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SDCEP > acute dental problems > Flashcards

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

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2
Q

how do you manage pain from a newly erupted child tooth? - 3

A

analgesia
soft brushing
rinse after food

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3
Q

if analgesia does not control pain, when should you see patient?

A

urgent - within 24hrs

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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

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5
Q

how do you manage pain from an erupting tooth in an adult? - 3

A

chlorhexadine
analgesia
urgent - see within 24 hrs

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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

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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

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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

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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

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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

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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

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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

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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

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14
Q

a patient has had ulcers for more than 3 weeks, what do you do?

A

see them urgently within 24hrs

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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

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16
Q

how do you manage an avulsed primary tooth

A

advise soft diet and analgesia
don’t reimplant

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17
Q

when is preimplantation of a permanent tooth most successful?

A

<6hrs <16 years old

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18
Q

give 2 examples of bisphosphonates

A

alendronic acid
zolendronic acid

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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

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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

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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.

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22
Q

what is the term for dry socket

A

alveolar osteitis

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23
Q

treatment options for an acute apical abscess

A

drainage of abscess - incision or through canal

analgesia

relieve occlusion

extract

NSAIDS post op

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24
Q

describe acute pericoronitis

A

Infection under the operculum, i.e. the gingiva tissue covering a partially erupted/erupting tooth

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25
Q

test to determine whether pt airway is compromised

A

pt is unable to swallow own saliva

patient unable to push tongue forward out of mouth

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26
Q

signs and symptoms of acute pericoronitis

A

Pain

Swelling of gingiva around PE tooth

Discomfort with swallowing

Limited mouth opening

Unpleasant taste or odour

Fever

Nausea

Fatigue

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27
Q

what advice would you give to a child with acute pericoronitis - 3

A

optimal analgesia
soft brushing around area
rinse after food

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28
Q

how would you manage pericoronitis in an adult

A

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

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29
Q

what do necrotising gingivitis and necrotising perio have in common and what is different

A

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.

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30
Q

what bacteria causes necrotising perio and necrotising gingivitis

A

Fusiform bacteria and Spirochetes

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31
Q

what is a periodontal abscess

A

an active period of periodontal breakdown in deep periodontal pockets

occurs whilst there is marginal closure of the deep periodontal pocket occluding drainage

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32
Q

signs and symptoms of necrotising perio disease

A

Pain (general or localised)
Swelling
Bleeding
Halitosis
Ulcerated gingival tissue
Loss of attachment
Malaise
Fever

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33
Q

signs and symptoms of perio endo lesion

A

generalised periodontal disease may be present with localised pain

swelling with or without suppuration on palpation

deep pocketing to root apex

BOP

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34
Q

signs and symptoms of perio endo lesion

A

generalised periodontal disease may be present with localised pain

swelling with or without suppuration on palpation

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35
Q

signs and symptoms of periodontal abscess

A

Pain
Increased tooth mobility
Fever
Presence of swelling on gingiva
Suppuration from the gingiva

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36
Q

management of acute periodontal conditions

A

scaling
0.2% chlorhexadine mouthwash
OHI
smoking cessation

NG or NP - metronidazole
perio-endo lesion - RCT

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37
Q

signs and symptoms of dentine hypersensitivity

A

sharp sudden pain
exposed root surface

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38
Q

what is dentine hypersensitivity

A

exposed dentine resulting in pain in response to an external stimulus e.g. hot or cold

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39
Q

how do you manage dentine hypersensitivity initially and subsequently

A

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

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40
Q

how would you determine if pulpitis is reversible?

A

Gives a positive or exaggerated response to sensibility test
NO TTP

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41
Q

how would you determine if pulpitis is irreversible?

A

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.

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42
Q

treatment options for irreversible pulpitis

A

extraction
pulpotomy-primary
pulpectomy-adult

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43
Q

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

A

corticosteroid antibiotic paste e.g. ledermix

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44
Q

how do you treat reversible pulpitis

A

dressing
restore

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45
Q

what is alveolar osteitis

A

Osteitis (inflammation) of a socket after a tooth is extracted

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46
Q

what increases risk of alveolar osteitis

A

most common after molar extraction
smokers

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47
Q

signs and syptoms of alveolar osteitis

A

Pain in vicinity of extraction site
tenderness of alveolar socket
Unpleasant taste or odour from the affected area
Swelling (occasionally)

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48
Q

treatment of dry socket

A

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.

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49
Q

post extraction haemorrhage advice

A

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.

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50
Q

what is haemorrhage a week after extraction indicative of

A

infection

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51
Q

what do you do if haemorrhage post op does not stop

A

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

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52
Q

give 4 causes of oral ulceration

A

herpes virus
recurrent apthous stomatitis
anaemia
nutrition deficienies
oral cancer

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53
Q

signs and symptoms of oral ulcers

A

Pain
Inflammation
Ulceration
Abnormal appearance
dehydration if severe

54
Q

treatment of ulcers present for more than 3 weeks

A

refer the patient for urgent care to investigate potential dysplasia or malignancy

55
Q

treatment of ulcers present for less than 3 weeks

A

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
Q

GI disease that causes oral ulceration

A

coeliac disease
crohn’s
ulcerative colitis

57
Q

haematological cause of oral ulceration

A

anaemia
leukaemia

58
Q

bacterial cause of oral ulceration

A

syphilis
tuberculosis

59
Q

viral cause of oral ulceration

A

herpetic stomatitis
HIV

60
Q

treatment of fractured teeth

A

ensure hasn’t inhaled
temporary dressing
analgesia
smooth rough edges
restore, pulp therapy or extract

61
Q

loose fitting dentures can indicate what serious condition?

A

stroke
indicative of malignancy

62
Q

what does FAST stand for

A

facial asymmetry
arm weakness
speech
time to call 999

63
Q

how do you manage loose fitting dentures?

A

rule out stroke - use FAST
analgesia
advise to remove denture
reline or remake denture

64
Q

signs and symptoms of sinusitis

A

Pain - bending down
toothache (especially upper teeth)
Nasal congestion
Purulent discharge

65
Q

management of sinusitis

A

analgesia
steam inhalation - not for children
antibiotics if signs of bacterial infection
contact GMP if symptoms worsen or persist

66
Q

emergency avulsion advice

A

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
Q

temporary first aid measure for fracture exposing dental pulp

A

setting CaOH to cover pulp

store tooth fragment in water

68
Q

first aid measure for dentine enamel fracture

A

desensitising toothpaste

69
Q

signs and symptoms of TMJ conditions

A

Pain
Swelling
Joint noises, e.g. pop, clicks and grating associated with movement
Limited opening of mouth
Headaches

70
Q

what is bells palsy

A

Acute onset paralysis or weakness of muscles only in the face

71
Q

treatment of bells palsy

A

rule out stroke - FAST
protect eye - eye patch, lubricants
prescribe prednisalone

72
Q

what increases risk of candidal infection?

A

HIV
inhaled corticosteroids
diabetes
leukaemia
nutrition deficiency

73
Q

characteristics of pseudomembranous candidosis

A

white patches on oral mucosa which become plaques

74
Q

characteristics of erythmatous candidosis

A

red patches on oral mucosa
depapillitated areas on dorsal tongue

75
Q

management of candidal infection in pt with corticosteroid inhaler

A

advise to rinse with water and brush teeth after use, ensure good technique and use of spacer

76
Q

what do you prescribe for candidal infection

A

for superficial infections, prescribe systemic fluconazole or miconazole oromucosal gel

77
Q

what increases the risk of osteonecrosis?

A

pt on bisphosphonates
pt who has had radiotherapy to head and neck

78
Q

signs and symptoms of osteonecrosis

A

pain
exposed intra-oral bone - fails to heal

79
Q

what is peri-implantitis

A

inflammation affecting hard and soft tissues around implant leading to loss of bone support

80
Q

temporal arteritis is also known as what?

A

giant cell arteritis

81
Q

describe temporal arteritis

A

damage to small and large blood vessels of the head - blindness risk

82
Q

signs and symptoms of temporal arteritis

A

pain
swelling
fever
vision difficulty

83
Q

describe trigeminal neuralgia

A

severe facial pain in the region of distribution of trigeminal nerve

84
Q

signs and symptoms of trigeminal neuralgia

A

pain - stabbing, shooting, severe
brief facial spasm or tic

85
Q

how do you manage trigeminal neuralgia

A

carbamazepine
optimal analgesia
long acting LA

86
Q

for mild to moderate odontogenic pain what paracetamol prescription

A

500mg paracetamol 2 tablets 4 times daily

87
Q

prescription ibuprofen for mild to moderate odontogenic, post-operative or inflammatory pain

A

400mg ibuprofen 4 times daily

88
Q

aspirin prescription for mild to moderate odontogenic/inflammatory pain

A

600mg four times daily
not in <16 Reyes syndrome risk

89
Q

how to manage dry mouth

A

maintain good OH
fluoride mouthwash
regular sips cold water
suck ice
sugar free chewing gum

90
Q

drug associated with osteonecrosis of jaw

A

bisphosphonates

91
Q

drug associated with oral thrush

A

corticosteroids

92
Q

drug associated with tooth discolouration

A

chlorhexadine

93
Q

drug associated with oral ulceration

A

NSAIDs

94
Q

drug associated with gingival overgrowth

A

cyclosporine
phenytoin
calcium channel blockers (e.g. nifedipine)

95
Q

define emergency care

A

contact with clinical advisor within 60 mins

96
Q

define urgent care

A

seek medical or dental care within 7 days unless condition worsens

97
Q

define non-urgent care

A

see dentist within 7 days if required unless condition worsens

98
Q

define self care

A

pt can manage problem but if symptoms worsen contact dentist or GP

99
Q

cardinal signs and symptoms of spreading infection

A

cellulitis
lymph node involvement
swelling

100
Q

signs and symptoms of systemic infection

A

fever and malaise

101
Q

when is it appropriate to prescribe antibiotics for oral infection - 2

A

where there is signs of spreading infection

when patient is immuno-compromised

102
Q

asthma symptoms may be exacerbated when you prescribe which group of drugs

A

NSAIDS

103
Q

3 drugs that interact with warfarin

A

NSAIDs
azole antifungals
antibiotics

104
Q

myopathy in those taking statins is associated with the prescription of which drugs

A

azoles
erythromycin
clarithromycin

105
Q

what should always be included in an assessment of a pt with an acute dental problem - 4

A

review medical history
clinical assessment tailored towards diagnosis
examination of oral mucosa
encourage irregular attenders to occur for full OH assessment

106
Q

most patients presenting with an acute dental problem will present with one or more of 6 symptoms, what are they

A

pain
swelling
bleeding
trauma
ulceration
altered sensation/abnormal appearance

107
Q

what is pain in the face causing visual disturbance suggestive of?

A

temporal arteritis

108
Q

what is pain in the face causing visual disturbance suggestive of?

A

temporal arteritis

109
Q

what is a possible cause of sudden and unexplained swelling

A

angioedema

110
Q

what heightens the concern for overdose - 3

A

pt not eaten
elderly
child

111
Q

what is pain in the face causing visual disturbance suggestive of?

A

temporal arteritis

112
Q

how do you manage an avulsed permanent tooth

A

avoid handling root
remove debris with water
re implant if possible and bite on gauze
if cannot re implant store in milk, saliva

113
Q

what is a possible cause of sudden and unexplained swelling

A

angioedema

114
Q

name a possible cause of multiple painful oral ulcers

A

herpes virus

115
Q

what heightens the concern for overdose - 3

A

pt not eaten
elderly
child

116
Q
A
117
Q
A
118
Q
A
119
Q
A
120
Q

drug and dose for NG or NP adult

A

metronidazole

400mg 1 tablet TID

121
Q

mucocutaneous disease that causes oral ulceration

A

lichen planus
chronic ulcerative stomatitis

122
Q

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

A

antiviral such as aciclovir or peniciclovir

123
Q

mucocutaneous disease that causes oral ulceration

A

lichen planus
chronic ulcerative stomatitis

124
Q

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

A

antiviral such as aciclovir or peniciclovir

125
Q

what can be hard to distinguish from toothache from upper posterior teeth

A

sinusitis

126
Q

mucocutaneous disease that causes oral ulceration

A

lichen planus
chronic ulcerative stomatitis

126
Q

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

A

antiviral such as aciclovir or peniciclovir

127
Q

what can be hard to distinguish from toothache from upper posterior teeth

A

sinusitis

128
Q

mucocutaneous disease that causes oral ulceration

A

lichen planus
chronic ulcerative stomatitis

129
Q

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

A

antiviral such as aciclovir or peniciclovir

130
Q

what can be hard to distinguish from toothache from upper posterior teeth

A

sinusitis

131
Q

what first aid measure would you advise for a patient with fractured orthodontic appliance

A

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

SDCEP (8 decks)

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