Unit 313 Flashcards
What are the components of a local anaesthetic cartridge?
Water - liquid volume
Buffering agent - maintains a neutral PH
Preservative - allows storage
Vasoconstrictor - constricts the blood vessels
Anaesthetic - blocks nerve signals to the brain
Usual ratio of adrenaline in local anaesthetic
1:80,000
What component of local anaesthetic should not be used for pregnant patients?
Felypressin - brings on labour
Nerve supply to the upper 1s, 2s and 3s
Anterior superior dental nerve
Nerve supply to the upper 4s, 5s and mesiobuccal root of the 6s
Middle superior dental nerve
Nerve supply to the upper distobuccal root of the 6s, 7s and 8s
Posterior superior dental nerve
Nerve supply to the front of the soft palate (1s, 2s and 3s)
Nasopalatine nerve
Nerve supply to the back of the palate (4s, 5s, 6s, 7s and 8s)
Greater palatine nerve
Nerve supply to the back of the hard palate (behind the teeth)
Lesser palatine nerve
Nerve supply to all lower teeth
Inferior dental nerve
Nerve supply to the floor of the mouth and 2/3 of the tongue
Lingual nerve
Nerve supply to the buccal of the lower 6s, 7s and 8s
Long buccal nerve
Nerve supply to the labial gingivae of the lower anterior teeth, lips and chin
Mental nerve
What is a foramen
A hole in the bone where the nerves and blood vessels can pass through
Signs of a partially blocked airway
Wheezing
Coughing
Red face
Signs of a fully blocked airway
Cyanosis
Collapsing
Grasping at the neck
Symptoms of a fully blocked airway
Panic
Unable to cough
What should you do if someone has a blocked airway
Encourage them to cough
If this does not work, administer 5 back blows and 5 abdominal thrusts
Call 999
Signs of anaphylactic shock
Swelling of the face
Rash
Rapid, weak pulse
Symptoms of anaphylactic shock
Breathing difficulty
Feeling faint
Nausea
What should you do if someone is in anaphylactic shock
Administer adrenaline 1:1000 and call 999
Signs of a grand mal seizure
Unconsciousness
Rigid limbs
Convulsions
Symptoms of a grand mal seizure
Possible aura beforehand
Halt in breathing
Signs of a petit mal
Dazed
In a world of their own
Symptoms of a petit mal
Daydreaming
Feeling spaced out
What should you do if someone is having an epileptic seizure
Time the seizure
Administer buccal midazolam
Call 999 if its been over 5 minutes, if it is their first seizure or if they fall in and out of seizures
What medication can cause gingival hyperplasia
Epanutin
What medication reverses midazolam
Flumazenil
Signs of an angina attack
Pale, clammy skin
Irregular pulse
Symptoms of an angina attack
Crushing pain in the chest and left arm
Unable to catch breath
What should you do if someone is having an angina attack
Administer GTN spray sublingually - 2 sprays - 0.4mg
Call 999
Signs of a myocardial infarction
Cyanosis
Grey pallor
Collapsing
Symptoms of a myocardial infarction
Severe pain
Vomiting
What should you do if someone is having a myocardial infarction
Try GTN spray
Administer aspirin 300mg
Call 999
Signs of cardiac arrest
No pulse
Loss of consciousness
No breathing
What should you do if someone is having a cardiac arrest
Call 999
Perform CPR
Signs of hypoglycaemia
Pale, clammy skin
Trembling
Slurred speech
Symptoms of hypoglycaemia
Sweating
Blurred vision
What should you do if someone is hypoglycaemic
Offer a sugary drink or tablet if conscious and administer glucogel
Administer glucagon 1mg injection if unconscious
Signs of a vasovagal syncope
Pale, clammy skin
Weak, thready pulse
Symptoms of a vasovagal syncope
Nausea
Tunnel vision
Tiredness
What to do if someone is having a vasovagal syncope
Lay them back with their feet higher than their head - restore blood flow to the brain
Give a sugary drink or tablet if conscious
Administer glucogel
Name of oral cancer
Squamous cell carcinoma
Signs of clinical shock
Pale, clammy skin
Rapid pulse
Symptoms of clinical shock
Nausea
Confusion
What to do if someone is in clinical shock
Call 999
Do not let them eat or drink
Premalignant patches
Leukoplakia (white)
Erythroplakia (Red)
Herpes labialis
Cold sores
Herpes varicella
Chicken pox
Zoster virus
Shingles
Non premalignant white patches
Lichen planus
What is mumps caused by
Parotitis - swelling of the parotid salivary gland
What is a mucocele
Minor salivary gland cyst
What are analgesics
Pain killers
What are antibiotics
Treat bacterial infections
What are anticonvulsants
Control epileptic fits
What are sedatives
Reduce anxiety/depression
Systolic number for a health adult
120 - pressure of the blood leaving the heart
Diastolic number for a healthy adult
80 - pressure of the blood in the arteries when the heart is not beating
Masseter - origin and insertion points
Originates at the zygomatic arch
Inserts at the ramus
Temporalis - origin and insertion points
Originates at the temporal bone
Inserts at the coronoid process
Medial pterygoid - origin and insertion points
Originates at the back of the maxilla - medial pterygoid plate
Inserts at the angle
Later pterygoid - origin and insertion points
Originates at the back of the maxilla
Inserts at the condyle neck
Muscles of facial expression
Orbicularis oris - encircles the mouth
Orbicularis oculi - encircles the mouth
Buccinator - pushes food onto the posterior teeth
What are the components of saliva
98% water
Proteins
Enzymes
Inorganic ions
What duct does the submandibular gland secrete saliva through
The whartons duct
What duct does the parotid gland secrete saliva through
The stensons duct
What duct does the sublingual gland secrete saliva through
18-22 ducts - Rivinus ducts
What are the two signs that should prompt a rescuer to begin BLS?
Unconsciousness and abnormal breathing
What does asystole mean?
The heart has stopped beating
What does fibrillating mean?
The heart is beating in effectively
What is an increased rate of respiration?
Faster than 20 breaths per minute
What is an increased heart rate?
Faster than 100 beats per minute
What is a falling blood pressure?
Systolic reading below 90
What is the ABCDE approach?
Airway, breathing, circulation, disability, exposure
What is the aim of BLS?
To maintain the flow of oxygenated blood around the casualty’s body until they recover, specialists arrive, the rescuer is too exhausted or the death of the casualty
After how long will the brain cells suffer irreversible damage without oxygen?
3-4 minutes
What does DRSABC stand for?
Danger, response, shout for help, airways, breathing, circulation
What does ACVPU stand for?
Alert, confused, verbal, pain, unresponsive
When should you not perform head tilt, chin lift?
If the casualty is suspected of having a spinal/neck injury
How long do you assess a casualty’s breathing for?
10 seconds
What is the normal rate of breathing?
12-20 breaths per minute
What does gasping or stridor (high pitched inspirations) indicate?
Upper airway is blocked
What does snoring indicate?
Semi conscious or unconscious casualty who is laying flat due to the tongue falling back
What does gurgling and rattling indicate?
Presence of fluid in the airway
What does wheezing indicate?
Narrowed bronchi and bronchioles (often during an asthma attack)
What is the log roll technique?
Rolling a casualty with suspected spinal/neck injury onto their back keeping their head in line with their neck
How many chest compressions per minute should be carried out?
100
How deep should the chest be compressed during BLS?
4-5cm
How much oxygen is in expired air?
16%
What is the most common problem during rescue breathing?
The chest does not lift when the breath is being given
What is being done if the abdomen is rising during a rescue breath?
The breath is too forceful or prolonged
How long should a lone rescuer perform BLS for before going to call for specialist help for a child?
1 minute
What side should an unconscious pregnant woman be laid on?
Left side
What blood vessels are squashed when a pregnant woman is laying on her back?
Inferior vena cava
Why should you place someone into the recovery position?
So that the tongue does not fall to the back of the mouth and any liquids can drain out of the mouth
Why are the maxilla bones hollow?
They would be too heavy to lift the head if they were solid
What is the name of the region where the two halves of the maxilla meet?
The intermaxilliary suture
What is the back end of each alveolar process called?
The maxillary tuberosity
When can the maxillary tuberosity be fractured?
During difficult upper wisdom tooth extractions
What is the name of the area where the 2 halves of the mandible join?
The mental symphysis
What is the vertical section of the mandible called?
The ramus of the mandible
What is the horizontal section of the mandible called?
The body of the mandible
What is the junction called where the body and ramus meet?
The angle
What type of joint is the TMJ?
A hinge joint
Where does the TMJ and the mandible meet?
At the head of the condyle
What does the alveolar process do?
Supports the lower teeth
Where does the condyle rest when the mouth is shut?
In the glenoid fossa
What does the front edge of the glenoid fossa form into?
The articular eminence
What disc prevents the two bones grating against eachother?
The meniscus disc
What is subluxation?
When the meniscus slips in front or behind it’s position causing clicking
How does the mouth open?
The condyle slides from the glenoid fossa to the crest of the articular eminence
What is trismus?
Involuntary painful contraction of the TMJ
Other than the TMJ, what can cause trismus?
Pericoronitis, after surgical extraction of lower wisdom teeth and during mumps
What do the suprahyoid muscles do?
Allow mouth opening and swallowing
What is trigeminal neuralgia?
A condition affecting the sensory nerves of the maxillary or mandibular divisions of the trigeminal nerve
What is Bells Palsy
Temporary paralysis of the facial nerve
What is a combination nerve?
A nerve carrying both sensory and motor fibres
What are the major arteries carrying oxygenated blood to the head and neck called?
Common carotid arteries
What does the external carotid artery supply?
The outside of the cranium including the face and oral cavity
What does the internal carotid artery supply?
The inner cranial structures including the brain and the eyes
Why is it easier for localised infections to spread to the head and neck?
Because the flow of deoxygenated blood is not always in one direction due to the veins not having a one way valve system
What arteries supply blood to the teeth?
The carotid arteries
What arteries supply blood to the tongue?
The lingual artery
What artery supplies blood to the upper teeth?
The maxillary artery
What artery supplies blood to the lower teeth?
The inferior alveolar artery
Where is the lining membrane found?
The inner surfaces of the checks and lips, floor of the mouth, underside of the tongue and soft palate
Where is the masticatory membrane found?
Covering the gingivae, topside and edges of the tongue and the hard palate
Where is the specialised membrane found?
Interspersed throughout the masticatory membrane on the top side and edges of the tongue
What does the lining membrane do?
Provides a physical barrier between anything entering the mouth and the deep structures of the oral cavity
What does the masticatory membrane do?
Provides a hard wearing surface that prevents traumatic damage from food, chemicals etc
What does the specialised membrane do?
Provides taste sensation
What does the soft palate do?
Seals off the oral cavity from the nasal cavity during swallowing
Correct term for swallowing
Deglutition
Why are drugs often administered sublingually?
It has a thin lining epithelium of mucous membrane
What is the correct term for inflammation of the tongue?
Glossitis
What causes glossitis?
Iron and vitamin B deficiency
What does glossitis look like?
Smooth, red glazed appearance of the tongue
What is dysphagia?
Difficulty swallowing
Name of mineral crystals and percentage of them in enamel
96% calcium hydroxyapatite
What happens to the enamel when it comes into contact with fluoride?
Hydroxyapatite crystals turn into fluorapatite crystals - more resistant to acid attacks
Name of mineral crystal and percentage of them in dentine
80% calcium hydroxyapatite crystals
What are the nerve endings called in dentine?
Fibrils
Name of mineral crystals and percentage of them in cementum
65% calcium hydroxyapatite crystals
Number of cusps on premolars
2
Number of cusps on permanent first molars
5 (palatal cusp of carabelli)
Number of cusps on permanent second molars
4
Number of cusps on deciduous first molars
4
Number of cusps on deciduous second molars
5
Name of the outer surface of the alveolar bone
Lamina dura - hard and compact
Name of the inner surface of the alveolar bone
Cancellous bone - soft and spongy
What is the gingiva called which is attached to the bone?
The mucoperiosteal layer
What is the interdental papilla?
Gingival tissue between each tooth
What are the periodontal ligament fibres made of?
Collagen
Inflammation of the periodontal ligaments
Periodontitis
Where is the parotid salivary gland located?
Between the ramus and the ear
Where is the submandibular salivary gland located?
In the posterior area of the floor of the mouth, beneath the mylohyoid muscle
Where is the sublingual salivary gland located?
In the anterior area of the floor of the mouth, above the mylohyoid muscle
What microorganism causes mumps?
Paramyxovirus
What salivary gland is most commonly associated with benign and malignant tumours?
The parotid gland
What salivary duct is most likely to become blocked by salivary stones?
The Wharton’s duct from the submandibular gland
What condition is associated with xerostomia?
Sjogrens syndrome
What is ptyalism?
Excess salivation
What drug can be taken during oral surgery to reduce saliva flow?
Atropine
Usual bacteria associated with caries
Streptococcus mutans
Streptococcus sanguis
Lactobacilli
What food group is turned into acid by bacteria?
Carbohydrates
What are cariogenic foods?
Capable of causing caries
What are intrinsic sugars?
Sugars found naturally within the cell structure of foods
What are extrinsic sugars?
Sugars added to foods in manufacturing or cooking, some can occur naturally such as honey and lactose in milk
Most damaging NME (free) sugars
Sucrose and glucose (dextrose)
What type of sugar is lactose?
Milk extrinsic
What type of sugar is fructose?
Intrinsic
How long does an acid attack last?
20 minutes
How long does bacteria take to turn carbohydrates into acid?
A minute or 2
What are the most common stagnation areas?
Interproximal and occlusal areas
What does a remineralised spot on the tooth look like?
A brown spot lesion
How does pulp necrosis occur?
The pulp cannot swell therefore pressure builds up and compresses the blood vessels which will stop the blood supply to the tooth
How does an alveolar abscess occur?
The dead pulp tissue drains through the apical foramen into the surrounding alveolar bone and cause the tissue to inflame
How does an acute abscess form into a chronic abscess?
Pus drains through the sinus, relieving pressure and symptoms
What enzyme in saliva digests carbohydrates?
Ptyalin (amylase)
What is term for tooth loss due to extrinsic acid on the enamel?
Erosion
What medical conditions can cause tooth erosion?
Bulimia, reflux and stomach ulcers
What tooth surfaces are particularly affected by erosion?
Labial and palatal of upper incisors and occlusal of the lower molars
What is the term for tooth loss due to excessive forces (like brushing)?
Abrasion
What type of patient is more likely to have abrasion cavities?
Smokers - using abrasive smokers toothpaste or brushing harder to remove stains
What is the most common surface to see an abrasion cavity on?
The cervical area of the tooth on the buccal or labial surface
What is the term for tooth loss due to tooth on tooth contact?
Attrition
Other than tooth loss, what can bruxing cause?
Face pain and TMJ problems
What surface does bruxing affect the most?
Occlusal
What is the term for tooth loss due to shearing forces in a single standing tooth?
Abfraction
What is the difference between abrasion and abfraction?
Abrasion happens over time, abfraction happens suddenly
Abfraction also affects the lingual and palatal surfaces, as well as the buccal and labial
What tooth is most likely to be affected by abfraction?
Single standing premolars
What is the difference between periodontitis and gingivitis?
Gingivitis is the inflammation of the gingiva alone, periodontitis is the inflammation of all supporting structures
What are iatrogenic factors?
Factors caused by imperfect dentistry
What is the specialist gingiva called at the junction where the neck of the tooth and gingiva meet?
Junctions epithelium
How does gingivitis turn into periodontitis?
The toxins soak through micro-ulcers and penetrate the deeper tissues, destroying the periodontal ligaments and alveolar bone
What virus causes acute herpetic gingivitis?
Herpes simplex
What group of patients is most commonly affected by acute herpetic gingivitis?
Infants
What does acute herpetic gingivitis show as in the oral cavity?
Small painful ulcers (acute herpetic gingivo stomatitis)
What antibiotic is commonly prescribed for ANUG?
Metronidazole
What is an acute lateral periodontal abscess?
Pus is unable to drain through a pocket and therefore accumulates at the base of the pocket to form an abscess
What areas are assessed during an oral health assessment?
Extra and intraoral soft tissues, dentition, occlusion and periodontal tissues
What are the responses of an electric pulp tester?
Normal response - healthy pulp
Increased response - early pulpitis
Reduced response - pulp is dying
No response - pulp is dead
Where is oral cancer most commonly seen?
Borders and underside of the tongue and the floor of the mouth
What instruments would you set out for a tooth charting assessment?
Mouth mirror, angled probe, tweezers and a briault probe
What teeth are most likely to be crowded?
Upper canines
Along with lower second premolars and lower third molars
What should be done when a score of 3 is recorded?
Radiographs should be taken to record bone levels, plaque retention factors removed and patient given effective oral hygiene advice
What should be done when a score of 4 is recorded?
Radiographs taken to see bone level, full pocket depths measured to see the problem areas and intensive periodontal treatment initiated
What is grade 1 mobility?
Side to side movement of less than 2mm
What is grade 2 mobility?
Side to side movement of more than 2mm
What is grade 3 mobility?
Vertical movement
What are the 3 things that can happen when taking an x ray?
X rays pass cleanly between atoms and are unaltered
X rays hit atoms and scatter, releasing energy as they do
X rays hit the atoms and are absorbed, releasing energy as they do
What must consent be?
Informed
Voluntary
Capacity
What act links to consent?
Mental capacity act
What is a right angled probe used for?
To defect occlusal caries
What is a briault probe used for?
To detect interproximal caries
What is a sickle probe used for?
To detect residual caries
What is a WHO probe used for?
BPE
What is a Williams probe used for?
6 point pocket charting
What are study models used for mainly?
Orthodontics
What is an elastomer material?
Putty
What is a silicone material?
Light body
What do the periodontal ligaments connect?
The cementum to the socket - the lamina dura lining
How does diabetes affect the salivary flow?
Reduce salivary flow - more prone to caries or perio
How does HIV affect the oral cavity?
High risk of all diseases and hairy leukoplakia
How will a patient suffering with a hernia affect the oral cavity?
Gastric reflux - acidic erosion
How does pregnancy affect the mouth?
Pregnancy gingivitis - interdental papilla grow to cause epilis
What can affect elderly patients more prominently than younger patients?
Gingival recession - root surface caries
What can cause xerostomia?
Chemotherapy, salivary gland blockages and calculi
What is lichen planus?
Inflammatory condition affecting the soft tissues, red swollen tissue, open sores or white Lacey patch
Leukoplakia
White patches caused by trauma or possible site for oral cancer
What should be noted when a patient is administered drugs and how long should this be kept for?
Expiry date and batch number - stored for a minimum of 2 years
Symptoms of hyperglycaemia
Increased thirst
Ketone smell to breath
What should you do if someone is suffering with hyperglycaemia?
Administer insulin
What might a patient be treated for a stroke with?
Anticoagulants (blood thinners)
What valve separates the right atrium and right ventricle?
The triscupid valve
What valves separates the left atrium and left ventricle?
Mitral valve
