During an inferior alveolar nerve block the needle ideally passes
a) posterior and medial to medial pterygoid.
b) anterior and lateral to medial pterygoid.
c) through medial pterygoid.
d) inferior to medial pterygoid.
Sunday, August 31, 2014
Saturday, August 30, 2014
SAQS for Dentistry- Anatomical landmarks in maxilla
Anatomical
landmarks in maxilla
Limiting structures
Labial frenum
Single band of fibrous connective tissue, must be properly relieved.
Labial vestibule
Extends from
labial frenum to buccal frenum. Proper lip support should be provided.
Buccal frenum
Consist of
one or more bands. Must be Relieved
Influenced
by 3 muscles- Orbicularis oris (forward),
Buccinator (backward), Caninus
(position)
Buccal vestibule
Buccal
frenum to hamular notch
Influenced
by Buccinator, Modiolus, Coronid process of mandible
Hamular notch
Pterygomaxillary
notch, Distal extension of denture ,Situated between the tuberosity and hamulus
of the medial pterygoid plate.
Posterior palatal seal
area
the soft
tissues along the junction of the hard and soft palates on which pressure within
the physiologic limits of the tissues can be applied by a denture to aid in the
retention of the denture.
Synonyms:
post dam area, postpalatal seal area
Supporting structures
Hard palate
Flat areas
as secondary retentive areas.
Flat palate
(not good support), V shaped palate (least favorable).
Residual ridge
Ridge left
after the extraction of teeth. Mucosa is firmly attached to the periosteum of
the bone. Consist of dense collagenous fibers.
Considered
as a secondary stress-bearing area
because it is subject to resorption contrary to horizontal portion of
hard palate.
Palatal rugae
Resist the
horizontal forces against the denture, Should not be over compressed.
Relief areas
Incisive papilla
Pad of
fiberous connective tissue over incisive foramen, Proper relief should be
given.
Aid in
arrangement of anterior teeth and jaw relation.
Mid palatine raphe
Junction of
palatine process of maxilla. Covered by a thin mucosa, Slightly elevated or
raised.
Proper
relief required.
Fovea palatine
Formed by coalescence
of several mucous gland ducts. Landmark for location of vibrating line.
Maxillary Tuberosity
The medial
& lateral walls resist the horizontal and torquing forces which would move
the denture base in lateral or palatal direction.
Therefore,
maxillary denture base should cover the tuberosities and fill the hamular
notches.
Sunday, August 24, 2014
MANDIBULAR FRACTURES MCQ REVIEW
TYPE
OF FRACTURE
Simple
Includes
a closed linear fractures of the condyle, coronoid, ramus and edentulous body
of the mandible.
Compound
Fractures
of tooth bearing portions of the mandible, into d mouth via the periodontal
membrane and at times through the overlying skin.
Communited
Usually
compound fractures characterized by fragmentation of bone
Pathological
Results
from an already weakened mandible by pathological conditions.
SITE OF FRACTURE
Dentoalveolar
Condyle
Coronoid
Ramus
Angle
Body
(molar and premolar areas)
Parasymphysis
SymphysisCAUSES OF GINGIVAL RECESSION MCQ REVIEW
What is Periodontal
fremitus
Periodontal
fremitus occurs in either of the alveolar bones when an individual sustains
trauma from occlusion. It is a result of teeth exhibiting at least slight
mobility rubbing against the adjacent walls of their sockets, the volume of
which has been expanded ever so slightly by inflammatory responses, bone
resorption or both. As a test to determine the severity of periodontal disease,
a patient is told to close his or her mouth into maximum intercuspation and is
asked to grind his or her teeth ever so slightly. Fingers placed in the labial
vestibule against the alveolar bone can detect fremitus.
Saturday, August 23, 2014
Thursday, August 21, 2014
Best of fives for dentistry- Sjögren's syndrome mcq review
Sjögren's syndrome
What is CREST?
CREST is a
form of Systemic Sclerosis (scleroderma) which is characterized by Calcinosis
(calcium deposits), usually in the fingers; Raynaud's;loss of muscle control of
the Esophagus, which can cause difficulty swallowing; Sclerodactyly, a tapering
deformity of the bones of the fingers; and Telangiectasia, small red spots on
the skin of the fingers, face, or inside of the mouth. (Also see: What is
Scleroderma?, Types of Scleroderma and Systemic Symptoms)
Calcinosis Raynaud's Esophagus Sclerodactyly Telangiectasia
It takes
only two of the five CREST symptoms for a diagnosis of CREST (either "pure" or
"plus") to be made. For example, a patient with Calcinosis and
Raynaud's would have CREST (which for precision may also be written as CRest,
but it is CREST nonetheless.)
CALCINOSIS
The systemic
forms of scleroderma can cause small white calcium lumps to form under the skin
on fingers or other areas of the body.
This is
called calcinosis . The lumps may break through the
skin and leak a chalky white liquid.
These most
commonly occur on the hands, or near joints such as elbows or knees, although
they may appear anywhere.
Raynaud's
Raynaud's is
a vascular disorder commonly found in sclerodema. It is an extreme spasm of
blood vessels in response to cold or stress. The fingers and/or toes become
white and/or blue, and may become red on re-warming.
sclerodactyly
When the
skin on the fingers become tight, stretched, wax-like, and hardened it is
called sclerodactyly. Sclerodactyly is commonly associated with atrophy of the
underlying soft tissues.
Telangiectasia are dilated superficial blood vessels
Sunday, August 17, 2014
ANTIFUNGAL AGENTS
ANTIFUNGAL AGENTS
Most fungal infections in the oral cavity are due to Candida species,
most commonly Candida albicans.
Where candidosis is related to dentures, denture hygiene instruction should be stressed. Non-metal dentures should be soaked regularly overnight in sodium hypochlorite 1% (Milton’s solution) and metal-containing dentures similarly in chlorhexidine 0.2% solution.
Nystatin and amphotericin (polyenes)
These agents attach to the fungal cell membrane and disrupt fluid and electrolyte permeability. They are not absorbed from the GI tract and hence act locally .
Dosage regimens for nystatin and amphotericin
Nystatin
Pastilles 100 000 units
Ointment/cream 100 000 units/g
Amphotericin
Oral suspension 100 mg/ml
Miconazole (an imidazole)
Similar action to the polyenes. Effective against some Gram-positive
bacteria such as Staph. aureus. More effective than polyenes in angular cheilitis due to possible mixed fungal/bacterial infection.
Available as oral gel, cream and in combination with hydrocortisone.
Oral gel (25 mg/ml) 5–10 ml held over area affected (after food) or applied to fitting surface of upper denture for the treatment of denture stomatitis (chronic erythematous candidosis).
Cream (2%) Apply to angles of lips 2–3 times daily. Cream or ointment (2%) with hydrocortisone (1%) Apply to angles of lips 2–3 times daily. May be useful for clearing long-standing angular cheilitis but should not be used for longer than 10 days.
Fluconazole (a triazole)
This systemically acting agent inhibits fungal enzymes concerned
with ergosterol synthesis. It appears to have low systemic toxicity.
Form Capsules (50 mg) and oral suspension (50 mg/5 ml). Dose 50 mg daily for 7–14 days. Higher doses will be required in immune compromised patients.
Cautions Avoid in renal disease, pregnancy and lactation, children.
Side effects Nausea, diarrhea and allergic manifestations are the most serious effects.
Main interactions are with antihistamines, oral hypoglycaemic agents and warfarin.
Itraconazole is another potent triazole antifungal agent.
Saturday, August 16, 2014
Thursday, August 14, 2014
Best of five Review - Angular cheilitis
Angular cheilitis
Angular cheilitis is a combined staphylococcal, streptococcal, and candidal infection, involving the tissues at the angle of the mouth, often with an underlying precipitating factor, e.g. iron deficiency and B12 deficiency anaemia. Therefore, haematological deficiency should be investigated with a FBC red cell folate, B12, and glucose.
Anecdote suggests an inadequate OVD can also predispose, but correction of this alone will not resolve the condition. Often associated with chronic atrophic candidosis. Clinically, see red, cracked, macerated skin at angles of the mouth, often with a gold crust.
Infecting organisms can be identified on culture of swabs of the area, although it is usual to make a clinical diagnosis.
Rx: miconazole cream, which is active against all three infecting organisms. Rx needs to be prolonged, up to 10 days after resolution of clinical lesion, and carried out in conjunction with elimination of any underlying factors.
Unless the classic golden yellow crusts associated with S. aureus are present, treatment should be commenced with antifungal drugs, e.g. a combined miconazole/hydrocortisone cream (miconazole has some antibacterial properties).
When clinical features indicate S. aureus infection, fusidic acid cream is appropriate. If intra-oral candidiasis is present, this must be treated concurrently or recurrence of the angular stomatitis will occur. Iron deficiency is a significant aetiological factor in angular cheilitis.
Patterson–Brown-Kelly syndrome (Plummer–Vinson syndrome)
Dysphagia (due to a post-cricoid candida web), microcytic
hypochromic anaemia, koilonychia and angular cheilitis (secondary to the anaemia)
