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3rd year dentistry > fixed pros/operative > Flashcards

fixed pros/operative Flashcards

1
Q

List the order of history taking for an exam for an existing patient

A

C/O HPC PDH PMH SH FH

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2
Q

Give the order of carrying out an examination

A

GENERAL - relevant E/O features; lips, cheeks, palate, FoM, oropharynx DENTAL - chart missing teeth accurately Abnormalities of tooth position (over eruption, crowding, migration) Restorations; type, amount and distribution Carious, fractured or leaking restorations, endodontic problemt Parafunction PERIODONTAL OCCLUSION

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3
Q

How should a periodontal exam be carried out?

A

VISUAL - supragvingival plaque/calculus, distribution and quantity Gingiva - erythema, hyperplasia, recession PROBING - BPE plus full periodontal chart as indicated ALSO NOTE - BOP, subgingival calculus, furcation lesions PALPATIONS - mobility (scores recorded on pocket chart) TTP is relevant

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4
Q

What are nociceptors and what is their function?

A

A alpha and C fibres are referred to as nociceptors and generate pain stimuli

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5
Q

Nociceptors are polymodal, what does this mean?

A

Nociceptors are sensitive to a number of stimuli; mechanical, thermal and chemical

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6
Q

What is the acronym SOCRATES used for and what does it stand for?

A

It is used for taking a pain history S - site O - onset C - character R - radiates A - associated symptoms T - time E - exacerbating S - severity

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7
Q

In the acronym SOCRATES what is meant by site?

A

Where exactly is the pain?

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8
Q

In the acronym SOCRATES what is meant by onset?

A

What were they doing when the pain started?

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9
Q

In the acronym SOCRATES what is meant my character?

A

What does the pain feel like?

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10
Q

In the acronym SOCRATES what is meant by radiates?

A

Does the pain go anywhere else?

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11
Q

In the acronym SOCRATES what is meant by associated symptoms?

A

Eg, nausea/vomiting

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12
Q

In the acronym SOCRATES what is meant by time?

A

How long have they had the pain? How long does it last for?

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13
Q

In the acronym SOCRATES what is meant by exacerbating?

A

Does anything make the pain worse or better?

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14
Q

In the acronym SOCRATES what is meant by severity?

A

Ask the patient for a pain score between 1 and 10

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15
Q

During tissue damage, several substances are released that are able to stimulate nociceptors, name some

A

Histamine, serotonin, bradykinin, prostaglandin E2, interleukins

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16
Q

C fibres conduct impulses generated by…

A

Temperature, mechanical and and chemical stimuli

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17
Q

Motor impulses for the body’s posture and movement are generated by…

A

A alpha fibres

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18
Q

List four reasons why periodontal health is important

A
  1. Periodontitis affects 50% of the population
  2. Inflammation at the gum margin destroys the bone that retains teeth
  3. Periodontitis impacts on the ability to chew, appearance, reduces quality of life, and is responsible for a substantial proportion of dental care costs
  4. The systemic inflammation associated with periodontitis impacts on general health, increasing the severity and prevalence of cardiovascular disease, diabetes, Alzheimers and rheumatoid arthritis
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19
Q

In relation to scoring and management of periodontal disease, what does a BPE score of 0 indicate?

A

no pockets exceeding 3.5mm (black band remains visible). No calculus, overhangs or BOP. NTR

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20
Q

In relation to scoring and management of periodontal disease, what does a BPE score of 1 indicate?

A

No pockets exceeding 3.5mm, no calculus or overhangs. Bleeding on probing. PGI at beginning and for monitoring during and after treatment, OHI

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21
Q

In relation to scoring and management of peiodontal disease, what does a BPE score of 2 indicate?

A

No pockets exceeding 3.5mm. Calculus or other plaque retentive factors are present. PGI at beginning and for monitoring during and after treatment. OHI, scaling and correction of restoration margins ect. RSD and selected sites. Re-evaluate

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22
Q

In relation to scoring and management of periodontal disease, what does a BPE score of 3 indicate?

A

Pockets of 3.5-5.5mm (black band partially visible). PGI at beginning and for monitoring during and after treatment. OHI. Scaling. Removal of overhangs. Root surface debridement at selected sites. Re-evaluate. Full perio chart required at re-evaluation

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23
Q

In relation to scoring and management of periodontal disease, what does a BPE score of 4 indicate?

A

Pockets greater than 5.5mm. Black band disappears into pocket. PGI and full mouth perio chart BEFORE RSD and at re-evaluation. OHI, scaling and correction of restoration margins. RSD. Re-evaluation

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24
Q

In relation to scoring and management of periodontal disease, what does a BPE score of * indicate?

A

Furcation detectable by probing. Perio chart of that sextant plus management as for codes scored elsewhere. Treatment of furcation as appropriate

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25
Q

what are the applications of a mini-sickle

A

a point scaler with two cutting edges on each blade. Used on buccal and lingual embrasure surfaces supra-gingivally

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26
Q

what are the applications of a columbial curette?

A

a universal curette with two cutting edges on each blade. Sub-gingival scaling anywhere in the mouth, limited access to deep pockets

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27
Q

what are the applications of the gracey curette 1-2 (grey)

A

single cutting edge. Fine/deep subgingival scaling upper and lower anteriors

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28
Q

what are the applications of the gracey curette 7-8 (green)?

A

single cutting edge on each blade. Used on buccal and lingual surfaces of posterior teeth

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29
Q

What are the applications of the gracey curette 11-12 (orange)?

A

mesial surfaces of posterior teeth

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30
Q

what are the applications of the gracey curette 13-14 (blue)

A

distal surfaces of posterior teeth

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31
Q

what are the applications of the hoe scaler 134-135 (yellow)?

A

buccal and lingual surfaces

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32
Q

what are the applications of the hoe scaler 156-157 (red)?

A

supra and subgingival scaling mesial and distal surfaces

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33
Q

What is the function of a BPE?

A

The BPE provides a simple and rapid periodontal screening for all new and existing patients at their regular exam appointments.

It does not provide a diagnosis of periodontal disease but indicates what further assessment and periodontal treatment, if any, the patient requires

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34
Q

When should radiographs be taken to assess bone level?

A

When a BPE scoring of 3 or 4 is recorded

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35
Q

What use do study models serve for patients with periodontal disease?

A

They can be used to monitor gingival recession

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36
Q

What is suppuration?

A

The process of pus forming

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37
Q

What special investigations are used in pre operative assessment and why?

A

Radiographs (caries, periodontal condition, peri-radicular/peri-apical lesions, previous RCT (and quality of))

Sensibility testing (ethyle chloride, EPT)

Mounted study models (fully adjustable articulator)

Diagnostic wax up (aesthetics, occlusion, communication with patient, achievability)

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38
Q

What are the clinical stages for indirect restorations?

A

Preparation

Temporisation

Impressions and occlusal records

cementation

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39
Q

What are the indications for an inlay?

A

Premolars and molars

Typically MO or DO

MOD if narrow, if not consider onlay

Low caries rate

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40
Q

What are the advantages and disadvantages of an onlay?

A

Advantages;

Superior materials and margins

Less chance of deterioration over time compared with direct restorations

Disadvantages;

Time

Cost

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41
Q

Name the two disadvantages of inlays

A

Time

cost

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42
Q

What are the preparation requirements of a ceramic/composite inlay?

A

* Isthmus 1.5 - 2mm

*Margins clear of occlusal contact points

*Flat pulpal floor (even depth, perpendicular to path of insertion)

*4-6 degree tapered walls (no undercuts)

*No bevel at occlusal aspect

*Butt-joint cavo surface margins

*Clear of adjacent tooth contacts

*(supra gingival) shoulder or chamfer margins

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43
Q

What are the preparation requirements for a gold inlay?

A

*Isthmus of 1mm

*Margins clear of occlusal contact points

*Flat pulpal floor (even depth, perpendicular to path of insertion)

*4-6 degree tapered walls with no undercuts

*15-20 decgree bevel upper third of isthmus wall

*Clear of adjacent tooth contact points

*Occlusal key/dovetail

*(supra gingival) shoulder or chamfer margins

*If proximal box required, keep margins clear of adjacent tooth contact areas

*Consider internal accessory retention features

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44
Q

What are the indications for providing an onlay?

A

*sufficient occlusal tooth substance loss with buccal andd/or lingual/palatal cusps remaining

*remaining tooth substance weakened

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45
Q

What are the uses of onlays?

A

*Tooth wear cases (increase OVD)

*Fractured cusps

*Restoration of root treated tooth

*Replace failed direct restoration

*Minor bridge retainers (not recommended)

46
Q

What are the preparation requirements for a ceramic/composite onlay?

A

*margins clear of occlusal contact points

*4-6 degree tapered walls (no undercuts)

*flat pulpal floor (even depth, perpendicular to path of insertion)

*proximal box (if required); 1mm width

*rounded internal line angles

*occlusal reductions (1.5mm non working cusps, 2mm working cusps)

47
Q

What are the preparation requirements for a gold onlay?

A

*margins clear of occlusal contact points

*4-6 degree tapered walls

*flat pulpal floor (even depth, perpendicular to path of insertion)

*proximal box (if required); 1mm width

*rounded internal line angles

*occlusal reductions; 0.5mm non working cusp, 1mm working cusp

*shoulder or chamfer margins 0.5mm supra gingival

48
Q

What should be included on a lab prescription for an indirect restoration?

A

*please pour impressions

*please mount casts on articulator (provide wax bite, occlusal record, facebow)

*Give FDI notation

*material to be used

*Thickness of material

*characteristics

*Shade

49
Q

what steps are carried out in a preparation appointment for an indirect restoration?

A

*LA (if no RCT)

*make putty index

*impression for temporary

*tooth preparation

*make temporary

*Impressions, bite reg and shade

*cement temporary

50
Q

what steps are carried out in the fit appointment of an indirect restoration?

A

*Remove temporary

*Isolate, clean and dry prepared tooth

*Try in, assess fit, adaptation, occlusion etc

*cement

*minor occlusal adjustment if needed

51
Q

What are the indications for veneers?

A

*Improve aesthetics (if considerable changes to be made, use diagnostic wax up)

*change teeth shape and/or contour

*correct peg shaped laterals

*reduce or close proximal spaces and diastemas

*align labial surfaces of instanding teeth

*enamel defects

*discolouration (intrinsic/extrinsic)

52
Q

What are the contraindications of veneers?

A

*Poor OH

*high caries rate

*gingival recession

*root exposure

*high lip line

*extensive prep needed (>50% no longer in enamel)

*labially positioned, severely rotated and overlapping teeth

*extensive tooth surface loss

*heavy occlusal contacts

*severe discolouration

53
Q

What preparation is required to provide a veneer?

A

*none in some cases

*use putty index

*incisal edge reduction (if required) 1-2mm

*incisal/coronal third reduction 0.5-1mm

*mid facial reduction 0.5mm

*cervical reduction 0.3mm

*slight chamfer margin (within enamel, supra gingival or 0.5mm sub gingival)

54
Q

What are the alternative to providing veneers?

A

*no treatment

*micro abrasion

*direct composite restorations

*crowns

55
Q

What are the four types of veneer preparation?

A

*Feathered incisal edge

*incisal bevel

*Intra enamel (window)

*overlapped incisal edge

56
Q

In what order should treatment planning be prioritised?

A
  1. Immediate
  2. Initial (disease control)
  3. Re-evaluation
  4. Reconstructive
  5. Maintenance
57
Q

In treatement planning, what is considered immediate treatment

A

Relief of acute symptoms. Consider endodontics and extractions. Consider immediate denture/bridge

58
Q

In treatment planning, what is considered initial treatment (disease control)?

A

Extraction of unrestorable teeth. OHI and dietary advice. HPT. Management of carious lesions and defective restorations with direct or provisional restorations. Endodontics. Denture design, wax up for fixed pros

59
Q

In treatment planning what is carried out at re-evaluation?

A

Re-assessment of periodontal status, confirm denture/bridge design.

60
Q

In treatment planning what is considered reconstructive?

A

Perio surgery. Fixed and removable prosthodontics

61
Q

In treatment planning what is considered maintenance?

A

Supportive periodontal care and review of restorations

62
Q

What are the six principles of crown preparation?

A
  1. Preservation of tooth structure.
  2. Retention and resistance
  3. Structural durability
  4. Marginal integrity
  5. Preservation of periodontium
  6. Aesthetic considerations
63
Q

Explain how informed consent is gained

A

Must be written and verbal.

Inform the patient; what treatment is to be performed, why it is necessary, consequences of not having the treatment, what risks may be involved, alternatives and their risks, relative costs

64
Q

What are five desirable characteristics of a provisional restorative material?

A

*Non irritant to pulp and periodontal tissues

*Low temperature rise during setting

*Dimensionally stable

*Adequate working time

*Adequate setting time

*Adequate strength and wear resistance

*Good aesthetics

65
Q

What movements are the muscles of mastication involved in?

A

Depression, elevation and lateral movements of the mandible

66
Q

What movements are the suprahyoid muscles involved in?

A

Elevate the hyoid bone or depress the mandible

67
Q

The temporalis is involved in what movements?

A

Elevates and retracts the mandible. Assists in rotation

68
Q

The lateral pterygoid is involved in what movements?

A

Positions disc in closing (superior head). Protrudes and depresses mandible and causes lateral movement (inferior head)

69
Q

The medial pterygoid is involved in what movements?

A

Elevates the mandible. Lateral movement and protrusion

70
Q

The masseter is involved in what movments?

A

Elevates and protracts the mandible. Assists in lateral movement

71
Q

Describe the movement of rotation of the condyle

A

*Small amount of mouth opening

*Condyle and disc remains within articular fossa

*No downwards or forwards movement

*Also known as hinge movement (rotation of the condylar heads around an imaginary horizontal line through the rotational centres of the condyles. The imaginary line is termed the terminal hinge axis)

*Facebows record terminal hinge axis and distance between the condyles.

72
Q

Describe translocation of the condyle

A

*Lateral pterygoid contracts

*Articular disc and condyle begin to move

*Travels downwards and forwards along the incline of the articular eminence

*May also travel laterally (laterotrusive movement)

73
Q

What is posselts envelope?

A

It traces the extremes of mandibular movement in the sagittal plane

74
Q

What are the 6 points in posselts envelope?

A
  1. ICP = intercuspal position
  2. E = edge to edge
  3. Pr = protrusion
  4. T = maximum opening
  5. R = retruded axis position

6 = RCP = retruded contact position

75
Q

Describe ICP (intercuspal position)

A

*tooth position regardless of the condylar position.

*The comfortable bite

*Best fit of the teeth

*Maximum interdigitation of the teeth

*Can be called centric occlusion

76
Q

Describe edge to edge

A

*Teeth slide forward from ICP guiding on palatal surfaces of anterior teeth.

*Incisal edges of upper and lower incisors touch

77
Q

Describe protrusion (Pr)

A

*Condyle moves forwards and downwards on articular eminence

*Only incosors +/- canines touch

*No posterior tooth contacts

*eventually no tooth contacts

78
Q

Describe maximum opening (T)

A

*No tooth contacts

*mouth wide open

*full translocation of the condyle over the articular eminence

79
Q

Describe retruded axis position (R)

A

*No tooth contacts

*Most superior anterior position of the condylar head in the fossa

*Terminal hinge axis

80
Q

Describe retruded contact position (RCP)

A

*First tooth contact when the mandible is in retruded axis position.

*ICP is approximately 1mm anterior to the RCT in 90% of the population

81
Q

How and when should you mark tooth contacts?

A

*using millers forceps and articulating paper

*Before; preparing a tooth or removing a restoration

*After; placement of a crown or restoration

82
Q

What is the definition of functional cusps?

A

*cusps that occlude with the opposing teeth in the intercuspal position. *The palatal cusps of the upper posterior teeth and the buccal cusps of the lower posterior teeth

83
Q

What is the definition of non-functional cusps?

A

*cusps that do not occluse with the opposing teeth in intercuspal position. *The buccal cusps of the upper posterior teeth and the lingual cusps of the lower posterior teeth

84
Q

What is the definition of a fossa?

A

*Depression or concavity on tooth surface

*Functional cusp of a tooth contacts the fossa of the opposing tooth

85
Q

Define ICP contacts

A

*The palatal cusp of an upper molar contacts the fossa of a lower molar

*The buccal cusp of a lower molar contacts the fossa of an upper molar

86
Q

Define overbite

A

Vertical overlap of incisors

87
Q

Define overjet

A

Relationship between the upper and lower teeth in horizontal plane

88
Q

Define crossbite

A

A condition where one or more teeth may be abnormally positioned bucally, lingually or labially with reference to opposing teeth. Can be anterior or posterior

89
Q

Define open bite

A

Anterior; lack of vertical overlap of anterior teeth when posterior teeth are in full occlusion.

Posterior/lateral; failure of contact between the posterior teeth when the teeth are in full occlusion

90
Q

Describe canine guidance

A

*Mandible moves to one side

*Contact only between the canines

*No posterior tooth contact; known as mutually protected occlusion.

*Gold standard of mutually protected occlusion is canine guidance, posterior disclusion in lateral excursions, no non working/working side contacts, no protrusive interferences

91
Q

Describe group function

A

*mandible moves to the left (working side), multiple teeth in contact on the left

*Bilateral group function frequently seen in tooth wear

*The most favourable alternative to canine guidance

*The most favourable group consists of canines, premolars and the mesio-buccal cusp of first molar

92
Q

What are occlusal interferences?

A

Undesirable tooth contacts that may produce mandibular deviation during closure to ICP or may hinder smooth passage to and from ICP

93
Q

What is working side contact?

A

When there is working side contact, similar cusps contact

94
Q

What is non working side contact?

A

Dissimilar cusps contact

95
Q

What is protrusive interference?

A

any posterior contact during protrusion

96
Q

Describe eccentric bruxism

A

*The parafunctional grinding of teeth.

*An oral habit consisting of involuntary rhythmic or spasmodic or functional gnashing, grinding or clenching of teeth in other than chewing movements of the mandible which may lead to occlusal trauma

97
Q

Describe centric bruxism

A

Clenching; the pressing and clamping of the jaws and teeth together. Frequently associated with acute nervous tension or physical effort

98
Q

What is occlusal trauma and what are the categories?

A

An injury resulting in tissue changes within the attachment apparatus, including periodontal ligament, supporting alveolar bone and cementum as a result of occlusal forces.

*Primary; intact periodontium

*Secondary; reduced periodontium

*Fremitus; palpable or visible movement of a tooth when subjected to occlusal forces

99
Q

List four causes of extrinsic causes of tooth discolouration

A

*Smoking

*Tannins (tea, coffee, red wine, guinness)

*Chromogenic bacteria

*Chlorhexidine

*Iron suppliments

100
Q

List five causes of intrinsic tooth discolouration

A

*Fluorosis

*Tetracycline

*Non-vitality (blood products)

*Physiological (age changes)

*Dental materials (amalgam, RF)

*Porphyria

*Cystic fibrosis

101
Q

How does vital external bleaching work?

A

*Discolouration is caused by the formation of chemically stable, chromogenic products withing the tooth substance

*These are long chain organic molecules

*Bleaching oxidises these compoounds

*Oxidation leads to smaller molecules which are often not pigmented

*Oxidation can cause ionic exchange in metallic molecules leading to lighter colour

102
Q

Name some constituents of bleaching gel

A

*carbamide peroxide, breaks down to produce hydrogen peroxide) *10% carbamide peroxide gives 3.6% hydrogen peroxide and 6.4% urea which increases the pH

*carbopol is a thickening agent that slows diffusion into enamel

103
Q

What warnings should be given to patients in regards to tooth whitening?

A

*sensitivity

*relapse

*restoration colour

*Allergy

*might not work

*compliance with regime

104
Q

What is internal non vital bleaching and what are the indications and contraindications?

A

Dead pulp bleeding into dentine. Blood products diffuse and darken, gives a grey discolouration.

Indications; non vital tooth. Adequate RCT. No apical pathology

Contra-indications; Heavily restored teeth. Staining due to amalgam. Doesnt always work but worth trying.

105
Q

What is microabrasion and what are the indications?

A

Removes discolouration limited to the outer layers of enamel. Combination of erosion (acid) and abrasion (pumice)

Indications; fluorosis, post ortho demineralisation. Demineralisation with staining. Prior to veneering if dark staining present

106
Q

What is the BEWE?

A
  • Basic erosive wear exam
  • Designed to follow a similar procedure as BPE
  • Should be used for every new patient exam
107
Q

What does a score of 0 in the BEWE indicate?

A

no erosive tooth wear

108
Q

What does a score of 1 on the BEWE indicate?

A

Initial loss of surface texture (brightness loss, opaque surface or frosted glass appearance)

109
Q

What does a score of 2 on the BEWE indicate?

A

Distinct defect, hard tissue loss, less than 50% of the surface area. Dentine could be involved

110
Q

What does a score of 3 on the BEWE indicate?

A

Hard tissue loss in more than 50% of the surface area. Dentine could be involved

111
Q

What is the definition of severe tooth wear?

A

Tooth wear with substantial loss of tooth structure, with dentine exposure and significant loss (> third) of the clinical crown

112
Q

Define pathological tooth wear

A

Tooth wear which is atypical for the age of the patient, causing pain or discomfort, functional problems, or deterioration of aesthetic appearance, which, if left to progress, may give rise to undesirable complications of increased complexity

3rd year dentistry (16 decks)

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