses in the surface of epithelium filled with neutrophils and lymphocytes
What is hairy tongue (aka coated tongue)?
It is a condition with poorly understood aetiology and a result of increased length of filliform papilla.
May be initiated by heavy smoking, atiobiotics and other.
Usually asymptomatic.
Increased number of chromogenic microorganisms thus a change in colour to usually darker one
What do we do in the instance of hariy tongue, migratory glossitis or other benign developmental deviation?
- Ensure the patient that this is not something pathological
- Take a smear if needed
What is haemangioma?
It is a localised vascular proliferation that may be congenital or arise later in life.
Could be single or multiple and results in soft tissue lesions usually
What is the hsitological appearance of haemangioma?
- Layer of epileium
- Perforations of endothelial blood vessels and cells - forming capillaries
What type of haemangioma is this?
This is capillary haemangioma due to the small capillary vessels presence
What type of haemgioma is this?
This is cavernous haemangioma due to larger blood vessels present
What conditions is this?
This is a caliber persistent labial artery.
It occurs when the inferior alveolar artery maintains it’s size after leaving the mental forament and becomes superficial in the lower lip.
It can present as a nodule. PLEASE PULPATE IT BECAUSE IT WILL PULSE
What is normal physiological pigmentation?
It is usually:
1. Symmetrical
- Follows normal anatomy/tissue architecture
- Commonly seen in the gingivae
- Associated with increase melanin production
What is this condition?
Oral melanotic macule or focal melanosis or an intraoral freckle
It is a well demarcated, uniform in colour, asymptomatic and has the same consitency as the surrounding mucosa macule.
Histologically it is related to increase melanin deposition.
Sometimes can arise due to medication use specifically oral medications.
Remeber macules DO NOT CHANGE OVER TIME
What is this condition?
This iss a mucosal menocytic naevus.
It is a rare oral cavity lesion or patch.
It is bening proliferation of neaevus cells.
The lesion is not neoplastic but is a hamartomatous lesion
What type of naevus is this?
This is a junctional naevus because is confined to the basal layer of the epithelium
What type of naevus is this?
This is intraomucosal naevus - because is is not in the epeithelium
What condition is this?
This is an amalgam tattoo - it is associated with some of the amalgam being incorporate into the adjcent soft tissue over time. PLEASE LOOK AT AMALGAM NEAR BY.
This lesion can grow but usually at a none alarming rate.
What are Fordyce spots?
They are ectopic sebaceous glands that usually occur on the buccal mucosa - their instance increases with age.
They are slightly elevated yellowish nodules.
It arises due to the arisal of the tissue from the ectoderm during the embrio development
What are the histological features of the Fordyce spots?
They are very similar to sebaceous glands
What condition is this?
These are lingual tonsils.
This is part of the lymphoid tissue (Welder’s ring) that is used to fight infection.
The lymphoid tissue underneath the folliate papilla goes through lymphoid hyperplasia (growth) and result in an elevation on the postra-lateral tongue surface.
What type of tissue is this?
This is lingual thyroid tissue
What are the Tori and exostoses?
They are bony protuberances.
Non-neoplastic.
Possibly inherited
Exotoses - multiple or single nodules at the buccal aspect of the alveolar bone
What are the two basic morphological potentials of a lesion?
- Sessile lesion - broad based lesion
- Pedunculatedlesion - on a stalk - use a perioprobe to see if a lesion has a neck
What are some of the other adjectives that can be used to describe a lesion?
- Papillary - any small growth projectin into a cavity
- Verrucous - warty surface appearance (small hyperkeratinised projections)
- Epulis - lump on the gum non-neoplastic
What is fibroepithelial hyperplasia?
It is a growth of fibrous connective tissue underneath an epithelium
WHat are the clinical features of fibroepithelial hyperplasia?
It is a exophytic lesion.
Site is a site of trauma
Size is around 1-2mm upto 1cm
Moprphology could be sessile or pedunculated
Colour is similar to normal mucosa but could look inflamed
Consistency could be soft to hard depending on the age of the fibrous tissue
What is papillary hyperplasiaof the palate?
It is a nodular overgowth that is associated with dentures and S.Candida infection.
Associated with nodular hyperplasia in histological samples
What is the common histological presentation of the S.Candida infection
It is a presented as a nodule appearance with chronic inflammatory cell infiltrate
What condition is this?
This is fibroepithelial polyp. It is a localised fibroepithelial hyperplasia. Can occur anywhere but commonly sites prone to trauma.
It is similar to the colour of the surroinding tissue but may appear a bit more inflammaed.
What condition is this?
This is fibroepithelial polyp. It is a localised fibroepithelial hyperplasia. Can occur anywhere but commonly sites prone to trauma.
What is the histopathology of fibroepithelial polyp?
It is an overlying epithelium - hyperplastic or atopic or normal. Bulk lesion is made up of densely collagenous fibrous connective tissue.
MAY OCCUR WITH OSSIFICATION
What condition is this?
This is pyogenic granuloma.
It is a localised soft tissue lesion that is common in people who are pregnant due to the hormone imbalance.
Site: Anywhere but classically arises from the interdental papilla
What are the clinical features of pyognic granuloma?
Usually sensile
Sudden onset and rapid growth
Bright red and haemorrhagic, ulcerated surface.
Tissue may mature thus becomes fibrosed
What is the hsitopathology of Pyogenic granuloma?
Many lesions are made up of exuberant granulation tissue. It is a very vascular lesion with large numbers of thin walled dilated blood vessels lined by endothelial cells
What is peripheral giant cell granuloma?
It is a similar lesion to the pyogenic granuloma but it also involves bone tissue
What is the histopathology of the peripheral giant cell granuloma?
It is a well vascularised cellular tissue with mononuclear cells.
If you see multinucleadted diant cells - probs a peripheral giant cell granuloma
What is the imortant aspect of the peripheral giant cell granuloma?
It is important to determine that the lesion is not an intra-bony or central lesion which has perforated cortical bone
What is ulcerated fibrous epulis with ossification? what are the clinical features?
It is a relatively common oral lesion. Presents as localised lesion of gingiva like fibrous epulis and pyogenic granuloma.
Clinical features:
1. Painless
- Relatively rapid growth
- Size usually less than 1 cm
- Sometimes - surface ulceration
What is the histopathology of ulcerated epulis with ossification?
It is a very cellular lesion - well vascularised and collagenous. IT CONTAINS CALCIFICATIONS.
What are generalised gingival hyperplastic lesions?
They are lesion that occur due to underlying factors such as plaque or use of certain medications such as hypertension medication (calcium channel blockers) or anti-covulsants or immunosupresants.
Drug Induced Gingival Overgrowth is one of them
What is morsicatio buccarum?
It is cheek biting which causes chronic mechanical trauma.
Clinical presentation is a unilateral or bilateral white patch on the buccal mucosa, which is rough and whitenned. Usually symptomless
What is frictional keratosis?
It is similar to the cheek biting and linea alba but usually occurs on commonly traumatised sites such as the lips, lateral border of the tongue, buccal mucosa, edentulous alveolar ridge.
Appears as a poorly demarcated white lesion.
What happens histologically in frictional keratosis? What is the management?
Histological features:
1. Hyperkeratosis
- No dysplastic changes
Management:
- Identify and try and remove a cause - might be difficult with edentulous patients
- Always biopsy if in doubt :)
What is smoker’s keratosis?
It is a diffused, white, moderately thickened palate that can be sometimes roughened.
It usually involves the entire palate with characteristic, red, minor salivary gland dots.
Associated with tobacco smoking, especially reverse smoking.
What condition is this?
This chronic hyperplastic candidiasis.
It is usually a single, fixed, white or mix of white and red patch that syays when whipped.
May occur anywhere but common sites are the tongue and buccal mucosa.
What is the histopathological appearance of chronic hyperplastic candidiasis?
Thickening large bulbus epithelial with keratinisation
What are histopathological features of the giant cell fibroma? What are the clinical features?
The main difference between giant cell fibroma is the Giant Stellate Cells rather than the osteoclast like cells.
The clinical features are similar: small, raised, pedunculated lesion that is asymptomatic
What is traumatic neuroma? What are it’s clinical signs?
It is a lesion thatoccurs due to the damage of a nerve trunk following some sort of injury (like surgery or pressure on dentures).
Essenially - the repair of the axon does not go as planned and the lesion if fully comprised of the neural tissue.
Clinical features: small swelling or nodule on mucosa near mental foramen, alveolar ridge, lips or tongue. Pressure on the nodule cuases pain
What is histapathology and treatment of traumatic neuroma?
Histopathology: Presents as a mass of irregular bundle situated in variable amount of connective tissue stroma.
Treatment: surgical excision
What is this condition?
This is verruciform xanthoma, it is a rare lesion that mimic squamous cell carcinoma.
It is flat, velvety, pebbly.
What is the histopathological appearacnce of verruciform xanthoma?
It is usually associated with foamy, lipid filled marophages.
The lesion is bening
What is a traumatic eosinophilic ulcer?
It is a bening chronic ulcer usually presenting on the tongue.
It is crateriform in shape.
What is the histopathological significance of eosinophilic ulcer and why should it worry us?
Eosinophilic ulcers are usually associated with an abnormal presentation of eosinophils thus it is important to send a biopsy sample of the ulcer for histopathological investigation to ensure it is not malignant
What is this condition?
This is a minor aphthous ulcer - which one of the most common ulcer of infectious origin.
It usually occurs in non-keratinised mucosa, it is shallow and rounded.
It has erythematous margins and yellowish floor
What is this condition?
This is a major Aphthous Ulcer - an uncommon ulcer of infectious origin.
It is usually very large and can involve keratinised mucosa. This need to be reffer for biopsy because this could be a melignancy.
What is this condition?
This is Herpetiform aphthous ulvers - it is an uncommon and are very very small.
Named herpetiform due to the resemblance of the ulcers to those of herpetic stomatitis
ONLY OCCURS ON NONE-KERATINISED TISSUES
What are the oral manifestations of Crohn’s disease?
- Diffuse lip swelling
- Coble stone thickening of the mucosa
- Ulcers
What is this condition?
This is necrotising gingivitis. It is usualy caused by a presence of an opportunistic bacteria and an underlying stress factor.
Clinical features: necrosis of the papilla, sudden onset, ulcer covered by greyish pseudomembrane from surrounding mucosa
Treatment:
- OHI
- Debridement
- CHx
- Metronidozole 400mg 6 hourly for 5-7 days
What is this condition?
This is cancrum oris (noma) - it is a destructive condition involving oral soft tissues and jawbone.
Usually associated with children who are malnourished and have lower immunity due to systemic infections.
Thought to arise from NG
What is this condition?
This is actinomyces - an infection characterised by multiple foci of chronic suppuration.
Patient present with firm swelling commonly in the submandibular region with variable pain symptoms.
Treatment: prologned antimicrobial treatment after cultures
What are the histological features of Actinomyces?
- Chronic granulomatous inflammation surrounded by abundant granulation tissue and fibrosis
- Granules consisting of tangled meshes of organisms may be seen
What are some of the oral manifestations of congenital syphilis?
- Notched permanent incisors
- Hypoplastic first molars
- Saddle bone deformity
What are the lesion of the primary syphilis?
It is a chancre - which occurs at the site of primary inoculation 3-4 weeks after infection.
Lesions are high infectious - be careful!
Heals naturally
What are the lesion of the secondary syphilis?
They are usually described as some mucous patch, rash or condyloma lactum.
Usually occur 6-8 weeks after primary stage.
Still infectious - please be careful
What are the lesion of the tertiary syphilis?
They are called Gumma - they usually involve the hard palate perfiration or syphilitic glossitis
What are the oral manifestation of Tuberculosis?
Mulitlobular ulcerated growth due to immundeficency - histologically it is associated with granuloma inflammation.
What are the oral manifestations of Leprosy?
Nodular mucosa lesions are present in 20-60% of the patient
What is the acute pseudomembranous candidosis or thrush?
it is most common type of acute candidiasis.
This is a lesion/lesions that is associated with soft, white/yellow plaque that can be lifted off the mucosa.
These plaques represent inflammatory exudate, dead cells and fungal colonies
Whatis a Chronic Hyperplastic Candidosis?
It is lesion/lesions that may occur anywere but are common to the tongue and buccal mucosa.
Present as white or mixed white/red patches or plaques on the mucosa.
THIS LESION CAN RESEMBLE OTHER PATHOLOGY - like lichen planus or early squamous cell cercinoma biopsy and re-biopsy after antifungal treatment
What is gingivostomatitis?
It is a widespread vesicular eruption involving skin, vermillion and mucosa.
It results in painful widespread infection that can be observed in the photo.
It is associated with young children or older adult who are immunocomprimised
What is recurrent herpes simlex vitus?
It is a vesicular eruption affecting perioral skin, lips, gignivae and palate - knowns as harpes labialis
What are the histological features of herpetic lesions?
- Intraepitheial vesicle formation - aka acantholysis
- The vesicles contain inflammatory cells and exudate
- Destruction of epithelial cells
What does the reactivation vericells virus lead to?
It leads to shingles.
Shingles may result in oral manifestations like vesicular lesiosn aorund the oral cavity.
What is Oral Hairy Leukoplakia?
It is a oral manifestation that relates to the Epstein Barr Virus and is associated with HIV invection
What is a leukoplakia?
It is a predominantly white plaque of questionable risk having excluded other known diseases or disorders that carry no increased risk of cancer
What is proliferative verrucous leukoplakia?
Proliferative verrucous leukoplakia is a progressive, persistent and irreversible disorder characterized by the presence of multiple leukoplakia that frequently become warty.
What is eryhtroplakia?
Erythroplakia is a predominantly fiery red patch that cannot be characterized clinically or pathologically as any other definable disease
What is lichen planus?
A lichen Planus is a chronic inflammatory disorder of uknown etiology with characteristis relapses and remissions, displaying white reticular lesions, accompanied or not by atrophic, erosive and ulcerative and/or plaque type areas. Lesion are frequently bilaterally symmetrical.
Desquamative gingivitis may be a feature.
What condition is this?
This is an oral lichenoid lesion - which is similar to oral lichen planus but is usually around a single site.
Usually associated with medications and go away when medication is stopped
What is the clinical presentations of malignant lesions?
RULE acronym:
- Red/white
2.Ulcer
3.Lump
Exceeding 3 weeks in duration
What are some of the other presentations of oral cancer coudl arise?
- Non-healing extraction socket
- Pigemented lesion (melanoma) with irregular borders
What is the pathology of squamous cell carcinomal?
- Invasion of malignant epithelial
- Localised tissue destruction like bone erosion - floating tooth on the radiograph (primary intraosennous carcinoma
- Spread to the lymphatic system
- Distant metastasis
What is the grading of tumours?
It is a process of examining the degree of differentiation of cells
Grade 1 - well differentiated squamous cell carcinoma
Grade 2 - moderately differentiated squamous cell carcinoma
Grade 3 - Poorly differentiated squamous cell carcinoma
Grade 4 - anaplastic - fucked
The greater the grade the worst a prognosis
What lesion is associated with human papilloma virus?
Squamous papilloma.
An asymptomatic, solitary lesion that is associated with cauliflower like apperance
What are the histological features of squamous papilloma?
Exaggerated growth of usually parakeratinsed benign squamous epithelium.
Finger-like projections of epithelium with central cres of fibrovascular tissue
What is another type of lesion that can be caused by HPV?
Genital warts in the mouth or Oral Condyloma Accuminatum.
It is an infections lesion that can cause transmission through direct contact.
It presents as a broad based pink nodule that grows and coalesce (come as one)
What are the oral manifestation of non-hodgkins lymphoma?
Large ulceration, swelling, pain, paraesthesia and losse teeth
Aetiology is unknowns
What is the main feature of oral malignant melanomas?
They have a defused appearance
What are some of the routes of entry of bacteria into the pulp?
- Caries
- Mechanical exposure
- Trauma
- Anachoresis - bacteremia
- Periodontal pockets - when pockets reach root apex
What are some of the locations found in tooth non hard tissue?
- Root canals
- Lateral/ accessory canals
- Dentine tubules
- Extra-radicular tissues
What are the six features are wrong with this OPG and what are the error on effect on final image?
- Unnecessary artefacts i.e. the glasses - Results in unnecessary object being presented on the DPR, the glasses
- Patient positioned forward - Anterior teeth blury and too small - spine sen on the film
- Failure to position the tongue against the palate - large, dark, shadow over the maxillary teeth between palate and dorsum of tongue
- Head is tilted to the side in the horizontal direction - condyles are not equal in height, nasal structure is distorted
- Head is turned to one side - seems like the RHS was closer to the detector than LHS - resulting in LHS ramus appearing larger
- Exposure factors have not been selected properly - the image appears to be blur overall
