acute dental problems Flashcards
1
Q
what is the first thing you should rule out when a patient presents with pain?
A
assess if atypical jaw pain and any other signs of MI
assess if overdose
If MI or overdose - 999
2
Q
how do you manage pain from a newly erupted child tooth? - 3
A
analgesia
soft brushing
rinse after food
3
Q
if analgesia does not control pain, when should you see patient?
A
urgent - within 24hrs
4
Q
pt is having pain from a recently extracted tooth, what do you do? - 4
A
advise analgesia
avoid smoking
maintain OH
see within 24 hrs
5
Q
how do you manage pain from an erupting tooth in an adult? - 3
A
chlorhexadine
analgesia
urgent - see within 24 hrs
6
Q
what do you do if patient is experiencing pain in the face causing visual disturbance suggestive of temporal arteritis?
A
emergency care - clinical adviser within 60 mins
7
Q
who is chlorhexadine mouthwash not suitable for and why?
A
children under 7 because of taste and limited ability to rinse without swallowing
8
Q
how do you treat pain from ortho appliance, sharp tooth or denture? - 4
A
analgesia
chlorhexadine mouthwash
malleable wax to sharp teeth and non-removable parts of appliance causing trauma
keep dentures out where possible
9
Q
what are the 5 questions you must ask a patient to assess the degree of swelling?
A
difficulty breathing
can they stick out or move tongue
is swelling closing eye
has swelling worsened within last hour
is swelling unexplained and sudden
10
Q
how do you manage a rapidly increasing swelling or a swelling likely to obstruct airway or close eye?
A
emergency care within 60 mins
11
Q
how do you manage a pt who has facial swelling and is systemically unwell (rigours, high temp., dehydrated) ?
A
emergency care - within 60 mins
12
Q
how do you manage a swelling that is increasing in size slowly, hot or firm to touch?
A
pt may require antibiotics
see within 24 hrs
13
Q
pt bleeding after recent extraction, what is your advice?
include if bleeding stops and if bleeding continues
A
rinse mouth once with warm water
bite on moist gauze
maintain constant pressure while sitting upright for 20 min
if bleeding stops - no smoking, alcohol or exercise for 24 hrs
if continues to bleed and on blood thinners emergency care
if continues to bleed repeat pressure advice and if still doesn’t stop they need urgent care or emergency care if brisk and persistent bleeding
14
Q
a patient has had ulcers for more than 3 weeks, what do you do?
A
see them urgently within 24hrs
15
Q
how do you manage ulcers for less than 3 weeks that have no relation to medication or medical condition?
A
advise optimal analgesia
use of chlorhexadine mouthwash
16
Q
how do you manage an avulsed primary tooth
A
advise soft diet and analgesia
don’t reimplant
17
Q
when is preimplantation of a permanent tooth most successful?
A
<6hrs <16 years old
18
Q
give 2 examples of bisphosphonates
A
alendronic acid
zolendronic acid
19
Q
briefly describe an acute apical abscess
A
Acute inflammation of the soft tissues immediately surrounding the tip of the root of a tooth
20
Q
what are the key signs and symptoms of acute apical abscess - 4
A
Pain - localised to a single tooth, easy to locate
Swelling of the gingiva, face or neck
Fever
lethargy
21
Q
how do you manage oral conditions before urgent care
A
Recommend optimal analgesia
Do not prescribe antibiotics unless there are signs of spreading infection
Advise the patient to seek urgent dental care.
22
Q
what is the term for dry socket
A
alveolar osteitis
23
Q
treatment options for an acute apical abscess
A
drainage of abscess - incision or through canal
analgesia
relieve occlusion
extract
NSAIDS post op
24
Q
describe acute pericoronitis
A
Infection under the operculum, i.e. the gingiva tissue covering a partially erupted/erupting tooth
25
test to determine whether pt airway is compromised
pt is unable to swallow own saliva
patient unable to push tongue forward out of mouth
26
signs and symptoms of acute pericoronitis
Pain
Swelling of gingiva around PE tooth
Discomfort with swallowing
Limited mouth opening
Unpleasant taste or odour
Fever
Nausea
Fatigue
27
what advice would you give to a child with acute pericoronitis - 3
optimal analgesia
soft brushing around area
rinse after food
28
how would you manage pericoronitis in an adult
Ultrasonic scaling around the partially erupted tooth, under LA
Irrigating under damaged tissue with 0.2% chlorhexidine and advise pt to rinse
Extracting the tooth if there are repeated episodes of pericoronitis
Extracting or adjusting an opposing tooth where there is trauma to the inflamed operculum
29
what do necrotising gingivitis and necrotising perio have in common and what is different
severe inflammatory conditions of the gingiva caused by pathogenic bacteria
Both involve the same disease process.
necrotising gingivitis limited to gingival tissue
Necrotising periodontitis involves loss of attachment.
30
what bacteria causes necrotising perio and necrotising gingivitis
Fusiform bacteria and Spirochetes
31
what is a periodontal abscess
an active period of periodontal breakdown in deep periodontal pockets
occurs whilst there is marginal closure of the deep periodontal pocket occluding drainage
32
signs and symptoms of necrotising perio disease
Pain (general or localised)
Swelling
Bleeding
Halitosis
Ulcerated gingival tissue
Loss of attachment
Malaise
Fever
33
signs and symptoms of perio endo lesion
generalised periodontal disease may be present with localised pain
swelling with or without suppuration on palpation
deep pocketing to root apex
BOP
34
signs and symptoms of perio endo lesion
generalised periodontal disease may be present with localised pain
swelling with or without suppuration on palpation
35
signs and symptoms of periodontal abscess
Pain
Increased tooth mobility
Fever
Presence of swelling on gingiva
Suppuration from the gingiva
36
management of acute periodontal conditions
scaling
0.2% chlorhexadine mouthwash
OHI
smoking cessation
NG or NP - metronidazole
perio-endo lesion - RCT
37
signs and symptoms of dentine hypersensitivity
sharp sudden pain
exposed root surface
38
what is dentine hypersensitivity
exposed dentine resulting in pain in response to an external stimulus e.g. hot or cold
39
how do you manage dentine hypersensitivity initially and subsequently
initial
-avoid acidic foods or drinks
-apply desensitising toothpaste to the affected area with a finger.
subsequent
-Eliminate other causes of dental pain
-consider fluoride varnish
40
how would you determine if pulpitis is reversible?
Gives a positive or exaggerated response to sensibility test
NO TTP
41
how would you determine if pulpitis is irreversible?
Pain may be difficult to localise to a single tooth and last for several hours
dull and throbbing pain may be worsened by heat
may also be alleviated by cold.
The pain can
occur spontaneously, typically keeping the patient awake.
42
treatment options for irreversible pulpitis
extraction
pulpotomy-primary
pulpectomy-adult
43
achieving anaesthesia can be difficult when trying to anaesthetise irreversible pulpitis for first stage endo treatment - what can you use to reduce inflammation for extirpation at a later date
corticosteroid antibiotic paste e.g. ledermix
44
how do you treat reversible pulpitis
dressing
restore
45
what is alveolar osteitis
Osteitis (inflammation) of a socket after a tooth is extracted
46
what increases risk of alveolar osteitis
most common after molar extraction
smokers
47
signs and syptoms of alveolar osteitis
Pain in vicinity of extraction site
tenderness of alveolar socket
Unpleasant taste or odour from the affected area
Swelling (occasionally)
48
treatment of dry socket
Irrigating with saline
Applying dressing to the socket, e.g. Alvogyl
Do not prescribe antibiotics unless there are signs of spreading infection, systemic infection, or for
an immunocompromised patient.
49
post extraction haemorrhage advice
Gently rinse the mouth once with warm water
Advise the patient to bite firmly on moist rolled up piece of cotton or a gauze
Maintain the pressure for 20 minutes before
checking whether the bleeding has stopped.
If necessary, repeat once.
If the patient is taking anticoagulant medication (e.g. warfarin, aspirin,
clopidogrel) send the patient for emergency care.
After the bleeding has stopped, advise the patient to avoid drinking alcohol, smoking or
exercising for 24 hours and to avoid disturbing the blood clot.
50
what is haemorrhage a week after extraction indicative of
infection
51
what do you do if haemorrhage post op does not stop
If the bleeding fails to stop and is brisk and persistent, send the patient immediately to
emergency care via NHS 24.
If the bleeding fails to stop, but is not brisk and persistent, send the patient for urgent dental care.
apply haemostatic dressing e.g. oxidised cellulose
suture the wound
52
give 4 causes of oral ulceration
herpes virus
recurrent apthous stomatitis
anaemia
nutrition deficienies
oral cancer
53
signs and symptoms of oral ulcers
Pain
Inflammation
Ulceration
Abnormal appearance
dehydration if severe
54
treatment of ulcers present for more than 3 weeks
refer the patient for urgent care to investigate potential dysplasia or malignancy
55
treatment of ulcers present for less than 3 weeks
0.2% chlorhexidine mouthwash if 7+
For children, recommend optimal analgesia, soft diet and advise
that ulcers are likely to resolve within 1-2 weeks.
If ulceration is due to ill-fitting dentures advise to keep dentures out where possible and fix denture
If there has been trauma from an adjacent tooth or orthodontic appliance, advise the patient to seek
non-urgent dental care
If due to trauma to tissue following LA advise the patient to avoid smoking, drinking hot liquids and biting the cheek or
lip
prescribe antiviral if due to viral infection
In all of the above cases, recommend optimal analgesia
56
GI disease that causes oral ulceration
coeliac disease
crohn's
ulcerative colitis
57
haematological cause of oral ulceration
anaemia
leukaemia
58
bacterial cause of oral ulceration
syphilis
tuberculosis
59
viral cause of oral ulceration
herpetic stomatitis
HIV
60
treatment of fractured teeth
ensure hasn't inhaled
temporary dressing
analgesia
smooth rough edges
restore, pulp therapy or extract
61
loose fitting dentures can indicate what serious condition?
stroke
indicative of malignancy
62
what does FAST stand for
facial asymmetry
arm weakness
speech
time to call 999
63
how do you manage loose fitting dentures?
rule out stroke - use FAST
analgesia
advise to remove denture
reline or remake denture
64
signs and symptoms of sinusitis
Pain - bending down
toothache (especially upper teeth)
Nasal congestion
Purulent discharge
65
management of sinusitis
analgesia
steam inhalation - not for children
antibiotics if signs of bacterial infection
contact GMP if symptoms worsen or persist
66
emergency avulsion advice
Handle the tooth by its crown (the white part), avoid touching the root.
If the tooth is dirty, wash it briefly under cold running water.
If it is feasible, reimplant the tooth in its socket and then bite gently on a handkerchief to hold it in
position.
If this is not feasible, store the tooth for transportation to the dentist in milk or saliva
Note that primary teeth should not be reimplanted
67
temporary first aid measure for fracture exposing dental pulp
setting CaOH to cover pulp
store tooth fragment in water
68
first aid measure for dentine enamel fracture
desensitising toothpaste
69
signs and symptoms of TMJ conditions
Pain
Swelling
Joint noises, e.g. pop, clicks and grating associated with movement
Limited opening of mouth
Headaches
70
what is bells palsy
Acute onset paralysis or weakness of muscles only in the face
71
treatment of bells palsy
rule out stroke - FAST
protect eye - eye patch, lubricants
prescribe prednisalone
72
what increases risk of candidal infection?
HIV
inhaled corticosteroids
diabetes
leukaemia
nutrition deficiency
73
characteristics of pseudomembranous candidosis
white patches on oral mucosa which become plaques
74
characteristics of erythmatous candidosis
red patches on oral mucosa
depapillitated areas on dorsal tongue
75
management of candidal infection in pt with corticosteroid inhaler
advise to rinse with water and brush teeth after use, ensure good technique and use of spacer
76
what do you prescribe for candidal infection
for superficial infections, prescribe systemic fluconazole or miconazole oromucosal gel
77
what increases the risk of osteonecrosis?
pt on bisphosphonates
pt who has had radiotherapy to head and neck
78
signs and symptoms of osteonecrosis
pain
exposed intra-oral bone - fails to heal
79
what is peri-implantitis
inflammation affecting hard and soft tissues around implant leading to loss of bone support
80
temporal arteritis is also known as what?
giant cell arteritis
81
describe temporal arteritis
damage to small and large blood vessels of the head - blindness risk
82
signs and symptoms of temporal arteritis
pain
swelling
fever
vision difficulty
83
describe trigeminal neuralgia
severe facial pain in the region of distribution of trigeminal nerve
84
signs and symptoms of trigeminal neuralgia
pain - stabbing, shooting, severe
brief facial spasm or tic
85
how do you manage trigeminal neuralgia
carbamazepine
optimal analgesia
long acting LA
86
for mild to moderate odontogenic pain what paracetamol prescription
500mg paracetamol 2 tablets 4 times daily
87
prescription ibuprofen for mild to moderate odontogenic, post-operative or inflammatory pain
400mg ibuprofen 4 times daily
88
aspirin prescription for mild to moderate odontogenic/inflammatory pain
600mg four times daily
not in <16 Reyes syndrome risk
89
how to manage dry mouth
maintain good OH
fluoride mouthwash
regular sips cold water
suck ice
sugar free chewing gum
90
drug associated with osteonecrosis of jaw
bisphosphonates
91
drug associated with oral thrush
corticosteroids
92
drug associated with tooth discolouration
chlorhexadine
93
drug associated with oral ulceration
NSAIDs
94
drug associated with gingival overgrowth
cyclosporine
phenytoin
calcium channel blockers (e.g. nifedipine)
95
define emergency care
contact with clinical advisor within 60 mins
96
define urgent care
seek medical or dental care within 7 days unless condition worsens
97
define non-urgent care
see dentist within 7 days if required unless condition worsens
98
define self care
pt can manage problem but if symptoms worsen contact dentist or GP
99
cardinal signs and symptoms of spreading infection
cellulitis
lymph node involvement
swelling
100
signs and symptoms of systemic infection
fever and malaise
101
when is it appropriate to prescribe antibiotics for oral infection - 2
where there is signs of spreading infection
when patient is immuno-compromised
102
asthma symptoms may be exacerbated when you prescribe which group of drugs
NSAIDS
103
3 drugs that interact with warfarin
NSAIDs
azole antifungals
antibiotics
104
myopathy in those taking statins is associated with the prescription of which drugs
azoles
erythromycin
clarithromycin
105
what should always be included in an assessment of a pt with an acute dental problem - 4
review medical history
clinical assessment tailored towards diagnosis
examination of oral mucosa
encourage irregular attenders to occur for full OH assessment
106
most patients presenting with an acute dental problem will present with one or more of 6 symptoms, what are they
pain
swelling
bleeding
trauma
ulceration
altered sensation/abnormal appearance
107
what is pain in the face causing visual disturbance suggestive of?
temporal arteritis
108
what is pain in the face causing visual disturbance suggestive of?
temporal arteritis
109
what is a possible cause of sudden and unexplained swelling
angioedema
110
what heightens the concern for overdose - 3
pt not eaten
elderly
child
111
what is pain in the face causing visual disturbance suggestive of?
temporal arteritis
112
how do you manage an avulsed permanent tooth
avoid handling root
remove debris with water
re implant if possible and bite on gauze
if cannot re implant store in milk, saliva
113
what is a possible cause of sudden and unexplained swelling
angioedema
114
name a possible cause of multiple painful oral ulcers
herpes virus
115
what heightens the concern for overdose - 3
pt not eaten
elderly
child
116
117
118
119
120
drug and dose for NG or NP adult
metronidazole
400mg 1 tablet TID
121
mucocutaneous disease that causes oral ulceration
lichen planus
chronic ulcerative stomatitis
122
what should you consider prescribing for a patient who either presents with severe symptoms of or is immunocompromised for primary herpetic gingivostomatitis or herpes zoster infection
antiviral such as aciclovir or peniciclovir
123
mucocutaneous disease that causes oral ulceration
lichen planus
chronic ulcerative stomatitis
124
what should you consider prescribing for a patient who either presents with severe symptoms of or is immunocompromised for primary herpetic gingivostomatitis or herpes zoster infection
antiviral such as aciclovir or peniciclovir
125
what can be hard to distinguish from toothache from upper posterior teeth
sinusitis
126
mucocutaneous disease that causes oral ulceration
lichen planus
chronic ulcerative stomatitis
126
what should you consider prescribing for a patient who either presents with severe symptoms of or is immunocompromised for primary herpetic gingivostomatitis or herpes zoster infection
antiviral such as aciclovir or peniciclovir
127
what can be hard to distinguish from toothache from upper posterior teeth
sinusitis
128
mucocutaneous disease that causes oral ulceration
lichen planus
chronic ulcerative stomatitis
129
what should you consider prescribing for a patient who either presents with severe symptoms of or is immunocompromised for primary herpetic gingivostomatitis or herpes zoster infection
antiviral such as aciclovir or peniciclovir
130
what can be hard to distinguish from toothache from upper posterior teeth
sinusitis
131
what first aid measure would you advise for a patient with fractured orthodontic appliance
apply orthodontic wax on sharp non removable parts
if not available
sugar free chewing gum
wax off of cheese if no dairy allergy
remove fractured removable appliances
seek orthodontist appointment
