Asthma

Tx for asthma/medication: for acute attack-> Aminophylline

- Beta 2 adrenergic agonist: Albuterol, metaproteerol, salmeterol(slow acting)
(MAO: beta2 agonist..relax smooth muscle in lungs rapid sideffect
tachycardia and tremor)
- inhaled glucorticoids: beclomethasone, budesonide, fluisolide, fluticasone
(MAO: increases lipomdulin which inhibiting phospholipase A2 and Cox2),
- antimuscarinic: ipratropium MAO: blocks muscarinic receptors in lung leading
to bronchodilation sidefeffect xerostomia
- luekotriene synthesis inhibitor: zileuron taken orally reduces inflammation
- luekotriene receptor antagonist: montelukast, zafirlukast (block leukotriene
receptor cys-LT1)..long acting

- box 13-3 Management of acute asthma

Drugs: -adrenergic agonists (epinephrine or albuterol) via aerosol, O2,

and isoproterenol and glucocorticosteroids (via an IV route) are used to
manage severe acute attacks.
(Malamed, Stanley F.. Medical Emergencies in the Dental Office, 5th Edition.
C.V. Mosby, 012000. 13.5.2).
Syncope most common medical ER in dental clinic caused by #1 vasodepressor
due to stress (usually due to injection) #2 ASA type 3 and 4 patients dont deal
with stress well #3drug overdose (opiods, benzos, allergy to anesth)
- SIMPLE P-A-B-C-D (position, airway, breathing, circulation difinitve care
- Step 1: Shake and shout
- Step 2: terminate dental procedure
- Step 3: summon help
- Step 4: position patient head and thorax in same plane and with feet slightly
elevated
- 5: Identify if airway obstruction head-tilt chin

- box 5-3 Management of unconscious patients

-

(Malamed, Stanley F.. Medical Emergencies in the Dental Office, 5th

Edition. C.V. Mosby, 012000.).

Tx: trendelberg position, ammonia capsule,

Pregnant woman in supine position? Abdominal aorta, IVC (inferior vena cava),
placenta.
- Pressure is placed on the IVC
- Exceptions to the supine position rule include pregnant patients or those with
respiratory difficulties and/or chest pain. A pregnant woman can be placed on
her side with the legs slightly elevated to prevent further problems caused by
the weight of the fetus on the vena cava
What causes respiratory problems in children? Asthma?? (can tx: upper resp.
problems w/macrolides ie. Azithromycin, clarithromycin, erythromycin

Extrinsic asthma, also known as allergic asthma, accounts for 50% of

asthmatics and occurs more often in children and younger adults. Most
patients with this form of asthma demonstrate an inherited allergic
predisposition
(Malamed, Stanley F.. Medical Emergencies in the Dental Office, 5th Edition.
C.V. Mosby,
Cavernous sinus thrombosis (from abscess of the upper lip)
- CD=OV=CT--------Canine space and deep temporal space infection can
lead to cavernous sinus thrombosis by the spread of infection via the
ophthalmic vein *** Lateral pharyngeal infections (b/w m.pterygoid muscle
and s. phargeal constrictor muscle) can transverse the retropharyngeal and
prevertebral spaces and spread into the mediastinum.
- Formation of a blood clot within the cavernous sinus
- This area at the base of the brain drains deoxygenationed blood from the
brain back to the heart. The cause is usually from a spreading of infection in
the sinuses, ears, or teeth.
- S. aureus and Strep are the associated bacteria
- Life threatening condition and requires immediate treatment
- Vascular congestion (sclera, retina), periorbital edema, proptosis, ptosis,
dilated pupils, absent corneal reflex, and thrombosis of retinal veins. Nerves
involved 3, 4, V1, 6
Infective endocarditis in mitral valve/or lesion of upper lip
- Prophy dosages ADULT
CHILDREN
o Amoxicillin 2g 1 hr before.50mg/kg 1hr
o Clindamycin 600mg 1 hr before20mg/kg 1hr
o Cephalexin or cefadroxil 2g 1hr before50mg/kg 1hr
o Clarithromycin/azithromycin 500mg 1hr before..15mg/kg 1hr
o

o
o

Ampicillin 2g IM or IV 30min before50mg/kg

30min
Clindamycin 600mg IV 30 min before20mg/kg
30min
Cefazolin 1g IM or IV 30 min before25mg/kg 30

o
o
Congenitally missing tooth BUD (initiation stage) or Cap (proliferation stage)
Referred pain to the ear (mandibular molars)
Question (tricky) aversive conditioning/positive reinforcement ---- know all
definitions of these!
Cohort, etc.

??Aversive conditioning punishment for doing the wrong habit

Positive reinforcement positive consequence that increases desired
behavior (to reward for doing the right thing)
Cohort
- Retrospective Cohort evaluate the effect that a specific exposure
has had on a population (ie. Occupational hazard) the investigator
chooses or defines a samplelook at a group/population at one
specific time period in the past
- Prospective Chort to follow a group/population through a time
period and evaluate risk factors by means of surveys to help
predict/detect the outcome of interest

What % of Fl in water in US? 85% of water in the US with Fl. (0.7-1.2 ppm)
Sensitivity the percentage of persons with the disease who are classified as having
the disease.
- True Positive
- Sensitivity = ((TP/(TP+FN)) x100%
Specificity the percentage of persons without the disease who are correctly
classified as not having the disease
- True Negative
- Specificity = ((TN/TN+FP)) x100% (percentage)
*** These two values are directly inverse to each other as one goes up the other
goes down
What population will have recurrent decay? Black, white, Hispanics, Native
Americans
- Caucasians had mean coronal DFS (decayed filled surfaces) twice
as high as African Americans

Proportion of population that has untreated coronal caries for

entire population is three times as higher in African Americans
than Caucasians
Root caries is the same b/w both populations

Waters view for max sinus

Reverse Townes for condylar neck fractures
Oblique view- for position of Mand 3rd molars
Complete dentures. What do they complain about? Lower?
- Possibly dislodgement due to overextension of denture in area of masseter
muscle. Or it could be pain due to the impingement of the denture on the
mental nerve/incisal nerve.
- If discomfort in distal lingual s. pharyngeal constrictor mussle is being
irritiated
Fentanyl . what is used to reverse it? Naloxone, naltrexone (opiod antagonist)
Barb and benzo overdoese= tx: flumazenil
Atropine overdose= tx: pheostygmine
Non-working: lingual incline of mandib facial cusps
Know what to give patient for bilateral angular cheilitis
- Since candidiasis is usual cause
o Nystatin combined w/triamcinolone acetonide
cream.topically for angular chelitis w/o a bacterial
component
o Clotrimazole cream is useful for angular chelitis w/bacterial
component (60% of angular chelitis is caused by
candidiasis + Staph. Aureus)
o Angular chelitis has a malignant potential can go to SCC
Mandib denture, the lingual flange, what muscles would affect it? Superior
constrictor
What muscle will the denture sit on? Buccinators
Nitrates for angina. Know how they work.
- NO is released causing direct vasodilation.
Sialoliths most common site is Submandibular Tx: manually palpate/milk, give
sialologues(EX-pilocarpine), excise surgically
Mucocele/definition

Recurring submucosal nodule of saliva. Rupture of salivary gland duct and

spillage of mucin into the surrounding tissue usually local trauma but sometimes
not.; mucous extravasation phenomenon. Most common site is lower lip histo:
foamy histocytes/macrophages (see the same in Ranula)
Ranula basically a larger mucocele but found in floor of mouth; mucin rupture in
sublingual or submandibular gland tx: extravasation of feeding gland or
marsupilazation

Dry socket
- Alveolar osteitis
- Delayed healing not associated with an infection; primary complication is
moderate to severe pain without the usual signs and symptoms of infection
such as fever, swelling, and erythema.
- The term dry socket describes the appearance of the tooth extraction
socket when the pain beings. 3rd or 4th day after removal of the tooth. Almost
all dry sockets occurs after the removal of lower molars. On examination, the
socket appears to be empty, with loss of blood clot, and some bony surfaces
of the socket are exposed.
- Tx includes: irrigation and insertion of a medicated dressing.
o Irrigated with sterile saline. Then the socket is carefully suctioned of all
excess saline, and small strip of iodoform guaze soaked with the
medication is inserted into the socket. The medication contains
eugenol.
o The dressing is changed every other day for the next 3 to 6 days,
depending on the severity of the pain.
Definition of allograft
- Graft from another member of the space species
Malocclusion is least common? Class III (1-2%) Class II (13-25%) Class 1 most
common
Prevalence of cleft lip and cleft palate 1 in 700 births (in ortho section of Mosbys)
but varies with racein ODR section of Mosbys, says Cleft lip: 1 in 1000 births Cleft
palate: 1 in 2000
- Rule of 10: Tx: cleft lip is done in 10 Weeks, when baby weighs 10 lbs,
Hemoglobin is 10g/deciliter

- Epidemiology
o 1/700overallincidenceforfacialclefting(notrare)

o Cleftlip+/cleftpalate(CL/P)clustersinfamiliesdistinctfromisolated
cleftpalate(CP)(differentembryologyseebelow)
o CleftingmorecommoninAsians(1/400)andlesscommoninAfrican
American(1/2000)
o Cleftscanbeunilateralorbilateral;Leftsidemorecommonfor
unilateral
o Syndromicclefting(patternofmultipleanomalies)accountsfor5060%
pts
o Ofthese,halfareknownpatterns;otherssimplyshowmultiple
anomalies
o Highincidenceofcongenitalheartdiseaseandrenaldiseasescreen
carefullyforthese
o Otherassociatedmidlineabnomalitieshypopituitarismpossible
- Embryology
o Weeks46:Maxillaryprocessesgrowmedially&fusewithfrontonasal
process
o Failurehere>>cleftlip+/primary(anterior)palate
o Weeks67:Tonguedescent,migration&fusionofpalatalshelves
o Failurehere>>cleftsecondary(posterior)palate(PierreRobin,&other)
- Etiologies
o Teratogens:ethanol(FAS),anticonvulsants,steroids,chemo,excessVit
A
o Maternal/intrauterineconditions:infantofdiabeticmom,amniotic
bands
o Chromosomalabnormalities,monogeniccauses(AR,AD,XL)

o Unknown
Prevalence of cleft palate 1 in 2000 births
- Often have hearing problems and speech problems
- Tx: done around 1 year before speech begins
Differentiate cleidocranial dysplasia and ectodermal dys. (I had a lot of questions on
these)
Cleidocranial dysplasia (CCD) absence of clavicles, supernumerary teeth, retained
primary teeth; permanent teeth not erupting, frontal bossing, hypertolerism.
- Autosomal Dominant problem w/chromosome#6.. gene core binding factor
alpha 1 (CBFA-1)
- Many supernumerary teeth (so does Gardners syndrome but not as much as
CCD
Ectodermal dysplasia abnormalities of two or more ectodermal structures such as
hair, teeth, nails, sweat glands, etc. these people have thin hair, thick nails, lightly
pigmented skin, sweat glands that function abnormally (these people cannot
perspire or regulate body temperature); teeth are congenitally absent
- X-linked hypohidrotic ectodermal dysplasia (most well known form)
- Sparse hair, little yey brow hair, light pigmentation
- Oligodontia most common usually not anodontia mutation with
Chromosome 14 pax 9 gene
- Sometimes teeth exhibit taurodontism
Taurodontism:
- This conditions may exist as an isolated trait (autosomal dominant) or as part of several
syndromes including the trichodentoosseous syndrome (TDO), otodental dysplasia, ectodermal
dysplasia, tooth and nail syndrome, amelogenesis imperfecta and others
If Pagets disease of bone (osteitis deformans) occurs in the Jaw will see
HYPERCEMENTOSIS
Dentinogenesis Imperfecta type 1 : w/osteogenesis imperfecta
Dentinogenesis Imperfecta type 2 : without osteogenesis imperfecta
Dentinogenesis Imperfecta type 3 : shell teeth
Dentin dysplasia type 1: have crowns but no roots
Dentin dysplasia type 2: pulp ascends to the crown (thistle) but teeth of normal
size. pulp stones
Amelogenesis imperfecta:
- autosomal dominant condition affecting both deciduous and permanent teeth. Affected teeth are
gray to yellowbrown and have broad crowns with constriction of the cervical area resulting in a

tulip shape. Radiographically, the teeth appear solid, lacking pulp chambers and root canals.
Enamel is easily broken leading to exposure of dentin that undergoes accelerated attrition

Fluoride and the ages

Birth-6months, < 0.3ppm, no fluoride supplementation
6 months 3 years, if < 0.3 ppm then give 0.25 mg; if between 0.3 ppm 0.6 ppm
none, 0.6 none
3-6 years, if < 0.3 ppm then give 0.50 mg; if between 0.3 ppm 0.6 ppm give 0.25,
0.6 none
6-16 years, if < 0.3 ppm then give 1.0 mg; if between 0.3ppm 0.6 ppm give 0.50,
0.6 none
Ludwigs angina bilateral swelling causes airway obstruction
- Bilateral swelling of submandibular, submental, and sublingual spaces.
Pic showing either an aneurysmal bone cyst or traumatic bone cyst (post mandible)
Hurler syndrome aka MPS(mucopolysacchridosis) 1
- Both are lysosomal diseases but Hurler Autosomal recessive
- Lack of Alpha L- iduronidaseBuilup of glycosaminoglycans
- Developmental delay is evident by the end of the first year, and patients usually stop developing between ages 2 and 4. This is
followed by progressive mental decline and loss of physical skills. Language may be limited due to hearing loss and an
enlarged tongue. In time, the clear layers of the cornea become clouded and retinas may begin to degenerate. Carpal tunnel
syndrome (or similar compression of nerves elsewhere in the body) and restricted joint movement are common

Distinct facial features (including flat face, depressed nasal bridge, and bulging forehead) become more evident in
the second year. By age 2, the ribs have widened and are oar-shaped. The liver, spleen and heart are often enlarged.

Hunter aka MPS II

- X-linked
- lack of iduronate 2-sulfatase
- distinctive coarseness in their facial features, including a prominent forehead, a nose with a flattened bridge, and an
enlarged tongue

Nasolabial cyst doesnt involve the bone

Signs for HPV in oral cavity
- oral HPV type 16
- Anogenital condyloma acuminatum, strongly linked with HPVs 6 and 11 are probably sexually transmitted.
OKC/basal cell nevus aka Gorlin syndrome
- Palmar pits
- Bilamellar calcifications of falx cerebri
- Rib anomalies (bifid rib)
- Cleft lip sometimes
- Frontal bossing hypertolerism

- Multiple OKC
Patient were to get a crown, but they want bleaching. Whats the sequence?
- Bleaching is always 1st step and then the restoration is matched to the
lightest shade.
Tx sequence
Oral signs of Addisons disease (hypoadrenocorticism low adrenal
corticosteroids b/c destruction of adrenal cortex)
-diffuse melanin pigmentation in floor of mouth/ventral surface of
tongue (usually 1st sign of addisons later the bronzing of skin can
occur usually in sun-exposed areas)
After flap surgery, how does the tissue heal? Long junctional epithelium
- Only in GTR does long junctional epithelium not occur and is by the actual
movement of osteocytes movement from PDL to area
In what order do you extract the molars?
Serial Extractions:
- 1st: primary Lateral incisor (as perm. Erupt only if nec)
- 2nd:primary canine (as perm. Lat. Erupt).. 8-9 yrs
- 3rd: primary 1st molar (6-12mos. Before normal exfoliation).. done to erupt 1 st PM
to erupt before normal time so they can be extracted.. and permit Canine to
move distally into space 9-10 yrs
- 4th:perm. 1st PM (just as canine emerges through mucosa
Max. canine. Know if they have two canals
- Max. canine only has 1 canal mandibular canine can have 2 canals
30%
Canine frenum attachment
Local Anest. Patient has an adverse reaction to it.
- Probably due to preservative methylparaben (1mg/ml)
- Prilocaine metabolite o-toludine can cause Methamoglobinemia
Kennedy class I, no retention? Where is the problem?
- Class 1 is strict tissue retained problem could be in base?
Pic of white plaque that cant be rubbed offleukoplakia
H1
-

histamine and H2 (gastric)

H1: 1st generation sedative/hypnotic
Dephenylhydarmine, pyralamine, chlorpheramine, promethazine
Hydroxzine used for pediatric anesth.

H1: 2nd gen do not cross BBB.. non sedative

Loaratide, Desloratide, Cetrizine, Actrivastine

Fexofanadine (can not be taken w/Cimetidine)

H2 blockers
-Cimetidine, ranitidine, fmootidene, nizatidine tx: Gerd, ulcer, stop parietal
secretion of H+
Cheek biting (dentures)
- horizontal overlap
If patient cant make F and V sounds, whats the problem? Too far superior and too
anterior
Lot of questions on irreversible pulpitis/aap
- AAP: symptomatic, no radiolucency, percussion positive, pulp, tooth vital or
nonvital EPT/pulp test most imp. Way to confirm if vital pulp, simple
occlusion adjustment will be enough tx if nonvital and untreated will lead to
acute apical abscess
- Acute apical abcess: purulent exudates around apex, symptomatic, PDL maybe
normal looking or slightly thickened in xray, normal or slight thinkened lamina
dura, SWELLING rapid onset of swelling, mod. To severe pain, pain
w/percussion and palpation, slight inc. in tooth mobility
- Chronic periradicular periodontitis: asymptomatic, radiographic visible,
endotoxins cascadeing into pulp cause extensive demineralization of cancellous
and coritical bone, slight tenderness to percussion/palpation
- Chronic periradicular periodontitis/phoenix abscess: similar presentation as
acute apical abcess BUT radiographic evidence/ periapical Radiolucency histo:
liquefaction necrosis w/PMN, viable macrophages and occasional lymphocytes
and plasma cells,
- Suppurative periradicular periodontitis/chronic periradicular abcess: draining
sinus tract w/o discomfort, mimic perio pocket, non-vital pulp, bone loss xray
Operative gypsum (setting time/working time)
Pat had two surface caries, where you smooth surface caries? Below the contact
Pat had mesial/distal lesion, would you compromise all the tooth structure? No..
MOD.. but if its a primary 1st Mand. Molar.. pre-fab crown
Curing light? LED? 400-499 wavelenght
Selecting shade for pt, what do you consider? Value, chroma, hue
- 1st. Hue, 2nd: Chroma, 3rd Value
Cantilever abutment? Worst prognosis
Canine as abutment for cantilever

After perio surgery, most important thing for success? No retained plaque keep
plaque free envt.
After perio sugery, how does patient clean interproximal surfaces? Repeat question
In crevicular fluid, what cell do you find. 92% PMNs, 4% B-cells, 3% T-cells, 1%
phagocytes

Fusobacterium
nucleatum, Prevotella intermedia, and Capnocytophaga species by
a week time "tertiary colonizers", and includePorphyromonas
gingivalis, Campylobacter rectus, Eikenella corrodens, Actinobacillus
actinomycetemcomitans, and the oral spirochetes
(Treponema species) initial species: S. sanguis, A. viscous, S.
Mutans
After removing plaque (2days), what bacteria do you find?

C-factor
- The ratio of bonded to unbonded surface areas of a composite restoration.
- Polymerization shrinkage in a composite creates stress that can damage
surrounding enamel walls of the cavity preparation. The amount of stress
depends on the C-factor of the composite restoration. A high C-factor
indicates the cavity is more likely to be damaged. Incremental curing reduces
the C-factor, and therefore reduces the residual stress of the resulting
composite restoration.
Which tissue is least radiosensitive? Neurons, skeletal muscle. Cells that are
mitotically active are the most radiosensitive (basal cells of the oral mucosa)
Skeletal muscles are least radiosensitive
Cavulinic acid/augmentin incr. action of penicillin b/c calvunic acid is a betalacatamase inhibitor tx: H. influenza, N. gonnorreha, E. coli, P. numococci
2nd 1 molar distal shoe
HMO/PPO
HMO health maintenance organization is a type of managed care organization that
provides a form of health care coverage in the United States in which doctors and
other providers have a contract with.
PPO preferred provider organization is a managed care organization; doctors
accept reduced fees in exchange for referrals.

The
majority of North American dental schools reported marginal defects (84
Whats the most common reason patient needs to repair anterior composite?

percent) and marginal discoloration (73 percent) as the most common

indications for repairing RBC(resin based composite) restorations
Mjr and Toffenetti3 reported that secondary caries is the most common
reason for replacing restorations in general dental practice.
How do you treat a fearful patient?... ID: Fear
How long do you splint?
Avulsed: 7-10 days (closed apex). 3-4 weeks (open apex)
Luxatation: 14 days if alveolar process also damaged 4-6 weeks
Subluxation: 7 -10 days if mobile
Midroot/apical: 2-3 months
Alveolar process: 4-6 weeks (rigid splint)
classification: know how many weeks/months for calcification
- Primary teeth calicify: 14-18 mos in utero (A, D, B, C, E respectively)
- Secondary teeth calcify: 6=Birth, Max central/Mand Central & lateral = 3-4
months, max lat- 10-12months, Canines =4-5months,. Mandibular teeth are
.25 yrs after Max. 1st pm = 1.5yrs, 2nd pm=2 yrs, 2nd Molar = 2.5 yrs
how do you treat dry mouth?... sialogogues
Drugs for depression/seizure
Know what they work on
After ortho tx, rotated tooth, what causes this supracrestal periodontal fibers
Definition of efficacy
- The ability of a drug-receptot complex to produce a functional response.
Water on amalgam
- Is moisture is incorporated into an alloy that contains zinc, the water
reacts with the zinc to produce hydrogen gas, which causes severe
expansion of the amalgam.
Overtrituration decreased expansion
Root caries/xerostomia
Max tuberosity and retromolar area touching. What do you do?... reduce tuberosity
EDTA chelating/green stains???
Know the signs of trauma
Clinical signs include: increased tooth mobility, thermal sensitivity, attrition of
enamel, recession of the facial gingival tissue.
Difference between 245 and 330
- These two burs are very similar to one another. The 245 is 3.0mm long.
Preparing a veneer, in middle 3rd, how much do you reduce .5 mm
Implants how far should they be apart 47deg. C or 117deg. F (critical temp.)..
10mm vert and 6 mm horiz.

- 3mm apart from each other

- 1mm from root of implant to tooth
- 1mm from facial and lingual
- 5 mm from mental
- 2mm from Inf. Alv
- 1mm from PDL
- 1mm Nasal vestibule
Acetaminophen liver
Symptoms of down syndrome
Patient was dissatisfied with shade of crown. Dentist likes it. What do you do?....
surface characterization..
Remineralization of a tooth. How does it feel compared to a tooth that is normal?...
feels rough but hard like normal
Furcation involvement of a mandibular molar.
Hemisection.
- Treat like two premolars
3 wall, narrow vs a 2-wall shallow crater greater success rate for 3-wall defect
Pic of residual cyst
2 xrays, identify max sinus, orbit, zygomatic process
Pic on gingival inflammation
Pic of patient wearing denture. Candidiasis
Wax up for investing, casting,
Porosity in pulpal floor. What will it effect?... coping base will not sit properly
What drug to treat herpes? An antiviral agent penciclovir (denavir) is active against
the herpes virus. It is a cream indicated for the treatment of recurrent herpes
labialis (cold sores) in adults. It inhibits viral action by selectively inhibiting herpes
viral DNA synthesis and therefore resulting in the inhibition of viral replication.
Other agents indicated for use in treating the condition of herpes labialis are:
acyclovir tablets, cream, docosanol cream (abreva), lysine tablets, and valacyclovir
(valtrex)
Sealants
Pt had an implant 2 stage after there was bone loss and mobility. bone graft.
Histodifferentiation stages (development) know all of this.
Analgesic that lasts 8 hours. Naproxen
Problem with a drug and a dental device, who do you report it to: FDA
Black female with periapical dysplasia
Side effects of benzodiazepines.
- dependence

What center do these drugs work on? Emesis.

CTZ = chemoreceptor trigger zone for opiods; when stimulated, causes nausea and
vomiting
Apicoectomy why do you do this?
What cyst most likely turns into ameloblastoma?... dentigerous cyst

Neuropraxia - Neurapraxia is part of Seddon's classification scheme used to classify nerve damage. It
is a transient episode of motor paralysis with little or no sensory or autonomic dysfunction. Neurapraxia
describes nerve damage in which there is no disruption of the nerve or its sheath. In this case there is an
interruption in conduction of the impulse down the nerve fiber, and recovery takes place

Insurance:
- Down coding
- Up coding
- Bundling
- Unbundling
If patient is using heroin, why cant you give them nalbuine b/c it is a narcotic
agonist and antagonist
Methotrexate folic acid analogue
Methadone/morphine
Implants, purpose of a hex
Bone types/implants
When do you check for osseointegration
St. johnss wart
Gensing? What meds cant you give these patients if theyre taking a ginseng
supplement
Epulis fissuratum
Resin luting agents/all ceramic crowns
Augmentin
If pregnant patient becomes syncopal, what position do you place them?
What does alpha-1 cause?
Closed models
Osteoradionecrosis
Cracked tooth syndrome
Vertical crown fractures
Acute periradicular periodontitis vs. acute periodontal abscess
Angle of curette in relationship to line of the tooth
Distal extension of RPD displaced as a result of force placed on the fulcrum line -
somethings wrong with indirect retainer
W on the rubber dam clamp means what? It has wings
Know what the stafne bone cyst looks like

Know what osteomyelitis looks like. Patient had extraction and on clinical exam you
see suppuration.
Bells palsy
Compound odontoma xray
Gingival hyperplasia pic
Pic of inflammatory hyperplasia
Xray of dentin dysplasia (rootless teeth) sister also has it
Pic showing mucosa with white sponge nevus
Basal cell carcinoma pic of old man with lesion next to lip
Xray of periapical cement osseous dysplasia
Erosion due to bulimia
Attrition
LED lights vs. conventional halogen lights (light curing)
Papillon-Levfevre syndrome severe aggressive periodontal destruction at an early
age, which may involve primary and permanent dentition
Opioids and respiratory depression
Chi-square test
t-test
classification of behaviors of children in a dental setting (review pages 179-180 in
mosbys)
after ortho, tooth rotatesthis is due to what fibers of the PDL? Apical, oblique,
transseptal
residual cyst
radicular cyst
children with cleft lip/palate are in what occlusion?
Glass ionomer properties
Root surface caries
Reasons for beveling the functional cusp
Articaine only amide local anesthetic not metabolized in the liverit is
metabolized in the plasma
Hypophosphatasia
Hypothyroidism
Hyperthyroidism
Phenytoin for grand mal seizures
Ethosuximide for absence seizures
Phenothiazines dopamine
SSRIs serotonin
What allows correction of crowding as the mandibular incisors come in? usage of
primate spaces, leeway space, lingual eruption?
10 yr old child has a midline diastema with a fibrous frenum attached between
incisors. What is the preferred treatment? Observe until permanent canines erupt
Know the difference between Class II division 1 and Class II division 2
MRI used to image articular disc of the TMJ

Clinically there is a green discoloration at the margin of a PFM crown? What causes
this? Copper, zinc, palladium, cobalt?
Definition of hypertolerism
- Abnormally increased distance between the eyes
Patient visited doctor and had an HbAC1 of 12. Patient also had uncontrolled
periodontitis. What is your course of treatment? Request medical consultation from
doctor, Scaling & Root planning, premedicate and scaling and root planning?
- A form of hemoglobin used primarily to identify the average glucose
concentration over prolonged periods of time. It is formed in a nonenzymatic pathway by hemoglobins normal exposure to high plasma
levels of glucose.
- The American Diabetes Association recommends that the HbA1C be below
7.0 for most patients.
- A high value represents poor glucose control.
Hypoglycemia know what happens in these patients. Confusion, dizziness, etc

4-5-10
Patient needs a pain killer that lasts for 8 hours, which will you give? Naproxen
Tons of questions on Cohort studies and longitudinal studies (Public Health Section
of Mosbys)
Cohort studies-prospective and retrospective, studies follow a general population
over time for prevalence of some dz or the other way around for latter

Longitudinal ecologic studies use ongoing surveillance or

frequent cross-sectional studies to measure trends in disease
rates over many years in a defined population. By comparing
the trends in disease rates with other changes in the society
(e.g., wars, immigration, or the introduction of a vaccine or
antibiotics), epidemiologists attempt to determine the impact
of these changes on the disease rates.
Questions on chroma-intensity of the hue, value-relative lightness and darkness of a
color, and hue- dominant color of an object (Red, blue, green)
First order and second order bends (ortho)

FIGURE 1131 First-, second-, and third-order bends in

edgewise wires. A, First-order bends in a maxillary (left)
and mandibular (right) archwire. Note the lateral inset
required in the maxillary archwire, and the canine and
molar offset bends that are required in both. B, Secondorder bends in the maxillary incisor segment to
compensate for the inclination of the incisal edge of these
teeth relative to the long axis of the tooth. C, Third-order
bends for the maxillary central incisors and maxillary first
molars showing the twist in the archwire to provide a
passive fit in a bracket or tube on these teeth. Twist in an
archwire provides torque in a bracket; the torque is
positive for the incisor, negative for the molar.
Methotrexate toxicityaspirin or NSAIDs

Methotrexate is subject to a number of important drug

interactions. Highly plasma proteinbound drugs such as
salicylates, sulfonamides, and phenytoin may displace

methotrexate from its protein-binding sites and result in

greater toxicity. Organic acids such as salicylate and
probenecid inhibit the tubular secretion of methotrexate,
resulting in increased concentrations of methotrexate and
toxicity. Penicillins can also compete with methotrexate for
renal tubular secretion.33 In patients receiving large gram
doses of methotrexate, the concurrent use of NSAIDs should
be avoided because this drug class can also reduce renal
blood flow and increase the risk of nephrotoxicity.
If a patient is taking Ginsing, which pain killer would you not want to give the
patient? Aspirin (b/c of bleeding potential) taken with diuretics will increase bp
because diuretics wouldnt have effect
Know interactions of medications with St. Johns Wart

Meperidine and tramadol probably should be avoided in

patients taking St. John's wort because of the agents' shared
potential for increasing 5-hydroxytryptamine activity in the
brain, possibly resulting in a serotonergic syndrome of
restlessness, motor hyperactivity, and coma.

Pain medication best to give a pregnant patient. Acetaminophen

Pain medication best to give a child with a high fever
When its necessary to use a band and loop-

first primary molar missing

Gn as compased to Go
Gn-the center of the inferior point on the mandibular symphysis (bottom
of chin)
Go- the midpoint of the contour connecting the ramus and body of the
mandible
Frankforts horizontal

FIGURE 650 In the Steiner analysis, the angles SNA and

SNB are used to establish the relationship of the maxilla
and mandible to the cranial base, while the SN-MP
(mandibular plane) angle is used to establish the vertical
position of the mandible
Pt overdosed on BDZ, what do you administer..flumanezil
Pt overdosed on narcoticnaloxone
What component is present in IRM that is not present in ZOE
-Four types of ZOE
Type 1-temp cement
Type 2-permanent cement
Type 3-Temp filling material and thermal insulating base (IRM)
Type 4-Cavity liner
Type 3 is known as reinforced ZOE and the powder is composed of zinc oxide and
finely divided polymer particles (polymethyl-methacrylate) in the amount of 2040% by weight. Its able to withstand the pressure of amalgam condensation and
has minimal effect on the pulp.
Which is the best area to obtain a free gingival graft

=>Free gingival graft is used to create a widened zone of attached gingival, facial
attached gingival at the mucogingival junction with both ends of incision on existing
mucogingival line.

The classic or conventional-free gingival graft technique

consists of transferring a piece of keratinized gingiva
approximately the size of the recipient site. To avoid the
large wound that this procedure sometimes leaves in the
donor site, some alternative methods have been proposed.
The original technique is described first, followed by several
of the most common variants. For the classic technique, a
partial-thickness graft is used. The palate is the usual site
from which donor tissue is removed. The graft should
consist of epithelium and a thin layer of underlying
connective tissue. Place the template over the donor site,
and make a shallow incision around it with a #15 blade.
Insert the blade to the desired thickness at one edge of the
graft. Elevate the edge and hold it with tissue forceps.
Continue to separate the graft with the blade, lifting it
gently as separation progresses to provide visibility. Placing
sutures at the margins of the graft helps control it during
separation and transfer and simplifies placement and
suturing to the recipient site.
Know minimum amount of space between two implants -3 mm between implants
and 1 mm from tooth, 4 mm of implant width, drill must be low speed with high
torque, a lot of irrigation and bone must be maintained at less than 47 degrees
celcius
Also, minimum amount of space between implant and inferior alveolar nerve
mm above the mental n., 2 mm from IAN
-10mm vertical bone dimension, 6mm horizontal bone dimension

-5

TONS of questions on Apexogenesis vs Apexification!!

Also, know protocol if tooth is avulsed >1 hr and <1 hr
If there is a combined perio-endo lesion, which would you treat first
Know which cells predominate in a healthy pulp vs hyperemic pulp
Know the cells dominate in early stages of gingivitisPMNS, lymphocytes, and
plasma cells. The answer for that particular question was plasma cells b/c it asked
for that specific time frame (see chart in perio section of Mosbys)
Shape of access opening for mandibular canine
Know sequence of teeth extraction for seriel extraction
Know fluoride chart
Know reduction for functional cusps vs nonfunctional cusps
Where is porcelain strongercompressive strength (options were tensile, etc)

If a natural tooth is opposed to porcelain, what is the restoration for the tooth in
question
Which of the following materials would give the best result in wear resistance? Gold
Osteogenesis imperfect
Hypoplastic vs hypocalcified enamel
Ectodermal dysplasia vs cleidocrainial dysplasia
Source agent for herpangiaCoxsackie virus
Recurrent aphthous ulcer
HSV1
Had picture of SCC on lip
Had picture of Stafne cyst
Picture of radiolucent lesion between maxillary central incisorsnasopalatine canal
If attempting an extraction of a maxillary third molar and tooth is displaced
posteriorly and superiorly, where will it be locatedinfratemporal space
What is the depth to which brushing goes into the sulcus, what is depth that flossing
goes into the sulcus.
How apically/ coronally do you place implant related to neighboring tooth in an
esthetic area
Which medication is the best med to tx systemic fungal infection.-nystatin,
ketaconazole, amphotericin B, clotrimazole
What receptor do opiods act on to cause their effect ..mu
What I biggest advantage of using nitrous oxide as sedative
Calculation of amounts of ml of anest., and vasocontrictor can be given to pts.
Affects of Sjorgen syndrome
What med increase salivation
What is disadvange of using NiFi files compared to stainless stell files
Which of the following do not cuase gingival enlargementphenotin, cyclosporine,
nifedipine, digoxin
Define if case is primary perio/endo lesions or primary endo/perio lesion
Which bacteria is found in normal flora
Know abfraction lesion
Know what medicare is and what it coverage for dental procedures
What term defines color saturationchroma, hue , value
Which test would you use to analyze proportions of men and women with oral
cancer t test, chi 2 test
Bacterial flora of aggressive perio
Difference b/w fear and anxiety
Difference b/w acute periapical abscess and acute periodontal abscess
Pic of zygomatic process
Pic of papilloma
Pic of intermaxillary suture
What herbal supplement strengthen the effect of antioxidants.chamomille, st. john
worts.
St. johns wort acts as whatantidepressant
What does an area of impant need to have, mm of space buccal lingually
When would u tx an avulsed tooth with calcium hydroxide therapy related to
splinting2 wks after splinting, immediately before splinting, after splinting and
evaluation

How would use remove maxillary torusy shaped incision

How remove mandibular tori txd area if tissue over area becames denuded and
sloughs off
Conventional osteotomies vs distraction osteotomy procedures
Alveoplasty indications
What xray best for determining midface fractures
What do you do with endo tx tooth with lateral canal w no material in the lateral
canal.retreatement, wait and evaluate later
What caused pain in pt with previous RCT overinstrmentation of canal, separated
file w/in canal, overextension apically, breakage of apical seal
Pic of vertical root fracture
Pic of MRI asked what image was
How does gingival tissue connect to implant
How do you check probing depth of implant
What instruments do you use to scale an implant
Esoniphillic granulosum
Cancer from body metastizises to where in the oral cavity most frequently
What cancer of the oral enviroment is most malignant
What is disulfiram used fortx of alcohol abuse
Benzodiazepine MOA
Phenothiazines should not be used with what med
Phenothiazines MOA
Maoi cant be used with with indirect acting sympathomimetics likeamphetamine

1.
2.
3.
4.

What responds to cytology better? Histoplasmosis, candiadsis, etc.

A child, fear? Fear makes pain worse
Four questions on TELL-SHOW-DO
If you have a mentally challenged pt. who is screaming and resistant how
to treat for recall only
5. Pushed root of 3rd molar (max) in, what space is it in?
6. When taking pano, pt. moves for 1 second what will it look like?
7. Dependence of NO, what signs will you have?
8. Pt. w/otis media, given NO, what happens?
9. Mid-face fracture best viewed by? Waters view
10.Palatal tori indicated for removal when? Immediate denture, lack of arch
space, disrupts post. Palatal seal
11.What is most similar to epiphyseal plate? Suture, fontanella, cartilage, etc.
12.Signs of hyperthyroidism/hypothyroidism?
13.Asthma: inspiratory wheeze, expiratory wheeze, bronchi?
14.Pt. on warfarin but needs extractions, prescribe vit. K, if INR = 3.5 OK, see
oral surgeon
15.Pic of 2 yr. old bright red lips w/lesions, pt. has fever what is it? Primary
herpes, herpangina, etc?
16.2 pulps, fused body. What is it fusion, germination, etc?
17.Blue sclera, what is it osteogenesis imperfect
18.Kid w/ectodermal dysplasia what is sign? Sparse hair
19.SNB angle is -6, what class occlusion? I think he meants ANB angle of -6
which would make it Class 3

20.What skeletal profile is Class 3 occlusion? Concave Class 1 straight

class 2 convex
21.Cause of cheek biting w/complete dentures? Inadequate horizontal overlap
22.What problem can you diagnose a dentist? Anorexia, bulimia (erosion in
lingual anteriors), etc.
23.After placing tooth back in socket less than 1 hour, when do you use calcium
hydroxide? 1-2 weeks, never, etc.
24.Pt. can not breathe through nose, what will you find? Anterior open bite
25.What is the first thing you do on recall? Check plaque score, asses next
treatment, etc.
26.Pt. w/HIV has viral count of 100,000, CD4 count of 40. No tx. b/c chance of
infection is high
27.Most susceptible surfaces to caries of radiation tx. Proximal, facial, lingual,
all?
28.Problem w/Sjorgens put pleomorphic adenoma?
29.Caf au lait macules neurofibromatosis, peutz-jeguger, etc?
30.Radiation affects the cells how?
31.Where are yo8u more likely to get metaplastia in oral cavity posterior
mandible, floor of mouth, hard palate, etc?
32.Dentist switches from 8 inche bilateral technique to 16 inch parallel
techniques how much extra radiation?
33.Which sex age group more susceptible to autoimmune disease?
34.Flush water lines 2 mins before starting day purpose?
35.One way valve in handpiece. Purpose?
36.Brush goes into subgingival sulcus how man mm?... floss how many mm?...
NEED TO KNOW BOTH
37.Scaling/Rp how is it effective?
38.Splinting in periodontically involved pt. why?
39.Know how plaqe formation process
40.Enamel hypoplasia when does it start?
41.What % is considered generalized? 20%,30%,50%....I believe its 30%
42.Le Fort 1 + BSSO, class 3
43.How to deal with angry pt.
44.ADA and advertising
45.Parent/child -> lap
46.Acute periradicular vs. periodontal abscess (pulp, perc, xray, ept)
47.Opiate contraindications
48.Gingival hyperplasia
49.Empathy
50.Non-verbal communication
51.Tardive dyskinesia.side effect of anti-psychotic drugs haloperidol
52.Molar extraction sequence
53.Class 2 furcation, what dont you do?
54.GTR what affects success the least? RCT, width, depth
55.Gingevectomy internal/external bevel?
56.What dont you do.. stainless steel crown prep, reduce F/L on occlusal 1/3,
chamfer on proximal, etc.
57.All ceramic crown finish line sholder + chamfer, or sholder + bevel
58.Class 2 composite, what is not important (esthetics, convenience for access,
extension for prevention)

59.What is the least significant cause of alveolar bone loss in primary dentition?
60.Enamel hatchet vs. marginal trimmer
61.Caries w/wide base and gets smaller? Smooth, pit,
etc?...Smooth/proximal pit inverted V
62.Reverse architecture?
63.Vertical root fracture
64.Class 2 amalagmam, pain (cold) when chewing
65.Pt. in pain comes in sequence of tx. Pain, tx. Plan, etc
66.17 y/o w/mandibular canine sticking facially.. what happened?... gingival
recession, ankylosis, mobility?
67.w/ cardio problems. 2 carpules
68.Replacement of class 1 amalgam. Recurrant caries
69.Steven Johnsons
70.Gardners
71.Sturge-weber
72.Periodontitis
73.Statistics
74.Pt. management
75.implant

St. Johns wort for mild depression

Depth that toothbrush and floss goes into the sulcus1mm brush; 2-3 for floss
Implants (lots)how do u probe an implant
Meds that do gingival enlargement exceptphenytoin, cyclosporine, digoxin?,
nefedipine
Stevens Johnson syndrome
Sturge weber syndrome
Warfarininr, cant give LA without epi
Stafne defect
Mri or ct scan? Blk white photo
Diff btw distraction, osteogenesis and conventional osteotomies
Herbal supp inc mechanism of effect of antioxidantstaminil, st. johns wort
Lots of pharm
Best systemic antiviral med
Sed hypnotic to give if want pt to sleep at night after appt
Tx lichen planus
Hemangioma, ranula, mucoceole
Weird endo questionstooth avulsed, caoh therapy is done when? 1-2 weeks after
replantation? Reimplant and wait 1-2 weeks to complete caoh therapy
Know amantidine (MOA,
MOA given; which is direct antagonist based on that
Antibuse used for ?? Alcohol
Acetaminophen hepatotoxicity
Cohort questions
Chi squared which one used in det proportion of oral cancer amongst men and
women

Used to compare distributions; t test used to compare means he put chi

square as answer
Depth to put implant compared to neighboring teeth
Hex in implants
How do you curette implantsplastic scaler; gave 4 instruments
Diff btw marginal trimmer and enamel hatchetbibeveled?, contraangled
Class 2 composite restoration: which part of restoration most likely to fail?
What do you do if
Value, hue, chroma
Pt didnt like crown and dentist didmicro etch and put veneer/direct veneer
25 modeling and behavior models
Medicare and Medicaid questions (medicare isnt as good as Medicaid.)
Diff btw apical periradicular abcess and apical periodontal abscess
Vital pulp vs. necrotic pulp
Irreversible pulpitis and what vital pulp therapy you do on it
Know MOA for meperidine***
Flumazinilbdz antagonist

What potentiates the effect of anticoagulants? Saw palmetto, licorice, St. Johns
wort, ___
Amantidine
BDZ MOA
What type of study is smokers and nonsmokers and gave them questionnaire about
oral cancer?
Nefidipine
Pregnant woman: cant give her what in second trimester. meperidine,
acetaminophen, or___.
Meperidine?
Vital permanent tooth with open apex and discoloration and not responding to ept?
Apexofication
Nefedipine, nitroglycerin, and something else are they all antianginals, congestive
heart failure tx??
Furosamide (lasix)is it a thiazide diuretic, anticoagulant??
Comparing proportion of two things? T-test
Chroma, hue, value of course
What instrument cant be used on implant
Is the epithelial attachment the exact same in an implant as in natural tooth/
connective tissue attach?
What is the main cause of loss of M-D space in arch? Caries, prematurely exfoliated
primary teeth
Most common effects of orthodontic tooth movement Except? MODERATE root
resorption, mobility,
Relapse tendancy or bone remodeling
SNB larger than SNA means what? Class 3
If lose primary 2nd molar early then have tendancy to become which classification?
Class 2
Advantage of Glass Ionomer over resin?
Root caries
What is the most common carious lesion now that caries is more under control in
US? Root, facial,

Interproximal or occlusal
Sjogrens dz
Blue sclera of Osteogenesis imperfect
Patient sweating off one side of face why? Some type of syndrome
Reiters, crohns, which one has rectal bleeding
Stevens Johnson and Sturge weber which one makes tongue bald and red and white
(pic)
Which one becomes blanched when pressed with finger? Hemangioma, fibroma,
mucoceole, neuroma
What is found on FOM and is doughy when pressed? Ranula, hemangioma, tumor
All the ones from the previous sectionwe had the same exact exam!!

What do you not use to clean a implant? Stainless steel scaler, sonic scaler with
plastic sleeve, plastic scaler

Cases:
Aredia, fosamax
USP Premarin
Adderall
Albuterol
Salbuterol
Rheumatic Fever
Allergy to Codeine: what meds can you give a pt for moderate pain?
Cleft palate: lateral incisors are in crossbite? Does cleft palate cause this to happen?

SYNDROMES W/ORAL CAVITY FINDINGS:

Aperts Syndrome (Acrocephalosyndactyly)

Craniosynostosis syndrome
Mutation in FGFR2; 1 in 65,000 to 160,000 births, AD
Acrobrachycephaly (tower skull); kleeblattschdel (severe cases)
Ocular proptosis; hypertelorism; vision loss; beaten metal
radiographs
Midface hypoplasia; V-shaped arch open-mouth feature;
hearing loss
SYNDACTYLY of the 2nd, 3rd and 4th digits; MENTAL RETARDATION
Pseudo cleft palate due to swellings (accumulation of glycosaminoglycans)
of the lateral hard palate and crowding of
maxillary teeth; bifid uvula

Treacher-Collins Syndrome (Mandibulofacial Dysostosis)

Defects of 1st and 2nd BA
AD; 1 in 25,000 to 50,000 births; 60% new mutations
Mutations in the TCOF1 gene
Characteristic face: Hypoplastic zygoma causing narrow face with
depressed cheeks and downward slanting palpebral fissures
Coloboma (notch) at the outer portion of lower eyelid
Ears anomalies: Deformed pinnae, extra ear tags, middle ear
ossicle defects cause hearing loss
Underdeveloped mandible; condyle and coronoid hypoplasia
Lateral facial clefting and cleft palate
No treatment required in most cases; Cosmetic surgery in
severe cases

Papillon-Lefevre syndrome EARLY PERIO PROBLEMS

Teeth erupt in normal sequence, position and time
1.5 to 2 years, a severe gingivo-periodontal inflammatory process develops
Edema, bleeding, alveolar bone resorption, and mobility of teeth with
consequent exfoliation
Teeth are lost in the sequence they are erupted. After loss of last teeth,
gingiva regains a normal appearance
Permanent teeth are lost before 14 years
Peripheral blood neutrophil is depressed in all patients with Papillon-Lefvre

suggesting that neutrophils are important factor in pathogenesis of severe

periodontal disease
Papillon-LeFvre Syndrome
Retinoid therapy: Improves the skin condition but not the periodontal therapy
Periodontal condition: No effective treatment
Cherubism
Autosomal dominant
Facial appearance similar to cherub-like
2 5 yrs of age
The clinical alterations typically progress until puberty,
stabilize and slowly regress
Bilateral involvement of the posterior mandible most
common appearance cherub-like (all 4 quadrants)
Eyes upturned to heaven appearance due to involvement
of the infraorbital rim and orbital floor
Painless bilateral expansion of the post. mand.
Marked widening and distortion of alveolar ridges
Tooth displacement and eruption failure
Radiographic features
Multilocular radiolucency with massive expansion
Both erupted and unerupted teeth are randomly distributed
After stabilization, lesions exhibit a ground glass appearance
Histopathology
Similar to giant cell granuloma
But clinical and radiographic correlation necessary
Vascular fibrous tissue and giant cells (smaller and
more focal)
Eosinophilic cuffing around blood vessels
Treatment
Prognosis is unpredictable
Delayed till after puberty (curettage)

Cleidocranial Dysplasia
Caused by a defect in Cbfa1/Runx2 gene
Autosomal dominant and sporadic pattern
Bone defects involve the clavicle and skull
Clavicles are absent (unilateral or bilateral) 10% of cases
Short stature with large heads; ocular hypertelorism; broad
base of nose and depressed nasal bridge
Large heads and parietal bossing
Skull sutures show delayed closure and may remain open
Dental manifestations include narrow, high-arched palate
with increased prevalence of cleft palate
Presence of numerous unerupted permanent and
supernumery teeth with many distorted crown and root shapes
Prolonged retention of deciduous teeth and delay or complete
failure of eruption of permanent teeth
Histology:
Unerupted permanent teeth lack secondary cementum

Treatment:
No treatment; full-mouth extractions with denture construction;
removal of primary and supernumery teeth followed by
exposure and orthodontic treatment of permanent teeth
Multiple Nevoid Basal Cell
Carcinoma Syndrome (Gorlin
Syndrome)
A.D.; high penetrance, variable expressivity
patched mutation, chr. 9
Chief characteristics: multiple basal cell
carcinomas, odontogenic keratocysts,
epidermal cysts, palmar/plantar pits, calcified
falx cerebri, rib anomalies, hypertelorism
Less common: strabismus, kyphoscoliosis,
CNS tumors
Multiple Nevoid Basal Cell
Carcinoma Syndrome (Gorlin
Syndrome)
Face: Frontal and temporoparietal bossing
(big head), hypertelorism, mild mandibular
prognathism
Skin: Basal cell carcinomas even in children
and adolescence, often on non-sun exposed
skin, few to hundreds; plantar and palmar
pits (retardation of the epithelial growth)
Skeletal: bifid ribs, kyphoscoliosis
More than one odontogenic keratocysts

Neurofibromatosis
(von Recklinghausen disease of
the skin)
A.D.; 50% of cases are new mutations;
1:3,000 births
Many forms
NF1 most common; chr. 17
Malignant transformation
Neurofibromatosis
(von Recklinghausen disease of the skin)
Diagnostic criteria (2 or more needed)
Six or more caf au lait macules over 5mm in
prepubertal and 15mm in postpubertal
Two NFs or one plexiform NF
Axillary freckles (Crowes sign)
Optic glioma
Lisch nodules (brown pigmented spots of the iris)
Distinct osseous lesions (thinning of long bone cortex)
1st degree relative with 2 or more of these findings
Neurofibromatosis
(von Recklinghausen disease of
the skin)
Oral lesions
NFs anywhere

 Enlargement of fungiform papillae

Enlargement of mandibular foramen
Enlargement of the mandibular canal
Multiple Endocrine Neoplasia, Type
IIB
MEN I: tumors of pancreatic islets, adrenal
cortex, parathyroid glands and pituitary
gland
MEN IIA: Sipple syndrome,
pheochromocytomas and medullary
thyroid carcinoma
MEN IIB: MEN IIA and mucosal neuromas
Multiple Endocrine Neoplasia,
Type IIB
A.D.; 50% new mutations
Mutation of ret proto-oncogene, chr.10
Marfanoid phenotype
Narrow face, thick lips, everted upper eyelid
Neuromas on conjuctiva, eyelid margin or cornea
Oral lesions may be the first sign
Lips, anterior tongue, buccal mucosa, gingiva,
palate, bilateral commissural neuromas
Multiple Endocrine Neoplasia,
Type IIB
Pheochromocytoma
Secretion of catecholamines
Sweating, diarrhea, headaches, flushing,
heart palpitations and hypertension
Medullary carcinoma of the thyroid
Calcitonin production
Highly metastatic

Peutz-Jeghers Syndrome
Autosomal Dominant
Multiple perioral and oral ephelides or melanotic macules
Intestinal polyposis
Considered hamartomas but have minimal neoplastic
potential (2 to 3% adenocarcinoma)
Small intestine (jejunum)
Abdominal pain, rectal bleeding and diarrhea

Osteogenesis Imperfecta
Heterogeneous group of disorders characterized by impairment
of collagen maturation
Mutations in type I collagen gene
Most common type of inherited bone disease
Collagen forms a major portion of bone, dentin, sclerae,
ligaments, and skin
Autosomal dominant, autosomal recessive hereditary; sporadic
Severity varies
Weak bones, blue sclera, altered teeth, hearing loss,
long bone and spine deformity and joint hyperextension
Radiographic features include osteopenia, bowing,
deformity of long bones and multiple fractures
Oral manifestations are clinically similar to dentinogenesis
imperfecta premature pulpal obliteration
Shell teeth can also be noted
However the two are different processes caused by different
mutations
Opalescent teeth if associated with OI
Maxillary hypoplasia
Osteogenesis Imperfecta
Four major types of OI
Type I: Most common and mildest form
Type II: Most severe; patients die before 4 weeks of age
Type III: Most severe form beyond the perinatal age
Type IV: Mild to moderate form
Treatment: No treatment of OI

Hypophosphatasia
Autosomal recessive trait
Decreased alkaline phosphatase
Increased blood and urinary phosphoethanolamine
Bone defects similar to rickets
Premature loss of primary teeth without evidence of
inflammatory response
No cementum on teeth
Perinatal: most severe
Infantile: normal till 6 months; failure to grow after that (severe)
Childhood: usually detected at later age; teeth defects with enlarged pulp
chambers; open fontanelles with premature fusion of cranial sutures
Adult: mild
Vitamin D-Resistant Rickets
(Hereditary Hypophosphatemic Rickets)
Rickets resistant to vitamin D
Inherited as X-linked dominant trait
Males affected more severely than females
Mutations in PHEX gene
Rickets, hypophosphatemia due to decreaed capacity to reabsorb phosphate
Teeth with large pulp chambers with pulp horns that extend almost
to the DE junction leading to very small pulp exposures leading to multiple

Periapical lesions and gingival sinus tracts

It will as though periapical lesions on otherwise normal teeth as the
exposures are so tiny
CASE Based disorder remembered from 2010

Ectodermal dysplasia represents a group of

inherited conditions in which two or more ectodermally derived anatomic
structures fail to develop. Thus depending on the type of ectodermal
dysplasia, hypoplasia or aplasia of tissues (e.g., skin, hair, nails, teeth,
sweat glands) may be seen.
Ectodermal Dysplasia:

Heat intolerance (b/c reduced eccrine sweat glands)

Fine, sparse hair reduced density of eyebrow and eye lash hair
Periocular skin may show fine wrinkling and hyperpigmentation
Midface hypoplasia

ORAL/FACIAL manifestations
-

Hypodontia/oligodontia sometimes anodontia but uncommon

taurodontism
regional odontodysplasia (ghost teeth) bimodal appearance 2-4 yrs (deciduous)
7-11 yrs (permanent)
conical crown forms (incisors) molar crowns are reduced in diameter
xerostomia (b/c salivary glands are derived from ectoderm.. pt. may not have
any)

TREATMENT:
-

Genetic counseling for parents and patient

Dental Tx: managed by prosthetic replacement of the dentition w/complete,
overdentures, or fixed appliance depending on number and location of
remaining teeth.