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Prometric Review - Original

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Prometric Review - Original

Uploaded by

Camila Freitas
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© © All Rights Reserved
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Nerb, Adex & Florida Prometric CSCE Slide Review Andy Codding, RDH OA rea Wisi maaan ol W aN esi Oelnlevicas Simulated Clinical Exercise (CSCE)? The CSCE consists of 100 mini-case presentations that include: health assesstnent and medical emergencies, radiology, infection control, disease Peano aye nese) a0 nme move oe eed el nN techniques, orthodontics, pediatric dentistry and therapeutics. Critical clinical conditions and situations commonly presented by patients in the offices of general dental practitioners are simulated by way of computer- enhanced photographs, radiographs (x-rays), optical images of study and working models, laboratory data and other clinical digitized reproductions. BAe Oe eM crc ned ee ae ad to recognize and appropriately respond to clinical conditions and situations encountered commonly in the practice of dental hygiene. alee IAN aleac zeae ence NO eee Rectan the first time and with a high score! Good luck! Topics Covered in this Review Radiology (Slides 4-92) Dental Anatomy & Histology (Slides 93-118) Intra/Extra Oral Assessments (Slides 119-163) Occlusion (Slides 164-178) Periodontics (Slides 179-218) Pharmacology (Slides 219-250) Oral Pathology (Slides 251-321) Fluoride and Nutrition (Slides 322-347) Special Needs and Dental Emergencies (Slides 348-388) Premedication Guidelines (Slides 389-407) Patient Education (Slides 408-435) Instrumentation (Slides 436-448) Sterilization, Infection Control, HIPAA (Slides 449-492) Radiology Panoramic Anatomy i The numbers on the diagram below and on the next slide (air spaces) correspond to the numbers on the key (slide 7). ©VNHHAUNS Panoramic Anatomy Key Berea Reon are ets ronan DTD Led RAT uaa Ree . zygomaticotemporal suture . zygomatic process ecg uray DeLee Peary . middle cranial fossa Yee Cert aed die Rec rrr] Boreas Weare airy nara) Bune eee ae ries DEA raid eras Pee eee “1-9 rao a. crs err nro) Der ee ere are Ree era Pre Er ET SA crm ce coo 35. ET i Ere Ere roe oe nd he poetry See areel CU eee ay Tred ee ta PUP er ee areer) ee a ne eed Cae Led Paes eared ENE ad Sey Pee ined Le) co cs cae 46. ae eae ear eee Paes PRL ENa Eee td) Bre ana ee eee ed Peer eee ee ete Radiopaque Landmarks on the Maxilla BNE aaaei *Anterior nasal spine Blah cia cie i M1 A A 0 RZ) *Floor or inferior border of the sinuses ole titan a APLIIAIM Om MOLMele Aero t e_ataaLd =Zygomatic process =Zygoma *Maxillary tuberosity =Pterygoid plates *Hamulus (Hamular process)—downward projection of the medial aN naelee =Coronoid process—sometimes seen overlapping the maxillary tuberosity Radiopaque Landmarks on the Mandible Tae fen (cer a1 Ke) redone Clerc ma aten aa clea oni aT rear surface of the body of the mandible that gives attachment below to the geniohyoid muscle and above to the genioglossus muscle *Mental ridge—extends from the premolar region to the symphysis "Oblique ridge—appears as a radiopaque line of varied width across nanan laa z|el =Mylohyoid ridge—is inferior and runs parallel to the oblique line «Inferior border—is only visible if the radiograph is deeply depressed lan atea lolol a aise ag Radiolucent Landmarks on the C Maxilla SIM Cera lean orl Ne c=1 01 0h MTA con gree Cella cee com aS midline of the palate and junction of the right and left maxilla «Incisive foramen—pear shaped opening near or between the apices of the central incisors (often times mistaken for an abscess) Nasal fossa—visible superior to the roots of the incisors "Maxillary sinus—visible from the canine to the molar region Radiolucent Landmarks on the a Mandible «Lingual foramen—small circular area surrounded by the genial tubercles a Ic1al-] ele lei clf eet=ie1c182] eral Oma ml aaa, i Terol ge maecte cl BIE al 1101 leer 18) el lag mean em ac mylohyoid ridge Remember your landmarks... 7 Coronoid Process of the Mandible Remember your landmarks... 7 Zygomatic Process (Malar Bone) Also known as the U shape, or Zygoma Remember your landmarks... External Oblique Ridge Remember your landmarks... 7 Genial Tubercles Dens Invaginatus vs. Dens Evaginatus = Remember the difference between Dens HTaNZeYeUarNau towne M Pxcla tom eaZ-Ve |g TAU oa Meal will try to confuse you. = Dens invaginatus, also known as dens in dente ("tooth within a tooth’) is a condition a(oViaMane Aaa nea xe e ae Miler areca lee = Dens evaginatus is a condition found in Meecan Mn mn AON a t-elce]2) 1c) form an extra bump or cusp. Premolars are more likely to be affected than any other tooth. Ci cist in| cama Z_V COLA cl(c a aa mole alee lare NO7milselicaeaencanclelean Dens evaginatus Radiographic Bone Loss Know how to recognize vertical and horizontal bone loss on a radiograph. Know that either is an indicator of periodontal disease. Horizontal Bone Loss Vertical Bone Loss Radiographic Recurrent Decay Know how to recognize recurrent decay Note: There is recurrent decay on teeth #5 18, 19, & 20. Can you spot it? Recent Extraction Site on a Radiograph if Following normal tooth extraction, the extraction socket is clearly demarcated by the radiopaque bundle bone into which the periodontal ligaments had anchored the tooth. A radiographic image of a recent first Cia lare ole lan teel alice eae eM AML Vide 1272 enema Rel rel Oa root socket. With healing, new bone is deposited into the socket, and, with time, the bundle bone slowly fades. After about 18 months, it can no longer Zo Cele aiatcTetedarcZ) from the Emer Radiographic Falatal & Mandibular Tori Mandibular Tori Remember what palatal and mandibular tori look like on radiographs. SD mall aaleie- Acre = On the exam they will ask you to identify mesiodens ona radiograph. ei Moet ea ere clase pelea aaa a VAAN aan ea maw ekeaaiae HTateiicfolaon = Mesiodens usually results in (lel dae cir veg I) malocclusion, food impaction, poor aesthetics, and cyst formation. Concrescence A condition of teeth ieee meta cgi 04a overlying the roots of at CZIinVemecacan (ella) together. The cause can sometimes be attributed to trauma or crowding of teeth. Surgical separation of the Sy can amNAcA A clels x d) Brown tumor of hyperparathyroidism Practice Question Mica lal elle aan Mn) leet 1 caries, are asymptomatic and respond normally to vitality tests. The most likely diagnosis of the radiolucency to which the arrows point is: b) Mental foramen Practice Question Mehr era ae ee and the black arrows are pointing to the a) Incisive foramen, incisive cz b) Incisive canal, incisive forar c) Nasal septum, palatal cana da) Palatal canal, nasal ra ag Practice Question The white arrows are pointingtothe and the black arrows are pointing to the b) Incisive canal, incisive foratl Practice Question What caused the vertical bone loss? Practice Question PNG tea ed Remember bone loss can be from a periodontal abscess, not always periodontal disease. The problem is not blood supply to the nerve at the root tip (as in a regular abscess), but rather the health of the bone and fibers that hold the tooth in the socket. Practice Question What landmark are the arrows pointing to? Practice Question (Nt geist ol aw elea lala *Note: Remember which landmarks are radiolucent and which are radiopaque. Practice Question What is the radiolucency seen near the black arrow? Practice Question Answer - Mental Foramen Practice Question What radiopacity can be observed on tooth #23 on this radiograph? Practice Question NU eeel casa eI ma orenag Practice Question What are the arrows pointing to? Practice Question Answer — Maxillary Tuberosity Practice Question er , eee try You will not always get questions about landmarks ona periapical or bitewing radiograph on the exam. A question about a landmark may be in a panoramic radiograph such as the image above that is depicting the maxillary tuberosity. Eruption Fatterns: Mixed Dentition Radiographs mmm UMA aaron vlc lec]e- ln Neuman clean aM ea Ker dentitions that ask why teeth have not erupted yet. pee ZANE) en eal cea ele mandibular second molars. Check which anterior teeth are Am ance mMeNe au all Nake Ieee Re See cee aOR RAR ola ln lee mal a oe ea anal ea or elec) tol ON ee Oko er too = Ifthe lower permanent canines are erupted then the patient is most likely around age 9 to 10. That means the patient should not have 2" molars yet and that they are still forming. That (lols MMOL MCAT cate 2er Eruption Patterns: Mixed Dentition Radiographs You will be given a mixed dentition radiograph and you'll need to determine if a particular tooth is impacted, delayed eruption or if nothing is wrong with it meaning it is not time to be erupted yet. Dor't just look at the molars, look at every tooth to estimate the age of the patient. TiN UR el Ama Olan 1c ae em AOL be, check the condition of the surrounding teeth. If the adjacent teeth are blocking the tooth from erupting then the tooth is impacted. If the tooth is not impacted the Elam eae Nee ae Eruption Fatterns: Mixed Dentition Radiographs = Be sure you can identify a patient's approximate age by Leleh area NAMA cle] | nto «= Ifyou see permanent premolars erupting into the mouth and the primary molars have exfoliated or are near exfoliation, then the approximate age is 10-12. = Remember the first permanent molar typically starts aM anion Eruption Fatterns: Mixed Dentition Radiographs Remember how to approximate the age of a eae) patient from a panoramic radiograph. Practice Question We ie mmalce kettle el Oneal mera a) 5-6 Ee c) 9-10 Pear Practice Question What is the approximate age of this patient? Practice Question What is the approximate age of this patient? a) 5-6 b) 7-8 c) 9-10 d) 11-12 F Practice Question What is the approximate age of this patient? b) 7-8 Practice Question What is the approximate age of this patient? a) 6-7 EES) Ona d) 12-13 Practice Question Wier ilemalr-\) Nein cr- le \ Ren MeN oI Lal Practice Question What is the approximate age of this patient? a) 5-G years old b) 7-8 years old c) 9-10 years old da) 11-12 years old Practice Question What is the approximate age of this patient? b) 7-6 years old Practice Question What is the approximate age of this patient? a) 7-8 years old b) 9-10 years old c) 11-12 years old da) 13-14 years old Practice Question War Walmaale-lol one) uae lo Aelia erg c) 11-12 years old *Note: The 12 year old molars are partially erupted and deciduous F is exfoliating, therefore the patient is between the ages of 11-12. Practice Question What permanent tooth will replace primary eos aes) b) #19 EEE a ~~ ae Practice Question What permanent tooth will replace primary tooth K? vey’) | ee Dental Anatomy & Histology Tooth Anatomy — Know the Farts of a Tooth Enamel - Makes up the protective outer surface of the crown of the tooth. Pee een een inner surface of the tooth. It cannot Renee conden Dentin a) Reale are Maremma) that holds the nerves and blood vessels mn acco cml aun ce ieee a7elol eA se) a a eee ad root of the tooth. The pulp is composed of fibroblasts, blood vessels, lymphatic channels, nerves and conne HesvIed Pulp Cementum Cort Th a el ec ceol ma xelo Leia ler) Ceca dam acolo a a eacas Piel a Practice Question Which of the following parts of the tooth is the first to form? a) Enamel me aaiaial Ocaatcaaablia d) Pulp Practice Question Which of the following parts of the tooth is the first to form? Easel laalc *Note: The first part of the tooth to form in the bone is the outer shell of the enamel. Practice Question Mesenchyme gives rise to all of the following except one. Which of the following is the exception? ED Ser aaal b) Dentin c) Pulp Ce mecatcaaaelia Practice Question Mesenchyme gives rise to all of the following er mola Cm AA eae alate) LA Ye oma exception? Emel laaic *Note: Mesenchyme gives rise to the dentin, pulp and cementum, but NOT the enamel. Compact Bone Compact bone forms the outer layer of all bones and most of the structure of long bones. Lacunae are the small spaces aa Nccim acacia cal ial(eL contain the bone cells (called osteocytes’) are located. The lacunae are linked together by minute channels called canaliculi. SUL la Re eanee lean a which nutrients can reach the osteocytes and waste products can leave them Ne Vein Artery ‘analiculi Osteocyte \— Lacunae Congenitally Missing Teeth = Hypodontia — having LESS than 6 congenitally missing teeth = Oligodontia - having 6 or MORE congenitally lexan aca Variations of Root Anatomy « Ifyou see a radiograph with a bifurcated premolar or canine, that it is NOT an anomaly, it is Sia Rail memneatir ls On occasion, the root is Agee meen 8 The double root may, or may not be accompanied by a deep depression in the root. Bifurcated Mandibular Premolar Retrocuspid Fapilla « The retrocuspid papilla (RCP) is a circumscribed nodule that lies lingual ivomaa aula ively cuspid on the gingival tissue. RCP is observed more frequently in young children and seems to regress or disappear with age. Enamel Fearls aka Enamelomas || Many conditions are known primarily by one name, but some also can have two names and either name could be used on the exam. mt Tin Enamel pearls or | \ “enamelomas” Ankylosis Ankylosis of primary molars has been adem Mod ace an Igo od anomalies in permanent dentition, like taurodontism of the first permanent molar, impaction of succedaneous tooth, ectopic eruption of premolars/canine. (erupting in the wrong place), aplasia of Eee meena Cee mele ae) develop), or tipping of the adjacent teeth. Ankylosis is usually associated with hypodontia and occurs most time when a tooth fails to exfoliate (usually from a missing permanent tooth). The most common tooth is the primary 2™ molar that is ankylosed and the 2™4 permanent. recite eam en mae needa Ave e)en 4 « % eee Deciduous Ankylosis TO es erat el Internal Resorption Sinatra acl ee : unusual condition where the realidad a resorb centrally within the root (eo Ta| "The first evidence of the lesion | i‘ may be the appearance of a pink-hued area on the crown of the tooth; the hyperplastic, eUeaell mecca aca the resorbed areas. Lm Ole My We lel] e- | gmatea 201 ence acl eA LETeeIcn Stensen’s Duct The parotid duct, also known as Poly alta We mero acoA ieelaene Zeer ee lara 0 Ler mucosa. Each parotid gland is wrapped Ele Raat are lcci eLa eai2 Eee ar ee eae nal cele rane aac e aa aioe Stensen duct facilitates mastication and swallowing and Llama ca clan Ona a el ol Blockage, whether caused by salivary duct stones or external compression, may cause pain and swelling of the parotid gland (parotitis). Iie lane mica coal mom al Stensen's duct. Wharton's Duct = The submandibular duct or Wharton duct is one of the salivary excretory ducts. = It drains saliva from each bilateral Wie lare 0 la) e002 and sublingual gland to the sublingual caruncle Pan alo AOL tongue. The arrows are pointing to the Wharton's ducts. Dental Anatomy Where can you find the oblique iulalc Omni aaa All IN mlle cae molar? Kh) Wei ee AK Ne Zz A= Oblique Ridge (1) Dental Anatomy Where can you find the oblique inte \clemOlam Aa eat ellie molar? Ke), Va late “ JP eae A= Oblique Ridge [truns from the DB cusp to ML I cusp. Practice Question What is the developmental oe Pee in the photos? Ey alee b) Gemination c) Dilaceration da) Turner's Tooth Practice Question What is the developmental eal lanaaa photos? c) Dilaceration Practice Question What is the arrow pointing to above? Practice Question TN een en en Wiel Two orifices on each side of the midline, distal to the vibrating line. They act as collecting ducts for a group of minor palatine salivary CElem A eed aa are Re canoe eNO making dentures. Practice Question What is the reason for ankylosis? a) Delayed eruption of the permanent teeth b) Delayed shedding of the primary teeth c) Delayed eruption of the primary teeth da) Both A and B are correct answers Practice Question What is the reason for ankylosis? da) Both A and B are correct answers ul Noy ain ate laL A e)=i7e eee eB alae cele displace the permanent tooth that is trying to erupt into its position. Also, the ankylosis can cause reduction of the space needed for the permanent tooth to erupt causing an impaction. Practice Question The space between the premolar and canine is most likely due to: a) Deposits of calculus between the teeth causing pressure b) Acheek and tongue biting habit c) Loss of posterior teeth d) Cystic expansion at the apex of the premolar Practice Question The space between the premolar and canine is most likely due to: c) Loss of posterior teeth Intra/Extra Oral Assessments Extra Oral Examination = There is a high probability of you needing to know the procedures and landmarks Velo aleaacelanlirc ean odar ele examination on a patient. This can be asked several ways. For example, you may see a photograph of a clinician performing the exam, and you have to identify the landmark they are relevance You may also see a photo of a patient with an obvious enlargement and you will be asked what lymph node would you palpate to examine the condition. Extra Oral Examination = \ Which lymph node is being examined here? Extra Oral Examination rs N PN a eetel Att iNeed The lower lip, lower anterior gingiva, corners of the mouth, and skin and tissue of the chin drain to the submental node. Extra Oral Examination (/ “UO Which lymph node is being examined here? Extra Oral Examination = “os PNA eed Aue ere UE ere od There are three groups of nodes associated with the submandibular gland. Extra Oral Examination What is being examined in this photograph? Extra Oral Examination Answer - Temporomandibular Joints Examined by having the patient open and close while the fingers are in the canal or Cella mele en Ae neler) ee al ee which should signal you to the correct answer being the TMJ. aNele Aan MIM 10) Mela Ao al mee eae ll ren ao Extra Oral Examination What is being examined in this photograph? Extra Oral Examination Y = = | aad Answer - Sternocleidomastoid Muscle Remember you are palpating for anterior superficial and deep nodes, NOT palpating for the muscle! These nodes are often palpable in lal emer M lancer aoa nolan el(olo-N v1 cn commenced ered might also say “anterior and as (deep) cervical nodes.’ Extra Oral Examination What is being examined in this photograph? Extra Oral Examination Answer - Sternocleidomastoid Muscle The anterior superficial and deep nodes. The answer choic might also say ‘anterior and/or posterior (deep) cervical nodes.” These are considered part of the “cervical chain’. Extra Oral Examination / ee What is being examined in this photograph? Extra Oral Examination , — 1d Ni dened arab ela eee) The supraclavicular lymph nodes are a set of lymph nodes found just above the clavicle or collarbone, toward aval agte) lol Melin Nae Extra Oral Examination What lymph node would you palpate to examine th (To ahr Extra Oral Examination ad Answer - Postauricular Node Natasa ad atenolol el ene lkeeg Chana ae cna deca eI Read all the questions carefully! Practice Question Ea ea Miia el aten aa oz leleXa What is the abnorm Answer — Next Slide Practice Question NN Ae eee lie arena cause? What is the abno Answer — Diastema The cause is hereditary. Practice Question What is the blue arrow pointing to above? Answer — Next Slide Practice Question What is the blue arrow pointing to above? Answer — Enlarged Circumvallate Fapilla Practice Question EF e What is the green and grey arrows pointing to EUs Answer — Next Slide Practice Question What is the green and grey arrows pointing to Ex Answer — The grey arrow is pointing to an enlarged lingual tonsil. The green arrow is pointing to a prominent foliate papilla (tonsillar tissue) at the ian aaa inate lar lace Zell Practice Question What papillae is most numerous on the tongue? a) Circumvallate ' Palatine Tons b) Fungiform : SG) Lirovat Tons ‘apiliae A c) Foliate = Folate Papiloe ee Fungiforny F ~Filiform Papiliae d) Filiform Papioe Se Practice Question What papillae is most numerous on the tongue? da) Filiform Palatine Tonsi }\ Lingual Tonsil Foliate Papillae Eungiformy ~Filiform Papillae Papillae ~ Practice Question Hairy tongue is caused by the elongation of what papillae? a) Circumvallate b) Fungiform c) Foliate d) Filiform Practice Question Hairy tongue is caused by the elongation of what papillae? d) Filiform Practice Question What is the MOST likely cause of this stain? a) Cigarette smoking b) Smokeless tobacco Me etaraglatc d) Green Tea Practice Question What is the MOST likely cause of this stain? a) Cigarette smoking Practice Question What is the cause of the erythema in this intraoral photo? a) Mouth breathing b) Hot food c) Ortho retainer da) Thumb sucking Practice Question What is the cause of the erythema in this intraoral photo? c) Ortho retainer Practice Question What is the gingival condition above and alam a eMac Mn Practice Question Answer - Melanin Pigmentation, which is normal so leh aaa giana lela B Practice Question What is the blue lesion above and what is the standard treatment for it? Practice Question Answer - Lingual Varicosities The blue color and bilateral symmetry of the "lesions" on the ventral tongue are indicative of lingual varicosities (varicose veins). These are common findings in geriatric patients and no treatment is needed. Practice Question What factors do not cause flaring of the teeth? EDM are Vito) Delite elmaaiavicla c) Thumb sucking d) Occlusal trauma Practice Question i What factors do not cause flaring of the teeth? Ey MRGA ae IViic) Practice Question These yellow spots on the buccal mucosa have been present for at least 3 years. What are they? Practice Question Answer - Fordyce Granules Practice Question = Ifyou see a picture of Fordyce granules and it asks which neat alea lo) necessary, the answer is NO TREATMENT as its just a sebaceous gland. & Frenum Attachment Remember that a frenum attachment can be the cause of recession. Don't rule it out as a reason especially if it is localized to one area. Practice Question lf a patient has a tongue piercing which of the following can happen due to the piercing: a) Chipped tooth b) Trigeminal neuralgia on \ c) Infective endocarditis d) Allof the above Practice Question lie No NAln a) Soe- Odie Ul ieellal Ma ea NoLm al following can happen due to the piercing: d) Allof the above GV. Black Classification of Carious Lesions > Class |—occlusal areas and buccal or lingual pits > Class |l—posterior interproximal | AO Id leer -ig keer > Class |\V—anterior interproximal including the incisal edge > Class V—gingival at facial or lingual > Class VI—cusp tip Practice Question Which G. V. Black classification would you give tooth #20? a) Class | b) Class ll c) Class ll PC OleleroaN Practice Question Which G. V. Black classification would you give tooth #20? mer tral *Note: #20 has a ‘ Class Il restoration — posterior interproximal. Occlusion Review Occlusion... (A)Normal occlusidi®)Class | malocclusion; (C)Class II malocclusi@#Class Il malocclusion Note the position of the mesial cusp of the maxillary n relative to the groove of the mandibular molar in each t ee Occlusion Know how to diagnosis different types of malocclusion. crossbite deep bite Pony (Ofere [Breiteyal Know how to diagnosis different types of malocclusion. class Ill Class | Occlusion - Normal Occlusion * The mesiobuccal i ™ %

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