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1
Q

clinical records from pt for bridgework

A

master impressions with bite reg
tooth selection - size, shape, shade
chosen bridge designs

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2
Q

+s of RMGI

A

higher mechanical strength
lower solubility than GIC
command set via light

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3
Q

why is it wrong to use GI filling material as a luting agent?

A

glass powder particle size too large - interfere with seating of Rx
may absorb moisture
weak mechanically - prone to caries ingression

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4
Q

disadvantages of pocket chart

A

standardised - don’t account for individual pt morphology

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5
Q

why does furcation involvement mean poor prognosis?

A

hard to keep clean

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6
Q

discolouration/staining could be?

A

potential caries ingress

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7
Q

NST may fail to eliminate bacteria from PD pockets

A

pockets may be blocked e.g. calculus
instruments may not reach depths of pocket as too big so do not disrupt biofilm
pt compliance and skill set
clinician skills

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8
Q

oral ABs limited use for periodontitis tx

A

unable to penetrate biofilm
may not reach sites
chance of developing AB resistance

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9
Q

PD abscess SDCEP

A

careful subgingival instrumentation short of base of PD pocket to avoid iatrogenic damage, may need LA
if pus - drain by incision or through PD pocket
recommend optimal analgesia
no ABs unless signs of spreading infection/systemic involvement
recommend 0.2% CHX MW until acute symptoms subside
following acute management review within 10 days and carry out definitive RD instrumentation and arrange appropriate recall interval

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10
Q

why relief/window in midline of U denture?

A

palatine torus

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11
Q

how to rectify attrition of occluding denture teeth in short term?

A

add autopolymerising resin to build teeth back up

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12
Q

essential info for a NHS prescription

A

pt details: name, address, age (legally required if under 12), DOB, CHI
drug - generic name, prep, dose, daily freq and dose, length of duration, total amount of prep needed for length of duration
GDP - name, practice address and contact number, signature
date of prescription and cross out any free space

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13
Q

non-controlled drugs prescription expiry

A

6m

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14
Q

CD prescription expiry

A

28days

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15
Q

OAF pt symptoms

A 
fluid from nose when drinking
nasal/whistle sound when breathing
bad taste
halitosis and bad smell
difficulty smoking
difficulty using straw
difficulty playing wind instruments
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16
Q

OAC POIs

A 
no forceful nose blowing
don't use straw
no smoking/alcohol
open mouth when sneezing
use steam inhalation
amoxicillin 7 days
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17
Q

medical conditions associated with pseudomembranous candidiasis

A

diabetes - poor control/undiagnosed

HIV - IC

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18
Q

mouth swab pros and cons

A

site specific

can be painful and easily contaminated

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19
Q

oral rinse pros and cons

A

sufficient quantity of MOs as whole cavity

not site specific so incs MOs which may not be relevant to diagnosis

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20
Q

fluconazole interactions

A

warfarin - increases free warfarin so increases bleeding risk
statins - increases risk of rhabdomyolysis and hepatotoxicity

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21
Q

where does HSV lie dormant?

A

trigeminal ganglion

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22
Q

triggers for recurrent HSV

A

trauma (physical to lip, UV)
immunocompromised, cold/illness
stress

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23
Q

microcytic anaemia

A

Fe deficiency

thalassaemia

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24
Q

topical therapies for minor RAU

A

benzydamine MW/spray
CHX MW 0.2% 10ml x2 daily
steroids - betamethasone MW, beclomethasone inhaler

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25
effects of supernumeraries on permanent dentition
delayed/failed eruption crowding/impaction/ectopic position of permanent teeth diastemas pathology - cyst formation
26
Down syndrome medical conditions
``` CHDs - VSD leukaemia hypothyroidism hearing loss cataracts epilepsy ```
27
Down syndrome EO
``` frontal bossing widely spaced eyes Brushfield spots- white spot on iris small midface (hyoplasia) - small nose class 3 upslanting palpebral fissures low set small folding ears short neck ```
28
Down syndrome IO
``` class 3 incisors microdontia hypodontia macroglossia with fissures AOB increased caries and PDD risk wear facets ```
29
SEs of chronic cocaine use
numbness of gingiva (area where rubbed) erosion of floor of nasal cavity ulceration of gingivae wear due to bruxism
30
complications if LA with adrenaline administered to pt who has recently abused cocaine
``` increased hr (hypertension) - palpations, LOC mood swings - aggressive ```
31
SEs of opiate abuse
``` addiction vomiting, nausea drowsiness resp depression death ```
32
methadone
opioid
33
methadone caries
acidic and sugar
34
disadvantage of SF methadone
doesn't have chloroform so less irritant to inject - need to monitor pt closely
35
cleaning essential to ensure effective disinfection/sterilisation
removes gross debris removes any Rx materials helps next stage to reach all surfaces of instrument ensure equipment functioning optimally and correctly
36
non y2 amalgam pros
corrosion resistance less creep higher mechanical strength better marginal seal
37
reducing y2 amalgam
add Cu - preferentially reacts with tin making less available to produce y2
38
zinc free amalgam
originally was necessary to add Zn - scavenger, so it preferentially oxidises rather than other constituents but can get creep - formation of ZnO (slag) - increase pressure which could cause Rx to rise ZnO +H2O - ZnO + H2 (react with saliva/blood) H2 increases pressure - downward pulpal pain, upward sits proud - risk of Rx fracture
39
vertical bone loss
plaque - destruction of bone with a 2mm radius which may be more than the thickness of bone in that area leading to a vertical bone defect
40
short term Rx of crown and core fracture
rebond vacuum formed splint holding it in place overdenture - keep space by covering teeth
41
retention in upper denture
peripheral seal post dam full extension into buccal sulcus
42
factors that cause displacement of a mandibular fracture
direction of fracture line opposing muscles/occlusion force applied to fracture
43
discolouration pt info
SHADE assessment - sensibility scores, draw out the teeth and areas of discolouration on them and shade of different areas of the teeth and lesions take photos record and get pt to sign saying they agree with current shade
44
why do you use a soft flex disc after microabrasion?
to remove the prismless layer that has formed
45
6 links in chain of infection
``` infectious agent reservoir portal of exit mode of transmission portal of entry susceptible host ```
46
protaper sequence
``` 10,15 - 2/3 EWL s1 - no deeper than 15 10 - find CWL 15 - glide path to CWL s1 s2 f1 f2 etc ```
47
prognosis of individual teeth perio
pocket probing depths LOA mobility furcation involvement
48
ABs might not be effective in eliminating pocket bacteria
``` may be inactivated may be resisted by biofilms super-infection could occur may not reach site of disease activity may have inadequate drug conc and retention ```
49
transient sensitivity to thermal stimuli and pain on biting after composite and preventing
uncured resins insufficient coolant on prep fluid from tubules occupying space under Rx pulp exposure prevent - pulp cap - cure in increments - coolant - liner - stepwise excavation
50
local factors contributing to DG
plaque and SLS
51
local haemostatic agents
surgicel LA with vasoconstrictor bone wax ferric sulphate
52
general implant checks
``` PDD smoking diabetes osteoporosis bisphosphonates bleeding disorder ```
53
local implant checks
quality and quantity of remaining bone position of teeth - rotations, angulations OH
54
tx options for impacted FPMs
``` monitor XLA E disc distal E ortho separator ortho appliance attached to 6 to bring into position ```
55
complications of a fixed retainer
debond fracture OH issues gingivitis risk
56
complications of PFR
can be lost can alter occlusion chip or fracture low compliance
57
local causes of pigmentation
amalgam tattoo malignant melanoma naevus
58
general causes of pigmentation
smoking racial pigmentation drug Addison's
59
capillary haemangioma histology
non-capsulated aggregates of closely packed, thin-walled capillaries, with single layer endothelial lining and separated by CT
60
cavernous haemangioma histology
encapsulated nodular mass composed of dilated, cavernous vascular spaces with endothelial lining separated by CT. Smooth muscle cells surround the vascular spaces
61
UE tooth investigations
radiograph sensibility test mobility
62
angular cheilitis organisms
s aureus, c albicans (streptococcus)
63
bonding to amalgam
MDP | 4-META
64
BEWE
``` 0 - no tooth wear 1 - initial loss of E surface texture 2 - distinct defect, hard tissue loss <50% surface area* 3 - hard tissue loss ≥ 50% SA* *D often involved ```
65
contraindications to the Dahl technique
``` active PDD bisphosphonates implants existing bridgework post-ortho TMD short roots ```
66
why is IV sedation consent separate visit?
once pt sedated consent no longer valid | amnesic effect of midazolam - may forget giving consent if on same day
67
midazolam dosage
5mg/ml (1mg/ml) | 2mg bolus then 1mg increments every 60s
68
flumazenil dosage
500mcg/5ml | 200mcg then 100mcg increments every 60s
69
MIH problems
``` sensitivity wear caries risk erosion difficult to bond to ```
70
when is reactionary bleeding
<48hrs
71
what is secondary bleeding caused by?
infection causing breaking down of the clot
72
factors which can cause displacement of a mandibular fracture?
muscle attachments mechanism of injury unfavourable fracture lines mechanism of force
73
possible IO features of class 3
``` posterior CB displacement on closing crowded maxilla class 3 incisors decreased/reverse OJ retroclined L incisors ```
74
learning outcomes of an intervention
``` reinforce good practice identify gaps in knowledge allow people to work in small groups encourage continued learning help staff understand importance of... modify attitudes ``` after this carry out a clinical audit to see what changes are required and implement them carry out another clinical audit to see if improvement has been made
75
why is severe class 2/3 contraindicated for SDA?
less likely for there to be occluding pairs in severe malocclusion
76
why is PDD contraindication for SDA?
poor prognosis of teeth drifting of teeth under occlusal load loss of alveolar bone leading to compromised denture bearing area in the long term
77
subalveolar fracture poor prognosis
lack of tooth tissue to support a Rx difficulty of isolation and moisture control for any tx difficulty of placing subgingival crown margins clamp/isolation for endo
78
features of denture induced stomatitis
erythematous | papillary hyperplasia
79
instructions to lab re special tray
pour in 50/50 stone/plaster construct special trays in light cure acrylic, non-perforated U with 2mm wax spacer L 1mm wax spacer IO handles and finger rests in premolar region ensure muscle attachments are relieved
80
minimise risk of debond RBB
tooth with large bonding area for abutment | cantilever design for anterior sextant
81
factors causing debond RBB
poor moisture control during cementation unfavourable occlusion poor E quality on abutment inadequate coverage of abutment
82
material RBB wing
CoCr
83
clinical indicators of malignancy
``` exophytic raised rolled borders firm and indurated friable bleeding persistent >3wks without obvious cause ```
84
mandibular displacement on closing
discrepancy between arch widths meaning teeth meet cusp to cusp so the mandible must deviate to one side to achieve ICP
85
why should mandibular displacement on closing be corrected?
can lead to TMJ symptoms and can cause attritive wear
86
correcting a bilateral posterior CB
midpalatal screw on URA to expand maxilla 4 Adams clasps reciprocal anchorage self cure PMMA with FPBP and mid-palatal split
87
S+S of TMD
``` hypertrophic/tender MofM pain linea alba scalloped tongue occlusal surface wear clicking/popping noises on opening ```
88
what GI conditions can cause microcytic iron deficiency anaemia?
Crohns UC Coeliac
89
other oral conditions associated with microcytic iron deficiency anaemia
candidosis dysaesthesia aphthous ulcers
90
cocaine use features
nasal septal defect oral ulceration bruxism and TW from grinding
91
side effects of opioid use
``` constipation sedation xerostomia excessive sweating addiction ```
92
complication of methadone containing sugar
rampant caries
93
risk of SF methadone
more likely to inject it
94
lower RPD not supplied and complete upper
will get resorption of bone, deposition of fibrous tissue, causing flabby ridge
95
Cu denture retained
muscular adhesion/cohesion post-dam extension into buccal sulcus - peripheral seal
96
biometric guidance setting U and L teeth
Hanau's quint | Watt and McGregor
97
features of a tooth that will make it successful/unsuccessful to tx
``` ferrule perio status mobility remaining tooth tissue pulp status ```
98
short term options to replace tooth
temp bridge temp RPD if tooth not XLA temp post crown
99
10% carbamide peroxide breaks down into
3. 4% H2O2 | 6. 6% urea
100
Albrights syndrome
polyostotic fibrous dysplasia abnormal pigmentation precocious puberty
101
what can alkaline phosphatase indicate?
liver damage or a bone disorder
102
what is hypercalcaemia often due to?
hyperparathyroidism
103
what associated condition can you get with temporal arteritis?
polymyalgia rheumatica - pain and stiffness in shoulder and neck muscles
104
SS ABs
anti-SSA (anti-Ro) or anti-SSB (anti-La)
105
2 things to do after audit cycle
implement changes | repeat audit cycle
106
clinical governance 6 components
``` education and training clinical audit clinical effectiveness research and development openness risk management ```
107
Audit cycle
``` identify problem/issue set criteria/standards observe practice/data collection compare performance with criteria and standards implement change ```
108
prevalence of hypodontia primary dentition
<1%
109
prevalence of hypodontia permanent dentition
6%
110
tx options for ectopic canines
XLAc and review 6m accept and monitor expose and ortho align XLA3 and replacement or autotransplant
111
differential diagnoses for L8 dull throbbing pain
otitis media irreversible pulpitis pericoronitis
112
how a splint works
habit breaker stabilises occlusion keeps MofM in relaxed position minimises loading on TMJ
113
arthrocentesis
inject fluid into TMJ to flush out inflammatory exudate and remove adhesions
114
features of zygomatico-orbital fractures
``` periorbital ecchymosis numbness of cheek subconjunctival haemorrhage diplopia lacerations enophthalmos swelling then flattening asymmetry trismus reduced acuity pain on eye movements ```
115
xrays for zygomatico-orbital fractures
OM 15/30
116
management of zygomatico-orbital fractures
undisplaced - monitor and conservative advice | displaced/symptomatic (eye/nerve)/defect on xray/suspicion of late enophthalmos - ORIF
117
disadvantage of rinse
not site specific | only indicates presence of microbe, doesn't guarantee its implication in infection
118
pseudomembranous candidiasis - what to ask pathologist for
culture and sensitivity
119
herpes groups that cause oral ulcers
HSV1 HSV2 CMV
120
coxsackie diseases
HFMD | herpangina
121
EBV diseases
glandular fever | hairy leukoplakia
122
effect of supernumeraries on permanent dentition
root resorption delayed eruption ectopic eruption diastemas
123
class 2 div 1 incisors
lower incisor edges lie posterior to the cingulum plateau of the upper incisors increased OJ U central incisors proclined or of average inclination 15-20%
124
why are elderly more at risk of postural hypotension?
age-related impairment in baroreflex mediated vasoconstriction deterioration of diastolic filling of heart low bp
125
reasons pt LOC
hypoglycaemia epilepsy stroke
126
NES 3 other types of formal QI activity within NHS "terms of service"
peer review research project SEA - critical incident review scottish pt safety initiative
127
peer review
groups of dentists get together to review aspects of practice share experience and identify areas in which changes can be made with objective of improving quality of care, share learning and implement change
128
practice based research project
participation in formal/approved research project within Scottish Dental Practice Based Research Network (SDPBRN)
129
steps of SEA
``` identify event collect and collate info set up a meeting to discuss events meet and undertake a structured analysis - what? why? learned? implement changes and monitor progress write up the SEA seek external feedback/comment ```
130
balancing ext
ext of a tooth from the opposite side of the same arch | designed to minimise midline shift
131
LP histology
hugging band of T lymphocytes change in surface epithelium: hyperkeratosis/atrophy civatte bodies: apoptosing intra-epithelial cells basal cell liquefaction saw-tooth rete pegs
132
pemphigoid lab
hemidesmosomes/BM linear appearance subepithelial bullae CT inflammatory response (immunofluorescence along BM)
133
pemphigus lab
``` intra-epithelial desmosome split, bullae basket weave appearance, IF suprabasal acantholysis suprabasal split, tzank cells in cleft intact basal cell layer still attached to basal lamina mild inflammatory infiltrate ```
134
causes of LP
idiopathic immunomediated hep c
135
LTR causes
drugs SLS amalgam plaque (desquamative gingivitis)
136
which drugs can cause LTR?
``` NSAIDs B-blockers anti-hypertensives hypoglycaemics diuretics ```
137
LP/LTR tx
``` SLS free tp good OH monitor CHX stop smoking ```
138
oral effects of cannabis
dry mouth, can lead to PDD | vomiting - wear
139
oral effects of cocaine/crack cocaine
acidic when mixes with saliva - erosion grinding/muscle spasms "buccolingual dyskinesia" rub powder on gums - gum sores snorting - damage to HP - hole between nose and mouth
140
oral effects of ecstasy/amphetamines
grinding | dry mouth
141
oral effects of heroin
crave sugar | grind
142
oral effects of meth
caries, crave sugar bv effects - gums dry mouth grinding
143
CHX mechanism
dicationic | one to pellicle, other to bacterial membrane to increase permeability and then to cell death at higher concs
144
nystatin mechanism
polyene | bind to sterols in fungal membranes, allows leaking of metabolites
145
polyenes mechanism
bind to sterols in fungal membranes, allows leaking of metabolites
146
azoles mechanism
interfere with the primary sterol component of fungal cell walls
147
restoring excessive FWS with worn dentures
occlusal pivots restore occlusal surface with autopolymerising acrylic resin replica technique if only occlusal surface needs adjusted
148
aetiology of TN
trigeminal nerve ischaemia distortion of myelin sheath therefore interrupted/altered electrical conductivity abnormal electrical current in sensory nucleus of trigeminal
149
TN investigations
``` rule out odontogenic MRI FBC LFT/ U+E assessment of suicidal intent ```
150
localised causes of pigmentation
``` Am tattoo malignant melanoma melanotic macule/naevi peutz-jehger's syndrome KS pigmentary incontinence ```
151
generalised causes of pigmentation
``` Addisons drugs OCP racial smoking ```
152
black hairy tongue
chromogenic bacteria and stained with cigarette smoke and trauma
153
amalgam LTR actions
replace may need new RPD review to ensure resolution of lesion refer to specialist if no improvement following tx for provision of topical steroid tx to reduce symptoms from lesion
154
TMD red flags and red flags for orofacial pain
prev hx of malignancy persistent or unexplained neck lump/cervical lymphadenopathy (may indicate neoplastic, infective, AI cause) persistent and worsening pain jaw pain in pts taking bisphosphonates concurrent infection hx of recent H/N trauma neurological symptoms: headache, CN abnormalities facial asymmetry/swelling/profound trismus recurrent epistaxis, purulent nasal discharge, persistent anosmia, reduced hearing on ipsilateral side - may indicate nasopharyngeal carcinoma unexplained fever/weight loss new-onset unilateral headache/scalp tenderness, jaw claudication, general malaise, esp if >50yrs - giant cell arteritis occlusal changes
155
TMD differential diagnoses
dental - caries, PDD, tooth abscess, 8 eruption parotitis/sialadenitis/sialolithiasis maxillary sinusitis headaches - migraine, tension-type, cluster and other TACs, meds overuse neuralgias - TN, peripheral neuritis, post-herpetic neuralgia, post-traumatic and post-surgical neuralgia ear conditions e.g. otitis media other viral conditions - mumps, shingles AI - RA, SLE, SS ORN giant cell arteritis
156
instructions to lab for stabilisation splint
``` pour imp in 100% stone hard splint covering entirety of occlusal surfaces halfway down crown min 2mm thick made with hard acrylic ```
157
desquamative gingivitis
clinical descriptive term to describe an oral manifestation of MC disorder (usually) where the superficial layer of the epithelium is atrophied/separated from the remainder of the epithelium. Relates to an immune response tissues involved - attached gingiva to MG jct, sparing margins, full thickness, striae possible. Labial
158
burning mouth causes
poor vascularisation as bv's decrease in size poor nutrition means atrophy of the tissue/mucosa sensory receptors change into nociceptors
159
differential diagnoses of burning mouth
``` oral dysaesthesia diabetes stroke xerostomia hormonal imbalance (menopause) stress anxiety cancerphobia fungal infection allergy ```
160
tx of burning mouth
investigate - haematinics, FBC, AB, blood glucose, saliva, parafct, denture, cancerphobia, psychiatric reassure pt correct deficiencies and underlying disease difflam correct parafct/denture problems gabapentin/antidepressant CBT
161
what is dermatitis herpetiformis?
AI skin condition linked to celiac disease - IgA deposits due to gluten
162
6 types of candidiasis
``` acute pseudomembranous acute erythematous (AB sore mouth) chronic erythematous (denture induced) CHC MRG angular cheilitis ```
163
investigating pt with candida
``` FBC haematinics blood glucose dry mouth HIV swab/rinse ```
164
mechanism of action of bisphosphonates
reduce bone turnover by inhibiting formation, recruitment, activity of OCs
165
diseases bisphosphonates are used for
osteoporosis bone disease/metastases malignancy
166
MRONJ criteria
>8wks exposed necrotic bone take bisphosphonates etc no hx of H+N radio
167
where are bisphosphonates esp active?
areas of high bone turnover i.e. jaw - reduce blood supply and turnover
168
Pagets pathogenesis
enlargement of maxilla due to overactivity of OCs and OBs normal bone remodelling is replaced by chaotic bone alteration of bone deposition and resorption, with resorption dominating early stages - hypercementosis - evidence of Paget's in >5% >55yrs, mainly men
169
RPI action
``` saddle sinks into denture bearing area rotation about mesial rest distal guide plate and I bar clasp rotate downwards and mesially disengage from tooth torque forces avoided ```
170
symptoms of increased OVD
difficulty eating and speaking teeth together at rest pain
171
symptoms of reduced OVD
poor facial profile lack of chewing pressure angular cheilitis generalised facial discomfort
172
why can't impression be mucocompressive in a flabby ridge?
leads to denture being well-adapted when compressed during occlusal pressure but will cause displacement during tissue recoil at rest window technique
173
indications for replica technique
correct position of teeth (in neutral zone) polished surfaces satisfactory wear of occlusal surfaces (indicates long-term wear) replacement of immediate dentures spare set loss of retention in otherwise favourable dentures deterioration of denture base materials
174
contraindications for replica technique
polished surfaces incorrect not in neutral zone major modifications needed prev dentures not available
175
neutral zone
zone of minimal conflict of muscular displacing force
176
management of knife-edge ridge
take imp as normal roll finger along ridge to identify areas of discomfort, cut relief in impression and take imp again with mucostatic material e.g. light-bodied PVS soft lining surgery to smooth ridge down
177
when would you use a lingual plate?
if no space for a lingual bar
178
pt concerns re amalgam
``` colour leaching/toxicity/poisoning allergy oral cancer toothwear longevity cost ```
179
amalgam pt reassurance
``` mercury within compound so non-toxic minute amounts clinical evidence good longevity no link to cancer cheap ```
180
where shouldn't you finish a restoration?
on contact point
181
how composite bonds to dentine
etch - demineralises D surface, widening tubules and exposing collagen fibrils dry prime - invades spaces created from etching with primer monomer - displacing water by solvent. Has a bi-fct coupling molecule which is both hydrophobic and hydrophillic bond - unfilled resin monomer infiltrates spaces occupied by primer, creates hybrid layer which when cured forms strong cross-linked bond to D, resin tag creating micromechanical retention. Air inhibition of surface layer leaves unreacted monomer to subsequently bond with incrementally built up composite
182
bonding agents based on chain length
bis-GMA medium UDMA short - more polymerisation shrinkage tegDMA long
183
potential problems when designing bridge
``` long axis angulations coincident occlusal interferences adequate root area for support (ante's law) aesthetics resorbed alveolus - floating tooth syndrome large saddle technique sensitive pontic choice ```
184
D hypersensitivity mechanism
pain arising from exposed D in response to a thermal, tactile or osmotic stimulus. thought to be due to dentinal fluid movement stimulating pulpal pain receptors diagnosis by exclusion of other causes
185
tx of D hypersensitivity
eliminate or reduce aetiological factors | reduce permeability of dentinal tubules
186
what do you use to assess occlusion when designing bridgework?
semi-adjustable articulator with FB mount and customised incisal guidance table
187
what to look for when assessing occlusion in bridgework?
overeruption of occluding teeth space m-d for teeth angulation of adjacent and occluding teeth
188
pros and cons of PMMA as temp Rx
+ high wear resistance and strength | - polymerisation shrinkage, exothermic, free monomer
189
pros and cons of PEMA as temp Rx
+ less shrinkage, less exothermic | - mod strength and wear resistance, discolours and stains easily
190
pros and cons of bis-acryl composite as a temp Rx
+ high wear resistance, less shrinkage, aesthetics | - brittle in thin sections, difficult to add/repair to, £
191
cracked tooth syndrome S+S
short sharp pain on opening from bite often large Rx + response to vitality testing may be associated w bruxing habit pain can usually be elicited by pt biting on a tooth sleuth transillumination and possible removal of Rx may aid visualisation
192
tx of cracked tooth syndrome
temp - band around tooth comp on minimal Rxs may need onlay/crown (full occ coverage) occ RCT
193
reasons for post failure
``` perforations reintroduced bacteria on post prep accessory canals not cleaned poor post design/placement not considered occlusion not cemented correctly ```
194
addressing concerns re a child
``` raise concerns with parents explain what changes are required offer support keep accurate records continue to liase with parents/carers monitor progress if concerned pt suffering/at risk of harm - involve other agencies ```
195
long term effects of trauma in primary teeth
discolouration discolouration and infection delayed exfoliation
196
AI - hypoplastic
yellow brown | E crystals don't grow to correct length
197
AI - hypomineralised
yellow/brown soft and rough | crystallites fail to grow in thickness and width
198
AI - hypomaturation
yellow brown and calculus | E crystals grow incompletely in thickness or width but to normal length with incomplete mineralisation
199
AI mixed type
with taurodontism | brown mottled
200
clinical aspects of AI
E soft and thin, teeth appear yellow and easily damaged affects both primary and permanent dentition pt c/o sensitivity
201
radiographic aspects of AI
UE crowns have normal morphology E has reduced contrast to D taurodontism has large pulps
202
types of DI
type 1 - OI - blue sclera type 2 - AD brandywine - maryland USA
203
clinical DI
``` affects both dentitions no complaint of sensitivity aesthetics caries susceptibility spontaneous abscess blue sclera ```
204
radiographic DI
bulbous crowns obliterated pulps E loss
205
local factors causing discolouration
``` caries demineralisation hypomineralisation extrinsic tooth staining fluorosis pulpal necrosis internal resorption ```
206
diagnostic features of fluorosis
E defects - opacities affecting >1 tooth history of F ingestion/high F water concentration
207
indications for treating an anterior CB
mandibular displacement - predisposition to TMD a traumatic displacing anterior occlusion may deflect a lower incisor labially and compromise D support pt aesthetics
208
epidemiology of ectopic canines
2% pop | 85% are palatally ectopic
209
aetiology of ectopic canine
``` crypt displacement long eruption path small/absent laterals crowding for buccals, spaced/uncrowded for palatals retention of deciduous canine genetic factors ```
210
clinical signs of impacted 3s
``` delayed eruption retained c unable to clinically palpate distal tipping of 2s loss of vitality and mobility of 1s and 2s diminuitive 2s ```
211
features of class 2 div 1 amenable for URA
labial tipping needs good anchorage space available can correct OB
212
what causes tooth mobility
``` loss of attachment occlusal trauma PA lesion trauma following perio tx ```
213
-s of ABs perio tx
``` may be inactivated or degraded by non-target organisms biofilms resist ABs resistant organisms superinfection allergic reactions ```
214
-s of a pocket chart
assumes all pts' teeth have same root lengths therefore making some teeth seem like they have a poorer prognosis than they actually do potential for errors: probing force, probe angulation, presence of Rxs/calculus, degree of inflammation, clinical experience, visibility, pt cooperation
215
theories of vertical bone loss defect
usually localised and related to occlusal trauma (glickmans theory) wide interdental bone between teeth and plaque present (waerhaugs theory) overhanging Rxs - plaque trap leading to a bony defect progressing faster than rest of jaw
216
theory for horizontal bone loss
more generalised chronic periodontitis | ID bone <2mm
217
what does CHX substantivity depend on?
absorption to oral surfaces active when absorbed slow neutralisation of antimicrobial activity
218
2 doses of CHX
0. 2% 10ml = 20mg x2 daily | 0. 12% 15ml = 18mg x2 daily
219
aims of root coverage surgery
improve aesthetics facilitate plaque control address sensitivity
220
is the prognosis of the tooth negatively affected by an NaOCl accident?
no
221
S+S of NaOCl extrusion
``` intense pain facial swelling profuse bleeding into RC from PR tissues burning haematoma ecchymosis of skin ```
222
pathogenesis of NaOCl extrusion
severe acute inflammatory reaction, can be oedomatous and/or haemorrhagic can lead to significant tissue necrosis as NaOCl has tissue dissolving properties
223
tx of NaOCl extrusion
``` stop inform and reassure LA for pain relief aspirate any NaOCl out irrigate with copious saline temporise nsCaOH analgesia cold then warm compresses - reduction of ST swelling and elimination of haematoma review 24hrs if severe - refer ```
224
why do NiTi rotary instruments reduce creation of blocks, ledges, transportations and perforations?
remain centred within the natural path of canal
225
management of pt panic attack
``` stop any tx sit upright reassure pt - safe env, tell them they are in control offer support encourage breathing arrange follow up appt ```
226
acts re illegal drugs
Classification of drugs | Misuse of Drugs Act
227
general health problems with illegal drugs
BBVs psychotic illness STDs liver disease

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