PPQs Flashcards

Question

recommended alcohol limit for males & females

Answer 1

no more than 14 units per week spread evenly over 3 or more days

Answer 2

1. licensing (scotland) act 2005 2. alcohol (scotland) act 2010 3. criminal justice and licensing (scotland) act 2010 4. air weapons and licensing (scotland) act 2015 5. local government (scotland) act 1973

Answer 3

- changing scotland's relationship with alcohol; framework for action plan - minimum pricing per unit alcohol - ban on multi buy drink promotions - increased investment in alcohol treatment & care services with available access - introduction of scottish lower drink drive limit of 22mg of alcohol / 100ml

Answer 4

5A's - brief intervention; - Ask ptx about alcohol consumption - Advise ptx - Assess ptx - Assist ptx on getting help - Arrange follow up for ptx 2A's & 1R; - ask ptx about alcohol - advise your ptx on alcohol - refer to stop alcohol services ABIs - alcohol brief interventions which are opportunistic & effective

Answer 5

1. pseudomembranous; thrush 2. erythematous; denture induced stomatitis, atrophic HIV related & candida leukoplakia 3. hyperplastic - candida leukoplakia 4. angular chelitis - poor OH, dry mouth, anaemia, immunocompromised, over closed denture from reduced OVD

Answer 6

pseudomembranous - - nystatin oral 1ml 4x daily for 7 days - chlorhexidine 3ml rinse for 7 days - fluconazole 50mg daily for 7 days - miconazole oromucosal gel pea sized amount after food 4x daily - itraconazole 10-20mg OD for 14 days erythematous - - if steroid related rinse with mouth wash after using inhaler / spacer device - if denture induced ensure thorough hygiene instructions given with milton for 20mins or chlorhexidine, advise removing denture at night - drug tx = fluconazole capsules 50mg for 7 days or miconazole oromucosal gel pea sized amount to fitting surface of upper denture after food 4x daily hyperplastic - - confirm diagnosis through microbiology & histopathology - systemic antifungals i.e. fluconazole 50mg OD or itraconazole 10-20mg OD - iron, folate or B12 may be required if deficient angular chelitis - - chlorhexidine mouthwash 3ml per rinse for 7 days - miconazole cream (2%) apply to angle of mouth 2x daily; use for 10 days after lesions have stopped - sodium fusidate ointment 2% apply to angles of mouth 4x daily - miconazole 2% & hydrocortisone 1% cream applied to angles of mouth 2x daily ensure miconazole is not prescribed for those on warfarin or statins

Answer 7

azoles mechanism of action is the inhibition of the cytochrome P450 dependent enzymes (particularly 14a-demethylase) which is involved in the biosynthesis of ergosterol which is required for fungal cell membrane structure & function

Answer 8

candida species C.krusei & C.glabrata are naturally resistant to fluconazole & some strains of C.abicans have formed sensitivity & resistance to fluconazole systemic tx this is why it may be important to carry out sensitivity & subtyping to ensure what candida species is causing the candidosis

Answer 9

maxillary features: coverage of tuberosity, hamular notch, extension anterior to vibrating line for post dam, functional depth & width of sulcus to create good peripheral seal & ensure hard palate & residual ridge are functional for primary support mandibular features: coverage of pear shaped pad & buccal shelf, retromolar pad & extension into lingual pouch should occur, functional width & depth of sulcus, ensure area of primary support of buccal shelf & retromolar pad general features: ensure denture bearing areas covered, good functional sulcus, good surface detail with no airblows

Answer 10

- post dam should sit 1-2mm anterior of vibrating line between junction of hard & soft palate - should be at level of hamular notch to produce a good posterior seal which is located between distal surface of tuberosity & hamular process of medial pterygoid plate of maxilla

Answer 11

primary: 1. impression compound - non elastic material which records poorer surface detail, not cheap, can be messy but good for primary due to high mucocompressive viscosity 2. alginate - elastic material that flows into undercuts & records adequate surface detail for primary imps master: 1. silicone - dimensionally stable & can be made into variety of consistencies which means it accurately records surface detail 2. polyether/impregum - dimensionally stable & accurate recording of surface detail 3. alginate - elastic so will flow into undercuts if present

Answer 12

a disabling progressive disease process thought to be caused by degeneration of dopaminergic neurones in basal ganglia (substantia nigra) or brain but reason for this degeneration is unclear

Answer 13

1. postural instability; impaired gait & falls, impaired use of upper limbs 2. resting tremor 3. bradykinesia; slow movement & slow initiation of movement 4. rigidity; increased motor tone

Answer 14

mask like face, slow speech & difficult swallowing, impaired dexterity, abnormal posture & difficulty walking (shuffling gait), memory problems

Answer 15

difficulty accepting treatment; tremor of body at rest, often facial remorse reduces purposeful movement e.g. mouth opening, lack of control of oral muscles dry mouth common due to anti-cholinergic effects of drug treatment (benztropine) increased risk of drug interactions

Answer 16

general - fidgeting, pacing, repetitive motions, refusal to eat or cooperate, crying, groaning facial - frowning, grimacing, teeth clenching, biting, rubbing area that is sore behavioural - aggressive, depression, isolation, sleep disturbances, withdrawal

Answer 17

parkinsons presents as intention tremors & tremor at rest; intention tremor is present when tremor amplitude increases during visually guided movements towards target at the termination of movement ataxia cerebral palsy typically presents with action intentional tremors which is especially apparent when carrying out precise movements

Answer 18

Chlorhexidine is an antiseptic and disinfectant that helps reduce the number of bacteria in mouth / skin mechanism of action - Chlorhexidine is a cationic surfactant synthetic biguanide with broad-spectrum antibacterial and less pronounced antifungal activity. It disrupts microbial cell membranes and coagulates cytoplasmic proteins & has a residual activity of several hours

Answer 19

- contains bisbiguanides which is the gold standard for active use against gram +/- bacteria, fungi, yeasts & viruses - no known bacterial resistance or superinfection reported with use - has 12hr substantively - good safety record, available without prescription - requires little to no skill or motivation to use

Answer 20

chlorhexidine mouth rinse 0.2% 10ml x2 daily for 1 min after breakfast & before bed for 1-2wks

Answer 21

usually 12hrs but depends on: - absorption to oral surfaces - maintenance of antimicrobial activity - slow neutralisation of antimicrobial activity - other drugs - certain food & drinks - sodium lauryl sulfate

Answer 22

- short term for specific problems such as candidosis (pseudomembranous / erythematous) - to clean dentures causing denture stomatitis - post oral or perio surgery - in disabled ptx where good OH is not easy to maintain - immunocompromised ptx can benefit from use to prevent oral infections spreading to systemic infection - tx of ANUG - management of aphthous ulcers - irrigant during RCT - management of mucositis in cancer ptx

Answer 23

anaphylaxis, hypersensitivity, mucosal irritation, parotid gland swelling, reversible brown staining of teeth / comp restorations, taste distrubance, tongue discolouration, burning of gums if not diluted properly can potentially impair fibroblasts & normal periodontal healing

Answer 24

incidence: no of new disease cases developing over a specific period of time in a defined population, incidence rate = no of new cases of a disease in a period / no of individuals in the population at risk, incidence estimates are obtained from longitudinal studies prevalence: number of disease cases in a population in a given time, prevalence = no of affected individuals / total no of persons in population, prevalence estimates are obtained from cross sectional studies or derived from registers which can relate to attributes to absence or presence of disease

Answer 25

scottish index of multiple deprivation which is an area based index which uses a range of data to decide which neighbourhoods are most deprived by ranking data zones in order of deprivation from most to least deprived, with 1 being most deprived

Answer 26

1. employment status 2. income 3. health & health care services 4. geographic access to services 5. crime 6. housing, living & working conditions 7. education, skills, training

Answer 27

A - active component - induces a force by introducing displacement forces R - retention - resistance to displacement forces A - anchorage - resistance to unwanted tooth movement, newton's 3rd law: for every action there is an equal & opposite reaction B - baseplate - to provide anchorage, connector for retentive components, cohesion, adhesion & stability

Answer 28

Aim - please construct a URA to correct an anterior crossbite on patient's 12 A - Z spring (double cantilever spring) on 12; 0.5mm HSSW R - 16, 14, 24, 26 Adam's clasps; 0.7mm HSSW A - yes B - self cure PMMA posterior bite plane

Answer 29

Aim - please construct a URA to expand the upper arch A - midline palatal screw R - 16, 14, 24, 26; Adam's clasps; 0.7mm HSSW A- reciprocal anchorage B - self cure PMMA - posterior bite plane; most incorporate all posterior teeth to prevent unwanted tooth eruption

Answer 30

anterior - 1 activation per month posterior - 1 activation per week should only be 1-2 teeth moving 1mm pr month for bone remodelling

Answer 31

1. adam's clasps - 4s & 6s 0.7mm HSSW (0.6mm in deciduous teeth) 2. southend clasps - 1s & 2s 0.7 HSSW 3. labial bows - 0.7mm HSSW 4. c clasps - 0.7mm HSSW

Answer 32

anchorage is resistance to unwanted tooth movement described by newton's 3rd law - for every action there is an equal & opposite reaction used to ensure only 1-2 teeth are moved at a time

Answer 33

proclination on upper anteriors & retro-clination of lower anteriors with localised anterior open bite (AOB) or incomplete open bite (OB); it can also narrow the upper arch with a unilateral posterior crossbite sucking effects will also be superimposed on existing skeletal patterns & incisor relationships & can cause lisping while talking

Answer 34

1. immediate post op period: - reactionary & rebound bleeding which occurs within 48hrs of XLA - caused by vessels opening up as the vasoconstriction effects of LA wears off, sutures become loose / lost, or ptx traumatising socket with finger / tongue / toothbrush / food 2. secondary bleeding - often due to infections commonly occurring 3-7 days post XLA - usually a mild ooze but can cause major bleed

Answer 35

- apply firm pressure by biting on damp gauze packs / using finger - LA reapplied with vasoconstrictor - surgical oxidised cellulose / gelatin sponge inserted to act as framework for clot formation - whitehead's varnish pack containing iodoform, gum benzoin etc ribbon gauze soaked in WHVP sutured into socket will require removal - bone wax - thrombin liquid & powder in socket - fibrin foam into socket - suture socket with interrupted / horizontal mattress suture - ligation of vessels & diathermy may be used

Answer 36

inferior alveolar nerve lingual nerve some fibres of incisive & mental branches

Answer 37

- numbness of lip & chin on same side of IDB - numbness of lingual gingivae & 2/3s of tongue - check teeth on that side & tooth being XLA by walking probe down long axis of tooth & checking it ptx can feel it

Answer 38

consistent dryness in the mouth which generally develops when flow of saliva decreases to around 1/2 the normal unstimulated rate - 0.3ml/min very common & often seen as side effect to polypharmacy

Answer 39

tricyclics anti depressants - amitriptyline & nortriptyline anti psychotics - phenothiazine benzodiazepines - diazepam, lorazepam anti-cholinergic - atropine beta blockers - atenolol, propanolol antihistamines - cetirizine, loratadine

Answer 40

medical tx - radiotherapy of head & neck, chemotherapy, removal of salivary glands medical conditions - sjogren's, undiagnosed diabetes, HIV, AIDS, alzheimer's, cystic fibrosis, rheumatoid arthritis, stroke nerve damage severe dehydration

Answer 41

1. stimulate salivary glands - chew sugar free gum / sweets 2. substitute saliva - oral lubricants - biotene system which is a salivary LPE enzyme system that helps to maintain oral environment 3. treat / modify underlying causative disease / problems causing it in the 1st place e.g. diagnose & treat diabetes 4. drug use - pilocarpine used for tx following irrigation for head & neck cancer & for dry mouth in sjogren's; only effective in ptx who has residual salivary gland function 5. management techniques - suck on ice cubes & frequent sips of water - avoid mouthwash containing alcohol - avoid dry hard food - avoid alcohol / caffeine - avoid sweet / sugary food - moisten food when eating with water & sauces

Answer 42

working clockwise T, R , RCP, ICP, E, Pr

Answer 43

- centric relation (retruded arc) which is a dynamic relationship between maxilla & mandible is not in a static position - said to occur when condyles are in their most superior position in the articular fossa & is determined by anatomy of TMJ - it is a border movement and is reproducible over a period of treatment

Answer 44

T - maximal mandibular opening with full anterior - inferior translation of condylar heads R - maximal mandibular opening with the condylar heads in reproducible retruded position but no anterior-inferior condylar translation. the arc R-RCP has its centre of rotation passing through the condylar heads (terminal hinge axis). in edentulous ptx the point at which prosthetic tooth contact is made along this arc (OVD) is determined by dentist as RCP RCP - retruded contact position ICP - intercuspal position RCP-ICP = path is termed a slide, has the potential for horizontal, vertical & lateral components; lateral element cannot be seen in the sagittal plane E - edge to edge position of incisors Pr - maximum protrusion

Answer 45

1. jaw reg 2. occlusal rims - setting upper teeth in wax rim and setting lowers to upper in RCP note - tooth shade & mould should also be recorded

Answer 46

1. furcation bone loss 2. external and / or internal resorption 3. radiolucencies 4. periapical periodontitis - widening of PDL

Answer 47

1. sinus/tender in sulcus 2. colour 3. TTP 4. mobility 5. EPT 6. ethyl chloride thermal testing 7. percussion note 8. radiographs

Answer 48

tx: - bond fragment to tooth or place composite bandage - take 2 periapical x ray to rule out root fracture or luxation - sensibility testing & evaluate tooth maturity - place definitive restoration follow up at 6-8wks & 1yr: - x ray checked for width & length of root canal development, compare tooth with contralateral - check for internal & external inflammatory resorption & periapical pathologies prognosis: - 5% risk of pulp necrosis in 10yrs

Answer 49

evaluation: - size of pulp exposure - time since injury - associated PDL injuries tx: <24hrs = pulp cap: - LA & dental dam ->clean area with water, disinfect with NaOH, apply CaOH (dycal) or MTA white to pulp exposure -> restore with CR - dam not required if associated luxation injuries - review 6-8wks, then 1yr >24hrs = partial (Cvek) pulpotomy: - LA & dental dam -> clean with H2O then NaOH, remove 2mm of pulp with high speed rough diamond bur (if no bleeding or cannot arrest bleeding proceed to full coronal pulpotomy), place saline coated (ferric sulfate?) CW pellet over exposure until haemostasis achieved, apply CaOH then vitrebond then restore with CR full coronal pulpotomy: - begin with partial then assess haemostasis, remove all of coronal pulp if hyperaemic or necrotic, place CaOH in pulp chamber, seal with GIC lining & quality coronal restoration follow up 6-8wks, 1yr. aim to preserve pulp vitality and avoid full extirpation unless tooth is clearly non vital

Answer 50

pain oedema bruising changes in bite missing part of tooth inability to close mouth tooth discolouration lacerations in mouth

Answer 51

BLACK - non infected household waste i.e. paper towels, food containers, put in wheelie bin to be lifted by council ORANGE bag - low risk waste; dressings, swabs, disposables i.e. PPE, other items that have been in contact with ptx. bags filled to manufacture line, securely sealed with ratchet tag / swan tie then lifted by specialist services for heat disinfection (HDS) ORANGE bin - low risk waste i.e. broken glass, blood & contaminated liquids inc bags & tubes, filled to line, label completes & source identified on bin, picked up for HDS YELLOW stream - high risk i.e. recognisable body parts e.g. teeth without amalgam fillings, medicines & anaesthetics, used / unsure sharps or drug vials, contaminated metal parts or surgical instruments, highly infectious waste such as infectious blood, containers filled to line, labelled & picked up for incineration RED stream - for amalgam, amalgam capsule, teeth with amalgam etc, filled to line, label completed, picked up as it requires specialist waste reprocessing so chemicals can be recovered

Answer 52

1. description of waste 2. origin source of where waste has come from 3. quantity 4. transport & destination

Answer 53

1. special waste (amendment) regulations 2004 2. health & safety at work act 1974 3. COSHH 2002 4. environmental protection act 1990 5. health & safety executive HSE 6. scottish environmental protection agency SEPA

Answer 54

1. alzhiemer's; reduction in size of cortex, severe in hippocampus, presence of plaques which are deposits of protein fragments of beta-amyloid that build up in spaces between nerve cells & tangles 2. vascular - caused by reduced blood flow to brain which damages & eventually kills brain cells 3. dementia with lewy bodies - deposits of abnormal protein (lewy bodies) inside brain cells 4. frontotemporal - frontal lobe has associated ubiquitous clumps of protein linked with TDP-43 found on it rarer forms = parkinson's, HIV, corticobasal degeneration, MS

Answer 55

1. human rights act 2000 2. disability discrimination act 2005 3. equality act 2010 4. adults with incapacity act (scotland) 5. mental capacity act (england & wales)

Answer 56

GP dentist consultant neurologist dementia nurse macmillan nurse physio carers

Answer 57

EARLY - misattributed to stress, bereavement or normal ageing: - loss of short term memory - confusion, poor judgement, unwilling to make decisions - anxiety, agitation, distress over perceived changes - inability to manage everyday tasks - communication problems; decline in ability or interest in talking, reading etc MIDDLE - increased obvious symptoms - more support required inc reminders to eat, wash, dress, use bathroom - increasingly forgetful & will fail to recognise people - distress, aggression, anger, mood changes - risk of wandering & getting lost - behave inappropriately - experience hallucinations, throw back memories LATE - progressive symptoms - inability to recognise familiar faces, objects, surroundings - increasing physical frailty, start to shuffle / walk unsteady - difficulty eating & sometimes swallowing, weight loss, gradual loss of speech, associated incontinence - progressive & irreversible

Answer 58

1. occlusal reduction: - retain some morphology but reduce cusps & marginal ridges - take into consideration relative thickness of metal & porcelain - use diamond tapered fissure bur or round/rugby ball diamond bur 2. separation: - use long tapered diamond bur to separate from adjacent tooth 3. buccal reduction: prepare in 2 planes: i) using diamond tapered shoulder bur for 1st reduction plane ii) use the same for 2nd reduction plane but keep handpiece following incline of cusp - avoid buccal pulp horns - interproximal margin should follow gingival contour 4. palatal / lingual reduction: - completed in 1 plane for premolars & molars - follow palatal contour for canines & incisors - both should use diamond chamfer bur 5. shoulder & chamfer finish: - use both burs to finish shoulder margins or corresponding sides

Answer 59

non functional cusps = 2mm functional cusps = 2.5mm incisal = 2mm buccal shoulder / heavy chamfer = 1.2-1.3mm (2 plane) palatal chamfer margin = 0.5mm (1 plane) between 10-20o taper

Answer 60

- silicone (addition cured silicone putty) is placed over crown prep as it is dimensionally stable, has variety of consistencies, resistant to tear & records very accurate surface detail - alginate impression can be then placed which is cheaper to use & is elastic so can flow into undercuts

Answer 61

- delay in seeking help & delayed presentation of injuries - story vague, lacking in detail, vary with telling person to person - account not compatible with injury - parents mood is abnormal - parental behaviour gives cause for concern i.e. refusal to allow proper tx or hospital admission, unprovoked aggression towards staff, explanation inconsistent with injuries - child appearance & interaction with parent is abnormal - history of previous injury - suspicious injuries / facial bruising - history of violence within family

Answer 62

OBSERVE - child's behaviour & injuries RECORD - always record conversations & findings in ptx notes COMMUNICATE - with child & parents; ask how they got injuries, does it math description, reason for delayed presentation REFER for assessment - if still concerned contact child protection for advice, follow up in writing & speak with health visitor, GP, school etc to investigate further, continue with referral to social services duty of care to share concern about risk to a child's wellbeing with child's named person

Answer 63

3 stages - 1. preventative dental team management; single unit approach = raise concerns with parents, offer support, set targets, keep records & monitor progress 2. preventative multiagency management = - lease with other professionals to see if concerns are shared i.e. health visitor, GP - child may be subject to common assessment framework (CAF) - check if child is subject to child protection plans - agree joint plan of action, review at agreed intervals - letter to health visitor of children u5 who fail appointments & failed to respond to letter from practice 3. child protection referral - - in complex or deteriorating situations - follow local guidelines - referral to social services if required

Answer 64

1. von willebrand's - deficiency and/or defect of blood factor (von willebrand's factor) that promotes platelet adhesion 2. haemophilia A - factor VIII deficiency, 25% cases 3. haemophilia B - factor IX deficiency (Christmas factor), 5% cases 4. rarer forms - 10%

Answer 65

may be due to a problem in the platelets themselves or to an external factor that alters the function of normal platelets can be inherited or acquired with both increasing the risk of excessive & spontaneous bleeding

Answer 66

condition characterised by abnormally low levels of thrombocytes (platelets) in the blood diagnosed when below the normal limit of 150x10 to the 9/L

Answer 67

FBC - haematology coagulation screen - prothrombin time PT, partial thromboplastin time PTT, activated partial thromboplastin time APTT, APTT ratio, INR thrombophilia & haemophilia factor screen

Answer 68

INR screen to determine how long it takes for your blood to clot as warfarin affects Vit K dependent clotting factors 2, 7, 9, 10 INR = 1 indicates level of coagulation equivalent to an average person not on warfarin but >1 indicates longer clotting time and so longer bleeding time INR < 4 = allow for tx to occur without interrupting anti coag medication; safest between 1.5-2.5

Answer 69

regular injections of the clotting factor they are missing - haemophilia A; berlate P injection which is recombinant factor VIII // DDAVP - haemophilia B; benefix injection which is recombinant Christmas factor -vWD; desmopressin (DDAVP) - thrombocytopenia; platelet transfusions, INR - rare conditions; FFP intravenously to replace all factors if recombinant factors are not available dental injections - all injections can be used except lingual infiltration & IDB

Answer 70

- tobacco use - alcohol use - prolonged sun exposure - HPV - gender - age - poor OH - poor diet & nutrition - weakened immune system

Answer 71

a biofilm comprises of an aggregate of microorganisms whose cells adhere to one another & embed in a surface the adherent cells become embedded within a self produced matrix of extracellular polymetric substances which allows adherence to a surface

Answer 72

an ecological niche is the role & position a species has in its environment, how it meets its needs for food & shelter, how it survives & reproduces a species niche includes all of its interactions with the biotic & abiotic factors of its environment

Answer 73

1. adhesion 2. colonisation 3. accumulation 4. complex community 5. dispersal

Answer 74

1. streptococcus spp = produce linking film i.e. strep mutans in caries development 2. actinomyces spp = cause coaggregation & reconditioning of the film i.e. actinomyces actimomycetemcomitans A.a in perio or candida albicans in candidiasis

Answer 75

microbial adhesion: - fimbrillar adhesins which are virulence factors used to help invade membrane vesicles of host cells by binding to cellular inetgrins - LPS (cell wall component of outer membrane) of gram - bacteria with potential structural diversity to mediate specific adherence - lipotechoic acid = cell wall components of gram + bacteria that may be involved in non specific / specific adherence - protein fimbriae are filamentous proteins on surface of bacterial cells that may behave as adhesins for specific adherence - lectins are any proteins that bind to a carbohydrate - cell wall proteins host receptors = glycolipid, glycoproteins, integrins, collagen, heparin

Answer 76

requires adherence, substrate & liveable environment i.e. 1. host - mucosa surface, pellicle, acid rich police proteins, minerals, lectins 2. saliva - mechanical washing, bactericidal enzymes, buffering, secretor IgA 3. bacterial - adhesins, LTA, protease, virulence factors

Answer 77

- approximate & reposition tissues - compress blood vessels - cover bone - prevent wound breakdown - achieve haemostasis - encourage healing by primary intention

Answer 78

1. resorbable a) monofilament i.e. monocryl b) multifilament i.e. vicryl rapide; holds tissue edges together temporarily, vicryl breakdown via absorption of water into filaments causing polymer to degrade 2. non resorbable a) monofilament i.e. prolene b) multifilament i.e. mersilk - black silk if extended retention periods are required use these but must be removed post op, usually for closure of OAF or in exposure of canine teeth

Answer 79

triangular rectangular semilunar envelope

Answer 80

- create maximal access with minimal trauma as bigger flaps heal just as quick as smaller ones - wide based incision should be used for circulation - use scalpel in 1 firm continuous stroke - no sharp angles - minimise trauma to dental papilla - flap reflection should be down to bone and done cleanly - no crushing of tissues - keep tissues moist - ensure flap margins & sutures lie on sound bone - make sure sounds are not closed during tension - aim for healing by primary intention to minimise scarring

Answer 81

straight electrical hand piece with saline cooled bur: round or fissure tungsten carbide burs air drive hand piece may lead to surgical emphysema embolism to form

Answer 82

1. discolouration - immediate may indicate vitality and intermediate change over wks can indicates non-vitality 2. delayed exfoliation of primary tooth - may not resorb normally after trauma so XLA necessary or permanent successor will erupt ectopically 3. enamel defects (44% cases) - - hypomineralisation; yellow/white spots, normal thickness of enamel, tx = mask with composite, localised removal & restore with composite, external bleaching - hypoplasia; yellow/brown spots, less than normal enamel thickness, tx = repair with composite / porcelain veneers when gingival level is stabilised at 16yrs 4. abnormal root morphology - - crown/root dilacerations; requires surgical exposure & ortho - delayed eruption; premature loss of primary teeth may result in delayed eruption of up to 1yr due to thickened mucosa, take radiographs if >6mths, surgical exposure & ortho may be required 5. ectopic tooth positions 6. arrest in tooth formation (RCT/XLA) 7. complete failure of permanent tooth to form 8. odontome formation (surgical removal) 9. underdeveloped tooth germ; may sequester spontaneously or require removal

Answer 83

- usually affects all of the maxillary teeth as smooth surface caries around the gingival margin - lower incisors are protected by tongue but mandibular canines can be infected

Answer 84

- ensure they're using F- toothpaste suitable for age group i.e. 1000ppm < 3 and 1500ppm <10 high risk - ensure free flow spout from 6mths with no sugar in cup - don't give bottle at night, only before brushing - keep to meal times and don't let child sip on sugar all day

Answer 85

1st & 2nd molar pits & fissures susceptible & usually first interproximal areas where there are tight contacts between teeth normally not smooth surface unless extremely bad

Answer 86

core gains interradicular support for definitive coronal restorations such as a crown post then retains the core holding onto the coronal restoration; however, this will weaken the tooth

Answer 87

- manufactured; preformed or prefabricated / custom made - material; cast metal (type IV gold / Au), steel, zirconia, carbon / glass fibre - shape; parallel sided, tapered - surface; non threaded passive, serrated, smooth, cement retained

Answer 88

parallel sides -> avoid wedging, greater retention than tapered, less likely to cause root fracture as load is not dispersed horizontally; transfers down long axis tapered posts -> high strength & stiffness, conservative, less retentive than parallel or threaded posts, should be used in small circular canals & avoid in flares canals

Answer 89

length: at least equal to crown height 2/3 of root length 4-5mm root filling should be left apically so apical foramen is sealed never extend past a bend in the root should reach alveolar crest height width: no more than 1/3 of root width at narrowest point 1mm of remaining circumferential coronal dentine should fit for AL preparation & anti-rotational design

Answer 90

used to provide anchorage, connector for retentive components, cohesion, adhesion & stability

Answer 91

1. gravity 2. mastication 3. tongue 4. talking / vibrations 5. active components

Answer 92

force is proportional to deflection x radius4/length3

Answer 93

1. check it is correct appliance for ptx 2. check it is correct design & matches prescription 3. check for any sharp / protruding areas on polishing & fitting surface which could cause trauma 4. check integrity of wire work i.e. areas of damage (dark spot where the chromium layer is damaged which can lead to corrosion/fracture) or areas of work hardening (darkness caused by bending back & forth) 5. try in ptx mouth 6. check for signs of blanching, damage & trauma to soft tissues 7. check occlusion: 1. flyover of posterior retention; high flyover can cause metal fatigue & wire fracture, undercut area moving so it won't engage & causes gum stripping. 2. arrowheads. 3. check anterior retention 8. active components should be in passive state so this is when they can be activated to allow 1mm of movement/ month 9. demonstrate to ptx correct insertion & removal & get them to demonstrate back 10. book review in 4-6wks

Answer 94

1. likely to impinge on speech so get them to read aloud with device in 2. will feel big & bulky so reassure they will get used to it quickly 3. once activated will feel mild discomfort so indicates appliance is working & can take analgesia if needs be at start 4. likely to have excess salivation (will pass in 24hrs)

Answer 95

1. wear 24/7 including meal times 2. take out & clean with soft brush after every meal 3. store in safe container if taking part in active / contact sports 4. non compliance will significantly lengthen tx 5. avoid hard & sticky food, caution with hot food & drink 6. give emergency contact details if components fail

Answer 96

- check wear on acrylic - reactivate appliance - monitor through overjet measurement; ensuring space between UR3 & UR4 are reducing & ensuring OJ has not changed - check overbite reduction - check MR in case anchorage is slipping - if compliance is good, tx should only take 6-9mths

Answer 97

produced as the x ray tube start position directs the bra posteriorly towards then opposite TMJ region and then moved behind ptx head, when the image of the premolar is being created the beam is coming from a more posterior point on opposite side & ghost products such as earrings are usually more anterior due to this ghost images that occur are always higher due to vertical beam angulation of 8o and be horizontally magnified & usually further forwards due to change in anterior-posterior position ghost images can occur when there is horizontal distortion if ptx is in incorrect position relative to focal plane typical ghost images = earrings, metal restoration, soft tissue calcification, soft palate, hyoid bone, denture & fixed appliance

Answer 98

when you require a full view of dentition & surrounding structures inc TMJ & condyles; it will show: - fractures & elevation of trauma - 3rd molar & relationship to ID canal on lowers - bone loss in generalised perio disease - large lesions that wouldn't be seen on occlusal, bitewings or periapical - retained/unerupted teeth & development of dentition - developmental & acquired anomalies - TMJ evaluation - inability to tolerate intra oral radiographs

Answer 99

a stroke is an acute neurological defecit resulting from cerebrovascular disease and lasting more than 24hrs or causing earlier death due to hypoxia of brain tissue; 2 types: 1. no local cerebral flow; infarction of tissue or haemorrhage into brain tissue 2. temporary ischaemia; TIA (transient ischaemic attack)

Answer 100

1. impaired mobility & dexterity; reduced attendance, importance of OH & techniques for getting into mouth 2. communication difficulties; dysphonia & dysarthria issues, cognitive difficulties 3. risk of cardiac emergencies; MI & further stroke are at increased risk 4. loss of protective reflexes; aspiration risk, techniques for managing saliva 5. loss of sensory information; difficulty in adapting to new oral environment i.e. denture 6. stroke pain; CNS generated pain perception may be enhanced

Answer 101

hypertension - DBP >110mmHg x15 risk compared to 80mmHg, sustained BP of 140/90 or above smoking frequent & heavy alcohol consumption ischaemic heart disease atrial fibrillation diabetes mellitus previous strokes prolonged stress

Answer 102

1. reduce risk factors; smoking, stress & alcohol reduced, diabetes & hypertension controlled 2. anti platelet action - decreases platelet aggregation & inhibits thrombus formation effective in arterial circulation e.g. aspirin, clopidogrel, dipyridamole 3. anti coag action - suppressing synthesis or function of various clotting factors and prevent formation of blood clots in veins & arteries; if at emboli risk such as AF, left ventricular thrombus given warfarin / heparin 4. carotid endarterectomy - used when there is severe stenosis & previous TIAs under age of 85 5. neurosurgery - aneurysm clips or AV malformation correction

Answer 103

ACUTE PHASE: 1. limit damage: - calcium channel blockers for survivable ischaemia - thrombolysis within 3hrs to improve blood flow & O2 - achieve normal glycaemia levels 2. reduce future risk: - remove haematoma if possible - give 300mg aspiring daily & anticoagulants if required CHRONIC PHASE 1. rehabilitation: - immobility support - speech and language therapy - occupational therapy 2. reduce future risk with medication

Answer 104

needle injected at junction of buccal fat pad in pterygomandibular, lateral to pterygomandibular raphe and medial to coronoid notch of the ramus of the mandible, 1cm above occlusal plane of molars position of needle is approached from opposite premolar region and advanced until you reach bone then retract 1cm; aspirate & begin slow administration

Answer 105

facial palsy as LA injected (too posteriorly) into facial nerve which runs through parotid causes eye on affected side to shut similar to stroke symptoms & cannot move eyebrows as temporal branch affected to manage - reassure, cover eye with pad until blink reflex returns to normal, book review

Answer 106

1. neuroses (person contact is retained with reality) - anxiety states, phobic, OCD, hypochondria, depressive 2. psychoses (persons contact is lost with reality) - manic depression, schizophrenia, korsakoff's psychosis 3. mood disorders - dementia, depressive, dysthymia, bipolar, cyclothymia 4. eating disorders 5. personality disorders

Answer 107

1. anxiety - denture intolerance, oral somatostatin, parafunction, TMD issues, oral dysesthesias (dry, burning, facial pain but no cause) 2. psychoses - may be hyperactive / aggressive, delusional, hallucinations, poor concentration, poor insight, reckless behaviour 3. mood disorders - reduced interest & motivation, poor concentration, appetite disturbance, unreasonable self approach 4. eating disorders - xerostomia, recurrent ulcers, infections, bleeding, dental erosion general - poor attenders, local dental care facility may not be able to provide specialist care, may not accept care due to anxiety so need sedation / GA, problems with capacity & consent

Answer 108

antipsychotics - phenothiazine, butryrophenones, thiozanthenes sedatives - benzodiazepines anti depressants - selective serotonin reuptake inhibitors (SSRIs) i.e. prozac, monoamine oxidase inhibitors (MAOIs) i.e. phenelzine, tricyclic antidepressants i.e. amitriptyline

Answer 109

concerned purely with management and treatment of psychiatric disorders - acknowledges person has mental disorder - medical tx is available which could stop condition progressing or help treat some symptoms - if tx not provided there would be significant risk for ptx / others - ensures compulsory powers may be necessary especially if persons mental problem prevents them from making decisions about medical tx it also deals with detention limits

Answer 110

aims to - empower & protect people who may not be able to make decisions for themselves - enables people to plan ahead incase they are unable to make decisions for themselves in the future - states that over 16 you have capacity to consent

Answer 111

1. must benefit patient 2. be the least restrictive option 3. take into account the wishes of the patients and those involved 4. consultation with relevant others i.e. carer, guardian 5. encourage the person to use exercise residual capacity

Answer 112

identification if there are any decisions which the patient can make for themselves in so far as it is reasonable or practicable to do so, encourage adult to exercise whatever skills they have concerning property, financial affairs or personal welfare as the case may be and to develop such new skills

Answer 113

power of attorney 1. continuing power of attorney - cannot consent to dental tx 2. welfare power of attorney - can consent for dental tx 3. combined power of attorney - can consent for dental tx guardianship orders 1. welfare guardian - can consent for dental tx 2. financial guardian - cannot consent for dental tx

Answer 114

AMCUR inability to act on decision make decision communicate decision understand decision retain memory of decision

Answer 115

1. randomised control trial - gold standard for comparing the effectiveness of one treatment to another, they provide the strangers evidence on effectiveness of tx in clinical trials 2. cohort studies - individuals in this study are observed over a period of time to measure frequency of occurrence of disease, amount of people exposed to risk factor and people not exposed to the risk factor 3. case control studies - retrospective study which compares individuals with disease (cases) and those without disease (control) then assess risk factors through past histories & exposure to suspected harmful agents compared; less robust than cohort study but can be used as preliminary investigations of hypothesis followed by cohort

Answer 116

CI - range of values the absolute risk difference will take in the population - 95/100; the CL will contain the true population ARD so it wouldn't overlap 0 which means there is sufficient evidence - a narrow CL is better as the larger the sample the narrower the CL p values : - used in stats to help determine significance of your results - p value <0.05 means you reject the null hypothesis & your results are statistically significant

Answer 117

6mths - 3yrs = 0.25mg / day 3-6yrs = 0.5mg/ day 6+yrs = 1mg / day

Answer 118

eruption of 1st tooth - 3yrs = 1000ppm 4-16yrs = 1450-1500ppm high risk u10yrs = 1500ppm high risk 10-16yrs = 2800ppm high risk 16+yrs = 5000ppm

Answer 119

toxic dose = >1mg/kg bodyweight potentially lethal dose = 5mg/kg certainly lethal = 32-64mg/kg

Answer 120

nausea, abdominal pain, diarrhoea, vomiting

Answer 121

1. <5mg/kg give calcium orally; milk, observe for a few hrs 2. 5-15mg/kg give calcium orally; milk, calcium gluconate, calcium lactate & admit to hospital 3. >15mg/kg take to hospital straight away for IV calcium gluconate & cardiac monitoring

Answer 122

1. physical - spina bifida, cerebral palsy, arthritis 2. intellectual - down's, autism 3. mental - schizophrenia, dementia, Alzheimer's 4. sensory - visually / hearing impaired 5. emotional - anxiety, depression, bipolar 6. social - illegal drug use, alcohol abuse, obesity, homelessness, poverty

Answer 123

handicap - disadvantage for given individual, resulting from impairment / disability that limits or prevents fulfilment of a role that is normal for that individual disability - a restriction / lack (resulting in impairment) of ability to perform an activity in a manner or within the range considered normal for a human being; it is concerned with the performance of activities impairment - any loss of abnormality of psychological, physiological or anatomical structure or function; it is concerned with abnormalities in structure or functioning of the body or its parts

Answer 124

legislation - humans rights act 2000, disability discrimination act 2005, the equality act 2010 adaptations - designated parking close to premises, appropriate sign posting with sensory impairments, ground floor level access, area for wheelchair access, hearing loop in place, handrails for support on step & ramps, wide doors & corridors for wheelchairs, unisex disabled toilet facilities with hoist available, wide clutter free corridors, wheelchair turning circle within surgery layout

Answer 125

inherited autosomal recessive disorder on CFTR gene on chromosome 7 that causes an inherited defect in cell chloride channels which produces excess sticky mucous affecting the lungs & pancreas

Answer 126

lung congestion & persistent chest infections (staphylococci & pseudomonas), malabsorption by pancreas, failure to thrive, smaller than average, finger clubbing, barrel chested

Answer 127

troublesome cough, repeated chest infections, prolonged diarrhoea, poor weight gain, liver dysfunction, prone to osteoporosis, diabetes symptoms, reduced fertility in males

Answer 128

- physio; help remove mucous secretions from lungs - medication; respiratory: bronchodilators to open airways, antibiotics to reduce chest infection frequency, steroids to reduce airway inflammation, DNase to breakdown mucous & digestive system; pancreatic enzyme replacement, nutritional supplements - exercise; necessary to keep lung functional optimal & build physical bulk & strength - transplantation; not a cure but can be used in end stage lung disease, 70% survival up to 2yrs, longest survival 12yrs

Answer 129

1. delayed dental development 2. enamel opacities 3. increased calculus 4. cannot have GA due to pulmonary involvement 5. increased bleeding if liver is impaired 6. tetracycline staining

Answer 130

origin = zygomatic arch insertion = lateral surface of angle of mandible action = elevates mandible testing = clench teeth together nerve supply = masseteric branch of mandibular division of trigeminal nerve

Answer 131

origin = floor of temporal fossa insertion = coronoid process & anterior border of ramus action = elevates & retracts mandible testing = clench teeth together & palpate nerve supply = deep temporal nerve branches of mandibular division of trigeminal nerve

Answer 132

origin = lateral surface of lateral pterygoid plate insertion = anterior border of condyle and intra articular disc via 2 independent heads: 1. inferior belly of lateral pterygoid attaches to the head of the condyle 2. superior belly inserts into the intra articular disc action = protrudes & laterally deviates the mandible & inferior head functions with the mandibular depressors during opening testing = cannot test through intra/extra oral exam but can examine response to resisted movement nerve supply = nerve to lateral pterygoid branch of mandibular division of trigeminal

Answer 133

origin = deep head to medial surface of lateral pterygoid plate & superficial head to tuberosity of maxilla insertion = medial surface of angle of mandible action = elevates & assists in protrusion of mandible testing = cannot test through IO/EO exam nerve supply = nerve to medial pterygoid of mandibular division of trigeminal nerve

Answer 134

1. primary endodontic - non vital tooth, local periodontitis only present 2. endodontic lesion with periodontal involvement - if suppurating primary endodontic disease remains untreated it may become secondarily involved with periodontal breakdown: - plaque forms at gingival margin on sinus tract & leads to plaque induced perio in that area - when plaque / calculus is detected the tx & prognosis of tooth are different than those teeth involved with only primary endo as both perio & endo tx required - chronic drainage via gingival sulcus will result in root surface being contaminated by plaque & epithelial down growth where endo therapy will not result in complete regeneration of attachment

Answer 135

dental pain sharp in character & of short duration, arising from exposed dentine surfaces in response to a stimuli i.e. thermal, tactile, osmotic, chemical, electrical and which cannot be ascribed to any other dental disease. porous enamel / exposed dentine facilitates fluid flow within dentinal tubules to activate A-delta nerve fibres known as the hydrodynamic theory which elicits responses felt by ptx

Answer 136

inflammation that should resolve following appropriate management of aetiology i.e. no RCT causes - exposed dentine (hypersensitivity), caries, deep restorations radiography - no significant changes in periapical region of suspected tooth symptoms - discomfort is experience when a stimulus is applied lasting only a few seconds, pain not spontaneous, pain to cold; lasts a short time, no change in blood flow, hydrodynamic expression; microleakage from a-delta fibres

Answer 137

characterised by destruction of junctional epithelium & CT attachment of tooth together with bone destruction & formation of periodontal pockets, the disease progresses slowly & amount of bone loss tends to reflect the age of the patient over time. generalised affects >30% of teeth

Answer 138

same as chronic but affects <30%

Answer 139

severe condition usually found in younger cohort which may be associated with a family history of aggressive perio; disease progression is rapid with severe destruction of CT attachment & bone considering age of ptx, plaque levels may be inconsistent with level of disease seen

Answer 140

1. primary periodontal - generalised periodontitis present, minimally unrestored tooth, usually non vital, combined perio-endo lesion occurs when ptx has not only clinical LoA but also necrotic or partially necrotic pulp 2. perio lesion with endo involvement - apical progression of perio pocket may continue until apical tissues involved so pulp can become necrotic as a result of infection entering via lateral canals or apical foramen. this results in plaque colonisation of external root surfaces which has limited effect on a normal healthy pulp but pulp necrosis may occur when the perio disease has extended to involved the apical foramen. if blood supply circulating through the apex is intact, the pulp has good prospects of survival; pulpal changes resulting from perio disease are more likely to occur when apical foramen is involved & in these cases, bacteria originating from the perio pocket are the most likely source of root canal infection

Answer 141

does not cause perio, causes tooth mobility which is progressively increasing, tooth mobility with associated symptoms & radiographic evidence of an increased PDL width; in combination with plaque induced inflammation this may exacerbate LoA; tx: - control plaque induced inflammation - correction of occlusal relations - splinting of teeth when; mobility is due to advanced LoA, when mobiltiy causing discomfort / difficulty when chewing, when teeth need stabilised for debridement

Answer 142

usually formed when an endo lesion progresses coronally & joins with an infected periodontal pocket progressing apically meaning the tooth will be non vital & periodontitis will likely be detected in other areas of mouth with clear periapical & alveolar bone loss; it is the coalescence of independently rising endo & perio lesions on the same tooth

Answer 143

localised acute exacerbation of pre-existing pocket (chronic perio) caused by trauma to pocket epithelium or obstruction to pocket entrance symptoms - pain on biting / constant pain o/e - swelling adjacent to periodontal pocket, tooth may be TTP, suppuration - discharge through sinus / pocket, more likely to have pain on lateral movement, more likely to have generalised horizontal bone loss tx - drainage via incision or via pocket with instrumentation to dilate, gentle sub-gingival debridement, hot saline mouthwash, XLA of teeth with poor prognosis, antibiotic use if systemic involvement & may prevent rapid destruction of attachment (amoxicillin / metronidazole) follow up - HPT, surgery if required, maintenance

Answer 144

can be symptomatic / asymptomatic: SYMPTOMATIC: - represents inflammation usually of apical periodontium that extends beyond root canals, can cause resorption & LoA - may be painful response to biting, palpation or percussion - may be accompanied by radiographic changes such as periapical radiolucency - severe pain to percussion is indicative of degenerating pulp & RCT required ASYMPTOMATIC: - inflammation & destruction of apical periodontium of pulpal origin apical migration of junction epithelium - appears as apical radiolucency & does not present with clinical symptoms; no pain on percussion / palpation risk factors = plaque accumulation, diabetes, stress

Answer 145

1. mild = <30% root length i.e. coronal 1/3 2. moderate = 30-50% root length i.e. mid 1/3 3. severe = >50% root length i.e. apical 1/3

Answer 146

primary endodontic lesion with 2ndary perio involvement; suppurating primary endo disease remains untreated, plaque forms at gingival margin of sinus tract and leads to plaque induced perio in this area

Answer 147

sinus tract - you can place gutta percha cone 25-30mm and pass it into sinus tract which allows it to follow to the point of origin of the endodontic lesion

Answer 148

occlusal trauma as it does not cause periodontitis, it causes tooth mobility which is progressively increasing, associated symptoms & radiographic evidence of increased PDL width which in combination with plaque induced inflammation may exacerbate LoA

Answer 149

tx - control plaque induced inflammation correction of occlusal relations splinting of teeth when: - mobility is due to advanced LoA - when mobility is causing discomfort / difficulty when chewing - when teeth need stabilised for debridement

Answer 150

generalised chronic gingivitis: - plaque & gingivitis charting - OHI - removal of supragingival plaque, calculus & staining - removal of sub-gingival plaque & calculus - correction of restoration margins - full periodontal 6PPC of all teeth - RSD where necessary - take radiographs of affected areas - re-evaluation

Answer 151

symptomatic irreversible pulpitis; pulpectomy then RCT / XLA required, antibiotics / analgesics usually have no effect

Answer 152

1. jaw reg 2. occlusal rims - setting upper teeth to wax rim & set lower to uppers in RCP

Answer 153

FWS = RVD-OVD which is ideally around 2-4mm if FWS is negative / reduced due to increase in OVD it will cause the dentures to click if teeth contact during speech there is not enough inter-occlusal space which means the OVD needs reduced to give more FWS

Answer 154

using standard infection control precautions (SICPs) are the basic infection prevention & control measures necessary to reduce the risk of transmission of infectious agents from both recognised & unrecognised sources of infection

Answer 155

1. patient placement / assessment for infection risk 2. hand hygiene 3. respiratory & cough hygiene 4. PPE 5. safe management of care equipment 6. safe management of care environment 7. safe management of linen 8. safe management of blood & bodily fluid spillages 9. safe disposal of waste inc sharps 10. occupational safety; prevention & exposure management inc sharps

Answer 156

actichlor plus (sodium hypochlorite) - 10,000ppm for 3-5mins

Answer 157

1. infectious agent (bacteria, viruses, fungi, parasites) 2. reservoir (dirty surfaces & equipment, people, animals) 3. portal of exit (open wounds, skin, aerosols, splatter of fluids) 4. mode of transmission (contact, ingestion, inhalation) 5. portal of entry (broken skin/incisions, mucous membranes) 6. susceptible host (elderly, immunocompromised more likely)

Answer 158

chain is broken at the reservoir where there dirty contaminated forceps should break the chain by cleaning, disinfecting & sterilising instrument prior to use

Answer 159

cochrane reviews which are systematic assessments of all the relevant randomised controlled trials (RCTs) which give the highest level of evidence

Answer 160

1. randomisation reduces bias & and be double blind studies 2. gold standard for comparing the effectiveness of one treatment to another 3. control group comparability to no treatment

Answer 161

1. when confidence limit does not overlap 1 - statistically significant 2. if P value is less than 0.05 - statistically significant

Answer 162

it is the ratio of incidence in exposed groups to incidence rates in non exposed groups it is the measurement of proportionate increase in disease rates of exposed groups it makes allowance for frequency of disease amongst people not exposed to harmful agents

Answer 163

1. cohort studies - prospective studies which recruit groups of people who have no manifested the disease at time of recruitment & assess risk factors, individuals in this study are observed over a period of time to measure frequency of occurrence of disease among people exposed to risk factors & people not exposed to risk factor 2. case control study - a retrospective study which compares individuals with disease (cases) to those without disease (controls) and then you trace back to assess risk factor through past histories & exposure to suspected harmful agents compared, these are less robust than cohort studies but they may be used for preliminary investigations of hypothesis followed by cohort if possible, controls should be random sample of population from which cases are selected

Answer 164

randomised double blind placebo controlled study to investigate dimethyl fumarate (tecfidera) on annual relapserate, progression of disability & MRI findings in RRMS ptx. features: 1. randomised double blind reducing bias of results which meant ptx were unaware of which treatment they were receiving & were randomly selected into the 2 groups 2. compares one tx over placebo to investigate it there is any statistically significant results from use of tecfidera 3. randomisation of these studies facilitates statistical analysis 4. follow up over 2 years which will give increased results for analysing 5. rely on volunteers and would want large volunteer group who haven't' been on any prior DMDs to carry out one of the key features: making a key eligibility criterion to ensure there is a large volunteer group who have RRMS but haven't been on previous DMDs = - age group 18-55 - diagnosis of RRMS by McDonald Criteria - baselines score of 0-5 on expanded disability status scale (EDSS) - no previous DMD tx for RRMS - radiographic evidence of relapse in last year

Answer 165

dental - teeth erupted, absence of crowding / spacing, good alignment, incisors of average inclination, Cs & Ds may be mobile or exfoliated, may have midline diastema with distally tipped central & lateral incisors as normal development feature due to position of upper Es relative to 3s roots = ugly duckling stage, canines palpable buccally, tooth wear on deciduous teeth occlusal - incisors class I = normal to have OJ & OB, molars tend to be slight class II due to relatively large size of lower Es, there should be no cross bite

Answer 166

- painful swelling of mandible - renal stones - bone pain elsewhere - polydipsia / polyuria - peptic ulceration pain

Answer 167

1. generalised osteoporosis 2. loss of lamina dura 3. sub-periosteal resorption in fingers & resorption in terminal phalanges 4. multiple bone cysts

Answer 168

1. calcium raised 2. phosphate & alkaline phosphatase may be raised 3. hypercalciuria (calcium in urine) 4. parathyroid hormone (PTH) raised 5. vit D levels reduced

Answer 169

1. irreversible renal damage 2. pathological features

Answer 170

1. parathyroidectomy 2. vit D supplementation

Answer 171

a) possibly myocardial infarction b) priority is to transfer ptx to hospital as an emergency, give 300mg crushed aspirin, reassure ptx & loosen any tight clothing, call ambulance, initiate BLS using 100% oxygen at 15L/min, use of defibrillator until ambulance arrives if in cardiac arrest begins

Answer 172

30 compressions to 2 rescue breaths using bag valve mask until ambulance arrives while using both CPR & defib if ptx has shockable rhythm ( ventricular fibrillation & pulseless ventricular tachycardia)

Answer 173

1. adrenaline IM injections (1:1000, 1mg/ml) 2. aspirin dispersible (300mg) 3. glucagon IM injection (1mg) 4. glyceryl trinitrate GTN spray (400ug/dose) 5. midazolam IM injection (5mg/ml, 2ml ampoules)

Answer 174

1. oxygen cylinder with bag valve mask 2. single use sterile needles 3. automated external defib (AED) 4. portable powered suction machine with appropriate suction tips & tubing 5. oro-pharyngeal airways adjuvants for adults & children

Answer 175

1. dental trauma 2. periodontitis causing LoA 3. malocclusions 4. inflammation of tissues supporting teeth e.g. periapical abscess

Answer 176

splint teeth when: - mobility due to advanced LoA - mobility is causing discomfort / difficulty chewing - teeth need stabilised for debridement when trauma has occurred & requires stabilisation & correct of occlusal relations to prevent pain / loss of tooth etc when tooth has periapical pathologies & possible pulpal involvement it may require RCT/XLA

Answer 177

mobility can increase after successful HPT as all calculus deposits that may have been giving tooth some support would now be removed also due to advanced perio there would already be evidence of tooth mobility with obvious radiographic bone loss which cannot be replenished even after HPT

Answer 178

- best option due to horizontal bone loss present would be XLA with immediate partial denture fitted then possibility of bridge after 6mths once XLA sockets have healed - it ptx is adamant they won't have teeth removed then carry out HPT steps & possibly splint teeth to prevent discomfort & difficulty eating but over time this will fail & if oral hygiene is not kept up to standard the bone loss will progress & eventually teeth would fall out on their own - ptx needs to be made aware that they don't want to end up in pain & is any periapical / periodontal pathologies arise then it wouldn't be beneficial to RCT & would need XLA

Answer 179

- wide based incision for circulation - use of scalpel in 1 firm continuous stroke with no sharp angles - adequate sized flap as large flaps heal just as quickly as smaller ones - flap reflection should be down to bone & done cleanly to minimise trauma to dental papilla - should be no crushing of tissues & keep tissues moist - ensure flap margins & sutures will lie on bone - make sure wounds are not closed under tension - aim for healing by primary intention to minimise scarring

Answer 180

1. type of surgery being carried out i.e. retrieval of # roots, surgical XLA, apical lesions, periradicular surgery, OAC/OAF, apex removal 2. proximity of important structures such as nerves & muscles - lingual nerve can be damaged during surgical removal of lower 3rd molars 3. area of mouth - design can be influenced if area of aesthetics, if there is a narrow ridge bone augmentation may be required so wide flap designs should be utilised

Answer 181

use of electric straight handpiece with a saline cooled bur: - round or fissure tungsten carbide bur should be used - air driven hand piece may lead to surgical emphysema so use electric

Answer 182

1. physical debridement - bone file / handpieces used to remove sharp bony edges, Mitchell's trimmer / Victoria curette used to remove soft tissue debris 2. irrigation - sterile saline / water put into socket & under flap to flush out any debris 3. suction - aspirate under flap to remove debris, check socket for retained apices etc

Answer 183

1. FBC - haematology 2. coagulation screen - prothrombin time (PT), partial thromboplastin time (PTT), activated partial thromboplastin time (APTT), APTT ratio, INR, fibrinogen 3. thrombophilia & haemophilia factor screen

Answer 184

thrombocytopenia - condition characterised by abnormally low levels of thrombocytes (platelets) in blood; diagnosed when below normal lower limit of 150x10 to 9/L

Answer 185

all techniques except lingual infiltrations & IDB

Answer 186

INR = 1 ; level of coagulation equivalent to an average person not on warfarin but INR > 1 indicates long clotting time and so longer bleeding time. these should be checked 72hrs prior to oral surgery INR < 4 = allows for tx to occur without interrupting anti coag medicine, safest between 1.5-2.5

Answer 187

infiltrations (except lingual), intraligamentary or mental nerve blocks are best used if no alternative & IDB needs to be used, the injection should be administered slowly using aspirating technique

Answer 188

1. rigid waste bin containers with suppressant & screw top lids to prevent mercury vapour from seeping into atmosphere 2. clearly labelled with amalgam & have a red lid & white body to easily differentiate from other bin types for waste which are usually yellow bodied

Answer 189

the consignment note which should be kept for at least 3 years

Answer 190

1. pseudomembranous i.e. thrush 2. erythematous i.e. atrophic (HIV related), denture related, candida leucoplakia 3. hyperplastic i.e. angular cheilitis

Answer 191

1. systemic oral azoles - fluconazole, miconazole, itraconazole 2. topical polyenes & echinocandins - nystatin (polyene), caspofungin (echinocandin) these are active & resistance is rare

Answer 192

Azole mode of action (Fluconazole, Miconazole): — Azoles mechanism of action is the inhibition of cytochrome P450- dependent enzymes (particularly 14ademethylase) which is involved in the biosynthesis of ergosterol, which is required for fungal cell membrane structure and function. — Ensure that Miconazole is not prescribes for patients taking warfarin or statins - Polyene mode of action (Nystatin): — These interact with fungal membrane sterols physiochemically. They bind to ergosterol in the fungal cell membrane which weakens it, causing leakage of potassium and sodium ions which may contribute to fungal cell death. - Echinocandin (Caspofungin): — New class of antifungal drugs that inhibit the synthesis of glucan in the cell wall, via non-competitive inhibition of the enzyme 1,3-Beta-glucan synthase which the yeast requires to survive

Answer 193

1. azole resistance: - decreased drug conc; The development of active efflux pumps results in decreased drug concentrations at the site of action. Efflux pumps encoded in candida species become overexpressed and upregulated especially MDR1 in azole resistant candida albicans - target site alteration; It had been found that mutations in ERG11 which encodes the target enzyme lanosterol C12-alpha-demethylase prevents binding of azoles to the enzymatic site. 2. polyene resistance - Polyene resistant candida isolates have relatively low ergosterol content which is thought to be due to a defect in the ERG3 gene involved in ergosterol biosynthesis 3. enchocandin resistance - In candida sp, secondary resistance is associated with point mutations in the Fks1 gene of the beta-1,3-Dglucan synthase complex

Answer 194

candida glabrata This is a non-dimorphic species of yeast as no mating is observed compared to C. albicans which is dimorphic — Highly opportunistic pathogen in the urogenital tract and bloodstream of immunocompromised patients where as C. albicans is part of the normal human gut flora. — Nystatin is the first line treatment for C. Glabrata infections whereas fluconazole is generally used in C. albicans infections

Answer 195

- age of child as they must be 6+ - check if they are on any other fluoride supplements - ensure ptx has ability to spit & not swallow

Answer 196

Conventional: — Used when there is sufficient tooth crown tissue left to place a conventional crown on top — Much stronger type of crown as no preparation is required of the root canals for a post - Post and core: — Used when there is significant loss of crown tooth tissue so a core is used t gain intraradicular support for a definitive coronal restoration such as retention for a crown and the post then retains the core holding onto the coronal restoration — Root canal preparations for a post will weaken the tooth

Answer 197

will retain core by holding on to coronal restoration

Answer 198

post - metals (gold, SS, brass, titanium), ceramics (alumina or zirconia), fibre (glass, quartz, carbon) core - composite, amalgam, GI

Answer 199

1. customs posts - cast directly from pattern fabricated in a patient's mouth as an impression of the pot hole & wax up of post in lab occurs 2. post placement - 4-5mm of root filling should be left apically which should be known from CWL and post takes up rest of canal 3. sufficient alveolar bone support - at least 1/2 of post length must go into root, maximum of 1;1 post length / crown height ratio

Answer 200

narrow - risk of perforation dur to thin / tapering & narrow roots wide - requires further prep which weakens tooth general issues - perforations, core fractures, root fractures or cracks, post fracture, post removal required which is difficult as significant pressure has to be applied

Answer 201

Narrows the arteries and increases atherosclerosis - Increased risk of stroke - Increased chest infections, COPD, bronchitis, emphysema and lung cancer - Increased stomach ulcers and stomach cancer - Increased risk of CHD and heart attacks - Can cause macular degeneration and peripheral vascular disease

Answer 202

Increased risk of oral cancer (2-4x higher risk) - Increase in periodontal disease, alveolar bone loss, attachment loss and pocket formation - Increased risk of dry socket after dental extractions - Bad breath (halitosis) and xerostomia - Staining of teeth and restorations - Black hair tongue and nicotine stomatitis

Answer 203

- Age of purchase increasing from 16 to 18 - Plain packaging of tobacco with health warnings on the packet which are no longer visibly on sale - Vending machines stopped selling cigarettes - Public smoking ban in 2006

Answer 204

- 5As (brief cessation): — Ask your patient — Advise your patient — Assess your patient — Assist your patient — Arrange a follow up for your patient - Alternative model - Ask advice and refer (2As and 1R): — Ask your patient about smoking — Advise your patient about smoking — Refer to stop smoking services which varies locally with group therapy or one-to-one - ABC (brief); — Ask your patient about smoking — Brief advice to quit given to your patient — Cessation support for those who want to quit - SCAPE 30 second approach (very brief): — Smoking Cessation Action in Primary carE

Answer 205

Incisal surface: i. What is the margin design and reductions? - 1.5-2mm reduction to accommodate porcelain and metal b. Labial surface: i. What is the margin design and reductions? - 1-1.5mm reduction extending into gingival sulcus - Labial shoulder used ii. What are the benefits of the margin design? - Rounds the angles and allows for resistance and retention for the crown - Technique preserves tooth surface which avoids weakening the tooth structure and damaging the pulp c. Palatal surface: i. What is the margin design and reduction? - 1-1.5mm reduction following contour of incisor tooth - Palatal chamfer used (palatal chamfer for all ceramic crown) ii. What are the benefits of the margin design? - Rounds the angles and allows for resistance and retention for the crown - Technique preserves tooth surface which avoids weakening the tooth structure and daring the pulp. - It also keep marginal integrity to accommodate a robust margin with close adaption to minimise microleakage

Answer 206

- Sectional impression technique: — Addition cured silicone putty (president): i. Can be disinfected and kept by the patient or clinic and can be re-used which is very beneficial if the crown is ever lost or broken. ii. Resistant to tearing when removing from undercut areas. — Alginate: i. Cheaper to use but cannot be kept or reused ii. Elastic material so flows into undercuts iii. Usually used for diagnostic wax-ups — Softened modelling wax: i. Easy to adjust and smooth and is cheap to use ii. It is unsuitable for deep undercuts as it distorts and cannot be reduced

Answer 207

- Alginate use for special trays should have 3mm spacer - Silicone/polyether use for special trays should have 2mm for upper and 0.5-1mm spacers for lowers - Upper trays should have stops to the space prescribed in the canine and post dam regions which will allow accurate correction of the posterior borders of the tray and will perform space for the impression material. - Lower trays should have stops to the space prescribed on the retro-molar pad and on the ridge in the canine areas. This will allow preformed space for the impression material

Answer 208

- Usually alginate is used as it is an elastic materials so flows into undercut areas. It gives an accurate record of surface detail for impressions and is cheap and easy to use.

Answer 209

Silicone is dimensionally stable and is hydrophobic so can cause small defects and blows. It is generally only used for master impressions and not for the production of special trays as it is very messy and technique sensitive

Answer 210

hard palate & residual ridge

Answer 211

- Retro-molar pad - Muscles that lie next to it are: — Laterally buccinator — Posteriorly temporalis tendon — Medically superior constrictor and the pterygomandibular raphe

Answer 212

It can interfere with the location of the occlusal plane and reduce the space available for the denture in the retro-molar pad region.

Answer 213

- Infectious agent - Reservoirs - Portal of exit - Means of transmission - Portal of entry - Susceptible host

Answer 214

Break at portal of exit: — Ensuring hand hygiene is always performed — PPE is worn — Respiratory etiquette — Control of aerosols and splatter - Break at mode of transmission: — Ensuring hand hygiene is always performed — PPE is worm — Food safety — Isolation of personals affected — Cleaning, disinfection and sterilisation

Answer 215

- There should be a good peripheral seal - Should have adequate surface detail recorded - Complete reproduction of prepared margins without voids present - No air blows present or distortion - No tears when removing if there are undercuts present

Answer 216

- Impression becomes distorted: — not dimensionally accurate or stable — Alginate too stiff so the impression has lumpy appearance — Alginate tearing away from the tray - Insufficient depth in the lingual, labial or buccal sulcus: — due to lack of Impression material — Using low pressure to seat the tray — Material is too cold and can’t flow - Incomplete reproduction of preparation margins: — Insufficient retraction used — Blood and saliva present around the presentation which should have been cleaned — Working time exceeded, flowability becomes impaired - Void on the margins: — Blood and saliva contamination around preparation — Improper syringe technique — Working time exceeded, flowability becomes impaired — Air bubble in elastomer syringe — Tray not seated properly

Answer 217

- Rinse under the tap to remove gross debris and saliva - Place in perform for 10 minutes then re-rinse and place in bag covered in a wet paper towel to prevent the impression from drying out - Fill out lab prescription ensuring it has been ticked that it has been disinfected and send to lab - Perform contains: — Potassium periximono sulphate — Sodium benzate — Tartanic acid — An ionic surfactants — Non-ionic surfactants — Soap and phosphanate

Answer 218

- The saggital condylar guidance angle - The inclination of the occlusal plane - Compensating curves - The cusp height - The Incisal guidance angle

Answer 219

- It has bactericidal and bacteriostatic properties - It has a high pH making it alkaline which: — stimulates fibroblasts for reparative dentine formation — Stimulates recalcification of demineralised dentine by stimulating pulpal cells — Neutralises low pH from acidic restorative materials - They adhere directly to the dentine rather than the restorative material - It is thin which means it won’t reduce the strength of the restorative material - It won’t dissolve in biological liquids

Answer 220

1. inhibits bacterial growth 2. can be easily removed 3. seals canals laterally & apically

Answer 221

- Exhibits tackiness to provide good adhesion - Establishes a hermetic seal - Radiopacity - No shrinkage on setting - Non-staining - Bacteriostatic - Slow setting - Insoluble in tissue fluids - Tissue tolerant - Soluble on re-treatment - Easily mixed

Answer 222

- 20% gutta percha - 65% zinc oxide - 10% radio-pacifiers - 5% plasticisers

Answer 223

- Sensitivity: — Common in 60% of patients — Worse initially then resolves over 2-3 days post bleaching - Wears off-relapse: — Oxidised chromosomes gradually reduce with time — Retreatment required every 1-3 years - Cytotoxicity/multiagency: — High concentration of hydrogen peroxide causes problems — No evidence for 10% carbamine peroxide - Gingival irritation: — Related to concentration used – worse with higher concentrations — Must check tray extension is correct - Problems with binding to teeth: — Residual oxygen from the peroxide remains within the enamel structure initially but gradually dissipates over a short time — Restorative procedures should be delayed for at least 24 hours-1 week post bleaching

Answer 224

- Pre-existing sensitivity - High concentration of bleaching agent used - Frequency of use - Bleaching method – less likely at home than in office - Gingival recession

Answer 225

- Capacity means the ability to use and understand information to make an informed decision, and communicate any decision made. - A person lacks capacity if their mind is impaired or disturbed in some way and this mans the person is unable to make a decision at that point in Time 1. adults with incapacity act (scotland) 2000 2. mental capacity act (england & wales) 2005

Answer 226

- Bradykinesia – slow movement - Rigidity - Resting tremor - Postural instability - Gradual symptom progression - Mask like face

Answer 227

- Parkinson’s typically presents with intention tremors and Parkinsonism tremor at rest: — Intention tremor is present when tremor amplitude increases during visually guided movements towards a target at the termination of movement - Ataxia Cerebral palsy typically presents with action intentional tremors which is especially apparent when carrying out precise movements.

Answer 228

Medications and polypharmacy: — Tricyclics antidepressants – amitriptyline — Anti-psychotics – phenothiazine — Benzodiazepines – diazepam — Anti-cholinergic – atropine — Beta blockers – atenolol — Antihistamines – cetirizine - Medical treatments: — Radiotherapy and chemotherapy - Medical conditions: — Parkinson’s disease — Rheumatoid arthritis — Undiagnosed diabetes — Sjorgen’s syndrome — Neurological disorders — Cystic fibrosis

Answer 229

- Stimulation of salivary glands: — With chewing sugar free gum/sweets - Supplementation or provide a substitute for saliva: — Oral lubricants - Management: — Taking frequent sips of water — Moisten food when eating with water or sauces — Avoid mouthwashes that contain alcohol — Suck on ice chips/cubes — Avoid dry hard food — Avoid drinks containing alcohol or caffeine

Answer 230

- Speed of beam through the teeth and image receptor through the beam must be synchronised to produce an accurate image - Patients canine behind the canine guide line which means it is closer to the x-ray source than the machine expects. This causes the speed of the beam to be slower through the teeth as it is closer to the rotation centre. If not compensated, the image receptor will be too fast and the image will be magnified horizontally. - Patients canine in front of the canine guide line means it is further from the x-ray source than the machine expects. This causes the speed of the beam to be faster through the teeth as it is further from the rotation centre. If not compensated the image receptor will be too slow and the image of teeth will be reduced in width horizontally.

Answer 231

1. supernumerary tooth 2. dilaceration caused by trauma

Answer 232

- Surgical exposure - Removal of supernumerary if there is one present - Binding using gold chain - Orthodontic traction used if over age of 9 - Fixed appliance use - Bonded retainer

Answer 233

- Improve function: — Anterior cross bite or anterior open bite CNS make it difficult to incise food - To facilitate other dental treatment: — Rearrange spaces in hypodontia cases prior to bridges or implants - Improve appearance and aesthetics - Improve dental health as the teeth become more easy to clean - Reduce risk of trauma

Answer 234

- Bitewings: — For small proximal cavities, monitoring, occult caries, furcation pathology and restoration margin integrity - OPT: — For poor cooperating children and when caries is more than minimal — Delayed development cases - Maxillary occlusal: — trauma cases - Periapicals: — Trauma, periapical pathologies, fracture etc.

Answer 235

- Restoration sequences: — Fluoride varnish — Fissure sealants — Preventative restorations (GI) — Simple fillings e.g. shallow cervical cavities — Restorations requiring LA but not into the pulp — Pulpotomy (upper arch first) — Extractions under LA or GA - Preventative programme: — Radiographs — Tooth brushing instruction — Strength of fluoride in toothpaste advice — Fluoride varnish — Fluoride supplementation — Diet advice — Fissure sealants — Sugar free medication

Answer 236

- The aim of HPT is to: — Arrest the disease process — Regenerate lost tissue — Maintain periodontal health long term — Prevent extractions — Preservation of functional dentition for life - HPT allows evaluation of the patients motivation and plaque control while improving soft tissue consistent for easier surgical management. - Some Deep pockets that may be present can heal after HPT meaning surgical intervention may not be required. - It is essential to carry out HPT prior to surgical procedures to ensure that the patient can maintain good oral hygiene as any surgical or restorative treatments carried out before HPT would have a greater risk of failure when oral hygiene is poor

Answer 237

- The indications for periodontal surgery are: — At re-evaluation at least 4-6 weeks after completion of non-surgical phase is there is pockets of 5mm or greater that exist in the presence of excellent oral hygiene. - The aims of periodontal surgery are: — To arrest the disease by gaining access to complete root surface debridement and to regenerate lost periodontal tissues.

Answer 238

- Re-evaluation at 4-6 as you don’t want to be probing tissues that are in the process of healing and repairing - Sutures may be required to be removed after 1 week

Answer 239

- Poor oral hygiene with persistent inflammation: — Supportive care or repeat cause related therapies - Good oral hygiene with inflammation resolved: — Supportive care and proceed with treatment plan - Good oral hygiene with persistent deep pockets with bleeding on probing: — Surgical access or repeat SRP, then re-evaluate

Answer 240

localised / alveolar osteitis it is inflammation affecting the lamina dura which causes dry socket; this is when the blood clot at the site of XLA has failed to develop / dislodges / dissolves before the wound has fully healed; usually isn't associated with infection

Answer 241

Affects 2-3% of all extractions - 20-35% of lower 8 extractions - Predisposing factors: — Molars are more common – risk is increased from anterior to posterior — Mandible is more common than maxilla — Smoking increases risk due to reduced blood supply — More common in females than in males — Oral contraceptive pill can increase risk — Excessive trauma during extraction procedure — Excessive mouth rinsing post extraction which washes the clot away — Family history of previous dry sockets

Answer 242

- Signs: — Often begins 3-4days after extraction and can take 7-14 days to resolve — No blood clot present in the extraction socket - Symptoms: — Moderate to severe dull aching pain — Pain that keeps the patient awake at night — Pain that throbs and can radiate to the patients ear — Exposed bone is sensitive and is the source of pain — Characteristic smell/bad odour (halitosis) with patient complaining of bad taste

Answer 243

- Supportive: — Reassurance and use systemic preemptive analgesia — Give the patient information on dry sockets - Can give LA block to relive severe pain - Irrigate the socket with warm saline to wash put food and debris - Curettage/debridement: — Encourage bleeding and new clot formation - Use whiteshead varnish pack (WHVP) or Alvogyl: — WHVP is ribbon gauze socked in WHVP often sutured into the pocket which will need removed — Alvogyl is a mixture of LA and antiseptic (ensure patient doesn’t have an iodine allergy) - Advise patient on analgesia and hot salty mouthwashes or chlorhexidine use

Answer 244

Degassing must occur, if we leave added oxygen/air in the water this inhibits cavitation and a different bubble is formed with less intensity — Without degassing the cleaner would be less effective

Answer 245

Always run an air purge (degassing) cycle after filling the ultrasonic in the morning to remove air and oxygen from water before cleaning

Answer 246

Sterilised: — When something has went through a process of becoming free from bacteria and all other living microorganisms. - Sterile: — An object that is free from all microorganisms

Answer 247

Difficulty of access due to: — Trismus – limited mouth opening — Reduced aperture of the mouth — Crowded and malpositioned teeth - Abnormal resistance: — Thick cortical bone — Shape/form of roots – divergent/hooked roots — Number of roots — Hypercementosis — Ankylosis - Fractures: — Teeth fractures of crown and/or root — Alveolar/tuberosity — Jaw fractures — Alveolar plate - Root problems: — Fused — Convergent/divergent roots — Extra roots — Morphology of the roots different — Hypercementosis — Ankylosis - Involvement of the maxillary antrum: — Oro-antral fistula/communication (OAC/OAF) — Loss of root into antrum — Fractured tuberosity - Loss of tooth - Soft tissue damage - Damage to nerves and vessels: — Crushing injuries — Cutting/shredding injuries — Transaction — Damage from surgery or damage from LA - Haemorrhage: — Due to damage of veins (bleeding), arteries (spurting, haemorrhaging), arterioles (spurting/pulsating bleed) - Dislocation of TMJ - Damage to adjacent teeth and restorations: — Hitting opposing teeth with forceps — Cracking/fracturing or moving adjacent teeth with elevators — Cracking/fracturing/removing restorations, crown, bridges on adjacent teeth - Extractions of permanent tooth germ: — When removing deciduous molars there can be damage or extraction of the developing permanent premolars - Wrong tooth extracted

Answer 248

- The mental foramen is located on the anterior surface of the mandible. It transmits the terminal branches of the interior alveolar nerve and mental artery. - It is located roughly between the 1st and 2nd premolars on the mandible - It provides sensory innervation to the buccal soft tissue anterior to the mental foramen, lip and the chin and the anterior teeth on that side of the arch

Answer 249

1. triangular 3 sided flap for retained single roots 2. envelope 2 sided flap for retained 2 rooted teeth 3. semilunar 1 sided flap used for periapical involvement

Answer 250

Types 1 diabetes mellitus: — Results from the pancreas’s failure to produce enough insulin due to the loss of insulin producing beta cells of the islets of Langerhans which leads to insulin deficiency. — Most commonly associated with juvenile onset - Type 2 diabetes mellitus: — Condition that begins with insulin resistance where the pancreatic cells fail to respond to insulin properly. — Most commonly associated with excessive body weight and insufficient exercise - Gestational diabetes: — Occurs in pregnant women due who develop high blood sugar levels during pregnancy - Diabetes insipidus: — Is a condition characterised by large amounts of dilute urine and thrust due to lack of the hormone vasopressin (ADH) which dan be caused due to damage to the hypothalamus, pituitary gland or genetics.

Answer 251

Blood glucose levels: — Normal 3.5-5.5mmol/l; diabetic 4-7mmol/l before meals — Normal less than 8mmol/l; 5-9mmol 2 hours after meals - Urine testing - HbA1c 3 monthly: — Adults with diabetes target is below 4rmmol/l

Answer 252

Oncologist Surgeon/consultant - Radiotherapist (radiation oncologist) - Chemotherapist (medical oncologist) - Clinical nurse specialist - Radiologist - Others as indicated by the cancer type (gynaecologist; urologist) - GDP - Maxillofacial surgeon (oral cancer)

Answer 253

General tiredness - Burns – clothing/shaving/sunlight issues — May leave permanent pigmentation and telangiectasia (spider veins) - Hair loss in the treatment area - Dry mouth/taste loss if head and neck radiotherapy - Menopause induction in premenopausal women if in pelvic/abdominal area - Risk of osteoradionecrosis if head and neck involvement

Answer 254

- Rapidly diving cells are killed: — Hair loss — Oral ulceration — Bone marrow suppression – reduction in WBC and platelets - Damage to DNA of remaining cells: — Risk of lager cancers — Damage to fertility — Induction of menopause - Drug specific effects: — Taste loss/drug mouth — Nephrotoxicity can occur

Answer 255

- Gypsum plaster is calcium sulfate dihydrate which is used to cast a positive replica of an oral cavity. - Type 1 plaster/impression plaster is used in making primary impressions of edentulous oral cavity in complete denture fabrication. - Type III dental stone is an alpha form of calcium sulfate hemihydrate which is used to make master casts

Answer 256

- It is the inter relationship of 5 factors in order to maintain a balanced occlusion: — The saggital condylar guidance angle — The inclination of the occlusal plane — Compensating curves — The cusp height — The incisal guidance angle

Answer 257

Centre line, occlusal plane/central incisor plan, residual ridge contour, canine line and occlusal vertical dimension

Answer 258

Retention: — Mandible – retro-mylohyoid space — Maxilla – tuberosity, peripheral seal - Support: — Mandible - Retro-molar pad, residual ridge, buccal shelf — Maxilla – hard palate and residual ridge - Relief: — Bony prominences (tori), high frenal attachments

Answer 259

All metal restorations: — Precious gold or platinum — Non precious nickel, titanium and chromium - Metal-ceramic Restorations: — Porcelain fused to metal

Answer 260

A post retains the core holding onto the coronal restoration. Where the core gains intraradicular support for a definitive coronal restoration such as retention for a crown

Answer 261

Manufacture: — Preformed/prefabricated or custom made - Material: — Cast metal (Type IV gold/Au), steel, zirconia, carbon/glass fibre - Shape – parallel sided or tapered: — Parallel sided — Non threaded passive — Cement retained

Answer 262

Ferrule (dentine collar) which is an encirclement of 1-2mm of vertical axial tooth structure within walls of the crown which is present to prevent tooth fracture.

Answer 263

4-5mm of root filling should be left apocalyptic so that the apical foramen is sealed

Answer 264

Posts are used to retain the core holding into the coronal restoration - When more than ½ of a tooth’s original crown portion has been lost, a post is needed to assist with anchoring the core to the tooth

Answer 265

Non functional cusps = 2mm reduction - Functional cusps = 2.5mm reduction - Incisal = 2mm reduction - Shoulder/heavy chamfer = 1.2-1.3mm reduction - Between a 10-20o taper

Answer 266

- Horizontal: — Most common pattern which occurs when the path of inflammation is to the alveolar crest which is perpendicular to the tooth surface - Vertical: — Less common pattern which occurs when the pathway of inflammation travels directly into the PDL spaces and occurs intra-dentally.

Answer 267

- They will present higher due to vertical beam angulation of 8o - Be horizontally magnified - Usually further forward due to change in Antero-posterior position

Answer 268

- Use of rectangular collimating combined with a beam-aiming device and film holder which reduces x-ray dose by 30% - Reducing the area irradiated, and therefore volume irradiated will also reduce the number of scattered photons produced as well as reducing patients dose. - High tube kVp which produces higher energy photons meaning the photoelectric interactions and the contrast between different tissues is reduced, meaning the dose absorbed by the patient also reduces.

Answer 269

compton: — X-Ray photon Interacts with loosely bound outer shell electrons. The photon energy considerably greater than the electron binding energy. — The electron is ejected taking some of the photon energy as kinetic energy causing a recoil electron. This gives off an atom that is positively charged. — Following the collision the photon has lower energy so is called a scatter photon as it undergoes a change in direction: i. Forward direction – high energy ii. Backward direction – low energy photoelectric: — X-ray photon interacts with inner shell electron generally the k shell which has the highest energy. This photon has energy higher than the binding energy of the electron which makes the x-ray photon disappear. — The Difference in energy between the 2 levels is emitted as light and heat. — Most of the photon energy used to overcome binding energy of the electron remainder gives electron kinetic energy meaning the electron is ejected as a photoelectron. It results in complete absorption of photon energy meaning the photon does not reach the film and preventing any interaction with active component of the image receptor – images appear white if all photos are involved; grey is some are involved

Answer 270

- Lead is used to prevent leakage >7.5uSvh-1 - Lead film is for photoelectric absorption which absorbs scatter x-rays to prevent image degradation and its 2nd function is to absorb some of the primary beam.

Answer 271

- Zinc is used to prevent leakage >7.5uSvh-1 in shielding - Aluminium and zinc used for the final spectrum of X-ray energy filtration.

Answer 272

Triangular (3-sided) L shaped: — When removing a single root tooth retained root a triangular (l-shaped) 3-sided flap design should be utilised which will extend from the mesial aspect of the canine to the distal aspect of the 2nd premolar — Advantages: i. It ensures there is an adequate blood supply, satisfactory visualisation, very good stability and reapproximation ii. It is easily modified with a small releasing incision or additional vertical incision or when lengthening is required with a horizontal incision. — Disadvantages: i. Limited access to long roots and tension is created when the flap is held with a retractor which can cause defects in the attached gingivae

Answer 273

Extra-alveolar dry time (EADT): — The EADT is critical to survival of the PDL as the longer the EADT the more damage to the PDL which increases the amount of resorption that can be expected. — It is the time it takes from avulsion to placement in a storage medium — <30 mins better survival — >30 mins risk of alveolar/ligament death - Extra-alveolar time (EAT): — This is the total extra-alveolar time from avulsion to reimplantation which is an important indicator of potential damage to the PDL — Reports have found that teeth forming radiographically normal PDLs after being stored in milk for 2 hours prior to reimplantation

Answer 274

- Saliva (or in buccal sulcus) - Milk - Saline/water - Blood

Answer 275

- Ensure that the person holds the tooth by the crown of the tooth and not the root and run it under cold water for no more than 10seconds to clear any debris then reminder into the patients mouth and bite on tissue - If they cannot reimplantation the tooth place it in a storage medium such as Saliva, milk, saline.water) and seek immediate dental advice ASAP

Answer 276

flexible splint for 2 weeks

Answer 277

- High risk children under 10 – 1500ppm of fluoride toothpaste - Fluoride tablet supplementation – 0.5mg/day - Fluoride varnish at least 2x yearly – 22,600ppm

Answer 278

- Shimstock - 8um in thickness used with mosquito forceps - Articulating – 20um used with millers forceps

Answer 279

- Chlorhexidine is an antiseptic that has both bacteriostatic and bactericidal properties against bacteria, viruses and fungi. - Chlorhexidine has a dicatonic action: — Positively charged chlorhexidine molecule reacts with the negatively charged clean surface of micro grains s and damages the microbial cell envelope — When there is a low concentration of the bacterial membrane there will be increased permeability — When there is high concentration of the bacteria’s membrane there will be precipitation of the cytoplasm and resultant cell death which also inhibits absorption from the gut

Answer 280

- Headaches, nausea, vomiting, constipation. Dizziness, drowsiness trouble sleeping, nervousness - Gingival hyperplasia and bleeding gums

Answer 281

- Calcium channel blockers – amlodipine and nifedipine - Immunosuppressants – cyclosporine

Answer 282

- Plaque control, OHI, sub and super gingival scaling Regularly - Medical management where the consultant leading the treatment of the condition can possibly reduce the dose of the drug or use another drug which doesn’t have the side effect of gingival hyperplasia

Answer 283

metronidazole 400mg TID for 3 days for adults metronidazole 200-250mg TID for 12-18yr olds amoxicillin 500mg TID for 3 days if metronidazole is inappropriate

Answer 284

only if it hasn't gone away in a few days or if there is lymphadenopathy or systemic involvement

Answer 285

- Smoking increases periodontal disease by 2-6x fold. - It increases rates of alveolar bone loss, attachment loss and pocket formation but this may not be evident to the smoker as the smoking masks the signs of gingivitis usually associated with periodontitis which means the gums bleed less due to vasoconstriction properties of nicotine. - This means when patients stop smoking their gums will then bleed - Periodontal pathogens found in smokers are: — Tannerella forsythia — Prevotella intermedia — Treponema denticola

Answer 286

1. warfarin 2. clopidogrel

Answer 287

- Granular porosity: — Granular effect on the denture surface due to low powder liquid ratio. - Contraction porosity: — Appears as irregular voids throughout and on the surface of denture due to insufficient material and/or insufficient pressure - Gaseous porosity: — Shows fine uniform bubbles particularly in thicker regions - Localised porosity: — Improper mixing of components or early packing

Answer 288

1. orthognathic surgery 2. rhinoplasty 3. velopharyngeal surgery

Answer 289

- X-rays are produced when fast-moving electrons are brought rapidly to a stop - An electron is a negatively charged particle in an atom which conceptually sites itself in the orbits around the nucleus as stated by the Bohr model. - Process: — Source of the x-ray from the x-ray machine and the object is the teeth and jaws with the interaction of xrays with matter — Image receptor will be digital or film — Processing is the conversion of latent image to permanent visible image by computer technology or by chemical processing means

Answer 290

- We consider validation of decontamination equipment when we review if the practice is safe. This related to regulation15 (premises and equipment) and regulation 12 (safe care and treatment). - Maintain and servicing decontamination equipment appropriately is essential to ensure that equipment performs to an optimum standard. This should be done in accordance with the manufacturers instructions.

Answer 291

- This is known as a pericellular matrix, which is glycoproteins and glycolipids covering that provides a protected surrounding around the cell membranes of some bacteria, epithelial and other cells. - This allows the bacteria to evade the immune system cells more easily and can incorporate into biofilms. - Bacteria such as staphylococci sp., streptococcus sp., and pseudomonas sp

Answer 292

- Reduce carbohydrates in saliva by changing diet habits - Increase tooth resistance to acid attack by addition of fluoride - Reduce tooth susceptibility by fissure sealants - Reduce or eliminate carcinogenic micro-organisms by mechanical removal of the biofilm - Possibility of the use of inhibitors, probiotics, vaccinations and immunisation in the future

Answer 293

— Is the formation of dentine performed by odontoblasts which begins at the late bell stage of tooth development — The different stages of dentine formation after differentiation of the cell results in different types of dentine: i. Mantle dentine, primary dentine, secondary dentine and tertiary dentine

Answer 294

— This is the formation of enamel and begins when the crown is forming during the advanced bell stage of tooth development after dentinogenesis. — Although dentine must be present for enamel to be formed, ameloblasts must also be present for dentinogenesis to continue. — Message are sent from newly differentiated odontoblasts to the inner enamel epithelium (IEE) causing the epithelial fella to further differentiate into active secretory ameloblasts. — Stages: i. Pre-secretory stage ii. Secretory stage iii. Maturation stage

Answer 295

1. vasoconstriction 2. platelet aggregation forming platelet plug 3. formation of fibrin clot

Answer 296

rivaroxaban, Apixaban and Dabigatran: i. All new oral anticoagulants ii. Factor X inhibitors that inhibits conversion of prothrombin to thrombin stopping the producing of the fibrin clot iii. Short-life – effect rapidly lost iv. If it is a short course for DVT – postpone dental treatment until stopped especially extractions v. Dental drug interactions: 1. safe with all except macrolides such as erythromycin and clarithromycin 2. safe with antifungals – topical and fluconazole 3. safe with LA 4. safe with antivirals 5. NSAID will prolong action and inhibit platelets – AVOID

Answer 297

- Streptococcus mutans - Lactobacilli acidophilus - Actinomycetes viscosus - Nocardia sp.

Answer 298

- Streptococcus mutans - Lactobacilli acidophilus - Actinomycetes viscosus - Nocardia sp.

Answer 299

- Porphyromonas gingivalis - Actinobacillus actinomycetemcomitans - Prevotella intermedia - Bacteroides Forsythus

Answer 300

- Porphyromonas gingivalis: — Host cell adherence and invasion – fimbriae — Elaboration with proteases – collagenase, fibrinolysinl phospholipase A and ohosphotases — Endotoxins (LPS) — Capsular polysaccharide and outer membrane vesicles — Tissue toxic metabolic by products – hydrogen sulphide, ammonia and fatty acids - Actinobacillus actinomycetemcomatins: — Leukotoxins, cytotoxins, LPS, Fc binding proteins, membrane vesicles, glycoproteins matrix and fimbriae — It invaded host immune system through phase variation, subverting the host cell and immunity

Answer 301

- Biofilms can produce a penetration barrier of LPS which prevents antimicrobials and antibiotics from penetrating. - Biofilms also require mechanical disruption do alone medications will not work to remove them fully

Answer 302

recognises & responds to pathogens in similar way to adaptive but does not provide long lasting immunity to host: — Recruits immune cells to sites of infection through the production of chemical factors, including cytokines — Activation of the complement cascade to identify bacteria. Activate cells and promote clearance of antibody complexes or apoptosis cells — Identification and removal of foreign substances preset in organs, tissues, blood and lymph specialised by WBC subtypes such as macrophages — Activation of the adaptive immune system through a process known as antigen presentation — It also acts as a physical and chemical barrier to infectious agents

Answer 303

1. vasodilation; leads to increased blood flow causing redness & warmth (rubor & calor) 2. increased permeability; leads to exudation of protein rich fluid into extravascular space causing swelling (tumour) 3. loss of fluid from vessels leads to concentration of red cells resulting in decreased velocity & stasis of blood flow 4. leukocyte rolling, adhesion & migration leads to accumulation of inflammatory cells

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