Mixed Deck — All ORE PART 1 Topics Flashcards

What opioid is commonly prescribed for moderate-to-severe dental pain?

Answer: Codeine phosphate (30–60 mg) combined with paracetamol, or dihydrocodeine as alternatives in UK primary dental care

In UK primary dental care, codeine phosphate (mild opioid) combined with paracetamol is used for moderate dental pain. Stronger opioids are reserved for hospital settings or specific circumstances under specialist care.

What is the purpose of the 'FGDP Selection Criteria for Dental Radiography'?

Answer: Evidence-based guidance for UK dentists on when radiographs are clinically justified — specific criteria for new patients, recall intervals, and specific clinical situations

The FGDP (Faculty of General Dental Practice, UK) Selection Criteria provide evidence-based guidance on clinical situations justifying radiographic exposures, including recall bitewing intervals, periapical indications, and specific clinical scenarios.

What is the normal resting blood pressure range for a healthy adult according to NICE hypertension guidelines?

Answer: Below 140/90 mmHg

NICE guidelines define hypertension as a clinic blood pressure persistently at or above 140/90 mmHg (with ambulatory or home monitoring confirmation at 135/85 mmHg). Below 140/90 is considered the normal range in clinical practice, though lower targets may apply for certain patient groups.

What is the average root length of the maxillary central incisor?

Answer: Approximately 13 mm

The maxillary central incisor has a crown length of approximately 10–11 mm and a root length of approximately 13 mm, giving a total tooth length of approximately 23 mm on average.

Which antibiotic can reduce the efficacy of the combined oral contraceptive pill?

Answer: Current evidence suggests ONLY enzyme-inducing antibiotics (e.g., rifampicin) reduce OCP efficacy — broad-spectrum antibiotics no longer considered to do so per FSRH 2019 guidance

FSRH updated guidance (2019): non-enzyme-inducing antibiotics (amoxicillin, metronidazole, etc.) do not significantly reduce OCP efficacy. Only enzyme inducers (rifampicin, some anticonvulsants) require additional contraceptive precautions.

The cementoenamel junction (CEJ) shows three possible relationships. Which is the most common arrangement?

Answer: Cementum overlaps enamel

In approximately 60% of teeth, cementum overlaps the enamel at the CEJ. In about 30%, they meet edge to edge, and in approximately 10%, there is a gap exposing the underlying dentine, which can contribute to cervical sensitivity.

What is the formula for the primary dentition and how many primary teeth are there?

Answer: I 2/2, C 1/1, M 2/2 = 20 teeth total

The primary dentition has 20 teeth: 2 central incisors, 2 lateral incisors, 2 canines, 2 first molars, and 2 second molars per arch (10 upper, 10 lower). There are no premolars in the primary dentition.

What is the evidence base for using low-level laser therapy (LLLT) in orofacial pain management?

Answer: Emerging evidence for benefit in TMD myofascial pain, oral mucositis, and dentine hypersensitivity — but evidence quality is currently insufficient to make strong recommendations in most guidelines

LLLT uses low-power lasers to modulate tissue healing and pain. There is emerging evidence for benefit in TMD myofascial pain, post-irradiation mucositis, and dentine hypersensitivity, but the evidence base is still developing and guidelines do not yet recommend it as a mainstream standard of care.

What does the ALARP principle stand for in dental radiography?

Answer: As Low As Reasonably Practicable

ALARP stands for As Low As Reasonably Practicable. It is the UK regulatory principle requiring that radiation doses be kept as low as is reasonably practicable while still obtaining diagnostically adequate images. This includes using rectangular collimation, correct exposure settings, and digital sensors where possible.

What is 'balanced analgesia' (multimodal analgesia) in dental pain management?

Answer: Using different analgesic classes with different mechanisms simultaneously (e.g., paracetamol + ibuprofen) to achieve better pain control with lower doses of each, reducing side effects

Multimodal (balanced) analgesia combines agents acting at different points in the pain pathway (e.g., paracetamol reduces central sensitisation; NSAIDs reduce peripheral inflammation), achieving superior analgesia with lower doses of each drug individually.

Which permanent tooth is the first to erupt in the mouth?

Answer: Lower first molar

The lower first permanent molar is typically the first permanent tooth to erupt, usually appearing at approximately 6 years of age. It erupts distal to the second deciduous molar and is often mistaken for a primary tooth by parents because no primary tooth is lost during its eruption.

Which radiographic technique is used to assess the alveolar crest bone level in periodontal disease?

Answer: Horizontal bitewing radiographs

Horizontal bitewing radiographs are the gold standard for assessing alveolar bone levels in the premolar and molar regions, clearly showing the interdental crest bone height relative to the cemento-enamel junction.

What does IL-1β (interleukin-1 beta) do in periodontal disease?

Answer: A pro-inflammatory cytokine produced by macrophages that stimulates bone resorption (via RANKL pathway) and collagenase production — a key mediator of periodontal tissue destruction

IL-1β is a pivotal pro-inflammatory cytokine in periodontitis. It stimulates osteoclast activity through RANKL upregulation causing bone loss, promotes collagenase (MMP) production destroying collagen, and perpetuates the inflammatory cycle.

What is the primary mechanism by which amoxicillin exerts its antibacterial effect?

Answer: Inhibition of bacterial cell wall synthesis by binding to penicillin-binding proteins

Amoxicillin, like all beta-lactam antibiotics, works by binding to penicillin-binding proteins (PBPs) and inhibiting transpeptidation, the final step in bacterial cell wall (peptidoglycan) synthesis. This leads to cell lysis, particularly of actively dividing bacteria, making it bactericidal.

What is the 'tubercle of Zuckerkandl' (Carabelli cusp) and where is it found?

Answer: An accessory cusp on the mesiopalatal cusp of the maxillary first molar

The Cusp of Carabelli is a 5th (accessory) cusp found on the mesiopalatal surface of the maxillary first molar (occasionally second molar). It is more common in people of European descent.

What are the contraindications to prescribing ibuprofen for dental pain?

Answer: Active peptic ulcer, severe renal impairment, third-trimester pregnancy, uncontrolled heart failure, hypersensitivity to NSAIDs/aspirin

Ibuprofen is contraindicated in: active peptic ulceration, severe renal/hepatic impairment, third-trimester pregnancy (risk of premature ductus arteriosus closure), uncontrolled heart failure, and known NSAID hypersensitivity (including aspirin-exacerbated respiratory disease).

What local anaesthetic technique is used for maxillary anterior teeth?

Answer: Infiltration (supraperiosteal) injection buccally adjacent to the apex of each tooth — due to the thin buccal bone and cancellous structure of the maxilla allowing LA diffusion

In the maxilla, infiltration anaesthesia (injecting above the root apex under the mucoperiosteum) is effective for most teeth due to the thin, porous buccal cortical bone allowing diffusion of the LA to reach the root and surrounding periodontium.

What is the pharmacological basis for prescribing prophylactic amoxicillin before dental procedures?

Answer: Current NICE guidance (NG178, 2008 updated) no longer recommends routine antibiotic prophylaxis for infective endocarditis in at-risk patients undergoing dental procedures in the UK

NICE guideline NG178 (2008, updated 2016): antibiotic prophylaxis for infective endocarditis prevention is NOT recommended for any dental procedure in at-risk patients in the UK — in contrast to previous practice and some international guidelines.

What is the role of the 'referral criteria' in dental radiography?

Answer: Evidence-based guidelines (e.g., FGDP Selection Criteria for Dental Radiography) that ensure X-rays are only taken when clinical benefit justifies the radiation risk — not as routine

Referral criteria (selection criteria) ensure radiographs are only prescribed when clinical information gained will positively influence patient management. Routine radiographs without clinical justification are unjustified exposures.

What error on a periapical radiograph is caused by incorrect horizontal angulation?

Answer: Overlapping of adjacent tooth contacts — proximal surfaces of adjacent teeth appear superimposed rather than open

Incorrect horizontal angulation of the X-ray beam causes overlapping of adjacent proximal contacts, making it impossible to see interproximal surfaces clearly for caries detection. The beam must be directed through the contact points.