Part 3: Oral Surgery, Endodontics, Pediatrics, Orthodontics, Behavior Science, Public Health, OSHA & Infection Control

ALLOGENEIC GRAFTS

(Allografts or Homografts)composed of tissue taken from a donor of the SAME SPECIES who is not genetically related to the recipient (usually cadaver bone).

Isogenic Grafts

(Isografts or Syngenesioplastic Grafts)composed of tissues taken from an individual of the SAME SPECIES who is GENETICALLY RELATED to the recipient.

Note: after filling a canal with gutta-percha, if there is a horizontal line of material (gutta-percha or sealer) extending both mesially & distally from the canal to the PDL space, this indicates a

ROOT FRACTURE.

An appropriate candidate for post-orthodontic circumferential supracrestal fibrotomy is a

ROTATED maxillary lateral incisor. Circumferential supracrestal fibrotomy-a minor surgical procedure where a simple incision into the sulcus is made to the crest of bone to incise all of the collagen fibers that are inserted into the tooth root. Cutting the collagen fibers eliminates relapse potential due to collagen fiber retraction and allows new fibers to form to help retain the tooth in its new position.

When using BUCCAL COIL SPRINGS to try and regain space by pushing a tooth mesially or distally, be careful because what commonly occurs is

ROTATION of that tooth, rather than actual movement.

Medications that can be prescribed for 1 week:

antibiotics (penicillin or erythromycin), decongestant nasal spray, and/or an oral decongestant.

2. Fear-

anticipation of a threat elicited by an external object generally agreed to be harmful. In evaluating a patient's dental fears, take note of what the patient says, how he/she behaves, and how they appear while in the dental office. Fear is distinguished from anxiety on the basis of the person's ability to locate the threatening agent "out there" and to recognize the clear presence of a behavior that will reduce perceived danger. Patients who are fearful or anxious will do anything to put off making dental appointments.

DISINFECTANTS-

antimicrobial chemical agents (solutions, sprays, or wipes) used to destroy/kill microorganisms on when applied to inanimate objects/surfaces like countertops, lights, bracket trays, headrests, light handles, dishes, tables, floors. Disinfectants are not safe to use on living tissues (however antiseptics are safe). Thus, are only applied to inanimate objects. Disinfectants are germicidal (kill) and prevent pathogenic microorganism growth (microbiostatic) Alcohols, Chlorhexidine, & Quaternary Ammonium Compounds are disinfectants.

If unanticipated bleeding occurs, administer an

antimicrobial prophylaxis within 2 hours after the procedure!

Local anesthesia works by reducing

anxiety and sensitivity during the procedure. Local anesthesia acts by reducing sensitivity which thus reduces anxiety and stress related to treatment. Salivation is also decreased.

In low doses barbiturates reduce

anxiety, respiration, BP, HR, and REM sleep.

Nitrous oxide is SAFE to administer in asthmatics, and is especially indicated for patients whose asthma is triggered by

anxiety. If the patient is taking steroids, consult their physician for the possible need for corticosteroid augmentation.

Behavioral Development-

any observable response mediated through the neuromotor system. To understand the development of human behavior, you must understand the basic concepts of maturation and learning.

Spore-forming pathogens provide the ultimate test for efficacy of sterilization. Since bacterial spores are resistant to

boiling (100°C at sea level), they must be exposed to a higher temperature. This temperature cannot be achieved unless the pressure is increased. For this purpose, an autoclave chamber is used where steam at a pressure of 15lbs/in reaches a temperature of 121°C for 1520min. This kills even the highly heat-resistant spores of Clostridium botulinum (causes botulism) with a margin of safety.

A high percentage of children with cystic fibrosis have

dark-colored teeth.

Patient information required to plan dental hygiene care includes:

health & dental history, dietary analysis, and periodontal examination.

PEDS The mandibular foramen is located at a level lower than the

occlusal plane of the primary teeth in the child patient. Thus, the injection is made slightly lower and more posterior than for an adult.

CRACKED TOOTH SYNDROME-

one of the most frustrating dental conditions involving the possible need for endodontic treatment, because its symptoms are usually characterized by a SHARP, but BRIEF PAIN occurring unexpectedly only when the patient is chewing. Having a patient bite forcefully on a bite stick (tooth slooth) and noticing the cusps that occlude when the pain occurs helps locate the cracked tooth.

Posterior crossbite may be corrected with a

palatal expansion which causes diastema formation between the central incisors and expands the nasal floor. Tooth movement and skeletal expansion are inevitable when the midpalatal suture is widened with a palatal expander.

Premedication with a barbiturate may cause

paradoxical excitement in a young child.

Radiographic exam rarely reveals the fracture because the crack is usually

parallel to the x-ray film. Radiographs (without first wedging the tooth) RARELY show vertical tooth fractures.

ANUG is usually associated with

poor oral hygiene, and is most common in conditions where there is crowding and malnutrition. Emotional stress and smoking are also risk factors.

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)- Clinical Signs:

poor school performance due to inability to attend to tasks or sit still during school. Short-term memory deficient, impulsive, hyperactivity, inattentiveness, and highly talkative inhibit learning.

A tooth with internal resorption may respond to

pulp vitality tests, but when detected, a pulpectomy should be performed. Once the pulp tissue responsible is removed, all resorption stops. To "wait and see" may cause sufficient destruction to perforate the root.

2. Cell-free zone (zone of Weil)-

pulp layer rich in capillaries, nerve networks, and contains the Nerve Plexus of Rashkow.

Traumatic blows to teeth also cause

pulp space calcification sometimes to a point where locating the canal is very difficult. With primary teeth, trauma may cause calcifications in the pulp chamber, which can cause a yellowish discoloration of the tooth.

Recently traumatized teeth may give false negative responses to

pulp vitality tests. This impaired nerve conduction may be temporary or permanent, but only time will tell.

A short, painful response to cold suggest

pulpal hyperemia. Pulpal hyperemia is an excessive accumulation of blood in the pulp due to vascular congestion. It is the engorgement of pulpal vessels with blood. Once the causative agent (i.e. bacteria or a restoration in hyperocclusion) is removed or adjusted, the pulp usually returns to normal.

Failure of a direct pulp capping procedure is indicated by symptoms of

pulpitis at any time, or the lack of vital response after several weeks or months.

3. Straight-pull headgear:

similar to cervical-pull headgear, but this appliance places a force in a straight distal direction from the maxillary molar. Like cervical-pull headgear, straight-pull headgear is indicated for Class II, Division I malocclusions (when bite opening is undesirable).

2. Tooth-Borne Functional Appliances: Bionator:

similar to the activator in function, but its design is a trimmed-down version of the activator to make it more comfortable to wear.

Anterior Crossbite (especially crossbite of the incisors), is RARELY FOUND in children who do not have a

skeletal Class III jaw relationship. A crossbite relationship of 1 or 2 anterior teeth, however, may develop in a child who has good facial proportions. Maxillary lateral incisors tend to erupt to the lingual, and may become lingually trapped especially in the presence of severe crowding. In this situation, extracting the adjacent primary canines usually leads to spontaneous correction of the crossbite. It is important to evaluate the space situation before attempting to correct any anterior crossbite. If enough space is available to accomplish this movement, a maxillary removable appliance is usually the best mechanism to correct a simple anterior crossbite that requires a tipping movement. Anterior crossbite in a primary dentition usually indicates a SKELETAL GROWTH PROBLEM.

The properties of sealants are closer to

unfilled direct resins than to filled resins (composites). Sealants are weaker than filled resins, but their strength is sacrificed allow it to flow into pits and fissures (its viscosity must be low enough to flow into pits and fissures).

The virus that causes acute herpetic gingivostomatitis is closely related to

the herpes virus that causes chickenpox (varicella zoster).

Curettage of the socket to remove periapical pathosis is

unnecessary because the socket wall should be MINIMALLY manipulated during replantation.

Medulla-

the last area of the brain depressed during general anesthesia. This area is the most vital part of the brain and contains the cardiac, vasomotor, and respiratory centers of the brain.

Distoangular Impaction-

the maxillary 3 molar impaction most likely displaced into the antrum (maxillary sinus) and infratemporal space if correct extraction techniques are not used. Mandibular 3 rd rd molars with a distoangular impaction are the most difficult impaction to remove.

The big difference between Division I & II is in a Division II,

the maxillary laterals are tipped labially & mesially.

Formocresol Pulpotomy Technique- Indications:

tooth sensitive to sweets, pulp exposure during caries excavation, and radiographic evidence of deep caries approximating the coronal pulp.

The MOST personal behavior by the dentist is

touching the patient gently on the arm.

Posterior movement predominates in the

tuberosity area. The primary movement of the alveolar region & palate is downward, the nasal region moves forward, and zygomatic process moves posteriorly and laterally.

Access Preparation Mistakes: During mandibular molar access preparation,

two regions tend to be "overcut" resulting in undesirable over preparation of the canal access (mesial aspect under marginal ridge & lingual surface under lingual cusps). Mandibular molars tip mesially and lingually, thus if a bur is directed straight inferior, it may cause unnecessary loss of tooth structure in the mesial and lingual areas.

PPO (Preferred Provider Organization)-

typically involves contracts between insurers and dentists. Patients can choose their dentist depending on if the dentist participates in the PPO arrangement.

SMALLPOX (Variola)- Oral manifestations:

ulceration of the oral mucosa and pharynx. Sometimes, the tongue is swollen and painful, making swallowing difficult.

Due to distortion, there may be difficulty in making speech sounds

"F" & "V" in a Skeletal Class III.

The existence of a FORWARD SHIFT of the mandible during closure to avoid incisor interference is found in

"Pseudo" Class III malocclusions. To avoid teeth interference, the patient can adopt a jaw position on closure that is forward to normal (this may look like a Class III position in the absence of a "true" skeletal Class III relationship. Thus, it is called a "pseudo" Class III malocclusion. In most cases they have an edge-toedge bite.

A thorough medical history is obtained for all patients at the first visit and updated and reviewed at subsequent visits. However, since not all patients with infectious diseases can be identified from a medical history, physical exam, or readily available lab tests, the CDC introduced the concept of

"Standard Precautions". Universal precautions are effective in preventing disease transmission from dental worker to patient, patient to dental worker, and patient to patient.

CASE CONTROL STUDY

(RESTROSPECTIVE STUDY)the best approach to study a RARE disease.

Neuroleptic + Narcotic analgesic + N2O→Neurolept Anesthesia

(a state of neurolept anesthesia & unconsciousness produced by combined administration of a narcotic analgesic and neuroleptic agent with inhalation of N2O & oxygen). • The induction of anesthesia is slow, but consciousness returns quickly after nitrous oxide inhalation is stopped.

Cartilage Growth Occurs 2 Ways: Appositional Growth-

. by the recruitment of fresh cells, chondroblasts, from perichondral stem cells and the addition of new matrix to the surface. The perichondrium consists of a fibrous outer layer and chondroblastic inner layer.

How much epi in each carpule (1.8cc) of 2% lidocaine?

0.018mg of EPI are in each cartridge/carpule (1.8cc) of 2% lidocaine with 1:100,000 EPI. 0.018mg = 1.8cc x .01mg EPI.

pH of APF gels falls in the

1-4 range (pH is 3.0-3.5 which is acidic).

An acute infected tissue emphysema is usually caused by indiscreet use of:

1. Air-pressure syringes: in drying out a root canal with a compressed air syringe, septic material can be forced through the apical foramen into the cancellous portion of the alveolar process, and ultimately out through the nutrient foramina into adjacent soft tissues, resulting in formation of a septic cellulitis & tissue emphysema. 2. Atomizing spray bottles activated by compressed air: a similar condition can be induced by using a compressed-air spray bottle for irrigating wounds (especially in the retromolar region). It is safer to use a hand-activated syringe when irrigating wounds or drying root canals since to reduce the chance of producing a tissue emphysema.

5 Ways to Obtain Wound Hemostasis:

1. Assisting natural hemostatic mechanisms: usually by placing a cotton sponge with pressure on the bleeding vessels or using a hemostat directly on the vessel. 2. Heat on the cut vessels (thermal coagulation). 3. Suture ligation of the vessel. 4. Placing a pressure dressing over the wound (most bleeding from oral surgery can be controlled this way). 5. Vasoconstrictive substances like EPI in local anesthetics.

Components of Pit & Fissure Sealants:

1. Bis-GMA: monomer that can be diluted with TEGDMA to reduce viscosity. 2. Initiator: Benzyol Peroxide in self-cured sealants and Diketone in visible-light cured. 3. Accelerator: amine is self-cured. 4. Opaque Filler: small amounts of TiO (titanium oxide) are added to make the appearance slightly different from the occlusal enamel.

Objectives of Root Canal OBTURATION (Filling with Gutta-Percha):

1. Develop a fluid-tight seal at the apical foramen. 2. Complete filling of the root canal space. 3. Create a favorable biologic environment for the process of tissue healing.

STAGES OF TOOTH HISTOGENESIS (formation and development of tooth tissues):

1. Elongation of the inner enamel epithelial cells of the enamel organ. This influences mesenchymal cells on the periphery of the dental papilla to differentiate into odontoblasts. 2. Differentiation of odontoblasts. 3. Deposition of the 1 st layer of dentin then 1 layer of enamel, followed by deposition of root dentin and cementum.

Method of tissue removal depends on the type of biopsy:

1. In a needle (percutaneous) biopsy, the tissue sample is simply obtained by using a syringe. A needle is passed into the tissue to be biopsied, and the cells are removed through the needle. 2. In an open biopsy, an incision is made in skin, the organ is exposed, and a tissue sample is taken. 3. A closed biopsy involves a much smaller incision than an open biopsy. The small incision is made to allow insertion of a visualization device that can guide the physician to the appropriate area to take the sample.

BIOPSY TYPES OF BIOPSIES:

1. Incisional Biopsy-removes only part of the lesion. Most often used for oral lesions. A (-) incisional biopsy report of a highly suspicious oral lesion suggest another biopsy specimen is necessary in view of the clinical impressions. The key is a highly suspicious oral lesion. 2. Excisional Biopsy-removes the entire lesion. Most often used for oral lesions. 3. Needle Biopsy-aspiration biopsy. 4. Exfoliative Cytology-pap smear.

3 STAGES OF WOUND HEALING:

1. Inflammatory stage-consists of a vascular and cellular phase where neutrophils and lymphocytes predominate. The macrophage is the most important inflammatory cell for wound healing. 2. Proliferative Stage (Fibroblastic Stage)-this stage is mediated by fibroblasts which form collagen and new blood vessels. 3. Maturation Stage (Remodeling Stage)-foreign material, necrotic tissue, ischemia, and tension.

Beneficial Effects of Fluoride:

1. Interferes or inhibits plaque formation on enamel surfaces. Dental plaque adheres to teeth because DEXTRANS are insoluble and sticky. 2. Has antibacterial qualities depending on the concentration (fluoride is bactericidal in high concentrations). 3. Enhances enamel remineralization to help reduce and eliminate early carious lesions. 4. Decreases enamel solubility. 5. Inhibits glycolysis (the process by which sugar is metabolized by bacteria to produce acid). When glycolysis is inhibited, the caries process is inhibited.

#15 Scalpel is UNIVERSALLY used for oral surgery. 3 incisions are used in oral surgery:

1. Linear incision-a straight-line incision used for Apicoectomies. 2. Releasing incision-used to add a vertical leg to a horizontal creation incision for extractions, augmentations. The correct position for ending a vertical releasing incision is at the TOOTH LINE ANGLE (not over the tooth's buccal surface). If the incision ends over a buccal surface, the edges are difficult to approximate, which can cause periodontal problems. 3. Semi-lunar incision-a curved incision used mostly for Apicoectomies.

N2O % induction whats least likely to occur with N20

1. N O: 10-20% (maximum 35%) causes rapid induction and recovery. *Ventricular fibrillation is LEAST 2 LIKELY to occur during anesthesia with nitrous oxide. The primary danger associated with using N2O anesthesia in concentrations exceeding 80% is HYPOXIA.

Proper Management of Syncope:

1. Place the patient in the supine position with their feet slightly elevated. 2. Establish airway (head tilt/chin lift) and administer 100% oxygen via a face mask (O is indicated for treating all types of syncope EXCEPT hyperventilation syndrome). 2 3. Monitor vital signs and support the patient. Pupils may dilate from lack of oxygen to the brain. 4. Maintain your composure. Apply a cool, wet towel on the patient's forehead. 5. Follow-up treatment. Determine factors causing the unconsciousness.

Causes of Tooth Discoloration:

1. Porphyria-a condition that results in discoloration of teeth. 2. Cystic Fibrosis: these children have teeth dark in color (ranging from yellowish-gray to dark brown), and may be related to the usual high doses of tetracycline given to these children. 3. Erythroblastosis Fetalis: characterized by an excessive destruction of erythrocytes. Primary teeth may have a blue-green color. 4. Tetracycline Therapy: can cause tooth crowns to become discolored from yellow-to-brown, and gray-toblack. The drug stains permanent teeth that have not completed enamel formation at the time the drug is given (i.e. if a 5-year old child receives tetracycline therapy, the teeth affected will be the canines, premolars, and 2 nd molars. Important: incisors and 1 molars have already completed enamel formation. st

Serial Extraction Stages:

1. Primary Canines are removed 1 . 2. Primary 1 st 3. Permanent 1 Molars are removed 2 st st nd Premolars are removed last (usually).

3 periods of dentition in man:

1. Primary dentition (6 months to 6 years) 2. Mixed dentition (6 to 12 years) 3. Permanent dentition (12+ years)

3 Principals when Treatment Planning an Impacted Tooth:

1. The prognosis is based on the extent of displacement and surgical trauma required for exposure. 2. During surgical exposure, flaps should be reflected so that the tooth is ultimately pulled into the arch through keratinized tissue (NOT through alveolar mucosa). 3. Adequate space should be provided in the arch BEFORE attempting to pull the impacted tooth into position.

AIR VOLUMES:

1. Tidal Volume (TV)-volume of air normally inhaled or exhaled by quiet breathing. 2. Residual Volume (RV)-volume of gas in the airway that does not participate in ventilation. 3. Expiratory Reserve Volume (ERV)-amount of air that can be exhaled in addition to the TV. 4. Inspiratory Reserve Volume (IRV)-amount of air that can be inhaled in addition to the TV. 5. Vital Capacity (VC)-total lung capacity. VC = TV + ERV + IRV. 6. Functional Residual Capacity (FRC)-the amount of air remaining in the lungs at the end of a normal expiration. This air is used to provide air to alveoli to aerate the blood evenly between breaths. A larger than normal functional residual capacity (FRC) causes N 2 O sedation to take longer. FRC = ERV + RV.

5 FACTORS TO MANAGE TRAUMATIC TOOTH AVULSION INJURIES:

1. Time: the time interval from injury until tooth replacement is a MAJOR factor in maintenance of PDL viability & subsequent root resorption. Teeth replanted within 30min exhibit very little resorption, while most teeth replanted after 2hrs have extensive external root resorption (MAIN cause of failure of replanted teeth is external root resorption). 2. Storage Media: if the tooth cannot be replanted immediately, proper storage can favorably influence PDL cell viability. MILK is the BEST storage media due to its near neutral pH (6.5-6.8) and osmolality which is conducive for cell survival. Physiologic saline and saliva are other tooth storage media. 3. Tooth Socket: should not be damaged by curettage or forceful replantation. 4. Root Surface: should not be scraped, dried, or manipulated with caustic chemicals. 5. Splint Stabilization: a splint that allows physiologic movement is placed for a maximum of 2 weeks to allow the initial reattachment of the PDL fibers.

Radiation Safety: Endodontic procedures involve taking multiple radiographs.

1. To protect the dentist and staff if there is no barrier available to stand behind, the stand at least 6 feet away in the area that lies between 90-135º to the xray beam (an area of minimal scatter radiation). 2. A fast (sensitive) film like "E-speed" film is preferred over slower films, since faster films require less radiation exposure while providing a quality image. 3. Dental units should operate at 70kVp or higher. The higher kVp = lower patient skin doses or radiation. 4. Collimation (i.e. restricting x-ray beam size so it does not exceed 2.5inch at the patient's skin) decreases exposure. 5. Patients must be protected with a lead apron and thyroid collar for each exposure. 6. Dental personnel who may get exposed to occupational x-radiation MUST wear film badges to record exposure, and must never exceed the max permissible dose (MPD) of 50mSv per year per person.

3 types of DI exist:

1. Type I: often associated with osteogenesis imperfecta. Child may also have blue sclera, fragile bones, and hearing loss. 2. Type II: the most common type of dentinogenesis imperfecta. 3. Type III (Brandywine Type): characterized by multiple pulpal exposures in the deciduous dentition.

PERIRADICULAR SURGERY INDICATIONS:

1. non-negotiable canal, blockage or severe root curvature in which non-surgical treatment is impossible. 2. complications arising from procedural accidents (i.e. instrument separation, ledging, or perforations) that cannot be handled without surgical exposure of the site. 3. failed treatment due to irretrievable posts or root fillings. 4. horizontal apical fractures where the apical end of the pulp becomes necrotic. 5. biopsy to diagnose non-odontogenic causes of symptoms (i.e. patient with a history of previous malignancy, lip parsthesia, or anesthesia).

Stainless Steel Crowns- Tooth Preparation: ♦ When preparing a primary tooth for a stainless steel crown, the cusps are reduced

1.0-1.5mm to allow clearance with opposing teeth and to prevent traumatic occlusion after placing the stainless steel crown. ♦ Reduce proximal surfaces (mesial & distal); vertical reductions are made and carried gingivally to the extent that contact with the adjacent tooth is broken. ♦ Remove all sharp line angles. It is usually not necessary to reduce the buccal or lingual surfaces. This aids in crown retention (undercut area). However, it may be necessary to reduce the distinct buccal bulge, especially on the primary 1 molar. ♦ When festooning and trimming the crown during st fitting, greater length is needed in the mesiofacial bulge region on a primary 1 st molar.

When placing a Class II amalgam in a primary tooth, with isthmus width should be

1/3 of the intercuspal width. If an amalgam fracture occurs, it is most likely to occur here.

Employers must offer the vaccination to a new employee within

10 working days of initial assignment to a position involving exposure. OSHA requires the employee to be trained regarding Hepatitis B and the vaccination prior to being offered vaccination.

N20=There is no biotransformation, and the gas is rapidly excreted by the lungs when the concentration gradient is reversed. It is recommended that the patient be maintained on

100% oxygen for 3-5 minutes after the sedation period.

The acceptable maximum exposure level allowed by OSHA for nitrous oxide is

1000ppm.

In good health, the ratio of calcium to phosphorus in the blood is

10:4. If a glandular imbalance exists (especially with the parathyroid glands), then this ratio is maintained at a different level, causing long-term health deterioration. A high ratio of phosphorus to calcium sensitizes the body and increases inflammatory tendencies.

Doses of IV midazolam usually is in the range of

15mg just before the dental procedure. Children's dosing is based on body weight, ranging from 0.25mg-0.5mg per kilogram (2.2 pounds). Maximum dose is 20 milligrams. The syrup is given to a child 30 to 45 minutes before the dental procedure.

A child should STOP taking fluoride supplements at

16-18 years old.

A 7-year old should have

18 primary teeth (except the two mandibular centrals) and 6 permanent teeth (all 4 first molars & 2 mandibular central incisors) clinically visible.

How is pH stabilized in local anesthetics?

1mg of methylparaben (a preservative) and NaOH to stabilize the pH.

Because total airway obstruction usually occurs during inspiration, there is usually adequate oxygen left in the cerebral blood to permit up to

2 minutes of consciousness. If the obstruction is not recognized, managed, and oxygen is not delivered to the victim's lungs, blood, and brain, permanent neurologic damage occurs in 3-5 minutes.

Between boys & girls, the difference is onset of pubertal growth spurt is

2 years. Girls reach puberty 2 years before boys.

A patient with DRY SOCKET develops a severe, dull throbbing pain when

2-4 days AFTER a tooth extraction. The pain is often excruciating, may radiate to the ear, and is not relieved by oral analgesics. There may be an associated foul odor and taste, and the extraction site is filled with necrotic tissue, which is delayed wound healing.

For an adult, the LETHAL DOSE of fluoride is between

2.5-10g, with the average lethal dose is 4-5g. Death has occurred in infants with as little as 0.25g (250mg). Death is likely in a child who ingests > 15mg of F-/kg body weight (i.e. 5 teaspoons of APF gel for a 44lb child). Thus, it is weight dependent. Most fluoride absorption occurs in the stomach (an acidic pH is required to facilitate this diffusion process). The minimum does that could cause toxic signs and symptoms (including death), and that should trigger immediate therapeutic intervention and hospitalization is 5mgF/kg weight = 2.27mgF/lb (this is the "probable toxic dose")

The ideal time to remove impacted 3 molars is when the root is approximately

2/3 formed. The patient is around 17-21 years old. At this time, bone is more flexible and the roots are not formed well enough to have developed curves and rarely fracture during extraction.

When one turns on the N2 O, the initial concentration is

20%. Initially, some start with 100% oxygen.

Agents Useful for Surgical Anesthesia: Cyclopropane:

20-35% for Stage 3 causes rapid induction and recovery, good muscle relaxant, and sensitizes the heart to catecholamines.

Adrenal cortex secretes how much hydrocortisone

20mg of hydrocortisone daily. During stress, the cortex can increase its hydrocortisone output to 200mg daily.

Ex: 70lb patient whats the maximum allowable dosage

224mg (maximum allowable dosage) / 36mg (amount of lidocaine in 2% carpule) = 6.2 carpules (~6).

MANDIBUAR AND MAXILLARY ROOT ANATOMY Mandibular 1 Premolar:

25% MAY have 2 canals with 2 apical foramina. Thus, treatment can be tricky. At least 23% can have 2 or 3 canals starting anywhere down the root. If a straight-on preoperative radiograph of a mandibular 1 st premolar shows the pulp canal disappearing in midroot, this is an important indication that 2 canals are present. Pulpitis can cause referred pain to the MENTAL REGION OF THE MANDIBLE.

2. Ethylene

25-35% causes rapid induction & recovery, not often used due to explosiveness and disagreeable odor

What is the agent of choice to debride intraoral wounds.

3% H2O2

Agents Useful for Surgical Anesthesia: Halothane:

3% induction and 1-2% maintenance causes relatively slow induction and recovery. Not a good muscle relaxant. Side effects: sensitizing heart to the catecholamines, hypotension, and cardiac arrhythmias. Not a good analgesic, so used as an adjunct. Halogenated hydrocarbons are associated with liver damage if toxic doses are used.

Mandibular leeway space averages

3-4mm & the Maxillary leeway space averages 2-2.5mm. The important factor is that some space will be available in the posterior part of the mouth. This leeway space serves to at least accommodate the permanent canines (which are usually larger than primary canines).

Barbiturates DEPRESS the CNS, which lasts

3-8 hours depending on the dose. The barbiturates of choice for the dentist are usually the short-acting drugs because the onset of sedation is short (~30 minutes to 1hr), and the duration of effect (3-4 hours) is more than sufficient for most dental procedures.

For Carbocaine without EPI, the maximum allowable dose is

3.0mg/lb.

Restorative Options for Endodontically Treated Posterior Teeth: If performing a pulp-chamber-retained amalgam, must place amalgam

3.0mm into each canal for retention.

MAXIMUM allowable dose of 2% lidocaine with 1:100,000 EPI is

3.2mg lidocaine/ per lb. (or 7mg/kg). *1kg = 2.2 lbs.

Acute Fluoride Toxicity symptoms may appear within

30 minutes of ingestion and persist for up to 24hrs. Patients may experience nausea, vomiting, diarrhea, and abdominal cramping since 90-95% of ingested fluoride is absorbed through the stomach and small intestines. Fluorides are mainly eliminated from the body via the kidneys. However, the fluoride that remains in the body is found mostly in skeletal tissue.

They are administered as GASES (their partial pressure or "tension" in the inhaled air or in blood or tissue is a measure of their concentration). Since the standard pressure of the total inhaled mixture is atmospheric pressure (760mm Hg at sea level), the partial pressure can also be expressed as a %. Thus, 50% N O in the inhaled air would have a partial pressure of

380mm Hg.

Cleft lip deformity occurs during what time of pregnancy

4-6 weeks of pregnancy. Cleft lip occurs following the failure of the permanent union between the maxillary process & frontonasal process.

School water fluoridation optimal concentration is

4.5x that of city water supplies because of less water consumption at school.

Heart inflammation (carditis) disappears gradually usually within

5 months. However, it may permanently damage the heart valves, resulting in rheumatic heart disease. The mitral valve (valve between left atrium & ventricle) is most commonly damaged and may become leaky (mitral valve regurgitation), abnormally narrow (mitral valve stenosis), or both. The pulmonary valve is RARELY involved.

Rheumatic fever is most common in children ages

5-15yrs. The onset is sudden and often occurs 1-5 symptom free weeks after recovery from a sore throat or from scarlet fever. Mild cases may last 3-4 weeks, while severe cases may last 2-3 months. Treatment: Penicillin & Rest.

Maximum concentration of N 2 O should not exceed

50% (some say 40%).

When one starts conscious sedation, the flow rate of n20 is about

6 liters/minute. The correct total liter flow of nitrous oxide-oxygen is determined by the amount necessary to keep the reservoir bag 1/3-2/3 full

TOOTH DEVELOPMENT & ERUPTION Primary teeth begin to form at

6 weeks in utero & begin to calcify at 4 months in utero. Permanent teeth begin to develop at 4 months in utero.

The time required to UPRIGHT A MOLAR takes between

6-12 months (a severely tipped molar or molar that requires mesial movement to shorten the pontic space requires longer treatment). A Fixed Edgewise Appliance is usually used for MOLAR UPRIGHTING

After RCT is completed on a tooth with a periapcial radiolucency, it takes

6-12 months before a marked reduction in the size of the radiolucency is evident on a radiograph. Desired periapcial tissue changes are regeneration of alveolar bone, deposition of apical cementum, and PDL re-establishment.

LOCAL ANESTHESIA & COMPLICATIONS Local anesthetics are MOST EFFECTIVE in tissues above a pH

7 (alkaline). Local anesthetics are alkaloid bases combined with acids to form water-soluble salts. A pH > 7 causes hydrolysis of the anesthetic salts. The potential action of all local anesthetics depends on the anesthetic salt's ability to liberate the free alkaloidal base (the non-ionic lipophilic molecule). The potency of local anesthetics increases with increasing lipid solubility.

A lateral cephalograph usually shows magnification with up to

7-8% magnification which is considered acceptable. The resulting double shadows are traced, and the average is used for measurements.

There is no set rule as to when a malocclusion should be treated. The age of treatment depends on the problem. Malocclusions are more identifiable in children ages

7-9 because the eruption of permanent incisors reveals tooth-arch length discrepancies.

Normal serum concentration of glucose is

70-120mg/dl.

Professional Applied Topical Fluorides (applied 2x/year):

8% Stannous Fluoride, 1.23% Acidulated Fluorophosphates (APF gel), & 2% Sodium Fluoride.

MANDIBUAR AND MAXILLARY ROOT ANATOMY Mandibular 2 Premolar:

97% have 1 canal at the apex. It has less variation than the mandibular 1 nd premolar. It usually has 1 root and 1 well-centered canal, with an oval access opening. The mental foramen lies in close proximity to the root apex, so avoid overinstrumentation and overfill, and do not misdiagnose the foramen as a premolar abscess on a radiograph. Thus, before performing root canal therapy, ensure that all diagnostic test st st confirm your finding. Pulpitis can cause referred pain to the MENTAL REGION OF THE MANDIBLE.

Cephalometric analysis of Class I malocclusions indicates an ANB angle

< 4° (indicates a harmonious skeletal profile and sagittal harmony between the maxillary and mandibular dental arches).

On a cephalometric analysis, all Class III malocclusions have an SNA angle

> 84° (maxillary prognathism).

SPACE MAINTENANCE:

A 9 year old patient had an extraction of the primary mandibular first molar. The ideal treatment at this time is PLACE A SPACE MAINTAINER. Although this can be done with either fixed or removable appliances, fixed appliances are preferred in most situations because they eliminate the factor of patient cooperation. If the space is unilateral, it can be managed by a unilateral fixed appliance ("band & loop" space maintainer). If molars on both sides have been lost, and the permanent incisors have erupted, it is usually better to place a lingual arch space maintainer.

A Cushing Syndrome patient: what must be checked prior to surgery

A Cushing Syndrome patient's cardiovascular status MUST be evaluated and treated if necessary prior to surgery.

A person on suppressive steroid doses will take as much as ? to regain full adrenal cortical function.

A person on suppressive steroid doses will take as much as 1 year to regain full adrenal cortical function.

Acute Apical/Alveolar Abscess (AA)-diagnosis

AA diagnosis is based on history, exam, and radiographs. An AA tooth will not respond to EPT or cold tests, but MAY respond to HEAT.

22. For a patient on anti-coagulants (Coumadin/Warfarin) or with Peptic Ulcer Disease, who has a headache and fever, the drug of choice is

ACETAMINOPHEN (TYLENOL), NOT IBUPROFEN or ASPIRIN.

Amphetamines (i.e. Dextroamphetamine) also treat

ADHD.

Universal sequelae of an allogeneic tooth transplant is

ANKYLOSIS & PROGRESSIVE ROOT RESORPTION. Allogeneic tooth transplant is when a tooth from one patient is placed into the socket of another patient.

When extracting maxillary teeth, the patient's maxilla is

AT THE SAME HEIGHT as the dentist's shoulders. Stand in front of and to the side of the patient for maximum visibility and leverage.

Achieving ? is the BEST and most reliable indicator of adequacy of root canal debridement.

Achieving GLASSY, SMOOTH CANAL WALLS is the BEST and most reliable indicator of adequacy of root canal debridement.

Anterior open bites are much more common in

African Americans than Caucasians.

Technique: root sensitivity treatment

After cleaning the hypersensitive areas, rub the paste into the exposed root surfaces with a porte-polisher and orangewood stick or rubber cup for 1-5 minutes. Satisfactory results are usually obtained. No caustic effects on the gingiva or mucosa result from contact with the paste. However, it is toxic if accidentally ingested.

Rejection of a graft is MOST common when

Allografts or Xenografts of bone and cartilage are used in oral surgery.

Anterior crossbite is ? after orthodontic correction by the overbite achieved during treatment.

Anterior crossbite is EASILY RETAINED after orthodontic correction by the overbite achieved during treatment.

3 Planes of Space To Classify Malocclusion:

Antero-posterior, Transverse, & Vertical.

Any teeth not contraindicated are ? candidates for successful endodontic therapy.

Any teeth not contraindicated are EXCELLENT candidates for successful endodontic therapy.

RECURRENT APHTHOUS ULCERS clinical presentation

Appear as painful white or yellow ulcers surrounded by a bright red area on non-keratinized oral mucosa and inner surface of the cheeks, lips, st tongue, soft palate, and base of gingiva.

Hemangiomas clinical presentation

Asymptomatic, soft, bluish lesion on the tongue, present for 5 years and has had a minimal increase in size.

MOST COMMON SITE of a SUPERNUMERARY TOOTH IS

BETWEEN MAXILLARY CENTRAL INCISORS.

Sealants are generally comprised of

BIS-GMA RESINS (bisphenol A diglycidyl ether methacrylate) that does not hydrolyze into BPA. The ADA currently states patients are NOT at risk from BPA exposure through dental sealants since BPA exposure is too low and infrequent (sinece the longest duration of salivary BPA was 3 hours).

35. Pit and fissure SEALANTS are generally comprised of

BIS-GMA RESIN.

Palatal coverage of a removable plate like a Hawley retainer makes it possible to incorporate a

BITE PLANE lingual to the maxillary incisors to CONTROL BITE DEPTH. This design is important for any patient who once had an EXCESSIVE OVERBITE. Palatal coverage with acrylic is the major source of anchorage in the Hawley appliance.

Dead space in a wound usually fills with

BLOOD which creates a hematoma with a high infection potential. Dead space in a wound is any area that remains DEVOID OF TISSUE after closing the wound. Dead space is created by removing tissues in the depths of a wound or by not re-approximating tissue planes during closure.

Ectopic eruption of a permanent maxillary first molar is often treated by a

BRASS WIRE separating device placed between the primary second molar & permanent first molar to cause the permanent first molar to tip distally.

An injection into the parotid gland (capsule) when attempting to administer an IA nerve block may cause

Bell's Palsy facial expression (paralysis of the forehead muscles, eyelid, and upper and lower lips on the same side of the face that the injection was given.

Other Rubber Dam Advantages: PEDS

Better access and visualization. Controls saliva and moisture in the operating field. Decreased operating time. Provides protection from aspiration or swallowing of foreign bodies. Child becomes primarily a nasal breather when the dam is in place, enhancing the effects of nitrous oxide if applicable.

Occupational Safety & Health Administration (OSHA)-a federal agency created by Congress in 1970 to protect WORKERS from hazards in the work place. OSHA is concerned with regulated WASTE within the dental office. According to OSHA, "regulated waste" includes:

Blood or other potentially infectious materials (including saliva) in dental procedures. Items that would release blood and other potentially infectious materials (including saliva), if compressed. Items caked with dried blood or other potentially infectious materials capable of releasing these materials during handling. Contaminated sharps Pathological and microbiological waste containing blood or other potentially infectious materials (including saliva).

Hiccoughs is the most common side effect due to rapid injection of

Brevital.

6. Inflammation and fissuring at the corners of the mouth (labial commissures) caused by

CANDIDA ALBICANS, RIBOFLAVIN (B2) DEFICIENCY, or ILL-FITTING DENTURE (DECREASED VERTICAL DIMENSION) is called ANGULAR CHEILITIS (PERLECHE).

*Hyperventilation in an anxious dental patient leads to

CARPODEDAL SPASM (spasm of hand, thumbs, foot, or toes).

• When only 1 canal is present in a maxillary 1 or 2 premolar, it is usually in the

CENTER of the access preparation. If only 1 canal is found, but is not in the center of the tooth, it is probable than another canal is present. Overfilling either premolar may force gutta-percha material directly into the MAXILLARY SINUS. nd st

12. The MOST COMMON head and neck malformation in humans is

CLEFT LIP & PALATE.

34. ENVIRONMENTAL PROTECTION AGENCY (EPA) monitors fluoride concentration in

COMMUNITY DRINKING WATER, while the FDA establishes fluoride limits in BOTTLED WATER.

A major site of growth of the mandible is the

CONDYLE. Mandible growth occurs by cartilage proliferation at the condyles, and by apposition & resorption of bone at the mandible surfaces. Resorption occurs along the anterior surface of the ramus (creates space for mandibular molars), while bone apposition occurs along the posterior surface of the ramus. However, the mandible's MAIN GROWTH SITE is in the CONDYLAR CARTILAGE. The "V principal" of growth is best illustrated by growth of the mandibular ramus.

OSHA regulates

CONTAMINATED SHARPS. Contaminated sharps are any contaminated object that can penetrate the skin, including, but not limited to needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires. There may be other objects used in the dental office that are sharps, and if they become contaminated with blood or other potentially infectious materials (including saliva), then they must be regulated.

29. Experimental treatment is withheld from

CONTROL GROUPS that receive the PLACEBO.

A 7 year-old child with good occlusion has a LINGUALLY LOCKED maxillary permanent central incisor. There is sufficient room for the tooth. To treat this condition properly, the dentist should

CORRECT THE CONDITION IMMEDIATELY WITH A SIMPLE APPLIANCE. Ideally, this anterior crossbite should have been corrected BEFORE it reached the occlusal plane (while it was erupting). The most probable etiologic factor for this happening is PROLONGED RETENTION OF PRIMARY MAXILLARY INCISORS.

THE MOST COMMON ACTIVE TOOTH MOVEMENT in the primary dentition is to

CORRECT A POSTEIROR CROSSBITE (a transverse plane of space problem).

THE CLOSER THE CORRELATION CO-EFFICIENT IS TO +1 OR -1, THE STRONGER (MORE PERFECT) THE

CORRLEATION.

Criteria that must be met BEFORE a canal is obturated with gutta-percha:

Canal must be prepared in a manner that ensures optimum canal debridement and access to the apical area so the filling material can be condensed to obliterate the entire preparation. • Tooth must be asymptomatic, and canal must be dry at the time of fill. • If a bacteriologic culture test is being used, a negative culture must be obtained.

Children with leukemia are very susceptible to

Candida fungal infections, thus, NYSTATIN rinses or popsicles are effective treatments.

Cystic fibrosis is usually recognized in infancy or early childhood, occurring mainly in

Caucasians.

Deep bites are much more common in

Caucasians.

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)- cause and most common in

Cause is unknown, and is 10x more common in males than females.

There is also an interaction between face height & antero-posterior position of the mandible. All other factors being equal, a long face predisposes the patient to

Class II malocclusion, while a short face predisposes the patient to a Class III malocclusion.

Fractured maxillary anterior teeth occur most often in children with

Class II, Division I malocclusion (flared maxillary anteriors).

Coronoid process is or is not a weak point in the mandible where fractures are common?

Coronoid process is NOT a weak point in the mandible where fractures are common.

Drugs that when administered 1 hour prior to the dental appointment are safe and effective ways to reduce fears of an apprehensive ADULT dental patient and avoid a psychogenic reaction in the dental chair include:

Diazepam (Valium): 5-10mg orally (PO). * Promethazine (Phenergan): 25mg orally (PO). * Pentobarbital (Nembutal) or Secobarbital (Seconal): 50-100mg orally (PO). * These drugs are NOT recommended unless the dentist has experience with them and can handle any complications from their use. For a dentist to use "enteral sedation" (use of a pharmacological method that produces a minimally-depressed level of consciousness), some states require special training and registration with the state.

Anti-Coagulants (Blood Thinners):

Dicumarol, Heparin, Antithrombin III, Enoxaparin, & Warfarin.

Due to distortion, there may be difficulty in making speech sounds ? in a Skeletal Class III.

Due to distortion, there may be difficulty in making speech sounds "F" & "V" in a Skeletal Class III.

INFERIOR ALVEOLAR NERVE BLOCK COMPLICATIONS

During an inferior alveolar nerve block injection, the needle passes through the mucous membrane & buccinator muscle, and lies lateral to the MEDIAL PTERYGOID MUSCLE. If the needle accidentally passes posterior at the level of the mandibular foramen, it penetrates the parotid gland causing the patient's cheek to feel numb (patient may develop paralysis of muscles of facial expression CN VII).

Center for Disease Control suggests a new mask for

EACH PATIENT. Masks should have at least 9599% filtering efficiency for small particle aerosols 13μm.

9. NITROUS OXIDE (N2O) works by

ELEVATING THE PAIN THRESHOLD.

14. High basal metabolism associated with HYPERTHYROIDISM is due to

EXCESSIVE THYROXIN (T4) PRODUCTION.

For an orthodontic appliance to be effective in TRANSLATING TOOTH ROOTS it MUST be capable of

EXERTING A TORQUE.

8. A BENIGN radiopaque BONY OVERGROWTH or protuberance of pre-existing bone found at the MIDLINE of the HARD PALATE and/or mandibular lingual surfaces is an

EXOSTOSIS (TORI = OSTEOMA).

Ectopic eruption occurs in ?% of the population and spontaneously corrects itself in ~?% of cases.

Ectopic eruption occurs in 2-6% of the population and spontaneously corrects itself in ~60% of cases.

Motor innervation to the tongue comes from the

Hypoglossal nerve (CN XII).

Permanent dental formula:

I 2/2 + C 1/1 + B 2/2 + M 3/3 = 16 x 2 =32 (8 per quad = 16/ arch = 32)

An emergency cricothyrotomy may be required to bypass the laryngeal obstruction if

If a patient loses consciousness and is unable to breathe

In local anesthesia, what is a manifestation of the toxic effects of the solution.

In local anesthesia, depression of respiration is a manifestation of the toxic effects of the solution.

In preparing the edentulous mandible for dentures, each may be safely excised by the OMS except

In preparing the edentulous mandible for dentures, each may be safely excised by the OMS (labial and lingual frenums, mylohyoid ridge, and exostosis). Genial tubercles are never excised, because it they were removed, the tongue would be flaccid.

3. The only condition contraindicated with WATER FLUORIDATION is a patient with

KIDNEY FAILURE on RENAL DIALYSIS since it requires the use of mineral-free water.

18. Small, irregular red dots with bluish-white centers on the BUCCAL MUCOSA and SOFT PALATE in a patient diagnosed with the RNA MEASELS (RUBEOLA) VIRUS are called

KOPLIK SPOTS.

Mandible undergoes more growth in the

LATE TEENS than the maxilla.

3. The MOST common site for oral cancer is the

LATERAL BORDER OF THE TONGUE.

Bone deposition in the MAXILLARY TUBEROSITY REGION is responsible for

LENGTHENING OF THE MAXILLARY ARCH. The maxillary arch elongates, moves posterior, and increases in height. Bone deposition in the tuberosity region is responsible for the lengthening (elongation) of the maxillary arch. The posterior movement is due to resorption of the labio-alveolar surface, and apposition of the lingual surface. Alveolar growth is responsible for an increase in the height of maxillary bones.

The earliest symptoms of conscious sedation is

LIGHT HEADEDNESS. Laughing or crying, paresthesia of arms, legs, and oral cavity, and feeling of floating are seen in the second stage.

In both maxillary and mandibular arches, the permanent incisor tooth buds lie

LINGUAL & APICAL (inferior) to the primary incisors. This results in a tendency for mandibular permanent incisors to erupt somewhat lingually, and in a slightly irregular position (this occurs in children who have normal dental arches and normal spacing within the arches). Permanent teeth normally move OCCLUSALLY & BUCCALLY while erupting.

6-15 months is the interval between extractions. To aid in support and retention during serial extraction treatment, a

LINGUAL ARCH is used in the mandible and HAWLEY APPLIANCE in the maxilla. This is usually followed by full orthodontic treatment. THE KEY TO SUCCESS IS TO EXTRACT THE 1 PREMOLARS BEFORE THE PERMANENT CANINES ERUPT. st

Most COMMON ERROR in recording BP is applying the blood pressure cuff TOO

LOOSELY. This gives falsely elevated readings. Using the wrong cuff size can result in erroneous readings.

The incidence of malocclusion in a HOMOGENOUS population is generally

LOWER than in a HETEROGENOUS population (where the incidence is higher). Dental arch form is ultimately determined by the interaction of environmental influences on the genetic pattern.

Is lidocaine safe for pregnancy and lactation

Lidocaine is SAFE during pregnancy and lactation.

Local anesthetics depress small, non-myelinated nerve fibers ?, and depress large, myelinated nerve fibers ?.

Local anesthetics depress small, non-myelinated nerve fibers FIRST, and depress large, myelinated nerve fibers LAST.

Which sealants wet acid-etched tooth surfaces the best.

Low viscosity sealants wet acid-etched tooth surfaces the best.

38. The first-line oral hypoglycemic of choice to treat DIABETES MELLITUS TYPE 2 (Non-Insulin Dependent) when exercise and diet have failed is

METFORMIN (GLUCOPHAGE).

Most of the time, anterior open bite is ? with normal posterior occlusion.

Most of the time, anterior open bite is ASYMMETRICAL with normal posterior occlusion.

Best use for Gly-Oxide is in

NARROW and/or CURVED canals, utilizing glycerol's slippery effect.

While internal resorption can occur ONLY when some pulp tissue is still vital, a

NEGATIVE sensibility test does NOT rule out this etiology.

Discolored primary teeth that are asymptomatic and show no radiographic changes should

NOT BE TREATED. They should be examined periodically by taking a radiograph. Primary teeth often darken (become gray) after injury due to pulp bleeding and diffusion of biliverdin into the dentinal tubules.

A tooth prepared for RCT that responds to thermal tests, indicates inadequate debridement (cleaning), since a pulpless tooth should

NOT respond to any stimuli. Thus, all nerve must be removed before the canal is obturated.

Pulpotomy procedures performed on fully developed permanent teeth are

NOT successful. Thus, it is only a temporary procedure for fully developed permanent teeth.

most common SIDE EFFECT of nitrous oxide analgesia.

Nausea is the most common SIDE EFFECT of nitrous oxide analgesia.

While erupting, the permanent teeth move

OCCLUSALLY & BUCALLY. Also, during active tooth eruption, there is apposition of bone on all surfaces of the alveolar crest and on the bony socket walls.

2. Fluoride converts hydroxyapatite→fluorapatite by substituting

OH - for Fl - . F decreases the solubility of hydroxyapatite crystal, while increasing the crystal size. Fluoride ion is easily exchanged with the hydroxyl ion in the lattice structure of enamel because Fl - is slightly smaller than OH with a greater affinity for hydroxyapatite crystals than OH - - -

7. A MALIGNANT tumor of BONE-FORMING tissue is an

OSTEOSARCOMA.

3. Odontoblastic layer-

OUTERMOST pulp layer that contains odontoblasts, and lies next to predentin & mature dentin.

Shy, submissive children are often the product of parents who are

OVERPROTECTIVE.

The most effective agent in initial treatment of respiratory depression due to overdose of barbiturates is

OXYGEN under positive pressure.

HERPANGINA- Treatment:

PALLIATIVE.

24. Operculum inflammation around a partially impacted MANDIBULAR 3 MOLAR crown due to plaque accumulation and resulting in pain, erythema, edema, and foul taste is

PERICORNITIS.

Antigens most responsible for an immediate Type I allergic reaction to natural rubber latex are

PROTEINS. Only a few of the 250 proteins are found in sap of the rubber tree.

7. A rare, but dangerous adverse effect of taking CLINDAMYCIN is

PSEUDOMEMBRANOUS COLITIS (overgrowth of Clostridium difficile that produces a toxin causing colitis).

VENOUS RETURN of both dental arches is the

PTERYGOID PLEXUS of veins.

5. Stages of PERIAPICAL CEMENTAL DYSPLASIA when viewed radiographically in a middle-aged African American female are:

RADIOLUCENT (Stage 1), MIXED (Stage 2), & RADIOPAQUE (Stage 3).

Allergic reactions to amides are

RARE, but if they occur are usually caused by the PRESERVATIVE in the anesthetic solution. There is typically NO cross allergenicity, although Lidocaine and Mepivacaine may show cross-allergy.

Treatment: irreversible pulpitis

RCT (complete pulp debridement).

In these cases, the value of precise pocket probing and correct appraisal of pulp vitality is crucial. In some doubtful cases, it is best to wait until after

RCT is complete to see if spontaneous resolution (pocket closure and osseous fill-in) will occur before surgical periodontal procedures are begun.

If a permanent tooth fractures, but has a fully formed root and the pulp is exposed (large exposure), complete, whats the treatment of choice

RCT is the treatment of choice. Apexification is NOT needed because the root is fully formed. If the pulp exposure is small and the length of time is short (30min-1hr), then direct pulp capping with CaOH followed by a restoration is the treatment of choice.

Carious exposures in permanent teeth pulp usually require

RCT. Immature (open apex) permanent teeth with carious exposures can be treated with pulp capping or a pulpotomy.

Cleaning surfaces PRIOR to disinfection in clinical settings is required to

REDUCE the concentration of pathogens. The simplest way to approach environmental surface disinfection is to adhere to the aseptic technique of CLEANING IT FIRST. All disinfectant products include specific label instructions for cleaning PRIOR TO DISINFECTION. Cleaning physically removes debris, reduces the number of microorganisms present, and removes blood, tissue bioburden, and other debris that can interfere with disinfection.

One of the most important aspects of orthodontic therapy is

RETENTION. After malposed teeth have been moved into the desired position they must be mechanically supported until the hard & soft tissues have been thoroughly modified in structure and function to meet the new position's demands. Once the desired occlusal results are achieved, and the hard tissues are in normal function, the next step is to maintain or modify the soft tissues in the retention phase. Important: most clinicians believe the collagen fibers in the supra-alveolar tissue are primarily responsible for relapse of orthodontically rotated teeth and for redevelopment of spaces between orthodontically moved teeth.

N 2 O has its main effects on the

RETICULAR ACTIVATING and LIMBIC SYSTEMS.

Radiographs do NOT disclose ?.

Radiographs do NOT disclose periapical pathology.

According to buccal object rule, when the x-ray tube is repositioned either at a more mesial or more distal angulation and a film is exposed, the root/canal farther from the film (the buccal) moves in the

SAME direction that the cone is directed. Thus, when the cone is aimed to the distal (angled from the mesial direction), the buccal root/canal moves to the distal and appears distal to the lingual/palatal root/canal.

Hemophilia A & B are inherited as a

SEX-LINKED RECESSIVE trait where males are affected and females are carriers. Most people afflicted with hemophilia have type A, and it presents under age 25yrs. Signs, symptoms, and clinical manifestations are excessive bleeding from minor cuts, epitaxis, hematomas, and hemarthroses.

A FLAT mandibular plane angle correlates with

SHORT anterior facial vertical dimensions (height) & anterior deep bite malocclusion. A short face predisposes the patient to a Class III malocclusion.

Whether a bone cyst or other cysts are completely enucleated or treated by marsupialization depends on the

SIZE & LOCATION to vital structures.

Fluoride rinses are most beneficial to

SMOOTH tooth surfaces and there are some benefits to pits & fissures..

Parotid gland is drained by

STENSON'S DUCT which pierces the buccinator muscle and crosses the masseter muscle where it opens into the vestibule of the mouth opposite the maxillary 2 molar.

DO NOT DISINFECT WHAT CAN BE

STERILIZED.

UNIVERSAL sign of laryngeal obstruction is

STRIDOR (crowing sounds). Stridor is a high-pitched, noisy respiration, like blowing of the wind. It is a sign of respiratory obstruction, especially in the trachea or larynx.

Important: nerve endings of CN VII, IX, & X are widely distributed in which nerve

SUBNUCLEUS CAUDALIS of trigeminal nerve (CN V). A profuse, intermingling of these nerve fibers creates potential of referred dental pain to many sites.

The most common emergency seen after using local anesthetics is

SYNCOPE (fainting). Syncope often occurs when upright, but can also occur while sitting. Syncope never occurs when lying down. The patient may complain of feeling generalized warmth with nausea and palpitations.

After receiving injecting a local anesthetic containing 2% lidocaine with 1:100,000 EPI, the patient loses consciousness. The most probable cause is

SYNCOPE, caused by transient cerebral hypoxia.

Sealants need what kind of retention

Sealants need micro-mechanical retention. The surfaces should be cleaned with a prophylaxis brush or rubber cup and pumice with water. When the teeth are effectively isolated from saliva contamination, the surfaces are dried and acid etched by applying 3050% phosphoric acid solution for 1 minute. The solution should be gently agitated during application and is then washed away and dried to leave a frostyappearing etched surface.

SEDATIVE HYPNOTICS-their principal effect is sedation and sleepiness. 2. Short-Acting Barbiturates:

Secobarbital (Seconal) & Pentobarbital (Nembutal) are sedative drugs sometimes used for pediatric conscious sedation by oral administration, but are of very limited value. They are non-analgesic and may cause hyper-excitability rather than sedation in some children.

Sensitivity & Specificity are ? proportional. As the specificity of a test increases, the sensitivity ?.

Sensitivity & Specificity are INVERSELY proportional. As the specificity of a test increases, the sensitivity decreases.

Child Control Techniques: ► Angry Child:

Separate the parent and child, and place the child in the chair abruptly and be firm. Use "hand-over-mouth" technique (HOME) after getting the parent's permission! Display authority and command the child's respect by continuing with treatment even if he/she is uncooperative. Comfort the parent at the end of the visit, and compliment the child at the end of the visit.

What should be avoided to prevent dry socket

Smoking, spitting, or drinking through a straw creates negative pressure in the oral cavity, thus encouraging this condition. *Careful technique and minimal trauma reduce the chance of dry socket.

Curing sealant materials occurs one of two ways.

Some sealants are chemically cured via "autopolymerization". These materials are dispensed as two components. As soon as the components are mixed, polymerization begins. Curing is complete in ~60 seconds. Other sealant material is cured with visible light, but the curing light must be of high quality and should be tested frequently for the value of light emitted. Retention rates for chemically cured and light cured sealants are similar.

reversible and irreversible pulpitis: what to do when you cant decide which diagnosis?

Sometimes it is hard to distinguish between reversible and irreversible pulpitis, in which case caries control (placing a temporary filling) is a conservative approach toward making the final diagnosis. If a tooth responds well to the temporary filling, the there is no need for RCT at this time.

The following are included in procedures to evaluate an exposure incident:

State the policies that were in place at the office at the time of the incident. State the engineering controls (i.e. needle recapping device, sharps container, rubber dam) and work practices that were in place at the office at the time of the incident. • State the personal protective equipment (gloves, lab coats, etc.) that were in use at the office at the time of the incident.

Maxillary 2 nd st Premolar: Usually (85%) have 1 root, while (15%) 2 separate roots exist (each with 1 canal). The access opening is also a

THIN OVAL (exactly like maxillary 1 premolars).

TOOTH TRAUMA

The alternate loosening and tightening of a deciduous tooth before it is shed due to the alternate resorption and apposition of cementum and bone. If during a routine exam, you notice a permanent tooth trying to erupt while the primary tooth remains firmly in place, the best treatment is to extract the primary tooth and allow the permanent tooth to erupt

Straight wire bracket and a bracket with a .0222 x .028 rectangular slot.

The bracket slot size of .022 inch allows a wide range of wire sizes to be used. The alternate slot size is .018 inch, which can also upright the molar, but limits the wires sizes available. The tipped 2 molar should be banded because the considerable posterior masticatory forces produced can easily nd shear off bonded brackets.

The lingual surface is always ? to the cone, while the buccal surface is always ? away from the cone. To apply SLOB rule, you MUST have a ?

The lingual surface is always CLOSEST to the cone, while the buccal surface is always FARTHER away from the cone. To apply SLOB rule, you MUST have a reference object.

The maxillary arch is slightly longer (~?mm) than the mandibular arch (~?mm).

The maxillary arch is slightly longer (~128mm) than the mandibular arch (~126mm).

Acute Apical/Alveolar Abscess (AA)-symptoms

The tooth becomes more painful, elongated, and loose. At times, the pain may decrease or completely disappear. The patient may appear weak, irritable, and have a fever.

Management of a child who must undergo dental extractions is based on these factors: • Child's age & maturity.

This often determines the type of anesthesia best suited for the intended procedure. Children below the age of reason are best managed under general anesthesia, since a slight amount of discomfort is always associated with the administration of a local anesthetic. It is very important to have total anesthesia before starting the procedure. Use both buccal & palatal infiltration on maxillary teeth, and block anesthesia on mandibular teeth with infiltration.

REVERSIBLE PULPITIS symptoms

Tooth is usually percussion negative, and with thermal tests, the pulp responds more readily to cold than to hot (the response leaves shortly after the irritant is removed).

Periapical Abscess- Tooth will or will not respond to EPT or cold tests, but may respond to ?.

Tooth will NOT respond to EPT or cold tests, but may respond to heat.

Topical Steroids are suggested to relieve aphthous ulcer symptoms:

Triamcinolone (Kenalog) in Orabase 0.1%, Disp: 5gm tube, Sig: coat the lesion with a thin film after each meal and at bedtime.

Most high-speed turbine drills used in routine restorative dentistry are

UNACCEPTABLE for oral surgery. Air exhausted from these drills goes into the wound and may be forced deeper into tissue planes and produces tissue emphysema, a potentially dangerous situation.

Root fractures of primary teeth are relatively

UNCOMMON because the more pliable alveolar bone allows primary tooth displacement. When a primary tooth root fractures, it is treated identical as for permanent tooth root fractures. However, the prognosis is LESS FAVORABLE. The pulp in a permanent tooth with a fractured root has a better chance to recover since the fracture allows immediate decompression and circulation is more likely to be maintained.

. Reverse-pull headgear:

UNLIKE ALL OTHER HEADGEAR BECAUSE IT HAS AN EXTRAORAL COMPONENT supported by the chin, cheeks, forehead, or combination of these structures. Indicated for Class III malocclusions (where protraction of the maxilla is desirable).

Mandibular growth involves a synchronous & selective deposition and resorption of bone from membrane surfaces and interstitial & appositional growth changes in the condyle. The MAIN GROWTH THRUST is in an

UPWARD & BACKWARD direction causing the body of the mandible to move DOWNWARD & FORWARD. In this process, bone is deposited along the posterior aspects of the ramus and in the condylar area.

TMJ SENSORY innervation is from

V3 (mandibular branch of trigeminal) and bloods supply is from the EXTERNAL CAROTID ARTERY (superficial temporal branch). TMJ development occurs at 12 weeks in utero when the joint spaces and articular disc develop.

OVERBITE-

VERTICAL overlapping of maxillary anterior teeth over the mandibular anterior teeth.

If a patient develops a Type I, immediate allergic reaction to latex during dental treatment, the next time you treat them wear

VINYL or NITRILE gloves.

The success of a pulpotomy for a primary molar depends primarily upon a

VITAL ROOT PULP.

Vasoconstrictors act at which receptors

Vasoconstrictors act at ALPHA RECEPTORS to produce constriction of arterioles. Cocaine acts as an intrinsic vasoconstrictor that increases the PRESSOR ACTIVITY of both EPI & NE.

Vasoconstrictors do or do not reduce the chance of developing an allergic reaction to the local anesthetic.

Vasoconstrictors do NOT reduce the chance of developing an allergic reaction to the local anesthetic.

Wearing gloves, protective eyewear, and a facemask is recommended

WHEN TREATING ALL PATIENTS. Masks and protective eyewear are required when splashes, spray, splatter or droplets of blood or other potentially infectious materials (including saliva), may be generated and eyes, nose, or mouth contamination can be reasonably anticipated. A face shield may be substituted for masks and eyewear if you prefer.

4. The most likely cause of an OPPORTUNISTIC infection presenting as a

WHITE CREAMY LESION on the BUCCAL MUCOSA or TONGUE that WIPES OFF is CANDIDA.

27. The greater the RANGE (STANDARD DEVIATION) the

WIDER the distribution curve.

ANUG usually affects

YOUNG ADULTS ages 15-35 years old. It is rare in preschool children, and is easily diagnosed due to involvement of interproximal papillae and presence of a pseudomembranous necrotic covering of the marginal tissues.

The highest incidence of fractures occurs in

YOUNG MALES ages 15-24 usually from trauma (i.e. car accidents).

First Order Bend-

a bend of an orthodontic wire in the HORIZONTAL PLANE.

DOWN SYNDROME (TRISOMY 21)-

a genetic disorder caused by a chromosomal abnormality (TRISOMY 21) that occurs during the PREIMPLANTATION PERIOD of prenatal development. Marked by various degrees mental impairment, physical growth delays (short, flattened skull, slanting eyes (ophthalmic disorders), thickened tongue/fissured, broad hands/feet), potential heart defects, weakened immune system (increased infection susceptibility), risk of leukemia, early Alzheimer's disease and hearing loss. Trisomy 21 is the most common chromosomal abnormality in humans, and its incidence increases with maternal age (greater risk after 35 years age).

Direct pulp capping should NOT be attempted on teeth with

a history of pain, sensitivity to percussion, or periapical radiolucencies. Instead, RCT may be indicated.

Greenstick Fracture-

a mandibular fracture that extends only through the cortical portion of bone without complete fracture of the bone. It is a closed fracture involving incomplete fractures with flexible bone, most common in children.

Segmental Osteotomy-

a maxillary procedure where the maxilla is sectioned into two or more pieces. Bone may or may not be removed.

After an inferior alveolar nerve block or mental nerve block, a prickly or tingling sensation (paresthesia), or complete numbness in the lower lip may result and persist for a considerable time due to direct trauma or piercing of the nerve trunk by the needle. This happens more often in

a mental nerve block injection. The paresthesia symptoms gradually diminish (may last from two weeks to 6 months), but there is usually a complete recovery.

Methylphenidate (Ritalin)-

a mild CNS stimulant often used in ADHD children (children over age 6). Among the more serious adverse reactions are nervousness, insomnia, and anorexia.

NEUROFIBROMA-

a moderately firm, encapsulated tumor caused by the proliferation of Schwann cells. Found on the tongue, buccal mucosa, vestibule, & palate. Neurofibromas appear as solitary or multiple sub-mucosal enlargements, and may become malignant (5-15%). Multiple lesions are associated with Neurofibromatosis (Von Recklinghausen's Disease).

Example of a Special Case:

a previously traumatized tooth may show complete obliteration of the pulp chamber & canal, but the PDL may appear normal. The patient will be asymptomatic and the tooth will not respond to pulp vitality testing. Treatment of choice: observe as long as the tooth remains asymptomatic & no periapical changes are evident.

Bone Healing (3 Phases): 2. Callus Formation:

a primary callus is formed in the next 10-20 days. A secondary callus forms in 20-60 days.

Leukemia-

a progressive, malignant disease of the blood-forming organs.

6. SIMPLIFIED ORAL HYGIENE INDEX-

a reversible index used to measure oral hygiene status by estimating the tooth surface covered with plaque and/or calculus.

4. GINIGIVAL INDEX (GI)-

a reversible index used to assess the severity of gingivitis based on color, consistency, and BOP.

Crown Fracture Classification: 1. Ellis Class I Fracture-

a simple crown fracture involving little or no dentin. Treat with enameloplasty and/or bonding.

The integrity of the maxillary sinus floor is at greater risk with surgery involving removing

a single remaining maxillary molar due to possible ankylosis.

The main advantage of topically applying an 8% solution of stannous fluoride instead of a 2% solution of NaF, is

a single treatment may be given.

Cross-elastics from the maxillary lingual to mandibular labial can be used to correct

a single- tooth crossbite. A maxillary removable appliance can also be used. When elastics are used to move teeth they should be ATTACHED DIRECTLY TO THE APPLIANCE COMPONENTS.

Behavior Modification (Behavior Therapy)-

a type of psychotherapy that attempts to modify observable, maladjusted behavior patterns by substituting a new response or set of responses to a given stimulus. Psychologists have developed many techniques to modify patient behavior by using the principles of learning theory. Examples of techniques/methods used mainly in pediatric dentistry:

Sanitization-

a type of antimicrobial treatment (i.e. used for drinking water) to lower the total microbial load to safe public health levels. Used to treat water supplies to reduce microbial levels to safe public health levels.

Specificity-

ability of the test to classify health. Specificity is defined by the number of true negative (TN) results divided by the total number of false positive (FP) + true negative (TN) results in a sample. Specificity = TN/FP + TN.

People taking an equivalence of 100mg Cortisol per day (20-30mg of Prednisone/day) will have

abnormal cortical function in a week.

Hypodontia-

absence of only a few teeth.

Unless the cause is removed, pericoronitis may present as a recurrent condition requiring multiple treatments. In severe episodes, an

acute pericoronal abscess may develop which may remain localized or spread to involve one or more of the adjacent deep surgical spaces, and may be associated with systemic and local signs and symptoms.

Patients who take insulin daily and check their urine regularly for sugar & ketones (controlled diabetics), can usually be treated in the normal manner without

additional drugs or diet alterations. If any doubt exists as to the patient's medical status, consult with their physician and do not assume anything!

Care is taken not to mix the sealant resin too vigorously prior to placement or to over-manipulate the sealant resin upon placement. Either of these errors can incorporate

air into the sealant resin, causing a void in the sealant surface. As long as the sealant remains in tact, decay will not develop under it.

Alcohol Disadvantages:

alcohol evaporates too quickly and has diminished activity against viruses in dried blood, saliva, and other secretions on surfaces due to the presence of tissue proteins and glycoproteins that render alcohol ineffective. Thus, alcohols are not effective surface cleansing agents (i.e. cleaning a dental operatory after treatment).

Water-based disinfectants are better than

alcoholbased disinfectants.

Advantages of using alcohols (70% isopropyl & 70% ethyl alcohol) as surface disinfectants:

alcohols are bactericidal, tuberculocidal, and are economical. Alcohols are NOT sporicidal.

If the diastema is caused by an abnormal frenum, it is best to

align the teeth orthodontically and then do a frenectomy (this is usually not done until the permanent canines erupt).

Review child's existing

allergies and medications (to include OTC vitamins and herbal supplements).

When removing a mandibular exostosis (mandibular torus), what flap should be used

an envelope flap design (has no vertical components) should be used.

Hertwig's Epithelial Root Sheath (HERS)-

an epithelial diaphragm formed/derived from the joining of the inner + outer enamel epithelium of the enamel organ. After crown formation, the root sheath grows down and shapes the tooth root and induces root dentin formation. Uniform growth of HERS results in formation of a single-rooted tooth, while medial outgrowths or evaginations of the sheath produce multi-rooted teeth.

Physiologic tooth movement-

an example is mesial drifting of a permanent molar into a space created by the premature loss of a primary molar. Important: permanent molars have a natural tendency to drift MESIALLY.

SCARLET FEVER-

an exotoxin-mediated disease arising from group A-beta-hemolytic streptococcal infection that peaks in children 4-8 years old. Symptoms include strep throat, sudden onset of fever, sore throat, headache, nausea, vomiting, abdominal pain, muscle pain, fatigue, and STRAWBERRY TONGUE.

Treatment of choice for hypoglycemia in a CONSCIOUS diabetic is administration of

an oral carbohydrate (orange juice, cola beverages, candy bars)

ELEMENTS OF GENERAL ANESTHESIA:

analgesia, relaxation, hyporeflexia, and narcosis (not hyperpyrexia = elevated body temperature).

INDICATIONS for ROOT CANAL THERAPY (RCT): 4. Chronic Periapical Granuloma-

asymptomatic, associated with a non-vital tooth, and the MOST common sequelae of pulpitis. Endodontic treatment is necessary.

Collagen fibers are the main components of

attached gingiva. When teeth are orthodontically moved, collagen fibers stretch like rubber bands to adjust to the new position. However, like rubber bands, the fibers have a strong tendency to return to their former position (pulling the teeth with them as they go).

BEHAVIORAL SCIENCE Psychosocial Factors that strongly influence behavior:

attitudes, beliefs, values, family, society, culture, and education. Behavior is a determined, purposeful unit of activity.

Geudel's Stages of General Anesthesia: 3. Stage 3 (Surgical Anesthesia):

begins with establishing a regular pattern of breathing, total loss of consciousness, and is the period when signs of respiratory or cardiovascular failure first appear. Patient is unconscious with no pain reflexes. Respiration is very regular and BP is maintained. This stage has 4 planes. Spinal reflexes are depressed and skeletal muscle relaxation occurs.

When shaping behavior, the dentist assistant or dentist is teaching a child how to

behave. Young children are led through these procedures stepby-step.

FINGER SPRINGS-

best method for TIPPING maxillary & mandibular ANTERIOR TEETH. Finger springs are attached to a removable appliance. The most common problems associated with these simple removable appliances are lack of patient cooperation, poor design leading to a lack of retention, and improper activation. An undesirable common side effect of a finger spring is the tendency for the root apex to move in the direction opposite from the crown.

Submarginal Triangular & Rectangular Flap Advantages:

better access & visibility than a semilunar flap, but NOT better than a full mucoperiosteal flap.

When a patient (young or old) is in active orthodontic treatment, and the gingiva is inflamed, the dentist should encourage

better oral hygiene. It may be useful to recommend using water irrigation devices to help flush food debris away from the orthodontic brackets.

REMOVABLE orthodontic appliances-are generally restricted to TIPPING teeth. 2. Passive Removable Appliances:

bite planes, occlusal splints, and retainers.

When operative or surgical procedures are performed on the mandibular primary or permanent teeth, the INFERIOR ALVEOLAR NERVE must be

blocked by administering the conventional mandibular block. The supraperiosteal injection technique (local infiltration) is sometimes helpful in anesthetizing mandibular primary incisors, but cannot be relied on for complete anesthesia of mandibular primary or permanent molars.

3 common signs that indicate the correct level of sedation has been reached with Valium are

blurring of vision, slurring of speech, and 50% ptosis of the eyelids (Verrill's sign).

Pus is produced in bone, which may cause a

bone abscess that deprives the bone of its blood supply.

The mandibular plane angle is visualized clinically by placing a mirror handle or other instrument along the

border of the mandible.

The importance of canal obturation (filling) is SECOND only to

canal debridement. ~40% failures are caused by incomplete obturation of the canal (most failures are due to incomplete debridement). If the canal is not filled, tissue fluid and microorganisms from periapical tissues can enter the voids, causing endodontic failure. However, if an accessory (lateral) canal is not totally filled during obturation, the appropriate treatment is to observe the tooth and evaluate every 3 months.

NiTi methods: The instrument's action, NOT type of instrument used, determines the

canal preparation's general shape:

4 Basic Headgears:

cervical-pull, straight-pull, highpull, & reverse-pull. These are selected based on the direction of force (pull) needed.

Oligodontia-

congenital absence of MANY, but not all teeth.

A patient who has permanent central incisors, permanent canines, and primary canines anterior to the premolars most likely has

congenitally missing permanent lateral incisors.

2. Cervical-pull headgear:

consists of a neck strap connected to a face-bow to produce a DISTAL & DOWNWARD force against the maxillary teeth & maxilla. Major disadvantage: possible extrusion of maxillary molars. Likely results include an open bite, and move first molars distally, and decrease forward growth of the maxilla. Indications: Class II, Division I malocclusions.

Maxillary fractures have a greater tendency to produce

facial deformities than mandibular fractures. Due to the slope of the sphenoid bone comprising the cranial vault floor, blows to the maxilla drive the maxilla backwards and downwards, resulting in a potential open bite or impingement of the airway.

Bell's Palsy-

facial paralysis (a functional disorder of the facial nerve) caused by nerve irritation or viral infection, thus is usually temporary.

3 Types of Inappropriate Healing: 2. Non-union:

failure of the fracture segments to unite properly. May be caused by infection, improper immobilization, or interposition of soft tissue.

If the genioglossus muscle is paralyzed, the tongue has a tendency to

fall back and obstruct the oropharyngeal airway with risk of suffocation.

By placing the fingertips in the patient's external auditory meatus, this technique can produce

false joint sounds during mandibular function because of pressure against the thin ear canal cartilage.

A normal adult BP cuff placed on an obese patient's arm produces

falsely elevated readings. This same cuff applied to a very thin arm of a child will produce falsely low readings.

Acute Lymphocytic/Lymphoblastic Leukemia (ALL)-Early signs in a child are

fatigue, pallor, weight loss, and easy bruising. This progresses to fever, hemorrhages, extreme weakness, bone/joint pain, and repeated infections.

Nitrous oxide is very appropriate for children who are

fearful and timid.

As blood pools in the periphery, ↓ BP and cerebral blood flow occurs, causing the patient to complain of

feeling dizzy or weak. Compensatory mechanisms attempt to maintain adequate BP, but they soon fatigue, causing vagally-mediated bradycardia. Once BP drops below levels necessary to sustain consciousness, syncope occurs.

Pulmonary volumes and capacity are 20-25% less in

females than males, and are greater in large and athletic people. N 2 O sedation varies accordingly.

Cells Found in Dental Pulp:

fibroblasts (the main cell), odontoblasts, histiocytes (macrophages), & lymphocytes.

Sealants can be

filled or unfilled sealants. Fillers (glass and quartz) provide hue, strength, and enhance wear resistance. Unfilled sealants typically do not require occlusal adjustment (ex: 3M Clinpro), while filled sealants (ex: VOCO Grandio) must be adjusted if hyper-occluded

Scopolamine, Atropine, and Benztropine decrease saliva flow and secretion from respiratory glands during

general anesthesia.

Treatment: dry socket

gently irrigate debris with saline solution and place a sedative dressing (eugenol) in the socket (eugenol is the active component in most sedative dressings). Gauze provides an attachment for the obtundent paste so it stays in the socket. Prescribe analgesics if needed.

GI, Papillary, Marginal, & Attached Gingiva Index (PMA Index) are confined to measurements within the

gingiva. PMA index is used to record the prevalence and severity of gingivitis in school children. The presence or absence of gingivitis is noted in the gingival papillae, gingival margin, and attached gingiva.

PRIMARY DENTITION Succedaneous teeth-

in each quadrant, 5 permanent teeth (incisor, canine, & premolars) succeed/replace the 5 primary teeth. Permanent molars do not replace primary teeth, thus are not succedaneous teeth.

The most reliable sign of "oxygen want" while monitoring a patient during general anesthesia is

increased pulse rate. Cyanosis may also be present.

Brevital is metabolized in the

liver and excreted by the kidney.

The most common type of leukemia in children is

lymphoblastic leukemia.

CEMENTUM-

main function of cementum is ATTACHMENT of the PDL principal fibers. Cementum also functions to compensate for loss of tooth surface due to occlusal wear by apical deposition of vital cementum throughout life. Cementum also protects the root surface from resorption during vertical eruption and tooth movement, and has a reparative function that allows reattachment of C.T. after periodontal treatment.

FRACTURE HEALING: • Periosteal Proliferation-

occurs within the C.T. covering all pones (periosteum).

FIXED Orthodontic Appliances-

offer controlled tooth movement in all 3 PLANES OF SPACE. 4 basic components of a fixed appliance are BANDS, BRACKETS, ARCHWIRES, & AUXILLARIES (elastics or ligatures to hold the archwire in the brackets). ALLOYS used for orthodontic archwires: stainless steel, chromium-cobalt, & titanium.

Interrupted Suture Pattern/Method-

offers strength and flexibility because each suture is independent to one another. This is advantageous because if one suture is lost or loosens, the integrity of the remaining sutures is not compromised. The major disadvantage of this pattern of suturing is the extra time required for placement.

APERT SYNDROME- Dental Considerations:

often associated with supernumerary teeth (disrupt eruption of other teeth), severe crowding, and Class III malocclusion.

2. Emphysema-

often coexists with chronic bronchitis. Labored breathing and increased susceptibility to infection.

It is not necessary to prescribe fluoride supplements to a child who is consuming

optimally fluoridated water.

Pulpal hyperemia is congestion of blood within the pulp chamber caused by

physical, chemical, or bacterial insult. After restoration placement, teeth often become hyperemic and sensitive to cold for a few days. The pain is not spontaneous, and does not last after the stimulus is removed. This short pain duration and low intensity is what distinguishes pulpal hyperemia from the pain of acute pulpitis ("irreversible pulpitis").

7. Attrition-

physiologic wearing away of enamel & dentin due to NORMAL function or excessive GRINDING/GRITTING/CLENCHING teeth together (BRUXISM-pathologic attrition due to teeth grinding). The most noticeable effects are POLISHED FACETS (flat incisal edges that usually develop on the linguoincisal of maxillary canines & central incisors, and facioincisal of mandibular canines). Discolored tooth surfaces, and exposed dentin. Age-related process not due to caries

Walking Bleach Technique:

place a thick paste consisting of sodium perborate and 2-3 drops of Superoxol in the tooth chamber with a temporary restoration. Several repetitions of this technique works well.

FRACTURES Radiographic views helpful to evaluate mandibular fractures:

posteroanterior view, lateral oblique view, Towne view, and panoramic view. Control of airway is vital to treating any patient with a facial fracture. The maxilla and mandible are in a critical relationship to the upper airway. Thus, displacement of fractures can cause airway obstruction and cause respiratory arrest.

Non-verbal behaviors:

posture, facial expression, eye-contact (most important), body position (physical proximity), and gesticulations. Eye Contact is the primary non-verbal cue that two or more people use to regulate verbal communication. Eyes are directed toward the patient and engage the patient's eyes as frequently as is comfortable for the speaker and listener.

Factors that may influence which teeth are candidates for sealants:

presence of interproximal decay, patient age, how caries prone the patient is.

Bimaxillary Dentoalveolar Protrusion-

present when the teeth protrude in both jaws. In this condition you will see severe dental and lip protrusion accompanied by severe lip strain which is needed to bring the lips into closure.

PULPOTOMY-

preserves radicular VITAL pulp tissue when the entire coronal pulp is amputated, and allows resorption & exfoliation of the primary tooth, but preserves its role as a natural space maintainer. The reason to perform a pulpotomy using either of the following two techniques is that the coronal pulp shows evidence of inflammation and degenerative change due to microorganisms located there.

Fundamental principles of public health are

prevention, cost-efficiency, and teamwork. Prevention is the major objective of public health programs because it entails ethics, teamwork, and cost-efficiency. It is more ethical to prevent disease than to cure it. Teamwork is necessary to handle large groups efficiently. Cost-efficiency plays a major role because prevention is cheaper than a cure.

DIRECT PULP CAPPING-

primarily used on permanent teeth (not widely used on primary teeth because of CaOH's alkaline pH). To perform a direct pulp cap on a primary tooth, the tooth MUST be asymptomatic and must be a small exposure with little or no hemorrhaging. CaOH can effect (irritate) the pulp mildly or most often severely:

INDIRECT PULP CAPPING:

primary goals are to preserve pulp vitality, prevent pulp exposure, save tooth structure, arrest caries, and promote reparative dentin formation.

Periodontal therapy is initiated first ONLY in the case of a

primary periodontal lesion, with subsequent secondary endodontic involvement.

Primate spaces are normally present from the time the

primary teeth erupt. Developmental spaces between the incisors are often present from the beginning, but become larger as the child grows and as alveolar processes expand. Generalized spacing of the primary teeth is required for proper alignment of the permanent incisors. This spacing is most frequently caused by growth of the dental arches.

Composite resin & resin-modified glass ionomers are also commonly used to restore

primary teeth.

ANTERIOR CROSSBITE It is most often associated with prolonged retention of a

primary tooth. Delayed treatment can lead to serious complications (i.e. loss of arch length). The most essential factor related to correcting an anterior crossbite is the amount of M-D space available. It is easily retained once it is corrected.

Young children do not always understand what "numb lip" means when you ask them this after a mandibular block. The best indicator of a profound block is to

probe the labial attached gingiva between the lateral incisor and canine with an explorer. If this is done without a reaction, the child is anesthetized.

PROBING LESIONS: 3. Narrow Sinus Tract Lesion-

probing reveals normal depths all around the tooth except at one very narrow area. Thus, the probe can pass down the root surface to some distance (sometimes to the apex). The tooth is pulpless (non-vital). Once RCT is complete, the lesion completely heals within one week. Another clue for diagnosis is a non-vital (necrotic) pulp.

1. Enucleation-

process by which the TOTAL REMOVAL of a cystic lesion is achieved. Enucleation is the treatment of choice whenever possible for congenital cysts, mucoceles, and most odontogenic cysts.

Patients taking steroids or people with disease of the adrenals have a decreased ability to

produce more glucocorticoids (hydrocortisone) during stress (i.e. extractions). This is because glucocorticoid secretion is stimulated by ACTH, which is produced in the anterior pituitary in response to stress by increasing ACTH output, thus glucocorticoid production increases. A relative lack of glucocorticoids also increases ACTH output. An overabundance of circulating systemic steroids inhibits ACTH production. Patients on large steroid doses repress ACTH production, causing atrophy of the adrenal cortex.

1. High-pull headgear:

produces a DISTAL & UPWARD force on the maxillary teeth & maxilla. This headgear consists of a head cap connected to a face-bow. This type of headgear has a more direct effect on the anterior segment of the arch. Indicated for Class II, Division I malocclusions that have an open bite.

3. ACIDULATED PHOSPHATE FLUORIDE (1.23%)

professionally applied, more acceptable taste than stannous fluoride, and can be applied to both arches simultaneously. However, it may damage porcelain restorations.

Treatment & Dental Management:

prolonged rest, administer oxygen. * Digitalis causes patient to be prone to nausea and vomiting. * Patients taking diuretics/vasodilators are prone to orthostatic hypotension, also avoid excessive EPI. * Dicumarol patients may have bleeding problems.

Prilocaine is available as a 4% solution with or without EPI, which

prolongs the anesthetic effect. Prilocaine is 50% as toxic as Lidocaine, since methemoglobinemia is a possible reaction.

Dry Heat Sterilization-

proper time & temperature for dry heat sterilization is 320°F (160°C) for 2hrs, or 340°F (170°C) for 1hr. Items usually sterilized by dry heat can be autoclaved. They should be removed immediately after cycle to diminish the possibility of instrument corrosion and dulling of sharp points or edges (carbon steel instruments). Dry heat destroys microorganisms by causing COAGULATION OF PROTEINS.

Cationic Detergents-

quaternary ammonium compounds widely used for SKIN ANTISEPTICS. Detergents are "surface-active" agents composed of a long chain, lipid-soluble, hydrophobic portion, and a polar hydrophilic group that can be a cation, anion, or non-ionic group. These surfactants interact with the lipid in the cell membrane through their hydrophobic chain, and with the surrounding water through their polar group and thus, disrupt the cell membrane.

CHLOROFORM-

reagent of choice to DISSOLVE guttapercha. Highly concentrated chloroform is very effective, but use with caution because its vapor is potentially hazardous so it is dripped directly in the canal to avoid excessive flooding.

REGIONAL LYMPH NODES: 1. Parotid lymph nodes-

receive lymph from a strip of scalp above the parotid salivary gland, anterior wall of the external auditory meatus, and from lateral parts of the eyelids and middle ear. Efferent lymph vessels drain into the deep cervical lymph nodes.

OPERCULECTOMY-

removal of operculum (flap of tissue over an unerupted or partially erupted tooth).

RESEARCH SAMPLES:

representative portion of the population: 1. Random Sample: every element in the population has an EQUAL chance of being selected; reduces the chance of bias. REDUCES BIAS. 2. Stratified Random Sample: selecting an element according to certain subgroups; accomplished by selecting a proportionate number of participants from each subgroup for the sample (ex: identify all of the dental schools studying from the DENTIN NBDE II BOARD PREP and select two members from each school). Subjects are randomly chosen from a previously subdivided population. 3. Systematic Sample: the researcher randomly chooses the first participant from the population, then selects every 'nth" subject to participate. Ex: a researcher has a population of 100, but only needs 7 subjects. He first picks his starting number "5" then picks his interval as "4". Thus, the members of his sample would be subjects: 5, 9, 13, 17, 21, 25, 29. There is a chance for researcher bias. 4. Judgment Sample: someone familiar with the population selects the sample; HIGH chance of bias. (ex: your class president selects fellow students to be in one of four simulation lab groups). 5. Convenience Sample: sample group is chosen based solely on convenience (ex: the first 20 people to walk through the door today were asked to complete a questionnaire). ELIMINATES BIAS.

Anatomic Distribution of Mandibular Fractures: Symphysis area (chin)-

represents 22% of fractures, and is usually where blows are sustained. These blows often result in fractures of the subcondylar region.

Anatomic Distribution of Mandibular Fractures: Condylar neck-

represents 25% of fractures. It is a safety feature that allows the blow to the jaw to be dispersed at this point rather than driving the condyle into the middle cranial fossa.

Hemophilia A:

represents most people with hemophilia. The classic type caused by a deficiency of coagulation Factor VIII (anti-hemophilic factor).

FLAPS & SLOB RULE Submarginal Triangular & Rectangular Flap (Ochsenbein-Leubke)-

requires at least 4mm of attached gingiva and a healthy periodontium. This flap is raised by a SCALLOPED INCISION in attached gingiva with 1 or 2 vertical incisions. Less risk of incising over bony defects, with no post-surgical gingival recession. May be indicated for root-end surgery on an anterior tooth.

MANDIBUAR AND MAXILLARY ROOT ANATOMY Mandibular 1st molar

requires endodontic treatment more than any other tooth in the oral cavity. Pulpitis can cause referred pain to the EAR.

The emergency most often experienced during outpatient general anesthesia is

respiratory obstruction.

A young epileptic who has a grand mal seizure in the dental office generally recover if

restrained from self-injury and oxygen is maintained.

A patient who sustained a subcondylar fracture on the left side is unable to deviate the mandible to the

right. This is usually treated by a closed procedure involving intermaxillary fixation which immobilizes the concomitant fractures and corrects jaw displacement associated with the condylar fracture. This corrects the shift of the midline toward the side of the fractured condyle and slight premature posterior occlusion on that side.

Systemic fluorides are least effective on

root surfaces.

3 TMJ LIGAMENTS: attach and determine the farthest boundaries of mandibular movement: 2. Stylomandibular ligament-

separates the infratemporal region anteriorly from the parotid region behind. Runs from the styloid process of sphenoid bone to the angle of the mandible. Separates the parotid and submandibular salivary glands, and is taut when the mandible protrudes.

Clinical signs of Acute Maxillary Sinusitis:

severe, constant, localized pain (any unusual motion or jarring accentuates the pain). Tenderness to percussion of the maxillary posterior teeth and tenderness over the anterior sinus wall, and mucopurulent exudates also manifest.

Hepatitis B virus infection commonly occurs by

sexual intercourse, prenantal transfer, and percutaneous inoculation.

Teeth are resistant to crush, but are not resistant to

shear. Thus, place the forcep beaks opposite to each other at the same level on the tooth. Forcep beaks are applied in a line parallel with the long axis of the tooth.

Geudel's Stages of General Anesthesia: 4. Stage 4 (Premortem or Medullary Depression)-

signals danger (characterized by maximally dilated pupils and cold, ashen skin). BP is extremely low and often unmeasurable. Cardiac arrest is imminent. *Eyes are greatly enlarged in size and do not react to bright light when functional circulation to the brain has stopped. Patient experiences severe respiratory and cardiovascular depression/paralysis requiring mechanical & pharmacologic support.

Clinically (ACUTE) HERPETIC GINGIVOSTOMATITIS: can result in

spherical discrete vesicles.

A 52-year old women requests extraction of a painful mandibular 2 molar. She tells you she has not rested for two days and nights because of the pain. Her medical history is unremarkable, except that she takes 20mg of Prednisone daily for Erythema Multiforme. To treat this patient, you would give

steroid supplementation and remove the tooth with local anesthesia and sedation. nd

Patients with ESRD are often on

steroid therapy, are more susceptible to post-operative infections, and have an increased tendency to bleed.

Access Preparation Objectives:

straight-line access, conservation of tooth structure, pulp chamber unroofing, and remove pulp horns.

Suture size is based on

strength and diameter. This system uses "0" as the baseline average size suture. As suture diameter decreases, "0s" are added or numbers followed by a "0" (i.e. 000 and 3-0 are the same size). As suture diameter increases above "0", numbers are assigned to the suture material.

Titanium alloys offer a highly desirable combination of

strength, springiness, & reasonably good formability.

Lymphatic drainage from the sublingual & submandibular glands goes to the

submandibular and deep cervical lymph nodes.

MAXILLARY ARTERY-

supplies maxillary & mandibular teeth, muscles of mastication, palate, and almost the entire nasal cavity. 1. Inferior alveolar artery-a branch of the maxillary artery that supplies blood to the mandibular teeth. 2. PSA artery-a maxillary artery branch that supply blood to the POSTERIOR maxillary teeth. 3. ASA & MSA arteries-maxillary arch branches that supply blood to the ANTERIOR maxillary teeth.

Stress or fatigue can cause an adrenal crisis in a patient with

suppressed adrenal function.

If mandibular anterior crowding is noted during the mixed dentition phase, the most appropriate approach to management is to

take study models and perform an arch length analysis. This mandibular incisor crowding usually results from a tooth size-arch length discrepancy.

ORTHODONTICS PRIMARY TEETH OCCLUSION: Flush Terminal Plane-

the NORMAL relationship of the primary molars in the deciduous (primary) dentition. The terminal plane relationship of primary second molars determines the future antero-posterior position of the permanent first molars.

26. The MOST COMMON method of DISPERSION in oral hygiene research that represents the RANGE OF DATA is

the STANDARD DEVIATION.

While extracting a mandibular 3 molar, if you notice the distal root tip is missing, it is most likely to be found in

the SUBMANDIBULAR SPACE. To prevent this, avoid all apical pressures when removing roots or root tips of all mandibular molars. If a mandibular molar root tip is displaced inferiorly, it may be in the mandibular canal, or through the lingual cortical plate.

32. The BEST dental index to detect EARLY signs of GINGIVITIS is

the SULCULAR BLEEDING INDEX (SBI).

• Correct total liter flow of nitrous oxide/oxygen is determined by

the amount needed to keep the reservoir bag 1/3-2/3 full.

Maxillary mandibular plane angle (MMPA)-

the angle between the mandibular plane (Go-Me line) & maxillary plane (ANS-PNS line) whose normal value is 27° (+ 4°). The greater MMPA, the longer the anterior facial height.

Steiner Analysis: 1. SNA angle-

the angle formed at the intersection of 2 lines (one line from sella turcica (S) to nasion (N), and the other line from nasion to Point A). These two lines show the maxilla's position relative to the cranial base. Steiner indicates in a good skeletal pattern, the SNA angle is ~82°. • SNA > 82° = maxillary prognathism. • SNA < 82° = maxillary retrognathism.

2. SNB angle-

the angle formed by the intersection of line SN & NB. It defines the sagittal location of the mandibular denture base. Steiner states an 80° angle is compatible with skeletal harmony. • SNB angle > 80° = mandibular prognathism. • SNB angle < 80° = mandibular retrognathism.

The most likely result of inadvertently sealing a small carious lesion in the occlusal surface is

the caries is arrested.

Pulpal hyperemia caused by bacterial insult is a limited inflammation of the pulp. The tooth can recover if

the caries is eliminated by timely operative treatment.

Infections of the face can cause a septic thrombosis of

the cavernous sinus. Furunculosis and infected hair follicles in the nose are frequent causes. Extractions of maxillary anterior teeth in the presence of an acute infection and especially curettage of the socket under such circumstances can cause CST. The infected thrombus ascends in the veins against the usual venous flow. It usually occurs in the OPHTHALMIC VEIN because of the absence of valves in the angular, facial, & ophthalmic veins.

ATELECTASIS-

the collapse of part or all of a lung by blockage of the air passages (bronchus or bronchioles), or by very shallow breathing. Atelectasis is the MOST COMMON anesthetic complication occurring within the first 24hrs after surgery under general anesthesia. Symptoms include: diminished breath sounds, fever, increasing dyspnea. Prolonged atelectasis can lead to PNEUMONIA.

The earliest possible diagnosis of a skeletal open-bite is essential because

the condition is not selfcorrecting, and usually worsens with time. Anterior open bites can be classified as a form of apertognathism (an open-bite deformity). AS A CHILD MATURES, THEIR FACIAL PROFILES BECOMES LESS CONVEX.

2. Operant Conditioning-

the consequences of a behavior is in itself a stimulus that can affect future behavior. The consequences that follow a response alter the probability of that response occurring again in a similar situation. It is a form of learning in which the person undergoing therapy is rewarded for the correct response and punished for the incorrect response. There are 4 types of operant conditioning distinguished by the nature of the consequence: positive & negative reinforcement, omission, and punishment.

As a result of trauma to the primary dentition, there should not be problems with permanent successors unless

the crown is not calcified. In this case, the tooth will be hypocalcified (most common with mandibular incisors).

RELIABILITY-

the degree to which a measurement is CONSISTENTLY reproducible. Determined by taking several measurements on the same study subjects

MIXED DENTITION- Ortho

the dentition phase when some of the teeth in the oral cavity are permanent, and some are primary. The earliest indication of a mixed dentition consists of the primary dentition & permanent mandibular first molars. Supervising a child's development of occlusion is MOST CRITICAL from ages 7-10yrs (mixed dentition stage).

If VITAL cementum is resorbed or nicked in surgical procedures, the defect is repaired by

the deposition of new cementum. Repair cannot occur where pockets exist or where the gingiva has receded and cementum is exposed. Exposed cementum that forms part of the clinical crown is often removed during scaling, root planing, or brushing. Deposition of new cementum continues periodically throughout life, whereby root fractures may be repaired. Cementum is indistinguishable on radiographs.

Lidocaine can skip the excitatory phase and go straight to

the depression phase (drowsiness).

Somatogenic Reaction-

the development of a reaction from an organic pathophysiologic cause.

Primary Maxillary Canine- Mesial cusp ridge is longer than

the distal cusp ridge, and its cusp is much longer & sharper than the permanent maxillary canine. This is the opposite on all other canines. It also is very wide and short.

The force generated in the spring is DIRECTLY proportional to

the distance that an orthodontic spring is deflected and the radius (r) of the wire. The force is INVERSELY proportional to the spring's length.

Brevital (Methohexital)-

the drug most commonly used to attain GENERAL anesthesia (an IV barbiturate prescribed to induce anesthesia in short surgical procedures as a supplement to other anesthetics.

Concentration & contact time are critical factors that determine

the effectiveness of an antimicrobial agent against a particular microorganism. Any or all three of the major portions of microbial cells can be affected: cell membrane, cytoplasmic contents (especially enzymes), and nuclear material (DNA, RNA).

In general, removing primary teeth is not difficult. It is facilitated by

the elasticity of young bone and resorption of root structure. Do NOT use a "cowhorn" forcep to extract mandibular primary molars because the sharp beaks of these forceps can damage unerupted permanent premolar teeth.

6. Eruption-

the emergence of tooth structure through the gingiva.

Patients with cardiac pacemakers do not require antibiotic prophylaxis since

the endocardium is not involved.

PITUITARY DWARF-

the eruption rate and shedding of the teeth are delayed. Clinical crowns and roots appear smaller, the dental arch is smaller causing malocclusion, and the mandible is underdeveloped.

The compression cuff's width should be ~20% greater than

the extremity diameter on which the BP is being recorded. If you need to take additional readings, wait at least 15 seconds before re-inflating the BP cuff.

Mandibular Central Incisor-

the first deciduous (primary) tooth to erupt.

MANTLE DENTIN-

the first formed dentin that is laid before the odontoblast layer is organized. Thus, the pattern of deposition and size of collagen fibers differs from circumpulpal dentin. It is less mineralized than circumpulpal dentin and contains VAN KORFFS FIBERS (thick Type III collagen). Lays closest to the DEJ

ORAL HEALTH SURVEY-

the first step in a public oral health procedure. A sound basis to assess the current oral health status of a population and its future oral health needs.

MAXILLARY CENTRAL INCISOR-

the first succedaneous tooth to erupt. ► The crown of the primary maxillary central incisor is larger M-D than the permanent maxillary central incisor. ► Primary maxillary central incisor has a shorter crown length inciso-cervically than the permanent maxillary central incisor. ► primary maxillary central incisor's incisal edge is straighter than the permanent maxillary central's incisal edge. ► No mamelons are present on the primary maxillary central incisor, only on permanent maxillary central incisors. ► Labial and lingual cervical ridges are prominent on all primary incisors.

10% Formalin-

the fixative of choice used for a routine biopsy specimen. After removal, the tissue is immediately placed in 10% formalin solution (4% formaldehyde) that is at least 20x the volume of the surgical specimen. The tissue must be totally immersed in the solution, and care is taken to ensure the tissue has not become lodged on the container wall above the level of the formalin.

Gingivitis is most commonly scored with the gingival index of Loe & Silness which grades the gingiva based on

the four surfaces of each tooth based on inflammation and bleeding.

Fluids in several forms should be continually urged on the patient. In severely dehydrated individuals, they must get to

the hospital immediately. IV fluids quickly reverse dehydration, and is often life-saving in young children and infants.

Speech problems associated with cleft lip & palate are usually the result of

the inability of the soft palate to close air flow into the nasal area.

As caries enter dentin, it spreads laterally at the DEJ due to

the increased organic content and involvement of many dentinal tubules. Tomes fibers-react, cause fatty degeneration and later decalcification (sclerosis).

STAGES OF TOOTH DEVELOPMENT (Life Cycle): 1. Initiation (Bud Stage)-

the initial interaction between oral epithelium & mesenchyme (ectomesenchyme) formation of dental lamina. Fused or geminated teeth occur during this stage.

Streptococcus species may not be as important in the progression of a carious lesion (leading to pulp exposure) as much as it is in

the initiation of the lesion. Strict anaerobes play a major role in periapical pathoses.

PAROTID GLAND-

the largest salivary gland and pure SEROUS gland supplied by general visceral efferent (motor) nerve fibers of the glossopharyngeal nerve. The parotids are located below and just anterior to the ear, and are divided into deep and superficial lobes with the stylomandibular tunnel (which encloses the facial nerve) being the dividing line. Thus, a portion of the parotid lies superficial to the mandibular ramus and another portion lies deep.

Once sufficient amounts of bone are removed from around the impacted tooth, the tooth is usually sectioned to allow portions of the tooth to be removed separately with elevators through the opening provided by bone removal. Bone is rarely, if ever, removed on

the lingual aspect of the mandible because of the likelihood of damaging the lingual nerve.

When removing the mylohyoid ridge, be careful to protect

the lingual nerve.

MANDIBUAR AND MAXILLARY ROOT ANATOMY MANDIBULAR TEETH ROOT ANATOMY:

the lingual wall of mandibular teeth is most easily perforated when preparing an access opening due to the lingual inclination of these teeth.

A common dental condition that can benefit from orthodontic treatment prior to prosthetic treatment is

the long-term loss of a mandibular permanent 1 molar which causes tipping, migration & rotation of adjacent teeth into the edentulous space. The best way to upright a 2 molar that drifted mesially is tipping its crown DISTALLY and opening up space for a pontic to replace the missing first molar, rather than attempting to move the 2 nd molar mesially to close the space. st nd

Luxation-

the loosening of the tooth in the socket by progressive severing of the PDL fibers using patience and controlled force, NOT brute strength. The force is applied as far down on the root as possible. You should also support the jaw with your other hand, with a thumb and finger on either side of the tooth being extracted.

• N 2 O is carried in the bloodstream in physical solution. There is no metabolism or degradation of N O in the body. Rather, it is excreted solely by

the lungs, unchanged. High blood levels of N O can be achieved quite quickly. N 2 2 O is non-toxic to body tissues (the only toxicity using N O is the lack of oxygen that can result from operator error). The gag reflex is only slightly obtunded with N 2 2 2 O analgesia.

LIDOCAINE (XYLOCAINE):

the most common local anesthetic used in dentistry, may be found in topical anesthetic agents, and an IV ANTI-ARRHYTHMIC AGENT to effectively treat (reverse) life-threatening ventricular arrhythmias to decrease cardiac excitability.

T-TEST-

the most common method to evaluate the HYPOTHETICAL DIFFERENCE IN MEANS BETWEEN TWO GROUPS. • Unpaired t-test: compares differences between males and females oral hygiene indices in a sample group. • Paired t-test: compares the effects of two toothpastes to improve the oral hygiene index.

DIABETES-

the most common pancreatic endocrine disorder and metabolic disease involving mostly carbohydrates (glucose) & lipids owing primarily to a relative or complete lack of insulin secretion by beta cells of the pancreas. Diabetes is caused by an absolute deficiency of insulin (Type I) or resistance of insulin's action in the peripheral tissues (Type II). Classic triad of symptoms is polydipsia, polyuria, & polyphagia.

1. Sodium Hypochlorite (NaOCl)-

the most commonly used IRRIGANT in endodontics to aid in canal preparation used in concentrations of 1%, 2.6%, or 5.25%. There is no agreed single-concentration value of NaOCl that is most effective while being the safest, thus these percentages are all acceptable.

Status Asthmaticus-

the most severe clinical form of asthma, usually requiring hospitalization that does not respond adequately to ordinary therapeutic measures. If not managed properly, chronic partial airway obstruction may lead to death from respiratory acidosis (produced by hypoxemia & hypercapnea).

K-Type Instruments: 1. K-Files-

the most useful instruments for removing hard tissue to enlarge canals. Files are made by twisting a blank (a square stainless steel rod producing a series of cutting flutes). The K-type file's action in the canal is a clockwise-counterclockwise motion while directing pressure apically (can be a filing or reaming action). Ktype files are the STRONGEST and cut the LEAST aggressively. K-flex file-a modified K-type file.

Alcohol-

the most widely used antiseptic, and is used to reduce the number of microorganisms on the skin surface in a wounded area. Alcohol denatures proteins, extracts membrane lipids, and acts as a dehydrating agent, all of which contribute to its effectiveness as an antiseptic. Even some viruses (lipophilic viruses only) are inactivated by alcohol.

Education plays an important role in public health because it decreases

the need for government intervention. When people learn why regulations are of value, they will comply. Ex: when people learn how many lives are saved annually by seatbelts, they are more inclined to wear them.

3. ANB angle-

the norm for this critical angle is 2° (it is the difference between SNA & SNB norms). A Class I skeletal profile has a 2° ANB angle. • ANB angle > 4° = Class II skeletal profile. • ANB angle < 0° (negative angle) = Class III skeletal profile.

If the communication opening is large (7mm or larger),

the opening is closed with a flap.

Retained primary teeth are an outstanding oral manifestation of Ectodermal & Cleidocranial dysplasias. This prolonged retention of the primary teeth may cause a change in

the path of eruption of the succeeding teeth.

STERILIZATION-

the process of KILLING (or removing) all microorganisms (including bacterial spores) on an object or in a material (i.e. liquid media). Sterilization is the complete destruction of all forms of microbial life (including SPORES) without particular reference to microbial organisms. The limiting requirement is destruction of heat-resistant spores.

PEER REVIEW (REFEREEING)-

the process of subjecting a dental author's scholarly research or work to the scrutiny of dental experts in the same field before the journal or book is published to improve research validity.

OPEN REDUCTION-

the reduction of a fractured bone by manipulation after incision into skin and muscle over the fracture site. The most common site for open reduction is at the angle of the mandible. Once the incision is made, an intraosseous wire is placed through holes made on either side of the fracture. Reduction is accomplished under direct vision, and immobilization is obtained by tightening the wires. This procedure is usually reserved for fractures that cannot be reduced and immobilized adequately by closed methods. Best used to reduce a fracture when teeth are missing in one or more of the fractured segments.

CLOSED REDUCTION-

the reduction of a fractured bone by manipulation without incision into the skin. It is the simplest method of reduction and is used most often when both fractured segments contain teeth. After manipulation of the bone, it is usually maintained in place by intermaxillary fixation (IMF).

The use of hydrofluosilicic acid is advantageous because of

the relatively inexpensive equipment required compared to the equipment used with powered components. Hydrofluosilicic acid is added directly to the water by a chemical dosing system that consists of a chemical feed pump, analyzer/controller, injector, drum scale, and 55-gallon drum of the acid solution. Diluting the acid prior to adding it to the water is not recommended because of the hazards involved in handling the acid, and errors associated with dilution.

Morphine-

the standard drug to which all analgesic drugs are compared. It causes euphoria, analgesia, drowsiness, miosis, and respiratory depression.

Exposure Control Plan-

the standard requires that every employer have a written exposure control plan designed to eliminate or minimize employee exposure to bloodborne diseases. The plan must set forth office policies and protocols to protect employees from these diseases.

Concrescence-

the state of teeth joined together only by cementum. A type of fusion that occurs after root formation is complete, possibly due to a traumatic injury.

After sedating a child, always keep an eye on

the status of the child.

Epidemiology-

the study of the incidence, prevalence, mode of transmission, and control of diseases in a defined human population to establish programs to prevent and control their development and spread.

PULP TREATMENT PULPECTOMY (RCT)-

the suggested treatment when an 11-year old child traumatized a permanent maxillary central incisor and the tooth becomes painful, with swelling, and a periapical radiograph discloses a pathosis associated with the apex.

Patient Instructions: HEAD & NECK CANCER patients

the trays containing the fluoride are placed over the teeth for a prescribed period of time (usually 10 minutes), and the patient cannot eat or drink for at least 30 minutes. This is usually done at night after toothbrushing and just before going to bed.

Pasteurization-

the treatment of dairy foods (milk) for short intervals using HEAT to kill certain disease-causing microorganisms. The target of pasteurization is to destroy MYCOBACTERIUM TUBERCULOSIS.

Intermediate level agents like phenols, iodophors, hypochlorite, and certain preparations containing alcohols and other cleaner disinfectant chemicals can penetrate

the wax and lipid outer layers surrounding mycobacteria.

A close correlation exists between a sealant retention and

their effectiveness. The effectiveness of sealants is equal whether applied by dentists, hygienists, or dental assistants provided that they have received appropriate training.

Recurrent aphthous ulcers & intra-oral herpes lesions are distinguished largely on

their location. Recurrent aphthous ulcers occur mainly on mobile mucosa, while intra-oral herpes lesions occur on tissue bound to periosteum.

Ester local anesthetics are no longer available as dental anesthetic injections due to

their relatively HIGH ALLERGIC REACTION POTENTIAL & INCIDENCE.

Children with defiant behavior are usually stubborn or spoiled. For hostile or angry children, try to identify the underlying source of

these emotions (this holds true for adult patients too).

Participants of HMOs are much more limited in their dentist selection because

they have to stay within network.

TMJ COMPONENTS: 3. Articular Capsule-

thick, fibrous tissue that surrounds the TMJ and is attached above to the articular eminence (tubercle) and to the margins of the mandibular fossa and below to the neck of the mandible. Synovial Membrane-lines the articular joint capsule in the superior and inferior spaces of the joint and PRODUCES SYNOVIAL FLUID for lubrication. It does not cover the articular surfaces or articular disc.

TMJ Surgical Approaches: 2. Submandibular Approach (Risdom Approach)-

this is the standard surgical approach to the mandibular ramus and neck of the condyle. Not the best approach for procedures within the joint space itself.

FALSE POSITIVE RESULT-

this result erroneously assigns an individual to a specific diagnostic or reference group, due particularly to insufficiently exact methods of testing.

Severe mental retardation is caused by the improper development of the CNS. If cretinism is recognized early, it can be markedly improved with the use of

thyroid hormones.

Ectopic eruption of mandibular lateral incisors (which occurs more commonly than mandibular 1 molars), can cause

transposition of the lateral incisor & canine. A poor eruption direction of the canine, sometimes leading to impaction is often observed, but is usually due to the eruption path being altered by a lack of space.

Autoclaving time varies directly with the type of load placed into the chamber. The 3-minute "flash cycle" is best indicated for

unwrapped instruments. For wrapped instruments, a longer sterilization cycle is required to permit adequate penetration of steam for proper disinfection.

Hawley retainer can be made for the

upper & lower arch. The lower retainer is fragile and may be difficult to insert because of undercuts in the premolar region. A patient may have difficulty pronouncing linguoalveolar consonants for a few days after receiving a maxillary Hawley until the tongue adapts to the palatal coverage.

Patients with chronic bronchitis (or any COPD) can have difficulty during oral surgery. Many of these patients depend on maintaining an

upright posture to breathe adequately. They often experience difficulty breathing if placed in an almost supine position or if placed on high-flow nasal oxygen.

2. DEFT Index (Decayed, Extracted, Filled Teeth)-

used for the primary dentition.

Unbuffered Phosphoric Acid (35-50%)-

used as an ETCHING AGENT for 1 minute before direct bonding of orthodontic brackets. After etching, the tooth surface has a FROSTED appearance. When etching, the tooth surface cannot be contaminated with saliva that promotes immediate remineralization, until bonding is complete to avoid re-etching. DO NOT USE topical fluoride before etching as FLUORIDE DECREASES ENAMEL SOLUBILITY.

Ethylene Oxide Gas Sterilization-

used extensively in hospitals to sterilize heat-sensitive materials like surgical instruments and plastics. It kills by alkylating proteins and nucleic acids (it is an alkylating agent that irreversibly inactivates cellular nucleic acids (DNA) and proteins). It is a slow process (10-16hrs) depending on the material to be sterilized. This gas is fairly toxic to humans and is flammable, so its use is limited.

Space Maintainers that REPLACE MULTIPLE PREMATURELY MISSING PRIMARY TEETH: 2. Nance appliance (transpalatal appliance)-

used for BILATERAL LOSS of primary maxillary molars. An acrylic button rests on the palate, and is attached to bands that are bilaterally cemented on the permanent maxillary molars. This appliance prevents MESIAL ROTATION & DRIFTING of the permanent maxillary molars to which it is attached.

FRACTURE IMMOBILIZATION: 3. External Skeletal Fixation-

used in most cases in which the management of a fractured bone segment is not satisfactorily accomplished by intermaxillary fixation. It involves placing screws or pins through the skin on each side of the fracture and a cold cure acrylic bar that holds the screws in proper relationship with the fracture in the reduced position. It is cumbersome and esthetically displeasing.

Invasive Procedures for Obstructed Airway: these procedures are only performed by people trained in these techniques and with the proper equipment: Tracheotomy-

used more for long-term airway maintenance, not for emergency airway.

Whip-Spring Appliances-

used to DE-ROTATE one or two teeth.

Vertical Ramus Osteotomy-

used to correct mandibular prognathism. By vertically sectioning the ramus in a line from the lower aspect of the mandibular notch vertically downward over the mandibular foramen, or just posterior to the lower border of the mandible at the angle.

Anatomical (Skeletal) Crossbite-

usually demonstrates a smooth closure into centric occlusion.

Treatment: REVERSIBLE PULPITIS

usually a sedative filling or new restoration with a base.

There is no reliable method to determine pulp vitality in the case of a recently traumatized primary tooth. Often, traumatized teeth do not respond to

vitality testing. Pulp vitality testing is NOT routinely performed in the primary dentition because primary teeth do not respond to such test reliability since the test requires a relaxed and cooperative patient objectively reporting a reaction.

Toxic Waste-

waste capable of causing a poisonous effect.

Hazardous Waste-

waste causing harm or injury to the environment (not all hazardous waste is toxic/poisonous).

Infectious Waste-

waste that contains strong enough pathogens in sufficient quantity to cause disease. All infectious waste is contaminated, however, not all contaminated waste is infectious (may not be able to cause disease).

Hevea brasiliensis-

water-soluble macromolecules that can leach out of latex gloves when a person perspires, or may be detected on surfaces of other products containing natural rubber latex (NRL). These proteins cause Type I, immediate, IgEmediated reactions to natural rubber latex.

Oral Complications: Type I Diabetes

xerostomia, infection, poor healing, increased incidence and severity of periodontal disease, and burning mouth syndrome.

*Within the lower 1/3 of anterior face height, the mouth should be

~1/3 of the way between the nose & chin.

Important: the maxillary arch is slightly longer than the mandibular arch. The sum of the M-D diameter of the maxillary permanent teeth is

~128mm, and is 126mm for the mandibular permanent teeth.

Proper management of an avulsed PERMANANT tooth replanted by the dentist within 2hrs of the accident:

• 10-14 days after replantation, clean and shape (prepare) the root canal, and place calcium hydroxide paste into the canals. Replace this paste every 3 months for on year. After 1 year, if the root resorption has reversed or stopped, a permanent gutta-percha filling can be placed.

Important Human Development Facts:

• At age 6, a child's head is 90% of its adult size. This is typical of all neural tissues in the body. At birth, the cranial vault is very near the size it will eventually attain in adulthood (compared to the cranial base, mandible, mid-face, etc.). The brain and cranial base are fully developed by age 6. • At birth the jaw is large enough to accommodate all primary teeth if they were to erupt simultaneously. • At birth, the width of the face has reached its greatest percentage of its adult size (as opposed to height and depth). • At birth, the palate is flat. In adults, it is vault-shaped (this occurs by deposition of alveolar crestal bone). • In early life, tonsils function to filter bacteria and program the production of antibodies. • At birth, a newborn cannot differentiate between sour, salt, or bitter tastes. • From ages 6-12, the body's lymph tissue is 200% of its normal adult mass. Consequently, enlarged tonsils in a 6-year old are at age 12, most likely smaller because lymphoid tissue in the nasopharynx decreases at puberty, while at the same time, the genital tissue is developing.

Specific Ways to Effectively Communicate with Patients:

• Describe, be specific, be responsive, time appropriate, and pay attention (the best way to show a patient you care about what he/she is telling you is to use EYE CONTACT). Do not evaluate, be general, be evasive or premature, too deep, or inattentive or wander.

Predominant bacterial species isolated from INFECTED ROOT CANALS include:

• Eubacterium, Peptostreptoccus, Fusobacterium, Porphyromonas, and Prevotella species.

Ways to reduce patient anxiety:

• Explain procedures before doing them and forewarn about the possibility of pain. • Give the patient some control over the procedures and pain (i.e. raise your hand if you feel anything). • Build trust between you and the patient. • Watching a patient's eyes or eyebrows is a good indication if the patient feels pain during dental treatment.

Infection Control:

• Exposure is not synonymous with infection. • Do not disinfect when you can sterilize. • Known AIDS patients can be treated using Standard Bloodborne Precautions. • It is not possible or necessary to sterilize all environmental surfaces that become contaminated during patient care. In many instances, because of the relatively low risk of microbial transmission, thorough cleaning of surfaces is sufficient to break the cycles of cross-contamination and cross-infection. Thus, sterilization of all clinical instruments and inanimate environmental surfaces is NOT mandatory.

NEEDS AND LEARNING:

• Needs are driving forces that prompt a person to act. Motivation stimulates a person to act on his needs and is a fundamental part of every learning situation. Motivation can be artificial or built-in. Needs and goals may provide motivation, and patients rarely learn without some motivation. Motivation arouses and maintains interests. • Short-range goals are less remote and more easily attained than long-term goals. Goals should be attractive and attainable to be meaningful. Goaldirected activity is required for learning. • The learning process is continual and multiple, and occurs as a person attempts to satisfy needs. • Telling a person what he needs may convince him that a behavior change is desirable. • Expressing needs helps pinpoint them for the dentist and patient. • Recording educational needs can be as important as recording treatment needs.

Other possible complications of the zygomatic complex fractures:

• Paresthesia-the most common complication, but usually subsides. • Antrum (sinus) may be filled with a hematoma, which usually evacuates itself. • Ocular muscle balance may be impaired because of fracture of the orbital process.

Midazolam Contraindications:

• Pregnant women • Alcoholics • Narrow-angle glaucoma (increased eye pressure) • Sleep apnea (can cause respiratory depression)

Usual Exfoliation (Fall-out) Age of Deciduous Teeth:

• Primary central incisors are exfoliated between ages 6-8. • Primary lateral incisors are exfoliated between ages 7-9. • Primary canines are exfoliated between ages 9-12. • Primary 1 st & 2 molars are exfoliated between ages 10-12.

Primary Molars vs. Permanent Molars:

• Primary crowns are shorter with pronounced B & L cervical ridges and a constricted cervical area. • Primary occlusal table is narrow F-L. • Anatomy is shallower (i.e. cusps are short, ridges are not as pronounced, and fossae are not as deep). • A prominent mesial cervical ridge (makes it easy to distinguish rights from lefts). • Roots are longer and more slender than the roots of permanent molars. The roots are extremely narrow M-D and very broad lingually. • Roots are very divergent and less curved. There is little or no root trunk. • The sum of the M-D widths of primary molars in any one quadrant is 2-5mm greater than the permanent teeth that succeed them (premolars). Also, the enamel on the occlusal surfaces of primary molars is of uniform thickness and is ~1mm thick, compared to permanent molars (2.5mm) thick.

NiTi methods:

• Push & pull stroke, reaming motion, or engine-driven rotary motion (uses only a reaming motion). • Hand instrumentation is done by either filing (push & pull) or reaming (repeated rotations).

Thrombocytopenia Clinical Features:

• Spontaneous appearance of purpuric or hemorrhagic lesions of the skin which may vary in size from tiny, red pinpoint petechiae, to purplish ecchymosis and even massive hematomas. Patients also exhibit a tendency to bruise. • Nosebleeds, GI bleeding, and urinary tract bleeding. • Severe and often profuse gingival hemorrhage and petechiae on the oral mucosa.

Considerations When Checking Vital Signs:

• The patient should not have had alcohol, tobacco, caffeine, or performed vigorous exercise within 30min of the exam. • Ideally the patient should be sitting with their feet on the floor and their back supported. The examination room should be quiet and the patient comfortable. • History of hypertension, slow or rapid pulse, and current medications should always be obtained. • Abnormalities of vital signs are often clues to diseases, and an alteration of vitals can be used to evaluate a patient's prognosis. In complicated cases do not hesitate to contact a patient's physician or previous dentist for a consultation.

Symptoms of Dehydration:

↓ BP, weight loss, ↑ HR, CO, body temperature, and sunken eyeballs.

When oral surgery is performed on patients taking anticoagulants, these steps may help prevent hemorrhage:

► Hemostatic agent is placed within the socket. ► Soft diet, intra-oral pressure packs, and avoid mouth rinses ► Multiple sutures are placed in the surgical area ► ice packs are applied extra orally.

V3 Sensory Innervation:

► Long buccal nerve (sensory only) to the cheek and 3 mandibular buccal gingiva. ► Auriculotemporal nerve (sensory only) to TMJ, auricle, and external auditory meatus. ► Lingual nerve (sensory only) to floor of mouth, mandibular lingual gingiva, and anterior 2/3 of tongue. ► Inferior alveolar nerve (sensory & motor) to mandibular teeth, chin skin, and lower lip.

Baby Bottle Caries Preventive Measures:

♦ Infants should not be put to sleep with a bottle containing a liquid other than water. ♦ Infants should be encouraged to drink from a cup prior to their first birthday, and should be weaned from the bottle at 12-14 months of age. ♦ Infants should start to supplement their diet with non-liquids at age 4-6 months. ♦ Juices should only be offered in a cup. ♦ Oral hygiene should be started with eruption of the first primary tooth. ♦ Within 6 months of eruption of the first tooth (no later than the first birthday) it is time for the first dental visit.

Advantages of Restructuring an Atrophic Ridge with HA granules:

♦ It is a simple surgical technique suitable as an office procedure. ♦ No donor site is required to obtain autogenous bone graft material. ♦HA is totally biocompatible and non-resorbable.

Types of Fixed Appliances:

♦ Lingual Archwire Appliance & Whip-Spring Appliance ♦ Fixed-Space Maintainers & Palatal-Separating Devices ♦ Edgewise Mechanism ♦ Light-wire, twin wire, & universal appliances

Arteries that vascularize the TMJ:

♦ Middle meningeal artery (branch of maxillary artery (a terminal branch of external carotid artery). ♦ Ascending pharyngeal artery (branch of the external carotid artery). ♦ Deep auricular artery (branch of maxillary artery). ♦ Superficial temporal artery (terminal branch of the external carotid artery).

Clinical Observations of Phlebitis:

♦ Vessels feel hard, thready, or cord-like. ♦ It is extremely sensitive to pressure. ♦ The surrounding area may be erythematous and warm to touch. ♦ The entire limb may be pale, cold, and swollen.

The best anesthetic technique used in oral surgery to avoid aspiration of blood or other debris when a patient is under general anesthesia is

endotracheal intubation with pharyngeal packs.

A cricothyrotomy may be life-saving in an anaphylactic reaction where a patient shows signs of laryngeal obstruction. If a patient shows signs of laryngeal obstruction (stridor/crowing sounds), what should be administered?

epinephrine and oxygen is administered.

MEPIVACAINE (CARBOCAINE)-

equal to lidocaine in efficacy, but HAS THE SHORTEST DURATION OF ACTION of all amides. Not best (less useful) for dental procedures more than 25-30 minutes (short effects). Can be used without EPI (plain), or with EPI vasoconstrictor Levonordeferin (neo-cobefrin). Ineffective topically. TOXIC TO NEONATES, so avoid for labor and infants.

If the eruption path of the maxillary first molar carries far too mesially at an early stage, the permanent molar cannot

erupt and the primary molar root can be damaged. The mesial position of the permanent molar means the arch will be crowded unless the child receives treatment. Important: this mesially inclined position of the permanent molar makes it susceptible to decay. If it shows signs of caries, extract the adjacent primary second molar immediately. The resultant space can then be maintained as part of orthodontic treatment.

Fluoride's main effect occurs AFTER the tooth has

erupted above the gingiva ("post-eruptive"). This topical rd effect happens when small amounts of fluoride are maintained in the mouth in saliva and dental plaque. Fluoride works by stopping or even reversing the decay process. It keeps enamel strong and solid by preventing the loss of and enhancing the re-attachment of important minerals from tooth enamel. Fluoridation of community water is credited for reducing tooth decay by 50-60% in the U.S. since WWII. Recent estimates show decay reduction at 18-40%, which reflects that even in communities that are not optimally fluoridated, people are receiving some benefits from other sources (i.e. bottled beverages, toothpaste).

Band Cementation:

glass-ionomer cements (resin or non-resin based) due to their fluoride releasing properties and retentive strengths, are fast replacing zinc phosphate cement. The cold slab ("frozen slab technique") is used to mix the cement on regardless of the cement that is used to allow a greater amount of powder into the cement liquid, to produce a stronger cement.

During mandibular lateral excursions (deviation) to one side, the TMJ

glides on one side and rotates on the opposite side.

3. Fluoride inhibits

glycolysis where sugar is converted into acid by bacteria (fluoride ion inhibits enzymatic production of glucosyltransferase). Fluoride mouth rinses are shown to have the greatest effect on NEWLY ERUPTED TEETH, making it essential to have rinsing continued into the teen years to protect the 2 and 3 permanent molars.

Symptoms of Diabetes Mellitus:

glycosuria, polyuria, polydipsia, hyperglycemia, weakness, weight loss, ketoacidosis, and vascular abnormalities.

APEXIFICATION-

goal is to INDUCE FURTHER ROOT DEVELOPMENT in a pulpless tooth (dead tooth) by stimulating the formation of a hard substance at the root apex to allow obturation of the root canal space. Apexification may be required after pulpectomy (as at age 7, the root apex must be open). The apex closes 2-3 years after eruption. 1. Isolate the field with a rubber dam, make an access cavity, and remove all pulp using reamers and files. 2. Premixed syringe of calcium hydroxidemethylcellulose paste (i.e. Pulpdent syringe) is injected into the canal and filled to the cervical level. The paste must reach the apical portion of the canal to stimulate tissues to form a calcific barrier. A double cement seal is made to close off the access cavity. 3. Patient is recalled after 3 months to see if apexification occurred. If not, a fresh supply of paste is placed. Once apexification occurs, only then is conventional RCT performed.

AUTISM SPECTRUM DISORDER (ASD)- Dental Management (ASD):

goal is to get the child comfortable with the dental experience. Have parent simulate the dental visit with the child before the appointment if possible, and have child bring a favorite toy. Establish trust using "tell-show-do", consistency, and positive reinforcement techniques. Have parents present in operatory. Short and frequent appointments in a relaxed setting (dim lights or sunglasses, keep sound and touch stimuli to a minimum). May require N2O or sedative drug. Higher risk for caries and gingivitis. Provide positive reinforcement during dental appointment and OHI.

Advantages of N2 O Analgesia:

good analgesia, nonflammable, suitable for all ages and therapeutic for many medically compromised patients, has virtually no adverse effects in the absence of hypoxia, titratable, and produces euphoria.

Public health problem does NOT always result in

government passing new laws against a problem nor result in public demand for immediate government intervention.

KETAMINE Side Effects:

hypertension, increased pulse, delirium.

Proponents of this theory believe that most behavior is learned, and learning is the establishment of a connection between a stimulus and a response. Thus, it is sometimes called the

"Stimulus-Response Theory" (SR Theory).

Disc Displacement WITH Reduction:

"clicking joint" disc is out of place. If painless with no dysfunction (no treatment necessary), patient has normal opening or an "S" shaped opening. TMJ is only ROTATING (not translating). Reciprocal clicking on opening and closing is a sign. A reproducible reciprocal click. On closing, the disc is forward to the condyle. Disc should be between the condyle & articular eminence.

Braces may also be placed on the maxillary teeth during the palatal expansion to eventually close the

"gap-tooth grin" that develops as the maxilla is expanding. Once expansion is complete, the child may need to wear a full set of braces for 1-2 years to achieve an ideal occlusion.

When the pulp becomes severely inflamed as indicated by a thermal stimulus producing pain that lasts long after the stimulus is removed (longer than 10 seconds), this suggests

"irreversible pulpitis" and the pulp is unlikely to recover after removing the caries. Pulpal pain (spontaneous or elicited by an irritant) that lingers more than 10-15 seconds.

Dental fluorosis typically causes

"mottled" discoloration and pitting of the enamel of permanent and deciduous teeth. The severity of mottling increases with an increasing amount of fluoride in the drinking water. Thus, there is little mottling at a level below 0.9-1.0ppm of fluoride in the drinking water, while children living in temperate zones where the water supply contains a higher content of fluoride are most often affected.

The lateral head radiograph (cephalometric radiograph) must be compared with the

"normal" lateral radiographs to form an accepted norm. Linear & angular measurements are obtained using known anatomical landmarks in the lateral head radiography of the patient. These measurements are then compared with measurements considered within normal limits and in that way enable the orthodontist to assess aberration in the dentition and jaw structures that result in malocclusion.

When the distocclusion occurs on ONLY ONE SIDE OF THE ARCH, this UNILATERALITY is called a

"subdivision" of its division (Class II, Division I Subdivision where ONE SIDE of the maxillary arch is in a Class II relationship with its occluding mandibular quadrant, while the other side is in a Class I relationship). The protruded maxillary incisors (centrals & laterals) and maxillary overjet and other anterior aberrations are usually confined to one side of the maxillary arch.

2. Marsupialization, Decompression, & Partsch Operation all create a

"surgical window" in the wall of the cyst. The cyst is uncovered or "deroofed" and the cystic lining is made continuous with the oral cavity or surrounding structures. The cyst sac is opened and emptied.

Irregular incisors (especially lingual position of maxillary incisors), creates a difficulty to produce sounds

"t" & "d".

Xenogenic Implants

(Xenografts or Heterografts)composed of tissue taken from a donor of ANOTHER SPECIES (i.e. animal bone grafted to man). Rarely used in oral surgery.

Broussard buccal tube

(allows for the use of the segmented arch technique used to intrude teeth).

ASA nerve

(anterior superior alveolar nerve)innervates canines and incisors.

Pneumonitis

(inflammation of the lung) & Atelectasis are the two most common causes of fever in a patient who has had general anesthesia.

MIDFACIAL FRACTURES- 4. Zygomatic complex fractures

(most common midfacial fracture). Fractures of the facial bones (especially the zygomatic complex) may on rare occasions be complicated by damage to the contents of the superior orbital fissure.

Possible side effects of lidocaine systemic absorption

(not necessarily toxic levels) are tonicclonic convulsions, respiratory depression, and decreased CO.

The rule states that if eyewear is required, if must be goggles or glasses with solid

(not perforated) side shields.

SUBLUXATION

(slipping of the condyle from its socket) occurs when the condyle head moves too far ANTERIORLY on articular eminence. Caused by injury to the articular capsule surrounding the TMJ.

Edgewise Appliance Components: o Siameses twin bracket

(used on maxillary anterior teeth).

1cc of 2% lidocaine with 1:100,000 EPI contains:

* 20mg of lidocaine, 0.01mg EPI, 6mg NaCl, 0.5mg sodium-metabisulfate (preservative to stabilize EPI).

1.8cc of 2% lidocaine (1 carpule) with EPI 1:100,000 contains:

* 36mg lidocaine (1.8 x 20mg), 0.18mg EPI (1.8 x .01mg), 10.8mg NaCl (1.8 x 6mg). * .90mg sodium-metabisulfate (1.8 x 0.5), 1.8mg of methylparaben (1.8 x 1mg), and NaOH to stabilize the pH.

Biopsy Indications:

* A lesion that persists for more than two weeks with no apparent etiologic basis. * Persistent hyperkeratotic changes in surface tissues. * Bone lesions not specifically identified by clinical and radiographic findings. * A lesion with malignant characteristics. * An inflammatory lesion that does not respond to local treatment after 14 days (i.e. removing a local irritant). * A persistent swelling (visible or palpable) below relatively normal tissue.

Local Contraindications to Tooth Extractions:

* ANUG, irradiated jaws, and malignant disease. * Acute infection with uncontrolled cellulitis. * Acute infectious stomatitis.

Antibiotics that treat sinus infections:

* Ampicillin: treats sinusitis due to upper respiratory infections. * Penicillin & Amoxicillin: treats sinusitis caused by odontogenic foci.

Biopsy Techniques & Surgical Principles:

* Anesthesia: block local anesthetic techniques are used when possible. If not, infiltration may be used, but the solution should be injected at least 1cm away from the lesion. * Tissue stabilization: use fingers or clamps. * Hemostasis: gauze compresses (avoid high speed suction). * Incision: sharp scalpel * Extent of Tissue: obtain some normal tissue adjacent to the lesion is possible. * Handling of Tissue: use a traction suture through the specimen, not tissue forceps to avoid specimen trauma. * Specimen Care: after removal, the tissue should be immediately placed in 10% formalin solution that is at least 20x the volume of the surgical specimen. *No other solution is acceptable.

When treating patients with Renal Insufficiency and patients on Hemodialysis:

* Avoid using drugs metabolized or excreted by the kidneys. * Do not use NSAIDs, as they are nephrotoxic. * Perform oral surgery the day after dialysis. * Consult the patient's physician for possible prophylactic antibiotics.

Systemic Contraindications to Elective Surgery:

* Blood dyscrasias (i.e. hemophilia, leukemia) * Uncontrolled diabetes mellitus (controlled diabetes is NOT a contraindication to elective surgery). * Addison's Disease or any steroid deficiency * Fever of unexplained origin * Nephritis * Any debilitating disease * Cardiac disease (i.e. coronary artery disease, uncontrolled hypertension, and cardiac decompensation) can complicate exodontia. Usually a post-infarction patient is not subjected to oral surgery within 6 months of his infarction. However, emergency procedures can be performed, if the patient's physician has been consulted. Patients with these systemic conditions can be treated, but you need to consult with their physician before treatment. In most cases, these patients are best treated in the hospital by an oral surgeon.

• Common CHF Signs:

* Exertional dyspnea * Paroxysmal nocturnal dyspnea (patient wakes up gasping for air). Earliest & most common sign. * Peripheral edema (swollen ankles). * Cyanosis, Orthopnea (sitting or standing to breathe comfortably), and high venous pressure.

Minor Oral Surgical Procedures:

* Exodontia (routine extractions, multiple extractions, surgical extractions) * Treatment of dental infections (periapical, periodontal, pericornitis, facial infections (cellulitis). * Treatment of hard tissue (alveoplasty) and soft tissue (biopsy, benign lesions) pathologies.

FLUORIDE "TEST PEARLS":

* Fluoride does NOT reduce caries by making enamel harder, but reduces its rate of solubility. * Substantial reductions in dental decay in the young U.S. population are due to use of systemic & topical fluorides. * Fluoride concentration in body fluids is regulated by an equilibrium relationship between bone & urinary excretion. * Most fluoride is absorbed in the small intestine and excreted through the kidneys. * Fluoride passes the placental barrier slowly and is deposited in calcified tissues (i.e. bones). * At 1.0ppm fluoride is tasteless, colorless, & odorless. 1.0ppm is the optimum fluoride concentration in community drinking water. * U.S. Public Health Service sets the optimal fluoride level at 0.7-1.2ppm for public water. Optimal fluoride concentration in community drinking water depends on the average air temperature and water consumption. For temperate climates, the optimum is 1.0 ppm, and for warmer and colder climates the amount is adjusted from 0.7-1.2ppm, respectively. * Fluoride uptake on teeth depends on the amount of ingested or delivered fluoride in contact with the tooth during the day. * Fluoride is deposited in calcified tissues (skeletal), and normally accumulates slowly in bones as a person ages. * Proximal tooth surfaces derive the greatest benefit from fluoridation. * Dental fluorosis can occur in permanent and deciduous teeth. * Fluoride's cariostatic effect is produced during the calcification stage of tooth development. * Fluoride converts hydroxyapatite→fluorapatite to decrease enamel's solubility.

N2O Contraindications:

* Hypoxemia: abnormal deficiency of oxygen in arterial blood. * Respiratory disease: emphysema, asthma, upper respiratory obstruction. * Emotional instability and contagious diseases because cannot sterilize the entire tube. * N O is acceptable for a pregnant patient, but from a risk management point it may be 2 prudent not to use nitrous oxide on any pregnant patient.

One system describes the angulation of the long axis of the impacted 3rd molar w/r/t the 2nd molar's long axis:

* Mesioangular = 43% of all impacted teeth. * Vertical = 38% of all impacted teeth. * Distoangular = 6% of all impacted teeth. * Horizontal = 3% of all impacted teeth.

Daily use of fluoride gel in custom trays at home is indicated in these situations:

* Rampant enamel or root caries in any age group. * Xerostomia (can be due to medications or head/neck radiation therapy). * Use on abutment teeth under an overdenture. * Hypersensitive root surfaces.

Practice Techniques that may prevent a vasovagal syncopal reaction after local anesthetic admin:

* Slowly injecting the anesthetic solution. * Watching the patient's color change during the injection. * Using a topical anesthetic prior to administration of the local anesthetic. * Using a low concentration of vasoconstrictor. * Premedicating extremely anxious patients. * Sympathetic, but confident handling of the patient. * Proper patient preparation.

Impacted teeth are also classified based on their relationship to bone and tissue:

* Soft tissue impaction = tooth is impacted only by soft tissue. * Partial bony impaction = crown is partially covered rd by bone. * Full bony impaction = tooth is completely covered by bone.

Management of a Therapeutically Anticoagulated Patient:

* Surgery is deferred until the platelet-inhibiting drugs have been stopped for 5 days. * Always consult with the patient's physician to determine the safety of stopping the anti-coagulant for several days. Medical consultation is always indicated before surgery if the patient is taking anti-coagulant or anti-platelet therapy. * Take measures during surgery to help promote clot formation and retention. * Restart the drug therapy the DAY AFTER surgery if no bleeding is present.

Systemic Contraindications to Tooth Extractions:

* Uncontrolled diabetes mellitus * Uncontrolled cardiac disease and dysrythmias. * Uncontrolled leukemias and lymphomas. * Debilitating diseases. * Severe bleeding disorders. * Patients taking certain medications (i.e. immunosuppressives, corticosteroids, & cancer chemotherapeutic agents).

Cushing's Syndrome Symptoms:

* Upper body obesity, rounded face, increased fat around the neck, thinning arms and legs. * Children tend to be obese with slowed growth rates. * Skin becomes thin and fragile, and bruises easily and heals poorly. * Purplish pink stretch marks may appear on the abdomen, thighs, buttocks, arms, and breasts. * Bones are weakened, and routine activities like bending, lifting, or rising a chair may cause backaches, rib and spinal column fractures. * Most people have severe fatigue, weak muscles, high BP and high blood glucose levels. * Irritability, anxiety, and depression are common. * Women usually have excess hair growth on their face, neck, chest, abdomen, and thighs. Their menstrual periods may become irregular or stop. * Men have decreased fertility with diminished or absent desire for sex.

2. DIRECT PULP CAPPING-placed a calcium hydroxide base directly on a pulpal exposure. Favorable factors for direct pulp capping:

* Visual evidence of un-inflamed (pink) pulp tissue. * Absence of copious hemorrhage through the exposure. * No previous symptoms of pulpitis. * Small non-carious exposure (mechanical pulp exposure) * Clean cavity uncontaminated with saliva. * Direct pulp capping is very successful in immature teeth.

Local anesthetics affect the nerve membrane by

+ DECREASING the membrane's permeability to Na and DECREASING the membrane's excitability. Local anesthetics bind to inactivation gates of fast voltage gated sodium channels, stabilizing them in closed position, effectively prolonging the absolute refractory period. This + decreases Na membrane permeability, thus reducing membrane excitability. When membrane excitability is reduced below a critical level, a nerve impulse fails to pass through the anesthetized area.

If the communication opening is moderate sized (2- 6mm)

, a figure-eight suture is placed over the tooth socket.

Maximum allowable dose of EPI that can be administered to a cardiac-risk patient is In terms of local anesthetics, this is equivalent to either:

0.04mg. ► 1 cartridge (1.8cc) with anesthetic concentration of 1:50,000. ► 2 cartridges (3.6cc) with anesthetic concentration of 1:100,000. ► 4 cartridges (7.2cc) with anesthetic concentration of 1:200,000.

To prevent dental caries, the Centers for Disease Control & Prevention recommends at least how much fluoride

0.7ppm of fluoride be present in drinking water. The maximum fluoride amount is 1.2ppm.

A person who has been on SUPPRESSIVE DOSES OF STEROIDS will take up to

1 year to regain full adrenal cortical function. Guidelines to help determine if a patient's adrenal function is suppressed (if any doubt exists, consult with the patient's physician):

Koplik's Spots-

1-2mm yellowish-white oral lesions pathognomonic of measles, appearing usually as necrotic ulcers surrounded by a bright red margin on the buccal mucosa.

Agents Useful for Surgical Anesthesia: Methoxyflurane:

1-3% causes slow induction and recovery, good muscle relaxant, sensitizes the heart to catecholamines, a respiratory depressant, and good analgesic.

Septocaine Indicated for local, infiltrative, or conductive anesthesia in simple and complex dental and periodontal procedures. The onset of anesthesia after administration is

1-6min after injection. Complete anesthesia lasts about 1 hour for local infiltration and 2 hours for nerve blocks (longer duration than Prilocaine, but shorter than Marcaine).

A public health problem must meet these criteria:

1. A widespread condition or situation that is the actual or potential cause of morbidity and/or mortality. 2. Involves a perception by the public, public health authorities, and government that a public health problem is occurring.

American Society of Anesthesiologists (ASA) Classification of Patient Physical Status:

1. ASA-I: normal, healthy young patient with unremarkable medical history and no systemic disease. 2. ASA-II: patient with mild systemic disease or significant health risk factor (smoking, excessive alcohol use, obesity). 3. ASA-III: patient with severe disease that is not incapacitating. 4. ASA-IV: patient with severe systemic disease that is a constant threat to life. 5. ASA-V: a moribound patient who is not expected to survive without the operation. 6. ASA-VI: patient is declared "brain-dead" and their organs are being removed for donor purposes.

TWO TYPES OF CEMENTUM (functionally they are the same):

1. Acellular Cementum-contains no cells, and predominates on the coronal two-thirds of the root (found at the CEJ). It is thinnest at the CEJ. 2. Cellular Cementum-contains cementoblasts, inactive cementocytes, fibroblasts from the PDL, and cementoclasts. Found on the apical third of the root (apex), and is thicker to compensate for attritional wear of the occlusal/incisal surface and passive eruption of the tooth. Root hypersensitivity decreases as the tooth forms CELLULAR CEMENTUM.

EPT Responses:

1. Acute pulpitis-indicated by a lower than normal current, as acute inflammation mediators lower the pain threshold. 2. Chronic pulpitis-indicated by a response at a HIGHER current than normal. 3. Hyperemia-indicated by a LOWER than normal current, but a higher current than with an acute pulpitis. 4. Pulp necrosis/Abscess-indicated by no response at any current level.

NORMAL POST-EXTRACTION PROCEDURE:

1. All loose bone spicules and portions of the tooth, restoration, or calculus are removed from the socket and from the buccal and lingual gutters and tongue. 2. Compress the socket must with the fingers to reestablish the normal width present before the buccal plate was surgically expanded. *The natural recontouring of the residual ridge occurs primarily by resorption of the labial-buccal cortical bone. 3. Sutures are usually not placed unless the papillae have been excised, there is severe bleeding from the gingiva, or if the gingival cuff is torn or lose, only then would you place a suture over a single extraction socket. 4. Socket is covered with a gauze sponge folded and moistened slightly at its center with cold water. 5. Patient is instructed to bite down on the pressure dressing for 30-60 minutes. 6. Printed instruction sheet is given to the patient. *The most common cause of post-extraction bleeding is failure of the patient to follow post-extraction instructions. 7. Prescription for pain is given if the need is anticipated.

ROUTINE VITAL SIGNS:

1. BP (normal 120/80) 2. Pulse Rate (normal 72) 3. Temperature can be measured several ways: ♦ Oral with a glass, paper, or electronic thermometer (normal 98.6°F or 37°C). ♦ Axillary (under arm) with a glass, or electronic thermometer (normal 97.6°F or 36.3°C). LEAST accurate. ♦ Rectal or "core" with a glass or electronic thermometer (normal 99.6°F or 37.7°C). MOST accurate. ♦ Aural (ear) with an electronic thermometer (normal 99.6°F or 37.7°C).

CEPHALOMETRIC LANDMARKS:

1. Bolten (Bo)-the highest point in the upward curvature of the retrocondylar fossa of the occipital bone. 2. Baison (Ba)-the lowest point on the anterior margin of the foramen magnum, at the base of the clivus. 3. Articulare (Ar)-the intersection of 3 radiographic shadows, inferior surface of the cranial base, & posterior surfaces of the necks of the mandibular condyles. 4. Porion (Po)-the midpoint of the upper contour of the metal ear rod of the cephalometer. 5. Sphenooccipital synchondrosis (SO)-the junction between the occipital & basisphenoid bones. 6. Sella (S)-the midpoint of the cavity of the sella turcica. 7. Pterygomaxillary fissure (Ptm)-the point at the base of the fissure where the anterior & posterior walls meet. 8. Orbitale (Or)-the lowest point on the inferior margin of the orbit (floor of orbit). 9. Anterior nasal spine (ANS)-the tip of the anterior nasal spine. The point above the root the maxillary central. 10. Point A (Subspinale)-innermost point on contour of the mandible between the incisor and bony chin. 11. Point B (Supramentale)-innermost point on contour of the mandible between the incisor and bony chin. 12. Pogonion (Pog)-the most anterior point of the chin's contour (on the mandibular symphysis). 13. Menton (Me)-the most inferior point on the mandibular symphysis (the bottom of the chin). 14. Gonion (Go)-the lowest, most posterior point on the angle of the mandible with the teeth in occlusion. 15. Nasion (Na)-anterior point of the intersection between the nasal and frontal bones.

TYPES OF SHOCK:

1. Cardiogenic Shock-most commonly caused by MYOCARDIAL INFARCTION. Shock consists of a set of hemodynamic changes that diminish blood flow below a level that provides adequate oxygen for the metabolic needs of organs and tissues. Shock is circulatory collapse resulting from pump failure of the LEFT VENTRICLE, most often caused by a massive myocardial infarction. 2. Hypovolemic Shock-produced by a reduction in blood volume due to severe hemorrhage, dehydration, vomiting, diarrhea, or fluid loss from burns. 3. Septic Shock-due to severe infection caused by endotoxin from gram (-) bacteria. 4. Neurogenic Shock-results from severe injury or trauma to the CNS. 5. Anaphylactic Shock-occurs from a severe allergic reaction.

5 Major Areas Discussed when taking Patient Medical History:

1. Chief complaint 2. History of present illness 3. Specific drug allergies 4. Review of systems (heart, liver, kidney, brain) 5. Nature of systems

• 4 Classes of Cleft Lip:

1. Class I: a unilateral notching of the vermillion NOT extending into the lip. 2. Class II: unilateral notching of the vermillion, but the cleft extends into the lip, but NOT to the nose floor. 3. Class III: a unilateral notching of the vermillion, but the cleft extends into the lip and floor of the nose. 4. Class IV: any bilateral clefting of the lip whether incomplete notching or complete clefting.

4 Classes of Cleft Palate:

1. Class I: involves only the soft palate. 2. Class II: involves the soft and hard palates, but not the alveolar process. 3. Class III: involves the soft and hard palates, and the alveolar process on one side of the premaxilla. 4. Class IV: involves the soft palate and continues through the alveolus on both sides of the premaxilla

Emergency Treatment of Fractures of Permanent Teeth with Immature Apices:

1. Class I: smooth enamel edges, restore the tooth. 2. Class II: apply calcium hydroxide to exposed dentin and restore the tooth with a permanent restoration. 3. Class III: immediately after injury, apply calcium hydroxide over exposure and place a temporary restoration. If the exposure is large or the injury was several hours or days ago, perform a calcium hydroxide pulpotomy. Once the apex closes, do a pulpectomy. 4. Class IV: do a calcium hydroxide pulpotomy. Once the apex closes, do a pulpectomy.

STAGES OF SHOCK:

1. Compensatory stage-the early stage where compensatory mechanisms (↑HR and peripheral resistance) maintain perfusion to vital organs. 2. Progressive stage-metabolic acidosis occurs and compensatory mechanisms are no longer adequate. 3. Irreversible/refractory stage-organ damage occurs and survival is impossible.

3 Classes of Recurrent Aphthous Ulcers:

1. Recurrent aphthous minor- < 1cm in diameter, are common, last over 2 weeks, and heal without scarring. 2. Recurrent aphthous major- > 1cm in diameter, are much less common, last over 2 weeks, and heal with scarring. 3. Recurrent herpetiform-consists of clusters and ulcers. Patients with frequent recurrences should be screened for diabetes mellitus or Bechet's Syndrome.

Routine Pre-Operative Tests for a patient being admitted to the hospital for surgery:

1. Complete blood count (CBC) that includes an evaluation of the hemoglobin and hematocrit indices. 2. Total WBC count with a differential count. 3. Assessment of circulating platelets 4. Urinalysis (a gross and microscopic urinalysis). 5. Patients scheduled for general anesthesia should have a chest x-ray (patients > 40yrs should also have an E.K.G.)

Aggression:

1. Constructive Aggression-an act of self-assertiveness in response to a threatening action for purpose of selfprotection and preservation. 2. Destructive Aggression-an act of hostility unnecessary for self-protection or preservation directed toward an external object or person. 3. Inward Aggression-destructive behavior directed against oneself. 4. Aggressive personality-a personality with behavior patterns characterized by irritability, tantrums, destructiveness, or violence in response to a frustration.

RESEARCH STUDY VARIABLES:

1. Dependent variable-the variable whose value depends on those of others (i.e. in the formula x = 3y + z) x is the dependent variable. 2. Independent variable-the variable whose value determines the other variable values (i.e. x = 3y + z) y & z are the independent variables.

The employee's medical record must include:

1. Employee name and SSN. 2. Copy of the employee's hepatitis B vaccination status (dates and medical records regarding the employee's ability to receive the vaccination). 3. Medical opinions and evaluations. 4. Test results 5. Details about exposure incidents (routes of exposure and how the exposure occurred).

Two additional problems often experienced when using alloplastic materials for genioplasty are:

1. Erosion of the chin prominence contiguous with the implant. 2. Unpleasant sensation in the implant region when exposed to cold temperatures.

If a child is returns for a periodic evaluation and prophylaxis and you find that two of the four sealants placed at the prior re-care were lost, it was most likely due to one or more of the following:

1. Etchant was not rinsed thoroughly off the tooth surface. 2. Dry field was not maintained and the tooth surface was contaminated with saliva after etching. 3. Contaminated air supply to air/water syringe. 4. Tooth was not thoroughly dried prior to applying the sealants.

TOOTH FRACTURES Diagnostic Aids to Identify Vertical Root Fracture:

1. Fiberoptic light for transillumination. 2. Wedging the tooth in question and take an x-ray. 3. Persistent periodontal defects in an otherwise healthy tooth. 4. Have patient bite forcefully on a bite stick (tooth slooth).

SPEED of inhalation induction of anesthetic effects depends on:

1. Gas solubility (the primary factor). The more soluble the gas in blood, the slower rate of induction. 2. Inspired gas partial pressure. 3. Ventilation rate. 4. Pulmonary blood flow. 5. Arteriovenous concentration gradient.

Cardinal Rules of Tooth Eruption:

1. Girls teeth erupt before boys. 2. Mandibular teeth before maxillary. 3. Slender teeth before stocky (anterior before posterior teeth).

Technique for Applying Sealants:

1. Gross debridement of enamel surfaces (use plain flour or pumice). Do not use anything that contains fluoride because it inhibits etching. Rinse thoroughly. 2. Isolate teeth with a rubber dam or cotton roll to keep the tooth dry. Dry isolated teeth thoroughly. 3. Acid-etch the teeth with phosphoric acid (30-50% concentration). Apply etchant by gentle dabbing of the enamel surface. Etching time for permanent teeth is 1 minute (2 minutes for primary teeth). 4. Rinse and dry thoroughly. A properly etched surface appears dull and chalky. 5. Apply sealant (procedure differs with the method of polymerization). 6. Evaluate results, floss the tooth, and check occlusion.

A CBC test includes:

1. Hematocrit: the volume % of RBC in whole blood. Normal male (45-50%), normal female (40-45%). Hematocrit is the amount of your blood that is occupied by red blood cells (its like chocolate milk; how much is chocolate vs. milk). Hematocrit is the volume % of RBC in whole blood. Normal male (45-50%) & normal female (40-45%). *The minimal acceptable value of hematocrit is 30% for elective surgery. 2. Hemoglobin: normal men (14-18g/dL) and normal women (12-16g/dL). 3. Total Leukocytes (WBC): normal (5000-10,000/mm ); dental infection (15,000-20,000/mm ). 4. Total Erythrocytes (RBC): normal men (4.5-6.0) x 10 6 /mm 3 ; normal women (4.3-5.5) x 10 3 6 /mm 3 . 3

5 HEALING PHASES OF AN EXTRACTION SITE:

1. Hemorrhage and blood clot formation. 2. Clot organization by granulation tissue. *Glucocorticoids have the greatest effect on granulation tissue by retarding healing. 3. Replacement of granulation tissue by C.T. and epithelialization of the site. 4. Replacement of C.T. by fibrillar bone. 5. Recontouring of the alveolar bone and bone maturation.

CEMENTUM contains 2 Types of Collagen Fibers:

1. Sharpey's Fibers-the terminal portions of PDL principal fibers embedded in cementum (run PERPENDICULAR to cementum) on one end and alveolar bone on the other. 2. Collagen Fibers-found within the cementum itself running PARALLEL to the cementum surface. Found in gingival C.T. Function to provide firmness to attached gingival tissue and underlying CEMENTUM & ALVEOLAR BONE.

PARENT TYPES:

1. Manipulative Parents: have excessively demanding attitudes that usually start with appointment times and can extend to directing the course of diagnosis or treatment. 2. Overprotective Parents: insist on remaining with the child in the dental operatory, regardless of the situation or child's age. Pointing to the lack of apprehension of a young child and the importance of establishing a one-toone relationship between the child and dentist, usually satisfies most overprotective parents. Overprotective parents usually have children who are shy, docile, and manageable. 3. Hostile Parents: question the necessity for treatment usually due to distrust, not curiosity. 4. Neglectful Parents: fail to maintain appointments, miss recall visits, or do not oversee the child's oral hygiene.

3 Muscle Groups Displace the Mandibular Condyles:

1. Masseter, medial pterygoid, & temporalis ELEVATE the mandible during mastication and cause upward displacement of the proximal segment. 2. Digastric, mylohyoid, geniohyoid, & lateral pterygoid DEPRESS the mandible and displace the distal fractured segment inferiorly and posteriorly. 3. Lateral pterygoid is responsible for forward displacement of the condylar head when the condyle neck is fractured.

Performing a Mixed Dentition Analysis:

1. Measure the M-D diameter of the mandibular incisors and ADD them together. 2. Measure the space available for the mandibular incisors. 3. Subtract #1 from #2 (a negative number indicates CROWDING in the incisor region). 4. Measure the space available for the canine and premolars on each side of the arch. 5. Calculate from the prediction table the size of the canine and premolars. 6. Subtract #6 from #5 on each side (again, a negative number indicates CROWDING). 7. By this step, there are 3 numbers that are added: (a (-) number = crowding; a (+) number = space). 1. number for incisor crowding or excess space. 2. number for the right canine and premolar crowding or excess space. 3. number for the left canine and premolar crowding or excess space.

CONTRAINDICATIONS for ROOT CANAL THERAPY (RCT):

1. Non-restorable or non-strategic tooth (i.e. tooth not in occlusion). 2. Poor-to-Hopeless periodontal support. 3. Vertical root fracture. 4. Extensive internal or external resorption. 5. Canal unsuitable for instrumentation or surgery (i.e. broken instruments, dentinal sclerosis, sharp dilacerations or extensive calcification).

TESTS TO MEASURE CLOTTING MECHANISMS: the most important consideration to rule out hemorrhagic disorders is history.

1. Normal Prothrombin Time (PT): < 11 sec (+ 2 sec). PT is the best test to determine if oral surgery can be safely performed on a patient taking COUMADIN (or any oral anti-coagulant). To be a good candidate for surgery, PT time should be within 5-7 seconds of the control sample. 2. Partial Thromboplastin Time (PTT): detects coagulation defects of the intrinsic system. The basic test for hemophilia. Normal value is 25-36 seconds. 3. Bleeding Time (Ivy Method): normal value is < 9 minutes. 4. Platelet Counts: normal value 150,000-450,000 per mm of blood. Minimal platelet count for oral surgery is 50,000.

Types of Questions: These are all VERBAL communication behaviors.

1. Open-Ended Questions: requests information in the patient's own words and specifies a general content area. Ex: "How are you doing with your brushing and flossing?" When presenting treatment plans always use open-ended questions (questions that cannot be answered with a simple "yes" or "no"). Open-ended questions are the most effective in helping patients to express their understanding of the proposed treatment plan. When reviewing oral hygiene, have the patient repeat what you have gone over with them. 2. Direct Questions: questions that ask the patient for a specific bit of information. Ex: "Is it easier to hold the brush this way?" 3. Probing Questions: questions that ask for more specific information that the patient offers spontaneously. Ex: "What else did you notice about your gums?" 4. Laundry-List Questions: questions that ask the patient to respond from among a list of alternative adjectives or descriptions provided. Ex: "Is the pain throbbing, aching, dull, or sharp?" 5. Leading Questions: questions that entice a patient to answer a specific way. Ex: "You are not afraid of needles, are you?" 6. Facilitating Questions: questions that encourage the patient to say more without specifying an area or topic. Ex: "How are you?"

Any school-based program to promote oral health should have these fundamental components:

1. Oral health services: involves preventive procedures, health screening and treatment, referral, and follow-up. 2. Health instruction: includes personal and community health topics. 3. Healthy environment: attention to all aspects of the school environment that could affect the health of students or school personnel. The more successful school-based programs use a high degree of active involvement of the participants.

There are 4 major fields of behavior:

1. Personal Social-is usually a function of environment, work, play, and society. 2. Motor-starting point to access maturity. 3. Language-vocalization, words, sentences, facial, and manual movements. 4. Adaptive-use of motor capacity and solutions to practical behavior.

Porphyrias are characterized by 3 major findings:

1. Photodermatitis (light sensitivity causing rashes). 2. Neuropsychiatric complaints. 3. Visceral complaints (abdominal pain, cramping).

Reasons Vasoconstrictors (EPI) are placed in Local Anesthetics:

1. Prolong the duration of action of the local anesthetic (most important reason). 2. Reduce the toxicity because less local anesthetic is necessary 3. Reduce the rate of vascular absorption by causing vasoconstriction. 4. Help make the anesthesia more profound by increasing the concentrations of the local anesthetic at the nerve membrane.

Conditions that require Antibiotic Prophylaxis prior to oral surgery:

1. Prosthetic heart valve 2. Rheumatic valve disease 3. Most congenital heart malformations

EPT is NOT reliable in these circumstances:

1. Pus-filled canal or a nervous patient (gives a false +). 2. Recent dental trauma, an insulating restoration, or wearing gloves (gives a false (-) response). Do not wear gloves when using the EPT. 3. Secondary dentin deposits, moisture contamination, immature tooth (open apex), patient taking analgesics, improper application, or weak EPT batteries.

Concepts that relate to quality assurance:

1. structure-the layout and equipment of a facility. 2. process-involves the actual services that the dentist and assistant perform for patients, and how well they perform. 3. outcome-the change in health status that occurs as a result of the care delivered

FRENECTOMY SURGICAL TECHNIQUES:

1. Simple excision and Z-plasty: are effective when the mucosal and fibrous tissue band is relatively narrow. These techniques relax the pull of the frenum. 2. V-Y plasty (localized vestibuloplasty)-often preferred when the frenal attachment has a wide base. This technique is good for lengthening tissue and usually results in less scarring.

Diagnostic tests indicated for recently traumatized teeth:

1. Soft tissue exam to observe lips, face, tongue, etc. 2. Hard tissue exam to visually look and then palpate the injured tooth and alveolus to reveal the extent of tooth mobility, any alveolar fractures, and areas of inflammation. Check for occlusal disharmonies to help detect tooth displacements and jaw fractures. 3. Radiographic examination to reveal tooth displacement, root fractures, previous RCT, periapical radiolucencies. 4. Other diagnostic tests. EPT (pulp vitality testing) is CONTRAINDICATED since the traumatized pulp undergoes temporary paresthesia thus giving a false reading. A percussion test is NOT usually performed since it is painful. 5. Observe adjacent and opposing teeth for injury.

7 Steps in the Educational Process:

1. Step 1 (Recognizing Needs)-the dentist recognizes educational needs as he checks for treatment needs. Then, the dentist helps the patient recognize his own needs. 2. Step 2 (Expressing Needs)-the dentist records educational needs and helps the patient state his own needs. 3. Step 3 (Stimulating Motivation)-motivation arouses and maintains interest. The dentist may appeal to inner needs or use artificial stimuli. 4. Step 4 (Setting Goals)-goals may be short-term or longterm guides to activity. The goals must be meaningful, attractive, and attainable. 5. Step 5 (Acting to Achieve Goals)-activity is necessary to learning. The activity should be directed toward specific goals. 6. Step 6 (Reinforcing Learning)-review and repetition aid in retention of learning. 7. Step 7 (Evaluating Results)-aids in judging what the patient has learned and how effective the dentist's teaching has been. This can help clarify or redefine the goals. Each learning situation will not follow these steps in this exact sequence, but most learning situations will include all of these steps in some form.

Fluoride Mechanisms to Inhibit Caries:

1. Topical effect of constant infusion of a low fluoride concentration into the oral cavity ↑ enamel remineralization. • One of the most effective means of reducing caries activity is by decreasing the solubility of enamel to the acid attack of bacteria. Enamel demineralization begins when the pH reaches 5.5 (the pH threshold level at which enamel demineralization occurs). • The main anti-cariogenic effect of fluoride is by enhancing remineralization. Its secondary role is to decrease demineralization by increasing the resistance of the tooth's outer surface (enamel). Lastly, the least understood property of fluoride are its antimicrobial properties.

Retention is necessary because:

1. gingival and periodontal tissues are affected by orthodontic tooth movement, and require time for reorganization when the appliances are removed. 2. changes produced by growth may alter the orthodontic treatment result. 3. teeth may be in an inherently unstable position after treatment so that soft tissue pressures constantly produce a tendency for relapse. Thus, gradual withdrawal of an orthodontic appliance is of no value. The only possibilities are accepting relapse or using permanent retention. Fortunately, only the first two reasons apply to most orthodontic patients, and maintaining the teeth's position until remodeling of the supporting tissues is complete and growth has stopped allows a stable orthodontic result without further retention.

Clinically, the general order of loss of nerve function from a local anesthetic is:

1. pain 2. temperature (cold and warmth). 3. touch & pressure. 4. proprioception. 5. skeletal muscle tone (motor). Nerves regain their function in the reverse order.

Components of the Health Belief Model:

1. person's own perception of susceptibility to a disease or condition. 2. likelihood of contracting that disease or condition. 3. person's perception of the severity of the consequences of contracting the condition or disease. 4. perceived benefits of care and barriers to preventive behavior. 5. internal or external stimuli that result in appropriate health behavior by the person.

Removable Orthodontic Appliance Components:

1. retentive component-retains the appliance in function, and consists of various clasps (i.e. Adam's crib). 2. framework (baseplate)-made of acrylic and provides anchorage. 3. tooth-moving elements-are either springs or screws. 4. anchorage component-resists force of active components (i.e. acrylic base-plate). Anchorage components can also cause desired or undesired tooth movements. 5. active components (tooth moving components)springs, screws, or elastics.

Indirect Bracket Bonding Procedure:

1. take an accurate alginate impression and pour it with orthodontic model stone to be used as a working model. 2. draw vertical lines on the teeth to aid in bracket placement, and a separating media is applied. 3. brackets are then loaded with a filled resin paste and cured. 4. after its initial set, individual positioning of a tray with silicone is prepared by applying it over the bracketed teeth on a plaster model. 5. entire set-up is placed in warm water to dissolve the separating media. 6. silicone tray is then removed from the plaster model with brackets embedded in it. 7. brackets are cleaned under running water making sure that pads have cured resin. 8. enamel is etched, conditioned, and unfilled resin is applied. Unfilled resin is also applied to cured resin on the base of the bracket pads. 9. silicone tray with embedded brackets is then positioned on the teeth being bonded and held in position until the initial set of unfilled resin is reached.

Abnormal reductions in the number of platelets are caused when abnormalities occur in any of 3 processes:

1. ↓ platelet production by bone marrow. 2. ↑ trapping of platelets by the spleen. 3. faster than normal destruction of platelets.

most common sequela of fractures.

A FAT embolism is most often a sequela of fractures.

ECTODERMAL DYSPLASIA- symptoms

Atrophic skin, defective hair, partial anodontia, & hypoplastic sweat glands.

Employers must ensure that ALL employees with occupational exposure participate in a training program at no cost, during working hours, with material appropriate to the education, literacy, and language of the employee. Training is critical to OSHA compliance and must include:

A copy of the standard and explanation of its contents. • A general explanation of the epidemiology, symptoms, and modes of transmission of bloodborne diseases. • An explanation of the office's exposure control plan, and how the employee can obtain a copy of it. • Information about the office's protocol for gloves, gowns, masks, and eyewear (or faceshields), including the type of equipment available, its location and when it is to be used, and how it is to be removed, handled, decontaminated, and disposed. • An explanation of how to recognize tasks that may involve occupational exposure and how to prevent or minimize such exposures (i.e. how to use a sharps container properly). • Information on the hepatitis B vaccine, including efficacy, safety, how it is administered, vaccination benefits, and that the vaccination is free of charge. • Information on how to handle emergencies involving occupational exposure (what actions to take and who to contact). • An explanation of the office protocol for handling exposure incidents like injuries from contaminated sharps, how to report the incident, follow-up medical care, and evaluation. • An explanation of the biohazard labels used in the office. • An opportunity for interactive questions and answers with the trainer.

The principal feature of a sealant required for success is

ADEQUATE RETENTION. Sealant success is highly depends on obtaining and maintaining intimate adaptation of the sealant to the tooth surface to hopefully seal it. Research shows caries protection is 100% in pits and fissures that remain completely sealed.

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)- Dental Management (ADHD):

ADHD children typically do not require special treatment. However, SHORT-MID MORNING appointment after breakfast and taking RITALIN works best. Maintain eye contact, use tell-show-do, and let child assist and be involved during dental treatment (holding the suction, just as you would with most children).

If a topical fluoride is used in conjunction with a pit and fissure sealant, the fluoride is applied

AFTER the sealant. When topical fluoride is used, it is applied either before the conditioner (acid etchant) or after the sealant. When cleaning the tooth prior to application, do not use glycerine-containing products. Applying fluoride after the conditioner decreases the bond strength.

The optimal concentration of fluoride for community water depends on

AIR TEMPERATURE.

Standard (formerly "Universal") infection control precautions for bloodborne pathogens requires changing gloves BETWEEN

ALL PATIENTS. Gloves and gowns are required when you reasonably anticipate skin contact with blood or other potentially infectious materials, including saliva. Thus, if you reasonably anticipate the forearms will be spattered with saliva or blood, then the forearms must be covered.

MAXILLARY TEETH ROOT ANATOMY: Maxillary Incisors & Canines:

ALL have 1 root, 1 canal, & a distal axial inclination. Thus, when penetrating along the long axis of the tooth, the bur must be slightly angled toward the distal surface to avoid perforation of the mesial portion of the root.

Sterilization is the use of physical or chemical procedures to destroy

ALL microbial life (including bacterial endospores). Sterilization refers to the absence of all living forms.

MAXILLARY TEETH ROOT ANATOMY: Maxillary 1 Premolar:

ALMOST ALWAYS has 2 canals. ~60% have 2 roots (1 B, 1 Palatal) each with 1 canal. The buccal & palatal roots can be completely separate, or twin projections rising from the root's middle 1/3 to the apex (this is more common). These 2 roots are usually equal in length from apex to cusp. However, the palatal root and canal may be wider.

MAXILLARY TEETH ROOT ANATOMY: Maxillary Central Incisor:

ALWAYS has 1 root & 1 canal. The root is bulky with a slight distal axial inclination, but rarely has a dilacerations. The pulp chamber access opening is OVALTRIANGULAR (it is somewhat triangular, as opposed to oval). The triangle base will be the facial, and triangle apex is lingual. If it is not triangular, then it must be oval. Pulpitis can cause referred pain to the FOREHEAD.

MAXILLARY TEETH ROOT ANATOMY: Maxillary Canine-

ALWAYS has 1 root & 1 canal, and is the LONGEST tooth in the maxillary arch. The access opening is OVAL. Pulpitis can cause referred pain to the NASOLABIAL AREA.

NaOCl is a good tissue solvent, has some antimicrobial effects, and acts as a lubricant for root canal instrumentation. NaOCl is toxic to vital tissue so

ALWAYS use a rubber dam.

21. ACETAMINOPHEN (TYLENOL) is an

ANALGESIC AND ANTIPYRETIC, but is NOT an antiinflammatory (NSAID) and DOES NOT AFFECT PLATELET AGGREGATION (CLOTTING).

Nitrous oxide is a gas used as an

ANESTHETIC in SURGERY to provide light anesthesia and is delivered in various concentrations with oxygen. Nitrous oxide alone does NOT provide deep enough anesthesia for major surgery, so it is supplemented with other anesthetic agents. It is often given for induction of anesthesia, preceded by the administration of a barbiturate or analgesic narcotic. Induction and recovery are rapid. *Sedation can be reversed rapidly when using inhalation as the route of administration of drugs.

Acute Osteomyelitis-Radiographically:

AO progresses rapidly and demonstrates little radiographic evidence of its presence until it has developed for at least 1-2 weeks. At that time, diffuse lytic changes in bone appear. A "moth-eaten" radiolucency is evident.

BONE GROWTH occurs ONLY BY

APPOSITIONAL GROWTH which below the covering periosteal layer of bone. Periosteum consists of a fibrous outer layer & a cellular inner layer of osteoblasts, which lay down bone. Due to its rigid structure, interstitial growth is not possible.

The MAIN FUNCTION of CEMENTUM is to

ATTACH & ANCHOR THE PDL PRINCIPAL FIBERS TO THE ROOT from the surrounding alveolar bone. Additional Cementum Functions: 1. Compensates for the loss of tooth surface due to occlusal wear by apical deposition of cementum throughout life. 2. Protects the root surface from resorption during vertical eruption and tooth movement. 3. Reparative function that allows reattachment of C.T. after periodontal treatment.

tertiary compounds that penetrate the CNS more readily than quaternary

Atropine, Benztropine, Scopolamine, Dicyclomine, Trihexyphenidyl are tertiary compounds (these penetrate the CNS more readily than quaternary (i.e. ionized) compounds. However, at normal doses Atropine penetrates the CNS poorly.

Avoid what when taking theophylline

Avoid using aspirin, NSAIDs, barbiturates, narcotics, and erythromycin (if the patient is taking Theophylline).

The MOST PREVALENET characteristic of Class I malocclusion is

CROWDING due to insufficient alveolar arch length to accommodate all teeth in ideal alignment and in a good sagittal position. When a crowding diagnosis is made (crowding > 4mm in the mandible), extractions are often required to attain an excellent, stable result. However, the decision to extract teeth depends greatly on performing a mandibular space analysis which is usually performed (referral) to the orthodontist.

Premature loss of a primary maxillary second molar usually produces a

Class II molar relationship on the affected side. DISTAL SHOE SPACE MAINTAINER may help alleviate this potential problem. This maintainer extends backwards from the primary first molar crown, and subgingivally to the mesial line of the unerupted first permanent molar, thus preventing mesial migration.

Acute Osteomyelitis-clinical symptoms

Clinically, the afflicted person has severe pain, temperature/fever, and regional lymphadenopathy. The teeth in the involved area are loose and sore making eating difficult, if not impossible.

Closure of the apices of deciduous teeth occurs how long AFTER eruption.

Closure of the apices of deciduous teeth occurs 18 months AFTER eruption.

The only reliable clinical evidence that secondary dentin has formed is

DECREASED TOOTH SENSITIVITY (seen a few weeks after placing a filling). When dentinal tubules become completely calcified, dentin is insensitive.

As PULP ages, the number of reticulin fibers

DECREASES (pulp becomes less cellular and more fibrous), and the size of the pulp decreases due to the continued deposition of dentin. However, as pulp ages, collagen fibers & calcifications within the pulp (denticles or pulp stones) both increase.

In the head and neck, all lymph ultimately drains into the

DEEP CERVICAL LYMPH NODES which form a chain along the course of the internal jugular vein, from the skull to the root of the neck. These nodes receive lymph from neighboring structures and from all other regional lymph nodes in the head and neck. The efferent lymph vessels join to form the jugular lymph trunk (this vessel drains into either the thoracic duct or right lymphatic duct).

9. The panorex of a 30 year-old female reveals a painless, unilocular radiolucency with well-defined margins around the CROWN of an impacted permanent mandibular 3 molar. This is most likely a

DENTIGEROUS CYST (FOLLICULAR CYST).

NUMBER ONE cause of KIDNEY DISEASE, responsible for 40% of all kidney failures is

DIABETES. High BP is the 2 cause (25%). Another form of kidney disease is Glomerulonephritis (a general term for many types of kidney inflammations). Genetic diseases, autoimmune diseases, birth defects, and other problems can also cause kidney disease.

The most common cause of restricted mandibular movement is

DISC INTERFERENCE DISORDERS, which change the relationship of the disc and condyle.

Painful and limited opening (< 30mm) WITHOUT SOUND is caused by

DISK DISPLACEMENT WITHOUT REDUCTION. Normal, full opening is 4050mm as measured from the maxillary and mandibular incisal edges.

CLICKING and POPPING when opening is caused by

DISK DISPLACEMENT WITH REDUCTION.

In most Class II, Division I malocclusions, the body of the mandible and its superimposed dental arch are in a

DISTAL relationship to the maxilla, and the maxillary incisors are usually in a labial axial inclination. Also, the relationship of the maxillary first molars and canines to their mandibular counterparts is such that the DB cusp of the maxillary first molar occludes in the buccal developmental groove of the mandibular first molar, and the maxillary canines occlude mesial to the mandibular canines. Besides the labial-axial inclination of the maxillary incisors (overjet), various aberrations in the individual alignment of the teeth (i.e. crowding) can be superimposed on this class.

Studies show solvent softening

DOES NOT ultimately result in a better apical seal. Thus, this time consuming procedure is not used if tugback (slight resistance to dislodgement) is achieved. The gutta-percha cone should also have a definite apical seat (should not be able to be pushed further apically).

Principal therapeutic uses of anti-cholinergic drugs in dentistry:

Decrease saliva flow during dental procedures (anti-sialogue) and the secretion from respiratory glands during general anesthesia. Atropine is the most commonly used anti-cholinergic drug for these purposes. Scopolamine penetrates the CNS more readily than Atropine, but is rarely used. ► A patient pre-medicated with Atropine will exhibit mydriasis (dilated pupils).

CRETINISM Dental Findings:

Dental Findings: underdeveloped mandible, overdeveloped maxilla, enlarged tongue causing malocclusion like anterior open bite and flared anterior teeth, delayed tooth eruption, and longer retention of the deciduous teeth.

Child Abuse:

Dentists are morally, ethically, and legally obligated to report a suspected case of child abuse. Once an injury or a suspicious nature is observed, the dentist's first and immediate responsibility is to protect the child. Reports should be made to the designated state agency (Social Services or Police). Dentists must familiarize themselves with the exact procedures to be followed in their states.

Serum glucose is increased in

Diabetes Mellitus, adrenal tumors, ↑ growth hormone, and liver dysfunction.

*Serum calcium is decreased in

Diabetes Mellitus.

ORAL SURGERY CONDITIONS & TREATMENT CONSIDERATIONS

Dyspnea-the unpleasant sensation of difficulty breathing. Apnea-transient cessation or absence of breathing. Hypercapnea-excess CO Hypocapnea-below normal CO 2 in arterial blood. 2 in arterial blood. Hyperapnea-abnormally deep and rapid breathing. Respiratory arrest-permanent cessation of breathing (unless corrected). Hyperventilation-increased pulmonary ventilation in excess of metabolic requirements. Hyperventilation results in loss of CO from the blood (hypocapnea), thus causing a decrease in BP and sometimes fainting. 2 Hypoventilation-underventilation in relation to metabolic requirements. Hypoventilation results in an increased level of CO 2 in the blood (hypercapnea).

Conditions associated with multiple supernumerary teeth:

Gardener's syndrome, Down's syndrome, Cleidocranial dysplasia, & Sturge-Weber Syndrome.

Hyperemic teeth respond on a lower level of current on the

EPT (electric pulp tester) than a normal tooth.

Relative to the primary mandibular canines, the permanent mandibular canines

ERUPT IN A FACIAL (LABIAL) direction or are often right in line with the primary canines. If there are eruption problems, these teeth can be displaced either lingually or labially, but they are usually displaced LABIALLY if there is not enough room to accommodate them within the arch. The mesial inclined plane of the primary maxillary canine articulates with the distal inclined plane of the primary mandibular canine. This is the normal relationship.

The best way to palpate the posterior aspect of the mandibular condyle is

EXTERNALLY over the posterior surface of the condyle with the mouth open. The TMJ should be evaluated for tenderness and noise. When checking for joint noises (clicking and crepitus), the joint is palpated laterally (in front of the external auditory meatus) while the patient opens and closes the mandible.

BONE FORMS by

Endochondral ossification or Intramembranous ossification. Bone formation begins in the embryo where mesenchymal cells differentiate into either fibrous membrane or cartilage. Do not confuse bone growth & bone formation. Once bone is formed, it then GROWS by appositional growth (growth by the addition of new layers on top of previous formed layers). This leads to two paths of bone development.

SCARLET FEVER- clinical symptoms

Enlargement of fungiform papillae extending above the level of the white desquamating filiform papillae gives the appearance of an "unripe strawberry". During the course of scarlet fever, the coating disappears and the enlarged red papillae extend above a smooth denuded surface, giving the appearance of a red strawberry or raspberry.

LYMPHANGIOMA- • Treatment:

Excisional biopsy.

VERTICAL ROOT FRACTURE- Treatment:

Extraction or endodontic surgery (ex: apicoectomy).

After IV administration of an ultra-short acting barbiturate (i.e. Brevital or Pentothal), the last tissue to become saturated as a result of redistribution is

FAT (because it is not as vascular as liver, brain, and muscle tissue).

~40% of maxillary 1 premolars, only 1 root is present (usually with two separate canals). In cross section at the cervical line, the canal is shaped like a

FIGURE EIGHT (ELLIPSE). The access is a THIN OVAL. Be careful not to perforate on the mesial (due to the mesial concavity).

It is important to correct posterior crossbites (which are related to the TRANSVERSE PLANE OF SPACE) and mild anterior crossbites in the

FIRST STAGE of treatment, even if the permanent 1 molars have not erupted. Severe anterior crossbites st are usually not corrected until the SECOND STAGE of conventional treatment.

Small, myelinated nerve fibers that conduct pain and temperature sensations are affected

FIRST, then touch, proprioception, and skeletal muscle tone.

Most effective method to reduce dental caries in the general population is

FLUORIDATION of the communal water supply. The optimal concentration in the communal water supply varies with mean annual temperature, but is 1ppm in most states. Fluoride supplements are recommended if the water fluoride content is < 0.7ppm. Fluoride supplements are normally NOT indicated after age 13.

The most commonly used allogenic bone is

FREEZEDRIED. These grafts consist of freeze-dried bone and freeze-dried decalcified bone from another source (human cadaver bone).

CPR GUIDELINES

First step when initiating CPR is establish unresponsiveness by shaking the patient and shouting "are you OK", then use the "ABCs": Process is CAB: 1. Circulation: check the carotid pulse. 2. Airway: open the airway with the head tilt-chin lift. This is the easiest technique in most medical emergencies. 3. Breathing: look, listen, and feel.

For restorative dentistry, what is usually all that is needed to treat a child who fears the dentist.

For restorative dentistry, N2 O and local anesthesia is usually all that is needed to treat a child who fears the dentist.

FUNCTIONAL APPLIANCES:

Frankel, Bionator, Clark's Twin Block, Herbst, & Activator. Functional appliances are classified as either tissue borne or tooth borne.

INTELLECTUAL DISABILITY (MENTALLY CHALLENGED): other

Give a tour to the patient before attempting any treatment. Introduce the patient to the office personnel. Give only one instruction at a time. Reward the patient with compliments after the procedure is successfully completed. • Dentist should assess the degree of developmental disability by consulting with the patient's physician before starting dental treatment.

39. The most common cause of HYPOTHYROIDISM in the U.S., affecting more women then men is the autoimmune disorder

HASHIMOTO'S DISEASE (THYROIDITIS).

Viral concentrations detected in hepatitis C virus infected patients range between numbers for

HBV and HIV. Thus, we target the most infectious bloodborne pathogen with our infection control standards.

Sterilization involving the use of

HEAT is recommended for all instruments used in the mouth. Heat is the most efficient, reliable, and biologically monitorable sterilization method. During a routine cycle using an autoclave, unsaturated chemical vapor sterilizer, or dry-heat unit, CELL DEATH OCCURS because the heat inactivates critical enzymes and other proteins within microbial cells.

Dentists must provide "at-risk" employees with protection from

HEPATITIS B. The federal standard for occupational exposure to bloodborne pathogens requires employers to provide the Hepatitis B vaccination. Employers must offer the vaccination (and boosters if these are recommended in the future) to all employees who have occupational exposure at no cost to the employees. The employee may refuse the vaccination, but OSHA will require proof that an employee has refused.

23. GINGIVECTOMY contraindications are

HIGH CARIES INDEX, INFRA-BONY ABSCESS, & NARROW ZONE OF ATTACHED GINGIVA.

Important: a granuloma or cyst is ONLY differentially diagnosed via

HISTOLOGIC EXAMINATION.

Types of Managed Care Practices:

HMO, PPO, IPA (Independent Provider Association).

Anterior tooth root fractures, usually occur in a more

HORIZONTAL PLANE and may be visible on the radiograph. Anterior tooth fractures are usually due to accidental trauma (i.e. blow to the jaw/teeth). If the fracture line is not too far down the root, it may be saved with RCT and a crown.

OVERJET-

HORIZONTAL projection of maxillary anterior teeth beyond the mandibular anterior teeth. Labial-axial inclination of the maxillary incisors. Reverse Overjetassociated with Class III skeletal patterns with more than 2 maxillary anterior teeth in linguoversion.

15. PARATHYROID ADEMOMA is the most common cause of

HYPERPARATHYROIDISM.

AIDS prompted OSHA to adopt the Bloodborne Pathogens Standard for Dentistry. OSHA is also concerned with

Hepatitis B and other bloodborne diseases, but AIDS is the disease that prompted regulatory action.

Generalized causes of Failed or Delayed Eruption:

Hereditary Gingival Fibromatosis, Down's syndrome, & Rickets. Generalized eruption failure or "primary failure of eruption" is caused by the failure of the eruption mechanism itself. The involved teeth do not erupt spontaneously and are not amenable to any orthodontic recourse. Fortunately, the condition is rare.

All access cavities are made through the

LINGUAL on anterior teeth & OCCLUSAL on posterior teeth.

Additionally, teeth can be angled buccally or lingually (*most mandibular 3 molars are angled toward the

LINGUAL).

the most infectious target of Standard (Universal) Blood Precautions.

Human Immunodeficiency Virus (HIV) the most infectious target of Standard (Universal) Blood Precautions. While HBV is the most infectious bloodborne pathogen, it is not the most infectious target of Standard Blood Precautions. Infection control precautions are aimed at preventing its viral transmission and are also effective in preventing HIV & HCV cross-infection.

Deciduous dental formula:

I 2/2 + C 1/1 + M 2/2 = 10 x 2 = 20 (5 per quadrant = 10/ arch = 20)

Patients experience few subjective signs of anesthesia after receiving a PSA nerve block, compared to an

IA nerve block (numb lip).

Bone marrow for grafting defects in the mandible & maxilla is usually obtained from the

ILIAC CREST. Also used for ridge augmentation.

36. The purpose of pouring casts of alginate impressions within 10 minutes of taking the impressions and wrapping the impressions in MOIST paper towels (rather than soaking them in a water bowl for 30 minutes), is to prevent distortion by expansion, or

IMBIBITION.

Obtaining clean canal shavings on a file or clean irrigating solution are

INACCURATE measures to determine the end point of debridement.

Important: one of the MOST COMMON CAUSES OF MALOCCLUSION IS

INADEQUATE SPACE MANAGEMENT AFTER EARLY LOSS OF PRIMARY TEETH.

Best method to elicit the most accurate thermal response is to

INDIVIDUALLY ISOLATE the suspected teeth with a rubber dam, then bathe each tooth in hot or cold water. All other methods may stimulate the tooth in only one section of one surface, thus are less accurate. Thermal tests may yield a false-negative in immature, recently traumatized teeth, or due to premedication with an analgesic.

Root canal access is the

INITIAL STEP in canal preparation. Straight-line access to the apical foramen must be established to ensure free movement of the instrument during debridement and canal preparation. All subsequent treatment hinges on the correctness of the access preparation.

1. Cell-rich zone-

INNERMOST pulp layer that contains fibroblasts.

• N 2 O works on the CNS, and is the only

INORGANIC gas used by the anesthesiologist. Room air contains 21% oxygen (so the patient MUST receive at least this much oxygen). Maximal safe concentrations of N O (70% nitrous & 30% oxygen) produce intoxication, analgesia, and amnesia. 2

BLOOD GLUCOSE concentration is regulated by

INSULIN (↓ blood glucose) and GLUCAGON (↑ blood glucose). Glucose normally does not appear in urine, although it is freely filtered because it is reabsorbed in the proximal convoluted tubule of the kidney.

FLAT BONES of the skull & part of the clavicle are formed by

INTRAMEMBRANOUS OSSIFICATION.

37. The first step when placing a dental sealant is to

ISOLATE TO OBTAIN A DRY FIELD.

Treatment of choice for hypoglycemia in an UNCONSCIOUS diabetic is

IV injection of 50% dextrose in water.

Administration of an inhalation anesthetic (except N O) is usually preceded by

IV or intramuscular administration of a short-acting sedative hypnotic drug (often a barbiturate). The procedure almost always requires endotracheal intubation.

Thrombocytopenia is common in people with

Idiopathic thrombocytopenic purpura (ITP) where an autoimmune disease causes very low platelet counts.

31. The only index that is REVERSIBLE & IRREVERSIBLE because it measures both gingivitis and periodontitis is the

PERIODONTAL DISEASE INDEX (PDI).

SECOND most common cause of root canal failure is

LEAKAGE from a poorly filled canal. This is common even after apical curettage (i.e. RCT performed on a tooth with apical curettage of a lesion that was found to be a cyst. 3 years later the lesion was even bigger than before). Thus, the failure was due to LEAKAGE from a poorly filled canal. When a canal is prepared properly, any of the acceptable filling methods will produce a successful result as long as the canal is COMPLETELY filled.

Incision for Drainage (I&D) in an area of acute infection is only performed after

LOCALIZATION of the INFECTION. Physiologically, it is at this time that nature has constructed a barrier around the abscess, walling it off from the circulation and making it possible to palpate the presence of purlent material within the abscess cavity ("fluctuance").

Personal protective equipment clinic jackets are required to be

LONG SLEEVE, HIGH NECK for optimal protection and to minimize the potential for exposed skin contact that can become contaminated with a patient's blood, saliva, or other potentially infectious material.

A STEEP mandibular plane angle correlates with

LONG anterior facial vertical dimensions & anterior open bite malocclusion. A long face predisposes the patient to Class II malocclusion.

Most common pathognomonic sign of a mandibular fracture is

MALOCCLUSION. Other signs and symptoms of a mandibular body or angle fracture are lower lip numbness, mobility, pain, or bleeding at the fracture site. In a fracture involving the angle of an edentulous mandible, the proximal segment is usually displaced anteriorly & superiorly.

Most frequently IMPACTED teeth are

MANDIBULAR 3 MOLARS (followed by maxillary 3 molars and maxillary canines).

Lying down or bending over: Irreversible pulpitis

Lying down or bending over intensifies the pain because the overall increase in cephalic blood pressure is relayed to the confined pulp tissue.

The best diagnostic imaging tests to examine DISK POSITION and FUNCTION is

MAGNETIC RESONANCE IMAGING (MRI) or CT scan.

8% of 6-year olds, & 49% of 11-year old children have a

MAXILLARY (MEDIAN) DIASTEMA caused by either a tooth-size discrepancy, mesiodens, abnormal frenum attachment, or a normal stage of development.

MOST COMMON IMPACTED ANTERIOR TEETH are

MAXILLARY CANINES. Failure of a permanent tooth to erupt may damage the roots of other teeth and create a severe orthodontic problem. Orthodontic consultation is indicated when first observed on a radiograph. An impacted canine or other tooth in a teenage patient can usually be brought into the arch by orthodontic traction after being surgically exposed. In older patients, there is an increasing risk that the impacted tooth has become ankylosed. Even adolescents have a risk that surgical exposure of a tooth will cause ankylosis.

MOST COMMON SITE for a supernumerary tooth is the

MAXILLARY INCISOR AREA. When it occurs here, it is called a MESIODENS (these teeth are usually small, pegshaped, and do not resemble the teeth normal to the site). Treatment of mesiodens is by surgical removal.

Strong apical pressure with a small straight elevator may displace root tips of maxillary premolars & molars into the

MAXILLARY SINUS. If the root tip is small (2-3mm), non-infected, and cannot be removed through the small opening in the socket apex, no additional surgical procedure is performed through the socket, and the root tip is left in the sinus. If the root tip is left in the sinus, measures should be taken similar to those taken when leaving any root tip in place. The patient must be informed of the decision and given proper followup instructions.

1. Class I (A) Malocclusion:

MB cusp of the maxillary first permanent molar occludes with (lines up with) the buccal groove of the mandibular first permanent molar. Also, maxillary centrals overlap mandibular centrals. THE MOST COMMON OCCLUSION (~70% of the population) and is associated with an ORTHOGNATHIC FACIAL PROFILE where the nose, lips, & chin are harmoniously related.

The behavior of patients under GENERAL anesthesia suggests that the most resistant part of the CNS is the

MEDULLA OBLONGATA (cardiac, vasomotor, and respiratory centers of the brain). The most controllable route of administration of a general anesthetic is inhalation.

The MOST RAPID LOSSES IN ARCH PERIMETER are usually due to a

MESIAL TIPPING & ROTATION of the permanent first molar after removal of the primary second molar. When the primary second molar is lost, ALWAYS rd MAINTAIN SPACE until the second premolar arrives.

During the canine-premolar transition period, the permanent first molars generally move

MESIALLY into the leeway space after the primary second molars are shed, thus causing a loss in arch length. This is called "the late mesial shift of a permanent first molar".

Amides are INACTIVATED BY

MONOAMINE OXIDASE ENZYME.

Complete canal debridement is the

MOST EFFECTIVE way to reduce canal microorganisms. Debridement is done using various ways depending on the case, and may involve canal instrumentation, placement of medicaments/irrigants, and/or surgery.

The EDGE-TO-EDGE position of permanent maxillary & mandibular first molar cusps is the

MOST COMMON initial relationship (when primary molars are in a flush terminal plane). This will most likely become a Class I molar relationship by both molars drifting forward ("early mesial shift"), with the mandibular molar drifting two times farther than the maxillary molar.

Mineral Trioxide Aggregate (MTA)-

MOST superior retrofilling (reverse filling = retrograde amalgam filling) material and material of choice today. MTA seals the APICAL portion of the root canal, and is ALWAYS after an apicoectomy alone will not yield a good result. A reverse filling (MTA) MUST always be placed when an apical seal may be faulty (i.e. with a calcified root canal, it is impossible to obdurate most of the canal and get an apical seal. If just the root apex where cut off (apicoectomy), the incompletely filled canal might act as a source of reinfection. To prevent this, after the root tip is resected, the apical foramen is found, enlarged, and filled with zinc-free amalgam to create a seal.

Scopolamine is very effective for preventing

MOTION SICKNESS and this indication is its most common clinical use. Since scopolamine depresses the CNS, it is used as a sedative before anesthesia and as an anti-spasmodic in certain disorders characterized by restlessness and agitation (i.e. delirium, tremors, psychosis, mania, and Parkinsonism).

Maxillary 1 molar is innervated by the

MSA & PSA nerves (middle superior and posterior superior alveolar nerves). To extract the maxillary 1 st molar, you MUST numb both the PSA & MAS nerves, and the greater (anterior) palatine nerve for palatal anesthesia (soft tissue).

Infection control training records and medical records if the employee is involved in an occupational exposure

MUST be maintained. The employer must maintain a medical record for each employee whose job involves occupational exposure to blood and other potentially infectious materials.

40. A rare, but life-threatening sequela from suddenly discontinuing SYNTHROID (Levothyroxine) for HYPOTHYROIDISM is

MYXEDEMA COMA.

Respiratory Alkalosis-

Major Causes: hyperventilation from anxiety, pain, liver cirrhosis, low 2 levels of oxygen in the blood (high altitudes), & aspirin overdose. *Much LESS COMMON than respiratory acidosis.

Usually, the FIRST clinical sign of mild lidocaine toxicity is

NERVOUSNESS. Mild toxicity can be caused by an intravascular injection, unusually rapid absorption, or too large a total dose of the local anesthetic. Clinical manifestations of a mild lidocaine toxicity related to CNS excitation: Nervousness (increased anxiety), talkativeness, muscular twitching, perioral numbness, ↑ HR, BP, RR.

PEDS In most cases, proper treatment for an intruded primary anterior tooth is

NO TREATMENT. Immediate attention should be given to soft-tissue damage. However, an x-ray of the area should be taken. If the intruded incisor is contacting the permanent tooth bud, the primary tooth should be extracted.

Replantation of a PRIMARY TOOTH is

NOT recommended due to potential danger to the permanent successor tooth from sequels of trauma (i.e. infection, ankylosis, or damage due to manipulation during the procedure). Thus, if a mother of a 4 year old child calls your office reporting that her child has suffered a trauma to one of his front teeth that has avulsed out of the socket, advise the mother to leave the tooth and come to the office immediately.

Therapy for horizontal root fractures is always difficult. Root canal treatment (RCT) is

NOT indicated if the fracture site remains in close proximity and if pulp retains its vitality. However, if clinical symptoms develop, or the segments appear to be separating on the x-ray, some treatment is necessary.

This is treated the same way that you would treat the adult patient. At age 11, the root of a maxillary central incisor should be completely formed, thus an apexification procedure is

NOT indicated. If the root were not fully formed, then an apexification process should be started. This involves the placement of calcium hydroxide paste into the canal to stimulate continued apical closure.

AMIDES have a longer duration of action, and are metabolized by

P450 enzymes in the liver so toxicity is more likely if administered to individuals with liver dysfunction or with other drugs that may alter hepatic metabolism.

13. A 62-year old man who complains that "my dentures don't fit" or "my hat is too tight" with radiographs that show COTTON WOOL RADIOPACITIES and ROOT HYPERCEMENTOSIS, most likely has

PAGET'S DISEASE.

A common clinical finding of a periodontal problem is

PAIN to LATERAL PERCUSSION on a tooth with a wide sulcular pocket.

? is the primary direction of luxation for extracting maxillary primary/deciduous molars, while the ? is the primary direction for adult maxillary molars. This is because primary molars are more ? positioned, and the ? root is strong and less prone to fracture.

PALATAL is the primary direction of luxation for extracting maxillary primary/deciduous molars, while the BUCCAL is the primary direction for adult maxillary molars. This is because primary molars are more palatally positioned, and the palatal root is strong and less prone to fracture.

For mandibular extractions, the patient is positioned so the occlusal plane of the mandibular arch is

PARALLEL to the FLOOR when the mouth is opened, and the chair should be as low as possible. Stand directly to the side or behind the patient.

HORMONES, CALCIUM & BLOOD GLUCOSE Calcium levels are regulated by

PARATHYROID HORMONE (increased hormone causes bone resorption) which then increases calcium levels. Calcium is also regulated to some extent by the kidney tubules and GI mucosa (lowering pH causes increased calcium absorption). Low serum calcium levels result in hyperirritability of nerves and muscles.

Phosphorus concentration is also regulated by

PARATHYROID HORMONE. Increased hormone causes the kidneys to increase the rate of phosphate excretion, which causes a decrease in plasma phosphate concentration.

Face mask should be changed BETWEEN

PATIENTS (every patient) or more often if heavy spatter is generated during treatment. CDC recommends the mask to be changed between patients or during patient treatment if the mask becomes wet or moist from within or without.

A patient who fractured his jaw in a car accident received an IM injection of 60mg of Meperidine, then subsequently developed a severe reaction characterized by tachycardia, hypertension, hyperpyrexia, and seizures. When questioned, the uninjured father revealed his son takes a drug for a psychiatric condition. The psychiatric drug most likely responsible for this untoward reaction with Meperidine is

PHENELZINE. Concomitant administration of Meperidine and MAO inhibitors can cause lifethreatening hyperpyrexic reactions that may culminate into seizures or coma.

28. Conducting a TRIAL RUN of the planned study on a small sample of the population is the purpose of a

PILOT STUDY.

Antibiotic prophylaxis is NOT indicated for dental patients with

PINS, PLATES, & SCREWS, nor is it routinely indicated for most dental patients with total joint replacements. PREMEDICATION IS NO LONGER REQUIRED for patients after artificial joint replacement surgery. However, the dentist can consult with the patient's physician if the patient has a compromised immune system (diabetes, RA, cancer, chemotherapy, and chronic steroid use) which may increase the risk of orthopedic implant infection.

The most severe tissue reaction occurs with

PLAIN CATGUT SUTURE material. Resorbable sutures evoke an intense inflammatory reaction (thus, plain and chromic gut are not used to suture the surface of a skin wound).

30. The PRIMARY goal in any oral health preventive program is

PLAQUE CONTROL.

Cells Found in Diseased Pulp:

PMN's, plasma cells, basophils, eosinophils, lymphocytes, & mast cells (contain histamine & heparin).

6. A 62-year old male with no allergies presents for root planing. He had bilateral hip replacement surgery nearly two years ago without complication, has mitral valve prolapse with regurgitation, and has a cardiac pacemaker. The appropriate antibiotic prophylaxis is

PRE-MEDICATION IS NOT REQUIRED.

Most important concept of Winslow's definition of public health is

PROMOTION THROUGH ORGANIZED COMMUNITY EFFORT.

MOST important consideration BEFORE filling a root canal is

PROPER CLEANING (debridement) and SHAPING (instrumentation) of the canal. Once the canal is obturated, any organisms that enter periapical tissues from the canal are eliminated by the body's natural defenses. The MOST common cause of root canal failure is incompletely and inadequately disinfecting the root canal system.

Trauma causing deep intrusion to a permanent tooth causes

PULP NECROSIS and conventional RCT is necessary.

IRREVERSIBLE PULPITIS symptoms

Pain is usually not readily localized by the patient, but is diffuse in nature.

Patient's mandible deviates to ? upon opening.

Patient's mandible deviates to the side of injury upon opening.

Effects of Environmental Influences during Growth & Development of the face, jaws, and teeth:

Patients who have excessive overbite or anterior open bite usually have posterior teeth that are infraerupted or supra-erupted respectively. • A non-nutritive sucking habit causes malocclusion only if it continues during the mixed dentition stage. • Negative pressure created in the mouth during sucking is not a cause of maxillary arch constriction. • Adenoids that lead to mouth breathing, cannot be with certainty considered an etiologic agent of a long-face pattern of malocclusion as studies show most of the long-face population do not have nasal obstruction.

SCARLET FEVER- drug of choice

Penicillin is the drug of choice for treatment. Early diagnosis and treatment are important to prevent complications (i.e. local abscess formation, rheumatic fever, arthritis, and glomerulonephritis).

Malignant Hyperthermia- genetics and how its passed down

People with MH are informed of their condition and advised that 50% of their first-degree relatives are likely to have the trait.

How to treat Syncope

Placing the patient in the supine position while administering 100% oxygen is often all that is required. Additional treatment is based on symptoms.

Significant Bacteroides species involved in pulpalperiradicular infection are

Porphyromonas & Prevotella which received a separate genus (undergone taxonomic revision) due to their distinct characteristics.

Restorative Options for Endodontically Treated Posterior Teeth:

Posterior teeth with RCT are more prone to fracture than non-treated posterior teeth due MAINLY to the destruction of coronal tooth structure and reduced structural integrity.

Buccal Object Rule (SLOB Rule =

Same Lingual, Opposite Buccal)-a shift-cone technique/rule that allows the dentist to determine on the radiograph which canal is the buccal and which is lingual. Buccal object rule also allows one to determine working length of superimposed canals, root/canal curvatures, and the facial-lingual orientation of instruments or other anatomical objects.

HEAD & NECK CANCER patients can benefit from using

Sodium fluoride & Stannous fluoride for home-care custom tray use. The gel contains 1% sodium fluoride or 0.4% stannous fluoride. For maximum benefit, the gel must be in direct contact with teeth. Fluorides are recommended to protect cancer patients from postirradiation caries.

Studies show an increased risk of developing an allergic reaction to latex protein (Type 1) or certain chemicals used in the latex manufacturing process (Type IV) in certain groups of people. Current information has NOT shown a cross-reaction between pollen allergies and watersoluble latex allergens. Individuals who are predisposed to readily developing Type I hypersensitivity reactions (i.e. people who are atopic), can become sensitized to latex allergens more readily than people with few or no allergies.

Studies show an increased risk of developing an allergic reaction to latex protein (Type 1) or certain chemicals used in the latex manufacturing process (Type IV) in certain groups of people. Current information has NOT shown a cross-reaction between pollen allergies and watersoluble latex allergens. Individuals who are predisposed to readily developing Type I hypersensitivity reactions (i.e. people who are atopic), can become sensitized to latex allergens more readily than people with few or no allergies.

Important: A canal is instrumented and shaped so it has a continuously

TAPERING FUNNEL SHAPE. The canal's widest diameter should be at the orifice (opening), while its narrowest diameter is at the dentinocemental junction (DCJ or .5-1.0mm from the radiographic apex). Ideally, .5-1.0mm from the canal apex is where all teeth should be filed to and filled.

Root fractures are only visualized on a radiograph if the x-ray beam passes

THROUGH THE FRACTURE LINE. Since the fracture line can extend diagonally, an additional radiograph is taken with a steep (45º) vertical angulation in addition to the conventional 90º degree.

10. During a routine extra-oral examination, a 10-year old child presents with a painless swelling at the anterior midline of the neck just below the hyoid bone. Your knowledge of pathology tells you this is the MOST COMMON CONGENITAL, BENIGN NECK CYST that requires a referral to an ENT physician for further evaluation. This lesion is a

THYROGLOSSAL DUCT/TRACT CYST.

STANNOUS FLUORIDE- STAINED (DISCOLORED) demineralized areas and margins of enamel (pits, fissures, grooves), composite, and porcelain YELLOWISH-BROWN due to the reaction of the

TIN ION. May also cause gingival sloughing.

• First symptom of nitrous oxide analgesia is

TINGLING OF THE HANDS.

Due to their potential to cause allergic reactions, ESTER LOCAL ANESTHETICS ARE MAINLY USED ONLY AS

TOPICALS (Benzocaine 20% is the most common topical). ALL TOPICAL ANESTHETICS are ESTERS except for 5% lidocaine (an amide). Other ester anesthetics: Procain (Novocaine), Tetracain (Pontocaine), Propoxycaine (Ravocaine), Dibucaine).

The most common cause of TMJ ANKYLOSIS is

TRAUMA. ANKYLOSIS is common with RA.

An 8 year old child with a PULPALLY INVOLVED primary second molar comes into your office The IDEAL and best approach to manage this case is to

TREAT THE PULP and RETAIN the tooth as a space maintainer BECAUSE there is no prefabricated space maintainer that is as good as the natural tooth. In this case, proper pulpal therapy followed by a restorative procedure is needed on this tooth to allow it to function as a space maintainer.

The MOST definite clinical sign indicating extension of an odontogenic infection into the masticator space is

TRISMUS (difficulty opening the mouth due to a tonic spasm of the muscles of mastication). Trismus is also caused by passing the needle through the medial pterygoid muscle during an inferior alveolar nerve block.

Clinically, the picture of the masticator space infection is dominated by

TRISMUS, PAIN, SWELLING occurring within a few hours after a molar extraction, or mandibular trauma. These signs increase rapidly and peak in 3-7 days. Spontaneous intra-oral drainage usually occurs between 4-8 days. If intraoral drainage does not occur, then surgical drainage is indicated.

ECTODERMAL DYSPLASIA-teeth development

Teeth develop abnormally with possible complete failure of the teeth to develop (anodontia) or oligodontia (partial anodontia). Conical-shaped anterior teeth characteristic of oligodontia and associated with ectodermal dysplasia.

best aid to diagnose an irreversible pulpitis.

Tooth may be tender to percussion (tooth is usually percussion positive), heat may intensify the pain response, while cold may relieve it (in advanced stages). Usually HOT & COLD cause severe and lasting pain. Thus, thermal test is the best aid to diagnose an irreversible pulpitis.

EXTERNAL CERVICAL INFLAMMATORY RESORPTION

Treatment: SRCT to gain access to the full extent of the lesion with surgical operating microscope. Trichloro-acetic acid may be used to cauterize the vascular lesion, and areas of resorption are removed with small burs.

Neuroleptic agent (Droperidol) + Narcotic analgesic (Fentanyl)→Neurolept Analgesia (conscious).

Under the influence of this combination, the patient is sedated and demonstrates psychic indifference to the environment, but remains conscious and can respond to questions and commands. Neurolept analgesia only produces an unconscious state if nitrous oxide is also administered. Nitrous Oxide & Ethylene are useful ONLY for sedation & analgesia.

TO PREDICT THE TIME OF PUBERTAL GROWTH SPURT while treating jaw mal-relationships in a growing child, the orthodontist can get the most valuable information from a

WRIST-HAND RADIOGRAPH. The physiologic age (developmental age) is judged by determining the skeletal development. Wristhand radiographs offers the best aid to do this by examining the ossification & development of the wrist's carpal bones, hand's metacarpals, and finger's phalanges to give the orthodontist an idea regarding the chronology of skeletal development. Comparing the overall pattern observed in the hand-wrist radiograph, with age standards in a reference atlas, does this.

ENDODONTIC INSTRUMENTATION Broken Instruments:

When a broken instrument (file) protrudes past the apex, surgery should be performed to remove it because it is a constant irritant (i.e. during cleaning & shaping of a canal, your K-file (#25) separates in the canal. Your first attempt to retrieve it results in a broken instrument through the apex). To manage this case, raise a flap and remove the instrument surgically, then fill the canal with gutta-percha.

When a tooth clinically erupts in the mouth, how much root development has happened

When a tooth clinically erupts in the mouth, 2/3 of the root structure has developed. For primary teeth, the root is completely formed by 18 months (for permanent teeth, it takes 3 years).

Fluoride helps teeth in two ways.

When children under age 6 ingest fluoride in small doses, it becomes incorporated in their developing permanent teeth, making it harder for acids to cause demineralization. Fluoride also works directly on teeth in children and adults by speeding up remineralization and disrupting acid production by bacteria.

Primary herpes occurs only in

YOUNG PATIENTS (baby, children, adolescents). Fever, malaise, pain, or could be CHICKENPOX (varicella zoster virus) in a 6yr old child. Multiple vesicles, sick for one week.

Most root canal sealers are some type of

ZOE cement capable of producing a seal while being well-tolerated by periapical tissues. All sealers have some radiopacity (caused by metallic salts in the sealer), thus are visible on a radiograph. This radiopacity helps disclose any accessory canals, resorptive areas, root fractures, and the shape of the apical foramen.

When performing a pulpectomy on primary teeth, the canals are filled with

ZOE paste because it causes only a minimal tissue reaction and it resorbs when the primary tooth begins its normal resorption process.

Cavernous Sinus Thrombosis is not usually caused by

a bacteremia, trauma, or ear infections.

MEASURE OF CENTRAL TENDENCY (AVERAGES)-

a central or typical value of a probability distribution. The frequency of distribution is plotted on an x-y graph to create a pictorial representation of the data. The most common measures of central tendency are MEAN, MEDIAN, & MODE.

1. Ethylene Diamine Tetra-Acetic Acid (EDTA)-

a chelating agent that removes the mineralized portion (decalcify) of the smear layer. EDTA's decalcifying process is self-limiting, and can decalcify up to a 50sm thin layer of root canal wall. o EDTA is normally used in 17% concentration. o RC-Prep & EDTAC are types of EDTA preparations. o EDTA has a limited value as an irrigation solution, since the decalcifying process induced by EDTA is self-limiting and stops as soon as the chelator is used up. o EDTA remains active in the canal for 5 days if not inactivated. Thus, upon appointment completion, the canal MUST be irrigated/inactivated with sodium hypochlorite (NaOCl) containing solution.

OSHA Bloodborne Pathogens Standard-

a comprehensive rule that sets forth the specific requirements OSHA believes will prevent the transmission of bloodborne diseases to EMPLOYEES (not patients or employers).

OCCUPATIONAL SAFETY & HEALTH ADMINISTRATION (OSHA) INFECTION CONTROL Standard ("Universal") Infection Control Precautions-

a method of infection control in which all human blood and certain body fluids (saliva in dentistry) are treated as if known to be infectious for HIV, HBV, HCV, and other blood borne pathogens. The same infection control procedures are used for all patients.

Apicoectomy (root resection = root amputation)-

a procedure where the buccal tissue is flapped back, the buccal bone around the root apex and the root apex itself are removed, and the area is curetted out. Apicoectomy is a resection of the most apical portion of the root. It is best accomplished by obliquely RESECTING the most apical portion of the involved root.

Dens-in-Dente (Dens Invaginatus)-

a "tooth within a tooth" caused by an invagination of all enamel organ layers into the dental papilla. It most frequently involves the MAXILLARY LATERAL INCISOR. The pulp is usually exposed, thus is necrotic or inflamed and the pulp canals should be cleaned and filled (RCT). This invagination can range in severity from an accentuated lingual pit to a "densin-dente".

IV sedation is usually done with

a 21-gauge needle with a Valium (Diazepam). The rate of injection of valium is 1ml/minute (1ml of injectable valium contains 5mg of valium. The injection is discontinued when the eyelids droop (ptosis).

Class III subdivision:

a Class III relationship of the teeth on one side, with a Class I relationship on the other side.

TMJ COMPONENTS: 2. Articular Disc (Meniscus)-

a FIBROCARTILAGE, saddle-shaped (bioconcave) tissue associated with the TMJ made of dense, irregular C.T. that SEPARATES THE CONDYLE & TEMPORAL BONE (it divides the TMJ into superior and inferior joint spaces and prevents bone-to-bone contact), and provides a smooth articulating surface. Thickest at the posterior, thinner in the center. It moves with the condyle under normal function. THE DISC IS SURROUNDED and PROTECTED by the FIBROUS C.T. JOINT CAPSULE. The disc is considered DISPLACED when it lies ANTERIOR to its usual position.

Quad Helix-

a FIXED appliance that consists of 4 helices (2 anterior & 2 posterior) used for POSTERIOR CROSS- BITE cases with a digital-sucking habit.

TMJ is what type of joint

a GINGLYMOARTHRODIAL JOINT (rotational and translational); it is a hinging AND sliding joint. It involves the condylar process of the mandible and glenoid (articular) fossa of the temporal bone.

Gingival Abscess-

a RARE abscess that occurs when bacteria invade through a break in the gingival surface. Caused by mastication, oral hygiene procedures, or dental treatment.

Frankel's Appliance-

a REMOVABLE functional appliance used for abnormal (hyperactive) soft tissue patterns.

4. Observational Learning (Modeling or Behavior Shaping)-

a behavior acquired through initiation of a behavior observed in a social context. There are two distinct stages in observational learning: acquisition of the behavior by observing the behavior and the actual performance of the behavior. Having an open dental office design may aid in the dentist in this method. Children can watch other cooperative children, and this may rub off on them. Modeling is a technique in which the person learns a desired response by observing it being performed. Relative maturity modifies expectations of a child's behavior in that a child cannot be expected to learn a mode of behavior until he has matured to a stage at which he is ready for such learning.

The most common complication of N2 O sedation is

a behavioral problem (laughing, giddy).

OSTEOMYELITIS-

a bone infection characterized by progressive inflammatory destruction after formation of new bone. It is most often caused by STAPHYLOCOCCUS AUREUS (but can be caused by Streptococcus pyogenes, Pneumococcus species, Pseudomonas aeruginosa, and Escherichia coli). Reduced blood supply predisposes bone to osteomyelitis. Osteomyelitis may be chronic or acute. It commonly results from a combination of local trauma (usually trivial, but causing a hematoma) and an acute infection originating elsewhere in the body. In children, long bones are usually affected, while in adults, the vertebrae and pelvis are most commonly affected.

Drug Enforcement Administrations (DEA)-

a branch of the U.S. Department of Justice that determines the degree of control for substances with abuse potential (Schedules I-V).

Auriculotemporal Nerve-

a branch of mandibular division (V ) that provides the major SENSORY innervation to the TMJ's posterior portion. Transmits pain in the TMJ 3 capsule and disc periphery.

FDA (Food & Drug Administration)-

a branch of the U.S. Department of Health & Human Services that determines which drugs and medical services can be marketed in the U.S. The FDA requires both drug safety and efficacy. FDA is also responsible for regulating handpieces and recommending sterilization procedures to the CDC.

1. INDIRECT PULP CAPPING-

a calcium hydroxide base is placed on a thin layer of questionable dentin remaining over the pulp. It is performed when a carious exposure is anticipated. After a 3-4 month waiting period, the tooth is re-opened and remaining decay is removed. During the waiting period, hopefully secondary dentin formation occurred, allowing complete removal of the decay without pulp exposure.

Zinc Oxide-Eugenol (ZOE)-

a cement with a long history of successful use as a based root canal sealer. The MAIN function of a root canal sealer is to FILL DISCREPANCIES between the core-filling material and the dentin walls. This function makes it even more important than the core filling material.

When fluoride concentrations in excess of 1.5-3.0mg/L are consumed,

a chemical combination can occur within tooth enamel, resulting in mottled and permanently discolored teeth. Concentrations > 4mg/L can be toxic.

Diagnosis of Porphyria:

a child present with red urine, purplish-brown teeth, sensitivity to sunlight, and develops blisters and swelling on the face and hands when exposed to sunlight.

The onset of pulpal inflammation is an insidious process characterized by

a chronic cellular response of plasma cells, macrophages, and lymphocytes. There is no direct pulp exposure to caries, thus the cellular response is not acute.

The most likely cause of transplantation failure is

a chronic, progressive EXTERNAL ROOT RESORPTION.

Roots can be removed by using

a closed technique. The surgeon should begin a surgical removal if the closed technique is not immediately successful.

PROBING LESIONS: 2. Blow-Out (acute) Probing Lesion-

a clue for diagnosis is a non-vital (necrotic) pulp that can completely heal after RCT. A tooth with this lesion shows normal sulcus depth all around the tooth until the area of swelling is probed. At this point, the probe drops to a level near the root apex. Probing depths in all other areas are within normal limits.

Periodontic-Endodontic Abscess-

a combined lesion that usually shows radiographic involvement of the periodontium & apex of the involved tooth.

Pulp capping success is recognized by the formation of

a complete barrier of dentin at the site of pulpal exposure.

AUTISM SPECTRUM DISORDER (ASD)-

a complex developmental disability that typically appears in the first 3 years of life due to a CNS disorder affecting brain function (4x more prevalent in boys than girls (1 in 42 boys and 1 in 189 girls in U.S.). Thought to be caused by a combination of autism risk genes and environmental factors affecting early brain development.

HEALTH BELIEF MODEL-

a conceptual framework that describes a person's health behavior as an expression of his or her health beliefs. HBM was designed to predict a person's health behavior, including the use of health services and to justify intervention to alter maladaptive health behavior. Health Belief Model suggests that individuals will act to prevent disease only when they believe they are susceptible to disease. A patient's compliance is affected by their perception of a disease's severity and length of a treatment regimen.

End-Stage Renal Disease (ESRD)-

a condition in which there is a permanent and almost complete loss of kidney function. The kidney functions at < 10% of its normal capacity. In ESRD, toxins slowly build up in the body. Normal kidneys remove these toxins (i.e. urea and creatinine) from the body through urine.

Respiratory Alkalosis-

a condition in which the blood is alkaline because rapid or deep breathing results in a low blood CO level.

2. Metabolic Acidosis-

a condition in which the blood has too much acid or too little base, often causing a decrease in blood pH (more acidic blood). When blood pH falls below normal (7.3), the CNS becomes so depressed the person first experiences disorientation, then is comatosed. *The normal blood bicarbonatecarbonic acid ratio is 20:1. A 10:1 ratio indicates uncompensated acidosis. Severe acidosis always occurs during CPR. Metabolic acidosis is excessive blood acidity characterized by an inappropriate level of bicarbonate in the blood. Major Causes: chronic renal failure, diabetic ketoacidosis, lactic acidosis, poisons, and diarrhea.

4. Chronic Bronchitis-

a condition of excessive bronchial mucus and a productive cough that produces sputum (hypersecretion of mucus) for 3 months or more in at least 2 consecutive years without any other disease that could account for this symptom. A productive cough, often without wheezing, is the universal factor of chronic bronchitis.

Fusion-

a condition produced when two tooth buds are joined together during development and appear as a macrodent (single large crown). Fusion usually occurs in the incisor area. The single crown may have two roots or a grooved root, but there are usually two root canals. It is often difficult to distinguish between gemination and fusion.

Anhidrotic Ectodermal Dysplasia-

a condition that only affects males, characterized by lack of perspiration caused by partial or complete absence of sweat glands.

ABSCESSES Periapical Abscess-

a condition that results from a pulpal infection that extends through the apical foramen into the periapical tissues. MOST COMMON OF ALL DENTAL ABSCESSES. It is a localized collection of pus in the alveolar bone at the root apex after pulpal death with the infection extending into the periapical tissue.

1. Metabolic Alkalosis-

a condition where the blood is alkaline because it has too much base or too little acid (high level of bicarbonate), occasionally causing an increase in blood pH. The major effect on the body is over-excitability of the nervous system, which may cause tetany (tonic spasm).

Frequency-

a count.

2. Translation (bodily movement)-

a coupled force is applied to the crown to control root movement in the same direction as crown movement (force is applied through the tooth's center of resistance). Translation is very difficult to accomplish.

The most effective way to increase fluoride content in the external tooth layers is

a daily application of 1.23% APF in fitted trays for 4 minutes. However, this is not realistic since we do not routinely do "daily" applications.

ORAL HEALTH INDICES DENTAL INDEX-

a data collection instrument used to numerically express the oral health status of a population.

CRETINISM (Child Hypothyroidism)-

a deficiency disease caused by the congenital absence of THYROXINE (hormone secreted by the thyroid gland). Cretinism is severe hypothyroidism in a child, characterized by defective mental and physical development.

Hydroxyapatite-

a dense, biocompatible material produced synthetically or obtained from biologic sources like coral. The granular or particle form is most commonly used for alveolar ridge augmentation. When placed in a subperiosteal environment, HA bonds physically and chemically to bone.

MIXED DENTITION-

a dentition phase during which some teeth present in the oral cavity are permanent, and some are deciduous (primary). The earliest indication of a mixed dentition consists of the primary dentition & permanent mandibular 1 molars.

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)-

a developmental and behavioral disorder characterized by an attention span that is shorter than expected for the child's age, hyperactivity, talkative, inattentive and impulsive behavior. These children are easily distracted, have difficulty paying attention, and may be unable to focus more than a few moments on mental tasks. They may be physically active and behave impulsive.

Teeth conditions that usually DO NOT require endodontic treatment if managed properly because pulp remains vital: 3. Globulomaxillary cyst-

a developmental cyst found at the junction of the globules and maxillary processes of the maxilla, between the lateral incisor and canine roots. This cyst arises from cells in a fissural line of bone. Teeth are vital.

Enamel Hypoplasia-

a developmental defect in which the enamel is hard in context, but thin and deficient in amount due to defective enamel matrix formation with a deficiency in the cementing substance. There is a lack of contact between teeth, rapid breakdown of occlusal surfaces, and a yellowish-brown stain that appears where dentin is exposed. This condition affects both primary and permanent teeth, and can be transmitted genetically, or caused by environmental factors (i.e. vitamin deficiency, fluorosis, or metabolic disturbances during the prenatal period). It is a common dental sequelae in a child with a history of generalized growth failure in the first 6months of life. Hypoplastic areas on teeth are seen if a child has illnesses in early childhood. Hypoplastic enamel is also a dental manifestation of hypoparathyroidism, preventable by early treatment with vitamin D.

The MOST COMMON CAUSE of Class I malocclusion is

a discrepancy between tooth structure and amount of supporting bone length.

DIABETES MELLITUS- PEDS

a disease where the body cannot properly use and store glucose. Glucose backs up in the bloodstream causing blood glucose levels to rise too high. The classic triad of symptoms is always present (polydipsia/extreme thirst, polyphagia/extreme hunger, & polyuria/frequent urination). Weight loss, poor wound healing, or extreme unexplained fatigue are other symptoms.

Class II, Division I:

a distal relationship of the mandibular first permanent molar's buccal groove to the MB cusp of the maxillary first permanent molar & maxillary incisors (maxillary central & lateral incisors are in extreme labioversion (protruded).

Class II, Division II:

a distal relationship of the buccal groove of the mandibular first permanent molar to the MB cusp of the maxillary first permanent molar and maxillary laterals being tipped labially and mesially (sometimes overlapping the centrals). Its a malocclusion where the body of the mandible and its superimposed dental arch are also in distal relationship to the maxilla, while the molar & canine occlusion are the same as Class II Division I. The DB cusp of the maxillary first molar occludes in the buccal developmental groove of the mandibular first molar, and maxillary canines occlude mesial to mandibular canines. The maxillary centrals are near normal antero-posteriorly or slightly in linguoversion (usually retruded), and maxillary lateral incisors are usually labiomesially flared and overlap the central incisors. An impinging overbite may also exist.

Scopolamine-

a drug structurally similar to Acetylcholine. Scopolamine acts by interfering with the transmission of nerve impulses by acetylcholine in the PNS and produces symptoms typical of parasympathetic system depression (dilated pupils, rapid heartbeat, dry skin and mouth, and dry respiratory passages).

SEDATIVE HYPNOTICS-their principal effect is sedation and sleepiness. 1. Chloral Hydrate-

a drug widely used for pediatric sedation by acting on the CNS to induce sleep. At normal doses, the sleep induction does not affect breathing, BP, or reflexes. It may be used before some surgeries or procedures to help relieve anxiety and induce sleep. When used with analgesics, it can help manage pain after surgery. Its onset of action is 15-30 min when given orally. Children often enter a period of excitement and irritability before becoming sedated. As with barbiturates, pain may cause paradoxical reactions.

Poor Man's Cephalometric Analysis-

a facial profile analysis that delinates the same information as that obtained from lateral cephalometric radiographs. The difference is there is greater detail obtained from the lateral cephalometric. However, the Poor Man's Cephalometric Analysis is a vital diagnostic technique for primary evaluation as it is a quick, simple, and inexpensive technique that readily gives the following information: 1. anteroposterior position/proportion of the jaws relative to each other. 2. lip posture (competent/incompetent) and incisor prominence. 3. vertical facial proportions. 4. inclination of the mandibular plane angle.

GERMAN MEASLES (Rubella)-

a fairly benign viral disease, with symptoms of a red, bumpy rash, swollen lymph nodes (around the ears and neck), and a mild fever. Some people feel achy. The virus can manifest in the oral cavity as small petechiae-like spots on the soft palate. The defects of congenital infection from an infected mother are more severe (enamel defects, hypoplasia, pitting, and abnormal tooth morphology).

LYMPHANGIOMA-

a fairly well-circumscribed nodule or mass of lymphatic vessels that occurs most often in the neck and axilla. Compressible and spongy red-to-blue translucent enlargements/lesions.

Each TMJ is covered by

a fibrous capsule, and the non-articular TMJ surfaces are covered with periosteum.

3. RC-PREP-

a foamy solution that combines functions of EDTA + urea peroxide to provide chelation & irrigation. RC-prep has a natural effervescence that is increased by irrigation with NaOCl to help remove canal debris.

MIDFACIAL FRACTURES- 3. LeFORT III (Transverse Fracture or Craniofacial Dysfunction)-

a fracture in which the entire maxilla and one or more facial bones are completely separated from the craniofacial skeleton. These patients have restricted mandibular movement.

4. Ellis Class IV Fracture-

a fracture where the entire crown is lost. Treatment is pulpectomy. The tooth restoration involves using a stainless steel or celluloid crown.

Restorative Options for Endodontically Treated Posterior Teeth: CROWNS (ZIRCONIUM, PORCELAIN, PFM):

a fullcoverage crown is preferred when remaining coronal tooth structure does not provide enough sufficient tooth structure for an onlay. Goal is to prevent cracked tooth syndrome.

3. Stress-

a general disturbance in psycho-physiological adaptation. It implies a person who is being maladaptively influenced by more than one negative or aversive factor. Stress is mostly associated with response aspects.

APERT SYNDROME-

a genetic defect that falls under the broad classification of cranial-limb anomalies, primary characterized by specific malformations of the skull, midface, hands, and feet. Blindness is NOT a clinical feature.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)-

a group of disorders characterized by airflow obstruction during respiration. COPD is a chronic airway obstruction resulting from emphysema, chronic bronchitis, asthma, or any combination of these diseases. In most cases, bronchitis and emphysema occur together. *Secondary pulmonary hypertension is most often caused by COPD.

PORPHYRIA-

a group of inherited disorders involving abnormalities in the production of heme pigments, myoglobin, & cytochromas. It can result in discoloration of teeth.

GRANULOMA-

a growth of granulomatous tissue continuous with the PDL due to pulpal death with diffusion of toxic products into the periapical area. Is usually asymptomatic. Radiographically, a well-defined area of rarefaction (radiolucency) with some irregularities is evident. Clinically, the tooth is NOT sensitive.

Submarginal Curved Flap (Semilunar Flap)-

a half-moon shaped flap raised with a curved horizontal incision in the mucosa or attached gingiva with the concavity towards the apex. While it is simple and does not impinge on surrounding tissue, its disadvantages outweigh its advantages, thus it is NOT used for anterior tooth rootend surgery. 1. limited access and visibility. 2. tearing of incision corners when trying to improve accessibility by stretching the flap. 3. if a lesion is larger than expected, the incision lies over the bony defect, and healing occurs by scarring. 4. incision extent is limited by attachments (i.e. frenum, muscles).

"Antiseptic" best relates to

a handwash agent. Antiseptics are used for antimicrobial agents applied onto living tissues.

HEMOPHILIA-

a hereditary BLEEDING DISORDER that mostly affects MALES, where it takes a long time for blood to clot and abnormal bleeding occurs. A true hemophiliac has prolonged partial thromboplastin time (PTT), but normal prothrombin time (PT) and bleeding time (BT).

Enamel Hypocalcification-

a hereditary dental defect affecting the enamel of primary and permanent teeth. The enamel is soft and undercalcified in context, but normal in quantity due to the defective maturation of ameloblasts (defect in mineralization of the formed matrix). The teeth are chalky, the surfaces wear down rapidly, and a yellow-to-brown stain appears as the underlying dentin is exposed.

PIERRE ROBIN SYNDROME-

a hereditary disorder that presents micrognathia (smallness of the jaws), glossoptosis (downward displacement or retraction of the tongue), & a high-arched or cleft palate. Most children require orthodontics.

ECTODERMAL DYSPLASIA-

a hereditary/congenital condition characterized by abnormal development of the skin & associated structures (hair, nails, teeth, sweat glands). Several types of ectodermal dysplasia exist, but the x-linked anhidrotic ectodermal dysplasia is the most common.

MEASLES (Rubeola)-

a highly contagious viral illness characterized by fever, cough, and spreading rash due to PARAMYXOVIRUS. The incubation period is 1-2 weeks before symptoms usually appear.

MIDFACIAL FRACTURES- 1. LeFORT I (Horizontal Fracture)-

a horizontal segmented fracture of the alveolar process of the maxilla in which the teeth are usually contained in the detached portion of the bone, causing an OPEN BITE. A LeFort I osteotomy is most commonly used to correct maxillary retrognathia.

MAXILLARY TORUS (Torus Palatinus)- Indications for Removal:

a large, lobulated torus with a thin mucoperiosteal cover extending posteriorly to the vibrating line of the palate that prevents seating of a denture and formation of a posterior seal at the fovea palatine. Chronic irritation, interference with speech, rapid growth, and patients with a cancer-phobia are also indications.

Good Samaritan Law-

a law enacted in all states that provides immunity from suit for specified health practitioners who render emergency aid to victims of accidents, provided there is no evidence of gross negligence. Not all states include dentists in the Good Samaritan Law.

A large diastema between maxillary incisors can create

a lisp, making it difficult to pronounce "s" & "z".

PRILOCAINE (CITANEST, CITANEST FORTE)-

a local anesthetic amide used for nerve block, epidurals, and regional anesthesia.

However, anterior crossbite of one or more permanent incisors may suggest

a localized discrepancy and a condition that should almost always be treated in the mixed dentition state, or as soon as it is identified. It is NOT a self-correcting condition.

Acute Apical/Alveolar Abscess (AA)-

a localized collection of pus inside alveolar bone at the root apex after pulpal death, with the infection extending into the periapical tissue. FIRST SYMPTOM of AA may be slight tooth tenderness, that later develops into a SEVERE THROBBING PAIN to percussion with swelling of the overlying mucosa.

Chronic Apical Abscess (suppurative apical periodontitis)-

a long-standing, low-grade infection of the periapical bone with the root canal being the source of the infection. It is generally asymptomatic, and sometimes so painless that it may go undetected for years until revealed by an x-ray. Treatment is conventional root canal therapy.

Peds Rubber Dam:

a main advantage of using a rubber dam is it aids in child management. It seems to quiet and calm the patient because it acts as a separation/barrier both physically and psychologically between the patient and dentist. Thus, the rubber dam works for a very nervous or anxious patient.

OPEN BITE-

a malocclusion (abnormal bite) where some teeth (usually the front teeth) cannot be brought into contact with their opposing teeth. Tongue thrusting DOES NOT cause crossbite or an open bite. A tongue thrust swallow is the result of displaced incisors (not the cause). Recent studies show that "tongue thrust swallowing" does not cause open bite as there is no tongue force on the teeth during swallowing even though the tip of the tongue is placed forward. The tendency to place the tongue forward originates from the need to attain an oral seal. By placing the tongue between the teeth (in cases of anterior open bite) an oral seal is formed during swallowing. Thus, the forward position of the tongue during swallowing is due to the anterior open bite, and the reverse is not true "a tongue thrust swallow thus is considered the result of displaced incisors, not the cause".

1. Classical Conditioning (Pavlovian or Respondent Conditioning)-

a mechanism by which behavioral responses are learned. Operates by associating one stimulus with another. A stimulus leads to a response. If individuals in white coats give painful injections that cause crying, the sight of an individual in a white coat soon may provoke a crying outburst. If this is not reinforced, the conditioned response will no longer occur (extinction of the conditioned behavior). Classical conditioning is a form of learning in which a previously neutral stimulus comes to elicit a given response through associative training.

Hemophilia-

a medical condition that is NOT a contraindication to conventional endodontic therapy, but is strongly recommended that the dentist obtain clearance from the patient's physician before treatment.

FRENUM-

a membranous fold of skin or mucous membrane that supports or restricts movement of a part or organ like the small band of tissue that connects the underside of the tongue to the floor of the mouth. When a frenum is malpositioned and interferes with the normal alignment of teeth, or results in pulling away gingiva from the tooth surface causing recession (attachment loss), it is often removed via a FRENECTOMY.

Cellulitis may be caused by

a necrotic primary or permanent tooth, resulting in considerable swelling of the face or neck, and the tissue appears discolored. It is a very serious infection that can be life-threatening. The child appears acutely ill and may have a very high temperature with malaise and lethargy

BELL CURVE-

a normal "bell shaped" curve (Gaussian Curve) represents plotted data that are EQUALLY distributed around the mean, median, and mode. When sample data is plotted on a NORMAL BELL CURVE, the MEAN, MEDIAN, & MODE are EQUAL.

Pink Tooth-

a pathognomonic sign of internal resorption (not replacement resorption), and sometimes a sign of cervical root resorption, characterized by a pinkish appearance of the tooth due to granulation growth undermining the coronal dentin.

INDICATIONS for ROOT CANAL THERAPY (RCT): 1. Apical Scar-

a periapical granuloma, cyst, or abscess that heal with scar tissue. It's a well-circumscribed radiolucency resembling a granuloma. Tooth is nonvital, so endodontic treatment is necessary.

PROBING LESIONS: 1. Conical-Shaped Probing Lesion-

a periodontal probing defect that cannot be managed by endodontic treatment alone that is typical of a periodontal problem. Periodontal Lesions characteristically show bone loss that starts at the crestal bone level and progresses apically. Thus, probing defect is conical-shaped. Periodontal lesions may not be amenable to RCT alone even if it is associated with a pulpless tooth. However, endodontic treatment must be completed PRIOR to treating the periodontal problem.

Trendelenburg's Position-

a position where the patient is on an elevated and inclined plane (~45°) with the head down and legs and fee over the edge of the table. It is used in abdominal operations to push abdominal organs toward the chest, and is usually used to treat shock (i.e. anaphylaxis reactions). However, if there is an associated head injury, the head should not be kept lower than the trunk.

Meperidine (Demerol)-

a potent narcotic analgesic prescribed to relieve moderate-to-severe pain, and as a cough suppressant. Demerol is probably the most widely used narcotic in U.S. hospitals. It compares favorably with morphine (the standard for narcotic analgesics). Meperidine is the most abused drug by health professionals.

Submandibular Space-

a potential space of the neck bound by the oral mucosa and tongue anteriorly and medially, superficial layer of deep cervical fascia laterally, and hyoid bone inferiorly. It comprises two spaces (sublingual & submaxillary spaces), divided by the mylohyoid muscle.

Chlorine-

a powerful oxidizing agent that inactivates bacteria and most viruses by oxidizing free sulfhydryl groups. Chlorine is the active component of hypochlorite (bleach) and is used as a disinfectant.

SEALANTS SEALANTS-

a preventative barrier to protect tooth occlusal surfaces (PITS & FISSURES) from bacteria that cause dental caries by sealing unprotected pits and fissures with resin. Sealants also provide a smooth surface for saliva and toothbrush bristles to clean

If spacing is present, it is possible that DRIFTING of the adjacent teeth will occur if there is a loss of

a primary incisor. However, if no spacing exists, and the primary anterior teeth were in contact before the lost incisor, a collapse in the arch after the loss of one of the primary incisors is almost certain. This is not true in the case of a lost permanent incisor as space closure occurs rapidly whether spacing is present or not prior to the primary tooth loss. Space maintenance would be indicated.

3 principles of public health:

a problem exists, solutions exist, and solutions to the problem are applied.

Body Osteotomy-

a procedure that involves extracting mandibular teeth bilaterally (usually premolars), a piece of bone is removed from the mandible, and everything slides back. Corrects mandibular prognathism (Class III malocclusion).

SERIAL EXTRACTION-

a procedure that involves the orderly removal of selected PRIMARY & PERMANENT TEETH in a predetermined sequence. Serial extraction is primarily indicated in SEVERE CLASS I malocclusion in the mixed dentition that has insufficient arch length. It benefits children who have an arch-length discrepancy. Important: severe arch space deficiency in the permanent dentition (> 10mm) almost always requires extractions to properly align teeth.

GENIOPLASTY-

a procedure that surgically alters the chin's position. The most common techniques for genioplasty are osteotomy or augmentation using natural or alloplastic materials. The best way to enlarge the prominence of the chin for best long-term results is to reposition the lower border anteriorly by OSTEOTOMY (horizontal sliding osteotomy).

Adjuncts to Endodontic Treatment: Crown lengthening-

a procedure to apically position the gingival margin and/or to reduce cervical bone. Used to treat subgingival caries, perforations, and resorptions.

Invasive Procedures for Obstructed Airway: these procedures are only performed by people trained in these techniques and with the proper equipment: Cricothyrotomy-

a procedure to establish EMERGENCY AIRWAY when other methods are unsuitable or impossible. The access site is the cricothyroid membrane of the trachea, located on the anterior neck between the cricoid and thyroid cartilages.

Gemination-

a process where a single tooth germ splits or shows an attempt to splitting to form two completely or partially separated crowns, resulting in incomplete formation of two teeth. Most commonly occurs in the incisor region.

Vasovagal syncope-

a psychogenic reaction and the most commonly experienced complication associated with using local anesthetic solutions. The clinical signs closely resemble shock. These psychogenic reactions readily respond to placing the patient in a supine position.

A cooperative 5-year old child has a carious lesion in her primary mandibular second molar. There is no tooth mobility, but the dentist notes a small, draining sinus tract adjacent to the tooth. Treatment of choice is

a pulpectomy.

NiTi methods: Filing-

a push-pull action with emphasis on the withdrawal stroke. Its efficiency is greater with files than with reamers to remove dentin due to the greater number of flutes in contact with canal walls during the rasping motion of removing the file. Filing action produces a canal that is irregular in shape, thus a canal prepared with this push-pull filing action MUST be filled with gutta-percha in a condensation procedure.

NiTi methods: Circumferential filing-

a push-pull filing action that SCRAPES canal walls to create a smooth, tapered preparation. The file is moved first towards the canal's buccal side, reinserted, then removed slightly mesially. This is done all the way around the canal until all dentin walls are planed. Circumferential filing technique enhances preparation when a flaring method is used.

ANODONTIA-a developmental abnormality characterized by the TOTAL ABSENCE OF TEETH. 1. Complete True Anodontia-

a rare condition in which all of the teeth are missing. It may involve both primary and permanent dentitions; usually associated with hereditary ectodermal dysplasia.

RIEGER SYNDROME-

a rare genetic disorder characterized by delayed sexual development, hypothyroidism, and dental features like hypodontia, underdeveloped premaxilla, cleft palate, and a protruding lower lip. Eye anomalies are is a min symptom of Rieger Syndrome.

CUSHING'S SYNDROME (Hypercortisolism)-

a relatively rare hormonal disorder caused by prolonged exposure of the body's tissues to high levels of CORTISOL HORMONE. Most commonly affects adult's ages 20-50yrs. 10-15 out of every 1 million people are affected each year. Most common cause of Cushing's Syndrome is pituitary adenomas.

Post-operative Ecchymosis-

a result of trauma to underlying blood vessels when blood escapes from the vascular tree and accumulates in the tissues. It is common after extractions in elderly patients due to the fragility of the vessel walls. All patients should be warned it can occur after extractions. Sometimes the patient will complain of a diffuse, non-painful, yellowish discoloration of the skin. Moist heat often speeds the resolution of postoperative ecchymosis.

7. PLAQUE INDEX (PI) of Silness & Loe-

a reversible index to assess the THICKNESS of plaque at the gingival margin (measures oral debris). Used to determine plaque accumulation. The best time to perform a plaque index is at the beginning of the appointment. The plaque index is a specific index for scoring plaque and oral debris. It was derived from the papillary, marginal, and attached gingiva index (PMA). The plaque index is based on an assessment of the severity and location of soft debris aggregates in terms of scores 0, 1, 2, 3. A plaque score of "0" means the gingival area of the tooth surface is plaque free. The examination is made by passing a probe over the tooth surface into the gingival sulcus. If no soft material adheres to the probe, the area is given a "0". A plaque score of "1" is given when plaque cannot be observed on the tooth, but is observed on the probe. A plaque score of "2" is given when a thin to moderately thick plaque layer is visible to the eye. A plaque score of "3" is given when a heavy accumulation of plaque fills the area between the gingival margin and the tooth surface, or fills the interdental area. In this system, the most stress is placed on the THICKNESS OF PLAQUE at the gingival margin area on all four surfaces of each tooth. The scores of all three areas of all teeth are added then divided by the number of teeth. The plaque index has been extensively used, but does NOT have universal acceptability. Some studies show 80-90% of children have inflammatory periodontal disease (gingivitis or periodontitis) by age 15. Localized acute gingivitis is the most common form. Epidemiologic studies show the strongest relationship between prevalence and severity of periodontal disease with oral hygiene and age.

5. PERIODONTAL INDEX (PI)-

a reversible index that measures conditions that can be changed (plaque and bleeding). Measures the periodontal condition of a population. Used to assess the prevalence of periodontal disease in populations of people. The best time to perform this index is at the beginning of the appointment. ♦ The condition of the gingiva AND bone are estimated individually for each tooth. A progressive scale that gives little weight to gingival inflammation, and more weight to alveolar bone resorption is used for scoring. ♦ Scores from each tooth are added together, then is divided by the number of teeth in the mouth to give the patient's periodontal disease index. This score reflects the average status of periodontal disease in a given mouth without reference to the type or causes of disease. The community's score is the average of individual scores of persons examined.

Korff's Fibers-

a rope-like grouping of fibers in the pulp periphery that are involved with formation of the dentin matrix. Thick collagenous fibers in the developing tooth that starts in the dental papilla.

FLAP-

a section of soft tissue that is outlined by a surgical incision, carries its own blood supply, allows surgical access to underlying tissues, can be replaced in the original position, and maintained with sutures and is expected to heal. • Flap design should ensure adequate blood supply (flap base is always larger than the flap apex). • Flap reflection should adequately expose the operative field. • Flap design should permit atraumatic closure of the wound.

1. CLEFT LIP-

a separation of the two sides of the lip that occurs during the 5 th -6 week of embryonic life due to failure of the maxillary & frontonasal processes to merge. Cleft lips are more common in MALES, and more common on the left side than right side.

Exposure Incident-

a specific occupational incident involving the eyes, mouth, other mucous membranes, nonintact skin, or parenteral contact with blood or other potentially infectious materials (including saliva). An injury from a contaminated sharp is the most common exposure incident.

. Anxiety-

a state or feeling of apprehension, uneasiness, agitation, or uncertainty resulting from the anticipation of some threat or danger, usually of intrapsychic rather than external origin, whose source is generally unknown or unrecognized. The ANXIOUS patient is usually considered the most difficult patient. Most dentists become anxious with an anxious patient. Most patients who are anxious have had a traumatic experience in a dental or medical setting.

P-VALUE (STATISTICAL SIGNIFICANCE):

a statistic used to test a hypothesis to help the researcher determine the SIGNIFICANCE of test results or probability that a condition or circumstance would occur by chance without any experimental manipulation. All hypothesis tests use p-value to weigh the strength of evidence.

LATE MANDIBULAR GROWTH is the theory that best explains why there is

a strong tendency for mandibular anterior crowding in the late teens and early 20's. The current concept is that late incisor crowding develops as the mandibular incisors and possibly the entire mandibular dentition, move DISTALLY relative to the body of the mandible late in mandibular growth.

RESEARCH METHODS, VARIABLES, & STATISTICS RANDOMIZED STUDY-

a study where ALL subjects have an equal chance of being assigned to either the study or control group. Statistical probability is such that the assumption can then be made that the groups differ ONLY in terms of the agent under study. Any uncontrolled variables influencing the outcome are likely to affects subject in both groups equally. Thus, researchers prefer the "random assignment method" for placing subjects into either the study or control group.

DOUBLE BLIND STUDY-

a study where BOTH subjects and researcher are unaware of which subjects belong to the experimental group or the control group to prevent researcher and subject bias (BEST study method to prevent bias). Dental clinical boards are often double-blind examinations.

BLIND STUDY-

a study where subjects are unaware of if they are in a test or control group. One way of achieving a blinded study is using placebos.

GINGIVOPLASTY-

a surgical procedure to reshape the gingiva to create a normal, functional form.

ALVEOPLASTY-

a surgical procedure used to recontour the supporting bone structures in preparation of a complete or partial denture. It is the surgical preparation of the alveolar ridges (i.e. removing undercuts) to receive dentures or shaping and smoothing the socket margins after extractions with subsequent suturing to ensure optimal healing. * Objectives of bone recontouring should provide the best possible tissue contour for prosthesis support, while maintaining as much bone and soft tissue as possible.

ASTHMA-

a syndrome consisting of dyspnea, cough, and wheezing caused by bronchospasm, which results from a hyperirritability of the tracheobronchial tree. Two types of asthma exist (allergic asthma) the most common, and idiosyncratic asthma.

If bleeding persists for some time after an extraction, instruct the patient to bite on

a tea bag. Tannic acid in the tea bag helps promote hemostasis.

3. Aversion Conditioning-

a technique in which punishment, unpleasant or painful stimuli are used in the suppression of undesirable behavior. In dentistry it is called the "Hand-Over-Mouth" technique (HOME).

5. Systemic Desensitization-

a technique used to eliminate maladaptive anxiety associated with phobias. The procedure involves the construction by the person of a hierarchy of anxiety producing stimuli and the general presentation of these stimuli until they no longer elicit the initial response of fear.

"Sunday Bite"-

a term given to the forward postural position of the mandible adopted by people with Class II profiles in an effort to improve their esthetics.

FALSE NEGATIVE RESULT-

a test result that erroneously excludes an individual from a specific diagnostic or reference group, due mainly to insufficient exact methods of testing. Simply stated, if a diagnostic test fails to identify a case of true disease, it is a false negative result.

ANOVA (Analysis of Variance)-

a test to compare the hypothetical statistical differences between THREE or more mean scores.

RECURRENT APHTHOUS ULCERS Usually begin with

a tingling or burning sensation, followed by a red spot or bump that ulcerates. Pain spontaneously decreases in 7-10 days, with complete healing in 1-3 weeks.

Autogenous Tooth Transplantation-

a tooth from the same individual is move to another socket in the mouth. The MOST common indication for tooth transplantation is SEVERE DECAY of a 1 MOLAR. (The first molar is atraumatically extracted, and replaced with the 3 st molar in its socket).

Intentional Replantation (Replant Surgery)-

a tooth that requires endodontic therapy is purposely REMOVED from its socket, some type of canal or apical preparation and/or filling is performed, and the tooth is RETURNED to its original socket. Replant Surgery Indications: 1. When routine endodontic therapy is impractical or impossible. 2. When a canal is obstructed via a broken instrument or calcification, and periapical surgery is impractical (a lower molar with the mandibular canal is close proximity). 3. When perforating internal or external is present, yet surgery is impractical. 4. When previous treatment has failed, but non-surgical treatment or surgery is impractical.

2. Tooth-Borne Functional Appliances: Clark's Twin Block:

a two-piece acrylic appliance that postures the mandible forward with help of occlusally inclined guiding planes and bite blocks. The vertical separation of the jaws is also configured by the height of the bite blocks.

SKELETAL OPEN BITE ("Long Face Syndrome")-

a type of malocclusion that is most often associated with MOUTH BREATHING. Factors associated with chronic mouth breathing include narrow face & oropharyngeal space, chronic rhinitis (inflammation of the mucous membranes of the nose), chronic tonsillitis, allergies, and a deviated nasal septum.

GOMPHOSIS-

a type of fibrous joint in which the conical process is inserted into a socket-like portion, such as the styloid process in the temporal bone or the teeth in the dental alveoli.

MIDFACIAL FRACTURES- 2. LeFORT II (Pyramidal Fracture)-

a unilateral or bilateral fracture of the maxilla in which the body of the maxilla is separated from the facial skeleton and the separated portion is pyramidal-shaped. Signs: periorbital edema, ecchymosis, subconjunctival hemorrhage, and nose bleeding. A common finding is paresthesia over the distribution of the infraorbital nerve.

Dissociative Anesthesia-

a unique method of pain control that reduces anxiety and produces a trance-like state where the person is not asleep, but feels separated from their body. Used in emergency situations (i.e. injury/trauma) and can be used for short, painful procedures (i.e. changing bandages). This method is safe and lasts only a short time. Since the person does not usually remember the procedure, dissociative anesthesia is useful in CHILDREN. A person who received dissociative anesthesia usually does not remember the procedure, especially if a sedative was given with the pain medication. Most people feel normal within a few hours. As the medication wears off, an individual may have intense dreams or hallucinations.

Always aspirate a central bone lesion to rule out a vascular lesion. If a lesion seems compressible, pulsatible, blue, or a bruit is heard using a stethoscope, beware of

a vascular lesion and biopsy only under a controlled hospital setting.

N20:Used in adults and children to reduce anxiety and fear. In adults, it is given through

a vein in the arm. During the last 20 years, it has almost totally replaced diazepam as the drug of choice for IV sedation. It causes less burning and pain during injection. In children, it is usually given orally as a sweet-tasting syrup. Some dentists may elect to give midazolam as a nasal spray.

NURSING BOTTLE CARIES (Baby Bottle Tooth Decay or Bottle Mouth Syndrome)-

a widespread carious destruction of the deciduous (primary) teeth most commonly affecting the MAXILLARY INCISORS. Inappropriate feeding of children may cause a typical nursing pattern decay. There is early carious involvement of the maxillary anterior teeth, followed by maxillary & mandibular 1 molars, and mandibular canines. Mandibular incisors are less affected since the tongue covers them. AKA: Early childhood caries, Nursing caries, Bottle caries, or Infant caries.

Sensitivity-

ability of the test to diagnose correctly a condition or disease that actually exists. Sensitivity measures the proportion of people with a disease who are correctly identified by a positive test. Sensitivity is defined as the number of true positives (TP) divided by total number of potential positive findings (true positives and false negatives) in the sample. Sensitivity = TP/TP + FN.

When the root is fully formed, the possibility increases for

abnormal root morphology and fracture of root tips during extraction.

For use with URA, the direction of force

above the occlusal plane aids in retention.

Oligodontia-ortho

absence of one or more teeth. More common in females, and often associated with a smaller than average tooth-size ratio.

Pulp cappings are more successful if the exposure was

accidental (trauma or with a dental bur = mechanical) rather than carious. Also, the pulp exposure should only be pinpoint in size to expect success. Repair occurs when a dentin bridge forms at the pulp exposure site. Even a small carious exposure should have RCT for the best longterm prognosis.

Reduction of secretions occurs by competitive blockade of

acetylcholine and other cholinergic stimuli at cholinergic receptor sites on salivary and bronchial glands. Antagonism of acetylcholine on the sphincter and ciliary body in the eye causes mydriasis (dilation of pupils).

Inflammation and infection cause tissues to become

acidic. The cationic (water-soluble) form of the anesthetic predominates (there is less free base available). Thus, the penetration through the membrane is decreased, giving the anesthetic poor effectiveness.

Myofascial Pain Dysfunction (MPD) Syndrome-often responds to an

acrylic night guard (occlusal separator or occlusal appliance) along with a soft diet, limited talking, and elimination of gum chewing. Moist heat applied to the face and nonsteroidal anti-inflammatory agents are also helpful during the acute phase.

The most probable post-operative complication of tooth bleaching that has not been properly obturated is

acute apical periodontitis.

ulnar seaside or hamate bones are landmarks to obtain an estimate of the timing of the

adolescent growth spurt. Wrist-hand radiographs in the dental office are obtained using a standard cephalometric cassette and dental radiograph.

2. Tooth-Borne Functional Appliances : Activator:

advances the mandible to an edge-to- edge position to induce mandibular growth to correct a Class II malocclusion. The maxillary teeth are prevented from erupting by the acrylic shelf, while mandibular posterior teeth are free to erupt. This improves the deep-bite seen in Class II cases.

1. SODIUM FLUORIDE (NaF 2% or 5% = 22,600 ppm)-

advantages are basic pH (9.2), more acceptable taste than stannous fluoride, and no adverse effect on restorative materials (does not etch or roughen composite and porcelain restorations). MOST EFFECTIVE professional fluoride delivery system for patients with RAMPANT CARIES, GERD, or BULEMIA is the TRAY METHOD WITH SODIUM FLUORIDE (NaF).

Pump spray disinfectants are better than

aerosol spray disinfectants.

Pulp contains myelinated (sensory) & unmyelinated (motor) nerve fibers that are

afferent & sympathetic. Unmyelinated fibers regulate the lumen size of the blood vessels. However, proprioceptors (respond to stimuli regarding movement) are NOT found in dental pulp.

POSTERIOR CROSSBITE

after prolonged thumb sucking & ANTERIOR CROSSBITE in mildly prognathic children are usually seen with displaced teeth related to functional shifts.

CHELATING AGENTS-

aid and simplify preparation of highly sclerotic canals after the apex is reached with a fine instrument. Chelating agents act on calcified tissues only with little effect on periapical tissue. Chelating agents act by substituting Na+ ions that combine with dentin to form soluble salts for Ca+ ions that are bound in a less soluble combination. Thus, canal edges become softer, to facilitate canal enlargement.

A 6-year old should have

all 20 primary teeth and 4 first molars (6-year molars) clinically visible in the mouth. • Permanent mandibular centrals erupt between ages 6-7. • Permanent maxillary centrals erupt between ages 78.

AMIDE LOCAL ANESTHETICS AMIDE LOCAL ANESTHETICS:

all are metabolized in the LIVER (except Articaine), and the metabolites are then renally excreted. All " have an "amide" grouping within their chemical structure. An amide grouping is a bridge or link containing the -CONHCH - configuration. Amides are present in urine Amides are the only local 2 anesthetics presently available as dental injectables (Lidocaine (Xylocaine), Prilocaine (Citanest), Bupivacaine (Marcaine), & Mepivacaine (Carbocaine), Etidocaine, & Articaine). All drugs with two letter "i" in the name. Amides are metabolized by the "hepatic microsomal enzyme system", and the products formed to not have anesthetic actions and are excreted from the body by the KIDNEY.

SEVERE malocclusion may compromise

all aspects of oral function (speech, swallowing, and mastication). There may be difficulty in masticating if only a few teeth meet, and jaw discrepancies may force adaptive alterations in swallowing. It can be difficult or impossible to produce certain sounds, and speech therapy may require some preliminary orthodontic treatment. Referral to a speech therapist is helpful as both patient and parents can benefit. Even less severe malocclusions can affect mastication, swallowing and speech, not so much by making function impossible, but by requiring physiologic compensation for the anatomic deformity.

If a child lives in a temperate zone most of their childhood (up to age 9-10yrs.),

all permanent teeth will most likely be affected (remember: 3 molars begin calcification between ages 7-9yrs, so if the child moves before this age, the 3 molars may not be affected).

Maxillary incisor rotation is not commonly treated during the mixed dentition stage, but is BEST TREATED after

all permanent teeth have erupted (in the early permanent dentition) with SIMPLE REMOVABLE APPLIANCES. However, if the incisor is in anterior crossbite, it should be corrected ASAP (while it is erupting).

Host MUST produce ALL of the essential elements in the graft bed for an

allogeniec bone graft to become resorbed and replaced.

If a permanent 1 molar is extracted on a child before the permanent second molar erupts, the best approach is to

allow the second molar to erupt and allow mesial drifting to occur naturally as this will usually fill in the space.

Full Mucoperiosteal Flap (Full-thickness)-

allows MAXIMUM access & visibility. This wide flap is raised from the gingival sulcus (elevating gingival crest & interdental gingival), and its outline precludes any incisions over bony defects, and allows various periodontal procedures (i.e. curettage, SRP, bone re-shaping). Can be indicated for root-end surgery on an anterior tooth. Disadvantages: it's a large flap that may be difficult to reposition, suture, make alterations, and post-surgical gingival recession is possible.

Reasons to Section Teeth:

allows for minimal bone removal, minimal force to remove the tooth, and shortens the entire surgical procedure. Tooth sectioning is performed with a bur or chisel, but the bur is used by most surgeons.

Petit Mal Epilepsy (Absence Seizures)-

almost always develops in childhood usually in children under age 16. Clinically, this seizure consists of a brief lapse of consciousness, normally lasting 5-10 seconds, and rarely lasts beyond 30 seconds. The patient makes no movement during the episode, and termination of the episode is equally abrupt. Management of petit mal and partial seizures is of a protective nature. The doctor merely prevents any injury to the victim. There is little or no danger to the victim, so that even without assistance from staff members, morbidity seldom occurs. However, if this seizure should last a significant length of time, medical assistance is required.

Maxillary 1 Molar: DB canal:

also a small, tapering canal, but its orifice has no direct relation to the DB cusp. The DB orifice is usually located by its relation to the MB orifice. The DB canal is found 2-3mm distal and slightly palatal to the MB canal orifice.

Isopropyl Alcohol-

also used for hand hygiene procedures, but products containing 60-80% alcohol DO NOT use water, thus is a waterless hand hygiene agent. Isopropyl alcohol (90-95%) is the major form used in hospitals.

Short-term therapy (1-3 days) of even high dose steroids does NOT

alter adrenal cortical function.

Premedication with Scopolamine prolongs certain effects (similar to premedication with Morphine) like

amnesia, psychic sedation, and decreased salivation.

TMJ Syndrome is Divided into 3 Categories: 2. Internal Derangement (Disc Displacement)-

an abnormal relationship of the articular disc to the mandibular condyle, fossa, & articular eminence (or tubercle). The most common direction the TMJ's articular disc can become displaced is ANTERIORLY. Internal derangement is present when the posterior band of the articular disc is anteriorly displaced in front of the condyle. As the articular disc translates anteriorly, the posterior band remains in front of the condyle and the retrodiscal tissue (bilaminar zone) becomes abnormally stretched. Often the displaced posterior band returns to its normal position when the condyle reaches a certain point (this is anterior displacement with reduction). When the articular disc reduces the patient often feels a pop or click in the joint.

When a 15-year old female who has lived in a nonfluoridated area all her life moves to a community where the drinking water naturally contains 6ppm of fluoride, whats likely to increase for her

an increase in the amount of fluoride stored in her bones is most likely to occur. Moderate fluorosis will not occur, because by age 15, her entire dentition has undergone complete enamel calcification (except possibly the 3 rd molars).

1. DMFT Index (Decayed-Missing-Filled Teeth Index)-

an irreversible index (measures conditions that cannot be reversed like caries) applied only to permanent teeth. DMFT index results yield a group's caries susceptibility. DMFT has received universal acceptance, and is probably the best known of all dental indices. DMFT is the best caries index to use if the major purpose of an epidemiologist's research is to determine caries susceptibility as opposed to immediate treatment needs. DMFT determines the total dental caries experience (past and present) but is only used for permanent teeth. It has received universal acceptance and is the best know of all dental indexes.

Behavior Shaping (Successive Approximation)-

an operant conditioning technique used in behavior therapy in which new behavior is produced by providing reinforcement for progressively closer approximations of the final desired behavior. It is a common non-pharmacologic technique.

MIDAZOLAM (Versed Injection, Syrup, or Nasal Spray)

an anti-anxiety (benzodiazepine) drug that relaxes and makes child sleepy. Closely related to diazepam (Valium).

DENTAL FLUOROSIS-

an "irreversible" diffuse symmetric hypomineralization disorder of ameloblasts that only occurs with exposure to fluoride when enamel is developing (during the calcification period). Dental fluorosis is a toxic manifestation of chronic (low-dose, long-term) fluoride intake. Dental fluorosis is not caused by repeated topical application of fluoride.

Periodontal Abscess-

an acute abscess that develops through the periodontal pocket that involves alveolar bone loss, pocket formation, and periodontal pathologic conditions. Tooth is usually palpation & percussion positive, and responds to EPT (unlike the periapical abscess). Bacteria associated with the periodontal abscess are gram (-) rods (i.e. Capnocytophaga species, Vibriocorroding organisms, Fusobacterium species).

Chronic apical abscess may follow

an acute alveolar abscess or unsatisfactory RCT. Radiographs reveal a diffuse radiolucency & PDL thickening. The tooth may be slightly loose, or tender to percussion.

Inhalation of a selective beta -agonist (Terbutaline, Albuterol) is the preferred treatment for

an acute asthmatic attack.

Important: growth at the mandibular condyle during puberty usually results in

an increase in posterior facial height.

MUMPS-

an acute contagious viral infection characterized mainly by unilateral or bilateral swelling of the salivary glands (usually the PAROTID = PAROTITIS). Mumps is usually a childhood disease, but may also affect adults. The papilla on the opening of the parotid duct on the buccal mucosa is often puffy and reddened.

Acute Necrotizing Ulcerative Gingivitis (ANUG, Vincent's Angina or "Trench Mouth")-

an acute gingival disease characterized by painful hyperemic gingiva, punched-out erosions of interproximal papilla, covered by a GRAY pseudomembrane with an accompanying fetid/foul odor.

HERPANGINA-

an acute infection (stomatitis/mouth inflammation) affecting YOUNG CHILDREN caused by the A strain COXSACKIE VIRUS. It is differentiated clinically from HSV-1 (cold sore virus) as herpangina oral ulcerations/vesicles typically occur on the BACK OF THE THROAT (SOFT PALATE, TONSILS, POSTERIOR PALATE). May also appear on the tongue.

Rheumatic Fever (RHD)-

an acute inflammatory disease with systemic manifestations and particular involvement of the heart valves, which follows an upper respiratory infection with a Group A beta-hemolytic streptococcus. Although rheumatic fever may follow a streptococcal infection, it is NOT an infection, but an inflammatory reaction to an infection.

CELLULTIS-

an acute spreading infection of the dermis and subcutaneous tissues causing pain/tenderness, erythema, edema, and warmth of the affected area (hallmarks of cellulitis). Cellulitis is a common infection that may progress to a serious illness by uncontrolled spread contiguously or via the lymphatic or circulatory systems. Group A Streptococci & Staphylococcus Aureus are the most common causative organisms.

SMALLPOX (Variola)-

an acute viral disease that manifest clinically by a high fever, nausea, vomiting, chills, and headache. The skin lesions begin as small macules and papules that first appear on the face, but rapidly spread to cover much of the body.

DIPHTHERIA-

an acute, contagious disease caused by the bacterium Corynebacterium diphtheria, characterized by the production of a systemic toxin which is very damaging to tissues of the heart and CNS. Immunization is available to all U.S. children.

COCAINE-

an addictive CNS stimulant and only local anesthetic that increases the vasoconstriction activity of EPI & NE. NOT routinely used in dentistry. Cocaine is a stimulant, anesthetic, and vasoconstrictor. Snorted as a powder, smoked as "crack", or injected to produce symptoms for 5-30 minutes.

Glutaraldhyde (2%)-

an alkalizing agent highly lethal to essentially all microorganisms. It takes 10hrs to kill bacterial spores when a dental instrument is placed in a 2% glutaraldehyde solution. If the 10hr sufficient contact time is provided, there is absence of extraneous organic material.

Mixed Dentition Analysis (transitional dentition analysis)-

an analysis performed during the mixed dentition to predict the amount of crowding AFTER the permanent teeth erupt. It determines the space available vs. space required. It is performed using a boley gauge, study models, and a prediction table. The analysis is based on a correlation of tooth size (one may measure a tooth or group of teeth and predict accurately the size of the other teeth in the same mouth.

Bilateral dislocated fractures of the condylar necks cause

an anterior open bite and inability to protrude the mandible.

Bactericidal-

an antibacterial solution that directly KILLS bacteria. Bactericidal agents are preferred to "bacteriostatic" chemicals because bacteriostatic do not directly kill or inactivate microbes, but merely inhibit their metabolism and replication. Thus, these organisms can remain viable, but inactive for extended intervals. Application of a bactericidal agent or process ensures microbial inactivation.

Phoenix Abscess (suppurative apical periodontitis = recrudescent abscess)-

an apical lesion (acute abscess) that develops as an acute exacerbation of a chronic apical abscess. It develops as the granulomatous zone becomes contaminated or infected by root canal elements. Diagnosis is based on acute symptoms (pain to percussion) and radiographic examination (reveals a large periapical radiolucency).

Managed Care-

an arrangement where a third-party payer (insurance company, federal government, or corporation) mediates between doctors and patients, negotiating fees for services and overseeing the types of treatment provided.

Malignant Hyperthermia-

an autosomal dominant inherited condition and life-threatening, acute pharmacogenetic disorder occurring in patients undergoing general anesthesia. Classic MH usually manifests in the operating room, but can also occur within the first few hours of recovery from anesthesia. Characterized by a sudden, rapid rise in body temperature associated with signs of increased muscle metabolism (i.e. tachycardia, tachypnea, sweating, and cyanosis, increased CO production, and muscle rigidity).

Hedstrom files-

an effective "H-Type" stainless steel CUTTING instrument made using a sharp, rotating cutter to gauge triangular segments out of a round blank shaft to produce a very sharp edge. Used carefully with ONLY a filing action, this file successfully planes dentin walls much faster than K-type files or reamers. S-file-a modified Hedstrom file.

Through the OSHA Bloodborne Pathogen Standard, OSHA directs that uniform clothing worn in the dental office is laundered at the dental office or by an outside service, NOT at

an employee's home. Offices must use barrier techniques, communicate hazards to employees (training), perform proper cleaning of the office, and offer Hepatitis B vaccinations.

2. Ellis Class II Fracture-

an extensive crown fracture involving considerable dentin, but not pulp. The standard of care used to involve covering exposed dentin with calcium hydroxide or a glass component cement to seal out oral flora. It is now recommended to also place a glass ionomer restoration.

Mesiodens-

an extra tooth that occurs between the maxillary central incisors. Mesiodens are usually small peg-shaped teeth (microdontia) that do not resemble the normal teeth of the site. An impacted mesiodens can cause a diastema between the maxillary central incisors, while an inverted mesiodens can cause delayed eruption of the maxillary central incisors.

A 15-year old female has lived in a non-fluoridated area her entire life. When she moves to a community where the drinking water naturally contains 6ppm of fluoride, she will experience

an increase in the amount of fluoride stored in her bones. • Moderate fluorosis will not occur, because by age 15 her entire dentition has undergone complete enamel calcification (except possibly the 3 molars). A 50% reduction in dental caries is not probable because her entire dentition has already undergone complete enamel calcification. rd

Ex: a radiograph of a 1st molar shows gross decay that may involve a dental pulp horn. The ideal treatment is to do

an indirect pulp cap and place a sedative filling (IRM). If the tooth remains asymptomatic, in 3-4 months you can re-enter the tooth and remove all decay with subsequent placement of a permanent filling. *If this patient had tooth pain (aggravated by heat and tender to percussion), and excavation of the caries revealed pulp horn exposure without evidence of vital tissue, the emergency treatment pending eventual RCT is to place a small cotton pellet dampened with eugenol over the exposure and seal the cavity with a temporary material (IRM).

INFECTION CONTROL Opportunistic Infection-

an infection caused by normally non-pathogenic microorganisms in a host whose resistance has been decreased or compromised. • The percentage of people living with a wide variety of immune compromised conditions continues to increase. Along with the clinical manifestations of those types of diseases, there can be accompanying deficiencies in aspects of hostimmune defenses. The severity of deficiency can range from mild, to life-threatening, and predispose the compromised person to infections by organisms that would not usually occur in other people with intact innate and specific immunity.

Desflurane-

an inhalation anesthetic with a low blood: gas partition coefficient, but is not used to induce anesthesia because of its pungency (irritates the airway) which causes patients hold their breath. The pungency of desflurane leads to a high incidence of coughing, bronchospasm, and can cause centrally mediated tachycardia and ↑BP.

Cleiodocranial Dysplasia (Dysostosis)-

an inherited disorder of bony development characterized by absent or incompletely formed clavicles, characteristic facial appearance, and dental abnormalities. Occurs equally in M & F, with the presence of supernumerary teeth being one of the most distinguishing features.

Dentinogenesis Imperfecta-

an inherited condition and dental anomaly transmitted as a dominant trait that causes undermineralized dentin. It can affect the primary & permanent dentition. Crowns are bulbous with short roots, and teeth may appear gray or brown with opalescent dentin that overgrows and obliterates the pulp cavity. Teeth wear rapidly.

TOOH ABNORMALITIES Amelogenesis Imperfecta-

an inherited condition in which teeth are covered with thin, malformed enamel. This genetic condition is transmitted as a dominant trait and causes SOFT, THIN ENAMEL. Teeth appear yellow due to dentin visible through the thin enamel. Teeth are easily damaged and susceptible to decay. The pulpal outline and root morphology appears normal.

CYSTIC FIBROSIS-

an inherited disease of exocrine glands, affecting ~30,000 children and adults in the U.S. Cystic fibrosis causes the body to produce an abnormally thick, sticky mucus due to a faulty transport of Na+ and Cl within cells lining organs like the lungs and pancreas. The glands most affected are in the pancreas, respiratory system, and sweat glands.

2. CLEFT PALATE-

an opening in the roof of the mouth where two sides of the palate did not unite. It occurs in 6 th -8 week of embryonic life. Isolated clefts of the palate are more common in females. It is characterized by a fissure in the midline of the palate due to the failure of the two sides to fuse during embryonic development.

PROCAINE (NOVOCAINE)-

an original ester-type local anesthetics. When metabolized by plasma cholinesterase, a highly allergic compound "Paraaminobenzoic Acid" (PABA) was formed. Not used today in dentistry because many patients developed an allergy to PABA. Hydrolysis of procaine occurs mainly in plasma.

2. STANNOUS FLUORIDE (SnF ) (8%)-

an unstable solution that must be freshly mixed, tastes bad (metallic 2 due to tin ion), stains silicate restorations, and is acidic (2.1-2.3 pH). SnF only advantage is it does not etch porcelain restorations. At one point was not used in 2 any approved dentrifices in the U.S. Has bacteriocidal and bacteriostatic properties. Used as an ingredient due to its wide range of benefits against caries, plaque, gingivitis, dentinal hypersensitivity, and breath malodor.

Exposure Control Plan must be accessible to employees and must be updated at least

annually and whenever necessary to reflect office changes (i.e. new procedures that affect occupational exposure and new positions). The plan must be provided to OSHA upon request.

Abscesses within the masticator space may point at the

anterior aspect of the masseter muscle, either into the cheek or mouth, or they may point posterior below the parotid gland.

CLASSIC SYMPTOMS of a digit sucking habit:

anterior crossbite, crossbite, proclination of maxillary incisors, constriction of the maxillary arch (not expansion) retroclination of mandibular incisors, and a Class II malocclusion.

Malignant Hyperthermia- Usually occurs in

apparently healthy children and young adults at an average age of 21 years (equally in males & females).

SUPEROXOL- Chairside Technique:

apply heat to Superoxolsaturated cotton pellets in the tooth chamber, and repeat until the tooth is lighter. This heat liberates the oxygen in the bleaching agent.

SEDATION INDICATIONS:

apprehensive or scared patients, decrease stress in a medically compromised patient, or to perform several procedures on a patient who is extremely anxious. The optimum site for IV sedation for an outpatient is the MEDIAN CEPHALIC VEIN which lies in the lateral aspect of the antecubital fossa (anterior to the elbow). Avoid entering the brachial artery to avoid immediate burning at the injection site (arm appears blotchy, and the arm pulse is weak compared to the other arm).

Premature exfoliation of a primary canine may indicate an

arch length deficiency. Premature loss of a primary mandibular canine may cause a lingual collapse of the mandibular anterior teeth.

• Transplant success is most predictable when the root apices to be transplanted

are 1/3-1/2 formed with open apices and the bordering bony plates are intact. Adequate M-D width of the host implant site, absence of acute periapical or periodontal inflammatory states, and the general good oral health are also required for successful tooth transplantation.

Chromium-cobalt alloys

are advantageous because they can be supplied in a softer, thus more formable state, and can be hardened by heat treatment after being shaped. The heat treatment increases strength significantly.

Stainless Steel Crowns-

are considered superior to large multi-surface amalgam restorations, with a longer clinical lifespan. Two common stainless steel crowns are pretrimmed & pre-contoured crowns.

DENTIN TYPES: 4. Sclerotic Dentin-

are dentinal tubules that become calcified. Hypermineralized peritubular dentin that reduces the width of dentinal tubules.

ESTER LOCAL ANESTHETICS ESTERS:

are metabolized in BLOOD PLASMA. Esters are metabolized by the plasma enzyme "plasma cholinesterase" or "pseudocholinesterase" which splits the ester linkage within the chemical structure rendering the anesthetic ineffective.

HERPANGINA-Clinical Features:

are mild and short duration compared to HSV-1. Herpangina begins with a sore throat, fever, headache, and sometimes vomiting & abdominal pain. Herpangina usually runs its course and resolves without treatment in less than 1 week.

Anterior teeth lobes

are much less noticeable and are separated by developmental depressions. All anterior teeth have 4 lobes (3 labial, 1 lingual = cingulum).

MIDFACIAL FRACTURES- 5. Zygomatic arch fractures-

are nicely demonstrated by the submental vertex view. This fracture may not cause any problem other than a possible slight sinking of the cheekbone area. There may be some encroachment and impairment in closure of the jaw if it comes down and entraps the coronoid process of the mandible.

PEDIATRIC DISEASES & CONDITIONS Cleft Palate & Cleft Lip: how common?

are the MOST COMMON craniofacial malformations, accounting for 50% of all defects. They can be unilateral or bilateral.

Ecchymosis-

area of hemorrhage into the skin & subcutaneous tissue > 1cm in diameter often caused by injury, but clotting and bleeding disorders can predispose an ecchymosis formation. Grossly, an ecchymosis presents as a bluish lesion in its earliest stages of onset. As RBCs in the lesion undergo progressive degeneration, & hemoglobin is converted through bilirubin→hemosiderin, the lesion progressively changes color from blue→green→purple→brownish discoloration.

Central Zone (Pulp Proper)-

area that contains large nerves & blood vessels, and is lined peripherally by a specialized odontogenic area that has 3 layers:

MEAN-

arithmetic average of scores, and most common measure of central tendency. Mean is the sum of a collection of numbers DIVIDED by the number or numbers in the collection. Add all the scores together and divide by the number of scores. The mean is sensitive to extreme values (outliers). Ex: If 10 dentists scored a total of 950 points out of 1000 possible points on the NBDE II after using the DENTIN study guide, then the mean score is 950/10 = 95%.

Orthodontic treatment to correct a crossbite in children should start

as early as possible. Maxillary expansion-is the first step of treatment to broaden the maxilla with an "expander" appliance. This palatal expander is fixed to the roof of the mouth and is widened each night for 1-2 months with a turn key, and remains in the mouth for ~3 additional months to allow the bone to harden in its new position.

Used caution when extracting over-retained primary teeth

as the succedaneous tooth bud may be in close proximity. This is especially true when placing the beaks of forceps into bifurcations of primary molars in older children. The most common cause of fracture of root tips in extracting a primary molar is root resorption between the apex and bifurcation.

Negative Correlation-

as the value of x decreases, the value of y increases; the score on one scale predicts an opposite score on the other scale. Ex: An increase in patient oral hygiene proficiency resulting in a decrease in plaque accumulation.

Positive Correlation-

as the value of x increases, the value of y increases AND as the value of x decreases, the value of y decreases; reflects a DIRECT association between the variables. Ex: The more dietary carbohydrates and sugar consumed, the greater chance of caries and obesity).

To stabilize an intentionally replanted tooth, a very effective method is to

ask the patient to close in centric occlusion for the rest of the day.

Injections should always be made slowly with

aspiration to avoid intravascular injection and prevent a systemic reaction to the local and vasoconstrictor used in many solutions. The presence of a vasoconstrictor does not prevent an intravascular injection or systemic absorption. The acute intravenous toxicity of a local anesthetic with a vasoconstrictor may be higher than that of the anesthetic agent alone. If drowsiness is apparent after administration of a local anesthetic, then the reaction is probably due to the toxic effect of the anesthetic, rather than a psychogenic reaction.

Drugs that can potentiate Bleeding post-extraction:

aspirin, anti-coagulants, broad-spectrum antibiotics, alcohol, and anticancer drugs. Antianxiety drugs do NOT potentiate bleeding after extraction. If a patient is taking any of these 5 drugs, be prepared to take special measures to control the bleeding. Patients with specific systemic diseases also have prolonged bleeding time (i.e. non-alcoholic liver disease, hepatitis, cirrhosis, and hypertension).

Reverse Overjet-

associated with Class III skeletal patterns with more than 2 maxillary anterior teeth in linguoversion.

Internal resorption is usually

asymptomatic, and discovered on routine radiographic evaluation. The root canal's anatomic configuration is altered and increases in size, appearing as an irregular radiolucency anywhere along the canal space. Radiographic presentation of internal resorption is a fairly uniform enlargement of the root canal space. The root canal "disappears" into the lesion.

80% of primary incisors that darken due to injury are

asymptomatic. Occasionally, these teeth will lighten. 15% of these teeth will need to be extracted within 1 year due to repeated trauma. • 85% of these teeth will remain until normal exfoliation.

Nitrous oxide is a slightly sweet smelling, colorless, inert gas that must always be coupled with

at LEAST 20% oxygen. N 2 O is quickly absorbed from the lungs and is physically dissolved in the blood.

3 TMJ LIGAMENTS: attach and determine the farthest boundaries of mandibular movement: 3. Sphenomandibular ligament-

attaches to the spine of sphenoid bone & lingula of the mandible. Becomes taut when the mandible protrudes. A remnant of Meckel's cartilage and a landmark when administering an IA nerve block.

Hand-pieces and reusable air-water syringe tips must be

autoclaved between patients. Disposable air-water syringe tips are available. Disposable saliva ejectors cannot be reused.

OPTIMAL bone grafting material should be of

autogenous origin. Autogenous bone is from the same person (from one part of the body to another). Autogenous grafts are usually used to restore large areas of lost mandibular bones after oncological surgery or trauma. Of all facial bones resected in oncological surgery, the mandible is the most frequently removed.

Non-invasive Procedures for Obstructed Airway:

back blows, manual thrusts, Heimlich maneuver, chest thrust, and finger sweep.

Sealants act as a PHYSICAL BARRIER to prevent

bacteria accumulation in pits and fissures.

As caries progresses, dentin destruction is followed by

bacterial invasion of the tubules and complete dentin destruction. Once odontoblasts are involved, pulpal changes occur (i.e. initially vascular dilation and local edema).

Vital pulp resists

bacterial invasion. Even if vital pulp is exposed to microorganisms for 2 weeks, the bacterial penetration may extend no > 2mm into the pulp. In contrast, non-vital pulp is a fertile ground for bacterial growth and leads to necrosis.

Geudel's Stages of General Anesthesia: 2. Stage 2 (Delirium/Disinhibition & Excitement):

begins with loss of consciousness and includes the onset of total anesthesia. The patient may move their limbs, chatter incoherently, hold their breath, or become violent. Vomiting with the attendant danger of aspiration may occur. Patient appears delirious and excited, amnesia occurs, reflexes are enhanced, and respiration is typically irregular; retching and incontinence may occur. The patient is brought to Stage 3 as quickly and smoothly as possible. Loss of consciousness-motor centers. • Respirations irregular, lateral nystagmus, pupillary reflex intact, muscle tonus decreases as this stage progresses. Laryngeal and pharyngeal reflexes become obtunded.

Primary Intention (Primary Closure or First Intention):

bone repair that involves both endosteal & periosteal proliferation. Primary intention occurs when bone is either incompletely fractured, or a surgeon closely reapproximates the fractured ends of a bone. Little fibrous tissue is produced with minimal callus formation. Primary intention occurs when wound margins are nicely apposed. Healing is more rapid with a lower risk of infection, with less scar formation, and less tissue loss than wounds that heal by secondary intention. Examples of primary intention (well-repaired and well-reduced bone fractures).

Americans with Disabilities Act:

both state and federal statutes define disability as having a physical or mental impairment that substantially limits one or more major life activities of the individual, a record of such impairment exists, and the patient is regarded as having such impairment. • Dentists cannot deny anyone care due to a disability and cannot dismiss employees due to a disability. • Dental offices must undergo structural changes to allow access for the disabled. • HIV patients are protected under the Americans with Disabilities Act.

On the side TOWARD where the tooth is being moved, osteoclasts are

breaking bone down, while on the side of the root from where the tooth moves osteoblasts that are remodeling/forming bone.

If a gutta-percha cone passes past the apex, a file must then be used beyond the apex to avoid

breaking the cone. A broken cone in the periapical area can cause orthograde re-treatment failure.

Must monitor patient's blood pressure, heart, pulse and breathing. Pulse oximeter to measure heart rate and indirectly, breathing. Midazolam can sometimes affect

breathing. Midazolam potential side effects: nausea, vomiting, xerostomia, confusion, decreased coordination.

Cellulitis Treatment includes

bringing the child to the hospital if the signs and symptoms warrant it.

DENTIN 1,001+ "HIGH-SPEED DRILL" NBDE II PREVIEW 1. Oral manifestations associated with TRISOMY 21 (DOWN SYNDROME) include

bull-shaped molars (TAURODONTISM), missing teeth (HYPODONTIA), increased gingivitis and periodontal disease, and DECREASED CARIES.

ATROPHIC GINGIVITIS-

characterized by gingival recession without a corresponding rate of alveolar bone loss. Minor marginal and papillary gingival inflammation is found. RECESSION is the main clinical finding.

Pulp stones-

calcifications associated with chronic pulpal disease from advanced carious lesions or large restorations.

Z-Springs-

can also be used for tipping anterior teeth, but deliver excessively heavy forces & lack range of motion.

3 Types of Inappropriate Healing: 3. Mal-union:

can be delayed or complete union in an improper position. May be caused by improper immobilization or imperfect reduction.

2. Tooth-Borne Functional Appliances: Herbst Appliance:

can be fixed or partially removable. A metal-rod & tube-telescopic apparatus are attached bilaterally to the maxillary first molars & mandibular first premolars to help posture the mandible forward and induce growth. Jasper modified Herbst by replacing the telescopic apparatus with a flexible plastic open coil spring.

ORTHODONTIC APPLIANCES Orthodontic Appliances:

can irritate the gingiva, act as plaque harbors, and make proper oral hygiene difficult to perform. Prolonged orthodontic treatment has long been associated with causing inflammatory periodontal disease. However, if meticulous oral hygiene is maintained at all times during orthodontic treatment, periodontal health can be maintained.

Clinical diagnosis or rheumatic fever is made when two major (or one major and one minor) criteria (the "Jones Criteria") are met. Major Jones criteria: Minor criteria include:

carditis, arthritis, chorea, erythema marginatum, & subcutaneous nodules. fever, arthralgias, history of rheumatic fever, EKG changes, and lab tests.

When the space lacking is < 4mm, in most cases, it is obtained by

carefully stripping some interproximal enamel from each anterior tooth. A space deficiency > 4mm indicates extraction to correct the malocclusion.

The initial event in a vasovagal syncope episode is the stress-induced release of increased amounts of

catecholamines that cause ↓ peripheral vascular resistance, tachycardia, and sweating.

Quaternary Ammonium Compounds-

cationic detergents used as disinfectants & antiseptics. Gram (+) bacteria are most susceptible to destruction. These compounds are NOT sporicidal, tuberculocidal, or viricidal, and are inactivated by anionic detergents (soaps and iron found in hard water). Ex: Benzalkonium Chloride.

EXTERNAL CERVICAL INFLAMMATORY RESORPTION (ECIR)-

cause if often unknown, but is correlated with orthodontics, trauma, and fractures. Typically presents as vascular granulation tissue that creates a cavity at the CEJ. Prognosis depends on degree of resorption, which can be determined with CBCT (Cone-Beam CT).

INTERNAL ROOT RESORPTION (INFLAMMATORY)

caused by dental trauma, partial removal of pulp (pulpotomy), caries, pulp capping with calcium hydroxide, or a cracked tooth. Causes loss of pulp vitality & subsequent infection of coronal pulp causing inflammation. Inflammation due to infected coronal pulp is generally the cause of internal resorption. Teeth with internal resorption have a history of trauma, crown preparation, or pulpotomy.

Hemophilia B (Christmas Disease):

caused by a deficiency of Factor IX (plasma thromboplastin component).

3 Types of External Root Resorption: 1. Surface Resorption-

caused by acute injury to the PDL & root surface. If injury is not repeated, healing occurs forming new cementum and PDL. Root surface resorption is limited to cementum, may heal itself, and is not visible on a radiograph.

EXTERNAL ROOT RESORPTION-

caused by periradicular inflammation, dental trauma (resulting in damage to attachment apparatus), excessive orthodontic forces, impacted teeth, bleaching of non-vital teeth. ALWAYS accompanied by bone resorption and is the chief cause of failure of replantation of permanent teeth (the main cause of failure of replanted teeth).

Psychogenic Reaction-

caused by psychological factors (rather than physical factors like drugs). Signs: nausea, pallor and cold perspiration, widely dilated pupils, eyes rolled up, and brief convulsions.

Amalgam is still used to some degree to restore primary teeth. The most important modification in its use is in the

cavity preparation. Properly contoured restorations are important to maintain proximal contacts and length of the dental arch.

4. Apposition-

cells that were differentiated into specific tissue-forming cells begin to deposit the specific dental tissues (enamel, dentin, cementum, & pulp). The majority of cells of the dental pulp are fibroblasts.

PEDS: LUDWIG'S ANGINA-

cellulitis that affects the submandibular, sublingual, & submental spaces, and causes elevation of the tongue and mouth floor resulting in obstruction of the patient's airway and makes swallowing impossible. The patient MUST be taken to the hospital immediately.

RADICULAR CEMENTUM-

cementum found on root surfaces whose thickness INCREASES with age. It is thicker apically than cervically, and its thickness ranges from 0.05mm-0.6mm.

cervical root resorption does or does not occur exclusively at the cervical area of the root? Pulp does or does not play a role in cervical root resorption.

cervical root resorption does not occur exclusively at the cervical area of the root. Pulp does NOT play a role in cervical root resorption.

*When a tooth has been avulsed (out) of the mouth for > 2hrs, the treatment of the tooth socket, root surfaces, and time required for splint stabilization

changes.

Acute Apical Periodontitis (AAP)-

characterized by pain commonly triggered by chewing or percussion. AAP alone does not indicate irreversible pulpitis. AAP indicates irritated apical tissues possibly associated with a vital pulp with a potential reversible pulpitis. In the absence of acute pain, a negative EPT or frank apical radiolucency, a carious tooth with sensitivity to percussion may respond to caries control (temporary filling). If it does not respond to a sedative filling, RCT is indicated.

ANTISEPTICS-

chemically safe to be administered to external body surfaces or mucous membranes to decrease microbial numbers. Antiseptics cannot be taken internally. Antiseptics are chemical agents similar to disinfectants, but can be applied onto living tissues (i.e. hand-washing) to remove accumulated transient microorganisms, and temporarily lower the concentration of normal, resident flora. Soap only removes microorganisms.

After pulp exposure, acute inflammatory cells (mainly PMNs) are

chemotactically attracted to the area. Histologically, the tissue is likely to show signs of acute inflammation near the exposure site, and a band of chronic inflammatory cells b/t the acute inflammation and the underlying normal pulp.

Nitroglycerin is given sublingually only to manage patients having

chest discomfort or possible MI. It is not used for asthma attacks.

Before immunization, measles were common during

childhood, as 90% of the population was infected by age 20.

Primary herpetic gingivostomatitis is MOST likely to occur in

children ages 1-5 years.

Post-anesthetic lip biting is a common post-treatment complication in

children. After extracting a tooth on a child, the biggest post-operative concern is preventing lip biting.

Liquid antimicrobial preparations (antiseptics) for handwashing:

chlorhexidine gluconate, parachlorametaxylenol, idophors, and triclosan.

Cystic fibrosis Early signs are a

chronic cough, frequent foul-smelling stools (steatorrhea), and persistent upper respiratory infections. The most reliable diagnostic tool is the SWEAT TEST (shows elevated levels of Na+ and Cl).

MAIN reason for recapitulation (using your MAF after each increase in file size) during canal instrumentation is to

clean the canal's apical segment of any dentin filings not removed by irrigation.

ANUG: Debridement helps with what

clear up the infection and antibiotics reduce acute symptoms.

Periapical Abscess- For endodontic infections that do not respond to penicillin,

clindamycin is recommended as it produces high bone levels, and is effective against anaerobic bacteria, but must be used with caution due to the potential for pseudomembranous colitis.

Regulated waste MUST be placed in containers that are

closable, constructed to contain all contents and prevent leakage, and labeled appropriately. The container must be closed prior to removal to prevent spillage or protrusion of contents. The rule also requires that if the outside of the container becomes contaminated, it must be placed in a second container with the same characteristics. The need for a second container is extremely unlikely in a dental office.

CLOSED REDUCTION-

closing the space between a fractured bone without cutting through soft tissue or surrounding bone.

Dead space is eliminated by

closing the wound in layers to minimize the postoperative void, applying pressure dressings, using drains to remove any bleeding that accumulates, and placing packing into the void until bleeding stops.

APICAL portion of pulp contains more

collagen than the coronal portion. This facilitates a pulpectomy using barbed broaches or endodontic files. ♦ Type 1 & 3 collagen is mainly found in pulp in a 55%:45% ratio. Type 5 collagen is found in only small amounts. ♦ Type 1 collagen predominates in DENTIN. ♦ Odontoblasts synthesize Type 1 collagen. ♦ Fibroblasts in pulp synthesize Type 1 & 2 collagen.

AUTOGENOUS GRAFTS (Autografts)-

composed of tissues taken from the SAME INDIVIDUAL. Most often used in oral surgery. Autogenous grafts, while often present surgical & technical problems, do not usually involve rejection or immunological complications.

TMJ COMPONENTS: 4. Temporal Bone's Articular Surface-

composed of the concave articular fossa (glenoid fossa) and convex articular eminence (tubercle) that limits forward movement of the condyle.

4 Reasons Fractures Do Not Heal: 4. Infection:

compound fractures have a tendency to become infected.

Amides are used with caution, or not at all in patients with

compromised liver function.

IRREVERSIBLE PULPITIS ("Acute Pulpitis")-

condition characterized by SPONTANEOUS PAIN with periods of cessation (intermittent in nature). Clinical symptoms severity varies as the inflammatory response increases. Pain varies from a mild & readily tolerated discomfort, to a severe, throbbing, and excruciating pain that is spontaneous, intermittent, and LINGERS AFTER THE IRRITANT IS REMOVED.

Mandibular fractures are classified based on

condition of the bone fragments at the fracture site, and possible communication with the external environment:

Mandible deviates toward the injury side in cases of:

condlyar ankylosis (the most common cause of TMJ ankylosis is TRAUMA), and with a unilateral condylar fracture. Also, with a lateral pterygoid injury, the mandible deviates toward the side of injury).

local anesthetics: how do they affect conductances of K+ , Ca2+ , & Cl-

conductances are unchanged.

Mandible deviates away from the affected side of injury in cases of:

condylar hyperplasia (malocclusion is a common occurrence with this injury).

Localized causes of Failed or Delayed Eruption:

congenital absence, abnormal position of the crypt, lack of arch space (crowding), supernumerary teeth, and dilacerated roots.

If CPR efforts are effective, the pupils will

constrict. If too much pressure is incorrectly applied directly over the xyphoid process, the liver may be injured. The result of interruptions in chest compressions while performing CPR is a reduction of blood flow and drop in BP to zero.

FRANKFORT-HORIZONTAL PLANE-

constructed by drawing a line connecting PORION & ORBITALE. FHP is the best representation of the NATURAL ORIENTATION OF THE SKULL.

Indications for open reduction are

continued gross displacement of the bony segments and an unfavorable fracture that is likely to cause further displacement of the fractured segments caused by muscle pull. This type of reduction is commonly performed for displaced angle or body fractures. *Condylar neck fractures are usually treated by closed reduction.

5. Torque-

controlled root movement F-L or M-D while the crown is held relatively stable (M-D root movement is also called "uprighting").

In an older child with a fully formed apex, if there is a pinpoint exposure and it has been a while (day) since the fracture, whats the treatment of choice?

conventional RCT with gutta percha is the treatment of choice. If the child is seen immediately, then a direct pulp cap with calcium hydroxide is indicated, followed by a permanent restoration.

3. Bronchiectasis-

copious purulent sputum, hemoptysis, and recurrent pulmonary infection.

Common results of Chronic Bronchitis:

cor pulmonale (enlargement of the heart's right ventricle), airway narrowing and obstruction, & squamous metaplasia of the bronchial tree. Patient's with chronic bronchitis may be predisposed to lung cancer (bronchogenic carcinoma).

The eyes are taped shut prior to draping a patient before surgery to prevent

corneal abrasion.

When painting fluoride on, it is important to isolate the teeth with

cotton rolls. When using fluoride trays, cotton rolls may be placed in the premolar areas to increase patient comfort and kept the fluoride in place. Patients should not brush, rinse, eat, or drink for 30 minutes after fluoride treatment so that the fluoride is left undisturbed and can continue to react with the hydroxyapatite for some time after the initial application. Fluoride treatments should be applied for 4 minutes, although there are now some 1minute products available.

Primary Maxillary Canine- the teeth most likely to be

crowded out of the arch.

After you incise and drain the fluctuant mass, it may be prudent to

culture for antibiotic sensitivity. This should always be done if after I&D, the swelling does not subside despite large doses of antibiotics.

Cretins have dwarfed bodies with

curvature of the spine and a pendulous abdomen. Limbs are distorted, their features are coarse, and their hair harsh and scanty.

Dentigerous Cysts (Primordial or Follicular Cysts)-

cysts associated with the crowns of unerupted teeth, probably the result of degenerative changes in the reduced enamel epithelium.

Chronic apical abscess is differentiated from cysts & granulomas because

cysts & granulomas are welldefined radiolucencies.

Eruption Cysts-

cysts that form when a tooth is erupting and interfere with normal eruption of teeth, and are more commonly found in the child or young adult, and may be associated with any tooth. If treatment is indicated, a simple incision or "deroofing" is all that is needed.

ANUG Treatment:

debridement, H 2 O mouth rinses, and antibiotic therapy.

Non-Succedaneous teeth-do not succeed/replace

deciduous teeth (permanent maxillary & mandibular 1 , & 3 rd molars)

Enamel and dentin are thinner in primary teeth, thus amalgam preparations are

deeper. The thickness of coronal dentin in primary teeth is ½ that of permanent teeth. Pulpal horns of primary teeth are longer and pointed, thus amalgam preps must be conservative to avoid pulpal exposure.

Occupational Exposure-

defined by OSHA as any reasonably anticipated skin, mucosal, eye, or parenteral contact with blood or other potentially infectious fluids during the course of one's duties while at work. OSHA includes saliva in dental procedures in the definition of "other potentially infectious materials" because saliva can be mixed with blood in some dental procedures. Thus, OSHA concluded that saliva should be treated as potentially infectious even though scientists believe bloodborne diseases are not transmitted via saliva.

Cellulitis in a child is harder to treat because

dehydration occurs more frequently, rapidly, and severely in children.

Cleiodocranial Dysplasia (Dysostosis)- Oral findings:

delayed permanent teeth eruption, peg-shaped teeth, and congenitally missing teeth.

The rationale of desensitization procedures is not fully understood. Some techniques may depend on

denaturation of the superficial ends of Tomes' fibers or nerve endings in dentin. Other procedures are designed to deposit an insoluble substance on the ends of the fibers or nerves to act as a barrier to stimuli. Others are designed to stimulate secondary dentin formation to insulate the pulp from external stimuli.

underdeveloped motor coordination is the most common cause of

dental trauma in very young children's primary dentition ages 1 ½ - 2 ½ years old.

POSTERIOR CROSSBITE in the MIXED DENTITION should be corrected ASAP and be thoroughly diagnosed as either a

dental, functional, or skeletal crossbite and may be associated with a mandibular shift.

DENTIN TYPES: 2. Secondary Dentin-

dentin formed AFTER completion of the apical foramen at a slower rate than primary dentin as functional stresses are placed on the tooth. It is a regular and uniform layer of dentin around the pulp cavity. The junction between primary and secondary dentin is characterized by a sharp change in the direction of the dentinal tubules.

Amelogenesis Imperfecta- Treatment:

depends on its severity and demands of esthetic improvement. Since the dentin is normal, the teeth can be prepared for full crowns.

LIDOCAINE is the local anesthetic that may manifest its toxicity clinically by initial

depression and drowsiness (rather than stimulation and convulsion). The initial effect on the brain for local anesthetics is usually stimulation, then depression. However, it is possible that the excitatory phase of the reaction may be extremely brief, or may not occur (this is true especially with lidocaine and mepivacaine) causing patients to feel drowsiness. *Lidocaine & Mepivacaine can also show crossallergenicity.

GENERAL ANESTHESIA Geudel's Stages of General Anesthesia: 1. Stage 1 (Amnesia & Analgesia):

describes conscious sedation that begins with the administration of anesthesia and continues until the loss of consciousness. Respiration is quiet, though sometimes irregular, and reflexes remain present. Patient has decreased awareness of pain, sometimes with amnesia. Consciousness may be impaired, but is not lost. The best monitor of the level of analgesia is the verbal response. Altered consciousness, loss of sensory from cerebral cortex occurs.

IRRIGANTS-

destroy bacteria during endodontic therapy. Irrigant's bactericidal action is much greater than the action supplied by intracanal medicaments, thus are used COPIOUSLY throughout the instrumentation phase of root canal procedures.

Congestion of blood within the pulp chamber a short time after injury can often be

detected in the exam. Shining a bright light on the facial surface and holding the mirror to view the lingual usually shows a reddish hue which indicates pulpal hyperemia. If this red color change is evident after several weeks, it often indicates a poor prognosis. EPT is seldom reliable to determine pulp vitality if taken immediately after the injury. The thermal test is the MOST RELIABLE, especially in primary incisors. Failure of a tooth to respond to heat indicates pulpal necrosis.

CORRELATION CO-EFFICIENT:

determines the strength of relationship between two variables. Shows probable cause and effect. Given as a number between +1 and -1.

Recent studies show not all latex-allergenic people were able to use hypoallergenic gloves, since many Type I allergic individuals still

developed allergic manifestations when using these gloves

1. Type I Diabetes (Insulin-Dependent Diabetes or Juvenile-Onset):

diabetes affecting young adults where the body completely stops producing insulin. Type I diabetics are totally insulin deficient, thus must take daily insulin injections to survive. Juvenile diabetics tend to be unstable, brittle, and prone to ketoacidosis. Blindness is a serious complication that may develop.

CEPHALOMETRICS in Orthodontics are used for

diagnosis, analysis of treatment results, and longitudinal study of growth. Cephalometrics is useful to assess tooth-to-tooth, bone-to-bone, & tooth-to-bone relationships. Serial cephalometric film can show the amount and direction of growth.

CROSS-SECTIONAL STUDY-

different subjects of different groups are compared at ONE POINT IN TIME (snapshot in time). Researcher selects children previously treated with fluoride varnish who are currently in grades 1-12. The effect of prior fluoride varnish is evaluated once (a snaphot in time). Less expensive and fast compared to a longitudinal study. LESS VALID THAN LONGITUDINAL STUDY.

Hyaline Cartilage-

differs from bone in that hyaline cartilage may grow by INTERSTITIAL GROWTH.

Mineral Trioxide Aggregate (MTA)- DisAdvantages:

difficult to manipulate & long-setting time.

For impacted mandibular 3 molars, mesioangular impactions are the least

difficult to remove, followed by horizontal and vertical impactions, then the most difficult to remove which is the distoangular impaction.

For impacted maxillary 3 rd molars, mesioangular impactions are the most

difficult to remove, while vertical and distoangular impactions are the easiest to remove.

1. Bronchial Asthma-

disorder marked by DYSPNEA & WHEEZING expiration caused by episodic narrowing of the airways.

3. Extrusion-

displacement of the tooth from its socket in the direction of eruption.

ACHONDROPLASIA- Clinical Features:

disproportionate short stature (head is large, and arms/legs are short compared to the trunk length). Prominent forehead, depressed bridge of the nose, small maxilla causing overcrowding of teeth, and Class III malocclusion.

SLOB RULE= If taken from the distal, the lingual surface appears more

distal (closer to the cone) than the buccal surface which appears father mesially.

1. Metabolic Alkalosis- Major Causes:

diuretics (thiazides, furosemide, ethacrynic acid) ingestion of alkaline drugs, vomiting gastric acid contents, or overactive adrenal gland as in Cushing's Syndrome or use of corticosteroids).

1. Simple fracture-

divides a single bone into two distinct parts with no external communication (closed fractures with no lacerations of the oral mucosa or facial tissues).

MEDIAN-

divides the distribution of score into two equal parts. 50% of the scores will be above the median; 50% will be below. NOT affected by extreme high or low scores. To calculate, place scores in a data matrix and locate midpoint.

INDIRECT PULP CAPPING: Contraindications:

do not use in cases where there is spontaneous pain, furcation involvement, or pulpal involvement. Most pediatric dentists feel indirect pulp capping is contraindicated in the primary dentition.

Material Safety Data Sheets (MSDS)-

documents that contain information concerning a hazardous chemical. Chemical manufacturers and importers are required to obtain a material safety data sheet for each hazardous chemical they produce or import. Distributors are responsible for ensuring their customers are provided with a copy of these MSDS. Employers must have an MSDS for each hazardous chemical they use, and may rely on the information received from their suppliers.

Allogeneic Advantages:

does not require another site of preparation in the host, and a similar bone or bone of similar shape to the bone being replaced can be obtained.

EPINEPHRINE-

drug of choice to manage acute allergic reaction involving bronchospasm (acute narrowing of the respiratory airway) and hypotension.

Instruments MUST BE DRY before using

dry heat sterilization and ethylene oxide sterilization, because water interferes with the sterilization process.

Initially, a patient suffering from dehydration will clinically demonstrate only

dryness of the skin and mucous membranes. However, a dehydration progresses, the turgor (fullness) of the skin is lost. If dehydration persists, oliguria (↓ urine output) occurs to compensate for the fluid loss. More severe degrees of fluid loss are accompanied by a shift of water from the intracellular space to the extracellular space (a process that causes severe cell dysfunction, especially in the brain). Systemic BP falls with continuous dehydration, and declining perfusion eventually leads to death.

TEMPOROMANDIBULAR JOINT (TMJ) TEMPEROMANDIBULAR JOINT (TMJ)-

dual articulation between the condyle of the mandible and squamous portion (glenoid fossa) of the temporal bone (skull).

The role of MSDS under the rule is to provide detailed information on

each hazardous chemical (including its potential hazardous effects, physical and chemical characteristics, and recommendations for appropriate protective measures). This information is useful to employers responsible for designing protective programs, and to workers. If you are not familiar with the MSDS and chemical terminology, you may need to learn to use them yourself. A glossary of MSDS terms may be helpful in this regard. Most employers using hazardous chemicals will primarily be concerned with MSDS information regarding hazardous effects and recommended protective measures. MSDSs must be readily accessible to employees when they are in their work areas during work shifts. You must decide what is appropriate for your particular office. Some employers keep MSDSs in a binder in a central location. As long as employees can access the information they need, any approach can be used. Employees must have access to the MSDS themselves.

Maintaining a 4-year-old child's healthy dentition starts with

educating the parent.

Cavernous Sinus Thrombosis incidence has decreased greatly with the advent of

effective antibiotics. Most cases are due to an acute infection in an otherwise healthy individual. However, most patients with chronic sinusitis or diabetes mellitus may be at a slightly higher risk.

Dry Heat Advantages:

effective/safe for sterilizing metal instruments, and does not dull or corrode instruments.

Steam autoclaves operate at

either 121°C (250°F) at a pressure of 15lbs/square inch (psi) for 15-20 minutes, or at 134°C (270°F) at a pressure of 30psi for a minimum of 3 minutes ("flash cycle"). To effectively kill all living organisms, the minimum required temperature is 121°C (250°F).

Phlebitis (Thrombophlebitis) Treatment:

elevate the limb, apply moist heat, and possibly use anti-coagulants.

During HINGE (ROTATIONAL) MOVEMENT, the mandible is

elevated (masseter, temporalis, medial pterygoid) and depressed (lateral pterygoid). Rotational movement occurs mainly between the disc and mandibular condyles in the lower synovial cavity.

TMJ COMPONENTS: 1. Mandibular Condyles-

elliptically-shaped mandibular bone, with its long axis oriented medio-laterally. Condyle ROTATES in the fossa, and slides forward along the articular fossa to the articular eminence (TRANSLATES); the TMJ disc normally moves with the condyle which is wrapped by the JOINT CAPSULE.

"Rule of Four"

enables you to determine the number of teeth present at any given time and implies the eruption of 4 teeth every 4 months beginning with 4 teeth at age 7 months.

A young child with a tendency toward a Class III malocclusion will have

end-to-end contact of the primary incisors. A true anterior crossbite in the primary dentition is rare because mandibular growth LAGS BEHIND maxillary growth. The primary incisors wear down rapidly, and an anterior shift of the mandible to escape occlusal interferences rarely occurs until the permanent incisors begin to erupt. A pattern of anterior displacement of the mandible may develop when the permanent incisors come into contact, however, producing an anterior crossbite from the shift.

Combined Periodontal-Endodontic Lesion-

endodontic treatment takes precedence over periodontal management. Combined endodontic-periodontal therapy is widely used because the anatomic and clinical connections b/t the pulp and periodontal structures are close & numerous. In most combined endo-perio lesions, endodontic procedures are performed first, and when necessary, are followed by periodontal treatment.

Ex: If bone loss extends from the cemento-enamel junction (CEJ) to the tooth apex on a radiograph, probing depth are above normal all around the tooth, but at one point the probe drops precipitously to an even greater depth, and vitality test is negative. This patient may require

endodontic treatment followed by periodontic treatment.

In serial extraction procedures, concerns about eruption sequence are usually related to the

eruption pattern of the permanent mandibular canines & first premolars. After extracting the maxillary first premolar in a serial extraction procedure, the maxillary canines' path of eruption will usually be downward and backward.

Acute Osteomyelitis- Treatment:

establish & maintain drainage, and prescribe antibiotics to prevent further spread and complications.

Acute Apical/Alveolar Abscess (AA)- Treatment:

establish drainage & debride the canal system of necrotic tissue to relieve the acute symptoms. At a later date, perform conventional RCT. (Note: if the abscess ruptures through the periosteum into soft tissue, the patient's symptoms will subside).

Periapical Abscess- Emergency treatment:

establish drainage (ideally through the canal) and prescribe antibiotics & analgesics to relieve the acute symptoms, followed by conventional RCT at a later date.

FRACTURE IMMOBILIZATION: 2. Intermaxillary Fixation (IMF)-

establishing a proper occlusal relationship by wiring the teeth together. The method successfully treats most mandibular fractures. The main methods for IMF are wiring, arch bars, and splints. This is the classical way to immobilize the fracture after closed reduction.

Radiographically: cyst

evident as a well-defined area of rarefaction (radiolucency) that is limited by a continuous radiopaque, sclerotic border of bone.

When oral surgery procedures are performed on ESRD patients, meticulous attention to good surgical technique is necessary to reduce the risks of

excessive bleeding and infection.

Respiratory Acidosis-

excessive blood acidity caused by a buildup of CO in the blood due to poor lung function or slow breathing (decreased respiratory 2 rate).

Fluorosis may result from

excessive fluoride consumed during the mineralization stage of tooth development, and can occur in permanent and primary teeth.

OSHA requirements: • Employers covered by BPS must make

exposure determinations and develop an exposure control plan. Employers must use engineering and work practice controls to prevent employee exposure, and develop a system to evaluate exposure incidents.

Maximum dose of Articaine (Septocaine) recommended in one appointment is

expressed as mg/kg body weight (not as total mg). 7mg/kg is the maximum recommended dose of Articaine in children and adults. In a typical kg adult male, the 7mg/kg dose = 490mg. Thus, the maximum recommended amount of Articaine for a 70kg adult in one appointment is 490mg.

Stainless Steel Crowns- Primary Teeth Indications:

extensive carious lesions, hypocalcified teeth, teeth with dentinogenesis or amelogenesis imperfecta, restoration after pulpotomy or pulpectomy, on an abutment tooth for a crown and loop space maintainer, or temporary restoration of a fractured tooth.

3. Ellis Class III Fracture-

extensive crown fracture with pulpal exposure. Treatment include pulp therapy via pulp capping, pulpotomy, or pulpectomy, followed by a permanent restoration. Usually, a Class III fracture in a primary tooth leads to pulpal necrosis. RCT using ZOE paste as a filling material is indicated. Unlike gutta percha, ZOE resorbs with resorption of the primary tooth roots.

3 Types of External Root Resorption: 2. External Inflammatory Resorption-

external resorption in which an infected pulp may further complicate the resorptive process. Characterized by bowl-shaped resorption areas involving cementum and dentin that rapidly progresses and continues if treatment is ignored.

3 Types of External Root Resorption: 3. Replacement Resorption (Ankylotic Resorption)

external root surface resorption that becomes substituted by bone, causing ankylosis (common in unsuccessful avulsed tooth replant cases). Replacement resorption accompanies dento-alveolar ankylosis due to extensive trauma to the tooth's attachment apparatus. It is characterized by progressive replacement of the root by bone. Histologically, it shows direct contact between dentin and bone, with no intervening PDL or cemental layer.

SUPERNUMERARY TEETH-

extra teeth that develop in excess of the normal complement of teeth that can occur in the maxilla or mandible, but are most common in the maxilla in the midline of the anterior teeth, and sometimes distal to the molars. Supernumerary teeth have a 2:1 predilection for MALES.

The most common cause of paresthesia of the lower lip is

extracting a mandibular 3 molar (especially horizontally impacted 3 rd molars).

An acute dentoalveolar abscess should NOT be a contraindication to

extraction because infections can resolve very quickly when the affected tooth is removed. However, it may be difficult to extract the tooth either because the patient cannot open sufficiently wide enough, or because adequate local anesthesia cannot be obtained.

Dentists are also ethically obligated to identify and refer cases of domestic violence. Practitioners should be familiar with the physical signs of domestic violence, especially since 68% of battered women injuries involve the

face, 45% the eyes, and 12% the neck.

Headgear intra-oral component:

facebow which has an outer & inner bow. The length & position of the outer bow is set according to the inner bow. The inner bow relates to the center of resistance of the tooth and effects anchorage and/or traction.

When luxating a tooth with forceps, the movements should be firm and deliberate, primarily to the

facial with secondary movements to the lingual.

When an instrument breaks off in the canal's apical third and is lodged tightly with no evident periapcial radiolucency, the remaining root canal space can be

filled with gutta-percha, the patient is informed, and placed on a 3-6 month recall.

Liquids are generally sterilized by

filtration. The most commonly used filter is composed of nitrocellulose and has a pore size of 0.22μm. This size retains all bacteria and spores. Filters work by physically trapping particles larger than the pore size.

3. Differentiation (Bell Stage or Histodifferentiation)

final shaping of the tooth, cells differentiate into specific tissue-forming cells (ameloblasts, odontoblasts, cementoblasts, and fibroblasts) in the enamel organ.

Bones, plates, biphasic pins, titanium mesh, and intraosseous wires are used to

fixate bone grafts. Sutures are not generally used.

Intermaxillary Fixation-

fixation obtained by applying wires or elastic bands between the upper and lower jaws in which suitable anchoring devices have been attached. The most common technique for IMF is the use of pre-fabricated arch bars.

Treatment: PRIMARY (ACUTE) HERPETIC GINGIVOSTOMATITIS:

fluid intake, good oral hygiene, and gentle debridement of the mouth. In healthy individuals, the lesions heal in 7-14 days, and the ulcers heal WITHOUT SCARRING.

Some believe the pumice prophylaxis may be omitted as studies show fluoride can make its way through the pellicle and plaque to the tooth surface. However, heavy stains may interfere with

fluoride absorption, thus stains should be removed.

If a 6-year old child were receiving fluoridated water in the amount of 3ppm, the result would most likely be

fluorosis, but not systemic toxicity. However, if a child age 6-7 were receiving 8ppm of fluoridated water, there is a good chance of systemic toxicity and moderate-to-severe fluorosis.

Center for Disease Control & Prevention (CDC) recommends a minimum of 20-30sec of

flushing water lines between patients, and several minutes of flushing water lines if the system has been idle for a period of time (i.e. over the weekend).

Adjuncts to Endodontic Treatment: Orthodontic extrusion-

force controlled vertical tooth movement occlusally in the socket. Orthodontic extrusion indications: PRIOR to implant placement, untreatable subgingival pathoses (i.e. cervical caries, cervical fracture, periodontal defects, resorptive lesions, and perforations in the cervical area).

DENTIN TYPES: 3. Reparative (Tertiary) Dentin-

formed very rapidly in response to irritants. Throughout life, dentin responds to environmental changes (normal wear, caries, operative procedures). These changes initiate the deposition of reparative dentin which is limited to the site of irritation. The composition or reparative and secondary dentin is same, except reparative dentin is more irregular and they differ only in location and deposition. If the environment insult is strong enough, it will kill the odontoblast and its tubular process, leaving the tubule empty. If there is a collection of empty tubules (dead tracts), in time these dead tracts calcify and become sclerotic dentin.

Coronal Cementum-

forms on the enamel covering the crown.

DENTIN TYPES: 1. Primary Dentin-

forms the initial shape of the tooth, and is deposited before completion of the apical foramen. The majority of primary dentin is CIRCUMPULPAL DENTIN (forms most dentin surrounding the pulp, except the space that occupies secondary dentin). Has more tubules than secondary dentin.

During SLIDING (GLIDING), the disk and condyle move

forward (protrude by lateral pterygoid) and backward (retrude by temporalis).

Unilateral fracture through the neck may cause

forward displacement of the head of the condyle due to pull of the lateral pterygoid muscle

Cellular Cementum-

found on the APICAL THIRD of the root, and contains cementocytes in lacunae in its cementum matrix. It occurs more frequently on the apical third of the root and in furcations. It is usually the thickest to compensate for attritional wear of the occlusal/incisal surfaces and passive eruption of the tooth. Cellular cementum is formed AFTER the tooth reaches the occlusal plane.

Complications most often seen after extraction of an isolated residual maxillary erupted molar are

fracture of the tuberosity or sinus floor. *Warning: beware of the lone molar.

2. Compound fracture-

fracture that communicates with the outside environment (open fracture). This may occur by laceration of the oral tissues exposing the bone fragments, fracture of the maxilla into the sinuses, or via skin lacerations that would expose the fracture segments. The most common complication of an open fracture is INFECTION.

MIDFACIAL FRACTURES-

fractures affecting the maxilla, zygoma, & nasoorbital ethmoid complex. Types of midfacial fractures:

Inlays can cause

fractures. If a patient complains of pain during mastication since inlay placement, suspect a fractured cusp (using a bite stick or tooth slooth helps determine which cusp is fractured).

Local anesthetic infiltration is usually sufficient for surgical treatment of

frenal attachments. Care is taken to avoid excessive infiltration directly in the frenum area because it may obscure view of the anatomy during the excision.

Preventive dentistry for Adolescents:

frequent dental visits, fluoride rinses at home, fluoride tray applications, brushing and flossing, sealants, and fluoride tablets.

Irritation Dermatitis- The most common manifestation is irritation dermatitis (a non-specific immune reaction often caused by contact with a substance that physically or chemically damages the skin). The condition is aggravated by

frequent handwashing, residual glove powder left on hands, and the harshness of repeated use of some antiseptic handwash agents. Healthcare workers who live in colder climates may also experience chapping during the winter months.

Anterior teeth that have had RCT do not necessarily need a

full coverage crown. If the access opening is conservative and there is not extensive caries compromising the clinical crown, a lingual composite or amalgam can simply be placed to conserve tooth structure.

Sealants should be placed right after the tooth has

fully erupted, before the decay process has begun. For permanent molar placement, this is usually around age 6 and 12 (give or take 6 months).

ANUG is an acute fusospirochetal infection of the gingiva caused by

fusiform/fusobacterium, spirochetes, & Prevotella intermedia. ANUG is a progressively painful infection with ulceration, swelling, and sloughing off of dead tissue from the mouth and throat due to the spread of infection from the gums.

Complete Blood Count (CBC) & Urinalysis are two tests that should be performed prior to administering

general anesthetic for surgical procedures. If a bleeding problem is suspected, PTT (partial thromboplastin time) is also evaluated.

A very young child is best managed under

general anesthesia (inhalation or in combination with small doses of IV barbiturates). VERSED is the most common premedication prior to general anesthesia.

A patient with an acute respiratory infection is contraindicated for

general anesthesia.

Acute Lymphocytic/Lymphoblastic Leukemia (ALL)- Oral Features:

gingival oozing, petechiae, hematoma, ecchymosis, oral ulceration, pharyngitis, gingival infection that is unresponsive to conventional therapy, and submandibular lymphadenopathy.

Growth of the maxilla and its associated structures occurs from a combination of

growth at sutures, and direct remodeling of the surface of the bone.

Hand-wrist radiographs are LESS useful in evaluating if

growth has stopped or is continuing (patient's position on the growth curve). Serial Cephalometric radiographs are used for this purpose.

Superimposition in longitudinal cephalometric analysis is on a reference plane and registration point. This best demonstrates the

growth of structures furthest from the plane and the point. The most stable area to evaluate craniofacial growth is the anterior cranial base because of its early cessation of growth.

Nickel titanium instruments (NiTi)-

hand-operated or engine-driven to CLEAN & SHAPE canals.

Chlorhexidine Gluconate & Triclosan-

handwash agents with broad antimicrobial effect. They also have "substantivity" or a residual action on washed tissues for extended periods of time.

CEMENTUM CEMENTUM-

hard dental tissue that is 50% mineralized like bone. Cementum covers the ANATOMICAL root surfaces of teeth. Cementum is formed by PDL cementoblasts and is nourished by PDL.

Analysis of cephalometric radiographs is NOT limited to

hard structures (i.e. bone & teeth), but include measurements of soft tissue structures (i.e. nose, lips, soft tissue chin).

MANDIBUAR AND MAXILLARY ROOT ANATOMY Mandibular Central Incisor:

has ONLY 1 ROOT that is narrow M-D, but relatively wide labiolingually. The root may have a distal and/or lingual curvature, and 2 CANALS may be present (if so, the labial canal is straighter). Access opening for a mandibular central or lateral is a LONG OVAL, with the greatest width placed incisogingivally, and the incisal extent very close to the incisal edge. Pulpitis can cause referred pain to the MENTAL REGION OF THE MANDIBLE.

BUPIVACAINE (MARCAINE)-

has the LONGEST DURATION OF ACTION of any dental amide anesthetic available. May be used with EPI. Good for extended procedures and when post-operative pain is expected. The long duration of effect does increase risk of systemic absorption & toxicity. Radiotoxic in some patients and used with caution if cardiovascular disease, elderly, or pediatric population. Often used in labor & procedures where motor control is essential because exhibits a strong preference for sensory fibers & is long-acting.

Premolars lobes

have 3 buccal + 1 lingual lobe (except mandibular 2 premolar which has 3 buccal + 2 lingual lobes).

• 2 nd Molars lobes

have 4 lobes (4 cusps); 1 for each cusp.

• 1 st Molars lobes

have 5 lobes (5 cusps); one lobe for each cusp. The average age when the mineralization of permanent 1 molar crown is completed is 4-5years. st

MAXILLARY TEETH ROOT ANATOMY: Maxillary Molars:

have a TRIANGLE pulp chamber outline. The pulp chamber floor is formed by the buccal canals, and the apex is formed by the palatal canal. The line connecting the mesial & palatal canals is the longest. If a 4 canal exists, it is usually lingual to the orifice of the MB canal, and in the MB root. The 4 th th canal is more common than previously believed.

MAXILLARY TEETH ROOT ANATOMY: Maxillary 2 nd st Premolar:

have a higher incidence of accessory canals (60%) than maxillary 1 premolars. A pulpitis of this tooth MOST often refers PAIN to st the TEMPORAL REGION and sometimes NASOLABIAL REGION. If careful diagnosis does not reveal the affected tooth, other teeth and related anatomic structures become suspect. Referred painoccurs when a pulpitis in one tooth causes pain in another area.

• 3rd Molars lobes

have at least 4 lobes (4 cusps) 1 for each cusp, but variation are seen. Maxillary 3 rd molars usually have only 3 cusps.

Fluoride found in commercial toothpastes is not adequate for people who had

head and neck radiation. These patients must continue to use the fluoride gel as directed for their entire life to protect their teeth from rampant decay.

4 Reasons Fractures Do Not Heal: 2. Excessive Mobility:

healing is prevented and pseudoarthrosis or a pseudo-joint may occur.

CONGESTIVE HEART FAILURE (CHF)-

heart failure resulting from progressive diseases that weakens the heart directly or cause an increased demand on the heart. CHF occurs most commonly in association with atherosclerotic coronary heart disease, valvular deformities, and hypertensive cardiopathy. *Usually the left ventricle fails first, follow soon after by right-sided failure.

The main reason to use water irrigation when cutting bone is because

heat generated by the drill affects bone vitality (you do not want to burn the bone). Irrigating the surgical wound during and after the procedure is critical. Copious amounts of coolant spray are crucial in minimizing osseous necrosis caused by heat generated from the bur. Irrigation also cleans the crypt and areas beneath the flap of bony debris, tooth fragments, and blood.

The recommendation that all reusable items that contact a patient's blood, saliva, or mucous membranes must be sterilized using

heat is now routinely accepted and used in dental facilities.

In a young child, the ALVEOLAR PROCESS grows in

height & length to accommodate the developing dentition. Alveolar process bone exists ONLY TO SUPPORT TEETH. If a tooth fails to erupt, alveolar bone will never form in that area. If a tooth is extracted, the alveolus resorbs after the extraction until finally the alveolar ridge completely atrophies.

Excessive bleeding causes formation of

hematomas, which increase the chance of infection.

Submarginal Triangular & Rectangular Flap Disadvantages:

hemorrhage from the cut margins & scarring.

If bleeding does not stop even after more apical amputation, then

hemostatic agents are used as a compromise treatment. These are closely monitored, and if pulp vitality is lost, then apexification (pulpectomy) procedures are performed.

Properties of an IDEAL WIRE MATERIAL for orthodontic purposes should possess

high strength, high range, high formability, and low stiffness (stiffness of orthodontic wires is a function of the wire's length & diameter, and the wire's alloy composition. The material should be weldable or solderable, so hooks or stops can be attached to the wire. Loops & Helices are incorporated into archwires to increase the activation range.

INTELLECTUAL DISABILITY (MENTALLY CHALLENGED): Oral Health Concerns:

higher incidence of gingivitis, periodontitis, and caries due to personal neglect/noncompliant. Bruxing, mouth-breathing, open-bite from tongue thrusting.

Ethylene oxide gas Advantages:

highly penetrative, does not damage heat-sensitive materials (rubber, cotton, plastics), evaporates without leaving a residue, and works well for materials that cannot be exposed to moisture.

OSHA requires the plan to contain these elements:

how and what schedule your office is implementing OSHA's requirements for barrier techniques, hepatitis B vaccination, housekeeping, disinfection of contaminated work surfaces/equipment, handling regulated waste, post-exposure evaluation and follow-up, communication of bloodborne pathogen hazards to employees, and record keeping. • The exposure control plan should outline office protocol for when gloves, gowns, masks, and eyewear (or faceshields) are used. When and how you will provide training for employees, your specific practices for disinfection, how you launder gowns (onsite or using a service), where to keep your records (training and medical records, and OSHA standard). • Office policy on the hepatitis B vaccination, and office protocol for handling regulated waste.

Other potential infectious materials (OPIMs):

human body fluids (semen, vaginal secretions, CSF, synovial fluid, pleural and pericardial fluids, peritoneal fluid, amniotic fluid, & saliva in dental procedures). Only in dental procedures is saliva considered a potentially infectious material. Also an

In 1986, unions representing healthcare workers petitioned OSHA for an emergency rule to protect their members from workplace exposure to the

human immunodeficiency virus (HIV) and hepatitis B virus (HBV). OSHA denied the petition, but agreed to adopt a permanent rule on exposure to bloodborne pathogens through the regular rule making process. It took five years to develop the rule which now applies to hospitals, physician offices, nursing homes, other healthcare settings, emergency response personnel, funeral homes, and dental offices.

Erythema Multiforme-

hypersensitivity syndrome characterized by polymorphous eruption and mucous membranes. Macules, papules, nodules, vesicles, or bullae and target ("bulls-eye-shaped") lesions are seen. A severe form of this condition is "StevensJohnson Syndrome". These patients may be receiving moderate doses of systemic corticosteroids, thus may be unable to withstand the stress of an extraction. Consultation with their physician is absolutely necessary before treating these patients.

Respiratory Acidosis- Major Causes:

hypoventilation, emphysema, chronic bronchitis, severe pneumonia, pulmonary edema, and asthma.

Prilocaine is not used for patient with

hypoxic conditions (oxygenation problems) or patients with Hepatic (liver) disease. Prilocaine is metabolized into orthotoluidine (a product than can produce methemoglobinemia, a condition characterized by increased levels of methemoglobin in the blood which is less effective then hemoglobin in carrying oxygen in the blood. Thus, Prilocaine is contraindicated in patients with methemoglobinemia (a condition in which the iron in hemoglobin does not carry oxygen effectively), sickle cell and other anemias, and patients taking Tylenol (Acetaminophen).

Apicoectomy Indications:

if a reverse filling (MTA) must be placed, it is necessary to gain access to an area of pathosis, the poorly filled apical portion of the root is to be removed to the level of canal obturation. Retreating teeth with posts are the MOST common reason for an apicoectomy and retrograde filling.

Maxillary Sinus Communication:

if a small communication is made with the maxillary sinus while extracting a maxillary 2 molar, no additional surgical treatment is needed, simply allow a blood clot to form. Advise the patient to avoid vigorous mouth washing, frequent nose blowing, smoking, sucking on a straw, and violent coughing or sneezing.

Necrotic pulp and bacteria are necessary components of inflammatory resorption. Thus, this process is arrested with

immediate RCT (open the tooth, clean & shape the canal, and place calcium hydroxide paste in the canal every 3 months for 1 year). If resorption stops after 1 year of treatment, then place a permanent root canal filling (gutta-percha). A calcium hydroxide-based root canal sealer is strongly recommended.

If a permanent tooth bud is accidentally extracted while removing a primary molar, the best treatment is to

immediately orient the tooth bud, replant the bud using digital pressure, and suture. The best way to extract a primary molar that has the permanent tooth bud close to it is to section the tooth and remove the parts individually.

Difficult to treat an autistic patient due to

impaired verbal communication (inability to communicate with the child). New technology is improving communication through hand-held electronic devices.

The most severe handicap imposed by cleft palate is an

impaired mechanism preventing normal speech and swallowing. The child almost always needs orthodontic treatment once the palate is surgically repaired. Speech therapy is also required since these patients have problems related to the inability of the soft palate to close airflow into the nasopharynx. Orthognathic surgery may be needed to correct the concave appearance of the face due to deficient maxillary growth.

N 2 O creates an altered state of awareness with

impaired motor function. It is a CNS depressant, but produces little analgesia. The combined volume of gases being delivered (oxygen and nitrous) should be at least 3-5 liters/min. The operator should encourage the patient to breathe through their nose with the mouth closed. The feeling of floating or giddiness with tingling of the digits is the proper response to nitrous oxide.

A NORMAL ANGULATION of a molar is desirable because it

improves the direction & distribution of occlusal forces, alveolar contour, crown-to-root ratio, and the st nd periodontal environment by eliminating plaque-retentive areas. It decreases the amount of tooth reduction required for parallelism of the abutments and the possibility of endodontic, periodontic, or more complex prosthodontic procedures. It increases restoration durability due to better force distribution.

Loose Removable Appliances:

include functional appliances and functional jaw orthopedic appliances.

VARIATIONS of the basic Edgewise Appliance:

includes double (tandem) brackets (Siamese twin brackets), & narrow slotted brackets, 0.18 from top to bottom. A straight wire appliance is a version of the edgewise appliance with several features that allow placement of an ideal rectangular archwire without bends.

REMOVABLE orthodontic appliances-are generally restricted to TIPPING teeth. 1. Active Removable Appliances:

includes extra-oral traction devices (head gears, face masks, chin cups), lip bumpers, active plates (Schwartz appliance & anterior spring aligners), and vacuum formed appliances.

Chronic bronchitis is a very common, debilitating respiratory disease, characterized by

increased production of mucous by the glands of the trachea & bronchi. It has a strong association with CIGARRETTE SMOKING.

SMALL p-values (< 0.05)

indicate statistically significant results ( <.05) and strong evidence that the results DID NOT OCCUR BY CHANCE (allows you to reject the null hypothesis).

LARGE p-values (> 0.05)

indicate the occurrences were likely DUE TO CHANCE (cannot reject the null hypothesis). P-value greater than 0.5 (1-20) affects study results (this means there is a 5% chance that the relationship between the variables in the sample is due to chance). The higher the pvalue, the LESS likely a relationship exists between two variables.

Restorative Options for Endodontically Treated Posterior Teeth: POST-CORE:

indicated when there is insufficient clinical crown remaining to retain a core build-up and allow for adequate crown preparation. Requires the tooth to have RCT then post-placement to provide suitable coronal structure for an optimum crown preparation.

INDIRECT METHOD OF BONDING BRACKETS to a tooth over the direct method: • Disadvantage:

indirect bonding is more complex, more technique sensitive, & requires extra precautions than direct bonding.

In some patients, the articular disc remains anteriorly displaced at full mouth opening (anterior displacement without reduction). The articular disc is reduced by

inducing downward pressure on the posterior teeth and upward pressure on the chin, accompanied by posterior displacement of the entire mandible.

Prior to actual abscess formation, however, the infection can produce a cellulitis in the soft tissues of the involved region. The palpable tissues take on a condition called

induration (appearing hard, dense, and brawny). Treatment during this period involves localizing the infection. Early administration of antibiotics may be extremely important in a severe and life-threatening infection. Localization of the infection may be aided by using warm compresses and warm mouth rinses at frequent intervals.

Uncontrolled bleeding is a sign of

inflamed pulp tissue. Radicular pulp must be uninflamed for a successful pulpotomy. It is not uncommon to find uninflamed pulp at a more apical level, especially in cariously exposed teeth.

ANUG Clinical Manifestations:

inflamed, painful, bleeding gingival tissues, poor appetite, fever, general malaise, and fetid odor. ANUG is necrotic, foul-smelling ulcers of the gums and throat.

Parotitis-

inflammation of the parotid gland.

PERICORONITIS-

inflammation of the soft tissues (operculum) associated with the crown of a PARTIALLY erupted tooth seen most commonly in relation to the MANDIBULAR 3 rd MOLAR. Maxillary 3 molar is the most frequent contributing factor to pericoronal infections found around mandibular 3 rd molars, so always examine the maxillary 3 rd rd molar because it may be supererupted or malaligned.

CYST-

inflammatory response of the periapex that develops from pre-existing granulomatous tissue (granuloma), characterized by a central, fluid-filled, epithelium-lined cavity, surrounded by a granulomatous tissue & peripheral fibrous encapsulation. Often associated with a chronically infected and potentially mobile tooth, but is usually asymptomatic

Maxillary 3 molars can also be displaced into the

infratemporal space during elevation of the tooth, the elevator may force the tooth posteriorly through the periosteum into the infratemporal fossa. If access and light are good, the tooth may be retrieved with a hemostat. If the tooth is not retrieved after a short amount of time, the area should be closed, and the patient informed that the tooth was displaced and will be removed by an oral surgeon who will use a special technique to remove it.

Respiratory Alkalosis- Treatment:

ingestion of AMMONIUM CHLORIDE.

Respiratory Acidosis- Treatment:

ingestion of SODIUM BICARBONATE.

General Anesthetics most commonly used are

inhalation alone, barbiturates alone, barbiturates with oxygen, and nitrous in combination with a more potent agency like Halothane. Also, a local anesthetic is sometimes used for vasoconstriction and to decrease the amount of barbiturate used in lengthy procedures.

NITROUS OXIDE NITROUS OXIDE-

inhalation anesthetic with the FASTEST ONSET of action. It is a colorless, non-irritating gas with a pleasant, mild odor and taste. It has a blood/gas partition coefficient of 0.47, thus is poorly soluble in blood. It is excreted unchanged by the lungs. N O is stored under pressure in steel cylinders painted blue (oxygen is stored in green tanks). N 2 2 O is the oldest gaseous anesthetic used today, and the only inorganic substance used as an anesthetic. Nitrous oxide is a great drug to reduce anxiety.

von Willebrand's Disease-

inherited as an AUTOSOMAL DOMINANT BLEEDING DISORDER that occurs equally in males and females. Due to a deficiency in the vonWillebrand factor (a large glycoprotein with binding sites for Factor VIII, and facilitates platelet adhesion to collagen (important for platelet plug formation).

The same stages that occur in normal wound healing of soft tissue injuries (inflammation, fibroplasias, & remodeling) also occur in repair of

injured bone. However, osteoblasts and osteoclasts are also involved to repair damaged bone tissue.

PRE-CLEANING is the most important step in

instrument sterilization. Debris acts as a barrier to the sterilant and sterilization process. Ultrasonic instrument cleaning is the safest and most efficacious method of precleaning.

CYTOMEGALIC INCLUSION DISEASE is the most common VIRUS that can cause

intellectual disability.

FETAL ALCOHOL SYNDROME increases the genetic risk of

intellectual disability.

Maxillary 1 premolar is the least likely to be removed by rotational forces due to

its root structure (molars are obviously NOT removed using rotation).

Anticholinergic Drugs-

interfere with binding of acetylcholine at its receptor. The most common method for categorizing anti-cholinergic drugs is to identify the ionization state of nitrogen (i.e. tertiary or quaternary) because this affects the drug's ability to penetrate the CNS.

Irreversible pulpitis is an acute inflammation of the pulp characterized by

intermittent spasms of pain that becomes continuous. In the early stages, it may appear as a very severe hyperemia. As the condition continues, the pain is gnawing or dull-throbbing, and is generally increased by heat and relieved by cold.

♦ The absence of the predentin layer predisposes dentin to

internal resorption by pulp cells. Immediately adjacent to the odontoblastic layer in the pulp, 10-47.m of the dentin matrix remains unmineralized. If this unmineralized dentin layer is lost due to trauma or an infectious process, it predisposes the dentin to internal resorption by odontoclasts.

With severe irritation, internal resorption can occur. In primary teeth, severe irritation often results in

internal resorption. However, in permanent teeth, this rarely occurs because the severe inflammatory response causes reparative dentin formation.

Children in an elementary school exhibit a high

interproximal caries rate. For these children, the school-based program that will be most effective is fluoride mouthrinse.

Barbed Broaches-

intracanal stainless steel instruments designed to remove pulp tissue, cotton pellet absorbent points, and other soft materials. It is NOT used for canal enlargement. The barbs are notched out of the instrument shaft and represent a weakened point. If the broach is not used with utmost care or is forced apically, the barbs will bend and engage the canal walls, making removal difficult.

FRACTURE HEALING: • Primary (Bone-to-Bone) Healing-

involves both endosteal and periosteal proliferation.

Pseudo-Class III malocclusion: Treatment:

involves eliminating the CO-CR discrepancy early in the treatment to avoid abnormal wear and abnormal growth influences. Occlusal interferences and anterior cross bites are treated subsequently.

FRACTURE HEALING: • Secondary Bone Healing-

involves mostly endosteal proliferation into the void/space between 2 pieces of bone). The space fills in with callus.

Adjuncts to Endodontic Treatment: Root submersion-

involves resection of tooth roots 3mm below the alveolar crest, then cover with a mucoperiosteal flap. Submerged roots will prevent alveolar resorption and maintain better proprioception. • Indications: rampant caries, adverse periodontal conditions, repeated failure of prosthetic cases, and especially useful in medically compromised or handicapped patients requiring better denture control. Sometimes, root submersion is performed to avoid formation of an esthetic defect that may result after extraction.

PERICORONITIS- Treatment:

irrigate the area (if possible, establish drainage). Place the patient on antibiotics and instruct the patient to rinse with warm saline mouthwashes. As soon as acute symptoms are relieved, definitive treatment may be instituted (extraction).

Trismus is most likely caused by

irritation of the medial pterygoid muscle during an inferior alveolar nerve block.

2. EDTAC-

is EDTA + Cetavlon (a quaternary ammonium compound) with a greater antimicrobial action than EDTA, but has more inflammatory potential to tissues. NaOCl inactivates EDTAC.

MAXILLARY TEETH ROOT ANATOMY: Maxillary Lateral Incisor:

is MOST likely to have a curved root. It ALWAYS has 1 root with 1 canal. The root is more slender than in the maxillary central incisor and often (55%) of the time has a distal and/or lingual curvature or dilacerations. The access opening is OVAL. Pulpitis can cause referred pain to the FOREHEAD.

2. Endochondral ossification-

is how the remainder of the skeleton forms and takes place within a hyaline cartilage model. Cartilage cells are replaced by bone cells (osteocytes replace chondrocytes), organic matrix is laid down and calcium and phosphate are deposited. Endochondral ossification is mainly responsible for formation of SHORT & LONG BONES (i.e. ethmoid, sphenoid, & temporal bones of the skull).

Hemophilia C (Rosenthal's Syndrome):

is not sexlinked, and there is less severe bleeding due to a deficiency of Factor XI (plasma thromboplastin antecedent).

Acute Fluoride Poisoning-

is rare, but the most common causes of death are cardiac failure & respiratory paralysis. Fluoride toxicity shows up in the bones as osteosclerosis. Ingestion of 15mg/kg of fluoride can be lethal to a child. The adult lethal dose is 4-5gm. In mg/kg body weight, the LETHAL DOSE of fluoride falls in the range of 20-50mg/kg.

GRAFTS IDEAL GRAFT

is replaced by the host bone, withstands mechanical forces, produces no immunological response or rejection, and actively assists osteogenic (bone-forming) processes of the host. The greatest osteogenic potential occurs with an autogenous cancellous graft and hemopoietic marrow.

FIRST SYMPTOM OF Periapical Abscess-

is slight tooth tenderness that later develops into a severe throbbing pain (acute abscess) with swelling of the overlying mucosa.

Topical fluoride (with occlusal sealants)

is the primary preventive agent during adolescence (past age 12) because the entire dentition (except 3 molars), normally erupts by age 13. Thus, fluoride tablets may not be as beneficial. Fissure sealants succeed by altering host susceptibility.

BENZOCAINE

is the MOST COMMON TOPICAL ANESTHETIC used in dentistry. Because some local anesthetics are rapidly absorbed when applied to mucous membranes, prevent toxicity reactions by using only the needed amount of topical GEL (avoid topical sprays since they have a higher incidence of toxicity reaction).

A disadvantage of a panorex with peds patients

is the loss of image detail (it is hard to diagnose early carious lesions). Thus, bitewing x-rays are required to diagnose carious lesions. For a clinically caries-free child, the first bite-wing x-ray should be taken when the spaces between the posterior teeth have closed.

Mycobacterium Tuberculosis

is the marker microorganism for intermediate surface disinfection. Antimicrobial activity against MT is recognized as a significant benchmark criterion for disinfectant effectiveness. While tuberculosis is not transmitted via inanimate environmental surfaces, its morphology and structure make tubercle bacilli relatively resistant to penetration by many lowlevel disinfectant chemicals.

ANTERIOR OPEN BITE-

is the most common sequelae of a digit sucking habit. Unilateral crossbites can also occur. Increased pressure from the buccinator muscles during sucking constricts the maxillary arch. Other mechanical forces cause the maxillary incisors to procline & mandibular incisors to retrocline. As the hand rests on the chin, it retards mandibular growth, causing a Class II profile.

FLUORIDE FLUORIDE

is the most effective caries prevention agent available. It is completely safe when used properly. However, ingestion of high fluoride concentrations can cause nausea, vomiting, dental fluorosis (mottling), or in extreme cases, death (especially in children).

KETAMINE

is the primary medication used in dissociative anesthesia, but a sedative is often given before the Ketamine to reduce anxiety. A single dose of ketamine produces a trancelike state for 1030 minutes, and pain control for 30-45 minutes. The patient's eyes are open during the procedure, but he/she is in a daze and feels no pain.

Maxillary 1 Molar: Palatal canal:

is the straightest, widest, and most tapering canal. The most common curvature of the palatal root is to the facial. The U-SHAPED radiopacity commonly seen overlying the palatal root apex is most likely the ZYGOMATIC PROCESS of the maxilla.

The nice thing about panoramic x-rays with peds patients

is they are taken without placing the film in the mouth so it does not alarm a nervous child. Rather, children are often "entertained" by the panoramic unit.

When painting fluoride on, it is critical to

isolate the teeth with cotton rolls. When using fluoride trays, cotton rolls may be placed in premolar areas to increase patient comfort and help keep the fluoride in place. Patients are asked not to brush, rinse, eat, or drink for 30 minutes after a fluoride treatment so the fluoride is left undisturbed and is able to continue reacting with the hydroxyapatite for some time after the initial application. Fluoride treatments should be applied for 4 minutes, although there are now some 1-minute products available on the market.

Treatment of a mandibular fracture using only intermaxillary fixation (IMF) is a closed reduction because

it does not involve direct opening, exposure, and manipulation of the fractured area.

HISTOLOGICALLY, cementum differs from enamel because

it has collagen fibers and cellular components in the mature tissue.

MAXILLARY TORUS (Torus Palatinus)- Removal Technique:

it should not be excised en masse to prevent entry into the nose (the palatine bone will come out with the torus). Subdivide the tori into segments with a bur and remove the segments with an osteotome. Any protuberances are smoothed out with a bone file. The flap is then loosely sutured and place a palatal splint to prevent hematoma formation and to support the flap.

MAXILLARY TEETH ROOT ANATOMY: Maxillary 1 Molar:

its 3 canal orifices are arranged in a TRIANGLE shape. ~59% have 4 st th canal (ML) st with its orifice located just lingual to the MB canal orifice. This 4 ML canal is in the MB root, and may join the MB canal or exit through a separate foramen. If a lesion exists on the MB root prior to RCT and does not heal in the usual time frame (6-12 months) after treatment, it is most likely due to a missed ML canal.

Primary disadvantage of N2 O as a general anesthetic is

its LACK OF POTENCY.

Calcium Hydroxide (CaOH)-

its action promotes formation of a hard substance at the root apex by creating an ALKALINE environment that promotes hard tissue deposition.

Supplied as articaine HCL 4% solution with EPI 1:100,000 concentration. Comes in a lower dose due to

its increased potency.

The state of physical maturity or skeletal development co-relates well with the

jaw growth. Orthodontist use this information to predict the amount of expected jaw growth. After sexual maturity, much less growth is expected, thus growth modification is not attempted.

The ethical rules and principles of professional conduct for the practice of dentistry are set forth in the ADA's publication "Principles of Ethics and Code of Professional Conduct". The ethical principles found in this code are

justice, autonomy, and beneficence. • Justice-the quality of being impartial and fair. • Autonomy-to inform patients about treatment, to be truthful, and protect their confidentiality. • Beneficence-to be kind and give the highest quality of care one is capable of providing.

Heat sterilization is the most EFFICIENT way to

kill microbes. Heat is the most efficient, reliable, and biologically monitorable sterilization method. During a routine autoclave cycle, unsaturated chemical vapor sterilizer or dry heat unit, cell death occurs via heat inactivation of critical enzymes and other proteins within microbial cells.

Pathognomonic signs of external resorption:

lack of mobility, metallic sound to percussion, and infraocclusion of the involved tooth in the developing dentition.

Indications for using solvent-softened custom gutta- percha cones:

lack of an apical stop, abnormally large apical portion of the canal, or an irregular apical portion of the canal. Tugback within 1mm of working length is NOT an indication.

Other principles in preparing cavities in primary teeth:

lat pulpal floor. • Beveled axio-pulpal line angle to help reduce stress in the amalgam and provide greater bulk of material in this area. • Rounded angles throughout the preparation to result in less concentration of stresses and allows more complete condensation of amalgam into extremities of the preparation.• In Class II preparations, the facial and lingual walls of the proximal box should be carried to self-cleansing areas and should be parallel to the external surfaces and converge slightly. • The gingival margin is not beveled in Class II preparations because enamel rods in this area incline occlusally. • In Class II preparations, the gingival floor is not ideal in most cases as the preparation gets deeper in this area due to the cervical constriction found in this area on primary molars.

Tenderness is assessed by palpating the

lateral aspect of the joints when the mouth is closed and during opening of the mouth. The joint should also be palpated for tenderness while the patient opens maximally, and the fingertip should be positioned slightly posterior to the condyle to apply force to determine if there is inflammation of the retrodiscal tissue.

Behavior Shaping is regarded as a

learning model. A general rule about learning models is the most efficient learning models are those that follow the learning theory model most closely. Ex: attempting to change several aspects of a patient's oral hygiene regimen should be done one aspect at a time (sequentially). Have the patient mimic the correct oral hygiene behavior to increase the chances of succeeding in changing the patient's behavior.

Anatomic Distribution of Mandibular Fractures: Body of mandible (17%), Ramus (2%), & Coronoid Process (1%)-

least common fracture site.

INTELLECTUAL DISABILITY (MENTALLY CHALLENGED):

limited intellectual functioning (IQ < 70) affecting a person's ability to learn, reason, make decisions, and problem-solve. Adaptive behaviors like the ability to communicate and interact effectively with others, and selfcare are limited.

Local anesthetics "reversibly block" nerve impulse conduction and produce reversible loss of sensation at their administration site. The action site of local anesthetics is at the

lipoprotein sheath of nerves.

Hemangiomas are common on the

lips, tongue, and buccal mucosa, appearing as flat or raised lesions, usually deep red or bluish-red and rarely wellcircumscribed. Hemangiomas are removed surgically, while other do not require treatment.

GENAIL TUBERCLES-

located on the lingual surface of the mandible midway between the superior & inferior borders. There are 4 (two are situated on each side and adjacent to the symphysis). While they are usually relatively small, they may be fairly large and extend outward from the surface as spinous processes. Geninal tubercles are the area of muscle attachment for the SUPRAHYOID MUSCLES.

Dry Heat Disadvantages:

long cycle, poor penetration, and ruins heat-sensitive materials.

Glutaraldehyde Disadvantages:

long period required for sterilization, allergenic, not an environmental disinfectant, and extremely toxic to tissues.

DEHYDRATION-

loss of water and important blood salts like potassium (K+) & sodium (Na+). Vital organs (i.e. kidneys, brain, and heart cannot function without a certain minimum of water and salt). Causes include decreased intake (lack of water) and/or increased output (vomiting, diarrhea, blood loss, drainage from burns, diabetes mellitus, diuretic use, or a lack of ADH (anti-diuretic hormone) owing to diabetes insipidus (kidneys are unresponsive to ADH, or ADH is not being produced by the posterior pituitary).

The control of "flash" (excess resin)

makes clean-up easier, and the controlled thickness of it accurately expresses the built-in prescription of the appliance. Also, in situations where visibility is a problem (i.e. lingual appliances), this technique is almost always used.

Patients with anterior open-bite may have difficulty

making speech sounds "th, sh, ch" due to distortion. An anterior open-bite can also create a lisp, making it difficult to pronounce "s" & "z" sounds.

MALOCCLUSION-

malocclusion is MOST OFTEN HEREDITARY. There may be a disproportion between the size of the maxilla & mandible, or between the jaws and tooth size resulting in overcrowding of teeth or in abnormal bite patterns. Supernumerary teeth, malformed teeth, impacted or lost teeth that erupt in an abnormal direction may cause malocclusion. Less frequent causes of malocclusion are thumb sucking or tongue thrusting habits.

Pseudo-Class III malocclusion:

malocclusion where the mandibular incisors are forward of the maxillary incisors in centric occlusion, but the patient can bring the mandible back without strain so that the mandibular incisors can touch the maxillary incisors (this ability is often considered diagnostic). Thus, this type is a milder form of the "true" Class III malocclusion, and is more amenable to conservative orthodontic movement, while a "true" Class III malocclusion often requires surgical correction.

Costochondrial Rib Graft-

may be used with the cartilaginous portion simulating the TMJ and condyle. When used for ridge augmentation, extensive shrinkage is noted.

Ex: Ashley, a 32-year-old women, comes in for her routine cleaning appointment. Stephanie, the hygienist finds that Ashley has not been following the home care program recommended six months ago. Stephanie believes Ashley's problem is a

management deficiency, not a skills deficiency. Thus, the best course of action for Stephanie to take is to meet with her supervising dentist to determine the future course of action.

The space between the jaws into where the teeth erupt is provided by growth at the

mandibular condyles (especially the molars). Condyle is a major site of vertical growth in the mandible. Many arguments have been made about the condyle's function in mandibular growth. Most agree that soft-tissue development carries the mandible forward and downward, while condylar growth fills in the resultant space to maintain contact with the base of the skull.

The first step to treat mid-facial fractures that affects the occlusal relationship is similar to treating

mandibular fractures (re-establish a proper occlusal relationship by placing the maxilla into proper occlusion with the mandible.

Class II (B) canine relation:

mandibular canine's distal surface is DISTAL to maxillary canine's mesial surface. The maxillary canine is mesial to the mandibular canine.

Class III (C) canine relation:

mandibular canine's distal surface is MESIAL to maxillary canine's mesial surface. The maxillary canine is DISTAL to the mandibular canine.

2. Class II (B) Malocclusion (Retrognathism = Overbite):

mandibular first permanent molar's buccal groove is DISTAL to the MB cusp of the maxillary first permanent molar (the mandible is "distal" to the maxilla). The MB cups of the maxillary first molar is between the mandibular first molar & second premolar. The lower jaw and chin may appear small and withdrawn. The mandibular incisors occlude even more posterior to the maxillary incisors so that they may not touch at all. Associated with a RETROGNATHIC FACIAL PROFILE where the convexity is due to the relative prominence of the maxilla compared to the mandible. The mandibular incisors will most likely be tipped forward. This is less common (~25% of population). An SNB angle < 78° indicates mandibular retrognathism, while an SNA angle < 82° indicates maxillary retrognathism.

Submandibular space usually drains infections from

mandibular premolars & molars since their apices lie BELOW the mylohyoid muscle attachment.

DOWN SYNDROME (TRISOMY 21)- Oral Manifestations:

mandibular prognathism, delayed teeth eruption, higher incidence of congenitally missing teeth (hypodontia), taurodontism, malocclusion, enamel dysplasia, increased gingivitis and periodontal disease, thickened or fissured tongue, MACROGLOSSIA, mouth breathing (open mouth and dry, cracked and protruding lips). DECREASED DENTAL CARIES.

K-Type Instruments: 2. Reamers-

manufactured similar to files, but with fewer flutes. Reamers are used in canal preparations to SHAVE DENTIN using ONLY a reaming action to enlarge canals. Reamers remove intracanal debris with a CLOCKWISE reaming action, and place materials into the apical portion of the canal using a COUNTERCLOCKWISE rotation.

Hypoplastic primary incisors is a dental anomaly resulting from

maternal rubella in the first trimester of pregnancy

Acute or subacute osteomyelitis may involve the

maxilla or mandible. The disease usually remains fairly well-localized to the area of initial infection in the maxilla. In the mandible, bone involvement is more diffuse and widespread.

Research indicates pit and fissure sealants are best retained on

maxillary and mandibular premolars. However, maxillary and mandibular 1 molars benefit the most from sealants.

Prolonged sucking habits often produce a mildly narrow

maxillary arch and a tendency toward bilateral crossbite. Children with this condition usually shift the mandible to one side on closure to gain better function, which can guide permanent molars, or later guide premolars into a crossbite relationship.

The last primary tooth to be replaced by a permanent tooth is usually the

maxillary canine (the permanent maxillary canine usually erupts between age 11-12). Permanent mandibular canine usually erupts between 9-10yrs.

For the MAXILLARY ARCH, mandibular incisors are used to predict the size of

maxillary canines & premolars. Follow the same steps as for mandibular teeth.

Class I (A) canine relation:

maxillary permanent canine occludes with the distal half of the mandibular canine & mesial half of the mandibular first premolar (maxillary canine lies between the mandibular canine & first premolar).

A facial access is recommended for

maxillary primary incisors.

PEDS Local infiltration can be used to anesthetize

maxillary primary teeth. Adequate diffusion of the local anesthetic readily occurs in children because their bones are less dense than in adults.

PULPAL NECROSIS (Pulp Death)-

may have no painful symptoms and does not respond to EPT at any current level, but the tooth sometimes responds to heat, but NO COLD RESPONSE. A tooth affected with a necrotic pulp may have no painful symptoms and may appear discolored. EPT is valuable because there will be no response at any current level. Treatment: RCT or extraction.

Bone Healing (3 Phases): 3. Functional Reconstruction:

mechanical forces are important in this phase. Haversian systems are lined up according to stress lines and excess bone is removed. The shape of the bone is molded to conform with functional usage so that bone can be added to one surface, and removed from another surface. It takes 2-3 years to completely reform a fracture.

Submental Space-

medial part of the submaxillary space that contains submental lymph nodes that drain the median parts of the lower lip, tip of tongue, and mouth floor. It usually drains infections from mandibular incisors and canines because their apices lie ABOVE the mylohyoid muscle attachment.

If the needle tip is resting well below the mandibular foramen, it penetrates the

medial pterygoid muscle.

Lidocaine 2% with 1:100,000 EPI (vasoconstrictor) provides profound anesthesia of ? duration.

medium

The most commonly used dental materials deemed HAZARDOUS by OSHA are

mercury, nitrous oxide, & chemicals used to develop film.

Tooth development is initiated by

mesenchyme's inductive influence on the overlying ectoderm. Enamel is derived from ectoderm of the oral cavity. Ectodermal cells determine crown root and shape. All other tooth tissues differentiate from the associated mesenchyme (mesoderm). Tooth development depends on a series of sequential cellular interactions between epithelial & mesenchymal components of the tooth germ. Once the ectomesenchyme influences the oral epithelium to grow down into the ectomesenchyme and become a tooth germ, the following events occur:

SLOB RULE= If taken from the mesial, the lingual surface (ML canal) will appear more

mesial (closer to the cone) than buccal surface (MB canal) which appears farther distally.

Modern artificial joint replacement procedures use

metal alloplastic grafts. For bone replacement, a man-made material that mimics natural bone is used. Most often, this is a form of calcium phosphate (i.e. tricalcium phosphate, calcium carbonate, or hydroxyapatite) that is used for augmentation of the mandible.

N2O inhibits

methionine synthetase which is required for vitamin B12 production (can cause fatigue).

Water's view, PA skull view, & submental vertex view are radiographic views helpful to evaluate

midfacial fractures.

The most effective way to reduce pulp injury during tooth preparation is to

minimize dehydration of dentin.

Research suggests the association of impacted canines with

missing lateral incisors or shortened roots of lateral incisors. The distal aspect of the lateral incisors root guides the eruption of canines.

Disadvantages of N2 O Analgesia:

misuse potential with patients and dentists, is not a complete pain reliever (a local anesthetic is still required for most dental procedures), nausea is the most common patient complaint, and diffusion hypoxia can occur (so give 100% oxygen at the end of dental procedures to prevent it). *Inhalation of 100% oxygen is contraindicated in a patient with COPD (chronic obstructive pulmonary disease).

Young patients tolerate surgery very well, with minimal post-operative complications. Older patients have the most post-operative difficulties, as the bone is

more dense and the patient usually responds more slowly to the entire process (anesthesia and surgery).

DRY SOCKET (Post-Extraction Fibrinolytic Alveolar Osteitis or Localized Alveolar Osteitis)-

most common complication after surgical removal of a MANDIBULAR MOLAR resulting from a pathologic process combining the loss of a healing blood clot with a localized inflammation.

Mesioangular Impaction-

most common and LEAST difficult impaction to remove, comprising 43% of all impacted teeth.

REVERSIBLE PULPITIS (Pulpal Hyperemia = Pulpal Inflammation)-

most commonly caused by bacteria. Pain is not spontaneous, but requires an external irritant to evoke a painful response (i.e. cold, sweets). Pains are SHARP & BRIEF, stopping when the irritant is removed. Radiographs appear normal (may show deep caries or cavity preparation).

LUDWIG'S ANGINA-

most commonly encountered neck space infection that involves sublingual, submandibular, & submental spaces.

PRIMARY (ACUTE) HERPETIC GINGIVOSTOMATITIS:

most commonly occurs in CHILDREN & YOUNG ADULTS. Patients develop FEVER, irritability, regional lymphadenopathy, and headache. Within days, the gingiva is intensely inflamed. Any part of the oral mucosa and lips may become involved. Vesicles then form and rupture shortly later to leave shallow VERY PAINFUL ulcers covered with a GRAY MEMBRANE and surrounded by a RED HALO. Ulcers heal on their own in 7-14 days.

MAXILLARY TORUS (Torus Palatinus)-

most frequently located on the MIDLINE of the hard palate. They usually appear before age 30, and affect females more often than males. Maxillary tori present few problems when the maxillary dentition is present and only occasionally interferes with speech or become ulcerated from frequent trauma to the palate.

Post-Operative Hypertension-

most often due to postoperative pain, so treat with narcotics and sedatives. It is also caused by hypercarbia (> normal CO amounts in the blood), or administration of a vasopressor or catecholamine agents

Space Maintainers that REPLACE ONE PREMATURELY MISSING PRIMARY TOOTH: 1. "Band & Loop" Space Maintainer-

most often used when the PRIMARY FIRST MOLAR must be prematurely extracted. Used after a unilateral loss of a primary first molar. It consists of a band that is usually cemented to a primary second molar. Attached to the band is a loop that extends to the canine's distal surface. The loop prevents mesial migration of the primary second molar. Note: limited strength allows only single tooth-space maintenance.

Glutaraldehyde Advantages:

most potent category of chemical germicide, capable of killing spores (after 10hrs), EPA registered as a chemical sterilant, and can be used on heat-sensitive materials. Used in hospitals to sterilize respiratory therapy equipment.

Space Maintainers that REPLACE MULTIPLE PREMATURELY MISSING PRIMARY TEETH: 3. Partial Denture-

most useful for bilateral posterior space maintenance when permanent incisors have not erupted. Also used for missing anterior teeth when esthetics are a concern.

INDIRECT PULP CAPPING: Indications:

mostly for permanent teeth with rampant caries and large carious lesions close to the pulp that are not chronically painful.

Since this is not a skills deficiency problem, reviewing homecare techniques is not going to solve the problem. Ashley knows what to do. Now Stephanie and Ashley's supervising dentist needs to find a way to

motivate Ashley to find the time to brush and floss.

2. Hydrogen Peroxide (3% solution)-

much less solvent action than NaOCl, but a widely used irrigant in endodontics as many clinicians use H 2 O & NaOCl alternately during treatment.

Primary molars have an exaggerated cervical bulge that makes the matrix band adaptation

much more difficult. Primary molars have an exaggerated cervical constriction which requires special care in the formation of the gingival floor in Class II preparations.

3. Comminuted fracture-

multiple fractures of a single bone that can be simple or compound.

FACIAL NERVE (CN VII)- 1. motor innervation:

muscles of facial expression, posterior belly of digastric and stylohyoid muscles, stapedius muscle within the middle ear. Lower motor neuron lesions of CN 7 cause ipsilateral (same side) flaccid paralysis of the facial muscles.

The line of fracture determines if

muscles will be able to displace the fractured segments from their original position.

Zygomatic bone fractures is the 2 most common fracture of facial bones behind

nasal bone fractures (most common facial bone fracture). The mechanism of injury usually involves a blow to the side of the face from a fist, object, or secondarily to motor vehicle accidents (studies show 80% of these injuries are due to motor vehicle accidents).

NON-AVERSIVE CONDITIONS are perceived as

nonaversive, and the dentist-patient interactions seeks to MAXIMIZE them. Communication-gathering information, identifying problems, giving information (as in case presentations). • Preventive oral-health behavior. • Management of exceptional patients such as the physically or emotionally disabled. For these patients, gradually expose them to the dental office.

TMJ Syndrome is Divided into 3 Categories: 3. Degenerative Joint Disease (Osteoarthritis)-

natural degeneration of the TMJ's articular surfaces.

4 Reasons Fractures Do Not Heal: 1. Ischemia:

navicular bone of the wrist, femoral neck, and lower third of the tibia are all poorly vascularized, thus are subject to ischemic necrosis after a fracture.

Malignant Hyperthermia- When MH is diagnosed early and treated promptly, the mortality rate should be

near zero. Whenever anesthesia is administered, Dantrolene should be readily available and the protocol for MH management (100% oxygen, cooling procedures, and correcting acidosis and hyperkalemia). Dantrolene is currently the only known drug that treats MH by impairing calcium-dependent muscle contraction, 2 and controlling hypermetabolism manifestations.

Headgear extra-oral components:

neck strap, chin cup, & head cap.

Double Blind Study-

neither participants (subjects) nor examiners know the group allocations (test or control groups).

ALLOPLATIC GRAFTS-i

nert, man-made synthetic materials. Alloplastic materials used for augmentation genioplasty tend to MIGRATE from the position they were placed at the time of surgery.

Variations in susceptibility of nerve fibers to local anesthetics depend on

nerve diameter and distance between the nodes of Ranvier.

Inadvertent intravascular injection of a local anesthetic with a vasoconstrictor (EPI) may cause clinical signs of

nervousness, tremors, dizziness, blurred vision, and excitation and/or depression of the CNS. These signs may be followed by drowsiness, convulsions, unconsciousness, and possible respiratory arrest.

When sealants are applied correctly, there is a decreased development of

new carious lesions and a decreased progression of pre-existing lesions.

Child abuse most commonly involves

newborns and children up to age 3 years.

A wide variety of latex-alternative infection control items appeared in the market within the last 10 years. The most widely recognized are

newer generations of vinyl or nitrile gloves that do not cross-react with latex allergens. Products designated "hypoallergenic" are no longer labeled latex alternatives since they contain latex with a chemical coating over the latex.

Agents currently used in INHALATION ANESTHESIA are

nitrous oxide (a gas) and several easily vaporized liquid halogenated hydrocarbons (Halothane, Desflurane, Enflurane, Isoflurane, Sevoflurane, & Methoxyflurane). These anesthetics are liquid at room temperature and are vaporized in precisely controlled concentrations in a metered stream of oxygen and N O. Inhalation anesthetics are absorbed and primarily excreted through the lungs. 2

Late incisor crowding occurs in individuals with

no 3 molars, so the presence of these teeth is not a critical variable. However, the extent of late mandibular growth is a critical variable.

Lidocaine toxicity: If the clinical manifestations do not progress beyond these signs with retention of consciousness,

no definitive therapy is needed. The lidocaine will undergo redistribution and biotransformation, and the blood level will fall below the toxic level in a short time.

Intentional replantation is considered ONLY when there is

no other alternative treatment to maintain a "strategic" tooth. Long-term follow-up is required to monitor for complications, periodontal defects, and ankylosis with replacement resorption.

If the canal preparation is properly flared, fitting the master cone is

not a time-consuming procedure. A gutta-percha cone the same size as the last file used during preparation (MAF) is selected and placed as far as possible into the canal, but NOT past the working length.

Teeth conditions that usually DO NOT require endodontic treatment if managed properly because pulp remains vital: 2. Traumatic bone cyst-

not a true cyst since there is no epithelial lining. Found mainly in young people and is asymptomatic. Appears as a radiolucency that scallops around teeth roots. Teeth are usually vital. No treatment.

The immersion of dental instruments in cold disinfectants will

not destroy spores or hepatitis viruses (they are resistant to physical and chemical agents).

Pulp capping-

not recommended in primary teeth with carious pulp exposures due to its high failure rate and because pulpotomy (having similar time requirements) is very successful. Pulp capping can be done if a mechanical pulp exposure occurs.

Pulp capping-

not recommended in primary teeth with carious pulp exposures due to its high failure rate and because pulpotomy (having similar time requirements) is very successful. Pulp capping can be done if a mechanical pulp exposure occurs.

Repositioning displaced mobile primary teeth is

not recommended. Extraction is recommended due to potential aspiration in young children.

Any gown or clinic jacket that prevents blood or other potentially infectious materials (including saliva) from reaching work clothes, street clothes, or skin is considered adequate. Fluid-resistant gowns are

not required unless it is anticipated that large amounts of blood, saliva, or other body fluids will soak through the gown to the employee's clothing. OSHA considers cotton or cotton/polyester clinic jackets or lab coats as satisfactory barriers for most routine dental procedures. When surgical procedures are performed involving large quantities of blood (i.e. trauma surgery), additional personal protective equipment like long-sleeved gowns are required. According to OSHA, the selection is to be based on the quantity and type of exposure expected.

After extracting mandibular teeth on a child after a mandibular block was given, always advise the child

not to bite his/her lip while he/she is numb. Also inform the parents to watch the child to prevent this.

Incidence-

number of NEW cases of a specific disease occurring within a population at a certain amount of time. Expressed as a rate (cases)/(population)/(time). Incidence is a "rate" that requires a unit of time.

Fracture of the infraorbital rim presents with the symptoms of

numbness of the upper lip, cheek, and nose on the affected side. *Water's view is best to evaluate orbital rim areas.

Atropine is contraindicated for

nursing mothers and patients with glaucoma.

Molar Uprighting Facts:

o A severely lingually tipped mandibular molar is MORE DIFFICULT to control and upright properly. o Molar uprighting treatment in high angles cases results in excessive bite opening (increases vertical dimension of occlusion VDO). o Stabilization (retention) should last until the lamina dura & PDL reorganize which takes ~2 months for simple uprighting, and up to 6 months for uprighting and osseous surgery or grafts. This retention (stabilization) is provided by an appliance or well-fitting provisional restoration to stabilize the tooth positions and allow for reorganization of the PDL. Slow progress in molar uprighting in an adult patient is most likely due to occlusal interferences.

► Fearful Child:

o Have the parent stand quietly behind the chair. o Dentist must be consistent in tonal quality. o Allow the child to express his fears (identify the fear). o Change the child's focus off fear. o Lastly, sedation.

Incipient Malocclusion Signs:

o Lack of interdental spacing in the primary dentition. The significance of the lack of spacing related to the increased M-D width of the permanent teeth. o Crowding of permanent incisors in the mixed dentition. Since arch perimeter increases after the incisors erupt and is small in the maxilla and essentially non-existent in the mandible, arch growth cannot usually contribute to further dental alignment. o Premature loss of primary canines (especially in the mandibular arch). Premature loss of the mandibular primary canine reflects insufficient arch size in the anterior region. As such, the crowns of lateral incisors during eruption impinge on the primary canines' roots and cause them to resorb. When the canine is shed, the midline will shift in the direction of the lost tooth, and there is lateral and lingual migration of the mandibular incisors.

Enamel rods in the gingival third of primary teeth extend

occlusally from the DEJ. This eliminates the need in Class II preparations for the gingival bevel which is always required when preparing Class II preparations on permanent teeth.

Pathologic occlusion-

occlusion that cannot function without contributing to its own destruction, and may manifest itself by any combination of excessive tooth wear without sufficient compensatory mechanisms, TMJ problems, pulpal changes ranging from pulpitis to necrosis, and periodontal changes.

CROSSBITES-

occur when some of the teeth move on the "wrong side of the track". Crossbite can be unilateral (on one side), or bilateral (on both sides), and can occur anteriorly or posteriorly. Crossbites are associated with a jaw-size discrepancy, hereditary (genetics), reverse over-jet, and a scissor bite. Crossbites are NOT associated with tongue thrusting.

4 Reasons Fractures Do Not Heal: 3. Interposition of soft tissue:

occurs between the fractured ends.

Cartilage Growth Occurs 2 Ways :2 . Interstitial Growth-

occurs by the mitotic division & deposition of more matrix around chondrocytes already established in the cartilage. Examples of sites that grow by interstitial growth include the mandibular condyle, nasal septum, and spheno-occipital synchondrosis.

Bone Healing (3 Phases): 1. Hemorrhage:

occurs first and is associated with clot organization & proliferation of blood vessels. This nonspecific phase occurs during the first 10 days of healing.

favorable fracture-

occurs if the fracture line prevents displacement of the fracture by muscle pull.

unfavorable fracture-

occurs if the fracture line results in a muscle pull displacing the fracture segment.

Acute Osteomyelitis-

occurs in the jaws, most commonly caused by a DENTAL INFECTION. It is not a common disease, but is a serious sequela of a periapical infection that often results in a diffuse spread of infection throughout the MEDULLARY SPACES, with subsequent necrosis of a variable amount of bone.

Acute Osteomyelitis-

occurs more frequently in the MANDIBLE than the maxilla because the blood supply in the maxilla is much richer and comes from many different arteries, while the mandible draws its main blood supply from the inferior alveolar artery. Also, the dense overlying cortical bone of the mandible prevents penetration of periosteal blood vessels, thus the mandibular cancellous bone is more likely to become ischemic and thus infected.

ECTOPIC ERUPTION -

occurs when a tooth erupts in the WRONG PLACE (most commonly occurs in the eruption of maxillary first molars & mandibular incisors), and is much more common in the maxilla, and often associated with a developing skeletal Class II malocclusion.

Secondary Intention (Secondary Closure or Second Intention):

occurs when a wound is large and exudative. This side fills in with granulation tissue. Healing is slower and produces more scar tissue. Bone repair that involves mostly endosteal proliferation. If fractured bones remain more than 1mm apart, this type of repair occurs. Lots of fibrous tissue is formed and a callus is formed (which eventually ossifies). Examples (extraction sockets, poorly reduced fractures, and large ulcers).

3. Class III (C) Malocclusion (Mandibular Prognathism = Underbite):

occurs when the body of the mandible and its superimposed dental arch are in a MESIAL relationship to the skull base & maxilla. The maxillary first molar occludes distal to the mandibular first molar, while the maxillary canine is an exaggerated distal relationship to the mandibular canine. mandibular first permanent molar's buccal groove is MESIAL to the MB cusp of the maxillary first permanent molar (MB cusp is between the mandibular first & second molars). The chin may protrude like a bulldog. Mandibular incisors overlap anterior to the maxillary incisors (mandibular incisors are forward to the maxillary incisors). Maxillary incisors are usually tipped lingually. LEAST COMMON MALOCCLUSION (< 5%). Associated with a PROGNATHIC FACIAL PROFILE (MANDIBLE) where the mandible is markedly forward past the maxilla giving a concave midfacial appearance (the mandible protrudes forward, and the mandibular teeth extend over the maxillary teeth).

FRACTURE HEALING: • Endosteal Proliferation-

occurs within a bone.

INDICATIONS for ROOT CANAL THERAPY (RCT): 3. Chronic Dental Abscess-

often the cause of a sinus tract in the gingival tissue of children. It is often the result of a periapical granuloma, appearing as a radiolucent area at the apex of a non-vital tooth. A fistula is often found leading from an abscess cavity. Tooth pain stops upon drainage. Endodontic treatment is necessary.

SPLIT TOOTH-

often the result of the long-term progression of a cracked tooth. Identified by a crack with distinct segments that can be separated. The cracked portion is removed and restored with a restoration or crown unless the crack extends apical to the crest of bone, in which case extraction may be required.

5.25% solution provides excellent germicidal solvent action, but is dilute enough to cause

only mild irritation when contacting periapical tissue. Thus, gutta-percha points can be disinfected by placing them in 5.25% NaOCl solution for 1 minute.

The dentist is responsible for providing information and dental care. However, the patient is ultimately responsible for maintaining his/her own

oral health (brushing, flossing, etc.).

GIGANTISM-

oral manifestations are an enlarged tongue causing the teeth to be tipped either to the buccal or lingual. Mandibular prognathism and roots may be longer than normal are other oral features.

Nausea is the most common pos-operative complication of

outpatient general anesthesia.

Sutures should never be

over tightened or closed under tension, should be 2-3mm apart, placed from mobile tissue into fixed tissue, and from thin into thick tissue.

Treatment of a sustained convulsive reaction to a local anesthetic includes

oxygen and Diazepam IV. If proper equipment and adequately trained staff are unavailable, do not attempt injections.

Urine Values:

pH 6 (4.7-8.0); specific gravity (1.005-1.025).

PERICORONITIS- Signs & Symptoms:

pain, bad taste, inflammation, pus expressible from beneath, and the pericoronal tissues are aggravated by trauma from the opposing tooth. Pericornitis is a criteria by the NIH (National Institute of Health) for removing 3 molars.

ARTICAINE Approved in the U.S. in 2000, but controversy within U.S. dentistry remains due to potential increased incidence of

paresthesia with inferior alveolar nerve (mandibular) blocks.

Bloodborne Pathogens-

pathogenic microorganisms present in human blood that can cause disease in humans.

Subluxation (Dislocation or Open Lock):

patient opens wide or maintains open mouth for a long time, causing the posterior band to stretch and the joint to travel beyond the articular eminence (condyle is in front of the eminence). Patient cannot close (mouth is stuck open) after keeping mouth open for a long time in the dental chair.

Communication is basic to all aspects of the dentist-

patient relationship. Without proper communication (verbal or non-verbal), dentist-patient relationships would fail. Acceptable non-verbal behavior varies with age, sex, ethnic background, geographical region, culture, and situation.

Factors that DELAY the healing process of an extraction site:

patient with protein deficiency or on glucocorticoid therapy, older patients, and local infections.

EXODONTIA General Surgery Concerns:

patient's nutritional status, body fluids and electrolytes, pre-operative and postoperative information, wound healing (primary and secondary), and most important—infection. *The difference between acceptable and an excellent surgical outcome depends on how the surgeon handles the tissue.

Septocaine Contraindications:

patients with hypersensitivity to local anesthetics containing sodium bisulfite, patients with impaired cardiovascular function, or with congenital or idiopathic methemoglobinemia. HEADACHE & PAIN are the most common adverse reaction (2%).

While doing a vital pulpotomy on a young, immature permanent tooth, if hemorrhage after pulpal amputation cannot be controlled with cotton pellets even after several minutes, the next step is to

perform the amputation at a more apical level.

25. When evaluating an OSSEOUS DEFECT, the ONLY WAY TO DETERMINE the number of walls left surrounding the tooth is by

periodontal EXPLORATORY SURGERY.

Having your teeth cleaned and examined regularly and keeping them clean daily at home is the best way to prevent

periodontal disease.

The diastema closes as the

permanent canines erupt. The greater the spacing, the LESS likely a maxillary central diastema will completely close on its own.

Occlusal anatomy of primary teeth is not as defined as

permanent teeth anatomy, thus amalgam preparations can be more conservative.

Supernumerary teeth can cause crowding of the normal teeth and can delay

permanent tooth eruption.

When treating a child who is obviously afraid, the dentist should

permit the child to express his fear (identify the fear). All behavioral patterns are motivated by anger and fear. The crying child is NOT an abnormal child. Anger is easier to treat than fear. Fear is most likely exhibited by a young child on his first visit to the dentist, and is related to anxiety over being separated from a parent. The PARENT (not the dentist), has the greatest influence on the child's reaction at this initial visit.

RECOVERY-

phase of anesthesia commencing when surgery is complete and delivery of the anesthetic is terminated, and ending when the anesthetic has been eliminated from the body.

INDUCTION-

phase of anesthesia that begins with the administration of anesthetic and continuing until the desired level of patient unresponsiveness is reached. The depth of general anesthesia by inhalation varies with the partial pressure (tension) of the anesthetic agent in the brain, and the rates of induction and recovery depend on the rate of change of tension in this tissue, blood supply to the lungs, pulmonary ventilation, and concentration of the anesthetic influence the induction rate. The signs and stages of anesthesia are most likely seen with an anesthetic with a slow rate of induction.

Drugs to avoid in patients taking barbiturates:

phenothiazines, alcohol, antihistamines, & antihypertensives. These drugs enhance the CNS depression of barbiturates.

Placing sealants is a highly effective way to prevent

pit and fissure caries. It is safe, but underused in the private and public dental health care delivery systems. The substantial reductions in dental decay in the U.S. youth population is due to systemic and topical fluorides. The control of smooth surface caries provided by fluorides is critical to the additional effectiveness of sealants. Sealants are highly effective in preventing pit and fissure caries.

Pulp Capping-

placing a sedative and antiseptic dressing on an exposed healthy pulp to allow it to recover and maintain normal function and vitality. Dycal (CaOH = calcium hydroxide) is the most commonly used dressing.

At the ONSET of pulpal inflammation, these cells are involved in the cellular response:

plasma cells, macrophages, & lymphocytes, but NOT Polymorphonuclear (PMN) Leucocytes.

Aspirin & NSAIDs inhibit

platelet aggregation. Thus, if given to a patient already taking an anticoagulant, the effects can be life-threatening.

APF ACIDULATED PHOSPHATE FLUORIDE is contraindicated on

porcelain and composite restorations because it causes pitting and etching of these materials. Acidulated fluorides should be avoided on implant patients because they can corrode the surface of titanium implants.

Hepatitis B Virus (HBV)-

poses the greatest occupational healthcare worker risk for bloodborne infection. The basis of the current standard (formerly "universal") infection control precautions were first recommended by the CDC in 1987 to protect healthcare workers from occupational transmission of all bloodborne infectious diseases during the provision of patient care. While many health professionals focused on HIV, evidence demonstrated that HBV was responsible for infection in 10-30% of exposed, susceptible healthcare workers. HBV concentrations in blood of a chronic carrier can range between 1-100 million virions/ml, in contrast to significantly lower viral loads shown for both HIV and AIDS infected patients. Precautions that minimize potential HBV infection/spread prevent crossinfection of less infectious microorganisms. Exposed employees who have declined the Hepatitis B vaccination can change their mind at any time and receive FREE vaccination. Exposed employees who have begun their Hepatitis B vaccination series can work at their jobs even though the series is not complete.

Treatment for tonic-clonic seizures (grand mal)

position the patient in the supine position, preventing injury to the convulsing patient, initiating basic life support (head tilt). If cyanosis occurs, oxygen is administered.

When communicating with children, try to reinforce

positive behavior by telling the child exactly what he is doing well.

2 Oral Surgery Concerns with Thrombocytopenia Patients:

post-operative hemorrhage caused by a decrease in blood platelets, and patients with the chronic form may be on steroids and have adrenal insufficiency. They may be unable to handle the stress of extractions.

DOWN SYNDROME (TRISOMY 21)- Dental Management (Trisomy 21):

practice "tellshow-do" and involve caregiver (some patients cannot verbally communicate depending on severity). May require antibiotic pre-medication if a congenital heart defect exist (affects 45% of newborns), due to compromised immunity and infection susceptibility. Avoid air polisher and ultrasonic scalers. Use positive reinforcement. Physicians consult regarding need for pre-medication with antibiotic due to susceptibility to infections due to congential heart defects.

ANUG: Rarely occurs in

pre-school children and has a slow onset.

Peds: The greatest problem in pulpal diagnosis is

predicting the amount or extent of inflammation. Successful management of deep caries and pulpally involved teeth in children depends on the extent of pulpal inflammation.

The natural tooth will preserve ARCH LENGTH & INTEGRITY better than any

prefabricated space maintainer.

APERT SYNDROME- Major Features:

prematurely fused cranial sutures, retruded midface (often corrected with Lefort III surgery), fused fingers and toes.

Rubber Dam Peds Contraindications:

presence of fixed orthodontic appliances, a patient with congested nasal passages/nasal obstruction, or a recently erupted tooth that will not retain a clamp.

Lobes-

primary centers of ossification always separated by developmental grooves that are very prominent in posterior teeth and form specific patterns. The minimum number of lobes from which any tooth may develop is 4.

PULP, DENTIN, & CEMENTUM PULP-

primary function of pulp is DENTIN FORMATION. Other pulp functions: 1. induction-forms dentin which then induces enamel formation. 2. nutrition-dentinal tubules are linked to the pulp to maintain pulp hydration and formation of peritubular dentin.

5. Calcification (Mineralization)-

primary teeth begin to calcify/mineralize during the 2 trimester of pregnancy (14 weeks or 4 months in utero). In a 2 year-old child, 40 teeth have calcified. At birth, 20 deciduous and 4 1 molars have commenced mineralization (24 teeth). Maxillary and mandibular 1 st st molars begin to calcify at birth and are the first to begin calcification. Mandibular 3 molars are the last teeth to begin calcifying at age 8-10 years. rd The cariostatic effect of fluoride is manifested during the calcification stage of tooth development. Tetracycline stain is incorporated and discoloration occurs during calcification. Calcification of the roots is completed by age 3-4.

Hyperparathyroidism, however, causes premature exfoliation (loss) of

primary teeth.

Maintenance-

process of keeping a patient in surgical anesthesia.

Disinfection-

process of reducing the numbers or inhibiting growth of microorganisms (especially pathogens) to the point that they do not pose a threat of disease. Disinfection uses chemical agents to destroy pathogenic microorganisms, but not necessarily all pathogens or resistant spores on INANIMATE surfaces. Disinfection is less lethal than sterilization, and involves a chemical process of microbial inactivation that destroys virtually all pathogenic microorganisms on inanimate surfaces, but not necessarily all microbial forms (spores). Disinfection is the killing of many, but not all, microorganisms. It does not include the destruction of bacterial spores.

Autoclave (Moist Heat Sterilization or "Saturated Steam")-

proper time and temperature for autoclaving is 250°F (121°C) for 15-20 minutes. These conditions yield 15lbs of pressure of steam per square inch. MOIST HEAT destroys bacteria by denaturation of high proteincontaining bacteria. Autoclave provides sterilization when used at the 250°F (121°C) for 15-20 min because it applies the heat under pressure, which greatly speeds up the protein denaturation process (compared to boiling water). Usually only 10 minutes is required to destroy all bacteria, but the increased time is allowed for penetration when instruments are wrapped in thick towels. Autoclaving effectiveness is best determined by culturing bacterial spores. Spore testing of autoclave units is recommended weekly.

Phlebitis (Thrombophlebitis) of a vein after administration of IV valium is usually attributed to the presence of

propylene glycol in the mixture. Phlebitis is irritation or inflammation of a vein sometimes seen after IV administration of valium due to the propylene glycol in the mixture. Phlebitis is more likely to occur if a vein in the hand or wrist is used and may be more common after repeated injection, especially in heavy smokers, elderly, and women taking oral contraceptives.

When working with x-ray processing solutions, use

protective eyewear & rubber gloves, work in a well- ventilated area, and store solutions in tightly covered containers.

When handling chemical agents or cleaning a dental office, always wear

protective eyewear, mask, and heavy-duty utility or nitrile gloves.

A patient on anticoagulant therapy (Warfarin, Heparin, Aspirin, or an NSAID) will most likely have a prolonged

prothrombin time (PT) and bleeding time (BT). For elective extractions, this patient should stop taking the anticoagulant for 5 days prior to extractions. Always consult with the patient's physician before recommending this.

RANDOMIZED CONTROL TRIALS-

provide the STRONGEST FORM OF EVIDENCE.

Rapid Heat Transfer Sterilization-

provides a very fast cycle time, no dulling of cutting edges, & dry instruments after the cycle. FDA-approved, forced air, dry heat convection ovens are appropriate for sterilizing heat-stable instruments and other reusable items used in patient care. They use a higher temperature than other dry heat units, and there is controlled internal air flow within the chamber. In contrast to traditional dry heat sterilizers, a rapid heat transfer unit can sterilize items in much shorter times, while offering the advantages of dry heat. Rapid Heat Transfer Sterilization requires 375°F (191°C) for 12 minutes for wrapped instruments, and 6min cycle time for unwrapped instruments.

Continuous Suture Pattern/Method-

provides ease and speed of placement, distributes tension over the entire suture line, and a more watertight closure than the interrupted pattern or method.

BPS requires training of all employees who provide or assist in

providing patient care and training to those who clean operatories, instruments, and gowns.

AVERSIVE CONDITIONS of interaction between the dentist & patient:

psychophysiological reactions, stress, anxiety, fear, and pain. These conditions are perceived as aversive and the dentist-patient interactions seeks to MINIMIZE them.

VITAL STATISTICS-

quantitative data routinely collected by epidemiologists and public health professionals on mortality, morbidity, natality, birth-death ratios, and crude death ratios. Vital statistics are quantitative methods to monitor and evaluate the life history of a specific population. Vital statistics identify community health needs, estimate healthcare costs, and evaluate health program effectiveness. 1. Mortality (Death Rate)-number of deaths caused by a specific disease. It is the ratio of the number of deaths caused by the disease, to the total number of cases of the disease at a specific time. 2. Morbidity-the incidence of a specific disease within a given population. 3. Natality (Birth Rate)-the ratio of births to the general population. 4. Birth-Death Ratio (Vital Index)-the number of births in a given year divided by the number of deaths in a given year. It is an indication of the population growth, stability, and reduction. 5. Crude Death Rate-ratio of the number of deaths occurring within a given time period and population to the total population during that time.

Glycopyrrolate, Ipratropium, & Probanthine are

quaternary compounds that cannot penetrate the CNS.

Formocresol Pulpotomy Technique-Contraindications:

radiographic evidence of internal resorption is a contraindication for a formocresol pulpotomy on a primary molar. Also, a tooth that is painful with swelling is a contraindication to a pulpotomy. You need healthy ROOT pulp tissue for pulpotomy success.

Important: 30%-50% of bone calcium must be altered before

radiographic evidence of periapical breakdown occurs. This alteration occurs at the junction between the cortical and cancellous bone.

Chronic pulpal infection in primary molars is usually first noted

radiographically as a change in the bony furcation.

Traumatized teeth may be fine for a long time, but many develop

radiolucencies. Thus, do not indiscriminately do root canals before checking pulp vitality. Perform RCT only in teeth that do not respond to pulp testing (i.e. trauma to maxillary anterior teeth. A few years later x-rays reveal radiolucencies around incisor apices). Check pulp vitality of all anterior teeth before performing root canals.

Mineral Trioxide Aggregate (MTA)- Advantages:

radiopaque, hydrophilic, biocompatible, non-toxic, induces hard tissue formation.

Marsupialization is the treatment of choice for

ranulas (for a recurrent ranula, treatment also involves excision of the sublingual gland). Also the treatment of choice when a cyst is large and close to vital structures.

General anesthesia induction and recovery using Brevital is

rapid.

Disc Displacement WITHOUT Reduction (Closed Lock):

rarely clicking with occasional locking. Clicking and popping has disappeared with limited opening & pain (< 35mm). These patients have a consistent limited opening ("hard-end feel"). Patient deviates on opening to affected side (jaw goes to the affected side). Treatment: always treat conservative (4-6 weeks first) before considering surgery (95% improve without surgery). Surgery is mainly done to restore disc position and increase opening (normal opening is 50mm). There is NOT a REPRODUCIBLE reciprocal click. Most disc displacements are ANTERIOR & MEDIAL.

ANODONTIA-a developmental abnormality characterized by the TOTAL ABSENCE OF TEETH. 2. Partial Anodontia (Congenitally Missing Teeth)-

rather common and usually affects maxillary 3 molars, maxillary lateral incisors, & mandibular 2 rd premolars. As a rule, if only one or a few teeth are missing, the absent tooth is the most distal tooth of any given type (if molar, then it would be the 3 nd rd molar).

REGIONAL LYMPH NODES: 3. Submental lymph nodes-

receive lymph from the tip of the tongue, floor of the mouth below the tip of the tongue, mandibular incisors and associated gingiva, the center part of the lower lip, and skin over the chin. Efferent lymph vessels drain into the submandibular and deep cervical lymph nodes.

INDIRECT METHOD OF BONDING BRACKETS to a tooth over the direct method: • Advantages:

reduced chair-side time, accurate placement on teeth, controlled resin thickness between the tooth & bracket interface, and easier clean-up during bonding & de-bonding.

Environmental Protection Agency (EPA)-

regulates waste transportation from the dental office. CDC considers the following groups as "highrisk": IV drug users, homosexual/bisexual males, people receiving transfusions or blood products, and healthcare workers who may come into contact with body fluids. OSHA considers part-time, temporary, and probationary workers as employees. It is important that the employer stress to employees that Hepatitis B has been a long-standing occupational threat in dentistry. HBV is a hardy virus that only takes a low concentration to transmit the virus and infect someone. Dental healthcare workers are at greatest risk for contracting HEPATITIS. As a dentist (employer), you must offer to provide vaccination to all employees who have occupational exposure. Any FDA-approved hepatitis vaccine is acceptable (Recombivax HB & Engerix-B). Hepatitis B virus is usually transmitted by percutaneous inoculation, sexual intercourse, or prenatal transfer. Treat each patient and instrument as potentially infectious (Standard Infection Control Precautions).

PULPOTOMY-

removal of a portion of the pulp that is indicated for: 1. cariously exposed deciduous (primary) teeth with healthy radicular pulps. 2. traumatic or carious exposure of permanent teeth with undeveloped roots. 3. an alternative to extraction when endodontic treatment is not available. 4. emergency treatment in permanent teeth with acute pulpitis.

DEBRIDEMENT-

removal of foreign material & contaminated or devitalized tissue from or adjacent to a traumatic infected lesion until surrounding healthy tissue is exposed. Chemomechanical debridement of the root canal system is the MOST crucial aspect of root canal treatment.

Adolescent patients with rampant caries may require caries control prior to final restorations to arrest all deep carious lesions and halt their advancement toward the pulp. This involves

removing gross caries then placing calcium hydroxide and an interim restoration like IRM (reinforced ZOE).

Caries is an infectious disease that must be eliminated by

removing the caries and restoring or extracting the tooth. To ensure arch integrity, restoring the involved tooth, if possible is preferred.

The rationale for RETENTION in orthodontics (accomplished with fixed or removable retainers) is to allow

reorganization of gingival & periodontal tissues, minimize changes due to growth, and to maintain the teeth in unstable conditions. Maintaining the treatment outcome after orthodontic treatment is one of the most difficult aspects of the entire treatment process.

With a mild irritation, there is a mild inflammatory reaction that resolves itself and regroups as

reparative dentin.

NiTi methods: Reaming-

repeated clockwise instrument rotation especially during insertion. A reaming action produces a canal that is relatively ROUND in shape. A reaming method is usually most efficient if using a silver cone to fill a canal.

The most effective way to teach oral hygiene skills is by having the patient participate in

repeated, supervised training sessions.

Properties of Barbiturate Hypnotic Agents:

respiratory depression, induction of liver microsomal enzymes, tolerance development, & suppression of REM sleep. Barbiturates can cause hyperanalgesia (↑ sensitivity to pain).

An abnormality in one or more of the pH control mechanisms can cause two types of major disturbances in the body's acid-base balance. Depending on the condition cause, acidosis or alkalosis can be

respiratory or metabolic:

Class I & II preparations should include areas with caries and that retain plaque, and potential carious areas (pits and fissures). This "extension for prevention" is only done when

restoring with amalgam. It is not necessary to "extend for prevention" when restoring with composite resin or resin-modified glass ionomer, it is possible to seal the remaining pits and fissures.

Scissor Bite (Bilateral Lingual Crossbite)-

results from a narrow mandible or wide maxilla. Milder cases may involve only maxillary first premolars. Severe cases may require contraction of the maxilla or expansion of the mandible.

Chronic Osteomyelitis-

results when bone tissue dies due to the lost blood supply.

Indications of Removable Appliances:

retention after comprehensive treatment, limited tipping movements, & growth modification during the mixed dentition.

Sealant materials can be unfilled, filled with opaquer, clear, and colored. However, there is no difference in

retention rates. Filled materials are easier to see and monitor, but clear materials allow the operator to continue to see the filled fissures. Sometimes operators prefer colored sealants to make monitoring retention easier. The newest sealant material is "fluoride releasing" where fluoride is released from the sealant after polymerization. The clinical significance of this is not yet determined, but the fluoride release is thought to occur at the base of the sealed groove, which provides a fluoride-rich layer available when remineralization of an incipient lesion occurs.

If a tooth with previous endodontic treatment becomes reinfected, it is best to

retreat it conventionally by removing the filling material, debride the canals, and refill. However, if the tooth has been restored with a post, core, and crown, then apical curettage, then an apicoectomy and retrofill should be performed.

6. Rotation-

revolving the tooth around its long axis. Recurring tooth rotations after orthodontic correction occur due to the persistence of the elastic supracrestal gingival fibers (mainly free gingival & transseptal fibers). Need adequate retention to prevent relapse. Thus, supracrestal fibers are commonly associated with relapse after orthodontic rotation of teeth.

A history of rheumatic fever should lead the dentist to an in-depth dialogue history seeking the presence of

rheumatic heart disease. If RHD is present, antibiotic coverage is indicated to minimize the risk of subacute bacterial endocarditis (SBE).

As the pH of the tissue decreases and [H +] increases, the cationic (water-soluble) form

rises and free base decreases. Conversely, as pH is increases and [H + ] is decreased, the free base (fat-soluble) form increases and the cationic form decreases. This free base form readily penetrates the lipid-rich nerve.

If root development is insufficient (1/3 or less), the tooth is more difficult to remove because it tends to

roll in its crypt (like a ball in a socket), preventing easy elevation.

Techniques to remove gutta-percha:

rotary instruments, ultrasonic, heat, heat & instrument, and file & chemical.

Mamelons-

rounded or conical prominences on the incisal ridge of newly erupted incisors that represent the 3 lobes from which the incisors developed from. Mamelons are usually worn off after the tooth comes into functional position. The presence of mamelons in a teenager or adult is evidence of malocclusion (usually an anterior open bite relationship where the incisors do not touch).

Latex Allergy Risk Factors:

rubber industry workers, atopy, persons with multiple surgeries and banana allergies, and spina bifida.

3 TMJ LIGAMENTS: attach and determine the farthest boundaries of mandibular movement: 1. Temporomandibular ligament (lateral ligament)-

runs from the articular eminence (tubercle) to the neck of the mandibular condyle. It provides lateral reinforcement for the capsule & PREVENTS POSTERIOR & INFERIOR DISPLACEMENT OF THE CONDYLE (prevents the mandible from excessive retraction or from moving backward). Resists posterior movement of the mandibular condyle, and is found on the TMJ's lateral surfaces.

Ketamine ↑ secretions of

salivary and bronchial glands, BP, HR, and muscle tone (not respirations).

3 Types of Inappropriate Healing: 1. Delayed-union:

satisfactory healing that requires greater than the normal 6-week period. May be caused by infection, interposition of soft tissue, or muscle between the fractured segments.

In communities without fluoridated water supplies, the most cost-effective method of delivering fluoride to 6-12 year old children is via

school water fluoridation (it is better than tablets, brushing with fluoride gel, or rinsing with fluoride mouthrinse).

DENTAL PUBLIC HEALTH-

science and art of preventing and controlling dental disease, and promoting dental health through organized community efforts. A form of dental practice that serves the community as a patient rather than serving the individual. Dental public health involves providing dental education to the public, research, and applying research findings with the administration of dental care programs for groups, and the prevention and control of dental disease through a community approach.

If the preoperative radiograph shows that the permanent premolar is tightly wedged between the bell-shaped roots of the primary tooth, the best treatment is to

section primary molar crown and remove the two portions separately. This helps to not disturb the permanent tooth.

Barbiturates can lead to excessive

sedation and cause anesthesia, coma, even death. Barbiturate overdoses may occur because the effective dose of the drug is not too far away from the lethal dose.

Barbiturates have two major effects:

sedative (decreases anxiety) and hypnotic (helps sleep).

After recovery from primary HSV, the virus is not cleared from the body, but lies dormant in a nonreplicating state in the

sensory nervous system (trigeminal ganglion). Periodically, latency reactivates and allows the virus to return to the skin or mucous membranes, where it causes a recurrent infection.

While attempting to remove a grossly decayed mandibular molar, the crown fractures. The recommended next step to facilitate removal of the tooth is to

separate the roots with a chisel, elevator, or most easily with a bur. Teeth with two or more roots often need to be sectioned into single entities prior to successful removal. A popular sectioning method is to make a bur cut between the roots, then inserting an elevator in the slot and turning it 90° to cause a break.

INERGLOBULAR DENTIN-

separates MANTLE and CIRCUMPULPAL DENTIN.

ANTERIOR CROSSBITE in the primary dentition often indicates a

skeletal growth problem & a developing Class III malocclusion. Anterior crossbite can be caused by a labially situated supernumerary tooth, traumatic injury, or an arch length discrepancy.

Procedures essential for successful intentional replantation of an avulsed tooth include:

skillful extraction, minimum out-of-socket time, minimum root damage while the tooth is held during apical root end preparation, and repair of any perforation or resorptive defect before replantation.

Nursing bottle caries is RAMPANT DECAY due to

sleep time bottle-feeding combined with Streptococcus mutans activity. The stagnation of milk around the necks of anterior teeth and fermentation of the disaccharide lactose (a sugar found in milk), also contributes to this caries process.

Compared to lidocaine in equal amounts, Prilocaine has an intermediate duration of action that is

slightly LONGER, LESS POTENT, and produces LESS vasoconstriction due to its lower EPI content of (1:200,000) compared to lidocaine (1:100,000).

Direct pulp capping involves prompt application of a setting calcium hydroxide cement to a

small (< 1mm in diameter), well isolated traumatic pulp exposure. Direct pulp capping is expected in most instances, to stimulate formation of a reparative "dentin bridge" over the exposure site and preserve underlying pulpal tissue in a healthy condition.

Fluorides often added to water supplies are

sodium fluoride, sodium silicofluoride, & hydrofluosilicic acid.

Components of Sodium Fluoride Paste to Treat Root Sensitivity:

sodium fluoride, kaolin, glycerin (present in paste in equal parts).

3 Fluorides used in Public Drinking Water Supply:

sodium fluoride, sodium silicofluoride, & hydrofluosilicic acid (supplied as an aqueous solution in 55 gallon drums and is commonly used at ground water well houses). The first two fluorides are supplied in bulk, crystalline form, and are regularly used at water treatment plants.

STANNOUS FLUORIDE Before 2006, stannous fluoride was not FDA approved in U.S. dentrifices, however, P&G produced a new stannous fluoride formulation that tastes better and causes less staining. New formulations like Crest-Pro Health combine stannous fluoride with

sodium hexametaphosphate (fights stain and tarter)

In higher doses, barbiturates can increase

some types of behavior and act like a stimulant. These effects may be caused by depression of inhibitory brain circuits (barbiturates at these doses act to remove inhibitory behavior).

If during the first 6 months after the injury, you observe pulpal necrosis (tooth darkens), the tooth can receive RCT if needed as long as the tooth is

sound in the socket and no pathologic root resorption is evident. If the tooth is asymptomatic, leave it alone.

If a primary tooth is lost, an orthodontic evaluation is indicated to determine whether

space maintenance is needed. This decision is based on the patient's skeletal and dental development (i.e. if a 10 year old child loses the primary first molar, no treatment is usually needed, since the permanent first molar usually erupts between ages 10-12yrs).

PRIMATE SPACES-

spaces found in the primary dentition. Spacing is normal throughout the anterior part of the primary dentition, but is MOST NOTICABLE in these two locations: ♦ Maxillary arch: primate space located between the lateral incisors & canines. ♦ Mandibular arch: primate space located between canines and 1 st molars

INTELLECTUAL DISABILITY (MENTALLY CHALLENGED): Dental Management:

speak simply and reassuringly, "tell-show-do", positive reinforcement. Relative contraindication for use of nitrous-oxide/oxygen sedation. Keep appointments short, and schedule the patient early in the day, since staff, dentist, and patient are less fatigued earlier. Speak slowly and in very simple terms and listen carefully to the patient. Ask the patient if there are any questions about anything you will be doing.

As a general rule, a maxillary central diastema of 2mm or less will usually close

spontaneously, while total closure of a diastema initially greater than 2mm is unlikely. If the space is 2mm or less, and maxillary laterals are in a good position, it is most likely the result of a normal developmental process.

Saturated steam (autoclave) is the most practical, economical, most currently effective

sporicide, and the most efficient method for destroying viral and fungal microorganisms.

• ZOE Disadvantages:

staining, slow setting time, nonadhesion, and solubility.

Cystic fibrosis is a combination of

steatorrhea, chronic respiratory infections, and functional disturbances in secretory mechanisms of various glands.

Ethylene oxide gas has been widely used as a

sterilization agent, especially for pre-packaged, disposable plastic ware in hospitals. Exposure of materials to ethylene gas must be performed in special sealed chambers, and items must be cleaned and dried thoroughly before the sterilization process.

The recommendation stating that all reusable items that come into contact with a patient's blood, saliva, or mucous membranes must be

sterilized using heat is now routinely accepted and used in dental facilities.

Myofascial Pain Dysfunction (MPD) Syndrome- is believed to be a

stress-related disorder. An increase in stress produces an increase in mandibular muscle tension and in combination with teeth clenching causes muscle spasm, pain, and dysfunction.

Laryngospasm-

sudden acute spasm of the vocal cords and epiglottis that can result in airway occlusion and death. A patient under general anesthesia loses the laryngeal reflex. If blood and saliva collect near the vocal cords, this stimulates the patient to go into spasm (laryngospasm) and the vocal cords close. When this happens, air cannot pass through. The two most important steps in initial management of a laryngospasm are applying oxygen under positive pressure and administering succinylcholine (a skeletal muscle relaxant used when performing endotracheal intubation and endoscopies).

Sometimes on a radiograph, an external resorptive lesion can

superimpose the canal space to mimic internal resorption. In such cases, another radiograph is taken at a different angle since the radiolucent lesion inside the canal space will not shift.

When treating multi-canaled bicuspids & molars, it is often difficult to determine radiographically which canal is more toward the buccal. When a straight-on exposure is taken of a bicanaled tooth, the canals become

superimposed on the film, and visualization of each canal is impossible. If the x-ray cone is moved to give an angled exposure, the roots will be separate on the film.

Sublingual Space-

superior part of the submandibular space that contains the sublingual gland & loose C.T. surrounding the tongue.

People on small doses (5mg of Prednisone/day) will have

suppression if they have been on the regimen for a month.

Treatment: Mesiodens

surgically removing the supernumerary teeth and observing the progress of the permanent teeth.

VERTICAL ROOT FRACTURE-

symptoms and clinical tests show pulpal pathosis in a posterior tooth, but no decay or restoration in any proximity to the pulp on the radiograph is pathognomonic of a vertical tooth fracture. Vertical root fractures are cracks that BEGIN IN THE ROOT and extend TOWARD the chewing surface and often present minimal signs and symptoms, thus may go unnoticed for a period of time. Often discovered when surrounding bone and gingiva become infected.

Anionic Surface-Acting Substances/Detergentsare

synthetic anionic detergents and soaps that alter the nature of interfaces to lower surface tension and increase cleaning. Their primary value is their ability to remove microorganisms mechanically from the skin surface. *Non-ionic chemicals DO NOT have anti-microbial properties.

1. Intramembranous ossification-

takes place IN membranes of C.T. Osteoprogenitor cells in the membrane differentiate into osteoblasts, and a collagen matrix is formed which undergoes ossification. The maxilla & mandible are formed this way.

11. The most common primary lesion of carcinoma metastasizing to the MANDIBLE in females is

the BREAST.

MOST RELIABLE INDICATOR of readiness of eruption of a succedaneous (permanent) tooth (and the need for a space maintainer) is

the EXTENT OF ROOT DEVELOPMENT determined by radiographic evaluation. A space maintainer is NOT required if eruption of the succedaneous (permanent) tooth is imminent.

RECURRENT APHTHOUS ULCERS (Canker Sores)-

the cause is UNKNOWN, but they can be triggered by stress, dietary deficiencies (iron, folic acid, vitamin B ), menstrual periods, hormonal changes, food allergies, etc.

HEREDITY is most frequently responsible for

the congenital absence of teeth. The roots of the primary tooth will resorb slower than normal without the presence of the permanent tooth. As a general rule, if only 1 tooth or a few teeth are missing, the absent tooth is the MOST DISTAL TOOTH of any given type (i.e. if a molar is congenitally missing, it is almost always the 3 molar; if an incisor is missing, it is nearly always the lateral, if a premolar is missing, it is almost always the 2 rd premolar). Rarely is a canine the only missing tooth. nd

Caries activity is directly proportional to

the consistency, frequency, & oral retention of fermentable carbohydrates ingested.

Vertical fractures through root structures have an almost HOPELESS prognosis, unless

the fractured segment can be removed, and gingivoplasty & alveoplasty are performed. However, unrealistic or overambitious case selection leads to failure.

Fusion or gemination of teeth occurs during

the initiation and proliferation stages of tooth development.

A major disadvantage of endodontic implants is

the lack of an apical seal.

Acute Lymphocytic/Lymphoblastic Leukemia (ALL)-

the most common PEDIATRIC CANCER (peaks around age 4) that is a life-threatening disease where cells that normally develop into lymphocytes (lymphoblasts) become cancerous and rapidly replace normal cells in bone marrow. ALL is the form of acute leukemia most responsive to therapy.

TMJ Syndrome is Divided into 3 Categories: 1. Myofascial Pain Dysfunction (MPD) Syndrome-

the most common cause of TMJ pain. It is a disease primarily involving the muscles of mastication.

A space maintainer can be removed as soon as

the permanent tooth begins to erupt through the gingiva.

Pulpectomy is the treatment of choice when

the primary mandibular 2 molar in a 4-year old has a large carious lesion with pulpal involvement. Radiographically there is periapical pathology on the distal root. There is also furcation involvement and slight mobility. Pulpectomy is the treatment of choice when there is periapical pathology. If there were no periapical pathology, a formocresol pulpotomy is indicated. If the child were older and there was a periapical radiolucency but successful nd pulpectomy could not be accomplished, the treatment of choice is extraction and placement of a space maintainer to prevent damage to surrounding bone and the developing permanent tooth.

Unsaturated Chemical Vapor Sterilization (UCVS)-

the proper time and temperature is 270°F (132°C) for 20-40 minutes. These conditions yield 20lbs of sterilizing vapor pressure. The main operation of CVS is similar to steam sterilizers, but rather than using distilled water, UCVS uses a solution of alcohol, formaldehyde, ketone, acetone, and water to produce the sterilizing vapor. • The temperature and pressure required for chemical vapor sterilizers is greater than for autoclave. • MAIN advantage of this system is it does not rust or corrode metal instruments and carbon steel. • Disadvantages: instruments must be dried completely before processing, a special chemical solution must be used, and it destroys heat-sensitive plastics.

3. DMFS Index (Decayed, Missing, Filled Surfaces)-

the same as DMFT, but records involved tooth surfaces.

All esters have an "ester" grouping them within their chemical structure. An ester grouping is a bridge or link containing

the -COOCH - configuration. Drugs with 1 letter "i" in the name.

20. NITROUS OXIDE is contraindicated in

the 1 Trimester of Pregnancy, COPD, cystic fibrosis, sickle-cell anemia, upper respiratory infections, and patients with EMOTIONAL or BEHAVIORAL INSTABILITY.

• Cleft palate deformity occurs/develops during

the 1 trimester of pregnancy (6-9wks). st

► Most common congenitally missing permanent tooth is

the 3 rd molar, then the mandibular 2 premolar, then the maxillary lateral incisor. nd

Dentinogenesis imperfecta & Amelogenesis imperfecta occur during

the Bell Stage.

An individual must inherit a defective copy of

the CF gene (one from each parent) to get the disease. In CF cells, salt does not move properly because the protein product of the CF gene is defective and makes a faulty channel for the chloride to exit.

2. Patient with DOWN SYNDROME (TRISOMY 21) would most likely present with

the CLASS III malocclusion (protruded mandible).

LEEWAY SPACE-

the DIFFERENCE in the total of the M- D widths between the primary canine, first molar, and second molar, AND permanent canine, first premolar, and second premolar. The permanent successors are usually SMALLER than their primary predecessors.

Adjuncts to Endodontic Treatment: Thermal Sensitivity-

the EARLIEST and MOST COMMON symptom of pulpal edema/inflamed pulp (acute pulpitis) is thermal sensitivity to hot and/or cold stimuli. Usually involves increased and persistent pain to cold.

Access Preparation Mistakes: Mandibular incisors & maxillary 1 premolars are

the EASIEST teeth to perforate during access preparation due the limited access mesiodistally. Thus, care must be taken when initiating treatment on these teeth.

Acellular Cementum-

the FIRST cementum to be formed, does not contain any cells in its matrix, and usually covers the root's CORONAL TWO-THIRDS (cervical third or half of the root). It is thinnest at the CEJ and plays a major role in TOOTH ANCHORAGE.

Maxillary 1 Molar: MB canal:

the MB canal orifice is usually the MOST DIFFICULT to locate because it is under the MB cusp and must be accessed from a distolingual position. It is the small canal that often splits into two canals, and may be calcified and difficult to instrument.

ANGLE MALOCCLUSION CLASSIFICATION (Permanent Molar Relationships)-

the MESIOBUCCAL CUSP of the maxillary first molar serves as the REFERENCE POINT in identifying Angle's Class I, II, & III occlusions.

Hawley Retainer-

the MOST COMMON REMOVABLE RETAINER used is orthodontics. It incorporates clasps on molar teeth and a characteristic outer bow with adjustment loops that span from canine-to-canine.

SUPEROXOL-

the MOST COMMON bleaching agent for endodontically treated teeth that is a 30% aqueous solution by weight of H 2 O in distilled water. It is a potent oxidizing agent whose bleaching effect is due to direct 2 oxidation of stain-producing substances. Tooth bleaching causes color change in enamel and dentin.

FIXED EDGEWISE APPLIANCE -

the MOST WIDELY USED APPLIANCE TODAY by orthodontists. In its essential form, the mechanism consists of bands on all teeth, tubes on the last molar, and brackets on all other teeth. One labial arch is used at a time. The ultimate labial arch wire is .0125 x .028 in diameter, and the narrow dimension (edge) fits precisely into the bracket slot (which is .022inch wide from top to bottom). It finds its greatest application in treating comprehensive malocclusions of the adolescent permanent dentition.

ROOT RESORPTION-

the MOST frequent sequela to avulsed tooth replantation.

MODE-

the MOST frequently occurring score within the data matrix. Affects the skew of the graph. To calculate: using an ungrouped tally system, identify the score that occurs most often.

Weak points in the mandible where fractures are most common are

the angle of the mandible, condylar neck, and symphysis area. The location and extent of mandibular fractures are determined by the direction and intensity of the blow and specific points of weakness in the mandible.

Allogenic grafts are treated to reduce

the anti- genicity. However, these treatments destroy any remaining osteogenic cells it the graft. These grafts offer a hard tissue matrix only (this graft is eventually replaced by the host's bone).

Determined- Purposeful- Unit of Activity-

the assumption that behavior is lawful and has determinants. the assumption that behavior is goaloriented, that is seeks to achieve positive and reduce negative need or motivational states. what a person does that can be reported or described as discrete elements. Ex: teeth do not behave, individuals behave. Observing that a pulpal or periodontal problem exists is a common behavior for the dentist. Avoiding the dentist, even though an objective need exists and the patient requires treatment, is a common behavior for patients. Both meet the criterion of being determined, purposeful units of human activity.

The best time to determine a patient's plaque index (to assess the effectiveness of patient homecare) is at

the beginning of the appointment. Rather than just asking about the patient's homecare skills, have the patient demonstrate their brushing/flossing skills.

Stress, Anxiety, & Fear are simultaneously negative or aversive emotional states, full of symptoms that can motivate through a process of threat appraisal. The interaction of the intensity of an emotional response with threat appraisal determines the content of

the behavior that will follow (whether or not to show up at the dentist's office, to submit to an injection, to accept the need for an extraction or filling, etc.)

TMJ Surgical Approaches: 1. Preauricular-

the best incision to expose the TMJ. A perpendicular incision is made just anterior to the external ear parallel to the superficial temporal artery. The incision extends from 1 inch above the zygomatic arch to the lower extremity of the ear. The condyle is approached from behind. With this approach, care must be taken not to damage the facial nerve or the vessels that richly supply this area.

Medical records MUST be maintained for

the duration of the employment plus 30 years, and must be kept strictly confidential. However, each employee is entitled to review their medical record. Also, the OSHA-required records must be transferred to the new owner. If you go out of business and there is no new owner, you must notify the Director of the National Institute for Occupational Safety and Health (NIOSH) at least 3 months before you intend to dispose of the records and offer to transmit the records to NIOSH.

During a routine prophylaxis, it is possible that the use of abrasive polishing agents may remove

the fluoride-rich layer of enamel. The greatest concentration of fluoride ions exist on the OUTERMOST ENAMEL LAYER (not just beneath the enamel surface). Since this fluoride-rich layer may be inadvertently removed while polishing, all patients would benefit from a topical fluoride application after a routine prophylaxis.

A massive invasion of pulpal contaminants will result in

the formation of an acute abscess (Phoenix abscess).

Impacted maxillary 3 molars are occasionally displaced into

the maxillary sinus (antrum), from which they are removed via a Caldwell-Luc approach. If a large root fragment or the entire tooth is displaced into the maxillary sinus (antrum), it should be removed using a Caldwell-Luc approach (a surgical procedure where an opening is made into the maxillary sinus via an incision into the canine fossa above the level of the premolar roots. The tooth or root is then removed. *An oral surgeon to whom the patient should be referred should perform this procedure.

Behavior Management-

the means by which the dental health team effectively & efficiently performs treatment for the patient while simultaneously instilling a positive attitude. Most researchers believe changes in behavior are a prerequisite to changes in attitude.

Quality Assurance-

the measurement of the quality of care and implementation of any necessary changes to maintain or improve the quality of care rendered. Quality assurance includes the additional dimension of action to take the necessary corrective steps to improve the situation in the future.

Restorative Options for Endodontically Treated Posterior Teeth: ONLAYS:

the minimum and most conservative preparation and restoration to cover cusps and marginal ridges, especially posterior teeth with prior root canal therapy (RCT). Goal is to prevent cracked tooth syndrome.

Osteoradionecrosis (ORN)-

the most SERIOUS potential complication after extractions from areas previously irradiated. ORN is a condition of non-vital bone in a site of radiation injury, that can be spontaneous, but most often results from tissue injury. The absence of reserve reparative capacity is a result of the prior radiation injury.

Hydrodynamic Theory-

the most accepted theory to explain unusual sensitivity and response of exposed root surfaces to various stimuli which postulates the pain results from indirect innervation caused by dentinal fluid movement in the tubules which stimulates mechanoreceptors near the predentin.

Once tugback and apical positioning are obtained, a radiograph is taken to verify cone positioning. If an accurate determination and careful enlargement are performed, the x-ray will show the master cone reaching

the most apical position of the preparation or extending just 1mm short of the apical foramen. When the cone is slightly short, the pressure of condensation & the sealer's lubrication action are sufficient to produce complete seating of the cone. If the cone is > 1mm from the radiographic apex, remove the cone and fit a smaller one, or instrument more in the apical third.

Primary Maxillary Lateral Incisor-

the most common congenitally missing primary tooth (although this is rare). This tooth is most often atypical in size (i.e. peg-shaped).

Anatomic Distribution of Mandibular Fractures: Angle-

the most common anatomic site of fracture of the mandible (30% of fractures). Frequently, impacted 3 molars are located in this region and further add to the weakness of the mandible in this area.

HEMANGIOMA-

the most common benign tumor of INFANTS. Hemangiomas are vascular birthmarks where the proliferation of blood vessels leads to a mass that resembles a neoplasm. Hemangiomas differ from other vascular birthmarks because they are biologically active (their growth is independent from the child's growth). Most hemangiomas appear within a week or two after birth, and are 5x more common in girls.

THROMBOCYTOPENIA-

the most common cause of hemorrhagic disorders (bleeding disorders). It is a blood disease characterized by abnormally low number of platelets in the bloodstream. Normal platelet count is between 150K-450K cells per microliter of blood. When platelet numbers falls below 150K cells per microliter of blood, the person is "thrombocytopenic".

Irritation Dermatitis-

the most common form of an adverse epithelial (skin) reaction noted for healthcare professionals. Many published reports have cited data suggesting 20-30% of healthcare workers suffer occasional or chronic dermatitis on their hands.

ACHONDROPLASIA-

the most common form of short-limb dwarfism that occurs in all races, equally affected males and females. Many of these children die before age 1. Deficient growth in the cranial base is evident in many children who survive.

Grand Mal Epilepsy-

the most common seizure disorder (present in 90% of epileptics). ~60% of epileptics have this form alone, while 30% have other seizure types in addition to grand mal. Grand mal epilepsy can occur in any age. This tonic-clonic type seizure is produced by neurological disorders, or develops in a neurologically sound brain secondary to a systemic metabolic or toxic disturbance. Grand mal seizures usually last 2-5 minutes.

Bilateral Sagittal Split Osteotomy-

the most commonly performed mandibular orthognathic procedure to correct mandibular retrognathia (Class II malocclusion). When performed correctly, this technique allows for versatile, accurate, expeditious corrections of mandibular disharmonies. The mandible is split sagitally and can be used to either advance the mandible (i.e. retrognathia) or to set back the mandible (i.e. prognathia). It is the standard procedure used today. *Position of the condyle is unchanged when correcting mandibular prognathism or retrognathism.

Iodine-

the most effective skin antiseptic used in medical practice that acts as an oxidizing agent, and irreversibly combines with proteins.

ANTI-ANXIETY DRUGS INHALATION NITROUS OXIDE-

the most frequently utilized route of administration for sedation in pediatric patients.

Pulpotomy is

the removal of the pulp chamber contents only.

MANDIBUAR AND MAXILLARY ROOT ANATOMY Mandibular Canine:

the root canal is THIN mesiodistally, but WIDE labiolingually. They usually have 1 root, but in rare cases may have 2 separate roots. The access opening is a large OVAL with the greatest width placed incisogingivally. This tooth usually has a slightly labial axial inclination of the crown. Thus, the access opening must be directed towards the lingual surface. Pulpitis can cause referred pain to the MENTAL REGION OF THE MANDIBLE.

TELL-SHOW-DO-

the most important technique of behavioral management in the pediatric dental patient used to manage an extremely apprehensive 5-year old child. Tell-show-do is the backbone of the educational phase of developing an accepting, relaxed child patient. ► In this technique, you tell the child what is going to happen, you show the child what is going to happen, then perform the actual procedure in the mouth. Tell-show-do works especially well when treating a child with a different cultural background. ► The clinical examination of the infant and toddler should be accomplished with the parent's assistance in a non-threatening environment. Most often, it is not necessary nor recommended that the dental chair be used. The parent and dentist sit facing each other in a knee-to-knee position, supporting the child with the head cradled on the dentist's lap. ► Aggressive behavior in the dental office is usually a fear reaction. The most realistic approach to managing a difficult child in the dental office is to attempt to recondition the child through techniques of applied psychology.

Over-retained primary teeth in the mixed dentition may prevent

the normal eruption of permanent teeth, may be caused by the abnormal root resorption of the primary teeth, and are often treated by extraction.

A corrected anterior crossbite is BEST RETAINED by

the normal incisor relationship that is achieved from the treatment (the overbite), not from appliances.

Prevalence-

the number of OLD cases of disease present in a population at risk at a specific period of time. It is the proportion of persons in a population suffering from a particular disease at a given point in time. A proportion expressed as a percentage of the population.

1. Tissue-Borne Functional Appliance: Frankel's Functional Appliance-

the only TISSUE-BORNE FUNCTIONAL APPLIANCE whose function is to expand the arch by "padding" against the pressure of the lips & cheeks on the teeth and postures the mandible forward and downward.

ARTICAINE (SEPTOCAINE)-

the only amide local anesthetic metabolized in the BLOODSTREAM (not in the liver). Chemically unique because its ester group is attached to a molecule that can be acted upon by plasma cholinesterase to make it ineffective.

Free nerve endings-

the only nerve ending found in pulp. Free nerve ending is a specific pain receptor. Regardless of the source of stimulation (heat, cold, pressure), the ONLY response will be PAIN.

Phenol-

the original disinfectant used in hospitals, but is rarely used today because it is too caustic.

The difference between conscious sedation vs. general anesthesia with respect to patient response is

the patient retains all reflexes under conscious sedation, but not under general anesthesia.

When an instrument breaks off anywhere in the canal and a periapical radiolucency is present and minimal canal enlargement has been performed before the accident, surgery is indicated since

the periapical tissues have had little opportunity for healing to be stimulated. You would prepare and obdurate to the point of blockage, and then perform an apicoectomy Sand retrofilling.

CEMENTIOD-

the peripheral layer of developing, uncalcified cementum.

Pneumothorax-

the presence of air in the pleural cavity. It can occur as a post-operative complication of aspiration of liquid vomitus into the trachea and bronchi. Onset of pneumothorax is accompanied by a sudden, sharp chest pain, followed by difficult, rapid breathing, cessation of normal chest movements on the affected side, tachycardia, weak pulse, hypotension, diaphoresis, and elevated temperature, pallor, dizziness, and anxiety.

In the case of a congenitally missing 2 nd premolar, you want to maintain

the primary 2 molar as long as possible. If it is still present, it may be ankylosed. Cessation of eruption is most diagnostic of an ankylosed primary molar. nd

An equivalent of Angle's Class III is almost NEVER SEEN in

the primary dentition because of the normal pattern of craniofacial growth where the mandible lags behind the maxilla.

Mesial Step-

the primary dentition's equivalent to an Angle Class I malocclusion.

Distal Step-

the primary dentition's equivalent to an Angle Class II malocclusion (retruded mandible).

In infancy, the ramus is located at about the spot where

the primary first molar will erupt. Progressive posterior remodeling creates space for the second primary molar and then for the sequential eruption of the permanent molar teeth. More often than not, however, this growth stops before enough space has been created for eruption of the 3 permanent molar, which becomes impacted in the ramus. After age 6, the greatest increase the mandible size occurs distal to the first molars.

Space Maintainers that REPLACE MULTIPLE PREMATURELY MISSING PRIMARY TEETH: 1. Lingual arch space maintainer-

the primary second molars or permanent first molars are banded. Typically, the "lingual arch" space maintainer is comprised of two bands that are cemented to the primary second molars or permanent first molars with a loop of wire that rests on the cingula of the incisors. Used to maintain space when multiple primary teeth are missing and the permanent incisors have erupted. It does NOT restore function, and should be made completely passive.

Inter-proximal caries on primary teeth may result in eventual loss of

the primary tooth, loss of tooth structure, and arch length loss. Decay in primary teeth must be treated the same as in permanent teeth. To just "watch" this decay can cause loss of tooth structure, and eventual loss of the primary tooth with resultant loss in arch length.

Recapping Sharps:

the rule generally prohibits bending, recapping, breaking, shearing, or removing sharps. However, recapping with a one-handed method or using a mechanical device is permitted if the employer can demonstrate that not alternative is feasible, or that such action is required by a specific medical procedure. The rule's introduction lists the administration of an anesthetic as a medical procedure that may require recapping (i.e. reinjection of the same patient to enhance the local anesthetic).

The object toward the lingual side (closer to the film) appears to shift on the film to

the same direction as the repositioned x-ray cone. If the xray cone is angulated mesially, the lingual/palatal root shifts toward the same (mesial) side in the resultant radiograph, and is easily visualized.

PERIAPICAL CURETTAGE:-

the same procedure as an Apicoectomy that flaps back the buccal tissue and buccal bone removal, but DOES NOT remove the root apex. Removal and examination of the diseased tissue and determining the extent of the lesion are the objectives of apical curettage.

PUBLIC HEALTH, RESEARCH METHODS, AND ORAL HEALTH INDICES PUBLIC HEALTH-

the science & art of preventing disease, prolonging life, and promoting physical health & efficiency through organized community efforts.

A tooth can stay asymptomatic for several weeks after pulp capping is performed, but this may only be temporary. If pulp capping fails and the tooth becomes symptomatic, it may be nearly impossible to treat with routine endodontics due to

the severe calcifications in the root canal. Perforations may occur when attempting to follow the obliterated canal to gain apical patency (perforations into furcations of multi-rooted teeth have the poorest prognosis).

FRACTURE IMMOBILIZATION: 1. Barton Bandage-

the simplest form of immobilization. Primarily a first aid measure until definitive therapy can be instituted.

MOYER'S Mixed Dentition Analysis-

the size of unerupted canines & premolars is predicted from knowing the size (M-D width) of the mandibular incisors that have already erupted into the mouth early in the mixed dentition. Maxillary incisors are not used in any of the predictive procedures, since they show too much size variation. Mandibular incisors are measured to predict the size of maxillary and mandibular posterior teeth.

Deposition of fluoride occurs on

the smooth surfaces of teeth.

VALIDITY-

the test or study measures what it is supposed to measure. Degree that a study or procedure can be conclusive yet sufficient realistic; Does the test measure what it claims to be measuring. Ex: increase in CAL loss has been shown to be the BEST predictor of advancing periodontal disease. It is a valid way to test periodontal bacteria.

6 Types of Tooth Movement Accomplished with Orthodontics: 1. Tipping-

the tooth crown moves in one direction, while the root tip/apex is displaced in the opposite direction due to rotation or pivoting of the tooth around the axis of resistance (axis of rotation) which is located somewhere in the apical 1/3 of the root. Tipping is best accomplished with a removable appliance and most easily with anterior incisors.

Prognosis of a tooth with a broken instrument is best if

the tooth had a vital pulp and no periapical lesion.

Permanent Mandibular 2 Premolars-

the tooth most likely malposed in cases of mandibular arch space discrepancy. nd

The extraction forcep beak is designed so most of the pressure exerted during extraction is transmitted to

the tooth root.

A lobe is one of the primary sections of formation in the development of

the tooth's crown (it represents a cusp on posterior teeth, and mamelons & cingula on anterior teeth).

2. Proliferation (Cap Stage)-

the tooth's shape is evident and the enamel organ is formed. Fused or geminated teeth occur during this stage. Fusion or gemination of teeth occurs during initiation & proliferation stages of tooth development.

Dicalcium Phosphate-

the toothpaste/dentrifice component most likely to inactivate fluoride ion.

FRACTURE IMMOBILIZATION: 4. Direct Intraosseous Wiring combined with a period of IMF-

the traditional method of bone stabilization after open reduction. This method of stabilization can be accomplished through various wiring techniques. The wire is placed through holes on either side of the fracture and immobilization is accomplished by tightening the wires.

RCT ADJUNCTS, INDICATIONS, & CONTRAINDICATIONS Adjuncts to Endodontic Treatment: Transplantation-

the transfer of a tooth from one alveolar socket to another in the same person or into another person. Transplanted teeth with partial root development have a better prognosis than fully developed roots. Intentional replantation is NOT a substitute for endodontic surgery if it can be done.

Primary Maxillary 1 Molar-

this is the most atypical tooth of all the molars (primary and permanent). It is intermediate in form and development between a premolar and molar. st ► It is the smallest molar in all dimensions EXCEPT the labiolingual diameter. ► The crown of this tooth is bicuspid (two cusped). It has a wide MB (the longest cusp) and narrow ML cusp (second longest and sharpest). The indistinct cusps are the DB & DL. ► Its cervical line is higher mesially than distally. ► The cervical ridge stands out very distinctly on the MB portion of the tooth. ► H-shaped occlusal pit-groove pattern. ► Primary maxillary 1 molar has THREE ROOTS and its root form closely resemble the permanent maxillary 1 st molar. st

Primary Mandibular 1 st Molar-

this tooth does not resemble any other primary or permanent tooth. • It has an oval occlusal surface that is wider M-D than B-L. • From an occlusal view, the MB angle is acute and prominent due to the mesial cervical ridge on the buccal surface. The DB angle is obtuse. • Occlusal table is rhomboid-shaped, and is the chewing surface inside the cusp ridges and marginal tables. • Has a prominent transverse ridge that unites the MB + ML cusps, and separates the mesial portion from the rest of the occlusal surface. • MB cusp is always the largest and longest cusp, occupying nearly 2/3 of the buccal surface. • ML cusp is larger, longer, and sharper than the DL cusp. • Crown is wider M-D than cervico-occlusally. • Mesial marginal ridge is very well developed and resembles a cusp. It has a prominent MB cervical ridge. • Class II cavity preparations are difficult due to its morphology, and it has NO central fossa. • Mandibular 1 Molar- first permanent tooth to erupt and first to begin calcifying. • Maxillary 1 st st Molar- second permanent tooth to erupt. • Maxillary and mandibular 1 molars are NOT succedaneous teeth. • Primary 1 st st molars are the teeth with the most noticeable morphologic deviations from permanent teeth.

Shock Symptoms:

tiredness, sleepiness, confusion. Skin is cold, sweaty, bluish, and pale. Pulse is weak & rapid, and BP drops. Reduces cardiac output (CO) is the MAIN factor in all types of shock.

A primary advantage of IV sedation is the ability to

titrate individualized dosages.

Diagnosis: Mesiodens

to localize a supernumerary or impacted tooth and its relationship to other teeth, take two or more periapical radiographs at different angles, and an occlusal view film.

During extraction of a maxillary 3 molar, if you realize the tuberosity has also been extracted, the proper treatment is

to smooth sharp edges of the remaining bone and suture the remaining soft tissue. A fracture of the maxillary tuberosity most commonly results from extraction of an erupted maxillary 3 rd rd molar (or 2 molar if it is the last tooth in the arch). If the tuberosity is fractured but intact, it should be manually repositioned and stabilized with sutures.

Mandibular left 2 molar of a 14-year old boy is unerupted. Radiographs show a small dentigerous cyst surrounding the crown. The treatment of choice is

to uncover the crown and keep it exposed.

The primary airway hazard for an unconscious dental patient in a supine position is

tongue obstruction (so head tilt and lift the chin)

A tooth with a vertical root fracture has a POOR prognosis. Studies show most vertical root fractures are caused by using

too much condensation force during obturation with guttapercha.

Class II lever classification is used during

tooth extractions. Teeth are extracted by luxation forces perpendicular to the long axis of the tooth (not by pulling along the long axis). The fulcrum is as close to the tooth apex as possible. *Rotational forces can be used on single rooted teeth.

Systemic distribution of fluoride may affect

tooth morphology. Systemic distribution of fluoride is accomplished by fluoride in the water, fluoride tablets, and vitamins that contain fluoride.

Water fluoridation and diet supplementation may affect

tooth morphology, while self and professionally applied topical treatments will not.

Pathologic tooth movement-

tooth movement caused by pathologic conditions.

4. Intrusion-

tooth movement into the socket along the tooth's long axis. Intrusion is very difficult to accomplish.

Post-Operative Hypotension may be due to the effect of

transfusion reactions, fat embolism, anesthetic or analgesics on the myocardium (the most common cause), liver failure, or anaphylaxis. Treatment: Narcan (narcotic antagonist) if hypotension is due to narcotics. Use Atropine (anti-cholinergic) if bradycardia is present.

Hepatitis C Virus (HCV)-

transmitted primarily in infected blood via accidental needlesticks, blood transfusions, or drug addicts sharing contaminated syringes. Historically, parenteral drug abusers, people receiving transfusions, organ recipients, and hemophiliacs receiving Factor VII or IX are at high risk for HCV infection. More recently, people receiving tattoos or undergoing body piercings have been infected via contaminated, unsterilized needles.

Internal resorption is often precipitated by

traumatic injury to the tooth. Undifferentiated reserve C.T. pulp cells are activated to form dentinoclasts that resorb the tooth structure in contact with the pulp.

1. Calcium Hydroxide Pulpotomy Technique-

treats permanent teeth when there is a pathological change in the pulp at the carious exposure site. CHT is especially indicated for permanent teeth with immature root development and with healthy pulp tissue in the root canals. The success of a pulpotomy in this case would be indicated when the root apex (if incompletely formed) completes its full development in time (apexogenesis). This technique is completed in one appointment. Only those teeth free of symptoms of painful pulpitis (severe toothache, lingering pain) are considered. A dentin bridge will form at a level below the level of amputation of the coronal pulp. Histologically, you would see a necrotic layer immediately under the calcium hydroxide.

2. Formocresol Pulpotomy Technique-

treats primary teeth with a carious exposure. Teeth selection is the same as for the CaOH technique, and is performed in one appointment. After the coronal pulp is removed (amputated), a cotton pellet moistened with formocresol is placed in contact with the pulp stumps and remains for 5 minutes. The pellet is then removed and the pulp chamber dried. A thick paste of ZOE is placed over the chamber and the tooth is restored. The success of formocresol pulpotomy for a primary tooth depends primarily on a vital root tip. Formocresol (formalin and cresol) causes surface fixation of the pulpal tissue and odontoblast degeneration.

8. Sulcus Bleeding Index (SBI)-

used to determine the bleeding and gingival health.

HEADGEAR-

used to maintain EXTRA-ORAL ANCHORAGE& TRACTION. The ~required force for anchorage is 250g for 10hrs/day. The required force for traction is 500g for 14-16hrs/day. One of the greatest advantages of using extraoral anchorage (headgear) is it PERMITS POSTERIOR MOVEMENT OF TEETH IN ONE ARCH without adversely disturbing the opposing arch.

Space Maintainers that REPLACE ONE PREMATURELY MISSING PRIMARY TOOTH: 2. Distal Shoe Space Maintainer-

used when a primary second molar is lost BEFORE the permanent first molar erupts (typically children under age 5 or 6).

Because suture material is foreign to the body, the smallest diameter suture sufficient to keep the wound closed properly should be

used. Most OMS procedures require 3-0 or 4-0 sutures. 9-0 suture size has the least strength and smallest diameter.

3. Urea Peroxide (Gly-Oxide)-

useful irrigant available in an anhydrous glycerol base (Gly-Oxide) to prevent decomposition. Better tolerated by periapical tissue than NaOCl, yet has greater solvent action and is more germicidal than H 2 0 thus is an EXCELLENT IRRIGANT for treating canals with normal periapical 2, tissue and wide apices.

INFERENTIAL STATISTICS-

uses a random data sample from a population to describe and make general inferences based on what the population might think. Valuable when it is impractical or possible to examine each member of an entire population. Ex: 50 out of 100 people randomly sampled in a Virginia suburb said they floss. Thus, it is inferred that 50% of all people in that Virginia suburb floss their teeth. Uses three main tests to determine statistical significance:

Begg Appliance-

uses round wires that fit loosely into the bracket's vertical slot.

Methods to Close a Diastema:

using a lingual arch with finger springs, a Hawley appliance with finger springs, or using cemented orthodontic bands with inter-tooth traction.

Teeth conditions that usually DO NOT require endodontic treatment if managed properly because pulp remains vital: 1. Cementoma (periapical cemental dysplasia)-

usually occurs in the anterior region of the mandible, starting as a radiolucent lesion that eventually calcifies. Cementoma DOES NOT affect pulp vitality.

Cavernous Sinus Thrombosis (CST)-

usually caused by a late complication of an infection (Staphylococcus Aureus) of the central face or paranasal sinuses. CST is an unusual occurrence that is rarely the result of an infected tooth. It is usually a fulminant process with high rates of morbidity and mortality.

Functional Crossbite-

usually caused by thumb sucking does not demonstrate a smooth closure into CO.

Electric Pulp Tester (EPT = Vitalometer)-

usually elicits a response at a HIGHER current than normal if the tooth being tested has CHRONIC PULPITIS. EPT checks tooth sensibility/vitality by stimulating nerve endings with a low current and high potential difference in voltage. While EPT manufacturers give normal reference values of current the BEST way to check "normal/baseline" values is to use it on adjacent (non-pathological) teeth, then compare the normal values with the values obtained on the tooth in question.

MANDIBUAR AND MAXILLARY ROOT ANATOMY Mandibular Molars:

usually have a TRAPEZOIDAL outline of the pulp chamber formed by two canals in the mesial root, and one oval canal in the distal root. ~40% of cases, the distal root may have a 2 canal (4 canal overall). The pulp chamber is located in the mesial 2/3 of the crown. Look for a 4 th canal if the first canal found in the distal root lies more toward the buccal, rather than in the center.

INDICATIONS for ROOT CANAL THERAPY (RCT): 2. Radicular Cyst-

usually occurs in a pre-existing granuloma, is rarely painful, and appears as an apex radiolucency of a non-vital tooth. Endodontic treatment is necessary.

When extracting primary incisors where the roots have been partially resorbed due to pressure from the developing permanent teeth, the facial part of the remaining primary root is

usually the longest and most securely attached to the gingiva.

Anti-Retraction Valves-

valves used on handpiece and air-water syringe hoses to prevent the retraction of fluid back into the tubing (they prevent patient fluids from getting into the water lines) and reduce the risk of crosscontamination other patients.

The properties of stainless steel wires used for archwires can be controlled over a wide range by

varying the amount of cold working annealing during manufacturing. Steel is softened by annealing and is hardened by cold working (work hardening).

The most common cause of transient loss of consciousness in the dental office is

vasovagal syncope due to a series of cardiovascular events triggered by emotional stress brought on by the anticipation of or delivery of dental care. Any signs of an impending syncopal episode should be quickly treated by placing the patient in a FULLY SUPINE POSITION, or a position where the legs are elevated above the level of the heart (TRENDELENBURG POSITION), and by placing a cool, moist towel on the forehead. The most common early sign of syncope is PALLOR (paleness).

BEHAVIOR MANAGEMENT A dentist has offered plaque-control instructions to a patient. To ensure the patient understands the instructions, the dentist should ask the patient to

verbalize her understanding.

Pulp capping is overused in dentistry today, with

very few indications for its use. Young pulps are more vascularized, thus more amenable to repair. Accidental exposure of the pulp and the pulp of a young child are two situations where pulp capping offers better success. Carious exposure of the pulp or the pulp of a middle-aged person are not indications for pulp capping.

The response of vital pulp to microbial invasion is

very resistant based on observation that even after 2 weeks of traumatic pulp exposure, only 2mm of coronal pulp may "give in" to microorganisms. However, non-vital pulp is a "fertile ground" for microbial growth.

Cystic fibrosis has various symptoms. The most common are

very salty tasting skin, persistent coughing, wheezing, or pneumonia, excessive appetite, but poor weight gain, and bulky stools.

After the permanent teeth have reached full occlusion, small tooth movements occur to compensate for

wear at the contact areas (by mesial drift) and occlusal surfaces (by deposition of cementum at the root apex).

It is easier to retrieve an instrument if it is

wedged coronal or at the curvature of the canal, but very difficult if the instrument has passed the canal curvature.

When working with or handling mercury, work in a

well-ventilated space, avoid direct skin contact with the metal, and store scrap amalgam in tightly sealed containers covered with sulfide solution (an effective agent to suppress or eliminate the emission of mercury vapor from the scrap).

Physiologic occlusion-

while it is not necessarily an ideal Class I occlusion, it is an occlusion that adapts to the stress of function, and can be maintained indefinitely.

Primary Maxillary 2 nd Molar-

while smaller, this tooth morphologically resembles the permanent maxillary 1 molar. ► Crown's F-L measurement is greater than its M-D measurement. ► May have a 5 cusp of Carabelli. ► Prominent MB cervical ridge and an oblique ridge. ► MB cusp is almost equal in size or slightly larger than th the ML cusp. ► MB pulp horn is the largest and longest. ► Primary 2 nd molars are larger than primary 1 molars and resemble permanent 1 st molars. st st

Ethanol (70%)-

widely used to clean skin prior to immunization or venipuncture.

People with well-controlled diabetes are no more susceptible to infections than patients

without diabetes. However, they have more difficulty containing infections due to altered leukocyte function.

Root fractures in the APICAL THIRD are often repaired

without treatment (root fractures in the apical third are more likely to undergo self-repair). Many dentists recommend a relatively long stabilization period of 2-3 months for teeth with fractured roots. A longer stabilization period encourages a more favorable type of healing with calcified tissue. HEAVY WIRES are recommended when stabilizing teeth with fractured roots. Splinting is NOT recommended in the primary dentition. Occlusion should be adjusted so the injured tooth is not further damaged during normal mastication. Follow-up radiographs and pulp tests are done at frequent intervals during the 6-month period after the injury. These teeth often remain functional and vital.

RECURRENT APHTHOUS ULCERS Occur more in

women than men. May occur at any age, but usually first appear between ages 10-40yrs.

♦ Other chemicals that dissolve gutta-percha:

xylol, halothane, benzene, carbon disulfide, essential oils, methyl chloroform, and white rectified turpentine.

The primary herpes infection (HSV-1) that mainly affects YOUNG CHILDREN (1-5 years old), but may also affect

young adults (15-25yrs). Usually occurs in a child who has not had any contact with HSV-1, and who thus has no neutralizing antibodies. Nearly all primary infections are of the sub-clinical type that may only have flu-like symptoms, with 1-2 mild sores in the mouth that go unnoticed by parents. In other children, the primary infection may be manifested by acute symptoms (acute herpetic gingivostomatitis) these prodromal symptoms are (fever, malaise, irritability, headache, dysphagia, vomiting, cervical lympadenopathy) 1-2 days prior to local lesions. Then, fiery red gingival tissues and small yellowish vesicles form that rupture quickly, causing painful shallow, round, discrete ulcers with an erythematous (red) halo on the FREE & ATTACHED MUCOSA. Thus, the primary HSV-1 infection ranges from sub-clinical (asymptomatic) to severe systemic infections. Dehydration is the most serious potential problem due to the child not wanting to eat or drink because of the pain. A generalized marginal gingivitis may precede the ulcers.

The employer MUST provide the following information to the healthcare professional who performs the evaluation:

• A copy of the OSHA standard. • Description of the employee's duties as they relate to the incident. • Documentation of route(s) of exposure and circumstances under which exposure occurred. • Results of the source individual's blood testing if available. • All medical records relevant to treatment of the employee (including vaccination status) which are the employer's responsibility to maintain.

Restoring Endodontically Treated Teeth:

• A major disadvantage of posts (dowels) is it WEAKENS ROOT/TOOH STRUCTURE. • All posts designs are predisposed to leakage. • At least 4mm of gutta-percha MUST remain to preserve the apical seal. • Threaded screw posts may increase root fractures. Thus, parallel-sided posts and tapered posts are preferred. • Pins increase stresses and microfractures in dentin, thus should not be used. • Cusps adjacent to lost marginal ridges should be restored with an ONLAY.

ZOE (root canal sealer) functions:

• Acts as a lubricant to facilitate gutta-percha cone placement. • Forms a bond between the gutta-percha and dentin walls. • Exerts antibacterial activity (some exert more than others) which is highest in the period of time immediately after its placement.

Avulsed Tooth Management:

• After 60 minutes of dry storage of an avulsed tooth, few periodontal ligament cells survive. • Storage of an avulsed tooth in tap water is as bad as dry storage. • Saliva is hypotonic, thus allows storage for up to 2hrs, but MILK has a maximum storage time of 6hrs. • Teeth with complete root development should be treated endodontically ASAP even if replanted within 30 min. • Teeth with incomplete root development that are replanted within 30 min may not require endodontic treatment.

Factors to Consider when Prescribing a Child Fluoride Supplement:

• Amount of fluoride in the child's drinking water, child's age, and how responsible the person administering the fluoride supplement is (whether it be the patient or patient's parents). When determining the appropriate dose of systemic fluoride supplement for a child, it is most important for the dentist to consider the child's age and fluoride content of the drinking water. Before prescribing topical and/or systemic fluoride, the dentist must consider the child's AGE.

Proper management of an avulsed PERMANANT tooth out for > than 2hrs of the accident:

• Ankylosis & external root resorption will probably occur within 2 years. Ankylosis caused by the replacement gives a better prognosis than external root resorption which leads to failure. • RCT is performed in its entirety PRIOR to replantation. • Soak the tooth in 2.4% fluoride solution acidulated at 5.5pH for at least 20min. Fluoride slows the resorptive process. • Gently curette the blood clot out of the alveolar socket and irrigate with saline. • Rinse the tooth with saline, replant it into the socket, and splint for 4-6 weeks.

Only discontinue CPR under these conditions:

• Another trained person takes over the CPR for you. • EMS personnel arrive and take over care of the victim. • You are exhausted and cannot continue or the scene becomes unsafe. IF THERE IS AN AED ON THE SCENE, USE IT FIRST BEFORE STARTING CPR USING CAB

Signs & Symptoms of a ZYGOTMATIC FRACTURE:

• Binocular diplopia (can be secondary to muscle entrapment, neuromuscular injury, or intramuscular hematoma). • Difficulty with mastication (trismus) due to masseter spasm or bony impingement of the coronoid process. • Ipsilateral epistaxis occurs in some patients to a lacerated maxillary sinus mucosa.

H2O2 has two modes of action:

• Bubbling action occurs when it contacts tissue, and certain chemicals physically foams debris from the canal (effervescent effect). • Liberation of oxygen strictly destroys anaerobic microorganisms.

Adverse responses that can occur after a direct pulp capping procedure:

► Physical or microbial insult to the pulp may cause persistent inflammatory changes that can culminate in partial or complete pulpal necrosis. ► Regulation of the mineralization process involved in dentin bridge formation may become deranged, causing extensive calcification and obliteration of the pulp canal space by mineralized tissue. ► Very rarely, the differentiation of odontoclasts may be induced with the development of internal resorptive lesions.

Contraindications of performing a direct pulp cap on primary teeth:

► Spontaneous pain from the tooth (symptomatic). ► A large exposure (only used for pinpoint/small exposures). ► Excessive hemorrhaging (bleeding). ► Radiographic evidence of internal resorption.

Cardiopulmonary Resuscitation (CPR): PROCESS: C-AB

• C = CIRCULATION: Check for a carotid pulse by feeling for 5-10 seconds on the side of the victim's neck. If there is a pulse, but the victim is not breathing, give rescue breathing at a rate of 1 breath every 5 seconds, or 12 breaths per minute. If there is no pulse, begin chest compressions as follows: • Place heal of one hand on the lower part of the victim's sternum. With your other hand directly on top of the first hand, depress the sternum 1.5-2.0 inches. • Perform 30 compressions for every 2 breaths (rate: 80-100 per minute). Check for pulse return every minute and continue uninterrupted until advanced life support (ALS) is available. • A = AIRWAY: * Place the victim flat on his/her back on a hard tissue. * Shake victim at the shoulders and shout "are you ok?" * If no response, call EMS (911) then, do a head- tilt/chin lift (open the victim's airway by tilting their head back with one hand while lifting up their chin with your other hand). • B = BREATHING: * Position your cheek close to the victim's nose and mouth, look toward the victim's chest and look, listen, and feel for breathing (5-10 seconds). * If patient is not breathing, pinch the victim's nose closed and give 2 full breaths into the victim's mouth. * If breaths will not go in, reposition the patient's head and try again to give breaths. If it is still blocked, perform abdominal thrusts (Heimlich Maneuver).

Cementum Characteristics:

• Cementum is slightly softer and lighter in color (yellow) than dentin and is formed by PDL cementoblasts (dentin is formed by pulp odontoblasts). • Contains cementocytes (trapped cementoblasts) in lacunae. • Cementum most closely resembles BONE, except there are no haversian systems or blood vessels (cementum is avascular, while bone is vascular). Cementum has NO NERVE INNERVATION. • 50% inorganic (hydroxyapatite), 40% organic (mainly collagen and protein), and 10% water. • Cementum is important in ORTHODONTICS as it is more resistant to resorption than alveolar bone, permitting orthodontic movement of teeth without root resorption.

Child Periodontium vs. Adult Periodontium:

• Child periodontium has greater blood and lymph supply. • Alveolar crest is flatter, and alveolar bone is thinner (especially in the lamina dura area) since there are fewer trabeculae in the alveolar bone of the pediatric patient. • Gingival pocket depths are larger and the attached gingiva is narrower. • Gingival tissues are redder since child's gingiva is more vascular, thinner, and less keratinized. • There is lack of stippling because the C.T. of the lamina propria is shorter and flatter. • Child has rounded and rolled gingival margins due to normal eruption patterns. • Cementum is thinner and less dense than the adults, as cementum increases with age. • PDL fibers run parallel to the teeth. In adults, PDL fibers are more horizontal against the tooth. The child's PDL is also wider (this is why you may see more tooth mobility and decreased resistance to forces). PDL fiber bundles increase with age.

DMFT Index Limitations:

• DMFT values are not related to the number of teeth at risk. • DMFT index can be invalid in older adults because teeth can become lost for non-caries reasons. • DMFT index can be misleading in children whose teeth have been extracted for orthodontic reasons. • DMFT cannot be used for root caries and cannot account for sealed teeth.

After a report of an exposure incident is made, the employer must make immediately available at no cost to the employee, a confidential medical evaluation and follow-up that includes:

• Documentation of route(s) of exposure and circumstances in which the incident occurred. • Identification and documentation of the source individual (patient), unless the employer can establish that identification is not feasible or prohibited by state or local law. • Results of testing of the source individual's blood, it the patient is available. • Collection and testing of the employee's blood AFTER consent is obtained. • Medically indicated prophylaxis • Counseling • Evaluation of reported illnesses in the weeks after the incident.

Certain drugs may cause midazolam systemic build up, thus can increase risks of Midazolam side effects. These drugs include:

• Erythromycin (Eryc) and Clarithromycin (Biaxin). • Azole antifungal drugs: Ketoconazole (Nizoral) and Fluconazole (Diflucan). • Ulcer medicines: Cimetidine (Tagamet) and Omeprazole (Prilosec).

FLUORIDE CHARACTERISTICS:

• Fluoride concentration increases in the external layer of enamel throughout life. • Fluoride concentration increases during topical application, but decreases for a few days after treatment. • Increasing fluoride content in the external tooth layers increases enamel's resistance to demineralization. • Fluoride uptake is greater in enamel than in dentin or cementum.

Conditions that can complicate MOLAR UPRIGHTING:

• High mandibular plane angle (one of the most significant complications because if the molar is uprighted unsuccessfully, it can cause an increased open bite, and loss of anterior guidance). • Presence of periodontal disease. • Poor crown-to-root ratio and/or short roots. • Root resorption. • Significant CR to MIC discrepancy. • Severe lingual inclination of the tooth in addition to the mesial tipping. • Occlusal plane disharmony (i.e. extruded maxillary & mandibular molars). • Open bite. • Severe skeletal discrepancies.

Conditions Causing Increased Serum Calcium (Ca2+):

• Hyperparathyroidism • Chronic Glomerulonephritis • Hypervitaminosis D • Malignant diseases of the skeleton (i.e. multiple myeloma)

Primary Mandibular 2 Molar:

• Its morphology and amalgam preparation outline nd closely resembles the permanent mandibular 1 molar. st • Relative size of the distal cusp. The MB, DB, and distal cusps are nearly equal in size. However, the distal cusp of the permanent molar is smaller than the MB and DB cusps. • From the buccal aspect, it is has a narrow M-D dimension at the cervical portion of the crown compared to the dimension M-D on the crown at the contact level. The mandibular permanent 1 molar is wider at the cervical portion. • Groove patterns are different on the occlusal surface. • Primary molar has more divergent roots to allow eruption of the 2 premolar. • Primary molar has a more prominent facial crest of contour. • Primary 2 nd nd st molar has the greatest F-L diameter of all primary teeth.

Virulence Factors involved in Periradicular Pathosis:

• Lippolysaccharide (LPS)-found on the surface of gram (-) bacteria. • Enzymes-neutralize antibodies and complement components. • Extracellular vesicles-involved in bacterial adhesion, proteolytic activities, hemagglutination, and hemolysis. • Fatty acids-affect chemotaxis and phagocytosis.

Antibiotic Prophylaxis for TOTAL JOINT REPLACEMENTS:

• No scientific evidence currently supports antibiotic prophylaxis to prevent HEMATOGENOUS INFECTIONS before dental treatment in patients with total joint prosthesis. 2014 panel of experts convened by the ADA Council of Scientific Affairs developed an evidence-based clinical practice guideline (CPG) to clarify the 2012 panel of the American Academy of Orthopaedic Surgeons (AAOS) and American Dental Association (ADA). The final recommended is in general, for patients with prosthetic joint implants, prophylactic antibiotics are NOT recommended before dental procedures to prevent prosthetic joint infection. The reasoning behind the 2014 recommendation is evidence shows dental procedures are not associated with prosthetic joint infections, antibiotics provided before oral care do not prevent joint implant infections, the potential harms of antibiotics like anaphylaxis, antibiotic resistance, opportunistic infections like Clostridium difficile, and the benefits or antibiotic prophylaxis may not exceed the risks for most patients.

Management of a child who must undergo dental extractions is based on these factors: Other

• Past medical and dental experiences that might influence the child's behavior. • Child's physical status. • Length of time and amount of manipulation necessary to accomplish the surgery.

Wait 14 days before obtaining a biopsy of an oral ulcer, since almost all oral ulcers caused by trauma heal within 14 days. Thus, any ulcer present for 2 weeks or more should be biopsied. A biopsy is also indicated in these situations:

• Pigmented lesions (black/brown). • When tissue is associated with paresthesia. This is often an ominous sign. • If a lesion suddenly enlarges.

Primary Teeth vs. Permanent Teeth:

• Primary teeth are lighter in color than permanent teeth. • Pulp cavities are proportionately larger in primary teeth. • Crowns of primary teeth are more bulbous and constricted than permanent teeth. • Crown surfaces of all primary teeth are much smoother than permanent teeth (less pits & grooves in primary teeth). • Crowns of primary anterior teeth are wider M-D and shorter incisocervically than permanent anterior teeth. • Crowns of primary molars are shorter and narrower M-D at the cervical third than permanent molars. • Roots of primary anterior teeth taper more rapidly than permanent anterior roots. • Roots of primary molars are longer and more slender than permanent molar roots. • Enamel ends abruptly at the cervical line on primary teeth, rather than becoming thinner as on permanent teeth. Buccal and lingual surfaces of primary molars are flatter above the crest of contour than on permanent molars.

Fluoride Therapies for a 13-year old child prone to decay who lives in a community where the water is appropriately fluoridated:

• Professionally applied fluoride every 6 months, and fluoride toothpaste. • Low concentration fluoride mouth rinse. High concentration mouth rinses must be professionally prescribed and require a prescription. These rinses reduce root surface hypersensitivity. • Dietary fluoride supplements are contraindicated since the community water is appropriately fluoridated.

Fingers on the left hand (for a right-handed dentist) serve to:

• Retract soft tissue, provide the operator with sensory stimuli to detect expansion of the alveolar plate and root movement under the plate. • Help guide the forceps into place on the tooth, protect teeth in the opposite jaw from accidental contact with the back of the forceps, and support the mandible while performing mandibular extractions.

INSTRUMENTS TO REMOVE BONE:

• Rongeur Forceps are the most commonly used instrument to remove bone. A chisel & mallet, and bone file can also be used. However, the technique most oral surgeons use to remove bone is the bur & handpiece.

Panoramic Radiographs are EXCELLENT to demonstrate the following in a YOUNG PATIENT (CHILD):

• Supernumerary teeth, congenitally missing teeth, and axial inclinations of teeth. • Apical development of permanent teeth and impacted teeth • View pathologic jaw lesions and mandibular condyles.

Conditions that DELAY exfoliation of primary teeth and DELAY eruption of permanent teeth:

• Systemic conditions: Cleidocranial dysostosis, Down syndrome, Ectodermal dysplasia, Gardner's syndrome, Osteogenesis imperfecta, rickets, severe congenital heart disease, and mental retardation. • Localized pathologic conditions: abscess of a primary tooth, or ankylosis of a primary or permanent tooth. • Hypothyroidism, Hypopituitarism, Hypoparathyroidism, and heredity/genetics.

Normal Values for Coagulation:

• Template Bleeding Time: 1-9 minutes. • Prothrombin Time (PT): 11-16 seconds (compared to normal control). • Partial Thromboplastin Time (PTT): activated, 32- 46 seconds (compared to normal control). • Platelets: 140,000-440,000/ml.

Management of an Acute Asthmatic Episode during Oral Surgery:

• Terminate all dental treatment and position the patient in an erect or semi-erect position. • Patient should administer their own bronchodilator using an inhaler. In most severe asthma attacks or when the patient's bronchodilator is ineffective, EPI (0.3ml of a 1:1,000 dilution) can be injected IM or SC. • Administer oxygen and monitor vital signs.

Table Reads:

• The appropriate amount of DAILY fluoride supplement that should be given to a 6-16 year old patient in an area with a 0.25 ppm water fluoride concentration is 1.00 mg. • The appropriate amount of DAILY fluoride supplement given to a 6 month-3 year old child living in an area with a 0.5 ppm fluoride ion concentration in drinking water is NONE.

Major Oral Surgical Procedures:

• Treatment of maxillary and mandibular fractures. • Pre-prosthetic surgery (tuberosity reductions and vestibuloplasty). • Reconstructive surgery (orthognathic surgery and facial deformities). • Traumatology (treatment of wounds, injuries, and resulting disabilities). • Exodontia (including routine, multiple, & surgical extractions) is NOT a major oral surgery procedure.

Emergency treatment in the dental office for a child who has accidentally ingested a large amount of fluoride includes:

► Induce vomiting manually or with the help of Ipecac syrup and call 911. ► Have the patient drink a large quantity of milk or another calcium-containing liquid to decrease stomach acidity and to form complexes with the fluoride to decrease its absorption. ► Do NOT have the patient drink large quantities of sodium bicarbonate or crush ammonia vaporole under the patient's nose.

WHEN REGAINING CANAL PATENCY:

♦ A "crown-down" sequence (larger to smaller) of instruments is used from coronal to apical. ♦ Rotary instruments work faster and improve the access early in the treatment compared to heated instruments. ♦ Very light apical pressure is applied when using Nickel Titanium (NiTi) rotary files. ♦ Over-extended gutta-percha cones had to be removed by extending the file periapically. ♦ Glass Bead Sterilizer-sterilizes endodontic files in 15 sec at 220º C (428ºF).

* Disadvantages of Restructuring an Atrophic Ridge with HA granules:

♦ Migration of the hydroxyapatite granules. ♦ Poor ridge form (inadequate height). ♦ Abnormal color under the mucosa. ♦ Mental nerve neuropathy (excessive augmentation).

Indications for using BANDS instead of bonded brackets:

♦ To provide better anchorage for greater tooth movement. ♦ For teeth that need both lingual and labial attachment. ♦ Teeth with short clinical crowns. ♦ Tooth surfaces that are incompatible with successful bonding.

Internal jugular vein descends through the neck within the

carotid sheath and unites behind the sternoclavicular joint with the subclavian vein to form the brachiocephalic vein whose right and left segments unite in the superior mediastinum to form the superior vena cava (this returns blood to the right atrium of the heart).

If the patient's face becomes distended and swollen after a PSA block due to an intravascular injection, place

cold packs and pressure on the affected side, and explain that he/she may become black and blue on that side.

FACIAL NERVE (CN VII)-

originates in the PONS, traverses the facial canal of the temporal bone, and exits the cranium through the stylomastoid foramen where it then extends laterally around the neck of the mandible through the PAROTID GLAND. *If you cut the facial nerve just after it exits the foramen, it causes loss of innervation to the muscles of facial expression. Branches of the facial nerve to muscles of the face are enmeshed in the parotid gland. Functions:

CN V (trigeminal) contains NO

parasympathetic component at its origin.

SUBLINGUAL GLAND- Innervated by

parasympathetic secretomotor fibers from the FACIAL NERVE, which run in the chorda tympani and lingual nerve (V3 branch) and synapse in the submandibular ganglion. Blood supply is from the SUBLINGUAL ARTERY (branch of the lingual artery, which is a branch of the external carotid artery).

Submandibular glands are innervated by

parasympathetic secretomotor fibers from the FACIAL NERVE, which runs in the chorda tympani and lingual nerve (V3 branch) and synapse in the submandibular ganglion (this is the same as the sublingual glands). Blood supply to the glands comes from the FACIAL ARTERY (a branch of external carotid artery).

External carotid artery and its terminal branches within the

parotid gland (superficial temporal & maxillary arteries) supply the parotid gland. Lymphatic drainage of the parotid is through the parotid nodes to the deep cervical lymph nodes.

Mandibular Division (V3 ) of Trigeminal Nerve-

passes through FORAMEN OVALE and supplies MOTOR 3 innervation to tensor veli palatine, tensor tympani, muscles of mastication (temporalis, masseter, lateral & medial pterygoids), anterior belly of digastric, & mylohyoid muscles.

Unilateral lesions of the hypoglossal nerve cause deviation of the

protruded tongue towards the affected side due to the lack of function of the genioglossus muscle on the diseased side. Injury of the hypoglossal nerve eventually produces paralysis and atrophy of the tongue on the affected side with the tongue deviated to the affected side. Dysarthria (inability to articulate) may also occur.

Posterior Superior Alveolar (PSA) nerve block-

provides anesthesia for 1 st , 2 nd , 3 molars, but not mucoperiosteum of the palate. PSA injection does not always anesthetize all roots of the maxillary 1 rd molar. Thus, if anesthesia of this tooth for restorative or extraction is required, a local infiltration injection is given over the second premolar.

openings into pterygopalatine fossa:

pterygomaxillary fissure, inferior orbital fissure, sphenopalatine foramen, pterygoid canal, pharyngeal canal, and foramen rotundum.

REGIONAL LYMPH NODES: 2. Submandibular lymph nodes- Paranasal Sinuses-

receive lymph from the front of the scalp, nose, and adjacent cheek, upper and lower lips (except the center part), paranasal sinuses, maxillary & mandibular teeth (except mandibular incisors), anterior 2/3 of the tongue (except the tip), floor of the mouth and vestibule, and gingiva. Efferent lymph vessels drain into the deep cervical lymph nodes. a series of mucous membrane- lined air spaced that lighten the skull and enhance voice resonance. Located within the frontal, ethmoid, maxillary, & sphenoid bones.

During surgical procedures of the neck, structures within the carotid sheath can be

retracted (pulled aside) as a unit (common carotid artery, internal jugular vein, internal carotid artery, & vagus nerve). However, the cervical sympathetic trunk would remain in place when the carotid sheath is retracted because it is not within the sheath.

Facial vein unites with the

retromandibular vein below the border of the mandible and empties into the main venous structure of the neck (internal jugular vein)

Masticator Space is formed by the

splitting of the superficial layer of cervical fascia to enclose the ramus, masseter, medial pterygoid, and lower portion of the temporalis muscle. It lies largely among the muscles of mastication.

Sometimes the numerous sublingual ducts join to form a single main excretory duct (Bartholin's Duct) that usually empties into the

submandibular duct.

LINGUAL ARTERY-

supplies blood to the TONGUE (which also receives blood from the tonsillar branch of the facial artery & ascending pharyngeal artery). • Lingual artery arises from the external carotid artery at the level of the tip of the greater horn of the hyoid bone in the carotid triangle (below the facial artery). Branches include dorsal lingual artery, suprahyoid artery, and sublingual artery (supplies the sublingual gland). It terminates as the deep lingual artery, which ascends between the genioglossus & inferior longitudinal muscles. Floor of the mouth also receives its blood supply from the lingual artery.

Ophthalmic Artery-

supplies blood to the orbit and its contents.

Somatic SENSORY bodies of the ganglion's sensory fibers enter the: 2. Maxillary Division (V2 )

supplies general sensation to nasal cavity, maxillary teeth, palate, & skin over the maxilla.

Somatic SENSORY bodies of the ganglion's sensory fibers enter the: 1. Ophthalmic Division (V1 )

supplies general sensation to the ORBIT & SKIN of the face above the eyes.

Somatic SENSORY bodies of the ganglion's sensory fibers enter the: 3. Mandibular Division (V 3 )

supplies general sensation to the mandible, TMJ, mandibular teeth, floor of mouth, tongue, and skin of mandible.

ARTERIES & GLANDS EXTERNAL CAROTID ARTERY-

supplies most of the head & neck (except the brain, which gets its blood supply from the internal carotid and vertebral arteries). External carotid passes through the parotid salivary gland and terminates as the maxillary & superficial temporal arteries (terminal branches). The superficial artery supplies the scalp.

Lymphadenopathy is the most common cause of

swelling of the submandibular triangle tissues (not cysts or sialoliths).

FACIAL NERVE (CN VII)- 3. motor (parasympathetic innervation):

tear secretion from the lacrimal gland and salivation from the sublingual and submandibular glands.

NERVE ANATOMY Trigeminal Nerve (CN V)-

the LARGEST of the 12 cranial nerves and principal general sensory nerve to the head and face. Trigeminal exits the inferolateral pons as a sensory and motor root. The larger sensory root enters the trigeminal (semilunar, gasserian) ganglion in the middle cranial fossa.

Von Ebner's glands-

the only other adult salivary nd glands that are PURELY SEROUS. These glands are located around circumvallate papilla of the tongue. Their main function is to RINSE FOOD AWAY FROM PAPILLA after it has been tasted by the taste buds.

SUBLINGUAL GLAND-

the smallest salivary gland that contains mostly MUCOUS ACINI. Sublingual glands are in the floor of the mouth below the tongue, close to the midline. Mylohyoid muscle supports the individual sublingual glands inferiorly. They have many small ducts (Rivian Ducts) that open onto the mouth floor. Most of its secretory units are mucous-secreting with serous demilunes.

Facial Trauma-

trauma to the facial nerve destroys the ability to contract facial muscles on the affected side of the face and distorts taste perception. The affected side of the face sags because muscle tonus is lost.

Proprioceptive fibers from muscles & TMJ are found only in

trigeminal's mandibular division (V ). Cell bodies of proprioceptive 1 order neurons are found in the mesencephalic nucleus, not the trigeminal ganglion. The TMJ (as with all joints), receives no motor innervation, however the muscles that move the TMJ receive the motor innervation.

Greater Palatine Injection-

used if extracting any or all of the 3 molars and to anesthetize mucoperiosteum of the palate.

4 Factors to Consider when deciding to hospitalize a patient for an Elective Procedure:

• Medical problems compromising treatment (diabetes, hemophilia). • Difficulty and extent of surgery. • Consideration of the individual patient (emotionally disturbed, handicapped, etc.). • Hospitalization costs (time and money).

TONGUE SENSORY INNERVATION:

* Lingual nerve (branch of V3)→supplies anterior 2/3 of tongue. * Glossopharyngeal nerve (CN IX)→supplies posterior 1/3 of tongue (taste & sensation) & vallate papillae. Also supplies sensory to the tonsil, nasopharynx, and pharynx. * Vagus nerve (CN X) via internal laryngeal nerve→supplies the area near the epiglottis. * Facial nerve (CN VII) via chorda tympani→supplies taste to anterior 2/3 of tongue.

The axons of the neurons enter the PONS through the sensory root and terminate in 1 of 3 nuclei of the trigeminal sensory nuclear complex.

1. mesencephalic nucleus-mediates proprioception (i.e. muscle spindle). 2. main sensory nucleus-mediates general sensation (i.e. touch). 3. spinal nucleus-mediates pain and temperature from the head and neck.

Buccinator muscle originates from 3 areas:

1. pterygomandibular raphe-a thin, fibrous band or tendon running from the hamulus of the medial pterygoid plate down to the mandible. Pterygomandibular raphe lies between the buccinator and superior constrictor muscles. 2. maxillary & mandibular alveolar processes.

Lingual Artery Branches:

1. suprahyoid artery: supplies suprahyoid region. 2. dorsal lingual artery: supplies dorsum of tongue (top of the tongue). 3. deep lingual artery: the terminal branch that supplies the anterior 2/3 of tongue. 4. sublingual artery: supplies mouth floor and sublingual gland.

Inferior alveolar nerve & artery, and lingual nerve are found in the

PTERYGOMANDIBULAR SPACE between medial pterygoid muscle and ramus of the mandible. IA nerve passes lateral to the sphenomandibular ligament.

Lingual artery arises from the

EXTERNAL CAROTID ARTERY. It passes deep to the hyoglossus muscle to supply the tongue, and DOES NOT accompany the corresponding nerve throughout its course. Lingual artery supplies structures of the mouth floor and posterior and inferior surface of the tongue.

GREATER (Descending) PALATINE ARTERY-

GPA sends a branch to anastomose with the nasopalatine branch of the sphenopalatine artery in the incisive foramen to supply the mucosa of the hard palate anterior to the maxillary canine.

During its course, Wharton's duct is closely related to the

LINGUAL NERVE which eventually crosses over the duct. This is important because if you incise the mucous membranes of the mouth floor, you can expose the lingual nerve, Wharton's duct, and the sublingual gland. To expose the duct intraorally, only mucous membrane needs to be cut through.

Masseteric, Pterygomandibular, & Temporal spaces =

Masticator Space. These spaces are bound by the muscles and fascia of mastication. Masticator space infections are almost always of dental origin, especially from the mandibular molar region. *Needle tract infections after and IA block initially involve the pterygomandibular space.

Lateral pterygoid muscles form the

ROOF of the PTERYGOMANDIBULAR SPACE.

Greater (Anterior) Palatine Nerve-

a branch of the maxillary (CN V-2) nerve that provides soft tissue st innervation to the posterior 2/3 of the hard palate. It emerges into the hard palate via the greater palatine foramen and passes forward halfway between the alveolar crest and midline. Supplies soft tissues of the palate as far anteriorly as the canine where it overlaps with nasopalatine nerve branches. It is necessary to anesthetize the GPN if extraction or surgical procedures are contemplated in this area of the palate. Anesthetize the greater palatine nerve, deposit local anesthetic at the greater palatine foramen (between the 2 nd maxillary molars ~1cm from the palatal gingival margin toward the midline).

Nerve to Mylohyoid Muscle-

a branch of the mandibular nerve (V ). Mylohyoid muscle elevates the hyoid bone, base of tongue, and floor of mouth. The sublingual gland is 3 superior to the mylohyoid muscle.

Hypoglossal Nerve-

a motor nerve supplying all intrinsic & extrinsic tongue muscles (except palatoglossus), which is supplied by the vagus nerve. It leaves the skull through the hypoglossal canal medial to the carotid canal and jugular foramen. Soon after it leaves the skull through the hypoglossal canal, it is joined by C1 fibers from the cervical plexus. It passes above the hyoid bone on the lateral surface of the hyoglossus muscle deep to the mylohyoid muscle. It loops around the occipital artery and passes between the external carotid artery and internal jugular vein.

MUSCLES OF MASTICATION & TMJ Buccinator Muscle-

a muscle of mastication that forms the muscular substance of the cheek just lateral to the teeth. The maxillary & mandibular alveolar processes, and pterygomandibular raphe are the buccinator attachments.

Pterygopalatine Fossa-

a small space behind and below the orbital cavity that lies between sphenoid bone's pterygoid plates and palatine bone below the orbit apex. Maxillary nerve (V-2) & artery pass through the pterygopalatine fossa. communicates laterally with the infratemporal fossa through the pterygomaxillary fissure. * communicates medially with the nasal cavity through the sphenopalatine foramen. * communicates posteriorly with foramen lacerum through the pterygoid canal. * communicates superiorly with the skull through foramen rotundum. * communicates anteriorly with the orbit through the inferior orbital fissure.

Mumps-

a viral disease of the parotid gland.

Lateral Pterygoids (Right & Left)-

acting together are the PRIMARY PROTRACTORS of the mandible. *In addition to opening and protruding, they move the mandible from side-to-side (lateral excursions). For right lateral excursive movements, the LEFT lateral pterygoid is the primary mover (and vice versa). Thus, when a patient attempts PROTRUSION, the mandible deviates markedly to the right causing the buccinator, temporalis, and left lateral pterygoid to contract. However, the right lateral pterygoid cannot contract during protrusion.

Buccinator muscle INSERTS

at orbicularis oris and skin at the angle of the mouth. Facial and maxillary arteries supply blood to the buccinator muscle. The buccinator's action is to compress the cheeks against the molar teeth for sucking and blowing.

Masseteric Nerve (nerve to the masseter)-

branch of mandibular division (V ) that carries a few sensory fibers to the TMJ's anterior portion.

When draining purulent exudates from an abscess of the pterygomandibular space from an intraoral approach, the which muscle is most likely to be incised.

buccinator

MAXILLARY SINUSES-

open into the HIATUS SEMILUNARIS (groove in the middle meatus of the lateral nasal cavity that contains openings of the frontonasal duct & anterior ethmoid air cells). The maxillary sinuses develop after the permanent teeth have erupted, and growth continues throughout adulthood. Maxillary sinus is innervated by the maxillary division of the trigeminal nerve (CN V-2 which includes ASA, PSA, MSA, & infraorbital nerves).

GREATER (Descending) PALATINE ARTERY-

descends through the greater (descending) palatine canal to the greater palatine foramen. It supplies the hard palate, gingiva of maxillary teeth, & lateral nasal wall.

When the floor of the mouth is lowered surgically, the mylohyoid & genioglossus muscles are

detached.

Wharton's Duct (Submandibular Duct)-

emerges from the anterior end of the deep part of the submandibular gland, and passes forward along the side of the tongue, beneath the mucous membrane of the mouth floor. It opens into the mouth on the summit of a small papilla situated at the side of the frenulum of the tongue. Clinically, the submandibular duct and deep part of the gland can be readily palpated through the mucous membrane of the mouth floor alongside the tongue. Saliva can usually be seen emerging from the duct orifice.

Trigeminal nerve 3 sensory divisions arise from the ganglion and leave the cranial cavity through

foramina in the sphenoid bone. The smaller motor root passes under the ganglion and joins the mandibular division (V ) as it exits through FORAMEN OVALE. Mandibular division (V 3 ) innervates 8 muscles.

FACIAL NERVE (CN VII)- 4. sensory (taste impulses & sweet sensation):

from taste buds on the anterior 2/3 of the tongue, floor of mouth, and palate.

FACIAL NERVE (CN VII)- 2. sensory innervation (proprioception):

from the same muscles of facial expression that receive motor innervation.

Parotid gland receives its parasympathetic secretomotor innervation from the

glossopharyngeal nerve via the lesser petrosal nerve, otic ganglion, and auriculotemporal nerve (branch of V3).

GREATER (Descending) PALATINE ARTERY- gives rise to the

greater and lesser palatine arteries which pass through the greater and lesser palatine foramina (respectively), and supply the hard & soft palates. Lesser palatine artery also helps supply the tonsils (along with the tonsillar artery-a branch of the facial artery).

The canine and 1 premolar on the injection side can be removed without pain after administering an

inferior alveolar and lingual nerve block. You must give a long buccal injection to extract all molars and 2 st premolar. For operative procedures, a long buccal injection may not be needed for these teeth. nd * Incisors may need local infiltration for extractions. * Bone of the maxilla is more porous than the mandible, thus it can be infiltrated anywhere.

Branchiomeric motor fibers-

innervate temporalis, masseter, medial & lateral pterygoids, anterior belly of 3 digastric, mylohyoid, tensor tympani, and tensor veli palatine (palati).

PSA nerve-

innervates the DB root of the 1 molar and distal to it (2 nd and 3 molars).

MSA nerve-

innervates the MB root of the 1 rd molar and the two premolars.

If a tooth or large fragment is displaced into the maxillary sinus,

it should be removed. If the tooth fragment is irretrievable through the socket, it should be retrieved using a "Caldwell-Luc" approach ASAP. However, only perform this technique if you know what you are doing. If not, refer the patient to an OMS.

Pterygopalatine Ganglion-

lies in the pterygopalatine fossa just below the maxillary nerve (V ). It receives preganglionic parasympathetic fibers from the facial 2 nerve (CN VII) via the greater petrosal nerve. It sends postganglionic parasympathetic fibers to the lacrimal gland and glands in the palate and nose.

CAROTID SHEATH-

located at the lateral boundary of the retropharyngeal space at the level of the oropharynx on each side of the neck deep to the SCM muscle. It extends from the skull base to the first rib and sternum. It contains the carotid arteries, internal jugular vein, vagus nerve, and deep cervical lymph nodes.

SUBMANDIBULAR GLANDS-

located in the submandibular triangle (digastric triangle.

Masticator Space is traversed by the

mandibular nerve (V ) and maxillary blood vessels.

Infections of the zygomatic or temporal bones may pass to the

masticator space, and so may abscesses from mandibular molars.

When placing the film for a periapical view of mandibular molars, the mylohyoid muscle can

obstruct the view if it is not relaxed.