1
Q
state aims for raising a flap
A
- allows better access to the tooth if finding any difficulty to extract e.g. due to abnormal resistance, ankylosis etc.
- helps with closure of an OAF
2
Q
state aims of retracting a flap
A
- protection of the soft tissue
- better access and vision
3
Q
state factors which influence flap design
A
- design may be influenced if the tooth is in an area of aesthetics
- narrow ridge- bone augmentation may be required so wide flap desisgns should be utilised
- the anatomy surrounding the tooth being treated e.g. nerves and muscles (lingual nerve can be damaged during surgical removal of lower 3rd molars)
- the treatment which is being carried out
- ability to access/visualise and ability to suture it back
4
Q
name 3 types of flap design
A
- semi-lunar
- triangular
- rectangular
5
Q
what type of handpiece is used for bone removal?
A
- electric straight handpiece with saline cooled bur
- round or fissure yungsten carbide burs
- air driven handpieces may lead to surgical emphysema
6
Q
what are the 3 methods of debridement?
A
- physical
- aspiration
- irrigation
7
Q
describe physical debridement
A
using bone file or handpiece to remove sharp bony edges
mitchell’s trimmer/Victoria curette to remove soft tissue debris
8
Q
describe debridement by irrigation
A
sterile saline/water placed into the socket and under flap
9
Q
describe debridement by aspiration
A
aspirate under the flap to remove debris
check the socket for retained apices
10
Q
what is the clinical term for a dry socket?
A
alveolar osteitis
(inflammation of the lamina dura)
11
Q
what are the predisposing factors of a dry socket?
A
- female
- young
- previous dry socket
- smoker
- trauma during extraction
- excessive swishing in the mouth post extraction (damage to blood clot)
- more common on the mandible
- oral contraceptive pill
12
Q
what are the signs and symptoms of a dry socket?
A
- dull aching pain
- exposed, sensitive bone
- patient will be kept up at night
- pain can radiate to the ears
- bad breathe
- bad taste in the pts mouth
13
Q
what are the treatment options for dry socket?
A
- remove the blood clot to encourage new clotting
- irrigate the socket with warm saline
- support and reassure the patient
- antiseptic pack e.g. BIP
14
Q
what family of drugs does apixiban belong to?
A
NOAC
novel oral anticoagulant
15
Q
what does apixiban inhibit?
A
factor Xa
stops conversion of prothrombin to thrombin, stopping the production of a fibrin clot
16
Q
what are the uses of apixiban?
A
- inhibits conversion of prothrombin to thrombin
- prevention of DVT
- prevention of pulmonary embolism
- can prevent stroke and reduce risk in pts with AF
17
Q
what blood tests do you carry out on a patient who is on apixiban before treatment?
A
APTT
activated partial thromboplatin time assay
18
Q
what do you do for a patient who is taking a NOAC before a low risk procedure?
A
- do not disrupt the medication
- treat the patient according to general advice for managing bleeding risk
- plan treatment early in the day
- limit the intial treatment area
- actively consider suturing and packing
19
Q
give examples of low risk procedures
A
- simple extraction (1-3 teeth)
- incision and drainage
- 6PPC
- RSD and subgingival scaling
- direct or indirect restorations with subgingival margins
20
Q
how should a pt alter their NOAC before a high risk procedure?
A
miss morning dose for apixiban or dabigatran
delay morning dose until after procedure- rivaroxaban
21
Q
give examples of high risk procedures
A
- extraction >3 teeth
- biopsies
- surgical procedure (perio surgery, periradicular, crown lengthening etc.)
22
Q
how do you manage a patient who is taking a NOAC and receiving a high risk procedure?
A
- Treat the patient according to the general advice for managing bleeding risk
- Plan treatment for early in the day.
- Consider carrying out the treatments in a staged manner.
- Actively consider suturing and packing
- Advise the patient when to restart their medication.
23
Q
give methods of haemostatic control
A
apply pressure by biting on damp gauze
LA with vasoconstrictor
Suture
Surgicel
Bone wax
Diathermy
24
Q
give physical features of downs syndrome
A
- broad flat face, flat nasal bridge
- short neck
- short nose
- small arched palate
- macroglossia- big tongue and protruding tongue. Fissured tongue
- upslanting palpebral fissure
- open bite
- class 3 malocclusion
- hypodontia
- abnormal ears
25
what is the result of a genetic tesgt for down's syndrome?
extra copy of chromosome 21
26
why are people with Down's syndrome at increased risk of perio disease?
* immunocompromised
* poor oral hygiene
* less saliva
27
what are 2 reasons for a patient with down's syndrome not having capacity?
learning difficulty
dementia
28
what are the two types of power of attorney and the difference between them?
* welfare- matters relating to health and personal welfare
* continuing - financial affairs and property
29
describe a power of attorney
* granted by the adult while they still have capacity
* certified bu a lawyer or medical practitioner
* powers only come into effect when the adult is incapable fo decision making
30
describe a welfare guardian
* appointed by the court after the adult has lost capacoty
* requires 2 medical reports
* continuous management of welface and financial matters
* usually appointed for 3 years
31
when should antibiotic prophylaxis be taken?
1 hour before the procedure
32
gives features of parkinson's
- bradykinesia – slow movement
- rigidity – increase motor tone
- mask like face
- resting tremors
- posture instability – impaired use of upper limbs; impaired gait and falls
33
how does Parkinson's disease differ from other cerebellar diseases?
Parkinson's- resting tremors
other cerebellar diseases- intentional active tremors
34
why might a patient with Parkinson's suffer from dry mouth?
medication due to antichollinergic effects of drug treatment (Benztropine)
35
how do you prevent a denture getting lost in a care home?
initial it during processing
if already constructed, can mark using sandpaprer or a sealant
store them in a labelled container
36
why would you avoid extracting teeth in.a denture wearing patient with Parkinson's?
* tremor can make extraction difficult
* poor motuh opening due to rigidity
* will require new prostheses to replace missing teeth- won't be able to tolerate it
37
define local malocclusion
a localised problem or abnormality within either arch, usually confused to one, two or several teeth producing a malocclusion
tends to get worse with time
38
gives reasons for abnormalities of tooth number
* supernumerary teeth
* hypodontia
* retained primary teeth
* early loss of primary teeth
* unscheduled loss of permanent teeth
* variation of timing
39
state 4 types of supernumerary
conical
tuberculate
supplemental
odontome
40
how do you measure anterio-posterio skeletal relationship?
visual assessment
palpate skeletal bases
measure the ANB angle on a lateral cephalogram
41
how do you measure vertica skeletal relationship?
* Frankfort Mandibular Plane Angles (FMPA)
* LAFH to TAFH ratio
42
who sets the classifications for incisor relationships?
British Standards Institute
43
describe a class I incisor relationship
The lower incisor edges occlude with or lie immediately below the cingulum plateau of the upper central incisors
44
describe a class II incisor relationship
The lower incisor edges lie posterior to the cingulum plateau of the upper incisors
45
what is the difference between a clas II division 1 and class II division 2 incisor relationship?
divison 1- upper incisors are proclined or of average inclination and there is an increase in overjet
division 2- upper central inciors are retroclined- overjet is usually minimal or may be increased
46
describe a class III incisor relationship
The lower incisor edges lie anterior to the cingulum plateau of the upper incisors. The overjet is reduced or reversed.
47
how is porcelain surface prepped in the lab for bonding?
hydrofluoric acid is applied to produce a retentive surface
48
what do you use to bond porcelain to composite luting resin?
silane coupling agent
49
how does silane coupling agent act chemically?
double carbon C=C bonds attach to composite luting agent
oxide groups in the silane coupling agent attach to the porcelain
50
what metal can be used for an acid-etch retained bridge?
CoCr or NiCr
51
what chemical agent do you use to bond to metal?
MDP, 4-META
52
give 4 examples of questions you would ask a patient about their smoking habits
* what do you smoke?
* how many cigarettes a day?
* how long have you been smoking?
* are you thinking of quitting?
53
what would you tell patients about e-cigarettes?
* suggest use of research backed product e.g. patches
* they are not harmless but considerably safer than conventional cigs if used in moderation
* dont use them in public spaces
* can cause dry mouth, soft tissue damage due to battery overheating
54
what is the methodology for smoking cessation?
* Ask
* Advise
* Assess
* Assist
* Arrange a referral
55
give advice services you could refer a smoker to
* community clinics
* hospital advisor
* mental health in-patient service
* specialist pregnancy service
* prison serive
* community pharmacy setting
56
what do you do if a patient tells you they do not currently wish to quit smoking?
* provide a leaflet and emphasise that when they do want to stop, support is available
* record advice given in notes
57
why is alginate a more suitable impression material than silicone for 3mm spacing?
* alginate is a mucostatic and will take an accurate record of the tissue without displacement
* silicone is a mucocompressive and is likely to tear- also not effective if undercuts are present
58
name 2 support areas for the maxilla (dentures)
residual ridge
hard palate
59
name the primary support for the mandible (dentures)
* residual ridge
* retromolar pad
* buccal shelf
60
which part of the mandible can interfere during maxillary working impression?
coronoid process
61
how is PICO used in study design?
* Population- can only be one group of people
* intervention- represents the intervention of interest
* comparison- a standard deviation
* outcome- expected result
62
how do you reduce bias during a study design?
randomising
double blinding
63
what is the absoulte risk difference?
the difference in risk between groups
64
what is a confidence interval?
* the range of values the ARD witll take in the population
* 95 times out of 100 the CI will contain the TRUE population ARD
65
what is the most important thing for preventing healthcare associated infection?
PPE- gloves, apron, visors, face masks
66
name SICPs
standard Infection Control Precautions
* hand hygiene
* respiratory and cough etiquette
* ppe
* safe management of care equipment
* safe management of blood and bodily fluid spillages
* safe disposal of waste including sharps
* occupational safety
67
name 2 agesnt which can be used to clean a blood spillage
* sodium dichloroisocyanurate
* sodium hypochlorite
68
how do you break the chain of infection at transmission for dirty forceps?
the chain is broken at the reservoir wherethere are dirty contaminated forceps- break by cleaning, disinfecting, sterilising prior to use
69
what features of extracellular matrixs make them resistant?
* the biofilm impairs diffusion
* it causes binding of antibiotics
* extracellular DNA persists
70
name microorganisms that cause caries
* lactobacillus acidophilus
* streptococcus mutans
* candida albican
* actinomyces viscosus
71
name systemic diseases related to periodontal disease
* diabetes
* rheumatoid arthritis
72
describe Herb Schilder's endodontic principle
* create a continuously tapering funnel shape
* maintain apical foramen in original position
* keep apical opening as small as possible
73
why is irrigant a useful (apart from disinfection)?
* dissolves organic materials
* flushes out debris
* lubricate root canal instruments
* removes the endodontic smear layer
74
what is the best irrigant and ideal strength?
sodium hypochlorite
3%
75
what features should you take into account whilst using irrigant?
NAoCl can damage the soft tissues
can discolour fabric
opthalmic injuries if contact with eyes is made
allergic reactions
76
indications that trauma is NOT accidental
* injuries to both sides of the body
* injuries to soft tissue
* injuroes with particular patterns
* any injury that doesn't fit the explaination
* delay in presentation
* untreated injury
77
what are the effects of trauma on the primary dentition?
discolouration
delayed exfoliation
infection
78
what are the effects of trauma on permanent teeth?
* fails to form
* ectopic eruption
* dilaceration
* hypomineralisation
* odontoma formation
* delayed eruption
* enamel defects
* abnormal tooth/root morphology
* delayed eruption
* ectopic tooth position
* arrest in tooth formation
* complete failure of tooth to form
* odontome formation
79
when is the ideal time to extract permenant first molars in children?
* when bifurcation of 7s is visible
* when permanent premolars and wisdom teeth present
* class 1 incisor relationship
80
why might a child be nervous at the dentist?
* media coverage prior to dental experience
* family experience
* poor knowledge of treatment
* expectation of pain
* past negative medical/dental experience
* dental experince of friends and siblings
* the attitude of the parents
81
how woul dyou treat an anxious child?
* positive reinforcement
* tell-show-do
* acclimatisation
* desensitisation
* voice control
* distraction
* role modelling
* relaxtion technique/hypnosis
82
how do overhangs occur?
* poor adaptation of the matrix band
* excessive force applied when condensing amalgam
83
how do you fix an overhang?
you can remove and replace the restoration
use of finishing strips/soft flex files
84
give features of a ghost image
* image is always higher
* the image is horizontally magnified
* on theopposite side
* can interfere with diagnosis
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