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case pres Flashcards

1
Q

what is the American association of endodontists definition of previously treated

A

a clinical diagnosis indicating that the tooth has been endodontically treated and the canals are obturated with various filling materials other than intra canal medicaments
the tooth typically does not respond to thermal or electric pulp testing

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2
Q

what is the American association of endodontists definition of symptomatic apical periodontitis

A

represents inflammation, usually of the apical periodontium, producing clinical symptoms involving a painful response to biting/ percussion/palpation
this may or may not be accompanied by radiographic changes (depending on the stage of disease there may be normal PDL width, or a peri apical radiolucency)
severe pain to percussion or palpation is highly indicative of a degenerating pulp and root canal treatment is needed

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3
Q

what is the function of potassium nitrate in sensitive toothpastes

A

blocks transmission of nerve pain from tooth to brain
usually 5%

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4
Q

what is the function of strontium chloride in sensitive toothpastes

A

strontium ions block fluid flow in dentine tubules

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5
Q

what is the function of novamin in sensitive toothpastes

A

calcium formulation in sensodyne that builds a protective layer over enamel/dentine

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6
Q

what is the function of stannous fluoride in sensitive toothpastes

A

provides a shield that occludes dentine tubules

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7
Q

how does exposure to cold stimulus lead to tooth sensitivity

A

the cold stimulus decreases the hydrostatic pressure of the fluid within the dentine tubules, this causes an outward fluid flow away from the pulp which stretches the nerve terminal within the tubule and leads to action potentials firing in A-beta and A-delta nerves (large and small myelinated fibres that cause sharp pain in response to touch, and pain/temperature respectively)

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8
Q

how does the rate of fluid flow within dentine cause sensitivity

A

nerve endings from the pulp extend into the dentine tubules
the stimulus increases the rate of the fluid flow in the tubules which generates action potential in the nerves, leading to pain
works by a hydrodynamic mechanism

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9
Q

what are the risk factors for hypertension

A

stress
high caffeine intake
smoking tobacco
alcohol
high salt intake
genetics (family history of heart disease)

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10
Q

explain the blood pressure reading of 164/102 mmHg

A

stage two hypertension (>160/>100) requires multiple medications and lifestyle changes

the top number (systolic pressure) is the force the heart pumps blood around the body
the bottom number (diastolic) is the resistance to blood flow in blood vessels between heart beats

important to treat as it puts the patient at risk of heart attack, strokes, renal failure

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11
Q

how is hypertension treated

A

aim to get BP to <120/90 mmHg
single daily drug dose (ACE inhibitors, B blockers, Ca channel blockers, diuretics)
modify risk factors (lower salt intake, exercise, lower caffeine, stop smoking, reduce alcohol)

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12
Q

how does hypertension relate to the patient’s dental care

A

MI risk (keep dental environment as stress free as possible)
possible link to periodontal disease
dentist can reinforce diet, alcohol, smoking advice
medications have side effects (dry mouth, gingival hyperplasia)

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13
Q

what are the risk factors for malignant melanoma

A

UV light (UVB causes melanoma) and repeated sunburns
immunosuppression (steroids, diabetes)
age
pale skin
previous radiotherapy

this patient worked in the Middle East for many years without sunscreen

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14
Q

how is malignant melanoma diagnosed

A

ABCDE checklist: asymmetric, borders (ragged), colours (2 or more ie brown/red/grey), diameter (>6mm), enlarged or elevated

new mole that is getting bigger and changing shape or colour and bleeding/itchy/crusty

commonly on the back in males, and legs in women

excision biopsy
MRI
CT scan

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15
Q

what is a sentinel lymph node biopsy

A

determines microscopic melanoma that has spread to lymph nodes
done at same time as excisional biopsy of stage 1B-2C skin cancer
blue dye injected into where the mole was removed from and follows the path the melanoma has spread to
the first lymph node the dye reaches is the sentinel lymph node - if not affected then very unlikely to have spread to other nodes

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16
Q

how was this patient’s malignant melanoma treated

A

stage 2C (melanoma thicker than 4mm and the outermost layer of skin is ulcerated) was treated with surgery (wide local incision to remove the melanoma and a small area of unaffected tissue around it)

he had a sentinel lymph node biopsy that showed no spread

he is monitored every 4 months for new melanoma/return of original melanoma/ lymph node spread

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17
Q

how may malignant melanoma manifest in the oral cavity

A

very rarely in the mouth but if it is there it is aggressive

brown/red/grey swelling

risk factors = HPV, alcohol, smoking, genetics, poorly fitting denture

differential diagnosis = melanotic macule, mole, amalgam tattoo, Addison’s

if treated with radiotherapy to the head and neck it puts the patient at risk of osteoradionecrosis of the jaw (bone dies as the lumen of blood vessels shrinks in response to irritation from the radiation and there is no blood flow to bone) and radiation caries (xerostomia from destroyed salivary glands)

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18
Q

what is osteoarthitis

A

degenerative joint disease affecting weight bearing joints
cartilage repair dysfunction means that the cartilage in joints becomes thinner and bones rub together, leading to pain

not wear and tear

commonly in weight bearing joints like hips and knees

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19
Q

what are the signs and symptoms of osteoarthritis

A

joint pain that improves with rest
loss of funciton
immobility
radiographic changes (loss of joint space and subchondral sclerosis)
crepitus
swelling
MRI shows loss of cartilage

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20
Q

how is osteoarthritis treated

A

nothing alters the disease progression so treat symptoms rather than cause

joint replacement when function is impacted

treat pain with NSAIDs, weight loss to reduce weight on bones, increase muscle strength around joint, walking aids

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21
Q

how might osteoarthritis affect a patient’s dental care

A

access/mobility
manual dexterity
chronic NSAID use can cause oral ulcers and bleeding (anti-platelet)
can affect TMJ - flattening of condylar head and subchondral sclerosis

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22
Q

what is Felodipine’s mechanism of action

A

Ca channel blocker that is used to treat hypertension and angina

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23
Q

what are the side effects of felodipine

A

dizziness, headache
gingival hyperplasia (tough swelling of the gums caused by increased fluid retention and fibrocytes causing inconsistent growth and gingival bleeding)

grapefruit can worsen side effects as it blocks the enzyme that breaks down (metabolises) the drug so more enters the blood

can interact with erythromycin and clarithromycin (second line antibiotics) and fluconazole and miconazole - increased exposure to felodipine
can interact with GTN spray and nitrous oxide - risk of hypotension

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24
Q

what is naproxen’s mechanism of action

A

NSAID that treats pain and inflammation associated with rheumatic disease by decreasing prostaglandin synthesis (by blocking COX1 and COX2), increasing prostacyclin and decreasing thromboxane A2
inhibits platelet aggregation so can increase patient’s bleeding risk

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25
Q

what are the side effects of naproxen

A

bleeding risk (up to 1h - factor in to appointment time) due to inhibiting platelet aggregation
stomach ulcer risk, especially with prolonged use
agranulocytosis (severely low WBC)
when taken with excessive alcohol use there is an increased risk of GI haemorrhage

treat without interrupting medication; use local haemostat measures; limit treatment area (1 XLA at a time); effect lasts 7 days after last dose as the platelet is affected for the lifespan of the platelet

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26
Q

what is omeprazole’s mechanism of action

A

proton pump inhibitor prevents the release of gastric acid from parietal cells in the stomach
used to treat H pylori infection/ gastric ulcers (prophylaxis for patients with prolonged NSAID use)/ GORD

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27
Q

what are the side effects of omeprazole

A

dry mouth
bone fracture with prolonged use - gastric acid secretion increases calcium absorption so reduced gastric acid secretion means there is low calcium absorption, leading to low bone density and possible osteoporosis
tell patients to increase their calcium and vitamin B12 to prevent this

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28
Q

what is paracetamol’s mechanism of action

A

painkiller and anti pyretic that inhibits prostaglandin synthesis (lipids found at the side of damage/inflammation)

dentists can prescribe at 2x 500mg tablets taken 4x a day for 5 days

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29
Q

what are the side effects of paracetamol

A

thrombocytopenia
over dose = >4g in 24h (8 tablets); signs tend to develop 4-6 days later and include vomiting, nausea, right subcostal pain/tenderness

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30
Q

what is sertraline’s mechanism of action

A

selective serotonin reuptake inhibitor (SSRI) used to treat depression/OCD/PTSD

this patient is prob on sertraline as tricyclic anti depressants such as amitriptyline interact with felodipine (cayuse hypotension)

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31
Q

what are the side effects of sertraline

A

dry mouth
bruxism - indirectly lowers dopamine levels (dopamine inhibits jaw clenching)
altered taste
postural hypotension

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32
Q

what is simvastatin’s mechanism of action

A

statins inhibit enzyme-dependent cholesterol synthesis in the liver, leading to reduced total and LDL cholesterol levels

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33
Q

what are the side effect of simvastatin

A

myopathy (muscle weakness/spasms)
thrombocytopenia
erythromycin/clarithromycin/miconazole/fluconazole all cause increased exposure to simvastatin so risk myopathy

nystatin oral suspension is the preferred anti fungal treatment for this patient

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34
Q

what causes TMJ clicking

A

lack of coordinated movement between the condyle and the articular disc
the condyle has to overcome the mechanical obstruction before full joint movement can be achieved
the disc is initially displaced anteriorly by the condyle during opening until disc reduction occurs - the clicking noise is the disc snapping back into place
signs and symptoms include jaw stiffness, mandible deviating to the affected side on opening
can progress to osteoarthritis if left untreated

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35
Q

what does a facebow measure

A

the relationship of the maxillary teeth to the terminal hinge axis of rotation (an imaginary horizontal line drawn through the condylar heads)
it is used to mount the upper cast on an articulator (the lower cast is mounted based on the occlusal record - done in RCP for this patient)
Denar facebows also record the inter condylar distance (used when mounting on semi or fully adjustable articulator)

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36
Q

what are the functions of each of the muscles of mastication

A

masseter - elevates and retracts the mandible
temporalis - elevates and retracts the mandible
lateral pterygoid - protrudes, depresses and moves the mandible laterally
medial pterygoid - elevates, protrudes and moves the mandible laterally

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37
Q

what is rotational movement of the mandible

A

20mm opening of the mandible around the terminal hinge axis
the condyle head and articular disc remain in the articular fossa and there is no downward or forward movement of the condyle

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38
Q

what is lateral translation of the mandible

A

lateral pterygoid contracts on the non working side to move the mandible to the working side (ie if the mandible moves to the patient’s right their right is the working side) = Bennet movement

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39
Q

what is the Bennet angle

A

Bennet angle is made with the sagittal plane and the path of the non working condyle during lateral translation of the mandible when viewed in a horizontal plane

40
Q

describe the positions in the posset’s envelope

A

RCP = retruded contact position = first tooth contact when the mandible is in the retruded axis position; used in wear cases where there are insufficient index teeth to create a reproducible ICP

ICP = intercuspal position = tooth position regardless of condyle position; the best fit of teeth; AKA centric occlusion

edge to edge

protrusion

T = maximum opening = no tooth contact; full translation of the condyle over the articular eminence

R = retruded axis position = no tooth contact; most superior anterior position of the condylar head in the fossa

41
Q

what is canine guidance

A

during lateral movements of the mandible only the canines touch
this discludes the posterior teeth and protects them from horizontal forces (mutually protected occlusion)

42
Q

what is group function

A

there are multiple teeth contacting on the working side during lateral movements (buccal to buccal cusp is preferred)

commonly have bilateral group function in wear cases; this means that there are lateral forces on posterior teeth and the muscles don’t get a rest

43
Q

why is RCP used in wear cases

A

there are insufficient index teeth to gain a stable, reproducible ICP

44
Q

what is OVD

A

the superior-inferior relationship between the maxilla and the mandible when the teeth are in occlusion

45
Q

what evidence suggests increasing the OVD by 2mm is appropriate in this case

A

approximately how much tooth height has been lost
improved facial aesthetics
composite restorations require 1-2mm space to be placed according to the British society of restorative dentistry booklet

46
Q

what are the stages for recording a Denar Slidematic Facebow

A

apply bite registration paste or softened alminax to bite fork; seat with the locating arm on the patient’s right hand side and allow the wax to harden; recheck it can be seated into the correct position in the mouth

use a ruler to mark the anterior reference point on the patients face (43mm above the incisal edge of the lateral incisor)

assemble the transfer jig to the ear bow and tighten the screw securely

position the bite for intra-orally and ask the patient to hold in place (the numbers 1 and 2 should face the operator); insert the bite fork into clamp 2

ask the assistant to gently guide the ear bow into the external auditory meatuses and tighten the anterior connecting screw

adjust and position the ear bow vertically until the locating arm is aligned with the anterior reference marked on the patient’s face; tighten screw 1 to secure this position

tighten screw 2

detach the facebow from the bite fork and transfer jig; disinfect and send to lab ensuring the screws are tightened

47
Q

what is the intercondylar distance on a semi adjustable articulator

A

110mm

Bennet and condylar guidance angles are set by operator

48
Q

what are the set values of an average value articulator

A

bennet angle set at 15 degrees

condylar guidance angle set at 30 degrees; the angle formed by the Frankfort plane at the head of the condyle and the path of the condyle during function

49
Q

name the types of articulator and when each should be used

A

semi and fully adjustable - require facebow registration and are used in cases with group function that require multiple adjustments

simple hinge and average value - used in cases with canine guidance where the posterior teeth disclude during lateral movements
arcon

50
Q

how would you explain the radiation of a peri apical radiograph to a patient

A

daily background radiation is 10uSv, eating a banana is 0.1uSv, getting a peri apical is 0.2uSv, getting an OPT is 10uSv

51
Q

what are some problems with sensibility tests

A

the tests stimulate nerve fibres which may not directly correlate with blood supply so cannot indicate the state of blood supply; tooth vitality is related to blood supply, not nerve transmission

there can also be issues in testing multi rooted teeth

peri radicular inflammation occurs before the pulp is totally necrotic

laser doppler is needed to assess blood flow

52
Q

how does an electric pulp test work

A

stimulates sensory A-delta nerve fibres at the pulp-dentine junction
unmyelinated C-fibres may or may not respond

positive response suggests there is vital pulp tissue in the coronal aspect of the pulp chamber; no indication of reversibility of inflammation; no correlation between pain threshold and pulp condition (measurement of electric voltage/ score is not accurate)
negative response indicates pulpectomy is required in 97% of cases

EPT is unreliable in young teeth (open apices) or recently traumatised

53
Q

what is the procedure for an electric pulp test

A

dry teeth - prevents current transferring to adjacent teeth
isolate tooth
conducting medium (toothpaste) on tip of EPT probe
EPT placed adjacent to pulp horn (incisal edge or cusp tip) as most sensory nerves are found here
patient completes the circuit by holding the EPT
current slowly increased and patient indicates when tingling/heat sensation is felt

test tooth in question, then contralateral, then tooth question

54
Q

how do thermal sensibility tests work

A

hydrodynamic forces cause fluid movement within dentinal tubules in response to thermal stimulus

55
Q

how would you perform a cold sensibility test

A

cotton pellet sprayed with ethyl chloride/ difluorochloromethane (-500 degrees Celsius)/ endo-ice (-27.2 degrees celsius)
placed on dried and isolated tooth, next to pulp horn

or isolate tooth with dam and no LA and spray cold water and air on tooth

negative response is highly indicative of pulp necrosis

56
Q

why are heated sensibility tests not commonly used

A

too much heat can cause irreversible pulpitis

hot GP cone or green stick are added to tooth

57
Q

how could age impact response to sensibility tests

A

continued dentine formation reduces pulp size and volume over time
dentine has increased fibrous content and calcification
dentine has decreased cellular components and number of blood vessels/nerves
overall the pulp is less likely to reverse an inflammatory response

58
Q

what are the contra indications to using en electric pulp test

A

patients with cardiac pace makers as the test may interfere with the electric activity of the tooth

teeth with open apices as the relationship between the nerve fibres and the odontoblasts has not fully developed yet so my lead to a false negative reading

59
Q

what may lead to a false negative EPT result

A

extensive caries
high amount of reparative dentine
patients heavily medicated with analgesics
teeth with open apices
recently traumatised teeth
improper placement of EPT tip
low battery of EPT

60
Q

what may lead to a false positive EPT result

A

presence of partially necrotic pulp in one root of multi rooted teeth
EPT tip contacting any part of the oral mucosa
anxious patient pre emptying the sensation
improper isolation of tooth

61
Q

what evidence suggests the benefit of using cold pulp test as well as EPT to determine pulp vitality

A

BMC Oral Health (peer reviewed journal) has an article by Huachao Sui et al published in July 2021 that suggests both EPT and cold pulp tests have “similar reliability in judging pulp vitality and are both superior to hot pulp tests. As pulp sensibility testing is subjective, combining EPT with a thermal pulp test for comprehensive diagnosis and mutual verification is warranted”

62
Q

how can toothwear be measures

A

tooth wear indices such as BEWE, ACE, TWI
3D scans
photos
study casts
sectional silicone index
radiographs

63
Q

discuss the Smith and Knight tooth wear index from 1984

A

used to measure and diagnose multi factorial tooth wear
each surface of the tooth is scored based on the extent of enamel/dentine/colour lost (0 - 4)
mostly used or research as time consuming and need a computer programme to account for all the data collected
can underestimate pathological tooth wear as the estimations for tooth wear related to age (physiological tooth wear) are high

64
Q

what are the scores for the simplified tooth wear index

A

0 no wear into dentine
1 dentine just visible (including cupping) or dentine exposed
2 dentine exposure greater than 1/3 of surface
3 exposure of pulp or secondary dentine

65
Q

discuss the use of the BEWE

A

basic erosive wear examination
based on the BPE screening tool to guide management of toothwear
simple, easy, reliable, consistent results between clinicians
most severely affected surface of each sextant is scored and the cumulative score is added together to dictate risk of progression and management

some discrepancy between examiners when scoring enamel lesions

66
Q

what are the sextant scores for BEWE

A

0 no erosive tooth wear
1 initial loss of surface texture
2 distinct defect, hard tissue loss <50% of the surface area
3 hard tissue loss >50% of the surface area

scores 2 and 3 often involve dentine

67
Q

what are the risk levels and guides to clinical management for BEWE

A

none (2 or less) - routine maintenance and observation; repeat at 3 year intervals
low (3-8) - OH and dietary assessment and advice; routine maintenance and observation; repeat at 2 year intervals
medium (9-13) - OHI and diet advice; identify the main etiological factor(s) for tissue loss and develop strategies to eliminate respective impacts; consider fluoridation measures to increase the resistance of tooth surfaces; ideally avoid placement of restorations and monitor erosive wear with study casts/photos/silicone index; repeat at 6-12 months
high (14 or more) - as for medium; consider special care that may involve restorations in cases of severe progression

68
Q

discuss the Anterior Clinical Erosive (ACE) Classification

A

developed to be easier than BEWE; score based on most severely affected tooth
patients are grouped into 1 of 6 classes based on 5 parameters relevant to treatment and prognosis
a treatment plan is suggested for each class
only looks at anterior maxillary teeth

69
Q

what are the five parameters of the ACE classification

A

dentine exposure in contact points
preservation of incisal edges
length of remaining clinical crown
enamel on buccal surfaces
pulp

70
Q

what are the benefits of a lower soft splint

A

easy to manufacture
easy for patient to get used to
won’t wear down restorations - best suited for patients with cosmetic restorations

paper by Sameh and Khaled published by the Saudi Dental Journal in 2015 showed that both soft and hard splints improved TMD symptoms in patients with internal derangement or myofacial pain after 4 months; however soft splints exhibited superior results (dentist measured all parameters of TMJ function (pain visual analog scores, tenderness of masticatory muscles, clicking and tenderness of the TMJ, and range of mouth opening)

71
Q

explain how you recorded the modified plaque and bleeding scores

A

ramfjord’s teeth (16, 21, 24, 36, 41, 44) are used in order to best reflect the condition of the whole mouth

plaque - interproximal/buccal/lingual surfaces scored 0 (no plaque)/ 1 (plaque on probe when skimmed across gingival margin)/ 2 (visible plaque); scores added together and divided by 36 (or 30 if one tooth missing like in this patient) then x100 to get percentage

bleeding - mesial/buccal/distal/lingual surfaces scored 0 (no marginal bleeding)/ 1 (bleeding up to 30s after probe swept around the gingival sulcus); scores are added together and divided by 24 (or 20 if one tooth missing like in this patient) then x100 to get percentage

72
Q

describe the process of making immediate dentures

A

take upper and lower alginate impressions and medium body PVS bite registration
request perforated special trays and wax occlusal rims
take master impressions, perform jaw reg, take a shade
request wax try in denture
perform wax try in and ask lab to process, noting which teeth are being replaced (can request a socket-fitting denture to control bleeding and allow for gingival contouring)
extract on the same day as denture delivery; ensure haemostasis achieved before denture fitted; remove any sharp or rough areas
give denture advice
replace in 2 weeks then 6 months once the bone has remodelled and they are used to the new OVD

73
Q

what denture advice would you give to this patient

A

wear the temporary’s for 24 hours to protect the formed blood clot; thereafter remove at night and store in water
clean after eating with warm soapy water and a soft toothbrush
if using denture cleaners then follow manufacturer’s instructions
if rubbing then take out and only wear when you need to; wear for the 48h up to the review appointment so we can see where the rubbing is
practice reading aloud to get used to wearing them

74
Q

describe the process of designing the CoCr denture

A

identify saddle areas (Kennedy and Craddock classification)
support - rest seats (tooth borne) and mucosal coverage
clasps - CoCr need to be 15mm (flexibility) and engage in 0.25mm undercuts
reciprocation - resistance to tooth movement on insertion/removal of the denture; given by denture base/ reciprocal arm
indirect retention - resistance to rotational displacement of the denture; placed at 90 degrees to clasp axis; rests/base plate/ minor or major connectors
select connector
simplify design

75
Q

what are the benefits of lingual bar

A

well tolerated by patients
gingival clearance prevents gingival stripping and food packing
easy to maintain good OH

need 8mm (3mm from gingival margin, 4mm width of bar, 1mm from floor of mouth)

76
Q

what are the properties of a ring connector

A

rigid, minimal soft tissue coverage
can annoy the tongue, poor support
not suitable in those with high vaulted palates or palatine tori

77
Q

how does saliva buffer the acidic oral environment

A

carbonate (pH6.3), phosphate (pH7.2) and amylase/albumin/IgA protein (<pH5) buffers act to neutralise the acidic environment caused by cariogenic bacteria (streptococcus mutans and lactobacilli)

78
Q

what is attrition

A

tooth wear caused by friction of contacting surfaces of teeth
can be physiological (by age) or pathological (clenching/grinding)
presents as flattened cusp tips and incisal edges
lack of posterior support exacerbates attrition

79
Q

what is erosion

A

chemical process that doesn’t involve bacteria action
bilateral concave lesions with translucent incisal edges
severity depends on type and frequency of acid (titratability means that something may be more acidic by neutralised quicker so causes less damage)

80
Q

how could GORD contribute to erosion

A

intrinsic source of acid with a pH 1
instruct patient to rinse with bicarb or water after reflux and wait 30m to brush teeth

81
Q

how is stomach acid produced

A

parietal cells in the stomach respond to acetylcholine, histamine and gastrin to produce and pump out acid
all three of these must be blocked to prevent acid transport

82
Q

what medications can be used to treat GORD

A

H2 receptor antagonists (ranitidine) - prevent histamine activation of acid production; limited affects as alternative pathways still open

PPIs (omeprazole) - stop acid secretion; very effective; steroids and NSAIDs have a side effect of gastric bleeding so PPIs help protect from this

antacids - don’t stop reflux; turn acids into salt

can also be treated by losing weight, avoid triggering activity, stop smoking (improves sphincter)

83
Q

what are the causes of GORD

A

defective lower oesophageal sphincter
impaired lower clearing
impaired gastric emptying

84
Q

what are the signs and symptoms of GORD

A

heartburn
epigastric burning (worse lying down)
dysphagia
GI bleeding
severe pain mimics MI - oesophageal muscle spasm

can lead to ulceration, inflammation, metaplasia (Barrett’s oesophagus where the epithelium changes from simple columnar to stratified squamous - risk of adenocarcinoma or SSC)

85
Q

why is aetiology important when planning treatment for a toothwear patient

A

attempt to reduce further wear
plan for contingencies and failure
allow you to be realistic with yourself and the patient
identifies wider wellbeing issues that can be signposted
prognosis indicator
enhances consent
aids clinical diagnosis and treatment planning

86
Q

what are the modifying factors for attrition

A

lack of posterior teeth increases rate of wear on remaining teeth
occlusion (edge to edge)
restorations (ceramic crowns)
combination with erosion (synergistic)
stress and anxiety increase the progression of wear

87
Q

what are the modifying factors for erosion

A

amount and frequency
level of control
intrinsic = eating disorders, GORD, poorly controlled diabetes
extrinsic = fizzy drinks, swimming, inhalers, alcohol, fruits

88
Q

what are the common features of erosion

A

initially on palatal of upper centrals
cupping on lower molars
sensitivity
interproximal caries
polished/ erosion around restorations

89
Q

what is some common preventative advice for toothwear

A

ensure all advice is individualised
high F intake (alcohol free mouthwash and toothpaste)
dietary modification (frequency, quantity, method of delivery, elimination and addition)
tooth brushing instruction (wait 30 mins after acid intake; spit don’t rinse)
signposting to CBT or GMP as some aetiology may be outside of scope of GDP

90
Q

why is it important to preserve teeth in bruxism patient

A

aim to avoid full dentures as bruxism doesnt stop so can lead to fractured dentures, ridge resorption, pain and ulceration under complete denture

91
Q

how can bridgework be used to simplify small saddles

A

the Pontic is made of ceramic which is inherently stronger than acrylic denture tooth so less likely to break
need to ensure that it is not involved in protrusive or excursive movements otherwise it could fail

92
Q

what can be done with the diagnostic wax ups to aid placement of the composite build ups

A

the diagnostic wax ups are made to the new increased OVD and they are cast into stones that give new working casts that can be used to make stents which act as templates to place the temporary or permanent build ups

the stents can be hard acrylic vacuum formed; or made from semi clear silicone (memisil) that can be made on the wax ups so don’t need to make the stone working casts and can cure the composites through the memisil

93
Q

what evidence is there for managing tooth wear

A

direct composites have annual failure rates of 0.7%-26.3% (Hemmings et al 2000)
parafunctional activity can result in devastating forces that increase risk of mechanical failure at restoration and tooth level (Hemmings et al 2018)
frequent failure of denture components (Hemmings et al 2018)
patients need realistic expectations of future reconstruction so they do not attribute failure to inadequate clinical work (Hemmings et a 2018)

94
Q

what are the keys to success when managing failure in tooth wear cases

A

comprehensive history and exam (information gathering)
thorough planning
seek advice if needed
prevention !
avoid over ambitious treatment !
effective communication !
decision making and treatment planning around basic principles
keep plans simple
have effective maintenance strategy and regularly reassess the situation

95
Q

how can you ensure effective communication when managing failure

A

effective listening
honesty and transparency
taking patients wishes into account
addressing difficult issues
seeking advice
giving patients a reality check
documenting discussions
being assertive and compassionate
time and patience
avoiding patient led treatment
have a holistic approach to treatment

bds4 (13 decks)

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