Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OSCE 5th year > 12 minute stations > Flashcards

12 minute stations Flashcards

1
Q

In paediatric caries prevention, how do you encourage behaviour change?

A
  • Explore current habits. Seek permission. Open questions. Affirmations. Reflective listening. Summarising. Elicit change talk.
  • Educational intervention - improve knowledge and skills
  • Action planning - set time, date and place to start
  • Encourage habit formation
  • Repeat at each recall
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What toothbrushing advice should be offered to paediatric patients at their exams?

In brackets - enhanced

A
  • Once per year (or each recall) remind to brush thoroughly twice daily, including last thing at night
  • Use age appropriate amount and concentration of F (script?)
  • Spit dont rinse
  • Supervise brushing
  • Demo toothbrushing annually (each recall)
  • Action plan/habit stacking
  • Advise brushing on eruption of first tooth.
  • use short scrubbing motion
  • Use timer/watch/app for 2+ minutes
  • Wait 30 minutes after acidic food to brush
  • Highlight brushing technique for PE teeth
  • Recommend aids such as toothbrushing/sticker charts, timers, disclosing tablets
  • Offer free toothbrush/toothpaste
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What diet advice should be offered to paediatric patients?

A
  • Advise on benefits of healthy diet
  • Limit consumption of food/drink containing sugar. Restrict to meal times.
  • Drink only water or milk between meals
  • Snack on lower sugar foods; veg, breadsticks, oatcakes, cheese, some fruit
  • Nothing but milk/water in baby bottle
  • Nothing to eat/drink after brushing at night
  • Beware of hidden sugars
  • Beware of acid content
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the three possible scores in a modified plaque score?

A 
2 = visible plaque without use of a probe
1 = no visible plaque but a probe skimmed over tooth surface reveals plaque
0 = no plaque

All scores are added together to give a total, which is then divided by the maximum plaque score possible (36)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the purpose of grading periodontal disease and what are the three grades?

A

Grading indicates the progression of bone loss.
Grade A - slow - less than half patients age
Grade B - moderate half to equal to patients age
Grade C - rapid - greater than patients age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How should the assessment of facial trauma/zygomatic fracture be approached?
Exam, diagnosis, indicate further investications

A
  • E/O exam; lacerations. Nasal bleeding/deviation/patency (by obstructing each nostril). Palpation of zygoma bilaterally from behind the patient. Assymetry? Limitation of mandibular movement? Examine sensation of infra-orbital region (upper lip, lateral nose, over eyelid). Examine eye; periorbital ecchymosis, subconjunctival haemorrhage. Vision assessment - pupillary reaction to light, ask if presence of double vision. Assess eyeball mobility.
  • I/O features; tenderness of zygomatic buttress. Bruising/swelling/haematoma. Occlusal derangement and step deformitites. Lacerations (especially gingivae), loose/# teeth. Anaesthesia/parasthesia of teeth.
  • Further investigations; radiographs (occlusal maxillary. CT. CBCT). Identify fracture on radiograph
  • Diagnose ie zygomatic fracture
  • Management; urgent phone to OMFS unit or A+E for advice/referral. Surgical - ORIF or conservative if displaced, asymptomatic or greater than one month
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

You expose a pinpoint pulp exposure when doing a cavity prep on an asymptomatic tooth. How should this be addressed?

A
  • Explain to the pt what has happened and that a pulp cap is required
  • Explain risk of future RCT if symptoms occur
  • Ensure tooth is asymptomatic, no pain history, pulp exposure is small and surrounding dentine is hard.
  • Dam should have been placed prior to exposure
  • Cavity cleaned with sterile saline and blotted dry with CWP
  • Cover exposure with setting CaOH (dycal) and line with RMGI (vitrebond)
  • Complete restoration
  • KUO to monitor vitality.
  • RCT if symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Assume dam has been fitted and pulp has been exposed during cavity prep, there is still caries present. How to address this?

A
  • Extirpate - pulpectomy
  • Remove coronal pulp tissue with sterile spoon excavator. Irrigate with saline and dry.
  • Discuss with pt XLA or RCT required
  • Temporise with odontopaste/ledermix (AB/steroid) ahead of XLA/RCT
  • CWP and GIC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is the extent of periodontal disease recorded?

A
  • Localised - less than 30% of teeth
  • Generalised - greater than 30% of teeth
  • Molar incisor pattern
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How should smoking cessation advice be offered? What information will the actor be looking for?

A

ASK What do you smoke? How long have you smoked for? How many cigs per day? How quickly after waking do you have your first cig? Does anyone else in the house/family smoke?
ADVISE Smoking is harmful for general health (cardiovascular and respiritory). Detrimental to oral health - risk of tooth loss, reduced ability to heal, staining, perio disease, oral cancer. Personal such as cost/smell
ASSESS motivation to quit. Interested in quitting? Any past attempts? How many? What worked/didn’t work?
ASSIST offer referral/sign post. Champix, gum, patches, lozenges.
Ecigs; newish, don’t fully know side effects. Likely less harmful than tobacco. Don’t vape around children. Maintains habit and culture of smoking.
ARRANGE/REFER Those interested to pharmacy/stop smoking services. Can self refer. Run by NHS staff and trained advisors. Arrange follow up

Actor is looking for non-judgemental, easy to understand advice, listening, good eye contact, open body language

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How can regular alcohol consumption cause cancer?

A

Bacteria in your mouth can metabolise alcohol to a toxic chemical which can accumulate over time and cause changes to DNA (acetaldehyde).
Alcohol can increase levels of oestrogen which is linked to breast cancer.
Alcohol can reduce your body’s natural defenses making it easier for other carcinogens to be absorbed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name three oropharynx sites cancer may be detected

A
  • Base of tongue
  • Tonsils
  • Soft palate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name five oral cavity sites cancer may be detected

A
  • Lateral border/anterior two thirds of tongue
  • Floor of mouth
  • Lip mucosa
  • Retromolar trigone
  • Buccal mucosa
  • Hard palate
  • Alveolus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the 7 red flags for oral malignancy?

A
  • Ulcer persists for more then two weeks despite removal of any obvious causation.
  • Rolled margins (raised periphery. Firm/hard), central necrosis.
  • Speckled appearance (erythroleukoplakia; red and white patches)
  • Cervical lymphadenopathy (enlarged ( >1cm), firm, fixed, tethered, non tender), should be picked up on during extra oral exam.
  • Worsening pain (at primary site. Neuropathic, dysaesthesia, parasthesia)
  • Referred pain (ear, throat, mandible, teeth)
  • Weight loss. Moving from local to systemic effects. Cachexia (wasting of the body/rapid weight loss due to the metabolic demand of the disease process)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A patient questions why they need a dental exam before starting chemotherapy.
What information should you provide?

-

A
  • it is important to be dentally fit before chemo begins
  • dry mouth is common during treatment, which affects dental health
  • mouth soreness and ulcers (mucositits) can occur 7-14 days following initial treatment, to varying degrees. Symptoms can be managed with good OH, avoiding spicy foods and topical LA
  • Infection risk must be reduced as chemo impairs immunity and causes coagulation defects.
  • When immuno-compromised infections can be life threatening
  • prioritites are to eliminate/remove source of infection and prevention
  • Dental treatment during chemo should be avoinded as much as possible
  • pt at risk of dry mouth, sore mouth, difficulty wearing dentures, fungal infections and altered taste (oral radiotherapy)
  • Increased caries risk
  • Dental treatment needs to be complete at least ten days before chemo starts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What should be provided for a patient at a pre cancer treatment assessment?

A
  • full exam
  • OPT and PAs are a must
  • Detailed OHI, TBI, ID cleaning
  • Fluoride - topical, duraphat TP, MW
  • Tooth mousse
  • Dietary advice
  • PMPR
  • Consider CHX mw/gel
  • Restore carious teeth
  • Removal of trauma; sharp edges on teeth/dentures
  • Imps for fluoride trays/soft splint
  • XLA or poor prognosis teeth no less than ten days before cancer tx begins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some side effects of cancer treatments?

A
  • Surgical tumour resection can produce alterations to normal anatomy
  • H+N cancer tx can have adverse effects on respiration, mastication, swallowing, speech, taste, salivary gland function, mouth opening and outward appearance.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some clinical signs and symptoms of a fractured mandible?

A
  • Pain, swelling, limitation of function
  • Occlusal derangement
  • Numbness of lower lip
  • Loose or mobile teeth
  • Bleeding
  • Anterior open bite
  • Facial asymmetry
  • Deviation of mandible to opposite side
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the 3 steps in management of a mandible fracture?

very basic steps

A
  • clinical exam
  • Radiographic assessment
  • treatment (control of pain and infection)
  • Two basic principles - reduction and fixation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What radiographs might be taken to assess a fractured mandible?

A
  • OPT and PA mandible
  • Occlusal
  • Lateral oblique
  • Towns view
  • SMV
  • CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is observed in an exam following facial trauma?

A

Carried out only after cardiopulmonary and neurological exam deemed satisfactory.
Soft tissue injuries;
- Abraisions
- Lacerations
- Incision
- Wound margins (well defined/clean cut edges, serrated, rounded, necrotic?)
- Size - measure with ruler
- Depth; dermal, fat, muscle or deep to bone
Bruising
- Describe colour; red/pink, bluish, greenish, yellow
- Location;
- Mastoid (Battle sign) may indicate significant brain injury.
- Bilateral peri-orbital, inner canthus, lower border of mandible
- Haematomas; a solid swelling of usually clotted blood within the tissues caused by a break in a vessel wall
- Ear; cauliflowering and any associated bleeding/CSF otorrhoea
Swelling;
- Palpate
Visible deformation
- Eg flattened malar region or zygomatic arch deformity, nasal bone deformity, frontal bone depression. Pupilary level, eye position.
Abnormal movement;
- upon extra-oral palpation
- Malocclusion
- Impared function
- Nerve injury (examine cranial nerves)
Tenderness and pain
Intra-oral;
- sublingual bruising
- Gingival lacerations
- Palatal bruising
- Mandibular deformity
- Missing/fractured teeth
- Occlusion

22
Q

What is the purpose of staging periodontal disease and what are the four stages?

A

Staging is based on severity.
Stage 1 - Early/mild. Interproximal bone loss less than 15% or 2mm
Stage 2 - Moderate. Coronal third of root involved.
Stage 3 - Severe (potential for additional tooth loss), mid third of root involved.
Stage 4 - very severe (posential for loss of dentition) Apical third of root involved

23
Q

Tx planning station with xrays, photos, models. How to approach this

A
  • Introduce yourself (name and BDS5)
  • Explain clinical findings, using props to demo
  • Radiographic report - caries, bone loss, impacted teeth, crowding etc
  • Discuss Tx including different options (RCT vs ext, comp vs amalgam etc)
  • Give perio diagnosis and explain
  • Offer smoking/alcohol advice
  • Offer OH, diet advice
  • Identify if there is toothwear and offer Tx options.
  • Make sure the pt understands
24
Q

How should a Tx plan be prioritised?

A

IMMEDIATE
- Address pain (per-coronitis, TA, perio abscess, PAP)
- INITIAL
- OHI, PGI, 6PPC, supra/sub gingival PMPR.
- Diet advice
- Any relavent referrals
- Smoking/alcohol advice
- Impacted teeth
- NCTSL - find cause. Tx - restore/splint
- Caries management
- Endo
RE-EVALUATE
- Perio 12/52
- NCTSL photos/study mods
RECONSTRUCTIVE
- dentures/bridges
MAINTENANCE

25
Q

How to systematically go through a radiographic report?

A
  • State the type of xray
  • Diagnostically acceptable/unacceptable
  • dentition;
  • teeth - erupted/unerupted/permanent/primary/missing/supernumerary/impacted/ectopic
  • restorations (heavily/minimally restored) overhangs, poor margins
  • trauma
  • Disease;
  • Caries (primary/secondary) Supra/subgingival calculus, PAP
  • Perio- bone levels, local/generalised
  • Endo - well/poorly condensed, distance from apex, separated instruments etc
  • TMJ
  • Any other pathologies
  • Give diagnosis summary
26
Q

How to approach a conversation with a patient about risks of extraction and MRONJ before starting alendrontic acid?

A
  • Introduce yourself
  • Explain alendrontic acid is a bisphosphonate drug
  • Explain action of bisphosphonate drugs; they reduce the turnover of bone. They accumulate in sites of high bone turnover such as the jaw.
  • Relevance of bisphosphonate drugs in dentistry; risk of poor wound healing following extraction. Need to remove teeth of poor prognosis before therapy. Important to do everything possible to prevent further tooth loss in future.
  • Reduced turnover of bone and reduced vascularity can lead to death of bone - osteonecrosis.
  • Specifically name MRONJ
  • Risk of MRONJ in osteoperosis is low
  • Make and explain any clinical diagnosis; perio, caries, PAP
  • Discuss Tx options and risks.
27
Q

Paes trauma. EDP#
Outline procedure to parent of an anxious child

A
  • Explain nature of injury
  • Explain Tx (pulpotomy) as this is a large exposure, Tx of choice is pulpotomy.
  • Partial removal of pulp. Explain aim is to keep undamaged tooth tissue alive. Explain this keeps the tooth alive so it continues to grow.
  • Baseline sensibility tests (shows how the injured tooth and adjacent teeth respond. Gives baseline for future monitoring.)
  • LA required (give description and why its required)
  • Describe use of dental dam. Rubber sheet to isolate and protect tooth and airways.
  • Describe use of handpiece to remove damaged pulp
  • Pulp will be dressed with setting CaOH and MTA
  • Tooth coloured filling to restore aesthetics
28
Q

Breaking bad news. Give results of biopsy confirming oral cancer.

A

SPIKES
SETTING sit down at same level as patient. Is anyone with you today? How have you been since last time?
PERCEPTION. Do you know why you’re here today? Do you know the purpose of the biopsy? Can you explain your understanding of things up until now?
INFORMATION Tell patient you have biopsy results. Ask patient if they’d like you to go over the results.
KNOWLEDGE Give a warning shot. ‘I wish I had better news. I’m afraid the results aren’t good. The test has shown that there are abnormalitits in the cells. I’m afraid the results confirm that you have mouth cancer.’ Pause and let it sink in, let paient dictate pace of conversation
EMPATHY I understand you’ll have lots of questions, does anything come to mind just now? Would you like your partner to come in?

Summaise. Repeat news, summarise plan going forward , The good news is we’ve acted quickly. Treatment will begin asap, I will speak to the surgeons and then with you to discuss treatment.’ Offer follow up appt, offer phone number and any written material

29
Q

Patient has pain from denture and sore palate. Test done confirms denture induced stomatitis affecting palate. MH includes type 2 diabetes, warfarin and atrial fibrilation. Explain findings and offer advice

A
  • Introduce self
  • Brief history, ackowledge diabetes and ask about control. Ask if dentures are worn at night. Ask about denture hygiene.
  • Explain findings - denture induced stomatitis - a yeast/fungal infection, can be a particular problem with diabetics as blood sugars can encourage growth.
  • Management - palate brushing daily. Denture cleaning advice; clean after meals and soak in CHX or NaOH 15 mins 1-2 x daily. Leave denture out overnight and as often as possible. Check denture fit - may need to be adjusted or replaced.
  • Offer smoking advice if necessary. Offer diet advice/sugar control
  • Confirm patient understands.
  • Antimicrobials? None or CHX. Nystatin 2nd line drug. Pt cannot use azole antifungals due to interaction with warfarin.
30
Q

OAF. Take a history, explain the diagnosis from images/x-rays and history. Explain management and surgical closure

A

Chronic OAF pt may complain of;
- Fluids coming out of nose
- Nasal sounding speech
- Problems playing wind instruments
- Problems using a straw
- Bad taste/odour, pus discharge
- pain/sinusitis type symptoms

  • An OAC is an acute communication of the air sinus with the oral cavity
  • In your case the communication hasn’t closed over and instead has healed forming a little skin lined communication between the air sinus and the mouth
  • This is something that should be managed as it makes you more prone to developing sinus infections

Management;
- Excise sinus tract/fistula, removing epitheliym + buccal advancement flap
- ABs (amoxicillin 500mg 7 days, 1 3 x daily. Doxycycine 100mg 7 days, 1 x daily, 2 on day 1)

Post op;
- Refrain from blowing nose/stifling sneeze
- Use steam or menthol inhalators
- Avoid straws
- Avoid smoking

31
Q

Crown critique. Cold crown fitted onto mounted casts. Assess crown and make decision to fit or remake.

A

Pre-cementation checks
- is the restoration as asked for?
- Check on cast; rocking, m/d contact points, marginal integrety, adjacent teeth (can be damaged when prepped tooth sawn off cast)
- Check for occlusal interference on excursions. Check adequate reduction
- Check occlusion with crown on cast

Remove crown from cast
Check if natural teeth occlude properly
Check if tooth is under prepped.
Measure crown thickness with calipers. Min 0.5mm circumferential, 1.5mm functional cusps/1mm non functional cusps

Management
- check amount of interference and if able to reduce crown without making it too thin then adjust and cement.
- Otherwise re-do prep and send back to lab.
- Follow crown prep principles; ideal taper 6 degrees, retentive grooves/slots, bevel functional cusps, two plane buccal reduction, smooth prep margin at gingival margin.

Avoiding fault in future;
measure temp crown thickness before cementing.
Use sectioned putty index when prepping

32
Q

Recurrent Aphthous Stomatitis - Recurrent Minor Ulcers (6 mins)
27-year old patient presents with ulcers. The patient’s ulcers are no more than 10mm in size (history provided etc). Using this information and the available lab results (Patient has low iron and folate). Discuss the lab findings, the diagnosis and management options for this condition with the patient. You do not need to gain any more information from the patient.

A
  • Build up and diagnosis. Are you aware of what you’re here to discuss? You were here a few weeks ago c/o pain/ulceration and we took bloods. Would you like me to run through results? Nothing sinister or to worry about. Results show you have a type of anaemia called microcytic anaemia caused by an iron deficiency.
    Iron deficiency anaemia is a condition where lack of iron in body leads to reduction in RBC. Iron used to produce RBC which help store and carry O2 in blood and around the body. If you have fewer than normal RBC, your organs and tissues won’t get as much O2 as normal. Many people with iron deficiency only have some symptoms; tiredness/lethargy, SoB, palpitations, pale complection, feeling cold. and in some cases oral ulceration.
  • Aetiology - lack of iron in diet, heavy periods, history of stomach ulcers.
  • Management - iron supplements, increased iron in diet. This should resolve ulceration in 1-2 weeks. GP can prescribe and may do further tests to pinpoint cause.
    Advise increase in iron through diet (dark green leafy, iron fortified cereal, pulses, beans, nuts, seeds, meat, fish, tofu, eggs, dried fruit.
    Avoid spicy food if painful. If unable to eat script for benzydamine mw 0.15%. 300ml, 15ml every 90 mins as required. no more than 7 days.
    Vit C helps absorption.
    Caffiene inhibits absorption.
    Reassure pt. Should resolve within 2 weeks with no scarring. Any Qs?
33
Q

30 yo unregistered patient c/o signs of ANUG.
Smoker and cervical lymphadenopathy. Discuss diagnosis and proposed management.

A

Diagnosis - ANUG. Presents as acute form of gum disease. Develops quicker and more severe than normal.
Aetiology - can be caused by a variety of reasons but tends to be in people with high levels of stress, smokers, poor OH, poor nutrition, immunocompromised.
Symptoms include painful, bleeding gums, painful ulcers, receeding gums in between teeth, bad breath, bad taste. Can cause systemic symptoms, swollen lymph nodes, fever.
Management; reassure pt that it can be managed by local measures; OHI NSHPT inc RSD with LA. CHX 0.2%. Smoking cessation, stress management.
Systemic involvement; metronidazole 200mg, 1 tab 3 x daily for 3 days. No alcohol.
Amoxicillin 500mg 1 tab 3 x daily for 3 days
Analgesia advice, register with GDP, review in ten days and refer if no improvement.

34
Q

Phantom head child. Place separator, remove pre placed separator, size hall crown and select correct cement

A
  • Use two pieces of floss through ortho separator
  • Pull tight and move down between contacts but not subgingival, mesial and distal of tooth
  • Leave in place for 2 - 7 days
  • Remove with blunt probe
  • Sit child upright
  • Protect airway with gauze
  • Choose crown (smallest size that will seat, use sticky stick. Should cover all cusps and approach contacts with slight springiness - dont fully seat.
  • Dry crown, fill crown with GIC
  • Dry tooth (if its caviated fill with GIC first)
  • Place crown over tooth
  • Seat fully with finger pressure
  • Pt can seat by biting gauze
  • Remove excess cement with CWR, apply pressure for 2/3 mins
  • Floss between contacts
35
Q

white patch on FoM, discuss biopsy and poss oral cancer. Discuss risk factors

A
  • Possible causes; hereditary, keratosis (smoking, trauma), lichenoid, lupus, pseudomembranous candidosis, carcinoma
  • Explain to pt there could be a number of causes. Some completely harmess but some can be more serious and possibly cancerous.
  • FoM is high risk site for oral cancer and as you have other risk factors (smoking, alcohol) it would be best to have this checked out
  • Biopsy will be taken by OM/Maxfac to send to lab, sutures.
  • Risk factors - smoking and alcohol cessation. Reduce alcohol, dont mention 14 units, wake up call to quit
36
Q

A patient with fixed appliances has returned to ask for advice on how to avoid decalcification

A
  • Decalcification will happen around the periphery of the brackets, it weakens the enamel to caries and leaves unsightly staining
  • you’re at a higher risk if you have history of caries, evidence of decal elsewhere or NCTSL
  • Give OH advice on small toothbrush head and single tufted around brackets
  • Advise on use of interdental brushes and superfloss
  • Brush 2 x daily, spit dont rinse, clean after meals, use of discloving tablets, colgate mw 250ppm F
  • Diet advice should include limiting sugar amount and frequency (less than 3 x daily)
  • Avoid snaking between meals
  • Avoid hard or chewy foods, fizzy drinks, sports drinks, chewing gum
  • Beware of hidden sugars
  • Rinse mouth after eating
  • Fluoride; duraphat 2 x daily, normal TP outwith this. Keep for yourself not other family members, particularly children. 0.619% 2800ppmF 75g
  • 1.1% 5000ppmF 51g
37
Q

Paeds trauma. Supluxation of upper As in 18 month old. Pt brough by dad. Describe knee to knee exam and explain management/consequences to dad

A
  • Introduce self
  • Reassure dad and child
  • What happened, when, loss of consciousness? other injuries? Any pain relief?
  • Knee to knee exam; explain what you’re doing. sit knee to knee, knees toughing and kept together. Ask dad to have childs legs around waist, lower child onto knees and ask dad to hold arms.

Trauma Stamp; colour, EPT, ethyl chloride, TTP, percussion note, mobility, displacement, radiograph, sinus
Subluxation signs - TTP, mobile, bleeding from gum. No displacement
Explain injury; we call this injury a subluxation, it’s an injury to the ligaments that support the teeth. This has affected the baby teeth.
There is no treatment to be done, KUO. Today we can clean the tooth and mouth with saline, CHX and gauze.
At home stick to softer diet for a week. Keep mouth clean and free of plaque to encourage healing. Brush 2 x daily with soft TB. Swab area with CHX 2 x daily for one week.

Child may have pain, swelling, discolouration, the tooth becomes more loose, delayed exfoliation, infection. KUO signs of infection, normal to have some pain following trauma.
Possible complications in permanent teeth - premature or delayed eruption. Enamel hypoplasia/hypomineralisation, crown/root dilaceration, failure to form or erupt. Odontome formation.

Follow up in 1 week and 6 weeks

38
Q

Consent process for surgical extraction of lower 8

A

Discuss Tx
* Confirm tooth to be removed under LA
* LA means you will be awake, numb lower lip, tongue. Cannot take away feeling of pressure but no pain
* A cut will be made in the gum to expose the top of the tooth, may need to remove some bone around the tooth, similar sensation to having fillings.
* The tooth itself may need to be sectioned
* Area will be cleaned with saline and some dissolving stitches placed
* Some unpleasant sounds, squelchy, cracking etc as the tooth is close to your ear
* Complications; pain, bleeding, swelling, bruising, infection, dry socket, stiff/achy jaw, damage to adjacent tooth/filling. Temporary/permanent damage to nerve. Sensory nerve so no change in appearance/function. Altered sensation or taste.
* <10% temp, <1% permanent
* Describe coronectomy if suitable
* Eat before appt. Don’t need a chaperone. Day off work sensible. Take it easy

39
Q

What are the differences between N and B sterilisers?

A

N steriliser - non-vacuum, passive air removal, unwrapped solid products, non hollow and non lumened.
B sterilisers - vacuum, active air removal, packaged instruments. Lumened, hollow or porous instruments

40
Q

What are the cycle stages and parameters for type B steriliser?

A

Stages - air removal, sterilising, drying, cooling
134-137o 2-2.3 bar for minimum holding 3 mins
water used - reverse osmosis, distilled, sterile, deionised

41
Q

What are the different steriliser tests?

A

Daily - wipe clean, change water, automatic control test, steam penetration test (Bowie Dick, Helix)
Weekly - ACT, steam penetration, vacuum leak test, automatic air detector function test
Quarterly - validation report - data collection to determine effectiveness of steriliser
Annual report carried out by insurance company for safety (pressure release valves)
Need signature to know it’s valid

42
Q

You find instruments on top of the steriliser. How do you know if they’re clean? What should you do?

A
  • Shouln’t be overlapping and hinged instruments open
  • Check if there is a reciept print out
  • Check if there is colour change on the packaged instruments (brown to pink or yellow to blue)
  • If unsure, go through the process again
43
Q

Lymph node exam - name lymph nodes examined. Suspect cancer FoM so take history and discuss

A

Preauricular, parotid, submandibular, submental, occipital, postauricular, jugulo digastric, jugulo-omohyoid, deep cervical, supraclavicular
Brief history, have you been aware of this lesion? How long for? Pain? Problems when eating or swallowing? Hoarse voice? Relevant MH. Smoke/drink? Regular attender? MW?
Discuss lesion; has a number of possible causes, some are harmless but some more sinister and as this is a high risk site and you have risk factors, I’d like to refer for biopsy.
I’ll send an urgent referral to maxfax where a biopsy will be taken and sent to a lab for testing. What to expect - LA, small amount of tissue removed and dissolving stitches. Post op advice
Offer review appt
Management of risk factors

44
Q

Pt presents with severe pericoronitis, area has been debrided/irrigated but you feel ABs required. Pt is alcoholic, write script

A

Metronidazole AB of choice, can write script but state pt is alcoholic to pharmacist.
Otherwise script for amoxicillin.
Correct pt name, address in full, CHI number.
Amoxicillin 500mg, send 9 capsules, take 3 x daily for 3 days.
Sign and date

45
Q

Pt presents with post and core crown on tooth with no endo. Lingual caries present, pt does not want Tx. Currently no pain. Discuss options.

A
  • leave KUO - risk of pain, infection, abcsess, tooth breakdown, catastrophic root #
  • Remove crown and remove caries, attempt new crown. Removes risk of post removal, doesn’t resolve problem of no endo, infection risk
  • Remove post and core, RCT and replace - risk of removing post and core (root #/core/post#), RCT involves cleaning out the tooth and filling - several appts
  • Risk of tooth being unrestorable - XLA required. Replacement options
46
Q

How to identify and manage a facial palsy following IDB

A
  • caused by injection into the parotid gland affecting facial nerve.
  • Diagnose by testing branches of facial nerve
  • Generalised weakness of the ipsilateral side of the face, inablility to close eyelid, obliteration of the nasolabial fold, drooping of the corner of the mouth, deviation of the mouth to the unaffected side.
  • Confirmed by the temporal branch being affected - if it was a stroke the pt would still be able to wrinkle their forehead
  • Manage by reassuring the patient, cover the eye with a pad until blink reflex returns.
47
Q

What are the causes and treatment options for a child with staining?

A

Causes - MIH, fluorosis, decalcification, tetracycline, trauma, dentinogenesis, ameliogenesis imperfecta
Treatment;
* microabraision - easy, effective, removal of tooth tissue and uses acid
* vital external bleaching - may not work, gingival recession, sensitivity, no effect on restorations, relapse/overbleach
* Localised composite addition - can make tooth bulky, may not mask completely
* composite/porcelain veneer - good aesthetics, tooth prep needed, wait until 18 for stable gingival level
* MCC most destructive

48
Q

What to remember during a veneer prep station

A
  • PPE
  • Seating position
  • Position chair and turn light on
  • take 2 putty index, 1 for temp, one for reduction (section this one)
  • 0.5mm prep in two planes with chamfer bur
  • reduce incisal edge 0.75-1.5mm
  • Use finishing bur to smooth prep
49
Q

Perio. Compare pre and post treatment pocket charts. Indicate where healing has occured and where it hasn’t. Reasons for failure

A
  • Missing teeth - identify causes
  • Gingival margin, from ACJ, recession
  • Probing depths - indicator of Tx difficulty
  • LOA, indicater of disease severity
  • Bleeding on probing - indication of disease activity
  • Furcation involvement, indication of Tx difficulty
  • Mobility - gives rise to symptoms, poorer prognosis

Reasons for failure;
* smoker
* Non compliant - poor oh
* Inability of pt to maintain good oh (hard to reach areas such as furcations or stand alone teeth), poor manual dexterity
* Systemic factors; stress, diabetes, pregnancy, malnutrition/poor diet
* Inadequate debridement
* overhangs/poor margins

50
Q

Dry mouth, pt is taking amitriptyline. How to establish effects and manage

A

History; how is dry mouth affecting pt? Need to sip water, need water to eat/swallow, affecting speech, causing discomfort?
What medications is pt taking. Drinking? Smoking?
MH - diabetes, epilepsy, anxiety, stroke, sjogrens?
Features; difficulty swallowing, clicking speech, discomfort, altered taste, cervical caries, halitosis, candidal infections.
Management; treat cause, address dehydration, chew gum, modify drugs, reduce caffiene, quit smoking/drinking.
Prevention advice.
Saliva substitutes
Can contact GMP

51
Q

Pt has lichen planus. Explain what it is and what causes it.

A

White patches in mouth. Can occur on skin anywhere but in some cases presents in the mouth. Most common condition seen in oral med dept. Caused by extra keratin deposits. Keratin is a protein found all around your body and in the skin, it can be stimulated by trauma to form a callous. It can be a type of allergic reaction, most commonly to medications or silver amalagm fillings.
Very small chance of developing into something more sinister. Around 1% of cases in ten years. Treated by removing obvious cause. Avoid SLS toothpaste, stop mw use, avoid bezoates.
Difflam/corticosteroids if symptomatic
KUO
Any questions

52
Q

Candidal leukoplakia advice and management.

A
  • Fungal infection of the cheek/mouth
  • potentially malignant - can progress to cancer
  • Risk factors; OH, steroid inhaler, diet, diabetes, deficiency, dry mouth, antibiotics, immunosuppresion
  • Management - refer to OM (incisional biopsy). OHI, reduce carbohydrate intake, rinse mouth after inhaler. correct deficiencies, control diabetes, stop smoking, improve denture,
  • systemic antifungal - fluconazole 50mg send 7 tablets, one to be taken daily for 7 days, then reveiw

OSCE 5th year (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions