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Dentistry Year 1 > Caroline Chang > Flashcards

Caroline Chang Flashcards

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1
Q

What is cardiac output

A

Rate of blood flow from the heart: blood volume pumped from one ventricle in one minute

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2
Q

What is peripheral vascular resistance and what causes it

A

Resistance to flow produced mainly by arterioles

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3
Q

How do you calculate blood pressure

A

Cardiac output X Peripheral vascular Resistance

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4
Q

What are the 4 main controls of arterial blood pressure

A

Autonomic nervous system
Capillary shift
Endocrine and neuroendocrine responses
Kidney fluid balance

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5
Q

What term control over blood pressure does the autonomic nervous system have

A

Short term minute to minute control via negative feedback

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6
Q

What is the flow of input of control of blood pressure by autonomic nervous system

A

Higher centres in brain send signals to….

Medulla which integrates these with info from mechano and baroreceptors and sends signals to….

Parasympathetic branch of vagus nerve
Or sympathetic efferent branches from spinal chord

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7
Q

Where are mechanoreceptors and baroreceptors found

4

A

Carotid sinus
Aortic arch
Heart
Lungs

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8
Q

What is capillary shift

What term of control does it have over BP

A

Pressure gradient along capillaries

Medium term minutes to hours

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9
Q

What is the mechanism for capillary shift controlling blood pressure

A

When pressure falls too low fluid is absorbed from tissues into circulation to increase blood volume thus pressure

When pressure rises too high fluid lost from circulation to reduce blood volume thus pressure

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10
Q

What does endocrine relate to

A

Hormones released via glands in one part of body travelling in blood to target organs

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11
Q

What does neuroendocrine relate to

A

Endocrine systems with neural features

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12
Q

What term of control do endocrine responses have

A

Medium and long term

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13
Q

What are catecholamines and what do they do

A

Hormones secreted in response to sympathetic stimulation such as adrenaline and noradrenaline that increase cardiac output and peripheral resistance

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14
Q

What type of hormone is aldosterone and how does it act

2

A

Adrenal cortical steroid hormone

Causes renal collecting duct of kidneys to conserve sodium ions, promote potassium ion secretion and regulate acid base balance to increase blood pressure

Promotes vasopressin release which increases water retention from kidneys and increases blood pressure

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15
Q

Describe the renin angiotensin system

A

Hypotension (low blood pressure)
Angiotensin release from liver and renin release from kidneys
Renin converts angiotensin to angiotensin 1
Angiotensin1 converted to angiotensin 2 by ACE enzyme
Angiotensin 2 increases sympathetic activity, increases H2O retention, stimulates aldosterone release, causes vasoconstriction,increases ADH secretion

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16
Q

What term of control is kidney fluid balance

How do kidneys regulate BP

A

Long term

Increase or decrease blood volume by renin angiotensin system

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17
Q

How is renal blood flow regulated 3

A

Renin angiotensin aldosterone system

Pressure diuresis: blood pressure increase increases filtration through kidneys and urinary output

Pressure natriuresis: sodium secretion increases when blood pressure increases so less water reabsorbed to decrease blood pressure

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18
Q

Define shock

A

Shock is a state in which arterial blood pressure is insufficient to maintain an adequate supply of blood to tissues

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19
Q

Hypovolemic shock

A

Severe blood or fluid loss

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20
Q

Cardiogenic shock

A

Heart can’t pump enough blood

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21
Q

Septic shock

A

Sepsis leading to abnormally low blood pressure

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22
Q

Distributive shock

A

Abnormal distribution of blood flow

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23
Q

Anaphylactic shock

A

Allergic reaction

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24
Q 
At stage 1 haemorrhagic shock
How much blood volume lost
What is heart rate
What is blood pressure 
What is central Venus pressure 
Clinical signs?
A 
Less than 10% blood volume lost
Normal 
Normal 
Unchanged 
Normal
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25
``` At stage 2 haemorrhagic shock How much blood volume lost What is heart rate What is blood pressure What is central Venus pressure Clinical signs? ```
``` 10-19% 100-120 Normal Pressure decreases a little Clinical signs of over activity ```
26
``` At stage 3 haemorrhagic shock How much blood volume lost What is heart rate What is systolic blood pressure What is central Venus pressure Clinical signs? ```
``` 20-39% 120-140 100 Central Venus pressure decreases a lot Clinically restless ```
27
``` At stage 4 haemorrhagic shock How much blood volume lost What is heart rate What is systolic blood pressure What is central Venus pressure Clinical signs? ```
``` Over 40% Over 140 Over 80 Decreases majorly Unconscious ```
28
How much blood lost during minor oral surgery and what stage of shock
10-30ml | Stage 1
29
What are the local responses to stress | 2
Inflammation | Repair
30
What are the systemic responses to stress | 3
Conserve fluid Generate energy Ebb phase- depression of enzyme activity and oxygen consumption Flow phase- catabolic phase with fat and protein mobilisation and increased urinary nitrogen excretion and anabolic phase where fat and protein stores restored
31
Where does the apex of the heart lie
Between 5th and 6th rib in 5th intercostal space lining up with middle of left clavicle
32
Which arteries branch off the aorta
Left and right coronary artery branch off ascending aorta Brachiocephalic artery dividing into right subclavian artery and right common carotid artery branches off arch of aorta Left common carotid artery branches of arch Left subclavian artery branches of arch Descending aorta
33
Properties of arteries | 5
Thick walls Thin lumen Elasticity to maintain high blood pressure Smooth endothelium lining so blood flows Thick tunica media layer of smooth muscle
34
Properties of veins | 7
Thin walls Large lumen May have valves Few elastic fibres Walls contain lots of collagen for support Thin tunica media layer of smooth muscle Capacitance vessel containing most of blood volume
35
Properties of arterioles | 3
Link arteries and capillaries More smooth muscle for vasoconstriction and vasodilation Reduce blood pressure before capillaries
36
Properties of capillaries | 4
Link arterioles and venules Large surface area Walls single endothelial cell thick Cross section larger than supplying arteriole to slow blood for diffusion
37
Define systole | What are pressures at end
Contraction of the heart during which arteriole then ventricular pressure increased and blood is forced out, by the end low pressure in heart and high pressure in arteries
38
Define diastole | What are the pressures in heart and arteries
Relaxation of the heart during which atria and ventricles fill and volume and pressure in heart build with low pressure in arteries
39
What are the stages in the cardiac cycle blood flow
Deoxygenated blood enters R atrium through vena cava at low pressure Tricuspid valve opens and RV fills R Atrium contracts RV contracts and tricuspid valve closes so deoxygenated blood forced through pulmonary valve to pulmonary artery to capillary bed of lungs Oxy blood from lungs enters LA from pulmonary vein Bicuspid valve opens and LV fills LA contracts forcing blood into LV LV contracts forcing oxygenated blood through aortic valve to aorta
40
What is pulmonary circulation
Blood flow from heart to lungs to heart
41
What is systemic circulation
Blood flow from heart to body to heart
42
What is meant by the term compliance
The index of elasticity of large arteries
43
What is Normal blood pressure value
Below 120 mmHg systolic
44
``` What are the values for: Elevated blood pressure Hypertension stage 1 Hypertension stage 2 Hypertensive crisis ```
120-129 mmHg systolic 130-139 mmHg systolic 140-180 mmHg systolic Above 180 mmHg systolic
45
What is the value for hypotension
Below 90 mmHg systolic
46
What are the four components of blood and their % by volume
Erythrocytes 40-45% Thrombocytes less than 5% Leukocytes less than 5% Plasma 55%
47
Properties of erythrocytes | 5
Deliver oxygen to tissues using haemoglobin Small, 8 micrometers across so can squeeze through vessels Bioconcave shape No nuclei or organelles Lifespan 100-120 days
48
What hormone stimulates erythrocytes formation How many red blood cells do humans have How many cells by number %
Erythropoietin 20-30 trillion 70% cells by number
49
What is the action of haemoglobin with partial pressure of oxygen
As partial pressure of oxygen increases % saturation of haemoglobin to oxyhemoglobin increases
50
What is normal red blood cell count for men and women
Men = 4.7-6.7 million cells per microlitre Women = 4.2-5.4 million cells per microlitre
51
When does anaemia occur
When there are low levels of erythrocytes in circulation
52
When does polycythemia occur
When haematocrit is high due to high erythrocytes production or low plasma levels
53
What is sickle cell disease
A genetic condition in which red blood cells are misformed causing pain attacks, anaemia and organ damage due to red blood cells becoming trapped
54
What is the major role of platelets or thrombocytes
Blood clotting
55
How big are thrombocytes How many platelets per microlitre of blood
2-3 micrometers 150 000 - 450 000 platelets per microlitre of blood
56
What is thrombocytopenia
Low platelet count below 50 000 per micro litre of blood These patients show excessive bleeding and bruising
57
Where do leukocytes come from
Multipotent stem cells in bone marrow
58
How many white blood cells do we have
3,500-10,500 cells per microlitre
59
What is leukopenia
Less white blood cells than normal
60
What is leukocytosis
More white blood cells than normal
61
What are the types of white blood cell and when are they raised
Monocytes - raised in bacterial infection Neutrophils- raised in bacterial infection Eosinophils- raised in parasitic infection, asthma or allergic reaction Lymphocytes- raised in viral infection and lowered in HIV Basophils- raised in bone marrow conditions
62
What is the main role of plasma
Maintaining osmotic balance
63
What does blood plasma contain | 5
``` Water Proteins including antibodies Ions Hormones Dissolved gasses ```
64
Types of primary bond | 3
Covalent Metallic Ionic
65
Types of secondary bonds | 2
Van der waals | Hydrogen bonds
66
How do you calculate stress
Stress = force / area
67
How do you calculate elastic modulus
Elastic modulus = stress / strain
68
How do you calculate strain
Strain = change in length/ original length
69
What does the area under stress strain curve represent
Toughness
70
What is meant by ductile materials
Extensive plastic deformation and energy absorption before fracture
71
What is meant by brittle materials
Little plastic deformation and low energy absorbtion before fracture
72
What is biocompatibility What is bioactive What is bioinert
Compatibility with a living tissue or system by not being toxic, injurious or physiologically reactive and not causing immunological rejection Substance having biological effect Substance with no biological effect
73
Which licensing bodies establish specifications for dental materials on an international level
FDI CEN ISO
74
Which licensing body measures clinically significant chemical and physical properties How often must it be renewed
ADA | ADA deal of acceptance must be renewed every 1-5 years
75
Which licensing body uses risk based classification system
FDA
76
What does CE mark mean
The manufacturer declares that the product complied with essential requirements of the relevant European health, safety and environmental protection legislation
77
What is meant by primary level of protection Secondary level of protection Tertiary level of protection
Protection against disease Limiting progression and effects of disease Rehabilitation with further preventive care
78
When does systemic action of fluoride take place
Pre eruption
79
What are the effects of systemic fluoride action | 3
Reduces acid solubility Cristalites larger and more stable Effects tooth morphology creating shallower pits and fissures
80
When does topical action of fluoride take place
Post eruption
81
What are the effects of topical fluoride action | 4
Reduced demineralisation Increases remineralisation by forming Fluor paper it’s when in solution Inhibits plaque bacteria growth and glycolysis Inhibits bacteria synthesis of extra cellular polysaccharide
82
How much toothpaste should a 0-3 year old use Ppm at standard risk Ppm at giving concern
Smear No less than 1000ppm 1350-1500ppm
83
How much toothpaste should a 3-6 year old use What ppm at standard risk What ppm giving concern
Small pea Over 1000ppm twice a day 1350-1500ppm twice a day
84
How much toothpaste should a 7 year old to adult use What ppm at standard risk What ppm giving concern
Large pea 1350-1500 twice a day Giving concern 7-9 : 1500ppm Giving concern 10-15 : 2800ppm Giving concern 16+ : 5000ppm
85
What level of fluoride is in fluoridated water
1ppm
86
How does mild fluorosis present clinically and what level of water fluoridation causes it
Small white patch | 2ppm
87
How does moderate fluorosis present clinically and what level of water fluoridation causes it
White opacity of whole crown with some brown mottling | 3-4ppm
88
How does severe fluorosis present clinically and what level of water fluoridation causes it
White opacity of whole crown with brown mottling, pitting and hypoplasia 4ppm
89
What is the certain lethal dose of fluoride toxicity
32-64 mg/kg body weight
90
What is the hospitalise dose of fluoride
5mg/kg body weight
91
What should you do if a child consumes large amounts of fluoride below 5mg/kg body weight
Drink large amounts of milk
92
What is the ratio of powder/alloy phase to liquid/mercury phase in dental amalgam and what constitutes the alloy
1:1 | Alloy- silver tin zinc copper
93
What are the forms of alloy and how are they made | 3
Large cut- cut by large from ingots to form chippings then heat treated to relieve stress Spherical- alloy ingredients melted then sprayed in inert atmosphere Admixed - mixture of lathe cut and spherical
94
What is gamma phase and what is it’s role in amalgam
Ag3Sn silver tin | Reacts with mercury to form amalgam
95
What is coppers role in amalgam
Improves hardness and strength
96
What is zincs role in amalgam
Acts as scavenger by preventing oxidation of metals in alloy during manufacturing and delays expansion
97
What is the amalgam setting reaction
Y + mercury ➡️ Y + Y1 + Y2 | Ag3Sn + Hg ➡️ Ag3Sn + Ag2Hg3 + Sn7Hg
98
What are the strengths of the components of amalgam and how does mercury effect this
Gamma and gamma1 have similar strength Gamma 2 softer More mercury yields more gamma 2 so weaker amalgam
99
What factors decrease amounts of mercury in amalgam | 2
Condensation gives 50% Hg | Spherical alloy gives 45% Hg
100
What is creep in the context of amalgam When does amalgam melt and creep
Deformation of amalgam restoration under load after it has set Creeps at 40 degrees, melts at 80 degrees
101
What creates amalgam with less creep
Less gamma 1 and gamma 2
102
How can amalgam corrosion be advantageous
Can seal gaps to prevent against secondary caries
103
Which phase of amalgam is corrosion linked with and what is the equation for this
Gamma 2 Y2 (Sn7Hg) + O2 in oral fluids ➡️ Sn salts + free mercury
104
When was high copper amalgam introduced
1962
105
How much copper does high copper amalgam contain
At least 12%
106
What is added to traditional amalgam to form high copper amalgam and how does this effect setting reaction
Spherical alloy of AgCu | Used in eutectic phase to eliminate Y2
107
What is the two stage setting reaction of high copper dental amalgam
Stage 1 Ag3Sn + Hg ➡️ Ag2Hg3 + Sn7Hg Y + mercury ➡️ Y1 + Y2 Eutectic phase Sn7Hg + AgCu ➡️ Cu6Sn5 + Ag2Hg3 Y2 + Eutectic ➡️ n + Y1
108
What are the manufacturers variables in amalgam and how do they effect its properties 2
Composition, high copper amalgam have less creep and corrosion and higher strength, they don’t contain zinc so there is no delayed expansion but are prone to tarnish Particle size and shape, smaller particles easier to carve but result in more mercury whereas coarse particles result in less mercury but are easily dislodged from surface
109
When would practitioner decrease trituration time
To lengthen working time If mix too hot If mix too wet
110
When would practitioner increase trituration time
To shorten working time | If mix too dry
111
How much force should condensation of amalgam take
30-49N
112
What is the minimum depth for an amalgam filling | What Cavo surface angle should be used
2mm | 90 degrees
113
What are the disadvantages of amalgam | 9
``` Poor aesthetics Mercury toxicity High thermal conductivity Galvanic effects Lack of adhesion so requires mechanical retention Limited lifespan Tooth fracture due to undermined enamel Recurrent caries Marginal breakdown ```
114
When where composites introduces
1960s
115
What are the 3 components of composites
Organic resin Inorganic filler Coupling agent
116
What is the organic resin matrix made up of
High viscosity monomers Low viscosity monomers Inhibitors Activator/initiator systems
117
Give examples of high viscosity monomers | 3
MMA Bis GMA UDMA
118
Give examples of low viscosity monomers | 3
TEGDMA | EDMA
119
What is the main inhibitor used in the organic matrix of composites
Hydoquinone
120
What are the inorganic fillers composed of
Silica, quartz and silicate particles
121
What are the effects of inorganic fillers on composite properties 6
``` Enhance mechanical properties Reduce thermal expansion coefficient Reduce polymerisation shrinkage Provide radiopacity Provide antibacterial activity Improves aesthetics ```
122
What does the coupling agent in composite do
Forms bonds between fillers and resin
123
How are coupling agents chemically bifunctional
Two functional groups Hydrolysable alkoxy group reacts ugh silica particles of filler Methacrylate group forms carbon carbon double bond with monomers
124
How are self curing composites activated
Chemical activator plus initiator produces free radicals for addition polymerisation
125
How are light cure composites activated
Initiator creates free radicals during photochemical activation
126
What is the light source for UV activated composite What is the wavelength What is depth of cute
Mercury discharge lamp 10-400 nanometers 2mm
127
What is the light source for VLA activated composite What is the wavelength What is the depth of cure
Quartz halogen lamp 460-480nm 3-4mm
128
What are the sizes of particle fillers from smallest to largest
``` Mani fillers Micro fillers Nano hybrid Hybrid Small particle fillers Macro fillers ```
129
What is the effect of increasing filler load
Strength, toughness, durability and clinical performance increases Thermal expansion coefficient and polymerisation shrinkage decreases Increases viscosity Increases radiopacity
130
What is the effect of decreasing filler size
Increases surface smoothness and aesthetics
131
What are the stages in applying composites | 7
``` Cavity preparation Acid etching Primer Bonding agent Placing composite Curing Final shaping ```
132
Advantages of composites | 3
Insoluble in oral fluids High biocompatibility Coloured to match tooth
133
Disadvantages of composites | 4
Polymerisation shrinkage Allergic reactions if components leak Don’t match mechanical properties of enamel Can discolour over time
134
Which are the major salivary glAnds and how much do they contribute to saliva 3
Parotid 25% Submandibular 65% Sublingual 5%
135
What is the parotid duct called What is the submandibular duct called What is the sublingual duct called
``` Parotid = stensons Submandibular = whartons Sublingual = bartholins ```
136
What shape is parotid gland and what is it’s innervation
Inverted pyramid | Parasympathetic supply from CN9 and 5
137
What shape is submandibular gland and what is it’s nerve supply
J shaped | Parasympathetic supply from CN7 and 5
138
What shape is sublingual gland and how is it innervated
Almond shaped | Parasympathetic should from CN7 and 5
139
What type of saliva is produced by parotid gland and from which cell Which cells line parotid gland
Serious watery secretion by serous acinar epithelial cells Cuboidal cell lining
140
What is amylase and lysozyme activity of saliva from parotid gland
High amylase, no lysozyme
141
What type of saliva is produced by submandibular gland and from which cells What cells line submandibular gland
Mixed serous and mucus from serous and mucus acinar epithelial cells Columnar cell lining
142
What is amylase and lysozyme activity in saliva from submandibular gland
Medium amylase activity, high lysozyme activity
143
What type of saliva is produced by sublingual gland by which cells Which cells line sublingual gland
Mucous predominately, produces by mucous acinar epithelial cells Stratified cuboidal cell lining
144
What is amylase and lysozyme activity of saliva produced by sublingual gland
Low amylase and low lysozyme activity
145
What is the difference in roles of mucous and serous saliva
Mucous protects soft tissues whereas serous protects hard tissues and aids eating and digestion
146
What does a secretory unit consist of | 5
Acinus, myoepithelial cells, intercalated duct, striated duct, excretory duct
147
What is meant by serous demilune
Serous cells can form cap over mucous cells in mixed glands
148
What happens in acinus
Protein and mucous secretion
149
What do myoepithelial cells of gland do
Sit over acinus with muscular features to help force saliva out
150
What shape of epithelial cells is the intercalated duct formed of and what is it’s purpose
Simple cuboidal intercalated duct cells | Act as conduit from acini to striated duct
151
What forms striations of striated duct
Mitochondrion rich areas
152
What cells form striated duct
Large simple columnar cells with large nuclei
153
What happens in striated duct
Sodium and chlorine reabsorption and hydrogen carbonate secretion
154
What type of cells are excretory ducts made of
Stratified cuboidal
155
What is the process of saliva production moving through secretory unit
Parasympathetic or sympathetic stimulation causes acinus to produce isotonic fluid In striated duct potassium and hydrogen carbonate move into lumen and sodium and chloride move out of lumen Saliva becomes hypotonic and moves into excretory duct
156
What is the 2 stage model of saliva secretion
Stage 1 Acinar cells secrete fluid containing amylase and electrolytes called primary saliva Stage 2 Salivary gland duct cells in striated duct reabsorb sodium chloride from lumen and secrete potassium hydrogen carbonate into lumen
157
What is the difference between whole and ductal saliva | How much whole saliva produced a day
Whole is mixture of saliva from different sources, 1-1.5 litres produced a day Ductal saliva is directly from duct opening so pure
158
What is the difference between stimulated and un stimulated flow
Unstimulated/resting flow keeps mouth lubricated and moist and is produced by submandibular and sublingual glands, it is mucous Stimulated saliva is produced by parotid gland, it is serous and makes up 80-90% saliva production
159
Normal unstimulated flow Low unstimulated flow Normal stimulated flow Low stimulated flow
0.3-0.4 ml per min Below 0.1 ml per min 1-7 ml per min Below 0.5 ml per min
160
What percentage of saliva is water
99%
161
What is the equation for demineralisation/remineralisation of enamel
Ca10 (PO4)6 OH2 🔁 10Ca2+ + 6PO42- + 2OH-
162
``` Hydroxyapatite content of Newly formed enamel Dentine Cementum Bone Enamel ```
Dentine 70% Cementum 70% Bone 70% Enamel 90%
163
How does pH affect ionisation
Decrease in pH promotes ionisation leading to demineralisation Increase in pH decreases ionisation leading to remineralisation
164
What is critical pH of the oral environment What is normal pH of oral environment
5.5 6-7
165
How long after glucose attack does pH drop below critical value How long after glucose attack is pH at safe level How long after glucose attack does pH return to normal
2-3 mins 40mins 2 hours
166
Which processes exhibit demineralisation/ionisation | 5
``` Destructive carious lesions Acid etch Sialolithiasis Dental erosion Drinking carbonated drinks ```
167
Which processes exhibit remineralisation | 3
Recalcification of early lesions Fluoride application Calculus deposition
168
What is the formula for carbonatoapatite
Ca5 (PO4 CO3) 3 (OH)
169
What is the form of fluoroapatite
Ca10 (PO4)6 F2
170
How does fluoride protect the tooth | 3
Inhibits bacterial metabolism Lowers critical value for demineralisation Promotes remineralisation
171
What are the effects of fluoride on dentine | 3
Increases hardness Reduce hypersensitivity May inhibit collagen formation at high concentrations
172
What are the tree theories of dental pain
Neural theory- dentine tubules in dentine contain nerve endings Odontoblastic transduction theory- when odontoblast processes membrane excited release neurotransmitters to nerve endings in pre dentine, odontoblast zone and pulp Hydrodynamic theory- rapid shifts in fluid in dentine tubules activates nerves in inner dentine
173
What can varnish be used as Advantages Disadvantages
Liner Low cost Washes out at margins
174
What can calcium hydroxide be used as Advantages Disadvantages
Liner , temporary cement Low cost Most effective when in contact with pulp
175
What can zinc oxide Eugenol be used as Advantages Disadvantages
Liner, base, cement Antibacterial, sealing ability Unable to withstand condensation forces
176
What can zinc oxyphosphate be used as | What can zinc polycarboxylate be used as
Base and cement
177
What is a liner
Thin coating which acts as barrier to chemical irritants and bacteria to protect pulp
178
What are properties of calcium hydroxide liner | 4
PH12- very alkaline Antibacterial Direct pulp capping agent Compatible with all materials
179
What are bases
Layer that minimises bulk of restorative material by acting as barrier to chemical irritants and bacteria and providing thermal insulation
180
What is the powder and liquid part of zinc oxide eugenol and what ratio are they mixed at
Powder part = zinc oxide and magnesium oxide Liquid part= oils such as euginol Mixed 3:1 ratio for 1 minutes
181
What does a varnish do
Resin dissolved in organic solvent seals dentine tubules to reduce micro leakage
182
Which temporary restoration materials last 3-4 days
ZOE Zinc oxyphosphate Zinc polycarboxylate
183
Which temporary restoration materials last 6 months
GIC
184
Which temporary restoration materials can also be used as permanent restorations
RMGIC | Compomers

Dentistry Year 1 (5 decks)

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