SURGERY

1. Most common to be missing: 3M, 2PM, upper LI

2. Least likely to be missing: C

3. V comes thru: Foramen ovale

4. Ectopic eruption of Mand 1M in relation w/primary 2M. What to do: Ext 2M primary

5. Order of ext of upper molars: 3-2-1 to prevent fracture of tuberosity

6. Most common complication of ext? Hemorrhage, infection, Root Fracture

7. X-ray of Mand M ext site. Pain & pus. Didn’t have dry socket. Osteomyelitis (common bone
infection after ext - showed on X-ray with lots of bone resorption)

8. Osteomyelitis usually begins in the medullary space involving cancellous bone

9. Non-suppurative osteomyelitis: chronic sclerosis osteomyelitis, garrets sclerosis osteomyelitis -

actinomycotic osteomyelitis

10. Tx for osteomyelitis after ext: curettage of walls

11. Max resorption of bone after ext: upward - inward

12. Mand resorption of bone after ext: downward - outward

13. Root fracture during ext, 1st thing to do: hemostasis and visualize root

14. Luxate primary tooth: Palataly

15. Luxate adult tooth: Bucally

16. After removed tooth: bend back the bone UNLESS ortho or implant

17. When do you do serial ext? For space de ciency in mand ant region

18. Ankylosed tooth: “athypical sharp sound on percussion”

19. Day after ext and penicillin, pt comes with swelling, dysphagia, fever —> refer to OMFS

20. Max 3M most common to be displaced to infratemporal fossa

21. Luxate of distoangular Max 3M: DB

22. #16 half bony, half in gum: most common impaction & easiest to take out —> FALSE

23. Indications to ext 3M: space for ortho, prevent crowding, pain during eruption, infection,
truisms,

24. Absolute indication to ext: x-ray showing bone pathology

25. Pericoronaritis w/o surgery tx: clean and ATB

26. Pericoronaritis w/ surgery: before surgery, control infection. Irrigate, drain, ATB then ext

27. Oro-antral communication <2mm: do nothing - 2-6mm ATB, nasal decongestant, analgesic,
antihistamine + gure 8 suture - >6mm ap surgery

1. Medication: afrin nasal (local decongestant) - amoxi - actifed (sysetemic descongestant)

28. Caudwell lock technique? Incision over canine fossa to remove tip from sinus

29. Horizontal impaction must always involve bone removal and sectioning during EXT

MEDICAL COMPLICATIONS

1. Adderall ok

2. Therapy to avoid osteoradionecrosis: ext questionable teeth in area to receive 60+grays

3. Patient undergoing radio therapy, needs ext. what to do? Endo and amputate crown without
trauma to soft tissue of bone

4. Pt w/ radio therapy needs ext. what to do? pre-ext & post-ext hyperbaric oxygen

5. Osteoradionecrosis: swelling, degeneration & necrosis of blood vessels w/ resulting thickening

of vessels walls. Use: Hyperbaric oxygen for angiogenesis

6. IV bisphosphonates needs ext: RCT then coronotomy and seal

7. IV bisph for 6m or 2 years: RCT

8. BRONJ & bone exposed. What to do? chx rinse and ATB

9. Nerve injury tx: medal dosepak (steroid)

INSTRUMENTS

• #9 periosteal elevator

• Mandibular

• #74 ash forced (PM)

• #151A (PM ONLY)

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 •
Cryer elevator: single retained root of M

•
#17 M (but not fused roots)

•
#23 cowhorn (M)

•
#222 fused conical root (M)

• Maxillary:

• #65 beyonet-sharpet forces: I or roots

• #150 universal (PM, C, I)

• #88 R/L cowhorn force (M)

• #286: root tip

1. Elevator can be used to advantage when interdental bone is used as fulcrum

2. Elevator: lever

3. #301 most commonly used. Straight elevator

4. Rongeurs: gubia: trim interradicular bone

SUTURE

1. What suture use when only removing one side of tooth: interrupted

2. What suture use when only buccal tissue is disrupted? Interrupted

3. Interrupted: immobilizes the ap

4. What suture contains wicks that allows bacteria to enter/invade ext site? Silk

5. Incision on corner of lip. Where do you put suture? Movable to xed tissue (most important is
the vermilion border)

6. 2cm laceration on lip. What suture? Continuous

7. Suture in single ext —> when there is severe bleeding from gingiva or if gingival cu is torn or
loose

8. Primary purpose: immobilize ap (from movable to non-movable)

ALVEOLAR OSTEITIS

1. Most common negative outcome of ext? Alveolar osteitis

2. What causes dry socket? Dislodgment of clot ( brinolysis of clot)

3. Alveolitis: No ATB, no curettage. JUST irrigation medical dressing (palliative)

FRACTURES

- Le fort I: horizontal - associated w/ max sinus

- Le fort II: pyramidal -separation of Max attached nasal complex from orbital and zygomatic
fracture

- Le fort III: nasoethmoidal complex, zygoma and maxilla from cranial base—>craniofacial
separation.

- Pathognomonic sign: periorbital ecchymosis/hematoma, diplopia (double vision) &/or

subconjuntival hemorrhage, infraorbital nerve damage

- Zygomaticomaxillary complex fracture: formerly known as a tripod fracture, caused by direct

blow to molar eminence, involves bleeding under conjunctiva

- Pano: mandible fracture

- Reverse Townes: condyle fracture

- Submentovertex: zygomatic fracture

- Water: max sinus

- CBCT: facial fracture

1. Key sign of mand fracture? Occlusal discrepancy or change in occlusion

2. Pt w/ condylar fracture. What happens when mandible grows? Asymmetric growth w/ damage
side lagging (una ected side will continue growing)

3. Child has mand trauma, what do you have late? Midline facial asymmetry

4. Primary consequence of trauma in jaw kids? Retards growth

5. Condyle > angle > symphysis

6. Greenstick: fractures most seen in kids (closed fractures)

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 7. Ankylosis of condyle most common due to: trauma

8. Splinting closed a bone fracture: 6 weeks

9. Paresthesia (lower lip numbness) occurs most common in: angle fracture

10. Guerin sign (ecchymosis in the region of greater palatine vessels) is a feature of: Le Fort I

11. Le Fort I: brings the lower midface forward (from level of upper teeth to above nostrils)

12. Le Fort II: separation & mobility of midface, gagging on posterior teeth, ant open bite

13. Le Fort III: brings the entire mid face forward, from upper teeth to just above cheekbones

14. Le Fort III most common injured nerve: infraorbital

15. Subconjuntival hemorrhage is seen in what fracture? Zugomaticomaxillary complex

16. Pt w/ numbness of left upper lip, cheek, and left side of nose following a fracture of midface.
Symptoms from: intraorbital rim

17. Most common fracture in face? Zygomaticomaxillary complex

18. X-ray to see fracture of mand symphysis? A-P or CT

19. Mand symphisys closes at: 6-9 months

20. Fracture through body of mand (bilateral) will compromise pt respiration

21. You get punched on lower right & broken jaw: contralateral condylar fracture

22. Fracture is always opposite side condyle

23. When doing ext, jaw fractures. What to do? Open ap and see, remove all fractured pieces that
are not attached to periosteum

24. What x-ray to con rm horizontal fracture? 3 x-rays moving vertical angulation

25. Better to see midface fracture? Water - ct

26. What causes trauma in US: car accidents

27. Pt in an accident, shows RL inf over body of mandible, close to angle. This RL is: fracture

28. Subcondylar fracture, the lat pterygoid will displace the condyle anterior and medially

29. Most common associated with mandibular fracture management: infection

30. Line of fracture will determine whether muscle will displace fractured segments from their
original position

31. Le fort I: referred as transmaxillary fracture

32. Le Fort I: for recursive maxilla or vertical excess

33. Mand fracture ideally tx: open reduction & internal xation (ORIF)

34. BSSO: for retrusie or protrusive mand - condyle position should be unaltered

ORTHOGNATIC SURGERY

- Osteotomy: surgery where bone is cut to shorten, Lengthen or change its alignment

- Distractive osteogenesis: surgical process used to reconstruct skeletal deformities and lengthen
the long bones of the body. Bene t of simultaneous ingress of bone length and volume of
surrounding soft tissue. Easier in children, show less relapse. High discomfort

- BSSO: split bilateral and moved to more balanced position, correct malocclusion. Stable for
normal/decreased facial heigh but ↑ relapse for pt w/ high mandibular plane angles. Most
common used for mand advancement or retraction

1. Correction of severe class II: BSSO - Max impaction and autorotation of the mandible

2. Most complication of BSSO: IAN, loss of sensitivity - neurosensory disturbance

3. Fix class III: Le Fort I w/ BSSO

4. 16 yo. Can’t to rapid palatal expander bc she is OLD

5. BSSO: splint for 4-6 weeks

6. Pt has skeletal deformity w/ class III. Deformity as result of max de ciency. Tx? Surgical
repositioning of maxilla

7. Main di erence between distraction osteogenesis & regular osteotomy? DO has more stability
during wide span of movements

8. DO: bigger and stable movements

9. DO preferred over traditional osteotomy: when a large advancement is needed

10. Complications of DO: long term f/u

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 BIOPSY
- Incisional: lesion large >1cm, suspicious of malignancy, or anatomic area w/ ↑ morbidity

- Excisional: small <1cm, benign appearance. Remove w/ margin tissue

1. Incisions parallel to lines of muscle tension

2. Wait 14 days to biopsy an lesion

3. White patch on buccal mucosa: smear

4. Candidiasis biopsy choice: cytologic smear

5. Store the sample: formalin

6. Before exploration of intrabony pathology —> aspiration biopsy must be done

OTHER
1. Contraindications for ext: acute pericoronitis, end-stage renal dz, acute infectious stomatitis

2. Ways to eliminate dead space: close wound in layers to minimize pos-op void - apply pressure
dressings - use drain to remove any bleeding that accumulates

3. Milohyoid ridges can be safely excised to prepare edentulous mandible for denture

4. Before removing a palatal torus, a stent should be fabricated

5. Leaset invasive for TMJ: arthroscopy

6. Immunocompromised pt: bactericidal agent are preferred over bacteriostatic

7. Narrow PDL of impacted 3M, makes it hard to ext

8. Side e ects of obstructive sleep apnea: hypertension - cor pulmonate - cardiac arrhythmia

9. Rescue breathing: once every 5-6 seconds

10. Barbiturates —> sedation but not analgesia - Depress CNS - anticonvulsant e ects

11. Nerve most damaged on TMJ surgery: Facial

12. Nerve to mylohyoid muscle —> V3

13. Most common cause of Cushing syndrome: Pituitary Adenomas

14. Nitroglycerin: chest discomfort —> anginal attach

15. Anxiety —> respiratory alkalosis

16. Scopolamine —> preoperative med to produce amnesia and ↓ salivary & respiratory
secretions

17. Cavernous sinos thrombosis —> staphylo aureus

18. Right lat pterigoid muscle with lateral pterigoid injury, mandible will deviate toward injury side

19. Temporomandibular ligament from TMJ —> prevents post and ins displacement

20. Sliding genioplasty —> best long-term result for enlargement of chin

21. Most commonly used allogeneic bone —> freeze-dried

22. Larger than normal functional residual capacity makes nitrous oxide take longer

23. Ventricular ejection below 50% —> CHF

24. CHF causes—>MI, ischemic heart dz, uncontrolled hypertensions, cardiomyopathy. Usually
LEFT vent fails rst

25. Pain is the sensation that disappears rst on LA. then: temperature - touch - deep pressure -
skeletal muscle tone. They will regain it in reverse order

26. To control laryngospasm —> oxygen and syccinylcholine

27. Local contraindications for ext: ANUG - irradiated jaw - malignant dz - acute infections
stomatitis - acute pericornitis - acute infection with uncontrolled cellulitis

28. Systemic contraindications for ext: diabetes - cardia - bleeding disorders - leukemia -
debilitating dz

29. Endosseous implant has between bone and implant: bone-implant interface

30. Compensatory stage of shock —> increased heart rate

31. Anaphylactic —> trendelenburg position

ANESTHESIA
MOA: work on impulse conduction directly by:

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 - Inducing reversible % dose-dependent reduction of AP hight —> progressing to total
inhibition

- blocking Na+ intracellular: prevent expected transient permeability increase (↓ sodium

uptake)

- Ester: metabolized by plasma esterase, release PABA

- Amides: metabolized in liver by P450 enzyme (except Arti - liver and plasma(1st) —> has ester
group also)

- Onset of action & duration depend: dose & lipid solubility (potency)

- ↑ liposolubility: rapid penetration + duration

- High pKa: slow onset.

- ↑ protein binding: ↑ duration (ex. Bupi, tetra)

1. Anterior superior alveolar nerve block: 1.0mL

2. LA broken down by: biotransformation

3. Prilocaine: Methemoglobinemia (w/ given over 500-600mg)

1. Symptoms: cyanosis, headache, confusion, weakness, chest pain —> tx: methylene blue

2. Max dose: 600 mg

4. < pKa: faster onset of action

5. Mepivacaine: best LA use w/o VC

1. comes in more than 1 concentration in the US

2. lowest pKa

3. least VD

4. Max dose: 400mg

6. Bupivacaine: longest action - most hydrophobic and ↑ degree of protein binding

1. Max dose: 90 mg

7. Why some LA are longer duration than others: VC - % protein binding - degree of lipid
solubility

8. Articaine: packed in the highest [ ] of all LA

1. short half-life

2. Max dose: 500mg

9. Max dose Lido: 500 mg

10. Anesthesia of facial nerve: doesn’t cause excessive salivation

11. Least likely allergy reaction: Lido

12. For LA administration —> supine position

13. Slow injection —> not less than 1mL in 30 sec

14. Best indicator for success of intra-pulsar anesthesia: feel the back pressure during injection
(stops hemorrhage, anesthesia after 30 sec)

15. Disappear: 1 pain - 2 temp - 3 touch - 4 pressure

16. Block of maxillary division of V nerve: in pterypalatine space

17. Multiple sclerosis: use Mepi (no Epi)

18. Foraminous: 16 mm needle penetration

19. Complete osseointegration —> 6 months

20. Lido - prilo and etidocaine —> pregnant

21. Epinephrine, and opioids contraindicated in MAOI

22. Trismus after IAN injection —> medial ptreygoid muscle

23. Numb kid soft tissue: for 3 hr

24. Max allowable dose of 2% lido with 1:100,000 epi —> 3.2mg lido / lb

25. Emphysema —> barrel-chested appearance

26. Mucus or foreign object obstructs air ow in a main-stem brooches causing collapse of the
a ected lung tissue into an airless state —> atelectasis

GENERAL ANESTHESIA
1. 26 months kid w/ 12 caries: general anesthesia

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 2. General anesthesia kid: chloral hydrate + midazolam

3. Pt under general anesthesia monitor: respiration, oxygen saturation level, skin and oral mucosa

1. Don’t monitor: electro cardiogram

4. #1 cause for problem during IV sedation: hypoxia

5. Sedation IV Midazolam: 2mg

6. Sedation IV Diazepam: 10 mg

7. Most common cause of fever within 24 hr of general anesthesia: atelectasis & pneumotosis

8. Atelactasis: typically occurs 36 hr post-op. Prolonged atelectasis can lead to pneumonia. One
of the 2 most common causes of fever in pt that had general anesthesia. The other one is
pneumonitis.

9. Neuroleptic anesthesia (unconsciousness) —> neuroleptic + narcotic analgesic + nitrous

10. Neuroleptic anesthesia: neuroleptic analgesia + nitrous oxide in oxygen

11. Neuroleptic analgesia: neuroleptic agent (droperidol) + narcotic analgesic (fentanyl)

12. Geudel’s stage of anesthesia:

1. Stage I: amnesia, analgesia —> Nitros oxide

2. Stage II: delirium and excitement

3. Stage III: surgical anesthesia

4. Stage IV: premortem

13. Ketamine: dissociative anesthesia

14. Verill sign (dropping upper and lower eyelid) during IV sedation helps the anesthesiologist
determine the depth and adequacy of sedation. Safe limit has been reached

NITROUS
- Absolutely contraindicated: severe respiratory compromised, COPD, respiratory infection,
pneumothorax/collapsed lungs, head injury, pregnancy (1st trimester)

- Relative contraindicated: cardiovascular conditions, pregnancy (teratogenic e ect), nasal

congestion, children w/high anxiety,

1. Nitrous oxide works on CNS

2. Nitrous oxidizes the cobalt in vit B12, resulting in the inhibition of methionine synthase

3. Reservoir bag should be 1/3 to 2/3 full

4. Device used in evaluation of N2O: Pulse oximeter (measures oxygen in blood)

5. Total ow: 4-6 L per min

6. Max for kids: 50%

7. Max for adult: 70%

8. Abuse of nitrous it results in peripheral neuropathy

9. Side e ect: nausea

10. If patient doesn’t have 100% oxygen: di usion hypoxia

11. Weak anesthetic used w/ other agents (thiopental) to produce surgical anesth—> Nitrous Oxide

12. Nitrous oxide and oxygen ration having 4L/min oxygen and 3L/min nitrous shows 57% oxygen
[ ]

IMPLANTS
- 1mm bone (F/L), inferior border, max sinus, nasal cavity

- 1.5mm: Between implant and tooth (heigh of contour)

- 2mm: IAN

- 3mm: between implants

- 5mm mental nerve

- Min vertical height of bone: 10mm

- Min width bone: 6mm

- Adjacent CEJ: apical 2-3mm

- Mini implant: 2.4mm

- CI: uncontrolled diabetes, immunocompromised, reduced volume and height of bone,

bisphosphonate therapy, brusixm, Tabacco, cleft palate, young kids, adolescent

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 1. Bone-implant interference: osseointegration is the most long-term stable: forms titanium oxide
layer

2. Implant osseointegration best in Ant mand (best area for implant)

3. Worst least successful implant: max post

4. Post max: > rate in osseointegration failure

5. Succes: mand ant > mand post > max ant > max post

6. Bone quality:implant success from high to low

1. Type I:ant mand

2. Type II: post mand

3. Type III: ant max

4. Type IV: post max

7. Bacteria under implants: gram - rods and laments anaerobic (responsible of failure)

8. After 4 seeks will start integration (Titanium & Zirconia)

9. Emergence pro le for esthetic: 2-3 mm capital to adjacent tooth CEJ

10. Most popular implants used: root form implants

11. Trans-osteal: Mand anterior

12. Gingival bers orient next to implant: parallel with cu (implant)

13. Peri implant bone loss <0.2mm per year after rst year is ok

14. 47C/1’ or 40C/7’ enough to compromise osseointegration —> cool down w/ alkaline irrigation

15. Main reason for implant failure: surgical error

16. Worst type of force for an implant? Horizontal (widening of crestal bone)

17. Greates incidence on implants failure: smoking

18. 1mm crestal bone remains around implant after 1 year. Why? In ammation

19. Epithelium attaches the same as natural teeth (hemidesmosome) - Not CT

20. High torque / slow speed to place implant

21. Success rate of implants in 10 years: 80%

22. Success rate of implants after 5 years: 85%

23. When getting a crown for implant, what occlusal scheme is preferred? Metal occlusal

24. For cement retainers: need more interocclusal space. When there is little space: screw retained

25. Purpose of external hex screw: anti-rotational (of crown)

26. Internal components helps: prevent rotation of abutment

27. Replication of implant in cast: analogue

28. Stent: angulation, alignment

29. Preload of implant is comparable to what force? Compressive

30. High loading can lead to implant creep

31. Advantage of open tray impression: reduce e ect of implant angulation

32. Most common complication for crown: screw loosening

33. When not to immediately load implant? Bone grafting + GTR

34. Complete denture over implant: maxillary 4 - mandibular 2

35. FPD from nat tooth and implant: max stress is concentrated on superior portion of implant
(crown - fracture)

36. RPD never occlusal rest on implant

37. Edentulous patient should not ware anything for 2 weeks after implant placement

38. Implant supported prosth, only 2-3 implants seat. What to do? Separate/section and re-index

PERIODONTICS
39. When drilling for implant do not exceed 47C in 1 min

40. Contraindications to selective grinding in natural dentition:

1. Pulp chambers are large

2. Presence of tooth sensitivity

3. When major occlusal discrepancies may require ortho

4. In patients who are poor candidates for full mouth reconstruction because of psychologic
factors

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 41. Reason of splinting —> pt comfort

PERIODONTUM

1. Epithelialization to be completed after gingivectomy: 5-14 days

2. Periodontal probe in inter proximal area: touch the contact area and the tip should angle
slightly beneath and beyond the contact area

3. Gingival bers are found within: free gingiva

4. Gingival bers arranged in 3 groups: circular, gingivodental, transseptal

5. Apical bers: prevent tipping and dislocation of the tooth

6. Mesial surface of ant teeth: ↑ contour of the cervical lines and gingival attachments

7. Buccal mucosa: not keratinized

8. Most abundant cell of PDL: broblasts

9. Main functions of cementum: attachment of principal bers of the PDL - compensate - protects
- reparative

1. Sharper: perpendicular to cement. Principal of PDL

2. Type I collagen bers: within the cementum run parallel to surface of cementum

10. Sulcular epithelium: thin, nonkeratinized strati ed squamous epith without rete pegs

11. Degrees of gingival enlargement:

1. Grade 0: no

2. Grade 1: enlargement in interdental papillae

3. Grade 2: enlargement papilla & marginal gingiva

4. Grade 3: enlargement covers 3/4 or more of the crown

CAL & BIOLOGICAL WIDTH

1. Biological width: 2mm —> from alveolar crest to base of sulcus

2. Biological width: JE and CT attachment to tooth above alveolar crest

3. Length of JE: 0.25-1.35 mm

4. Thickness of PDL: 0.2mm wide

5. Junctional ephitelium: collar-like band of strati ed columnar epithelium 10-20 cells thick near
the sulcus and 2-3 cells thick at apical end

6. Attached gingiva: from mucogingival junction to free gingival groove

7. Attachment loss: loss of connective attachment w/apical migration of JE away from CEJ

8. Loss of clinical attachment: main di erence between gingivitis and periodontitis

BACTERIAS

1. Red complex: BOP, deep pockets

2. Associated with periodontal health? strep. Gordonii

3. Actinomyces: not associated with perio dz

4. Healthy sulcus most abundant bacterias: strep and actinomycetes

5. Plaque depends on? Bacterial interaction & bacterial polymers (Doesn’t depend on host)

6. Prevotella intermedia was known as Bacteroides intermedius

7. Smokers have an increase in Tannerella forsythia, and demonstrate orange & red complex

PERIODONTAL IMMUNE RESPONSE

1. Periodontitis: initial (PMN), early (Lymph), establish (plasma cells)

2. Medical conditions leading to periodontal dz: diabetes, HIV, leukocyte adhesion de ciency,
leukemia, neutropenia, acrodynia, histiosytosis X, hypophosphatasia, chadiak-higashi sx,
papillon lefevre sx, down sx, ehlers-danson sx

3. Medical conditions that in uences in perio dz: coronary heart dz, atherosclerosis, stroke,
diabetes, low-birth-weight delivery

4. When tx diabetic, most common problem seen associated with: Hypoglycemia

5. Periodontitis always begins with gingivitis

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 6. Most importan plaque retentive factor is: Calculus

7. Calculus is detrimental to gingival tissue bc it is covered with bacterial plaque

8. Main crystal form of inorganic component of calculus: HA (58%) - Magnesium Whitlockite

9. Plaque index used for pt motivation

10. Perio index aws: gingival recessions are not taken into account

11. Gingival index: ordinal include numbers: 0-3

12. CPITN: community periodontal index tx needs

13. Smoking is the single major preventable risk factor for periodontal dz

14. Malnutrition not associated as a risk factor on perio dz

15. Least likely to occur with occlusal trauma? Gingivitis

16. Most common clinical sign of occlusal trauma: tooth mobility

17. Periodontal pocket formation —> not caused by occlusal trauma

18. After brushing —> mature plaque 24-48hr (gram+ cocci & rods)

19. Periodontal health: gram+, nonmotile, facultative anaerobes

20. Chronic perio: G - (P. Gingivalis)

21. Primary microorganism colonizing perio abscess: G- anaerobic rods

22. Least cause of bone loss of primary teeth: plaque

23. Polymorphisms in IL-1 genes have been associated with severe chronic periodontitis

24. IL-1 most important in the activation of osteoclast and stimulation of bone loss seen in perio dz

25. Interleukin causes bone loss

26. Stress long term causes problem in periodontium bc increases cortisone, and this brings ↓
immune system

27. Plasma cell in stage III of in ammation in gingivitis

28. Organic matrix of cementum: I & III collagen bers

29. Leukocytes control 3 stages of in ammation

30. Chronic infection: lymphocytes - macrophages

31. Chronic stage of gingivitis: plasma cells predominate

32. T cells: important in cell-mediated immunity

33. Vascular phase of acute in ammation involves: platelets - tissue mast cells - basophils

34. In in ammation —> dilation of capillaries: redness

35. collagen found in the gingiva: type I - not the same as other parts of the body - is not as rapid
as in the periodontal - accounts for 60% of gingival proteins

36. B cells: mature in bone marrow and migrate to lymphoid organs - germinal centers of spleen
and lymph nodes - progenitors of plasma cells - NOT involved in cell mediated immunity -
antibody mediated immunity

37. Predominant in ammatory cell in perio pocket: Neutrophils

38. Predominant in sulcular uid? PMNs

DEHISCENCE & FENESTRATION

1. Fenestration: isolated ares in which root is denuded of bone, and root surface is covered by
gingiva and periosteum, where marginal bone is intact

2. Dehiscence: when the denuded areas extend though the marginal bone.

3. Dehiscence is not a infrabony defect

INSTRUMENTS

1. Gracey curets:

- 1-2: anterior - also lingual & buccal of posterior

- 3-4: anterior - shorter ant 1-2

- 5-6: anterior

- 7-8 universal

- 9-10: posterior - M and PM buccal and lingual

- 11-12: posterior Mesial

- 13-14: posterior Distal

- 15-16: posterior Distal

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 2. Periodontal le: crush or fracture heavy tenacious calculus —> followed by curette. Also used
to reduce amalgam overhangs

3. When sharpening, a wire edge is produced: when the last stroke of the stone is drawn away
from the cutting edge

4. The push stroke: is likely to injure the junctional epithelium

5. When probing if we have resistance: lift the probe away from the tooth and attempt to move it
apically

PERIO TX

1. Perio tx sequence for mild-moderate chronic perio: plaque control, Sc/Rp, caries control, perio
surgery

2. Why you do perio before ortho: bc perio can cause gingival and osseous changes

3. Which tooth commonly relapse after perio tx (< long term prognosis): Max M (due to furcation
anatomy)

4. Pt with class III furcation and 3mm exposure? EXT

5. Class III furcation tx: GTR

6. Class II almost III furcation. Main goal: convert it to class I by GTR

7. Furcation III: wide enough & the curette is too big to clean it

8. Root amputation MB: cut a furcation and smoothen for pt to keep clean

9. Most common periodontitis in school-aged kids: marginal gingivitis

10. Which therapy in which adding ATB + debridement have minimal e ects? Chronic perio

11. Generalized perio >30%

12. Diagnosis 40yo, generalized bone loss, localized vertical bone defect, gross calculus: chronic
perio

13. PDL dz that causes rapid destruction of alveolar bone? Periodontal abscess

14. 2 pt (1 old 1 young) with same perio. Old person > prognosis (bc the young got into same dz
faster than older one)

15. Most common cause of mobility: advanced perio

16. Tooth mobility is reversible with tooth movement

17. Cuplike resorptive area at crest of alveolar bone: early periodontitis

18. X-ray evidence of bone loss needs to be evident in order to make a diagnosis of periodontitis

19. Plaque control is part of phase I

20. Stippling of the gingival tissue: least important diagnostic aid in recognizing early gingivitis

21. Goal of gingival or sub gingival curettage: maintain treated areas of recurrent in ammation and
where pocket reduction surgery has previously been performed - ↓ in ammation prior to
pocket elimination - remove chronically in amed periodontal tissue

OH & MEDICATIONS

1. Best interrproximal plaque removal with open contacts: interrproximal brush

2. Best brushing technique to clean perio pockets: sulcular (modi ed bass)

3. Least e ective for crevicular plaque? Waterpik (removes debris not plaque)

4. Likely to be abrasive after osseous surgery? Waterpik

5. Class II furcation, worst to clean with: rubber stimulating tip (this is for interdental papilla)

6. Toothbrush can reach perio pocket 1mm

7. Floss can reach perio pocket: 2-3mm

8. Most e cient topical antimicrobial agent currently available: Chx

9. Teeth green: bacteria, gingival hemorrhage, medications and hyperbilirubinemia

10. Green orange in Max Inc: poor oral hyg

11. Proper way to reinforce OHI: verbal & written

12. Why we don’t use acidulated F- toothpaste? Ruins polish of crown

13. bad breath: quaternary ammonium compounds.

14. toothpaste component that removes stains and oils —> sodium laurel sulfate.

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 15. Listerine MOA: antiseptic rinse broad-spectrum microbial & kill bacteria associated w/ plaque &
gingivitis by disruption cell wall, bacterial enzymatic inhibition and extraction of bacterial
lipopolysaccharides

16. Action of Listerine? Uncharged phenolic compound

17. Medically compromised child for plaque control: CHX

18. Role of CHX: substantivity

19. CHX MOA: binds to cell wall and causes disruption, cell lysis

20. Use of CHX: reduce plaque accumulation. Broad spectrum, positively charged

21. Sodium pyrophosphate action: plaque removal. (Removes Cristal of Ca and Magne, inhibits
mineralization of bio lm/staining

22. Why are inorganic pyrophosphates in anti-tartar toothpaste? Acts as tartar control agent
(chelating + abrasion), prevents Ca phosphate crystals

23. Periostat 2x day 20mg inhibits collagenase (MMP)

24. Periostat sub-antimicrobial doxycycline

25. Root surface tx: use citric acid, bronectin and tetracycline

26. Least complication for OH: open contact

27. Sodium benzoate from toothpaste —>preservative

28. Spongy oss of SuperFloss —> to clean around appliances and between wide spaces

29. Sti -end threader: oss under appliances

30. Abrasives from toothpaste: 20-40%

31. Aid to massage gingiva —> stim-u-dent

32. Local delivery atb: 10% doxycycline

33. To clean class II furcation —> per aid

34. Actisite —> 12.7mg of tetracycline HCL

35. Frequency of maintenance vitas: depends of appearance and clinical condition of the gingival
tissues and ability and performance in home care

36. Most important factor in the control of hypersensitive roots among pt with periodontal dz after
gingival recession has exposed the cervical portions of teeth is: thorough daily plaque control.

PERIO INSTRUMENTS

1. What edge of curette do you want to be in contact at line angle? Lower 1/3

2. Curette, which 3er adapts tooth? Apical third

SCALING & ROOT PLANING

1. Sc/Rp removes diseased cementum

2. What is not an objective of Sc/Rp? Remove cementum

3. After Sc/Rp how does new attachment form? Long JE

4. Kind of gingiva more favorable for S/R: edematous gingiva

5. Best result of S/R will be on patient with edematous gingiva

6. Maximum shrinkage after gingival curettage can be expected from Edematous tissue

7. What to do after S/R if there is 2 probing sites of 6mm? Perio surgery

8. Pt had SRPs and came back to perio maint but there are still 5-6mm pocket. What to do?
Open debridement

9. Why do we check occlusion in pt with perio abscess? Edema can cause teeth to supra erupt

10. First thing you do on recall appt? Update medical history

11. Plaque removal: most important procedure during initial post-op visit after periodontal surgery

12. What do you not do at perio maint appt? SRPs pockets 1-3mm

13. Perio maint can di er from each pt

14. Perio maint evaluate BOP, plaque, pocket depth

15. BOP —> In ammation

16. Hr until plaque acucmulation after brushing? 1hr

17. Part of CI that collects the most plaque? Lingual surface

18. Extensive scaling and root planing: do per quads

19. Incidental gingival curettage is performed during: sailing and root planning

20. Goal of scaling and root planning: eliminate the cause of periodontal in ammation

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ULTRASONIC

1. 20-45K cycles/second

2. Contraindication: pacemaker, communicable dz, titanium implants, kids

3. Piezoelectric, sonic, linear vibration. Water and air kills bacterias

4. Magnetostrictive, cavitron: elliptical.

5. When sensitivity during cavitron: proceed to another teeth and then return - move instrument
faster and controlled movements - adjust water (to avoid heat) - use less pressure

AGGRESIVE PERIODONTITIS

1. Localized aggressive periodontitis (juvenile): AA and Capnocytophaga ochraceus

2. Depressed neutrophil function or defective PMN

3. Hyperresponsive macrophage, w/ ↑ levels of PGE2 and IL1b

4. Health patients in general

5. Progression of pathogenesis may be self-limiting, good response to ATB

6. Localized form: 1M & I. Pubertal onset, robust serum antibody response - serotype antibody is
IgG-2. Most common in black

1. Tx: S/P, surgery, tetra, metronidazole atb c/amoxi (systemic atb)

2. AA & Capnocytophaga bacteria

7. Generalized: pt <30yo, poor serum antibody response

1. AA & some cases P. Gingivalis

8. Most teeth lost in Localized? Max molars

9. Localized: vertical bone loss

10. Reasons why pt gets aggressive? Host can’t ght o

11. Common to generalized aggressive and chronic perio: distribution among the teeth

12. Clinical sign of aggressive perio? Tooth mobility & deep pocket with lack of in ammation

13. Not associated w/ localized aggressive perio: local factors (in ammation, plaque, calculus)

14. Not true about local aggressive perio? A ect <30%

15. Not a characteristic of LAP? Gingival in ammation

16. What is not associated w/ LAP ? Calculus

ANUG

1. “Trench mouth”

2. 15-35 yo

3. Punched out papillae (cratered gingiva), painful, bleeding, ulceration of interdental papilla w/
necrosis sought (Vincents infection)

4. Fetid odor & metallic taste

5. Bacteria: anaerobic fusobacteria + spirochetes (ex prevotella intermedia) + fusiform

6. Tx: debridement + and (metronidazole) +OHI

7. Pseudomembrane gray on gingiva

8. HIV associated ANUP: debridement & antimicrobial rinse

9. For ANUG: normally don’t give ATB. If pt has fever or systemic indications like HIV: Metro

PREGNANCY & PUBERTY

1. Pregnancy gingivitis has altered metabolism of progesterone

2. Bacteria: P. Intermedia

3. Pregnant DONT give: tetra, metro, gentamicin and vancomycin

4. Puberty bacteria most associated: P intermedia - hormonal induced

DRUG-INDUCED GINGIVAL HYPERPLASIA

1. Oral contraceptive doesn’t cause gingivitis

2. Anticonvulsant:

1. Phenytoin (dilantin)

2. Valproic acid (depakene)

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 3. Carbamazepine (tegretol)

4. Vigabatrin (sabril)

3. CCB

1. Amlodipine (norvasc)

2. Diltiazem (cardizem, Carter, Dilacor, taztia, tiazac)

3. Felodipine (pendil)

4. Isradipine (dynaCirc)

5. Nicardipine (Cardene)

6. Nifedipine (Adatta, nifedical, Procardia)

7. Nisoldipine (sular)

8. Verapamil (calan, covera-HS, Verelan)

4. Immunosuppressants

1. Cyclosporine A (neoral, Sandimmune)

2. Tacrolimus (Prograf)

3. Mycophenolate mophetil (CellCept)

4. Sirolimus (rapamune)

5. Pt has inter papilla gingiva swollen: anticonvulsant meds

6. #1 med that causes gingiva hyperplasia? Anticonvulsant (Dilantin) 30% of all drug induced

7. DIGOXIN doesn’t cause hyperplasia

8. Pt is on CCB, what to do? Tell them to see dr to switch meds

9. Pt immunosupresant for transplanted liver, what happens in mouth? CT overgrowth &

hyperplasia

PERIODONTAL SURGERY

1. Periodontal aps: preferred for mand ant

2. Lateral repositioning is done for gingival recession

3. Modi ed Widman ap: internal bevel incision, not pocket depth ↓, but removes pocket lining &
pocket shrink after healing

4. Displacement ap: PD reduction. Excision procedure of gingiva = gingivectomy. Internal bevel

gingivectomy but also reverse bevel. Final placement of ap determined by 1st incision.

5. Apical positioned ap: internal bevel incision for pocket elimination (by apical reposition) and/or
↑ width of attached gingiva. Best position is 2mm apical to alveolar crest.

6. Distal wedge: heals by primary intention.

1. Most common incision given by oral surgeon? Envelope ap

2. Apical position ap contraindicated in maxillary palatal

3. Can’t do apical ap? Lingual max molars

4. Where are you most likely to damage a nerve in vertical release of ap? Lingual

5. Distal wedge contraindicated: on 3M w/o attach gingiva (not enough keratinized tissue)

6. On crown lengthening: apical repositioning ap

7. To prevent exposure of a dehiscence or fenestration what ap do? Partial or split thickness ap

8. Full thickness ap will result in bone loss (atrophy) in: thin periradicular bone

9. Double papilla ap: variation of laterally positioned ap. Used for trauma from incorrect
toothbrushing - covering exposed root surface

10. Apically positioned ap: full-thickness, mucoperiosteal ap that has a relatively high degree of
predictability and is a “work-horse” of periodontal therapy —> to eliminate deep pockets, tx of
infra bony defects and root planing - furcation involved teeth - crown lengthening

11. Modi ed Widman ap is not meant to reduce pocket depth

12. Palatal aps can’t be displaced

13. Laterally positioned ap: mucogingival surgical technique indicated in areas where there is
gingival recession that is narrow, adjacent to which a wide band of attached gingiva exists,
which can be used as a donor site

GINGIVECTOMY & GINGIVOPLASTY

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 - Gingivectomy: excision of gingiva, provides visibility & access to complete calculus remove &
root smoothing to create favorable environment for gingival healing & gingival contour

- Goal: eliminate suprabony pockets, eliminate gingival enlargement or suprabony periodontal

abscess

- DONT DO: if osseous recontouring is needed, if pocket depth is apical to mucogingival

junction, if there is inadequate attached gingiva or if esthetic is a concern

- Gingivoplasty: reshaping of gingiva to create physiological gingival contour in absence of pocket

* Wound healing:

* Primary intention: tissue approximated/closed. Ex: stitch, ap. Very little tissue loss

* Secondary intention: extensive wound, considerable tissue loss, edges can’t be brought
together. Ex: ulcer, S/R, gingivectomy. > time to repair, > scaring, >change of infection

* Tertiary intention: delayed/secondary closure, delayed suturing/wound closure. Ex: poor

circulation or drainage to wound area so wait, tissue graft

1. What direction is the reverse bevel (internal) incision: axial toward bone

2. Internal bevel: apical to base of perio pocket, but coronal to MGJ

3. Purpose of “bleeding incision” in gigivectomy? Guide for incision - outline incision line

4. How does a site heal after gingivectomy? Long JE

5. Not to do gingivectomy: infrabony pocket, little attached gingiva, high smile line

6. Contraindicated gingivectomy: sulcus apical to crest of alveolar bone (infrabony pocket)

7. What to considere for gingivectomy? Level of attachment

8. Base of incision for gingivectomy: above MGJ

9. Gingivectomy incision: excisional (external bevel)

10. How many mm does epithelium grow over CT? 0.5-1mm

11. External bevel heals: secondary intention (endothelium of blood vessels)

12. External bevel incision for gingivectomy is made: JE (apical to base of pocket) on epith
attachment

PERIO REGENERATION & REPAIR

- Regenerative surgery: for regeneration w/ bone graft while ap surgery - to get access for better
S/R

- Regeneration: type of healing that completely replicates the original architecture & functions.
Involves formation of new cementum, PDL, and alv bone

- Repair: replacement of loss apparatus with scar tissue. Doesn’t completely restore architecture
or function. End product is a long JE attachment at tooth-tissue interface

1. JE will form on cementum in 1-3 weeks

2. Perio regeneration involves: sharpey bers, cementum, and alveolar bone

3. Healing in S/R and free gingiva: long JE & CT

4. After ap surgery, repair occurs: PDL moves occlusal

5. After periodontal surgery, most most of the times is: repair

GINGIVAL GRAFT, BONE GRAFT, GBR

- GBR (guided bone regeneration): barrier membrane to direct the growth of new bone & gingival
tissue at sites w/ insu cient volumes of dimension of bone or gingiva for proper functions,
esthetic or prosthetic restoration

- GTR: Blocks the re-population of the root surface by long JE and CT to allow cells from PDL and
bone to re-populate the periodontal defect

- Soft tissue grafts:

- CT graft: most common method to tx exposed root. From palate, and stictched to gum tissue
surrounding the exposed root

- Free gingival Graf: used mostly in people w/ thin gums to begin with & need additional tissue
to enlarge the gums. From palate

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 - Pedicle graft: gum grafted from or near the tooth needing repair. Partially cut away so that one
edge remains attached & the gum is then pulled over or down to cover the exposed root and
sewn into place

1. 3 things you need when doing GTR: bone, sharpey bers, cementum

2. Correction of inadequate zone of attached gingiva on several adjacent teeth: FGG

3. Gingival recession in anterior region: Pedicle graft.

4. What has ultimate e ect on the thickness of epith FGG: Recipient CT

5. Best graft for sinus lift: autogenous & alloplastic

6. Most osteogenic? ONLY autograft (also is osteo-conductive & osteo-inductive)

7. Allograft osteo-conductive & osteo-inductive

8. All remaining grafts ONLY (xenograft & alloplast): osteo-conductive

9. Decalci ed freeze dried bone allograft: has bone morphogenetic proteins (BMP) - platelet
derived growth factor

10. Best allograft material: dried fried bone

11. Max C: contraindicated in grafting procedures

12. Least likely to need bone graft ? 3 wall narrow

13. 3 wall wide & deep: GTR

14. Best prognosis for GTR: 3 walls

15. Recession of single tooth: double papilla graft

16. Mand 1PM also least likely to be successful facial soft tissue graft

17. Class II furcation: GTR

18. Class III furcation: least successful in GTR. Best tx: Hemisection (mand) - amputation (max)

19. Purpose of GTR: prevent Long JE

20. GTR excludes gingival epith cells to allow progenitor cells to close the wound. Gingival and CT
tissue are excluded by the membrane.

21. Purpose of barrier: coronal movement of PDL cells

22. Hemisection better prognosis: furcation more coronal

23. Surgical dressing: protect the wound

24. Contraindications for gingivectomy: infra bony pockets and lack of attachment tissue

25. Pedicle graft: soft tissue graft that is rotated or otherwise repositioned to correct an adjacent
defect

26. Primary reason for the failure of free gingival autograft: disruption of the vascular supply before
engraftment

27. Free mucosal autograft: connective tissue without epithelial covering

28. Most common osseous defect: 2-walls defect

29. Using rosin in periodontal dressing acts as ller for strength

30. Suprabony pockets: horizontal bone loss

FRENECTOMY

1. Wait for C eruption -> ortho -> frenum surgery

2. Z-plasty is better than diamond in labial frenum bc: ↓ e ects of scar contracture. Improves
appearance of scars and purpose is to relax the frenum pull - less contracture

3. V-Y advancement: best for a wide-base frenectomy

4. Diamond excisions or Z-plasty frenectomy—> tissue narrow

BISPHOSPHONATES
- Osteonecrosis is more comon with IV (Zolendronic acid and Pamidronate)

- IV: ibandronate (Bovina) - Zolendronic acid (Reclast) - Pamidronate (Aredia)

- Oral: Alendronate (Fosamax) - Rosedronate (Actonel) - Ibandronate (Boniva)

- Stage and tx strategies

- At risk category: no apparent exposed/necrotic bone in pt who have been tx w/ oral or IV —>
no tx indicated - pt education

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 - Stage 0: systemic management including use of pain meds and ATB

- Stage 1 ( exposed/necrotic bone in pt who are asymptomatic and have no evidence of

infection: —> antibacterial mouth rinse- clinical follow-up quarterly - pt education and review
of indications for continued bisph therapy

- Stage 2 (exposed/necrotic bone associated w/ infection as evidence by pain and erythema in

region of exposed bone with or w/o purulent drainage —> symtomatic tx with broad-
spectrum oral ATB (penicillin, cephalexin, Clinda..). - oral antibacteral rinse - pain control -
only super cial debridement to relieve soft tissue irritation

- Stage 3 (exposed/necrotic bone in pt with pain, infection and 1 or more of the following:
pathologic fracture, extraoral stula, or osteolysis extending to the inferior border) —>
antibacterial rinse - ATB and pain control meds - surgical debridement/resection for long term
palliation of infection and pain

1. To get osteoradionecrosis, radiation dose must be: > 50gys

2. Risk for ORN: IV lisp for a year, radiation 65 grays

3. Uses of Bisphosphonates: multiple myeloma, metastasis to bone from breast cancer,

metastasis to bone from prostate cancer

4. Indications for bisphosphonates: osteoporosis

5. NOT used for osteomyelitis.

6. 3 months holiday is recommended for pt taking ORAL for more than 3 years.

7. Does bison add calcium to bone? NO, it inhibits osteoclast via apoptosis (MOA)

8. Contraindications: Ortho tx - bone graft

9. Pt taking bison for 1 year. IV, high risk during dental tx? Osteonecrosis

10. Patient taking bison and gets osteonecrosis: osteonecrosis without radiation

11. Osteoradionecrosis most associated w/ mandible

12. Hyperbaric oxygen pre and post if doing invasive procedures

13. Pt in stage 1 from bison. What to do?

1. Stage 1: rinse CHX

2. Stage 2: refer to OS or do under hyperbaric oxygen

14. Pt has history of osteonecrosis & IV bisph and needs ext: DO under hyperbaric 02

15. Best tx for bisph pt: section crown o and do RCT

16. Oral more than 3 years: 3 months holiday (regardless corticosteroids)

17. Oral less than 3 year w/corticoesteroids: 3 months holiday

18. Oral less than 3 years w/o corticosteroids: no alteration or delay on planned surgery

ANEMIA, BLEEDING TIME AND MEDS

- Aplastic anemia: bone marrow doesn’t make enough RBC

- Sickle cell anemia: abnormal Hg “sickle hemoglobin” or hemoglob S, autosomal recessive

- Pernicious anemia: body can’t make enough healthy RBC bc lack of vit.B12. they lack intrinsic
factor, a protein made in stomach. The lack of this protein leads to Vit B12 de ciency

- Microcytic hypochromic anemia: iron de ciency anemia (most common)

- Hemolytic anemia: RBC are destroyed & bone marrow can’t produce fast enough

1. What is not contraindicated for pt w/sickle cell anemia? Nitrous

2. Pt has sickle cell anemia & has a thrombolytic crisis. What could precipitate this? Cold

3. Sickle cell anemia: black people. Periods of unusual stress or of 02 de ciency (hypoxia) can
precipitate a sickle cell crisis

4. What dz is most predominant in males? Hemophilia

5. Microcytic anemia. De ciency B vitamine

6. Microcytic anemia: iron de ciency anemia

BLOOD TEST & MEDICATIONS

- Anticoagulants act to antagonize vit K to work & ↑ bleeding. INR used for Coumadin pt

- Warfarin: anti-coag that reversibly to anti-thrombin II & prevent conversion brinogen- brin

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 - Dicoumarol: anti-coag that inhibits vit K reductase & a ects K-dependant coagulation factors

- Hemophilia: X-linked, recessive disorder,

- A: factor 8

- B: factor 9 (Christmas dz)

- C: (Rosenthal’s syndrome)

- PT: Extrinsic syst (vit k coag factors) —> test warfarin/Coumadin e ect, for liver damage, & vit K
status

- PTT: Intrinsec system, use to test Heparin

- Bleeding time: determines platelet function (adherence)

- CBC report: Hematocrit normal values male 45% - female 40%

- Normal HbA1C: 4-5.6%

- 5.7 - 6.4% —> pre diabetic

- > 6.5% —> diabetic

- > 7% —> uncontrolled

- INR: 1 normal

- 2-3: e ective tx of Warfarin

- >3: Don’t tx, refer

- Platelet count: 150,000 - 450,000/mm3

- Glucose fasting level above 140mg/dL: diabetes

- Glucose non-fasting level above 200mg/dL: diabetes

1. Pt taking warfarin (Coumadin). What test to run prior ext? INR (2-3)

2. PT: measures the clotting tendency of blood. Normal dance 12-13 seconds. This will be
prolonged by warfarin

3. Best wat to test clotting function on pt taking warfarin? INR

4. INR ideal 1 (12 sec)

5. NO TX INR >3

6. True hemophiliac —> prolonged PTT (partial thromboplastin time) - normal PT - normal
bleeding time

7. Minimal platelet count for oral surgery? 50,000

8. Emergency ext can me done w/ 30,000 if worked w/ hematologist & good manag of tissues
technique

9. Pt Coumadin, stop medication 1-2 (5days ADA) days prior ext

10. Warfarin MOA: decrease K+ needed to synthesize factors II, VII, IX, X

11. Most important anti-coag e ect of heparin is interfere w/ conversion of brinogen —> brin

12. Pt taking dicumarol (Vit K antag) is probably treated for: coronary infarct

13. Coumadin (warfarin): give vit K

14. Alcoholic pt come for ext. what to order? PT/INR

15. Severe alcohol recovering needs ext. INR

16. Aspirin burn due to: coagulation necrosis

17. Aspirin a ects: BT

18. Aspiring ↓ platelet function

19. Aspirin has no e ect on PT, PTT or INR

20. Aspirin contraindicated with Coumarin (Coumadin)

21. Clopidogrel (plavix) + aspirin: alter platelet function, inhibits platelet aggregation irreversibly

22. E ect of plavix: inhibits platelet aggregation - given to pt allergic to aspiring —> no ulcer side
e ect, given to pt w/ past ulcer history

23. Prostaglandin ↓ gastric acid and ↑ gastric mucous. Inhibiting PG will ↑ gastric acid and ↓
mucosa.

24. What makes PG: arachidonic acid

25. Ginseng is an anti platelet (interfere w/coagulation - not given w/aspirin or warfarin)

26. Ginseng for energy, avoid Aspirin

27. Pt taking saw palmetto (herbal supplement that potentiates anti-coagulant), avoid Aspirin

28. Pt had ext and socket still bleeding 5 hr later: refer for INR

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29. Tooth ext and 3 day later, area starts hemorrhage. Cause: brinolysis

30. Pt taking gingko blob: avoid Heparin

31. Hypercortisolemia can lead to Cushing

32. Hypocortisolemia: Addison

33. Hypocalcemia: ionized Ca level below 2 or serum Ca [ ] lower than 9 mg/dL.

34. Causes of hypocalcemia: renal failure and hypoalbuminemia

35. EMS activated immediately when pt unresponsive

36. Which phase of hemostasis is most a ected on pt taking anticoagulant (Warfarin) Coagulation
phase

DIABETES
- Hypoglycemia signs: headache, mental confusion, somnolence, tremors, nervousness,
tachycardia, mydriasis (dilation), diaphoresis (sweating)

- Medications

- 2nd generation sulfonylureas: enhance insulin secretion

- Biguanides: produce less glucose in liver (metformin)

- Alpha glucosidase inhibitors: slow carbohydrate digestion

- Insulin: rapid acting (5-15min) - short acting (30-60min) - intermediate (2-4hr) - long acting
(6-10 hr) —> premixed (30-60min)

1. Overweight, has to pee 2x night: diabetes

2. Diabetes most common: black men

3. Hb1Ac: measuring glucose level over extended period

4. Pt who took too much insulin will have all except: hyperglycemia

5. ↓ glycogeneis in liver would be expected w/ Insulin

6. Pt appears disoriented & hypoglycemia: administer glucose

7. Risk factor for hypoglycemia: alcohol

8. Ketone breath: diabetes type 1 (hyperglycemic)

9. Diabetes type 1 leads to blindness

10. Glucocorticoids contraindicated in: diabetes (steroids ↑ blood sugar, and increase med
needed to control sugar levels) diabetics on steroids may have to ↑ insulin dose dramatically

11. Oral hypoglycemic drug for diabetes: Sulfonylurea & Metformin

12. Why don’t you give sulfonylurea to type 1? They do not have beta cells for insulin &
sulfonylureas MOA is to stimulate those cells, estimating them to release insulin, stimulate
binding, decreases glucagon levels. This drugs increase insulin production and sensitivity by
beta cells stimulation by binding to ATP-dependent K channels, causing depolarization, which
leads to stimulation of calcium ion in ux & induces insulin secretion

13. MOA Metformin: surpasses glucose production in liver (↓ hepatic gluconeogenesis) —> ↓
glucagon leves - binds to AMP-protein kinase rct

PERIO-ENDO dz + DIABETES

1. Controlled diabetic pt doesn’t get more perio dz than non-controlled

2. Controlled diabetes same perio issues as no diabetic pt

3. Diabetic:

1. ↑ collagenasa in crevicular uid

2. ↑ glucose in crevicular uid

3. ↑ IL-1

4. ↑ thickness of basilar lamina of blood vessels in periodontum

4. Diabetics are more prone to perio (15x) and less resistant to e ect of bacterias

5. Uncontrolled diabetes (ASA III)

1. Aggressive bone loss

2. Bleeding gums

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 3. Teeth mobility

6. Perio dz associated with systemic: diabetes - HIV

7. Elective endo tx contraindicated: uncontrolled diabetes (will alter healing)

8. Insuline shock if conscious: give orange juice (don’t give insulin, blood sugar is already low)

9. If unconscious: 50% dextrose IV

IV SEDATION + DIABETES

- schedule in the morning

- Insulin-dep: not eat, not take short-acting insulin and take 1/2 dose of Long-Acting insulin

- Pt is non-insulin dependent diabetic and needs IV sedation: regular dose of diabetes med

- Pt insulin dependent diabetic, IV sedation: regular dose of insulin and no food

CONGESTIVE HEART FAILURE/HEART CONDITIONS

1. Pt with orthopnea (shortness of breath - fatigue - paroxysmal nocturnal dyspnea - dyspnea -
while lying at), pedal edema: CHF

2. Most common reason for cardiac arrest in kids? Respiratory distress

3. Most common heart condition in children? Ventricular septal defects

4. Peripheral edema, increase systole: CHF

5. Distended jugulars, pitting edema and dyspnea: CHF

6. MI and arrhythmia di erence? Trombosis

7. Pt chest pain in heart region when sleeping or at rest: unstable angina (occurs at rest)

- Angina: nitroglycerin, propanolol, CCB

- Nitroglycerin: VD on coronary artery smooth muscle —> more O2 supply

- Propanolol: prevent chronotropic response to Epi/emotion/exercise —> less O2 demand

- CCB: VD of peripheral resistance —> less O2 demand

- CHF drugs: + inotropic e ect, ↑ myocardium contraction force by inhibiting Na+/K+ ATPasa &
↑ Ca in ux

- Digitalis: ↓ A-V conduction rate

1. Why is pt taking ACE? Hypertension / CHF

2. Pt taking cardiac glycoside (↑ contraction of Ca in an active heart muscle). Used for: CHF

3. Glycoside (digitalis): inhibit Na/K ATPasa —> ↑ Ca in ux (ionotropic:contraction)

4. Digitalis/cardiac glycoside: common indications for use for atrial brillation

5. Garlic: used for cardiovascular dz. CI: contraceptives and antivirals (HIV), caution w/bleeding

6. MOA of most drugs to tx arrhythmia: ↓ depolarization rate, ↑ refractory period

7. Side e ect of nitroglycerin: orthostatic hypotension & headache

8. TIA (transient ischemic attack): more chance to get stroke

9. Nitrates and nitriles have what systemic e ect? VD of arteries —> ↓ BP —> tachycardia

10. Nitriles/nitrates: blood vessel VD. They relax and widen vessels, allowing more blood and
oxygen to ow to heart. Since arteries are wider, heart pumps more blood.

11. You have a pt w/ angina & give nitroglycerin. HR goes ↑. Why? Natural re ex to the ↓ in BP

12. Amilnitrate & nitrogly? VD coronary arteries for angina pectoris - chest pain cause by occlusion
of coronary arteries —> chest pains, SOB

13. Diuresis after tx of angina w/glycoside? Bc ↑ blood ow caused increased blood ow to

kidney

14. EPI and nitrogly: antagonist

15. Why give hydralazine w/chloral hydrate? ↓ nausea

16. MOA Hydralazine: direct-acting smooth muscle relaxant used to tx HTN by acting as VD
primary in arteries and arterioles to ↓ peripheral resistance, thereby ↓ BP and ↓ afterload

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 17. Main prophylactic tx for angina? Propanolol

18. Tx of angina: thiazides

19. Quinidine txs: SV arrhythmia

PULMONARY/LUNGS
“Su x for bronchodilators” —> -terol

1. Asthma causes constriction on bronchioles, constriction of smooth muscles & in ammation of

bronchioles? Beta 2 rct for lungs, beta 1 rct for heart

2. Asmathic: wheezing when exhaling

3. Child wheezing before injection: asthma (induced by stress)

4. Asthma: have problems breathing in - and wheeze when exhaling

5. COPD: problems exhaling

6. Most common cause for breathing di culty in dental chair? Hyperventilation

7. Hyperventilation: tachycardia and tachypnea (rapid breathing)

8. Perio surgery, air to sulcus —> subcutaneous emphysema

9. Symptoms of emphysema: dyspnea, wheezing, cough tightness. Air sacks are all destroyed
(narrowing of distal airway)

10. Crowing sound when breathing (Stridor)? Laryngospasm (blockage of upper resp tract)

11. EPI for laryngiospasm: bronchodilator, ↑ HR, ↑ BP

12. Theophylline: prevent and treat wheezing, shortness of breath, di culty breathing cause by
asthma, chronic bronchitis, emphysema, or other lung dz. it relaxes and opens air passages in
the lungs, making it easier to breath

13. Drug for asthma? Levabuterol

14. Accuse asthma attach: Salbutamol (Albuterol) beta-2 agonist, bronchodilator

15. Pt asthma attach, took albuterol, didn’t work. What next? EPI

16. Severe asthma attach: EPI

17. Severe bronchial asthma attach: Albuterol - corticosteroids - aminophylline

18. Long term asthma: corticosteroid

19. Child taking albuterol: Asthmatic

20. What drug causes asthma (bronchospasm) ? Aspirin - NO NSAIDs for asthmatic patients

21. Asthmatic can use acetaminofem (Tylenol)

22. Pt begins to wheeze: beta-2 agonist inhaler —> Albuterol

23. Dry mouth: albuterol

SYNCOPE
* Orthostatic hypotension: (head rush-dizzy spell) —> BP suddenly ↓ w/ standing up or stretch

* Vasovagal syncope: most common fainting, malaise mediated but vagus nerve

* Trendelenburg position (for anaphylaxis): elevated and inclined plane 45degree, head down, legs
feet up. To tx shocks - (if head injury don’t put the head lower than trunk)

1. Pregnant: IVC compression —> put her on left side

2. Most common to do when syncope: maintain airway

3. Pt swallow a crown: put him upright position

4. Pt having syncope: trendelenburg position

5. Most common early sign of syncope: pallor (paleness)

6. All type of shocks have: ↓ perfusion to tissues

7. Vasovagal is a common cause of transient loss of consciousness

8. Syncope: 100% oxygen works, except hyperventilation syndrome

9. Oxygen: vasovagal - neurogenic - orthostatic

10. You give LA and BP and HR ↑. Due to: VC injected into venous system

11. EPI overdose: BP & HR ↑

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 12. Syncope: BP ↓

13. Carpopedal spams: hyperventilation

1. Painful cramps on hand/feet

2. Caused by ↓ blood Ca levels or by tetanus

14. Drugs that may produce orthostatic hypotension: antihypertensives (prasozin) - phenothiazines
(chlorpromazine & thioridazine) - Tricyclic antidepressants (Doxepin, amitriptyline, imipramine) -
antiparkinson drugs (levodopa and carbidopa+levadopa)

SEIZURE & SEDATIVE MED

- BDZ
- MOA: modulate activity inhibit NT (GABA) rct

- Advantages vs Barbit: < addiction potential, < CNS/respiratory depression, > therap index

- Disadvantage: respiratory depression —> someone can die from this

- CI: pregnant, myasthenia gravis, acute narrow glaucoma, COPD, emphysema

* Grand mal seizure: Phenytoin (Dilantin)

* Petit mal seizure - absence seizure: ethosuxidemi (zanronti)

* valproic acid (depakene, depacon) —> gran mal - petit and myoclonic seizure

* Status epilepticus (tonic-clonic): IV: Valium (Diazepam) - Lorazepam - phenobarbital

* Broad spectrum drug: Clonazepam: alternative drug due to undesirable sedation & tolerance

15. Most common seizure in children? Grand Mal seizure

16. Status epileptic drug-of-choice: Diazepam (valium) 5-10mg IV / per min —> hepatic biotransf

17. Drug administer IV least likely to cause respiratory depression: Diazepam

18. Cause of seizure: low sodium (hyponatremia)

19. Epileptic pt med: Lasix (furosemide) - HTN loop diuretic

20. Advantages of Midazolam over diazepam:

1. < incidence of thrombophlebitis

2. Short elimination half-life

3. No signi cant active metabolites

4. More rapid and predictable onset of action when given IM (mild e ect, but long lasting)

5. NOOOOO.. THIS IS NOT AN ADVANTAGE: less respiratory depression

21. Narcotics used in outpatients anesthesia: Fentanyl - Sufentanil - meperidine - morphine

22. Diazepam IS NOT A NARCOTIC

23. Verrill sign for IV conscious sedation: it is recommended as end-point

24. Frequently signs for IV diazepam sedation: ptosis (Verrill sign), altered speech, blurred vision

25. Tx of choice for lidocaine-induced seizure: Diazepam

26. Barbiturate: very lipid soluble - rapid onset action

SEDATIVES

Generic name Brand name Onset of action Peak onset Half-life

alprazolam xanax 15-30 min 0.7-1.6 hr 6-20 hr

clonazepam Klonopin “ 1-4 hr 18-36 hr

diazepam valium Within 15 min 1 hr by mouth 20-50 hr

lorazepam Ativan 15-30 min by 1-1.5 hr by mouth 10-20 hr

mouth

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 - BDZ: enhance e ect of gamma aminobutyric acid (GABA) at GABBA rct on Cl- channels. This ↑
chloride channel frequency

- Alpha-hydroxylation is a rapid route of metabolism unique to: Triazolam, Midazolam, Alprazolam

—> short sedative

- BDZ: safe to use in liver failure: Oxazepam - Lorazepam - Temazepam (LOT)

- CI: pregnancy

- Barbiturates: Enhance the e ect of GABA on the chloride channel but also ↑ chloride channel
conductance independently of GABA, specially at ↑ doses. Increases duration of Cl- channel
opening

- Long acting: phenobarbital (to tx some seizure) - diazepam

- Intermediate-acting: amobarbital, pentobarbital (occasionally used to sleep), secobarbital

- Short-acting: hexobarbital, methohexital, thiopental

- Zolpidem (Ambien) & Zaloplon: short half-life, used for insomnia, selective active at BZ1 rct

- Not a BDZ but acts like it, reversed by Flumazenil, potentiates GABA rct

1. MOA of BZD: facilitates GABA rct binding by ↑ the frequency of chloride channel opening

1. Barbiturates increase the duration of chloride channel opening

2. BDZ used for depression & anxiety for OCD: Xanax (Alprazolam)

3. Diazepam action in GABA: anti-convulsant & sedative

4. Valium is NOT used for: emesis (vomiting) and insomnia

5. Diazepam: not e ect on respiration as opposed to other BDZ

6. Hypnosis a ects: voluntary muscles

7. BZD not for elderly? Long-acting (diazepam)

8. BDZ great for dentistry bc: amnesia & little memory of event

9. Best BZD for IV sedation: MIDAZOLAM (amnesia)

10. Reverse BDZ: Flumazenil (competitive GABA rct)

11. BDZ or barb for antianxiety: ↓ depression, dos not propentiate depressants (< resp
depression)

12. BDZ anxiolytic e ect: moderate dose (antianxiolytic) - high dose (sedative)

13. Several anxiolytics and hypnotics have a rebound e ect, causing severe anxiety and insomnia
even worse than original

14. Barbi most readily penetrates blood-brain barrier: Thiopental

15. Sodium thiopental: rapid-onset short ultra-acting Barbi (IV) for general anesthesia

16. Metabolization of short-acting barbi: oxidation (in liver)

17. A pt is early recovery from a ultra-short acting barbi. Related primarily to: redistribution

ANTI-HISTAMINE MEDS
* Histamine is bronchospastic and VD

* H1 anti-hist: competitive histamine rc blocker

* Tx of dermatological manifestations of allergic reaction

* Controlling parkinsons symptoms

* Pre-operative meds for sedation, anti-cholinergic e ects

* 1st generation: Diphenhydramine (Benadryl) - H1 anti-hist, anti-cholinergic, sedative

* Side e ect: dry mouth and throat, ↑ rate pulse, pupil dilation (mydriasis), urinary retention,
constipation - anti-cholinergic

* 2nd generation: Allegra (Fexofenadine) - Claritin (Loratadine) - Clarinex (Desloratadine) - Zyrtec

(Cetirizine) - dont cross BBB, poor CNS penetration

* H2 anti-hist: reduce gastric secretions by block the action of histamine on parietal cells in
stomach —> Cimetidine, Ranitidine, Famotidine, Nizatidine

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 -EPI: physiological antagonist of histamine

1. Histidine decarboxylase (HDC) enzyme catalyzes the reaction that makes histamine from
Histidine w/ vit B6

2. Benadryl (Diphenhydramine) 1st generation anti-hist (H1 blocker)

3. Motion sickness: diphenhydramine (benadryl)

4. Benadryl causes xerostomia (anti-cholinergic, anti-histamine, sedative)

5. What property of benadryl causes xerostomia: anti-cholinergic

6. What property of diphenhydramine would alleviate pruritus? Anti-histamine (by blocking

histamine released by allergies)

7. What anti-hist causes less drowsiness: H1- blocker 2nd generation bc they don’t cross BBB
and have poor CNS penetration

8. Less sedative e ect: H1- blocker 2nd generation

9. Most sedative e ect: benadryl

10. Least likely to cause drowsiness: loratadine (claritin)

11. Slow onset after IV: loratadine

12. What to give to someone allergic to Ester & Amides LA? Benadryl

13. How does antihistaminic work? Competitive inhibition of histamine rct

14. H1-blocker e ects: CNS/ Respiratory depression - ↑ acid secretion - LA

15. Action of H1-blocker: VC, bronchodilator, and ↓ capillary permeability

16. H2 antihistamine: cimetidine - ↓ ulcers (inhibits stomach acid production - used as antacid)

17. Used for GERD or gastric re ux: cimetidine - ranitidine

18. What do bradykinin do? Dilate blood vessel and ↓ BP

19. 23 yo female breast feeding 12m old child and currently pregnant, which sedative would you
give? Promethazine

OPIOID / ANALGESIC
“Su x for opioids —> done”

-group 1: opiates - naturally agents derived from opium plant -morphine, codeine, thebaine

-group 2: semi-synthetics

-Hydrocodone, oxycodone, hydromorphone, oxymorphone, buprenorphine, heroin

-group 3: synthetics

-Fentanyl (alfantanyl, sufentanil..) methadone, tramadol, propoxyphene, meperidine

All group 1 and 2 agents are structurally similar to each other, and should not be given if a true
allergy exists to any other natural or semi-synthetic derivative

Group 3 agents have structures di erent enough that they can be given to a patient intolerant to
the natural or semi-synthetic w/o fear of cross sensitivity. They are also very di erent from other in
this same group.

Mixed agonist-antagonist analgesic - pentozoine, nabuphrine

*Naloxone: treat morphine overdose, antagonist

*Methadone: use in detoxi cation of morphine addicts

MOA opioids: binds to speci c rct (MU) in (medulla) CNS —> agonist acting as MU rct agonist

-symptoms: respiratory depression, bronchiolar constriction, euphoria, sedation, dysphoria,

analgesia, antitussive, chronic cough, constipation, urinary retention, vomiting/nause, xerostomia

-overdose: constipation, coma, hypotension, euphoria, miosis (pin-point pupils), hypothermia,

respiratory depression (loss of sensitivity of medullary respiratory center to CO2)

-SE: constipation

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 -Tylenol #1: 8mg codeine + acetaminophen

-Tylenol #2: 15 mg codeine + “

-Tylenol #3: 30 mg codeine + “

-Tylenol #4: 60 mg codeine + “

-Percoset (oxycodone + acetaminophen)

-Vicodin (hydrocodone + acetaminophen)

1. which opioid analgesic is associated w/ series life threatening interaction when administer with
MAO inhibitor? Meperidine (pethidine, demerol) —> life throwing hyperpyrexia reaction (fever)

2. Drug-drug interaction w/ MAOI (hydralazine) and meperidine (opiod) —> MAOI CI

3. Opiod CI: severe head injury

4. Opiate type MAA with agonist and antagonist properties: Pentazocine - Nalbuphine

5. Pt addicted to oxycodone. CI: pentozocaine

6. Common e ects to pentobarbital, diazepam, meperidine? Sedation and dependence

7. Absolute CI to opiod prescribing: allergy to codeine/oxycodone/hydrocodone

1. Give methadone or meperidine or tramadol (group 3)

8. Miosis see in opiod abuse except Meperidine

9. Sedation on children? Secobarbital - pentobarbital (good for pre-op/anxious kids)

10. Mepedirine: should not be used in kids

11. Which is not done by opiates? Diuresis (they cause urinary retention)

12. Oral opiod overdose: hypothermia - cold and clammy skin

13. Most common side e ect of morphine/opiods? Respiratory depression

14. Morphine poisoning common symptom: pin-point pupils (miosis)

15. If you give too much opiod (is not overdose) what’s the rst sign: constricted pupils & absent/
slow breathing

16. Opiod rct: bran, spinal cord and digestive GI tract

17. Opiod cause stomach upset by action on BRAIN

18. Naloxone: opiod overdose (fantanyl, morphine, meperidine, methadone, sulfentanil, codeine,
heroin, dextromethorphan, oxycodone)

19. How does antagonist work? No intrinsic activity, high a nity

20. Opiot that is part of the intradermal system? Fentanyl (given via transdermal patch)

21. Methadone helps alleviate withdrawal from heroin

1. Is detoxi cation of opiod addicts, will decrease withdrawal symptoms

2. Is a synthetic opiod, analgesic, antitussive, anti-addictive, acts on Mu rct producing similar

e ect of opioids but without addictive qualities, rct antagonist to glutamate. Long half-life

22. Why is nalbuphine contraindicated in previous heroin addict? Its a mixed agonist-antagonist
which may potentiate/↑ withdrawal symptoms

23. Sedative drugs such as hydroxyzine, meperidine & diazepam are carried in blood as: Serum

24. Codeine produce nausea bc: works on medulla (stimulates medullary chemoreceptor trigger
zone)

25. How does morphine cause emesis (vomiting): via central action (medulla)

26. Codeine: analgesic, antitussive, anti-diarrheal, anti-hypertensive, anxiolytic, anti-depressant,

sedative and hypnotic and addictive

27. Allergic to codeine: to control pain: acetaminophen + aspirin (mild pain) - meperidine or
fentanyl (Synthetics Opiods for severe pain) also Naproxen

28. Allergic to aspirin: Tylenol #3 (acetaminophen + codeine) —> ↑ activity and ↑ how long its
around due to clearance

29. Acetaminophen + hydrocodone so e ective bc work di erently, and combining these e ects
makes it stronger

1. Acetaminophen blocks the binding of protein w/hydrocodone, so hydrocodone level higher

in blood —> strong response

2. Narcotic works in brain (CNS) while NSAIDS/Acetaminophen in peripheral tissues (PNS)

30. Mild pain from ortho: aspirin, ibuprofen, naproxen DONT GIVE: HYDROCODONE

31. Moderate pain post-ext: opiods

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 32. Breastfeeding mother. Don’t give: codeine, tetra, benzo

33. Pt taking narcotic for long term what causes: headache due to ↑ intracranial pressure

34. DEA schedules drugs by: abuse potential or dependency potential

NSAIDS & ACETAMINOPHEN

- Baby aspirin (81mg day)

- Aspirin max dose 4000mg

- Aspirin and NSAIDs inhibit platelet cox, thereby blocking formation of TXA2

- Aspirin irreversible blocks COX and action persist in circulation platelets lifetime

- NSAIDs inhibit COX reversibly and duration depends on drug dose/serum level/ half-life

- Non-selective NSAIDs (aspirin, naproxen, ibuprofen) inhibit COX1 and 2.

- Selective (Celebrex) target COX2

1. How to tx acetaminophen overdose/reversal? N-acetylcysteine-liposome

2. Tylenol can cause hepatotoxicity

3. Hepatic disfunction: Naproxen

4. Relationship between Tylenol and aspirin/advil: anti-pyretic and analgesic

1. Aspirin is anti-in ammatory

5. Acetaminophen (Tylenol) no anti-in ammatory action

6. Aspirin: reyes fever and adults GI problems. If liver problems give Aspirin

7. Aspirin: inhibits platelet aggregation

8. NSAID irreversible a ects platelets & suppress in ammatory response

9. NSAIDs MAO of suppressing platelets: inactivate COX —> ↓ prostaglandin synthesis

10. Aspirin stops pain by: stopping local signal production and trasduction

11. NSAIDs least likely to a ect stomach: Celebrex (selective) — no e ect on platelets

12. Celebrex: causes bleeding as side e ect

13. Least likely to cause dyspepsia (stomach upset): acetaminophen, ibuprofen (aspirin more than
ibuprofen)

14. Pt taking baby aspiring. Not necessary to stop - stays in body for 7-10 days

15. Allergic to aspirin: NO IBU - give acetaminophen

16. If someone can’t take ibuprofen. You can give: Demerol (narcotic w/o aspirin)

17. Ibuprofen: ceiling analgesia at 400mg

18. Asthma patient: NSAID contraindicated

19. Pt in aspiring 3-5g per day for 3 months: acidosis and ↑ bleeding time

20. Ketorolac moderate-severe pain. After surgery. And after IV dose of it

21. NSAID a ect kidney in negative way. Also a ect liver

22. Renal vascular dz: acetaminophen

23. Tylenol: non-narcotic analgesic of choice for pt taking anti-coagulant

24. Methotrexate (immune suppressive drug) toxicity ↑ w/ Penicillin and NSAIDs

25. Pregnant 3er trimester: Tylenol 325mg !! Nothing w/ Codeine

26. Pain med for child w/asthma: Tylenol (acetaminophen)

27. 5yo fever and pain: Tylenol

28. Pain after surgery, at least 8 hr of relief: naproxen

GENERAL PHARMACOLOGY
PHARMACOKINETICS:

- ↑ Therapeutic index: safer

- Potency: response to a drug over a given range of concentrations. Depends on dose of drug

- E cacy: max intensity of drug. Depends on level of drug binding to its rct

- Max e ect: intrinsic activity

- Bioavailability: highly absorbed: high bioavailability - how much drug is in blood/circulation

- Idiosyncrasy: abnormal response to drug due to various factors, hard to predict

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1. EPI: physiological antagonist of histamine & nitroglycerin

2. Biotransformation: increase in polarity, more ionized and more water soluble

3. Conjugated metabolites are: more ionized in plasma (more water soluble)

4. To be absorbed: liposoluble and non-ionized

5. To be excreted: water soluble and ionized

6. What happens to a drug after conjugation? More ionic

7. Why do you use sodium bicarbonate for? All drugs or alcohol (phenobarbitals) - excretion of
acidic drugs is accelerated w/ sodium bicarbonate

8. After drug goes though liver: more water soluble and less lipid soluble

9. First pass metabolism: enzymatic degradation in liver prior to drug reaching site of action

10. First pass: enterohepatic circulation

11. What is used to determine whether a drug will cross glomerulus: attached to a protein or not.

12. Which drug absorbs better in stomach acid? Weak acid

13. In order for a drug to do its e ect, in what state should it be? Liposoluble - non-ionized

14. When a drug doesn’t exert its maximum e ect is bc is bound to: albumin

15. Which best explains why drugs that are highly ionized tend to be more rapidly excreted than
those that are less ionized? Less lipid soluble

16. LD50: at this dose, 50% animals died

17. Drug A has > e cacy than B. Drug A will produce > e ect at lower dose. Drug A has > potency

ATB
Prophylaxis antibiotic:

- Prosthetic cardiac valves repair: including transcatheter-implanted prostheses & homografts

- History of infective endocarditis

- Cardiac transplant w/ valve regurgitation

- Congenital heart dz:

- Cyanotic congenital heart disease that has not been fully repair, surgical shunts and
conduits

- Congenital heart defect that has been completely repaired w/ prosthetic for 1st 6 moths
after repair

- Repaired congenital heart dz w/ residual defects (leaks or abnormal ow)

- Un-repaired cyanotic congenital heart dz, including palliative shunts and conduits

- Un-repaired cyanotic congenital heart disease, including palliative shunts and conduits

- Any repair congenital heart defect w/ residual shunts or valvular regurgitation at the site or
adjacent to prosthetic patch or device

1. Amoxi: prophy

2. Penicillin: odontogenic infection

3. Tetra: periodontal infection

4. Cardiac pacemaker and to do a prophy: NO need of prophylaxis atb

5. Pacemaker: no use of ultrasonic and electric testing / electrocauteryzation

6. Pt w/ Mitral valve prolapse w/regurgitation: NO premed

7. Pt needs pre med, he is taking already penicillin. What to do? Give clindamycin

8. Allergic to penicillin: clindamycin 600mg - 20mg/kg

9. Adddddd new Ryan video

ATB

1. Most basteriostatic work by: inhibiting protein synthesis

2. Broad spectrum antibiotics like Tetra: ↑ superinfection and resistance —> that’s why we don’t
want to use broad spectrum

3. Atb are less useful to tx what perio condition: Chronic periodontitis

4. Atb metabolism is a ected by chronic use of Benzodiaz

5. Pt taking atb, which metabolizes in liver. Metabolism will ↓ if taking: Diazepam

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 6. Penicillin is good bc: ↓ toxicity, cheap

7. Mechanism of action of penicillin resembles: cephalexin (Ke ex)

8. Transpeptidase enzyme is inhabit by penicillin. It is a bacterial enzyme that cross-links the

peptidoglycan chains to form rigid cell walls

9. Ticarcillin is a carboxypenicillin. Used to tx pseudomonas aureginosa

10. Penicillin ↓ e ectiveness in abscess? Hyaluronidase (penicillin unable to reach organism)

11. #1 dental atb for infection within 24 hr: Pen V 1gr booster and 500mg q6h / 7days

12. Penicillin V: slow onset. Bactericidal agains gram + cocci & major pathogen of mixed anaerobic
infections.

13. For endo, pulp involvement: pen VK

14. Cephalosporin does not have a broader spectrum than penicillin

15. Chlortetracycline: broadest atb e ect

16. Tetra MOA: protein synthesis inhibitor (30s) bacteriostatic. Blocks activity of collagenase, binds
to 30S (block AA linked tRNA). They can cause yeast infections

17. Doxycycline: acts on 50s ribosome —> to tx malaria

18. Doxycycline as perio dressing 20mg: inhibits collagenase - no anti-bacterial e ect

19. Tetracycline is more concentrated in GCF than in blood

20. Tetra: bacteriostatic

1. Minocycline and doxycycline: ↑ GCF section and are release in it

21. MOA Minocycline (tetra) in arestin: decrease collagenasa activity (inhibits MMP activity)

22. Anti-acids and mil ↓ absorption of tetra

23. Tetra staining: before 4 months in utero for primary, birth for permanent

24. Lactating female: NO codeine & tetra

25. Tetra/ erythromycin will ↓ e cacy of Peni —> antagonists

26. Maxillary sinusitis: amici + clavulanic acid (Augmentin) more resistant to b-lactamase bact

1. Clavulanic acid: prevents beta lactam degradation by beta lactase producing fact

2. Augmentin: blocks action of penicillinase —> penicillinase resistant

27. Erythromycin: bacteriostatic - inhibits protein synthesis

1. #1 SE: stomach upset - lethal doses: GI damage

2. Don’t use in myasthenia gravis

28. Metronidazole: NUG or agressive perio

1. CI: alcohol —> disul ram

2. Red urine

3. Agains only anaerobes parasites (protozoa)

4. To tx clostridium di cile (colon in ammation). If patient breast-feeding use vancomycin

5. MOA: fungal protozoa disruption

29. Best tx for aggressive perio: tetra, doxycycline

30. Aminoglycosides (Gentamicin): may cause auditory nerve deafness - oto and nephron toxicity

31. Pseudomonas colitis: C. Di cile & clynda

32. Clynda: e ective agains most anaerobe

33. Cipro oxacin: e ective agains pseudomonas aeruginosa

34. Chloramphenicol: aplastic anemia

ANTI-CANCER DRUGS
1. Least likely to cause: thromboembolism

2. Don’t mix methotrexate w/ drugs (specially amoxi) —> wont clean out of the system

1. Penicillin can ↓ elimination of Methotrexate (cancer drug), ↑ risk of toxicity, and seizure

1. DONT MIX AMOXI + METHOTREXATE

3. Methotrexate: antimetabolite and antifolate drug —> cancer, autoimmune dz, ectopic

1. also used: rheumatoid arthritis and psoriasis.

2. Pregnancy, for induction of abortions. It inhibits folic acid metabolism (folate reductase)

4. To tx overdose of methotrexate: Leucovorin (folic acid)

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 5. Drugs that inhibit folic acid: sulfa, trimethoprim, methotrexate

6. Mechlorethamine (was an alkylating agent): neurotoxic

7. Alkalizing (procarbazine): hepatotoxicity —> inhibits CYP450, ↑ e ect of barbiturates,

phenothiazines and narcotic. Has monoamine oxidase inhibition (MAOI), and should not be
taken w/ most antidepressants and certain migraine meds

8. Non-alkylating anti-cancer SE: myelosuppresion (bone marrow suppression)

9. 5- uorouracil: to treat squamous cell carcinoma of head and neck.

10. Alkylating (antineoplastic drug) don’t react with RNA synthesis which prevents cell
reproduction.

11. Acute lymphoblastic leukemia is the most common childhood cancer. It has a high cure rate if
detected early. Agents used: vincristine, prednisone, asparaginase, cyclophosphamide,
Methotraxate.

12. Unilateral swelling child African is likely: Burkitt Lymphoma (B cell lymphoma) that can be tx
with Rituximab

13. Spontaneous bleeding: not seen on radiation therapy patient

ANTI-VIRAL DRUGS
1. Common:

1. Amantadine: in uenza A

2. Oseltamivir (Tami ue) & zanamivir: in uenza A & B

3. Acyclovir: herpes I, VZV, EBV

4. Gancyclovir: CMV

5. Ribavirin: hep C and resp syncytial virus

6. AZT, Didanosine, Zalcitabine, Abacavir, Ritonavir, Saquinavir, Ne navir, Amprenair: HIV

2. Amantadine: anti-viral and anti-parkinson

3. Valaclyclovir: tx HSV, VZV, CMV

4. What virus causes postherpetic neuralgia: VZV

5. Acyclovir has selective toxicity MAO bc only phosphorylated and activated in infected cells

6. Retrovir: HIV/AIDS

HIV & DRUGS

1. HIV pt w/ sinusitis due to: Murcomycosis

2. HIV progression: CD4 count (<200 on infected)

3. Pt has viral load of 100,000: ↑ virus load and prone to infection

4. T-cell load on healthy: 500-1500 units/ml

5. Risk of oral cancer: tobacco, alcohol, HPV. —> HIV IS NOT a risk factor for oral cancer

6. Zidovudine: used for HIV infection

7. Children w/HIV oral manifestation: candidiasis

8. Fungal agent for HIV: Fluconazole or Ketoconazole

9. Candidiasis and HIV, topic or systemic use of: Nystatin

ANTI-FUNGAL DRUGS
- Azoles: inhibit lanosterol conversion to ergosterol

- Polyenes: bind to ergosterol on cell mb and create a pore/transmembrane channel

- Example: Amphotericin B

* Topical: Mycelex (clotrimazole), nystatin, ketoconazole

* Systemic: Fluconazole (di ucan), Amphotericin B, Ketoconazole (FAK)

1. Topical for localized candida in normal immune pt:

1. nystatin oral suspension: 5ml aid

2. Clotrimazole troches: 10mg 5x/day for 15 days. Don’t chew. Let it dissolve

2. Systemic for disseminated dz and/or immunocompromised:

1. Fluconazole tablets: 100mg/day

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 2. Itraconazole tables: 200mg/day

1. Nystatin: swish & swallow

1. Angular cheilitis

2. Oral anti-fungal infections (also clotrimazole)

2. Systemic anti fungal: uconazole

3. Griseofulvin: used for athletes foot (ringworm)

4. Clotrimazole MOA: alter the enzyme for synthesis of ergosterol= alters cell mb permeability

5. Miconazole MOA: inhibits synthesis of ergosterol

6. Best topical anti fungal: Mycelex

ALPHA & BETA ADRENERGIC DRUGS

- Adrenergic rct blocker: alpha/beta drugs act by blocking competitive inhibition of post-junctional
adrenergic rct

- E ects of EPI in presence of alfa/beta rct:

- EPI stimulates both a/b —> HR ↑, VC

- EPI reversal: when also taking A-blocker cause ↓ BP bc beta-mediated VD predominates

- Beta2 trumps A1 so VD happens & BP decreases

- Vagal re ex: blocked by atropine, vagus stimulates ↓ heart rate

- If patient on nonselective beta-blocker receives a systemic dose of EPI, however, the beta-
blocker prevents the VD, leaving unopposed alpha VC

- Alpha 1 agonist: ↑ smooth muscle tone, VC: ↑ BP

- Alpha 2 agonist: given orally bc they cause hypotension by ↓ sympathetic CNS out ow

1. What does A1 do: VC of peripheral vessels (smooth muscle)

2. What happens when stimulates alpha 1: VC

3. What does A1 rct do to heart? VC, ↑ BP, ↑ peripheral resistance, mydriasis and urinary
retention

4. Adrenalin-EPI: stimulates alpha 1, 2 beta 1,2 rct

5. Hear has beta-1 rct

6. Slow infusion of EPI cause: A1 (VC during anaphylaxis) - B1 (↑ heart output) - B2 (broncho-D)

7. Pt BP spike after EPI. What rct? B1

8. Hemostatic agent in retraction cord. What rct? A1 (VC)

9. Retraction cord w/epi can cause: ↑ BP, HR. Don’t use in hyperthyroid or cardiac dz

10. Smooth muscle relaxation is caused by: prazosin

11. Combination of agents would be necessary to block cardiovascular e ect produced by

injection of sympathomimetic drug? Prazosin & Propranolol

12. EPI + propanolol: ↑ BP, ↓ HR

13. Propanolol is a nonselective B-blocker so epi only acts at A-rct which in the periphery are
mainly A1 rct.

1. This causes VC & ↑ BP —> ↑ ring, which triggers aortic and carotid sinuses —> ↑ vagal
activity on heart: ↓ HR

14. Change propanolol for metoprolol —> little change on HR but no marked ↑ BP

15. Propanolol + EPI: bad reaction due to: drug interaction —> hypertensive crisis: A1 rct

16. E ect seen when propranolol and epi are injected simultaneously: in mild reaction causes
hypotension - severe reactions it is malignant hypertension

17. Propanolol does not alter ionic movement

18. Pt w/ propanolol has acute asthmatic attack. Manage with: aminophylline

19. Drug of choice for adrenergically-induced arrhythmia: propranolol

20. EPI reversal: alpha adrenoreceptor blocker (Phenoxybenzamine)

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 1. Inhibit VC e ect but not the VD e ect of epi.

AMPHETAMINES (INDIRECT-ACTING SYMPHATHOMIMETICS)

* Amphetamine, teaming, ephedrine: stimulate release of stored NE

* TCA & cocaine block NE re-uptake

* MAOI block enzymatic NT destruction

-NE stimulates A1/A2 & B1 rct more than B2

-For ADHD:

- methylphenidate (Ritalin) —> blocks dopamine uptake in central adrenergic neurons by

blocking dopamine transport or carrier proteins

- Amphetamine (Adderall) —> & cocaine: ↑ catecholamine NE serotonin dopamine release

as primary mechanism. Adderall psychostimulant med composed of amphetamine and
dextroamphetamine, which increase the amount of dopamine and NE in brain

1. ADHD: > in boys

2. Amphetamine induces anxiety, and is contraindicated in very nervous patients

3. Amphetamine symptoms: ↑ HR & excitability

4. Indirect symphatomimetic drug: dyphenyl amphetamine

AUTONOMIC: ANTICHOLINERGIC & CHOLINERGIC DRUG

- cholinergic: ↓ heart, constrict pupil (miosis), stimulate GI smooth musc, ↑ sweat & saliva

- Cholinergic crisis: bradycardia, lacrimation, salivation, voluntary muscle weakness, diarrhea,

bronchoconstriction —> tx w/Atropine

- Salivary ↑ w/ Pilocarpine, Neostigmine (cholinergic agonist), ,methacholine, cevimeline

(Sjogren)

- Anticholinergic agents: block the neurotramsiter acetylcholine in CNS/PNS

- Atropine/Scopolamine overdose: confusion, hallucination, burning mouth, hyperthermia —> tx

w/ Physostigmine

- Saliva ↓ w/ use of atropine & scopolamine & glucopyrrolate

* Direct acting cholinergic agonist: pilocarpine, methacholina (used for xerostomia)

* Indirect acting (prevent enzyme breakdown)

* Reversible anti-cholinesterase: physostigmine (CNS/PNS) & neostigmine (PNS only)

* Irreversible anti-cholinesterase: inseticides + organophosphate

* Competitive muscarinic rct blocker: atropine, scopolamine, propantheline

- Atropine: muscarinic antagonist (anticholinergic) antidote for organophosphates and

insecticides, blocks vagal re ex —> tachycardia

- Atropine: doesn’t cause miosis

- Belladonna derivates: anticholinergic

- Neostigmine: cholinesterase inhibitor, doesn’t penetrate BBB tx of M. Graves, ↑ salivation

- Physostigmine: use for atropine and scopolamine overdose, tx of glaucoma,

acetylcholinesterase inhibitor

- Pilocarpine: muscarinic agonist, for glaucoma and xerostomia

- Scopolamine: anticholinergic agent, used for motion sickness & in eye drops to induce mydriasis
(dilation)

5. Insu cient cholinesterasa leads to hypotension (bradychardia)

6. Pt w/ bradycardia. Give: atropine —> will ↑ HR

7. Atropine poisoning: physostigmine

8. Side e ect of pilocarpine: bradycardia and hypotension, excess sweat & saliva, bronchospasm

9. Propantheline bromide (pro-banthine): anti-cholinergic (anti-muscarinic), relive cramps or

spams of stomach, intestine and bladder

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10. CI for glaucoma: Anticholinergic - adrenergic blocking —> will ↑ intraocular pressure

11. Succinylcholine to pt de cient in serum cholinestereasa cause: prolonged apnea

12. Miosis: opiods + cholinergic

13. Mydriasis (increase serotonin + anticholinergics)

DOPAMINE DRUGS
- Carbidopa + Levodopa (sinemet): most potent combo for Parkinson.

- Carbidopa: prevents levodopa from being converted into dopamine in bloodstream,

peripheral enzymatic degradation so more reaches the brain. … prevents breakdown of
levodopa before it crosses BBB (blood brain barrier) … carbidopa potentiates e ect of
dopamine

- Smaller dose of levodopa is needed to tx symptoms

- L-dopa is a precursor to NT like dopamine, NE, EPI. Its a sympathomimetic & is used in tx of
Parkinson to ↑ dopamine

1. Levodopa MAO: it replenishes a de ciency of dopamine

2. Cause of Parkinson: dopamine de ciency

ANTI-PSYCHOTICS
Sedate, blunt emotional expression, attenuate aggressive & impulsive behavior. Produce
anticholinergic adverse e ects, dystopias and extrapyramidal symptoms. Tardive dyskinesia mood
common after several years

- Phenothiazines: block Dopamine rct, act on extrapyramidal pathway

1. Where in brain does anti-psychotic work? Blocking absorption of dopamine

2. What catecholamine does phenothiazine a ect? Dopamine

3. SE: tardive dyskinesia

4. Onset action: 5-6 days

5. Most common psych disorder: depression

6. Lithium: to tx bipolar disorder

DEMENTIA & DEPRESSION

1. Most common psychological problem in elderly? Depression

2. Age is associated w/ depression

3. Main sign of dementia: shot-term memory loss

4. Not a sign of dementia: long-term memory loss

ANTIDEPRESSANT
- Selective serotonin reuptake inhibitors (SSRIs): prozac, Zoloft, Axil, Laxapro, Luvox —> well
tolerated, inhibits serotonin

- Trycyclic antidepressants (TCA): rarely used due to side e ects. TCA 2nd generation:
nortriptyline (pamelor, aventyl), desipramine (norpramin), protriptyline (vivactil), amitriptyline—>
inhibits serotonin/ 5-HT, NE, muscarinic M1, histamine H1, A-adrenergic rct.

- Caution in cardiac pt: risk of AF, AV block or ventricular tachycardia. More Letha in overdose
than newer antidepressants

- Don’t take w/ MAOI

- MAOIS (monoamine oxidase inhibitors): rarely used due to side e ects

- Phenelzine, tranylcypromine —> inhibit MAO type A&B, enzyme that breaks down serotonin,
dopamine, NE. Signi cant drug interaction w/ opiods & sympathomimetic amines (don’t give
w/ phenylthylamine or phenylephrine)

- Serotonin-norepinephrine reuptake inhibitors (SNRIs): Venlafaxine (E exor), duloxetine

(Cymbalta)

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 * Buspirone (Buspar): partial agonist at a speci c serotonin rct (5-HT1A). Doesn’t cause CNS
depression/muscle relaxant or anti-convulsant. Anxiolytic and antidepressant

1. Where in brain does anti-depressant work: ↓ amine-mediated neurotrasmission in brain

2. Tricyclic anti-depresant MAO: inhibit reuptake of NE, 5-HT & serotonin

3. Pt taking tricyclic anti-depressant. Take in consideration: epinephrine limit

4. Most common antidepressant does what? Phenothiazine: block D2 rct

5. Depression and wants to quit smoking: Zyban (bupropion) - NO chantix (only smoke cessation)

6. Amitriptyline: most common TCA, inhibits reuptake of NE and serotonin

7. Prozac acts on serotonin (SSRI)

8. What does St. John wort do? Decrease the body immunity, used for depression.
Noncompetitive reuptake inhibit of serotonin. Don’t use w/ BDZ and HIV med

9. Drugs for conscious sedation: SSRIs/BDZ Diazepam, prozac (Fluoexitine)

ANTIINFLAMATORY/CORTICOESTEROIDS
- SE: Gastric ulcers, immunosupression, acute adrenal insu ciency, osteoporosis, hyperglycemia,
redistribution of body fat

1. Negative e ect of chronic use corticosteroid: infection, reduce in ammation, hyperglycemia

2. Long-term side e ect: osteoporosis & hyperglycemia

3. CI: Diabetes, HIV, TB, Candidiasis, Pept ulcers

4. Aspirin contraindicated w/ corticoid use

5. Steroid insu ciency: 20mg/2 weeks in last 2 years

6. Cortisone exerts its action by binding to intracell rct

7. Asthma long-term: give corticosteroids to ↓ in ammation

OPERATIVE DENTISTRY
CARIES & BACTERIA

1. Transparent dentin & subtransparent —> a ected dentin

2. SUCROSE: carbohydrates found in human diet is most responsible for caries

3. Most cariogenic? Sucrose

4. Most important etiologic factor on getting caries? Re ned sugar

5. Eburnated dentin: sclerotic, rm to touch, seen in older —> not need to be restored

6. Remineralized tooth/arrested caries are stronger than regular enamel. (Dark, opaque, harder,
more resistant to acid)

7. pH Enamel where starts demineralizing? 5.5

8. Least likely to predict future cavities? Amount of sugar intake

9. Child caries depend most on: amount, consistency & time

10. Early sign of caries: change in enamel opacity

11. True about strep. Mutans? Has to live on a non-shedding surface

12. Mutans converte sucrose in dextran using enzyme glucosyltransferase

13. Helps in caries progression, but is not primary initiator? lactobacillus

14. How to determine if pt is ↑ risk of cavities? Assessment

15. Early childhood caries a ects: C and M

16. Increasing in the US: root caries

17. Best clinical determinant of root caries? Soft spot on tooth - visual & tactic methods

18. Pit & ssures: most common enamel caries

19. Inter proximal caries: start apical to contact

20. When do you restore a lesion? When is cavitated

21. F- works the best in smooth surface

22. Conical shaped caries w/broad base with apex towards pulp: smooth caries

23. When looking at X-ray caries, you are looking at body zone demineralization

24. Caries indicator stains infected dentin

25. Caries detection is the Difoti used for? Class I, II, & III (incipient, frank & recurrent)

26. DIFITO: occlusal, interprox, and smooth surface caries

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 27. DaignoDent: class I (occlusal)

28. DMF index: measures how permanent dentition is a ected by caries

AMALGAM
• Amalgam depth: 0.5mm / 2.0mm dentin remaining - axion pulp into DEJ

• Extension of pulpal oor in class I primary? Just into dentin (total 1.5mm: 1mm enamel - 0.5
mm dentin)

• High mercury content —> severe marginal breakdown

• ↑ Cooper and ↓ mercury —> ↓ creep

• Creep: happens over time, undertrituration ↑ creep /↑ condensation pressure ↓ creep

• Amalgam is preferred to be overtriturated rather than undertriturated (↓ strength, faster

corrosion, rougher nished surface)

• ↑ trituration time —> ↓ setting expansion, sets too fast, ↑ compressive strength

• Class V amalgam NEEDS retentive grooves

• Polishing: ↓ marginal discrepancy, prevents tarnishing, improves appearance

• Setting reaction of amalgam proceeds primary by: mercury reaction w/ silver

• Leakage of the margins of amalgam restoration: ↓ as the restoration gets older

• Beveled palpal-axial line angle: feature of MO amalgam prep that WILL NOT prevent the rest
from falling out into adjacent edentulous space.

• according to GV Black, the outline form of a cavity prep is the shape of the prep: along the
cavosurface margin

• Half-life of mercury in human body: 55 days

• Pins 2mm into dentin, 2mm within amalgam and 1mm from DEJ

• Resistance: bevel in axiopulpal line angles - rounded angles - at oor

• Retention: BL walls convergence and 2nd retention grooves/occlusal dovetails

• Acute mercury toxicity: muscle weakness (hypotonia) & hair loss

• Most likely for amalgam to fail: poor condensation (revels mercury)

• Most common reason of amalgam failure in primary: inadequate cavity prep

• Overhanging amalgam on x-ray:m overcarved

• How to account for M concavity in 1PM max when restoring with amalgam? Custom wedge

• Most corrosion: tin-mercury phase (gamma2)

• Zinc in amalgam: ↓ oxidation of other elements (deoxidizer)

• Dental o ce amalgam: elemental type of mercury

• Most toxic mercury methyl mercury (organic)

• Admix needs more condensing than spherical

• Admix: better for proximal contacts bc ↑ condensation forces

• ↓ Cooper content: most corroded amalgam (in pictures)

• Amalgam contaminated with water: delayed expansion

• Where is acceptable to leave unsupported enamel? Occlusal wall of class V amalgam

• Class I & V amalgam have in common: both extend into dentin

• MOD onlay vs amalgam: better facial contour

• Inlay vs amalgam? Esthetic, less tooth reduction

• Isthmus: convergent in amalgam

• Istmus: divergent in inlay

• Best way to prevent proximal dislodgement/fracture class II amalgam: retentive grooves (for
proximal resistance)

• Matrix band: 1mm above adjacent marginal ridge

• Remove matrix band from amalgam PRIOR to nal carving of restoration

COMPOSITE

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 • Components of composite: bis-GMA + dimethacrylate monomer (TEGMA, UDMA, HEDMA) +
ller (silica) + photo iniciator (camphoroquinone)

• Monomers for composite resins: BIS-GMA UEDMA TEGDMA

• Main disadvantages to using methyl methacrylate as permanent restorative material: low

resistance to abrasion and high thermal coe cient of expansion

• Lowest thermal conductivity and di usivity —> un lled resin

• Filler particles: ↓ coe cient of thermal expansion, ↓ polym shrinkage, ↑ harness, ↑ tensile &
compressive strength

• Steps for 4th generation bonding system after tooth prep is completed —> etch - rinse and
leave moist - primer - adhesive - lightcure

• Composite: highest linear coe cient of expansion of all materials (gold-teeth-amalgam)

• Sensitivity: occlusion or de-bonding

• Micro lm composite: > color stable & smooth nish than hybrid.

• Flowable: less ller content

• Filler: wear resistance, translucency

• Composite to tooth: micro-mechanical bond

• Successful posterior composite restoration: type of resin + type of prep

• What determines class II prep: extent of caries

• Oblique ridge is included if less than 0.5mm

• Class II into cementum. Restore with: GI

• Large MOD composite. What’s disadvantage? Occlusal wear

• > walls > C factor.

• C factor related to amount of stress.

• Class I and class V: ↑ C factor

• Part of composite that stains the most: Gingival proximal

• Secondary cavities most likely: gingival margin

• Transillumination: class III

• Class V: GI (bevel enamel)

• Color too light of composite recently done. Add composite tint or do a composite veneer.
Remove 1mm prep and add more composite

• After caries removal, sound tissue is in cementum (or subgingival). How to restore? Build up
with GI and place composite

• Why do you bevel in ant composite? More surface area

• When do you see micro leakage w/ composite done without rubber dam? 2-4 weeks later

• Higher chance of leakage under rubber dam: holes too close

• Using rubber dam, dehydrates teeth, color shade not accurate

• W on a rubber damn clamp means: wingless

• Diketones activates by visible light. Composite resins contain alpha diketones as

photoiniciators. Blue light produce slow reaction. Amines are added to accelerate curing time.
Crosslink reaction

• Most RO of composite: barium - zirconia glass

• Heat indirect composite has better bonding to dentin and enamel

• Composite more color stability? Light cure (heat cured) due to TEGDMA

• With TEDGMA and HEMA: light cure maintain proper shade

• Light cure vs self cure in terms of shade balance: less # of nitrates when you light cure

• Blue light: 450-750

• Led light: narrow spectrum, less heat generation, light bulb last longer & generally smaller

• Laser & LED lights don’t cure all resins bc some resins photoiniciator require light sources out
of this range

• Hybrid resin is better tan porcelain agains enamel

• Beter to restore canine: Gold > Amalgam > GI > Composite

• On a class III of a canine: don’t use composite

CEMENTS & MATERIALS

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 - Acid etch technique: converse tooth structure, reduces micro leakage, improves esthetics and
provides micro mechanical retention. Improve marginal seal, helps in wetting enamel, cleans
surface debris, create microspores (roughness of surface)

- Smear layer: debris that consist of HA + altered denatured collagen. Removed by etch.

- GI as cement: low pH can cause sensitivity, pulp irritation, least erosive

- GI as restorative: releases F-, low solubility, thermal ins, similar therm expansion as tooth,
chemical adhesion, biocompatible. Less surface hardness, compressive strength, and tensile
compared to Composite

- Components of GI: alumina, silicate & polycarboxylate

- GI is brittle: high compressive, low tensile strength

- Compomer: GI & composite modi ed w/ polyacid group. Used in low-stress-bearing areas (less
wear resistance than composite, but releases F-). Root caries and class V is better.

1. Bevel in acid etch: increase surface area

2. Etch cleans tooth and creates micropores for micro mechanical retention

3. Etch DOESNT provide chemical bond - ↓ irregularities at cavosurface margin - ↑ strength of

composite

4. Etch ↑ wettability of enamel - remove smear layer & exposes collagen bers to form hybrid
layer with resin

5. Hybrid layer: primer within interlobular dentin

6. Most unreliable etch system? Self-etch (all in 1)

7. Filler on resin: strength. The > ller the < uidity

8. > llers have > strength, but do not polish as well

9. HEMA: contact dermatitis

10. Acid of GI: silicate( uoroaluminosilicate) glass powder + polyacrilyc acid

11. Cool glass slab: more powder incorporation. ↑ working T’ and shorter setting time

12. What is the most practical way to seat a casting at the time of cementation? Grind the inside
away

13. To make sure a casting seats, do all: increase thermal expansion of investment, mix cement
thin. DONT DO: remove internal nodule with occlude.

14. If crown doesn’t t: don’t change cement ratio mixture

15. Why we lute all-ceramic crown with composite/resin? ↑ strength (strength bond)

16. Why don’t you use GI resin to cement all-ceramic? Its expansion could cause cracking of
porcelain

17. Resin Ionomer and GI can cause ↑ pulp sensitivity

18. Which cement is easiest to remove after procedure? Zinc phosphate cement (water based)

19. Zinc phosphate pH 3.5. means it might also cause pulp sensitivity (acid - irritates pulp)

20. What component of cement contributes to adhesion? Polycarboxil acid (chelation between
carboxyl group and Ca in tooth)

21. RMGI advantage besides F- release: ionic bond between enamel and dentin

22. Pulp capping: use CaOH & in order to protect pulp, put 2mm thickness of liner/base (GI)

23. How to improve success of CaOH on direct pulp cap? Add GI liner

24. Primary tooth deep caries. Most unsuccessful: DPC

25. Strength in IRM: add MMA (methylmetacrylate)

26. ZOE: good biological seal

27. Main component of any root sealer: Zinc Oxide

28. RCT on primary: ll with ZOE w/o accelerator or catalyst

29. Add BIS-GMA to PMMA (acrylic): ↑ strength

30. Cross liking factor of P-MMA: BIS-GMA

31. Cross-linking in polymers leads to: better strength

32. Excessive monomer in acrylic: ↑ shrinkage

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 BASE - LINERS - CEMENTS
• after the initial setting period: GI cements tend to have the < solubility, & zinc polycarboxylate
the >

• 2) Zinc phospate: permanent cementation

• 3) Temporary cementation

• Generally, GI cements contain: ouro-alumina-silica powder & polyacrylyc acid

• Glass ionomer: only that can be used as cement and restorative agent

• ZOE cement pH: near 7 (good for temporary sedative restoration)

• IRM should be mixed less 1min

• Zinc phosphate: shrink slightly upon setting —> can cause irreversible pulp damage

• Zinc polycarboxylate rst material to chemically bond to tooth structure

• Varnish applied prior to base zinc phosphate

• IPC: Wait 3-4 months to reopen

• Polycarboxylate cement —> chemical bond —> chelation to calcium

• > cement powder-to-liquid ratio < solubility

• Most important clinical property of cement: solubility (should be VERY LOW)

• Compomer cement —> metal-ceramic, some all ceramic, inlays, veneers. Has low solubility
and sustained release of Fl-.

• Main disadvantage of RMGI compared w/ GI—> ↑ expansion

BURS AND INSTRUMENTS

• Most important design characteristic of a bur blade is: the rake angle

• The clearance angle of a bur is: angle formed between the clearance face and a tangent to the
path of rotation

• Hoe excavator —> class III and V preps for direct gold

• Angle former —> sharpening line angles and especially useful to form convenience points for
gold foil preps

• Ordinary hatchet excavator —> used primarily on anterior teeth for prep retentive areas

• Enamel hatchet: most e ective to plane enamel of facial and lingual walls of class II amalgam

• The retention with a pin increases as the diameter of the pin increases

• Minimal interpin distance for Minikin pin: 3 mm

• Minimal interpin distance for Minim pin: 5 mm

• Wrinkles after placing rubber dam —> holes punched too far apart

• Woodbury frame for rubber dam provides more retraction of soft tissue

• Soft material, acrylic, are cut most e ectively w/ positive rake angle burs

• For a dental hand instrument with a formula of 10-85-7-14. The number 10 refers to what:
width of blade in tenths of a mm

• Rubber dam is inverted to provide a complete seal around teeth

• Di erence between 245 and 330: length. All other dimensions are the same

• Used for pediatric: 245

• 245 best for occlusal convergence

• Diameter of 245: 0.8mm

• Amalgam retention class II? #245

• Amalgam convergence of walls: #169

• Steel: for polish

• Excavation of cavitie: large bur from periphery to center

• Chisel: intended to cut enamel

• Di erence between enamel hatchet & gingival marginal trimmer? Both chisels but GMT has
curved blade and angled cutting edge with EH cutting angle in plane of handle

• Advantage of GMF over EH: angle of blade

• Don’t use to bevel inlay prep: EH

• Don’t use to bevel ginvival margins? Tapered diamond (enamel fracture)

• Don’t use to bevel gingival margins on MOD prep? EH

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 • Most common displacement of odontoblastic processes? Desiccation related to hydrodynamic
theory

BLEACHING

• 10% carbamide peroxide —> home bleaching

• 35% Peroxide hydrogen —> in-o ce bleaching

• 35% perox hydrogen, Cabamined perox & sodium Perborate(walk-in bleach): Non-vital bleach

• Most common used in internal bleaching? Sodium perborate

• SE internal bleaching with superoxide: external cervical root resorption. Its indicated to place
glass ionomer cement in the thickness in a scalloped manner following the EJ. This is known
as the bobsled tunnel technique, used to prevent enamel resorption as enamel is thinnest in
this region with highest chance of resorption.

• Home bleaching causes: sensitivity

• Wait 1 week after vital tooth bleaching to bond a resin

• Prognostic of bleaching is favorable when discoloration is caused by necrotic pulp

• O ce bleaching changes shade though all except: etching tooth

GOLD / METALS
* Onlay: Capp funcional cusp - shoed non-funcional cusp

* Gold: ↑ resistance to tarnish & corrosion’s

* Copper: hardens alloy

* Silver: color modifying

* Ductility ↓ with ↑ of temperature

* Ductility: deform(without fracture) under tensile strength: gold > silver >platinum > iron > nickel >
Cooper > aluminum > zinc > tin > lead

* Malleability ↑ with ↑ of temperature

* Malleability: deform (without fracture) under compressive strength. Gold > silver > lead > Cooper
> aluminum > tin > platinum > zinc > iron > nickel

* Investing: surrounding the wax pattern w/a material that duplicates shape & anatomical feature

* Quenching: rapid cooling by immersion in water of a dental casting from high temperature

* Gold minimal occlusal reduction working cusp 1.5mm - non-working 1mm

* PFM reduction: 1.5 - 2

* For gold casting alloy, Zinc is added to act as a scavenger for oxygen during casting process

* Gold inlay/onlay prep: divergent walls (2-5o per wall), 30o bevel margin for better t, skirt beyond
line angle

* Resistance/retention: 2-5o of taper per wall as tall as possible

* Primary retention: form wall height & taper

* Secondary retention: from retention grooves, skirt, groove extensions

* Hardest gold: IV

* Only advance of porcelain over gold: esthetics

* Advance of gold on occlusal and porcelain in facial: conserve tooth structure

* Why do you bevel the edge of gold? Better adaption

* Weakest part of gold MOD inlay? Cement layer

* Gold or PFM: zinc phosphate to cement

* Zirconia: GI

* Burnishing in gold: yield strength

* Gold casting wrong? Hygroscopic expansion

* Remove gold inlay: section isthmus and remove in 2 pieces

* Reason of burnish gold to the margin? Acute angle of gold margin

ONLAY/ONLAY
1. Removing cusp: a ects retention form

2. Increasing intercuspal distance: a ects resistance

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 3. Marginal ridges help with resistant

4. Loss of marginal ridge a ect both resistance and retention

5. Isthmus of MOD prep extends over 1/3 intercuspal dimension. How to tx? Onlay

6. Inlays are less than 1/3 intercuspal dimensions

7. Surface that is not beveled on Onlay? Pulpal

8. Use of indium (tin & iron) with alloy is mainly to provide chemical bond w/ porcelain

9. Best case to use inlay? Low caries index

10. Cause of post-op sensitivity in direct inlay? Polymerization shrinkage

11. Cement for porcelain: has to be resin

FIXED PARTIAL DENTURES (FPD)

1. Hygienic pontic: mandibular molar - hygiene - poor esthetic

2. Saddle: all teeth - esthetic - poor hygiene

3. Conical: molars area - hygiene - poor esthetic

4. Ovate: max anterior - esthetic - requiere surgical prep

5. Modi ed ridge lap: all teeth - esthetic - easy to clean - minimal contact w/residual ridge

6. Most esthetic: modi ed ridge lap

7. Anterior best pontic: ovate

8. Ante’s law: root surface of abutment teeth have to be > than root surface of Pontic

9. Most immediate sign after high occlusion on bridge? Myofacial pain

10. Fixed partial denture keeps breaking. Why? Poor framework - inadequate design

11. Strength of abutment connection to pontic. Which is more important? Occlusoging width 3mm

12. Edentulous space is wider than adjacent anterior tooth, how to match them? Make pontic line
angles closer and deeper interprox embrasure

13. ↓ the width of an arti cial tooth: take the F line angle labially (closer together) and ↑ inter
proximal embrasure

14. How to make a crown narrower? Move line angles more facially (closer together)

15. Worts cantilever: lat abutment with central pontic

16. Strength of soldered connector of FPD is enhanced by increasing height

17. When soldering, what’s the most important factor? Height

18. What system is best for soldering adjusted FPD framework? Gas air blowtorch

POST/CORE
1. Active post: engages (screw) into dentin in the canal space. Do when length is inssu cient for
passive post

2. Inactive post: cement retained

3. Keyhole for post/core is to prevent rotation

4. Advantage of ber post? Fiber post = modulus of elasticity as dentin

5. How does a dowel post & core help prevent vertical fracture? Ferrule

6. Function of putting a dowel post on a RCT tooth? Retain core

7. Prep RCT tooth for cast post? Need at least 4mm GP to preserve apical seal

COLOR/SHADE
HUE: color

CHROMA: saturation

VALUE: back&white, brightness 0 black -100 white

1. Value is the most critical of the 3 when attempting to match an adjacent natural tooth, hue is
the least important

2. Most important when selecting shade? VALUE

3. Least important? HUE

4. METAMERISM: visual e ect in which a color appears di erently under di erent light sources

5. How to prevent metamerism? Look at shade under multiple light sources

6. Dentist adjust shade by using complementary color or orange. This results in: ↓ value

7. What does staining produce to ceramic? ↓ value

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8. What can’t you change? ↑ value

9. When you add a di erent color to a resin, you ↑ chroma

10. Which represents position on the spectral wavelength? Hue

11. Half-close eyes determines: VALUE

12. On a crown:

1. VALUE: 1/3 medio

2. CHROMA: 1/3 gingival

3. HUE: 1/3 incisal

OCCLUSION
1. Selective grinding in complete dentures for CR:

1. Selective grinding of the inner inclines of secondary centric holding cusps can be done if
there is a balancing side interference.

2. Grinding only the cusp tips of the upper B and lower L if there are premature in centric,
lateral of protrusive movements (BULL)

3. Primary centric holding cups are max L cusp

4. Secondary centric holding cups are mand B cusps

2. Working side interference generally occur on the outer aspect of L cusp of max M

3. Intercuspal position, L cusp of Max 2PM occludes: distal triangular fossa of mand 2PM

4. During non-working, excursive movements, the permanent max 1M ML cusp scapes through:
DB groove of mand 1M

5. When establishing a balanced occlusion, the L cups of max post teeth on balancing side
should contact lingual inclines of facial cusp of mand post teeth

6. Interocclusal record material: < resistance to pt jaw & < ow at mixing

7. In bilateral balanced occlusion a maximum teeth should contact during excursive movements

8. In ideal intercuspal position, the oblique ridge of max 1M opposes DB developmental groove
(between DB and D cusps of mand 1M)

9. Selective grinding should be done BEFORE construction of bridge or partial denture

10. < vertical dimension —> excesive interoccclusal distance when mand in rest position (>
freeway space)

11. CR —> condyles in their most superior-anterior position with the disc interposed at its thinnest
location

12. Maxillary occlusal rim parallel to Campers line

FUNCIONAL/NON-FUNCTIONAL MOVEMENTS
Balancing —> LUBL

Working —> BULL

Protrusive —> DUML

1. Upper M crown has wear facet in porcelain on MB inclination of MB cusp. Associated with?
Interference in protrusion & working

2. Contact on L portion of B mad molar: Non-working

3. Contact on B portion of L cusp of max molar: Non-working

4. Working interferences: P inclines of B cusp of upper - B inclined of L cusp in lower

5. MB incline of MB cusp of mand M has wear. This is on Working & protrusive movement

6. Mesial angle of ML max 2M occludes with: Distal MB cusp

7. Bennett angle? Angle that is formed by the non-working condyle and the sagittal plane during
lat movements

GYPSUM

1. Lowest percentage of expansion: IV gypsum

2. Powder into water: reduce air bubble and better powder mixing

3. Gypsum: calcium sulfate hemi-hydrate

4. Dental stone is produced by heating Gypsum under steam pressure in autoclave at 120-150C

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 5. Dental plaster is produced by heating gypsum in an open vessel at 150-160C

IMPRESSION MATERIALS
1. Elastic material, sets by chemical reaction, and no by-product during reaction: polyether

2. PVS does NOT set by stepwise polymerization reaction. All other elastomers do (polysul de -
polyether - condensation silicone)

3. Condensing silicone releases ethanol as by-product

4. Reversible hydrocolloids: sets by physical reaction

5. Filler of alginate: diatomaceous earth (silica)

6. > tear strength: polysul de

7. > dimension stability: PVS (also in moisture environment)

8. > sti ness: Polyether

9. < tear strength - dimensional stability & sti ness: Hydrocolloid

10. Alginate impression container with moisture, inadequate bulk, premature removal from mouth,
prolonged mixing—> tear

11. Polysul de is more stable than hydrocolloids

12. Latex a ects PVS (retards setting time)

13. Heavy body materials: 60% llers

14. Elastomers more e cient 2-4mm thickness

15. Polysul de impression material should be poured: within 1 hr

16. Polyether should be poured in 1 hr

17. Silicone condensation: poured 30 min

18. To disinfect and impression —> rst rinse w/ water then iodophor - glutaraldehide - hypoclorite

19. Disadvantages of Polyether: sticks to teeth/hard to remove from teeth. - its hard, engages
undercuts - sti er. - most rigid impression material

20. Catalyst of polysul de impression material: lead dioxide

21. Condensing silicone better in being the least distorted by water

IMPRESSION MATERIALS
1. Take impression and lip immediately swells: Angioedema (allergy reaction)

2. C-1 Esterase: inhibitors are used in angioedema to inhibit complement system

- Hydrocolloid irreversible alginate: Setting time↑ (↑ water ratio, ↓ expansion)—> most

inaccurate

- Mixing faster and ↑ T —> ↓ setting time

- Imbibition: expansion & Syneresis: shrinkage

- Gypsum:

- longer spatulation, ↑ water temp, use of slurry water, ↓ water = ↑ expansion ↓ setting time

- Older investment: ↓ expansion

- ↑ water: ↓ expansion, longer setting time

- ↑ trituration time will ↓ setting expansion

Polysul de

- exothermic setting reaction w/ water as a by-product

- Advantages:

- Long working time

- Flexible and tear resistance

- Disadvantages:

- Long setting time

- Odor and taste

- Highest permanent deformation

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Condensation silicone: sets in a cross-linking polym reaction and gives o the by-product ethanol.

- Disadvantages:

- Must be poured immediately

- Poor dimensional stability due to evarporating of ethanol

- Hydrophobic

- Low tear strength

Addition silicone (PVS). There are no by-product compared to condensation silicones.

- Advantages:

- Excelent dimensional stability

- Excellent surface detail

- Low permanent deformation

- Disadvantages:

- Hydrophobic. - Temperature sensitive

PROSTHODONTICS
CD
1. Mand denture DB overextended: Masetere

2. Mand denture L overextended: Mylohioid

3. Mandibular distal extension: cover retromolar pads

4. Max denture DL overextended: superior pharyngeal constrictor

5. Max denture dislodged on DB: coronoid process

6. Posterior palat seal —> does not improves Stability/Support of denture

7. Posterior seal of max CD: completes the border seal of max denture, prevents impaction of
food beneath tissue surface of the denture, improves the physiologic retention of denture,
compensates for shrinkage of the denture resin during processing (polymerization & cooling
shrinkage).

8. Posterior seal: at vibrating line 2mm before fovea palatina

9. What determines the posterior palatal seal? Throat form, tissue type and fovea location

10. Excessive depth of posterior palatal seal: unseating of denture

11. Deep palatal vault: vibrating line is more pronounced & forward

12. Primary reason for most extensive area coverage for mand denture: ↑ capacity of underlying
structures to withstand the stress due to biting force and to ↑ e ective seal

13. Remove palate Toris to ↑ peripheral seal.

14. Remove tori then make denture

15. Palatal torus: 20% population

16. Ideal major connector when tori is not going to be removed: Horseshoe

17. Reasons for splint in palatal torus removal: prevent infection, ap necrosis, hematoma

18. New dentures evaluation: 24 hr after delivery

19. Most important bene t of over denture —> preserve alveolar ridge

20. Porosity —> insu cient pressure during processing of dentures

21. Lower dentures are more an issue than upper

22. Retention of CD is impacted by saliva ow (watery and thin is better)

23. ↓ saliva = ↓ retention

24. Primary stability on max: palate & residual ridges

FACEBOW TRANSFER & PLASTER INDEX

1. Before accurate face-bow transfer record can be made on a pt, which of the following must be
determined? Location of the hinge axis point

2. Occlusal or plaster index: preserve face-bow transfer

3. Hinge axis: face-bow

4. If you want to ↑ 4mm VOD: take new CR and remount

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 SOUNDS & VDO/VDR

1. Sibilant sounds (s/h) max incisor nearly touch mand Inc.—> check VDO

2. Fricative sounds (f/th) max inc touch lower lip (@ vermilion border) —> check labial inclination
of ant teeth

3. VDR-freeway space: VDO

4. Phonetics checked in wax tray in appt

5. If upper teeth anterior too superior and forward: pt can’t say F and V (Fricative)

6. When saying “s” post teeth touching: excessive vertical —> so decrease VDO

7. Which point depends on patients posture (siting or laying down): VDR

8. Pt with lower face and sagging lips: increase VDO

9. Excessive VDO —> clicking tooth

10. Decreased VDO —> cheek bite (inadequate horizontal overate/overlap of post teeth)

11. At VDO & tuberosity touches retromolar pad, what to do? Surgery on tuber

12. Pt feels fullness of upper lip after delivery of CD: overextended labial ange.

13. Maxillary anterior on F and tuberosities undercuts: Reduce tuberosities

14. Generalized speech di culty: faulty tooth position - faulty palatal contours

TISSUE CHECK

1. Burning on lower lip after delivering CD: impinges of mental nerve

2. Upper denture burning sensation —> incise foramen

3. General sourness, but not sore spots or any clinical change: signi cant malocclusion

4. Soreness along ridge? Hyper occlusion —> adjust

5. Pt used dentures for 19 years, now is sore on buccal —> relive and re-eval in 2 weeks

6. 6x3mm white lesions asymptomatic under denture, adjust and check in 1 week, if persist
biopsy

7. Main reason of removing CD at night: rest to tissues

8. Pt has mobile upper ant tissue that is in amed. Before making a new denture, apply
conditioner to existing denture

9. New denture, pt cheek bite: grind B of lower teeth

10. Abused tissues: educate the pt - remove dent - clean them - resilient tissue conditioning
material

DENTURE PROCESSING

1. Not light cured: pour or uid resin technique

2. Teeth falls of denture: some wax that was not removed

3. MMA polymer most used in dentistry

4. Excessive monomer added to acrylic resin —> ↑ shrinkage

DENTURE SET UP

1. How far do you extend max CD: hamular notch

2. Inclined area towards Retromolar pad: dislodges denture

3. Not in ascending area of mandible: bc occlusal forces over this ramus will dislodge denture

4. During try-in: check full movement of tongue and do all working movements

5. If teeth on wax try in don’t occlude: remount, redo teeth, and try again

6. Main bene t of immediate CD: esthetics

7. Teeth at 20-degree condylar when 45 needed: ↑ compensating curve or ↓ incisal guidance

8. Best way to preserve ant guidance? Translate horizontal & vertical relationship onto Inc table

9. How do you determine the angle of Inc table? By horizontal plane (occlusal plane)

10. Class III pt, will have ↓ incisal angle

11. Anterior guidance: TMJ translation

12. Retruded tongue habit w/CD: di culty swallowing

DENTURE MUSCULATURE

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1. Mand denture sits on masseter

2. Muscle that covers denture anges and doesn’t a ect stability? Buccinator

3. Mand impression lingual area: Mylohyoid also can be sup pharyngeal constrictor

4. Help retention of mand CD: sup constrictor, palatoglossus, mylohyoid and genioglossus

5. Buccal frenum: orbicularis oris

6. First sign of increased occlusion: myofascial

OVERDENTURE

1. How to protect roots under over denture: RCT w/ cast copings

2. Which roots are kept under over denture? Dense bone areas (ex. mand canine)

1. Canine > PM > I > M

3. Pt with Acromegaly and needs dentures. Mand denture will not t

4. Acromegaly: jaw deformity with endocrine involvement

COMBINATION SYNDROME

- Kelly syndrome (combination syndrome): in pt edentulous max and partially edentulous mand w/
preserved ant teeth: severe anterior resorption + hypertrophic & atrophic changes in di erent
quads of max and mand

- Plummer-Vinson sx (also called, Paterson-Brown-Kelly sx - sideropenic dysphagia): rare dz

characterized by di culty in swallowing, iron de ciency anemia, glossitis, cheilosis and
esophageal webs

- Class I mand RPD vs Max CD: bone loss in ant max, overgrowth in max tuberosity, papillary
hyperplasia of hard palate, supra eruption of mand ant teeth, bone loos (atrophy) in D
extension. Pt has abby max anterior ridge, denture ant teeth don’t show, tuberosity abby
and enlarged.

1. Which is not a symptom of combination (Kelly sx)? ↑ VDO

RPD
- REST: Prevents displacement of RPD toward the tissue & transfers mastication forces to
supporting teeth

- < CONNECTOR: Stress distribution connecting all components to > connector (connects each
side of the arch)

- CLASP (DIRECT RETAINER): prevents RPD from moving away from the hard & soft tissues

- Retentive: engages undercut below height of contour, gingival 1/3 of crown

- Reciprocal: Passively touches above height of contour, middle 1/3 of crown. Functions:
stability & reciprocation agains retentive arm, denture stabilized agains horizontal movements,
acts as indirect retainer (prevent minor rocking)

- INDIRECT RETAINER: 1 or more rests, < connector and proximal plates adjacent to edentulous
areas. Goes on the opposite side of fulcrum line, preventing denture displacement. Farm from
distal extension base

- SUPPORT (RIGIDITY & VERTICAL FORCE): base, > connector and rests

- STABILIY (HORIZONTAL FORCES) < connector, reciprocal clasp

- RETENTION: indirect & direct retainers.

1. Primary role of rest: vertical support

2. Part of clasp assembly that provides support rather than retention or stability? Rest

3. Most likely to cause rest fracture: inadequate rest-seat preparation

4. Purpose of > connector: stability & rigidity

5. Purpose of reciprocating arm clasp: stabilization

6. Where does the retentive clasp engage on abutment: passively on the suprabulge

7. Purpose of indirect retainer? Prevent distal extension from lifting up

8. Purpose of < connector: stability

9. Purpose of B ange: stability

10. What is the primary retention for mand denture? Buccal shelf

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 11. Primary stress bearing area in mand? Buccal self

12. Main area of support for D extension RPD? Buccal shelf

13. Primary support mand denture: buccal shelf, ridges (2nd)

14. Primary support max denture: max ridge - palate (2nd)

15. Altered cast technique when doing distal extension RPD? support. This method of impressions
mostly for distal extension (class I & II), requires selective tissue placement to obtain desired
support from tissues, mostly in mand area

16. What property of RPD framework will limit adjustment of clasps? Yield strength

17. Why prefer Lingual rest over Incisal rest in C? < leverage is exerted agains tooth by L rest.

18. Retention is the ability of RPD to resist dislodging forces during function

19. Short arm clasp (<7mm) —> 20 gauge wire

20. Immediate dentures should be relined 5-10 months after ext

21. Major connectors for mandible

1. >7mm and lingual tori: lingual plate(CI: anterior severe crowding)

2. Minimum 7 mm: lingual bar (simplest and most common used)

3. Large mandible tori or lower teeth severely lingualized: labial bar

22. Distance between > connector of max RPD framework and gingival margin should be at least
6mm

23. Indirect retainer that provides best leverage against lifting the denture: the one located furthest
from clasp tips which is located nearest the edentulous area

24. Wire clasp have an elongation percentage of > 6%

25. Surveyor:

- Aid in the placement of an intracoronal retainer

- Block out a master cast

- Measure a speci c depth of an undercut

26. After surveying and designing: reduction for proximal plate

27. How should D extension of RPD t compared to other RDP? Passive clasp t

28. < connector for mand distal extension: extend posteriorly 2/3 the length of edentulous ridge

29. Circumferential clasp —> > than 180 degrees of encirclement, a D rest on the tooth anterior to
edentulous area, a M rest on the tooth posterior to edentulous area

30. A < connector of RPD —>should conform to the interdental embrasure

31. Guide plane surface contacted by a < connector of a RPD function: positive path of placement
and remove and provide additional retention

32. Lack of reciprocation of a RPD clasp —> abutment tooth displacement during removal &
insertion

33. In what Kennedy class is a indirect retainer very important? 2

34. Reline for Kennedy class 1, be sure RPD is seated

RPD ERRORS

1. What happens when no indirect retainer on distal extension? Distal extension pop up

2. Class I K, and when putting pressure in 1 side and the other lifts. “feels loose”: no indirect
retention used

3. Distal extension lower RDP, when you put pressure in that area and indirect retainer comes up.
How to x? Reline (if excessive: altered cast)

4. Main reason to break clasp? Too rigid. ↑ module of elasticity

5. Beveling on rim: length is good but inadequate interarch/interocclusal space (VDO)

METAL CHARACTERISTICS

1. Noble alloys do not oxidize on casting

2. Molten alloy:

1. Gold shrinks: 1.5%

2. Nickel-chromium: 2.4%

3. Nickel from base metal alloys —> responsible for ductility

4. Chromium produces passivating lm for corrosion resistance

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 5. Cobalt increases rigidity

6. Base metal advantage over noble metal —> stronger and has lower density

7. Allergy to Nickel is most common seen

8. Gold alloy exceeds a base metal in speci c gravity number

9. E ect of ux when heating area to be sold —> remove oxides from the metal surface

PORCELAIN/PMF
1. STRONGER - to weak: glass-in ltrated alumina > castable glass > leucite-reinforced ceramic >
feldspathic

2. Undermined enamel in all cusps —> crown

3. Common feature between porcelain veneer & all-ceramic crown prep: rounded internal

4. Most important thing for retention: surface area

5. Lab most complain: tooth under reduced

6. Porcelain is stronger under compression forces

7. Porosity in PMF: inadequate condensation

8. Best material to oppose a porcelain crown: porcelain

9. Silver turns porcelain: green

10. PMF turns green at cervical 1/3: Cooper (at the margins Cooper, the rest silver)

11. Margins of anterior PMF: subgingival

12. Minimum incisal reduction in anterior PFM and all ceramic: 2mm

13. Mid-Facial reduction for PMF and all-ceramic: 1.5mm

14. Facial reduction for PFM and all ceramic at gingival 3er: 1.1 - 1.3mm

15. Lingual clearance PFM: 0.75-1mm

16. Lingual clearance all-ceramic: 1mm

17. Lingual-gingival reduction PFM: 0.65mm

18. Lingual-gingival reduction all-ceramic: 1mm

19. Short crown for PMF. To ↑ retention: buccal grooves - to ↑ resistance proximal

20. What causes the most retention of crown? Axial taper

21. Junction between tooth & metal: right angle

22. Junction between metal & porcelain: rounded

23. Sequence to inspection of a crown: internal t, contacts, margin

24. DONT do in cementation of porcelain crown: etch with hydro uoric acid

25. ↑ resistance of 3/4 gold crown: proximal grove on facial / lingual surface

PORCELAIN VENEERS
1. Incisal reduction: 1-1.5mm

2. Mid Face reduction: 0.5-0.75mm

3. Cervical reduction: 0.3-0.5 mm

4. Advantage of direct composite vs veneer: only 1 appt

5. Brown staining at margins of veneer: microleakage or not enough cement (depends of duration
of pt return)

6. Repair porcelain veneer w/ composite —> microetch, etch, silane, resin

7. To cement veneer: resin cement

8. Fluoride to use for veneers: NaF-

FIXED PROSTH
1. Max number of post teeth that can be replaced with a xed bridge? 3

2. Part of tooth prep that can be managed by operator: parallelism - taper

3. 3/4 crown: partial veneer crown in which buccal surface is left uncovered.

1. Path of insertion: parallel to incisal 1/2 to 2/3 of labial surface rather than long axis of tooth

2. Use: as retainer for short span bridge

1. As a single restoration

2. As a splint in anterior teeth

3. Indications:

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 1. On teeth with clinical crown of good length and thickeness labiolingual

2. Good OH

3. No caries on B or L surface

4. Contraindications:

1. Short teeth

2. Poor OH- extensive caries

3. Narrow proximal surface

4. Long span bridge.

5. Modi ed 3/4 preserves the lingual surface and is indicated for mandibular molars or teeth
with severe lingual inclination.

4. Porcelain adheres to metal —> chemical bond

5. Metal coping must have all surfaces smooth and rounded to prevent porcelain shrinkage

6. Allows with a casting temperature over 2100F should be casted in an investment with a binder
other than gypsum

7. When casting base metal alloys from metal-ceramic crow: gypsum-bonded investment

8. When prep a tooth for either full or partial-veneer casting, the functional cusp bevel is an
integral part of the occlusal reduction phase. The functional cusp bevel: provides space for
restorative mat of adequate thickness in an area of heavy occlusal ct

9. Full ceramic or PFM: 2mm functional cusp - 1.5 non-functional

10. Acceptability to soft tissues: glazed porc > polished gold > unglazed porc > polished acrylic

11. Ideal crown-root ration: 1:2

12. Minimum ration accepted 1:1

13. Biologically and mechanically acceptable, a solder joint should be: circular in form and
occupies the region of the ct area

14. Pontinc that looks more like a tooth? Saddle-ridge-lap pontic (hard to clean)

15. Ovate pontic: sanitary susbtitute for saddle-ridge-lap design

16. Chamfer: preferred nishing line for gold restoration

17. Shoulder at 90 degree of 1mm: preferred nishing line for porcelain and full-ceramic

18. Shoulder w/bevel: proximal box of Inlay - occlusal shoulder of mand 3/4 crown and labial
margin of metal-ceramic crown.

19. The diameter of the sprue pin should be = or > than the thickest portion of the pattern

20. When using a T-shaped key design, the dovetail keyway in the retainer should be placed on
distal aspect of mesial abutment

21. An 7/8 crown is a 3/4 crow whose vertical DB margin is positioned slightly medial to the middle
of the buccal surface.

1. 7/8 crowns:

1. Posterior teeth

2. Esthetic is good since the veneered DB cusp is obscured by th MB just

3. > coverage than 3/4 —> > resistance

4. Used when distal surface has caries or decalci cation

5. Serves as excellent abutment for bridge

2. Reverse 3/4 mand molars

22. Gold crown —> occlusal reduction 0.5-1mm

23. Gold crown —> bevel or feathered edge

24. What is a common feature between veneer and crown prep? Rounded internal line angles

25. In uencing in retention —> tooth prep, surface texture, tooth taper.

26. Most important predictor of post&core success —> amount of remaining coronal structure

27. Prepping max ant teeth for metal-ceramic crown. Which of the following is necessary to
preserve and restore anterior guidance ? Costume incisal guide table

28. In porcelain fused to metal ant crown is too opaque as viewed from facial, what is most likely
reason: body and Inc porcelain layers are too thin

29. A posterior tooth has been prep to receive a crown, but the clinical crown prep is short. What
can be done to improve its facial-lingual resistance? Create Proxima grooves

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 PORCELAIN
1. Dental porcelain has good biocompatibility, but is very brittle

2. The compressive strength of ceramic bodies is > than tensile or shear strength

3. High fusing porcelain: denture teeth

4. Middle fusing: all-ceramic crowns

5. Low fusion porcelain: metal-ceramic crowns

6. Feldespatic —> tendency to form crystalline mineral Lucite when melted

7. Stearing of a ceramic —> increasing its density

8. Purpose of applying a layer of opaque porcelain in metal-ceramic restoration is: create a bond
between the metal and porcelain - mask the metal oxide layer and provide a porcelain-metal
bond

9. Prep for Zirconia crown same as: metal-ceramic, full metal, all-ceramic

10. Sintering of a ceramic —> increases its density

11. Best ceramic mimicking optical properties of enamel and dentin: predominantly glass

OTHER
12. Hypertension pack cord use: alumn (aluminum potassium sulfate) to impregnate it

13. Diabetes associated: rapidly progression periodontal dz w/ marked alv bone loss, ↑ calculus
formation and predilection for periapical abscess

14. Severe imbrincation of teeth —> contraindication for veneers

15. What’s the rst thing you check when receiving back a crown from lab: Esthetics

16. optimal esthetics of max denture teeth. The incisal edge follows lower lips during smiling

17. Electrosurgery contraindicated: cardiac pacemaker, insulin pump, delayed healing,

transcutaneous electrical nerve stimulation unit (TENS)

ANATOMY
1. Sensory innervation of palate: V2

2. Motor innervation of tensor veli: V3

3. Glossopharyngeal IX: parotid gland

4. Facial VII: lacrimal, submandibular, sublingual gl

5. Average sinus size: width: 2.5 cm - Height: 3.75 cm - depth: 3cm

6. Lingual art: arises from ant surface of ECA and then passes near the grater Cornu of hyoid

7. Buccinator & sup constrictor of pharynx attached to each other at pterygomand raphe

8. Parasympathetic innervation of parotid gland: glossopharyngeal nerve and otic ganglion

9. IAN can damage: Sphenomand lig

10. Tooth displaced to infratemporal fossa: lateral to lat pteryg plate - inferior to lat petering muscle

11. Carotid sheath: carotid art - jugular vein - vagus nerve

12. Mylohyoid nerve serves as a erent server of mand 1M

13. ECM: accessory nerve (XI)

14. V2 exits foramen rotundum

15. V3: foramen oval

16. V1: superior orbital ssure

17. Small myelinated nerve are block rst

18. Pt has bilateral white lines @ occlusal plane. Microscopic: epith hyperkeratosis, frictional
keratosis, linea alba.

19. Fordyce granules: all, raised, pale red, yellow-white or skin-colored bumps that appear on
penis shaft, labia, scrotum or vermilion border of lip. - ectopic sebaceous gland

20. Varices: in elderly ventral tongue.- caused by Hypertension

21. Pt with bilateral asymptomatic blue stu under Tongue: Varices

22. Stafne e ect: salivary gland depression defect: depression of mandible on lingual surface. Is
normal, as the depression is created by ectopic salivary gland tissue associated with summand
gland. On PANO: very well de ned round RL BELOW IAN

Spaces:
- submand: below mylohyioid muscle

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- Sublingual: above mylohyoid muscle

- Secondary: retropharyngeal: skull-mediastinum

Ludwig angina: swelling of perimandibular spaces (sublingual, submental & summand)

Can spread to mediastinum via fascial space of neck

FACIAL expression muscles: 2nd arch

MOM:
-Mesoderm of 1st arch

-V3

* Medial Pterygoid:

* Origin: maxillary tuberosity

* Insertion: medial surface of ramus & angle

* Action: elevates & protrudes mandible. Moves mandible toward opposite site

* Masseter:

* O&I: zygomatic arch - Lat surface of ramus & angle

* A: elevates mandible. Super cial bers (protrude) - deep bers (retract) moves mandible
toward same side

* Temporal:

* O&I: temporal fossa - Coronoid process.

* A: elevates mandible. Post bers (retract mand)

* Lat Pterygoid:

* O&I: infra temporal crest and lat surface of lat pterygoid plate - articular disc and pterygoid
fovea

* A: depresses & protrudes mandible. Moves mandible toward opposite site.

MASSETER —> elevates mandible

TEMPORALIS —> elevates mandible - retracts mandible

MEDIAL PTERIG —> elevate mandible

LAT PTERIGOID —>one muscle (lateral deviation of mandible contralateral)

two muscle (protrusion of mandible)

TONGUE:

Derives from mesoderm

MOTOR: Hypoglossal (XII) - and Palatoglossal (by Vagus X)

SENSORY & TASTE: POST 1/3 Glosspharingeal (IX)—> 3er arch

SENSORY ANT 2/3: Lingual branch of V3 —> 1st arch

TASTE ANT 2/3: Chorda tympani bran of VII, carried by lingual branch —> 2nd arch

- Extrinsic: position of the T

- Hyoglossus: Depresses T

- Genioglossus: Protrudes T

- Palatoglossus: Elevates back part of T

- Styloglossus: Retracts T

- Intrinsec: XII. Alter shape of tongue —> longitudinal, transverse, vertical.

Mylohioid: elevates hyoid and tongue. V3

Papillae:

-Fungiform: tip

-Foliate: side back

-Filiform: center

-Circunvallate: V back

Salivary GL

- Parotid: Serous

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 - sensory innervation ( Auriculotemporal V3) and parasympathetic (Glossopharyngeal IX)

- Submandibular: Mixed. Majority of saliva - most common sialolithiasis

- Parasympathetic: chorda tympanie (VII)

- Sublingual: mucous

- Same as submand

Soft palate:

- palatopharyngeous: pulls pharynx and larynx ↑. CN X

- Muscle uvula: helps closes nasopharynx during swallowing. CN X

- Tensor veli palatini: tenses soft palate, opens auditory tube. Its tendon hooks around the
pterygoid hamulus and forms palatine aponeurosis across the soft palate. CN V3

- Levator veli palatini: elevates soft palate to close o nasopharynx on swallow. CN X

- Salpingopharyngeous: helps equalize pressure. CN X

TMJ

Least joint to start forming - 7 weeks in utero

Disc: collagen type I

Articular cartilage that lines articular bone: type II collagen & protroglycans

Ligament: intrinsic - temporomand (limits opening)

Extrinsic - stylomand (limits protrusion of mand)

- Sphenomand (from Meckels cartilage) helps support mand but not limiting

Neuromuscular supply: V3 (auriculotemporal), and < innervation from masseteric & deep temporal
(from V3)

Super cial temporal and maxillary artery (ECA)

1. CR: condyles superior-anterior-medial

2. TMJ: upper compartiment (translation) lower (rotation)

3. Both condyle break: anterior open bite

4. Dislocation of condyle: mandible deviates

5. Clicking on TMJ: internal derangement w/ reduction

6. NO CLICK: Without reduction: limit opening <30mm

7. Artery: MADS (middle meningeal from Max, Ascending pharyngeal, Deep auricular, Super al
temporal)

8. Best image for TMJ (soft tissue, disc & condyle): MRI

9. TMJ ankyloses: trauma

10. Deviation of jaw to painful side upon opening mouth

11. Innervation: V3

12. Brach of facial nerve gets damaged the most during TMJ surgery: temporal

13. Muscle most responsible of positioning and translating condyle: Lat Pterig

14. Elevate mandible: masseter, temporal, medial pterig, and SUPERIOR belly of lat pterig

15. Trismus: medial pterygoid

SYNDROMES
1. What causes problems in babies in embryo? Teratogens: any agent that can disturb the
development of an embryo or fetus

MUSCLE DYSTROPHY

- Group of muscle dz that weaken musculoskeletal system & hamper locomotion. Characterized
by progressive skeletal muscle weakness, defects in muscle proteins, and death of muscle cells
and tissues

- Muscular dystrophy: muscle weakness, “long face” which is characterized by lower vertical
facial height and open bite

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 1. Muscle dystrophy, after LA is most likely due to? Lido toxicity

2. Pt w/ muscular weakness - muscle dystrophy: lower face w/ open bite

3. Considerations for muscle dystrophy: weakness of muscles of mastication (< biting forces,
open mouth breathing)

ADDISON DZ & OTHER ADRENAL DZ

- Addison dz (primary adrenal insu ciency): chronic endocrine disorder, adrenal glans do not
produce enough steroid hormones (too little cortisol & sometimes, insu cient aldosterone)

- Symptoms: come slowly: abdominal pain, weakness, skin darkening and weight loss

- Adrenal crisis: low blood pressure, vomiting, lower back pain, loss of consciousness. Can be
triggered by stress (injury, surgery or infection)

- Tx: Cortisol

1. Acute adrenal insu ciency: hypotension

2. Addison dz causes: pigmentation of mucosa

3. Clinical manifestation of Addison dz: hyperpigmentation of mucous

4. Pheochromocytoma: neuroendocrine tumor in medulla of adrenal gland —> excess

catecholamines (ex. Epi)

CEREBRAL PALSY:

- Group of permanent center motor/movement disorders that appear in early childhood, caused
by abnormal development or damage to the parts of brain that controls movement, balance,
muscle tone, posture. Signs and symptoms vary & include: poor coordination - sti muscle -
weak muscle -tremor. Other problems: sensation - vision - hearing - swallowing - speaking.

5. Cerebral palsy: developmental disorder. 2nd after Autism

6. CP: 95% congestive imparimen, all bruxism. NO SHOW increase in perio dz

7. CP: Spastic oral mucosa during tx

8. Involuntary uncoordinated movements w/ larynx problems: CP

9. Common nding w/ cerebral athetoid palsy: anterior teeth fracture

1. Damage to basal ganglia. Has hypertonia/hypotonia

CLEFT LIP/PALATE

- Cleft imcomplete: cleft uvula - cleft soft palate and can be part of hard

- Cleft complete:

- Unilateral: from uvula to incisive foramen in the midline and alveolar process unilaterally

- Bilateral: soft and hard palate, and alveolar process of both sides of premaxilla, leaving it free
and often mobile

- Cleft lip and palate 50%

- Submucosal cleft: defect in muscle and sometimes bone of palate, with intact mucosa

1. Cleft lip and palate: 6-9 weeks in utero

2. Fix cleft lip: 3-6 months

3. Fix cleft palate: 12 months or earlier

4. Pt w/ cleft lip & palate: class III malocclusion

5. Cleft lip: most common in boys

6. Cleft palate: most common in girls

7. Pt had cleft lip and palate. Later in life during ortho analysis. You see: De cient maxilla

8. Most prevalent development deformity in maxilla: cleft palate

9. Most common than amelogenesis or dentinogenesis imperfect, or ectodermal dysplasia

10. Cleft palate class III: soft & hard palate + alveolar process

11. Cause: multifactorial

12. Speech problems: inability of soft palate to close air ow into nasal area

13. Cleft lip: maxillary process w/ frontonasal process

14. Age to repair cleft palate: when canine tooth is 3/4 formed (8-9 yo)

15. Correcting cleft problem, you nish: suturing lip

16. 1/750 caucasian have cleft lip and palate

17. 1/1000 cleft palate US

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18. 1/2000 cleft palate w/o lip

19. 1/500 asian: most common

20. Pt angles class I according to molar relationship buy skeletal class III bc ANB and cleft palate

21. Surgery that cleft palate pt most likely needs? Move mandible back

22. How does a kid w/ fetal alcohol syndrome present with? Cleft lip

TREACHER COLLINS SYNDROME

- Called also mandibulofacial dysostosis

- Mutation of 5q32 gene

- Autosomal, dominant

- Down slanting eye

- Notched lower eyelids

- Midface developmental de ciency: Some bones and tissues in face are not developed

- Usually present w/ cleft palate

- Shorten soft palate

- Malocclusion - anterior open bite

- Enamel hypoplasia

- Underdeveloped, malformed, and/or prominent ear

1. Which disorder has the least developmental delay? Treacher Collins sx

2. Teacher collins has loss (hypoplasia) of zygomatic bone.

3. Cleidocranial dysplasia: loss of clavicle

4. Mandibular hypoplasia, malformed ear, lower eyelids, ear pinna: TCsindrome

5. TC: pt are not mentally retarded and they have ear abnormalities

DOWN SYNDROME

- Trisomy 21

- Mandibular prognathism

- Thickened tongue (macroglosia)

- Midface hypoplasia —> class III pro le

- Delayed eruption

- Supernumerary teeth

- ↑ chance of perio dz

1. Low incidence of caries

2. Characteristic of DS: mid face hypoplasia

3. Turner and down syndrome: short mid face

4. Orbital hypertelorism: wide-set eye (also in Crouzon, Cleidocranial dysostosis, Gorlin sx)

5. Delayed development: trisomy 21 - hurler sx - cru di chat.

1. Trisomy 18 (Edward Sx) is not a delayed development: small head (microcephaly), w/

prominent back portion of head (occiput), low-set, malformed ear, abnormally small jar, cleft
lip/palate, upturned nose, narrow eyelid folds (palpebral ssures) widely spaced eyes
(hypertelorism)

BONE AND SUTURE LINES:

1. What resembles epiphyseal plate? Synchondrosis

2. What age does mand synthesis closes: 6-9 months

3. Spenooccipital closes w/ cartilage

4. Intersticial growth: occurs by the mitotic division and deposition of more matrix around
chondrocytes already established in the cartilage. Ex: Condyle, nasal septum, spheno-occ

5. Intrasphenoid: closes 1st

6. Spenooccipital: latest to close

7. Synostosis: abnormal fusion of bones

8. Craniosynostosis: early closure of suture between bones

CROUZAN SYNDROME

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 - Autosomal dominant, 1st branchial arch syndrome, mutation in broblast growth factor rct II —>
brous joints between certain bone of skull (cranial sutures) close prematurely (craniosynostosis)

- Beaten metal skull

- Characteristics: crania synostosis, also as brachycephaly (short and broad head),

- exophtalmia or proptosis (bulging eyes) hypertelorism,

- hypoplastic maxillary

- mandibular prognathism

- Fuzzy xrays

1. Synostosis - early/late closing of sutures: Crouzon syndrome

2. Pt w/de ciency mid-face, proptosis: Crouzon sx

HURLER & HUNTER’s SYNDROME

- Hurler (mucopolysaccharidosis type I (MPS I), Gargoylism)

- Autosomal recessive (build up of glycosaminoglycans) due to de ciency of alpha-L

iduronidase (enzyme responsible for degradation of mucopolysaccharides in lysosomes —>
heparin sulfate and derma tan sulfate occurs in the body

- Hunter sx (mucopolusachharidosis II)

- Genetic X-linked recessive disorder due to defect in anchoring between epidermis and
dermis, resulting in friction and skin fragility. De ciency in enzyme iduronate 2-sulfatase (I2S)
also, lead to glycosaminoglycans build up

1. Hurler and hunter what do they have in common: both have mucopolysaccaridosis & build up
of GAG

2. Hunter sx has: lysosome storage disease. Get abdominal hernias, ear infections, prominent
forehead, enlarged tongue, ID, sti joints

CLEIDOCRANIAL DYSPLASIA

- Hereditary congenital disorder (usually autosomal dominant)

- Delayed ossi cation of midline structures.

- Bone defects usually involve clavicle (hypo plastic or aplastic) &

- skull: short, big head, shoulders move in

- Dental:

- narrow high palate,

- increased rate of cleft palate

- Many unerupted permanent, retained primary & supernumerary teeth w/ distorted crowns/root
shape (PANO IS FULL OF TEETH EVERYWHERE !!!!)

1. Most signi cant in cleidocranial dysplasia: supernumerary teeth & problem w/ eruption

2. Very narrow facial structures and delayed eruption of permanent? Cleidocranial sx

3. What allows for compression of skull during birth: fontanelles (enable bony plates of skull to
ex) —> close anterior 12-18 months / posterior: 3-4 months

PAPILLON LEFEVRE SYNDROME

- Palmoplantar keratoderma w/periodontitis.

- Autosomal recessive disorder caused by de ciency in cathepsin C

- Severe perio: early/young loss of primary & permanent teeth (after eruption of 1 molar)

- Hyperkeratosis of palm & feet: sore

1. 15yo edentulous w/keratosis on hands and feet: papillon lefevre

PIERRE ROBIN SYNDROME

- Unknown case

- Micrognathia

- Glossoptosis (tongue falls back in throat - hard to breath)

- High arch palate

- Cleft palate

- Absent gag re ex

- Teeth appear when baby is born

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1. Triad of cleft palate, glossoptosis, absence of gag re ex: PRsyndrome

WEBBER SYNDROME

- Sturge-Webber sx: neurological disorder present at birth

- Port-wine stain on the face and brain or eye abnormalities due to overabundance of capillaries
near skin surface

- Sometimes seizures or neurological symptoms

1. Vascular malformation, eye and hemangioma

2. Port-wine stain, angiomatosis of leptomeninges

METABOLIC SYNDROME

- ↑ cholesterol, hypertension & diabetes, metabolic problem: metabolic sx

- BMI: 36, overweight and cholesterol.

- Normal fat % intake per day: 30% of total calories & saturated fat is 10% of daily calories intake

THYROID DISEASE

1. Endocrine gland: parathyroid, thyroid, adrenal

2. Hyperparathyroid child for normal development of teeth: Vit D (binds in Ca)

3. Thyrotoxicosis syndrome: diaphoresis (sweating), fever, hypertension and tachycardia

1. Thyroid storm is a severe version of thyrotoxicosis

4. Thyrotoxic pt manifestation: Tachycardia

5. LA w/ epi contraindicated: hyperthyroidism

6. Symtoms of hypothyroid attach: loss of brain function due to severe, longstanding low level of
thyroid hormone in blood (hypothyroidism)

1. Hypothyroidism primary symptoms: altered mental status & hypothermia. Hypoglycemia,

hypotension, hyponatremia, hypercapnia, hypoxia, bradycardia, hypoventilation

7. Myxedema is due to: severe hypothyroidism

1. Myxedema: swelling of skin, waxy consistency

8. Thick hair becomes thin: thyroid - hypothyroidism (cretinism in kids and myxoedema in adults)

9. Pt gaining weight, lower voice, ne hair, feels cold: hypothyroidism

1. Other symptoms: bradycardia, fatigue

10. Which thyroid drug doesn’t let iodine bond to hormone? Radiate Iodine (from hyperthyroidism)

11. Graves dz (hyperthyroidism): exophthalmos

12. Thyroid hormone decrease. Give: Levothyroxine

PARATHYROID DISEASE & HYPOPHOSPHATASIA


- Hypophosphatasia: metabolic bone disease, low alkaline phosphatase

1. ↑ in alkaline phosphatase is related to: hyperparathyroidism

2. ↓ alkaline phosphatase: hypophosphatasia

3. Central giant cell granuloma: hyperparathyroidism

4. Osteoporosis associated w/ hyperparathyroidism

RADIOLOGY
1. Most of the x-ray is converted to? Heat

2. Oil in X-ray tube: cooling o anode

3. Thermionic emission: cathode

4. Best x-ray: short wavelength, ↑ energy

5. Primary source of radiation to the operator when taking x-ray? Scatter from the pt

6. In performing normal dental diagnostic procedures, the operator receives the grates hazard
from which type of radiation? Secondary and scatter

7. Secondary radiation: coming o the matter

8. Max radiation dose for dental professional per year 50msv/year or 5rem/year

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 9. Filament produces heat in the x-ray

10. Digital imagen. Which is digital detector? Charge coupled device

11. MRI. Uses what electromagnetic wave? Radiowave

COLIMATION

1. What does collimation do? ↓ x-ray beam size/diameter & vol of irradiated tissue. Usually w/
circle diameter of 2.75 in

2. NOT a function of collimator: increase permeability

3. Collimator: ↓ low energy radiation

4. Coloration: block (lead)

5. Collimator: ↓ volume of tissue, and reduce amount of scattered radiation by 60%

6. Collimating devide does all, except: prevents fogging

7. Collimator control of size & shape of x-ray beam

8. The greatest ↓ in radiation to pt can be achieved by: collimator ( from round to rectangular)

9. Square collimator reduce 80% radiation vs rectangular

FILTRATION

- mechanism where the low quality, long wavelength x-ray are absorbed from the existing beam.
Aluminum disks absorb lower penetrating x-ray.

- Inherent ltration: glass, oil

- Total ltration: aluminum

1. Intensifying screen: ↓ radiation

2. X-ray lters. Used to ↓ intensity of electron beam, selectively absorbs low energy photons

3. Filter in x-ray machine: aluminum

4. Filter absorbs: long wavelength

5. X-ray tube target is made out of tungsten.

ANGULATION

- Elongation & foreshortening: excessive vertical

- Perpendicular to object but not to t: elongation

- Perpendicular to lm but not to object (TEETH): foreshortening

- If head/chin is too low, max ant will be elongated and mand ant will be foreshortened

- If head/chin is too high (a lack of negative vertical angulation, the occlusal plane of teeth will
then appear horizontal or, with a positive occlusal plane, as a “frown line”: reverse smile line

1. Change in vertical angulation while taking PA: elongation or Foreshortening

2. If in a PA tooth foreshortened. Why? Vertical angulation was too large

3. If bean perpendicular to lm but not to tooth: foreshortening

4. Pano with short upper roots: patient didn’t put tongue in roof of mouth

PENUMBRA

- blurring at edge of structure on x-ray

- The area on the oil, that represents the img of a tooth is the umbra, or complete shadow

- Area around umbra is called penumbra or partial shadow.its the zone of unsharpness along the
edge of the img. The larger it is, the less sharp the img will be

- > penumbra, < contrast < sharpness

1. Fuzziness on outside of x-ray due to? Penumbra

2. Penumbra is a ected by all except: moving x-ray tube, moving lm, x-ray dimension/ eld/
scatter, lm-object distance. (Reduction of lm target distance)—> this is the except!

3. How does penumbra a ects the contrast of an x-ray? ↓ in contrast

4. Penumbra, how to prevent this in x-ray: ↓ size of focal spot, ↑ source-object distance, ↓
object- lm distance, center ray must be perpendicular to tooth, object and lm, no movement

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 5. ↓ penumbra: ↓ thoot/ lm distance

6. Prevent penumbra: x-ray should be parallel

7. PA distortion answer according to an article online is 14%

8. Pano distortion is: 25%

9. When pt moving during pano: vertical blur line vs horizontal defects

TYPE OF X-RAY

1. Best to evaluate orbit rim areas: Water

2. Lesion on max sinus: Water

3. Sialolitiasis in Whartons? Occlusal

4. Sinusitis or sinus infection: CT (know that sinus is best viewed with Water.

5. Fracture on symphysis? Posterior-anterior also mand occlusal. Lat oblique for fractures in
angle body and ramus

6. Best to see zygomatic arch: submentovertex

7. You have a pano, what can’t you do without intraoral photos? Space analysis

8. Pterygomaxillary ssure in pano: teardrop shape next to sinus

9. Nutrients canals seen on x-ray most common: mand inc

10. Can’t be seen on PA? Coronoid notch - mandibular foramen

11. Source/object distance for lat ceph? 5 ft

EXPOSURE

Kvp: ability for beam to penetrate tissue, energy

mA: # of x-ray in a beam —> radiation quantity (not quality), density, & patient dose

For MOST PENETRATION: ↑ KVP and ↓ mA

D to E will < radiation by 30-40%

D to F 60%

F to digital 40%

*Dark lm: overexposed/img too dense: due to incorrect mA (too ↑), exposure (too long), incorrect
kVp (too ↑)

*Light lm: underexposed/img not dense enough: due to incorrect mA (too ↓), or exposure (too
short), incorrect focal- lm distance of cone too far from pt face, or lm is placed backwards

- Deterministic e ects: has threshold, severity of e ect is dose-related

- Stichastic e ect: no threshold & no dose-related, probability of e ect/likehood that something

will happen.

- Associated with long-term low-level exposure to radiation. Increase level of exposure make
these health e ects more likely to occur, but do not in uence the type of severity of the e ect.

- Radiosensitive: bone marrow, reproductive cells, lymphoid cells, immature cells, intestine

- radioRESISTENT: muscle, nerve

- Which of the following is the most radiosensitive type of cell? Basal epithelial cell

12. Digital has 50% less radiation exposure

13. From D speed to digital: speed increases

14. Latent period: time between when you exposed pt and clinical reaction to x-ray (onset
symptoms)

15. Which electron shell has the highest power? Outermost shell

16. K electron has the highest binding energy

17. Xray looked washed out, too light, no contrast. What was adjusted? ↑ kVp

18. Xray appears too white. The problem is Low mA

19. Xray too dark, it was long time in developer

20. You take X-ray at certain mA, kVp and exposure 8” with beam at 10 inches away. What if
everything is the same except bean is 20 inches away —> quadruple exposure time

21. You increase distance 2x, how much does x-ray exposure ↓: intensity ↓ by 4

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 22. How to increase average energy of the beam? kVp

23. Deterministic radiology e ects: ↑ e ect with dosage-direct e ect

24. The severity of response ↑ with amount of x-ray exposure: deterministic

25. Irradiation causes saliva to have: ↓ sodium content

26. How does x-ray interact with matter? Phoelectronic e ect

27. Radiation injury from: free radical formation from indirect

28. How do you minimize exposure radiation? Minimizing the amount of tissue being radiated

29. Which type of radiation is constantly in e ect? Inhaled radon radiation.

30. Most radiation from nature? Inhaling radon

31. Dentist is exposed to what type of radiation besides machine? Scatter patient

32. How does radiation damage cells / a ects body? Hydrolysis of water molecules

33. Radiation induced mutation is the result of? Hydrolysis of water molecules

34. Radiation injury from: free radical formation from indirect

35. xerostomia. Chemo o radiation? Radiation

36. Radiation of 4 Gy to skin: erythema

37. ↑ kilovoltage: ↑ density, > penetration ↑ energy

38. ↑ mA = ↑ temp of lament & # of x-ray produced = ↑ contrast

39. ↑ distance, need to ↑ mA

40. How do you change from < contrast to > contrast without changing density? ↓kVp & ↑mA

41. If something is a structure in mouth is thick, appears more RO on x-ray

1. ↑ density is caused by which of the following? Decrease distance target-object

2. If an unwrapped x-ray lm is exposed to ambient light for a second and then processed, it will
be completely black.

3. In radiography, maximum resolution and minimum magni cation are achieved by: maximizing
target-object distance and minimizing object-img distance

4. Which dental tissue is most likely to interact with x-rays via photoelectric absorption? Enamel

5. Modi cations for taking children X-rays: Reduce exposure time

6. Deterministic e ects: xerostomia, sterility, cataract formation, oral mucositis.

7. When taking radiographs, the amount of radiation received by the pt is best reduced by which
of the following measures? Rectangular collimation

8. Which of the following in uences the mean energy of the x-ray beam? Amount of ltration
9. All of the following are features of periodontal dz that can be assessed in a radiographic
examination of PA and BW img except one: amount of wall of periodontal defects

10. What is the function of the anode in an x-ray tube? Converse electrons into photons

11. Cone-cutting results from which of the operator errors? X-ray machine improperly aimed

12. An 18 yo male comes to your clinic for a routine cleaning & exam including FMX. You are
unsure of the location of an impacted lower right canine. A second view of the same region,
made with the x-ray machine oriented more from the medial reveals that the canine has moved
distally with respect to the adjacent teeth. What is the location of the impated canine? Buccal
to the other teeth.

13. You notice that the radiographic img are fuzzier and have less contrast than usual. You
postulate that the penumbra is a ecting the img quality. Which of the following could be
causing this? Decrease lm-target distance

ENDO DIAGNOSIS
- Normal P: asymptomatic - mild to moderate transient response to therma & electrical stimuli

- Reversible P: symptomatic, thermal (cold), quick, sharp hypersensitive transients response. No

complains of spontaneous pain. Caused by an irritant that a ects Pulp

- Irreversible Symptomatic: irreversible (even when removing irritant). Spontaneous intermittent or

continuous pain. Thermal (cold): lingering pain. Postal chances increase pain.

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 - Irreversible Asymptomatic: microscopically similar to anterior, but no symptoms

- Pulp necrosis: asymptomatic but not always. Can be partial or total. Caused duct to long-term
interruption of blood supply. Seen with discoloration (specially anterior)

14. Pulp test evaluation: tooth, adjacent teeth, contralateral tooth

15. asymp apical perio: apical RL for long time, no symptoms, no sinus tract, necrotic pulp

16. Molar super erupted with irreversible P: RCT & crown

17. Irreversible P with acute periapical abscess: sensitivity that lingers w/ thermal test, sinus tract,
+ to percussion

18. Pulp necrosis: prolonged, unstimulated pain at night

19. Necrotic pulp: tooth not responsive to thermal & EPT, but + to palpation and percussion

20. Endo test:

1. Percussion: in ammation of PDL or not —> apical diagnosis

2. Palpation: spread of in ammation to peridontum from PDL or not —> apical diagnosis

3. EPT: pulp vitality - necrotic —> Endo diagnosis

4. Thermal: hot (irrev) cold (rev): Dichlorodi uoromethane -30C —> Endo diagnosis

21. Most reliable to test vitality of tooth: thermal test

22. DONT do EPT for traumatic tooth

23. Electric pulp tester gives a higher response than normal if: chronic pulpitis

24. An 8yo pt presents with Ellis class II fracture of tooth #8. In an e ort to attain a pulpal
diagnosis, which of the following tests is least reliable? Electric pulp test

25. DD between chronic perio and suppurative perio: percussion

26. Spontaneous pain with periods of cessation —> irreversible pulpitis

27. If you have pain, what would be the hardest to anesthetize? Irrev pulpitis —> Mand M - PM -
Max M - PM - Mand Ant - Max ant

28. Tooth not responsive to cold, not to percussion, and palpation is tender: necrotic pulp &
chronical apical periodontitis

29. Tooth with crown: cold is better test (thermal)

30. Di erentiate between Endo/perio lesion: EPT

31. DD of perio abscess & periradicular/endo abscess: vitality (Perio pulp is vital)

32. Untrue about EPT: more reliable than cold testing for necrotic teeth

ENDO/PERIO ABSCESS & LESIONS

- Normal apical tissues: no pain percussion or palpation

- Sympt Apical Periodontitis: painful in ammation around apex. Pain percussion and intense
throbbing pain. Localized, in ammatory in ltrate within PDL

- Asymp Apical Periodontitis: RL. Con rmation of pulpal necrosis

- Acute Apical abscess: rapid swelling, severe pain, pus

- Chronic Apical Abscess: sinus tract without discomfort

1. Periapical abscess:

1. I&D

2. ATB and re evaluate if RCT is needed

3. Use gutta to nd it

2. Phoenix abscess: apical lesion that develops as an acute exacerbation of a chronic apical
abscess (suppurative apical periodontitis) - Recrudescent abscess

3. Pathognomonic symptom of symptomatic apical periodontitis: Tenderness to palpation

4. Acute perio abscess: uctuant, local lesion

5. Acute apical abscess is only observed in association with necrotic pulp

6. Perio started from Endo: best prognosis

7. Perio lesion vs Endo lesion: pain on lateral percussion with wide sulcular pockets

8. endo abscess w/no sinus tract can drain though PDL. no further tx is needed

9. best way to diagnose acute periradicular periodontitis: sensitive to percussion

10. X-ray acute apical abscess: not evident. But histologically bone destruction is noted

11. “Hallmark” of chronic apical abscess: sinus tract drainage

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12. DD: A periradicular RL of Endo origin may be: cyst, granuloma, abscess

13. Vital teeth and usually do not warrant Endo therapy: traumatic bone cyst - globulomaxillary
cyst - cementoma

14. Completely asympt but requieres Endo tx: necrosis & chronic periradicular periodontitis

15. Chronic Periradicular abscess: necrotic pulp

16. Lesion non-Endo origin remains in apex regardless x-ray angulation: NO

17. Lesion Endo origin remains in apex regardless x-ray angulation: YES

18. Tx of sinus tract: RCT - no ATB - heals 2-4 weeks after RCT - if persist, surgery Endo

PEDIATRIC ENDO

1. Primary 1M w/furcation: EXT

1. RL in furcation indicates necrotic pulp

2. Primary 2M w/furcation but restorable: PE

3. Any teeth without furcation: PO

4. Primary tooth got necrosis and the in ammation went down through furcation & a ects
permanent tooth. It can disturb ameloblastic layer of permanent successor or spread infection

5. In primary, apical infection is seen in furcation on x-ray

6. most common medication for PO/PE: Formocresol

7. Ca Hydrox contraindicated in PO in primary bc: irritation, leading to resorption in primary teeth

8. Lest reliable test on primary: EPT, false results bc thin enamel

9. Most reliable test on primary: Percussion

10. Vital pulp or Caries exposure 1M primary: PO

11. Open apex CI 3hr ago fractured with 2mm exposure “bleeding pulp” —> PO w/ Ca Hyd

12. X-ray sign of successful PO in permanent —> apex has formed

13. Vital PO open apex permanent tooth, the hemorrhage after pulp amputation is not controlled —
> perform amputation at a more apical level. Uncontrolled bleeding is a sign of in amed pulp
tissue.

APEX ENDO

APEXIFICATION: NONVITAL w/OPEN apex & pulp exposure —> CaHyd for apical closure. Want
to create an apical barrier if a necrotic tooth with open apex ( ll close to apex)

- Induce calci ed apical barrier by placing dense CaHyd paste after instrumentation. Canals
are obturated when barrier is formed 3-6 months

- Placement of arti cial apical barrier, MTA, prior to obturate.

APEXOGENESIS: VITAL w/OPEN apex & pulp exposure —> CaHyd to preserve vitality &
encourage the continued development of root. Vital pulp therapy performed to allow continued
formation of root ( ll coronal portion). De nition: process of induced root development or apical
closure of the root by hard tissue deposition.

- Place CaHyd over radicals pulp strump. Recall every 3m to check pulp status

- RCT indicated when root development is completed

APICOECTOMY: root-end resection/excision of apical portion of root. Indications:

- Persistent periradicular pathosis following Endo tx

- Periradicular lesion that gets bigger after Endo

- A marked over-extension of obturation material interfering with healing

- When apical portion of root w/ periradicular pathosis cant be cleaned, shaped and
obtruded

PE: ZOE in open apex primary teeth

14. Major advantage of Zinc oxide-eugenol: long history of successful usage

15. You did a PO in 7yo pulp exposed decayed #30. Why? To allow completion of root formation
(apexogenesis)

16. Traumatic pulp exposure on max CI, open apex: Apexogenesis

17. Irreversible pulpitis with open apex: Apexogenesis

18. When to do apicoectomy? Failed existing RCT that can’t be re-tx

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 19. Apico surgery when: persistent apical pathology after RCT

20. RCT reinfected: re-tx, remove lling material, debride canals and re ll

21. RCT reinfected and restored w/post & core, crown: apical curettage, then apicoectomy and
retro ll

22. Periapical abscess biopsies after apicoectomy of RCT to tooth, tooth still sensitive, with
neutrophils, plasma cells, nonkerat strati ed epith and brous CT —> Granuloma

23. Studies show there is extraradicular plaque in an infected tooth. Do: mechanochemical
irrigation & debridement of canal.

24. 6yo necrotic pulp on permanent 1M: APEXIFICATION

25. This emergency pt presents with sympt irrev pulpitis and symp apical periodontitis of #12. Best
tx? Pulpectomy

26. Why you perform apexi cation (non-vital)? When you have necrosis on open apex

27. 6 months recall after RCT on open apex that was placed CaHyd. When examining, apex still
open. What to do? CaHyd

28. Vital 8yo open apex. What to do? CaHO2 —> Apexogenesis

29. Why are traumatized primary I discolored ? Pulp necrosis & pulpal bleeding

TOOTH AVULSION & INTRUSIONS

Extra-oral dry time <60min or tooth kept in special storage media:

- Clean root surface and socket with saline

- Gently replant

- Stabilize using exible splint 7-10 days or until mobility is <

- ON OPEN APEX

- Pulpal revascularization may occur: monitor regularly vitality & root develop

- When vital doesn’t return —> Apexi cation procedures are followed by RCT

- ON CLOSED APEX:

- RCT performed when splint is removed

OPEN & CLOSED APEX

Extra-oral dry time >60 min

- Don’t replant

On avulsion: exible splint, ATB (ONLY AVULSION)

On Horizontal root fracture: Rigid split 3m

Extrusion: 2-3 week splint

1. Reasons of failure of replantation of avulsed tooth: ext resorption

2. Most important factor about avulsed tooth: TIME

3. Most crucial in reimplantation? Time management <2hr

4. They fail bc: too much extra-oral time

5. Before 15’ success rate: 90%

6. By 30’ success rate: 50%

7. DONT rinse with water

8. Best storage media: HANK ( HBSS: hanks balanced salt solution, Na, K, Ca + glucose)

9. If close apex, immerse tooth in 2.4% NaF pH 5.5 for 20’ —> reduce root resorption

10. primary avulsed tooth <60’ —> DONT REPLANT

11. Avulsed open apex, close with MTA

12. CaHyd for avulsed? NO

13. Intrusion of permanent: reposition & splint

14. Intrusion of permanent closed apex —> pulp necrosis (96% cases)—> RCT

15. Most likely to cause pulp necrosis: Avulsion

16. Most damage to PDL: Intrusion

17. Luxated tooth, - EPT. Why? Disruption of nerves to tooth

18. Dark permanent LI. Cause? Damage to permanent LI

19. Worst thing to do to a tooth you will reimplant —> scrap with curette

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 20. Xray shows a horizontal fracture apical 1/3. Best tx? Splint & re-eval tooth for pulp vitality at a
later time

21. 1 mm intrusion 8yo tooth #8: allow to reerupt

LONG TERM RESPONSES TO TRAUMA

* External resorption: initiates in periodontum due to damage to cementoblastic layer. Ragged and
poor de ned margins - Moves with angles x-ray

* Replacement resorption: ankylosis, PDL replaced with bone

* Cervical resorption: sub-epith sulcular infection from trauma or non-metal bleaching

* In ammatory root resorption: bacteria & byproducts from necrotic pulp travel through
dentinal tubes to a ect periodontum.

* Internal resorption: initiates in root canal system due to damage to Odontoblast if layer. Margins
sharp and well-de ned. Doesn’t move with x-ray

* In ammation due to necrotic pulp from caries or trauma

* Tx: RCT

* Calci cation metamorphosis: trauma induces Odontoblast to rapidly form extensive amount of
reparative dentin within pulp space. More likely with open apex, intrusion & severe crown
fracture. Canal obliteration - yellow-orange color

* Internal better prognosis than external

* Sodium perborate —> safer internal bleaching

* Superoxol: most commonly bleaching agent for endodontically tx teeth

* External resorption in which an infected pulp may further complicate the resorptive process:
in ammatory resorption

ENDO MATERIALS

* Chelating agents: bind w/Ca & carry it out of canal. Removes smear layer/Inorganic material in
dentin to expose tubules for penet of Endo sealers & exposing bact. Ej. EDTA (lubricates)

* Good for sclerotic canals. Substitute sodium ions % soften canals walls

* Sodium Hypochlorite: 5.25% irrigation, germicidal, bleach, dissolve Organic

* Other irrigation: urea peroxide (glycerol based) & 3% Hydrogen peroxide

* Chloroform: dissolve GP in re-tx

-NiTi rotary les: remain better centered, less transportation, Instrument faster than SS due to high
exibility & resistance to torsional fracture. They have 10x the stress resistances of SS

-SS les: bulk strength as well as edge strength - resistance to cyclic fatigue - recording curve -
inexpensive $

-K le(Kerr): twisted □, winding method -H- le(Hedstrom): spiral cone. Cuts in retraction

*CaOH2: stimulates secondary Odonto last to produce dentin - High pH (cauterized tissue and kills
bacteria) - resorbable

*MTA: stimulates cementoblasts to produce hard tissue - has 3 minerals (Ca, Silica, Aluminum) -
bismuth oxide (opaci er & can stain tooth) - long 3 hr setting time - sets in presence of moisture -
antimicrobiano - nonresorbable - RO - Hydrophilic - biocompatible - non-toxic - hard to
manipulate

1. Not an advantage of SS le: allows the le to be centered in canal

2. Advantage of using NiTi le over SS: exibility, bending memory

3. Weakness of NiTi les vs SS: strength

4. Resistance to fracture is not an advantage of NiTi over SS

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 5. Broaches are not used to enlarge canal. They have to be used with care and < apical pressure

6. Irrigation doesn’t facilitate obturation

7. Primary purpose of sodium hyp (NaOCl): dissolve necrotic tissue.

8. Concentration of hypochlorite: not stipulated

9. Sodium hypochlorite is NOT a chelating agent

10. NaOCl accident: cold compress within 24 hr, analgesic, ATB.

11. Job of Ca Hyd (Ca(OH)2) during RCT: intracanal medicament

12. Contraindication of Ca Hyd: pulp symptomatic for last month

13. Least cytotoxic for perforation repair? MTA

14. EDTA 17%

15. PARL on asymptomatic. When opened, the canal is calci ed. What to do? Put EDTA

16. Untreated internal resorption: pink tooth (pink tooth Mummery)

17. Tx for Internal resorption: RCT (NOT an option to observe until resorption stops)

18. Int resorp: x-ray symmetrical w/pulp space, can reabsorb all the way to PDL, pink tooth.

19. ankylosed tooth, what type of resorption? Replacement Resorption

20. When reimplanting a tooth —> ankylosis (replacement bone formation)

21. Tx of choice for in ammatory external root resorption on non-vital: remove necrotic pulp -
place Ca Hyd (every 3 months until PDL is healthy, then complete RCT)

22. When reimplanted tooth has ext resorption? Just obturate (instrument) and place CaOH

23. Gutta properties: RO - biocompatible - antibacterial

24. Gutta main component: Zinc oxide

25. Gutta has no good adaption by itself (needs sealer to adapt to tooth)

26. Gutta + ZOE to seal.

ENDO FAILURES

- 1st: Inadequate disinfected canals (insu cient canal debridement) - cleaning bacterias

- 2nd: poorly lled canals

- incomplete removal of bacteria, pulp debris, dentinal shavings is cause by failure to irrigate
throughly. Another reason of failure: obtain a straight line access

- Least likely to cause failure RCT: GP beyond apex

- Endo wont fail bc sealed 2mm from apex, or beyond apex

1. Best prognosis: extruded Gutta - Over lling with Gutta

2. Calci ed canal: yellow tooth

3. Hyperbillirubinemia: grayish-blue: Xtina

4. Blood products in the dentinal tubules: grey tooth

5. Elective Endo: pulp exposure.

6. Endo contraindicated in non-restorable tooth

7. Most common cell in necrotic pulp: PMN cells

8. RCT done 1.5y ago, now RL and stula —> incomplete RCT

9. RCT on non-vital with 1mm RL. 5m after 5mm RL. —> improperly done. Re-Tx

10. Endo le breaks when you are at #15: tell pt & refer to Endodontist

11. Endo le broken 3mm from apex and obturated above it. Best prognosis: vital pulp w/no
periapical lesion

12. Endo le break: excessive force, jumping le size, lack of irrigation/lubrication, not replacing
les often enough. NiTi more likely to fracture

13. When broken instrument pass the apex: surgical removal will be needed

14. worst prognosis: perforation through furcation

15. Strip perforation: due to excessive coronal aring.

16. Danger zone: fracture most common Mand molar. Concavity on distal side of M root

17. Danger zone: Mand M: furcation

18. Ledge formation: NiTi less likely to ledge. Use small instrument to bypass ledge

1. Not straight line access, lack of irrigation/lubrication - straightening out curve canals

ROOT FRACTURE

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- Vertical fracture: J-shape or teardrop - RL

- Starts apically and progresses coronally

- Most common: mand posterior

- Most common cause:

- in Endo tx’d tooth: excessive lat condensation of Gutta

- In vital teeth: physical trauma

- After cementation of a post

- Tx: single root tooth: ext - multiple root (can do resection of root a ected)

- Horizontal fracture: most common in Ant. Success and healing requires immediate reduction of
the fractured segment & immobilization of coronal segment 12 weeks (3m)

Cracked tooth syndrome:

-pain on biting on release

-sensitive to cold-hot

-completely also asymptomatic

-cracks usually extend into dentin and propagate M-D often on marginal ridge

-dyes and transillumination are more helpful than xrays

-tooth slooth on each cusp can aid in location of crack

-healthy pulp: splint with band and observe or crown

-diseased pulp: conservative RCT and crown

1. Most common tooth w/cracked tooth syndrome: Mand 2M > Mand 1M - Max PM

2. Useful diagnostic aids to determine vertical crown-root fracture:

1. Fiberoptic light for transillumination

2. Wedging the tooth in question and then take x-ray

3. Persistent periodontal defects in an otherwise healthy tooth

4. Bite forcefully on a bite stick

3. Few months after RCT & Crown w/pain upon biting: cracked tooth

4. Apical 3er don’t splint longer to avoid ankylosis

5. Pain during biting & cold after RCT & Crown: vertical root fracture

6. Crown cemented 2 weeks ago, sensitive to pressure & cold: occlusal trauma

7. RCT contraindicated for vertical root fracture (it is non-restorable)

8. Most likely direction of cracked tooth? The direction of crack usually extends M-D

9. Least likely to fracture: Max M

10. Cracked tooth with no pulpal involvement: extracoronal restoration

11. Best indicator of vertical root fracture: isolate deep pocket depth

12. Transillumination shows crack.

1. Light up entire tooth (show evenly thought tooth): Craze line

13. vertical tooth fractured also called cracked teeth. And prognosis varies w/ extension & depth of
crack

14. If 2 cavities were thought to be 2 separate llings but upon exam it was a crack through the
isthmus. What to do with this symptomless crack: Observe

15. Horizontal fracture: reduce & immobilize

16. What to do 1st on horizontal rood fracture: splint

17. Apical horizontal root fracture & no pain: RCT if tested non-vital

18. Apical 3er horizontal root fracture, no symptoms, no pain, no mobility: monitor

19. On horizontal root fracture: take multiple vertical angulated x-rays

20. Max CI adult traumatized. Slightly tender to percussion, in good alignment, response normally
to vitality test. X-ray shows horizontal fracture of apical 3er —> splint (7-10d) & re evaluate
vitality at later time

21. Worst prognosis for RCT: vertical fracture during obturation. Ideal tx: Ext

22. Non-vital after fracture: reevaluate at later time

23. Tooth #30 big MOD amalgam, hurts when eating: root fracture

24. Pt with line of separation coronoapical, asymptomatic but hurts when eating: Ext only if
moveable pieces. If asymptomatic & no mobility —> fair prognosis —> RCT

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25. After placing MOD amalgam, pt has pain when biting and to cold: check occlusion

PULP ANATOMY & OTHER Q

- Access preparation: most important technique of RCT. Straight-line access to ori ce & apex

- I: △ 1 canal. - Max M: Blunted △ or rhomboid

- Mand L: can have 2 canals - MB most often 2 canals —> 4 canals

- C: 0 Max & Mand: 1 canal - Mand M: Trapezoidal

- PM. 0 narrow. Max & Mand: 2 canals - D root more often 2 canals —> 3 canals

- Max 1PM: most often: 2 ROOTS. - other possibility 2 canals per root —> 4 canals

1. Primary 2M: 4 canals

2. Shape of access of Mand 1M: trapezoid

3. Max 1M access: triangular - blunted triangle

4. PM most likely to have 3 canals: Max 1PM

5. Max 1PM 91% most likely to have 2+ canals

6. Maxillary 1st PM almost always: 2 canals

7. Why triangular access on I? Help expose pulp horn

8. 20-25% of Mand 1PM will have 2 canals w/2 foramina.

9. Max 2PM has a ↑ incidence of accessory canals (60%) than mand 1PM

10. Mand C: thin M-D wide L-B

11. Overcut areas on mandibular molars: medial aspect under the margins ridge - lingual surface
under lingual cusps

OTHER:

1. Most critical for pulp protection: remaining dentin thickness (2mm)

2. What will not regenerate after RCT: Denting formation (taken away odontoblast)

3. Taurodontism: enlarged pulp chamber in Apical direction. Condition found in M where body of
tooth and pulp chamber are enlarged vertically at the expense of the roots.

4. Endo infection usually is polymicrobial. Obligated anaerobic bacteria —> bacteroide

5. Reinfected RCT —> gram + facultative anaerob

6. New studies —> obligate anaerobes and not facultative

7. Porphyromonas and prevotella: pulpal-periradicular infections

8. Elective RCT contraindicated —> recent MI

9. Endo tx M > susceptible to fracture than untreated teeth —> destruction of coronal architecture

10. # of reticulin bers decrease with age

11. More collagen in apical portion

12. Acute osteomyelitis of jaw: dental infection

13. Referred pain to temporal region: maxillary second premolar

14. Pulp exposure, the acute in ammatory cells (PMN) are chemotactically attracted to the area

15. The most adequate root canal debridement is: achieve glassy smooth walls of the canal

16. A reaming action produces a canal that is relatively: round in shape

17. Onset of pulpal in ammation is characterized by chronic cellular response (plasma cells,
macrophages and lymphocytes)

18. TUGBACK within 1 mm of working length is not an indication to use solvent-softener custom
cones

19. solvent-softener custom cones indicated for: lack of apical stop, abnormally large or irregular
apical portion of the canal, after an apexi cation procedure.

20. Parallel sided posts are preferred over screw posts

21. A periodontal probing defect which may not be managed by Endodontics tx: conical shaped
probing

22. Most likely to have accessory canals: Max 1M (MB root) —> ↑ Endo failure

23. Absence of prevention predisposes it to int resorption by cells present in the pulp

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 SURGICAL RCT

If RCT failed and problem is at or outside Apex

-I&D: soft tissue - localized & uctuant

-Trephination: same but hard tissue (to release exudate & pressure)

-Periapical microsurgery: RCT done - open soft tissue ap -Trephination - Remove 3mm of apex
(Apicoectomy) at 45 degrees bevel with round burs- better ultrasonic tip - then instrument 3mm
and retro t with MTA. Seal retrograted

ORTHO - PEDIATRIC
1. Child in primary dentition is mots likely to have: decrease overbite

2. Trisomy 21 has all… except: high risk of cavities

3. When class III elastics are used, the max 1M: move Mesial and extrusive

4. What occlusion is present when the MB cusp of 1M max is mesial to the buccal groove of the
permanent mand 1M in centric relation? Class II

5. What is the typical order of removing teeth if serial ext is chosen as tx to alleviate severe
crowding? Primary canine, primary 1M, permanent 1PM

6. Child has a distal step in primary dentition. Which of the following molar relationships is most
likely to develop in permanent dentition: class II

7. Which of the following ortho wire materials would be the best choice for pt with Nickel allergy?
Beta Titanium

8. Condition with glossoptosis, mandibular retrognathia, and cleft palate: Pierre-robin

9. Orthographic surgeries from < to > chance of post surgical relapse: max up < max forward <
mand back

10. Which of the following space analyses predicts MD width of permanent canines and PM using
a prediction table and a sum of widths of lower inc? Moyers

11. Of the following events that occur when heavy ortho force is applied to teeth: PDL
compression on the pressure side - PDL undergoes hyalinization - alv. Bone experiences
undermining resorption - tooth move within remodeled socket.

12. 10 yo child presents to you clinic in the “ugly duckling” stage. The only CC is an anesthetic
space between 2 front teeth. The diastema between 8-9 is measured at just under 2mm. What
do you recommend as preferred tx? Wait until upper canines to erupt

13. Child has a sister who is 8 yo. She has unilat posterior crossbite with a function shift to the
right. What do you recommend as preferred tx? Hyrax expander

14. Functional appliances: Frankel - bionator - clarks twin block - Herbst - activator

15. Fixed appliances: Lingual achwires - whip-spring - palate-separator devices - Edgewise

mechanisms - light-wire appliances

16. SS compared to NiTi wires—> SS higher modulus of elasticity and lower resistance

17. Most widely used appliance? Edgewise

18. Etch: 35-50% unbu ered phosphoric acid

19. Cervical-pull headgear —> may cause extrusion of max 1M

20. Expanded maxillary arch is not a sign of sucking habit

21. Class II molar relationship and ceph ANB 2 —> class II dental malocclusion

22. SNB > 80: MANDIBULAR PROGNATHIS

23. SNA > 82 MAXILLARY PROGNATHIS

24. ANB > 4 CLASS II SKELETAL

25. ANB <0 CLASS III SKELETAL

26. ANB = 2 CLASS I SKELETAL

27. To see soft tissue clearly on cephalometric —> soft tissue shield needed

28. Frankfort-horizontal plane: connects Porion to orbitale point in cep

29. Hand-risk X-ray to see growth

30. Post-ortho circumferential supracrestal brotomy is performed to serve collagen bers, this
reducing tendency of rotated tooth to relapse.

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 31. Retainers: to maintain teeth in unstable conditions ( after tx they may be unstable, so because
of pressure constantly there is tendency to relapse)

32. Cranial vault: intramembranous bone formation without cartilaginous precursors

33. Cartilage can grow in appositional and interstitial

34. Bone grows by appositional (once is formed)

35. Bone is formed either endochondral ossi cation or intramemb ossi cation

36. Endochondral: ethmoid, occipital, sphenoid

37. Bone deposition in the tuberosity region is responsible for the lengthening of the max arch

38. Which of the following synchondroses closes last? Sphene-occipital

39. Maxillary is 2 mm longer than mandible

40. Time required to stabilize a molar: 2-6 months

41. Signs of incipient malocclusion: lack of space in primary - crowding in mix dent (ant) -
premature loss of mand primary Can

42. “Longe face syndrome” skeletal open bite

43. 70% population class I

44. 25% population class II

45. 5% population class III

46. 15% adolescents have crowding severe enough to consider ext of permanent teeth

47. 98% of 6yo Childs have maxillary diastema

48. Generalized causes of failure or delay tooth eruption: Hereditary gingival bromatosis - down
syndrome - Rickets

49. Hyperparathyroidism: premature exfoliation of primary teeth

50. “Adenoids” is not the etiology agent of “long-face pattern” malocclusion

51. Mand permanent inc erupt lingually

52. Permanent teeth normal erupt facially

53. Mand leeway space > max

54. Lest likely to see in ortho: devitalization of moved teeth

55. 7 yo 4mm diastema: take xray to see posible supernumerary

56. Reduction of overbite: intrude max inc

57. Conscious sedation: minimal depressed level of consciousness that retains pts ability to
maintain airway independently and continuously and respond appropriately to physical
stimulation or verbal command

58. Closing diastema: 1st ortho - 2nd frenum surgery

59. After trauma, pulpal necrosis: pulpal hyperemia

60. 12 yo with mand anterior crowding: crowding is not likely to improve over time

61. De ant pt: pt says “no I don’t want to” and doesn’t open mouth

62. Uncontrolled pt: temper tantrum

63. Stage I anesthesia: paresthesia - vasomotor - drift - dream

64. After local anesthesia, maintained in conscious sedation: 20-40% Nitrous

65. Least accurate to calculate peak of adolescent growth: dentition eruption

66. Doubling force —> double moment

67. Superelastic behavior of NiTi arch wires: based on a reversible transformation between
austenitic & martensitic phase

68. Cervical-pull headgear: max M: distalize & extrude

69. Inferior movement of maxilla & widen: least stable ortognatic movement

70. Primary mand M anesthesia: IAN, L, B block

71. Primary dentition, mand foramen: same plane of occlusion

72. Min alv concentration (MAC) of Nitrous: 105%

73. Round angles amalgam: ↓ internal stress in restoration material

74. MTA better success rate than formocresol as pulpotomy medicament

75. Formocresol: toxic and there is possibility of blood-borne spread to vital organs

76. Preventive support counseling: 1yo 1st exam, parent asking teething, OH, Fl tips..

77. Most neonatal teeth are primary, and NO ext needed

78. Congenital missing teeth: on initiation stage

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 79. Dentinogen imp: primary & perm - enamel chips easy - small/absent pulp chamb or canals

80. Initiation - proliferation - histodi erentiation - apposition - calci cation

81. Enamel hypoplasia: from birth-1yo

82. Fluorosis —> calci cation stage

83. Young permanent I, open apex, pinpoint exposure from trauma in the last 24 hr: open pulp
chamber to nd health pulp tissue and pulpotomy

84. #8 avulsed on 8yo pt within 30 min”: splint with Non-rigid for 7 days

85. Permanent I with closed apex is intruded: gradual ortho repositioning and calcium hydroxide
pulpectomy

86. Contraindications to do pulpotomy in primary: pt requiring infective endocarditis antibiotic

premedication - swelling associated with tooth - furcation RL

87. Dolichocephalic: long narrow face

88. Neural tissue grows until 6-7yo

89. Which tissue grows the most at rst 6yo? Neural

90. Which is the system most fully developed at birth? Neural system

91. Majority of face tissue derives from? Ectoderm

92. Eruption of primary sequence? CI-LI-1M-C-2M

93. The space for the eruption of permanent mand 2M & 3M is created by? Resorption at anterior
border of the ramps

94. Additional space for eruption of permanent max molar is provided by? Apposition growth at the
max tuberosity

95. Low occlusal plane leads to? Tongue biting

96. Normal class I has max MB cusp in buccal groove of mand molar

97. 1M MB cusp is distal to groove of mand 1M —> class III

98. Distalized occlusion w/ upright central ant and deep bite? Class II div II

99. What is the di erence between primary class II and permanent class II? Broad contacts

100. Most common type of occlusion in primary? Flush terminal plane

101. Highest % occlusion in US? class I —> 30% (normocclusion)

102. Most common pt with anterior tooth fracture or trauma? Class II div I

103.Doesn’t help to diagnose type of occlusion class? Study models

104.Flush terminal plant will erupt end-to-end; early mesial shift into class I

105.Class II: distal step

106.Class I: from ush terminal or mesial step

107.Primate space max: M to C

108.Primate space mand: D to C

109.PRIMATE SPACE: ANTERIOR

110.LEEWAY SPACE: POSTERIOR

111.Premature loos of which would lead to arch length de ciency? Primary canine

112.Mand primary C permatury lost. What happen? Midline will shift in direction of lost tooth

113.Child lost bot primary mand C. Leads to lack of arch space

114.If kid primary molar is lost, eruption delayed of permanent

115.If kid loses primary after 7yo: eruption acelerated

116.Dimensions compared in the mixed dentition analysis? Space available / space required

117.What happens with inter canine distance after mixed dentition? Decreases

118.Movers predict the width of permanent C & PM

119.Tanaka uses 1/2 of sum of all lower I

120.IPR for <4mm crowding

121.>4mm crowding: EXT

122.What headgear to correct class III? Reverse pull headG

123.What headgear used to bring maxilla towards protrusive? Reverse pull

124.Pt with max arch constricted of 3mm and post cross bite. What will you see? Midline shift
toward a ected side

125.Hawley appliance not used for correction of skeletal cross bite

126.Unilateral posterior cross bite in kids usually due to mand shift, that with max expander

127.Cross bite in kids? Fix ASAP

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 128.Most common cause of anterior cross bite? Lack of interdental arch space

129.Mouth breath: ant open bite, bilateral cross bite, narrow palate vault, convex pro le, lip
incompetence

130.10 yo loosing primary molars: do nothing, PM are in eruption age.

131.Which space maintainer?

1. Distal shoe: 2M primary ext with unerupted 1M permanent

2. Nance: max problem w/ 1M primary present

3. LLHA: mand problem 2/ 1M & I permanent present

4. Band/crown and loop: primary 1M ext

132.Lost of 1M primary —> band and loop

133.Lost of 2M primary —> distal shoe

134.Most common space maint: band & loop

135.Band and loop: doesn’t create vertical stop

136.Most common tooth that involves space maint in primary? 2M

137.Mand 2M permanent eruption before 1PM & 2PM—> arch discrepancy

138.Eruption is determined by how much root is formed

139.Best age to correct thumb sucking? During primary dentition. Kids are easier to desensitize

140.Teeth erupt through bone when 2/3 formed, and though gingiva when 3/4 formed

141.Permanent teeth erupt lingual & inferior to primary teeth

142.Apical root closure 2.3-3.5 years

143.12 primary & 12 permanent: 8.5 yo

144.Ortho

1. 1st light and round wire: Leven & align

2. 2nd rectangular or square wire: correct vertical discrepancy, control crown & root
movement

3. 3er light round wire: nish arch wires.

145.Rectangular: root torque

146.Round: move tooth above gum

147.Edgewise bracket: for intrusion motion

148.Advantage of rectangular wire: control crown and root movement

149.Force put on crown, where is the center of translation or rotation? Apical 1/3

150.Ortho nger springs: tipping of ant mand and max teeth

151.Prevent rotation in ortho? Anti-rotational clasp

152.16mm overjet: ortho w/surgery

153.Ortho uprighting of molar. Common problem: occlusal interferences. What to do? Adjust
occlusion

154.Why should you move a tooth before doing perio? More likely to get bone loss after perio
surgery

155.Ortho movement widen PDL due to tension

156.Transeptal bers function: protect inter proximal bone and maintain tooth-tooth contact

157.Which ber are associated with relapse following ortho rotation of teeth? supracrestal

1. Supracrestal, in particular transseptal bers have been implicated as a > cause of

postretention relapse of ortho tx

158.Non compliant retention: xed

159.ANB 6: class II

160.ANB: normal 2-3 (1-5) SNA-SNB

1. +: max positioned anteriorly related to mand (class I or II malocclusion) >6

2. -: max is posterior to mand (Class III) <1

161.SNA normal 81+-3

162.SNB normal 78+-3

PATIENT MANAGEMENT
ORAL HEALTH INDICES AND PREVENTION

• Ramfjord test: selects 6 permanent teeth

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 • Dental index: validity, reliability, utility, sensitive, clinically acceptable and quanti able

• Cambra: evidence-based approach to prevent and manage caries

• Evidence-based practice: the judicious use of current best evidence when making decisions
about the care of individual pt.

* Integrates the dentist clinical expertise, the patients needs and preferences, and the most
current clinically relevant scienti c evidence as part of the decision-making process for
patient care.

* ask, acquire (search), appraise (evaluate evidence), apply, asses/analyze.

* 3 components: clinically relevant questions, systemic review, evidence based

conclusion

• Root hypersensitivity decreases as cellular dentin formation increases

• Cementum demineralization: 6-6.7

• Enamel demineralization: 5.5

• 5% sodium uoride varnish: as cavity liner and reduce hypersensitivity

• Pain associated with dentinal hypersensitivity is transient

• Dentifrices component that reduces dentinal hypersens.: potassium nitrate, sodium citrate and
strontium chloride

• Stannous urried part that is responsible of yellowish-brown stain: tin ion

• Acidulated phosphate uoride: contraindicated on composite, porcelain and sealants

• Exam type IV: tongue depressor and light —> community prevention oral health

• Exam type III: mirror and light —> community prevention oral health

FLUORIDE

- F- breaksdown collagen, is bacteriocisdal, ↓ solubility of enamel, excreted kidney (3mg/day)

- Fluoride replaces hydroxyl radicals of HA in enamel, producing FA.

- Primary prevention: aims to prevent dz before occurs. Health education, water F, sealants

- Secondary prevention: eliminates or ↓ after occur. Composite lling

- Tertiary prevention: rehab an individual in later stages to restore tissues after the failure of
secondary prevention. Ex: denture and crowns

- F facts:

- 40-70 mg/day can cause heartburn and pain in extremities

- Ca therapy to treat uoride toxicity

- Topical uoride doesn’t cause uorosis

- School water F-: 4x than city

- ↑ [ ]: outermost layer of enamel

- Toothpaste: 1100 ppm

- ADULT LETHAL DOSE: 4-5 gr

- CHILD LETHAL DOSE: 15mg/kg

- Toxic dore: 5-10 mg/kg

• Sodium uoride paste to treat root sensitivity: sodium uoride - kaolin - glycerin

• Home-care uoride therapy for head and neck cancer pt: 0.4% stannous uoride and 1.23%
acidulated phosphate uoride

• Fluoride supplements for 2 yo child who lives in a non uoride community: Fluoride drops

• Fluoridation prevents decay for: all ages

• Most e ective and least objectionable topical uoride: Acidulated phosphate uoride

• Fluoride professionally applied topical —> sodium uoride (2%) - stannous F (8%)

• APF uoride pH: 3-3.5

• Sodium uoride pH: 9.2

• Stannous uoride pH: 2.1-2.3

• Fluoride DOES NOT make enamel harder

• HEAD & NECK CANCER —> home-care 0.4% stannous F & 1% neutral sodium uoride

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 • 1 mg of F in 1L of water at 1ppm

• Fluoride doesn’t increase strength of collagen, it breaks down.

• Fluorosis: inhibits remineralization (irreversible)

• Fluoride: doesn’t have direct action on plaque

• In-o ce F: 4 min

• Fluoride supplementation is e ective in anyone but mostly in children

• < F age: 6 months

• Fluoride supplement should start at 6 months

• Fluoride in utero: 4 months

• Rinse of uoride kid in school: 0.2 weekly

• Fluoride in schoo: 0.2% rinse 1x/week

• Drinking neutral F of 0.6ppm. The F level is raised by 0.4ppm. tooth decay is expected to ↓ by
what % after 7 years? 40%

• Biggest storage of F in tissue? Skeletal tissue

• F works best in smooth surface

• Least likely to cause baby bottle caries? Water w/o F

• ECC (early child caries) are caused by: breast feeding - bottle feeding w/formula w/F water -
juice.

• ECC most common location: Max I & M

• EPA regulates. Maximum allowed: 4mg/L (4ppm)

• 65-70% US uoridated water

• CDC in 2012 reported 79% - 204 millions

• 20-40% e ectiveness agains caries in permanent tooth

• Daily use of tablet cause 30% reduction in new carious lesions

• Pt has discoloration w/o sensitivity near cervical region of #29. What to do? 5% uoride

• F in water? Fluprosilicic acid (hydro uorosilicate)

• F in toothpaste? Sodium F

• Mouthwash for kids? NaF

• Rinse to ↓ plaque? CHX

• F- not in toothpaste? Acidulated F (don’t use with porcelain crowns)

• In dental o ce acidulated [ ]: 1.23%

• Use NaF in GI llings instead of acidulated. Bc acid of F will wear away GI

• Pt with amalgam, PFM, composite, implant: 1.1% NaF

• 1.1% as standard of care

163.Who is responsible for educating public on the safety and e ectiveness of community water
uoridation? All health workers (nurse, hygiene, physicians…)

SEALANTS

• Sealants —>low viscosity

• Age: 6-12

• Mechanical microretention binding to tooth

• Contraindication: rampant or gross caries

ETHIC PRINCIPLES

1. Change amalgams bc there are not good: Veracity

2. Dr keep up with technology and learning: Non-Male cence

3. Refer di cult case: Non-Male cence

4. Informed consent —> Autonomy

5. What do you do before getting informed consent? Be sure pt can sign and has a guardian

6. 16yo can make decision for elder pt, if kid has the power of an attorney

7. If you don’t obtain informed consent, what kind of o ense is this? Battery

8. Emancipated minor (<18yo): if she/he graduated from high school, married, pregnant, is
responsible for his/her own welfare and lives independently of parental control & support

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 9. Which of the following is not included in the ADA code of conduct? Licensure by credentials

EMOTIONAL RESPONSE:

1. Rapport best with empathy

2. What best characterizes rapport? Understanding pt feeling and talking w/ pt

3. De nition of rapport: mutual openness/harmonious relationship - sense of truth

4. Share personal experiences is not empathy

5. Not true about paraphrasing? To put your own words

6. Paraphrasing: repeating, in ones words, what someone said. This serves to con rm ones
understanding, validate a pt feeling, convey interest in the pt experience (build rapport) and
highlight important points

7. Pt companies of ↑ fees, how should the dentist answer? Fee is ne according to the
geographic area

8. Closest a dentist should get to pt: tap their shoulder

9. Reasons to not have parent in room with dentist and kid? Communication barrier between
dentist and child

10. Most important component of systematic desensitization is exposure to fearful stimulus

1. Ex: Ryan has a strong gag re ex during x-ray procedures. You suggest he take several x-
rays packets home and practice holding the packets in his mouth for increasingly longer
period of time. Which of the following techniques does this best exemplify? Systematic
desensitization - graded exposure

11. Systemic desensitization: substitution of a relaxation response for an anxiety response when
one is exposed to a hierarchy of feared stimuli

12. Pt crying but less on the same appt. but the dr continued to work until at the end almost not
crying. Respect the crying only: extinguished the behavior

13. Operant extinction: removal of reinforcements that decrease a behavior

1. Ex: Pt always talks during dental appt, after some appt, the dentist starts working and the
child eventually settles down and allows him to work —> extinction

14. Behavior shaping: providing + reinforcement for approximation of behavior you are desiring.

15. Behavior shaping —> successive approximation

16. Behavior modi cation —> behavior therapy. Mostly used in pediatric.

17. Behavior development is de ned as any observable response which is mediated through the
neuromotor system. 4 major eld: personal social - motor - language - adaptive

18. Piaget 4 stages of cognitive development

1. Sensorimotor: from birth to acquisition of language

2. Pro-operational: 2-7. Least to speak

3. Concrete operations: 7-11. Use of logic

4. Formal operational: 11-20. Intelligence thought the logical use of symbols related to
abstract concepts

19. Smiling, eye contact and telling pt he is doing a good job: social reinforcement

20. Main disadvantage of desensitization: time

21. Deal with angry patient: listen and validate emotion

22. “ I have so much going on right now, I don’t think I will wear a NG” —> sustain talk

SMOKING

Method: nicotine patches, nicotine gum, nicotine lozenges: OTC

Method Rx: nicotine inhaler, nicotine nasal spray

Other:

-Bupropion (Zyban): CI: seizure, anorexia or bullimia, discontinuation of alcohol, bdz,

barbiturates and antiepileptical drugs

-Varenicline (Chantix). CI: alcohol intoxication, depression, ↑ cardiovascular risk, coronary

artery bypass graft, heart attack, acute sx of heart, angina, transient ischemia attach, stroke,
peripheral vasc dz, several renal impairment, seizure, feel like throwing up, schizophrenia, manic-
depression, suicide thoughts. DON’T COMBINE W/PATCHES

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 PEDIATRIC BEHAVIOR MANAGEMENT

1. Reduce stress and anxiety: tell-show-do

2. Frank behav rating scale: 4 indicates positive rapport with dentist

3. Intelectual disable child: positive reinforcement. Short and brief, tell-show-do, explain things

4. Disable pt comes in and is not cooperative. What to do? Be permissiveness

5. Best way to treat a developmentally disable patient? consistency

6. Autistic kids have: repetitive behavior

7. Autist: high sensitivity to light and sounds

8. Kids with Aversive conditioning: voice control

9. Voice control technique: set boundaries

10. 1-3 yo afraid of separation

11. 4-6 yo afraid to unknown

12. Euphemism (LA sleepy juice..) relabelling

13. Behavioral responses are learned operates by the simple process of association of one
stimulus with another? Classical conditioning

1. Distraction: not good for hyper vigilant patient. You are not going to full them.

1. Educational process:

1. Recognizing needs

2. Expressing needs

3. Stimulating motivation

4. Setting goals

5. Acting to achieve goals

6. Reinforcing learning

7. Evaluating results

2. Behavior is strongly a ected by which of the following psychosocial factors? Job strain

3. Destructive aggression: aggression as an act of hostility unnecessary for self-protection that is

directed toward an external object or person? Destructive aggression

4. Verbal communication behaviors

1. Leading question: you are afraid of needles, are you?

2. Facilitating question: how are you? —> without specifying a topic

3. Laundry question: is the pain throbbing, arching, dull or sharp? —>from a list

4. Probing question: what else did you notice about you gums —>speci c - spontaneosly

5. Direct question: is it easier to hold the brush this way? —> speci c

6. Open-ended question: how are you doing with you brushing and ossing? —>specify

5. Health belief model: conceptual framework that describes a persons health behavior as an
expression of his/her health beliefs. Prevent dz only when they believe that they are
susceptible.

6. Best strategy for addressing dental fear that is based on distrust of the dentist is: inhale
information & behavioral control

7. Which behavior change theory emphasizes the importance of self-e cacy and behavioral
modeling and reinforcement? Social cognitive theory

8. Which of the following is a component of the OARS model? A rmations

9. Motivational interview: focusing, evoking, engaging, planning

10. With no other intervention or instruction, which of the following is most likely to trigger a
physiologic relaxation response? Diaphragmatic breathing

11. Cognitive appraisal: controllability, familiarity, predictability & imminence

ANXIETY

- Fear: results from anticipation of a threat arising from an external origin

- Anxiety: results from anticipation of a threat arising from an unknown or unrecognized origin.

- This type is the most di cult, they cause anxiety to the dr too

1. Fear is painful, anxiety is a disease

2. Most di cult patient? Anxious patient

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3. Pt never had LA, but got a vaccine injection. Fear to needles: generalization

4. Anxiety according to Freud and K: aversive inner state that people seek to avoid or escape

5. Freud said that inadequate resolution becomes anxiety

6. > cause of anxiety: traumatic past experiences

7. Systematic desensitization: construct a hierarchy, relaxation exercises, associate components

of hierarchy w/ relaxation state

8. Panic attack: fear of impeding doom

9. Which technique is typically not useful in treating and anxious patient? Reassuring the pt by
telling the pt not to worry

10. Anxious patient: more likely to sit still, hands clasped together and keep to himself and not
speak unless spoken to.

11. What is an example of a contains stimulus for a dental pt that had a previous bad experience?
Dental chair

12.

OTHER ADA CODE, FEE, MARKETING…

1. ADA is not included? Licensure by credential

2. What can’t be advertised by a general dentist? Specialty

3. Problem with a certain drug. Notify FDA

4. What’s not a reason for ↑ dental costs? # of dental students in dental schools

5. Medicaid covers: Ext, 1 time denture, child under 18

6. Who pays medicare? Federal programs.

7. Government spends most of the money in: Medicare

8. Most aid for nance: Medicaid

9. Leading payer for dental tx? Self-pay

10. Majority of health service in USA: Private

11. Who pays most of dental tx? Pt 56% - ins 33%

12. Medicaid and medicare doesn’t cover dental tx for elders

13. Adverse selection (patients a high risk, most likely to get insurance)

14. Direct reimbursement: self-founded group dental plain in which the employee is reembursed
based on a % of dollar spent for dental care provided, and allow employees to seek tx from
dentist of their choice

15. 1997: SCHIP (state children ins health program) ↑ income modest not enough to Medicaid

16. Dentist did not accept copayment and did not report to insurance? Overbilling

17. Plan allowing dentist to charge the pt a di erence between what the plan agrees to pay and the
dentist UCR: balance billing

18. American disabilities act includes HIV pt

19. Patients with HIV are protected under the Americans with Disabilities Act

20. FDA is a branch of United States Department of Health and Human Services

ABUSE

1. Most common age: 3yo

2. Abuses that have to be reported to authorities: colleagues w/ chemical impairment, colleague

false advertising on media, child abuse, domestic violence, elderly abuse

3. Child abuse what’s true? You see at least 2 a year

4. Child abuse: social service (CPS)

5. Elderly abuse: Health Human services

6. Elderly abuse is often: underreported

DENTAL PRACTICE

1. When opening a dental practice, what makes it more successful? Better communication

2. Dentist biggest issue: fearful patients

3. Dr is stressed because of pt, and treats bad the assistant: transference (unconscious
redirection of feeling from 1 person to another)

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4. Least chance of needle injury? Setting up

5. Most likely chance of needle injury? Recapping needle

6. Test every year? TB

7. Rampant caries. What’s primary responsibility of dentist? Figure out etiology

8. First thing before/in tx planning: make sure pt doesn’t need translator

9. Proper order of tx planning: emergency care - dz control - reevaluation - de nitive tx -

maintenance care

10. Best way of determine outcome of dz? Med history of pt

11. Borderline personality disorder: serious mental illness marked by unstable moods, behavior
and relationships (going to 6 dentist in the last month - talking bad about one dentist and now
saying you are the best..)

12. Pt who has a complex med history, that is not debilitating but will require medical management
and dental modi cations: ASA 3

18. The measure of the quality of care provided in a particular setting —> quality assessment

19. Optimum —> acronym for a patient management system

CLEANING UP

1. Between pt: disinfectant spray 10 minutes and then wipe o

2. Benchmark for sterilization: Bacilus spores - other option “ clostridium Botulinum”

3. Mycobacterium tuberculosis is benchmark for disinfection (intermediate disinfection)

4. Denaturation of proteins: Alcohol & Autoclave

5. Coagulation of proteins: Dry Heat

6. Which method of sterilization needs higher temperature? Dry heath 160C or 320F

7. Temperature of autoclave: FDA

8. Dry heat or unsaturated chemical vapor: don’t corroded and are best to sterilize burs

9. Ethylene oxide: for heat-sensitive instruments

10. Most common method to sterilize? Autoclave

11. Chemical disinfectant: iodophors, sodium hypochlorite, phenol, glutaraldehyde

12. PPE jackets: long sleeve, high neck

13. Sterilization involving the use of heat is recommended for all instruments that are used in the
mouth

14. HIV is the most infectious target of Standard (universal) blood precautions

15. Antiseptic: hand wash agent

16. Hadnwash agent: chlorhexidine gluconate and triclosan

17. Quaternary ammonium compounds —> cationic detergents

18. Chemical vapor at 250F to sterilize: 20-40min

19. Minimum temperature for autoclave: 250F

20. 2% glutaraldehyde to kill spores: 10 hr

21. Chlorine: powerful oxidizing agent that inactive bacteria and most viruses by oxidizing free
sulfhydryl groups

22. Alcohol as surface disinfectants are not sporicidal - not a chemical disinfectant

23. Proteins: antigens most responsable for an immediate type I reaction to natural latex

24. Disinfectants: antimicrobial chemical agents which destroy microorg when applied onto
inanimate surfaces

25. Ethylene oxide: only gaseous chemical agent that can be relied on for complete sterilization of
dental instruments

26. Which method of sterilization is least likely to dull and corrode carbide instruments? Dry heat

OSHA

1. NOT found on the OSHA poster? How many days each employee is allowed to work w/ that
chemical

2. OSHA guideline: updated 1/year

3. MSDS is not OSHA. Is made by manufacturer

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 4. Hazard communication standard: created by OSHA to make sure employees know about
hazardous/toxic materials

5. OSHA sets blood borne pathogen standard for dentistry, HIV & HBV

6. Which sharps does OSHA regulate? Contaminated sharps

7. OSHA blood borne pathogens standard requires testing of the source patients blood for HIV
and HBV and disclosure of the results to exposed employee: only where it is permitted and not
in con ict with applicable laws or regulations

STATISTICS & STUDIES

- T-test: small sample size. Means of 2 group

- Z-test: large sample size. Means of 2 group

- Chi-square test: correlation between 2 independent variables (non-parametric) ex: men-woman

- Cohort: incidence & relative risk. Ej: how will/does people react using new mouthwash vs
nonusers

- Case-control: Retrospective. 1 group w/dz and 1 group w/o dz. looks back to see how the risk
for dz is compared to actually getting dz. ej: how did people react to new mouthwash vs non
mouthwash

- Cross sectional: entire population- snapshot at 1 point in time. Prevalence.

- Clinical trial: gold standard for establishing cause/e ect. Compare tx w/no tx. Typically
government agencies approve or disapprove new tx based on clinical trial results. They are not
perfect on discovering side e ects, particularly those for long-term and interaction between
experimental drugs and other drugs.

1. Test not accurate but gives consistent result: reliable

2. Which is needed on a test to be accurate? Validity

3. In an article, where is the de nition of dependent and independent variable? Method

4. Purpose of research. Summarizes background and focus of the study, population sampled and
experimental design, nds and conclusions? Abstract

5. Researcher interpret and explain the result obtained: discussion

6. Determine risk ratio? Cohort

7. Study among smoker/non-smoker in 6 years to develop dz? Cohort

8. Find cause: Analytical / observational / development

9. Descriptive: # dz

10. Experimental: E ectiveness of tx

11. Dentist doing research on 5 unrelated pt: clinical trial

12. A research conducted a research between students self studying vs attending lectures.

1. Independent variable: attending lecture or Self study

2. Dependent variable: students result

13. Minimize cofounding variable by randomizing

14. An outside variable that in uences the validity of a study —> Confounder.

15. Narrow con dence interval comes from: large study

16. An experiment comparing the e ectiveness of new uoride gel verses old, a null hypothesis is
rejected when: CHI SQUARE IS ↑

17. If you have ↑ CHI SQUARE —> high likely chance of your P-value < 0.05, so in that case you
reject your null hypothesis

18. Come with speci c regulated product literature and claims are restricted to clinical evidence:
prescription drugs

19. Degree that conclusions describe that happened in a study: internal validation

20. Degree that conclusions are appropriate when applied outside the study: ext validation

21. Wrong result due to chance-disruption in any direction: random error

22. Wrong result due to bias-disruption in 1 direction: systematic error

23. Primary sources: research articles, case studies

24. Secondary sources: review articles, meta-analysis

25. Tertiary type of sources: text books, encyclopedias, internet, popular press, manuals
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 26. Strati ed random sample: randomly chosen from a previously subdivided population.

27. Randomized control trials: strongest form of evidence

28. Meta-analysis: statistical tool for commonly use systemic review - statistically quanti es
available data while systemic review doesn’t.

29. Double-blinded: Best study to prevent bias. Ex: experiment, the experimenter is unaware of
which tx group the participant is

30. Pilot study: trial run of the planned study on a small sample

31. A trial which determines the feasibility and practicality of a study: pilot study

32. Longitudinal study: same subject collection of data over a long time

• Types: panel, cohort and retrospective

33. Judgment sample: greatest bias potential.

34. Scienti c method: asking a research questions

• steps: observation/research, hypothesis, prediction, experimentation and conclusion

35. What is the agent when studying oral epidemiology? Disease

36. Barriers to the uptake of dental care: anxiety and cost
37. Epidemiological triad: Agent, Host, Environment
38. Most common index plaque in clinical research trial? Turesky Modi cation of Quigley Hein
39. Researcher follows a group of individuals in a population over 10 years to determine who
develops cancer ant then evaluates the factors that a ected the group —> prospective cohort
40. Why are systematic review and meta analyses at the top of the “level of evidence” pyramid:
they collect data from # of studies, striving to minimize bias and maximize objectivity
41. Increasing level of evidence: animal research, color studies, randomized controlled trials,
systematic reviews
42. A dental company has claimed that ozone is better than conventional method for tx decay in
people mouths. Which of the following would provide the best evidence? Systematic review
of randomized controlled trials
43. You want to evaluate e ectiveness of using Tetra as adjunct to scaling and root planning for tx
of chronic perio. What type of primary study design would be most appropriate? Randomized
controlled trial
44. Level of evidence of case series is 4

45. Evidence from which one of the following study designs would most support the use of Fl in
water supply? Systematic review

46. Evidence hierarchy from lowest evidence to highest: expert opinion, animal/lab studies, case
reports, case-control, cohort, randomized clinical trials, systematic reviews, and meta-analysis.

47. Randomize study type: simple (for extensive clinical trial), block and strati ed.

48. Clinical trial of a drug development:

-phase 1: 20-80 participants

-phase 2: hundreds

-after, FDA determine how large-scale studies will be completed

-phase 3: thousands

- Applied: directed toward a speci c objective/goal, for example, development of a new drug, tx
or surgical procedure. Most often conducted using animals. Also computer simulations.

- Clinical: to test potential drugs and tx in humans when basic and applied research have already
been established in their development.

- Basic: conducted to increase fundamental knowledge, it serves as a building block for other
types of research

- Biomedical: area of science devoted to the study of the processes of life, prevention and tx of
dz, and the genetic and environmental factors related to dz and health. Examples: chemical,
mechanical, Mathematica, computer simulations, in vitro test. Clinical research takes place
during the last stage of biomedical research.

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 Analytical / observational / developmental research

1. cohort study, an exposure is assessed and the participants are followed prospectively to
observe whether they develop the outcome: True

1. Example: In 1945 there were 1000 women who worked in a factory painting radium dials on
watches. The incidence of bone cancer in these women up to 1975 was compared with
that of 1000 women who worked as telephone operator in 1975. 20 of the painters and 4 of
the telephone operators developed bone cancer between 1945 and 1975.

2. can determine incidence and causality bc is prospective over a population over a period of
time. Its expensive, time-consuming, not used for rare dz. example Iowa uoride study

2. Case control study: Best approach to study a rare dz

1. Example are used very commonly in environmental epidemiological research. And example
may be possible health e ects of exposure to electromagnetic elds

2. retrospective study

3. are prospective in that they follow the cases and controls over time and observe what
occurs: False

4. You are interested in nding out what the risk indicators are for a rare form of oral cancer
and decide to undertake a study to examine this. What type of study would be the most
appropriate?

5. Advantage: they can simultaneously look at multiple risk factors, they are useful to initially
establish an association between a risk factor and a dz or outcome, they take less time to
complete because the condition of dz has already occurred

6. less time, cheaper, multiple exposures evaluation, good for rare dz, retrospective, higher
risk of selection bias. Disadvantage: gives odds ration, does not determine incidence,
prevalence or casualty. Relies on historical data which may not be reliable.

7. Ex: pt w/speci c condition or disorder are compared w/controls. Investigators seek an

association with or cause for a condition. Investigators seek to establish a temporal
relationship between cause and condition

3. Cross-sectional study collect data on a group of subjects at 1 point in time, observational

1. Biggest downfall of cross-sectional study: only 1 point in time

2. Ex: compares relationship between smoke & male in single point of time

HYPOTHESIS

- Hypothesis: a supposition from and observation - proposed explanation to a phenomenon

- Null hyp: is a hypothesis which the research tries to disprove, reject or nullify - opposite to the
hypothesis

- Refers to the common view of something.

- Type1 error: rejects null hypothesis when is true. Reject a null that should be accepted

- Type 2 error: accepting a false null hypothesis. Accept a null that should be rejected

- <= 0.5 (5%) null hyp is rejected. “Statistically signi cant” - did not occur by chance

- >0.5 (5%). Null hyp is accepted. “Not signi cant” by chance - less likely a relationship exist
between 2 variables. - there is no su cient evidence of a true e ect

- Sensitivity ++ # of people w/ dz and tested + (TP > FN)

- Speci city - - # of people w/o dz and tested - ( TN > FP)

1. Error type 2 is more dangerous medically bc a pt is diagnosed as “healthy” when they actually
have dz

2. Error type 1 less dangerous in terms of research, no conclusion bc null hypothesis is rejected

3. Prevalence: total cases of dz within population “Old dz” —> cumulative e ect past and present
in time

4. Incidence: new dz cases in given period of time in speci c population. “New dz”

5. Incidence of caries in your o ce this year is 300 out of 1000, last year was 200.. what is for this
year? 10%

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 1. (300-200)/1000 —> 100/1000: 0.1 —> 10%

6. Precision measures values on average are close to true values, a ected by systemic error

MEDIAN, MEAN, MODE

1. Which doesn’t describe the spread of data? Median

2. What do you use for average Q? Mean

3. Which of the following represents the variability about the mean-value of a group of
observations? Standard deviation

4. Histogram is used to show: variance

5. Outliers control: standard deviation

6. Grater range (standard deviation) the wider the distribution curve

7. An outlier has a bigger e ect on which? Standard deviation

8. Ratio: average

9. Range: di erence between high and low score

10. Mean: most common measure of dental tendency

11. Median: middle observation - half of the observations are larger and half are smaller

12. Mode: most frequent observation

13. Data set: (2,3,4,7,8,8,12,14,14)

1. Mean: 8

2. Median: 8

3. Mode: 8-14

14. Measures of central tendencies: mean, media, mode

15. Bell curve (-1 +1): mean, media and mode are equal

ORGANIZATION MEANS

- Categorical (nominal) black hair, blonde hair

- Ordinal: order or rank (low-med-high)

- Interval: is like ordinal but the values are equally spraced: 10, 15, 20

- Cardinal: #. How many

- Nominal: name or label something

- Ratio

1. O ce uses perio scale 1=gingivitis, 2=mild perio, 3= moderate. What type of scale is this?
Ordinal

2. Pulse, BP, kelvins: Ratio

3. Celcius: Interval

4. GI index: ordinal

1. Survival rate of stage 4 cancer in 65 yo: >10%

2. % of population having type 1 hypersensitivity: 20-30%

3. Oral cancer: 2%
4. Oral cancer cases are more commonly found in African Americans

5. % of calculus: 73%

6. True: mand Inc >40% have 2 canals but separate foramina in only 1%

7. True: max Inc shape of canal access is triangular

8. % of health periodontal gums: 17%

9. Excelent oral health population: 10%

10. Dentate adults with visible plaque: 66%

11. Dentate adult with arti cial crowns: 37%

12. Adults with tooth decay: 31%

13. % of dentate adults has at least one lled tooth: 84%

14. % adults has perio pocket >4mm: 45%

15. Mand Inc with separate foramina: 1%

16. Tooth erosion at 6yo: 52%

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 17. Bacterial load decreases by cleaning up: 80%

RANDOM QUESTIONS

1. Buccal corridor: dark spaces between upper teeth and cheeks when smiling

2. Initiation of 1st menstruation is best indicative of: skeletal age (After peak of growth)

3. Axon damage most likely to cure itself? Neuropraxia

4. Neuropraxia: transient episode of motor paralysis with little or no sensory or autonomic

dysfunction. It deserves nerve damage in which there is no disruption of the nerve or its
sheath.

5. Interruption in conduction at axon: reversible nerve damage

6. Trephination: hole in bone to drain exudates (endo)

7. HBsAg in surface: acute hepatitis contagious

8. Patient tested positive HEP B. Organs a ected: pancreas, kidney, GI.

1. Thyroid not a ected

9. Most common cause of frequent urination during 3 trimester? Pressure of uterus on bladder

10. Innervation of soft palate? Glosshopharyngeal

11. Best use on infected oral wound? Hydrox peroxide

12. Associated with Billirubin? Kernicterus. (Bilirubin-induced brain dysfunction)

13. Multiple endocrine neoplasia syndrome: MEN-adrenal over production

14. Macroglosia Not seen in Hyperthyroidism

15. Macroglosia seen in

1. In ammatory: Glossitis

2. Traumatic: post-op edema

3. Metabolic cause: myxedema, amyloidosis, looped protenosis, chronic steroid therapy and
acromegaly

4. Congenital cause: cretinism, hemangioma, lympahngioma, down sx, beckwith-weidman sx,

generalized gangliosidosis sx, mycopolysacharidosis

16. CONSORT: consolidated of the standards of reporting trials. A statement published in 1996.
The intension is that this initiative will improve the quality of randomized controlled trials and
their reporting in publications. The statement consist of 22 items on a checklist and ow
diagram. Many journals requiere papers reporting RCTs to adhere to it

PATHOLOGY
1. Mobile mass initially, but now is sessile: indicative of malignancy

2. Metastasis is most common to posterior mandible

3. Discrete, non-tender, soft tissue swelling: benign tumor

4. Hypertrophic liform papilla: hairy tongue

5. Causes of hairy tongue: atb, corticosteroid, hydrogen peroxide, heavy smoker,

poor OH, fungal/bacterial overgrowth

6. Hyperplasia folliate papilla: lingual tonsil hyperplasia

7. Hyperplasia lingual tonsil resembles: SCC

8. Loss of liform papilla: vit B de ciency

9. Transillumination of soft tissues useful in children to detect: sialolithiasis

10. Baby nodules on palate: Epstein pearls (midline)

11. Neonate # nodules on alveolar ridge: bohns nodule (away from midline)

12. Hutchinson triad: Hutchinson teeth - interstitial keratitis - 8th nerve deafness

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 13. Hutchinson triad: syphilis congenital.

14. Stage of syphilis most infectious: secondary. (Bacteria have spread in the
bloodstream and have reached their highest #

15. Chancre (syphilis) resembles: herpes

16. Oral histoplasmosis resembles: SCC

17. DD: peripheral ossifying broma & peripheral giant cell granuloma.

- This 2 only occur on gingiva or alveolar mucosa

- “Pink growth on palate between canine and 1pm” —> peripheral ossif b

- Peripheral giant cell granuloma: mand, more likely to cause bone resorption

18. Texture/consistency of dermoid cyst vs radula: dermoid (Doughy/rubbery)

ranula (more uctuant - bluish - oor mouth under tongue)

19. Astral Y (inverted Y): x-ray anatomical landmark Y line of Ennis: superimposition
of oor of nasal cavity (straight RO line) and border of max sinus (curved RO
line)

20. DD mandible grows excessively:

- Acromegalia (homonal disorder)

- Cherubism (autosomal dominant) —> hereditary —> stops at puberty

- McCune-Albright syndrome: Fibrous dysplasia. —> stops at puberty

- Paget’s dz —> 50yo

21. What is most common? Dentinal dysplasia, dentinogenesis imp, amelogenesis

imp or cleft lip/palate
22. Dens in dens: maxillary lateral incisor

23. Talon cusp is for: dent evagenatus

DEVELOPMENTAL CONDITIONS
1. Cleft lip / palate: lack of media nasal process & maxilla or palate shelves

2. Lip pits: invaginations near midline or comissures.

1. Van Der Woude sx: cleft + pits

3. Fordyce granules: Buccal or labial mucosa

4. Leukoedema: bilateral. No tx. Grey-white on buccal - disappear w/stretched

5. Lingual thyroid: midline base of tongue or neck (thyroid descendent)

6. Thyroglossal duct cyst: midline neck swelling (embryo path thyroid descend)

7. Branchial cyst: lat neck swelling w/lymph node of neck

8. Geographic tongue / erythema migrains: benign white border: red

(depapillation). Dorsal tongue - burning - migrates - unknown cause - Tx cortic
rinse.

9. Fissured tongue: dorsum.

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 1. Merkensson-rosenthal sx: ssured t + granulomat cheilitis + VII paralysis

10. Angioma: tumors composed of blood vessel or lymph - + test for blanching
1. Cherry angioma

2. Hemangioma: congenital focal prolif of capillaries. If persist, excision.

Tongue “hermartoma” (browns as same rate as surrounding tissue)

3. Lymphangioma: congenital focal prolif of lymph vessel. Oral rare (purple pots
on tongue). Neck (cyst hygroma)

4. Sturge-Weber sx: angiomas of leptomeninges + skin along CNV

11. Exostosis / torus: excessive cortical bone growth

12. Dermoid cyst: midline mass FOM above Mylohyoid. Also: extraoral. Contains
adrenal structures (hair - sebaceous gl) “Doughy” rm sac-like.

13. Oral lymphoepithelial cyst: epith cyst within lymphoid tissue of oral mucosa.
Palate & lingual tonsils common area - usually enlargement of parotid or
lacrimal gl - Round yellow-white bump underneath tongue

- Young child w/ uid nodules on right side of tongue, rest of mouth WNL.

14. Stafne bone cyst: below mand canal. RL - due to concavity of jaw

15. Nasopalatine duct cyst: Most common non-odontogenic cyst “heart” caused by
cysti cation of canal remnants. Tx excision, enucleation. Intraoral: incisive
papilla swelling & discolored

16. Globulomaxillary lesion: RL between Max C & IL.

17. Traumatic (simple) bone cyst / idiopathic bone cavity: RL scalloped around vital
roots. Mand - asymptomatic - teenagers - associated w/ jaw trauma. Tx
aspiration (nothing inside - “pseudocyst” heals by itself

MUCOSAL LESIONS - REACTIVE

1. Linea alba: white buccal @ occlusal plane. Focal hyperkerat: chronic friction

2. Traumatic ulcer: distinguish from erosion (incomplete break). Ulcer complete

break through epith (submucosa)

3. Chemical burn: aspirin, hydrogen peroxide, silver nitrate, phenol.

4. Nicotine stomatitis: red dots in amed salivary ducts opening. Only pre-
malignant if related to “reverse smoking”

5. Amalgam tattoo: traumatic implantation of amalgam into mucosa. RO

6. Smoking-associated melanosis: brown di use irregular macula - ant gingiva

7. Melanotic macule: benign hyperpigmentation in mucosa. “Freckle”

1. Peutz-Jegher sx: autosomal dominant: freckle, melanosis (lip, face, mouth) +

intestinal polyps & agonist for insulin rct. NO CAFE-AU-LAIT

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8. Hairy tongue: elongated FILIFORM papillae

9. Dentifrice-associated sloughing / allergic mucositis : white mucosa. Sodium

laurel sulfate. - cinnamon avor - stomatitis “plasma cell gingivitis”

10. Submucosal hemorrhage: extravasation. Do not blanch. Petequias (1mm) -

Purpura - Ecchymosis (>1cm) - Hematoma. No tx.

MUCOSAL LESIONS - VIRAL

1. Herpes simplex: Keratinized (attached gingiva): gingivostomatitis heretic (fever
peak 2-3 yo - most subclinical asymptomatic) - recurrent (lip - intraoral mucosa
overlying bone - hard palate) - with low ( ngers)

- Tx: Acyclovir, valtrex (Valacyclovir), docosanol (abreva), penciclovir

- Ganciclovid (IV): CMV

- 80-85% US have herpes

- Heal 7-10 w/o scar

- Cytology exfoliative: multinucleate cell

- Secondary herpes: lip - gingival - palate

- < 3 days onset: tx w/ acyclovir 15mg/kg for 7 days

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 - > 3 days onset: palliative

- MOA Acyclovir:only phosphorylated in infected cells & inhibits viral mRNA

- Kaposi sarcoma by herpes 8. Hard palate

2. VZV: primary - recurrent (herpes zoster “shingles” post herpetic neuralgia). Tx

Acyclovir

1. Ramsay Hunt sx: herpes zoster reactivation in geniculate ganglion a ecting

CN VII & VIII: paralysis facial, vertigo, deafness

3. Coxsackie: hand-foot-mouth. Herpangina: post oral cavity (soft palate, throat,

tonsils)

4. Measles (Rubeola): primary - koplik spots (buccal dot ulcers) - skin rash

5. Papilloma: HPV. Pedunculate or sessile (dome) cauli ower-like mass on tongue

(post border), lip, gingiva, soft palate. Most common bening neoplasm of
epithelial tissue origin.

1. Verruca vulgaris: common skin wart

2. Condyloma acuminatum: epidermotropic 6 & 11. Genital, oral sex. Tx:

excision-↑ recurren. DD: Fibroma (no cauli ower-like, pebbly appearance)

3. Focal epith hyperplasia (Hecks dz): 12 & 32. Small dome oral mucosa. Tx:
excision - excelent prognosis

4. Xanthoma: fatty deposit under skin

6. Hairy leukoplakia: EBV. NO WIPE OFF. Opportunistic infection associated w/HIV

& Burkitts Lymphoma

MUCOSAL LESIONS - BACTERIA

1. Syphilis: Treponema pallidum (spirochete). Primary (chancre) - secondary (oral
patch, condyloma LATUM, maculopapular rush) - tertiary (gumma, CNS & CN
involvement) - congenita (Hutchinson triad: notched I, Mulberry M, deafness,
occular keratitis)

2. TB: oral non-healing chronic LARGE ulcers @ tongue base & gingiva + cervical
lymph nodes following lung infection. Primary- Ghon complex (inhaled bad
surrounded in a granuloma that undergoes caseating necrosis + infected hilar
lymph node draining the 1st lesion). Secondary ( more widespread lung -

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 tongue - palate - lip). Military (systemic spread). HIV ↑ risk progression. Tx:
Isoniazid - Rifampin - Ethambutol

3. Gonorrhea: oral pharyngitis rarely seen

4. Actinomycosis: Israeli: opportunists infection anaerobe , chronic and

granulomatous. Perioral (jaw infection-lumpy jaw) - cervicofacial (infection) -
sulfur granules in purulent sinus tract. Tx: long term ↑ dose Penicillin + ID

5. Scarlet fever: Strep A (pyogenes). When strep throat —> systemic (chills,
vomiting & abdominal pain) “Strawberry tongue” in amed FUNGAL papillae -
painful

MUCOSAL LESIONS - FUNGAL

1. Candidiasis: tx: Azole (Fluconazole) - Statin (Nistatin)

1. Pseudomembranous: white patch - burning - palate, buccal, dorsum tongue

- WIPE OFF. etiology: immunosuppression - atb therapy

2. Atrophic / erythematous: red macules - burning - post hard palate, buccal,

dorsum tongue. Etiology: immunosupression - atb therapy - xerostomia

3. Median rhomboid glossitis: red, athrophic, asymptomatic, posterior dorsum

tongue - loss FILLIFORM papilla. Etiology: immunosupresions

4. Angular cheilitis: red, ssured irritant corner mouth. Etiology:

immunosupresion - ↓ VDimension - vit de ciency

5. Hyperplastic (Leukoplakia): non-removable white plaque - asymptomatic -

ant buccal mucosa. Etiology: immunosup - smoker.

6. Denture stomatitis: red - asymptomatic - palate under denture

2. Deep Fungal infection: most common US histoplasmosis.

Questions Candidiasis
1. HIV pt w/oropharyngeal candidiasis: Fluconazole

2. Children w/HIV oral manifestation: candidiasis

3. Vaginal candidiasis: Fluconazole (di ucan)

4. Chemotherapy: candida albincans

5. Multiple white patches that scrap o : candida

6. Oral cytology smear used to diagnosis: pseudomembranous candida

7. Systemic medication for candidiasis: amphotericin B

8. Leukoplakia - biosy: incision

MUCOSAL LESIONS - IMMUNOLOGIC DZ - Corticoest tx (except Erythema

multiform / lyme dz)
1. Aphtous ulcer “canker sore”: non-keratinized - unattached gingiva (buccal,
labial, FOM, soft palate, ventral tongue). < (no scar) - >/sutton dz (scar) - painful
- doesn’t form vesicle and has no fever or gingivitis

1. Behcets sx: multi vasculitis aphthous-ulcer oral & genital + eye in amm
(uveitis)

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 2. Erythema multiform / Lyme dz: Unknown cause. Possible mediated by
deposition of IgM in super cial microvasc of skin & oral mucosa mb & lips that
follows infection or drug exposure. Nikolsky sign. < (HVS hypersensit) > (drug
sensitivity)

1. Steven-Johnson sx: > form (eye - mouth - genital) toxic epidermal necrolysis
- life threatening skin condition, dead cells causes epidermis to separate
from dermis.

3. Angioedema: allergic to drug or food contact. Di use swelling lip, neck, face.
Mediated by mast cell release IgE and Histamine. Tx: Antihistamine

4. Wegeners Granulomatosis: allergic to antigen inhaled. “Strawberry-gingivitis”

5. Lichen Planus: Mucocutaneous. T lymph target and destroy basal

keratonocytes. Unknown reason. Basal zone vacuolization & “sawtooth” “loose
of rete pege” secondary to destruction. Hyperkeratosis, lymphocyte in ltrate at
epith-CT interface. Intraoral most common (bilateral on buccal)

1. Reticular: Wickham stria - more common - often asymptomatic - women

2. Erosive: Wickham stria + red ulceration. DD. Geogra c tongue (both pain)

6. Lupus Erythematosus: Collagen/CT multi-system disease. Unknown cause.

Chronic autoimmune dz, body becomes hyperactive and attacks normal,
healthy tissue. Resulting in in ammation, swelling, damage to joint, skin, kidney,
blood, heart & lungs - Female 30yo

1. Discoid chronic: face skin: disc-like lesion - oral: mimic erosive lichen p
(palate, B mucosa, gingiva)

2. Systemic Acute: multiple organ involved - heart (warty vegetations on valves:

Libman-sacks endocarditis) - kidney (glomerulonephritis 50% of the times) -
butter y rush - ANA test

7. Scleroderma: hard skin & CT. Blue ngers, hair loss, skin abnormally dark/light.
Restrict moth open - uniform widening PDL. Deposition of collagen in organs
leads to organ failure

8. Penphigus vulgaris: autoimmune type II hypersensitivity. suprabasilar -

autoantib IgG agains desmosomas Dsg3 (attachment of epith oral & skin)
agains demosglein, causing Sloughing - multiple pain ulcer proceded by bullae.
+ Nikolsky. has acantholysis, Tzanch cells. Immuno uorescence. Tx: incisional
biopsy

9. Penphigoid: sub-basilar - autoantib IgG agains basement mb

(hemidesmosomes)agains bullous pemphigoid antigen. Skin & eye. Oral
anywhere - women - mid age - immuno uorescence. Another name for chronic
desquamative gingivitis: cicatricial phemphigoid

MUCOSAL LESIONS - PREMALIGNANT

1. Leukoplakia (clinical lesion): white patch NO WIPE OFF. Tx: biopsy

2. Proliferative Verrucous Leukoplakia: HPV 16 &18. Recurrent & warty. —> ↑ risk
to become SCC or Verrucous carcinoma

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 3. Erythroplakia (Clinical lesion): red point palate - ↑ risk than leukoplakia. Tx.
Biopsy. Nicotinic stomatitis (hard palate). Severe dysplasia - Commonly w/
dysplasia and carcinoma in situ

4. Actinic Cheilitis: actinic=solar: damage UVB radiation - loss of vermillion border

- atrophy & focal keratosis in lip. Tx: 5-Fluorouracin (block DNA synthesis) —>
can become SCC

5. Smokeless tabacco-associated lesion: white mucosa in vestibule due to direct

e ect of smokeless tabacco.

MUCOSAL LESIONS - MALIGNANT *Induration* FOM #1 - Lat tongue #2

- white people: < oral carcinoma

- Black people: > oral carcinoma

1. Verrucus Carcinoma: Chew tabacco & HPV 16 & 18. Buccal common site. In
vestibule better prognosis than FOM. No tendency to metastasis. Slow grow.
Large broad based exophytic papillary leukoplakia lesion. Tx: Excision

2. SCC: HPV 16 & 18 - external factors - stress - alcohol - tobacco - UV radiation -

vit de ciency - immunocompromised - iron de ciency - xerostomia. Lat border
tongue - caused by oncogenes or inactivation of tumor suppressor genes (P.53)
w/ invasion into alveolar ridge: poorly de ned RL w/o a reactive sclerotic border.
5 years survival (50%). Tx. Excision + radiation. Incisional biopsy. DD
keratoacanthoma (disappears)

1. Plummer-Vinson sx: mucosal atrophy + dysphagia + IRON de ciency anemia

+ ↑ risk oral cancer

3. Basal cell Carcinoma: least dangerous - no intraoral - sun damage - rare

metastasize - abnormal uncontrolled growth - painless - can be on side of lip
(round bluish lesion). Tx: surgery

4. Oral Melanoma: malignancy of melanocytes - Palate & gingiva. 5 year survival

skin (>65%) - oral (<20%)

Extra info:

- Best survival rate: Adenocarcinoma (more than osteosarcoma - SCC)

- Betel nut can cause: gingival recession - SCC - staining

- #1 risk factor: tobacco

- Most common and most malignant in oral cavity: SCC

- Low grade mucoepidermoid carcinoma can become malignant

- 30,000 SCC new cases annually in US

CT TUMORS - BENIGN
1. Fibroma: traumatic - irritation - hyperplastic scar. Hyperplasia to chronic trauma
or irritation.

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 2. Gingival hyperplasia: “CDC” Tx: gingivectomy & discontinue drug if possible

3. Denture-induced brous hyperplasia: Epulis ssuratum (trauma: vestibule) -

Papillary Hyperplasia (palate) - poor tting denture

4. Traumatic Neuroma: enlargement submucosa smooth nodule painful of neural

tissue & scar. By injury/trauma to peripheral nerve (denture pressure on mental
foramen)

1. Multiple endocrine Neoplasia (MEN 2B): # neuromas + medullary thyroid

cancer + pheochromocytoma of adrenal gl

5. Pyogenic Granuloma: tumor-like hyperplasia of capillaries: red - interdental

papilla most common - RAPID develop. Chronic trauma or irritation - “Bleeding
swelling” that blanches - common in pregnant & in normal conditions

6. Nodular Fasciitis: Neoplasm of Fibroblast. Tx: excision (easy to eradicate, rarely

recurs)

7. Fibromatosis: Neoplasm of Fibroblast. Di cult to eradicate, often recurs

8. Granular Cell Tumor / Shwannoma: neoplasm of Shwann cell. Autosomal

dominant. Unin amed, slow elargmenet, asymptomatic that aries in size from
tiny to large peduculous masses. Has a granular cytoplasm. Dorsal tongue.
“Supernumerary teeth posible”. Variant on gingiva (congenital epulis of
newborn).

- Cafe eu lait & lisch nodules on iris - also seen in McCune Albright syndrome

1. Pseudoepitheliomatous Hyperplasia: mimics SCC & congenital epulis -

in ammatory papillary hypeplasia - chronic hyperplastic candida -
blastomycosis. Histology most similar to granular cell tumor

9. Shwannoma: Neoplasm of Schwann cell. Acellular bodies in Antoni A tissue.

10. Neuro broma: most common being peripheral nerve tumor. Neoplasm of
Shwann cells & broblast.

1. Neuro bromatosis type I - Von Recklinghausens dz: # neuro bromas + #

skin freckles (Cafe au-lait) + axillary freckles (Crowes sign) + iris freckles
(Lisch spots) —> neuro broma can transform to neuro brosarcoma here

11. Leiomyoma: neoplasm Smooth muscle cells

12. Rhabdomyoma: neoplasm skeletal muscle cell

13. Lipoma: neoplasm fat cell. Most common on buccal mucosa

CT TUMORS - MALIGNANT
1. Fibrosarcoma: proliferation of Fibroblast

2. Neuro brosarcoma - malignant peripheral nerve sheath tumor: prolif Shwann

3. Kaposis Sarcoma: prolif endothelial cell. HHV8 (herpes virus) and seen as
complication of AIDS. Purple lesions hard palate

4. Leiomyosarcoma - Rhabdomyosarcoma - Liposarcoma

SALIVARY GLAND DISEASE - REACTIVE

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 1. Mucus extravasation phenomenon: trauma to salivary gl. Mucocele (lower lip) -
Ranula (FOM sialolith or trauma) tx: complete excision (↑ recurrence if not)

2. Mucous retention cyst: similar as anterior but a true cyst. Blockage of salivary
duct by sialolith (most common Whartons duct - submand)

1. Sialolithiasis:

- “Sausage link” appearance: sialodochitis (ductal sialoadenits)

- Parotid gl: chronic sialodochitosis

- Initial tx of painful sialolith in Wartons duct: moist heat - if small stone

- Tx in large cases: cannulation & dilation (sialotomy and remove stone)

3. Necrotizing sialometaplasia: rapid expanding ulcer lesion - painless. Ischemic

necrosis < salivary gl palate from trauma or LA. heals 6-10 weeks w/o scar.
Commonly confused w/ carcinomas

4. Sinous retention cyst - antra pseudocyst: block of gl in sinus mucosa: RO dome

in oor of sinus. No tx.

5. Sinous mucocele: trauma or block of ostium. Expands gradually and more

aggressive than sinous retention cyst

6. Sarcoidosis: hyperimmune - granulomas that form nodules. Triggered by

mycobacteria. Primary pulmonary dz, also a ects salivary gl and mucosa - skin
patches - swollen lymph nodes - xerostomia. (TB is similar) Tx: Cortic

1. Lefgrens sx: erythema nodosum + bilat hilar lymphadenopathy + arthritis

2. Heerfordt sx - uveoparotid fever: ant uveitis + parotid gl enlargement + facial

nerve palsy + fever.

7. Sjogrens sx: autoimmune - lymphocyte mediated, destroys salivary & tears gl.
Primary (keratoconjuntivitis sicca + xerostomia) - Secondary (primary +
rheumatoid arhritis). Test: SSA - SSB - ANA - RE (rheumatoid factor) - ↑ risk of
developing “Non-Hodgkin lymphoma” *Xerostimia is rarely due to vitamin
de ciency*

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SALIVARY GL TUMORS
- Most are benign but the parotid gl are where most malignant start.

- Major: salivary gl consist of parotid - submand - sublingual

- Minor: small mucus-secreting gl in pallet, nasal and oral cavity

1. #1 benign major or minor: pleomorphic adenoma (mixed): Best prognosis)

2. #1 malignant major: mucoepirdermoid carcinoma

3. #1 malignant minor: adenoid cystic carcinoma “Swiss cheese”

4. Adenoid cystic carcinoma: best prognosis of malignancy

5. Worst prognosis: adenomatoid and malignant mixed tumor

SALIVARY GLAND DISEASE - BENIGN

1. Pleomorphic Adenoma - mixed (epith + CT) #1 - Firm rubbery swelling (any
size). Most common palate (< gl) - ear (parotid)

2. Monomorphic Adenoma: single type cell - includes: basal cell adenoma,

canalicular adenoma, myoepithelioma & oncocytic tumor. Tx. Excision

3. Warthins tumor: old men - parotid - composed of oncocytes & lymphocytes cell
& germinal centers. (Oncocytes: epith cell w/ excessive # of mitochondria)

SALIVARY GL DISEASE - MALIGNANT

** Most common palate ** **adeno=gl**

1. Mucoepidermoid Carcinoma: #1 common - mucous and epith cell

2. Polymorphous low-grade Adenocarcinoma: #2

3. Adenoid cyst Carcinoma: cribriform “Swiss-cheese”- palate most common area

- spread though peri-neurial spaces. 5 years survival (70%) - 15 years survival
(10%).

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 LYMPHOID NEOPLASM
* All are malignant by nature bc invade passing basement mb into lymph tissue w/
lymph node, CT & vessels —> metastasis

4. Hodkins Lymphoma: rare oral - Reed-tenberg cells (malignant B cells). Tx:

chemo/radiation

5. Non-Hodkins Lymphoma: neoplasm of B and T cells. Tx: chemo/radiation

1. Burkitts lumphoma: type B cells NHL w/bone marrow involvement, swelling

pain, tooth mobility, lip paresthesia, half root development.

6. Multiple Myeloma - plasma cell myeloma: monoclonal neoplasm of antibody-

secreting B cells (Plasma cell) responsible for producing antibodies. Initially no
symptoms. When advances, bone pain (limbs & thorax), bleeding, frequent
infection, anemia. Punched out RL in skull. Complications: amyloidosis
(accumulation of complex amyloid proteins that develop from antibody light
chains). ↑ M protein in serum - Brence Jones protein in urine. Tx: chemo, poor
prognosis

7. Leukemia: neoplasm of bone marrow cell (Lymph, NK cell, Granulocytes &

megakaryocyts). Classi cation based on cell linage (Myeloid or Lymphoid) and if
acute or chronic. 3 clinical signs: bleeding (platelets), fatigue (RBCs) and
infection (WBCs) - problem healing

1. ALL > CML > AML > CLL (youngest to oldest pt)

1. ALL: acute lymphoid leukemia: most common in Kids

2. CML: chronic myeloid leukemia: Philadelphia chromosome 22

(translocation)

3. AML: acute myeloid leukemia

4. CLL: chronic lymphoid leukemia: lymph node enlargement is main

nding. May be complicated by autoimmune hemolytic anemia.

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 ODONTOGENIC CYST
1. Radicular cyst - periapical cyst: #1 - RL apex - non-vital tooth (necrotic) Acute
(abscess) - chronic (granuloma). Tx: RCT - apicoectomy or Ext (curet)

1. Epithelial rest of Malassez from henrtwigs epith roots sheet within pocket of
in ammation encapsulate the lesion resulting in formation of cyst.

2. Dentigerous cyst / eruption cyst in kids: #2. RL attached to CEJ of impacted

tooth (3M, C). Accumulation of uid between crown and reduced enamel epith.
Tx excision. Can become Odontogenic tumor- Ameloblastoma

3. Lateral periodontal cyst: most common Mand PM. Vital tooth.Tx: Excision

4. Gingival cyst of adult: soft tissue counterpart Lat period cyst. Tx: excision

5. Gingival cyst of Newborn: Bohns nodule (lat palate) - Epteins pearl (midline
palate). Rest of dental lamina epitheliaze the small lesion. Tx: No

6. Primordial cyst: develops where a tooth would have formed. Most common
Mand 3M. Tx: complete removal

7. Keratocyst Odontogenic Tumor (KCOT): aggressive & recurrent. Post ascending

ramus of mand, also can be Max. Unilocular RL lesion - swelling - pain. Thin
parakeratinized epith (from epith rests). Tx: aggressive enucleation w/ or w/o
curettage.

1. Gorlin sx - Nevoid basal cell carcinoma: # KCOT, # Nevoid BCCs, calci ed

Falx cerebri, palmar pitting, plantar keratosis, cyst in jaw, fatal

8. Calcifying odontogenic cyst - Gorlin cyst: rare - unpredictable. “Ghost cell”

empty space where nucleus was and keratin lls in, can undergo calci cation
and little RO detected

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 ODONTOGENIC TUMOS - Bone: epith or mesenchymic cell

1. Ameloblastoma: benign but most aggressive. #1. DD for multilocular RL in post

mand is Ameloblastoma, KCOT, CGCG, COF. Mand molars. Solid, well-de ne
multicystic or polycystic “soap bubble”. Microscopic: stellate reticulum in bell
stage, epith in net ex pattern. Best description of ameloblastoma: local
invasion. Tx: wide excision or resection (↑ recurrence if too conservative)

2. Calcifying Epithelial Odontogenic Tumor (CEOT) - Pindborg tumor: RL w/ driven

snow calci cations (white ecks). Amorphous pink amyloid w/ concentric
calci cations termed Liesegang rings. Tx: excision (good progno)

3. Adenomatoid Odontogenic tumor (AOT): arises from enamel organ or dental

lamina. contains epith duct-like spaces and enameloid material. Mostly Max ant
over impacted C.Mostly young females.- Asymptomatic - lesion “specks” in it -
on x-ray goes to apex of tooth. (RL w/RO inside). Tx. Excision (good pr).

4. Odontogenic Myxoma - myxo broma - slimy stroma: uncommon benign.

Arising from embryonic CT associated w/ tooth formation. myxomatous CT
(pulp-like with little collagen). Usually posterior, no symptoms, moves teeth,
cortical expansion and root displacement, always messy RL w/ unclear border
and honeycomb pattern. Consist mainly if spindle shaped cells and scattered
collagen bers distributed through a loose, mucoid material “soap bubble”
Soap bubbles also ameloblastoma Tx excision (moderate recurrence).

5. Dental Odontogenic Fibroma (COF): dense collagen w/ strands of epith. Central

(bone, well-de ned multilocular RL). Peripheral (gum)

6. Cementoblastoma: well-circumscribed RO mass. ball of cementum and cement

oblast replacing tooth root. Tx. Excision and ext

7. Ameloblastic broma: children and teens. Post Mand. Myxomatous CT. Tx:
excision

8. Odontoma: benign. Starts of RL that develops small calci cations RO lesion

composed of dental hard tissue. Can block eruption. Mand most common.
Compound (mostly Ant. Mini teeth) - Complex (mostly Post. Conglomerate RO
mass inside RL). - can give rise to dentigerous cyst

1. Gardner sx: autosomal dominant: # odontomas + intestinal polyps.

- Garner, peutz-jegher & Crohn have in common: GI polyps

Other information

- Dentigerous cyst —> can lead to ameloblastoma

- Distinguish ameloblastoma from OKC —> reactive light microscopy

- Ameloblastic broma: compared to ameloblastoma - young age, slow growth,

not in ltrate. Associated w/impacted teeth.

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- Painless, well circumscribed RL and RO in post mandible of 11yo. DD:
ameloblastico broma - odontoma

BONE LESIONS - FIBRO-OSSEOUS *Benign tumor compound: brous tissue

bonny island develop - RO component
1. Central Ossifying Fibroma: composed of broblastic stroma in which foci of
mineralized products are former. Central (bone, well-circumscribed RL) -
Pheriferal (gum) - Juvenil (aggressive, rapid grow). Similar appearance and
behavior to cementifying broma. Tx: excision

2. Fibrous dysplasia: bone disorder where scar-like ( brous) tissue develops in

place of normal. Weaken a ected bone (fracture, deform). Asymtomatic.
“Orange peel”- “ground glass”. On Pano big (di used RO) vital teeth. Stops
growing after puberty. Tx: surgical recontouring for cosmetic

1. McCune-Albright sx: polyostotic (>1 bone) brous dysplasia areas RL/RO +

skin cafe au-lait + endocrine abnormalities (precoz puberty) potential
malignant transformation

3. Periapical cemento-osseous dysplasia - cementoma: reactive, unknown reason.

Mand Ant (teeth VITAL apex). 30-50yo black female. Asymptomatic RL border:
RO center. Tx: no

4. Osteoblastoma: circumscribed RO mass (bone and osteoblast). Tx: excision

BONE LESIONS - GIANT CELL *Multinucleated giant cell microscopically

1. Central Giant Cell Granuloma: benign - broblast & multinucleate giant cells.
Ant Mand/Max. Central (CGCG): bone RL with thin wispy separations. -
Peripheral (gum, red-purple gingival mass) - young women. Lesion expands the
cortical plate & can reabsorb root + move teeth. Test (Ca levels) Tx. Excis

2. Aneurysmal bone cyst: pseudocyst (blood lled) - multilocular RL - expansile -

post mand - tx: excision (aspiration biopsy)

3. Hyperparathyroidism: # bone lesions (look like CGCG) resulting from excessive

levels of parathyroid hormone. Brown tumor (excess osteoclast activity). ↑
alkaline phosphatase (too much breakdown of bone).

1. Von Recklinghausen dz OF BONE (Don’t confuse with neuro bromatosis)

4. Cherubism: autosomal dominant - symmetrical bilateral swelling, expansile

multilocular RL in lower part of face, in early child both mand and max become
enlarged as bone is replaced w/ painless cyst-like growth. Stops growing after
puberty. Tx: no

5. Langerhans cell dz - idiopathic histiocytosis: rare type of cancer. Langerhans

cell or histiocytes are normally found in skin as antigen presenting cell, but can
cause damage if they build up in other parts of body- discrete punched out “ice
cream scoop” RL that lead “ oating teeth” and loose them- Oral signs: bad
breath, sore mouth - Tx: excision, chemo & radiation

1. Hand-Schuller-Christian dz: associated w/ multifocal langerhans cell

histiocytosis. Triad: diabetes insidious, exophthalmos, lytic bone lesions

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 6. Pagets dz: Osteitis deformans: chronic progressive metabolic disturbance of
many bones (spine, femur, skull, jaws): symmetrical enlargement but fragile,
hypercementosis, loss of lamina dura - old (50yo) - ↑ alkaline phosphatase in
serum- “cotton wool” - dentures and hats become too tight - Tx: bisphosph,
Calcitonin. Risk of osteosarcoma

BONE LESIONS - INFLAMMATORY -Assoc w/periodontal, periapical or trauma

1. Acute Osteomyelitis: odontogenic infection or trauma (that begins in medullary

space involving the cancellous bone and spreads to cortical, periosteum and
soft tissues). Symptoms: deep and intense pain - high or intermittent fever -
paresthesia IAN - tooth NOT loose. Tx: ATB & drain

2. Chronic Osteomyelitis: Di use mottled RL - sequestra (dead bone) - Tx. ATB &
debridement

1. Garre’s Osteomyelitis: chronic OM w/ proliferative periostitis: alternating RL /

patch at inferior border mand “onion skin”

3. Focal Sclerosing Osteomyelitis (condensing): bone sclerosis from low-grade

in ammation (chronic pulpitis) - dense bone to wall up infection. Causes bone
production rather than destruction. > common near apex of PM & M (RO due to
sclerotic reaction). Tx: none, address cause of tooth infection.

4. Di used Sclerosing Osteomyelitis: same as previous, wider. Can lead to jaw

fracture and osteomyelitis. Tx: ATB - address cause

5. Bisphosph-related Osteonecrosis of Jaw (BRONJ): > risk IV. Jaw Pain - >
healing time after ext. “..Dronaid” drugs. Tx:CHX rinse, ATB, conserv surgery

- Garres (proliferative periostitis) and Ewing sarcoma: “onion skin”

BONE LESIONS - MALIGNANT - Numb lip, paresthesia > related to Maligancy.

1. Osteosarcoma: (CT aggressive malignancy where NEW bone (mesenchymal

origin) produced by tumor cell) of jaw -paresthesia & mand growth - #1
primary malignant tumor in children & young adults - “Sunburst“ “symmetric
widening PDL” - 5y survival 25-40%. - Pagets dz of bone: osteosarcoma. Tx.
Resection & chemo

2. Chondrosarcoma: jaw where NEW cartilage produced by tumor cell - >

common condyle of mand due to cartilaginous origin (endochondral ossif)

3. Ewing’s Sarcoma: long bones involving “round cell” - a ects jaw - children -
involves swelling “onion skin”

4. Metastatic Carcinoma: pain - swelling - paresthesia - III de ned changes are

noted. Breast > Lung > Kidney > Colon > Prostate

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HEREDITARY CONDITIONS
1. White sponge nevus: Autosomal dominant - CANT WIPE OFF - asymptomatic
spongy thick white buccal usually bilateral, sometimes: labial mucosa, alv ridge
or FOM (Rare ging margin - dorsum tongue). Before puberty. - DD: Leukoplakia
(later on life)

2. Epidermolysis Bullosa: Autosomal dominant or recessive - CT dz that cause

blisters in skin & mucosa (to be fragile) due to defect in anchoring between
epidermis and dermis. Lethal if severeand blister easily - infants/children

3. Heredirary Hemorrhagic Telangiectasia: Autosomal dominant - telangiectasia

(red macule or papule, dilated or broken capillary, if pressure:pale) abnormal
capillary formation of skin, mucosa and viscera, associated w/ Iron-de ciency
anemia, epistaxis (nose bleed)

1. Olsen-Weber-Rendu sx: lip, gingiva, palate, tongue, FOM: “freckles"

4. Cleidocranial dysplasia: autosomal dominant -missing clavicles-super# teeth

5. Ectodermal dysplasia: X-linked recessive where there are abnormalities of 2+

ectodermal structures (hair, teeth, nail, sweat & salivary gl, cranial facial
structures, digits)—missing teeth (Bud stage) anodontia or oligodontia (partial),
or hypodontia (fewer # of teeth) alveolar bone de ciency - Vertical dimension
lower face is reduced, retained primary teeth, lack of permanent and or growth
of teeth “peg-shaped”ant teeth - hypoplastic hair/nail - sparse hair -
hypohidrotic child (sweat dysfunction)

6. Osteopetrosis - Albers-Schonberg dz and marble done dz: Autosomal dominant

or recessive - lack of bone remodeling & resorption leads to “stone bone”

7. Amelogenesis Imp: Autosomal dominant, recessive or X-linked. Bell stage -

intrinsic alteration of enamel (Malfunction of enamel proteins: ameloblastin,
enamelin, tuftelin & amelogenin) Abnormal color by hypo-plastic pitting enamel
(yellow-brown-grey) - rapid attraction, excessive calculus deposit - gingival
hyperplasia - both dentitions ALL teeth - thin enamel (dentin & pulp normal) - on
x-ray open contacts Tx: full-coverage crowns for esthetics

8. Dentinogenesis Imp: Autosomal dominant, bell stage, intrinsic alteration of

dentin - all teeth BOTH dentition - short & narrow roots, bulbous-short crowns
(due to constricted DEJ) & obliterated pulps - teeth blue-brown and translucent
enamel. Poor mineralized dentin, enamel frequently fractures - rapid wear and
attriction. tx: full coverage crown for esthetics

1. Type 1: is with osteogenic imperfect (blue sclera: eye blue)

2. Type 2: not w/ osteogenic imperfect - only dentinogenesis seen

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 3. Type 3: bradywine type, occurs in absence of OI. Multiple periodical RL,
shell-like (dentin thin - & large pulp chamber) / frequent exposure

9. Dentin Dysplasia: Autosomal dominant, intrinsec alteration of dentin - clinically

crown NORMAL. On x-ray: pulp obliteration, short blunted roots & sometimes
PARL. Both dentitions - Teeth generally mobile, frequent abscess and can be
lost prematurely

1. 1 (short roots - completely obliterated pulp) 2 (chevron pulps). Teeth are not
good candidates for restoring (pulp exposure)

10. Regional Odontodysplasia / odontogenesis imperfecta: enamel hypoplasia

(altered matrix formation - bell stage) quad of teeth w/ short roots, open apex
and enlarged pulp chambers - “Ghost teeth - cells”. Tx: ext of a ected

11. Fusion: tooth # ONE LESS - initiation stage. 2 buds merge into 1 tooth (crown) -
separate root canals - primary > permanent - almost always in ant

12. Gemination: initiation stage - tooth # normal - 1 root bud into 2 crowns. Shared
root canal

- CONGENITAL: dentin dysplasia - amelogenesis imp - ectodermal dysplasia

- NO CONGENITAL: odontogenesis imp - regional odontodysplasia

DENTINOGENESIS IMPERFECTA vs DENTINAL DYSPLASIA

- Ectodermal dysplasia: NOT associated w/ dentinogenesis imperfect

- Dentinal Dysplasia:

- coronal: pulp enlarged “thistle” tube appearance, primary dentition appears

similar to DI type II

- Short roots & open apex kid. Sister has same condition: autosomal dominant
(dentinal dysplasia)

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OTHER COMMON TESTED
NASOLABIAL CYST

- rare non-odontogenic, soft-tissue, development cyst occurring inferior to nasal

alar region. Derived from epith cells retained in mesenchyme after fusion of
medial & lat nasal process + maxillary prominence or due to persistence of
epithelial remmanents from nasolacrimal duct extending between lat nasal
process and maxillary prominence.

- Slow enlarging - asymptomatic swelling

- Not a bone cyst. —> not seen on x-rays

- Lining: pseudo strati ed squamous

- Rarest cyst: lateral periodontal cyst

CAVERNOUS SINUS THROMBOSIS:

- Head and neck drained by valveless veins (retrograde ow from face to sinus)

- CN III, IV, VI, VI (?)

- Vascular congestion (sclera, retina), periorbital edema, proptosis, ptosis, dilated

pupils, absent corneal re ex, ↓ or loss of vision, thrombosis of retinal veins,
chemises (edema of eye conjunctiva), exophthalmos, ptosis, headaches (1st
sign), and paralysis of the nerves that course through the cavernous sinus

- Blood clot formation 2/ in the CN at the base of brain, which drains

deoxygenated blood from brain back to heart. Usually from infection from nose,
sinuses, ears, teeth or forunculo

- Staph aureus and strep. Usually associated

- Life threatening and requires immediate TX

- Max ant, upper lip, canine space are associated “dangerous triangle” (1 point in
bridge of nose and two points corner of mouth) —> send infection back to brain

- Soft tissue abscess, subcutaneous abscess upper lip

LUDWIG’S ANGINA:

- Serious bilateral cellulitis (CT infection) of FOM. If untreated: obstruct airways risk
(needed a tracheotomy)

- Symtoms: swelling, pain and raising tongue, swelling neck & tissues of mand,
sublingual & submental space, malaise, fever, dysphagia, stridor or di culty
breathing, edema of glottis

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 - Infection of mand buccal PM: submandibular space

- Infection in lat pharyngeal space, muscle involved: medial pterygoid

- IAN tract infection involves: pterygomandibular space

TURNERS TOOTH

- Hypoplasia: abnormality in teeth —> missing or ↓ enamel on permanent teeth

- Occurs w/ developing permanent teeth is damaged by periapical infection of

primary, leading to enamel defect

- > common cause: trauma when young - or local infection

DEQUAMATIVE GINGIVITIS DZ:

- liquen plans, pemphigoid (95%)

- Band of red atrophic or eroded mucosa a ecting attached gingiva. Unlike

plaque-induced in ammation, it is a dusky red & extends beyond marginal
gingiva. Often to full width of attached gingiva and sometimes onto alveolar
mucosa.

- Lichen Plans and pemphigoid: sub epithelial

- Pemphigus: suprabasilar vesicle

BELLS PALSY

- unilat facial paralysis w/no cause. There is loss of excitability of facial nerve.
Onset abrupt & most symptoms reach peak in 2 days. 1 theory is that nerve
becomes in amed within temporal bone (viral etiology)

- Droopy eyelid, unable to close it.

- Droopy corner of mouth

- Herpes simplex: most common cause - also it says is “idiopathic”

ANKYLOGLOSSIA

- congenital anomaly, ↓ tongue mobility - caused by unusually short, thick lingual

frenulum from tongue to FOM

PARULIS (GUM BOIL)

- Parulis: localized collection of pus in gingival soft tissue. As a result of necrosis

of non-vital pulp tissue or occlusion of deep perio pocket

- Incomplete RCT can cause it

CROHNS DZ

- Child w/ granulomatous gingival hypertrophy and bleeding recta-anus

- In ammatory bowel dz that a ects lining of GI tract, rectal bleeding

- Oral granulomas, apthous ulcer

TRIGEMINAL NEURALGIA

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 - average onset: 60s. But can occur at any age. Symptomatic or secondary tends
to occur in young patients >35yo

- Nature of pain: electric shock like sensation. Brief (1-2min) and paroxysmal. May
occur severe times a day, and between episodes no pain.

- Distribution: Unilateral. Usually V2 and V3 are involved.

- Tx: carbamazepine

PERIPHERAL OSSIFYING FIBROMA

- gingival nodule composed of broblastic CT stroma, associated w/ formation of

randomly dispersed mineralized products (bone, cementum-like, or dystrophic
calci cation)

- “Lesion in gingiva that - Reveals bone formation”

AURICULOTEMPORAL SYNDROME / FREYS SYNDROME

- Strong salivation. Sweat near cheek when eating. Often after parotid surgery

CONDYLAR HYPERPLASIA

- unknown etiology.

- Persistent or accelerated growth of condyle when growth should be slowing or

ended.

- Slowly progressive unilateral enlargement of heads & neck of condyle —> cross
bite, facial asymmetry, shifting to una ected site. Pt may appear prognathic.

KERATOACANTHOMA

- Relatively common low-grade tumor that originates in pilosebaceous gl & closely

resembles SCC

- Buccal mucosa

- Has a bump with crusty crater in the middle, BCC can be pink, waxy/pearly or
skin colored or brownish, and looks more at with crust

EAGLE SX

- Sharp nerve pain in jaw bone and join, back of throat, base of tongue. Triggered
by swallowing, moving jaw or turning neck.

- Caused by elongated styloid process or calci cation of stylohyoid ligament.

ORAL PATHOLOGY
QUESTIONS AND ANSWERS
1. One of the primary etiologic agents of aphthous (Inmunologic nature) stomatitis
is proposed to be: Human leukocyte antigen

2. Intracellular viral inclusions are seen in tissues specimens of which of the

following? Hairy leukoplakia

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 3. Sjogren’s syndrome has been linked to which of the following malignancies?
Lymphoma. Sjogrens syndrome involves lymphocytes

4. Acantholysis, resulting from desmosome weakening by autoantibodies directed

against the protein desmoglein, is the disease mechanism attributed to which of
the following? Pemphigus vulgaris

5. HPV has been found in all of the following (oral papillomas, verruca vulgaris,
condyloma acuminatum, focal epithelial hyperplasia) lesions except:
Condyloma Latum (syphilis)

6. Syndromes presents with light-brown patchy macule (cafe au lait spots):

Neuro bromatosis type I (von Recklinghausen’s disease)

7. Conservative surgical excision would be appropriate tx and probably curative

for which of the following? Since is conservative will not be malignant —>
nodular fasciitis

8. A cutaneous maculopapular rash of the head and neck preceded by koplik’s

spots in buccal mucosa would suggest? Rubeola

9. Which syndrome classical contains lessons on oral, ocular, genital regions?

Behcet’s syndrome

10. The odontogenic neoplasm, which is composed of loose, primitive-appearing

connective tissue that resembles dental pulp, microscopically is called:
odontegenic myxoma —> slimy stroma mixoma.

11. Which of the following odontogenic cyst occurs as a result of stimulation and
proliferation of the reduced enamel epithelium? Dentigerous cyst

12. 2 cystic RL in the mandible of a 16 yo boy were lined by the, parakeratinezed

epithelium showing palisading of basal cells. All teeth were vital, and the patient
had no symptoms. —> odontogenic keratocysts

13. When a diagnosis of odontogenic keratocyst is made, the pt should be advised

regarding the__. Aggressive and recurrente rate

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