Lebanon Dental Colloquium cheat sheet

Recurrent aphthous stomatitis: minor (<10 mm, heals <14 days, no scar), major (>10 mm, 2-6 weeks, scarring), herpetiform (1-3 mm clusters, dozens of ulcers).

Oral lichen planus: bilateral white striae (Wickham striae) on buccal mucosa; erosive form carries ~1% or lower malignant transformation risk and needs biopsy of erosive/atrophic areas.

Oral candidiasis types: pseudomembranous (wipes off, leaving erythema), erythematous (denture stomatitis, angular cheilitis), hyperplastic (does not wipe off; biopsy to exclude dysplasia).

Sjögren syndrome: dry eyes plus dry mouth plus positive anti-Ro/SSA or anti-La/SSB or labial salivary gland biopsy focus score ≥1; unstimulated salivary flow ≤0.1 mL/min supports hyposalivation.

Pemphigus vulgaris: flaccid bullae, positive Nikolsky sign, intercellular IgG on direct immunofluorescence; mucous membrane pemphigoid: desquamative gingivitis, linear IgG/C3 at basement membrane.

Oral potentially malignant disorders: leukoplakia (nonspecific white patch, cannot be rubbed off), erythroplakia (red patch, highest dysplasia rate), oral submucous fibrosis (areca nut, restricted mouth opening).

Trigeminal neuralgia: paroxysmal electric-shock pain in V2/V3, triggered by touch, cold, chewing; carbamazepine is first-line; onset before age 40 or sensory loss warrants MRI.

Burning mouth syndrome: chronic intraoral burning with normal mucosa and normal blood work; check ferritin, B12, folate, zinc, thyroid, glucose before labeling primary/idiopathic.

Halitosis: 80-90% is oral in origin (tongue coating, periodontal disease); volatile sulfur compounds from bacterial proteolysis; check for tonsillar and sinonasal causes if oral examination is normal.

Odontogenic keratocyst: parakeratinized lining, palisaded hyperchromatic basal layer, satellite cysts; high recurrence; multiple cysts warrant evaluation for nevoid basal cell carcinoma syndrome (PTCH1).

Ameloblastoma: benign but locally aggressive odontogenic epithelial tumor, posterior mandible, mixed radiolucency/radiopacity (soap-bubble); resection with margins reduces recurrence versus curettage.

Odontoma: most common odontogenic tumor; compound type has tooth-like denticles, complex type an irregular mass; both are hamartomas.

Pleomorphic adenoma: most common salivary gland tumor, parotid, well-defined, mobile; superficial parotidectomy, not enucleation, to avoid recurrence from capsule rupture.

Mucoepidermoid carcinoma: most common malignant salivary tumor; graded on proportion of mucous, intermediate, and epidermoid cells; MAML2 translocation is characteristic.

Squamous cell carcinoma: most common oral malignancy; lateral tongue and floor of mouth are high-risk sites; biopsy any ulcer persisting beyond 2-3 weeks without identifiable cause.

Fibrous dysplasia: ground-glass bone, blending with surrounding bone, no cortical expansion of the inferior alveolar canal; monostotic versus polyostotic (McCune-Albright: polyostotic plus café-au-lait plus endocrinopathy).

Cysts: radicular (periapical, inflammatory, nonvital tooth), dentigerous (crown of unerupted tooth), lateral periodontal, nasopalatine (heart-shaped, midline maxilla).

Diagnostic sequence: history, extraoral and intraoral examination, imaging (periapical, panoramic, CBCT), then incisional biopsy for lesions; brush cytology is not a substitute for biopsy.

Working length: radiographic apex minus 0.5-1.0 mm; electronic apex locator confirms; apical constriction is typically 0.5-1.0 mm short of the radiographic apex.

Canal preparation: crown-down technique with rotary nickel-titanium files; irrigant is sodium hypochlorite (0.5-5.25%), with EDTA used to remove the smear layer.

Irrigation safety: sodium hypochlorite beyond the apex causes severe pain, swelling, and tissue necrosis; stop immediately, do not attempt to neutralize with more irrigant, and manage symptomatically.

Obturation: gutta-percha with sealer to the apical constriction; length within 0-2 mm of the radiographic apex is acceptable; extrusion and short fills increase failure.

Endodontic success predictors: absence of preoperative apical periodontitis, intact crown, adequate coronal seal, and no untreated canals; retreatment or apical surgery for persistent disease.

Composite adhesion: total-etch or self-etch; enamel etching with phosphoric acid improves bond; do not bond to sclerotic or contaminated dentin; rubber dam isolation for moisture control.

Caries removal: selective removal to firm dentin in deep lesions; leave affected dentin to avoid pulp exposure; indirect pulp capping with calcium hydroxide or bioactive cement.

Occlusal principles: centric occlusion and maximum intercuspation coincide in about 90% of dentate adults; avoid heavy contacts in excursive movements; group function or canine guidance are both acceptable.

Post and core: retain only when insufficient coronal tooth structure; at least 4-5 mm of apical gutta-percha seal and at least half the root length of remaining tooth structure.

Fixed partial denture success: abutment selection favors at least 1:1 crown-to-root ratio, periodontal health, and a long span is avoided; cantilever is acceptable for a single premolar when the abutment is sound.

Occlusal vertical dimension: increase only with a documented need; a trial with a removable appliance or provisional restoration before definitive treatment.

Implant-supported fixed prostheses: screw-retained restorations allow retrievability; cement-retained restorations allow easier correction of angulation but carry cement-retention risk of peri-implant disease.

Complete denture retention: factors are adhesion, cohesion, surface tension, atmospheric pressure, and border seal; neuromuscular control contributes to stability.

Neutral zone and polished surface: place teeth and contours in the neutral zone to balance tongue and cheek forces; a thick polished surface aids stability.

Removable partial denture design: use a rigid major connector, rests to direct forces along the long axis, and clasps for retention; avoid a free-end saddle without support.

Balanced occlusion in complete dentures: bilateral simultaneous contacts in centric and excursive movements; monoplane occlusion may be used when the residual ridge is severely resorbed.

Provisional restorations: protect the pulp, maintain position, and allow esthetic and functional evaluation; use for at least several weeks before final impressions in extensive cases.

Denture stomatitis: Candida-related erythema under the denture; treat with antifungal plus denture hygiene, remove dentures at night, and reline or remake ill-fitting prostheses.

Periodontal staging (2017 classification): Stage I/II/III/IV based on interdental clinical attachment loss (1-2 mm, 3-4 mm, ≥5 mm) and tooth loss; grading A/B/C reflects progression rate.

Periodontitis severity: Stage III includes CAL ≥5 mm, radiographic bone loss extending to the middle third of the root, and up to 4 teeth lost; Stage IV includes ≥5 teeth lost or masticatory dysfunction.

Pocket depth interpretation: 1-3 mm is healthy, 4-5 mm indicates moderate disease, ≥6 mm indicates severe disease; bleeding on probing plus depth predicts progression.

Implant osseointegration: titanium surface, primary stability, and healing of 3-6 months depending on bone quality; early loading requires adequate insertion torque.

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

Risk factors: smoking, poorly controlled diabetes (HbA1c >7%), and genetic susceptibility increase periodontal disease progression; smoking also increases implant failure.

Nonsurgical therapy: scaling and root planing plus oral hygiene instruction; re-evaluate at 6-8 weeks; adjunctive antibiotics are reserved for aggressive or refractory cases.

Gingival enlargement: drug-induced from phenytoin, nifedipine, and cyclosporine; management includes substitution when possible plus meticulous plaque control and surgery.

Implant placement: minimum 1.5 mm between implants and 1.5-2.0 mm from adjacent teeth; avoid the inferior alveolar nerve with at least 2 mm safety margin.

Third molar extraction: indications include recurrent pericoronitis, caries, cyst, and orthodontic need; contraindications include uncontrolled systemic disease and high risk to the inferior alveolar nerve.

Inferior alveolar nerve injury risk: assessed on panoramic radiograph by root superimposition, darkening, and narrowing of the canal; CBCT is used when risk is high.

Dry socket (alveolar osteitis): severe pain 2-4 days after extraction with exposed bone; treatment is irrigation and medicated dressing, not antibiotics alone.

Mandibular fracture: most common site is the angle, then body, then condyle; bilateral condylar fractures can cause anterior open bite.

Le Fort fractures: I is low transverse (mobile palate), II is pyramidal (nasal bone involved), III is craniofacial dysjunction (whole midface mobile).

Odontogenic infection: spread follows fascial spaces; submandibular and sublingual spaces (Ludwig angina) need urgent airway assessment, incision and drainage, and antibiotics.

Orthognathic surgery: Le Fort I osteotomy for maxilla, bilateral sagittal split for mandible; plan with cephalometric prediction and model surgery.

Bleeding management: local measures (pressure, sutures, hemostatic agents) plus reversal of anticoagulation when appropriate; check INR for warfarin; direct oral anticoagulants usually do not require stopping for simple extraction.

Class I malocclusion: normal molar relationship with crowding or spacing; Class II: mandibular first molar distal to the maxillary first molar; Class III: mandibular first molar mesial.

Skeletal versus dental: cephalometric ANB angle of 2-4 degrees is skeletal Class I; greater than 4 degrees suggests Class II, less than 0 degrees suggests Class III.

Growth modification: maxillary expansion for transverse deficiency; functional appliances (Twin Block, Herbst) for Class II in growing patients; timing relates to pubertal growth spurt.

Cephalometric landmarks: SNA measures maxillary position, SNB mandibular position, ANB the skeletal relationship; Frankfort horizontal and mandibular plane angle assess vertical pattern.

Extraction decisions: consider arch length discrepancy, profile, and anchorage; premolar extraction is common for severe crowding and bimaxillary protrusion.

Anchorage: maximum anchorage uses headgear, palatal implants, or miniscrews; reciprocal anchorage distributes space equally.

Retention: fixed lingual retainer plus removable retainer; relapse risk is highest in the first year; retain indefinitely in many cases.

Cleft lip and palate: nasoalveolar molding before lip repair; timing of palate repair affects speech and maxillary growth; multidisciplinary team approach.

Impacted canines: early detection on panoramic radiograph at age 9-10; interceptive extraction of the primary canine can allow spontaneous eruption.

Eruption timing: primary teeth begin at 6 months, complete by 2.5-3 years; permanent first molars and central incisors erupt around 6-7 years.

Early childhood caries: affects children under 6; prevention includes no bottle at bedtime, no sugary drinks, fluoride varnish, and establishing a dental home by age 1.

Fluoride varnish: 5% sodium fluoride (22,600 ppm) applied 2-4 times per year for high caries risk; safe from eruption of the first tooth.

Fluoride toothpaste: smear for under 3 years, pea-sized for 3-6 years; supervise brushing to limit swallowing.

Pulpotomy versus pulpectomy: pulpotomy removes coronal pulp only, used for vital pulp exposure; pulpectomy removes all pulp and is used for infected primary teeth.

Space maintenance: a band-and-loop or crown-and-loop maintains space after premature loss of a primary molar; a space maintainer is placed when the succedaneous tooth is not erupting soon.

Behavior guidance: tell-show-do, positive reinforcement, and parental presence decisions; nitrous oxide is safe and effective for anxious children.

Trauma in primary teeth: intrusion and avulsion are managed conservatively; do not replant a primary avulsed tooth because of damage to the developing permanent tooth.

Molar-incisor hypomineralization: demarcated enamel opacities on first molars and incisors; management ranges from desensitizing to full-coverage restorations.

DMFT index: counts decayed, missing, filled permanent teeth; dmft is the primary dentition equivalent; used for caries prevalence surveys.

Community periodontal index (CPI): scores 0-4 based on bleeding, calculus, and pocket depth; used in WHO oral health surveys.

Sensitivity and specificity: sensitivity is the proportion of true positives detected; specificity is the proportion of true negatives detected; predictive values depend on prevalence.

Levels of prevention: primary (before disease), secondary (early detection and treatment), tertiary (rehabilitation and limiting disability).

Water fluoridation: optimal concentration around 0.7-1.0 ppm; reduces caries by about 25-40% in children; monitor for fluorosis.

Screening programs: school-based screening improves early caries detection; follow-up with referral and case management is essential.

Lebanese oral health context: national surveys report high caries prevalence in children; the Ministry of Public Health runs school oral health programs; private insurance and NSSF cover parts of dental care.

Epidemiological study designs: cross-sectional for prevalence, cohort for incidence, case-control for rare outcomes; randomized controlled trials provide the strongest evidence for interventions.

Oral health promotion: common risk factor approach targets sugar, tobacco, and alcohol; settings-based programs in schools and workplaces.

Local anesthetics: lidocaine 2% with 1:100,000 epinephrine gives about 60 minutes of pulpal anesthesia; articaine 4% provides similar or better depth.

Maximum doses: lidocaine 4.4 mg/kg (or 300 mg absolute), articaine 7 mg/kg, mepivacaine 6.6 mg/kg; calculate by weight and account for epinephrine.

Antibiotics: amoxicillin 500 mg three times daily is first-line for odontogenic infection; penicillin allergy uses clindamycin or azithromycin; antibiotics are not indicated for simple pulpitis.

Analgesics: ibuprofen 400-600 mg every 6-8 hours is first-line for dental pain; paracetamol is an alternative; avoid aspirin in children under 16 due to Reye syndrome.

Anticoagulants: warfarin is continued for simple extractions when INR is within therapeutic range; direct oral anticoagulants are usually continued; check with the prescribing physician.

Bisphosphonates: risk of medication-related osteonecrosis of the jaw (MRONJ); avoid elective extractions when possible; conservative management for established MRONJ.

Drug interactions: epinephrine with nonselective beta-blockers can cause hypertension; metronidazole with alcohol causes a disulfiram-like reaction.

Pregnancy: lidocaine with epinephrine is considered safe; avoid tetracyclines and high-dose NSAIDs in the third trimester; elective treatment in the second trimester.

Antifungals: nystatin suspension or miconazole gel for oral candidiasis; miconazole interacts with warfarin and should be avoided in patients on anticoagulants.

Syncope: most common emergency; place the patient supine with legs elevated, ensure airway, and monitor vital signs; recovery is usually rapid.

Anaphylaxis: epinephrine 0.3-0.5 mg intramuscularly in the anterolateral thigh, repeat every 5-15 minutes; call emergency services; oxygen and IV fluids.

Local anesthetic overdose: signs include tinnitus, metallic taste, and seizures; stop injection, support airway, and use benzodiazepines for seizures.

Hypoglycemia in diabetes: give oral glucose if conscious; glucagon 1 mg intramuscularly or IV dextrose if unconscious; check blood glucose.

Airway obstruction: if a foreign body is visible, remove it; otherwise use abdominal thrusts or back blows; be prepared for cricothyrotomy in a complete obstruction.

Basic life support: 30 compressions to 2 breaths for adults; compression depth 5-6 cm at 100-120 per minute; use an AED as soon as available.

Medical history: ask about cardiac disease, hypertension, diabetes, asthma, bleeding disorders, and medications; classify ASA physical status before treatment.

Epinephrine in local anesthetic: use with caution in patients with severe cardiovascular disease; the benefit of vasoconstriction usually outweighs the risk in controlled hypertension.

Nitrous oxide: contraindicated in pregnancy, severe COPD, and bowel obstruction; monitor oxygenation and use a scavenging system.

Informed consent: must include diagnosis, treatment options, risks, benefits, and alternatives; document the discussion and the patient's decision.

Patient confidentiality: protected health information may be disclosed only with consent or when required by law, such as reporting infectious disease or suspected abuse.

Scope of practice: dentists must practice within their licensed scope; referral to a specialist is required when the case exceeds competence.

Record keeping: maintain complete records including radiographs, treatment notes, and consent forms; retention periods follow national regulations.

Advertising and professional conduct: avoid false or misleading claims; maintain professional boundaries and avoid conflicts of interest.

Lebanon: the Lebanese Order of Dentists regulates licensure and professional conduct; the Ministry of Public Health oversees health facilities and public health programs.

Malpractice: negligence requires a duty of care, a breach, causation, and damages; document carefully and maintain professional liability insurance.

Mandatory reporting: suspected child abuse and certain communicable diseases must be reported to the relevant authorities.

Fees and insurance: disclose fees before treatment; NSSF and private insurers reimburse according to contracted schedules; avoid fee-splitting arrangements.

Aphthous ulcer types and healing times

Lichen planus features and malignant risk

Candidiasis subtypes and management

Sjögren syndrome diagnostic criteria

Autoimmune blistering diseases and immunofluorescence

Oral potentially malignant disorders

Trigeminal neuralgia features and treatment

Burning mouth syndrome workup

Halitosis origins