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Mock Case Presentation Flashcards

1
Q

what does a bimaxillary osteotomy involve

A

surgery on both jaws

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2
Q

what type of malocclusion does a bimaxillary osteotomy treat

A

open bite

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3
Q

why might someone need a bimaxillary osteotomy

A

severe jaw misalignment
incorrect jaw position or size
impaired jaw function

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4
Q

what are the risks and side effects of bimaxillary osteotomy

A

lip numbness
hearing changes
jaw relapse
jaw fracture
TMJ dysfunction
severe bleeding
need for second surgery
general surgery risks

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5
Q

what is asthma

A

airway narrowing due to:
1. bronchial smooth muscle constriction
2. bronchial mucosal oedema
3. excessive mucous secretion into the airway lumen

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6
Q

what are the symptoms of asthma

A

cough
wheeze
shortness of breath
diurnal variation
difficulty breathing out

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7
Q

what does PEFR track

A

airway resistance

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8
Q

what are the triggers for asthma

A

infections
environmental
cold air
atopy

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9
Q

what test can we use for allergy induce asthma

A

skin prick

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10
Q

what is the asthma biphasic response due to

A

early response related to mast cell degranulation
late response due to cellular inflammation

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11
Q

what is the early asthma attack blocked by

A

beta agonists (salbutamol)

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12
Q

what is the late asthma attack blocked by

A

corticosteroids

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13
Q

what are the main asthma drugs

A

SA beta agonists
LA beta agonists
high and low corticosteroids

adjuvant therapy (monteleukast, prednisolone, biologic therapy)

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14
Q

what is the action of beta agonists

A

relax bronchial smooth muscle by reducing bronchoconstriction and reduce resting bronchial tone

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15
Q

when are beta agonists used in asthma

A

either as short acting reliever drug or long acting preventer drug

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16
Q

what actions does corticosteroids have

A

immune cell and epithelial actions
reduce inflammation in the bronchial walls

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17
Q

when do you start using an inhaled
low dose corticosteroid with asthma

A

if using short acting beta agonist more than 3 times each week

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18
Q

when do you move to a high dose inhaled corticosteroid

A

if symptoms indicate need

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19
Q

what non-oral side effects can corticosteroids have?

A

adrenal suppression
osteoporosis

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20
Q

what do spacers do

A

reduce the risk of side effects from medicine affecting your mouth and throat

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21
Q

what are the common oral side effects of fluticasone

A

oral thrush
dry or sore throat or hoarse voice

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22
Q

our patient is on salbutamol and fluticasone, what is the severity of the asthma and why

A

low severity as salbutamol is SA agonist and corticosteroid (dont know dose though)

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23
Q

what is it important to know about a patients asthma as a densit

A

triggers
how to assess and treat during acute asthma attack

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24
Q

how quickly does a short acting beta agonist work

A

2-3 minutes

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25
Q

how long does a SA beta agonist work

A

4-6 hours

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26
Q

what are short acting beta agonists used to treat

A

acute bronchial constriction

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27
Q

what is the immunology of asthma

A

chronic inflammation by infiltration and activation of immune cells like dendritic cells, eosinophils, neutrophils, lymphocytes, innate lymphoid cells and mast cells

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28
Q

what is depression

A

persistent sadness for weeks or months

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29
Q

what are the symptoms of depression

A

unhappiness
hopelessness
losing interest in hobbies
constantly tired
sleep badly
no appetite

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30
Q

what can cause depression

A

upsetting or stressful life event
bereavement
low self-esteem
overly critical
family history
post-natal
menopause
loneliness
alcohol and drugs
illness

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31
Q

what are some of the treatments for depression

A

guided self help (CBT)
exercise
talking therapies
antidepressants

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32
Q

what are the different types of antidepressant

A

SSRI
tricyclic antidepressants
SNRI

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33
Q

what type of antidepressant is sertraline

A

SSRI

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34
Q

what does SSRI stand for

A

selective serotonin reuptake inhibitor

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35
Q

what do SSRIs do

A

increase serotonin levels in the brain by blocking the reuptake (reabsorption) of it into the nerve cells meaning there is more serotonin available to the body

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36
Q

what is serotonin

A

messenger chemical that carries signals between nerve cells in brain
has good influence on mood, emotion and sleep

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37
Q

what are the side effects of SSRIs

A

agitation, anxious
diarrhoea
dizziness
blurred vision
loss of libido

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38
Q

what are the side effects of sertraline

A

nausea
headaches
being unable to sleep
feeling sleepy
diarrhoea
dry mouth
feeling dizzy
feeling tired or weak

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39
Q

what type of drug is propranolol

A

non-selective beta blocker
(targets B1 and B2)

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40
Q

what is the action of beta blockers

A

prevent increase in heart rate
reduce heart efficiency
block beta receptors in lungs

does this by blocking the effects of adrenaline

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41
Q

what are the common uses of propranolol

A

high BP
heart rhythm disorders
angina
migraines
tremor
anxiety

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42
Q

what symptoms of anxiety can propranolol help to relieve

A

rapid heartbeat
sweating
dizzy feel
shaky hands or voice

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43
Q

what are the side effects of propranolol

A

abdominal discomfort
slow heartbeat
confusion
depression
vomiting
visual impairment
headache
fatigue

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44
Q

what is the safe alcohol units per week

A

14

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45
Q

what should we be doing with the units of alcohol we drink per week

A

spread over at least 3 days if drinking 14 units
with some alcohol free days

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46
Q

what is 14 units equivalent to in terms of wine glasses and pints

A

6 pints
10 small glasses of wine

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47
Q

what is linea alba caused by

A

friction in the mouth such as
grinding
orthodontic appliances
overenthusiastic brushing

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48
Q

what is linea alba

A

frictional thickening of buccal mucosa appearing as raised white line running horizontally along the occlusal plane (on buccal mucosa)
deposition of excess keratin

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49
Q

what can we do to help linea alba

A

reassure the patient it is non-malignant
take a history of patient (grinding/stress)
could construct a splint if the patient has trouble grinding overnight
advise patient to try to relax

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50
Q

how is a diet diary used

A

write everything you eat down over 3-4 days with at least one day at the weekend

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51
Q

what is the difference between plaque scores and modified plaque scores

A

plaque scores use every tooth in the mouth and all 4 sides of the tooth. Also only uses a score of 1 or 0
modified plaque uses ramfjords teeth so is quicker. Uses scores 2, 1, 0.

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52
Q

why are bitewings taken

A

to assess for presence of caries

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53
Q

why have periapicals been taken in this case

A

to assess condition of indirect restorations and periapical health

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54
Q

why would you sensibility test the 37

A

to assess the pulpal health of the tooth
the patient is not sore at the moment however it may be a good idea to gain more knowledge about the state of the pulp

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55
Q

what sensibility tests would you want

A

EPT
ethyl chloride
TTP

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56
Q

what is this patients periodontal diagnosis

A

generalised gingivitis

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57
Q

what gives a diagnosis of generalised gingivitis

A

code 0/1/2 with >30% bleeding on probing sites

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58
Q

what would the periodontal treatment be for someone with a BPE of 2

A

Step 1 Treatment:
OHI
remove plaque retentive factors
supragingival PMPR

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59
Q

what does step 1 periodontal treatment include

A

explain disease and risk factors
explain OHI
reduce risk factors and plaque retentive factors
provide individually tailored advice for ID cleaning and brushing
supragingival PMPR of clinical crown

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60
Q

what is step 2 periodontal treatment

A

reinforce OHI
subgingival instrumentation

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61
Q

what is step 3 periodontal treatment

A

revisiting the non-responding sites of deep residual pockets

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62
Q

what is step 4 periodontal treatment

A

maintenance
regular OHI
regular targeted PMPR

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63
Q

what is an engaging periodontal patient

A

plaque levels <20% and bleeding <30%

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64
Q

what is a non-engaging patient

A

plaque >20% and bleeding >30%

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65
Q

what is symptomatic irreversible pulpitis

A

a clinical diagnosis stating that the vital inflamed pulp is incapable of healing with lingering thermal pain/spontaneous pain/referred pain

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66
Q

what is normal apical tissues

A

teeth with normal periradicular tissues not TTP or palpation testing
lamina dura surrounding the root is intact and PDL space is uniform

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67
Q

what is asymptomatic apical periodontitis

A

inflammation and destruction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area and does not produce clinical symptoms

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68
Q

how do you clinically assess a tooth which might have a root canal problem

A

check coronal seal
look for ferrule
decide if restorable with dam
swelling
sinus
TTP
buccal sulcus - TTP?
mobility
increased pocketing

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69
Q

what do you look for radiographically with a tooth which may have a root canal problem

A

root filling
unfilled/missed root canals
shape of canal
patency
bone support
crown to root ratio
pathology

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70
Q

what problems can we have after RCT when thinking about restoring the tooth

A

amount of remaining tooth structure
restoration type
lack or no ferrule
wide post holes
endodontic complications

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71
Q

what is coronal microleakage

A

ingress of oral micro-organisms into the root canal system

72
Q

how long should root filled unrestored teeth go before having to be re-root treated

A

3 months

73
Q

how do we avoid coronal microleakage

A

trim GP to the ACJ and place RMGI over pulp floor and root canal openings

74
Q

what are the restorative options for an anterior tooth with intact marginal ridges

A

composite restoration
veneer

75
Q

what are the restorative options for an anterior tooth with intact marginal ridges and discolouration

A

bleaching
veneer
crown

76
Q

what are the restorative options for anterior teeth with marginal ridges destroyed

A

core build up with crown
post crown

77
Q

what does a post and core do

A

post gains intraradicular support for definitive restoration
core provides retention for crown

78
Q

why are posts avoided in mandibular incisors

A

thin tapering and narrow mesiodistal roots

79
Q

if a post is to be placed in a premolar what canal should it be placed in

A

widest root canal

80
Q

how long should the root filling be for a post

A

4-5mm

81
Q

how wide should a post be

A

no more than 1/3 of root width at narrowest point and 1 mm of remaining circumferential coronal dentine

82
Q

what is the post length to crown length ratio supposed to be

A

minimum 1:1

83
Q

what is the minimum requirements of a ferrule

A

1.5mm height and width of remaining coronal dentine

84
Q

what is a ferrule

A

1-2mm of vertical axial tooth structure within walls of a crown

85
Q

what is the purpose of a ferrule

A

to prevent tooth fracture
fracture risk increases significantly if crown not placed onto solid tooth structure

86
Q

what are the dimensions of a restorable tooth with a post crown

A

1:1 post to crown length
at least 1mm ferrule width and 1.5mm height
3.5mm prep length for crown
5mm for apical RCF

87
Q

what are the advantages of a parallel post

A

avoid wedging
more retentive than tapered

88
Q

what is the advantage of using a non-threaded (passive) post

A

less stress to remaining tooth

89
Q

what is the advantage of using cement to retain a post (rather than it being threaded)

A

acts as buffer between masticatory forces and post/tooth

90
Q

what type of post material is radiopaque on radiographs

A

metal

91
Q

what are the disadvantages of using a metal post

A

poor aesthetics
root fracture
corrosion
nickel sensitivity

92
Q

what type of post material is radiolucent on radiographs

A

fibre

93
Q

what are the advantages to using a fibre post

A

flexible
similar properties to dentine
aesthetics
retrievable
bone to dentine with DBAs

94
Q

why do you use cuspal coverage after RCT of posterior tooth

A

coronal seal
prevention of fracture

95
Q

what material is most commonly used for a core build up and why

A

composite
good aesthetics
bonds to tooth

96
Q

what is a nayyar core made of

A

amalgam

97
Q

what is the disadvantage of a nayyar core

A

cannot crown prep for 24hrs until amalgam sets

98
Q

what provides retention for a nayyar core

A

packing the amalgam into the root canals

99
Q

what are the problems with posts

A

perforation
core fracture
root fracture or crack
post fracture

100
Q

name a tool used to remove posts

A

masseran kit

101
Q

what is the main reason for post failure

A

restorative

102
Q

what would the indications for an onlay be

A

sufficient occlusal tooth substance loss
remaining tooth substance weakened
restoring RCT teeth

103
Q

what types of material can be used for an onlay

A

porcelain
gold
composite

104
Q

what cementing systems are used to cement ceramic onlays

A

NX3 (nexus)
relyX

105
Q

what cementing systems are used to cement metal backed indirect restorations

A

aquacem
panavia

106
Q

what could the alternative to an onlay on an RCT tooth be

A

crown
GSC
MCC
PJC

107
Q

what special tests can you do before placing an indirect restoration

A

sensibility testing
radiology
analyse study casts

108
Q

when are resin retained brides used

A

when abutments are unrestored or minimally restored

109
Q

what type of luting cement is used for bonding metal wings of resin retained bridges (give brand too)

A

adhesive resin luting cements
panavia

110
Q

what component of panavia allows it to bond to both metal and the etched tooth

A

4-META

111
Q

what can you do to overcome the issue of premature contacts with bridge design when a patient has a complete overbite

A

adjust opposing tooth
create occlusal clearance in prep
accept high occlusion and get used to it

112
Q

when are onlays used

A

extensively restored and weakened teeth
root filling in posterior tooth needing cuspal coverage

113
Q

what are the advantages of using gold as an onlay material

A

high strength, ductility, accurately cast
less reduction of tooth required as doesnt need to be bulky to have strength
not as abrasive
good for wear patients

114
Q

what are the advantages of using composite for an onlay

A

higher cure rate improving strength and reducing wear

115
Q

what are the disadvantages of using composite for an onlay

A

less accurate fit
absorbs dietary stains

116
Q

when do you use ceramic for an onlay

A

for aesthetics

117
Q

what is the main disadvantages of using ceramic for an onlay

A

brittle
abrasive for opposing surfaces

118
Q

what cement is used for cementing a ceramic onlay

A

resin based luting cement

119
Q

what factors are considered when deciding if a tooth is restorable or not

A

cost
longevity and functionality
clinical benefit of restoring
periapical status/RCT present/bone levels
pulp sensibility
amount of remaining tooth
subgingival damage

120
Q

what factors are favourable when deciding if a tooth is restorable

A

vital pulp/good RCT
adequate tooth structure remaining
pockets of 3-4mm, >50% bone level remaining
canine guidance
good OH, motivated patient

121
Q

what factors are not so favourable when deciding if a tooth is restorable or not

A

symptomatic/pathology at the periapical region
little tooth structure remaining after prep
active perio
reduced OVD meaning little space for restoration
poor OH, not motivated patient

122
Q

when would you opt to replace missing teeth

A

appearance
occlusal stability
mastication

123
Q

what are the effects of calcium hydroxide

A

bacteriocidal due to high pH stimulating reparative dentine formation
stimulates recalcaification of demineralised dentine
neutralises low pH from acidic restorative materials
cytotoxic so can kill pulp cells

124
Q

what are the options for treating pulpal damage

A

indirect pulp cap
direct pulp cap
partial pulpal removal
full pulpal removal

125
Q

what are the clinical objectives of endodontic therapy

A

removing canal contents
eliminating infection

126
Q

what are the 3 principles of design for endodontics

A

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

127
Q

what does mechanical preparation of the root canal allow

A

space creation for irrigating solutions and medicaments to more effectively eliminate micro-organisms from the root-canal system

128
Q

what is the advantages of using sodium hypochlorite for endodontics

A

potent antimicrobial
dissolves pulp remnants
dissolves necrotic and vital tissue
helps disrupt smear layer

129
Q

what factors are important for the function of NaOCl

A

concentration
volume
contact
mechanical agitation
exchange

130
Q

what concentration of NaOCl should be used for endodontics

A

between 0.5% and 6%

131
Q

what are the problems with NaOCl

A

effect on dentine properties
cant remove smear layer
effect on organic material
discolouration of fabric
eye injuries
apical extrusion = necrosis
allergic reactions

132
Q

what percentage of EDTA is used to remove the smear layer

A

17%

133
Q

what is the necessary contact time of EDTA to remove the smear layer

A

1 minute

134
Q

what is the disadvantage of using chlorhexidine

A

cant disrupt biofilms

135
Q

what are the advantages of using chlorhexidine

A

dentine which comes into contact with it acquires antimicrobial substantivity
biocompatible

136
Q

what should the canal be irrigated with once canal preparation is complete

A

3% NaOCl (30ml) for 10 mins
17% EDTA (3ml) 1min
3% NaoCl final rinse

137
Q

why are intra-canal medicaments used

A

destroy microorganisms and prevent re-infection

138
Q

when are anti-microbial pastes used in endodontic treatment

A

for hot pulps
corticosteroid medicament

139
Q

what is the pH of non-setting calcium hydroxide and what does this mean

A

12.5
antibacterial

140
Q

where should root canal preparation end

A

at the junction of pulpal and periapical tissue
(apical constriction)

141
Q

when should root canal obturation be completed

A

after root canal preparation and when the infection is considered to have been eliminated and canal be dried

142
Q

what are the constituents of gutta percha

A

gutta percha
zinc oxide
radiopacifiers
plasticisers

143
Q

what is the function of a root canal sealer

A

seal space between dentinal wall and core
fill void and irregularities in canal, lateral canals and between points
lubricates during obturation

144
Q

give examples of 3 different types of sealer

A

ZOE
GI
resin

145
Q

what are the steps of root canal treatment

A

create access cavity
get straight line access
establish working length
coronal flare (gates gliddens/rotary/hand files)
apical preparation (hand file/rotary)
need to irrigate and recapitulate throughout
obturation with cold lateral condensation

146
Q

what is the purpose of a dental implant

A

replace missing teeth with aesthetics and function

147
Q

what medical conditions may affect the survival of dental implants

A

medications - bisphosphonates, SSRIs, PPIs, steroids
radiotherapy
diabetes

148
Q

what is the relevant maxillary anatomy when placing an implant

A

sinus
nasal floor
nasopalatine canal
infra-orbital nerve

149
Q

what is the relevant mandible anatomy when placing an implant

A

IAN
mental foramen
incisive canal
lingual perforating vessels
submandibular fossa

150
Q

what will implant positioning depend on

A

implant system
proposed gingival margin
local anatomy
prosthetic plan

151
Q

what is the minimum mesio-distal distance you need for placing an implant

A

1.5mm

152
Q

how much bone is needed labially for an implant

A

> 1mm or >2mm HT/ST

153
Q

what aids are needed to plan for implants

A

study models
diagnostic wax up
surgical template
essex
clinical photographs
CBCT
surgical guide

154
Q

what are the risk factors that you need to consider before implant placement

A

medical status
smoking habit
patients aesthetic demand
lip line
gingival biotype
shape of tooth crown
bone level at adjacent teeth
local infection at implant site
restorative status of neighbouring teeth
width of edentulous space
soft tissue anatomy
bone defect at implant site

155
Q

what is the ICRP

A

internal commission for radiological protection

156
Q

what are the basic principles of the ICRP

A

justified
optimised
limited

157
Q

what does it mean if radiation exposure is justified

A

must do more good than harm

158
Q

what does it mean if radiation exposure is optimised

A

magnitude of exposures and number of people exposed must be ALARP

159
Q

what does it mean if radiation exposure is limited

A

dose limits used to ensure no one received unacceptable level of exposure

160
Q

what is IRR17

A

ionising radiations regulations 2017

161
Q

what is IRMER17

A

ionising radiation medical exposure regulations 2017

162
Q

what does IRR deal with

A

occupational exposures and general public exposure

163
Q

what does IRMER deal with

A

medical exposure of patients

164
Q

what does IRR mean for dentists

A

need to submit application the HSE to register for use of x-rays

165
Q

what causes conventional feldspathic dental ceramics to fail during loading

A

low tensile strength
low flexural strength
low fracture toughness

166
Q

what helps to make zirconia crowns strong and hard

A

Yttria stabilisation

167
Q

what part of the crown is the zirconia

A

the core

168
Q

what type of ceramic is used for a cast ceramic

A

lithium disilicate

169
Q

what type of ceramic material has superior aesthetics

A

LiDiSi

170
Q

what type of crown material is strongest

A

zirconia

171
Q

what type of ceramic can be used for posterior teeth

A

zirconia based ceramic

172
Q

what type of ceramic is used for anterior teeth

A

LiDiSi

173
Q

what type of material are emax crowns made of

A

LiDiSi

174
Q

what luting material would you use for a MCC

A

GIC
RMGIC

175
Q

what luting material is used for a composite inlay/onlay

A

dual cure comp and DBA (Nexus)

176
Q

what luting material is used for a porcelain inlay/onlay

A

dual cure composite and DBA
and silane coupling agent (Nexus)

177
Q

what luting material is used to bond non-precious metal wings e.g., bridgework

A

composite luting resin (Panavia) and DBA and metal bond agent

Case Presentation (2 decks)

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