Dentinal hypersensitivity is discomfort (sharp, shooting, or stabbing pain) caused by exposed dentin and open dentinal tubules (often due to gingival recession). The open dentinal tubules permit rapid fluid movement inside the tubules that subsequently stimulate pulpal mechanoreceptors. Dentinal hypersensitivity most commonly affects the buccal surfaces of premolars (but can occur on any tooth). Causes include overzealous toothbrushing, periodontal disease, acidic diet, GERD, and xerostomia. Treatment involves occluding (blocking) the open dentinal tubules orifices with glass ionomer or CPP-ACP varnish to physically prevent pulpal hyper-stimulation.
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Approximately 85% of TMJ and orofacial pain cases are MUSCLE-RELATED. Thus, non-surgical, minimally invasive TMJ and orofacial pain trigger-point muscle injections with botulinum toxin (Botox) may be highly effective for dentists to treat facial esthetics, TMJ/orofacial pain, and bruxism. Trigger-point injections often eliminate headaches caused by stress-induced clenching and grinding. While BOTOX treatment for these disorders is currently in the early stages, clinical evidence suggests that BOTOX is an extremely effective treatment. It is important that dentists expand their TMD treatment repertoire beyond occlusal splints (night guards) and NSAIDs, and consider alternative effective TMD treatment with trigger-point injections to treat orofacial pain.
HPV is a double-stranded DNA virus that infects epithelial cells of the skin and mucosa. There are over 200 HPV strains, but HPV-16 is the LEADING cause of oropharyngeal cancer. 80% of Americans will acquire HPV in their lifetime with 99% clearing the infection without consequence and without symptoms. White males, non-smokers 35-55 yrs are the highest risk population (4:1 females). The most effective way to screen for HPV related oral and oropharyngeal cancer is a visual and tactile exam by the dentist or dental hygienist. The most common areas orally are the uvula, tongue base, and tonsils.
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The immunoglobulin commonly found in HIGH CONCENTRATIONS in SALIVA, BREAST MILK, and MUCOSAL LININGS of the respiratory and GI tracts is IgA.
The HYOID BONE, MUSCLES OF FACIAL EXPRESSION, BUCCINATOR, and FACIAL NERVE all arise from the SECOND (2nd PHARYNGEAL ARCH).
The MANDIBLE, MAXILLA, MUSCLES OF MASTICATION, and TRIGEMINAL NERVE all arise from the FIRST (1st PHARYNGEAL ARCH).
WATER-SOLUBLE VITAMINS: (all vitamins B-complex and C). Dissolve in water, are NOT STORED BY THE BODY (low toxicity risk), and are easily absorbed then excreted by the kidneys. OBTAINED FROM DIET. Function to release energy (ATP) from consumed foods through the metabolism of fats, proteins, and carbohydrates. Involved in HEMOPOIESIS (RBC and platelet production in bone marrow). Water-soluble vitamin deficiencies often cause oral pathology (ex: petechaie, angular cheilitis, and glossitis).
FAT-SOLUBLE VITAMINS (A, D, E, K): absorbed through the intestinal tract and stored in the LIVER and adipose tissues for long periods, thus pose a greater toxicity risk due to accumulation (not readily excreted by the kidneys). Exccessive accumulation can lead to HYPERVITAMINOSIS.
The four pairs of muscles of mastication are innervated by the MANDIBULAR DIVISION (V3) of the TRIGEMINAL NERVE and receive blood supply from the PTERYGOID BRANCH OF THE MAXILLARY ARTERY (the larger terminal branch of the external carotid artery).
- TEMPORALIS: anterior & superior fibers ELEVATE THE MANDIBLE. Posterior fibers RETRACT THE MANDIBLE and maintain the resting position when the mouth is closed.
- MASSETER-THE MOST POWERFUL MASTICATORY MUSCLE that ELEVATES the MANDIBLE to occlude teeth. Forms a sling around the angle of the mandible.
- MEDIAL PTERYGOID-ELEVATES THE MANDIBLE & MOVES IT LATERALLY.
- LATERAL PTERYGOID (2 Heads)-OPENS & PROTRUDES THE MANDIBLE & MOVES IT LATERALLY (SIDE-TO-SIDE). For right lateral excursive movements, the left lateral pterygoid muscle is the primary mover, while for left lateral movements the right lateral pterygoid is the primary mover.
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ALL TASTE SENSATIONS (BITTER, SWEET, SOUR, SALTY, UMAMI) come from ALL TONGUE REGIONS AND ARE PERCEIVED EQUALLY WELL. Different tongue regions are NOT exclusively responsible for the different basic tastes (the “tongue map” misconception was disproven by various PhD researchers). While different tongue regions are slightly more sensitive to certain tastes initially, all tongue regions equally convey the various five tastes. For example, the sides of the tongue are only slightly more sensitive to all tastes than the middle of the tongue, and the posterior tongue is more sensitive to BITTER as a defense mechanism to protect us from swallowing spoiled or poisonous substances.
The HYOID MUSCLES originate from above or below the U-shaped HYOID BONE in the anterior midline of the neck. The hyoid bone is NOT attached to any other bone, but is anchored by muscles and ligament to support the tongue during speech and swallowing.
SUPRAHYOID MUSCLES: elevate the hyoid bone to RETRACT and DEPRESS the mandible. Consists of DIGASTRIC, MYLOHYOID, GENIOHYOID and STYLOHYOID muscles. Innervated by CN VII, V3 and CN XII (C1).
INFRAHYOID MUSCLES: stabilize the hyoid bone when the suprahyoid muscles contract. Consists of TOSS (Thyrohyoid, Omohyoid, Sternohyoid, Sternothyroid) muscles. Innervated by ANSA CERVICALIS.
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Of the 22 different amino acids in proteins, eight are ESSENTIAL AMINO ACIDS. ESSENTIAL AMINO ACIDS are NOT produced by the body, but must be obtained through DIET. Essential amino acids include:
Isoleucine, Leucine, Lysine, Methionine, Valine, Phenylalanine, Threonine, and TRYPTOPHAN
Since we are getting ready to celebrate Thanksgiving, it’s important to highlight TRYPTOPHAN. When TRYPTOPHAN reaches the CNS (crosses the blood-brain barrier), it is converted into SEROTONIN (affects mood) and MELATONIN (affects sleep-wake cycles). TRYPTOPHAN is also a biological precursor of NIACIN (vitamin B3). Tryptophan is found in most protein-based foods and egg whites, spinach, and cheese actually contain higher amounts of tryptophan than TURKEY. So if you feel tired after eating a big meal on Thanksgiving, it might simply be from the daily grind of dental school and not the turkey! Happy Thanksgiving from DENTIN.
TOBACCO is a drug that contains NICOTINE (a stimulant) used in cigarettes, cigars, pipes, chewing and dipping products and is the world’s #1 greatest cause of preventable disease or death.
Tobacco increases the risk of lung cancer, COPD, hypertension, heart disease, ORAL & NECK CANCER (squamous cell carcinoma), pancreatic cancer, spontaneous abortion, SIDS, and PERIODONTAL DISEASE (7-10 times greater risk due to reduced vascularity).
SMOKING DECREASES the PLAQUE ACCUMULATION RATE, GINGIVAL VASCULARITY, gingival inflammation and decreases BOP. Smokers are NOT at increased risk for caries (due to the decreased plaque accumulation rate).
In terms of dental management, ALWAYS perform a thorough comprehensive exam due to the increased risk for oral cancer and provide smoking cessation assistance. Apply the “5 A’s” to a smoking cessation program: (1st Ask, 2nd Advise, 3rd Assess, 4th Assist, and 5th Arrange). For more helpful practical NBDE & NBDHE information, please visit dentin.co.
While DIGOXIN (LANOXIN) is the most versatile and widely used cardiac glycoside (anti-arrhythmic) to treat atrial fibrillation and heart flutter, it is no longer the first line drug of choice to treat Congestive Heart Failure (CHF). THE FIRST LINE DRUGS OF CHOICE FOR CHF are BETA BLOCKERS or ACE INHIBITORS.
For dentists and hygienists, it is best practice to treat the CHF patient in the SEMI-SUPINE/SEMI-RECLINING or UPRIGHT POSITION in the dental chair (not in the supine position). Remember: Dental treatment is contraindicated with uncontrolled CHF. Source: DENTIN NBDE II & NBDHE study guides.
Developed by JCNDE, and is administered at Prometric Testing Centers. NBDE II is a two day examination of 500 multiple choice questions. The day 1 exam is 8 hours and 15 minutes, and covers and consists of 400 discipline-based, multiple choice questions. The day 2 exam is 4.0 hours, and covers 100 patient case-based items to test the dental student’s ability to apply broad-based knowledge to practical clinical cases. Official NBDE 2 test results are reported as pass/fail, with scaled scores ranging from 49-99, with a minimum passing score of 75. Over the past several years, NBDE 2 pass rates hover just above 90% (99% with DENTIN's NBDE II study guide). Prepare for the NBDE II by visiting dentin.co.