Mock Exam 1 Study mode

Zinc phosphate cement has a low initial pH and can irritate the pulp.

Chapter 16 -page 664 -oxford handbook of clinical dentistry 7th edition

Tartaric acid lengthens the working time of glass ionomer cements.

Chapter 16 -page 660 -oxford handbook of clinical dentistry 7th edition

 The etch-and-rinse system uses phosphoric acid to completely remove the smear layer and demineralize dentine.

Chapter 16 -page 659 -oxford handbook of clinical dentistry 7th edition

Most dentine adhesive systems aim to modify and partially remove the smear layer, by the application of an acidic primer. this demineralizes the underlying surface, exposing the collagen and opening up the dentinal tubules. It is important to keep this surface moist to prevent the collagen becoming flattened.

Chapter 16 -page 658 -oxford handbook of clinical dentistry 7th edition

An etching time of 15–20 seconds is adequate for achieving the best enamel etch pattern.

Chapter 16 -page 656 -oxford handbook of clinical dentistry 7th edition

: Bulk-fill materials like SDR® flow+ can be cured to a depth of 4 mm due to advanced flowable technology.

Chapter 16 -page 655 -oxford handbook of clinical dentistry 7th edition

: The C-factor is the ratio of bonded to unbonded surfaces in a cavity. A higher C- factor increases the risk of polymerization shrinkage effects.

Chapter 16 -page 654 -oxford handbook of clinical dentistry 7th edition

The practical depth of cure for light-cured composites is 2 mm , Preparations >2mm depth should be cured incrementally.

Chapter 16 -page 654 -oxford handbook of clinical dentistry 7th edition

Light-cured composites use amine + diketone activated by blue light (460–470 nm) to initiate polymerization.

Chapter 16 -page 652 -oxford handbook of clinical dentistry 7th edition

Nanofilled composites combine wear resistance, polishability, and a high luster, making them ideal for anterior restorations with esthetic demands.

Chapter 16 -page 652 -oxford handbook of clinical dentistry 7th edition

Bis-GMA is the resin matrix of composite resins, not a filler. Chapter 16 -page 652 -oxford handbook of clinical dentistry 7th edition

Overfilling ensures the Hg-rich surface layer is removed during carving, improving the final restoration quality.

Chapter 16 -page 650 -oxford handbook of clinical dentistry 7th edition

The Sn–Hg or λ-2 phase is the weakest phase in set amalgam and is eliminated in high-copper amalgams.

Chapter 16 -page 650 -oxford handbook of clinical dentistry 7th edition

High-copper amalgams (10–30%) eliminate the weak Sn–Hg (λ-2) phase, improving strength, durability, and resistance to corrosion.

Chapter 16 -page 650 -oxford handbook of clinical dentistry 7th edition

Rationale:

Nitrous oxide is administered by titration, such that the drug is delivered in increments and the patient response monitored until the desired level of sedation is achieved.

Titration allows precise control of the level of sedation. A 10% nitrous oxide and 90% oxygen mixture is administered initially for a period of about 3 minutes and then the concentration of nitrous oxide is increased if necessary, in increments of 5% every 2–3 minutes, until the desired level of sedation is achieved and up to a maximum of 70% nitrous oxide.

Source:

Master dentistry vol. 1 (3ed edition) ch.4 p.73

Available Benzodiazepines for Sedation
Midazolam
Midazolam is a water-soluble imiadazobenzodiazepine, which is painless on intravenous injection. It is available in three concentrations: 5 mg in 5 mL, 10 mg in 5 mL or 10 mg in 2 mL. The lowest concentration (5 mg in 5 mL) is the standard preparation for intravenous sedation. The 10 mg in 2 mL preparation is still used for oral sedation.
Pharmacokinetic properties. Midazolam is a short-acting drug with an elimination half-life of about 90 min-utes. Its metabolites are largely inactive.
The metabolism of midazolam occurs both in the liver and extrahepatically. The half-life of midazolam is less affected by liver disease than any of the other benzodiazepines.
The effects of a single titrated dose are not prolonged by renal disease.
Midazolam is the first choice of oral and transmucosal sedative, despite the lack of a product licence for its use in

In this case patient taking ticagrelor and it is an antiplatelet drug , management of patients taking antiplatelet medication such as aspirin, clopidogrel (e.g. Plavix), dipyridamole (e.g. Persantin), aspirin plus dipyridamole (e.g. Asasantin Retard) will have prolonged bleeding,

-for minor surgery use a compination of local measures to stop bleeding: tranexamic acid

(Tranexamic acid mouthwash may decreases oral bleeding), and an absorbable haemostatic dressing should be placed to the socket that should then be sutured using a resorbable material.

-For more significant surgery, the patient should be managed in a hospital setting and the antiplatelet therapy may be stopped before surgery in consultation with the interventional cardiologist.

Similarly, patients taking aspirin plus clopidogrel should be referred to a specialist.

Source:

Master dentistry vol. (3ed edition) ch3 p.35

Key signs of life-threatening asthma

• Cyanosis or respiratory rate less than 8 per minute
• Bradycardia (heart rate less than 50 per minute)
• Exhaustion, confusion, decreased conscious level

Key signs of acute severe asthma

• Inability to complete sentences in one breath
• Respiratory rate >25 per minute
• Tachycardia (heart rate >110 per minute)

Management The priority is to transfer a patient displaying symptoms of life-threatening asthma to hospital immediately as an emergency.

Assess the patient. Sit patient upright. Administer 100% oxygen – flow rate: 15 litres/ minute. Administer the patient’s own bronchodilator (2 puffs); if unavailable, administer a salbutamol inhaler, 4 puffs (100 micrograms per actuation), through a large-volume spacer, repeat as needed.

If a patient suffering from a severe episode of asthma does not respond to treatment with bronchodilators within 5 minutes of administration, they should also be transferred to hospital as an emergency.

Source:

Sdcep-drug-prescribing-for-dentistry-3rd-edition.pdf

n conscious patients, administer oral glucose (10-20 g), repeated, if necessary, after 10-15 minutes

If not, administer glucagon, 1 mg, i.m. injection

Source:

sdcep-drug-prescribing-for-dentistry-3rd-edition.pdf

The current recommended drugs for medical emergencies are:

• Adrenaline, 1-ml ampoules or prefilled syringes of 5 ml of 1:1000 solution for intramuscular (i.m.) injection
• Aspirin, 300 mg dispersible tablets
• Glucagon, for m. injection of 1 mg
• Glyceryl trinitrate (GTN) spray, 400 micrograms per metered dose
• Midazolam oromucosal solution, 5 mg/ml, for topical buccal administration¥
• Oral glucose (there are several alternative forms, including non-diet fizzy drinks, glucose gel, powdered glucose and sugar lumps)
• Oxygen cylinder, two size D or two size CD or one size E‡
• Salbutamol inhaler, 100 micrograms per actuation

Although the above list includes midazolam for topical administration, parenteral midazolam is a suitable alternative for use by appropriately trained individuals

Source:

Sdcep-drug-prescribing-for-dentistry-3rd-edition.pdf

A typical washer-disinfector cycle includes five stages:

1. Flush - removes gross contamination using a water temperature of less than 45C
2. Wash - removes remaining soil using detergents specified by the manufacturer
3. Rinse(s) - removes detergents

4. Thermal disinfection - temperature raised for required time: 80^OC for 10 minutes or 90^OC for 1 minute, for example
5. Drying - heated air removes residual moisture

Source:

BDA infection control 2017

Endodontic reamers and files should be treated as single-use. In England, endodontic instruments that are designated reusable should be treated as single patient use to reduce the risk of prion

transmission. If reusing these items on a single patient, your practice systems must ensure that they are associated with the correct patient. If cleaned manually, the instruments should be cleaned

separately from other instruments.

Clinical waste (infectious) Include : blood/saliva contaminated dressings; disposable gowns and clinical gloves; and other waste that may present a risk of infection. • Classified as hazardous: EWC

18 01 03 • Storage is in orange bags (not yellow); disposal is by incineration or alternative treatment.

Source:

BDA infection control 2017

Single-use (disposable) items ‘Single-use’ items must be used on one patient during one treatment session and then discarded. Equipment that cannot be safely decontaminated for re-use must be considered ‘single-use’. Where instruments are difficult to clean, single-use alternatives (if available) should be considered – matrix bands, saliva ejectors, aspirator tips and three-in-one tips, for

example. Endodontic reamers and files should be treated as single-use. In England, endodontic

instruments that are designated reusable should be treated as single patient use to reduce the risk of prion transmission. If reusing these items on a single patient, your practice systems must ensure that they are associated with the correct patient. If cleaned manually, the instruments should be cleaned separately from other instruments.

Source:

BDA infection control 2017

Masseter muscle insertion: Lateral aspect of the ramus and angle of the mandible as far anteriorly as the last molar tooth.

Source:

1G2 Chapter 12 Deep Face (Textbook of Head and Neck Anatomy Fourth Edition)

Rationale:

The mandibular division of the Trigeminal Nerve is the portion of the trigeminal nerve (cranial nerve V) that supplies motor innervation to the muscles of mastication and sensory innervation to the TMJ and the side of the head.

The auriculotemporal nerve arises from the posterior division of the mandibular nerve, usually as two roots that join after encircling the middle meningeal artery just before that artery enters the foramen spinosum. The auriculotemporal nerve then courses deep to the lateral pterygoid muscle as it passes posteriorly deep to the parotid gland. The nerve then surfaces between the auricula and the temporomandibular joint below the zygomatic arch.

Source:

Chapter 12 Deep Face p. 205, 188 (Textbook of Head and Neck Anatomy Fourth Edition)

The motor nucleus of the facial nerve supplies muscles of facial expression, stapedius, stylohyoid, and post. belly of digastric

Lateral rectus is supplied by the 6^th cranial nerve, not the facial nerve.

Temporal muscle is supplied by the trigeminal nerve.

Source:

Page 280 Chapter 18 Cranial Nerves (Textbook of Head and Neck Anatomy Fourth Edition)

on intraoral X-ray sets, the beam can be restricted to a rectangle of 4cm by 3cm, leading to a substantial dose reduction over the conventional 6-cm-diameter round beam

This beam restriction method results in a dose reduction to patients of about 65% compared with conventional 6-cm-diameter round beams

Source:

Master dentistry vol. 1 (3rd edition) Ch. 16 p.343

misc_pub_DentalGuidanceNotes.pdf (publishing.service.gov.uk)

Chediak–Higashi syndrome A combination of defective neutrophil function, abnormal skin pigmentation, and i susceptibility to infection (severe gingivitis, periodontitis, and aphthae in young children). It is a genetic disease.

Source:

OXFORD HANDBOOK OF Clinical Dentistry 6th edition p.

People aged 16 or over are entitled to consent to their own treatment. This can only be overruled in exceptional circumstances.

Like adults, young people (aged 16 or 17) are presumed to have sufficient capacity to decide on their own medical treatment, unless there's significant evidence to suggest otherwise.

Children under the age of 16 can consent to their own treatment if they're believed to have enough intelligence, competence and understanding to fully appreciate what's involved in their treatment. This is known as being Gillick competent.

Otherwise, someone with parental responsibility can consent for them.

Reference:

https://www.nhs.uk/conditions/consent-to-treatment/children/

When a person with dementia can no longer make informed decisions for themselves, their family and health and social care staff may have to make a ‘best interest decision’.

When making a best interest decision, you should consider:

• the person’s current wishes and views, or wishes and

views they have expressed previously

• their culture and beliefs
• Whether they have an Advance Care Plan and/or LPA, and what these say.

Reference:

https://www.dementiauk.org/get-support/legal-and-financial-information/capacity- decision-making/#making-decisions

• This consent is considered to be invalid as it is not
• Treatment without any consent = assault/battery.
• Treatment with general consent, but without explanation of what is involved may = negligence.
• Valid consent is the voluntary and continuous permission of a capable patient to receive a particular treatment based on the patient being informed regarding the purpose, nature, and likely risks of the treatment, including the likelihood of its success and any alternatives to it. Permission given under any unfair or undue pressure is not consent. Consent is seen as a continual process and not a 'one-off' episode, so it is important to ensure communication throughout all stages of treatment is clear and ensures consent is still valid at all times.

• The Montgomery Rule declares that a material risk to that patient has to be considered when consenting a patient, this means that while it might not be necessarily a relevant (or material) risk to all patients undergoing the same procedure, in that particular case it may be a significant material risk to that patient, and therefore would determine if they undergo the procedure or not. For example, a professional to root player may well place a completely different material risk on an individual. that could involve parathesia (either permanent or transient- understand than someone else, given that this may be a material risk to their It is therefore important to have

clear conversations with patients about what they might reasonably see is a material risk to them as an individual.

Reference:

Chapter 17, page 694, Oxford handbook

Rationale:

You do not have to pay for NHS Dental Service if you're:

• Under 18, or under 19 and in full-time education
• Pregnant or have had a baby in the last 12 months
• being treated in an NHS hospital and your treatment is carried out by the hospital dentist (but you may have to pay for any dentures or bridges)
• receiving low income benefits, or you're under 20 and a dependent of someone receiving low income benefits

Reference:

https://www.nhs.uk/nhs-services/dentists/who-is-entitled-to-free-nhs-dental-treatment- in-england/

Rationale:

An NHS complaint may be made either to the practice or direct to the Health Board/NHS England. A private complaint can be made either to the practice or via the Dental Complaints Service.

NHS England/Health Board

Can deal with an NHS complaint directly or, with the patient's consent, refer the complaint to the practice to address. Where a complaint is difficult to resolve it may:

• Offer mediation--a confidential, voluntary process which seeks to assist complaint resolution in a non- confrontational manner.
• Advise patient of their right to approach the

Reference:

Chapter 17, page 690, Oxford handbook

Acknowledge receipt/respond to the complaint within 3 working days of receipt (2 days for an NHS complaint in Wales). If the complaint is made in person, provide the patient with a copy of the complaint procedure. Advise in writing of the estimated response timetable. Aim to provide a full response within 10 working days (or 20 working days for a hospital/trust or NHS complaint in Scotland).

Reference:

Chapter 17, page 690, Oxford handbook

The Mental Health Act requires that it should be assumed that a patient over age 16yrs has the capacity to consent to treatment unless proved otherwise.

Reference:

Chapter 17, page 695, Oxford handbook

a child will be considered in need if:

• they are unlikely to achieve or maintain or have the opportunity to achieve or maintain a reasonable standard

of health or development without provision of services from the Local Authority;

• their health or development is likely to be significantly impaired, or further impaired, without the provision of services from the Local Authority;
• they have a disability:

Disability includes blindness, hearing impairments, mental disorders and permanent illnesses, injuries or congenital deformities.

It shall be the general duty of every Local Authority:

• to safeguard and promote the welfare of children within their area who are in need; and
• So far as is reasonably consistent with that duty, to promote the upbringing of such children by their families, by providing a range and level of services appropriate to those children’s needs.

Reference:

https://childlawadvice.org.uk/information-pages/child-in-need-services/

CPD (Continuing Professional development) is mandatory for all dental professionals in order to continue their registration, so all dental professionals must carry out the required amount of CPD which is:

100h for dentists

75h for dental therapists, dental hygienists, orthodontic therapists and clinical dental technicians

50h for dental nurses and dental technicians

Reference:

Chapter19, page 772, Oxford handbook

The General Dental Council (GDC) registers and regulates dental professionals (dentists, dental nurses, dental hygienists, dental therapists, dental technicians, clinical dental technicians, orthodontic therapists) in the UK. Some contractors, employers and managers of dental professionals are not required to register with the GDC but play a significant role in supporting the dental team to maintain high standards of professionalism and ensure a continuous focus on patient safety.

Reference:

https://www.gdc-uk.org/standards-guidance/supporting-the-dental-team

• Annual appraisal for dental staff should be
• Appraisal should be based on the GMC Good Medical Practice Framework for appraisal and revalidation
• Appraisal should include both a summative element, assessing staff performance since their last appraisal, and a formative element, discussing their professional development and setting out their personal development plan for the year

ahead.

Reference:

https://www.rcseng.ac.uk/standards-and-research/standards- andguidance/revalidation/appraisal/

Clinical records (including radiographs and models) should be kept for at least 11yrs. For children, they should be retained until age 25yrs, or for 11yrs, whichever is the longer.

Reference:

Chapter17, page 710, Oxford handbook

Nurses should immediately report exposures to their supervisor or manager. This is one of the largest problems; nurses are extremely busy and sometimes choose not to report right away. They are afraid of discipline for reporting a sharps injury.

Reference:

https://www.nhs.uk/common-health-questions/accidents-first-aid-and-treatments/what- should-i-do-if-i-injure-myself-with-a-used-needle/

The extinguishers should be appropriate to the nature of the potential fire:

• Wood, paper and cloth – water extinguisher;
• Flammable liquids – dry powder or foam extinguisher;
• Electrical – carbon dioxide (CO2)

Nominated people should be trained in how to use extinguishers.

Reference:

https://www.hse.gov.uk/construction/safetytopics/generalfire.htm

Rationale:

Toothpastes are aid tooth cleaning, but, most importantly, provide fluoride.

In the UK they contain : abrasives (to a specified abrasivity standard), detergents, humectants, flavouring, binding agents, preservatives, and active agents, including:

• Most toothpastes contain sodium monofluorophosphate C/ or NaF, in concentrations of 1000–1500ppm (i.e. 1–1.5mg per 1cm of paste).

• Anti-calculus agents, g. sodium pyrophosphate, can d calculus formation by 50%.
• Desensitizing agents, g. 10% strontium or potassium chloride, or 1.4% formaldehyde.
• Antibacterial agents, g. triclosan, it is an antibacterial agent with low toxicity, which, along with a copolymer for aiding retention, can be added to toothpastes to reduce plaque and gingivitis.

Source:

oxford handbook of clinical dentistry – chapter 2 -page 31

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775959/#:~:text=Triclosan%20is%20an%20anti bacterial%20agent,(inflammation%20of%20the%20gums).

Mouth washes are contraindicated in children less than 7 years.

Frequency of use depends upon the Fluoride concentration in mouth washes: 0.2% weekly or 0.05% daily. Daily use is the most beneficial.

Caries reductions of 16–50% have been reported with rinsing alone. Mouth wash should be done at a separate time to brushing.

Source:

oxford handbook of clinical dentistry – chapter 2 -page 30

Fluoride varnish (e.g. Duraphat® 5% NaF) is a topical fluoride that must be professionally applied and is useful for applying directly to individual caries lesions to aid arrest. Fluoride varnish has been shown to be effective in minimize caries incidence in children, and regular

application is now advocated for all children over age 3yrs deemed to be at risk of caries as two times per year, or where the caries risk is increased, it is then better to be applied three or four times per year.

Application of Duraphat® varnish is contraindicated with asthma, stomatitis, and ulcerative gingivitis

Source:

oxford handbook of clinical dentistry – chapter 2 -page 30

There is a very small risk of allergy to one component of Duraphat (colophony), so for children who have a history of allergic episodes requiring hospital admission, including asthma, varnish application is contraindicated. Other brands of varnish may have

different constituents. Its use is contraindicated with asthma, stomatitis, and ulcerative gingivitis

Source:

Delivering better oral health: an evidence-based toolkit for prevention Third edition NHS Adverse effects of colophony - PubMed (nih.gov)

Fluoride varnish (e.g. Duraphat® 5% NaF) is a topical fluoride that must be professionally applied and is useful for applying directly to individual caries lesions to aid arrest. Fluoride varnish has been shown to be effective in minimize caries incidence in children, and regular

application is now advocated for all children over age 3yrs deemed to be at risk of caries as two times per year, or where the caries risk is increased, it is then better to be applied three or four times per year.

Application of Duraphat® varnish is contraindicated with asthma, stomatitis, and ulcerative gingivitis

Source:

oxford handbook of clinical dentistry – chapter 2 -page 30

There is a very small risk of allergy to one component of Duraphat (colophony), so for children who have a history of allergic episodes requiring hospital admission, including asthma, varnish application is contraindicated. Other brands of varnish may have different constituents. Its use is contraindicated with asthma, stomatitis, and ulcerative gingivitis

Source:

Delivering better oral health: an evidence-based toolkit for prevention Third edition NHS Adverse effects of colophony - PubMed (nih.gov)

Systemic fluoride

To minimize the risk of mottling, only one systemic measure should be used at a time. Types of systemic fluoride consuming:

• Water fluoridation

At 1ppm (1mg Fluoride per liter), water fluoridation reduces caries by 50%. The main advantages are systemic and topical effect; no effort is required on the part of the individual; and the low cost. Yet despite this, only 10% of the UK population has fluoridated water.

• Fluoride drops and tablets

The regimen (mg F per day) depends upon drinking water content .This approach can be almost as effective as fluoridated water, but requires good parental motivation. Unfortunately,

compliance is generally poor, so benefit as a public health measure is questionable.

• Milk

Adding levels of fluoride equal to 2.5–7ppm to the milk or milk-based products has been tried successfully.

• Salt

Cheap and effective for rural communities in developing countries where water fluoridation is not feasible.

Source:

oxford handbook of clinical dentistry – chapter 2 -page 30

Fluoride toxicity levels:

• Safely tolerated dose (STD): Dose below which symptoms of toxicity are unlikely = 1mg/kg body

• Potentially lethal dose (PLD): Lowest dose associated with a Patient should be hospitalized = 5mg/kg body weight.

• Certainly lethal dose (CLD): Survival unlikely = 32–64mg/kg body

Antidotes:

Less than 5mg F/kg body weight: give a large volume of milk.

More than 5mg F/kg body weight: refer to the hospital quickly for gastric lavage. If there is any delay, give intravenous (IV) calcium gluconate and an emetic.

Source:

oxford handbook of clinical dentistry – chapter 2 -page 29

Fluoride is absorbed rapidly, mainly from the stomach. Peak blood levels are achieved 1 hour later. It is excreted through the kidneys, and traces are found in breast milk and saliva. The placenta only allows a small amount of fluoride to cross, so prenatal fluoride is relatively ineffective.

Source:

oxford handbook of clinical dentistry – chapter 2 -page 28

Fluoride is present in all natural waters to some extent. Many simple chemicals are toxic when consumed in excess, and the same is true of fluoride. Fluoride is absorbed rapidly, mainly from the stomach. Peak blood levels are achieved 1 hour later. It is

excreted through the kidneys, and traces are found in breast milk and saliva. The placenta only allows a small amount of fluoride to cross, so prenatal fluoride is relatively ineffective.

• Safely tolerated dose (STD): Dose below which symptoms of toxicity are unlikely = 1mg/kg body
• Potentially lethal dose (PLD): Lowest dose associated with a Patient should be hospitalized = 5mg/kg body weight.
• Certainly lethal dose (CLD): Survival unlikely = 32–64mg/kg body source:

oxford handbook of clinical dentistry – chapter 2 -page 28

Child physical abuse (non-accidental injury)

All professionals involved with children need to be aware of the principles of safeguarding and alert to the possibility of child abuse or neglect. NB: the term ‘child abuse’ is now favoured over ‘non-accidental injury’.

The following signs are associated with abuse:

• Usually younger children are
• The presenting injuries may not match the parent’s account of how they were The account may change over time.
• Delay attending at a surgery or clinic for managment of the
• Bruises/injuries of different vintages are found on
• Ear pinches and frenal tears in children <1yr old are highly
• 50% of abused children will have signs on the head C/or

Approximately 65% of cases diagnosed as NAI have extra- and intraoral facial trauma; consequently, the dental practitioner may be the first professional to see or suspect abuse. Injuries may take the form of contusions and ecchymoses, abrasions and lacerations, burns, bites and dental trauma.

The following points should be considered whenever doubts and suspicions are aroused.

1. Could the injury have been caused accidentally and, if so, how?
2. Does the explanation for the injury fit the age and the clinical findings?

3. If the explanation of cause is consistent with the injury, is this itself within normally acceptable limits of behaviour?
4. If there has been any delay seeking advice, are there good reasons for this?
5. Does the story of the accident vary?
6. The nature of the relationship between parent and
7. The child’s reaction to other
8. The child’s reaction to any medical/dental
9. The general demeanour of the
10. Any comments made by child and/or parent that give concern about the child’s upbringing or
11. History of previous

Reference:

master dentistry vol 2(3ed edition),Chapter8,page234,235

Patients with less severe disabilities can be treated in dental practice. those with severe medical C/or mental impairments are probably best managed by a specialist who will have access to specialist facilities.

Treatment planning: an initial plan should be formulated ignoring the disability. Where treatment needs are not urgent, it is advisable to start with OHI and prevention, then reassess treatment requirements in the light of the response. For those patients for whom a satisfactory standard of OH is not possible, restorative treatments should aim to decrease plaque

accumulation.

Reference:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition ,Chapter3 ,page47

First permanent molars are never the first choice for extraction, as even if they are removed at the optimal time, a good spontaneous alignment of the remaining teeth is unlikely. However, if there is hypoplasia or a large restoration is required in a molar tooth for a child, the long-term prognosis should be considered. A well-timed extraction may be better for the child (and your BP) than heroic attempts to restore hopeless molars. Equally well, placing a dressing and maintaining a poor-quality 6 until the 7 has erupted and the extraction can be incorporated into an orthodontic plan.

• Check the remaining teeth are present and in a good If not, avoid extraction of 6 in affected quadrant.
• Timing of loss of a 6 is There is a greater tendency for mesial drift in the maxilla, therefore, the timing of loss of 6 is less important.
• In the lower arch, good spontaneous alignment is more likely following extraction 6 if:

(i) lower second permanent molar development has reached bifurcation, (ii) angulation between crypt 7 and 6 is <30°, (iii) lower second permanent molar crypts overlap lower first permanent molar roots.

Reference:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition ,Chapter4 ,page140

• Congenital Is the most likely cause for failure of appearance of 2 (% Hypodontia (oligodontia)

 Hypodontia (oligodontia): Developmental absence of one or more teeth. Prevalence at primary dentition: 0.1–0.9%, permanent dentition: 3.5–6.5%.

In Caucasians most commonly affected teeth are 8 (25–35%), 2 (2%), lower 5 (3%). Affects F > M and is often associated with smaller than average tooth size in remainder of dentition.

So for permanent first molar it is unlikely to be congenitally missed , its failure to eruption is most likely to be due to another causes , as mentioned in the chart

• Congenital Is the most likely cause for failure of appearance of 2 (% Hypodontia (oligodontia)

 Hypodontia (oligodontia): Developmental absence of one or more teeth. Prevalence at primary dentition: 0.1–0.9%, permenant dentition: 3.5–6.5%.

In Caucasians most commonly affected teeth are 8 (25–35%), 2 (2%), lower 5 (3%). Affects F > M and is often associated with smaller than average tooth size in remainder of dentition.

Peg-shaped 2 often occurs in conjunction with absence of contralateral 2.

NB: 3 migrates down guided by the distal aspect of 2. When 2 is absent, peg-shaped, or small- rooted, it is important to monitor the maxillary canine for signs of ectopic eruption.

Aetiology Often familial—polygenic inheritance. Also associated with ectodermal dysplasia and Down syndrome.

Reference:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition,Chapter3 ,page68

master dentistry vol 2(3ed edition),Chapter10, page294

Toothbrushing

• Brush twice daily(bd)with a >1000ppm fluoride tooth paste .
• >3yrs and those at risk of developing caries use 1350–1500ppm fluoride
• Children <3yrs of age should use a ‘smear’ and >3yrs a small pea-size blob (<0.3mL) of toothpaste.
• Spit out well, but do not rinse, after
• Brushing with fluoride toothpaste should start as soon as the first teeth erupt (about 6 months of age). Parents should supervise brushing up to at least 7yrs of age to avoid over-ingestion of toothpaste and ensure adequate plaque

Reference:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition ,Chapter2 ,page31

• Growth modification is indicated in moderate-to-severe class Il malocclusion in the mixed dentition when the child is Treatment should commence just prior to the pubertal growth spurt so that maximum advantage is taken of the growth potential. Depending on the contribution of

maxillary prognathism or mandibular retrusion to the etiology of the malocclusion,

• treatment attempts to restrain maxillary vertical and forward growth and/or encourage mandibular In doing so, the growth expression of the maxilla and/or mandible is altered but the amount of growth of both is unaffected. This is carried out by either a functional appliance or headgear (1000 g required to restrain maxillary growth), or by a combination of the two. At least 14 hours per day wear is required of any appliance trying to modify growth. After occlusal correction, the appliance should be worn until growth is reduced to adult levels in late teens or until a second phase of treatment commences, possibly with extractions and fixed appliances
• When functional appliance treatment is planned, assessing standing height and secondary sexual characteristics assists in determining if a patient has begun the pubertal growth The stage of cervical vertebral maturation (CVM) viewed on a lateral cephalometric film has also been shown to be useful in assessment of optimal treatment timing. Following overjet

correction, wear of the appliance as a retainer until growth has reduced to adult levels is required, unless a second phase of treatment to align the arches with fixed appliances and possibly extractions is considered.

Reference:

master dentistry vol 2(3ed edition),Chapter 10, page 307

• Bodily movement requires greater force (100-150g).

• This force range seems to be optimal for orthodontic tooth movement, patient comfort, and potentially exhibit fewer side effects
• Bodily movement or translation of teeth occurs when the crown with the root moves an equal distance in the same direction , This happens when the applied force passes through a tooth's center of resistance (COR).
• For bodily movement ,a force couple must be applied,loading uniformly the whole of the periodontal ligament in the direction of translation so both crown and root move in the same direction by equal

Reference:

master dentistry vol 2(3ed edition),Chapter 11, page 341

• The upper left canine is ectopic mesio-palatally
• Surgical removal of the palatally ectopic canine should be considered if there is radiographic evidence of early root resorption of the adjacent incisor teeth (but exposure and alignment of the ectopic canine is usually indicated in cases where severe root resorption of an incisor tooth has occurred necessitating the extraction of the incisor).
• The best results are achieved if there is good contact between the lateral incisor and first premolar, or the patient is willing to undergo orthodontic treatment to substitute the first premolar for the
• The possible risk of damaging the roots or the neurovascular supply of adjacent teeth during the act of surgically removing the impacted canine should be assessed and discussed with the patient.
• Routine palpation of the buccal sulcus at 10 years to detect the canine prominence which indicates a normal path of

Reference:

https://www.rcseng.ac.uk/-/media/files/rcs/fds/guidelines/2management- of-the-palatally-ectopic-maxillary-canine--revised-with-edits-25-jan- 2023.pdf

• Z spring has been used as the most conversant appliance as it is easy to fabricate and applies adequate magnitude of force to advance the teeth in cross But most of the times a successful outcome becomes difficult due to compliance issues.
• In anterior cross bite, If the tooth inclination is amenable to tipping, an upper removable appliance with buccal capping to free the occlusion and a Z-spring for proclination may be used
• Anterior retention must be good to resist the displacing force caused by the action of the spring. Alternatively, an appliance with a screw section, clasping the teeth to be moved, overcomes this problem
• Palatal finger Used to move a tooth mesiodistally.
• Hawley active appliance is used to correct minor orthodontic issues that don't require braces such as slight tooth inclinations and rotations

Reference:

master dentistry vol 2(3ed edition),Chapter 10, page 315

• The maxillary canine is ectopic in approximately 2% of the population, with 15% of these buccal and 85% palatal to the
• From an initial position high in the maxilla, the tooth moves buccally downwards and for- wards to be guided into its final position by the distal aspect of the lateral

incisor root. For this reason, absence or diminution in the size of the lateral incisor increases the incidence of displacement (×2.4).

• There also appears to be a greater incidence of palatal canine displacement where the maxillary arch is spaced or in class II division 2 malocclusion; a genetic link has been suggested and palatal displacement has a familial tendency, is more common in females than males, occurs bilaterally more than seems likely and is associated with absent or small teeth.
• Buccal displacement is more common in crowded
• This patient would be placed in the Index of Orthodontic Treatment Need DHC grade 4 (Great) which includes increased overjet >6mm but ≤G
• functional appliance therapy and treatment is usually best started in the late mixed (6-12 years old).
• The canine position is best assessed by using occlusal

Reference:

master dentistry vol 2(3ed edition),Chapter 10, page 300

·         A lateral cephalometric radiograph is indicated to assess more accurately the

magnitude of the Class III skeletal pattern and the incisor angulations, which will facilitate treatment planning. It will also form a baseline from which treatment progress/growth changes can be evaluated by comparison with future cephalometric films.

Uses of lateral cephalometric analysis

• as a diagnostic aid
• to check treatment progress
• to assess treatment and growth

Reference: master dentistry vol 2(3ed edition),Chapter 9 page 273

Provided the periapicals can be taken with a paralleling technique, these are the ideal views. They provide a geometrically accurate projection with true relationships to the adjacent structures. They are also convenient for single extractions.

Source:

Clinical Problem Solving in Dentistry p,114

The No. 11 is an elongated triangular blade sharpened along the hypotenuse edge with a strong pointed tip, making it ideal for stab incisions needed when lancing an abscess.

Source:

https://www.juniordentist.com/instruments-used-for-incision-in-dentistry.html

Although far less common than dry sockets, injury to sections of a nerve is another possible complication of wisdom tooth removal. It can cause pain, a tingling sensation, and numbness in your tongue, lower lip, chin, teeth, and gums.

The damage is usually temporary, lasting for a few weeks or months. However, it can be permanent if the nerve has been severely damaged Source:

https://www.nhs.uk/conditions/wisdom-tooth-removal/complications/

Dry socket is osteitis of the socket following tooth removal.

I is commonest in the mandible after the removal of molars, especially 8. Predisposing factors are smoking, surgical trauma, LA, history of bone disease, oral contraceptives, or immunodeficiency.

Source: OXFORD HANDBOOK OF Clinical Dentistry 7th edition-ch 10 -p409

rationale:

Retrobulbar haemorrhage is an arterial bleed behind the eye globe following trauma. It presents as a painful, proptosed eye with affected vision and is a surgical emergency. The clot must be decompressed and evacuated. Medical management with mannitol 20% (2 g/kg), acetazolamide 500 mg, and prednisolone at least 1 mg/kg all IV, may help while the surgical theatre is being arranged. Evacuation is by lateral canthotomy. Involve ophthalmology

Source:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition- Chapter 12 - p496

The reflex is mediated by the nasociliary branch of the ophthalmic branch of the trigeminal nerve, sensing the stimulus on the cornea only (afferent fiber), while the efferent mediated by facial nerve VII fibers  Source:

p.891, Anatomy An Essential Textbook

Posterior superior alveolar block carries a significant risk of post- injection haematoma. If necessary due to failure of infiltration for 6, the technique should be modified by depositing

solution distal to the zygomatic buttress and massaging it backwards towards the posterior superior alveolar foramen (maxillary molar block).

Source:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition -Ch 3 -p 83

Further discussion of the aetiology, management, and progression of periodontal disease, along with further oral hygiene instruction, should take precedence over further treatment.

Referral for periodontal surgery is inappropriate, as periodontal surgery is contraindicated in the presence of plaque and poor plaque control by the patient. Periodontal surgery is mostly considered after a course of non-surgical debridement .(Specialist periodontists are unable to provide any additional treatment until suitable levels of plaque control are attained.)

Antibiotics are not routinely used to treat periodontitis, unless disease is rapidly progressing and suggestive of grade C (aggressive) periodontitis.

Oxford handbook of clinical dentistry 7th edition – page 202 -chapter 5

The three attachment structures of the periodontium to the tooth are as follows (coronal to apical):

1 The junctional epithelium

2. The connective tissue attachment
3. The periodontal

Following successful non-surgical therapy, the epithelial cells migrate the quickest and are the first to colonize the root surface, starting at the apical portion of the pocket and migrating coronally. This leads to the formation of a long JE. The connective tissue repair then helps to stabilize this new attachment. In regenerative therapies, the aim is to restore the original

periodontal architecture before disease and facilitate the formation of new cementum, PDL, and bone. Healing following successful non-surgical periodontal therapy is therefore reparative whereby a long JE develops

Master dentistry vol. 2 third edition -chapter 1- page 42

Various systemic conditions are associated with rapid periodontal destruction. Examples

include: Chèdiak–Higashi syndrome, Down’s answers 75 syndrome, Ehlers–Danlos syndrome, hypophosphatasia, leucocyte adhesion deficiency, and Papillon–Lefèvre syndrome.

Papillon–Lefèvre Syndrome is a rare autosomal recessive hereditary condition, most common in the South Asian population. A genetic mutation results in the loss of function of a lysosomal enzyme found in neutrophils called cathepsin C; this has an important function in bacteria destruction.

Other clinical findings include: palmar–plantar keratosis, arachnodactyly, recurrent skin infections, pes planus (flat feet), onychogryphosis (hypertrophic nails), and acro-osteolysis (resorption of distal phalanges). Management of these patients is difficult, and there is a high

risk of tooth loss and edentulism. Furthermore, implants placed in these patients are high risk for peri-implantitis.

Master dentistry vol. 2 third edition -chapter 1- page 37

Localized gingivitis should be carefully examined to consider all possible aetiologies. In this case, recent crown placement is evidently the causative factor. Poor crown margins are extremely common occurrences that should be rectified, if present. By definition, crown

margins that are intra-sulcular have not invaded the junctional epithelium and, as such have not encroached upon the supracrestal attached tissues. Excess cement and poor crown margins were not identified upon clinical examination, and allergy to adhesive resin would be extremely rare.

Poor bulbous emergence profiles can hinder oral hygiene practices and promote plaque and biofilm development. Where insufficient reduction has been provided, the technician has to overbulk the restoration to create sufficient thickness of porcelain for aesthetics and strength.

In this scenario, the opaque appearance is potentially suggestive of inadequate reduction. The veneering ceramic is thinner than required for optimal aesthetics, and the more opaque layer becomes visible. Restorations with this design fault could represent a plaque-retentive factor, which would ultimately lead to localized gingivitis.

Extra coronal restoration-chapter 10-page 111

E Rotational pedicle graft

Gingival recession following orthodontic treatment is relatively common. Camouflage of the malocclusion can occasionally result in a tooth being positioned outside of the bony envelope, leading to dehiscence or fenestration. If there is associated inflammation in the tissue and the biotype is thin, then recession can result. Thicker biotypes with a greater bulk of connective

tissue tend to result in less recession, as they are more robust.

When aesthetics is not a major concern and the patient has no complaints of sensitivity, root coverage surgery is not necessary unless the defect is progressing or excessive.

If sensitivity is present, then desensitizing agents may be used to remedy this initially.

The next consideration relates to the effect of the high frenal attachment. Previous

investigations demonstrated little evidence to suggest a frenal pull during muscular activity has any direct effect on gingival recession. However, the high attachment may inhibit effective

plaque removal. Some clinicians also suggest there is a plunging effect which drives plaque into the gingival sulcus or an effective gingival seal is prevented, either way perpetuating further

local inflammation. Anecdotally, therefore, relieving the frenal attachment can help improve local plaque control and stabilize the situation.

Alternatively, if the patient can maintain good plaque control, then surgery may not be warranted. Moreover, where there is little sulcal depth, apical displacement of the frenum during the procedure will help to create greater sulcal depth and facilitate any future root

coverage procedures. Some clinicians may do this as a single-stage procedure, combined with root coverage, depending on the situation. It should be appreciated that treatment planning in these situations is contentious and very scenario-specific.

Master dentistry vol. 2 third edition -chapter 1- page 47-49

The majority of clinical trials have shown powered toothbrushes to be as, if not more, effective for removing plaque than conventional manual brushes. Most of these observations are short term and may well be the result of a ‘novelty effect’ of using a new brush rather than as a consequence of better mechanical cleaning. Some powered units have brush heads that are designed specifically for cleaning fixed appliances. Powered brushes are more expensive.

Instructions for use of powered brushes are provided by the manufacturers. Generally, the

brushes should be guided around the dental arches with the knowledge that the movement of the brush head itself is generated by the powered unit.

Master dentistry vol. 2 third edition -chapter 1- page 39

The tooth may be non-vital if there is a combined periodontal–endodontic lesion. If the infection is primarily of periodontal origin, the tooth will very likely still be vital, and the

associated tooth usually painful. Local instrumentation and drainage should be the primary treatment. Periodontal abscesses usually drain through the pocket opening, thus reducing the need for systemic antimicrobials.

Master dentistry vol. 2 third edition -chapter 1- page 29

1. advantages of local delivered antimicrobial:

The antimicrobials are released slowly as the vehicle matrix biodegrades/breaks down.

Placement is site specific so the entire dose of the antimicrobial is targeted to the site where it is required.

As the product is placed by the clinician, there is no need for patient compliance. Furthermore, the majority of products now available in the UK have a bio-degradable matrix so the products do not have to be removed at a follow-up visit.

The incidence of adverse reactions will be reduced by avoiding the systemic route of drug administration.

Master dentistry vol. 2 third edition -chapter 1- page 51

Traditionally, the condition has been associated with a fusobacterial–spirochaetal complex, although aspects of the disease are characteristic of viral involvement (e.g., the relatively narrow age range affected and the tendency to recur). As yet, however, no specific virus has been identified as causal.

NUG is characterize by acute pain, bleeding gum and bad odor.

treatment of NUG is non-surgical RSI and OHI and in severe cases only metronidazole is prescribed , the disease is very likely to recur. If predisposing factors are not removed.

Master dentistry vol. 2 third edition -chapter 1- page 11

Chlorhexidine digluconate is available as a mouthrinse (0.2%, 0.12% or 0.06% w/v). The

compound can also be applied as a gel and has been incorporated into chewing gum, slow- release devices and periodontal packs. At low concentrations, chlorhexidine is bacteriostatic; at high concentrations, it is bactericidal.

Rinsing with chlorhexidine reduces the number of bacteria in saliva by between 50% and 90%. A maximum reduction of 95% occurs around 5 days, after which the numbers increase gradually to maintain an overall reduction of 70–80% at 40 days.

An important property of chlorhexidine is its substantivity, that is, the retention in the mouth and subsequent release from oral structures. After a 1-minute oral rinse of 10 ml of chlorhexidine

0.2%, approximately 30% of the drug is retained; within 15 seconds of rinsing, half will have bonded to receptor molecules.

The main unwanted effects are staining of the teeth, restorations and the tongue, and taste disturbances.

Master dentistry vol. 2 third edition -chapter 1- page 41

aim of root surface instrumentation is to remove calculus deposits , disrupt the subgingival

biofilm and facilitate healing and gaining of attachment level , A long junctional epithelium may form as part of the healing response.

Master dentistry vol. 2 third edition -chapter 1- page 42

vertical infrabony defect is typically associated with: first permanent molars ,localized aggressive periodontitis , a tooth which has ‘tipped’ into an extraction space, an overhanging restoration that lead to Local bone loss associated with plaque accumulation.

Source: Master dentistry vol. 2 third edition -chapter 1- page 15

Traumatic occlusal forces initiate neither periodontitis nor connective tissue attachment loss in a healthy periodontium, although there may be an increase in tooth mobility due to

compensatory widening of the periodontal membrane space. Master dentistry vol. 2 third edition -chapter 1- page 36

(It is fundamentally important that a high level of oral hygiene is maintained before and after surgery; surgical treatments will fail if plaque is not adequately controlled.)

Other indications for periodontal surgery include:

• crown lengthening to increase clinical crown length
• gingivectomy for the removal of overgrown gingival tissues
• guided tissue regeneration (GTR) to regenerate periodontal supporting structures
• mucogingival surgery for correction of mucogingival and aesthetic

healing occurs by the formation of a long junctional epithelium. This leads to reduced probing depths, which are easier to maintain in the maintenance phase of periodontal therapy.

In the other hand, it usually result in gingival recession and poor esthatics, but the width of keratinised gingiva can be maintained in flap procedures.

Master dentistry vol. 2 third edition -chapter 1- page 45

Classification of furcation involvement:

Class 1: Probe can be inserted less than 3 mm between the roots. Requires scaling and root planing, possibly with furcation plasty.

Class 2 :Horizontal probing depth exceeding 3mm but not extending fully through the width of the furcation area.

GTR together with graft materials and EMD (enamel matrix derivatives <emdogain>) can be used to treat class 2 furcations.

Class 3: Horizontal through-and-through destruction in the furcation area. May require tunnel preparation, C/or root resection, C/or extraction.

GTR less predictable with Class 3 defects.

a resorbable membrane or non resorbable membrane can be used with GRT ad both produces the same result

The main idea of GTR is that the space under the membrane must be filled with stable clot, which acts like a scaffold for the migration of colonising cells from the periodontal ligament.

GTR results in probing depths reduce and gains in attachment are seen, but there is usually an increase in recession of 1–2mm following GTR.

Osseointegration refers to the intimate contact observed between alveolar bone and the titanium surface of implants.

Master dentistry vol. 2 third edition -chapter 1- page 46 Oxford handbook of clinical dentistry- chapter 5- page 216

Fluoride varnish has been shown to be effective in decreasing caries incidence in children, and regular use is now advocated for all children over 3 years

deemed to be at risk of caries. application should be two times per year in cases of moderate risk of caries, increased to three or four times per year where caries risk is high.

Source:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition-p30 Chapter 2

Group function is multiple tooth contacts on the working side during lateral excursions.

but no contact on the non-working side.

Source:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition-p234-chapter 6

Surveyors are used to establish the path of insertion. Define those undercuts that may be used to retain the denture and those undercuts that require blocking.

out prior to finish. Source:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition -p 298 -Chapter 7

Anterior guidance is a functional relationship between the maxillary and mandibular anterior teeth. Disclusion in posterior teeth is seen during protrusion. Source:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition-p234,236 Chapter 6

The Frankfort plane is the line joining the superior aspect of the external auditory meatus to the orbitale (the lowest point of the bony orbit).

source:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition-p.124 Chapter 4

Soft linings are indicated for

• Older patients with a thin atrophic Usually for lower complete denture .
• Following prosthetic
• To utilize soft tissue undercuts for increasing retention, g. following hemimaxillectomy, clefts.

Source: OXFORD HANDBOOK OF Clinical Dentistry 7th edition-p.315 -Chapter 7

Nickel-titanium (NiTi) files are popular as they are much more flexible, even with increased diameters. Benefits also include less preparation time, fewer files required to complete preparation, and less operator and patient fatigue.

Source:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition-p340 -Chapter 8

This is indicated for fluorosis, post-orthodontic demineralization, localised hypoplasia due to infection or trauma, and idiopathic hypoplasia where discoloration is limited to the outer enamel layer. Affected teeth are carefully isolated, cleaned, and dried before ‘polishing’ the teeth with a slurry of either phosphoric acid (etch) mixed with pumice or a similar commercially available product (usually based on hydrochloric acid). Teeth treated in this way should

be reviewed at 1–4 weeks for effect once teeth have rehydrated and photographs taken.

Indications:

• • Idiopathic speckling • Postorthodontic demineralization •

Prior to veneer placement, check for well-demarcated stains. • White or brown surface staining (e.g., secondary to primary predecessor infection or trauma; Turner teeth)

Source: oxford handbook of dentistry , 7^th edition -chapter 6-page 257

Indications of apicectomy :

• Impossible to prepare and fill apical one- third of tooth (e.g. pulpal calcification, curved apex, open apex).
• Irretrievable broken instrument in

• Post crown on tooth with apical pathology (only if post crown has sealed the coronal root and crown margin adequately).
• Root
• Fractured and infected apical one-
• Persistent infection due to apical cyst or other lesion requiring biopsy, and repeat root canal therapy has been performed and is adequate or ‘pull through’ technique is planned. A coronal seal must be achievable.

canal restoration options:

identify the canal and prepare it with a no. 1/ 2- round bur or ultrasonics (depending on availability).

Seal with super ethoxy benzoic acid (EBA), Intermediate Restorative Material® (IRM®), or MTA and debride. Close, using interrupted or vertical mattress sutures.

Source:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition-p.402- Chapter 10

Remove enough tooth substance to allow an adequate thickness of gold,which will be 1.5 mm on the functional cusp and 1mm elsewhere (including margin), following original tooth contours.

source:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition-p268- Chapter 6

OXFORD HANDBOOK OF Clinical Dentistry 7th edition-p319 -Chapter 7

Metal dentures should not be cleaned with hypochlorite but rather with alkaline peroxide, as it can corrode metal components.

Source:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition -p316- Chapter 7

Coronal seal after completing obturation, a good coronal seal must be achieved by placement of an ideal restorative material on the pulp chamber f loor and canal orifices and placement of a definitive restoration. This is now recognized as very important for success in endodontics. Too often good endodontic therapy is jeopardized by a poor restoration that does not provide a good coronal seal.

Therefore, After obturation, a good coronal seal must be achieved by placing an ideal restorative material on the pulp chamber floor and canal orifices and

placing a definitive restoration. This is now recognised as very important for success in endodontics.

Source:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition-Pages 352 ,Chapter 8

Balanced force filing This is performed at 90° clockwise followed by 270° anticlockwise using a k- flexofile. Its benefit is to remove dentine equally on all walls.

Source: oxford handbook of dentistry , 7^th edition -chapter 8-page 348

B is incorrect as the properties of acrylic dentures are

• Poor impact strength and low resistance to fatigue fracture
• Abrasion resistance is not very good but is usually
• Good (can be stained)

C is incorrect.

Acrylic monomer can cause an allergic reaction and should be considered in a patient complaining of a ‘burning mouth’.

The concentration of monomer is high in poorly cured acrylic and greater in Self-cure than heat- cured.

In that case, extended curing can be done (e.g., 24 h), and that may decrease the concentration of monomer to an acceptable level; if it doesn't, then a cobalt chrome or SS denture base can be used.

D is incorrect, as acrylic dentures need a wide mucosal coverage to provide maximum support, and this may avoid the production of a gum-stripping denture.

Source:

• OXFORD HANDBOOK OF Clinical Dentistry 7th edition-p 293 Chapter 7
• OXFORD HANDBOOK OF Clinical Dentistry 7th edition- 684 Chapter 16

• OXFORD HANDBOOK OF Clinical Dentistry 7th edition-680 Chapter 16

Symptoms

A Fleeting sensitivity or pain to hot, cold, or sweet with immediate onset The pain is usually sharp and may be difficult to locate. (Fleeting means that It subsides within just a few seconds after the removal of the stimulus.)

Signs:

An exaggerated response to pulp testing. There can be a cavity or leaking restoration present.

The Tooth is not tender to percussion.

Treatment:

Remove any caries present and restore the tooth.

Source:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition-p.230 Chapter 6

This is pain caused by exposed dentine in response to a thermal, tactile, or osmotic stimulus (not all exposed dentine gives rise to symptoms). It is thought to be due to dentinal fluid movement stimulating pulpal pain receptors.

About 25–30% of the adult population reports dentine hypersensitivity.

Diagnosis is made through the elimination of other possible causes and by evoking symptoms.

Treatment:

Involves removing causative factors (promoting oral hygiene or treating intrinsic or extrinsic erosion) and decreasing the permeability of dentinal tubules (e.g., by toothpaste containing strontium and potassium salts and/or fluoride treatment or placement of varnishes, dentine desensitizers, dentine adhesive systems, or, if indicated, a restoration).

Source:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition-p.231- Chapter 6

Symptoms :

Can include severe pain that will disturb sleep. The tooth is exquisitely tender to touch.

Signs

The tooth is usually extruded, mobile, and tender to percussion. It may be associated with intraoral swelling and facial swelling or with only localised intraoral swelling.

Sensibility testing may be misleading as pus may conduct stimulus to apical tissues.

Radiographic changes can range from a widening of the apical periodontal ligament space to radiolucency.

Source:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition-p. 232 Chapter 6

Patient experiences Sharp pain on biting (e.g., a cotton wool roll or a "Tooth Slooth) that lasts for a short duration may go away on release of pressure.

Sensitivity to cold is possible. Some patients find pain on release of biting.

Signs

Often, there are relatively few, therefore diagnosis is difficult. The tooth often has a large restoration.

A crack may not be apparent at first by transillumination. Removal of the restoration may aid visualisation. There is a positive response to vitality (sensibility) testing. Cracked tooth syndrome May be associated with bruxing habits. Source:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition-ch 6 -p 231

Reversible pulpitis

- Symptoms Fleeting sensitivity/ pain to hot, cold, or sweet with immediate onset. Pain is usually sharp and may be difficult to locate. Quickly subsides after removal of the stimulus.

-Signs Exaggerated response to pulp testing. Carious cavity/ leaking restoration. Tooth not tender to percussion.

Source:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition-p. 230 Chapter 6

source: oxford handbook of dentistry , 7^th edition -chapter 7-page 293

Amalgam restorations are prone to fracture at the isthmus in restorations extended occlusally; therefore, sufficient depth must be provided in this area. The width of the isthmus should not be overcut (ideally one- quarter to one-fifth intercuspal width). If the cusps are extensively undermined or missing, they should be replaced with a bonded restoration.

source:

OXFORD HANDBOOK OF Clinical Dentistry 7th edition-p.247- ch. 6

Following amendment in 2012, the current European Directive position is as follows:

• Whitening is the practice of dentistry and that it should only be undertaken by regulated dental professionals.
• Products containing or releasing between 1% and 6% hydrogen peroxide cannot be used on any person under 18yrs of age.
• Products containing between 1% and 6% hydrogen peroxide should only be used after appropriate clinical examination to ensure there are no risk factors or oral pathology concerns.
• Products should be available only via a dentist/ hygienist or dental
• For each cycle of use, the first use must be carried out by dental practitioners or under their direct supervision.

• After that, the product may be provided by the dental practitioner to the consumer to complete the cycle of use.

source: oxford handbook of dentistry , 7^th edition -chapter 6-page 256

Indications of surgical root canal treatment or apicectomy

• Pulpal calcification, a curved apex, and an open apex cause extreme difficulty in preparing the apical third.
• broke an instrument in the canal that can’t be retrived
• post-crown on a tooth with apical pathology (only if the post-crown has sealed the coronal root and crown margin adequately).
• Root
• Fractured and infected apical one-third

• Persistent infection due to an apical cyst or other lesion requiring biopsy and repeat root canal therapy have been performed and are adequate. A ‘pull through’ technique is planned.

A coronal seal must be achievable.

source: OXFORD HANDBOOK OF Clinical Dentistry 7th edition -P 402- Chapter 10