3rd year Flashcards
(150 cards)
1
Q
Clinical presentation of reversible pulpitis
A
Hot/cold stimuli
Seconds duration
2
Q
Clinical presentation of irreversible pulpitis
A
Spontaneous hot/cold stimuli
Hours/constant duration
Night waking
3
Q
Clinical presentation of infective periapical periodontitis
A
Localised
Biting/pressure stimuli
Hours/constant duration
Night waking
4
Q
Clinical presentation of traumatic periapical periodontitis
A
Localised
Biting/pressure stimuli
Hours/constant duration
5
Q
Clinical presentation of TMJ
A
TMJ dysfunction causing pain in the joint/surrounding muscles, clicking in the jaw joint, limited mouth opening or locking
6
Q
Clinical presentation of trigeminal neuralgia
A
Severe pain, lasting seconds, spontaneous or triggered by touch, eating, talking
7
Q
Clinical presentation of burning mouth syndrome
A
Burning sensation experienced in the absence of identifiable organic cause
8
Q
4 clinical presentations of impacted 3rd molars
A
Pain
Swelling
Bad taste
Number of episodes
9
Q
2 types of 3rd molar impaction
A
Soft tissue
Boney: mesioangular, distoangular, vertical, horizontal
10
Q
What is the white Winters line
A
Drawn along the occlusal surfaces of the erupted mandibular molars to show the difference in occlusal level of the 1st and 2nd molar and the 3rd molar
11
Q
What is the amber Winters line
A
Drawn from the surface of the bone on the distal aspect of the 3rd molar to the crest of the inter-dental septum between 1st and 2nd molars to show the margin of alveolar bone covering the 3rd molar and how much bone will need to be removed
12
Q
What is the red Winters line
A
Drawn perpendicular from the amber line to point of application - usually cemento-enamel junction on mesial aspect of the tooth
13
Q
4 signs that the inferior dental nerve is close to the tooth
A
Deviation of nerve
Narrowing of nerve
Loss of tram lines
Change in radiodensity of tooth
14
Q
6 treatment options for impacted 3rd molars
A
Surgical removal
Coronectomy
Opercolectomy
Remove opposing tooth
Surgical exposure
Monitor
15
Q
9 indications for removal of 3rd molars NICE guidelines
A
Pericoronitis: 2 or more episodes
Unrestorable caries
Non-treatable pulpal disease
Resorption of tooth or adjacent tooth
Periodontal disease
Fracture of tooth
Disease of follicle- cyst /tumour
Tooth impeding surgery
Tooth involved in field of tumour resection
16
Q
4 indications not to remove impacted 3rd molars
A
No/ minimal symptoms
Because the contralateral tooth is being removed
Because the patient requests it
Close proximity to ID nerve
17
Q
4 features of informed consent
A
Written consent
What is involved
Risks of surgery: post op pain, bruising, time off work, risk of infection, damage to adjacent teeth, damage to ID and lingual nerves
Risks of leaving tooth in situ
18
Q
STALL mnemonic
A
Swelling
Trismus
Anaesthesia
Labial
Lingual
19
Q
3 treatment options for impacted maxillary canines
A
Leave and monitor
Exposure: open or closed with bracket and chain
Surgical removal
20
Q
Describe impacted tooth positions identified by parallax
A
Moves with beam: canine palatally ectopic
Moves opposite to beam: canine labially ectopic
Doesn’t move: in line of the arch
21
Q
4 common impacted teeth
A
3rd molars
Canines
Mesiodens
Supernumeraries
22
Q
Define ameloblastoma
A
Commonest odontogenic tumour
Benign, locally invasive
23
Q
Clinical features of ameloblastoma
A
Incidental finding or presents as swelling, pain, UE teeth
24
Q
Treatment, prognosis and follow up of ameloblastoma
A
Requires resection at least 10-15mm beyond radiological margins
Recurrence inevitable if removal incomplete
Annual follow-up for 5 years then every 3 years thereafter
25
Define odontome
Hamartomatous malformation composed of dentine, enamel, pulp and cementum
Commonest odontogenic tumour-like lesion
26
Clinical features of odontome
Incidental finding or swelling, UE teeth
27
Treatment and prognosis of odontome
Enucleation
No recurrence
28
Define dilacerated incisor
Trauma displaces the crown of the developing tooth, root development continues but at an angle
29
Define turner teeth
Disorders ranging from yellow brown pigmentation of enamel to extensive pitting and irregularity of crown in permenant teeth
Due to local trauma or infection
30
Define regional odontodysplasia
Ghost like appearance of teeth
Due to a developmental disorder
31
Define enamel opacities
White, cream, yellow or brown patches on enamel of random distribution
Caused by local factors
32
Define tetracycline staining
Grey coloured teeth due tetracycline being ingested and incorporated into teeth and bone mineralising at the time
33
Define systemic disease or malnutrition teeth disorders
Horizontal band of pitting
Due to systemic disease or malnutrition affecting developing teeth
34
Define fluorosis
Hypomineralised or hypoplastic enamel due to ingestion of Fl- during tooth formation
35
Define connation
Union of two teeth during development involving enamel, dentine and pulp
36
Define concrescence
Union of teeth at the roots by disposition of cementum - always affects the roots
37
Define dens-in-dente
Deeply-penetrating pit extending into the tooth from the crown
Due to local disturbance of tooth development
38
Treatment of dens-in-dente
Endodontic/restorative or extraction as required
39
Define amelogenesis imperfecta
Inherited congenital defects of enamel formation
40
Clinical features of hypoplastic amelogenesis imperfecta
Thin enamel, surface discoloured and rough but of normal hardness
41
Clinical features of hypomature amelogenesis imperfecta
Abnormal thickness, opaque or discoloured and slightly softer than normal
42
Clinical features of hypocalcified amelogenesis imperfecta
Abnormal thickness of enamel, normal colour but very soft
43
Treatment of amelogenesis imperfecta
Complex restorative procedures required
44
Define dentinogenesis imperfecta
Inherited congenital defects in dentine formation, which may or may not be associated with osteogenesis imperfecta
45
Treatment of dentinogenesis imperfecta
Complex restorative procedures required
46
4 reasons to suspect Gardeners syndrome
Multiple odontomes
Supernumerary teeth
Shortened/deformed roots
“Osteomas” or other stigmata
47
Common additional teeth
Mandibular and maxillary 3rd molars
48
Common teeth with connation
Incisors and deciduous canines
49
Common teeth with concrescence
Molars
50
Common teeth with dens-in-dente
Maxillary lateral incisors
51
Define cleidocranial dysplasia
Genetic condition that affects teeth and bones
52
6 clinical features of cleidocranial dysplasia
Short stature
Prominence of frontal, parietal and occipital bones “bossing”
Absent or hypoplastic clavicles
High-arched palate
Delayed shedding of deciduous teeth
Multiple unerupted teeth in both jaws
53
Define hypohidrotic ectodermal dysplasia
Genetic condition characterised by a developmental failure of ectodermal structures, particularly skin, hair, sweat glands and teeth
54
Clinical features of hypohidrotic ectodermal dysplasia
Underdeveloped facial and jaw bones
Few teeth, cone-shaped
55
Define Down’s syndrome
Congenital condition characterised by intellectual, physical disability and trisomy of chromosome 21
56
6 clinical features of Down’s syndrome
Hypodontia of deciduous and permanent dentitions
Larger deciduous teeth
Small permanent teeth
Conical, shovel-shaped, talon-cusped incisors
Taurodont molars
Active periodontal disease
57
Define dentoalveolar abscess
Acute lesion characterised by a localised collection of pus in the structures that surround the teeth
58
4 conditions that may lead to an abscess
Periapical periodontitis
Periodontal disease
Acute pericoronitis
Infection of a cyst
59
Clinical presentation of abscess following periapical periodontitis
Severe pain
Poorly localised
TTP
Non responsive to vitality test
History of caries/ trauma
Soft fluctuant swelling
60
Clinical presentation of abscess following periodontal disease
Mobile tooth
TTP
Positive vitality testing
Swelling often nearer gingival margin
Pus may extrude from gingival margin on probing
61
Radiographical features of an abscess
Loss of periapical lamina dura
Periapical radiolucency
Well defined (infection causes loss of definition of margin)
62
Management of an abscess
Establish drainage of pus: via root canal – RCT, extraction, incision
Antibiotics not indicated if no evidence of spreading infection
63
Clinical presentation of spreading infection
Local spread of infection: trismus, cervical lymphadenopathy
Systemic toxicity: pyrexia, tachycardia
64
Define cellulitis
Rapidly spreading infection of connective tissue
65
Define Ludwig’s angina
Spreading cellulitis involving submandibular, sublingual and submental spaces bilaterally
66
Define cavernous sinus thrombosis
Blood clot within the cavernous sinus which can arise from maxillary dentoalveolar infection
67
Define dental cyst
Inflammatory cyst, causing gradual progressive swelling associated with non vital tooth
Most common jaw cyst
68
Dental cyst contents
Fluid, pus if infected
High level of soluble protein
Cholesterol crystals
69
Define apical granuloma
Mass of fibrous/granulation tissue related to apex of non vital tooth
70
Define residual dental cyst
Dental cyst which failed to resolve after extraction
71
Define paradental cyst
Inflammatory odontogenic cyst that develops in relation to crown or root of a partially erupted tooth
72
Define dentigerous cyst
A developmental, epithelial lined cyst which surrounds the crown of an unerupted tooth and is attached to the amelocemental junction
73
What 3 teeth are dentigerous cysts most often associated with
3rd molars
Canines
Premolars
74
Dentigerous cyst contents
Fluid, pus if infected
High levels of soluble protein >5mg/100ml
75
Define keratocyst
Developmental odontogenic cyst with a characteristic epithelial lining and a high tendency to recur
76
Follow up for keratocyst
Long term clinical and radiographical follow up mandatory
Annually for first 5 years, 3 years thereafter
Recurrence usually presents within first 5 years
77
Define nasopalatine cyst
Developmental non-odontogenic cyst of the incisive canal in the palate believed to arise from remnants of the nasopalatine duct
78
Define dermoid cyst
Rare developmental non-odontogenic cyst, involving soft tissues only
79
Define nasolabial cyst
Developmental non-odontogenic cyst of the soft tissues of the face found within the nasolabial fold
80
Management of cysts
Enucleation
Marsupialisation
Resection
81
What is enucleation
Complete removal of cyst lining by primary closure or secondary intention
82
What is marsupialisation
Partial removal of cyst lining
83
What is resection
Removal of the whole sac
84
Define acute alveolar osteitis/dry socket
Post-extraction condition characterised by loss of the clot from the socket
85
Treatment of dry socket
Wash out socket with warm saline
Place protective obtundent dressing into socket: Alvogyl - Antiseptic and analgesic paste easily adheres to the alveolus containing
Prescribe NSAID for pain
Review patient
86
Define osteomyelitis
Infection of the bone and bone marrow spaces
87
Define suppurative osteomyelitis
Infection of the bone and bone marrow spaces resulting in bone necrosis and the production of pus
88
Treatment of suppurative osteomyelitis
Surgical debridement
Antibiotics
Ultrasound therapy
89
Define chronis sclerosing osteomyelitis
An infection of the bone characterised by bone sclerosis, without the formation of pus
90
Treatment of chronis sclerosing osteomyelitis
Requires endodontics or extraction of tooth
Might require debridement or antibiotics
91
Define osteogenesis imperfecta
Group of genetically-determined disorders of bone characterised by excessive fragility and a tendency to fracture
92
Treatment of osteogenesis imperfecta
Diet rich in calcium and vitamin D
Physiotherapy
Physical aids
Bisphosphonates
Surgery
93
Define giant cell granuloma
Benign tumour like lesion of jaw bones characterised by numerous osteoclast like giant cells
94
Treatment of giant cell granuloma
Curettage
Extraction of loosened teeth
95
Define torus
Boney hard swelling, occurring either in palate or mandible which may be lobulated
96
Define fibrous dysplasia
A benign developmental condition characterised by the presence of fibrous connective tissue with irregular trabeculae of bone
97
Treatment of fibrous dysplasia
None usually
Surgery may be required
Bisphosphonates
98
Define Paget’s disease (osteitis deformans)
A progressive disorder representing a disturbance of the “coupling” of synthesis and resorption of bone
99
Treatment of Paget's disease
Calcitonin
Bisphosphonates
100
Define at risk stage of osteochemonecrosis
No apparent necrotic bone in patients who have been treated with either oral or IV bisphosphonates
101
Define stage 0 of osteochemonecrosis
No clinical evidence of necrotic bone, but non-specific clinical findings, radiographic changes and symptoms
102
Define stage 1 of osteochemonecrosis
Exposed and necrotic bone, or fistulae that probes to bone, in patients who are asymptomatic and have no evidence of infection
103
Define stage 2 of osteochemonecrosis
Exposed and necrotic bone, or fistulae that probes to bone, associated with infection as evidenced by pain and erythema in the region of the exposed bone with or without purulent drainage
104
Define stage 3 of osteochemonecrosis
Exposed and necrotic bone or a fistula that probes to bone in patients with pain, infection, and one of the following: exposed and necrotic bone extending beyond the region of alveolar bone, resulting in pathologic fracture, extra-oral fistula, oral antral/oral nasal communication, or osteolysis extending to the inferior border of the mandible of sinus floor
105
Define osteochemonecrosis
Medical related osteonecrosis of the jaws following treatment with Bisphosphonates, Denosumab, Anti-angiogenic medications
106
Define osteoradionecrosis
Exposed irradiated bone that fails to heal over a period of 3 months, excluding areas of residual or recurrent tumour
107
Define Notani classification I of osteoradionecrosis
Confined to dentoalveolar bone
108
Define Notani classification II of osteoradionecrosis
Limited to dentoalveolar bone or mandible above the inferior dental canal, or both
109
Define Notani classification III of osteoradionecrosis
Involving the mandible below the inferior dental canal, or pathological fracture, or skin fistula
110
4 management strategies for osteoradionecrosis
Triple therapy
Local debridement
Ultrasound therapy
Hyperbaric oxygen therapy
111
Outline triple therapy for osteoradionecrosis
Chlorhexidine mouthwash 10ml bi-daily
Doxycycline 100mg once daily
Pentoxifylline 400mg bi-daily
Tocopherol (Vitamin E) 1000IU (caps) or 1000mg (suspension)
112
3 ways to prevent osteoradionecrosis
Extract teeth with poor long term prognosis prior to radiotherapy (at least 2 weeks)
Ensure dentures fit well/leave dentures out
Avoid need for further extractions
113
6 intra-operative complications of exodontia
Root fracture
Fracture of alveolar bone
Fractured tuberosity
Oro-antral communication
Root displaced into antrum
Damage to dento-alveolar nerve
114
2 post-operative complications of exodontia
Haemorrhage
Dry socket
115
Radiographic features of ameloblastoma
Usually large
Radiolucent and often multilocular
Expands bone, displaces and reabsorbs teeth, destroys lower border of the mandible
116
Radiographic features of odontome
Speckled or dense radiopacity with radiolucent areas
Circumscribed mass, well defined periphery
May displace adjacent teeth
117
Define hypodontia
1-6 teeth missing (excluding 3rd molars)
118
Define oligodontia
7 or more teeth missing (excluding 8’s)
119
Name an malignant tumour with an odontogenic epithelium without odontogenic ectomesenchyme
Ameloblastoma
120
Name an malignant tumour with an odontogenic epithelium with odontogenic ectomesenchyme
Odontome
121
4 common absent teeth and their prevalence
3rd molars (20-30% of population)
Upper lateral incisors (2%)
Lower second premolars (2%)
Lower central incisor (0.2%)
122
Prevalence of absent deciduous teeth
Less than 1%
123
Prevalence of additional permanent teeth
1-3%
124
Prevalence of dens-in-dente
1-5%
125
How does ameloblastoma grow
By epithelial proliferation extending between trabeculae of bone
126
How do dental cysts grow
By fluid accumulation
127
How do dentigerous cysts grow
By luminal fluid accumulation
128
What syndrome can be associated with keratocysts
Gorlin syndrome
129
How do keratocysts grow
By epithelial proliferation, hydrostatic forces
130
Prevalence of dry socket after extractions
3 – 4 % of extractions
20% of wisdom teeth
131
What syndrome is fibrous dysplasia associated with
Albright’s syndrome
132
Describe patients at low risk of osteochemonecrosis
Patients being treated for osteoporosis or other non-malignant diseases of bone with oral/IV Bisphosphonates or Denosumab for less than 5 years who are not concurrently being treated with systemic corticosteroids or other immune-suppressants
133
Describe patients at high risk of osteochemonecrosis
Patients being treated for osteoporosis or other non-malignant diseases of bone with oral Bisphosphonates or yearly infusions of intravenous bisphosphonates for more than 5 years
Patients being treated for osteoporosis or other non-malignant diseases of bone with Bisphosphonates or Denosumab for any length of time who are being concurrently treated with systemic corticosteroids or other immuno-suppressants
Patients taking an anti-resorptive or anti-angiogenic drug (or both) as part of the management of cancer
Patients with a previous diagnosis of medically related osteonecrosis of the jaw
134
Prevalence of osteoradionecrosis in irradiated patients
7%
135
Immediate treatment of periocoronitis
Irrigation below operculum and oral hygiene instruction
136
Define pericoronitis
Inflammation of the gum tissue around wisdom teeth
137
When should you suspect osteochemonecrosis
Current or previous treatment with anti-resorptive drugs
Exposed bone that persists for > 8 weeks
138
What syndrome is associated with odontomes
Gardeners
139
Define supplemental teeth
Additional teeth that closely resembles a tooth of normal series
140
Define supernumerary teeth
Additional teeth that do not closely resemble a tooth of normal series
141
4 reasons keratocysts have a high tendency to recur
Lining thin and friable
Extension into cancellous bone – difficult to remove all lining
Satellite cysts
Vigorous proliferative activity of epithelial lining
142
Treatment of a patient in the at risk category of osteochemonecrosis
No treatment indicated
Patient education
143
Treatment of a patient in the stage 0 category of osteochemonecrosis
Pain medication
144
Treatment of a patient in stage 1 category of osteochemonecrosis
Antibacterial mouth rinse
Clinical follow-up on a quarterly basis
Review of indications for continued bisphosphonate therapy
145
Treatment of a patient in stage 2 category of osteochemonecrosis
Pain control
Antibacterial mouth rinse
Oral antibiotics
Debridement
146
Treatment of a patient in stage 3 category of osteochemonecrosis
Pain control
Antibacterial mouth rinse
Oral antibiotics
Debridement/resection
147
3 things assessed prior to exodontia both clinically and radiographically
Crown integrity
Root size and morphology
Condition of the surrounding bone
148
Name a haemorrhage that occurs during surgery
Primary
149
Name a haemorrhage that occurs within 24 hours due to a failure to follow post-op instructions
Reactionary
150
Name a haemorrhage that occurs days after extraction due to infection
Secondary
