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
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
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)
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
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
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
7
Q
What are 6 medical conditions that may predispose patients to a medical emergency?
A
- angina
- heart attack
- anaphylaxis
- diabetes
- epilepsy
- asthma
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
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
10
Q
What are 3 medications that may cause oral manifestations?
A
- phenytoin
- nifedipine
- tri-cyclic antidepressants
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
12
Q
What is one example of a medical condition that may contra-indicate certain drugs?
A
asthma and ibuprofen
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
14
Q
What should be assessed during an extra-oral exam?
A
- overall evaluation of face, head and neck
- TMJ
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
16
Q
What 4 things should be recorded when assessing TMJ?
A
- clicking
- grating/grinding
- deviation
- posturing forward
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
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
19
Q
How are the anterior cervical nodes assessed?
A
palpate from angle of the jaw to top of clavicle
20
Q
How are the posterior cervical nodes assessed?
A
palpate from mastoid bone to clavicle
21
Q
How are the submental nodes and glands assessed?
A
palpate below the chin, may want to ask patient to tip head forward
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
23
Q
How are the pre-auricular nodes assessed?
A
palpate anterior to the ear
24
Q
How are the parotid nodes and glands assessed?
A
palpate further forward than pre-auricular nodes and slightly lower
25
How are the occipital nodes assessed?
palpate base of the skull
26
What 9 anatomical structures should be assessed during an intra-oral exam?
- lips
- buccal mucosa
- sulci (underneath lips)
- tongue
- floor of mouth
- palate
- fauces (uvula area)
- periodontal tissues
- teeth
27
When assessing periodontal tissues, what 4 things should be assessed?
- presence of plaque and calculus including position and quantity
- colour, contour, consistency of gingiva
- any tooth mobility
- BPE
28
When assessing occlusion, what 6 things should be assessed?
- 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
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
lateral excursion
30
When assessing occlusion the following is done to assess...?
| - from ICP, ask the patient to slide forward
protrusion
31
The following skeletal relationship is known as what class?
| - average maxilla to mandible relationship
class I
32
The following skeletal relationship is known as what class?
| - mandible sitting further back to the maxilla
class II
33
The following skeletal relationship is known as what class?
| - mandible sitting further forward to the maxilla
class III
34
When assessing occlusal relationships, how are the molar relationships assessed?
- 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
When assessing molar relationships, the following is described as what class?
- upper 6 MB cusp in relationship to buccal groove of lower 6
class I
36
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
full class II
37
When assessing molar relationships, the following is described as what class?
- MB cusp tip is dead centre to lower MB cusp tip
1/2 class II
38
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
class I
39
When assessing incisal relationship, the following is known as what class?
- lower incisal edge sitting further back on the cingulum
- upper incisors sticking out
class II div 1
40
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
class II div 2
41
When assessing incisal relationships, the following is known as what class?
- lower incisors are sitting further forward than upper incisors
class III
42
When assessing dentures, what 5 things should be noted?
- age of dentures
- cleanliness
- retention and stability
- any fractures
- occlusal surfaces
43
What are special tests that can be done during an examination?
- radiographs
- vitality tests (colour, presence of sinus, radiographs)
- thermal and electrical stimuli
- percussion
- diet diary
44
When may you get a false negative response to thermal and electrical stimuli?
- after trauma
| - heavily restored tooth
45
When may you get a false positive response to thermal and electrical stimuli?
- anxiety
- poor testing method
- pus in canal
46
What are 4 examples of pulpal diagnosis?
- reversible pulpitis
- irreversible pulpitis
- necrotic pulp with acute periapical periodontitis
- acute apical abscess
47
What are the 9 points that treatment plans should cover and the order in which you should lay out trt plan?
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
What are 3 treatment methods of relieving pain?
- removal of caries and dressing
- extirpation of pulp
- extraction
49
What are 4 treatment options for stabilisation?
- extractions if required
- dressing of caries/immediate pulpal extirpations
- temp dentures
- remove necrotic pulp
50
What should be considered when doing restorations where a cobalt chrome denture is also on the treatment plan?
rest seats
| have to accommodate these so the patients bite is not propped open
51
What are the 3 importances of making a treatment plan and recording it in patients file?
- ensures that dentist reviews treatment in all stages
- a record for future reference
- avoid disorderly management
52
Treatment plans are based on sound diagnosis, which is composed of?
- history
- exam
- special investigations
53
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
reversible pulpitis
54
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
irreversible pulpitis
55
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
pulpal necrosis (with acute periapical periodontitis)
56
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
pulpal necrosis (with chronic periapical periodontitis)
57
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
acute apical abscess
58
What is the name for the following tooth condition?
| - bone loss and pus has built up from periodontal pocket
lateral periodontal abscess
