2023 Flashcards
1
Q
How to replace space?
A
- Implant
- RPD
- Resin bonded bridge
2
Q
What are the non periodontal challenges in replacing a space?
A
- width of edentulous area
- Restorative status of adjacent teeth
- Smile line
3
Q
2 advantages of an implant?
A
- Restore function
- Restore aesthetics and improve patient confidence
4
Q
2 disadavantages of implants?
A
- cost - expensive
- Require a surgical procedure
- Long healing time (3-6 months)
5
Q
What is the name of this seating position?
A
Neutral or balance seat position
6
Q
Describe operator seat position (4)
A
- 90 degree angles at the hip and knee
- Thighs parallel to the floor
- Feet on the floor with back and neck upright
- Relaxed shoulder
7
Q
Describe nurses position? (4)
A
- Straight back with relaxed shoulder
- Thighs parallel to the floor
- Hip parallel with patient shoulder
- Feet supported by chair ring to provide stability
8
Q
What is the nurse position relative to the dentist position?
A
nurse 2-4 inches higher than dentist
9
Q
What are the two types of aspiration?
A
Direct and indirect
10
Q
What is direct aspiration?
A
- adjacent to the tooth being treated
- Slightly distal to the tooth
11
Q
What is indirect aspiration?
A
- lower left quadrant for right handed
- Side closest to you in the anterior region
12
Q
How to avoid soft tissue damage during a procedure?
A
By retracting soft tissues
13
Q
3 ways a dental nurse can retract soft tissues?
A
- 3 in 1 syringe to retract lips with Aspirator retract the cheek
- Cheek retractor
- Tongue depressor
- 3 in 1 syringe (lips) with dental mirror (cheek)
14
Q
What can be the agents of bias in RCTs?
A
- Reporting bias
- Selection bias
- Attrition bias
- Performance bias
- Publication bias
15
Q
What will a patient with burning mouth syndrome complain of ? (4)
A
- dysgeusia - foul, salty or metallic taste
- dry mouth
- burning sensation in the mouth
- Paraesthesia - tingling
16
Q
What psychological disorder is associated with burning mouth syndrome?
A
Anxiety or Stress
17
Q
What other tests to carry out for burning mouth syndrome other than haematinics?
A
- Thyroid function test
- Full blood count
18
Q
What organism is involved in chronic hyperplastic candiasis ?
A
- Candida albicans
- Hyphae form
19
Q
What other 2 conditions are associated with candida albicans?
A
- Denture stomatitis
- Oral candidiasis
- Angular cheilitis
20
Q
What 2 special investigations can be carried out for oral candidiasis?
A
- Oral swab or oral rinse for microbiological culture testing
- Biopsy for histopathological analysis
21
Q
What staining is involved in histology?
A
- H&E (Haematoxylin and Eosin)
- Periodic acid-schiff staining
22
Q
What is the most common drug prescribed in oral medicine and what class of drug is it?
A
Chlorhexidine - bisbiguanide antiseptic
23
Q
What is the typical symptom of trigeminal neuralgia?
A
Unilateral Stabbing pain in the face
24
Q
4 reasons why trigeminal neuralgia may have occured ?
A
- Vascular compression of the trigeminal nerve
- Intracranial lesions
- Multiple sclerosis
- arteriovenous malformation
25
Patient feels pain in the morning after washing face, why does this occur and give 2 changes to regime?
* Washing the face with cold water in the morning can trigger an a pain attack in trigeminal neuralgia patient
* Use warm water instead of cold
* Increase the night dose of carmazepine
26
What two other medications than carbamazepine can treat trigeminal neuralgia?
* Oxcarbazepine
* Lamotrigine (slow onset of action)
Antiepileptics
27
Why does patient need blood tests for cabamezapine?
* Due to the side effects of carbamazepine such as thrombocytopenia and liver toxicity
* It is best to make sure patient fit and healthy during treatment
28
What would you do if a patient gets an attack of trigeminal neuralgia in the dental chair?
Administer local anaesthesia
29
Define erosion?
The loss of the tooth substance due to a chemical process
30
Define attrition?
Physiological wearing away of tooth structure as a result of tooth to tooth contact
31
Describe the DAHL technique?
* It is a method of gaining space for anterior localised toothwear by placing an anterior bite plane (CoCr) that leads anteriors to intrude and posteriors to erupt into occlusion allowing space for anterior restoration
* This increases the OVD 2-3 mm
* within 3-6 months
32
5 ways a cusp may fracture in a tooth with an amalgam restoration?
* Bruxism
* Previous RCT
* Occlusal trauma
* Weakened tooth structure
* Trauma
33
What indirect restoration would you place for a failed amalgam restoration ? and what material?
Onlay , composite
34
You want to place an Onlay and you do not have putty or study casts , how do you temporarily restore the tooth?
* a direct temporary restoration using glass ionomer
35
What are 5 risk factors of OAC?
* Previous OAC
* Older patient
* Extraction of Maxillary molars/pre-molars
* Large bulbous roots
* Roots of tooth close to maxillary sinus
36
Give 6 clinical signs of OAC during an extarction?
* Dark hole when visualising socket
* Bubbling of socket
* Change in suction sound
* Fluid comes out from nose
* non healing socket
* Bone removed at trifurcation when XLA
37
4 things to tell patient not to do after confirming an OAC?
* Do not Sneeze with mouth closed
* Do not blow nose
* Avoid drinking from a straw
* Avoid flying or diving
38
5 ways to identify a patient anxiety?
* Ask patient about previous dental experiences
* Use MDAS (Modified dental anxiety scale)
* Look at non verbal cues such as shaking, disconnected or nervous
* Look at physiological signs such as dry mouth, altered tone voice
* Low pain tolerance (stomatisation)
39
Give 4 non pharmacological management options for anxiety?
* CBT
* Desensitisation
* Relaxation techniques - breathing
* Make patient take control - raise finger if you want treatment to stop
40
3 pharmacological ways to treat a patient anxiety?
* Midazolam
* Nitrous oxide gas
* Beta blockers
41
Give the doses and routes of administration of Midazolam, Nitrous oxide , Beta blockers ?
* Midazolam - 5mg/ml - intravenous
* Nitrous oxide 5-6 L with oxygen through nose (nasal)
* Beta blockers - oral , 10mg
42
How can you order extractions for full mouth clearance?
* Start with simple extractions then complicated extractions
* Start from maxillary arch
43
When to review a patient after an immediate denture?
24-48 hours
44
2 things to tell a patient after delivering an immediate denture?
* they may come loose over time due to bone resorption after extractions and another denture is going to be made
* It may be uncomfortable and painful but this will go away once healing has occurred
45
What can a functional appliance do that a URA can't?
* Complex tooth movements
* Control the root of the tooth
46
What is TAD?
Temporary anchorage device using non osseointegrating mini screws in cortical bone to achieve absolute anchorage
47
Why is TAD better?
* It have good anchorage control as the force is transmitted into cortical bone instead of using other teeth for anchorage
48
Give 4 risks of receiving orthodontic treatment?
* Relapse
* Gingival recession
* Decalcification
* Root resorption
49
What features of a malocclusion can lead to marginal gingivitis?
* Increased overjet
* Deep overbite
50
What is facebow used for?
* Transfer the relationship between the maxilla and terminal hinge axis of rotation of the mandible into an articulator
* This reproduces the patient mandibular movements on an articulator
* Can be used in severe toothwear cases or when constructing several posterior indirect restorations that may change the occlusion
51
4 methods/materials used to take registration in ICP?
* No material - ICP obvious to technician
* Wax - ICP not obvious
* Registration paste - ICP not obvious
* Records blocks - Free end saddles
52
Give 2 types of articulators used ?
* Arcon
* Average value
* Semi-adjustable
53
Grossly carious canine , what space can infection travel to ?
* if upper - infraorbital space
* If lower - submental
54
What 4 things that can affect a dental infection route of travel?
* Anatomic site of initial infection
* Nearby anatomical spaces
* Thickness of nearby muscles and facia attachments
* Thickness of cortical bone
55
What is your immediate management if you suspect infection spread?
Refer the patient urgently to secondary care
56
What system is used for periodontal risk?
Through the periodontal risk assessment tool
57
Why is the periodontal risk assessment used?
* Determine further progression of periodontal disease
* Determines subsequent tooth loss
58
Give 4 things for successful posterior restorations? (4)
* Good marginal seal
* Can withstand occlusal forces
* Correct material choice
* Good retention and resistance
59
Label the apical parts of the root
60
Describe using the landmarks provided how you would prepare and obturate
* Create a continuously tapering funnel shape of the root canal
* Maintain apical foramen in original position
* Keep apical constriction as small as possible
61
What are two ways to measure working length without apex locator? (2)
* Tactile sensation using a handfile
* Using a radiograph of the tooth taken with a handfile in the canal according to estimated working length from pre-operative radiograph
62
What 2 ways an apex locator reading might be affected?
* Moisture or inflammatory exuadate - gives a shorter working length
* The size of the apical foramen - shorter working length
* The type of file used - more accurate reading when file touches all the root canal walls
63
Class III BSI definition?
* The lower incisors lie anterior to the cingulum plateau of the upper incisors
* The overjet is reduces or reversed
64
What is the treatment options for Class III? (4)
* Intercept early with URA if anterior crossbite present
* Growth modification - chin up, reverse twin block, frankel III , headgear with rapid maxillary expansion
* Camouflage - fixed appliances
* Orthognathic and orthodontic treatment - in cases where growth is completed
65
What 3 dental issues associated with Class 3 malocclusion?
* Anterior or buccal crossbites
* Reduced overbite
* Anterior open bite
* Tendency to reverse overjet
66
What 3 difficulties are associated with using fixed appliances in Class III adults?
* lack of growth - mid-palatal suture is closed so cannot achieve maxillary expansion with appliances alone
* Periodontal disease - loss of support leads to less anchorage value , tooth centre of rotation moves apically
* Decreased cell turnover - initial movement becomes slower , use light forces
67
What is the most likely cause for lower retroclined incisors?
Sucking habits ( lips, finger, thumb)
68
How can you measure freeway space? (3)
* Using willis bite gauge or dividers
* Measure the RVD and the OVD
* The freeway space is the difference between RVD and OVD and is usually 2-4mm
69
What instrument do you usually use to help adjustment of record blocks
Fox's bite plane to check occlusion and adjust blocks accordingly using hot wax plate
70
What are 4 things that may cause stress in dentistry?
* Feeling of a personal or professional inadequacy
* Frustration at work
* Low self esteem
* Overwork
71
What 3 ways to reduce or minimise exposures to risks that are diminishable?
* Exercising
* Maintaining a good work life balance
* Better regulation and governance
72
3 ways to reduce risks that are unavoidable and continue to persist as a problem?
* Reaching out for support
* Maintain mental and physical fitness
* Being aware of the situation and thinking about it rationally
| AKA resilience
73
How can you consent for an extraction? (7)
* Let the patient be aware of the procedure being carried out ; XLA
* Risks
* Benefits
* Cost
* Other treatment options : restorations , RCT
* Expected outcome
* Signs the consent form
74
Patient getting a routine XLA , the XLA goes wrong and she requires a surgical XLA , How to tell how about what they will do in Oral surgery? (4)
* The procedure is going to be under local anaesthesia which means you will be numb
* The Surgeon is going to open your gum to access they area and remove/section your tooth to get it out using instruments
* Bone may be removed if reqiured but you will not feel any pain you might feel some pressure or cracking sound
* Then the surgeon is going to place sutures to close the gums at the area of the tooth
75
2 management options for 38 with pericoronitis?
* Irrigation with saline or chlorhexidine under operculum
* Incision of abscess if present and drain
76
3 Signs of close proximity to IAN of a 38?
* Shadowing of roots as it crosses the canal
* Diversion of the canal
* interruption of white lines in the canal
77
Give 6 warnings to give pt before doing surgical extraction of 38?
* risk of prologned bleeding
* Dry socket
* tingling sensation
* temporary or permanent sensation loss
* damage to nearby structures
* alveolar bone fracture
78
2 nerves likely to be as risk when carrying out a coronectomy?
* Lingual nerve
* Inferior alveolar canal
79
How does bisphosphonate work? and what can they cause?
* They work by slowing down bone turnover through inhibiting osteoclasts risking necrosis of bone at the extraction site (unhealing socket) which is a condition called MRONJ
80
What is the target INR for a patient taking Warfarin?
* 2.5-3.5
81
What INR is required for safe management of a patient taking warfarin?
* INR below 4
82
How would you manage a patient taking apixaban?
* low risk procedures treat without interrupting medication
* For high risk procedures miss morning dose
* Treat early in the morning
* Limit initial treatment area
* Use atruamtic technique
* Stage complex treatment
* Consider suturing and packing
83
Give 3 sociodemographic determinants for oral cancer and which group is most at risk?
* Gender - males
* Age - Older
* Socioeconomic status - low socioeconomic status
84
What are 4 behavioural risk factors for Oral cancer?
* Tobacco smoking or chewing
* Betel quid chewing
* Exposure to UV light
* Alcohol consumption
* Poor nutrition
85
What emerging factor to differentiate between OSCC and OPSCC?
OPSCC is have a stronger association with HPV with an over-expression of p16 in p16 positive OPSCC
86
What are 3 clinical or laboratory findings found in vesiculobullous disease?
* Nikolsky's Sign
* Basket weave or linear pattern of Direct immunofluorescence of IgG and C3 deposits
* Acantholysis on histological examination
87
What 2 further investigations would you carry out for vesiculobullous disease?
* Biopsy for histopathological analysis and Direct immunoflueresence test
* Blood sample for indirect immunofluorescence test
88
Give differential diagnosis for a blister other than mucous pemphigoid?
* Lichen planus
* Pemphigus Vulgaris
* Erythema multiform
89
Example of immunosuppressant used to treat blistering disease?
* Prednisolone
90
What other mucous membranes does MMP affect?
* Eyes
* Genitals
91
8 questions to ask a mom when presenting with ulcers in child?
* When did it start ?
* How often do this occurs?
* How many ulcers?
* What size?
* Where ?
* Is there anything that makes it worse?(food/drink)
* Is there any other sites affected?
* Any associated symptoms?
92
How do you explain HSV infection to mom?
* This is caused by a virus called primary simplex
* It occurs during childhood and is transmitted through droplets
* It can happen later in a milder form as a cold sore which is the secondary infection of this virus
* Approximately all adults have this virus and can transimt it to children who were never infected by it
93
What advice to give mom regarding HSV infection? 4
* Adequate bed rest
* Rehydration and hydration
* can use paracetamol to reduce symptoms
* Use of antimicrobial gel
94
If HSV recurs in 14 days , what do you think it is and what treatment do you provide?
* Herpes labialis
* Aciclovir cream
95
What are 3 histological features of lichen planus?
* Thick band of lymphocytes under epidermis
* Civatte bodies
* Orthokeratosis
96
What factors contributing to lichen planus that may indicate malignancy ?
* Smoker
* Symptomatic lesion
97
What 2 medicines to use for lichen planus (prescription only?
* Beclomethasone inhaler
* Betamethasone rinse
98
What do you ask to diagnose MIH? 7
* General health of mother during 3rd trimester of pregnancy
* If there was any trauma during birth or pre-term birth?
* If the child had any infections in childhood (rubella, measles, chicken pox)
* if child took any medications during first 2 years
* Socioeconomic status
* How long did they child breast feed (dioxins)
99
Main symptom of MIH?
Aesthetic concerns
100
When do you extract 6s?
* Presence of formation of bifurcation of the 7
* Evidence of calcification of the 8
101
Methods of prevention for MIH/asthma patients
* High fluoride toothpaste
* OHI at every visit with toothbrushing demonstration Fluoride mouthwash if age appropriate
* Colophony-free FV x4 yearly if not hospitalised for asthma
* Fissure sealants
102
What dental complications are there with children who have asthma ?
* increased risk of erosion due to steroid inhaler
* xerostomia from inhaler use
* increased caries risk secondary to xerostomia
* Many triggers for asthma in the dental environment such as anxiety, prolonged supine position and aerosols
* Allergy to FV containing colophony
103
What advice would you give regarding inhaler use?
* Use of spacer - to maximise the benefit
* Rinse mouth or toothbrush after steroid inhaler use
104
What alloy is used for metal in bridges?
CoCr , NiCr
105
What is the minimum thickness of metal in RRB?
0.7 mm
106
What are the advantages of modified lap pontic bridge?
* Good aesthetics on the buccal aspect
* Easier to clean on the lingual side
107
Two alternative bridge designs on 12 , 13 as abutement other than resin bonded bridge?
* Fixed-Fixed adhesive
* Spring cantilever design
108
What is oxyguard gel?
An oxygen inhibitor placed around cement margins for 3 minutes to ensure optimal setting ( complete polymerization)
109
What to check in sedation assessment appointment?
* Heart rate
* Blood pressure
* Oxygen saturation
* Weight and height for BMI
* Signs of anxiety
* Full history = social , medical , dental
* ASA classification
110
What should you tell the patient on the day of sedation? (8)
* Re-confirm consent
* Ask about any changes in medical history
* Ask about alcohol consumption in the last 24 hours
* Ask about recreational drugs in the last 48 hours
* When did they last eat
* How are they getting home after treatment and with who
* About pregnancy
* Explain procedure and answer any questions the patient have
111
What are the medicines used in IV sedation?
** Benzodiazepines **
* Midazolam
* Propofol
* Diazepam
* multiple agent
112
What are the signs and symptoms of Sepsis? (8)
* Uncontrolled shivering
* not passing as much urine as normal
* Cold/blotchy hand and feet
* high or low body temprature
* Lymphadenopathy
* Rapid heartbeat
* Light headedness due to low blood pressure
* Clammy and sweaty skin
* Confusion
113
Prescribe antibiotic for sepsis?
Pen V 250mg for 5 days
Send : 40 tablets
Label : 2 tablets, 4 times daily
114
Histology of fibrous epulis? 3
* Ulceration
* Granulation tissue
* Metaplastic bone formation
115
How can you manage fibrous epulis?
* Remove source of irritation - remove overhangs
* Excisional biopsy and coe pack dressing
116
What tests to carry out for Sjogren's syndrome?
* Salivary ultra sound scan
* Anti-ro antibody test
* Schrimer's test
* Unstimulated whole salivary flow test
* Baseline MRI - for future comparison
* Fluorescein tear film assessment
If still not sure
* Labial gland biopsy for histological examination
117
What are the signs and symptoms of Sjogren's disease?
* Recurrent salivary gland swellings
* Recurrent sand sensation in the eyes
* Dry eyes
* Daily feeling of dry mouth for more than 3 months
118
What happens to lymph nodes in Sjogren's syndrome?and what test to do?
* Lymphadenopathy and increased risk of lymphoma due to chronic stimulation and proliferation of B-cells
* Labial gland biopsy for histological examination
* Usually present with unilateral gland swelling in lymphoma patients
119
What is domestic abuse?
Any form of physical, psychological, financial, verbal or sexual abuse that takes place within the context of a relationship
120
Which act is relevant to domestic abuse?
Adult support and protection act 2007
The domestic abuse act 2018
121
How to support if you suspect domestic abuse in your clinic?
* Ask about the abuse
* Validate patient feeling
* Document in details in notes and take photos where possible
* Refer - signpost to appropriate services such as the Scottish domestic abuse helpline
| A V D R
122
What questions would you ask a patient if you suspect abuse? (3)
* Is everything okay?
* Do you feel safe?
* Has someone hurt you?
123
What are the types of domestic abuse? (5)
* Physical
* Verbal
* Financial
* Psychological
* Sexual
124
What other types of abuse other than domestic? (5)
* Bullying
* Trafficking
* Sexual Assaults
* Child Abuse
* Elder Abuse
125
What guidance would you refer to for domestic abuse?
NICE domestic abuse guidance
126
What is child-smile universal approach?
Ensure all children benefit from childsmile programme
127
Give 2 examples of childsmile universal components?
* Supervised toothbrushing for all children in nurseries
* Preventive dental primary care contract
128
What is the proportionate (targeted) approach of childsmile?
That interventions should be proportionate to the level of need
129
Give 2 examples of childsmile targeted approach?
* Supervised toothbrushing in P1 and P2 in schools
* Fluoride varnish application twice a year in nurseries and schools in disadvantaged areas twice a year
* Community oral health support for families in disadvantaged circumstances
130
Give 2 examples of downstream upstream and mid stream interventions by childsmile?
**Upstream -**
* Contribute to healthy eating in Schools regulations
* Support sugar and obesity policy
**Mid stream -**
* Preventive dental primary care contract
* Oral health support for families in disadvantaged circumstancer
**Low stream -**
* chairside dental health education
* Chairside prevention (FV)
131
What components to look for to assess caries risk? 7
* Fluoride use
* Saliva
* Clinical evidence of previous caries - most indicator
* Social history - socioeconomic status
* Medical history
* Plaque control
* Dietary habits
132
What is biological caries management?
A non restorative way to manage caries through reducing the cariogenic potential of the lesion by altering the environment of the plaque biofilm overlying the carious lesion through brushing, dietary advice and high fluoride application
133
Give 3 examples of biological caries management
* Application of flouride varish 4 times a year , dietary management and tooth brushing demonstration of carious lesions (make cavity cleansable)
* SDF ( Silver Diamine Fluoride) application
* Fissure seal pits and fissures
134
2 indications of non restorative caries management
* Primary tooth with arrested caries/non restorable/close to exfoliation
* Primary tooth with extensive lesion where other alternatives are not feasible ( pre-cooperative?)
135
What questions do you ask a parent presenting with an asthmatic child to get a Fluoride varnish? (6)
* What are the exacerbating factors of the asthma?
* What medication do they take for it and how often?
* Is it well controlled?
* Was the child hospitalised due to their asthma or due to an allergic reaction in the last 12months?
* Is the child allergic to sticking plaster?
* PEFR and FEV1 values if available to determine severity
136
What are 3 contraindications for fluoride varnish?
* Hospitalised due to severe asthma or allergy in the past 12 months
* Allergy to sticking plaster (colophony)
* If they had fluoride varnish applied in the past 24h
137
How does fluoride varnish work? (4)
* Promotes remineralisation - of enamel by the formation of Fluoriapatite
* Inhibits demineralisation - of enamel by making enamel more resistant to acid attack
* Antimicrobial effect - reduce bacterial acid production by inhibiting bacterial sugar metabolising enzymes
* Prolonged contact - adhesive property allowing more F intake by enamel
138
What instructions do you give patient after placing fluoride varnish? (3)
* Do not eat or drink for at least 30 minutes
* Soft food and liquid can be consumed after 30 minutes
* Wait at least 4 hours before toothbrushing or consuming hard food
139
List 6 extra oral signs of TMD?
* Facial asymmetry
* TMJ clicking
* TMJ crepitus
* Mom tenderness
* mandibular deviation on closing
* Limited Jaw movement
140
List 6 intraoral signs of TMD?
* Linea alba
* Tongue scalloping
* Occlusal toothwear
* Cheek biting
* Mom hypertrophy
* Limited mouth opening (inter-incisal angle)
141
Reversible management options for TMD? (6)
* Patient education
* Physical therapy - massage , relaxation, acupuncture, hypnotherapy, physiotherapy
* Splints - bite raising , anterior repositioning
* Medications - TCA , NSAIDs, Botoxs , steroids
* Jaw exercised
* electromyographic recording
142
Irreversible management options for TMD?
* Occlusal adjustment
* TMJ surgery
143
6 possible surgeries for TMJ?
* high condylar shave
* Disc removal
* Disc repair
* Disc repositioning
* Total joint replacement
* Arthroscopy
* Joint aspiration
144
What are the 4 zones in dentistry for positioning?
* Operating zone - operator work here
* Static zone - kept clear as across patient head
* Nurse's zone - dental nurse works here
* Transfer zone - instruments passed here
145
Operating zone
7-11 O'clock
146
Static zone
11 - 2 O'clock
147
Nurse's zone
2 - 4 O'clock
148
Transfer zone
4 - 7 O'clock
149
How to clean hand scalers while assisting chairside?
* Use a narrow bore aspirator tip and suction the debris away
150
List the SCIPS relevant to dentistry?
* Personal protective equipment
* Respiratory and cough hygiene
* Hand Hygiene
* Safe management of care environment
* Safe management of blood and body fluid spillages
* Safe management of care equipment
* Safe disposal of waste (including sharps )
* Occupational safety : prevention and exposure management (including sharps)
151
Patient attends with pain when drinking something cold , you notice the gingival level is high. What may have caused the pain?
* Dentine sensitivity due to gingival recession
152
What may cause gingival recession?
* Periodontitis
* Trauma due to piercings
* Abrasive toothbrushing
* Orthodontic appliances
* Think attached gingivae
153
How to manage gingival recession?
* Carry out periodontal examination and diagnose patient and identify factors contributing to the recession
* Eliminate the cause of recession
^ toothbrushing - brushing instructions (atraumatic technique)
^ ortho tx - stop treatment and seek advice
^ Piercing - advice on piercing removal
^ Periodontitis - Step 1
* Manage sensitivity by
^ atraumatic toothpaste and topical F toothpaste
^ if did not work , apply FV , or cervical restorations (GI)
* Monitor using study casts, photographs , 6PPC
