Sem 2 exam questions Flashcards
1
Q
How does fluoride affect PEP-PTS system?
A
It inhibitis enolase - an enzyme which is use if break down of carbohydrates
2
Q
There i s a pleomorphic nuclei with prominent intercellular bridges, keratin pearls in lamina propria. What is the most likely diagnosis?
A
SCC
3
Q
Which factor decreases densty in bitewings?
A
Decrease in kVp
4
Q
In cancer treatment, what do analogs inhibit the production of?
A
Folate and pyrim
5
Q
What is the most common recepto in the oral cavity?
A
Merkel’s disk for fine discrimination for light touch
6
Q
What do you do with an angry patient?
A
- Aknowledge frustrations
- Say sorry
- Provide opportunity to ask question and relate their experiences
- Discuss the potential consequences of the injury
- Discuss the steps that are taken to prevent that injury from reoccuring
7
Q
What are the requirements for writing a prescription?
A
- Patient name
- Our name and adress of practice
- Generic drug name
- Form of the drug aka tablet or capsule
- Strength
- Quantity
- Dose & frequency of administration
- Our signature
- Date
8
Q
What are the difference between the atrophic oral lichen planus and biofilm induced gingivitis?
A
- Red buccal gingiva
- Pain on brushing
- Eating certain foods
- Condition does not resolve post debridement
9
Q
What are the treatment for disquamative gingivitis?
A
- Topical steroid - 0.05% betamethasone diproponate 2x daily for about 7-14 days - continue for 7 days after smptom subside
- Rinses with 0.2% CHx muhtrinse for 2 weeks seperate to the betamethasone and tooth brushing
- Avoid spicy foods
- Brush with soft brissle tooth brush
10
Q
What are the steps for critique of a bitewing?
A
- Exposure settings- contrast and density
- Orientation of detector- dot to distal
- Horizontal detector placement
- Vertical detector placement
- Horizontal beam angulation
- Vertical beam angulation
- Central beam position
- Collimator alignment
- Sharpness of image
Overall diagnostic quality
11
Q
How would you restore 15 distal?
A
Direct bond approach: etch-37 % orthophosphoric acid+ primer+ adhesive + CR
20% polyacrylic acid for 10secs,RMGIC base/liner+ CR
Sectional matrix+ clamp + wedge + ball burnisher/flat plastic
Tofflemire matrix +retainer+ wedge + ball burnisher/flat plastic
LC
Floss (+/- polishing strip if required)
12
Q
What is the result of higher pKA?
A
Slower onset and diffusuion of LA
13
Q
What enzyme is produced by periodontal pathogens?
A
Gingipain
14
Q
What medicament would you use for a child’s pulpotomy in student clinic?
A
Ferric Sulfate
15
Q
What is the best way to restore an anterior tooth in an annoying ass kid?
A
Composite strip crown
16
Q
What are the components of alginate for gelation reaction?
A
Potassium alginate and calcium sulphate
17
Q
What are the bacteria between the first colonisers and late colonisers which binds the bacteria?
A
P.Intermedia, P.Nigrescens and F. Nucleatum
18
Q
IgG detection and chicken wire appearance. Likely diagnosis?
A
Pemhigus vulgaris
19
Q
Which nerve fibre is least affected by LA?
A
A alpha
20
Q
Which muscles is most liekly to refer as tinnitus?
A
Deep masseter
21
Q
What are the 5 contra indication of pulpotomy?
A
- Special needs kids
- Tooth close to exfoliation
- Immunocompromised kids
- Periapical/furcation involvement
- Root resorption
22
Q
What are the main differences between equia forte and fuji II LC?
A
Equia forte: Has better fluoride release and can be placed subgingivally without LC - but has less compressive strength
Fuji II: better compressive strength, better aesthetics and more working time - but can not be cured subgigivally as nice
23
Q
What are 6 commercial products you could use for a patient with sensativity? How do they work
A
Sensodyne Rapid relief- stannous fluoride; forms a metal precipitate to occlude dentinal tubules
Sensodyne Daily Care,Sensodyne Pronamel- potassium nitrate, desensitises nerves
Sensodyne Repair and Protect- contains Novamin, occludes dentinal tubules
Oral B Pro Health- contains stannous fluoride which forms a metal precipitate to occlude dentinal tubules
Colgate Pro Relief- contains stannous fluoride which forms a metal precipitate to occlude dentinal tubules
Duraphat/Clinpro- contains resin base and fluoride protector polyurethane; forms insoluble Ca f2 globules after application
24
Q
Patient wants to know how the maxilla grow?
A
Mx growth in length and width:
- Type of growth: appositional growth from both sides of sutures, itramembranous growth + surface remodeling
- Method of growth: Maxilla grows forward and down from the cranial base either by a push from the growth of the cranial base or by the growth at the sutures
- As the downward and forward movememnt occurs, the sapce at the sutures opens up and than filled by the deposition of bone.
- Bone deposited at the posterior surface of the maxilla creates additional space which accounts for needed space for permanent molars + maxillary tuberosity
- The apical base increases in length through seperation of midpalatine suture and deposition of the bone in the area - note this is the basis of different maxillary expansion techniques that allow for correction of posterior cross bites
25
Patients wants to know how the mandible grows?
Two distinct types of growth
1. Types of growth - appositional growth and remodeling + intramembranous growth + endochondral ossification
2. Around the condyle - endochondral ossification
Other areas - direct surface apposition and remodeling
3. Body of the mandible grows longer by periosteal apposition only on the posterior surface - the ramus moves away from the chin
4. The ramus grows higher by endochondral replacement at the condyle by surface remodeling
5. Translation occurs as the bone moves downward and forward along wit the soft tissues it's embedded in - deposition at the back adn resorption as at the front
26
What are some of the methods of fixing a posterior crossbite for a general dentist?
Upper removable appliance (URA) or refer to an orthodontist for maxillary expansion.
Remember - dentist can only fix dental related problems with occlusion - ortheopedic problems should be mostly treated by a specialsit multidisciplinery team
27
What are some of the methods of fixing a anterior crossbite for a general dentist?
Upper removable appliance (URA), elimination of oral habits, bonded composites slopes or refer to an orthodontist.
Remember - dentist can only fix dental related problems with occlusion - ortheopedic problems should be mostly treated by a specialsit multidisciplinery team.
28
Why are vaccine preventable diseases becoming more common?
1. anti vaccination movement
2. waning effectiveness of certain vaccines
3. pathogen adaptation
4. travel to areas where the disease is endemic
29
What are 6 social factors for vaccine hesitancy?
1. distrust of govt
2. distrust of medical authorities
3. religious reasons/cultural belief differiing
4. personal beliefs about the nature of their immunity
5. concerns about side effects
6. belief that viral diseases are mild and self limiting
7. parental use of non medical exemptions to bypass vaccination requirements
30
What is special about virsuses that prevents us to achieve heard immunity?
Viruses can mutate and evolve to bypass immune systems.
31
What are mild side effects of vaccines?
1.Pain/swelling at injection site
2. Headache/muscle ache/fever/itching/fatigue
3. Fever induced by cytokines and mounted by own immune response
32
What can you use as a fixative for immunofluresence?
You CAN NOT USE FORMALIN only use saline or Michel's transport medium
33
Your patient has crusty lips and multiple oral lesions?
Erythema multiforme
34
Which one factor that might make you think that a tooth is moderatley difficult under AAE classification?
Crown and root axis moderatlet different
35
What is the primary reason for porcelaine failure?
Crack propagation
36
Localised gingival recession at one site of tooh. What is the most likely diagnosis?
Brushing for more than 2x day with hard bristles
37
What are some of the receptors of osseopreceptuon?
TMJ, mucosal, periosteal and cutaneous
38
You have a lesion at the focal point (apex of the tooth), it was previously radiolucent and now ti is radioopaque and did not really grow. WHat is it?
Most likely a COD (cemento osseous dysplasia)
Other diagnosis cementoblastoma - odontogenic tumour so probs not
Cemento-ossifying fibroma - could be but fibroma is mostly a miexed lesion and it appear as a mixed lesion
39
What is gthe poitn of a lateral condenser?
To fit more accessory GP points
40
What does SLOB stand for?
Same lingual, opposite buccal
41
Why does "I am sorry this has happened to you. I am sorry you have been going through this." is a good response in open disclosure?
1. It helps the patient to go through the situtation aka cope with trauma
2. It is a sicnere expression which reassure the patient they ar enot alone.
42
What are the three medication that cause prolonged bleeding?
1. Ibuprofen
2. Anticoagulants
3. Aspirin
43
What medication associated with fungal infections?
Steroid inhaler
44
What are the two groups of populations that are more susceptible to serious infections? Why?
1. Older people - the function of the immune system reduces with age
2. Taking immunosuppresants - immune suppresant reduce the function of the immune ysstem
45
When should you recall the patient after completion of the innital phase of dembridment and provision of at home OHI?
After around 12 weeks in order to give the periodontium the chance to heal
46
What is supportive periodontal treatment?
It is treatment that plans to maintain already achieved goals with improvement of periodontal health. Patient should come back for assessment every 3-12 months depending on their risk profile )high risk - come every 3 months, low risk - every 12 months)
47
How can we evaluate risk of periodontal disease progression in the patient?
There dirrent matrix you can use to determine the recall frequency - a common one is the PRA (periodontal risk assessment) and it can be accessed online.
Preio-tools.com seems like the website to go to to find different matrix that may assist you.
48
Shouldyou probe all the teeth at SPT session
YES of course you should to understand the health of pockets - but you can choose not to do a brand new perio chart unless you find some findings
49
What are the differential diagnosis for a lesion that is similar lichen planus?
1. Lichen planus
2. Lupus eythematosus
3. Cheek biting/ frictional keratosis
4. Graft versus host disease
5. Candidosis
6. Idiopathic leukoplakia
7. Squamous cell carcinoma
8. Chronic ulcerative stomatitis
50
What do you do if you confirm lichen planus?
1. Long term monitoring
2. Reducing factors associated with lichen planus such as tobaco or other
3. Control of symptoms - use CHx and maybe avoid certain foods. Use Corticosteroids, topical injection, antifungal therapy.
51
What are the topical steroid used for lichen planus?
Betamethasome dipropionate 0.05% cream or ointment topically to the lesions, twice daily after meals, until symptoms resolve
52
What is the main difference between high risk approach vs the population approach?
The main difference are:
- Exposures with high individual risk can have a small impact on population risk if the exposure is rare (aka people with sever conditions are very rare - thus intervention is not as widespread)
- Exposures with low individual risk can have a big impact on population health if exposure is widespread (aka people with not so severe conditions are common - thus intervention is more widespread)
53
What are the advantages of high risk approach?
1. Beneficial for the individuals
2. Important in addressing inequalities
54
What are the disadvantages of high risk approach?
1. Does not change population levels of disease
2. Issues in identifying who is at risk
3. Does not change the drivers in the population
55
What are the advantages of population approach?
1. Tries to remove the reason why the disease is common
2. Almost everyone benefits
3. May have a large impact at a population level
56
What are the disadvantages of population approach?
1. May not address health inequalities
2. Does not represent a large benefit to the individual
57
What are some of the levels of prevention?
1. Primary prevention
2. Secondary prevention
3. Tertiary prevention
58
What are some of the example of secondary prevention?
Secondary prevention occurs to treat asymptomatic disease - example: small restorations
59
What are some of the example of primary prevention?
Primary prevention occurs to stop the disease - example: water fluoridation
60
What are some of the example of tertiary prevention?
Tertiary prevention occurs in established diseases or established disease with complications - example: full mouth rehabilitation
61
What is the "creed" of antibiotic therapy?
In dental clinics - primary removal of infection is essential
M - microbiology guides therapy
I - indications should be evidence-based
N - narrowest spectrum required
D - dosage appropriate to the site & typ of infection
M - minimise duration of therapy
E - ensure monotherapy in most situations
62
How do antiobitcs have a bacteriostatic effect?
Sulfanilamide antibiotics have a bacteriostatic effect by targeting synthesis of folica acid - an important component of bacterial RNA and DNA
Sulfanilamide can completitivley inhibit enzymes that are used in production of folic acids, thus slotwing the synthesis thus slowing growth of bacteria due to reduced production of plasmids (circular DNA in bacteria).
63
How do antiobtics have a bacteriocidal effect?
By inhibiting cell wall synthesis through rapid depolarization.
Beta-lactam - like amoxycillin - able to bind to bacterial cell walls causing repid depolirasation resulting in loss of membrane potential leading to inhibition of protein synthesis and destruction of DNA.
64
What are the steps to treatment planning?
1.. Completion of all histories and exams
2. Taking consent for additional testing
3. Diagnosis, presentation of treatment plan and consent
4. Emergency management - aka pain relief
5. Preventativve care/disease control - fluoride, OHI, smoking sessation
6. In chair treatment
7. Close date recall
8. Transition to regular recall
9. Session breakdown
65
What are the steps for partial pulpotomy?
1. Consent, LA, Appropriate rubber dam
2. Disinfect the tooth after caries removal with CHx
3. Remove 1-2mm of superficial pulp tissue
4. If extensive bleeding observed , extend the preparation apically
5. Use preassure yo facilitate haemostasis
6. Calcium hydroxide liner or MTA use
7. Restore tooth
8. Recall every pattern: 1, 3, 6 and 12 months
66
What are the steps for a full pulpotomy?
1. Consent, LA, Appropriate rubber dam
2. Disinfect the tooth after caries removal with CHx
3. Remove entire mass of coronal pulp tissue to level of canal
4. If extensive bleeding observed , extend the preparation apically
5. Use preassure yo facilitate haemostasis
6. Calcium hydroxide liner or MTA use
7. Restore tooth
8. Recall every pattern: 1, 3, 6 and 12 months
67
How to write a diagnosis for endodontic diagnosis?
1. Pulpal and root canal condition - aka irreversible pulpitis, necrotic pulp, reversible pulpitis
2. Periapical status - clear periapical radiolucency with a corresponding draining sinus or no periapical radiolucency
68
What factors should you consider before endodontic treatment?
1. Strategic value of the tooth
2. Periodontic factors
3. Patient factors - MHx, age, compliance
4. Restorability options - consider oral hygine - and consider teeth that are not restorable
69
What are the types of irrigants used in chemo-mechanical debridement?
1. EDTAC - 15% commonly used as a removal of smear later and to increase permeability of dentinal tubules
2. Sodium hypochlorite - 1% commonly used, dissolves organic matter - DANGEROUS
70
What are the steps to an initial endodontic procedure?
1. Consent, LA, rubber dam isolation
2. Removal of caries and access to the pulp
3. Idenitifcation of the appropriate access using radiographs
4. Identification of canals using endo probe
5. Using a small size file a few milimeters into a precieved canal in order to confirm that it is actually a canal
6. Irrigation with a bent needle for safety
7. Flaring of the coronal protion of each canal using Gate-Glidden burs
8. Irrigation
9. Estimationg of working length of each canal.
10. Determination pf correct working length with appropriate file, raiographs and apex locators
11. Apical preperation of each canal. Pre-curved files, watch-winding technique performing circumferential filing
12. Recapitulate with a size 10 file between each file and irrigate well between each file
13. Work up until file 25 -take radiograph to check the master apical file is at an appropriate length
14. - irrigate and try master gutta percha of the the biggest size possible
15. Place medicaments with lentulo spiral
16. Resore with cavit and GIC
71
What are the steps to root canal obturation?
1. Consent, LA, Rubber dam isolation
2. Re-access tooth and remove caivt safeyl
3. Irrigate
4. Check master apical file goes to correct working length
5. Select master GP largest size that goes to correct working length
6. Take radiograph to confirm
7. Dry canals with paper points
8. Place the sealer with lentulo spiral
9. Coat master GP with sealer and place into the canal
10. Use lateral spreader to condense the master GP
11. Place accessory GP into space create
12. Continue with lateral spreader until the space is filled
13. heat the end of the endodontic pluger and burn off GP points
14. FInal level of root-fillin should bet at or below CEJ
15. Clean pulp chamber and reestore.
72
What are the Kennedy's classifications of partial edentulous arch?
Class I - bilaterla edentulous areas located posterior to the remaining natural teeth
Class II - A unilateral edentulous area located posterior to the remaning natural teeth
Class III - A unilateral edentulous area with natural teeth remaining both anterior and posteror
Class IV - A single, bilaterla edentulous crossing mid line
73
What is good guide to stages of periodontits?
1. Severity - no tooth loss is Stage I or II, tooth loss of 4 teeth of less Stage III, anything above is Stage 4 - look at radiographic bone loss, if it is upto 15% it is stage I if more stages 2,3,4
2. Complexity - If there are major need for rehabilitation - it is stage 4. IF maximum probing depth is above or equal to 5mm it is probs stage II and above
3. Extent - localised if less than 30% of teeth are involved
74
What is a good guide for grades of periodontitis?
1. Loss over 5 years - if no than A, if less than 2mm than B if more than 2mm than C
2. If a lot of biofilm deposits - probs gare B or C
3. If smoking less than 10cig a day grade B if more Grade C
4. If diabetes are above 7.0 Grade C if below is Grade B
75
What is the 2017 Periodontits Case definition?
1.Interdental CAL detectable at 2 non adjacent teeth
or
2. Buccal or oral CAL above or equal to 3mm with pocketing equal or more than 3mm at 2 or more teeth
AND
OBSERVED CAL CANNOT BE ASCRIBED TO NON-PERIODONTITIS CAUSES: SUCH AS VERTICAL ROOT FRACTURE/S
76
How many appointments do you need for a general denture?
1. Denture consult + primary impressions
2. Secondary impressions
3. Bite registration + shade mould selection
4. Denture try on
5. Denture insert
6. Review denture
77
What are the indications for temporary denture? How many appointment does a construction require?
As an interim denture or immediate partial denture
Usually 3 appointments:
1. Denture consult, alginate impression + shade selection
2. denture try in
3. Denture insert (after extractions)
+
Review
(Can't be chrome or varplast)
78
What are the standard appointments for a valplast denture contruction?
1. Consult, alginate impressions, bite reg, shade selection adn mould
2. Dentur try in
3. Denture insert
4. Review
79
What is a triple wammy?
It is a pharmacodynamic problem which occurs with use of ACE inhibitor, diuretic and NSAID and can result in Acute Kidney Injury (AKI)
Process:
1. ACE inhibitors preserve renal function and also cause relaxation of efferent renal arteriole - reducing the GFR
2. NSAID are able to increase the vasoconstriction of the afferent arteriole by inhibiting the production of prostoglandins - a potent afferent arteriole dilator - reducing GFR
3. Dirutetic drive the increase exertion of water through the renal system thus increasing the amount of blood that is carried to the glomerulus through the afferent arteriole - reducing GFR
4. All three factors compound reduce the GFR significantly to cause kidney injury
5. Solution - avoid NSAIDs
80
When do you want to catach potential orthodontic case for interceptive treatment?
Class II treatment are most effective when you detect that the patient cephalogram is at CS 1 or 2 and you able to utilise maximum mandibular growth.
Class III treatment is most eefective when it is broken down itno two distinct stage: Maxillary expansion before maximum mandibular growth AND mandibular manipulation during pre-pubertal/pubertal stages.
81
What is the differene between infraocclusion and supra occlusion?
Infra-occlusion- tooth has not reached the occlusal level
Supra-occlusal - tooth has erupted past occlusal level
82
What is an aesthetic plane known as Rickett's plane?
It is a line that is drawn betweent eh pronasale and mental protuberance
83
What are the two main types of rotators of the mandible?
1. Backward rotators - more likely to have a class 2 relationship
2. Forward rotators - more liekly to be class 3
84
What are the vertical portion thirds?
1. Trichion to glabella
2. Glabella to subnasale
3. Subnasale to menton
85
What are the indications for crowns?
1. Protection of weak tooth structure
2. To re-establish the occlusion
3. Modification of tooth shape
4. Replacement of missing tooth structure
5. As retainers
6. Aesthetics
86
What are the contraindications for crowns?
1. Poor oral hygiene and active dental disease
2. Cost
3. Patient's age - young patients who have large pulp chambers which may be exposed
4. Excessive removal of tooth structure
87
What are some of the considerations for a crown selection
1. Occlusion
2. Endodontic status/vitality
3. Other teeth requiring treatment
4. Future of tooth
5. Future dentition
6. Restorability of tooth/teeth
88
What are the indications for a veneer?
1. Diastema closure
2. Alter shape, contour, position
3. Alter tooth color
4. Mask tooth surface anomalies
89
What are primary functions of a post?
1. Retain the core
2. Stabilise the core
3. Obturation of the post canal
90
WHat are the 5 key principles of crown prep?
1. Preservation of tooth structure - preserve remaining tooth structure
2. Retention and resistance form
3. Structural durability - enough thickness of the crown material so it doesn't fail - each material requires different thickness
4. Marginal integrity - utilise finish lnes - bevels, chamfers, shoulders - remember bad margin = caries, gingivitis and perio - to recreate the appropriate finish design - use the right bur! easy peasy (remember to just use half of the bur so you dont create undermined enamel) - burs come in different sizes, so the size of the bur will dictate the width of the finish line
5. Preservation of periodontium - dont fuck up the periodontium - put your margins supragingival ideally
91
What is retention and resistance form?
1. Retention prevents removal of the restoration along the path of insertion
2. Resistance prevents dislodgement of the restoration by forces in an apical or oblique direction (rocking)
92
How do we achieve appropriate retention and resistance form in crown prep?
1. Appropriate taper - the more parallel the walls are - the more resistance you have - combined angle of 6 degrees is optimal (3 degrees deviation at the crownal part comparing to the base of the tooth on each side, 3+3=6)
2. MORE SURFACE AREA - think big teeth retain crowns better - more crown height and width
3. Path of insertion - NO UNDERCUTS, NO NEIGHBOURING TEETH TILTING
93
What are the steps for indirection restoration in terms of visits?
Visit 1 - Exam and alginates for study models + shade selection
Visit 2: Putty key, LA, crown preperation, secondary impression and prvisional restoration
Visit 3: LA, remove provisional and insert final
94
Why do we use triple-trays in fixed prosthodontics/special trays?
1. It take bit registration with the imprsion
2. Impressions are way more accurate
3. Reduce the wastage of material
95
What is the point of a retration cord in fixed prosthodotnics?
1. Retract soft tisssues to allow impression material to flow to the margins of the preparation
2. Control bleeding
96
What is the purpose of study cast in fixed prosthodontics?
1. Wax up
2. Occlusal analysis
97
What is a purpose of temporary crown?
1. Pulpal protection
2. Reestablish occlusion
3. Prevent supra-eruption
98
Why reduce incisal edge for anterior PBM cron by 2mm?
1. For placement of porcelain for aesthetics and strength
2. Enamel thickness is the greatest there so you could do it
99
What is the purpose of subgingival margins?
1. Aesthetic reasons
2. To increase retention - the crownal height is too short
100
What are the downsides of subgingival margins?
1. It is harder to access for appropriate biofilm control
2. There is a risk of intrusion into biological width leading to further recession
101
What would you do to a tooth that you believe to be carious?
1. Examination and history taking
2. Esing the tip of the explorer on the dry field and good light on the tooth surface, try the tooth for any cavitation - tactile sensativity
3. Use air ont eh tooth to triger any dentinal sensativities
4. Rdiographically - look for any pathological radiolucent areas
102
103
What are the measurements for the prep of an anterior tooth
The labial:
1/3 (gingival) - 1.0 to 1.3 mm
2/3 (incisal) - 1.5 mm
Proximal
0.5mm at gingival to 1.5 mm at incisal
Lingual:
Gingival cingulum wall - 0.5mm
Concave surface - if metaland ceramic = 1.0mm, If metal only = 0.5mm to 0.8mm
104
What are the 4 major burs you use in PBM crown prep?
1. Technic 847 - tapered wall and flat end
2. L10 - thin bur
3. Komet 8877 - for shoulder
4. Horico 239 - pear shape bur (VERY AGGRESSIVE)
5. 8877 bur - for smoothness
105
What are the functions of provisional restoration?
1. Pulpal protection
2. Positional stability
3. Restoring function
4. Restoring esthetics
5. Maintain periodontium
6. Protect underlying tooth structure
106
What are some of the options for a temporary crown?
1. Prefibricated - crown formers - could be metal for posteriors!
2. Custom made - using Protemp4
107
What are the steps of constructing of a temporary crown?
1. Take impression of tooth on study model or intra-orally before cutting preparation - use take one putty
2. Place 'Protemp4' in impression and seat on prepared tooth
3. Remove temp from tooth when resin has set to "rubbery" stage - remove with flat plastic
4. Trim with soflex disc
5. Assess the margins, polish and check contact
6. Check the crown on - cement the crown with temporary cement - preferably eugenol free temporary cement - most common is tempbond
7. Check occlusion but remember that the material might crack
108
What are the criteria for a satisfactory secondary impression?
1. Good recording of crown margins and adjacent cervical tooth/root surface
2. All surfaces and line angls of crown preparation
3. All retentive features
4. Adjacent teeth + 'emergence profile' which is the relationship of cervical tooth contrours and gingival tissues
5. Occlusal surfaces so can articulate upper and lower models
6. Edentulous ridge form for bridgework
109
What technique do we apply when we placing gingival retraction cords?
We use a double cord technique:
1. Primary cord - in order to create vertical displacmenet
2. Secondary cord - usually a one size larger cord - to create vaertical and lateral displacement
110
How do PolyVinyl Siloxanes (PVS) set? What is it's advantages and disadvantages?
It sets via cross-linking which is better than condensation. It is the most common material use in light and heavy body.
Advantages: Super stable, odor neutral, great tear strength and elastic recovery - amazing delivry system via a gun (automix) or machine (pentamix)
Disadvantages: chemical reaction reacted with latex, locking into undercuts and open membranes and is expensive as shit
111
How do Polyethers set? What is it's advantages and disadvantages?
It sets via cross-linking and is an excellent material in terms of dimensional stability because it does not have a bi-product int eh reaction
Advantages: amazing ccuracy and very good shelf life
Disadvantages: VERY STIFF VERY VERY STIFF do not use if you have undercuts again VERY STIFF VERY VERY STIFF, shorter working time than PVS silicones and sometimes it gets stuck to oral mucosa
112
What are the trays that we can use for secondary impressions?
1. Stock trays that fit most of people - S, M, L sizes - pretty standard
2. Special position tray - it is custom made, expensive but it is super accurate
3. Triple tray - amazing tray but expensive - dual sided, take bite registration aswell - great for gagging patients
113
What type of adhesive do we use on the tray?
Use PVS for PVS, use PE for PE - dont be an idiot
114
What type of technique in terms of viscosity do we use when constructing a secondary impression?
Dual Viscosity Technique
1. Ask DA to start loading heavy body
2. Remove secondary cord Discard 5 mm of light body on the tray, than inject around the margins of the tooth, entire tooth and adjacent teeth
3. Keep the tie below the surface to avoid air bubbles
4. Seat the tray
5. Allow to set for 5 minutes
6. Remove tray
7. Wash with water
8. Dry impression and assess
9. Send to the lab with instruction
115
What are the three main components of the restoration of endodontical teeth using post and core systems?
1. Dowel (post) - core retention
2. Core - replacement of the lost coronal structure
3. Coronal - restoration itself
116
What is the function of the dowel? What are types of dowels?
Function:
1. Give retention of the core
2. Distribute the stresses along the root
3. Use for obturation
Classification:
1. According to material - metallic, combination and all non-metallic
2. According to attachment - 3 piece (all object separate), detached
3. According to method of construction - pre-fibricated or custom made
117
What are the characteristics of ideal post?
1. Post diameter - diameters should be just sufficient to resist bending but not too large to induce root fracture - wider is better for retention but too wide may result in fracture - recommendation if 1/3 of root diameter
2. Post length -
RULES:
1. two thirds the length of the canal - good retention
2. half the length of the root supported by bone in case periodontally affected tooth
3. A minimum of 4-5 mm of GP should be left '
3. Post material - withstand functional stresses and resists corrosion
4. Radio-opacity - needs to be clearly seen on radiographs
5. Bio-compatible
6. Retrievable
7. Can bond to tooth structure and dental materials
8. Consider crack factor
9. No interference with aesthetics
118
When is post necessary?
A post is required if there is insufficient sound coronal tooth structure remaining to provide stability and retention for the final restoration
119
What are contraindications for posts?
1. If core can be retained and supported without post
2. Non-restorable tooth
3. Short roots, thin roots and carious roots
4. Bends/blockages in root canals
5. Existing tooth pathology
6. Poor periodontal support
120
What is the "Ferrule Effect"?
Even is you have build up a core - a certain amount of tooth structure needs to remain in order to provide adequate resistance in order to reduce 'splitting' of the root.
121
What are some of the problems with post-retained restorations?
1. Loss of retention
2. Secondary caries
3. Root fracture
4. Post fracture
5. Post bending
6. Root resorption
7. Apical infection
122
What are the steps for placement of a stainless steal crown for a child?
1. Consent from the parent guardian
2. Adequate LA
3. Rubber dam using cuff technique
4. Occlusal reduction 1-1.5 mm
5. Caries removal and pulpotomy - build up with RMGIC
6. Interproximal reduction
7. Trial a crowns - go from lingual to buccal
8. Crimpthe crown
9. Cement with a cement or GIC
123
124
Why does caries progress rapidly in decidious teeth?
1. Thinner enamel and dentine
2. Wider dentine tubules
3. Large pulp chambers
4. Extensive pulp horns
125
What are some of the contraindications for extraction for a child?
1. Haemophilia
2. Von Willebrands disease
3. Platelet disorder
126
What are some of the medical contraindications for pulpotomy?
1. Congenetial heath disease
2. Immuno-compromised
3. Poor healing potential
4. Special needs/ or sever disability
127
What are some of the indication of extraction of a tooth in a child?
1. Irreversible pulpitis
2. TTP
3. Abscess formation
4. Mobility increase
5. Facial swelling
6. Radiolucency in the interradicular space
7. Tooth is VERY unrestorable
128
What are some of the questions to ask a patient for pulpal diagnosis?
1. Stimulated pain - hot cold biting
2. Spontaneous pain
3. Getting better/worse
4. How long has pain been for
5. Kept awake at night?
129
What do you report on a radiograph for a child?
1. Extent of carious
2. Proximity to pulpal horns
3. Presence and position of the permanent successor
4. Status or root and surrounding bone
130
What are the stes for a pulpotomy of 85?
1. Consent from parent
2. LA + sedation - IANB with 2% lignocaine, 1:80000 adrenaline, 2.2 mL
3. Rubber dam isolation with cuff technique
4. Initial phase - removing disease and bacterially contaminated tissues with use of slow speed handpieces. Previously - acess with high speed bur
5. Remove entire roof of pulp chamber and remove pulp from the entire chamber and root orifice
6. Achieve haemostasis
7. Place medicament over radicular pulp stums - formocresol
8. Condense IRM into chamber
9. Restore with GIC/RMGIC following appropriate GIC/RMGIC procedures
10. Restore tooth with stainless steel crown - coronal sela is essential
11. Review in 3 months - inform the patient that if pain persists you might need to extract
131
What is a fornocresol?
It is a medicament that is used for devitalisation of the pulpal tissue in kids.
Acts as potent tissue fixative
132
What are other 2 medicament that can be used for pulpotomy in childrens?
1. MTA
2. Ferric Sulphate
133
What is some of the appoitments you cna have with a kid?
Appoitment 1 - Consent, exam, Symptomatic treatment, Bitewings and treatment plan confirmed
Appoitments 2-5 - quadrant care
Appointment 6 - prophilaxis and modification of risk factors
recall in 3 months for re-assessmnet
134
What are the landmarks that help to locate teh site of IAN?
1.Level - coronoid notch, 1cm above lower occlusal plane, midway between arches with mouth wide open, buccal pad
2.Angle - opposite premolars
3.Entry point - pterygotemporal depression
135
What framework can be used to assess fissure sealants?
CAMST.
Coverage - is the fissure fully covered
Amount - is there enough FS material
Margins - are the margins sealed & flush
Surface - is the surface smooth
Tooth - at future appts check the tooth
136
What a diagnostic statement?
It is when you write clinical problems in order of most importance
137
What are the 4 basic counselling skills?
1. Open questioning
2. Affirmations
3. Reflections
4. Summaries
138
What are the four processes of motivational interviewing?
1. Engaging
2. Focusing
3. Evoking
4. Planning
139
What are some of the barriers to quitting smoking?
1. High nicotine dependence
2. Lack of knowledge
3. Not ready to quit
4. Psychological or emotional concerns
5. Fear of weight gain
6. Fear that quit attempt will be unsuccessful
7. Substance use
8. Living with other smokers
9. Giving quitting a low priority due to other circumstances
140
What are some of the symptoms of nicotine withdrawal?
1. Difficulty concentrating
2. Headache of dizziness
3. Irritable
4. Tiredness
5. Excessive Sweating
6. Coughing
7. Feeling hungry
8. Diarrhoea or constipation
9. Tingling Fingers
10. Feeling tense or angry
11. Restlessness
141
What is the 5 As framework?
1. Ask - ask if they smoke
2. Assess - assess their stages of change
3. Advise - information is the key
4. Assist - discuss the benefits of quitting
5. Arrange - arrange for follow-up
142
What are the goals of treatment for a person with nicotine addiction?
1. To increase motivation
2. To reduce withdrawal intensity
3. To decrease exposure to tobacco smoke
4. To improve coping responses to stress and anxiety
5. To facilitate abstinence from tobacco smoking
143
What is a good framework to conduct motivational interviewing?
Being with OARS
1. Open questions
2. Affirmations on progress
3. Reflections
4. Summaries
Find point at which the client is in stages of change, gather information and move on to principles of motivational interviewing
1. Develop discrepancy - change os uncomfortable so it is important to informt he cleint about benefit sof change
2. Roll with resistance - listen to clients arguments, don't refute them, make a neutral statement -DONT GIVE SOLUTION, maybe adressing an issue later will help the client to keep the issue at the back of their mind and build a good relationship with you
3. Build self efficacy - encrouage the client, to benefits of change and affirm general better outcomes - comment that it is good that they thought about the change
4. Express empathy - again change is hard and for a person who is uner pressure it is evne harder.
144
What are some of the example of change talk?
1. Desire to change " I want to"
2. Ability to change "I think I can"
3. Reasons to change "My kids wnat me to"
4. Need "I think I need to do it"
145
Why is change talk is important?
Change talk shows that the patient is more engaged with the question thus is more likely to be opne to changes and be motivated to change
146
What is the final part of motivational interviewing?
Planning.
Always plan with your client.
147
What are the zones of the panoramic imaging assessment?
Zone 1 - Nose and sinuses
Zone 2 - Md Body
Zone 3 - Articular Eminence, Condyle, Mx Tuberosities, Pterygo Mx
Fissures, EAM, Cervical Spine
Zone 4 - Epiglottis
Zone 5 - Md Ramus and Spine
Zone 6 - Dentition
148
Why is bisecting angles technique not ideal?
It is not ideal because it is susceptible to errors
149
Why would you use a bisecting angles technique?
You would use it if you need to overcome problems encountered with paralleling technique and related to anatomy
150
What are the advantages of bisected angle technique?
1. Increased atient comfort
2. Detector positioning is quick and easy
3. When done correctly - appropriate clinical image cna be created
151
What are the disadvantages of bisected angle technique?
1. Success very dependent on skill of operator
2. High risk of destortion
3. Overlapping
4. Bone level not accuratley demonstrated
5. Not reproducible
6. Cone cutting
152
What are the clinical steps in making an alginate impression?
1. Informing the patient about the procedure
2. Equipment needed selected
3. Assess the oral cavity
4. Tray selection
5. Tray try-in
6. Md Tray try-in
7. Mx Tray try-in
8. Mandibular impression - preparing and mixing alginate
9. Loading the Md tray
10. Making the Md impression
11. Making the Mx impression
12. Checking your working area
13. Laboratory form/instructions
14. Record keeping
153
What are three most common anaesthetics used in the ADH
1. 2% Lignocaine with 1:80000 adrenaline (Lignospan special)
2. 3% Mepivicaine (Scandonest Plain)
3. 4% Articaine with 1:100000 adrenaline (Articadent)
154
What is TRIM?
TRIM is an acronomy for:
Timing
Relevance
Involvment
Method
155
How would you write your statement for LA administration?
1. Put the local anaesthetic : 5% lidocaine Ziagel placed into buccal sulcus near 22
2. Put the technique : Supraperiosteal infiltration
3. Put the anaesthetic and amount and purpose: Lignospan special (2% lignocaine with 1:80000 adrenaline), 1/2 carpule for both soft tissue and pulpal anesthesia
156
What is the key differene between the Miller technique and Tube shift technique in localisation?
1. Miller technique - two radiographs are taken at right angles to each other - good at determining the position of an impacted tooth
2. Tube shift - a slight shift of the tube is needed after the first radiograph (SLOB) to discern which root is which
157
What is complete denture retention?
Complete denture retention is the resistance to displacement of the denture base away from the ridge. It provides psychologic comfort to the patient.
158
What is denture stability?
Stability is the resistance to horizontal and rotational forces. Stability has been cited as the most significant property in providing for physiologic comfort.
159
What is denture support?
Support is the resistance to vertical movement of the denture base towards the ridge.
160
What are 3 impression material used for rem pros in the ADH?
1. Alginate - halas
2. PVS - Honigun
3. Polyether - Impregum duosoft
161
What are the steps to describing radiographic lesions?
1. Relative radiodensity - mixed, radioopaque or radiolucent - CONSIDER SOFT TISSUE SHADOWS
2. Site
3. Size
4. Shape
5. Outline or border
6. Effects on adjacent structures
162
What is a dentigerous cyst?
It is a developmental odontogenic cyst of the jaws surrounding the crown of an unerupted tooth, the lining attached to the cementoenamel junction
163
What is an odontogenic keratynocyst?
It is a genetic mutation of PTCH1 gene that activates cell proliferation. It is an aggressive cyst. IT CAN EXPAND THE JAW and IT CAN RE-OCCUR.
It arises from dental lamina and is significant due to active epithelial growth rather than take up of water.
There is a risk of recurrence and occurs in the posterior body and the ramus.
Associated with Gorlin Syndrome or Naevoid Basal Cell Carcinoma Syndrome (same thing).
It could present as a multi-locular appearance
164
What is the lining of odontogenic keratynocyst histologically?
Thing lining of parakeratinised stratified squamous epithelium with palisading hyperchromatic basal cells
165
What is ameloblastoma?
Ameloblastoma is a benign but locally infiltrative epithelial odontogenic neoplasm of the jawbones characterised by ameloblas-like cells.
MOST COMMON ODONTOGENIC TUMOUR - most common in the mandible
166
What are clinical features of ameloblastomas?
1. Slow destructive area
2. Expansion rather than perforation
3. Seldom painful
4. Somehow it can mestasise but it is very rare
Radiographically:
1. Typically well defined, multilocla radiolucency
2. FLOATING TOOTH APPEARANCE
167
What is the histology of ameloblastoma?
Core components: Outer layer adjacent to CT resembling pre-ambeloblasts and centra, more loosely organised zone like stellate reticulum cystic breakdown
*there is no mineralised dental tissues or matrices
168
What are some of the pre-requisites for health according to the Ottawa Charter?
1. Peace
2. Shelter
3. Education
4. Food
5. Income
6. A stable exosystem
7. Sustainable resources
8. Social justice and equity
169
What are some of the action areas of health promotion according to Ottawa charter?
1. Build healthy public policy - think sugar tax
2. Create supportive environments - think ban of sugary foods in schools
3. Strengthen community action - support your local dental programs such as the indigenous oral health unit
4. Develop personal skills - raising awareness with patients
5. Reorient health services - focus on both high risk and popuation approach
170
What are some of the ways we can introduce the drug to the organism?
1. Enteral - through the intestine - oral, sublingual and rectal
2. Parentral - everything else due to them being sensative to gastric juices or we need a quick effect - injections basically - intravenous, intramuscular or subcutaneous
3. Other routes - inhalation, tranasal, topical, transdermal patches and other other like eyes, nose, ears drops
171
What kind of obturation technique do we use?
Cold lateral condensation
172
What are the steps of approval of a drug in Australia?
1. Aims - to protect public from drugs that are: unsafe, ineffective and poor quality
2. Process - TGA is presented data
3. Evaluation of quality, safety and efficacy
4. Registration
5. Movement to the market
173
Do blood thinning drugs actually thin blood?
No - they affect the clotting cascade thus reducing the ability to clot. Old fashion warfarin for example affect Vitamin K which is an important clotting factor. To counter warfarin, just drink some Vitamin K
174
What is the difference between the reliever and a dialator?
Preventer is taken before to lower the chance or severity of asthma through different vasodialating effect. Usually a low dose of corticosteroids
Reliever - is usually just use for quick relaxation of smooth muscles.
175
Whatis the interaction between cliclosporin and Saint John's wort?
Ciclosporin is an immunosupresant that is able to aid in organ transplants.
St John's Wort is a over the counter herb that cna aid in depression.
St John's Wort is able to trigger an increase production of an enzyme that metabolises ciclosporin.
Thus decreasing long term plasma concentration leading to transplant organ rejetion by the body.
176
Why cant you give warfarin and miconazole together?
Miconazole can potentiate the actions of warfarin thus increasing International Normal Rate.
Thus make a patient more likely to bleed.
Miconazole is inhibiting hepatic microsomal cytochrome P-450 enzymes. increasing concentration of warfarin.
177
What is an example of potentiation effect of medications?
Warfarin and iboprofen/aspirin - increase bleeding significantly
178
What is the endo-perio aetiology?
1. Primary endo infection - carious lesions affect the pulp and secondarily affect the periodontium
- Inflamed pulp exerts little or no effect on the periodontium
- Necrotic pulp cause bone resorption
- Sinus tract drain through PDL into gingival sulcus
- Isolated periodontal defect
2. Primary perio - periodontal disease introduces bacteria through different channels of communication in
179
What are some of the diagnostic hints that might lead us to see that the lesion is a primary endo secondary perio lesion?
1. Pulp test negative
2. Compromised coronal integrity
3. Isolated deep narrow peridontal pocket - might need to use a guttapercha and take a PA
180
What is the treatment of primary endo secondary perio lesion?
1. RCT
2. No immediate scaling and root instrumentation - please await healing first - 3-6 months should be enough for healing and reassessment
181
What are some of the diagnostic hints that might lead us to see that the lesion is a primary perio secondary endo lesion?
1. Sever periodontitis
2. Pathological changes occur in pulp
3. Retrograde pulpitis - acute pain for long duration
4. Pulp test incoclusive
5. Coronal integrity intact
6. Deep periodontal pockets around the tooth
182
What is the treatment of primary perio secondary endo lesion?
1. Scaling and root instrumentation needs to be done together with the root canal treatment
or
1. Extraction depending on prognosis
183
What is the diagnostic clues of a combination endo-perio lesion?
1. Pup test is negative
2. Deep peridotnal pockets on multiple sites
184
How to write a diagnostic statement for a endo-perio lesion?
1. Write that it is a endo perio lesiom
2. Root damage extent
3. Perio status of the patient
4. Grade of the problem
185
What are the classifications of periodontal pockets associated with an endo-perio lesion associated with periodontitis patients?
Grade 1 - narrow and deep periodontal pocket in 1 tooth surface
Grade 2 - wide deep periodontal pocket in 1 tooth surface
Grade 3 - wide deep periodontal pocket in more than 1 tooth surface
186
What are the classifications of periodontal pockets associated with an endo-perio lesion associated with non-periodontitis patients?
Grade 1 - narrow deep periodontal pocket in 1 tooth surface
Grade 2 - wide deep periodontal pocket in 1 tooth surface
Grade 3 - deep periodontal pockets in more than 1 tooth surface
187
What is the BPE and how do we use it for paediatric patients?
BPE stands for basic periodontal examination and we use it as a code system similar to PSI!
Children with codes 0,1,2 should just have routine exams
While children with codes 3 & 4 should be undergoing consistent periodontal care to improve their condition
Note that some times Code 3 in a mixed dentition could be just erupting teeth so please be considerate.
188
How do you write a diagnostic statement for periodontist modified by diabetes?
1. Type of periodontal disease
2. Disease extent
3. Stage
4. Grade
5. Current disease status
6. Risk factor profile
E.g.
Periodontitis: generalized (65%), Stage III (CAL <10 mm), Grade C (HbA1c 8.9%), currently unstable (PPD <8mm, BOP 45%).
Risk factors: uncontrolled diabetes (HbA1c 8.9%), smoking 20 cig/day, high strss levels (change in work)
189
What are the criteria to assess alginate impresion?
1. Alginate mix is homogenous and smooth - is it mixed well, is it too runny
2. Tray appropriate size - are all teeth included and past the tuberocity area
3. Alginate has had adequate time to be inserted into the mouth, seated onto the teeth and set prior to removal - is it seated on teeth correctly, has it set, has the material flown past the CEJ
4. Adequate amount of alginate in tray and the treay has been seated and muscled trimmed correctly - has muscle been trimmed, have the tongue been placed properly
5. Tray has been removed correctly
190
What is important aspects to assist a patient with general stress?
1. Open communication about fears and concerns
2. Short appoitment
3. Mornign appoitment
4. Ensure profound local anaesthesia
5. Need to provide adequate post-operative pain control
6. Post-procedure telephone call
191
What are the basic drugs and equipment that should be available at every dental practice required by law?
Drugs:
1. Oxygen
2. Adrenaline
3. Glucose
4. Bronchodilator
5. Aspirin
6. Hydrocortisone
Equipment:
1. Blood pressure monitor
2. Glucose monitor
3. Pulse oximeter
4. Automated external defibrillators
5. Laryngeal airways
192
What is syncope, what's it's causes and how do we manage it?
Syncope - transient self-limiting loss of consciousness. The onset is rapid and spontaneous and complete. Has presyncope phase of light-headed, nauseated, anxious and pale.
The underlying mechanism - cerebral hypoperfusion - i.e. low oxygen levels
Causes:
Vasovagal
Orthostatic
Cardiac dysrhythmias
Cardiac disease
Managmenet:
1. Stop treatment
2. Lie the patient down
3. Support airway by removing all object for the mouth
4. Measure the patient's blood pressure and heart rate
5. If the patient does not regain consciousness - call 000 begin DRSABCD
193
What is the protocol of action if you suspect the patient having coronary ischaemia syndromes in chair?
1. Stop treatment
2. Measure: blood pressure, heart rate and pulse oximetry
3. Assess consciousness
4. To relieve symptoms use glyceryl as instructed, call the registered nurse
If patient reports pain to be THE WORST EVER DO:
1. Call 000
2. Give glyceryl to a patient with previous history of angina
3. Give aspiring 300 mg orally
4. Measure: blood pressure, heart rate and pulse oximetry
5. Start supplemental oxygen - call registered nurse
6. Provide reassurance
7. If patient loses consciousness - start DRSABCD protocol
194
What is cardiac arrest, what are signs and causes, what is the management of the patient?
Cardiac arrest is the stop of heart function.
Signs: no pulse, loss of consciousnes and respiration
Causes: ventricular tachycardia, ventricular fibrillation, asystole
Managment:
1. Stop dental treatment
2. Call 000
3. DRSABCD
195
What is the management of mild or moderate asthma?
1. 4 puffs of slabutamol inhaler, 1 puff at a time, shaken before each puff
2. Ask the patient to take 4 breaths in and out of the spacer after each puff
3. Wait 4 minutes
4. If no imporvement - repeate
5. If no improvement again - define this as a sever or life-threatening attack
196
What is the management of sever or life threatening asthma attack?
1. Call 000
2. Start oxygen and airway support
3. Salbutamol - 12 puffs for 6+ years, 6 puffs for less than 6 year olds
4. 1 puff at a time, 4 breaths in between
5. When waiting for help - perform the protocol every 20 minutes
6. If patient is worsening - continuously administer salbutamol
197
What are the signs of partial airway obstruction?
1. Wheeze
2. Stridor (noisy inspiration
3. Laboured breathing
4. Coughing spasms
5. Cyanosis
198
What are the signs of complete obstruction of the airways?
1. Inability to breath, speak, cry or cough
2. Agitation, gripping of the throat
3. Cyanosis
4. Bulging of the neck veins
5. rapid development of respiratory failure
6. Loss of consciousness
199
What are the steps of management if the patient is conscious with signs of airway obstruction?
1. Call 000
2. Reassure the patient and ask them to relax, breete deeply and try to dislodge the object by coughing
3. If coughing is ineffective - give upto 5 back blows between the shoulder blades - check between each hit
4. If the back blows dont work, do 5 chest thrust similar to CPR
5. Continue until assistance arrives
200
What are the steps of management if the patient is unconscious with signs of airway obstruction?
1. Call 000
2. Inspect the back of the throat for foreign object
3. Start DRSABCD
4. Consider performing cricothyroidotomy
5. DO NOT DO THE HEIMLICH MANOEURVE
201
What is the management of seizures?
If history of epilepsy or seisures is present - please use a bite block on the patient
1. Stop dental treatment
2. Ensure patient is not in danger
3. Turn the patient to the side
4. Avoid restrainning
5. Wait until seizure stops
6. Maintain airways
7. Assess the patient
8. If still unconscious, call 000 and maintain airways
202
What to do if you given the patient a partial paralysis of priocular muscles because of the injection intro the parotid plexus?
1. Stop administratioe patchn of local anaesthetic
2. Explain what happened
3. Tell the patient to not rub their eye
4. Close the eye with an eye patch
5. Keep the patient under observation until the ability to blink starts to return
6. Advise patient not to drive
7. Phone the patient in 12 hours and make sure the issue resolved - if not refer for extra medical care
203
How to manage a person with hypoglycaemia?
1. Stop dental treatment
2. Give 15 g of glucose or a similar drink or food
3. Measure blood glucose - if does not return to normal - repeat the dose
4. If after 3 doses normal blood sugar not returned - call for help
5. If unconscious call 000 than DRSABCD
204
How to manage a person with hyperglycaemia?
Call 000
205
When does an addisonian crisis occur and how to manage it?
Usually occurs in patient with hyperthyroidism or use of corticosteroids 6-12 hours after surgica; stress
Managment:
1. Call 000
2. Give hydrocortisone 200 mg
3. Think about GIVING MORE STEROID BEFORE PROCEDURES
206
What is step by step management of mild urticaria or angiodema?
1. Stop dental treatment
2. Remove or stop administration of the allergen
3. Recommend oral anti-histamine
207
What is the step by step management of a patient with anaphylaxis?
1. Stop dental treatment
2. Remove or stop administration of the allergen
3. Lie patient flat
4. Give an intramuscular injection of adrenaline
5. Call 000
6. Start supplemental oxygen and airway support if needed
7. DRABCD
8. Repeat adrenaline every 5 minutes
208
What are some of the important information that needs to be considered when treating a patient with ischaemic heart disease (myocardial infraction)?
1. Need to reduce the stress and anxiety
2. Patient taking none selective beta blockers - need to consider the amount of epinephrine injected
3. Patient taking aspirin may have excessive bleeding
4. Patient who had coronary artery bypass graft may require antibiotics
5. Patient may have some degree of heart failure
6. If patient has a pacemaker, some dental equipment may potentially cause electromagnetic interference
Remember of having INR of less than 3.5 and speak to the cardiologist
209
What are some of the important information that needs to be considered when treating a patient with COPD?
1. Avoid treating if upper respiratory infection is present
2. Treat in upright chair position
3. Avoid rubber dam in sever disease
4. Use pulse oximetry in severe disease
5. Avoid nitrous oxide/oxygen inhalation sedation with sever COPD - in order to not reduce the respiratory drive
6. Avoid using narcoticts - in order to not reduce the respiratory drive
7. Consider using steroids before the appoitment
210
How does the diabetes damage the body?
Higher Blood glucose leads to advanced glycosylated end products (AGE) and free radicals which damage tissues - mostly on two levels
Microvascular damage - think perio
Macrovascular - think coronary artery disease and renal disease
211
What medicament would you use for a child's pulpotomy in student clinic?
Ferric sulphate
212
Where does the cusp of 13 occlude in a class 1 occlusion?
Between 44 and 43
213
What are 2 factors affecting reduced vaccination in low-income countries?
-lack of access,funding and opportunity
-low education,distrust of authority and discrimimation towards minority groups
-virus> more mutations + variants in low income countries
-reduced efficacy of vaccines
214
215
What is the role of sodium alginate in alginate material?
Sodium alginate forms a hydrogel former
216
What is the role of calcium sulphate dihydrate in alginate material?
It provide clcium ions
217
What is the role of sodium phosphate in alginate material?
It controls working time - acts as a retarder of the rapid use of calcium within the reaction
218
Describe the setting process of alginate.
1. When mixed with water, a cross-link polymer chain is formed, resulting in a three-dimensional network structure
2. Calcium sulphate dihydrate provides the Ca ions for the cross-linking reaction that the sol to a gel
3. In order to decrease the setting time, sodium phosphate is added, which acts as a retarder, decreasing the number of Ca ions available for cross linking
4. When a certain threshold of Ca ions have been achieved, the cross linking reaction fully sets
219
What is the cartilage theory of craniofacial growth?
This theory was popularized by Scott in 1950s and states that cartilage determines the craniofacial growth. Proponents of this theory state that cartilage is responsible for the growth and bone just replaced it.
220
What is the functional matrix theory of craniofacial growth?
The functional matrix hypothesis was popularized by Melvin Moss in 1962. This theory said that neither bone nor cartilage is a major determinant of growth but soft tissue is. His view stated that as soft tissues around the jaw and face grow, bone and cartilage follow the growth of these soft tissues.
221
What type of bones are present in the cranial vault?
Flat membranous bones with suture in between. Osteogenesis occurs in the ossification centres + sutures. The cause of increase area of bones occurs due to brain growth. The out cortical plate usually deposits and inner cortical plate resorts.
222
What are the key points to craniofacial growth in orthodontics?
1. Much of the vertical face height increase due to tooth eruption + alveolar bone production
2. Mx & Md + dentitions desplaced down and forward relative to the cranial base
3. Individuals experience differing amounts and direction of facial growth
4. Around adolescence, slight differential growth of Md relative to Mx - meaning mandible tries to catch up
5. Facial growth dependent on idividual growth patterns
6. Factors infleuncing growth & development: genetics, SES, neural control, exercise, neural control, hormones and more.
223
What is crowding and what types of crowding are there?
Crowding - the discrepancy between tooth size & jaw size that results in the misalignment teeth.
Primary crowding - genetic origin
Secondary crowding - environmental factors such as extraction as a child
Tertiary crowding - occurs in the post adolescent period
224
What is leeway space?
It is the difference between the combined mesio-distal width of the permanent canine & premolars and the width of the corresponding precursors.
This space is eventually lost as mesial drift of first primary molars occurs following eruption of permanent canine & pre-molars
225
What is incisor liability?
It is the difference between the total mesio-distal dimensions of the decidous and permanents incisors
226
How do permanent incisors have enough space to fit in the arch during eruption?
Space is gained from:
1. Residual spacing between deciduous incisors
2. Permanent incisors erupt into more labial position and occupy a great arch perimetes
3. Deciduous canines move distally as incisors erupt
4. Transvers increase in intercanine arch width
227
WHat is a physiological explanation of a common upper midline spacing aka "ugly duckling gap?
It is a variation of normal dental development
It arises as the effcts of:
- incisor apicies initially close together as incisors erupt
- lateral pressure from erupting laters and canines
Diastema may close after laterla incisors erupt
Diastema may persist if:
- deciduous canines have been lost
- upper incisors are flared labially
228
What are the factors that facilitate dental arch allignment?
1. Use of interdental, primate and leeway spaces
2. Increased inter-canine width; mainly due to transverse growth
3. Proclined eruption of permanent incisors, forming a wider arch & increases dental arch length
4. Appositional growth of alveolar processes in 3 planes
5. Appropriate size of apical base and teeth
229
From which branchial arch does the mandible originate?
1st Branchial arch.
230
How do we define cases of gingivitis in a reduced periodontium without history of periodontitis?
Localized gingivitis: Probing attachment loss – Yes, Radiographic bone loss – Possible, Probing depth all sites – less than 3mm, BOP score – between 10% to 30%
Generalised gingivitis: Probing attachment loss – Yes, Radiographic bone loss – Possible, Probing depth all sites – less than 3 mm, BOP score – above 30%
231
How do we right diagnostic statement for gingivitis?
1. Extend - localised of generalised
2. Disease - gingivitis
3. Specification - biofilm induced, mediated by pregnancy or leukaemia
232
What is the unit of absorbed radiation?
It is called a Gray (Gy) or a Jkg-1
233
What type of biopsy would you use to confirm an ameloblastoma?
Incisional biopsy
234
What is the type of biopsy would you use to confirm of radicular cyst?
Fine needle aspiration
235
What is the H band?
It is a zone of thick filaments that is not actin
236
What is the I zone?
It is a zone of no myosin fillaments.
237
What nerve exerts pressure to anterior palate?
Nasopalatine
238
What nerve innorvates gingiva of mandibular canine?
Incisive branch of IAN
239
What are the 3 elements of autoclave sterilisation?
Moist hear in the form of saturated steam under pressure in an air tigh vessel.
Heat, steam, pressure and air tight vessel.
240
What type of cyst can be between 11 and 21?
1. Nasopalatine cyst - mostlikely
2. Nasolabial cyst
3. Pariapical granuloma
4. Apical periodontitis
241
How do you help a pregnant patient with gingivitis?
1. Educate the patient about the diagnosis, peform debridmenet and provide OHI
2. Use soft bristle tooth brush along gingival margins using modified Bass technique
3. Use CHx for 2 weeks
242
What do you consider before extracting a tooth from a patient with diabetets?
1. Pre-operative and post operative moutrinse with CHx to reduce bacteria number to reduce infection post extraction
2. Minimise truama during extraction
3. Ue longer lasting LA
4. Good haemostatic control like cotton pellets
5. Prescription of analgesics
6. Post operative instructions: don't drink hot liquids, don't rinse after extraction, don't smoke
7. NEXT WEEK FOLLOW UP APPOINTMENT
243
What are some of the systematic considerations for a patient with diabetets?
1. Consider multidisciplinery care with GP and oral surgeon
2. Stock dental practice and train personal for hypolglycemic/hyperglycemic situations
3. Consider oral consequences of diabetes: poor healing, increased infection rate, increase xerostomia
4. Risk of periodontitis
5. Consider early appoitments
6. Remember - these patient are immunosupressed
244
What is the mechanism of warfarin?
1. Competitively inhibits and blocks COX 2 enzymes
2. This affects platelet thromboxane A2 activity which inhibits platelet activation
3. Thus - reduction in clotting
245
Why can't you take codeine and alcohol together?
Codeine can not be taken with alcohol.
Codein acts on the central nervous system together with alcohol.
This increases sedation.
Also alcohol inhibits metabolism of codeine so that increases blood concentration of codeine metabolites to cause overdose.
246
Who should avoid fluconazole?
1. People who take warfarin - due to increased risk of bleeding
2. Pregnant ladies - it is a Category C drugs due to risk f foetal damage, decrease growtha dn development of the feutus, potential risk of miscarriage
247
What is the point of using 20% polyacrylic acid?
To remove smere layer to facilitate ion exchange
248
What is the purpose of RMGIC liner?
1. Fluoride release to remineralised dentine
2. Chemically sealing dentina tubules for pulp protection
249
What is the purpose of putting resin in less than 2mm increments?
1. Reducing C factor and hence minimise polymerisation shrinkage
2. Allow for pappropriate polymerisation
250
What can a tooth be asymptomatic even if caries that is deep?
Hypermineralised/sclerotic dentine formed in response to caries
251
What are the differences between infected and affected dentine?
Infected dentine:
1. Demineralised and stained
2. Collagen framework denatured and collapsed
3. Bacteria present
Affect dentine:
1. Collagen framework intact
2. Dentine transperent and demineralised
3. There is no bacteria present
252
What are the two patient centered reasons to do open disclosure?
1. It is part of legal requirements
2. It respects patient autonomy
3. Helps patient ot build trust in the dentla porfession
253
What does LA do?
It is an hibitor that reduces the influx of sodium particles into the nerves thus stopping the genertion of action potential
254
Acid changes from 5.5 to 4.5, name two chemical changes that occur when this happens in the presence of fluoride?
1. Demineralisation of hydroxyapatite
2. Formation of calcium fluoride
255
Why does LA not work in infections?
1. Infection or inflammation in the region causes pH to drop
2. Concentration of the unionised (lipophilic RN) decreases
3. Areas of inflammation also jave increase blood supply due to vasodialation - thus increase LA washout
256
What causes Tuberculosis?
Mycobacterium tuberculosis
257
What are the 2 symptoms of Tuberculosis?
1. Coughing with blood or mucus
2. Chest pain
258
What are the first 2 things you need to do in order to manage a patient you suspect has tuberculosis?
1. Initiate transmission based precautions
2. Patient placed in an area away from other patients
259
Why does organic matter like blood and saliva affect sterilisation?
1. It interference with actions of disinfectants
2. Disinfectant ability to penetrate down to the object's surface and provide thorough disinfection
260
What bacteria is associated with caries?
S. mutans
261
What bacteria is associated with shift from health to perio?
P. Gingivalis
262
What are commensal bacteria?
Those type of microbes that reside on either surface of the body or at mucosa without harming human health.
263
What is the name of the virulence mechanism produced by P. Gingivalis?
Lipopolyshecheraide and gingipans
264
What are the two different PCC techniques you can use to present bad news?
PREPARED:
1. Prepare for discussion
2. Relate to the person
3. Explore priorities
4. Provide information
5. Acknowldege emotions and concerns
6. Foster realistic hope
7. Encourage questions
8. Document
TRIM:
1. Timing - correct amount and type of info - chunk the information
2. Relevance - what will help the patient connect to this info? - relate to patients perspective
3. Involvement - How can patient contribute? - offer suggestions and choices rather than directives
4. Method - Help patient understand and recall? - use visual methods of conveying - PANFLETS
SPIKES
Setting - Find a quite and private setting
Perception - Estabslih how much the patient knows and his or her perceptions abut the medical situation
Invitation or information - Ask the patient and significant other how much and what kind of information will be helpful
Knowledge - Share bade news with the patient using gentle, nonclinical language is small segments
Empathy - Acknowledge the patient's emotions and reaction with appropriate responses
Summarise and strategise - summarise in language that the patient can understand. Ask the patient to repeat or summarise the information received and the next steps
265
How do you deal with an upset patient?
1. Show empathy to neutralise the situation
2. Present the factual information again
3. Tell the patient that it is within their right not to do anything about the situation or seek another opinion - empower the patient
266
267
What are the steps to occlusal analysis?
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
268
What are some of the factors that affects growth?
1. Gender
2. Nutrition
3. Socieconomic factorcs
4. Exercise and health
5. Environemntal factors
6. Genetics
269
What are some of differential diagnosis for a radiolucency in the posterior mandible?
1. Dentigerous cyst
2. Odontogenic keratocyst
3. Ameloblastoma
4. Ameloblastic Fibroma
5. Odontogenic myxoma
