2005-2007 Flashcards
Pt has loose dentures , process to follow to make an effective tx plan for new dentures?
-history/PC: wrong with dentures, what is the problem, when it feels loose, any other problems, what pt likes/dislikes about dentures
-DH: how long denturs, ho many sets, edentulous for how long, best pair, recurring problem, aesthetics, fixative, pt expectations,
-MH: any meds which cause dry mouth , Sjögren’s syndrome,Paget’s disease causing hyperplastic maxilla, mucous membrane diseases,
-SH, EXAM
-exam: facial symmetry, lip line, smile line, occlusion like OVD, RFH,
-I/O: check ridges atrophic, fibrous, neutral zone. Peripheral seals, overextensions like retro molar pads, frenula’s, moisture , anatomical structures, bone augmentation?,
-denture exam: assess dentures extraourallu, dentur hygien and cleaning, fractures, retention or stability, overextensions, balanced occlusion or articulation
-does pt want new denture or Copy of old one,
-explain tx plan , informed consent , risks and benefits , alternatives
Indications for inhalation sedation in children?
-mild anxiety
-needle phobia
-children
-sever gag
-mild learning difficulties
-medically Compromised
-to avoid GA if medically compromised
Contraindications for inhalation sedation in children ?
-severe anxiety,
-enlarged tonsils
-uncooperative
-fear of mask.
-MS
-anterior teeth’
-can’t breathe through nose
-recent ophthalmic surgery
-claustrophobia
-can’t consent
-no escort
-severe learning difficulties
-maxillofacial injuries
Advantages of N20 IH over IV?
- no escort, less preop instructions , less post op, quicker onset, quicker metabolism , lower half life
-not metabolised
-safe
-quick recovery
-low side effects
-non invasive
-non cardiac or respiratory depression
-reduces gag reflex
-simpler to administer
-analgesic properties
-predictable action
Disadvantages of N20 over IV?
-expensive
-space occupying equipment
-can scare pt
-Ned ventilated room
-pt must be able to breathe thru nose
-not advised if pt trying to conceive
-chronic hazard exposure
-addiction
-lack of potency
Advantages of IV
Rapid onset
Predictable action
-short recovery
-cannula
Good potency
Low incidence of side effects
Reversal agent -flumazanil
Disadvantages of IV?
Venepuncture,
Need escort, pt needs monitoring after
-no analgesic affects
-allergy
Sexual fantasy
Cardiac or respiratory depression
Why undertake a clinical audit?
Measurement performance against set criteria
Form part of clinical governance for quality assurance
Improve quality of service
Enable practices to see where improvement is needed. To monitor levels of quality against the gold standards and helps set clinical policies. Clinical audit can be used as part of CPD. Ensure patient safety e.g. radiation exposure
• Identify a problem e.g multiple grade 3 radiographs
• Find the gold standard/ follow FGDP guidelines that state 70% grade 1, 20% grade 2, 10% grade 1
• Collect data assess all practices rads and count no. of grade 3 rads
• Compare the data with gold standard
• If meeting the gold standard you would appraise and continue and review in a few months time. If not you would implement change and re-audit
How to defuse a complaint in dental practice
-dont react , be calm and constructive
-if verbal deal with it then and there or make an appt to discuss
-written record of complaint
-avoid over the phone
-speak openly with patient an reassure them ,will be in confidence
- within 24 hours if possible
-PALS written complaints procedure
Ask pt what they want
-ask indemnity
Offer gestures of goodwill
Be fair, put things right and seek improvement
Complaints procedure in waiting room
Ottawa charter?
The first international conference on health promotion organized by WHO was held in ottawa 1986
They produced this agreement called Ottawa charter, which outlined five action areas for health rmotion:
1. Creating supportive environments e.g water fluoridation, smoking ban
2. Healthy public policies e.g tax on smoking
3. Strengthening community action e.g. support groups, mums against sweets
4. Developing personal skills e.g education, school programs
5. Reorienting health services e.g. towards prevention e.g new contract
Indications for undertaking surgical apicetomy of a tooth?
-better visualisation if u are struggling to access
-corrective procedure like root perforation repair
-enucleation of radicular cysts
-persistent periradicular lesion despite good RCT
-to avoid removing post retained restoration
-failures of previous endo surgery
-biopsy
-non surgical RCT is not feasible
Causes of gingival recession?
Lack of bone, thin cortical plate, occlusal trauma, long standing perio, deep overbite, fresnel pull , abrasion, perio, gingivitis, parafunction like nail biting bruxism, toothbrushing
Problems like sensitive, aesthetics, mobile, plaque, root caries,
10 year old has localised brown enamel opacity on permanent central incisor?
Treatment should always start with the least invasive.
1. Discuss with child exactly what they don’t like and which marks concern them
2. Clinical photographs (taken pre and post op)
3. Techniques depend on aetiology as some defect are resistant to treatments but:
a. Micro abrasion (uses an acid & mechanical removal of superficial enamel stains – 50 – 250um) safe, effective, conservative, simple, economical
b. Tooth whitening (bleaching) – 15% carbamide peroxide used nightly in custom made trays for 2 weeks – degrades to 5% hydrogen peroxide. Possibility of sensitivity
c. ICON - seals the enamel prisms. If you do this, can’t do tooth whitening after.
d. Direct composite – can use strip crowns and opaquers
e. Indirect composite veneer
f. Porcelain veneers over 18
g. Review at each stage
9 year old has opacities on central incisors, what would you ask to determine cause?
-any other teeth,
-family history so AI, MIH
-prenatal so mum has like vit d def, pyrexia, diabetes, vomiting
-perinatal so twins,complications at birth, c section, premature
-post nata, ent infections, respiratory problems, seizures, uti, antibiotics,
-MH so epidermolysis bullosa
-fluoride intake so water, supplemts, tooothpaste, swallowing habits
-trauma as a child,
Tetracycline antibiotics,
-teeth extracted,
-dental decays
-orthodontics tx
-loss of vitality. Trauma or infection
Why are dentists important in primary dental services?
Teamwork is important in dentistry and every team works best when the team members have a clearly defined and understood role. A DCP (dental care professional) provides care for patients as a member of the team and is usually directed by a dentist
DCP - Dentists, Dental Nurses, Dental Technician, Clinical dental technician Hygienists, H&Ts, Orthodontic Therapist, Clinical
GDC Standard - Work with colleagues in a way that is in the patient’s best interest (teamwork)
They all have a key role to provide quality, safe and effective treatment which is in the best interest of the patient.
Could talk about Scope of practice.
Increase use of DCPs is influenced by:
• A workforce shortage: many dentists are going into private work and it is cheaper to train DCPs
• Nuffield report: highlighted the use of DCPs in improving efficiency
• Political: 2001 PM pledged everyone who needed NHS dentistry could get it – DCPs needed to achieve this
• Older people are keeping their teeth longer but they tend to be heavily restored – DCPs can do a lot of this work
• Direct Access - Gives H&T’s the ability to complete treatment without prescription of the dentist and without having to see a dentist first.
• Skill Mix - If they can delegate more simpler tasks, they can concentrate more on the more complicated treatment
Benefits:
● Delivery of a more responsive and patient centred service
● More cost effective
● More satisfying roles & career paths for primary health care workers – dentists as well
● Give dentists the ability to specialise
● Less stress for dentists
● More money
● Planning and efficiency
● Avoids working in isolation
● Develops a more comprehensive healthcare plan which benefits individual patients and communities
