Mock Case Presentation Flashcards
(177 cards)
1
Q
what does a bimaxillary osteotomy involve
A
surgery on both jaws
2
Q
what type of malocclusion does a bimaxillary osteotomy treat
A
open bite
3
Q
why might someone need a bimaxillary osteotomy
A
severe jaw misalignment
incorrect jaw position or size
impaired jaw function
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
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
6
Q
what are the symptoms of asthma
A
cough
wheeze
shortness of breath
diurnal variation
difficulty breathing out
7
Q
what does PEFR track
A
airway resistance
8
Q
what are the triggers for asthma
A
infections
environmental
cold air
atopy
9
Q
what test can we use for allergy induce asthma
A
skin prick
10
Q
what is the asthma biphasic response due to
A
early response related to mast cell degranulation
late response due to cellular inflammation
11
Q
what is the early asthma attack blocked by
A
beta agonists (salbutamol)
12
Q
what is the late asthma attack blocked by
A
corticosteroids
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)
14
Q
what is the action of beta agonists
A
relax bronchial smooth muscle by reducing bronchoconstriction and reduce resting bronchial tone
15
Q
when are beta agonists used in asthma
A
either as short acting reliever drug or long acting preventer drug
16
Q
what actions does corticosteroids have
A
immune cell and epithelial actions
reduce inflammation in the bronchial walls
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
18
Q
when do you move to a high dose inhaled corticosteroid
A
if symptoms indicate need
19
Q
what non-oral side effects can corticosteroids have?
A
adrenal suppression
osteoporosis
20
Q
what do spacers do
A
reduce the risk of side effects from medicine affecting your mouth and throat
21
Q
what are the common oral side effects of fluticasone
A
oral thrush
dry or sore throat or hoarse voice
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)
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
24
Q
how quickly does a short acting beta agonist work
A
2-3 minutes
25
how long does a SA beta agonist work
4-6 hours
26
what are short acting beta agonists used to treat
acute bronchial constriction
27
what is the immunology of asthma
chronic inflammation by infiltration and activation of immune cells like dendritic cells, eosinophils, neutrophils, lymphocytes, innate lymphoid cells and mast cells
28
what is depression
persistent sadness for weeks or months
29
what are the symptoms of depression
unhappiness
hopelessness
losing interest in hobbies
constantly tired
sleep badly
no appetite
30
what can cause depression
upsetting or stressful life event
bereavement
low self-esteem
overly critical
family history
post-natal
menopause
loneliness
alcohol and drugs
illness
31
what are some of the treatments for depression
guided self help (CBT)
exercise
talking therapies
antidepressants
32
what are the different types of antidepressant
SSRI
tricyclic antidepressants
SNRI
33
what type of antidepressant is sertraline
SSRI
34
what does SSRI stand for
selective serotonin reuptake inhibitor
35
what do SSRIs do
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
36
what is serotonin
messenger chemical that carries signals between nerve cells in brain
has good influence on mood, emotion and sleep
37
what are the side effects of SSRIs
agitation, anxious
diarrhoea
dizziness
blurred vision
loss of libido
38
what are the side effects of sertraline
nausea
headaches
being unable to sleep
feeling sleepy
diarrhoea
dry mouth
feeling dizzy
feeling tired or weak
39
what type of drug is propranolol
non-selective beta blocker
(targets B1 and B2)
40
what is the action of beta blockers
prevent increase in heart rate
reduce heart efficiency
block beta receptors in lungs
does this by blocking the effects of adrenaline
41
what are the common uses of propranolol
high BP
heart rhythm disorders
angina
migraines
tremor
anxiety
42
what symptoms of anxiety can propranolol help to relieve
rapid heartbeat
sweating
dizzy feel
shaky hands or voice
43
what are the side effects of propranolol
abdominal discomfort
slow heartbeat
confusion
depression
vomiting
visual impairment
headache
fatigue
44
what is the safe alcohol units per week
14
45
what should we be doing with the units of alcohol we drink per week
spread over at least 3 days if drinking 14 units
with some alcohol free days
46
what is 14 units equivalent to in terms of wine glasses and pints
6 pints
10 small glasses of wine
47
what is linea alba caused by
friction in the mouth such as
grinding
orthodontic appliances
overenthusiastic brushing
48
what is linea alba
frictional thickening of buccal mucosa appearing as raised white line running horizontally along the occlusal plane (on buccal mucosa)
deposition of excess keratin
49
what can we do to help linea alba
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
50
how is a diet diary used
write everything you eat down over 3-4 days with at least one day at the weekend
51
what is the difference between plaque scores and modified plaque scores
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.
52
why are bitewings taken
to assess for presence of caries
53
why have periapicals been taken in this case
to assess condition of indirect restorations and periapical health
54
why would you sensibility test the 37
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
55
what sensibility tests would you want
EPT
ethyl chloride
TTP
56
what is this patients periodontal diagnosis
generalised gingivitis
57
what gives a diagnosis of generalised gingivitis
code 0/1/2 with >30% bleeding on probing sites
58
what would the periodontal treatment be for someone with a BPE of 2
Step 1 Treatment:
OHI
remove plaque retentive factors
supragingival PMPR
59
what does step 1 periodontal treatment include
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
60
what is step 2 periodontal treatment
reinforce OHI
subgingival instrumentation
61
what is step 3 periodontal treatment
revisiting the non-responding sites of deep residual pockets
62
what is step 4 periodontal treatment
maintenance
regular OHI
regular targeted PMPR
63
what is an engaging periodontal patient
plaque levels <20% and bleeding <30%
64
what is a non-engaging patient
plaque >20% and bleeding >30%
65
what is symptomatic irreversible pulpitis
a clinical diagnosis stating that the vital inflamed pulp is incapable of healing with lingering thermal pain/spontaneous pain/referred pain
66
what is normal apical tissues
teeth with normal periradicular tissues not TTP or palpation testing
lamina dura surrounding the root is intact and PDL space is uniform
67
what is asymptomatic apical periodontitis
inflammation and destruction of apical periodontium that is of pulpal origin, appears as an apical radiolucent area and does not produce clinical symptoms
68
how do you clinically assess a tooth which might have a root canal problem
check coronal seal
look for ferrule
decide if restorable with dam
swelling
sinus
TTP
buccal sulcus - TTP?
mobility
increased pocketing
69
what do you look for radiographically with a tooth which may have a root canal problem
root filling
unfilled/missed root canals
shape of canal
patency
bone support
crown to root ratio
pathology
70
what problems can we have after RCT when thinking about restoring the tooth
amount of remaining tooth structure
restoration type
lack or no ferrule
wide post holes
endodontic complications
71
what is coronal microleakage
ingress of oral micro-organisms into the root canal system
72
how long should root filled unrestored teeth go before having to be re-root treated
3 months
73
how do we avoid coronal microleakage
trim GP to the ACJ and place RMGI over pulp floor and root canal openings
74
what are the restorative options for an anterior tooth with intact marginal ridges
composite restoration
veneer
75
what are the restorative options for an anterior tooth with intact marginal ridges and discolouration
bleaching
veneer
crown
76
what are the restorative options for anterior teeth with marginal ridges destroyed
core build up with crown
post crown
77
what does a post and core do
post gains intraradicular support for definitive restoration
core provides retention for crown
78
why are posts avoided in mandibular incisors
thin tapering and narrow mesiodistal roots
79
if a post is to be placed in a premolar what canal should it be placed in
widest root canal
80
how long should the root filling be for a post
4-5mm
81
how wide should a post be
no more than 1/3 of root width at narrowest point and 1 mm of remaining circumferential coronal dentine
82
what is the post length to crown length ratio supposed to be
minimum 1:1
83
what is the minimum requirements of a ferrule
1.5mm height and width of remaining coronal dentine
84
what is a ferrule
1-2mm of vertical axial tooth structure within walls of a crown
85
what is the purpose of a ferrule
to prevent tooth fracture
fracture risk increases significantly if crown not placed onto solid tooth structure
86
what are the dimensions of a restorable tooth with a post crown
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
what are the advantages of a parallel post
avoid wedging
more retentive than tapered
88
what is the advantage of using a non-threaded (passive) post
less stress to remaining tooth
89
what is the advantage of using cement to retain a post (rather than it being threaded)
acts as buffer between masticatory forces and post/tooth
90
what type of post material is radiopaque on radiographs
metal
91
what are the disadvantages of using a metal post
poor aesthetics
root fracture
corrosion
nickel sensitivity
92
what type of post material is radiolucent on radiographs
fibre
93
what are the advantages to using a fibre post
flexible
similar properties to dentine
aesthetics
retrievable
bone to dentine with DBAs
94
why do you use cuspal coverage after RCT of posterior tooth
coronal seal
prevention of fracture
95
what material is most commonly used for a core build up and why
composite
good aesthetics
bonds to tooth
96
what is a nayyar core made of
amalgam
97
what is the disadvantage of a nayyar core
cannot crown prep for 24hrs until amalgam sets
98
what provides retention for a nayyar core
packing the amalgam into the root canals
99
what are the problems with posts
perforation
core fracture
root fracture or crack
post fracture
100
name a tool used to remove posts
masseran kit
101
what is the main reason for post failure
restorative
102
what would the indications for an onlay be
sufficient occlusal tooth substance loss
remaining tooth substance weakened
restoring RCT teeth
103
what types of material can be used for an onlay
porcelain
gold
composite
104
what cementing systems are used to cement ceramic onlays
NX3 (nexus)
relyX
105
what cementing systems are used to cement metal backed indirect restorations
aquacem
panavia
106
what could the alternative to an onlay on an RCT tooth be
crown
GSC
MCC
PJC
107
what special tests can you do before placing an indirect restoration
sensibility testing
radiology
analyse study casts
108
when are resin retained brides used
when abutments are unrestored or minimally restored
109
what type of luting cement is used for bonding metal wings of resin retained bridges (give brand too)
adhesive resin luting cements
panavia
110
what component of panavia allows it to bond to both metal and the etched tooth
4-META
111
what can you do to overcome the issue of premature contacts with bridge design when a patient has a complete overbite
adjust opposing tooth
create occlusal clearance in prep
accept high occlusion and get used to it
112
when are onlays used
extensively restored and weakened teeth
root filling in posterior tooth needing cuspal coverage
113
what are the advantages of using gold as an onlay material
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
what are the advantages of using composite for an onlay
higher cure rate improving strength and reducing wear
115
what are the disadvantages of using composite for an onlay
less accurate fit
absorbs dietary stains
116
when do you use ceramic for an onlay
for aesthetics
117
what is the main disadvantages of using ceramic for an onlay
brittle
abrasive for opposing surfaces
118
what cement is used for cementing a ceramic onlay
resin based luting cement
119
what factors are considered when deciding if a tooth is restorable or not
cost
longevity and functionality
clinical benefit of restoring
periapical status/RCT present/bone levels
pulp sensibility
amount of remaining tooth
subgingival damage
120
what factors are favourable when deciding if a tooth is restorable
vital pulp/good RCT
adequate tooth structure remaining
pockets of 3-4mm, >50% bone level remaining
canine guidance
good OH, motivated patient
121
what factors are not so favourable when deciding if a tooth is restorable or not
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
when would you opt to replace missing teeth
appearance
occlusal stability
mastication
123
what are the effects of calcium hydroxide
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
what are the options for treating pulpal damage
indirect pulp cap
direct pulp cap
partial pulpal removal
full pulpal removal
125
what are the clinical objectives of endodontic therapy
removing canal contents
eliminating infection
126
what are the 3 principles of design for endodontics
create continuously tapering funnel shape
maintain apical foramen in original position
keep apical opening as small as possible
127
what does mechanical preparation of the root canal allow
space creation for irrigating solutions and medicaments to more effectively eliminate micro-organisms from the root-canal system
128
what is the advantages of using sodium hypochlorite for endodontics
potent antimicrobial
dissolves pulp remnants
dissolves necrotic and vital tissue
helps disrupt smear layer
129
what factors are important for the function of NaOCl
concentration
volume
contact
mechanical agitation
exchange
130
what concentration of NaOCl should be used for endodontics
between 0.5% and 6%
131
what are the problems with NaOCl
effect on dentine properties
cant remove smear layer
effect on organic material
discolouration of fabric
eye injuries
apical extrusion = necrosis
allergic reactions
132
what percentage of EDTA is used to remove the smear layer
17%
133
what is the necessary contact time of EDTA to remove the smear layer
1 minute
134
what is the disadvantage of using chlorhexidine
cant disrupt biofilms
135
what are the advantages of using chlorhexidine
dentine which comes into contact with it acquires antimicrobial substantivity
biocompatible
136
what should the canal be irrigated with once canal preparation is complete
3% NaOCl (30ml) for 10 mins
17% EDTA (3ml) 1min
3% NaoCl final rinse
137
why are intra-canal medicaments used
destroy microorganisms and prevent re-infection
138
when are anti-microbial pastes used in endodontic treatment
for hot pulps
corticosteroid medicament
139
what is the pH of non-setting calcium hydroxide and what does this mean
12.5
antibacterial
140
where should root canal preparation end
at the junction of pulpal and periapical tissue
(apical constriction)
141
when should root canal obturation be completed
after root canal preparation and when the infection is considered to have been eliminated and canal be dried
142
what are the constituents of gutta percha
gutta percha
zinc oxide
radiopacifiers
plasticisers
143
what is the function of a root canal sealer
seal space between dentinal wall and core
fill void and irregularities in canal, lateral canals and between points
lubricates during obturation
144
give examples of 3 different types of sealer
ZOE
GI
resin
145
what are the steps of root canal treatment
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
what is the purpose of a dental implant
replace missing teeth with aesthetics and function
147
what medical conditions may affect the survival of dental implants
medications - bisphosphonates, SSRIs, PPIs, steroids
radiotherapy
diabetes
148
what is the relevant maxillary anatomy when placing an implant
sinus
nasal floor
nasopalatine canal
infra-orbital nerve
149
what is the relevant mandible anatomy when placing an implant
IAN
mental foramen
incisive canal
lingual perforating vessels
submandibular fossa
150
what will implant positioning depend on
implant system
proposed gingival margin
local anatomy
prosthetic plan
151
what is the minimum mesio-distal distance you need for placing an implant
1.5mm
152
how much bone is needed labially for an implant
>1mm or >2mm HT/ST
153
what aids are needed to plan for implants
study models
diagnostic wax up
surgical template
essex
clinical photographs
CBCT
surgical guide
154
what are the risk factors that you need to consider before implant placement
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
what is the ICRP
internal commission for radiological protection
156
what are the basic principles of the ICRP
justified
optimised
limited
157
what does it mean if radiation exposure is justified
must do more good than harm
158
what does it mean if radiation exposure is optimised
magnitude of exposures and number of people exposed must be ALARP
159
what does it mean if radiation exposure is limited
dose limits used to ensure no one received unacceptable level of exposure
160
what is IRR17
ionising radiations regulations 2017
161
what is IRMER17
ionising radiation medical exposure regulations 2017
162
what does IRR deal with
occupational exposures and general public exposure
163
what does IRMER deal with
medical exposure of patients
164
what does IRR mean for dentists
need to submit application the HSE to register for use of x-rays
165
what causes conventional feldspathic dental ceramics to fail during loading
low tensile strength
low flexural strength
low fracture toughness
166
what helps to make zirconia crowns strong and hard
Yttria stabilisation
167
what part of the crown is the zirconia
the core
168
what type of ceramic is used for a cast ceramic
lithium disilicate
169
what type of ceramic material has superior aesthetics
LiDiSi
170
what type of crown material is strongest
zirconia
171
what type of ceramic can be used for posterior teeth
zirconia based ceramic
172
what type of ceramic is used for anterior teeth
LiDiSi
173
what type of material are emax crowns made of
LiDiSi
174
what luting material would you use for a MCC
GIC
RMGIC
175
what luting material is used for a composite inlay/onlay
dual cure comp and DBA (Nexus)
176
what luting material is used for a porcelain inlay/onlay
dual cure composite and DBA
and silane coupling agent (Nexus)
177
what luting material is used to bond non-precious metal wings e.g., bridgework
composite luting resin (Panavia) and DBA and metal bond agent
