Pre Exam 1 cards + PIA revision Flashcards
1
Q
What are the differences between infected and affected dentine?
A
Infected dentine:
1. Demineralised and stained
2. Collagen framework denatured and collapsed
3. Bacteria present
Affect dentine:
1. Collagen framework intact
2. Dentine transperent and demineralised
3. There is no bacteria present
2
Q
What is the common appearance of MRONJ?
A
Pains, swelling and draining sinuses. Bone destruction. Periosteal reaction is common.
3
Q
What are the indications for crowns?
A
- Protection of weak tooth structure
- To re-establish the occlusion
- Modification of tooth shape
- Replacement of missing tooth structure
- As retainers
- Aesthetics
4
Q
What is the mechanisms of pain in cracked teeth?
A
Due to peripheral location and low excitability threshold of A-beta and A-delta fibers, rapid sharp pain is generated. In cracked teeth, the increased rapid movement of dentine fluid in dentinal tubules during relaxation after prolonged biting result in such symptom. When bacterial toxins infiltrate the pulp, hyperalgesia can result. This is a state of pulpal inflammation, which lowers the threshold of stimulation of A-delta fibers. Thus patient feels pain easier. A second type of pulpal stimulation is occurs through activation of C-fibers. C-fibers have a higher threshold of excitability thus only respond to prolonged inflammation of pulpal tissues. C-fibers activation means more than likely, pulp treatment is needed.
5
Q
What is the presentation of periodontal abcess?
A
1.Ovoid elevation of the gingival along lateral aspect of the root
2.Oedematous, red gingiva with calculus usually present
3.Pus coming out of the gingival margin
4.Increased tooth mobility
5.Pain on plapation
6.Some systemic symptoms may be observed
6
Q
What is a common radiographical appearance of squamous cell carcinoma?
A
Smoking adults. Ill-defined, permeative lesion. Spread localy and lymph nodes. Destroys bone.
7
Q
What is a Type 6 indicator and what does it do? What is it’s disadvantage?
A
Indicators that emulates the critical conditions for sterilization. E.g. 134 degrees for 3.5 minutes. GOLD STANDARD.
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.
8
Q
What is the needle stick inury protocol in dental emergencies?
A
- Stop
- Place needle/sharp aside
- Take off gloves
- Wash hands with soap and water
- Dry and cover with non-stick dressing
- Apply pressure if bleeding
- Let tutor know
- Contact SADS registered nurse for risk assessment
- Write up incident report - SLS
9
Q
What are some of the action areas of health promotion according to Ottawa charter?
A
- Build healthy public policy - think sugar tax
- Create supportive environments - think ban of sugary foods in schools
- Strengthen community action - support your local dental programs such as the indigenous oral health unit
- Develop personal skills - raising awareness with patients
- Reorient health services - focus on both high risk and popuation approach
10
Q
What are Dens Invaginatus?
A
They are deep surface invaginations of inner enamel. Most common in lateral incisors. Needs fissure sealing and maintenance of clean fissures as they are at generally higher risk of pulpal necrosis and abscess.
11
Q
What medications should you use for a person with indications for prophylaxis?
A
amoxicillin 2g for 60 minutes before a procedure
OR
clindamycin 600mg orally 60 -120 minutes before the proceudre
12
Q
What are the feature of aggressive lesions?
A
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
13
Q
What is the reasons for carrying out periodontal surgery?
A
1.Improve access to root surfaces
2.Removal of diseased tissues
3.Pocket elimination
4.Regenerative techniques
5.Removal of severely hyperplastic gingival tissues
6.Exploration of defects
7.Restorative-crown lengthening
8.Remove excess tissues
14
Q
What is the antifungal therapy for oral candidiasis?
A
Miconazole 2% gel 2.5 mL topically then swallowed, 4 times a day after food, 7 to 14 days, continue treatment for at least 7 days after symptoms resolve
OR
Nystatin liquid 100000 units/mL 1 mL topically after food, 7 to 14 days, continue treatment for at least 2-3 days after symptoms resolve
15
Q
What is the 5 As framework?
A
- Ask - ask if they smoke
- Assess - assess their stages of change
- Advise - information is the key
- Assist - discuss the benefits of quitting
- Arrange - arrange for follow-up
16
Q
What does periodontal regeneration involve?
A
Regeneration involved the placmenet of a physical/biological barrier to ensure that the root surface becomes repopulated with cementum, PDL and bone. The placment of the physical/barrier permits the growth of bone and PDL cells rather than epithelial or gingival connective tissue into the periodontal defect.
17
Q
What are the 5 moments for Hand Hygiene?
A
- Before touching a patient
- Before a procedure
- After a procedure or body fluid exposure risk
- After touching a patient
- After touching a patient’s surrounding
18
Q
What is the first line of treatment for mildly affected MIH teeth?
A
1.Remineralisation
2.Fissure sealant
19
Q
How to write a diagnosis for rem pros?
A
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
20
Q
What are the stages of tooth socket healing?
A
- haemostasis and coagulation - this is where suturing in warfarin is important
- Inflammation
- Proliferation
- Modeling and remodeling
21
Q
What is infective endocarditis?
A
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
- bacteremia - introduction of bacteria in the blood stream result in adherence of bacteria to the endocardium
- Fomation of infective vegetations
- Resulting in valve destruction, embolic events and heart failure
22
Q
What are the two types of indirect restorations?
A
- Intra-coronal - inlays or onlays
- Extra-coronal - crowns or veneers
23
Q
What is the systematic way to examine a lesion?
A
- Site - using anatomical terminology
- Size - measure with a probe
- Morphology - elevated, flat or depressed
- Colour - compare to adjacent normal tissue
- Consistency - how it feels (ONLY CLINICAL DO NOT SAY THIS IN EXAM), texture - how the surface looks like (PHOTOS ARE APPROPRIATE :))
24
Q
What is the treatment for a mandbiular and condyle fracture?
A
- Direct epihpyseal fracture of the mandible, single, closed
- Indirect fracture of the RHD condular head
Treatment for 1 - exposure of the fracture at site at the mandible and placement of direct plating of the fracture (ORIF)
Treatment for 2 - intermaxillary fixation with use of arch bars to allow the condyle to heal if it is not displaced, comminuted or severely damage in other way. This will manage the occlusion. TMJ ficxation with direct bars may be possible.
Remember:
Soft food, and wire shut jaw for the next 3 months at least.
After the surgery, patient needs to be observed until reasching 12 hour stability.
Review 24 hours, a week, a month and 3 months after. If any complications occur, review.
Remove arch bars when the condyle is healed. A period of physiotherapy might be needed.
25
Give 5 differential diagnosis for a white lesion
1. Leukodema
2. Leukoplakia
3. Lichen Planus
4. Frictional keratosis
5. Oral squamous cell carcinoma
26
Why does LA not work in infections?
1. Infection or inflammation in the region causes pH to drop
2. Concentration of the unionised (lipophilic RN) decreases
3. Areas of inflammation also jave increase blood supply due to vasodialation - thus increase LA washout
27
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.
28
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
29
What structure is under number 11?
RHS Maxillary Sinus
30
What is a common appearance of mucoepidermoid carcinoma?
Well-defined border in posterior body or angle of mandible.
31
What is the difference between the cavity preperation for a direct restoration vs indirect intra-coronal restoration?
Cavity prep can not have undercuts
32
What are the contraindications for crowns?
1. Poor oral hygiene and active dental disease
2. Cost
3. Patient's age - young patients who have large pulp chambers which may be exposed
4. Excessive removal of tooth structure
33
What is the structure number 15a?
LHS External Acoustic Meatus
34
What is a common appearance of osteogenic sarcoma?
Posterior mandible. Painless swelling. Ill-defined borderd\s. "Sun-ray" spiculation appearance. Breaks bone.
35
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.
36
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.
37
Give 5 differential diagnosis for red lesions
1. Pyogenic granuloma
2. Haemangioma
3. Peripheral Giant Cell Granuloma
4. Erythroplakia
5. Oral squamous cell carcinoma
38
What structure in under number 7?
Ear lobe
39
What is the first line of treatment for severely impacted MIH teeth?
1.Immediate treatment – desensitising
2.Intermediate treatment – SSC
3.Long-term treatment – extraction or complex restoration
4.Always consider extraction in young patient as it prevent need of life-long maintanance
40
What happens if we have 2 clicks - not equally spaced on the opening-closing process?
This could be as a result of anterior disc displacement - could be due to discal ligament being loose
41
What is structure under number 17?
Nasal septum
42
What is structure under number 4?
Pterygo-maxillary fissure
43
Why does organic matter like blood and saliva affect sterilisation?
1. It interference with actions of disinfectants
2. Disinfectant ability to penetrate down to the object's surface and provide thorough disinfection
44
What is the Australian fluoride guide?
6-17 months – no fluoride
18 months – 6 years – childrens toothpaste (400-550ppm) 2x per day spit no rinse
6+ years – normal tooth paste 1000ppms x2 a day spit no rinse
6+ years + high risk of caries – 5000ppm tooth paste 2x times a day spit no rinse
45
What are 2 factors affecting reduced vaccination in low-income countries?
-lack of access,funding and opportunity
-low education,distrust of authority and discrimimation towards minority groups
-virus> more mutations + variants in low income countries
-reduced efficacy of vaccines
46
What is the cultural iceberg?
1. Behaviors & practices - clothing, greeting, speech
2. Atttitudes - levels of fomality - manners or politness
3. Core values - good or bad behaviours
47
What is treatment for peridontal abscess?
1.Fully debried the area with or without use of surgery, under LA with saline irrigation
2.Analgesia in form of panadol
I3.f systemic symptoms exist – amoxicillin 500mgs tds+ metronidozole 400 mgs bs x 5-days
48
What are risk factors for early childhood caries?
1.Previous carious experience – but not when super young lol
2.Visible plaque – remember to screen all children
3.Dietary factors – especially sleeping with a bottle of something sugary and free sugars
4.Breast feeding IS NOT assoicated with ECC – because lactoferin kills MS
5.Enamel developmental defects
6.Low socioeconomic and sociocultural factors
7.Children with medical conditions – such the ones that need to use meidcations causing xerostomia or that predispose them to enamel hyperplasia
49
What is the common appearance of osteomyelitis?
PAIn _ subtle changes in bone density. Bone destruction with sequestration formation.
50
What is change talk?
It is the client speech that favors movement in the direction of change. When clinet says "I wish" or "I want" it is important to reinforce those believes.
51
Why would you choose a intra-coronal restoration rather than a direct material?
1. Need for stronger material
2. Difficulty with getting appropriate contact with direct restoration
52
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
53
Why can be difficult to say sorry at times?
1. Innate fight or flight response
2. Vulnerability aspect
3. Fear
4. Self-image issues
5. Worry that patient might still file a complaint
6. Lack of confidence
54
What antibiotic interacts with warfarin?
Metronidozole
55
What is effect of benzodiazapines?
1.Anxiolytic
2.Sedative
3.Hypnotic
56
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
57
What is HSPM?
Hypomiralisaed second primary molars is a condition where the second primary molar is hypomineralised. There is association between that and Molar hypomineralisation (MH)
58
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
59
When does an addisonian crisis occur and how to manage it?
Usually occurs in patient with hyperthyroidism or use of corticosteroids 6-12 hours after surgica; stress
Managment:
1. Call 000
2. Give hydrocortisone 200 mg
3. Think about GIVING MORE STEROID BEFORE PROCEDURES
60
What transmitters help to induce vomiting?
Aceetylcholine and histamine 1 at the vomiting center. Also, drugs and toxins are detected by chemoreceptor trigger zone in the brain which use dopamine 2, 5ht3 (seratonin), neurokanine 1 so you need to block the chemoreceptor trigger zone.
61
What is the pathogenesis of periodontitis?
1. Initial colonisation of the periodontal pocket by Strep and Actinomyces species
2. Increase in the amount of biofilm causing a shift from aerobic to anerobic species
3. Initial sub-gingival build up biofilm occurs, initiation of immune response in form of PMN mobilisation for containment of infection
4. Cytokine releases in response of bacteria in form of IL-1, TNF-a and IL-6, resulting in amplification of inflammatory response
5. Production of MMPs (especially MMP 8 and 9) resultin in destruction of periodontal tissues.
6. Osteoclastic activation through RANKL from IL1 and TFN-a, resulting in alveolar bone loss
7. Reduction in alveolous anf soft tissue results in periodontal pocket
8. Diabtes and Smokign makes it worst through AGEs and immunomodulation
62
What are the side effect of topical corticosteroids?
1.Oral candida
2.Hoarse voice
3.Rash
63
What are the steps to assisting a patient with facial trauma?
1.ABC – airway, breathing consciousness
2.Neurological symptoms
3.Stability - is patient stable
4.Full secondary survey with primary care pshycision at the hospital. Head to toe with all histories taken if the patient is awake.
5.Diplopia – eye movement exams. Up,down, side to side
6.Nose, upper and lower jaw examination
7.Assessment of cranial nerves especially 5 + 7 but also all other nerves
8.Intra-oral examination - find all teeth, order chest x-ray if one is missing
9.Radiology order – plain x-rays first with OPG, PA skull, submentovortex and Lat ceph
10. Treatment planning for surgery including history
11. Consent from patient
64
What happens if you use high doses of exogenous corticosteroids for a perio of time?
The cells within the cortex are not stimulated to grow by ACTH from petuitary gland. This mean when the exogenous source is depleted, there is no support coming from an endogenous source (ie natural source, self-produced by the body). For example in stress. The usual amount is more than 5mg/day of prednisolone for more than 2 weeks will require more corticosteroid.
65
What can you use as a fixative for immunofluresence?
You CAN NOT USE FORMALIN only use saline or Michel's transport medium
66
What are the aims of fixed prosthodontics?
It ranges from restoration of a single tooth to rehabilitation of the entire occlusion.
The main aims are:
1. Restore biological health
2. Restore function
3. Restore aesthetics
67
How does the diabetes damage the body?
Higher Blood glucose leads to advanced glycosylated end products (AGE) and free radicals which damage tissues - mostly on two levels
Microvascular damage - think perio
Macrovascular - think coronary artery disease and renal disease
68
What are the objective of treatment for a patient with DDE?
1.Reduce pain & sensitivity
2.Provide adequate restoration
3.Eliminate need for multiple repeat restorative procedures
4.Minimise dental anxiety and fear
5.Maintain occlusion and minimise cplexity of any furutre ortho treatment
6.Aesthetic rehabilitation
69
What is the SADS protocol for internal bleaching?
1.Patient need to be elidgible – no EMERINT PROSGENINT OR EMERREPAIR COCs
2.Consent – multiple appoitments, replacemen of restoration, upredictable, not stable and retreatment may be possible. Cervical resorption may occur
3.Titanium – 117- application of internal bleaching, 990-subsequent application of internal bleaching
4.Remove extrinsic staining
5.Record pre-op shade
6.Rubber dam
7.Remove restorative mamterial from access cavity, keep stained dentine
8.Remove endodontic filling 1-2mm below CEJ
9.Seal the access to the endodontic filling wit 2mm of GIC or cavit
10.Etch pulp chamber, rinse and dry
11.Mix sodium perborate with water until stiff paste is formed
12.Place into the labila surface of the access cavity
13.Cover the bleach with cotton pellet and seal with cavit or GIC
14.Repeate steps of bleaching every 7 days untile desired colour is achieved
15.Remove all bleaching material an rinse throughly
16.Record post-op shade
17.No definite resoration for 7 days because enamel might have been weakened
70
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
71
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
72
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.
73
What shade guide do we use in SADS?
Vita classical – used commonly in many aspects of dentistry – does not sit in the tooth banana nicely thus covers it inconsistently, with some fall outside of the banana, really incosistent value
Vita 3D Master Shade Guide – amazing for dentistry – sit nicely in the shade banana, amazing value when shown in black and white when going from 1-5 (5 is darkest thus lowest value) - Number 1 is value, Letter 1 is hue, Last number is chroma A3 and 3m2 is nearly the same colour. Infinitely compatible.
74
How do we express regret? Give an example.
I am sorry that this has happened to you.
75
What is osteoconduction?
It permits bone growth on surface or pores. This occurs in bone implants.
76
What structure in under number 2?
LHS Condyle
77
What are the parts of a dental bridge?
1. Abutment - a tooth that serves to support or retain the bridge
2. Pontic - an artificial tooth/teeth on a prosthesis that replaces a missing natural tooth
78
Why is open disclosure important?
1. Patient has a right to be informed of what is happening to them
2. To minimise harm to the patient
3. We have a duty of care to the paitnet
4. To maintain trust in the dentist-patient relationship
5. To gian informed consent for any further treatment related to the incident
6. To prevent a recurrence of the incident to others
7. To possibly avoid formal complaint
79
What is the problem with hypomineralised enamel?
1.It has an increased instance of enamel fractures
2.It has a decreased ability for retention of adhesive materials
80
What is the 4A's framework?
Ask, assess, acknowledge and address that can be used to adress a patient with dental anxiety
81
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.
82
How can we help with xerostomia?
Efficacy in unproven:
1. Saliva substitutes – Aqueae
2. Salivary peroxidase
3. Mouth washes
4.M3 receptor agonists - slaframine
5.Check prescriptions and maybe stop taking the over counter medications
6.Sip water
7. Ice blocks
8.Spray bottle
9. Suagrless lollies or sugar-free gum
10. Limit caffein & alchohol
11. Adhere to preventative dental program
83
What are biological immunomodulators?
Something like monoclonal antibodies like interferon. Patient will receive an infusion or an injection periodically.
84
What is MRONJ?
Medication-related osteonecrosis of the jaw (MRONJ) is an area of exposed bone in the jaw persisting for more than 8 weeks in a patient currently or previously treated with an antiresorptive drug, an antiangiogenic drug or romosozumab, who has not received radiation therapy to the craniofacial region. Antiresorptive drugs include bisphosphonates and denosumab. Antiangiogenic drugs (eg bevacizumab, cabozantinib, lenvatinib, sunitinib) interfere with the formation of new blood vessels, and are used in the treatment of some malignancies. Romosozumab, a sclerostin antibody inhibitor, increases bone formation and bone mineral density.
85
What is the prescritpion of analgesia for a post extraction patient for for severe acute pain?
ibuprofen 400mg orally, 6-8 hourly for 5 days if pain persists please seek review with GP
PLUS
Paracetamol 1000mg orally 4-6 hourly to a maximum of 2g for the shortes duration possible
PLUS
oxycodone immediate-release 5mg orally, 4 to 6 hourly, for 3 days. PRESCRIBE small quantities
86
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
87
What is a Type 5 indicator and what does it do? What is it's disadvantage?
Integrating indicators whouse time, temperature and pressure. Provide the same amount as a biological indicator, mimicking the conditons require to destroy biological organisms.
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.
88
What are two types of hypoglycemia?
1. Adrenergic – release of adrenaline
2. Neuroglycopenic – damage to neural cell - common in diabetics
89
What structure is under number 1?
LHS inferior border of the orbit
90
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
91
What are the different types of alveolar bone defects?
Class 1 – Bucco-lingual deficiency
Class 2 – vertical deficiency
Class 3 – combination
92
What structure is under number 15b?
Genial tubuciles
93
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
94
What are the functions of a crown?
1. Reproduces the morphology of the damaged coronal portion
2. Restore function
3. Protect remaining tooth structure
95
What are two different types of ankylosis?
1.With replacement resorption – bone is replacing dentine
2.Without replacement resorption - no bone replacing den
96
What are the two basic categories that make someone a smoker
1. Individual inflences - beliefs about smoking, self-esteem, rebellion, curisosity
2. Environental influences - parents & siblings, peers, media, availability
97
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?
98
What is syncope, what's it's causes and how do we manage it?
Syncope - transient self-limiting loss of consciousness. The onset is rapid and spontaneous and complete. Has presyncope phase of light-headed, nauseated, anxious and pale.
The underlying mechanism - cerebral hypoperfusion - i.e. low oxygen levels
Causes:
Vasovagal
Orthostatic
Cardiac dysrhythmias
Cardiac disease
Managmenet:
1. Stop treatment
2. Lie the patient down
3. Support airway by removing all object for the mouth
4. Measure the patient's blood pressure and heart rate
5. If the patient does not regain consciousness - call 000 begin DRSABCD
99
What are the signs of complete obstruction of the airways?
1. Inability to breath, speak, cry or cough
2. Agitation, gripping of the throat
3. Cyanosis
4. Bulging of the neck veins
5. rapid development of respiratory failure
6. Loss of consciousness
100
How do you deal with an upset patient?
1. Show empathy to neutralise the situation
2. Present the factual information again
3. Tell the patient that it is within their right not to do anything about the situation or seek another opinion - empower the patient
101
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.
102
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
103
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?
104
When do you use fluoride gel/foam?
Every 6 months for 4 minutes at 12300 ppm. Not recommended to less than 10 year old.
105
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
106
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
107
What is structure under number 19?
Nasal cavity/sinus
108
What are some medication that can be used for herpes simplex and varicella??
Aciclovir available orally, IV and topically. Or vallaciclovir or famciclovir.
109
What is structure under number 20?
RHS Maxillary tuberosity
110
What are the benzodiazepines avaliable for dentist?
1.Oxazepam
2.Temzepam
3.Nitrazepam
4.Diazepam – please only prescribe 1-3 tablets
111
What are the two categories of restorations?
1. Direct - activated in mouth
2. Indirect - prepared in labs or milling machines (think outside mouth and cemented in)
112
What are SGLT inhibitors?
Gliflozins. Inhibits glucose transported in renal tubules. Associated with weight loss. Can cause dehydration and infection in the urinary tract.
113
What is a good measure for double teeth?
1.Fissure sealing
2.Surgical separation
3.Ortho, implants, autotransplants or prosthesis
114
What is common appearance of periapical cemental dysplasia?
At apex bone is replaced with fibrous material. Lesion persistent after extraction.
115
How do we identify secondary images?
1. They are blurred and put of focus
2. They have the same orientation as the primary image
3. They are larger than primary image
4. They are higher up and on the opposite side
116
What are adverse effects of benzodiazapines?
1.Drowsiness
2.Impaired performance
3.Respiratory depression ESPECIALLY WITH OPIODS
4.Paradoxical excitation
5.Retrograde amnesia
6.Fantasy
7.Dependence – give 1-2 tablets only
117
What are the elements of open disclosure?
1. An apology or expression of regret
2. A factual explanation of what happened
3. An opportunity for the patient to relate their experience
4. An explanation of the steps being taken to manage the event and prevent recurrence
5. Appropriate documentation of the process
118
What are some of the pre-requisites for health according to the Ottawa Charter?
1. Peace
2. Shelter
3. Education
4. Food
5. Income
6. A stable exosystem
7. Sustainable resources
8. Social justice and equity
119
What is structure under number 8?
LHS Inferior Alveolar Nerve Canal
120
What is guided bone regeneration?
GBR involves the placement of a physical/biological barrier to ensure that the hard tissue deficiency becomes repopulated with bone.
121
What are the eruption times for permanent teeth?
1.Lower central incisors – 6-7 years
2.Upper First molar – 6-7 years
3.Lower First molar – 6-7 years
4.Upper Central Incisors – 7-8 years
5.Lower Lateral Incisors – 7-8 years
6.Upper Lateral Incisors – 8-9 years
7.Lower canine – 9-10 years old
8.Upper first premolar – 10-11 years
9.Lower first premolar – 10-12 years
10.Upper second premolar – 10-12 years
11.Upper cannines – 11-12 years old
12.Lower second molar – 11-13 years old
13.Upper second molar – 12-13 years old
14.All third molars 17-21 years old
122
What is pre-opertaive set up for a facial traum surgery?
1. Order of toxicology report for recent drug use
2. Order a blood cell count (full blood count test)
3. Order blood glucose level test if they have diabetes
4. Order IV antibiotics to reduce the chance of infection as well as IV fluids and alagesia
4. Order 1 bag of blood if need, tho not very common for facial fracutre surgery
5. Contact naethetis and book an operating room
123
What sould we record in RA notes?
1. Signed informed consent
2. Indications of Use
3. Nitrous oxide dosage in percent of N2O and O2 with flow rates and duration of the procedure
4. Patient response
124
What is the treatment for MRONJ?
For patients receiving antiresorptive drugs or romosozumab for osteoporosis, the benefits of continued therapy outweigh the low risk of medication-related osteonecrosis of the jaw in most patients—consider the following points:
Although stopping bisphosphonates for a short period is unlikely to cause harm in a patient at low risk of fracture, there is no evidence that this approach reduces the risk of medication-related osteonecrosis of the jaw.
Denosumab is a reversible antiresorptive administered every 6 months for osteoporosis. If it is possible to delay a bone-invasive dental procedure in a patient taking denosumab for osteoporosis, ideally schedule the procedure just before the next dose of denosumab. It is never appropriate to interrupt or delay the dose of denosumab; withdrawal of denosumab has been associated with an increased risk of spontaneous vertebral fractures.
Interrupting treatment with romosozumab results in a loss of bone mineral density and potential risk of fracture.
125
What is treatment for pericoronitis?
1.Debride area under operculum using monoject
2.Place patient on chlorexidine for a week
3.If major or systemic symptoms give amoxicillin in combination with metronidazole for one week
4.If it is recurring and tooth has a terrible position – extraction or operculectomy
126
What is the maximum does of fluoride roxicity?
3-5mg of fluoride/Kg. Toospase has 1mg/g. Meaning a 10kg baby needs about 30mg or 30 grams.
127
What are the steps of management if the patient is unconscious with signs of airway obstruction?
1. Call 000
2. Inspect the back of the throat for foreign object
3. Start DRSABCD
4. Consider performing cricothyroidotomy
5. DO NOT DO THE HEIMLICH MANOEURVE
128
What structure is under number 6?
Zygomatic arch
129
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.
130
What are clinical features of ECC?
1.Follows the pattern of eruption – starts with lagial, gingival and lingual surfaces of maxillary incisors and spread to molars
2.Rapid progression – DO NOT OBSERVE MAY LEAD TO DISASTER
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 is the equipment for the nitrous oxide machine?
1. Gas delivery machine – continuous flow of O2 and N2O, minimum 2.5L/minute, for children 4-5/L
2. Nasal hood – various sizes and flavours
3. Inflatable bag – provide source of additional gas, mechanisms for patient respiration, in emergency used as a method of providing positive pressure oxygen
4. Scavenging system – to trap experied gas by the patient
5. O2 flush valve – in emergency to provide jet ventilation, can cause barotrauma
133
What is the contect of odontopaste?
Clindamycin and triamcinolone
134
What is a Stafni's bone defect?
It is a salivary inclusion cyst. A well-defined oval lucencies anterior to angle of mandible.
135
What structure in under number 12?
RHS Zygomatic Arch
136
What is the prescription of amoxicillin + clavulanate for spreading odontogenic infection?
Amoxicillin 875 + clavulanate 125mg) orally, 12 hourly for 5 days
137
What is the DOT DAM principle of radiology?
Don't Order Tests that Don't Affect Management
138
How to maintain staff safety during the OPG?
1. Distance
2. Position
3. SHielding
139
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
140
What are therapeutic roles of glucocorticoids?
1. Replacement in hypoadrenalism eg Addison's disease (Addisonian crisis hehehe)
2. Immune suppression (arthitis, skin conditions or even prevention of organ transplant rejection)
141
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.
142
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
143
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
144
What is at of extreme importance when you have an aesthetic case?
For signs of erosion, attrition and abrasion. Parafunctional wear = poor longevity of a restoration. Patient will need a night guard.
145
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
146
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
147
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
148
What is parafunction in terms of the TMJ activity?
It is a day and night time, non-functional, masticatory muscle activity
149
What structure in under number 16?
Mandibular notch/oro-pheryngeal space
150
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
151
What is structure under number 18?
Infra-orbital fissure
152
How do you determine a kids dental age
1. First molar is out - above aorund 5.5 -6
2. Central incisors out - 6-8
3. Lateral out - above 8
4. First premolar out - above 10
5. Canine is not out - below 11
153
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
154
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.
155
What are the advantages of low individual effort for the population?
1. Widespread effect on nearly all populations across the social spectrum
2. Large impact at population levels
3. In certain instances - may be able to target health inequalities, though can only apply on legislative level
156
What is a good treatment plan set up?
Session 1:First impression, history, examination, X-rays, consent and tretament plan debridment, improvement in OHI and diet, Prophylaxis and fissure sealants if possible. If too much suggest GA.
Session 2: RA + Q1
Session 3: RA + Q2
Session 4: RA + Q3
Session 5: RA + Q4
3 months recall, more treatment if need
157
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
158
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
159
What are the 3 elements of autoclave sterilisation?
Moist hear in the form of saturated steam under pressure in an air tigh vessel.
Heat, steam, pressure and air tight vessel.
160
How do you write a diagnostic statement for periodontist modified by diabetes?
1. Type of periodontal disease
2. Disease extent
3. Stage
4. Grade
5. Current disease status
6. Risk factor profile
E.g.
Periodontitis: generalized (65%), Stage III (CAL <10 mm), Grade C (HbA1c 8.9%), currently unstable (PPD <8mm, BOP 45%).
Risk factors: uncontrolled diabetes (HbA1c 8.9%), smoking 20 cig/day, high strss levels (change in work)
161
What are the eruptions times for deciduous teeth?
1. Lower central incisors – 6-10 months
2. Upper Central inicsor – 8-12 months
3. Upper Lateral inicsor – 9-13 months
4. Lower lateral incosr – 10-16
5. Upper First molar – 13-19 months
6. Lower First Molar – 14-18
7. Upper Canine – 16-22 months
8. Lower canine – 17-23 months
9. Lower seond molar – 23-31 months
10. Upper Second molar 25-33 months
162
What are some of the considerations for a crown selection
1. Occlusion
2. Endodontic status/vitality
3. Other teeth requiring treatment
4. Future of tooth
5. Future dentition
6. Restorability of tooth/teeth
163
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
164
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
165
What is the structure number 10?
RHS Styloid Process
166
In what instances shoudl you have antibiotic prophylaxis?
1. Prosthetic cardiac valve
2. prosthetic material for valve repair
3. previous infective endocarditis
4. Congenetive heart disease but only if it involved: unrepaired cyanotic residual defect and repaired defect with residual defects
5. Rheumatic heart disease
167
What is the role of dental practitioner in terms of reducing smoking rates in patients?
1. Take the time to talk to your patient
2. Provide smoking cessation materials in the waiting room
3. NRT doubles the chance of success for smoking cessation
4. NRT + behavioural support further increases the chance of success
168
What are the steps of pathology for a transverse root fracture?
1.Facial trauma, frontal force
2.Transverse fracture – occurs if dentine, cementum and pulp involved, if enamel is also involved – it is a crown root fracture
3.Take radiograph and do all of the test
4.Reparative tissue in a form of tertiary dentine is laied down in the fracture area
5.Over time – root canal stenosis may occur – pulpal tissue will be replaced with deposited hard tissue through "buldging hard tissue" with prior joining of fracture line with fibrous connective tissue - this is done primarily by the pulp - the reparative capacity of dental hard tissue should not be underestimated
169
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
170
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
171
What is the process of vitamin C depletion related to smoking?
1. Vitamin C is a water soluble vitamin that acts as an anti-oxidant to eradicate cancer causing free radicals in the body
2. Cigarette smoking speeds up the production of free radicals
3. This depletes the levels of free Vitamin C in the system
There is evidence that reduction in Vitamin C also relates to poor dietary intake.
172
What is structure under number 14?
Secondary image of RHS palate
173
What are anticholinergic bronchodilators used for?
Ipratropium or Tiotropium are used in treatment of chronic COPD or acute asthma. Remember, dry mouth
174
What are 6 social factors for vaccine hesitancy?
1. distrust of govt
2. distrust of medical authorities
3. religious reasons/cultural belief differiing
4. personal beliefs about the nature of their immunity
5. concerns about side effects
6. belief that viral diseases are mild and self limiting
7. parental use of non medical exemptions to bypass vaccination requirements
175
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
176
What is nasopalatine cyst?
A defined radiolucency that occurs in the palate
177
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
178
FheFGive 5 differential diagnosis for a gum lump?
1. Haemangioma
2.Fibroepithelial epulis
3. Pyogenic granuloma
4. Peripheral giant cell granuloma
5. Calcifying fibroblastic granuloma
179
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.
180
What is the prescription of intravenous antibiotics for spreading odontogenic infection?
Benzylpencilli aintravenously in intensive care 2.4g 4 hourly
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
What is a common appearance of cementoblastoma?
Slow growing lesion full of cementum like tissue. Attached to root apex. Well-defined with cortical border.
183
Give 5 differential diagnosis for a pigmented lesion?
1. Oral melanotic macule
2. Mucosal melanocytic naevus
3. Amalgam tattoo
4. Malignant melanoma
5. Smokers melanosis
184
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
185
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
186
What are the steps of management if the patient is conscious with signs of airway obstruction?
1. Call 000
2. Reassure the patient and ask them to relax, breete deeply and try to dislodge the object by coughing
3. If coughing is ineffective - give upto 5 back blows between the shoulder blades - check between each hit
4. If the back blows dont work, do 5 chest thrust similar to CPR
5. Continue until assistance arrives
187
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.
188
What are the indications for a veneer?
1. Diastema closure
2. Alter shape, contour, position
3. Alter tooth color
4. Mask tooth surface anomalies
189
Give 5 differential diagnosis for an ulcer?
1. Herpetiform ampthous ulcer
2. Mild amthous ulcer
3. Major ampthous ulcer
4. Traumatic acute ulcer
5. Traumatic chronic ulcer
190
What type of bones are present in the cranial vault?
Flat membranous bones with suture in between. Osteogenesis occurs in the ossification centres + sutures. The cause of increase area of bones occurs due to brain growth. The out cortical plate usually deposits and inner cortical plate resorts.
191
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
192
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
193
What intra-operative factors are associated to negative outcome in endo?
1.Iatrogenic perforation
2.Patency at apical terminus
3.Extrusion of root fillings
194
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
195
Up until which point can you perform a pulpotomy?
Up until reversible pulpitis as after, according to the continuum of Pulp Status, an extraction or a pulpectomy is recommended. Followign symptoms are bad:
1.Spontaneous pain kept awake at nigh
2.TTP
3.Abscess
4.Mobility
5.Facial swelling celulitis
196
What is the use of sedative and hypnotics in dentistry?
Majority will be used to reduce anxiety before/during dental procedures
197
What is a prescription of anaelgisics for mild-to-moderate acute dental pain if NSAIDs are contra indicated?
Paracetamol 1000mg 4-6 hourly for shortest duration possible
198
What is osteoinduction?
Recruitment of immature cells and stimulation of these cells to develop into pre-osteoblast e.g. bone healing situations
199
What is the structure number 5?
Condesnsing osteotitis around the 35
200
What happens if we have 2 clicks - equally spaced on the opening-closing process?
This could due to a deviation in form - a condylar or eminence bulge!
201
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!
202
What are the proton pump inhibitors?
Omeprazole or other. Irreversibly inhibit the proton pump stopping the production of gastric acid. Very rare adverse effect.
203
What is structure under number 13?
Primary image of RHS hard palate
204
What are factors to consider for pharmacological intervention for behaviour management?
1.Patient age
2.Patienet behaviour
3.Treatment required
4.Medical condiitons
5.Distance travelled
6.Language barrier
7.Risk and benefits
8.Practitioner experience
9.Informed consent
205
What are some of the positive reinforcements?
1. Motivational advice
2. Verbal praise, non-verbal such as smile or STICKERS
206
What are the most commonly used material in periodontal regenerations?
1.Bone grafts
2.Membranes
3.Growth factors
207
What is pericoronitis?
It is a localised infection in gingival tissue and mucosa surrounding a partially erupted tooth. Patient complain of a sore tooth. Explain to patient that pain actually arises from infection and inflammation in the soft tissues surrounding the tooth and not the tooth itself.
208
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
209
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
210
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.
211
What is structure under number 3?
Superimposed over the sinus, malar process
212
What type of plan works the best for client who would like to change?
A SMART plan:
Specific
Measurable
Achievable
Relevant
Timed
213
What are the actions of corticosteroid in lung disease?
1. Anti-inflammatory
2. Reduce bronchial hyperactivity
3. Increase number of beta 2 adrenpreceptors
4. Increase responsiveness to beta 2 agonsits
Example: Beclomethasone
214
What is molar-incisor hypomineralisation?
It is a qualitative enamel defects of systemic origin, affecting one to four first permanent molars and frequently associated with affected incisors
215
What are small moluce immunosupressants?
Cyclosporine and tacrolimu for example. They can potentially interfere with healing and immunity. Can also cause gingival hyperplasia.
216
What are good antiemetics?
1. Metoclopramide – dopamine antagonist (please don’t use in Parkinson's disease) - may cause extrapyramidal effects – use 10mg 6-8 hour;y oral
2. Prochlorperazine – dopamine antagonists, also anthistamine, alpha blocker and anticholinergic – problems: drowsiness, hypotentsion, dry mouth also cardiac effect
217
What is the common appearance of eosinophilic granuloma?
Solitary lesion, well-defined bu non-corticated with irregular margins. DESTROYS BONE AND LEAVES THE FLOATING TOOTH APPEARANCE. Periosteal new bone formation is common.
218
What are considered sever cutaneous reactions to penicillin?
1.Rash with mucosal ulceration
2.Oustules, blister, desquamation
3.More
These features show that the next ras could be fatal. Non-beta lactam antibiotic should be usd.
219
How does peiodontal abscess form?
1.As an acute exacerbation of untreated perio
2.During periodontal therpay or immediatley after scaling
3.In refractory periodontitis (low response to treatment)
4.Due to dislodgement of calculus
5.Treatment with antibiotics but without debridement – change in subgignival microbiota leading to superinfection
220
What nerve innorvates gingiva of mandibular canine?
Incisive branch of IAN
221
What is a motivational interview?
It is an effective (evidence based) way to communicate with an individual about change
222
What is Type 2 indicator and what does it do? What is it's disadvantage?
Type 2 are specific test indicators designed to show air removal and rapid or even steam penetration.
Disadvantage: may react at a point of sterilisation that is below the point of adequate sterilisation.
223
What are sulphonylureas?
They stimulate the release of insulin from pancrease. Can cause hypoglycemia. Abuse pancrease so no good. Causes weight gain.
224
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
225
What is structure under number 9?
Central Hyoid bone
226
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
227
What are the two patient centered reasons to do open disclosure?
1. It is part of legal requirements
2. It respects patient autonomy
3. Helps patient ot build trust in the dentla porfession
228
What are the symport relievers available?
1.Salbutamol
2.Tobuterol
They are short acting and there duration is 3-6 hours or can be made into long acting for upto 12 hours.
229
What are Dens Evanginatus?
They are cusp-like elevations of enamel located in central groove or lingual of premolars and molars. They are prone to fractures so early diagnosis is essential. Partial pulpotomy might be beneficial. Can occur in anterior teeth as "talon cusp", and it should be removed.
230
What is the prescritpion of analgesia for a post extraction patient for mild to moderate acute pain?
ibuprofen 400mg orally, 6-8 hourly for 5 days if pain persists please seek review with GP
PLUS
Paracetamol 1000mg orally 4-6 hourly to a maximum of 2g for the shortes duration possible
231
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.
232
How do we define cases of gingivitis in a reduced periodontium without history of periodontitis?
Localized gingivitis: Probing attachment loss – Yes, Radiographic bone loss – Possible, Probing depth all sites – less than 3mm, BOP score – between 10% to 30%
Generalised gingivitis: Probing attachment loss – Yes, Radiographic bone loss – Possible, Probing depth all sites – less than 3 mm, BOP score – above 30%
233
What are predisposing factor to periodontal abcess?
1.FUrcation areas
2.Patients with diabetes – impaired cellular immunited, decreased leukocyte chemotaxis and bactericidal activity
234
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
235
How come periodontal abscess occur in patient without periodontitis?
1.Impaction of foreign bodies like orthodontic elastics or popcorn
2.Local factors affecting tooth morphology
236
What are two separate but linked process are initiated in SA dental post patient incident?
1. Open disclosure
2. Incident reporting
237
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.
238
What are giant cell lesions?
Anterior to first molar. Slow growing with well-defined margin. Some cortical expansion can occur.
239
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%.
240
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
241
What are the major classses of antobiotics in dentistry?
1.Beta-lactams – inhibit bacterial walls and interference of bacterial wall synthesis. Beta lactamase can build resistance to beta lactams. Good spectrum of action, safe and wide therapeutic index. Generics: benzyl penicillin or phempxymethyl penicillin. Act on gram positive cocci thus can affect oral flora. Could be short spectrum or moderate spectrum (amoxycyllin). Can be used with clavulanate (inhibitor of beta lactamase) making it target anaerobes, good for elderly. Main side effects: allergy, GI issues and hepatoxicity.
2. Cephalsporins – also beta lactam but not pencillins. Broader spectrum. Not very much used.
3. Nitromidazole – metronidozole. Inhibits DNA synthesis and covers anaerobes. Adverse reactions: GI problems, dizziness, bitter and metalic tase. No alcohol as metronidozole inhibits the brekdown of alchohol. Need to wai 72 hours after finishing a script
4. Lincosamides – clindamycin. Inhibits bacteria protein synthesis. Good for Gram positive and anearobic bacteria. Adverse reactions: GI problems (bad ones), allergy
5. Macrolieds – erythromycin. Good for gram positive but not for anaerobes. Adverse effects: GI issues, a lot of drug interactions
242
What is the spirit of motivational interviewing?
4 concepts are the:
1. Partnership or collaboration between individual and councillor
2. Acceptance - respecting the client's autonomy
3. Compassion - keep clients best interest in mind
4. Evocation - the best ideas come from the client
243
What are two types of local anaesthetic?
1. Amino esther - broken down by enzymes
2. Amide type - metabolised in the liver
244
What does the pKa in local anaesthetic represent?
It represent the balance between charged and uncharged molecles of the solution. I.E. at pKa 7.6 there is equal number of molecules, thus at pH 7.6 there will be am equal number of molecules
245
What is the importance of RN in local anaesthetic?
The uncharged RN molecules, represent the number of molecules that can pass through the phospho-lipid bi-layer as they are water soluble. Turns to RNH+ which actually bind to sodium channel.
246
Why is the pH of injecting site important?
The pH at the injecting site may alter the numbers of RN making it unable to diffuse into the cells.
247
What happens when the pKa of LA is high?
This can decrease the number of RNs at the injection site thus will prolong the onset of the anaesthetic.
248
What is the objective of vasoconstrictors in LA?
1.Decrease blood flow
2.Slow absorption of LA into blood stream
3.Maintain higher local concentrations of LA
4.Longer duration of LA action
5.Reduced bleeding
249
What is the standard local anaesthetic equipment?
1. Aspirating and non-aspirating syringes
2. Short (25mm) and long (40mm) needles
3. 25, 27 (the usual size, and 30 gauge needles
4. Glass cartridges
250
What are 3 commonly used LA techniques?
1. Topical
2.Block
3.Infiltration
251
What are the landmarks that help to locate teh site of IAN?
1.Level - coronoid notch, 1cm above lower occlusal plane, midway between arches with mouth wide open, buccal pad
2.Angle - opposite premolars
3.Entry point - pterygotemporal depression
252
What is common appearance of allergic reaction to SLS?
Ulcers, biofilm and tissue slouching
253
What toothpaste would you recomend for a person with SLS allergy?
Sensodyne Full Protection
254
What is the function of sodium metabisulfite in LA?
It is an antioxodienta that helps to prevent oxidation of epinephrine, thereby maintain its effectiveness
255
What is the function of methylparaben in LA?
It is a preservative that prevents microbial growth
256
What is the function of water in injection in LA?
Solvent used to dissolve all the other components to form the injectable solution.
257
How many microsieverts does bitewing produce?
5
258
How many microsieveerts does OPG produce?
around 20-30
259
How many microsieveerts does CBCT produce?
around 30-200 depending on the number of units of areas included in the scan
260
How many microsieveerts does convetional CT produce?
2000-4000
261
How many microsieveerts does MDCT produce?
1000-2000
262
What are two different types of damage you can recieve from radiation?
Determenistic - cell death
Stocastic - cell alteration resulting in cancer
