Case Pres Flashcards
What is Beconase Aqueous Nasal Spray used for?
What is the dental relevance? What are the side effects?
Used as a decongestant - it works by reducing the swelling of the blood vessels in the nose, to open up the airways
It is a Corticosteroid
Has side effects such as;
Stinting/burning sensation in nose
Xerostomia
Candidiasis
Unpleasant taste in mouth
How can you assess xerostomia intra-orally?
Measure unstimulated saliva flow rate for 15 mins
Abnormal is <1.5ml in 15 mins
Palpate and assess salivary gland ducts for secretions
Mirror stick test to cheek and tongue
Check for saliva pooling
What are the oral signs and symptoms of xerostomia?
Swallowing difficulties Speech difficulties Poor denture control Altered taste Increased cervical caries Frothy saliva Increased risk of candida and periodontal disease
How can xerostomia be managed?
SLS free toothpaste Keep hydrated with plenty of water Chew gum Good preventive regimen Consider alternative medications Saliva substitutes; Pilocarpine - saliva stimulant usually taken 4 times a day Biotene (active ingredient is Lactoferrin and you take as required)
What is the mechanism of action of Carbimazole?
Used in the treatment of Hyperthyroidism
After it is absorbed, it is converted to its active form of Methimazole which inhibits the thyroid peroxidase enzyme which reduces the production of thyroid hormone T3 and thyroxine T4
What is the dental relevance of Carbimazole?
Side effects include;
Taste disturbances
Agranulocytosis which is a deficiency of granulocytes in the blood which can cause increased vulnerability to infection and mouth ulcers
Thrombocytopenia which is a deficiency of platelets in the blood (less than 150,000 platelet count)
What is hyperthyroidism?
What are the causes?
How is it diagnosed?
Overactivity of the thyroid gland
Common, affects 2-5% of all females
Causes include;
Graves disease (exact aetiology unknown)
Toxic nodules
Diagnosed via a thyroid function test
If TSH levels are low (<0.4) and FT4 levels are high (>25) this suggests an overactive thyroid
What are the treatment options for hyperthyroidism?
Antithyroid drugs
Radioactive iodine to destroy gland by local radiation
Surgery
What are the clinical features
Goitre (swelling of thyroid gland)
Tremor
Weight loss
Increase body temperature
What is the dental relevance of hyperthyroidism?
May accelerate periodontal disease
May weaken oral and facial bones
Patient may be sensitive to adrenaline
Antithyroid drugs may predispose patients to infections and poor wound healing
What are the considerations of a patient receiving a hysterectomy (removal of uterus/womb)?
Patient may experience early menopause and may be taking HRT to replace oestrogen
HRT has a risk of blood clots so patient may be taking an anticoagulant as a result
What are the different types of arthritis?
Rheumatoid arthritis;
Chronic inflammation of smaller joints e.g. hands, feet
Osteoarthritis;
Degeneration of joint cartilage and underlying bone, common in hip, knee
How is osteoarthritis treated?
Lifestyle changes - losing weight and exercising more
Pain relief
Physiotherapy
What is the mechanism of action of penicillin?
Prevents cross linking of peptidoglycan which weakens the bacterial cell wall
Could not prescribe amoxicillan
Why are interdental brushes effective?
They reach interproximal areas that brushing alone would not be able to reach
Patient can get size that suits the spaces in their mouth
Contains small bristles and is bigger than floss so is more effective for plaque removal
What is the active ingredient in Colgate Mouthwash?
Cetylpyridinium Chloride (CPC) Antiseptic that kills bacteria and other organisms
How would you assess the lymph nodes? What lymph nodes do you assess in a typical extra-oral exam?
Start with auricular nodes then move towards the submandibular and submental nodes
Then palpate the jugular nodes using the sternocleidomastoid muscle as a reference point then move down towards the deep cervical and supraclavicular nodes
What is denture induced stomatitis?
It is the adherence and colonisation of acrylic surfaces by co-aggregation and biofilm formation
It results in erythema and inflammation of the denture bearing area
Patient will often experience discomfort on this area and may also experience halitosis
What are the classifications of denture induced stomatitis?
Newton type I = Localised inflammation and erythema
Newton type II = Diffuse inflammation and erythema confined to denture bearing mucosa
Newton type III = Granular inflammation with erythema and papillary hyperplasia
How would you treat denture induced stomatitis in the first instance?
Local measures;
Brush palate daily
Soak dentures in CHX for 15mins twice daily
Remove dentures at night
Drug treatment;
Fluconazole 50mg
Once daily for seven days
Miconazole Oromucosal Gel 20mg/g
Nystatin Oral Suspension 100,000 units/ml
1ml after food - four times daily
What are the treatment options for frictional keratosis?
Identify and treat underlying cause
Smooth acrylic at that region
Tissue conditioner
Patient was not concerned therefore we monitored
What is frictional keratosis?
It is a benign white lesion of the oral mucosa as a result of regular friction
Usually presents no symptoms
What else could the white lesion have been apart from frictional keratosis?
Hairy leukoplakia - this most commonly affects the lateral borders of the tongue and is associated with HIV
Thrush - lesion could not be wiped off
White spongy naevus - hereditary condition with increased production of keratin
Lichen planus - usually bilateral and symmetrical
What is lichen planus?
Chronic inflammatory condition that can affect the mucous membranes of the mouth or any other areas of the body
Commonly affects females aged 30-50
What are the different types of lichen planus?
Reticular - lacy appearance
Erosive - oral ulcers
Papular - small pinhead vesicles
Plaque-like - large homogenous white patches
Atrophic - similar to erosive form, more prominent
Bullous - fluid filled vesicles
How do you assess a denture for retention and support?
Support = gently press on pre-molar region
Retention = gently pull in vertical direction
Why have you mounted on a average value articulator?
To reproduce patients static relationship of the maxilla to the mandible in ICP
Average value has condylar angle fixed at 30 degrees
Why did you take peri-apicals?
To assess caries, bone levels and peri-apical pathology
What dosage is used for a peri-apical radiograph?
8 microsievers
In IRMER, what is the role of the practitioner?
Responsible for justification of the exposure
In IRMER, what is the role of the operator?
Responsible for practical aspect of taking radiograph and authorisation
In IRMER, what must the referrer supply the operator with?
Sufficient medical data relevant to exposure requested
This allows the operator to decide whether there is sufficient benefit
What does IRMER stand for?
Ionising Radiation Medical Exposure Regulations
What is generalised bone loss?
Affects >30% of teeth
What are the different grades of bone loss?
Mild = <30% of root length Moderate = 30-50% of root length Severe = >50% of root length
What is a MCC?
Porcelain that has been bonded to a metal alloy Advantages; Strength Aesthetics Minimum palatal reduction
Disadvantages;
Stress on tooth
Destruction of tooth tissue
Allergy
What is a MC?
A crown that is made from precious or non-precious metal
Advantages;
Minimal reduction of tissues
Can be soldered to other structures
Disadvantages;
Aesthetics
Allergy
Cost
What are the constituents of amalgam?
Silver Tin Copper Mercury Zinc
Why did you choose this co/cr design for the upper denture?
Replicated the same design the patient already has as she is happy with current design
Horseshoe design has large mucosal coverage which offers additional mucosal borne support
Why did you not change the path of insertion/removal for the upper co/cr denture?
Anterior aspect does not offer undercuts to allow this to be advantageous
There are sufficient undercuts present for the clasps that have been incorporated to the design
Is there anything you would change about the denture design?
I would move clasp from the 25 to the 24 to allow for a triangle of retention
What are the ethical considerations of your patient seeing their own GDP as well as yourself?
Communication between the two healthcare professionals and the patient is key
It is my responsibility to ask;
Does your GDP know you are attending here?
What dental work have you has carried out recently?
Have you had any radiographs recently?
What is the mechanism of action of CHX?
It has a dicationic action as the positively charged CHX molecules react with the negatively charged microbial molecules
This damages the microbial cell envelope as there is an increase in permeability resulting in cell content leakage and resultant cell death
How would you offer smoking brief intervention?
5As; Ask Advice Assist Assess Arrange
2A1R;
Ask
Advice
Refer
What are the recommended allowances for alcohol intake for males and females?
14 units per week with at least 2 alcohol free days
No more than 3 units in one day
What intervention can be used for alcohol abuse?
Alcohol brief intervention; Raise the issue about if they drink Screen and give feedback of risks Listen for readiness to change Suitable referral/information and advice
What are the restorative requirements for a cavity to be suitable for amalgam?
Undercuts required
Adequate bulk - at least 2mm space for the placement of amalgam
Dovetails required in cavity design to prevent dislodgement of restoration
Cavosurface margin line angle between 90-120 degrees
Internal dimensions of cavity must be greater than access to it
