Case Pres Flashcards
Why PA rather than OPT
The choice of panoramic vs. intra-oral periapical radiographs may depend on a range of factors including preference and
availability. In general, full mouth periapical radiographs using a paralleling technique, give more accurate and detailed
assessment of periodontal bony defects. In contrast, a good quality panoramic radiograph is quicker, less uncomfortable,
and may provide useful assessment of bone levels and other pathologies. Panoramic radiographs might need to be
supplemented with periapical views especially in the anterior sextants due to the likelihood of image distortion in these
regions. With both techniques appropriate collimation must be considered in order to reduce the patient received radiation
dose to a minimum. Ideally this involves using some form of rectangular collimation for periapical radiographs and field
size collimation for DPTs, designed specifically to reduce the dosage to the orbits and parotid glands.
what radiographs for perio assessment
For uniform probing depths ≥4 and <6 mm and little or no recession, take horizontal
bitewing radiographs. If the anterior teeth are affected, take intra-oral periapical views using
the long cone paralleling technique
For irregular probing depths, take horizontal bitewing radiographs and supplement these
with intra-oral periapical radiographs taken using the long cone paralleling technique.
problems from too short endo?
bacteria in root canal .:. continuing infection
problems from too long endo?
inflammation in apical tissues
how to correct perforation
MTA
biocompaible but takes 24 hours to set, irretrievable and hard to use
options for space maintaining
pt preference- leave and monitor
implant
denture
conventional bridge
bpe use?
a simple and rapid screening tool that is used to indicate the level of examination needed
and to provide basic guidance on treatment need.
oral side effects corsodyl
staining
taste disturbances
anaphylaxis/ allergy
salivary gland enlargement
paper on alcohol
what does it show?
R. Grocock. Relevance of alcohol to dental practice. BDJ Dec 2017
- general trend of reduction of binge drinking
- but increase in alcohol related hospital admissions
- scotland has highest alcohol related death rate
- one unit 10ml or 8g pure alcohol
- no safe level of alcohol consumption
paper of endodontic results?
what does it show?
sjogren et al. factors affecting long term results of endodontic treatment. Journal of endodontics. oct 1990.
re-endo = 60%
w/o periapical = 95%
with periapical = 90%
talk to me about her orthodontic needs?
mild crowding
moderate complete overbite
no problem to function or soft tissue damage.
pt happy with appearance
alcohol intervention?
FRAMES
feedback responsibility advice menu empathy self-efficacy
feedback- graphs to show individualised risk
responsibility placed on patient
advice given if indicated - only when asked
menu of options- AA, self help programmes, 12 step programmes
empathetic approach
self efficacy- emphasis placed on patients ability to make and mantain change
units per week for alcohol
which guidelines
chief medical officer
no more than 14 units per week and evenly spread out over 3 or more days
2 alcohol free days per week
difference between depression and anxiety
depression is low mood for extended period with symptoms like losing interest in things once enjoyed, loss of apetite, insomnia
whereas anxiety is feeling constantly uneasy or worried about multiple situations or a wide range of issues
risk category for caries
risk factors
high risk:
crowding of teeth previous caries incidence high mh: started sertraline- may cause low salivary flow family history poor oh evidence of primary and secondary caries poor diet
risk category for perio
risk factors
high
obesity
restorations or calculus below gingival margin
poor nutrition
poor oral hygiene
psychological stress- van dyke 2005: risk factors for periodontitis. thought to be due to increase of interleukin 6 in stressed individuals
occlusal trauma
diabetes
smoking
genetic factors
nine factors: Patient age Smoking history Diagnosis of diabetes History of periodontal surgery Pocket depth Furcation involvements Restorations or calculus below the gingival margin Radiographic bone height Vertical bone lesions.
why prescribe high fluoride toothpaste?
attempt to arrest active caries
why onlay vs crown?
keep as much of remaining tooth tissue as possible
support remaining tooth tissue rather than remove during prep
cuspal coverage =onlay
in general practice crown likely as onlay not covered by nhs
why would you prescribe antibiotics?
spreading infection
evidence of cellulitis - infection deeper layers of skin
systemic involvement
unable to drain abscess
why amoxicillin/ metro before clindamycin?
1st line antibiotics used if necessary
empirical use of 2nd line offers no advantage
use contributes to development of antimicrobial resistance
but if no response to 1st line, refer before prescribing clindamycin
restricted to severe infections only
severe side effects- diarrhoea/ coliitis
how does amoxicillin work?
side effects
amino- penicillin beta-lactam AB bind to pencillin-binding proteins inhibit transpeptidation activation of autolytic enzymes in bacterial cell wall .:. lysis of cell wall bactericidal killing
like all penicillins- hypersensitivity reactions,- inc rashes, anaphylaxis
diarrhoea
500mg tid 5 days
how does metronidazole work?
side effects
inhibits nucleic acid synthesis by disrupting DNA of microbial cells.
metro needs to be partially reduced .:.
only effective against anaeobes
suitable for abscesses in pts not able to take penicillins
or adjunct to amoxicillin in spreading infection
need to avoid alcohol- disulfiram like reaction
anticoagulant effect of warfarin increased.
400mg tid 5 days
how does clindamycin work?
side effects
inhibits ribosomal translation .:. inhibits protein synthesis
.:. bacteriostatic
but if no response to 1st line, refer before prescribing clindamycin
restricted to severe infections only
150mg qid, 5 days
diarrhoea
ab associated colitis
alcohol effect on body?
–heart disease- cardiomyopathies, arrythmia, stroke, high blood pressure
–liver- steatitis, alcoholic hepatitis, cirrhosis, fibrosis
– cancer - head and neck, esophageal, breast, liver, colorectal
–pancreatis
– reduced immune function - pneumonia, tuberculosis
principles of cavity prep
remove enamel to identify extent of lesion at adj, smooth enamel margins remove caries moving peripheral to deep only then remove caries overlying pulp external form modification internal modification
why so many dental schools?
dental shopping
natural movement with finishing uni and moving
dental anxiety
justification for rads?
- caries detection
- review of overhanging restoration
- review of presenting complaint - endodontically treated teeth
- bone level assessment - bpes of 3
alcohol effect on body?
–heart disease- cardiomyopathies, arrythmia, stroke, high blood pressure
–liver- steatitis, alcoholic hepatitis, cirrhosis, fibrosis
– cancer - head and neck, esophageal, breast, liver, colorectal
–pancreatis
–drug interactions
– reduced immune function - pneumonia, tuberculosis
– compliance with tx plans
alcohol effect on oral?
oral cancer (50g alcohol per day increases risk 2-3 times)
erosion and tooth wear
trauma risk - violent behaviour and domestic abuse
halitosis
staining
caries
perio
what is diazepam?
how does it work
benzodiazepine medicine that has sedative, anxiety-relieving and muscle-relaxing effects.
facilitation of GABA- inhibitory neurotransmitter in CNS
oral effect diazepam?
xerostomia or excessive saliva production
general effects diazepam?
addiction - higher in those with substance abuse history decreased alertness muscle spasms constipation anxiety confusion depression GI upset hypotension headaches nausea sleep disorders
what is sertraline?
how does it work
selectively inhibit reuptake of serotonin at presynaptic membrane
selective serotonin reuptake inhibitor
used in therapy of depression, anxiety disorders and obsessive-compulsive disorder.
oral effect sertraline?
xerostomia
bruxism - grinding, attrition
general effects sertraline?
nausea dizziness drowsiness excessive sweating diarrhoea insomnia gi upset
how to restore endodontically treated teeth?
cuspal coverage = onlay
crown
what causes jaw clicking?
anterior disc displacement with reduction
advice on using corsodyl?
use at different time to brushing
what are the issues with pt not taking course of clindamycin?
no resolution of spreading infection
systemic involvement
pt becomes seriously unwell
what is dental anxiety?
fear or stress in dental setting
rated with MDAS scale
modified dental anxiety scale
5 item questionairre
sugar free drinks- good or bad and why?
advice on straw use
good in terms of no sugar- but acidic .:. contributing to erosion
straw - back of mouth placement otherwise still washing teeth in acidic liquid
tehcnique used for OHI
TIPPS
what material for onlay
cast metals - gold/ palladium alloys
base metal alloys
porcelain
composite
what does bpe 2 mean,
si,
tx indicated
Pockets < 3.5mm
First black band
completely visible
Supra or subgingival
calculus or plaque
retention factor
(overhang
Plaque and bleeding charts
repeat bpe next visit
what does bpe 3 mean
si
tx indicated
Probing depth 3.5 - 5.5mm First black band partially visible, indicating pocket of 4-5mm
• Plaque and bleeding charts
• Radiographs should be considered (in order
to establish if there is attachment loss)
Periodontal charting of sextants
scoring 3, after initial therapy
initial therapy including self-care advice (oral hygiene instruction and risk factor control) then post-initial
therapy, record a 6-point pocket chart in that sextant only
what is gingivitis?]
what % adults suffer from?
a reversible plaque-induced inflammation of the gingivae. It is recognised by erythema, oedema and bleeding
on brushing or probing.
55% adults suffer from
irmer?
ionising radiation medical exposure regulations
- minimising unintended, excessive or incorrect medical exposure
- ensuirng benefits outweigh the risk - justification
-keeping doses in diagnostics ALARP
as low as reasonably possible - optiminisation
how to take medical history
heart and bleeding chest and lungs stomach and bowel kidney and liver skin and bones fits and feints diabetes
how to take medical history
heart and bleeding chest and lungs stomach and bowel kidney and liver skin and bones fits and feints diabetes
nodes would examine
occipital post auricular pre auricular parotid facial - infraorbital, maxillary, supramandibular submandibular submental superficial cervical
tonsils
lingual
palatine
tubal
pharyngeal
tonsils
lingual
palatine
tubal
pharyngeal
how to modify if dentally anxious
relaxation technqiues paced breathing acclimitisation encouraging question and answer explaining all procedures fully
