Key

Question 1

3 roles of epidemiology

Answer 1

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

Question 2

prevalence

Answer 2

number of disease cases in a population at a given time

estimates obtained from a cross sectional studies adn derived from registers

Question 3

incidence

Answer 3

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

Question 4

risk factor

Answer 4

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

Question 5

causative agent

Answer 5

external factor that causes/results in disease in susceptible individuals

Question 6

determinant

Answer 6

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

when exposed to, develops the disease

Question 7

confounding variable

Answer 7

minor variable

left uncontrolled

which may or may not affect results

Question 8

3 types of risk index

Answer 8

absolute risk

attrivutable risk

relative risk

Question 9

absolute risk

Answer 9

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

Question 10

attributable risk

Answer 10

difference between incidence rates in exposed and non-exposed groups

Question 11

relative risk

Answer 11

measurement of proportionate increase in disease rates in exposed group

Question 12

5 methods of fluoride delivery and concentrations

Answer 12

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

Question 13

SIMD

Answer 13

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

Question 14

consent

Answer 14

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

Question 15

capacity

Answer 15

ability to act (decide)

make a reasoned decision

understand decision

communicate a decision

retain the memory of decision

Question 16

randomised control trial

Answer 16

clinical trial

gold standards for efficacy and effectiveness

4 design elements

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

Question 17

cohort study

Answer 17

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

Question 18

case-control study

Answer 18

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

Question 19

absolute risk difference

Answer 19

difference in risk between groups

Question 20

number needed to treat

Answer 20

1/ARD

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

Question 21

confidecence intervals

Answer 21

range of values that ARD will take in population

95% of time contains the true mean

Question 22

value of no difference

Answer 22

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

indicates insufficient evidecne for difference between treatment and control groups

Question 23

signs/symptoms of withdrawl from niccotine

Answer 23

irritability

poor concentration

depression/low mood

restlessness

increased appetites

sleep distruption

Question 24

3 oral side effects of smoking

Answer 24

staining

halitosis

nicotinic stomatitis

Question 25

things to ask about smooking in SH

Answer 25

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

Question 26

types of quitting advice

Answer 26

**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

Question 27

e-cigs

Answer 27

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

Question 28

benefits of e-cigs

Answer 28

* Cheaper * Safer (95%) * Generally successful in helping to quit * Maintain hand-to-mouth habit * Psychosocial aspects

Question 29

risks of e-cigs

Answer 29

unknown long term side effects not 100% safe gateway to smoking possible

Question 30

stroke definition

Answer 30

acute focal neurological deficicit due to cerbrovascular disease

Question 31

risk factors for stroke

Answer 31

smoking hypertension increased alcohol hyperlipidaemia TIA transient ischaemic attacks

Question 32

3 types of stroke

Answer 32

haemorrhage infarction embolic

Question 33

signs/symptoms of stroke

Answer 33

face droop (unilateral) can't raise and hold arm speech slurred FAST

Question 34

prevention methods for stroke

Answer 34

antiplatelets (aspirin) statins (reduce chloesterol) stop smoking

Question 35

management/Tx options

Answer 35

Ca channel blocker thrombolysis/remove clot oxygen

Question 36

complications of stroke

Answer 36

depends on location and extend of lesion sensory/motor loss dysphagia dysphonia cognitive impairment

Question 37

define epilepsy

Answer 37

recurrent seizure associated with reduced GABA levels in brain

Question 38

main types of seizure in epilepsy

Answer 38

* Generalised * Tonic clonic * Absence * Atonic * Myoclonic * Focal/partial * Simple partial * Complex partial * Simple sensory

Question 39

tonic clonic seizures

Answer 39

* Prodromal aura * Initial tonic (stiff) * Clonic (rapid spasms) * Post-ictal drowsiness * Last 2-4mins commonly

Question 40

absence seizures

Answer 40

* 5-15secs * Loss of consciousness * No loss of postural reflexes * Individual unaware it has happened

Question 41

cause and management of acute febrile convulsion

Answer 41

raised temp (37^oC, pyrexia) commonly children cool down (antipyretics, cool bath)

Question 42

causes of seziures

Answer 42

idiopathic CNS disease (tumour, meningitis, encephalitis, stroke) trauma (head injury)

Question 43

precipitators of seizures

Answer 43

illness fatigue stress infection

Question 44

epilepsy tx

Answer 44

anticonvulsants/anti-epileptics (phenytoin)

Question 45

emergency seizure tx

Answer 45

protect head (cushion) clear area around them give O₂ (OPA if possible) if \>5mins - consider benzodiazepines (buccal midazolam) post seizure: reassurance and support

Question 46

components of fit history

Answer 46

last 3 fits medications and compliance with medications when fits most likely (morning, tired etc)

Question 47

status epilepticus

Answer 47

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

Question 48

multiple sclerosis

Answer 48

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

Question 49

presentation of multiple sclerosis

Answer 49

intention tremor muscle weakness paraesthesia visual disturbance/optic atrophy

Question 50

motor neuron disease

Answer 50

degeneration in spinal cord, affecting bulbar motor nuclei

Question 51

osteoporosis

Answer 51

loss of matrix, secondary loss of mineral reduced bone mass/ inc bone loss osteoclastogenesis \> osteoblastogenesis

Question 52

risk factors for osteoporosis

Answer 52

age sex genes

Question 53

impact of osteoporosis

Answer 53

increased risk of fracture height loss

Question 54

preventions for osteoporsis

Answer 54

increase peak bone mass reduce bone loss (HRT, bisphosphonates)

Question 55

gout

Answer 55

acute monoarthropathy affecting single joint (usually great toe)

Question 56

cause of gout

Answer 56

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

Question 57

symptoms of gout

Answer 57

pain inflammation swelling red joint

Question 58

treatment for gout

Answer 58

NSAIDs allopurinol for LT prevention

Question 59

osteoarthrisitis

Answer 59

pain progressive, degenerative joint disease due to cartilage repair dysfunction

Question 60

signs/symptoms of osteoarthritis

Answer 60

pain brief morning stiffness joint swelling deformity

Question 61

radiographic signs of osteoarthritis

Answer 61

progressive loss of PIP and DIP joint space osteophytes lipping at joint edges

Question 62

Tx of osteoarthritis

Answer 62

NSAIDs prosthesis for pain inc muscle bulk around joint

Question 63

rheumatoid arthritis

Answer 63

function affected autoimmune disease of synovium

Question 64

types and features of rheumatoid arthritis

Answer 64

seropositive (RF present, affects peripheral joints) seronegative (RF absent, affects central joints)

Question 65

signs and symptoms of rheumatoid arthritis

Answer 65

thumb Z deformity finger ulcer deviation at MCP joint symmetrical synovitis of PIP, DIP and MCP PIP joint hyperextension

Question 66

Tx of rheumatoid arthritis

Answer 66

monoclonal antibodies methotrexate (DMDs) NSAIDs physio and occupational therapy prostheses for function

Question 67

dental features of rheumatoid arthritis

Answer 67

atlanto-axial instabiltiy sjorgren's syndrome

Question 68

types and features of seronegative arthritis

Answer 68

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

Question 69

sjorgren's syndrome

Answer 69

autoimmune condition affective moisture producing glands

Question 70

signs and symptoms of sjorgen's syndrome

Answer 70

dry eyes dry mouth (xerostomia) vaginal dryness raynaud's phenomenon inc risk of salivary lymphoma and caries

Question 71

acne vulgaris

Answer 71

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)

Question 72

eczema

Answer 72

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

Question 73

psoriasis

Answer 73

dysregulated epidermal proliferation extensor surfaces of skin tx * vit A derivatives * UV

Question 74

psychiatric disorders

Answer 74

neurosis - contact with reality maintained psychosis - contact with realtiy lost

Question 75

metal health act (scotland) when

Answer 75

2003

Question 76

depression signs and symptoms

Answer 76

* Low mood * Loss self esteem and confidence * Reduced motivation and interest * Lethargy and tiredness * Sleep disturbance * Early morning waking

Question 77

3 types of antidepressants

Answer 77

* Tricyclics (TCAs) * Dry mouth * Weight gain * Sedative * SSRIs * Acute anxiety * GI upset * Dry mouth * Weight gain * MAOI (mono amine oxidase inhibitors)

Question 78

schizophrenia

Answer 78

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

Question 79

symptoms of schizophrenia

Answer 79

* Auditory hallucinations * Delusions of thought control * Delusions of thought * Delusional perception

Question 80

tx of schizophrenia

Answer 80

* Antipsychotics (phenothiazines) * ECT * Psychological therapy

Question 81

anorexia nervosa

Answer 81

* Dysmorphic body image – think heavier than they are * Unhealthy low body weight * Either restrictive or binge and purge

Question 82

bulimia

Answer 82

* Normal weight * Binge eating and compensation behaviours (vomiting, laxatives)

Question 83

route of CNV2 (maxillary)

Answer 83

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.

Question 84

CNV3 (mandibular) route

Answer 84

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

Question 85

stroke neuroanatomy

Answer 85

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

Question 86

facial palsy

Answer 86

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

Question 87

management of facial palsy

Answer 87

* 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

Question 88

muscles of mastication innervation

Answer 88

CNV3 mandibular branch of trigeminal nerve

Question 89

masserter function

Answer 89

elevation and protrusion of the mandible

Question 90

masseter origin

Answer 90

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

Question 91

masseter insertion

Answer 91

angle and ramus of mandible

Question 92

temporalis function

Answer 92

elevation and retrusion of mandible

Question 93

temporalis origin

Answer 93

tamporal fossa and deep part of temporal fascia

Question 94

temporalis insertion

Answer 94

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

Question 95

medial pterygoid function

Answer 95

elevation and protrusion of mandible

Question 96

medial pterygoid origin

Answer 96

medial surface of lateral pterygoid plate (Deep) maxillary tuberosity (superficial)

Question 97

medial pterygoid insertion

Answer 97

medial surfaces of ruam and angle of mandible

Question 98

lateral pterygoid function

Answer 98

depression and protrusion of mandible

Question 99

origin lateral pterygoid

Answer 99

lateral surface of lateral pterygoid plate (inferior) infratemporal surface of greater wing of sphenoid (superior)

Question 100

lateral pterygoid insertion

Answer 100

neck of mandible and capsule/intracapsular disc

Question 101

suprahyoid muscles

Answer 101

mylohyoid geniohyoid stylohyoid digastric

Question 102

mylohyoid functin

Answer 102

elevates the hyiod bone and the FOM

Question 103

mylhyoid origin

Answer 103

mylohyoid line of the mandible

Question 104

mylohyoid insertion

Answer 104

attaches to hyoid bone

Question 105

geniohyoid function

Answer 105

depress the mandible elevates the hyoid bone

Question 106

geniohyoid origin

Answer 106

inferior mental spine of mandible

Question 107

insertion of geniohyoid

Answer 107

hyoid bone (by travelling inferior and posteriorly)

Question 108

sylohyoid function

Answer 108

initiates swallowing by pulling the hyoid bone posterior superior

Question 109

stylohyoid origin

Answer 109

stylohyoid process of temporal bone

Question 110

stylohyoid insertion

Answer 110

lateral aspect of hyoid bone

Question 111

digastric function

Answer 111

depress the mandible elevates the hyoid bone

Question 112

digastric origin

Answer 112

anterior belly - digastric fossa of mandible posteior belly - mastoid process of the temporal bone

Question 113

digastic insertion

Answer 113

2 bellied connected by intermediate tendon attaches to hyoid bone via fibrous sling

Question 114

stages in decontamination

Answer 114

clean disinfect inspect pack sterilise transport store use transport

Question 115

decontamination

Answer 115

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

Question 116

policy

Answer 116

overall statement of intent

Question 117

procedures

Answer 117

guidelines of major methods used to meet policy

Question 118

objective

Answer 118

landmark event in pursuit of overall intent

Question 119

work instruction

Answer 119

specific steps used to carry out procedures

Question 120

operator

Answer 120

person with authority to operator equipment can carry out daily tests, make safe etc

Question 121

user

Answer 121

person responsible for day to day running of LDU can operate equipment and train operators

Question 122

manager

Answer 122

person ultimately resposible for LDU operation

Question 123

3 key laws for decon

Answer 123

**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**

Question 124

sinner circle

Answer 124

temperature time enegy chemicals

Question 125

cleaning

Answer 125

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

Question 126

immersion

Answer 126

clean under running water mirrors, probes (solid instruments)

Question 127

non-immersion

Answer 127

wipe clean (according to manufacturer's instructions) lumened instruments, electrical equipment

Question 128

ultrasonic cleaner

Answer 128

pre-tx to washer disinfector for removal of gross/difficult to remove contamination not for handpieces/lumened instruments

Question 129

degas

Answer 129

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

Question 130

disinfection

Answer 130

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

Question 131

daily checks for WD

Answer 131

clean filter check/clean door and seal check detergent

Question 132

daily test cycle for WD

Answer 132

first daily run with instruments automatic control test

Question 133

Washer disinfector steps

Answer 133

flush wash rinse disinfect dry

Question 134

inspection

Answer 134

lit magnifier hinges, rough surfaces

Question 135

steilisation

Answer 135

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

Question 136

3 types of steriliser

Answer 136

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)

Question 137

demineralised/sterilised water

Answer 137

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

Question 138

optimum sterilisation condidion

Answer 138

134-137^oC 2-2.3 bar min 3 mins

Question 139

daily checks for steriliser

Answer 139

wipe door seal and chamber check door safety devices drain and refil daily (leave drained overnight)

Question 140

daily tests for steriliser

Answer 140

bowie dick/jelix test - challenge device

Question 141

10 SICPs

Answer 141

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

Question 142

chain of infection

Answer 142

infectious agent reservoid portal of exit mode of transmission portal of entry susceptible host

Question 143

blood spillage management

Answer 143

* 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

Question 144

sharps injury

Answer 144

* 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

Question 145

black waste disposal

Answer 145

domestic paper towels, instrument wrappers

Question 146

orange waste disposal

Answer 146

low risk clinicla waste PPE, soiled dressings

Question 147

yellow waste disposal

Answer 147

high risk clincal waste sharps, body parts

Question 148

red clincal waste

Answer 148

special amalgam

Question 149

blue clincal waster

Answer 149

medications

Question 150

amalgam bin features

Answer 150

red lid - lockable and leak proof internal mercury suppressant chemical/compound

Question 151

4 components of waste disposal

Answer 151

segregation storage disposal documentation

Question 152

key laws for waste disposal 3

Answer 152

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

Question 153

necrotising ulcerative gingivitis/periodontitis

Answer 153

* 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)

Question 154

signs/symptoms of NUG

Answer 154

* Malodour/hallotsis * Inter proximal necrosis * Gingivitis * Pain * Swelling * Bleeding * Metallic taste * Bleeding

Question 155

associated bacteria for NUG risk factors

Answer 155

* Anaerobic fusospirochete bacteria Risk factors * Poor OH * Immunocompromised * Stress * Smoking

Question 156

tx for NUG

Answer 156

* Smoking cessation * OHI * Mechanical debridement * Mouthwash (6% H2O2 or 0.2% CHX) Antibiotics – which and when * 400mg metronidazole (500mg amoxicillin in 2^nd choice) * 3x day for 3 days * If resistant/persistent/immunocompromised

Question 157

abscess

Answer 157

localised collection of dead and dying neutrophils

Question 158

signs and symptoms for abscess

Answer 158

TTP in lateral direction pain swelling redness pus drainage (sinus tract) bleeding

Question 159

types of abscess

Answer 159

gingival periodontal pericoronal periapical perio-endo

Question 160

acute abscess

Answer 160

rapid onset symptomatic - pain, swelling

Question 161

chronic abscess

Answer 161

gradual onset asymptomatic - sinus tract, intermittent pus discharge, periapical pathology

Question 162

Tx abscess

Answer 162

* 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 2^nd choice) * 3x day for 3 days * If spreading infection, systemic symptoms (fever, malaise, lypmphadenopathy) or if immunocompromised

Question 163

occlusal trauma effects on healthy periodontium

Answer 163

areas of intermittent pressure and tension areas widened PDL hypermobility in abscence of plaque, ginival margin remains intact (no perio disease)

Question 164

occlusal trauma response of healthy periodontium

Answer 164

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)

Question 165

occlusal trauam effecs on healthy periodontium but reduced

Answer 165

previous loss of attachement and bone resorption tooth effectively on fulcrum - inc effect of same level force

Question 166

occlusal trauma effects on disease periodontium

Answer 166

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)

Question 167

causes of mobility

Answer 167

PDL width PDL height presence of inflammation shape/number/lenght of roots

Question 168

mobility is unacceptable when

Answer 168

progressively increasing symptomatic associated with deep pockets

Question 169

how to Tx or reduce mobility

Answer 169

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)

Question 170

causes of migration

Answer 170

unfavourable occlusal forces unfavourable soft tissue profiles

Question 171

tx of migration

Answer 171

accept and stablise correct occlusal relations orthodontics tx perio disease

Question 172

purpose of perio surgery

Answer 172

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

Question 173

contraindications to perio surgery

Answer 173

poor OH/plaque control smoker

Question 174

indications for perio surgery

Answer 174

poor CRT/NSPT excellent OH inflammation resolved pocket 5mm+

Question 175

pros gingivectomy

Answer 175

improves aesthetics facilitates plaque control

Question 176

reasons for gingivectomy

Answer 176

reduce overgrowth pseudo pockets areas with difficult access ginival fibromatosis

Question 177

substantivity

Answer 177

persistence of action (how long works/adheres for)

Question 178

depends on

Answer 178

maintenancy of antimicrobial activity slow neutralisation of antimicrobial activtiy

Question 179

chlorhexidine is

Answer 179

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

Question 180

disadv antibiotic

Answer 180

allergy resistance superinfection cannot penetrate biofilms well high conc required to be effective can be inactivated/degraeded by non target organisms

Question 181

indication for AB

Answer 181

immunocompromised spreading facial infection

Question 182

benefits systemic AB

Answer 182

delivered via serum to tissues reaches non-dental reservoirs cheaper, less chairside time

Question 183

benefits local AB

Answer 183

reaches site directly adequately high drug concentration low systemic effects better compliance high conc in GCF

Question 184

aims of perio tx

Answer 184

arrrest disease regenerate lost perio tissue maintain long term perio health

Question 185

side effects/cons of perio tx

Answer 185

sensitivtiy gingival recession short term bleeding

Question 186

clincal attachment loss/gain post perio tx and why

Answer 186

gingival recession and gain in attachment through long junctional epithelium

Question 187

pulp communications

Answer 187

apical forament lateral and furcal canals fractures perforations

Question 188

primary endo lesion progresses to involve perio

Answer 188

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

Question 189

primary perio lesions progresses to involve endo

Answer 189

pocket forms progresses apically to accessory canal/apical foramen bacterial ingress into canal - pulp inflammation greneralised perio disease, tooth often not/minimally restored

Question 190

true combine lesion (perio and endo)

Answer 190

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

Question 191

perio-endo prognosis

Answer 191

generally poor, worse if true combine mainly dependent on severity of perio disease and response of perio disease to tx

Question 192

tx for peri-endo lesions

Answer 192

primary RCT secondary NSPT - if unresolved perio surgery

Question 193

drusg which can cause gingival hyperplasia

Answer 193

calcium channel blockers (nifedipine) immunosuppressants (cyclosporin A) anticonvulsants (phenytoin)

Question 194

barriers to care

Answer 194

physical attitudinal professional centrered people centered

Question 195

impairment

Answer 195

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

Question 196

disability

Answer 196

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

Question 197

handicap

Answer 197

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

Question 198

key legislation for SCD

Answer 198

* **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**

Question 199

WHO disabilities inc

Answer 199

* Umbrella term covering impairments, activity limitation and participation restrictions

Question 200

ways to make communication easier with sensory impaired

Answer 200

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

Question 201

dentally fit (3)

Answer 201

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

Question 202

MDT

Answer 202

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)

Question 203

chemotherapy

Answer 203

systemic drugs used to target rapidly dividing cells side effects: mucosistis, hair loss, tiredness, immunocompromised

Question 204

radiotherapy

Answer 204

ionising radiation damage to cellular DNA delivered in fractioned doses side effects: mucositis, tiredness, burns, dry mouth, taste loss, ORN, trismus, radiation caries

Question 205

muscositis

Answer 205

acute inflammation of oral mucosa ## Footnote 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)

Question 206

Parkinson's

Answer 206

progressive degeneration of dopaminergic neurons in substantia nigra features * resting tremor * bradykinesia * mask-like/expressionless face * impaired balance and gait * rigidity

Question 207

difference in presentation of Parkinson's and cerebellar disease

Answer 207

Parkinson's - resting tremor cerebellar disease - intention tremor

Question 208

dental issues in parkinsons

Answer 208

xerostomia swallowing issues access issues limited self care drooling (forward tip)

Question 209

dry mouth in parkinsons why

Answer 209

antichlonergic effect of dopaminergic drugs forward tip leads to saliva pooling at front of mouth

Question 210

dementia

Answer 210

deterioration in cognitive function beyond what might be expected from normal ageing Risk factors * age * sex * genes

Question 211

4 types of dementia

Answer 211

alzheimer's vascular with Lewy bodies frontotemporal

Question 212

symptoms of dementia

Answer 212

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

Question 213

diagnostic tools for dementia

Answer 213

MMSA mini mental state exams bleeded dementia scale Montreal cognitive assessment single neuropychological test (delayed word recall)

Question 214

tx plan features for pt with dementia

Answer 214

* 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)

Question 215

features of dementia friendly dentist/health care environment

Answer 215

* 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

Question 216

methods of assisted communication in care homes

Answer 216

* rescuing * briding * chaining * hand-over-hand * distraction

Question 217

medical model of disability

Answer 217

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

Question 218

social model of disability

Answer 218

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

Question 219

Down's syndroms genetic test

Answer 219

trisomy 21

Question 220

physical/dental features of Down's syndroms

Answer 220

atlanto-axial instablity macroglossia hypo/microdontia class III maxillary hypoplasia caries risk perio disease

Question 221

associated health conditions of Down's syndrome

Answer 221

congenital heart diseases haematological malignancy (leukaemia) epilepsy early onset alzheimers coeliac disease learning disability

Question 222

consent/capacity 4 features need to have

Answer 222

able to make decision understand the decision - risks, benefits, alts communicate a decision retain memory of decision

Question 223

autism

Answer 223

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

Question 224

signs/symtoms ASD

Answer 224

isolated/withdrawn literal interpretation of language difficultly relating to people socially awkward and naive

Question 225

dental management of ASD

Answer 225

pre-visit social story allow more time consider sensory issues (quiet etc) communication aids hide non-essential items/equipment

Question 226

measure to eval diabetes control

Answer 226

HbA1c better indication of long term control than GTT

Question 227

ideal value for diabetic pts

Answer 227

6.5%/48mmol/mol want to be slightly higher before dental tx booke early app advise pt to eat breakfast

Question 228

dental features of poorly controlled diabetic

Answer 228

increased risk perio dry mouth delayed/poor wound healing fungal/candida infection

Question 229

types of anticoagulants

Answer 229

* Vitamin K dependent anticoagulants (coumarins – warfarin, heparin) * New/Direct oral anticoagulants (NOAC/DOAC)

Question 230

warfarin inhibits

Answer 230

extrinsic coagulation pathway inhibits production of clotting factors 2, 7, 9 and 10

Question 231

warfarin check when

Answer 231

INR 24hrs before extraction \<4.0 (SDCEP) ideally stable for 72hrs pre-extraction

Question 232

normal INR value (not on warfarin)

Answer 232

1.0

Question 233

NOAC

Answer 233

* Dabigatran (dTi – CF 11a) * Apixaban (CF 10a) * Rivaroxaban (CF 10a)

Question 234

high risk bleeding procedures acc to SDCEP

Answer 234

* 3+ extractions * Flap raising procedures (surgical extractions, perio surgery) * Gingival recontouring * biopsies

Question 235

antiplatelets what to do

Answer 235

if on * 1 – fine * 2 – grey area * 3 – avoid

Question 236

inherited bleeding disorders types and tx

Answer 236

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

Question 237

causes of jaundice

Answer 237

alcohlic liver disease non alcholic fatty liver disease infective liver disease (hepatitis)

Question 238

effect of liver disaese on dental care

Answer 238

inc bleeding risk

Question 239

alcohol recommended weekly units

Answer 239

14 units a week over 3+ days 2+ alcohol free days

Question 240

excessive alcohol intake bleeding risk because

Answer 240

damages liver inhibiting production of CF

Question 241

key blood tests for bleeding problems

Answer 241

FBC LFT coagulation screen

Question 242

platelet levels for extractions and what transfusion required

Answer 242

* \>100⁹ for GDP * 50-100⁹ for secondary care \<50⁹ – FFP/platelet transfusion

Question 243

incapacity law and 5 principles of it

Answer 243

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

Question 244

types of Power of Attorney

Answer 244

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

Question 245

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

Answer 245

section 47 certificate for specific proposed tx

Question 246

who can give consent

Answer 246

* 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

Question 247

emergency tx

Answer 247

preserveration of life/ to prevent serious deterioation

Question 248

types of dental emergency

Answer 248

bleeding spreading infection (associated with abscess) swelling inhibiting breathing

Question 249

causes of oral ulceration

Answer 249

oral cancer trauma medicaion side effect nutritional deificiency

Question 250

guidelines to check for oral ulcerations

Answer 250

Scottish referral guidelines for suspected cancer NICE guideline 12

Question 251

modifiable risk factors for oral ulceration

Answer 251

smoking alcohol poor OH sun exposure

Question 252

bisphosphonates are used to tx/manage

Answer 252

osteoporosis multiple myeloma (and metastatic cancer) Paget's disease

Question 253

key organisms in caries

Answer 253

s mutans lactobacillus acidophilus

Question 254

virulence factors of caries MO

Answer 254

adhesions binding proteins (glucosyltransferase) sugar modifying enzymes polysaccharides (glucans) acid tolerance and adaptation (ATPase)

Question 255

MO methods of acid tolerance

Answer 255

maintain pH balance (ATPase) alters cell membrnaes protection and repair mechanisms

Question 256

anticaries activities of Fluoride

Answer 256

Systemic * incorporated into developing enamel as fluoroapatites (remineralisation) Topical * converts into surface enamel into fluoroapatite (remineralisation) Antimicrobial * inhibits plaque metabolism and ATPase action

Question 257

red Socransky's organismis perio

Answer 257

P gingivalis T denticole T forsythia

Question 258

virulence factors of red socransky's mo

Answer 258

gingipains (degrades chemokines, activates MMPs) adhesions tissue toxic metabolic by products

Question 259

systemic diseases linked with perio pathogens

Answer 259

cardiovascular disease rheumatood arthrititis diabetes mellitus

Question 260

types of oral canididosis

Answer 260

pseudomembranous eruthematous hyperplastic

Question 261

causes of oral candiosis

Answer 261

poor denture hygiene catheter surgery immunocompromised

Question 262

candida species

Answer 262

c albicans c glabrata (resistant to azole antifungals)

Question 263

virulence factors of candida

Answer 263

hyphae (formed by C albicans when stressed) adhesins hydrolytic enzymes (haemolysi, proteinase, phopholipase)

Question 264

antifungal tx and how they work

Answer 264

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

Question 265

methods of candida resistance

Answer 265

* 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

Question 266

key features of biofilm development

Answer 266

adhesion colonisation accumulation to form complex community

Question 267

porcelain features

Answer 267

aesthetics hard rigid forms microcracks at fitting surface

Question 268

types of bond in MCC

Answer 268

chemical mechnical stressed skin

Question 269

most common metal alloy

Answer 269

CoCr

Question 270

purpse of metal oxide bond

Answer 270

helps eliminate cracks on porcelain surface

Question 271

max C in steel

Answer 271

\<2%

Question 272

iron is

Answer 272

allotropic undergoes 2 solid state phase changes with temperature Phase changes * \<900^oC BCC lattice structure, low carbon solubility * 900-1400^oC FCC lattice structure, high carbon solubility * \>1400^oC BCC lattice structure, low carbon solubility

Question 273

4 types of FeC on phase diagram

Answer 273

Austenite above 720^oC 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

Question 274

stainless steel chromium%

Answer 274

\>13%

Question 275

composition of stainless steel and their functions

Answer 275

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

Question 276

weld decay

Answer 276

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

Question 277

cold work

Answer 277

* 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

Question 278

pros of PMMA

Answer 278

non toxic non irritant high softening temperature good aesthetics high abrasion resistance

Question 279

cons of PMMA

Answer 279

poor mechanical properties low thermal conductivity

Question 280

PMMA reaction

Answer 280

free radical additon polymerisatioon low thermal conducitivty

Question 281

heat cure Vs self cure PMMA

Answer 281

* 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

Question 282

ideal features of investment materials

Answer 282

porous expands easily removed from cast smooth surface strong

Question 283

components and functions of investment materials

Answer 283

binder - forms coherent mass refractory - expansion, withstands high temperatures

Question 284

hygroscopic expansion

Answer 284

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

Question 285

4 ways to inc hygroscopic expansion

Answer 285

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

Question 286

types of investment material

Answer 286

* 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

Question 287

types of elastomers

Answer 287

addition silicones polyethers

Question 288

why are hydrophillic elastomers better

Answer 288

incoroporation of non-ionic sufactant (wets tooth surface)

Question 289

ideal elastic behaviour vs actual

Answer 289

* 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

Question 290

impression material key features

Answer 290

* low viscosity * low viscoelasticity * high tear strength * high tear resistance * high elastic recovery * good wettability * good surface detail * able to flow under pressure

Question 291

luting agents key features

Answer 291

* strong * good aesthetics * biocompatible * good marginal seal * low viscosity * low thermal conductivity * easy to use

Question 292

types of luting agents

Answer 292

* conventional dental cements * GIC * Composite resins * Self-adhesive composites * Surface modifying chemicals

Question 293

types of dental cements

Answer 293

zinc phophate zinc polycarboxylate

Question 294

pros and cons of dental cements

Answer 294

pros * Cheap * Easy to use Cons * Low initial pH * Exothermic setting reaction * Brittle * Opaque * Don’t bond to tooth/not adhesive

Question 295

GIC components

Answer 295

polyacrylic acid tartaric acid glass powder silica

Question 296

setting reaction of GIC

Answer 296

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

Question 297

how GIC bonds to tooth

Answer 297

ion exchange wiht calcium in enamel and dentine and hydrogen with collagen in dentine strong, durable bond

Question 298

pros of GIC

Answer 298

* no/limited setting contraction * F release * Strong bond to tooth * Easy to use * Durable

Question 299

RMGIC components

Answer 299

* Fluoro-alumino-silcate glass * Barium glass * HEMA * Polyacrylic acid * Tartaric acid

Question 300

RMGIC pros

Answer 300

* Stronger * Good bond to tooth * Longer working time * Set on demand

Question 301

cons of RMGIC

Answer 301

* Setting contraction * Moisture sensitive * Unreacted cytotoxic HEMA

Question 302

2 cure types for RMGIC

Answer 302

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

Question 303

when to use GIC

Answer 303

MCC metal post zurconia crown gold restoration

Question 304

composite luting cement what used to bond

Answer 304

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

Question 305

benefits of composite luting cement

Answer 305

better physical properties and aesthetics less soluble

Question 306

bond to porcelain

Answer 306

sandblast/etch to roughen surface to form micromechanical bond

Question 307

bond to precious metal

Answer 307

use metal bonding agent (MDP/ 4-META) tooth - DBA - compusite luting resin - metal bonding agent - precious metal

Question 308

where to use light cure materials

Answer 308

is restoration thin e.g. veneer

Question 309

where use dual cure materials

Answer 309

allow oxide formation (complicated, technique sensitive)

Question 310

self adhesive composite use

Answer 310

thick restoration metal restoration most crowns, bridges, posts fibre posts composite inlay and porcelain inlay

Question 311

ceramic

Answer 311

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

Question 312

felspathic

Answer 312

replace kaolin Feldspar – fluxing agents (lowers fusion and softening temperature of glass) * Silica 1150-1500^oC * Forms leucite * Powder of known chemical and physical properties

Question 313

crown fabrication

Answer 313

* 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

Question 314

sintering

Answer 314

* 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

Question 315

pros of ceramic

Answer 315

* Best aesthetics * Less staining * Biocompatible * Similar thermal properties to tooth * Low thermal diffusivity * Hard * High compressive strength

Question 316

possible materials for cores

Answer 316

- Alumina - Zirconia

Question 317

static fatigue

Answer 317

* 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

Question 318

pros of alumina

Answer 318

* High flexural strength * Good aesthetics * Cheap * Alumina particles act as crack stoppers

Question 319

luting alumina (silica-containing ceramics)

Answer 319

hydrofluoric and silance coupling agent

Question 320

types of alumina in cores

Answer 320

In-ceram procera

Question 321

zirconia pros

Answer 321

hard strong excellent fit

Question 322

luting zirconia

Answer 322

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

Question 323

type zicronia used

Answer 323

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

Question 324

process of casst and pressed ceramics

Answer 324

* 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

Question 325

design objectives for endo

Answer 325

create a continuously tapering funnel shape maintain apical foamen in original position keep apical opening as small as possible

Question 326

clinical objectives of endo

Answer 326

remove canal contents eliminate infection

Question 327

2 things that improve endo success

Answer 327

sodium hypchlorite dam

Question 328

function of dam

Answer 328

protect airway imporve access efficacy and vision prevent contamination protect soft tissues

Question 329

normal pulp dx

Answer 329

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

Question 330

reversible pulpitis dx

Answer 330

* inflamed, pain to stimulus, resolves with treatment

Question 331

symp irreversible pulpitis dx

Answer 331

lingering pain to stimulus, pain with postural changes

Question 332

asymp irreversible pulpitis dx

Answer 332

* no symptoms, usually normal thermal test

Question 333

pulpal necrosis

Answer 333

* negative pulp test, TTP, radiographic osseous breakdown, can be asymptomatic

Question 334

normal apical dx

Answer 334

not TTP, uniform PDL space

Question 335

symptomatic apical periodontitis dx

Answer 335

TTP, pain with biting, PA radiolucency

Question 336

asymp apical periodontitis dx

Answer 336

asymptomatic, PA radiolucency

Question 337

acute apical absces

Answer 337

rapid, swelling, TTP, spontaneous pain, systemic symptoms

Question 338

chronic apical abscess

Answer 338

gradual, asymptomatic, PA radiolucency, sinus ± pus discharge

Question 339

condensing osteitis

Answer 339

* localised bony reaction to low-grade inflammatory stimulus, diffuse PA radiopacity

Question 340

developmental stages of biofilm

Answer 340

adhesion colonisation accumulation to form complex community dispersal

Question 341

resisance features of biofilm

Answer 341

antimicrobials cannot penetrate beyond surface layer trapped/destroyed enzymes inactive against non-growing organisms expression of biofilm specific resistant genes

Question 342

mechanical endo prep aim

Answer 342

create space to allow irrigants and medicaments to more effectively eliminate micro-organisms remove infected hard and soft tissue

Question 343

stages in mechanical prep for endo

Answer 343

* Tooth prep * Access cavity * Confirm straight line access * Initial negotiation * Coronal flaring * Working length determination * Apical preparation

Question 344

apical prep determined by

Answer 344

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

Question 345

irrigants used in endo

Answer 345

3% NaOCl 17% EDTA 0.2% CHX

Question 346

final irrigation steps

Answer 346

10mins NaOCl 1min EDTA 10mins NaOCl dry between with paper points

Question 347

ideal irrigant properties for endo

Answer 347

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

Question 348

NaOCl pros and cons

Answer 348

Pros * Dissolves organic material * Disrupts smear layer * Effective antimicrobial Cons * Doesn’t remove smear layer * Dissolves fabrics * Accidents

Question 349

NaOCl accident management

Answer 349

copius irrigation analgesia review

Question 350

prevent NaOCl accident

Answer 350

* 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

Question 351

smear layer

Answer 351

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

Question 352

removal of smear layer by

Answer 352

* 17% EDTA * 10% citric acid * MTAD

Question 353

intra canal medicament why

Answer 353

* Non setting CaOH Why * Antibacterial * Reduces inflammation * Kills MO in canal * Effective at removing tissue debris

Question 354

purpose of chemomechanical prep

Answer 354

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

Question 355

essential to do whilst chemomechanical instrumentating

Answer 355

copious irrigation recapitulation patency filing

Question 356

modified double flare technique

Answer 356

* 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.)

Question 357

estimated working length

Answer 357

* estimated length at which instrumentation should be limited * usually 1mm short of radiographic apex

Question 358

corrected working length

Answer 358

* actual length at which instrumentation should be limited

Question 359

master apical file

Answer 359

largest file taken to working length represent final prepared size of apical portion of canal

Question 360

types of instrument motion

Answer 360

* 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

Question 361

cons of hand files

Answer 361

time consuming less predictable ledges apical zipping perforations blockages

Question 362

NiTi main features

Answer 362

super elasticity

Question 363

pros of rotary files

Answer 363

quicker more predictable increased flexibility and cutting efficacy easier to use safer

Question 364

cons of rotary files

Answer 364

limited posterior access potential expensive

Question 365

prevent # with rotary files by

Answer 365

create guide path crown down technique ensure straight line access gentle pressure

Question 366

glide path

Answer 366

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

Question 367

process of glide path

Answer 367

* 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)

Question 368

purpose of early coronal flaring

Answer 368

reduce hydrostatic pressure in canal during irrigation provide reservoid for irrigants

Question 369

ideal properties for obturation material

Answer 369

non staining bacteriostatic radiopaque non irritant inert

Question 370

why obturate

Answer 370

fluid tight apical seal kill remaining microbes prevent microbial reinfection seal off lateral canals

Question 371

GP composition

Answer 371

20% GP 65% ZnO 10% radiopacifier 5% plasticisers

Question 372

functions of endo sealer

Answer 372

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

Question 373

properties of endo sealer

Answer 373

* Non staining * Bacteriostatic * Radiopaque * Biocompatible * Low viscosity (able to flow) * Non-irritant * inert

Question 374

4 obturation methds

Answer 374

* warm lateral compaction * carrier based obturation * continuous wave obturation * cold lateral compaction

Question 375

cold lateral compaction

Answer 375

* 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

Question 376

risks of RCTx

Answer 376

perforation instrument separation failure pain

Question 377

successful outcome of RCTx

Answer 377

asymptomatic, normal PDL

Question 378

uncertain outcome of RCTx

Answer 378

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

Question 379

unfavourable outcome of RCTx

Answer 379

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

Question 380

management options of RCTx failure

Answer 380

monitor re tx periradicular surgery extraction

Question 381

basic steps in RCT

Answer 381

* coronal access * instrumentation * chemomechanical preparation * obturation * coronal seal * final restoration

Question 382

law of centrality

Answer 382

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

Question 383

law of concentricitiy

Answer 383

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

Question 384

law of ACJ

Answer 384

most consistent, repeatable landmark for locating position of pulp chamber

Question 385

law of symmetry 1

Answer 385

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

Question 386

law of symmetry 2

Answer 386

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)

Question 387

law of colour change

Answer 387

colour of pulp chamber floor is always darker than the walls

Question 388

law of orifice location1

Answer 388

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

Question 389

law of orifice location 2

Answer 389

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

Question 390

law of orifice location 3

Answer 390

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

Question 391

7 caries risk assessment components

Answer 391

clincal evidence dietary evidence medical history social history saliva plaque control fluoride use

Question 392

8 caries risk prevention components

Answer 392

radiographs dietary advice tooth brushing instruction topical fluoride fissure sealants systemic fluoride

Question 393

paeds tx plan order

Answer 393

OHI fluroide varnish fissure sealants restoration no LA (upper before lower) restoration with LA (upper before lower) pulp tx extractions

Question 394

types of caries

Answer 394

arrested rampant early childhood/nursing bottle secondary/recurrent interproximal pit and fissure smooth surface

Question 395

caries detection methods

Answer 395

* Visual (dry tooth, direct light) * Radiographs * Orthodontic separators * FOTI

Question 396

paeds caries tx options

Answer 396

* Complete caries removal and restoration * Partial removal and restoration/seal * No removal and hall crown * Prevention only * Make self-cleansing * Fissure sealant only

Question 397

best time to X6

Answer 397

beginning of calcification of bifurcation of L7s 5s and 8s present class I incisors

Question 398

pros and cons of X6s

Answer 398

pros * caries free dentitin * 7s erupt mesially into space cons * loss of permanent tooth * furture anxiety/fear of tx * 5s may drift distally

Question 399

indications for paeds pulp tx

Answer 399

MH excludes extractions good cooperation and motivation good attendance

Question 400

contraindications for paeds pulp tx

Answer 400

poor attendance poor cooperation and motivation

Question 401

pulpotomy

Answer 401

remove disease/infection control bleeding and retain radicular pulp

Question 402

pulpectomy

Answer 402

remove/control infection by removing all (radicular) pulp cleaning and obturating

Question 403

radiographic signs of paeds pulp tx failure

Answer 403

furction bone loss internal inflammatory resorption external inflammatory resorption periapical pathology

Question 404

reasons for DFA

Answer 404

previous experience parents opinion/experiences new/unknown environment peer stories

Question 405

features of DFA

Answer 405

* SoB * Increased HR * Sweating * Palpitation * Fidgeting * Hypervigilance * Aggression

Question 406

management techniques for DFA

Answer 406

* Distraction * Tell-show-do * Acclimatisation * Desensitisation * Role modelling * Positive reinforcement * Relaxation * Hypnosis * CBT

Question 407

how to track progression of permanent tooth trauma

Answer 407

* Colour * TTP * Radiographs * Ethyl chloride * EPT * Mobility * Sinus * Displacement * Percussion note

Question 408

aim of emergency tx

Answer 408

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

Question 409

management of E#

Answer 409

bond fragment / grind sharp edges

Question 410

management of ED#

Answer 410

bond fragment / composite bandage and restore

Question 411

managament of EDP#

Answer 411

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)

Question 412

management of concussion

Answer 412

observe

Question 413

management of subluxation

Answer 413

2 weeks flex splint

Question 414

management of extrusion

Answer 414

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

Question 415

management of intrusion

Answer 415

open apex * \<7mm leave * \>7mm ortho/surgical realignment closed apex * \<3mm leave * 3-7mm ortho * \>7mm surgical 4 week flex splint

Question 416

management of displaced root #

Answer 416

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

Question 417

signs of healing

Answer 417

calcified union across # line connective tissue formed

Question 418

signs of non healing

Answer 418

granulation tissue usually associated with loss of vitality

Question 419

avulsion

Answer 419

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

Question 420

replant post avulsion contraindicationss

Answer 420

* Other more serious injuries require investigation/tx * Immunocompromised * Very immature lower incisors * Very immature tooth with EAT \>90mins

Question 421

post replant resorptiont types

Answer 421

* Internal inflammatory * External inflammatory * External surface * Replacement ankylosis

Question 422

management dento-alveolar #

Answer 422

* Reposition * Ensure occlusion as before (selective grinding if needed) * 4 week flex splint * 2-4 weeks post

Question 423

follow up radiographs for trauma

Answer 423

* 2-4 weeks post tx * 6 months * Every year for 5 years

Question 424

effects of trauma on primary dentition

Answer 424

* Discolouration * Early – usually will stay vital * Delayed ‘bruising’ – usually sign loss of vital * Infection * Delayed exfoliation

Question 425

long term effects of trauma on permanent dentition

Answer 425

* Delayed eruption * Ectopic position * Arrest in development/formation * Failure to form * Odontoma formation * Enamel defects * Anatomy/morphology abnormalities

Question 426

supracrestal attachment

Answer 426

* Dimension of soft tissue attached to tooth coronal to alveolar crest * 2mm

Question 427

simplified BPE on

Answer 427

0-2 (bleeding, calculus) * On teeth 16, 11, 26, 36, 31, 46 7-11 years

Question 428

when can F mouthwash be used

Answer 428

\>7 years, can spit 225ppmF

Question 429

GA what is it types stages indications and contraindications

Answer 429

* 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

Question 430

child protection

Answer 430

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

Question 431

child abuse/neglect

Answer 431

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

Question 432

dental neglect

Answer 432

the persistent failure of those resposible for the care to maintain an appropriate level of oral health obvious disease, care offered not taken up

Question 433

wilful neglect

Answer 433

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

Question 434

features of dental team management in neglect cases

Answer 434

preventative dental managment preventative multi agency managment child protection referral

Question 435

what is expected of dental team in neglect cases

Answer 435

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

Question 436

index of suspicion in child neglec

Answer 436

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)

Question 437

principles of radiaiton protection

Answer 437

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

Question 438

IRMER people

Answer 438

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

Question 439

blue image receptor holder

Answer 439

anterior PA

Question 440

yellowimage receptor holder

Answer 440

posterior PA

Question 441

redimage receptor holder

Answer 441

BW

Question 442

greenimage receptor holder

Answer 442

endo

Question 443

paralleling technique for PA

Answer 443

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

Question 444

bisecting angle technique for PAs

Answer 444

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

Question 445

Bitewing technique

Answer 445

image receptor parallel to line of arch. Front edge of film packed mesial to 3/4 contact. collimation, tube head alignment

Question 446

reasons for OPT

Answer 446

trauma development of dentition can't tolerate IO x-rays

Question 447

cons of OPT

Answer 447

inc exposure time position difficulties

Question 448

technique for OPT

Answer 448

* 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

Question 449

focal through factors affect it

Answer 449

* layer in pt containing structures of interest, demonstrated with sufficient resolution to be recognisable Factors * distance from rotation centre, x-ray beam width

Question 450

OPT stretched/magnified horizontally

Answer 450

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

Question 451

ghost image features

Answer 451

interfere with dx * reflected onto opposing side of image * always horizontally magnified * higher

Question 452

x ray production

Answer 452

* 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

Question 453

tube head

Answer 453

* 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

Question 454

attenutaion and appearance

Answer 454

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

Question 455

photoelectric effect

Answer 455

* 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)

Question 456

effect of dose on image quality for photoelectric effect

Answer 456

inc in dose and inc in image quality

Question 457

compton scatter

Answer 457

* 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

Question 458

how to reduce compton scatter

Answer 458

collimation lead foil lining packets

Question 459

effect on dose of image quality for compton scatter

Answer 459

inc in dose, no inc in image quality

Question 460

absorbed dose

Answer 460

energy impaired by radiation to unit mass of tissue

Question 461

how to reduce absorbed dose

Answer 461

higher kVp (higher energy photons, less absorbed)

Question 462

pros and cons of digital radiographs

Answer 462

Pros * Image enhancement * Instant image production * Dose reduction * Constant quality * No chemicals/processing Cons * Expensive * Large size of image receptors

Question 463

solid state sensors

Answer 463

* image detected on photomultiplier. * Direct link to computer, * active area smaller than film

Question 464

PSP digital film

Answer 464

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

Question 465

lateral cephalogram

Answer 465

standardised and reproducible true lateral view of facial bones, base of skull and upper cervical spine also shows sinus and soft tissues

Question 466

EO reference lines in lat ceph

Answer 466

* MS reference line/plan * FP * Pupillary line * OM line

Question 467

indications for lat cep

Answer 467

* Pts with skeletal AP/vertical discrepancies * Monitor and check growth * Ortho pt

Question 468

technique for lat ceph

Answer 468

* 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

Question 469

lead foil role in xray film

Answer 469

absorb scatter xrays, preventing image degradation

Question 470

intensifying screen role radiogrpahs

Answer 470

fewer photons, reduce dose and image quality

Question 471

processing chemical stages

Answer 471

development rinse fixation wash dry

Question 472

darker image made why?

Answer 472

inc time/temp/concentration

Question 473

localisation in x rays indications requirements

Answer 473

* Unerupted tooth position * Trauma * Root/canal location requirements * Stable reference point * Horizontal/vertical tube shift (for non-right angle views)

Question 474

parallax

Answer 474

* Apparent change in position in object caused by real change in position of observer

Question 475

functional occlusion

Answer 475

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

Question 476

mutually protected occlusion

Answer 476

gold standard canine guidance posterior disclusion in excursion, no working/non-working side contacts, no protrusive interference

Question 477

anterior/canine guidance

Answer 477

reproducible, protects posterior teeth

Question 478

group function guidance

Answer 478

occlusion of multiple working side posterior teeth during excursion

Question 479

noraml occlusal forces

Answer 479

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

Question 480

parafunction occlusal forces

Answer 480

* Purposeless grinding and clenching. * Forces may be horizontally directed, * heavier forces, * neuromuscular reflexes don't work, * long duration, * damaging

Question 481

posselt's envelope

Answer 481

extremes of mandibular movement in sagittal plane ## Footnote 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

Question 482

rest position

Answer 482

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

Question 483

freeway space

Answer 483

difference between OVD and RVD/ICP and rest position 2-4mm normal

Question 484

pros of veneers

Answer 484

close/hinge gaps and spaces preferentially change shape/contour of teeth

Question 485

contraindication to veneers

Answer 485

interproximal caries severaly rotated teeth severe NCTSL heavy occlsual contacts

Question 486

indications for onlays/inlays

Answer 486

cusp replace failing indirect restoration posterior tooth with access difficulties

Question 487

contraindications for onlays/inlays

Answer 487

active caries active perio disease time consuming expensive

Question 488

pros of crowns

Answer 488

protect weakened tooth structure improve and restore function and aesthetic

Question 489

contraindications for crowns

Answer 489

* Active caries * Active perio disease * Lack of tooth tissue remaining

Question 490

principles of crown prep

Answer 490

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

Question 491

reduction for metal/cast metal crown

Answer 491

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

Question 492

reduction for feldspathic ceramic/PJC crown

Answer 492

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

Question 493

reduction for MCC crown

Answer 493

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

Question 494

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

Answer 494

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

Question 495

pros of provisional restoration

Answer 495

* Restore tooth characteristics * Improve function * Restore aesthetic * Prevent sensitivity * Prevent over eruption * Restore tooth as functional unit

Question 496

types of provisional restorations

Answer 496

* 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

Question 497

anterior endo tx tooth resoration options

Answer 497

composite/veneer - marginal ridge intact crowns - margingal ridge destroyed

Question 498

posterior endo tx tooth restoration options

Answer 498

inlay/crown and composite core

Question 499

residual dentine collar

Answer 499

ferrule

Question 500

ferrule

Answer 500

residual dentine collar left after crown prep that helps to prevent # 1.5 mm height and width

Question 501

core

Answer 501

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

Question 502

post

Answer 502

placed in root, retains core dose not strengthen/reinforce tooth (post preparation weakens tooth)

Question 503

ideal features of posts

Answer 503

parallel sided (non tapered) non threaded (passive) cement retained

Question 504

types of post

Answer 504

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 #

Question 505

post placement considerations/ideals

Answer 505

* 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

Question 506

extrinsic staining

Answer 506

smoking tanins CHX iron supplements

Question 507

intirinsic staining

Answer 507

fluorosis tetracycline amalgam/materials loss vitality

Question 508

before bleaching try

Answer 508

HPT scaling

Question 509

process of extrinsic discolouration and bleaching

Answer 509

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

Question 510

bleaching gel constituents

Answer 510

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

Question 511

max carbamide peroxide conc in bleaching agents

Answer 511

16.7% breaks down into 10% H2O2

Question 512

bleaching indications

Answer 512

* Post smoking cessation * Fluorosis * Age related discolouration * Non vital, good RCT and no PAP * Tetracycline

Question 513

bleaching contraindications

Answer 513

* Painful sensitivity * G6PD deficiency * \<16 yrs * Heavily restored tooth * Smokers * Amalgam staining

Question 514

side effects of bleaching

Answer 514

* 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

Question 515

external vital bleaching procedure

Answer 515

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

Question 516

non vital bleaching procedure

Answer 516

* 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

Question 517

external cervical resorption occurs how how to prevent

Answer 517

Diffusion of high concentration of H2O2 through dentine into perio tissues and application of heat. * Prevent by using adequate RMGIC restorations at ACJ

Question 518

combination bleaching procedure

Answer 518

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

Question 519

micro abrasion

Answer 519

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

Question 520

indications for micro abrasion

Answer 520

* Post ortho demineralisation * Mild fluorosis * Dark staining pre-veneering

Question 521

con of micro abrasion

Answer 521

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

Question 522

what can be used more accessibly if no HCl for bleaching

Answer 522

phosphoric acid only removes 10um Vs 100um etch 30secs prior to apply acid pumic mux for 30s/tooth (longer)

Question 523

regulations for teeth whitening

Answer 523

* 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

Question 524

indications for extractions

Answer 524

traumatic tooth position unrestorable tooth symptomatic partially erupted tooth orthodontic considerations

Question 525

tooth may be unrestorable because

Answer 525

gross caries advanced periodontial disease tooth/crown/root # pulp necrosis

Question 526

pre-extraction complications

Answer 526

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

Question 527

peri operative complications

Answer 527

* Bleeding/haemorrhage * Nerve damage * OAC * Damage to adjacent tooth/restoration * Lost tooth * Tooth #

Question 528

access/vision difficulties

Answer 528

* Limited mouth opening (reduced aperture) * Trismus * Crowded/malpositioned teeth

Question 529

abnormal resistance

Answer 529

* Hypercementosis * Ankylosis * Long/divergent/increased number of roots * Thick cortical bone

Question 530

causes of tooth #

Answer 530

caries alignmenet root size misdirection of force

Question 531

causes of jaw #

Answer 531

misdirection of force atrophic mandible cyst in bone impacted 8

Question 532

signs/symptoms of jaw #

Answer 532

crack step (visual/palpable) tear in gingiva at # line abnormal disclusion

Question 533

managament of jaw #

Answer 533

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)

Question 534

alveolar # management

Answer 534

suture disect free smooth edges

Question 535

TMJ dislocation management

Answer 535

relocate (condyles down and back)

Question 536

OAC Dx tools

Answer 536

direct vision (aspiration, good lighting - blood bubble at base of pocket) nose blow test - hold nose, gently blow blunt probe radiograph

Question 537

managment of OAC

Answer 537

if small/lining in tact - encourage clot, suture margins if large/lining torn - buccal advancement flap

Question 538

pt instructions for OAC

Answer 538

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

Question 539

maxilary tuberosity # causes

Answer 539

extraction in wrong order (front to back) last standing molar unknown unerupted 8

Question 540

signs/symptoms of maxilary tuberosity #

Answer 540

loose/mobile tuberosity/tooth tear in palate noise

Question 541

managemenet of maxilary tuberosity #

Answer 541

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

Question 542

how to retrieve rooth from antrum

Answer 542

suction (narrow bore) small curette irrigation ribbon gauze

Question 543

management of lost tooth

Answer 543

stop, search for it inhalation? A&E for chest x ray contact indemnity

Question 544

causes of damage to adj tooth/restoration

Answer 544

using tooth to lean on with elevator forceps slip and hit opposing tooth restoration overhang in contact with tooth to be extracted

Question 545

management of damage to adj tooth/restoration

Answer 545

temporary restoration arrange definitive

Question 546

causes of broken instruments

Answer 546

instrument fatigue incorrect use (using luxator as an elevator etc)

Question 547

management of broken instruments

Answer 547

retrieve radiogrpah to confirm refer if unable to retrieve

Question 548

types of nerve injuries

Answer 548

crush injuries cutting/shredding injuries transection injuries

Question 549

effects of nerve damage options

Answer 549

* Anaesthesia * Dyaesthesia * Paraesthesia * Hyperaesthesia * Hypoaesthesia

Question 550

neuropraxia

Answer 550

* Temporary loss of function due to blockage in nerve conduction * Bruise/contusion * Epineural sheath and axons maintained

Question 551

axontmesis

Answer 551

* Gradual loss of function distal to injury site * More severe contusion/crush * Epineural sheath disrupted, axons maintained

Question 552

neurotemesis

Answer 552

* Most severe type * Transection * Complete loss of nerve continuity * Epineural sheath and axons disrupted

Question 553

reasons for bleeding/haemorrhage

Answer 553

* Medication side effects * Undiagnosed/unmanaged clotting abnormality * Liver disease/dysfunction * Local factors (mucoperiosteal tear etc)

Question 554

soft tissue management for bleeding/haemorrhage

Answer 554

* Bite on damp gauze * Introduce haemostatic agents * Suture * Diathermy * Haemostatic forceps/artery clips

Question 555

bone managent for bleeding/haemorrhage

Answer 555

* Bite on damp gauze * Introduce haemostatic agents * Bone wax * Pack * suture

Question 556

haemostatic agents can use

Answer 556

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

Question 557

basic prinicples of minor oral surgery

Answer 557

* 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

Question 558

features of flap design

Answer 558

* 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

Question 559

methods of soft tissue retraction

Answer 559

rake retractor howarth's periosteal elevator

Question 560

reasons for soft tissue retractions

Answer 560

improve access to field protect soft tissues

Question 561

elevator functions

Answer 561

loosen/remove teeth remove retained roots

Question 562

3 modes of use for elevators

Answer 562

wheel and axle wedge lever

Question 563

handpiece to use in oral surgery

Answer 563

electric straight handpiece with saline-cooled straight/fissure tungsten carbide bur * air driven à surgical emphysema – don’t use

Question 564

6 possible methods of debridement

Answer 564

* handpiece, * bone file, * mitchell’s trimmer * Victoria curette * Irrigation (under flap) * Aspiration (under flap)

Question 565

6 aims for suturing

Answer 565

* 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

Question 566

possible nerve damage during extraction of L8

Answer 566

inferior alveolar lingual buccal nerve to mylohyoid

Question 567

pain pathway

Answer 567

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)

Question 568

features of aspirin

Answer 568

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

Question 569

side effects of aspirin

Answer 569

mucosal burns antiplatelet - thins bloods GI upset

Question 570

contraindications to aspirin use

Answer 570

not for use with other NSAIDs antiplatelet/anticoagulant peptic ulcer pregnant/under 16/ breast feeding (Reye's)

Question 571

ibuprofen is

Answer 571

NSAID less effect on platelets and gastric mucosa than aspirin

Question 572

side effects of ibuprofen

Answer 572

dizzy headache tired GI upset

Question 573

contraindications for ibuprofen

Answer 573

not for renal/hepatic impairment other NSAID use long term steroids peptic ulcer

Question 574

paracetamol action

Answer 574

indirectly inhibits COX by reducing PGs in CNS pathway

Question 575

contraindications for paracetamol

Answer 575

not for renal/hepatic impairment alcoholic

Question 576

dental opioid

Answer 576

dihydrocodeine

Question 577

contraindications to opioids

Answer 577

not for raised ICP (head injury) acute alcoholism

Question 578

problems associated with opioids

Answer 578

tolerance and dependence

Question 579

possible post extraction complications

Answer 579

* bruising * swelling * pain * bleeding * dry socket * OAF * Trismus * Infected socket * ORN * MRONJ

Question 580

pain/swelling/brusing post extraction why?

Answer 580

* Poor technique (trauma) * Rough tissue handling * Tear in gingiva/mucoperiosteum

Question 581

trismus is

Answer 581

limited mouth opening due to muscle spasm

Question 582

possible oral surgery reasns for trismus

Answer 582

surgical reasons (open too long, muscle spasm) LA into muscle (masseter) haematoma in muscle

Question 583

management of trismus

Answer 583

soft diet CHX mouthwash gentle opening techniques (wooden spatulas, trismus screws)

Question 584

OAF

Answer 584

oro antral fistula occurs secondary to OAC if OAC incorrectly heals/doesn't heal formation of epithelial lined tract between antrum and mouth

Question 585

Tx OAC

Answer 585

remove tract suture closed

Question 586

types of post op bleed

Answer 586

Immediate * reactionary/rebound (vessels not being compressed anymore), within 48hrs, usually ooze Delayed * usually 3-7 days post, often due to infection

Question 587

management of post op bleed

Answer 587

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

Question 588

pt instructions about bleeding

Answer 588

don't rinse that day don't smoke no alcohol/excessive exercise bleeding management - bite on gauze for 20 mins continuously emergency number

Question 589

dry socket a.k.a

Answer 589

localised osteitis alveolar osteitis

Question 590

predisposing factors to dry socket

Answer 590

* posterior tooth * mandibular tooth * smoking * excessive pre and post extraction rinsing * female * OCP * Previous dry socket * FH of dry socket

Question 591

signs/symptoms of dry socket

Answer 591

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

Question 592

management of dry socket

Answer 592

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

Question 593

pt instructions about dry socket

Answer 593

* Warm salt water mouth wash from next day * No excessive rinsing * Don’t dislodge clot

Question 594

sequestrum

Answer 594

piece of dead bone formed within diseased/injured bone

Question 595

how to manage sequestrum

Answer 595

remove it

Question 596

infected socket

Answer 596

rare bacterial infection with pus discharge causing delayed healing

Question 597

management of infected socket

Answer 597

clean socket/drain pus irrigate radiograph debride suture

Question 598

osteomyelitis

Answer 598

inflammation of bone marrow

Question 599

progression of osteomyelitis

Answer 599

medullary cavity to cancellous bone to cortoical bone to periosteum bacteria invade bone, cause local soft tissue necrosis and ischaemia

Question 600

predisposing factors for osteomyelitis

Answer 600

odontogenic infection #mandible immunocompromised comorbitidies

Question 601

3 types of osteomyelitis

Answer 601

early acute suppurative chronic +/- pus

Question 602

management of osteomyelitis

Answer 602

refer blood test surgery

Question 603

radiographic appearance of osteomyelitis

Answer 603

mottled bone sequestrum involucrum

Question 604

osteoradionecrosis starts how

Answer 604

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

Question 605

prevention and tx of ORN

Answer 605

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

Question 606

MRONJ

Answer 606

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

Question 607

stages of MRONJ

Answer 607

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

Question 608

bacteria involved in actinomycosis

Answer 608

a.israelli/vicosus

Question 609

actinomycosis is unique how

Answer 609

erodes through tissue, doen't follow fascial planes

Question 610

management of actinomyocosis

Answer 610

refer antibiotics long term antibiotics to prevent

Question 611

infective endocardititis

Answer 611

bacterial inflammation of endocardium, particularly affecting heart valves Management * Consult with cardiologist * Consider antibiotic prophylaxis -\> SDCEP

Question 612

high risk category for IE

Answer 612

* Previous IE * Cyanotic CHD * Prosthetic valve (replacement surgery)

Question 613

5 URA disloding forces

Answer 613

gravity muscles/tongue active component speech mastication

Question 614

HSSW made by

Answer 614

* drawing cold state metal through a series of successively smaller diameter dies * also causes work hardening, increasing springiness

Question 615

steel fractures by

Answer 615

* overwork * mechanical abrasion/crushed/marked * fatigue * weld decay

Question 616

3 ortho appliance categories and how they work

Answer 616

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

Question 617

ARAB

Answer 617

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

Question 618

active component

Answer 618

any component that uses force to move a tooth/teeth 1-2 teeth at a time

Question 619

retentive component

Answer 619

resistance to displacement forces

Question 620

anchorage

Answer 620

resistance to unwanted tooth movement

Question 621

base plate

Answer 621

provides anchorage, connector, retention through adhesion-cohesion

Question 622

URA fitting check

Answer 622

* 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

Question 623

URA fitting pt instructions

Answer 623

* 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

Question 624

retract canines and reduce OB

Answer 624

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

Question 625

retract and distalise canines

Answer 625

* 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

Question 626

anterior crossbite

Answer 626

* Z-spring (0.5mm HSSW) * 14+24+16+26 Adams clasps (0.7mm HSSW) * PBP

Question 627

posterior crossbite /expand upper arch

Answer 627

* Midline palatal screw * 14+24+16+26 Adams clasps (0.7mm HSSW) * Reciprocal anchorage * PBP

Question 628

reduce OJ/continue to reduce OB

Answer 628

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

Question 629

aims of ortho tx

Answer 629

stable functional aesthetic occlusion *aid other tx*

Question 630

indication for ortho tx

Answer 630

inc risk of trauma/disease impaired oral function unesthetic/psychological

Question 631

contraindications to ortho tx

Answer 631

uncontrolled epilepsy poorly controlled diabetes poor attendance/motivation poor OH

Question 632

benefits of ortho tx

Answer 632

reduce risk of trauma/disease improves function, aesthetics, dental health

Question 633

risks of ortho tx

Answer 633

decalcification relapse root resorption

Question 634

limitation of URA

Answer 634

teeth only stable in neutral zone (may relapse) no/minimal effect on skeletal patterns movement limited by shape and size of alveolar process

Question 635

ideal occlusion

Answer 635

* Gold standard by which occlusal irregularities and treatment may be judged. * Anatomically perfect, class I relationships

Question 636

normal occlusion

Answer 636

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

Question 637

malocclusion

Answer 637

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

Question 638

Andrew's 6 keys of ideal occlusion

Answer 638

* Correct molar relationship * Correct crown angulation * Correct crown inclination * Absence of rotations * Tight proximal contacts/ no spaces * Flat occlusal plane

Question 639

BSI class I

Answer 639

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

Question 640

BSI class II

Answer 640

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

Question 641

BSI class III

Answer 641

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

Question 642

Angle's class I

Answer 642

neutrocclusion MB cusp of U6 occludes with buccal groove of L6

Question 643

Angle's class II

Answer 643

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

Question 644

Angle's class III

Answer 644

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

Question 645

canine class I

Answer 645

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

Question 646

canine class II

Answer 646

* U3 occludes mesial to L3/4 embrasure

Question 647

canine class III

Answer 647

U3 occludes distal to L3/4 embrasure

Question 648

crossbite can be

Answer 648

* Buccal or lingual * Anterior or posterior

Question 649

overjet

Answer 649

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

Question 650

overbite

Answer 650

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

Question 651

methods of anterio-posterior skeletal base assessment

Answer 651

visual palpate skeletal bases ANB on lat ceph

Question 652

methods of vertical skeletal base assessment

Answer 652

FMPA anterior face height

Question 653

method for transverse skeletal base assessment

Answer 653

mid sagittal reference line

Question 654

skeletal AP classification

Answer 654

* Class I - maxilla 2-3mm in front of mandible * Class II - maxilla \>3mm in front of mandible * Class II - maxilla \<2mm/behind mandible

Question 655

cephalometric values for AP

Answer 655

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

Question 656

long face

Answer 656

LAFH \>55% of AFH FMPA \>31 anterior open bite tendency

Question 657

short face

Answer 657

LAFH \<55% of AFH FMPA \<23 deep overbite tendency

Question 658

local malocclusion

Answer 658

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

Question 659

possible reasons for local malocclusion

Answer 659

supernumerary hypodontia retained primary teeth early loss of permanent teeth micro/macrodontia

Question 660

4 classes of supernumeries

Answer 660

odontoma (complex, compound) supplemental tuberculate conical

Question 661

differential pressure theory of tooth movement

Answer 661

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

Question 662

mechano-chemical theory of tooth movement

Answer 662

pressure causes chemical release causing resorption/deposition

Question 663

piezo-electric theory of tooth movement

Answer 663

pressure causes electric current generation causing resorption/deposition

Question 664

force needed for tipping tooth movement

Answer 664

35-60g

Question 665

force needed for bodily tooth movement

Answer 665

150-200g

Question 666

force needed for intrusive tooth movement

Answer 666

10-20g

Question 667

force needed for extrusive tooth movement

Answer 667

35-60g

Question 668

force needed for rotation tooth movement

Answer 668

35-60g

Question 669

force needed for torque tooth movement

Answer 669

50-100g

Question 670

light forces pathophysiology

Answer 670

* 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

Question 671

moderate forces pathophysiology

Answer 671

* 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

Question 672

heavy forces pathophysiology

Answer 672

* necrosis * undermining resorption * root surface resorption * pain * permanent change

Question 673

factors affecting response to orthodontic force

Answer 673

* magnitude * duration * age * anatomy

Question 674

facial growth IUL

Answer 674

7-8weeks

Question 675

2 areas of skull

Answer 675

viscerocranium (face) neurocranium (vault and base)

Question 676

neurocranium growth

Answer 676

intramembranous ossification vault endochondral ossification base

Question 677

unique jaw growth

Answer 677

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

Question 678

5 units of mandible

Answer 678

* condylar * coronoid (in response to temporalis) * angular (in response to masseter and medial pterygoid) * alveolar (in response to teeth) * body (in response to IAN)

Question 679

growth of skull vault when born

Answer 679

at fontanelles/sutures (anterior closes at 2, posterior closes at 1). Growth at sutures until 7 and then external surface deposition/internal surface resorption

Question 680

growth of skull base

Answer 680

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

Question 681

3 sites of secondary cartilage formation in mandible

Answer 681

* Condylar * Coronoid * Symphysis

Question 682

primary abnormality is

Answer 682

anomaly in development causes sutrual defect

Question 683

secondary abnormality is

Answer 683

external influence interrups/stops normal development

Question 684

deformation

Answer 684

anomaly due to external mechanical effect on existing structure

Question 685

agenesis

Answer 685

failure to form/develop (absent)

Question 686

sequence

Answer 686

single factor cause numerous secondary effects

Question 687

syndrome

Answer 687

group of anomalies with common origin

Question 688

types of embryonic stage syndromes

Answer 688

foetal alcohol syndrome hemifacial microsomia treacher collins cleft lip and palate

Question 689

foetal alcohol syndrome

Answer 689

small head, cognitive impairment, short nose

Question 690

hemifacial microsomia

Answer 690

spectrum of facial asymmmetry

Question 691

Treacher Collins syndrome

Answer 691

mandibulofacial dysostosis hypoplastic/missing zygomatic arch, mandible

Question 692

cleft lip and palate can cause

Answer 692

crowding, hypoplastic teeth, 'nick' out of lip, caries

Question 693

syndromes associated with skull growth

Answer 693

achondropasia Crouzon's aperts

Question 694

achondropasia

Answer 694

problems with endochondral ossification stunted growth, flat bones develop normally (large vault), base of skull defects

Question 695

Crouzon's

Answer 695

early closure of cornal and lambdoid sutures proptosis, prominents nose, class III

Question 696

Apert's

Answer 696

early closure of almost all cranial sutures parrot beak, acrosyndactyly, AOB, CLP (30%)

Question 697

places of post natal growth

Answer 697

cranial sutures base of skull synchondrosis surface deposision beneath periosteum

Question 698

forward adverse growth factor affect

Answer 698

short face (chin up)

Question 699

backwards adverse growth factor affect

Answer 699

long face (down)

Question 700

interceptive ortho

Answer 700

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

Question 701

dental features at birth

Answer 701

class II AOB gum pads (upper rounded, lower U)

Question 702

primary eruption sequence

Answer 702

6 months - 3 years a b d c e

Question 703

no spacing in primary crowding in permanent?

Answer 703

66% crowding risk

Question 704

\<3mm spacing in primary crowding in permanent?

Answer 704

50% crowding risk

Question 705

3-6mm spacing in primary permanent crowding risk?

Answer 705

20% crowding risk

Question 706

6+mm spacing in primary permanent crowding risk

Answer 706

no crowding risk

Question 707

permanent dentition eruption

Answer 707

Early * 6s at 6 * 1s at 7 * 2s at 8 Late * 4s at 10 * 3s and 5s at 11-12 * 7s at 12-13

Question 708

leeway space

Answer 708

difference between c,d,e and 3,4,5 maxilla = 1.5mm mandible = 2.5mm

Question 709

balancing extraction

Answer 709

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

Question 710

compensating extraction

Answer 710

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

Question 711

management of early loss of primary teeth

Answer 711

a/b monitor c balance d consider balance e monitor

Question 712

management of early loss 6s best time to lose 6s

Answer 712

if L6, compensate best time with 7s bifurcation forming, 5s and 8s present, moderate lower crowding

Question 713

tx of developing anterior crossbite

Answer 713

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

Question 714

tx of developing posterior crossbite

Answer 714

overcorrect with URA and midline screw

Question 715

management of unerupted permanent central incisor

Answer 715

* observe (1.5yrs) * create space * remove supernumerary/deciduous tooth * exposure and bond

Question 716

management of ectopic 6

Answer 716

extract e distalise 6

Question 717

management of retained primary tooth

Answer 717

if successor present usually exfoliates/extract 1yr later if successor absent extract early (space closes) or retain as long as possible

Question 718

infra occluded

Answer 718

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

Question 719

management of ankylosed tooth

Answer 719

Successor present usually exfoliates/extract 1yr later Successor absent extract when 1mm of crown left showing above gingiva margin

Question 720

occlusal effect of digit sucking

Answer 720

proclie upper incisors retrocline lower incisors anterior open bite (localised/asymmetric) prosterior cross bite/narrow maxilla

Question 721

digit sucking tx options

Answer 721

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

Question 722

interceptive tx for developing skeletal class II

Answer 722

* Growth modification * Twin block functional appliance +/- headgear to restrict maxilla forward growth

Question 723

interceptive tx for developing skeletal class III

Answer 723

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

Question 724

when and how to examine for ectopic canines

Answer 724

9-10years visual and palpate gingiva around canine (should feel bulge) radiograph if no - parallax or OPT

Question 725

management and success rate of ectopic canines

Answer 725

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

Question 726

options for ortho tx

Answer 726

* Do nothing * Extractions only * Appliances +/- extractions * Removable * Fixed * Functional * Orthognathic surgery

Question 727

2 methods of crowding assessment

Answer 727

* Overlap technique (estimate/eyeball) * Space required Vs space available (callipers)

Question 728

lower crowding classes and management

Answer 728

Mild 0-4mm non extraction stripping, X5 Moderate 5-8mm X5, X4 Severe \>8mm X4

Question 729

how to manage upper crowding

Answer 729

Lower extraction * Compensation No lower extraction * Extract upper (class II molar relationship) * Distalise upper buccal segment with headgear (class I molar relationship)