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DG1009 - CK 1 > Clinical Decision Making > Flashcards

Clinical Decision Making Flashcards

1
Q

What are the 4 main clinical decisions to make during an examination?

A
  • diagnosis
  • prognosis
  • treatment options
  • further preventative measures
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2
Q

What 7 background questions should be asked during an exam?

A
  • personal details
  • reason for attendance
  • complaints
  • history of complaint
  • past dental history
  • past medical history
  • family and social background
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3
Q

What does SOCRATES stand for in relation to pain diagnosing?

A 
S - site (generalised, localised)
O - onset (better or worse at any time)
C - character (dull, sharp)
R - radiation 
A - association (malaise, fever etc)
T - time (how long it lasts, when it started)
E - exacerbating factors (hot, cold, sweet)
S - severity (/10)
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4
Q

What are 6 key questions regarding past dental history that should be asked?

A
  • dental phobia
  • last dental visit
  • regular attendance or not
  • OHR
  • diet
  • willingness to meet treatment needs/attitude and motivation
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5
Q

What 10 key points of medical history information should be taken/considered?

A
  • pregnancy
  • medication or receiving treatment
  • history of heart or chest disease
  • anaemia
  • allergies
  • bleeding disorders
  • HIV or hepatitis
  • hospitalisation, GA, transfusion
  • GI, kidney, liver etc diseases
  • diabetes, epilepsy, fainting
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6
Q

What are 7 reasons of why taking a medical history of medical conditions and meds is of importance?

A

certain medical conditions:

  • may predispose patients to a medical emergency
  • may put patients at risk during dental treatment
  • may cause oral manifestations
  • can be treated with medications that can cause oral manifestations
  • can be treated with medications that can interact with those prescribed by a dentist
  • may contra-indicate certain drugs
  • may pose a risk to dental employees and other patients
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7
Q

What are 6 medical conditions that may predispose patients to a medical emergency?

A
  • angina
  • heart attack
  • anaphylaxis
  • diabetes
  • epilepsy
  • asthma
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8
Q

What are 3 medical conditions that may put patients at risk during dental treatment?

A
  • haemophilia or on anti-coagulants
  • allergies
  • infective endocarditis
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9
Q

What are 5 medical conditions that may cause oral manifestations?

A
  • leukaemia - bleeding gingiva
  • hiatus hernia - acid erosion
  • anaemia
  • pregnancy
  • HIV - hairy leukoplakia
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10
Q

What are 3 medications that may cause oral manifestations?

A
  • phenytoin
  • nifedipine
  • tri-cyclic antidepressants
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11
Q

What are 3 examples of medications that may interact with drugs that can be prescribed by dentists?

A
  • metronidazole enhances effect of warfarin
  • metronidazole reduces metabolism of phenytoin therefore increasing plasma levels
  • erythromycin reduces carbamazepine levels
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12
Q

What is one example of a medical condition that may contra-indicate certain drugs?

A

asthma and ibuprofen

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13
Q

What are 3 examples of medical conditions that pose a risk to dental staff and patients?

A
  • Hep B or C
  • TB
  • HIV
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14
Q

What should be assessed during an extra-oral exam?

A
  • overall evaluation of face, head and neck

- TMJ

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15
Q

How is the TMJ joint assessed?

A
  • sit directly behind patient
  • palpate joint and its associated muscles
  • ask the patient to open and close their mouth several times
  • then ask the patient to move the opened jaw left, then right, and then forward
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16
Q

What 4 things should be recorded when assessing TMJ?

A
  • clicking
  • grating/grinding
  • deviation
  • posturing forward
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17
Q

How is the masseter muscle examined?

A
  • sit directly behind patient
  • place fingers over the masseter muscle and ask patient to clench the teeth together several times
  • feel for enlargement
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18
Q

How are the lymph nodes examined?

A
  • sit directly behind patient
  • examine both sides simultaneously
  • palpate using all 4 finger tips of each hand
  • walk fingers down the area applying steady, gentle pressure
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19
Q

How are the anterior cervical nodes assessed?

A

palpate from angle of the jaw to top of clavicle

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20
Q

How are the posterior cervical nodes assessed?

A

palpate from mastoid bone to clavicle

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21
Q

How are the submental nodes and glands assessed?

A

palpate below the chin, may want to ask patient to tip head forward

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22
Q

How are the submandibular nodes and glands assessed?

A

palpate along the underside of the jaw, may wish to ask patient to tip head towards the side you are feeling

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23
Q

How are the pre-auricular nodes assessed?

A

palpate anterior to the ear

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24
Q

How are the parotid nodes and glands assessed?

A

palpate further forward than pre-auricular nodes and slightly lower

25
Q

How are the occipital nodes assessed?

A

palpate base of the skull

26
Q

What 9 anatomical structures should be assessed during an intra-oral exam?

A
  • lips
  • buccal mucosa
  • sulci (underneath lips)
  • tongue
  • floor of mouth
  • palate
  • fauces (uvula area)
  • periodontal tissues
  • teeth
27
Q

When assessing periodontal tissues, what 4 things should be assessed?

A
  • presence of plaque and calculus including position and quantity
  • colour, contour, consistency of gingiva
  • any tooth mobility
  • BPE
28
Q

When assessing occlusion, what 6 things should be assessed?

A
  • ICP: check overjet, overbite and anterior open bite
  • lateral and forward excursive movements
  • trauma, tooth wear, dental defects, missing & malpositioned teeth
  • skeletal relationships
  • occlusal relationships
  • incisal relationships
29
Q

When assessing occlusion the following are done to assess…?

  • place fingers inside patients lips and ask to bite in their normal closed position
  • ask the patient to slide across to the left, identify which teeth are in contact as they slide
  • the teeth in contact will typically be either the canines (canine guidance) or 2 or more premolars/molars (known as group function)
  • repeat on the right
A

lateral excursion

30
Q

When assessing occlusion the following is done to assess…?

- from ICP, ask the patient to slide forward

A

protrusion

31
Q

The following skeletal relationship is known as what class?

- average maxilla to mandible relationship

A

class I

32
Q

The following skeletal relationship is known as what class?

- mandible sitting further back to the maxilla

A

class II

33
Q

The following skeletal relationship is known as what class?

- mandible sitting further forward to the maxilla

A

class III

34
Q

When assessing occlusal relationships, how are the molar relationships assessed?

A
  • place the back of the mirror/finger inside the left cheek
  • ask the patient to bite together
  • look at the relationship between the upper and lower first molars
  • repeat on the right side
35
Q

When assessing molar relationships, the following is described as what class?
- upper 6 MB cusp in relationship to buccal groove of lower 6

A

class I

36
Q

When assessing molar relationships, the following is described as what class?

  • lower molars are more posteriorly placed
  • MB cusp of upper 6 is now anterior to buccal groove of lower 6
A

full class II

37
Q

When assessing molar relationships, the following is described as what class?
- MB cusp tip is dead centre to lower MB cusp tip

A

1/2 class II

38
Q

When assessing incisal relationship, the following is known as what class?
- incisal edge of the lower incisors sits in the concavity below cingulum of the upper anteriors

A

class I

39
Q

When assessing incisal relationship, the following is known as what class?

  • lower incisal edge sitting further back on the cingulum
  • upper incisors sticking out
A

class II div 1

40
Q

When assessing incisal relationship, the following is known as what class?

  • lower incisal edge is sitting further back on the cingulum
  • upper incisors are tilted back
A

class II div 2

41
Q

When assessing incisal relationships, the following is known as what class?
- lower incisors are sitting further forward than upper incisors

A

class III

42
Q

When assessing dentures, what 5 things should be noted?

A
  • age of dentures
  • cleanliness
  • retention and stability
  • any fractures
  • occlusal surfaces
43
Q

What are special tests that can be done during an examination?

A
  • radiographs
  • vitality tests (colour, presence of sinus, radiographs)
  • thermal and electrical stimuli
  • percussion
  • diet diary
44
Q

When may you get a false negative response to thermal and electrical stimuli?

A
  • after trauma

- heavily restored tooth

45
Q

When may you get a false positive response to thermal and electrical stimuli?

A
  • anxiety
  • poor testing method
  • pus in canal
46
Q

What are 4 examples of pulpal diagnosis?

A
  • reversible pulpitis
  • irreversible pulpitis
  • necrotic pulp with acute periapical periodontitis
  • acute apical abscess
47
Q

What are the 9 points that treatment plans should cover and the order in which you should lay out trt plan?

A
  1. relief of pain
  2. prevention
  3. stabilisation
  4. review
  5. routine conservation including denture design (if required)
  6. review
  7. advanced conservation
  8. prosthodontics
  9. recall and maintenance
48
Q

What are 3 treatment methods of relieving pain?

A
  • removal of caries and dressing
  • extirpation of pulp
  • extraction
49
Q

What are 4 treatment options for stabilisation?

A
  • extractions if required
  • dressing of caries/immediate pulpal extirpations
  • temp dentures
  • remove necrotic pulp
50
Q

What should be considered when doing restorations where a cobalt chrome denture is also on the treatment plan?

A

rest seats

have to accommodate these so the patients bite is not propped open

51
Q

What are the 3 importances of making a treatment plan and recording it in patients file?

A
  • ensures that dentist reviews treatment in all stages
  • a record for future reference
  • avoid disorderly management
52
Q

Treatment plans are based on sound diagnosis, which is composed of?

A
  • history
  • exam
  • special investigations
53
Q

The following symptoms are of which tooth condition?

  • feels widespread, difficult to locate
  • sharp, non-throbbing
  • mild-moderate, lasts as long as stimulus up to ~ few mins
  • does not keep patient awake
  • exacerbated by cold, hot, sweet
  • eased by painkillers, local anaesthetic
  • no associated factors
  • exaggerated response to vitality test
  • may be evidence of caries on X-ray, no periodical pathology
A

reversible pulpitis

54
Q

The following symptoms are of which tooth condition?

  • may or may not be difficult to locate, feels widespread
  • severe, dull, throbbing ache
  • lasts up to many hours
  • intermittent, spontaneous, keeps patient awake
  • exacerbated by hot, cold, sweet
  • may be eased by strong analgesics, local anaesthetic
  • exaggerated response to hot and cold but as pulp becomes necrotic this reduces
  • may be evidence of caries or heavily restored tooth, may or may not be periapical pathology
A

irreversible pulpitis

55
Q

The following symptoms are of which tooth condition?

  • localised, patient able to identify tooth
  • pain may radiate
  • severe, dull throbbing ache
  • continuous, lasts hours, gradual onset often preceded by sharp pain some weeks before
  • intermittent, spontaneous, keeps patient awake
  • exacerbated by pressure, biting
  • relieved but not dispelled by analgesics
  • tooth ttp
  • tenderness/redness in buccal sulcus
  • no response to vitality test
  • widening of periodontal ligament space
A

pulpal necrosis (with acute periapical periodontitis)

56
Q

The following symptoms are of which tooth condition?

  • gross caries, heavily restored tooth, previous trauma to the tooth
  • no acute pain
  • tooth may or may not be tender to finger
  • may be tenderness/redness in buccal sulcus
  • may be a sinus tract
  • no response to vitality test
  • widening of periodontal ligament space on X-ray
A

pulpal necrosis (with chronic periapical periodontitis)

57
Q

The following symptoms are of which tooth condition?

  • gross caries, heavily restored tooth
  • localised, patient able to identify tooth
  • pain may radiate
  • severe, dull, throbbing ache
  • exacerbated by pressure, biting
  • may be intra/extra oral swelling, redness
  • may have discharging sinus
  • tooth may be mobile
  • relieved but not dispelled by analgesics
  • may have fever, malaise, lymphadenopathy
  • no response to vitality test
  • widening of periodontal ligament on xray
A

acute apical abscess

58
Q

What is the name for the following tooth condition?

- bone loss and pus has built up from periodontal pocket

A

lateral periodontal abscess

DG1009 - CK 1 (4 decks)

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