Weak Areas

Question 1

list the fat soluble vitamins

Answer 1

A D E K

Question 2

summarise dental caries

Answer 2

host, time, fermentable carbohydrates and cariogenic biofilms are required

there are primary modifying factors and secondary modifying factors (primary are tooth anatomy, saliva, pH, fluoride, diet, oral hygiene, immune system and genetic factors) (secondary are socioeconomic status, education, lifestyle, environment and occupation)

critical pH for enamel is 5.5, for dentine it is 6.2

low pH drives calcium and phosphate from the tooth to biofilm to attempt to reach equilibrium

severe demineralisation of enamel results in the formation of a cavitation in the enamel. severe demineralisation of dentine results in the exposure of the protein matrix, which is denatured by host MMPs and the degraded by them, leading to dentine cavitation.

primary caries is a carious lesion that is not adjacent to an existing restoration or crown. secondary caries lies adjacent to an existing restoration or crown. residual caries refers to when carious tissue is not completely excavated prior to placing a restoration.

cavitated carious lesion is a lesion resulting in the breaking of the integrity of a tooth. non cavitated is a lesion that has not yet created a cavity, referred to as white spot lesions a lot.

Question 3

list the functions of the gastrointestinal tract hormones

Answer 3

gastrin
- gastric antrum and duodenum g cells
- stimulate the secretion of gastric acid and intrinsic factor from parietal cells
- stimulate secretion of pepsinogen from chief cells
- promote gastric and intestinal motility
- mucosal growth

CCK
- duodenum and jejunum I cells
- stimulate gallbladder contraction
- stimulate release of pancreatic enzymes
- relax sphincter of oddi for release of bile and enzymes
- role in inducing satiety

secretin
- duodenum and jejunum S cells
- stimulate secretion of bicarbonate form the pancreas
- inhibit gastrin and gastric acid secretion

vasoactive intestinal peptide
- enteric nerves
- increase water and electrolyte secretion from the pancreas and gut
- relax smooth muscle via nitric oxide in the gut

gastric inhibitory polypeptide
- duodenum and jejunum K cells
- reduce gastric acid secretion and intestinal motility
- stimulate insulin release

motilin
- throughout the gut from Mo cells and ECL cells
- increase small bowel motility (MMC during fasting)
- gastric emptying increase

somatostatin
- stomach, small intestine, pancreas delta cells
- inhibit secretion and action of many hormones including all of the above

Question 4

describe the different uses of bins in the clinical environment

Answer 4

sundries go into waste bag

instruments go into the red lid box - the sharps box should be positioned at waist height and never be filled above the black line

sharps that contain medicinal waste are disposed of in tall yellow bin with blue lid

amalgam shavings and empty amalgam capsules go into red stream waste amalgam tubs

healthcare waste including bibs, cups, denture bowls, gauze, drapes, gloves and aprons go into the healthcare waste binds that are tall and white and have orange lids and bin bags

black bags have domestic waste including cardboard, packaging, empty containers etc.

Question 5

describe the muscle control of the different movements of the temperomandibular joint

Answer 5

rotational movements

elevation
- temporalis, masseter, medial pterygoid muscles
depression
- lateral pterygoid, digastric, geniohyoid and mylohyoid

translational movements
protrusion
- lateral pterygoid, medial pterygoid, masseter
retraction
- posterior fibres of temporalis, deep part of the masseter
lateral deviation
- posterior fibres of the temporalis, digastric, mylohyoid, geniohyoid muscles for ipsilateral movement
- lateral and medial pterygoid muscles for contralateral movement

Question 6

describe the use of alginate

Answer 6

seaweed, gypsm, phosphate, colouring and flavouriing

made of irreversible hydrocolloid

2 scoops of powder and 2 measures of water, room temp at around 21-25 degrees, hot water accelerates the set. mix for 45 seconds.

rinse and submerge in perform for 10 minutes and then rinse again, wrap with tissue, dampen to prevent distortion, bag and label

Question 7

list the different cells of the skin, their stimulus and which layers of the epidermis/dermis they are found in

Answer 7

meissners corpuscles
- dermal papilla
- fine touch

merkels disc
- stratum basale
- superficial pressure and fine touch

pacinian corpuscles
- dermis and hypodermis
- detect pressure and vibration

peritrichial nerve endings
- wrapped around nerve endings
- movement of hair

ruffini corpuscles
- stretch of the skin and vibrations

melanocytes
- melanin production
- stratum basale

langerhans cells
- antigen presentation
- stratum spinosum

Question 8

stephan curve

Answer 8

critical pH is 5.5
relates pH in the saliva and time

Question 9

saliva contains many proteins that aid in caries prevention. list them, their action and their effect on the plaque biofilm community

Answer 9

amylase
- cleaves 1-4 glycosidic bonds
- increases the availability of oligosaccharides in the plaque

lactoperoxidase
- catalyses hydrogen peroxide mediated oxidation, adsorbs to hydroyapatite in active form
- lethal to many organisms, suppresses the plaque formation on tooth surfaces

lysozyme
- lyses cells by degradation of cell walls, releasing peptidoglycans, binds to hydroxyapatite in active conformation
- lethal to many organisms, peptidoglycans activate the complement system and suppresses plaque formation on tooth surfaces

lipases
- hydrolysis of triglycerides to free fatty acids and partial glycerides
- free fatty acids inhibit attachment and growth of some organisms

non enzyme proteins

lactoferrin
- ties up free iron
- inhibits growth of iron dependent microbes

IgA (also small amounts of IgG and IgM)
- agglutination of bacteria inhibits the bacterial enzymes
- reduces numbers in saliva by precipitation, slows bacterial growth

glycoproteins
- mucins
- agglutination of bacteria
- reduces numbers in saliva by precipitation

Question 10

what are the essential vitamins, amino acids and fatty acids

Answer 10

essential amino acids
- histidine
- isoleucine
- leucine
- methionine
- phenylalanine
- threonine
- tryptophan
- valine
- lysine

essential fatty acids
- alpha linoleic acid
- linoleic acid

essential vitamins and minerals for oral health
- calcium
- phosphorus
- fluoride
- D
- C
- A

Question 11

list the charting symbols

Answer 11

Question 12

give an overview on protein secondary structures as well as some examples of different globular proteins

Answer 12

secondary structures
- rod like, right handed, found in strong and extensible proteins
- hydrogen bonds stabilise it
- the CO of each amino acid is hydrogen bonded to the NH of the amino acid four residues ahead in the sequence
- there are 3.6 residues per turn of the alpha helix

triple helix
- collagen structure
- water insoluble fibres
- three chains wound round each other to form tropocollagen. comprised of three left handed polyproline like helices
- 1000 amino acids per chain
- no hydrogen bonds in each chain
- every third amino acid is glycine. the others are often proline and hydroxyproline

globular proteins
- 3 or 4 degree structures eg myoglobin and actin are three degree and haemoglobin is 4 degree
- myoglobin is a single chain of 153 amino acids with 8 helical regions and no beta pleated sheets
- haemoglobin is associated with four degree structures, and there are two pairs of polypeptide chains forming a spheroidal molecule. the alpha chains have 141 amino acids ad the beta chains have 146 amino acids.

Question 13

describe the process of PPE donning and then doffing

Answer 13

hand hygiene
apron
face mask
visor
gloves

gloves
apron
visor
face mask
hand hygiene

Question 14

describe the partial pressures of circulation

Question 15

list the water soluble vitamins

Answer 15

thiamine (B1)
riboflavin (B2)
niacin (B3)
B5 (pantothenic acid)
B6
biotin (B7)
folic acid (B9)
cobalamin (B1)
C

Question 16

describe the clinical significance of the pterion region on the skull

Answer 16

the anterior division of the middle meningeal artery runs underneath the pterion, any sort of traumatic blow o the pterion may rupture the artery and cause an epidural haematoma or subdural haemorrhage leading to syncopy and confusion

Question 17

what is dietary starch composed of

Answer 17

amylopectin and amylose

Question 18

describe the different forms of carious lesions

Answer 18

common sites of caries occur on smooth surfaces, particularly below contact points, in pits and fissures, and recurrent around the edges of existing restorations

smooth surface caries
- usually seen below contact points and near the gingiva
- hard and shiny, white and opaque lesion but can sometimes be a brown spot lesion
- as lesion progresses, a conical lesion with the apex toward the ADJ can be seen, there is lateral spread at the ADJ and a larger dentinal lesion
- these changes are thought to be due to loss of interprismatic material, roughening of enamel rods and enhancement of striae of retizius
- broad area of origin and pointed extension toward ADJ. parallel to the long axis of enamel rods in the region. after caries penetrates the ADJ, softening of the dentine spreads rapidly laterally and pulpally

pit/fissure caries
- commonly brown and yellow, sticky lesions, could be chalky white
- as the lesion progresses through the enamel, a conical lesion with the base toward the ADJ is observed, caries follows the enamel rods, there is then lateral spread at the ADJ with more tubules involved as the base is wider
- there is a larger dentinal lesion
- changes thought to be caused by the same factors as seen in smooth surface
- entry site appears much smaller than the actual lesion. wide area of surface attack extends inward, paralleling the enamel rods. affects a greater area of ADJ than smooth surface.

Question 19

label the lymph nodes of the neck on this model

Answer 19

Question 20

describe the steps to take if patient confidentiality has been breached

Answer 20

• proper apology, in person and in writing
• investigate details of what happened and why
• offer a meeting with patient to discuss
• staff training and review of current record keeping system
• inform patient of steps being taken
• security of patient information is a legal obligation

Question 21

what is myxedema

Answer 21

severe hypothyroidism causing thickening of the skin

Question 22

describe the law on confidentiality

Answer 22

lawful disclosure
- when patients give consent (implicit if it is for the purpose of directly supplying their care, explicit if it is secondary)

• when it is required by law (court order, consent not required but patient should be informed and disclosure kept to a minimum)
• when there is compelling public interest (safety of others, consent not required, patient should be informed or persuaded)

Question 23

describe diet diaries

Answer 23

important factors in caries control are:
- plaque control
- use of fluoride
- dietary modification

dietary factors involved in caries incidence
- amount of fermentable carbohydrate eaten
- sugar concentration of food
- physical form of carbohydrate
- oral retentiveness
- frequency of eating meals and snacks
- length of interval between eating
- sequence of food consumption

four forms of carbohydrate that cause caries
- sucrose
- fructose
- glucose
- maltose

ideal diet diary
- includes all the food and drink consumed, the amount in readily estimated units and the time of eating or drinking
- recorded over three days

diet analysis
- sugar rich foods and whether they are confined to mealtimes or whether they are eaten frequently and spaced throughout the day as snacks
- number of sugar exposures should be counted and discussed with the patient
- consistency of the food as dry and sticky foods can have longer clearance times
- sugary drinks should not be taken before bed as salivary flow is decreased during sleep

advice to patients
- acceptable, practical and affordable
- reduce snacks containing sugar, replace with healthy snacks
- eat sweets all in one rather than spreading them out
- only drink plain milk or water between meals
- avoid food within 20 minutes of bed time

extrinsic erosion caused by acid strength of 2.5 or weaker
intrinsic erosion caused by acid strength of 1, typically 100 times stronger than extrinsic erosion

titratable acidity is more important than pH of the diet as it reflects the number of hydrogen ions available for erosive attack, allowing for more accurate assessment of the erosion potential

Question 24

important terms for clinical environment

Answer 24

clean room
- instrument storage

dirty room
- contaminated instrument storage

domino cabinet
- found in surgery, storage of single use items only, mobile worksurface for dental nurse to work from

danicentre
- holds disposable aprons and gloves, may be found outside of the dental pods

ABHR
- alcohol based handrub
- 60% alcohol content
- isopropyl alcohol

clinell wipes
- yellow are detergent only
- green are detergent and disinfectant

Question 25

describe the epithelial lining of the salivary glands

Answer 25

interlobar ducts are lined by columnar stratified epithelium

interlobular ducts are lined by pseudostratified columnar epithelium

striated ducts and intercalated ducts have little connective tissue supporting them

striated ducts are lined by simple cuboidal which goes into columbar epithelium.

intercalated ducts are lined by simple cuboidal

myoepithelial cells lie between the secretory cells and basal lamina, they contract and squeeze the secretions from the acini along the duct

Question 26

describe patient rights in respect to confidentiality

Answer 26

• patients are entitled to have access to their dental records

Question 27

describe the microscopic features of enamel caries

Answer 27

4 zones identified as pre cavitation

1 - translucent zone
- advancing edge of the enamel lesion, present in 50% of lesions, increased fluoride concentration, no protein loss
2 - dark zone
- lies adjacent and superficial to translucent, present in 95% of lesions
- dark appearance due to light scattering when trying to pass through the zone on ground section examination
variable thickness, a wider dark zone indicates a slower advancing lesion
3 - body of the lesion
- largest part of the lesion and lies between the surface zone and dark zone
- area of greatest demineralisation, transparent on assessment
4 - surface zone
- zone appears almost unaffected in the superficial layer
- minimal demineralisation until dentine is involved, calcium and phosphate ions re-precipitate and remineralise from deeper zones. higher fluoride concentration also favours remineralisation

Question 28

outline the system of courts in which the law is applied

Answer 28

criminal cases are high court.
civil cases are court of session.

order of courts for civil:
- tribunal
- specialist
- sheriff
- court of session (outer is first instance and inner is appeal or for very important cases)
- supreme court

order of the courts for criminal cases:
- justice of the peace
- sheriff
- high court of justiciary

Question 29

list the medications that can cause xerostomia

Answer 29

• tricyclic antidepressants
• antihistamines
• diuretics (furosemide)
• antihypertensives
• opioids, hypnotics
• proton pump inhibitors

Question 30

describe some of the fundamentals of chairside assistance

Answer 30

face should be 12-18 inches from the patients face

dental nurse should be 2-4 inches higher than the operator so they can see over obstructions

right handed operation zone
operating zone is 7-11
static zone is 11-2
nurses zone is 2-4
transfer zone is 4-7

left handed operation zone
operating zone 5-1
static zone 1-10
nurses zone 10-8
transfer zone - 8-5

use of aspirator
- held in dominant hand, held firmly where the tip joins the suction tubing
- bevel of aspirator should be held adjacent and distal to the tooth being treated
- firm but gentle

direct aspiration
- adjacent to the tooth being treated
- bevel adjacent to the tooth
- do not go over the tongue to get access to the back of the mouth

indirect aspiration
- useful if access for aspirator is limited or if it is obscuring the view of the operator
- held at anterior teeth, positioned on side closest.

describe the features of using the upper left quadrant for aspiration
- 3:1 syringe retract to support the lower lip and cheek
- aspirator should retract and support the cheek, placed in the buccal sulcus
- this allows for maximum access and extra oral illumination

describe the features of the using the lower left quadrant for aspiration
- 3:1 syringe should retract and support the lower lip
- take care not to press the lip onto the teeth
- aspiratory should retract and support the cheek and gently stretch the soft tissues to allow maximum access and extra oral illumination

describe the features of using the upper right quadrant for aspiration
- use 3:1 syringe to retract and support the cheek
- aspiratory should be positioned on the palatal surface
- always check the back of the mouth for fluid or debris build up

describe the features for using the lower right quadrant for aspiration
- 3:1 to retract and support the cheek
- use water and air in the 3:1 syringe as required
- place the aspirator between the tongue and on the lingual surfaces of the teeth
- retract the tongue

Question 31

describe the process for cleaning dental surgery unit

Answer 31

start at the top - light handles and arm, headrest, back of the chair and arm rests

replace the tuffie wipes and then do worktops, bracket tables, overhead arm and handle, motors ,cables and housing

replace the wipe and then clean suction tubing and partition between the units

Question 32

starlings law

Answer 32

increased filling of heart chambers stretches the heart muscle. preload is the stretching of myocytes prior to contraction, indicated by ventricular end diastolic volume
- magnitude of stretch determines the strength of contraction

Question 33

give an outline on amino acids and proteins

Answer 33

smallest functional protein is thyrotropin releasing hormone

because amino acids central carbon has four different groups attached, it is asymmetric, glycine is the exception as it is double bonded to a hydrogen
protein contain only L amino acids, the D isomers occur in bacterial cell walls

acidic amino acids are aspartate
glutamine
cysteine
tyrosine

basic amino acids are
lysine
arginine
histidine

some post synthetic modifications of amino acid side chains
- hydroxyproline (OH group stabilises the collagen fibre, insufficient hydroxylation leads to scurvy)
- y-carboxyglutamate (carboxylation of glutatmate in prothrombin -lack of carboxylation leads to haemorrhage)
- o-phosphoserine (phosphorylation of serine is the most common form of regulation of protein activity)

pyruvate dehydrogenase has 48 chains of amino acid interacting with one another
prolactin is a single polypeptide chain

Question 34

what converts trypsinogen to trypsin

Answer 34

enteropeptidase

Question 35

describe the temperomandibular joint

Answer 35

synovial joint articulating the mandibular fossa and articular tubercle of the temporal bone, and the condylar process of the mandible. the articular surfaces are lined by fibrocartilage rather than hyaline cartilage

allows for a range of movements of the lower jaw, called translational movements and rotational movements. translational include protrusion, retraction and lateral deviation. rotational include elevation and depression.

main components:
- joint capsule
- synovial membrane
- articular disc

major ligament of the TMJ is lateral temperomandibular ligament

minor ligaments are stylomandibular and sphenomandibular

Question 36

describe how to label an ECG recording

Answer 36

phases of ECG
- P wave (atrial depolarisation)
- QRS complex (ventricular depolarisation
- T wave (ventricular repolarisation)
- P-R interval (delay through the atrioventricular node)
- S-T interval (plataeu phase of ventricular action potential)
- R-R interval (time between ventricular systole)

Question 37

describe adoptive cell transfer

Answer 37

transfer of cells into a patient
most commonly derived from the immune system with the goal of improving immune functionality and characteristics

Question 38

give an overview on polysaccharides

Answer 38

sugars are the monomers (ie monosaccharides)

glycogen and starch function in storage

cellulose, chondroitin sulphate and peptidoglycan function in structure

Question 39

describe the oxygen haemoglobin dissociation curve values

Answer 39

PO2 10mmHg = 10% saturation

PO2 20mmHg = 35% saturation

PO2 30mmHg = 60% saturation

PO2 40mmHg = 75% saturation

PO2 50mmHg = 80% saturation

PO2 70mmHg = 90% saturation

PO2 80mmHg+ = 98% saturation

Question 40

give an overview on some key information for recombinant DNA

Answer 40

restriction enzymes with flush ends
- Hae III
- EcoR V
- Bal I

restriction enzymes with sticky ends
- EcoR I
- Msp I

dna sequencing: sangar sequencing

• dideonucleotide chain termination
• there is gel based and automated
• gel bases has 250-500 base pairs, there are 8 samples per run
• automated have 750-1000 base pairs per sequence of the sample and there are up to 96 samples sequenced per run

Question 41

describe the attenuation patterns of different disorders and features of the oral cavity

Answer 41

thickness and object density of the tissues and materials contribute to determining the overall appearance of the radiograph
subtle variations of light and dark can aid in diagnosis

light is radiopaque
dark is radiolucent

radiopaque restorative materials
- amalgam and other metals

radiolucent/radiopaque restorative materials
- composite resins, sealants, cements, bases, porcelain

radiolucent restorative material
- temporary crowns and bridges made of acrylic, resins and porcelain

soft tissues
- not dense, do not attenuate x rays that well - radiolucent

hard tissues
- enamel is very compact and is the densist tissue of the body, very radiopaque
- bone is less dense than enamel but still radiopaque
- dentine and cementum are considerably less dense and the x ray beam can penetrate the tissues much more readily

Question 42

impact of kidney failure and the drugs taken to treat it

Answer 42

uremic stomatitis
xerostomia in stage 4
taste alteration
periodontal disease

Question 43

identify some key legislation that governs dental practice, including parental responsibility for children

Answer 43

age of legal capacity scotland act 1991
children scotland act 1995
adults with incapacity scotland act 2000
mental health in care and treatment scotland act 2003
equality act 2010
data protection act 2018

parental responsibility
- defined in children Scotland act 1995
- protect in law parental rights and responsibilities, including the power to make day to day decisions about a child’s health care
- mothers automatically have parental responsibility, natural fathers acquire it by being married to the mother, and it is not lost after divorce
- since 2006, in Scotland, unmarried natural fathers acquire parental responsibility if they are registered as the father on the child’s birth certificate
- step parents do not automatically get parental rights and must acquire through an agreement, adoption or application to court
- adoptive parents do have parental rights and responsibilities, and the natural parents will lose the rights after adoption
- it is possible for someone looking after the child to act on behalf of the person with parental responsibility when given explicit permission to do so

Question 44

give an overview on nucleic acids

Answer 44

nucleotides are the monomers

DNA is the main type - involved in information and expression

Question 45

where do b cells mature

Answer 45

spleen

Question 46

describe the absorption mechanisms for the different macronutrients

Question 47

summarise the different growth disorders (take this form the immunity flashcards)

Answer 47

developmental disorders of growth:

agenesis
- organ does not develop at all

aplasia
- an organ fails to develop normal structure from the primitive embryonic structure

hypoplasia
- less tissue formed, normal structure
- enamel hypoplasia

hamartoma
- tumour like growth
- only grows when the patient is growing, but the growth is excessive
- eg pigmented naevi, haemangioma and lymphangioma

haemangioma
- type of hamartoma
- present at birth
- if developed later in life, it is a vascular malformation
- sturge weber syndrome

lymphangioma
- mostly cavernous
- cystic hygroma in newborns

pigmented naevi
- moles

ectopia
- normal tissue in abnormal site
- eg meckels diverticulum, ectopic pregnancies and ectopic teeth

acquired disorders of growth (adaptation of cells in response to environmental stresses)

atrophy
- reduced cell size
- occurs by reduced in organelle size, imbalanced cell loss, can involve apoptosis
- can be localised due to ischaemia, pressure, disuse, denervation, idiopathic
- can be generailsed, due to nutrition, hormones or senile

hypertrophy
- increased cell size due to increased production of cellular proteins
- muscle
- often occurs with hyperplasia

hyperplasia
- increase in cell numbers
- increased tissue size and function, regresses when stimulus is removed, only occurs in labile and stable cells
- eg gingival hyperplasia
- mechanism is growth factor driven, and increased output of cells from stem cells.
- eg liver regeneration

hyperplasia and hyperplasia together
- muscle growth
- goitre due to thryoid follicular hypertrophy and hyperplasia as a result of iodine deficiency

metaplasia
- change from one differentiation to another
- adaptive response due to change in environmental demand
- ciliated columnar in smokers becomes squamous
- barretts oesophagus whereby squamous becomes columnar

dysplasia
- disordered growth occuring in metaplastic tissue, severity may indicate malignant change

neoplasia
- abnormal mass of tissue
- persists after stimulus is removed

Question 48

give an overview on lipids

Answer 48

fatty acids are the monomers of lipids

triglycerides
- storage
- triesterine, glycerol

diglycerides
- membrane structure
- phosphatidylcholine
- phosphatidylglycerol

sterols
- membrane structure
- cholesterol

Question 49

discuss the structure of the UK legal system

Answer 49

public law is criminal cases
private law is civil cases

fuunction
criminal cases is to prosecute, convict, punish, admonish or exonerate.
civil cases is to determine fault and liability

parties involved:
criminal cases: action brought by the state, prosecutor vs defendant, court
civil cases: action brought by a person or organisation, pursuer/claimant vs defendant

standard of proof:
of criminal cases is beyond reasonable doubt
for civil it is a balance of probabilities

decision:
for criminal is guilty or not guilty
civil is liable or not liable

criminal cases are decided by justice of the peace, sheriff or jury if in high court.
civil cases are decided by sheriff or justice of the peace
powers of the court:
in criminal cases include prison, fine, probation, community work, admonishing and exonerating
:in civil cases it is damages or injunction

Question 50

describe the different charting symbols part two

Answer 50