Reviewer's Questions Flashcards
Eric: What is bulimia versus anorexia?
Bulimia nervosa: Eat larges amounts of food and then purges
Anorexia: Self-starvation
Eric: Different types of bulimia?
Which one has oral manifestations?
- Purging type: Self-induced vomiting, laxative abuse, diuretics or enemas (oral manifestations)
- Non-purging type: Excessive fasting, extreme dieting, or excessive exercise
Eric: BP of 114/74 is what blood pressure classification according to who?
Normal BP per American Heart Association
Normal: 120/ <80
Elevated: 120-130/<80
Stage 1: 130-139/80-89
Stage : 140+/90+
Hypertensive crisis: 180+/120+
Eric: Mechanism of fluorosis
What level of fluorosis does your patient have?
Excessive fluoride intake during enamel development (birth to 8 years)
- Disruption of ameloblast function (the ameloblasts don’t regulate mineral deposition properly)
- Hypomineralization of enamel (excess protein retention in enamel leading to porosity)
- Increased enamel porosity (retained enamel proteins trap water - leads to white lines)
She has mild - White striations
Eric: Differentiate mild/moderate/severe fluorisis
Mild: White striations or opaque areas
Moderate: More pronounced opacities with surface roughness
Sever: Brown staining, pitting, loss of enamel integrity
Eric: Normal ROM
What does clicking, popping, crepitus, or tenderness on palpation indicate?
40 to 50 mm
Clicking: Disk displacement with reduction (one click as it goes back onto disk)
Popping: Subluxation of the condyle (ligament laxity or joint instability)
Crepitis: Osteoarthritis (cartilage breakdown and bone-on-bone contact)
Tenderness: Capsulitis, synovitis, or myofascial pain)
Eric: Besides esthetic plane, what other planes are used to evaluate esthetics?
E-line (tip of nose to anterior point of chin): Upper lip slightly behind or touching and lower lip slightly behind
Ricketts Esthetic Plane (tip of nose to chin prominence): Upper lip 2 mm behind and lower lip 4 mm behind
Camper’s Plane (parallel to occlusal plane)
S-line (Steiner) - Line from chin to lower border of nose - lip should touch. If ahead, then protrusive and behind is concave
Eric: How did I test her saliva quality and quantity?
Quality: clear, watery - checked via mirror sticking to tongue or difficulty with gauze; patient report of dryness, dehydration
Quantity: Again, mirror stickiness or difficulty with gauze. Unstimulated test after 5 minutes should have .3 to .4 ml saliva
How did you evaluate the CO to MIP slide?
I evaluated the patient’s CO to MIP slide by guiding the mandible into an unstrained centric relation using bimanual manipulation (per Dawson).
Once in CO, I instructed the patient to gently close. It’s hard to
Eric - Who discussed long centric and freedom in centric?
Long centric: Gysi - 1.25
Freedom in Centric: Dawson - Less than 0.5
Achieved through a lingual concavity in maxillary anterior teeth
Besides fluorosis - what about amelogenesis imperfecta.
What is it?
What are the types (4)? Which is most common?
How would you diagnose?
- Amelogenesis imperfecta - Malfunction of proteins in the enamel resulting in abnormal enamel formation
Type 1: Hypoplastic (defective enamel formation - thin enamel and teeth, well mineralized)
Type 2: Hypomaturation (enamel formed/normal thickness - proteins don’t develop right, but it is soft, brittle, and prone to damage)
Type 3: most common Hypocalcified (Enamel formed/normal thickness, but not enough calcium - enamel is chalky and prone to tartar - enamel soft)
Type 4: Hypomaturation-hypoplasia with Taurodontism (teeth are small, thin enamel, large pulp chambers (taurodontism)
Diagnosis: Family history + clinical & radiographic findings + genetic testing
Treatment: Bonding, full coverage restorations,
Besides fluorosis - Dentinogenesis Imperfecta
What are the three types and which is most common?
Inherited disorder the affects dentin
Type 1 (OI-associated) - translucent, opalescent teeth that may appear yellow, brown, or blue-gray
- Teeth are weak/prone to fracture
Type II (Classic) - Most common
- Teeth are translucent, opalescent, blue-gray.
- Pulp chambers may be enlarged, leading to “shell teeth”
Type III (Brandywine)
- Teeth are translucent, opalescent, and often have a dark brown or black hue
- Mainly found in African Americans - dark brown/black hue (southern Maryland)
Driscoll: How can anti-anxiety and anti-depressants affect the patient? (4)
What are the types of drugs? What “generations” are they?
- Xerostomia, altered taste, bruxism, oral bleeding
- SSRI and Tricyclic antidepressants
- SSRI: Second generation and TCA first (blocks neurotransmitters NE and Serotonin. Hence the term “selective”
Driscoll: How does Estradiol affect the patient in terms of oral health?
Can promote wound healing but also can lead to inflammation
Driscoll: What does flattening of the condyle indicate?
Degenerative joint disease (osteoarthritis)
Temporomandibular disorders
Condylar Remodeling
Condylar Resorption
Patrick: Wetselaar/Lobbezoo TWES
Treatment Module: Primary criteria:
- Grade 0/1 indicates what when it’s on what surfaces?
- Grade 2 indicates what when it’s on what surfaces?
- Grade 3/4 indicates what when it’s on what surfaces?
0/1 - Occlusion/articulation surfaces or non-occlusal: Counseling/preventive measures/monitoring
2: Non-occlusal/non incisal surface: Treatment must be considered
3/4: Occlusion/articulation surface: Treatment must be considered
Patrick: Wetselaar/Lobbezoo TWES
Secondary criteria (3) for treatment?
- Speed of tooth wear process (slow: Monitor / fast: restore)
- Age (younger the patient, sooner you treat
- Etiological factors (the more and more difficult to eliminate, you should treat)
Patrick: Wetselaar/Lobbezoo TWES
Quanitification module:
What is the 5 point scale used for occlusal and incisal grading?
What about the palatal?
Difference between this system and the Basic Erosive Wear Examination?
0: No (visible) wear
1: Visible wear w/in enamel
2: Visible wear w/ dentin exposure and loss of clinical crown height <1/3
3: Loss of clinical crown height 1/3 < x < 2/3
- Loss of clinical crown height >2/3
Palatal:
0: No wear
1: Wear in enamel only
2: Wear w/ exposed dentin
Difference: TWES isn’t summated, but BEWE is
Patrick: TWES
What modules are in the TWES? (9)
- Qualification
2: Quantification, screening module (each sextant + max ant palate gets one score)
- Quantification: Clinical crown length (quick/easy to do)
- Quantification, finer-grained measurements (each individual tooth - 8 point scale for incisal/occlusal and 3 point for non-occlusal)
- Questionaires
- Salivary analysis
- Treatment - complaints of patient versus clinical reasons
- Treatment - When to start treatment (Amount of wear, which teeth, number of teeth; Speed of wear, age, etiological factors)
- Level of difficulty
Patrick: Tooth Wear Evaluation System
Clinical signs of erosion (10)
- Occlusal cupping, incisal grooving/cratering, rounding of cusps and grooves
- Wear on non-occluding surfaces
- Raised restorations
- Broad concavities within smooth surface enamel, convex areas flatten, or concavities become present
- Increased incisal translucency
- Clean, non-tarnished appearance of amalgams
- Presentation of enamel “cuff” in gingival crevice
- No plaque, discoloration, or tartar
- Hypersensitivity
- Smooth silky-shining, silky-glazed appearance, sometimes dull surface
Patrick: Tooth Wear Evaluation System (TWES) by Wetselaar & Lobbezoo
Clinical signs of attrition (5)
Clinical signs of abrasion (3)
AT1: Shiny facets, flat and glossy
2: Enamel and dentin wear at same rate
3. Matching wear on occluding surfaces
4. Possible fracture of cusps/restorations
5. Impressions in cheek, tongue, and/or lip
AB1: Usually at cervical areas of teeth
2. Lesions are more wide than deep
3. Premolars and cuspids affected
Patrick: What classification systems exist for Tooth Wear?
- Verrett
- Smith & Knight Tooth Wear Index
- Basic Erosive Wear Examination (Barlett 2008)
- Tooth Wear Evaluation System (Peter Wetsalaar and Lobbezoo 2017))
Patrick: What amount of wear for the molar and premolars is thought to be physiological a year?
Molars: 29 um/year
Premolars: 15 um/year
1989 article by Lambrechts on Quantitiave in vivo wear of human enamel
Patrick: Basic Erosive Wear Exam (Barlett)
- What’s the four point criteria breakdown for erosive wear?
- Why isn’t dentin clearly mentioned in the breakdown?
- What are the risk level breakdowns? At which risk level were restorations acceptable?
0: No erosive wear
1: Initial loss of surface texture
2: Distinct defect, hard tissue loss <50% of surface area
3: Hard tissue loss >50%
*Dentin often involved in 2/3
- Authors argue differentiating enamel/dentin loss is difficult.
- Risk:
None: 0-2
Low: 3-8
Medium: 9-13
High: 14+ (avoid restorations, but cases of severe progression may consider special care that may involve restorations)
