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REVISION BDS > Key > Flashcards

Key Flashcards

1
Q

3 roles of epidemiology

A

measure the amount of disease

measure distribution and naturual history of disease

assess people’s risk of disease, health care needs assessment and service planning

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2
Q

prevalence

A

number of disease cases in a population at a given time

estimates obtained from a cross sectional studies adn derived from registers

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3
Q

incidence

A

number of new disease cases developing over a specific period of time in a defined population

estimates obtained from longitudinal stides and derived from registers

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4
Q

risk factor

A

factor that increases the probability of disease if removed/absent reduces probability

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5
Q

causative agent

A

external factor that causes/results in disease in susceptible individuals

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6
Q

determinant

A

attribute/circumstance which affects liability of an individual to be expsed to disease

when exposed to, develops the disease

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7
Q

confounding variable

A

minor variable

left uncontrolled

which may or may not affect results

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8
Q

3 types of risk index

A

absolute risk

attrivutable risk

relative risk

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9
Q

absolute risk

A

incidence rate of disaese in those exposed to the agent (assumes no exposure = no risk)

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10
Q

attributable risk

A

difference between incidence rates in exposed and non-exposed groups

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11
Q

relative risk

A

measurement of proportionate increase in disease rates in exposed group

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12
Q

5 methods of fluoride delivery and concentrations

A

Toothpaste

  • 1,000ppmF low risk, under 3
  • 1,500ppmF normal concentration/high risk, under 10
  • 2,800ppmF high risk, over 10 0.619%
  • 5,000ppmF high risk, over 16

Fluoride varnish

  • 22,600ppmF, 5% sodium fluoride
  • 0.25ml for 2-6 years
  • 0.4ml for 6+
  • Twice a year for low risk
  • 4 times a year for high risk

Mouthwash

  • 7+ - must be able to spit
  • 225ppmF

Supplement

Water

  • Ideal 1ppmF
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13
Q

SIMD

A

Scottish Index of Multiple Deprivation

Area based index of multiple deprivation

Statistical tool used to support policy and decision making

Ranks data zone in order of deprivation

  • 1 most deprived
  • Grouped into quantiles (1-5) or deciles (1-10)

Level of deprivation is derived from a number of sources – housing, income, geographic access to services, health education, skills and training, education and crime

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14
Q

consent

A

valid, informed, with capacity, voluntary, not coerced, not manipulated

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15
Q

capacity

A

ability to act (decide)

make a reasoned decision

understand decision

communicate a decision

retain the memory of decision

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16
Q

randomised control trial

A

clinical trial

gold standards for efficacy and effectiveness

4 design elements

  • specification of participants (inclusion/exclusion criteria)
  • control
  • randomisation
  • blinding/masking
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17
Q

cohort study

A

prospective study

establishes group and measures exposure

follows groups over time, identifies those that develop disease/outcome of interest

used for estimative incidence, investigating causes and determining prognosis

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18
Q

case-control study

A

retrospective study

identifies 2 groups - those that develop disase and those that don’t

looks back in time at exposure to a particular risk factor in both groups

looks at potential causes of disease

less robust

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19
Q

absolute risk difference

A

difference in risk between groups

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20
Q

number needed to treat

A

1/ARD

number needed to treat to prevent one pt developing outcome/disaese

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21
Q

confidecence intervals

A

range of values that ARD will take in population

95% of time contains the true mean

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22
Q

value of no difference

A

when ARD=0 or RR(risk ratio)=1

indicates insufficient evidecne for difference between treatment and control groups

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23
Q

signs/symptoms of withdrawl from niccotine

A

irritability

poor concentration

depression/low mood

restlessness

increased appetites

sleep distruption

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24
Q

3 oral side effects of smoking

A

staining

halitosis

nicotinic stomatitis

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25
Q

things to ask about smooking in SH

A

how long have you smoked

what do you smoke

how many do you smoke per day

have you tried quitting before

would you like to quit now

would you like help to quit

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26
Q

types of quitting advice

A

5As – ask, advise, assess, assist, arrange

3As – ask, advice (tailored), act (offer help – signpost)

AAR – ask, advise, refer

ABC – ask, brief cessation advice, cessation advice for those who want it

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27
Q

e-cigs

A

stimulate tobacco smoking through vapourised nicotine delivery, without burning conventional tobacco

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28
Q

benefits of e-cigs

A
  • Cheaper
  • Safer (95%)
  • Generally successful in helping to quit
    • Maintain hand-to-mouth habit
    • Psychosocial aspects
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29
Q

risks of e-cigs

A

unknown long term side effects

not 100% safe

gateway to smoking possible

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30
Q

stroke definition

A

acute focal neurological deficicit due to cerbrovascular disease

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31
Q

risk factors for stroke

A

smoking

hypertension

increased alcohol

hyperlipidaemia

TIA transient ischaemic attacks

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32
Q

3 types of stroke

A

haemorrhage

infarction

embolic

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33
Q

signs/symptoms of stroke

A

face droop (unilateral)

can’t raise and hold arm

speech slurred

FAST

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34
Q

prevention methods for stroke

A

antiplatelets (aspirin)

statins (reduce chloesterol)

stop smoking

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35
Q

management/Tx options

A

Ca channel blocker

thrombolysis/remove clot

oxygen

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36
Q

complications of stroke

A

depends on location and extend of lesion

sensory/motor loss

dysphagia

dysphonia

cognitive impairment

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37
Q

define epilepsy

A

recurrent seizure associated with reduced GABA levels in brain

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38
Q

main types of seizure in epilepsy

A
  • Generalised
    • Tonic clonic
    • Absence
    • Atonic
    • Myoclonic
  • Focal/partial
    • Simple partial
    • Complex partial
    • Simple sensory
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39
Q

tonic clonic seizures

A
  • Prodromal aura
  • Initial tonic (stiff)
  • Clonic (rapid spasms)
  • Post-ictal drowsiness
  • Last 2-4mins commonly
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40
Q

absence seizures

A
  • 5-15secs
  • Loss of consciousness
  • No loss of postural reflexes
  • Individual unaware it has happened
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41
Q

cause and management of acute febrile convulsion

A

raised temp (37oC, pyrexia) commonly children

cool down (antipyretics, cool bath)

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42
Q

causes of seziures

A

idiopathic

CNS disease (tumour, meningitis, encephalitis, stroke)

trauma (head injury)

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43
Q

precipitators of seizures

A

illness

fatigue

stress

infection

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44
Q

epilepsy tx

A

anticonvulsants/anti-epileptics (phenytoin)

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45
Q

emergency seizure tx

A

protect head (cushion)

clear area around them

give O2 (OPA if possible)

if >5mins - consider benzodiazepines (buccal midazolam)

post seizure: reassurance and support

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46
Q

components of fit history

A

last 3 fits

medications and compliance with medications

when fits most likely (morning, tired etc)

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47
Q

status epilepticus

A

single epleptic seizure lasting more than 5 mins or 2 or mroe within a 5 min period without person returning to normal between them

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48
Q

multiple sclerosis

A

progressive demylination of axons (degradation/loss of myelin sheath around axons) leading to reduce nerve conductivity

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49
Q

presentation of multiple sclerosis

A

intention tremor

muscle weakness

paraesthesia

visual disturbance/optic atrophy

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50
Q

motor neuron disease

A

degeneration in spinal cord, affecting bulbar motor nuclei

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51
Q

osteoporosis

A

loss of matrix, secondary loss of mineral

reduced bone mass/ inc bone loss

osteoclastogenesis > osteoblastogenesis

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52
Q

risk factors for osteoporosis

A

age

sex

genes

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53
Q

impact of osteoporosis

A

increased risk of fracture

height loss

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54
Q

preventions for osteoporsis

A

increase peak bone mass

reduce bone loss (HRT, bisphosphonates)

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55
Q

gout

A

acute monoarthropathy affecting single joint (usually great toe)

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56
Q

cause of gout

A

uric acid crystal deposition (increased uric acid levels in blood - due to diet etc)

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57
Q

symptoms of gout

A

pain

inflammation

swelling

red joint

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58
Q

treatment for gout

A

NSAIDs

allopurinol for LT prevention

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59
Q

osteoarthrisitis

A

pain

progressive, degenerative joint disease due to cartilage repair dysfunction

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60
Q

signs/symptoms of osteoarthritis

A

pain

brief morning stiffness

joint swelling deformity

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61
Q

radiographic signs of osteoarthritis

A

progressive loss of PIP and DIP joint space

osteophytes lipping at joint edges

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62
Q

Tx of osteoarthritis

A

NSAIDs

prosthesis for pain

inc muscle bulk around joint

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63
Q

rheumatoid arthritis

A

function affected

autoimmune disease of synovium

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64
Q

types and features of rheumatoid arthritis

A

seropositive (RF present, affects peripheral joints)

seronegative (RF absent, affects central joints)

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65
Q

signs and symptoms of rheumatoid arthritis

A

thumb Z deformity

finger ulcer deviation at MCP joint

symmetrical synovitis of PIP, DIP and MCP

PIP joint hyperextension

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66
Q

Tx of rheumatoid arthritis

A

monoclonal antibodies

methotrexate (DMDs)

NSAIDs

physio and occupational therapy

prostheses for function

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67
Q

dental features of rheumatoid arthritis

A

atlanto-axial instabiltiy

sjorgren’s syndrome

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68
Q

types and features of seronegative arthritis

A

Associated with HLA-B27

Ankylosing spondylitis

  • Arthritis of spinal joints
  • Limited back movement
  • Neck flexion and mouth opening
  • Intermittent lower back pain

Reactive arthritis/reiters disease

  • Conjunctivitis
  • Urethritis
  • Arthritis

Enteropathic arthritis

  • Chronic inflammatory arthritis associated with IBD
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69
Q

sjorgren’s syndrome

A

autoimmune condition affective moisture producing glands

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70
Q

signs and symptoms of sjorgen’s syndrome

A

dry eyes

dry mouth (xerostomia)

vaginal dryness

raynaud’s phenomenon

inc risk of salivary lymphoma and caries

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71
Q

acne vulgaris

A

Features

  • Comedones
  • Papules
  • Pustules
  • Nodules
  • Inflammatory cysts

Pathogen associated P.acnes

Exacerbated by

  • Greasy skin cleaners
  • Some oral contraceptive pills
  • Steroids
  • Some anticonvulsants

Tx

  • Topical
    • Gentle skin cleanser
    • Antibacterial lotion (benzoyl peroxide)
    • Antibiotics
  • Systemic
    • Antibiotics (tetracycline, retinoids)
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72
Q

eczema

A

Where – flexor surfaces of skin

Triggers

  • Weather changes
  • Stress
  • Illness
  • Menstruation

Types

  • Atopic
  • Contact
  • Discoid
  • Gravitational/venous
  • seborrhoeic

Tx

  • topical steroids
  • cotton clothing
  • emoillients
  • soap substitutes
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73
Q

psoriasis

A

dysregulated epidermal proliferation

extensor surfaces of skin

tx

  • vit A derivatives
  • UV
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74
Q

psychiatric disorders

A

neurosis - contact with reality maintained

psychosis - contact with realtiy lost

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75
Q

metal health act (scotland)

when

A

2003

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76
Q

depression

signs and symptoms

A
  • Low mood
  • Loss self esteem and confidence
  • Reduced motivation and interest
  • Lethargy and tiredness
  • Sleep disturbance
  • Early morning waking
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77
Q

3 types of antidepressants

A
  • Tricyclics (TCAs)
    • Dry mouth
    • Weight gain
    • Sedative
  • SSRIs
    • Acute anxiety
    • GI upset
    • Dry mouth
    • Weight gain
  • MAOI (mono amine oxidase inhibitors)
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78
Q

schizophrenia

A
  • Fundamental and characteristic distortions of thinking and perception
  • Relapsing and remitting periods of acute psychosis
  • Possibly due to multifactorial abnormality in dopaminergic neurotransmission
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79
Q

symptoms of schizophrenia

A
  • Auditory hallucinations
  • Delusions of thought control
  • Delusions of thought
  • Delusional perception
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80
Q

tx of schizophrenia

A
  • Antipsychotics (phenothiazines)
  • ECT
  • Psychological therapy
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81
Q

anorexia nervosa

A
  • Dysmorphic body image – think heavier than they are
  • Unhealthy low body weight
  • Either restrictive or binge and purge
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82
Q

bulimia

A
  • Normal weight
  • Binge eating and compensation behaviours (vomiting, laxatives)
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83
Q

route of CNV2 (maxillary)

A

Leaves Base of Skull at foramen rotundum.

tracks down towards the pterygopalatine fossa

  • giving off the pharyngeal branch on its way.

gives off 3 branches around the pterygopalatine ganglion

  • nasopalatine and nasal branches

before continuing its course towards the infra orbital fissure

  • giving off greater and lesser palatine nerves, zygomatic nerve and posterior superior alveolar nerve en route.

At the inferior orbital fissure, the maxillary nerve becomes the infraorbital nerve.

  • It gives off middle and anterior superior alveolar nerves before exiting the infraorbital foramen

terminating as palpebral, nasal and labial branches.

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84
Q

CNV3 (mandibular) route

A

leaves Base of Skull at foramen ovale.

Travels down, giving off the branch to the medial pterygoid and the auticulotemporal branch,

  • before dividing into an anterior and posterior branch.

The anterior branch supplies the remaining muscles of mastication (masseter, deep temporal branches and lateral pterygoid), before terminating as the buccal branches.

The posterior branch divides into the lingual nerve (giving off the chordates tympani) and the inferior alveolar nerve,

  • which also gives off the nerve to mylohyoid before terminating as the mental nerve
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85
Q

stroke neuroanatomy

A

Occurs due to an interruption in the blood supply/rupture of a blood vessel in the brain.

  • Causes loss of blood supply (ischaemia/pressure compresses BVs from haematoma) to certain areas of the brain.

An interruption in the supra-nuclear fibres from the motor areas of the cerebral cortex causes the opposite 2/3 of the face to begin to ‘droop’ due to loss of motor function.

  • affects opposite side of face to hemisphere affect.

Also can’t raise arms.

Only lower 2/3 of face affected (only receives crossed fibres from opposite hemisphere), as upper 1/3 of face receives both crossed and uncrossed fibres (from both hemispheres)

  • upper saves upper
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86
Q

facial palsy

A

due to injection of LA from IDB into parotid gland (to far back, no contact with bone).

LA trapped within the dense tissue, within the capsule of parotid gland, near to where CVII branches/divides and so affects all branches of CNVII

  • affects entire side of face - same side of affected parotid gland
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87
Q

management of facial palsy

A
  • Confirm not a stroke (close eyes, wrinkle forehead, raise and hold arms),
  • explain what has happened,
  • cover affected eye with damp gauze patch,
  • reassure that sensation will return when LA wears off in a few hours - monitor or send home and follow up
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88
Q

muscles of mastication innervation

A

CNV3 mandibular branch of trigeminal nerve

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89
Q

masserter

function

A

elevation and protrusion of the mandible

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90
Q

masseter

origin

A

maxillary process of zygomatic bone (superficial) and zygomatic arch of temporal bone (deep)

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91
Q

masseter

insertion

A

angle and ramus of mandible

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92
Q

temporalis

function

A

elevation and retrusion of mandible

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93
Q

temporalis

origin

A

tamporal fossa and deep part of temporal fascia

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94
Q

temporalis

insertion

A

coronoid process and anterior border of ramus of mandible (condenses into tendon)

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95
Q

medial pterygoid

function

A

elevation and protrusion of mandible

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96
Q

medial pterygoid origin

A

medial surface of lateral pterygoid plate (Deep)

maxillary tuberosity (superficial)

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97
Q

medial pterygoid insertion

A

medial surfaces of ruam and angle of mandible

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98
Q

lateral pterygoid function

A

depression and protrusion of mandible

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99
Q

origin lateral pterygoid

A

lateral surface of lateral pterygoid plate (inferior)

infratemporal surface of greater wing of sphenoid (superior)

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100
Q

lateral pterygoid insertion

A

neck of mandible and capsule/intracapsular disc

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101
Q

suprahyoid muscles

A

mylohyoid

geniohyoid

stylohyoid

digastric

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102
Q

mylohyoid functin

A

elevates the hyiod bone and the FOM

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103
Q

mylhyoid origin

A

mylohyoid line of the mandible

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104
Q

mylohyoid insertion

A

attaches to hyoid bone

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105
Q

geniohyoid function

A

depress the mandible

elevates the hyoid bone

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106
Q

geniohyoid origin

A

inferior mental spine of mandible

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107
Q

insertion of geniohyoid

A

hyoid bone (by travelling inferior and posteriorly)

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108
Q

sylohyoid function

A

initiates swallowing by pulling the hyoid bone posterior superior

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109
Q

stylohyoid origin

A

stylohyoid process of temporal bone

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110
Q

stylohyoid insertion

A

lateral aspect of hyoid bone

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111
Q

digastric function

A

depress the mandible

elevates the hyoid bone

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112
Q

digastric origin

A

anterior belly - digastric fossa of mandible

posteior belly - mastoid process of the temporal bone

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113
Q

digastic insertion

A

2 bellied connected by intermediate tendon

attaches to hyoid bone via fibrous sling

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114
Q

stages in decontamination

A

clean

disinfect

inspect

pack

sterilise

transport

store

use

transport

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115
Q

decontamination

A

process of making re-usbale medical devicses safe for handline by operators and safe for use on pts

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116
Q

policy

A

overall statement of intent

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117
Q

procedures

A

guidelines of major methods used to meet policy

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118
Q

objective

A

landmark event in pursuit of overall intent

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119
Q

work instruction

A

specific steps used to carry out procedures

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120
Q

operator

A

person with authority to operator equipment

can carry out daily tests, make safe etc

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121
Q

user

A

person responsible for day to day running of LDU

can operate equipment and train operators

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122
Q

manager

A

person ultimately resposible for LDU operation

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123
Q

3 key laws for decon

A

health and safety at work act 1974

health and safety (medical device) regulations 1996

medical devices directives 1993

control of substances hazardous to heatlth 2002

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124
Q

sinner circle

A

temperature

time

enegy

chemicals

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125
Q

cleaning

A

removal of contamination from item to extent necessary for its further processing and intended use

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126
Q

immersion

A

clean under running water

mirrors, probes (solid instruments)

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127
Q

non-immersion

A

wipe clean (according to manufacturer’s instructions)

lumened instruments, electrical equipment

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128
Q

ultrasonic cleaner

A

pre-tx to washer disinfector

for removal of gross/difficult to remove contamination

not for handpieces/lumened instruments

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129
Q

degas

A

after filling up with fresh/new water (start of every cycle before loading)

to remove oxygen/air from water, preventing cavitation inhibitions

ensures bubbles produced are of equal consistency/intensity

improving cleaning efficacy/removal of contamination

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130
Q

disinfection

A

destruction of pathogenic and other kinds of micro-organisms by physical and chemical means

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131
Q

daily checks for WD

A

clean filter

check/clean door and seal

check detergent

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132
Q

daily test cycle for WD

A

first daily run with instruments

automatic control test

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133
Q

Washer disinfector steps

A

flush

wash

rinse

disinfect

dry

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134
Q

inspection

A

lit magnifier

hinges, rough surfaces

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135
Q

steilisation

A

process of making medical device free from live, reproductive micro-organisms so that the probability of viable micro-organisms following the process should be less than 1 in a million

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136
Q

3 types of steriliser

A

type N – non vacuum passive air removal (solid, non wrapped)

type B – vacuum active air removal (wrapped, lumened)

type S – vacuum, specific instruments only (check manufacturers guidance)

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137
Q

demineralised/sterilised water

A

RO - reverse osmosis

deionised

distilled

sterile

used to prevent limescale and debris build up on instruments, which would provide a rough surface for MO to adhere to

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138
Q

optimum sterilisation condidion

A

134-137oC

2-2.3 bar

min 3 mins

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139
Q

daily checks for steriliser

A

wipe door seal and chamber

check door safety devices

drain and refil daily (leave drained overnight)

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140
Q

daily tests for steriliser

A

bowie dick/jelix test - challenge device

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141
Q

10 SICPs

A
  1. Respiratory and cough hygiene
  2. Hand hygiene
  3. PPE
  4. Patient placement
  5. Safe management of care environment
  6. Safe management of care equipment
  7. Safe management of linen
  8. Safe disposal of waste
  9. Prevention and management of occupational exposure
  10. Blood and bodily fluid spillages
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142
Q

chain of infection

A

infectious agent

reservoid

portal of exit

mode of transmission

portal of entry

susceptible host

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143
Q

blood spillage management

A
  • Cordon off area and get equipment and don PPE
  • Brush and pan to clear up debris (glass etc)
  • Paper towels to absorb blood
  • Mop until visibly clean (water and detergent solution)
  • Saturate area with sodium hypochlorite/sodium dichlorosocyanurate
    • 3-5mins
    • 10,000ppm Cl
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144
Q

sharps injury

A
  • Sharp and area safe
  • Encourage to bleed
  • Hold under warm running water
  • Wash (don’t scrub)
  • Dry and cover with waterproof dressing
  • Consider risk of source of blood
  • Establish contact with tutor/supervisor, occupational health and document – DATIX

HBV – 1/3

HCV – 1/30

HIV – 1/300

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145
Q

black waste disposal

A

domestic

paper towels, instrument wrappers

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146
Q

orange waste disposal

A

low risk clinicla waste

PPE, soiled dressings

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147
Q

yellow waste disposal

A

high risk clincal waste

sharps, body parts

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148
Q

red clincal waste

A

special

amalgam

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149
Q

blue clincal waster

A

medications

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150
Q

amalgam bin features

A

red lid - lockable and leak proof

internal mercury suppressant chemical/compound

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151
Q

4 components of waste disposal

A

segregation

storage

disposal

documentation

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152
Q

key laws for waste disposal 3

A
  • Health and safety at work act 1974
  • COSHH 2002 (control of substances harmful to health)
  • Environmental protection act 1990
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153
Q

necrotising ulcerative gingivitis/periodontitis

A
  • Painful ulceration and blunting of interdental papilla
  • Grey/yellow necrotic slough

NUP – irreversible attachment loss occurred (can be due to recurrent or inadequately tx NUG)

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154
Q

signs/symptoms of NUG

A
  • Malodour/hallotsis
  • Inter proximal necrosis
  • Gingivitis
  • Pain
  • Swelling
  • Bleeding
  • Metallic taste
  • Bleeding
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155
Q

associated bacteria for NUG

risk factors

A
  • Anaerobic fusospirochete bacteria

Risk factors

  • Poor OH
  • Immunocompromised
  • Stress
  • Smoking
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156
Q

tx for NUG

A
  • Smoking cessation
  • OHI
  • Mechanical debridement
  • Mouthwash (6% H2O2 or 0.2% CHX)

Antibiotics – which and when

  • 400mg metronidazole (500mg amoxicillin in 2nd choice)
  • 3x day for 3 days
  • If resistant/persistent/immunocompromised
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157
Q

abscess

A

localised collection of dead and dying neutrophils

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158
Q

signs and symptoms for abscess

A

TTP in lateral direction

pain

swelling

redness

pus drainage (sinus tract)

bleeding

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159
Q

types of abscess

A

gingival

periodontal

pericoronal

periapical

perio-endo

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160
Q

acute abscess

A

rapid onset

symptomatic - pain, swelling

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161
Q

chronic abscess

A

gradual onset

asymptomatic - sinus tract, intermittent pus discharge, periapical pathology

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162
Q

Tx abscess

A
  • Mechanical debridement short of base of pocket (avoid damage)
  • Drain pus (through pocket/ incision and drainage)
  • Irrigation
  • Analgesia
  • CHX Mouthwash

Antibiotics – what and when

  • 500mg amoxicillin (400mg metronidazole 2nd choice)
  • 3x day for 3 days
  • If spreading infection, systemic symptoms (fever, malaise, lypmphadenopathy) or if immunocompromised
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163
Q

occlusal trauma

effects on healthy periodontium

A

areas of intermittent pressure and tension

areas widened PDL

hypermobility

in abscence of plaque, ginival margin remains intact (no perio disease)

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164
Q

occlusal trauma

response of healthy periodontium

A

PDL width increases until forces adequately dissipateed (inc mobility)

PDL width stablises and returns to normal if demand/forces reduced

if forces cannot be adequately dissipated/forces increase, PDL continues to widen until tooth lost (pathological failure of adaptation)

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165
Q

occlusal trauam effecs on healthy periodontium but reduced

A

previous loss of attachement and bone resorption

tooth effectively on fulcrum - inc effect of same level force

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166
Q

occlusal trauma effects on disease periodontium

A

zone of co-destruction (physiological and pathological)

occlusal forces cause PDL widening at base of pocket, and may cause clinical attachment loss (pathological) or excessive bone loss (combined - pressure causes resorption as does pathology)

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167
Q

causes of mobility

A

PDL width

PDL height

presence of inflammation

shape/number/lenght of roots

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168
Q

mobility is unacceptable when

A

progressively increasing

symptomatic

associated with deep pockets

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169
Q

how to Tx or reduce mobility

A

Treat perio disease/inflammation

Correct occlusal relations (selective grinding)

Splinting

  • Last resort
  • Used to stabilise teeth for debridement/if discomfort/chewing difficulties
  • May lead to OH difficulties and does not influence rate of disease (does not slow/stop/treat perio)
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170
Q

causes of migration

A

unfavourable occlusal forces

unfavourable soft tissue profiles

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171
Q

tx of migration

A

accept and stablise

correct occlusal relations

orthodontics

tx perio disease

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172
Q

purpose of perio surgery

A

arrest disease by gaining access to complete RSD and regenerate lost perio tissues

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173
Q

contraindications to perio surgery

A

poor OH/plaque control

smoker

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174
Q

indications for perio surgery

A

poor CRT/NSPT

excellent OH

inflammation resolved

pocket 5mm+

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175
Q

pros gingivectomy

A

improves aesthetics

facilitates plaque control

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176
Q

reasons for gingivectomy

A

reduce overgrowth

pseudo pockets

areas with difficult access

ginival fibromatosis

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177
Q

substantivity

A

persistence of action (how long works/adheres for)

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178
Q

depends on

A

maintenancy of antimicrobial activity

slow neutralisation of antimicrobial activtiy

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179
Q

chlorhexidine is

A

antiseptic

bibiguanide

Dicationic action - one cation binds to pellicle-coated tooth, other cation sticks to negatively-charged bacterial membrane.

In low concentration, causes increased permeability.

In high concentrations causes cytoplasm precipitation leading to cell death

Uses - endodontic irrigant, pre-/post-surgery MW, MW for immunocompromised/limited self-care, surgical scrub

Cons - staining, minimal GI absorption, mucosal erosion, parotid swelling, bitter taste

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180
Q

disadv antibiotic

A

allergy

resistance

superinfection

cannot penetrate biofilms well

high conc required to be effective

can be inactivated/degraeded by non target organisms

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181
Q

indication for AB

A

immunocompromised

spreading facial infection

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182
Q

benefits systemic AB

A

delivered via serum to tissues

reaches non-dental reservoirs

cheaper, less chairside time

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183
Q

benefits local AB

A

reaches site directly

adequately high drug concentration

low systemic effects

better compliance

high conc in GCF

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184
Q

aims of perio tx

A

arrrest disease

regenerate lost perio tissue

maintain long term perio health

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185
Q

side effects/cons of perio tx

A

sensitivtiy

gingival recession

short term bleeding

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186
Q

clincal attachment loss/gain post perio tx and why

A

gingival recession and gain in attachment through long junctional epithelium

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187
Q

pulp communications

A

apical forament

lateral and furcal canals

fractures

perforations

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188
Q

primary endo lesion progresses to involve perio

A

pulp infection travels down root canal to PA area

periapical pathology/abscess - progresses corronally to gingival/alveolar bone margin

localised perio disease, non vital tooth

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189
Q

primary perio lesions progresses to involve endo

A

pocket forms

progresses apically to accessory canal/apical foramen

bacterial ingress into canal - pulp inflammation

greneralised perio disease, tooth often not/minimally restored

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190
Q

true combine lesion (perio and endo)

A

zone of co-destruction

endo disease proliferates coronallay and perio disease proliferates apically and they combine into one lesion

non-vital tooth, periodontal and alvelar bone loss

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191
Q

perio-endo prognosis

A

generally poor, worse if true combine

mainly dependent on severity of perio disease and response of perio disease to tx

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192
Q

tx for peri-endo lesions

A

primary RCT

secondary NSPT - if unresolved perio surgery

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193
Q

drusg which can cause gingival hyperplasia

A

calcium channel blockers (nifedipine)

immunosuppressants (cyclosporin A)

anticonvulsants (phenytoin)

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194
Q

barriers to care

A

physical

attitudinal

professional centrered

people centered

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195
Q

impairment

A

any loss/abnormality of psychological, physiological or anatomical structure or function

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196
Q

disability

A

restriction/lack of ability to perform an activity in a manner/within the range considered normal for a human being

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197
Q

handicap

A

disadvantageous for a given individual, resulting from an impairment or disability that limits/prevents normal role of fulfilment for that individual

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198
Q

key legislation for SCD

A
  • Equality act 2010
  • Adults with Incapacity (Scotland) act 2000
  • Mental Health (care and treatment) (Scotland) act 2003
  • Mental health capacity act 2005
  • Disability discrimination act 1995/2005
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199
Q

WHO disabilities inc

A
  • Umbrella term covering impairments, activity limitation and participation restrictions
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200
Q

ways to make communication easier with sensory impaired

A

Visual

  • identify yourself, use names, say what you’re doing before doing it, avoid non-verbals

Hearing

  • have a loop system, face person when speaking, use a clear speech, use written aids, reduce background noise, use name badges
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201
Q

dentally fit (3)

A

free from active disease (removal of infection foci)

prevent/inhibit the potential for future disease development (consider removal of teeth of poor prognosis)

establish preventative regime

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202
Q

MDT

A

muli disciplinary treatment

group of individuals from multiple medical specialities working together to provide a holistic care for an individual

e.g. surgeon, pathologist, radiologist, clinical care nurse specialist, oncologist (medical/clinical)

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203
Q

chemotherapy

A

systemic drugs used to target rapidly dividing cells

side effects: mucosistis, hair loss, tiredness, immunocompromised

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204
Q

radiotherapy

A

ionising radiation damage to cellular DNA delivered in fractioned doses

side effects: mucositis, tiredness, burns, dry mouth, taste loss, ORN, trismus, radiation caries

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205
Q

muscositis

A

acute inflammation of oral mucosa

Grade 0 – normal oral mucosa

Grade 1 – mild – soreness and erythema

Grade 2 – moderate – erythema ulcers (can swallow solids)

Grade 3 – severe – ulcers with extensive erythema (can swallow liquids)

Grade 4 – life-threatening – extensive mucositis (oral alimentation not possible)

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206
Q

Parkinson’s

A

progressive degeneration of dopaminergic neurons in substantia nigra

features

  • resting tremor
  • bradykinesia
  • mask-like/expressionless face
  • impaired balance and gait
  • rigidity
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207
Q

difference in presentation of Parkinson’s and cerebellar disease

A

Parkinson’s - resting tremor

cerebellar disease - intention tremor

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208
Q

dental issues in parkinsons

A

xerostomia

swallowing issues

access issues

limited self care

drooling (forward tip)

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209
Q

dry mouth in parkinsons

why

A

antichlonergic effect of dopaminergic drugs

forward tip leads to saliva pooling at front of mouth

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210
Q

dementia

A

deterioration in cognitive function beyond what might be expected from normal ageing

Risk factors

  • age
  • sex
  • genes
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211
Q

4 types of dementia

A

alzheimer’s

vascular

with Lewy bodies

frontotemporal

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212
Q

symptoms of dementia

A

early

  • SHTML, indecisive, poor judgement, confusion

Middle

  • Increasingly forgetful, angry, distress, mood changes, may fail to recognise people

Late

  • Increasing frailty, fail to recognise familiar people/objects/places, swallowing difficulties, gradual loss of speech
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213
Q

diagnostic tools for dementia

A

MMSA mini mental state exams

bleeded dementia scale

Montreal cognitive assessment

single neuropychological test (delayed word recall)

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214
Q

tx plan features for pt with dementia

A
  • Plan for future
  • Establish preventative regime
  • Aim to retain key teeth
  • Provide complex treatment first
  • Atraumatic restoration technique (ART – partial caries removal with instrument, GIC restoration)
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215
Q

features of dementia friendly dentist/health care environment

A
  • Reception desk visible from front door
  • Good level of natural light
  • Signs at eye level
  • No unnecessary signs
  • Signs contain simple text and colour/pictures
  • Walls/floor/furniture distinctively different colours and tones
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216
Q

methods of assisted communication in care homes

A
  • rescuing
  • briding
  • chaining
  • hand-over-hand
  • distraction
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217
Q

medical model of disability

A

people are disable by their impairments/differences and as such should be fixed/changed

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218
Q

social model of disability

A

people are disabled by the way society is organised rather than by their impairments/differences

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219
Q

Down’s syndroms genetic test

A

trisomy 21

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220
Q

physical/dental features of Down’s syndroms

A

atlanto-axial instablity

macroglossia

hypo/microdontia

class III

maxillary hypoplasia

caries risk

perio disease

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221
Q

associated health conditions of Down’s syndrome

A

congenital heart diseases

haematological malignancy (leukaemia)

epilepsy

early onset alzheimers

coeliac disease

learning disability

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222
Q

consent/capacity 4 features need to have

A

able to make decision

understand the decision - risks, benefits, alts

communicate a decision

retain memory of decision

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223
Q

autism

A

lifelong developmental spectrum disorder affecting areas of the brain resposible for language, social interaction and abstract/creative thinking

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224
Q

signs/symtoms ASD

A

isolated/withdrawn

literal interpretation of language

difficultly relating to people

socially awkward and naive

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225
Q

dental management of ASD

A

pre-visit

social story

allow more time

consider sensory issues (quiet etc)

communication aids

hide non-essential items/equipment

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226
Q

measure to eval diabetes control

A

HbA1c

better indication of long term control than GTT

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227
Q

ideal value for diabetic pts

A

6.5%/48mmol/mol

want to be slightly higher before dental tx

booke early app

advise pt to eat breakfast

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228
Q

dental features of poorly controlled diabetic

A

increased risk perio

dry mouth

delayed/poor wound healing

fungal/candida infection

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229
Q

types of anticoagulants

A
  • Vitamin K dependent anticoagulants (coumarins – warfarin, heparin)
  • New/Direct oral anticoagulants (NOAC/DOAC)
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230
Q

warfarin inhibits

A

extrinsic coagulation pathway

inhibits production of clotting factors 2, 7, 9 and 10

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231
Q

warfarin

check

when

A

INR 24hrs before extraction

<4.0 (SDCEP)

ideally stable for 72hrs pre-extraction

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232
Q

normal INR value (not on warfarin)

A

1.0

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233
Q

NOAC

A
  • Dabigatran (dTi – CF 11a)
  • Apixaban (CF 10a)
  • Rivaroxaban (CF 10a)
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234
Q

high risk bleeding procedures acc to SDCEP

A
  • 3+ extractions
  • Flap raising procedures (surgical extractions, perio surgery)
  • Gingival recontouring
  • biopsies
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235
Q

antiplatelets what to do

A

if on

  • 1 – fine
  • 2 – grey area
  • 3 – avoid
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236
Q

inherited bleeding disorders types and tx

A

Haemophilia A (CF VIII deficient)

  • Tranexamic acid, DDAVP, recombinant factor

Haemophilia B (CF IX deficient)

  • Tranexamic acid, DDAVP, recombinant factor

Von Willebrand disease (vW factor deficient)

  • Tranexamic acid, DDAVP
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237
Q

causes of jaundice

A

alcohlic liver disease

non alcholic fatty liver disease

infective liver disease (hepatitis)

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238
Q

effect of liver disaese on dental care

A

inc bleeding risk

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239
Q

alcohol

recommended weekly units

A

14 units a week

over 3+ days

2+ alcohol free days

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240
Q

excessive alcohol intake bleeding risk because

A

damages liver

inhibiting production of CF

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241
Q

key blood tests for bleeding problems

A

FBC

LFT

coagulation screen

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242
Q

platelet levels for extractions and what transfusion required

A
  • >1009 for GDP
  • 50-1009 for secondary care

<509 – FFP/platelet transfusion

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243
Q

incapacity law and 5 principles of it

A

Adults with Incapacity Scotland Act 2000

  • Benefit
  • Minimum necessary intervention
  • Take account of the wishes if the adult
  • Consultation with relevant others
  • Encourage adult to exercise residual capacity
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244
Q

types of Power of Attorney

A

PoA – appointed by individual before they lose capacity

  • Continuing (financial) or welfare (health)

WG

  • court appointed when an individual who has never had capacity turns 16 or when adult without PoA loses capacity
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245
Q

if adult deemed to have no capacity what is required for tx

A

section 47 certificate for specific proposed tx

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246
Q

who can give consent

A
  • Adult (with capacity)
  • Parent (if child <16 yrs and lacks capacity)
  • Welfare PoA
  • Welfare guardian
  • GP/GDP (with section 47)
  • Relative who has been appointed officially by court
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247
Q

emergency tx

A

preserveration of life/ to prevent serious deterioation

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248
Q

types of dental emergency

A

bleeding

spreading infection (associated with abscess)

swelling inhibiting breathing

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249
Q

causes of oral ulceration

A

oral cancer

trauma

medicaion side effect

nutritional deificiency

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250
Q

guidelines to check for oral ulcerations

A

Scottish referral guidelines for suspected cancer

NICE guideline 12

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251
Q

modifiable risk factors for oral ulceration

A

smoking

alcohol

poor OH

sun exposure

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252
Q

bisphosphonates are used to tx/manage

A

osteoporosis

multiple myeloma (and metastatic cancer)

Paget’s disease

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253
Q

key organisms in caries

A

s mutans

lactobacillus acidophilus

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254
Q

virulence factors of caries MO

A

adhesions

binding proteins (glucosyltransferase)

sugar modifying enzymes

polysaccharides (glucans)

acid tolerance and adaptation (ATPase)

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255
Q

MO methods of acid tolerance

A

maintain pH balance (ATPase)

alters cell membrnaes

protection and repair mechanisms

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256
Q

anticaries activities of Fluoride

A

Systemic

  • incorporated into developing enamel as fluoroapatites (remineralisation)

Topical

  • converts into surface enamel into fluoroapatite (remineralisation)

Antimicrobial

  • inhibits plaque metabolism and ATPase action
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257
Q

red Socransky’s organismis

perio

A

P gingivalis

T denticole

T forsythia

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258
Q

virulence factors of red socransky’s mo

A

gingipains (degrades chemokines, activates MMPs)

adhesions

tissue toxic metabolic by products

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259
Q

systemic diseases linked with perio pathogens

A

cardiovascular disease

rheumatood arthrititis

diabetes mellitus

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260
Q

types of oral canididosis

A

pseudomembranous

eruthematous

hyperplastic

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261
Q

causes of oral candiosis

A

poor denture hygiene

catheter

surgery

immunocompromised

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262
Q

candida species

A

c albicans

c glabrata (resistant to azole antifungals)

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263
Q

virulence factors of candida

A

hyphae (formed by C albicans when stressed)

adhesins

hydrolytic enzymes (haemolysi, proteinase, phopholipase)

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264
Q

antifungal tx and how they work

A

azoles – fluconazole

  • fungistatic
  • indirectly target ergosterol in fungi cell walls by inhibiting/interrupting the activity of the enzyme involved in its production (14a demthylase)

polyenes – nystatin

  • fungicidal
  • directly targets ergosterol in fungi cell wall, causing perforation and leakage of intracellular contents
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265
Q

methods of candida resistance

A
  • antimicrobials cannot penetrate beyond surface layer of biofilm (without mechanical disruption of biofilm)
  • degraded by enzymes
  • not active against non-target organisms
  • expression of biofilm-specific resistant genes
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266
Q

key features of biofilm development

A

adhesion

colonisation

accumulation to form complex community

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267
Q

porcelain features

A

aesthetics

hard

rigid

forms microcracks at fitting surface

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268
Q

types of bond in MCC

A

chemical

mechnical

stressed skin

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269
Q

most common metal alloy

A

CoCr

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270
Q

purpse of metal oxide bond

A

helps eliminate cracks on porcelain surface

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271
Q

max C in steel

A

<2%

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272
Q

iron is

A

allotropic undergoes 2 solid state phase changes with temperature

Phase changes

  • <900oC BCC lattice structure, low carbon solubility
  • 900-1400oC FCC lattice structure, high carbon solubility
  • >1400oC BCC lattice structure, low carbon solubility
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273
Q

4 types of FeC on phase diagram

A

Austenite above 720oC

Cementite Fe3C

Ferrite low temperature

Pearlite eutectoid mixture of cementite and ferrite

Pearlite formed – slow cool austenite/temper martensite

Martensite formed – quench austenite/when no time for carbon to diffuse

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274
Q

stainless steel chromium%

A

>13%

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275
Q

composition of stainless steel and their functions

A

Iron

72%

Forms steel with carbon

Chromium

18%

Increases corrosion resistance

Nickel

8%

Increases UTS and corrosion resistance

Titanium

1.7%

Stabilises weld decay

Carbon

0.3%

Forms steel with iron

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276
Q

weld decay

A
  • Where chromium carbides precipitate at grain boundaries, making the material more brittle and susceptible to corrosion
  • Occurs at 500-900oC
  • Stabilised/prevented by incorporation of titanium and low carbon content
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277
Q

cold work

A
  • Strengthening of metal by plastic deformation
  • Work being done on the metal at low temperatures (bending, swaging) that causes dislocations to collect at grain boundaries (slip)
  • Material is strengthened and develops resistance to dislocation formation
  • Used for shaping partial denture clasps and ortho wires
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278
Q

pros of PMMA

A

non toxic

non irritant

high softening temperature

good aesthetics

high abrasion resistance

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279
Q

cons of PMMA

A

poor mechanical properties

low thermal conductivity

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280
Q

PMMA reaction

A

free radical additon polymerisatioon

low thermal conducitivty

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281
Q

heat cure Vs self cure PMMA

A
  • Heat cure
    • better mechanical properties (stronger), less unreacted monomer
    • curing can cause porosity, longer time
  • Self cure
    • Quicker, cheaper
    • Poorer mechanical properties, more unreacted monomer
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282
Q

ideal features of investment materials

A

porous

expands

easily removed from cast

smooth surface

strong

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283
Q

components and functions of investment materials

A

binder - forms coherent mass

refractory - expansion, withstands high temperatures

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284
Q

hygroscopic expansion

A

water molecules attracted between crystals forces crystals apart

increased by:

  • lower powder/water ratio (more water to powder)
  • higher water temperature
  • longer immersion time
  • higher silica content
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285
Q

4 ways to inc hygroscopic expansion

A

lower powder/water ratio (more water to powder)

higher water temperature

longer immersion time

higher silica content

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286
Q

types of investment material

A
  • dental stone/plaster
  • gypsum bonded
    • smooth surface, porous, adequate strength
    • calcium sulphate hemihydrate combines with water to form calcium sulphate dihydrate
  • phosphate bonded
    • porous, easy to use, stronger
  • silica bonded
    • sufficient strength, not porous, complicated manipulation
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287
Q

types of elastomers

A

addition silicones

polyethers

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288
Q

why are hydrophillic elastomers better

A

incoroporation of non-ionic sufactant (wets tooth surface)

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289
Q

ideal elastic behaviour vs actual

A
  • material applied and set, upon removal, material reaches max strain almost instantly, strain held during removal, when fully removed – material instantly returns to original strain and pre-removal shape
    • no permanent deformation

Actual elastic behaviour

  • material applied and set, upon removal, material gradually increases to just below max strain, when fully removed – material quickly (instantly) returns to almost original shape
    • permanent deformation/strain and permanent change in dimension
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290
Q

impression material key features

A
  • low viscosity
  • low viscoelasticity
  • high tear strength
  • high tear resistance
  • high elastic recovery
  • good wettability
  • good surface detail
  • able to flow under pressure
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291
Q

luting agents key features

A
  • strong
  • good aesthetics
  • biocompatible
  • good marginal seal
  • low viscosity
  • low thermal conductivity
  • easy to use
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292
Q

types of luting agents

A
  • conventional dental cements
  • GIC
  • Composite resins
  • Self-adhesive composites
  • Surface modifying chemicals
293
Q

types of dental cements

A

zinc phophate

zinc polycarboxylate

294
Q

pros and cons of dental cements

A

pros

  • Cheap
  • Easy to use

Cons

  • Low initial pH
  • Exothermic setting reaction
  • Brittle
  • Opaque
  • Don’t bond to tooth/not adhesive
295
Q

GIC components

A

polyacrylic acid

tartaric acid

glass powder

silica

296
Q

setting reaction of GIC

A

MO.SiO2 + H2A –> MA + SiO2 + H2O

Dissolution

  • acid added to solution.
  • H ions interact and attack glass surface.
  • Glass ions are released and leach out, leaving a layer of silica gel around unreacted glass

Gelation

  • bivalent Ca ions crosslink with polyacid by chelation with carboxyl groups

Maturation/hardening

  • trivalent Al ions ensure good cross linking, increasing strength
297
Q

how GIC bonds to tooth

A

ion exchange wiht calcium in enamel and dentine and hydrogen with collagen in dentine

strong, durable bond

298
Q

pros of GIC

A
  • no/limited setting contraction
  • F release
  • Strong bond to tooth
  • Easy to use
  • Durable
299
Q

RMGIC components

A
  • Fluoro-alumino-silcate glass
  • Barium glass
  • HEMA
  • Polyacrylic acid
  • Tartaric acid
300
Q

RMGIC pros

A
  • Stronger
  • Good bond to tooth
  • Longer working time
  • Set on demand
301
Q

cons of RMGIC

A
  • Setting contraction
  • Moisture sensitive
  • Unreacted cytotoxic HEMA
302
Q

2 cure types for RMGIC

A

dual cure (acid base reaction, light cure - camphorquinone)

tri cure (acid base reaction, light cure, redox)

303
Q

when to use GIC

A

MCC

metal post

zurconia crown

gold restoration

304
Q

composite luting cement

what used to bond

A

surface wetting agent/silance coupling agent

  • Hydrophilic end forms bond between oxide groups in silane and porcelain surface
  • Hydrophobic ends react with composite resin forming bond
  • Similar to DBA
305
Q

benefits of composite luting cement

A

better physical properties and aesthetics

less soluble

306
Q

bond to porcelain

A

sandblast/etch to roughen surface to form micromechanical bond

307
Q

bond to precious metal

A

use metal bonding agent (MDP/ 4-META)

tooth - DBA - compusite luting resin - metal bonding agent - precious metal

308
Q

where to use light cure materials

A

is restoration thin e.g. veneer

309
Q

where use dual cure materials

A

allow oxide formation (complicated, technique sensitive)

310
Q

self adhesive composite use

A

thick restoration

metal restoration

most crowns, bridges, posts

fibre posts

composite inlay and porcelain inlay

311
Q

ceramic

A

Solid material compromising of an inorganic compound metal, non-metal or metalloid atoms held in ionic and covalent bonds

312
Q

felspathic

A

replace kaolin

Feldspar – fluxing agents (lowers fusion and softening temperature of glass)

  • Silica

1150-1500oC

  • Forms leucite
    • Powder of known chemical and physical properties
313
Q

crown fabrication

A
  • Powder fritted (rapidly cooled) and milled into fine powder.
  • Binder and distilled water added and mixed together.
  • Applied to die, built-up into restoration/crown, fusion in furnace (sintering), staining/glazing, finishing
314
Q

sintering

A
  • When ceramic particles begin to fuse into a solid mass.
  • Occurs above glass transition temperature.
  • Glass phase softens and fuses (controlled diffusion), forming a solid mass.
    • 20% material contraction
315
Q

pros of ceramic

A
  • Best aesthetics
  • Less staining
  • Biocompatible
  • Similar thermal properties to tooth
  • Low thermal diffusivity
  • Hard
  • High compressive strength
316
Q

possible materials for cores

A
  • Alumina
  • Zirconia
317
Q

static fatigue

A
  • Time dependent reduction in strength, even in absence of applied load
  • Likely due to hydrolysis of Si-O groups within material, over time in aqueous environment
318
Q

pros of alumina

A
  • High flexural strength
  • Good aesthetics
  • Cheap
  • Alumina particles act as crack stoppers
319
Q

luting alumina (silica-containing ceramics)

A

hydrofluoric and silance coupling agent

320
Q

types of alumina in cores

A

In-ceram

procera

321
Q

zirconia pros

A

hard

strong

excellent fit

322
Q

luting zirconia

A

inert fitting surface and strong enough to be self-supporting - so conventional dental cement

323
Q

type zicronia used

A

Yttria-stabilised zirconia

  • Normal zirconia is monoclinic crystal at room temperature.
  • When a crack forms (and stress at crack tip reaches critical level), crystal structure transforms into a monoclinic structure, causing the material to expand slightly and close up the crack tip
324
Q

process of casst and pressed ceramics

A
  • Wax up
  • Investment
  • Cast from heated ingot of ceramic
  • No sintering occurs
  • Creaming
  • Staining

2 stages in creaming

  • Crystal formation – maximum number of crystal nuclei formed
  • Crystal growth – to maximise physical properties
325
Q

design objectives for endo

A

create a continuously tapering funnel shape

maintain apical foamen in original position

keep apical opening as small as possible

326
Q

clinical objectives of endo

A

remove canal contents

eliminate infection

327
Q

2 things that improve endo success

A

sodium hypchlorite

dam

328
Q

function of dam

A

protect airway

imporve access

efficacy and vision

prevent contamination

protect soft tissues

329
Q

normal pulp dx

A

asymptomatic, normal thermal response (mild/short sensitivity), vital

330
Q

reversible pulpitis dx

A
  • inflamed, pain to stimulus, resolves with treatment
331
Q

symp irreversible pulpitis dx

A

lingering pain to stimulus, pain with postural changes

332
Q

asymp irreversible pulpitis dx

A
  • no symptoms, usually normal thermal test
333
Q

pulpal necrosis

A
  • negative pulp test, TTP, radiographic osseous breakdown, can be asymptomatic
334
Q

normal apical dx

A

not TTP, uniform PDL space

335
Q

symptomatic apical periodontitis dx

A

TTP, pain with biting, PA radiolucency

336
Q

asymp apical periodontitis dx

A

asymptomatic, PA radiolucency

337
Q

acute apical absces

A

rapid, swelling, TTP, spontaneous pain, systemic symptoms

338
Q

chronic apical abscess

A

gradual, asymptomatic, PA radiolucency, sinus ± pus discharge

339
Q

condensing osteitis

A
  • localised bony reaction to low-grade inflammatory stimulus, diffuse PA radiopacity
340
Q

developmental stages of biofilm

A

adhesion

colonisation

accumulation to form complex community

dispersal

341
Q

resisance features of biofilm

A

antimicrobials cannot penetrate beyond surface layer

trapped/destroyed enzymes

inactive against non-growing organisms

expression of biofilm specific resistant genes

342
Q

mechanical endo prep aim

A

create space to allow irrigants and medicaments to more effectively eliminate micro-organisms

remove infected hard and soft tissue

343
Q

stages in mechanical prep for endo

A
  • Tooth prep
  • Access cavity
  • Confirm straight line access
  • Initial negotiation
  • Coronal flaring
  • Working length determination
  • Apical preparation
344
Q

apical prep determined by

A

Apex size (largest passive ISO file taken to WL – ideally, passive gauging to ISO 25)

345
Q

irrigants used in endo

A

3% NaOCl

17% EDTA

0.2% CHX

346
Q

final irrigation steps

A

10mins NaOCl

1min EDTA

10mins NaOCl

dry between with paper points

347
Q

ideal irrigant properties for endo

A
  • Disinfect canal (remove MO)
  • Dissolve organic and inorganic material
  • Remove smear layer
  • Cheap
  • Non-toxic to PA tissues
348
Q

NaOCl pros and cons

A

Pros

  • Dissolves organic material
  • Disrupts smear layer
  • Effective antimicrobial

Cons

  • Doesn’t remove smear layer
  • Dissolves fabrics
  • Accidents
349
Q

NaOCl accident management

A

copius irrigation

analgesia

review

350
Q

prevent NaOCl accident

A
  • Bib/eyewear
  • Slow flow rate (1ml/15secs)
  • Depress with index finger
  • Don’t lock needle in canal
  • Use side-vented Leur-lock 27G needle
  • Avoid excessive pressure
351
Q

smear layer

A

Superficial (1-5um) layer of organic pulpal and inorganic dentinal material formed during preparation

  • With packing into dentinal tubules

Prevents/interferes with disinfection and sealer penetration

352
Q

removal of smear layer by

A
  • 17% EDTA
  • 10% citric acid
  • MTAD
353
Q

intra canal medicament

why

A
  • Non setting CaOH

Why

  • Antibacterial
  • Reduces inflammation
  • Kills MO in canal
  • Effective at removing tissue debris
354
Q

purpose of chemomechanical prep

A

irrigate to remove microbes

remove smear layer

prepare shape for obtuartion to WL

flush out debris

remove infected hard/soft tissues

allow delivery of irrigants to WL

355
Q

essential to do whilst chemomechanical instrumentating

A

copious irrigation

recapitulation

patency filing

356
Q

modified double flare technique

A
  • Enlarge/flare coronal part of root canal,
  • negotiate narrower apical part,
  • flare apical and middle parts using ‘step-back’ technique (apex-1mm = file at apex - 1 size, etc.)
357
Q

estimated working length

A
  • estimated length at which instrumentation should be limited
  • usually 1mm short of radiographic apex
358
Q

corrected working length

A
  • actual length at which instrumentation should be limited
359
Q

master apical file

A

largest file taken to working length

represent final prepared size of apical portion of canal

360
Q

types of instrument motion

A
  • Filing
  • Reaming
  • envelope of motion
  • Watch-winding
    • 30-60 degree oscillation movement with light apical pressure
  • Balanced force
    • engage file, 1/4 turn CW, 1/2 turn CCW, repeat x2, irrigate, patency file, irrigate, recapitulate, irrigate, repeat
361
Q

cons of hand files

A

time consuming

less predictable

ledges

apical zipping

perforations

blockages

362
Q

NiTi main features

A

super elasticity

363
Q

pros of rotary files

A

quicker

more predictable

increased flexibility and cutting efficacy

easier to use

safer

364
Q

cons of rotary files

A

limited posterior access

potential

expensive

365
Q

prevent # with rotary files by

A

create guide path

crown down technique

ensure straight line access

gentle pressure

366
Q

glide path

A

use of smaller files (to workinig length) before introducing larger files to prevent #

367
Q

process of glide path

A
  • Confirm straight line access, explore anatomy,
  • introduce ISO files 10-25 to resistance only (coronal only),
  • early coronal flaring (S1),
  • ISO 10 watch winding to WL to establish apex,
  • irrigate,
  • recapitulate,
  • repeat with ISO 15 (watch winding) and ISO 20 (balanced force)
368
Q

purpose of early coronal flaring

A

reduce hydrostatic pressure in canal during irrigation

provide reservoid for irrigants

369
Q

ideal properties for obturation material

A

non staining

bacteriostatic

radiopaque

non irritant

inert

370
Q

why obturate

A

fluid tight apical seal

kill remaining microbes

prevent microbial reinfection

seal off lateral canals

371
Q

GP composition

A

20% GP

65% ZnO

10% radiopacifier

5% plasticisers

372
Q

functions of endo sealer

A

seal lateral canals

fill voids/seal spaces that GP doesn’t fit

seal between GP points and GP points and dental wall

lubricates during obturation

373
Q

properties of endo sealer

A
  • Non staining
  • Bacteriostatic
  • Radiopaque
  • Biocompatible
  • Low viscosity (able to flow)
  • Non-irritant
  • inert
374
Q

4 obturation methds

A
  • warm lateral compaction
  • carrier based obturation
  • continuous wave obturation
  • cold lateral compaction
375
Q

cold lateral compaction

A
  • remove access
  • patency filing
  • recapitulate to final prepared size
  • irrigate, dry, place corresponding GP cone,
  • ug-back with locked tweezers at WL
  • cone-fit radiogratph
  • dry, coat in sealer, fit master cone
  • finger spreader to 2mm from apical stop forcing GP to fit apical collar and force to side of canal
  • accessory points inserted until full
  • excess GP removed (melted)
  • points drilled together (slow speed) to 1-2mm below ACJ, RMGIC coronal seal, definitive restoration
376
Q

risks of RCTx

A

perforation

instrument separation

failure

pain

377
Q

successful outcome of RCTx

A

asymptomatic, normal PDL

378
Q

uncertain outcome of RCTx

A

a/symptomatic, PAP same size/reduced but not gone after 4yrs

379
Q

unfavourable outcome of RCTx

A

symptomatic, continuing root resorption, PAP larger/new after 4 yrs

380
Q

management options of RCTx failure

A

monitor

re tx

periradicular surgery

extraction

381
Q

basic steps in RCT

A
  • coronal access
  • instrumentation
  • chemomechanical preparation
  • obturation
  • coronal seal
  • final restoration
382
Q

law of centrality

A

floor of pulp is always located in centre of the tooth at the level of ACJ

383
Q

law of concentricitiy

A

walls of pulp chamber are always concentric to external surfaces of tooth at level of ACJ

384
Q

law of ACJ

A

most consistent, repeatable landmark for locating position of pulp chamber

385
Q

law of symmetry 1

A

orifices of canals are equidistant form line drain in mesio-distal direction through pulp chamber floor (except U6s)

386
Q

law of symmetry 2

A

orifices of canals lie on a line perpendicular to line draw in mesio-distal direction across the centre of the floow of the pulp chamner (except U6s)

387
Q

law of colour change

A

colour of pulp chamber floor is always darker than the walls

388
Q

law of orifice location1

A

orifices of root canals are always located at juctions of walls and the floor

389
Q

law of orifice location 2

A

orificies of root canals are always located at the angles in floor-wall junction

390
Q

law of orifice location 3

A

orificies of root canals are located at terminus or root development fusion lines

391
Q

7 caries risk assessment components

A

clincal evidence

dietary evidence

medical history

social history

saliva

plaque control

fluoride use

392
Q

8 caries risk prevention components

A

radiographs

dietary advice

tooth brushing instruction

topical fluoride

fissure sealants

systemic fluoride

393
Q

paeds tx plan order

A

OHI

fluroide varnish

fissure sealants

restoration no LA (upper before lower)

restoration with LA (upper before lower)

pulp tx

extractions

394
Q

types of caries

A

arrested

rampant

early childhood/nursing bottle

secondary/recurrent

interproximal

pit and fissure

smooth surface

395
Q

caries detection methods

A
  • Visual (dry tooth, direct light)
  • Radiographs
  • Orthodontic separators
  • FOTI
396
Q

paeds caries tx options

A
  • Complete caries removal and restoration
  • Partial removal and restoration/seal
  • No removal and hall crown
  • Prevention only
  • Make self-cleansing
  • Fissure sealant only
397
Q

best time to X6

A

beginning of calcification of bifurcation of L7s

5s and 8s present

class I incisors

398
Q

pros and cons of X6s

A

pros

  • caries free dentitin
  • 7s erupt mesially into space

cons

  • loss of permanent tooth
  • furture anxiety/fear of tx
  • 5s may drift distally
399
Q

indications for paeds pulp tx

A

MH excludes extractions

good cooperation and motivation

good attendance

400
Q

contraindications for paeds pulp tx

A

poor attendance

poor cooperation and motivation

401
Q

pulpotomy

A

remove disease/infection

control bleeding and retain radicular pulp

402
Q

pulpectomy

A

remove/control infection by removing all (radicular) pulp

cleaning and obturating

403
Q

radiographic signs of paeds pulp tx failure

A

furction bone loss

internal inflammatory resorption

external inflammatory resorption

periapical pathology

404
Q

reasons for DFA

A

previous experience

parents opinion/experiences

new/unknown environment

peer stories

405
Q

features of DFA

A
  • SoB
  • Increased HR
  • Sweating
  • Palpitation
  • Fidgeting
  • Hypervigilance
  • Aggression
406
Q

management techniques for DFA

A
  • Distraction
  • Tell-show-do
  • Acclimatisation
  • Desensitisation
  • Role modelling
  • Positive reinforcement
  • Relaxation
  • Hypnosis
  • CBT
407
Q

how to track progression of permanent tooth trauma

A
  • Colour
  • TTP
  • Radiographs
  • Ethyl chloride
  • EPT
  • Mobility
  • Sinus
  • Displacement
  • Percussion note
408
Q

aim of emergency tx

A

retain vitality of tooth and reduce/immobile displaced/mobile teeth

409
Q

management of E#

A

bond fragment / grind sharp edges

410
Q

management of ED#

A

bond fragment / composite bandage and restore

411
Q

managament of EDP#

A

direct pulp cap (<1mm, 24hrs)

pulpotomy (>1mm, >24hrs - partially intially; if fail to stop bleeding or not bleeding at all go onto full coronal)

pulpectomy (long exposure/necrotic/still bleeding after full coronal pulpotomy)

412
Q

management of concussion

413
Q

management of subluxation

A

2 weeks flex splint

414
Q

management of extrusion

A

reposition

2 week flex splint (open apex) or 4 week flex splint (closed apex)

415
Q

management of intrusion

A

open apex

  • <7mm leave
  • >7mm ortho/surgical realignment

closed apex

  • <3mm leave
  • 3-7mm ortho
  • >7mm surgical

4 week flex splint

416
Q

management of displaced root #

A

LA digital reposition

splint (4 week flex if apical/middle third, 4 month flex if coronal third)

417
Q

signs of healing

A

calcified union across # line

connective tissue formed

418
Q

signs of non healing

A

granulation tissue

usually associated with loss of vitality

419
Q

avulsion

A

replant 4 week flex splint (unless open apex/EADT <60mins then just 2 week)

  • Hold by crown, wash obvious debris off under cold running water, stick back in socket, bite on tissue, get to dentist ASAP
  • Saliva, milk, physiological saline, blood
  • EAT <60mins, EADT <30mins
420
Q

replant post avulsion contraindicationss

A
  • Other more serious injuries require investigation/tx
  • Immunocompromised
  • Very immature lower incisors
  • Very immature tooth with EAT >90mins
421
Q

post replant resorptiont types

A
  • Internal inflammatory
  • External inflammatory
  • External surface
  • Replacement ankylosis
422
Q

management dento-alveolar #

A
  • Reposition
  • Ensure occlusion as before (selective grinding if needed)
  • 4 week flex splint
  • 2-4 weeks post
423
Q

follow up radiographs for trauma

A
  • 2-4 weeks post tx
  • 6 months
  • Every year for 5 years
424
Q

effects of trauma on primary dentition

A
  • Discolouration
    • Early – usually will stay vital
    • Delayed ‘bruising’ – usually sign loss of vital
  • Infection
  • Delayed exfoliation
425
Q

long term effects of trauma on permanent dentition

A
  • Delayed eruption
  • Ectopic position
  • Arrest in development/formation
  • Failure to form
  • Odontoma formation
  • Enamel defects
  • Anatomy/morphology abnormalities
426
Q

supracrestal attachment

A
  • Dimension of soft tissue attached to tooth coronal to alveolar crest
  • 2mm
427
Q

simplified BPE on

A

0-2 (bleeding, calculus)

  • On teeth 16, 11, 26, 36, 31, 46

7-11 years

428
Q

when can F mouthwash be used

A

>7 years, can spit

225ppmF

429
Q

GA what is it

types

stages

indications and contraindications

A
  • Technique which causes loss of consciousness and/or abolition of protective reflexes in specific situations associated with medical/surgical interventions by depressing specific areas of the brain

Types

  • IV
  • Inhalation

Stages

  • Induction
  • Excitement
  • Surgical anaesthesia
  • Respiratory paralysis/OD

Indications

  • For pre-cooperative/ anxious
  • if child required to be still

Risks/contraindications

  • GA risks – death, coma etx
  • Future anxiety towards dental tx
430
Q

child protection

A

activity undertaken to protect specific children who are at risk of/from suffering harm

431
Q

child abuse/neglect

A

actions/inactions of those entrusted with care of children do/fail to do which damages the child’s prospects of a safe and healthy development into adulthood

432
Q

dental neglect

A

the persistent failure of those resposible for the care to maintain an appropriate level of oral health

obvious disease, care offered not taken up

433
Q

wilful neglect

A

when a problem is pointed out but not corrected/acted upn

434
Q

features of dental team management in neglect cases

A

preventative dental managment

preventative multi agency managment

child protection referral

435
Q

what is expected of dental team in neglect cases

A

observe, record, communication (raise concenrs), refer for assessment

436
Q

index of suspicion in child neglec

A

dela in tx

story changing/vague/doesn’t match presentation of injuries

unusual pattern of injuries (bilateral soft tissue etc)

unusual child/carer interactions

concenring behaviour (pre-occupied, detached, concerning)

437
Q

principles of radiaiton protection

A

Justification

  • any exposure must benefit pt/provide new information for dx/tx planning

Optimisation

  • ALARP

Dose limitation_​_

  • for radiation workers and members of public, achieved via rectangular collimation, high KVp, rare-earth screens, digital/fast film speed
438
Q

IRMER people

A

Employer, referrer, practitioner (authorisation, justification, optimisation), operator (dose limitation)

439
Q

blue image receptor holder

A

anterior PA

440
Q

yellowimage receptor holder

A

posterior PA

441
Q

redimage receptor holder

442
Q

greenimage receptor holder

443
Q

paralleling technique for PA

A

image receptor and object parallel but not in contact. Some distance apart, so long fsd used to reduce magnification

444
Q

bisecting angle technique for PAs

A

image receptor and object in partial contact but not parallel. Beam 90o to bisceting line, halfway between long axis of tooth and plane of image receptor

445
Q

Bitewing technique

A

image receptor parallel to line of arch.

Front edge of film packed mesial to 3/4 contact.

collimation, tube head alignment

446
Q

reasons for OPT

A

trauma

development of dentition

can’t tolerate IO x-rays

447
Q

cons of OPT

A

inc exposure time

position difficulties

448
Q

technique for OPT

A
  • Mid sagittal plane centred,
  • Frankfort plane horizontal (parallel to floor).
  • vertical canine line shines on U3,
  • hold handles,
  • bite on bite block,
  • tongue to palate,
  • no jewellery/dentures
449
Q

focal through

factors affect it

A
  • layer in pt containing structures of interest, demonstrated with sufficient resolution to be recognisable

Factors

  • distance from rotation centre, x-ray beam width
450
Q

OPT stretched/magnified horizontally

A

canines behind vertical canine line (too close to x-ray source) and not corrected

451
Q

ghost image features

A

interfere with dx

  • reflected onto opposing side of image
  • always horizontally magnified
  • higher
452
Q

x ray production

A
  • X-rays are produced by the rapid deceleration of electrons.
  • Electrons fired at atoms at high speed and collide (lower electron speeds), releasing kinetic energy, which is converted into EM radiation (x-rays) and heat.
  • X-ray photon is the aimed at subject
453
Q

tube head

A
  • Filament - provides current for x-ray production
  • Target - focal spot
  • Lead – shielding
  • Aluminium – filtration
  • Rectangular collimator - reduce scatter, reduce area irradiated
  • Spacer cone - controls target fsd
454
Q

attenutaion and appearance

A
  • No attenuation - black - pass through unaltered
  • Partial - grey - absorbed and scattered (partially absorbed)
  • Complete - white - complete absorption, electron energy lost in tissues
455
Q

photoelectric effect

A
  • Low energy phenomenon.
  • Photon interacts with inner shell electron and so the photon energy is just greater than the electron binding energy.
  • Photon energy used to eject electron.
  • Atom rearranges, releasing energy as characteristic spectrum radiation.
  • Outer void filled by colliding photon (as it has delivered its total energy to a single electron and is completely absorbed)
456
Q

effect of dose on image quality for photoelectric effect

A

inc in dose and inc in image quality

457
Q

compton scatter

A
  • Mid energy phenomenon.
  • Photon interacts with loosely bound electron and so the photon energy is much greater than the electron binding energy.
  • Photon collides with electron, ejecting it.
  • Atom rearranges, releasing energy as continuous spectrum radiation.
  • Outer void filled by free electron capture.
  • During collision, the photon loses some of its energy (decelerated) and is deflected/ scattered (recoil electron), free to interact with other atoms.

Effect

  • Photons scattered backwards after the image receptor may reach the image receptor and contribute to darker image
458
Q

how to reduce compton scatter

A

collimation

lead foil lining packets

459
Q

effect on dose of image quality for compton scatter

A

inc in dose, no inc in image quality

460
Q

absorbed dose

A

energy impaired by radiation to unit mass of tissue

461
Q

how to reduce absorbed dose

A

higher kVp (higher energy photons, less absorbed)

462
Q

pros and cons of digital radiographs

A

Pros

  • Image enhancement
  • Instant image production
  • Dose reduction
  • Constant quality
  • No chemicals/processing

Cons

  • Expensive
  • Large size of image receptors
463
Q

solid state sensors

A
  • image detected on photomultiplier.
  • Direct link to computer,
  • active area smaller than film
464
Q

PSP digital film

A
  • latent image stored after x-ray exposure, transferred from sealed packet, laser scanning, light emission, electronic signal.
  • Flexible plate,
  • variable light sensitivity
465
Q

lateral cephalogram

A

standardised and reproducible true lateral view of facial bones, base of skull and upper cervical spine

also shows sinus and soft tissues

466
Q

EO reference lines in lat ceph

A
  • MS reference line/plan
  • FP
  • Pupillary line
  • OM line
467
Q

indications for lat cep

A
  • Pts with skeletal AP/vertical discrepancies
  • Monitor and check growth
  • Ortho pt
468
Q

technique for lat ceph

A
  • X-ray tube head and cephalostat lined up with image receptor,
  • thyroid collar,
  • FP horizontal, MS plane vertical and 5ft from source, centric occlusion,
  • ear rods in EAM, nation support, magnification scale in image
469
Q

lead foil role in xray film

A

absorb scatter xrays, preventing image degradation

470
Q

intensifying screen role

radiogrpahs

A

fewer photons, reduce dose and image quality

471
Q

processing chemical stages

A

development

rinse

fixation

wash

dry

472
Q

darker image made why?

A

inc time/temp/concentration

473
Q

localisation in x rays

indications

requirements

A
  • Unerupted tooth position
  • Trauma
  • Root/canal location

requirements

  • Stable reference point
  • Horizontal/vertical tube shift (for non-right angle views)
474
Q

parallax

A
  • Apparent change in position in object caused by real change in position of observer
475
Q

functional occlusion

A

absence of pathology and free from interference to smooth-gliding mandible movements

476
Q

mutually protected occlusion

A

gold standard

canine guidance

posterior disclusion in excursion, no working/non-working side contacts, no protrusive interference

477
Q

anterior/canine guidance

A

reproducible, protects posterior teeth

478
Q

group function guidance

A

occlusion of multiple working side posterior teeth during excursion

479
Q

noraml occlusal forces

A
  • Forces directed down long axis of tooth,
  • only for few mins/day,
  • ICP in chewing and swallowing,
  • light forces,
  • protective neuromuscular reflexes prevent injury
480
Q

parafunction occlusal forces

A
  • Purposeless grinding and clenching.
  • Forces may be horizontally directed,
  • heavier forces,
  • neuromuscular reflexes don’t work,
  • long duration,
  • damaging
481
Q

posselt’s envelope

A

extremes of mandibular movement in sagittal plane

ICP - maximum interdigitation of teeth
RCP - guided tooth position. First tooth-tooth contact on retruded arc of closure, when condyles are in their most superior anterior position in their fossa
R - maximum opening position of rotation (when condyles are in their most superior anterior position in their fossa)
T - maximum opening position of mandible. Condyles leave their fossa and slide over the articular eminence
Pr - protrusion. Position when mandible pushed as far forward as possible, so lower incisors occlude anterior to upper incisors
E - edge-to-edge. Position when upper central incisor incisal edges occlude with lower central incisor insical edges

482
Q

rest position

A

maxilla-mandibular relationship when patient relaxed and sitting upright. Teeth slightly apart (interocclusal clearance), TMJ in fossa

483
Q

freeway space

A

difference between OVD and RVD/ICP and rest position

2-4mm normal

484
Q

pros of veneers

A

close/hinge gaps and spaces

preferentially change shape/contour of teeth

485
Q

contraindication to veneers

A

interproximal caries

severaly rotated teeth

severe NCTSL

heavy occlsual contacts

486
Q

indications for onlays/inlays

A

cusp

replace failing indirect restoration

posterior tooth with access difficulties

487
Q

contraindications for onlays/inlays

A

active caries

active perio disease

time consuming

expensive

488
Q

pros of crowns

A

protect weakened tooth structure

improve and restore function and aesthetic

489
Q

contraindications for crowns

A
  • Active caries
  • Active perio disease
  • Lack of tooth tissue remaining
490
Q

principles of crown prep

A
  • Tooth preservation
  • Resistance and retention forms (6 degree taper)
  • Structural durability
  • Marginal integrity
  • Perseveration of periodontium
  • Aesthetic considerations
491
Q

reduction for metal/cast metal crown

A

0.5mm axial reduction, 0.5mm non-functional cusp reduction, 1.5mm functional cusp reduction, 0.5mm chamfer finish line

492
Q

reduction for feldspathic ceramic/PJC crown

A

1.0mm axial reduction, 1.0mm non-functional cusp reduction, 1.5mm functional cusp reduction, 1.0mm shoulder finish line

493
Q

reduction for MCC crown

A

1.3mm axial reduction, 1.3mm non-functional cusp reduction, 1.8mm functional cusp reduction, 1.3mm labial/buccal shoulder (0.4mm metal + 0.9mm porcelain) and 0.5mm chamber (metal) finish lines

494
Q

reduction for core-strengthened ceramic (alumina/zirconia) crown

A

1.5mm axial reduction, 1.5mm non-functional cusp reduction, 2mm functional cusp reduction, 1-1.5mm chamfer finish line

495
Q

pros of provisional restoration

A
  • Restore tooth characteristics
  • Improve function
  • Restore aesthetic
  • Prevent sensitivity
  • Prevent over eruption
  • Restore tooth as functional unit
496
Q

types of provisional restorations

A
  • Custom
    • Bis-acrylic (resin)
      • Excellent fit
      • Restores tooth to pre-prepared character
      • More expensive for pt
      • Technique sensitive
  • Preformed
    • Metal, plastic, polycarbonate
      • Good for trauma cases/no pre-preparation impression
      • Cheaper for pt
      • Large bank needed (expense)
      • Unlikely to fit accurately
497
Q

anterior endo tx tooth resoration options

A

composite/veneer - marginal ridge intact

crowns - margingal ridge destroyed

498
Q

posterior endo tx tooth restoration options

A

inlay/crown and composite core

499
Q

residual dentine collar

500
Q

ferrule

A

residual dentine collar left after crown prep that helps to prevent #

1.5 mm height and width

501
Q

core

A

provides retention for crown, strengthen the tooth when there is an inadequate amonth of sound tooth tissue remaining to retain a conventional crown - composite, amalgam

502
Q

post

A

placed in root, retains core

dose not strengthen/reinforce tooth (post preparation weakens tooth)

503
Q

ideal features of posts

A

parallel sided (non tapered)

non threaded (passive)

cement retained

504
Q

types of post

A

Fibre

  • bonds to dentine like composite, good aesthetics, radiolucent

Ceramic

  • high flexural strength, good aesthetics, difficult to retrieve

Metal

  • poor aesthetics, radiopaque, may cause root #
505
Q

post placement considerations/ideals

A
  • 1:1 post/crown ratio
  • aim for longest/straightest canal
  • at least 1/2 of post into root
  • 4-5mm GP apically to maintain apical seal
  • <1/3 of root width
506
Q

extrinsic staining

A

smoking

tanins

CHX

iron supplements

507
Q

intirinsic staining

A

fluorosis

tetracycline

amalgam/materials

loss vitality

508
Q

before bleaching try

A

HPT

scaling

509
Q

process of extrinsic discolouration and bleaching

A

Discolouration caused by formation of chemically stable chromogenic products on tooth surfaces.

Bleaching causes oxidation through H2O2.

This causes the formation of smaller molecules,

  • which are often colourless/not pigmented,
  • as well as ion exchange with metallic molecules, leading to a lighter colour
510
Q

bleaching gel constituents

A

Carbamine peroxide

  • active agent. Breaks down to form H2O2 and urea

Urea

  • stabilises H2O2, increases pH

Carbapol

  • thickening agent. Increases adherence of H2O2 to surface of tooth and slows diffusion into enamel

Fluoride

  • desensitising agent, prevents erosion
511
Q

max carbamide peroxide conc in bleaching agents

A

16.7%

breaks down into 10% H2O2

512
Q

bleaching indications

A
  • Post smoking cessation
  • Fluorosis
  • Age related discolouration
  • Non vital, good RCT and no PAP
  • Tetracycline
513
Q

bleaching contraindications

A
  • Painful sensitivity
  • G6PD deficiency
  • <16 yrs
  • Heavily restored tooth
  • Smokers
  • Amalgam staining
514
Q

side effects of bleaching

A
  • Sensitivity
    • pre-existing
    • inc conc of bleaching agent
    • gingival recession
    • inc time use
    • method
    • frequency of change
  • Gingival irritation
  • Might not work
  • Wears off/relapse
  • Cervical resorption
515
Q

external vital bleaching procedure

A

chairside

  • dam, apply bleach to tooth, heat/light/laser (dehydrates tooth, better initial effects), wash, dry, repeat

Home

  • impressions for custom trays (1mm short of gingival margin, with buccal spacer);
  • brush teeth, floss, load 1mm bleaching gel into buccal portion of trays, fit trays for 2hrs (ideally overnight), repeat
516
Q

non vital bleaching procedure

A
  • Remove restoration and GP to 1-2mm below ACJ,
  • RMGIC coronal seal.
  • Place 10% CP gel and cotton wool in coronal space, seal with GIC.
  • Replace weekly, then restore palatal cavity
517
Q

external cervical resorption occurs how

how to prevent

A

Diffusion of high concentration of H2O2 through dentine into perio tissues and application of heat.

  • Prevent by using adequate RMGIC restorations at ACJ
518
Q

combination bleaching procedure

A

inside outside

  • Internal non-vital + home external vital.
    • Place CP in coronal space as well as in tray (create palatal reservoir).
    • Replace frequently over the week
519
Q

micro abrasion

A

Removal of stained enamel (outer layer/ superficial)

  • Dam, apply 18% HCl and pumice mix to teeth, rub in with prophylactic cup for 5s/tooth, wash, dry, repeat, remove dam, fluoride prophy paste to seal tubules
520
Q

indications for micro abrasion

A
  • Post ortho demineralisation
  • Mild fluorosis
  • Dark staining pre-veneering
521
Q

con of micro abrasion

A

over use = yellowing teeth (dentine shows through) and/or permanant sensitivity

522
Q

what can be used more accessibly if no HCl for bleaching

A

phosphoric acid

only removes 10um Vs 100um

etch 30secs prior to apply acid pumic mux for 30s/tooth (longer)

523
Q

regulations for teeth whitening

A
  • OTC <0.1%.
  • 0.1-6% - only dentists.
  • Not for <16yrs, except only where intended wholly for prevention of disease.
  • >6% only where intended wholly for prevention of disease.
  • >0.1% can be collected from dentist for home use after first cycle
524
Q

indications for extractions

A

traumatic tooth position

unrestorable tooth

symptomatic partially erupted tooth

orthodontic considerations

525
Q

tooth may be unrestorable because

A

gross caries

advanced periodontial disease

tooth/crown/root #

pulp necrosis

526
Q

pre-extraction complications

A

medication history precludes extractions (uncontrolled bleeding condition, unsuitable blood results)

pre-operative radiograph shows tooth ankylosed to bone

pt refuses consent/unable to consent

proximity to imp anatomical structures

tooth position inadequate for access/limited mouth opening

527
Q

peri operative complications

A
  • Bleeding/haemorrhage
  • Nerve damage
  • OAC
  • Damage to adjacent tooth/restoration
  • Lost tooth
  • Tooth #
528
Q

access/vision difficulties

A
  • Limited mouth opening (reduced aperture)
  • Trismus
  • Crowded/malpositioned teeth
529
Q

abnormal resistance

A
  • Hypercementosis
  • Ankylosis
  • Long/divergent/increased number of roots
  • Thick cortical bone
530
Q

causes of tooth #

A

caries

alignmenet

root

size

misdirection of force

531
Q

causes of jaw #

A

misdirection of force

atrophic mandible

cyst in bone

impacted 8

532
Q

signs/symptoms of jaw #

A

crack

step (visual/palpable)

tear in gingiva at # line

abnormal disclusion

533
Q

managament of jaw #

A

immediate analgesia (LA block)

radiograph (OPT/occlusal)

refer

provide analgesia and AB

if required, stabilitse (tie free end of bone to teeth opposite # line and teeth together)

534
Q

alveolar # management

A

suture

disect free smooth edges

535
Q

TMJ dislocation management

A

relocate (condyles down and back)

536
Q

OAC Dx tools

A

direct vision (aspiration, good lighting - blood bubble at base of pocket)

nose blow test - hold nose, gently blow

blunt probe

radiograph

537
Q

managment of OAC

A

if small/lining in tact - encourage clot, suture margins

if large/lining torn - buccal advancement flap

538
Q

pt instructions for OAC

A

don’t dislodge clot

no straws

avoid wind instruments for 2 weeks

dont rinse today

warm salt water mouth wash from tomorrow

avoid nose blowing - closed sneezing/stifle sneezing

steam inhalation

539
Q

maxilary tuberosity # causes

A

extraction in wrong order (front to back)

last standing molar

unknown unerupted 8

540
Q

signs/symptoms of maxilary tuberosity #

A

loose/mobile tuberosity/tooth

tear in palate

noise

541
Q

managemenet of maxilary tuberosity #

A

small - remove and close

large - reduce and stabilise- replace, RCT tooth adn ensure occlusion free then surgically remove 8weeks later

542
Q

how to retrieve rooth from antrum

A

suction (narrow bore)

small curette

irrigation

ribbon gauze

543
Q

management of lost tooth

A

stop, search for it

inhalation? A&E for chest x ray

contact indemnity

544
Q

causes of damage to adj tooth/restoration

A

using tooth to lean on with elevator

forceps slip and hit opposing tooth

restoration overhang in contact with tooth to be extracted

545
Q

management of damage to adj tooth/restoration

A

temporary restoration

arrange definitive

546
Q

causes of broken instruments

A

instrument fatigue

incorrect use (using luxator as an elevator etc)

547
Q

management of broken instruments

A

retrieve

radiogrpah to confirm

refer if unable to retrieve

548
Q

types of nerve injuries

A

crush injuries

cutting/shredding injuries

transection injuries

549
Q

effects of nerve damage options

A
  • Anaesthesia
  • Dyaesthesia
  • Paraesthesia
  • Hyperaesthesia
  • Hypoaesthesia
550
Q

neuropraxia

A
  • Temporary loss of function due to blockage in nerve conduction
  • Bruise/contusion
  • Epineural sheath and axons maintained
551
Q

axontmesis

A
  • Gradual loss of function distal to injury site
  • More severe contusion/crush
  • Epineural sheath disrupted, axons maintained
552
Q

neurotemesis

A
  • Most severe type
  • Transection
  • Complete loss of nerve continuity
  • Epineural sheath and axons disrupted
553
Q

reasons for bleeding/haemorrhage

A
  • Medication side effects
  • Undiagnosed/unmanaged clotting abnormality
  • Liver disease/dysfunction
  • Local factors (mucoperiosteal tear etc)
554
Q

soft tissue management for bleeding/haemorrhage

A
  • Bite on damp gauze
  • Introduce haemostatic agents
  • Suture
  • Diathermy
  • Haemostatic forceps/artery clips
555
Q

bone managent for bleeding/haemorrhage

A
  • Bite on damp gauze
  • Introduce haemostatic agents
  • Bone wax
  • Pack
  • suture
556
Q

haemostatic agents can use

A
  • oxidised regenerated cellulose (surgicel)
  • adrenaline-containing LA (on pledget/gauze/into socket)
  • fibrin foam
  • thrombin liquid
557
Q

basic prinicples of minor oral surgery

A
  • maximal access with minimal trauma
  • clean flap reflection down to bone
  • keep tissues moist
  • no crushing injuries to tissues
  • aim for healing by primary intention to minimise scarring
  • re-approximate tissues
558
Q

features of flap design

A
  • use scalpel in one, continuous motion
  • no sharp angles
  • ensure tension-free closure (relieving incision)
  • consider antibiotics
  • achieve haemostasis
  • aim for healing by primary intention to minimise scarring
559
Q

methods of soft tissue retraction

A

rake retractor

howarth’s periosteal elevator

560
Q

reasons for soft tissue retractions

A

improve access to field

protect soft tissues

561
Q

elevator functions

A

loosen/remove teeth

remove retained roots

562
Q

3 modes of use for elevators

A

wheel and axle

wedge

lever

563
Q

handpiece to use in oral surgery

A

electric straight handpiece with saline-cooled straight/fissure tungsten carbide bur

  • air driven à surgical emphysema – don’t use
564
Q

6 possible methods of debridement

A
  • handpiece,
  • bone file,
  • mitchell’s trimmer
  • Victoria curette
  • Irrigation (under flap)
  • Aspiration (under flap)
565
Q

6 aims for suturing

A
  • Achieve haemostasis
  • Prevent wound breakdowns
  • Re-approximate tissues
  • Aim for healing by primary intention to minimise scarring
  • Cover bone
  • Ensure margins and sutures lie on sound bone
566
Q

possible nerve damage during extraction of L8

A

inferior alveolar

lingual

buccal

nerve to mylohyoid

567
Q

pain pathway

A

trauma causes release of arachidonic acif from cell membranes

interacts with COX to activate PGG2 adn PGH2 (activated PGE2)

causes release and influx of inflammatory products (pain, swelling, red)

568
Q

features of aspirin

A
  • Analgesia – COX inhibitor
  • Antipyretic – reduces raised temp in fever
  • Anti-inflammatory – reduces production of PGs
  • Metabolic – reduces platelet aggregation, raises BMR
569
Q

side effects of aspirin

A

mucosal burns

antiplatelet - thins bloods

GI upset

570
Q

contraindications to aspirin use

A

not for use with other NSAIDs

antiplatelet/anticoagulant

peptic ulcer

pregnant/under 16/ breast feeding (Reye’s)

571
Q

ibuprofen is

A

NSAID

less effect on platelets and gastric mucosa than aspirin

572
Q

side effects of ibuprofen

A

dizzy

headache

tired

GI upset

573
Q

contraindications for ibuprofen

A

not for renal/hepatic impairment

other NSAID use

long term steroids

peptic ulcer

574
Q

paracetamol action

A

indirectly inhibits COX by reducing PGs in CNS pathway

575
Q

contraindications for paracetamol

A

not for renal/hepatic impairment

alcoholic

576
Q

dental opioid

A

dihydrocodeine

577
Q

contraindications to opioids

A

not for raised ICP (head injury)

acute alcoholism

578
Q

problems associated with opioids

A

tolerance and dependence

579
Q

possible post extraction complications

A
  • bruising
  • swelling
  • pain
  • bleeding
  • dry socket
  • OAF
  • Trismus
  • Infected socket
  • ORN
  • MRONJ
580
Q

pain/swelling/brusing post extraction why?

A
  • Poor technique (trauma)
  • Rough tissue handling
  • Tear in gingiva/mucoperiosteum
581
Q

trismus is

A

limited mouth opening due to muscle spasm

582
Q

possible oral surgery reasns for trismus

A

surgical reasons (open too long, muscle spasm)

LA into muscle (masseter)

haematoma in muscle

583
Q

management of trismus

A

soft diet

CHX mouthwash

gentle opening techniques (wooden spatulas, trismus screws)

584
Q

OAF

A

oro antral fistula

occurs secondary to OAC

if OAC incorrectly heals/doesn’t heal

formation of epithelial lined tract between antrum and mouth

585
Q

Tx OAC

A

remove tract

suture closed

586
Q

types of post op bleed

A

Immediate

  • reactionary/rebound (vessels not being compressed anymore), within 48hrs, usually ooze

Delayed

  • usually 3-7 days post, often due to infection
587
Q

management of post op bleed

A
  • Rapid history
  • Remove jelly like residue
  • Identify source
  • Same as peri-op management
    • If cant get haemostasis à A&E
588
Q

pt instructions about bleeding

A

don’t rinse that day

don’t smoke

no alcohol/excessive exercise

bleeding management - bite on gauze for 20 mins continuously

emergency number

589
Q

dry socket a.k.a

A

localised osteitis

alveolar osteitis

590
Q

predisposing factors to dry socket

A
  • posterior tooth
  • mandibular tooth
  • smoking
  • excessive pre and post extraction rinsing
  • female
  • OCP
  • Previous dry socket
  • FH of dry socket
591
Q

signs/symptoms of dry socket

A
  • Continuous intense throbbing pain (dull throb – kept awake at night)
  • May radiate to ear/jaw
  • Malodour/halitosis
  • No signs of infection
  • Exposed sensitive bone
592
Q

management of dry socket

A
  • Ensure no remaining tooth/sequestrum
  • Analgesia – LA
  • Irrigate to remove food trapped and clean
  • Debride
  • Encourage clot formation
  • Suture
593
Q

pt instructions about dry socket

A
  • Warm salt water mouth wash from next day
  • No excessive rinsing
  • Don’t dislodge clot
594
Q

sequestrum

A

piece of dead bone formed within diseased/injured bone

595
Q

how to manage sequestrum

596
Q

infected socket

A

rare bacterial infection with pus discharge causing delayed healing

597
Q

management of infected socket

A

clean socket/drain pus

irrigate

radiograph

debride

suture

598
Q

osteomyelitis

A

inflammation of bone marrow

599
Q

progression of osteomyelitis

A

medullary cavity to cancellous bone to cortoical bone to periosteum

bacteria invade bone, cause local soft tissue necrosis and ischaemia

600
Q

predisposing factors for osteomyelitis

A

mandible

odontogenic infection

immunocompromised

comorbitidies

601
Q

3 types of osteomyelitis

A

early

acute suppurative

chronic +/- pus

602
Q

management of osteomyelitis

A

refer

blood test

surgery

603
Q

radiographic appearance of osteomyelitis

A

mottled bone

sequestrum

involucrum

604
Q

osteoradionecrosis

starts how

A

high dose radiation induces local enarteritis obliterans which leads to progressive fibrosis and capillary loss, leaving bone susceptible to avascular necrosis

  • mandible more likely as thicker bone and poorer blood supply
605
Q

prevention and tx of ORN

A
  • hyperbaric oxygen
  • pre-op scaling
  • CHX mouthwash use
  • Good OH
  • Atraumatic technique
  • Suture (primary healing)
  • Resect necrotic bone
  • Antibiotics
606
Q

MRONJ

A

Medicated-induced osteonecrosis of the jaw.

  • Reduced bone turnover (inhibition of osteoclastogenesis).
    • New bone formed faster than old bone lost

High risk category

  • Oral/IV bisphosphonates (or RANKL inhibitors) for non-malignant bone conditions for >5yrs
  • Oral/IV bisphosphonates (or RANKL inhibitors) for any length of time in combination with systemic glucocorticoids
  • Anti-angiogenic/anti-resorptive drugs involved in cancer treatment/management
  • Previous MRONJ
607
Q

stages of MRONJ

A

Stage 0

  • symptomatic, no necrotic/exposed bone

Stage 1

  • asymptomatic, necrotic bone/fistula that probes to bone

Stage 2

  • symptomatic, infection, necrotic bone/fistula that probes to bone

Stage 3

  • necrotic bone/fistula that probes to bone with one/more of: EO fistula, OAC, necrosis extends beyond alveolus, osteolysis extending to border of mandible/sinus
608
Q

bacteria involved in actinomycosis

A

a.israelli/vicosus

609
Q

actinomycosis is unique how

A

erodes through tissue, doen’t follow fascial planes

610
Q

management of actinomyocosis

A

refer

antibiotics

long term antibiotics to prevent

611
Q

infective endocardititis

A

bacterial inflammation of endocardium, particularly affecting heart valves

Management

  • Consult with cardiologist
  • Consider antibiotic prophylaxis -> SDCEP
612
Q

high risk category for IE

A
  • Previous IE
  • Cyanotic CHD
  • Prosthetic valve (replacement surgery)
613
Q

5 URA disloding forces

A

gravity

muscles/tongue

active component

speech

mastication

614
Q

HSSW made by

A
  • drawing cold state metal through a series of successively smaller diameter dies
  • also causes work hardening, increasing springiness
615
Q

steel fractures by

A
  • overwork
  • mechanical abrasion/crushed/marked
  • fatigue
  • weld decay
616
Q

3 ortho appliance categories and how they work

A
  • removable - tipping
  • functional – influences orofacial muscles and dentoalveolar development
  • fixed – rotational, torque, bodily movement (all)
617
Q

ARAB

A

Aim

  • Active components
    • 0.5mm HSSW.
    • Any component that uses force to move a tooth/teeth. 1-2 at a time
  • Retentive
    • 0.7mm HSSW.
    • Resistance to displacement forces
  • Anchorage
    • resistance to unwanted tooth movements
  • Base-plate
    • self-cure PMMA (quicker, cheaper, sufficient mechanical properties).
    • Provides anchorage, connector, retention through adhesion-cohesion
618
Q

active component

A

any component that uses force to move a tooth/teeth

1-2 teeth at a time

619
Q

retentive component

A

resistance to displacement forces

620
Q

anchorage

A

resistance to unwanted tooth movement

621
Q

base plate

A

provides anchorage, connector, retention through adhesion-cohesion

622
Q

URA fitting

check

A
  • Check for right patient,
  • check design matches prescription,
  • check for sharp areas,
  • check for pre-existing damage,
  • try in and check for trauma/blanching,
  • check posterior retention (flush flyover, then check arrowhead engages undercuts),
  • check anterior retention,
  • activate appliance for 1mm movement per month (uncoil spring coils),
  • demonstrate to patient how to get it in and out,
  • get patient to demonstrate putting in and taking out,
  • review every 4-6 weeks to reactivate active components
623
Q

URA fitting

pt instructions

A
  • URA is big and bulky but will get used to it,
  • might affect speech so practice reading out loud for speech,
  • excess salivation but only for first 24 hours,
  • might be achy and mild discomfort – means it is working,
  • avoid hard and sticky foods,
  • be careful with hot foods and hot drinks,
  • wear all the time,
  • take out if doing contact/active sports,
  • take out and clean after every meal,
  • poorer compliance = longer treatment,
  • emergency contacts – if something breaks off, get in touch
624
Q

retract canines and reduce OB

A
  • Palatal fingersprings and guards (0.5mm HSSW)
  • 16+26 Adams clasps, 11+21 Southend clasp (0.7mm HSSW)
  • FABP OJ+3mm
625
Q

retract and distalise canines

A
  • Buccal canine retractors (0.5mm HSSW) and 0.5mm ID tubing
  • 16+26 Adams clasps, 11+21 Southend clasp (0.7mm HSSW)
  • FABP OJ+3mm
626
Q

anterior crossbite

A
  • Z-spring (0.5mm HSSW)
  • 14+24+16+26 Adams clasps (0.7mm HSSW)
  • PBP
627
Q

posterior crossbite /expand upper arch

A
  • Midline palatal screw
  • 14+24+16+26 Adams clasps (0.7mm HSSW)
  • Reciprocal anchorage
  • PBP
628
Q

reduce OJ/continue to reduce OB

A
  • Roberts retractors (0.5mm HSSW) and 0.5mm ID tubing
  • 13+23 mesial stops (0.7mm flattened HSSW)
  • 16+26 Adams clasps
  • FABP
629
Q

aims of ortho tx

A

stable

functional

aesthetic occlusion

aid other tx

630
Q

indication for ortho tx

A

inc risk of trauma/disease

impaired oral function

unesthetic/psychological

631
Q

contraindications to ortho tx

A

uncontrolled epilepsy

poorly controlled diabetes

poor attendance/motivation

poor OH

632
Q

benefits of ortho tx

A

reduce risk of trauma/disease

improves function, aesthetics, dental health

633
Q

risks of ortho tx

A

decalcification

relapse

root resorption

634
Q

limitation of URA

A

teeth only stable in neutral zone (may relapse)

no/minimal effect on skeletal patterns

movement limited by shape and size of alveolar process

635
Q

ideal occlusion

A
  • Gold standard by which occlusal irregularities and treatment may be judged.
  • Anatomically perfect, class I relationships
636
Q

normal occlusion

A

minor deviations from ideal that do not constiture functional/aesthetic problem

637
Q

malocclusion

A

more significant deviations from ideal that may be considered functionally/aesthetically unsatisfactory and may require treatment

638
Q

Andrew’s 6 keys of ideal occlusion

A
  • Correct molar relationship
  • Correct crown angulation
  • Correct crown inclination
  • Absence of rotations
  • Tight proximal contacts/ no spaces
  • Flat occlusal plane
639
Q

BSI class I

A

lower incisor edges occlude with/lie immediately behind cingulum plateau of upper central incisors

640
Q

BSI class II

A

lower incisor edges lie posterior to cingulum plateau of upper incisors

  • Class II div. 1 - upper incisors are proclined/of average inclination. Increase in overjet
  • Class II div. 2 - upper central incisors are retroclined. Overjet usually minimal/may be increased
641
Q

BSI class III

A

lower incisor edges lie anterior to cingulum plateau of upper incisors. Overjet reduced/reversed

642
Q

Angle’s class I

A

neutrocclusion

MB cusp of U6 occludes with buccal groove of L6

643
Q

Angle’s class II

A

distocclusion

buccal groove of L6 occludes distal to class I position. Post-normal relationship

644
Q

Angle’s class III

A

mesiocclusion

buccal groove of L6 occludes mesial to class I position. Pre-normal relationship

645
Q

canine class I

A

U3 cusp occludes between L3/4 contact/with embrasure between L3/4

646
Q

canine class II

A
  • U3 occludes mesial to L3/4 embrasure
647
Q

canine class III

A

U3 occludes distal to L3/4 embrasure

648
Q

crossbite can be

A
  • Buccal or lingual
  • Anterior or posterior
649
Q

overjet

A

extent of horizontal (AP) overlap of upper central incisors over lower central incisors

650
Q

overbite

A

extent of vertical overlap of upper central incisors over lower central incisors

normal if uppers cover 1/3 or more of lower when in occlusion

651
Q

methods of anterio-posterior skeletal base assessment

A

visual

palpate skeletal bases

ANB on lat ceph

652
Q

methods of vertical skeletal base assessment

A

FMPA

anterior face height

653
Q

method for transverse skeletal base assessment

A

mid sagittal reference line

654
Q

skeletal AP classification

A
  • Class I - maxilla 2-3mm in front of mandible
  • Class II - maxilla >3mm in front of mandible
  • Class II - maxilla <2mm/behind mandible
655
Q

cephalometric values for AP

A

Class I - SNA - 81±3, SNB 78±3, ANB 3±2, FMPA 27±4

Class II - SNA increased/average, SNB reduced, ANB >5 (4-6 mild, 6-8 moderate, >8 severe)

Class III - SNA reduced, SNB average/increased, ANB<1 (0-2 mild, 0-(-3) moderate

656
Q

long face

A

LAFH >55% of AFH

FMPA >31

anterior open bite tendency

657
Q

short face

A

LAFH <55% of AFH

FMPA <23

deep overbite tendency

658
Q

local malocclusion

A

more significant deviations from ideal that may be considered functionally/aesthetically unsatisfactory and may require tx, confined to one/few teeth in one arch

659
Q

possible reasons for local malocclusion

A

supernumerary

hypodontia

retained primary teeth

early loss of permanent teeth

micro/macrodontia

660
Q

4 classes of supernumeries

A

odontoma (complex, compound)

supplemental

tuberculate

conical

661
Q

differential pressure theory of tooth movement

A

intermittent forces lead to areas of pressure and tension, cause bone resorption (pressure side) and bone deposition (tension side), causing teeth to be moved in the direction the force is pressing in

662
Q

mechano-chemical theory of tooth movement

A

pressure causes chemical release causing resorption/deposition

663
Q

piezo-electric theory of tooth movement

A

pressure causes electric current generation causing resorption/deposition

664
Q

force needed for tipping tooth movement

665
Q

force needed for bodily tooth movement

666
Q

force needed for intrusive tooth movement

667
Q

force needed for extrusive tooth movement

668
Q

force needed for rotation tooth movement

669
Q

force needed for torque tooth movement

670
Q

light forces

pathophysiology

A
  • PDL hyperaemia,
  • osteoclasts and osteoblasts appear,
    • resorption of lamina dura from pressure side,
    • apposition of osteoid on tension side,
  • remodelling of socket,
  • PDL fibres reorganise
671
Q

moderate forces

pathophysiology

A
  • Occlusion of PDL vessels on pressure side and PDL vessel hyperaemia on tension side,
  • pressure side hylinisation (cell-free area),
    • period of stasis,
  • undermining resorption (increased endosteal vascularity),
  • relatively rapid movement of tooth with bone deposition on tension side (mobility),
  • healing of PDL – reorganisation and remodelling
672
Q

heavy forces

pathophysiology

A
  • necrosis
  • undermining resorption
  • root surface resorption
  • pain
  • permanent change
673
Q

factors affecting response to orthodontic force

A
  • magnitude
  • duration
  • age
  • anatomy
674
Q

facial growth IUL

675
Q

2 areas of skull

A

viscerocranium (face)

neurocranium (vault and base)

676
Q

neurocranium growth

A

intramembranous ossification vault

endochondral ossification base

677
Q

unique jaw growth

A

develop intramembranously, but adjacent to/preceded by cartilaginous skeleton (nasal capsule and Meckel’s capsule)

678
Q

5 units of mandible

A
  • condylar
  • coronoid (in response to temporalis)
  • angular (in response to masseter and medial pterygoid)
  • alveolar (in response to teeth)
  • body (in response to IAN)
679
Q

growth of skull vault when born

A

at fontanelles/sutures (anterior closes at 2, posterior closes at 1).

Growth at sutures until 7 and then external surface deposition/internal surface resorption

680
Q

growth of skull base

A

Cartilaginous growth centres between sphenoid and occipital bones and in nasal septum

681
Q

3 sites of secondary cartilage formation in mandible

A
  • Condylar
  • Coronoid
  • Symphysis
682
Q

primary abnormality is

A

anomaly in development causes sutrual defect

683
Q

secondary abnormality is

A

external influence interrups/stops normal development

684
Q

deformation

A

anomaly due to external mechanical effect on existing structure

685
Q

agenesis

A

failure to form/develop (absent)

686
Q

sequence

A

single factor cause numerous secondary effects

687
Q

syndrome

A

group of anomalies with common origin

688
Q

types of embryonic stage syndromes

A

foetal alcohol syndrome

hemifacial microsomia

treacher collins

cleft lip and palate

689
Q

foetal alcohol syndrome

A

small head, cognitive impairment, short nose

690
Q

hemifacial microsomia

A

spectrum of facial asymmmetry

691
Q

Treacher Collins syndrome

A

mandibulofacial dysostosis

hypoplastic/missing zygomatic arch, mandible

692
Q

cleft lip and palate

can cause

A

crowding, hypoplastic teeth, ‘nick’ out of lip, caries

693
Q

syndromes associated with skull growth

A

achondropasia

Crouzon’s

aperts

694
Q

achondropasia

A

problems with endochondral ossification

stunted growth, flat bones develop normally (large vault), base of skull defects

695
Q

Crouzon’s

A

early closure of cornal and lambdoid sutures

proptosis, prominents nose, class III

696
Q

Apert’s

A

early closure of almost all cranial sutures

parrot beak, acrosyndactyly, AOB, CLP (30%)

697
Q

places of post natal growth

A

cranial sutures

base of skull synchondrosis

surface deposision beneath periosteum

698
Q

forward adverse growth factor affect

A

short face (chin up)

699
Q

backwards adverse growth factor affect

A

long face (down)

700
Q

interceptive ortho

A

Any procedures that will eliminate/reduce severity of a developing malocclusion (utilisation of eruption and growth)

701
Q

dental features at birth

A

class II

AOB

gum pads (upper rounded, lower U)

702
Q

primary eruption sequence

A

6 months - 3 years

a b d c e

703
Q

no spacing in primary

crowding in permanent?

A

66% crowding risk

704
Q

<3mm spacing in primary

crowding in permanent?

A

50% crowding risk

705
Q

3-6mm spacing in primary

permanent crowding risk?

A

20% crowding risk

706
Q

6+mm spacing in primary

permanent crowding risk

A

no crowding risk

707
Q

permanent dentition eruption

A

Early

  • 6s at 6
  • 1s at 7
  • 2s at 8

Late

  • 4s at 10
  • 3s and 5s at 11-12
  • 7s at 12-13
708
Q

leeway space

A

difference between c,d,e and 3,4,5

maxilla = 1.5mm

mandible = 2.5mm

709
Q

balancing extraction

A

extraction of same tooth on opposite side of arch to minimise centre-line shift (cs)

710
Q

compensating extraction

A

extraction of tooth in opposite quadrant to minimise occlusal interference and prevent over eruption (lower 6s)

711
Q

management of early loss of primary teeth

A

a/b monitor

c balance

d consider balance

e monitor

712
Q

management of early loss 6s

best time to lose 6s

A

if L6, compensate

best time with 7s bifurcation forming, 5s and 8s present, moderate lower crowding

713
Q

tx of developing anterior crossbite

A

treat early (when 2s erupt) with URA and z-spring

714
Q

tx of developing posterior crossbite

A

overcorrect with URA and midline screw

715
Q

management of unerupted permanent central incisor

A
  • observe (1.5yrs)
  • create space
  • remove supernumerary/deciduous tooth
  • exposure and bond
716
Q

management of ectopic 6

A

extract e

distalise 6

717
Q

management of retained primary tooth

A

if successor present usually exfoliates/extract 1yr later

if successor absent extract early (space closes) or retain as long as possible

718
Q

infra occluded

A

(submerging) ankylosed primary tooth with occlusal surface lower than other teeth

719
Q

management of ankylosed tooth

A

Successor present usually exfoliates/extract 1yr later

Successor absent extract when 1mm of crown left showing above gingiva margin

720
Q

occlusal effect of digit sucking

A

proclie upper incisors

retrocline lower incisors

anterior open bite (localised/asymmetric)

prosterior cross bite/narrow maxilla

721
Q

digit sucking tx options

A
  • URA and rake (habit breaker)
  • Plaster/bad taste on digit
  • Advise to do something else when tempted (avoidance/distraction behaviour)
722
Q

interceptive tx for developing skeletal class II

A
  • Growth modification
    • Twin block functional appliance +/- headgear to restrict maxilla forward growth
723
Q

interceptive tx for developing skeletal class III

A
  • Growth modification
    • Functional regulator of Frankel + revere pull headgear (with facemask) +/- RME/elastic traction applied to fixed bone screws
  • Camouflage
    • URA and screw section
724
Q

when and how to examine for ectopic canines

A

9-10years

visual and palpate gingiva around canine (should feel bulge)

radiograph if no - parallax or OPT

725
Q

management and success rate of ectopic canines

A

Extract c (balance)

Sometimes expose and bond

Success rates of tx

  • If U3 overlaps U2 root by <50% 90% success rate
  • If U3 overlaps U2 root by >50% 60% success rate
726
Q

options for ortho tx

A
  • Do nothing
  • Extractions only
  • Appliances +/- extractions
    • Removable
    • Fixed
    • Functional
  • Orthognathic surgery
727
Q

2 methods of crowding assessment

A
  • Overlap technique (estimate/eyeball)
  • Space required Vs space available (callipers)
728
Q

lower crowding classes and management

A

Mild 0-4mm non extraction stripping, X5

Moderate 5-8mm X5, X4

Severe >8mm X4

729
Q

how to manage upper crowding

A

Lower extraction

  • Compensation

No lower extraction

  • Extract upper (class II molar relationship)
  • Distalise upper buccal segment with headgear (class I molar relationship)

REVISION BDS (43 decks)

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