Round 1 Revision

Question 1

How does medications that are used to treat dry mouth aids in dysphagia?

Answer 1

1. Lubrication
2. Facilitating Bolus Formation
3. Moistening Oral Mucosa
4. Protection and Sensitivity
5. Easing Passage through the Oesophagus

Question 2

How is liver physiology relevant to dental disease?

Answer 2

Medication related:
1. Viral hepatitis
2. Alcoholic liver disease
3. Cirrhosis
4. Jaundice (esp. oral mucosa)

Physiology related:
5. Parotid enlargement
6. Bleeding tendency (esp. gingiva)
7. Dry mouth

Dental treatment may need to be modified in affected patients

Question 3

How does liver disease cause Dry Mouth? Xerostomia

Answer 3

1. cirrhosis can cause fluid build up in the abdomen, and oedema, which care managed with diuretics. This can lead to dehydration, reducing saliva production.
2. Liver dysfunction can affect autonomic nervous system regualtion, impairing salivary gland function, thereby decreasing salivary secretion.

Question 4

How does liver disease cause bleeding tendency?

Answer 4

• The liver is the main site of synthesis for most of the clotting factors (e.g., fibronogen, prothrombin, and factors VII, IX, X). In liver disease, particularly cirrhosis, the liver’s ability to produce these clotting factors is significantly impaired, leading to a bleeding tendency.
• The liver is also essential for producing vitamin K-dependent clotting factors. The liver disease often results in poor bile production, which is crucial for the absorption of fat-soluble vitamins, including Vit K.

Question 5

How does liver disease cause parotid enlargement?

Answer 5

• chronic alcohol comsumption leads to fatty infiltration or sialadenosis of the parotid glands -> swelling.

Question 6

Pt fastens and does not drink enough water -> what risk is he at.

Answer 6

Gallstone

Question 7

Why would pancrease produce inactivated zymogens?

Answer 7

prevent their function within the pancreas, the zymogens would only be activated once they enters the small intestine, therefore, preventing autodigestion.

Question 8

What are purines and pyramidines?

Answer 8

purines (adenine and guanine) are two-carbon nitrogen ring bases while pyrimidines (cytosine and thymine) are one-carbon nitrogen ring bases.

Question 9

Urea formation is one function of the liver.

Answer 9

Most important in NH3 disposal.

Question 10

Discuss types of diabetes.

Answer 10

Diabetes is characterised by hyperglycemia due to impaired insulin regulation.

in type 1 diabetes, the immune system destroys pancreatic beta cells in the islet of langerhans, leading to insufficient insulin supply.

in type 2 diabetes, cells become insulin-resistant, and the pancreas may eventually fail to produce enough insulin to overcome this resistance.

Question 11

What happens to if the lymphatic system fails?

Answer 11

1. unable to remove adequate interstitial fluids from tissue space -> local oedema -> circulatory failure.
2. unable to transport adequate lipid soluble vitamins (A, D, E, K)
3. unable to carry adequate lymph fluid around the body which contains large numbers of white blood cells.

Question 12

What is gingivitis?

Answer 12

gingivitis is the early, reversible stage of gum disease, characterised by inflammation of the gingiva (gums) without damage to the supporting structures of the teeth. it is primarily caused by plaque build up at the gumline, leading to redness, swellling, and bleeding during brushing or flossing. Importantly, in gingivitis, the inflammation is confied to the soft tissue of the gums and does not extend to the underlying bone or connective tissues.

Question 13

What is periodontitis?

Answer 13

Periodontitis is an advanced, irreversible stage of gum stage that develops when gingivitis is left untreated. In periodontitis, the infection and inflammation spread beyond the gingiva to affect the periodontal ligament, alveolar bone, and connective tissue that support the teeth. This results in the formation of periodontal pockets and progressive loss of bone, ultimately leading to tooth mobility and potentially tooth loss if untreated. Periodontitis is characterised by permanent destruction of the bone and ligaments supporting the teeth.

Question 14

How is clinical periodontal health defined?

Answer 14

Pristine periodontal health, defined as total absence of clinical inflammation and physiological immune surveillance on a periodontium with normal support. -> (no attachment loss, no BOP, no PPD>3mm, no redness, clinical swelling/oedema and pus)

Clinical periodontal health, characterised by an absence or minimal levels of physiological immune surveillance or clinical inflammation in a periodontium with normal support. -> (absence or very low level of clinical indicators of inflammation such as BOP<10% and inflammatory markers in gingival crevicular fluid).

Question 15

What are the two types of microflora?

Answer 15

resident flora is consistsing of relatively fixed types of microorganisms regularly found in the oral cavity at a given age. If disrupted or removed, it reestablishes itself quickly.

Transient flora is consisting of non-pathogenic or potentially pathogenic microorganisms that inhabit the oral cavity for hours / days. It derives from the environment, does not reestablish itself permanently on the surface and does not cause disease.

If the resident flora is disturbed or the host resistance changes, transient microorganisms may colonise or members of the resident flora become opportunistic pathogens, proliferate and produce disease.

Question 16

Describe the initial response when bacteria enters the gingiva.

Answer 16

1. Mast cells release histamine (capillaries widen)
2. Direct (A): LPS or OMP react with endothelial
   cells
3. Indirect (B): after contact with LPS/ OMP
   macrophages release proinflammatory cytokines
4. ELAM-1 is expressed (PMNs roll)
5. Contact between leucocyte adhesion receptor
   Integrin ß2 with endothelial Integrin ICAM-1
6. PMNs leave vessel by amoeboid diapedesis
7. PMNs follow gradient of chemotactic factors
   (FMLP, IL-8) towards sulcus

Question 17

Describe the NETosis process of PMNs.

Answer 17

1. NET formation is triggered, and Neutrophil Elastin (NE) is released into the cytoplasm.
2. NE migrates to the nucleus and assists the decondensation of chromatin.
3. chromatin expands.
4. NET is released, and the pathogen is trapped.

Question 18

Describe the first line of defence for chemical barrier system AMPs

Answer 18

antimicrobial peptide, e.g., LL-37, at the sites of expression of neutrophil, gingival sulcus and saliva, is responsible primarily for 1. primary antibacterial, 2. expression is defective in Morbus Kostmann syndrome.

Question 19

PMN are part of the non-specific, general immediate imune response. How do they influence the biofilm growth in the sulcus?

Answer 19

In the gingival sulcus, PMNs migrate through the junctional epithelium in response to chemotactic signals such as IL-8 produced by host tissues and biofilm bacteria. Upon arrival, PMNs release reactive oxygen species (ROS) and antimicrobial enzymes like myeloperoxidase, which act to disrupt bacterial cells and the surrounding matrix, attempting to limit biofilm expansion. They also carry out phagocytosis and NETosis, engulfing and neutralizing bacterial cells, thereby reducing the bacterial load.

However, this constant interaction can also have unintended consequences for the biofilm environment. The release of enzymes and ROS can damage both the bacteria and surrounding host tissues, resulting in increased gingival inflammation. This inflammation leads to increased gingival crevicular fluid (GCF) flow, which, while containing immune factors, also provides nutrients that can further support biofilm growth. As PMNs engage in their defense efforts, they may also contribute to a chronic inflammatory environment, leading to tissue damage that facilitates deeper penetration of the biofilm. This dynamic means that while PMNs initially help to limit biofilm expansion, their response can paradoxically alter the environment in a way that may support biofilm persistence and growth, especially in conditions where inflammation becomes chronic, such as in gingivitis or periodontitis.

Question 20

What are the signs of gingival inflammation?

Answer 20

Colour: erythematous, cyanotic
Contour: bulbous, swollen papillae, rolled margin
Consistency: edematous, spongy, loosely adapted
Texture: smooth, shiny
Exudate
Marginal bleeding: moder to severe
probing depth>3mm
tissue resistance: minimal to probe penetration
BOP>10%
Pain: moderate or severe

Question 21

explain the role of the JE in the periodontal defense system

Answer 21

The junctional epithelium (JE) plays a critical role in the periodontal defense system by acting as a physical barrier and facilitating immune response against pathogens. It forms a seal at the base of the gingival sulcus through hemidesmosomes, preventing bacterial penetration. Its permeability allows leukocyte migration, particularly PMNs, from underlying tissues to the sulcus, contributing to an innate immune response. The JE also produces chemotactic signals like IL-8 to attract immune cells and releases antimicrobial peptides to neutralize bacteria. Its high cell turnover helps maintain barrier integrity, while providing active defense to protect against deeper bacterial invasion and inflammation, thereby maintaining periodontal health.

Question 22

What are the 4 functions of Gingival crevicular fluid?

Answer 22

1. cleanses sulcus
2. antimicrobial function
3. antibody activity
4. cell adhesion

Question 23

explain the stages of microbial colonization of the sulcus

Answer 23

1. Initial Attachment: Pioneer bacteria, primarily Streptococcus species, attach to the pellicle via adhesins.
2. Early Coaggregation: Secondary colonizers like Actinomyces adhere to primary colonizers, beginning to form multi-layered biofilm structures.
3. Maturation of Biofilm: Fusobacterium nucleatum facilitates late colonizer attachment, and EPS matrix forms, providing protection and structural integrity.
4. Late Colonization: Pathogenic species like Porphyromonas gingivalis join, increasing virulence and resistance.
5. Host Immune Response: Persistent biofilm leads to chronic inflammation, attracting immune cells and leading to gingivitis or periodontitis.
6. Dispersion: Bacteria actively or passively detach from the biofilm to colonize new surfaces, promoting biofilm spread.

Question 24

describe the demin and remin process with the use of stephen’s curve

Answer 24

Stephen’s Curve illustrates the changes in plaque pH over time following the consumption of sugar and helps explain the processes of demineralization and remineralization in tooth enamel. After sugar intake, bacteria in the dental plaque metabolize these carbohydrates, producing acids that rapidly lower the pH below the critical threshold of 5.5, which initiates demineralization, where calcium and phosphate ions diffuse out of the enamel, weakening its structure. As the sugar is metabolized and saliva starts to buffer the acids, the pH rises back above 5.5, allowing remineralization to occur, where calcium and phosphate, sometimes aided by fluoride, are redeposited into the enamel, restoring its strength. This dynamic balance depicted by Stephen’s Curve highlights how frequent exposure to acidic conditions promotes demineralization, whereas neutral pH periods favor remineralization, emphasizing the importance of oral hygiene, controlled sugar intake, and fluoride use in maintaining enamel integrity and preventing caries.

Question 25

What are the definitions of high risk carious groups? how does this link to caries development and relate it with open and close systems.

Question 26

Where is the likely location for extrinsic acids and intrinsic acids?

Answer 26

extrinsic more likely to accumulate on the buccal surfaces while intrinsic are most likely to accumulate on palatal surfaces.

Question 27

how is risk of caries linked with diet?

Answer 27

Why is cheese good for caries?
- ACP-CPP
- Calcium and phosphate concentration

Question 28

What is the trim framework and how do you apply it on patients?

Answer 28

Timing
Relevancy
Involvement
Method

clinical communicatiosn:
relationship skills
avoid blocking behaviour
question styles (open, closed questions and avoid compound or leading questions that suggest answers.)
avtive listening
feedback & signposting.

Question 29

How to approach ethical dilemma?

Answer 29

whenconsidering a scenario we have a few steps
determine alternativees
determine ethical considerations
determine judgement from others
rank alternatives

4 principles of biomedicine: non-maleficience, beneficience, autonomy and justice.

Question 30

There is always immuno responses prior to cardinal signs of inflammation.

Question 31

How to rank the level of importance?

Answer 31

erosion > attrition > caries.

Question 32

Discuss the function of high speed hand pieces.

Answer 32

High Speed handpiece: 100,000-800,000 rpm. Conventional high-speed handpieces run at 300,000 rpm.
* for bulk removal of enamel during cavity preparations and crown and bridge preparations, for removal of old restorations.
* crown and bridge preparations
* removal of old restorations

Question 33

Discuss the slow speed hand piece.

Answer 33

Slow speed
6,000rpm – 160,000 rpm
usually 4k for prophylaxis.
having Latch and friction chuck

Question 34

paratopes are found on antibodies while epitopes are found on antigens.

Question 35

Describe the mechanisms of function of cytotoxic and NK cells.

Answer 35

1. detects a range of antigen complex and MHC I on a diseased cell.
2. adhere to cell surface
3. release porforins to create channels on cell membrane for immunal agents to enter.
4. Granzymes enters the cell through the channel, leading to apoptosis (systemic death).
5. interferons -> prevents viral replicaiton.
6. Tumour Necrosis Factor (TNF) -> activation of macrophages and destruction of cancer cells.

Question 36

Discuss the different types of antibodies and their functions.

Answer 36

1. IgA - found in saliva, tears, mucous and breast milk. They are responsible for protection against pathogens.
2. IgD - part of B receptor, activates basophil and mast cells.
3. IgE - responsible for allergic reactions and parasitic attacks.
4. IgG - secreted by plasma cells in blood. they can pass thru placenta into fetus
5. IgM - may be attached to B surface or released into blood -> early stages of immunity

Question 37

How does the body destroys antigen-antibody complexes?

Answer 37

1. Complement fixation and activation: immune complexes expose complement binding sites that initiates complement fixation into the antigenic’s cell surface and subsequent cell lysis.
2. Neutralization: Pathogens are neutralised by binding antigen to antibodies, preventing pathogens from attaching to host cells, disrupting ability to infect or cause harm. This complex can then be destroyed by phagocytes.
3. Opsonization: Antibodies can also tag pathogens for destruction by immune cells, via the process of opsonization. The immune complex acts as a signal that marks the pathogen for phagocytosis (engulfment) by white blood cells like macrophages and neutrophils.
4. Agglutination: In some cases, antibodies can cause pathogens to cross-link and clump together, a process known as agglutination. This makes it easier for immune cells to recognize and remove the larger particles.
5. Precipitation: In solution, the formation of antigen-antibody complexes can lead to the precipitation of the complex out of the solution, making the precipitated molecules easier to be engulfed by phagocytes.

Question 38

what is the composition of saliva?

Answer 38

Saliva, which is derived from the salivary glands, consists mainly of water (approximately 99%). It also has some organic components including substances called glycoproteins. These substances consists of a protein core with CHO side-chains, and give saliva its viscosity.

Question 39

how does saliva support plaque formation?

Answer 39

Glycoproteins are important in plaque formation as they are selectively adsorbed to enamel in the presence of bacteria to form a thin film. This film, which forms within 30 minutes of brushing is called the acquired pellicle. Bacteria can attach to the pellicle and subsequently multiply and produce extracellular polysaccharides which make the plaque bulkier and sticky. Bacteria rarely attach directly to teeth, e.g., they need the pellicle to enable them to attach to the tooth surface.

Question 40

Bacteria biofilm develops differently, why?
Plaque compositions changes with time, why?

Answer 40

Plaque composition changes with time. Generally plaque consists of cocci and bacilli but as plaque gets older differences in the types of cells occur between those at the tooth surface and those near the salivary interface.

Plaque composition also differs in different parts of the mouth, e.g., occlusal grooves compared with subgingival areas.

Plaque + fermentable CHOs can -> dental caries
And
Plaque around the necks of teeth (especially in the gingival crevice) can -> inflammation of gums (gingivitis).

Question 41

How does bacteria differ comparing the ones from tooth surface and gingival crevice and why?

Answer 41

The gingival crevice represents a unique environment for bacteria that can colonise it. Subgingival plaque differs from supragingival plaque because:

saliva rarely enters the crevice and therefore the pellicles and interbacterial matrix is different.
the crevice is a relatively retentive and stagnant area so less adherent bacteria may accumulate.
conditions favour anaerobic bacteria.
crevicular fluid is produced and provides nutrients for certain bacteria.

plauqe that has been present for some time may become calcified to produce calculus or tartar.
This may occur supragingivally or subgingivally and once formed is not easy to remove by brushing.
The calculus provides a good site for further plaque formation.

Question 42

What are the factors to consider to analyse one’s caries risk?

Answer 42

1. host (genetic factors -> tooth compositon, cleaning methods, salivary quality and quantity, tooth composition)
2. microflora (types of bacteria, whether commensal or pathogenic)
3. diet (supply of substrates -> sucrose allows the build up of EPS capsules)
4. time (time for demin/remin to occur and cause consequences)

Question 43

Caries pathogenesis stages

Answer 43

Initial demineralisation - remineralisation due to Ca and P ions in saliva may occur.

Further demineralisation - continued drops in plaque pH will cause further demineralisation, which tends to be more extensive below the surface layer of enamel. A lesion can therefore be quite advanced before it can be detected clinically. Radiographs may show early carious lesions, especially in interproximal areas.

Surface breakdown - continued pH drops will eventually lead to surface breakdown and cavity formation.

Progression of lesion - caries may progress through enamel to dentine and then to the pulp. Pulpitis (or inflammation of the pulp) may follow and produce pain. Pulp necrosis or death may follow and toxic products from the pulp can then produce pathology of periapical tissues. e.g., an abscess.

Question 44

Can caries be transmitted?

Answer 44

Caries is an infectious disease -> could be transmitted through exchange of bodily fluids - saliva. it doesn’t exist in germ-free animals and can be transmitted.

Question 45

Describe the process of caries formation

Answer 45

Caries are developed from the acids produced by bacteria within the dental plaque, as sufficient diet (free sugar, sucrose and fructose) are provdied. As time progresses, the acidic contents protected within the biofilm accumulate. If the pH in plaque falls below a certain critical level (usually HA = 5.5), microscopic demineralisation of the enamel can occur. Enamel is HA and will breakdown in an acid environment. 
Repeated cycles of acid generation can, in time (say 18+-6 months), cause an early or incipient carious lesion, an opaque white or brown spot beneath the plaque layer. As more demineralisation occurs, the surface enamel loss hardness, bacteria penetrate into the enamel, and a macroscopic cavity appears.

Question 46

What is the most cariogenic organism? Why is streptoccus not prone to antimicrobial agents?

Answer 46

The results of experimental studies in animals indicate that one of the most cariogenic organism(s) is Streptococcus mutans, a gram positive acidogenic organism. other microorganisms are also likely to be involved too, e.g., Lactobacillus S. mutans seems to be particularly important in smooth surface caries, e.g., interproximally, whereas Lactobacillus and others play a role in pit and fissure caies.

Gram positive does not have two layers of membrane with the outer membrane having LPS attach to it to give it protection.

Question 47

Why is streptoccus mutans a likely candidate in caries production?

Answer 47

It can rapidly form lactic acid and other acids from CHOs, e.g., sucrose, glucose.
It can survive in a low pH environment.
It can produce extracellular polysaccharides from sucrose. Two important extracellular polysaccharides are fructans and glucans (homopolymers of glucose and fructose). Glucans form the bulk of the plaque matrix. They are sticky and insoluble and enable bacteria to stick to the tooth and also stick to each other, e.g., aid in colonisation of bacteria. They also protect bacteria and retainan acid environment at tooth surface. Fructans can be metabolised to acid even after sucrose is cleared from the mouth.

Question 48

Discuss the importance of saliva.

Answer 48

Saliva is a very important determinant in the aetiology of dental caries.
Saliva has the ability to buffer plaque acids, i.e. resist changes in pH. Phosphate ions and bicarbonate ions are important buffering agents.
Saliva is supersaturated with respect to calcium and phosphate ions and can therefore contribute to remineralisation of surface enamel. The fluoride content of saliva is low, but still contributes to
protection of the tooth.
Saliva flow is important. As flow decreases, caries tends to increase (e.g. in patients who have had radiation therapy for cancer and some damage to salivary glands has occurred). Also, saliva flow tends to decrease at night.
Saliva contains antibacterial factors, e.g. lysozyme and lactoperoxidase.

Question 49

Discuss the proline rich proteins and saliva and how do they contribute to caries formation.

Answer 49

Salivary glycoproteins are important in colonisation of tooth surfaces by bacteria. Bacteria must adhere to a surface first, and then they can multiply.
A group of salivary proteins, designated proline rich proteins (or PRPs) because of their high content of the amino acid proline, have been associated with early plaque formation. These proteins have a similar composition to enamel matrix proteins and bind tightly to hydroxyapatite crystals. At least eight different forms of PRPs have been identified and they are all coded for by a block of genes located on chromosome No. 12. There is some evidence that certain individuals may be inherently more susceptible to caries because of their salivary protein make-up.

Question 50

What are the signs of periodontal disease and what are its consequences?

Answer 50

Signs of peridontal inflammation: puffy, swollen, red, bleeding gums with a bad taste in the mouth.

The inflammation could extend to involve the supporting tissues (periodontitis) causing:
1. loss of attachment of the gingivae
2. apical migration of the epithelial attachment
3. pocket formation
4. recession
5. loss of alveolar bone
6. mobility of teeth and possible loss of teeth

Question 51

Explain the role of bacterial plaque in the development of periodontal disease.

Answer 51

Bacteria in plaque around the necks of teeth can produce toxic products that may cause inflammation of the periodontal tissues. The balance between bacteria and the body’s defence system is very important, however; that is, bacteria are essential agents, but their presence is in itself insufficient. Host factors must be involved if the disease is to develop and progress.

Question 52

How does caries and periodontal disease formation differ?

Answer 52

There is a difference then between caries and periodontal disease: tooth enamel is relatively inert whereas the periodontal tissues are vital (living tissues).

Question 53

How does periodontitis progress?

Answer 53

In the gingival region the body respoonds to the gorwing abcterial mass. White blood cells called polymorphonuclear leucocytes (PMNs) emigrate out from the blood vessels in the gingival tissues into the sulcus or crevice where they hagocytose (engulf) and kill bacteria. They form a protective barrier which tries to prevent or control plaque extension. if there is a build-up of plaque, toxic products produced by bacteria may cause actue inflammation in this tissues.

This initial stage is followed by early lesions that is characterised by persistence of actue inflammation but also within infiltration of lymphocytes, macrophages, and plasma cells (part of the body’s immune system). With time, the establshed lesion develops with mainly plasma cells, characteristics of chronic inflammation.

The established lesion may:
1. disappear
2. remain stable
3. transform to become destructive, wtih destruction of alveolar bone - periodontitis.

Question 54

What are the signs of periodontitis?

Answer 54

In chronic periodontitis, there is gingival or periodontal pocket formation with ulceration of the pocket epithelium. Bacteria can then invade the periodontal tissues. The body mounts al of its defence mechanisms against the bacteria which can produce various antigenic substances including enzymes, exotoxins, and endotoxins.

Question 55

what are the factors that may predispose gingivitis?

Answer 55

There are certain factors that may predispose to gingivitis. These factors may be general or local:
1. general factors - apart from natural variation in susceptibility between individuals, certain disease or hormonal changes may predispose to or modify gingivitis, e.g., pregnancy, diabetes.
2. Local factors - areas where plaque can accumulate are likely to be affected, e.g., malaligned teeth, faulty restorations (overhangs), dentures, orthodontic appliances.

Question 56

What is a moral dilemma?

Answer 56

A moral dilemma occurs in situations where all the options seem to you to be wrong or to violate a moral principle. Such a situation creates the feeling that we are condemned to moral failure. The French existentialist philosopher John Paul Sartre gave a famous example. Sartre recalls a young man who faced a tough choice. Either the man could stay at home with his grieving mother who had lost her other son in the war and who desperately needed the comfort of her only living child. Alternatively, he could leave home to fight the invading German army, with no guarantee of success. The young man felt that either he must betray his mother or betray his country; he was torn between two powerful moral principles: love for a parent and loyalty to their homeland. Incidentally, Sartre held that there was nothing that could guide either a person caught in such a dilemma or indeed any other moral situation. Is this an overly pessimistic view of ethics?

Question 57

When presented with a bitewing radiograph, explain how you would determine its correct orientation. Identify and describe three key orientating features, including the significance of the locating dot, and discuss how tooth morphology can assist in this process.

Answer 57

To determine the correct orientation of a bitewing radiograph, I would first ensure the locating dot (embossed dot) is facing towards me (convex side out), confirming proper film placement; second, I would assess tooth morphology, noting that mandibular molars often exhibit an H-shaped pulp chamber due to their two roots, distinguishing them from maxillary molars; third, I would compare the morphology of molars versus premolars, recognizing molars by their larger size and multiple cusps, which helps identify the correct anatomical positions and sides on the radiograph.

Question 58

Chart the teeth.

Answer 58

Charting the mandibular teeth from the radiograph: Tooth 46 (mandibular right first molar) has a densely radiopaque MOD restoration (mesial-occlusal-distal surfaces) indicating a metallic (amalgam) filling, extending onto buccal and lingual surfaces (+Bu/Li); Tooth 47 (mandibular right second molar) shows a moderately radiopaque MO restoration (mesial-occlusal surfaces) suggesting a composite resin, with no buccal or lingual involvement; correct terminology is used—lingual (not palatal) for mandibular teeth; only mandibular teeth are charted with accurate quadrants and tooth numbers; restorations are specified with their radiopacity levels for full clarity.

Question 59

Part 1: Explain to a patient, in a patient-friendly and conversational manner, why a soft tissue examination is performed during dental visits, providing at least two thorough reasons that highlight both oral and general health aspects without causing unnecessary alarm.

Part 2: Identify and label specific anatomical structures in the oral cavity, specifically structures labeled as (iii), (iv), (v), and (vi) in a provided image.

Answer 59

Part 1:

“Hello! I wanted to share why we do a soft tissue exam during your dental visits. First, by examining the soft areas of your mouth—like your gums, cheeks, and tongue—we can spot any early signs of issues such as sores or changes that might need attention. This helps us keep your mouth healthy and comfortable.

Second, the soft tissues can give us clues about your overall health. Conditions like diabetes or nutritional deficiencies sometimes show signs in the mouth before anywhere else. By checking these areas, we can help you maintain not just oral health but overall well-being. It’s all about early detection and keeping you healthy without causing any worry.”

Part 2:

(iii) Palatoglossal fold/arch: The front arch at the back of the mouth, leading from the soft palate to the tongue.
(iv) Retromolar pad/region: The soft tissue area just behind the last lower molar.
(v) Palatine tonsils or tonsillar fossa: The area between the two arches at the back of the throat where the tonsils are located.
(vi) Palatopharyngeal fold/arch: The rear arch that extends from the soft palate to the pharynx (throat).

Question 60

Part 1: What are the key purposes of using cotton rolls during dental procedures?

Part 2: Describe the correct method for placing a cotton roll in the mandibular anterior region.

Answer 60

Part 1:

Cotton rolls are essential in dental procedures for moisture control and soft tissue retraction. They absorb saliva and other fluids, keeping the working area dry, which is crucial for the effectiveness of dental materials and procedures. Additionally, cotton rolls help retract soft tissues like the cheeks, lips, and tongue, providing improved access and vision to the treatment area. This also allows the operator’s hands to remain free, enhancing efficiency and ergonomics during the procedure.

Part 2:
To correctly place a cotton roll in the mandibular anterior region:
1. Bend the cotton roll to create a slight curve that conforms to the shape of the vestibule.
2. Retract the lower lip gently to expose the vestibule and the labial frenum.
3. Place the cotton roll on either side of the frenum, positioning it deep into the fornix or vestibule.
4. Ensure the cotton roll is securely in place to maintain soft tissue retraction and effective moisture control throughout the procedure.

Question 61

what are the different gingival phenotypes and their differentiation?

Answer 61

The two primary gingival phenotypes are the thin scalloped phenotype and the thick flat phenotype. The thin scalloped phenotype is characterized by delicate, highly scalloped gingiva with slender papillae, thin tissue where a periodontal probe is visible through the gingiva (probe transparency test), and triangular-shaped teeth; this phenotype is more prone to gingival recession. In contrast, the thick flat phenotype features dense, fibrous gingiva with flatter gingival margins, thick papillae, and square-shaped teeth; the gingiva is opaque, and a probe is not visible through the tissue, making it more resistant to recession but susceptible to pocket formation. Clinically, differentiation involves assessing gingival thickness using the probe transparency test, observing the contour and scalloping of the gingival margin, and noting tooth morphology to guide treatment planning and predict periodontal outcomes.