Mosby Part 2

Front 1

Pulp Pain fibers

Back 1

A-delta
- Larger myelinated nerves that cause quick, sharp, momentary pain that quickly dissapates
- Intimate Association with odontoblastic cell layer and dentin is referred to as Pulpodentinal Complex

C afferent fibers
- Small unmyelinated nerves that course centrally in pulpal stroma
- Diffuse Pain occurs with tissue injury and is mediated by inflammatory mediators, vascular changes, and increase in pressure
- Felt as dull aching pain when exaggerated A-delta pain subsides and can spread to other teeth.
- Signifies Irreversible local tissue damage

Front 2

Hyperalgesia

Back 2

Exaggerated and disproportionate pulpal response to challenging stimulus

Front 3

Pulpodentinal Complex

Back 3

Intimate association of A-delta fibers with odontoblastic cell layer and dentin

*- C fibers are not associated with the Pulpodentinal complex

Front 4

Pulpal Disease Clinical Classifications - 4

Back 4

1) WNL
2) Reversible pulpitis
3) Irreversible pulpitis, Symptomatic and Asymptomatic
4) Necrosis

Front 5

WNL Pulpal classification - 3

Back 5

1) Asymptomatic
2) Normal pulp produces mild to moderate transient response to thermal and electrical stimuli and subsides almost immediately when stimulus is removed
3) No painful response upon percussion or palpation

Front 6

Reversible Pulpitis classification - 3

Back 6

1) Thermal stimuli causes quick, sharp, hypersensitive response that subsides quick when removed
2) Can be caused by caries, SRP, Deep restorations without a base
3) If irritant is removed, will return to healthy state

Front 7

How to distinguish between Reversible and Irreversible Pulpitis and Crossover Point

Back 7

1) Reversible pulpitis causes momentary painful response to thermal change that subsides quickly which Irreversible causes lingering pain
2) Reversible pulpitis does not involve spontaneous pain

Crossover Point: Frank penetration of bacteria into the pulp

Front 8

Irreversible Pulpitis Classification - 3

Back 8

Classified as Symptomatic and Asymptomatic Irreversible Pulpitis

1) Pulp has damaged beyond repair
2) See micro abscess of pulp begin as tiny zones of necrosis with inflammatory cells. Intact nerves seen in areas of degeneration
3) Pulpal death may occur quickly or require years. May be painful or asymptomatic

Front 9

Asymptomatic Irreversible Pulpitis possible Consequences - 2

Back 9

1) Hyperplastic Pulpitis - Reddish cauliflower growth of pulp tissue through carious exposure. Attributed to low-grade chronic irritation and generous vascular supply in young people
2) Internal Resorption
- Commonly identified during routine radiographic exam and can perforate the root
- Only prompt Endodontic therapy will prevent further tooth destruction

Front 10

Histological Appearance of Chronic Pulpitis - 3

Back 10

1) Chronic Inflammatory cells
2) Multinucleated giant cells adjacent to Granulation tissue
3) Necrotic pulp coronal to resorptive defect

Front 11

Symptomatic Irreversible Pulpitis - 4

Back 11

1) Spontaneous intermittent or continuous pain
2) Temperature changes and sometimes Postural changes elicits prolonged episodes of lingering pain
3) May see thickening of apical portion of PDL
4) Electric pulp test has little value in diagnosing Symptomatic Irreversible Pulpitis

Front 12

Necrotic Pulp classification - 4

Back 12

1) May result from untreated irreversible pulpitis, traumatic injury, or any even causing long term interruption to pulp blood supply
2) May be partial or total. Partial necrosis such as in one canal may present as irreversible pulpitis. Total necrosis is Asymptomatic before it affects PDL with no response to thermal or EPT
3) May present with Crown Discoloration in anterior teeth
4) Protein breakdown and bacterial toxins will spread down apical foramen to cause thikening of PDL and sensitivity to percussion and chewing

Front 13

Microscopic characteristics of Necrotic Pulp - 3

Back 13

1) Liquefaction Necrosis in center of pulp due to inflammation
2) Increase in tissue pressure and destruction due to Insufficient drainage caused by lack of collateral circulation and unyielding dentin walls
3) Bacteria penetrating Dentinal Tubules, so its important to remove superficial layers of dentin during cleaning and shaping of canals

Front 14

General Characteristics of Periradicular diseases - 3

Back 14

Sign most indicative of a periradicular inflammatory lesion is radiographic bone resorption but is unpredictable

No correlation between histologic findings and clinical signs.

Acute and Chronic refers to clinical signs

Front 15

Classification of Periradicular disease - 5

Back 15

Acute Periradicular Periodontitis

Acute Periradicular Abscess (Acute Apical Cyst)

Chronic Periradicular Periodontitis

Suppurative Periradicular Periodontitis (Chronic Periradicular Abscess)

Chronic Focal Sclerosing Osteomyelitis (Condensing Osteitis)

Front 16

Acute Periradicular Periodontitis cause and characteristics

Back 16

Can be due to
- Extension of pulpal disease
- Canal overfill
- Occlusal trauma

May occur around vital and non vital teeth so pulp test to confirm need for endo

Front 17

Acute Periradicular Abscess cause and characteristics

Back 17

aka Acute Apical Abscess
- Painful purulent exudate around apex
- Result from exacerbation of Acute periradicular periodontitis

- Rapid onset of swelling, pain, mobility
- May be localized or spread to become Cellulitis

Front 18

Phoenix Abscess

Back 18

Infection and rapid tissue destruction arising from within chronic periradicular periodontitis

Same symptoms as acute apical abscess

When Periapical radiolucency is evident in Acute periradicular abscess its called a Pheonix Abscess

Front 19

Chronic Periradicular Periodontitis Cause and Diagnosis

Back 19

- Long standing lesion usually accompanied by radiographic apical resorption

- Caused by bacteria and endotoxin release into periapical region from necrotic pulp, which provides safe harbor for bacteria from no vascularity

Diagnosis confirmed by
1) Absence of symptoms
2) Confirmation of pulpal necrosis
3) Radiographic presence of periapical radiolucency

Front 20

Chronic Periradicular Abscess

Back 20

aka Suppurative Periradicular Periodontitis

- Characterized by draining sinus tract
- May also drain through gingival sulcus mimicking a peridontal pocket
- Resolves with non-surgical RCT

Front 21

Condensing Osteitis

Back 21

aka Chronic Focal Sclerosing Osteomyelitis

- Excessive bone mineralization around apex of asymptomatic vital tooth
- Caused by low grade pulp irritation
- Benign and Does not require RCT

Front 22

Characteristics of Non-odontogenic pain

Back 22

- Episodic pain with remission
- Pain travels across midline
- Pain that is seasonal or cyclic and surfaces with increasing mental stress
- Paresthesia

Front 23

Systemic contraindications for RCT

Back 23

Uncontrolled diabetes or MI within 6 months

Front 24

Patient's description of pain location

Back 24

- Pulp tissue only transmits pain, and no proprioception

- Once infection reaches PDL, proprioceptive fibers will allow easier identification

Front 25

Referred odontogenic Pain

Back 25

- Rare to cross midline
- Pain in molars can be referred to opposing quadrant or other teeth in same quadrant
- Maxillary molars refer pain to zygomatic, parietal, and occipital regions
- Mandibular molars refer pain to ear, angle of jaw, or posterior neck

Front 26

Palpation

Back 26

When periradicular inflammation from pulpal necrosis has begun burrowing through facial cortical bone affecting overlying mucoperiosteum
- May feel tenderness before swelling is evident

Front 27

Percussion

Back 27

- Does not reveal health of pulp but shows inflammation of apical PDL
- Degree of response correlates to degree of PDL inflmmation
- Clinician should first percuss with finger, then move to mirror if patient is unable to discern

Other causes of percussion sensitivity
- Rapid ortho movement
- Recently placed restoration in hyperocclusion
- Lateral Periodontal Abscess

Front 28

Thermal Test

Back 28

Valuable to pinpoint when pain is diffuse. Careful to avoid refractory response from repeated stimulation

4 Responses
- No response: Non vital pulp, or may be false negative from calcification, immature apex, or recent trauma
- Mild to Moderate response with 1-2 seconds. Normal
- Strong painful response that subsides in 1-2 seconds. Reversible pulpitis
- Strong response that lingers. Irreversible Pulpitis

Cold test
- Cold water bath, ice, Ethyl chloride, Dichlorodifluoromethane (DDM;Endo-Ice), Carbon dioxide ice sticks
- Use cotton pellet in middle 3rd of facial surface for 5 sec or when patient feels pain

Heat test
- Hot water bath will yield most accurate patient response

Front 29

EPT

Back 29

Contraindicated with Pace Makers
- Does not suggest health or integrity of pulp, and does not provide information about vascular supply to pulp
- Does not correlate with histologic health or disease status or pulp
- Only indicates that there are vital sensory fibers within pulp


- Dry tooth and code Electrode with viscous conductor
- Apply to middle third of facial surface. Not to restorations

False Positives
- Contact electrode with metal restoration of gingiva
- Patient anxiety
- Failure to isolate

False Negatives
- Patient heavily premedicated
- Recently traumatized tooth or excessive calcification of canal
- Partial Necrosis

Front 30

Mobility Endo test

Back 30

Tooth mobility is directly proportional to integrity of attachment apparatus or extent of PDL inflammation

Other causes for mobility
- Horizontal root fracture
- Recent trauma
- Chronic Bruxism
- Excessive Ortho

Front 31

Radiographic PA radiolucency initiation

Back 31

Does not appear until demineralization extends through cortical plate of bone

Front 32

Cracked Tooth Syndrome symptoms, diagnosis, and treatment

Back 32

- Sustained pain during biting and upon release
- Sensitivity to thermal changes and mild stimuli

Diagnosis
- Transillumination & Tooth Slooth
- Stain or use stream of air to detect pain from crack

Treatment
1) Healthy pulp - Splint with ortho or prep and observe with temp
2) Irreversible pulpitis or necrosis - Endo and crown, maybe post

Front 33

Vertical Root Fracture

Back 33

- Usually in buccal lingual plane
- May show J shaped radiolucency from apex to middle of root
- May be caused by mechanical stress and over enlargement from obturation or unfavorable posts

Diagnosis is confirmed with exploratory flap

- Hopeless prognosis. May do hemisection for a multi-rooted tooth

Front 34

Perio-Endo relationships communication, characteristics, and types

Back 34

Communicates via Tubules, Lateral or accessory canals, Furcation canals, or apical foramen

- Endo can cause perio disease but perio generally doesn't cause endo

Types
Primary Endo lesion
- Non vital tooth, with possible sinus tract appearing like narrow pocket
- Treat with endo

Primary perio
- Starts in sulcus and migrates to apex
- Broad based pocket formation in vital tooth
- Treat with periodontal therapy

Primary Perio with secondary Endo
- Deep pocketing with extensive perio
- Endo First then periodontal therapy

True Combined lesions
- Once endo and perio lesions coalesce, they are indistinguishable
- Prognosis depends on the degree of periodontal component

Front 35

Working Length determination

Back 35

Select reference point and take diagnostic film with 10k or 15k file

Estimate working length and adjust to 1mm short of radiographic apex

Front 36

File Dimensions

Back 36

D0 - File size a tip. Size 8 file is 0.08mm at tip

D16 - Diameter where cutting flutes end, usually 16mm for most files

Taper - Amount that the file diameter increases each millimeter up from tip.

8 file with 0.02 taper
D0 - 0.08mm
D16 - 0.4

Front 37

Best indicator of clean walls

Back 37

Level of smoothness obtained

Front 38

Irrigation and Medicaments

Back 38

Sodium Hypochlorite - NaOCl
- Disinfects root canals with Hypochlorite Anion ClO-
- Dissolves Organic matter
- DOES NOT remove smear layer

EthyleneDiamineTetraAcetic acid - EDTA
- Aqueous solution of 17% EDTA
- Removes Inorganic matter and Smear layer
- Chelating agent

Calcium Hydroxide - CaOH
- Best intracanal medicament
- High pH causes antibacterial affect
- Inactivates LPS and dissolves tissue

Front 39

Sodium Hypochlorite Accident

Back 39

Signs & Symptoms
- Instant extreme pay
- Excessive bleeding from tooth
- Rapid swelling
- Bruising and sensory/motor deficits

Treatment
- Long lasting anesthetic
- Steroids & Antibiotics
- Daily follow up

Front 40

Gutta Purcha advantage and disadvantage

Back 40

Advantages
- Plasticity
- Easy to manage and remove
- Little toxicity and does not support bacterial growth

Disadvantage
- Does not seal without sealer
- Lack of adjesion to dentin
- Elasticity causes rebound and cooling shrinkage

Front 41

Trephination

Back 41

Surgical perforation of alveolar cortical bone to release accumulated exudates

Front 42

Anesthesia in presence of infection

Back 42

Difficult to achieve due to acidic pH of abscess and Hyperalgesia

Front 43

Root end resection indications, contraindications, and procedure

Back 43

aka Periradicular surgery or Apicoectomy

Indications
- Persistent or enlarging PA pathosis following RCT
- Biopsy

Contraindications
- Anatomic & Neurovascular factors
- Nonrestorability, Poor crown to root

Procedure
- Remove diseased root tip
- Use a lesser bevel 0-20 degrees rather than traditional 45deg to decrease leakage
- Remove 3mm if possible and leave 3mm for root end cavity prep and filling

Front 44

Hemisection

Back 44

Surgical division of a multirooted tooth and defective half is extracted

Indications
- Class 3 or 4 periodontal furcation defect
- Vertical root fracture
- Coronal fracture extending to furcations

Requires RCT treatment on all retained root segments. Preferable to complete root canal with permanent restoration prior to hemisection

Front 45

Bicuspidization

Back 45

- Surgical division where both halves are retained
- Results in separation of roots and creation of two separate crowns

Front 46

Root resection

Back 46

aka Root amputation

Removal of one or more roots of a multi-rooted tooth
- Requires RCT in all retained root segments preferably beforehand

Front 47

Intentional Replantation

Back 47

Insertion of a tooth into its alveolus after the tooth was extracted to do a root-end filling
- Indicated when PA surgery is not possible or presents a high risk to anatomical structures
- If possible, preform RCT before procedure

Front 48

Surgical removal of apical segment of fractured root

Back 48

Indicated when coronal tooth segment is restorable and functional
- Raise flap, remove targeted tissue

Front 49

Categories of Endo emergency

Back 49

Pretreatment
- Presents with pain and/or swelling
- Challenge is diagnosis and treatment of offending tooth

Interappointment and postobturation emergency
- aka Flareup
- Easier to manage since offending tooth was identified
- No relationship exists between flareups and treatment procedures

Front 50

Management of Painful Irreversible Pulpitis

Back 50

- Complete RCT is preferred tx
- Pulpotomy is usually effective in absence of percussion sensitivity
- Chemical medicaments sealed in chambers are not effective for pain
- Antibiotics are not indicated

Front 51

Management of Pulpal necrosis with PA pathosis

Back 51

No swelling
- Complete canal debridement

Localized swelling
- Complete debridement and drainage from tooth and/or mucosa
- Seldom have elevated temperatures so antibiotics are not necessary

Diffuse swelling into facial spaces
- Most important is removal if irritant via canal debridement or exo
- Swelling incised and drained with possible drain insertion for 1-2 days
- Systemic antibiotics are indicated for diffuse rapid swelling

Front 52

Glutaraldehyde

Back 52

Only used for instruments that can't withstand heat
- 24hrs of immersion are required to achieve cold sterilization
- Immersion is good for disinfection but will not sterilize

Front 53

Pressure sterilization

Back 53

Wrapped and autoclaved
- 121 deg Celcius and 15psi
- 20 Minutes
- Kills all bacteria, spores, and viruses
- Chemical instead of water causes less rusting
- Both steam and chemical will dull edges of cutting instruments

Front 54

Dry Heat Sterilization

Back 54

Best for preserving cutting edges
- 60minutes after reaching 160 Celcius
- If falls below 160, must repeat full 60 minute cycle
- Disadvantage is time required for sterilization and cooling

Front 55

Endo Disinfection

Back 55

Sponge soaked in 70% Isopropyl alcohol or Quaternary ammonium solutions
- Cleans but does not disinfect instrument

Front 56

Endo radiograph technique

Back 56

Paralleling technique is most accurate
- Less distortion and better reproducibility

Modified parallel technique is acceptable

Bisecting angle is lease accurate technique

Front 57

Exposure and film

Back 57

E film at intermediate kilovoltage - Adequate clarity and decreased exposure

F film - requires 20-25% less exposure than E film

Front 58

Optimal Voltage setting for maximal contrast

Back 58

70 kV gives maximal contrast between radiopaque and radiolucent structures

Front 59

Microbiology of Endo, Primary vs Secondary

Back 59

- Polymicrobial infection
- Positive correlation between number of bacteria and size of Periradicular Radiolucency

Primary
- Strict Anaerobes predominate
- Gram Neg: Porphyromonas species and Bacteroides Melaninogenica
- Gram Pos: Actinomyces from root caries

Secondary
- From unsuccesful RCT
- High faculative anaerobes
- Enterococcus Faecalis: Rarely found in infected but untreated tooth

Front 60

LPS in endodontics

Back 60

Endotoxin found on surface of Gram Negative bacteria
- Capable of diffusing across dentin
- Relationship has been established between presence of endotoxins and PA inflammation

Front 61

Antibiotics used in Endo

Back 61

Pen VK
- First choice and effective against most strict anaerobes and gram positive faculative anaerobes

Clindamycin
- Effective against many gram pos and neg, strict and faculative anaerobes

Metronidazole
- Effective against strict anaerobes but not others

Front 62

Transportation

Back 62

Tendency of files to cut dentin towards the outside of the curvature at the apical portion of root
- May gouge into dentin and create a ledge or perforation

Front 63

Types of perforations

Back 63

Coronal perforation

Furcal perforation
- usually occurs during searching for canal orifices
- Must be repaired Immediately

Strip perforations
- Involves Furcation side of coronal root surface
- Result of excessive flaring

Root perforations
- Apical perforation
- Midroot perforation

Front 64

Prognosis of Perforations

Back 64

Perforation into PDL results in a questionable prognosis and patient must be informed
- If located above alveolar bone, more favorable. Can repair with restoration
- If below crest, attachment often recedes to extent of defect and perio pocket forms

Front 65

Treatment of Perforations

Back 65

Surgical repair: Try to position apical portion of defect above crestal bone
- Hemisection
- Root amputation
- Intentional replantation

Nonsurgical repair
- Mineral Trioxide Aggregate (MTA) has show to promote deposition of cementum like material

Front 66

Exam of Traumatic injuries of teeth

Back 66

- Teeth are sensitive to percussion
- Apical displacement with injuries to vessels may result in pulpal necrosis

Vitality testing
- Testing immediately following injury may yield a false negative
- Should serve as baseline for future reference up to 6-12 months
- Tests should be repeated at 3wks, 3 months, 6 months, 12 months, and yearly

Front 67

Uncomplicated Fractures

Back 67

1) Infraction - Incomplete crack of enamel without loss of tooth struction

2) Ellis Class I - Enamel fracture
- Involves enamel only
- Grind and smooth rough edges or restore lost structure

3) Ellis Class II - Crown fracture without pulpal exposure
- Enamel and Dentin only
- Restore with bonded resin

Front 68

Complicated Fractures

Back 68

Ellis Class III
- Involves pulp exposure

Treatment depends on factors
- Immature tooth, vital pulp therapy should be attempted
- Within 24hrs after traumatic injury, initial reaction is proliferative with no bacteria
- Periodontal injury compromises nutritional supply
- More complex restorations should have RCT first

Front 69

Horizontal Root Fracture Diagnosis and Healing Patterns,

Back 69

Coronal segment is usually displaced and apical segment remains fixed
- May have necrosis of coronal segment while apical segment remains vital
Diagnosis
- May be oblique, and PA may miss it
- Radiographs should include an occlusal, and three PA's, 0deg, +15deg, and -15deg from vertical

Healing patterns: Four types. First three is good
1) Healing with calcified callus at fracture site. Ideal healing
2) Healing with interproximal connective tissue
3) Healing with bone and connective tissue
4) Interproximal inflammatory tissue without healing

Front 70

Horizontal Root Fracture Treatments and Prognosis

Back 70

Coronal fracture
- Extremely Poor prognosis
- Stabilize coronal fragment with rigid splint for 6-12wks
- May have to extract coronal portion and restore root later

Midroot fracture
- Stabilize for 3 wks
- Pulp necrosis occurs 25% of time usually limited to coronal segment

Apical Root fracture
- Best prognosis
- Pulp will most likely be vital and tooth will have little to no mobility

Prognosis
- Improves approaching the Apex
- Horizontal > Vertical
- Oblique > Transverse
- Non-displaced > Displaced

Front 71

Luxation types

Back 71

Ellis Class V
- Tooth Dislocated from Alveolus

1) Concussion: No displacement with normal mobility
- Take baseline vitality and make Occlusal adjustment. No immediate treatment

2) Subluxation: Tooth is loosened but not displaced
- Baseline vitality and occlusal adjustment
- Splint for 3wks if mobile
- 6% rate of pulpal necrosis with closed apicies
- 0% with open apicies

3) Extrusion or Lateral Luxation: Partially extruded from socket
- May have involved alveolus
- Take radiographs, reposition teeth, and splint
- Endo if necessary
- 65% necrosis for Extrusive, 80% for Lateral Luxation

4) Intrusive Luxation: Apical displacement
- If immature tooth, allow to re-erupt
- Mature teeth can have orthodontic or surgical repositioning
- Endodontic treatment is indicated since there is 96% rate of necrosis

Front 72

Ellis Class 4

Back 72

Traumatized tooth that has become non-vital without loss of tooth structure

Front 73

Avulsion Treatment

Back 73

Ellis Class 6- Complete separation from Socket

Treatment
- Reimplant immediately if possible to prevent tooth resorption
- Critical time: 90% if less than 15 minutes, 50% at 30 minutes, and 10% at 60 minutes

Closed Apex
1) Less than 1 hour
- Do not handle root surface and do not curette socket
- Reimplant and stabilize for 7-10days
- PCN 4x a day for 7 days or Doxycycline 2x a day for 7 days
- Refer to Physician for Tetanus
2) Greater than 1 hour
- Remove debris and necrotic PDL
- Immerse in 2.4% Sodium Flouride with 5.5 pH for 5min and reimplant
- Stabilize and give antibiotics
- Refer for Tetanus

Open apex
1) Less than 1 hour
- Clean if contaminated with saline stream
- Place in doxycycline 1mg/20ml saline
- Stabilize and give antibiotics
- Refer for tetanus
2) Greater than 1 hour
- Replantation is usually not indicated

Endo tx
1) Closed Apex
- Initiated 7-10 days
- Give long tern CaOH if RCT is delayed or resorption is present
2) Open Apex
- Should check for Re-Vascularization and avoid Endo treatment.

Front 74

Tooth Storage Media

Back 74

Optimal Storage Environment (OSE) maintains and reconstitutes metabolites
- Viaspan
- Hank's Balanced Salt Solution (HBSS)

Wet: Maintains viability
- Milk
- Saline
- Saliva: Hypotonic, Cell lysis
- Water: Least desirable

Front 75

Consequence of Attachment damage

Back 75

External Resorption
1) Surface resorption
- Extremely common and self limiting
- Due to mechanical damage to Cementum
- Root surface undergoes destruction and repair

2) Replacement Resorption
- Ankylosis Occurs in 60% of replanted teeth
- Continous replacement of loss root with bone
- Show progressive submergence and is irreversible
- Metallic sound upon percussion

3) Cervical Resorption
- May be due to trauma, ortho or perio treatment, and bleaching
- Vitality testing normal
- Usually begins at attachment level CEJ and has moth eaten appearance
- May mimic cervical caries or internal resorption
- Pink spot possible due to granulation tissue
- Surgically remove granulation tissue and restore

Front 76

Consequence of Neurovascular Supply damage

Back 76

1) Pulpal Obliteration: Calcific Metamorphosis
- 27% of postluxation complications
- Increased chance with immature teeth, intrusions, and severe crown fractures

2) Pulpal necrosis
- Concussion 2%
- Subluxation 6%
- Extrusion 65%
- Lateral Luxation 80%
- Intrusion 96%
- Immature development 17%
- Mature development 68%

3) Inflammatory Resorption
- Occurs as bacteria and toxins enter dentinal tubules and lowers pH
- Shows bowl shaped resorption in dentin and cementum as early as 3wks post trauma
- Usually at apical 3rd of root, may progress into entire root

Front 77

Materials for Pulp therapy

Back 77

Calcium Hydroxide
- High pH of 12.5 cauterizes tissue and causes superficial necrosis
- Encourages pulp to induce hard tissue repair with secondary odontoblasts

Mineral Trioxide Aggregate (MTA)
- Portland Cement derivative made of Fine Hydrophilic Particles
- Calcium phosphate and Calcium oxide
- Sets in moisture and is non-resorbable

Front 78

Indirect Pulp Cap

Back 78

Material is placed on thin remaining carious dentin
- Used when teeth have deep carious lesions near the pulp but no signs of pulpal degeneration
- Wait 6-8wks for deposition of reparative dentin to allow remineralization

Front 79

Direct pulp cap

Back 79

Dental material placed directly on a vital pulp exposure
- Pulp exposed less than 24hrs
- Asymptomatic with small exposure site
- Test and take radiograph at followup

Front 80

Partial Pulpotomy

Back 80

Surgical removal of a small portion of coronal pulp tissue
- Used when inflammation is less than 2mm into pulp chamber but hasn't reached roots or with traumatic exposures less than 24hrs
- Test and take radiograph at next visit

Front 81

Pulpotomy

Back 81

Surgical removal of coronal portion of vital pulp to preserve vitality of remaining radicular pulp
- Vital pulp in immature teeth with exposure after 72hrs
- No history of spontaneous pain, abscess, radiolucency or mobility
- Cannot determine if all diseased tissue was removed

Front 82

Apexogenesis

Back 82

Maintain pulp vitality to allow development of entire root
- Root formation is usually complete 3yrs after eruption
- Used in immature tooth with incomplete root formation with damaged coronal pulp but healthy radicular pulp

Front 83

Non-Vital pulp therapy

Back 83

Pulpectomy
- Not vital pulp therapy because tooth is pulpless

Apexification
- To stimulate formation of calcified tissue at open apex of pulpless teeth
- Used for teeth with open apices that can't be obturated

Front 84

Internal bleaching techniques

Back 84

1) Thermocatalytic Technique
- Place oxidizing agent, 30% H2O2 Superoxol, in chamber and apply heat
- May have external cervical resorption from chemicals and heat

2) Walking bleach
- Place mix of Sodium Perborate and water in chamber
- Return in 2-6wks

Front 85

Considerations of Endodontically treated teeth

Back 85

- Major cause of endo failure is Coronal Leakage. Coronal seal is more important than Apical seal
- Endo treated teeth do not become brittle, and moisture content stays the same
- Presence of PA lesion will reduce success rate of Endo by 10-20%
- 1mm Ferrule will have double the fracture resistance
- Atleast 4-5mm of apical gutta percha is recommended after Post insertion

Front 86

Strep Mutans

Back 86

- Nonmotile gram-positive cariogenic bacteria
- Adheres to enamel and forms polysaccharide to adhere to tooth
- Produces and tolerates acid
- Thrives on sucrose
- Produces Bacteriocins to kill off competing organisms

Front 87

Site of Initial decalcification

Back 87

Initial decalcification occurs at the subsurface and may take 1-2 years before cavitating

Front 88

Protective mechanism of Saliva

Back 88

1) Glycoproteins clear
2) Urea and other compounds buffer
3) Lysozyme, Lactoferrin, Lactoperoxidase, and IgA are antimicrobial
4) Remineralization

Front 89

Benefits of Fluoride

Back 89

- Bacteriocidal
- Provides fluoride ion for remineralization

Front 90

Xylitol

Back 90

Natural 5 Carbon sugar from Birch trees
- Cannot be fermented by MS

Front 91

Indirect Tooth colored restorations

Back 91

Processed Composites
- Improved wear resistance against direct composites
- Indicated for conservative Class 1 and 2 restorations

Felspathic Porcelain
- Highly esthetic but high incidence of fracture
- Also wears opposing teeth

Cast Ceramic
- Excellent fit, and superior strength
- Also low abrasion

CAD/CAM
- One appointment is required
- Superior physical characteristics compared to direct composite and highly esthetic
- More costly

Front 92

Indication for Cast Metal Restorations

Back 92

- May be treatment of choice for patients undergoing occlusal rehabilitation
- Also good for preps with deep subgingival margins

Front 93

Hand Instrument Materials

Back 93

Carbon Steel
- Harder than stainless steel
- Corrodes if unprotected

Stainless steel
- Will not corrode but will lose it's edge

Carbide
- Hard and wear resistant
- Brittle

Front 94

Instrument Design

Back 94

Cutting
- Handle, Shank, Blade

Non cutting
- Part corresponding to blade is the Nib.
- End of the Nib, or working surface is called the face

Front 95

Cutting instrument formulas

Back 95

First number
- Width of blade in tenths of a millimeter

Second number
- Primary cutting edge angle from line parallel to handle in clockwise centigrade.
- Expressed as a percent of 360deg and usually exceeds 50
- If edge is perpendicular to the blade, then this number is usually omitted

Third number (Or second in a 3 number)
- Blade length in millimeters

Fourth number (Or third in a 3 number)
- Blade angle relative to long axis of handle in clockwise.
- This number is always 50 or less

Front 96

Common Design of Burs

Back 96

Shank
Neck
Head

Front 97

Round Bur

Back 97

- Initial Entry
- Extension of preps for retention and caries removal

Front 98

Excavators

Back 98

Hatchet
- Cutting bedge is parallel to handle and is bibeveled

Hoes
- Primary cutting edge of blade is perpendicular to axis of handle
- Usually used in a pull motion

Angle formers

Spoons

Front 99

Handpiece Speed Ranges

Back 99

Slow Speed
- 12k RPM

Intermediate
- 12k - 200k RPM

High Speed
- Greater than 200k RPM

Front 100

Inverted Cone Bur

Back 100

- Apex directed towards shank
- Head length is appx same as diameter
- Used for making undercuts

Front 101

Parts of Diamond Instrument

Back 101

Metal Blank

Powdered diamond abrasive

Metallic bonding material honding diamond powder onto blank

Front 102

Initial Preparation

Back 102

Extension of preparation walls to sound tooth structure in all directions except pulpally
- Extension to initial depth of 0.2 to 0.75mm into dentin

Front 103

Enameloplasty

Back 103

Removal of defect no deeper than 25% thickness of enamel
- If thicker than one fourth, wall must be extended

Front 104

Pulpal Communication Size

Back 104

<1mm
- Direct Pulp cap
- Use Calcium Hydroxide and Resin Modified Glass ionomer

>1mm
- Endo treatment

Front 105

Liners and Bases

Back 105

Liner
- To cover a direct or near pulpal exposure with calcium hydroxide
- May use RMGI for composites as stress breakers for class 1 or on root-surface portion of class 2

Base
- Additional bulk provides mechanical and thermal protection to pulp under metal

Front 106

Amalgam Liners and bases

Back 106

Shallow - 2mm or more
- Dentin sealer or desensitizing agent such as Gluma Desensitizer is used

Moderately Deep - 0.5-2mm
- Light cured RMGI base can be considered followed by dentin sealer/desensitizing agent
- Goal is to provide the 2mm

Deep - May involve exposure less than 1mm
- Calcium Hydroxide 0.5-0.75mm
- RMGI base
- Gluma Desensitizer

Front 107

Composite & Cerec liners and bases

Back 107

Shallow to moderately Deep
- If more than 0.5mm, no liner or base is needed

Deep
- Calcium hydroxide 0.5-0.75mm
- RMGI Base
- Gluma Desensitizer

Front 108

Gold liners and bases

Back 108

Shallow
- Nothing is needed
- RMGI cement can be used for cementation

Moderately deep
- RMGI for axial and pulpal wall contour

Deep
- Calcium hydroxide, RMGI,

Front 109

Amalgam types and properties

Back 109

Low Copper
- Generally Inferior

High Copper
1) Spherical
- Greater Leakage
- Greater postoperative sensitivity
2) Admix

Properties
- Linear coefficient of Thermal Expansion is greater than tooth
- Tensile strength is lower than tooth
- Compressive strength is similar
- Brittle, and low edge strength
- High Thermal Conductivity

Front 110

Initial Amalgam Prep Depth

Back 110

0.2mm inside DEJ or 1.5mm from central groove whichever is deeper
- Initial depth of axial wall should be 0.2mm inside DEJ with no retention locks, 0.5mm if retention locks are used

- Axial depth on root surface should be 0.75 to 1mm deep

Front 111

Tooth Damage

Back 111

Attrition - Normal tooth wear

Abrasion - Mechanical wear from external source such as toothpicks

Erosion - Wear due to chemical presence

Abfraction - Biochemical loading causing bending and damage at cervical

Front 112

Composite shrinkage forces

Back 112

Up to 7 Megapascals

1MPa = 150lb/sq inch

Front 113

Total Etch micrscopic effects

Back 113

Tooth structure etched with 35% phosphoric acid to open microspaces in enamel and dentin
- Etched enamel looks chalky, Dentin does not

Etched dentin exposes layer of collage and primer raises collagen

Adhesive flows between collagen and interlocks with it to form a hybrid layer
- Most bond strength is from formation of hybrid layer

Seals the dentin

Front 114

Etch, Primer, and Adhesive/Bond

Back 114

Etch
- 35% Phosphoric acid
- Etches our hydroxyapatite to leave collagen fibrils
- Removes smear layer
- Widens dentinal tubules
- Demineralized dentin surface

Prime
- Hydroxyethyl Methacrylate/bi-phenyl dimethacrylate (HEMA/BPDM)
- Resin monomer wetting agent
- Wets dentin to increase surface tension and bonds to overlying resin

Bond
- Bisphenol A glycidyl Methacrylate (BISGMA)
- Penetrates primed intertubular dentin and tubules
- Bonds primer and composite

Front 115

Self Etching Primer (SEP)

Back 115

All in one
- Does not remove smear layer
- not as good bonding to dentin

Two step
- Does not remove smear layer
- Requires appx five coats
- No rinsing or worrying about moisture

Front 116

Types of Composites

Back 116

Unfilled resins
- Esthetic and smooth
- Discolor and quickly wears over time

Silicate Cements
- Fluoride released
- Biodegraded over time

Conventional Composites
- Glass fillers
- Improved qualities with some roughness

Microfill composites
- Very smooth and good wear resistance
- Reduced physical properties

Hybrids
- aka Composite resins and Resin based composites

Flowable composites
- Lower filler content
- High polymerization shrinkage

Packable composites
- Increased viscosity

Nanofill composites
- Can incorporate high filler content
- Good potential

Front 117

Gold Inlay Draw/Draft

Back 117

0.2 - 5 degrees per wall

Front 118

Burnishable gold margin

Back 118

Must be between 30-50deg
- Gold margins less than 30 degrees may be too thin and fracture
- Margins greater than 50 won't bend

Front 119

Gold Inlay tooth preparation

Back 119

- Use diamond
- 0.5mm Bevel at 40 degrees
- Cusp counterbelvel and gingival margin bevel should be 0.5-1mm and at 30 degrees

Front 120

Restoration Coefficient of Expansion

Back 120

Composite
- Greatest
- 2.5 times tooth

Amalgam
- 2 times greater than tooth

Gold
- Slightly higher than tooth

Front 121

Contraindications

Back 121

- Severe uncontrollable diabetes
- End stage renal disease
- Advanced cardiac conditions

Patients with Lymphoma, Leukemia, clotting disorders, Pericoronitis, should be treated prior to extraction.

Front 122

Contraindications to extraction of impacted teeth

Back 122

Extremes of age
- Pre-teens
- Asymptomatic full bony impaction greater than 35yrs

Compromised medical status

Likely damage to adjacent structures

Front 123

Classification of Impacted teeth

Back 123

Angulation
- Mesioangular: Least difficult
- Horizontal
- Vertical
- Distoangular: Most difficult

Pell and Gregory Classifications
Relationship to anterior border of ramus
- Class 1: Normal position anterior to ramus
- Class 2: Half of crown in in ramus
- Class 3: Full crown is embedded
Relationship to occlusal plane
- Class A: Tooth at same plane as other molars
- Class B: Between occlusal and cervical line of second molar
- Class C: Below cervical line of second molar

Front 124

Localized Osteitis

Back 124

aka Dry Socket
- Occurs in 3% of mandibular 3rd molar extractions
- Does not require antibiotics
- Irrigate and pain control

Front 125

Most common graft sites for Autogeneous bone

Back 125

Iliac crest
Rib
Anterior cortex of chin
Lateral cortex of ramus/external oblique ridge

Front 126

Radiographic evaluation of Mandible fractures

Back 126

- Can almost always identify on Panoramic
- Should be visualized in atleast two radiographs
- Panoramic, Townes, Posterior Anterior skill, Lateral oblique

Front 127

Most common sites for mandibular fracture

Back 127

Condyle
Angle
Symphysis
Body

- Least likely is Coronoid Process

Front 128

Types of mandibular fractures

Back 128

Greenstick
- A partial breakage in bone

Simple
- Fracture with no damage to soft tissue

Compound
- Breakage in soft tissue

Comminuted
- Broken into a number of pieces

Front 129

Apertognathia

Back 129

Anterior Open bite

Front 130

Maxillary and Mandibular surgery

Back 130

Maxillary
- LeFort I osteotomy
- Can be more easily moved down and forward than up and back

Mandibular
- Bilateral Saggital Split osteotomy
- Vertical ramus Osteotomy
- Genial osteotomy/Genioplasty

Front 131

Neuropathic Facial pain

Back 131

Trigeminal Neuralgia
- aka Tic Douloureux
- Treated with anticonvulsant drugs such as Carbamazepine, Oxcarbazepine, Gabapentin

Front 132

TMD Surgical Treatments

Back 132

Arthroscopy
- Placement of two cannulas to allow access for intracapsular instrumentation of superior joint space

Disc repositioning Surgery
- Disc is mobilized and repositioned
- Used for painful persistent clicking
- 10%-15% reported no benefit or worsened

Discectomy
- When disc is severely damaged and associated with pain and dysfunction

Condylotomy
- Intraoral Vertical Ramus Osteotomy without fixation to allow muscles to guide condyle

Total Joint Replacement
- Seen in RA, Ankylosis, Neoplasia, etc
- Costocontral bone graft is most common

Front 133

Organisms and Pathophysiology of Odontogenic Infections

Back 133

Organisms
- Aerobic and Anaerobic Gram-Positive Cocci
- Anaerobic Gram-Negative Rods

Pathophys
- Strep species initiate process
- Cellulitis occurs
- Anaerobic bacteria proliferate

Front 134

Aspiration Biopsy

Back 134

Atleast 2mL of purulent aspirate is adequate
- Use 5-10mL syringe with 18 gauge needle

Front 135

Osteomyelitis

Back 135

Inflammation of Medullary bone
- Rare and more common in mandible due to lower blood supply
- Organisms are similar to those causing odontogenic infection

- Occurs through vascular channels

Front 136

Malignant Jaw Tumors Characteristics

Back 136

- Most common are Epidermoid Carcinomas from Squamous cell
- Other sources of primary malignancy include salivary glands, blood vessels, lymphatics, muscle, bone, and other connective tissue

- Common H&N Metastases are from Breast, Prostate, Lung, Kidney, Thyroid, Blood, and Colon

Front 137

PD and PK of Local Anesthetics

Back 137

PharmacoDynamics
- Blocks sodium channels
- Must block a minimum number of nodes of Ranvier to block action potential
- All nerves are susceptible to blockade motor and sensory
- Sensations return in order of Pain, Cold, Hot, Touch, Pressure, Motor

PharmacoKinetics
- Increased Protein binding and Lipid solubility increases duration
- Lower pKa, more acidic, faster the onset, but does not affect duration

Front 138

Anesthetic Allergies

Back 138

Allergic Responses
- Esters metabolized in the Plasma, have 5% Incidence. Only one with Ester bond is Articaine, but connecting chain is Amide
- Amides metabolized in the Liver have low incidence <1%. All are Tertiary Amines
- Benadryl is good choice

Metabisulfite
- Antioxident with low incidence of allergenicity
- Protects vasoconstrictor from oxidation

Methemoglobinemia
- Unique to Prilocaine when exceeding 600mg for a 70kg adult
- Lower dose applies to hereditary methemoglobinemia

Front 139

Drug & Pregnancy interactions Local Anesthetics

Back 139

Antidepressants
- Amitriptyline, Trazadone
- Increases sensitivity to Epinephrine

Nonspecific Beta Blocker
- Propranolol/Inderal
- Decreases HR while Epi increases it. Net result is increase in BP without Tachycardia

Pregnancy and Lactation
Class C - Bupivacaine, Mepivacine, Articaine, Epinephrine
Class B - Lidocaine, Prilocaine

Front 140

Local anesthetic Max dose

Back 140

Normal - 0.2mg of Epi

CV compromised - 0.04mg per appt

Front 141

Needle Dimensions

Back 141

Length
- Short needles average 20mm
- Larger needles average 32mm

Size
- 30 Gauge 0.3mm
- 27 Gauge 0.4mm
- 25 Gauge 0.5mm

- Positive aspiration is directly correlated to Needle Gauge
- Patients cannot tell diff between 25,27 and 30 gauge needles

Front 142

PSA

Back 142

Area of anesthesia
- Maxillary molars
- Does not anesthetize palatal tissue
- May not anesthetize mesiobuccal aspect of first molar

Technique
- 45,45,45
- 15-16mm depth

Front 143

Anterior Superior Alveolar Block

Back 143

aka Infraorbital block

Area
- Midline of maxilla to Mesiobuccal of First Molar

Technique
- Just below the IO rim along the line from pupil to ipsilateral commissure of lip
- Penetrate over maxillary first premolar
- 15mm deep and inject 1.0mL
- Apply pressure for 2min

Front 144

Greater Palatine Block

Back 144

Area
- From canine to posterior hard palate
- From gingival margin to palatal midline

Technique
- Located halfway between gingival margin and midline of palate 5mm anterior to junction of hard and soft palate
- Pressure anesthesia for 20 sec
- Penetrate to bone about 5mm

Front 145

Nasopalatine

Back 145

Area
- Palatal tissue from canine to canine

Technique
- Topical, and Pressure
- 45deg penetration at junction of palate and incisive papilla

Front 146

Vazirani-Akanosi

Back 146

Good for uncooperative children, or patients with trismus

Area
- IAB, Lingual and Long buccal

Technique
- Inserted parallel to maxillary occlusal plane at level of buccal vestibule
- Penetrate about 1/2 mesiodistal length of ramus about 25mm in adults. Hub should be opposite mesial of second molar
- Injection is performed blindly because no bony endpoint exists

Front 147

Gow-Gates

Back 147

Unique because operator does not attempt to get as close to nerve as possible

Area
- IAB, Lingua, Long buccal 75% of time
- Auriculotemporal
- Mylohyoid nerve

Technique
- Patient open as widely as possible to translate condyle
- Make puncture at distobuccal cusp of maxillary second molar
- Contact bone and inject

Front 148

Systemic Sequelae of Obstructive Sleep Apnea Syndrome

Back 148

HTN
Cor Pulmonale
Cardiac Arrhythmia

Front 149

Local Anesthetic Concentrations and Max Dose

Back 149

Lidocaine - 2% 300mg 4.4mg/kg

Mepivacaine - 300mg 4.5mg/kg
- Only one packaged in both 2% and 3% in US

Prilocaine - 4% 400mg 6mg/kg

Articaine - 4% 500mg 7mg/kg

Bupivicaine - 0.5% 90mg 1.3mg/kg

Front 150

Cleft rates

Back 150

Lip
- 1 in 1000 births but varies with race
- 80% unilateral 20% Bilateral

Palate
- 1 in 2000 births
- Cleft lip 25%, Cleft Palate 25%. Both 50%

Front 151

Congenital Thyroid problem

Back 151

Lingual Thyroid
- Midline tongue base
- Cased by incomplete decent of thyroid anlage
- May be patient's only thyroid

Thyroglossal Tract cyst
- Midline neck swelling due to cyst change
- Along embryonic path of thyroid descent

Front 152

Geographic Tongue

Back 152

- Common benign condition of tongue
- White annular lesions surrounding atrophic red central zones
- May feel burning
- No treatment necessary

Front 153

Causes of Macroglossia

Back 153

- Congenital hyperplasia/hypertrophy
- Lymphagioma
- Salivary gland tumors
- Acromegaly, Gigantism
- Cretinism
- Amyloidosis

Front 154

Melkerson-Rosenthal Syndrome

Back 154

aka Cheilitis Granulomatousa
- Granulomatous Cheilitis
- Fissured Tongue
- Facial Paralysis

Front 155

Sturge-Weber Syndrome

Back 155

aka Encephalotrigeminal Angiomatosis
- Skin lesions along branches of trigeminal nerve. Port Wine Nevus
- Leptomeninges of cerebral cortex also calcify leading to mental retardation and seizures

Front 156

Hygroma Coli

Back 156

aka Cystic Hygroma
- Most common form of Lymphangioma
- Commonly occurs in left posterior triangle of the Neck

Front 157

Oral Lymphoepithelial Cyst

Back 157

- Lymphoid cyst that is the counterpart of Branchial Cleft cyst
- Common in soft palate, oral floor, and lateral tongue

Front 158

Globulomaxillary Cyst

Back 158

Clinical term denoting any pathologic lucency between maxillary cuspid and lateral incisor

Front 159

Nicotine Stomatitis

Back 159

White changes in palate from Smoking
- Red dots in lesions are inflamed salivary duct orifices
- Not premalignant unless related to reverse smoking

Front 160

Melanotic Macule

Back 160

Most common Melanocytic Lesion
- May be associated with Puetz-Jegher's syndrome

Front 161

Drug induced pigmentation

Back 161

- Minocycline
- Chloroquine
- Cyclophosphamide
- Azidothymidine

Front 162

Hairy Tongue

Back 162

Elongation of Filiform Papillae
- Cosmetic significance only

Front 163

Coxsackie Infections

Back 163

Hand, Foot, Mouth & Herpangina
- Self limiting systemic infections
- Herpangina only occurs in posterior soft palate

Front 164

Measles

Back 164

aka Rubeola
- Self limiting childhood disease with fever malaise and skin rash
- Koplick spots precede Skin rash

Front 165

HPV Lesions

Back 165

Papillomas
- Benign epithelial Proliferations
- Includes Verruca Vulgaris

Condyloma Acuminatum
- Genital warts
- Caused by HPV 6 and 11

Focal Epithelial Hyperplasia
- aka Heck's disease
- HPV 13 and 32.
- Multiple small dome shaped warts

Front 166

EBV infections

Back 166

Hairly Leukoplakia
- Opportunistic infection causing white patches on lateral tongue
- Usually associated with HPV
- Diagnosis via intranuclear viral inclusions

Malignancies
- Burkitt's Lymphoma: Fastest Growing
- Nasopharyngeal carcinoma

Front 167

Hutchinson's triad

Back 167

Notched incisors
Deafness
Ocular Keratitis

Front 168

Scarlet Fever

Back 168

Caused by Group A Strep
- Skin rash with erythrogenic toxin
- Strawberry tongue
- Treated with PCN

Front 169

Behcet's Syndrome

Back 169

Multisystemic disease
- Vasculitis is priminent feature
- Oral and Genital Aphthous, Conjunctivitis, uveitis, arthritis, etc
- Treat with corticosteroids and immunosupressives

Front 170

Erythema Multiforme

Back 170

Hypersensitivity reaction affecting skin or mucosa
- Minor form associated with secondary herpes simplex

Steven-Johnson syndrome is major EM, and triggered by drugs

Front 171

Midline Lethal Granuloma

Back 171

Destructive necrotizing midfacial phenomenon
- May mimic Wegener's
- Represent peripheral T-cell lymphomas
- Perforation of palate
- Treat with radiation

Front 172

Pemphigus Vulgaris & Pemphigoid

Back 172

Pemphigus
- Autoimmune disease targeting Desmoglein 3 in Desmosomes
- Positive Nikolsky sign

Pemphigoid
- Autoimmune disease targeting Hemi-Desmosomes of basement membranes. Laminin 5, BP180 etc
- Usually affects older adults
- Also positive Nikolsky's sign

Front 173

Proliferative Verrucous Leukoplakia

Back 173

- High risk Leukoplakia
- Unknown cause but may be associated with HPV
- High risk of Malignant transformation to Verrucous carcinoma or Squamous cell

Front 174

Actinic Chelitis

Back 174

- Caused by UV light especially UVB from 2900 to 3200nm
- Lower lip more commonly affected
- Junction of vermilion and skin becomes indistinct
- May progress to SCC

Front 175

Oral Submucous Fibrosis

Back 175

Irreversible Mucousal change due to hypersensitivity to dietary substances like Betel Nut
- May progress to SCC

Front 176

Verrucous Carcinoma

Back 176

- Well differentiated slow growing
- Rarely metastasizes
- Treated by surgical excision with good prognosis

Front 177

SCC

Back 177

- Clinical stage is more important than microscopic classification relative to prognosis
- 5yr survival is 45-50%
- 25% with Neck metastasis

Front 178

Oral Melanoma

Back 178

- High risk on Palate and Gingiva
- 5year survival in oral is less than 20%, on skin is greater than 65%

Front 179

Granular Cell Tumor

Back 179

Benign nonrecurring submucosal neoplasm of Schwann cells
- Most often occurs on tongue
- See PseudoEpitheliomatous Hyperplasia

Front 180

Neurofibroma

Back 180

Benign neoplasm of Schwann cells and Perineural fibroblasts

Front 181

Neurofibromatosis 1

Back 181

Von Recklinhausen's disease
- Multiple Neurofibromas
- Cafe-au-lait macules
- Axillary freckling
- Malignant transformation

Front 182

Multiple Endocrine Neoplasia Type 3

Back 182

MEN III
- Autosomal dominant
- Oral mucosal neuromas
- Medullary carcinoma of thyroid
- Pheochromocytoma of adrenal gland

Front 183

Mucous Retension Cyst

Back 183

Submucosal nodue due to blockage of salivary duct by sialolith
- Common in FOM, palate, buccal mucosa, and upper lip
- Known as Ranula when occurring in FOM

Front 184

Necrotizing Sialometaplasia

Back 184

Chronic ulcer of palate due to ischemic necrosis of palatal salivary glands
- Heals in 6-10wks
- Mimics carcinoma clinically and microscopicly

Front 185

Bilateral parotid enlargement

Back 185

- Alcoholism
- Dietary
- Obesity
- Diabetes
- HTN & Hyperlipidemia
- Sjogren's syndrome: Increased risk of Lymphoma

Front 186

Benign salivary gland diseases

Back 186

Pleomorphic adenoma
- Most common benign salivary gland tumor
- Mix cellularity
- Palate is most common site

Monomorphic Adenoma
- Benign salivary tumor
- Single cell type
- Consists of Basal cell adenoma, Canalicular adenoma, Myoepitheliomas, and Oncocytic tumors
- Oncocytes stain pink due to mitochondria

Warthin's
- Found in parotid of old men
- Associated with smoking
- Occasionally Bilateral

Front 187

Malignant Salivary gland tumors

Back 187

Mucopidermoid Carcinoma
- Most common malignant salivary tumor
- Palate is most common

Polymorphous low-grade Adenocarcinoma (PLGA)
- Second most common minor salivary gland malignancy
- Palate most common site

Adenoid Cystic carcinoma
- Palate most common
- Cribriform of Swiss Cheese microscopic pattern

Front 188

Amyloidosis

Back 188

Formation of complex proteins from immunoglobulin light chain precursors
- Deposited into various organs
- React with Congo red to produce Green Birefringence in polarized light

Front 189

Gingival Cysts of Newborn

Back 189

From Dental Lamina
- Bohn's nodules on gingiva and Junction of HP & SP
- Epstein's pearls on palate

Front 190

COC

Back 190

Calcifying Odontogenic Cyst
- Has recurrent potential
- Shows Ghost Cell Keratinization

Front 191

Cystic Ameloblastoma

Back 191

Less aggressive and less likely to recur

Front 192

Pindborg Tumor

Back 192

Calcifying Epithelial Odontogenic Tumor
- Similar distribution to Ameloblastoma
- Also aggressive, but slightly less than Ameloblastoma

Front 193

Adenomatoid Odontogenic Tumor

Back 193

Tumor of 2/3
- 2/3 in Maxilla
- 2/3 Females
- 2/3 Anterior jaws
- 2/3 Associated with Impacted teeth

Front 194

Fibrous Dysplasia

Back 194

Uncommon Lesion
- Involves entire half jaw, more commonly the Maxilla
- Usually affects children and stops at Puberty

Widespread Fibrous Dysplasia is McCune-Albright Syndrome

Front 195

McCune-Albright Syndrome

Back 195

Polyostotic Fibrous Dysplasia
- Cafe-Au-Lait with Puetz-Jeger
- Endocrine abnormalities, Precocious puberty

Front 196

Langerhan's Cell Disease

Back 196

- Show Punched out lesions
- Floating teeth
- Eosinophils mixed in

3 Types
- Eosinophilic granuloma: Chronic Localized. Bone Lesions
- Hand-Schuler-Christian: Chronic Disseminated. Bone lesions, Exophthalmos, Diabetes Insipidus
- Letterer-Swiwe: Acute Disseminated. Bone, Skin, and Internal organs

Front 197

Xray Machine Setup

Back 197

Cathode (-)
- Filament emits electrons when heated
- Focusing cup focuses electrons into narrow beam directed at the Focal Spot on the Anode

Anode (+)
- Tungsten target converts kinetic energy of the directed electrons into mostly heat and x-ray photons
- Sharpness of image increases as size of focal spot decreases

Copper Stem
- Dissapates Heat

Front 198

mA

Back 198

Milliamperage
- Regulates temperature of filament and thus # of electrons emitted
- Controls quantity of radiation produced(Intensity), but does not control Beam Energy

Front 199

kVp

Back 199

Controls Beam Quality which is the mean energy of an x-ray beam
- Higher energy photons have shorter wave-lengths
- Beam intensity, number of photons, also increases with kVp

Front 200

Bremsstrahlung Radiation

Back 200

- Primary source of x-ray photons from x-ray tube
- Results from electrons interacting with tungsten Nucli in the target
- Generate photons with continuous spectrum of energy

Front 201

X-ray Filtration and Collimation

Back 201

Aluminum filter in the path of beam reduces patient dose and mean energy
- 1.5mm for up to 70kVp
- 2.5mm for higher voltages

Metallic barrier to reduce size of xray beam
- Usually collimated to a circle of 2.75 inches or 7cm
- Rectangular collimators futher limit size of beam reducing radiation by 48%

Front 202

Inverse Square Law

Back 202

Intensity of x-ray beam is inversely proportional to square of distance from source

Front 203

X-ray Interactions with Matter

Back 203

Coherent Scattering: 8%
- When low energy photon passes near outer electron.
- Photon is absorbed, and when electron returns to ground state, another photon with same energy is generated
- Changes direction and contributes to film fog

Photoelectric Absorption: 30%
- When photon ejects electron and then ceases to exist
- Contributes greatly to diferences in optical density of enamel, dentin, and bone

Compton Effect: 62%
- When photon hits an electron
- Electron takes some energy and is ejected
- Photon now has new direction and lower energy

Front 204

Dosimetry

Back 204

Absorbed dose
- Unit is Gray (Gy)
- 1 Gy is 1 Joule/kg, and 100 Rad

Effective dose
- Used to estimate risk in humans
- Unit is Sievert (Sv)

Radioactivity
- Decay rate
- Unit is Becquerel (Bq)
- 1 Bq = 1 disintegration/second

Front 205

Radiation Effects

Back 205

Deterministic effects
- Severity of response is proportional to dose
- There is threshold below which response is not seen

Stochastic effects
- Probability of response is dose-dependent

Front 206

Radiation damage

Back 206

Direct effect
- To carbohydrates, lipids, proteins, DNA by radiation
- 1/3 of damage

Indirect effect
- Radiolysis of water to form hydroxyl free radicals
- 2/3 of damage

Front 207

Radiation on Oral tissues

Back 207

- Near end of second week, cells die and show areas of mucositis
- Forms a white to yellow pseudomembrane which is desquamated epithelial layer
- May see secondary candida infection

- Healing is rapid and completed in 2 months

- After months to years, mucous membrane becomes atrophic, thin, and avascular.
- Complicates denture wearing

Front 208

Radiation to Salivary glands and Taste buds

Back 208

Salivary glands
- See dose dependent loss of saliva in first few weeks
- Mouth becomes dry and tender from loss of lubrication
- Reduced beyond 1 year is unlikely to show significant recovery

Taste Buds
- Causes extensive degeneration of normal histological architecture of taste buds
- Loss of taste acuity during second or third week

Front 209

Radiation to Bone

Back 209

- Damage results from radiation to vasculature or periosteum and cortical bone
- Normal marrow may be replaced with fatty marrow and fibrous tissue
- More common in mandible due to lower vascular supply and more frequent radiation.

Front 210

Sources of Radiation exposure

Back 210

Natural radiation - 83%
- External background radiation, inhaled radon, ingested radionuclides

Artificial radiation - 17%
- Medical diagnosis and tx is 11%
- Dental xrays is 2.5% of that
- Nuclear medicine, and consumer/industrial products

Front 211

Radiation dose limits

Back 211

Occupational exposure limit is 50mSv of whole body radiation in 1 year
- Dental x-rays are on average 0.2mSv a year

No dose limits for patients exposed in the course of dental and medical treatment

Front 212

X-ray Film composition

Back 212

Emulsion
- Contains silver bromide grains sensitive to x-ray
- Smaller the crystals, greater the resolution

Base
- Flexible plastic to support Emulsion

Identification dot
- Raised towards viewer

Front 213

Intensifying Screens

Back 213

Made of base supporting material with Phosphor layer
- Usually made of rare-earth elements
- Reduces patient dose but decreased resolution from dispersion

Front 214

Film Latitude

Back 214

Measure of range of exposures that can be recorded on film
- Films with a wide latitude can record a subject with a wide range of contrast
- Films with narrow latitude can distinguish similar subject contrasts

Front 215

Radiographic Noise

Back 215

Appearance of uneven density of uniformly exposed film
- Radiographic Mottle is uneven density due to physical structure of film or intensifying screens

Front 216

Resolution vs Sharpness

Back 216

Resolution
- Ability to record separate structures that are close together

Sharpness
- Ability of radiograph to define an edge precisely
- Can be improved by increasing distance between focal spot and object using long open ended cylinder

Front 217

Film Development

Back 217

Developer coverts exposed silver halide crystals with Neutral Silver atoms into metallic Siver seen as dark
- Phenidone is first electron donor to reduce silver ions to metallic silver
- Hydroquinone provides electron to Phenidone so it can continue reducing

Rinse Dilutes developer which slows the process
- Removes Alkali activator to prevent neutrilization of acid fixer

Fixer dissolves and removes undeveloped silver halide
- Hypo, an Ammonium Thiosulfate dissolves silver halide crystals
- Hardener is Aluminum Sulfate complexes with Gelatin to prevent damage

Washed in water to ensure removal of all thiosulfate ions and silver thiosulfate complexes

Front 218

Digital Detector

Back 218

Charge-Coupled device CCD and Complementary metal oxide semiconductors CMOS
- Silicon sensor captures x-ray energy as voltage potential
- Silicon chip reads out voltage of each pixel

Front 219

Lateral Fossa

Back 219

aka Incisive Fossa
- Gentle radiolucency at apex of maxillary lateral

Front 220

Most common route for furcation involvement

Back 220

Mesial of Maxillary 1st molar

Front 221

Condyloma Latum

Back 221

Secondary Syphillis

Front 222

Angle Classifications and Population

Back 222

Class I Normal - 30%
Class I Malocclusion - 50%
Class II Malocclusion - 15%
Class III Malocclusion - 1%

Front 223

Cranial Vault and Base Development

Back 223

Cranial Vault - Intramembranous bone
- At birth, widely separated by fontanelles
- Pushed apart during growth and new bone occurs at sutures
- New bone is added to external surfaces and removed on internal surfaces

Cranial Base - Endochondral bone
- Ethmoid, Sphenoid, Occipital bones
- Three Synchondroses
1) Intersphenoid - Closes at 3
2) Sphenio-Ethmoid - Closes at 7
3) Spheno-occipital - Closes later

Front 224

Maxilla Growth

Back 224

Intramembranous
- Grows at sutures posterior and superior to maxilla
- Anterior movement negated by anterior resorption, Downward migration is augmented by inferior apposition of bone
- Bone is added at posterior

Front 225

Mandible Growth

Back 225

Both endochondral and intramembranous
- Begins just lateral to Meckel's Cartilage, which later disintegrates and forms Malleus and Incus
- Cartilage is transformed to bone at the condyle
- Growth occurs by new formation at condyle and resorption anteriorly with deposition posteriorly
- Space for posterior teeth is made by Ramus resorption

- Growth at condyle moves mandible downward and forward. Posterior face height exceeds anterior and chin becomes more prominent.
- If condylar growth exceeds molar eruption, may have shorter face and deep overbite
- Rarely, if Molar growth exceeds Condylar growth, will have longer face and anterior open bite

Front 226

Scammon Growth Curves

Back 226

- Neural tissues grow rapidly and hit 100% at 6-7
- Lymphoid tissues also grow quickly, reaching twice adult size at age 10 and then involutes
- Genital tissue don't grow till puberty
- Muscle and Bone grow rapidly at birth, slow, then grows again at puberty
- Maxilla is close to brain and grows close to neural growth, and mandible shows growth spurt like reproductive tissues

Front 227

Growth Sex Differences

Back 227

- Girls reach peak at 2 yrs earlier at 12, Boys at 14
- Earlier the peak of growth, the shorter duration and less overall growth
- Girls generally start growth sooner, but growth is shorter and will grow less

Front 228

Predictors of Growth

Back 228

- Growth is not correlated with age, and even less with dental age
- Hand-Wrist radiograph or vetebral bones on Ceph is good predictor
- Sexual development is a good correlation

Front 229

General Direction of Jaw Growth

Back 229

- Growth in width is completed before growth spurt
- Length continues to grow through spurt
- Vertical growth lasts longer

Front 230

Cleft Lip and Palate

Back 230

Incidence
- Most common craniofacial defect. 1 in 700 births
- Second only to Clubfoot overall

- Nearly all tissues originate from Ectoderm
- Cleft lip occurs when there is a failure of fusion between Frontonasal process and Maxillary process
- Closure of secondary palate occurs anterior to posterior while it elevates and joins together.

Front 231

Normal Dental Development size and relationships

Back 231

Gum pad stage from 6-7months of age
- Maxillary anteriors are 75% the size of permanent anteriors
- Mandibular anteriors are 6mm narrower than permanent

- Overbite is normally 10-40%.
- Overjet is 0-4mm

Primate spaces are most noticeable
- Between lateral and canine in maxilla
- Between canine and first primary molar in mandible

Front 232

Primary Molar Relationship

Back 232

Determined by Distal aspects of primary second molar
- Flush terminal plane: Distals are lined up
- Mesial Step
- Distal Step

- By age 5, 90% are flush or with 1mm or greater mesial step
- First permanent molars are guided along terminal plane

Front 233

Antimere

Back 233

Corresponding contralateral tooth
- Once a tooth erupts, the Antimere is expected to erupt within 6 months

Front 234

Ugly Duckling Stage

Back 234

When two maxillary centrals erupt moving labially leaving diastema
- Will resolve when canines erupt to close it

Front 235

Leeway Space

Back 235

Difference in Mesio-Distal size between primary canine, primary first & second molars, and their permanent replacements
- 1.5mm per side in Maxilla
- 2.5mm per side in Mandible

Front 236

Dimensional Changes in dental arches

Back 236

Width
- Intercanine width & Intermolar width
- All increases and then decreases. Maxillary intercanine width just increases.

Length
- Taken at midline between centrals to tangent touching Distal of second primary molars or Mesial of first permanent molars
- Small decrease in both because incisors become upright and loss of Leeway space

Circumference
- From Distal of second primary molar around the arch to other side
- Mandibular arch decreases significantly due to mesial shift into leeway space, interproximal wear, and lingual positioning of incisors from differential growth
- Maxillary arch increases slightly

Front 237

Eruption Sequence

Back 237

Generally Female teeth erupt 5 months earlier

Primary
- Centrals, Lateral, First molar, Canines, Second molar

Permanent
- Maxillary: First molar, Central, Lateral, First premolar, Second premolar, Canine, Molars
- Mandibular: First molar, Central, Lateral, Canine, premolars and back

Front 238

Rickett's Esthetic Line

Back 238

Extends from tip of nose to chin
- Lip should be slightly behind this line for esthetics

Front 239

Ba, Gn/Me, Pog, Bo, Ar, Po, So, Ptm, Go, S

Back 239

Ba: Basion
- Lowest point on anterior margin of Foramen magnum

Gn/Me: Gnathion/Menton
- Center of interior point on mandibular symphysis. Bottom of chin

Pog: Pogonion
- Most anterior point on the contour of chin

Bo: Bolton's point
- Highest point in upward curvature of retrocondylar fossa of occipital bone

Ar: Articular
- Where Zygomatic arch and posterior border of mandible intersect

Po: Porion
- Midpoint of upper contour of external auditory canal

So: Sphenoccipital Synchondrosis
- Junction between Occipital and Basisphenoid bones

Ptm: Pterygomaxillary Fissure
- Point at base of fissure

Go: Gonion
- Angle of mandible

S: Sella Turcica
- Middle of concavity

Front 240

ANB, MP, MP-SN, Y-axis, 1/-SN,

Back 240

ANB
- AP difference between maxilla and mandible
- More positive indicates Class 2, More negative is class 3

MP: Mandibular Plane
- Go-Me, Go-Gn

MP-SN: Mandibular plane angle
- Bigger is steeper and indicaates vertical growth pattern with longer face and anterior open bite

Y-axis: S-N to S-GN
- Bigger indicates more vertical development and longer lower face with anterior open bite tendency

1/-SN: Upper incisor angulation
- Bigger is more flared

Front 241

Hyalinization

Back 241

Forms on compression side of PDL when heavy orthodontic forces are applied
- Area of PDL that has lost structural organization and shows signs of necrosis
- Area of Undermining resorption occurs within alveolar bone
- Secondary tooth movement cannot occur until lag period of undermining resorption has taken place

Front 242

Center of resistance

Back 242

In a healthy tooth, its half the distance from crest to apex
- About 10mm from where bracket would be

Front 243

Moment

Back 243

Tendency to rotate
- 1st order: In occlusal view
- 2nd order: From facial view
- 3rd order; From mesiodistal view

- If a force is applied away from the center of resistance, a moment is created
- M=Fd

Front 244

Couple

Back 244

- Two equal and opposite, noncolinear forces

- Couple applied to tooth produces pure rotation without translation
- M=Fd

Front 245

Pure Rotation

Back 245

- When a couple is applied to a tooth
- Rotates about center of resistance

Front 246

Tipping

Back 246

- When force is applied at bracket
- Center of resistance moves in direction of force and crown tips while apex moves in the opposite direction
- Center of rotation is apical to center of resistance

- Easiest and fastest movement but often least desirable

Front 247

Crown Movement

Back 247

- Force is applied at bracket and small couple is applied to negate tipping
- Center of rotation at apex
- Difficult and occurs slowly

Front 248

Pure Translation

Back 248

- Force applied to bracket and larger couple is applied to negate tipping
- Center of rotation is Apical to Infinity
- Difficult and slow

Front 249

Root Movement

Back 249

Force applied at bracket and larger couple is applied
- Center of rotation is at crown
- Most difficult and slowest type of movement

Front 250

Types of Anchorage

Back 250

Reciprocal Tooth movement
- Pitting two segments against each other for equal movement

Reinforced anchorage
- Adding more teeth to the anchorage segment to distribute force over larger area
- Headgears are also another form of reinforced anchorage

Stationary Anchorage
- Pit hard slow posterior movements such as bodily movement against simple anterior movements such as tipping

Cortical Movement

Implants for anchorage

Front 251

Most common bracket slot size

Back 251

0.018 x 0.025inch

0.022 x 0.028inch

Front 252

Stress vs Strain

Back 252

Stress
- Internal response of a wire to application of external forces
- Defined as Force per cross sectional area. Sigma = FA

Strain
- Deformation or deflection as a result of stress
- Defined as dimensional change divided by original dimension. Epsilon = DeltaD/D

Front 253

Wire Properties

Back 253

Strength, Stiffness, and Range

Double Length
- Half Strength
- 8 times less stiff
- 4 times range

Double diameter
- 8 times strength
- 16 times stiffness
- Half range

Front 254

Ortho Wire materials

Back 254

Nickle-Titanium
- Low modulus of elasticity and Wide working range

Beta Titanium
- Also known as TMA, Titanium-Molybdenum alloys
- In between Stainless Steel and Ni-Ti in terms of elasticity
- High coeffcient of friction

Stainless Steel
- Good mechanical properties and coorosion resistance
- 18% Chromium gives corrision resistance.
- Highest elasticity and lowest springback

Front 255

Headgear

Back 255

Should be worn for about 14 hours a day
- 250-500g per side for orthopedic
- 100-200 per side for dental movement

High pull
- Treat Class 2 with increased vertical dimension and minimal overbite
- Restrict anterior and downward maxillary growth or molar distalization and eruption control

Cervical Pull
- Correct Class 2 with deep bite
- Restrict anterior maxillary growth
- Also distalizes and extrudges maxillary molars

J-Hook Headgear
- High pull headstrap that connects to anterior maxillary archwire
- Usually Retracts canines and incisors

Protraction Headgear, Reverse-full, Facemask
- Treat class 3 Malocclusions with maxillary deficiency
- Downward and forward pull on maxilla

Chin cup
- Correct class 3 to force mandible superior and posteriorly

Front 256

Functional Appliance - 4

Back 256

- Used in Function
- Corrects Class II
- Restrains Maxilla and displaces mandible while allowing normal mandibular growth

Herbst
Activator
Bionator
Twin Block

Front 257

Herbst

Back 257

Functional Appliance
- Piston and tube to place mandible in forward position
- Mandibular incisors may flare due to indirect forces

Front 258

Activator/Bionator

Back 258

Funcational Appliances

Activator
- Two acrylic bodies on maxilla and lingual of mandible
- Facets allow Maxillary occlusal, distal, and buccal movements
- Also allows Occlusal and Mesial movement
- Can also tip anterior teeth and control Eruption

Bionator
- Similar to Activator but is less bulky and impedes speech less
- Horseshoe acrylic with wire in palatal

Front 259

Twin Block

Back 259

Funcational Appliance
- Interaction between maxilla and mandible controls how much mandible is postured forward and vertical separation
- Supposedly more tolerable

Front 260

Pendulum

Back 260

Another type of appliance to correct class 2
- Uses palate as anchorage with springs to distalize molars

Front 261

Cross Bite Appliances - 5

Back 261

- If expansion is at 0.5mm/day, its called a Rapid Palatal Expander
- Slow expander is 1mm/week

Hyrax
Haas
Hawley Type removable with Jackscrew
Quad Helix. W-arch
Transpalatal arch

Front 262

Hyrax Appliance

Back 262

Crossbite Appliance
- Metal framework connecting Maxillary first molars and first premolars
- Screw is activated by atleast 0.25mm, a quarter turn, daily
- Continued till maxillary lingual cusps contact with lingual inclines of buccal cusps
- Diastema usually appears

Front 263

Haas Appliance

Back 263

Crossbite Appliance
- Same as Hyrax but with acrylic pads
- Contact with palate is believed to have more skeletal effect
- Difficulty in cleaning and possible palatal inflammation are drawbacks

Front 264

Hawley type removable appliance with jackscrew

Back 264

Crossbite Appliance
Can correct mild posterior crossbites
- Compliance and difficulty retaining are drawbacks

Front 265

Quad-Helix, W-Arch

Back 265

Crossbite Appliance
- For dental expansion
- Can use for symmetrical or asymmetrical expansion
- May tip teeth buccally so suggested for small amount of expansion

Front 266

Transpalatal Arch

Back 266

Consists of heavy wire between the first molars across palate
- Can be used for expansion or constriction of intermolar width
- Can produce root movement of first molar or derotation
- Also can be used for anchorage reinforcement

Front 267

Appliances for Mixed Dentition

Back 267

Nance
- Space maintainer

Lower Lingual arch
- Anchorage reinforcement, space maintenance, expansion, or increasing arch length

Lip bumper
- Anterior portion lies 2-3mm away from alveolar process
- Controls mandibular arch length by allowing lateral and anterior development
- Uprights tipped molars by transferring lip force to first molar

Front 268

Vertical Dimension Appliances

Back 268

Intrusion Arch
- Used for deep bite correction
- Extrudes molars and intrudes incisors

Extrusion arch
- Used for open bite correction to intrude molars and extrude incisors

Front 269

Elastics

Back 269

Class I
- Between teeth of the same arch

Class 2
- Between Maxillary anteriors to Mandibular posteriors
- Corrects Class 2, reduces overbite, and retract anterior maxillary teeth

Class 3
- Between Mandibular Anteriors to Maxillary posteriors
- Protracts maxillary posterior teeth to improve overjet

Crossbite elastics
- From palatal of maxilla to buccal of mandible
- Also causes extrusion so caution with open bite and long anterior lower facial height

Anterior Diagonal Elastics
- From one side of maxillary teeth to other side of mandibular teeth crossing midline
- Correct non-coinciding maxillary and mandibular midlines

Front 270

Dealing with Space loss

Back 270

Slight <3mm
- Space regaining
- Removable appliance with finger spring
- Headgear
- Activated lingual arch
- Lip bumper

Moderate <4mm
- Extract primary canines
- Borrows space till permanent teeth erupt
- Use lingual arch if mandibular canines are extracted

Severe >4mm
- Serial extractions
- Extract canines to allow incisors to alight
- Extract primary first molars for premolar to erupt
- Extract 1st permanent premolars for canine to erupt

- Will see increased overbite since incisors will tip back to fill space
- Comprehensive treatment later on is always necessary

Front 271

Ortho Retention

Back 271

Significant reorganization occurs in 3-4 months. Full time retension is recommended

Part time retention from 4-12 months

Hawley
Wraparound retainer - Similar to Hawley but without wires crossing occlusion
Positioner

Front 272

Problematic Surgical Stability

Back 272

Maxilla Down or wider
Mandible Back

Front 273

Tooth Number anomaly

Back 273

Supernumerary
- Male to Female is 2:1
- 3% of population
- Most common is mesiodens

Hypodontia
- 1.5-10% excluding 3rd molars
- Most common is Mandibular second premolar followed by lateral incisor, then maxillary second premolar

Front 274

Taurodontism

Back 274

Vertically long pulp chambers and short roots

Front 275

Dentin Dysplasia

Back 275

Shields Type 1
- Normal crown anatomy and color
- Short pointed roots
- Absent pulp chambers and canals
- Multiple PA radiolucencies in primary and permanent teeth

Shields type 2
- More similar to dentinogenesis imperfecta
- Permanent teeth have normal color
- No PA radiolucencies

Front 276

Frankl Behavior

Back 276

1 - Definite negative refusal
2 - Negative reluctance but not pronounced
3 - Positive acceptance with cautious behavior and reservation
4 - Good rapport, interested, and laughter

Front 277

Pediatric Local dosage

Back 277

- All are 4.4mg/kg
- Get kg by dividing pounds by 2.2

Front 278

Minimum Alveolar Concentration

Back 278

Measure for potency
- Minimum concentration required to produce immobility in 50% of patients
- For Nitrous its 105%

Front 279

Medicaments

Back 279

Formocresol
- Most commonly used medicament for pulpotomies on primary teeth
- 35% Cresol and 19% Formalin

Ferric Sulfate
- Less toxic

Mineral Trioxide Aggregate - MTA

Front 280

Factors for planning space maintenance

Back 280

Amount of primary roots
- If more than 1/4th of root remains from normal resorption, space maintenance is likely needed

Amount of bone covering permanent tooth
- If there is no bone and permanent cusp tip is at furcation, no space maintenance is necessary
- If bone is interposed, then space maintenance is necessary

Amount of root development
- Average tooth pierces bone with 2/3 root formation
- Then pierces gingiva with 3/4 root formation

Time lapse since loss
- Most space closure occurs within first 6 months
- In molar area, closes via tipping

Eruption of neighboring teeth
- Active eruption creates increased space loss

Age
- Rule of 7 for primary molars
- Eruption is delayed if loss of primary molar is before age of 7
- Eruption is accelerated if its lost after 7

Front 281

Humphrey Appliance

Back 281

Used to correct ectopic Permanent First Molar when it impacts on Primary second molar
- More common in maxilla

Front 282

Ectopic Premolars

Back 282

Distal Eruption
- Most common in Mandibular second Premolars
- Distal root is resorbed but mesial root remains
- Requires extraction

Buccal or Lingual Eruption
- Common
- If primary molars aren't ready to exfoliate within a few weeks, should extract

Front 283

Trauma Followup

Back 283

Radiographs and Assessment at 1,2,6 months

Front 284

Rule of 6's

Back 284

If Flouride is greater than 0.6ppm, no systemic flouride

If patient is less than 6mo old, no flouride

If older than 16, no flouride

Front 285

Digit sucking appliance

Back 285

Fixed crib at palate

Blue grass appliance - with roller

Front 286

Natal & Neonatal teeth

Back 286

- Natal teeth is present at birth
- Neonatal are those that erupt in first 30 days
- Most are primary teeth, and most are mandibular incisors

Extract If
- Supernumerary
- Primary teeth if extremely mobile and in danger of aspiration
- Riga-Fede disease and causing ulceration on ventral tongue. May be smoothed or extracted

Front 287

ECC

Back 287

Ecc - Presence of more than one decayed, missing, or filled primary tooth on a child 71mo or younger

S-ECC
- Any sign of smooth surface caries on younger than 3 years
- One or more cavitated, caries missing, or filled smooth surface in primary maxillary anterior
- Also any decayed missing, or filled surface score (DMFS) greater than 4 at age 3, greater than 5 at age 4, or greater than 6 at 5

Front 288

Moyer's mixed analysis

Back 288

Widths of the mandibular permanent incisors are used to predict width of buccal segment
- Predicts canine, first and second premolars
- Add up the sum of the differences
- Add -1.7mm for for each side in an end to end relationship

Front 289

Oral Cancer Epidemiology

Back 289

- 30,000 New cases diagnosed annually
- Most are SCC
- 2/3 lip and oral cavity, 1/3 pharyngeal cancer
- 3% of new cancers for males and 1.6% of new cancers for femailes
- Uncommon before 40
- Caucasians have higher lip cancer, but male African Americans have higher incidence of pharyngeal cancer

Front 290

Three levels of Prevention

Back 290

Primary
- Prevents disease before it happens. Fluoride and Sealants

Secondary
- Eliminates or reduces diseases that have occured
- Restorations

Tertiary
- Limits disability from disease and rehabilitates
- Dentures and crown and bridge

Front 291

Community Water Fluoridation

Back 291

- 0.7-1.2 ppm
- Most communities are 1ppm which is 1mg per Liter of water
- Fluoridation prevents 50%-70% of caries in permanent teeth
- 20%-40% due to other fluoride containing products

- School Fluoridation is 4.5 times concentration of community Fluoridation

Front 292

Prevalence vs Incidence

Back 292

Prevalence
- Expressed as percentage
- Number of people with disease / Total people at risk

Incidence
- New cases over a period of time
- Number of new cases / Total number at risk

Front 293

Cohort Study

Back 293

Prospective Cohort
- Measures risk factors in each subject.
- General population is followed through time to see who develops disease

Retrospective Cohort Study
- Measures effect that a specific exposure has had on a population.
- Measures risk factors in each subject that may have predicted subsequent outcome

Front 294

Sensitivity vs Specificity

Back 294

Sensitivity
- Percentage of persons with disease who are correctly classified as having disease
- Insensitive test leads to missed diagnoses
- True Positive/(TP + FN) * 100%

Specificity
- Percentage of persons without disease that is classified as not having it
- Low specificity test produces false positives
- True Negative/(TN + FP) * 100%

Front 295

Hep B & C

Back 295

Hep B
- Dane Particle
- 30% transmission after percutaneous injury

Hep C
- 3%-10% risk of transmission
- After needle stick is 1.8%

Front 296

HIV

Back 296

- 0.3% from percutaneous
- 0.09% from mucous membrane exposures

- Confirmed with 2 Positive ELISA followed by Positive Western Blot

Front 297

Ethylene Oxide & Chemical sterilization

Back 297

Ethylene Oxide
- 2-3hrs at 120F or 48.9C

Chemical (Cold) Sterilization
- Used for heat sensitive items
- 10 hours in 2% Glutaraldehyde solution

Front 298

Noise Control

Back 298

- Hearing loss develops from exposure exceeding daily average of 90dB
- Protection is recommended at 85dB with frequency from 300 to 4800 cps
- Protection is mandatory where levels reach 95dB

Front 299

MSDSs

Back 299

Material Safety Data Sheets

- Blue is Health Hazard
- Red is Fire Hazard
- Yellow is Reactivity or stability of a chemica
- White is required PPE when using the chemical

- Numbered 0-4. Higher the number, greater the danger

Front 300

Operant Extinction

Back 300

- Asking mother to refrain from providing attention
- Ma show Extinction burst at first

Front 301

Premack principle

Back 301

More probable behaviors will reinforce less probable ones

Front 302

Beneficence

Back 302

Dentist has a duty to promote patient's welfare

Front 303

Veracity

Back 303

Dentist has duty to communicate truthfully

Front 304

Emancipation

Back 304

Conscious Mentally competent patient under 18 may consent if
- Graduated form HS
- Married
- Pregnant
- Living on their own

Front 305

Statute of Limitations

Back 305

2 years from moment of discovery
- Should advise a patient and document so statue will begin to run

Front 306

Education vs Behavioral Intervention

Back 306

Educatin is not nearly as effective as behavioral intervention

Front 307

Balance Billing

Back 307

Charge patient difference between plan payment and UCR

Front 308

Phases of Specific Bacteria

Back 308

Early primary colonizors
- Streptococcal and Actinomyces Species

Late colonizers
- Prevotella Intermedia, Prevotella Loescheii, Capnocytophaga species, Porphromonas gingivalis, Troponema species, and AA.

- Fusobacterium Nucleatum serves as an important middle bridging organism. Can coaggregate early and late colonizers.

Front 309

Necrotizing Diseases

Back 309

- Prevotella Intermedia
- Spirochetes
- Fusobacterium Species

Front 310

A.A

Back 310

Non Motile, Gram Negative rod
- Capnophilic. Grows in CO2

Virulence factor
- Leukotoxin that kills WBC
- LPS
- Collagenase
- Protease that cleaves IgG

Front 311

Tannerella Forsythia

Back 311

Nonmotile, Gram Negative rod
- Requires N-AcetylMuramic, NAM, Acid as growth factor.

Virulence Factors
- Proteolytic Enzymes that cleave immunoglobulins and complement components

Front 312

Porphyromonas Gingivalis

Back 312

Nonmotile, Gram negative rod
- Anaerobic and becomes darkly pigmented when grown on blood agar plates

Virulence
- Fimbriae
- Capsule
- Proteases and collagenases
- Hemolysin

Front 313

Prevotella Intermedia

Back 313

Non-motile, gram negative rod
- Associated with Pregnancy Gingivitis

Front 314

Chemotaxins for Neutrophils

Back 314

TNFa
IL-1
IL-8
Leukotriene B4
Interferon Gamma

Front 315

Inflammatory Cytokines

Back 315

IL-1 - Bone resorption

IL-8 - Attracts inflammatory cells. Chemotactic

TNFa - Activates Macrophages

Front 316

Prognoses

Back 316

Good
- Adequate alveolus
- Good patient cooperation
- No systemic factors

Fair
- Mobility
- Grade I furcation
- Adeuqate patient cooperation

Poor
- Moderate to advanced alveolar bone loss
- Grade I and II furcation
- Questionable cooperation

Questionable
- Advanced bone loss
- Grade II and III furcation

Hopeless
- Advanced bone less
- Exo indicated

Front 317

Gracey Curettes

Back 317

- Blade is angled 60-70 degrees from lower shank

1-2 and 3-4: Anteriors
5-6: Anteriors and Premolars
7-8 and 9-10: Facial and lingual of posterior teeth
11-12: Mesial of Posterior teeth
13-14: Distal of Posterior teeth

Front 318

Ultrasonics

Back 318

- Vibrations range from 20,000 to 45,000 cycles per second
- Contraindication is Cardiac Pacemakers, and patients with communicable diseases. Also implants

Magnetostrictive
- Elliptical pattern

Piezoelectric
- Linear back and forth

Front 319

Flap design

Back 319

Internal Bevel incision
- Made from free gingival margin or just coronal from base of flap

Crevicular Incision
- Made from base of pocket to crest of alveolar bone

Interdental Incision
- Separates collar of gingiva from tooth

Front 320

Miller recession classification

Back 320

I - Recession does not extend to mucogingival junction. Without loss of interdental bone

II - Extends beyond mucogingival junction. Without loss of interdental bone

III - Extends beyond mucogingival junction with bone and soft tissue loss interdentally or malpositioned teeth

IV - Extends beyond mucogingival junction with severe interdental bone loss or severe tooth malposition

Front 321

Resective Osseous Surgery

Back 321

Ostectomy
- Removal of tooth supporting bone

Osteoplasty
- Removal of nonsupporting bone

Front 322

Guided Tissue Regeneration

Back 322

Method for preventing epithelial migration along cemental side of a pocket following flap reflection
- Covers bone and PDL to exclude epithelium and connective tissue from root surface
- Can use Citric acid, Fibronectin, EMPs like Emdogain can enhance new attachment

Front 323

Evaluation of Bone graft materials

Back 323

Osteogenic
- Induce formation of new bone by cells in graft

Osteoinductive
- Ability to induce neighboring cells into osteoblasts

Osteoconductive
- Ability to serve as scaffold to favor outside cells to penetrate and form bone

Front 324

Allograft materials

Back 324

Undecalcified, freeze-dried bone allograft
- Osteoconductive

Decalcified, free-dried, bone allograft DFDBA
- Osteogenic due to presence of BMPs

Front 325

Regeneration success

Back 325

Most successful in three walled bony defects

Lease successful in through and through class III furcation defects

Front 326

Local Antibiotics for Perio

Back 326

Atridox - 10% Doxycycline

Arestin - 2% Minocycline

Periochip - 2.5mg Chlorhexidine

Front 327

Biological Width

Back 327

Junctional Epithelium - 0.97mm

Connective Tissue attachment - 1.07mm

Total - 2.04mm

Front 328

Polymorphism and Severe Chronic Periodontitis

Back 328

Polymorphism in IL-1 gene is associated with severe chronic periodontitis

Front 329

coxib
dipine
ilol/alol
onium/urium
osin
pril/prilat
sartan
triptan

Back 329

coxib - Cox 2 inhibitors. Celecoxib
dipine - dyhydropyridine calcium channel blockers. Nifedipine
ilol/alol - beta blocker and blocks a1. Carvedilol, Labetalol
onium/urium - quaternary ammonium compounds, competitive skeletal muscle relaxers. Pancuronium
osin - a1 blocker. Prazosin
pril/prilat - ACE inhibitors. Captopril
sartan - Angiotensin 2 receptor blocker. Losartan
triptan - Serotonin 5-HT agonist, Antimigraine. Sumatriptan

Front 330

Efficacy vs Affinity

Back 330

Efficacy
- Emax
- Measures Intrinsic Activity

Affinity
- EC50
- Measures Potency

Front 331

Kd

Back 331

Measurement of affinity to receptor
- Lower the Kd, higher the affinity

Front 332

EC50

Back 332

Effective concentration leading to half maximal effect
- Measurement of Potency

Front 333

Therapeutic Index

Back 333

LD50/ED50
- Higher the Better

Front 334

Drug Metabolism

Back 334

- Drug made active my metabolism is prodrug

Phase I
- Oxidation, Reduction, Hydrolysis

Phase II
- Conjugation with chemical substituent
- Most common is Glucuronide Conjugation

Front 335

Half Life equation

Back 335

t1/2 = 0.693 * Vd/Cl

Vd = Total Drug in body / Plasma concentration

Front 336

Drug testing phases

Back 336

Phase I - Use normal volunteers to test safety and PK

Phase II - Use affected patients to test efficacy, PK, and safety

Phase III - Large number test involving several centers

Phase IV - Post marketing surveillance.

Front 337

ACh receptors

Back 337

Nicotinic Receptors
- Synapses
- Skeletal Muscle
- At adrenal Medulla

Muscarinic Receptors
- Heart, Smooth muscle
- Sweat glands

Front 338

Epinephrine, Norepinephrine, Isoproterenol, Phenylephrine

Back 338

Epinephrine - alpha and beta. Reverse anaphylaxis, vasoconstrict, bronchodilate
Norepinephrine - No beta 2. Vasocinstriction
Isoproterenol - Only beta. Bronchodilation
Phenylephrine - Only alpha. Nasal vasoconstriction

Front 339

Phentolamine and Phenoxybenzamine

Back 339

Nonselective alpha blockers
- Rarely used because of nonselectivity

"osin" are Selective a1 blockers

Front 340

Prazosin

Back 340

Selective a1 blocker
- Treats HTN, Heart failure, and BPH

- Adverse effects is hypotension, fluid retension, dry mouth, and nasal stuffiness

Front 341

Carvedilol

Back 341

Nonselective beta blocker
- Also blocks a1 receptors
- Used for heart failure

Front 342

Carbachol

Back 342

Only Cholinergic Agonist that has stronger Nicotine than Muscarine effects
- Used to treat Glaucoma

Front 343

ACh on receptors

Back 343

Given in low doses stimulates mostly muscarinic receptors
- In high doses, more nicotinic effects occur

Front 344

Pralidoxime

Back 344

Used to reactivate Acetylcholinesterase after irreversible inhibition by drugs such as Sarin and Soman

Front 345

"stigmines"

Back 345

Cholinesterase inhibitors
- Neostigmine, Physostigmine, Pyridostigmine
- Edrophonium
- Parathion, Sarin, Soman

Front 346

Autonomics of the eye

Back 346

Muscarinic agonists cause circular muscle of eye to contract
- Contracts ciliary musle for near vision
- Also enhances removal of intraocular fluid

- a1 adrenergic receptor does opposite

Front 347

Atropine and Scopolamine

Back 347

Antimuscarinic drugs

Atropine - Reduce salivary flow and antivagal effect during surgery.

Scopolamine
- For motion sickness
- Has CNS depression so better for preanesthetic agent

Both will block cardiac slowing effect of vagus nerve at high doses

Front 348

Dantrolene

Back 348

Relaxes skeletal muscle without blocking Nicotinic receptors
- Prevents release of Ca2+ from sarcoplasmic reticulum

Front 349

Antipsychotic drugs

Back 349

- Block Dopamine and Serotonin Receptors

apine - Clozapine
azine - Promazine
idone - Risperidone
idol - Haloperidol

Front 350

Antidepressant Drugs

Back 350

Increases Serotonin/5-HT or Norepinephrine at synapses in the brain
- Fluoxetine, Fluvoxamine
- Tricyclic Antidepressants - Amitriptyline, Despiramine

Front 351

Antimania Drugs

Back 351

Lithium
- Works inside cell to block conversion of inositol phosphate to inositol
- May have toxicity showing nausea, diarrhea, convulsions, coma. Thyroid enlargement.
- Must have monthly blood checks because margin of safety is narrow

Carbamazepine - Also used for Tic Douloureux
- Blocks sodium channels

Valproic acid
- Blocks sodium and calcium channels

Front 352

Benzodiazepines and Barbiturates Mechanism of Action

Back 352

Sedative Hypnotics

Benzodiazepine
- Enhance effect of GABAa on chloride channel receptors
- Increase chloride channel conductance

Barbiturate - Largely replaced by Benzodiazepines
- Enhance effect of GABA on chloride channel but also increase chloride channel conductance independently of GABA, especially at high doses.

Front 353

Antihistamine and Sedation

Back 353

Blocks H1 histamine receptors in CNS
- Leads to sedation
- Diphenhydramine

Front 354

Antiepileptic drugs

Back 354

Mechanisms
- Sodium channels
- Chloride channel receptors
- T-type calcium channels

Phenytoin - Also Anti-arrhythmic
Carbamazepine
Phenobarbitol

Front 355

Anti-Parkinson

Back 355

Strategy
- Increase dopamine in basal ganglia
- Block muscarinic receptors in basal ganglia since they oppose dopamine

L-dopa & Carbidopa - Sinemet
- Penetrate BBB and converted into dopamine
- Carbidopa inhibits dopa decarboxylase to prevent L-dopa conversion outside of CNS.

Selegiline MAO-B inhibitor
Tolcapone & Entacapone - COMT inhibitor

Front 356

o-toluidine

Back 356

Metabolite of Prilocaine that causes Methemoglobinemia

Front 357

Stages of General Anesthesia

Back 357

I - Amnesia is common. N2O for conscious sedation

II - Delirium. Excitement phase. Begins with unconsciousness

III - Surgical anesthesia. Loss of reflexes and muscle control

IV - Repiratory paralysis

Front 358

Blood:Gas solubility coefficient

Back 358

Lower the blood:gas solubility coefficient, faster the onset and termination of anesthesia
- N2O is very low

Front 359

MAC

Back 359

Minimum concentration of anesthetic in alveolus that is sufficient to give no response from surgical stimulus in 50% of patients

Front 360

Injectable Anesthetics

Back 360

Propofol
- IV
- Rapid onset and termination

Thiopental
- Barbiturate
- Fast acting

Ketamine
- Blocks NMDA, N-methyl-D,aspartate (Glutamate) receptors.
- May cause hallucinations upon emergence so give Diazepam
- Associated with Laryngospasm

Front 361

Antihistamines given for conscious sedation

Back 361

Promethazine - Previously used as anti-psychotic hence "azine"

Hydoxyzine

Front 362

Opioid Antagonists

Back 362

Naloxone and Naltrexone

Front 363

Opioid Mechanism

Back 363

Activates Gi to increase Potassium conductance and decrease Calcium conductance
- Decreases presynaptic release and increase postsynaptic potential

Front 364

Morphine

Back 364

- CNS analgesia, drowsiness, Miosis, respiratory depression.
- Head injury is contraindication
- Decreased peristalsis
- Histamine release
- Orthostatic HTN

- Significant liver metabolism
- Metabolite morphine-6-glucuronide is active metabolite
- 3hr half-life

Front 365

Codeine

Back 365

- 3hr half life
- Well absorbed orally
- Less potent than morphine
- Converted to morphine by 2D6

Front 366

Meperidine

Back 366

Opioid
- In between codeine and morphine
- More rapid onset but shorter duration than morphine.
- Not recommended for long term pain relief
- No miosis
- Most abused drug by health professionals
- Do not give with MAOi

Front 367

Methadone

Back 367

- Useful for treating opioid addiction
- 15-40hr half life

Front 368

Asprin toxicity

Back 368

- Initially increases respiration leading to respiratory alkalosis
- Eventually cause metabolic acidosis

Front 369

Drugs for Migraine

Back 369

Triptans - Serotonin blockers
- Sumatriptan
- 5-HT receptor agonists
- Abortive tx

Ergot alkaloids
- Ergotamine
- Vascular toxicity
- Abortive tx

Methysergide
- Use for prophylaxis tx

Front 370

Antihistamine Generations

Back 370

Second generation
- Does not cross BBB so no drowsiness
- Does not have antimuscarinic activity
- Longer half life

- Only first generation has local anesthesia, reduce motion sickness, and promotes sleep

Front 371

H2 Blockers

Back 371

H2 histamine receptor blocker inhibits histamin on parietal cells
- Treats GERD, and peptic ulcers

Cimetidine has antiandrogen effect
- Impotence, loss of libito, gynecomastia

Front 372

Antiarrhythmic Drug classes

Back 372

1 - Block sodium channels
2 - Block b-adrenergic receptors
3 - Block potassium channels
4 - Block calcium channels

Front 373

Digitalis

Back 373

Digoxin
- Increases force of contraction of heart
- Inhibits Na+/K+ ATPase and increasing intracellular calcium

Front 374

Clopidogrel & Abciximab

Back 374

Clopidogrel
- Inhibits effect of ADP on platelets

Abciximab
- Antibody that inhibits GP IIb/IIIa glycoprotein receptor on platelets

Front 375

Major diuretic drugs and MOA

Back 375

Thiazide - Na+ and Cl- transport

Loop diuretic - Decrease Na+/K+/2Cl- co-transport

Amiloride, Triamterene - Na+ channel blocker. Potassium sparing

Front 376

Spironolactone

Back 376

Aldosterone antagonist diuretic
- Potassium sparing

Front 377

Wafarin and Heparin

Back 377

Wafarin
- Inhibits Potassium dependent synthesis of factors 2, 7, 9, 10

Heparin
- Stimulates Antithrombin III

Front 378

INR

Back 378

Normal = 1

Taking anticoagulants = 2.5-3.0

If beyond 4.0, may have excessive bleeding

Front 379

Plasminogen Activators

Back 379

Breakdown clots by promoting Fibrinolysis
- tPA
- Streptokinase
- Urokinase

Front 380

Sulfonylureas

Back 380

Used for Type 2 Diabetes - Increases insulin secretion from Pancreas
- Glimeperide
- Tolbutamide
- Tolazamide
etc

Front 381

Metformin

Back 381

Reduces glucose production by liver
- Increases sensitivity to insulin in muscle, liver, and fat cells

Front 382

Dental antifungals

Back 382

Clotriamzole Oral Troches
Nystatin Pastilles or rinse

More Extensive Disease
- Fluconazole
- Itraconazole
- Caspofungin

Front 383

Semiadjustable Articulator

Back 383

Arcon
- Condyles are attached to lower member of the articulator
- Fossae is in the upper member
- Better for Removable

Non-arcon
- Condyles are on upper member
- Condylar guidance is associated with lower member
- Rigidly attached
- Better for Fixed

Front 384

Implant placement space

Back 384

Implants should be 3mm apart and atleast 1mm away from tooth

Front 385

Christensen's Phenomenon

Back 385

Distal space created between maxillary and mandibular occlusal surfaces of occlusion rims of dentures
- Caused by downward and forward movement of condyles

Front 386

Vertical Dimension of Denture

Back 386

Closest speaking space
- 1 to 1.5mm

Front 387

Denture Support, Stability, and Retention

Back 387

Support
- Resistance to vertical seating forces

Stability
- Resistance to horizontal dislodgement

Retention
- Withstand vertical dislodging forces

Front 388

Nystatin Oral Rinse and Cream

Back 388

Nystatin Oral Syspension
*Contains Sugar
Dispense: 60mL of 100,000 units/mL
- 4mL three times daily. After each mean, rinse for 2 minutes and expectorate.

Nystatin Ointment for Angular Cheilitis
- Disp 15g tube
- Apply to affected area four times daily for 2 wks

Front 389

RPD Classification

Back 389

Class 1 - Bilateral edentulous areas posterior to remaining teeth
Class 2 - Unilateral edentulous area posterior to remaining natural teeth
Class 3 - Unilateral edentulous area in between teeth
Class 4 - Single edentulous ridge crossing the midline

Rules
- Classification should follow extraction of teeth
- If 2nd or 3rd molar is missing and not replaced, it is not considered in the classification
- Most posterior edentulous area determines the classification

Front 390

Palatal Strap vs Bar

Back 390

Strap - Greater than 8mm

Bar - Less than 8mm. Needs bulk for stability

Front 391

Beading RPD

Back 391

Scribing rounded 0.05mm groove to anterior and posterior border of major connector
- add strength to major connector
- Prevents food impaction

Front 392

Rest Seat Design

Back 392

Occlusal
- 1/3 Facial Lingual Width
- 1/2 Width between cusps
- 1.5mm deep for base metal

Cingulum rest
- Mesiodistal length 2.5-3mm
- Labiolingual width 2mm
- Incisoapical depth 1.5mm

Incisal rest
- 2.5mm wide, 1.5mm deep

Front 393

Crown Thickness

Back 393

Metal thickness of 1.5mm at functional cusp and 1mm at nonfunctional cusp

Need 2mm when porcelain is used

0.5mm minimum at margin to prevent distortion

Front 394

Impression Materials

Back 394

Reversible Hydrocolloid
- Hydrophilic and long working time
- Low tear resistance and low stability
- Must pour immediately

Polysulfide
- Contains sulfur as accelerator and catalyst reactor.
- Water is released as polymerization byproduct
- High tear strength
- Must pour within 1 hour

Condensation Silicone
- Release Alcohol as by product
- Hydrophobic
- Pour immediately

Addition Silicone: Vinyl Polysiloxane
- Hydrophobic
- May release H2
- DImensional stability

Polyether
- No byproduct
- Very succeptible to water absorption
- Poured promptly
- Set material very stiff so care not to break teeth

Front 395

Classificaiton of Alloys

Back 395

Nobel metals are Gold, Platinum, Paladium, and Silver

High nobel
- Nobel metal content >60% and Gold content >40%

Nobel
- Nobel metal content >25%

Base metal
- <25%

Front 396

Bonding of Metal to Porcelain

Back 396

Metal oxide formation is necessary for ceramic bonding
- Accomplished by heating metal in furnace

Coefficient of thermal expansion of metal must be slightly higher than porcelain
- Porcelain is stronger under compressive forces than tensile forces

Front 397

Porcelain Composition

Back 397

Composition
- Feldspar: Main constituent
- Quartz: Strength
- Kaolin: Binder
- Metallic Oxides: Opacity and Color

Layers
- Opaque Porcelain: Mask dark oxide color and provide metal bond. 0.1mm
- Body or Dentin porcelain: Contains most of color or shade
- Incisal porcelain: Most translucent layer

Front 398

Shade selection and color

Back 398

Hue
- Shade or color
- Selected first

Chroma
- Saturation or intensity of color or shade
- Always better to choose lower chroma

Value
- Lightness or darkness of a color

Front 399

Metamerism

Back 399

Color match under light is different under another lighting condition

Front 400

Fluorescence & Opalescence

Back 400

Fluoresence
- Physical property where object emits visible light when exposed to UV light
- Dentinal layer of tooth

Opalescence
- Light effect of a translucent material appearing blue in reflected light and red-orange in transmitted light

Front 401

Cements

Back 401

Zinc Phosphate
Zinc Polycarboxylate
- High solubility and High leakage

Glass ionomer
- Adheres to enamel and dentin and releases fluoride
- Superior mechanical properties to zinc phosphate and polycarboxylate

Resin-Modified Glass ionomer
- Similar to glass ionomer but higher strength and lower solubility
- Should not use with all-ceramic due to fracture

Resin Luting agents
- Unfilled resins that bond to dentin.
- Less biocompatible and greater film thickness

Front 402

Gypsum

Back 402

Type 1: Plaster, Impression plaster
Type 2: Model plaster
Type 3: Dental Stone
Type 4: Die stone
Type 5: high strength

- Increasing water increases set time and decreases strength and expansion

- Potassium Sulfate and Sodium Chloride Accelerate setting
- Sodium Citrate and Borax Retard setting

Front 403

Flux

Back 403

Prevent oxide formation
- Allows solder to wet surface freely and spread over metal surface

Front 404

Safest Intracoronal Bleaching Chemical

Back 404

Sodium Perborate

Front 405

Axial depth gingival to CEJ

Back 405

0.75-0.8mm

Front 406

Skirt

Back 406

Mini crown prep around line angle
- Increases retention and resistance
- Should be prepared by diamond in long axis of tooth extending to gingival 3rd
- Extends outline so is least esthetic

Front 407

Mercury Half Life

Back 407

55 Days

Front 408

Casting Oxygen Scavenger

Back 408

Zinc

Front 409

Slots

Back 409

- Atleast 1mm in depth with Inverted cone bur
- Longer the better
- Can segment or continuous
- Atleast 0.5mm into DEJ

Front 410

Local Anesthetic unapproved for children

Back 410

Bupivicaine

Front 411

Ectopic Lymphoid Tissue

Back 411

FOM, Posterior lateral tongue, Soft palate, Tonsilar Pillar

Front 412

Splinting

Back 412

Avulsion
- Nonrigid splint
- 7-14days

Root fractire
- Rigid Splint
- 2-3 Months

Front 413

Extinction

Back 413

Identifying all positive reinforcements of a bad behavior and withholding them

Front 414

Systematic Desensitization

Back 414

Process of pairing a relaxation response with a hierarchy of increasingly feared stimuli while using relaxation skills
- Most important component is exposure to feared stimulus

Front 415

Classical Conditioning

Back 415

Neutral stimulus is paired with unconditioned stimulus
- After a few pairings, neutral stimulus elicits conditioned response without the presence of the unconditioned stimulus

People in white coats automatically triggers fear response

Front 416

Operant Conditioning

Back 416

An individual's behavior is modified by its consequences; the behavior may change in form, frequency, or strength

- When a Stimulus-Response pattern is reinforced, and individual is conditioned to respond a certain way

- Positive and Negative reinforcement strengthen behavior
- Punishment and Extinction weaken behavior

Front 417

Factors of Cognitive Appraisal of Stress

Back 417

Controllability
Familiarity
Predictability
Imminence

Front 418

Graded Exposure

Back 418

Systematic process of exposing patient to hierarchy of increasingly anxiety provoking stimuli

Front 419

Supplemental Fluoride Dosing

Back 419

<0.3ppm
- 6mo - 3yr: 0.25mg
- 3yr - 6yr: 0.5mg
- 6yr - 16yr: 1.0mg

0.3-0.6ppm
- 6mo - 3yr: Nothing
- 3yr - 6yr: 0.25mg
- 6yr - 16yr: 0.5mg

>0.6ppm
- Nothing

Front 420

Types of Epidemiology

Back 420

Descriptive - Quantify disease status in a community
- Prevalence and Incidence

Analytical/Observational - Determines etiology of disease
- Cross sectional, Case control, Cohort studies.

Experimental - Intervention studies. Determines etiology and establish effectiveness of program or therapy
- Clinical trials, and Community trials

Front 421

Acceptable quality of dental office water

Back 421

CDC recommends <500 CFU/mL

ADA recommends <200 CFU/mL

Front 422

DHHS

Back 422

Department of Health and Human Services
- US govt's agency for protecting health of all Americans and providing essential human services

Includes NIH, HRSA, AHRQ

Front 423

HRSA

Back 423

Health Resources and Services Administration
- Provides access to essential healthcare services for low-income, uninsured, or rural areas

Front 424

AHRQ

Back 424

Agency for Healthcare Research and Quality
- Supports research on health care systems, cost and quality issues, and effectiveness of treatments

Front 425

Diabetes Control and Periodontitis

Back 425

Well controlled diabetes is not more severe than non diabetes
- Well controlled diabetes can be treated with conventional periodontal therapy

Front 426

Oral Contraceptives and Perio

Back 426

Exacerbates impact of bacterial plaque and gingiva
- Cannot induce gingivitis

Front 427

Scaling, Root Planing, Currettage

Back 427

Scaling
- Remove plaque, calculus and stains from tooth
- Done on crown and root

Root Planing
- Create smooth root surface through removal of calculus and rough cementum
- Root only

Curettage
- Used to remove epithelial lining of periodontal pocket

Front 428

Epithelial Cell migration and Healing

Back 428

Migrates 0.5mm/day
- Gingivectomy takes 5-14days for repithelialization to complete

Front 429

Benztropine

Back 429

Reduce parkinsonlike symptoms caused by dopamine blocker Haloperidol used for antipsychosis
- Benztropine Reduces salivary flow and cause xerostomia

Front 430

Halothane

Back 430

Inhalational general anesthetic containing Bromine
- Can cause cardiac arrhythmia when administered with Epinephrine and other catecholamines

Front 431

Ibuprofen, Naproxen and Asprin

Back 431

Ibuprofen and Naproxen are both reversible COX inhibitors

Asprin is irreversible inhibitor

Front 432

Diazepam, Epinephrine, Insulin receptor types

Back 432

Diazepam - Ion channel receptors

Epineprhine - G protein receptors

Insulin - Tyrosine Kinase receptor

Front 433

Fanconi Syndrome

Back 433

Proximal tubule damage
- Renal tubular acidosis
- Aminoaciduria
- Hyperphosphaturia

- Can be hereditary or caused by Outdated Tetracyclines

Front 434

Elimination Half-time for PCN V

Back 434

0.5 hours due to active tubular secretion
- Very little is metabolized

Front 435

Polycarboxylate Cement

Back 435

Carboxylate groups in polymer chelates to calcium and forms a chemical bond

Front 436

Belladonna Alkaloids

Back 436

Atropine
Scopolamine

Muscarinic Antagonists

Front 437

Nonsedating Antihistamine not contraindicated with Cimetidine

Back 437

Fexofenadine

Front 438

Local Anesthetic Structure Generalizations

Back 438

Bigger the alkyl substitution on hydrophilic nitrogen, the greater the activity

Longer the intermediate chain, greater the activity and toxicity.

Most effective substitutions that increase or decrease action is on lipid soluble group

Front 439

Chloramphenicol

Back 439

Broad Spectrum Antibiotic

Can cause bone marrow toxicity
- Bone marrow supression which is a direct effect and is reversible
- Aplastic anemia which is idiosyncratic and is fatal

Front 440

Lingual Tori technique

Back 440

1) Grooving the superior surface then

2) Shearing the torus off with a mono-beveled chisel.

3) Area is then smoothed with a bone file.

Front 441

Gluteal injections for child

Back 441

Gluteus maximus does not develop till child walks so avoid Dorsal Gluteal injections

Give Ventrogluteal injections instead in Gluteus Medius

Front 442

Antibiotic associated with majority of Oral Contraceptive Failure

Back 442

Rifampin
- RNA blocker

Front 443

Phenytoin vs Phenobarbital

Back 443

Phenobarbital is a barbiturate that is anticonvulsant in subhypnotic doses
- Chief side effect is drowsiness

Phenytoin
- causes gingival hyperplasia, irreversible hypertrichosis, and Stevens-Johnson syndrome
- Contraindicated for infants, young females, and children undergoing ortho
***- Also Anti-Arrhythmic

Front 444

Valproic Acid

Back 444

Anticonvulsant
- Withdrawal is associated with Seizures, Gingival Hemorrhage, and Acute Stomatitis

Front 445

Types of Porosities

Back 445

Solidification shrinkage: Irregular Shape
- Shrinkage porosity: Large irregular voids found near sprue casting junction. Caused by poor sprue size
- Suck back porosity: External void opposite the sprue caused by hotspot. Avoid by reducing temp difference between mould and molten alloy
- Microporosity: When casting freezes too rapidly. Mould or casting temperature is too low

Gas caused shrinkage: Usually Spherical
- Pin Hole porosity: When metals dissolve gasses. Pa and Pd dissolve Hydrogen. Co and Ag dissolve Oxygen.
- Gas inclusion porosity: Larger than pinhole and caused by gasses trapped by molten metal. Due to poorly adjusted blow torch

Back Pressure Porosity
- Characterized by Porous casting with Rounded Short Margins
- Caused by air trapped in mould. No more than 1/4 inch thickness of investment between bottom of casting ring and wax pattern.
- Air is usually pushed out through bottom, but if investment is too thick, air can't escape.

Front 446

Most likely cause of failure in pre-ceramic soldering technique

Back 446

Overheating parts to be joined

Front 447

Spherical Amalgam

Back 447

Particles tend to roll over one another
- Should use larger condensers and laterally applied condensation forces

Front 448

Stone Expansion and Strength factors

Back 448

Increased mixing time and Decreased Water/Powder ratio will increase the number of nuclei of crystallization of calcium sulfate dihydrate.
- Shortens set time and Increases expansion by providing more nuclei per unit volumn
- Stronger Stone

Slurry water shortens set time
- Does not affect strength or expansion

Accelerators and Retarders
- Decreases compressive strength and expansion by changing shape of crystals

Colloidal materials
- Lengthens set time but weakens stone by poisoning nuclei

Front 449

Pulpal response to caries and dental procedure

Back 449

Most important factor is effective depth

Second most important is heat
- Dessication is a factor when water is not present

Vibrations

Front 450

Desiccation

Back 450

When water in Tomes fibers are eliminated, will pull odontoblasts into tubules leading to their degeneration.
- Drying out is the worst for the pulp

Front 451

Heparin

Back 451

Increases inhibitory effect of Anti-thrombin III
- Increases inhibitions of Factors Xa and Thrombin
- Most important effect is inhibition of Thrombin and prevents conversion of Fibrinogen to Fibrin

Front 452

Ductility
Malleability
Resilience
Brittleness

Back 452

Ductility
- Material's ability to deform under tensile strength
- Ability to be stretched into a wire

Malleability
- Ability to deform under compressive forces
- Forms a thin sheet by hammering or rolling

Resilience
- Ability of a material to absorb energy when it is deformed elastically and release it upon unloading
- Modulus is maximum energy that can be absorbed without creating a permanent distortion

Brittleness
- When subject to stress, breaks without significant deformation
- High compressive strength but low tensile strength

Front 453

% of people without dental insurance

Back 453

65-70%

Front 454

Torsades de Points

Back 454

Ventricular tachycardia
- Can be caused by Erythromycin and Interaction with Terfenadine

Front 455

Affinity of opioid receptor binding

Back 455

Sodium lowers affinity of opioid receptor for agonists and antagonists

Front 456

Prescription Parts

Back 456

Superscription
- Abbreviation for Recipe, Rx symbol

Inscription
- Body of prescription. Provides names, quantities, dose, and dosage form

Subscription
- Specific instructions. Used in old days

Transcription
- Sig. Gives instructions to patient on how to take it.

Followed by special instructions and refills

Front 457

Amyl Nitrite

Back 457

Potent vasodilator
- Expands blood vessels
- Relaxes involuntary muscles
- Tachycardia

Used as antidote for Cyanide Poisoning
- Acts as an oxidant to induce formation of Methemoglobin
- Can cause Methemoglobinemia

Front 458

Quinidine

Back 458

Antiarrhythmic
- May cause Ventricular Tachyarrhythmias in patients with Atrial Fibrillation
- Can give with Digitalis to prevent that

Front 459

Cardiac Glycosides

Back 459

Used to treat congestive heart failure and arrhythmias
- Digoxin, Ouabain

- Blocks Sodium Potassium pump, which pumps sodium out, and and potassium in.
- Intracellular sodium is increased

Front 460

Hydralazine

Back 460

Antihypertensive drug
- Acts on arterial smooth muscle to cause vasodilation

Front 461

Neuroleptic

Back 461

Antipsychotic

Front 462

Paternalism

Back 462

aka Parentalism
- Limits one's autonomy for one's own good

Front 463

Sedative Most likely to cause dry mouth

Back 463

Hydroxyzine
- First Generation Anti-Histamine

Front 464

Neuronal Depleting drugs

Back 464

Reserpine
- Depletes NE granules and releases NE

Guanethidine
- Blocks adrenergic nerve endings

Metyrosine
- Inhibits tyrosine hydroxylase
- Prevents formation of L-dopa, Epinephrine and NE

Front 465

Beta blockers that also block a1

Back 465

Carvedilol and Labetalol

- Both are nonselective beta-blockers that also bloack alpha 1 receptors

Front 466

Epinephrine Reversal

Back 466

Alpha blocking to reverse pressor action of epinephrine.
- NE pressor effect is blocked
- Epi will bring about a fall in blood pressure from B2 receptors since alpha is blocked.

Front 467

Most common side effect of Beta Blockers

Back 467

Weakness and Drowsiness

- As with all selective beta blockers, Selectivity for beta 1 is lost at high concentrations

Front 468

Metoprolol and Atenolol

Back 468

Selective B1 blockers
- Both longer acting and more predictable than propranolol
- At high concentrations selectivity for beta 1 is lost

Front 469

Acebutolol

Back 469

B1 selective blocker used to treat HTN and control Ventricular Arrhythmias
- Low lipid solubility and has intrinsic sympathomimetic activity. Partial agonist at B2

Front 470

Methylparaben

Back 470

Perservative used in local anesthetics
- May cause allergies

Front 471

Chloral Hydrate

Back 471

Used for Pedo pre-op anxiolysis
- Does not relieve pain
- Children may become more excited and irritable before becoming sedated
- Prodrug that is metabolized into actie Trichloroethanol
- May cause Hypoprothrombinemia by displacing wafarin from binding site

Front 472

Dyclonine Hydrochloride

Back 472

Oral Anesthetic used as Throat Lozenges
- Has Ketone intermediate linkage

Front 473

Maximum Local Dose

Back 473

Lidocaine - 300mg 2% 8.3carp
Mepi - 300mg 3% 5.6 carp
Prilo - 400mg 4% 5.6 carp
Bupiv - 90mg 0.5% 10 carp

Articaine: 7mg/kg

Front 474

NItrous and Oxygen

Back 474

Nitrous Blue

Oxygen Green

Front 475

Ketamine

Back 475

IV general anesthetic agent
- Produce hallucinations or illusions upon emergence
- Give diazepam to relieve this
- Also associated with Laryngospasm

Front 476

Cocaine as local

Back 476

Only local anesthetic that vasoconstricts
- Mepivacaine has less vasodilator effect compared to everything else

Front 477

Buspirone

Back 477

Orally administered antianxiety drug with short half life
- Not chemically related to any other anxiolytics
- Acts at Serotonin receptors
- Not anticonvulsant or muscle relaxing. Does not impair psychomotor function or cause sedation

Front 478

Erythromycin Common Side effect

Back 478

GI upset
- Take with Food

Front 479

Aminoglycosides

Back 479

Bacterialcidal antibiotics that creates fissures in outer membrane and binds to 30S subunit
- Aerobic, Gram Negative bacteria.
- Gentamicin is most commonly use followed by Amikacin.

- May cause neuromuscular weakness due to curare-like effect. So avoid in myasthenia gravis, botulism, or parkinsonism.
- ***Causes Ototoxicity and Nephrotoxicity

Front 480

Sulfonimides

Back 480

Structurally similar to PABA which is needed for folic acid synthesis
- Bacteriostatic
- Used for UTI and not dental infections.
- May cause Blood Dyscrasias

- Sulfamethoxazole, Sulfisomidine,

Front 481

Probenecid

Back 481

Causes uric acid excretion and treats Gout
- Used to prolong action of penicillin

Front 482

Broadest penicillins

Back 482

Piperacillin
Ticarcillin

Front 483

Fluoroquinolones

Back 483

Inhibits DNA Gyrase
- xacins: Ciprofloxacin
- Bacteriocidal
- Nausea & Headache

Front 484

Bacitracin

Back 484

Inhibits Cell wall synthesis
- Can cause nephrotoxicity

Front 485

Photosensitivity

Back 485

Caused by Tetracyclines

Front 486

Neuraminadase Inhibitors

Back 486

Oseltamvir
Zanamivir

- Blocks Neuraminasase cleavage to release viruses

Front 487

Acyclovir

Back 487

Inhibits DNA synthesis

Front 488

Amantadine
Rimantadine

Back 488

Interferes Viral Protein M2 which is required for viral uncoating

Front 489

Antipsychotics

Back 489

First Generation: D2 antagonist. Shows Extra pyramidal symptoms - muscle rigidity, parkinson-like movements, spasms of neck and facial muscles.
- Phenothiazines - "azines"
- Butyrophenones: Haloperidol. Schizo and Tourette's
- Thioxanthenes: Weak. Schizo

Second Gen: Bind dopamine receptors in Limbic system, and has affinity for serotonin receptors. Reduced induction of Extra Pyramidal Symptoms
- Clozapine "apines" : Specific for limbic receptors and not muscles. Low EPS and Tardive Dyskinesia
- Risperidone
- Olanzapine
- Quetiapine
- Ziprasidone
- Aripirazole

Can cause Motor restlessness, Long QT and arrhythmias, parkinsonism, antimuscarinic effects

Front 490

Tardive Dyskinesia

Back 490

Irreversible Neurological disorder from taking antipsychotic/neuroleptic drugs for more than a year. 20%
- Uncontrollable movement of body parts.

- Also seen with Tricyclic Antidepressants

Front 491

N-Acetylcysteine

Back 491

Specific antidote for acetaminophen poisoning

Front 492

Anticholenergics

Back 492

Mecamylamine - Nicotinic ganglion blocking drug

- Atropine
- Benztropine
- Scopolamine
- Glycopyrrolate
- Propantheline Bromide
- Trihexyphenidyl HCL

Front 493

Neuromuscular Blockers

Back 493

Non-Depolarizing: Competes with ACh at nicotinic receptor
- Tubocurare is prototype
- Others are Mivacurium, Vecuronium, Doxacurium, the "Curs"

Depolarizing
- Succinylcholine. Nicotinic agonist and depolarizes motor end plate. Causes initial excitation followed by blockade of trasmission

Dantrolene - Acts within skeletal muscle fiber to inhibit Calcium from SR

Botox - Prevents release of ACh from motor terminal.

Front 494

Cholinesterase Inhibitors

Back 494

Physostigmine
Neostigmine
Pyridostigmine
Edrophonium
Tacrine
Donepezil

*Rivastigmine, Galantamine and Donepezil are approved for Alzheimer's.

Malathione and Sarin are Irreversible

Front 495

Pilocarpine

Back 495

Cholinergic alkaloid Salagen
- Used to treat open angle glaucoma. Also to induce salivary flow from radiation reduced flow.

Cevimeline Evoxac
- Treats xerostomia in Sjogren's

Front 496

Pralidoxime

Back 496

Reverses effects of Anticholinesterase poisoning

Organophosphates include Thiones, Tabun, Soman, Sarin, Echotiophate, Isoflurophate

Front 497

Antimuscarinic Drugs

Back 497

- Atropine & Scopolamine
- Glycopyrrolate
- Benztropine
- Homatropine
- Trihexphenidyl
- Ipratropium
- Oxybutynin

Contraindication of antimuscarinic drugs
- Narrow-angle glaucoma
- Prostatic hyperplasia
- Tachycardia

Front 498

Inhaled corticosteroids

Back 498

Fluticasone
Flunisolide
Budesonide
Beclomethasone
Triamcinolone

Front 499

Peripheral Vasodilators

Back 499

Hydralazine
Minoxidil

Front 500

Calcium Channel Blockers

Back 500

Verapamil
Nifedipine
Diltiazem

- Effective indirect vasodilators to treat HTN

Front 501

Most potent broad spectrum antiarrhytimic

Back 501

Amiodarone
- Blocks sodium, calcium, potassium, and beta receptors

Front 502

Antidote for Heparin

Back 502

Protamine
- Heparin Antagonist

Front 503

PT vs PTT

Back 503

PT - Prothrombin time
- Tests for deficiency of V, VII, X
- Expressed as INR and tests for Wafarin & Vitamin K

PTT - Partial Thromboplastin time
- Heparin

Front 504

Alkylating agents

Back 504

Cisplain
Cyclophosphamide
- Anticancer

Front 505

Antidiabetic agents

Back 505

Sulfonureas
- Close potassium channels, Stimulate beta cells, Increase sensitivity of organs to insulin
- First gen: Bound to proteins. Tolbutaminde, Tolazamide, Chlorpropamide.
- Second gen: Not bound: Glizipide, Glyburide, Glimepiride

Biquanides: Metformin - Decreases hepatic glucose production. Minor effects on insulin sensitivity. No effect on Pancreas.

Thiazolidinediones: Increases muscle and liver sensitivity.
- Rosiglitazine, Pioglitazone

Meglitinide: Stimulates release of insulin in short bursts
- Repaglinide, Nateglinide

a-Glucosidase inhibitors: Inhibits pancreatic a-amylase and membrane a-glucosidase hydrolase. Delays glucose absorption.
- Acarbose, Miglitol

Front 506

Loperimide

Back 506

Opiate that does not penetrate CNS
- Antidiarrheal that inhibits peristalsis
- Sold OTC
- No evidence of abuse or dependence

Front 507

"limus"

Back 507

Immunosupressants
- Pimecrolimus
- Sirolimus
- Tacrolimus

- Used to treat dermatitis and to prevent organ rejection

Front 508

Inhaled Nicotine

Back 508

Contains 10mg but delivers 4
- Absorbed through mouth, not the lungs.
- Also contains 1mg Menthol

Front 509

Potency vs Efficacy

Back 509

Potency is measured by lower EC50

Efficacy is maximal effect

Front 510

Maxillary First Molar Endo

Back 510

Highest failure rate due to complex Mesiobuccal root
- Many have major fins or second canals
- Second canal is usually lingual to mesiobuccal canal orifice

Triangular outline
- Base formed by buccal canals
- Apex by palatal canal
- Mesial buccal to Palatal is longest

Front 511

Referred pain

Back 511

Maxillary Incisors - Forehead
Maxillary canines and premolars - Nasolabial area
Maxillary Second Premolars - Temporal region
Maxillary Molars - Zygomatic, Parietal, Occipital regions

Mandibular anteriors and premolars - Mental region
Mandibular molars - Ear, angle of jaw, posterior neck

Both Max and Mand molars - Opposing quadrant or to other teeth in same quadrant

Front 512

Recapitulation

Back 512

Use MAF after each increase in file size

Front 513

Urea Peroxide

Back 513

Gly-Oxide
- Irrigant available in anhydrous glycerol base
- Better tolerated by PA tissue than NaOCl, and has greater solvent action and germacidal than Hydrogen Peroxide
- Excellent irrigant for narrow and curved canals utilizing slippery glycerol

Front 514

Techniques to remove Gutta Percha

Back 514

Rotary
Ultrasonic
Heat and Instrument
File and Chemical

- Chloroform is reagent of choice to dissolve gutta-percha

Front 515

Disinfection of Endo Instruments and Materials

Back 515

Gutta percha can be disinfected by placing in 5.25% of NaOCl for 1 minute

Glass bead Sterilizer can sterilize endo files in 15 seconds at 220deg C

Front 516

Chelating Agents

Back 516

Substitutes sodium ions for calcium ions.
- Makes edges of canal softer and facilitates canal enlargement. Also removes smear layer, and provides cleaner surface.
- Usually EDTA and it will remain active in canal for 5 days if not inactivated with NaOCl

EDTAC - EDTA with addition of Cetavlon: Quaternary ammonium compound with antimicrobial action, but with greater inflammatory potential.
- Inactivated by NaOCl

RC-Prep: Combines EDTA with Urea Peroxide to provide chelation and irrigation.

Front 517

Broken File

Back 517

- If past the apex, must do surgery

- If breaks off in canal with a PA radiolucency present. Surgery is indicated.
- Obturate to blockage and do apico

- If broken off in apical 3rd and lodged tightly without any PA radiolucency, may obturate and inform patient.

Front 518

ZOE as Sealer

Back 518

Act as lubricant
Form a bond
Exert antibacterial activity

Disadvantages of ZOE
- Staining
- Slow setting time
- Non-adhesion
- Soluble

Front 519

Major objectives of access preparation

Back 519

Straight line access
Conservation of tooth structure
Unroofing chamber and removing pulp horns

Front 520

Endo instrument types

Back 520

All made of stainless steel

K-type
- Files: Manufactured by twisting a blank square rod to produce a series of cutting flutes. Strongest of all files and cuts least aggressively.

Reamers
- Fewer flutes, and used in canal preparation to shave dentin and enlarge canals with reaming action.

H-Type
- Hedstrom Files: Sharp rotating cutter to gauge triangular segments out of a round blank shaft. Produces very sharp edges and used to cut. Use filing action only. Modification is S file

Front 521

Internal Bleaching

Back 521

Superoxol
- 30% hydrogen peroxide solution
- Potent oxidizing agent that directly oxidizes stain producing substances
- Application of heat to liberate oxygen in bleaching agent

Front 522

Bleaching Side effects

Back 522

- Cervical Root resorption is a potential side effect that won't occur for 6 months.

- Most probable post-op complication of a tooth that is not adequately obturated is acute apical periodontitis

*** - Bleaching changes color of both Dentin and Enamel

Front 523

Walking Bleach technique

Back 523

Sodium Perborate and water
- Place paste into chamber and temp for 4-7 days

Front 524

X-ray safety

Back 524

Minimal Scatter radiation
- 6ft away 90 to 135 degree from beam

Dental personnel should have no more than 50 mSv per year for whole body

Dental units should operate at 70kV or higher to lower skin doses

Front 525

Predominant bacteria in root canals

Back 525

Strict anaerobes predominate
- Porphyromonas species
- Bacteroides Melaninogenica

Enterococcus Faecalis is associated with failed root canals

Front 526

Pulp Structure

Back 526

Cell rich zone - Innermost zone containing fibroblasts

Cell free zone - Rich in capillaries and nerve networks. Plexus of Raschkow is here

Odontoblastic layer - Outermost layer that contains odontoblasts

Contains Fibroblasts, Odontoblasts, Histiocytes, and Lymphocytes

Front 527

Predentin

Back 527

Layer of dentin immediately adjacent to odontoblast layer 10-47 microns thick
- If this unmineralized layer is lost, predisposes dentin to internal resorption by odontoclasts

Front 528

Avulsed permanent tooth

Back 528

Within 2 hours
- Splint for 7-10 days no more than 2 wks.
- Prep canal and place calcium hydroxide paste
- Replace paste every 3 months for a year and place permanent gutta percha

More than 2 hours
- Perform RCT prior to replantation.
- Soak tooth in 2.4% Fluoride solution at 5.5pH for 20min
- Resorption will be most frequent sequela

Front 529

Inflammatory Resorption

Back 529

Internal resorption - Dental trauma, caries, pulp capping, cracked tooth
- Shape canal and place calcium hydroxide paste.
- Replace every 3 months for a year, and then place gutta percha.

Surface resorption - Caused by acute injury to PDL and root surface. Excessive ortho, and internal bleaching.
- Very common and reversible. Once injury is not repeated, healing takes place with new cementum and PDL

Replacement Resorption
- Ankylosis

Front 530

Advantages and Disadvantages of MTA

Back 530

Advantages
- High pH so induces hard tissue
- Superior sealing ability
- Low inflammation

Disadvantage
- Difficult to manipulate and Long set time

Front 531

Trephenation

Back 531

Making a bur hole

Apical trephination can be done by aggressively placing 15 or 25K file beyond apex

Surgical trephination is perforation of alveolar cortical bone with 15 scalpel and bur

Front 532

Apexification

Back 532

Induce further root development in a pulpless tooth with Calcium Hydroxide-Methylcellulose paste.
- Alkaline environment promotes hard tissue deposition

Apexogenesis is maintaining pulp vitality during pulp treatment to allow continued development of root

Front 533

Root submersion

Back 533

Resection of roots 3mm below crest and coronal part is removed
- Root portion is kept in to maintain alveolar bone and preserve proprioception.

Front 534

Custom Tray Distolingual and Retromylohyoid Extensions

Back 534

Distolingual
- Superior constrictor

Retromylohyoid area
- Limited posteriorly by palatalglossus and inferiorly by superior constrictor muscle

Front 535

ZOE impression material

Back 535

ZOE must be border molded during one insertion within setting time of material

Front 536

Primary Support Area for Dentures

Back 536

Maxilla - Residual Ridges on Maxillary and Palatine bones
- Rugae are secondary support areas

Mandible - Buccal shelf

Front 537

Most critical area in Maxillary Border Molding

Back 537

Mucogingival fold above tuberosity

Front 538

Pantograph

Back 538

Precise tracing of paths followed by condyles
- Used when the hinge axis is transferred to a fully adjustable articulator

Front 539

Solder temp

Back 539

Atleast 150deg F below fusion temp of metals being soldered

Front 540

Dental Investment Materials

Back 540

Gypsum bonded - Binder is Gypsum (Calcium Sulfate Hemihydrate)
- Used for 65% - 75% gold alloys near 1,100C

Phosphate-bonded - Binder is metallic oxide and a phosphate
- Type 1 is used for base metal
- Type 2 is for RPD frameworks
- Both can withstand high temperatures above 1,100C

Silica bonded is not used today.

Front 541

Gold Alloy types

Back 541

Types 1 and 2 are for inlays. Very ductile and easily burnished

Type 3 is for gold crowns and bridges.Can be heat treated

Type 4 is hardest. Intended for bridges and RPD's. Can be heat treated

Front 542

Flux Composition

Back 542

Sodium Pyroborate
Borax
Silica

- Also contains Potassium Fluoride to dissolve film supplied by chromium.

Front 543

Cements

Back 543

Zinc Phosphate
- Standard
- High compressive strength
- Low initial pH, Lack of chemical bond, lack of anticariogenic effect.
- Use Frozen Slab technique to extend working time

Zinc Polycarboxylate cement
- Chemical adhesion from chelation between cement carboxyl and calcium
- Bonds mostly to enamel and weaker to dentin
- Short working time and requires tooth conditioning step

Glass Ionomer Cement
- Chemical bonding to Enamel and Dentin
- Anticariogenic effect by releasing fluoride
- Good physical properties better than Zinc based cements
- Low initial pH may result in sensitivity

Resin Modified Glass Ionomer Cement
- Higher strength and Lower solubility compared to Glass ionomer
*- Do not use with all ceramic cements

Resin Luting agents
- Unfilled resins that Bonds to dentin.
- Irritates pulp and has high film thickness
- Best choice for Ceramic Restorations

Front 544

7/8th Crown

Back 544

3/4th crown that involves distobuccal extention towards mid facial

Front 545

Glass vs Ceramics

Back 545

Highly esthetic Ceramic crowns are predominantly glass

High strength ceramics are predominantly Crystalline

Front 546

Nickel, Chromium, Cobalt

Back 546

Nickle - Responsible for Ductility of alloy

Chromium - Corrosion resistance

Cobalt - Rigidity

Front 547

Gypsum Types

Back 547

1 - Impression plaster. Not really used today

2 - Modeling plaster. Ortho casts

3 - Dental stone. Yellow stone or Microstone. For regular casts and removable

4 - Die stone, low expansion. Densite or Improved Dental Stone
- Dies for crown, bridge, and implants.

5 - Die stone, High expansion. DieKeen.
- Crown and Bridge

Front 548

Gypsum Reaction Product

Back 548

All gypsum forms Calcium Sulfate Dihydrate

- Alpha-hemihydrate requires less water and is stronger. Used in Stone or Die stone

- Beta-hemihydrate is plaster of paris. Uses more water and is weaker.

Front 549

Gypsum production

Back 549

Plaster - Heating in open vessel at 150-160deg celcius. Produces porous and irregularly shaped weakest prodct

Stone - Steam and Autoclave

High strength Die Stone - Boiling in 30% CaCl and MgCl

Front 550

Polyether

Back 550

- No reaction byproduct is produced
- Excellent dimensional stability and hydrophilic

- Most rigid and most difficult to remove from mouth
- Unstable in Moisture

Front 551

Condensation Silicones

Back 551

- Captures details well
- Cheaper

- Low tear strength
- Condensation reaction from evaporation of alcohol results in shrinkage and poor dimensional stability

Front 552

Reversible Hydrocolloid

Back 552

- Hydrophilic
- No custom trays or adhesives
- Cheap

- Unstable and Low tear strength
- Needs special equipment
- Must pour immediately and with stone only

Front 553

Irreversible Hydrocolloid

Back 553

Filler - Diatomaceous Silica
Forms Sol - Potassium Alginate
Reactor - Calcium Sulfate
Retarder - Sodium Phosphate

- Low cost
- Straightforward technique

- Unstable and low tear strength
- Poor accuracy and high deformation

*** - Most accurate when there is atleast 3mm thickness. Other materials are more accurate when there is less materials
- Fast removal from mouth improves compressive and tear strength

Front 554

Addition Silicones

Back 554

PVS
- Accurate
- Stable

- Hydrophobic
- Releases hydrogen gas

Front 555

Syneresis
Imbibition
Hysteresis

Back 555

Syneresis - Drying out and shrinking

Imbibition - Sucking up water and expanding

Hysteresis - Characteristic of melting temperature that is different from gellation temperature

Front 556

Polysulfide

Back 556

- Highest Tear Strength and high flexibility
- Long working time
- Good detail

- Messy and staining
- Poor dimensional stability
- Requires custom trays
- Long setting time
- Must be poured within 1 hour

Front 557

Fluorescence and Opalesence

Back 557

Fluoresence is reflection of UV radiation
- Usually blue white hues
- Fluoresence makes a definite contribution to brightness and vital appearance of teeth

Opalesence is light effect of translucent material.
- Teeth are usually blue in reflected light and red-orange in transmitted light

** - Value is most important factor and Hue is chosen first.

Front 558

Porcelain classification based on Fusion

Back 558

High fusing - Denture teeth

Medium fusing - All ceramic and Porcelain jacket crowns

Low fusing - PFM crowns

Front 559

Pickling

Back 559

Removing surface oxides by placing casting in a acidic solution prior to polishing

Front 560

Degassing

Back 560

Necessary for all gold-porcelain systems
- Removes impurities and bubbles, and forms oxides for bonding

Front 561

Main cause of porcelain fracture at porcelain metal interface

Back 561

Poor metal framework design

- Most common type of fracture occurs in the porcelain

Front 562

Sintering

Back 562

Ceramic metal is heated in furnace
- Pores in ceramic will close and decrease defects

Front 563

Average Interocclusal Distance

Back 563

3mm

Front 564

Christensen's Phenomenon

Back 564

Space that opens up in the posterior teeth as mandible moves anteriorly
- Increases as incisal guidance and horizontal condylar guidance increases

Front 565

Chromium Alloys for RPD

Back 565

Chromium - Resist Corrosion
Cobalt - Strength
Nickel - Ductility

Front 566

Cingulum rest Dimensions

Back 566

2.5-3.00 mm MD length
2.0 mm Labiolingual Width
1.5 mm Depth

Front 567

Dentinogenesis Imperfecta

Back 567

Autosomal Dominant trait affecting histodifferentiation phase of both primary and adult teeth
- Blue-gray teeth that abrade rapidly
- Radiographs show obliteration of pulp chambers
- *Roots appear narrower and more fragile with more bulbous crowns.

Shield I - Associated with Osteogenesis Imperfecta
Shield II - Hereditary opalescent dentin. Separate entity
Shield III - Teeth with shell like appearance with multiple pulp exposures

Front 568

Amelogenesis Imperfecta

Back 568

Normal Pulpal and Root morphology
- Occurs at Bell stage

Hypoplastic - Histodifferentiation stage. Insufficent quantity
Hypomaturation - Apposition stage. Normal thickness but low radiodensity and mineral content
Hypocalcification - Soft and fragile enamel. Easily fractured.

Front 569

Concresence

Back 569

Union of two teeth by cementum only

Front 570

Dentin Dysplasia

Back 570

Shields Type I - Normal primary and permanent crown morphology with amber translucency
- Short and constricted roots
- Multiple radiolucencies and absent pulp chambers

Shields type II
- Permanent teeth appear normal but have thistle-tube-shaped pulp chambers with many pulp stones
- No PA radiolucencies

Front 571

Cleft Lip and Palate Classes

Back 571

Lip
1 - Unilateral notching of vermillion not extending into lip
2 - Extends to lip but not to nose
3 - Extends to nose
4 - Anything bilateral
- Affects Males More

Palate
1 - Only soft palate
2 - Soft palate and hard palate but no alveolar process
3 - Alveolar process on one side
4 - Both side alveolar process
- Affects Females more

Front 572

Achondroplasia

Back 572

Disproportionate short stature
- Head is large while arms and legs are short
- Maxilla may be small with crowding of teeth
- Class 3 is common finding

Front 573

Leukemia of Childhood

Back 573

Acute Lymphoblastic Leukemia (ALL)

Front 574

Rule of 4's

Back 574

Starting at 7 months, 4 teeth erupt every 4 months

7 - Centrals
11 - Laterals
15 - First molars
19 - Canines
23 - Second molars

Front 575

Calcification order

Back 575

Primary dentition begins calcification at 14wks. 3.5months

Permanent dentition
- Birth: First molars
- 4 months: Maxillary centrals and canines. Mandibular antierors
- 10 months: Maxillary lateral
- 16months: First premolars
- 22months: Second premolars
- 28months: Second molars
- Maxillary 3rd molar at 8yr and Mandibular 3rd molars at 9yr

Front 576

Leeway Space

Back 576

Size differential between primary canine, first and second molars, and permanent replacements

1.3mm per quadrant on maxilla
3.1mm per quad on mandible

Front 577

Most commonly retained primary tooth

Back 577

Mandibular first molar
- If permanent tooth is close, best method is sectioning it

Front 578

Most common ectopically erupted teeth

Back 578

Maxillary first permanent molars and canines

Front 579

Begg vs Edgewise

Back 579

Begg
- Narrow slot with a loosely fitted archwire held in place with locking in
- Can only be used with round wires

Edgewise
- Have archwire channel that is rectangular in cross-section, with largest dimensions horizontally. Can also be used with round archwires

Front 580

Moment

Back 580

Potential for rotation

Front 581

SNA, SNB, and ANB

Back 581

SNA - 82deg

SNB - 80deg

ANB - 2deg.
- Greater than 4 is Class 2
- Less than 0 is Class 3

Front 582

Maxillary-Mandibular Plane angle

Back 582

Normal value is 27deg
- Greater indicates longer anterior face height

Long face favors Class 2
Short face favors Class 3

Front 583

Aversion Conditioning and Systemic Desensitization

Back 583

Aversion conditioning
- Punishment or Unpleasant stimuli are used to supress undesirable behavior. Hand Over mouth technique

Systemic Desensitization
- Used to eliminate maladaptive anxiety associated with Phobias.
- First taught a relaxation activity, and person uses it to overcome each step of anxiety hierarchy

Front 584

Chemical Vaporization

Back 584

Needs higher temperature and pressure than autoclave
- 132degC 20-40min
- Uses alcohol, formaldehyde, ketone etc
- Does not rust or corrode

Front 585

Glutaraldehyde

Back 585

Most potent chemical germicide
- 2% Kills spores after 10hrs
- Allergenic and toxic to tissues

Front 586

Flash cycle

Back 586

134C, 30psi for 3 minutes

Front 587

Oxidizing disinfectant

Back 587

Chlorine in Bleach
- Oxidizes free sulfhydryl goups on bacteria and viruses

Front 588

Handwash Agents

Back 588

Chlohexidine
- Disrupts microbial cell membrane
- Good against gram pos and neg bacteria and some fungi

Triclosan
- Inhibits fatty acid synthesis

Front 589

Ramfjord teeth

Back 589

Maxillary Right first molar, Left central, Left 1st premolar

Mandibular Left 1st molar, Right central, Right 1st premolar

Front 590

Flumazenil

Back 590

Benzodiazepine Antagonist

Front 591

Benzodiazepines

Back 591

Midazolam: Versed
- Most lipid soluble so Short acting and Fast recovery time
- Rapid onset of action, high effectiveness and low toxicity level
- Anterograde Amnesia
- Better patient comfort when administered IV or IM and does not require Propylene Glycol like Diazepam or Lorazepam

Diazepam: Valium
- Water insoluble and requires organic solvent Propylene Glycol
- Onset time is slightly slower than Midazolam

Lorazepam
- Least lipid soluble
- Slow onset but long duration limits its use for pre-op anesthesia

Chloral Hydrate is seadative/hypnotic that is used in pediatric dentistry.

Front 592

Verrill's Sign

Back 592

Ptosis of eyelids
- Seen in moderate to deep sedation

Front 593

Preoperative studies before general anesthesia

Back 593

CBC and Urinalysis

Front 594

TMJ Ligaments

Back 594

Temporomandibular ligament
- aka Lateral Ligament
- Articular Eminence to Mandibular condyle
- Prevents inferior and posterior displacement
- Keeps head of condyle in place during fracture

Collateral ligaments
- aka Discal ligaments. Medial and Lateral
- Arises from periphery of disc and attached to medial and lateral poles of condyle to stabilize disc preventing discal movement.

Front 595

Articular Disc

Back 595

Dense Fibrous CT
- Posterior band is thicker and attached to retridiscal tissues
- Anterior band is continuous with capsular ligament, condyle, and superior lateral pterygoid

Retrodiscal tissue is highly vascularized and innervated

Front 596

TMJ Innervation

Back 596

Auriculotemporal nerve

Masseteric nerve

Posterior Deep Temporal Nerve

Front 597

Oxygen Full E tank

Back 597

600L at 2000psi

Front 598

Myelin nerve blockade

Back 598

Myelinated nerves have heavier sodium channels at Nodes of Ranvier
- Blocked before same size unmyelinated fibers

Front 599

Neuroleptic Analgesia vs Anesthesia

Back 599

Neuroleptic Analgesia - Neuroleptic/Antianxiety agent + Narcotic

Neuroleptic Anesthesia
- Also add Nitrous Oxide

Front 600

Inhalation Anesthetics

Back 600

Enflurane, Halothane, Isoflurane, Sevoflurane, Desflurane, and One inorganic gas Nitrous Oxide

- All require vaporizer but Desflurane vaporizer has heating component for delivery at room temperature
- All can trigger Malignant Hyperthemia. MH
- Administration is preceded by IV sedative/hypnotic like Barbiturate. Requires intubation

Front 601

Signs indicating correct level of sedation using Valium

Back 601

Blurring of vision
Slurring of speech
50% ptosis - Verill's sign

- Valium is contraindicated in narrow angle glaucoma

Front 602

Ketamine

Back 602

Dissociative anesthetic
- Sedative is usually given before procedure
- Patients usually don't remember procedure
- Increases airway secretions so may induce Laryngospasm
- May induce intense dreams and hallucinations as medication wears off

Front 603

Treatment for Malignant Hyperthermia

Back 603

Dantrolene
- Impairs calcium-dependent muscle contraction

Front 604

Propylene Glycol

Back 604

Usually mixed into IV Valium and Lorazepam
- May cause Phlebitis

Front 605

Kassmaul Breathing
Cheyne-Stokes Breathing
Stridor

Back 605

Kassmaul Breathing - Increase in rate and depth of respiration. Hyperventilation

Cheyne-Stokes Breathing - Alternating Hyperpnea, shallow respiration, and apnea. See in children and elderly.

Stridor - High pitched respiratory sound heard in laryngeal obstruction

Front 606

Hemophilia

Back 606

A - Factor 8
B - Christmas factor, Factor 9
C - Non sex linked. Factor 11

All show Prolonged PTT

Front 607

Opioid Receptors

Back 607

Mu
- Mu1: Analgesia
- Mu2: Respiratory depression, dependence, Euphoria

Kappa - Analgesia, sedation, Psychomimetic

Delta - Analgesia, modulates activity at Mu receptor

Front 608

Caldwell Luc approach

Back 608

Used to remove teeth from Maxillary sinus

Front 609

Tannic Acid

Back 609

Found in tea bags to stop bleeding

Front 610

Compartment Syndrome

Back 610

Severe swelling after fracture puts pressure on blood vessels and causes muscles to die

Front 611

Least common site of mandibular fracture

Back 611

Coronoid Process

Front 612

Treatment for Trigeminal Neuralgia

Back 612

Carbmazepine

Front 613

TMJ Procedures

Back 613

Arthroscopy
- Direct visualization of structures, biopsy, removal and injection of materials

Disc repositioning
- Used in patients with painfil persistent clicking
- Posterior wedge is removed and sutured to reposition.

Disc repair or removal
- When disc is severly damaged

Condylotomy
- Intraoral vertical ramus osteotomy

Total Joint replacement
- Rheumatoid arthritis, and sever degenerating bone disease
- Costochondral bone graft reconstruction is most common material

Front 614

Stages of Articular Disc Internal Derangement

Back 614

1 - Reciprocol clicking occurs suddenly and spontaneously after injury

2 - Reciprocal clicking with intermittent locking. Painful

3 - Limited opening. Termed Closed lock <27mm opening

4 - Increase in opening and crepitus from degenerative changes. Less painful

Front 615

Antibiotic used in treating Pseudomonas and Indole-positive Proteius species

Back 615

Carbenicillin
Ticarcillin
Piperacillin
Ciprofloxacin

Front 616

Treats Vaginal Candidiasis

Back 616

Fluconazole

Front 617

Antibiotic that blocks NMJ

Back 617

Streptomycin
- Causes Respiratory Difficulties

Front 618

Cycloplegia

Back 618

Loss of Lens accomodation
- Caused by Muscarinic Blocking agents such as Atropine

Front 619

Nalidixic Acid

Back 619

It is especially used in treating urinary tract infections

Front 620

Penicillinase Resistant Penicillins

Back 620

COND

Cloxacillin
Oxacillin
Nafcillin
Dicloxacillin

Front 621

Demeclocycline

Back 621

- Tetracycline known to cause nephrogenic diabetes insipidus.
- Has reaction to Sunlight

Front 622

Most slowly excreted Tetracycline

Back 622

Doxycycline
- Long half life
- Allows once per day dosage

Front 623

CPR guidelines

Back 623

30 compressions for every 2 breaths
- Ideally want 100 compressions a minute or more

Front 624

Anachoresis

Back 624

Localization of Microbes in a site of inflammation

Front 625

Propranolol may decrease the metabolism of:

Back 625

Lidocaine

Front 626

What is the best combination of drugs to treat Parkinson’s Disease

Back 626

Levodopa (L-dopa) and decarboxylase inhibitors (Carbidopa). Secondary drugs for Parkinson’s: anti-cholinergic, anti-histamines, or amantidine

Front 627

Contraindicated with Erythromycin

Back 627

Terfenidine and Ketoconazole
- May cause cardiac arrhythemia in people with liver damage

Front 628

Flushing water lines

Back 628

3min beginning of day and 1min between patients

Front 629

Oz to mL

Back 629

1oz = 30ml

Front 630

Percent of mandibular first molars with 4 canals

Back 630

35-40%

Front 631

What is the percentage of chlorhexidine (0.1-0.2%) that remain after rinsing

Back 631

30%

Front 632

What amalgam works best to restore proximal contours

Back 632

Admixed

Front 633

Mg and Ca interferes with the action of

Back 633

Tetracyclines

Front 634

Ginkgo

Back 634

Memory Enhacement
- May affect anticoagulants and can inhibit MAO

Front 635

St. John's Wort

Back 635

Treats Depression
- Speeds up estrogen metabolism so don't take with Contraceptives
- ALso interacts with Benzodiazepines, and Wafarin
- May cause photosensitivity and cataracts
- Aggravates Psychosis in Schizo
- Eliminates free radicals

Front 636

Feverfew

Back 636

Used for headaches but doesn't work
- Discontinuation could cause withdrawal syndrome. Headaches, muscle and joint pain
- Contact dermatitis
- Mouth ulcers and numbness
- Can interact with blood thinners
- Do not take while pregnant

Front 637

Henly & Huntler syndrome

Back 637

Lysosomal storage disorder accumulating GAGs
- X linked
- Prominent forehead, a nose with a flattened bridge, and an enlarged tongue
- Frequent infections of the ears and respiratory tract.

Front 638

Zinc pyrithione

Back 638

Antifungal and Antibiotic
- Dandruff and Seborrhoeic Dermatitis
- Treats Psoriasis, Eczema, Ringworm, Athletes foot, Atopic dermatitis, Tinea, Vitiligo

Front 639

Neuropraxia

Back 639

Damage to the myelin sheath but leaves the nerve intact and is an impermanent condition
- Mildest nerve damage
- Does not show wallerian degeneration

Front 640

Mepivacaine Calculation

Back 640

2% 4.4mg/kg up to 300 mg

Same as lido

Front 641

Guerin sign

Back 641

Floating Maxilla
- Lefort 1

Front 642

Cleidocranial Dysplasia

Back 642

Hypoplasia of clavicles, cranial bossing, hypertelorism, retained primary teeth, supernumary teeth, malaligned teeth, unerupted teeth.

Front 643

Implant be placed in relation to adjacent CEJ

Back 643

2-3mm below

Front 644

Liquid of Glass Ionomer Cements

Back 644

Liquid made of FluoroAluminoSilicate glass component and Polyacrylic Acid
- Acid Base reaction

Front 645

Vicodin

Back 645

Paracetamol/Acetaminophen + Hydrocodone
- Regular 5.0/500
- ES 7.5/750
- HP 10/660

Front 646

Nominal Data

Back 646

A set of data is said to be nominal if the values / observations belonging to it can be assigned a code in the form of a number where the numbers are simply labels.

Front 647

Antibiotic Prophylaxis

Back 647

Amoxicillin
- 2g
- 50mg/kg kids

Clindamycin
- 600mg
- 20mg/kg kids

Cephalexin
- 2g
- 50mg/kg kids

Azithromycin
- 500mg
- 15mg/kg kids

Front 648

Order of extraction

Back 648

Max before mandibular and posterior before anterior

Front 649

Sulfonylrea

Back 649

Stimulation of pancreas insulin production

Front 650

Amitriptyline

Back 650

Most common tricyclic antidepressant
- Inhibits reuptake of NE and serotonin

Front 651

Fluoride toxic dose

Back 651

5-10 mg/kg

Front 652

Dolichocephaly

Back 652

Long narrow face

Front 653

Q value

Back 653

The q-value of an individual hypothesis test is the minimum False Discovery Rate at which the test may be called significant

Front 654

Implant Space requirement

Back 654

Greater or Equal to 1.5mm from adjacent tooth

3mm from Adjacent implant

1mm from Buccal and Lingual wall

2mm from Vital structures

Front 655

Mechanism of action of Listerine

Back 655

- Bacterial cell wall destruction
- Extraction of bacterial lipopolysaccharides
- Bacterial enzymatic inhibition

Front 656

Zn in Amalgam

Back 656

Mercury retained, dimensional change, compressive strength, and creep
- Physical properties

Front 657

Treatment for Cocaine Overdose

Back 657

Benzodiazepine
Acetaminophen
Lebetalol

Front 658

Which Syndrome least developmental delay

Back 658

Trecher collins syndrome

Front 659

BRONJ Radiagion

Back 659

Below 60Gy is rare

Front 660

Amalgam Trituration

Back 660

Better to Overtriturate
- Soupy before hardening and less expansion
- Strength also increases
- **Working time of amalgam will decrease with over-trituration

- Undertrituration will become crumbly, dull, and weak
- Both over and under triturated will increase creep

Front 661

Canine Access

Back 661

Maxillary canine - Angle towards distal because all maxillary anterior teeth have distal axial inclination

Mandibular canine - Direct towards lingual because it has labial axial inclination.

Front 662

Amalgam Strength

Back 662

Most important factor is Mercury content
- High Copper minimizes Hg matrix, and minimizes Gamma II(SnHg) phase which is the weak corrosive phase

Front 663

Cerebral Palsy

Back 663

Due to prenatal trauma to brain
- Most common handicap 2/1000
- Bruxism, GERD, Gingival over growth, hypertonic tongue
- Higher incidence of Perio and Caries

Front 664

Do not with vasocronstrictor in:

Back 664

Nonselective beta blockers
- Not contraindicated in selective beta blockes like Atenolol, Metoprolol, Acetutolol.

Tricyclic Antidepressants
- No more than 3 carpules

Cocaine

Front 665

ZOE

Back 665

Sedative. Relieves Pain and calms nerve
- Offers protection to pulp
- Cannot be used with composites so use GIC
- Not very durable so used in IRM

**Varnish shold be placed after ZOE or CaOH. But if using Zinc Phosphate, Varnish placed before. ZP does not help Dentin, and decreases pH

Front 666

Taper Fissured

Back 666

669-703

Front 667

Fluoridated Population of US

Back 667

62%

Front 668

How long to grow back bone in Jaw Fracture

Back 668

8-12wks
- 2-3wks for inflammation
- 4-8wks soft callus
- 8-12wks hard callus
- Bone remodeling for years

Front 669

MRI vs Cone beam vs xray

Back 669

MRI - shows good soft tissue in TMJ. Doesn't show bone structures

Cone beam - Shows good soft and hard tissue, and vessels

xray - Shows Bone and Blood vessels but no soft tissues.

Front 670

Special xrays

Back 670

Towns - Condyle and ramus

Waters - Sinus

Submentovortex - Zygomatic arch, Jug, Pan

Front 671

Prozac

Back 671

Selective Serotonin Receptor Inhibitor
- Antidepressant

Front 672

All porcelain Facial reduction

Back 672

1mm

Front 673

Chi test

Back 673

Chi square test compares observed data w/ expected data

Front 674

z vs t test

Back 674

Z test - Preferable with n>30

t test - Less than 30 and good for more variety. Paired t test for groups that are not independent of each other. Like same group before and after tx.

Front 675

C factor

Back 675

Bonded to unbonded surfaces
5 for class 1 Weak high stress bond
2 for class 2
0.2 for class 4 Strong bond

- high configuration is bad. Should be layered

Front 676

W on clamp

Back 676

w/o Wings

Front 677

Morbidity

Back 677

# of ill out of the population
- Rate of incidence of a disease

Front 678

Green Stains

Back 678

Silver

Front 679

Difference between 245 and 330

Back 679

Both are pear shaped
- 245 is 3mm
- 330 is 1mm

Front 680

Veneer reduction

Back 680

0.3mm Gingival 3rd
0.5mm Middle and Incisal 3rd

0.5mm Proximal margins

Front 681

CMV

Back 681

Gancyclovir, Cidofovir, Foscarnet

Front 682

Primary teeth calcification in utero

Back 682

14wk - 3.5months

Front 683

Cell in crevicular fluid

Back 683

92% PMNs, 4% B-cells, 3% T-cells, 1% phagocytes

Front 684

Carbamide Gel

Back 684

30%

Front 685

Order to extract Molars

Back 685

Max posteriors leaving 1st molar
Max anteriors leaving Canine
1st molar, then Canine
- Visitbility, Sinus and tuberosity considerations

Front 686

Healing and Long Junctional Epithelium

Back 686

- New epithelium in 1-2wks
- Inflammation reduced in 3-4wks

Front 687

Canine Canals

Back 687

Max canine- 100% one canal; Mand canine – 70% one canal

Front 688

Warfarin- Surgery

Back 688

Stop Wafarin 2 days before surgery if INR is >3
- Want INR less than 1.5

Front 689

Most common problem with complete dentures

Back 689

Loose Dentures then Pain

Front 690

Incident of cleft palate / Cleft lip in US

Back 690

1/700

Front 691

What is the limit before bone dies in implant procedure

Back 691

55 Deg
- Vitality of bone is altered beyond 47deg

Front 692

Most toxic Mercury

Back 692

Methyl Mercury
- It works its way up the food chain.

Front 693

Papillon–Lefèvre syndrome

Back 693

- Hyperkeratosis of palms and soles of feet
- Periodontitis
- Early loss of primary and permanent teeth

Front 694

Which is least likely to be successful facial soft tissue graft

Back 694

Lower 1st premolars

Front 695

What is the most common tooth that involves space management in primary teeth

Back 695

1st molars

Front 696

Most common race ECC, Perio, and Caries

Back 696

ECC - Hispanics
Perio - Natives
Caries - Natives

Front 697

Ginseng

Back 697

Do not take with
- NSAIDS - ASPRIN
- Wafarin
- Diabetes drugs
- Anti-depressants

Front 698

Chamomile

Back 698

Countains Coumarin
- Anticoagulant