INBDE Updates to Mental Dental Videos

Dr. Ryan's Mental Dental Videos provide a great overview of high-yield topics you need to know for the INBDE. We want to make sure you have the most up-to-date information, so we have listed a few updates and corrections below that you can use to study for the INBDE.

Oral Pathology and Oral Radiology

Oral Pathology

Lesson: Bone Inflammatory Lesions‍

• Time point: 0:50
• ‍Correction: Slide says with acute osteomyelitis “Tooth is NOT loose, this is caused by periodontitis”. However, tooth mobility does occur due to destruction of bone.

Lesson: Mucosal Immunologic Diseases‍

• Time point: 10:28
• ‍Correction: Video says that in mucous membrane pemphigoid autoantibodies attack the basement membrane. However, autoantibodies in mucous membrane pemphigoid attack hemidesmosomes.

Lesson: Hereditary Conditions‍

• Time point: 10:32
• ‍Correction: Dr. Ryan says that dentin dysplasia type II exhibits chevron-shaped pulps. However, it is dentin dysplasia type I that has chevron-shaped pulps due to pulpal obliteration. Dentin dysplasia type II has enlarged pulp chambers that are constricted at the base, resulting in "thistle tube"-shaped pulp chambers.

Lesson: Hereditary Conditions‍

• Time point: 10:40
• ‍Correction: Dr. Ryan says that regional odontodysplasia is a hereditary condition. However, regional odontodysplasia is a localized, nonhereditary developmental abnormality.

Lesson: Developmental Conditions‍

• Time point: 16:12
• ‍Correction: The tongue is the most common site for oral lymphoepithelial cysts.

Lesson: Odontogenic Cysts‍

• Time point: 6:35
• ‍Correction: Bohn's nodules are thought to be derived from minor salivary gland remnants. Epstein pearl are thought to be derived from epithelium entrapment during fusion of palatal shelves.
  

Oral Radiology

Lesson: Film vs. Digital Imaging‍

• Time point: 10:44‍
• Correction: Film radiographs having higher contrast resolution than digital radiographs only applies to first generation digital radiographs. Current digital imaging has equivalent resolution to film.

Lesson: X-Ray Settings‍

• Time point: 21:40‍
• Correction: An increase in filtration will cause a decrease in both density AND contrast.

Pharmacology

Lesson: Autonomic Nervous System‍

• Time point: 18:10‍
• Correction: Succinylcholine is an agonist, not antagonist.

Lesson: Antibiotics‍

• Time point: 16:52‍
• Correction: Antibiotic recommended for IE prophylaxis for patients allergic to penicillin is azithromycin, not clindamycin - per AHA 2021 update to guidelines.

Lesson: Antibiotics‍

• Time point: 19:12‍
• Correction: Antibiotic prophylaxis is no longer recommended for patients with prosthetic joint replacements, even if complications (such as infection) related to the prosthetic joint have occurred.

Lesson: Antibiotics‍

• Time point: 23:19‍
• Correction: Mental Dental says -cidal and -static drugs cancel each other out, however AHA recommendations state that amoxicillin (bactericidal) and azithryomycin (bacteriostatic) can be used together - this is used in clinical practice.

Lesson: Cardiovascular Pharmacology‍

• Time point: 15:57‍
• Correction: In addition to atrial fibrillation and supraventricular tachyarrhythmias, class 1a anti-arrhythmic drugs are also used to treat ventricular arrhythmias.

Medicine

Oral Medicine

Lesson: Hypertension‍

• Time point: 13:01‍
• Correction: Flow chart suggests several modifications in patients with hypertension and readings over 120/80. ADA suggests no modifications needed for patients with hypertension and reading less than 160/100. Additionally, for levels higher than this the video gives the option to proceed and monitor citing AHA but ADA has different guidelines. Read more here: https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/hypertension

Lesson: Hypertension‍

• Time point: 8:00‍
• Correction: Video states that when the blood pressure cuff is rolled out that the length should be 80% of the patient's arm circumference and 40% of the width. The "cuff bladder" should be these sizes, not the entire cuff.

Lesson: ASA Classification‍

• Time point: 4:13 
• ‍Correction: Video states that ASA III including stroke >3 months generally okay for elective care, literature suggests 6 month postponement of elective care for patients who have had a stroke.

Lesson: Steroids & Adrenal Insufficiency‍

• Time point: 11:17
• ‍Correction: Video says to avoid benzodiazepines in patients with Addison's disease due to an interference with corticosteroid metabolism. However, the literature does not show enough evidence for this claim to be clinically significant.

Lesson: Substance Abuse‍

• Time point: 14:00
• ‍Correction: Dr. Ryan uses clonidine as an example of a beta-blocker. However, clonidine is a centrally-acting alpha agonist, not a beta blocker.

Lesson: Cancer, Chemo, and Radiation‍

• Time point: 5:26
• ‍Correction: Dr. Ryan lists the order for the most common sites of oral cancer. However, the correct list should state tongue (most common) > floor of mouth > lip (least common).

Lesson: GERD & Peptic Ulcers

• Time point: 3:44
• ‍Correction: Ranitidine has been withdrawn from the market due to posing a risk for cancer and is no longer a recommended drug for GERD.

Fields of Dentistry

Operative Dentistry

Lesson: Amalgam

• Time point: 2:33‍
• Correction: Video states that gamma-1 is strongest with least corrosion, but gamma is strongest with least corrosion. Gamma1 is second strongest and next corrosion resistant.

Lesson: Composite Resin and Glass Ionomer

• Time point: 22:13‍
• Correction: Video states that benzoyl peroxide is the initiator in the base paste of self-curing composites. However, benzoyl peroxide is the initiator in the catalyst part of self-curing composites.

Lesson: Practice Questions

• Time point: 10:00‍
• Correction: Video states that a retentive feature of class II amalgam preparations is convergent proximal walls. However, class II amalgam preparations should be divergent on proximal walls with dovetail features and the buccal and lingual walls should be made convergent.

Endodontics

Lesson: Root Canal Treatment‍

• Time point: 7:09‍
• Correction: The video correctly points to the mesial of the tooth but incorrectly says "distal." The correct statement would be the mesial root of the mandibular molar most frequently has 2 canals whereas the distal root has 1.

Lesson: Root Canal Treatment‍

• Time point: 11:44‍
• Correction: Slide says that D1 = diameter at tip (of an endo file). However, D0 is the diameter of the tip of an endo file. The remainder of the calculations on the slide are correct.

Lesson: Traumatic Injuries‍

• Time point: 6:10‍
• Correction: Splinting guidelines are inconsistent with International Association of Dental Traumatology (IADT).

Lesson: Traumatic Injuries‍

• Time point: 3:01‍
• Correction: There is a discrepancy between the Ellis classifications in the videos. Please see below for the correct classification:

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Lesson: Adjunctive Endodontic Treatment‍

• Time point: 1:31‍
• Correction: The chemical formula for calcium hydroxide is Ca(OH)2, not CaOH2.

Lesson: Practice Questions‍

• Time point: 1:30‍
• Correction: Dr. Ryan states that percussion is the most reliable test for pulpal diagnosis. This is incorrect; cold testing is the most reliable for pulpal diagnosis.

Oral Surgery

Lesson: Impaction & Extraction Facts‍

• Time point: 7:19‍
• Correction: Discrepancy in sequence of most commonly congenitally missing teeth. The correct order is as follows:
  third molars > mandibular second premolars > maxillary laterals > maxillary second premolars

Lesson: Medical Emergencies‍

• Time point: 3:00‍
• Correction: Trendelenburg position is no longer recommend as treatment for patients experiencing syncope or syncopal episodes as it increases intracranial pressure and causes restricted respiratory movement via compression of the diaphragm. Trendelenburg position can also put the patient at risk of falling out of the dental chair. Instead, supine position is the correct position to place a patient in who is experiencing syncope.

Lesson: Medical Emergencies‍

• Time point: 12:58‍
• Correction: Breathing into a brown paper bag during hypocarbia induced by hyperventilation is no longer recommended as it can lead to undesirable outcomes, including mortality.

Lesson: Medical Emergencies‍

• Time point: 8:00‍
• Correction: The video states that for episodes of angina, 911 should be called after giving three doses of nitroglycerin without resolve of symptoms. However, the most appropriate time to call 911 is after giving the first dose of nitroglycerin. This will allow ample time for emergency medical services (EMS) to arrive in the case the patient's symptoms do not resolve and that a true medical emergency is occuring, such as a myocardial infarction.

Orthodontics

Lesson: Diagnosis and Treatment Planning‍

• Time point: 4:15‍
• Correction: The video states that there are Class I and II Subdivisions under the Class II Malocclusion system. However, the correct terminology is Class II division 1 and Class II division 2.

Lesson: Diagnosis and Treatment Planning‍

• Time point: 39:40‍
• Correction: Video lists that the mandibular plane extends from the gonion (Go) to the gnathion (Gn). However, it can also be defined as extending from the gonion (Go) to the menton (Me) and this occurs more commonly. You will not see both of these as answer choices on the exam within the same question.

Pediatrics

Lesson: Developmental Disturbances of Teeth‍

• Time point: 1:37‍
• Correction: Discrepancy in sequence of most commonly congenitally missing teeth. The correct order is as follows:
  third molars > mandibular second premolars > maxillary laterals > maxillary second premolars

Lesson: Developmental Disturbances of Teeth‍

• Time point: 22:00‍
• Correction: Dentin dysplasia type I exhibits obliterated pulps and appears radiographically as "chevron-shaped" pulps. Dentin dysplasia type II exhibits enlarged pulp chambers and appears radiographically as "thistle tube-shaped" pulps.

Lesson: Dental Trauma in Children‍

• Time point: 10:01‍
• Correction: Video has information on prognosis of replanted avulsed primary teeth. However, avulsed primary teeth are typically not replanted because it can render them susceptible to trauma again or can cause damage to the permanent successor.

Lesson: Child Behavior‍

• Time point: 26:50‍
• Correction: The American Academy of Pediatric Dentistry (AAPD) and the American Dental Association (ADA) recommend that children under the age of 3 use an amount of toothpaste the size of a smear of a grain of rice and a pea-size amount for those 3 to 6.

Lesson: Dental Trauma in Children

• Time point: 8:57‍
• Correction: According to the most updated guidelines by the International Association of Dental Traumatology, when a primary tooth is extruded less than 3 mm, no treatment is needed and the recommended plan is to follow-up and monitor for spontaneous repositioning.

Prosthodontics

Lesson: General Considerations‍

• Time point: 24:58‍
• Correction: Screw-retained implants have a propensity to loosen more than a cement-retained implant.

Lesson: Metal Alloys‍

• Time point: 2:47‍
• Correction: Class V restorations are not the only type of direct restoration that type I gold alloys can be used for, but type I gold can also be used for indirect restorations (mostly inlays).

‍

Lesson: Gypsum Materials‍

• Time point: 4:00‍
• Correction: The video says that more water leads to less expansion and less water leads to more expansion. Additional water will push the crystals apart and increase the expansion of the setting material.

Lesson: Major & Minor Connectors‍

• Time point: 2:16‍
• Correction: The video states that the complete palatal plate is the most rigid of the maxillary major connectors. However, the anterior-posterior (AP) palatal bar is the most rigid.

Patient Management, Ethics, and Behavior

Patient Management

Lesson: Materials & Equipment Safety‍

• Time point: 4:00‍
• Correction: Video says “Not recommended to flush lines at beginning of clinic because makes no difference”. However, the FDA says to flush them at night and when units are out of service, then after each patient. It doesn't say anything about the beginning of clinic or morning. The CDC says to flush waterlines in the morning and after each patient.

Lesson: Infection Control‍

• Time point: 16:00‍
• Correction: Video says pressure sterilization/autoclaving should be at 121°C at 15psi for 20 min per the FDA. However, the CDC governs this guideline and states that "recognized minimum exposure periods for sterilization of wrapped healthcare supplies are 30 minutes at 121°C (250°F) in a gravity displacement sterilizer."

Lesson: Infection Control‍

• Time point: 16:23‍
• Correction: The Center for Disease Control and Prevention (CDC) is the agency that governs the standards for disinfection and sterilization guidelines, including standard temperatures for autoclaving.

Anatomy and Physiology

Head and Neck Anatomy

Lesson: Soft Palate Muscles‍

• Time point: 4:17‍
• Correction: Video incorrectly includes salpingopharyngeus and leaves out palatoglossus as a part of the soft palate. The salpingopharyngeus is not directly part of the soft palate but is closely related anatomically and functionally to the muscles involved in velopharyngeal closure and swallowing.