General Exam question form last years - MCQ, EMQ, SAQ Flashcards
FFWhat happens to the non working condyle when lateral excursion occurs?
During lateral excursion movement, the non-working condyle moves downward, inward and forward.
With metal primer - what bond do they use?
A carbon double bond
What radiogrpahy technique uses two beams at right angles?
Miller’s technique. bisected angle, PA and occlusal
What theory explain phantom pain theory?
Neuromatrix
What is the name for the TMJ side that does not participate in the chewing process?
Balancing side - moves inferiorly, anteriorly and medially
What microbes increase in periodontoal disease?
Gram + facultative anaerobe cocci
What is the common sprichetes psecies found in periodontitis?
Treponema denticola
What is the enzymes that normally breaks glycosidic bonds during glycoprocessing or catabolism of oligosaccharides?
Glycosidase
Which nerve pathway is responsible for pain/fear?
Limbic pathway
What nerve innervates the anterior belly of the digastric muscle?
Trigeminal nerve through inferior alveolar nerve (V)
If you move 44 laterally againt an opposing tooth, what force is induced on buccal cervical regoin of 44?
Tensile force
What is the main operative difference between prismatic enamel rods and aprismatic enamel rods?
Prismatic enamel rods are more resistant to etch
What is the key feature of cariogenic plaque?
- Low resting pH, proliferatipn of acidogenic and aciduric bacteria and decrease in urea ammonia production
Which taste buds from which portion of the tongue are innervated by chondra tympani CN VII?
Anterior two thirds of tongue
Upper and middle of the masseter muscles sometimes get pain what can the pain be
mistaken for?
Pain in the uper posteir teeth
What is the composition of flexular stength?
Tensile and compressive strengths
What is the mechanism behind burning mouth syndrome?
Potentially -idiopathic neuropathic (psychological) or due to trigeminal neuralgia
What is the purpose of periodontal mechano receptors or PMRs?
They aid in oral stereognosis
Which receptors are responsible to discriminate between 2 points?
Merkel cell receptors
Which anatomical structure can elicits fear and anxiety from smell?
Olfactory bulb sending singnals to the amygdala
What receptors are effective for jaw stabilisation during running?
Spindle receptors on the mostly) jaw closing muscles that detectet stretch and compensate it using reflexes
What jaw reflexe is inhibited during mastication?
Periodontal mechanoreceptors
Veilonella is a group of bacteria that is found in periodontal pockets. What is the danger of this bacterium?
Veillonellae are able to use some of the lactic acid produced by bacteria such as streptococci and lactobacilli that potentially induce dental caries below the gingival margin.
What is the most common initial coloniser group?
Mitis group
What are water trees?
They are water channels in adhesive layer
What does the smear layer do?
It decreases tensile strength of CR and GIC
What does the decrease in filler size particles affects?
Polymerisation shrinkage
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.
Why do microorganism preffer to reside in the biofilm?
- 3D structure of the extra-cellular matrix provide a site for adhesion
- Provides water and nutrient channels
- Provides protection from desication
- Provides protection from host defences - think B-Lactam aggregation
What is the most common bacteria associated with fissure caries?
S. Mutants
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 polyp
- 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 is the function of primer in dry bonding?
Re-stiffen collagen tubules/structure
What is the function of silane?
Coupling agent, act as intermediary which binds organic and inorganic components phases
What does the outflow of dentinal fluid trigger?
A-delta fibre and sometime C fibres
What does one click in the TMJ mean upon opening?
Anterio-medially displaced disc
LA for 36 for cestaration with cervical cord is needed. What LA would you give?
LHS IANB + long buccal nerve block
You give and IANB to a patient - they come back the next day with limited opening. WHat structure is involved?
Medial pterygoid
You give and IANB to a patient - they come back the next day with limited opening. WHat is this condition called?
Trismus
Your patient comes in with sensatvitiy to hot and cold, they also look very tired - seems like the tooth ache does not let them sleep at night. WHat is most likely diagnosis?
Irreversible pulpitis
Your patient comes in with pain in his tooth - he says it flares up after biting. What is most likely diagnosis?
Fractured cusp
Your patinet comes in with generalised pain in their upper molars - they complain of having a stuffy nose - the pain aggravates when they move their had. What is most likely diagnosis?
Maxillary sinusitis
What is an alteration in taste called?
Dysgeusia
What is the name of pain where trigger point can be identified from the patients face?
Myofacial pain
What is the pain with uncontrolled muscle movement with limited opening called?
Myospasm
What condition is assoiacted with loss of transport in chemical modality in sense of smell and teste?
Sjogren’s syndrome - lack of saliva thus no transport
What enzyme helps to break down amino acid starter chain?
Exoprotease
What muscles are associated with clenching?
Masseter and temporalis
What is left behind when Meckel’s cartilage is gone?
Malleus and Incus - bonny ossifications of the ear canal
In the adult graph charts - what is the fastest growing line?
Lymphoid
In the adult charts - what line goes into platoe the fastest?
Neural
What does it mean when a person is in the top 3 percentile of growth?
Means they are taller than 97% of the population
WHat chemical sensitises nociceptors?
Prostoglanding
What is the most common early coloniser?
Strep bacteria
What species attaches initially in attachment to the dental pellicle?
Actinomyces
When the mandible deviates to the left on opening which muscle is activated?
Righat lateral pterygoid
Where does superior medial pterygod muscle attach?
Pyramidal process
WHat nerve innervates sternocleidomastoid and trapezius muscles?
Cranial Nerve XI
What does shiny, non-scooped surface an indicator off?
Active grinding
What does shiny, scooped surface an indicator off?
Active erosion
Which part of the pyramid represent periodontitis?
The full pyramid
Which pyramid will you find pure fusobacterium nucleatum?
Orange complex bacterium
Which pyramid part will represent plaque from gingivitis?
Usually the green and small amount of orange complex bacterium
Which pyramid part will represent most gram negative bacteria?
The red complex bacteria only
Which cell is lysed to get iron for prolifiration of p.Gingivalis?
Erythrocytes
Which enzyme breaks sialic bonds?
Glycosidase
Which enzyme used to break down complex carbs to attach to acquired pellicle?
Amylase
Which enzyme does P.Gingivalis use to disrupt the enzyme control of collagen formation?
Matrix metalloproteinases
Which enzyme is used by initial colonizers to take down the immune defence?
IgA protease
On this envelope of motion diagram - what does 3 represent?
Edge to edge
On this envelope of motion diagram - what does 1 represent?
Retruded contact
On this envelope of motion diagram - what does 4 represent?
Maximum protruded contact
Secondary caries is a common cause of restoration failure. What is the most common cause of secondary caries at the margins of composite resin restorations?
Microleakage
While obtaining an alginate impression of a patient’s maxillary arch for night guard construction, you notice several air bubbles present in the impression material upon removal. The air bubbles are small and mainly located on the occlusal surfaces and cusp tips. What would you do to prevent this from recurring in the future?
Please dry the surface of the teeth before seating the tray
Odontoblasts continue to deposit dentine throughout life. What type of dentine is formed locally in response to noxious stimuli such as tooth wear, dental caries and restorative procedures?
Tertiary dentine
Dental alginate is a material used in the clinic when making impressions. When mixing the alginate for around 30 seconds you notice it becomes stiff and cannot be loaded into the tray. How could you overcome this problem on your second attempt while still maintaining the best physical and chemical properties of the material?
Decrease the water temperature
A shade match for anterior tooth-coloured restorations should always be done before rubber dam is placed. What is the main reason for shade selection prior to rubber dam placement?
Rubber dam isolates the tooth from the oral cavity and saliva and dehydrates the tooth, thereby changing its refractive index.
What is the origin and insertion of stylomandibular ligament?
Styloid process of temporal bone (origin) & angle of mandible (insertion)
How do you palpate the medial pterygoid on a patient during full occlusion?
Inner aspect of the mandible
Where would you palpate for the medial pterygoid muscle?
Medial/lingual surface of mandible
Mr Smith presents with the following symptoms related to his TMJ: sore teeth, frontal headaches and sore muscles upon waking, clicking on opening and closing. Further examination determines that the click is at the same position on opening and closing. Into which of the following diagnostic categories do Mr Smith’s symptoms best fit?
Muscle problems and TMJ internal derangement
A young girl presents at your clinic with a significant anterior open bite. Upon closer examination, you note that she has a Class 2 Division 1 malocclusion. What are the distinguishing features of this type of malocclusion?
Mesio-buccal cusp of upper 6 occludes mesial to the mesio-buccal groove of lower 6; significantly proclined central and lateral incisors
In the clinic/laboratory, facebows are often used in conjunction with an articulator. What is the purpose of a facebow?
To relate the condyles to the maxillary arch
In which area of the focal trough the narrowest?
Anterior
Distortion of panoramic images can be caused by the patient’s head position. What characteristics of a radiograph would you see if the patient rotates their head to the left?
The teeth on the right hand side appear wider than the left
Which fibre is anaesthesised last during local anaesthesia?
A-beta fibres
Which fibre is anaestehthesised first during local anaesthesia?
C-fibres
Hot pulp is a condition associated with antidromic release of what?
CGRP - calcitonin gene related peptide
What is ‘hot’ pulp caused by?
Antidromic activation of nociceptors/sensory endings
Which receptors allow for delicate manipulation of food?
Periodontal mechanoreceptors
Giving LA/GA to prevent post-op pain before extracting a tooth is an example of what?
Central sensitisation
Anterior temporalis muscle reffered pain can be felt where?
Maxillary anterior teeth
What are the three common reflexes in the jaw?
- Jaw opening
- Jaw closing
- Periodontal
Which papilla has the most taste buds?
Circumvallate
The tongue is the human body’s primary taste organ. To which taste are the sides of the tongue most sensitive?
Sour
Oral stereognostic ability (OSA) is the neurosensorial ability to recognize and discriminate different forms in the oral cavity. What receptors play a major role in OSA during free manipulation of test objects in the oral cavity?
Periodontal mechanoreceptors
What is the ecological niche for P. Gingivalis in health?
Tongue
How do cells generate nucleotides?
Through de nove and salvage and pathways
WHat is the common mechanisms of fluoride, CHX & Xylitol in caries control?
Inhibition of PEP/PTS
What do bacteria do to increase the pH of their environment?
Release ammonia
Which salivary enzyme is involved in the catabolism of complex carbohydrates binds to enamel to form part of the acquired pellicle and facilitates attachment of early colonisers?
Amylase
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
Mrs X is a healthy 32 year old mother who comes into your practice complaining about ulcers in her mouth that appeared 3 days ago and which are preventing her from eating properly. She mentions that her children are also having the same problem and she wonders if it is because of something they ate. You notice that Mrs X’s hands are covered with small vesicular rashes and there are also multiple ulcers in her mouth. What is the most likely cause of Mrs X’s condition?
Coxsackie viruses (type A)
Jo, a newly employed dental assistant reports that recently, she has noticed some rashes on her hand after removal of her latex gloves. She adds that she has never experienced this before. What type of hypersensitivity is she most likely to be experiencing?
Type IV
54 year old Jakob presents at your surgery with mild pain on the right side. He is unsure whether the pain is from the top or bottom of his mouth. You wish to gain a full history and complete a thorough examination, including pulp sensibility tests, so you can accurately diagnose Jakob’s problem. His right premolar bitewing radiograph is presented above.
What is the most likely cause of the radiolucency evident on the distal cervical portion of Jakob’s lower second premolar?
Inappropriately packed restoration
It is important that a dentist understand patients’ ability to perceive touch, temperature and pain in the orofacial environment.
During running or jumping exercise, the position of the mandible relative to the maxilla is maintained. Which receptors help to maintain the rest position of the mandible during locomotion?
Muscle Spindle receptors
Sensory information from the teeth and supporting structures is transmitted to the brain via the trigeminal nerve. What is the location of the cell bodies of the first order neurons arising from the periodontal mechanoreceptors of the lower premolars?
Mesencephalic nucleus
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
There is usually always magnification with radiography, however there is one
radiograph technique can make the image smaller than the object?
DPR or OPG
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
Using a surgical sieve - please give at least one potential cause for a lesion like this.
Developmental - Oral White Spngey Naevus
Inflammatory - Smokers keratosis
Hyperplastic - Fibroepithelial Hyperplasia
Degenerative - Chronic hyperplastic Candiasis
Hormonal - /
Neoplastic - Oral squamous cell carcinoma
Idiopathic - Idiopathic lesion
Please give diagnosis given that the epithelial tissues have invaded the connective tissue however these are no evidence of vascularisation or neural proliferation?
Always think Oral Squamous Cell Carcinoma - send for biopsy
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 kind of material / materials would you use in order to restore this tooth - considering you will remove the amalgam?
I think a packable resin composite is appropriate because
- Appropriate strength and resistance to fractures
- There us enough tooth structure to bond to
- Easier ability to provide future repair if any fracture occur
What are the steps to restoring this tooth - please be very specific!!!!
First obtain consent
For this tooth specifically - apply Ziagel (5% lignocaine) in the labial area adjacent of 27 and 25, use Lignospan Special (2% lignocaine with 1:80000 adrenaline) in the labial area adjacent of 27 and 25 - 3/4 carpule at 25 and 1/4 carpule at 27
- Prepare rubber dam for isolation from 27 to 23 - use the W3 damn with prior flossing through - please try the clamp on first
- Take a shade before putting on the rubber dam - consult with the patient!
- Put the rubber dam and do appropriate inversion
- Access the cavity with an 838 or 822 diamond high speed bur
- Clean the caries with slow speed bur of appropriate size
- Use a caries disclosing solution
- After caries is clean apply a sectional matrix appropriately
- Use 37% orthophosphoric acid as an etch solution for 20-30 seconds or as recommended by the manufacturer and recent dental material research
- Wash and dry very well
- Apply the unfilled resin to the dentine and enamel - cure for 20 seconds every 2mm increments
- Apply packable resin - cure for 20 seconds
- Polish apropriatley
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
Would you retake this OPG?
We always want to follow the ALARA principles.
But if the concern is to understand the overall periodontal health or have an understanding of a specific lesion - you might consider to retake the image.
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)
Why is the object in the ghost image appears higher?
Because of the negative nature of the angle at which the beam is pointed.
Please give a differential diagnosis to this blue lesion using surgical sieve
Developmental - Oral melanotic macule
Inflammatory - Smoker melanosis
Infective - Amalgam tattoo
Hyperplastic - Mucsal melanocytic naevus
Hormonal
Neoplastic - Oral Squamous Cell Carcinoma, Malignant Melanoma
What is the status of the pulp if the pulp sensebility test came back with no response?
No response = non-vital pulp or false- negaitve
What is the status of the pulp if the sensibility test came back with a mild response?
Mild response = normal pulpal health
What is the status of the pulp if the sensibility test came back with a strong bu brief response?
Strong but brief response = reversible pulpitis
What is the status of the pulp if the sensibility test came back with a strong but lingering response?
Strong but lingering = irreversible pulpitis
What are some of the causes of false negatives during pulpal sensibility testing?
- Calcified canals
- Immature apex
- trauma
- Premedication of the patient
When would you do a pulp test?
- Prior to restorative dental treatment
- Prior to root canal therapy
- Following trauma to teeth
- Prior to other dental treatment
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
What is the role of sodium alginate in alginate material?
Sodium alginate forms a hydrogel former
What is the role of calcium sulphate dihydrate in alginate material?
It provide calcium ions
What is the role of sodium phosphate in alginate material?
It controls working time - acts as a retarder of the rapid use of calcium within the reaction
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 is the purpose of methylparabens in LA solution?
They act as an antibacterial preservative?
What is the purpose of bisulphote in LA solution?
They act as an anti-oxidant for the vasoconstrictor
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
What nerve innovate the upper molars?
The posterior superior alveolar nerve
What nerve innovates the upper premolars?
The middle superior alveolar nerve
What nerve innovates the anterior upper teeth?
The anterior superior alveolar nerve
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..
What does informed consent include?
- Alternatives and all options for treatment
- Information surrouding the nature and what the treatment involves
- Risks of treatment
- Pros and Cons of treatment and No intervention
- Cost of treatment
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
E.g. Periodontitis; generalised, Stage III, Grade C, currently unstable. Risk factors: smoking 20cig/day
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.
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 perform indirect pulp capping?
- Do normal steps of caries removal BUT do not remove all of the infected dentine
- When try to remove as much infected as possible, slowly, preferably not using a power headpiece with leaving a small layer at the bottom of the cavity prep
- Using RMGIC or GIC base cover the cavity, incrementally, ensuring THERE IS APPROPRIATLEY CORONAL SEAL
- Reduce the RMGIC and replace with Resin
- Tell the patient they might experience sesativity in the tooth, thus might needs to take some NSAIDS -recall in 3 months for re-examination if the tooth remains asymptomatic
What are the potential causes of reaction to LA for a patient with dental anxiety?
Patient causes: panic attack due to hyperventilation and dental anxiety
Operator: Intravascular injection
Or Both at the same time
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
If a GP point is present in a radiograph, what intraoral signs will you experience?
- Draining sinus
- Non-responsive to sensibility test
- Tenderness to percussion
- Tooth mobility
- Tenderness to apical palpation
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 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
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 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 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 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 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?
- Senssile 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 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 is the classification of streptococci?
- Alpha - patial lysis of red blood cells
- Beta - complete lysis or red blood cells
- Gamma - no haemolysis
How do we differentiate between S.Aureus and S.Epidermidis (associated with hospitals)?
Coagulase test - extra-cellular protein that binds to prothrombin - coagulation only occurs with S.aureus
What stain can we use to stain M.Tuberculosis?
Acid-fast stain can be used - the TB will be seen in red
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
