PIA Flashcards
1
Q
What is special needs dentistry?
A
Branch of dentistry that manage pt who are adversely affected by their general health condition:
o Complex Medical hx
o Intellectual disability
o Physical disability
o Psychiatric disability
o Geriatric pt
Need a special methods or techniques to prevent or treat oral health + modify conventional tmt plan. Primary dental practitioners may not be able to manage these pt in the primary care setting:
o Liase w ppl giving consent
o Liase w support worker
Specifically tailored preventive and corrective tmt (tailored OHI and rational dental care)
2
Q
When to refer to SNU?
A
- Pt who are unable to cope/ cooperate with dental tmt provided in the primary care settings
- Beyond (clinical or knowledge) skill set of the general dentist in the primary care settings
3.Require adjunctive support (eg haematological, behavioural, medico-legal aka consent, bariatric, portable dental equipment
3
Q
What is the criteria for capacity to provide consent?
A
Criteria for capacity to provide consent:
o Understanding, relating & using relevant information to make the decision
o What is the tmt and procedures involved?
o Why is it proposed?
o Risks and Benefits
o Consequences of no tmt
o Tmt alternatives
Communicate their decision in any manner +/- assistance
Not being comatose or unconscious
Understand, appreciate, remember, communicate
4
Q
What are the barriers for special needs patients?
A
- Government/ Organisation
o Legislation and policy
o Public SNU/ Geriatric progem
o Private health insurance - Physical barriers (supply)
o Environmental
o Transport
o Infrastructure - Professional and workforce barriers (supply)
o Undergrad/ postgrad training program
o Professional development
o Professional attitude - Pt or carer barriers (demand)
o Social determinants
o Health literacy and education
o Staffing ratios - Financial barriers (demand)
o Public funding
o Private funding
5
Q
What are the steps to achieve effective communication?
A
o Encouraging to continue
o Appropriate eye contact
o Questioning and summarizing
o Open & relax body language
o Noddin/ shaking head
o Silence -> give room for pt to talk
o Checking for understanding
o Smiling or serious facial expression
6
Q
What are the barriers of effective communication?
A
o Language barriers
o Time
o Too many questions
o Cultural issue: Discomfort with the topic
o Lack of interest
o Speech ability
o Dysphonia
o Illness
o Mental state
o Psychological
o Gender differences
7
Q
What are the parts of emotional intelligence?
A
o Self-awareness
o Self-management
o Motivation
o Empathy
o Relationship management aka interpersonal skills
8
Q
What are some differentials for a small exophytic lesion on lateral surface of the tongue with a wart like appearance?
A
- Oral squamous papilloma
- Veruccifor xanthoma
- Vericous carcinoma
- Verucous leukplakia
9
Q
What are some differentials for a unilocular radiolucency associated with ectopic pre-molar?
A
- Dentigerous cyst
- Odontogenic keratocyst
- Unicystic ameloblastoma
10
Q
What is occult caries?
A
A type of dental caries that can’t be seen on the surface of a tooth but can be detected on a radiograph
11
Q
A
12
Q
What are two different types of ankylosis?
A
1.With replacement resorption – bone is replacing dentine
2.Without replacement resorption - no bone replacing den
13
Q
What the three different types of healing following transverse root fracture?
A
- Through deposition of reparative hard tissue
- Fibrous hard tissue
- Bone and periodontal ligament
- No healing and pulp necrosis of the coronal portion (trick question) - this one is pretty rare
14
Q
What is apexification?
A
it is a method of inducing a calcified barrier at the apex of a non-vital tooth with incomplete root formation. Originally calcium hydroxide is used for coagulation necrosis of remaining pulpal tissues
15
Q
What can be result of apixification?
A
- Formation of calcified dome in the tooth
- Formation of pulp-like tissue and formation and growth of roots
- Rejection
16
Q
What are the indications for MTA?
A
- Vital Pulp Therapy
- Immature apices
- Perforations - lateral and furcation
- Retrograde root canal filling
17
Q
What is apexogenesis?
A
A vital pulp therapy procedure performed to encourage physiological development and formation of the root.
18
Q
What are the options for a tooth with replacement resorption?
A
- Decoronation and submergence of the tooth
- Extraction, orthodontics and implantation
- Translpalantation
19
Q
What is a root fracture? What is the treatment?
A
Root fracture is a type of fracture that involves dentine, pulp and cementum.
Treatment:
- Always reposition the coronal segment ASAP and check radiographically
- Stabilise the coronal segment with a passive and flexible splint for 4 weeks. If cervical, for 4 months
- No endo immediately
- Endo might be needed for the coronal aspect with use of apexification
- In mature teeth with cervical fractures above the alveolar crest
20
Q
What is alveolar fracture? What is the treatment?
A
It is the fracture that involves the alveolar bone and may extend to adjacent bones.
Treatment:
- Reposition any displaced segment
- Stabilise the segment by splinting the teeth with a passive and flexible splint for 4 weeks
- Suture gingival lacerations
- No root canal treatments
- Monitor the pulp contion of all teeth involved
21
Q
What is subluxation? What is the treatment?
A
An injury to the tooth-supporting structures with abnormal loosening, but without displacement.
Treatment:
- Usually no treatment
- A passive and flexible splint to stabilize the tooth for up to 2 wk if there is excessive mobility
22
Q
What is extrusive luxation? What is the treatment?
A
It is the displacement of the tooth out of its socket in an incisal/axial direction.
Treatment:
1. Reposition the tooth by gently pushing it back into the socket
- Stabilise with 2 week using a passive and flexible splint
- Monitor pulp. If necrotic, start treatment appropriate for the stage of tooth maturation
23
Q
What is lateral luxation? What is the treatment?
A
It is the displacement of the tooth in any lateral direction, usually associated with a fracture or compression of the alveolar socket wall.
Treatment:
1. Reposition the tooth digitally by disengaging it from its locked position and gently reposition it into its original location under LA
- Stabilised the tooth for 4 weeks with passive and flexible splint
- Monitor and at 2 weeks make an endodontic evaluation
- For immature teeth - might need endodontic procedure IF THE PULP IS NOT NORMAL. Similar for mature teeth
24
Q
What is intrusive luxation? What is the treatment?
A
It is displacement of the tooth in an apical direction into the alveolar bone.
Treatment:
For immature teeth:
1. Allow re-eruption without intervention
- if no re-eruption within 4 weeks, initiate orthodontic repositioning
- Monitor pulp
- IF PULP BAD THAN TREAT
- Parents must know that follow up visits are essential
For mature teeth:
1. Allow for re-eruption without intervention if intrusion is less than 3 mm. If does not happen after 8 weeks, surgical reposition and splint for 4 weeks or reposition orthodontically before ankylosis develops
- If the tooth is intruded 3-7mm, reposition surgically (prefered) or orthodontically
- If the tooth is intruded beyond 7mm, reposition surgically
- Endo treatment will be probably needed
25
Your patient comes in with an avulsed tooth that has already been re-implanted. The tooth is believed to have a closed apex. What are the steps for management?
1. Leave tooth in place
2. Clean affected are with water, saline or 0.1% CHx
3. Suture all lacerations
4. Varify normal position of the replanted toothr adiographically
5. Apply flexible splint for upto 2 weeks
6. Immidiatley or shortly after replatation, apply corticosteroid+antibacterial dressing (e.g. odontopaste) to the tooth for atr leats 2 weeks
26
Your patient comes in with an avulsed tooth that has been placed in a storage medium or has been drying out for less than 60 minutes. The tooth is believed to have a closed apex. What are the steps for management?
1. Clean the root surface and apical foramen with saline
2. Administer LA
3. Irrigate the socket with saline
4. Examine the socket
5. Replant the tooth slowly
6. Suture lacerations
7. Varify normal position with a radiograph
8. Apply splint for 1-2 weeks
9. Immidiatley or shortly after replatation, apply corticosteroid+antibacterial dressing (e.g. odontopaste) to the tooth for atr leats 2 weeks
27
Your patient comes in with an avulsed tooth that has been drying out for more than 60 minutes. The tooth is believed to have a closed apex. What are the steps for management?
The prognosis is poor
1. Remove necrotic tissue attached to the root using gauze
2. Treat the tooth with sodium fluoride for 20 minutes
3. LA administration
4. Irrigate the socket
5. Examine the socket for possible fracture and reposition
6. Performed root canal treatment prior or right after reimplantation
7. Stabilise with a passive splint for 2 weeks
8. Suture laceration
9, Verfiy normal position of the tooth
28
What are the guidlines for prescription of antibiotics for tooth avulsion?
First of all, ensure that the aptient had their tetnus shots.
Give doxycyclin to children aboe 8 years old for 7 day in doses
less than 26 kg - 50mg
26-35 kg - 75mg
35kg+ 100mg
If the child is less than 8 years old
amoxicillin 500mg, 3 times a day for 7 days
+ CHx mouthrinse
29
Your patient comes in with an avulsed tooth that has already been re-implanted. The tooth is believed to have an open apex. What are the steps for management?
1. leave the tooth in place
2. Clean area with saline
3. Suture gingival lacerations
4. Varify normal position of the replanted tooth radiographically
5. Apply flexible splint for 2 weeks
30
Your patient comes in with an avulsed tooth that has been placed in a storage medium or has been drying out for less than 60 minutes. The tooth is believed to have an open apex. What are the steps for management?
1. Clean the root and apical foramen with saline and do not touch the root
2. Soak the tooth in doxycycline (1mg per 20 ml of saline) for 5 minutes if possible
3. Administer local anesthesia
4. Irrigate the socket with saline
5. Examine for possible fractures and repositoon if necessary
6. Replant the tooth slowly with digital pressure
7. Verify with radiograph
8. Suture gingival lacerations
9. Apply flexible splint for 2 weeks
31
Your patient comes in with an avulsed tooth that has been drying out for more than 60 minutes. The tooth is believed to have an open apex. What are the steps for management?
he prognosis is poor
1. Remove necrotic tissue attached to the root using gauze
2. Treat the tooth with sodium fluoride for 20 minutes
3. LA administration
4. Irrigate the socket
5. Examine the socket for possible fracture and reposition
6. Performed root canal treatment prior or right after reimplantation
7. Stabilise with a passive splint for 4 weeks
8. Suture laceration
9, Verfiy normal position of the tooth
32
What is important to understand about ankylosis?
After the delayed reimplantation, ankylosis is essentially unavoidable and needs to be considered
33
What are follow up procedures for a patient who has a closed apex with extra oral dry time of less than 60 minutes?
First 7-10 days - Root canal treatment & calcium hydroxide for upto 4 weeks
Weight and height measurments
2 weeks - splint removal
4 weeks - radiographs
3 months -radiographs
6 months - radiographs
1 year - radiographs
Yearly - radiographs upto 5 years and better beyond
34
What are follow up procedures for a patient who has a closed apex with extra oral dry time of more than 60 minutes?
First 7-10 days - Root canal treatment & calcium hydroxide for upto 4 weeks
Weight and height measurments
2 weeks - splint removal
4 weeks - radiographs
3 months -radiographs
6 months - radiographs
1 year - radiographs
Yearly - radiographs upto 5 years and better beyond
35
What are the types of internal resoprtion?
1. Internal surface resorption
2. Internal inflammatory resorption
3. Internal replacement resorption
36
What is internal surface resorption?
It is a type of resorption that is defined as minor areas of resorption of the dentin walls of the root canal. It is believed to be transient and self-limiting.
37
What is internal inflammatory resorption? What is the treatment?
It is a type of resorption defined as an inflammatory process within a section of the pulp/root canal that results in loss of dentin commencing at the root canal wall and progressing towards cementum. A radiographic oval shape appearance is very common
This can be caused by traum or caries.
Treatment: Root canal treatment with corticosteroid and antibiotic + calcium hydroxide after
38
What is internal replacement resorption? What is the treatment?
Internal replacement resorption is a process where the pulp and dentin are replaced with bone. It usually begins within the pulp/root canal and on the root canal walls and it progresses towards the cementum. Clinical appearance may be normal or discolored.
Usually as a result of insult to the pulp.
Treatment: observation and eventual extraction. If diagnosed early, root canal treatment may be feasible.
39
What are the types of external tooth resorption?
1. External surface resorption
2. External inflammatory resorption (apical or lateral)
3. External replacement resorption (transient or progressive)
4. External Invasive Resorption
5. External Pressure Resorption
6. Orthodontic Resorption
7. Physiological Resorption
8. idiopathic Resorption
40
What is external surface resorption? What is the treatment?
External surface resorption is a self-limiting process which is usually caused by a localized to the involved part of the cementum and/or PDL.
Treatment: self-limiting so no treatment.
41
What is external inflammatory resorption? What is the treatment?
External inflammatory resorption occurs when the tooth has an infected root canal system and there has been damage to the external surface or communication between the pulp and external surface.
Can occur at the apex or lateral surface of the root.
Treatment: preventative approach: after external injury, utilise systemic antibiotics + corticosteroid based root canal treatment. Interceptive approach: when the resorption is already evident use corticosteroid based root canal treatment
42
What is external replacement resorption? What is the treatment?
External replacement resorption is the process where cementum and dentin are resorbed and replaced by bone.
Aetiology: can occur after external injuries
Treatments: lower the amount of time out of the socket after avulsion
43
What is external invasive resorption? What is the treatment?
It is a process that is not fully understood. It commences at the sub-gingival location and spreads through out the tooth in all directions.
According to Prof Heithersay, it can be classified as Class I-IV using a PA.
Class I-II are better treated with trichloroacetic acid (TCA) to the resorbing tissues followed by curettage of the defect and restored with glass ionomer cement. Result are usually quite good.
Class III might need adjunt treatment such as root canal treatment.
Class IV have undpredictable outcomes and patient need to be made aware of future issues and probable extraction
44
What is external pressure resorption? What is the treatment?
It is a resorptive process that occurs when there is pressure applied to the external surface of a tooth root.
Can be caused by impacted teeth or pathologies such as cysts.
Treatment: Removal of impacted tooth or removal of pathology or removal of resorbing tooth and extrusion of the impacted tooth with ortho
45
What is orthodontic resorption? What is the treatment?
Orthodontic resorption is the process by which the apical part of one or more teeth undergo resorption, resulting in a shortened root.
Treatment: when ortho stops, resorption stops. Monitor and treat when other conditions occur.
46
What is physiological resorption? What is the treatment?
It is the physiological resorption is the resorptive process that primary teeth undergo as they exfoliate. It is normal.
Treatment: monitoring exfoliation or extraction of primary teeth
47
What is idiopathic resorption? What is the treatment?
It is resorption with no apparent causes. Typically it involves multiple teeht with shorter roots.
Treatment: determining systemic causes through general health checks and after monitoring.
48
What is TAB?
Transient apical breakdown (TAB) is a phenomenon that indicates temporary apical periodontal destruction and root resorption after tooth luxation injuries, followed by the healing process of the dental pulp.
This is why in luxation injuries, root canal treatment is usually needed in mature teeth but not always. WATCH FOR SYMPTOMS.
49
What is improtant to understand in injuries to orthodontically resorbed roots?
Technically, because of the apical resorption, the teeth have an open apex thus can heal better. They are considered premature.
50
What are the problems with Cone beam CT?
1.Movement artifact – shown as multiple lines– patient need to be very still
2.No soft tissue resolution – use convetional CT
51
Do you need a radiologist?
Yes because:
1.It provides a provider number to allow Medicare rebates
2.Review of all areas of the scan
3.Removes much of the legal responsibility
52
What are the medicolegal responsibilities of dentist in terms of radiology?
Dentists who record OPG radiographs must take responsibility for all non-dental diagnosis from such images or alternatively have them assessed on referral by an oral radiologist or medical radiologist and include this cost in their estimate of fees to the patient.
53
What are the two different groups of unwanted effect after CBCT?
1.Deterministic – result of cell killing
2.Stochastic – result from cell modification
54
What is the DOT DAM principle of radiology?
Don't Order Tests that Don't Affect Management
55
What is the ALARA principle of radiology?
As Low As Reasonably Achievable
56
What are the different types of artifact available on CBCT?
1.Beam hardening – streaks arising from very dense objects
2.Scatter – soft streaking
3.Motion – blurry or double vision
4.Poor machine care – multiple artifacts
5.Faulty detector – rind around the jaw
57
How do you view a CBCT?
1.From down to up
2.From outside to inside
3.From Left to right
58
What is a good rule of thumb when understanding where the pathogloy comes from?
1.If above the mandibular canal – possibly dental origin because only non-dental related pathology occurs bellow the mandibular canal
2.Non-dental lesions are move common in tooth bearing areas
59
How do you examine at radiographic boney lesions?
1.Location
2.Margin – well-defined or illdefined
3.Zone of transition – short or long
4.Periosteal reaction
5.Internal matrix
6.Single vs multiple
7.Relationships to the joints
8.Effect on soft tissue
60
What are the features of non-aggressive lesions?
1.Well-defined margin
2.Often schlerotic border
3.Short zone of transition
4.Little or no periosteal reaction
5.Bone often thinned and/or expanded
6.Minimal effect on soft tissues
61
What are the feature of aggressive lesions?
1.Poorly-defined margin
2.Long zone of transition
3.Periosteal reaction may be extensive
4.Bone often destroyed
5.Permeative appearance
6.Soft tissue involvement is common
62
What is the common appearance of the radicular cyst?
Lesion consists of a lucent centre and a thin, well-defined sclerotic rim. Cortical bone destruction may occur if cyst becomes too big.
63
What is the common appearance of the dentigerous cyst?
Lesion uniformly lucent with a thin, well-defined sclerotic rim attached to the cemento-enamel junction.
64
What is a common appearance of a odontogenic keratocyst?
Odontogenic keratocyst is a well-defined sclerotic which causes less jaw expansion and grows along the jaw bone.
65
What is a common appearance of an ameloblastoma?
Has aggressive growth characteristics. Typically well-defined and radiolucent. Cause root resorption, tooth displacement and bone expansion. Floating tooth appearance.
66
What is a common appearance of an adenomatoid odontogenic tumour?
Anterior mandible, well defined with corticaed border. Tooth displacement is common, root resorption is uncommon.
67
What is a common appearance of cemento-ossifying fibroma?
Mandible, fibrous capsule gives a thin raiolucent halo. Rapid expansion and tooth displacement. May contain abnormal bone and cementum like tissue.
68
What is a common appearance of cementoblastoma?
Slow growing lesion full of cementum like tissue. Attached to root apex. Well-defined with cortical border.
69
What are giant cell lesions?
Anterior to first molar. Slow growing with well-defined margin. Some cortical expansion can occur.
70
What is nasopalatine cyst?
A defined radiolucency that occurs in the palate
71
What is a Stafni's bone defect?
It is a salivary inclusion cyst. A well-defined oval lucencies anterior to angle of mandible.
72
What is a common appearance of mucoepidermoid carcinoma?
Well-defined border in posterior body or angle of mandible.
73
What is a common appearance of osteogenic sarcoma?
Posterior mandible. Painless swelling. Ill-defined borderd\s. "Sun-ray" spiculation appearance. Breaks bone.
74
What is the common appearance of metastases to the jaw?
Usually from renal, breast, lung, colon and prostate. Affect posterior mandible. Ill-defined, lytic lesions with clear bone destruction.
75
What is the common appearance of osteomyelitis?
PAIn _ subtle changes in bone density. Bone destruction with sequestration formation.
76
What are the 7 signs of IAN involvement?
1.Darkening of the roots
2.Interruption of the white line
3.Diversion of the mandibular canal
4.Deflection of the roots
5.Narrowing of the roots
6.Dark and bifid roots
7.Narrowing of mandibular canal
77
What is the common appearance of fibrous dysplasia?
Genetic disorder resultin in replacing of bone with fibrous tissue. Ill-defined margin and grounnd-glass appearance. Only condition that can displace the mandibular canal superiorly.
78
What is the most important part of pre-implant assessment?
7-10 mm of crestal bone need to be available to withstand stresses.
79
What are the important aspects of assessment for mandibular implants?
1.Mandibular canal
2.Mental foramen
3.Anterior loop of mandibular canal
4.Incisive branch of IAN
5.Lingual canal in the midline
80
What is pressure resorption and orthodontic resorption?
Type of traumatic resorption that occurs due to impacted teeth or orthodontic treatment
81
What is internal inflammatory root resorption?
Resorption that occurs internally
82
What is external inflammatory root resorption?
Resorption due to periapicla infection
83
What is communication internal-external inflammatory resorption?
Both internala nd external resorptions
84
What is surface resorption?
Type of trauma-induced tooth resorption. Involves cementum and small amount of dentine.
85
What is Transient apical internal resorption?
This process can follow luxation injuries and may be associated with TAB
86
What is replacement resorption?
Can follow trauma. Tooth structure is replaced.
87
What is considered to be moderate diffuclty in the AAE classifications?
One or two of the following:
1. ASA class 3 patient
2. Vasoconstrictors intolerance
3. Anxiety
4. Limitation in opening
5. Gagging
6. Moderate pain or swelling
7. extensive differential diagnosis
8. Difficulty in obtaining radiographs
9. 1st molar
10. Moderate inclination - 10-30 degress
11. Soem trouble with rubber dam
12. Coronal distruction or complex restoration
13. Canal morphology is slightly more complex
14. Pulp stones
15. 3-5 mm near the IAN
16. Minimal apical resorption
17. Crown fracture
18. Previous access without complications
19. Endo-perio lesion
88
What is considered to be high diffuclty in the AAE classifications?
3 or more in moderate difficulty and at least one in the high diffuculty such as?
1. ASA 4
2. Can't get anaesthesia
3. Uncooperative
4. Significant limitation in opening
5. Extreme gaggin
6. Sever pain
7. History of orofacial pain
8.2nd or 3rd molar
9. Extreme inclanation
10. Extreme rotation
11. Significant deviation from normal tooth/root form
12. C-shape morphology, extreme curvature or S-shape curve, rare root morphology, very long teeth
13. Pulp chaber not visible
14. extremly close to IAN (<3mm)
15. Extreme resopriton
14. Root fractures
15. Previous endo
89
What are the the symptoms of pericoronitis?
1.Difficulty swallowing
2.Limited opening
3.Enlarged lymph nodes
4.Fever
5.Facial cellulitis
6.Pain
7.Localised swelling
8.Pus discharge
90
What are the types of resective surgery?
1. Gingivectomy – removal of pocket epithelium, connective tissue and mucosal epithelium
2. Modified Widman flap – removal of pocket epithelium and connective tissue +/- osseous, leacing behind mucosal epithelium
91
What are the most commonly used material in periodontal regenerations?
1.Bone grafts
2.Membranes
3.Growth factors
92
What are the indication for surgical correct of recession?
1. Increase in recession
2. Dentinal hypersensitivity
3. Aesthetic concerns of the patient
4. Persistent inflammation
5. Age
93
When can periodontal disease cause endodontic problems?
If the periodontal pocket reaches the apex
OR
If there is a large laterla canal in the tooth
OR
When it reaches the furcation canal
94
What is considered to be Grade C periodontitis?
1. More than 2mm bone loss over 5 years
2. Bone loss to age ratio between 1.0 inclusive radiographically (ie for a 50 year old patient the range is around 50.0 percent and above)
3. Low biofilm deposit and large amount of periodontal destruction. Unequal pattern, resulting in small amount of biofilm but large amount of destruction.
4. Smoking more than 10 cigarettes per day
5. HBA1c level of more than 7.0 in diabetic patient
95
What are the 5 moments of hand hygiene?
1. Before touching a patient
2. Before a procedure
3. After a procedure or body fluid exposure
4. After touching a patient
5. After touching a patient surroundings
96
What is spaulding classification?
It is a classification of instruments depending on their level of causing infection during their use, example is:
1. Critical – using a perio-probe for surgical procedures – anything that pierces the mucosa must be sterilized and recorded (ideally)
2. Semi-critical – single use items such as micro-brushes or curing light with a sleeve – you need to clean it but you might not need to sterilize it
3. Non-critical – example is bib chains – they come in contact with intact ski
97
What are the steps for reprocessing of Reusable medical devises (RMDs)?
1. Pre-cleaning at the chairside
2. Mechanical cleaning using ultrasonic
3. Manual cleaning using of professional cleaning machines
4. Thermal disinfection
5. Thermal disinfection using washer-disinfection
6. Inspection
7. Choice of packaging material and sealing of packages
8. Labelling packages of reuseable medical devices
9. Run a Bowie-Dick type tests for air removal and steam
98
What is a Type 4 indicator and what does it do? What is it's disadvantage?
Type 4 are 2 process parasmter indicator. they react to two seperate processes of the sterilisation cycle such as temperature and pressure.
Disadvantage: If one of the processes fail, the indicator will not be able to show it. Thus, either of the two components have failed or both of them have failed. This can create confusion and hinder the resolution of the sterilisation machine problem.
99
How does tobacco affect periodontal disease?
1. Negative affect on tissue vasculature
2. interfering with normal humoral immune reaction and host inflammatory response
3. changes of subgingival microflora thsu facilitating early acquisition and colonisation
4. changes in bone turnover
100
What are 5 components of discussion when it comes to informed consent?
1. Diagnosis of condition
2. Recommended treatment plan
3. Alternate treartment plan
4.Potential risks of all treatemnt alternatives
5. Potential risks of no treatment
101
What is the relationship between periodontal disease and respiratory disease?
Oral cavity can act as the reservoir for pulmonary pathogens thus adequate debridement, use of chlorhexidine and at-home care can help with lung diseases
102
What are different types of anti-thrombotics?
1. Anticoagulants - warfarin
2. Antiplatelet - clopidogrel
3. Target-specific oral anticoagulatns - apixaban
103
What are local haemostatic measures?
1, Pressure
2. Minimal trauma
3. Cellulose or collagen
4. Sutures
5. 4.8% tranexamic acid for blood clot stability (warfarin only). Before surgery + 10ml for 2 minutes 4 times a day for 2 days
104
What are the oral manifestations of chemo-therapy?
1. oral mucostitis
2. Increased risk of bacterial infections
3. Increase risk of viral infections
4. Increased risk of fungal infections
5. Malnutrition
6. Painful oral hygiene
7. Oral haemorhage
8. Increased risk of trismus
105
What are the oral side effects during radiotherapy?
1. Mucositits
2. Taste changes
3. Dry mouth
4. Increased mucous
5. Tooth hypersensitivity
6. Dysphagia
7. Weight loss
106
When should you give AB prophylaxis for a person undergoing dyalisis?
When they have an AV graft which is a graft that is sticking out of the arm
107
When should you not use SDF?
1. Heavy metal allergy
2. Pregnancy or breastfeeding
3. Lesions close to the pulp/possible pulpal involvement
4. Signs or symptoms of periapical pathology
5. Ulceration, mucositis or stomatitis
6. Restoratio of permanenet anterior teeth
108
What is the use of benzydamine?
Benzydamine is an NSAID that reduces inflammation and pain in oral mucositis.
Available of as DifFlam or DifFlam C
109
What are pharmacological behaviour management technique?
1. Oral sedation - benzodiazapine pre-medication
2. Relative analgesia - nitrous analgesia
3. Conscious/iv sedation (need to follow appropriate legislation)
4. General anaesthesia
110
What are some good relaxation techniques?
1. Deep breathing
2. Muscle relaxation (like progressive msucle relaxation)
111
What is trauma?
Trauma is simply exposure to any traumatic situation or event that overwhelms your ability to cope
112
What is trauma-informed care?
It is an approach to engaging people with histories of trauma that recognise the presence of trauma symptoms and acknowledges the role that trauma has played in their lives.
113
What is a pick up impression?
Denture in the alginate for tooth replacement. FItting surfaces are okay
114
What is the significance of curve of spee in dentures?
1. it maintains occlusal harmony
2. Supports efficient mastication
3. Allows posterior disocclusion during portrusive movement
115
What should you mark on the wax rims?
1. Mark mid line
2. Mark canine lines
3. Mark smile line
116
What should you try during the denture try in stage?
1. Denture articulation
2. In patient mouth
3. Aesthetics
4. Occlusion
5. Fitting surface
6. Check function and pronunciation
7. Obtain patient consent
117
What are the steps for chrome denture design?
1. Saddle
2. Support
3. Retention
4. Connectors
5. Simplification
118
What kind of clasps do you use for anteriors?
Gingival approaching
119
What is the minimal length for clasps?
15 mm for cast clasps
7 mm for wrought clasp
120
What are the steps for evaluation of alginate impressions?
1.Alginate mix is homogenous and smooth – no streaks or air bubles
2.Tray appropriate size – tray not shwoing through
3.Alginate has had adequate time to be inserted into the mouth, seated onto the teeth and set prior to removal – smooth surface with no drag lines
4.Adequate amount of alginate in tray and has been seated and muscles trimmed correctly anatomical featyres, tray is centered, no large air bubles
5.Tray has been removed correctly – no tearing of the materials
121
When would you do a wash impression for a denture reline?
Using the denture itself, apply a heavy material and after using that impression apply ligth material and take the impression again. This is used for reline.
122
What if a patiet has problem with gaggin?
The extension of the denture may need to be modified.
Following options:
1. Remove the palatal extension of the denture
2. Reduce the buccal extension of the denutres
3. Desensitisation therapy
4. Re-do the denture with a reduced secondary impression
123
What kind of questions should you ask a patient during denture review?
How is your denture
Can you eat and speak with it
Does it cause any sore spot on the gum or teeth
Can you eat with your denture
Can you pronounce words normally?
Do you have a list of what you would like me to adjust your denture?
124
WHat is a code to replace a broken tooth?
071+766
125
How do you examine at radiographic boney lesions?
1.Location
2.Margin – well-defined or illdefined
3.Zone of transition – short or long
4.Periosteal reaction
5.Internal matrix
6.Single vs multiple
7.Relationships to the joints
8.Effect on soft tissue
126
What is the common appearance of MRONJ?
Pains, swelling and draining sinuses. Bone destruction. Periosteal reaction is common.
127
What is the Mach effect?
It is an optical illusion. Form of edge enhancement which facilitates the detection of the edges of an object. Basically, the edges between light and dark appear darker. SO NO PATHOLOGY.
128
What are the three optical properties of dental sctructures?
Opalascence – the ability of the body to look different in reflected or transmitted light
Fluorescence – the ability of the body to emit light that is a wavelength less then incident radiation e.g. crime scene fluoresent lights
Translucence – the ability of the body to appear to transmit light and reflect little of it back
129
What are the three factors of tooth colour?
Hue – base pigment – red, pink, green, blue and other
Value – most important – quantity of light reflected – how bright is the object can be shown with black and white images
Saturation – chroma – intensity or vividness – how much of base pigment is there within tooth structure
130
What is incisal configuration?
It is the V shaped area between the incisors. It needs to be at 90 degrees to both of the teeth making up the incisal configuration
131
What questions should you ask particularly an elderly before prescribing an NSAID?
1. Have you experience recent changes in your bowel habits, such as black or tarry stools?
2. Any episodes or recent nausea, vomiting or abdominal pain?
3. Have you noticed any changes in your urine output or color?
4. have you experienced any shortness of breath, chest pain or swelling?
5. Do you have a care giver or support group that may aid you or remind you about taking the medication?
6. Do you take any over the counter medications recently that are beyond the once in your medical history?
7. Do you take a deuretic or an ACE inhibitor?
132
What equipment shpudl you have at your practice for dental emergencies?
1.Oxygen source
2.Disposable plastic airways
3.Adrenaline 1in 1000 injection
4.Pulse oximeter
5.Glucose
6.Glyceryl trinitrate spray 600 mcg
7.Short-acting bronchodialator and space
8.Aspirin
9.Blood pressure monitor
10.Blood glusode monitor
11.Automated external defibrillator
133
What are some allergic reactin that may occur in chair?
1. Urticaria – red itchy patches – stop administration of any allergens and administer a less sedating oral antihistamine like cetirizine or fexofenadine (not on PBS but good to have around and they are cheap)
2. Anaphylaxis – cardiovascular collapse and bronchoconstriction – stop administration of any allergens, call 000 and lie patient flat and give intramuscular injection of adrenaline, start supplemental oxygen, support airway, start CPR if needed. Do proper documentation.
134
What to do if a patient has chest pain or angian?
1.Stop treatment
2.Pulse oximeter on, see if patient is concious, check heart rate and blood pressure – if no pulse, CPR - ask patient if they used viagra, as it can make GTN way more potent
3.Use glyceryl trinitrate spray 400 micrograms sublinguallt, repeat 5 minutes if pain persists, for total of 3 dosease if tolerated
4.If pain continues, call 000
5.Give 300mg of aspirin orally chewede before swallowing
6.Strat supplemetan oxygen and maintain oxygen between 90-96% saturation
135
What to do in a hypoglycemic event?
1. Stop treatment
2. Give 15 g of glucose and measure glucose level in 15 minutes
3. If still low, administer 3 or more portions
4. f symptoms persist, seek medical advise and call 000 if patient is unconcious
5. IF all is good after a few protions, no dental treatment today, get some longer acting carbohydrates like a sandrwich or yogurt and observe the patient until they feel okay
136
What should you cover in penicillin allergy history?
1. What did patient react to?
2. What was the type of rection? Is it really sever, did it limit their function or made them die? Did it have it for mono, that one can create a fake reaction to antibiotic
3. How long after start of treatment did it occur eg after a few hours or many days?
4. How long ago was the reaction?
5. How was it treated?
6. Have they had similar antibiotics since?
137
What are the indications of RA?
1. Anxious patient
2. Older children with poor dental experiences
3. Complex or long procedures
4. Child with special needs
5. Fear of needles
6. To aid analgesia
7. Increased gage reflex
8. AND MEDICALLY FIT ASA I AND ASA II
138
What are contraindication for RA
Pulmonary heart disease
Sever asthma
Blocked nose
Refusal to breathe through nose
CNS disease
Otitis media or middle year disturbance/surgery - only active
Claustrophobia
GI issues
Cystic fibrosis
139
When would you not report abuse?
1. IF there is a reasonable belief that another person has reported abuse
2. IF the suspecion was due soley to being informed of the abuse by a police officer or child protection officer
140
What do you do if during tell-show-do exercise a child retracks their hand fromt eh prophy brush?
1.Retrace your steps. The show componenet needs to be modified
2.Ask the child how they are feeling, if they are withdrawn they are probably just anxious
3.Maybe to give them a more sense of control, do it on your fingernail first
4.Then let a child hold a hand mirror next to your finger to give them a sense of control
5.After do it on their finger
6.And finally on their tooth
7.Praise the child for being brave
8.Promise a sticker if you can do it on al teeth – children love stickers
141
What is the recommended dose of lignocaine in children?
4.4. mg/kg and one carpule has 44mg. So per every 10 kg you can have 1 carpule max. So for a 25 kg child you can have 2-3 carpule with some interspacing. Also remember about topical.0.1g has about 5 mg!
142
What are the mechanisms of exodontia?
Stop if the kid says ouch, especially if they are cooperative and top up
1.Expansion of the bony socket to permit removal of its contained tooth.
2.Use elevators with utmost caution
3.Use three basic mations: wheel and axle (screwdriver), wedge and lever. Alvaolar bone is the fulcrum
4.Support jaw bone with your other hand
5.Use of level and fulcrum principle to force tooth or root out of socket along the path of least resistance
6.Always use the forceps as sungingivally as possible
7.Push buccaly for 3 seconds, then move to figure of 8
8.Repeate until the tooth is out
143
How would you diagnose DDE?
1.Describe the distinct border
2.Describe the type
3.Resulting enamel – smooth or soft and pourus
4.If there is any unprotected dentine
5.If there is any caries
6.Is there post-eruptive breakdown of the dental hard tissue
7.ALWAYS perform examination on wet teeth as drying teeth may result in pain
144
What are the stages of tooth socket healing?
1. haemostasis and coagulation - this is where suturing in warfarin is important
2. Inflammation
3. Proliferation
4. Modeling and remodeling
145
When do we say a person has a gummy smile?
When we see more then 3mm of gingiva past the gingival margin in a person.
146
What is osteoconduction?
It permits bone growth on surface or pores. This occurs in bone implants.
147
What are the Miller Classification of gingival recession?
Class I – recession that does not extend to the mucogingival junction with no periodontal bone loss
Class II – recession that extends to or beyond mucogingival junction with no bone loss
Class III - recession that extend to or beyond mucogingival junction with loss of bone in the interdental area
Class IV - recession that extend to or beyond mucogingival junction with loss of bone in the interdental area with exposure of interproximal root surface
148
How to set up a provisional treatment plan for perio?
1. Emergency phase - e.g. exo
2. Systemic phase - e.g. control systemic diseases
3. Initial phase - e.g. testing and debridement
4. Surgical phase - regenerative surgery
5. Restorative phase - temporary crowns
6. Maintenance phase - depending on risk close recall or normal recall
149
What kind of surgery could you perform for recession?
1. Lateral sliddding flap
2. Coronally repositioned flap
3. Free gingival flap
4. Subepithelial connective tissue graft
150
How to write a diagnosis for rem pros?
Type of edentulousness
Edentulousness
Location
Tissue or tooth support
Associate issues
Example: Bilateral edentulous maxillary arch with localised periodontitis and unilateral edentulous mandibular arch with large mandibular tori
151
What is the pathogenesis of rheumatic heart disease?
1. upper respiratory tract infection by Group A streptococcus
2. M protein is used by Strep As for bacterial virulance
3. Creation of antibodies for M proteins by leucocytes and eliminations of M proteins
4. M proteins have a molecular mimicry to cells of the endocardium
5. Body miounts a response to the cells of endocardium resulting is valve damage, valvale deformities, fibrosis and calcification
6. This makes a patient more predisposed to heart failure, artirial fibrilation and infective endocarditis
152
What is infective endocarditis?
It is a condition where the predisposing factors such as:
1. Rheumatic heart disease
2. Prosthetic valves or use of prothetic material in repair of valves
3. Previous Endocarditis
4. Unrepairde cynotic defects
5. Repaired but residual cynotic defects
1. bacteremia - introduction of bacteria in the blood stream result in adherence of bacteria to the endocardium
2. Fomation of infective vegetations
3. Resulting in valve destruction, embolic events and heart failure
153
What is the definition of open disclosure?
Open disclosure is the process of providing an open, consistent approach to communicating with patients/consumers, their family, carer and/or support person following a patient incident. The process includes expressing regret or saying sorry.
154
What is cardiac arrest, what are signs and causes, what is the management of the patient?
Cardiac arrest is the stop of heart function.
Signs: no pulse, loss of consciousnes and respiration
Causes: ventricular tachycardia, ventricular fibrillation, asystole
Managment:
1. Stop dental treatment
2. Call 000
3. DRSABCD
155
Acid changes from 5.5 to 4.5, name two chemical changes that occur when this happens in the presence of fluoride?
1. Demineralisation of hydroxyapatite - and uptake of fluoride by demineralised dentine and enamel to form flurapatite
2. Formation of calcium fluoride and it could act as a slow releasing fluoride reservoirs
156
What are the two different PCC techniques you can use to present bad news?
PREPARED:
1. Prepare for discussion
2. Relate to the person
3. Explore priorities
4. Provide information
5. Acknowldege emotions and concerns
6. Foster realistic hope
7. Encourage questions
8. Document
TRIM:
1. Timing - correct amount and type of info - chunk the information
2. Relevance - what will help the patient connect to this info? - relate to patients perspective
3. Involvement - How can patient contribute? - offer suggestions and choices rather than directives
4. Method - Help patient understand and recall? - use visual methods of conveying - PANFLETS
SPIKES
Setting - Find a quite and private setting
Perception - Estabslih how much the patient knows and his or her perceptions abut the medical situation
Invitation or information - Ask the patient and significant other how much and what kind of information will be helpful
Knowledge - Share bade news with the patient using gentle, nonclinical language is small segments
Empathy - Acknowledge the patient's emotions and reaction with appropriate responses
Summarise and strategise - summarise in language that the patient can understand. Ask the patient to repeat or summarise the information received and the next steps
157
What are the steps to occlusal analysis?
1.Teeth present/missing
2.Morphology of teeth
3.Wear - mild, moderate, sever
4.Crowding,spacingrotations
5.Axail inclanations
6.Shape of dental arch
7.Cruve of spee and wilsons curve
8.Angle molar classification/canine classification
9.Overbite (%) / overjet (mm)
10.Mediolateral
158
How to maintain staff safety during the OPG?
1. Distance
2. Position
3. SHielding
159
How to examine the entire panoramic images?
1. Examine for quality of the image first - check image sharpness, contrast and density
2. Examine the image for patient preperation and positioning
3. Examine the image fro diagnostic purposes - are structure examined well displayed?
160
What are the six features are wrong with this OPG and what are the error on effect on final image?
1. Unnecessary artefacts i.e. the glasses - Results in unnecessary object being presented on the DPR, the glasses
2. Patient positioned forward - Anterior teeth blury and too small - spine sen on the film
3. Failure to position the tongue against the palate - large, dark, shadow over the maxillary teeth between palate and dorsum of tongue
4. Head is tilted to the side in the horizontal direction - condyles are not equal in height, nasal structure is distorted
5. Head is turned to one side - seems like the RHS was closer to the detector than LHS - resulting in LHS ramus appearing larger
6. Exposure factors have not been selected properly - the image appears to be blur overall
7. Chin down - the V shape - joker brain
8. Chin up - fraun
161
What are the standard precautions?
1. Hand hygine, as consistent with the 5 moments for hand hygiene
2. The use of appropriate personal protective equipment
3. The safe use and disposal of sharps
4. Routine environment cleaning
5. Reprocessing of reusable medical equipment and instruments
6. Respiratory hygiene and cough etiquette
7. Aseptic technique (the dirty and clena areas)
8. Waste management
162
What is the needle stick inury protocol in dental emergencies?
1. Stop
2. Place needle/sharp aside
3. Take off gloves
4. Wash hands with soap and water
5. Dry and cover with non-stick dressing
6. Apply pressure if bleeding
7. Let tutor know
8. Contact SADS registered nurse for risk assessment
9. Write up incident report - SLS
163
What is a Type 4 indicator and what does it do? What is it's disadvantage?
Type 4 are 2 process parasmter indicator. they react to two seperate processes of the sterilisation cycle such as temperature and pressure.
Disadvantage: If one of the processes fail, the indicator will not be able to show it. Thus, either of the two components have failed or both of them have failed. This can create confusion and hinder the resolution of the sterilisation machine problem.
164
How do cements act?
1. Mechanical – through interlocking with surface irregularities
2.Micromechanical – air abrasion or acid etching
3.Chemical bonding
165
What are some examples of resin based temporary cements?
TempBond Clear – dual cure cements
166
How do we take history about a lesion?
1. Duration when the patient first started seeing the lesion
2. Variations in site and character of the lesion
3. Symptoms - related to the lesion and any systemic symptoms
4. Onset - any associated hsitorical events related to the lesion
167
What is one of the treatment of oral candidosis?
Miconazole 2% gel 2.5 mL topically (then swallowed), 4 times daily, after food, for 7 to 14 days; continue treatment for at least 7 days after symptoms resolve
Or Amphotericin B 10 mg lozenge sucked (then swallowed),4 times daily, 7 to 14 days; continue treatment 2 to 3 days after resolved
168
What are risk factors for cancer
1. Tobacco
2. Alcohol
3. Betel-quid (tobaco in a different form) - bucal sulcus
4. Human Papillomavirus (HPV) types 16 and 18
5. Ultraviolet radiation
169
What is a good guide for culturally safe communication suggested by Jennings et al 2018?
Health professional should realise that something so simple as good, caring talk has the ability to reconfigure these experiences and relationships between Indigenous client and the healthcare system. Sharing some personal experience may also be beneficial
170
What are some good practice tips that allow to imrpove cross cultural communication?
1. Allow a support person to accompany the client
2. Recognise that not all Aboriginal and Torres Strait Islander people want to work with an Aboriginal and Torres Strait Islander worker
3. Share some personal information about yourself
4. Don't expect them to share information regarding their families and culture or local history
5. Silence should not be misunderstood and should be respected.
171
What is a dry socket?
Absence of blood clot in the socket post extraction (socket is either empty or full of debris)
172
What is the management of dry socket?
o Clean of debris (may need curettage)
o Irrigate
o Place dressing (Alveogyl) for symptom relief
o +/- primary closure
o Script of analgesics
o Review in 2 weeks
o NO antibiotic because it is not an infection
173
What are the steps for internal bleaching?
1. Remove extrinsic staining
o Prophy, U/S
o Pt education re extrinsic staining
2. Pre-op shade
3. RD
4. Remove restoration but not stained dentine
5. Remove GP 1-2mm below CEJ
6. Place Cavit or GIC to seal GP from the orifice
o At least 2mm of GIC or cavit
7. Etch pulp chamber, rinse and dry
o Request DA to dispense bleaching material
8. Mix sodium perborate with water until u get a stiff paste consistency
9. Place bleach mix onto the labial surface of access cavity
10. Seal bleaching material w cotton pellet and seal w GIC or cavit
11. Repeat the above steps every 1wk until the desired colour is achieved
12. Once the shade is reached
o Remove all bleaching material
o Rinse thoroughly
o Record post-op
13. Defer definitive restoration for 7d,
o Enamel margin might be weakened -> bond strength may be compromised
174
What are the initial recall for SPT?
8-12 weeks
175
What are the principals of a post?
* Diameter
Wider diameter -> more retention but more risk of root fracture
=> recommend 1/3 of root diameter
Need to assess all direction
* Only MD direction on radiograph -> check the master GP for the diameter of the root canal
* Length
At least 1/2 or 2/3 of the root
Sufficient GP (minimum 4-5mm) from the Apex -> measure from end of GP to end of the post
* For adequate apical seal
* Can leave more if u have longer root (eg upper canine)
Bone lvl
* Make sure the post is below the alveolar crest
* Material
Aim
* Withstand functional stresses
* Resist corrosion
* Radiopacity
To check on radiograph
* Biocompatibility
Non-corrosive
Non-toxic
* Retrievable
* Bond to the resin cements
* Elastic modulus similar to dentine
Potential fracture location due to the uneven distribution of occlusal load by the post to the tth
- Not interfere with aesthetics
176
What should you do if the crown is 1mm out of margin howere it sits perfectly on the cast?
* Check contact point with adjacent teeth
* Check fitting surface (intaglio surface)
* Check for excess temporary cement
* Check the tooth has not moved
* Check soft tissue and hard tissue defect
177
What are the best pontic designs?
1. Ovate - great but needs surgery
2. Sanitary - with 2mm clearance - for posterior
3. Modified ridge-lap - great and go to
178
What is Ante's Law?
The total root surface area of all supporting teeth must equalt or exceed the total root surface area of the teeth being replaced
179
What is the problem with black triangles?
1. Aesthetics
2. Food trapping
3. Trouble with pronouncing S sounds
4. Saliva extrusion
180
What is the role of standard precautions?
Standard precautions are used to prevent or reduce the likelihood of transmission of infectious agents from one person or place to another, and to render and maintain objects and areas as free as possible from infectious agents. Minimizing the risk of transmission.
181
What is Type 1 indicator and what does it do? What is it's disadvantage?
Type 1 is known as process indicators.
It is used on every pack in every load or on a tray of every unpacked load.
It helps to distunguish between processed and unprocessed loads.
Diasdvantage: may react at a point of sterilisation that is below the point of adequate sterilisation.
182
How do NOACs impact treatment?
1. No patient risk factors or dentla procedure with no/low risk - jsut consider liver/renal health and use local measures
2. Patient risk factors and dental procedure low risk - contact GP and try to postpone the drug for 24-48 hours
3. Patient risk factors and high risk dentla procedure - no surgicla treatment
183
What are some of the factors affecting the uptake of oral healthcare by those who experience homelessness?
1. Dental care is a low priority
2. Higher level of dental phobia
3. Reporting being treated with low respect
4. Low number of information and available services
184
What sound will a person make if the teeth are set too lingually?
Th sound like D
185
What are some of the effective minor connectors for mandible?
Lingual bar – need 4mm space at least below the teeth
Lingual plate - need 4mm space at least below the teeth
Sublingual bar - need 4mm space at least below the teeth
Cingulum bar
186
What are the important aspects of assessment for mandibular implants?
1.Mandibular canal
2.Mental foramen
3.Anterior loop of mandibular canal
4.Incisive branch of IAN
5.Lingual canal in the midline
187
What to do if a patient has an asthma attack?
1. Stop treatment
2. Oximeter is placed straight away moderate is above 94%, sever 90-94%, life threatening below 90%
3. f mild – give 4 puffs of salbutamor via spacer 1 puff at a time with patietbreathing in 4 times
4. Wait 4 minutes, if not imrpoving treat as sever or lifethretening
5. Call 000
6. Maximum of 12 puffs but if it is bad even after just keep giving salbutamo with 4 breaths in between before ambulance arrives
188
What are considere high risk reaction to penicillin?
1. Any previous respiratory disressm, swelling of mouth or throat
2. Any history of diffuse rash which comes immediately after starting treatment
3. Diffuse or localised rash which is delayed but occurred less than 10 yearsago
Re-exposure may cause anaphylaxis, so non-beta lactam
189
What the 3 purposes of reservoir bag?
1. Provide a source of additional gas should the patient inspire more gas than is being supplied ◦
2. Provides a mechanism for monitoring the patient’s respiration (watch the expansion and contraction of the bag) and for adjusting the flow (not too stretched or collapsed)
3. Functions in an emergency as a method of providing positive pressure oxygen
190
How do you administer RA?
Use slow induction technique – from zero to desired 10% at a time per minute
Keep N2O concentration below 50%
Reduce concentration N2O
If patient falls asleep, turn O2 to 100%
Avoid fluctuations
Monitor patient closely
Use 100% of oxygen for 5 minutes at the end of the session
191
What are some of the positive reinforcements?
1. Motivational advice
2. Verbal praise, non-verbal such as smile or STICKERS
192
What are some aspects of child management?
1.Time efficiency – kids do not like to sit in the chair for too long
2.Behaviour management techniques: Modelling for the first visit, Tell-Show-Do to reduce anxiety, Voice control do not yell, Use of appropriate language to the kid like euphemism (sleep juice from a magic wand), monitoring the child for sense of control, distractions with triplex or wrigling the toes, positive reinfocement, systemic desensitazantion (a bit advanced and for older children because they realise that fear is irrational), behaviours shaping where you slowly shape the child behaviour from non-cooperative to cooperative with ability to retrace your steps
3.If the kids is dangerous, you can use aversie conditioning BUT NOT IN AUSTRALIA you can just do GA
4.Do not do the treatment if child does not cope with it, it is about quality treatment and overall positive treatment outcomes
193
Why does tranexamic acid work on warfarin but not apixaban?
Tranexamic acid is antifibrinolytic which means it prevents breakdown of already created clots.
Apixaban inhibits factor Xa which revents fromation of thrombin and consequently fibrin clots, which means is stop coagulation before tranexamic acid can safe the clot, by not creating a clot to begin with.
Warfarin works on vitamin K as an antagonist (affecting factors II, VII, IX and X). Which means, it reduces reduces the clotting factors but does not eliminate the. This means that tranexamic acid can work on small amoutn of forming clots.
194
How do we treat hypersensitivity?
1. Block dentinal tubules - using restorations or protective coverings
2. Block nerve activity - stanous fluoride and potassium nitrate
3. Remove the cause - erosion and toothbrushing technique change
195
What is the systematic way to examine a lesion?
1. Site - using anatomical terminology
2. Size - measure with a probe
3. Morphology - elevated, flat or depressed
4. Colour - compare to adjacent normal tissue
5. Consistency - how it feels (ONLY CLINICAL DO NOT SAY THIS IN EXAM), texture - how the surface looks like (PHOTOS ARE APPROPRIATE :))
196
What is the antifungal therapy for angular cheilitis?
Miconazole 2% cream topically then swallowed, 2 times a day after food, 14 days, continue treatment for at least 14 days after symptoms resolve
197
What are the steps for open disclosure?
1. Acknowledgement of the incident, and offering initiating or signalling the need for open disclosure
2. Preparing for, and engagin in open disclosure discussion, including expressing regret
3. Providing follow up to patient and family/caregiver, including actions taken as a result of the investigation
4. Completing process and maintaining documentation
198
What is the management of seizures?
If history of epilepsy or seisures is present - please use a bite block on the patient
1. Stop dental treatment
2. Ensure patient is not in danger
3. Turn the patient to the side
4. Avoid restrainning
5. Wait until seizure stops
6. Maintain airways
7. Assess the patient
8. If still unconscious, call 000 and maintain airways
199
How do we right diagnostic statement for gingivitis?
1. Extend - localised of generalised
2. Disease - gingivitis
3. Specification - biofilm induced, mediated by pregnancy or leukaemia
200
What are the examples of of resin cement?
RelyX Unicem 2 (dual cure, Self adhesive, capsule) - good but needs real dry field
Nexus III (Dual and light cure, total etch, automix and try in gel is available) - good but needs the whole bonding system
Panavia F 2.0 (dual cure, adhesive resin) - good but ed primer or alloy primer may cause the mucosa to go white and needs a special bonding system including different primers
201
What is the significant finding of studies that looked at the likelyhood of indigenous people to access care?
1. Aboriginal and torres Strait Islander patient are more likely to access services where provider comminicate respectfully and have some understanding of Aboriginal culture and build good relationships with Aboriginal community
2. Where Aboriginal or Torres Strait Islander health worker are part of the health care team
202
What information do we need to gather before bleaching?
o Base line shade
o Cause of discoloration (discoloured from haemorrhage, pulp necrosis)
o Has the root been RCT?
o Colour change is unpredictable, unstable in long term
o May require retreatment
o Multiple appt
o Risk of external invasive resorption
o Risk of soft tissue burn
203
What are the potential causes of a false positive in ept?
o Anxious pt
o Presence of exudate in the pulp chamber
o Moisture control
o Contact with metal restoration
o Contact with gingiva
o Vital tissues still present in the partially necrotic teeth or multi-rooted teeth
204
What are the activities of daily living?
Personal hygiene
Continence management
Dressing
Feeding
Moving
205
What is Community periodontal index? How is it used?
Purpose:
The CPI is designed to:
Identify individuals in a population with periodontal disease. Assess the severity of the disease. Monitor periodontal health trends over time at both community and global levels.
Aid in planning public health initiatives related to oral care.
Examination Protocol:
The CPI uses a specially designed CPI probe (a periodontal probe with a 0.5 mm ball tip), marked at 3.5 and 5.5 mm for easy measurement.
The mouth is divided into sextants (six sections): three in the maxilla and three in the mandible.
In each sextant, only the worst periodontal condition is recorded, based on clinical indicators such as probing depth, calculus, and bleeding.
CPI Codes and Scoring:
Each sextant is scored with one of the following codes:
Code 0: Healthy – No signs of periodontal disease.
Code 1: Bleeding on probing – There is no calculus or periodontal pockets, but the gingiva bleed upon gentle probing.
Code 2: Calculus detected – Presence of supragingival or subgingival calculus, but the probing depth is 3.5 mm or less.
Code 3: Shallow pockets (4-5 mm) – Probing depth between 3.5 mm and 5.5 mm.
Code 4: Deep pockets (≥6 mm) – Probing depth greater than 5.5 mm.
Code X: Excluded sextant – Sextant not suitable for scoring (less than two teeth present in a sextant).
Code 9: Not recorded – Missing data for the sextant.
Interpretation:
The highest score in each sextant is recorded, and the periodontal condition of the individual or population is assessed.
Higher scores (Code 3 or 4) indicate more severe periodontal conditions, such as periodontal pockets, which require more complex treatment.
Lower scores (Code 0 to 2) suggest healthier periodontal status or less severe conditions that might be managed with preventive care.
206
What are the advantages of Honigum PVS heavy and lgiht body?
Advantages:
1. Excellent detail
2. high elastic recovery
3. Excellent dimensional stability
4. Easier to remove than PE
5. Easier disinfect as it takes up less water than PE
6. Taste better than PE
Disadvantages:
1. latex contamination or rectraction cords
2. Need better isolation than PE
207
What are the advantages of Impregun PE heavy and lgiht body?
Advantages:
1. Moderate hydrophilicity thus is excellent in taking impressions in moist environemnts
2. Excellent flowability
3. Amazing reproducability of preperated tooth structure
Disadvantages:
1. Taste
2. Sometime too rigid
3. Easily takes up water after impression is taken - dimensional stability may be affected
4. Short wokring time
208
What are the GIC cements available at ADH?
Ketac Cem or Fuji 1
209
What are the RMGIC cements available at ADH?
Fuji Plus or Fuji Cem
210
What are modifiable risk factors for periodontitis?
Tobacco use
Alcohol consumption
Poor diet
Diabetes
Medications
Hormonal changes
Obesity
Stress
Insufficient personal/oral hygiene
211
What are the boundaries of the submandibular space?
Anteriorly and laterally: The mandible
Medially: The anterior belly of the digastric muscle
Superiorly: The mylohyoid muscle
Inferiorly: The hyoid bone
Below and laterally: The skin, superficial fascia, platysma muscle, and superficial layer of the deep cervical fascia
212
How do you calculate the maximum amount of LA?
usually per kg of weight, you can inject 7mg of compound so
for a 60 kg person 60x7 = 420 mg
A carpule of 2.2mL of solution around 44mg of lignocaine 2%.
So theoractically a max dose is around 420/44= 9.5 carpules or 9 carpules
213
How do you manage OSA?
1. General measures including weight loss, regular aerobic exercise, nasal decongestants, preventing sleeping in supine position & avoiding sedatives & alcohol near bedtime which can decrease muscular tone in pharynx which can increase collapsibility
2. Continuous positive airway pressure machine (CPAP) to act as a pneumatic stent to create positive intraluminal pressure at all levels from nasal cavity to alveoli
3. Mandibular advancement device which mechanically increase volume of upper airway in retropalatal and retroglossal areas – may stretch TMJ and result in teeth/periodontium/Md &TMJ pain
4. Upper airway surgery using powell-riley protocol w/ 2 stage approach advocating surgical tx to specific regions of airway obstruction
214
What is a 2 minute test for TMD?
Bilateral palpation of:
Plapate the lateral polls
wear on teeth
limited opening
clicking
facial muscle tenderness
If two are positive, you need to book 30 minute appoitment
215
What are the treatment for TMD?
Treatment:
1. Patient awareness
2. Physio exercise
3. Splint therapy for 4 months
4.behaviour change
216
What are the reason for falls positive in ept?
1. Hit the gingival
2. Multi rooted teeth
3. Bad moisture control,
4. Metalic restorations
5. Patient anxiety
217
What are the treatments for dans evaginatus?
1. Observation
2. Slow cuspal reduction
3. Fluoride application
4. Fissure sealant application
5. Adjusting occlusion of opposing teeth
6. Selective pulpotomy
218
219
What should be included on a prescriptions script?
Remember ePrescriptions are preferred
1. Patient's name, address and DOB
2. Name & address of practitioner, phone number, qualifications, AHPRA reg
3. Drug name – GENERIC
4. Drug form – e.g. tablets
5. Drug strength- e.g 15 mg
6. Drug quantity in pills (word, symbol e.g Ten,10)
7. Dose & frequency of administration
8. Duration of days
9. Instruction clearly
10. Write (For dental treatment only)
11. A line to signify no other prescriptions
12. Signature of prescriber
13. Date of prescription
14. Signature
15. PBS number for prescribers
220
When should you not prescribe NSAID?
1.Kidney impairment
2.Heart failure or arterial fibrilation
3.Active GI ulcer
4.Bleeding disorder and their drugs
5.Corticosteroid or anticoagulation use
6.Multiple risk factors for increase NSAID toxicity
7.If unsure contact GP
221
What are considered to be low risk reactions to penicilin?
1. Uknown reaction more than 10 years ago
2. Childhood exanthem, unlear details with no evidence of hospitalisation
3. Diffuse or localise rash with no other symptoms after 24 hours after strating the antibiotic more than 10 years ago. This make the risk of rash on re-exposing about 5%.
222
What are considere high risk reaction to penicillin?
1. Any previous respiratory disressm, swelling of mouth or throat
2. Any history of diffuse rash which comes immediately after starting treatment
3. Diffuse or localised rash which is delayed but occurred less than 10 yearsago
Re-exposure may cause anaphylaxis, so non-beta lactam
223
What is heart failure?
Heart incapable of pumping sufficient output for needs of the peripheral tissues at usual filling pressure. Result in fluid accumulation, shortness of breath (pulpmonary oedema) from lying down and ankle swelling. Do not take NSAID's please (remember tripple whammy).
224
How to manage a patient with corticosteroids?
1. Find out how long they have been on steroids
2. Reduce stresses
3. If extraction or other steroids, to prevent an Addisonia crisis start teatment in the morning and get more steroids the day before (double the dose) and the day of treatment (double the dose) - contact GP prior.
225
What is the prescription of oral candidiasis infection for a patient with warfarin?
Nystatin liquid 100 000 units/mL 1 mL (then swallowed), 4 times a day after feeding, 7 to 14 days continue treatment for 2 to 3 days aftert symptoms resolve
226
How do ghost images occur?
Ghost images occur when an object if between the x-ray source and the center of rotation
227
Why are teeth never great ghost imagez?
Because the Panoramic X-ray is set up so the centers of rotation do not interfere with the dentition. Meaning the teeth are always between the center of rotation and receptor plate
