Clinical Skills Flashcards
What preventative factors should you consider when treating a pregnant patient in the 1st trimester
- Defer non-indicated radiographs
- Use lead shielding with radiographs
- OHI to prevent pregnancy gingivitis
- Management of vomiting with morning sickness
- Management of sweet/food cravings
- Manage alcohol/smoking usage
- Maintain sound OH
- Dental care best delivered in 2nd semester
- GA/IV Sedation contraindicated until after pregnancy
- Ensure any medications are not contraindicated for Teratogenic effect
What constitutes standard precautions for infection control?
Standard Precaution = PAW HEEL procedure
Protective Gear Aseptic Technique Waste Management Hand Hygiene Equipment Reprocessing Environmental Management Laundry
What conditions would constitute usage of transmission precautions?
Where Standard Precautions may be insufficient to prevent transmission of infection
Airborne Transmission : pulmonary TB, measles
Droplet Transmission: rubella, pertussis
What are the steps to deal with a needle stick injury?
Stop Operation Remove Gloves Wash Under Warm soapy water Dry Bandage/First Aid Call Registered Nurse - counsel on options and next steps Know Patient’s Immune Status/Vaccination Possible Blood test for yourself/patient Possible Prophylaxis
What are the steps to deal with a eye splash injury?
Stop Remove PPE Apply Gel Irrigate with water Call Registered Nurse - counsel on options and next steps Know Patient’s Immune Status/Vaccination Possible Blood test for yourself/patient Possible Prophylaxis
What is a mesiodens?
Incisal Supernumerary Tooth
What constitutes burnout?
Emotional exhaustion Depersonalisation
Loss of personal accomplishment
What is the purpose of wiping down a surface?
Decreasing the microbial load
What is aseptic technique?
Having clearly clean and dirty zones to reduce microbial load
What Post Operative Instructions would you give for LA?
- Area will be number for next few hours
- Avoid eating for the next 30 minutes and eat room temperature foods until sensation returns
- Don’t eat on the numb area
- Be careful not to bite tongue, lips
- If numbness persists after 24 hours contact ADH
What Post Operative Instructions would you give for Neutral NaF fluoride?
- Don’t eat for next 30 minutes
2. Brush tonight
What Post Operative Instructions would you give for MI Varnish?
- Don’t brush or floss for at least 4 hours
- Avoid hard, hot sticky foods in 4 hours
- Brush next day
What Post Operative Instructions would you give for a scale and clean
- Possible Tooth Sensitivity
- Soft tissue soreness
- Some bleeding possible
- Warm Salt Water rinse
What are the instructions for use for MI Varnish?
- Tooth surfaces should be cleaned and dried before application. Prophylaxis is not required.
- Peel off the foil lid of the unit dose container of MI Varnish.
- Apply a thin, uniform layer of MI Varnish on teeth / surfaces using a disposable brush.
- MI Varnish sets when in contact with water or saliva.
- MI Varnish should remain undisturbed on the teeth for four hours. Instruct patients to avoid hard, hot or sticky foods, tooth brushing and flossing, products containing alcohol (oral rinses, beverages, etc.) during this time period.
What are the POI for MI Varnish?
MI Varnish should remain undisturbed on the teeth for four hours. Instruct patients to avoid hard, hot or sticky foods, tooth brushing and flossing, products containing alcohol (oral rinses, beverages, etc.) during this time period.
Who is contraindicated for Fluoride varnishes?
Very rare reaction in asthmatics
What concentration of Fluoride is Duraphat?
22,600ppm (5% w/v Sodium Fluoride)
What are the contraindications for Duraphat?
- Hypersensitivity to colophony (natural resin)
- Ulcerative gingivitis
- Stomatitis
- Bronchial asthma
What are the instructions for use for Duraphat?
- Application to demin lesions susceptible to caries attack.
- Prophylaxis is only required if thick plaque deposits are present.
- Teeth should be isolated and gently dried.
- Duraphat can be applied using a brush, probe or applicator.
- POI for no brushing, eating hard foods for 4 hours. Fluids / Soft food can be consumed
How do you manage a patient with a gag reflex?
- Build rapport + trust
- Give context of the treatment and why it’s necessary to proceed
- Identify triggers and adjust treatment
- Distraction techniques - get DA to talk to her, get her to wiggle her toes
- Minimise length of treatment
- LA of soft tissues may help
Your patient has a gag reflex to rubber dam. What are alternative methods of moisture control?
Dry Guard
Chemical Drying Agents
Cotton Rolls
High Speed Suction
A patient presents with an emergency appointment due to trauma from a bicycle accident. What clinical examinations should you do in order to assess any cognitive injuries from the accidents?
Priority for the patient is whether the trauma involves brain injury. The operator should check for the following and if trauma suspected, should call 000 and get an ambulance to take the patient to hospital:
- Patient is vague
- Lacks concentration
- Ask to count fingers, unable to give correct answer
- Shine light in eyes: difference in dilation between eyes
What are options in regards to pulp capping materials?
- Life: CaOH
- Ledermix: a steroidal product
- Theracal: a light cured resin modified calcium silicate
- Zinc Oxide-Eugenol
- Mineral Trioxide Aggregate (MTA)
- Biodentine
What is the clinical goal of direct pulp capping?
Create necrosis of tissue in contact with the pulp capping tissue to create a good seal for tertiary dentine formation
What procedures would undertake to ensure a safe treating environment for a patient that is allergic to latex?
- Treat as the first patient of the day so there is less latex in the environment
- Avoid latex items: Rubber Dam, Rubber Gloves, LA Plunger, Gutta Percha, Ortho Bands, Rubber Stops on Endo Files, Rubber Burs
- Check for any other allergies
How do you manage a patient having an anaphylactic response?
- If Possible, patient to administer epipen themselves, else you should do it
- Call 000
- Start First Aid (DRSABCD)
- Place in Supine + Recovery position (if breathing)
What are alternatives to rubber dam for subgingival isolation
- Retraction Cord
- Gingevectomy with lasers/scalpel
- Trichloroacetic Acid (Astringent Hemastatic Agent)
- Gingival Retractor Tool
- Use an offset anterior dam clamp
What is the cuff technique?
When subgingival access is required a rubber dam is placed normally and anchored. The teeth needing subgingival access has the dam cut to increase access to the space.
What OHI would you give to a patient with high caries risk who is about to go backpacking for 18 months?
- Patient Education: increase awareness about current damage to teeth, how caries develops and why it’s important to change
- Self Care instruction: brushing technique, flossing, appropriate choice of F agent with travelling in mind (Tooth Mousse Plus + Floss)
- Harm Minimisation whilst travelling: how to stay adequately hydrated and have access to F whilst in countries that don’t have this available. Reduce sugar intensity. Xylitol Chewing Gum
- Address main restorative issues before patient leaves
- Book recall for anticipated time of return
