1
Q
ways to restore teeth space?
A
Bridge
Implant
RPD
Orthodontics to close space
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2
Q
What are the non periodontal challenges in placing an implant?
A
bone levels
restorative status of adjacent teeth
soft tissue anatomy
bone levels at adjacent teeth
Lip line
Smoking habit
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3
Q
What is the placement protocol types for implants?
A
1- immediate implant placement
2- Early implant placement with soft-tissue healing (four to six weeks)
3- Early implant placement with partial bone healing
4- Late implant placement in healed sites (six or more months)
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4
Q
What are the disadvantages of implants?
A
- Requires more than one visit
- expensive
- outcome depends on operator skills
needs excellent oral hygiene
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5
Q
What are the advantages of implants?
A
patient gains confidence
replaces missing teeth with good function and aesthetics
good prognosis and long lasting
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6
Q
What are the primary aims of a dental implant?
A
- replace missing teeth with predictable function and aesthetic
- long term stability
- low rate of complications during healing and maintenance period
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7
Q
What is the neutral seating position?
A
- Operator back at 90 degrees
- thigh is parallel to floor
no slouching
feet is on the floor to support posture
12’’ to 18’’ between patient and operator
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8
Q
What is the position of the nurse in relation to operator position? and why?
A
- 2’‘-4’’ higher than operator
To enable operator to see over obsructions
-The dental nurse and operator should be seated in the balance position
-no twisting and bending and lower back should be fully seated on the back of the chair
-bottom should be at the back of the chair
-nurse should position their thigh adjacent to the shoulder of the patient and be angled inwards
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9
Q
Name the seating zones
A
Operating zone (7-11o’Clock)
Static zone (11-2 o’Clock)
Nurse’s zone (2-4 o’Clock)
Transfer zone (4-7 O’clock)
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10
Q
What are the types of aspiration?
A
Direct and indirect
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11
Q
How to hold an aspirator? and how to check it?
A
like a pencil grip
make sure tip is secured in aspirator tubing
bevel of aspirator should be held adjacent or distal to tooth being treated
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12
Q
How to perform direct aspiration?
A
Adjacent to tooth treated
Slightly distal
remove any excess fluid from the back of the mouth
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13
Q
How to perform indirect aspiration?
A
- if aspirator obstructs operator view
- lower left quadrant
- anteriors - side closest to you
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14
Q
How to retract soft tissues?
A
Cheek retractor
mirror
3:1 syringe
Aspirator
Tongue depressor
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15
Q
What is the risk ratio (relative risk)
A
It is the risk of an event in exposed group to the risk of an event in unexposed population
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16
Q
What is odds ratio?
A
It is the odds of an event in exposed population to the odds of an event to unexposed group
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17
Q
how to interpret RR
A
1- no difference
more than one - icreases the risk of outcome
less than 1 - reduces the risk of the outcome
ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group
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18
Q
How does pain present in trigeminal neuralgia?
A
Stabbing
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19
Q
Pt wakes up in the morning and washes face with cold water which triggers TN , what changes to regime might the pt do?
A
- Use warm water instead of cold , avoid touching the face
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20
Q
What other medications for trigeminal neuralgia
A
Oxcarbazepine
gabapentin
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21
Q
What 2 features of malocclusion are related to gingivitis?
A
increased overjet
anterior cross-bite
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22
Q
What are the uses of facebow?
A
It is used to mount casts on an articulator
Used to investigate the relationship between the maxilla to the terminal hinge axis of the mandible
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23
Q
Describe 4 materials used to mount casts in ICP
A
- No material - many tooth contact so ICP is obvious
- Wax wafer - place wax over biting surfaces and let patient bite
- Registration paste - place over biting surface and get patient to bite down
- Record blocks - when free-end saddles present and casts cannot be hand articulated (use with bite reg paste)
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24
Q
Different types of articulators
A
arcon
average value
semi-adjustable
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25
Q
Spread of infection in upper anteriors?
A
lip
nasolabial region
lower eyelid
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26
Q
upper lateral incisors spread of infection?
A
Palate
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27
Q
upper premolars and molars spread of infection?
A
Cheek
infraorbital region
maxillary antrum
Palate
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28
Q
Lower anteriors spread of infection?
A
Mental and submental space
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29
Q
Lower molars and premolars spread of infection?
A
Buccal space
submasseteric space
Sublingual space
Submandibular space
Lateral pharyngeal space
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30
Q
What are the bias agents?
A
Selection bias
Performance bias
Attrition bias
Detection bias: refers to systematic differences in the way outcomes are determined
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31
Q
What is risk ratio (relative risk)?
A
the risk of an event in the exposed group to the risk of this event in an unexposed group
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32
Q
What is the odds ratio?
A
the odds of an event occurring in the exposed group to the odds of an event occurring in the non exposed group
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33
Q
What is the confidence interval and what does it determine?
A
It tells you if there is sufficient evidence
if overlaps 1 = sufficient evidence
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34
Q
Complaints to burning mouth syndrome?
A
Xerostomia
paraesthesia
altered taste - metallic
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35
Q
What psychological effects are associated with burning mouth syndrome
A
Depression and anxiety
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36
Q
Blood tests for burning mouth syndrome other than haematinics
A
Urea and electrolytes
Liver function test
Thyroid function test
HbA1c
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37
Q
What organism is associated with chronic hyperplastic candiasis
A
Candida albicans
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38
Q
What type of staining is involved in histopathology?
A
Hematoxylin and Eosin staining
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39
Q
What is the most common drug used in oral medicine?
A
Prednisolone - corticosteroid
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40
Q
What might cause a cusp fracture?
A
- Caries
- Parafunctional habits such as bruxism
- High occlusal load
- Trauma
- Poor OH leading to caries
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41
Q
What is the likely cause of discolouration in teeth?
A
- Excessive fluorise use
- diet : coffee , etc (dark foods)
- trauma
- genetics
- medications : tetracycline
-amalgam - non vital tooth
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42
Q
Risk factors of OAC
A
XLA upper molars and premolars
Last standing molars (sinus grew down due to missing adjacent teeth)
Older patient
if the patient previosly had OAC
Recurrent sinusitis
Big bublous rootsH
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43
Q
How does OAC happen?
A
extraction
osteonecrosis
tuberosity fracture
cysts and tumours
implants
Trauma
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44
Q
Pre op clinical signs of OAC?
A
Size of tooth
radiographic position of roots in relation to antrum
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45
Q
Peri operative clinical signs of OAC?
A
bubbling at socket
change in suction sound
direct vision
bone removed at trifurcation
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46
Q
post op clinical signs of OAC?
A
unilateral discharge
non healing socket
difficulty singing
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47
Q
What to tell a patient who had an oroantral communication?
A
do not blow nose
sneeze with mouth open
use inhalation aids or nasal decongestion spray
Avoid flying or diving
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48
Q
How to identify anxieties?
A
- ask patient about previous dental experience and their reaction to it
- Use MDAS (modified dental anxiety scale)
- Look at patient non verbal cues : ex. shaking. disconnected, nervous?
- Look at phyisologial cues such as dry mouth , altered tone voice
- Low pain tolerance
-stomatisation
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49
Q
non phamacological ways to manage anxiety
A
- CBT
- densitisation
- Relaxation techniques
- make patient take control for example tell them to rase their finger when they want to stop the treatment
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50
Q
Pharmacological ways to manage anxiety?
A
- intravenous sedation - midazolam (5mg/5ml) - max dose 10mg
- topical anaesthesia - lidocaine 5% gel
- inhalation sedation - nitrous oxide 5-6L with oxygen through nose
- transmucosal sedation with midazolam
- local anaesthesia using lidocaine (1cartridge per 10kg)
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51
Q
How to order extractions?
A
Start with simple extractions first
Extract from anterior to posterior to avoid OAC and fractured tuberosity
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52
Q
When to review a patient with dentures?
A
In one week
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53
Q
Things to tell patient about the immediate denture
A
This is not the final denture at it is a temporary one given after extractions to allow healing and gets you used to wearing a denture
The denture might feel sore and uncomfortable at the beginning but will be more comfortable as the healing process completes
A new denture will be made after 3-6 months depending on the healing process
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54
Q
What is TAD? give an example and why is it better?
A
temporary anchorage devices such as non osseointegrating mini screw
because it has anchorage control as unwanted forces are transferred to cortical bone
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55
Q
Risks of orthodontic treatment
A
- Gingival recession
- Demineralisation and decalcification
- root resorption
- relapse
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56
Q
Treatment options for increased overjet
A
Fixed appliance
growth modification
URA
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57
Q
Malocclusions leading to marginal gingivitis
A
- increased overjet
-anterior crossbite
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58
Q
What things to tell hygienist before referring for an LA ?
A
- frequency
- dose
-route of administration
-type of anaesthesia
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59
Q
Things that affect where the infection can travel to
A
- thickness of cortical bone
- anatomic site of initial infection
- type of microorganism involved
- nearby anatomical spaces
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60
Q
Management options for abscess
A
- Drainage
- Removal of source of infection
- Antibiotic therapy
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61
Q
How to assess periodontal risk
A
through the periodontal risk assessment tool which is a spider web-shaped diagram composed of six vectors each corresponding to a risk factor and indicator (bleeding on probing score, prevalence of pockets 5mm or deeper, number of missing teeth , ratio between the severity of one loss at worst site , patient age , systemic and genetic aspects and smoking status)
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62
Q
Why is it important to assess the risk of periodontitis ?
A
- To assess the distribution of factors that may have an impact on future periodontal prognosis of patient and tooth loss
- To assess the patient response to treatment
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63
Q
What four things are considered for a successful posterior restoration
A
- Material used
- Marginal seal of the restoration
- Excellent cuspal coverage
- The ability of the patient to maintain good oral hygiene
- Does not interfere with occlusion
- Caries removal
- good tooth preparation
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64
Q
Label apical parts of a root
A
- Apical constriction
- Apical foramen
-Apex - Dentine
-cementum
-cementodentinal junction
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65
Q
two ways to measure working length without apex locator
A
- Using a pre-op radiograph to determine the estimated working length - the working length is about 2mm short to the radiographic estimated working length
- Using a K-file that is bent at the tip to determine the working length using tactile sensation
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66
Q
What might affect the apex locator reading?
A
- Fluid in the canal
- Debris in the canal including inflammatory exudate
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67
Q
What alloy is used in metal bridgework?
A
Gold - due it bearing high occlusal load and its malleable
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68
Q
What metal is used for bridge retainer?
A
Cocr or Nicr
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69
Q
Ideal crown to root ratio in bridgework?
A
ideally 2:3
but minimum of 1:1
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70
Q
Minimim thickness of metal?
A
0.7mm
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71
Q
Types of pontics in bridgework
A
- wash through (allows cleaning) - (in lower molar area, for function rather than appearance)
- dome Pontic (bullet shaped) - in lower incisors, premolar or upper molar areas ) , have poor aesthetics if gingival third of tooth is visible
- Ridge lap pontic - full saddle
- modified ridge lap - full to gingivae on buccal area (for a more natural appearance , allows adequate cleaning on the lingual surface)
- ovate Pontic - create a dome in gingivae and seat inside
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72
Q
What are the advantages of modified lap bridge?
A
allows adequate cleaning on the lingual surface
Good aesthetics as the buccal side is extended to the gingivae
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73
Q
What monomer is used in PANAVIA?
A
MDP monomer
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74
Q
What monomer is used in Nexus ?
A
Bis-GMA
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75
Q
What monomer is used in RMGI?
A
HEMA (hydroxyethylmethacrylate)
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76
Q
What is oxyguard gel and why is it important?
A
It is an oxygen inhibitor to inhibit oxygen around the cement to allow complete curing of the cement as it is an aerobic cement (cures in the absence of oxygen)
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77
Q
How to measure FWS
A
- Use Willis gauge or dividers
- for dividers put two reference points on the patient face one above the lips (usually the nose) and one under the lips (avoid mentalis muscle as it can move the reference point)
- measure the RVD and OVD
- The free way space is the difference between the RVD and OVD
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78
Q
What is the most important line in the upper record block
A
Midline
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79
Q
What instrument do you use for assessing the anterior and posterior occlusal planes?
A
Fox’s bite plane
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80
Q
Give two treatment option for pericoronitis on tooth 38
A
Surgical extraction
Coronectomy
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81
Q
How to access third molar for surgery?
A
through raising a buccal mucoperiosteal flap
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82
Q
Instruments used for reflection of flaps
A
- mitchell’s trimmer
- howarth’s periosteal elevator
- curved warwick james elevator
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83
Q
How to debride for surgical removal of M3M?
A
Physical - bone file or hand-piece to remove sharp bony edges
Irrigation - sterile saline into socket and under flap
Suction - aspirate under flap to remove debris and check socket for retained apices
you must irrigate below the flap before you reposition it
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84
Q
What are the aims of suturing?
A
reposition tissue
cover bone
prevent wound breakdown
achieve haemostasis
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85
Q
When to review patient after corenectomy?
A
1-2 weeks
then 3-6 months
then 1year
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86
Q
What things you must warn the patient about when before a corenectomy?
A
- if the root is mobilised during crown removal the entire tooth must be removed (more likely with conical fused roots)
- Leaving roots behind could result in infection (this is rarely seen)
- can get a slow healing or painful socket
- the roots may migrate later and begin to erupt through the mucosa and may require extraction
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87
Q
Notes on removal of upper third molar
A
- support tuberosity with finger and thumb
- if there is undue resistance to elevation/extraction then excessive force can fracture the tuberosity (support tuberosity and use forceps to reduce the risk)
- If it is not possible to get access to the partially erupted upper third molar a buccal flap can be raised and appropriate bone removal carried out)
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88
Q
What makes an upper third molar extremely difficult to remove?
A
- grossly carious
- partially erupted
- diverging roots
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89
Q
What are the types of injury to nerves while extractions?
A
Crushing
cutting
transection
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90
Q
What does neurpraxia ,axonotmesis and neurotmesis mean?
A
They are types of nerve injuries
- Neuropraxia : contusion of nerve : continuty of epinural sheath and axons are maintained
-Axonotomesis: interruption of axon continuity wth partial or no damage to connective tissue
- neurotmesis - complete loss of nerve continuity
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91
Q
Why do 3rd molars impact?
A
- against adjacent teeth
- alveolar bone width
- surrounding mucosal soft tissues
or a combination of these factors
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92
Q
Nerves at risk during third molar surgery?
A
- inferior alveolar nerve
- lingual nerve
- nerve to mylohyoid
- long buccal nerve
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93
Q
Where is the lingual nerve usually located?
A
- close to lingual plate in mandibular and retro-molar area
- at or above the level of the lingual plate
between 0-3.5 medial to the mandible
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94
Q
Radiographic signs of close proximity of IAN canal?
A
A. Radiolucency across the roots of the third molar
B. Deviation of the canal
C. Interruption of the white line of the canal.
D. Deflection of the third molar roots by the canal
E. Narrowing of the inferior nerve canal
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95
Q
What are the 4 things that cause stress in dentistry?
A
- financial worries
- time concerns
-working for exams - isolation
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96
Q
how to reduce exposure to stress?
A
exercise
eat healthy and sleep well
better regulation and governance
maintaining a good work/life balance
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97
Q
How to reduce stress?
A
By resilience which can be acheived by the following :
Awareness - noticing what is going on around you and inside your head
Thinking - Able to interpret events in a rational way
Reaching out: ask out for help from others
Fitness: mental and physical ability to cope with challenges without becoming ill
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98
Q
What risk factor is specifically associated with oropharyngeal cancer
A
- HPV virus infection especially HPV-16
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99
Q
Sociodemographic factors of oral cancer
A
- socioeconomic status
- Sex
- Age
Socioeconomic status is the most at risk
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100
Q
Behavioral risks of oral cancer
A
- Chronic sun exposure
- Poor oral hygiene
- poor diet
- Smoking tobbaco
- Alcohol use
- Smoking and tobbaco use
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101
Q
How does the uk manage HPV as it is being a risk factor in cancer?
A
By introduction of the HPV vaccination programmes , by introducing them to girls and boys at school which makes it more effective as it decreases the transmission of the virus through sexual intercourse
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102
Q
What is first line treatment or advice to give to a patient having herpatic gingivostomatitis?
A
-Re-assure that the lesions will heal spontaneously in 1-2 weeks
- hydration
- advice on use of topical analgesia
- keep mouth clean (use soft brush with toothpaste)
- advice on the infectious nature of this disease
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103
Q
If symptoms of herpatic stomatitis persist what to prescribe?
A
Prescribe aciclovir cream
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104
Q
How to describe aetiology herpatic gingivostomatitis to mother?
A
This is a viral infection caused by a virus called Herpes simplex virus which can affect children under the age of 5 , usually it does not require any treatment as it goes away on its own , this virus has two types of infection , primary and secondary , this is the primary form of it , secondary form comes as what is known as cold sores . This virus can spread through infected saliva and contact with active lesions.
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105
Q
What causes MIH?
A
disturbance to enamel formation resulting in reduced mineralised content affecting permanent molars and central incisors might be caused by birth trauma, premature birth,
106
Q
What question to ask mother of patient presenting with MIH to rule out fluorosis?
A
- does the patient use fluridated toothpaste?
- does the patient drink fluridated water?
- why fluoride supplement use?
- what is the child oral hygiene regime?
- Are there any siblings on high flouride toothpaste?does the child use that?
107
Q
What questions to ask the mother about the discolouration? to diagnose
A
- Type of birth : natural or C section
- any severe illness during pregnancy such as anaemia ; any problems in 3rd trimester such as pre-eclampsia?
- Any birth trauma?or preterm birth?
- how long did the child breastfeed for ?Any fever or medication during this time?Socioeconomic status
- did the child get any infections such as measles , rubella or chicken pox?
108
Q
Dental implications in patient with asthma
A
- Increased candida infection
-increased periodontal disease risk - increase of caries risk
- increased erosion due to acidity
- decrease in salivary flow leading to xerostomia
- patient cannot sit for long periods on dental chair
- allergy to fluoride varnish that include colophany
- Oral ulcers
- bad breath
- rough tongue
- changes in taste
109
Q
How to manage a patient on inhalers?
A
- tell them to use spacer
- tell them to rinse mouth after using inhaler
110
Q
What does the depth of third molar tells you when treatment planning
A
it tells you how much bone you should remove
111
Q
What are the predisposing factors of periocoronitis?
A
- partial eruption and vertical , distoangular impaction
- opposing tooth on opposite arch causing trauma to operculum
- upper respiratory tract infections as well as stress and fatigue
- poor oral hygiene
- insufficient space between ramus and second molar for the third molar to erupt
- white race and a full dentition
112
Q
Seven things to discuss with patients to get consent before an extraction
A
- explain the procedure carried out
- explain the risks and benefits
- explain other treatment options
- explain your recommended option
-explain risk of doing nothing - check patient understanding
113
Q
how to describe retained root procedure to patient
A
This happened to the tooth being grossly carious and with the applications of the instruments and pressure the crown of the tooth came off. Assure that this can be managed by a procedure involving lifting the gums and removing the roots that are retained. The root might need to be cut in half to be removed so there is a possibility of drilling. After removing this the dentist will put in stitches to aid the healing process. This procedure will **not be painful as you will be numbed up **you will only feel some pressure.
114
Q
What to check in sedation assessment
A
History - social , dental and medical
Examination - intraoral and extraoral and vital organs
Heart rate
Blood pressure
Oxygen saturation
BMI (more than 35 is contraindicated)
115
Q
What is sepsis?
A
when bacteria spread throughout the body via blood leading to organ dysfunction and it is life threatening
116
Q
Symptoms of sepsis
A
very high or low temparature
uncontrolled shivering
confusion
cold and blotchy hands and feet
not passing as much urine as normal
117
Q
What is SIRS
A
systemic inflammatory response syndrome
118
Q
What are the requirements for SIRS?
A
temp less than 36 or above 38
pulse less than 90 per min
Resp rate >20/min
WCC below 4 or more than 12
Varying degrees of facial swelling
Trismus
Dehydration
119
Q
What is the ASA classification?
A
It is a classification that classifies patients according to their physiological health to assess their operative risk
120
Q
What are the ASA classes??
A
ASA I - normal healthy patient
ASA II - patient with mild systemic disease
ASA III - patient with severe systemic disease
ASA III - patient with severe systemic disease that is a constant threat to them
ASA IV - A moribund patient that is not expected to survive without the operation
ASA V - A declared brain dead patient whose organs are being removed for donor purposes
121
Q
What are the medical contraindications of IV sedation
A
Intracranial pathology , Myasthenia gravis
Hepatic insufficiency
Pregnancy and lactation
122
Q
What are the contraindications for IS ?
A
blocked nasal airway
COPD
pregnancy
123
Q
What are the disadvantages of sedation in general?
A
Training required
Equipment required
recovery time and after care
124
Q
What is biological caries management?
A
It is a non-invasive way in managing caries or a non operative way of managing caries by remineralising the tooth tissues
125
Q
Caries risk assessment
A
diet
medical history
social history
fluoride use
clinical evidence
plaque control
saliva
126
Q
What is the aetiology of Sjogren’s syndrome?
A
related to gentic predisposition associated with ant-ro and anti-la autoantibodies leading to dysregulated inflammatory process with dentritic AP cells recruiting band T cell responses,leading to exocrine gland destruction, can be triggered by environmental factors and tissue injuries
127
Q
What is sjogrens syndrome
A
An autoimmune disease affecting salivary and lacrimal glands leading to destruction
128
Q
How does sjogren’s syndrome present in salivary glands?
A
As a snowstorm radiopacity in the salivary gland area
129
Q
What happens to lymph nodes in Sjogren’s syndrome
A
Become enlarged due to inflammation or secondary infection due to sjogren’s patients being more suceptible to disease as they are immunocompromised , and lymphoma as sjogren’s patients have a higher risk of developing lymphoma
130
Q
How to check lymphnodes
A
By palpating the lymphnodes and if suspected lymphandenopathy, then do MRI of major salivary glands
131
Q
What are the complications associated with sjogrens syndrome?
A
- lymphoma risk (can present with unilateral gland swelling)
- salivary enlargement
- Dry mouth
- increased caries risk
- increased periodontal disease risk
132
Q
What to do if the patient present with a salivary gland disease and no dry mouth?
A
This means it is caused by a systemic disease and need to lialise with rheumatologist
133
Q
What are the causes of TMD?
A
Myfacial pain
Disc displacement
degenerative diseases
Chronic recurrent dislocation
Ankylosis
Hyperplasia
Neoplasia
Infection
Parafunctional habits
Stress
134
Q
What are the common clinical features of TMD?
A
- affects more females
- age between 18-30
-intermittent pain of several months or years duration - Muscle/joint and ear pain
- Trismus/locking
- Clicking/popping joint noises
- headaches
-crepitus indicated late degenerative changes
-muscle hypertrophy
135
Q
Treatment of TMD (reversible)
A
- Patient education :
reassurance
soft diet
masticate bilaterally
no wide opening
no chewing gum,
do not incise foods
cut food into small pieces
stop parafunctional habits
Support mouth when opening
- Splints
Bite raising appliance stabilise occlusion and improve function of mastucatory muscles)
Anterior repositioning splint
**- physical therapy **
physiotherapy
massage/heat
acupuncture
relaxation
ultrasound therapy
**- Medications **
NSAIDS
muscle relaxants
Tricyclic antidepressants
Botox
Steroids
- Jaw exercises
136
Q
Treatment of TMD (irreversible)
A
- Occlusal adjustment (rarely done and there is no evidence of benefit)
- TMJ surgery
arthrocentesis
arthroscopy
disc repositioning surgery
disc repair and removal
high condylar shave
total joint replacement
137
Q
What are the drugs used in sedation
A
IV - midazolalm , propofol and multiple agent
IS - nitrous oxide
138
Q
Best way to clean hand scalers?
A
ultrasonic bath
139
Q
What is fibrous epulis?
A
It is a hyperplastic fibrous inflammation on the gingivae due to irritation (overhanging restoration) can be describes as smooth, pink and pedunculated
140
Q
What is the histological signs of fibrous epulis?
A
- metaplastic bone formation
- granulation tissue
141
Q
Management of fibrous epulis?
A
- excisional biopsy
- coe pak dressing
- removal source of irritation
-OHI advice CHX mouthwash???
142
Q
What are the SCIPS?
A
Hand hygiene
Personal protective equipment
Safe management of care equipment
Safe management of care environment
Safe management of blood and body fluid spillages
Safe disposal of waste (including sharps)
Occatoinal safety: prevention and exposure management (including sharps)
Respiratory and cough hygiene
143
Q
How to clean a blood spillage?
A
- local policy must be followed
- Appropriate PPE to be worn, apron, mask, gloves and eye protection
- Organic matter to be removed using a disposable absorbent towel
- dispose in healthcare waste
- apply the appropriate granules or solution to disinfect area and leave for 3 minutes
- remove granules using a scope and dispose
144
Q
What procedure to follow after receiving a sharps while treating a patient?
A
- immediately stop the procedure
- inform patient about what happened
- make the sharp safe
- first aid - encourage bleeding, wash injured area, dress with waterproof plaster dressing
-notify supervising clinicians - risk assessment carried out by appropriate person (not the person injured)
- Contact occupational health
- Consent patient for bloods - taken within the GDH
- Paperwork
- Datix
145
Q
Examples of bone pathologies
A
Developmental
- Tori
-Fibrous dysplasia
-osteogenesis imperfecta (type 1 collagen defect )
Inflammatory
-Dry socket
- Osteomyelitis
Neoplasm (abnormal new growth)
steoma
osteosarcoma
osteoblastoma
Metabolic
osteoporosis
146
Q
What is Sepsis?
A
Sepsis is spread of an infection throughout the body via blood
147
Q
What are the two types of toothwear?
A
Physiological: normal and increases with age
Pathological: happens at a faster rate with some factors causing it
148
Q
OPT errors and reasons
A
- Distorted anteriors - patient not in focal plane leading to horizontal distortion(too forward in the machine)
- blurry image - patient moving during exposure
-image too wide - patient canine is behind x-ray machine canine line - patient far back in the machine
149
Q
How to limit positioning errors?
A
- using correct patient positioning
chin rest
bite blocks between incisors
hand rests to prevent movement
guidelines - centre line , canine line and frankfort plane
150
Q
What are the characteristics of ghost images?
A
higher due to vertical beam angulation
horizontally magnified
further forward - due to anterior posterior position
151
Q
Ways to reduce patient dose to radiation?
A
Use E speed film
Use Kv range from 60-70Kv with focus skin distance more than 200mm
- rectangular collimation and use film holders
152
Q
Campton scatter and absorption
A
Xray photon interacts with outer shell electrons which is greater than the electron energy which results in change of direction of the photon due to the electron taking some of the photon energy
153
Q
What is the photoelectric effect?
A
X-ray photon react with inner shell electron resulting in absorption and ejection of the electron leading to a white image
154
Q
what metal absorbs X-rays
A
lead
prevents back scatter of photon
absorbs scattered photon
absorb some primary beam
155
Q
What metals are present in the x-ray tube heads?
A
Copper (heat cinductor)
- tungston (cathode filament)
- aluminum (filtration)
156
Q
What 5 radiation features advised by IRR99
A
controlled area for radiation
- signs showing controlleed area
-sign lights up when equipment is on
- light and audible sound during exposure
-exposure stops automatically or when button is not held
157
Q
ALARA
A
As low as reasonably achievable
158
Q
How is ALARA achieved?
A
using E speed film - fewer photons
- Using Kv range from 60-70, fsd>200mm
- Rectangular collimation, film holders
- aluminum filtration system
- beam diameter less than 60mm at end of spacer
159
Q
IRMER guidelines
A
- ionising radioation medical exposure regulations
minimising unintended or excessive or incorrect medical exposure
ensure benefits outweigh the risks
keeping doses as low as reasonably achievable
160
Q
What are the main principles for radiation protection?
A
Justification
Optimisation
Dose limitation for workers and public
161
Q
Pesonnel and responsibilities in IRMER
A
Employer
-responsible for safety
-making sure equipment in line with regulations
-ensure staff is trained and follow regulations
Referrer - requesting examination
Practitioner - provides justification
Operator - takes radiograph and report it
162
Q
What is the paralleling technique in radiography?
A
image receptor and object are parallel but not in contact (require cotton wool and film holder)
163
Q
What is the bisecting technique?
A
image receptor and object not parallel and partially in contact (close at crowns and apart from apex) - use ling fsd 20cm , does not require the use of film holders
164
Q
what medications may cause BPE scores of 3 in young children?
A
epilpsy - phenytoin
immunsuppression - cycloprine
165
Q
What medical conditions may cause BPE’s of 3s in children?
A
aggressive periodontitis
leukaemia
down’s syndrome
agranulocytosis
puberty
166
Q
What are the things that determine prognosis of a fractured tooth?
A
stage of root development
type of injury
damage to pdl
time between injury and treatment
presence of infection
167
Q
possibilities of tooth fragment location and management
A
ingested - A/E for stomach scan
inhaled - A/E for chest Xray
imbedded in soft tissues - radiograph to confirm, remove and suture if required
168
Q
what to discus with patient regarding treatment of trauma?
A
- inform of complications - disolouration, pain , sinus and infection
- inform of tooth prognosis
- inform of treatment options (consent)
169
Q
how to manage if patient had heart valve defect?
A
manage normally but consult GP if suspected a risk of infective endocarditis for advice on antibiotiic prophylaxis
170
Q
is molar incisor hypomineralisation inherited?
A
no
171
Q
What is MIH
A
hypomineralisation of systemic otigin affectin 1-4 permanent first molars associated with affected incisors
172
Q
Subluxation treatment options
A
flexible splint for 2 weeks
173
Q
when to palpate for canines
A
age 9
174
Q
what method to know ectopic canine position?
A
vertical parallax technique
OPT + upper anterior occlusal
Pa + upper anterior occlusal
2 periapicals from different angles
175
Q
ideal age for interceptive orthodontics?
A
11-13 years
176
Q
when to review canines after extractions of C ?
A
6 months
177
Q
What syndromes are associated with hypodontia?
A
down’s syndrome
pierre robin syndrome
cleft lip and palate
anhidrotic ectodermal dysplasia
178
Q
What to tell patient in sedation asessment?
A
Discuss all treatment options available
give pre and post instructions
answer any questions the patient have
introduce patient to the environment and staff
give information leaflet
179
Q
What type of antibiotics is given to patients of sepsis?
A
intravenous antibiotics in maximim dose
180
Q
What to inform patient regarding tooth discolouration treatment?
A
It needs long term maintenance for life
181
Q
What are treatment options for tooth discolouratoin?
A
- microabrasion: the removal of the surface layer of opaque enamel
- localised composite restoration
- Bleaching : vital and non vital
182
Q
What are the techniques used in non vital bleaching?
A
- walking bleach technique - renew bleach every two weeks
-if no change after 3-4 renewals stop
-6-10 changes in total - regress 50% at 2-6 years
183
Q
What are the potential complications of non vital bleaching (inside out technique) ?
A
external cervical resorption
spillage of bleaching agents
failure to bleach
over bleach
brittleness of tooth crown
184
Q
What is the bleaching agent used in dental bleaching?
A
Carbamide peroxide (hydrgen peroxide 3% and % urea)
185
Q
How to differentiate between fluorosis and Amelogenesis imperfecta?
A
amelogenesis imperfecta have less brown lesions
186
Q
What is attrittion
A
the physiological wearing away of tooth structure as a result of tooth to tooth contact
187
Q
What is abrasion
A
the physical wear of tooth substance through abnormal mechanical process independent of occlusion - such as hard toothbrushing
188
Q
What is erosion
A
The loss of tooth surface by a chemical process that does not involve bacterial action
189
Q
What is abfraction?
A
the loss of hard tissue from eccentric occlusal forces leading to compressive and tensile stresses at the cervical fulcrum areas of the tooth
190
Q
clinical signs of abfraction and why?
A
V shaped tooth loss where the tooth is under tension
Sharp rim at the amelo-cemental junction
caused by biomechanical loading forces result in flexuure and failure of the enamel and dentine at a location away from the loading
191
Q
Most common type of toothwear in old patients?
A
physiological
192
Q
how to diagnose toothwear
A
Recognise the problem
grade its severity
diagnose the likely cause or causes
monitor the progression of the disease
193
Q
What are the BEWE scores?
A
0 - no erosive wear
1- initial loss of surface texture
2- distict defect - hard tissue <50% of surface
3- Hard tissue loss more than 50% of the surface area
194
Q
Risk levels of tooth wear from BEWE score
A
None
Low risk - between 3 and 8
Medium risk - between 9 and 13
High risk - between 14 and over
195
Q
Intrinsic causes of erosion?
A
eating disorders
GORD
other medical conditions
196
Q
A
197
Q
What are the two types of toothwear?
A
physiological
pathological
198
Q
What are the causes of toothwear
A
Attrition
Abrasion
Erosion
Abfraction
199
Q
What is attrition
A
physiological tooth wear as a result of tooth to tooth contact
200
Q
What is Abrasion
A
Physical wear of tooth substance through abnormal mechanical process abnormal of occlusion. It involves a foreign object or substance repeatedly contacting them
201
Q
What is erosion (most common type of pathological tooth wear )
A
it is the loss of tooth substance due to a chemical process that does not involve bacterial action
202
Q
How to prevent abrasion?
A
- remove the foreign object or substance involved in causing the abrasive wear
- Change toothpaste
- Alter tooth brushing habits
- change habits
- cervical toothbrush abrasion
203
Q
How to prevent attrition?
A
Splints
Soft is as a diagnostic device to see extent of toothwear as it will wear off
Hard more robust and can be used over a long term
204
Q
How to prevent erosion?
A
Diet advice
Flurode varnish
desensitising agents can aid in symptomatic relief
205
Q
How dos fluoride work in teeth?
A
It works by preserving calcium and phosphate in the mouth, which increases the remineralization of enamel. It also replaces hydroxyapatite with fluoroapatite
206
Q
What to ask parent before delivering fluoride varnish
A
Ask about medical history , asthma if they have been hospitalised or if they have an allergy to colophany
207
Q
What is childsmile universal approach?
A
to reduce the gradient of health inequalities, actions need to be universal, but with the intensity proportionate to the level of disadvantage and need
208
Q
What did childsmile do
A
Childsmile is scotland programme for improving oral health in children
209
Q
What is childsmile universal approach
A
That actions needs to universal to reduce the gradient of inequality. The intensity should be proportionate to the level of advantage and need.
210
Q
What did childsmile do
A
- A core programme – including universal daily tooth-brushing in all nurseries and targeted tooth- brushing in primary schools.
- targeted nursery and school fluoride varnish programme (2x a year)
- A universal practice programme
211
Q
What is the 2018 new classification of periodontal disease?
A
- Periodontal health, gingival disease and conditions
* periodontal health and gingival health
- gingivitis - induced by dental biofilm
- gingival diseases : non dental biofilm induced
2. Periodontitis - necrotising periodontal disease
- periodontitis
- periodontitis as a result of systemic disease
- other conditions affecting the periodontium
* systemic diseases or conditions affecting the periodontal supporting tissues
* periodontal abscess and periodontic endodontic lesions
* mucogingival deformities and conditions
* Traumatic occlusal forces
* tooth and prosthesis related factors
212
Q
What is the nice guidelines for infective endocarditis?
A
- problems affecting the structure of the heart (replacement heart valve and hypertrophic cardiomyopathy)
- people who are having any dental surgery
- people who are had previous endocarditis
213
Q
What does SDCEP tells us about these guidelines?
A
classified people at risk of infectiive endocarditis as two groups , is it advised to consult with cardiologist and ask patient if they want to have the prophylaxis
214
Q
Who are people at high risk of getting antibiotic prophylaxis? (SDCEP)
A
- prosthetic valve
- who had a previous episode of infective endocarditis
- people with congenital heart disease
215
Q
diagnosis ,urgent suspicion of cancer, referral of head and neck cancer
A
- persistent unexplained head and neck lumps for more than three weeks
- unexplained ulceration or unexplained swelling/induration of the oral mucosa persisting for more than 3 weeks
- persistent (not intermittent) hoarseness lasting for more than 3 weeks
- persistent pain in the throat or pain in swallowing lasting for more than 3 weeks
- This might also manifest as difficulty speaking , difficulty chewing and tasting - in case of cancer on the tongue
216
Q
What percentage of maxillary first molars have an MB2 canal
A
93%
217
Q
What are the three design objectives of endodontics
A
- continuous tapering funnel shap
- keep apical foramen as small as possible
maintain apical foramen position
218
Q
What are the advantages of the crown down technique?
A
- removes bulk of infecteted tissue
- reservoir for irrigant
- keeps refernce point for WL
- makes straight line access easier
- limits spread of infection material at apical foramen
219
Q
What is the crown down technique?
A
- Widening of the canal orifice by using gates glidden
- followed by incremental removal of the canal organic matter from the orifice to the apical portion using manual files
- The files are used from larger to smaller
220
Q
name 3 laws of pulpal floor anatomy
A
- law of colour - pulp always darker
- law of symmetry - orifices lie equidistant from a line drawn mesiodistal through pulp chamber (except maxillary molars)
- law of symmetry 2 - orifices lie perpendicular on a mesiodistal line (except maxillary molars)
221
Q
Give three rules at locating orifices in the pulpal floor?
A
- always at the junction of the floor and wall
- always at angle of flor and wall junctino
- always at terminus of developmental fusion lines
222
Q
Give 4 reasons for irrigation during endodontic treatment?
A
- Mechanical preparation alone does not remove all bacteria.
- Reaches areas files cannot get to.
- Flush out debris.
- Organic and non-organic content is dissolved
- Remove smear layer.
- Lubrication
223
Q
How is the smear layer removed?
A
EDTA
224
Q
Name 2 intracanal medicaments and state their use
A
Ledermix -> corticosteroid and tetracycline paste for ‘hot pulps’
non setting CaOH - antbacterial PH 11 - may weeken root if left for too long
225
Q
what are the 4 types of composite?
A
microfilled
macrofilled
nanofilled
hybrid
flowable
226
Q
contraindications for placing a bridge?
A
long span
poor/insufficient enamel
parafunction
perio abutement
227
Q
what monomer to cement metal bridge?
A
MDP (panavia) , Meta
228
Q
When is a dual cured cement indicated?
A
Cementing a thick or opaque indirect
restoration that a light cure cannot penetrate.
229
Q
Principles of cavity prep
A
- Gain Access
- Identify extent at ADJ
- Remove caries
- Cavity
_____________________________
modifications Gain access, identify extent at ADJ, remove peripheral caries in dentine, remove deeper caries at pulp, ensure any restorative material is removed completely, choose restorative material, modify cavity outline and internal form.
230
Q
What 3 criterio must be fulfilled before obturation
A
Asymptomatic
canal fully dried
full biomechanical cleaning in all canals
231
Q
Consistuents of GP
A
Zinc oxide
radio pacifiers
plasticisers
Guttta percha
232
Q
sealers used for obturation
A
CaOH
Epoxy resin sealer (AH26 plus)
Bioceramic sealer (calcium silicate and calcium phosphate)
ZOE
RMGI
233
Q
How to assess obturation in a radiograph
A
- Check correct length
- check correct taper
- Check compaction and no voids
- All canals should be filled with GP
234
Q
Why do we need to obturate
A
- seal remaining bacteria
- provide apical and coronal seal
- prevent reinfection
235
Q
four methods of obturation
A
cold lateral compaction
warm vertical compaction
continuous wave compaction
carrier based obturation
236
Q
Post materials
A
Cast metal (Type IV gold m , SS)
cermics
fibre
237
Q
four core materials
A
composite
amalgam
glass ionomer
238
Q
What determines post length
A
4-5mm of root filling should be left apically
at least half of post length goes into the root
minimum of 1:1 post length:crown height
239
Q
Materials to cement posts ?
A
GI luting cement
Composite resin luting cement
240
Q
What is a periodontal abscess
A
An acute Excacerbation of periodontal poocket caused by trauma to the pocket epithelium or obstruction of the pocket entrance , without RSD this causes pus accumulation and lead to abscess
241
Q
Tooth 15 root treated with 9mm pocket, differential diagnosis?
A
perio endo lesion
true combined lesion
242
Q
interventions for inadequate bone levels
A
guided tissue regeneration
bone grafting
biological mediators
sinus lift
243
Q
Describe the pattern of one loss that will be seen on radiograph of a vertical bony defect
A
Generally V shaped and sharply outlined
244
Q
Determine success for periodontal treatment
A
Pocket depths less than 4mm
plaque scores less than 15%
bleeding scores <10%
245
Q
If surgery fail to treat bony defect give other options
A
Root resection
Tunnel preparation
Hemisection
XLA
Palliatibe care
246
Q
Define RPI
A
it is a stress relieving system which is used in free end saddle designs to prevent stress on the last abutement tooth and can also provide reciprocation
247
Q
What is the functions of the components of the RPI
A
Rest mesially acts as an axis of rotation. As the proximal plate and I bar rotates downwards and mesially around the axis of rotation during occlusal load , avoiding potentially traumatic torque
248
Q
Why is a sub- alveolar fracture important in making it unrestorable?
A
- poor moisture control to place restoration
- it will be difficult to establish marginal integrity and the patient may have difficulty cleaning
249
Q
When to use a lingual bar?
A
when there is 8mm clearance from floor of mouth to gingival margins
250
Q
What is combination syndrome
A
When we have a partial and complete denture in the same patient , this results in a flappy ridge , this causes rapid bone loss which is replaced with fibrous tissue of the anterior region where the partial denture displaces.
251
Q
How to manage combination syndrome?
A
- Use window technique - cut relief holes in special trays on anterior region
- take mucostatic impression at rest
- use 2 stage impression technique : medium body silicone first then cut out impression material in flabby ridge area and take seconod impression with light body
252
Q
What is Ante’s Law?
A
root surface area of abutment tooth should be equal to or greater than that of the tooth being replaced with a pontic
253
Q
What are the advantages a fixed-fixed bridge?
A
Maximum retention and strength
Abutment teeth are splinted together for support
Can be used in long span designs
Lab construction is straight forwards
254
Q
What are the disadvantages of a fixed fixed bridge?
A
Preparation is difficult
Removal of tooth tissue puts pulp in danger
Path of insertion may not be parallel
255
Q
What is A fixed moveable bridge
A
This type of bridge has a rigid connector usually at the distal end of the pontic and a moveable connector mesially to withstand vertical movement at the mesial abutement tooth ( this is solution when we have a pontic between two abutments with different paths of insertion)
256
Q
Advantages of fixed moveable ?
A
- preparation do not require a common path of insertion
- Each preparation designed to be retentive independent of others
- more conservative of tooth tissue
- allows minor tooth movement
- may be cemented in two parts
257
Q
Disadvantages of fixed moveable?
A
- limited length span
- lab construction is more complicated
- possible difficulty in cleaning beneath moveable joint
- cannot construct provisional bridge
258
Q
What is a spring cantilever bridge?
A
This type of bridge carries one pontic which is attached to the end of a metal arm that runs across the palate to a rigid connector on the palatal side of a retainer
259
Q
How to temporarily restore inlay/onlay after prep if. there is no putty and no study cast
A
- Direct temporary restoration using GI or zinc oxide eugenol
260
Q
A
