4 Flashcards
shingles
caused by varicella zoster virus reactivation (same virus that causes chickenpox)
can affect any branch of trigeminal nerve, usually occurs unilateral
begins with prodromal pain that pt may think is toothache
2-3 days later a unilateral painful blistering rash will appear on face and mouth
post herpetic neuralgia
lasting pain in areas of skin where pt previously had shingles
very painful , a constant burning sensation
trigeminal neuralgia
pt experiences extreme episodes of pain (seconds)
most common in females and maxillary and mandibular branches most likely to be affected
carbamazepine is a common treatment
burning mouth syndrome
ongoing/recurrent burning sensation in mouth without a cause
assosciated with anxiety and depression and is more common in females
signalling issue between mouth and brain
majority of cases have no known cause
name 3 things the childsmile programme implements
universal supervised toothbrushing for nursery pupils
targeted fluoride varnish application in nurseries and schools
targeted dental health support workers for families who need it most
toothbrushing pack given to all p1s to take home
targeted supervised toothbrushing for p1 and p2 pupils
logic model
tells you how your intervention is supposed to work
helps plan , implement and evaluate
outcome related research perspective
efficacy and effectiveness questions
methods include randomised control trials, cohort studies and ecological studies
process related research perspective
programme theory and systems interactions - focuses on feasability and implementation questions
uses a mixed methods approach - surveys, routine admin data, qualitative studies inc. in depth interviews and focus groups
what are the 3 broad questions to ask when critically appraising a piece of writing/ journal/ product marketing etc
- are they results of the trial valid?
- what are the results?
- are the results relevant to my clinical practice ?
how would we judge if the results of a trial were valid
- did the trial address a clearly focused issue - think PICO (Population e.g individuals undergoing ortho, Intervention (what is being tested/new tx, Comparison (to old tx/ placebo), Outcome (has intervention been succesful)
- were all participants who started trial accounted for at its conclusion
- were the groups similar at start of trial e.g smoking status which would impact results
- were the pts, healthworkers and study personnel blind to who was in what group
how would we judge the results of a trial
assess the effect of treatment
look for an absolute risk difference that includes confidence intervals
if a tx has been successful confidence intervals will not overlap 0. If they do there is insufficient evidence of benefit of treatment
NNT
number needed to treat
calculated by 1/absolute risk difference
number of patients you would need to treat to prevent one person developing the disease/outcome
split mouth design what is it and what are the pros and cons
uses same patient for treatment and placebo by splitting mouth in half
pros: less participants required, reduced inter-individual variation , easy to determine patient preferences
cons: carry across effect (depending on tx , may see leaking of tx from one side to the other), selection of patients matching criteria may be tricky (e.g finding pts who have caries in only there lower Ds), statistical analysis more difficult
ITT analysis
intention to treat analysis analyses data as though anyone who switched tx midway through trial is still in original randomised group
preferred and more conservative method
alternative is per protocol analysis
per protocol analysis
analyses data according to treatment patient actually received
alternative is intention to treat analysis
