MSA 2016 Flashcards
5 factor categories that can cause candidsis
physiological
trauma
haematological
iatrogenic
endocrinological
physiological factors for oral candidosis
pregnancy
age
saliva flow
trauma factors for candidosis
cellular immunodeficiency
neutropenia
iatrogenic factors for oral candidosis
antibiotics
catheters
surgery
endocrinological factors for candidosis
diabetes
addison disease
organisms that causes candidosis
and 3 virulence factors of it
candida albicans
hyphe, adhesins, hydrolytic enzymes
4 key stages of biolfilm formation
adhesion
colonisation
accumulation to form complex commuity
dispersal
how would you test for candida albicans and suggest a lab identification method
take a swab and culture the swab content’s on Sobouraud’s Agar and if present candida will present as white creamy colonies
lab testing - germ tube formation
PCR
example azole and mechanism
fluconazole
work by indirectly targeting th ergosterol in the fungi cell wall by interrupting the activity of the enzyme that produces it - 14 alpha demethylase
FUNGISTATIC
example polyene antifungal and mechanism of action
nystatin
directly target the ergosterol and cause perforation and leakage of intracellular contents
FUNGICIDAL
higher virulence but less well tolerated
example echinocandins and action
micafungin
FUNGICIDAL
3 classess of antifungals
azoles
polyenes
echinocandins
2 year with caries in all upper incisors and 6s
pattern of caries here
nursing bottle/early childhood caries
explain pattern and distribution of decay in nursing bottle/early childhood caries
why are some teeth not in the pattern?
lower incisors are spared from decay as they are physically protected by the nursing position of the child’s tongue - the artifical nipple of bottle rests against the palate, while tongue is extended over the lower incisors
maxillary incisors - 1st to experience the cariogenic challenge and suffer the longest cariogenic attack because of early eruption
if habit continues, other teeth (mandibular canines and all 6s) will be subjected to the cariogenic challenge in sequence of eruption
5 causes of nursing bottle/early childhood caries
- no brushing of teeth - minimal fluride exposure
- child put to bed with a bottle thus allowing prolonged exposure of the baby’s teeth to cariogenic sugars
- as a result of inappropriate use of feeding bottles and cups (contents sugar)
- prolonged breastfeeding
- baby may not swallow all milk or contents of bottle and therefore remnants can swirl around the oral cavity for prolonged timeframes
fluoride regime for 2 year old with high caries risk in dental setting
- 0.25ml F varnish (5%) - 22600ppm applied twice a year in the dental setting
- Fluoride toothpaste 1000ppm - smear on toothbrush
4 brushing instructions for high caries risk 2 year old
- 2-3 times a day
- spit don’t rinse
- assisted brushing until age of 7
- fluoride toothpaste of 1000ppm
ED# in 8 year old boy
most important emergency tx
aim to retain vitality of any damaged or displaced tooth by protecting exposed dentine by means of an adhesive dentine bandage
9 signs/symptoms to track progression of trauma (things on trauma stamp)
- sinus
- colour
- mobility
- displacement
- TTP
- percussion note
- sensibility testing
- thermal testing
- radiographs
4 radiographic signs of non-vital tooth
peri-apical radiolucency
internal inflammatory resorption
external inflammatory resorption
ankylosis
child who has history of trauma is continuing to play active contact sports (rugby) what should you do
provide him with a mouthguard
5 signs digit sucking habit
proclined upper incisors
retroclined lower incisors
anterior open bite or incomplete open bite
unilateral posterior cross bite
narrowed upper arch
how does thumb sucking affect posterior dentition
pt thumb and digits are positioned in the mouth in such a way that they result in the mandible to drop open
- this cause the pt’s tongue to be held and occupied in a lower position that what is deemed normal
sucking action initiaited by the muscular forces in the cheek’s narrows the maxillary arch - causing posterior cross bite
4 methods of preventing/stopping a digit sucking habit
- behaviour management therapy (positive reinforcement)
- plasters, gloves or bitter flavoured agents applied to digits to make habit less satisfying
- URA with a rake
- habit reversal - do another activity when urge to suck arises
local cause of malocclusion
a localised problem or abnormality within either arch, usually confined to 1, 2 or several teeth producing a malocclusion
it is something that tends to get worse with time
4 conditions of tooth number which can cause malocclusion
- supernumerary teeth
- hypodontia
- retained primary teeth
- early loss of primary teeth
- unscheduled loos of permanent teeth
4 supernumerary teeth
- conical
- tuberculate
- supplemental
- odontome
4 factors of anatomy which can cause tooth mobility
width of PDL
height of PDL
inflammation
number, length and shape of roots
4 pathological reasons for tooth mobility
periodontal disease
periapical abscess
trauam
external inflammatory resorption
3 times when you would intervene to stop tooth mobility
if it is progressively increasing
if it gives rise to symptoms
if it creates difficulty with restorative treatment
would you expect tooth mobility to inc or dec in a pt with moderate-advanced perio disease following HPT - why?
expect to decrease
expect clinical reattachment via long junctional epithelium
pt has mobile lower incisors and refuses XLA
what would you advise? what are disadv?
splinting may be appropriate when tooth mobility is caused by advanced LOA, or causing discomfort or difficulty chewing
but splinting does not influence the rate of periodontal destruction and may create hygiene difficulties
- last resort Tx
components of stainless steel (5)
iron
chromium
nickel
titanium
carbon
iron % in stainless steel
72
chromium % in stainless steel
18
nickel % in stainless steel
8
titanium % in stainless steel
1.3
carbne % in stainless steel
0.7%
describe work hardening
work done on a metal at low temperatures which causes slip, which is where dislocations collect at grain boundaries - thus resulting in a stronger harder material
what is meant by springiness
ability of a material to undergo large deflections
can undergo large deflections without permanent deformation
2 disadvantages of self cure PMMA
poor mechanical properties
- poor compressive strength
- poor tensile strength
residual monomer (allergy
if Risk ratio is less than 1
outcome less likely
if Confidence interval is 0.5-3.3
is there sufficient evidene
no
as CI contains 1
randomised contol trial
specification of participants for a representative sample, randomisation by computer, control used
Gold standard study for clinical trials
they are particularly useful for clinical studies and incorporate 4 design elements - specification of particpants (inclusion/exclusion criteria), control, randomisation, blinding
randomised control trial
4 design element
specification of particpants (inclusion/exclusion criteria), control, randomisation, blinding
cohort study
prospective study
establish group and measire exposures
following group over time, identify thost that develop disease
used for estimating incidence and causes of disease
case control study
retrospective study
looks back to exposure of particular risk factor and looks at potential causes of disease
examples of relationships/patterns from graphs
sections to not reach threshol/ annomalies
trends
difference - greatest between…
SIMD
scottish index of multiple deprivation
ranks 6600 data-zones in order of deprivation (1 most), area based index of multiple deprivation
derived from a range of data sources looking at: employment, income, health, education, skill, training, geography access to services, crime, housing
5 roles of epidemiology
- measurement of amount and distribution of disease, and natural history of disease
- study of causes/determinants of disease
- assess people’s risk of disease
- health care needs assessment and service planning
- development of preventative programmes
incidence
number of new disease cases devloping over a specific period of time in a defined population
prevalence
number of disease cases in a population at a given time
types of dementia
- Alzheimer’s disease
- vascular
- dementia with Lewy bodies
- fronto-temporal
- Korsakoff’s syndrome
5 signs of late stage dementia
unaware of time and place
difficulty in recognising faces of friends and relatives
increasing need for self care help
difficulty walking
behaviour changes - aggression
4 cognitive tests for dementia
mini-mental state exam (MMSE)
blessed dementia scale
montreal cognitive assessment (MoCA)
single test - clock draw, delayed word recall, category fluency
4 ways to make dental practice dementia friendly
reception disk visible from entrance
signage at eye level - clear text, colour and pictorial elements
colour and tone of walls should be distinct from flooring and furniture
staff or locked rooms coloured the same as the walls to avoid attention
dentally fit
being free of dental disease and any oral sources of infection at the start of cancer tx
multidisciplinary team
team of individuals from a wide variety of disciplines/specialities who work alongside each other in order to provide the best and holistic care for the pt
example members of cancer pt MDT
- oral maxiollofacial surgeon
- radiologist
- chemotherapist
- cancer nurse specialist
- speech and language therapist
- pathologist
- ENT
3 complications of radiotherapy to head and neck
xerostomia
mucositis
osteoradionecrosis
4 modifiable factors for head and neck cancer
smoking
alcohol
oral hygiene
betal chewing (tobacco)
9 functions of provisional restorations
- restore aesthetics and function
- prevent sensitvity and micro leakage of bacteria
- coronal seal of an endodontic tx
- prevent plaque build up and caries
- preserve or improve function (mastication and speech)
- prevent drifiting or tilting of prepared teeth
- maintain gingival health and contour
- isolation for RCT
- matrix for core build up
3 types of preformed provisional crowns
- polycarbonate (silica) - tooth coloured
- clear-plastic crowns forms: filled with composite (strip crowns)
- metal: aluminium, stainless steel
2 adv of preformed crowns
cheaper
no need for lab involvement so can construct tooth prep and cement crown in 1 visit
5 stages in changing standard operating procedures
- identify the problem
- set criteria and standard
- observe practice/data collection
- compare performance with set out standards
- implement change
4 principles of wast disposal
- segregation
- storage
- disposal
- documentation
laws and regulations relating to waste disposal
- Health and Safety at Work Act 1974
- The Controlled Waste regulations 2012
- The hazardous waste directive 2011
- the carriage of dangerous goods regulations
- control of substances hazardous to health (COSHH) 2002
3 design components of amalgam container
leak and spill proof
mercury vapour suppressant lid
white body and red lid drum
disinfect blood spill
sodium dichlorosiocyanurate or sodium hypochlorite
active ingredient and concentration for blood spill
sodium hypochlorite/dichloroisocyanurate
10,000ppm chlorine solution for 3-5 mins
3 ways to ensure SOP changes are followed up by colleagues
- carry out another clinical audit
- take a day out to observe the practice disinfection control
- ensure colleagues attended required CPD session (training)
dentist causes facial palsy as a result of right IAN block
pt has sore right TMJ
how is the facial palsy caused?
if the clinician doesn’t hit the bone and inserts the needle too far back, LA is deposited in parotid gland
facial nerve runs through it, due to the dense fascia around the gland the LA will remain for a long time and cause paralysis of the facial muscles that the nerve innervates
dentist causes facial palsy as a result of right IAN block
pt has sore right TMJ
3 differences between stroke and facial palsy
- facial palsy occurs as a result of LA administered into the parotid gland and affects the side injected
- stroke causes loss of movement of facial muscles on opposite side
- if it is stroke, the pt can still wrinkle their forehead on the affected side
explain the neural anatomy which accounts for difference between stoke and facial palsy
in a stroke there is interruption of supra nuclear fibres from the motor areas of cerebral cortex, before they reach the facial motor nucleus
the upper part of the facial motor nucleus receives crossed and uncrossed fibres and the frontalis and orbicularis oculi still have the ability to function as a result
unlike in facial palsy
dentist causes facial palsy as a result of right IAN block
pt has sore right TMJ
4 ways to intially manage the pt
reassure them
tell them that sensation will return in a few hours
cover the eye with an eye patch to prevent cornea drying out
give a contact number
3 things to assess to determine if impression is usable
- no air blows present on the impression
- ensure impression is not separated from impression tray
- ensure all soft tissue anatomy (e.g. gingival margin) is recorded
list 4 potential faults with impressions
air blows/voids
missing anatomy
dragging due to removal prior to material set
tear upon removal
reasons for potential impression faults
- wrong or no adhesive applied to impression trays prior to loading of impression material
- ? hydrophobic impression used when haemostasis or moisture control poor
- retraction cord or past not used to retract soft tissues
- wrong ration of base paste and catalyst paste
- impression material used is expired
how to decontaminate an impression
- rinse the impressin under cold running water prior to putting into the perform to remove gross debris and saliva
- inspect impression prior to disinfection
- disinfect in perform for at least 10 mins
- sodium benzoate and potassium peroxomonosulphate
- take it out and rinse under cold water, wrap in damp gauze and put it in a plastic bag with pt details and sent it to lab
XLA of lower premolar
list 4 preoperative complications
- tooth position inadequate for access for elevators or forceps
- pt medical history states bleeding tendency
- radiograph shows teeth appear likly to be ankylosed or infraoccluded or sings of hypercementosis
- close to revelant antatomical structure (here metal foramen)
XLA of lower premolar
14 perioperative complications
- difficulty of access
- fracture tooth/root
- fracture alveolar plate
- fracture tuberosity
- jaw fracture
- loss of tooth
- soft tissue damage
- damage to nerves/vessels
- haemorrhage
- dislocation of TMJ
- damage to adjacent teeth/restorations
- extraction of permanent tooth germ
- wrong tooth
if upper - involved of maxillary antrum (OAC/OAF)
pt root fracture during standard XLA procedure
what radiograph to take
periapical radiograph
draw flap design for 44
crevicular incision with a distal relieving incision
mind mental foramen
where is the mental foramen
between the 4 and 5
mental nerve innervates
lower lip and chin
lower teeth anterior to the mental nerve
INR table - values, dates, signature
what 2 coloumns most useful for XLA a pt with warfarin
INR and date columns
must be within the last 24 hrs and INR below 4
what would you want INR of pt on warfarin to be for XLA
must be within the last 24 hrs and INR below 4
stable
most appropriate post op analgesic for warfarin pt
aspirin, paracetamol, warfarin
paracetamol
how does the GP assess if pt INR is unstable
by taking a blood sample of a pt to assess the prothrombin time
mechanism of apixaban
factor Xa inhibitor
do you need to make alterations regarding apixaban for restoration of tooth 16 occlusal?
no
proceed because procedure is minimum risk
do you need to make alteration regarding apixaban for XLA of uncomplicated 22
no change
low bleeding risk according to SDCEP
2 reasons for amalgam overhangs
poor adaptation of matrix band
excessive force applied when condensing amalgam
5 complications of overhangs
- food trap
- difficulty cleaning
- plaque stagnation
- secondary caries
- eventually gingivitis and periodontal disease
2 ways to manage overhangs
by retreatment - replace restoration
- use wedges to ensure well adapted
- preferred method if caries detected on radiograph under restorations
- can result in further tooth tissue loss
using finishing strips or soft flex discs
- no need for LA
- only is no need for replacement indicated
