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Year 2 > clinical dent > Flashcards

clinical dent Flashcards

1
Q

What does a primary caries lesion refer to?

A

A primary lesion occurs at the tooth surface due to external bacteria. It is not related to a restoration

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2
Q

What does a secondary caries lesion refer to?

A

A secondary lesions occurs at he external or internal interface of the tooth due to external bacteria and is in relation to a restoration

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3
Q

What is a recurrent caries lesion?

A

A lesion occurring deep in the tooth, at restoration interface due to internal bacteria left in the cavity.

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4
Q

Why is it important to detect caries early?

A
  • cavitation is not inevitable with caries
  • prevented by simple measures
  • small lesions remineralise more readily
  • remineralised lesions are more resistant
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5
Q

What risk factors should be assessed for caries?

A
  • biological factors eg saliva, enamel quality
  • medical factors
  • dental factors eg multiple restorations
  • dietary factors
  • social and demographic factors
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6
Q

What visual features would indicate enamel demineralisation?

A
  • White matte appearance

- brown due to exogenous stain

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7
Q

What visual features would indicate caries being spread into dentine?

A

Grey discolouration

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8
Q

True or false:

You can determine root caries by visual examination provided you have good lighting and the teeth are clean

A

FALSE = colour is not a good indicator of activity for root caries

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9
Q

List the diagnostic methods to determine caries

A
  • Visual
  • radiography (bitewings)
  • fiberoptic transillumination (FOTI)
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10
Q

List 5 minimal interventions in the management of dental caries

A
  • Modification of oral flora
  • patient education
  • remineralisation of non cavitated lesions of enamel/dentine
  • minimal operative intervention of ‘early’ cavitated lesions
  • repair/ replacement of restorations
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11
Q

Why should we restore teeth? and when restored, why should preventative measures still be pursued?

A
  • eliminates plaque traps formed by cavities
  • eliminate pain/ discomfort
  • improve appearance

however, no restoration gives the perfect seal therefore preventative measures are still needed

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12
Q

What is a retentive cavity?

A

A cavity where tooth tissue can support material

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13
Q

True or false;

placing amalgam into a large cavity will lead to cusp fracture

A

TRUE

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14
Q

Which statement is false regarding composites?

a) micro-mechanical bonding to acid-etched enamel
b) adheres to dentine via bonding agents
c) stronger than amalgam

A

c) stronger than amalgam

composite is WEAKER than amalgam

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15
Q

Why is acid etching necessary to bond composites to enamel?

A

Acid-etching produces micro-porosities to give micro-mechanical retention

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16
Q

Which statement regarding GICs is false?

a) inferior aesthetics to composites
b) releases fluoride
c) micro-mechanically bonds to tooth tissue
d) weaker than composites

A

c) micro-mechanically bonds to tooth tissue

GICs form a CHEMICAL bond with tooth tissue and therefore DO NOT require mechanical retention

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17
Q

Why is the proportion of acidogenic microorganisms in plaque higher in older people than younger ones?

A

due to decreased salivary secretions and higher prevalence of removable dentures

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18
Q

A carious lesion is clinically seen as shiny, smooth, hard and has no microbial deposits. Is it an active, progressive, or arrested lesion?

A

ARRESTED

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19
Q

Based on pattern of mineralisation, what are the differences in active and arrested lesions?

A

ACTIVE: soft extensive demineralisation with no evidence of intact surface mineral layer

ARRESTED: hard uniform distribution of mineral throughout lesion

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20
Q

True or false:

the critical pH for the dissolution of the root tissue is higher than that of enamel

A

TRUE
Enamel critical pH :5.2-5.7
Root pH: 6.0-6.7

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21
Q

What would result from having no commensal microflora in the gut?

A
  • Hypoplastic peyer’s patches
  • Decreased IgA plasma cells
  • Decreased lamina propria CD4+ cells
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22
Q

List the physical barrier components in the oral cavity (3 things)

A
  • Adherent mucus layer
    ( sticky, slippery gel that allows transit of nutrients but not bacterial toxins/products. Also taps bacteria for prolonged exposure to host antibacterial agents)
  • Desquamation
    ( shedding of cells)
  • Epithelial antibody receptors
    ( secretory component receptors found on buccal epithelium - anchor bacterial-antibody complexes, which are then shed with the cell)
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23
Q

What is desquamation?

A

The shedding of cells

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24
Q

Which one is Keratinised stratified squamous epithelium?

a) floor of mouth
b) gingiva
c) ventral surface of tongue
d) inner lips
e) cheek

A

b) gingiva

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25
Q

What is acquired enamel pellicle?

A

An acellular protein film on the enamel surface

formed from selective adsorption of proteins derived from oral fluid such as

  • salivary proteins ( eg amylase, S-IgA, lysozyme)
  • Gingival crevicular fluid proteins
  • streptococcal enzyme - glycosyltransferase
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26
Q

What are granzymes and perforins?

A

granzymes: proteases that induce apoptosis - released by NK and Tk cells
perforin: protein causing lesion-like pores in cell membranes - released by NK cells

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27
Q

how to cells infected with viruses trigger the innate immune response?

A

Infected cells release interferons which trigger macrophages to release cytokines that stimulate NK cells to release proteins such as granzymes and perforins to trigger apoptosis of infected cell

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28
Q

What are the three types of dendritic cells?

A
  • Langerhans
  • interdigitating cells
  • Follicular dendritic cells
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29
Q

What are follicular dendritic cells?

A

a type of dendritic cell found in specialised areas of lymph nodes.

they present unmodified antigens to B cells

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30
Q

What are Toll-like receptors and PAMPs?

A

Toll-like receptors are found on cell membranes that recognise PAMPs, triggering release of cytokines, chemokines and beta defensins

PAMP - pathogen associated molecular pattern
are NOT found in eukaryotes, therefore the body is able to recognise them as foreign material.

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31
Q

Which antimicrobial agent is bacteriostatic-iron binding ?

a) Secretory IgA
b) Lactoferrin
c) myeloperoxidase system
d) complement
e) agglutins

A

b) Lactoferrin

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32
Q

Which antimicrobial agent works by being bacteriocidal in the presence o H2O2?

a) Secretory IgA
b) Lactoferrin
c) myeloperoxidase system
d) complement
e) agglutins

A

c) myeloperoxidase system

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33
Q

Which antimicrobial agent is from gingival crevicular fluid?

a) Secretory IgA
b) Lactoferrin
c) myeloperoxidase system
d) complement
e) agglutins

A

d) complement

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34
Q

Name three ways of compliment activation

A
  • antigen-antibody complex
  • lectin binding to pathogen surface
  • pathogen surface
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35
Q

What does complement activation lead to?

A
  • opsonisation
  • recruitment of inflammatory cells
  • killing of pathogen
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36
Q

Which complements are peptide mediators of inflammation and are involved in phagocyte recruitment?

A

C3a and C5a

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37
Q

Which complement binds to complement receptors on phagocytes to initiate opsonisation of pathogens and removal of immune complexes?

A

C3b

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38
Q

What are the role of terminal complement components?

A

form membrane-attack complexes, lysis of certain pathogens

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39
Q

List the differences between innate and adaptive immunity

A

INNATE:

  • non specific
  • no memory
  • unchanged magnitude of response
  • instructs adaptive immunity
  • recognises foreign organisms

ADAPTIVE:

  • memory and specificity
  • magnitude increases upon second exposure
  • activated by components of innate immunity
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40
Q

What is the difference between humoral and cellular immunity?

A

HUMORAL immunity is associated with circulating antibodies produced by B cells specific for an antigen on a microbes surface. triggers activation of complement cascade

CELLULAR immunity is a response to activated, antigen specific T cells . induction of further Th cells = B cell activation, Tk cells and macrophages+NK cells

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41
Q

Which antibody plays the most crucial role in mucosal membranes?

A

SIgA (IgA)

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42
Q

Which antibody is found in all secretions?

A

SIgA (IgA)

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43
Q

In enamel apatite structure, what is F- substituted for?

a) Ca
b) PO4
c) OH
d) Mg
e) O2H

A

c) OH

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44
Q

In enamel apatite structure, what is CO3 substituted for?

a) Ca
b) PO4
c) OH
d) Mg
e) O2H

A

b) PO4

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45
Q

What is the enamel crown thickness?

A

~2mm

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46
Q

What are the ways to deliver fluoride?

A
  • water fluoridation
  • fluoride drops+tablets
  • milk
  • salt
  • topical fluorides eg varnish, gel, toothpastes, rinsing solutions
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47
Q

What are the pre-eruptive effects of fluoride on teeth?

A
  • improve crystallinity
  • increase crystal size
  • decrease acid solubility
  • more rounded cusps
  • improve fissure sealant patterns
48
Q

What are the post-eruptive effects of fluoride on teeth?

A
  • inhibit demineralisation
  • promote remineralisation of early caries
  • increase degree+speed of remineralisation
  • inhibit glycolysis un cariogenic bacteria = decreased acid production
  • fluoride in plaque inhibit synthesis of extracellular bacteria
49
Q

What are the effects of chronic fluoride toxicity?

A
  • exostoses ( bony growth on bone surface)

- stiffness and pain of joints

50
Q

What are the effects of acute fluoride toxicity?

A
  • poisoning
  • nausea, vomiting
  • limb spasms, convulsions
  • BP and pulse rate fall
  • depressed respiration
  • unconsciousness
51
Q

What is fluorosis?

A

effects of excessive fluoride intake characterised by mottles enamel

52
Q

True or false;

Dentine is harder than bone

A

TRUE

53
Q

What is the difference between tertiary and sclerotic dentine?

A

both are formed in response to an external challenge however tertiary dentine is laid down in the PULP whereas sclerotic is laid down in the TUBULES (peritubular dentine) as the odontoblast processes retract forming dead tracts

54
Q

Why is zone of tubular sclerosis translucent on ground section?

A

due to higher mineralisation

55
Q

What is tubular sclerosis?

A

the laying down of peritubular dentine in tubules due to an external challenge eg caries.

purpose is to block entry of bacteria through tubules.

odontoblast processes retract from acid stimulus and increase peritubular formation. as processes retract dead tracts are formed.

56
Q

What is reactionary dentine?

A

tertiary dentine formed as a result of external challenge at the pulp-dentine interface.

serves to increase distance from pulp and noxious stimulus

57
Q

How can the mucosal surfaces of the mouth affect the distribution of microflora?

A
  • keratinised and non keratinised areas affect distribution
  • papillary surfaces of dorsal tongue provide habitat for microorganisms that otherwise wouldve been removed by mastication/saliva flow
  • tongue crypts have low redox potential and act as a reservoir for gram negative anaerobes
58
Q

Which statement is incorrect?
Streptococcus mutans…

a) have a high isolation frequency
b) are a primary pathogen in enamel caries in children and young adults
c) gram negative cocci
d) have low prevalence on sound enamel
e) primary pathogen in root caries of the elderly

A

c) gram negative cocci

streptococcus mutans are gram POSITIVE

59
Q

Which Streptococcus group is often isolated from infective endocarditis ?

a) Strep. mutans
b) Strep. salivarius
c) Strep. milleri
d) Strep. oralis

A

d) Strep. oralis

60
Q

Which Streptococcus group is often isolated from purulent disease?

a) Strep. mutans
b) Strep. salivarius
c) Strep. milleri
d) Strep. oralis

A

c) Strep. milleri

61
Q

Which bacterium species is involved in root canal infections?

a) Streptococcus
b) Enterococcus
c) Staphylococcus
d) Micrococcus
e) Stomatococcus

A

b) Enterococcus - specifically E. faecalis

62
Q

Which bacterium are involved in actinomycosis?

a) A. naeslundii
b) A. israelii
c) Eubacterium
d) Lactobacillus casei
e) P. propionicus

A

b) A. israelii

AND

e) P. propionicus

63
Q

Which bacterium are associated with root surface caries and increase in number with gingivitis?

a) Enterococcus
b) Staphylococcus
c) Actinomyces
d) Eubacterium
e) Lactobacillus

A

c) Actinomyces

Lactobacillus also involved in advanced caries lesions of root surface

64
Q

What are the functions of established dental plaque?
a) for the bacteria

b) for the host

A

FOR BACTERIA

  • metabolic efficiency of community is increased
  • organisms can persist and grow over a wider habitat range
  • maintenance of favourable conditions during periods of unfavourable changes
  • enhanced catabolism of endogenous nutrients
  • recycling of nutrients

FOR HOST

  • bacterial competition for adhesion sites, nutrients
  • bacterial production of inhibitory substances
    (both help in excluding exogenous organisms from entering and establishing)
65
Q

Briefly describe the process by which plaque is formed

A

1) pellicle is formed on enamel tooth surface by selective adsorption of proteins from saliva, GCF and bacterial enzymes
2) pioneering species of bacteria (eg streptococci and actinomyces) attach onto pellicle via van der waals/ electrostatic/ hydrogen bonds
3) pioneering species multiply and form a confluent layer + co aggregation occurs via cell-cell interactions (eg actinomyces and fusobacterium)
4) growth of bacteria = decreased O2 = growth of anaerobic bacteria eg fusobacterium
5) plaque matures and is attained at stagnant sites = climax community

66
Q

What contributes to the extent of pH drop AFTER glucose challenge? (5 points)

A
  • type and amount of CHO present
  • bacteria present
  • salivary composition and flow
  • thickness and age of dental plaque
  • other food ingested
67
Q

Define acidogenicity and aciduricity

A

ACIDOGENICITY: the ability of bacteria to produce organic acids from fermentable carbohydrates

ACIDURICITY: the ability of bacteria to live in a low pH environment

68
Q

What is the difference between homofermentative and heterofermentative bacteria?

A

Homofermentative: produce over 90% lactic acid&raquo_space;> cariogenic bacteria

heterofermentative: produce a mixture of metabolites eg organic acids, ethanol

69
Q

What is the function of intracellular storage polymers in plaque?

A
  • storage form of carbohydrate
  • energy production and acids when dieteary CHO is depleted
  • contributes to acidogenicity and aciduricity
  • produced by most plaque bacteria
70
Q

What is the function of extracellular polysaccharides in plaque?

A
  • may serve as carbohydrate storage
71
Q

What are the indications of fissure sealing?

A
  • children with special needs
  • children with extensive caries in primary dentition
  • children with caries in permanent molars
  • molars with deep pits and fissures
  • incisors with deep cingulum pits
  • molars with complex fissure patterns
  • molars with stained fissures
72
Q

What are the materials that can be used for fissure sealing?

A
  • filled resin
  • unfilled resin
  • GIC
73
Q

What is PRR?

A

preventative resin restoration whereby the pit/fissure decay is removed and restored and the rest of the fissure pattern is also sealed to prevent future decay.

74
Q

Why restore deciduous dentition?

A
  • eradicate disease = restore health and general well being
  • to give child the simplest form of treatment and avoid more complex procedures eg root canal treatment
  • avoid infection that follows root exposure
  • maintain arch length for permanent dentition
  • restore function (mastication can be painful of teeth are unhealthy)
  • psychological benefits + quality of life
75
Q

Which statement is incorrect regarding the differences between deciduous and permanent teeth

a) deciduous teeth have longer, more slender and splayed out roots
b) deciduous teeth have higher pulpal horns and proportionally larger pulp chambers
c) The enamel rods at the cervix of deciduous teeth slope gingivally whereas for permanent teeth slope occlusally
d) The cervical ridges are more pronounced for deciduous teeth
e) deciduous teeth have comparatively thicker dentine over the pulpal wall at the occlusal fossa

A

c) The enamel rods at the cervix of deciduous teeth slope gingivally whereas for permanent teeth slope occlusally

it is the other way around

deciduous teeth: enamel rods slope occlusally at cervix

permanent teeth: enamel rods slope gingivally at cervix

76
Q

List some of the indications of using a stainless steel crown in deciduous teeth

A
  • 2 or more carious surfaces or one extensive surface caries
  • following pulp therapy
  • developmental problems eg amelogenesis imperfecta
  • fractured primary molars
  • high caries risk patients
  • special need patients with reduced oral hygiene/ high risk of intra-coronal breakdown of restoration

-

77
Q

List the contradictions of s stainless steel crown use

A
  • allergy/sensitivity to nickel

- if primary molars are about to exfoliate

78
Q

List the advantages of using air abrasion to remove carious tissue

A
  • reduced need for anaesthetics
  • doesn’t produce burning smell
  • no vibrations/ noise
  • reduced failure rate of bonded sealant/filling (due to surface being dry)
  • removes carious tissue without cutting healthy tissue
  • reduced risk of micro-fracture
79
Q

What makes up the base of the gingival sulcus?

a) sulcar epithelium
b) junctional epithelium
c) oral epithelium

A

b) junctional epithelium

80
Q

What are the three components of gingival epithelial tissues?

A
  • oral epithelium
  • sulcar epithelium
  • junctional epithelium
81
Q

What are the different fibre types in periodontal ligament?

A
  • alveolar crest
  • horizontal
  • oblique (principal)
  • interradicular
  • apical
82
Q

Which fibres in the periodontal ligament form Sharpay’s fibres as the enter the cementum/alveolar bone?

A

Oblique fibres

83
Q

Which statement concerning the junctional epithelium in the gingiva is FALSE

a) the junctional epithelium is attached to the enamel and cementum
b) the junctional epithelium makes up the base of the gingival sulcus
c) has three basement membranes
d) permeable to GCF and defence cells

A

c) has three basement membranes

it has TWO basement membranes

84
Q

What are the functions of the periodontal ligament

A
  • physical (supportive)
  • nutritional (highly vascularised)
  • sensory
  • source of stem cells for bone, cementum and other CT cells (remodelling)
85
Q

What are the types of cementum?

A
  • acellular (on cervical 2/3 of root)

- cellular ( on apical 1/3 of root)

86
Q

In periodontal disease, what is the sulcus depth?

a) <1mm
b) 1-3mm
c) >3mm

A

c) >3mm

87
Q

What is the difference between probing depth and attachment loss?

A

probing depth is the distance between the gingival margin and sulcus base

attachment loss is the distance between the cementoenamel junction and sulcus base

88
Q

What is the difference between chronic and aggressive periodontitis?

A

CHRONIC:

  • common,
  • increasing age=increasing prevalence
  • slow,
  • subgingival calculus present
  • mainly generalised distribution but can be localised

AGGRESSIVE

  • uncommon,
  • under 30yr olds
  • often localised to first molar/incisor + two additional teeth (can be generalised )
  • rapid rate (episodically)
  • often few calculus deposits
89
Q

List some of the local risk factors of periodontitis

A

anatomical: enamel pearls/ root grooves/ furcations/ recession

tooth position: malalignment/crowding

iatrogenic: restorative margins/ partial dentures/ ortho appliances

90
Q

What is the difference in collagen between dentine and pulp?

A

dentine has type I

pulp has type I, III and V

91
Q

What is the dentine pulp complex?

A

a dynamic tissue that responds to mechanical, bacterial and chemical stimuli as a functional unit

92
Q

What two material can be used for pulp capping?

A

Calcium hydroxide

Mineral trioxide aggregate

93
Q

What are the differences in crack formation between bonded and non-bonded restorations?

A

bonded restorations have cracks forming within the enamel in contact with the opposing tooth (contact points)

non-bonded restorations will have cracks in the internal line angles and ADJ

94
Q

What is the difference between retention-form and resistance-form in relation to cavity designs?

A

retention form: the aspects of a cavity design that resists OCCLUSALLY displacing forces

resistance form: aspects of cavity design that resist COMPRESSIVE AND OBLIQUE displacing forces

95
Q

What are GHM articulating foil and millers forceps used for?

A

To check occlusion prior to restoration

96
Q

What is the difference between abfraction- and abrasion lesions?

A

ABFRACTION: caused by either chronic forces applied onto tooth eg bruxism or by normal occlusal forces but with misaligned teeth

ABRASION: eg by forces of heavy toothbrushing on the exposed root surfaces

both present as notches at the gumline

97
Q

Why cure composites incrementally?

A

To minimise shrinkage

98
Q

At which stage of gingivitis does collagen destruction begin?

a) initial stage (4-5 days)
b) early lesion (7-14 days)
c) established gingivitis (2-3 weeks)
d) advanced lesion - periodontitis

A

b) early lesion (7-14 days)

99
Q

Which immune cell is the predominant defence cell in the gingival crevice during periodontal disease?

A

PMNs - neutrophils

100
Q

Which statement is false concerning cytokines in periodontal disease

a) released by PMNs and macrophages
b) increase inflammation
c) stimulate bone growth by osteoblasts
d) stimulate collagen breakdown by fibroblast production of MMPs

A

c) stimulate bone growth by osteoblasts

they stimulate bone RESORPTION by osteoCLASTs

101
Q

Which statement concerning prostaglandins is false in periodontal disease?

a) produced by macrophages
b) cause vasoconstriction
c) stimulate fibroblasts to release MMPs to breakdown collagen
d) stimulate osteoclasts

A

b) cause vasoconstriction

causes vasoDILATION

102
Q

Which probe is used for a BPE chart?

A

WHO probe

103
Q

Which probe is used for a six point pocket chart (6PPC)?

A

Williams probe

104
Q

On the BPE chart, what does a score of 3 signify?

A

pocket depth between 3.5-5.5mm

requires a 6PPC

105
Q

On the BPE chart, what does a score of 1 and 2 signify?

A

1 = pocket depth <3.5mm + bleeding on probing

2 = pocket depth <3.5mm + calculus

106
Q

Which measurements are missing on a William’s probe?

A

4mm and 6mm

107
Q

What is the difference between diagnosis and prognosis?

A

diagnosis: the identification of the nature of an illness by examination of the symptoms
prognosis: a prediction of the probable course and outcome of a disease

108
Q

What is the difference between abfraction and attrition?

A

attrition occurs due to occlusal forces of opposing teeth leading to loss of tissue at the occlusal/incisal surfaces

abfraction is loss of tooth tissue around the gumline due to occlusal forces

109
Q

What is perimolysis?

A

a rim of enamel left around the tooth due to erosion

110
Q

What is pica?

A

a compulsive eating of non-foods often seen in pregnancy

111
Q

Which statement is incorrect? Subgingival calculus is

a) highly mineralised
b) usually dark in colour
c) widely distributed
d) confined to one tooth surface
e) difficult to remove

A

d) confined to one tooth surface

112
Q

At what stage is increased vascularity seen in gingivitis staging?

a) Initial stage gingivitis
b) Early lesion of gingivitis
c) Established lesion of gingivitis
d) Advanced lesion

A

b) early lesion of gingivitis

7-14 days after plaque accumulation

113
Q

At what stage is collagen destruction noted in gingivitis?

a) Initial stage gingivitis
b) Early lesion of gingivitis
c) Established lesion of gingivitis
d) Advanced lesion

A

b) Early lesion of gingivitis

7-10 days of plaque accumulation

114
Q

At what stage do neutrophils begin to migrate to the gingival sulcus in gingivitis?

a) Initial stage gingivitis
b) Early lesion of gingivitis
c) Established lesion of gingivitis
d) Advanced lesion

A

a) Initial stage gingivitis

4-5 days of plaque accumulation

115
Q

At what stage do plasma cells dominate in the infiltrate of gingivitis?

a) Initial stage gingivitis
b) Early lesion of gingivitis
c) Established lesion of gingivitis
d) Advanced lesion

A

c) Established lesion of gingivitis

2-3 weeks of plaque accumulation

116
Q

At which stage of gingivitis do clinically gums bleed upon probing?

a) Initial stage gingivitis
b) Early lesion of gingivitis
c) Established lesion of gingivitis
d) Advanced lesion

A

c) Established lesion of gingivitis

2-3 weeks of plaque accumulation

(but tissue swelling and bleeding occurs at initial stage too… so idk)

Year 2 (10 decks)

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