past papers quick notes Flashcards
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
paget’s disease
Which condition would be the most likely cause in
pt with bony expansion of maxilla and has a raised serum calcium level
hyperparathyroidism
Which condition would be the most likely cause in
pt with bony expansion of maxilla and is 15years old and has bilateral maxillay expansion
cherubism
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
Paget’s disease
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
Albright’s syndrome
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.
oral dyseasethesia (burning mouth)
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
Maxillary sinusitis
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
chronic paroxysmal hemicranias
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
trigeminal neuralgia
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
giant cell arteritis with polymyalgia rheumatica
pt referred to OM for evaluation of dry mouth
feature associated dehydration
abnormally high glucose levels - diabetic
pt referred to OM for evaluation of dry mouth
feature associated sjogren’s syndrome
anti ro antibody positive
pt referred to OM for evaluation of dry mouth
feature associated ectodermal aplasia
sparse hair follicles
biopsy for sjorgren’s from where
labial gland
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
periodontal abscess
periapical abscess
2 special investigations undertake for this
periapical radiograph
sensibility testing (EPT, ECl)
2 ways could drain this swelling
incise and drain
drain through periodontal pocket
initial management of this swelling if not endodontically involved
- 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
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
- unfavourable occlusion
- insufficient coverage with adhesive wing for bonding
- poor enamel quality of abutments
- inadequate moisture control during cementation
- caries
4 methods of checking bridge debonding clinically
- 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?
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
RPD or implant
adhesive cantilever using 21 as retainer only or spring cantilever using 16 as retainer
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
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
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
- 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
suspicious of close proximity to IDC of lower 8 - what to do
CBCT
infor pt of risk to nerve
potential complications of extracting tooth which is close proximity to IDC
inferior alveolar nerve paraesthesia (numbness)
inferior alveolar nerve dysthesia (pain)
temporary or permanent
procedure for lower 8s to reduce risk of complications to IAN
coronectomy
3 scenarios where inc risk of bleeding post XLA
anticoagulant (apixaban, dabigatran, rivaroxaban, wafarin)
antiplatelet (clopidogrel, aspirin)
alcoholic liver disease
post op methods of achieving haemostasis
damp gauze and pressure
surgicel (oxidised cellulose) and suturing
LA with vasoconstrictor
diathermy
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
- pain
- MoM hypertrophy
- clicking, popping, crepitus of TMJ
- linea alba
- tongue scalloping
- tooth wear - attrition
2 muscles to palpate for TMD
temporalis
masseter
6 conservative pieces of advice for TMD
- 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
edentulous ridge classifications
6
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
RPD reistance
resistance to vertical disloding forces
RPD indirect retention
use of supportive components to resit rotation forces
components are placed at 90 degrees to clasp axis and on opposite side from disloding forces
describe desquamative gingivitis
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
3 conditions that you would see desquamative gingivitis
lichen planus
Mucous membrane pemphigoid (MMP)
pemphigus vulgaris
management of desquamative gingivitis
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
another gingival disease that is painful on presentation
necrotising ulcerative gingivitis
patient presents at your practice with a large discoloured swelling
Name 4 local and 3 generalised causes of pigmentation
local
* malignant melanoma
* melanocytic naevus
* amalgam tatto
* haemangioma
generalised
* racial pigmentation
* addison’s disease
* smoking
patient presents at your practice with a large discoloured swelling
Name 4 local and 3 generalised causes of pigmentation
local
* malignant melanoma
* melanocytic naevus
* amalgam tatto
* haemangioma
generalised
* racial pigmentation
* addison’s disease
* smoking
name 2 types of haemangioma and 2 histological differences between them
capillary or cavernous haemagiomas
cavernous is encapsulated and capillary is not
cavernous is dilated vascular space and capillary is thiin walled
4 key personnel involved in decon and description of their roles
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
water used for final rinse cycle and why? (opposed to mains water)
reverse osmotic
mains water has minerals in it which can - damage instruments, cause limescale build up, give roughened surface for bacteria to adhere to
describe the appearance of dental fluorosis
diffuse chalky discolouration, symmetrical
% of Fluoride which is optimum in drinking water
1ppm (1mg/l)
methods of delivering fluroide to 8 year old
3
fluoride toothpaste 1450ppm
fluoride mouthrinse 225ppm (if can demo rinse)
fluoride varnish 22600ppm
local action of fluoride on oral cavity
3
promotes remineralisation of any demineralised enamel
forms fluoroappatite which has a higher erosion resistance
inhibits bacterial metabolism and acid production
best tx option for fluorosis
adv of this (2)
microabrasion
conservative - only removing 100microns enamel
results are permanent (unlike external vital bleaching)
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
pseudomembranous candidosis
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)
local
* use of corticosteorid inhaler
* removable prosthesis (URA)
systemic
* diabetes
* systemic immunosuppressive tx
* immunosuppression side effect of tx (e.g. chemo)
adv and disadv of oral swab
adv - site specifc
disadv - not quantitive
adv and disadv of oral rinse
adv - quantitive
disadv - not site specific
1st line medications for pseudomembranous candidosis
fluconazole
50mg capsules, 1 capsule daily for 7 days
(child 3mg/kg daily (max 50mg till 17)
fluconazole interactions and nature of them
warfarin
* inc risk of bleeding (inc free warfarin)
statins
* cause muscle death and rhambdomyolysis
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
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
Describe how Porcelain is treated to improve its retention
sandblasting of fitting surface and hydrofluoric acid to etch the surface and then silane coupling agent applied
2 luting cements, other than resin based, that could be used to bond porcelain crown
RMGIC/GIC
zinc polycarboxylate
describe how a resin based luting cement bonds to porcelain
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
adv of pacing crown as posterior restoration
Cuspal coverage to provide support and protection for the remaining tooth tissue
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
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
5 restorative features to prevent pt complaining of pain on biting and transient theremal stimuli after restoration placed
- 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
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
what is the fluoride strength of the toothpaste
how much of teh toothpaste did the child ingest
what is the weight of the child
child has ingested possibly toxic fluoride dose, what is your advice?
2
ingest a large amount of calcium (milk)
take child to A+E immediately
most common cause of fluorosis in UK
water
pt is 10 with fluorosis what is the 1st line of tx
microabrasion
1 yo living in an area of <0.3ppm fluoridated water
fluoride supplement value
0.25mg per day
4yo living in an area of <0.3ppm fluoridated water
fluoride supplement value
0.5mg per day
7yo living in an area of <0.3ppm fluoridated water
fluoride supplement value
1mg per day
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
tooth has not been displaced in the socket
inc mobility of the tooth
bleeding from gingival sulcus
splint for subluxation
how long for
passive flexible splint (up to 0.4mm)
2 weeks
onto tooth either side of traumatised one
when to review subluxation
2 weeks for splint removal
1month
3months
6months then 6monthly for 2years
2 features to assess for radiographically after subluxation
forming of any periapical lesion (widening of PDL)
initiation of infection related resorption
how would infection related resorption present clinically and radiographically
what would it indicated about tooth
what to do
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
how many hours of verifiable CPD in a 5 year cycle under clinical goveranance?
100 hours
3 CPD topics and hours indicated by clinical governance for them
decontamination - 5 hours
medical emergencies - 10 hours
radiology and radiographic protection - 5 hours
components of clinical governance
6
research and development
education and training
clinical effectiveness
risk management
openness
clinical audit
dimensions of healthcare quality
6
pt centered
safe
effective
efficient
equitable
timely
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.
oro-antral communication/fistula
tuberoisty fracture
root displaced in the maxillary sinus
how to dx OAC
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
how to dx # tuberosity
crack felt/heard during mobilisation of tooth
tear in palate
mobility of ridge and tuberosity palpable
how to dx root in antrum
good suction and irrigation for vision assessment
radiograph shows root placed in sinus
CBCT
management of OAC
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
management of root in antrum
try to retrieve with ribbon gauze technique
refer to Oral surgery
how to manage # tuberoisty
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
uses of URA other than tipping/tiliting teeth
4
habit breaker
retainer
growth modification
overbite reduction
URA to reduce 8mm OJ.
First premolars have previously been extracted and previous URA retracted canines and reduced the overbite.
Pt. has permanent dentition.
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)
signs of ‘good wear’ of URA on visit
6
- 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
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
ulceration and recession of papilla
greyish slough over ulcers which can be removed
red and puffy gingiva
puched out creater like ulcers
4 risk factors predispose to ANUG
smoking
poor OH
stress
malnutrition
tx for necrotising ulcerative gingivitis
- 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)
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
secondary caries
poor moisture control during cementation
root #
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
biocorrosion
lack of sufficient ferrule
trauma
example of a wetting agent use to bond metal to resin within resin based luiting cement.
MDP, 4-META
3 ways of retrieving a fractured post
ultrasonic tip
eggler forceps
mokisto forcepts
28 year-old patient fit and well attended your practice, full mouth peri-apicals reveal severe angular bone loss.
dx and why
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
28 year-old patient fit and well attended your practice, full mouth peri-apicals reveal severe angular bone loss.
special invesitgations
full mouth 6PPC - for clinical attachment loss
MPBS - for OH levels
thorough history inc FHx to see if relatives with similar symptoms
perio prognosis for each tooth based on
4
clinical attachment loss
mobility score
furcation involvement
pocket depth
possible tx options for periapical radiolucencies
4
no tx and monitor
RCT
periradicular surgery
XLA
valid consent
4 criteria
informed
current and continuous
communicated
for specifc procedure
things to tell pt for valid consent
- risks and benefits of tx plan
- alteranative tx
- likely consequence of no tx
- complications
- likelihood of success
- cost
capacity
4
communicate decision
able to understand risks/benefits of tx
retain decision
understand the decision made
pt has space between 13 and 14
special investigations needed and justification for them
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
pt with space between 13 and 14
what would make case difficult
Presence of supernumerary causing root resorption of these teeth, requiring XLA
Position of tooth may make surgical extraction difficult
pt with space between 13 and 14
what would make implant placement difficult in this area
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
what is the kennedy class
classification of edentulous jaw conditions and partial dentures, based on the distribution of edentulous spaces
3 features of RPD for tooth support
occlusal rests
cingulum rests
incisal rests
RPD gingival margin clear
good beacuase
improved periodontal health and prevents gum stripping and food packing
2 organisms linked to angular cheilitis
staphylococcus aureus
candida albicans
sample for angular cheilitis
oral swab
angular cheilitis sample taking long to be processed
why prescribe miconazole?
has antimicrobial action against both candida and staphylococci
give example of immunocompromised disease and impact on angular cheilitis
HIV or cancer tx
immunosuppression allows oppurtunistic pathogens to cause disease (e.g. candida albicans)
give example of GI disease and impact on angular cheilitis
Crohn’s disease or coeliac
lack of absorption causing malnutrition (vit b12, folate, iron)
also immune suppression tx in crohns
elderly pt has angular cheilits
what condition likely to see intra orally
denture induced candidiasis/stomatitis
denture hygiene advice for pt with denture induced candidiasis
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
why use alginate and medium body PVS for master imps
good flowability, wetability and capture good surface detail and good tear strength
alginate made of
sodium alginate and calcium sulphate
PVS made of
polyvinylesiloxane and filler
MOD amalgam has #, underlying intact GP
restorative options
MCC crown
onlay
MOD amalgam has #, underlying intact GP
been over 6 months since # pt thinks
what now
have to reRCT tooth as GP been exposed >3months, bacteria could have reinfected canal and have loss of coronal seal
features of Nayyer core
RCT as normal
2-3mm of coronal GP removed
amalgam is packed into canal as the core is build up and inc retention
things that can be used to bond to amlagam
2
MDP or 4-META
higher bond strength
composite or amalgam?
composite
20-50MPa Vs 3-10MPa
pemphigus
immunofluorescence and histology findings
Basketweave appearance of the immunofluorescence
Suprabasal split
Presence of Tzank cells in the split
Loss of epithelium and shedding of epithelial layer
aetiology of pemphigus vulgaris
Caused by autoimmune antibodies IgG, caused by a genetic predisposition and an environmental trigger, more common in women
pemphigus vulgaris similar clinically to what
but they differ histologically
pemphigoid
pemphigus - basket weave fluoresence, suprabasal split, tzank cells
pemphigoid - linear fluorescnece, subepithelial split (CT junction)
two risk factors for squamous cell carcinoma
smoking
alcohol
poor diet (lack vitamins)
staging for cancer
TNM staging
size, lymph node involvement, metastasis
grading of cancer
histopathologically
by level of dysplasia, mitotic figure and invasion of other tissue (eg underlying muscle)
medical and surgical tx for SCC
surgical removal
chemo and radiotherapy
options to replace function of tissue after surgical removal of tumour
tissue graft
speech therapy
BEWE grading system
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%
3 topical fluorides can give to pt
Fluoride varnish 22,600ppm
Toothpaste up to 5000ppm
Mouthwash 225ppm
DAHL technique
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)
how does DAHL technique work
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)
contraidicated groups for DAHL technique
Bisphosphonates, implants, existing bridgework, previous ortho
4 constituents of composite resin
Resin - bis-GMA
Filler - silica
photoinitiator - camphorquinone
binding agent - silane coupling agent (bonds resin to silica)
8yo, #11
what to ask about injury
all tooth fragments accounted for? pieces missing?
where and how did the injury happen?
8yo, #11
mum asks about prognosis what factors are involved?
4
any pulp exposure
displacement of tooth within socket
fracture of root
length of time any pulp has been exposed for
8yo, #11
just an enamel-dentine fracture
what would you do about missing fragment and how to follow this up
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
8yo, enamel-dentine #11
composite placement decided
pt has a heart valve defect - would you change your tx?
place an indirect pulp cap to minimise risk of future RCT
why get consent at 2 different times for IV sedation
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
3 things to monitor during IV sedation
HR, BP and O2 saturation
IV sedation
drug and concentration
midazolam 5mg/5ml
reversal drug in IV sedation
flumazenil
3 post op instructions specific to IV sedation
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
factors influencing DMFT scores in different areas of scotland
3
Socioeconomic status in the areas (SIMD)
access to care in the areas
preventative programmes active in the area
D3MFT
what does the 3 mean
obvious decay into dentine
Child with 6s and incisors yellow/brown/discoloured and unhappy
What questions would you ask the patient and parent
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?
Child with 6s and incisors yellow/brown/discoloured and unhappy
congenital or acquired
congenital
child with 6s and incisors yellow/brown/discoloured and unhappy
what is it
molar incisior hypomineralisation
hypomineralisation of systemic origin of 1-4 permanent first molars, frequently associated with affected incisors
questions toask parent to rule out fluorosis
Fluoride supplements
water fluoridated
fluoride supplements
any toxic fluoride ingestion
toothpaste strength used
problems that may encounter with MIH
sensitivity - temp, toothbrushing
wear
caries risk
difficult to bond to
scottish population wide intervention
childsmile - toothbrushing and fluoride varnish (nursery and primary)
BPE score of 3
max probing depth between 3.5-5.5mm in that sextant (black band partially in pocket)
length of ACJ to bone creast av
2mm
modified BPE teeth for children
16, 11, 26, 36, 31, 46
13y with orthodontic decal
types of fluoride delivery
fluoride varnish 22600ppm
fluoride toothpaste 2800ppm 0.619% sodium fluoride
fluoride mouthwash 225ppm 0.05% sodium fluoride
tablets 1mg
diet and OHI advice
risks of fixed appliance ortho tx
**root resorption
relapse
decalcification **
failure
periodontal issues - recession
enamel wear
soft tissue trauma
loss of vitality
allergy
term for delayed onset bleeding post XLA
reactionary (up to 48hrs)
secondary (up to 1week - infection break down of clot)
congenital bleeding disorders
2 e.g.
haemophilia
von willebrands
acquired bleeding disorders
2 e.g.
drug therapy
alcohol liver disease
8 signs and symptoms of mandibular #
numbness
pain
bruising
occlusal derangement
AOB
bony step
multiple mobile teeth
asymmetry
2 radiographic views to take to dx mandibular #
PA of mandible
OPT
factors which can cause displacement of mandibular #
4
muscle attachments
mechanism of injury
unfavourable fracture lines
magnitude of force
management options for mandibular fracture
no tx and monitor
Open Reduction and Internal Fixation
Intermaxillary fixation
30yo with class III occlusion
3 ways to assess pt
frakfort parallel to floor to visually assess
palpate skeletal bases
lateral cephalometry
special invesigation for ortho assess
radiographs and lateral celaphalgram
study models
photographs
BPE
MPBS
sensibility tests
intral oral features of class III occlusion
6
posterior crossbite
displacement on closing
crowded maxilla
class III incisor relationship (LI infront of UI)
decreased/reversed OJ
retroclined lower incisors
30yo with class III occlusion
why apparent now?
acromegaly?
Nurses with uniform on getting bus to work
2 things could mention
professionalism
infection control
Nurses with uniform on getting bus to work
learning outcomes of intervention
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
Nurses with uniform on getting bus to work
methods of action after seeing it
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
How many occlusal units for 2 occluding premolars and one pair of occluding molars
3 units
skeleatal class contraindicated with SDA
severe class II or class III
as less likely to haev occluding pairs in severe malocclusion
3 reasons why periodontal disease is a contraindication to SDA
poor prognosis of teeth
drifting of teeth under occlusal load
loss of alveolar bone leading to comtpromised denture bearing area in long term
metal used for casting adhesive bridge and why
CoCr
strong, hard, high young’s modulus
5 year survival rate for RRB
80% approx
Sub Alveolar fracture of 12, 11 with enamel-dentine fracture. >1mm and >24hours
describe immediate management
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
Sub Alveolar fracture of 12, 11 with enamel-dentine fracture. >1mm and >24hours
has poor prognosis - why?
3
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
Sub Alveolar fracture of 12, 11 with enamel-dentine fracture. >1mm and >24hours
options for repalcement of tooth when extracted
3
RBB
RPD
implant
2 features notice about palatal tissues
erythematous
papillary hyperplasia
dx
chronic hyperplastic candidiasis (denture induced)
1st line tx
denture hygiene advice - sodium hypochlorite 15mins, out overnight in water, brush with soap after meals
tissue conditioner on fitting surface
CHX mouthwash
2nd line tx
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
instructions for special trays for C/C master imps
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
patient has caries on palatal 12, sensitive to sweet
pulpal dx
reversible pulpitis
design to minimise the risk of debond of RRB cantilever
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
4 faults that can occur during cementation of RRB
poor moisture control
unfavourable occlusion
poor enamel quality on abutment
inadequate coverage of abutment
factors that can cause melanosis of epithelium
smoking
chewing tobacco
alcohol
histological presentation indicative of malignancy
dysplasia
clinical presentation indicative of malignancy
6
exophytic
raised rolled borders
firm and indurateed
friable
bleeding
persistent >3weeks with no obvious cause
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
discrepancy between arch width meaning teeth meet cusp to cusp so the mandible must deviate to one side to achieve ICP
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
can lead to TMJ symptoms and cause attritive wear
Child with mandibular displacement on closing to RHS. Posterior unilateral crossbite of d, e and 6 on the RHS
what corrects bilateral posterior crossbite
mid palatal screw on URA to expand maxilla
Child with mandibular displacement on closing to RHS. Posterior unilateral crossbite of d, e and 6 on the RHS
URA design
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
immediate management of wisdom tooth pain/pericoronitis
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
information you can get on lower 8s from radiograph
8
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
3 GI conditions which can cause microcytic anaemia
crohn’s
ulcerative colitis
coeliacs
3 oral conditions that microcytic anaemia can be associated with
candidosis
dyseasthesia
apthous ulcers
primary herpetic gingivostomatitis
presenting features
child
erythematous gingiva, ulcerated mucosa, intact vesicles, ulceration on lip, white tongue due to buildup of dead squamous cells
HSV infection
child 13 presents ulceration
8 questions to ask
- 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
3 head and neck features of cocaine use
nasal septal defect,
oral ulceration,
bruxism and tooth wear from grinding
5 side effects of opioid use
constipation,
sedation,
xerostomia,
excessive sweating,
addiction - dependence and tolerance
methadone belongs to which drug group
opioid
complication of methadone containing sugar
rampant dental caries
risk of sugar free methadone preparation
more likely to inject it
