Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
698 Cards in this Set
- Front
- Back
Pulp Pain fibers
|
A-delta
- Larger myelinated nerves that cause quick, sharp, momentary pain that quickly dissapates - Intimate Association with odontoblastic cell layer and dentin is referred to as Pulpodentinal Complex C afferent fibers - Small unmyelinated nerves that course centrally in pulpal stroma - Diffuse Pain occurs with tissue injury and is mediated by inflammatory mediators, vascular changes, and increase in pressure - Felt as dull aching pain when exaggerated A-delta pain subsides and can spread to other teeth. - Signifies Irreversible local tissue damage |
|
Hyperalgesia
|
Exaggerated and disproportionate pulpal response to challenging stimulus
|
|
Pulpodentinal Complex
|
Intimate association of A-delta fibers with odontoblastic cell layer and dentin
*- C fibers are not associated with the Pulpodentinal complex |
|
Pulpal Disease Clinical Classifications - 4
|
1) WNL
2) Reversible pulpitis 3) Irreversible pulpitis, Symptomatic and Asymptomatic 4) Necrosis |
|
WNL Pulpal classification - 3
|
1) Asymptomatic
2) Normal pulp produces mild to moderate transient response to thermal and electrical stimuli and subsides almost immediately when stimulus is removed 3) No painful response upon percussion or palpation |
|
Reversible Pulpitis classification - 3
|
1) Thermal stimuli causes quick, sharp, hypersensitive response that subsides quick when removed
2) Can be caused by caries, SRP, Deep restorations without a base 3) If irritant is removed, will return to healthy state |
|
How to distinguish between Reversible and Irreversible Pulpitis and Crossover Point
|
1) Reversible pulpitis causes momentary painful response to thermal change that subsides quickly which Irreversible causes lingering pain
2) Reversible pulpitis does not involve spontaneous pain Crossover Point: Frank penetration of bacteria into the pulp |
|
Irreversible Pulpitis Classification - 3
|
Classified as Symptomatic and Asymptomatic Irreversible Pulpitis
1) Pulp has damaged beyond repair 2) See micro abscess of pulp begin as tiny zones of necrosis with inflammatory cells. Intact nerves seen in areas of degeneration 3) Pulpal death may occur quickly or require years. May be painful or asymptomatic |
|
Asymptomatic Irreversible Pulpitis possible Consequences - 2
|
1) Hyperplastic Pulpitis - Reddish cauliflower growth of pulp tissue through carious exposure. Attributed to low-grade chronic irritation and generous vascular supply in young people
2) Internal Resorption - Commonly identified during routine radiographic exam and can perforate the root - Only prompt Endodontic therapy will prevent further tooth destruction |
|
Histological Appearance of Chronic Pulpitis - 3
|
1) Chronic Inflammatory cells
2) Multinucleated giant cells adjacent to Granulation tissue 3) Necrotic pulp coronal to resorptive defect |
|
Symptomatic Irreversible Pulpitis - 4
|
1) Spontaneous intermittent or continuous pain
2) Temperature changes and sometimes Postural changes elicits prolonged episodes of lingering pain 3) May see thickening of apical portion of PDL 4) Electric pulp test has little value in diagnosing Symptomatic Irreversible Pulpitis |
|
Necrotic Pulp classification - 4
|
1) May result from untreated irreversible pulpitis, traumatic injury, or any even causing long term interruption to pulp blood supply
2) May be partial or total. Partial necrosis such as in one canal may present as irreversible pulpitis. Total necrosis is Asymptomatic before it affects PDL with no response to thermal or EPT 3) May present with Crown Discoloration in anterior teeth 4) Protein breakdown and bacterial toxins will spread down apical foramen to cause thikening of PDL and sensitivity to percussion and chewing |
|
Microscopic characteristics of Necrotic Pulp - 3
|
1) Liquefaction Necrosis in center of pulp due to inflammation
2) Increase in tissue pressure and destruction due to Insufficient drainage caused by lack of collateral circulation and unyielding dentin walls 3) Bacteria penetrating Dentinal Tubules, so its important to remove superficial layers of dentin during cleaning and shaping of canals |
|
General Characteristics of Periradicular diseases - 3
|
Sign most indicative of a periradicular inflammatory lesion is radiographic bone resorption but is unpredictable
No correlation between histologic findings and clinical signs. Acute and Chronic refers to clinical signs |
|
Classification of Periradicular disease - 5
|
Acute Periradicular Periodontitis
Acute Periradicular Abscess (Acute Apical Cyst) Chronic Periradicular Periodontitis Suppurative Periradicular Periodontitis (Chronic Periradicular Abscess) Chronic Focal Sclerosing Osteomyelitis (Condensing Osteitis) |
|
Acute Periradicular Periodontitis cause and characteristics
|
Can be due to
- Extension of pulpal disease - Canal overfill - Occlusal trauma May occur around vital and non vital teeth so pulp test to confirm need for endo |
|
Acute Periradicular Abscess cause and characteristics
|
aka Acute Apical Abscess
- Painful purulent exudate around apex - Result from exacerbation of Acute periradicular periodontitis - Rapid onset of swelling, pain, mobility - May be localized or spread to become Cellulitis |
|
Phoenix Abscess
|
Infection and rapid tissue destruction arising from within chronic periradicular periodontitis
Same symptoms as acute apical abscess When Periapical radiolucency is evident in Acute periradicular abscess its called a Pheonix Abscess |
|
Chronic Periradicular Periodontitis Cause and Diagnosis
|
- Long standing lesion usually accompanied by radiographic apical resorption
- Caused by bacteria and endotoxin release into periapical region from necrotic pulp, which provides safe harbor for bacteria from no vascularity Diagnosis confirmed by 1) Absence of symptoms 2) Confirmation of pulpal necrosis 3) Radiographic presence of periapical radiolucency |
|
Chronic Periradicular Abscess
|
aka Suppurative Periradicular Periodontitis
- Characterized by draining sinus tract - May also drain through gingival sulcus mimicking a peridontal pocket - Resolves with non-surgical RCT |
|
Condensing Osteitis
|
aka Chronic Focal Sclerosing Osteomyelitis
- Excessive bone mineralization around apex of asymptomatic vital tooth - Caused by low grade pulp irritation - Benign and Does not require RCT |
|
Characteristics of Non-odontogenic pain
|
- Episodic pain with remission
- Pain travels across midline - Pain that is seasonal or cyclic and surfaces with increasing mental stress - Paresthesia |
|
Systemic contraindications for RCT
|
Uncontrolled diabetes or MI within 6 months
|
|
Patient's description of pain location
|
- Pulp tissue only transmits pain, and no proprioception
- Once infection reaches PDL, proprioceptive fibers will allow easier identification |
|
Referred odontogenic Pain
|
- Rare to cross midline
- Pain in molars can be referred to opposing quadrant or other teeth in same quadrant - Maxillary molars refer pain to zygomatic, parietal, and occipital regions - Mandibular molars refer pain to ear, angle of jaw, or posterior neck |
|
Palpation
|
When periradicular inflammation from pulpal necrosis has begun burrowing through facial cortical bone affecting overlying mucoperiosteum
- May feel tenderness before swelling is evident |
|
Percussion
|
- Does not reveal health of pulp but shows inflammation of apical PDL
- Degree of response correlates to degree of PDL inflmmation - Clinician should first percuss with finger, then move to mirror if patient is unable to discern Other causes of percussion sensitivity - Rapid ortho movement - Recently placed restoration in hyperocclusion - Lateral Periodontal Abscess |
|
Thermal Test
|
Valuable to pinpoint when pain is diffuse. Careful to avoid refractory response from repeated stimulation
4 Responses - No response: Non vital pulp, or may be false negative from calcification, immature apex, or recent trauma - Mild to Moderate response with 1-2 seconds. Normal - Strong painful response that subsides in 1-2 seconds. Reversible pulpitis - Strong response that lingers. Irreversible Pulpitis Cold test - Cold water bath, ice, Ethyl chloride, Dichlorodifluoromethane (DDM;Endo-Ice), Carbon dioxide ice sticks - Use cotton pellet in middle 3rd of facial surface for 5 sec or when patient feels pain Heat test - Hot water bath will yield most accurate patient response |
|
EPT
|
Contraindicated with Pace Makers
- Does not suggest health or integrity of pulp, and does not provide information about vascular supply to pulp - Does not correlate with histologic health or disease status or pulp - Only indicates that there are vital sensory fibers within pulp - Dry tooth and code Electrode with viscous conductor - Apply to middle third of facial surface. Not to restorations False Positives - Contact electrode with metal restoration of gingiva - Patient anxiety - Failure to isolate False Negatives - Patient heavily premedicated - Recently traumatized tooth or excessive calcification of canal - Partial Necrosis |
|
Mobility Endo test
|
Tooth mobility is directly proportional to integrity of attachment apparatus or extent of PDL inflammation
Other causes for mobility - Horizontal root fracture - Recent trauma - Chronic Bruxism - Excessive Ortho |
|
Radiographic PA radiolucency initiation
|
Does not appear until demineralization extends through cortical plate of bone
|
|
Cracked Tooth Syndrome symptoms, diagnosis, and treatment
|
- Sustained pain during biting and upon release
- Sensitivity to thermal changes and mild stimuli Diagnosis - Transillumination & Tooth Slooth - Stain or use stream of air to detect pain from crack Treatment 1) Healthy pulp - Splint with ortho or prep and observe with temp 2) Irreversible pulpitis or necrosis - Endo and crown, maybe post |
|
Vertical Root Fracture
|
- Usually in buccal lingual plane
- May show J shaped radiolucency from apex to middle of root - May be caused by mechanical stress and over enlargement from obturation or unfavorable posts Diagnosis is confirmed with exploratory flap - Hopeless prognosis. May do hemisection for a multi-rooted tooth |
|
Perio-Endo relationships communication, characteristics, and types
|
Communicates via Tubules, Lateral or accessory canals, Furcation canals, or apical foramen
- Endo can cause perio disease but perio generally doesn't cause endo Types Primary Endo lesion - Non vital tooth, with possible sinus tract appearing like narrow pocket - Treat with endo Primary perio - Starts in sulcus and migrates to apex - Broad based pocket formation in vital tooth - Treat with periodontal therapy Primary Perio with secondary Endo - Deep pocketing with extensive perio - Endo First then periodontal therapy True Combined lesions - Once endo and perio lesions coalesce, they are indistinguishable - Prognosis depends on the degree of periodontal component |
|
Working Length determination
|
Select reference point and take diagnostic film with 10k or 15k file
Estimate working length and adjust to 1mm short of radiographic apex |
|
File Dimensions
|
D0 - File size a tip. Size 8 file is 0.08mm at tip
D16 - Diameter where cutting flutes end, usually 16mm for most files Taper - Amount that the file diameter increases each millimeter up from tip. 8 file with 0.02 taper D0 - 0.08mm D16 - 0.4 |
|
Best indicator of clean walls
|
Level of smoothness obtained
|
|
Irrigation and Medicaments
|
Sodium Hypochlorite - NaOCl
- Disinfects root canals with Hypochlorite Anion ClO- - Dissolves Organic matter - DOES NOT remove smear layer EthyleneDiamineTetraAcetic acid - EDTA - Aqueous solution of 17% EDTA - Removes Inorganic matter and Smear layer - Chelating agent Calcium Hydroxide - CaOH - Best intracanal medicament - High pH causes antibacterial affect - Inactivates LPS and dissolves tissue |
|
Sodium Hypochlorite Accident
|
Signs & Symptoms
- Instant extreme pay - Excessive bleeding from tooth - Rapid swelling - Bruising and sensory/motor deficits Treatment - Long lasting anesthetic - Steroids & Antibiotics - Daily follow up |
|
Gutta Purcha advantage and disadvantage
|
Advantages
- Plasticity - Easy to manage and remove - Little toxicity and does not support bacterial growth Disadvantage - Does not seal without sealer - Lack of adjesion to dentin - Elasticity causes rebound and cooling shrinkage |
|
Trephination
|
Surgical perforation of alveolar cortical bone to release accumulated exudates
|
|
Anesthesia in presence of infection
|
Difficult to achieve due to acidic pH of abscess and Hyperalgesia
|
|
Root end resection indications, contraindications, and procedure
|
aka Periradicular surgery or Apicoectomy
Indications - Persistent or enlarging PA pathosis following RCT - Biopsy Contraindications - Anatomic & Neurovascular factors - Nonrestorability, Poor crown to root Procedure - Remove diseased root tip - Use a lesser bevel 0-20 degrees rather than traditional 45deg to decrease leakage - Remove 3mm if possible and leave 3mm for root end cavity prep and filling |
|
Hemisection
|
Surgical division of a multirooted tooth and defective half is extracted
Indications - Class 3 or 4 periodontal furcation defect - Vertical root fracture - Coronal fracture extending to furcations Requires RCT treatment on all retained root segments. Preferable to complete root canal with permanent restoration prior to hemisection |
|
Bicuspidization
|
- Surgical division where both halves are retained
- Results in separation of roots and creation of two separate crowns |
|
Root resection
|
aka Root amputation
Removal of one or more roots of a multi-rooted tooth - Requires RCT in all retained root segments preferably beforehand |
|
Intentional Replantation
|
Insertion of a tooth into its alveolus after the tooth was extracted to do a root-end filling
- Indicated when PA surgery is not possible or presents a high risk to anatomical structures - If possible, preform RCT before procedure |
|
Surgical removal of apical segment of fractured root
|
Indicated when coronal tooth segment is restorable and functional
- Raise flap, remove targeted tissue |
|
Categories of Endo emergency
|
Pretreatment
- Presents with pain and/or swelling - Challenge is diagnosis and treatment of offending tooth Interappointment and postobturation emergency - aka Flareup - Easier to manage since offending tooth was identified - No relationship exists between flareups and treatment procedures |
|
Management of Painful Irreversible Pulpitis
|
- Complete RCT is preferred tx
- Pulpotomy is usually effective in absence of percussion sensitivity - Chemical medicaments sealed in chambers are not effective for pain - Antibiotics are not indicated |
|
Management of Pulpal necrosis with PA pathosis
|
No swelling
- Complete canal debridement Localized swelling - Complete debridement and drainage from tooth and/or mucosa - Seldom have elevated temperatures so antibiotics are not necessary Diffuse swelling into facial spaces - Most important is removal if irritant via canal debridement or exo - Swelling incised and drained with possible drain insertion for 1-2 days - Systemic antibiotics are indicated for diffuse rapid swelling |
|
Glutaraldehyde
|
Only used for instruments that can't withstand heat
- 24hrs of immersion are required to achieve cold sterilization - Immersion is good for disinfection but will not sterilize |
|
Pressure sterilization
|
Wrapped and autoclaved
- 121 deg Celcius and 15psi - 20 Minutes - Kills all bacteria, spores, and viruses - Chemical instead of water causes less rusting - Both steam and chemical will dull edges of cutting instruments |
|
Dry Heat Sterilization
|
Best for preserving cutting edges
- 60minutes after reaching 160 Celcius - If falls below 160, must repeat full 60 minute cycle - Disadvantage is time required for sterilization and cooling |
|
Endo Disinfection
|
Sponge soaked in 70% Isopropyl alcohol or Quaternary ammonium solutions
- Cleans but does not disinfect instrument |
|
Endo radiograph technique
|
Paralleling technique is most accurate
- Less distortion and better reproducibility Modified parallel technique is acceptable Bisecting angle is lease accurate technique |
|
Exposure and film
|
E film at intermediate kilovoltage - Adequate clarity and decreased exposure
F film - requires 20-25% less exposure than E film |
|
Optimal Voltage setting for maximal contrast
|
70 kV gives maximal contrast between radiopaque and radiolucent structures
|
|
Microbiology of Endo, Primary vs Secondary
|
- Polymicrobial infection
- Positive correlation between number of bacteria and size of Periradicular Radiolucency Primary - Strict Anaerobes predominate - Gram Neg: Porphyromonas species and Bacteroides Melaninogenica - Gram Pos: Actinomyces from root caries Secondary - From unsuccesful RCT - High faculative anaerobes - Enterococcus Faecalis: Rarely found in infected but untreated tooth |
|
LPS in endodontics
|
Endotoxin found on surface of Gram Negative bacteria
- Capable of diffusing across dentin - Relationship has been established between presence of endotoxins and PA inflammation |
|
Antibiotics used in Endo
|
Pen VK
- First choice and effective against most strict anaerobes and gram positive faculative anaerobes Clindamycin - Effective against many gram pos and neg, strict and faculative anaerobes Metronidazole - Effective against strict anaerobes but not others |
|
Transportation
|
Tendency of files to cut dentin towards the outside of the curvature at the apical portion of root
- May gouge into dentin and create a ledge or perforation |
|
Types of perforations
|
Coronal perforation
Furcal perforation - usually occurs during searching for canal orifices - Must be repaired Immediately Strip perforations - Involves Furcation side of coronal root surface - Result of excessive flaring Root perforations - Apical perforation - Midroot perforation |
|
Prognosis of Perforations
|
Perforation into PDL results in a questionable prognosis and patient must be informed
- If located above alveolar bone, more favorable. Can repair with restoration - If below crest, attachment often recedes to extent of defect and perio pocket forms |
|
Treatment of Perforations
|
Surgical repair: Try to position apical portion of defect above crestal bone
- Hemisection - Root amputation - Intentional replantation Nonsurgical repair - Mineral Trioxide Aggregate (MTA) has show to promote deposition of cementum like material |
|
Exam of Traumatic injuries of teeth
|
- Teeth are sensitive to percussion
- Apical displacement with injuries to vessels may result in pulpal necrosis Vitality testing - Testing immediately following injury may yield a false negative - Should serve as baseline for future reference up to 6-12 months - Tests should be repeated at 3wks, 3 months, 6 months, 12 months, and yearly |
|
Uncomplicated Fractures
|
1) Infraction - Incomplete crack of enamel without loss of tooth struction
2) Ellis Class I - Enamel fracture - Involves enamel only - Grind and smooth rough edges or restore lost structure 3) Ellis Class II - Crown fracture without pulpal exposure - Enamel and Dentin only - Restore with bonded resin |
|
Complicated Fractures
|
Ellis Class III
- Involves pulp exposure Treatment depends on factors - Immature tooth, vital pulp therapy should be attempted - Within 24hrs after traumatic injury, initial reaction is proliferative with no bacteria - Periodontal injury compromises nutritional supply - More complex restorations should have RCT first |
|
Horizontal Root Fracture Diagnosis and Healing Patterns,
|
Coronal segment is usually displaced and apical segment remains fixed
- May have necrosis of coronal segment while apical segment remains vital Diagnosis - May be oblique, and PA may miss it - Radiographs should include an occlusal, and three PA's, 0deg, +15deg, and -15deg from vertical Healing patterns: Four types. First three is good 1) Healing with calcified callus at fracture site. Ideal healing 2) Healing with interproximal connective tissue 3) Healing with bone and connective tissue 4) Interproximal inflammatory tissue without healing |
|
Horizontal Root Fracture Treatments and Prognosis
|
Coronal fracture
- Extremely Poor prognosis - Stabilize coronal fragment with rigid splint for 6-12wks - May have to extract coronal portion and restore root later Midroot fracture - Stabilize for 3 wks - Pulp necrosis occurs 25% of time usually limited to coronal segment Apical Root fracture - Best prognosis - Pulp will most likely be vital and tooth will have little to no mobility Prognosis - Improves approaching the Apex - Horizontal > Vertical - Oblique > Transverse - Non-displaced > Displaced |
|
Luxation types
|
Ellis Class V
- Tooth Dislocated from Alveolus 1) Concussion: No displacement with normal mobility - Take baseline vitality and make Occlusal adjustment. No immediate treatment 2) Subluxation: Tooth is loosened but not displaced - Baseline vitality and occlusal adjustment - Splint for 3wks if mobile - 6% rate of pulpal necrosis with closed apicies - 0% with open apicies 3) Extrusion or Lateral Luxation: Partially extruded from socket - May have involved alveolus - Take radiographs, reposition teeth, and splint - Endo if necessary - 65% necrosis for Extrusive, 80% for Lateral Luxation 4) Intrusive Luxation: Apical displacement - If immature tooth, allow to re-erupt - Mature teeth can have orthodontic or surgical repositioning - Endodontic treatment is indicated since there is 96% rate of necrosis |
|
Ellis Class 4
|
Traumatized tooth that has become non-vital without loss of tooth structure
|
|
Avulsion Treatment
|
Ellis Class 6- Complete separation from Socket
Treatment - Reimplant immediately if possible to prevent tooth resorption - Critical time: 90% if less than 15 minutes, 50% at 30 minutes, and 10% at 60 minutes Closed Apex 1) Less than 1 hour - Do not handle root surface and do not curette socket - Reimplant and stabilize for 7-10days - PCN 4x a day for 7 days or Doxycycline 2x a day for 7 days - Refer to Physician for Tetanus 2) Greater than 1 hour - Remove debris and necrotic PDL - Immerse in 2.4% Sodium Flouride with 5.5 pH for 5min and reimplant - Stabilize and give antibiotics - Refer for Tetanus Open apex 1) Less than 1 hour - Clean if contaminated with saline stream - Place in doxycycline 1mg/20ml saline - Stabilize and give antibiotics - Refer for tetanus 2) Greater than 1 hour - Replantation is usually not indicated Endo tx 1) Closed Apex - Initiated 7-10 days - Give long tern CaOH if RCT is delayed or resorption is present 2) Open Apex - Should check for Re-Vascularization and avoid Endo treatment. |
|
Tooth Storage Media
|
Optimal Storage Environment (OSE) maintains and reconstitutes metabolites
- Viaspan - Hank's Balanced Salt Solution (HBSS) Wet: Maintains viability - Milk - Saline - Saliva: Hypotonic, Cell lysis - Water: Least desirable |
|
Consequence of Attachment damage
|
External Resorption
1) Surface resorption - Extremely common and self limiting - Due to mechanical damage to Cementum - Root surface undergoes destruction and repair 2) Replacement Resorption - Ankylosis Occurs in 60% of replanted teeth - Continous replacement of loss root with bone - Show progressive submergence and is irreversible - Metallic sound upon percussion 3) Cervical Resorption - May be due to trauma, ortho or perio treatment, and bleaching - Vitality testing normal - Usually begins at attachment level CEJ and has moth eaten appearance - May mimic cervical caries or internal resorption - Pink spot possible due to granulation tissue - Surgically remove granulation tissue and restore |
|
Consequence of Neurovascular Supply damage
|
1) Pulpal Obliteration: Calcific Metamorphosis
- 27% of postluxation complications - Increased chance with immature teeth, intrusions, and severe crown fractures 2) Pulpal necrosis - Concussion 2% - Subluxation 6% - Extrusion 65% - Lateral Luxation 80% - Intrusion 96% - Immature development 17% - Mature development 68% 3) Inflammatory Resorption - Occurs as bacteria and toxins enter dentinal tubules and lowers pH - Shows bowl shaped resorption in dentin and cementum as early as 3wks post trauma - Usually at apical 3rd of root, may progress into entire root |
|
Materials for Pulp therapy
|
Calcium Hydroxide
- High pH of 12.5 cauterizes tissue and causes superficial necrosis - Encourages pulp to induce hard tissue repair with secondary odontoblasts Mineral Trioxide Aggregate (MTA) - Portland Cement derivative made of Fine Hydrophilic Particles - Calcium phosphate and Calcium oxide - Sets in moisture and is non-resorbable |
|
Indirect Pulp Cap
|
Material is placed on thin remaining carious dentin
- Used when teeth have deep carious lesions near the pulp but no signs of pulpal degeneration - Wait 6-8wks for deposition of reparative dentin to allow remineralization |
|
Direct pulp cap
|
Dental material placed directly on a vital pulp exposure
- Pulp exposed less than 24hrs - Asymptomatic with small exposure site - Test and take radiograph at followup |
|
Partial Pulpotomy
|
Surgical removal of a small portion of coronal pulp tissue
- Used when inflammation is less than 2mm into pulp chamber but hasn't reached roots or with traumatic exposures less than 24hrs - Test and take radiograph at next visit |
|
Pulpotomy
|
Surgical removal of coronal portion of vital pulp to preserve vitality of remaining radicular pulp
- Vital pulp in immature teeth with exposure after 72hrs - No history of spontaneous pain, abscess, radiolucency or mobility - Cannot determine if all diseased tissue was removed |
|
Apexogenesis
|
Maintain pulp vitality to allow development of entire root
- Root formation is usually complete 3yrs after eruption - Used in immature tooth with incomplete root formation with damaged coronal pulp but healthy radicular pulp |
|
Non-Vital pulp therapy
|
Pulpectomy
- Not vital pulp therapy because tooth is pulpless Apexification - To stimulate formation of calcified tissue at open apex of pulpless teeth - Used for teeth with open apices that can't be obturated |
|
Internal bleaching techniques
|
1) Thermocatalytic Technique
- Place oxidizing agent, 30% H2O2 Superoxol, in chamber and apply heat - May have external cervical resorption from chemicals and heat 2) Walking bleach - Place mix of Sodium Perborate and water in chamber - Return in 2-6wks |
|
Considerations of Endodontically treated teeth
|
- Major cause of endo failure is Coronal Leakage. Coronal seal is more important than Apical seal
- Endo treated teeth do not become brittle, and moisture content stays the same - Presence of PA lesion will reduce success rate of Endo by 10-20% - 1mm Ferrule will have double the fracture resistance - Atleast 4-5mm of apical gutta percha is recommended after Post insertion |
|
Strep Mutans
|
- Nonmotile gram-positive cariogenic bacteria
- Adheres to enamel and forms polysaccharide to adhere to tooth - Produces and tolerates acid - Thrives on sucrose - Produces Bacteriocins to kill off competing organisms |
|
Site of Initial decalcification
|
Initial decalcification occurs at the subsurface and may take 1-2 years before cavitating
|
|
Protective mechanism of Saliva
|
1) Glycoproteins clear
2) Urea and other compounds buffer 3) Lysozyme, Lactoferrin, Lactoperoxidase, and IgA are antimicrobial 4) Remineralization |
|
Benefits of Fluoride
|
- Bacteriocidal
- Provides fluoride ion for remineralization |
|
Xylitol
|
Natural 5 Carbon sugar from Birch trees
- Cannot be fermented by MS |
|
Indirect Tooth colored restorations
|
Processed Composites
- Improved wear resistance against direct composites - Indicated for conservative Class 1 and 2 restorations Felspathic Porcelain - Highly esthetic but high incidence of fracture - Also wears opposing teeth Cast Ceramic - Excellent fit, and superior strength - Also low abrasion CAD/CAM - One appointment is required - Superior physical characteristics compared to direct composite and highly esthetic - More costly |
|
Indication for Cast Metal Restorations
|
- May be treatment of choice for patients undergoing occlusal rehabilitation
- Also good for preps with deep subgingival margins |
|
Hand Instrument Materials
|
Carbon Steel
- Harder than stainless steel - Corrodes if unprotected Stainless steel - Will not corrode but will lose it's edge Carbide - Hard and wear resistant - Brittle |
|
Instrument Design
|
Cutting
- Handle, Shank, Blade Non cutting - Part corresponding to blade is the Nib. - End of the Nib, or working surface is called the face |
|
Cutting instrument formulas
|
First number
- Width of blade in tenths of a millimeter Second number - Primary cutting edge angle from line parallel to handle in clockwise centigrade. - Expressed as a percent of 360deg and usually exceeds 50 - If edge is perpendicular to the blade, then this number is usually omitted Third number (Or second in a 3 number) - Blade length in millimeters Fourth number (Or third in a 3 number) - Blade angle relative to long axis of handle in clockwise. - This number is always 50 or less |
|
Common Design of Burs
|
Shank
Neck Head |
|
Round Bur
|
- Initial Entry
- Extension of preps for retention and caries removal |
|
Excavators
|
Hatchet
- Cutting bedge is parallel to handle and is bibeveled Hoes - Primary cutting edge of blade is perpendicular to axis of handle - Usually used in a pull motion Angle formers Spoons |
|
Handpiece Speed Ranges
|
Slow Speed
- 12k RPM Intermediate - 12k - 200k RPM High Speed - Greater than 200k RPM |
|
Inverted Cone Bur
|
- Apex directed towards shank
- Head length is appx same as diameter - Used for making undercuts |
|
Parts of Diamond Instrument
|
Metal Blank
Powdered diamond abrasive Metallic bonding material honding diamond powder onto blank |
|
Initial Preparation
|
Extension of preparation walls to sound tooth structure in all directions except pulpally
- Extension to initial depth of 0.2 to 0.75mm into dentin |
|
Enameloplasty
|
Removal of defect no deeper than 25% thickness of enamel
- If thicker than one fourth, wall must be extended |
|
Pulpal Communication Size
|
<1mm
- Direct Pulp cap - Use Calcium Hydroxide and Resin Modified Glass ionomer >1mm - Endo treatment |
|
Liners and Bases
|
Liner
- To cover a direct or near pulpal exposure with calcium hydroxide - May use RMGI for composites as stress breakers for class 1 or on root-surface portion of class 2 Base - Additional bulk provides mechanical and thermal protection to pulp under metal |
|
Amalgam Liners and bases
|
Shallow - 2mm or more
- Dentin sealer or desensitizing agent such as Gluma Desensitizer is used Moderately Deep - 0.5-2mm - Light cured RMGI base can be considered followed by dentin sealer/desensitizing agent - Goal is to provide the 2mm Deep - May involve exposure less than 1mm - Calcium Hydroxide 0.5-0.75mm - RMGI base - Gluma Desensitizer |
|
Composite & Cerec liners and bases
|
Shallow to moderately Deep
- If more than 0.5mm, no liner or base is needed Deep - Calcium hydroxide 0.5-0.75mm - RMGI Base - Gluma Desensitizer |
|
Gold liners and bases
|
Shallow
- Nothing is needed - RMGI cement can be used for cementation Moderately deep - RMGI for axial and pulpal wall contour Deep - Calcium hydroxide, RMGI, |
|
Amalgam types and properties
|
Low Copper
- Generally Inferior High Copper 1) Spherical - Greater Leakage - Greater postoperative sensitivity 2) Admix Properties - Linear coefficient of Thermal Expansion is greater than tooth - Tensile strength is lower than tooth - Compressive strength is similar - Brittle, and low edge strength - High Thermal Conductivity |
|
Initial Amalgam Prep Depth
|
0.2mm inside DEJ or 1.5mm from central groove whichever is deeper
- Initial depth of axial wall should be 0.2mm inside DEJ with no retention locks, 0.5mm if retention locks are used - Axial depth on root surface should be 0.75 to 1mm deep |
|
Tooth Damage
|
Attrition - Normal tooth wear
Abrasion - Mechanical wear from external source such as toothpicks Erosion - Wear due to chemical presence Abfraction - Biochemical loading causing bending and damage at cervical |
|
Composite shrinkage forces
|
Up to 7 Megapascals
1MPa = 150lb/sq inch |
|
Total Etch micrscopic effects
|
Tooth structure etched with 35% phosphoric acid to open microspaces in enamel and dentin
- Etched enamel looks chalky, Dentin does not Etched dentin exposes layer of collage and primer raises collagen Adhesive flows between collagen and interlocks with it to form a hybrid layer - Most bond strength is from formation of hybrid layer Seals the dentin |
|
Etch, Primer, and Adhesive/Bond
|
Etch
- 35% Phosphoric acid - Etches our hydroxyapatite to leave collagen fibrils - Removes smear layer - Widens dentinal tubules - Demineralized dentin surface Prime - Hydroxyethyl Methacrylate/bi-phenyl dimethacrylate (HEMA/BPDM) - Resin monomer wetting agent - Wets dentin to increase surface tension and bonds to overlying resin Bond - Bisphenol A glycidyl Methacrylate (BISGMA) - Penetrates primed intertubular dentin and tubules - Bonds primer and composite |
|
Self Etching Primer (SEP)
|
All in one
- Does not remove smear layer - not as good bonding to dentin Two step - Does not remove smear layer - Requires appx five coats - No rinsing or worrying about moisture |
|
Types of Composites
|
Unfilled resins
- Esthetic and smooth - Discolor and quickly wears over time Silicate Cements - Fluoride released - Biodegraded over time Conventional Composites - Glass fillers - Improved qualities with some roughness Microfill composites - Very smooth and good wear resistance - Reduced physical properties Hybrids - aka Composite resins and Resin based composites Flowable composites - Lower filler content - High polymerization shrinkage Packable composites - Increased viscosity Nanofill composites - Can incorporate high filler content - Good potential |
|
Gold Inlay Draw/Draft
|
0.2 - 5 degrees per wall
|
|
Burnishable gold margin
|
Must be between 30-50deg
- Gold margins less than 30 degrees may be too thin and fracture - Margins greater than 50 won't bend |
|
Gold Inlay tooth preparation
|
- Use diamond
- 0.5mm Bevel at 40 degrees - Cusp counterbelvel and gingival margin bevel should be 0.5-1mm and at 30 degrees |
|
Restoration Coefficient of Expansion
|
Composite
- Greatest - 2.5 times tooth Amalgam - 2 times greater than tooth Gold - Slightly higher than tooth |
|
Contraindications
|
- Severe uncontrollable diabetes
- End stage renal disease - Advanced cardiac conditions Patients with Lymphoma, Leukemia, clotting disorders, Pericoronitis, should be treated prior to extraction. |
|
Contraindications to extraction of impacted teeth
|
Extremes of age
- Pre-teens - Asymptomatic full bony impaction greater than 35yrs Compromised medical status Likely damage to adjacent structures |
|
Classification of Impacted teeth
|
Angulation
- Mesioangular: Least difficult - Horizontal - Vertical - Distoangular: Most difficult Pell and Gregory Classifications Relationship to anterior border of ramus - Class 1: Normal position anterior to ramus - Class 2: Half of crown in in ramus - Class 3: Full crown is embedded Relationship to occlusal plane - Class A: Tooth at same plane as other molars - Class B: Between occlusal and cervical line of second molar - Class C: Below cervical line of second molar |
|
Localized Osteitis
|
aka Dry Socket
- Occurs in 3% of mandibular 3rd molar extractions - Does not require antibiotics - Irrigate and pain control |
|
Most common graft sites for Autogeneous bone
|
Iliac crest
Rib Anterior cortex of chin Lateral cortex of ramus/external oblique ridge |
|
Radiographic evaluation of Mandible fractures
|
- Can almost always identify on Panoramic
- Should be visualized in atleast two radiographs - Panoramic, Townes, Posterior Anterior skill, Lateral oblique |
|
Most common sites for mandibular fracture
|
Condyle
Angle Symphysis Body - Least likely is Coronoid Process |
|
Types of mandibular fractures
|
Greenstick
- A partial breakage in bone Simple - Fracture with no damage to soft tissue Compound - Breakage in soft tissue Comminuted - Broken into a number of pieces |
|
Apertognathia
|
Anterior Open bite
|
|
Maxillary and Mandibular surgery
|
Maxillary
- LeFort I osteotomy - Can be more easily moved down and forward than up and back Mandibular - Bilateral Saggital Split osteotomy - Vertical ramus Osteotomy - Genial osteotomy/Genioplasty |
|
Neuropathic Facial pain
|
Trigeminal Neuralgia
- aka Tic Douloureux - Treated with anticonvulsant drugs such as Carbamazepine, Oxcarbazepine, Gabapentin |
|
TMD Surgical Treatments
|
Arthroscopy
- Placement of two cannulas to allow access for intracapsular instrumentation of superior joint space Disc repositioning Surgery - Disc is mobilized and repositioned - Used for painful persistent clicking - 10%-15% reported no benefit or worsened Discectomy - When disc is severely damaged and associated with pain and dysfunction Condylotomy - Intraoral Vertical Ramus Osteotomy without fixation to allow muscles to guide condyle Total Joint Replacement - Seen in RA, Ankylosis, Neoplasia, etc - Costocontral bone graft is most common |
|
Organisms and Pathophysiology of Odontogenic Infections
|
Organisms
- Aerobic and Anaerobic Gram-Positive Cocci - Anaerobic Gram-Negative Rods Pathophys - Strep species initiate process - Cellulitis occurs - Anaerobic bacteria proliferate |
|
Aspiration Biopsy
|
Atleast 2mL of purulent aspirate is adequate
- Use 5-10mL syringe with 18 gauge needle |
|
Osteomyelitis
|
Inflammation of Medullary bone
- Rare and more common in mandible due to lower blood supply - Organisms are similar to those causing odontogenic infection - Occurs through vascular channels |
|
Malignant Jaw Tumors Characteristics
|
- Most common are Epidermoid Carcinomas from Squamous cell
- Other sources of primary malignancy include salivary glands, blood vessels, lymphatics, muscle, bone, and other connective tissue - Common H&N Metastases are from Breast, Prostate, Lung, Kidney, Thyroid, Blood, and Colon |
|
PD and PK of Local Anesthetics
|
PharmacoDynamics
- Blocks sodium channels - Must block a minimum number of nodes of Ranvier to block action potential - All nerves are susceptible to blockade motor and sensory - Sensations return in order of Pain, Cold, Hot, Touch, Pressure, Motor PharmacoKinetics - Increased Protein binding and Lipid solubility increases duration - Lower pKa, more acidic, faster the onset, but does not affect duration |
|
Anesthetic Allergies
|
Allergic Responses
- Esters metabolized in the Plasma, have 5% Incidence. Only one with Ester bond is Articaine, but connecting chain is Amide - Amides metabolized in the Liver have low incidence <1%. All are Tertiary Amines - Benadryl is good choice Metabisulfite - Antioxident with low incidence of allergenicity - Protects vasoconstrictor from oxidation Methemoglobinemia - Unique to Prilocaine when exceeding 600mg for a 70kg adult - Lower dose applies to hereditary methemoglobinemia |
|
Drug & Pregnancy interactions Local Anesthetics
|
Antidepressants
- Amitriptyline, Trazadone - Increases sensitivity to Epinephrine Nonspecific Beta Blocker - Propranolol/Inderal - Decreases HR while Epi increases it. Net result is increase in BP without Tachycardia Pregnancy and Lactation Class C - Bupivacaine, Mepivacine, Articaine, Epinephrine Class B - Lidocaine, Prilocaine |
|
Local anesthetic Max dose
|
Normal - 0.2mg of Epi
CV compromised - 0.04mg per appt |
|
Needle Dimensions
|
Length
- Short needles average 20mm - Larger needles average 32mm Size - 30 Gauge 0.3mm - 27 Gauge 0.4mm - 25 Gauge 0.5mm - Positive aspiration is directly correlated to Needle Gauge - Patients cannot tell diff between 25,27 and 30 gauge needles |
|
PSA
|
Area of anesthesia
- Maxillary molars - Does not anesthetize palatal tissue - May not anesthetize mesiobuccal aspect of first molar Technique - 45,45,45 - 15-16mm depth |
|
Anterior Superior Alveolar Block
|
aka Infraorbital block
Area - Midline of maxilla to Mesiobuccal of First Molar Technique - Just below the IO rim along the line from pupil to ipsilateral commissure of lip - Penetrate over maxillary first premolar - 15mm deep and inject 1.0mL - Apply pressure for 2min |
|
Greater Palatine Block
|
Area
- From canine to posterior hard palate - From gingival margin to palatal midline Technique - Located halfway between gingival margin and midline of palate 5mm anterior to junction of hard and soft palate - Pressure anesthesia for 20 sec - Penetrate to bone about 5mm |
|
Nasopalatine
|
Area
- Palatal tissue from canine to canine Technique - Topical, and Pressure - 45deg penetration at junction of palate and incisive papilla |
|
Vazirani-Akanosi
|
Good for uncooperative children, or patients with trismus
Area - IAB, Lingual and Long buccal Technique - Inserted parallel to maxillary occlusal plane at level of buccal vestibule - Penetrate about 1/2 mesiodistal length of ramus about 25mm in adults. Hub should be opposite mesial of second molar - Injection is performed blindly because no bony endpoint exists |
|
Gow-Gates
|
Unique because operator does not attempt to get as close to nerve as possible
Area - IAB, Lingua, Long buccal 75% of time - Auriculotemporal - Mylohyoid nerve Technique - Patient open as widely as possible to translate condyle - Make puncture at distobuccal cusp of maxillary second molar - Contact bone and inject |
|
Systemic Sequelae of Obstructive Sleep Apnea Syndrome
|
HTN
Cor Pulmonale Cardiac Arrhythmia |
|
Local Anesthetic Concentrations and Max Dose
|
Lidocaine - 2% 300mg 4.4mg/kg
Mepivacaine - 300mg 4.5mg/kg - Only one packaged in both 2% and 3% in US Prilocaine - 4% 400mg 6mg/kg Articaine - 4% 500mg 7mg/kg Bupivicaine - 0.5% 90mg 1.3mg/kg |
|
Cleft rates
|
Lip
- 1 in 1000 births but varies with race - 80% unilateral 20% Bilateral Palate - 1 in 2000 births - Cleft lip 25%, Cleft Palate 25%. Both 50% |
|
Congenital Thyroid problem
|
Lingual Thyroid
- Midline tongue base - Cased by incomplete decent of thyroid anlage - May be patient's only thyroid Thyroglossal Tract cyst - Midline neck swelling due to cyst change - Along embryonic path of thyroid descent |
|
Geographic Tongue
|
- Common benign condition of tongue
- White annular lesions surrounding atrophic red central zones - May feel burning - No treatment necessary |
|
Causes of Macroglossia
|
- Congenital hyperplasia/hypertrophy
- Lymphagioma - Salivary gland tumors - Acromegaly, Gigantism - Cretinism - Amyloidosis |
|
Melkerson-Rosenthal Syndrome
|
aka Cheilitis Granulomatousa
- Granulomatous Cheilitis - Fissured Tongue - Facial Paralysis |
|
Sturge-Weber Syndrome
|
aka Encephalotrigeminal Angiomatosis
- Skin lesions along branches of trigeminal nerve. Port Wine Nevus - Leptomeninges of cerebral cortex also calcify leading to mental retardation and seizures |
|
Hygroma Coli
|
aka Cystic Hygroma
- Most common form of Lymphangioma - Commonly occurs in left posterior triangle of the Neck |
|
Oral Lymphoepithelial Cyst
|
- Lymphoid cyst that is the counterpart of Branchial Cleft cyst
- Common in soft palate, oral floor, and lateral tongue |
|
Globulomaxillary Cyst
|
Clinical term denoting any pathologic lucency between maxillary cuspid and lateral incisor
|
|
Nicotine Stomatitis
|
White changes in palate from Smoking
- Red dots in lesions are inflamed salivary duct orifices - Not premalignant unless related to reverse smoking |
|
Melanotic Macule
|
Most common Melanocytic Lesion
- May be associated with Puetz-Jegher's syndrome |
|
Drug induced pigmentation
|
- Minocycline
- Chloroquine - Cyclophosphamide - Azidothymidine |
|
Hairy Tongue
|
Elongation of Filiform Papillae
- Cosmetic significance only |
|
Coxsackie Infections
|
Hand, Foot, Mouth & Herpangina
- Self limiting systemic infections - Herpangina only occurs in posterior soft palate |
|
Measles
|
aka Rubeola
- Self limiting childhood disease with fever malaise and skin rash - Koplick spots precede Skin rash |
|
HPV Lesions
|
Papillomas
- Benign epithelial Proliferations - Includes Verruca Vulgaris Condyloma Acuminatum - Genital warts - Caused by HPV 6 and 11 Focal Epithelial Hyperplasia - aka Heck's disease - HPV 13 and 32. - Multiple small dome shaped warts |
|
EBV infections
|
Hairly Leukoplakia
- Opportunistic infection causing white patches on lateral tongue - Usually associated with HPV - Diagnosis via intranuclear viral inclusions Malignancies - Burkitt's Lymphoma: Fastest Growing - Nasopharyngeal carcinoma |
|
Hutchinson's triad
|
Notched incisors
Deafness Ocular Keratitis |
|
Scarlet Fever
|
Caused by Group A Strep
- Skin rash with erythrogenic toxin - Strawberry tongue - Treated with PCN |
|
Behcet's Syndrome
|
Multisystemic disease
- Vasculitis is priminent feature - Oral and Genital Aphthous, Conjunctivitis, uveitis, arthritis, etc - Treat with corticosteroids and immunosupressives |
|
Erythema Multiforme
|
Hypersensitivity reaction affecting skin or mucosa
- Minor form associated with secondary herpes simplex Steven-Johnson syndrome is major EM, and triggered by drugs |
|
Midline Lethal Granuloma
|
Destructive necrotizing midfacial phenomenon
- May mimic Wegener's - Represent peripheral T-cell lymphomas - Perforation of palate - Treat with radiation |
|
Pemphigus Vulgaris & Pemphigoid
|
Pemphigus
- Autoimmune disease targeting Desmoglein 3 in Desmosomes - Positive Nikolsky sign Pemphigoid - Autoimmune disease targeting Hemi-Desmosomes of basement membranes. Laminin 5, BP180 etc - Usually affects older adults - Also positive Nikolsky's sign |
|
Proliferative Verrucous Leukoplakia
|
- High risk Leukoplakia
- Unknown cause but may be associated with HPV - High risk of Malignant transformation to Verrucous carcinoma or Squamous cell |
|
Actinic Chelitis
|
- Caused by UV light especially UVB from 2900 to 3200nm
- Lower lip more commonly affected - Junction of vermilion and skin becomes indistinct - May progress to SCC |
|
Oral Submucous Fibrosis
|
Irreversible Mucousal change due to hypersensitivity to dietary substances like Betel Nut
- May progress to SCC |
|
Verrucous Carcinoma
|
- Well differentiated slow growing
- Rarely metastasizes - Treated by surgical excision with good prognosis |
|
SCC
|
- Clinical stage is more important than microscopic classification relative to prognosis
- 5yr survival is 45-50% - 25% with Neck metastasis |
|
Oral Melanoma
|
- High risk on Palate and Gingiva
- 5year survival in oral is less than 20%, on skin is greater than 65% |
|
Granular Cell Tumor
|
Benign nonrecurring submucosal neoplasm of Schwann cells
- Most often occurs on tongue - See PseudoEpitheliomatous Hyperplasia |
|
Neurofibroma
|
Benign neoplasm of Schwann cells and Perineural fibroblasts
|
|
Neurofibromatosis 1
|
Von Recklinhausen's disease
- Multiple Neurofibromas - Cafe-au-lait macules - Axillary freckling - Malignant transformation |
|
Multiple Endocrine Neoplasia Type 3
|
MEN III
- Autosomal dominant - Oral mucosal neuromas - Medullary carcinoma of thyroid - Pheochromocytoma of adrenal gland |
|
Mucous Retension Cyst
|
Submucosal nodue due to blockage of salivary duct by sialolith
- Common in FOM, palate, buccal mucosa, and upper lip - Known as Ranula when occurring in FOM |
|
Necrotizing Sialometaplasia
|
Chronic ulcer of palate due to ischemic necrosis of palatal salivary glands
- Heals in 6-10wks - Mimics carcinoma clinically and microscopicly |
|
Bilateral parotid enlargement
|
- Alcoholism
- Dietary - Obesity - Diabetes - HTN & Hyperlipidemia - Sjogren's syndrome: Increased risk of Lymphoma |
|
Benign salivary gland diseases
|
Pleomorphic adenoma
- Most common benign salivary gland tumor - Mix cellularity - Palate is most common site Monomorphic Adenoma - Benign salivary tumor - Single cell type - Consists of Basal cell adenoma, Canalicular adenoma, Myoepitheliomas, and Oncocytic tumors - Oncocytes stain pink due to mitochondria Warthin's - Found in parotid of old men - Associated with smoking - Occasionally Bilateral |
|
Malignant Salivary gland tumors
|
Mucopidermoid Carcinoma
- Most common malignant salivary tumor - Palate is most common Polymorphous low-grade Adenocarcinoma (PLGA) - Second most common minor salivary gland malignancy - Palate most common site Adenoid Cystic carcinoma - Palate most common - Cribriform of Swiss Cheese microscopic pattern |
|
Amyloidosis
|
Formation of complex proteins from immunoglobulin light chain precursors
- Deposited into various organs - React with Congo red to produce Green Birefringence in polarized light |
|
Gingival Cysts of Newborn
|
From Dental Lamina
- Bohn's nodules on gingiva and Junction of HP & SP - Epstein's pearls on palate |
|
COC
|
Calcifying Odontogenic Cyst
- Has recurrent potential - Shows Ghost Cell Keratinization |
|
Cystic Ameloblastoma
|
Less aggressive and less likely to recur
|
|
Pindborg Tumor
|
Calcifying Epithelial Odontogenic Tumor
- Similar distribution to Ameloblastoma - Also aggressive, but slightly less than Ameloblastoma |
|
Adenomatoid Odontogenic Tumor
|
Tumor of 2/3
- 2/3 in Maxilla - 2/3 Females - 2/3 Anterior jaws - 2/3 Associated with Impacted teeth |
|
Fibrous Dysplasia
|
Uncommon Lesion
- Involves entire half jaw, more commonly the Maxilla - Usually affects children and stops at Puberty Widespread Fibrous Dysplasia is McCune-Albright Syndrome |
|
McCune-Albright Syndrome
|
Polyostotic Fibrous Dysplasia
- Cafe-Au-Lait with Puetz-Jeger - Endocrine abnormalities, Precocious puberty |
|
Langerhan's Cell Disease
|
- Show Punched out lesions
- Floating teeth - Eosinophils mixed in 3 Types - Eosinophilic granuloma: Chronic Localized. Bone Lesions - Hand-Schuler-Christian: Chronic Disseminated. Bone lesions, Exophthalmos, Diabetes Insipidus - Letterer-Swiwe: Acute Disseminated. Bone, Skin, and Internal organs |
|
Xray Machine Setup
|
Cathode (-)
- Filament emits electrons when heated - Focusing cup focuses electrons into narrow beam directed at the Focal Spot on the Anode Anode (+) - Tungsten target converts kinetic energy of the directed electrons into mostly heat and x-ray photons - Sharpness of image increases as size of focal spot decreases Copper Stem - Dissapates Heat |
|
mA
|
Milliamperage
- Regulates temperature of filament and thus # of electrons emitted - Controls quantity of radiation produced(Intensity), but does not control Beam Energy |
|
kVp
|
Controls Beam Quality which is the mean energy of an x-ray beam
- Higher energy photons have shorter wave-lengths - Beam intensity, number of photons, also increases with kVp |
|
Bremsstrahlung Radiation
|
- Primary source of x-ray photons from x-ray tube
- Results from electrons interacting with tungsten Nucli in the target - Generate photons with continuous spectrum of energy |
|
X-ray Filtration and Collimation
|
Aluminum filter in the path of beam reduces patient dose and mean energy
- 1.5mm for up to 70kVp - 2.5mm for higher voltages Metallic barrier to reduce size of xray beam - Usually collimated to a circle of 2.75 inches or 7cm - Rectangular collimators futher limit size of beam reducing radiation by 48% |
|
Inverse Square Law
|
Intensity of x-ray beam is inversely proportional to square of distance from source
|
|
X-ray Interactions with Matter
|
Coherent Scattering: 8%
- When low energy photon passes near outer electron. - Photon is absorbed, and when electron returns to ground state, another photon with same energy is generated - Changes direction and contributes to film fog Photoelectric Absorption: 30% - When photon ejects electron and then ceases to exist - Contributes greatly to diferences in optical density of enamel, dentin, and bone Compton Effect: 62% - When photon hits an electron - Electron takes some energy and is ejected - Photon now has new direction and lower energy |
|
Dosimetry
|
Absorbed dose
- Unit is Gray (Gy) - 1 Gy is 1 Joule/kg, and 100 Rad Effective dose - Used to estimate risk in humans - Unit is Sievert (Sv) Radioactivity - Decay rate - Unit is Becquerel (Bq) - 1 Bq = 1 disintegration/second |
|
Radiation Effects
|
Deterministic effects
- Severity of response is proportional to dose - There is threshold below which response is not seen Stochastic effects - Probability of response is dose-dependent |
|
Radiation damage
|
Direct effect
- To carbohydrates, lipids, proteins, DNA by radiation - 1/3 of damage Indirect effect - Radiolysis of water to form hydroxyl free radicals - 2/3 of damage |
|
Radiation on Oral tissues
|
- Near end of second week, cells die and show areas of mucositis
- Forms a white to yellow pseudomembrane which is desquamated epithelial layer - May see secondary candida infection - Healing is rapid and completed in 2 months - After months to years, mucous membrane becomes atrophic, thin, and avascular. - Complicates denture wearing |
|
Radiation to Salivary glands and Taste buds
|
Salivary glands
- See dose dependent loss of saliva in first few weeks - Mouth becomes dry and tender from loss of lubrication - Reduced beyond 1 year is unlikely to show significant recovery Taste Buds - Causes extensive degeneration of normal histological architecture of taste buds - Loss of taste acuity during second or third week |
|
Radiation to Bone
|
- Damage results from radiation to vasculature or periosteum and cortical bone
- Normal marrow may be replaced with fatty marrow and fibrous tissue - More common in mandible due to lower vascular supply and more frequent radiation. |
|
Sources of Radiation exposure
|
Natural radiation - 83%
- External background radiation, inhaled radon, ingested radionuclides Artificial radiation - 17% - Medical diagnosis and tx is 11% - Dental xrays is 2.5% of that - Nuclear medicine, and consumer/industrial products |
|
Radiation dose limits
|
Occupational exposure limit is 50mSv of whole body radiation in 1 year
- Dental x-rays are on average 0.2mSv a year No dose limits for patients exposed in the course of dental and medical treatment |
|
X-ray Film composition
|
Emulsion
- Contains silver bromide grains sensitive to x-ray - Smaller the crystals, greater the resolution Base - Flexible plastic to support Emulsion Identification dot - Raised towards viewer |
|
Intensifying Screens
|
Made of base supporting material with Phosphor layer
- Usually made of rare-earth elements - Reduces patient dose but decreased resolution from dispersion |
|
Film Latitude
|
Measure of range of exposures that can be recorded on film
- Films with a wide latitude can record a subject with a wide range of contrast - Films with narrow latitude can distinguish similar subject contrasts |
|
Radiographic Noise
|
Appearance of uneven density of uniformly exposed film
- Radiographic Mottle is uneven density due to physical structure of film or intensifying screens |
|
Resolution vs Sharpness
|
Resolution
- Ability to record separate structures that are close together Sharpness - Ability of radiograph to define an edge precisely - Can be improved by increasing distance between focal spot and object using long open ended cylinder |
|
Film Development
|
Developer coverts exposed silver halide crystals with Neutral Silver atoms into metallic Siver seen as dark
- Phenidone is first electron donor to reduce silver ions to metallic silver - Hydroquinone provides electron to Phenidone so it can continue reducing Rinse Dilutes developer which slows the process - Removes Alkali activator to prevent neutrilization of acid fixer Fixer dissolves and removes undeveloped silver halide - Hypo, an Ammonium Thiosulfate dissolves silver halide crystals - Hardener is Aluminum Sulfate complexes with Gelatin to prevent damage Washed in water to ensure removal of all thiosulfate ions and silver thiosulfate complexes |
|
Digital Detector
|
Charge-Coupled device CCD and Complementary metal oxide semiconductors CMOS
- Silicon sensor captures x-ray energy as voltage potential - Silicon chip reads out voltage of each pixel |
|
Lateral Fossa
|
aka Incisive Fossa
- Gentle radiolucency at apex of maxillary lateral |
|
Most common route for furcation involvement
|
Mesial of Maxillary 1st molar
|
|
Condyloma Latum
|
Secondary Syphillis
|
|
Angle Classifications and Population
|
Class I Normal - 30%
Class I Malocclusion - 50% Class II Malocclusion - 15% Class III Malocclusion - 1% |
|
Cranial Vault and Base Development
|
Cranial Vault - Intramembranous bone
- At birth, widely separated by fontanelles - Pushed apart during growth and new bone occurs at sutures - New bone is added to external surfaces and removed on internal surfaces Cranial Base - Endochondral bone - Ethmoid, Sphenoid, Occipital bones - Three Synchondroses 1) Intersphenoid - Closes at 3 2) Sphenio-Ethmoid - Closes at 7 3) Spheno-occipital - Closes later |
|
Maxilla Growth
|
Intramembranous
- Grows at sutures posterior and superior to maxilla - Anterior movement negated by anterior resorption, Downward migration is augmented by inferior apposition of bone - Bone is added at posterior |
|
Mandible Growth
|
Both endochondral and intramembranous
- Begins just lateral to Meckel's Cartilage, which later disintegrates and forms Malleus and Incus - Cartilage is transformed to bone at the condyle - Growth occurs by new formation at condyle and resorption anteriorly with deposition posteriorly - Space for posterior teeth is made by Ramus resorption - Growth at condyle moves mandible downward and forward. Posterior face height exceeds anterior and chin becomes more prominent. - If condylar growth exceeds molar eruption, may have shorter face and deep overbite - Rarely, if Molar growth exceeds Condylar growth, will have longer face and anterior open bite |
|
Scammon Growth Curves
|
- Neural tissues grow rapidly and hit 100% at 6-7
- Lymphoid tissues also grow quickly, reaching twice adult size at age 10 and then involutes - Genital tissue don't grow till puberty - Muscle and Bone grow rapidly at birth, slow, then grows again at puberty - Maxilla is close to brain and grows close to neural growth, and mandible shows growth spurt like reproductive tissues |
|
Growth Sex Differences
|
- Girls reach peak at 2 yrs earlier at 12, Boys at 14
- Earlier the peak of growth, the shorter duration and less overall growth - Girls generally start growth sooner, but growth is shorter and will grow less |
|
Predictors of Growth
|
- Growth is not correlated with age, and even less with dental age
- Hand-Wrist radiograph or vetebral bones on Ceph is good predictor - Sexual development is a good correlation |
|
General Direction of Jaw Growth
|
- Growth in width is completed before growth spurt
- Length continues to grow through spurt - Vertical growth lasts longer |
|
Cleft Lip and Palate
|
Incidence
- Most common craniofacial defect. 1 in 700 births - Second only to Clubfoot overall - Nearly all tissues originate from Ectoderm - Cleft lip occurs when there is a failure of fusion between Frontonasal process and Maxillary process - Closure of secondary palate occurs anterior to posterior while it elevates and joins together. |
|
Normal Dental Development size and relationships
|
Gum pad stage from 6-7months of age
- Maxillary anteriors are 75% the size of permanent anteriors - Mandibular anteriors are 6mm narrower than permanent - Overbite is normally 10-40%. - Overjet is 0-4mm Primate spaces are most noticeable - Between lateral and canine in maxilla - Between canine and first primary molar in mandible |
|
Primary Molar Relationship
|
Determined by Distal aspects of primary second molar
- Flush terminal plane: Distals are lined up - Mesial Step - Distal Step - By age 5, 90% are flush or with 1mm or greater mesial step - First permanent molars are guided along terminal plane |
|
Antimere
|
Corresponding contralateral tooth
- Once a tooth erupts, the Antimere is expected to erupt within 6 months |
|
Ugly Duckling Stage
|
When two maxillary centrals erupt moving labially leaving diastema
- Will resolve when canines erupt to close it |
|
Leeway Space
|
Difference in Mesio-Distal size between primary canine, primary first & second molars, and their permanent replacements
- 1.5mm per side in Maxilla - 2.5mm per side in Mandible |
|
Dimensional Changes in dental arches
|
Width
- Intercanine width & Intermolar width - All increases and then decreases. Maxillary intercanine width just increases. Length - Taken at midline between centrals to tangent touching Distal of second primary molars or Mesial of first permanent molars - Small decrease in both because incisors become upright and loss of Leeway space Circumference - From Distal of second primary molar around the arch to other side - Mandibular arch decreases significantly due to mesial shift into leeway space, interproximal wear, and lingual positioning of incisors from differential growth - Maxillary arch increases slightly |
|
Eruption Sequence
|
Generally Female teeth erupt 5 months earlier
Primary - Centrals, Lateral, First molar, Canines, Second molar Permanent - Maxillary: First molar, Central, Lateral, First premolar, Second premolar, Canine, Molars - Mandibular: First molar, Central, Lateral, Canine, premolars and back |
|
Rickett's Esthetic Line
|
Extends from tip of nose to chin
- Lip should be slightly behind this line for esthetics |
|
Ba, Gn/Me, Pog, Bo, Ar, Po, So, Ptm, Go, S
|
Ba: Basion
- Lowest point on anterior margin of Foramen magnum Gn/Me: Gnathion/Menton - Center of interior point on mandibular symphysis. Bottom of chin Pog: Pogonion - Most anterior point on the contour of chin Bo: Bolton's point - Highest point in upward curvature of retrocondylar fossa of occipital bone Ar: Articular - Where Zygomatic arch and posterior border of mandible intersect Po: Porion - Midpoint of upper contour of external auditory canal So: Sphenoccipital Synchondrosis - Junction between Occipital and Basisphenoid bones Ptm: Pterygomaxillary Fissure - Point at base of fissure Go: Gonion - Angle of mandible S: Sella Turcica - Middle of concavity |
|
ANB, MP, MP-SN, Y-axis, 1/-SN,
|
ANB
- AP difference between maxilla and mandible - More positive indicates Class 2, More negative is class 3 MP: Mandibular Plane - Go-Me, Go-Gn MP-SN: Mandibular plane angle - Bigger is steeper and indicaates vertical growth pattern with longer face and anterior open bite Y-axis: S-N to S-GN - Bigger indicates more vertical development and longer lower face with anterior open bite tendency 1/-SN: Upper incisor angulation - Bigger is more flared |
|
Hyalinization
|
Forms on compression side of PDL when heavy orthodontic forces are applied
- Area of PDL that has lost structural organization and shows signs of necrosis - Area of Undermining resorption occurs within alveolar bone - Secondary tooth movement cannot occur until lag period of undermining resorption has taken place |
|
Center of resistance
|
In a healthy tooth, its half the distance from crest to apex
- About 10mm from where bracket would be |
|
Moment
|
Tendency to rotate
- 1st order: In occlusal view - 2nd order: From facial view - 3rd order; From mesiodistal view - If a force is applied away from the center of resistance, a moment is created - M=Fd |
|
Couple
|
- Two equal and opposite, noncolinear forces
- Couple applied to tooth produces pure rotation without translation - M=Fd |
|
Pure Rotation
|
- When a couple is applied to a tooth
- Rotates about center of resistance |
|
Tipping
|
- When force is applied at bracket
- Center of resistance moves in direction of force and crown tips while apex moves in the opposite direction - Center of rotation is apical to center of resistance - Easiest and fastest movement but often least desirable |
|
Crown Movement
|
- Force is applied at bracket and small couple is applied to negate tipping
- Center of rotation at apex - Difficult and occurs slowly |
|
Pure Translation
|
- Force applied to bracket and larger couple is applied to negate tipping
- Center of rotation is Apical to Infinity - Difficult and slow |
|
Root Movement
|
Force applied at bracket and larger couple is applied
- Center of rotation is at crown - Most difficult and slowest type of movement |
|
Types of Anchorage
|
Reciprocal Tooth movement
- Pitting two segments against each other for equal movement Reinforced anchorage - Adding more teeth to the anchorage segment to distribute force over larger area - Headgears are also another form of reinforced anchorage Stationary Anchorage - Pit hard slow posterior movements such as bodily movement against simple anterior movements such as tipping Cortical Movement Implants for anchorage |
|
Most common bracket slot size
|
0.018 x 0.025inch
0.022 x 0.028inch |
|
Stress vs Strain
|
Stress
- Internal response of a wire to application of external forces - Defined as Force per cross sectional area. Sigma = FA Strain - Deformation or deflection as a result of stress - Defined as dimensional change divided by original dimension. Epsilon = DeltaD/D |
|
Wire Properties
|
Strength, Stiffness, and Range
Double Length - Half Strength - 8 times less stiff - 4 times range Double diameter - 8 times strength - 16 times stiffness - Half range |
|
Ortho Wire materials
|
Nickle-Titanium
- Low modulus of elasticity and Wide working range Beta Titanium - Also known as TMA, Titanium-Molybdenum alloys - In between Stainless Steel and Ni-Ti in terms of elasticity - High coeffcient of friction Stainless Steel - Good mechanical properties and coorosion resistance - 18% Chromium gives corrision resistance. - Highest elasticity and lowest springback |
|
Headgear
|
Should be worn for about 14 hours a day
- 250-500g per side for orthopedic - 100-200 per side for dental movement High pull - Treat Class 2 with increased vertical dimension and minimal overbite - Restrict anterior and downward maxillary growth or molar distalization and eruption control Cervical Pull - Correct Class 2 with deep bite - Restrict anterior maxillary growth - Also distalizes and extrudges maxillary molars J-Hook Headgear - High pull headstrap that connects to anterior maxillary archwire - Usually Retracts canines and incisors Protraction Headgear, Reverse-full, Facemask - Treat class 3 Malocclusions with maxillary deficiency - Downward and forward pull on maxilla Chin cup - Correct class 3 to force mandible superior and posteriorly |
|
Functional Appliance - 4
|
- Used in Function
- Corrects Class II - Restrains Maxilla and displaces mandible while allowing normal mandibular growth Herbst Activator Bionator Twin Block |
|
Herbst
|
Functional Appliance
- Piston and tube to place mandible in forward position - Mandibular incisors may flare due to indirect forces |
|
Activator/Bionator
|
Funcational Appliances
Activator - Two acrylic bodies on maxilla and lingual of mandible - Facets allow Maxillary occlusal, distal, and buccal movements - Also allows Occlusal and Mesial movement - Can also tip anterior teeth and control Eruption Bionator - Similar to Activator but is less bulky and impedes speech less - Horseshoe acrylic with wire in palatal |
|
Twin Block
|
Funcational Appliance
- Interaction between maxilla and mandible controls how much mandible is postured forward and vertical separation - Supposedly more tolerable |
|
Pendulum
|
Another type of appliance to correct class 2
- Uses palate as anchorage with springs to distalize molars |
|
Cross Bite Appliances - 5
|
- If expansion is at 0.5mm/day, its called a Rapid Palatal Expander
- Slow expander is 1mm/week Hyrax Haas Hawley Type removable with Jackscrew Quad Helix. W-arch Transpalatal arch |
|
Hyrax Appliance
|
Crossbite Appliance
- Metal framework connecting Maxillary first molars and first premolars - Screw is activated by atleast 0.25mm, a quarter turn, daily - Continued till maxillary lingual cusps contact with lingual inclines of buccal cusps - Diastema usually appears |
|
Haas Appliance
|
Crossbite Appliance
- Same as Hyrax but with acrylic pads - Contact with palate is believed to have more skeletal effect - Difficulty in cleaning and possible palatal inflammation are drawbacks |
|
Hawley type removable appliance with jackscrew
|
Crossbite Appliance
Can correct mild posterior crossbites - Compliance and difficulty retaining are drawbacks |
|
Quad-Helix, W-Arch
|
Crossbite Appliance
- For dental expansion - Can use for symmetrical or asymmetrical expansion - May tip teeth buccally so suggested for small amount of expansion |
|
Transpalatal Arch
|
Consists of heavy wire between the first molars across palate
- Can be used for expansion or constriction of intermolar width - Can produce root movement of first molar or derotation - Also can be used for anchorage reinforcement |
|
Appliances for Mixed Dentition
|
Nance
- Space maintainer Lower Lingual arch - Anchorage reinforcement, space maintenance, expansion, or increasing arch length Lip bumper - Anterior portion lies 2-3mm away from alveolar process - Controls mandibular arch length by allowing lateral and anterior development - Uprights tipped molars by transferring lip force to first molar |
|
Vertical Dimension Appliances
|
Intrusion Arch
- Used for deep bite correction - Extrudes molars and intrudes incisors Extrusion arch - Used for open bite correction to intrude molars and extrude incisors |
|
Elastics
|
Class I
- Between teeth of the same arch Class 2 - Between Maxillary anteriors to Mandibular posteriors - Corrects Class 2, reduces overbite, and retract anterior maxillary teeth Class 3 - Between Mandibular Anteriors to Maxillary posteriors - Protracts maxillary posterior teeth to improve overjet Crossbite elastics - From palatal of maxilla to buccal of mandible - Also causes extrusion so caution with open bite and long anterior lower facial height Anterior Diagonal Elastics - From one side of maxillary teeth to other side of mandibular teeth crossing midline - Correct non-coinciding maxillary and mandibular midlines |
|
Dealing with Space loss
|
Slight <3mm
- Space regaining - Removable appliance with finger spring - Headgear - Activated lingual arch - Lip bumper Moderate <4mm - Extract primary canines - Borrows space till permanent teeth erupt - Use lingual arch if mandibular canines are extracted Severe >4mm - Serial extractions - Extract canines to allow incisors to alight - Extract primary first molars for premolar to erupt - Extract 1st permanent premolars for canine to erupt - Will see increased overbite since incisors will tip back to fill space - Comprehensive treatment later on is always necessary |
|
Ortho Retention
|
Significant reorganization occurs in 3-4 months. Full time retension is recommended
Part time retention from 4-12 months Hawley Wraparound retainer - Similar to Hawley but without wires crossing occlusion Positioner |
|
Problematic Surgical Stability
|
Maxilla Down or wider
Mandible Back |
|
Tooth Number anomaly
|
Supernumerary
- Male to Female is 2:1 - 3% of population - Most common is mesiodens Hypodontia - 1.5-10% excluding 3rd molars - Most common is Mandibular second premolar followed by lateral incisor, then maxillary second premolar |
|
Taurodontism
|
Vertically long pulp chambers and short roots
|
|
Dentin Dysplasia
|
Shields Type 1
- Normal crown anatomy and color - Short pointed roots - Absent pulp chambers and canals - Multiple PA radiolucencies in primary and permanent teeth Shields type 2 - More similar to dentinogenesis imperfecta - Permanent teeth have normal color - No PA radiolucencies |
|
Frankl Behavior
|
1 - Definite negative refusal
2 - Negative reluctance but not pronounced 3 - Positive acceptance with cautious behavior and reservation 4 - Good rapport, interested, and laughter |
|
Pediatric Local dosage
|
- All are 4.4mg/kg
- Get kg by dividing pounds by 2.2 |
|
Minimum Alveolar Concentration
|
Measure for potency
- Minimum concentration required to produce immobility in 50% of patients - For Nitrous its 105% |
|
Medicaments
|
Formocresol
- Most commonly used medicament for pulpotomies on primary teeth - 35% Cresol and 19% Formalin Ferric Sulfate - Less toxic Mineral Trioxide Aggregate - MTA |
|
Factors for planning space maintenance
|
Amount of primary roots
- If more than 1/4th of root remains from normal resorption, space maintenance is likely needed Amount of bone covering permanent tooth - If there is no bone and permanent cusp tip is at furcation, no space maintenance is necessary - If bone is interposed, then space maintenance is necessary Amount of root development - Average tooth pierces bone with 2/3 root formation - Then pierces gingiva with 3/4 root formation Time lapse since loss - Most space closure occurs within first 6 months - In molar area, closes via tipping Eruption of neighboring teeth - Active eruption creates increased space loss Age - Rule of 7 for primary molars - Eruption is delayed if loss of primary molar is before age of 7 - Eruption is accelerated if its lost after 7 |
|
Humphrey Appliance
|
Used to correct ectopic Permanent First Molar when it impacts on Primary second molar
- More common in maxilla |
|
Ectopic Premolars
|
Distal Eruption
- Most common in Mandibular second Premolars - Distal root is resorbed but mesial root remains - Requires extraction Buccal or Lingual Eruption - Common - If primary molars aren't ready to exfoliate within a few weeks, should extract |
|
Trauma Followup
|
Radiographs and Assessment at 1,2,6 months
|
|
Rule of 6's
|
If Flouride is greater than 0.6ppm, no systemic flouride
If patient is less than 6mo old, no flouride If older than 16, no flouride |
|
Digit sucking appliance
|
Fixed crib at palate
Blue grass appliance - with roller |
|
Natal & Neonatal teeth
|
- Natal teeth is present at birth
- Neonatal are those that erupt in first 30 days - Most are primary teeth, and most are mandibular incisors Extract If - Supernumerary - Primary teeth if extremely mobile and in danger of aspiration - Riga-Fede disease and causing ulceration on ventral tongue. May be smoothed or extracted |
|
ECC
|
Ecc - Presence of more than one decayed, missing, or filled primary tooth on a child 71mo or younger
S-ECC - Any sign of smooth surface caries on younger than 3 years - One or more cavitated, caries missing, or filled smooth surface in primary maxillary anterior - Also any decayed missing, or filled surface score (DMFS) greater than 4 at age 3, greater than 5 at age 4, or greater than 6 at 5 |
|
Moyer's mixed analysis
|
Widths of the mandibular permanent incisors are used to predict width of buccal segment
- Predicts canine, first and second premolars - Add up the sum of the differences - Add -1.7mm for for each side in an end to end relationship |
|
Oral Cancer Epidemiology
|
- 30,000 New cases diagnosed annually
- Most are SCC - 2/3 lip and oral cavity, 1/3 pharyngeal cancer - 3% of new cancers for males and 1.6% of new cancers for femailes - Uncommon before 40 - Caucasians have higher lip cancer, but male African Americans have higher incidence of pharyngeal cancer |
|
Three levels of Prevention
|
Primary
- Prevents disease before it happens. Fluoride and Sealants Secondary - Eliminates or reduces diseases that have occured - Restorations Tertiary - Limits disability from disease and rehabilitates - Dentures and crown and bridge |
|
Community Water Fluoridation
|
- 0.7-1.2 ppm
- Most communities are 1ppm which is 1mg per Liter of water - Fluoridation prevents 50%-70% of caries in permanent teeth - 20%-40% due to other fluoride containing products - School Fluoridation is 4.5 times concentration of community Fluoridation |
|
Prevalence vs Incidence
|
Prevalence
- Expressed as percentage - Number of people with disease / Total people at risk Incidence - New cases over a period of time - Number of new cases / Total number at risk |
|
Cohort Study
|
Prospective Cohort
- Measures risk factors in each subject. - General population is followed through time to see who develops disease Retrospective Cohort Study - Measures effect that a specific exposure has had on a population. - Measures risk factors in each subject that may have predicted subsequent outcome |
|
Sensitivity vs Specificity
|
Sensitivity
- Percentage of persons with disease who are correctly classified as having disease - Insensitive test leads to missed diagnoses - True Positive/(TP + FN) * 100% Specificity - Percentage of persons without disease that is classified as not having it - Low specificity test produces false positives - True Negative/(TN + FP) * 100% |
|
Hep B & C
|
Hep B
- Dane Particle - 30% transmission after percutaneous injury Hep C - 3%-10% risk of transmission - After needle stick is 1.8% |
|
HIV
|
- 0.3% from percutaneous
- 0.09% from mucous membrane exposures - Confirmed with 2 Positive ELISA followed by Positive Western Blot |
|
Ethylene Oxide & Chemical sterilization
|
Ethylene Oxide
- 2-3hrs at 120F or 48.9C Chemical (Cold) Sterilization - Used for heat sensitive items - 10 hours in 2% Glutaraldehyde solution |
|
Noise Control
|
- Hearing loss develops from exposure exceeding daily average of 90dB
- Protection is recommended at 85dB with frequency from 300 to 4800 cps - Protection is mandatory where levels reach 95dB |
|
MSDSs
|
Material Safety Data Sheets
- Blue is Health Hazard - Red is Fire Hazard - Yellow is Reactivity or stability of a chemica - White is required PPE when using the chemical - Numbered 0-4. Higher the number, greater the danger |
|
Operant Extinction
|
- Asking mother to refrain from providing attention
- Ma show Extinction burst at first |
|
Premack principle
|
More probable behaviors will reinforce less probable ones
|
|
Beneficence
|
Dentist has a duty to promote patient's welfare
|
|
Veracity
|
Dentist has duty to communicate truthfully
|
|
Emancipation
|
Conscious Mentally competent patient under 18 may consent if
- Graduated form HS - Married - Pregnant - Living on their own |
|
Statute of Limitations
|
2 years from moment of discovery
- Should advise a patient and document so statue will begin to run |
|
Education vs Behavioral Intervention
|
Educatin is not nearly as effective as behavioral intervention
|
|
Balance Billing
|
Charge patient difference between plan payment and UCR
|
|
Phases of Specific Bacteria
|
Early primary colonizors
- Streptococcal and Actinomyces Species Late colonizers - Prevotella Intermedia, Prevotella Loescheii, Capnocytophaga species, Porphromonas gingivalis, Troponema species, and AA. - Fusobacterium Nucleatum serves as an important middle bridging organism. Can coaggregate early and late colonizers. |
|
Necrotizing Diseases
|
- Prevotella Intermedia
- Spirochetes - Fusobacterium Species |
|
A.A
|
Non Motile, Gram Negative rod
- Capnophilic. Grows in CO2 Virulence factor - Leukotoxin that kills WBC - LPS - Collagenase - Protease that cleaves IgG |
|
Tannerella Forsythia
|
Nonmotile, Gram Negative rod
- Requires N-AcetylMuramic, NAM, Acid as growth factor. Virulence Factors - Proteolytic Enzymes that cleave immunoglobulins and complement components |
|
Porphyromonas Gingivalis
|
Nonmotile, Gram negative rod
- Anaerobic and becomes darkly pigmented when grown on blood agar plates Virulence - Fimbriae - Capsule - Proteases and collagenases - Hemolysin |
|
Prevotella Intermedia
|
Non-motile, gram negative rod
- Associated with Pregnancy Gingivitis |
|
Chemotaxins for Neutrophils
|
TNFa
IL-1 IL-8 Leukotriene B4 Interferon Gamma |
|
Inflammatory Cytokines
|
IL-1 - Bone resorption
IL-8 - Attracts inflammatory cells. Chemotactic TNFa - Activates Macrophages |
|
Prognoses
|
Good
- Adequate alveolus - Good patient cooperation - No systemic factors Fair - Mobility - Grade I furcation - Adeuqate patient cooperation Poor - Moderate to advanced alveolar bone loss - Grade I and II furcation - Questionable cooperation Questionable - Advanced bone loss - Grade II and III furcation Hopeless - Advanced bone less - Exo indicated |
|
Gracey Curettes
|
- Blade is angled 60-70 degrees from lower shank
1-2 and 3-4: Anteriors 5-6: Anteriors and Premolars 7-8 and 9-10: Facial and lingual of posterior teeth 11-12: Mesial of Posterior teeth 13-14: Distal of Posterior teeth |
|
Ultrasonics
|
- Vibrations range from 20,000 to 45,000 cycles per second
- Contraindication is Cardiac Pacemakers, and patients with communicable diseases. Also implants Magnetostrictive - Elliptical pattern Piezoelectric - Linear back and forth |
|
Flap design
|
Internal Bevel incision
- Made from free gingival margin or just coronal from base of flap Crevicular Incision - Made from base of pocket to crest of alveolar bone Interdental Incision - Separates collar of gingiva from tooth |
|
Miller recession classification
|
I - Recession does not extend to mucogingival junction. Without loss of interdental bone
II - Extends beyond mucogingival junction. Without loss of interdental bone III - Extends beyond mucogingival junction with bone and soft tissue loss interdentally or malpositioned teeth IV - Extends beyond mucogingival junction with severe interdental bone loss or severe tooth malposition |
|
Resective Osseous Surgery
|
Ostectomy
- Removal of tooth supporting bone Osteoplasty - Removal of nonsupporting bone |
|
Guided Tissue Regeneration
|
Method for preventing epithelial migration along cemental side of a pocket following flap reflection
- Covers bone and PDL to exclude epithelium and connective tissue from root surface - Can use Citric acid, Fibronectin, EMPs like Emdogain can enhance new attachment |
|
Evaluation of Bone graft materials
|
Osteogenic
- Induce formation of new bone by cells in graft Osteoinductive - Ability to induce neighboring cells into osteoblasts Osteoconductive - Ability to serve as scaffold to favor outside cells to penetrate and form bone |
|
Allograft materials
|
Undecalcified, freeze-dried bone allograft
- Osteoconductive Decalcified, free-dried, bone allograft DFDBA - Osteogenic due to presence of BMPs |
|
Regeneration success
|
Most successful in three walled bony defects
Lease successful in through and through class III furcation defects |
|
Local Antibiotics for Perio
|
Atridox - 10% Doxycycline
Arestin - 2% Minocycline Periochip - 2.5mg Chlorhexidine |
|
Biological Width
|
Junctional Epithelium - 0.97mm
Connective Tissue attachment - 1.07mm Total - 2.04mm |
|
Polymorphism and Severe Chronic Periodontitis
|
Polymorphism in IL-1 gene is associated with severe chronic periodontitis
|
|
coxib
dipine ilol/alol onium/urium osin pril/prilat sartan triptan |
coxib - Cox 2 inhibitors. Celecoxib
dipine - dyhydropyridine calcium channel blockers. Nifedipine ilol/alol - beta blocker and blocks a1. Carvedilol, Labetalol onium/urium - quaternary ammonium compounds, competitive skeletal muscle relaxers. Pancuronium osin - a1 blocker. Prazosin pril/prilat - ACE inhibitors. Captopril sartan - Angiotensin 2 receptor blocker. Losartan triptan - Serotonin 5-HT agonist, Antimigraine. Sumatriptan |
|
Efficacy vs Affinity
|
Efficacy
- Emax - Measures Intrinsic Activity Affinity - EC50 - Measures Potency |
|
Kd
|
Measurement of affinity to receptor
- Lower the Kd, higher the affinity |
|
EC50
|
Effective concentration leading to half maximal effect
- Measurement of Potency |
|
Therapeutic Index
|
LD50/ED50
- Higher the Better |
|
Drug Metabolism
|
- Drug made active my metabolism is prodrug
Phase I - Oxidation, Reduction, Hydrolysis Phase II - Conjugation with chemical substituent - Most common is Glucuronide Conjugation |
|
Half Life equation
|
t1/2 = 0.693 * Vd/Cl
Vd = Total Drug in body / Plasma concentration |
|
Drug testing phases
|
Phase I - Use normal volunteers to test safety and PK
Phase II - Use affected patients to test efficacy, PK, and safety Phase III - Large number test involving several centers Phase IV - Post marketing surveillance. |
|
ACh receptors
|
Nicotinic Receptors
- Synapses - Skeletal Muscle - At adrenal Medulla Muscarinic Receptors - Heart, Smooth muscle - Sweat glands |
|
Epinephrine, Norepinephrine, Isoproterenol, Phenylephrine
|
Epinephrine - alpha and beta. Reverse anaphylaxis, vasoconstrict, bronchodilate
Norepinephrine - No beta 2. Vasocinstriction Isoproterenol - Only beta. Bronchodilation Phenylephrine - Only alpha. Nasal vasoconstriction |
|
Phentolamine and Phenoxybenzamine
|
Nonselective alpha blockers
- Rarely used because of nonselectivity "osin" are Selective a1 blockers |
|
Prazosin
|
Selective a1 blocker
- Treats HTN, Heart failure, and BPH - Adverse effects is hypotension, fluid retension, dry mouth, and nasal stuffiness |
|
Carvedilol
|
Nonselective beta blocker
- Also blocks a1 receptors - Used for heart failure |
|
Carbachol
|
Only Cholinergic Agonist that has stronger Nicotine than Muscarine effects
- Used to treat Glaucoma |
|
ACh on receptors
|
Given in low doses stimulates mostly muscarinic receptors
- In high doses, more nicotinic effects occur |
|
Pralidoxime
|
Used to reactivate Acetylcholinesterase after irreversible inhibition by drugs such as Sarin and Soman
|
|
"stigmines"
|
Cholinesterase inhibitors
- Neostigmine, Physostigmine, Pyridostigmine - Edrophonium - Parathion, Sarin, Soman |
|
Autonomics of the eye
|
Muscarinic agonists cause circular muscle of eye to contract
- Contracts ciliary musle for near vision - Also enhances removal of intraocular fluid - a1 adrenergic receptor does opposite |
|
Atropine and Scopolamine
|
Antimuscarinic drugs
Atropine - Reduce salivary flow and antivagal effect during surgery. Scopolamine - For motion sickness - Has CNS depression so better for preanesthetic agent Both will block cardiac slowing effect of vagus nerve at high doses |
|
Dantrolene
|
Relaxes skeletal muscle without blocking Nicotinic receptors
- Prevents release of Ca2+ from sarcoplasmic reticulum |
|
Antipsychotic drugs
|
- Block Dopamine and Serotonin Receptors
apine - Clozapine azine - Promazine idone - Risperidone idol - Haloperidol |
|
Antidepressant Drugs
|
Increases Serotonin/5-HT or Norepinephrine at synapses in the brain
- Fluoxetine, Fluvoxamine - Tricyclic Antidepressants - Amitriptyline, Despiramine |
|
Antimania Drugs
|
Lithium
- Works inside cell to block conversion of inositol phosphate to inositol - May have toxicity showing nausea, diarrhea, convulsions, coma. Thyroid enlargement. - Must have monthly blood checks because margin of safety is narrow Carbamazepine - Also used for Tic Douloureux - Blocks sodium channels Valproic acid - Blocks sodium and calcium channels |
|
Benzodiazepines and Barbiturates Mechanism of Action
|
Sedative Hypnotics
Benzodiazepine - Enhance effect of GABAa on chloride channel receptors - Increase chloride channel conductance Barbiturate - Largely replaced by Benzodiazepines - Enhance effect of GABA on chloride channel but also increase chloride channel conductance independently of GABA, especially at high doses. |
|
Antihistamine and Sedation
|
Blocks H1 histamine receptors in CNS
- Leads to sedation - Diphenhydramine |
|
Antiepileptic drugs
|
Mechanisms
- Sodium channels - Chloride channel receptors - T-type calcium channels Phenytoin - Also Anti-arrhythmic Carbamazepine Phenobarbitol |
|
Anti-Parkinson
|
Strategy
- Increase dopamine in basal ganglia - Block muscarinic receptors in basal ganglia since they oppose dopamine L-dopa & Carbidopa - Sinemet - Penetrate BBB and converted into dopamine - Carbidopa inhibits dopa decarboxylase to prevent L-dopa conversion outside of CNS. Selegiline MAO-B inhibitor Tolcapone & Entacapone - COMT inhibitor |
|
o-toluidine
|
Metabolite of Prilocaine that causes Methemoglobinemia
|
|
Stages of General Anesthesia
|
I - Amnesia is common. N2O for conscious sedation
II - Delirium. Excitement phase. Begins with unconsciousness III - Surgical anesthesia. Loss of reflexes and muscle control IV - Repiratory paralysis |
|
Blood:Gas solubility coefficient
|
Lower the blood:gas solubility coefficient, faster the onset and termination of anesthesia
- N2O is very low |
|
MAC
|
Minimum concentration of anesthetic in alveolus that is sufficient to give no response from surgical stimulus in 50% of patients
|
|
Injectable Anesthetics
|
Propofol
- IV - Rapid onset and termination Thiopental - Barbiturate - Fast acting Ketamine - Blocks NMDA, N-methyl-D,aspartate (Glutamate) receptors. - May cause hallucinations upon emergence so give Diazepam - Associated with Laryngospasm |
|
Antihistamines given for conscious sedation
|
Promethazine - Previously used as anti-psychotic hence "azine"
Hydoxyzine |
|
Opioid Antagonists
|
Naloxone and Naltrexone
|
|
Opioid Mechanism
|
Activates Gi to increase Potassium conductance and decrease Calcium conductance
- Decreases presynaptic release and increase postsynaptic potential |
|
Morphine
|
- CNS analgesia, drowsiness, Miosis, respiratory depression.
- Head injury is contraindication - Decreased peristalsis - Histamine release - Orthostatic HTN - Significant liver metabolism - Metabolite morphine-6-glucuronide is active metabolite - 3hr half-life |
|
Codeine
|
- 3hr half life
- Well absorbed orally - Less potent than morphine - Converted to morphine by 2D6 |
|
Meperidine
|
Opioid
- In between codeine and morphine - More rapid onset but shorter duration than morphine. - Not recommended for long term pain relief - No miosis - Most abused drug by health professionals - Do not give with MAOi |
|
Methadone
|
- Useful for treating opioid addiction
- 15-40hr half life |
|
Asprin toxicity
|
- Initially increases respiration leading to respiratory alkalosis
- Eventually cause metabolic acidosis |
|
Drugs for Migraine
|
Triptans - Serotonin blockers
- Sumatriptan - 5-HT receptor agonists - Abortive tx Ergot alkaloids - Ergotamine - Vascular toxicity - Abortive tx Methysergide - Use for prophylaxis tx |
|
Antihistamine Generations
|
Second generation
- Does not cross BBB so no drowsiness - Does not have antimuscarinic activity - Longer half life - Only first generation has local anesthesia, reduce motion sickness, and promotes sleep |
|
H2 Blockers
|
H2 histamine receptor blocker inhibits histamin on parietal cells
- Treats GERD, and peptic ulcers Cimetidine has antiandrogen effect - Impotence, loss of libito, gynecomastia |
|
Antiarrhythmic Drug classes
|
1 - Block sodium channels
2 - Block b-adrenergic receptors 3 - Block potassium channels 4 - Block calcium channels |
|
Digitalis
|
Digoxin
- Increases force of contraction of heart - Inhibits Na+/K+ ATPase and increasing intracellular calcium |
|
Clopidogrel & Abciximab
|
Clopidogrel
- Inhibits effect of ADP on platelets Abciximab - Antibody that inhibits GP IIb/IIIa glycoprotein receptor on platelets |
|
Major diuretic drugs and MOA
|
Thiazide - Na+ and Cl- transport
Loop diuretic - Decrease Na+/K+/2Cl- co-transport Amiloride, Triamterene - Na+ channel blocker. Potassium sparing |
|
Spironolactone
|
Aldosterone antagonist diuretic
- Potassium sparing |
|
Wafarin and Heparin
|
Wafarin
- Inhibits Potassium dependent synthesis of factors 2, 7, 9, 10 Heparin - Stimulates Antithrombin III |
|
INR
|
Normal = 1
Taking anticoagulants = 2.5-3.0 If beyond 4.0, may have excessive bleeding |
|
Plasminogen Activators
|
Breakdown clots by promoting Fibrinolysis
- tPA - Streptokinase - Urokinase |
|
Sulfonylureas
|
Used for Type 2 Diabetes - Increases insulin secretion from Pancreas
- Glimeperide - Tolbutamide - Tolazamide etc |
|
Metformin
|
Reduces glucose production by liver
- Increases sensitivity to insulin in muscle, liver, and fat cells |
|
Dental antifungals
|
Clotriamzole Oral Troches
Nystatin Pastilles or rinse More Extensive Disease - Fluconazole - Itraconazole - Caspofungin |
|
Semiadjustable Articulator
|
Arcon
- Condyles are attached to lower member of the articulator - Fossae is in the upper member - Better for Removable Non-arcon - Condyles are on upper member - Condylar guidance is associated with lower member - Rigidly attached - Better for Fixed |
|
Implant placement space
|
Implants should be 3mm apart and atleast 1mm away from tooth
|
|
Christensen's Phenomenon
|
Distal space created between maxillary and mandibular occlusal surfaces of occlusion rims of dentures
- Caused by downward and forward movement of condyles |
|
Vertical Dimension of Denture
|
Closest speaking space
- 1 to 1.5mm |
|
Denture Support, Stability, and Retention
|
Support
- Resistance to vertical seating forces Stability - Resistance to horizontal dislodgement Retention - Withstand vertical dislodging forces |
|
Nystatin Oral Rinse and Cream
|
Nystatin Oral Syspension
*Contains Sugar Dispense: 60mL of 100,000 units/mL - 4mL three times daily. After each mean, rinse for 2 minutes and expectorate. Nystatin Ointment for Angular Cheilitis - Disp 15g tube - Apply to affected area four times daily for 2 wks |
|
RPD Classification
|
Class 1 - Bilateral edentulous areas posterior to remaining teeth
Class 2 - Unilateral edentulous area posterior to remaining natural teeth Class 3 - Unilateral edentulous area in between teeth Class 4 - Single edentulous ridge crossing the midline Rules - Classification should follow extraction of teeth - If 2nd or 3rd molar is missing and not replaced, it is not considered in the classification - Most posterior edentulous area determines the classification |
|
Palatal Strap vs Bar
|
Strap - Greater than 8mm
Bar - Less than 8mm. Needs bulk for stability |
|
Beading RPD
|
Scribing rounded 0.05mm groove to anterior and posterior border of major connector
- add strength to major connector - Prevents food impaction |
|
Rest Seat Design
|
Occlusal
- 1/3 Facial Lingual Width - 1/2 Width between cusps - 1.5mm deep for base metal Cingulum rest - Mesiodistal length 2.5-3mm - Labiolingual width 2mm - Incisoapical depth 1.5mm Incisal rest - 2.5mm wide, 1.5mm deep |
|
Crown Thickness
|
Metal thickness of 1.5mm at functional cusp and 1mm at nonfunctional cusp
Need 2mm when porcelain is used 0.5mm minimum at margin to prevent distortion |
|
Impression Materials
|
Reversible Hydrocolloid
- Hydrophilic and long working time - Low tear resistance and low stability - Must pour immediately Polysulfide - Contains sulfur as accelerator and catalyst reactor. - Water is released as polymerization byproduct - High tear strength - Must pour within 1 hour Condensation Silicone - Release Alcohol as by product - Hydrophobic - Pour immediately Addition Silicone: Vinyl Polysiloxane - Hydrophobic - May release H2 - DImensional stability Polyether - No byproduct - Very succeptible to water absorption - Poured promptly - Set material very stiff so care not to break teeth |
|
Classificaiton of Alloys
|
Nobel metals are Gold, Platinum, Paladium, and Silver
High nobel - Nobel metal content >60% and Gold content >40% Nobel - Nobel metal content >25% Base metal - <25% |
|
Bonding of Metal to Porcelain
|
Metal oxide formation is necessary for ceramic bonding
- Accomplished by heating metal in furnace Coefficient of thermal expansion of metal must be slightly higher than porcelain - Porcelain is stronger under compressive forces than tensile forces |
|
Porcelain Composition
|
Composition
- Feldspar: Main constituent - Quartz: Strength - Kaolin: Binder - Metallic Oxides: Opacity and Color Layers - Opaque Porcelain: Mask dark oxide color and provide metal bond. 0.1mm - Body or Dentin porcelain: Contains most of color or shade - Incisal porcelain: Most translucent layer |
|
Shade selection and color
|
Hue
- Shade or color - Selected first Chroma - Saturation or intensity of color or shade - Always better to choose lower chroma Value - Lightness or darkness of a color |
|
Metamerism
|
Color match under light is different under another lighting condition
|
|
Fluorescence & Opalescence
|
Fluoresence
- Physical property where object emits visible light when exposed to UV light - Dentinal layer of tooth Opalescence - Light effect of a translucent material appearing blue in reflected light and red-orange in transmitted light |
|
Cements
|
Zinc Phosphate
Zinc Polycarboxylate - High solubility and High leakage Glass ionomer - Adheres to enamel and dentin and releases fluoride - Superior mechanical properties to zinc phosphate and polycarboxylate Resin-Modified Glass ionomer - Similar to glass ionomer but higher strength and lower solubility - Should not use with all-ceramic due to fracture Resin Luting agents - Unfilled resins that bond to dentin. - Less biocompatible and greater film thickness |
|
Gypsum
|
Type 1: Plaster, Impression plaster
Type 2: Model plaster Type 3: Dental Stone Type 4: Die stone Type 5: high strength - Increasing water increases set time and decreases strength and expansion - Potassium Sulfate and Sodium Chloride Accelerate setting - Sodium Citrate and Borax Retard setting |
|
Flux
|
Prevent oxide formation
- Allows solder to wet surface freely and spread over metal surface |
|
Safest Intracoronal Bleaching Chemical
|
Sodium Perborate
|
|
Axial depth gingival to CEJ
|
0.75-0.8mm
|
|
Skirt
|
Mini crown prep around line angle
- Increases retention and resistance - Should be prepared by diamond in long axis of tooth extending to gingival 3rd - Extends outline so is least esthetic |
|
Mercury Half Life
|
55 Days
|
|
Casting Oxygen Scavenger
|
Zinc
|
|
Slots
|
- Atleast 1mm in depth with Inverted cone bur
- Longer the better - Can segment or continuous - Atleast 0.5mm into DEJ |
|
Local Anesthetic unapproved for children
|
Bupivicaine
|
|
Ectopic Lymphoid Tissue
|
FOM, Posterior lateral tongue, Soft palate, Tonsilar Pillar
|
|
Splinting
|
Avulsion
- Nonrigid splint - 7-14days Root fractire - Rigid Splint - 2-3 Months |
|
Extinction
|
Identifying all positive reinforcements of a bad behavior and withholding them
|
|
Systematic Desensitization
|
Process of pairing a relaxation response with a hierarchy of increasingly feared stimuli while using relaxation skills
- Most important component is exposure to feared stimulus |
|
Classical Conditioning
|
Neutral stimulus is paired with unconditioned stimulus
- After a few pairings, neutral stimulus elicits conditioned response without the presence of the unconditioned stimulus People in white coats automatically triggers fear response |
|
Operant Conditioning
|
An individual's behavior is modified by its consequences; the behavior may change in form, frequency, or strength
- When a Stimulus-Response pattern is reinforced, and individual is conditioned to respond a certain way - Positive and Negative reinforcement strengthen behavior - Punishment and Extinction weaken behavior |
|
Factors of Cognitive Appraisal of Stress
|
Controllability
Familiarity Predictability Imminence |
|
Graded Exposure
|
Systematic process of exposing patient to hierarchy of increasingly anxiety provoking stimuli
|
|
Supplemental Fluoride Dosing
|
<0.3ppm
- 6mo - 3yr: 0.25mg - 3yr - 6yr: 0.5mg - 6yr - 16yr: 1.0mg 0.3-0.6ppm - 6mo - 3yr: Nothing - 3yr - 6yr: 0.25mg - 6yr - 16yr: 0.5mg >0.6ppm - Nothing |
|
Types of Epidemiology
|
Descriptive - Quantify disease status in a community
- Prevalence and Incidence Analytical/Observational - Determines etiology of disease - Cross sectional, Case control, Cohort studies. Experimental - Intervention studies. Determines etiology and establish effectiveness of program or therapy - Clinical trials, and Community trials |
|
Acceptable quality of dental office water
|
CDC recommends <500 CFU/mL
ADA recommends <200 CFU/mL |
|
DHHS
|
Department of Health and Human Services
- US govt's agency for protecting health of all Americans and providing essential human services Includes NIH, HRSA, AHRQ |
|
HRSA
|
Health Resources and Services Administration
- Provides access to essential healthcare services for low-income, uninsured, or rural areas |
|
AHRQ
|
Agency for Healthcare Research and Quality
- Supports research on health care systems, cost and quality issues, and effectiveness of treatments |
|
Diabetes Control and Periodontitis
|
Well controlled diabetes is not more severe than non diabetes
- Well controlled diabetes can be treated with conventional periodontal therapy |
|
Oral Contraceptives and Perio
|
Exacerbates impact of bacterial plaque and gingiva
- Cannot induce gingivitis |
|
Scaling, Root Planing, Currettage
|
Scaling
- Remove plaque, calculus and stains from tooth - Done on crown and root Root Planing - Create smooth root surface through removal of calculus and rough cementum - Root only Curettage - Used to remove epithelial lining of periodontal pocket |
|
Epithelial Cell migration and Healing
|
Migrates 0.5mm/day
- Gingivectomy takes 5-14days for repithelialization to complete |
|
Benztropine
|
Reduce parkinsonlike symptoms caused by dopamine blocker Haloperidol used for antipsychosis
- Benztropine Reduces salivary flow and cause xerostomia |
|
Halothane
|
Inhalational general anesthetic containing Bromine
- Can cause cardiac arrhythmia when administered with Epinephrine and other catecholamines |
|
Ibuprofen, Naproxen and Asprin
|
Ibuprofen and Naproxen are both reversible COX inhibitors
Asprin is irreversible inhibitor |
|
Diazepam, Epinephrine, Insulin receptor types
|
Diazepam - Ion channel receptors
Epineprhine - G protein receptors Insulin - Tyrosine Kinase receptor |
|
Fanconi Syndrome
|
Proximal tubule damage
- Renal tubular acidosis - Aminoaciduria - Hyperphosphaturia - Can be hereditary or caused by Outdated Tetracyclines |
|
Elimination Half-time for PCN V
|
0.5 hours due to active tubular secretion
- Very little is metabolized |
|
Polycarboxylate Cement
|
Carboxylate groups in polymer chelates to calcium and forms a chemical bond
|
|
Belladonna Alkaloids
|
Atropine
Scopolamine Muscarinic Antagonists |
|
Nonsedating Antihistamine not contraindicated with Cimetidine
|
Fexofenadine
|
|
Local Anesthetic Structure Generalizations
|
Bigger the alkyl substitution on hydrophilic nitrogen, the greater the activity
Longer the intermediate chain, greater the activity and toxicity. Most effective substitutions that increase or decrease action is on lipid soluble group |
|
Chloramphenicol
|
Broad Spectrum Antibiotic
Can cause bone marrow toxicity - Bone marrow supression which is a direct effect and is reversible - Aplastic anemia which is idiosyncratic and is fatal |
|
Lingual Tori technique
|
1) Grooving the superior surface then
2) Shearing the torus off with a mono-beveled chisel. 3) Area is then smoothed with a bone file. |
|
Gluteal injections for child
|
Gluteus maximus does not develop till child walks so avoid Dorsal Gluteal injections
Give Ventrogluteal injections instead in Gluteus Medius |
|
Antibiotic associated with majority of Oral Contraceptive Failure
|
Rifampin
- RNA blocker |
|
Phenytoin vs Phenobarbital
|
Phenobarbital is a barbiturate that is anticonvulsant in subhypnotic doses
- Chief side effect is drowsiness Phenytoin - causes gingival hyperplasia, irreversible hypertrichosis, and Stevens-Johnson syndrome - Contraindicated for infants, young females, and children undergoing ortho ***- Also Anti-Arrhythmic |
|
Valproic Acid
|
Anticonvulsant
- Withdrawal is associated with Seizures, Gingival Hemorrhage, and Acute Stomatitis |
|
Types of Porosities
|
Solidification shrinkage: Irregular Shape
- Shrinkage porosity: Large irregular voids found near sprue casting junction. Caused by poor sprue size - Suck back porosity: External void opposite the sprue caused by hotspot. Avoid by reducing temp difference between mould and molten alloy - Microporosity: When casting freezes too rapidly. Mould or casting temperature is too low Gas caused shrinkage: Usually Spherical - Pin Hole porosity: When metals dissolve gasses. Pa and Pd dissolve Hydrogen. Co and Ag dissolve Oxygen. - Gas inclusion porosity: Larger than pinhole and caused by gasses trapped by molten metal. Due to poorly adjusted blow torch Back Pressure Porosity - Characterized by Porous casting with Rounded Short Margins - Caused by air trapped in mould. No more than 1/4 inch thickness of investment between bottom of casting ring and wax pattern. - Air is usually pushed out through bottom, but if investment is too thick, air can't escape. |
|
Most likely cause of failure in pre-ceramic soldering technique
|
Overheating parts to be joined
|
|
Spherical Amalgam
|
Particles tend to roll over one another
- Should use larger condensers and laterally applied condensation forces |
|
Stone Expansion and Strength factors
|
Increased mixing time and Decreased Water/Powder ratio will increase the number of nuclei of crystallization of calcium sulfate dihydrate.
- Shortens set time and Increases expansion by providing more nuclei per unit volumn - Stronger Stone Slurry water shortens set time - Does not affect strength or expansion Accelerators and Retarders - Decreases compressive strength and expansion by changing shape of crystals Colloidal materials - Lengthens set time but weakens stone by poisoning nuclei |
|
Pulpal response to caries and dental procedure
|
Most important factor is effective depth
Second most important is heat - Dessication is a factor when water is not present Vibrations |
|
Desiccation
|
When water in Tomes fibers are eliminated, will pull odontoblasts into tubules leading to their degeneration.
- Drying out is the worst for the pulp |
|
Heparin
|
Increases inhibitory effect of Anti-thrombin III
- Increases inhibitions of Factors Xa and Thrombin - Most important effect is inhibition of Thrombin and prevents conversion of Fibrinogen to Fibrin |
|
Ductility
Malleability Resilience Brittleness |
Ductility
- Material's ability to deform under tensile strength - Ability to be stretched into a wire Malleability - Ability to deform under compressive forces - Forms a thin sheet by hammering or rolling Resilience - Ability of a material to absorb energy when it is deformed elastically and release it upon unloading - Modulus is maximum energy that can be absorbed without creating a permanent distortion Brittleness - When subject to stress, breaks without significant deformation - High compressive strength but low tensile strength |
|
% of people without dental insurance
|
65-70%
|
|
Torsades de Points
|
Ventricular tachycardia
- Can be caused by Erythromycin and Interaction with Terfenadine |
|
Affinity of opioid receptor binding
|
Sodium lowers affinity of opioid receptor for agonists and antagonists
|
|
Prescription Parts
|
Superscription
- Abbreviation for Recipe, Rx symbol Inscription - Body of prescription. Provides names, quantities, dose, and dosage form Subscription - Specific instructions. Used in old days Transcription - Sig. Gives instructions to patient on how to take it. Followed by special instructions and refills |
|
Amyl Nitrite
|
Potent vasodilator
- Expands blood vessels - Relaxes involuntary muscles - Tachycardia Used as antidote for Cyanide Poisoning - Acts as an oxidant to induce formation of Methemoglobin - Can cause Methemoglobinemia |
|
Quinidine
|
Antiarrhythmic
- May cause Ventricular Tachyarrhythmias in patients with Atrial Fibrillation - Can give with Digitalis to prevent that |
|
Cardiac Glycosides
|
Used to treat congestive heart failure and arrhythmias
- Digoxin, Ouabain - Blocks Sodium Potassium pump, which pumps sodium out, and and potassium in. - Intracellular sodium is increased |
|
Hydralazine
|
Antihypertensive drug
- Acts on arterial smooth muscle to cause vasodilation |
|
Neuroleptic
|
Antipsychotic
|
|
Paternalism
|
aka Parentalism
- Limits one's autonomy for one's own good |
|
Sedative Most likely to cause dry mouth
|
Hydroxyzine
- First Generation Anti-Histamine |
|
Neuronal Depleting drugs
|
Reserpine
- Depletes NE granules and releases NE Guanethidine - Blocks adrenergic nerve endings Metyrosine - Inhibits tyrosine hydroxylase - Prevents formation of L-dopa, Epinephrine and NE |
|
Beta blockers that also block a1
|
Carvedilol and Labetalol
- Both are nonselective beta-blockers that also bloack alpha 1 receptors |
|
Epinephrine Reversal
|
Alpha blocking to reverse pressor action of epinephrine.
- NE pressor effect is blocked - Epi will bring about a fall in blood pressure from B2 receptors since alpha is blocked. |
|
Most common side effect of Beta Blockers
|
Weakness and Drowsiness
- As with all selective beta blockers, Selectivity for beta 1 is lost at high concentrations |
|
Metoprolol and Atenolol
|
Selective B1 blockers
- Both longer acting and more predictable than propranolol - At high concentrations selectivity for beta 1 is lost |
|
Acebutolol
|
B1 selective blocker used to treat HTN and control Ventricular Arrhythmias
- Low lipid solubility and has intrinsic sympathomimetic activity. Partial agonist at B2 |
|
Methylparaben
|
Perservative used in local anesthetics
- May cause allergies |
|
Chloral Hydrate
|
Used for Pedo pre-op anxiolysis
- Does not relieve pain - Children may become more excited and irritable before becoming sedated - Prodrug that is metabolized into actie Trichloroethanol - May cause Hypoprothrombinemia by displacing wafarin from binding site |
|
Dyclonine Hydrochloride
|
Oral Anesthetic used as Throat Lozenges
- Has Ketone intermediate linkage |
|
Maximum Local Dose
|
Lidocaine - 300mg 2% 8.3carp
Mepi - 300mg 3% 5.6 carp Prilo - 400mg 4% 5.6 carp Bupiv - 90mg 0.5% 10 carp Articaine: 7mg/kg |
|
NItrous and Oxygen
|
Nitrous Blue
Oxygen Green |
|
Ketamine
|
IV general anesthetic agent
- Produce hallucinations or illusions upon emergence - Give diazepam to relieve this - Also associated with Laryngospasm |
|
Cocaine as local
|
Only local anesthetic that vasoconstricts
- Mepivacaine has less vasodilator effect compared to everything else |
|
Buspirone
|
Orally administered antianxiety drug with short half life
- Not chemically related to any other anxiolytics - Acts at Serotonin receptors - Not anticonvulsant or muscle relaxing. Does not impair psychomotor function or cause sedation |
|
Erythromycin Common Side effect
|
GI upset
- Take with Food |
|
Aminoglycosides
|
Bacterialcidal antibiotics that creates fissures in outer membrane and binds to 30S subunit
- Aerobic, Gram Negative bacteria. - Gentamicin is most commonly use followed by Amikacin. - May cause neuromuscular weakness due to curare-like effect. So avoid in myasthenia gravis, botulism, or parkinsonism. - ***Causes Ototoxicity and Nephrotoxicity |
|
Sulfonimides
|
Structurally similar to PABA which is needed for folic acid synthesis
- Bacteriostatic - Used for UTI and not dental infections. - May cause Blood Dyscrasias - Sulfamethoxazole, Sulfisomidine, |
|
Probenecid
|
Causes uric acid excretion and treats Gout
- Used to prolong action of penicillin |
|
Broadest penicillins
|
Piperacillin
Ticarcillin |
|
Fluoroquinolones
|
Inhibits DNA Gyrase
- xacins: Ciprofloxacin - Bacteriocidal - Nausea & Headache |
|
Bacitracin
|
Inhibits Cell wall synthesis
- Can cause nephrotoxicity |
|
Photosensitivity
|
Caused by Tetracyclines
|
|
Neuraminadase Inhibitors
|
Oseltamvir
Zanamivir - Blocks Neuraminasase cleavage to release viruses |
|
Acyclovir
|
Inhibits DNA synthesis
|
|
Amantadine
Rimantadine |
Interferes Viral Protein M2 which is required for viral uncoating
|
|
Antipsychotics
|
First Generation: D2 antagonist. Shows Extra pyramidal symptoms - muscle rigidity, parkinson-like movements, spasms of neck and facial muscles.
- Phenothiazines - "azines" - Butyrophenones: Haloperidol. Schizo and Tourette's - Thioxanthenes: Weak. Schizo Second Gen: Bind dopamine receptors in Limbic system, and has affinity for serotonin receptors. Reduced induction of Extra Pyramidal Symptoms - Clozapine "apines" : Specific for limbic receptors and not muscles. Low EPS and Tardive Dyskinesia - Risperidone - Olanzapine - Quetiapine - Ziprasidone - Aripirazole Can cause Motor restlessness, Long QT and arrhythmias, parkinsonism, antimuscarinic effects |
|
Tardive Dyskinesia
|
Irreversible Neurological disorder from taking antipsychotic/neuroleptic drugs for more than a year. 20%
- Uncontrollable movement of body parts. - Also seen with Tricyclic Antidepressants |
|
N-Acetylcysteine
|
Specific antidote for acetaminophen poisoning
|
|
Anticholenergics
|
Mecamylamine - Nicotinic ganglion blocking drug
- Atropine - Benztropine - Scopolamine - Glycopyrrolate - Propantheline Bromide - Trihexyphenidyl HCL |
|
Neuromuscular Blockers
|
Non-Depolarizing: Competes with ACh at nicotinic receptor
- Tubocurare is prototype - Others are Mivacurium, Vecuronium, Doxacurium, the "Curs" Depolarizing - Succinylcholine. Nicotinic agonist and depolarizes motor end plate. Causes initial excitation followed by blockade of trasmission Dantrolene - Acts within skeletal muscle fiber to inhibit Calcium from SR Botox - Prevents release of ACh from motor terminal. |
|
Cholinesterase Inhibitors
|
Physostigmine
Neostigmine Pyridostigmine Edrophonium Tacrine Donepezil *Rivastigmine, Galantamine and Donepezil are approved for Alzheimer's. Malathione and Sarin are Irreversible |
|
Pilocarpine
|
Cholinergic alkaloid Salagen
- Used to treat open angle glaucoma. Also to induce salivary flow from radiation reduced flow. Cevimeline Evoxac - Treats xerostomia in Sjogren's |
|
Pralidoxime
|
Reverses effects of Anticholinesterase poisoning
Organophosphates include Thiones, Tabun, Soman, Sarin, Echotiophate, Isoflurophate |
|
Antimuscarinic Drugs
|
- Atropine & Scopolamine
- Glycopyrrolate - Benztropine - Homatropine - Trihexphenidyl - Ipratropium - Oxybutynin Contraindication of antimuscarinic drugs - Narrow-angle glaucoma - Prostatic hyperplasia - Tachycardia |
|
Inhaled corticosteroids
|
Fluticasone
Flunisolide Budesonide Beclomethasone Triamcinolone |
|
Peripheral Vasodilators
|
Hydralazine
Minoxidil |
|
Calcium Channel Blockers
|
Verapamil
Nifedipine Diltiazem - Effective indirect vasodilators to treat HTN |
|
Most potent broad spectrum antiarrhytimic
|
Amiodarone
- Blocks sodium, calcium, potassium, and beta receptors |
|
Antidote for Heparin
|
Protamine
- Heparin Antagonist |
|
PT vs PTT
|
PT - Prothrombin time
- Tests for deficiency of V, VII, X - Expressed as INR and tests for Wafarin & Vitamin K PTT - Partial Thromboplastin time - Heparin |
|
Alkylating agents
|
Cisplain
Cyclophosphamide - Anticancer |
|
Antidiabetic agents
|
Sulfonureas
- Close potassium channels, Stimulate beta cells, Increase sensitivity of organs to insulin - First gen: Bound to proteins. Tolbutaminde, Tolazamide, Chlorpropamide. - Second gen: Not bound: Glizipide, Glyburide, Glimepiride Biquanides: Metformin - Decreases hepatic glucose production. Minor effects on insulin sensitivity. No effect on Pancreas. Thiazolidinediones: Increases muscle and liver sensitivity. - Rosiglitazine, Pioglitazone Meglitinide: Stimulates release of insulin in short bursts - Repaglinide, Nateglinide a-Glucosidase inhibitors: Inhibits pancreatic a-amylase and membrane a-glucosidase hydrolase. Delays glucose absorption. - Acarbose, Miglitol |
|
Loperimide
|
Opiate that does not penetrate CNS
- Antidiarrheal that inhibits peristalsis - Sold OTC - No evidence of abuse or dependence |
|
"limus"
|
Immunosupressants
- Pimecrolimus - Sirolimus - Tacrolimus - Used to treat dermatitis and to prevent organ rejection |
|
Inhaled Nicotine
|
Contains 10mg but delivers 4
- Absorbed through mouth, not the lungs. - Also contains 1mg Menthol |
|
Potency vs Efficacy
|
Potency is measured by lower EC50
Efficacy is maximal effect |
|
Maxillary First Molar Endo
|
Highest failure rate due to complex Mesiobuccal root
- Many have major fins or second canals - Second canal is usually lingual to mesiobuccal canal orifice Triangular outline - Base formed by buccal canals - Apex by palatal canal - Mesial buccal to Palatal is longest |
|
Referred pain
|
Maxillary Incisors - Forehead
Maxillary canines and premolars - Nasolabial area Maxillary Second Premolars - Temporal region Maxillary Molars - Zygomatic, Parietal, Occipital regions Mandibular anteriors and premolars - Mental region Mandibular molars - Ear, angle of jaw, posterior neck Both Max and Mand molars - Opposing quadrant or to other teeth in same quadrant |
|
Recapitulation
|
Use MAF after each increase in file size
|
|
Urea Peroxide
|
Gly-Oxide
- Irrigant available in anhydrous glycerol base - Better tolerated by PA tissue than NaOCl, and has greater solvent action and germacidal than Hydrogen Peroxide - Excellent irrigant for narrow and curved canals utilizing slippery glycerol |
|
Techniques to remove Gutta Percha
|
Rotary
Ultrasonic Heat and Instrument File and Chemical - Chloroform is reagent of choice to dissolve gutta-percha |
|
Disinfection of Endo Instruments and Materials
|
Gutta percha can be disinfected by placing in 5.25% of NaOCl for 1 minute
Glass bead Sterilizer can sterilize endo files in 15 seconds at 220deg C |
|
Chelating Agents
|
Substitutes sodium ions for calcium ions.
- Makes edges of canal softer and facilitates canal enlargement. Also removes smear layer, and provides cleaner surface. - Usually EDTA and it will remain active in canal for 5 days if not inactivated with NaOCl EDTAC - EDTA with addition of Cetavlon: Quaternary ammonium compound with antimicrobial action, but with greater inflammatory potential. - Inactivated by NaOCl RC-Prep: Combines EDTA with Urea Peroxide to provide chelation and irrigation. |
|
Broken File
|
- If past the apex, must do surgery
- If breaks off in canal with a PA radiolucency present. Surgery is indicated. - Obturate to blockage and do apico - If broken off in apical 3rd and lodged tightly without any PA radiolucency, may obturate and inform patient. |
|
ZOE as Sealer
|
Act as lubricant
Form a bond Exert antibacterial activity Disadvantages of ZOE - Staining - Slow setting time - Non-adhesion - Soluble |
|
Major objectives of access preparation
|
Straight line access
Conservation of tooth structure Unroofing chamber and removing pulp horns |
|
Endo instrument types
|
All made of stainless steel
K-type - Files: Manufactured by twisting a blank square rod to produce a series of cutting flutes. Strongest of all files and cuts least aggressively. Reamers - Fewer flutes, and used in canal preparation to shave dentin and enlarge canals with reaming action. H-Type - Hedstrom Files: Sharp rotating cutter to gauge triangular segments out of a round blank shaft. Produces very sharp edges and used to cut. Use filing action only. Modification is S file |
|
Internal Bleaching
|
Superoxol
- 30% hydrogen peroxide solution - Potent oxidizing agent that directly oxidizes stain producing substances - Application of heat to liberate oxygen in bleaching agent |
|
Bleaching Side effects
|
- Cervical Root resorption is a potential side effect that won't occur for 6 months.
- Most probable post-op complication of a tooth that is not adequately obturated is acute apical periodontitis *** - Bleaching changes color of both Dentin and Enamel |
|
Walking Bleach technique
|
Sodium Perborate and water
- Place paste into chamber and temp for 4-7 days |
|
X-ray safety
|
Minimal Scatter radiation
- 6ft away 90 to 135 degree from beam Dental personnel should have no more than 50 mSv per year for whole body Dental units should operate at 70kV or higher to lower skin doses |
|
Predominant bacteria in root canals
|
Strict anaerobes predominate
- Porphyromonas species - Bacteroides Melaninogenica Enterococcus Faecalis is associated with failed root canals |
|
Pulp Structure
|
Cell rich zone - Innermost zone containing fibroblasts
Cell free zone - Rich in capillaries and nerve networks. Plexus of Raschkow is here Odontoblastic layer - Outermost layer that contains odontoblasts Contains Fibroblasts, Odontoblasts, Histiocytes, and Lymphocytes |
|
Predentin
|
Layer of dentin immediately adjacent to odontoblast layer 10-47 microns thick
- If this unmineralized layer is lost, predisposes dentin to internal resorption by odontoclasts |
|
Avulsed permanent tooth
|
Within 2 hours
- Splint for 7-10 days no more than 2 wks. - Prep canal and place calcium hydroxide paste - Replace paste every 3 months for a year and place permanent gutta percha More than 2 hours - Perform RCT prior to replantation. - Soak tooth in 2.4% Fluoride solution at 5.5pH for 20min - Resorption will be most frequent sequela |
|
Inflammatory Resorption
|
Internal resorption - Dental trauma, caries, pulp capping, cracked tooth
- Shape canal and place calcium hydroxide paste. - Replace every 3 months for a year, and then place gutta percha. Surface resorption - Caused by acute injury to PDL and root surface. Excessive ortho, and internal bleaching. - Very common and reversible. Once injury is not repeated, healing takes place with new cementum and PDL Replacement Resorption - Ankylosis |
|
Advantages and Disadvantages of MTA
|
Advantages
- High pH so induces hard tissue - Superior sealing ability - Low inflammation Disadvantage - Difficult to manipulate and Long set time |
|
Trephenation
|
Making a bur hole
Apical trephination can be done by aggressively placing 15 or 25K file beyond apex Surgical trephination is perforation of alveolar cortical bone with 15 scalpel and bur |
|
Apexification
|
Induce further root development in a pulpless tooth with Calcium Hydroxide-Methylcellulose paste.
- Alkaline environment promotes hard tissue deposition Apexogenesis is maintaining pulp vitality during pulp treatment to allow continued development of root |
|
Root submersion
|
Resection of roots 3mm below crest and coronal part is removed
- Root portion is kept in to maintain alveolar bone and preserve proprioception. |
|
Custom Tray Distolingual and Retromylohyoid Extensions
|
Distolingual
- Superior constrictor Retromylohyoid area - Limited posteriorly by palatalglossus and inferiorly by superior constrictor muscle |
|
ZOE impression material
|
ZOE must be border molded during one insertion within setting time of material
|
|
Primary Support Area for Dentures
|
Maxilla - Residual Ridges on Maxillary and Palatine bones
- Rugae are secondary support areas Mandible - Buccal shelf |
|
Most critical area in Maxillary Border Molding
|
Mucogingival fold above tuberosity
|
|
Pantograph
|
Precise tracing of paths followed by condyles
- Used when the hinge axis is transferred to a fully adjustable articulator |
|
Solder temp
|
Atleast 150deg F below fusion temp of metals being soldered
|
|
Dental Investment Materials
|
Gypsum bonded - Binder is Gypsum (Calcium Sulfate Hemihydrate)
- Used for 65% - 75% gold alloys near 1,100C Phosphate-bonded - Binder is metallic oxide and a phosphate - Type 1 is used for base metal - Type 2 is for RPD frameworks - Both can withstand high temperatures above 1,100C Silica bonded is not used today. |
|
Gold Alloy types
|
Types 1 and 2 are for inlays. Very ductile and easily burnished
Type 3 is for gold crowns and bridges.Can be heat treated Type 4 is hardest. Intended for bridges and RPD's. Can be heat treated |
|
Flux Composition
|
Sodium Pyroborate
Borax Silica - Also contains Potassium Fluoride to dissolve film supplied by chromium. |
|
Cements
|
Zinc Phosphate
- Standard - High compressive strength - Low initial pH, Lack of chemical bond, lack of anticariogenic effect. - Use Frozen Slab technique to extend working time Zinc Polycarboxylate cement - Chemical adhesion from chelation between cement carboxyl and calcium - Bonds mostly to enamel and weaker to dentin - Short working time and requires tooth conditioning step Glass Ionomer Cement - Chemical bonding to Enamel and Dentin - Anticariogenic effect by releasing fluoride - Good physical properties better than Zinc based cements - Low initial pH may result in sensitivity Resin Modified Glass Ionomer Cement - Higher strength and Lower solubility compared to Glass ionomer *- Do not use with all ceramic cements Resin Luting agents - Unfilled resins that Bonds to dentin. - Irritates pulp and has high film thickness - Best choice for Ceramic Restorations |
|
7/8th Crown
|
3/4th crown that involves distobuccal extention towards mid facial
|
|
Glass vs Ceramics
|
Highly esthetic Ceramic crowns are predominantly glass
High strength ceramics are predominantly Crystalline |
|
Nickel, Chromium, Cobalt
|
Nickle - Responsible for Ductility of alloy
Chromium - Corrosion resistance Cobalt - Rigidity |
|
Gypsum Types
|
1 - Impression plaster. Not really used today
2 - Modeling plaster. Ortho casts 3 - Dental stone. Yellow stone or Microstone. For regular casts and removable 4 - Die stone, low expansion. Densite or Improved Dental Stone - Dies for crown, bridge, and implants. 5 - Die stone, High expansion. DieKeen. - Crown and Bridge |
|
Gypsum Reaction Product
|
All gypsum forms Calcium Sulfate Dihydrate
- Alpha-hemihydrate requires less water and is stronger. Used in Stone or Die stone - Beta-hemihydrate is plaster of paris. Uses more water and is weaker. |
|
Gypsum production
|
Plaster - Heating in open vessel at 150-160deg celcius. Produces porous and irregularly shaped weakest prodct
Stone - Steam and Autoclave High strength Die Stone - Boiling in 30% CaCl and MgCl |
|
Polyether
|
- No reaction byproduct is produced
- Excellent dimensional stability and hydrophilic - Most rigid and most difficult to remove from mouth - Unstable in Moisture |
|
Condensation Silicones
|
- Captures details well
- Cheaper - Low tear strength - Condensation reaction from evaporation of alcohol results in shrinkage and poor dimensional stability |
|
Reversible Hydrocolloid
|
- Hydrophilic
- No custom trays or adhesives - Cheap - Unstable and Low tear strength - Needs special equipment - Must pour immediately and with stone only |
|
Irreversible Hydrocolloid
|
Filler - Diatomaceous Silica
Forms Sol - Potassium Alginate Reactor - Calcium Sulfate Retarder - Sodium Phosphate - Low cost - Straightforward technique - Unstable and low tear strength - Poor accuracy and high deformation *** - Most accurate when there is atleast 3mm thickness. Other materials are more accurate when there is less materials - Fast removal from mouth improves compressive and tear strength |
|
Addition Silicones
|
PVS
- Accurate - Stable - Hydrophobic - Releases hydrogen gas |
|
Syneresis
Imbibition Hysteresis |
Syneresis - Drying out and shrinking
Imbibition - Sucking up water and expanding Hysteresis - Characteristic of melting temperature that is different from gellation temperature |
|
Polysulfide
|
- Highest Tear Strength and high flexibility
- Long working time - Good detail - Messy and staining - Poor dimensional stability - Requires custom trays - Long setting time - Must be poured within 1 hour |
|
Fluorescence and Opalesence
|
Fluoresence is reflection of UV radiation
- Usually blue white hues - Fluoresence makes a definite contribution to brightness and vital appearance of teeth Opalesence is light effect of translucent material. - Teeth are usually blue in reflected light and red-orange in transmitted light ** - Value is most important factor and Hue is chosen first. |
|
Porcelain classification based on Fusion
|
High fusing - Denture teeth
Medium fusing - All ceramic and Porcelain jacket crowns Low fusing - PFM crowns |
|
Pickling
|
Removing surface oxides by placing casting in a acidic solution prior to polishing
|
|
Degassing
|
Necessary for all gold-porcelain systems
- Removes impurities and bubbles, and forms oxides for bonding |
|
Main cause of porcelain fracture at porcelain metal interface
|
Poor metal framework design
- Most common type of fracture occurs in the porcelain |
|
Sintering
|
Ceramic metal is heated in furnace
- Pores in ceramic will close and decrease defects |
|
Average Interocclusal Distance
|
3mm
|
|
Christensen's Phenomenon
|
Space that opens up in the posterior teeth as mandible moves anteriorly
- Increases as incisal guidance and horizontal condylar guidance increases |
|
Chromium Alloys for RPD
|
Chromium - Resist Corrosion
Cobalt - Strength Nickel - Ductility |
|
Cingulum rest Dimensions
|
2.5-3.00 mm MD length
2.0 mm Labiolingual Width 1.5 mm Depth |
|
Dentinogenesis Imperfecta
|
Autosomal Dominant trait affecting histodifferentiation phase of both primary and adult teeth
- Blue-gray teeth that abrade rapidly - Radiographs show obliteration of pulp chambers - *Roots appear narrower and more fragile with more bulbous crowns. Shield I - Associated with Osteogenesis Imperfecta Shield II - Hereditary opalescent dentin. Separate entity Shield III - Teeth with shell like appearance with multiple pulp exposures |
|
Amelogenesis Imperfecta
|
Normal Pulpal and Root morphology
- Occurs at Bell stage Hypoplastic - Histodifferentiation stage. Insufficent quantity Hypomaturation - Apposition stage. Normal thickness but low radiodensity and mineral content Hypocalcification - Soft and fragile enamel. Easily fractured. |
|
Concresence
|
Union of two teeth by cementum only
|
|
Dentin Dysplasia
|
Shields Type I - Normal primary and permanent crown morphology with amber translucency
- Short and constricted roots - Multiple radiolucencies and absent pulp chambers Shields type II - Permanent teeth appear normal but have thistle-tube-shaped pulp chambers with many pulp stones - No PA radiolucencies |
|
Cleft Lip and Palate Classes
|
Lip
1 - Unilateral notching of vermillion not extending into lip 2 - Extends to lip but not to nose 3 - Extends to nose 4 - Anything bilateral - Affects Males More Palate 1 - Only soft palate 2 - Soft palate and hard palate but no alveolar process 3 - Alveolar process on one side 4 - Both side alveolar process - Affects Females more |
|
Achondroplasia
|
Disproportionate short stature
- Head is large while arms and legs are short - Maxilla may be small with crowding of teeth - Class 3 is common finding |
|
Leukemia of Childhood
|
Acute Lymphoblastic Leukemia (ALL)
|
|
Rule of 4's
|
Starting at 7 months, 4 teeth erupt every 4 months
7 - Centrals 11 - Laterals 15 - First molars 19 - Canines 23 - Second molars |
|
Calcification order
|
Primary dentition begins calcification at 14wks. 3.5months
Permanent dentition - Birth: First molars - 4 months: Maxillary centrals and canines. Mandibular antierors - 10 months: Maxillary lateral - 16months: First premolars - 22months: Second premolars - 28months: Second molars - Maxillary 3rd molar at 8yr and Mandibular 3rd molars at 9yr |
|
Leeway Space
|
Size differential between primary canine, first and second molars, and permanent replacements
1.3mm per quadrant on maxilla 3.1mm per quad on mandible |
|
Most commonly retained primary tooth
|
Mandibular first molar
- If permanent tooth is close, best method is sectioning it |
|
Most common ectopically erupted teeth
|
Maxillary first permanent molars and canines
|
|
Begg vs Edgewise
|
Begg
- Narrow slot with a loosely fitted archwire held in place with locking in - Can only be used with round wires Edgewise - Have archwire channel that is rectangular in cross-section, with largest dimensions horizontally. Can also be used with round archwires |
|
Moment
|
Potential for rotation
|
|
SNA, SNB, and ANB
|
SNA - 82deg
SNB - 80deg ANB - 2deg. - Greater than 4 is Class 2 - Less than 0 is Class 3 |
|
Maxillary-Mandibular Plane angle
|
Normal value is 27deg
- Greater indicates longer anterior face height Long face favors Class 2 Short face favors Class 3 |
|
Aversion Conditioning and Systemic Desensitization
|
Aversion conditioning
- Punishment or Unpleasant stimuli are used to supress undesirable behavior. Hand Over mouth technique Systemic Desensitization - Used to eliminate maladaptive anxiety associated with Phobias. - First taught a relaxation activity, and person uses it to overcome each step of anxiety hierarchy |
|
Chemical Vaporization
|
Needs higher temperature and pressure than autoclave
- 132degC 20-40min - Uses alcohol, formaldehyde, ketone etc - Does not rust or corrode |
|
Glutaraldehyde
|
Most potent chemical germicide
- 2% Kills spores after 10hrs - Allergenic and toxic to tissues |
|
Flash cycle
|
134C, 30psi for 3 minutes
|
|
Oxidizing disinfectant
|
Chlorine in Bleach
- Oxidizes free sulfhydryl goups on bacteria and viruses |
|
Handwash Agents
|
Chlohexidine
- Disrupts microbial cell membrane - Good against gram pos and neg bacteria and some fungi Triclosan - Inhibits fatty acid synthesis |
|
Ramfjord teeth
|
Maxillary Right first molar, Left central, Left 1st premolar
Mandibular Left 1st molar, Right central, Right 1st premolar |
|
Flumazenil
|
Benzodiazepine Antagonist
|
|
Benzodiazepines
|
Midazolam: Versed
- Most lipid soluble so Short acting and Fast recovery time - Rapid onset of action, high effectiveness and low toxicity level - Anterograde Amnesia - Better patient comfort when administered IV or IM and does not require Propylene Glycol like Diazepam or Lorazepam Diazepam: Valium - Water insoluble and requires organic solvent Propylene Glycol - Onset time is slightly slower than Midazolam Lorazepam - Least lipid soluble - Slow onset but long duration limits its use for pre-op anesthesia Chloral Hydrate is seadative/hypnotic that is used in pediatric dentistry. |
|
Verrill's Sign
|
Ptosis of eyelids
- Seen in moderate to deep sedation |
|
Preoperative studies before general anesthesia
|
CBC and Urinalysis
|
|
TMJ Ligaments
|
Temporomandibular ligament
- aka Lateral Ligament - Articular Eminence to Mandibular condyle - Prevents inferior and posterior displacement - Keeps head of condyle in place during fracture Collateral ligaments - aka Discal ligaments. Medial and Lateral - Arises from periphery of disc and attached to medial and lateral poles of condyle to stabilize disc preventing discal movement. |
|
Articular Disc
|
Dense Fibrous CT
- Posterior band is thicker and attached to retridiscal tissues - Anterior band is continuous with capsular ligament, condyle, and superior lateral pterygoid Retrodiscal tissue is highly vascularized and innervated |
|
TMJ Innervation
|
Auriculotemporal nerve
Masseteric nerve Posterior Deep Temporal Nerve |
|
Oxygen Full E tank
|
600L at 2000psi
|
|
Myelin nerve blockade
|
Myelinated nerves have heavier sodium channels at Nodes of Ranvier
- Blocked before same size unmyelinated fibers |
|
Neuroleptic Analgesia vs Anesthesia
|
Neuroleptic Analgesia - Neuroleptic/Antianxiety agent + Narcotic
Neuroleptic Anesthesia - Also add Nitrous Oxide |
|
Inhalation Anesthetics
|
Enflurane, Halothane, Isoflurane, Sevoflurane, Desflurane, and One inorganic gas Nitrous Oxide
- All require vaporizer but Desflurane vaporizer has heating component for delivery at room temperature - All can trigger Malignant Hyperthemia. MH - Administration is preceded by IV sedative/hypnotic like Barbiturate. Requires intubation |
|
Signs indicating correct level of sedation using Valium
|
Blurring of vision
Slurring of speech 50% ptosis - Verill's sign - Valium is contraindicated in narrow angle glaucoma |
|
Ketamine
|
Dissociative anesthetic
- Sedative is usually given before procedure - Patients usually don't remember procedure - Increases airway secretions so may induce Laryngospasm - May induce intense dreams and hallucinations as medication wears off |
|
Treatment for Malignant Hyperthermia
|
Dantrolene
- Impairs calcium-dependent muscle contraction |
|
Propylene Glycol
|
Usually mixed into IV Valium and Lorazepam
- May cause Phlebitis |
|
Kassmaul Breathing
Cheyne-Stokes Breathing Stridor |
Kassmaul Breathing - Increase in rate and depth of respiration. Hyperventilation
Cheyne-Stokes Breathing - Alternating Hyperpnea, shallow respiration, and apnea. See in children and elderly. Stridor - High pitched respiratory sound heard in laryngeal obstruction |
|
Hemophilia
|
A - Factor 8
B - Christmas factor, Factor 9 C - Non sex linked. Factor 11 All show Prolonged PTT |
|
Opioid Receptors
|
Mu
- Mu1: Analgesia - Mu2: Respiratory depression, dependence, Euphoria Kappa - Analgesia, sedation, Psychomimetic Delta - Analgesia, modulates activity at Mu receptor |
|
Caldwell Luc approach
|
Used to remove teeth from Maxillary sinus
|
|
Tannic Acid
|
Found in tea bags to stop bleeding
|
|
Compartment Syndrome
|
Severe swelling after fracture puts pressure on blood vessels and causes muscles to die
|
|
Least common site of mandibular fracture
|
Coronoid Process
|
|
Treatment for Trigeminal Neuralgia
|
Carbmazepine
|
|
TMJ Procedures
|
Arthroscopy
- Direct visualization of structures, biopsy, removal and injection of materials Disc repositioning - Used in patients with painfil persistent clicking - Posterior wedge is removed and sutured to reposition. Disc repair or removal - When disc is severly damaged Condylotomy - Intraoral vertical ramus osteotomy Total Joint replacement - Rheumatoid arthritis, and sever degenerating bone disease - Costochondral bone graft reconstruction is most common material |
|
Stages of Articular Disc Internal Derangement
|
1 - Reciprocol clicking occurs suddenly and spontaneously after injury
2 - Reciprocal clicking with intermittent locking. Painful 3 - Limited opening. Termed Closed lock <27mm opening 4 - Increase in opening and crepitus from degenerative changes. Less painful |
|
Antibiotic used in treating Pseudomonas and Indole-positive Proteius species
|
Carbenicillin
Ticarcillin Piperacillin Ciprofloxacin |
|
Treats Vaginal Candidiasis
|
Fluconazole
|
|
Antibiotic that blocks NMJ
|
Streptomycin
- Causes Respiratory Difficulties |
|
Cycloplegia
|
Loss of Lens accomodation
- Caused by Muscarinic Blocking agents such as Atropine |
|
Nalidixic Acid
|
It is especially used in treating urinary tract infections
|
|
Penicillinase Resistant Penicillins
|
COND
Cloxacillin Oxacillin Nafcillin Dicloxacillin |
|
Demeclocycline
|
- Tetracycline known to cause nephrogenic diabetes insipidus.
- Has reaction to Sunlight |
|
Most slowly excreted Tetracycline
|
Doxycycline
- Long half life - Allows once per day dosage |
|
CPR guidelines
|
30 compressions for every 2 breaths
- Ideally want 100 compressions a minute or more |
|
Anachoresis
|
Localization of Microbes in a site of inflammation
|
|
Propranolol may decrease the metabolism of:
|
Lidocaine
|
|
What is the best combination of drugs to treat Parkinson’s Disease
|
Levodopa (L-dopa) and decarboxylase inhibitors (Carbidopa). Secondary drugs for Parkinson’s: anti-cholinergic, anti-histamines, or amantidine
|
|
Contraindicated with Erythromycin
|
Terfenidine and Ketoconazole
- May cause cardiac arrhythemia in people with liver damage |
|
Flushing water lines
|
3min beginning of day and 1min between patients
|
|
Oz to mL
|
1oz = 30ml
|
|
Percent of mandibular first molars with 4 canals
|
35-40%
|
|
What is the percentage of chlorhexidine (0.1-0.2%) that remain after rinsing
|
30%
|
|
What amalgam works best to restore proximal contours
|
Admixed
|
|
Mg and Ca interferes with the action of
|
Tetracyclines
|
|
Ginkgo
|
Memory Enhacement
- May affect anticoagulants and can inhibit MAO |
|
St. John's Wort
|
Treats Depression
- Speeds up estrogen metabolism so don't take with Contraceptives - ALso interacts with Benzodiazepines, and Wafarin - May cause photosensitivity and cataracts - Aggravates Psychosis in Schizo - Eliminates free radicals |
|
Feverfew
|
Used for headaches but doesn't work
- Discontinuation could cause withdrawal syndrome. Headaches, muscle and joint pain - Contact dermatitis - Mouth ulcers and numbness - Can interact with blood thinners - Do not take while pregnant |
|
Henly & Huntler syndrome
|
Lysosomal storage disorder accumulating GAGs
- X linked - Prominent forehead, a nose with a flattened bridge, and an enlarged tongue - Frequent infections of the ears and respiratory tract. |
|
Zinc pyrithione
|
Antifungal and Antibiotic
- Dandruff and Seborrhoeic Dermatitis - Treats Psoriasis, Eczema, Ringworm, Athletes foot, Atopic dermatitis, Tinea, Vitiligo |
|
Neuropraxia
|
Damage to the myelin sheath but leaves the nerve intact and is an impermanent condition
- Mildest nerve damage - Does not show wallerian degeneration |
|
Mepivacaine Calculation
|
2% 4.4mg/kg up to 300 mg
Same as lido |
|
Guerin sign
|
Floating Maxilla
- Lefort 1 |
|
Cleidocranial Dysplasia
|
Hypoplasia of clavicles, cranial bossing, hypertelorism, retained primary teeth, supernumary teeth, malaligned teeth, unerupted teeth.
|
|
Implant be placed in relation to adjacent CEJ
|
2-3mm below
|
|
Liquid of Glass Ionomer Cements
|
Liquid made of FluoroAluminoSilicate glass component and Polyacrylic Acid
- Acid Base reaction |
|
Vicodin
|
Paracetamol/Acetaminophen + Hydrocodone
- Regular 5.0/500 - ES 7.5/750 - HP 10/660 |
|
Nominal Data
|
A set of data is said to be nominal if the values / observations belonging to it can be assigned a code in the form of a number where the numbers are simply labels.
|
|
Antibiotic Prophylaxis
|
Amoxicillin
- 2g - 50mg/kg kids Clindamycin - 600mg - 20mg/kg kids Cephalexin - 2g - 50mg/kg kids Azithromycin - 500mg - 15mg/kg kids |
|
Order of extraction
|
Max before mandibular and posterior before anterior
|
|
Sulfonylrea
|
Stimulation of pancreas insulin production
|
|
Amitriptyline
|
Most common tricyclic antidepressant
- Inhibits reuptake of NE and serotonin |
|
Fluoride toxic dose
|
5-10 mg/kg
|
|
Dolichocephaly
|
Long narrow face
|
|
Q value
|
The q-value of an individual hypothesis test is the minimum False Discovery Rate at which the test may be called significant
|
|
Implant Space requirement
|
Greater or Equal to 1.5mm from adjacent tooth
3mm from Adjacent implant 1mm from Buccal and Lingual wall 2mm from Vital structures |
|
Mechanism of action of Listerine
|
- Bacterial cell wall destruction
- Extraction of bacterial lipopolysaccharides - Bacterial enzymatic inhibition |
|
Zn in Amalgam
|
Mercury retained, dimensional change, compressive strength, and creep
- Physical properties |
|
Treatment for Cocaine Overdose
|
Benzodiazepine
Acetaminophen Lebetalol |
|
Which Syndrome least developmental delay
|
Trecher collins syndrome
|
|
BRONJ Radiagion
|
Below 60Gy is rare
|
|
Amalgam Trituration
|
Better to Overtriturate
- Soupy before hardening and less expansion - Strength also increases - **Working time of amalgam will decrease with over-trituration - Undertrituration will become crumbly, dull, and weak - Both over and under triturated will increase creep |
|
Canine Access
|
Maxillary canine - Angle towards distal because all maxillary anterior teeth have distal axial inclination
Mandibular canine - Direct towards lingual because it has labial axial inclination. |
|
Amalgam Strength
|
Most important factor is Mercury content
- High Copper minimizes Hg matrix, and minimizes Gamma II(SnHg) phase which is the weak corrosive phase |
|
Cerebral Palsy
|
Due to prenatal trauma to brain
- Most common handicap 2/1000 - Bruxism, GERD, Gingival over growth, hypertonic tongue - Higher incidence of Perio and Caries |
|
Do not with vasocronstrictor in:
|
Nonselective beta blockers
- Not contraindicated in selective beta blockes like Atenolol, Metoprolol, Acetutolol. Tricyclic Antidepressants - No more than 3 carpules Cocaine |
|
ZOE
|
Sedative. Relieves Pain and calms nerve
- Offers protection to pulp - Cannot be used with composites so use GIC - Not very durable so used in IRM **Varnish shold be placed after ZOE or CaOH. But if using Zinc Phosphate, Varnish placed before. ZP does not help Dentin, and decreases pH |
|
Taper Fissured
|
669-703
|
|
Fluoridated Population of US
|
62%
|
|
How long to grow back bone in Jaw Fracture
|
8-12wks
- 2-3wks for inflammation - 4-8wks soft callus - 8-12wks hard callus - Bone remodeling for years |
|
MRI vs Cone beam vs xray
|
MRI - shows good soft tissue in TMJ. Doesn't show bone structures
Cone beam - Shows good soft and hard tissue, and vessels xray - Shows Bone and Blood vessels but no soft tissues. |
|
Special xrays
|
Towns - Condyle and ramus
Waters - Sinus Submentovortex - Zygomatic arch, Jug, Pan |
|
Prozac
|
Selective Serotonin Receptor Inhibitor
- Antidepressant |
|
All porcelain Facial reduction
|
1mm
|
|
Chi test
|
Chi square test compares observed data w/ expected data
|
|
z vs t test
|
Z test - Preferable with n>30
t test - Less than 30 and good for more variety. Paired t test for groups that are not independent of each other. Like same group before and after tx. |
|
C factor
|
Bonded to unbonded surfaces
5 for class 1 Weak high stress bond 2 for class 2 0.2 for class 4 Strong bond - high configuration is bad. Should be layered |
|
W on clamp
|
w/o Wings
|
|
Morbidity
|
# of ill out of the population
- Rate of incidence of a disease |
|
Green Stains
|
Silver
|
|
Difference between 245 and 330
|
Both are pear shaped
- 245 is 3mm - 330 is 1mm |
|
Veneer reduction
|
0.3mm Gingival 3rd
0.5mm Middle and Incisal 3rd 0.5mm Proximal margins |
|
CMV
|
Gancyclovir, Cidofovir, Foscarnet
|
|
Primary teeth calcification in utero
|
14wk - 3.5months
|
|
Cell in crevicular fluid
|
92% PMNs, 4% B-cells, 3% T-cells, 1% phagocytes
|
|
Carbamide Gel
|
30%
|
|
Order to extract Molars
|
Max posteriors leaving 1st molar
Max anteriors leaving Canine 1st molar, then Canine - Visitbility, Sinus and tuberosity considerations |
|
Healing and Long Junctional Epithelium
|
- New epithelium in 1-2wks
- Inflammation reduced in 3-4wks |
|
Canine Canals
|
Max canine- 100% one canal; Mand canine – 70% one canal
|
|
Warfarin- Surgery
|
Stop Wafarin 2 days before surgery if INR is >3
- Want INR less than 1.5 |
|
Most common problem with complete dentures
|
Loose Dentures then Pain
|
|
Incident of cleft palate / Cleft lip in US
|
1/700
|
|
What is the limit before bone dies in implant procedure
|
55 Deg
- Vitality of bone is altered beyond 47deg |
|
Most toxic Mercury
|
Methyl Mercury
- It works its way up the food chain. |
|
Papillon–Lefèvre syndrome
|
- Hyperkeratosis of palms and soles of feet
- Periodontitis - Early loss of primary and permanent teeth |
|
Which is least likely to be successful facial soft tissue graft
|
Lower 1st premolars
|
|
What is the most common tooth that involves space management in primary teeth
|
1st molars
|
|
Most common race ECC, Perio, and Caries
|
ECC - Hispanics
Perio - Natives Caries - Natives |
|
Ginseng
|
Do not take with
- NSAIDS - ASPRIN - Wafarin - Diabetes drugs - Anti-depressants |
|
Chamomile
|
Countains Coumarin
- Anticoagulant |