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BDS 3 Sem 1 > Last exam questions for exam 1 > Flashcards

Last exam questions for exam 1 Flashcards

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1
Q

How to write a treatment plan?

A

1.Completion of all histories and exams
2. Taking consent for additional testing - TRI-PLAQUE GEL
3. Diagnosis, presentation of treatment plan and consent
4. Chief Concern
5. Preventative care
6. In chair treatment
7. Close date recall
8. Transition to regular recall

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2
Q

What type of framework are you going to use to access hard tissue or soft tissue abnormalities?

A

Site
Size
Morphology
Colour
Cosnistency
Texture

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3
Q

What are the steps to occlusal analysis?

A

1.Teeth present/missing
2.Morphology of teeth
3.Wear - mild, moderate, sever
4.Crowding,spacingrotations
5.Axail inclanations
6.Shape of dental arch
7.Cruve of spee and wilsons curve
8.Angle molar classification/canine classification
9.Overbite (%) / overjet (mm)
10.Mediolateral

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4
Q

How does smoking increases the risk of periodontitis and by how much on average does it increase the instance of periodontitis according to latest studies?

A

The mechanisms:
1. Chronic reduction in blood flow and vascularity
2. Increase the prevelance of potential periodontal pathogens in the sulcus
3. Shift in neutrophil function towards destructive activities
4. Shift to a dysbiotic, pathogen enriched microbiome
5. Affects PMNs making them more aggrevated
6. Increase the number of aggravated T cells that produce inflammatory cytokines

It increases the risk of periodontitis by 85%!

Smoking cessation has beneficial effect on therapy outcomes and disease progression - this should be attempted for patient with nicotine dependence/

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5
Q

Why is the pharyngeal phase is troubled for infants with cleft lip and palate?

A

Infants with cleft lip and palate may have trouble with the sealing of the nasal cavity as well as creating vaccum for sucking

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6
Q

What are the steps to performing bisected angle?

A
  1. Informed consent
  2. Sit the patient up right or on a slight angle - situated the tube next to the patients side where the taking of the x-ray will take place - check the settings on the x-ray machine
  3. Grab a standart size film
  4. Situated the film dot to slot - black to beam
  5. Situated the film parallel to the palatal/lingual surface of tooth being imaged
  6. Ask your patient to gently hold the film with their thumb - make sure the patient does not bend the film
  7. Horizontal beam angulation - align the beam at the right angle to the tooth of interest - similarly to a bitewing - unless 14
  8. Vertical beam angulation - assess the angulation of long axis of the tooth and angulation of detector - mentally bisect the angle created between the tooth & detector
  9. Vertical beam adjusted so central ray is at 90 degrees to bisecting line
  10. Technique is the same for all teeth in mouth
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7
Q

What are the steps of ribbond application?

A
  1. Measure the teeth and cut the Ribbond - could be done by making a pattern closely adapting a piece of tinfoil or dental floss around teeth
  2. Prepare lingual surfaces and labial interproximals for bonding - etch bond cure
  3. Wet the ribbond with resin
  4. Apply a thin layer of flowable resin the to the lingual and interproximal surfaces
  5. Adapt the ribbond around the ressin filled surfaces including interproximal contacts
  6. Remove excess composite
  7. Cure the first layer
  8. Cover the ribbond splint with a flowable
  9. Light cure the covering layer of composite
  10. BE VERY CAREFUL WHEN POLISHING
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8
Q

What are TMDs?

A

Temporomandibular disorders - are a cluster of musculoskeletal disorders of the masticatory system that share many common symptoms.

It is characterised by jaw and face pain, temporal headaches, referred ear symptoms, limited opening, TMJ clicking, crepitus and locking.

It fluctuate with time and may be self limiting.

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9
Q

What are the steps to TMJ examination?

A

History taking:
- History of pain or discomfort and general health
- Causative factors – trauma or everyday activity
- Social history

Extra-oral examination
- Symmetry of the facial features
- Signs of vertical dimension loss
- Palpation of masticatory muscles

Palpation and TMJ opening
- Palpation of the TMJ on opening checking for crepitus or clicking
- Assess the range of motion on opening
- Assess the amount of opening - use fingers

Intra-oral examination
- Occlusal analysis

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10
Q

What are some of the common TMD disorders dental school wants to focus on?

A
  1. Myofacila pain
  2. TMJ hypertranslation
  3. Inflammed TMJ
  4. TMJ Internal derangement
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11
Q

What is the definition of the myofacial pain?

A

Pain in the facial area (region
below orbitomeatal line,
above the neck and anterior
to the ears) that originates
from oral muscular structures.
However, the high density of
muscular structures within the
craniofacial region can lead to
pain radiating to other areas

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12
Q

What are the signs & symptoms of myofacial pain?

A
  1. Limited range of motion & compromised function
  2. Pain typically felt in the face, jaw and preauricular area that can radiate to ears, teeth, head & neck
  3. Characterised by terdeness on palpation
  4. Aching on contraction of masticatory muscles
  5. Common headaches
  6. Tendonitis
  7. Myositis

8.Myospasm

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13
Q

What are some of the management of the myofacial pain?

A
  1. Physiotherapy
  2. Muscle rest/relaxants - soft diet and reduced speech
  3. Pharmacological - only for acute conditions and temporary usage - NSAIDs
  4. Occlusal appliances - like a double layers, laminated night guard with a soft portion on the occlusal side of the night guard
  5. Trigger point injections
  6. Psychological therapy
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14
Q

What is the definition about TMJ Hypertranslation?

A

It is the excessive movement of condylar head anteriorly towards articular eminence during opening of mouth.

During opening of mouth, condyles are rotated around a horizontal axis. Anterior translation then occurs, in which the condyles and meniscus move downwards and forwards to the articular eminence.

When translation overshoot the insertion of the TMJ capsule on the temproal bone, hypertranslation occurs.

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15
Q

What are the signs & symptoms of TMJ Hypertranslation ?

A
  1. Pain in masticatory muscles and TMJ
  2. TMJ misaligmment
  3. Difficulty in performing mandibular movement - functional loss
  4. Open locking
  5. Disc displacement
  6. TMJ sounds - clicking, crepitation, eminance click
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16
Q

What is the management of TMJ hypertranslation?

A
  1. Patient education and behaviour modification - habit awareness - avoid wide opening
  2. Pharmacotherapy - NSAIDs can be used to manage inflammation
  3. Chiropractic care - not too much evidence to back this one up
  4. Prolotherapy - injection of medicaments could promote proliferation and repair the ligaments/tendons which have lost laxity
  5. Autologous Blood injections - blood injection into the superior joint space
  6. Surgical procedures - use as least resort
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17
Q

What is the definition of TMJ inflammation?

A

TMJ inflammation is a type of tempromandibular joint dysfunction which can present as pain in the tempromandibular joint during palpation or function such as chewing.

The aetiology is mostly of osteoarthitis origins is a progressive cartilage degeneration due to increased joint overload and inflammation causing subchondral bone, articular and sub-articular surface remodeling and reabsorption with chronic inflammation of the synovial tissue.

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18
Q

When do you do hot therapy and when do you do hot therapy?

A

Use cold therapy during initial injury - in order to reduce the symptoms of inflammation.

Use hot therapy if you experience muscle stifness.

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19
Q

What is the management of TMJ inflammation?

A
  1. Patient education
  2. Acute treatment - iburprofen Motrin 400mg, 3x/day for 14 days - unless you get GIT side effects
  3. Consultation with GP if the condition is systemic
  4. Prevention for re-tramautising - jaw relexation
  5. SHort term (3 months) Long term (12 months) review
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20
Q

What is the definition of TMJ internal derangement?

A

It is the condition where there is an abnomal relationship between the articular disc and the condylar head of the TMJ. Displacement of the articular disc results in loss of structure and function of intra-articular tissue resulting in the biomechanics of the TMJ.

The most common displacements or the articular discs are:
- Disc displacement with reduction resulting in a click
- Disc displacement without reduction result in plocked jaw

Aitiologically - usually caused by joint overload, leading to an inflammatory/degenerative arthropathy of TMJ.

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21
Q

What are the signs and symptoms of Internal TMJ derangement?

A
  1. Restricted jaw movement
  2. Pain and tenderness
  3. Clicking of the TMJ - usually painless, clicking occurs due to the articular discs’s movement onto and off the condylar head of the TMJ
  4. Headaches as well as pain associated with the mandible and the ears
  5. Changes in occlusion
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22
Q

What is the management of Internal TMJ derangement?

A
  1. Appropriate classification of the TMJ
  2. Need to focus on causative factors such as:
    - Excessive loading
    - Systemic arthropathy
    - Localised arthropathy
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23
Q

What are the four stages of mastication?

A
  1. Oral preparatory stage
  2. Oral propulsive phase
  3. Pharyngeal phase
  4. Oesophageal phase
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24
Q

What happens during oral preparatory phase?

A
  1. Food enters oral cavity
  2. Voluntary mastication and bolus formations
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25
What happens during oral propulsive phase?
Tongue elevated and propels bolus to pharynx
26
What happens during pharyngeal phase?
1. Machanoreceptos in the pharynx detect the bolus 2. Soft palate elevates to seal nasopharynx 3. Larynx and hyoid bone move anteriorly and superiorly 4. True and folse vocal cord adduct 5. Epiglotis moves posteriorly and inferiorly 6. Respiration stops 7. Pharyngeal wave occurs 8. Upper oesophageal sphincter relaxes and opens
27
What occurs during oesophegeal phase?
1. Bolus passes to oesophagus 2. Oesophagus contracts sequentially and involuntaraly 3. Lower oesophageal sphincter relaxes 4. Bolus reaches stomach
28
What is the pathway of the jaw closing reflex?
1. Muscle spindles within the muscle of mastication detect stretch 2. Through the first order neuron, which passes through the foramen ovale, trigeminal ganglion into the trigeminal tract nucleus 3. Synapses occurs and through the interneuron, the action potential is propagated to wht trigeminal motor nucleus 4. Synapses occurs in the trigeminal motor nucleus to the muscle of mastication (for example the masseter) in order to generate an appropriate response and maintaining the mandible in anappropriate position during running fo rexample
29
What is the purpose of the jaw closing reflex?
1. To test patients status of the trigeminal nerve 2. To keep the madnible in an appropriate position
30
What is the purpose of the jaw opening reflex?
The purpose of the jaw opening reflex is to inhibit the jaw-closing muscles due to painful oral and perioroal stimuli. In humans, the jaw opening reflex is essentially inhibition of jaw-closing muscle with little evidence for excitation of jaw opening muscles
31
What is the main theory of mastication?
It is the peripheral input + Cortical input + Central Pattern Generator theory. It is believed that the cortical and the peripheral inputs work with central pattern generator theory for successful masticatory function. 1. CPG sets the rhythm for mastication 2. Receptors in and around the mouth alter the: strength, duration, rate of force developmetnet - this ensures that the chewing strokes weaker and faster for soft food compared to hard food 3. Any painful stimulus or conscious decision can interrupt the acivity of the CPG 4. Change in synaptic potentials of receptors of teeth, gingiva, lips or jaws confirms modulation of synaptic input during chewing 5. Total lack of peripheral feedback generates inefficient and dangerous masticatory strokes - think about LA
32
How does GC Tooth Mousse help with dentinal hypersensativity?
Fluoride usually reacts with calcium in the saliva to form CaF2 which sits on the surface of the tooth and releases fluoride ions as it dissolves over time “slow release device”. Can occlude dentinal tubules.
33
How does Colgate Neutrafluor 5000 Plus Toothpaste help with dentinal hypersensativity?
Fluoride is able to create lobules and aid in occlusion of dentinal tubules.
34
How does stanous fluoride (SnF) help with dentinal hypersensativity?
1. Precipitation of metal ions on physically occlude dentinal tubule, relieving sensitivity 2. Precipitate is also acid resistant and can act as a barrier against future erosive lesions to an extent
35
How does MI varnish help with dentinal hypersensativity?
1. MI Varnish contains NaF and CPP-ACP dispersed in rosin and ethanol solution 2. When applied, it adheres to the tooth surface and seals exposed dentine tubules 3. Contact with saliva sets the varnish and starts the slow dissolution process, driving the release of fluoride and CPP-ACP 4. Fluoride ions that are released bind with calcium ions in pellicle and plaque to form globules of calcium fluoride. 5. These globules deposit on the tooth surface, providing additional blockage of exposed dentine tubules, enhanced acid resistance and promote calcium and phosphate enriched saliva
36
What would you like to be shown in a pathologist report?
1. Does the lesion invade beyond basement membrane into underlying CT? 2. What is the presensce/integrity of encapsulation? (is it well enxapsulated?) 3. Infiltrative or cohesive invasion pattern? 4. Degree of differentiation of lesional cells? 5. Lesion thickness - depth of infiltration? 6. Does the lesion involve vital structures? e.g. lymphatics 7. Is there necrosis? 8. Is there considerable chronic inflamm cellular infiltrate surrounding invading front of lesion? 9. Surgicl margins of specimen? (if the lesion is fully excised or no) 10. Bening vs Malignant lesion
37
How to involve the patient? Or what are the ways to involve a patient?
1. Assess patient preferences for shared decision-making. 2. Educate patients about all possible treatment options and how they fit into a patient's current health status. 3. Discuss patient values and health-related goals. 4. Come to a treatment decision with the patient.
38
What are the 5 pro-inflammatory actions that is caused by smoking?
It induces: 1. Advanced glycation end products 2. Monocyte and marcophage activation 3. Alteration responsiveness to acute pathogens 4. Inflammatory mediator release 5. Th2, and Th17 - type inflammation
39
What are the 5 suppressive effects of cigarette smoke on immunity?
Decreases: 1. Immunity to infections 2. Innate defenses againts pathogens 3. Adaptive immune cell activation 4. Function of natural killer cells 5. Phagocytic uptake of bacteria and apoptotic cells
40
What are the considerations for a patient undergoing dialysis and taking medication?
1. Consultation with nephrologist 2. Platelet dysfunction and anaemia resulting in bleeding tendency should be discussed 3. Heparin anticoagulation can be given to patient who is on haemodialysis - thus maybe try to do a procedure on another day 4. Avoid compression on the arm with the vascular access 5. Do not presribe some drugs - check with MIMS or consult with the renal specialist 6. Look out for renal osteodystrophy - there is weaker bone with those patients so extra care need to be taken care when performing surgery
41
How to manage a patient with a suspecious lesion?
1. Urgent referral - may curettage than send for histopathology 2. Similar management to normal-
42
What are the 4 effect of smoking on the oral cavity?
1. Xerostomia 2. Increase is dysbiosis of biofilm 3. Heat damage to the cells 4. Increase in extrinsice staining
43
What type of receptors are PMRs?
They are ruffini-type endings
44
During implant placement - how does some sensation occur?
Due to osseoperception - a type of mechanoreception in the absence of a functional periodontal mechanoreceptive input
45
What are the 4 locations where osseoperception may occur?
1. TMJ receptros 2. Receptors in the muscles 3. Mucosal receptors 4. Periosteal mechanoreceptors
46
What muscles cause referred pain in the ears?
Masseter and lateral pterygoid
47
What location can temporalis cause referred pain in?
Anterior temporalis: 1. Anterior maxillary teeth 2. Eye brows Posterior temporalis: 1. Posterior molar teeth 2. Just posterior of the temporal muscle
48
WHat is compressive force?
It is the property that affects shortening
49
What would a fracture of cribiforme plate cause?
Problems with smell
50
WHat will happen if the LHS ventral spinothalamic si affected?
Problems with crude touch, temperature and more
51
What are the 8 aspects of patient centered care?
1. Respect for the patient's values, preferences, and expressed needs; 2. Information and education; 3. Access to care; 4. Emotional support to relieve fear and anxiety; 5. Involvement of family and friends; 6. continuity and secure transition between health care settings; 7. physical comfort; 8. coordination of care.
52
What are the most likely diagnosis for an oral lesion in the retromolar area that appears as a white patch and coinsides with an over-errupted 18?
1. Frictional keratosis - due to friction 2. Oral lichenoid lesion 3. Oral squamous cell carcinoma
53
Why are root surface more susceptinle to caries?
1. Proximation to and creation of an ecological niche 2. Root surface is less minirelasied than enamel
54
How do bulk composites cure?
They cure by the use of a photo-initiator (light cure) but they can be cured deeper due to 1. A more translucent material 2. Filling that is more efficient in a present of a photo-initiator
55
Explaing the IMPEDE model
Statge 0 - health but overgrowth of G+ve bacteria in susceptible host individuals may cause gingival inflammation leading to Stage I Stage I - inflammation - gingival inflammation when prologned may cause alters in subgingival microenvironment, causing Stage II Stage II - polymicrobial emergence - now if the host is not susceptible, the immune system contains the polymicrobial emergence thus the patient goes between Stage I and II depending on different local and systemic factors - if they are suseptible, further deragulation of inflammation may occur causing Stage III Stage III - Inflammation-mediated dysbiosis - host immune and inflammatory reactions together with genetic pedisposition and environmental influences unable to contain infection and dysbiosis in tissues regulation occurs (early periodontitis) - if the conditions are not improve this leads to stage IV Stage IV - early periodontitis
56
What structure is under number 1?
LHS inferior border of the orbit
57
What structure in under number 2?
LHS Condyle
58
What is structure under number 3?
Superimposed over the sinus, malar process
59
What is structure under number 4?
Pterygo-maxillary fissure
60
What is the structure number 5?
Condesnsing osteotitis around the 35
61
What structure is under number 6?
Zygomatic arch
62
What structure in under number 7?
Ear lobe
63
What is structure under number 8?
LHS Inferior Alveolar Nerve Canal
64
What is structure under number 9?
Central Hyoid bone
65
What is the structure number 10?
RHS Styloid Process
66
What structure is under number 11?
RHS Maxillary Sinus
67
What structure in under number 12?
RHS Zygomatic Arch
68
What is structure under number 13?
Primary image of RHS hard palate
69
What is structure under number 14?
Secondary image of RHS palate
70
What is the structure number 15a?
LHS External Acoustic Meatus
71
What structure is under number 15b?
Genial tubuciles
72
What structure in under number 16?
Mandibular notch/oro-pheryngeal space
73
What is structure under number 17?
Nasal septum
74
What is structure under number 18?
Infra-orbital fissure
75
What is structure under number 19?
Nasal cavity/sinus
76
What is structure under number 20?
RHS Maxillary tuberosity
77
What are some of the common errors with bisected angle?
1. Elongation - vertical beam angulation is too shallow 2. Foreshortening - vertical beam angulation too steep 3. Vertical detertor postion - not the entire tooth structure present 4. Contact point of two adjacent teeth 5. Cone cutting
78
What are some of the options to achieve anaesthesia in the mandible?
1. IANB 2. Gal-gates technique 3. Mentla nerve block 4. Supraperiosteal infiltration
79
What are the steps to management of an oral lesion?
1. Take full patient history 2. Thourguh exam including palpations, stretchung and whipping - checking for symmetry 3. Risk factor modification 4. Accurate clinical diagnosis 5. SYmptom relief 6. Reviews/follow up
80
When is the perio unstable?
When there is BOP aove 10% and perio pockets are above 4mm OR Pocket above 5 mm
81
WHat is PSR?
It is perio screening test where teeth ahve been devided into sextant and probed Grade - 0 - nothing is occuring and nothing has to be done Grade 1 -bleeding on probing with no calculus - need for OHI and plque removal Grade 2 - bleeding and calculus present - OHI and subgingival and supragingival calculus removal Grade 3 - probing depth 3.5-5.5 - ohi, debridement and full periodontal exam and radiographs Grade 4 - probing depth abover 6mm - ohi, debridement, full periodontal exam, radiographs and surgical therapy
82
What are the six features are wrong with this OPG and what are the error on effect on final image?
1. Unnecessary artefacts i.e. the glasses - Results in unnecessary object being presented on the DPR, the glasses 2. Patient positioned forward - Anterior teeth blury and too small - spine sen on the film 3. Failure to position the tongue against the palate - large, dark, shadow over the maxillary teeth between palate and dorsum of tongue 4. Head is tilted to the side in the horizontal direction - condyles are not equal in height, nasal structure is distorted 5. Head is turned to one side - seems like the RHS was closer to the detector than LHS - resulting in LHS ramus appearing larger 6. Exposure factors have not been selected properly - the image appears to be blur overall 7. Chin down - the V shape - joker brain 8. Chin up - fraun
83
What are the standard precautions?
1. Hand hygine, as consistent with the 5 moments for hand hygiene 2. The use of appropriate personal protective equipment 3. The safe use and disposal of sharps 4. Routine environment cleaning 5. Reprocessing of reusable medical equipment and instruments 6. Respiratory hygiene and cough etiquette 7. Aseptic technique (the dirty and clena areas) 8. Waste management
84
What are the 5 moments for Hand Hygiene?
1. Before touching a patient 2. Before a procedure 3. After a procedure or body fluid exposure risk 4. After touching a patient 5. After touching a patient's surrounding
85
What is INR?
International Normal Rate is a test that identifies potential blood clotting issues by comparing them to an international norm (with 1 being norm and everything above is considered to be worst clotting = more bleeding)

BDS 3 Sem 1 (21 decks)

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