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Oral diseases/ radio > oral disease > Flashcards

oral disease Flashcards

1
Q

what is a cyst. why a radicular cyst might occur

A

a pathological cavity having fluid or semi-fluid contents, which has not been created by the accumulation of pus.
- not an abscess
-radicular= sequelae of periapical periodontitis

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2
Q

the 3 types of radicular cysts

A

Periapical= least common
Lateral= if lots of accessory canals
Residual- non-vital tooth has been extracted, cyst has not been treated and is left behind

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3
Q

signs and symptoms of a radicular cysts

A

-found at apex of non-vital tooth.
* Most common around the upper 2s
Presentation: Asymptomatic (if grossly carious), Pain ± Swelling, Tooth mobility / displacement
-Labial mucosa slightly bluish – compressible/ fluid filled qualities
-Has thinned labial plate of maxilla
-compressible

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4
Q

how cysts look on radiograph

A
  • Site - apex of non-vital tooth. Or at extraction site
  • Size - variable
  • Shape – round & unilocular (just one cavity)
  • Outline - well defined, corticated (got a clear white line around it) would be a tumour if not well defined outline
  • Radiodensity - uniformly radiolucent
  • Effects - buccal expansion (seen clinically), antral halo, root resorption (20%) & tooth displacement
    -potential root resorption, loss of interradicular bone
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5
Q

what is an astral halo and cause

A

resorption of antral floor in maxilla as a cyst has remodelled the floor and pushed it up.

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6
Q

what is the structure and histopathology of a cyst

A

-Most are Lined by non-keratinised stratified squamous epithelium. And hyaline bodies
-wall made of inflamed fibrous tissue with cholesterol clefts (breakdown products of blood/lipid) and haemosiderin (breakdown of blood)
-lumen filled with dead cells

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7
Q

how a cyst forms

A

-Hertwig’s root sheath breaks down to form epithelial rests of Malassez
-Proliferation of cell rests of Malassez, stimulated by inflammatory mediators
-At apex of tooth, rests begin to develop and form islands of epithelium
-Over time, as things epithelialize, cells in centre will break down due to lack of blood supply
-Accumulation of dead cells – forms a cavity
-Hypertonic – will draw water across into cavity (osmosis) enlarges
-Enlarges by unicentric blooming
-Wall has the capacity to produce bone resorbing factors as it contains inflammatory cells – resorbing factors released allow cyst to grow
-Not neoplastic – will eventually stop growing (no unlimited growth potential)

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8
Q

can cysts heal

A

yes. Orthograde root filling with good coronal seal should allow healing, if not it is a true cyst as these are not joined to the apical Forman

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9
Q

what is the difference between periapical abscess and radicular cyst and periodical granuloma

A

abscess = no epithelium lining. filled with pus
cyst = lined by epithelium
granuloma - simple chronic inflammation at apex

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10
Q

difference between apical true and pocket cysts. which respond to RCT

A

Pocket cyst – will heal after cleaning root canal, with good irrigation, as joined to apical foramen
True cyst – cyst not joined up to apical foramen. So not healed by RCT

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11
Q

Type of biopsy needed for cancer and a cyst

A

cancer= incisional biopsy
cyst= fine needle aspiration

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12
Q

how stroke and Bell’s palsy (facial nerve) symtpoms differs in the forehead

A

stroke= forehead sparing- can wrinkle forehead
cranial nerve palsy =paralysed so unable to wrinkle

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13
Q

what does periodic acid Schiff, ziehl hellion and elastic van gleson help stain

A
  1. fungal
  2. acid fast (eg. TB)
  3. blood vessels
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14
Q

which tooth is most likely to cause orbital cellulitis

A

upper canine

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15
Q

what to do if someone comes in with Ludwig’s angina

A

ring local A&E who will have to incubate them

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16
Q

what is median rhomboid glossitis and causes

A
  • a secondary form of candidosis
  • symmetrical shaped area in midline of tongue
  • Chronic infection
  • Atrophy of the filiform papillae
  • Associated with smoking & inhaled steroids
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17
Q

Actions of fluoride. what enzymes it inhibits

A

1-Reduces demineralisation: incorporated into outer layers, and in pits/ fissures. It can replace OH in calcium hydroxyapatite to make fluorapatite which is more stable and less acid-soluble
2-Promotes remineralisation: speeds up crystal precipitation, even at low pH, forming HA to mineralise the enamel.
3-Inhibits cariogenic bacteria: low plaque pH converts F to hydrofluoric acid which is taken up by bacteria. F ions released inside the cell which decrease microbial growth, metabolism and acid production by inhibiting enzymes. - inhibits pyruvate kinase and other enzymes to inhibit glycolysis so reduction in nutrients and reduction in lactic acid production
- inhibits ATP-ase proton pumps so less acidogenic
- Inhibits urease so bacteria less acidoduric

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18
Q

what is the critical pH in the mouth

A

-Solubility and therefore demineralization increases at low pH, below 5.5 (the critical pH).
- Calcium and phosphate are withdrawn from the enamel and into solution if pH is below this

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19
Q

How caries is caused

A

-bacteria metabolise free sugars in diet and produces lactic acid which demineralises minerals and disintegrates the organic material.
-Areas of the enamel can wear away creating a cavity.
-The bacteria and acid can reach the dentine which is softer and less resistant to acid. Dentine has tiny tubes that communicate with the pulp causing sensitivity.
- Bacteria can then make their way to the pulp which can become inflamed in response to the infection. The nerves become pressed, causing pain

-Primary teeth have thinner enamel & dentine so caries progresses more quickly.
-Posterior teeth have lots of grooves & multiple roots that collect food, and are harder to reach and clean so more prone to caries

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20
Q

What is IRMER and IRR. their aims, who they protect

A

-IRMER (2017)= ionising radiation medical exposure regulations. Protecting patients. Ensures good governance. Individuals are informed prior to exposure of the risks of any ionising radiation exposures they receive. Correct written protocols and documentation for procedures. Correct justification of exposures.

-IRR= Protecting staff and general public. Ensure staff follow local rules, code of practice, use warning lights, under close supervision.

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21
Q

Who sets the safe radiation doses

A

International Comission on Radiological Protection (ICRP)

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22
Q

What is a RPS and RPA

A

Radiation protection Advisor:
Is a medical professional that does routine checks, helps create local rules and helps with all aspects of radiation protection. checks the installation of radiation equipment

-Radiation protection supervisor:
- Is a named member of the practise who provide instructions to the radiology team and ensures local rules are followed

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23
Q

What are deterministic and non-deterministic effects of radiation

A

-deterministic= determined by dose. Effects include skin erythema (4Sv), cataracts, fatal death (50Sv)
-non-determinisitic= not determined by dose. No threshold dose value. occur by chance. There is no safe dose for even smallest amounts of radiation. no level of radiation where risk of cancer is zero

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24
Q

Different ways radiation can affect DNA, directly and indirectly

A

-Direct: Causes ionization which either can be repaired and survives, unable to repair causing cell death, mutate and cause cell death, or mutate and cause cancer where cell division does not stop
-Indirect: Interacts with water molecule causing it to split, causing free radical and causes unwanted reactions

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25
Q

Difference between absorbed dose, equivalent dose and effective dose of radiation. their units

A

-Absorbed= energy per unit mass of tissue (grey per m2 or DAP. How much hits the skin)
-Equivalent= considers radiation weighing. For X-rays you multiply by 1
-Effective dose (uSv)= more useful, considers type of tissue being radiated and how radiosensitive they are. Each tissue has specific values (eg. thyroid high so higher effective dose in mandible region)

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26
Q

How to calculate effective dose

A

equivalent dose x tissue weighting factor
=uSv

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27
Q

How much radiation is 2 PAs (effective dose)

A

5-10 uSv
Equivalent to European flight

28
Q

How much radiation is a full mouth of PAs, DPT, and CBCT (effective dose)

A

-full mouth of PAs = 150uSv
-DPT= 19uSv (equivalent to transatlantic flight)
-CBCT= 155uSv

29
Q

How the effective dose of a CBCT compares in the maxilla and for a mandibular molar

A

-maxilla = 33uSv
-mandible= 78uSv

due to thyroid in mandible view, which has high radiosensitiivty

30
Q

How much higher is risk of radiation in children compared to adults. What regulations are in place

A

under 10 years have risk factor x 3
-no routine views
-fastest image receptor
-collimation use
-thyroid collars (if don’t obstruct view)
-reduced child size exposure
-only CBCT when necessary (as use higher dose)

31
Q

Explain the model of efficacy for diagnostic imaging

A

-Fryback and thorn bury (1991) created a hierarchal model of efficacy of imaging, to help with justifying taking images using radiation
1. Technical efficacy= does the machine do what it is meant to (good quality, no artefacts)
2. Diagnostic accuracy (sensitive and specific)
3. Diagnostic thinking=images judged to be helpful
4. Therapeutic efficacy=helpful in planning treatment
5. Patient outcome=does it make a difference to the patient
6. Societal efficacy =cost-effectiveness analysis

32
Q

Explain the IRMER duty roles of referrer, practitioner, operator and reporter. What is the role of the employer

A

-referrer= Dentist/ dental therapist/ senior nurse, who wants to initiate imaging process. Need 3 forms of patient ID, relevant dental and medical history, previous imaging.
-practitioner= GDP or radiologist. Looking at the patient data and decides if it is justified
-operator=takes the image. Responsible for authorisation (correct patient, justification adequate)
-reporter= reports on image. called the IRMER operator.

Employer= sets policy and ensure all of this works well using a set of employers procedures. Entitles staff in their IRMER roles.

33
Q

What local rules include for radiation use

A

-dose level
-contigency plans and how to report accidents
-identifying controlled areas
-procedures to restrict staff exposures
-restricting access to controlled area, otherwise need protection measures
-wearing PPE if necessary
-arrangements for pregnant staff
-procedures for initiating investigations
-contact details for the RPA (radiation protection supervisor, who ensures Staff Induction and emergency actions)

34
Q

What are the 2 options of controlled areas

A

1-whole room is controlled area, so operator stands outside room
2-1.5m from tube head and anywhere in primary beam

35
Q

What is DAP

A

dose area product.
mGy per unit area (m^2). How much reaches patients skin
Absorbed dose, (does not tell you how damaging it is to tissues). Can be used to calculate the effective dose

36
Q

What are diagnostic reference levels (DRLs) for radiation

A

-curve that shows the distribution of what doses people relieve, and averages
to identify doses that are overly high. which will then need investigating

37
Q

Ways to reduce the probability and magnitude or an unintended exposure

A

-induction programmes for new staff
-grading and review of dental images
-clinical audit including audit of procedures
-good practice and technique applied
-investigation fo near miss incidents
-peer review of images - looking at image quality to include positioning, collimation, density, sharpness and exposure
-specific procedures and protocols in place and regularly reviewed
-patient identification

38
Q

Definition of consent and what is involved

A

-a person giving permission before they receive medical treatment, test or examination
-the must be given all the information (risks and benefits, alternatives) to make an informed decision

39
Q

When thyroid covers are needed

A

can be used to minimise exposure to thyroid
but Covering up thyroid may actually cover up something that is essential for the diagnosis
Never used with DPT as causes artefact

40
Q

Patient pregnancy and radiograhy in dentistry

A

-Radiography in dentistry is remote to area of fetus so can be taken as normal, using collimation
-not damaging to foetus except for vertical occlusal
- But if she would want to wait till after birth then that is her decision

41
Q

How pregnant staff should handle taking radiographs

A

-they must inform their employer as soon as they are aware
-they are required to ensure the dose to the foetus will not exceed 1 mSv for the remainder of the pregnancy and putting it in writing sets the start date.

42
Q

What to do if unintended or accidental exposure (eg. CBCT the wrong patient)

A

-this would be 20x the intended dose so…
-document
-report to RPS
-employer needed to do preliminary investigation
-inform practitioner and referrer
-analyse exposure using SAUE criteria
-report to Scott’s ministers or CQC
-The event then formally disclosed
to the patient- DUTY of CANDOUR
-carry out investigation

43
Q

How long after a significant accidental and unintended exposure must the employer notify the appropriate enforcing authority

A

as soon as possible after the preliminary investigation, no later than 2 weeks after discovering the incident

44
Q

What is SAUE

A

criteria for making a notification for an accidental or unintended exposure
contingency measures if dose level > 3mSv

You do not need to make a statutory notification for:
Repeat exposures involving no procedural, human, systematic or equipment errors. These are not included in the definition of SAUE. (eg.where original images are undiagnostic and need a technical repeat or are not diagnostic due to contrast extravasation or movement)

45
Q

How much training is required by the GDC for taking radiographs

A

5 hours per 5 year cycle

46
Q

What factors influence the justification of taking a radiograph

A

-Staff meet criteria of competence
-pathology
-consent by patient
-risk and benefit- is there net benefit
-dose required
-patient history
-other alternatives with no / reduced dose

47
Q

Cancer risk for intraoral, panoramic, staff at 1.5m, CBCT >60 years, CBCT 8-11 years old

A

Intraoral = 1 in 4 million per film
Panoramic = 1 in 2 million per film
Staff at 1.5 m = 1 in 67 million per film
CBCT >60 yrs =2.7 per Million
CBCT 8-11 years= 9.8 per Million
CBCT average = 6 per Million

48
Q

Which has higher dose, cone beam CT or medical CT. Which is used for seeing soft tissues, which for hard tissues

A

-CBCT= lower dose. better for hard tissues. Fine for seeing bone and ID canal
-Medical CT= higher dose. But see soft tissues much better. Fan beam. Patient supine

49
Q

What does a lateral ceph show. landmarks

A

image taken at a known distance so can work out measurements. Soft tissue profile seen against bone. Looking at pathology and development
-frontal sinuses, facial bones, pituitary fossa, upper cervical spine

50
Q

Is a lower or higher kv better for soft tissues

A

lower. 60kv instead of 70

51
Q

Does a larger or smaller distance between the object and film give larger magnification

A

large distance

52
Q

What is a cone beam CT

A
  • a cone shaped X- ray beam with a 2D detector.
    -X-ray tube rotates around patient
    3D data set made using an algorithm.
53
Q

Uses of CBCT in dentistry

A

-seeing hard tissues, Inferior dental canal in relation to lower 3rd molar
-TMJ problems
-virtual implant planning
-3D printing
-mapping out small vessels. Prevents floor of mouth bleeds which is life threatening
-endo
-ortho, but not as common as uses higher doses than lateral ceph
-orthognathic surgical planning
-trauma imaging
-cysts

54
Q

What is a conventional CT and how it works. and how MRI works

A

-computed tomography= take a fast series of X-ray pictures, which are put together to create images of the area that was scanned. Multi-slice scanner to create a 3D image. Can inject dyes to show vessels. Help diagnose tumors, investigate internal bleeding, or check for other internal injuries or damage
-magnetic resonance imaging= uses strong magnetic fields to align the body’s protons and the energy they give off are detected

55
Q

How ultrasound works

A

-Sound emitted, it bounces off afferent tissues differently, detector picks up sounds and creates an image
-Image produced due to Acoustic Impedance
- Soft tissue/bone interface 70% transmission
-Gas/ Soft tissue interface100% reflexion

-non-ionising so safer than x-rays
-can look at vasculature (atherosclerosis), parotid, cysts

56
Q

How ultrasound frequency affects resolution and penetration

A

Higher the frequency = Increased resolution
Higher the frequency = Decreased penetration

57
Q

When would you do an excision and incisional biopsy*

A

-When the entire tumor is removed, it is called an excisional biopsy. To both confirm a cancer diagnosis and remove a tumor during the same procedure. They’re used when a larger sample is needed to determine if a tumor is cancerous
-If only a portion of the tumor is removed, it is called an incisional biopsy. If cancerous can remove it later and still knows where it begin and ends

58
Q

When would you do a fine needle aspirate biopsy

A

fluid filled lesion - cyst or pus
cyst looks fatty oily shimmery

59
Q

Would you treat someone with cold sores

A

-don’t treat if infectious as don’t want it spreading and causing herpetic whitlow for example
-Encourage rest, fluids, paracetamol
-only treat once vesicles crusted over

60
Q

What to do with someone with a dental infection and fever

A

-it has become systemic
-need to figure out what is the cause
-IV antibiotics

61
Q

Do acrylic or cobalt chromium colonise more candida

A

acrylic as more porous. candida can into it so hard to clean and resolve the infection. Likely a new denture needs to be made. Ideally get the candida to resolve in the mouth by not wearing the dentures for a while as taking impressions while it is still inflamed would make them inaccurate

62
Q

Guidelines for bisphopshantes and extractions

A

-half life of 10 years so stopping medication won’t do anything. Consider other alternatives
-if need to take out, take out as atraumatic as possible. Review after 2 weeks to check it is healing ok
-then 8 week review

63
Q

In the Medicines act, explain GSL, P and POM medicines. List examples of drugs

A

-general sales list (GSL)= no pharmacist needed on site. Paracetamol 16 pack
-Pharmacy medicines (P)= over-the counter. No prescription needed but pharmacist needs to be present. Eye drops, paracetamol 23 pack
-Prescription only= antibiotics, LA

64
Q

What are controlled drugs

A

-considered potentially dangerous or harmful and may cause addiction. They also have the potential for misuse.
-3 categories:
Class A= Most dangerous
- A=Cocaine, ecstasy, heroin, LSD, methadone, Morphine, Methadone (after misuse of heroine)
-B=amphetamine, barbiturates, codeine, cannabis, Codeine, DHC
-C=mild amphetamines, anabolic steroids and minor tranquillisers. BDZs, Ketamine, Buprenorphine, Tramadol
-fitness to practice penalties associated with controlled drugs used for non-medicinal purposes

65
Q

Requirements for writing a prescription

A

in ink, dated, patient name, address, DOB, signed by prescriber, practice address

drug name, quantity (no. of tablets), dose (avoid decimal points), frequency, duration, regimen

66
Q

Rules for prescribing

A

only prescribe for dental issues
must not prescribe meds for yourself
unless in emergencies, don’t; prescribe for those you have a close relationship with
only use remote means to prescribe (those you haven’t seen) if there is no other viable option and it is in their best interests

67
Q

Difference between pharmacokinetic and pharmacodynamic drug interactions

A

-1 drug affects the concentration of another drug at its site of action by affecting absorption, distribution, metabolism or excretion
2-drug effect is influenced without its concentration at the site of action being affected. Agonising and antagonising effects

Oral diseases/ radio (2 decks)

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