MSA 2014 Flashcards
A
maxillary nerve
B
pterygopalatine fossa
C
posterior superior alveolar nerve
D
pterygoid hamulus
E
nasal bone
F
infraorbital nerve
G
anterior superior alveolar nerve
H
anterior nasal spine
through which foramen does the maxillary nerve exit the cranial cavity
foramen rotundum
which parasympathetic ganglion has its sensory root derived from the maxillary nerve
pterygopalatine ganglion
which radiograph for partially erupted 48 when there is no evidence of 38 in the mouth
right side OPT
5 periodontal pathways of communication between the pulp space and the PDL
- apical foramen
- accessory canals
- fractures
- dentine tubules
- perforations
deep suppurating pocket related to upper molar
no pocket elsewhere in the mouth and tooth non-vital
most likely Dx and Tx
endodontic lesion with periodontal involvement
RCT and sub-gingival scaling
4yo new pt C/O severe pain and sleep loss
E/O bruising on the right cheek and small abrasion right temple
concerned because
potential victim of child abuse and neglect
4yo new pt C/O severe pain and sleep loss
E/O bruising on the right cheek and small abrasion right temple
lead to child abuse and neglect because (2)
delay in seeking help
multiple injuries in abnormal places (temple)
4yo new pt C/O severe pain and sleep loss
E/O bruising on the right cheek and small abrasion right temple
Qs to ask to further investigate child abuse/neglect concerns
how and when did this happen?
why did you not come sooner?
3 outcomes after phoning for advice on potential child abuse case
- nothing
- investigated by social services and family support
- child taken into care
4yo new pt C/O severe pain and sleep loss
E/O bruising on the right cheek and small abrasion right temple
treat painful tooth, but several other carious teeth requiring attention - but parent fails to bring the child back for next appointment - what should you do?
duty to share concern - speak to health visitor
local child safe guarding team should be contacted
what type of study would provide the highest level of evidence for the effectiveness of tx
meta analysis of systematic reviews and RCTs
4 main features of RCT
comparison control
inclusion and exclusion criteria
blinding
randomisation
how will the actual extent of caries present clinically compared to radiograph
clincial presentation is normally worse - deeper and more extensive
4 stages of sequence of operative procedures to render tooth caries free (after LA and dam placement)
- access caries through enamel and dentine at marginal ridge
- determine spread of caries at ADJ
- remove peripheraly caries working inwards
- smooth margins and remove unsupported enamel
3 adv composite over amalgam
bonds to tooth directly
aesthetically more pleasing
minimal cavity prep (no need for undercuts)
special needs child presents with carious 6s - unable to coperate for bitewings, considering extraction of 6s and possible GA
what special invesitgatin would be appropraite
OPT
how is the fitting surface of a porcelain veneer tx in the lab to improve adhesion
hydrofluoric acid on porcelain surface to make rough and retentive
if using a composite resin cement what material would ensure a good bond to the porcelain cement
silane coupling agent
how does silane coupling agent work chemically
C=C bonds for the composite
oxides react covalently with the porcelain
where else is silane coupling agent used in dentistry (except with composite resin cement bonding to porcelain cement)
composite restorations to etch the cavity prep to allow an affective bond
when would you use a dual curing composite resin material to cement a veneer
if the veneer is thick
(light cure is acceptable for thin)
aims of retracting flap
to protect soft tissues
increase field of view
factors influenceing design of flap
- presence of local vessels and nerves
- how aesthetic it will look when flap replaced and whether good healing will be achieved
- access/visualisation and the ability to suture it back up
- type of procedure being carried out
insturment to remove bone
straight handpience
saline cooled with a round tungsten carbide bur
how to debride prior to suture
phsyiological - bone file or handpiece to remove sharp bony edges
irrigation - sterile saline into socket under flap
suction - aspirate under flap to remove debris
pt suspected to have bleeding disorder
3 Blood tests needed to investigate
aPTT (activated partial thromboblastic time)
FBC
prothrombin time
eg inherited coagulation disorder
haemophila A
e.g. disorder of platelet numbers
thrombocytopenia
what LA technique used for pt with bleeding disorder and extract 47
infiltraion with articaine 4% 1:100,000 adrenaline
clotting factors affected by warfarin (4)
2, 7, 9 and 10
max INR tolerated for extractions (warfarin pt)
4
SDCEP
what LA technique used for pt on warfarin for extraction 47
IDB if INR is less than 4
2 ways clinical waste is made safe before landfill
incineration
segregation
2 sources of amalgam
amalgam containing teeth
excess amalgam from clinical procedure
what licence regarding disposal of amalgam and how long to keep
consignment note
kept for 3 years
2 safety features of amalgam container
mercury vapour suppressant lid
spill/leak proof lid
before prescribing F mouth rinse what you check before prescribing?
paeds
can the child demonstrate spitting and are they over the age of 7
daily strength of F mouth rinse
225ppm
how to decide between conventional Vs Post and core
is there enough structure (ferrule) to maintain a conventional crown or would a post and core function better
fuction of post
to retain the core
materials for core and post
post: cast metal (gold), fibre, ceramic
Core: amalgam, composite
e.g.
fibre post and composite core
5 ways to determine post length
minimum 1:1 length of crown
below the alveolar crest
2/3 the length of the root
4-5mm GP left apically
at least half the post in the root
post too wide - probelms
can cause root fracture
post too narrow problems
poor retention of the core and post is more likely to fracture
4 general health effects of smoking
increased risk of lung cancer
COPD
hypertension
staining of skin around fingers
6 oral health effects of smoking
dry mouth
oral cancer
halitosis
pale keratinised gingivae
staining of teeth
periodontitis
3 recent health promotion approaches in Scotland to reduce smoking
hidden storage of cigarettes in shops
harmful effects advertised on cigarette packaging
cigarettes sales changed from age 16 to 18
2 expamples of smoking cessation approaches in dental practice
3As - Ask, Advise, Act
5As - Ask, Advise, Assess, Assist, Arrange
incisor crown prep
labial margin design and redcution
1.3mm shoulder
incisor crown prep
labial benefits of margin design (1.3mm shoulder)
lets you incorporate both porcelain (0.9mm) and metal (0.4mm)
incisor crown prep
palatal margin design and reduction
0.5mm chamfer
incisor crown prep
palatal margin design benefits (0.5mm chamfer)
only metal required for this region as not seen and not in aesthetic zone so minimal prep is sufficient
4 properties of impression material for suitable crown prep
- low viscosity
- low viscoelasticty
- high tear resistance
- low thermal expansion
xerostomia
dry mouth
xerostomia exacerbates which 4 oral health problems
caries
candida
periodontitis
sialadenitis
4 drugs that can cause xerostomia
- benzodiazepines - diazepam
- anti-diuretics - vasopressin, desmopressin, oxytocin
- anti-depressants - fluoxetine, citalopram
- anticholinergics - atropine
2 non drug related causes of xerostomia
sjorgen’s syndrome
diabetes
radiotherapy
ARAB definition ortho
active component
retention
anchorage
base plate
active component
components which apply force
retention
resistance to displacement forces - gravity, tongue, speech, mastication and active forces
5 possible displacement forces for ortho appliance
gravity
tongue
speech
mastication
active components
posterior cross bite -what component corrects
mid palatal screw
methods of retention for posterior cross bite URA and wire gauge (some permanent, some primary)
adams clasps
- 7mm HSSW (permanent)
- 6mm HSSW (primary)
anchorage for posterior cross bite URA
reciprocal from baseplate
how do you modify the base plate for posterior cross bite URA?
appliance cut in half and add flat posterior bite plane
function of flat posterior bite plane
takes the teeth out of occlusion allows the teeth to move
x-bites
what could be added to URA to stop thumb sucking?
rake or crib
full denture
custom tray 3mm spaced
what impression material and why?
alginate because it is mucostatic and will take a accurate record of the tissues without displacement
full denture
custom tray 3mm spaced
why not silicone for IM
because it is mucocompressive and is likely to tear
also not effective if undercuts present
2 areas of primary support on maxillar arch for full denture
residual ridge
hard palate
3 areas of primary support on mandible for full denture
residual ridge
retromolar pad
buccal shelf
what muscle lies on floor of mouth
mylohyoid muscle
what part of mandible might interfere with maxillary impression within tuberosity regions during lateral excursions while taking a functional impression
coronoid process
submandibular duct
length
5-6cm
submandibular duct
arises
submandibular gland
submandibular duct
opens
sublingual caruncle
submandibular duct
what crosses on inferior side
lingual and hypoglossal nerves
chlorohexidine
group it belongs to
bisbiguanide
chlorohexidine
mode of actions
dicationic - 1 cation attaches to the dental pellicle and the other attaches to the bacterial membrane
in a low concentration it increases the permeability of the membrane
in high concentration it causes precipitation of the cytoplasm and cell dealth
chlorohexide
action in low concentration
in a low concentration it increases the permeability of the membrane
chlorohexidine action in high concentration
causes precipitation of the cytoplasma and cell death
chlorohexidine
substantivity
persistence of action
chlorohexidine
3 factrs affecting substantivity
adsorption to oral surfaces
maintenance of antimicrobial activity
slow neutralisation of antimicrobial activity
volume, concentration and frequency of chlorohexidine (CHX)
- 2 x 10ml = 20mg 2x a day
- 12 x 15ml = 18mg 2x a day
4 indications for chlorohexidine
- post oral or periodontal surgery
- physically or mentally impaired
- immunocompromised pt
- short term use for specific problem
adjunt to oral hygiene
nursing home infected with food poisoning
3 factors increasing this risk
- no hand hygiene or use of gloves prior to food preparation
- meat storage mixed with other food stuffs when it should be kept separate on the bottom shelf
- food and medication stored in same place
6 key links in chain of infection
infectious agent
reservoir
mode of exit
mode of transmission
mode of entry
susceptible host
3 examples of advice to give carers when performing OH on elderly to stop cross infection
label toothbrushes
perform hand hygiene between pts
wear appropriate PPE (gloves, apron) and change between pts
ED# during rugby
what tx
- account for fragment
- either bond fragment to tooth or place composite bandage
- 2 periapical radiographs to rule out root fracture or luxation
- radiograph any lacerations to rule out embedded fragment
- sensibility testing and evaluate tooth maturity
- definitive restoration
- follow up 6-8 weeks and 1 year
4 non radiographic signs and symptoms to monitor over time of ED#
colour
tenderness to percussion
percussion notes
sensibility testing
4 radiographic signs tooth is non-vital
external inflammatory resorption
periapical pathology
ankylosis
internal resorption
