Understanding the Role of Renewable Energy in Sustainable Development, Exams of Medicine

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NBDE Part II What is the most useful when polishing an amlagam restoration - prophylaxis cup with tin oxide abrasive impregnated rubber points sof lex disks The best way to produce a radiographic image with low contrast is by doing what? - increasing the kilovoltage peak (kVp) Degeneration of the basal cell layer, a mononuclear inflammatory cell infiltrate in the subepithelial connective tissue, and "saw tooth" rete pegs are indicative of which mucocutaneous disorder? - lichen planus which treatment is indicated for a 5 year old patient with a sinus tract and a dark discoloration associated with their max central incisor that appeared following trauma? - extraction if you retained this tooth it can lead to abnormal formation of the permanent tooth cross allergy is most likely to happen with the anesthetic agents - lidocaine and mepivacaine IgE mediated reacitions with amide group local anesthtetics which locations would a perforation demonstrate the best prognosis? - apical third of the root the more apical the perforation, the more favorable the prognosis for the tooth, except for perforations of the crown replacement of defective amalgam with a cast gold restoration can achieve which of the following - provide better marginal seal provide more ideal contours the optimal incisal reduction for a PFM crown is - 2 mm what is an unfavorable consequence of placing mandib molars on the ascending border of the ramus during the fabrication of a complete denture - the occlusal forces over the inclined ramus would dislodge the mandib denture which is more likely to develop into a malignant lesion - actinic cheliitis during canal preparation, excessive instrumentation leads to the loss of the apical seat. The dentist should proceed by - increasing the file size and decreasing the file length periapical cemental dysplasia in its early stages is best differentiated clinically from an apical abscess by - pulp testing what is the name of the technique in which deep caries are excavated from a tooth, a small amount of affected dentin ins left (provided that a caries free DEJ is present) and a base is placed along with a permanent restoration - indirect pulp cap indirect pulp cap differs from stepwise caries excavations how? - stepwise involves the placement of temporary filling whereas an indirect pulp cap involves the placement of the permanent restoration in which direction would a mandib second molar move if the first molar were extracted - mesially which of the following osseous grafting materials is harvested from a human donor and placed in another human - allograft which test is most valuable for evaluating the surgical risk of a patient on warfarin who needs a tooth extracted? - prothrombin time normal is 12-13 seconds INF is used in conjunction and its normal is .8-1.2 which pharmaceutical is most closely associated with dermal photosensitivity - demeclocycline a tetracycline used in the treatment of Lyme disease, acne and bronchitis may induce photosensitivity, interfere with bone development and discolor teeth causes nephrogenic diabetes insipidous binds to 30 s and 50 s ribosomal subunits, impairing protein synthesis by bacteria what tends to occur following an intra arterial injection of anesthetic - retrieval of a broken tooth root from maxillary sinus removal of abnormal tissue growths treatment of maxillary infections DMFT or DMFS - decayed missing filled surfaces teeth the histological presence of which of the following indicates an infected dental pulp - lymphocytes and plasma cells what is the range of the lethal dose of flouride - 20-50 mg/kg what is the function of silanes in resin composites - to bind inorganic and organic materials with hydrogen and covalent bonds which pulpal condition is suggested when a patient experiences prolonged, unstimulated pain while trying to sleep - necrosis What is not always visible on radiographs? - Nasolabial cyst Nasolabial cysts are NOT always visible on radiographs because of their soft tissue origin and extraosseous occurrence. Nasolabial cysts are rare, non-odontogenic, soft-tissue, developmental cysts that occur inferiorly to the nasal alar region. They are also known as nasoalveolar cysts or Klestadt`s cysts. A patient exhibiting a "cotton wool" appearance of the bone on X-ray and an elevated level of alkaline phosphatase with normal calcium, phosphate, and aminotransferase concentrations in their blood is most probably suffering from which of the following diseases? - Paget's disease of bone is a chronic disorder that can result in enlarged and misshapen bones, pain, fractures, and arthritis. Paget's disease of bone is diagnosed by the presence of an elevated level of alkaline phosphatase and normal calcium, phosphate, and aminotransferase levels in the blood. The pathognomonic sign for Paget's disease is a radiopaque "cotton wool" appearance of the bone on X-ray. Other signs of Paget's disease include: •Enlarged skull and facial bones •Enlarged maxilla and alveolar ridges •Displaced teeth •Hypercementosis Which of the following conditions exhibit globular dentin, early pulpal obliteration, defective root formation, periapical granulomas/cysts, premature exfoliation, and appear to be normal clinically? - Dentin dysplasia is a hereditary disease characterized by a disturbance in normal dentin formation causing pulpal chamber obliteration, alteration or absence of root formation, and premature tooth exfoliation. Amelogenesis imperfecta affects ONLY the formation of enamel and NOT dentin. Dentinogenesis imperfecta is also a form of dentin dysplasia which causes dicoloration or some sort of translucency to affected teeth. Which diagnostic test would best allow a clinician to differentiate between amelogenesis imperfecta from dentinogenesis imperfecta? - Radiographic appearance Amelogenesis imperfecta is a hereditary tooth development disorder in which the teeth are covered with thin, abnormally formed enamel. Amelogenesis imperfecta involves weak and abnormally formed enamel. The enamel is avascular and highly calcified and does not contain the proteins ameloblastin, enamelin, tuftelin, and amelogenin. •The affected teeth are often yellow or brown. •The teeth of patients with osteogenesis are more likely to have a blue hue. •Severity of amelogenesis imperfecta ranges from complete absence of enamel to minor defects. •The enamel is deposited, but fails to fully mature. •The crowns of these teeth are often subject to rampant caries and excessive attrition. Radiographically amelogenesis enamel may appear totally absent. When present may appear as a thin layer, chiefly over the tips of the cusps and on interproximal surfaces. Squarish type of crown but devoid of the normal mesial and distal contours. Radiographically dentinogenesis appear with bulbous crowns with constricted short roots. Initially pulp chambers may be abmormally wide and resemble shell teeth but will progresseively obliterate. Metastatic squamous cell carcinoma of the tongue will likely migrate to which of the following sites first? - Squamous cell carcinoma of the tongue most commonly migrates to the cervical lymph nodes because the lingual lymph drainage occurs through the cervical lymph nodes. The spread of carcinoma in the cervical lymph nodes typically results in its poor prognosis. Surgical neck dissection is typically used to treat this type of cancer. A 42-year-old asthmatic patient who smokes and is human immunodeficiency positive (HIV+) presents to your office for a routine evaluation. Upon examination, you notice an asymptomatic red patch on the midline dorsum of their tongue and a marked loss of lingual papillae. Which of the following is the most likely diagnosis? - Median rhomboid glossitis is a condition characterized by a midline erythematous patch on the dorsum of the tongue immediately in front of the circumvallate papillae combined with a loss of lingual papillae. Median rhomboid glossitis is thought to be created by a chronic fungal infection, and usually is a type of oral candidiasis. Risk factors include: Smoking Denture wearing Corticosteroid sprays or inhalers Human immunodeficiency virus (HIV) infection Each of the following aids in the diagnosis or evaluation of Sjögren's syndrome EXCEPT ONE. Which is the EXCEPTION? - Exfoliative cytology uses the scraped off or exfoliated tissues to evaluate and examine lesions through cytopathologic analysis and CANNOT be used to diagnose Sjögren's syndrome. Labial salivary gland biopsy is an important diagnostic tool in identifying affected salivary glands and is performed by taking a small sample of the salivary gland for analysis. Determining any abnormality in saliva flow rate may hint for the presence of Sjögren's syndrome. Sialograms are used to determine any blockage or clogged structure at the salivary ducts and glands. It is a helpful tool to diagnose or rule out Sjögren's syndrome. A patient presents to your office with an indurated submucosal tumor that when biopsied, suggests a neoplasm of glandular and myoepithelial origin. Which of the following is the most likely diagnosis? - Pleomorphic adenoma Pleomorphic adenoma is a common benign salivary gland neoplasm of glandular cells along with myoepithelial components, that can potentially become malignant. used to follow patients border movements Casts poured from alginate are more accurately mounted with - wax records Casts poured from elastomeric materials are more accurately mounted with - elastomeric materials PVS or ZOE paste condylar guidance - slope of articular eminence represented by HCI on articular posterior determinant of occlusion incisal guidance - incisal edges of lower incisors against lingual slopes of upper incisors represented by pin and guide table on articulator anterior determinant of occlusion Canine guidance - when in lateral movements all posterior teeth are immediately discluded as contact occurs solely between the upper and lower canines on the working sided anterior guidance - refers to both incisal and canine guidance mutual protection - front teeth protect back teeth- front teeth disclude posterior teeth during protrusive and lateral movements back teeth protect front teeth- back teeth have flat occlusal surfaces and strong roots to help protect anterior teeth from bite forces vibrating line - from hamular notch to hamular notch 2 mm away from fovea palatini mandib labial frenum - orbicularis oris buccal frenum - orbicularis oris, buccinator lingual frenum - genioglossus labial vestibule of mandible - mentalis buccal vestibule - buccinator retromolar pad - marks distal extension of enentulous ridge ideally covered for support and retention since the integrity of the bone in this area is maintained contains attachments from temporalis, buccinator, superior pharyngeal constrictor and pterygomandibular raphe masseteric notch - refers to the distobuccal area on the impression/denture masseter contracts when the mouth closes against resistance Alvelolingual sulcus - between mandibular alveloar ridge and tongue Anterior region: from lingual frenum to the premylohyoid foss sublingual gland sits above mylohyoid muscle in thie region so the flange is shorter anteriorly and should touch the mucosa of the floor of the mouth middle region: from premylohyoid fossa to distal end of mylohyoid ridge flange is deflected medially away from mandible due to prominence of mylohyoid ridge in this area and contraction of mylohyoid medially posterior region: extends into retromylohyoid fossa although mylohyoid attaches higher posteriorly, the posterior fibers are directed more vertically so the denture seats deeper and the lingual flange is longer -flange is deflected laterally toward the ramus of the mandible to form typical S form of lingual sulcus denture extension in this area is limited by palatoglossous and superiror constrictor muscles frenectomy - labial>buccal>lingual (most to least common) free gingical graft - necessary for some overdenture teeth FGG widens band of keratinzed tissue hypermobile ridge - flabby edentulous ridges are common in anterior maxilla may use a tissue conditioner may use electro surgery or laser use large relief in tray or perforate a custom tray when taking impression epilus fissuratum - hyperplastic tissue reaction caused by an ill fitting or overextended flange treat with tissue conditioner and by adjusting flange may use surgery if inadequate response fibrous (pendulous) tuberosity - common when large tuberosities touch retromolar pads can limit interarch space corrected by surgicial excision of fiberous tissue and or bone combination syndrome - specific pattern of bone resorption in the anterior endentulous maxilla when it is opposing mandibular anterior teeth only overgrowth of tuberosities papillary hyperplasia in hard palate extrustion of lower anterior teeth loss of bone under the partial denture base when can residual root tips be left alone - if they have an intact lamina dura and no radiolucency Pagets Disease - unknown etiology, bone resportion and repair leading to deformities dentures not fitting--need to be remade periodically Alveoloplasty - surgical reshaping of alveolar bone useful for sharp, sping or extremly irredular edges vestibuloplasty - increase the relative height of the alveolar process to increase denture base area by apically repositioning the avleolar mucosa and the buccinator, mentalis and mylohyoid muscles as they inset into the mandible Vertical dimension of rest - The buccal surfaces of maxillary molars are also known to be at risk for calculus deposits because of their proximity to the Stensen duct of the parotid glands Phenytoin is indicated for treatment of epilepsy and - cardiac arrhythmia Phenytoin is commonly prescribed as an anticonvulsant and has an antiarrythmic effect. It decreases the activity of the motor cortex, thereby controlling seizures. Phenytoin can treat cardiac arrhythmias secondary to digitalis intoxication but cannot treat arrhythmias related to cardiac diseases. Determinants of Occlusion - ant. guidance post guidance cuspal anatomy tooth arrangement curve of spee - anteroposterior curve to ensure loading into long axis of each tooth more mesial inclination as you move distally curve of wilson - mediolateral curve along posterior cusp tips to ensure loading into long axis of each tooth more lingual inclination as you move distally Fricative or labiodental sounds f,v,ph - contact between max incisors and wet/dry line of lower lip help determine position of incisal edges of max anterior teeth have pt count up from 50-60 sibilant or lingualveolar sounds= s,z,sh,ch,j - contact between tip of tongue and the anterior palate or lingual surface of the teeth help determine vertical length and overlap of anterior teeth whistling--> too narrow arch form lisp where s becomes sh--> too wide arch form closest speaking space= also want to evaluate vertical dimension during pronunciation of s sound, the interincisal separation should be 1 to 1.5 mm count in the 60 linguodental sounds= th - contact between tip of tongue and upper and lower teeth help determine labiolingual position of the anterior teeth tongue is not visible=teeth are set too far forward tongue sticks out= teeth arfe set too far back bilabial sounds= b,p,m - contact between both lips insufficiant lip support by the teeth or labial flange can affect production of these sounds guttural sounds= g,k - contact between back of tongue and throat support - resistance to vertical seating forces for upper: palate and alveolar ridge for lower: buccal shelf and retromolar pad for denture: denture base stability - resistance to horizontal dislodiging forces for upper and lower: ridge height and depth of vestibule denture: denture flange retention - resistance to vertical dislodging forces denture: peripheral seal adhesion - attraction of unlike molecules salivia to tissues, saliva to denture bases intimate contact of denture base to tissues creates best seal occlusal prematurities may break retention cohesion - clinging of like molecules saliva to saliva thick and ropey saliva is unfavorable, thin and watery saliva causes better retention surface tension - combination of adhesion and cohesion froces that maintain film integrity overextension of denture - denture flange is too long get sore spot or ulcer after wearing tx: relieve denture and re-evaluate in a few weeks denture extends too far back- denture teeth are set so far back that they go to ramus. occlusal forces would dislodge denture underextension - denture flange is too short lack of retention ridge - the best indicator for success of a denture is the ridge wide broad ridge is the best situation PMMA - polymer (powder) MMA Methyl methacrylate - monomer (liquid) hydroquinone - inhibitor glycol dimethacrylate - cross linking agent dimethyl-p-toluidine - activator denture processing - shrinkage always occurs, but even more shrinkage if excessive monomer rest seat - prepared into the O, L, or I surface of an abutment tooth in order to receive and support a rest occlusal rest - rounded, semi-circular outline form (spoon shaped) one third MD width one half intercuspal width 1.5 mm deep for base metal floor inclines apically toward center angle formed with vertical minor connector is <90 CIngulum Rest - inverted V or U shape 2.5- 3 mm MD length 2 mm labiolingual width 1.5 mm deep contraindicated for mandibular incisors benefits include good distribution of occlusal load, esthetic, strength from closeness or major connector incisal rest - rounded notch at incisal angle 2.5 mm MD length 1.5 mm deep used as indirect retainer less favorable leverage than lingual rest not used often because of esthetic compromise proximal plate - metal plate that contacts proximal surface of abutment tooth (type of minor connector) guide planes - flat parallel surfaces of abutment teeth that provide path of insertion and removal one third buccolingual width extends 2-3 mm vertically down from marginal ridge indirect retainer - distal extension area of a partial is "loose" and is not anchored posteriorly there is rotational movement centered around an imaginary line drawn through the most distal rests indirect retainer is directly perpendicular and anterior to the fulcrum line which provides bracing to resist rotational movement of distal extension area direct retainer (clasp assembly) - rest= support minor connector= stability clasp arms retentive clasp arm=retention reciprocal clasp arm= stability extracoronal retainer - more common, conventional clasp design clasp should encircle a tooth at least 180 degrees intraconronal retainer - a precision attachment with key and keyway pattern more esthetic because no clasps retentive clasp - originates from minor connector and rest contacts tooth below height of contour/survey line shoulder and middle should be above HOC, only the tip should be under HOC tip is designed to engage in undercut and resist dislodging forces--only active when dislodging forces are applied to them, otherwise seat passively occlusal third of retentive clasp - support middle third of retentive clasp - stabilization gingival third of retentive clasp - retention reciprocal clasp (stabilizing clasp) - originates from minor connector and rest contacts tooth above HOC/survey line braces abutment tooth so it is not torqued by retentive clasp suprabulge - originate above survey line circumferential ring combination embrasure infrabulge - originate below survey line I bar Tbar bar type y type ring clasp - used when undercut is adjacent to BES RPI - rest, proximal plate, I bar (ideal class II level system) RPA - rest, proximal plate, Akers clasp RPC - rest, proximal plate, circumferential clasp clasp selection - wrought wire used for perio compromised and endo treated teeth BES use Akers clasps with rest seats located adjacent to endentulous space distal extension use in order of preference: RPI, RPA, and wrought wire cobalt chrominum - insufficient clearance for most materials difficult to visualize light chamfer - .3-.5 mm thick gold crowns wide gold collars of PFM crowns heavy chamfer - 1-1.5 mm thick PFM crowns and some all ceramic crowns if not given enough room, lab will be forced to overcontour crown shoulder - 1-1.5 thick porcelain of PFM restorations all ceramic crowns maximizes esthetics-eliminate display of metal aggressive preparation-potential for pulpal embarrassment inlay - within cusps onlay- - covers cusps 3/4 and 7/8 crowns - hybrid between onlay and full crown conserves tooth structure less restoration margin in close proximity to gingival tissues more easily seated during cementation occlusal schemes - occlusal point contacts preferred to be broad and flat to prevent wear cusp marginal ridge- seen in class I occlusion cusp fossa- seen in class II malocclusion Oral Pathology - Mental Dental Cleft lip - approx 1 in 1000 births unilateral (80%) bilateral (20) lack of fusion between medial nasal process and maxillary process Cleft palate - 1 in 2000 births lack of fusion between palatal shelves lip pits - invaginations at commissures or near midline Van der Woude Syndrome=clefts and pits fordyce granules - ectopic sebaceous glands leukoedema - white or whitish gray edematous lesion of buccal mucosa dissipates when cheek is stretched lingual thyroid - thyroid tissue mass at midline base of tongue located along embryonic path of thyroid descent thyroglossal duct cyst - midline neck swelling located along embryonic path of thyroid descent geographic tongue - migratory glossitis and erythemia migrans white annular (ringed) lesions surrounding central red islands that migrate over time occasionally hurt and burn Tx: none fissured tongue - folds and furrows of tongue dorsum Melkersson Rosenthal Syndrome= fissured tongue+granulomatous cheilitis+facial paralysis Angioma - tumors composed of blood vessels or lymph vessels hemangioma - congenital focal proliferation of capillaries most undergo involution but persistant lesions are excised Lymphangioma - congenital focal proliferation of lymph vessels -oral lymphangiomas are very rare, purple spots on tongue called a cystic hygroma when occurs in the neck sturge weber syndrome= angiomas of leptomeninges(arachnoid and pia mater) + skin along the distribution of the trigeminal nerve dermoid cyst - mass in midline floor of mouth if above mylohyoid mass in upper neck if below mylohyoid contains adnexal structures like hair and sebaceous glands doughy consistency branchial cyst - lateral neck swelling epithelial cyst within lymph node of neck oral lymphoepithelial cyst - epithelial cyst within lymphoid tissue of oral mucosa palatine and lingual tonsils are common regions stafne bone defect - radiolucency in posterior mandibular canal due to lingual concavity of jaw nasopalatine duct cyst - heart shaped radiolucency in nasopalatine canal caused by cystification of canal remnants Tx: excision Globulomaxillary lesion - latent in trigeminal ganglion recuurent--> herpes zoster aka shingles Ramsay Hunt Syndrome= herpes zoster reactivation in geniculate ganglion affecting cranial nerves VII and VIII resulting in facial paralysis, vertigo, deafness Tx: acyclovir coxsackie virus - hand foot and mouth disease herpangina-- posterior oral cavity (soft palate, throat and tonsils) Measles (Rubeola) - Koplik's spots (buccal mucosa dot ulcers) precede skin rash primary--> self limiting and childhood Papilloma (Wart) - caused by several strains of HPV Benign epithelial pedunculated or sessile proliferation on skin or mucosa Verruca Vulgaris - caused by several strains of HPV Common skin wart Condyloma Acuminatum - caused by HPV 6 and 11 genital wart or from oral sex with someone with genital warts Tx: excision with high recurrance Focal epithelial hyperplasia (Heck's disease) - caused by HPV 13 and 32 multiple small dome shaped warts on oral mucosa Tx: excision with excellent prognosis Oral Hairy Leukoplakia - caused by EBV white patch on lateral tongue that does not wipe off opportunistic infection associated with HIV associated with Burkitts lymphomia Syphillis - caused by contact with Treponema pallidum primary lesion--chancre secondary lesion- oral mucous patch, condyloma latum, maculopapular rash tertiary lesion--gumma, CNS involvement, CV involvement congenital syphilis- hutchinson's triad (notched incisors and mulberry molars, deafness, ocular keratitis Tuberculosis - caused by inhalation of Mycobacterium tuberculosis oral nonhealing chronic ulcers follow lung infection primary--> Gohn complex (inhaled bacteria surrounded in granuloma that undergoes caseating necrosis and infected hilar lymph node draining the first lesion) Hilum= root of the lung secondary= more widespread lung infection with cavitation miliary= systemic spread HIV patients are at high risk of getting progressive disease Tx: multidrug therapy (isonizid, rifampin, ethambutol) Gonorrhea - caused by neisseria gonorrhoeae oral pharyngitis rarely seen Actinomycosis - caused by Actinomyces israelii (filamentous) NOT FUNGAL opportunistic infection, chronic and granulomatous periapical--jaw infections cervicofacial- head and neck infections sulfer granules in purulent exudate tx: long term high dose penicillin Scarlet fever - caused by group A step (streptococcus pyogenes) this is when strep throat becomes a systemic infection strawberry tongue= white coated tongue with red inflamed fungiform papillae Tx: penicillin Candidiasis - also known as thrush pseudomembranous-white plaque that rubs off atrophic- red median rhomboid glossitis-loss of lingual papillae angular cheilitis- corner of mouth Tx: antifungal (azole or statin) Deep fungal infections - blastomycosis- US northeast, spores Coccidiodomycosis- US SW, valley fever Cryptococcosis- US West Histoplasmosis- US Midwest Apthhous ulcer - canker sore nonheratinized minor- heal without scarring major- heal with scarring Sutton Disease- another name for major form Behcet's syndrome= multisystem vasculitis that causes aphthous type ulcers of oral and genital and inflammation of eye Tx: corticosteroids for Behcets hyperthyrodism - teeth have bulbous crowns with a cervical constriction, partially or completely obliterated pulps and narrower or shorter roots, may be linked to dentinogenesis imperfectia Tx: no known cure hypophosphatasia - resembles osetogenesis imperfectia. its an inherited metabolic chemical bone disease that resulrs from LOW LEVELS OF ALKALINE PHOSPHATASE (enzyme essential to the calcification of bone tissue) loosening, hypocalcification and premature loss of deciduous teeth are characteristic radiographically, large pulp chambers and alveolar bone loss are present Pagets disease - a commone, chronic, non metabolic bone disorder characterized by an increase in serum alkaline phosphatase levels bones become enlarged and deformed, dense, but fragile due to excessive breakdown and formation of bone has potential to undergo spontaneous malinant transformation COTTON WOOL on pan effects males and females equally, but rarely under 40 yo signs and symptoms: pain in affected area, bone deformity and susceptibility to fractures in the affected area, headache and heaing loss. occur slowly increase in hat size or need for new dentures bones warm to touch due to increased vascularity lab tests show highly increased serum alkaline phosphatase, urinary calcium, and hydroxyproline with normal levels of serum phosphate and calcium tx: anti metabolites or CALCITONIN ti decease bone resportion or teat with a high protein and high calcium diet osteomalacia (adults rickets - softening of bones in adults because osteoid tissue in bones failed to calcify due to lack of vitamin D. more common in women and may be asymptomatic until a bone fracture occurs Steatorrhea- one of the most common causes of osteomalacia due to fat malabsorption where the body cannto absorb fats so ats are passed directly out of the body in stool causing poor absorption of vitamin D (fat soluble) and calcium osteomalacia affects all bones, specifically at their epiphyselal growth plats Rickets - causing skeletal deformities and usually accompanied by irritability and generalized muscle weakness bowlegs, pigeon breast, and protruding stomach are signs. teeth are affected by delayed eruption, maloccllusion, and developmentla abnormaliites of dentin and enamel with a higher caries rate cerebral palsy - a group of disorders affecting body movementand muscle coordination due to an insult of anomaly of the barins motor contorl centers spastic paralysis over voluntary muscles no oral pathologic manifestations are present but several conditions are more common or severe including: high incidence of peio, caries, bruxism and malocclusion prone to ginigival hyperplasia if Dilantin is used to control seizures more suspectible to trauma, especially max anterior teeth down syndrome - a congenital defect caused by chromosmal abnormality Trisomy 21, marked by various degrees of mental retardation and characteristic features: short, flattened skill, slanting eyes, thickened tongue/fissured , broad hands/feet) oral manifestations: mandibular prognathism, increased periodontal disease, thickened or fissured tongue, delayed teeth eruption, high incidence of congeitally missing teeth, malocclision and enamel dysplasia muscular dystrophy - a group of genetic diseased marked by progressive weakness and degeneration of skeletal or voluntary muscles that control movement oral manifestations: increase in dental disease of OH is neglected, weakness in muscles of mastication causeing decreased maxillary biting force, higher incidence of mouth breathing and open bite ectodermal dysplasia - hereditary condition characterized by abnormal development of the skin and associated structures involves all structures derived from extoderm Males:> females manifests orally as reduced/missing teeth clinical signs: hypothrichosis (decrease in hair) anhidrosis (no sweat or sebaceous glands, causing heat intolerance), anodontis (complete absence of teeth) oligodontia (partial absence of teeth), no tooth buds of the primary or permanent dentition, depressed nose bridge, lack of salivary glands. child apprears much older affects tooth bud development causing congenitally missing teeth, and peg shaped teeth, enamel may be defective tx: dentures for childrem, or implants upon complete growth cleidocranial dysplasia (dysostosis) - gentic disorder of bone development characterized by absent or incomplete formed COLLAR BONES, heavy protruding jaw, wide nasal bridge, and dental , abnormalities, (malalinged teeth, multiple supernumerary teeth and unerupted teeth) Pierre-robin syndrome - an inherited disorder with the following findings in the neonate: -micrognathia-smallness of the jaws -glossoptosis- downward displacement or retracted tongue - breathing problems and cleft palate lateral cefting of the lip - results from failure of the maxillary and frontal nasal process to merge cleft lip occurs during the 5th-6th week of embryonic life cleft palate - occurs in 6-8 week of embryonic life isolated cleft palates are more common in females, characterized by a fissure in the midline of the palate due to failure of the two sides to fuse during embryonic development. the most severe handicap caused by cleft palate is an impaired mechanism preventing normal speech and swallowing this speech problem is due to the inability of the soft palate to close airflow into the nasal area cherubisn - benign genetic autosominal dominant diease. typically by age 5 (males 2:1) most occur in the mandible. the jaws are firm and hard to palpation and regional lymphadenopathy may be present. Bilateral expansion of the jaws gives the child a very round face. the tumors stop growing shortly after puberty histologically:: lesions closely resemble central giant cell granulomas. Perivascular collagen cuffing is pathognomonic for cherubism tx: none scleroderma - a relatively rare autoimmune disease affecting the blood vessels, and CT characterized by hardness and rigidity of the skin and subcutaneous tissue clinical features: middle age in females!. the skin is affected first and becomes indurated wegeners granulmoatosis - allergic reaction to inhaled antigen strawberry gingivitis tx: corticosteroids and cyclophosphadmie ginigval cyst of the newborn - bohns nodules= lateral palate epstein pearls- midline palats rests of dental lamina- epithelialize the small lesions sjogrens syndrome has been linked to what malignacy - lymphoma HPV has been found in all the follong lesions except one. what is the exception a. oral papillmoas b. verucca vulgaris c. condyloma latum d. condyloma acuminatum e. focal epithelial hyperplasia - condylmoa latum its secondary syphillis conservative surgival excision woul dbe appropriate treatment and probably curative for which of the following? - nodular facilitis which syndrome classically contains lesions on oral, ocular and genital regions - Behcets syndrome the odontogenic neoplasm which is composed of loose, primitive appearing connective tissue that resembles dental pullp is known as - odontogenic myxoma which of the following odontogenic cysts occurs as a result of stimulation and proliferation of the reduced enamel epithelium - dentigerous cyst two cystic radiolecencies in the mandible of a 16 yr old boy were lined by thin parakeratinized epithelium showing palisading of basal cells. all teeth were vital, and pt had no symptoms. what is likely the cause - OKC when a diagnosis of OKC is made, the pt should be advised regarding the ____ - associated recurrence rate 15 yr old pt has a numb lower lip and pain in right posterior mandible. radiograph shows uniform thickening of periodontal membrane in space of tooth 30. abnormamly increaded mobility. what dx - malignancy when you read numb lip--cancer! oral traumatic neuroma - a soft tissue tumor due to trauma to a peripheral nerve, usually appearing as a very small nodule of the mucosa near/over the mental foramen on the alveolar ridge in edentulous areas.!! but they can occur whereever a tooth has been extracted may be due to trauma from a surgical procedure painful when palpated as applied digital pressure elicits a response described as electic shock multiple neuromas on the lips, tongue or palata may indicate MEN III Tx: surgical excision of nodule neurilemoma (schwannoma) - a benign soft tissue tumor of Schwann cells around the nerve that presents as an asymptomatic lump most common on the TONGUE!. covered by normal mucosa, sessile and does not metastiase but still do biopsy Tx: conservative excision neurofibroma - may be derived from schwann cell or perineural fibroblast and can be of 2 forms 1. solitary neurofibroma- an asymptomatic nodule on the tongue, buccal mucosa or vestibule treated by surgical excision 2. multiple lesions as part of the neurofibromatosis syndroms fibroma - MOST COMMON INTRA ORAL BENIGN neoplasm oF CONNECTIVE TISSUE most common tumor in the oral cavity most common on buccal mucosa, lateral border of tongue, and lower lip peripheral fibroma - well demarcated focal mass of hyperplastic tissue with either a sessile or pedunculated base 3 forms 1. peripheral ossifying fibroma- gingival mass with visible characteritic calcified islands of bone and an ulcerated surface. the gingivia naterior to th epermanent molars is most often affected. Young adult females 2. peripheral odontogenic fibroma- ginigval mass composed of well vascularized non encapsulated fibrous CT 3. giant cell fibroma- a fibrous hyperplasia composed of multi nucleated CT cells giant cell tumor - a bone tumor of multi nucleated giant cells that resemble osteoclasts scattered in a matrix of spindle cells papillary fibroma - a benign neoplasm of CT origin lipoma - completely benign tumor derived from adipose fat tissue yellow white nodular mass. floor of mouth, buccal mucosa, and tongue floats in formalin rhabdomyoma - a rare benign tumor of skeletal muscle tongue is most common sessile nonpainful and covered by normal mucosa leiomyoma - benign tumor or smooth muscle. non painful, sessile lymphangioma - a benign yellowish tan tumor composed of a mass of dilated lymph vessels most common site is the tongue painless, nodular, vesicle like swelling that equally affects both sexes papilloma - metastases to the jaws most commonly oirginate from primary carcinoms of breat, kidney, lung, colon, prostate and thyroid. least likely to originate from the brain paresthesia or anesthesia of the lip or chin most common osseous malignancies - osteosarcomas--> chondrosarcomas --> fibrosarcomas and ewings sarcome osteosarcoma - malignant bone tumor of anaplatic cells derived from mesechyme most common primary malignant tumor of bone, arising in long bones SUNBURST peak incidence is before epiphyseal fusion symmetrically widened PDL space. mixed RL RO Erwings sarcoma - malignant tumor developing from bone marrow, usually in long bones or pelvis of adolescent boys (10-20 years). highly lethal malignan neoplasm of bone pelvis, thigh and body trunk are most common sites MOTH EATEN, ONION SKIN intermittent pain and swelling of bone are earliest clinical signs and symptoms cells contain GLYCOGEN multiple myeloma - PUNCHED OUT fatal malignant neoplasm/lesion of bone marrow and plasma cells. elevated Bence JOnes Protein and multiple radiolucent areas in the mandible and skull 40 + years old. Males 2x- females mandibular molar ramus area is the most cmomone intra oral site lateral skull radiograph best confirms odontogenic myxoma - rare slow growing, usually asymptomatic mantibular tumor patients are usually <35 years of age causes localized jaw expansion tx: curettage osteochondroma - benign tumor of bone and cartilage melanoma - exhibits a radial (horizontal) or vertical growht phases in skin 1. radial growth phase- the inital growth phase of melanoma just above and below the dermoepidermal junction in a horizontal plate 2. vertical growth phase- begins when neoplastic cells populate the underlying dermis. characterized clincally by an increase in size, change in color, nodularity and ulceration. Metastasis is possible when the melanoa reaches this phase malignant melanoma - the most severe and potentially serious type of skin cancer often developed from or near a mole skin cancer is the most common malignancy in the US uncommon in the oral cavity but has a prediclection for the hard palate and maxillary alveolar ridges(hard palate is the most common intra oral site) 4 types of melanoma - 1. superficial spreading- most common form. lesion is tan, brown, black or admixed 2. nodular- there is no radial growth-- only vertical. more often on back head and neck of men 3. lentigo maliga melanoma- most common in the elderly population 4. acrolentiginous melaoma- occurs on hands and feet nevus - nearly all moles are normal acquired nevi - hard palate 5 subtypes 1. intramucosal nevus- most common in oral cavity 2. blue nevus- second most common 3. compound nevus- very rare. raised and solid 4. junctional nevus- rare in the oral cavity. interface between the epihtlium and lamina propria 5. intradermal nevus- the most common lesin of skin basal cell carcinoa - a malignant epithelial cell tumor that begins as a papule that enlarges peripherally forming a central crater that erodes, crusts and bleeds only found on the skin, and never in the mouth due to excessive sun exposure most common skin cancer. rarely produces metastasis squamous cell carcinoma - most common malignancy in the oral cavity!!!! a malignant epithelial tumor that is twice as prevalane in males more common on the lower lip than intra orally. the most common intra oral site is the lateral border and ventral surface of the tongue. floor of the mouth is the second most common intra oral site with the worst prognosis metastasis occurs via the cervical lymphatics three types of SSC - 1. verrucous carcinoma 2. carcinoma in situ 3. carcinoma invasive verrucous carcinoma - rare form of SSC. does not metastasize men 60+ whitish cauliflower or coal like papillay appearance slow growth pattern non aggressive, very well differentialed tumor that does not metastasize can be seen on the upper alveolar ridge carcinoma in situ - located only inside epithelium, atypical mitosis, hyperchromatism dentin pulp, and cementum are not affected by AI AI will only show pulp obliteration if there is advanced abrasion with secondary dentin formation 1 Hypoplastic AI- enamel has not formed to full normal thickness. defective formation of the enamel matrix 2. hypomaturation AI-immature crystallites 3. hypocalcifed AI- quantity of enamel is normal but so soft it can be removed during prophylaxis due to the defective minerralization of the enamel matrix dentinogenesis imperfecta - rare disorder found in only 1: 7000 children mesodermal defect of dentin opalescent hue pulp chambers completley obliterated type 1- blue sclara type 2- most common. no bone involvement type 3- only a dentin abnormally exists. there are clinical and radiographic variations that include multiple pulp exposures in the primary dentition dentin dysplasia - normal enamel, atypical dentin, pulpal obliteration, defective root formation, multiple periapical radiolucencis type I- radicular- more common type involving both dentitions.mobile teeth. root dentin is disorented. pulpal obliteration by excess dentin. chevron shaped root chambers type II- coronal involves both dentitions. bluish gray opalescent appearance. obliterated pulp chambers anodontia - total abscence of teeth oligodontia - congential absence of many but not all teeth hypodontia- - absence of only a few teeth actinic cheilits - a pre malignant condition cause by chronic and excesisve exposure to the UV sunlight there is a thick whitish discoloration of the lip at the border of the lip and skin may lead to SCC so must be treated filiform papillae - most numerous. small cones in the v shaped rows paralleing the sulcus. no taste buds fungiform papillae - scattered among filiform papallie. flattened mushroom shaped and found mainly at the tongue tip and lateral margins. have taste buds circumvallate papillae - the largest, least numerous papillae. circular shaped arranged in the inverted v shaped row toward th eback of the tongue. associated with ducts of von ebners glands. have taste buds foliate papillae - found on the lateral margins as 3-4 vertical folds. have taste buds purpura - hemorrhages in the skin and mucous membranes that cause the appearance of purplish spots or patches thrombocytopenic purpura (Werlhof's disease) - a bleeding disorder characterized by a deficiency in the number of platelets resulting in multiple bruises, petechiae and hemmorrhage into the tissues may be caused by heparin (warfarin ) therapy thrombocytopenia - dominated clinically by petechiae cutaneous bleeding, intra cranial bleeding and oozing from the mucosal surfaces characterized by decreased platelt count causing prolonged bleeding time. the most common cause of bleeding disorders idiopathic throbocytopenic purpra - a bleeding disorder due to a deficiency in the number of platelets causing multiple bruises, petechiae, and hemorrhage bleeding time is abnormally prolonged thrombotic thrombocytopenic purpura - a severe and fatal form characterized by thrombocytopenia, hemolytic anemia, renal insufficiency, fever and neurologic ambornamlities.. low platelet count in the blood and thrombosis in the terminal arterioles and capillaries of many organs prolonged bleeding time conditions - a patient taking Dicumarol- inhibits formation of prothrombin in the liver a patient taking heparin- acts as an antirhombin by preventing platelet aggregation idiopathic thrombocytopenic purpura often assoicated with leukemia von willebrands disease- deficiency of vWF results in impaired platelet adhesion long term treatment with asprin agranulocytosis - an abnormal condition due to severe reduction in the number of granulocytes caused by ingesting a drug prounced leukopenia WBC <2000 with almost complete absence of PMN neutrophils begins with high fever, chills and sore throat necrotizing ulcerations of the oral cavity eliminate the causative drugsic sickle cell anemia - a chronic disease marked by crescent shaped red blood cells characterized by fever, leg ulcersm jaundice and episodic pain due to production of abnormal hemoglobin (hemoglobin S) due to a genetic defect primary affects african americans radiographs show enlarged bone marrow medullary spaces because of loss of many bony trabeculae lamina dura and teeth are unaffected leukemias - cancers of white blood cells with most of unknown cause. uncontrolled proliferation of leukocytes causing a diffuse and almost total replacement of the red bone marrow with leukemic cells classified by the dominant cell type and by duration from on set to death. ionizing radiation, viruses (epstein barr) and genertic mutations (philidepphia chromosome 22 and 9) oral manifestations: oral lesions. the most common is seen in acute monocytic leukemia. where 80% have gingivitis, gingival hyperplasia, petechiae and hemmorhage myelogenous leukemiai - involves granulocytes and megakaryocytes. Philadelphia chromsome and low levels of leukocyte alkaline phaoshpathase. CML is characterized by uncontrolled proliferation of immature granulocytes lymphocytic leukemia - lymph node enlargemtne acute lymphocytic (lymphoblastic)= most common in children after an attack of herpes zoster involves CN 7 and geniculate ganglion that produces Ramsey Hunt Syndrome myasthenia gravis - a chronic condition of extreme muscle weakness due to an autoimmune disorder where the body creates antibodies against its own nicotinic ACh receptors in the neuromuscular junctions muscles are quicly fatigues with repetitive use flattened smile and droopy eyes xerostomia and rampant caries may be present because ACh needed for proper transmission of nerve impulses is destoryed, so salivary glands no not recieve adequate stimulation eaton lambert syndrome - Similar to myasthenia gravis, but is caused by inadequate release of Ach freys syndrome (auriculotemporal syndrome) - an uncommon phenomenon due to damage to the auriculotemporal nerve can occur after surgery gustatory sweating is the chief complaint Bells Palsy - facial paralysis from damage to Facial nerve sudden onset but paralysis begins to subside in 2-3 weeks branchiogenic cyst - arises from the persistence of the second branchial arch cleft cyst is located along the anterior border of the sternocleidomastoid muscle at any level in the neck tx: surgical excision dermoid cyst - relatively uncommon cyst in the oral cavity. this cyst contains hair, sebaceous and sweat glands and tooth structures most common site is the floor mouth thyroglossal duct cyst - found in midline position and is usually dark colors and may be vascular resembling a hemangioma hemorrhage into the mouth is a common and important symptom tx: complete excision of the tract to the base of the tongue non odontogenic fissural cysts (developmental cysts) - nasopalatine, nasoalveolar,median palatal and globulomaxillary cysts nasopalatine duct cyst (incisive canal cyst) - oval or heart shaped radiolucency in the midline of the hard palate most common non odontogenic /developmental /fissural cyst teeth are vital tx: surgical excision/enucleation radiographically: a circular (round) well demarcated oval or heart shaped between and above the maxillary central incisors. the lesion crosses the midline palatine papilla cyst - the soft tissue variant of the nasopalatine duct cyst nasolabial cyst (nasoalveolar cyst) - a soft tissue cyst of the upper lip superficially located in soft tissue of the upper lip that histologically develops from epithelial remnants from the inferior and anterior portion of the nasolacrimal duct cannt see this cyst on a radiograph globulomaxillary cyst - an inverted pear shaped radiolucency in bone between the roots of the maxillary lateral and canine (often causes roots of the involved teeth to diverge) usually asymptomatic . regional teeth are vital occurs within bone inverted pear shaped radiolucency median palatal cyst - rare but may occur along the median palatal raphe, usually in the hard palate midline, posterior to the pre maxilla may produce swelling on the palate. clinically this lesion presents as a firm, painless swelling median alveolar cyst - rare, but occurs in the bony alveolus between the central incisors distinguished from a peripical cyst by the fact that the adjacent teeth are vital lateral periodontal cyst - inflammatory in origin. forms along vital tooth lateral surface 95% along the mandibular canine premolar area radiographic: well defined, round or tear drop shaped radiolucency with an opaque margin radicular cyst - MOST COMMON ODONTOGENIC CYST mostly found at the root apex asymptomatic. tooth is necrotic, can be sensitive to percussionnnn residual cyst - occurs when a tooth with a radicular cust is extracted but the radicular cyst is left undisturbed and persisits within the jaw now as a residual cyst to prevent a residual cyst, you must curette the radicular cyst out of the tooth socket after extraction dental granuloma - the most common sequelae of pulpitis at the root apex. only distinguished from a radicular cyst histologically asymptomatic necrotic tooth but may be percussion sensitive dentigerous cyst - an odontogenic cysts always associated with the crown of an unerupted or developing tooth or dental anomaly most commonly found with a developing 3rd molar the bulging the cyst produces on the ridge is an eruption cyst found in children and teenagers 2nd most common odontogenic cyst eruption cyst - a soft tissue variant of the dentigerous cyst, invariably associated with an erupting tooth reddish pink or bluish pink black, fluctuant, localized swelling of the alveolar ridge over the crown of an erupting primary or permanent molar primoral cyst - aka follicular cyst well defined, oval radiolucent lesion that differs from other cysts since it contains no calcified structures found in the mandibular 3rd molar space found in place of a tooth rather than direclty associated with a tooth more common in young adults well circumscribed and demarcated from surrounding bone teeth displacement histocytosis X - disorders where abnoramal scavenger immune system cells hitiocytes and eosinophils proliferate in the bone and lungs causing scars to form eosinophilic granulmos - most benign form of histicytosis x males 20-40 yo may be totally asymptomatic but there may be locla pain or swelling especially if bone fracture occurs teeth on the affected side being loose and gingivitis pneumothorax is a common complication Letterer-Siwe disease - malignant histiocytosis <2 yrs old; diffuse eczematous rash; organ involvement damage to lungs usually fatal without treatment hand schuller cristian disease - early childhood -- boys triad of symptoms: exophthalmos, diabetes insipidus and bone destruction oral signs: bad breath, sore mouth, loose teeth Verruciform Xanthoma - Hyper plastic epithelium of mouth, skin, and genitalia, lipid-laden macrophages beneath epithelium, papillary but not associated with HPV ameloblastoma - most common epithelial odontogenic tumor! enlargement may spread to the buccal, lingual cortical plates of bone or palatal bone plates unerupted mandibular 3rd molar is associated with the radiolucent defect often assoicated with unerupted teeth mainly in the posterior body and angle of the mandible SOAP BUBBLE irregular scalloped margins Adenomatoid odontogenic tumor - a benign tumor of ectodermal origin children and teenagers females 2x anterior maxilla snowflake calcifications calcifying epithelial odontogenic tumor (Pindborg tumor) - a rare lesion purely from ectoderm 30-50 years old mandible (molar-pm area), painless, slow growing swelling is the most common clinical sign scalloped margin impacted tooth (3rd molar mandib) squamous odontogenic tumor - rare benign odontogenic tumor from ectoderm painless or mild painful gingival swelling assoicated with tooth mobility radiolucency lateral to the roots of an unerupted or erupted tooth cementoma - benign tumor that occurs most frequently in anterior mandible and affects multiple vital teeth an unusual response of the periapical bone to some loca factor no tx required occurs at apex or vital anterior teeth. women over 30 (especially black women) stage 1- lesion is periapical radiolucency stage 2- lesion begins to calcify and become more radiopaque (mixed) stage 3- well defined radiopacity borded by a thin radiolucent line benign cementoblastoma - males under 25 years mandibular pm or molars tooth is vital well demarcated, mottled or densely radiopaque mass with radiolucent periphery attached to the root causing the root resorption tx: extract the involved tooth giantiform cementoma - affects middle aged black women. multiple, often symmetrical , may cause jaw expansion large dense lobulated readiopaque masses odontogenic myxoma - an aggressive tumor derived from the papilla, dental sac or PDL adults 30-40 yrs as a painless welling in the mandible tx: curettage with cautery. high rate of recurrence if inadequatly treated odontogenic fibroma - derived from dental papilla, dental sacor PDL occurs as a painless welling in the mandible of children and young adults multilocular or unilocular that may be associated with unerupted or displaced teeth centifying fibroma - well defined radiolucency with scattered radiopaque foci occurs in the mandible of adults as a painless welling odontoma - any odontogenic tumor often assoicated with an unerupted tooth. 14 years old complex odontoma - radiopaque mass with a thin radilucent rim at the junction most common in the posterior mandible 20-30 years in mandib pm/molar area asymptomatic but may delay eruption of permanent teeth palate most common site Cribriform/ swiss cheese microscopic pattern spreads through perineural spaces MINOR SALIVARY GLANDS OF PALATE! Acinic cell carcinoma - Low-grade malignancy that consists of mature-appearing serous acinar cells; low clinical aggressiveness PAROTID GLAND Mucoepidermoid carcinoma - in the parotid gland pt usually asymptomatic swelling with a peak incidence in the 3rd decade of life facial weakness or paralysis conditions assoictaed with Parotid gland enlargement - diabetes mellitus, sjogrens syndrome, warthins tumor, ninfections, benign lymphoepithelial lesion, acute epidemic parotitis, malnutrition oncocytomas - a small, benign, rare glandular tumor composed of large cells with a granular and eosinophilic cytoplasm due to the presence of many mitochrondria development may be due to aging process cells have bright pink cytoplasm sialoscintigraphy - a simple, non invasive procedure that seperates benign tumors of the salivary glands from malignant tumors and greatly affects the course of treatment Warthin's tumor - benign parotid tumor arising from heterotopic ductal epitheliium within lymph nodes or near the parotid gland cigarette smoking 60-70 yr nodule over angle or ramus of the mandible pleomorphic adenoma - Most common benign salivary gland tumor Mix of more than one cell type ( epithelial and ct) Palate is most common site for minor gland lesions stevens johnson syndrome - a severe bullous form of erythema multiforme where systemic symptos are severe acute onset of fever, and eruptive ulcerative lesions on skin, oral mucosa and eyes BULLS EYE SHAPED LESIONS tx: IV fluids, systemic steroids, pallative rinses and antibiotics erythema multiforme - allergic hypersensitivity in response to medications, infections and illness damaged skin blood vessels with subsequent damage to skin tissues bulls eye shaped lesion actinomycosis - a subacture to chronic bacteria infection with Actinomycoses which are gram positive filamentous bacteria that are normal inhabants of the oral cavity SULFER GRANULES chronic suppurative lesions about the jaws lumpy jaw! histoplasmosis - disease caused by fungi histoplasma capsulatum primarily affect the lungs may produce a benign, mild pulmonary illness Syphilis - Treponema pallidum 1 primary : non painful ulcer/canker that appears 26 weeks after exposure 2: a highly infectious stage that occurs 6 weeks after non treatment of primary syphilis. skin rash with brown penny sized sores 3. tertiary : a gymma! Congenital syphilis - infection by spirochete bacteria treponema pallidum during the fatal period 50% of infants infected dueing gestation die shortly before or after birth newborn symptoms: saddle nose, frontal bossing, short and high maxilla older infant: hutchinsons incisors, peg shaped incisors no chancre!! herpes simplex type 4 - caused by epstein barr causes mono and hairy leukoplakia burkitts lymphoma (HSV 4) - EBV non hodgkins lymphoma with a viral etiology endemic in africa! moth eaten appearance with poorly marginated bone destruction older abdominal mass and intestinal obstruction first human cancer with strong evidence of viral etiology herpes simplex type 8 - kaposis sarcome HIV>AIDS superficial cancer of the skin, multiple made of blood vessels and is negative to pressure test red lesions to the hard palate hand foot and mouth disease - viral infection (coxsackie A) that affects infants and children produces red erythematous lesions in mouth, foot and hands fever , malaise, vomitting and fatigue Benign Mucous Membrane Pemphigoid - oral and ocular mucous membranes women 50+ better prognosis than pemphigus desquamative gingivitis most scattered x rays in diagnostic x ray imagine arise from Compton scattering. a leaded, rectangular cone best reduces the amoutn of scatter radiation collimnation - the control of the size and shape of the x ray beam radiation beam be as small as practical the diamater of a circular beam of radiation at the patients skin can not be longer than 2.75 inches short wavelength (high energy) x rays - have great penetrating power produced at higher kilovoltages and penetrate objects more readily form the image on the film long wavelength (low energy) - produced at lower kilovoltages thus have low penetrating power (are easily absorbed) aluminum discs are used to filter out these useless long wave rays to increase the overall quality of the x ray beam filtration - removal of parts of the x ray sepctrum using absorbing materials in the x ray beam filtration reduces patient dose, contrast and film density inherent filtration - the filtration of an x ray beam by any parts of the x ray tube or tube shield thorugh which the beam must pass the parts include the glass envelope of the x ray tube and OIL surrounds the x ray tube to cool the tube to dissipate heat added filtration - obtained by placing thin sheets of aluminum in the cone to filter the useful beam further, increase in quality decrease in quantity total infiltration - of the xray beam before it reaches the patient consists of the inherent filtration + added filtration. the recommended total is the equilvant of .5 mm (below 50 kvp_ and 2.5 mm over 70 kVp of aluminum when taking radiographs the operator should stand at least - 6 feet away from the patient ekta speed film - most effective way to reduce exposure time, amount of radiation reaching the patient and the amount of scatter radiation max exposure of radiation per year - 5 REM (.1 REM per week) sequence of radiation injury - 1. latent period period of time between radiation exposure and onset of symptoms 2. period of cell injury- comes after the latent period. cellular injury may cause cell death , changes i cell function or abnormal mitosis of cells 3. recovery period- some cells recover from the radiation injust, expically if radiation is low level effects of radiation are - addative what tissue is the most sensitive to radiation - hemopoietic tissue Roentgen (R) - the traditional unit of radiation exposure measure in air only applies to x rays and gamma rays what is the main reason to take bitewings? - to detect interproximal caries what angulation should vertical bitewings be - +8 and +10 degrees Submental vertical x ray - designed to diagnose basilar skull fractures and provides info about the zygoma, zygomatic arches and mandible Waters view - the standard radiograph of choice for showing an anterior view of the paranasal sinus and of th emid face and orbits water is one of the best films for radiographic diagnosis of mid facial fractures , sinus infections and lesions of the max sinus Townes view - the best view to visualize the condyles and neck of mandible from an AP projection assess the condyles, condylar neck and rami reverse townes view - used to idenify fractures of the condylar neck and ramus area developer solution - a chemical solution that converts the invisible image on a film into a viisble image composed of minute masses of black metallic silver. its function is to reduce silver halide crystals to black metallic silver x ray developming solution contains 4 chemicals - 1. developing agent (hydroquinone) - a chemical compound capable of changing the exposed silver halide crystals to black metallic silver. gives detalis to the x ray image 2. antioxidant preservative (sodium sulfite)- prevents developer solution from oxidizing in the presence of air 3. accelerator (sodium carbonate)- an alkali that activates the developing agents and maintains the alkalinity of the developer at the correct value 4. restrainer (potassium bromide)- is added to developers to control the action of the developing agent so it does not develop the unexposed silver halide crystals to produce fog as the developing solution gets weaker, the films get - lighter x-ray fixing solution - stops development and remove remaining unexposed crystals 1. clearing agent( sodium or ammonium thiosulfate) 2. antioxidant preservative (sodium sulfite)- prevents decompostion of the fixer chemical 3. acidifier (acetic acid)- correct action of other chemicals and neutralizes any alkaline developer 4. hardner (potassium alum) shrinks and hardens the gelatin in the emulsion after processing a film, it appears brown.... - its because the fixing time was not long enough incorrect vertical angulation - foreshortening- teeth appear too short elongation- most common error. teeth appear too long horizontal angulation error - overlapping-interproximal areas are overlapped due to incorrect horizontal tube angulation cervical burnout - caused by relatively low x ray absorption on the mesial or distal surfaces, between the edges of the enamel and adjacent crest of the alveolar ridge inverse square law- - only non ionized (free base) form can penetrate neuron membrane critical length ( better when 3 consecutive nodes of raniver are blocked Pharmacokinetics - Increased blood flow--> shorter duration of action increased lipid solubility/hydrophobicity--> more potent, longer duration of action increase protein binding--> longer duration of action decrease pKa--> faster onset of action Mepivicane: 7,6m lido, prilo and articane 7.8 and bupivicaine: 8.1 calculating local anesthetic - 1 mL of liquid at sea level weighs 1 g carpule/cartrige of anesthetic contains 1.8 mL so one carpule is 1.8 g for 1% LA, then 18 mg then multiple by whatever percent of the anesthetic you are using ex: 2% lido= 36 mg 4%articaine= 72 mg a carpule of 2% lidocaine solution with 1:100,000 epi would contain how much epi in mg - for .001% epi, = .018 mg vasoconstrictor - 1. prolong numbness 2 reduce toxicity 3. promote hemostasis toxicity - max epi for ASA 1: .2 mg max epi for cardio pt: .04 mg max lido w/o vasoconstrictor: 4.4 mg/kg max lido with vaso: 7 mg/kg slow injection - 1 carp per min needle dimensions - length: short= 20 mm long- 32 mm diamater 30 gauge- .3 mm blue 27 gauge- .4 mm yellow 25 gauge - .5 mm red IAN Block - highest failure rate Halsted= classif gow gates- open mouth akinosi- closed mouth numbs all mandib teeth and if lingual nevre bloacked then tongue. and soft tissue facial to anterior and pre molard buccal nerve block - done in tandem with IAN block to get soft tissue of molars mental nerve block - locate rubbery bundle with fingers apical to 2nd pm mental foramen by apices of premolars incisive nerve block - same as mental nevrve block except hold pressure for 2 mins after injection to force anesthetic into mental foramen PSA block - max molars 16 mm depth (half of length of needle high hematoma risk doesnt always do MB of max 1st molar infraorbital block - max anteriors and pm also called true ASA Block infraorbital foramen greater palatine nerve block - posterior hard palate greater palatine foramen nasopalatine block - hard palate from canine to canine most painful local infiltration - enter in vestibule aim for root apex works well in anterior because facial cortical plate is thin Sulfonamides - bacteriostatic (slows growth of bacteria) folate synthesis inhibitor (completes with PABA) Sulfadiazine, Sulfamethoxazole Fluoroquinolones - bactericidal DNA synthesis inhibitor Ciprofloxacin, Levofloxacin Penicillians - bactericidal cell wall synthesis inhibitor, B lactam cross allergenic with cephalosporins- because they are chemically related Penicillin G- IV more sensitive to acid degradation Penicillin V- oral amoxicillian-broad spectrum augmentin- amoxicillin_ clavolanic acid (beta lactamse resistant) methicillin/ dicloxacilin-B lactamase resistant ampicillin- best/broadest gram neg spectrum carbanicilli- used specifically against peseudomonas cephalosporins - bactericidal tetracycline what is associated with allergic cholestatic hepatitis - erythromycin estolate drug interactions - cidal and static drugs cancel each other out penicilin and probenecid tetracycline and antacids/dairy broad spectrum and anticoagulants antibiotics and oral contraceptives macrolides and seldane/digoxin drug concentration - clindamycin--> bone tetracycline-->gingival crevicular fluid Antivirals and antifungals - acyclovir and valcyclovir->herpes fluconazole, ketoconazole--> candidasis clotrimazole (mycelex) is in the troche form NSAIDS - nonsteroidal anti-inflammatory drugs limit or prevent inflammation Apirin (ASA) Cox 1 and 2 blocker (irreversible), GI ibuprofen (motrin/advil) - cox 1 and 2 blocker (reversible) kidney which two NSAIDs are only COX 2 blockers - Celecoxib and Meloxicam Acetaminophen Tylenol - inhibits pain in CNS, liver drug of choice in feverish child, whereas asprin can cause Reye's Syndrome max dose of ibuprofen - 3.2 g/day max dose of acetaminophen - 4g/day Therapeutic Effects of Aspirin - Analgesic-->inhibit COX 1 and 2 (PG synthesis) Anti inflammatory--> same Antipyretic (fevers)-->inhibits PG synthesis in temperature regulation center of hypothalamus bleeding time-->inhibit TXA 2 synthesis thereby inhibiting platelet aggregation toxic effects of aspirin - occult bleeding from GI tract tinnitis nausea and vomiting metabolic acidosis decreased tubular resorption of uric acid corticosteroids - prednisone, hydrocotrisone trimcinolone dexamthasone1 therapeutic effects of steroids - analgesic-->inhibit phospholipase A2 (AA synthesis) anti-inflammatory--Same side effects of steroids - gastric ulcers immunosuppressio acute adrenal insufficiency ( 20 mg for 2 weeks within 2 years of dental treatment) osteoporosis hyperglycemia redistribution of body fat Narcotics/opioids - mu opoid receptor agonists (in CNS) oxycontin- controlled release codeine- suppresses cough reflex, cough syrup tramadol- similar to codeiene meperidine (demerol) lethal if combined with a MAO) combined narcotics - vicoden- hydrocodone+ APAP Percocet= oxycodone+APAP Tylenol 1= 200 mg APAP + 8 mg Codeine tylenol 2- 300 mg APAP + 15 mg codeine tylenol 3- 300 mg APAP+ 30 mg codeine tylenol 4- 300 mg APAP + 60 mg codeine therapeutic and side effects of morphine - Miosis Out of it Respiratory depression Pneumonia Hypotension Infrequency Nausea and vomiting Euphoria and dysphoria overdose and addiction - Nalxone- inverse agonist, emergency naltrexone- antagonist, treat addition methadone- treat addiction pentazocine- mixed agonist antagonist nalbuphine-mixed agonist-antagonist buprenophine-mixed agonist-antagonist a nasal decongestant and mydriatic in ophthalmic preparations to treat chronic orthostatic hypotension 100 x less potent then EPI clonidine - alpha 2 selective agonist. used as a anti-hypertentive agent dobutamine - beta 1 selective agonist terbutaline - beta 2 selective agonist administered orally, subcutaneously or by inhalation primarily used in long term treatment of obstructive airway diseases or emergency treatment of bronchospasm emergency treatment of status asthmaticus and to delay premature delivery albuterol - beta 2 selective agonist primarly used in long term treatment of obstructive airway dieases, emergency treatment of bronchospasm or to delay premature delivery what is the doc to treat/reverse anaphylactic reactions - EPI isoproterenol - B1,2 agonist and the most potent bronchodilator if NE or EPI stimulate or combine with eye alpa receptors they cause - Mydrasis (pulpil dilation) indirect acting agonists (sympathomimetics - drugs that cause release of stored NE at post ganglionic nerve endings to produce their effects Tyramine, Amphetamine, Methamphetamine, hydrooxyamphetamine, methoxamine and ephadrine pharmaceutical agents that bring about tissue responses resembling those produce by stimulation of the sympathetic nervous system Amphetamines - sympathetic amines that stimulate CNS and PNS increase systolic and diasoltic blood pressures and act as weak bronchodilators and respiratoyr stimulants have high abuse potential pass rapidly into CNS and cause a rapid release of NE in the brain Methylphenidate (Ritalin) - a mild CNS stimulant that increases attention span, reduces hyperactivity and improves behavior in children with ADHD Concerta - a long acting form of Ritalin Adderal - ADHA mixture of dextroamphetamine and amphetamine strattera - first non stimulant approved for treating ADHD in children and adults narcolepsy - dextroamphetamine is used to prevent daytime sleepiness weight loss - phenermine is used sympatholytic agents - durgs that acts in a way opposite to sympathetic nervous systems. 4 types all treat hypertension Beta blockers - most common adverse effect are weakness and drowsiness treat hypertension, angina, cardiac arryhtmas, MI, glaucoma and prophylaxis of migrane Propranolol - treats hypertension decrease BP by decreasing CO nonselective B blockers are contraindicated in patients with asthma or other chronic obstructive airway disease as they cause fatal bronchospasm and in pt with insulin dependent diabates as they block hypoglycemia recovery BLOCKS BETA ADRENERGIC heart receptors Acebutolol - a B1 cardioselective antagonist that treats hypertension and controls ventricular arrhythmias. it has low lipid solubility which reduces its liklihood of producing adverse CNS effects Metoprolol - competitive B1 cardioselective to treat hypertension Alpha blockers - cause tachycardia, lower Bp, vasodilation and orthostatic hypotension any a antagonist can cause EPI reversal decreases BP , elicting reflex tachycardia act by competitively inhibiting catechloamine actions at the alpha receptor site to cause blood vessels to relax (dilate_ hypotension is the major adverse effect drugs that cause orthostatic hypotension - antihypertensives phenothiazines tricyclic antidepressants narcotics antiparkinsons drugs gamma blockers doxazosin - -Selective α1-blocker -Uses: urinary symptoms of BPH; -Hypertension -Toxicity: 1st-dose orthostatic hypotension, dizziness, headache longer duration of actino prazosin - selectivly blocks alpha 1 receptors and rarely used to treat hypertension due to unwanted adverse effects Terazosin - selective to block alpha 1 receptors to manage mild to moderate hypertension and treat benign prostate hyperplasia non selective alpha antagnoists - blocks alpha 1 and alpha 2 do not treat cardiac conditions as blocking both alpha receptors can cause tachycardia and palpatations used in pre surgical management of pheochrmocytoma and Raynauds phenomenon Tolazoline - selectively blocks alpha 2 receptros a parenteral anti hypertensive agent whose actions are caused by a direct peripheral vasodilation 6. methotrexate- may affect immune functiont tylenol - a weak inhibitor of prstaglandin synthesis lacks anti inflammatory effects of aspriin, but is a good analgesic when aspriin or ibuprofen are contraindicated better to used in GO, bleeding disorders, asthma, young children and pregnancy no peripheral anti inflammatory effects does not affect platelet aggregation or the coagulation pathway 2 major pharm actions: analgesic and antipyretic large doses= liver toxicity does not affect bleeding time codiene - less efficacious opoid analgesic with mod abuse potential codeine+aspirin(Empirin)- analgesic/antiinfmalltory--avoid in asthmatics and patients who cant take aspirin codiene+tylenol (Tylenol 3)- poor anti inflammatory but better than Empirin if pt has GI problems, pregnant hydrocodone - avoid in asthmatics poor anti inflammatory oxycodone - avoid in asthmatics treat mod to severe pain HIGHEST DEPENDNECY liability the body contains 3 naturally occuring endogenous opioids ppeptides - 1. beta endophins 2. Enkephalina- bind to delta receptors 3. dynorphins- most powerful opioids found throughout the CNS and PNS that bind to kappa receptors opioid receptors - 1. Mu- morphine 2. delta- enkephalins 3. kappa- dynorphins opioids - drugs without anti inflammatory properities most appropriate time to adminster inital dose of an analgesic to control post op pain is before the effect of local anesthttic wears off NAUSEA narcotic analgesics do not cause peptic ulcers or insomnia respiratory depression contraindicated in pts with severe head injury a drug with a high LD50 and low ED50 has - a high therapeutic index, thus is relatively sade therapeutic index - the greater a drugs therapeutic index, the less likely fatalities will follow an accident overdose effective dose ED - the effective dose at which 50% of people will respond lethal dose - the dose that kills 50% of the people who receive the drug, as determined by mice experimentation oral contraceptives - block ovulation by inhibiting the anterior pituitary hormones FSH and LH highest risk with use of oral contraceptives: thromboembolic disorders drugs that treat glacuoma - pilocarpine- causes papillary constriction latanoprost- a prostaglandin analog. reduce introcular pressure by increasing aqueous humor outflow betaxolol- beta blocker. redudce intraocular pressure by reducing aqueous humor production alkylating agents - most effective in treating chronic leukemias, lymphomas, myelomas and carcinomas form alkyl bonds to nucleic acids N-7 position of guanine is a common bonding site anthracyclines - destroy DNA so cell cant replicate Daunorubicin and doxorubicin. commonly associated with the development of oral mucosititis antimetabolites - act in the S phase of the cell cycle by interfeing with the biosynthesis of purine and pyrimidine bases hypoglycemia - the most serious and common complication of insulin therapy humulin - brand name for insuiln insulin - pancreatic hormone secreted by pancreatic beta cells of islets of langerhand decrease gluconeogenesis and increase triglyceride storage, glycogen synthesis and protein synthesis Prosth - Prosth double lingual bar (with continuous bar) - placed above the cingula and below inter proximal contacts need 7-8 mm above the mouth floor or cannot use best inducated for perio surgery cases for wide embrasures must have rest seats on the superior bar on at least the canines anterior posterior palatal strap - max major connector to almost always use for all kennedy classes greatest strength and rigidity used for large endentulous span kennedy class III mod I RPDs must be at least 15 mm between anterior and posterior straps straps are 6-8 mm wide horseshoe U shaped palatal connector - last desirable max major connector bc has the least strength and rigidity best vertical support attached totally within the abutments restored natural contours prefabricated key and keyway not used with extensive tissue supported distal extensions unless a stress breaker is used extra coronal retainer - placed on external surfaces of abutment teeth retentive clasp arm that is flexible and placed in areas below cervical to the tooth's height of controu (tooths gingival 1/3) longer and thinner (smaller diameter ) the clasp arm = - more flexible what is the most important factor when selecting a clasp for distal extensions - undercut location reciprocation - occurs when the retentive arm and bracing arm contact the tooth at the same time duing seating and removing the RPD timing is critical in reciprocation circumferental clasp - clasp of choice in class III and IV when the most posterior abutment undercut is away from the endentulous space (MB surface) undercut must always be on opposite side of the tooth/rest from where the clasp originates do not use when an undercut is adjacent to the edentuous space (DB or DL) ring claspp - indicated to engage an undercut of a mesially lingual tilted molar when a sevre tissue undercut exists that prevents using an i bar almost exclusively on mandib molar that drifted mesially and lingually to engage a lingual undercut allows the undercut to be approached from the tooths distal used almost exclusively on ML tilted molar abutments reverse action Hairpin clasp - used on abutments of tooth borne dentures where a proximal undercut is below the point of origin only iwhen a bar clasp is ocntraindicated due to a tissue undercut, tilted tooth, shallow vestible or high tissue attachment embrasure clasp - used on sound teeth with retentive areas or when multiple restorations are justified requires at least 1.5 mm marginal ridge reduction to prevent fracture of clasp assembly used with double occlusal rests wrought wires are never used with embrasure clasps half and half clasp - indicated for lingually inclined premolars back action clasp - a ring clasp modification use is difficult to justify bc you can use a c clasp multiple clasp - two opposing c clasps joined at the terminal end of the two reciprocal arms combination clasp - most commonly used when an abutment next to a distal extension where only a MB undercut exists or if large tissue undercuts prevent a bar clasp from being used bracing arm, wrought wire retentive circumferental arm and distal rest use when the undercit is on the side of the abutment away from the edentulous space bc it is more flexible extended arm clasp - never used with class I and II bc functional forces cause rotation around the rest and upward movement of the clasp tip infrabuldge retainers - approach abutment undercut from a gingival direction below the height of contour contra indicated: if a tissue undercut exists or with high frenum attachments or excessive buccal or lingual tilt of the abutment tooth I bar - always place the tip of I bar retentive arm Mesial to the greatest MD curvative on the abutments facial surface to ensure retention in the undercut the undercut must be mesial the greatest MD curvature on the abutments facial surface the foot of the i bar is completely below the height of contour in distal extension designs when a patient bites down the I bar should release from the undercut modified T bar - bar of choice for DB undercuts below the height of contour immediatel next to edentulous space indicated when undercuts are immediately next to an edentulous area and no tissue undercuts vertical arm must approach and engage mesial to the greatest MD curvature on the abutments facial surface RPI system - rest, proximal plate, I bar used only with kennedy class I or II (distal extensions) mesial rests are placed on the terminal abutment tooth for all distal extensions stress breaker - a device that relieves the abutment teeth to which an FPD or RPD is attached of all or part of the forces generated by occlusal the functional stress in directed onto the residual ridge and only minimal transfer of functional stress to abutment teeth occurs Wrought wire retentive clasp - the simplest form of stress relief advantages: higher yeid strength, greater flexibility, more ductile and resillent often used with M rest in class I and II deisgns on the most posterior abutment tooth if occlusion prevents using a mesial rest on the most posterior abutment in a distal extension only a WW can be used with a distal rest bc it is okay for its retentive tp to be in front of the axis of rotation tip of its retentive arm should engage the undercut anterior to the fulcrum line (axis of rotation). terminal end of its retentive arm is optimally placed in the middle of gingival 1/3 of clinical crown the retentive arm should be passive and applying no pressure on the teeth not used in class III and IV do not use wrought wires thorugh embrassures or with embrasure claps has a tensile strength at least 25% greater than the cast alloy from which it was made external finish line - the external junction (butt joint) of the metal framework and denture base internal finish line - the butt joint between the metal and acrylic on the tissue side of the edentulous area