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Dentistry Year 2 Term 2 > Jenna Judd > Flashcards

Jenna Judd Flashcards

1
Q

During what weeks in embryology does the basic face develop

Fusion of What 5 processes are involved

A

4-10 weeks in utero

Frontonasal prominence
Maxillary process x2
Mandibular process x2

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2
Q

What embryological features form the primary palate

When does the primary palate form

What does the primary palate extend posteriorly to

A

Fusion of the two medial nasal prominences

Forms towards end of week 5 in utero

Incisive foramen

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3
Q

What is the process of development of primary palate

4 steps

A
  1. Week 4- frontonasal, maxillary and mandibular processes form
  2. End of week 4 endothelial thickenings form on frontonasal process making the nasal placodes
  3. Week 6- epithelium of nasal placode invaginates to form nasal pits dividing frontonasal prominence into medial and lateral frontonasal processes
  4. End of week 6 medial nasal processes merge with each other and maxillary process to form upper lip and primary palate
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4
Q

What weeks does the secondary palate develop

A

Weeks 6-10 in utero

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5
Q

What happens during stage 1 of secondary palate formation

When does this happen

A

Week 6

Paired palatal shelves form from maxillary process and are orientated vertically separated by developing tongue

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6
Q

What happens during stage 2 of secondary palate formation

When does this happen

A

Week 7
Palatal shelves elevate to horizontal position above tongue
Palatal shelves contact each other but are separated by epithelium

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7
Q

What happens during stage 3 of secondary palate formation

When does this happen

A

Week 10
Medial edge epithelium of palatal shelves fuse to form midline palatal seam which degenerates to allow palate to be composed of a continuum of mesynchyme

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8
Q

What is the occurance rate of CLP

What side is CLP most common

What gender is cleft lip with or without cleft palate more common in

What gender is cleft palate on its own most common in

A

1 in 700 births

Left

Male

Female

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9
Q

What causes cleft lip

What are the following types of cleft lip caused by

Oblique facial cleft
Median cleft lip
Bilateral cleft lip
Mandibular cleft

A

Failure of fusion of medial nasal prominence and maxillary process

Oblique facial cleft- lack of fusion between maxillary and lateral nasal prominence
Median CL- lack of fusion between two medial nasal processes
Bilateral CL- lack of fusion between maxillary and two medial nasal processes
Mandibular cleft- lack of fusion of first brachial arches or malformation of the symphysis

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10
Q

What causes cleft palate

What can cleft palate result from
5

A

Cleft palate occurs when palatal shelves fail to fuse in the midline

  1. Cleft lip distorts development and stops palatal shelves fusing
  2. Failure of shelves to contact due to lack of growth or elevation
  3. Failure of epithelial breakdown following shelve contact
  4. Rupture after fusion of shelves
  5. Defective merging and consolidation of mesenchyme of the shelves
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11
Q

Where does closure of secondary palate initiate

What is indicative of interference at the start of palate closure
What is indicative of interference part way through palate closure

A

Closure of palate initiates anteriorly then moves posteriorly

Full clefting
Partial clefting

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12
Q

What are the oral manifestations of CLP

5

A 
Hypodontia
Microdontia
Abnormal tooth shape
Delayed eruption
Enamel defects
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13
Q

What is the human genome

When was the two initial drafts published

When was the final sequence published

A

The human genome is the complete set of nucleic acid sequences for humans encoded as DNA within the 23 chromosome pairs in cell nuclei and mitochondria

2001
2003

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14
Q

What is monogenic inheritance

Autosomal dominant
Autosomal recessive
X linked

What are some examples of monogenic conditions
3

A

Inheritance of a trait through one gene

Autosomal dominant- always expressed if present
Autosomal recessive- only expressed if two copies of the allele present
X linked- carried on x chromosome so carried by females and manifested in males

Cystic fibrosis
Sickle cell
Duchenne muscular dystrophy

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15
Q

What is cystic fibrosis

How many carry the gene

What is its inheritance pattern

What is the genetic cause of CF

A

CF is an autosomal recessive disorder that causes severe lung damage due to abnormalities in mucus secretion causing thick sticky mucus, is is progressive , required daily care and reduces life expectancy

1 in 25

Often present as single isolated case in absence of family history

Delta F 508 mutation in the CFTR gene - deletion of 3 bases
CFTR is a chloride ion transporter that helps make mucus which cannot fold properly with missing F so misfolded CFTR held in ER and degraded

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16
Q

What are the treatments of CF

Mucolytics
Antibiotics
Bronchodilators
New drug therapy (2)

A

Mucolytics - dornase alpha

Antibiotics- antibiotics for chest infections

Bronchodilators - beta 2 agonists (salbutamol), anticholinergics, theophylline

New drugs
Lumacraftor- corrects misprocessing of CFTR so more gets to cell surface
Ivacraftor- increases CFTR channel opening to increase chloride transport

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17
Q

What is sickle cell disease

What are the genetic causes

A

Sickle cell is an autosomal recessive disorder causing pain attacks, anaemia and organ damage as RBC misformed so become trapped

Caused by missence non conservative substitution mutation in which one base is changed in beta globulin gene
Glutamate (hydrophilic) replaced with valine (hydrophobic)
This change in AA sequence causes haemoglobin molecules to crystallise at low blood oxygen levels so RBCs sickle

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18
Q

What is Duchenne muscular dystrophy

What is the genetics

What is the inheritance pattern

A

Duchenne muscular dystrophy is a recessive x linked disorder causing progressive weakness and loss of muscle mass shortening life expectancy to mid 20s

X linked mutation in dystrophin gene making it non functional
Dystrophin connects cytoskeleton of muscle fibre to ECM for integrity

Carried by females and effects boys in a family

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19
Q

What is mitochondrial disease

What new therapy can be used to prevent mitochondrial disease

A

Mitochondrial disease is a multifactorial inherited disease carried by mother in the mitochondrial DNA causing compromised energy production so muscles don’t work properly

Donor egg cell combined with mothers nucleus and fathers sperm

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20
Q

What is the relationship between HER2 gene and breast cancer

What is a treatment for HER2 positive tumours and MOA

A

HER2 gene is involved in cell division, is some breast cancers HER2 is over expressed leading to uncontrolled cell division

Trastuzamab (Herceptin) : binds to HER2 causing cell cycle arrest

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21
Q

What is the MOA of penicillin

ADME

What are common side effects of all penicillins
6

A

Penicillins are a beta lactam bactericidal and act by interfering with bacterial cell wall synthesis by inhibiting cross linking of cell wall leading to lysis

They diffuse well into body tissues and fluids but penetration into cerebrospinal fluid is poor except when meninges are inflamed, they are excreted in urine in therapeutic concentrations

Diarrhoea, hypersensitivity, nausea, vomiting, skin reactions, thrombocytopenia

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22
Q

Benzylpenicillin
MOA

ADME

Common side effects
2

A

Narrow spectrum bactericidal against gram + bacteria
Ineffective against many infections as most staph aureus bacteria now produce beta lactamase

A: IV or IM due to poor oral absorption as broken down by low stomach pH
M: 16-30% IM dose metabolised to penicilloic acid and small amounts to 6 aminopenicillanic

Fever, jerisch herxheimer reaction

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23
Q

Phenoxymethylpenicillin (Penicillin V)

MOA

ADME

Oral indications

A

Narrow spectrum bactericidal against gram + bacteria
Ineffective against many infections as most staph aureus bacteria now produce beta lactamase

A: usually administered orally as acid stable
M: 35-70% oral dose metabolised to penicilloic acid which is an inactive metabolite with small amounts metabolised to 6 aminopenicillanic acid

Dental abscesses

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24
Q

Flucloxacillin

MOA

A

A beta lactamase resistant bactericidal drug against gram + bacteria
Altered structure prevents inactivation by resistant bacteria producing beta lactamase

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25
Amoxicillin MOA ADME Dental implications (2)
Amoxicillin is a broad spectrum bactericidal drug against gram + and some gram -ve bacteria It is inactivated by beta lactamase producing gram positive bacteria A: oral route M: metabolised to 7 metabolites in liver E: kidneys Dental abscess, pericoronitis
26
What is co amoxiclav | MOA
Co amoxiclav is a combination of amoxicillin, a beta lactam antibiotic and potassium clavulanate which is a beta lactamase inhibitor
27
What is MOA of aminoglycosides What are they used to treat CI (2)
Aminoglycosides are broad spectrum protein synthesis inhibitors which prevent elongation at 30s ribosomal subunit leading to inaccurate mRNA translation Used to treat gram -ve infections Can be nephrotoxic and ototoxic
28
What is the MOA of tetracyclines What impacts its oral absorption When is tetracycline CI What tetracycline can we prescribe for sinusitis
Tetracyclines are broad spectrum bacteriostatic antibiotics that bind reversibly to 30s ribosome subunit blocking aminoacyl tRNA to prevent translation, they also inhibit MMPs Absorption impaired when taken with calcium, magnesium or aluminium salts Under 12, pregnancy Doxycycline
29
What is the MOA of macrolides What is it effective against What negative side effect can they cause What are the CIs (2) What macrolide can be prescribed for dental abscess
Macrolides are broad spectrum bacteriostatic antibiotics that bind to ribosomal 50s subunit to prevent translocation Gram +ve and limited gram -ve infections Electrolyte disturbances Statins, pregnant or breastfeeding Clarithromycin
30
What is the MOA of lincosamides What are they effective against Which lincosamide can we prescribed for dental abscess
Lincosamides inhibit bind to 50s subunit of bacterial ribosome and prevent translocation thus inhibiting protein synthesis Gram +ve aerobes Clindamycin
31
Metronidazole MOA ADME Dental indications Contraindication (1)
Metronidazole inhibits nucleic acid synthesis by interacting with DNA causing loss of helical structure It is reduced to its active intermediate only in presence of anaerobic bacteria and acts against gram - anaerobes and protozoa A: oral or enteral route- well absorbed and widely distributed including to saliva M: hepatic hydroxylation, oxidation and glucaronidation to 2-hydroxymetronidazole E: 60-80% kidney, 6-15% feces Dental abscess, pericoronitis Alcohol- disulfriram like reaction
32
What are the symptoms of disulfiram like reaction | 3
Nausea, vomiting, tachycardia
33
What are the three theories of antibiotic resistance
1. Bacteria acquires genes encoding enzymes like beta lactamase which hydrolyses beta lactam ring of antibiotic 2. Bacteria acquires efflux pumps that eject antibiotic from cell 3. Bacteria acquire genes that alter their cell wall so no antibiotic binding site
34
What percentage of patients have penicillin allergy What percentage of patients have severe immediate hypersensitivity reaction What are the most common hypersensitivity reactions to penicillin
1-10% 0.5% Type 1: immediate (anaphylaxis) Type 3: immune complex mediated
35
What is the MOA of polyenes What are the two polyenes used in dentistry
Fungicidal by cell membrane disruption Interfere with biosynthesis of ergosterol causing generation of pores in membrane, cytoplasmic leakage and cell death Nystatin Amphotericin B
36
What are the MOA of azoles What are the 2 azoles relevant to dentistry What are their CIs (2)
Fungistatic by inhibition of ergosterol synthesis Prevents fungi growth by inhibiting biosynthesis of ergosterol by interfering with enzyme lanosterol demethylase Fluconazole Miconazole Warfarin, statins
37
What is the MOA of aciclovir ADME Dental implications (3)
Aciclovir is a nucleoside analog that inhibits the action of viral DNA polymerase and DNA replication in herpes virus A: usually given orally - low bioavailability 10-20% M: metabolised by alchohol dehydrogenase and aldehyde dehydrogenase E: 90-92% excreted unchanged in urine Shingles, cold sores, primary herpetic gingivostomatitis
38
What is the MOA of chlorhexidine What is chlorhexidine effective against (4) Absorption Dental indication
OTC broad spectrum antimicrobial used as topical antiseptic for inflammatory conditions in dentistry Disrupts microbial cell membranes as positive chlorohexadine molecules react with negatively charged phosphate groups on microbial cell wall - bacteriostatic at low conc, bactericidal at high conc Gram +, gram -, yeast, viruses 30% active ingredient remains in mouth after rinsing which is released into oral fluids Primary herpetic gingivostomatitis
39
Candida albicans Is it gram -ve or +ve How many people have c albicans as an oral commensal What percentage of oral yeasts does it account for What are the 4 main forms and function of each What is its mechanism of pathology
Gram +ve 35-55% 80% Budding yeast like cells- easily spread to new sites Pseudohyphae Germ tubes True hyphae- epithelium invasion Opportunistic pathogen
40
What are the innate immune systems response to candida infection (2) What is the adaptive immune systems response to candida infection (1)
Antimicrobial peptides- found in saliva or produced by epithelial cells Micro abscesses- collections of neutrophils form in epithelia due to candida infection Cell mediated response
41
What are the symptoms of acute pseudomembranous candidosis (thrush) What are plaques composed of Aetiology Treatment 3
Creamy lightly adhered plaques over an erythematous oral mucosa usually on cheek palate or oropharynx which can be scraped off leaving a raw erythematous base. Usually cause discomfort, burning, bad taste Plaques composed of desquamated epithelial cells and candida hyphae Affects 5% newborns and 10% elderly debilitated individuals Fluconazole, miconazole, nystatin
42
What are the symptoms of acute erythematous stomatitis (antibiotic stomatitis) Cause Treatments 2 categories
Red shiny atrophic appearance sometimes with coexisting thrush, painful and exacerbated by spicy food Opportunistic infection following use of broad spectrum antibiotics, inhaled steroids, HIV and xeristomia Elimination of cause: spacer, rinse mouth after inhaler use Antifungals: fluconazole, miconazole, nystatin
43
What are the symptoms of chronic hyperplastic candidosis (candidal leukoplakia) Aetiology Why is eradication difficult Treatment 3
White patch on buccal mucosa bilaterally or on dorsum of tongue that cannot be removed by scraping. It is associated with increase risk of malignant change. Usually asymptomatic Usually seen in middle age male smokers, also associated with iron, folate, B12 deficiency Candida hyphae present in superficial layers of epidermis Smoking cessation, fluconazole, surgical excision
44
What are the symptoms of chronic erythematous stomatitis (denture stomatitis) Aetiology Causes 6 Fungi prevalence% (3) Treatment 3 categories
Redness of palate under denture bearing area with petechial whitish areas, usually symptomless 30-60% denture wearers, females:males 4:1 Causes: poor denture hygiene, over use of dentures, iron and vitamin deficiency, steroids, xerostomia, high sugar diet C albicans 90% Other candida spp 9% Other 1% Denture care- ease wear, hygiene, new dentures Diet- reduce sugar intake Antifungals- miconazole gel
45
What are the symptoms of chronic muco cutaneous candidosis Cause Treatment
Oral candida lesions alongside cutaneous and nail lesions An immune defect syndrome in which T lymphocytes fail to produce cytokines required for immunity against c albicans Fluconazole
46
What are the symptoms of angular cheilitis What are some precipitating factors 4 What are the fungal causes % (3) Treatment 2
Red cracked macerated skin at angles of mouth with gold crust Trauma, inadequate vertical dimension of denture, iron deficiency, B12 deficiency Candida albicans 20% C albicans and staph aureus 60% Staph aureus 20% Miconazole cream, FBC and haematinics
47
What are the symptoms of median rhomboid glossitis Aetiology Treatment
Form of denture stomatitis affecting dorsum of tongue creating well demarcated symmetrical red patch in posterior midline of ant 2/3 of tongue which may be raised or smooth, usually asymptomatic and accompanied by loss of filiform papilla Seen in patients using steroid inhalers and smokers Antifungals if symptomatic but cant improve appearance
48
Lymphocyte Appearance Function
Spherical with large nucleus occupying most of vol | Adaptive immunity: T cells attack other cells, B cells release antibody, NK cells attack cells and bacteria
49
Neutrophil Appearance Function
Multi lobed nucleus | First responders, phagocytosis, release cytotoxic chemicals via granules
50
Mast cell Appearance Function
Contain histamine and heparin granules | Dilate blood vessels, induces inflammation, recruits macrophages and neutrophils, type 1 hypersensitivity reaction
51
Basophil Appearance Function
2 lobed nucleus with dense granules | Releases histamine granules to promote inflammation, parasite defense
52
Eosinophil Appearance Function
2 lobed nucleus with granules | Phagocytic particularly on antigen antibody complexes, antihistamine release, toxin release
53
Monocyte Appearance Function
Large cell with horse shoe nucleus | Phagocytosis, antigen presentation
54
Macrophage Appearance Function
Large cell with single round nucleus | Phagocytic, stimulates other immune cells
55
Dendritic cells Appearance Function
Cells with dendritic processes | Present antigen on surface to trigger adaptive immunity, located in epithelia then migrate to LN when activated
56
Statins (atorvastatin, simvastatin) What key condition are they prescribed to treat MOA Dental relevance
Management of CV disease Competitively inhibit HMG CoA reductase involved in cholesterol synthesis Statins cant be taken with fluconazole, miconazole, clarithromycin
57
Calcium channel blockers (amlodipine) What key condition are they prescribed to treat MOA
CV disease Calcium channel blockers interfere with inward movement of calcium ions through slow channels of cell membrane, this increases relaxation of muscles to reduce vascular tone
58
ACE inhibitors (rampril) What key condition are they prescribed to treat MOA
CV disease ACE inhibitors interfere with RAA system by inhibiting ACE preventing the conversion of angiotensin 1 to angiotensin 2 leading to decreased blood pressure by decreased water retention and vasodilation
59
Adrenergic blockers / beta blockers (bisoprolol) What key condition are they prescribed to treat MOA Dental relavance
CV disease Block affects of adrenaline so heart beats slower and vasodilation occurs Avoid using lidocaine with bisoprolol
60
Anti platelets (aspirin) What key condition are they prescribed to treat MOA Dental relevance
CV disease Irreversible COX inhibitor, this inhibits platelet aggregation by preventing formation of thromboxane A2 Cannot prescribe diclofenac or aspirin to patients on low dose aspirin
61
What is levothyroxine prescribed to treat | MOA
Thyroid disease Synthetic form of thyroxine acting as replacement
62
What is omeprazole prescribed to treat MOA dental relevance
Acid reflux Omeprazole is a proton pump inhibitor which inhibit gastric acid secretion by blocking proton pumps of gastric parietal cells Proton pump inhibitors such as lansoprazole or omeprazole should be prescribes with NSAIDs in patients with peptic ulcer disease
63
What Metformin prescribed to treat MOA
Diabetes (type 2) Metformin decreases gluconeogenesis and increases peripheral glucose use but only acts in presence of naturally produced insulin so patient must have some functioning pancreatic islet cells remaining
64
What are tricyclic anti depressants used to treat (amitriptyline) MOA Dental relevance
Depression Block reuptake of serotonin and noradrenaline in presynaptic terminals so higher conc in synaptic cleft Should not use LA containing adrenaline on patients on TCAs
65
What are selective serotonin reuptake inhibitors used to treat (sertraline, citalopram) MOA
Depression SSRIs block reabsorption of serotonin into neurones
66
What is the key reliever used in management of respiratory disorders What colour is the inhaler MOA
Salbutamol - bronchodilator Blue Salbutamol activates beta 2 adrenergic receptors leading to activation of adenyl cyclase causing increased cAPM which lowers calcium conc resulting in bronchodilation
67
What is the key preventer used in management of respiratory disorders What colour is the inhaler MOA Dental relevance
Beclometasone - corticosteroid Red/brown Beclometasone mediates anti inflammatory actions by increasing transcription of genes coding for anti inflammatory proteins and suppressing inflammatory gene expression Diclofenac CI in patients on beclometasone

Dentistry Year 2 Term 2 (4 decks)

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