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4 - misc > case pres > Flashcards

case pres Flashcards

1
Q

What is hypertension?

A

Elevated blood pressure
Stage 1 - 140/90 mmHg
Stage 2 - 160/100 mmHg

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2
Q

What is the difference between systolic and diastolic?

A

Systolic - pressure exerted by blood against artery walls when heart contracts
Diastolic - minimum pressure in arteries between heart beats

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3
Q

Issues treating patients with hypertension

A

Risk factor for CVDs including MI, stroke
Monitor blood pressure before tx
Stress reduction during anxiety inducing procedures - distraction, calming
If poorly controlled can delay healing, impairing oxygen delivery to tissues

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4
Q

How to recognise a stroke

A

FAST
Face drooping
Arm weakness
Speech difficulties
Time - call emergency services

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5
Q

Symptoms of a cardiac emergency

A

Shortness of breath
Increased respiratory rate
Pale and clammy
Nausea and vomiting
Weakened pulse, low B

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6
Q

How to tx angina/MI

A

Administer 100% O2 15L/min
GTN glyceryl Trini trate 2 puffs 400mcg per metered dose sublingual
Repeat after 3 minutes if chest pain remains
Call an ambulance
Aspirin 300mg orally

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7
Q

How does GTN work

A

Dilates blood vessels to increase blood supply to the heart

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8
Q

What is GORD

A

Gastro-oesophageal reflux disease
Stomach acid flows back into the oesophagus leading to inflammation and irritation
Lower oesophageal sphincter relaxes leading to heartburn and an acidic taste, dysphagia and chest pain

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9
Q

Dental implications of GORD

A

Tooth erosion - dentine hypersensitivity, increased caries risk, discolouration and gingival inflammation

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10
Q

Dental advice for GORD patients

A

Good OH - brush 2x daily, at least 30 minutes after eating with fluoridated toothpaste
Rinse with water after episodes of acid reflux to help neutralise residue stomach acid and minimise the effects on the enamel
Avoid brushing directly after reflux episodes - will exacerbate the erosion
Sugar free chewing gum to stimulate saliva and neutralise acids
Elevate head during sleep has been shown to help

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11
Q

What is erosion

A

The loss of tooth surface by a chemical process not involving bacterial action

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12
Q

What does erosion look like?

A

Early - enamel surface detail lost, surface becomes flat and smooth
Later - dentine becomes exposed, leads to cupping of occlusal surfaces

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13
Q

What is depression

A

Mental health disorder characterised by persistent feelings of sadness, hopelessness and loss of interest in activities that were once enjoyable
Associated with changes in sleep, appetite and fatigue

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14
Q

How is depression diagnosed?

A

By a healthcare professional using NICE guidelines
Clinical assessment
Diagnostic criteria
Look at severity
Look at duration and persistence

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15
Q

What meds commonly treat depression

A

SSRIs - inhibit serotonin reuptake
SNRIs - inhibit reuptake of serotonin and noradrenaline
TCA - block serotonin and noradrenaline, and have added effects on histamine and acetylcholine

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16
Q

How may depression affect pts?

A

Oral hygiene neglect
Dietary changes - increased sugar or irregular eating patterns
Dry mouth as a side effect from drugs
Bruxism
More likely to experience dental anxiety
More at risk for systemic health problems such as diabetes or CVD which could impact oral health

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17
Q

How can a dentist help pts with depression?

A

Oversee and listen to pt
Build trust and a good rapport
Express concerns and offer support
Provide info and refer to mental health professionals
Follow up and monitor
Continued education about mental health issues

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18
Q

What is amlodipine

A

Calcium channel blocker used to treat hypertension and angina

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19
Q

Amlodipine mechanism of action

A

Blocks calcium channels in the cell membranes of smooth muscle and cardiac muscle
By inhibiting calcium influx it causes relaxation of the smooth muscles of the blood vessels leading to vasodilation

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20
Q

Amlodipine contraindications

A

Unstable angina - may occur at rest of with minimal exertion, more severe and prolonged

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21
Q

Amlodipine cautions

A

Postural hypotension - risk of syncope and falls
Raise the dental chair slowly and supervise patient getting up

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22
Q

Amlodipine side effects

A

Gingival hyperplasia
Depression
Syncope
Palpitations

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23
Q

What is bisoprolol

A

Beta blocker used to treat hypertension and angina

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24
Q

Bisoprolol mechanism of action

A

Blocking the beta adrenergic receptors found in the heart and blood vessels
This reduces the effect of adrenaline and noradrenaline on the heart and blood vessels
This reduces heart rate and decreases the forces of contraction of the heart, lowering blood pressure by reducing workload on the heart and dilating blood vessels

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25
Q

Bisoprolol contraindications

A

Asthma
Hypotension

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26
Q

Bisoprolol cautions

A

Beware of potential airway obstruction
Portal hypertension - high blood pressure in the liver where blood is being transported to from abdominal organs

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27
Q

Bisoprolol side effects

A

Depression
Syncope
Bradycardia
Bronchospasm - constriction of the muscles surrounding the airways

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28
Q

What is esomeprazole

A

Proton pump inhibitor used to treat excessive stomach acid such in GORD

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29
Q

Esomeprazole mechanism of action

A

Inhibits proton pumps in the cells of the stomach lining, specifically the hydrogen-potassium ATPase enzyme which plays a key role in stomach acid production
Gives symptomatic relief

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30
Q

Difference between esomeprazole and omeprazole

A

Esomeprazole more potent and used for long term management of GORD in certain cases

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31
Q

Esomeprazole side effects

A

Abdominal pain
Dry mouth
Depression rarely
Stomatitis

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32
Q

What is venlafaxine

A

Serotonin-noradrenaline reuptake inhibitor (SNRI) used to dread depression and generalised anxiety

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33
Q

What is the mechanism of action of venlafaxine?

A

Increases levels of serotonin and noradrenaline in the brain
These neurotransmitters are involved in regulating mood, emotions and anxiety
Enhances their effects in the brain to alleviate symptoms

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34
Q

Venlafaxine cautions

A

Follow prescriber instructions - discontinuation can lead to withdrawal symptoms

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35
Q

Venlafaxine contraindications

A

Uncontrolled hypertension - bp should be monitored

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36
Q

Venlafaxine side effects

A

Anxiety
Dry mouth
Bruxism
Oral ulceration
Bleeding????
Hypertension
Dysgeusia

37
Q

What is dental anxiety?

A

A general type of fear occurring without a present triggering stimulus
Anticipatory due to previous negative experiences

38
Q

Why were bitewings taken?

A

To assess for caries
Can be used to view coronal bone loss

39
Q

Why were periapicals taken?

A

To view root morphology, periapical pathology, gain info on canal system

40
Q

What is IRR and IRMER

A

Ionising Radiation Regulations
Ionising Radiation (Medical Exposure) Regulations

41
Q

What are the IRMER regulations

A

Minimising unintended, excessive or incorrect medical exposures
Justifying each exposure - benefit outweighs risk
Optimising doses to keep them as low as reasonably practicable

42
Q

How are radiographs taken

A

Digital sensor placed inside the mouth adjacent to the teeth being examined
X-ray tube is placed outside of the mouth directed towards the area being imaged
Collimated focuses the X-ray beam and reduces scatter
X-ray machine is activated and X-rays pass through the teeth and surrounding the tissues
Image is then processed

43
Q

How are x-rays produced?

A

Negative cathode and positive anode
Electrons released at cathode filament repelled away and attracted to the anode
Electrons have high kinetic energy upon colliding with anode which produces the x-ray beams

44
Q

Timeline for taking radiographs?

A

2 years for low risk
6 months for high risk
Can be tailored to individual needs
Based on FGDP guidelines - faculty of general dental practice

45
Q

Methods of sensibility testing

A

Thermal testing - cold with ethyl chloride endo frost -50ºC
Electric pulp testing

46
Q

Expected results from ethyl chloride test

A

If tooth has a nerve supply it should have positive results and pt will feel the cold
Exacerbated with pulpitis

47
Q

How to use EPT and expected result

A

Dry tooth and use toothpaste as conductive medium
Electric stimulus applied at different intensities
Tests A delta fibres primarily
Compare to adjacent tooth
If pulpitis should get reactions to lower intensities

48
Q

What is attrition

A

The physiological wearing away of tooth structure as a result of tooth to tooth contact

49
Q

What causes attrition

A

Almost always related to a parafunctional habit eg - Bruxism

50
Q

What are the signs of attrition

A

Flattened tooth surfaces - wear facets
Increased sensitivity
Fractured or chipped teeth
Repeated restoration failure
Parafunctional habits

51
Q

Why are clinical photographs important?

A

To document a visual record of the oral condition
To communicate with and educate patients
Aids in treatment planning and diagnosis
Legal documentation

52
Q

Why are modified plaque and bleeding scores useful

A

Assess oral hygiene
Monitor periodontal health
Identify high risk areas
Patient motivation

53
Q

Why are diet diaries useful

A

To identify dietary risk factors
To see hidden sugars
Assess snacking frequency, and choices of food and drinks
All this may contribute to caries, erosion and periodontitis

54
Q

Difference between primary and secondary caries

A

Primary - initial lesions, new areas of decay
Secondary - also known as recurrent - areas that have been previously affected by decay or have undergone dental treatment such as restorations and crowns

55
Q

What dietary advice should be given to patients

A

Snack on healthier foods low in sugar eg - fresh fruit, oatcakes, cheese
Don’t eat or drink apart from tap water after brushing at night
Be aware of hidden sugars in foods
Be aware of acid content of drinks and restrict carbonated drinks to meal times choosing low or zero sugar varieties

56
Q

How can you tell if a radiograph is diagnostically acceptable

A

Good image quality
Proper positioning
Minimal artefacts
Correct exposure

57
Q

What is pulp necrosis

A

When the pulp loses blood supply leading to the death of the pulp tissue

58
Q

What is apical periodontitis

A

Inflammation and infection around the apex of a root

59
Q

What is generalised gingivitis

A

> 30% bleeding on probing with no obvious evidence of interdental recession

60
Q

What OHI was given

A

Brush 2x daily with 1,450ppm fluoridated toothpaste
Spit don’t rinse
Fluoridated mouthwash during day at different time to brushing eg - after a meal
ID cleaning 1x daily with floss

61
Q

What perio tx was carried out?

A

Step 1 - building foundations for optimal tx:
- explain gingivitis, OHI, risk factor modification (supra-gingival PMPR)

62
Q

What makes the toothwear physiological and not pathological

A

Toothwear is within a normal range for the patients age and isn’t causing any symptoms or sensitivity or causing difficulties with mastication

63
Q

What is normal physiological tooth wear

A

20-38 micrometers per year

64
Q

Why was composite used over amalgam?

A

For each restoration there was adequate moisture control to place composite
It has better aesthetics and bonds to enamel and dentine
Cavity prep is driven by caries removal and so less sound tooth structure was removed
Less thermal conductivity to pt less likely to experience sensitivity to hot or cold

65
Q

Why was only fluoride varnish used

A

SDCEP guidelines state that initial carious lesions should be treated with site specific prevention

66
Q

Different methods of caries removal

A

Complete caries removal
Selective caries removal - first choice for deep lesions
Stepwise caries removal

67
Q

What is selective caries removal

A

Clear peripheral caries completely to hard dentine to allow good bonding
Remove caries over pulp to firm dentine only as to not expose pulp

68
Q

What is stepwise caries

A

First visit - remove enough soft dentine so good temporary restoration can be placed
CSC placed and then restored with GIC - over time caries will arrest
Second visit - remove temp and remove caries to firm dentine, place a definitive restoration

69
Q

What is complete caries removal

A

Removing all caries to hard dentine even if pulp exposure occurs

70
Q

Why stepwise

A

If preparing cavity and dentine is not firm enough and you are close to the pulp

71
Q

Benefits and risk of selective caries removal

A

+ lower risk of pulp exposure especially if using bio dentine
+ saves clinical and pt time and cost compared to stepwise
- if pt sees new dentist, may appear to be caries radiographically
- if caries left, dentine may shrink and impair coronal restoration which could lead to pulpal complications

72
Q

Benefit and drawbacks of stepwise

A

+ less pain, less pulp exposures and inc number of vital pulps compared to complete caries removal
- two visits needed
- higher chance of irritating pulp as drilling into tooth twice

73
Q

Benefit and drawbacks of complete caries removal

A

+ all caries removed - no risk of leaving infected dentine behind
- higher risk of pulp exposure
- potential leading to pulp necrosis due to introduction of bacteria into the pulp

74
Q

Why is a core being used in 27

A

To replace missing coronal tooth structure prior to restoring with an indirect restoration as more than 50% of the coronal part of the tooth is missing

75
Q

When is 27 reviewed radiographically

A

6 months according to FGDP - tailored to pt situation
Before placing any indirect restoration

76
Q

Why is the patient being reviewed in 3 months

A

SDCEP guidance - high caries rate and presence of non-protective modifying factors such as frequent dietary acid intake and gastric reflux makes the pt high risk and so should be seen with a minimal interval of 3 months

77
Q

Why were 11 and 21 only added to and not built up

A

Looking at the dynamic occlusal relationship there wasn’t enough space to increase the height of the incisors without significantly increasing the risk of the composite fracturing
Explained to pt that even masking the wear defects the composite could potentially fall off and pt was happy with this

78
Q

Reasons for using a lithium disilicate crown

A

Good aesthetic appearance
Flexural strength comparable to the natural tooth - can withstand forces of mastication and resist fracture so suitable for posterior teeth
Biocompatible and well tolerated by oral tissues
Can be bonded directly to the tooth structure

79
Q

Why was a lower soft splint used

A

Pt toleration better than upper
Won’t need to remake the splint when providing upper indirect restorations

80
Q

What are the reasons against using splint in GORD/erosion

A

May exacerbate the erosion - monitor toothwear closely and stop using splint if any signs of erosion progressing

81
Q

How should toothwear be monitored

A

Regular clinical examinations and radiographs to be compared to previous ones
Tooth wear indices such as BEWE
Study models

82
Q

What are the dimensions of an emax prep

A

Axial reduction - 1.5mm
Funcional cusp - 2mm
Non-functional cusps - 1.5mm
Chamfer

83
Q

How do you bond to emax

A

Emax - etch with hydrofluoric acid, then phosphoric acid to clean off hydrofluoric acid excess, apply silane coupling agent
Enamel - etch with phosphoric
Cure with dual cure composite and dentine bonding agent

84
Q

What are the options to restoring the spaces

A
85
Q

What other materials can be used for crowns

A

Metal crowns - gold
Ceramic - porcelain
Metal ceramic
All ceramic - porcelain bonded to alumina or zirconia framework

86
Q

Reason for composite onlay

A

Good aesthetics
Reduction in polymerisation shrinkage as it is cured in the lab
Bond to tooth structure

87
Q

What other materials can be used for onlays

A

Gold
Ceramic

88
Q

Reasons for MCC over emax

A

If tooth is under especially high occlusal forces
For a less invasive prep

4 - misc (10 decks)

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