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  1. 1. SYLLABUS FOR STATE EXAM 2009/2010 6th YEAR Therapeutic Dentistry Part: Conservative Dentistry DENTAL CARIESEpidemiology - Epidemiological overview of dental caries and periodontal diseases - Dental caries occurance, economical importance, index DMFT and DMFSExamination of the patient – history, extraoral, intraoral and helpful investigationsDental caries aetiology, theories of the oncet of dental caries.Dental plaque, its aetiopathogenesis, relationship to dental caries and periodontal diseases .Oral environment, role of the dentition and role of the saliva in relation to oral diseases.Pathomorphological picture of dental caries, carious process in enamel, dentine, cementum.Primary enamel destruction mechanisms: demineralisation, white spot.Mechanisms of white spot revitalisation : remineralisation possibilitiesDefence reactions againts carious process in enamel, dentine and in the pulp.Dental caries diagnosis, clinical classification, subjective and objective signs of dental caries,its process and forms.X – ray diagnostics in conservative dentistry. DENTAL CARIES TREATMENTContemporary approaches for preparation techniques. Preventive composite fillings.Objectives of tooth preparation – conventional and microinvasive.Caries profunda – classification, clinical picture, diagnosis, therapeutical possibilities,contemporary approaches to pulp protection. Filling materialsIndication of filling materials and their relationship to dental hard tissue.Amalgam – composition, conventional amalgam, current types, current status, indications,toxicity. Handling, inserting, carving, basics of manipulation with AM, factors affectingthe quality of amalgam restoration.Failures in restoratine procedures, during preparation and cavity filling.Inlay – indications in modern dental practise, working procedures.Composite materials – development, composition, classification, properties, indications, 1
  2. 2. working procedures, Adhesiv systems – adhesion principles. Factors affecting the quality ofcomposite fillings.Glass – ionomer cements – development, composition, classification, properties, indications,working procedures. Factors affecting the quality of glassionomer fillings.Non – carious tooth defectsMechanical and chemical damage of the dental dard tissues – erosion, abrasion, attrition,abfraction, aetiology, clinical features, therapy.Dentine hypersensitivity – aetiology, clinical features, diagnosis, diff. diagnosis, therapeuticalpossibilities. ENDODONTICS Pathomorphology and pathophysiology of the pulpRegresive and degenerative pulpal changesAetiological factors of pulpal diseasesClinical and histopathological classification of pulpal diseasesReversible and irreversible forms of pulpal diseasesDiagnosis and differential diagnosis of pulpal diseasesHyperemy of the pulp – pathomorphological picture, clinical features, diagnosis, diff.diagnosis.Inflammation of the pulp: acute serous and purulent - pathomorphological picture, clinicalfeatures, diagnosis, diff. diagnosis, therapy.Inflammation of the pulp: chronic – clausa, aperta, granulomatosa interna, a tergo,pathomorphological picture, clinical features, diagnosis, diff. diagnosis, therapy.Pulpal necrosis – aetiology, clinical picture, diagnosis, diff. diagnosis, therapy.Pulpal gangrena - aetiology, clinical picture, diagnosis, diff. diagnosis, therapy Pathomorphology and pathophysiology of the apical periodontiumAetiological factors of apical periodontium pathologyDiagnosis and differential diagnosis of apical periodontium pathology 2
  3. 3. Apical periodontitis acute and chronicAcute apical parodontitis – of bacterial origin, traumatic, chemical origin.Chronic apical parodontitis – granulomatosus, rareficans.Exacerbation of chronic apical parodontitis. Pathomorphology and pathophysiology of the pulpo – periodontal lesionsPulpo – periodontal lesions – classification, diagnosis, therapy.Primary endodontic lesion, primary periodontal lesion, combine endodontic and periodontallesion.Therapeutical possibilities of pulpal diseasesDental pulp and defence reactions of the pulp during therapeutical methods with preservingof pulp vitality.Therapeutical methods with preserving pulp vitality – indirect and direct pulp capping,pulpotomy, indications, working procedures. Indications and contraindications of endodontic treatment Root canal system morphology and trepanation orifice – general anatomy of root canal system, apex anatomy, anatomy of the teeth, basics of trepanation, determination of working lenth methods. Biomechanical root canal preparation, root canal instruments, hand and power assisted, endodontic handpieces. Vital amputation and extirpation of the pulp – indication, contraindication, working procedures, clinical and radiological check. Mortal amputation and extirpation of the pulp - indication, contraindication, working procedures, devitalizing pastes, clinical and radiological check. Desinfectants in endodontology and root canal medicaments – root canal irrigation, irrigants, role of the irrigation. One – visit root canal therapy – indication, contraindication, working procedures. Multipe – visit root canal therapy – indication, working procedures. Endodontic mishaps and complications – of the tooth ,during endodontic therapy, after root canal filling.Endodontic mishaps and complications – of tissue next to treated tooth and other tissues.Root canal filling – materials used for obturation, properties, sealers – function,classification.Root canal filling techniques – criteria of success, radiological control of root canal filling,documentation. Relation of conservatiove dentistry to other branches of dentistry.Dental focal infection – mechanism, history, therapy.Endodontic surgery – indication of endodontic surgery, basic working procedures.Prosthetic treatment indications in relation to endodontic teratment, reconstruction of thecrown of non-vital teeth. Therapy of the fractured frontal tooth.Differences in the treatment of painful teeth with fixed prosthetic appliances.Orofacial pain – differential diagnosis of the pain of dental origin and from other tissues. 3
  4. 4. Preventive viewpoints in conservative dentistryIatrogenic irritations during conservative dentistry procedures.Preventive viewpoints during preparation and cavity fillings (composites, GIC, AM).Preventive viewpoints during the application and final arrangement of the fillings.Preventive viewpoints during endodontic treatment.Prevention in everyday dental practise. Part: Pediatric Dentistry 1. Systematic dental care at different age groups,documentation and registration in pedodontics (particularity of dental care in childhood,dental care in different age groups, examination chart for children,recording of findings) 2. Clinical examination of children in pedodontics (meaning and aim of examination, parts of clinical dental examination-initial interview and case history, general appraisal, measurements of growth and development assessment, extraoral examination,intraoral examination, X-ray examination, special test investigation) 3. The function of the primary dentition, differences between deciduous and permanent teeth ( bitting and mastication, keeping the space for permanent teeth, create normal dental arches and correct intermaxillary relations, help for correct articulation and phonation, aesthetic function, differences in: time, development,eruption,number,shape,colour,size, type of teeth, anatomical differences of dental hard tissues, pulp chamber and root canal ) 4. Radiographic examination of children (Particularity of X-ray examination in childhood, preparing the children, the choice of X-ray technique, film size, developmental stages of teeth in X-ray picture, indications in pedodontics, radiation protection in childhood) 5. Dental caries of the deciduous teeth (caries etiology, caries activity tests, clinical characteristics, predilection sites) 6. Epidemiology of dental caries in children ( frequence-prevalence of dental caries, index dmft, dmfs,special caries index in preschool children) 7. Treatment of dental caries (steps of caries preparations, treatment according to Black classification,treatment of deep caries lesions, filling materials used in primary dentition) 4
  5. 5. 8. Diseases of dental pulp (classification of pulp condition causes of inflammation of dental pulp, clinical picture of hyperemia pulpae, pulpitis serosa, pulpitis ulcerosa)9. Treatment of affected dental pulp ( description of vital methods, description of non vital methods, indication of mentioned methods)10. Diagnosis and treatment of necrosis pulpae and gangrena pulpae ( causes of necrosa and gangrena pulpae, clinical picture, diagnosis and treatment)11. Injuries of dental crowns ( causes of injuries in deciduous dentition, classification and treatment of fracture of the crown)12. Injuries of dental roots ( report about trauma, classification and treatment of fracture of the roots)13. Concussion and subluxation of deciduous teeth ( epidemiology of injuries in childhood, classification of injuries affected the periodontium, clinical picture of concussion and its therapy, clinical picture of subluxation and its therapy)14. Avulsion of deciduous teeth ( signs and symptoms suggestive of neurologic damage, possibility of treatment, condition for replantation, choice of method of replantation)15. Development and eruption of deciduous teeth ( development of primary dental lamina, creation of hard dental tissues, creation of dental roots, time of eruption, time of root resorption)16. Development and eruption of permanent teeth (development of secondary dental lamina, structure of enamel organ, creation of hard dental tissues,creation of dental roots, time of eruption, time of apexification)17. Psychoprophylaxis and psychotherapy in pedodontics ( proper communication between small child and dentist, active education of children, psychoprophylaxis and psychotherapy)18. Premedication for children (the aim of premedication, drugs used for decreasing of the pain, vomiting reflex, cough, ticks and tremor. The medication of drugs for reducing the stress from dental treatment in different groups of children. Dose factor for administration of drugs)19. Anesthesia in pedodontics ( aim of anesthesia in childhood, methods of administration, indication of different type of injection anesthesia, types of anesthesia solutions, side effects and complications, toxic and allergic reactions) 5
  6. 6. 20. Extraction of deciduous and permanent teeth ( extraction procedure, instruments for extraction, indication for extraction, contraindications, local complications, complications after extraction)21. Inflammation of lymph-nodes (morphology of lymph vessels and lymph-nodes, 3 groups of lymph-nodes on the face and neck, causes of inflammation of lymph-nodes, clinical picture of lymphonoditis acuta, therapy, prevention)22. Prosthetic treatment in deciduous dentition (characteristic of prosthetic treatment in childhood, basic and special function of prosthetics in childhood, main principles of prosthetics in childhood, fixed and removable appliances in deciduous dentition)23. Prosthetic treatment in permanent dentition (characteristic of prosthetic treatment of children and adolescents and indication removable appliances in permanent dentition)24. Methods of primary prevention of dental caries except fluorides (definition of the health status and primary prevention,aim of nutrition, reduction of consumption of sugar, hygiene of oral cavity, methods of oral hygiene, oral health education)25. Prevention of dental caries in the pits and fissures (3 phases of special prevention of dental caries, dental caries prevention by using fissure sealants, preventive filling)26. Fluorides for the prevention of dental caries ( effectivity of fluorides in caries prevention, methods of endogenic and exogenic fluoridation)27. Insipient caries lesion (white-spot )-diagnosis and treatment (caries process in enamel, process of demineralization and remineralization, measures for applicative remineralization – role of hygiene, sugar consumption and fluorides)28. Periodontitis apicalis in primary dentition (causes of perodontitis apicalis, diagnosis, clinical picture,therapy, prognosis, prevention)29. Estimation of dental age (definition of dental age, specific signs using for estimation, developmental stages of teeth, determination of dental age by mineralization of dental hard tissues, index of mineralization-MI)30. Treatment of immatured permanent teeth (characteristics of immatured teeth, anatomical,histological and biological differences, differences in the prevention, in the treatment of dental caries,pulp diseases and prosthetic indications) 6
  7. 7. Part : Periodontology and Oral Medicine1. Clinical morphology of periodontal tissues: definition and measurement of gingivalsulcus, width of attached gingiva, gingival and periodontal pocket, loss of attachment.• tissues of healthy periodontium (gingiva, periodontal ligaments and periodontal ligament space, alveolar bone, cementum, blood, lymphatic and nerve supply) - macroscopic and microscopic characteristics, division.2. Labial et accessory frenae and primarily shallow vestibulum oris: their impact onperiodontal tissues• types of frenal insertions, positive tug syndrome, locations of lateral frenae insertions, mechanism and consequences of their negative effect, examination)3. Indices describing level of oral hygiene and its relationship to gingival conditions:PBI, BoP index for bleeding scoring, PlI = Silness, Loe – plaque detection. • examination, evaluation and calculation, scoring criteria, manners for plaque detection, significance.4. CPITN (Ainamo et al.) – significance and clinical application • indication of examination, index significance, measurement, scoring (CPI + TN), WHO screening probe N°621 - description of the probe.5. Importance of thorough oral hygiene, toothbrushing techniques, instruction andpatient motivation. • definition and division of oral hygiene, importance of regular plaque removal • toothbrushing techniques (vertical method, circular, Stillman, Bass, Charter‘s method). • inappropriate techniques and their consequences6. Oral hygiene resources • toothbrush (composition, types, indications) • specific types of toothbrushes (single-tufted, sensitive, sulcular, ortho-toothbrush, for cleaning dentures) • aids for interdental hygiene (dental floss - waxed, nonwaxed, superfloss, toothpick, interdental toothbrush, stimulator) • toothpaste (basic function and demands , toothpaste division, composition of toothpastes, well known types) • mouthwashes7. Dental calculus, types, composition and formation. Instruments and ways of removal. • characteristics, composition, clinical classification, predilection sites, mechanism of development, and mineralisation • ways of calculus removal - manual, mechanical (phases of manual scaling) • supragingival plaque and calculus removal = supragingival scaling - indication, contraindication, instruments used, technique • mechanical scaling by ultrasound - indication, contraindication, technique • subgingival plaque and calculus removal = deep scaling - indication, contraindication, instruments, technique • root planing - removal of the pathologically altered cementum and smoothing of the root surface - major goal, used instruments, technique 7
  8. 8. 8. Importance, indication and technique of tooth surface polishing• instruments, polishing periods9. Prevention of periodontal diseases according to WHO criteria, oral health, definition,criteria• primary prevention - health maintenance• secondary prevention - prepathogenesis - specific protection, pathogenesis - early diagnosis and treatment• tertiary prevention - rehabilitation10. WHO goals for oral health in the project „ Health for all by the year 2000“ and„Health 21“• WHO oral health goals for the year 2000 - required goals in each age group for dental caries and periodontal diseases reduction, comparison with goals to the year 2010• Health 21 - basic declaration, goals (goal 8.5 : Reduction of the dental caries)11. Criteria for periodontal tissues examination. Documantation in Periodontology.• examination of the periodontal pocket, presence of subgingival plaque and calculus, periodontal pocket activity (BoP - bleeding on probing, exudation), examintion of the tooth mobility, furcation lesions, gingival recessus, after surgical treatment - loss of attachement and reattachement.• examination of the mucogingival conditions : measurement of the attached gingiva width in the lower frontal area 44-34, in relation with depth of vestibulum oris, examination of frenal insertions - frenulum labii superior, inferior and lateral frenae.• documentation in periodontology: personal data, code of the health insurance company, diagnosis, personal history (family history, personal anamnesis, medication history, allergic anamnesis), current disease - objective, subjective finding, oral hygiene, adjuvant examinations (X-ray, lab.), status, CPITN, pocket depth measurement (m,v,o,d), gingival recession (v,o), loss of attachement, furcation lesions, tooth mobility, width of attached gingiva, X-ray indications, oral mucosa and tongue conditions, orthodontic anomalies, treatment plan12. Determinants and general risk factors and their role in aetiology of periodontaldiseases• determining factors: age, race, sex• general risk factors: smoking, diabetes• risk indicators: osteopenia and osteoporosis, stress, genetic factors; immunologic disorders: AIDS, primary and secondary neutropenia, congenital neutropenia, drug induced agranulocytosis, Papillon-Lefevre syndrome, Ehlers-Danlos sy, hypophosphatemia• medication side effects: anticonvulsives, cyclosporine, calcium blockers13. Local risk factors in aetiology of periodontal diseases• low degree of oral hygiene (plaque, calculus), situations with worsening effect on hygienic conditions (orthodontic anomalies, inadequate restorations - fillings, prostetics)• functional disorders (occlusal trauma, parafunctions), aberrations in anatomic structure of periodontal tissues ( pathologic frenal insertions, primarily and secondarily shallow vestibulum oris)• principles of exogenic factors effect 8
  9. 9. 14. Classifications of periodontal diseases• review of classifications development, classification accoriding to AAP - American Academy of Periodontology - 1989, Classification system of periodontal diseases and conditions – World Workshop 1999• European classification according to Lindhe (Switzerland) : plaque associated diseases (gingivitis - chronic, acute; periodontitis - chronic, acute), non-plaque associated diseases (traumatic, infective and on immunologic base)• Internation Disease Classification - IDC10 - K05 (disease coding K05.0 - K05.6), K06 (K06.0- K06.9) - importance15. Chronic simplex gingivitis and chronic complex gingivitis• characteristics, aetiology, clinical picture, diagnosis, differential diagnosis, therapy16. Acute necrotising ulcerative gingivitis (ANUG)• aetiology, occurence, predisposing factors, clinical picture (subj., obj., pathognomic symptom), diagnosis, diff. dg., complications, therapy - local, systemic, prognosis)17. Periodontal abscess - diagnosis, diff.dg., therapy• definition, causes, clinical picture (subj., obj., inspection, palpation, relation to the periodontal pocket, vitality, percussion, X-ray), diff.dg. for comparison with odontogenic abscess and therapy.18. Adult periodontitis, principles of development. Clinical picture and radiographicpicture• definition and characteristics of the disease, epidemiology, aetiopathogenesis, clinical and radiographic picture – constant and non-constant symptoms, classification – types of periodontitis, diagnosis, diff.dg. (in comparison with gingivitis and atrophic changes on periodontal tissues)• therapy – conservative (local, systemic), surgical, complications, prognosis19. Aggresive periodontitis (localized, generalized) of primary and secondary dentition• prepubertal periodontitis (characteristics, occurence, forms, aetiology, therapy)• juvenile periodontitis (characteristics, occurence, aetiology, course - forms, clinical and radiographic picture, progression of the disease, therapy)20. Periodontitis - treatment plan• conservative – periodontal phase, maintenance period, surgical period• maintenance period + massage, conservative treatment + prostetic treatment, adjustment of articulation21. Indications for surgical treatment of periodontal diseases• division of surgical methods, indication of different types of surgeries and their goals, contraindication of surgical treatment• mucogingival surgery, periodontal surgery - principles of each types of operations• general surgical protocols for periodontal surgery 9
  10. 10. 22. Local and systemic treatment of inflammatory periodontal diseases• antiphlogistics (local medicaments - antiseptics, H2O2, chlorhexidine, local antibiotics, systemic antibiotics) - their effect, indications, dosage, duration of the treatment• physical methods of the treatment23. Postoperative care and patients‘ recall after surgical therapy of periodontitis• guidance of the patient – principles: icepacking, food, mouthrinsing, avoidance from physical activity, teethbrushing, role of periodontal dressing, sleeping, analgetics, recall periods after different types of surgical procedures24. Stomatitis - classification and aetiology• classification according to Neuwirth and Škach, devision according to symptomatology, classification according to etiopathogenesis, primary and secundary stomatitis, etiology: mechanical causes – trauma, decubitus, cotton-roll-stomatitis; physical changes, thermal (burns, frostbites), chemical – acids, alkalies, alkohol, galvanism; infections25. Bacterial stomatitis (excluding ANUG)• systemic infective diseases accompained by typical oral symptoms : bacterial infections like scarlatina, dyphteria, typhus, pertussis, specific inflammations – TBS, syphilis26. Herpetic gingivostomatitis• aetiology, Blanck - Ratke scheme of HSV infectiosity, clinical manifestation of primary infection, recurrent herpetic diseases, chronic infections• occurence, progression - stages, clinical picture (subj., obj.), complications, diff.dg., treatment27. Viral stomatitis (excluding HSV, HIV)• viral diseases accompanied by symptoms in the oral cavity (measles, rubella, mononucleosis, mumps, poliomyelitis, varicella, variola, epidemic stomatitis, hand-foot- mouth disease, herpes zoster, herpangina)28. Aphthous stomatitis and periadenitis mucosa necroticans recurrens• definition, aetiology, occurence, pathological and anatomical basis, clinical picture, dg., diff.dg., treatment, relation to systemic diseases and syndroms (Behcet‘s syndrome, Reiter‘s disease)29. Glossitis: traumatic glossitis, glossitis profunda, chemical, thermal and galvanicglossitis, glossitis areata migrans, glossitis accompanying deficiency syndromes• definition, characteristics, clinical picture, dg., diff.dg., treatment30. Stomatodynia, glossodynia• definition, practical classification, aethiopathogenesis, dg., treatment31. Oral candidiasis• aetiology, clinical division, division in relation to clinical course, predisposing factors (local, systemic), clinical picture (subjective, objective), dg., diff.dg., (in comparison with keratotic and non-keratotic white patches), treatment - local, systemic – antifungal drugs (dosage, duration of treatment) 10
  11. 11. 32. HIV-infection symptoms and AIDS with orofacial manifestation, possibilities oftreatment• AIDS brief definition of aetiopathogenesis, epidemiology, occurence, clinical picture - major and minor symptoms, stages of the disease• oral infections accompaing HIV: bacterial, viral, fungal and tumoral diseases - Kaposhi‘s sarcoma, changes of unknown aetiology - recurrens aphtosus stomatitis, idiopathic trombopatia, hyperpigmentations (clinical picture, diagnosis, treatment)• prevention regarding dental treatment in dental office33. Precancerous conditions in oral cavity• lichen ruber planus, preleukoplakia, leukoplakia oris, erytroplakia, lingua villosa nigra)• definition, dispensary, clinical picture, dg., diff.dg., treatment34. Sialosis• xerostomia as a symptom: definition, aetiology, clinical picture, types of xerostomia, estimation of salivation (standard, pathology)• causes of xerostomia, it‘s relation to systemic diseases, xerostomia as undesirable side effects of medicaments, diff.dg., treatment• Sjögren’s syndrome, Lupus erythematodes35. Manifestation of bullous dermatoses in the oral cavity• definition, division, aetiology, clinical picture, dg., dif.dg., treatment• pemphigus vulgaris, erythema exsudativum multiforme, Stevens-Johnson’s syndromeKnowledge on epidemiology of dental caries and periodontal diseases(terms – prevalence, severity, methodology of epidemiological studies, age groups for oralhealth evaluation: 5-years-old, 12-years-old, 35-44-years old, 65-74 years old)Dental microbial plaque – key factor in aetiology of dental caries and periodontaldiseases• definition: acquired pellicle, materia alba, dental microbial plaque, composition of plaque, plaque development, division according to localisation, microbial composition of developed plaque, distribution of microorganisms in the plaque, intermicrobial substance• plaque products - relation to dental caries and periodontal diseasesRole of saliva and microorganisms in development of orofacial diseases(physiology of oral environment, saliva, production, composition, properities and role ofsaliva, quantitative saliva examination, oral microorganisms in developement of dental cariesand periodontal diseases, division of microorganisms)Bacterial biofilm – aetiopathogenesis(definition, properities, characteristics) 11