24 Flashcards
1
Q
tests to confirm cracked tooth syndrome
A
transillumination
tooth sleuth
2
Q
management for cracked tooth syndrome
A
full coverage crown
RCT
xla
3
Q
factors which affect prognosis of cracked tooth syndrome tooth
A
pulpal involvement
extent/direction of crack
4
Q
properties of acrylic which make it suitable material as denture base
A
biocompatible
good aesthetics
dimensionally stable
ease of repair/modification
thermal expansion similar to Pontic teeth
5
Q
property of acrylic that makes it prone to breakage
A
brittleness
significant stress/impact = breakage
6
Q
most common breakages in complete dentures
A
midline fracture
loss of Pontic
loss of flange
7
Q
3 faults of denture construction
A
incorrect OVD/RVD
insufficient flange
insufficient post dam
8
Q
3 faults relating to denture finishing of acrylic
A
gaseous porosity
granularity
crazing
9
Q
how to know if new impression when denture fractures
A
can you relocate all pieces together
if missing any or cannot = new impression
10
Q
denture fracturing and being repaired repeatedly
what to do
A
strengthener
reinforce palate with wire mesh, glass-fibre mesh or stainless steel wire
use of ductile material in brittle material to increase strength
11
Q
denture fractures again after use of strengthener
if you were making new denture, what would you do to prevent
A
reevaluate occlusion
may have incorrect OVD
12
Q
advantages of non y2 amalgam
A
increased corrosion resistance
less creep
increase wear resistance
longer lasting rest
higher compressive/durability
13
Q
how does technician reduce y2
A
use of copper >=12%
allows tin to preferentially react with copper rather than mercury
creating Cu5Sn6
eliminating y2
14
Q
minimata convention 2013
what was discussed, what is conclusion
A
global agreement to phase down mercury use
health/environmental concerns
promote alternatives
15
Q
which 4 groups are amalgam contraindicated in
A
<15 y/o
pregnant
breastfeeding
known allergy/hypersensitivity
severe renal
neurological impairment
16
Q
adv + disadv of amalgam compared to composite
A
adv =
higher compressive strength
increased wear resistance
less technique sensitive
cheaper
disadv =
poor aesthetics
more destructive prep required
toxic
17
Q
what would be favourable outcome following pads trauma on radiograph
A
intact lamina dura and PDL
no root fracture
no pathology
18
Q
you assess pt one day post trauma
when will you see them again
A
2 weeks
likely commence RCT to prevent external inflammatory RR
19
Q
what cells and structures are present in an MIH affected pulp
A
increased immune cells
increased vascularity
increased neural density
odontoblasts, fibroblasts, neutrophils, macrophages
20
Q
what is the significance of pulp horn proximity in MIH
A
more reactive odontoblasts
altered sensitivity of nerve fibres
increased risk pulpal irritation
increased immune cell and inflammatory response due to porous enamel and dentine exposure
restorative challenges
21
Q
3 proposed pain theory for MIH
A
hydrodynamic theory =
dentine hypersensitivity due to exposed dentinal tubules allowing rapid fluid movement stimulating nerve endings
peripheral sensitisation = underlying pulpal inflammation lead to sensitisation of c-fibres
central sensitisation -
continued nociceptive input
22
Q
tx for MIH
A
fluoride
fs
crowns
composite
resin filtration
xla
23
Q
4 diagnostic factors of autoimmune mucous membrane disorders
A
vesicle/bullous formation on mucous membranes - oral, nasal, anogenital, scalp, nails, nasal
H+E staining
DIF
IIF
24
Q
what is DIF
A
detects autoantibody presence on tissues
25
what is indirect immunofluorsence
detects circulating autoantibodies
26
histopathology and DIF findings of pemphigus vulgaris
H+E =
intraepithelial splitting
DIF =
linear deposition of IgG + C3, chicken wire appearance
loss of cell cell contact, acantholysis
27
differentials of MMP
pemphigus vulgaris
erythema multuforme
linear IgA
erosive lichen planus
28
antigens on MMP
BP180, BP230
29
antigens of PV
dsg 1 + 3
30
mucous membranes affected in MMP
anogenital
scalp
nasal
pharyngeal
laryngeal
oral
31
risk factors for malignant change in leukoplakia
asymmetry
high risk site
verrucous leukoplakia
smoker, drinker, previous
heterozygosity
non-homogenous
dysplasia
32
4 types of oral lichenoid lesions according to van Der Waals classification
oral lichen planus
oral lichenoid drug reactions
oral lichenoid lesion contact hypersensitivty
oral lichenoid lesion in GVDH
33
histopathology of lichen planus
acanthosis
hyperparakeratosis
band like lymphatic infiltrate
destruction of basal keratinocytes
saw tooth rete pegs
34
strains of HPV related to tumours
HPV 16
HPV 18
35
mainstay tx for lichen planus and its side effect
topical steroids
betamethasone
beclamethasne
candidiasis
prednisolone
steroid dependancy
36
systemic immune modulators used in OLP
azathioprine
mycophenalone
hydrochloroquine
37
what medication are you required to sit up and drink a whole glass of water with
bisphosphonates
38
what questions would you ask re bisphosphonates
how long
any concurrent medications e.g. systemic glucocorticoid
oral/IV
is it for cancer
39
low risk MRONJ pt
how to manage xla
ensure education, prevention
no prophylaxis, atraumatic technique
review healing 8 weeks
pt to contact if unexpected pain, tingling, numbness, altered sensation, swelling
ensure valid consent
40
pt asks if she should stop bisphosphonates before xla
what should you say
discuss risk
no evidence MRONJ risk reduced if temporarily or permanently stop medication as can persist for 5 years
don't tell to stop
preventative measures
41
name 8 post-op complications
pain
swelling
bruising
bleeding
jaw stiffness
infection
dry socket
altered sensation
delayed healing
MRONJ
trismus
42
pt returned same day post xla with bleeding
how would you manage
reassure pt, sit upright
MH
assess source of bleeding, check no remaining fragments
apply pressure 20 mins w gauze
LA w adrenaline
suture
surgicel, collagen plug, haemostatic sponge if still bleeding
diathermy, thrombin liquid
POI
43
pt came back again few days post xla with bleeding
you manage the bleeding
what now
ask if poking/prodding
review MH
assess for bleeding disorder, liver cirrhosis
deep trauma
44
what is the importance of single-flow process in LDU
prevent cross-infection
45
3 PPE
gloves
marigold gloves
apron
mask
46
who is responsible for ensuring AWD is fit for use
user
47
who is responsible for quarterly testing
competent person
48
fill in the stages of reusable instrument cycle
cleaning - remove gross
disinfection - remove debris, thermal
packaging - package up
sterilisation - sterile at point of use if B
transport
storage
use
transport
49
explain components of LASHAL classification of CLP
left - right
lip, alveolus, soft palate, hard palate
looking straight up
50
CLP ages for tx stage
3-6 months; lip closure
6-12 months; palate closure
8-10 years; alveolar bone graft
12-15 years; ortho
18+; surgery
51
dental anomalies commonly seen in CLP
delayed eruption
hypodontia
supernumerary
ectopic canine
microdontia
high caries rate
52
pathogenesis of vertical root resorption
bacterial biofilm dysbiosis triggers immune response
pro inflammatory mediators simulate osteoclasts for resoprtion
anatomy of roots/furcation, thickness, alignment facilitate continued resorption vertically
infrabony defect
53
initial PMPR doesn't work for infrabony defect
what now
reinforce OH, motivation, risk factors
repeat PMPR
open flap debridement
guided tissue regeneration
enamel matrix derivative
54
intraoral signs of toothwear
attrition/erosion/abrasion
linea alba
tongue scalloping
wear facets
soft tissue trauma
worn rests
55
best management of discoloured 21 that has been RT
non-vital bleaching
56
technique for localised anterior toothwear
dahl technique
composite shelf added palatal UI,
posterior disclusion, extrude and anterior intrude
increase 2-3mm
57
8 clinical records taken to monitor and facilitate tx planning
study casts
diagnostic wax up
smith and knight
clinical photos
facebow
bewe
bpe
shade matches
radiographs
58
what 2 materials is the retainer of an adhesive bridge made from
NiCr or CoCr, Ti
zirconia
cemented w panavia as MDP for etching metal
59
reasons for adhesive bridge failure
unfavourable occlusion
poorly cemented
parafunction
trauma
poorly aligned teeth
60
how does panavia cement bond to enamel
micro mechanical and chemical via ca2+ in hydroxyapatite and 10MDP
metal = chemical via oxide layer
61
what materials could you take impression for indirect
polyether
polysulphide
62
what to discuss for valid consent
risks
benefits
alternatives
risk of nil
cost
procedure
complications
63
minimum length of GP left apically for post
4-5mm
64
function of core
replacing missing coronal toothbstructure
foundation for support and retain definitive restoration
65
dimension of core
4-5mm height
3-4mm width
66
what is the purpose of greenstick
extend coverage of special tray to allow extension into sulcus
accurate replication of tuberosity, post dam
palatal stop prevents excess flow
allows for functional depth and width of sulcus via border moulding to ensure good peripheral seal and retention
improves posterior palatal seal
67
what are you hoping to record in master imp
extension into sulcus for functional depth ad contour
replication
full extension of denture base
accurate mucosal detail in denture bearing area
post dam area for posterior seal
muscle movement and frenal attachment
- full extension denture base
- functional depth of sulcus
- mucosal condition
- muscle movement, frenal attachment
68
what should extension of special be, how short of sulcus
2mm
69
what lines are marked on jaw reg
centre line
smile line
canine line
70
what instrument for jaw reg
what anatomical plane
fox's bite plane
anterior = inter pupillary line
posterior = alatragus line
71
explain canal instrumentation, shaping and cleaning
1. Access cavity preparation
2. Establish Estimated Working Length (EWL)
○ Use pre-operative radiograph for initial estimate.
3. Initial exploration of canal
○ Use pre-curved K10 or K15 to explore the canal and confirm patency.
4. Determine Working Length (WL)
○ Once patency is confirmed to the estimated apex with a size 10 or 15, determine actual WL using:
§ Electronic apex locator
§ Confirm if needed with radiograph
○ ⚠️ This is where you go from EWL to WL.
5. Coronal/orifice enlargement
○ Use Gates Glidden or NiTi orifice shapers to enlarge upper third of canal for straighter access.
6. Shaping – Modified Double Flare technique
○ Balanced force or hybrid technique with:
§ Coronal flaring first (larger files, short of WL)
§ Then apical enlargement to WL (files 10, 15, 20, 25+ depending on canal)
§ Copious NaOCl irrigation throughout.
§ Recapitulate with K10 between files to maintain patency.
7. Irrigation sequence
○ Sodium hypochlorite (NaOCl) throughout
○ After shaping: rinse with EDTA (to remove smear layer)
○ Final rinse with NaOCl for disinfection.
8. Check patency
○ With a K10 beyond WL by 0.5 mm to ensure canal isn’t blocked.
9. Dry canal
○ Use paper points, ideally matching master apical file size.
72
faults during endo instrumentation
blockages = debris build up, insufficient irrigation
ledges = internal transportation, working short of length or as canal is straight
apical zipping/transportation = over-enlargement outer curvature and under of inner, don't rotate
perforation = incorrect WL, excessive pressure
instrument separation = cyclic fatigue
73
what is recapitulation
periodically re-introduce small hand file to working length
maintains patency
prevent blockage
74
features of tmd
pain worse in mornings
headaches
neck pain
limited mouth opening
jaw deviation
clicking
popping
crepitus
75
6 differential diagnoses for tmd
pericoronitis
chronic otitis media
sinusitis
myofascial pain
odontogenic
osteoarthritis
rheumatoid arthritis
trigmeinal neuralgia
76
tmd reversible tx
educate
don't incise, bilateral, no gum, avoid caffeine, yawning supported
CBT, hypnotherapy, physiotherapy
splint
acupuncture
botox
NSAIDs
77
clinical signs of mandibular fracture
step deformity
malocclusion
mobility of segment
unable to open or close
paraesthesia
swelling
malocclusion
bruising
78
imaging modalities for mandibular fracture
OPT
CT
CBCT
79
tx for displaced mandibular fracture
restore anatomical alignment for occlusion and function
stabilise for healing
80
what is a compound mandibular fracture
how does it affect management
open fracture, communicating with external environment
increased risk of infection
urgent tx
81
adv of surgical exposure and fixation plates
mandibular fracture
[ORIF]
direct visualisation
accurate reduction
stable fixation
decreases risk of malunion
rigid fixation
doesn't need prolonged wiring shut
82
how does resin infiltration work
infiltration of enamel with low viscosity light cured resin
surface layer eroded, lesions desiccated, alcohol pulls out water for penetration of lesion by resin then loses discolouration
well demarcated lesions reduce
83
alternatives to resin infiltration
enamel microabrasion
vital bleaching
84
adv of resin infiltration
conservative, minimally invasive, quick, aesthetic improvement
85
disadv resin infiltration
non-cavitated, only white spot lesions, technique sensitive, cost
86
what is PHG and how does it spread
primary herpetic gingivostomatitis
manifestation of herpes simplex virus 1
spread via direct contact
children
fever, malaise, vesicles rupture to ulcers and inflamed gingiva
87
advice and tx for PHG
reassure, educate
supportive, analgesia, chx, monitor, difflam, hydrations oft diet
88
advantages of SDA in elderly people
aesthetics
psychological benefits
function
speech
reduced cost
avoids dentures
e`sier maintenance
preserve remaining teeth
89
what is success rate of implants in 10 years
90-95%
90
4 clinical signs of peri-implantitis
increased pocket depths
bleeding on probing
suppuration
gingival recession
inflammation
erythema
bone loss beyond crystal bone level changes from initial bone remodelling
91
material risks to discuss pre implant
cost
aesthetic outcome
failure
complications
damage to adjacent structures
infection risk
pain
92
difference in peri-implantitis and implant mucositis
peri-implantitis involves progressive loss of supporting bone
93
what does bodily movement mean and how does it compare to URA
movement of crown + root as a unit
URA can only achieve tipping
94
3 elements in bracket prescription for fixed appliance
in / out
torque
tip
95
if elastics in fixed was
lower 3 - upper 6
what malocclusion
class 3 intraoral elastics
96
what material of wire is used in fixed appliances
what properties allow its function
NiTi
shape memory, superplasticity, low stiffness
97
what is GDP role in maintaining fixed appliance
OH monitoring, diet advice
prevention
check up
check integirty
manage emergencies
motivation
soft tissue lesions
98
what is the difference in recurrent oral ulceration and RAS
ROU - any cause, underlying, varied appearance, behcet, crohns
RAS - idiopathic, triggers, grey w erythematous halo
99
triggers of RAS
immunosuppression
trauma
haematinic deficiency
stress
hormones
infections
100
what info to confirm minor aphthous ulcers
where are the ulcers
= non-keratinised
how big
= <1cm
scar
= no
how long healing
= 7-10 days
101
clinical features of minor RAS
no scarring
<1cm
non-keratinised tissue
heals 7-10 days
grey/yellow void base erythematous halo
102
clinical features of behcet's
oral ulceration
genital ulcers
skin lesions
ocular lesions
uveitis
103
allele associated with behcet's
HLA B51
104
non steroidal tx for ulcers
chx
benztdamine spray/mw
105
intra-oral features of OFG
buccal cobblestoning
submandibular stag horning
mucosal tags
ulcers
gingival ulceration
lip swelling
lip fissures
peri-oral dermatitis
angular cheilitis
106
3 granulomatous disease of H+N
OFG
TB
sarcoidosis
syphilis
granulomatous polyangiitis
behcet
churg-strauss
107
why lip oedema in OFG
chronic inflammation
vascular permeability
fluid leakage into tissues causing persistent oedema
lymphatic obstruction or impairment
108
why faecal calprotectin for child with OFG
non-invasive marker of GI inflammation
crohns screening
differentiate
109
why growth of child needs monitored in OFG
poor growth is crohns indicator
chronic inflammation can lead to nutritional deficiencies
may impact growth hormones, puberty
110
3 socio-economic determinants of cancer and which is worst determinant
income = low
education = low
occupation = low
111
modifiable risk factors of oral cancer
smoking
alcohol consumption
betel/pan use
poor diet
obesity
112
name 2 interventions of upstream, midstream and downstream prevention of oral cancer
upstream = society
- smoking cessation adverts
- public health campaigns
midstream =
- screening in high risk
- health eduction
downstream =
- education
- regular check ups
113
what is inverse care law
how should it work in setting up oral cancer tx services
most in need of care is where there is the least or poorest quzlity
equitable access, high risk populations gain screenings access, education
114
