ADEX Dental cheat sheet

Trigeminal V3 (mandibular division) supplies sensation to mandibular teeth, gingiva, lower lip and chin via the inferior alveolar nerve; V2 supplies maxillary teeth via the superior alveolar nerves.

Chorda tympani (a branch of VII) carries taste from the anterior two-thirds of the tongue; IX serves the posterior third and initiates the gag reflex; XII is motor to the tongue.

Inflammation lowers tissue pH, increasing the charged fraction of local anesthetic and slowing onset; agents with lower pKa have a larger unionized fraction at physiologic pH and diffuse faster.

Heparin prolongs the aPTT (intrinsic pathway); warfarin prolongs the PT/INR (extrinsic pathway, factors II, VII, IX, X). A platelet count below 50,000/µL warrants hematology consultation before surgery.

Bone remodeling is coupled: osteoblast-derived RANKL binds RANK on osteoclast precursors; osteoprotegerin is a soluble decoy receptor; PTH and glucocorticoids raise the RANKL/OPG ratio.

Collagen type I predominates in bone, dentin, cementum and periodontal ligament; type II in cartilage; type IV in basement membrane.

Maxillary artery branches relevant to dentistry: middle meningeal, inferior alveolar, posterior superior alveolar, greater palatine, infraorbital, and sphenopalatine.

Caries pathogenesis: mutans streptococci initiate lesions and lactobacilli propagate them; plaque pH falls below the critical pH of about 5.5 for enamel after fermentable carbohydrate exposure.

Infective endocarditis prophylaxis for high-risk patients: amoxicillin 2 g orally 30-60 minutes preoperatively; alternatives include cephalexin 2 g or azithromycin 500 mg; clindamycin is no longer recommended.

Paralleling technique: receptor parallel to the tooth long axis with the central ray perpendicular; requires a holder, produces less distortion, and is preferred for endodontic and restorative imaging.

Bisecting-angle technique: central ray perpendicular to the plane bisecting the angle between tooth and receptor; insufficient vertical angulation elongates the image, excessive angulation foreshortens it.

Radiographic detection of periapical disease requires roughly 30-50% loss of bone mineral, so early lesions may be invisible; clinical tests must supplement the radiograph.

A periapical radiolucency plus a negative response to cold and electric pulp testing indicates a necrotic pulp; a vital response points to a nonendodontic source of the lesion.

Alveolar bone loss is measured from the CEJ to the crest; greater than 2 mm in adults is abnormal, and the pattern is described as horizontal or vertical (angular).

CBCT effective doses are roughly 20-100 µSv for small fields; select the smallest field of view that answers the clinical question and apply ALARA; CBCT is not a screening tool.

Prosthetic joint replacement and most cardiac conditions no longer require antibiotic prophylaxis; reserve prophylaxis for the high-risk cardiac groups named in current guidelines.

Biopsy any oral ulcer persisting beyond 2 weeks and any leukoplakia or erythroplakia; erythroplakia carries the highest malignant transformation risk of the red-white lesions.

ASA classification: I healthy; II mild systemic disease; III severe disease limiting activity; IV incapacitating disease with constant threat to life; V moribund; VI brain-dead organ donor.

GV Black classification: I pits and fissures, II proximal posterior, III proximal anterior sparing the incisal edge, IV proximal anterior including the incisal edge, V cervical third, VI cusp tips.

37% phosphoric acid: about 15 seconds on dentin and 15-30 seconds on enamel; over-etching dentin collapses the collagen network and reduces bond strength.

Total-etch bonding requires visibly moist dentin so the expanded collagen network can be infiltrated by primer; self-etch systems combine acidic monomer and primer and are less technique-sensitive on dentin.

C-factor is the bonded-to-unbonded surface area ratio; Class I preparations approach 5, producing high shrinkage stress, so composite is placed in increments no thicker than 2 mm.

Light-curing units should deliver at least 400 mW/cm²; a 2 mm increment typically needs 20 seconds, and the tip should be held within 2 mm of the restoration surface.

Amalgam has no chemical adhesion and requires mechanical retention; it is avoided where esthetics matter or where remaining cusps are undermined and unsupported.

Postoperative sensitivity after composite most often reflects incomplete marginal seal, voids within the increment, or air-drying of dentin during bonding.

38% silver diamine fluoride arrests active caries and reduces hypersensitivity; it permanently stains demineralized tissue black, so restrict use to nonesthetic areas.

Occlusal adjustment should produce light simultaneous contacts in maximum intercuspation and smooth excursive pathways free of working-side and balancing-side interferences.

Working length is set 0.5-1.0 mm short of the apical foramen using an electronic apex locator, confirmed by radiograph with the file in place.

Maxillary first molars have a second mesiobuccal canal in 60-80% of cases; mandibular first molars usually have two canals in the mesial root and one or two in the distal root.

Sodium hypochlorite (0.5-5.25%) dissolves necrotic tissue and kills planktonic bacteria; 17% EDTA removes the smear layer; never mix hypochlorite and chlorhexidine because a toxic precipitate forms.

Irrigants are delivered with side-vented needles kept loose in the canal to prevent extrusion and sodium hypochlorite accidents; apical negative-pressure systems further reduce risk.

Crown-down instrumentation with an established glide path lowers torsional and cyclic fatigue failure of nickel-titanium rotary instruments.

Master cone selection is confirmed by tug-back at working length; obturation uses warm vertical compaction or carrier-based techniques with an appropriate sealer.

A J-shaped radiolucency or an isolated deep narrow pocket along a root suggests vertical root fracture; a crack extending to the canal floor is generally nonrestorable.

AAE diagnostic terms: normal apical tissues, symptomatic apical periodontitis, asymptomatic apical periodontitis, acute apical abscess, chronic apical abscess, condensing osteitis.

Irreversible pulpitis in a vital tooth is managed by pulpotomy or pulpectomy for relief; antibiotics are not indicated for pulpitis without systemic involvement.

Clinical attachment level equals probing depth plus recession measured from the CEJ; it reflects cumulative attachment loss, whereas probing depth reflects only current pocket depth.

2017 classification: staging (I-IV) uses severity and complexity of attachment loss; grading (A-C) estimates progression rate from smoking, diabetes and bone-loss patterns.

Red complex organisms - Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola - are strongly associated with advanced lesions; Aggregatibacter actinomycetemcomitans is linked to aggressive periodontitis.

Nonsurgical therapy is subgingival scaling and root planing with reevaluation at 6-8 weeks; adjuncts include locally delivered antimicrobials and, in selected cases, systemic antibiotics.

Modifiable risk factors include smoking and poorly controlled diabetes (elevated HbA1c); local contributing factors include calculus, restorative overhangs, and occlusal trauma.

Biologic width averages about 2 mm, comprising 1 mm junctional epithelium and 1 mm connective tissue attachment; margins placed within it cause inflammation and bone loss.

Furcation involvement is graded I-IV; mandibular molars are approached from the buccal and maxillary molars from the buccal or mesial surfaces according to root anatomy.

Peri-implant mucositis is reversible inflammation without bone loss; peri-implantitis adds progressive bone loss and requires decontamination plus surgical or nonsurgical therapy.

Maintenance intervals of 3-4 months reduce recurrence; bleeding on probing and residual pockets of 5 mm or more are the strongest predictors of progression.

Ante's law: the total periodontal ligament area of the abutments should equal or exceed that of the teeth being replaced by the fixed partial denture.

Crown-root ratio: 1:2 is ideal and 1:1 is the minimum acceptable for a fixed abutment; a more apical ratio increases leverage on the root.

Ferrule of 1.5-2 mm of circumferential axial wall coronal to the margin improves fracture resistance of endodontically treated teeth.

Kennedy classification: I bilateral posterior edentulous, II unilateral posterior, III unilateral bounded posterior, IV single anterior span crossing the midline; the classification is assigned to the most posterior edentulous area.

A mandibular lingual bar needs about 8 mm from gingival margins to the floor of the mouth and at least 4 mm of vertical height; otherwise a lingual plate is used.

Border molding with modeling plastic or elastomer on a custom tray defines the denture periphery; the posterior palatal seal contributes retention and reduces food trapping.

Interocclusal rest space (freeway space) is 2-4 mm; changes in vertical dimension must respect phonetics, esthetics, and comfort.

Implant spacing: at least 1.5 mm between an implant and a tooth, 3 mm between adjacent implants, and about 2 mm of buccal bone for stable esthetics.

Mutually protected occlusion: anterior teeth disclude the posterior teeth in excursions while posterior teeth contact evenly in maximum intercuspation with light anterior contact.

Third molar removal is indicated for recurrent pericoronitis, caries, cysts, root resorption of adjacent teeth, and pathology; risks include inferior alveolar and lingual nerve injury near the lingual plate.

Alveolar osteitis (dry socket) appears 2-4 days postoperatively from clot fibrinolysis; treat with irrigation, eugenol-based dressing and analgesia, with antibiotics reserved for infection.

MRONJ risk is highest with intravenous bisphosphonates and antiangiogenic agents; stage 1 is managed conservatively, and drug holidays are decided with the prescribing physician.

Bleeding control: direct pressure, sutures, oxidized cellulose or gelatin sponge, and tranexamic acid rinse; persistent bleeding requires evaluation of platelets and INR.

TMJ dislocation is reduced with downward and backward pressure on the mandible while the head is stabilized; postreduction imaging and a soft diet limit recurrence.

Socket grafting limits ridge dimensional change; allow roughly 3-4 months of healing before implant placement in the posterior maxilla and longer when augmentation is performed.

Incisional biopsy samples part of a large or suspicious lesion; excisional biopsy is appropriate for small lesions that can be removed entirely with margins.

Postoperative swelling peaks at 48-72 hours; cold packs are used for the first 24 hours followed by moist heat and jaw exercises for trismus.

Orthognathic procedures: Le Fort I for the maxilla, bilateral sagittal split osteotomy for the mandible, and genioplasty for the chin, coordinated with presurgical orthodontics.

Squamous cell carcinoma accounts for about 90% of oral malignancy; the lateral tongue and floor of the mouth are the most common intraoral sites, and the lip vermilion is the most common site overall.

Red flags for malignancy: ulceration beyond 2 weeks, induration, fixation to deep structures, paresthesia, and cervical lymphadenopathy.

Leukoplakia is a white patch that cannot be diagnosed as another entity; erythroplakia is red and carries a higher malignant transformation rate.

Odontoma is the most common odontogenic tumor; ameloblastoma is a locally aggressive posterior mandibular tumor with a multilocular soap-bubble appearance.

Odontogenic keratocyst shows a parakeratinized lining, satellite cysts and high recurrence; it is linked to PTCH1 mutation in nevoid basal cell carcinoma syndrome.

Dentigerous cyst surrounds the crown of an impacted tooth, attaches at the CEJ, and is the most common developmental odontogenic cyst.

Mucous membrane pemphigoid shows subepithelial separation with a negative Nikolsky sign; pemphigus vulgaris shows suprabasal intraepithelial separation with a positive Nikolsky sign.

Recurrent aphthous stomatitis types: minor (under 1 cm, heals in 7-10 days), major (over 1 cm, scarring), and herpetiform (clustered pinhead ulcers).

Oral candidiasis variants: pseudomembranous (wipes off), erythematous (denture stomatitis), and hyperplastic; treat with nystatin or fluconazole and correct predisposing factors.

Angle classification uses the first molar relationship: Class I mesiobuccal cusp in the buccal groove, Class II cusp mesial to the groove, Class III cusp distal to the groove.

Normal overjet and overbite are about 2-3 mm; deep bite and open bite describe vertical discrepancies, while crossbite describes transverse discrepancy.

Cephalometric norms: SNA about 82°, SNB about 80°, ANB about 2°; a large ANB indicates a skeletal Class II pattern and a negative ANB a Class III pattern.

Leeway space is about 1.5 mm per side in the maxilla and 2.5 mm per side in the mandible; it is used to correct the permanent molar relationship.

Primary teeth erupt from about 6 months to 2.5 years; the first permanent molar erupts near 6 years and establishes the permanent occlusion.

Fluoride: community water at 0.7 ppm, 5% sodium fluoride varnish every 3-6 months for high-risk children, and 1.23% APF gel; limit ingestion under age 6 to prevent fluorosis.

Avulsed permanent tooth: replant immediately or store in milk, saline or Hank's balanced salt solution, splint flexibly for 2 weeks; primary teeth are not replanted.

Space maintenance after premature primary tooth loss: band and loop for a single posterior tooth, Nance or lingual arch for bilateral loss.

Pulp therapy in primary teeth: pulpotomy with formocresol, ferric sulfate or MTA when radicular pulp is healthy; pulpectomy when the radicular pulp is infected.

Maxillary anesthesia: posterior superior alveolar, middle superior alveolar, anterior superior alveolar (infraorbital), greater palatine and nasopalatine blocks.

Mandibular anesthesia: inferior alveolar nerve block (about 80-85% success), Gow-Gates block targeting the condylar neck, and the Vazirani-Akinosi closed-mouth technique.

One 1.8 mL cartridge of 2% lidocaine contains 36 mg of lidocaine; with 1:100,000 epinephrine it contains 0.018 mg of epinephrine.

Maximum doses for a healthy adult: lidocaine 4.4 mg/kg (absolute 300 mg), articaine 7 mg/kg (500 mg), mepivacaine 6.6 mg/kg (400 mg), prilocaine 8 mg/kg (600 mg), bupivacaine 1.3 mg/kg.

Epinephrine limit is about 0.2 mg in healthy patients and 0.04 mg in patients with significant cardiovascular disease.

Prilocaine and benzocaine can cause methemoglobinemia; treat with intravenous methylene blue 1-2 mg/kg.

Nitrous oxide has a blood-gas partition coefficient of 0.47, giving rapid onset and recovery; MAC is about 105%, so it is used only as an adjunct to local anesthesia.

Nitrous oxide contraindications: nasal obstruction, pneumothorax, bowel obstruction, first-trimester pregnancy, and vitamin B12 deficiency.

Sedation continuum: minimal anxiolysis, moderate sedation (responds to command), deep sedation (not reliably responsive), and general anesthesia; monitoring includes pulse oximetry, capnography, blood pressure and ECG.

Informed consent requires the diagnosis, nature and purpose of treatment, material risks and benefits, alternatives including no treatment, and the patient's voluntary agreement.

Core ethical principles: patient autonomy, nonmaleficence, beneficence, justice, and veracity.

Malpractice requires four elements: duty, dereliction of that duty, direct causation, and damages.

HIPAA requires minimum necessary disclosure, patient access to records, business associate agreements, and breach notification; psychotherapy notes receive stricter protection.

Minors generally require parent or guardian consent; emancipated minors and emergency or specified public health exceptions permit treatment without it.

Record retention is commonly at least 7 years from the last treatment, and for minors until the age of majority plus the applicable statute of limitations.

Mandatory reporting duties include suspected child, elder or dependent adult abuse and specified communicable diseases.

Practice metrics: overhead commonly runs 60-65% of collections; accounts receivable days, case acceptance rate and recall effectiveness indicate practice health.

Reimbursement models include fee-for-service, capitation, PPO and HMO arrangements; coordination of benefits and nonduplication clauses determine collections when a patient has two plans.

Spaulding classification: critical items penetrate tissue and must be sterilized; semicritical items contact mucosa and require high-level disinfection or sterilization; noncritical items touch intact skin and need low-level disinfection.

Steam autoclave cycles: 121°C at 15 psi for 15-30 minutes, or 132°C for 4-6 minutes; follow the instrument manufacturer's validated parameters.

Biological indicators are processed at least weekly: Geobacillus stearothermophilus for steam and unsaturated chemical vapor, Bacillus atrophaeus for dry heat and ethylene oxide.

Chemical indicators, external and internal, verify exposure to each load but do not prove sterility.

Hand hygiene: soap and water for 40-60 seconds when hands are visibly soiled; alcohol-based rub for 20-30 seconds; perform before and after glove use.

PPE removal order: gloves first, then eyewear, gown, and mask last, followed immediately by hand hygiene.

Needles are not recapped except by a one-handed scoop technique; sharps go into puncture-resistant containers replaced when three-quarters full.

Post-exposure management: wash the site, report immediately, test source and provider, and start HIV postexposure prophylaxis within 2 hours when indicated.

Dental unit waterlines are flushed at least 30 seconds between patients; sterile water or saline is used for surgical irrigation.