Primary Care Flashcards
(354 cards)
0
Q
What is the palmar system?
A
Primary teeth= a-e
Permenant teeth= 1-8
1
Q
How many teeth are in the primary dentition?
A
- 2 incisors, one canine and 2 molars
2
Q
What is the FDI system?
A
Permanent teeth= 1-8
Primary teeth=1-5
Quadrants numbered 1-8
First 4 are permanent quadrants
3
Q
What are primary eruption dates?
A
6-9 months= lower then upper As 7-10 months= lower then upper bs 12-16 months= all ds 16-20 months= lower then upper cs 23-30 months= lower the. Upper es
4
Q
What is the occlusion at birth?
A
Gum pads occlude distally
Anterior oval opening to allow suckling
Fleshy labial frenum
5
Q
What is the 6-10 month occlusion?
A
Maxillary incisors erupt labially to the mandibular incisors
6
Q
What is the 36 months/3 year occlusion?
A
Primary dentition is complete Incisors vertical and spaced Deep over bite Anthropoid spaces mesial to maxillary canine and distal to mandibular canine Flush terminal plane
7
Q
What is the occlusion at 6 years?
A
Overbite decreases
Spaces of anteriors
Attrition of incisors
8
Q
What are the eruption dates of the permanent dentition
A
6-7 years= lower 6s and 1s, then upper 6s, the upper 1s 7-8= lower 2s 8-9= upper 2s 9-11= lower 3s 10-12=all 4s then all 5s 11-12= upper 3s 11-13= all 7s
9
Q
What is the mixed dentition occlusion of a 6 year old?
A
Eruption of first permanent molars
Mesial migration of primary molars
Anthropoid spaces close
Permanent molars in class 1 or half class 2 relationship
10
Q
Occlusion of 7-8 year old?
A
Maxillary incisors erupt spaced and more proclaimed the there primary predecessors
Maxillary lateral incisors are often distally inclined
Maxillary incisors labial to mandibular
11
Q
What is leeway space?
A
The difference between the combined mesiodistal width of the primary canines and molars, and the permanent canines and premolars
12
Q
How big is the maxillary arch?
A
1.5mm
13
Q
How big is the mandibular arch?
A
2.5mm due to larger 2nd molars
14
Q
Describe the 9-12 year occlusion
A
Primary canines and molars are exfoliated Permanent molars drift into leeway space and form class 1 occlusion
15
Q
When can we palpate the upper canines?
A
At 10 years old
16
Q
Describe the 11-12 year occlusion
A
The Incisal spacing reduces as the maxillary canines erupt
17
Q
Describe the 11-13 permanent occlusion
A
All primary teeth have exfoliated
First permanent molars I class 1
Second permanent molars erupting
18
Q
What are the potential consequences of loosing primary teeth early?
A
Delayed or accelerated eruption of the successor
Space loss and crowding in the permanent arch
19
Q
Should teeth erupt out of sequence?
A
Eruption dates may vary, but sequence should not
A tooth may not erupt at the same time as it’s contralateral counterpart, but you should not be suspicious until a tooth has still not erupted 6 months after it’s counter part
20
Q
What were the conclusions of the child dental health survey?
A
Overall improvements in decay seen in permanent teeth
No significant reduction in decay experienced in primary teeth
Clear regional differences with no change
21
Q
What are the high risk categories?
A
Medical history Dietary habits Clinical evidence Social history Use of fluoride Plaque control
22
Q
What are the medical factors of caries risk?
A
Medically compromised
Physical disability
Xeristomia
Long term cariogenic medicine
23
Q
What are dietary factors of caries risk?
A
Frequent sugar intake
Intake between meals
24
What clinical signs help determine caries risk?
```
New various lesions
Premature extractions
Anterior caries/restorations
Multiple restorations
No fissure sealants
Fixed orth
```
25
What social signs help determine caries risk?
```
Social deprivation
High caries in family
Low knowledge of dental disease
Irregular attendance
Readily available snacks
Low dental aspirations
```
26
What fluoride factors help determine caries risk?
Fluoridated water
No toothpaste/un fluoridated
No fluoride supplements
27
What plaque control factors which help determine caries risk?
Infrequent or ineffective cleaning
| Poor manual control
28
Prevention strategies of caries
```
Diet
Fluoride
Fissure sealants
Ohi
Prevention of maternal transmission of s.mutans
Cpp-acp
```
29
What is ecc?
Early childhood caries
dmft in primary dentition before 71 months
Commonly seen due to bottle feeding. Lower anterior teeth spared
30
What are the causes of ecc?
Frequent consumption of sugary drinks in a bottle
Longer period of exposure to cariogenic substance
Low salivary flow at night
Parental history of untreated caries
31
What are the characteristics of ecc?
Rampant caries effecting the maxillary anteriors
Lesions appear later on posterior teeth
Canine usually less affected due to later eruption
32
What are the consequences of ecc?
Higher risk of new carious lesions
Increased treatment cost and time
Risk for delayed physical growth and development
Loss of school days and increased days with restricted activity
Diminished oral health related to quality of life
Hospitalisation and a and e appointment risks
33
How do we try to prevent ecc?
Reduce parent and siblings strep mutants levels to decrease over all transmission
Minimise saliva sharing activities
Implement oral hygiene measures
Avoid high frequency consumption of foods contains sugar
Encourage infants to drink a cup by 1 year
34
How do we manage ecc?
```
Cessation of habit
Dietary advise
Fluoride application
Build up of restorable teeth
Extractions if required
Appropriate advise, no blame
Possible treatment under GA
```
35
How do we know if we have successfully managed ecc?
```
Has the bottle stopped
Have oh practises changed
No progression of the disease
No new lesions
Caries shows signs of arresting
```
36
What is the purpose of a caries risk assessment?
Helps us treat the risk not the outcome of the disease
Individual selects frequency of protective and restorative treatment
Anticipates progression and stabilisation
37
Why do we do prevention based on risk?
Because decay is unevenly distributed within a population
38
What are the none fluoride prevention methods?
```
Diet modification
Oho and dental earth education
Fissure sealants
Sugar free medicine
Chewing gum
Chlorhexadine
```
39
What did the coma report 1989 say?
Caries is positively related to frequency and amount of non milk extrinsic sugar consumption
Recommended:
Consumption of nmes should be reduced and replaced by fruit, vegetables and starchy food
40
What is the daily recommended sugar intake according to delivering better oral health?
10% of daily energy intake
Less than 60g per day for adults
Less than 33g per day for young children
41
What did the vipeholm study show?
Positive correlation between caries and sugar intake
| More frequent sugar intake not at meal times leads to increased caries
42
What was the message of the hope wood house study?
Children ha massively reduced levels of decay compared to the rest of the population due to strict sugar controlled diet
When they left the house and no longer eat the provided diet, levels of decay massively increases
43
Will toothbrushing help prevent dental decay?
Little evidence to support that tooth brushing alone will prevent caries
However, use of fluoride toothpaste is of benefit
44
What do the cochranne collaboration say about fissure sealants in children and adolescents?
Recommended in the occlusal surface of permanent molars
Effectiveness is evident at high caries risk
78% less caries in permanent molar teeth with resin based sealer after 2 years and 60% less after 4 years
Some evidence that sealing is better than fluoride varnishes
45
Who do we fissure seal?
Children and young people with:
Impairments
Caries in primary teeth
46
Where can we fissure seal?
First permanent molars
Palatal pits of permanent lateral incisors
Second permanent molars and premolars
Primary posterior teeth in children at high risk of caries
Teeth must be erupted enough for good moisture control
47
How do we etch for fissure sealants?
With 30-40% phosphoric acid for 20-40 seconds
48
What materials can we use to fissure seal?
Resin
GIC
Compomer
Fluoride contains sealants
49
Can chewing gum prevent caries?
Xylitol and sorbitol have anti caries properties through saliva stimulation.
Xylitol is more effective than sorbitol
Should encourage patient use
According to sign 47
50
What does sign 47 say about chlorhexidine?
Can be used prophylactic in the form of rinse, gel or pasteand can achieve a substantial reduction in caries
Can also consider chlorhexidine varnish as prevention
51
What do cochrane say about fluoridated milk?
Insufficient evidence
52
What do cochrane say about topical fluoride?
Used in addition to fluoride toothpaste show a modest reduction in caries compared to fluoride toothpaste alone
53
What prevention should we consider for all children?
Diet diary and sugar reducing advise
Fissure sealants for first permanent molars
Evaluation of fluoride sources
Twice daily toothbrushing, supervised under sevens
55
What toothpaste should 3+ children be using?
1350-1500 ppm, a pea sized amount
56
What should we be doing for all high risk children?
1350-1500 ppm toothpaste
Duraphat varnish 3-4 times yearly
Also add ether mouthwash or prescribed higher fluoride toothpaste
57
How do we prescribe high fluoride toothpaste?
10+ 2800 ppm
| 16+ 5000 ppm
58
What mouthwash can we give children able to rinse and spit (6+)?
Sodium fluoride mouth was daily 10ml= 0.05%
| Sodium fluoride mouthwash weekly 10ml= 0.2%
59
What are the benefits of water fluoridation?
1ppm
50% overall reduction in caries. Particularly on interproximal and smooth surfaces
30% reduction in pits and fissure
Minimum amounts of mottling
60
How does fluoride work?
Low concentrations of fluoride in the saliva
Creation of fluorapatite crystals instead of hydroxyapatite
Reduces critical ph from 5.5 to 3.5
Resistance to acid dissolution
Reduces demineralisation
Predominant effect is topical
61
What's in our fluoride toolkit?
```
Toothpaste
Mouthwash
Varnish
Drops
Tablets
Gel
Foam
Glass beads
```
62
What did cochrane say about toothpaste?
Fluoride toothpastes are effective at preventing caries
Benefit only shown at 1000ppm and above
Dose response relationship
Potential for fluorosis i under 12
63
What did cochrane say about fluoride supplements?
Reduction in caries increment when compared to no supplement in permanent teeth
Effect unclear on primary teeth
Evidence overall is weak
64
When should we not use duraphat topical varnish?
Ulcerative gingivitis
Stomatitis
History of hospital admissions due to allergy, including asthma
65
What do cochrane say about topical fluoride varnish?
When used twice yearly:
DFMT prevented 46%
dmft prevented 33%
66
What is a toxic dose of fluoride?
Approx 1mg F/kg body weight causes gi upset
| 32-64 mg F/kg causes lethal poisoning
67
What happens with to much fluoride?
Blocks cell metabolism
Interferes with calcium metabolism
Nerve impulses and conduction
68
What are the signs and symptoms of fluoride over dose?
Nausea/vomiting/diarrhoea
Excessive salvation/tears/mucus/sweat
Headache
Generalised weakness
69
How do we deal with a fluoride overdoes?
Get a clear history
Check dose of fluoride against packet and see how much is left
Support vital signs
Management depends on dose. 5mg/kg+ send to a and e
As much milk as possible
70
What do we do with 5-15mg/kg overdose?
Send to a and e
Observe, support vitals, milk
Gastric lavage
71
What do we do with +15mg/kg over dose?
Send to a and e
Calcium gluconate Iv
Activated charcoal 1g/kg ever 4 hours and gastric lavage
Life support and cardiac monitoring
72
What is the mechanism of fluorosis?
Affect on enamel maturation by impairing mineral mineral acquisition
Greatest risk for centrals at 15-30 months
Coronal development completed at 6 years
73
How do we prevent fluorosis and overdoes?
```
Good history
Examine packaging carefully
Aim for topical not systemic
Avoid critical age 0-6
Targeted use
Good education for parents
Prescribe maximum of 120mg of supplements at a time
```
74
Describe the anatomy of primary molars?
```
Thin, uniform thickness enamel
Smaller crowns with marked constrictions
Narrow occlusal table
Broad contact areas
Large pulps
Large mesio buccal horn
Thin pulpal floor
Early radicular pulp involvement
```
75
What are the implication of primary molar anatomy on restorative dentistry?
Rapid caries progression
Short clinical crown makes matrix bands difficult
Need to restore broad contact point
Thin enamel with less tooth structure protecting the pulp
Mesio buccal pulp horn easily exposed
Long flared roots make pulp extinct difficult
76
Is ionisation radiation risk greater I'm children?
Yes. Below 10 the risk is 3x higher. Therefore radiation should be alarp
77
What is the first choice radiograph in children with both deciduous or mixed dentition?
Intra-orals
| Oblique laterals and dpts may be needed in some situations
78
Do radiographs in children improve diagnostic yield?
Yes. 2-8x more than clinical examination alone
79
What are the radiographic recommendations for high caries risk children?
6 monthly bitewings until no new active lesions are apparent and the individual has entered another category
80
What are the radiographic guidelines for a moderate caries risk child?
Annual bitewings
81
What are the radiographic guidelines for a low caries risk child?
Bitewings every 12-18 months in the primary dentition and every 2 years in the permanent. More extended intervals can be used if there is explicit evidence of low risk
82
What percentage of children have radiographs with there GA referral?
10-12%
| 100% need them
92
What toothpaste should 0-3 year olds be using?
1000 ppm, a smear
93
What are the limitations of radiographs in children?
Cooperation issues
Anatomical difficulties: narrow arch, shallow palate
Occlusal caries may not be visible
May have overlap
94
What size film should be used I under 10s?
Size zero
| With a tab not holder in under 7s
95
What is the distribution of disease in 5year olds?
70% have caries free dentition
Average dmft is 1.1
More than 86% of those with caries are untreated
96
What is the most frequent are of decay in 10year olds?
60% is interproximal
97
Wha are the factors influencing the choice of restorative material?
Patient factors: caries status, general health, para function, age, diet, cooperation
Tooth factors: teeth location, cavity design, pulp involvement, dentition, occlusal load, tooth quality
Operator factors: material properties, quality of finish, moisture control, expertise, anaesthesia
98
How do you manage approximal surface caries which is confined to enamel?
Encourage to arrest: topical fluoride, prevention advise, monitor
99
How do you manage approximal caries which is into dentine?
Restore: inter coronal/extra coronal restorations
100
What are Fuji 2 lc, Fuji 8, vitremer, photic fil?
Resin modified cement
| Lower viscosity but similar strength to compomer
101
What are the advantages of resin modified GIC?
```
Adhesive
Aesthetic
Leach fluoride potentially
Light cured
Radioopaque
Wear resistant
```
102
What are the disadvantages of resin modified cement?
Limited data
Leach fluoride?
Need good moisture control
103
What is poly acid modified resin?
Compomer
104
What are the advantages of compomer?
```
Adhesive
Aesthetic
Leach fluoride?
Light cured
Radiopaque
```
105
Disadvantages of compomer?
Multistage technique
Leach fluoride?
Moisture control
106
What are the advantages of GIC?
Adhesive
Aesthetics
Fluoride leaching
Good temporary
107
What are the disadvantages of GIC?
```
Long set
Brittle
Poor resistance to wear and erosion
Radiolucent
Moisture damage
Only useful for less than 2 years in class 2
```
108
What is the evidence for amalgam in class 2s in primary molars?
A systematic review shows they would survive a minimum of 3.5 years.
However concerns over safety and aesthetics are making them less popular, despite a lack of evidence
109
What does the evidence say about GIC and rmgic in class 2 cavities in primary molars?
A systematic review says that GIC should not be used. There is evidence that rmgic is successful in small to moderate cavities. There is some evidence that conditioning dentine improves the success of rmgic
110
Which dental material would we temporise with in child dentition?
Conventional GIC= triage/Fuji 7
111
What permanent restorations would we consider in the primary dentition?
If a rubber dam can be placed we would use composite. If not we would place rmgic (Fuji 2) or compomer (dyract)
112
Indications for a ssc in the primary dentition?
Most interproximal cavities
2 or more carious surface
All pulp ally involved primary molars
Young children
113
What are the contraindications of ssc in the primary dentition?
Non-vital
Small occlusal cavity
Tooth soon to exfoliate
Parental preference
114
What are the frankl behaviour ratings?
1=definitely negative
| 4=definitely positive
115
Is there a difference between pulp regeneration in primary and permeate teeth?
Not really
116
Is there a difference between reparative potential of dentine pulp complex in primary or permed any teeth?
Reparative potential is greater than anticipated in primary teeth, if caries progression can be haunted before the pulp is overwhelmed
117
What is pulpal inflammation like in primary teeth?
Occlusal less so than proximal
118
What are the symptoms of a reversible pulpitis?
```
Provoked
Disappears on removal of stimulus
Shorter duration
Relieved by analgesia
Sharp pain
```
119
What are the symptoms of irreversible pulpitis!
```
Spontaneous
Constant
Long duration
Not always relieved by analgesics
Dull throbbing
Sleep disruption
```
120
Do we vitality test primary teeth
No
121
Do we use ttp in primary teeth?
Yes. Distinguish food impact ion from peri-radicular pathology
122
When debating restore vs extract, what factors do we consider?
Medical
Social
Dental
Pulp status
123
What are some medical reasons we would retain a primary molar rather than extract?
Bleeding disorders
| Patient at risk of GA
124
What are some medical reasons we would extract a primary molar rather than restore?
Immune compromised
| Cardiac disorder such as ie risk
125
What pulp therapy would we consider in a vital pulp?
Pulp capping
| Pulpotomy
126
What pulp therapy would we consider in a non-vital primary pulp?
Pulpectomy
| Extraction
127
What is pulp capping?
A method of maintaining the vitality of the pulp by placing a dressing either directly on to an exposed pulp or onto residual dentine over nearly exposed pulp. Aims to protect pulpal health
128
What medicaments is commonly placed in a direct pulp cap?
Calcium hydroxide
129
What are the aims of a direct pulp cap?
To promote dentine bridge formation over exposure and to preserve vitality
130
Is direct pulp camping successful?
In permanent teeth yes
| Not recommended in primary molars as treatment is rarely iatrogenic
131
What are the aims of an indirect pulp cap?
Arrest caries
Allow for formation of reactionary dentine and remineralisation of dentine
Promote pulp healing and preserve vitality
132
What are the indications for an indirect pulp cap?
deep carious lesion
No signs/symptoms of pulpal pathosis
No radiographic pathology
133
What is a pulpotomy?
The removal of the coronal part of the pulp tissue, assuming this part is irreversibly inflamed
Done in vital, asymptomatic/transient pain, no radiographic pathology
134
Does pulpotomy use a rubber dam?
Yes
135
What are potential pulpotomy medicaments?
Ferric sulphate- haemostatic agent. Agglutination I blood proteins .Reaction with blood forms a barrier
136
Why don't we use calcium hydroxide in pulpotomy?
High failure rate
| Internal resorption
137
Why don't we use formocresol in pulpotomy?
Safety concerns
138
Why don't we use MTA in pulpotomy?
Expensive and not readily available
139
What is mih?
Hypo mineralisation of systemic origin of one or more of the four permanent molars, as well as any associated or affected incisors
140
What is the prevalence if mih?
3.6-25%
141
How does mih present?
```
Affects one or more of permanent molars
Demarcated patches
White-brown, cream
Post eruptive breakdown
Missing sixes
Heavily restored abnormal restorations
Calculus
```
142
What are the differential diagnosis's of mih?
Fluorosis
Ameligenesis imperfecta
Turner tooth
Idiopathic hypo mineralisation
143
What happens in amelogenesis?
```
Odontoblasts secrete type 1 collagen
Ameloblasts differentiate
Secrete enamel proteins
Change shape
Cause mineralisation
```
144
What happens during the secretory phase of amelogenesis?
Defines the form of the tooth
Deposition of organic matrix plus small thin crystals
Incremental growth in thickness
Not a continuous process
145
What causes enamel hypoplasia?
Disruption in secretory phase
Early in development
Small pits and grooves
Gross enamel surface defect
146
What is the maturation phase of amelogenesis?
```
Establishes the quality of the tooth
Degradation of the organic matrix
Mineralisation
Ameloblasts move ca2+ and po4
Process continues post eruption
Apoptosis of the ameloblasts
```
147
Describe enamel hypomineralisation
```
Disruption in the maturation phase
Poor mineralisation of matrix
Later in development
White/brown opacities
Normal thickness but more quality
```
148
How does enamel hypo mineralisation appear down the microscope?
Altered ca/p ration
Less distinct enamel rods
Bacterial penetration of enamel
Lower hardness
149
Is mih linked to chemical exposure?
Evidence for exposure to environmental chemicals is weak
It is connected with breast feeding
Weak evidence of an association with fluoride
150
Do peri-natal problems increase mih prevalence?
Malnutrition, maternal health, birth problems
Many confounding factors
Weak evidence
151
Do common childhood illnesses implant on mih?
No clear evidence
| Weak evidence for chronic problems
152
What are the options for repairing the aesthetics on mih incisors?
```
Micro abrasion
Etch bleach seal
Bleach
Composite
Bleach and composite
```
153
What do we do in etch bleach seal?
60s etch
Bleach 5% NaCL, 5-10 mins
Reetch and fissure seal
154
Is caries in the first permanent molars common?
Yes, over 50% of children over 11 have it
| Occlusal surface 6s accounts for 90% of caries in children
155
When managing first permanent molars we consider what?
Patient factors
Dental factors
Orthodontic factors
156
What radiographs do we need to assess patient factors I. The management of permanent molars?
Dpt to examine the other teeth, some yet to come through
157
When is the best time to extract a first permanent molar?
Root bifurcation of the 7 forming
| 8-10 years
158
Which is worse, late extraction of 6 or early?
Late
159
What is the preferred restorative technique in a fpm which is vital but with deep caries?
Indirect pulp capping
| Not direct or pulpotomy due to long term prognosis
160
What are the issues with ssc in fpm?
Technically more challenging
La often required
Monitor eruption of 7s as potential for impact
Occlusion
161
What anatomy will affect an idb in a child?
Children's ascending Ramus is shorter and narrower anterior posteriorly
Decreases depth of needle penetration
162
Describe articane
4%
| 1:100000 adrenaline
163
Which teeth are used for a grubby score?
Upper right six
Upper left one
Lower left six
Lower right one
164
What are the gum scores?
```
0= healthy pink and stippled
1= marginal reddening, no swelling
2= red with swelling
3= bleeding on gentle probing
```
165
What are the signs of a faint?
```
Nausea
Pallor
Thready pulse
Loss of consciousness
Cyanosis
Fits
```
166
How do we manage a faint?
Supine
Maintain airway
Give oxygen
167
What are the signs of hypoglycaemia?
```
Trembling
Sweating
Hunger
Truculence
Disorientation
Slurring
Loss of consciousness
```
168
How do we treat hypoglycaemia?
Conscious= glucose drink 10-20g
Unconscious= glucagon 1mg intra muscularly
Airway and oxygen
Transfer to hospital
169
How do we manage an epileptic fit?
Protect from injury during
Maintain airway and oxygen
In status epilepticus give midazolam buccal liquid 10mg/ml
170
What kind of la is articaine?
Ester, processed by plasma cholinesterases
171
In what form is la active?
Hydrophilic ionised form
172
What's the half life of lidocaine?
90mins
| 45-60 min pulpal duration
173
What's te half life of articaine?
20mins
| Pulpal duration 75mind
174
Which areas will be innervated by the posterior superior alveolar nerve?
All of the 8 and 7
| May not get the mesio buccal root of the 6
175
What does the nasopalatine nerve innervate?
Palatal gingival 3-3
176
What does the greater palatine nerve innervate?
Palatal gingival 8-4
177
What are the landmarks for an idb?
Thumb on the coronoid notch
| Pterygomandibular raphe
178
What is alveolar osteitis?
Dry socket
Usually post extraction
Inflammation of the alveolar bone
Thought to be loss of blood clot leaving alveolar bone exposed to the oral environment
179
What is the incidence of dry socket?
1-20% of routine extractions
| Up to 30% of third molar extractions
180
What are the symptoms of dry socket?
```
Occurs a few days after extraction
Painful
Bad taste and odour
Not relieved with analgesics
No pyrexia
No swelling or infection
```
181
What factors influence dry socket?
```
Smoking
Oral contraception
Local infection
Compromised patient
Altered bone metabolism
Excessive trauma
```
182
How do you manage dry socket?
Examination - consider X-ray for retained root
Irrigation of socket with saline or chlorhexidine
Obtudant pack=
Alveogyl resorbable
Zinc oxide eugonol pack requires removing
Bismuth sub nitrate and iodoform paste bipp
Lidocaine based gels
183
What is alveogyl?
A brown fibrous paste which contains the following per 100g
25.7g butamben
15.8g iodoform
13.7g eugenol
Also includes other ingredients like olive oil, spearmint oil and sodium lauryl
184
What are the signs of adrenal insufficiency?
Pallor
Rapid thready pulse
Decreased bp
Loss of consciousness
185
How do we manage adrenal insufficiency?
Supine
Maintain airway and oxygen
Hydrocortisone 100mg Iv/Im
No improvement then call ambulance
186
What are the signs of anaphylaxis?
```
Sob
Flushing
Itching
Pallor
Loss of consciousness
Cyanosis
Very weak pulse
Decreased bp
Oedema
```
187
How do we manage anaphylaxis?
```
Supine
Airway and oxygen
999
Adrenaline 0.5mls 1:1000 Im 1mg/ml
Repeat at 5minute intervals
```
188
How do we manage mi?
```
Airway and oxygen
Aspirin 300mg orally
Gtn
999
Bls if needed
```
189
How do we manage asthma?
```
Maintain airway and oxygen
Salbutamol inhaler 100 micrograms per puff
Salbutamol nebuliser 5mg
Hydrocortisone 100mg Iv im
Repeat as required
Consider adrenaline
```
190
What rate of chest compressions are needed?
100-120/min
191
What's the molecular structure of la?
Aromatic ring - lipophillic
Intermediate linkage - ester or anise
Terminal amine - hydrophilic portion
192
What kind of la is lidocaine?
Amide, processed by the liver
193
Does dry socket need antibiotics?
Not thought to influence
Some evidence they may work prophylacticly
Evidence to support use in the immunocompromised patient
194
What local measures do we use for bleeding?
```
Move to suitable clinical area
Good light
Auction
Assistance
La with vasoconstrictor
Sutures
Haemostatic acids e.g. Surgicel/fibrin blocks
Bone wax
```
195
What are the adult doses of amoxicillin for dental infections?
500mg every 8 hours
| Double in serve infections
196
What is the amoxicillin does in children following a dental infections?
1-1 year old= 62.5mg every 8 hours
1-5 years= 125mg every 8 hours
5-18 = 250g every 8hours
197
What do we need from a radiograph pre endo?
At least one good peri apical
Treatment tooth centrally located
At least 3-4mm peri radicular tissue visible
Taken with a film holder to minimise distortion
198
Why do we need straight line access to root canals?
Because without it the files will deflect and a groove will be filled down the labial wall of the canal
199
Should an access cavity be undercut?
No
200
What shape should the access cavity be?
Dependant on the tooth.
Incisors have three pulp horns so have a triangular access cavity
Canines and premolars have 2 horns so an oval access cavity
201
How can we locate root canals?
```
Knowledge of pulpal anatomy
Information from radiographs
Magnification techniques
Transillumination with white light
Canal probe e.g. Dg explorer
Fine endodontic hand instruments
```
202
When do we apply rubber dam in endo?
Once the pulp chamber is breached
203
What do we do in decayed teeth where isolation can't be achieved for endo?
Restore them for efficient isolation
204
How can we improve a rubber dam seal?
Ultradent oraseal caulking agent
205
What shape canal do we want in endo?
Narrowest apically
Widest part coronally
Gradual outward flare
206
How do we measure working length?
Tables of averages
Apex locator
Radiography
207
How does an apex locator work?
Measures electrical resistance with direct alternating and high frequency currents
Measuring voltage gradients
Calculating ratio between impedances
208
What are the problems with apex locators?
Wet canals in absolute al machines:
Hydrochloride
Pus
Tissue exudate
Heavily restored crowns:
Amalgam
Gold inlay
Poor contact with lip electrode
209
How do we measure a radiographic working length?
Measure from fixed reference point to radiographic apex, then minus 1mm
210
What is the design of k files?
Tapering square cutting from the corners
Steel
Square on top
211
What is the design of hedstrom files?
Christmas tree shaped. Tapering circle
Steel
More aggressive than k files
212
What is the design of pro taper files?
Nickel titanium with elastic memory
Spongy grip
More expensive
213
What is the diameter of a gates gladden but in hundredth of a mm?
20 (gg+1) +10
214
How do we do orifice enlargement?
A size 10k file is passed gents to apical constriction to check patency
Using the largest hedstrom which will pass 3mm of the canal orifice is used circumferentially around the canal periphery, cutting on the out stroke
Progressively smaller headstrong are used to penetrate further down the canal
Instruments should only be taken to te beginning of the curve
215
Why do we do orifice enlargement?
Removes heavily infected materials
Improves access to apical third of the canal
Improves irrigation
Reduces effective curvature of the canal
216
What is ISO?
International standards applied to endodontic files
Standardised sizing related to diameter 1mm from tip.
Standardised length of working part
Standardised taper
217
What are the three available file lengths?
21, 25, 31
218
What is the cutting length on a file?
16mm
219
What is the standard instrument taper?
2%
220
What is the width at the tip of a file?
The number on the file divided 100
| E.g. Size 25= 0.25
221
What are the endodontic instrument techniques?
Step back and crown down
222
What are the endodontic filing techniques?
Watch winding
Balanced force
Longitudinal circumferential
223
What is the main use of a modified step back technique?
Large canals
| Most often anterior teeth
224
What is a modified step back technique?
The coronal aspect is opened up first before creating an apical terminal stop and flaring backwards to original flare
225
What is a crown down technique?
The canal is instrumented from the coronal aspect to the terminus
226
How do we create an apical stop?
Using successively larger instruments
| Use balanced force and anticurvature filing
227
How many instruments are required to make an apical stop?
9
| Need to recapitulate with a smaller file to clear debris
228
How do we step back?
Step back at 1mm intervals with each a successively larger file
Recapitulating in-between with the master file
229
How many instrument changes are required to step back?
14
230
What are the advantages of balanced force technique?
Superior shaping
File remains central within the canal
Less debris pushed apically
231
What cautions need to be taken with balance force?
Flute cleaning
Copious irrigation
Disregard damaged instruments
232
What is phase one of balanced force filing?
Power
Place file until it binds
Advance file by clockwise rotation of 60 degrees
233
What is phase two of balanced force?
Control
Apply apical pressure
Rotate file by 120 degrees in anticlockwise direction
234
What are some errors relating to canal preparation?
Incomplete debridement
Lateral perforations
Apical perforations
Blockage of canals
Ledging
Apical zipping due to inappropriate rotations of instruments
Elbow formation due to inappropriate precurving of instruments
235
When would we use longitudinal circumferential filing in step back?
For large irregular shaped canals
| When balanced force is inappropriate as files would be to loose
236
What are the advantages of an anticurvature filing technique?
Avoids strip perforations
Uses a 3:1 filing ratio
Precurved k type files
237
How do we do a anticurvature filing technique?
Files are bent around mirror handle
Use push pull longitudinal filing technique
Never rotate
238
What are the ideal properties of a canal irrigant?
```
Non irritant
Bacteriacidal
Dissolve organic material
Remove inorganic material
Non staining to dentine
Lubrication of instruments
```
239
Describe sodium hypochlorite as an irrigant
0.5-5% solution
Antibacterial
Dissolves organic
Non irritant to vital tissues at low concentrations
240
What is a chelating agent?
EDTA
Breaks down inorganic debris
Lubricant
When used with sodium hypochlorite causes effervescence which assists cleansing of those parts of the canal which are u instrumented. This is due to nitrogen, hydrogen and oxygen release
241
What are the advantages of chlorhexidine as a canal medicament?
Low toxicity
Broad spectrum if activity
Substantivity due to bicationic
242
What is the cutting length on a pro taper file?
14mm
243
What are the advantages of pro taper files?
Better in right canals
Fewer files needed
Engage a smaller area of dentine which reduces torsional loads, file fatigue and potential for separation
Balanced pitch and helical angle
244
Describe the design of a pro taper file
```
Convex triangular cross section
Nickel titanium
Stress induced phase change
3-5 times the elastic flexibility of stainless steel
Decreased ledging and transportation
```
245
Describe sx alternative orifice enlargement
Enlarge dentine by gently turning clockwise until file is snug
Disengaged by rotating counterclockwise 45-90 degrees with pressure I ensure the file doesn't wind out of the canal
Re establish patency with size 10k file and watch winding. Repeat with size 15k and size 20, using balanced force with size 20
Rotate the handle clockwise whilst withdrawing to ensure removal of debris
246
Following orifice enlargement, what are the next steps of crown down?
Using s1 file to full length of the canal
Use s2 to the full length of canal
Check patency with 20k
Use f1 and reinstrument with 20k. Stop if snug
247
What precautions do we take between endodontic appointments?
Place a medicament and a temporary restoration to prevent reinfection
248
What does ledermix contain?
Demethylchlorotetracyxline
| Triamcinalone acetonide
249
When should we use ledermix?
Acutely inflamed vital pulp where analgesia can't be obtained
In pulpal exposure with insufficient time for root canal
250
What is the usual interappointment medicament?
Calcium hydroxide
251
How does the hydroxide in calcium hydroxide work?
```
Ph 12.5
Bacteriacidal
Effective solvent to organic material
Premises connective tissue repair
Promotes hard tissue genesis
Neutralises acids in areas of resorption
```
252
What are options for an interappointment temporary restoration?
GIC
| Zinc oxide eugenol
253
What does it mean if the gp cone is too long?
Incorrectly calculated working length
| Gp is to small and has pushed through he terminus
254
What does it mean if the gp come is too short?
Incorrectly calculated working length
Debris is blocking the terminus
To large of a master point
255
Why do we obturate?
Prevent microorganisms from entering and reinfecting the root canal
To prevent tissue fluids from percolating back into the canal system and acting as a culture medium for residual bacteria
Produce a 3d hermetic seal to prevent microleakage
Apical seal and coronal seal
256
What are the ideal requirements prior to filling a canal?
Dry canal
Absence of pain and other symptoms
Signs of resolution of infection -reducing Radiolucency
Absence of signs of residual infections - fistula or sinus
Reduction in mobility
257
In rct, what are the potential problems with a smear layer?
May harbour microorganism
May create an avenue for leakage of microorganism
May act as a substrate for proliferation
258
How do we remove a smear layer?
EDTA and sodium hypochlorite
| 10-55% citric acid followed by rinsing with sodium hypochlorite
259
What are the functions of a root cabal sealer?
```
Cements the core material into the canal
Helps fill voids
Lubricant
Bacteriacidal
Thermal insulator on placement if gp
```
260
What are the ideal characteristics if a sealer?
```
Non irritating to peri apical tissues
Hermetic seal
Insoluble in tissue fluids
Dimensionally stable
Radiopaque
Bacteriostatic
Non staining to dentine
Sticky with good adhesion to canal walls
Easily mixed and removed
```
261
Discuss zinc oxide eugenol sealers
```
Form a weak porous material when set
Decompose in tissue fluid
Cytotoxic
Extended working time available
Most popular
92-95% success
```
262
Describe calcium hydroxide sealers
Developed on the assumption that they would stimulate healing and hard tissue formation
Setting ability similar to Zoe
263
Discuss resin sealers
Good sealing and adhesive properties
I ritual inflammatory reaction
Antibacterial properties
Less popular due to expense and poor handling properties
264
Discuss GIC sealers
Ability to adhere to dentine
Initial inflammatory response which subsides
Patch sealing
265
What length should the finger spreader be?
2mm short of working length
266
What are common errors in obturation?
```
Inaccurate placement of master point
Lack of snug fit at the apex
Use I incorrect spreaders or points
Extrusion of file or sealant through apex
Use of excessive condensation pressure
Inadequate coronal seal
```
267
Why might la fail in an infected patient?
Increased vascularity removes the solution
Acidic conditions impedes active component
The prostaglandins increase the threshold of nerves
268
How do we manage la problems in an infected patient?
Give block injection
More la or more concentrated solution
Intraligamental
If none of the above work prescribe antibiotics and wait 3-4 days for acute inflammation to become chronic
269
What do upper straight forceps look like?
Two arms
| Not bent at the neck
270
What do upper premolars forceps look like?
Two arms
Bent, but not left or right
Fairly thin
271
What upper molar forceps look like?
Like premolars, but thicker and less bent
| Left and right differ - beak to cheek
272
What do lower root forceps look like?
Bent to the side
Two arms with no grooves
Narrow
273
What do lower molar forceps look like?
Bent to the side
Grooved beaks
Thick
274
What do lower cow horns look like?
Similar to lower molars
| Much thinner, have point not beaks
275
How many contact points are needed during an extraction?
2 points of contact between root and forceps blades
276
How do forceps enable delivery?
Expanding the socket
| Wedging blades of the forceps between the root and bony socket causing displacement of conical root from socket
277
Due to forcep design, where is the force delivered to the tooth?
Apically
278
Where are the blades of upper forceps?
Inline with the handle
279
Where are the blades in lower forceps?
At right angles to the handles
280
What movement do you do to extract upper incisors?
Rotation due to conical root
281
What movement do you do to extract upper 3-8?
Bucco palatal
282
What movement do you do to extract lower incisors and canines?
Labial then rotations
283
What movement do you do to extract premolars?
Rotations, and where roots curved addition buccal and lingual movements
284
What movement do you do to extract lower molars?
Buccal lingual pressure
| Deliver buccally
285
In what order should we do multiple extractions?
Start with lowers, and more posteriorly
Unless we need to extract a more anterior tooth to get better access
Extract painful tooth first
286
What is the difference between a liner and a base?
A liner is applied in a thin layer into dentine. A base is thicker and used to replace some missing dentine
287
What is the purpose of a liner?
Mainly used to seal dentine tubules to reduce pulpal injury due to microleakage
Thermal barrier especially in metallic fillings
A chemical barrier
An electric barrier
288
What is a luting material?
Used to retain or hold restorations in place
289
What properties should a luting material have?
Low initial viscosity to allow flow and proper seating
| Low solubility
290
Describe the composition of zinc phosphate?
Powder: zinc Oxide and other metallic oxides
Liquid: phosphoric acid 45-64%
291
What is de trey zinc?
Zinc phosphate cement
292
How do we mix zinc phosphate?
No set ratio
| Mixed on cooled slab
293
What are the properties of zinc phosphate?
No bonding affinity do tooth, metal or ceramic
Phosphoric acid roughens surface providing some microretention
Okay working time
Film thickness suitable for luting
Small be significant water solubility
May irritate pulp if used as a limit due to low ph (2-4)
Set material is opaque
294
What is poly f?
Zinc poly carboxylate
295
What is the presentation of poly f?
Powder and liquid
Powder: zinc oxide
Liquid: poly acrylic acid
Or
Powder:zinc oxide and freeze dried poly acrylic
Mix with water
Mix one scoop to two drops for luting
2:2 for temp
296
What are the properties of zinc polycaroxylate?
Acidic, but less so than zinc phosphate
Adhesive bond with enamel, dentine and non-precious metal
Weak bond with gold and no bond with porcelain
Strong bond with ss
297
What is aqua cem?
GIC cement
298
What is the composition of GIC luting cement ?
Powder: glass (sodium aluminosilicate glass) and 20% caF
Liquid: poly acid
2 scoops:4 liquid
299
Are particles of GIC bigger or smaller for luting and lining?
Smaller
300
What are the properties of GIC?
Same adhesive properties as poly f
More translucent than zinc oxide
Can withstand amalgam condensing
Thermal diffusivity close to that of dentine
301
What are resin luting cements?
Lightly filled composites with small sized filler particles to ensure thin film thickness
Strong, less soluble and more aesthetic than other cements
302
What is panavia f?
Resin Luton cement
303
What is kalzinol?
Zinc oxide eugenol
304
What is the composition of zinc oxide eugenol?
Powder: zinc oxide and zinc acetate
Liquid: eugenol and olive oil
5:1 mixed in glass slab
305
What are the properties of kalzinol?
```
Adequate working time and rapid setting
Eugenol has soothing effect on the pulp
High solubility so not suitable for luting unless temp
Effective thermal barrier
Thermal diffusivity similar to dentine
```
306
What is life?
Calcium hydroxide cement
307
What is the composition of calcium hydroxide?
The base is calcium hydroxide (50%), zinc oxide (10%) and sulphonamide (40%)
The catalyst is 40% glycol salicylate with varying amounts of titanium dioxide and calcium sulphate
308
What are the properties of life?
Weak
High solubility
Difficult to apply in thick sections so only used as lining
Highly alkaline so antibacterial and stimulates reparative dentine
309
What four things does caries need to develop?
Bacteria
Substrate
Tooth
Time
310
What kind of caries does actinomyces cause?
Root caries
311
What kind of caries does lactobacillus cause?
Progression of deep lesions
312
Where is the translucent zone in an early caries lesion?
The outer most later surrounding the body of the lesion.
313
Where is the dark zone in an early caries lesion?
Just before the translucent zone
314
Which is the most porous are of an enamel caries lesion?
Centre of body is 25% pore volume
315
What is happening at te advancing front of dentine caries?
Demineralisation but not infection yet
316
What is happening in the zone of penetration in dentine caries?
Tubules penetrated by bacteria
317
Describe the appearance of an arrested carious lesion
Matt due to porosity
| Soft and leathery texture
318
What are the defence mechanisms of the dentine pulp complex
Tubular sclerosis
Reactionary dentine
Inflammation of the pulp
Pulpitis symptoms
319
What are the ideal characteristics of a restorative material?
```
Radio-opaque
Tooth coloured
Adhesive to tooth
No volume change on setting
Provide protection from
Recurrent caries
Have adequate strength
Insoluble and non-corrodible
Non toxic and non irritant
Resist plaque formation
Wear rate similar to enamel
Coefficient of thermal expansion similar to tooth structure
Thermal diffusivity similar to tooth
Have low water absorption
```
320
What is a class 1 cavity?
Caries affecting pits and fissures
321
What is a class 2 cavity?
Posterior interproximal
322
What is a class 3 cavity?
Anterior interproximal
323
What is a class 4 cavity?
Caries affecting the approximal surface of anterior teeth and the Incisal edge
324
What is a class 5 cavity?
Caries effecting the cervical surfaces
325
Other than caries, why might we do a restoration?
Trauma
Erosion/abrasion
Enamel hypoplasia
Masking discolouration
326
What is an e1 lesion?
Caries confined to outer 1/2 of enamel
327
What is an e2 lesion?
Caries confined to inner 1/2 of enamel
328
What is a d1 lesion?
Caries 0.5mm into dentine
329
What is a d2 lesion?
Caries more the 0.5mm into dentine but more than 0.5mm from the pulp
330
What is a d3 lesion?
Caries within 0.5 mm of pulp
331
Are bite wings useful to diagnose class 2 lesion?
Increase diagnosis of interproximal lesions 4 fold when compared to clinical examination alone
332
Are laser fluorescence machines used?
Only for occlusal lesions with visual inspection
333
How long does it take for an interproximal lesion to reach the adj?
3-4 years in children
| Maybe as long as 6years in adults
334
When do we recommend interproximal intervention?
When lesions extend more than 0.5mm into dentine
335
Indications for posterior composites?
Small-moderate class 2
Metal allergy
Where unsupported enamel may be strengthened
Where it's not possible to obtain retention for a non-adhesive material
336
What are the contraindications to posterior composite restorations?
```
High caries activity and poor oh
Inadequate isolation
Multiple large restorations with cuspal contact
Bruxism
Allergies to resin
```
337
What is the survival are of a gold inlay after 25 years?
84%
338
What do ears involve?
The rebuilding of cusps
Provision of auxiliary retention
Postpone cast restoration
339
What are the advantages of ears over cast restorations?
Less invasive
Less expensive
Less time
340
How do we provide auxiliary retention?
Cavity design features
Pins
Adhesives
Posts
341
What is retention?
Features of a cavity preventing withdrawal of the restoration in the long axis of the prep
342
What is resistance?
Features preventing dislodgement of the restoration under other forms of loading
343
How should we create slots?
A depth no greater than 1mm
A width no more than the instrument used
Sharp internal form which increase stresses within the tooth material- for resistance form
344
Do pins provide retention or resistance?
Both!
345
What are the types of pins?
Cemented pins
Friction grip pins
Self threading pins- more retentive
346
What influences pin retention?
Larger diameter pins are more retentive
Depends on resilience and firmness of dentine
Only place in healthy dentine
347
What are the disadvantages of pins?
Pulp exposure
Root perforation
Cause stresses in the tooth - except cemented
Cracks I'm dentine surrounding the pins
348
What is the evidence for adhesives used with amalgam?
There isn't evidence for or against them
349
In what type of patient are ears likely to fail?
Old
350
What are the technical failures of ears?
Defective contact point/over hangs
Non retentive
Fractured restoration - doesn't necessarily come out. Could stay and facilitate secondary caries
351
What are inlays/onlays made from?
Gold alloys
Composites
Ceramics
Zinconium oxide
352
What are the indications for an inlay/onlay?
```
Large restoration
Endodontic tooth
Teeth at risk of fracture
Wide open contacts and occlusal plane correction
Prosthodontic abutment
Dental rehabilitation
Sub gingival lesion
```
353
Contraindications of an inlay/onlay?
```
Young dentition with large pulp chambers
Developing and deciduous teeth
Aesthetics
Poor oh
Small restorations
```
354
What are the advantages of inlay/onlays?
Strength
Biocompatibility
Low wear
Control of contours and contacts
355
What are the disadvantages of inlays/onlays?
```
Extensive tooth prep
Cemented restoration, discrepancy and microleakage
Abrasive and slitting forces on natural teeth
Galvanic currents
Number of appointments
Cost
Temporary required
Techniques sensitive
```
356
What are the feature of an inlay/onlay prep?
Undercut free
Maximum height
Minimum taper
Single path of insertion
357
How much chlorhexidine is in corsodyl?
0.2%
358
How much fluoride is in duraphat varnish?
22600 ppm
359
What are the 4 safety benefits of rubber dam?
Control root canal irrigants
Barrier between operator and oral fluids
Control and protection of soft tissues
Prevents inhalation or swallowing
360
What the advantages of rubber dam for patient management?
Avoids need for continued rinsing
Improves access and vision
Provides gingival retraction
reduces operating time
361
What are the disadvantages of rubber dam?
```
Gingival damage
Fractures porcelain restorations
Fractured heavily restored teeth
Inhalation of clamps
Contact allergy
```
362
What's the difference between bland and retentive claps?
Bland claps grab teeth above the gingival margin
| Retentive claps grasp below, they are angled downward accordingly
363
What is the correct placement of a rubber dam clamp?
The bow of the clamp is distal
The clamp has 4 anchorage points
The clamp grips below the maximum bulbosity
