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REVISION BDS > past papers quick notes > Flashcards

past papers quick notes Flashcards

1
Q

Which condition would be the most likely cause in
pt with bony expansion of maxilla and is elderly and has a high alkaline phosphotase level

A

paget’s disease

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2
Q

Which condition would be the most likely cause in
pt with bony expansion of maxilla and has a raised serum calcium level

A

hyperparathyroidism

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3
Q

Which condition would be the most likely cause in
pt with bony expansion of maxilla and is 15years old and has bilateral maxillay expansion

A

cherubism

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4
Q

Which condition would be the most likely cause in
pt with bony expansion of maxilla and radiography shoes a radiolucency with generalised loss of lamina dura

A

Paget’s disease

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5
Q

Which condition would be the most likely cause in
pt with bony expansion of maxilla and pt has pigmented spots on their skin and has precocoius puberty

A

Albright’s syndrome

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6
Q

Which condition would be the most likely cause in
pt presents with pain in their face and is Middle-aged, female patient with constant burning sensation affecting the palate and tongue, with erythema of the mucosa.

A

oral dyseasethesia (burning mouth)

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7
Q

Which condition would be the most likely cause in
pt presents with pain in their face and has recent onset dull throbbing pain over the maxilla worsened by bending over to tie shoelaces

A

Maxillary sinusitis

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8
Q

Which condition would be the most likely cause in
pt presents with pain in their face and is young adult F with episodic unilateral peri-orbital pain lasting 20 mins with nasal congestion, the pain being brought on by shaking of the head

A

chronic paroxysmal hemicranias

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9
Q

Which condition would be the most likely cause in
pt presents with pain in their face and is elderly F with sharp, shooting pain over the right cheek brought on by eating, associated with lacrimation

A

trigeminal neuralgia

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10
Q

Which condition would be the most likely cause in
pt presents with pain in their face and is elderly F with unilateral, throbbing pain and loss of muscular power around the shoulders

A

giant cell arteritis with polymyalgia rheumatica

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11
Q

pt referred to OM for evaluation of dry mouth

feature associated dehydration

A

abnormally high glucose levels - diabetic

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12
Q

pt referred to OM for evaluation of dry mouth

feature associated sjogren’s syndrome

A

anti ro antibody positive

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13
Q

pt referred to OM for evaluation of dry mouth

feature associated ectodermal aplasia

A

sparse hair follicles

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14
Q

biopsy for sjorgren’s from where

A

labial gland

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15
Q

Susan, is a 29 year-old patient who is a regular attender at your practice, she has previously undergone periodontal treatment. She attends your practice as an emergency pain appointment, complaining of pain in her upper front tooth. On examination you notice a swelling pertaining to the 11 as above, the tooth is TTP and there is associated lymphadenopathy.

2 differential dx

A

periodontal abscess

periapical abscess

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16
Q

2 special investigations undertake for this

A

periapical radiograph
sensibility testing (EPT, ECl)

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17
Q

2 ways could drain this swelling

A

incise and drain
drain through periodontal pocket

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18
Q

initial management of this swelling if not endodontically involved

A
  • LA and drain abscess through pocket
  • gentle irrigation and PMPR of pcket - short of the base to prevent traumatising
  • antibiotics due to lymphadenopathy (phenoxymethylpencillin 250mg tablets, 2 tablets 4xdaily)
  • advise on CHX mouthwash 0.2% 10ml 1min rinse 2xdaily (no more than 14days, 30min after toothbrush)
  • review to ensure resolution at 10days and further PMPR
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19
Q

A patient presents with an Adhesive Bridge, the pontic is replacing the 11 and the 12 and 21 have adhesive wings bonded to them as abutments. You fitted the bridge 3 months previous and it has debonded.

4 potential reasons for debonding of a bridge clinically

A
  • unfavourable occlusion
  • insufficient coverage with adhesive wing for bonding
  • poor enamel quality of abutments
  • inadequate moisture control during cementation
  • caries
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20
Q

4 methods of checking bridge debonding clinically

A
  • pressing on the pontic and looking for movement of adhesive wings
  • pressing on adhesive wings and looking for bubbling of saliva at wing/tooth interface
  • explore the margins with a proble looking for defects and place probe under pontic and apply coronal pressure and looking for movement of adhesive wing
  • try and pass floss under adhesive wing
  • radiograph?
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21
Q

A patient presents with an Adhesive Bridge, the pontic is replacing the 11 and the 12 and 21 have adhesive wings bonded to them as abutments. You fitted the bridge 3 months previous and it has debonded.

alternative to replce tooth other than bridge
alternative bridge design

A

RPD or implant

adhesive cantilever using 21 as retainer only or spring cantilever using 16 as retainer

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22
Q

A patient presents with an Adhesive Bridge, the pontic is replacing the 11 and the 12 and 21 have adhesive wings bonded to them as abutments. You fitted the bridge 3 months previous and it has debonded.

decide implant next
give 2 general and 2 local factors to check prior to implant placement

A

general - head and neck cancer tx (radiotherapy), bisphophonate use, diabetic, smoking status

local - bone height, space available between existing teeth and roots, OH, rotations/drifting of tooth

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23
Q

patient is attending treatment area for the extraction of their lower left third molar due to persistent pericoronitis

7 features that indicate a close proximity to IDC

A
  • deflection of canal
  • deflection of roots
  • interruption of tramlines of canal
  • narrowing of canal
  • narrowing of roots
  • juxta apical area
  • darking of roots where crosses the IDC

Rood and Shehab

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24
Q

suspicious of close proximity to IDC of lower 8 - what to do

A

CBCT
infor pt of risk to nerve

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25
Q

potential complications of extracting tooth which is close proximity to IDC

A

inferior alveolar nerve paraesthesia (numbness)
inferior alveolar nerve dysthesia (pain)

temporary or permanent

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26
Q

procedure for lower 8s to reduce risk of complications to IAN

A

coronectomy

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27
Q

3 scenarios where inc risk of bleeding post XLA

A

anticoagulant (apixaban, dabigatran, rivaroxaban, wafarin)
antiplatelet (clopidogrel, aspirin)
alcoholic liver disease

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28
Q

post op methods of achieving haemostasis

A

damp gauze and pressure
surgicel (oxidised cellulose) and suturing
LA with vasoconstrictor
diathermy

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29
Q

patient attends you practice complaining of jaw stiffness and on examination you notice intra-oral signs of bruxism and diagnose TMD.

signs/symptoms of TMD

6

A
  • pain
  • MoM hypertrophy
  • clicking, popping, crepitus of TMJ
  • linea alba
  • tongue scalloping
  • tooth wear - attrition
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30
Q

2 muscles to palpate for TMD

A

temporalis
masseter

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31
Q

6 conservative pieces of advice for TMD

A
  • stop any parafunctional habits - nail biting
  • prevent chewing gum all the time
  • cut food into small pieces/ softer diet/ don’t incise foods
  • chew bilaterally
  • supportive yawning
  • relaxation methods/reduce stress
  • jaw exercises booklet
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32
Q

edentulous ridge classifications

6

A

class 1 - tooth in alveolus
class 2 - immediate post XLA
class 3 - broad ridge
class 4 - knife edge
class 5 - flat
class 6 - submerged

cawood and atwood classfications
3-6 post XLA for definitive denture

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33
Q

RPD reistance

A

resistance to vertical disloding forces

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34
Q

RPD indirect retention

A

use of supportive components to resit rotation forces

components are placed at 90 degrees to clasp axis and on opposite side from disloding forces

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35
Q

describe desquamative gingivitis

A

a clinically descriptive term
erythematous and ulcerated gingiva caused by a number of conditions and allergies,
inflammation can extend beyound the mucogingival junction

reddish, glazed and friable with destruction of the epithelium

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36
Q

3 conditions that you would see desquamative gingivitis

A

lichen planus
Mucous membrane pemphigoid (MMP)
pemphigus vulgaris

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37
Q

management of desquamative gingivitis

A

biopsy area of mucosa and use immunoflurescence and histological analysis to determine cause

betametsone mouth rinse (500microgram soluble tablets, 1 in 10ml water rinse 4xdaily (100 total))

lidocaine ointment/bendydamine oromucosal spray 0.15%

systemic corticosteroids to prevent any new lesions forming (prednisolone)

diet advice and SLS free toothpaste

perio management if indicated - MPBS, 6PPC, OHI

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38
Q

another gingival disease that is painful on presentation

A

necrotising ulcerative gingivitis

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39
Q

patient presents at your practice with a large discoloured swelling
Name 4 local and 3 generalised causes of pigmentation

A

local
* malignant melanoma
* melanocytic naevus
* amalgam tatto
* haemangioma

generalised
* racial pigmentation
* addison’s disease
* smoking

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40
Q

patient presents at your practice with a large discoloured swelling
Name 4 local and 3 generalised causes of pigmentation

A

local
* malignant melanoma
* melanocytic naevus
* amalgam tatto
* haemangioma

generalised
* racial pigmentation
* addison’s disease
* smoking

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41
Q

name 2 types of haemangioma and 2 histological differences between them

A

capillary or cavernous haemagiomas

cavernous is encapsulated and capillary is not
cavernous is dilated vascular space and capillary is thiin walled

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42
Q

4 key personnel involved in decon and description of their roles

A

Operator
* Responsible for day to day operations, recording machine readings

User
* Responsible for daily testing and maintenance of records

Manager
* Ultimately responsible for running of LDU and release of instruments fit for use

Engineer
* Annual and quarterly testing of the machines and any maintenance

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43
Q

water used for final rinse cycle and why? (opposed to mains water)

A

reverse osmotic

mains water has minerals in it which can - damage instruments, cause limescale build up, give roughened surface for bacteria to adhere to

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44
Q

describe the appearance of dental fluorosis

A

diffuse chalky discolouration, symmetrical

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45
Q

% of Fluoride which is optimum in drinking water

A

1ppm (1mg/l)

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46
Q

methods of delivering fluroide to 8 year old

3

A

fluoride toothpaste 1450ppm
fluoride mouthrinse 225ppm (if can demo rinse)
fluoride varnish 22600ppm

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47
Q

local action of fluoride on oral cavity

3

A

promotes remineralisation of any demineralised enamel

forms fluoroappatite which has a higher erosion resistance

inhibits bacterial metabolism and acid production

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48
Q

best tx option for fluorosis

adv of this (2)

A

microabrasion

conservative - only removing 100microns enamel
results are permanent (unlike external vital bleaching)

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49
Q

10 year old boy presents at your surgery with his mother. His only complaint is a bad taste in his mouth. On examination you note generalised white plaque that scrapes off easily and leave an erythematous base.

dx

A

pseudomembranous candidosis

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50
Q

10 year old boy presents at your surgery with his mother. His only complaint is a bad taste in his mouth. On examination you note generalised white plaque that scrapes off easily and leave an erythematous base.

4 predisposing factors for pseudomembranous candidiasis (2 local and 2 systemic)

A

local
* use of corticosteorid inhaler
* removable prosthesis (URA)

systemic
* diabetes
* systemic immunosuppressive tx
* immunosuppression side effect of tx (e.g. chemo)

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51
Q

adv and disadv of oral swab

A

adv - site specifc
disadv - not quantitive

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52
Q

adv and disadv of oral rinse

A

adv - quantitive
disadv - not site specific

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53
Q

1st line medications for pseudomembranous candidosis

A

fluconazole
50mg capsules, 1 capsule daily for 7 days
(child 3mg/kg daily (max 50mg till 17)

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54
Q

fluconazole interactions and nature of them

A

warfarin
* inc risk of bleeding (inc free warfarin)

statins
* cause muscle death and rhambdomyolysis

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55
Q

Mrs. Dodds is a 45 year old woman. You placed a large MOD composite in her 46, 6 months ago.
She presents at your practice complaining that a bit of the filling has come away and she is not happy at all! You suspect that this may have something to do with the bonding and placement of the composite restoration.

describe how composite bonds to dentine

A

etch is used to remove any smear layer present and open up dentineal tubules and expose collagen fibres

prime and bond
primer (HEMA momomer) - aid in changing the surface from hydrophillic to hydrophobic
resin adhesive agent - when polymerising it flows into dentine tubules to form resin tags,
the polymer chains will aslo become entangled with exposed collagen fibres to give micrmechanical retention - Hybrid Layer

composite resin can bond to the hydrophobic adhesive resin surface

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56
Q

Describe how Porcelain is treated to improve its retention

A

sandblasting of fitting surface and hydrofluoric acid to etch the surface and then silane coupling agent applied

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57
Q

2 luting cements, other than resin based, that could be used to bond porcelain crown

A

RMGIC/GIC
zinc polycarboxylate

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58
Q

describe how a resin based luting cement bonds to porcelain

A

silane coupling agent bonds with the oxides present in the porcelain, also has C=C end of the molecule,

rending the surface hydrophobic and allowing resin based agent to bond to the surface

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59
Q

adv of pacing crown as posterior restoration

A

Cuspal coverage to provide support and protection for the remaining tooth tissue

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60
Q

A patient is referred to your practice to have a large MOD amalgam in their 46 replaced as it was causing a lichenoid tissue reaction. You successfully replace it with composite and take a radiograph after placement which confirms that there is no secondary caries or pathology of any kind. The patient attends 5 days later complaining on pain when biting up and down and to transient thermal stimuli.

5 possible causes of symptoms

A

cracked tooth syndrome
residual resin monomer causing pulpal inflammation
pulpal damage due to excessive heat production during cavity prep
high restoration causing premature occlusal contact
uncured HEMA expanding due to moisture

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61
Q

5 restorative features to prevent pt complaining of pain on biting and transient theremal stimuli after restoration placed

A
  • low configuration factor to prevent polymerisation shrinkage stresses
  • incremental placement to prevent soggy bottom
  • ensure bur cooled by water on high speed
  • check occlusion after placement using articulating paper
  • ensure an appropriate curing regime is used
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62
Q

The mother of one of you young patients phones your practice, stating that her son has ingested fluoride toothpaste and she is worried.

Qs to ask mum

3

A

what is the fluoride strength of the toothpaste
how much of teh toothpaste did the child ingest
what is the weight of the child

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63
Q

child has ingested possibly toxic fluoride dose, what is your advice?

2

A

ingest a large amount of calcium (milk)
take child to A+E immediately

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64
Q

most common cause of fluorosis in UK

A

water

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65
Q

pt is 10 with fluorosis what is the 1st line of tx

A

microabrasion

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66
Q

1 yo living in an area of <0.3ppm fluoridated water
fluoride supplement value

A

0.25mg per day

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67
Q

4yo living in an area of <0.3ppm fluoridated water
fluoride supplement value

A

0.5mg per day

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68
Q

7yo living in an area of <0.3ppm fluoridated water
fluoride supplement value

A

1mg per day

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69
Q

10 year old boy presents to your practice after having fallen and banged his upper front tooth.
On examination you diagnose a subluxation

dx features of subluxation

A

tooth has not been displaced in the socket
inc mobility of the tooth
bleeding from gingival sulcus

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70
Q

splint for subluxation
how long for

A

passive flexible splint (up to 0.4mm)
2 weeks

onto tooth either side of traumatised one

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71
Q

when to review subluxation

A

2 weeks for splint removal
1month
3months
6months then 6monthly for 2years

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72
Q

2 features to assess for radiographically after subluxation

A

forming of any periapical lesion (widening of PDL)
initiation of infection related resorption

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73
Q

how would infection related resorption present clinically and radiographically
what would it indicated about tooth
what to do

A

clinically - pink discolouration
radiographically - ballooned, irregular shaped canal

indicate infection destroying tooth root
need RCT ASAP or place non-setting CaOH (4weeks) or corticosteroid antibiotic medicament in (6weeks) to try halt process

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74
Q

how many hours of verifiable CPD in a 5 year cycle under clinical goveranance?

A

100 hours

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75
Q

3 CPD topics and hours indicated by clinical governance for them

A

decontamination - 5 hours
medical emergencies - 10 hours
radiology and radiographic protection - 5 hours

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76
Q

components of clinical governance

6

A

research and development
education and training
clinical effectiveness
risk management
openness
clinical audit

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77
Q

dimensions of healthcare quality

6

A

pt centered
safe
effective
efficient
equitable
timely

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78
Q

A patient attends your surgery for the provision of a complete upper denture.
They are retaining one single tooth in the upper arch a 17, which must be extracted.

3 possible complications associated with the extraction of a lone-standing upper molar.

A

oro-antral communication/fistula
tuberoisty fracture
root displaced in the maxillary sinus

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79
Q

how to dx OAC

A

bubbling of blood in socket
good light with direct vision
change in sound of suction over area (echoeing)
nose holding test or explore with blunt probe (caution)
bone present at trifurcation of the roots post XLA/ radiographically

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80
Q

how to dx # tuberosity

A

crack felt/heard during mobilisation of tooth
tear in palate
mobility of ridge and tuberosity palpable

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81
Q

how to dx root in antrum

A

good suction and irrigation for vision assessment
radiograph shows root placed in sinus
CBCT

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82
Q

management of OAC

A

If small then encourage clotting in the area, surgicel and suture the margins

Prescribe antibiotics and give post op advice including
* no nose blowing
* avoid playing wind/brass and drinking through a straw
* do not inhibit any sneezes
sinusitis - amoxicillin 500mg capsules, 1 capsule 3xdaily for 7 days

Review to ensure the communication has healed and no symptoms present (1week)

If larger communication then raise a buccal advancement flap, surgicel to encourage clotting and suture the buccal advancement flap to the palatal mucosa to close the wound, then manage the same as small

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83
Q

management of root in antrum

A

try to retrieve with ribbon gauze technique

refer to Oral surgery

84
Q

how to manage # tuberoisty

A

Dissect out and close wound (if small) Or reduce and stabilise

Reduction - Fingers or forceps – careful as sharp bone

Fixation
* Orthodontic buccal arch wire spot – welded with composite
* Arch bar
* Rigid Splints

remove or tx pulp
ensure occlusion free
antibiotics
post op instructions with antiseptic advice
remove tooth 8 weeks later

85
Q

uses of URA other than tipping/tiliting teeth

4

A

habit breaker
retainer
growth modification
overbite reduction

86
Q

URA to reduce 8mm OJ.
First premolars have previously been extracted and previous URA retracted canines and reduced the overbite.
Pt. has permanent dentition.

A

aim please provide URA to reduce OJ (8mm)

A - roberts retractor 0.5mmHSSW with 0.5mm ID tubing
R - Adam’s clasps 16, 26 0.7mmHSSW
A - appropriate
B - self cure PMMA

mesial stops 13, 21 0.7mmHSSW flattened

(OB already resolved so no need FABP)

87
Q

signs of ‘good wear’ of URA on visit

6

A
  • active component become passive
  • pt can insert/remove appliance competently
  • post dam mark present on palate
  • pt can speak normally with appliance in
  • no hypersalivation whne appliance in situ
  • signs of wear of appliance
88
Q

22 year old presents at your surgery complaining of pain. You can smell his halitosis from the waiting room.
clear dx of ANUG
4 intra oral signs of ANUG

A

ulceration and recession of papilla
greyish slough over ulcers which can be removed
red and puffy gingiva
puched out creater like ulcers

89
Q

4 risk factors predispose to ANUG

A

smoking
poor OH
stress
malnutrition

90
Q

tx for necrotising ulcerative gingivitis

A
  • OHI and ID cleaning advice
  • supra and subgingival PMPR to remove causative plaque - likely under LA
  • chlorhexidine mouth wash 0.2% 10ml for 1min twice daily for no more than 10 days, at least 30 mins after brushing
  • review in 10 days

metronidazole 400mg tablets, 1 3xdaily 3days(avoid alcohol, no warfarin)

91
Q

patient arrives at your practice with a debonded gold post and core crown
becoming a regular occurrence and you have seen them 3 times in the last 6 weeks for this same issue

3 reasons for why post core may have debonded

A

secondary caries
poor moisture control during cementation
root #

92
Q

patient arrives at your practice with a debonded gold post and core crown
becoming a regular occurrence and you have seen them 3 times in the last 6 weeks for this same issue

at the junction between post and core - 3 reasons why this may have happpened

A

biocorrosion
lack of sufficient ferrule
trauma

93
Q

example of a wetting agent use to bond metal to resin within resin based luiting cement.

A

MDP, 4-META

94
Q

3 ways of retrieving a fractured post

A

ultrasonic tip
eggler forceps
mokisto forcepts

95
Q

28 year-old patient fit and well attended your practice, full mouth peri-apicals reveal severe angular bone loss.

dx and why

A

rapid onset generalised periodontitis (no none risk factors) - likely stage 3 grade A

Bone loss excessive for the patients age
Patient is otherwise fit and well
Rapid progression of bone loss

96
Q

28 year-old patient fit and well attended your practice, full mouth peri-apicals reveal severe angular bone loss.

special invesitgations

A

full mouth 6PPC - for clinical attachment loss
MPBS - for OH levels
thorough history inc FHx to see if relatives with similar symptoms

97
Q

perio prognosis for each tooth based on

4

A

clinical attachment loss
mobility score
furcation involvement
pocket depth

98
Q

possible tx options for periapical radiolucencies

4

A

no tx and monitor
RCT
periradicular surgery
XLA

99
Q

valid consent
4 criteria

A

informed
current and continuous
communicated
for specifc procedure

100
Q

things to tell pt for valid consent

A
  • risks and benefits of tx plan
  • alteranative tx
  • likely consequence of no tx
  • complications
  • likelihood of success
  • cost
101
Q

capacity
4

A

communicate decision
able to understand risks/benefits of tx
retain decision
understand the decision made

102
Q

pt has space between 13 and 14

special investigations needed and justification for them

A

Radiograph (PA or OPT) - to check if there is a supernumerary or pathology causing the spacing

Sensibility testing - as supernumerary may cause root resorption and loss of vitality

Mobility assessment - root resorption due to supernumerary may cause mobility

103
Q

pt with space between 13 and 14

what would make case difficult

A

Presence of supernumerary causing root resorption of these teeth, requiring XLA

Position of tooth may make surgical extraction difficult

104
Q

pt with space between 13 and 14

what would make implant placement difficult in this area

A

lack of space between teeth needed for implant to be placed
aesthetic zone so more challenging
prosthesis will likely be involved in guidance - need to withstand more force

105
Q

what is the kennedy class

A

classification of edentulous jaw conditions and partial dentures, based on the distribution of edentulous spaces

106
Q

3 features of RPD for tooth support

A

occlusal rests
cingulum rests
incisal rests

107
Q

RPD gingival margin clear
good beacuase

A

improved periodontal health and prevents gum stripping and food packing

108
Q

2 organisms linked to angular cheilitis

A

staphylococcus aureus
candida albicans

109
Q

sample for angular cheilitis

A

oral swab

110
Q

angular cheilitis sample taking long to be processed
why prescribe miconazole?

A

has antimicrobial action against both candida and staphylococci

111
Q

give example of immunocompromised disease and impact on angular cheilitis

A

HIV or cancer tx
immunosuppression allows oppurtunistic pathogens to cause disease (e.g. candida albicans)

112
Q

give example of GI disease and impact on angular cheilitis

A

Crohn’s disease or coeliac

lack of absorption causing malnutrition (vit b12, folate, iron)
also immune suppression tx in crohns

113
Q

elderly pt has angular cheilits
what condition likely to see intra orally

A

denture induced candidiasis/stomatitis

114
Q

denture hygiene advice for pt with denture induced candidiasis

A

take denture out at night
soak in sodium hypochlorite for 15mins then in water overnight
brush with soap and water after every meal over basin

115
Q

why use alginate and medium body PVS for master imps

A

good flowability, wetability and capture good surface detail and good tear strength

116
Q

alginate made of

A

sodium alginate and calcium sulphate

117
Q

PVS made of

A

polyvinylesiloxane and filler

118
Q

MOD amalgam has #, underlying intact GP

restorative options

A

MCC crown
onlay

119
Q

MOD amalgam has #, underlying intact GP

been over 6 months since # pt thinks
what now

A

have to reRCT tooth as GP been exposed >3months, bacteria could have reinfected canal and have loss of coronal seal

120
Q

features of Nayyer core

A

RCT as normal
2-3mm of coronal GP removed
amalgam is packed into canal as the core is build up and inc retention

121
Q

things that can be used to bond to amlagam

2

A

MDP or 4-META

122
Q

higher bond strength
composite or amalgam?

A

composite
20-50MPa Vs 3-10MPa

123
Q

pemphigus
immunofluorescence and histology findings

A

Basketweave appearance of the immunofluorescence
Suprabasal split
Presence of Tzank cells in the split
Loss of epithelium and shedding of epithelial layer

124
Q

aetiology of pemphigus vulgaris

A

Caused by autoimmune antibodies IgG, caused by a genetic predisposition and an environmental trigger, more common in women

125
Q

pemphigus vulgaris similar clinically to what
but they differ histologically

A

pemphigoid

pemphigus - basket weave fluoresence, suprabasal split, tzank cells
pemphigoid - linear fluorescnece, subepithelial split (CT junction)

126
Q

two risk factors for squamous cell carcinoma

A

smoking
alcohol
poor diet (lack vitamins)

127
Q

staging for cancer

A

TNM staging

size, lymph node involvement, metastasis

128
Q

grading of cancer

A

histopathologically

by level of dysplasia, mitotic figure and invasion of other tissue (eg underlying muscle)

129
Q

medical and surgical tx for SCC

A

surgical removal
chemo and radiotherapy

130
Q

options to replace function of tissue after surgical removal of tumour

A

tissue graft
speech therapy

131
Q

BEWE grading system

A

basic erosive wear exam
0 = no surface loss
1 = initial loss of enamel surface detail
2 = distinct surface loss on <50% of sites
3 = >50%

132
Q

3 topical fluorides can give to pt

A

Fluoride varnish 22,600ppm
Toothpaste up to 5000ppm
Mouthwash 225ppm

133
Q

DAHL technique

A

a method of treating the localised wear of anterior teeth, without having to treat the back teeth
conservative method can be used to control incisal guidance and gain palatal space for restorative material (increasing the OVD)

134
Q

how does DAHL technique work

A

Composite added to anterior teeth, increasing the OVD and causing posterior disclusion, over the space of 3-6 months the posterior teeth over erupt back into contact at the new OVD, giving space for any definitive anterior restorations (usually the initial composite is definitive)

135
Q

contraidicated groups for DAHL technique

A

Bisphosphonates, implants, existing bridgework, previous ortho

136
Q

4 constituents of composite resin

A

Resin - bis-GMA
Filler - silica
photoinitiator - camphorquinone
binding agent - silane coupling agent (bonds resin to silica)

137
Q

8yo, #11
what to ask about injury

A

all tooth fragments accounted for? pieces missing?
where and how did the injury happen?

138
Q

8yo, #11
mum asks about prognosis what factors are involved?

4

A

any pulp exposure
displacement of tooth within socket
fracture of root
length of time any pulp has been exposed for

139
Q

8yo, #11
just an enamel-dentine fracture
what would you do about missing fragment and how to follow this up

A

Ask the patient if the fractured fragment was located post injury

If not or unsure then PA soft tissue view radiograph to check the soft tissues

If still not located then refer the patient for a chest x-ray under the concern that it has been inhaled or swallowed

140
Q

8yo, enamel-dentine #11
composite placement decided
pt has a heart valve defect - would you change your tx?

A

place an indirect pulp cap to minimise risk of future RCT

141
Q

why get consent at 2 different times for IV sedation

A

As once the patient has been sedated the consent is no longer valid, and the amnesic effects of midazolam may mean they forget giving consent if on the same day

142
Q

3 things to monitor during IV sedation

A

HR, BP and O2 saturation

143
Q

IV sedation
drug and concentration

A

midazolam 5mg/5ml

144
Q

reversal drug in IV sedation

A

flumazenil

145
Q

3 post op instructions specific to IV sedation

A

Do not be responsible for any children
Rest for the remainder of the day - need to have someone come with you
Do not sign any legal documents or any online shopping

146
Q

factors influencing DMFT scores in different areas of scotland

3

A

Socioeconomic status in the areas (SIMD)
access to care in the areas
preventative programmes active in the area

147
Q

D3MFT
what does the 3 mean

A

obvious decay into dentine

148
Q

Child with 6s and incisors yellow/brown/discoloured and unhappy

What questions would you ask the patient and parent

A

Did the mother take any fluoride supplements during third trimester?

Any illnesses in the third trimester?

Any difficulties during birth? Was it a cesarean section?

Premature birth?

Was the child in a intensive care baby unit? Low birth weight?

Any infections of the child in early months of life?
Any fluoride supplements for the child?

Any long term illness of the child in early life?

149
Q

Child with 6s and incisors yellow/brown/discoloured and unhappy

congenital or acquired

A

congenital

150
Q

child with 6s and incisors yellow/brown/discoloured and unhappy

what is it

A

molar incisior hypomineralisation

hypomineralisation of systemic origin of 1-4 permanent first molars, frequently associated with affected incisors

151
Q

questions toask parent to rule out fluorosis

A

Fluoride supplements
water fluoridated
fluoride supplements
any toxic fluoride ingestion
toothpaste strength used

152
Q

problems that may encounter with MIH

A

sensitivity - temp, toothbrushing
wear
caries risk
difficult to bond to

153
Q

scottish population wide intervention

A

childsmile - toothbrushing and fluoride varnish (nursery and primary)

154
Q

BPE score of 3

A

max probing depth between 3.5-5.5mm in that sextant (black band partially in pocket)

155
Q

length of ACJ to bone creast av

A

2mm

156
Q

modified BPE teeth for children

A

16, 11, 26, 36, 31, 46

157
Q

13y with orthodontic decal
types of fluoride delivery

A

fluoride varnish 22600ppm
fluoride toothpaste 2800ppm 0.619% sodium fluoride
fluoride mouthwash 225ppm 0.05% sodium fluoride
tablets 1mg

diet and OHI advice

158
Q

risks of fixed appliance ortho tx

A

**root resorption
relapse
decalcification **
failure
periodontal issues - recession
enamel wear
soft tissue trauma
loss of vitality
allergy

159
Q

term for delayed onset bleeding post XLA

A

reactionary (up to 48hrs)
secondary (up to 1week - infection break down of clot)

160
Q

congenital bleeding disorders
2 e.g.

A

haemophilia
von willebrands

161
Q

acquired bleeding disorders
2 e.g.

A

drug therapy
alcohol liver disease

162
Q

8 signs and symptoms of mandibular #

A

numbness
pain
bruising
occlusal derangement
AOB
bony step
multiple mobile teeth
asymmetry

163
Q

2 radiographic views to take to dx mandibular #

A

PA of mandible
OPT

164
Q

factors which can cause displacement of mandibular #

4

A

muscle attachments
mechanism of injury
unfavourable fracture lines
magnitude of force

165
Q

management options for mandibular fracture

A

no tx and monitor
Open Reduction and Internal Fixation
Intermaxillary fixation

166
Q

30yo with class III occlusion

3 ways to assess pt

A

frakfort parallel to floor to visually assess
palpate skeletal bases
lateral cephalometry

167
Q

special invesigation for ortho assess

A

radiographs and lateral celaphalgram
study models
photographs
BPE
MPBS
sensibility tests

168
Q

intral oral features of class III occlusion

6

A

posterior crossbite
displacement on closing
crowded maxilla
class III incisor relationship (LI infront of UI)
decreased/reversed OJ
retroclined lower incisors

169
Q

30yo with class III occlusion
why apparent now?

A

acromegaly?

170
Q

Nurses with uniform on getting bus to work
2 things could mention

A

professionalism
infection control

171
Q

Nurses with uniform on getting bus to work
learning outcomes of intervention

A

reinforce good practice
identify gaps in knowledge
allow people to work in small groups
encourage continued learning
help staff understand importance of ppe
modify attitudes

172
Q

Nurses with uniform on getting bus to work
methods of action after seeing it

A

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

173
Q

How many occlusal units for 2 occluding premolars and one pair of occluding molars

A

3 units

174
Q

skeleatal class contraindicated with SDA

A

severe class II or class III

as less likely to haev occluding pairs in severe malocclusion

175
Q

3 reasons why periodontal disease is a contraindication to SDA

A

poor prognosis of teeth
drifting of teeth under occlusal load
loss of alveolar bone leading to comtpromised denture bearing area in long term

176
Q

metal used for casting adhesive bridge and why

A

CoCr

strong, hard, high young’s modulus

177
Q

5 year survival rate for RRB

A

80% approx

178
Q

Sub Alveolar fracture of 12, 11 with enamel-dentine fracture. >1mm and >24hours

describe immediate management

A

account for any missing tooth fragments
radiograph to check for any root displacment of #

LA and dam (reposition tooth if any displacment)
remove coronal pulp until into healthy pulp
hameostasis - cotton wool pledget soaked in saline
if no haemostatis = cont remove pulp tissue until achieved haem

direct pulp cap placed and sealed using an adhesive restoration

179
Q

Sub Alveolar fracture of 12, 11 with enamel-dentine fracture. >1mm and >24hours

has poor prognosis - why?

3

A

lack of tooth tissue to support restoration
difficulty in isolation and moisture control for any tx - clamp tooth to carry out endo
difficulty of placing subgingval crown margins

180
Q

Sub Alveolar fracture of 12, 11 with enamel-dentine fracture. >1mm and >24hours

options for repalcement of tooth when extracted

3

A

RBB
RPD
implant

181
Q

2 features notice about palatal tissues

A

erythematous
papillary hyperplasia

182
Q

dx

A

chronic hyperplastic candidiasis (denture induced)

183
Q

1st line tx

A

denture hygiene advice - sodium hypochlorite 15mins, out overnight in water, brush with soap after meals
tissue conditioner on fitting surface
CHX mouthwash

184
Q

2nd line tx

A

systemic antifungals (fluconazole capusles 50mg, 1 cap daily for 7days)
topical antifungals (miconazole 20mg/g apply to fitting surface after food 4xdaily)

not if on warfarin or statin
* nystatin oral suspension 100,000units/ml, 1ml after food 4xdaily for 7days

185
Q

instructions for special trays for C/C master imps

A

please pour in 50/50 stone/plaster and construct special trays in light cure acrylic, non perforated,
upper with 2mm wax spacer and lower with 1mm spacer with intraoral handles and finger rests in premolar region

186
Q

patient has caries on palatal 12, sensitive to sweet

pulpal dx

A

reversible pulpitis

187
Q

design to minimise the risk of debond of RRB cantilever

A

pick tooth with large bonding area for abutment, cantilever design for anterior sextant

only one wing so less likely to go unnoticed compared to fix fix

188
Q

4 faults that can occur during cementation of RRB

A

poor moisture control
unfavourable occlusion
poor enamel quality on abutment
inadequate coverage of abutment

189
Q

factors that can cause melanosis of epithelium

A

smoking
chewing tobacco
alcohol

190
Q

histological presentation indicative of malignancy

A

dysplasia

191
Q

clinical presentation indicative of malignancy

6

A

exophytic
raised rolled borders
firm and indurateed
friable
bleeding
persistent >3weeks with no obvious cause

192
Q

Child with mandibular displacement on closing to RHS. Posterior unilateral crossbite of d, e and 6 on the RHS

what is mandibular displacement on closing to RHS

A

discrepancy between arch width meaning teeth meet cusp to cusp so the mandible must deviate to one side to achieve ICP

193
Q

Child with mandibular displacement on closing to RHS. Posterior unilateral crossbite of d, e and 6 on the RHS

why should you correct mandibular displacment

A

can lead to TMJ symptoms and cause attritive wear

194
Q

Child with mandibular displacement on closing to RHS. Posterior unilateral crossbite of d, e and 6 on the RHS

what corrects bilateral posterior crossbite

A

mid palatal screw on URA to expand maxilla

195
Q

Child with mandibular displacement on closing to RHS. Posterior unilateral crossbite of d, e and 6 on the RHS

URA design

A

aim - please construct URA to expand upper arch
A- mid palatal screw
R- Adams on Ds (0.6HSSW) and 6s (0.7 HSSW)
A - reciprocal
B - self cure PMMA with FPBP and mid palatal split

196
Q

immediate management of wisdom tooth pain/pericoronitis

A

Incise and drain any abscess
irrigate under operculum with saline / CHX
advise analgesics
consider antibiotics if systemic involvement
* metronidazole 200mg tablets, 1 3xdaily for 3days

197
Q

information you can get on lower 8s from radiograph

8

A

relationship to IDC of roots
dental caries present
bone levels
impaction status and direction
pathology of supporting structures (e.g. tumour, cysts)
periapical status of tooth
crown and root morphology
working length from distal 7 to ramus - surgical planning

198
Q

3 GI conditions which can cause microcytic anaemia

A

crohn’s
ulcerative colitis
coeliacs

199
Q

3 oral conditions that microcytic anaemia can be associated with

A

candidosis
dyseasthesia
apthous ulcers

200
Q

primary herpetic gingivostomatitis
presenting features

A

child
erythematous gingiva, ulcerated mucosa, intact vesicles, ulceration on lip, white tongue due to buildup of dead squamous cells

HSV infection

201
Q

child 13 presents ulceration
8 questions to ask

A
  • are they recurrent
  • how long have they been present
  • anything that triggers them
  • where are they in the mouth
  • do you get any pain with them
  • how long is the latency period between episodes
  • anything make them better or worse
  • any lesions elsewhere on the body
202
Q

3 head and neck features of cocaine use

A

nasal septal defect,
oral ulceration,
bruxism and tooth wear from grinding

203
Q

5 side effects of opioid use

A

constipation,
sedation,
xerostomia,
excessive sweating,
addiction - dependence and tolerance

204
Q

methadone belongs to which drug group

A

opioid

205
Q

complication of methadone containing sugar

A

rampant dental caries

206
Q

risk of sugar free methadone preparation

A

more likely to inject it

REVISION BDS (43 decks)

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