PPQs Flashcards
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
habit breaking
space maintainer
retainer
widen palate
You are delivering an appliance to the patient and have to give them instructions and warnings. Name
- wear it 24/7 - non compliance will significantly increase treatment time
- remove for contact sports an d swimming
- brush after eating with toothbrush and water
- will feel big, youl get used to it
- will salivate a lot initially, will stop in a day or so
- speech will be impared, practice and it helps
- some discomfort is normal - regular pain killers
- come back if any problems or it breaks
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?
avulsion
Name 3 appropriate storage media for this tooth in order of preference
- saliva
- milk
- water
(if they have physiological saline this is preferred to water)
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
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
How long would you splint the tooth if it had a EADT of greater than 60mins?
4 weeks rigid splint - needs ankylosis
What prognosis would you give mum for the 5 year survival of this tooth? that has EAT <60 mins
RCT is necessary - wont revascularise. necrosis is almost guaranteed
anklyosis is highly possible
loss is possible
What is the difference between a flexible and a rigid splint?
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
Name 3 herpes group viruses associated with intraoral vesiculation
HSV 1 and HSV 2
HH8 - kaposis sarcoma
VZV/HZV - shingles
Name 2 oral mucosal disease caused by COXSACKIE virus
HF&M
herpangina
(can also get aseptic meningitis)
What are 2 oral diseases caused by Epstein–Barr virus (EBV)
hairy leukoplakia
glandular fever
burkitts lymphoma
List 6 signs of “good wear” of a URA on visit.
- wearing it
- signs of wear on occlusal surface
- can talk with in it
- no hypersalivation
- active component is passive
- can see outline on palate
Describe the appearance of dental fluorosis
symmetrical
white/cream/yellow/brown mottling on teeth
diffuse
name 3 methods of delivering fluoride to an 8 year old and the concentrations for each
- toothpaste - 1450ppm
- FV 22600ppm
- MW 250ppm
- water 1ppm
What is the local action of fluoride in the oral cavity?
remineralisation
reduces demineralisation
inhibits ATPase H+ efflux pump in s mutans
Give two different options for treatment of dental fluorosis and include an advantage and disadvantage for each
- microabrasion
adv - works well to remove brown, permanent
disadv - removes up to 100um of enamel - veneers
adv - covers all colours
disadv - permanent prep, will need replacing, not unitil gingival margin has settled
. Give the 8 different classifications of gingival/periodontal disease form the annals of periodontology 1999.
Gingivitis Chronic perio Aggressive perio Perio as manifestation of systemic disease ANUG Periodontal abscess Perio-endo lesion Congenital abnormalities
Name 2 drawbacks of a FMPD pocket charts
time
assume all roots are the same length
discomfort for patients
operator variablity
Name 4 pieces of information you can get from a 6ppc
teeth present mobility BOP gingival margin pocket depth LOA furcal involvement
What features of Class II div I make it amenable to correction with URA
teeth need tipping
generally spaces to allow tipping
only a few teeth need moving
compliance is generally good due to obviousness
Name 6 constituants of saliva
mucins amylase lactoferrins histatin IgA Lipases
Give 4 risk of orthodontic treatment
- root resorption
- loss of vitality
- relapse
- decalcification
- failure of treatment
- trauma to soft tissues
- allergy to components
- pain
Describe 4 inta-oral signs of ANUG
- punched out papilla
- negative gingival architecture
- grey slough over erythematous gingiva
- gingivitis
- bleeding and ulcers
What 4 risk factors pre-dispose someone to ANUG?
- immunocompromised
- smoking
- poor OH
- malnutrition
- young adults
Outline your treatment for this patient with anug
explain the condition find causation/risk factors and minimise exposure ultrasonic scaling of pockets metronidazole 200mg TID 3 days H2O2 or CHX MW OHI
patient has lost 11
Describe 3 function and 3 aesthetic considerations that should be taken into account before designing their definitive bridge
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,
Describe The surgical procedure for removal of a salivary duct calculus
Consent
- Provide LA around site of salivary duct blockage.
- Incise FoM over duct to expose duct.
- Place a holding suture behind calculi to prevent movement further along the duct.
- Incise at duct orifice or along duct
- Squeeze out stone
- Provide suction
- Achieve haemostasis – suture wounds
Describe three factors that would make XLA of 17 an increased risk of creating an OAC
- upper molar
- cystic change of 7
- only remaining molar
- large sinuses
- hypercementosis
- excessive apical pressure on extraction
What would a patient complain of if they have an OAC?
water going up nose when they drink
cant use a straw
horrible taste in their mouth
sinusitis
How would you treat this patient if you did create an OAC that was larger than 2mm?
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
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)
macrocytic
- Vitamin B12 deficiency from Crohns disease or Pernicious anaemia
- Folate deficiency
you suspect anaemia, name 4 blood test they could carry-out to support your provisional diagnosis?
FBC MCV ferritin B12 Folate
What are problems with composite as a restorative material for posterior cavities?
- large cavities - cant bulk cure, need increments. time comsuing
- moisture control might be difficult - use dam
- wear of the material - make sure it is highly resin filled
What 7 factors would be assessed under the SIGN 47 guideline to determine Caries risk.
- clinical
- F- exposure
- diet
- saliva quality and flow
- social history
- medial history
- plaque control
Give below the correct eruption sequence and dates of the primary dentition
ABDCE 6 months 9 months 12 months 18 months 24 months
Give 4 possible indications for pulpotomy on URE
furcal radiolucency
abscess
to maintain tooth (space maintainer, medical Hx contraindicates)
no successor/not close to exfoliation
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
lidocaine 2% with 1:80 000 Adr = 4.4mg/kg
articaine 7mg/kg
What 3 factors should the posts satisfy radiographically?
should be the same length or greater than the crown
should extend into the alveolar bone
should have 4-5mm GP apically
3 indications for a placement of a crown
- after RCT to support the tooth structure
as abutment for bridge
hall technique
4 causes for failure of crown
- incorrect cement used
- incorrect preparation - walls too inclined
- retention and resistance form not appropriate
- caries
- subgingival margin
- not enough ferrule
Give 4 ideal properties of a luting cement
- high viscosity - can work in 20um thickness
- radiopaque
- long working time
- command set
- not toxic
- not soluble in oral fluids
- tooth coloured
Give one advantage to a GI luting cement(1 mark) Give one disadvantage to a RMGI luiting cement (1 mark)
GI - bonds to tooth and metal
RMGIC - hydrophobic
Describe how a composite luting cement bonds to porcelain
etch procelain with HFl.
silane coupling agent
converts hydrophilic to hydrophobic
Describe how a composite luting cement bonds to metal
Sand blast or acid etch
4meta resin bonding hydrophobic to hydrophilic
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
vitamin D
How do bisphosphonates work?
inhibit the activity of osteoclasts and reduce bone turn over
name 3 conditions a patient could be taking BPs for
osteoporosis
osteogenesis imperfecta
pagets disease of the bone
metastatic myeloma
Patient started taking BPs a week ago - are they high or low risk of MRONJ and why?
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
Give the three criteria that must be met for a patient to be diagnosed with MRONJ
non healing wound with exposed bone >8 weeks
history of taking BPs
no history of RxH&N
Describe preventative measures taken to prevent MRONJ
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
Describe your surgical management of a patient who has MRONJ
remove sequestra causing pain, smooth any exposed bone
refer to maxfacs
follow SDCEP guidelines
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)?
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
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?
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
The Risk ratio was calculated to be 0.2 to a 95 % CI [0.06 to 0.67] Describe what this result shows.
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
what is a knife edge ridge?
edentulous ridge
resorbed bone, leaving a high and thin ridge
class 4 atwoods
Name 3 circumstances that might cause a knife-edge ridge
loss of perio bone before
immediate denture poor surgical technique
Why are cantilever bridges more successful in anterior areas?
Divergent guidance paths due to the caternary curve
overall have greater survival that other bridge types
What are some disadvantages to cantilever bridges?
metal shine through
uncertain longevity
can debond - once increases the chance of next time
no trial period
What are the indications for a cantilever bridge?
younger (less likely to have Rx) good enamel quality large abutments minimal occlusal load single tooth replacement to aid RPD
What are contraindications for a cantilever bridge?
poor quality enamel (AI/MIH) long spans hard/soft tissue loss parafunctions tilted/spaced teeth
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?
- immediate partial denture
- vacuum formed stent
- 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
What needs to be included in the preparation of a RRB/
180 degree prep cingulum rests (ants) rest seats (posts) proximal grooves (not so much anymore) supragingival chamfer line ~0.5mm keep prep in enamel
what adhesives can be used for a resin retained bridge?
metal/metal ceramic: RMGI (RelyX), adhesive resin, GI, Zinc phosphate
panavia (any)
All ceramic: RelyxUnicam, Nexus
What is the process for cementation of a bridge with panavia?
- sandblast retainer
- degrease retainer with ethanol
- apply luting cement to retainer
- isolate tooth
- etch with 40% orthophosphoric acid, wash and dry
- primer (30 seconds) and dry
- fit retainer to tooth, remove excess cement
- place oxyguard (oxygen inhibitor) 3 mins and rinse
- check occlusion and OHI
How do you evaluate potential abutments for suitability?
- root surface area and crown/root ratio (ante’s law)
- root configuration
- angulation of abutment
- periodontal health
- surface quality
- risk of pulp damage
- tooth quality (endo Tx? re do? cores present? posts?
what is the function of a bridge?
restore appearance of a missing tooth
stabilise occlusion
improve mastication
What are some different materials for making a bridge?
All metal (Au, Ni/CoCr)
metal ceramic
all ceramic (lithium disilicate, zirconia - Lava or procera)
ceromeric (belleglass)
What is the SDA concept?
shortened dental arch, needs 3 to 5 occlusal pairs are left. generally 20 teeth
occluding premolars = 1 unit
occluding molar = 2 unit
What are criticisms of the SDA?
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
What are benefits of the SDA?
provide function
mastication
aesthetics
mandibular and occlusal stability
What are contraindications of SDA?
poor prognosis of remaining dentition perio disease TMJ pathological toothwear significant malocclusion (needs occlusal contact)
What is occlusal stability?
the stability of tooth positioning relative to its spacial relationship in the occluding dental araches
What are requirements of occlusal stability?
- stable contacts on all teeth - same intensity in centric relation
- anterior guidance within envelope of function
- disclusion of all post teeth on mand protrusive movement
- disclusion of teeth on non moving side during lateral movement
- disclusion of post teeth on working side during mand lat movement
What determines occlusal stability?
- absence of pathology
- perio support
- number of teeth
- interdental spacing
- occlusal contacts
- mandibular stability
What is a classification system for toothwear?
smith and knight
eccles and jenkins
BeWe
What is the clinical presentation for erosion?
reduction in clinical crown height thinned incisal edges irregular occlusal plane non uniform loss sensitive if active
What are different restorative considerations for dental erosion?
extent and severity teeth present and structure interocclusal splace - Dahl? confomative or re-organised approach? dentoalveolar compensation?
Where are the upper incisors placed when making a complete denture?
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
What are different ways to assess the A/P skeletal pattern?
- visual assessment
- palpate skeletal bases
- lateral cephalometry
What are the normal lat ceph values for a caucasian?
• SNA 81 deg • SNB 78 deg • ANB 3 deg • UI/Mxp 109 deg • LI/Mnp 93 deg • MMPA 27 deg m• IIA 135 deg
What is the presentation of hypodontia?
congenital absence of one or more teeth, severe >6 delayed or asymmetric eruption retained/infraoccluded deciduous absent deciduous abnormal tooth form
What are associated dental problems with hypodontia?
- 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
What potential problems caused by hypodontia?
spacing drifting over eruption aesthetic impairment functional problems
What are the advantages of simple space closure treatment in hypodontia?
no prosthesis - relatively low maintenance
good aesthetics if done well
can be done at an early age
What classifications of CLP are there?
clefts in: lip alveolus hard palate soft palate
unilateral
bilateral
(can go LAHSHAL where bilateral lip, alveolus and hard palate)
what is the incidence of CLP?
1:700 live births
M>F
What is the aetiology behind CLP?
genetic factors:
- syndromes
- FH
- Sex ratio
- laterality
- ethinicity
environment:
- social deprivation
- smoking
- alcohol
- antiepileptics
- multivitamins
What are implications of CLP?
aesthetics speech difficulties (if goes through tensor palatini you cant to plosive sounds) dental problems - hypodontia hearing and airway other anomalies
When do you close a CL?
around 3 months - helps with maternal bonding
to be safe for GA - 10 weeks/10lbs/10gHb
What conditions are associated with CLP?
peirre robin
hemifacial microsomia
Who is part of the multidisciplinary team for CLP?
cleft nurse surgeon speech therapist dental team ENT/respiratory geneticist psychologist
What are the key milestones for CLP surgeries?
3 months - lip closed 6-16 months - palate 8-10 years - alveolar bone graft 12-15 years - definitive ortho 18-20 years - surgery
What are dental issues with CLP?
missing teeth (lats) impacted teeth (denticles) crowding growth caries
What are the dental implications of having a cleft through the alveolus and why do you need different memebers of the team?
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
What are thought to be aetiological factors for RAS?
stopping smoking, haematinic deficiencies,stress, family history, HIV
what are some oral lesions related to candidal infections?
angular cheilitis denture stomatitis median rhomboid glossitis pseudomembranous hyperplastic
Why do you need to monitor
speckled leukoplakia
actinic cheilitis and
oral submucosa fibrosis?
they are potentially malignant lesions
What conditions is desquamative gingivitis seen in?
lichen planus
pemphigus vulgaris
mucouc membran pemphigoid
what do chloesterol clefts in a cyst denote?
there is infection related to the cyst
What are symptoms of gorlin goltz syndrome?
calcified falx cerebri
multiple basal cell carcinomas
skeletal abnormalities
multpiple odontogenic keratocysts
