Israel Dental Licensing cheat sheet

Le Fort I fracture separates the maxilla above the tooth apices through the nasal floor and pterygomaxillary junction; Le Fort II is pyramidal through the infraorbital rims; Le Fort III is craniofacial disjunction through the nasofrontal suture and zygomatic arches.

Mandibular angle fractures are the most common mandibular fracture; the most frequently fractured facial bone overall is the nasal bone.

Ludwig angina involves the submandibular, sublingual, and submental spaces bilaterally; it is a true emergency requiring airway control and urgent surgical decompression.

Inferior alveolar nerve injury risk is highest in third molar surgery, sagittal split osteotomy, and angle fractures; lingual nerve risk is highest with lingual retraction and lingual split technique.

Osteoradionecrosis typically follows radiotherapy above 60 Gy; the classic triad is hypovascularity, hypocellularity, and hypoxia, and management ranges from antibiotics and pentoxifylline-tocopherol to resection with free flap.

MRONJ risk factors include IV bisphosphonates, denosumab, antiangiogenics, and duration of therapy; staging runs 0 to 3, with stage 3 requiring resection.

Temporomandibular joint dislocation is reduced by downward and posterior pressure on the mandible with the patient's head stabilized; recurrent dislocation may need eminectomy or botulinum toxin.

Orthognathic surgery timing after Le Fort I or bilateral sagittal split osteotomy: most surgeons wait at least 6 to 12 months after completion of growth, verified by serial cephalometrics or hand-wrist films.

Working length is typically 0.5 to 1.0 mm short of the radiographic apex; the apical constriction lies about 0.5 to 1.0 mm from the anatomic apex.

Canal curvature classification by Schneider: mild under 5 degrees, moderate 5 to 20 degrees, severe over 20 degrees.

Sodium hypochlorite concentrations of 0.5 to 5.25 percent are used for irrigation; it dissolves organic tissue but does not remove the smear layer, which requires EDTA.

Smear layer removal with 17 percent EDTA for 1 minute followed by NaOCl improves tubular penetration of sealers.

Caries removal endpoint: dentin should be leathery and firm; soft, wet, infected dentin is removed, affected dentin may be retained in deep lesions to avoid pulp exposure.

C-factor equals bonded surface area divided by unbonded surface area; high C-factor in class I cavities increases polymerization contraction stress.

Posterior composite increment thickness should not exceed 2 mm to ensure adequate depth of cure with standard curing lights of at least 1000 mW/cm2.

Endodontic success is highest with a ferrule of at least 1.5 to 2 mm of circumferential dentin; a post does not strengthen a tooth and should be used only for core retention.

Complete denture posterior palatal seal is placed at the vibrating line; the seal provides retention by creating a partial vacuum and should be 0.5 to 1 mm deep.

Neutral zone concept: teeth and polished surfaces are placed where the tongue and cheeks exert balanced forces, improving stability in resorbed ridges.

Implant survival criteria (Albrektsson): less than 0.2 mm bone loss per year after the first year, no mobility, no pain, no radiolucency.

Crown-to-implant ratio greater than 2:1 is a biomechanical risk factor, not an absolute contraindication; splinting and wider platforms reduce risk.

Occlusal vertical dimension loss is assessed by resting and phonetic space; the closest speaking space is normally 1 to 2 mm.

All-ceramic zirconia requires adequate connector dimensions: about 3 mm for posterior and 2 mm for anterior connectors to resist fracture.

RPD design: the guiding plane, rest seats, and reciprocal arms control functional movement; the rest seat floor should be perpendicular to the path of insertion.

Bruxism management with occlusal splints does not stop bruxism; it protects teeth and restorations and reduces wear.

2017 classification: periodontitis staged I to IV by severity and complexity, graded A to C by progression rate; stage III includes probing depth of 6 mm or more and vertical bone loss of 33 percent or more.

Clinical attachment level equals probing depth plus recession (or minus hyperplasia); it is the reference for periodontal destruction.

Bleeding on probing has high sensitivity but low specificity for disease progression; absence of bleeding has a high negative predictive value.

Aggressive periodontitis (now stage III/IV grade C) is associated with Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis.

Scaling and root planing is indicated for pocket depths of 4 mm or more with bleeding; sites of 5 mm or more may need surgical access after re-evaluation at 6 to 8 weeks.

Systemic risk factors include poorly controlled diabetes (HbA1c above 7 percent), smoking, and HIV; smoking reduces bleeding and masks inflammation.

Gingival crevicular fluid flow and interleukin-1 beta levels rise with inflammation; they are research markers, not routine diagnostic tests.

Regenerative therapy for intrabony defects uses barrier membranes and bone grafts; the best prognosis is in deep, narrow, three-wall defects.

Eruption timing: first primary tooth at 6 months, first permanent molar at 6 years, and the mixed dentition lasts from 6 to 12 years.

Leeway space is about 1.5 mm per side in the maxilla and 2.5 mm per side in the mandible; it is used for relief of crowding.

Ugly duckling stage (Broadbent) occurs at 8 to 9 years with transient maxillary central diastema; it usually resolves spontaneously.

Class II division 1 has proclined maxillary incisors; division 2 has retroclined centrals with deep overbite.

Cephalometric norms: ANB 2 to 4 degrees, SNA about 82 degrees, SNB about 80 degrees; ANB greater than 4 suggests skeletal Class II.

Pulpotomy in primary molars uses formocresol, ferric sulfate, or MTA; MTA gives higher success and is preferred for vital pulp therapy.

Fluoride varnish 5 percent NaF is applied at 3 to 6 month intervals; silver diamine fluoride 38 percent arrests caries and stains lesions black.

Space maintenance: a band-and-loop or crown-and-loop maintains space after premature loss of a primary molar; a lingual arch maintains arch length in the mandible.

Red flags for oral cancer: ulcer persisting over 2 weeks, induration, fixation, paresthesia, and cervical lymphadenopathy; biopsy is the diagnostic standard.

Leukoplakia is a white patch that cannot be rubbed off and cannot be diagnosed as another disease; about 10 to 20 percent show dysplasia.

Aphthous ulcers are recurrent, painful, and non-keratinized mucosal lesions; major aphthae exceed 1 cm and heal with scarring.

Lichen planus shows Wickham striae, bilateral buccal involvement, and a band-like lymphocytic infiltrate; malignant transformation risk is about 1 percent.

Ameloblastoma is the most common clinically significant odontogenic tumor; it is locally aggressive and requires resection with margins.

Odontogenic keratocyst has a high recurrence rate (up to 25 percent) and is associated with PTCH1 mutations and nevoid basal cell carcinoma syndrome.

Radiographic radiolucency: a lesion must lose about 30 to 50 percent of mineral content before it is visible on plain film.

CBCT effective dose is roughly 10 to 100 times a panoramic radiograph; it is justified only when 2D imaging is insufficient.

Panoramic magnification is about 20 to 30 percent; it is not reliable for measuring bone levels or implant dimensions.

Cone beam CT: voxel size determines resolution; smaller voxels improve detail but increase dose and noise.

Beam hardening and metal artifacts appear as streaks; they are reduced by increasing kVp, using artifact reduction algorithms, or removing metal.

In panoramic imaging, the focal trough is the curved zone of sharpness; patient positioning errors cause ghost images and distortion.

Radiographic interpretation should follow a systematic search: bone, teeth, sinuses, TMJ, soft tissues, and airway.

Periapical radiography with a paralleling technique minimizes distortion; the bisecting-angle technique is less accurate but useful when the sensor cannot be parallel.

Informed consent for radiographs includes justification (ALARA), benefits, and risks; the referral should state the clinical question.

DMFT index counts decayed, missing, and filled permanent teeth; dmft is the primary dentition equivalent.

Community Periodontal Index of Treatment Needs (CPITN) uses sextants and scores 0 to 4; score 3 indicates 4 to 5 mm pockets, score 4 indicates 6 mm or more.

Water fluoridation at 0.7 mg/L reduces caries by about 20 to 40 percent; the optimal level depends on climate and other fluoride sources.

Herd immunity effect of water fluoridation benefits non-drinkers in the same community.

Screening programs should have high sensitivity and acceptable specificity; the WHO recommends oral health surveys at 5-year intervals.

Smoking cessation and alcohol reduction are the most effective oral cancer prevention measures; HPV vaccination reduces oropharyngeal cancer risk.

Sealants on permanent first molars reduce occlusal caries; retention is highest with proper isolation and resin-based sealants.

Amoxicillin is the first-line antibiotic for odontogenic infections; clindamycin or metronidazole is used for penicillin allergy or anaerobic coverage.

Antibiotics are adjuncts to drainage; they do not replace incision and drainage in abscess management.

NSAIDs inhibit COX-1 and COX-2; selective COX-2 inhibitors reduce GI risk but increase cardiovascular risk.

Paracetamol (acetaminophen) overdose causes hepatic necrosis; the antidote is N-acetylcysteine.

Local anesthetic maximum doses: lidocaine 4.4 mg/kg (7 mg/kg with epinephrine), articaine 7 mg/kg, mepivacaine 6.6 mg/kg, bupivacaine 1.3 mg/kg.

Epinephrine concentration 1:100,000 means 0.01 mg/mL; 1:200,000 means 0.005 mg/mL.

Warfarin patients with INR in therapeutic range can usually undergo simple extraction with local measures; do not stop anticoagulation without medical consultation.

Bisphosphonate-related osteonecrosis risk rises with IV administration and duration over 3 years.

Inferior alveolar nerve block landmarks: coronoid notch, pterygomandibular raphe, and occlusal plane; target is the lingula, about 6 to 10 mm above the occlusal plane.

Gow-Gates technique targets the neck of the condyle and provides a higher success rate for mandibular anesthesia than the standard inferior alveolar block.

Positive aspiration rates are highest with the inferior alveolar nerve block (about 10 to 15 percent) and lower with infiltration.

Maximum recommended epinephrine dose in healthy adults is about 0.2 mg per visit; in cardiac patients, limit to 0.04 mg.

Paresthesia is more common with articaine and prilocaine; the mechanism is not fully established.

Intraosseous anesthesia uses a perforator and provides rapid, profound anesthesia with small volumes.

Pain control ladder: paracetamol or NSAID first, then combination, then opioid only if necessary, with attention to dental-specific dosing.

Syncope management: supine position, legs elevated, airway patency, oxygen, and monitoring; most episodes resolve within minutes.

Anaphylaxis: intramuscular epinephrine 0.3 to 0.5 mg of 1:1000 in the anterolateral thigh, repeat every 5 to 15 minutes as needed, plus oxygen and IV fluids.

Angina: stop treatment, sit upright, sublingual nitroglycerin 0.3 to 0.6 mg, and call emergency services if pain persists beyond 15 minutes.

Hypoglycemia in a conscious patient: oral glucose; in an unconscious patient: IV glucose or intramuscular glucagon.

Basic life support: compression rate 100 to 120 per minute, depth 5 to 6 cm, and compression-to-ventilation ratio 30:2.

Standard precautions apply to all patients; hand hygiene is the single most effective infection control measure.

Sterilization by autoclave: 121 degrees Celsius at 15 psi for 15 to 20 minutes, or 134 degrees Celsius for 3 to 4 minutes; spore testing is weekly.

Needlestick injury: wash with soap and water, report immediately, and assess HIV and hepatitis B post-exposure prophylaxis within hours.

Orthognathic surgery planning uses cephalometric prediction and model surgery; the mandible-first or maxilla-first sequence depends on the planned movements.

Distraction osteogenesis is indicated for severe mandibular hypoplasia; the latency period is 5 to 7 days, and consolidation lasts 6 to 8 weeks.

Free flap reconstruction of mandibular defects: fibula is the workhorse; radial forearm is used for soft tissue and thin bone.

TMJ ankylosis management includes gap arthroplasty or costochondral graft reconstruction; early mobilization reduces re-ankylosis.

Cleft lip repair is typically at 3 to 6 months; cleft palate repair at 9 to 18 months to support speech development.

Third molar extraction difficulty is predicted by the Pederson or Winter classification; mesioangular impaction is generally easier than distoangular.

Nerve repair is best within 72 hours to 3 weeks; direct repair without tension gives the best outcome.

Nickel-titanium rotary instruments should be used with a crown-down technique and torque control; file separation risk rises with repeated use and curved canals.

Irrigation activation (ultrasonic or sonic) improves tissue dissolution and debridement in complex anatomy.

The most common cause of endodontic failure is coronal leakage and missed canals, particularly the MB2 canal in maxillary molars.

Vertical root fracture presents with a deep, narrow pocket and a J-shaped radiolucency; extraction is usually required.

Bonding to zirconia requires airborne-particle abrasion with alumina and a phosphate monomer (MDP) primer; hydrofluoric acid etching does not work on zirconia.

Immediate dentin sealing after preparation improves bond strength and reduces sensitivity.

Veneer preparation: 0.3 to 0.5 mm for porcelain laminate; incisal coverage should be at least 1 mm for strength.

Guided tissue regeneration is most predictable in intrabony defects and class II furcation involvement; class III furcation has poor prognosis.

Mucogingival surgery: free gingival graft increases keratinized tissue; connective tissue graft is preferred for root coverage.

Peri-implant mucositis is reversible; peri-implantitis involves bone loss and is not fully reversible.

Risk of peri-implantitis rises with a history of periodontitis, smoking, and poor plaque control.

Antibiotic adjuncts in periodontitis: amoxicillin plus metronidazole is the most studied combination for grade C periodontitis.

Maintenance therapy at 3 to 6 month intervals reduces tooth loss; compliance is the strongest predictor of long-term success.

Furcation involvement classification: grade I is incipient, grade II is partial, grade III is through-and-through.

Class III treatment in growing patients may use facemask therapy or a chin cup; timing is before the pubertal growth spurt.

Impacted canines are managed by surgical exposure and orthodontic traction; the earlier the intervention, the better the prognosis.

Cleft lip and palate patients need multidisciplinary care: orthodontics, speech therapy, and alveolar bone grafting around 8 to 11 years.

Premature loss of primary molars can cause space loss; a space maintainer should be placed promptly.

Fluoride toothpaste concentration: 1000 to 1500 ppm for children over 3; a pea-sized amount is recommended.

Early childhood caries is defined as one or more decayed, missing, or filled surfaces in children under 6; prevention includes fluoride and dietary counseling.

Ectopic eruption of first permanent molars may require a Halterman appliance or disking of the primary second molar.

Squamous cell carcinoma of the lip is most common on the lower lip; risk factors include sun exposure and smoking.

Verrucous carcinoma is a low-grade variant with exophytic, warty growth; it rarely metastasizes.

Pleomorphic adenoma is the most common salivary gland tumor, usually in the parotid; it requires complete excision with a margin.

Mucoepidermoid carcinoma is the most common malignant salivary tumor; grading depends on cystic and cellular components.

Osteosarcoma of the jaw shows a sunburst periosteal reaction; it is more common in the mandible.

Bisphosphonate-related osteonecrosis appears as a non-healing socket with exposed bone; imaging shows sclerosis and sequestration.

Langerhans cell histiocytosis presents with punched-out radiolucencies and may cause floating teeth.

MRI is the modality of choice for soft tissue tumors, TMJ disc displacement, and nerve involvement.

Ultrasound is useful for salivary gland and lymph node evaluation; it is operator dependent.

Sialography is largely replaced by ultrasound and MRI for salivary gland disease.

Cone beam CT is preferred for implant planning, impacted teeth, and endodontic anatomy; it should not replace panoramic radiography for screening.

Radiation protection: ALARA and ALADA principles; use the smallest field of view and the lowest dose that answers the clinical question.

Radiographic contrast agents are used in sialography and angiography; iodine-based agents carry allergy risk.

Digital subtraction radiography improves detection of small bone changes over time.

The Ottawa Charter for Health Promotion defines five action areas: public policy, supportive environments, community action, personal skills, and reorientation of health services.

Oral health-related quality of life is measured with instruments such as OHIP-14 and COHIP.

The basic package of oral care includes oral urgent treatment, affordable fluoride toothpaste, and atraumatic restorative treatment.

Community water fluoridation is cost-effective in populations above about 1000 people; it requires monitoring of fluoride levels.

School-based sealant programs reduce caries in high-risk children; targeting should be based on caries prevalence data.

The WHO oral health survey uses index ages 5, 12, 15, 35 to 44, and 65 to 74 years.

Tobacco and alcohol control policies are core components of oral cancer prevention at the population level.

Metronidazole is effective against anaerobes; it interacts with alcohol (disulfiram-like reaction) and warfarin.

Macrolides and azoles inhibit CYP3A4; they can raise levels of statins and calcium channel blockers.

Corticosteroids are used for severe aphthous ulcers and lichen planus; topical agents reduce systemic effects.

Antifungal therapy: nystatin for superficial candidiasis; fluconazole for systemic or refractory cases.

Chlorhexidine 0.12 to 0.2 percent is the gold standard antiplaque agent; it can cause staining and taste alteration.

Tramadol lowers the seizure threshold and interacts with SSRIs; it is a weak opioid with serotonergic effects.

Drug-induced gingival overgrowth is associated with phenytoin, cyclosporine, and nifedipine.

Local anesthetic systemic toxicity presents with perioral tingling, tinnitus, and seizures; treatment is lipid emulsion 20 percent.

The pterygomandibular space is the target for the inferior alveolar nerve block; the needle depth is about 25 mm.

The greater palatine nerve block is used for palatal anesthesia; the injection site is the greater palatine foramen.

The mental nerve block anesthetizes the lower lip and chin; it is useful for soft tissue procedures.

Topical anesthetics containing benzocaine can cause methemoglobinemia; avoid in infants and use with caution.

Nitrous oxide-oxygen sedation: nitrous oxide concentration should not exceed 70 percent; oxygen saturation must be monitored.

The Gow-Gates technique has a lower positive aspiration rate than the inferior alveolar block.

Myocardial infarction in the dental chair: stop treatment, call emergency services, give aspirin 300 mg chewed, oxygen, and monitor.

Stroke recognition uses FAST: face drooping, arm weakness, speech difficulty, time to call emergency services.

Adrenal crisis in a patient on long-term steroids may require supplemental corticosteroids before invasive procedures.

Local anesthetic overdose: stop injection, support airway and circulation, and give lipid emulsion if severe.

Infection control: high-level disinfection is required for semicritical items; sterilization for critical items.

Personal protective equipment includes gloves, mask, eye protection, and gown; change gloves between patients.

Vaccination of dental staff against hepatitis B is recommended; post-exposure prophylaxis depends on the source status.

Mandibular fracture management: closed reduction with maxillomandibular fixation for favorable fractures; open reduction and internal fixation for displaced or unfavorable fractures.

Zygomatic complex fractures present with malar flattening, diplopia, and infraorbital nerve paresthesia; the orbital floor must be evaluated.

Nasal bone fractures are the most common facial fracture; reduction is usually done within 7 to 10 days.

Orbital blowout fracture shows a teardrop sign and restricted upward gaze; urgent repair is needed for entrapment.

Condylar fractures may be managed closed or open; indications for open reduction include displacement and malocclusion.

Dental trauma: avulsed permanent tooth should be replanted immediately or stored in milk or saline; splinting is for 2 weeks.

Fracture healing: soft callus forms in 2 to 3 weeks, hard callus in 4 to 6 weeks, and remodeling over months.

Amalgam remains a durable posterior restorative; it is technique sensitive and requires adequate cavity preparation.

Composite resin polymerization shrinkage ranges from 2 to 6 percent; bulk-fill composites reduce shrinkage stress.

Glass ionomer releases fluoride and bonds chemically to dentin; it is used for pediatric and non-load-bearing restorations.

Resin-modified glass ionomer combines light curing with fluoride release; it is used for liners and pediatric restorations.

Ceramic strength: zirconia has the highest flexural strength (over 1000 MPa); feldspathic porcelain is the weakest.

Dentin bonding: etch-and-rinse versus self-etch; self-etch is less technique sensitive but may have lower bond strength to enamel.

Impression materials: addition silicone (polyvinyl siloxane) is the most accurate; alginate is used for study models.

Implant osseointegration requires primary stability and a healing period of 3 to 6 months depending on bone quality.

Implant success is higher in the anterior mandible than in the posterior maxilla due to bone density and sinus proximity.

Maxillary sinus lift: the lateral window approach is used for severe pneumatization; the osteotome technique is used for limited lift.

Implant-supported overdentures improve retention and patient satisfaction compared with conventional dentures.

Fixed implant prostheses require passive fit; misfit causes screw loosening and bone loss.

Removable partial denture frameworks should be designed with rests and guiding planes to distribute forces.

Occlusal scheme for implant prostheses: mutually protected occlusion with light centric contacts and no working-side interference.

Periodontal probing depth of 4 mm or more with bleeding indicates active disease; 1 to 3 mm is healthy.

Radiographic bone loss is measured from the cementoenamel junction to the alveolar crest; normal is 1 to 2 mm.

The plaque index and gingival index are used in clinical research; they are not diagnostic of periodontitis.

Systemic antibiotics are indicated for aggressive periodontitis and for severe chronic periodontitis as an adjunct to mechanical therapy.

Smoking cessation improves periodontal outcomes; smokers respond less well to nonsurgical therapy.

Diabetes control (HbA1c below 7 percent) improves periodontal healing and reduces recurrence.

Supportive periodontal therapy every 3 months is recommended for patients with a history of periodontitis.

Cephalometric analysis: the Frankfort horizontal plane and the mandibular plane angle describe skeletal pattern.

Pubertal growth spurt occurs around 11 to 12 years in girls and 13 to 14 years in boys; hand-wrist radiographs assess maturity.

Class II malocclusion treatment may use functional appliances (Twin Block, Herbst) in growing patients.

Class III malocclusion in growing patients may be treated with facemask therapy; in adults, orthognathic surgery is often needed.

Serial extraction is indicated for severe crowding with a predictable pattern; it requires careful case selection.

Habit correction: digit sucking can cause anterior open bite; appliances and behavioral therapy are used.

Eruption of permanent teeth: central incisors at 6 to 7 years, canines at 11 to 12 years, second molars at 12 years.

Diabetes mellitus is associated with periodontal disease, xerostomia, and delayed healing; glycemic control is essential before surgery.

HIV infection may present with oral candidiasis, hairy leukoplakia, and Kaposi sarcoma; these are markers of immunosuppression.

Sjogren syndrome causes xerostomia and keratoconjunctivitis sicca; it is associated with lymphoma risk.

Lichen planus is a chronic inflammatory disease; erosive forms are treated with topical corticosteroids.

Pemphigus vulgaris shows intraepithelial separation and oral blisters; pemphigoid shows subepithelial separation.

Anemia can cause glossitis and angular cheilitis; iron, B12, and folate deficiencies should be ruled out.

Medication-induced xerostomia is common with antihistamines, antidepressants, and diuretics.

Radicular cyst is the most common odontogenic cyst; it is inflammatory and associated with a nonvital tooth.

Dentigerous cyst surrounds the crown of an impacted tooth; it is the most common developmental odontogenic cyst.

Odontoma is the most common odontogenic tumor; it is a hamartoma and is usually asymptomatic.

Ameloblastoma is locally aggressive and has a high recurrence rate with curettage; resection is preferred.

Osteosarcoma of the jaw is rare; it shows a sunburst pattern and requires wide resection.

Metastatic tumors to the jaw are most commonly from the breast, lung, and prostate; they often present as a radiolucency.

Lymphoma may present as a painless swelling or ulceration; biopsy is essential for diagnosis.

CBCT is indicated for implant planning, impacted teeth, and endodontic anatomy; it should not be used for routine screening.

MRI is preferred for soft tissue and TMJ evaluation; it does not use ionizing radiation.

Ultrasound is useful for salivary gland and lymph node assessment; it is operator dependent.

Radiation dose: panoramic radiograph is about 0.01 mSv; CBCT is about 0.1 mSv; medical CT is higher.

ALARA principle: use the lowest dose that provides the necessary diagnostic information.

Radiographic interpretation should be systematic: bone, teeth, sinuses, TMJ, soft tissues, and airway.

Informed consent for radiographs includes justification and risk-benefit discussion.

DMFT index measures caries experience; it is used in epidemiological surveys.

CPITN assesses periodontal treatment needs; it uses sextants and scores 0 to 4.

Water fluoridation reduces caries by about 20 to 40 percent; it is cost-effective in communities above 1000 people.

Oral cancer screening programs should target high-risk groups; biopsy is the diagnostic standard.

Tobacco and alcohol control are core prevention strategies for oral cancer.

The WHO recommends oral health surveys at 5-year intervals; index ages are 5, 12, 15, 35 to 44, and 65 to 74 years.

Health promotion according to the Ottawa Charter includes public policy, supportive environments, community action, personal skills, and reorientation of health services.

Amoxicillin is first-line for odontogenic infections; clindamycin or metronidazole is used for penicillin allergy or anaerobic coverage.

Antibiotics are adjuncts to drainage; they do not replace incision and drainage.

NSAIDs inhibit COX enzymes; selective COX-2 inhibitors reduce GI risk but increase cardiovascular risk.

Paracetamol overdose causes hepatic necrosis; the antidote is N-acetylcysteine.

Local anesthetic maximum doses: lidocaine 4.4 mg/kg (7 mg/kg with epinephrine), articaine 7 mg/kg, mepivacaine 6.6 mg/kg.

Epinephrine 1:100,000 equals 0.01 mg/mL; 1:200,000 equals 0.005 mg/mL.

Warfarin patients with therapeutic INR can usually undergo simple extraction with local measures; do not stop anticoagulation without medical consultation.

Inferior alveolar nerve block landmarks: coronoid notch, pterygomandibular raphe, and occlusal plane; target is the lingula.

Gow-Gates technique targets the neck of the condyle and has a higher success rate than the standard inferior alveolar block.

Positive aspiration rates are highest with the inferior alveolar nerve block (about 10 to 15 percent).

Maximum epinephrine dose in healthy adults is about 0.2 mg per visit; in cardiac patients, limit to 0.04 mg.

Paresthesia is more common with articaine and prilocaine; the mechanism is not fully established.

Intraosseous anesthesia provides rapid, profound anesthesia with small volumes.

Local anesthetic systemic toxicity presents with perioral tingling, tinnitus, and seizures; treatment is lipid emulsion 20 percent.