2020 paper Flashcards
A patient presents with a 7 mm pocket that is discharging pus, on the mid-buccal aspect of tooth 26. The tooth is non-vital and there is very little pathological periodontal pocketing elsewhere in the patient’s mouth.
What is the diagnosis
Give TWO anatomical factors that may be responsible for the location of the
discharging pocket?
What treatment would you perform?
- Lesion of endodontic origin with perio involvement
- Furcation, accessory canals
- Root canal treatment, observe, RSD for residual pocket if required following 3months after RCT
- A 35-year-old patient presents complaining of mobility of tooth 34, which he feels is becoming worse. On examination, tooth 34 demonstrates Grade II mobility. There is no attachment loss but there is evidence of moderate toothwear affecting a number of teeth, likely attributable to attrition. Radiographic examination reveals generalised widening of the periodontal ligament space of tooth 34 and the tooth responds positively to sensibility testing
Diagnosis
How you would manage this patient
- Occlusal trauma
- Occulsal analysis with the use of Millers forceps and thin articulating paper
Occulsal adjustment to remove any interference on 34
Preventitive management of parafunction/tooth wear
- A 60-year-old patient presents complaining of generalised bleeding gums. There are CPITN scores of 4 in each sextant, with 78% sites showing bleeding on probing. A panoramic radiograph shows generalised horizontal bone loss, with 50% alveolar bone loss at the worst sites. The medical history is clear and the dentition is only lightly restored.
Diagnosis
Stage and Grade
What is the single most important factor to determine from the social history
What further investigations would you carry out
- Generalised perio
- Stage 3, Grade B
- Smoking
- Plq index, full mouth pocket chart
- A patient presents complaining of a constant throbbing pain from the right side of her mandible. This has kept her awake at night. On examination, you establish that tooth 46 is grossly carious and is tender to percussion.
Diagnosis
Further investigations
Best treatment options for relief of patients pain
- Periapical periodontitis
- Sensibility testing
PA or sectional panoramic radiograph - Pulpectomy then RCT
XLA of 46
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Number of canals found in upper first premolar
2
Where is considered the ideal end point of shaping/obturation in endo?
The apical constriction, cemento-dentinal junction
What is the term for mainintiang communication between the pulpal space and peri-radicular tissues
Patency
What is working length in endo
The extent from the apical terminus of the preparation and a predifined cornoal reference point
What 2 common intra-operative radiographs can be utilised during endo to aid working length determination
Corrected working length
Master cone radiograph
State 2 potential causes of a corrected working length chaning during the course of endo shaping?
Ledges
Transporation
Zipping
Perforation
Which systemic antibiotic is most apporpriate for ANUG
Metronidazole
What is the dose, frequency and total duration of adminstration for ANUG
Metronidazole - 400mg, 3 day for 3-5days
What 3 specific warnings should be given for the antibiotic for ANUG
Avoid alcohol
Do not take if pregnant
Stop taking antibiotic if any adverse reactions and seek medical advice
Increased risk of oral candidosis
What follow up care would you give for a patient with ANUG
Review in 1/2 weeks, HPT, Smoking cessation advice
Give a definition of dependence
A compulsive physiological and psychological need for habit forming substance
There are various evidence based treatments that can be used to help support patients who want to quit smoking.
give 2 examples
Nictonine patches, gum, onhalers
E cigs
Champix
Patient decides he does not want to quit just now, what should you do?
Outline the adivce you gave the patient in the patient’s records so its clear you addressed the topic
Make a note to bring it up at some point in the future to see if he has changed his mind
An 8-year-old boy in the mixed dentition attends your surgery complaining that he does not like the look of his front teeth (see photograph above). The deciduous tooth upper incisor became black and firm 3 years ago and fell out recently. He has no relevant medical history.
- What feature of the patients dental history is it important to determine
- What part of the physical examination is important
- What radiographic view would be most suitable for this child
- Given the history, give an account of thr sequence of events that have most likely caused non eruption of upper central incisor
- Give 1 other possible cause of non-eruption of the upper central incisor in this case
- What are the principles of ortho management of non eruption of upper central incisors
- a history of trauma
- palptation of the labial sulcus
- PA
- Trauma to decidous incisor, leading to dilaceration of permanent successor
- Unerupted supernumrary tooth preventing eruption, cogential absence
- Removal of obstruction, create space and observe, if non eruption, expose and place gold chain, ortho traction
Which external refernece plane of the patient should you position horizontal when setting up for a panoramic radiograph?
Frankfort plane
Postioning error for the incisor teeth being horizontally magnified?
Patient toot far back in the machine or too far away from cassette
Positioning error for the posterior teeth on one side being wider than on the other?
Patient is rotated in the machine
or
Patient not being symmetrically between incisors on bite peg
Panoramic for a pre extraction radiograph for PE 48 when there is no evidence of 38 in the mouth
Right half panoramic radiograph
Panoramic for a child patient with caries who cannto tolerate BW’s?
Orthogonal projection
Maxiallary sinus is found on a panoramic. Which margin walls are seens in:
- Horizontally above the roots of the premoalrs and molars
- Vertically above the 3rd molar region
- Inferior or floor
2. Posterior or distal
A 4-year-old child is brought to your surgery complaining of severe pain and sleep loss for the last six weeks. The child is a new patient to your practice. On extraoral examination you notice that the child has bruising on their right cheek and a small abrasion on their right temple (see photograph above).
- What might you be concerned about as a result of seeing this child?
(1 mark) - Which TWO parts of this presentation led you to have concerns regarding this?
(2 marks) - Suggest TWO questions which you would ask next to further investigate your concerns? (2 marks)
- You decide that some aspect of the response to these questions warrants further action. Who should you discuss this with?
(1 mark) - As a result of this onward discussion what THREE different courses of action may take place?
(3 marks) - You establish the only concern is regarding dental caries. After ensuring the painful tooth is treated you tell the parent that the child has a number of other carious teeth requiring attention and make two appointments for them to come back. The parent fails to bring the child back for either of these appointments. What should you do next?
- The child may be a victim of abuse or neglect
- Late presentation of severe pain/ sleep loss for 6 weeks
Multiple injuries on different parts of the face - how did the child sustain the injuries?
Has the child had previous injuries seen by someone else?
Why was the child not brought along to the surgery earlier? - Child protection advisor
- Further inestigations undertaken and the child portection advisor gets back to you
The child is referred directly to the lead paeds
The child protection advisor asks you to refer directly to social services - Multiagency response - inform health visitor
A 9-year-old poorly co-operative child attends your surgery with gross caries evident clinically in teeth 16, 36 and 46. The prognosis of these teeth is poor and they require extraction. All other teeth are caries free.
- What special investigation would be appropriate for this patient?
- What information are you ideally looking for to establish the suitability of the timing of these extractions?
- Detail your management of tooth 26
- List TWO advantages of extraction of first permanent molars of poor prognosis at this stage of development?
- List TWO disadvantages of extraction of first permanent molars of poor prognosis at this stage of development?
- What might this child require to enable these extractions?
- OPT
- Bifurcation of thr lower 7’s just formed
- XLA
- Sponatnuous space closure
Render child caries free
Reduction of future ortho needs - No molars for eating/spacing
Risk of GA
Bad experience
Removal of a carious free tooth - Sedation - inhalation sedation
GA
What types of drug is warfarin and what is its mechanism of action?
Anticougulant
Vit K anatagonist
Which test must be carried out prior to XLA
INR
Which guidance doc would you refer to for advice on dealing with patients on Warfarin and within what timeframe should this test be carried out prior to XLA
SDCEP and ideally within 24hrs
Below what level would it be safe to continue with XLA
<4
Outline options that you would carry out clincially to deal with post op bleeding
If following clinical interventions to stop post op bleeding does not work what would you do?
Prolonged pressure with damp gauze, Suture, LA with adrenaline, Haemostatic agent (surgicel), Tranxamic acid
Urgently refer to local Oral surgery
Name 2 adjustments that will allow a person in a wheelchair access to a above ground level dental practice
Lift
Ramp
2 revelant acts of law for impairment and disability
The disability discrimination act
The equality Act 2010
Give 2 augementative and alternative communication methods which could be used for someone with cerbral palsy
Eye tracking technology
Communication boards
Physical cues
2 options to allow for the improved positioning of someone who is unable to weight bear for a dental exam
Transfer to dental chair by hoist
Wheelchair tipper
Patient has reclining wheelchair
What particular aspect related to cerebral palsy may affect the dentist’s access to the mouth
Uncontrollable muscle spasm
What non- pharmacological adjuncts are available to ovecome and aid dentist’s access to mouth?
Bedi mouth
Toothbrush
Rubber spatual or bite stick
Give 2 medical aspects of Down syndrome which may have resulted in his lack of capactiy
Demtentia
Learning disability
Give 2 features associated with down syndrome that are likley to contribute to his perio disease
Ability to self care - Oh and calc Impaired oral function Altered tooth morophology Systemic immundeficiency Impaired migration of gingival fibroblasts
Antibiotic prophylaxis - What antibiotic and dose
Amoxicillin 3g dose
When should you provide antibiotic prophylaxis and obersve the person taking them?
A single dose 30-60mins before procedure
4 risk factors of mouth cancer
Smoking tobacco Chewing tobacco Alcohol Immunosuppression Diet low in fruit and veg
2 additional pieces of info do you require to know about radiotherapy treatment the person recieved?
Dose
Field
2 additional pieces of info do you require to know about radiotherapy treatment the person recieved?
What does of radiotherapy delivered to the primary tumour increases the risk of osteoradionecrosis
50-60 gray
Describe the pattern of decay evidenced which is unique to radiation caries
Cervical margins
Describe the pattern of decay evidenced which is unique to radiation caries
List 2 oral complications associted with radiation therapy other than osteoradionecrosis and radiation caries
Trismus Dry mouth Increased risk of oral infections Skin burns Radiation muscositis
List 2 preventitive measures thart should be implented to reduce risk of futre dental disease for patients who have recieved radiotherapy
Increased fluoride toothpaste - 2800ppm - 5000ppm
Tooth mousse
Fluoride trays
Prescribe oral saliva substitues
One mangement strategy for established osteoradionecorsis of head and neck
Surgical debridment
Hyperbaric oxygen therapy
3 examples of PPE and what each item is protecting you from
Gown - splashing
Marigold gloves - sharps
Full face visor - aerosols
What 2 methods are used for manual cleaning of instruments.
Give an example of an instrument cleaned in this way
Immersion - any solid instrument
Non immersion - hanpieces or insturment with lumen
How often should a Ultrasonic cleaner be degassed
Everytime it is filled from empty
What is remvoed by degassing an ultrasonic?
Air/oxygen
Why is it important to degass an ultrasonic?
Air/oxygen will prevent ultraosonic bubbles from reaching all the surface of the instruments
Why should dental handpieces not be placed in an ultrasonic cleaner
They may be damaged by the ultrasonic
Why is it important to use de-mineralised water in the steriliser?
To perevent the deposit of minerals on the machine and instruments
What term is used to describe the collective group of microgranisms within the oral cavity and what are they referrred to when attached to a surface
Microbime, biofilm (plq)
List 4 key microbial stages of caries plq formation
Adhesion
Colonisation
Maturation
Acid production
2 key virulence factors caused by strep. mutans that influecne enamel dissolution
Glucans
ATPase
Name the bacterium associated with secondary endo infection and name one of its key virulence factors
Enteroccus Faecalis
Adhesins, collagenase
Why is it difficult to determine causality from a specific bacteria in endo infection
Sterile sampling procedures, active bacteria
Which antimicrobial is used to disinfect root canal?
Sodium hypochlorite
What culture independent technique could be used to assess changes in the oral microbial populations following antibiotic exposure
What is the limitation of this approach?
Next generation sequencing
