Oral medicine, therapeutics & radiology

Question 1

Orofacial pain attributed to lesion or disease of the cranial nerves

Answer 1

trigeminal neuralgia

Question 2

Orofacial pains resembling presentations of primary headaches

Answer 2

migraine

Question 3

idiopathic orofacial pain

Answer 3

burning mouth syndrome

Question 4

orofacial musculoskeletal disorders

Answer 4

temporomandibular disorders (TMD)

Question 5

Diagnostic criteria for trigeminal neuralgia

Answer 5

A - recurrent “shocks” on one side of the face (not radiating past the area of the nerve)

B - Pain lasts 1 second —> 2 minutes, severe intensity, electric shock-like, shooting, stabbing or sharp

C - Caused by a non-harmful stimulus

D - Can’t be accounted for by another ICHD-3 diagnosis

Question 6

Diagnostic criteria for burning mouth syndrome

Answer 6

A - Oral pain fulfilling criteria B and C
B - Recurring daily for >2 hours per day for >3 months
C - Pain has both of the following characteristics (burning and felt superficially in the oral mucosa)
D - Oral mucosa is of normal appearance, and local or systemic causes have been excluded
E - Not better accounted for by another ICOP or ICHD-3 diagnosis

Question 7

Orofacial pain resembling presentations of primary headaches: migraine without aura

Answer 7

Recurrent headache lasting 4-72 hours. Can be one sides and pulsating, moderate to sever intensity.

Aggravation by routine physical activity and association with nausea (vomiting) and/or visuals and sounds.

At least 5 attacks with this criteria = diagnosis

Question 8

Migraine with aura

Answer 8

Aura = the sensory symptoms (visual, motor, speech etc) that come on before the migraine.

Question 9

Anterior disc displacement with reduction

Answer 9

Clicks upon opening

Question 10

Anterior disc displacement without reduction

Answer 10

Doesn’t slide over the disc - can cause jaw locking!

Question 11

Arthralgia

Answer 11

Pain of the articulating joint

Question 12

Myalgia

Answer 12

Pain of muscle origin

Question 13

Answer 13

Hairy leukoplakia
EBV (HHV-4)
Strong association with HIV/immunocompromised patients

Question 14

Definition of cone beam CT

Answer 14

A form of cross-sectional imaging suitable for assessing radiodense structures.

Question 15

How does cone beam CT work?

Answer 15

Takes multiple 2D images using ionising radiation to emit x-ray beams (this does one full rotation around the head), to construct a 3D image.

Question 16

Frankfort plane

Answer 16

Question 17

Negatives of CBCT

Answer 17

higher radiation
Poorer detail of the teeth
More expensive
Harder to interpret

Question 18

Radiation CBCT vs conventional CT

Answer 18

CT greater radiation

more detail of soft tissues

Question 19

Uses of CBCT in dentistry

Answer 19

Impacted molars (relationship with ID canal)

Implant planning

Complex root morphology for endodontics

Localising ectopic teeth

Pathologies proximity to structure

Question 20

Three orthogonal planes

Answer 20

Question 21

ALARP

Answer 21

As low as reasonably practicable

Question 22

Voxel

Answer 22

Reduce voxel size (more pixels = greater detail but not necessary!! causes more radiation)

Question 23

When can you not take a CBCT?

Answer 23

If plain radiographs are sufficient

Can’t use it for looking at soft tissues

Too many artefacts (too many post crowns etc)

Patient factors

Question 24

MRI

Answer 24

Magnetic resonance imaging —> Whole room is a magnetic field, based on radio frequency pulses and hydrogen protons.

Fat and fluids = white, bone = black (sort of opposite to other imaging techniques

Question 25

MRI advantages

Answer 25

No ionising radiation
Good for soft tissues

Question 26

Uses of MRI

Answer 26

TMJs
Salivary glands
Malignancies

Question 27

Ultrasound

Answer 27

High frequency sound waves
No ionising radiation

Question 28

Uses of ultrasound

Answer 28

Neck lumps
Salivary glands
Vascular
Biopsy guidance

Question 29

Nuclear medicine

Answer 29

PET
SPECT
Scintigraphy

Answer 30

Injected with a radiopharmaceutical which when it decays emits particles that are picked up on gamma camera.

Question 31

Uses of PET CT

Answer 31

Cancer diagnosis

Question 32

SPECT uses

Answer 32

Condylar hyperplasia

Question 33

Antibiotics: Dental abscesses

Answer 33

Pen V 250mg (take 2 tablets) x 4 for 5 days

Question 34

Antibiotics: NUG/Pericoronitis

Answer 34

Metronidazole 400mg x 3 for 3 days

Question 35

Antibiotics: acute bacterial sinusitis

Answer 35

Pen V 250mg (take 2 tablets) x 4 for 5 days

Question 36

MOA: Penicillin

Answer 36

Betalactam targeting to inhibit cell wall synthesis. Works well on rapidly divings bacteria.

Question 37

CI: Penicillin

Answer 37

ALLERGIES ! Warfarin, Methotrexate (arthritis etc decreases inflammation)

Question 38

MOA: Metronidazole

Answer 38

Anaerobic bacteria!

Question 39

CI: Metronidazole

Answer 39

Hepatic impairment (liver issues), ALCOHOL!, acenocoumarol (similar to warfarin)

Question 40

Oral manifestations from metronidazole

Answer 40

Sharp metallic taste, candida, stomatitis, glossitis

Question 41

Paracetamol: maximum dose

Answer 41

4000mg per 24 hours

Question 42

Ibuprofen: maximum dose

Answer 42

1200mg per 24 hours

Question 43

Paracetamol mg per kg

Answer 43

15mg per kg every 4-6 hours

Question 44

Paracetamol risk patients; SCRAPPP

Answer 44

St John’s Wort
Carbemazepine
Rifampicin
Alcohol
Phenobarbitol
Phenytoin
Primidone

Question 45

What would be used to counteract a overdose of paracetamol?

Answer 45

IV Acetylecystein