Sem 2 exams Flashcards
What do you need a secondary impression for?
Acrylic partial denture for multiple edentulous areas
Chrome denture
Complete denture
Some immediate dentures
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
What are contraindications for immediate denture?
Patient on bisphosphonate/blood thinner medications
Any contraindication for extraction
What code do we use for a denture rest?
731
What are the clinical features of pyognic granuloma?
Usually sensile
Sudden onset and rapid growth
Bright red and haemorrhagic, ulcerated surface.
Tissue may mature thus becomes fibrosed
What is a normal platalet count?
150-450 billion cells/L or 150,000 to 450,000/mcL
How many microsieverts does bitewing produce?
5
What are the categories of communication disorders?
- Language disorders: Speech Disorders (Autism or aphasia after stroke) or Auditory Processing (hearing impairment, vision impariment or ADD) - these disorders make speaking difficult
- Physical disorders: Oral Muscular - physical oro-motor disorders like mutism or dysphonia
- Intellectual delay and disability
What are the oral side effects after radiotherapy?
- Impaired quality and quantity of saliva
- Radiation caries
- Trismus
- Xerostomia
- Dysphagia
What should you do with mobility 2 teeth before primary impressions?
Splint them
What is a dry socket?
Absence of blood clot in the socket post extraction (socket is either empty or full of debris)
What are some social determinants of health?
- economic stability
- Physical environment
- Education
- Food
What are the steps of drawing a denture design?
Cross teeth not to replce
Outline denture saddles
Decide & draw clasp units and clasp types
Decided major connector
Decide denture base and denture teeth
Join all components together
Draw saddles
Draw support and draw major connectors
Indicate abutmnet tooth/teeth
Draw rests and clasp
Draw flanges (gum fitted vs buccal flange)
Specify/draw the extension of the denture
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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.
When should you consider antibiotic for periodotal treatment in non-acute patient?
A young patient in stage 3 or 4 Grade B or C in adjunct to periodontal treatment.
What is a primary impression?
It is an initial impression taken using a stock tray and alginate impression material. Used to produce study models
What is the treatment for periodontal abcess?
1.Debridement under LA and draining of the pus if patient can tolerate. If they can not tolerate, give LA, drain the pus and give antibiotics and recall in 3 days.
2.Irrigate area with Betadine (povidone-iodine antiseptic)
3.Chlorhexidine mouth rinse twice daily for a week
4.Investigation of causative factors
- If systemic symptoms exist – amoxicillin 500mgs tds+ metronidozole (very important for your anaerobic bacteria) 400 mgs bs x 5-days. You need to debride prior to this as the antibiotic will not be able to penetrate the biofilm througb the crevicular fluid!
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
What is the purpose of overall impression?
For denture repair
What are the consideration for regeneration?
- Defect size and topography. 3 wall defects are the most stable for regeneration.
- Defect cause
- Technical difficulties. Access or patient factors.
- Predictability. Always tell the patient the success rate. Grade 3 mobility, probably not the best idea.
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
What is pressure resorption and orthodontic resorption?
Type of traumatic resorption that occurs due to impacted teeth or orthodontic treatment
Do you need a radiologist?
Yes because:
1.It provides a provider number to allow Medicare rebates
2.Review of all areas of the scan
3.Removes much of the legal responsibility
In addition to examination what should you assess in a patient?
- perception of oral health - health literacy/beliefs/trust
- Oral health Seeking behaviour -Social/personal/cultural/medical influences
- Access to oral health care
- Their engagement in past oral health care processes - e.g. oral hygiene practices
What is subluxation? What is the treatment?
An injury to the tooth-supporting structures with abnormal loosening, but without displacement.
Treatment:
- Usually no treatment
- A passive and flexible splint to stabilize the tooth for up to 2 wk if there is excessive mobility
What is individual ageing?
Refers to the structural, sensory, motor, behavioural and cognitive changes in a person over time, in particular relating to how these factors influence opportunities and lifestyle at various stages of the life of the person.
What is external surface resorption? What is the treatment?
External surface resorption is a self-limiting process which is usually caused by a localized to the involved part of the cementum and/or PDL.
Treatment: self-limiting so no treatment.
What kind of clasps do you use for anteriors?
Gingival approaching
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)
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
How can we measure incisors?
Bioclear template that utilizes the Fibonacci gold sequence.
Within the context of special needs dentist, what are some of the other factors/barriers shoudl you consider when treating a patient?
- Medical conditions and treatments
- Medications
- patient ability to co-operate
- Patient’s expectations and wishes
What are the two different saddle design for a cobalt chrome denture?
Free-end Saddle design
Bounded saddle
How do we take history about a lesion?
- Duration when the patient first started seeing the lesion
- Variations in site and character of the lesion
- Symptoms - related to the lesion and any systemic symptoms
- Onset - any associated hsitorical events related to the lesion
What should we look out for when examining a patient with special needs when it comes to barriers?
Their capactiy to:
- Perceive the need for oral health care
- Seek oral health care when appropriate
- Reach or access oral health care
4.Engage in the oral health care process
What is the neutral zone?
Neutral zone is the area where the outward forces from the tongue are neutralised by the forces of the lip and chicls.
What is a bite registration?
It is the impression of patient’s occlusion when upper and lower teeth biting together. The purpose of the bite registration is to register maxillo-mandibular relationship so that lab can articulate casts and set up teeth. For partial dentures used maximal intercuspal position, for complete dentures use centric relation.
What questions should you ask particularly an elderly before prescribing an NSAID?
- Have you experience recent changes in your bowel habits, such as black or tarry stools?
- Any episodes or recent nausea, vomiting or abdominal pain?
- Have you noticed any changes in your urine output or color?
- have you experienced any shortness of breath, chest pain or swelling?
- Do you have a care giver or support group that may aid you or remind you about taking the medication?
- Do you take any over the counter medications recently that are beyond the once in your medical history?
- Do you take a deuretic or an ACE inhibitor?
What is trauma informed care?
Trauma-informed care is an approach to engaging people with histories of trauma that recognises the presence of trauma symptoms and acknowledges the role that trauma has played in their lives. It involves the awareness and avoidance of practices that lead to re-traumatisation.
What is this condition?
This is actinomyces - an infection characterised by multiple foci of chronic suppuration.
Patient present with firm swelling commonly in the submandibular region with variable pain symptoms.
Treatment: prologned antimicrobial treatment after cultures
What are the most commonly used material in periodontal regenerations?
1.Bone grafts
2.Membranes
3.Growth factors
In which Kennedy’s class would you use both soft tissue and tooth support?
Kennedy 1 and 2
What is common appearance of allergic reaction to SLS?
Ulcers, biofilm and tissue slouching
What is a secondary impression?
Secondary impression is a detailed impression to produce a master cast from which a denture is fabricated. AKA a master impression.
What should you write on a lab form prescription for partial chrome denture?
Describe saddles
Describe support
Specify abutment teeth
Draw rest seats – scoop them outh on the model
Speciy clasps and flanges
Specify the extensions of the denture
Fill lab form and draw design
What is hyperplasia?
It is an increase in the size of a particular tissue by increase in cell number - it is reversible and stimulus dependent
Give 5 differential diagnosis for a pigmented lesion?
- Oral melanotic macule
- Mucosal melanocytic naevus
- Amalgam tattoo
- Malignant melanoma
- Smokers melanosis
What do you want to record for bit registration in an edentulous patient?
Centric relation.
Centric relation is a maxillomandibular relationship, independent of tooth contact, in which the condyles articulate in the anterior-superior position against the posterior slopes of the articular eminences; in this position, the mandible is restricted to a purely rotary movement; from this unstrained, physiologic, maxillomandibular relationship, the patient can make vertical, lateral or protrusive movements; it is a clinically useful, repeatable reference position
What are the stages of tooth socket healing?
- haemostasis and coagulation - this is where suturing in warfarin is important
- Inflammation
- Proliferation
- Modeling and remodeling
What are the levels of patient-centered decision making?
From most basic to complex:
Level 1-Patient provided information only
Level 2-Patient provided information & choices
Level 3-Patient is provided infomation, choices and tools
Level 4-Patient is in full control of their treatment
What are follow up procedures for a patient who has an open apex regardless of extra oral dry time?
First 7-10 days - no root canal treamtnet unless clinical or radiographic signs of pulp necrosis are evidents
2-4 weeks - splint removal
4 weeks - radiographic examination
What are functionally dependent older adults?
They are those persons who are no longer able to survive in the community independently and are either homebound or living in institutions.
What do Australians define as age?
- Health status
- Appearance
- outlook and attitude to life
- level of fitness
What do you do if you have a mobility 3 tooth?
You need to extract it and recall the patient in 3 months
What are the steps of management of MRONJ when doing bone invasive procedures?
- Inform patient about the risk
- Drug holidays are essential
- No antibiotic prophylaxis
- Ensure optimal oral hygiene with use of mechanical debridment
- Reduce trauma to periosteum
- Monitor oral wound for 8 weeks, if does not heal than refer
- DO NOT DEBRIDE NONHEALING WOUNDS
What are the standard precautions?
- Hand hygine, as consistent with the 5 moments for hand hygiene
- The use of appropriate personal protective equipment
- The safe use and disposal of sharps
- Routine environment cleaning
- Reprocessing of reusable medical equipment and instruments
- Respiratory hygiene and cough etiquette
- Aseptic technique (the dirty and clena areas)
- Waste management
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
What embodies professionalism?
- Patient centered practice
- Effective communciation
- Ethical and trustworthy professionals
- Professionals that protect and promote health
- Regular reflections on practice
- Constant learning and improvement of skills
- Practicing within the scope of skills
- Commitment to safeety and quality in healthcare
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
What is a treatment for a patient with angular cheilitis?
Miconazole 2% gel 2.5 mL topically (then swallowed), 4 times daily, after food, for 14 days; continue treatment for at least 14 days after symptoms resolve
or
Chlorimazole 1% cream topically to the angles of the mouth, twice daily for at least 14 days; continue treatment for 14 days after symptoms resolve
How does tobacco affect periodontal disease?
- Negative affect on tissue vasculature
- interfering with normal humoral immune reaction and host inflammatory response
- changes of subgingival microflora thsu facilitating early acquisition and colonisation
- changes in bone turnover
What are the Tori and exostoses?
They are bony protuberances.
Non-neoplastic.
Possibly inherited
Exotoses - multiple or single nodules at the buccal aspect of the alveolar bone
What is a traumatic eosinophilic ulcer?
It is a bening chronic ulcer usually presenting on the tongue.
It is crateriform in shape.
Give 5 differential diagnosis for red lesions
- Pyogenic granuloma
- Haemangioma
- Peripheral Giant Cell Granuloma
- Erythroplakia
- Oral squamous cell carcinoma
What type of nodules are theses?
This is lymphoid hyperplasia
What are some of the effective major connectors for a maxilla?
Posterior palatal strap
Anterior palatal strap
What is the DOT DAM principle of radiology?
Don’t Order Tests that Don’t Affect Management
What is extrusive luxation? What is the treatment?
It is the displacement of the tooth out of its socket in an incisal/axial direction.
Treatment:
1. Reposition the tooth by gently pushing it back into the socket
- Stabilise with 2 week using a passive and flexible splint
- Monitor pulp. If necrotic, start treatment appropriate for the stage of tooth maturation
What are the different ways of high transmission?
- Contact
- Droplet
- Airborne
What should you try during the denture try in stage?
- Denture articulation
- In patient mouth
- Aesthetics
- Occlusion
- Fitting surface
- Check function and pronunciation
- Obtain patient consent
What is important to understand about ankylosis?
After the delayed reimplantation, ankylosis is essentially unavoidable and needs to be considered
What to do in a hypoglycemic event?
- Stop treatment
- Give 15 g of glucose and measure glucose level in 15 minutes
- If still low, administer 3 or more portions
- f symptoms persist, seek medical advise and call 000 if patient is unconcious
- 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
What do you do if a cobalt chrome denture is loose?
Adjust the clasps
How to maintain staff safety during the OPG?
- Distance
- Position
- SHielding
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
How would go about the extraction stage?
First you need to extract the posterio teeth and give a few months for healing and boney remodeling. Anterior teeth will be extracted before denture insert
What is an overall impression?
Pick up + wash impression together
What is eryhtroplakia?
Erythroplakia is a predominantly fiery red patch that cannot be characterized clinically or pathologically as any other definable disease
What are the three common oral HPV infections?
- Squamous papillomas/Oral warts
- Condyloma accuminatum
- Focal epithelial hyperpklasia
What is the prescription of amoxicillin + clavulanate for spreading odontogenic infection?
Amoxicillin 875 + clavulanate 125mg) orally, 12 hourly for 5 days
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.
What are some allergic reactin that may occur in chair?
- 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)
- 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.
How do we take a reline impression for a partial denture
Light body on denture sadled to record soft tissue
Pop the denture into the patients mouth
Take and alrginate impression
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.
What is the key of periodontal regeneration?
Formation of new cementum and bone
What is lichen planus?
A lichen Planus is a chronic inflammatory disorder of uknown etiology with characteristis relapses and remissions, displaying white reticular lesions, accompanied or not by atrophic, erosive and ulcerative and/or plaque type areas. Lesion are frequently bilaterally symmetrical.
Desquamative gingivitis may be a feature.
What denture can’t we repair?
Valplast
What is osteoconduction?
It permits bone growth on surface or pores. This occurs in bone implants.
How can we as dental specialist prepare patient for the impacts of agein?
- Start having conversations early about the longevity of treatment plans
- For aged care patients, long term dental fitness is essential
Your patient comes in with an avulsed tooth that has been placed in a storage medium or has been drying out for less than 60 minutes. The tooth is believed to have an open apex. What are the steps for management?
- Clean the root and apical foramen with saline and do not touch the root
- Soak the tooth in doxycycline (1mg per 20 ml of saline) for 5 minutes if possible
- Administer local anesthesia
- Irrigate the socket with saline
- Examine for possible fractures and repositoon if necessary
- Replant the tooth slowly with digital pressure
- Verify with radiograph
- Suture gingival lacerations
- Apply flexible splint for 2 weeks
What are the international frameworks that support the provision of care in the context of special needs dentistry?
- Universal declaration of human rights
- UN Convention on the Rights of Persons with Disabilities
What are neurological disabilities?
These are conditions that are attributable to a neurological cause which may impact on the ability to perform physical activities e.g. cerebral palsy
What is the similarity between rheumatoid arthritis and periodontal disease?
Both are:
1. Chronic inflammations
2. Involve imbalance of immune regulation
3. Release inflammatory cytokines
4. Have environmental and genetic factors
What is the 5 As framework?
- 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
What is the most appropriate type of empathy that can be used in a healthcare setting?
Compassionate empathy is the type of empathy that is usually most. Nobody wants to understand them or feel what they feel, they just want support.
What is lateral luxation? What is the treatment?
It is the displacement of the tooth in any lateral direction, usually associated with a fracture or compression of the alveolar socket wall.
Treatment:
1. Reposition the tooth digitally by disengaging it from its locked position and gently reposition it into its original location under LA
- Stabilised the tooth for 4 weeks with passive and flexible splint
- Monitor and at 2 weeks make an endodontic evaluation
- For immature teeth - might need endodontic procedure IF THE PULP IS NOT NORMAL. Similar for mature teeth
What is a Type 6 indicator and what does it do? What is it’s disadvantage?
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.
What are the indications for a veneer?
- Diastema closure
- Alter shape, contour, position
- Alter tooth color
- Mask tooth surface anomalies
What are the standard precautions?
- Hand hygiene, as consistent with 5 moments for hand hygiene
- The use of appropriate personal protective equipment
- Safe use and disposal of sharps
- Routine environmental cleaning
- Reprocessing of reusable medical equipment and instruments
- Respiratory hygiene and cough etiquette
- Aseptic technique – standard or surgical technique
- Waste management
- Appropriate handling of linen
What is a gingival zenith?
It is the line drawn at the terminus of the gingival margin at each incisors. Low gingival zenith in central and high in laterals will result in poor aesthetics. It central incisor and canine should coincide.
What is a leukoplakia?
It is a predominantly white plaque of questionable risk having excluded other known diseases or disorders that carry no increased risk of cancer
What should we examine/assess our patient fo access?
- Perceive the need for oral health care
- Seek oral health care when appropriate
- Reach or access oral health care
- Engage in oral health care process
What is the most aesthetic way for a incisal line to run?
You want it to run parallel to the lower lip.
What should you do if the crown is 1mm out of margin howere it sits perfectly on the cast?
- Check contact point with adjacent teeth
- Check fitting surface (intaglio surface)
- Check for excess temporary cement
- Check the tooth has not moved
- Check soft tissue and hard tissue defect
What to do if a patient has acute symptoms and you want to do debridement?
Give them anti-biotics and give them a few days and make them come back
What are the ideal cement properties?
Biocompatibility
Sufficient working time
Low film thickness
Low solubility
Compressive and tensile strength
Adhere to tooth structure and restorative material
Anticariogenic properties
Shade options
What are the aspects of shared decision making?
- Clinicians and patients are equally involved
- both share information equally
- Both express treatment preferences
- An agreement is reached
How do cements act?
- Mechanical – through interlocking with surface irregularities
2.Micromechanical – air abrasion or acid etching
3.Chemical bonding
What is MIP?
Maximal intercuspal position.
The complete intercuspation of the opposing teeth independent of condylar position, sometimes referred to as the best fit of the teeth regardless of the condylar position; comp, CENTRIC OCCLUSION
What is new attachment?
Formation of new collagen fibres which are embedded in newly formed cementum. This is the ideal process.
What is important to understand as a dentist when treating people with developmental disabilities?
You need to be aware of the different needs - behavioural, physical,e motional and cognitive.
You need to expand and update your skill set and techniques to meet the unique oral needs of people with developmental disabilities by creating a person-centered environment and identifying a person’s intellectual capability and level of cooperation.
What is the pathogenesis of periodontitis?
- Initial colonisation of the periodontal pocket by Strep and Actinomyces species
- Increase in the amount of biofilm causing a shift from aerobic to anerobic species
- Initial sub-gingival build up biofilm occurs, initiation of immune response in form of PMN mobilisation for containment of infection
- Cytokine releases in response of bacteria in form of IL-1, TNF-a and IL-6, resulting in amplification of inflammatory response
- Production of MMPs (especially MMP 8 and 9) resultin in destruction of periodontal tissues.
- Osteoclastic activation through RANKL from IL1 and TFN-a, resulting in alveolar bone loss
- Reduction in alveolous anf soft tissue results in periodontal pocket
- Diabtes and Smokign makes it worst through AGEs and immunomodulation
How do you deal with an upset patient?
- Show empathy to neutralise the situation
- Present the factual information again
- Tell the patient that it is within their right not to do anything about the situation or seek another opinion - empower the patient
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
- Relevance - what will help the patient connect to this info? - relate to patients perspective
- Involvement - How can patient contribute? - offer suggestions and choices rather than directives
- 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
What are some of the growth factors that can be used for regenerative surgery?
1.Autogenous – platelet rich plasma
2.Xenograft – enamel matrix protein like Emdogain (very common) (requires prior etching)
3.Synthetic
How to write a diagnosis for rem pros?
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
What are the barriers faced by people with special needs in Australia?
- Govemental, organisation or syste, barriers
- Physical barriers
- Professional or workforce barriers
- Patient or carer barriers
- Financial barriers
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
What are risk factors for cancer?
- Tobacco
- Alcohol
- Betel-quid (tobaco in a different form) - bucal sulcus
What are local haemostatic measures?
1, Pressure
- Minimal trauma
- Cellulose or collagen
- Sutures
- 4.8% tranexamic acid for blood clot stability (warfarin only). Before surgery + 10ml for 2 minutes 4 times a day for 2 days
What code do we use for a retainer?
732
What are the six features are wrong with this OPG and what are the error on effect on final image?
- Unnecessary artefacts i.e. the glasses - Results in unnecessary object being presented on the DPR, the glasses
- Patient positioned forward - Anterior teeth blury and too small - spine sen on the film
- Failure to position the tongue against the palate - large, dark, shadow over the maxillary teeth between palate and dorsum of tongue
- Head is tilted to the side in the horizontal direction - condyles are not equal in height, nasal structure is distorted
- Head is turned to one side - seems like the RHS was closer to the detector than LHS - resulting in LHS ramus appearing larger
- Exposure factors have not been selected properly - the image appears to be blur overall
- Chin down - the V shape - joker brain
- Chin up - fraun
How much of the radiation does CBCT produce?
75 uSv (microSieverts)
What is osteoconduction?
It permits bone growth on surface or pores. This occurs in bone implants.
What condition is this?
This is pyogenic granuloma.
It is a localised soft tissue lesion that is common in people who are pregnant due to the hormone imbalance.
Site: Anywhere but classically arises from the interdental papilla
What are some examples of Zin Oxide Eugenol temporary cements?
- TempBond – set time 7 minutes – dry tooth and restoration – DO NOT USE IF RESIN BASED PERMANENT NEED TO BE USED
- RelyX Temp – set time 1.5 minutes – DO NOT USE IF RESIN BASED PERMANENT NEED TO BE USED
When don’t you need secondary impressions?
- Valplast denture
- Small acrylic
- Temporary denture or short immediate
What code do we use for a denture tooth?
733
How do you calculate the new OVD during the examination?
Resting dimension minus freeway space. Think about it if OVD is between 2 point at occlusion, rResting vertical dimension minus freeway space will give you that!
What are the different types of alveolar bone defects?
Class 1 – Bucco-lingual deficiency
Class 2 – vertical deficiency
Class 3 – combination
What are some of the geriatric syndromes that can be experienced by older adults?
Different dementia related illnesses
How does it take to regenerate periodontal tissues like alveolar bone, periodontal ligament and cementum?
3-6 months
What is external pressure resorption? What is the treatment?
It is a resorptive process that occurs when there is pressure applied to the external surface of a tooth root.
Can be caused by impacted teeth or pathologies such as cysts.
Treatment: Removal of impacted tooth or removal of pathology or removal of resorbing tooth and extrusion of the impacted tooth with ortho
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. Not good prognosis
Class IV - recession that extend to or beyond mucogingival junction with loss of bone in the interdental area with exposure of interproximal root surface. Very unpredictable prognosis.
What is proliferative verrucous leukoplakia?
Proliferative verrucous leukoplakia is a progressive, persistent and irreversible disorder characterized by the presence of multiple leukoplakia that frequently become warty.
What are the 4 different types of cementum?
- Acellular Afibrillar Cementum (AAC): Protection of enamel surface (function not well understood).
2.Acellular Extrinsic Fiber Cementum (AEFC): Primary attachment for periodontal ligament fibers, crucial for tooth stability.
3.Cellular Mixed Stratified Cementum (CMSC): Adaptive and reparative functions, contributing to the periodontium’s response to occlusal forces. Most important cementum in regeneration of the periodontal pocket.
4.Cellular Intrinsic Fiber Cementum (CIFC): Repair and regeneration of damaged cementum and periodontal ligament, maintaining root integrity.
What rem pros appliances do not need a secondary impression?
Valplast denture
Acrylic denture for a small saddle replace one or two teeth
Temporary denture
What is this condition?
This is verruciform xanthoma, it is a rare lesion that mimic squamous cell carcinoma.
It is flat, velvety, pebbly.
What is the role of a general denstist for a patient with oral cancer?
- Detection of potentially problematic lesions and referral
- Management role - for any other oral concern, including complications from treatment of oral cancer
- Ongoing screening
What are the two different groups of unwanted effect after CBCT?
1.Deterministic – result of cell killing
2.Stochastic – result from cell modification
What materials are available at ADH for secondary impressions?
Alginate
Polyether – impregum – use if no undercuts (hard or soft tissue) are seen
Polyvinyl Siloxane – honigum – use if undercuts are present
How can we construct a rough prototype for restoration?
You can you putty or isolating material like PTFE tape and old, out of date composite just to get a nice 3D, functional structure. Do not bond as you need to remove it. Check with patient. Create a clear PVS bite reg material to register the prototype restoration so you can replace with permanent one – key guide.
What is the advantage of Bio-Oss and Emdogain comparing to Perioglas?
Both Bio-Oss and Emdogain results in formation of cementum
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
What are the principals of a post?
- Diameter
Wider diameter -> more retention but more risk of root fracture
=> recommend 1/3 of root diameter
Need to assess all direction - Only MD direction on radiograph -> check the master GP for the diameter of the root canal
- Length
At least 1/2 or 2/3 of the root
Sufficient GP (minimum 4-5mm) from the Apex -> measure from end of GP to end of the post - For adequate apical seal
- Can leave more if u have longer root (eg upper canine)
Bone lvl - Make sure the post is below the alveolar crest
- Material
Aim - Withstand functional stresses
- Resist corrosion
- Radiopacity
To check on radiograph - Biocompatibility
Non-corrosive
Non-toxic - Retrievable
- Bond to the resin cements
- Elastic modulus similar to dentine
Potential fracture location due to the uneven distribution of occlusal load by the post to the tth - Not interfere with aesthetics
Who are vulnerable people?
They are people aged under 18 or other individuals who may be unable to take care of themselves or are unable to protect themselves againt harm or exploitation.
What are the main barriers for people with special needs that prevent them from accessing primary care?
- Training of professionals
- Knowledge and awareness of the rpoviders
- Communication
- Fear and embarrassment
- Lack of involvement in healthcare decision-making
- Time constratins
What are the steps to the extra oral exam for rem pros?
- TMJ
- Facial thirds
- Facial shape
- Lip and cheek support
- SMile line
What is the purpose of AHPRA’s code of condutct?
To set expectation about professional behaviour and conduct for registered health practitioners based on the concept that maintaining a high level of professional competence and conduct is essential for good care.
What are the signs of salivary gland dysfunction?
- Frothy mucinous saliva
- Pooling of saliva in sublingual area
- Dry mucinous strands coating the tongue
- Epithelial atrophy
- Lack of calculus
- Candida infection
- Coronial root caries
- Accelerated tooth wear
What are 5 components of discussion when it comes to informed consent?
- Diagnosis of condition
- Recommended treatment plan
- Alternate treartment plan
4.Potential risks of all treatemnt alternatives
- Potential risks of no treatment
What are the causes of acute tooth pain?
- Reversible pulpitis
- Irreversible pulpitis
- Endodontic abscess
- Cracked tooth
- Root fracture
- Occlusal related pain
- Dentinal hypersensativity
When do you refer a patient to a special needs unit?
- Pt who are unable to cope/ cooperate with dental tmt provided in the primary care settings
- Beyond (clinical or knowledge) skill set of the general dentist in the primary care settings
- Require adjunctive support (eg haematological, behavioural, medico-legal aka consent, bariatric, portable dental equipment
What type of plan works the best for client who would like to change?
A SMART plan:
Specific
Measurable
Achievable
Relevant
Timed
What makes an experience traumatic?
- It involves a threat to one’s physical or emotional well-being
- it is overwhelming
- It result in intense feelings of fear
- it leaves people feeling helpless
- It changes the way a person understands themselves
What to do if the patient comes in with an immidiate denture, that is loose and they are unhappy with it’s aesthetics?
Construction of a new denture is the best option!
What are the cytological changes in dysplasia?
- Nuclear pleomorphism
2.Cellular pleomorphism
- Increased nuclear size
What is trauma?
Trauma is simply exposure to any traumatic situation or event that overwhelms your ability to cope
What is the significance of curve of spee in dentures?
- it maintains occlusal harmony
- Supports efficient mastication
- Allows posterior disocclusion during portrusive movement
What is the hierarchy of consent in South Australia?
- Patient themselves
- Advance care directive - ‘Substitute Decision maker’ - a person who can reflect the decision that the person would have made in the circumstances if they had the capacity to consent
- A guardian
- A spouse or domestic partner
- Adult related by blood
- Aboriginal or Torres Strait Islander kinship/marriage
- An Adult Friend
- An Adult Charged with overseeing the day-to-day care of the person
- The SA Civil Administrative Tribunal upon application as last resort to appoint a Public Advocate
What are secondary impressions used for?
For constructions of master models
For construction of wax bite or to make C/C frame
What is an intelectual disability?
It starts at the time before child turns 18 and is characterised by difficulties in communication, memory, udnerstanding and can also include physical skills
What is this condition?
This is Herpetiform aphthous ulvers - it is an uncommon and are very very small.
Named herpetiform due to the resemblance of the ulcers to those of herpetic stomatitis
What do you do if the patient takes injectable anti-thrombotic therapy?
Wait until they stop the therapy, it is usually given after hospital visit
How to write a diagnosis for rem pros?
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
What are the Indications of PBM crown?
o Heavy occlusal load
o Aesthetics
o Longevity
o Mask discolouration
What are the basic of acrylic denture designs?
Flange
Base
Teeth
Clasps
What are the steps for chrome denture design?
- Saddle
- Support
- Retention
- Connectors
- Simplification
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
What is the purpose of periodontal surgical therapy?
The goal and purpose can only be considered in conjuction with complete periodontal treatment. SO first initial closed surgical root debridement and then open surgical root debridement.
In Stage 1 and 2 perio, initial closed surgical root debridement is sufficient. In Stage 3 and 4, open surgical root debridement may be required.
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
What matterials are used for bite registration?
Exabite
Modeling/beuty wax
Copper wax
Wax rims – use only in large edentulous areas with unstable contacts
What are the 4 ethical principle of healthcare?
- Beneficence
- Non-maleficence
- Patient autonomy
- Justice (this is an essential principle of SND (social justice))
What are the contraindications for a partial denture?
- Lack of suitable abutment teeth
- Rampant caries
- Perio disease
- Poor oral hygiene
- Patient can not tolerate them
- Post readiotion tratment - osteoradionecrosis
When can periodontal disease cause endodontic problems?
If the periodontal pocket reaches the apex
OR
If there is a large laterla canal in the tooth
OR
When it reaches the furcation canal
How to use Vita 3D master guide?
1.Select value by leaving only M hue in guide body natural light and TURN OFF YOUR LIGHTS AND GO TO THE WINDOW. Get close to the tooth.
2.Chroma is evaluated. How saturated are the teeth
3.Hue selection. Is the tooth more yellowish then middle? Is it more red??? Move from middle (M) to either R or L
4.Remember computer generator system allow you to match shade in between value ranges or chroma
What is a gingivoplasty?
Reshaping of gingival tissues to improve gingival contours. Can be done with periodontal knife, scalpel, diamond stone or electrosurgery. Can be done after necrotising gingivitis.
What kind of structure is this?
This is herpes labialis - please do not touch them
Site - LHS vermillion border and just below the lower LHS conissure
Size - scattered but overall spands around 10-20mm, irregularly shapped, diffused
Morphology - slightly elevated but mostly flat, distinct, spread, a crop of vesicles
Colour - yellow but also some of the lesion is similar to the vermilion border
Consistency - NOPE IT IS A PHOTO Texture - rough because some have been bursed but some are smooth
What are the features of necrotising gingivtis?
1.Necrosis of interdental papillae and loss of gingival margin contour
2.Bleeding, halitosis and pain in the site
3.Punched-out and cratered depression/lesions in interdental sites covered with greay or grey-yellowish pseoudomembrane
4.Patient complains of metallic taste
How do we identify secondary images?
- They are blurred and put of focus
- They have the same orientation as the primary image
- They are larger than primary image
- They are higher up and on the opposite side
What are some of the patient-related factors that we need to consider when treating patient?
Generally, patient centered care (shared decision-making model) and evidence-based dentistry should be utilised.
Culturally safe practices should also be utilised.
Also:
- Social determinants of health
- Cultural issues
- Health literacy
- Previous life/dental experiences
- Health issues
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:
- Stop treatment
- Lie the patient down
- Support airway by removing all object for the mouth
- Measure the patient’s blood pressure and heart rate
- If the patient does not regain consciousness - call 000 begin DRSABCD
What are highlights of resin cements?
Use resin primarily
Mechinsms of matrix formation – self/auto cure, light cure or both
Bonding procedure – total etch and rinse (the best), one step etch and bond (self-etching) or self adhesive
Micromechanical bonding to tooth and etched crown
Good strength
Polymerization shrinkage can be significant
Difficult removal
Post-op sensitivity
Technique sensitive
Eugenol may inhibit polymerization – NON-EUGENOL TEMP CEMENT PLEASE USE
Use MDP and 4-META to bond to metals
What are the significant problems that could occur if the curve of wilson is not maintained appropriately?
There could be interference during lateral mandibular excursion and needs to be adjusted
What is the objective of periodontal regeneration?
To crease a physical barrier that permits the growth of bone and PDL cells rather than epithelial or gingival connective tissue into the periodontal defect.
This process takes weeks to months thus probing in GBR should not be performed.
What is the standard steps to diagnose dental pain?
- History taking
- Visual examination
- Pulp sensibility testing in form of electrical pulp testing and other teeth
- Percussion testing
- Periodontal probing
- Palpation
- Crack detection
- Radiograph
What is a developmental disability?
It applies to children aged 0-5 where conditions have appeared in the early developmental period, but no specific diagnosis has been made and the specific disability group has not yet been diagnosed. E.g. Autism or cerebral palsy
What is external inflammatory resorption? What is the treatment?
External inflammatory resorption occurs when the tooth has an infected root canal system and there has been damage to the external surface or communication between the pulp and external surface.
Can occur at the apex or lateral surface of the root.
Treatment: preventative approach: after external injury, utilise systemic antibiotics + corticosteroid based root canal treatment. Interceptive approach: when the resorption is already evident use corticosteroid based root canal treatment
What is important to let the patient know about peirodontal disease?
It is not a one off, it is a continuous process that takes multiple visits and ongoign care. If else, the systemic disease will get worst
What is external inflammatory root resorption?
Resorption due to periapicla infection
What are the indication for surgical correct of recession?
- Increase in recession
- Dentinal hypersensitivity
- Aesthetic concerns of the patient
- Persistent inflammation
- Age
What to do if a denture is retentive but falls out during chewing?
You might need to adjust occlusion. If it happens during speech you might need to change the extension or smooth the surface
What is SNU?
It is a branch of dentistry that manage pt who are adversely affected by their general health condition:
o Complex Medical hx
o Intellectual disability
o Physical disability
o Psychiatric disability
o Geriatric pt
Need a special methods or techniques to prevent or treat oral health + modify conventional tmt plan. Primary dental practitioners may not be able to manage these pt in the primary care setting
o Liase w ppl giving consent
o Liase w support worker
Specifically tailored preventive and corrective tmt (tailored OHI and rational dental care).
The need for special needs dentistry arose to address barriers faced by many individuals due to their special needs.
What is an endo-perio lesion?
It is a draining sinus that goes through the PDL
What is a normal fasted plasma glucose level?
4-6 mmol/L
For each of the Seatle Care groups, devise a quick treatment plan?
- Pre-dependency - consider the long-term viability of restorations and prostheses. Plan treatment outcomes for easy maintenance
- Low dependecy - focus on repair and replacement of strategically important teeth and plan for ongoing maintenance
- Medium dependency - repair or replace strategically important teeth with conservative treatments like the atraumatic restorative technique (GIC+use of hand instruments for removal of caries) and oral prosthesis to simplify oral hygiene
- High dependency - offer palliative treatment
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
What is the varicells virus?
It is also known as chicken pox!
It is a vesicular infection that migh have some oral mucosal involvement
What are the initial post denture instructions?
- Excessive saliva
- CHange in speech
- May feel bulky
- FOod might get stuck
- Denture move to some extend
- Migh have high spots
- Remove dentures and clean after meals
- Brush denture as brushing teeth
What should you mark on the wax rims?
- Mark mid line
- Mark canine lines
- Mark smile line
What is enamel infraction? What is the treatment?
It is an incomplete fracture of the enamel, without loss of tooth structure.
Treatment: usually, no treatment but if needed etching and sealing with bonding resin should be considered.
When do you need a secondary impression?
- Acrylic partial for multiple edentulous areas
- Chrome denture
- Complete denture
- Some immediate dentures
How to manage a patient with corticosteroids?
- Find out how long they have been on steroids
- Reduce stresses
- 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.
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.
What is important to understand about periodontal surgery?
Only small amount of attachment gain (through pocket healing) occurs after any form of conventional periodontal surgery at the base of the defect.
Goal of treatment: a non bleeding pocket of 5 mm or less. This is a healthy pocket depth.
Remember that presence of a pocket does not equate to active periodontitis but BOP and bone loss does.
What is apexogenesis?
A vital pulp therapy procedure performed to encourage physiological development and formation of the root.
What is the prescription of intravenous antibiotics for spreading odontogenic infection?
Benzylpencilli aintravenously in intensive care 2.4g 4 hourly
How do we deal with barries faced by people with special needs?
- We identify all the barries
- We adress barries we can adress throuh legislative changes, chaning our environemnt, trainign progress, population approaches and public funding
What is the common appearance of MRONJ?
Pains, swelling and draining sinuses. Bone destruction. Periosteal reaction is common.
What is orthodontic resorption? What is the treatment?
Orthodontic resorption is the process by which the apical part of one or more teeth undergo resorption, resulting in a shortened root.
Treatment: when ortho stops, resorption stops. Monitor and treat when other conditions occur.
What are some of the implication of our ageing population on access to oral health care and service delivery?
- Patient issues - residence, transport barriers, financial barriers, health issues, consent
- Workforce issures - suitability trained individuals, appropriate skills, equipment and willingness to provide care
When do you consider periodontal sugery?
After the initial phase of sub- and supra debridement for after about 8-10 weeks (to no breakdown the long junctional epithelium) if the pocket is above 6 mm with bleeding on probing.
If it does not have BOP or is only 5mm, simple deplaque and debridement is sufficient.
What are the material available for the primary impressions?
Alginate with periphery wax
What is a lipoma?
It is an uncommon lesion in the oral cavity - most commonly filled with adipose tissue (fat cells)
What are the options for replacement of loss teeth?
- Removable denture
- Implant
- Fixed pros
- No treatment
When do you cut rest sits?
Rest sits must be cut prior to secondary impression to be taken. DO NOT CHANGE IT
What are some of the oral that require urgent attention and referral?
- Long-standing ulcers with no obvious cause
- Indurated (hard) borders - PLEASE PALPATE
- Deep ulcers with rolled borders
- Ulcer that is fixed to underlying tissues - usually ulcers are mobile
- Painless ulcer
- Ulcers associated with lymphadenopathy - if there is a large swelling - EMERGENCY
How to communicate appropriately?
- Communicate courteousley, respectfully, compassionatley and honestly
- COnsider the ahre, amturity and intellectual capacity
- Be aware of health literacy issues
- Meet the specific language, cultural and communicaiton needs
- Endeavour to confirm a patient understading of the information
- Encourage the patient to engage in conversation
- Only relevant infromation
- Be non-judmental
What is incisal configuration?
It is the V shaped area between the incisors. It needs to be at 90 degrees to both of the teeth making up the incisal configuration
When should you not use SDF?
- Heavy metal allergy
- Pregnancy or breastfeeding
- Lesions close to the pulp/possible pulpal involvement
- Signs or symptoms of periapical pathology
- Ulceration, mucositis or stomatitis
- Restoratio of permanenet anterior teeth
What is a complicated crown-root fracture? What are the treatments?
It is a fracture involving enamel, dentin, cementum and the pulp.
Treatment: temporary stabilisation to the non-mobile fragment or adjacent teeth
In immature teeth: Partial pulpotomy
In mature teeth: Pulp extirpation
Then one of the following:
1. Completion of root canal treatment
2. Orthodontic extrusion
3. Surgical extrusion
4. Root submergenbce
5. Intentional replantation
6. Extraction
7. Autotransplantation
What is importatn to consider when treating patients with immunodeficiency/immunopcompromise/immunosupression?
- Review of serology
- Antibiotic prophylaxis
- Supportive blood products during surgery
- Assessment for opportunistic infection of the oral cavity
- Management of herpes simplex and zostra virus with acyclovir
- CHx rinse pre and psot operativley
- AIDS defining illnesses like Necrotising periodontits
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
What are the properties of saliva?
Physical properties:
- lubrication
- coats food bolus
- solvent for flavour
- cohesive effects
Chemcial properties:
- maintains pH
- neutralises acid
- controls bacterial growth
- remin
What should you cover in penicillin allergy history?
- What did patient react to?
- 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
- How long after start of treatment did it occur eg after a few hours or many days?
- How long ago was the reaction?
- How was it treated?
- Have they had similar antibiotics since?
What are the clinical steps for denture repair appoitment or reline?
Book with lab
9am – send denture to lab with alginate
4pm insert the denture or if cobal chrome allow 3 days if you need mollopalst reline, allow 24 hours
Review in 1 week
What is osteoinduction?
Recruitment of immature cells and stimulation of these cells to develop into pre-osteoblast e.g. bone healing situations
What are favourable fractures?
Favourable because the elevator muscles will not be able to displace the fracture. The anterior segment will obstruct the upward displacmenet.
Masseteric - posterior angled fracture
Medial pterygoid and mylohyoid - lingual angle fracture
What is a code for adding a tooth ona denture?
768+071
What code do we used for a denture fabrication stage?
799
What is the difference between serous and mucous saliva?
Serous - produced by the parotid gland and a bit by submandibular of protein rich watery fluid.
Mucous - produced by the sublingual and minor salivary glands. It is important for lubrication
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
What are the conditions for consent to be valid?
- Capacity - to understamt and appreciate the consequences of the decision
What is the neutral zone impression technique used for?
The neutral zone impression technique is applied for taking imp of atrophy and mandibular ridge.
What is the best bonding technique?
4th generation ethc-prime-bond-composite.
What are the oral side effects during radiotherapy?
- Mucositits
- Taste changes
- Dry mouth
- Increased mucous
- Tooth hypersensitivity
- Dysphagia
- Weight loss
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
What intra-operative factors are associated to negative outcome in endo?
1.Iatrogenic perforation
2.Patency at apical terminus
3.Extrusion of root fillings
What is replacement resorption?
Can follow trauma. Tooth structure is replaced.
What is free way space?
freeway space obs, slang: syn, INTEROCCLUSAL REST DISTANCE, INTEROCCLUSAL REST SPACE
What is traumatic neuroma? What are it’s clinical signs?
It is a lesion thatoccurs due to the damage of a nerve trunk following some sort of injury (like surgery or pressure on dentures).
Essenially - the repair of the axon does not go as planned and the lesion if fully comprised of the neural tissue.
Clinical features: small swelling or nodule on mucosa near mental foramen, alveolar ridge, lips or tongue. Pressure on the nodule cuases pain
Give 5 differential diagnosis for an ulcer?
- Herpetiform ampthous ulcer
- Mild amthous ulcer
- Major ampthous ulcer
- Traumatic acute ulcer
- Traumatic chronic ulcer
What is the cultural iceberg?
- Behaviors & practices - clothing, greeting, speech
- Atttitudes - levels of fomality - manners or politness
- Core values - good or bad behaviours
What is classified as moderate periodontitis by CDC/AAP?
- At least two proximal sites not on the same tooth with attachment loss of 4mm or more
- At least two such sites have pockets of 5mm or more
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
What type of tissue is this?
This is lingual thyroid tissue
What is main treatment for patient with oral cancer?
- Initial diagnosis
- Definitive treatment
- Management of complications and monitoring
What is a common radiographical appearance of squamous cell carcinoma?
Smoking adults. Ill-defined, permeative lesion. Spread localy and lymph nodes. Destroys bone.
What if a patiet has problem with gaggin?
The extension of the denture may need to be modified.
Following options:
- Remove the palatal extension of the denture
- Reduce the buccal extension of the denutres
- Desensitisation therapy
- Re-do the denture with a reduced secondary impression
What are the steps for reprocessing of Reusable medical devises (RMDs)?
- Pre-cleaning at the chairside
- Mechanical cleaning using ultrasonic
- Manual cleaning using of professional cleaning machines
- Thermal disinfection
- Thermal disinfection using washer-disinfection
- Inspection
- Choice of packaging material and sealing of packages
- Labelling packages of reuseable medical devices
- Run a Bowie-Dick type tests for air removal and steam
What are some of the pre-requisites for health according to the Ottawa Charter?
- Peace
- Shelter
- Education
- Food
- Income
- A stable exosystem
- Sustainable resources
- Social justice and equity
What is a normal GFR?
Above 60 if it is below 15 they are in kidney failure
What can you do to reline the denture to new OVD?
You can use CCA stopper or a wax compound + border molding + taking impression of upper and lower dentures with Upper first.
So the wax compound needs to increase the OVD and ned reline will ensure that soft tissue retention and supprot can be achieved.
Always use adhesive
What is the definition of dental impression?
Dental impression creates a negative imprint of hard and soft tissues in order to create a positive cast or model.
What are predisposing factor to periodontal abscess?
1.Furcation areas because they are hard to clean.
2.Patients with diabetes – impaired cellular immunity, decreased leukocyte chemotaxis and bactericidal activity.
What are some of the treatment for salivary dysfunction?
- Stimulation of salivary flow through masticatory sialagogues or medication
- Use of saliva substitutes in form of carboxycellulose or mucin based
- Use of mucosal wetting agents like water or GC dry mouth gel
What are the advantages of low individual effort for the population?
- Widespread effect on nearly all populations across the social spectrum
- Large impact at population levels
- In certain instances - may be able to target health inequalities, though can only apply on legislative level
What is the Mach effect?
It is an optical illusion. Form of edge enhancement which facilitates the detection of the edges of an object. Basically, the edges between light and dark appear darker. SO NO PATHOLOGY.
Give 5 differential diagnosis for a white lesion
- Leukodema
- Leukoplakia
- Lichen Planus
- Frictional keratosis
- Oral squamous cell carcinoma
What are the main types of temporary cements?
Zinc oxide eugenol
Zinc oxide non eugenol
Resin
What can you do to improve bone levels after periodontal surgery?
You can add a boney material for regeneration. But remember, no probing for at least this much for each material:
Perioglas – 6-12 months
Bio-Oss – 12-18 months
Emdogain – 2-3 years
When treating a patient with solid organ transplant what should you consider?
- Corticosteroid supplementation
- Any increased risk of bleeding
- Any infection risk
You are at a footy game and your mate avulses his tooth, what do you do?
Management of avulsion with alveolar fracture
First aid
* Keep pt calm
* Pick up the crown (not the root)
* If the tth is dirty,
o Rinse with milk/saline/pt saliva
o If the dirt is tenacious, use a damp gauze to gently wipe the tooth
* Replant immediately
* Ask pt to bite on the gauze/ handkerchief/napkin to hold the tth in place
* See dentist ASAP
* If replantation is not possible, plant the tth in a storage medium ASAP to avoid dehydration of the PDL cells on the root surface,
o Milk/ HBSS/pt saliva
o Let pt hold it in their buccal sulcus (make sure to warn them not to swallow the tth
o Water is a poor medium -> osmosis -> kill the cells. Better to leave in the air
What should you do if a patient takes anti-platelet therapy?
Use local haemostatis measures like pressures, coagulation assiting material like surgicel and suturing of the wound
What are the types of resective surgery?
- Gingivectomy – removal of pocket epithelium, connective tissue and mucosal epithelium
- Modified Widman flap – removal of pocket epithelium and connective tissue +/- osseous, leacing behind mucosal epithelium
How do you check for high pressure spots?
PIP creame on fitting surface
What are the 3 things that are suggested by Dr. Alison Nelson in regards to effective cross culture communication
- Building relationship/building rapports/building trust - be humble in your approach, be friendly. Remember, you are there to learn about the person and their culture.
- Genuinley reciprical communication. Tell them about yourself as well and use points of connection between yourself and individual under your care.
- Breakdown the power imbalance with person under your care
- Overcome cultural faux pas. Roll with mistakes and listen to patient in those situates. Be a learner not a teller.
What are the indications for MTA?
- Vital Pulp Therapy
- Immature apices
- Perforations - lateral and furcation
- Retrograde root canal filling
What can we repair on a denture?
Broken/cracked denture base
Broken/lost clasp
Chipped/broken/debonded denture tooth/teeth
Broken rest
What are the types of trauma-induced tooth resorption?
- Surface resorption
- Transient apical internal resopriton
- Pressure resorption
- Orthodontic resorption
- Replacement resorption
What is the significance of curve of wilson in dentures?
- Allows lateral mandibular excursion
What are two different types of ankylosis?
1.With replacement resorption – bone is replacing dentine
2.Without replacement resorption - no bone replacing den
What are the common accidental findings on CBCT?
1.Dense bone Islands
2.Torus
3.Osteomas
4.Degenerative Joint Disease
5.Chondrocalcinosis
6.Synovial osteochondromatosis
7.TMJ Dysfunction
8.Sinus pathology
9.Nasal septum pathology – including different sinusitis, and mucucoel
10.Nasal cycles
What is considered to be Grade C periodontitis?
- More than 2mm bone loss over 5 years
- Bone loss to age ratio between 1.0 inclusive radiographically (ie for a 50 year old patient the range is around 50.0 percent and above)
- Low biofilm deposit and large amount of periodontal destruction. Unequal pattern, resulting in small amount of biofilm but large amount of destruction.
- Smoking more than 10 cigarettes per day
- HBA1c level of more than 7.0 in diabetic patient
What should you put on a lab form?
Describe saddles, cross teeth which are not restored
Describe support and draw rests, major connector/plat
Specify abutment tooth/teeth
Specify clasps: rest, retentive, reciprocal
Specify flanges gum fitted vs buccal flange
Specify the extensions
Fill lab form and draw design
Obtain tutor signature
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
How can we overcome barries related to government, organisation or the way our system is set up?
- Through legislative changes that protect people with special needs and support them through policy change. E.g. Disability Discrimination Act or Australia’s Disability Strategy
- Highlightin groups that are less represented in healthcare and improving their access to health services e.g. Putting people with special needs in a priority population in National Oral Health Plan as there is large overlap between their complex medical/social situationa nd complex oral health conditions
What is an uncomplicated crown-root fracture? What are the treatments?
It is a fracture involving enamel, dentin and cementum.
Treatment: Temporary stabilisation of the loose fragment to adjacent teeth or non-movng fragment
And after one or multipel of the following:
1. Orthodontic extrusion
2. Surgical extrusion
3. Root canal treatment and restoration if pulp becomes necrotic
4.Root submergence
5. Intentional replantation
6. Extraction
7. Autotransplantation
What is rettachment?
It is the reunion of existing collagen fibres after tooth avulsion
How does PIP cream work?
Put the PIP in the denture and insert intot he patient mout. Make them chew nicely. Remove the denture. Where you see spots of missing PIP are usually high spots that cause patient to be in pain! Adjust with straight hand piece.
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.
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.
What are the materials available for bite registration?
- Wax rims
- Exabite
What are 4 parts of patient centered care?
- Explore illness and disease and their context
- Seeing the patient as a whole person - aka holistic care
- Showing compassion and empathy
- Reaching a shared sense of patient-doctor responsibility
What is an example of indirect retainer?
Rest, minor unit or major connector
What can implant do?
Always check for nerve injury and boney plate perforations.
What is a good measure for double teeth?
1.Fissure sealing
2.Surgical separation
3.Ortho, implants, autotransplants or prosthesis
What are some the benign lesion of epithelial layer with idiopathic or developmental origin?
- Leukoedema
- White Sponge Nevus
- Epidermolysis Bullosa
What do you do if the patient takes triple antitrhombotic therapy?
Refer to specialist
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. This exclusivley relates to the augmentation of resorped ridge.
What are the three different types of empathy?
o Cognitive empathy – desire to understand
o Emotional empathy – desire to feel
o Compassionate empathy – desire to help & support
What are the steps for internal bleaching?
- Remove extrinsic staining
o Prophy, U/S
o Pt education re extrinsic staining - Pre-op shade
- RD
- Remove restoration but not stained dentine
- Remove GP 1-2mm below CEJ
- Place Cavit or GIC to seal GP from the orifice
o At least 2mm of GIC or cavit - Etch pulp chamber, rinse and dry
o Request DA to dispense bleaching material - Mix sodium perborate with water until u get a stiff paste consistency
- Place bleach mix onto the labial surface of access cavity
- Seal bleaching material w cotton pellet and seal w GIC or cavit
- Repeat the above steps every 1wk until the desired colour is achieved
- Once the shade is reached
o Remove all bleaching material
o Rinse thoroughly
o Record post-op - Defer definitive restoration for 7d,
o Enamel margin might be weakened -> bond strength may be compromised
Your patient comes in with an avulsed tooth that has already been re-implanted. The tooth is believed to have an open apex. What are the steps for management?
- leave the tooth in place
- Clean area with saline
- Suture gingival lacerations
- Varify normal position of the replanted tooth radiographically
- Apply flexible splint for 2 weeks
What are some of the predisposing factor for necrotising gingivitis?
- Local factors – poor oral hygiene, plaque retentive factors (overhangs, crowded teeth and calculus), cigarette smoking
- Systemic factors – stress, poor nutrition (vitamin C deficiency), hormonal imbalance, systemic disease affecting immune response
What is a denture review code?
741_New
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
What are the potential causes of a false negative in ept?
o Incomplete root development
o Recently traumatised tth
* Teeth may lose their sensory function and not response to EPT immediately after trauma. However, the tooth is still have the vasculature intact
o Heavily calcified canal
o Recent ortho tmt
o Pt with psychotic disorders
Your patient comes in with an avulsed tooth that has already been re-implanted. The tooth is believed to have a closed apex. What are the steps for management?
- Leave tooth in place
- Clean affected are with water, saline or 0.1% CHx
- Suture all lacerations
- Varify normal position of the replanted toothr adiographically
- Apply flexible splint for upto 2 weeks
- Immidiatley or shortly after replatation, apply corticosteroid+antibacterial dressing (e.g. odontopaste) to the tooth for atr leats 2 weeks
What is the main feature of oral malignant melanomas?
They have a defused appearance
When would you not report abuse?
- IF there is a reasonable belief that another person has reported abuse
- IF the suspecion was due soley to being informed of the abuse by a police officer or child protection officer
What is the imortant aspect of the peripheral giant cell granuloma?
It is important to determine that the lesion is not an intra-bony or central lesion which has perforated cortical bone
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
What are the aitological factors to Oral Candidosis?
Local factors:
- Poor denture hygiene
-Reduced vertical dimension
-Reduced salivary flow
Systemic factors:
-Extreme of age
-Endocrine disturbances
-Malnutrition
-Antibiotic therapy
What are the most common causes of acute conditions of the mouth?
76% tooth related
18% periodontal related
6% other
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.
Why is open disclosure important?
- Patient has a right to be informed of what is happening to them
- To minimise harm to the patient
- We have a duty of care to the paitnet
- To maintain trust in the dentist-patient relationship
- To gian informed consent for any further treatment related to the incident
- To prevent a recurrence of the incident to others
- To possibly avoid formal complaint
When should you give AB prophylaxis for a person undergoing dyalisis?
When they have an AV graft which is a graft that is sticking out of the arm
What is the difference between post operative treament of gingivectomy and flap surgery?
1.Gingivectomy – sites can be probed 2-3 weeks after surgery
2.Flap surgery – need to wait 3-4 months
How do you manage patients with bleeding disorders?
Haemophilic patients or patient with von Willebrand disease require additional care depending of sverity of the conditon and the procedure that will be performed + peri operative and post operative care.
Consider case selection carefully and consider referring to up-to-date guidelines and discuss with ahetologist.
What are the best pontic designs?
- Ovate - great but needs surgery
- Sanitary - with 2mm clearance - for posterior
- Modified ridge-lap - great and go to
What are two different types of ankylosis?
1.With replacement resorption – bone is replacing dentine
2.Without replacement resorption - no bone replacing den
What is internal inflammatory resorption? What is the treatment?
It is a type of resorption defined as an inflammatory process within a section of the pulp/root canal that results in loss of dentin commencing at the root canal wall and progressing towards cementum. A radiographic oval shape appearance is very common
This can be caused by traum or caries.
Treatment: Root canal treatment with corticosteroid and antibiotic + calcium hydroxide after
What are the steps to effective communication?
- Appropriate eye contact
- Questioning and summarising
- opena dn relaxed language
- Nodding or shaking the head
- Some silence
- Checking for understanding
- Smiling or serious facial expression
- Encouraging to continue
What are the steps to achieve effective communication?
o Encouraging to continue
o Appropriate eye contact
o Questioning and summarizing
o Open & relax body language
o Noddin/ shaking head
o Silence -> give room for pt to talk
o Checking for understanding
o Smiling or serious facial expression
What is the DOT DAM principle of radiology?
Don’t Order Tests that Don’t Affect Management
What are some good practice tips that allow to imrpove cross cultural communication?
- Allow a support person to accompany the client
- Recognise that not all Aboriginal and Torres Strait Islander people want to work with an Aboriginal and Torres Strait Islander worker
- Share some personal information about yourself
- Don’t expect them to share information regarding their families and culture or local history
- Silence should not be misunderstood and should be respected.
How do you assess capacity to consent?
Step 1 - consider the following questions “Do they know what the procedure involves?” “ Do they know what treatment they getting?”
Step 2 - Do they understand the consequences of treatment proposed? Have the decision made freely and independently?”
Step 3 - directly ask the patient “How would this treatment help you?”. Remeber to ask open-ended questions and ensure it is the person being assessed who answers the questions”
What are the significant problem that could occur if the curve of spee is not maintained appropriately?
It could cause interference during protrusive movements thus may require adjustments to upper 7s
What is the use of benzydamine?
Benzydamine is an NSAID that reduces inflammation and pain in oral mucositis.
Available of as DifFlam or DifFlam C
Why would you do an overall impression?
For complex denture repair. Using all 3 material using the overall+wash techniques.
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.
What to do if a patient is complaining of a sore spot?
Check occlusion and adjust it
If it is not enough – use PIP cream and adjust the fitting surface
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.
What is physiological resorption? What is the treatment?
It is the physiological resorption is the resorptive process that primary teeth undergo as they exfoliate. It is normal.
Treatment: monitoring exfoliation or extraction of primary teeth
What do you do if your secondary impression for a full denture is not adequate and you unticipate that denture may not be as retentive as you would like?
You can request a temporary acrylic base mixed with wax (cold cure acrylic)! After denture try in – take a wash impression to improve retention! You can also take the bite registration with this tool. A 2-in-1.
What are the initial recall for SPT?
8-12 weeks
What are the aims of the review appoitment?
Receive feedback from the patient
Reassess dentures
To adjust denture to patient’s satisfaction
Test phonetics and polish the denture
To provide further support
How to set up a provisional treatment plan for perio?
- Emergency phase - e.g. exo
- Systemic phase - e.g. control systemic diseases
- Initial phase - e.g. testing and debridement
- Surgical phase - regenerative surgery
- Restorative phase - temporary crowns
- Maintenance phase - depending on risk close recall or normal recall
What is the difference between salivary gland hypofunction and xerostomia?
Salivary hypofunction: an objective finding of a reduced oral salivary flow that occurs in relation to salivary dysfunction
Xerostomia: a subjective complaint of dry mouth
What are the types of hyperplastic resorption?
- Internal replacement
- Invasive coronal
- Invesive cervical
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
What is internal inflammatory root resorption?
Resorption that occurs internally
In free saddle design, how can you achieve higher resistance and stability for the saddle area?
By including indirect retention through moving a retention point further anteriorly of the saddle. Thus, put a rest seat with a cirucmventional clasp on the mesial of the closest tooth.
What are the different types of boney defects? How do you determien them? Which one have the best treatment?
Types of boney defects
3 wall defect - bone only missing in specific site and surround on 3 different sides. This defect can be considered intrabony - best treated with regeneration.
2 wall defect - bone missing on multiple sites with only 2 sites surrounding the defect. This defect can be considered infrabony - can be treated with regeneration but not as successful
1 wall defect - bone missing on 3 different sites of the tooth and is only supported by 1 wall. This defect can be considered infrabony - regeneration is mostly unsuccessful.
Can be determined with step motion perio probing and radiographs.
What is the common condition that may be caused by radiotherapy?
Radiation mucositis
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
- Treatment planning for surgery including history
- Consent from patient
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.
What is the same as centric occlusion?
Intercuspation position. When the maxilla and mandible is in a balanced occlusion.
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
What are 5 components of emotional inteligence?
- Self-awareness - recognising your triggers
- Self-management - managing your own emotions
- Motivation - what moves us to action
- Empathy - ability to connect emotionally
- Relationship management - building rapport
What is external replacement resorption? What is the treatment?
External replacement resorption is the process where cementum and dentin are resorbed and replaced by bone.
Aetiology: can occur after external injuries
Treatments: lower the amount of time out of the socket after avulsion
What is improtant to understand in injuries to orthodontically resorbed roots?
Technically, because of the apical resorption, the teeth have an open apex thus can heal better. They are considered premature.
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!
What is the management of dry socket?
o Clean of debris (may need curettage)
o Irrigate
o Place dressing (Alveogyl) for symptom relief
o +/- primary closure
o Script of analgesics
o Review in 2 weeks
o NO antibiotic because it is not an infection
What are giant cell lesions?
Anterior to first molar. Slow growing with well-defined margin. Some cortical expansion can occur.
What are psychiatric disabilities?
They are conditions with recognisable symptoms and behaviour patterns, frequently associated with distress, which may impair personal functioning in normal social acitivity e.g. bipolar disorder or substance abuse
When do we need to take an impression for denture repair?
When you have a broken acrylic base or broken clasp
What kind of questions should you ask a patient during denture review?
How is your denture
Can you eat and speak with it
Does it cause any sore spot on the gum or teeth
Can you eat with your denture
Can you pronounce words normally?
Do you have a list of what you would like me to adjust your denture?
What are the steps for evaluation of alginate impressions?
1.Alginate mix is homogenous and smooth – no streaks or air bubles
2.Tray appropriate size – tray not shwoing through
3.Alginate has had adequate time to be inserted into the mouth, seated onto the teeth and set prior to removal – smooth surface with no drag lines
4.Adequate amount of alginate in tray and has been seated and muscles trimmed correctly anatomical featyres, tray is centered, no large air bubles
5.Tray has been removed correctly – no tearing of the materials
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
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.
What is informed consent?
A person’s voluntary decision about health care is made with knowledge and understanding of the benefits and risks involved.
This communication should ensure the patient has an understanding of all the available options and the expected outcomes such as the success rates and or/side effects for each option.
Objective of the dentist: provide comprehensive, evidence-based relevant information to the patient. Dialogue with patient is essential
What is the needle stick inury protocol in dental emergencies?
- 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
What are the Seattle Care Pathway process of assessment and decision-making for complex older patients?
- Complex older patient referred
- Medicala ssessment
- Assess mobility and ability to attend clinic
- Dental assessment
- mental capacity assessment
- Decision making
- treatment indication
- Treatment delivery
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
What is the relationship between periodontal disease and respiratory disease?
Oral cavity can act as the reservoir for pulmonary pathogens thus adequate debridement, use of chlorhexidine and at-home care can help with lung diseases
What condition is this?
This is an oral lichenoid lesion - which is similar to oral lichen planus but is usually around a single site.
Usually associated with medications and go away when medication is stopped
What is Special Needs Dentistry?
nAustralia, Special Needs Dentistry (SND) is a specialized field of dentistry focused on providing oral healthcare to individuals with physical, medical, developmental, or cognitive conditions that make it difficult for them to receive standard dental care. These individuals may include:
- People with disabilities (e.g., intellectual disabilities, physical disabilities).
- Medically compromised patients (e.g., those with cancer, heart conditions, diabetes).
- Older adults who may have age-related health issues like dementia, Parkinson’s disease, or frailty.
- Patients with mental health conditions (e.g., anxiety, depression, schizophrenia).
- Individuals with complex social or psychological circumstances that affect their ability to access or undergo routine dental care.
The goal of Special Needs Dentistry is to provide appropriate dental care that considers the individual’s unique health challenges and may involve specialized techniques, equipment, and environments. This might include working closely with a multidisciplinary healthcare team to manage underlying health conditions and ensure that dental treatments are safe and effective.
Australia recognizes Special Needs Dentistry as a registered specialty. Dentists who specialize in this field undergo additional training and certification to address the specific needs of these populations. They often work in hospitals, community clinics, or private practices that are equipped to handle complex cases, providing tailored care plans that address both oral health and broader health concerns.
What is important to understand about communication in a dental environment?
Communication is key and should not be considered as simply an act of giving and receiving information.
Communication is about establishing “connection” on a human level.
What is the treatment for a mandbiular and condyle fracture?
- 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.
What is apexification?
it is a method of inducing a calcified barrier at the apex of a non-vital tooth with incomplete root formation. Originally calcium hydroxide is used for coagulation necrosis of remaining pulpal tissues
What are different categories of aged adults?
- Functionally independent adults - two or more medical conditions but they can access dental care independently - treatment planning can be normal
- Frail older adults - some loss of independence with impairments and comorbidities - usually still living in a community but rely on support services - treatment needs to consider their polypharmacy and difficulty accessing treatment
- Functionally dependent older adults - have their activities of daily living fully supported with carers and are homebound or live in institutions. transportation is difficult if not impossible. Treatment planning: palative care essentially
What are follow up procedures for a patient who has a closed apex with extra oral dry time of more than 60 minutes?
First 7-10 days - Root canal treatment & calcium hydroxide for upto 4 weeks
Weight and height measurments
2 weeks - splint removal
4 weeks - radiographs
3 months -radiographs
6 months - radiographs
1 year - radiographs
Yearly - radiographs upto 5 years and better beyond
How can you use force to special needs patients?
You can apply for SACAT special powers Section 32 powers.
Application is made by the guardian
What is recurrent herpes simlex vitus?
It is a vesicular eruption affecting perioral skin, lips, gignivae and palate - knowns as harpes labialis
What are unfavourable fractures?
Unfavourable because the elevator muscles will be able to displace the fracture.
Masseteric - anterior angled fracture
Medial pterygoid and mylohyoid - buccal angle fracture
Why did we need Special Needs Dentistry?
The following factors were considered:
- Increasing life expectancy for people with disabilities and chronic disease
- Increasing disability or chronic disease progression into middle and older age
- Increasing size of ageing population, with increased functional dependence
- Increasing cancer survival
- increasing complexity of medical treatment provided and medication prescribed
- Increasing population expectation to retain teeth
- De-instutionalisation of people who are intellectually and or physically impaired
What is the ALARA principle of radiology?
As Low As Reasonably Achievable
What are the feature of aggressive lesions?
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
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
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
What is hypertrophy?
It is an increase in the size of particular tissue by increase in cell size.
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.
In which Kennedy class do you use exclusivley soft tissue support?
Not Kennedy but complete denture
What does the reactivation vericells virus lead to?
It leads to shingles.
Shingles may result in oral manifestations like vesicular lesiosn aorund the oral cavity.
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
What is an example of GIC cement?
Ketac Cem
What are some of the options of regeneration that can occur during periodontal treatment?
- Gingival connective tissue growth resulting in root resoprtion. This is not ideal.
- Epithelium growth and formation of long junctional epithelium. This occurs in closed and open debridment
- Alveolar bone prolifiration resulting in ankylosis. This is not ideal.
- PDL and bone regeneration resulting in strong tisseu attachement - this is the goal of GBR
What are the indications of RA?
- Anxious patient
- Older children with poor dental experiences
- Complex or long procedures
- Child with special needs
- Fear of needles
- To aid analgesia
- Increased gage reflex
- AND MEDICALLY FIT ASA I AND ASA II
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
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.
What happens in periodontal abscess?
Existing turtous pockets becomes isolated and favour formation of abscesses due to changes in composition of microflora and anaerobic bacteria virulence.
Host defences could make pocket lumen inefficient to drain increased suppuration (common in immunocomprimised).
What are the options for a tooth with replacement resorption?
- Decoronation and submergence of the tooth
- Extraction, orthodontics and implantation
- Translpalantation
When can periodontal abscesses occur?
- As acute exacerbation of an untreated periodontitis
- During periodontal therapy or immediately after scaling due to calculus being lodges in the pocket
- In refractory periodontitis (treatment resistant periodontitis)
What are the materials available for secondary impressions?
- Alginate
- PE
- PVS
What kind of surgery could you perform for recession?
- Lateral sliddding flap
- Coronally repositioned flap
- Free gingival flap
- Subepithelial connective tissue graft
What is the aetiology and treatment of fibroepithelial polyp?
Aetiology: chronic physical trauma and inflammation
Treatment: Excision
What are non-pharmacological behaviour management technique?
- Tell-show-do, voice control, non-verbal communication positive reinforcement, distraction, modelling, desensitization
- Physical restrain like weighted blankets, movement control, clinical holding
What is the pathogenesis of rheumatic heart disease?
- upper respiratory tract infection by Group A streptococcus
- M protein is used by Strep As for bacterial virulance
- Creation of antibodies for M proteins by leucocytes and eliminations of M proteins
- M proteins have a molecular mimicry to cells of the endocardium
- Body miounts a response to the cells of endocardium resulting is valve damage, valvale deformities, fibrosis and calcification
- This makes a patient more predisposed to heart failure, artirial fibrilation and infective endocarditis
What is a good guide for culturally safe communication suggested by Jennings et al 2018?
Health professional should realise that something so simple as good, caring talk has the ability to reconfigure these experiences and relationships between Indigenous client and the healthcare system. Sharing some personal experience may also be beneficial
What are the geriatric syndromes?
- Incontinence
- Falls
- Pressure Ulcers
- Delirium
- Functional decline
What is morsicatio buccarum?
It is cheek biting which causes chronic mechanical trauma.
Clinical presentation is a unilateral or bilateral white patch on the buccal mucosa, which is rough and whitenned. Usually symptomless
What are the oral manifestations of chemo-therapy?
- oral mucostitis
- Increased risk of bacterial infections
- Increase risk of viral infections
- Increased risk of fungal infections
- Malnutrition
- Painful oral hygiene
- Oral haemorhage
- Increased risk of trismus
What code do we use for a denture review?
741_NEW
WHat is a code to replace a broken tooth?
071+766
What is the biological width?
From top of the junctional epithelium to the height of the bone which equal about 2mm which you need to maintain when doing crown lengthening planning to account.
What is intrusive luxation? What is the treatment?
It is displacement of the tooth in an apical direction into the alveolar bone.
Treatment:
For immature teeth:
1. Allow re-eruption without intervention
- if no re-eruption within 4 weeks, initiate orthodontic repositioning
- Monitor pulp
- IF PULP BAD THAN TREAT
- Parents must know that follow up visits are essential
For mature teeth:
1. Allow for re-eruption without intervention if intrusion is less than 3 mm. If does not happen after 8 weeks, surgical reposition and splint for 4 weeks or reposition orthodontically before ankylosis develops
- If the tooth is intruded 3-7mm, reposition surgically (prefered) or orthodontically
- If the tooth is intruded beyond 7mm, reposition surgically
- Endo treatment will be probably needed
What are the steps where patient involvement is essential?
- Diagnosis - recognition of problems
- Treatment planning - identification of potential solutions
- Informed consent
- Risk management
How do you view a CBCT?
1.From down to up
2.From outside to inside
3.From Left to right
What are some of the factors that may influnces the choices of denture material suggestion during a denture consult?
MHx – diabetes, cancer, arthritism osteoporosis, blood thinners
SHx – smokers, soft drinks or busy lifestyle
DHx – bad oral hygiene, perio, decay, denture intolerant
What is idiopathic resorption? What is the treatment?
It is resorption with no apparent causes. Typically it involves multiple teeht with shorter roots.
Treatment: determining systemic causes through general health checks and after monitoring.
What is a buccal corridor?
It is a negative space in the corners of the smile that is not filled by tooth structure. 15.-2.5 mm is ideal.
What are the whistling and lisping sounds?
S whistling is due to narrow air space between tongue and upper teeth
S lisping broad airspace between tongue and upper teeth or thick plate you will need to thin the plate.
What is one of the treatment of oral candidosis?
Miconazole 2% gel 2.5 mL topically (then swallowed), 4 times daily, after food, for 7 to 14 days; continue treatment for at least 7 days after symptoms resolve
Or Amphotericin B 10 mg lozenge sucked (then swallowed),4 times daily, 7 to 14 days; continue treatment 2 to 3 days after resolved
What are the examples of RMGIC cement?
Fuji Plus (capsule, conditioning is needed)
FujiCem (hand mix form, prior dentine conditioning is needed)
What are the aims of rem pros?
- Restore dentition to a satisfactory condition
- Comfort
- Aesthetics
- Function
- Speech
- Preservation of remaining soft and hard tissues
What are the 5 moments of hand hygiene?
- Before touching a patient
- Before a procedure
- After a procedure or body fluid exposure
- After touching a patient
- After touching a patient surroundings
What are are the indication for surgical corrections of gingival recession?
1.Increases in recession
2.Dentinal hypersensitivity
3.Aesthetic concerns of the patient
What are pharmacological behaviour management technique?
- Oral sedation - benzodiazapine pre-medication
- Relative analgesia - nitrous analgesia
- Conscious/iv sedation (need to follow appropriate legislation)
- General anaesthesia
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
What is mucogingival surgery?
It is surgery usually performed to correct soft and hard tissue defects or deficiencies using soft tissue repositioning or grafting
What are the the symptoms of pericoronitis?
1.Difficulty swallowing
2.Limited opening
3.Enlarged lymph nodes
4.Fever
5.Facial cellulitis
6.Pain
7.Localised swelling
8.Pus discharge
How do we read INR? What are the impacts on treatment?
If using warfarin:
<2.0 - use local measures AND NOTIFY GP BECAUSE IT IS IN THE SUB-THERAPEUTIC RANGE
2.0-3.5 - use local measures
> 3.5 - NO SURGERIES TO PERFORM UNTIL INR DROPS - INFORM GP IMMEDIATLEY
How do you manage bleeding risk in aptients with liver disease?
- Fresh frozen plasma
- Vitamin K
- Cryoprecipitate
What are the 5 moments for Hand Hygiene?
- 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
What is the first line of treatment for mildly affected MIH teeth?
1.Remineralisation
2.Fissure sealant
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
What is a pick up impression?
Denture in the alginate for tooth replacement. FItting surfaces are okay
What condition is this?
These are lingual tonsils.
This is part of the lymphoid tissue (Welder’s ring) that is used to fight infection.
The lymphoid tissue underneath the folliate papilla goes through lymphoid hyperplasia (growth) and result in an elevation on the postra-lateral tongue surface.
What is a bite registration?
It i the impression of patient’s occlusion when upper and lower teeth bitting together.
Purpose - registration of maxillo-mandibular relationship so that lab can articulate the casts and set up teeth
What is Ante’s Law?
The total root surface area of all supporting teeth must equalt or exceed the total root surface area of the teeth being replaced
What is internal replacement resorption? What is the treatment?
Internal replacement resorption is a process where the pulp and dentin are replaced with bone. It usually begins within the pulp/root canal and on the root canal walls and it progresses towards the cementum. Clinical appearance may be normal or discolored.
Usually as a result of insult to the pulp.
Treatment: observation and eventual extraction. If diagnosed early, root canal treatment may be feasible.
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
What are risk factors for cancer
- Tobacco
- Alcohol
- Betel-quid (tobaco in a different form) - bucal sulcus
- Human Papillomavirus (HPV) types 16 and 18
- Ultraviolet radiation
FheFGive 5 differential diagnosis for a gum lump?
- Haemangioma
2.Fibroepithelial epulis
- Pyogenic granuloma
- Peripheral giant cell granuloma
- Calcifying fibroblastic granuloma
What are the steps of making a secondary impression?
Discuss with tutor if rest seats are required
Try on special tray and see if border molding is needed
Rest seats cut
Request impression material and prepare tray with adhesive
Load the mono/heavy body in the tray
Load light body imp material on teeth or rest seats
Seat tray and wait
If constructing full denture, create a second layer with light body
Remove the impression
Assess and wash blood and debris
If it is alginate cover with damp immediately
How does periodontal abscess form?
1.As an acute exacerbation of untreated perio
2.During periodontal therapy or immediately 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
What is alveolar fracture? What is the treatment?
It is the fracture that involves the alveolar bone and may extend to adjacent bones.
Treatment:
- Reposition any displaced segment
- Stabilise the segment by splinting the teeth with a passive and flexible splint for 4 weeks
- Suture gingival lacerations
- No root canal treatments
- Monitor the pulp contion of all teeth involved
What is a complicated crown fracture? What are the treatments?
It is a fracture confined to enamel and dentin with pulp exposure
Treatments:
Immature roots: partial pulpotomy or pulp capping to preserve pulpal health and cause apexogenesis (vital pulp therapy)
Mature roots: partial pulpotomy and if post required to restore, root canal treatment should be considered
What is classified as sever periodontitis by CDC/AAP?
- At least two proximal sites not on the same tooth with attachment loss of 6mm or more
- At least one such sites have pockets of 5mm or more
What are the steps for crown lengthening?
1.Soft tissue resection if there is an overgrowth of tissues
2.Soft and hard tissue resection if bone level is incorrect height
What is spaulding classification?
It is a classification of instruments depending on their level of causing infection during their use, example is:
- Critical – using a perio-probe for surgical procedures – anything that pierces the mucosa must be sterilized and recorded (ideally)
- Semi-critical – single use items such as micro-brushes or curing light with a sleeve – you need to clean it but you might not need to sterilize it
- Non-critical – example is bib chains – they come in contact with intact ski
What colour are the tissues on CBCT?
White is dense and black is low density
What are the two types of indirect restorations?
- Intra-coronal - inlays or onlays
- Extra-coronal - crowns or veneers
What is infective endocarditis?
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
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
What are frail older adults?
They are adults over 65 that lost some independence but still live in community with help of family and friends and might use professional support
What are different types of anti-thrombotics?
- Anticoagulants - warfarin
- Antiplatelet - clopidogrel
- Target-specific oral anticoagulatns - apixaban
How do you manage dysplastic lesions?
- Observation:
- Mangaing lifestyle risk factors
- Regular follow-ups
-Clinical risk assessment
Excision
- Cold-knife excision
- Cryosurgery
- CO2 laser ablation
- Photodynamic therapy
What are the appointments for a conventional acrylic denture?
- Consult + alginates
- Secondary impressions
- Bite reg + shade, mould selection
- Try-in
- Insert
- Reviews
Book all with 2 weeks gap
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.
What are the different types of alveolar bone defects?
Class 1 – Bucco-lingual deficiency
Class 2 – vertical deficiency
Class 3 – combination
What are some of the membranes that can be used in regenerative surgery?
1.Xenografts – from different species like Bio-gide (porcine, little pig)
2.Synthetic – Polyglyclolic like Vicryl sutures
What is nasopalatine cyst?
A defined radiolucency that occurs in the palate
What is important to understand about multiple myeloma?
It can result in renal insufficiency and painful lytic lesions in the mandible as a result it may lead to pathological fractures
In general, whata did different surveys of Oral Health in Australia conclude?
They have concluded that in general, oral health deteriorates with age
What are follow up procedures for a patient who has a closed apex with extra oral dry time of less than 60 minutes?
First 7-10 days - Root canal treatment & calcium hydroxide for upto 4 weeks
Weight and height measurments
2 weeks - splint removal
4 weeks - radiographs
3 months -radiographs
6 months - radiographs
1 year - radiographs
Yearly - radiographs upto 5 years and better beyond
How does smoking affect periodontitis rate?
Negatively.
In general, smoking does:
1. Affect tissue vasculature by reducing oxygenation
- Interferce with immune function
- Causes changes in subgingivalal fluora
- Increase the number of periodontal pathogens
Acid changes from 5.5 to 4.5, name two chemical changes that occur when this happens in the presence of fluoride?
- Demineralisation of hydroxyapatite - and uptake of fluoride by demineralised dentine and enamel to form flurapatite
- Formation of calcium fluoride and it could act as a slow releasing fluoride reservoirs
What are the indications for an immidiate denture?
Aesthetic reasons
Functional reasons
Convivence taking occlusal record
Mandatory requirements – caries and perio free on abudment teeth
Material of choice: acrylic
What are some of the commonly described variations in communication?
- Individualism - independent decision making
- Collectivism - utilising family members or other in making medicla decisions
What are the state frameworks that support provision of care in the context of special needs dentistry?
South Australian Equal Opportunity Act 1984
What are the parts of an ulcer?
- Border
- Depression
What type of CBCT available for jaws?
Small field and whole jaw
What is a root fracture? What is the treatment?
Root fracture is a type of fracture that involves dentine, pulp and cementum.
Treatment:
- Always reposition the coronal segment ASAP and check radiographically
- Stabilise the coronal segment with a passive and flexible splint for 4 weeks. If cervical, for 4 months
- No endo immediately
- Endo might be needed for the coronal aspect with use of apexification
- In mature teeth with cervical fractures above the alveolar crest
What kind of clasps do you use for molars and premolars?
Occlusal approaching
What are the feature of aggressive lesions?
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
How do you measure a pseudopocket?
- Estimate the position of the CEJ
- IDentify the gingival margin
- Measure the sulcular depth
- It is exceeds the distance between GM and CEJ than it can be considered a ture pocket
- If it does not than it is a pseudopocket and the CEJ is covered by gingival
What is the treatment for necrotising gingivitis?
1.Debridement under LA
2.Irrigate area with Betadine (povidone-iodine antiseptic)
3.Chlorhexidine mouth rinse twice daily for a week
4.Investigation of causative factors
- If systemic symptoms exist – amoxicillin 500mgs tds+ metronidozole (very important for your anaerobic bacteria) 400 mgs bs x 5-days. You need to debride prior to this as the antibiotic will not be able to penetrate the biofilm througb the crevicular fluid!
What is the most common bacteria in in gingivitis and periodontitis? What is type of bacteria are they?
Porphyromonas Gingivalis and Treponema denticola.
P. Gingivalis - gram-negaitve, anaerobic, rod shaped bacteria
T. Denticola - gram negative, obligate anaerobe (killed by oxygen), spirochaete bacteria.
Why does LA not work in infections?
- Infection or inflammation in the region causes pH to drop
- Concentration of the unionised (lipophilic RN) decreases
- Areas of inflammation also jave increase blood supply due to vasodialation - thus increase LA washout
What are some examples of resin based temporary cements?
TempBond Clear – dual cure cements
What are the main types of permanent cement?
GIC
RMGIC
Resins
Adhesive resin
Zinc phosphate
Zinc polycaboxylate
What are some of things that we should mention on a lab prescription form?
Type of saddle
Support of the denture
Specify abutment tooth/teeth
Draw rest seats
Specify clasps
Specify the extension of the denture
Fill lab and draw desing
How to examine the entire panoramic images?
- Examine for quality of the image first - check image sharpness, contrast and density
- Examine the image for patient preperation and positioning
- Examine the image fro diagnostic purposes - are structure examined well displayed?
What is OVD?
Occlusal vertical dimension.
The distance between two selected anatomic or marked points (usually one on the tip of the nose and the other on the chin) when in maximal intercuspal position; syn, VERTICAL DIMENSION OF OCCLUSION
What are some of the other adjectives that can be used to describe a lesion?
- Papillary - any small growth projectin into a cavity
- Verrucous - warty surface appearance (small hyperkeratinised projections)
- Epulis - lump on the gum non-neoplastic
Why would you do a pickup impression?
For denture repair! Use only alginate and leave the denture in the impression
What are the highlights of RMGIC cement?
Hydrophilic monomers or polymerizable resin added to conventional GIC making a dual reaction that is based on acid for GIC and chemical/light for resin polymerisation
Less moisture sensitive
Curing shrinkage
Higher compressive strength and tensile strength
Volumetric expansion – bad for veneers and ceramic crowns
Not good long term
Film thickness and adhesion similar to GIC
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.
What is an uncomplicated, enamel-dentine crown fracture? What is the treatment?
It is a coronal fracture involving enamel and dentine without pulp exposure.
Treatment: if the tooth fragment available, soak it in saline for 20 minutes, use GIC or resin to bond it. If 0.5mm away from pulp, place an indirect pulp cap with calcium hydroxide.
When checking for pronunciation what can you use?
- Misisipi
- 55 and 33
- Emma
What is external invasive resorption? What is the treatment?
It is a process that is not fully understood. It commences at the sub-gingival location and spreads through out the tooth in all directions.
According to Prof Heithersay, it can be classified as Class I-IV using a PA.
Class I-II are better treated with trichloroacetic acid (TCA) to the resorbing tissues followed by curettage of the defect and restored with glass ionomer cement. Result are usually quite good.
Class III might need adjunt treatment such as root canal treatment.
Class IV have undpredictable outcomes and patient need to be made aware of future issues and probable extraction
What are indication and contraindication for gingivectomy?
Indications: Pocket depth reduction associated with horizontal bone loss and adequate width of keratinised mucosa and gingival hyperplasia
Contraindications: Lack of keratinised mucosa and presence of vertical defects especially in aesthetic area
What is the objective of an Advanced Care Directive?
- Wishes, instruction and preferences for future health care, residential, accommodation and/or personal matters
- outcomes or intervention a person wishes to avoid
3.’binding provisions’ or refusal of health care
- Appoint one or more Substitute Decision-Makers
What is this condition?
This is a minor aphthous ulcer - which one of the most common ulcer of infectious origin.
It usually occurs in non-keratinised mucosa, it is shallow and rounded.
It has erythematous margins and yellowish floor
What is the minimal length for clasps?
15 mm for cast clasps
7 mm for wrought clasp
What is patient centred care?
It is providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.
Remember, moderating factors for patients are different, thus your treatment should be different.
What are functionally independent adults?
They are adults that live in the community unassisted, over 65 that might have two or more medical conditions
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.
In what instances shoudl you have antibiotic prophylaxis?
- Prosthetic cardiac valve
- prosthetic material for valve repair
- previous infective endocarditis
- Congenetive heart disease but only if it involved: unrepaired cyanotic residual defect and repaired defect with residual defects
- Rheumatic heart disease
What are some of the architectural changes that occur in dysplasia?
- Drop shaped rete pegs
- Irregular eppithelial stratification
- Loss of polarity in basal cells
- Increased number of mitotic figures
- SUPERFICIAL MITOSES
What are two separate but linked process are initiated in SA dental post patient incident?
- Open disclosure
- Incident reporting
What are the steps for clinical examination for crown lengthening?
1.Check periodontal heatlh
2.Gingival width and thickness
3.Thickness of radicular bone
4.Probing sulcular depth
5.Aesthetic evaluation
6.Radiographic exam
What is important to undrstand about the status of the teeth during a denture try in and denture insert?
At denture try in – teeth can still be resent. After the denture is fabricated, it is nearly impossible to reseat the teeth.
What are two different types of damage you can recieve from radiation?
Determenistic - cell death
Stocastic - cell alteration resulting in cancer
What are the essential parts of trauma informed care?
- Respectful and non-judgmental communication
- Emotional safety
- Trust and providing opportunity for choice and collaboration
- Empowernment
- Respect for diversity
What is power differentials experienced through talk?
Essentially experienced related to the talk. These experiences can be feeling demeaned, diminished or disempowered as well as talk that challenged or reoriented the relationship between Indigenous people and the health system.
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.
Who is a patient?
It is a person who is receiving healthcare from a registered health practitioner and also including their parent/carer/other family members.
When would you do a wash impression for a denture reline?
Using the denture itself, apply a heavy material and after using that impression apply ligth material and take the impression again. This is used for reline.
What kind of membranes can you use in GBR?
Always use membrane in GBR.
Non-resorbable reinforced or non-reinforced. Resorbable.
Non-resorbable membrane require additional bone cover or extra material unlike reinforce
What is the common bacteria associated with being a bridge between commensal (green) and pathogenic (red) bacteria? aka orange bacteria?
Fusobacterium Nucleatum.
F. Nucleatum is a Gram-negative, anaerobic bacterium.
What is communication internal-external inflammatory resorption?
Both internala nd external resorptions
What are the steps of build up?
1.Build up of palatal wall with dentine shade
2.Apply the needed maverick colours with use of bonding resin and stains. Separate the two and use with probe to dip into both and apply to the needed translucent halo area.
3.Layer with body shade
4.Layer the most superficial layer with enamel shade
What is important to have when you approach patient care?
Not one size fits all.
Make treatment plan specific for the person.
What are the signs of lost of OVD?
Flat filtrum
Hollowing of the cheeks
Collapsed appearance of the jaws
The distance between the tip of the nose and tip of the chin reduced
Increased naso-labial grooves
Increased marionette lines
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
What are some good relaxation techniques?
- Deep breathing
- Muscle relaxation (like progressive msucle relaxation)
What is the location of clasps?
0.25mm undercut for cobal chrome
0.5 mm for wrought wire
What are the classifications of oral candidosis?
- Acute:
- Atrophic (denture or antiotic-associated)
- Pseudomembranous condidosis - thrush - Chronic
-Atrophic
-Hyperpastic - Mucocutaneous
- Usually T cell deficiency
What are the steps for a trial denture?
Check denture on articulator
Try dentures, check aesthetics and pronunciation – check occlusion with articulating paper
Show patient dentures
Obtain patient’s consent to process the denture
Draw post dam line and lab form prescription
Send back to lab to process the denture
What are some of the other predictions made by NSAOH?
- Periodontitis is on the rise due to higher retention of teeht and other factors
- Indigenous population are at very high risk of periodntitis at about 87.5/100 indigenous people have periodontitis
- The socio-economic gap in widening
What is a myxoma?
It is an uncapsulate lesion with infiltrative growth and stellate and spindle.
Occurs as bubbly in appearance.
What are the national frameworks that support the provision of care in the context of special needs dentistry?
Australian Human Rights Commision Act
Age Discrimintation Act 2004
Disability Discrimination Act 1992
How can we define disability?
Disability is the result of environmental, attitudinal or organisation barriers.
This social model of disability is the current widely accepted model.
An impairment may not necessarily lead to disability, if the individual functions in an inclusive and accessible environment.
What is pre-opertaive set up for a facial traum surgery?
- Order of toxicology report for recent drug use
- Order a blood cell count (full blood count test)
- Order blood glucose level test if they have diabetes
- Order IV antibiotics to reduce the chance of infection as well as IV fluids and alagesia
- Order 1 bag of blood if need, tho not very common for facial fracutre surgery
- Contact naethetis and book an operating room
In which Kennedy’s class would you use exclusively tooth support?
Kennedy 3 and 4
What is trauma-informed care?
It is an approach to engaging people with histories of trauma that recognise the presence of trauma symptoms and acknowledges the role that trauma has played in their lives.
What is a dental concussion? What is the treatment?
It is when tooth is hit and concussed. It is tender to percussion but otherwise okay
Treatment: No treatment just monitor
What is the treatment of necrotising periodontitis?
Referral to specialist – IMMEDIATE. They will perfomr debridement and curettage of the area in association with high dose antibiotics.
What are the two types of abscesses around the tooth?
Periapical abcess (at the apicies of the tooth) or periodontal abscess (lateral to the root of the tooth)
What are the evaluation criteria of Yellowstone study casts of alginate impressions?
- Yellowstone mix is homogenous and smooth - think streakless mix with minimal airbubles
- Yellowstone has set adequately before removal of impression - think smooth surface with no drag lines
- Adequate amount of yellowstone - think good anatomy, no airbubles, good thickness
- Articulation of models - no soft tissue or air bubble interference
What are considered to be low risk reactions to penicilin?
- Uknown reaction more than 10 years ago
- Childhood exanthem, unlear details with no evidence of hospitalisation
- 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%.
What are the benefits and limitations of immediate dentures?
Benefits: aesthetics, preservation of OVD
Limitations: Unpredictable, painful, number of appointment and cost
What are the highlights of GIC cements?
Working time of 2-3 minuts
Water loss and abosrption
Low modulus of elasticity
High compression strength – use in areas of low masticatory action
Chemical bonding to tooth
Good translucency
Fluoride release
Low film thickness
Poor wear resistance
What are the indications of crown lengthening?
- Excessive gingival display
- Sever wear secondary to bruxism
- Exposure of sound tooth structure for proper restorative therapy. This includes, rem pros, fix pros and endo.
What are the materials available for bite registration?
- Exabite - best for good dentition
- Modeling wax
- Copper wax
- Wax rims - best for edentulous
What does periodontal regeneration involve?
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.
When constructing an acrylic denture for the upper jaw, what kind of strep do you want ot go for?
Go for the anterior strap as it easier to replace those teeth later on and it helps with gagging
What are some if the risk factors for prologned bleeding that a patient might have?
- High BP
- Abnormal kidney and lvier function
- prior stroke
- history of bleeding or bleeding disorders
- Drugs predisposing to bleeding
- Poor anticoagulatn control
- Alchohol consumption
What are the two different types of gingival phenotype?
Type 1 - thick bone phenotype
Type 2 - thin buccal bone phenotype
What are the aims of RA?
To enhance comfort whilst facilitating completion of the planned procedure
What are the indication of resective gingival surgery?
- Pocket depth reduction
- Removal of hyperplastic tissue: idiopathic or induced by medication
What are the basics of partial chrome dentures?
Major connectors
Minor connectors
Direct/indirect retainers
Denture base
Denture teeth
What is a gold standard indicator for sterilization?
Class 6 – measuring time, steam and temperature.
Class 1 – not great because it only shows temperature.
Class 4 – used in SAD
Why do liver disease increase bleeding risks?
- Impaired vitamin K metabolism
- XS fibrinolysis
- Failure to synthesis or over consumption of normal clotting factors
- poorly synthesised clotting factors
- Thrombocytopenia (low platelet count)
What are the suggested use of 38% silver diamine fluoride for aresting of caries?
topically, 2 times per year.
Use Riva Star
What is the current flavour of the month when it comes to triggering apixification?
Biodentine from Septodont
Why can be difficult to say sorry at times?
- Innate fight or flight response
- Vulnerability aspect
- Fear
- Self-image issues
- Worry that patient might still file a complaint
- Lack of confidence
What is the association between diabetes and periodontal disease?
In general, the relationship is considered to be bi-directional.
Poor glycemic control = periodontal disease
What is the antifungal therapy for oral candidiasis?
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
What are the side effect of topical corticosteroids?
1.Oral candida
2.Hoarse voice
3.Rash
What is the presentation of periodontal abcess?
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
- Pulp sensibility testing
- Radiographic analysis using a gutta percha
- Absence of caries
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
What is considered to be Grade B periodontitis
- Less then 2mm bone loss over 5 years
- Bone loss to age ratio between 0.25 to 1.0 non inclusive radiographically (ie for a 50 year old patient the range is around 12.5-49.9 percent)
- Heavy biofilm deposit and periodontal destruction are roughly equal thus following a pattern of more biofilm=more destruction
- Smoking less then 10 cigarettes per day
- HBA1c level of less then 7.0 in diabetic patient
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.
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.
What are the signs of complete obstruction of the airways?
- Inability to breath, speak, cry or cough
- Agitation, gripping of the throat
- Cyanosis
- Bulging of the neck veins
- rapid development of respiratory failure
- Loss of consciousness
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.
What is the step by step process to understand the arisal of a certain oral lesion?
Use this scheme
- Developmental origin
- Inflammatory origin
- Hyperplastic origin
- Degenerative origin
- Hormonal origin
- Neoplastic origin
- Idiopathic origin
DIHDHNI
What are some of the types of periodontal surgery?
1.Resective surgery – pocket depth reduction and removal of hyperplastic tissues
2.Access Flap Surgery
3.Periodontal regeneration
4.Mucogingival surgery
5.Implant surgery
What are some of the common reasons for tooth loss?
- Decay and periodontal disease
- Trauma
- Pathological causes
- Radiotherapy
- Impacted or congenital missing teeth
What are the medicolegal responsibilities of dentist in terms of radiology?
Dentists who record OPG radiographs must take responsibility for all non-dental diagnosis from such images or alternatively have them assessed on referral by an oral radiologist or medical radiologist and include this cost in their estimate of fees to the patient.
What kind of areas are we assessing in partial denture review?
Check aesthetics, comfort and function
Check occlusion
If the denture is loose – bend the clasps
IF there is food impaction under denture – check denture retention and stability
What are some of the impacts of salivary dysfunction?
Quantitative or qualitative
What is the most common reason for delay of dental treatment in Australia?
Cost related to treatment
How do you write a diagnostic statement for periodontist modified by diabetes?
- Type of periodontal disease
- Disease extent
- Stage
- Grade
- Current disease status
- 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)
What kind of grafts can you do for recession?
Sub-epithelial connective tissue graft (very good results with this technique)
Free gingival graft (unaesthetic as it creates white patches) taken from the palate
Advanced flap: Coronally repositioned flap
Rotational flap: Lateral sliding flap (creates recession in another tooth)
What are the contraindications to crown lenghtening?
1.Teeth with extensive periodontal involvement
2.Risk of sever furcation exposure
- Effect on aesthetics
4.Extensive caries in furcation areas or poor endodontic status of the tooth
5.Apical extent of fracture
- Unfavorable furcation location
What sould we record in RA notes?
- Signed informed consent
- Indications of Use
- Nitrous oxide dosage in percent of N2O and O2 with flow rates and duration of the procedure
- Patient response
What sound will a person make if the teeth are set too buccaly?
D sound like th
Why do we do the 6 step motion for periodontal pockets?
To define any fine points of bone loss around the tooth through systematic approach to probing.
How do we treat hypersensitivity?
- Block dentinal tubules - using restorations or protective coverings
- Block nerve activity - stanous fluoride and potassium nitrate
- Remove the cause - erosion and toothbrushing technique change
Your patient comes in with an avulsed tooth that has been placed in a storage medium or has been drying out for less than 60 minutes. The tooth is believed to have a closed apex. What are the steps for management?
- Clean the root surface and apical foramen with saline
- Administer LA
- Irrigate the socket with saline
- Examine the socket
- Replant the tooth slowly
- Suture lacerations
- Varify normal position with a radiograph
- Apply splint for 1-2 weeks
- Immidiatley or shortly after replatation, apply corticosteroid+antibacterial dressing (e.g. odontopaste) to the tooth for atr leats 2 weeks
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.
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
What are the indications and contraindications for a modified widman flap surgery?
Indications: Pocket depth reduction associated with horizontal bone loss and adequate width of keratinised mucosa, gingival hyperplasia especially in aesthetic areas
Contraindications: Lack of keratinised mucosa
What are the steps to a chrome denture design?
Saddle
Support
Retention
Connectors
Simplification
What is a common appearance of mucoepidermoid carcinoma?
Well-defined border in posterior body or angle of mandible.
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
What are the links between orla health and general health that are well established?
Periodontal leisons are considered to be a renewing reservoir for the systemic sprea of bacteria, antigens, cytokines other pro-inflammatory mediators.
Example:
CV disease, Cereborvascular disease, respiratory disease, adverse pregnancy outcomes, rheumatoid arthritits, osteoporosis, obesity/nutritional status, dementia
What are the steps of management if the patient is conscious with signs of airway obstruction?
- Call 000
- Reassure the patient and ask them to relax, breete deeply and try to dislodge the object by coughing
- If coughing is ineffective - give upto 5 back blows between the shoulder blades - check between each hit
- If the back blows dont work, do 5 chest thrust similar to CPR
- Continue until assistance arrives
What are the types of infection-induced dental resorption?
- Internal inflammatory root resorption (apical or intraradicular)
- External inflammatory root resorption
- Communication internal-external inflammatory resorption
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
According to the Australian Dental Council, what are professional competencies of the newly qualified dental practitioner?
- Social responsibilities and professionalism
- Communication and leadership
- Critical thinking
- Health promotion
- Scientific and clinical knowledge
- Person-centred care
What are the post insertion instruction that we give to the patient?
Excessive saliva is nomrmal
It may feel bulky and alter speecha and taste
Food might get stuck under denture
Might have a high spot or ulcer – DO NOT CONTINUE IF AN ULCER FORMS
Remove denture and clean after meals
Brush denture as brushing teeth
Wear religously if you can
What are the ideal dimensions for a rest?
1.5mmx1.5mm with 1.5mm occlusal depth. Meaning if the occlusal is 1.5mm no prep is needed
What condition is this?
This chronic hyperplastic candidiasis.
It is usually a single, fixed, white or mix of white and red patch that syays when whipped.
May occur anywhere but common sites are the tongue and buccal mucosa.
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
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
What is GTR?
Guided tissue regeneration refers to fixing the defects assosciated with loss of alveolar bone around teeth.
What are common acute periodontal conditions?
- Periodontal abscess
- Necrotising periodontal disease like NG and NP
- Endo-perio lesions
- Pericoronitis
- Ulcerations/oral pathology which presents on gingiva
What is biological ageing?
Biological ageing takes into account individual differences and mainly reflects the relationship between biological maturationa or deterioration and changes in an individual’s ability to adapt and perform specific physica, cognitive and social tasks.
What did NSAOH 17-18 told us in terms of dental health of australians?
- Fewer Australian are now edentate
- More people are retaining some of their natural teeth into old age
- While more older people are retaining natural teeth they report their oral health is only fair/poor
- More people are avoiding or delaying dental treatment due to cost
What is the equipment for the nitrous oxide machine?
- Gas delivery machine – continuous flow of O2 and N2O, minimum 2.5L/minute, for children 4-5/L
- Nasal hood – various sizes and flavours
- Inflatable bag – provide source of additional gas, mechanisms for patient respiration, in emergency used as a method of providing positive pressure oxygen
- Scavenging system – to trap experied gas by the patient
- O2 flush valve – in emergency to provide jet ventilation, can cause barotrauma
How do we look at the smile?
1.Lips – competence, colours, pigmentation of the skin, filtrum, skin pores, fine facial hair, vermillion border demarketion
2.Incisor display – how much of the teeth is shown
3.Tooth form and shade of teeth
4.Symmetry of the smile
5.Gingival condition
6.Opacity of incisal ridges
What is internal surface resorption?
It is a type of resorption that is defined as minor areas of resorption of the dentin walls of the root canal. It is believed to be transient and self-limiting.
What do we do for radiographic exam for crown lengthening?
- Interdental crestal margin
- Distance from contact point to interdental bone
- Root length
- Root morphology
- Furcation location or root trunk length
- Interdental width
- Apical extend of caries, prior restorations, fractures or root perforations
What do you do during insert appoitment?
Look at the denture and try in patient mouth
Check esthetics
Check phonetics – make them count to 25 or say missisipi a few tmes
Check occlusion – with horseshoe paper and it need to be very balanced
Check fittin surface using PIP
SHow to patient
Ask patient how they feel, any tissue impingment
Let them know that excessive salivais possible
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
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.
What are some basic principles of fracture management?
- Reduction
a. Open reduction: Need incision to access the fracture line. For unfavourable fracture and displaced fracture
b. Close reduction: No incision. For favourable fracture,children and non-displaced fracture - Fixation and immobilization
a. Indirect fixation: Intermaxillary fixation aka maxillary mandibular fixation Use dental wiring, arch bar etc
b. Direct fixation: use titanium plate and screw
What are the grades of EPL?
o EPL without root damage
o EPL without root damage
* Grade 1: narrow deep pocket band on 1 surface
* Grade 2: Wide deep pocket band on 1 surface
* Grade 3: Wide deep pocket band on 2 surfaces (eg true buccal and the entire mesial surface (MB+ML)
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
What are the guidlines for prescription of antibiotics for tooth avulsion?
First of all, ensure that the aptient had their tetnus shots.
Give doxycyclin to children aboe 8 years old for 7 day in doses
less than 26 kg - 50mg
26-35 kg - 75mg
35kg+ 100mg
If the child is less than 8 years old
amoxicillin 500mg, 3 times a day for 7 days
+ CHx mouthrinse
What are the challenges that occur when providing care for frail older adults?
- Deteriorating cognitive ability
- Detiorating physical ability
- Deteriorating ability for co-operation
What is common appearance of periapical cemental dysplasia?
At apex bone is replaced with fibrous material. Lesion persistent after extraction.
What type of conditon is this and why?
These are fordyce spots
They are sebatious glands in the oral mucosa.
Do not biopsy and reassure the patient that this is normal.
Pathogenesis: ectoderm refrences
What is the onus of a good clinician when it comes to cross-cultural communication?
Life-long self-reflection and learning is more appropriate than the notion of finality that terms such as cultural competency. Reduction of power differences and reaching beyond personal comfort zone are essential for cross-cultural communication.
What is a code for a broken clasp replacement?
762+071
How do we express regret? Give an example.
I am sorry that this has happened to you.
What are the types of internal resoprtion?
- Internal surface resorption
- Internal inflammatory resorption
- Internal replacement resorption
What is the common appearance of osteomyelitis?
PAIn _ subtle changes in bone density. Bone destruction with sequestration formation.
What can be used for alternative methods of communication?
- Alternative and augmentive communication devices
- Speech generative devices
- Prosthetic devices (OBTURATORS!!!)
What is the systematic way to examine a lesion?
- 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 :))
Your patient comes in with an avulsed tooth that has been drying out for more than 60 minutes. The tooth is believed to have a closed apex. What are the steps for management?
The prognosis is poor
- Remove necrotic tissue attached to the root using gauze
- Treat the tooth with sodium fluoride for 20 minutes
- LA administration
- Irrigate the socket
- Examine the socket for possible fracture and reposition
- Performed root canal treatment prior or right after reimplantation
- Stabilise with a passive splint for 2 weeks
- Suture laceration
9, Verfiy normal position of the tooth
What is the purpose of a trial denture appointment?
- To check aesthetics
- Confirm patient satisfaction
- Obtain patient’s consent to process the denture
What are the potential response following horizontal root fracture?
- Interposition of dental HT
- Interposition of bone and PDl
- Intrposition of dense fibrous CT
- Non-healing
What are the important aspects of assessment for mandibular implants?
1.Mandibular canal
2.Mental foramen
3.Anterior loop of mandibular canal
4.Incisive branch of IAN
5.Lingual canal in the midline
What is the role of standard precautions?
Standard precautions are used to prevent or reduce the likelihood of transmission of infectious agents from one person or place to another, and to render and maintain objects and areas as free as possible from infectious agents. Minimizing the risk of transmission.
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.
What are the actual treatment options for oral cancer?
- Surgery
- Radiotherapy
- Chemotherapy
- Combination of treatments above
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.
What are the most commonly used material in periodontal regenerations?
1.Bone grafts
2.Membranes
3.Growth factors
What is the role of dental practitioner in terms of reducing smoking rates in patients?
- Take the time to talk to your patient
- Provide smoking cessation materials in the waiting room
- NRT doubles the chance of success for smoking cessation
- NRT + behavioural support further increases the chance of success
What are some of the differences in culture in a dental context?
- Communication styles
- Some always agree with a dentla practitioner
- Approached ot completing tasks
- Tomorrow will be fine
- Decision-making styles
- Attitudes towards disclosure
- Approaches to knowing
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.
What is guided endodontic repair?
It is the combination of stem cells, scaffold and growth factors that allows for repair of immature permanent teeth. It is not very effective so just use calcium hydroxyde.
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.
What is the most common bacteria in acute periodontal conditions?
Aggregatibacter Actinomycetemcomitans.
AA is a gram negative, facultative anaerobe (can switch to oxygen thus can occur in none deep pockets)
What are some of the types of biopsy?
- Scalpel biopsy - incisional or exitional - most common procedure
- Fine needle aspiration
- Core biopsy
- Exfoliative cytology - taking the gunk and spreading it over a film
How do we right diagnostic statement for gingivitis?
- Extend - localised of generalised
- Disease - gingivitis
- Specification - biofilm induced, mediated by pregnancy or leukaemia
What are the two aspects of tooth convexity that are important?
Maximal convexity is survey line. In denture design the area below the survey line is used for retention clasp. The area above is used for bracing for stability especially with free-end saddles.
What is another type of lesion that can be caused by HPV?
Genital warts in the mouth or Oral Condyloma Accuminatum.
It is an infections lesion that can cause transmission through direct contact.
It presents as a broad based pink nodule that grows and coalesce (come as one)
What is peripheral giant cell granuloma?
It is a similar lesion to the pyogenic granuloma but it also involves bone tissue
What are the parts of a dental bridge?
- Abutment - a tooth that serves to support or retain the bridge
- Pontic - an artificial tooth/teeth on a prosthesis that replaces a missing natural tooth
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.
What are some of the effective minor connectors for mandible?
Lingual bar – need 4mm space at least below the teeth
Lingual plate - need 4mm space at least below the teeth
Sublingual bar - need 4mm space at least below the teeth
Cingulum bar
What sound will a person make if the teeth are set too lingually?
Th sound like D
What is a common appearance of cementoblastoma?
Slow growing lesion full of cementum like tissue. Attached to root apex. Well-defined with cortical border.
What are the features of necrotising periodontitis?
- Sever pain
- Necrosis of gingival tissues, PDL and alveolar bone
- Create rlike defects
- Squestration of pieces of bone may emerge
- Buccal and alvrolar bone involvement
- Most common in patient with systemic immunocomprimising conditions such as HIV, sever malnutritiona and other.
What the 3 purposes of reservoir bag?
- Provide a source of additional gas should the patient inspire more gas than is being supplied ◦
- 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)
- Functions in an emergency as a method of providing positive pressure oxygen
What lesion is associated with human papilloma virus?
Squamous papilloma.
An asymptomatic, solitary lesion that is associated with cauliflower like apperance
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
What the three different types of healing following transverse root fracture?
- Through deposition of reparative hard tissue
- Fibrous hard tissue
- Bone and periodontal ligament
- No healing and pulp necrosis of the coronal portion (trick question) - this one is pretty rare
What are the steps for post-implant assessment?
1.Pariapical films are adequate. Less than 0.2mm bone loss annually is normal
2.Mobility assessment
What are the activities of daily living?
Personal hygiene
Continence management
Dressing
Feeding
Moving
What are physical disabilities?
These are conditions that are atrributed to a physical cause or impact on the ability to perform physcial activities such as mobility e.g. deformity of limbs
What are the levels of intellectual disabiltiy?
- Mild - has basic maths, reading and writtign skills on 3-6 grade level
- Moderate - rrquries some oversight
- Severe - can learn skills but can not read and write . Requires daily supervision
- Profound - requires intensive support
What is osteoinduction?
Recruitment of immature cells and stimulation of these cells to develop into pre-osteoblast e.g. bone healing situations
Patient complains of lack of power when chewing – wat is the problem?
OVD of the denture is lackin, new OVD needs to be calculated:
1. denture may need to be redone with wax calculation
2. Denture may need to be relined
3. Consider a trial denture at new OVD
4. Immidiate, soft reline might be beneficial in shoprt term
What are the steps for bite record using wax rims for complete dentures?
Check wax rims on cast
Try wax rims in patients mouth
Determine incisal negth
Check lip support, facial profile and OJ
Check facial midline
Determine new OVD
Trim wax rims to OVD +1mm
Check wax rim using Fox bite plane – it needs to be parallel
Soften wax rims
Patient bite together in centric relation to new OVD – mark mid line, canine line and smile line
Wait for about 1 minute
Wax rims should be sealed
Select mold and shade
After write everything on a form “set teeth on…”
What is the reasons for carrying out periodontal surgery?
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
What is power of talk?
It is the esteem in which Indigenous respondents held talk, both individually and community-wide, with health professional as well as with each other.
What is a gold standard material used for bite registration?
Wax rims but if the saddle is small, you can use exabite
What is a Stafni’s bone defect?
It is a salivary inclusion cyst. A well-defined oval lucencies anterior to angle of mandible.
What is the vertical jaw relationship?
It is OVD.
You can calculate it by taking the Resting vertical dimension - 2-4 mm of free way space.
What is a good rule of thumb when understanding where the pathogloy comes from?
1.If above the mandibular canal – possibly dental origin because only non-dental related pathology occurs bellow the mandibular canal
2.Non-dental lesions are move common in tooth bearing areas
What is Transient apical internal resorption?
This process can follow luxation injuries and may be associated with TAB
What are the appointments for a valplast denture?
- Consult + alginates + shade, mould selection
- Try-in
- Insert
- Review if required
What information do we need to gather before bleaching?
o Base line shade
o Cause of discoloration (discoloured from haemorrhage, pulp necrosis)
o Has the root been RCT?
o Colour change is unpredictable, unstable in long term
o May require retreatment
o Multiple appt
o Risk of external invasive resorption
o Risk of soft tissue burn
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
What is the significant finding of studies that looked at the likelyhood of indigenous people to access care?
- Aboriginal and torres Strait Islander patient are more likely to access services where provider comminicate respectfully and have some understanding of Aboriginal culture and build good relationships with Aboriginal community
- Where Aboriginal or Torres Strait Islander health worker are part of the health care team
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.
Your patient comes in with an avulsed tooth that has been drying out for more than 60 minutes. The tooth is believed to have an open apex. What are the steps for management?
he prognosis is poor
- Remove necrotic tissue attached to the root using gauze
- Treat the tooth with sodium fluoride for 20 minutes
- LA administration
- Irrigate the socket
- Examine the socket for possible fracture and reposition
- Performed root canal treatment prior or right after reimplantation
- Stabilise with a passive splint for 4 weeks
- Suture laceration
9, Verfiy normal position of the tooth
What is surface resorption?
Type of trauma-induced tooth resorption. Involves cementum and small amount of dentine.
What are some of the active ingridients for sensitivity management and where can you find it?
- Arginine - Colgate Pro-Relief - immediate closure of dentinal tubules
- Potassium nitrate - Sensodyne daily care - takes 2-4 weeks and works for erosion
- Strontium chloride - Sensodyne rapid Relief - immidiate closure of dentinal tubules
- Novamin - Sensodyne Complete Care - forms artifical enamel when appliead
What is a common appearance of osteogenic sarcoma?
Posterior mandible. Painless swelling. Ill-defined borderd\s. “Sun-ray” spiculation appearance. Breaks bone.
What is the reasons for carrying out periodontal surgery?
1.Improve access to root surfaces.
2.Removal of diseased tissues (periodontal pockets or granulation tissue).
3.Elimination of inflammation and pocket activity under LA. Halting the progression of the disease process. This may cause tissue shrinkage.
- Enhancing of regeneration of periodontal tissue.
5.Removal of severely hyperplastic gingival tissues. This can be done with gingivectomy/gingivoplasty, flap surgery and minor osteoplasty.
6.Exploration of defects and removal of plaque retentive areas.
7.Restorative-crown lengthening.
8.Remove excess tissues after orthodontic extrusion.
What is ageing? What are we consider as aged?
Ageing in humans is a multidimensional process of physical, psychological and social change.
In terms of oral disease, ageing commonly impact chemo-sensory function.
In healthcare, those above the age of 65 is considered to be aged.
What are the options for a patient for rem pros?
Removable dentures
Implant – if it is an option
Fixed pros
Nothing
What is RVD?
Rest vertical dimension.
The postural position of the mandible when an individual is resting comfortably in an upright position and the associated muscles are in a state of minimal contractual activity syn, PHYSIOLOGIC REST POSITION, VERTICAL DIMENSION OF REST.
What are some of the positive reinforcements?
- Motivational advice
- Verbal praise, non-verbal such as smile or STICKERS
What are a steps to an immediate denture?
Consult pateitn, primary impressions
Stabilisation fo conditions
Scondayr impressions
Bite registration
Trial denture
Extraction and insert
Reviews (24 hours, one week, one month. 6 months)
Reline (temporary at 4 weeks, 3months with Coe Soft (751/752) and permanent at 6 months (must book with lab))
What is the clinical presentations of malignant lesions?
RULE acronym:
- Red/white
2.Ulcer
3.Lump
Exceeding 3 weeks in duration
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
When do you use a wash impression?
Reline of full denture
What is a purpose of a wash impression?
For denture reline
What is the management of cheek biting?
- Control of habit
- Might need to treat the underlying stress
What is an uncomplicated, enamel only crown fracture? What is the treatment?
It is a coronal fracture involving enamel only with loss of tooth structure
Treatment: if tooth fragment is available, bond back on. Alternatively smooth the edges and restore them if needed
What are generalised gingival hyperplastic lesions?
They are lesion that occur due to underlying factors such as plaque or use of certain medications such as hypertension medication (calcium channel blockers) or anti-covulsants or immunosupresants.
Drug Induced Gingival Overgrowth is one of them
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.
What are predisposing factor to periodontal abcess?
1.FUrcation areas
2.Patients with diabetes – impaired cellular immunited, decreased leukocyte chemotaxis and bactericidal activity
What is important to understand about the alveolar ridge for implants?
When teeth are lost, the ridge is lost. Furthermore, maxillary sinuses into remaining alveolar bone. Disuse atrophy occurs even if well-fitting dentures are used.
What are considere high risk reaction to penicillin?
- Any previous respiratory disressm, swelling of mouth or throat
- Any history of diffuse rash which comes immediately after starting treatment
- Diffuse or localised rash which is delayed but occurred less than 10 yearsago
Re-exposure may cause anaphylaxis, so non-beta lactam
What is another machine that can be used to observe soft tissues as well?
MDCT – multi detector computer tomography – 200 microSieverts
What is the systematic way to examine a lesion?
- 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 :))
What is considered to be an aged population?
Anyone above 65 statistically but geriatric dentistry refers mainly to function rather than age
What is this condition?
This is necrotising gingivitis. It is usualy caused by a presence of an opportunistic bacteria and an underlying stress factor.
Clinical features: necrosis of the papilla, sudden onset, ulcer covered by greyish pseudomembrane from surrounding mucosa
Treatment:
- OHI
- Debridement
- CHx
- Metronidozole 400mg 6 hourly for 5-7 days
What can be result of apixification?
- Formation of calcified dome in the tooth
- Formation of pulp-like tissue and formation and growth of roots
- Rejection
How do NOACs impact treatment?
- No patient risk factors or dentla procedure with no/low risk - jsut consider liver/renal health and use local measures
- Patient risk factors and dental procedure low risk - contact GP and try to postpone the drug for 24-48 hours
- Patient risk factors and high risk dentla procedure - no surgicla treatment
What brand is the PVS material?
Honigum
What is an example of overcoming physical barriers for people with special needs?
Example of this is Australasian Health Facility Guidlines which set minimal requirement for resources to be allocated to provide facilties for people with special needs to make facilities more inclusive.
Example is the Residential Aged Care Emergency (RACE) Dental Service
What are some of the factors affecting the uptake of oral healthcare by those who experience homelessness?
- Dental care is a low priority
- Higher level of dental phobia
- Reporting being treated with low respect
- Low number of information and available services
What is a normal oral glucose tolerance test?
2 hours after 75 grams should be below 11 mmol/L
What are the signs of dental anxiety?
- Muscle tightness
- Sweating
- Stiff posture
- holding things tightly
- other
After taking the bite registration what is important to note in the lab form?
Overbite and overjet values
What is the purpose of transmission-based precautions?
To reduce transmission opportunities that may arise due to the specific route of transmission of particular pathogen.
What is effect of benzodiazapines?
1.Anxiolytic
2.Sedative
3.Hypnotic
What are the categories of the Seattle Care Pathway?
- No dependency - fit, robust adults that exercise regularly
- Pre-dependency - chronic systemic conditions - treatment plan as normal
- Low dependency (functionally independent) - some cronic conditions that are affecting oral health - modified treatment planning with for example tooth brushes that are electric
- Medium dependency (frail elderly) - identified chronic conditions that currently impact on oral health. These patients deman treatment at home or do not have transport to a dental clinic - more invasive prevention might be needed like high fluoride tooth paste
- High dependency (functionally dependent) - people have complex medical problems preventing them from receiving oral health care at dental clinics. They must be seen at home - emphasisze management of pain and infection
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:
- Restore biological health
- Restore function
- Restore aesthetics
What are some other periodontal lesion that may occur?
1.Herpetic gingival lesions
2.Dermatoses
3.Lichen planus
When do we usually have a denture review?
One week after insertion
What is an example of direct retainer?
Clasp or precision
What is the contect of odontopaste?
Clindamycin and triamcinolone
What are 6 social factors for vaccine hesitancy?
- distrust of govt
- distrust of medical authorities
- religious reasons/cultural belief differiing
- personal beliefs about the nature of their immunity
- concerns about side effects
- belief that viral diseases are mild and self limiting
- parental use of non medical exemptions to bypass vaccination requirements
What are the management of lichen planus as a general dentist?
o Hx
o Investigation clinically
o Biopsy
o Immunofluorescence
o Betamethasone 0.05% cream topically 2x/d after meals until symptoms resolve
o Diflam mouthrinse (anti-inflammatory)
o Refer to OS
What are the steps for open disclosure?
- Acknowledgement of the incident, and offering initiating or signalling the need for open disclosure
- Preparing for, and engagin in open disclosure discussion, including expressing regret
- Providing follow up to patient and family/caregiver, including actions taken as a result of the investigation
- Completing process and maintaining documentation
What is the most important part of pre-implant assessment?
7-10 mm of crestal bone need to be available to withstand stresses.
What is the basic investigative process in oral pathology?
- Presentation of chief concers
- Information collection - medical history, patietn history, clinical examiantion and special tests
- Information collation
- Development of a differential diagnosis - list most likely diagnoses and do specific test to eliminate potential diagnoses
- Arrive to definitive diagnosis and commence treatment
What are some of the action areas of health promotion according to Ottawa charter?
- 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
What are the contraindications for crowns?
- Poor oral hygiene and active dental disease
- Cost
- Patient’s age - young patients who have large pulp chambers which may be exposed
- Excessive removal of tooth structure
What is the problem with black triangles?
- Aesthetics
- Food trapping
- Trouble with pronouncing S sounds
- Saliva extrusion
What to do if a patient has an asthma attack?
- Stop treatment
- Oximeter is placed straight away moderate is above 94%, sever 90-94%, life threatening below 90%
- f mild – give 4 puffs of salbutamor via spacer 1 puff at a time with patietbreathing in 4 times
- Wait 4 minutes, if not imrpoving treat as sever or lifethretening
- Call 000
- Maximum of 12 puffs but if it is bad even after just keep giving salbutamo with 4 breaths in between before ambulance arrives
What are the examples of of resin cement?
RelyX Unicem 2 (dual cure, Self adhesive, capsule) - good but needs real dry field
Nexus III (Dual and light cure, total etch, automix and try in gel is available) - good but needs the whole bonding system
Panavia F 2.0 (dual cure, adhesive resin) - good but ed primer or alloy primer may cause the mucosa to go white and needs a special bonding system including different primers
How do you compare permanent cements?
Resin cement have better flexural and compressive strength of all other cements
Compressive strength for self etch resin is greater than total etch but totral eth has greater flexural strength
What is improtannt to understand Rehumatoid Arthritis?
- Reduced dexterity resulting in inability to managem daily oral hygiene
- Use of cortical steroids increases the risk of adesonian crisis and MRONJ
What do you need to write on lab form for a partial denture?
- Describe saddles
- Describe support and draw rests, major connector or plate
- SPecify abutment tooth/teeth
- Specify clasps
- Speicy flanges - gum fitted vs buccal flange
- Specify the extension
- Fill lab form and draw design
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
What are the potential causes of a false positive in ept?
o Anxious pt
o Presence of exudate in the pulp chamber
o Moisture control
o Contact with metal restoration
o Contact with gingiva
o Vital tissues still present in the partially necrotic teeth or multi-rooted teeth
What type of bite registration position would you use?
Partial denture with stable tooth contacts: maximum intercuspal position
Partial denture with no tooth contact or unstable contact: centric relation
Completed denture: centric relation
What is ferrule? How can we increase it?
o Portion of circumferential coronal dentine that the crown engages
o How to get sufficient ferrule on compromised tooth?
* Crown lengthening
* Build up
* Ortho-extrusion
What should you put on gigngiva after gignivectomy or modified Widman flap?
A periodontal dressing or COE pack for 24-48 hours
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
What instrument can be used for a gingevectomy?
A kirkland knife
What is a common appearance of cementoblastoma?
Slow growing lesion full of cementum like tissue. Attached to root apex. Well-defined with cortical border.
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.
What are the types of external tooth resorption?
- External surface resorption
- External inflammatory resorption (apical or lateral)
- External replacement resorption (transient or progressive)
- External Invasive Resorption
- External Pressure Resorption
- Orthodontic Resorption
- Physiological Resorption
- idiopathic Resorption
What are the codes for a valplast denture?
721/722
What are the basic management plan for aphthous ulcers?
- Accurate diagnosis
- Symptomatic treatment
- Steroid
What is the management of seizures?
If history of epilepsy or seisures is present - please use a bite block on the patient
- Stop dental treatment
- Ensure patient is not in danger
- Turn the patient to the side
- Avoid restrainning
- Wait until seizure stops
- Maintain airways
- Assess the patient
- If still unconscious, call 000 and maintain airways
What is repair?
Healing mainly by resorption and ankylosis example of which is reimplantation of denuded root into bony socket
What is TAB?
Transient apical breakdown (TAB) is a phenomenon that indicates temporary apical periodontal destruction and root resorption after tooth luxation injuries, followed by the healing process of the dental pulp.
This is why in luxation injuries, root canal treatment is usually needed in mature teeth but not always. WATCH FOR SYMPTOMS.
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.
What does periodontal regeneration involve?
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.
What do we NOT need to take an impression for denture repair?
Debonded teeth or fractured or chipped tooth
What are the different types of bone grafts?
1.Autogenous – harvested from the patient
2.Autollogus – harvested from same species I.e. dead man bone
3.Alloplastic – bioactive glasses like Perioglass (don’t really use anymore)
4.Xenografts – harvested from different species I.e. Bio-Oss which is bovine bone (need to inform the patient)
What is crown lengthening?
Crown lengthening is a surgical procedure performed to expose a greater height of tooth structure in order to properly restore tooth proshtetically.
What is importance of interdental papillae?
Black triangles are bad
What is the same as centric relation?
Retruded contact position. Most stable and comfortable posion of the mandible regardless of condylar position. It is reproducable
What are the appointments for a cobalt chrome denture?
- Consult + alginates
- Secondary impressions
- Frame try-in, bite reg + shade, mould selection
- Try-in
- Insert
- Reviews
Book session 2 a fortnight after 1, appointment 3 4 weeks after that
What is the 4A’s framework?
Ask, assess, acknowledge and address that can be used to adress a patient with dental anxiety
What is Community periodontal index? How is it used?
Purpose:
The CPI is designed to:
Identify individuals in a population with periodontal disease. Assess the severity of the disease. Monitor periodontal health trends over time at both community and global levels.
Aid in planning public health initiatives related to oral care.
Examination Protocol:
The CPI uses a specially designed CPI probe (a periodontal probe with a 0.5 mm ball tip), marked at 3.5 and 5.5 mm for easy measurement.
The mouth is divided into sextants (six sections): three in the maxilla and three in the mandible.
In each sextant, only the worst periodontal condition is recorded, based on clinical indicators such as probing depth, calculus, and bleeding.
CPI Codes and Scoring:
Each sextant is scored with one of the following codes:
Code 0: Healthy – No signs of periodontal disease.
Code 1: Bleeding on probing – There is no calculus or periodontal pockets, but the gingiva bleed upon gentle probing.
Code 2: Calculus detected – Presence of supragingival or subgingival calculus, but the probing depth is 3.5 mm or less.
Code 3: Shallow pockets (4-5 mm) – Probing depth between 3.5 mm and 5.5 mm.
Code 4: Deep pockets (≥6 mm) – Probing depth greater than 5.5 mm.
Code X: Excluded sextant – Sextant not suitable for scoring (less than two teeth present in a sextant).
Code 9: Not recorded – Missing data for the sextant.
Interpretation:
The highest score in each sextant is recorded, and the periodontal condition of the individual or population is assessed.
Higher scores (Code 3 or 4) indicate more severe periodontal conditions, such as periodontal pockets, which require more complex treatment.
Lower scores (Code 0 to 2) suggest healthier periodontal status or less severe conditions that might be managed with preventive care.
What are the advantages of Honigum PVS heavy and lgiht body?
Advantages:
1. Excellent detail
2. high elastic recovery
3. Excellent dimensional stability
4. Easier to remove than PE
5. Easier disinfect as it takes up less water than PE
6. Taste better than PE
Disadvantages:
1. latex contamination or rectraction cords
2. Need better isolation than PE
What are the advantages of Impregun PE heavy and lgiht body?
Advantages:
1. Moderate hydrophilicity thus is excellent in taking impressions in moist environemnts
2. Excellent flowability
3. Amazing reproducability of preperated tooth structure
Disadvantages:
1. Taste
2. Sometime too rigid
3. Easily takes up water after impression is taken - dimensional stability may be affected
4. Short wokring time
What are the GIC cements available at ADH?
Ketac Cem or Fuji 1
What are the RMGIC cements available at ADH?
Fuji Plus or Fuji Cem
What are modifiable risk factors for periodontitis?
Tobacco use
Alcohol consumption
Poor diet
Diabetes
Medications
Hormonal changes
Obesity
Stress
Insufficient personal/oral hygiene
What are the boundaries of the submandibular space?
Anteriorly and laterally: The mandible
Medially: The anterior belly of the digastric muscle
Superiorly: The mylohyoid muscle
Inferiorly: The hyoid bone
Below and laterally: The skin, superficial fascia, platysma muscle, and superficial layer of the deep cervical fascia
How do you reposition the alveolar bone after fracture?
- Use gentle labial and lingual pressure digitally to reposition the alveolus
- Sometimes using a foreceps might be useful
- Take OPG or PA with tube shifting to determient he position of the bone
How do you calculate the maximum amount of LA?
usually per kg of weight, you can inject 7mg of compound so
for a 60 kg person 60x7 = 420 mg
A carpule of 2.2mL of solution around 44mg of lignocaine 2%.
So theoractically a max dose is around 420/44= 9.5 carpules or 9 carpules
What is occult caries?
It is a type of occlusal caries that can only be seen in radiographs and not clinically
How do you manage OSA?
- General measures including weight loss, regular aerobic exercise, nasal decongestants, preventing sleeping in supine position & avoiding sedatives & alcohol near bedtime which can decrease muscular tone in pharynx which can increase collapsibility
- Continuous positive airway pressure machine (CPAP) to act as a pneumatic stent to create positive intraluminal pressure at all levels from nasal cavity to alveoli
- Mandibular advancement device which mechanically increase volume of upper airway in retropalatal and retroglossal areas – may stretch TMJ and result in teeth/periodontium/Md &TMJ pain
- Upper airway surgery using powell-riley protocol w/ 2 stage approach advocating surgical tx to specific regions of airway obstruction
What is a 2 minute test for TMD?
Bilateral palpation of:
Plapate the lateral polls
wear on teeth
limited opening
clicking
facial muscle tenderness
If two are positive, you need to book 30 minute appoitment
What are the treatment for TMD?
Treatment:
- Patient awareness
- Physio exercise
- Splint therapy for 4 months
4.behaviour change
What are the reason for falls positive in ept?
- Hit the gingival
- Multi rooted teeth
- Bad moisture control,
- Metalic restorations
- Patient anxiety
