56. Oral medicine

Question 1

How many decidious/primary teeth vs permanent

Answer 1

20
32

Question 2

Portion of the tooth visible in the mouth. above gingivial margin = ____

Answer 2

crown

Question 3

Portion of the tooth visible in the mouth below gingivial margin = ____

Answer 3

root

Question 4

3 layers of crown outside to inside

Answer 4

enamel
dentin
pulp

Question 5

Outermost layer of tooth is enamel, what part of the root attaches peridontal ligmaent to adjacent alveolar bone?

Answer 5

cementum

Question 6

What color is dentin?

Answer 6

yellow

Question 7

What is the role of dentin?

Answer 7

support enamel
cushion in mastication

Question 8

What color and role is pulp?

Answer 8

red
neurovascular supply

Question 9

When should all primary teeth be present?

Answer 9

3y

Question 10

When does the first tooth show up?

Answer 10

6mo ish

Question 11

When do permanent teeth start showing up? First molar?

Answer 11

6y
13y

Question 12

32 permanent teeth with 8 teeth per quadrant, please name midline to outward, names of teeth in each quadrant

Answer 12

1. central incisor
   lateral incisor
   canine
   premolar
   premolar (above are also known as bicuspids)
   three molar/tricuspids

Question 13

How are teeth numbered?

Answer 13

1 to 32, starting with the upper right third molar (1) and moving to the upper left third molar (16), to the lower left third molar (17), and to the lower right third molar (32). The starting point for this numbering system can be recalled by the mnemonic “upright.”

Question 14

Tooth surfaces: apical vs coronal

Answer 14

apical is in the direction of the root, whereas coronal is toward the crown of the tooth.

Question 15

What is a cavity?

Answer 15

break- down of the teeth secondary to bacteria, demineralizing the enamel

Question 16

Tooth surfaces: facial vs oral vs mesial vs distal

Answer 16

The facial (also referred to as labial or buccal) surface faces outside the oral cavity; the oral (also referred to as palatal for upper teeth, or lingual for lower teeth) surface faces the tongue; the mesial surface is toward the midline; and the distal surface is toward the ramus of the mandible

Question 17

What is pulpitis?

Answer 17

initial tooth decay transmission from enamel to pulp, pulp reacts with inflammatory state *this. can be reversed - if not –> degeneration, necrosis ie irreversible pulpitis

Question 18

MC sign pulpititis

Answer 18

throbbing pain

Question 19

DDX of tooth pain

Answer 19

caries
maxillary sinusitis
dysbarism
inflammation
trigeminal neuralgia
Atypical odontalgia is a centralized trigeminal neuropathy localized in a tooth or teeth.
GCA

Question 20

How to provide a block for dental caries?

Answer 20

Dry with gauze
apply topcial anesthetic to gingiva (20% benzocaine or 5% lidocaine) - wait 5 mins
inject 1-2ml of 2% liodcaine through mucobuccal fold of affected tooth (bevel faces tooth)

vs inferior alveolar nerve block for mult teeth

Question 21

What is the peridontium composed of?

Answer 21

peridontal ligament
alveolar bone
cementum
gingiva/gums

Question 22

Peridontitis defn

Answer 22

Peri - nflammation of the supporting structures of the teeth (gingiva, alveolar bone, cementum, and periodontal ligament)

Question 23

What two bugs are common in necrotizing peridontal diseases?

Answer 23

fusobacterium
spirochetes

Question 24

If peridontitis spreads to the tonsils and pharynx, what is this called?

Answer 24

vincent angina

Question 25

What is pericoronitis?

Answer 25

gingiva and surrounding tissue become inflamed; during eruption of teeth, debris and bacteria get trapped between teeth and surrounding soft tissue

Question 26

What is gingivial hyperplasia?

Answer 26

overgrowth of gum tissue surrounding teeth secondary to poor oral hygeine, dental plaque build up or adverse reaction to meds

Question 27

MC meds implicated in gingival hyperplasia

Answer 27

ccb - nifedipine and diltiazem mc rare in amlo, felodipine, verapamil <5% immunosuppressants - cyclosporine 25-30$ in adults vs child 70% anticonvulsants (phenytoin mc), vpa rare

Question 28

What is the triad for necrotizing peridontal diseases?

Answer 28

papillary necrosis gingival bleeding pain

Question 29

DDX mucosa ulcerations

Answer 29

necrotizing stomatitis apthous ulcers (2-3cm, superficial, tender mucosal lesions whitish center without surrounding inflamm) *Behcet, hiv leukemia related

Question 30

Tx for apthous ulcers

Answer 30

hydrogen peroxidie rinses, topical anesthetic

Question 31

If patient has adequate oral hygiene and is not on meds associated with gingival hyperplasia, yet they present with this, what disease do you need to consider?

Answer 31

leukemia/infiltrative process

Question 32

Tx for ginvitis/peridontitis

Answer 32

gingivitis = ffloss and brush, chlohex or 3% hydrogen peroxide rinse in severe case nec peridontal disease --> see dentist sign disease = antimicrobials smoking cessation nsaid or acetaminophen severe pain = opioid

Question 33

Pericoronitis tx

Answer 33

rinses severe/systemic sx = penicillin 500mg po q8h 5-7d or clinda 150-300 q6h

Question 34

MC dental procedures: filling

Answer 34

cover caries, protect tooth from further decay

Question 35

What is a crown

Answer 35

cover the portion of the tooth exposed above the gingiva and require an intact root for attachment.

Question 36

What is a root canal?

Answer 36

opening the pulp chamber, removing pulp tissue and root, sterilizing the canal, and sealing it to pre- vent ingress of saliva and contamination.

Question 37

What is alveolar osteitis?

Answer 37

After an extraction, the patient will have an adherent clot in the fossa where the root of the tooth previously was. If this clot becomes dislodged (typically 3 to 4 days post-extraction) a condition called alve- olar osteitis (“dry socket”) can occur The pain is secondary to localized inflammation of the exposed surrounding alveolar bone.

Question 38

Management of alveolar osteitis

Answer 38

exposed bone = ca hydroxide cement to cover exposed surface nsaid next day to see oral surgeon, if f/u delayed: don't touch clot or further part of tooth; Medicated iodoform gauze with eugenol (an anesthetic) can be placed in the cavity and changed by the patient’s surgeon within 24 to 48 hours with repeat irrigation

Question 39

Two primary spaces that can be involvedd in maxillary deep neck infections

Answer 39

canine buccal spaces

Question 40

How does infection of the root of the maxillary canine present?

Answer 40

flattening of ipsi nasolabial fold

Question 41

Major complication from infection of the root of the maxillary canine

Answer 41

cavernous sinus thrombus

Question 42

3 spaces of the mandible

Answer 42

submental sublingual subamndibular

Question 43

An infection of all 3 spaces of mandible is known as ?

Answer 43

ludwig angina

Question 44

What is a complication of retrophagyneal abscess?

Answer 44

septic thrombophelbitis

Question 45

What is Lemierre syndrome?

Answer 45

septic thrombophelbitis of the IJV secondary to fusobacterium necrophorum

Question 46

Name two atypical facial cellulitis organisms

Answer 46

Actino- myces can cause cervicofacial actinomycosis with draining sinus tracts, tuberculosis can cause cervical lymphadenopathy (scrofula) with sec- ondary infection, and Bartonella henselae (the causative organism for cat scratch disease) can cause cervical lymphadenitis.

Question 47

RF for facial cellulitis and deep neck infection

Answer 47

poor dentition hx recent dental work or trauma recent upper airway manipulation or surgery IVDU AOM sinusitis immunocomp: hiv, cirr, idabetes, chemo, steroids

Question 48

Deep neck infection recommended abx

Answer 48

amp sulbactam and vanco if allergy to pen - clinda monotherapy in ummoncompotent host

Question 49

Who should be admitted with odontogenic infections

Answer 49

severe odontogenic infections, deep neck infections, systemic toxicity, or immunocompromised patients

Question 50

Dentoalveolar trauma - mc?

Answer 50

maxillary central incissor

Question 51

What are the different types of dentoalveolar trauma

Answer 51

concussed sublux luxated avulsed infraction (incompl fracture enamel) fractured

Question 52

ELLis system - what is this clasifcation for?

Answer 52

fractures of teeth

Question 53

Ellis I - what is this?

Answer 53

complete enamel fracture, still white

Question 54

Ellis II fracture

Answer 54

enamel-dentin fracture - yellow tint

Question 55

Ellis III fracture

Answer 55

enamel-dentin-pulp fracture pinkish tinge/small visible blood

Question 56

Luxation 4 types

Answer 56

(1) extrusive luxation is where the tooth is forced partially out of the socket in an axial direction, (2) intrusive luxation occurs when a tooth moves apically (and can be mistaken for an avulsion if completely intrusively luxated), (3) laterally luxated, where the tooth is displaced laterally with potential surrounding alveolar bone injury, and (4) avulsion where the tooth is completely out of the socket

Question 57

Management of dentoalveolar trauma: basics

Answer 57

- analgesia - tetanus - liquid diet few days and soft diet 1 week - can split or ca OH paste

Question 58

Please list 3 medications and doses for deep space infections

Answer 58

Ampicillin/sulbactam plus vancomycin 3 g IV every 6 h 15–20 mg/kg q8–12 hours (2 g maximum) Clindamycin 600 mg IV every 8 h If allergic to penicillin Meropenem plus vancomycin 1gIVevery8h 20 mg/kg (2 g maximum) If immunocompro- mised

Question 59

Management of Ellis I

Answer 59

none really

Question 60

Management of Ellis II and III fractures

Answer 60

Ca OH paste f/u dentist 24h

Question 61

How to cover an Ellis II/III paste - describe process

Answer 61

1. dry it - gauze mucobuccal fold and nasal cannula with air/o2 directed at anesthetized tooth 2. mix catalyst and base of ca OH --> directly apply to exposed tooth surface 3.

Question 62

When is it appropriate to reimplant an avulsed permanent tooth?

Answer 62

up to 60min (dry over this = peridontal lig cells die)

Question 63

If preserving a tooth, how is this done?

Answer 63

Hank’s balanced salt solution (e.g., Save-A-Tooth, EMT Toothsaver) or milk. Saliva should only be used if no other stor- age media are available

Question 64

Where to handle an avulsed tooth so that you avoid injury

Answer 64

only crown

Question 65

How to reimplant a permanent tooth

Answer 65

- analgesia - rinse with saline for debris off if any visible debris - irrigate socket with same - reimplant tooth into socket - consult a dentist or if not available, use coe-pak to splint tooth to adj teeth 24-48h - resin and catalyst paste, approximate the tooth - Advise the patient to have a soft diet (but avoid hot liquids that may soften the packing) and follow up with a dentist within 24 hours. Prescribe doxycycline 100 mg bid for 7 days for adults and penicillin 50 mg/kg/day divided qid (maximum 500 mg qid) for 7 days in children.

Question 66

How long can an avulsed tooth last in milk?

Answer 66

3-8h

Question 67

How long can an avulsed tooth last in Hank's Balanced solution or an oral rehydration solution

Answer 67

12-24h

Question 68

When do lacs to the buccal mucosa NOT need repair?

Answer 68

under 1cm

Question 69

Cause of TMJ disorder

Answer 69

jaw clenching and grinding associated with stress is thought to contribute. Tooth malocclusion was previously thought to be a common etiology, but this is rare unless there is an inciting event (e.g., if symptoms began after dental work with resultant malocclusion).

Question 70

How does TMJ dislocation occur?

Answer 70

condyle travels anteriorly along the eminence and becomes locked in the anterosuperior aspect of the eminence. The masseter, internal pterygoid, and temporalis go into spasm attempting to close the mandible; trismus results and the condyle cannot return to the temporal fossa.

Question 71

What is TMJ disorder definition?

Answer 71

ching in the muscles of mastication, sometimes with occasional brief severe pain on chewing, often associated with restricted jaw movement and clicking or popping sounds.” Patients may also report headache, facial pain, or even an earache.

Question 72

TMJ disorder 3 physical signs

Answer 72

joint sounds, such as crepitus or a joint click upon range of motion; limitations of joint movements with pain during assisted maximum mouth opening; and muscle and joint pain and pain just anterior to the auricular canal.

Question 73

How to reduce TMJ dislocation

Answer 73

For reduction of dislocation, the thumbs are placed intraorally and lateral to the lower molars, and pressure is applied to the lower molar ridge area near the jaw angle in a downward and backward direction. (E) When the mandibular condyle has cleared the articular eminence, muscle contraction returns the jaw to a normal closed position.

Question 74

TMJ Disorder management

Answer 74

NSAIDs, application of heat or cooling, and consideration of bite guards, if the patient has bruxism, are all reasonable first-line therapies. Heat therapy is typically 15 min- utes at a time, four to six times daily

Question 75

Syringe approach for TMJ relocation?

Answer 75

A hands-free approach for reduction of acute nontraumatic TMJ dislocation using a “syringe” technique has also been described. With this technique, a 5- or 10-mL syringe is placed between the posterior upper and lower molars (or gums if edentulous) on the affected side. The patient then gently bites down and rolls the syringe back and forth; the syringe is a rolling fulcrum that helps the anteriorly-displaced con- dyle slip back into its normal position.