Kuwait Dental Board General Dentistry cheat sheet

FDI notation: the first digit is the quadrant (1 upper right, 2 upper left, 3 lower left, 4 lower right); permanent teeth are 11–48 and primary teeth 51–85.

Enamel is about 96% inorganic hydroxyapatite by weight and cannot regenerate; dentin is roughly 70% inorganic, 20% organic (type I collagen) and 10% water.

Pulp nerve fibres: myelinated A-delta fibres mediate sharp, well-localized dentinal pain; unmyelinated C fibres mediate dull, poorly localized pain.

Periodontal ligament width is 0.15–0.38 mm, thinnest at mid-root; principal fibres transmit occlusal load as tension.

Saliva: 0.5–1.5 L/day, resting pH 6.7–7.4; bicarbonate is the principal buffer, with alpha-amylase and secretory IgA as key components.

Taste: chorda tympani (CN VII) supplies the anterior two-thirds of the tongue, glossopharyngeal (CN IX) the posterior third; general sensation of the anterior tongue travels via the lingual nerve (V3).

Caries microbiology: Streptococcus mutans initiates enamel demineralization; Lactobacillus and Bifidobacterium dominate advanced dentinal lesions.

Local anaesthetic ceilings: lidocaine 4.4 mg/kg plain or 7 mg/kg with epinephrine; articaine 7 mg/kg; mepivacaine 6.6 mg/kg; one cartridge is 1.8 mL.

G.V. Black classification: I occlusal pits and fissures, II proximal posterior, III proximal anterior, IV proximal anterior including incisal angle, V cervical third, VI cusp tip.

Enamel bonding: 37% phosphoric acid for 15–30 s creates type I and II etch patterns; resin-to-enamel bond strength is about 20 MPa versus 5–10 MPa to dentin.

Total-etch removes the smear layer and forms a hybrid layer; self-etch systems leave the smear layer and are less technique-sensitive on dentin.

Composite polymerization shrinkage is 2–3% by volume; increments of 2 mm or less and a low C-factor reduce stress at the gingival margin.

Light curing: camphorquinone absorbs at 400–500 nm; output should be at least 400 mW/cm² with the tip within 2 mm of the restoration.

Glass ionomer releases fluoride and bonds chemically to dentin but has low fracture toughness; resin-modified GIC improves strength while retaining fluoride release.

Cuspal coverage is indicated when a cusp is undermined by more than 50% of its width; isthmus width should not exceed one-third of the intercuspal distance.

Rubber dam isolation is required for adhesive dentistry, endodontics and any procedure with a risk of aspirating instruments or materials.

Working length is measured from a coronal reference point to 0.5–1.0 mm short of the radiographic apex and confirmed with an electronic apex locator.

Irrigation: NaOCl 0.5–5.25% dissolves tissue and disinfects; 17% EDTA removes the smear layer; never mix NaOCl with chlorhexidine because a precipitate forms.

Maxillary first molar: 3 roots and 3–4 canals, with MB2 present in about 60–90%; mandibular first molar: 3–4 canals, occasionally C-shaped.

Irrigation needles should be side-vented and placed 1–2 mm short of working length; never wedge a needle into the canal because of extrusion risk.

Reversible pulpitis: provoked, short-lived pain; irreversible pulpitis: spontaneous or lingering pain; necrotic pulp: no response to cold testing.

NiTi rotary files require a glide path, torque control and recapitulation; crown-down sequence and limited use reduce instrument separation.

Obturation uses gutta-percha plus sealer by cold lateral condensation or warm vertical compaction, followed by immediate coronal seal.

Endodontic failure most often reflects missed canals, untreated apical anatomy, coronal microleakage or vertical root fracture.

Healthy sulcus depth is 0.5–3 mm; probing depth of 4 mm or more with bleeding on probing indicates periodontitis until proven otherwise.

2018 classification: staging I–IV uses severity and complexity; grading A–C uses progression rate, smoking, diabetes and the bone loss to age ratio.

Nonsurgical scaling and root planing is re-evaluated at 4–6 weeks before surgery or adjunctive antibiotics are considered.

Systemic antibiotics are adjunctive only; amoxicillin 500 mg plus metronidazole 400 mg three times daily for 7 days is a common regimen.

Implant success: no mobility, no pain, no peri-implant radiolucency and bone loss below 0.2 mm per year after the first year.

Implant spacing: at least 1.5 mm from an adjacent tooth, 3 mm between implants and 3 mm from the buccal bone plate.

Peri-implant mucositis is reversible soft-tissue inflammation with bleeding and no bone loss; peri-implantitis adds progressive bone loss and needs surgical debridement.

Smoking and poorly controlled diabetes (HbA1c above 7%) increase attachment loss, implant failure and peri-implantitis risk.

Crown preparation: 1.5 mm occlusal reduction, 6–10° axial taper, 1.0–1.5 mm shoulder or chamfer; a 1.5–2 mm ferrule improves fracture resistance.

Ante's law: abutment root surface area must equal or exceed that of the replaced teeth; implants or splinting are alternatives for long spans.

Addition silicone is the most dimensionally stable elastomer; retraction cord and haemostatic agents control moisture at the margin.

Fixed partial denture failure is more likely with cantilevers, parafunction and short abutment crowns; porcelain chipping and secondary caries are common.

Kennedy classification: I bilateral posterior edentulous, II unilateral posterior, III unilateral bounded posterior, IV anterior; Applegate's rules govern application.

Complete denture: balanced occlusion in excursive movements, posterior palatal seal for retention and a neutral zone for muscular stability.

Vertical dimension of occlusion equals resting dimension minus 2–3 mm of freeway space; excessive VDO causes sore ridges and speech changes.

An occlusal splint or occlusal adjustment is considered before extensive fixed rehabilitation in patients with bruxism.

Inferior alveolar nerve block targets the pterygomandibular space with a 20–25 mm needle; aspirate in two planes and deposit 1.5 mL; failure often follows a high or medial deposition.

Ludwig's angina: bilateral submandibular, sublingual and submental swelling with tongue elevation and airway compromise; treat with airway control, IV antibiotics and incision and drainage.

Avulsed permanent tooth: handle by the crown, replant immediately or store in milk or HBSS; flexible splint for 2 weeks and root canal treatment if the apex is mature.

Mandibular fracture: the angle is the commonest site, then the condyle; Le Fort I is low transverse, II pyramidal and III craniofacial disjunction.

Post-extraction bleeding: pressure pack, sutures and tranexamic acid mouthwash; check INR and platelets in anticoagulated patients.

Syncope: supine with legs elevated, maintain airway and give oxygen; hypoglycaemia: oral glucose if conscious, IV dextrose if not.

Biopsy: incisional for large or malignancy-suspicious lesions, excisional for small benign lesions; image a suspected vascular lesion before biopsy.

Angle classification: Class I normal molar relationship, Class II (division 1 proclined incisors, division 2 retroclined incisors), Class III mandibular prognathism.

Cephalometric norms: SNA 82°, SNB 80°, ANB 2°; ANB above 4° suggests skeletal Class II and below 0° suggests Class III.

Primary teeth erupt from 6 to 30 months; permanent first molars at 6 years, central incisors 6–7 years, canines 11–12 years and second molars 12–13 years.

Fluoride varnish 5% NaF (22,600 ppm) is applied 2–4 times yearly from the first tooth in high-risk children, avoiding active ulceration.

Early childhood caries affects maxillary primary incisors first and is associated with bottle-feeding, sweetened drinks and night-time feeding.

Pulpotomy in primary molars: MTA or ferric sulphate is preferred over formocresol; stainless steel crowns restore multi-surface primary molars.

Space maintenance with a band-and-loop or Nance appliance follows premature loss of primary molars; space loss is fastest in the first 6 months.

Digit sucking beyond 4 years may cause anterior open bite; appliance therapy and behavioural intervention are used.

Oral potentially malignant disorders include leukoplakia, erythroplakia, oral submucous fibrosis and lichen planus; erythroplakia carries the highest transformation rate.

Oral squamous cell carcinoma is the commonest oral malignancy, most often on the lateral tongue and floor of mouth; early lesions may mimic benign ulcers.

Pemphigus vulgaris shows suprabasal acantholysis and intercellular IgG; mucous membrane pemphigoid shows a subepithelial split with linear IgG/C3 at the basement membrane.

Sjögren syndrome: xerostomia, keratoconjunctivitis sicca, anti-Ro/SSA and anti-La/SSB antibodies and increased lymphoma risk.

Ameloblastoma: posterior mandible, multilocular soap-bubble radiolucency, locally aggressive; odontoma is the commonest odontogenic tumour.

Imaging selection: bitewing for interproximal caries, periapical for the apex, panoramic for wide survey, CBCT for three-dimensional bone assessment under ALARA.

Well-defined radiolucency suggests a benign cyst or tumour; ill-defined margins suggest malignancy or infection; about 1.5 mm of bone loss is needed for conventional film detection.

Recurrent aphthous stomatitis: minor ulcers under 1 cm healing in 10–14 days, major ulcers over 1 cm with scarring, herpetiform multiple small ulcers.

DMFT/dmft counts decayed, missing and filled teeth; DMFS/dmfs counts surfaces; maximum DMFT in the permanent dentition is 32.

Fluoride concentrations: water 0.7–1.0 ppm, toothpaste 1,000–1,500 ppm, varnish 22,600 ppm, mouthrinse 0.05% NaF daily or 0.2% weekly.

Dean's index grades fluorosis as normal, questionable, very mild, mild, moderate or severe and is used for population surveillance.

WHO recommends free sugars below 10% of energy intake and ideally below 5%, with limited frequency of sugar exposure.

Pit and fissure sealants are indicated on caries-prone permanent molars and bond micromechanically after acid etching.

Recall intervals are risk-based: 3–6 months for high caries risk and 12–24 months for low risk rather than a fixed six-month rule.

Smoking cessation uses the 5 A's (Ask, Advise, Assess, Assist, Arrange), with brief advice at every visit.

Water fluoridation and fluoride toothpaste are the most cost-effective population-level caries-preventive measures.

Hand hygiene: soap and water for 40–60 s, alcohol-based rub for 20–30 s; perform before and after patient contact and after glove removal.

PPE: gloves, mask, eye protection and gown; change gloves between patients and change masks when wet or after about 4 hours.

Sterilization: autoclave at 121°C and 15 psi for 15 minutes or 134°C for 3 minutes; weekly biological spore test with Geobacillus stearothermophilus plus per-cycle indicators.

Disinfection: 2% glutaraldehyde for heat-sensitive instruments, 0.5–1% sodium hypochlorite for surfaces and 70% isopropyl alcohol for small items.

Sharps go immediately into puncture-resistant containers and are never recapped by hand; needlestick requires washing, reporting and HIV PEP within 2 hours.

Dental unit waterlines are flushed at the start of the day and between patients and maintained at or below 500 CFU/mL with independent reservoirs and disinfectants.

Rubber dam and high-volume suction reduce aerosol and respiratory transmission risk.

Hepatitis B: staff should be vaccinated with anti-HBs titres checked; non-responders need a booster or immunoglobulin after exposure.

Informed consent requires capacity, disclosure of material risks, benefits and alternatives, voluntariness and documentation; consent may be withdrawn at any time.

Confidentiality: disclose patient information only with consent or where required by law, and record the disclosure and its justification.

Record keeping: contemporaneous, legible, signed and dated; adult records are kept 7 years and minors' records until age 18 plus 7 years or the local statutory period.

Never events include wrong-tooth extraction, retained instruments and wrong-site surgery; a pre-procedure timeout and radiograph confirmation reduce risk.

Adverse event disclosure: inform the patient promptly, apologise, explain what happened, document and offer remediation without altering records.

Patient safety: medical history and allergy checks, an emergency drug kit, oxygen, suction and defibrillator access with staff trained in basic life support.

Practice management: fee transparency, infection control audits, radiation quality assurance and continuing professional development support licensure.

Refer when a case exceeds competence or requires specialist care, and document the referral and communication.