quizlet Flashcards
advice for dealing with splint
careful OH. particularly aroudn area
no contact sports
soft diet initially and avoid hard and sticky foods
possible chlorohexidine
advice for dealing with avulsed tooth
pick up ny crown, not root
rinse under cold running water for 10s
reinsert if possible, if not store in saliva or milk
get appointment ASAP
define sterile
theoretical probability of there being a viable microorganism on devise is equal to or less than 1 in a million
describe 4 streams of waste disposal
black = domestic
orange = low risk clinical
yellow = high risk clincal
red = special waste
describe a mobility test
apply gentle finger pressure and see how much tooth moves bucco-lingually
grade 0 - no apparent mobility
grade 1- <1mm mobility
grade 2- 1-2mm mobility
grade 3- >2mm mobility + occlusoapical movement
describe CPR in adults
30:2 compressions to breaths
compression 2 per second, 5-5cm deep
give 15l per min 100% oxygen
describe Craddock classification
describes support
1 - tooth borne
2- mucosa borne
3 - mixed
types of elevators
warwick james - right, left, straight
coupland’s - 5 types (1 = narrow)
Cryer’s - right and left, sharp beak
different levels of bleeding risk in dental setting
low - LA, BPE, supragingival scaling
medium - simple extractions, incision of swelling, 6PPC, PMPR, subgingival
high - complex extractions (3+ or adj), flaps, biopsies
external inflammatory resorption and how you would treat it
necrotic pulp releases bacteria that damage PDL
looks moth eaten on radiograph
RCT with CaOH left for 6 weeks pre-obturation
describe external surface resorption
pressure results in PDL damage
describe internal inflammatory resorption and how you would treat it
non vital pulp causes damage within tooth, resulting in ‘ballooning’ of pulp space
RCT with CaOH left with 6 weeks pre-obturation
descrive Kennedy’s classification
describes saddles
I - bilateral free end saddle
II - unilateral free end saddle
III - bounded saddle
IV - anterior bounded saddle over midline
describe lower extraction forceps
beak at right angle to handles
lower universal - 1s to 5s
lower roots - roots
lower molars - triangular beak for furcation
cowhorns - broken and multirooted teeth
possible smoking cessation discussion with a pt
5As
Ask - if willing to talk if and what they smoke
Advise - best to quit for oral and general health (clots,
higher bp, double heart attack)
Assess - how much they smoke? pack years? willingness to quit?
Assist - signpost to pharmacological and counselling services, set up plan, 4x more likely to quit with
support & 50-70% more likely with nicotine replacement therapy
Arrange - follow up at next appointment
describe replacement resorption
ankylosis
bony healing due to severe PDL damage
ARAB in URA design
active component - moves teeth via force
retention - resists dislodging forces
anchorage - resistance to unwanted tooth movement
baseplate - connection, retention, anchorage
chain of infection
infectious agent
reservoir
portal of exit
mode of transmission
portal of entry
susceptible host
BPE scores
0 - no bleeding, no pockets >3mm, no calculus
1 - bleeding, but no pockets >3mm or calculus
2 - calculus or overhangs
3 - pockets 3-5mm
4 - pockets >5mm
describe nickel titanium
exotic metal - exhibits super-elasticity, undergoing phase transistion when stressed to cope with it better
martensititc form - softer than austentitic
electrip pulp testing process
set dial to zero and attach tip
apply paste to tooth
hold on tooth and direct pt to hold it
slowly increase dial
describe external vital tooth whitening process
chairside - clean, dental dam, bleach, heat/light, wash, dry, repeat
home - apply dot to vacuum formed splint on the buccal of each tooth and wear fr at least 2 hours per day
process of internal non-vital tooth whitening
remove GP from pulp chamber and 1mm below ACJ, then seal GP with RMGIC and etch
then fill with bleaching gel and seal with cotton wool and GIC
repeat weekly until shade achieved
process of washer disinfector
neutral detergent for 12s at 80 degrees - ensure no overlap and hinges open
tx planning stages
immediate - releif of acute problems/pain
intial - e.g. HPT, restorations
re-evaluation - re-assess perio status
re-constructive - e.g. endo, pros
maintenance - review restorations
descibe the two types of Adam’s pliers
no 64 - straight edges, right angles
no 65 - one curved beak, coil formers
two types of manual wash
immersible - under water with detergent
non-immersible - wipe with cloth
describe the upper extraction forceps
beak in line with handles
upper straight - 1s and 2s
upper universals - for canines and premolars
upper roots - roots
upper molar - beak to cheek
upper bayonet - 3rd molars
upper bayonet roots - 3rd molar roots
how to determine occlusal plane
parallel to ala-tragus line
how can use elevators
rotate
lever
wedge
how does apixaban work
factor Xa inhibitor
how does bone resorb on edentulous arches
upper - up and in (narrower)
lower - down and out (wider)
how does dabigatran work
direct thrombin inhibitor
how does GI luting cement bond to tooh surface
bonds to calcium ions in enamel
how do you calculate Loss of attachment
add ginigval margin value (from gingival margin to ACJ, positive if recession, negative if inflammed)
to pocket depth (gingival margin to base of pocket)
deal with sharps injury
stop treatment and safely dispse of sharp
squeeze area to encourage bleeding
wash with water and non-antimicrobial soap
cover with waterproof dressing
inform pt
risk asses pt
document and contact occupational health
how to extract a tooth
support alveolar bone with left finger and thumb
place beaks far down root on ACJ
push to preak PDL and twist (single rooted - buccal to midline, multirooted - fingure of 8)
how to mix Glass ionomer
3 scoops to 3 drops distilled water
handpiece safety tests
try to rotate back cap anticlockwise
try to pull bur out of handpiece
rotate bur between fingers (should be smooth)
try to move bur laterally
check it running for 5secs for sound
(also ensure safely in chuck)
how to select an oropharngeal airway
hold base at angle of mandible and mouthpiece should rest level with incisors
how is retention achieved in complete dentures
accurate fit and flanges extended to sulcus depth and border seal with post-dam on uppers
how is retention achieved in RPD
clasps (ring, single, I bar)
guide planes (parallel surface on abutments)
altered path of insertion
RPI (for free end saddles)
how long should 6 step hand hygiene take
40-60 seconds for handwash
20-30 seconds for ABHR
how many teeth should be in sectant to qualify for BPE to be recorded
2
how to deal with suspected domestic abuse
Ask (e.g. i’ve noticed [injury] is everything OK? Are you safe?)
Validate (e.g. i am concerned for your safety, this is not OK)
Document - clearly in notes, in their words, specify injury
Refer by signposting pt e.g. Scottish Domestic Abuse Helpline
how to deal with bodily fluid spillage
cordon off area
assess spillage type
collect equipment
put on PPE
clean (sodium hypochlorite or sodium dichloroisocyanurate 10,000 for blood or 1000 urine)
how to tx alveolar bone #
reposition and splint
how to tx acute asthma attack
assess pt - if life threatening (will become bradycardic and dec resp rate) then transfer to hospital
sit upright and give their inhaler or 4 puffs of salbutamol
give 15l/min 100% oxygen
if doesn’t response in 5 mins send to hospital
how to tx acute coronary incident
give 15l/min 100% oxygen
give 2 puff GTN sublingually
if pain continues repeat GTN after 3mins
if pain continues, call 999 and give 300mg dispersible aspirin
how to tx anaphylaxis
assess pt and call 999
lie flat and raise feet to restore blood pressure
remove source of anaphylaxis if possible
give 15l/min 100% oxygen
give 0.5ml intramuscular adreanline
repeat adrenaline in 5 mins if necessary
how to treat ANUG
ultrasonic debridement
OHI
chlorhexidine
possible antibiotics if systemic
how to tx permanent avulsion injury
if <60mins out of mouth: replant and 2 week splint (with RCT within 10 days if closed apex)
if >60mins out of mouth: replant with 4 week splint (with RCT within 10 days if closed apex)
how to tx permanent concussion injury
occlusal relief if pain on biting
how to tx a permanent crown-root fracture
restore or remove fragments or extract
how to tx permanent enamel-dentine fracture
take 2 periapicals to ensure no luxation or root fracture bond fragment or composite bandage
how to tx a permanent enamel-dentine-pulp fracture
if vital tooth and small exposure <24hrs: pulp cap
if vital tooth but larger or older: pulpotomy
if non vital: pulpectomy
how to tx permanent enamel #
take 2 periapicals to ensure no luxation or root #
bond fragment and smooth edges
how to treat a permanent extrusion injury
reposition under LA and 2 week flexible splint
how to treat permanent intrusion injury
if open apex up to 7mm or closed up to 3mm can leave to spontaneously re-erupt
if larger injury on open apex or closed apex - orthodontic and/or surgical
how to tx permanent lateral luxation injury
reposition under LA and 4 week flexible splint
how to tx permanent root #
apical or middle 1/3: 4 weeks splint
coronal 1/3: 4 month splint
how would you treat a permanent subluxation injury
possible occlusal relief (add composite or file down) if pain on biting
2 week flexible splint
how to tx epilepsy
secure airway and give oxygen
if long fit (>5mins) or repeated, give midazolam
if first fit or different symptoms - hospital
how to tx hypoglycaemia
give 15l/min 100% oxygen
if concious, give 10-20g oral glucose
if unconcious, give 1mg glucagon injection
how to tx irrversible pulpitis
RCT or extract
how to tx primary avulsion
don’t replant
radiograph to ensure no remaining fragments
how to tx primary crown-root #
extract coronal fragments
how to tx primary extrusion
extract
how to tx primary lateral luxation
if no occlusal interference allow to spontaneously reposition
if there is - extract
how to tx reversible pulpitis
dress and restore
how to treat syncope
lie flat and raise feet if possible
loosen any tight clothing around neck
give 15l/mins 100% oxygen until concious
negative response to sensibility test
how to continue
check if TTP
radiograph (possible thickend PDL)
INR and warfarin
normally 2-3
can tx if <4 (take up to 72hrs before if well controlled, ideally 24hrs)
2 sealers used in endo
epoxy resin
calcium silicate (bioceramic)
noraml diabetic blood glucose levels
before eating: 4-7mmol/l
after eating: under 9mmol/l
normal levels for HbA1c (controlled diabetic)
48mmol/mol (6.5%)
pt presents with high resp rate and tachycardua and can’t complete sentences in one breath
acute asthma attack
pt presents with pain, hallitosis and bleeding gum
on examination, there are large ulcers on their papillae that are covered with greyish slough - when this is removed the tissue begin bleeding
necrotising periodontal disease
pt presents with severe, crushing central chest pain that radiates to left arm
acute coronary incident (angina or MI)
pt presents with tachycardia, sweating, shaking, issues concentrating, slurred speech, they then begin to lose conciousness
hypoglycaemia
pt presents with upper airway oedema and bronchospasm, stridor and wheeze, tachycardia, inc resp rate
anaphylaxis
state causes of tooth discoluration
intrinsic: dental materals, age, fluorsis, CF
extrinsic: smoking, tanins
state relevant legislation for decontamination
Health and Safety at Work Act 1974
articaine strength
4%
1:100,000 adrenline
lidocaine
strength
2% 1:80,000 adrenaline
prilocaine strength
3%
0.03IU/ml felypressin
types of RPD connector
plate/strap (thin, mucosal support)
bar (thicker tooth support)
3 types of hand hygiene
social
hygienic
surgical
7 elements of caries risk assessment
clinical evidence
medical history
social history
dietary habits
plaque control
saliva
fluoride use
use of elevators
mobilise teeth
issues with BPE
doesn’t describe extent of disease
pocket depth can be misleading (e.g. false pockets)
risk factors for ANUG
immunocompromised (HIV, malnutrition)
smoker
types of steriliser
N type - no vacuum
B type - vacuum
5 moments to perform hand hygiene
before touching pt
after touching pt
after touching pt surroundings
before aspectic procedure
after body fluid exposure risk
8 elements of caries prevention
radiographs (high risk - 6 monthly, low risk primary/mixed dentition - 12-18 months, low risk -adults 2 years)
dietary advice
OHI
fluoride varnish (22,600ppm 3 or 6 monthly)
fluoride supplements
fissure sealants (35% etch and bis-GMA resin)
sugar free medicine
components of amalgam
silver tin, copper, and mercury
components of glass ionomer
polyacrylic acid and silica and aluminium dioxide
conditions for sterilisation
134 degrees at 2.25bar pressure for at least 3mins
principles of cavity preparation
Access - identify and remove carious enamel
Extent - remove enamel to reveal lesion at ADJ
Remove Dentinal Caries - peripherallly from ADJ inwards, then remove deep caries over pulp
Modifications - smooth and remove sharp angles
Outline form - depending on restoration
stages of hygiene phase therapy
dental health education
OHI
scaling
PMPR
overhang removal
LA block too far back
parotid gland hit -> facial palsy
what can’t be placed in ultrasonic machine
handpieces
what component is activated by coiling
Robert’s retractor
factors affect sodium hypochlorite function
concentration
volume
contact with debris
mechanical agitation
what impacts the prognosis of permanent trauma
stage of root development
type of injury
presence of infection
PDL injury
time before treatment
what is a concussion tooth injury
pain on percussion but no increased mobility or displacment
use of luxator
breaking the PDL
what is subluxation injury
increased mobility but no displacment
what is collimation
lead device reduces size and shape of x-ray beam
therefore reducing irradiated tissue
what is TempBond made of
temporary luting cement made of two paste system - base (ZnO) + accelerator (eugenol +resin) soft for easy removal
what is the ‘artwork’ of cast
non anatomical area
what is the difference between RMGI restorative material and RMGI luting cement
smaller partical size
what is the hamular notch
indent at junction of maxillar and hamulus of sphenoid bone - distal border of denture
what is maximum tooth whitening gel strength
6% hydrogen peroxide (equates to 10-15% carbamine peroxide)
max x-ray beam diameter
60mm
min focus to skin distance
20cm
order of donning PPE
hand hygiene
apron
mask
visor/goggles
gloves
doffing PPE
gloves
apron
visor/goggles
mask
hand hygiene
paralleling technique for xray
image receptor and object parallel but not in contact
process of decontamination
washer disinfector
manual wash
ultrasonic
cold water rinse
washer disnfector
steriliser
Sinner Circle
factors determining the success of a wash (chemicals, energy, termperature, time)
what is used to bond composite
hydroxymethacrylate in acetone solvent
what is used to etch teeth and why
35% phosphotic acid creates micromechanical roughness in enamel and helps solubilise dentine to create hybrid layer (exposed collagen fibrils embedded in resin)
what makes up an intraoral film holder
bite block + film support + connecting rod + beam aiming device
what makes up composite
resin - bis-GMA (from bisphenol glucidyl methacrylate)
glass filler - silica or quartz
photoiniatitor - camphorquinone (440nm)
silane coupling agents
dimethacrylates
what makes up tooth whitening gel
carbamine peroxide
carbopol (thickens)
fluoride (decreases sensitivty)
what medicament can be used on a particularly inflammed pulp
ledermix antimicrobial paste (corticosteroid and tetracycline)
what might cause a false negative response to sensibility test
large restoration
thick lining
tertiary dentine
what migh cause a false positive result to a sensibility test
multirooted, some pulp may be vital and some non vital
canal full of pus
pt apprehensive and over reacts
what may cause pulpitis
caries
trauma
multiple restorations
what nerves are at risk during lower 3rd molar extractions
lingual
inferior alveolar
mylohyoid
buccal
Qs to ask about trauma
what happened?
when?
where is the tooth now?
pt gets BPE 3 what to do
6PPC in the area of 3
(SDCEP recommends pre and post tx, BSP recommends only after)
pt has BPE 4 what to do
full moiuth 6PPC pre and post tx
needle size use for block
35mm (long)
needle for infiltration
25mm (short)
film sizes for intraoral xrays
size 0 = deciduous BW or anterior PA
size 1 = anterior PA
size 2 = adult BW or posterior PA
size 4 = occlusals
sizes of intraoral film
size 0 = 21x24mm
size 1 = 24x40mm
size 2 = 30x40mm
size 4 = 70x50mm
speed of high speed handpiece
400,00rpm
speed of slow speed handpiece
20,000rpm
tests do to for permanent trauma
sinus
colour
TTP
percussion note
mobility
eletric pulp test
ethyl chloride
radiographs
tests to do for primary trauma
sinus
colour
TTP
percussion note
mobility
radiograph
types of caridac arrest that are shockable
ventricular fibrillation
tachycardia
(2/4)
when does a primary intrusion injury risk damage to permanent successor
if it is palatally displaced
when to use a flat posterior bite plane and why
z-spring: to prevent lower teeth interfering with movement (props open bite)
mid-palatal screw: to prevent lower arch expansion
blue gracey
subgingival of distal posteriors
columbia currette
anywhere (sub and supra gingival - limited sub)
green gracey
subginigival buccal/lingual of posteriors
mini sickle
anywhere supragingivally
orange gracey
sungiviguval mesial of posteriors
red Hoe
sub and supraginigial mesio/distal
yellow Hoe
sub and supra gingival buccal/lingual
where do you get support on complete dentures
upper = residual ridge, palate
lower = residual ridge, buccal shelf, retromolar pads
where to extend labial surface of complete dentrures
10mm in front of incisive papillae
why is copped added to amalgam
reacts with mercury-tin (product of silver-tim and mercury reaction) as it has low corrosion adn is weak so removing it improve properties
why is paediatric BLS different
anatomical differences - short neck, large head, large tonguem funnel shaped trachea
physiological differences - low resp reseve means high resp and pulse rate
why is RMGI better than GI
less soluble
better aesthetics
better tensile strength and wear resistance
normal non diabetic level HbA1c
below 42mmol/l (below 6%)
aim perio
arrest disease process
regenerate loss tissue
maintain perio health long term
valid consent (3)
specific to treatment
remains valid (pt still agrees)
was obtained recently enough
decide capacity
- to act/decide
- to make a reasoned decision
- to communicate a decision
- to understand a decision
- to retain memory of decision
GDC standards
- Put pt interest first
- communicate effectively with pts
- obtain valid consent
- maintain and protect pt’s info
- have a clear and effective complaints procedure
- work with colleagues in a way that is in pts best interest
- maintain, develop and work within your professional knowledge and skill
- raise concerns if pts are at risk
- make sure your professional behaviour maintains pt confidence in you and the dental profession
to obtain valid consent (4)
- informed - associated risk, costs, alternatives
- voluntary
- not coerced
- not manipulated
bacterial infections
1st step
local measures - incision and drain
bactetial infections
1st line antibiotics
penicillin V
250mg tablets, 4xdaily, 5 day regime
(severe adults - can double whole dose)
don’t prescribe if allergy to pencillin
bacterial infections
2nd line antibiotics
amoxicilllin 500mg capsules, 1 capsule 3xday for 5 days
(severe adults - can double whole dose)
don’t prescribe if allergy to pencillin (if pencillin V doesn’t work)
bacterial infections
3rd line antibiotics
metronidazole 400mg capsules, 1 capsule 3xday, 5 days
if allergic to penicillin or as adjunt to amoxicillin
not if on warfarin
BPE 1 action
OHI
Plaque and gingivitis scores
bleeding chart
BPE 2 action
OHI
Plaque and gingivitis and bleeding charts
PMPR
BPE 3 actions
OHI
Plaque and gingivitis and bleeding charts
PMPR
radiographs for attachment loss in scoring sextants and 6PPC
BPE 4 actions
OHI
Plaque and gingivitis and bleeding charts
PMPR
full mouth 6PPC
possible refer
components activated by uncoiling
Palatal finger spring
Z spring
Buccal canine retractor
(awat from midline)
