MSA 2015 Flashcards
non setting calcium hydroxide - why is it an ideal interappointment medicament
high pH 12.5 - allows killing of bacteria
hydrolysis of lipopolysaccharide which reduces inflammatory potential
removes tissue debris
3 reasons for obturating
to create fluid tight seal apically
to prevent reinfection of the canal
to seal off any bacteria within the canal thus preventing any bacterial growth
components of GP (other than rubber) (3)
zinc oxide 65%
radiopacifiers 10%
plasticisers 5%
reasons for sealer when using cold lateral compaction (3)
seals space between detinal wall and core
fills voids and irregularlities in canal, lateral canals and between GP points in lateral condensation
lubricates during obturation
technical term for dry socket
alveolar/localised osteitis
predisposing factors for dry socket (8)
- molars more common - risk increases from anterior to posterior
- mandible more common
- smoking
- female
- oral contraceptive pill
- local anaesthetic - vasoconstrictor
- excessive trauma during extraction
- excessive mouth rinsing post extraction
presenting symptoms and signs of dry socket (4)
- dull aching pain: moderate to severe
- usually throbs can can radiate to pt ear
- continuous, kept awake at night
- smell/bad odour and pt complain of bad taste
4 management techniques of dry socket
supportive, reassuranc/systemic analgesia
- LA block
- irrigate socket with warm CHX or saline to wash out food and debris
- WHVP or Alvogyl
- curettage/debridement to encourage bleeding and new clot formation
5 common features of parkinsons
resting tumour
rigidity
bradykinesia
mask like facial expression
postural instability
difference of movement of parkinsons from other cerebral disease
parkinsons is a resting tremor
cerebellar tremour is an intention tremor
most likely reason for dry mouth in parkinsons
antimuscarininc/cholinergic effect of drugs
ways to help pt prevent loosing dentures
mark initials on the denture during procedure
if already constructed then can make using sandpaper or use sealant
3 reasons to be cautious of extracting teeth in parkinson pt (resting tremor)
tremor could make extraction more difficult
poor mouth opening
will require new prostheses to replace missing teeth - will they be able to manage
reason of concern for parkinson pt future oral health
poor motor function therefore the ability to maintain sufficient oral hygiene is compromised
MOM for elevating mandible
masseter
MOM for protruding mandible
lateral pterygoid
anterior convex part of TMJ
articular eminence
posterior concave part of TMJ
mandibular fossa
4 forms of candidosis
pseudomembranous
erythematous
hyperplastic
angular cheilitis
azole action
prevents the biosynthesis of ergosterol by inhibiting the enzyem 1,4 dimethylase
3 resistance mechanisms of antifungals
changes in the ergosterol target enzyme
upregulation of efflux pumps
biofilm formation
2 species of candida and how to differentiate
candida albicans
candida glabrata
CG is resistant to fluconazole
paeds order for tx plan general
OHI
fluoride varnish
fissure sealants
upper filling NO LA
upper filling LA
lower filling LA
pulpotomy
extraction
signs of anxious pt
palpitations, perspiration, breathlessness
figedity - twiddling thumb
time delay by asking Qs
wide confidence interval may reflect
small sample size
master impression a.k.a
definitive impression
secondary impression
2 factors affecting physical retention
border seal
post dam
anatomical features for position of posterior border of upper denture
palatine fovea at vibrating line
hamular nothces
border of hard palate
3 anatomical features to include on mandibular denture
residual ridge
buccal shelf
retromolar pad
2 materials that can be used for master impression on lowers
polyvinyl siloxane (extrude)
alginate
3 characteristics of biofilm extra cellular matrix which causes resistance to antimicrobials
biofilm impairs diffusion
causes binding of antibiotics
extracellular DNA persisters
bacteria involved in periodontal disease according to socranskys
p.gingivalis
treponema denticola
tanerrella forsythia
2 bacteria involved in caries
streptococcus mutans
lactobacillus acidophillus
4 key features that enable caries bacteria to adhere and survive in acidic environment
- adhesins: SpaP - makes up fibrillar layer of cell wall
- Binding proteins: glucosyltransferase, fructoslytransferase, gluten binding protein
- Sugar modifying enzymes: fructanase, dextranase
- Polysaccharides
- Acid tolerance and adaptation: F1F0 ATPase
3 systemic diseases caused by periodontal disease
diabetes - up to 6 fold
cardiovascular disease - 1.2-3.9 fold
rheumatoid arthritis
nurse doesn’t wash hands before pt what to do
challenge her practice by asking her why she has not washed her hands and ask her to refer to the SOPs
carry out an audit to determine if this is common practice
if making a presentation about hand hygiene for your practice what are 4 topics to include
- when to carry out hand hygiene
- 6 steps of hand hygiene
- different types of hand hygiene: social, surgical, alcohol gel only
- reasons for non-compliance
if you see dentist ‘double gloves’ and deliberately booking blood disease pt for end of day what should you tell him
he is not allowed to discriminate between pts and he should tx pt according to standard infection control precautions
by using double gloves he is discriminating
how to ensure SOPs followed
ensure staff attend all relevant CPD and training sessions relating to SICPs and hand hygiene
observe future clincial practice
4 PPE for carrying out manual cleaning
apron
mask
full face visor
gloves and thick marigold gloves
when to degas ultrasonic
necessary before every fill, before instruments are processed
why does ultrasonic need degas
oxygen legft in water inhibits cavitation
therefore bubbles of lower intensity are formed meaning the ultrasonic is less effective at cleaning
degassing ultrasonic
remove any gases and ensures that bubbles are only produced from ultrasonic activity and that all bubbles are of the same intensity
2 types of manual cleaning and name examples of each
immersion - non lumen devices e.g. probes, mirrors
non-immersion - lumened devices e.g. handpieces
why use deionised water in a steriliser
to remove suspended particles and minerals which could create a rough surface on instruments for micro-organisms to cling to
% affect by sensitivity after tooth bleaching
60%
5 predisposing factors to sensitivity after bleaching
pre-exisiting sensitivity
high concentration of bleaching agent
frequency of change
gingival recession
bleaching method
bleaching method of action for external cervical resorption
due to diffusion of H2O2 through dentine into periodontal tissues
high concentration and heat would increase effect
causes of root resorption due to bleaching
heat during bleaching process
higher concentration of H2O2
history of trauma
how to prevent root resorption due to bleaching
place 1mm of RMGIC over GP to seal canal
seals dentine and prevents resorption
3 reasons for non surgical perio tx before surgical perio tx
- allows evaluation of pts motivation and plaque control
- improve soft tissue consistency for easier sugical management
- some deep pockets may heal following non-surgical therapy
2 indication for surgical perio tx at re-evaluation
pockets of 5mm or greater persist in the presence of excellent OH
furcation involvement
when to re-evaluate non-surgical perio tx
4-6 weeks after non-surgical therapy
aim of surgical perio tx (2)
to arrest disease by gaining access to complete root surface debridement
to regenerate lost periodontal tissue
supportive role of GDP after surigcal perio tx carried out by specialist (5)
- periodontal pocket chart annually and carry ut oral exam including plaque & bleeding scores
- review oral hygiene and use TIPPS
- remove supragingival and subgingival plaque and calculus deposits
- carry out RSD when needed
- re-apprasie mechanical plaque control
link of radiotherapy in parotid region to formation of ulcers
modderate to high dose levels are given to overlying tissue
can result in mucositis
why is enhanced prevention needed for radiotherapy of head and neck pts
- will suffer xerostomia due to impact of radiotherapy on salivary glands
- reduced salivary flow can lead to an increased caries risk as less salivary buffering and clearance ability
- oral hygiene instruction and fluoride application would need to be conducted
complication of extarction of radiotherapy of head and neck pt
why
irridiation of bone can result in osteoradionecrosis
may impair the healing of sockets post extraction
effects of chemo on blood count
bone marrow suppression
pancytopenia - inc WBC (infection), platelets (bleeding risk)
who can consent for a pt if they are unable to do so
welfare power of attorney
welfare guardian
doctor or dentist under section 47 of AWI act - need to have certificate
incapacity act
Adults with Incapacity Act (Scotland) 2000
questions to ask pt who smoke
- how long have you smoked for
- how many do you smoke a day
- have you considered giving up
- do you know the harmful effects of smoking
- have you tried quitting in the past
2 service you can refer smoker who wants to quit to
smoking cessation groups
local pharmacy
types of e-cig
disposable (rare)
rechargeable with replaceable cartridges
rechargable and re-fillable
advanced personal vaporiser (APVs) or MODS (adjustable wattage tanks)
rechargeable 2 and 3 piece (Cigalites)
advice on e-cigs
they are not harmless but likely to be considerably safer than conventional cigarettes if used in moderation
early research suggests they help quitting overall
not a lot research regarding health effects - less toxinc in them than normal tobacco cigs (no firm evidence regarding which is better)
use of nicotine replacement therapy is highly recommended
upper central incisor fails to erupt, trauama to previous primary exfoliated
4 inital management options
- check if contralateral has erupted and when it erupted (radiograph)
- palpate palatally and buccally in case ectopic
- maintain space/create space
- surgical exposure
- bond with orthodontic gold chain
- monitor for 1.5 year
refer to orthodontic/paed specialist
3 causes of failed eruption
supernumerary - tuberculate
early loss of primary tooth
hypodontia
4 aims of ortho tx
restore
- stability
- function
- aesthetics
aid other forms of dentistry - restorative (crowns, bridges etc)
horizontal line for OPT parallel to floor
frankfort plane
why may anteriors be horizontal magnified on OPT
pt too far back in machine
canine behind the guideline
why may posteriors on one side be horizontally magnified
pt is rotated in the machine
features of ghost image (3)
impact
- always higher
- always horizontally magnified
- on the opposite side
can interfere with Dx
before extraction of 48 and 28
what type of radiograph
right half panoramic
what radiograph should be used as second resort for child with caries who cannot tolerate bitewings
OPT
what border of maxillary sinus is above the molars (horizontal)
inferior
what border of maxillary sinus is vertical to 3rd molar
posterior border
carious lower 6s in child
special investigation
OPT
check formation of other teeth
what are you looking for to show suitable extraction timing of 6s
(4)
- bifurcation of 7s
- 5s and 8s present
- mild buccal segment crowding
- class I incisor relationship
tx for upper non carious 6
compensating extraction
2 adv of extraction of carious 6s at right time
caries free dentition
allows spontaneous eruption of the 7 therefore relieving the need for orthodontic tx
3 disadv of extraction of carious 6s
loss of permanent tooth
possible GA exposure risk
bad experience could affect future dental visits
2 methods to aid extraction of anxious child
GA, inhalation sedation, acclimatising
surgical extraction of roots 45
nerves to anaesthetise (3)
Inferior alveolar nerve
mental nerve
lingual nerve
how to test if IAN, mental nerve and lingual nerve anesthetised for extraction 45 roots
numbness of the tongue and lower lip
probe around tooth and determine if pain felt
5 possible nerve deficits
- anaesthesia (numbess)
- paraesthesia (tingling)
- dyseasthesia (umpleasant/pain)
- hypoaesthesia (reduced sensation)
- hyperaesthesia (increasd sensation)
neurpraxia
contusion of the nerve
continuation of epineural sheath/axons maintained
axontmesis
continuity of axond but epineural sheath disrupted
neurotmesis
complete loss of nerve continuity/ nerve transected
4 causes of nerve damage
- crush injuries
- cutting/shredding injuries
- transection
- damage from surgery or damage from LA
