1
Q
What does denture stomatitis look like
A
Erythema across denture bearing area
Oedema / Inflammation
2
Q
Treatment for denture stomatitis
A
Denture hygiene
Oral hygiene
Topical antifungal - Miconazole Oromucosal Gel 20mg/g > 4x daily pea-sized amount after food
3
Q
If first line treatment fails (denture stomatitis) what next
A
Remake denture
Systemic antifungal - fluconazole
4
Q
Lab prescription for special trays
A
Please pour up primary imps and create special trays
Non-perforated
Self-cure PMMA
Ensure muscle attachments are relieved
Standard handle
5
Q
What must a canal be before obturation
A
Asymptomatic (not TTP)
Dried
Full biomechanical cleaning to CWL
6
Q
Components of Gutta Percha
A
Zinc oxide - 65%
Gutta percha - 20%
Radiopacifiers - 10%
Plastisizers - 5%
7
Q
What does endo sealer do
A
Fills space between GP and canal
Fills voids
Provides tight seal
8
Q
Types of sealer
A
ZOE - zinc oxide eugenol
Non-setting CaOH
GI sealer
Resin based sealer
9
Q
Temporaries provided for crown prep, fracture at junction
A
Temp crown & post
Overdenture
Essix retainer with composite in place of tooth
10
Q
Material for post
A
Fibre
Metal
11
Q
Material for crown
A
Zirconia
Lithium disilicate (EMAX)
Ceramic
Gold
Composite
12
Q
What affects post length
A
4-5mm GP left apically to maintain seal
No more than 1/3 of roots narrowest width
13
Q
Differential diagnoses for an abscess
A
Chronic periapical abscess
Acute periapical abscess
Combined peri endo lesion
14
Q
Why will mechanical root surface debridment not help in pocket
A
Instrument cannot reach all areas
Soft tissue will still have bacteria biofilm causing recolonisation
Pocket may be blocked with calculus / plaque
15
Q
Post-op complications of XLA lower 8
A
Pain, bleeding, bruising, swelling
Trismus
OAC / OAF
Dry socket
Infection
Need for further surgery
16
Q
3 Herpes group viruses associated with intra-oral vesiculation
A
HSV1
HSV2
Epstein Barr Virus
Varicella Zoster Virus
17
Q
2 Oral mucosal diseases cause by COXSACKIE virus
A
Hand, foot & mouth disease
Herpangina
18
Q
2 Oral diseases caused by EBV
A
Glandular fever
Oral hairy leukoplakia
19
Q
Optimum F conc. in public water for caries prevention
A
1ppm
20
Q
2 Foods / drinks with good F source
A
Tea / coffee
Raisins
Bony fish
21
Q
8 yr old high caries risk
A
FV 22,600ppm
F MW 225ppm
F TP 1350 - 1500ppm
22
Q
Mechanism topical F prevents caries
A
Promotes remineralisation by forming fluorapetite
Inhibits demineralisation by increasing enamel resistance to acid
23
Q
Clinical appearance of fluorosis
A
Diffuse white opacities of enamel
Brown staining / discolouration
24
Q
Firsts choice tx. For fluorosis
A
micro-abrasion
25
Swallowing - Oral Stage
Bolus formation
Tongue presses food bolus against palate - squeeze back method
Bolus moves back to occlusal surfaces of molars
26
Swallowing - Pharyngeal Stage
Soft palate elevates
Larynx elevates and moves anteriorly
Epiglottis closes airway
Pharyngeal constrictors contract
27
Swallowing - Oesophageal Stage
Bolus enters oesophagus
Peristaltic contractions move bolus to stomach
Upper oesophageal sphincter relaxes
Lower oesophageal sphincter opens
28
Biological factors affecting mastication
Number of occluding teeth
Salivary flow
Biting force
29
Shortened dental arch
20 teeth - 2 central, 2 laterals, 2 canines, 4 premolars
30
Aspects of shortened dental arch that are acceptable in older patients
Speech
Aesthetics
Mastication
Maintenance of OH
31
Principles of informed consent - as per GDC
Options for tx, risks and benefits
Why proposed tx is needed and appropriate
Consequences; risks and benefits of proposed tx
Likely prognosis
Recommended option
Cost of tx
What may happen if nothing is done
Tx guarantee and how long for for
32
Pain LRQ, 45 & 46 amalgams - what do you expect to see on PA’s
Periapical pathology
Secondary caries
Vertical fracture
Wide PDL
33
Tests for cracked tooth syndrome
Transillumination
TTP
Tooth slooth
34
3 properties of acrylic that makes it a suitable denture base
Aesthetics
Light weight
Non-toxic + non-irritant
35
Common types of breakages in complete dentures
Tooth fractures off
Midline fracture
Piece of denture missing eg loss of flange
36
3 faults in acrylic process
Warping from rapid cooling
Contraction porosity > too much monomer
Under cured = free monomer = irritant
37
Denture has fractured - how do you know if you need another impression
All parts present and take imp with denture in
38
Denture fractures repeatedly - what can you do to strengthen palate
Strengtheners - wire mess, glass / fibre mesh, SS wire
39
Advantages non-gamma 2 amalgam
Reduces corrosion
Reduces creep
Increased strength
Increased longevity
40
how is gamma 2 reduced / removed
Increased copper content in alloy
Copper reacts with tin
41
Why was zinc added to amalgam
Acts as deoxidiser during alloy manufacture - removes oxygen impurities
42
Effect zinc causes in a freshly placed amalgam
Delayed expansion
43
Mechanism of zinc-induced delayed expansion
Zinc reacts with water
Hydrogen gas produced
Gas trapped within amalgam
Resulting in internal pressure > delayed expansion = pain
44
Minimata Convention (2013) - what was it and what was conclusion
Concern over environment and health effects of mercury
> Phase down use of dental amalgam (not complete ban)
45
Amalgam contraindicated - which groups
(As per UK guidance 2018)
<15yr old
Pregnant
Breastfeeding
Primary teeth - where there is an alternative
46
Advantages amalgam > composite
Less technique sensitive
Moisture tolerant
High load bearing areas
Longer lifespan in posteriors
Cheaper
47
Limitations, amalgam > composite
Poor aesthetics
Mechanical retention
No adhesive bonding
Mercury related concerns
48
MIH: pulpal changes and pulp horn proximity
Increased neural density
Increased vascularity
Increased inflam. cells
Hypomineralised porous enamel > post eruptive breakdown
Increase permeability > bacterial ingress
Large pulp chamber with pulp horns close to surface > early pulpal evolvement
49
3 proposed theories for the pain mechanism for MIH
Dentine hypersensitivity - porous enamel or exposed dentine facilitates fluid flow activating A delta fibres
Central sensitisation - from continued nociceptive input
Peripheral sensation - pulp inflam. > sensitisation of c-fibres
50
MIH: definitive tx
Molars: comp / GIC, XLA
Incisors: acid pumice microabrasion, comp, veneer (comp / porcelain)
51
Diagnostic factors of autoimmune mucous membrane disorder
Desquamative gingivits
Vesicles on lip or orally
Anogenital
Skin and scalp lesions
52
Histopath and DIF for Pemphigus Vulgaris
Intra-epithelial linning splitting
DIF chicken wire appearance
53
Antigens in MMP (mucous membrane pemphigoid)
BP180
BP230
54
Other differential diagnoses for MMP
Pemphigus Vulgaris
Erythema multiforme
Steven’s Johnson Syndrome
55
Other mucous membrane MMP can affect
**Ocular (conjunctiva)
**Anogenital
Oesophageal
Nasal
56
Risk factors for malignant change in leukoplakia
Smoking
Alcohol
Floor of mouth
Ventral / lateral tongue
Soft palate
Non homogeneous texture
Presence of erythroplakia
57
Van der Waals classification - 4 types
Amalgam-associated
Drug-induced
Contact hypersensitivity
GVHD-associated lichenoid lesions
58
Histopath of lichen planus
Saw tooth retention pegs
Death of keratinocytes
Acanthosis
59
2 strains of HPV related to tumours
HPV16 or 18
60
Treatment for lichen planus and side effects
Systemic steroids - prednisone
- steroid deficiency adrenal suppression, osteoporosis and immunosuppression
61
Systemic immune modulator example
Azathoprine
62
Pt taking bisphosphonates what do you ask
Dose
IV at any point
How long have they been on meds
Why are they taking meds
Previous MRONJ
63
Low risk of MRONJ - pt requires XLA
Primary care XLA - a traumatic
Advise pt of MRONJ risk
Advise of signs of non-healing socket
Review 8 wks
Suspected MRONJ > oral surg
64
Why pt shouldn’t stop meds
Low risk
Not routinely stopped
Risk of stopping outweighs low MRONJ risk
Meds remain in the system for years as they bind to bone so stopping will have no effect
Can liaise with GMP if need
65
Post-op bleeding 1 day post XLA
Apply pressure for 20 minutes
Saline soaked gauze and pressure
LA for vasoconstriction
Suture
Surgicel
Diathermy
66
If bleeding continues 2 day post-op XLA
Consider meds, MH
Irrigate and check would for fragment
67
Primary measure to prevent cross contamination
Hand hygiene
68
Who is responsible for ensuring Decon machines are for for use
Operator / user
69
Who is responsible for 1/4 testing of Decon machines
Authorised person
User / operator
70
Cycle for reusable instruments - first 5
Cleaning - remove gross-contamination
Disinfection - thermal disinfection, destroy micro-organisms
Inspection - ensures removal of visible contamination
Packaging - preserves sterility
Sterilisation - kills all viable micro-organisms ensuring safe to use
71
LAHSAL Classification
Right > Left
Lip, Alveolus, Hard palate, Soft palate, Alveolus, Lip
Uppercase - complete cleft
Lowercase - incomplete
. - no cleft
72
Cleft ages + tx
3mth: lip closure
6-12mth: palate closure
8-10yrs: alveolar bone graft
12-15yrs: ortho
18-20yrs: surgery
73
Dental anomalies seen in CLAPA
Hypodontia
Impacted teeth
Ectopic teeth
Delayed eruption
Enamel defects
Crowding
Caries
74
Intra-oral signs of tooth wear - not erosion, attrition, abrasion
Linea alba
Fractured / cracked teeth
Soft tissue trauma
Wear facets
Increased FWS
75
Explain Dahl Technique
Relative axial tooth movement technique
Creates space for restorations by raising anterior occlusion
Leads to: posterior tooth eruption and anterior tooth intrusion
Occlusion re-establishes over time
76
How is Dahl technique carried out
Composite build ups on anterior teeth (palatally)
Ensure posterior teeth are out of contact
Review periodically
Allow occlusion to re-establish
77
Records to monitor tooth wear
Study models
Clinical photos
BEWE score / Smith & Knight
Radiographs
6PPC
Diagnostic wax-up
Facebow
78
As per royal college TMD stabilisation splints
Hard splint
Michigan splint - upper
Tanner appliance - lower
Occlusal splint
79
Analgesics TMD - first line
Paracetamol and ibuprofen
- should consider lanzoprazole / omeprazole for pts at risk of GI problems (excessive alcohol, elderly, heavy smoking, GI issues history)
80
Analgesics TMD (Myogenous) - secondary
Amitriptyline (antidepressant)
Gabapentin (gabapentanoid)
Secondary care - diazepam and prednisolone can be considered
81
Pt high risk for infective endocarditis - as per SDCEP
Previous endocarditis
Prosthetic heart valves
Certain congenital heart conditions
- unrepaired cyanotic CHD
- CHD repaired with prosthetic valve (within 6mths)
- repaired CHD with residual defects
82
Infective endocarditis - as per SDCEP
Recommendation for XLA & surgery in high risk pt
Offer abx prophylaxis prior to tx. (60 minutes)
- XLA
- I&D of abscess
- All surgical procedures
- Perio & Endo surgery
- Implant placement
- Uncovering implants and components that are sub-mucosal
83
Pt moderate risk for infective endocarditis - as per SDCEP
Acquired valvular heart disease
Hypertrophic cardiomyopathy
Mitral valve prolapse with regurgitation
Some congenital heart disease
- non-cyanotic congenital defects
- repaired CHD >6mths no residual defects
84
Infective endocarditis - as per SDCEP
Recommendation for procedures that involve manipulation of the gingival or periapical region in high risk pt
Consider abx prophylaxis - reach shared decision with patient
- PMPR (supra and sub)
- BPE
- MPBS
- Sub-ging restorations including fixed prosthodontics
- Placement of preformed metal crowns
- Placement of sub-ging rubber dam clamps and matrix bands
- Placement and removal of ortho separators and bands
- Endo tx. before apical stop has been established
85
86
87
Infective endocarditis - as per SDCEP
Recommendation for moderate risk pt
Discuss potential benefits and harms of abx prophylaxis - explain not recommended as no evidence of benefit
If pt requests abx prophylaxis - make shared decision
If specified by cardiac team - follow high risk pathway
88
Infective endocarditis - as per SDCEP
Oral abx prophylaxis
Amoxicillin
Capsules - 2g (4x 500mg caps)
Oral Sachet - 3g oral sachet
Clarithromycin 500mg
89
MRONJ
Low risk pt
Tx for osteoporosis or other non-malignant diseases of the bone with oral Bisphosphonates for <5yrs + NOT currently on systemic glucocorticoids
Tx for osteoporosis or other non-malignant diseases of the bone with 1/4 or yearly IV bisphosphonates for <5yrs + NOT currently on systemic glucocorticoids
Tx for osteoporosis or other non-malignant diseases of the bone with denosumab NOT currently on systemic glucocorticoids
90
MRONJ
High risk pt
Tx for osteoporosis or other non-malignant diseases of the bone with oral Bisphosphonates OR 1/4 or yearly IV bisphosphonates for >5yrs
Tx for osteoporosis or other non-malignant diseases of the bone with Bisphosphonates or Denosumab for any length of time + simultaneously systemic glucocorticoids
Anti-resorptive or anti-angiogenic (or both) as part of cancer tx.
Previous diag. of MRONJ
91
MRONJ
Management of pts about to start tx of anti-resorptions and anti-angiogenics or have very recently started drug therapy
Advise of risk - small
Optimise OH + reg dental visits
Lifestyle advice - stop smoking and limiting alcohol
Advise on symptoms
Prioritise care to reduce trauma / avoid further surgery
Medically compromised - specialist advice
92
MRONJ - symptoms
Exposed bone
Loose teeth
Non-healing ulcers / sockets
Pain, swelling
Pus / discharge
Altered sensation (tingling / numbness)
93
MRONJ
Low risk pt management
Routine care - as normal
XLA / bone impacting tx - primary care
Requirements - risks and benefits (valid consent)
Aftercare - advise of symptoms and review in 8wks
94
MRONJ
High risk pt management
Routine care - as normal
XLA / bone impacting tx - if needed; explore all other options first
Specialist - cancer pts, IV Bisphosphonates / anti-angiogenics
Requirements - risks and benefits (valid consent)
Aftercare - advise of symptoms and review in 8wks
95
Design / prep features to lead to failure in a crown / abutment for a bridge
Lack of bonding surface
Occlusal load too heavy
Lack of sufficient ferrule
Margins finished subgingival
96
Conventional Bridge: Abutments 11 and 22, Pontic 21
22 has deboned
2 alternative bridges - 11 and 22 are prepped
Cantiliever bridge from 11 replacing 21 + separate crown 22
Fixed-fixed 12 & 11 abutments, 21 pontic + 22 crown
97
15 has existing RCT, 9mm pocket, abscess and vertical bony defect
3 differential diagnoses
Periodontal abscess
Periapical abscess
Combined peri-endo lesion
98
15 has existing RCT, 9mm pocket, abscess and vertical bony defect
What is the initial tx
Assess current RCT - PA
LA - attempt to drain abscess either via pocket - subging. instrumentation or via incise and drainage or accessing the canal
Re-RCT
99
Tooth with discolouration post trauma 2yrs previous
Discolouration is getting worse
How do you find out about aetiology
Take full history
Ask about extrinsic and intrinsic staining
100
17yr old pt 22 and 23 missing
What problems do you face with aesthetics
Teeth are in aesthetic zone
Midline may have shifted
Colour and shape of restorations / denture might not be identical match
101
17yr old pt 22 and 23 missing
What problems do you face with function
Teeth are subject to heavy load
Speech would be affected
Loss of canine guidance
Reduced incisal efficiency for biting
Altered occlusion
102
Mechanism of vertical bone defect
Plaque biofilm induces inflammation response with cytokine release leading to activation of MMPs and RANKL causing osteoclast mediated bone resorption
Local plaque retentive factors (calculus, overhangs) promote persistent site specific inflammation
Uneven / localised bone resorption along root surface results in angular defect
103
RPI meaning
R - Mesial rest
P - Proximal plate
I - Gingivall approaching I-bar clasp
104
How do you classify vertical bone defects
By the number of walls (1, 2, 3)
105
What functions and features in an RPI prevent the free-end saddle from damaging periodontium of the tooth
Mesial rest directs forces along long axis of the tooth
Proximal plate allows movement with minimal tooth contact
I-bar clasp disengages from undercut during function
106
Initial tx plan for denture induced stomatitis
Denture hygiene
Denture rest periods - take it out at night
107
What you would expect to see on occlusal surfaces of teeth in denture stomatitis pt and how do you fix it in the short term
Occlusal wear - reduce vertical dimension
108
Indications lower 8 is in close proximity of ID canal
Diversion of canal - canal bends around root
Interruption of white lines - loss of lamina dura borders
Darkening of root - overlap
Narrowing of canal - as canal passes apices
Narrowing of root - compression where crossing
Nerve deflection in tooth - root / canal displacement
Juxta-apical area - radiolucency lateral to root (not apex)
Dark & bifid roots - split root appearance
109
How to diagnose maxillary tuberosity fracture
Direct vision
Tear in palate
Noise
Mobility under pressure
110
How to diagnose an OAC
Positive Valsalva
Liquid passing from mouth to nose
Air from socket (air bubbles)
111
OAC - what is a Valsalva Manoeuvre
Ask pt to pinch nose and GENTLY try to blow air out through nose with mouth open
Look for air bubbles at XLA site
Bubbles = positive
No bubbles = negative
Can enlarge or create an OAC so must be done gently
112
Treatment of maxillary tuberosity fracture (peri-op)
Stop XLA and assess severity
Reposition tuberosity and stabilise
Delay XLA until healed - 6-8wks
113
Treatment of maxillary tuberosity fracture (post-op)
- bone comes out with tooth
Assess site and sinus involvement
Small = smooth bone and suture closed
Large = reposition and stabilise
114
Post XLA what tissues could be responsible for prolonged bleeding and how would you manage each
Soft tissue = gently suture
Local blood vessel = direct pressure, haemostatic agent (surgicel) and suture
Socket = irrigate & curette, pressure, haemostatic agent (surgicel) and suture
115
4 factors for bleeding risk
Anticoagulants
Antiplatelets
Bleeding disorder (haemophilia a or b, Von Williebrands)
Alcoholism
Liver disease
116
Local factors contributing to desquamative gingivitis
SLS
Plaque accumulation + poor OH
Calculus deposits
Restoration overhangs
117
Test for Sjogrens
Schirmer test
Autoantibodies - anti-Ro and anti-La
Unstimulated salivary flow - <1.5ml in 15 mins
118
What gland is biopsies - Sjogrens
Labial
119
2 things to ask Histopath when sending biopsy sample for sjogrens
Focus score (number of lymphocytic foci per 4mm squared of gland tissue)
Presence of focal lymphocytic sialadenitis (periductal lymphocytic infiltrate)
120
Features of parotid gland swelling that would cause malignancy suspicion
Facial nerve palsy
Hard, irregular
Painful swelling
Rapid increase in size
Unilateral
Fixed to underlying structures
cervical lymphadenopathy
121
Oral diseases associated with microcytic anaemia
Angular chelitis
Mucous Membrane Pemphigoid
Pemphigus Vulgaris
122
Conditions associates with hypodontia
Down syndrome
Cleft lip & palate
Ectodermal dysplasia
123
Percentage of people with hypodontia that are missing:
Primary
Permanent
Primary - 1%
Permanent - 6%
124
Actions of fluoride
Incorporate into enamel as fluoroapetite to remineralise
Inhibits bacterial metabolism
125
Features of non-accidental injury
Bruises at different stages of healing
Explanation inconsistent with injury
Finger-pattern bruising
Bruising aliens back of ear
Torn frenum
Bite marks
Delay in seeking tx
126
Effects of trauma on primary teeth
Discolouration
Infection
Delayed eruption
127
Effects of trauma on developing permanent tooth
Delayed eruption
Discolouration when erupted
Enamel hypoplasia
Arrested root development
Dilaceration of root/crown
128
Age for interceptive ortho
10-13yrs (growth period)
129
Ectopic canines: tx
Do nothing + monitor
Interceptive ortho
Surgical exposure + ortho alignment
Removable appliance
Auto transplant tooth (rare)
130
Ideal time to treat a crossbite
As soon as it is detected
131
Features of anterior crossbite that make it amenable to tx with URA
Tipping movement
Single tooth involvement
Adequate space in arch
132
21 in anterior crossbite
Design URA
Aim: Please construct an URA to correct anterior crossbite 21
A - Z-Spring 21, 0.5mm HSSW
R - Adam’s clasps 16 & 26 0.7mm HSSW, Adam’s clasps 44 & 45 0.6mm HSSW
A - yes only one tooth moving
B - Self cure PMMA
133
Clinical Governance
CPD hours
100 hours in 5yr cycle
- 20/2yrs
134
Clinical Governance
Define
Framework through which organisations are accountable for continuously improving the quality of their services and safeguarding to a high standard
135
Clinical Governance
Dimensions of healthcare (6)
Safety
Effectiveness
Patient centred
Timeliness
Efficiency
Equality
136
Clinical Governance
3 divisions of NHS Scotland and their function
General Dental Service - primary care, provides majority of dental care, provided by GDP
Public Dental Service - acts as a safety net for pts unable to access high-street general dentist including those with special needs, elderly in care homes and rural / remote pts
Hospital Dental Service - accepts referrals for specialised care eg oral surgery, oral med, ortho, restorative, endo, paeds
137
Clinical Governance
Recommended CPD topics
Medical emergencies - 10 hrs / cycle
Disinfection & decontamination - 5hrs / cycle
Radiograph & radiation protection - 5hrs / cycle
(Minimum requirements of each)
138
Clinical Governance
Steps in an audit cycle
Set standards / criteria
Collect data and compare with standards
Implement changes and re-audit
139
Clinical Governance - 7 pillars
P - Patient & public involvement
I - Information management & IT
R - Risk management
A - Clinical audit
T - Training & education
E - Clinical effectiveness
S - Staff management
140
19 yr old pt
Trauma to 12 and 11 Saturday evening
Dental apt Monday
12 - crown missing and subalveolar fracture
11 - pulpal exposure of 2mm
Both teeth sensitive to air
Immediate management
Full history - MH and trauma
Trauma assessment
- Sinus
- Colour
- TTP
- Mobility
- EPT / Ethyl Chloride
- Percussion note
- Radiograph
Tx pulp exposure - partial pulpotomy (cvek) or pulp cap > CaOH / MTA
Restore - composite / GI
Review and monitor
141
Why is a subalveolar fracture unrestorable
Cannot properly assess the severity as it is below gingival margin
Also cannot restore due to having to go subgingival
142
In generalised aggressive perio how would you decide prognosis of individual teeth
Pocket probing depth
Loss of attachment
Mobility
Furcation involvement
Symptoms (if any)
Patient desire
143
Decontamination
5 key personnel and their roles
User - manage day to day running of Decon and to keep records
Operator - person with the authority to operate decontamination equipment, note instrument readings and replenish solutions
Manager - ultimately responsible for the running of the Decon lab (practice owner)
Authorising engineer - provide expert advice, independently audit annual and quarterly test reports
Maintenance engineer - employed to carry out maintenance and repairs
144
Decontamination
Water for sterilisers type and why
Purified - low conductivity
De-ionised - water passed through ion exchange
Reverse osmosis - water forced through semi-permeable membrane under pressure
145
Decontamination
Why is purified water required for sterilisers
Prevents scale build up
Protects instruments and steriliser
Ensures effective sterilisation
146
RPD
What provides support, retention and indirect retention
Support - rests
Retention - clasps
Indirect retention - rest on tooth anterior to fulcrum line
147
Why is mechanical root surface debridement not successful in eliminating pocket bacteria
Bacteria invade soft tissues
Anatomical limitations
Biofilm structure
Rapid recolonisation
148
Why are abx not effective in eliminating pocket bacteria
Bacteria are protected within biofilm
Infection is localised limiting drug delivery
Abx will not remove plaque / calculus
149
What has greater bond strength composite or amalgam
Composite
150
Pt has gold post and core that has debonded several times
Why
Post fracture
Core fracture
Root fracture at post level
Secondary caries
Traumatic fracture
151
Fracture of post and core occurs at junction of post and core
Why
Tooth surface loss
Bruxism
Inadequate ferrule
Trauma
152
Nayyar core features
Post RCT
GP removed from canals
Amalgam packed into canals and tooth built up providing retention for amalgam
Cannot be prepped for 24 hours
153
Ways to remove fractured post that isn’t visible
Ultrasonic tip
Moskito forceps
Eggler forceps
154
Large amalgam restoration replaced a composite due to secondary caries
Causes of transient sensitivity to thermal stimuli and pain on biting 1 wk post op
Dentine exposure
Restoration high
Pulp exposure
Deep cavity
Polymerisation shrinkage causing micro-leakage
Cracked tooth
155
Child ingests toxic dose of fluoride what advice
Hospital
Calcium orally
156
Most common causes of fluorosis in UK
Fluoride in public water supply
157
What features of permanent dentition allows for the replacement of primary teeth without crowding
Growth of maxilla
Proclamation of permanent teeth
Extension of dental arch
158
What is Leeway space and how does it relieve crowding
Mesiodistal different between primary c, d, e and their permanent successors
Allows mesial movement of molars / alignment of permanent teeth helping to relieve mild crowding
159
Tests to diagnose trigeminal neuralgia
MRI
Diagnostic LA block of trigeminal branch (IAN block to rule out TMD / muscle pain)
160
Drug therapy for TN (including dose)
Tests every 3mths
Carbamazepine 100mg 20tablets > 1 tablet 2x daily
FBC and LFT
161
When surgical intervention for TN
Carbamazepine doesn’t improve condition (tried for substantial period of time)
Side effect from medication
Pt request
162
TN surgical example
Balloon compression
163
TMD
Signs and symptoms
Headaches
Pain - muscles of mastication
Trismus
Joint tenderness
Clicking / popping
Ear pain
Hypertrophy of muscles
164
TMD
Aspects of causative advice
Soft diet
Stop parafunctional habit
Support mouth opening
Physiotherapy
No chewing gum
Masticate bilaterally
165
Brown / grey pigmentation
Local causes
Amalgam tattoo
Melanotic macule
Oral Naevus
166
Brown / grey pigmentation
Generalised causes
Smoking
Racial pigmentation
Drugs
Hormonal imbalance - Addison’s disease
167
2 types of haemangiomas and histological difference between them
Capillary = non-capsulated
Cavernos = encapsulated
168
SIRS
4 components and parameters
Pt must have 2 or more of these
Temperature = <36°C or >38°C
WBC = >12 ×10⁹/L or <4 ×10⁹/L (or >10% immature forms)
Heart Rate = >90bpm
Respiratory Rate = >20/min
169
SIRS
Facial swelling - what to take note of
Airway compromise
Fever / systemic issues
Size
Trismus
Pus / suppuration
Dehydration
Duration
Dysphagia
Drooling
Pain
Palpation - feel for pulse (vascular)
Heat
170
Principles of cavity prep
Remove all carious enamel and unsupported enamel to define cavity margins
Establish a caries-free peripheral seal (remove caries at the amelodentinal junction circumferentially)
Remove infected dentine peripherally first, progressing centrally
Preserve affected dentine near the pulp to avoid exposure
Make any refinements, material requirements and internal design modifications
171
Intra-oral signs of erosion
Halo effect on palatal surfaces
Cupping
Loss of surface detail, smooth glazed surface
172
Erosion - causes
Diet
GORD
Acid reflux
Vomitting frequestly eg pregnant
Bulimia
173
Erosion - initial management
Diet advice
Fluoride application
Address underlying cause
OHI
Liaise with GP
174
RPD
What is axis of rotation when denture is under load
Axis = line drawn between 2 most posterior rests on either side of arch
Rotation occurs when this axis line is under load
175
RPD
What is the combination effect
Maxillary complete opposes mandibular anterior teeth without posterior support
Leading to anterior maxillary resorption and associated changes
176
Important features of complete dentures to check at try-in
Aesthetics
Speech
Occlusion
177
Signs and symptoms
Flattened cheek prominence
Periorbital bruising
Diplopia
Subconjunctival haemorrhage
Trismus
Pain
Swelling
Specific to orbital involv.
Infraorbital nerve paraesthesia
Enopthalmos
178
Zygomatic feature with orbital floor involvement
Diagnostic test
CT
179
Zygomatic feature with orbital floor involvement
Tx
Observation if minimal damage
Avoid nose blowing
Open reduction & internal fixation (ORIF)
180
Pseudomembranous candidosis
Medical conditions associated
HIV
Diabetes
181
Oral Med
Mouth swap and oral rinse - advantage and disadvantage
Oral rinse
- advantage = avoids contamination with oral commensal
- disadvantage = less reliable
Mouth swab
- advantage = non-invasive
- disadvantage = contaminated by oral commensal
182
Fluconazole interactions
Warfarin - increases INR
Statins - increases levers > MI
Midazolam - increases sedative effect
183
Neurological disorders giving rise to TN pain
Multiple sclerosis
Facial palsy
184
External inflammatory root resorption
Cause
Damage to PDL post trauma
Necrotic pulp
185
Down syndrome
Associated med. conditions
Epilepsy
Autism
Leukaemia
Heart defect
186
Down syndrome
Extra-oral features
Short neck
Flat face
Midface hypoplasia
Incompetent lips
187
Down syndrome
Intra-oral features
Class III
Anterior open bite
Large tongue
Hypodontia
Microdontia
188
Down syndrome
How would you alter prevention and tx plan
Extra time for apts
FV 4x / yr
Diet advice
FS
High FV tp
189
Ortho - Class III
What is dento-alveolar compensation
Adaptive tooth position changes in response to skeletal discrepancy
eg upper incisors proclined and lower incisors retroclined (like Class III)
190
Define: supernumerary
Extra tooth beyond normal dentition
191
Effects of supernumerary teeth
Crowding
Root resorption of other teeth
Cyst formation
Delayed eruption of permanent
Displacement of permanent tooth
192
Stages in chain of infection
Infectious agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host
193
Postural Hypotension
What happens briefly
Venous pooling in legs
Poor venous return
Fall in stroke volume
Fall in cardiac output
194
Pt collapses why
Postural Hypotension
MI
Hypoglycaemia
Dehydration
Shock
195
Postural Hypotension
What to do to prevent
Raise pt slowly from supine position
Allow time before standing
Monitor before discharge
196
Simplified BPE
What teeth
16, 11, 26
46, 32, 36
197
Simplified BPE
Ages for which codes
7-11yrs = 0, 1, 2
12-17yrs = 0, 1, 2, 3, 4, *
198
Simplified BPE
What does each code mean
0 = healthy
1 = BoP after gentle probing
2 = calculus / plaque retentive factor
3 = shallow pocket 4mm / 5mm
4 = deep pocket 6mm or more
* = furcation
199
Simplified BPE
Examples of when to refer
Aggressive perio
Systemic med condition associated with perio
Drug-induced ging overgrowth
Cases requiring evaluation for perio surgery
200
What is aggressive perio referred to as now
Grade C
201
Signs of ‘aggressive perio’
Rapid attachment loss
Patient otherwise healthy
Family aggregation (relatives have history of early tooth loss)
Destruction is disproportionate to amount of plaque present
202
Angular Chelitis
Organisms linked to it
Candida albicans
Staph aureus
203
Angular Chelitis
Why miconazole
Has antimicrobial action against candida and staphylococci
204
Immunocompromised bleeding disease
Explain aetiology
HIV and Cancer tx
Allows opportunistic pathogen to cause disease
205
Gastric bleeding disease
Explain aetiology
Crown’s and Coeliac’s
Lack of absorption causing malnutrition
206
What materials bond to amalgam
Vitrabond
Panavia
GI
207
What does Pemphigus Vulgaris look like under microscope
Intraepithelial split
Desomosomes (attaches cell wall to wall)
AntiDSG3 and antiDSG1
208
What does Mucous Membrane Pemphigoid look like under microscope
Subepithelial split
Hemidesmosomes (attaches at basement membrane)
AntiB18 and anti BP230
209
Aetiology of Pemphigus Vulgaris
Autoimmune antibodies IgG
Caused by genetic predisposition and environmental trigger
Common in women
210
How do you stage a SCC
TNM staging
Tumour size
Node involvement
Metastasis
211
How do you grade a SCC
Based on the degree of keratinisation, cellula and nuclear pleomorphism
By level of dysplasia
Mitotic figure
Invasion of other tissue
212
BEWE scores
0 - no surface loss
1 - initial enamel surface loss
2 - distinct surface loss, <50% surface area
3 - hard tissue loss, >50% surface area
213
What is the Dahl technique
Increases OVD over a period of time to gain space in cases of localised tooth wear
214
How does the Dahl technique work
Comp added to palatal of anteriors
OVD increases over 3-6mths
Causing posterior teeth to over-erupt back into contact
Giving space for any anterior restorations
215
Contraindicated groups for Dahl
Bruxists
TMD
Ortho
Perio
Severe Class III
216
Pt trauma enamel-dentine fracture
Tx typically composite but pt has heart valve defect, what tx would you now do
Indirect pulp cap to prevent future RCT
( RCT woul be high risk and require abx prophylaxis )
217
Dose of Midazolam for IV sedation
5mg/ml
218
Reversing agent for IV sedation
Flumazenil
219
D3MFT
What does the 3 mean
Obvious decay into dentine
220
3 interventions in Scotland on population basis
National nursery / school brushing programme
Targeted fluoridede varnish application
Dental health support worker involvement
221
MIH
What to ask parent
Low birth weight
Traumatic birth
Pre-mature birth
Gestational diabetes
Measles / rubella as a child
Any illness’s in third trimester
222
Length of ACJ > bone crest
2mm
223
Simplified BPE teeth
16, 11, 26, 36, 31, 46
224
Risks of ortho (8)
Root resorption
Relapse
Failure
Enamel demineralisation
Recession
Pain / discomfort
Gingival hyperplasia
Caries
225
2 congenital and 2 acquired bleeding disorders
Congenital - Haemophillia A & B, VWB
Acquired - alcoholic liver disease & drug therapy
226
Signs & symptoms mandibular fracture
Trismus
Pain
Malocclusion
Step deformity
Mobility of mandible
Paraesthesia of lower lip / chin
Laceration intraorally
227
Radiographs for a mandible fracture
PA Mandible
OPT
228
Mandible fracture
- cause of displacement
Muscle attachments
Site of fracture
Presence / absence of teeth
Force of injury
229
Intra-oral features Class III
Reverse overjet
Anterior crossbite
Proclined upper incisors
Restroclined lower incisors
230
SDA
What would count as one unit
1 occluding pair
231
SDA
Skeletal classes contraindicated
Severe Class II
Class III
232
SDA
Perio is a contraindication, why
Poor prognosis of teeth
Reduced periodontal support
Risk of disease progression
233
CoCr for RRB why
High strength
Rigid support
Thin = good for comfort and hygiene
234
What bridge design would minimise the risk of debonding
Maximise enamel bonding surface
Avoid occlusal contacts on abutment
235
What is mandibular displacement
Discrepancy between centric relation and centric occlusion
Due to premature contact > mandible shifts on closure
236
Why should you correct mandibular displacement
Can leads to TMJ issues
Can cause attrition
237
Immediate tx pericoronitits
Irrigation & debridment
OHI
Analgesia
238
Oral conditions associated with Microcytic anaemia
Oral mucosal pallor
Aphthous ulcers
Oral candidiasis
Angular chelitis
239
Child presents with ulceration on lip
What else is seen intraorally
Generalised inflammation of the gingiva
Multiple ulcers
Bleeding gums
240
Ulcer history
What to ask pt
How long have you had ulcer(s)
Have they changed in size
Do you burst like a blister
Does anything cause them to appear
Are they constant / recurrent
Do you have any other lesions
Are they painful
Does anything help them go away
241
Factors for implant placement
Local and general
Local
- bone quality
- bone quantity
- soft tissue quality
- proximity to vital structures
- space for crown
General
- smoking
- diabetes
- OHI
- pt compliance
- age
- alcohol / drug misuse
242
Head, neck and oral features associated with cocaine
Destruction of nasal septum
Attrition from grinding
Oronasal fistula
Gingival recession
Gingival ulceration
243
Side effects of opioid misuse
Constipation
Sedative effect
Respiratory depression
Nausea / vomiting
244
What group does methadone belong to
Opioid
245
Complications of methadone:
Sugar free
Non-sugar free
Sugar free - xerostomia
Non-sugar free - rampant dental caries
BDS4 Finals
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