Jordan Dental Exam cheat sheet

Cranial nerve lesions: XII lesion deviates tongue toward the weak side; X lesion causes uvula deviation away from the weak side; VII lower motor neuron lesion causes ipsilateral facial palsy including forehead.

Caries risk is driven by Streptococcus mutans and Lactobacillus; periodontal disease by Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia (red complex).

Enamel rod direction: rods run obliquely from the dentinoenamel junction, so cavity walls follow rod direction; enamel is 96% mineral by weight, dentin about 70%.

Local anesthetic pKa rule: higher pKa means a smaller fraction of uncharged base at tissue pH, slower onset; inflamed tissue (lower pH) further reduces the active base fraction.

Maximum doses: lidocaine 4.4 mg/kg (7 mg/kg with epinephrine), articaine 7 mg/kg, mepivacaine 6.6 mg/kg, prilocaine 8 mg/kg; 1 cartridge of 2% lidocaine with 1:100,000 epinephrine = 36 mg lidocaine and 0.018 mg epinephrine.

Warfarin inhibits vitamin K epoxide reductase (clotting factors II, VII, IX, X); heparin potentiates antithrombin III; aspirin irreversibly acetylates platelet COX-1.

Adrenal crisis prophylaxis: a patient with primary adrenal insufficiency needs corticosteroid supplementation before stressful procedures; normal cortisol output is about 20-30 mg/day.

Bone healing timeline: clot and inflammation days 1-7, soft callus weeks 2-3, hard callus weeks 4-6, remodeling months to years.

Enamel is formed by ameloblasts (lost after eruption, so enamel cannot regenerate); dentin by odontoblasts; cementum by cementoblasts; alveolar bone by osteoblasts.

Amelogenesis stages: morphodifferentiation, apposition, maturation; maturation-stage ameloblasts are ruffle-ended (resorptive) and smooth-ended (leaky), regulating ion transport.

Dentinal fluid movement in tubules (about 1-2.5 µm diameter, 20,000-45,000 per mm²) triggers the hydrodynamic theory of dentin sensitivity.

Saliva: resting flow about 0.3-0.4 mL/min, stimulated 1.5-2 mL/min; critical pH for enamel about 5.5, for root dentin about 6.2-6.7.

Pellicle forms within minutes from salivary glycoproteins; plaque biofilm maturation takes about 24 hours to become acidogenic and cariogenic.

Periodontal ligament principal fibers: transseptal, alveolar crest, horizontal, oblique (most numerous, resists axial load), apical, interradicular.

Gingival crevicular fluid flow increases with inflammation; it contains neutrophils, immunoglobulins, and inflammatory mediators used as biomarkers.

Tooth eruption requires the gubernacular canal and dental follicle; the reduced enamel epithelium fuses with oral epithelium to form the eruption pathway.

Recurrent aphthous stomatitis: minor (<1 cm, heals <2 weeks), major (>1 cm, heals up to 6 weeks, scars), herpetiform (multiple 1-3 mm clusters).

Leukoplakia is a clinical diagnosis of exclusion (white patch not otherwise diagnosable); erythroplakia has the highest malignant transformation risk of oral mucosal lesions.

Odontogenic tumors: ameloblastoma (locally aggressive, posterior mandible, soap-bubble radiolucency), odontoma (most common, hamartoma), keratocystic odontogenic tumor (now odontogenic keratocyst).

Oral lichen planus: bilateral white striae (Wickham striae), buccal mucosa, T-cell mediated; risk of malignant transformation is low but requires follow-up.

Squamous cell carcinoma risk: tobacco, alcohol (synergistic), betel quid, HPV16 (oropharynx), and chronic irritation; floor of mouth and lateral tongue are common sites.

Pemphigus vulgaris shows intraepithelial (suprabasal) separation with acantholysis and positive Nikolsky sign; mucous membrane pemphigoid shows subepithelial separation.

Sjögren syndrome: dry eyes and mouth, anti-Ro/SSA and anti-La/SSB antibodies, labial gland biopsy showing focal lymphocytic sialadenitis; increased lymphoma risk.

Trigeminal neuralgia: paroxysmal sharp pain in V2/V3, triggered by touch or chewing; first-line carbamazepine; consider MRI to exclude secondary causes.

Cavity classification: Class I pits and fissures; II proximal posterior; III proximal anterior without incisal edge; IV proximal anterior with incisal edge; V cervical third; VI cusp tips.

Enamel etching with 35-37% phosphoric acid for 15-30 seconds creates microporosity; etched enamel must be kept dry and contaminated enamel re-etched.

Dentin bonding requires moist dentin (not desiccated) for etch-and-rinse systems; self-etch adhesives are less technique sensitive but weaker on enamel.

Working length: apex locator plus radiograph; apical constriction is about 0.5-1 mm short of the radiographic apex.

Irrigants: sodium hypochlorite 0.5-5.25% dissolves organic tissue and is antimicrobial; EDTA 17% removes smear layer; chlorhexidine has substantivity but no tissue-dissolving ability.

Root canal preparation shapes a continuous taper; sodium hypochlorite must not be extruded beyond the apex (risk of severe pain, swelling, and tissue necrosis).

Rubber dam isolation is the standard of care for endodontic treatment and for adhesive restorative procedures.

Post-endodontic restoration: anterior teeth often restored with composite; posterior teeth with significant loss of structure require cuspal coverage (onlay or crown).

Crown retention and resistance form: ideal axial wall taper about 6 degrees (range 2-12); shorter crowns need grooves or boxes for retention.

Finish line: chamfer for metal and metal-ceramic; shoulder or deep chamfer for all-ceramic; feather edge is contraindicated.

Occlusal scheme for complete dentures: bilateral balanced occlusion in eccentric movements to stabilize the denture base.

Denture base acrylic (PMMA) polymerizes with residual monomer; heat-cured is stronger and has less residual monomer than autopolymerizing resin.

Kennedy classification: Class I bilateral edentulous posterior; II unilateral posterior; III unilateral bounded posterior; IV single anterior edentulous space crossing midline.

Implant success criteria (Albrektsson): no mobility, bone loss <0.2 mm/year after the first year, no pain, no peri-implant radiolucency.

Fixed partial denture abutment selection: crown-to-root ratio at least 1:1, adequate periodontal support, and no excessive span length.

Removable partial denture design: rests provide support, clasps provide retention, major connector provides rigidity; the guiding plane aids stability.

Periodontal disease classification (2017): staging uses severity (clinical attachment loss, bone loss, tooth loss) and grading uses progression rate (A slow, B moderate, C rapid).

Probing depth is measured from gingival margin to pocket base; clinical attachment level = probing depth plus recession (or minus hyperplasia).

Nonsurgical therapy: scaling and root planing with re-evaluation at 6-8 weeks; adjunctive antibiotics are reserved for aggressive or refractory cases.

Gingival index and plaque index are used for documentation; bleeding on probing is a predictor of disease progression when present at multiple sites.

Periodontal surgery: flap surgery for access, regenerative procedures with bone grafts or GTR membranes for intrabony defects, gingivectomy for suprabony pseudopockets.

Risk factors: smoking (dose dependent), poorly controlled diabetes (HbA1c), genetic susceptibility, and medications causing gingival overgrowth (phenytoin, nifedipine, cyclosporine).

Peri-implant mucositis is reversible inflammation without bone loss; peri-implantitis includes bone loss and requires debridement plus decontamination.

Maintenance: recall interval individualized; patients with history of periodontitis need more frequent supportive periodontal therapy.

Inferior alveolar nerve block targets the pterygomandibular space; landmarks include the coronoid notch, pterygomandibular raphe, and the contralateral premolars.

Local anesthetic maximum doses are calculated by weight and concentration; epinephrine limits are about 0.2 mg for cardiac patients and 0.04 mg per cartridge at 1:100,000.

Extraction forceps: maxillary central incisors use forceps 1, maxillary molars 18L/18R, mandibular molars 151; elevators include straight, Cryer, and periotomes.

Dry socket (alveolar osteitis) presents with severe pain 2-4 days after extraction with an empty socket; treatment is irrigation and medicated dressing.

Third molar assessment: Pell and Gregory classification for depth and ramus relationship; watch for proximity to the inferior alveolar canal and lingual nerve.

Odontogenic infection spread: submandibular, sublingual, and submental spaces; Ludwig angina is bilateral submandibular and sublingual cellulitis with elevation of the floor of the mouth.

Medical emergencies: syncope (position supine, elevate legs), hypoglycemia (oral glucose if conscious), anaphylaxis (epinephrine IM), and angina (rest, nitroglycerin).

Postoperative bleeding management: pressure pack, sutures, topical hemostatic agents; consider coagulation workup if bleeding is persistent.

Angle classification: Class I normal molar relationship; Class II mandibular first molar distal to maxillary; Class III mandibular first molar mesial to maxillary.

Eruption timing: primary teeth begin at 6 months, complete by 2.5-3 years; first permanent molar and mandibular central incisor at 6 years.

Cephalometric landmarks: SNA, SNB, ANB; ANB indicates skeletal relationship (normal about 2 degrees).

Space maintenance: band and loop for single primary molar loss; lingual arch for bilateral loss; space regain with a removable appliance.

Pediatric behavior management: tell-show-do, positive reinforcement, distraction; avoid restraint unless medically necessary and with consent.

Fluoride varnish is applied every 3-6 months for high caries risk children; fluoride toothpaste amount depends on age (smear for under 3, pea-sized for 3-6).

Pulpotomy is indicated for a vital primary molar with coronal pulp inflammation; pulpectomy for irreversible pulpitis with radicular involvement.

Habit correction: digit sucking beyond age 4 may cause anterior open bite; use reminder appliances or habit-breaking appliances.

Periapical radiography: bisecting angle technique and paralleling technique; paralleling is preferred for accuracy and less distortion.

Bitewing radiographs show crowns and alveolar crest; they are used for caries detection and crestal bone assessment.

Panoramic radiography gives a broad view with magnification and ghost images; it is not a substitute for periapical detail.

Cone beam CT provides 3D imaging with lower dose than medical CT; it is used for implant planning, impacted teeth, and endodontic anatomy.

Radiation protection: ALARA principle, lead apron and thyroid collar, rectangular collimation, and digital sensors reduce dose.

Radiographic interpretation: radiolucent lesions include cysts and tumors; radiopaque lesions include odontomas and condensing osteitis.

Caries detection: bitewing radiographs detect interproximal caries; clinical examination and transillumination are adjuncts.

Anatomical landmarks: maxillary sinus, mandibular canal, mental foramen, incisive foramen, and zygomatic process must be recognized to avoid misinterpretation.

Hand hygiene: alcohol-based hand rub for routine decontamination; soap and water when hands are visibly soiled or after contact with spore-forming organisms.

Personal protective equipment: gloves, mask, eye protection, and gown; change gloves between patients and after contamination.

Sterilization: autoclave at 121°C for 15 minutes or 134°C for 3-4 minutes; monitor with biological indicators (spore tests) and chemical indicators.

Disinfection: intermediate-level disinfectants (e.g., chlorine, glutaraldehyde) for surfaces; high-level disinfection for semicritical items.

Sharps safety: do not recap needles by hand; use a one-handed scoop or a needle guard; dispose in puncture-resistant containers.

Vaccination: hepatitis B vaccination is recommended for dental personnel; post-exposure prophylaxis depends on the source and immune status.

Waterlines: dental unit waterlines must meet drinking water standards (≤500 CFU/mL); flush lines and use antimicrobial treatments.

Waste segregation: sharps in rigid containers; infectious waste in designated bags; amalgam waste recycled through a separator.

Informed consent requires capacity, disclosure of material risks and alternatives, and voluntary agreement; document the discussion.

Record keeping: accurate, contemporaneous, and legible notes; retain records per local law; corrections should be dated and signed.

Patient safety: use checklists for procedures, verify patient identity and site, and report adverse events through incident reporting systems.

Ethical principles: autonomy, beneficence, nonmaleficence, and justice; confidentiality is limited by legal reporting requirements.

Practice management: appointment scheduling, recall systems, and fee transparency; insurance claims must be accurate and not fraudulent.

Risk management: document informed refusal, maintain equipment logs, and follow infection control protocols; malpractice claims often arise from poor communication.

Emergency preparedness: maintain an emergency kit, oxygen, and an automated external defibrillator; train staff in basic life support.

Professional boundaries: avoid treating family members when objectivity may be compromised; disclose conflicts of interest.