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Case presentation Flashcards

1
Q

What does the HPC suggest has happened to the tooth and give a pulpal diagnosis?
S – Upper right first pre-molar
O – 6 days prior the tooth had fractured and been sore ever since
C – It was a dull aching pain, tooth was sensitive
R – Did not radiate anywhere else
A – No associated symptoms
T – Painful when touch, gives off short sharp pain which lasts a few seconds
E – TTP
S – constant 2/10 then when bite 7/10

A
  • Tooth was grossly carious and this caused it to be weakened. The crown has then fractured.
  • As the tooth is TTP suggests symptomatic periapical periodontitis.
  • Irrervisble pulpitis
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2
Q

Why is taking a medical history important in dentistry?

A
  • Helps identify conditions and drugs that may effect dental treatment
  • Makes dentistry aware of any potential medical emergency risks
  • Also can aid diagnosis of oral manifestations of systemic disease
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3
Q

How would a previous heart attack, effect your dental treatment?

A
  • Patient may be on medications which will effect the mouth
  • Need to be aware of medical emergency protocol for dealing with heart attacks (oxygen, call 999 and 300mg of aspirin chewed orally)
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4
Q

What is a heart attack simply?

A

When the blood supply to the heart is suddently blocked

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5
Q

What is asthma?

A

Asthma is the inflammation of the tubes which carry air to and from your lungs. These tubes narrow and can have an increased amunt of mucous present which makes it more difficult to breathe.
This can be triggered by stress, allergies or smoke

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6
Q

How would you deal with the medical emergency of an asthma attack?

A

Get the pateint to take a few puffs of their inhaler (always check before they have it with them) . If this doesnt easy get them to take further puffs and call an ambulance.

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7
Q

What simple medical device can be used with an inhlaer to deliver more drug?

A

Spacer
Volumiser

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8
Q

What is osteoarthritis?

A
  • Osteoarthritis is pain of the joints. This happens as a result of the protective cartilage on the ends of your bones breaks down, causing pain, swelling and problems moving the joint. Boney growths can develop and the area can become red and swollen.
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9
Q

How may osteoarthritis affect your patient’s oral health?

A

They may have decreased manual dexterity so cannot hold objects like a toothbrush as well. Meaning they have poorer OH. You can get them special toothbrushes with bigger handles to make it easier for these patients
In addition, patients may also struggle to keep their mouths open for longer periods of time

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10
Q

What is Ramipril?

A

ACE inhibitor

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11
Q

What is ramipril used to treat? and by what mechanism does it work?

A

As it is an ACE inhibitor it is used to treat hypertension. It inhibits the production of angiotensin 2 which is responsible for narrowing of blood vessels and produces hormones which increase blood pressure

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12
Q

What are the oral side effects of ramipril?

A

Xerostomia
ACE inhibitors in general, cause alteration in taste, taste becomes more metallic or salty

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13
Q

What side effects does atrovastatin have on the mouth and the body?

A

No dental implication
Can cause naeseau, vomitting and flu like symptoms.

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14
Q

What is atrovastatin? and what does it do?

A

It is a statin and reduces risk of heart attack in patients with high amount of chloestral in the body. As with high chloestral fatty deposits can build up and break off causing blockages in the heart.

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15
Q

What is procoralan? does it have any dental implications?

A

Procoralan is used to treat symptoms of long term stable angina in patients with coronary heart disease.
No implications

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16
Q

What type of drug is aspirin?

A

Anti-platelet drug

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17
Q

How does the mechanism of aspirin work to reduce the risk of heart attacks?

A

Aspirin works by irreversibly inhibiting the enzyme cyclo-oxygenase (COX-1) which is required to make the precurrser for thomboxane within platelets.
This reduces thromboxane synthesis. Thromboxane is required to facilitate platelet agregation and to stimulate further platelet activation
75mg once a day

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18
Q

How does a patient taking aspirin effect dental treatment?

A
  • According to the SDCEP guidelines as this patient is only taking aspirin do not interrupt the treatment or the dose.
  • patient will be more at risk to bleeding
  • Therefore when planning more invasive procedures like XLA, you should limit inital treatment area, stage extensive or complex treatment and use local haemostatic measures like stitches, surgicel and pressure.
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19
Q

Should a patient on aspirin alter their dose before dental treatment and what guidance should you follow?

A

No they do not need to interupt their medication
Following the SDCEP guidance

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20
Q

What is montelukast medication used for?

A
  • Maintenance of asthma
  • Works by preventing the production of leukotrienes which is a chemical responsible for narrowing of the air way tubes
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21
Q

What is amitriptyline?

A

Anti-depressant used as a pain killer
It works on two chemicals noradrenaline and serotonin. Serotonin levels are increased which improves mood and reduces pain levels. Overall it reduces the pain signals to the brain.

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22
Q

What is a dental implication of amitriptyline?

A

Xerostomia reduces saliva flow by 26%

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23
Q

What is Salbutamol and what is it used for?

A
  • Is a beta-2 agonist inhlaer
  • Used to treat asthma, it works by realxing the muscles in the airway and widening the airways making it easier for the patient to breath
  • Quick onset 2-3mins
  • Lasts 4-6hrs
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24
Q

What side effect can salbutamol have on the oral cavity?

A
  • Decrease salivary production which in turn increases chance of tooth decay and erosion
  • This is only with steroid inhalers and this is a bronchiodilator. Oral thrush candida albicans (this works due to the steroids in the inhalers weakening the immune system in the mouth and throat)

Thrush can be uncomfortable and struggle with eating

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25
Q

How can you treat oral thrush in asthmatic patients?

A

Anti fungals topical applied to tongue as gels or fluids fuconazole and nyastatin
As well as getting patinet to use spacer and rinise mouth when using inhaler

26
Q

What is symbicort inhaler?

A

Long acting beta-2 agonist as well budesonide (a steroid)
Used to treat asthma

27
Q

What are the oral side effects of symbicort inhaler?

A

Sinusitis
Oral thrush

28
Q

If in the patients DH, they havnt attended the dentist for 4+ years on 2 seperate occassions. What does that tell you?

A
  • Patient could be dentally anxious
  • Patient only goes to dentist when they have a problem
  • Disease has been allowed to progress unchecked for a long period of time
29
Q

If patient admits to having poor OH and only brushes one a day. What advice can you give them to help imporve this?

A

TIPPS
- Need to exert a behavioural change with this patient explain to them the diseases and what can happen if something doesnt change
- Use aids like radiographs and pictures to help with this
- Make sure they understand
- Then can use disclosing tablets to show the areas in the mouth they need to focus on
- Show them the modifed bass technique and remind them to brush gums too with electric toothbrush 2x a day
- Higher fluoride toothpaste can prescribe this
- Interdental brushes to get riight shape and floss
- Then any other tools

30
Q

Patient says they have a poor diet with a lot of snacking on sugary treats. What would you do here?

A

The high sugar levels, combined with the high frequency outside of mealtimes are a breeding ground for bacteria and therefore caries. Patient was asked to fill out a diet diary (3 days one being weekend) and diet advice was given.

31
Q

What does a family history of periodontal disease suggest? and what can you do?

A
  • It is a risk factor
  • Prevention early on is important for these patients
  • As their immune system is more prone to causing bone loss as a result of bacteria
  • These patients have to have extremely good OH as they are genetically pre-disposed to more aggressive periodontis.
32
Q

How does periodontitis work simply? and how would you explain that to the patient?

A
  • In time plaque thats left on the teeth turns to calculus (this cannot be remove with OH anymore)
  • This calculus spreads below the ginigval margin. This bacteria present on the calculus irritates the gums and causes a chronic immune response as the source of the response hasnt been removed.
  • Your bodies natural immune response is to fight this with inflammation and fever, but by doing so your body also attacks itself and causes the bone and tissues to receed.
  • This causes pockets to form
  • These become abscesses that further the disease progression which can then spread throughout the body and cause severe health consequences.
  • If the source isnt removed eventualluy there will be no bone left and the tooth will fall out or have to be removed
33
Q

Why is smoking a risk factor for oral disease?

A
  • It causes vasocontriction to tissues in mouth which reduces ability to heal as well as reduced blood flow
  • slows down immune response
  • Increases chance of oral cancer
  • Leads to destruction of supporting tissues
34
Q

After quitting smoking how long does it take to improve gum health?

A

3months to a year

35
Q

With your patient being on so many different medications, what is a possible side effect and what effect does that have on the mouth?

A
  • Polypharmacy
  • This results in a decreased salivary flow rate, which increases the rates of caries and erosion of the mouth.

Acid acts as a buffer to acids and clears away bacteria and sugars out of the mouth

36
Q

How can older poorer restorations be a risk factor for oral disease?

A

They can have poor margins which act as a plaque trap and food trap for food.
These areas can also be more difficult to clean
Resulting in caries

37
Q

Your patient has a slight click on the LHS of their TMJ. What could this be due to?

A

His osteoarthritis is effecting the TMJ
Clenching, grinding and other parafunction habits

38
Q

What is black hairy tongue and is it serious?

A
  • Black hairy tongue is not serious
  • It is when the patient has a longer than normal papillae, this papillae can easily trap bacteria, food and other debris which stains the tongue black
39
Q

How do you treat black hairy tongue?

A

It is harmless you treat it by removing the causes and practising good oral hyigene
Also sucking on a peach stone can help

40
Q

Why did you only take one PA of the UR?

A

As when I first saw the patient upper and lower PA’s had been taken only 6 months prior. So i didnt have the justification (IRMER17) to repeat these. As the patient wasnt complaining of any pain or symptoms from these teeth.

41
Q

Why is pulp testing not always reliable. Especially in older people?

A

The pulp will reduce in size (sclerose) as the patient gets older and becomes less responsive to pulp testing.

42
Q

Why do you take a 6PPC before treatment starts?

A
  • To access the periodontal health and the identify the worse sites
  • Also gives you a baseline to compare with
43
Q

Why are diet diaries taken?

A
  • Diet diary was given to establish areas within the patient’s diet which could be responsible for high levels of caries. Then allow for more targeted advice.
44
Q

For you perio diagnosis what does each part mean?
Generalised, stage 3, grade C, unstable, risk factors of ex smoker and family history of periodontal disease.

A

Generalised periodontitis – more than 30% of mouth with pockets
Stage 3 – middle third of root for the worst sites of bone loss
Grade C – patient is 57 but there is more than 57% bone loss on the worst sites
Ex-smoker and family history of periodontitis– risk factors
Currently unstable – Have pockets of greater than or equal to 5mm.

45
Q

Why have you decided to make a partial acrylic denture for this patient instead of CoCr?

A
  • Acrylic is better as it is easier to add teeth to the design later. Which is good as this patient has teeth with poor prognosis
  • Furthermore, due to this patient’s periodontal disease you don’t want to be putting high levels of force onto the abutment teeth.
  • If I XLA any teeth will have to wait 3-6months for the tissues and bone to properly heal before you can start making CoCr
46
Q

Once you have carried out step 2 of the BSP guidance for perio. How long till you carry out a review 6PPC?

A

3months

47
Q

After quitting smoking how long does it take to see a real benefit and reduce in the risk of cancer?
Then how long does it take for a smoker to be the same as someone who has never smoked?

A
  • 1 year to 4 years
  • 20 years till someone who has never smoked
48
Q

What is asthma?

A

Chronic respiratory condition
characteristised by inflammation of the area way

49
Q

What are the 3 main features of asthma?

A
  • Contraction of the smooth muscle
  • Excess production of mucous
  • Narrowing of the airways to the lungs
50
Q

What considerations are there for asthmatic patients in dentistry?

A
  • Stress can be trigger so make sure salm enviroment
  • Medications like steroids and inhalers can cause erosion, caries, poor wound healing and candida infections
  • Make sure they can lie back okay as can be diffciult for them to breath when lying flat
  • Know any allergies as these can be triggers
  • Medical emergencies. Inhaler oxygen if not better another puff of inhaler and 999
51
Q

WHat is the triad of autism?

A

Communication
Imagination
Interaction

52
Q

What is autism?

A

It is a spectrum disorder which is a developmental disability caused by differences in the brain.

53
Q

Risks of long term steroid use?

A
  • Adrenal suppression
  • Osteoporosis
54
Q

pH for caries in enamel?

A

5.5

55
Q

Critical pH for root caries to develop?

A

6.5

56
Q

What are afferent and efferent fibres?

A

Afferent arrives to brain
Efferent exit

57
Q

What nerves fibres are responsible for pain and what type of pain do they cause?

A

Myelinated A delta fibres - Short sharp pain. Cutting into dentine, reversible pulpitis and dentine sensitivity
Unmyelinated C fibres - Dull aching pain, irreversible pulpitis, the release of inflammatory mediators (prostoglandins histamine etc) and the subsequent sensitization of C fibers result in an exaggerated pain response.

58
Q

What type of crown is an EMAX crown?

A

Lithium disilicate

59
Q

What is the difference between a zorconia crown and an EMAX crown(lithium disilicate) ?

A

Zorconia is stronger but less aesthetic so would be used more in posterior teeth. EMAX anterior teeth

60
Q

What are 3 of the reasons for this patients anterior attritive wear?

A
  • Physiological wear with age (20microns per year)
  • Lack of posterior support
  • Skeletal class 3 edge to egde relationship
61
Q

What is the increased risk of oral cancer from smoking? then alcohol? then together?

A
  • 2x
  • 2x
    Together 5x synergistic effect

BDS4 (24 decks)

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