HMCS Dental review Flashcards
What are the two line of defenses?
-Salivary amylase initiates the breakdown of starch.
-Lingual lipase breaks down triglycerides into fatty acids.
Is the hard palate keratinized or non-keratinized?
Keratinized
What are examples of non-keratinized areas of the mouth?
-Soft palate
-Floor of mouth
-Cheeks (buccal)
What are the three regions of the tooth?
-Crown
-Neck
-Root
What is the most visible region of the tooth?
-The crown
What is the area on the neck of the tooth where the enamel and cementum meet?
-Cementumal Enamel Junction (CEJ)
What is the hard white outer layer of the tooth?
-Enamel
What part of the tooth gives it basic shape and rigidity?
-Dentin
The pulp contains what?
-Connective tissue containing blood vessels, nerves, and lymphatic vessels
What is contained within the Attachment Apparatus?
-Cementum
-Periodontal ligaments
-The alveolar process
How many different types of teeth do we have and what are they?
-1.Incisors
-2.Canines
-3.Premolars
-4.Molars
What are the most posterior molars called?
-Wisdom teeth
How many teeth does an adult with all their teeth have?
-32
Most people in the military have how many teeth?
28
What tooth is tooth number one?
-Maxillary right third molar
What tooth is tooth number seventeen?
-Mandibular left third molar
What tooth is tooth number thirty-two?
-Mandibular right third molar
What is the only movable skull bone?
-Mandible
What is the only nerve associated with dental?
-Cranial Nerve V: Trigeminal
The cranial nerve comprises of what?
The lingual nerve
What does medial mean?
-Towards the midline
What does distal mean?
-Away from the midline
What anesthetic do you use for someone in pain on the ship and why?
-0.5% Bupivacaine /Marcaine because it lasts longer
Local infiltration is deposited where?
-At or near small terminal nerve endings in the immediate area of treatment. (The tooth that affected)
A regional block is deposited where?
-Near a major nerve trunk at a greater distance from the area of treatment, which provides wider areas of anesthesia.
Why do you use the tooth block (oral nerve block)?
-It reduces the need for oral analgesics
What are indications for an IA block?
-Fracture repair
-Removal of teeth
-Pain control
-NOT POSTOPERATIVE CARE
When you’re giving an IA block your target site is called what?
Lingula (a small bony bump about halfway back on the inner ramus of the mandible, where the inferior alveolar nerve enters the jaw)
When placing the barrel you place it opposite of what?
-Place barrel of syringe in commissure of mouth opposite to the site of injection. (Over the bicuspid on the opposite side)
What is the treatment for a tooth concussion?
Usually no treatment is required.
What is the most common cause of subluxation?
-Trauma
What is subluxation?
-Loose tooth
What is the treatment for subluxation?
-Gentle manipulation to make sure tooth is all the way in socket.
-Splint if necessary
Pt complains of pain and mobility after playing basketball, no visible displacement, what is the diagnosis?
-Subluxation
Avulsion is what?
-A traumatic injury where the tooth has been removed from the socket
What is the time frame to replace a tooth back in the socket?
-30 minutes to 1 hour
If re-implantation is unsuccessful what do you place the tooth in?
-Hank’s solution, milk, saline, or saliva (the patient’s mouth)
What do you not want to put a tooth in?
-Water
If your patient has an avulsed tooth what are you going to do for the patient?
Give them an IA (intraoral nerve block)
What anesthetic is used for an IA?
Bupivacaine /Marcaine
What are indications for an intraoral nerve block?
-Whenever anesthesia is desired in a fairly small anatomic area
-For laceration repair
-For incision and draining
-For oral pain management
-For repositioning/inserting traumatized teeth
-For teeth extraction
What are the different types of tooth fractures?
-Affect only the enamel (superficial)
-Expose the dentin
-Expose the pulp
-Include the root
If the fracture involves only the enamel what does the patient notice? What do you do for the patient?
-Patients notice rough or sharp edges but are asymptomatic.
-Treatment involves smoothing out the edges
If dentin is exposed but not the dental pulp, patients usually exhibit sensitivity to what?
-Cold air and water
What it the treatment for exposed dentin?
Drill and fill. Treatment consists of restoration of the tooth by a composite (white filling) or, if the fracture is extensive, a dental crown, to cover the exposed dentin
Is SIQ required for a dentin fracture?
-No
How can you tell if the pulp is exposed?
-Bleeding from the tooth
What is the treatment for pulp exposure?
-Root canal
Is SIQ needed for any tooth fractures?
-No
What do you do for a mandibular fracture?
Immobilize jaw and refer to dental
Inflammation of the dental pulp is called what?
-Pulpitis
What is pulpitis caused by?
-Carries/cavities not taken care of or carries/cavities redone multiple times (multiple restorations)
-Trauma
What is the treatment for pulpitis?
-Removing the decay
-Restoring the damaged tooth
-Sometimes performing root canal therapy or extracting tooth (last resort)
What is the primary symptom of pulpitis?
-Pain
In reversible pulpitis, pain occurs when what is applied to the tooth?
-Cold, sweets, or percussion
In reversible pulpitis when stimulus is removed how long does it take pain to cease?
he pain ceases within 1 to 2 seconds.
If the pain is longer than 1 to 2 seconds after stimulus is removed what is it?
-Irreversible pulpitis
-The pain may then cease for several days because of pulpal necrosis.
In irreversible pulpitis the tooth is sensitive to what?
-As infection develops and extends through the apical foramen, the tooth becomes exquisitely sensitive to pressure and percussion.
What is the most appropriate action for the IDC to take for pulpitis?
-Refer
Infectious sequelae of pulpitis includes what (most sever to least)?
-Osteomyelitis of the jaw
-Apical periodontitis
-Periapical abscess
Spread from mandibular teeth may cause what?
-Ludwig’s angina
If the patient has an infected molar and the floor of the mouth is nice and firm what does the patient have?
-Ludwig’s angina
Every time root canal therapy is done what should also be done?
-Put a crown on that tooth
What is a periapical abscess also known as?
-Apical abscess
Where is a periapical abscess located?
-At the apex of the tooth
What does a patient present with if they has a periapical abscess?
-Fluctuant swelling of the mucuosa that extends to the cheek but more severe.
What does this picture represent
Periapical/apical abscess
Where is a periodontal abscess located?
-Around the tooth
The initial treatment plan for a periapical abscess is what?
-Drainage via I & D
-Refer to dental for a root canal therapy or tooth extraction (last resort)
What do you see on a patient the presents with gingivitis?
-Swelling, redness, plaque (typically), bleeding of gums when touching, discomfort
-(Discomfort from the superficial gingival pain)
How does normal gingiva present?
-Firm, tightly adapted to the teeth, and contoured to a point. Keratinized gingiva near the crown is pink stippled tissue.
What is the main cause of gingivitis?
-Poor oral hygiene
Periodontal pockets contain what?
Bacteria that may cause both gingivitis and root caries
What is a secondary role to gingivitis?
-Faulty dental restorations and xerostomia
Chronic gingivitis will lead to what?
-Periodontitis.
What is Primary Herpetic Gingivostomatitis?
-A common, mild, self-limiting, viral infection of the mouth.
A viral infection has was intervention?
-Has no intervention
What are the prodromal symptoms of Herpatic gingivostomatitis?
Fever, cervical lymphadenopathy, and malaise
How does Herpatic gingivostomatitis present?
Numerous pin-head vesicles which rupture and ulcer on the perioral skin
-Severe and painful gingivitis with difficulty eating.
What is the treatment?
-Self limiting
-Heals spontaneously in 7-14 days
What can be prescribed for severe cases to speed up recover time?
-Acyclovir 200-800 mg five times daily for 7-14 days
What is the ratio for magic mouth wash?
-1:1:1
-2% viscous lidocaine (most important part and numbs the mouth)
-Liquid diphenhydramine
-Kaopectate or Maalox
What is Recurrent Herpes Simplex?
Common, mild, self-limiting re-manifestation
What is Herpes Labialis also known as?
-“cold sores” or “fever blisters”
What are the prodromal symptoms for recurrent?
Pain, burning, tingling, itching in areas where vesicles develop.
Where are herpes labialis normally found?
-Vermillion border and/or commissure of lips.
What is the treatment for recurrent herpes?
-Topical antivirals
NUG is also known as what?
trench mouth” and “Vincent’s Angina.”
How does NUG present?
-Acute, painful infection of the gums brought on by opportunistic Fusobacteria.
-Immunosuppression causes low WBC count
NUG appears as what?
-Punched-out appearance
-Foul breath
-Rapid onset
What is the treatment for NUG?
-Magic mouth wash
-Then a gentle debridement 24-48hrs after using magic mouthwash
What’s another name for Oral Candidiasis?
-Thrush
What is thrush caused by?
-Yeast and fungus
What is the treatment of thrush
-Fluconazole 100 mg x 7 days
How does thrush present?
-White “curdled milk” or “cottage cheese” like build up on dorsum of tongue, soft palate, or oropharynx.
Aphthous ulcers are also known as what?
-“canker sores”
-Recurrent Aphthous Stomatitis (RAS)
What may a patient with Aphthous ulcers complain of?
-Prodromal burning or itching.
How do Aphthous ulcers present?
-¼ to 6mm round ulcerations with yellow-gray fibrinoid centers surrounded by red halos (caused by erythema).
What is the treatment Aphthous ulcers
-Self healing, 10-14 days
-Topical corticosteroids
Temporomandibular disorders (TMD) is an umbrella term for what?
-Conditions producing dysfunction of the jaw joint or pain in the jaw and face
What is Internal Joint derangement?
Anterior misalignment of the articular disk above the condyle.
What is Infectious arthritis?
Traumatic arthritis, osteoarthritis, RA, and secondary degenerative arthritis can affect the TMJ.
What is Condylar Hyperplasia?
A disorder of unknown etiology characterized by persistent accelerated growth of the condyle.
What is Condylar Hypoplasia?
A facial deformity caused by a short mandibular ramus.
What is the treatment for TMD?
-NSAIDS
-Splint
-Refer to dental
Benign migratory glossitis is also known as what?
-Geographic Tongue
Where is geographic tongue found
-Migrates and doesn’t always look the same
-Dorsum and edges of tongue.
How does geographic tongue present?
-Often resembles a map
-Usually asymptomatic but may be associated with burning when eating spicy or acidic food.
What is Hairy Tongue?
-Dark, elongated filiform papillae, stained by chromeogenic microorganisms
How do you treat hairy tongue?
-Good oral hygiene
Mucus retention cyst is also known as what?
-“mucocele”
What causes a mucocele?
Occurs as a result of a ruptured or obstructed minor salivary gland.
Caries is also known as what?
-Cavities
What is the most common source of tooth pain?
-Dental caries
Pulpitis can results from what?
Untreated dental caries
Focal erythema, swelling, and fluctuance, with a possible sinus tract (fistula) would suggest what?
A periapical abscess or periodontal abcess
What is Pericoronitis?
-infected gingiva that results as bacteria is trapped over a partially erupted tooth, usually 3rd molars.
A patient presents after a dental extraction and it keeps bleeding what do you do?
-Apply direct pressure
What is the primary treatment of caries?
-Drill and fill
How long can temporary fills be left in place?
Filling may be left in place 6 to 10 weeks
What is the most common material used for fillings?
Silver amalgam
How long do silver amalgam fillings last?
-Average of 14 years
-However, with good oral hygiene and if placed with use of a rubber dam for isolation from saliva, many amalgam fillings last > 40 yr.
Why do we like using amalgam?
-Because composite shrinks (white filling) and amalgam (silver) does not
Glass Ionomers provide the same aesthetics as what?
As composites, but without shrinkage.
What do Glass Ionomers release into the tooth?
Slowly release Fluoride
Intermediate Restorative Material (IRM) contains what?
-Eugenol to relieve pain
-Also easy to remove or re-contour
Glass ionomers also known as Fuji are good for what
Bonding splints
What is Dycal used for?
-Used to temporarily re-bond a prosthetic.
If you have a patient that keeps coming in and getting cavities what are you going to promote?
Oral hygiene
If a patient is dental class 2 what is the status?
-Current Dental Exam (within 12 months)
-Routine treatment needs that can be delayed for 12 months
-Worldwide deployable
Intrinsic teeth staining (yellow) is a result of what?
Necrotic pulp, certain medications, or high fever during tooth development
Extrinsic staining (brown/black) is a result of what?
Tobacco, wine, beetle nut
Tobacco can also cause what?
Xerostomia, or lack of saliva production which leads to higher caries.
What can vasoconstriction lead to?
Gingival recession and eventual tooth loss.
What is a primary cause of gingival recession?
vasoconstriction
Throat, mouth, and lip cancer can be caused by what?
Tobacco
BUMEDINST 6200.12A is what?
Tobacco Cessation
When can calculus occur?
Can occur in as little as 24 hours, or several days/weeks.
How long is tooth brushing recommended for?
-2 minutes
Halitosis is a result from what?
An underlying medical condition such as liver failure or ketoacidosis.
What is the treatment for halitosis?
Most halitosis can be reversed with good oral hygiene to include flossing. Mouth rinses and sugar-free chewing gum can assist. Halitosis may take up to 48 hours to resolve.
What the purpose for an emergency dental exam?
-The patient is having pain
-IDC should examine the area of pain
A patient presents with white sores and redness the redness cannot be scraped off, what do you do?
-Refer
Is dental class 3 deployable?
-No
If a patient presents with pain and clicking in jaw what do you do?
-Refer to dental
