IPAP Dental
Multiple Segments
A comminuted fracture is one which leaves the bone in __________
- 32 Teeth - 3 sets of molars. - 2 sets of premolars. - 1 set of canines. - 2 sets of incisors.
Adults have ___ teeth, with X numbers of sets of : Molars, premolars, canines, incisors
Gingivitis - soft tissue - reversible Periodontitis - includes bone, gingiva and PDL - anaerobic bacteria - irreversible Occlusal trauma - inflamed PDL - excessive wear - reversible
Categories of periodontal disease
- *60% of total mucosa* - floor of mouth - ventral tongue - alveolar mucosa - cheeks, lips - soft palate - *Non keratinized stratified squamous epithelium (NKSS)*
Describe Lining Mucosa
- *25% of total mucosa* - Free, attached and inter-dental gingiva - *Keratinized/Parakeratinized stratified squamous epithelium (KSS/PKSS)*
Describe Masticatory Mucosa
- *15% off total* - Dorsal tongue - Cornified/non-cornified epethelial papillae
Describe Specialized Mucosa
- loss of the initial blood clot - inflammation of exposed, sensitive alveolar process - 3-4 days post-extraction
Describe alveolar osteitis (dry socket)
- middle layer - first layer to form - equal to bone in hardness - receives nutrients from pulp
Describe dentin
- hardest tissue in the body - Second layer to begin forming
Describe enamel
- hyperplasia - cyclosporine, phenytoin, nifedipine
Describe medication influenced gingivitis
inflammation of tissues surrounding the crown of a partially erupted tooth
Describe pericoronitis
They initially attach to sticky surface of pellicle. (reversible)
Describe planktonic bacteria
- Pathogenic *bacteria* adhere to pellicle - biofilm forms within interproximal spaces - *plaque and calculus*(tartar) form
Describe plaque associated gingivitis
- Last tissue to form - Is avascular - *Receives nutrients from the PDL* - Acellular covers coronal 2/3 of root - Cellular covers apical 1/3 of root
Describe the Cementum
- paired synovial joint - dual action: rotation & translation. - most used joint in the body.
Describe the Temporomandibular Joint
Attahed gingiva - Kerantinized - Stipple - Separated from alveolar mucosa by the mucogingival junction
Describe this portion of the gingiva
Free gingiva (aka *Marginal*) - Keratinized - Not Stippled - Bound apically by the gingival groove
Describe this portion of the gingiva
3-4 days
Dry socket generally occurs ___ days after tooth extraction
Start with the patients' *maxillary posterior right* and count anteriorly towards their maxillary left. Continue to move posteriorly (#1-#16). The mandibular teeth are numbered in the same manner but move from the patients' *mandibular posterior left* to their mandibular posterior right (17- 32).
How does the Universal Numbering System work?
1 hour
How long do you have to replace an avulsed tooth?
- Lateral Pterygoid muscle (anterior displacement of disk)
In a patient with TMD, what is the #1 most likely guess for which muscle is the offending muscle?
- 20 Teeth - 2 sets of molars. - 0 sets of premolars. - 1 set of canines. - 2 sets of incisors.
Kids have ___ teeth, with X numbers of sets of Molars, premolars, canines, incisors
- start at vermilion border - muscle layer = 3-0→4-0 (absorbable) - subcutaneous = 4-0→5-0 (absorbable) - epithelium = 6-0 nylon (non absorbable) Avoid silk on skin (non absorbable) due to ↑ acute inflammation and scarring
Laceration closure
*PAROTID GLAND* - parotid duct (Stensen duct) *SUBMANDIBULUAR GLAND* - submandibular duct (Wharton duct) *SUBLINGUAL GLAND* - ducts of rivinus
List the three major salivary glands and their associated ducts.
- 6 - 12
Mixed Dentition occurs when both primary and permanent teeth are present. This occurs between the ages of _____ (first set of molars erupt) and _____ (second set of molars erupt).
- Trench Mouth. - Caused by Stress (cortisol) and/or smoking - *blunted, punched out interproximal* papillae Not to be confused with meth mouth which is similar but different
Necrotizing Ulcerative Gingivitis (NUG) is also known as ________ It can be caused by _________ What are Sx?
- NUG - Meth mouth if there is previous history of drug use
Patient complains of pain and inability to chew. Presents with blunted, punched out papillae. What is likely diagnosis and differential?
- carious lesions. - vital sites
Space Infections are serious sequelae of _______ and may be pathways for infections into __________
- Clicking and popping - Grating sounds - Deviation during open/closing - Inability to fully open mouth - Pain in the pre-auricular area or in the TMJ itself. - Biting and Chewing with difficulty - Headache with or without tinnitus.
TMD signs/symptoms are:
Vestibule
The ______ is the space between the teeth and the inner mucosal lining of the lips and cheeks.
Oral cavity
The ______ is the space contained within the upper and lower dental arches
protrudes, retracts and depresses *is the muscle most often associated with TMD
The lateral Pterygoid ______ the mandible
Fracture
The lower jaw will deviate to the side of a ___
elevates
The masseter ______ the mandible
elevates, protrudes and laterally shifts
The medial Pterygoid ______ the mandible
elevates and retracts
The temporalis ______ the mandible
- Intrinsic muscles = hypoglossal nerve Extrinsic muscles - Palatoglossus = vagus - Genioglossus = hypoglossal - Hyoglossus = hypoglossal - Styloglossus. = hypoglossal
Tongue motor innervation
- facial space infections - diffuse swelling with *fever* - significant heart murmurs
What are clinical presentations that warrant the use of antibiotics?
Periapical abscess. Periodontal Abscess. Pericoronitis. Alveolar Osteitis (dry socket)
What are four common dental emergencies?
The palatal side of a tooth is the side closes to the palate (ie medial) in the maxilla. The palatal root is a third root on the palatal (medial) side of a tooth and are only found on maxillary molars.
What are palatal roots?
- collagen - synthetic absorbable - non absorbable
What are the 3 classes of sutures?
3 types: Attached, Free, interdental. KSS/PKSS (keratinized/parakeratinized stratified squamous epithelium).
What are the 3 types of gingiva and what type of tissue is it made of?
- Anterior face: Mesial. - Posterior face: Distal. - Lateral Face: Buccal. - Medial face: Palatal/lingual. - Bitting surface: Occlusal. - The root side
What are the 5 different sides of a molar? What is the apex?
1. Healthy tooth w/ plaque 2. Decay in enamel 3. Advanced Decay 4. Decay in Dentin 5. Decay in Pulp - *process is reversible until stage 4* - *pH ≤ 5.5*
What are the 5 stages of tooth decay?
- Opthalimic (V1)Sensory. - Maxillary (V2) Sensory. - Mandibular (V3) Sensory and motor - Lingual Nerve (branch of V3, tongue sensory).
What are the Branches of the Trigeminal cranial nerve?
- Cold Sores. - Usually seen in younger children - Vesicles initially...progresses to ulcers with red halos. - Spreads during asymptomatic viral shedding in the saliva. - Resolves in 5-7 days; acute cases 2 weeks. - May have fever and malaise.
What are the Si/Sx of Herpetic Stomatitis?
- 24hr. painful swelling - difficulty breathing or swallowing - severe trismus (lock-jaw)
What are the Sx that will send a Px immediately to OMFS (Oral & Maxillofacial Surgery)?
In order, Class 1, Class 2, Class3 (occlusion is the key to reconstruction)
What are the classes of these Angle's Occlusal ?
Class 1 - Needs no treatment. Class 2 - There are treatment needs, but they are not predicted to cause a dental emergency within 12 months. Class 3 - The treatment needs indicate that a dental emergency will occur within 12 months *Non-deployable*. Class 4 - Dental status unknown (examination required annually).
What are the four dental classes? Which one is non-deployable?
Filliform - devoid of taste buds, used for traction. Fungiform - may contain taste buds. Vallate - For sure has taste buds. Foliate - Side of the tongue. *papillae are only on the anterior 2/3 of the tongue
What are the four different types of papillae?
- Plaque associated - Necrotizing ulcerative (NUG) - medication influenced - Allergic
What are the four types of gingivitis?
- only considered life threatening when it obstructs the airway. - lower jaw deviates to side of fracture - Do not re-implant deciduous teeth - Central incisor most frequently avulsed
What are the key take aways for maxillofacial trauma?
*Heavy chewers:* - Masseter - Medial Pterygoid - Lateral Pterygoid. *Light Chewer:* - Temporalis.
What are the muscles of mastication?
- removing cause - establishing drainage - aggressive antibiotic therapy
What are the principles of severe infection management?
- Loss of stippling appearance - Bleeding on probing - Purulence - Receding gingival margin
What are the signs of gingival inflammation?
Mid face fractures - Lefort I: above the level of teeth. - Lefort II: at level of nasal bones. - Lefort III: at orbital level.
What are the three Lefort Classifications?
Sugar Bacteria, Free tooth space
What are the three prerequisites for caries?
1st: Zygomaticomaxillary Complex. 2nd :Mandible (50% of which are comminuted(multiple fractures)).
What are the two most common facial fractures?
Eleidin - protein that is more transparent than keratin Fordyce Granules - Ectopic sebaceous glands (also found in buccal mucosa)
What are the two testable anatomic terms used to describe portions of the vermillion border?
Hairy Leukoplakia
What can be seen in AIDS Px infected with the Epstein Barr Virus?
A tramatic rupture of a 'minor' salivary duct and accumulation of saliva in the tissue.
What is a Mucocele?
Defect in a major salivary duct causing accumulation of saliva resulting in a saliva-filled unilateral mass in the floor of the mouth
What is a Ranula?
dark lesion that does not blanch, may show a white radiopacity on x-ray. Caused by an accidental implantation of material such as amalgam or graphite.
What is an Amalgam tattoo?
One that has been displaced from it's socket.
What is an avulsed tooth?
Clenching of teeth
What is bruxism?
Applied topically (not systemically) Helps prevent demineralization and aids in remineralization.
What is fluoride used for?
- Junction between skin and mucous membrane. - Stratified Squamous Epithelium
What is the Vermilion border? What type of cells is it composed of?
Penicillin
What is the antibiotic of choice for odontogenic infections?
- Remove plaque - see a dental hygienist every 6 months (nunn doesnt count)
What is the cure for gingivitis?
- Gingivitis only involves the *soft* tissue and is reversible - Periodontal disease involves the *soft and hard* tissue (bone and PDL) and is *irreversible*
What is the difference between gingivitis and periodontal disease?
The formation of the *salivary pellicle.* Although this thin film of protein is protecting the enamel, it is also the primary site of attachment for colonizing bacteria
What is the first step in plaque formation?
Apthous Ulcer. Occur on loosly bound tissue like oral mucosa. Eti: precipitaed by food allergies or some type of stressful event
What is the official name of a canker sore?
Anterior ⅔: General sensations: *Lingual nerve* Special sensations: chorda tympani Posterior ⅓: General & special sensations: glossopharyngeal nerve. Base: General & special sensations: internal laryngeal nerve.
What is the sensory nerve supply to the tongue? Anterior 2/3. Posterior 1/3. Base:
Interproximal
What is this space called?
6 = 1st molars - 3, 14, 19, 30 12 = 2nd molars - 2, 15, 18, 31
What molars come in around age 6? How about 12?
mutant streptococci and lactobacillus
What two bacteria are primarily involved in the caries process?
Periapical is acute inflammation - at the *apex* - *non-vital necrotic tooth* - mucosal tissue Peridontal is the acute inflammation - in the *sulcus* of peridontal pocket - *preexisting peridontal lesion* - mobile but *vital tooth*.
What's the difference between a Periapical abscess and a Periodontal Abscess?
A = Free gingiva *(KSS)* B = Attached Gingiva *(KSS)* C = Alveolar mucosa *(NKSS)*
Whats A, B and C
Streptococci and Actinomyces spp. (*Aerobic*) They reduce the REDOX potential of the enviroment (which favors anaerobic spp.)
Which bacteria are the early colonizers?
*Anerobics* - Prevotella intermedia/loescheii - Capnocytophaga spp. - Fusobacterium nucleatum - Porphyromonas gingivalis.
Which bacteria are the secondary colonizers?
5-0
Which suture has a smaller diameter, 5-0 or 4-0?
*Porphyronas gingivalis* - Keystone bug for periodontal disease *Tanerella Forsythia* - Likely to trigger atherosclerosis *Treponema Denticola* - Ass with Alzheimer's Disease
Which three bacteria form the Red Complex? Which of the three causes peridontal disease? Which of the three can trigger atherosclerosis? Which of the three is associated with Alzeimer's?
- Pocket depths 1-3mm (>3 is diseased) - Gingiva is firmly attached to the bone
Which two anatomical features are periodontics most concerned with?
Ludwig's Anginia
_______ is diffuse brawny edema over both sides of the jaw and neck?
