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BDS5 OSCE > 6 minute stations > Flashcards

6 minute stations Flashcards

1
Q

What system should you use when offering smoking cessation

A

5As
Ask
Advise
Assess -motivation to quit
Assist
Arrange - refer

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2
Q

Give 4 points about E- cigarette use

A

New to the market don’t fully know the affects - no long term health data

Respiratory side affects - fluid in lungs

Likely less harmful than tobacco

Maintains habit and culture of smoking

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3
Q

Define direct retention

A

Resistance to vertical displacement of denture

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4
Q

Define indirect retention

A

Resistance to rotational displacement of denture

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5
Q

Why use an RPI system

A

Stress reliving clasp system used in free end saddle areas to prevent stress on last abutment tooth and can also provide reciprocation

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6
Q

When do we ideally want a patients INR for doing an extraction

A

Within 24hours
Can be 72 hours if patient stable - stable means INR less than 4 for 3 months

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7
Q

If cannot extract a patients tooth due to medication but they are in pain - what do you do

A

Acknowledge patients pain and have a discussion about dealing with the pain ie. Analgesia/pulp extirpation/sedative dressing

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8
Q

Explain to the patient that their medication alendronic acid is a bisphosphonates medication.
Now explain the mode of action of bisphosphonate drugs in relation to dentistry

A

Bisphosphonates drugs reduce the bone turnover
They accumulate in sites of high bone turnover - the jaw is one of these sites
This causes a risk of poor wound healing following a tooth extraction
Need to remove any teeth that may be poor prognosis before starting drug therapy
Important to do everything possible to prevent further tooth loss in the future
Reduced turnover of the bone and reduced vascularity can lead to death of the bone - osteoradionecrosis

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9
Q

Chronic periapical periodontitis with gross caries in the tooth

Explain this diagnosis to a patient and justify extraction

A

Area of infection associated with left back tooth
The tooth is too decayed to be saveable and place a filling in
The tooth has decay below the gum line so cannot be restored

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10
Q

What are the 6 hand piece safety checks

A

Back cap check - gripped and turn anti clockwise
Bur security checked - suitable force applied to remove bur
Tension applied to handpiece when fitted to coupling - assesses if handpiece is attached safely
Bur rotates laterally with fingers - spins bur along finger
Attempts to move but laterally - push but from side to side a few times
Handpiece sound tested when running ; run for 5 seconds or more

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11
Q

Explain a pulpotomy ; open apex to a paitient

This patient has a complicated pulp fracture

A

As there is a large exposure the treatment of choice will be a pulpotomy
Explain that this involves a partial removal of the pulp - the part closer to the crown of your tooth
This aims to keep the undamaged pulp at the bottom (apex) alive and allows it to continue to grow

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12
Q

A 50-year-old male patient attended for HPT with the hygienist 3 months ago. Their 35 is tender, has a swelling around the tooth and has 8mm pocket on the distal aspect as well as suppuration. The patient is systemically well and has a normal body temperature. Provide your diagnosis to the patient and discuss how you would like to investigate the matter further. Indicate to the examiner when you wish to receive the results of the special investigations.

A

Ask for: otherwise you won’t get it
o PA radiograph (2 marks) o Sensibility testing (2 marks)

EPT 35 & 36 respond positively PA radiograph shows periodontal/periapical pathology
 Swelling (2 marks)
 Pocket with pus (2 marks)
 Bone loss from radiograph (2 marks)

Diagnosis - Periodontal abscess (2 marks)

Treatment
Irrigate through pocket (2 marks) Debridement (2 marks)
Hot salty mouthwash (2 marks)
No antibiotics, since it’s a localised infection (2 marks)

Actor marks: Empathy (1 mark), Communication (1 mark), Understanding (1 mark)

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13
Q

Outline the management of a dental/ periodontal abscess

A

Abcesses do not require antibiotics unless patient systematically unwell

  1. Local measures first - incise and drain, extirpate, xla

2.PenV 250mg tablets send 40 - 2tablets 4xdaily 5 days
3.Amoxocillin 500mg capsules send 15 take 1tablet 3xdaily 5 days

Allergy to penicillin
Metronidazole 400mg tablets send 15 tablets 1tablet 3x daily 5 days

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14
Q

If a paitnet returns after having had local measures anda course of antibiotics - no response and a spreading cellutis what can be prescribed

A

Clindamycin 150mg capsule send 20, 1cap 4x daily for 5 days.

Paient must be reviewed due to a collitis

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15
Q

Outline the management of ANUG

A

First line local measures
Remove supra and subgingival deposits and provide OHI - due to pain this may need to be staged

If systemically unwell or spreading

1st line antibiotics
400mg Metrnonidazole send 9 tablets 1tablet3x daily 3 days

2nd - Amoxcillin 500mg 9 tablets 3x daily 3 days

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16
Q

What two groups of people cannot be prescribed metronidazole

A

Cannot have with alcohol - alcoholics

Patients on warfarin

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17
Q

What is the prescription for chlorhexidine

A

0.2% chlorhexidine send 300ml
Rinse mouth for 1min with 10ml 2 daily

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18
Q

What is the prescription for hydrogen peroxide mouthwash

A

6% hydrogen peroxide mouthwash send 300ml
Rinse mouth for 2 mins with 15ml diluted in half glass of warm water 3x daily

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19
Q

What are the 4 signs of SIRS

A

Temp <36 or >38
RR >20
HR >90
WC <4000 or >12000

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20
Q

Name 5 risk factors for dry socket

A

Molars and mandible (maxilla more vascular )
Female
Oral contraceptive pill
Smoker ( reduced blood supply )
Family history/ previous dry socket

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21
Q

Outline managment of a dry socket

A

Supportive reassurance and analgesia advice
LA
Irrigate with warm saline- wash out food and debris
Curretage and debridement - encourage bleeding to get new clot formation
Antiseptic pack - alvogyl - can help soothe the patient

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22
Q

Why do we start suturing on the buccal side

A

Do this so that the sutures finish on the buccal side meaning the knot of the suture isnt lingually and irritating the paitents tongue

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23
Q

What instruments should you ask for when suturing

A

Needle and a suture - always ask for size 4/0
Locking scissors
Normal scissors
Tweezers

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24
Q

To place a direct pulp cap the tooth must be what

A

Asymptomatic, vital and no history of a pulpitis

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25
Give 5 reasons why an RCT may have failed
Poor coronal seal Failure of restoration File fracture Missed canal Inadequately prepared
26
If the patient has diabetes what is the ideal control
48mmol/mol 6.5%
27
If a paient attends with denture stomatitis what two questions do you want to ask
Ask about their denture hygiene Ask if they are taking their dentures out at night
28
Outline local managment of denture induced stomatitis
Local measures first - clean the palate, cleaning the denture, leaving denture out at night, check denture fit, limit smoking
29
What antifungal is first line for management of denture induced stomatitis
Fluconazole 50mg capsules send 7 capsules take 1 a day for seven days
30
Which patients cannot be prescribed fluconazole
Those on statins or warfarin
31
If a patient has denture induced stomatis and local measures haven’t worked but the paitent is on warfarin and statins what can they be prescribed
Nystatin oral suspension 100,000 units/ml Send 30ml 1ml after food 4x daily for 7 days Remove dentures and rinse around mouth near lesion for 5 mins before swallowing
32
Define a class 2 div 1 malocclusion
The lower incisors occlude posterior to cingulum plateau of upper central incisors. The upper incisors are proclined or of average inclination. There is an increased OJ
33
Outline the treatment options for a class 2 division 1 malocclusion
1.Accept - Paitent must be aware if they accept now they will complicate further future tx. Due to trauma risk advise mouth guard 2. Growth modification “ what this means is is that your upper jaw has developed more than what you lower jaw or your lower has not developed enough. This tx is only suitable in growth spurt 11-14years Restrain maxillary growth and encourage mandibular growth Functional appliance ; twin block - large pieces of acrylic in the mouth that protrude the mandible on closure. Headgear can also be used 3. URA ; removable appliance that can tip and tilt the teeth - does not affect jaw position so not suitable in all cases. Gently pushes teeth into correct postion. Robert’s retractor. Only in mild cases - can end up tipping into a class 2 div2 position 4. Camouflage ; accept underlying skeletal base and correct the malocclusion; extractions like required. 5. Orthographic surgery - Carried out when growth is complete
34
How does a twin block appliance work in a class 2div1 malocclusion
Protrudes mandible forward on closure Distalising molars and retroclining upper incisors
35
Define a class 2 division 2 malocclusion
The lower incisor edges occlude posterior to cingulum plateau of upper incisors. The upper incisors are retroclined The OJ is reduced but can also be increased
36
Why do upper 2s end up flared and rotated in class2div2
They escape the effect of the lower lip trap due to their shorter clinical crown causing them to become flared and rotated
37
Outline treatment options for a class 2 division 2 malocclusion
1. Accept Mild malocclusion with acceptable aesthetics and no detriment to dental health 2. Growth modification 12+/- 2 Converting div 2 into div1 Modified twin block with ELSA spring to pro line labial segment 22 hours a day wear - needs to be followed by fixed appliance 3. Camouflage; accpet underlying skeletal base and aim to correct to class 1 incisors URA with FABP; to correct OB Fixed braces; palatal root torque 4. Orthognathic surgery Need to decompensate first so convert to class2 div1 Then will need post op braces
38
Following treamtent what is recommended for class 2 div2 paitents
Bonded retention - these paitents are difficult to treat and rotated laterals and deep OB have high relapse rate
39
Define class 3 malocclusion
The lower incosr edges occlude anterior to the cingulum plateau of the upper central incisors The OJ is reduced or reversed
40
Outline the treatment options for a class 3 malocclusion
1. Accept Mild class 3 with no dental health concerns - no attritions and no displacements 2. Intercept early with URA This is only suitable if the class 3 incisors have developed due to an early contact on the the permanent incisors. URA with a Z spring to procline the incisors over the bite 3. Growth appliance ; restrain mandibular and encourage maxillary growth Reverse twin block ; mild Rapid maxillary expansion 4. Camouflage ; Accept underlying skeletal base and correct incisors to class 5. Orthognathic surgery; growth must be stopped will require braces after
41
What are two good prognostic indicators for a class 3 malocclusion to be intercepted early with an URA
Deep OB Patient can get into edge to edge
42
Name 5 signs of primary herpetic gingivostomatiis
Lymphadenopathy Malaise Pyrexia Erytheamtous gingivae Ulceration
43
Explain to a parent about primary herpetic gingivostomaitis
It is a mouth infection caused by the herpes simplex virus the same virus which causes cold sores. It causes painful sore blisters which when they burst wil become ulcers on the mouth and gums.. it is a self limiting infection and will usually go away on its own within 7-10 days. It is common in the population mostly affecting children under the age of 5
44
Outline management of primary herpetic gingivostomatiis
Push fluid intake Analgesia to control pain/fever Bed rest and to take it easy Clean teeth and gums with damp gauze or cloth with dilute chlorhexidine
45
Antivirals are not routinely given for primary herpetic gingivostomatitis - if it is severe and the paitient is immuno compromised what can be given
Aciclovir 200mg (100mg if under2) Send 25 tablets Take 1tablet 5xdaily for 5 days Referral should also be made to hospital if child immunocompromised
46
What anagram should be used for delivering bad news
SPIKES Setting Perceptions Information Knowledge Empathy Summary
47
If extracting a tooth and discussing replacement options with the paitent what must you make sure to tell them
That it will be an immediate option for the first 3 months to allow the bone and the socket to heal in the site of extraction, this will if a denture eventually become loose and the denture will need to be replaced Permanent restoration cannot be placed until following that 3 months
48
Name 5 symptoms a patient with a chronic OAF might complain of
Fluid from the nose Speech sounding nasally Problems smoking or using a straw Bad taste/hallitosis Pain/sinusitis
49
How does glucagon work
Increases the concentration of glucose in the blood by promoting gluconeogenesis and glycogenesis to convefty glycogen to glucose
50
If patient is having a medical emergency - Hypoglycaemia - what medication should be administered
Img IM glucagon - Z track technique into thigh
51
What is the review period for perio amd why??
6-8 weeks
52
What can you prescribe for a patient who say is having pain and discomfort in their mouth from - ulcers, sore xla site?
Benzydamine Oromucosal Spray, 0.15% Send: 30 ml Label: 4 sprays onto affected area every 1½ hours OR Benzydamine Mouthwash, 0.15% Send: 300 ml Label: Rinse or gargle using 15 ml every 1½ hours as required Brand name is difflam
53
Patient presenting with apthous ulcers likely related to iron deficiencey anameia - encourage them to go and see their GP; what diet advice can you give?
Dark green leafy veg ; kale Iron fortified cereals meat fish tofu Vit C rich foods can help absorb Fe
54
Name 3 potential complications for permanent 1 if trauma to a
Ankylosis Arrested tooth formation Dilaceration displacement
55
Discuss causes of retained A/unerupted upper central
Trauma to A Lack of permanent successor Ectopic tooth germ Crowding Supernumerary ( most common cause)
56
Give 5 pieces of advice for a parent with a child with nursing bottle caries
Free flowing spout cup replacing bottle at 6 months Child should not be put to bed with a bottle No soy milk -unless medically advised Milk and water between meal times Sugar free medicines Sugar free snacking
57
If a patient is prone to fracturing their upper acrylic denture - what modifications could be made to the denture to prevent this
Inclusion of a metal plate Use of an alternative denture base material such as a high impact acrylic resin for thin underextended flanges
58
Name 4 things that make someone more prone to ANUG and what can make it worse
Smoking Stressed Malnourished Immunocompromised Poor OHI can make it worse
59
Local measures have been attempted first for ANUG ( scaling and oral hygiene advice) what medication should be prescribed for this condition
Metronidazole Tablets, 400 mg Send: 9 tablets Label: 1 tablet three times daily
60
Patient presents with ANUG - local measures have been taken - patient requires medication - patient is on warfarin and an alcoholic what should be prescribed
Metronidazole is first line medication in ANUG but is contraindicated in pts taking warfarin and alcohol use is not advised Amoxicillin Capsules, 500 mg Send: 9 capsules Label: 1 capsule three times daily
61
Define bracing
Bracing is the resistance to lateral movements
62
Describe how to deal with a blood spillage
Stop what you are doing Apply appropriate PPE Cover spill with disposable paper towels Apply sodium hypochlorite/ Sodium dichloroisocyanurate liquid/powder/granules 10,00ppm Leave for 3-5mins, use scoop to take up gross contamination and put into orange waste Clean with water and detergent wipes
63
When are the 2 instances acyclovir is prescribed for Primary herpetic gingivostomatitis
Severe infection in the non-immunocompromised Immunocompromised patient
64
Why would someone with a mandibular fracture have an anterior open bite
Due to bilateral ramus/sub-condylar fracture
65
Give 2 reasons why we want a cuspal coverage restoration over a RCT tooth
Reduces risk of tooth fracture/catastrophic failure Less microbial leakage and better seal
66
What are the 8 components of prevention in paeds
Radiographs Diet advice Tooth brushing instruction Strength of F in toothpaste Fluoride supplementation Fluoride varnish Fissure sealant Sugar free medicines
67
Name 5 pre-cementation checks you can do prior to cementing an indirect restoration
Is it the correct restoration/what you asked for Does the restoration rock on the cast Check the marginal integrity Check contact points Aesthetics
68
What is fine antibiotic prescription for pericoronitis? when can it not be used
Metronidazole Tablets, 400 mg Send: 9 tablets Label: 1 tablet three times daily Contraindicated in patients on warfarin and alcoholics ; prescribe amoxicillin instead
69
Name 4 ways you can attempt to remove a broken file from a canal during an endo ** Do what you are comfortable with and wat you are prepared for based on your illumination, magnification and access to instruments**
Do nothing - cleaned to apex, explained to the patient, dress and monitor/refer Attempt removal with tweezers if you can see separated file Dislodge and remove using an ultrasonic instrument Bypass the fragment by watch-winding a small file alongside the instrument and using EDTA to soften the dentine
70
When extracting
remember to put light on and adjust chair
71
Explain to a patient a pulpotomy in an open apex
Due to the trauma there has been a large pulp exposure necessitating a pulpotomy This means partial removal of the pulp/nerve of the tooth This is aiming to keep the undamaged pulp tissue alive Thus allowing the tooth to stay alive and continue to grow
72

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