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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
Bisoprolol contraindications
Asthma Hypotension
26
Bisoprolol cautions
Beware of potential airway obstruction Portal hypertension - high blood pressure in the liver where blood is being transported to from abdominal organs
27
Bisoprolol side effects
Depression Syncope Bradycardia Bronchospasm - constriction of the muscles surrounding the airways
28
What is esomeprazole
Proton pump inhibitor used to treat excessive stomach acid such in GORD
29
Esomeprazole mechanism of action
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
30
Difference between esomeprazole and omeprazole
Esomeprazole more potent and used for long term management of GORD in certain cases
31
Esomeprazole side effects
Abdominal pain Dry mouth Depression rarely Stomatitis
32
What is venlafaxine
Serotonin-noradrenaline reuptake inhibitor (SNRI) used to dread depression and generalised anxiety
33
What is the mechanism of action of venlafaxine?
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
34
Venlafaxine cautions
Follow prescriber instructions - discontinuation can lead to withdrawal symptoms
35
Venlafaxine contraindications
Uncontrolled hypertension - bp should be monitored
36
Venlafaxine side effects
Anxiety Dry mouth Bruxism Oral ulceration Bleeding???? Hypertension Dysgeusia
37
What is dental anxiety?
A general type of fear occurring without a present triggering stimulus Anticipatory due to previous negative experiences
38
Why were bitewings taken?
To assess for caries Can be used to view coronal bone loss
39
Why were periapicals taken?
To view root morphology, periapical pathology, gain info on canal system
40
What is IRR and IRMER
Ionising Radiation Regulations Ionising Radiation (Medical Exposure) Regulations
41
What are the IRMER regulations
Minimising unintended, excessive or incorrect medical exposures Justifying each exposure - benefit outweighs risk Optimising doses to keep them as low as reasonably practicable
42
How are radiographs taken
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
How are x-rays produced?
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
Timeline for taking radiographs?
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
Methods of sensibility testing
Thermal testing - cold with ethyl chloride endo frost -50ºC Electric pulp testing
46
Expected results from ethyl chloride test
If tooth has a nerve supply it should have positive results and pt will feel the cold Exacerbated with pulpitis
47
How to use EPT and expected result
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
What is attrition
The physiological wearing away of tooth structure as a result of tooth to tooth contact
49
What causes attrition
Almost always related to a parafunctional habit eg - Bruxism
50
What are the signs of attrition
Flattened tooth surfaces - wear facets Increased sensitivity Fractured or chipped teeth Repeated restoration failure Parafunctional habits
51
Why are clinical photographs important?
To document a visual record of the oral condition To communicate with and educate patients Aids in treatment planning and diagnosis Legal documentation
52
Why are modified plaque and bleeding scores useful
Assess oral hygiene Monitor periodontal health Identify high risk areas Patient motivation
53
Why are diet diaries useful
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
Difference between primary and secondary caries
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
What dietary advice should be given to patients
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
How can you tell if a radiograph is diagnostically acceptable
Good image quality Proper positioning Minimal artefacts Correct exposure
57
What is pulp necrosis
When the pulp loses blood supply leading to the death of the pulp tissue
58
What is apical periodontitis
Inflammation and infection around the apex of a root
59
What is generalised gingivitis
>30% bleeding on probing with no obvious evidence of interdental recession
60
What OHI was given
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
What perio tx was carried out?
Step 1 - building foundations for optimal tx: - explain gingivitis, OHI, risk factor modification (supra-gingival PMPR)
62
What makes the toothwear physiological and not pathological
Toothwear is within a normal range for the patients age and isn’t causing any symptoms or sensitivity or causing difficulties with mastication
63
What is normal physiological tooth wear
20-38 micrometers per year
64
Why was composite used over amalgam?
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
Why was only fluoride varnish used
SDCEP guidelines state that initial carious lesions should be treated with site specific prevention
66
Different methods of caries removal
Complete caries removal Selective caries removal - first choice for deep lesions Stepwise caries removal
67
What is selective caries removal
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
What is stepwise caries
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
What is complete caries removal
Removing all caries to hard dentine even if pulp exposure occurs
70
Why stepwise
If preparing cavity and dentine is not firm enough and you are close to the pulp
71
Benefits and risk of selective caries removal
+ 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
Benefit and drawbacks of stepwise
+ 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
Benefit and drawbacks of complete caries removal
+ 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
Why is a core being used in 27
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
When is 27 reviewed radiographically
6 months according to FGDP - tailored to pt situation Before placing any indirect restoration
76
Why is the patient being reviewed in 3 months
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
Why were 11 and 21 only added to and not built up
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
Reasons for using a lithium disilicate crown
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
Why was a lower soft splint used
Pt toleration better than upper Won’t need to remake the splint when providing upper indirect restorations
80
What are the reasons against using splint in GORD/erosion
May exacerbate the erosion - monitor toothwear closely and stop using splint if any signs of erosion progressing
81
How should toothwear be monitored
Regular clinical examinations and radiographs to be compared to previous ones Tooth wear indices such as BEWE Study models
82
What are the dimensions of an emax prep
Axial reduction - 1.5mm Funcional cusp - 2mm Non-functional cusps - 1.5mm Chamfer
83
How do you bond to emax
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
What are the options to restoring the spaces
85
What other materials can be used for crowns
Metal crowns - gold Ceramic - porcelain Metal ceramic All ceramic - porcelain bonded to alumina or zirconia framework
86
Reason for composite onlay
Good aesthetics Reduction in polymerisation shrinkage as it is cured in the lab Bond to tooth structure
87
What other materials can be used for onlays
Gold Ceramic
88
Reasons for MCC over emax
If tooth is under especially high occlusal forces For a less invasive prep

4 - misc (10 decks)

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