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1
Q

Describe 3 difference between stroke and a facial palsy?

A

LA same side, stroke opposite side
Stroke- can still wrinkle forehead
In stroke all muscles of the face/mastication/pharynx are still working except muscles of lower face and tongue from the opposite side
Facial palsy is often iatrogenic where stroke is caused by infarction

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2
Q

Definition of Xerostomia?

A

Dry mouth, subjective complaint of dryness of the mouth, can be a sign and a symptom
Half the amount of normal unstimulated flow rate. Clinically <0.15ml/min in unstimulated salivary flow

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3
Q

What are some medications that cause dry mouth (xerostomia)?

A

Tricyclic antidepressants, antihistamines, antichlorinergics, diuretcs, benzodiazepines, beta-blockers, antipsychotics (polypharmacy)

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4
Q

What are some other reasons for dry mouth?

A

Sjogrens syndrome
Radiotherapy to head and neck
diabetes
rheumatoid arthritis
parkinsons
alzheimers
stroke
nerve damage

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5
Q

What is platelet dysfunction?

A

Thrombocytopoenia (low circulating platelet)

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6
Q

What are the 3 blood tests to confirm thrombocytopoenia?

A

Bleeding time
INR (prothrombin time)
FBC
APTT (activated partial thromboplastin time)

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7
Q

What is the mechanism for apixaban?

A

Selective inhibitor of factor Xa
Apixaban has no direct effect on thrombin but indirectly inhibits platelet aggregation induced by thrombin

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8
Q

What alterations regarding apixaban do you make when extracting?

A

Do not take the first dose and just take the second dose as normal

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9
Q

What are the cardinal signs of patient’s with Parkinson’s disease?

A

Bradykinesia, postural instability, muscle rigidity, resting tremour

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10
Q

How does Parkinson’s cause dry mouth?

A

Anticholinergic effect of drugs

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11
Q

What is the difference between a patient with Parkinson’s and with cerebral disease?

A

Patients with Parkinson’s disease have a resting tremor whereas patients with a cerebral disease have an intension tremour

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12
Q

What are some symptoms of early stage dementia?

A

Difficulty concentrating, decreased memory of recent events, socialising becomes difficult, confusion, poor judgement, anxiety

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13
Q

What are some symptoms of middle stage dementia?

A

Major memory discrepancies and may need help with everyday activities like bathing and preparing meals
Forget names of friends and family
Personality changes
Risk of wandering

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14
Q

What are some symptoms of late stage dementia?

A

Essentially no ability to communicate, assistance required for most activities
Difficulty swallowing
Incontinence
Little/no motor skills

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15
Q

How can you adapt a practice to make it more disability friendly?

A

Ramps, hand rails, low desk at reception, wide clutter free corridors, hoists, disabled access toilets, visible signs for visually impaired

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16
Q

What are the 2 models of disability?

A

Social view: society must respond to medical problems, society is an issue, needs to be adapted
Medical view: People with disability are the issue, need treatment and care, should adapt to environment and society

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17
Q

Name 2 cognitive tests for dementia?

A

Mini-mental state examination (MMSE)
The Montreal Cognitive Assessment (MoCA)
Combined single tests

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18
Q

Describe the basic principle of tooth movement in orthodontics?

A

If prolonged pressure is applied to a tooth it will move as the bone around it remodels
Periodontal ligament mediates the bony response

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19
Q

What is spina bifida?

A

Neural folds fuse to form neural tube
Failure to fuse will lead to spina bifida

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20
Q

Describe the process of when light orthodontic forces are applied to a tooth.

A

Hyperaemia within PDL
Appearance of osteoclasts and osteoblasts
Resorption of lamina dura from pressure sides
Aposition of osteoid on tension side
Remodelling of socket- frontal resorption
Periodontal fibres reorganise but gingival fibres remain distorted

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21
Q

What does an EPT do?

A

Electric current used to stimulate sensory nerves
Primarily A-delta fast conducting fibres are stimulated
Unmyelinated C-fibres may or may not respond

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22
Q

On which teeth is the EPT unreliable?

A

Teeth with open apices

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23
Q

Why would you take pre-operative radiographs?

A

To show
-Any periradicular pathology and how far it extends
-The anatomy of the root canal
-Canal calcifications
-Check angulation of root in relation to adjacent teeth
-Number, length and morphology of roots
-Proximity of vital structures

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24
Q

What is the ideal shape of a root canal system?

A

Create a continuously funnelling tapered canal
Maintain apical foramen in original position
Keep apical foramen as small as possible

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25
What does sodium hypochlorite do?
Strong antimicrobial agent Dissolves pulp remants and collagen (organic part of dentine) debris. Thus helps disrupt the smear layer Dissolves both necrotic and vital tissue
26
What is EDTA used for?
Cheleating agent capable of removing smear layer when used with NaOCl Lubricant for files
27
What is the smear layer and what is its relevance to endodontic treatment?
Organic pulpal material and inorganic debris formed during prep Superficial 1-5micrometres with packing into tubules Bacterial contamination, substrate and interferes with disinfection Prevents sealer penetration
28
Describe the double flare canal preparation.
2 stages Apical enlargement -Diameter of apical portion gauged by inserting ISO hand files passively to working length until a file binds at the working length -Largest file used to working length is the master apical file (MAF). This file size is dependent on original size and curvature of root canal Apical Taper -Files of increasing size are used in an apical to coronal manner while stepping back which creates an apical taper and binds apical prep to coronal flare
29
What is the function of the intracanal medication?
Placed inside root canal between treatment appointments in an attempt to destroy microorganisms and prevent re-infection Reduce inflammation and exudate Control of root resorption
30
What is the purpose of obturation?
Prevent microorganisms from re-entering the root canal system Isolate any microorganisms that may remain within the tooth from nutrients in tissue fluids
31
What are the problems with incompetent lips?
Face may not develop properly, longer face, impeded speech, mouth-breathing leading to dry mouth
32
What are 4 signs of a child who has a digit sucking habit?
Proclination of upper anteriors Anterior open bite Reclination of lower anterior incisors Unilateral posterior cross bite Narrowing of the upper arch Reduced over bite
33
What are the causes of congestive heart failure? Name at least 4.
Coronary artery disease Cardiomyopathy Heart attack Alcohol abuse Hypertension Valve disease MI Diabetes
34
What are the symptoms of congestive heart failure?
Rapid irregular heart beat Fatigue and weakness Swelling of abdomen Swelling of leg/ankle/feet Nausea Shortness of breath Cough, wheezing Chest pain when breathing
35
What are the treatments and prophylaxis for congestive heart failure
Lifestyle changes (balanced diet, exercising, stop smoking) Medication -ACE inhibitors (ramipril) -Angiotensin-2 receptor blockers -Beta blockers (bisoprolol) -Diuretics (furosemide) Devices implanted in your chest to control your heart rhythm such as pacemaker, CRT, ICD -Heart valve surgery -Coronary angioplasty or bypass -Left ventricular assist devices -Heart transplant
36
What are the virulence factors involved in carious bacteria?
Adhesions - makes up fibrillar layer of cell wall Binding proteins - glucosyltransferase, glucan binding protein Sugar modifying enzymes - fructanase, dextranase polysaccharides Acid tolerance and adaptation
37
What are the virulence factors involved in periodontal disease?
Host cell adherence and invasion - fimbiae Elaboration with proteases Endotoxins (LPS) Capsular polysaccharide and outer membrane vesicles Tissue toxic metabolic by products- hydrogen sulphide, ammonia and fatty acids
38
Why do biofilms not allow antibiotics to penetrate them?
Biofilms can produce a penetration barrier of LPS which prevents antimicrobials and antibiotics from penetrating Biofilms also require mechanical disruption so alone medications will not work to remove them fully The biofilm impairs diffusion -Causes binding of the antibiotics -Extracellular DNA persists
39
What are some reasons for liver cirrhosis. Name at least 4
Alcohol abuse Viral hepatitis (B, C and D) Fat accumulating in the liver (non alcoholic fatty liver disease) Cystic fibrosis Iron build up in the body (haemochromatosis) Medications
40
How do you deal with a blood spillage?
Wear PPE (gloves, apron, visor, goggles) Contain with paper towel Assemble all equipment needed (spillage kit) Sprinkle chlorine releasing granules Clear affected area with paper towels and dispose of as clinical waste Wash area with water and detergent and then dry Make sure sharps are disposed of Perform hand hygiene
41
What do you use to clean a blood spillage? What concentration? How long do you leave it for?
Sodium dichloroisocyanurate Sodium hypochlorite 10,000ppm for 3-5 mins
42
Give 2 reasons why an overhang can occur when placing an amalgam restoration.
Poor adaptation of matrix band Excessive force applied when condensing amalgam
43
How can you improve an overhang?
Replace the restoration and retreat it By using finishing strips or soft flex discs
44
What are the short and long term consequences of an overhang?
Food trap Difficulty cleaning Trauma to soft tissues Plaque trap Secondary caries Gingivitis and periodontitis
45
What is the horizontal line for OPT parallel to the floor?
Frankfort plane
46
Why do anterior teeth appear horizontally wider in an OPT?
Canine behind the guideline Patient too far back in the machine
47
Why do posterior teeth appear horizontally wider?
Patient is rotated in the machine
48
Name 3 features of a ghost image.
Always higher Always horizontally magnified On the opposite side
49
What radiograph do you take for a pre extraction of 48 when the 38 is fine?
Right side OPT
50
How are ghost images produced?
Can occur when there is horizontal distortion if the patient is in the incorrect position relative to the focal plane
51
What else can you call a secondary impression?
Definitive impression Master impression
52
What anatomical features should be captured for the position of posterior border of the upper?
Palatine fovea at vibrating line Hamular notches Border of hard palate
53
What anatomical features should be captured on the mandibular?
Residual ridge Buccal shelf Retromolar pad
54
Name 2 materials that can be used for masters on lowers.
Alginate Light bodied silicone Impregnum
55
Name 3 reasons to do non-surgical before surgical treatment in perio.
Deep pockets may heal following non-surgical therapy Improve soft tissue consistency for easier surgical movement Allows evaluation of patients motivation and plaque control
56
Give 2 indications for surgical at re-evaluation of therapy.
Pockets of 5mm or greater persist Furcation Presence of excellent oral hygiene
57
What is the aim of surgical therapy?
To arrest the disease by gaining access to complete root surface debridement To regenerate lost periodontal tissue
58
When would you carry out surgical therapy and when would you re-evaluate non surgical therapy?
6-8 weeks after non-surgical therapy
59
Why do you keep a denture moist?
For retention and to stop infection and more comfortable in the patients mouth
60
Give 2 thermal properties of denture bases.
High softening temperature Low thermal conductivity
61
What are some gaseous properties of denture bases.
Monomer boiling Occurs in bulkier parts Occurs due to exothermic reaction of polymerisation (should be carried out slowly to prevent this) Porosity affects -Strength -Appearance -Rough sensation to tongue -Absorbs saliva- poor hygiene
62
Give 2 aims for raising a flap.
Better access Protection of soft tissues
63
Give 4 things that can influence flap design
Procedure being carried out Surrounding nerves Visualisation issues How much access is required Personal preference of the operator
64
What type of handpiece is used for bone removal?
Electrical straight handpiece with saline cooled bur Round or fissure tungsten carbide burs
65
Give 3 methods of debridement
Physical --using bone files or handpiece to remove sharp bony edges Irrigation --Sterile saline into socket Suction --Aspirate under flap to remove debris
66
What is apixaban used for?
Treatment or secondary prevention of DVT Prevention of stroke Prevention of pulmonary embolism
67
Give 2 reasons why there is an increased risk of periodontitis for those with Down Syndrome.
Immunocompromised Poor oral hygiene
68
Give 4 physical features of down syndrome.
Hypodontia Short neck Short nose Small arched palate Macroglossia - big tongue and protruding tongue Class III malocclusion Small arched palate
69
How do you prevent dentures being lost in a care home?
Initials during process - mark using sandpaper or a sealant Store them in a labelled container
70
When do you not extract teeth in individuals with Parkinson's?
Tremor could make the extraction difficult Poor mouth opening due to rigidity Will require new prostheses to replace missing teeth. Won't be able to tolerate it
71
When would you use a dual cure?
Thick porcelain Metal restorations
72
What do you use to bond porcelain to composite luting resin?
Silane coupling agent
73
What is the part of the mandible that interferes during maxillary working impression?
Coronoid Process
74
How do you reduce bias in a study?
Randomising Double blinding
75
What features of an ECM make them resistent?
The biofilm impairs diffusion It causes binding of antibiotics Extracellular DNA persists
76
What is a special investigation you can carry out on an uncooperative child?
OPT
77
When is the ideal time to remove 6's?
5's present Bifurcation of 7's Class I incisor relationship Mild buccal segment crowding
78
Give 2 ways to treat an anxious child.
Work quickly, calm manner Empathy Distraction techniques Densensisitisation
79
Give 4 reasons for a child to be anxious.
Past negative dental experience Attitude of parents towards the dentist Expectation of pain Past negative family experiences Poor knowledge of treatment
80
Name 4 behaviour management methods for children.
Positive reinforcement Acclimitisation Desensitisation Distraction Relaxion techniques Voice control
81
What is an endodontic lesion with periodontal involvement?
Primary endodontic disease remains untreated, it may become secondarily involved with periodontal breakdown Plaque forms at the gingival margin of the sinus tract and leads to plaque induced periodontitis in that area
82
What is generalised chronic periodontitis?
Characterised by the destruction of the junctional epithelium and connective tissue attachment of the tooth, together with bone destruction and formation of periodontal pockets Disease progresses slowly and the amount of bone loss tends to reflect the age of the patient

MSA Questions (3 decks)

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