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Dentistry BDS4 > PPQs > Flashcards

PPQs Flashcards

1
Q

You prescribe a URA to correct an anterior crossbite of the 11. Name 4 other uses of a URA that are not the tipping/ tilting of teeth

A

habit breaking
space maintainer
retainer
widen palate

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2
Q

You are delivering an appliance to the patient and have to give them instructions and warnings. Name

A
  1. wear it 24/7 - non compliance will significantly increase treatment time
  2. remove for contact sports an d swimming
  3. brush after eating with toothbrush and water
  4. will feel big, youl get used to it
  5. will salivate a lot initially, will stop in a day or so
  6. speech will be impared, practice and it helps
  7. some discomfort is normal - regular pain killers
  8. come back if any problems or it breaks
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3
Q

Your practice receptionist receives a call from a worried mother who’s son, John has just lost his upper tooth playing ruby. You have to give Mum advice as to what to do next. Her son is 13.
What is the name for this type of injury?

A

avulsion

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4
Q

Name 3 appropriate storage media for this tooth in order of preference

A
  1. saliva
  2. milk
  3. water
    (if they have physiological saline this is preferred to water)
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5
Q

However Mum informs you that a tooth has been out of the mouth for less than 60mins and the EAT is 50mins. Describe your management of this tooth

A 
wash gently with saline and soak in saline
provide LA, clean socket
reinsert tooth gently 
radiograph to check correct place
flexible splint for 2 weeks
tet ABs
check tetanus coverage
give instructions
review 
RCT within 10 days2/4/12/26/52 weeks and yearly
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6
Q

How long would you splint the tooth if it had a EADT of greater than 60mins?

A

4 weeks rigid splint - needs ankylosis

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7
Q

What prognosis would you give mum for the 5 year survival of this tooth? that has EAT <60 mins

A

RCT is necessary - wont revascularise. necrosis is almost guaranteed
anklyosis is highly possible
loss is possible

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8
Q

What is the difference between a flexible and a rigid splint?

A

rigid encourgages ankylosis, no physiological movement - 2 teeth either side
flexible - allows physiolgical movement, trying to get physiological healing not replacement. one tooth either side

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9
Q

Name 3 herpes group viruses associated with intraoral vesiculation

A

HSV 1 and HSV 2
HH8 - kaposis sarcoma
VZV/HZV - shingles

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10
Q

Name 2 oral mucosal disease caused by COXSACKIE virus

A

HF&M
herpangina
(can also get aseptic meningitis)

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11
Q

What are 2 oral diseases caused by Epstein–Barr virus (EBV)

A

hairy leukoplakia
glandular fever
burkitts lymphoma

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12
Q

List 6 signs of “good wear” of a URA on visit.

A
  1. wearing it
  2. signs of wear on occlusal surface
  3. can talk with in it
  4. no hypersalivation
  5. active component is passive
  6. can see outline on palate
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13
Q

Describe the appearance of dental fluorosis

A

symmetrical
white/cream/yellow/brown mottling on teeth
diffuse

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14
Q

name 3 methods of delivering fluoride to an 8 year old and the concentrations for each

A
  1. toothpaste - 1450ppm
  2. FV 22600ppm
  3. MW 250ppm
  4. water 1ppm
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15
Q

What is the local action of fluoride in the oral cavity?

A

remineralisation
reduces demineralisation
inhibits ATPase H+ efflux pump in s mutans

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16
Q

Give two different options for treatment of dental fluorosis and include an advantage and disadvantage for each

A
  1. microabrasion
    adv - works well to remove brown, permanent
    disadv - removes up to 100um of enamel
  2. veneers
    adv - covers all colours
    disadv - permanent prep, will need replacing, not unitil gingival margin has settled
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17
Q

. Give the 8 different classifications of gingival/periodontal disease form the annals of periodontology 1999.

A 
Gingivitis 
Chronic perio
Aggressive perio 
Perio as manifestation of systemic disease
ANUG 
Periodontal abscess
Perio-endo lesion
Congenital abnormalities
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18
Q

Name 2 drawbacks of a FMPD pocket charts

A

time
assume all roots are the same length
discomfort for patients
operator variablity

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19
Q

Name 4 pieces of information you can get from a 6ppc

A 
teeth present
mobility
BOP
gingival margin
pocket depth
LOA
furcal involvement
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20
Q

What features of Class II div I make it amenable to correction with URA

A

teeth need tipping
generally spaces to allow tipping
only a few teeth need moving
compliance is generally good due to obviousness

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21
Q

Name 6 constituants of saliva

A 
mucins
amylase
lactoferrins
histatin
IgA
Lipases
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22
Q

Give 4 risk of orthodontic treatment

A
  1. root resorption
  2. loss of vitality
  3. relapse
  4. decalcification
  5. failure of treatment
  6. trauma to soft tissues
  7. allergy to components
  8. pain
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23
Q

Describe 4 inta-oral signs of ANUG

A
  1. punched out papilla
  2. negative gingival architecture
  3. grey slough over erythematous gingiva
  4. gingivitis
  5. bleeding and ulcers
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24
Q

What 4 risk factors pre-dispose someone to ANUG?

A
  1. immunocompromised
  2. smoking
  3. poor OH
  4. malnutrition
  5. young adults
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25
Q

Outline your treatment for this patient with anug

A 
explain the condition
find causation/risk factors and minimise exposure
ultrasonic scaling of pockets
metronidazole 200mg TID 3 days
H2O2 or CHX MW
OHI
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26
Q

patient has lost 11
Describe 3 function and 3 aesthetic considerations that should be taken into account before designing their definitive bridge

A

colour/shape of existing teeth
ginigval margin
smile line - want to preserve prosthetic privacy
occlusion - if parafunction of increased load on bridge could traumatise abutments and cause bridge to faik
periodontal status of abutment teeth - can they take the load
prognosis of surrounding teeth - are they likely to be removed soon
bonding surface - any existing restorations,

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27
Q

Describe The surgical procedure for removal of a salivary duct calculus

A

Consent

  1. Provide LA around site of salivary duct blockage.
  2. Incise FoM over duct to expose duct.
  3. Place a holding suture behind calculi to prevent movement further along the duct.
  4. Incise at duct orifice or along duct
  5. Squeeze out stone
  6. Provide suction
  7. Achieve haemostasis – suture wounds
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28
Q

Describe three factors that would make XLA of 17 an increased risk of creating an OAC

A
  1. upper molar
  2. cystic change of 7
  3. only remaining molar
  4. large sinuses
  5. hypercementosis
  6. excessive apical pressure on extraction
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29
Q

What would a patient complain of if they have an OAC?

A

water going up nose when they drink
cant use a straw
horrible taste in their mouth
sinusitis

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30
Q

How would you treat this patient if you did create an OAC that was larger than 2mm?

A 
suture closed if possible
if not possible - buccal advacement flap
could do buccal pad of fat repair
metronidazole ABs 200mg TID for 5 days
post op instructions - no smoking and no blowing nose 
CHX mw
steam inhalations
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31
Q

You receive the following result: MCV = 100 fl.

What type of Anaemia is this? (1 mark) name 2 potential causes of this anaemia (2 marks)

A

macrocytic

  1. Vitamin B12 deficiency from Crohns disease or Pernicious anaemia
  2. Folate deficiency
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32
Q

you suspect anaemia, name 4 blood test they could carry-out to support your provisional diagnosis?

A 
FBC
MCV
ferritin
B12
Folate
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33
Q

What are problems with composite as a restorative material for posterior cavities?

A
  1. large cavities - cant bulk cure, need increments. time comsuing
  2. moisture control might be difficult - use dam
  3. wear of the material - make sure it is highly resin filled
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34
Q

What 7 factors would be assessed under the SIGN 47 guideline to determine Caries risk.

A
  1. clinical
  2. F- exposure
  3. diet
  4. saliva quality and flow
  5. social history
  6. medial history
  7. plaque control
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35
Q

Give below the correct eruption sequence and dates of the primary dentition

A 
ABDCE
6 months
9 months
12 months
18 months
24 months
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36
Q

Give 4 possible indications for pulpotomy on URE

A

furcal radiolucency
abscess
to maintain tooth (space maintainer, medical Hx contraindicates)
no successor/not close to exfoliation

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37
Q

You will need to give Local Anaesthetic prior to carrying out a procedure. Give below 2 local anaesthetic agents that could be administered and their maximum safe doses in mg/kg

A

lidocaine 2% with 1:80 000 Adr = 4.4mg/kg

articaine 7mg/kg

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38
Q

What 3 factors should the posts satisfy radiographically?

A

should be the same length or greater than the crown

should extend into the alveolar bone

should have 4-5mm GP apically

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39
Q

3 indications for a placement of a crown

A
  1. after RCT to support the tooth structure

as abutment for bridge

hall technique

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40
Q

4 causes for failure of crown

A
  1. incorrect cement used
  2. incorrect preparation - walls too inclined
  3. retention and resistance form not appropriate
  4. caries
  5. subgingival margin
  6. not enough ferrule
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41
Q

Give 4 ideal properties of a luting cement

A
  1. high viscosity - can work in 20um thickness
  2. radiopaque
  3. long working time
  4. command set
  5. not toxic
  6. not soluble in oral fluids
  7. tooth coloured
42
Q

Give one advantage to a GI luting cement(1 mark) Give one disadvantage to a RMGI luiting cement (1 mark)

A

GI - bonds to tooth and metal

RMGIC - hydrophobic

43
Q

Describe how a composite luting cement bonds to porcelain

A

etch procelain with HFl.
silane coupling agent
converts hydrophilic to hydrophobic

44
Q

Describe how a composite luting cement bonds to metal

A

Sand blast or acid etch

4meta resin bonding hydrophobic to hydrophilic

45
Q

Oliver is a 72 year old man who suffers from Osteoporosis, In your taking of his medical history he states that he has just started taking Alendronic acid a week ago.
Name 1 other drugs that he could be taking to manage this condition

A

vitamin D

46
Q

How do bisphosphonates work?

A

inhibit the activity of osteoclasts and reduce bone turn over

47
Q

name 3 conditions a patient could be taking BPs for

A

osteoporosis
osteogenesis imperfecta
pagets disease of the bone
metastatic myeloma

48
Q

Patient started taking BPs a week ago - are they high or low risk of MRONJ and why?

A

they are low risk

current guidelines say high risk is
taking BPs for >5 years
IV BPs
with concurrent steroids
for cancer treatment
previously had MRONJ

patient doesnt have any risk factors

49
Q

Give the three criteria that must be met for a patient to be diagnosed with MRONJ

A

non healing wound with exposed bone >8 weeks

history of taking BPs

no history of RxH&N

50
Q

Describe preventative measures taken to prevent MRONJ

A

make sure patient is dentally fit before starting Tx

avoid XLA at all costs -coronectomy if needed

make sure dentures fit well with no traumatic areas

good OH is necessary

51
Q

Describe your surgical management of a patient who has MRONJ

A

remove sequestra causing pain, smooth any exposed bone
refer to maxfacs
follow SDCEP guidelines

52
Q

Out of the 91 participants, 15 major failures in the control group and 3 in the intervention group. How would you calculate the Absolute risk reduction( ARR)?

A

3/91 = 0.03
15/91 = 0.16
ARR = 0.16-0.03 = 0.13
In ever 100 people, there will be 13 fewer events by using the hall technique

53
Q

The ARR was 13.2% to a 95% confidence interval [4.6 to 22.4] What does this confidence interval indicate about the difference between these two numbers?

A

The ARR does not cross 1, therefore there is a difference between the control and the test.

CI means that 95% of all results will fall within those two points

54
Q

The Risk ratio was calculated to be 0.2 to a 95 % CI [0.06 to 0.67] Describe what this result shows.

A

as the RR does not cross 1 - there is a difference between them. if RR = 1 then there is the same risk of the outcome in both groups

55
Q

what is a knife edge ridge?

A

edentulous ridge
resorbed bone, leaving a high and thin ridge
class 4 atwoods

56
Q

Name 3 circumstances that might cause a knife-edge ridge

A

loss of perio bone before

immediate denture poor surgical technique

57
Q

Why are cantilever bridges more successful in anterior areas?

A

Divergent guidance paths due to the caternary curve

overall have greater survival that other bridge types

58
Q

What are some disadvantages to cantilever bridges?

A

metal shine through
uncertain longevity
can debond - once increases the chance of next time
no trial period

59
Q

What are the indications for a cantilever bridge?

A 
younger (less likely to have Rx)
good enamel quality
large abutments
minimal occlusal load
single tooth replacement
to aid RPD
60
Q

What are contraindications for a cantilever bridge?

A 
poor quality enamel (AI/MIH)
long spans
hard/soft tissue loss
parafunctions
tilted/spaced teeth
61
Q

A patient comes in with a complicated EDP# of 12. 11 has a composite and 13 has an amalgam. they need an immediate replacement - what are you options and how?

A
  1. immediate partial denture
  2. vacuum formed stent
  3. use tooth as an immediate bridge - can decoronate, de-pulp and bone iwth composite to adjacents

longer term - replace amalgam with composite for bonding RRB to

62
Q

What needs to be included in the preparation of a RRB/

A 
180 degree prep 
cingulum rests (ants)
rest seats (posts)
proximal grooves (not so much anymore)
supragingival chamfer line ~0.5mm
keep prep in enamel
63
Q

what adhesives can be used for a resin retained bridge?

A

metal/metal ceramic: RMGI (RelyX), adhesive resin, GI, Zinc phosphate

panavia (any)

All ceramic: RelyxUnicam, Nexus

64
Q

What is the process for cementation of a bridge with panavia?

A
  1. sandblast retainer
  2. degrease retainer with ethanol
  3. apply luting cement to retainer
  4. isolate tooth
  5. etch with 40% orthophosphoric acid, wash and dry
  6. primer (30 seconds) and dry
  7. fit retainer to tooth, remove excess cement
  8. place oxyguard (oxygen inhibitor) 3 mins and rinse
  9. check occlusion and OHI
65
Q

How do you evaluate potential abutments for suitability?

A
  1. root surface area and crown/root ratio (ante’s law)
  2. root configuration
  3. angulation of abutment
  4. periodontal health
  5. surface quality
  6. risk of pulp damage
  7. tooth quality (endo Tx? re do? cores present? posts?
66
Q

what is the function of a bridge?

A

restore appearance of a missing tooth
stabilise occlusion
improve mastication

67
Q

What are some different materials for making a bridge?

A

All metal (Au, Ni/CoCr)
metal ceramic
all ceramic (lithium disilicate, zirconia - Lava or procera)
ceromeric (belleglass)

68
Q

What is the SDA concept?

A

shortened dental arch, needs 3 to 5 occlusal pairs are left. generally 20 teeth
occluding premolars = 1 unit
occluding molar = 2 unit

69
Q

What are criticisms of the SDA?

A 
reduced masticatory efficiency
mand displacement and TMJ issues
aesthetics
occlusal stability
food
will only work long term if remaining dentition can be preserved for the life time of the patient
70
Q

What are benefits of the SDA?

A

provide function
mastication
aesthetics
mandibular and occlusal stability

71
Q

What are contraindications of SDA?

A 
poor prognosis of remaining dentition
perio disease
TMJ
pathological toothwear
significant malocclusion (needs occlusal contact)
72
Q

What is occlusal stability?

A

the stability of tooth positioning relative to its spacial relationship in the occluding dental araches

73
Q

What are requirements of occlusal stability?

A
  1. stable contacts on all teeth - same intensity in centric relation
  2. anterior guidance within envelope of function
  3. disclusion of all post teeth on mand protrusive movement
  4. disclusion of teeth on non moving side during lateral movement
  5. disclusion of post teeth on working side during mand lat movement
74
Q

What determines occlusal stability?

A
  1. absence of pathology
  2. perio support
  3. number of teeth
  4. interdental spacing
  5. occlusal contacts
  6. mandibular stability
75
Q

What is a classification system for toothwear?

A

smith and knight
eccles and jenkins
BeWe

76
Q

What is the clinical presentation for erosion?

A 
reduction in clinical crown height
thinned incisal edges
irregular occlusal plane
non uniform loss
sensitive if active
77
Q

What are different restorative considerations for dental erosion?

A 
extent and severity
teeth present and structure
interocclusal splace - Dahl?
confomative or re-organised approach?
dentoalveolar compensation?
78
Q

Where are the upper incisors placed when making a complete denture?

A

High smile line, centre lines, canine lines (gives midpoint and size) and they are put labial to the alveolar ridge due to the way resorption occurs in the maxilla. They are kept 9-10mm away from incisive papilla

79
Q

What are different ways to assess the A/P skeletal pattern?

A
  1. visual assessment
  2. palpate skeletal bases
  3. lateral cephalometry
80
Q

What are the normal lat ceph values for a caucasian?

A 
• SNA 81 deg 
• SNB 78 deg 
• ANB 3 deg
• UI/Mxp 109 deg 
• LI/Mnp 93 deg 
• MMPA 27 deg 
m• IIA
135 deg
81
Q

What is the presentation of hypodontia?

A 
congenital absence of one or more teeth, severe >6
delayed or asymmetric eruption
retained/infraoccluded deciduous
absent deciduous
abnormal tooth form
82
Q

What are associated dental problems with hypodontia?

A
  • microdontia
  • cleft lip and/or palate
  • malformation of other teeth
  • short root anomaly –impaction
  • delayed formation and/or delayed eruption other teeth
  • crowding and/or malposition of other teeth
  • maxillary canine/first premolar transposition
  • taurodontism
  • enamel hypoplasia
  • altered craniofacial growth
83
Q

What potential problems caused by hypodontia?

A 
spacing
drifting
over eruption
aesthetic impairment
functional problems
84
Q

What are the advantages of simple space closure treatment in hypodontia?

A

no prosthesis - relatively low maintenance
good aesthetics if done well
can be done at an early age

85
Q

What classifications of CLP are there?

A 
clefts in:
lip
alveolus
hard palate
soft palate

unilateral
bilateral
(can go LAHSHAL where bilateral lip, alveolus and hard palate)

86
Q

what is the incidence of CLP?

A

1:700 live births

M>F

87
Q

What is the aetiology behind CLP?

A

genetic factors:

  • syndromes
  • FH
  • Sex ratio
  • laterality
  • ethinicity

environment:

  • social deprivation
  • smoking
  • alcohol
  • antiepileptics
  • multivitamins
88
Q

What are implications of CLP?

A 
aesthetics
speech difficulties (if goes through tensor palatini you cant to plosive sounds)
dental problems - hypodontia
hearing and airway
other anomalies
89
Q

When do you close a CL?

A

around 3 months - helps with maternal bonding

to be safe for GA - 10 weeks/10lbs/10gHb

90
Q

What conditions are associated with CLP?

A

peirre robin

hemifacial microsomia

91
Q

Who is part of the multidisciplinary team for CLP?

A 
cleft nurse
surgeon
speech therapist
dental team
ENT/respiratory 
geneticist
psychologist
92
Q

What are the key milestones for CLP surgeries?

A 
3 months - lip closed
6-16 months - palate
8-10 years - alveolar bone graft
12-15 years - definitive ortho
18-20 years - surgery
93
Q

What are dental issues with CLP?

A 
missing teeth (lats)
impacted teeth (denticles)
crowding
growth
caries
94
Q

What are the dental implications of having a cleft through the alveolus and why do you need different memebers of the team?

A

alveolus - missing area for lats. closure can cause crowding. no bone for lats/canines to erupt in to

need psychologist to help mum, need nurse to help with feeding initially and bonding. surgeon for the surgeries, ortho to help with crowding and spacing. most have class III from scarring and max not developing
higher caries rates from hyperplastic enamel needs paeds dentist and restorative
95
Q

What are thought to be aetiological factors for RAS?

A

stopping smoking, haematinic deficiencies,stress, family history, HIV

96
Q

what are some oral lesions related to candidal infections?

A 
angular cheilitis
denture stomatitis
median rhomboid glossitis
pseudomembranous
hyperplastic
97
Q

Why do you need to monitor
speckled leukoplakia
actinic cheilitis and
oral submucosa fibrosis?

A

they are potentially malignant lesions

98
Q

What conditions is desquamative gingivitis seen in?

A

lichen planus
pemphigus vulgaris
mucouc membran pemphigoid

99
Q

what do chloesterol clefts in a cyst denote?

A

there is infection related to the cyst

100
Q

What are symptoms of gorlin goltz syndrome?

A

calcified falx cerebri
multiple basal cell carcinomas
skeletal abnormalities
multpiple odontogenic keratocysts

Dentistry BDS4 (20 decks)

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