- Caries initiator
- Streptococcus mutans — acidogenic, aciduric; ferments sugar into enamel-demineralizing acid.
- Local anesthetic max dose rule
- Take the LOWEST of the weight-based limit, the absolute cap, and the epinephrine ceiling.
- mg per cartridge formula
- mg per cartridge = % × 10 × 1.8 mL (standard 1.8 mL cartridge).
- mg in a 2% lidocaine cartridge
- 2 × 10 × 1.8 = 36 mg of lidocaine per 1.8 mL cartridge.
- Lidocaine max dose
- 7 mg/kg, absolute cap 500 mg (with vasoconstrictor).
- Mepivacaine max dose
- 6.6 mg/kg, absolute cap 400 mg; available as 3% plain (no vasoconstrictor).
- Prilocaine max dose & risk
- 8 mg/kg, cap 600 mg; risk of methemoglobinemia.
- Bupivacaine facts
- ~2 mg/kg, cap ~90 mg; longest-acting and most cardiotoxic — avoid in children.
- Articaine metabolism
- Metabolized largely in plasma (by plasma esterases), unlike other amides.
- Max epinephrine — healthy vs cardiac
- 0.2 mg in a healthy patient; 0.04 mg in a cardiac patient (often the limiting factor).
- Epinephrine per cartridge (1:100,000)
- 0.01 mg/mL × 1.8 mL ≈ 0.018 mg of epinephrine per cartridge.
- Why epi is added to local anesthetic
- Vasoconstriction → slows absorption, prolongs anesthesia, reduces bleeding and systemic toxicity.
- Local anesthetic toxicity sequence
- CNS excitation/convulsions FIRST, then CNS and respiratory depression.
- Why LA fails in infected tissue
- Low (acidic) pH shifts the weak base to its ionized form, so less non-ionized base crosses the nerve.
- Amide vs ester anesthetics
- Amides (lidocaine, articaine) metabolized in liver/plasma; esters (procaine) by plasma cholinesterase, higher allergy risk.
- Ester allergy metabolite
- Esters metabolize to PABA, the usual cause of true local-anesthetic allergy.
- Antibiotic prophylaxis regimen
- Amoxicillin 2 g adult (50 mg/kg child), single dose 30–60 min before the procedure.
- Clindamycin & prophylaxis (2021)
- Removed as an alternative in 2021 due to C. difficile risk.
- Penicillin-allergic prophylaxis options
- Cephalexin, azithromycin, clarithromycin, or doxycycline (avoid cephalosporins if anaphylaxis to penicillin).
- Cardiac conditions needing prophylaxis
- Prosthetic valve/repair material, prior IE, transplant with valvulopathy, certain congenital heart disease.
- Conditions NOT needing prophylaxis
- Mitral valve prolapse, rheumatic heart disease, bicuspid aortic valve, routine prosthetic joints.
- NSAID mechanism
- Inhibit cyclooxygenase (COX) → less prostaglandin; first-line for acute dental pain.
- Acetaminophen vs NSAID
- Acetaminophen has analgesic/antipyretic but little anti-inflammatory effect; safer with bleeding/ulcer risk.
- Bisphosphonate dental risk
- MRONJ — medication-related osteonecrosis of the jaw, especially after extractions.
- Epinephrine + nonselective beta-blocker
- Unopposed alpha effect → hypertension with reflex bradycardia.
- Opioid mechanism
- Agonists at mu opioid receptors; reserved for severe pain; risk of respiratory depression and dependence.
- Naloxone use
- Opioid antagonist that reverses opioid overdose (respiratory depression).
- Flumazenil use
- Benzodiazepine antagonist that reverses benzodiazepine oversedation.
- Nitrous oxide facts
- Minimal sedation; rapid onset/offset; give 100% oxygen at the end to prevent diffusion hypoxia.
- Tetracycline & teeth
- Causes intrinsic tooth discoloration and enamel hypoplasia if given during tooth development; avoid <8 yr & in pregnancy.
- Warfarin mechanism & monitor
- Inhibits vitamin-K-dependent clotting factors (II, VII, IX, X); monitored by INR.
- Aspirin & platelets
- Irreversibly inhibits COX-1 → impaired platelet aggregation for the platelet's lifespan (~7–10 days).
- Adrenergic receptor: alpha-1
- Vasoconstriction (raises blood pressure).
- Adrenergic receptor: beta-1
- Increases heart rate and contractility.
- Adrenergic receptor: beta-2
- Bronchodilation and vasodilation in skeletal muscle.
- Corticosteroid dental concern
- Immunosuppression and impaired healing; possible adrenal suppression requiring steroid coverage.
- First-line acute dental pain drug
- An NSAID (e.g., ibuprofen), unless contraindicated.
- Therapeutic index
- Ratio of toxic dose to effective dose; a narrow index means a small margin of safety.
- Lidocaine vs articaine for blocks
- Both effective; articaine is popular for infiltration; both are amides.
- Periapical granuloma
- Granulation tissue at the apex of a NON-vital tooth; the most common periapical radiolucency.
- Periapical granuloma vs radicular cyst
- Identical on radiograph; distinguished only on histology (cyst has epithelial lining).
- Radicular (periapical) cyst
- Inflammatory cyst from an epithelialized periapical granuloma; on a non-vital tooth.
- Dentigerous cyst
- Develops around the CROWN of an unerupted tooth (commonly third molar).
- Odontogenic keratocyst (OKC)
- Aggressive, recurrence-prone developmental cyst; multiple OKCs suggest Gorlin syndrome.
- Ameloblastoma
- Benign but locally aggressive odontogenic tumor; multilocular 'soap-bubble' radiolucency at the mandibular angle.
- Ground-glass radiograph
- Fibrous dysplasia.
- Sunburst radiograph
- Osteosarcoma.
- Punched-out radiolucencies
- Multiple myeloma.
- Hair-on-end skull pattern
- Sickle cell disease (or thalassemia).
- Leukoplakia
- A white patch that cannot be rubbed off or attributed to another condition; potentially premalignant.
- Erythroplakia
- A red patch; higher malignant potential than leukoplakia — biopsy.
- Most common oral cancer
- Squamous cell carcinoma; classic high-risk site is the lateral/ventral tongue and floor of mouth.
- Aphthous ulcer
- Painful recurrent ulcer with a yellow-gray base and erythematous halo on non-keratinized mucosa; not infectious.
- Cementoblastoma (trap)
- Involves a VITAL tooth; do NOT treat endodontically.
- Periapical cemento-osseous dysplasia (trap)
- Involves VITAL teeth, mostly anterior mandible in middle-aged women; no treatment needed.
- Necrosis vs apoptosis
- Necrosis = uncontrolled cell death with inflammation; apoptosis = programmed death without inflammation.
- Apoptosis 'eat me' signal
- Externalized phosphatidylserine flags the cell for phagocytosis without a scar.
- Reversible vs irreversible cell injury
- Hydropic (vacuolar) swelling is reversible; irreversible injury includes membrane damage and nuclear changes.
- Granulation tissue
- New connective tissue and capillaries in healing; not the same as a granuloma.
- Granuloma
- Organized collection of macrophages (epithelioid cells), classic of TB and foreign-body reactions.
- Dysplasia
- Disordered, abnormal cell growth and maturation; a premalignant change.
- Metaplasia
- Reversible change of one mature cell type to another (e.g., smoker's respiratory epithelium).
- Hyperplasia vs hypertrophy
- Hyperplasia = more cells; hypertrophy = larger cells.
- Torus palatinus / mandibularis
- Benign bony exostoses (palate / lingual mandible); no treatment unless interfering with prosthesis.
- Fibroma (irritation fibroma)
- Most common benign reactive oral growth; smooth nodule from chronic irritation.
- Pyogenic granuloma
- Red, friable, vascular growth that bleeds easily; common on gingiva, often in pregnancy.
- Pleomorphic adenoma
- Most common salivary gland tumor; benign, usually in the parotid.
- Mucocele
- Mucus-extravasation lesion, commonly on the lower lip from a severed minor salivary duct.
- Lichen planus (oral)
- Wickham striae — lacy white lines on buccal mucosa; T-cell mediated.
- Candidiasis (thrush)
- White plaques that wipe off leaving erythema; Candida albicans; risk with immunosuppression/inhaled steroids.
- Herpes simplex (oral)
- Recurrent vesicles on keratinized/attached mucosa (lips, hard palate, gingiva).
- Caseous necrosis
- Cheese-like necrosis, classic of tuberculosis.
- Edema mechanism
- Increased hydrostatic pressure or decreased oncotic pressure shifting fluid into tissues.
- Muscles of mastication & their nerve
- Masseter, temporalis, medial & lateral pterygoid — all motor from V3 (trigeminal).
- Muscles of facial expression nerve
- Facial nerve (cranial nerve VII).
- Tongue: anterior 2/3 taste
- Facial nerve VII via the chorda tympani.
- Tongue: anterior 2/3 general sensation
- Lingual nerve (branch of V3).
- Tongue: posterior 1/3 (taste & sensation)
- Glossopharyngeal nerve (CN IX).
- Trigeminal nerve divisions
- V1 ophthalmic, V2 maxillary, V3 mandibular; V3 is the only one carrying motor fibers.
- Inferior alveolar nerve block failure
- Most often from depositing anesthetic too LOW (below the mandibular foramen).
- Maxillary teeth innervation
- Posterior, middle, and anterior superior alveolar nerves (branches of V2).
- Pterygopalatine fossa contents
- Maxillary nerve (V2) and the pterygopalatine ganglion (parasympathetic to lacrimal/nasal glands).
- Parotid gland innervation
- Parasympathetic secretomotor from the glossopharyngeal nerve (CN IX) via the otic ganglion.
- Submandibular/sublingual gland innervation
- Parasympathetic from the facial nerve (VII) via the chorda tympani and submandibular ganglion.
- Foramen ovale transmits
- Mandibular nerve V3.
- Foramen rotundum transmits
- Maxillary nerve V2.
- Pharyngeal arch 1 derivatives
- Muscles of mastication, malleus and incus, trigeminal nerve (V).
- Pharyngeal arch 2 derivatives
- Muscles of facial expression, stapes, facial nerve (VII).
- Enamel composition
- ~96% inorganic hydroxyapatite; the hardest, most mineralized tissue; no cells, cannot regenerate.
- Dentin
- Mineralized tissue with dentinal tubules; formed by odontoblasts; can form throughout life.
- Pulp
- Connective tissue with nerves and vessels; odontoblasts line its periphery.
- Cementum
- Mineralized layer covering the root; anchors periodontal ligament fibers.
- Critical pH for enamel
- About 5.5 — below this, enamel demineralizes.
- Salivary functions
- Buffering, lubrication, clearance, antimicrobial proteins, and secretory IgA — protects against caries.
- Xerostomia consequence
- Reduced saliva → loss of buffering/clearance → high caries and infection risk.
- Vitamin D role
- Promotes calcium and phosphate absorption needed for bone and tooth mineralization.
- Calcium homeostasis hormones
- Parathyroid hormone raises serum calcium; calcitonin lowers it.
- Hemostasis stages
- Vascular spasm, platelet plug, coagulation cascade, then clot retraction and dissolution.
- Cellular respiration ATP
- Glycolysis → Krebs cycle → oxidative phosphorylation in mitochondria yields most ATP.
- Buccinator nerve
- Buccal nerve (branch of V3) — sensory to the cheek; NOT the same as the facial nerve buccal branch.
- Maxillary sinus relation
- Roots of maxillary premolars/molars are close to the floor — oroantral communication risk on extraction.
- Bone remodeling cells
- Osteoblasts build bone; osteoclasts resorb it; osteocytes maintain it.
- Amelogenesis imperfecta
- Hereditary defective ENAMEL formation; thin/pitted/discolored enamel on all teeth.
- Dentinogenesis imperfecta
- Hereditary defective DENTIN; opalescent blue-gray teeth; often with osteogenesis imperfecta.
- Cleidocranial dysplasia
- Absent/hypoplastic clavicles, delayed sutures, many supernumerary and unerupted teeth.
- Gardner syndrome
- Colonic polyps (malignant potential) with osteomas and supernumerary/impacted teeth.
- Gorlin (nevoid BCC) syndrome
- Multiple basal cell carcinomas and multiple odontogenic keratocysts.
- Down syndrome (trisomy 21)
- Macroglossia, delayed eruption, periodontal disease, class III tendency.
- Cleft lip vs palate timing
- Cleft lip = failed fusion of medial nasal & maxillary processes; cleft palate = failed palatal shelf fusion.
- Autosomal dominant inheritance
- One mutant allele causes disease; affected in every generation; 50% offspring risk.
- Autosomal recessive inheritance
- Two mutant alleles needed; often skips generations; carriers unaffected.
- X-linked recessive
- Mainly affects males; no male-to-male transmission (e.g., hemophilia).
- Anodontia / hypodontia
- Congenitally missing teeth; most commonly third molars, then maxillary lateral incisors and second premolars.
- Supernumerary tooth (mesiodens)
- Extra tooth, classically between the maxillary central incisors.
- Fusion vs gemination
- Fusion = two tooth germs unite (usually fewer teeth); gemination = one germ splits (usually normal count).
- Dens invaginatus (dens in dente)
- Invagination of enamel into the tooth; high caries/pulp risk; common in maxillary lateral incisors.
- Turner's tooth (hypoplasia)
- Enamel hypoplasia from trauma or infection of the predecessor primary tooth.
- Regional odontodysplasia ('ghost teeth')
- Localized developmental defect with thin enamel/dentin and a faint radiographic outline.
- Ectodermal dysplasia
- Defect of ectodermal structures — hypodontia/anodontia, conical teeth, sparse hair, reduced sweating.
- Mutation vs polymorphism
- A mutation alters DNA sequence; a polymorphism is a common variant (>1% of population).
- Eruption sequence (first permanent tooth)
- First permanent molar (~age 6) — the '6-year molar.'
- Natal vs neonatal teeth
- Natal teeth are present at birth; neonatal teeth erupt within the first 30 days.
- Lactobacilli & caries
- Advance established (deep) caries lesions; acidogenic, aciduric.
- Periodontitis red complex
- Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola.
- Localized aggressive periodontitis organism
- Aggregatibacter actinomycetemcomitans (A. a.).
- Dental plaque definition
- A structured biofilm of bacteria in a matrix adhering to tooth surfaces.
- Biofilm significance
- Organized community more resistant to antimicrobials than free-floating bacteria.
- Gram-positive vs gram-negative
- Gram-positive retain crystal violet (thick peptidoglycan); gram-negative have an outer membrane with endotoxin.
- Endotoxin (LPS)
- Lipopolysaccharide of gram-negative outer membrane; triggers inflammation/septic shock.
- Bacterial vs viral structure
- Bacteria are cells; viruses are not — they need a host cell to replicate.
- ANUG organisms
- Fusobacterium and spirochetes; acute necrotizing ulcerative gingivitis with punched-out papillae and pain.
- Candida albicans
- Fungus causing oral candidiasis (thrush); opportunistic with immunosuppression or antibiotics.
- Actinomyces (cervicofacial)
- Filamentous bacteria causing 'lumpy jaw' with sulfur granules.
- HSV-1 in dentistry
- Causes primary herpetic gingivostomatitis and recurrent herpes labialis.
- Bacterial growth requiring oxygen
- Obligate aerobes need oxygen; obligate anaerobes are killed by it; facultative use either.
- Sterilization vs disinfection
- Sterilization kills ALL microbes including spores; disinfection reduces but may spare spores.
- Autoclave parameters
- Steam under pressure, commonly 121°C at 15 psi for ~15–20 minutes; the standard for instrument sterilization.
- Biological (spore) indicator
- Bacterial spores used to verify a sterilizer actually killed resistant organisms.
- Mutans streptococci transmission
- Vertically transmitted, often from caregiver to infant ('window of infectivity').
- Glucan from sucrose
- S. mutans glucosyltransferase converts sucrose into sticky insoluble glucan that aids plaque adhesion.
- Caries as a multifactorial disease
- Needs host/tooth + cariogenic bacteria + fermentable sugar + time.
- Hepatitis B transmission risk
- Bloodborne; high occupational risk in dentistry — vaccination is standard for staff.
- Innate immunity
- Immediate, non-specific, no memory — barriers, neutrophils, complement, saliva.
- Adaptive immunity
- Slower, specific, with memory — B cells/antibodies and T cells.
- Type I hypersensitivity
- IgE-mediated; immediate (anaphylaxis, allergy).
- Type II hypersensitivity
- Antibody (IgG/IgM)-mediated against cell-surface antigens (e.g., transfusion reaction).
- Type III hypersensitivity
- Immune-complex deposition (e.g., serum sickness, lupus).
- Type IV hypersensitivity
- Delayed, T-cell-mediated (contact dermatitis to latex/metals, TB skin test).
- First antibody in primary response
- IgM (then class-switch to IgG).
- Most abundant antibody
- IgG — crosses the placenta and provides long-term immunity.
- Secretory antibody
- IgA — protects mucosal surfaces; found in saliva and other secretions.
- Allergy/parasite antibody
- IgE.
- Complement function
- Opsonization, inflammation, and membrane-attack-complex lysis of pathogens.
- Neutrophil role
- First responders; phagocytose bacteria; dominant in acute inflammation and the periodontal pocket.
- Macrophage role
- Phagocytosis and antigen presentation; dominant in chronic inflammation.
- Helper T cell (CD4)
- Coordinates the immune response; the target of HIV.
- Cytotoxic T cell (CD8)
- Kills virus-infected and tumor cells.
- Active vs passive immunity
- Active = your own response (infection/vaccine, lasting); passive = transferred antibodies (e.g., maternal, temporary).
- Non-immune oral host defense
- Saliva flow, mucosal barrier, antimicrobial proteins (lysozyme, lactoferrin), and normal flora.
- Autoimmune disease example (oral)
- Pemphigus vulgaris and mucous membrane pemphigoid cause oral blistering/erosions.
- Inflammation cardinal signs
- Redness, heat, swelling, pain, and loss of function.
- Acute vs chronic inflammation cells
- Acute = neutrophils; chronic = lymphocytes, plasma cells, macrophages.
- Five principles of dental ethics
- Autonomy, nonmaleficence, beneficence, justice, veracity.
- Autonomy
- Respect for the patient's right to self-determination; basis of informed consent.
- Nonmaleficence
- Do no harm.
- Beneficence
- Act in the patient's best interest.
- Justice (ethics)
- Fairness in the distribution of care.
- Veracity
- Truthfulness; honest disclosure to the patient.
- Informed consent is grounded in
- Autonomy (NOT beneficence — a classic trap).
- Autonomy vs beneficence conflict
- A competent patient's autonomy overrides the dentist's beneficence.
- Informed consent requirements
- Disclosure of risks/benefits/alternatives to a patient with capacity, given voluntarily; revocable anytime.
- Hierarchy of controls
- Elimination → substitution → engineering → administrative → PPE (PPE is last).
- Standard precautions
- Treat all blood and body fluids as potentially infectious for every patient.
- Most common dental occupational exposure
- Percutaneous sharps injury.
- HIPAA
- Federal law protecting the privacy and security of patient health information.
- OSHA bloodborne pathogens standard
- Requires exposure control plan, PPE, hepatitis B vaccination, and sharps safety.
- ASA classification
- ASA I healthy → ASA VI brain-dead; estimates pre-treatment medical risk.
- Mandatory reporting
- Suspected child or elder abuse/neglect must be reported (dentists are mandated reporters).
- Negligence (4 elements)
- Duty, breach of the standard of care, causation, and damages.
- Standard of care
- What a reasonably prudent practitioner would do under similar circumstances.
- Abandonment
- Ending the dentist-patient relationship without notice during active treatment.
- Battery vs negligence
- Battery = treating without consent; negligence = falling below the standard of care.
- Capacity for consent
- Ability to understand information and appreciate consequences; minors usually need a guardian.
- Behavior management (pediatric)
- Tell-show-do, positive reinforcement, voice control; nonpharmacologic methods preferred first.
- Health Belief Model
- Behavior change depends on perceived susceptibility, severity, benefits, and barriers.
- Confidentiality exception
- Disclosure allowed when required by law (e.g., reportable abuse or communicable disease).
- Paternalism
- Overriding a patient's wishes for their perceived good — conflicts with autonomy.
- Sensitivity
- Of the truly diseased, the fraction the test correctly identifies; a test property (prevalence-independent).
- Specificity
- Of the truly healthy, the fraction the test correctly clears; prevalence-independent.
- Positive predictive value (PPV)
- Of those who test positive, the fraction truly diseased; changes with prevalence.
- Negative predictive value (NPV)
- Of those who test negative, the fraction truly healthy; changes with prevalence.
- High sensitivity rules ___
- Rules OUT (SnNOut) — a negative result is trustworthy.
- High specificity rules ___
- Rules IN (SpPIn) — a positive result is trustworthy.
- Relative risk (RR)
- Used in COHORT studies; ratio of risk in exposed vs unexposed.
- Odds ratio (OR)
- Used in CASE-CONTROL studies; ratio of the odds of exposure.
- Number needed to treat (NNT)
- Patients you must treat to prevent one bad outcome = 1 / absolute risk reduction.
- Evidence hierarchy top
- Systematic reviews and meta-analyses, then RCTs.
- Cohort study
- Follows exposed vs unexposed groups forward in time; can give incidence and relative risk.
- Case-control study
- Compares diseased vs non-diseased looking backward for exposure; uses the odds ratio.
- Randomized controlled trial
- Random assignment to intervention vs control; the strongest single study design for causation.
- Cross-sectional study
- A snapshot at one time point; measures prevalence.
- Confounding
- A third variable distorting the apparent association between exposure and outcome.
- Selection bias
- Systematic error from how subjects are chosen, making the sample unrepresentative.
- Blinding
- Keeping participants/investigators unaware of group assignment to reduce bias.
- Mean, median, mode
- Mean = average; median = middle value; mode = most frequent; median resists outliers.
- Type I vs Type II error
- Type I = false positive (reject a true null); Type II = false negative (miss a real effect).
- p-value < 0.05
- Result is statistically significant — less than a 5% chance it arose by chance alone.
- Incidence vs prevalence
- Incidence = new cases over time; prevalence = all existing cases at a point.
- Evidence-based dentistry
- Integrates best research evidence, clinical expertise, and patient values/preferences.
- Reliability vs validity
- Reliability = consistent/repeatable; validity = measures what it intends to.
- Absolute vs relative risk reduction
- Absolute = simple difference in risk; relative = proportional reduction (can look bigger).
- Amalgam properties
- Strong, durable, technique-tolerant, not bonded, poor esthetics; contains mercury alloyed with silver.
- Composite resin
- Esthetic, bonded resin with filler; undergoes polymerization shrinkage — place incrementally.
- Glass ionomer cement
- Chemically bonds to tooth and releases fluoride; lower strength; good for root caries and high-risk patients.
- Resin-modified glass ionomer
- Glass ionomer with resin added — better strength while keeping fluoride release.
- Four elastomeric impression materials
- Polysulfide, condensation silicone, addition silicone (PVS), and polyether.
- PVS (addition silicone)
- Accurate, dimensionally stable impression material; the fixed-prosthodontics workhorse.
- Polymerization shrinkage problem
- Composite shrinks toward the curing light, risking marginal gaps; managed by incremental placement.
- Acid etching purpose
- Phosphoric acid creates micro-porosities in enamel for micromechanical bonding of resin.
- Coefficient of thermal expansion
- How much a material expands with heat; a large mismatch with tooth causes microleakage.
- Gypsum products
- Plaster and dental stone (calcium sulfate hemihydrate) used for casts and dies.
- Fluoride mechanism
- Forms acid-resistant fluorapatite and promotes remineralization; mostly a topical effect.
- Optimal water fluoride level
- 0.7 ppm (parts per million).
- Dental fluorosis
- Enamel mottling from excess fluoride during tooth development.
- Fluoride toxic dose
- Probably toxic dose ~5 mg/kg — warrants medical evaluation.
- Stress vs strain
- Stress = force per area applied; strain = the resulting deformation.
- Modulus of elasticity
- Stiffness of a material; higher modulus = more rigid (less flexible).
- Galvanic shock
- Current between two dissimilar metals (e.g., amalgam touching gold) causing a brief pain.
- Setting reaction of amalgam
- Trituration mixes alloy with mercury; the gamma-2 phase is the weakest/most corrosion-prone (minimized in modern alloys).
- Bonding to dentin vs enamel
- Dentin bonding is harder due to moisture and the smear layer; needs a hybrid layer.
- Sealant material
- A resin (or glass ionomer) flowed into pits and fissures to prevent caries.
- pH scale basics
- 0–14; 7 is neutral; lower is more acidic; each unit is a 10-fold change in H+ concentration.
- pH of pure water
- 7 (neutral).
- Buffer
- A solution that resists pH change; bicarbonate is a major physiologic and salivary buffer.
- Acid vs base
- An acid donates H+ (proton); a base accepts H+.
- Oxidation vs reduction
- Oxidation is loss of electrons; reduction is gain (OIL RIG).
- Diffusion
- Net movement of molecules from high to low concentration; passive, no energy.
- Osmosis
- Movement of water across a semipermeable membrane toward higher solute concentration.
- Hypotonic solution effect
- Cells swell and can lyse — why water is the worst avulsed-tooth storage medium.
- Isotonic solution
- Equal solute concentration; no net water shift (e.g., normal saline).
- Hydrogen bonding
- Weak attraction giving water its high surface tension and solvent properties.
- Covalent vs ionic bond
- Covalent = shared electrons; ionic = transferred electrons (electrostatic attraction).
- Catalyst / enzyme
- Lowers activation energy and speeds a reaction without being consumed.
- Le Chatelier's principle
- A system at equilibrium shifts to counteract an imposed change (e.g., pH affecting LA ionization).
- Henderson-Hasselbalch idea
- Relates pH and pKa to the ratio of ionized to non-ionized drug — explains LA behavior.
- Surface tension
- Cohesive force at a liquid surface; relevant to wetting of impression materials.
- Concentration gradient
- Difference in concentration driving passive transport (diffusion, osmosis).
- Heat transfer modes
- Conduction, convection, and radiation.
- Viscosity
- A fluid's resistance to flow; affects impression and cement handling.
- Solubility
- How much solute dissolves in a solvent; low solubility is desired for cements in the mouth.
- Electrolyte
- A substance that dissociates into ions and conducts electricity in solution.
- Gingivitis vs periodontitis
- Gingivitis = reversible inflammation, no attachment loss; periodontitis = irreversible attachment and bone loss.
- Clinical attachment loss
- The true measure of periodontitis severity (from the CEJ), not just pocket depth.
- AAP/EFP perio classification
- Periodontitis is staged (I–IV, severity/complexity) and graded (A–C, rate of progression).
- Furcation involvement
- Bone loss between multi-rooted tooth roots; worsens prognosis.
- Scaling and root planing
- Nonsurgical removal of plaque, calculus, and biofilm from root surfaces — first-line perio therapy.
- Periodontal probe normal depth
- Healthy sulcus is about 1–3 mm; ≥4 mm with bleeding suggests disease.
- Calculus
- Mineralized plaque (tartar); a plaque-retentive factor, not the direct cause of inflammation.
- Pregnancy & gingiva
- Hormones exaggerate the gingival inflammatory response (pregnancy gingivitis / pyogenic granuloma).
- Reversible pulpitis
- Pain to stimulus that stops quickly; pulp is salvageable — remove the cause.
- Irreversible pulpitis
- Lingering or spontaneous pain; requires root canal therapy or extraction.
- Pulp necrosis test
- A non-vital tooth fails to respond to cold/electric pulp testing.
- Apical periodontitis source
- Bacteria/toxins from a necrotic pulp inflaming the periapical tissues.
- Acute apical abscess
- Rapid-onset swelling and severe pain from a necrotic pulp; treat with drainage and removing the source.
- Goal of root canal therapy
- Remove infected pulp, disinfect and shape the canals, and obturate to seal them.
- Fixed vs removable prosthesis
- Fixed (crown/bridge) is cemented and not patient-removable; removable (denture/partial) is taken out.
- Pontic
- The artificial tooth that replaces a missing tooth in a fixed bridge.
- Abutment
- The tooth (or implant) that supports a fixed or removable prosthesis.
- Centric relation
- The maxillomandibular relationship with condyles in the most superior position — a reproducible reference.
- Centric occlusion
- Maximum intercuspation — the fully interdigitated bite.
- Dental implant osseointegration
- Direct bone-to-titanium contact; the basis of implant stability.
- Avulsed permanent tooth
- Reimplant ASAP; handle by crown, do not scrub the root; store in milk or HBSS, never water.
- Avulsed primary tooth
- Do NOT reimplant — risk to the developing permanent successor.
- Dry socket (alveolar osteitis)
- Painful loss of the extraction blood clot ~3–5 days post-op; manage with irrigation and a medicated dressing.
- Oroantral communication
- An opening into the maxillary sinus after extraction of a maxillary posterior tooth.
- Ludwig's angina
- Rapidly spreading bilateral submandibular/sublingual cellulitis — an airway emergency.
- Le Fort fractures
- Midface fracture patterns I (horizontal), II (pyramidal), III (craniofacial separation).
- Angle Class I
- Mesiobuccal cusp of the maxillary first molar in the buccal groove of the mandibular first molar (normal molar relationship).
- Angle Class II
- Mandible/lower molar distal to Class I (retrognathic profile, overjet).
- Angle Class III
- Mandible/lower molar mesial to Class I (prognathic profile, often crossbite).
- Orthodontic tooth movement
- Light continuous force → bone resorption (pressure side) and apposition (tension side).
- Overjet vs overbite
- Overjet = horizontal anterior overlap; overbite = vertical overlap.
- Primary dentition count
- 20 primary teeth.
- Permanent dentition count
- 32 permanent teeth (including third molars).
- Pulpotomy vs pulpectomy
- Pulpotomy removes coronal pulp; pulpectomy removes all pulp tissue (primary teeth).
- Early childhood caries
- Rampant caries in young children, classically from prolonged bottle/sippy use with sugary liquids.
- Space maintainer
- Appliance that preserves arch space after early loss of a primary tooth.
- Diabetes & dentistry
- Impaired healing, higher infection and periodontitis risk; assess control (HbA1c) before surgery.
- Anticoagulated patient
- Usually continue therapy for routine dentistry; check INR for warfarin; use local hemostatic measures.
- Adrenal insufficiency risk
- Chronic steroid use can blunt the stress response — consider steroid coverage for major procedures.
- Bisphosphonate patient (MRONJ)
- Avoid elective bone surgery when possible; greatest risk with IV bisphosphonates.
- Pregnant patient timing
- Second trimester is safest for elective dental care; avoid teratogenic drugs.
- Hypertension threshold to defer
- Defer elective care and refer for very high readings (e.g., ≥180/110 mmHg).
- Allergy vs intolerance
- True allergy is an immune (often type I) reaction; intolerance/side effect is not immune-mediated.
- Xerostomia drug causes
- Many drugs (anticholinergics, antihistamines, antidepressants) reduce saliva and raise caries risk.
- Sjögren syndrome
- Autoimmune destruction of salivary/lacrimal glands → dry mouth and dry eyes; high caries risk.
- Bell's palsy
- Acute unilateral facial nerve (VII) paralysis; the forehead is involved (lower-motor-neuron lesion).
- Trigeminal neuralgia
- Sudden, severe, brief electric facial pain in a trigeminal distribution; carbamazepine is first-line.
- Fluoride varnish use
- Professionally applied topical fluoride to prevent and arrest caries, including in young children.
- Chlorhexidine
- Antiseptic mouthrinse that reduces plaque bacteria; side effect is tooth/restoration staining.
- Antifungal for oral candidiasis
- Topical nystatin or clotrimazole; systemic fluconazole for resistant/extensive cases.
- Acyclovir use
- Antiviral for herpes simplex infections.
- Squamous cell carcinoma risk factors
- Tobacco and alcohol (synergistic); HPV for oropharyngeal SCC.
- Fibrous dysplasia
- Benign replacement of bone by fibro-osseous tissue; classic 'ground-glass' radiograph.
- Paget disease of bone
- Disordered bone remodeling; 'cotton-wool' radiopacities and hypercementosis; high alkaline phosphatase.
- Geographic tongue
- Benign migratory glossitis — shifting red patches with white borders; usually asymptomatic.
