Year 3, Sem 1 Flashcards
(245 cards)
1
Q
What is is the vertical angulation for B/W’s?
A
5-8 degrees
2
Q
What are the 3 guiding principles for radiation exposure?
A
Principle of justification
Principle of optimization
Dose limitation
3
Q
What are the layers of the imaging plate structure?
A
- Protective layer
- Phosphor layer (barium-fluorohalide)
- Reflecting layer
- Base
- Backing layer
4
Q
If the epicentre of the lesion is above vs below the IAC, what is the origin?
A
Epicentre above IAC: odontogenic origin
Epicentre below IAC: non-odontogenic origin
5
Q
Briefly describe mechanism of bisphosphonates
A
Potent suppressor of osteoclastic activity and slow the remodelling process of bone thus leading to an increase in mineral density. It becomes permanently incorporated into bone. Unfortunately, the increase in density of the mandible along with the reduction in blood supply renders the mandible susceptible to bone infection following trauma such as tooth extraction.
6
Q
Signs of sinister lymph
A
Hard, fixed, immobile, firm, painless
7
Q
Signs of sinister oral ulcer
A
Rolled margins, quick increase in size, non-healing, non-painful, fissuring/cracks, rough, thickened, bleeding spot, appearance of growth
8
Q
List the 5 principles of the Ottawa Charter and give examples of intervention for each
A
- Building healthy public policy – community water fluoridation
- Creating supportive environments – healthy options available at school canteens
- Strengthening community action – engage the community to support water fluoridation
- Developing personal skills – discuss smoking cessation
- Reorient health services – educating primary health care workers on oral diseases
9
Q
What is white sponge naevus?
A
- Rare
- Familial
- Appears at birth, childhood or adolscence
- Symmetric distribution, corrugated or velvety diffuse
- No tx required
10
Q
What are fordyce spots?
A
- Ectopic sebaceous glands
- Common on buccal mucosa, lateral lip
- Yellowish
11
Q
What is HHT- clinical features, where, tx?
A
- Uncommon
- Epistaxis
- Red papules 1-2mm, blanch on diascopy
- Located on lip, tongue, B mucosa
- Can be seen on hands, feet, GIT, genitourinary or conjunctival mucosa
- Tx: electro surgery, cryotherapy
12
Q
What is smokers palate?
A
- No malignant potential
- Caused by heat
- >45 years age
- Palate is diffusely gray/white
- Slightly elevated papules with punctate red centres
- Tx: smoking cessation
13
Q
What is leukoedema?
A
- Common, unknown cause
- Diffuse, grey/white, milky or opalescent
- Folded surface or appear as wrinkles
- Bilateral on B mucosa
- Disappear on stretching
14
Q
Difference between petechiae, purpura and ecchymosis?
A
- Petechiae: minute haemorrhage
- Purpura: larger area affected
- Ecchymosis: accumulation over 2cm
Caused by trauma or bleeding disorder
15
Q
What is fibro-epithelial polyp- what is it, where, clinical features, tx?
A
- Reactive hyperplasia of connective tissue in response to local irritation or trauma
- Most common on B mucosa
- Smooth surface pink nodule
- 1.5cm or less
- Asymptomatic unless ulceration
- Tx: conservative excision
16
Q
What is pyogenic granuloma?
A
- Common tumour like growth caused by local irritaiton or trauma
- Smooth or lobulated
- Surface ulcerated, pink-red-purple
- Bleeds easily
- Can be seen on gingiva, lips, tongue and B mucosa
17
Q
What is a melanotic macule?
A
- Flat, brown mucosal discolouration
- Most commonly affects lower lip, gingiva and palate.
- Hyperactivity of melanocytes
- Rarely present larger than 1cm
- Tx: biopsy, excise if in aesthetic zone
18
Q
What is melanocanthoma?
A
- Relatively uncommon
- Diffuse, dark pigmentation of large mucosal area
- Asymptomatic, ill-defined, rapidly enlarging
- Tx: biopsy to exclude melanoma
19
Q
What is smokers melanosis?
A
- Heavy smoking leads to it
- Response to irritation from tobacco smoke and heat
- Diffuse patchy pigmentation
- Usually seen in anterior md and mx gingiva
20
Q
What is erythema migrans?
A
- Affects tongue
- Multiple well demarcated area of erythema/atrophy, surrounded partially by slightly elevated yellowish-white scalloped border
- Atrophy of filiform papillae
21
Q
What is a hairy tongue?
A
- Accumulation of keratin of filiform papillae
- Inc keratin production or decreased desquamation
- Possible caused by: AB, poor OH, oxidizing MW, overgrowth of fungi/bacteria, general debilitation
22
Q
Definition of Leukoplakia?
A
A predominantly white lesion of the oral mucosa that cannot be characterized clinically or pathologically as any other definable lesion
23
Q
Difference between macule, papule, plaque, nodule, vesicle, bullae, erosion, pustule, ulcer
A
- Macule: well circumscribed, flat, change in colour
- Papule: solid raised lesion, <1cm
- Plaque: solid raised lesion, >1cm
- Nodule: solid elevated lesions, present deeper in dermis/mucosa
- Vesicle: elevated blisters containing clear fluid, <1cm
- Bullae: elevated blisters containing clear fluid, >1cm
- Erosion: shallow defect due to loss of epithelium up to basal layer
- Pustule: blisters containing purulent material
- Ulcer: discontinuation of epithelium of skin or mucosa
24
Q
What is a cyst?
A
Epithelial lined pathological cavity containing fluid, semi-solid/gaseous material
25
What are features of jaw cysts?
* Sharply defined radiolucency with smooth borders
* Grow slowly
* Symptomless unless infected
* Rarely large enough to cause pathological fractures
* Fluid may be aspirated
26
What are characteristics of dentigerous cyst?
* Most common developmental odontogenic cyst
* Cyst encloses crown of an un-erupted tooth
* Formed by cystic changes in dental follicle
* Common in md 3rd molars
* Tooth missing or failed to erupt
* Asymptomatic unless infected
* Well-defined, sclerotic border
* Tx: extract and enucleation or marsupialise if favourable for eruption. If left untreated can transform to ameloblastoma
27
What are eruption cysts?
* Lies superficially in gingiva overlying unerupted tooth.
* Fluid accumulation within follicular space
* Soft rounded bluish swelling
* Rupture spontaneously upon eruption
28
What is an odontogenic keratocyst?
* Arise from cell rests of dental lamina
* Grow A-P without causing expansion
* High rate of recurrence
* Asymptomatic
* Well demarcated radiolucency with scalloped radiopaque margin
* May envelop an unerupted teeth without displacing them (would mimic dentigerous cyst)
* Tx: unilocular/small multilocular lesions- enucleation & curettage. Large cysts- excision
29
What is basal cell naevus syndrome associated with?
* Multiple OKC
* Multiple basal cell carcinomas of skin
* Cleft lip and palate
* Calcification of falx cerebri
* Frontal and parietal bossing
30
What are gingival cysts of adults?
* Rare
* Dome shaped swelling \<1cm
* Sometimes erode underlying bone
* Tx: enucleation, unlikely to recur
31
What are gingival cysts of infants?
* Small, multiple, whitish nodules or cysts in gingivae
* Very common
* No tx required
32
What is lateral periodontal cyst?
* Uncommon developmental cyst
* Md premolar area along lateral root surface
* Well-circumcribed
* \<1cm
* Tx: conservative enucleation
33
What is glandular odontogenic cyst?
* Rare
* Anterior region
* Well defined, sclerotic margin
* Small cysts asymptomatic
* Large cysts show expansion and sometimes paraesthesia
* Tx: conservative excision, strong tendency to recur
34
What is calcifying odontogenic cyst?
* Derived from odontogenic remnants in gingiva or bone
* Well demarcated margin, scattered irregular calcifications
* More common in mx
* More aggressive tx required
35
What are radicular cysts?
* Most common jaw cyst
* Slow progressing, painless swelling (unless infected)
* Rounded hard swelling initially
* Later becomes egg shell thickness, cracking sensation, fluctuant
* Non-vital tooth associated
* Bone resorption
* Sharply defined, condensed radiopaque periphery
* Adjacent teeth tilted/displaced
36
What are residual cysts?
* Common cause of swelling in edentulous jaw
* May persist after exo of causative tooth
* Oval/round radiolucency
37
What is lateral radicular cyst?
* Cyst at side of non-vital tooth
* Result of opening of lateral branch of root canal
38
How are radicular cysts treated?
* Exo and curettage
* RCT
* Enucleation
39
What are paradental cysts?
* Result from inflammation around partially erupted tooth
* Affected tooth is vital and shows pericoronitis
* Lower 3rd molars
* Tx: enucleation
40
What is nasopalatine duct cyst?
* Located within nasopalatine canal or incisive papilla
* Rare
* Slow growing, symmetric swelling
* Often asymptomatic
* Intermittent salty discharge
* Well defined radiolucency, sclerotic margin, may be heart shaped
* Tx: enucleation
41
What is nasolabial cyst?
* Soft tissue cyst of upper lip
* Uncommon
* Located deep to nasolabial fold
* Tx: simple excision
42
What is medial palatal cyst?
* Firm/fluctuant swelling of midline
* Asymptomatic
43
What is dermoid cyst?
Uncommon
Midline of FOM
Size varies
Slow growing, asymptomatic
Rubbery mass
44
What is solitary (simple) bone cyst?
* Benign, cavity with no epithelial lining (pseudocyst)
* More common in long bones
* Restricted to md
* Asymptomatic
* Well defined radiolucency, scalloping between roots
* Vital teeth, no root resorption
* Tx: surgical exploration and curettage
45
What is aneurysmal bone cyst?
* Blood filled spaces surrounded by cellular fibrous tissue
* More common in long bones
* Rapidly developing swelling
* Pain
* Malocclusion, mobility, resorption of involved teeth
* Tx: curettage or enucleation
46
Describe Herpes simplex- type 1&2
* Primary and recurrent infection
* Start with vesicles that rupture into shallow, round ulcers/ Ulcers may coalesce
* Fever
47
What is varicella (chicken pox)?
* Common in children
* Vesicles rupture to produce round/ovoid ulcers with inflammatory halo
48
What is zoster (shingles)?
* Reactivation of dormant virus
* Common over 50yrs
* Unilateral along distribution of trigeminal nerve
49
What is herpangina?
* Coxsackie virus
* Pain and burning on soft palate and uvula
* Numerous vesicles leading to scattered ulceration
* Febrile, cervical lymphadenopathy
50
What is hand foot and mouth disease?
* Coxsackie virus
* Vesicles rupture to cause small ulcers with erythematous halo
51
What is syphilis caused by?
Treponema pallidum
52
What is mycobacterium tuberculosis?
* Bacterial
* Uncommon
* Secondary to pulmonary infection
* Chronic ulcers
53
What are some haematological causes of ulcers?
* Iron, B12 or folic acid deficiency
* Leukaemia
* Neutropenia
54
What are some GI causes of ulcers?
* Coeliac disease
* Crohn's disease
* Ulcerative colitis
55
What is recurrent aphthous stomatitis?
* Most common non-infectious, non-traumatic ulceration
* Recurrent episodes in otherwise healthy subjects
* Ulcers are superficial, round, with yellow slough and peripheral erythema.
* Predisposing factors are genetics, nutritional deficiencies, hormonal, stress, trauma, smoking
* Minor, major and herpetiform types
56
What is a minor aphthous ulcer?
* \<1cm size
* Prodromal symptoms
* More common among females
* Heals 7-14 days without scarring
57
What is a major aphthous ulcer?
* 1-3cm
* Longer duration to heal
* Heals with scarring
* Deeper
58
What is necrotising sialometaplasia?
* Uncommon locally destructive inflammatory condition of salivary glands
* 75% in posterior palate
* 1-5cm size
* Heals spontaneously in 5-6 weeks
59
What are treatments for ulcers?
* Analgesics
* Antipyretics
* AB
* Improve OH, antiseptic mouthwash
* Eating, nutrition and fluid
60
What is nociceptive pain?
Pain that arises from actual or threatened damage to non-neural tissue and is due to activation of nociceptors
61
What is neuropathic pain?
Noxious stimuli are originated from abnormal neural structures (normal somatic structures, abnormal nerves)
62
What is evidence of neuropathic pain?
* Burning pain
* Spontaneous or triggered
* Ongoing and unremitting
* Disproportionate to stimulus
* May be accompanied by other neurologic signs
* No evidence of tissue damage
* Pain may be initiated or maintained by sympathetic nervous system
* Pain follows distribution of affected nerve
63
What is primary vs heterotopic pain?
* Primary: site and source identical
* Heterotopic: site and source different
64
Why can pain be referred from temporalis muscle to tooth?
Primary afferent of temporalis muscle has collateral branches to neuron of tooth
65
What structures pass through the infratemporal fossa?
* Temporalis muscle
* Lateral pterygoid muscle
* Medial pterygoid muscle
* Pterygoid venous plexus
* Mandibular nerve
* Posterior superior alveolar nerve
* Chorda tympani
* Otic ganglion
* Lesser petrosal nerve
66
What LA's are Amides?
* Lidocaine
* Mepivacaine
* Prilocaine
* Bupivicaine
67
What LA's are esters?
* Procaine
* Benzocaine
68
What is the %, vasoconstrictor, pulpal and soft tissue duration of lidocaine?
* 2% (44mg)
* 1:80 000 adrenaline
* Pulp: 55-90 mins
* Soft tissue: 3-5 hrs
69
What is the %, vasoconstrictor, pulpal and soft tissue duration of articaine?
* 4% (88mg)
* 1:100 000 adrenaline
* Pulp: 60-120 mins
* Soft tissue: 3-5 hrs
70
What can retroclination of upper incisors cause?
Stripping of labial gingiva of lower incisors
71
**What is Bolk’s Theory of Terminal Reduction?**
As a general rule, that if only one or a few teeth are missing, the missing germ will be the most distal tooth of any given type
72
**What is Bimaxillary Protrusion and how is it treated?**
Lips are full and incompetent because of procumbent incisors
Tx: retraction of the incisor segments to allow the lips to move lingually. This is done by extracting first premolars in both arches and retracting the incisor segments into the space made available by the extractions
73
What is leeway space?
Difference between the combined mesiodistal widths of the *deciduous canine, 1st and 2nd molar* and the *permanent* *canine and 1st and 2nd premolars*.
* Mx: 3mm
* Md: 5mm
74
What are space gaining strategies?
* **S**-Stripping (Interproximal)
* **P**-Proclination
* **E**-Expansion
* **E**-E space maintenance
* **D**-Distalisation (Headgear, Pendulum, Distal Jet, Jones Jig, etc)
* **E**-Extraction
75
How can mild crowding be relieved?
Expansion of arch in transverse dimension
76
What is sunday bite and its relevance?
When class II patients with md retrusion bite forward in order to “mask” their md deficiency. Important to assess this skeletal discrepancy.
77
Why should maxillary expansion be implemented before other skeletal alterations?
Transverse mx growth end earlier than growth in other directions
78
Why is early tx of class II div I not recommended?
Issues with relapse, stability and re-treatment. Burnout of pt cooperation can also result.
79
When should class II correction tx be managed?
Skeletal class II correction is usually attempted during a child’s pubertal growth spurt
* Females: 12
* Males: 14
Wait for eruption of premolars and permanent canines
80
Why should you assess the transverse plane during protrusion?
Ask pt to bite forward in edge-edge position and observe if there is a posterior crossbite. If there is, a mx expander will need to be used.
81
What are some appliances that correct class II?
* Twin block
* Bionator (causes md protrusion)
* Herbst (fixed)
* Jasper jumper
82
What is teuscher activator?
Stimulate growth of md while stopping growth of mx. Combined with headgear
83
What are options for class II skeletal pattern?
Growth modification
Camoflage
Surgery
84
How is class II div II managed?
Mx incisors should be proclined to normal position to prevent hindering md growth. Then undergo tx same as class II div I
85
What is class II camoflage treatment?
Extract upper 1st premolars then retract upper anteriors with fixed appliance. Molars will still be in class II relationship. Just reducing OJ and getting canines into class I relationship.
86
What does it mean if the patient can guide their mandible to an edge to edge position?
Their eitiology of class III is functional (pseudo class III)
87
What are negative factors for deciding whether to treat Class III malocclusion?
* Dolichofacial
* No anterior md shift
* Growth complete
* Severe skeletal disharmony
* Poor cooperation expected
* Class III familial pattern established
* Poor facial esthetics
88
What is the disadvantage of early treatment of class III's?
Any tx even if successful is still hostage to future md growth and results may relapse and surgery or camouflage tx has to remain as a final tx option.
89
When is maxillary protraction most effective (class III correction)?
During pre-adolescence (7-10years)
90
What are examples of headgear for maxillary protraction (treating class III skeletal)
* Delaire Face Mask
* Reverse pull headgear
91
What is the most appropriate treatment for patients with retrusive maxilla in the late mixed dentition stage?
Protraction headgear to apply orthopaedic forces. To maximise skeletal change, simultaneous rapid mx expansion has been suggested.
92
When does greatest growth of maxilla occur?
6-8
93
How many hours of wear is needed to effectively protract the maxilla with headgear?
12-16 hours
94
What are the effects of chin cup and mandibular restraining on mandibular growth?
* Redirects md growth vertically but doesn't affect growth velocity significantly.
* Backward md rotation and retroclination of lower incisors
* After using it, there is catch up growth which ultimately leads to relapse and no long term benefit.
95
Why does a flap need to have a broad base?
In order to ensure a good blood supply to keep tissue alive
96
What are the 2 basic types of flaps in oral surgery?
Random pattern: from the blood vessels in the area and not from a named anatomical vessel
Axial pattern: Particular artery e.g. palatal flap is based on greater palatine artery
97
How can bone be removed?
* Drill & bur
* Chisels or osteome
* Rongeurs (end/side cutting)
* Bone file
98
How does tranexamic acid work?
Antifibrinolytic agent- helps prevent breakdown of the clot.
99
What are non-resorbable sutures made from?
* Braided: silk
* Monofilament: nylon, proline
100
When are silk sutures indicated?
Excellent for pressure control of bleeding. Silk is braided and will unravel with time. It tends to wick bacteria/food down into the wound. Need to be removed early to reduce this
101
What are resorbable sutures often made out of?
Plain or chronic gut
102
How long does it take for plain vs chronic gut sutures to resorb?
Plain: within 1 week
Chronic: 10-14 days
103
What are signs & symptoms of dry socket?
* Loss of blood clot
* Exposed bone
* Pain
* Bad taste & smell
* Redness and sloughing of tissues around socket
* Debris in the socket
104
What are steps of clotting cascade?
1. Vasoconstriction
2. Platelet plug
3. Fibrin clot formation
4. Fibrinolysis
105
What is alveogyl?
- Self eliminating
- Made of fibres + eugenol
- Strong taste
- Don't rinse mouth out for rest of day
106
What is primary vs secondary intention?
* Primary: healing happens when wound edges are approximated e.g. by sutures
* Secondary: healing takes place when the wound edges cannot be approximated and the wound needs to heal from the bottom up
107
**What is the time frame for the best chance of survival for a permanent avulsed tooth being reinserted into its socket?**
\<20 mins
108
What is avulsion protocol for first responders?
* Locate the tooth and fragment
* Hold tooth by crown
* Rinse dirt from tooth (saline, milk, saliva)
* Immediately replant tooth in its socket using other teeth as a guide.
* Stabilise replanted tooth by biting on towel or holding in place with pressure
* See dentist ASAP or Hospital ED if no dentist available
109
**What patients should not be recommended to use nicotine replacement therapy (NRT)?**
* Patients \<18yrs
* GI disease
* Recent MI
* Renal and hepatic impairment
* Lactating mothers
* Recent cerebrovascular accident
* Peripheral vascular disease
110
**What is the optimum fluoride level in water?**
0.6-1.1mg/L
111
**What is the addition of fluoride to public water supplies controlled by?**
State gov except for QLD where it is local gov
112
What is fluorosis?
Increased deposition of fluoride in developing teeth causing whitish appearance of enamel in mild forms and pitted, mottled appearance in more severe forms
113
**Why does age contribute to periodontal disease?**
* Decreased immune function
* Altered nutritional status
* Medications
114
**What are the 4 ideal clinical outcomes?**
* \<10% BOP
* \<15% plaque coverage
* No pockets \>4mm
* No furcations
115
**Why should we sometimes adopt a temporary retention approach?**
* Immediate denture- anterior aesthetic zone
* Posterior stops- maintain height while prosthesis is fabricated
* If tooth can be extracted during periodontal surgery- lessen number of appointments.
116
**What are the phases of periodontal therapy?**
* Preliminary phase
* Non-surgical phase
* Surgical Phase
* Restorative phase
* Maintenance phase
117
**Describe plaque formation**
* After brushing teeth, a layer of pellicle forms on the tooth surface.
* Bacteria attach to the sticky pellicle.
* There is colonisation of bacteria.
* Biofilm maturation
* Detachment
118
**What is ecological plaque hypothesis?**
Disease occurs when there is a shift in the balance of resident microflora, driven by modification in local environmental conditions.
119
**How do smokers present with periodontitis? Why?**
Tissue destruction _without_ visible signs of inflammation (swelling, redness and bleeding). This is because nicotine causes vasoconstriction, thus reducing blood flow
120
**What history do we have to elicit from paediatric patients (BCDEF)?**
* Birth
* Childhood illness
* Developmental milestones
* Entertainment/education
* Family: Mother’s oral health? Any familial dental defects?
121
**What are the differences between primary and permanent teeth?**
* Primary teeth are wider M-D than cervico-occlusal dimension
* Primary teeth have larger pulp chambers and less enamel, dentine
* Primary teeth have more accessory root canals
* Broad flat contacts
* B and L surfaces converge toward occlusal
* Constriction between crown and roots in molars
122
**What is the impact of primary teeth having broader contacts?**
Preparation will need to be wider so there is less tooth structure remaining and therefor more likely to have breakage of tooth walls. Class II should utilise crown rather than resto.
123
**When should primary SSC crowns be used?**
* Deep caries, multi-surface
* High caries risk
* Marginal ridge involvement
* Tooth needing to last _\>_ 3 years
* Pulp treated
* Trauma/fracture
* Uncooperative
* Abutment for space maintainer
124
What are SSC made of?
Iron, chromium and nickel
125
What are the types of SSC?
* Untrimmed, contoured
* Pre-trimmed, pre-contoured (less flexible for fitting over tooth and may need to remove more tooth structure)
126
What primary teeth are hardest to crown?
Upper D's
127
What do crown margins for E's vs D's look like?
E: smiley face
D: S shape
128
What are contraindications for SSC
* Allergy to nickel
* Insufficient coronal tooth structure
129
What are advantages of SSC?
* Easy placement
* Economical
* Seal tooth
* Excellent longevity
* Restore occlusion
* Not technique sensitive
* Minimal-nil tooth prep
130
What is the clinical procedure for SSC placement?
1. Radiograph
2. LA
3. Check occlusion
4. Place rubber dam
5. Caries remove/pulp therapy (if required)
6. Crown selection
7. Trim O and IP surface if required
8. Round all sharp lines, contour crown
9. Place cement in crown (fuji plus)
10. Place crown L to B
11. Press down firmly and get pt to bite on cotton roll
12. Remove excess cement from margins
131
What are post op instructions for placing SSC?
* Don't eat anything chewy/sticky for 48hrs
* Take analgesics prn
* Bite may feel different and will settle
* Brush per normal
* Tooth will exfoliate normally with crown
132
What is the hall technique?
Sealing carious tooth with SSC without any tooth prep or removal of caries. The seal will arrest the lesion
133
What are indications for primary anterior composite strip crowns?
* Enamel defects
* Fracture
* Deep, rampant or multi-surface caries
* Pulp therapy
* High caries risk
* Sufficient coronal tooth structure and needing to last
134
What are pros and cons of anterior strip crowns?
Pros: Economical, aesthetics, easy, reasonable clinical time
Cons: technique sensitive, less wear resistant than SSC, moisture control required
135
What are contraindications for strip crowns?
* Cross bite
* Moisture control not possible
* Bruxism
* Crowding
* Insufficient tooth structure
* Haemorrhage
136
What is the procedure for anterior strip crown?
1. IP reduction unless primate spaces available
2. Inc reduction 1mm
3. Remove caries, pulp therapy and GIC lining if required
4. Cut collar of crown with scissors
5. Place vents at corners (to allow extrusion of material)
6. Etch and bond tooth
7. Place bond and CR in matrix (fill ½-⅔)
8. Place matrix on tooth gently and allow excess CR to extrude out
9. Hold firmly, spot cure
10. Remove excess from margins
11. Cure
12. Trim matrix on incisal palatal surface and peel off
137
What are the 3 forms of vital pulp therapy?
* Indirect pulp capping
* Direct pulp capping
* Pulpotomy
138
What is the selection criteria for indirect pulp therapy (IPT)?
* Reversible pulpitis, asymptomatic
* No pulp exposure
* Restorable crown
* No pathology
* Requires excellent seal
139
What liner agents can be used for indirect pulp therapy?
* GIC
* CaOH
* MTA
* ZOE
140
When is direct pulp capping performed?
If there's a small non-carious pinpoint pulp exposure
141
What is involved in direct pulp capping?
Application of CaOH or MTA to pin point exposure which stimulates dentine bridge formation over exposed area
142
What is a pulpotomy + steps?
Removal of infected, inflamed coronal pulp and keeping vital, healthy radicular pulp.
1. LA, rubber dam
2. Caries removal
3. Remove roof of pulp chamber and coronal pulp
4. Haemastasis (ferric sulphate or pressure)
5. Line pulp chamber floor with pulp agent (MTA)
6. Apply base (ZOE or GIC)
7. Restore with crown ideally
8. Review
143
What are indications for pulpotomy?
* Asymptomatic or reversible pulpitis
* Pulp exposure due to caries or trauma
* No furcation lucency, abscess or LEO
* Restorable crown
* At least ⅔ of root remaining
* No pathological RR
* If pt has bleeding disorder
144
What are contraindications for pulpotomy?
* Irreversible pulpitis
* Abscess, furcation lucency
* Mobility
* \<⅔ of root remaining
* Pathologic root resorption
* Unrestorable tooth
* Immunocompromised
145
What does the amount of bleeding of pulp indicate?
* No bleeding: pulp is infected (pulpectomy is indicated)
* Light red, easily arrested: less inflammation (pulpotomy fine)
* Deep red, profuse haemorrhage: inc inflammation, extending into canals (pulpectomy indicated)
146
If you treat a tooth with pulpotomy, at what point is it considered a failure?
* If you take radiograph and tooth has internal root resorption or calcification in radicular pulp, pulp is irritated/inflamed but still responsive (signs/symptoms within realms of tooth)
* HOWEVER, when there is furcation lucency or external root resorptions, it is considered a failure
147
What is MTA composed of and its benefits?
Fine hydrophilic powder composed of refined Portland cement
* Bioinductive
* Biocompatible
* Less inflammation, pulpal necrosis, hyperaemia
* Capable of maintaining high pH for long time
* Antimicrobial
* Excellent seal
148
What are contraindications for pulpectomy?
Unrestorable crown
Inaccessible canals
RR, significant BL, pathology extending into permanent tooth bud?
Dentigerous or follicular cysts
Pathologic resorption at least ⅓ of root with sinus tract
Cardiac and immunocompromised pts
Uncooperative child
149
What are features of primary teeth?
* Larger pulps
* Pulp form follows external anatomy
* Pulp horns closer to outer surface & under each cusp
* Wider M-D than cervico-occlusally
* Pulp chamber shallow
* Cervical constriction
* Wide dentine tubules and thin floor (infection/inflammation from coronal pulp can travel down to furcation easily)
150
**When does the primary tooth root begin to resorb? What happens at this stage?**
Primary teeth resorb once root length is complete. At this stage, secondary dentine is deposited within root canal system, producing alteration in the # and size of root canals as well as many small connecting branches.
151
Explain pulpectomy procedure in children (1 visit)?
1. LA, rubber dam
2. Caries removal & restoration
3. Access cavity, remove coronal pulp
4. Find canals
5. Irrigate chamber with saline
6. Remove radicular pulp with small file and find working lengths
7. Debride canal without shaping, enlarging 3 sizes from 1st file
8. Irrigate with saline frequently
9. Dry with paper points
10. Place pulp agent (iodoform paste, ZOE slurry)
11. Core build up
12. Radiograph
13. Crown
14. Follow up (1-2 weeks, 6 weeks, 6 months)
152
When should you do pulpectomy in 1 visit vs 2?
* 1 visit: asymptomatic, necrotic pulp, chronic abscess without persistent discharge, absence of cellulitis
* 2 visits: acute abscess, active/persistent discharge from root canals
153
What are the pulpectomy obturants for primary teeth?
* Iodoform paste (posterior teeth only as it stains brown, note alelrgies to iodine)
* ZOE slurry (anteior teeth as no staining)
* Ca(OH)2 + iodoform
154
What are 2 forms of perio disease in children?
* Prepubertal periodontitis
* Juvenile periodontitis
155
Are deep pockets normal in erupting/newly erupting teeth?
As teeth are erupting, margins, junctions and connections are not mature. Can get false pocket probing depth.
156
What are some systematic diseases associated with periodontitis?
* Hypophosphatasia
* Papillon-Lefevre syndrome
* Down syndrome
* Cyclic neutropenia
* Leukaemia
* Juvenile diabetes
157
What LA has ester and amide linkage?
Articaine
158
How are esters vs amides metabolised? Which has shorter half life?
Esters: blood (shorter half life)
Amides: liver
159
Why is bleeding common 6 hours after adrenaline containing LA is administered?
As adrenaline levels decrease over time, it's primary action on blood vessels reverts to vasodilation because Beta 2 receptor action predominates (vasodilation)
160
What LA's should be avoided if pt has methemoglobinemia?
Avoid prilocaine and articaine
161
When should adrenaline be avoided?
* Systolic \>190mmHg or diastolic \>115mmHg
* Avoid large doses of adrenaline containing LA in pts taking non-selective beta blockers
* Be careful in pts with unstable angina or recent MI
* MAOI's, TCA's, antiemetics, NA uptake blockers
* Recreational drugs in previous 24 hours
* Untreated hyperthyroidism
* Pheochromocytoma (secretes adrenaline)
162
What is the CNS action of LA overdose?
Lowers seizure threshold
163
What is the CV action of LA overdose?
Dilates blood vessels → reduces cardiac output → circulatory collapse
164
What are accidental locations for intravenous injection with LA and side effects?
* Inferior alveolar vein & pterygoid venous plexus
* Can result in tachycardia & potentially cause arrhythmia and CNS effects
165
What are side effects of intraarterial injection of LA?
* LA can be delivered into CNS or interfere with special senses
* Sight: misplaced PSA nerve block
* Hearing
* Hemiparesis
166
What can intraneural injection cause?
Long term anaesthesia
Paraesthesia (pins and needles)
Dyesthesia (neuropathic pain)
167
What are contraindications for LA?
* Local infection or sepsis in field
* Allergy to LA
* True needle phobics
* Haemangioma in field
168
What are possible contraindications for lidocaine?
* Heart block (heart beats more slowly or with an abnormal rhythm)
* Liver dysfunction (reduce dose)
* Myasthenia gravis
169
What are contraindications for articains?
* Heart block
* Cholinesterase deficiency
* Narrow angle glaucoma
* Children \<4 years
* Pts at risk of methemoglobinemia
170
What patients are at risk of methemoglobinemia?
G6PD, NADH, pyruvate kinase deficiency
Taking anti-malarials or sulphonamides
171
**What is the Gillick competence age range?**
14-16
172
Who can provide consent for patient if they are unable to themselves?
* Parent Guardian
* Statutory health attorney: spouse of adult pt, non-paid carer, over 18 close friend or relation
173
What are the systemic effects of diabetes?
* Increased periodontal disease
* Increase in cardiovascular problems
* Decreased renal function
* Increased susceptibility to infection
* Reduced wound healing
* Peripheral neuropathy
174
What are pros and cons of domiciliary services?
* Pros: reassuring for fearful pt, assess home conditions, level of carer support, check meds, assess oral care skills and self care levels
* Cons: reduced efficiency, portable dental equipment, no dental chair, safety issues, organisation
175
What side effects are associated with NSAIDS?
* Gastric ulcers
* Exacerbate asthma
* Dec renal function
176
What pts are more susceptible to gastric irritation with NSAID's?
People with early stage Alzheimer's disease being treated with acetylcholinesterase inhibitors
177
Who should tramadol be avoided in?
Pts taking anxiolytics (SSRI's) or St Johns Wort
178
What can happen if abscess is left untreated?
Enzymes can break down fibroblast wall and cause infection to spread to surrounding tissues (cellulitis)
179
What are side effects of metronidazole?
* Disulfiram effects if taken with alcohol- nausea, vomiting, tachycardia, shortness of breath
* Anticoagulant effect of Warfarin can be enhanced
180
**What are the max doses for body weight for metronidazole, amoxicillin and phenoxymethylpenicillin?**
Metronidazole: 10mg/kg
Amoxicillin: 12.5mg/kg
Penicillin V: 12mg/kg
181
**What does fluconazole and miconazole interact with?**
Drugs such as warfarin and statins
182
What pts are predisposed to candidosis?
Pts taking broad spectrum antibiotics
Diabetics
Immunocompromised
Smokers
Asthmatics taking inhaled corticosteroids
Nutritional deficiency
183
What drugs can be used to treat candidosis?
Fluconazole or miconazole ideally- otherwise Nystatin can be used
184
How can denture stomatitis be treated?
* Local measures
* CHX mouthwash
* Fluconazole, miconazole or Nystatin to adjucnt local measures to reduce inflammation before taking impressions
185
**What is angular cheilitis in denture vs non-denture wearing patients often caused by?**
Denture wearing: Candida spp
Non-denture wearing: Streptococcus
186
What is used to treat angular cheilitis?
Miconazole (effective against candida and streptococci)
If clearly fungal: nystatin can be used
If clearly bacterial: sodium fusidate ointment can be used
187
**When do NOAC levels peak and when should extractions ideally be undertaken?**
Peak 1-4 hours after taking NOAC
Should be taken as far away from peak levels as possible
188
When should you obtain INR measurement?
24-72 hours prior to surgery
189
**What are oral health issues associated with anxiety disorders?**
Bruxism
Neglect of oral health causing caries and periodontal disease
Hypersensitivity of teeth
Dry mouth due to meds
190
What are 2 approaches to aid management of dental anxiety?
* Diazepam (5mg) 2hrs prior to a procedure.
* Diazepam can be administered at the clinic (peak effect at 1 hour)
191
**What are the main side effects associated with therapeutic use of diazepam?**
Drowsiness
Confusion
Impaired coordination
Amnesia
Enhance depressant effects of other drugs including alcohol.
192
**What anxiolytics/sedatives can be used for children?**
* N2O
* Old antihistamines
* Oral midazolam
193
Who should antibiotic prophylaxis be used in?
Rheumatic heart disease
Artificial heart valve
Certain specific congenital heart defects
Cardiac transplant which develops faulty valve
Hx of infective endocarditis
194
**How can you tell the difference between acute apical periodontitis and a crack?**
Acute apical periodontitis: pain on occluding directly
Crack: pain on occlusal release
195
What is hydrogen peroxide vs sodium hypochlorite used for in endo?
Hydrogen peroxide 3%: remove blood
Sodium hypochlorite: dissolve tissue
196
**How are ISO instruments coded?**
* The number on the top of the handle indicates the diameter of the intrument. Size 15 has a diameter of 0.15mm
* The square indicates K file and the circle indicates H file
* The intrument length is displayed on the side of the handle.
197
**What is the definition of taper?**
For every 1mm of shaft, diameter increases by 0.02mm
198
**What are Gates Glidden Burs?**
Steel rotating burs that are used for tapering the first part of the root canal until the knee. They used for crown down technique (large to small).
199
**What is the Modified Double Flare Technique?**
* First flare: Crown down method using gates glidden burs (largest to smallest)
* Second flare: Bottom-up with hand instruments (smallest to largest). Preparation of apical stop and then step back technique.
200
What are pros and cons of modified double flare technique?
* Pros: Greater taper in mid and apical ⅓, improved obturation quality, easier irrigation, easier placement of stops, less chance of apical zip.
* Cons: not recommended for small or calcified canals, lengthy procedure, many file changes.
201
What are general issues with hand files?
* Production of zip/elbow and ledges common
* Time consuming and difficult
* Severe curves difficult to handle
202
What are issues to be aware with for NiTi instruments?
* Instruments can separate
* No pressure
* If force is too high, can fracture
* Limited use of instruments (single use)
* Additional shaping with hand instruments may be required. If oval shaped canal, it likely won't be shaped properly.
203
What are characteristics of TF adaptive?
* Adaptive reciprocation
* Just 3 files
* Needs a glide path of size #15
* Files are used down to WL
204
What are advantages of NiTi rotary instruments?
* Faster than hand instruments
* Better at shaping curved canals
205
**What is a disinfection agent that has a synergistic effect when used with hypochlorite?**
0.2% Chlorhexidine
206
**What is ChX effective against?**
E. facaelis when used as 2% concentration
207
What is the problem if ChX contacts sodium hypochlorite?
Forms a toxic brown precipitate in contact to sodium hypochlorite called parachloranilin
208
What is used to remove the smear layer in endo? Why is this needed?
EDTA 16% (strengthens disinfecting effect of irrigants)
209
What is the main component of GP cones?
ZnO
Beta-GP
210
What is AH Plus sealer based on?
Epoxy resin
211
What is tug back?
If you put cone in and then lift it out again there should be some resistance.
212
How do you obtain tug back?
· Check Length
· If you don't have tug back, remove tiny bit from tip.
· Put in again until "Tug Back"
AND check working length is maintained
213
Why is modified lateral condensation technique preferred?
* No need to apply strong forces
* Lower chance of fracture
* Quicker bc only need approx 3 GP accessory cones
214
**What are the classifications of discolorations? (4)**
* Physiological change of colour
* Calculus and plaque
* Extrinsic discolouration in enamel and dentine
* Intrinsic discolouration in enamel and dentine
215
**Why does tooth colour change during aging?**
Thinning of enamel
Sclerotization of dentine
Apposition of secondary dentine
216
**What are sources of exogenic (extrinsic) pigments? (chromophores)**
* Tobacco products
* Chemicals
* Foods (berries, tea, coffee, spices, vegetables, betel, juices)
* Chromogenic bacteria
* Caries
* Filling materials
217
**What are intrinsic pigmentations?**
* Pre-eruptive chromophores in dentine (tetracyclines, developmental defects)
* Pre-eruptive chromophores in enamel (tetracycline, fluorosis, amelogenesis imperfecta)
* Post-eruptive chromophores in dentine (tetracyclines, obliteration of pulp, sclerosis, filling materials, root canal sealer)
218
Would it work if these stains were treated from outside?
No bc this staining involves the dentine. Needs to be treated with internal bleaching.
219
How does bleaching work?
Oxidises chromophores so they change colour
220
How long after scale and clean can you start bleaching?
1 week (otherwise can be hypersensitive)
221
Where does bleaching chemical have to be placed to bleach dentine?
Inside pulp
222
What chemicals can be used for dentine bleaching?
* Sodium perborate
* Carbamide peroxide (35%)
(don't mix them as it can cause inflammation and resorption)
223
What is the procedure for internal bleaching?
1. Place GIC above root canal filling.
2. Place sodium perborate
3. Place temp filling over the top
4. Leave for 4-7days
5. Can repeat if needed
6. Replace with CaOH for 3-7 days to neutralise
7. Replace with definitive filling
224
What are contraindications for carbamide peroxide?
* Pregnancy
* Sensitive teeth
* Caries
* Multiple restos on front teeth
225
What agents can be used for power bleaching?
Hydrogen peroxide (10-38%)
Carbamide peroxide (35%)
(In office high concentration bleaching. Ensure gingiva is protected)
226
**What chemicals can be used for enamel bleaching?**
Peroxide or Carbamide Peroxide
227
How long each day are home bleach trays worn?
0.5-8 hours
228
**How long can 10%, 15-20% and 35% carbamide peroxide be worn for?**
* 10%: 8 hours
* 15-20%: 2-4 hours
* 35%: 1 hour (office only)
229
**What is the max hydrogen peroxide and carbamide peroxide % for do it at home whitening according to ADA?**
Hydrogen peroxide: 6%
Carbamide peroxide: 18%
230
**Are bleaching results for tetracyclines effective?**
Not really
231
What should you do if pt has caries but wants bleaching?
Do temporary restos first while you do bleaching. Then replace with definitive restos
232
What are synergistic drug effects?
2 drugs produce a clinical response greater than would be expected by sum of the individual effects
233
What does NSAIDs + ACE I cause?
Inc risk of renal impairment
234
What are additive drug effects?
2 drugs produce a clinical response equal to the sum of the effect produced by each agent alone
235
What are examples of synergistic/additive effects?
Alcohol + CNS depressant
St Johns Wort + Tramadol
236
What are symptoms of serotonin toxicity?
* Tremor, incoordination
* Confusion
* Agitation
* Shivering, Sweating
* Fever
* Diarrhoea
237
What are antagonistic drug effects? + example?
1 drug opposes/neutralises effects of another
* Corticosteroids (inc BGL) + oral hypoglycaemic (dec BGL)
* Salbutamol + atenolol
238
What enzyme family tends to mediate metabolism of drugs?
CYP450 (predominantly found in liver)
239
What is the physiologic purpose of metabolism?
Make substances more water soluble to facilitate excretion.
240
**What S levels are dentists permitted to prescribe?**
All S2, S3, S4 poisons to the extent necessary to practice dentistry.
241
**What level are S4 and S8 drugs? + give examples of each (as well as S2,3)**
* S2,3: ibuprofen, paracetamol
* S4: restricted drugs- antibiotics, panadeine forte
* S8: controlled- codeine, pentazocine
242
What needs to be written on S4 prescription?
* Prescribers name, qualification, number and signature
* Address of Clinic
* Date of prescription
* Patients name and address
* Drug names, dose, volume, formulation and directions
* “For dentistry treatment only”
243
**What needs to be written on a S8 prescription?**
Same as S4 as well as
* Pts DOB
* Drug quantities written in numbers and words
244
What S8 medications do dentists have access to/can prescribe?
Dentists have access to:
* Pentazocine
* Codeine
* Oxycodone (can only give in chair)
* Morphine (can only give in chair)
Dentists can only prescribe codeine and pentazocine (max 3 days, no repeats)
245
How many items are allowed per script?
3
