Written Exam 2 Flashcards
This person discovered X-rays
Used cathode rays on photo plate in his physics lab
Roentgen
This individual performed the first intraoral x-ray in 1895
Walkoff
This individual is known as the father of U.S. dental radiography
Kelly
Who developed “hot cathode” coolidge tube (hot, inefficient) using tungsten
Shockproof unit in 1919
Coolidge
This individual warned of X-ray damage and developed patient protection guidelines
Rollins
What warned of X-ray damage and developed patient protection guidelines
Rollins
What is the study or science of radiation as used in medicine/dentistry
Radiology/Roentgenology
What is a recorded images produced by X-ray on photographic film
radiograph
What is a transparent material covered with photographic emulsion
film
What serves the same purpose as film, receive the radiation?
What are the different types?
sensor
-
Direct digital detectors = wired to the computer, receives the remnant radiation
- Most sensitive - meaning less radiation is necessary
- Indirect digital detector = are used like film, photostimulable phosphor (PSP) imaging plates are thin and w/o wires, take in the remnant radiation and a computer reads it and produces a latent image
What is the act of making or exposing a radiograph?
exposure
***Radiographs are MADE, not taken
What appears dark on the radiograph, signifies a lack of structure or a less dense structure which higher amounts of remnant radiation passed through to sensor during exposure
Radiolucent
X-rays go through the image and have slight refraction
pulp chambers and sinuses
Appears light on a radiograph, signifies the presence of increasingly dense structure where little remnant radiation from exposure can reach the sensor
Radiopaque
X-rays cannot penetrate the structure
Enamel, restorations
What is the lamina dura?
Space around the tooth root
Explain the process of producing an X-ray
- Produced by bombarding a tungsten target (anode) with a stream of high-velocity electrons
- The electrons are produced at the tungsten filament (cathode) and are propelled toward the anode
- Onto a focal spot
Explain the component of an X-ray Tube
-
Cathode (-)
- Filament is a coil of tungsten
- Electrons released by thermionic emission - “boiling off” of electrons
- Focusing cup of negative molybdenum directs the cathode electrons to the Anode
-
Anode (+)
- Tungsten in a copper stem
- Target of the Cathode electrons
-
Focal Spot
- Where in the Tungsten target of the Anode the electrons are directed, smaller means a sharper image
What are the types of radiation produced upon electrons hitting the target?
- Bremsstrahlung Radiation (Breaking Radiation) - high energy electrons are deflected by forces within the atom
- Characteristic Radiation - the high energy electrons strike and eject electrons from their valence shells
- Give off energy as photons
What are the types of controlling factors in X-rays?
-
kV - kilovoltage
- Controls speed of electrons from cathode to anode (- to +)
- Controls quality of the X-ray beam
- High vK means more penetrating power
-
mA - milliamperage
- controls the number of electrons produced, thus controlling quantity of X-rays
- High mA means a dark radiograph
-
s- Time
- Also has an impact on quantity of X-rays
- Ex: 1 impulse = 1/60 sec
Which of the following controls the number of electrons produced, thus controlling quantity of X-rays
mA - milliamperage
What controls speed of electrons from cathode to anode (- to +) and controls the quality of the X-ray beam.
kV - kilovoltage
High vK means more penetrating power
What is the degree of blackness of the radiograph?
How is it effected?
What are the controlling factors?
Radiographic Density
Effected by X-ray quantity - how many X-rays are produced
Controlling factors: milliamperage (mA) and time (s)
What is the number of shades of gray on the radiograph?
How is it effected?
What is the controlling factor?
Radiographic Contrast
Effected by X-ray quality - how well the beam can penetrate
Controlling Factor: Kilovoltage (kV)
What the difference between high contrast and low contrast?
- High contrast = short scale, less shades of gray
- Low contrast = long scale, lots of shades of gray
High vK means increased energy/penetration and lower contrast
Think of contrast as an amount of “difference”
- High contrast, high difference - less gray area, each color contrasts more with the next
- Low contrast, low difference - more gray, each color is less contrasting with the next
From a grain hopper and belt standpoint, describe the difference between the Density vs. contrast
- Quantity of grains (electrons) controlled by mAs
- Speed (energy/quality) of the grains (electrons) controlled by kV
Explain the process of making an X-ray
- X-radiation (production of X-ray as described previously) is emitted from the end of the cone
- X-rays pass through patient tissues
- Relatively Dense tissues arrest some of the X-rays
- Some X-rays pass through tissue and hit the film/sensor
- X-rays that hit the film/sensor produce varying shades of gray (beam quality, penetration, kV) depending on the amount of radiation exposure
- Produce the black, white, gray representation of the various densities of each tissue - relative to tissue densities ad the X-ray
What does a full mouth radiographic survey consist of?
Explain each type of x-ray
14 periapical and 4 bitewings
-
Bitewings - see both upper and lower arches, apex of the root and alveolar bone not well represented
- Diagnostic, used to detect caries
- Must be able to visualize the interproximal spaces to see incipient decay
- Overlap of proximal surfaces would mean the bitewing is non-diagnostic
- Periapical - show only an upper and lower, visualize the crown, root and 2-3 mm of surrounding bone
Explain the types of pulpal abnormalities and what they are caused by
- Pulp stones - age or parafunctional activities
- Obliterated pulp - hard tissue deposits fills the pulp, leave it narrow and restricted
What are bitewing carious lesions?
Serve diagnostic purpose of bitewing
- Demineralization
- Consider the carious lesion’s proximity to the DEJ
What is at the apex of the tooth, lesion as a result of pulp death?
Periapical
What is related to the supporting structure of the tooth: alveolar bone, lamina dura, PDL - periodontal disease can result in loss of the alveolar crease
Periodontal
What is a (non-vital tooth) RADIOLUCENCY with a Periapical:
- Abscess: pocket of infection waste (pus) may have sinus, diffusive boarders on X-ray)
- Granuloma: infected area walled off with macrophages, more circumscribed on X-ray
- Cyst: membrane-bound fluid sac, large and well-defined on X-ray
Lamina dura may disappear or be continuous with the lesion sclerotic margin, NOT present at apex
Rarefying Osteitis
On a non-vital tooth, What has diffuse RADIOPACITY at apex, separated with widened PDL space
- Reactive bone tends to bend into normal bone with no radiolucency between it and normal bone
- Lamina Dura is lost at apex, widened apical PDL space
Condensing Osteitis
What is a VITAL radiopacity with no associated radiolucency
- not associated with an inflammatory process
- Same density as the cortical bone
- Defined border not seen in sclerosing Osteitis
Idiopathic Osteosclerosis
What is a VITAL RADIOPAQUE
- Excess cementum at the apex
- PDL surrounds the radiopaque cementum (there is no increase in radiolucency because there is no loss of structure
- Differentiate the cementum from the dentin (cementum is less calcified)
- Associated with periapical inflammation, periodontal disease, Paget’s, Gardner’s
Lamina Dura and PDL are continuous with the radiopacity
Hypercementosis
What is a VITAL RADIOLUCENT on anterior mandibular tooth:
- Radiolucency is between radiopacity and bone (differentiation from condensing osteitis, as well as vital vs. non-vital)
- Radiopaque deposits within the radiolucency may appear crescent-shaped
- Lamina Dura not present at the apex
Periapical Cemental Dysplasia
What is it if there is a widespread Periapical Cemental Dysplasia (PCD) - beyond the anteriors
Florid Cemento-osseous Dysplasia (FCOD)
What is it if on a VITAL tooth there is increased radiopacity as it matures:
- Apex of the root is obliterated by lesion
- Young adult males is more common
Cementoblastoma
Describe the relationship of the PDL and Lamina Dura to Apical Lesions for Rarefying Osteitis
Abscess, Granuloma, cyst
NON-VITAL - radiolucent (bone loss)
Lamina Dura = may disappear or be continuous with sclerotic margin of lesion. NOT present at apex
Explain the relationship of the PDL and Lamina Dura in Sclerosing Osteititis aka Condensing Osteitis
NON-VITAL Radiopaque (diffusive mineralization beyond an expanded PDL space)
- Lamina dura = will be lost at apex
- Widened apical PDL space
- Reactive bone that tends to blend into normal bone with no radiolucency between it and the normal bone
What is the relationship of PDL and Lamina Dura to Apical Lesions for Hypercementosis
- Lamina dura and PDL are continuous around the radiopacity
- Cementum is not as dense at dentin so can see the outline of the original tooth
What is the relationship of the PDL and Lamina Dura to Apical Lesions for Periapical Cemental Dysplasia, FCOD
- Lamina dura may disappear
- NOT present at apex
- Radiopacity deposits within the radiolucency and may appear crescent-shaped
What are the local irritants for periodontal disease?
-
Calculus - mineralized, hardened dental plaque
- Spur type (seem to act like an overhang)
- Overhangs - overhanging restoration material
- Caries - decay and disease of tooth structure
Describe the normal alveolar crest structure as seen on a radiograph
- Anterior crests - more pointed
- Posterior crests - flattened
- 1-2 mm apical and parallel to the CEJ
- Horizontal bone loss, the alveolar crest uniformly lowers, remains parallel to the adjacent CEJs
- Vertical Bone Loss, alveolar crest downs not decay evenly and is not longer parallel to the adjacent CEJs
Describe the types of Furcation involvement
Class I = incipient
Class II = partial
Class III = complete
Class IV = Visible clinically
**Furcations are less defined in maxillary molars than mandibular molars because of the superimposition of the palatal root
INVESTIGATE CLINICALLY
Explain Extra-oral imaging 0 image receptor outside the mouth
- Panoramic radiograph
- Cone beam computed tomography -CBCT
- Divergent X-rays
- Some offer bitewings
- Capture the whole mandible, TMJ, Maxilla, Maxillary sinus
- Treat the radiograph as if you are looking at the patient
- Pathology/Diagnosis
- Tell age based on growth and development
- Can visualize foramen for nerves
- Can follow CN V3 (inferior alveolar nerve) through the mandibular foramen and the mental foramen
What is:
- “ectopic” sebaceous glands in mouth - embryologic
- 80% of population
- Yellow or yellowish-white papules
- On buccal mucosa and the vermillion boarder
- No treatment necessary - recognize them for what they are and move on
Fordyce Granules
What is:
- White swelling
- Variation of normal in patients of color
- Excess fluid in tissue gives milky appearance - stretch and it disappears
- Intracellular edema
- No treatment necessary
Leukoedema
What is:
- In 0.5% of people
- Descriptive term = elongated filiform papillae, discolored
- Retain keratin, make more
- Trap debris, stain (bismuth - black)
- More common in smokers, those with poor hygiene
- Brush to cure
Hairy Tongue
What is:
- Long developing
- Midline bony growth of hard palate
- More in females, 20-35% of people, more in adults
- Only concern with trauma, denture fit
- Asymptomatic
Torus Palatinus
What is:
- Long developing
- Lingual mandible, premolar region
- Above mylohyoid ridge
- 7-10% of adults
- Ethnic predilection
- Asymptomatic - but may be impacted food, trauma
- Removal for prosthetics
Torus Mandibularis
What are common developmental teeth abnormalities
Environmental Alterations cause:
- Affect enamel mineralization
- Dose dependent
- Too much during development
- Caries resistance
- Esthetic issue
What are post developmental abnormalities that can occur on teeth? List and describe
- Attrition = tooth to tooth contact (normal with age, unless bruxism - parafunctional)
- Abrasion = mechanical action of external agent (hard brush, bobby pin, pipe)
- Erosion = non-bacterial chemical process (pH of stomach contents in vomit, sucking lemon wedges - sensitivity)
- Abfraction = occlusal stress with microscopic flexing (class V)
What is a localized disturbance?
Impaction - physical barrier to eruption (crowding, tumor)
- Damage to adjacent teeth
- Treatment = watch, orthodontic pulling/assistance, transplantation, surgical removal
What is hypodontia
decreased number - third molar, maxillary lateral incisors
What is hyperdontia
extra teeth, usually premolars
What is microdontia
smaller than normal = peg lateral
usually maxillary lateral incisor
What are shape developmental alterations?
Name and describe
-
Germination
- (developmental twinning, sharped pulp in radiograph
-
Fusion
- (joining of developing teeth, separate pulp chambers, and root)
-
Concrescence
- (roots joined by cementum only)
What are amelogenesis imperfecta
imperfect formation of enamel, pits, fissures
What is dentinogenesis imperfecta
Imperfect dentin formation under normal enamel
- Normal teeth are translucent. dentin-less teeth are not translucent
- Hereditary opalescence Dentin (hereditarily opaque)
- No pulp chamber on radiograph, but the slightest chamber in there
- Associated with osteogenesis imperfecta
What is mycobacterium tuberculosis cause
Tuberculosis
This had declined in the US, cinrease in foreign country/foreign born immigrands (undocumented) and there are 3 million deaths from complications with this disease.
Tuberculosis
INFECTION DOES NOT MEAN ACTIVE DISEASE
5-10% develop active disease (the immunocompromised)
Healthy body will suppress disease just fine
Immunosuppression can allow latent TB to activate
What is the most common pain for tuberculosis patients?
tooth ache
The off the grid people end up in dental schools and free clinics
How common are oral lesions in tuberculosis patients
0.5 - 5%
Non-healing ulcers and granulation (dorsal surface of the tongue, anterior mandibular labial vestibule are most common ulcer sites - it is where the sputum from pulmonary TB collects
What is the diagnosis technique for Tuberculosis?
- TB skin test, PPD
- Sputum culture
- Histopathology tests
- Giant cells
- Granulomas
- Caseous necrosis (cheesy)
What is the treatment for Tuberculosis?
Anti TB medications (AB)
Multiple and extremely resistant TB now exists (MDR, XDR)
What is a Dimorphic fungus in 30-50% of the population
Candidiasis
For the Dimorphic fungus of Candidiasis, what is the name for the Yeast form and what is the Hyphal form
Yeast form (innocuous)
Hyphal form (disease causing)
What type of Candidiasis is opportunistic, commonly found in infants after monther’s AB wears off, in immunosuppresed.
- Resembles cottage cheese
Acute Pseudomembranous Candidiasis
Where is Acute Pseudomembranous Candidiasis - Thrust - usually found? and how is it removed/treated?
Buccal mucosa, dorsal tongue, palate
Removed with gauze (pseudo mambrane)
(same as vaginal yeast infection)
What is commonly described as “burning mouth”, sore mouth (erythema)
Acute Pseudomembranous candidiasis - Thrush
What is:
- AB sore mouth
- Etiology is xerostomic (dry mouth)
- Cause Atrophic Glossitis - “bald tongue”
- Scalded sensation
- Clear infection and it returns to normal
Erythematous Candidiasis
Erythema withouth white component
What is an inflammation in a diamond shape at the midline
- AKA Central papillary atrophy of the tongue
- Infectious, can recur - NOT congenital based on research and presence of candida albicans, and not in any kids
- Junction of the anterior 2/3 and posterior 1/3 of the dorsal tongue
- Treat with antifungal, will recur - we chose not to treat because it has no impact and recurs anyway
Median Rhomboid Glossitis
What type of Median Rhomboid Glossitis is treated and where is it located?
“Kissing Lesion” of the palate
What are:
- Preleche
- Localized candidiasis
- Crease because of decreased vertical dimension (denture and attrition can cause decreased VD_ nutritional deficient
