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DH&T YR2 > Clinical Skills > Flashcards

Clinical Skills Flashcards

1
Q

What are the steps to carrying out a FS?

A
  1. Clean the fissures
  2. Isolate the tooth
  3. Etch, wash, dry
  4. Bond (can/can’t, doesn’t improve the efficacy of the sealant in the long term
  5. Light cure
  6. Apply sealant, using probe
  7. Light Cure
  8. Evaluate
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2
Q

What is a FS?

A

A FS is a preventative measure, it is a material that is applied to the pits and fissures of teeth in order to prevent dental caries/ prevent the development of dental caries.

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3
Q

What are the uses of FS?

A

Primary use: To prevent the formation of dental caries on susceptible tooth surfaces.

Secondary use: To prevent the development of dental caries in early non-cavitated lesions.

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4
Q

What is a PRR

A

A PRR is a restoration of carious lesions into dentine where the lesion is limited to areas of minimal occlusal load.

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5
Q

Who should get a FS

A

All high risk caries children

Susceptible tooth surfaces

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6
Q

Patient signs for a FS

A

Caries in primary teeth
Caries in permanent molars
Medical Condition
Risk factors e.g. Diet

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7
Q

Tooth signs for a FS

A

Hypoplasia
Inaccessible to clean
Hypomineralisation
Depth of fissures

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8
Q

When do we have high failure rates of FS

A

When placed in newly erupted teeth

Placed in mouths with previous high caries rate

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9
Q

Uses of PRR

A

Lesions into dentine

Areas of tooth bearing minimal occlusal load

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10
Q

Benefits of PRR

A

Minimal prep/ not invasive
Aesthetics
Minimal wear
Improved seal

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11
Q

Method of a PRR

A 
LA
Isolate the tooth
High/Slow speed caries removal
Etch
Bond
Light cure
Fill with composite, cure incrementally
Seal
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12
Q

Monitoring PRR is

A

Key for Success
Recall according to caries risk
Reassess the FS
Clinical and radiographic monitoring

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13
Q

What causes caries

A

Time
Sugar: fermentable carbohydrates
Susceptible tooth surface
Plaque

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14
Q

Who is at risk of developing caries

A 
Recreational drug users who crave sugars
Infants taking bottles to bed
Occupational: food tasting
Athletes: sports drinks
People taking sugar medicines
Xerostomia sufferers
Special needs patients
Socially deprived
Special diets: Carb rich
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15
Q

Preventative measures for high risk groups

A 
Diet analysis and advice
Topical fluoride application
OHI influencing spit don't rinse and 1450ppm fluoride
Fissures sealants
Regular assessment
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16
Q

What is the plaque biofilm?

A

Salivary pellicle forms
Many microorganisms
Initially the main microorganism is Streptococcus Sanguinis/Oralis
After 1-14 days becomes Actinomyces based

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17
Q

What diet advice can we give?

A 
Only water and milk in bottles
Promote use of beaker cups
Use a straw
Limit soft drinks to meal times
Limit sugars to meal times
No more than 4 sugar points per day
Use non sugar sweetners
No cariogenic snacks between meals
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18
Q

Key toolkit messages

A
  1. Smoking
  2. Fluoride
  3. OHI
  4. Alcohol
  5. Diet
  6. Perio health
  7. Prevention of erosion
  8. Behaviour management and change
  9. Sugar free medicines
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19
Q

What is caries and when does it occur

A

Caries is a multi factorial disease caused by the effect of fermentable carbohydrates on bacterial plaque.

It occurs when demineralisation outweighs remineralisation

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20
Q

Caries Risk Assessment

A

Low: Balanced diet with fruit and veg intake sugars restricted to mealtimes.

Medium: Regular sugar intake between meals

High: Sugar exposure greater than 3 times a day, prolonged exposure to food and drink

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21
Q

Advice for 0-3 year olds

A

First tooth eruption cleaning
Toothpaste smear containing no less than 1000ppm fluoride.
Supervised tooth-brushing
No more than X4 sugar exposures per day

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22
Q

Advice for 3-6

A

Pea sized amount of toothpaste
1350-1500ppm
Fluoride varnish application 2/12

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23
Q

Why do we restore teeth?

A

Pain relief for patients
Restore occlusion and function
Aesthetic reasons
Maintain structural integrity of the tooth
Minimise/prevent lesions from becoming larger

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24
Q

What is the median survival rate for amalgam

A

15 years with a 3% failure rate

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25
Q

What is the median survival rate for composite

A

8 years with 2% failure rate

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26
Q

Why does amalgam fail

A 
Incorrect case selection
Poor cavity preparation
Poor matrix preparation
Ditch/Creep
Contamination
Poor amalgam manipulation
Post op pain: poor lining
Poor contact points
Tarnishing/corrosion
Poor polishing/finishing techniques
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27
Q

What 3 factors cause restorations to fail

A

Patient
Operator
Material

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28
Q

What causes composite to fail

A

Poor moisture control: contamination
Not light curing in small enough increments
Difficult to get resin matrix to bond well to dentine for long periods of time
Polymerisation shrinkage: leads to secondary caries, marginal shrinkage, sensitivity

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29
Q

What is the average lifespan for GIC?

A

30-42 months in permanent teeth

7% annual failure rate

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30
Q

What causes GIC to fail

A

Placed in areas of high occlusal load

Difficult material to work with so handling of the material can lead to failure

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31
Q

Implications of failed restorations

A 
Time
Cost
Remaining tooth structure
Material
Technique
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32
Q

What patient factors effect restoration success/failure

A 
Pulpal health
Perio health
Caries risk: Good OH etc
Bruxism
Allergies: allergies to alloys in amalgam/HEMA in composite
Tooth to be restored
Cavity size and location
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33
Q

What operative factors effect restoration success/failure

A 
Good case selection
Correct material selected
Good operator technique when handling material
Good cavity design
Good polishing/finishing techniques
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34
Q

What material factors effect restoration success/failure

A

Compression strength
Flexural strength
Rigidity
Surface hardness/ surface wear characteristics

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35
Q

Which is the least common reason for replacing/restoring

A

Discolouration

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36
Q

Material factors causing amalgam to fail: in terms of microleakage

A 
Ditch/Creep
Thermal expansion
Resistance to fatigue
Solubility
Adhesion property
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37
Q

What is ditching

A

When the thin edge of the restoration breaks creating a V shaped indent

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38
Q

What is marginal leakage

A

When the restoration is subject to continual compressive strength that is not enough to fracture it causes slow breakdown of the amalgam. this is usually seen when using Gamma 2 phase amalgam.

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39
Q

What is creep

A

Creep happens when the corrosive products leak and fill the gap between the restoration and the tooth surface

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40
Q

How do we clinically detect restoration failure

A 
Visually
Tactile
Radiographically
Patient complaint of pain, discolouration
Occlusally
Transillumination
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41
Q

What are primary caries

A

Caries at a new site

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42
Q

What are secondary caries

A

Caries at the same site of a tooth

  • Formed in shrinkage of materials
  • Caries left from initial removal
  • At the margin under a restoration
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43
Q

When to repair a restoration

A

There is no sign of gross caries/spread that would structurally undermine the restoration.
Enough of the retained restoration so it is string enough to withstand occlusal forces.
No potential aesthetic mismatches
The possibility to bond to remaining tooth structure or previous restoration.

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44
Q

What is dental amalgam

A

It is powder which is an alloy of silver and tin that is mixed with mercury droplets.

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45
Q

What shaped amalgam powder particles can we get?

A

Lathed and Spherical

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46
Q

How do the different components of amalgam interact

A

Silver + Tin = Gamma
Silver + Mercury = Gamma 1 phase
Tin + Mercury = Gamma 2 phase

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47
Q

Why do we not want gamma 2 and how do we prevent gamma 2 phase

A

Gamma 2 causes for a weaker composition of amalgam, which can cause creep and corrosion and so to reduce this we can add copper to make the gamma 1 phase and it makes the amalgam stronger.

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48
Q

What 4 materials are found in amalgam powder

A

Silver
Tin
Copper
Zinc

49
Q

What percentage of mercury do we want in amalgam

A

Less than 50%

50
Q

How do we achieve less than 50%

A

Need amalgam to be mixed with more than 50% mercury or it is too brittle.
As we pack mercury vapours are released and mercury rises till we have a soft mercury layer on the top which is then scraped away during carving leaving us with less than 50% mercury

51
Q

What is the difference between laithed cut and spherical cut

A

Laithed is stronger and good for large build ups and spherical is softer and more flowable

52
Q

What are the benefits of amalgam

A 
Kind to opposing teeth
Minimal to wear
Good compression strength
Cheap
Easy to use
Long life span
Chemical set
Radiopaque
53
Q

What are the disadvantages of amalgam

A

PRF if not applied correctly
Not aesthetic
Weak in thin section
Thermal expansion: damage to pulp via heat
Not chemically retentive, micro mechanical retention

54
Q

Clinical uses for amalgam

A

Building up teeth before crowning
Class 1/2 restorations
High occlusal load bearing sites
Aesthetics not an issue

55
Q

How do we prep an amalgam cavity

A

Remove infected dentine leaving affected
Undercut walls to provide retention
Cavo surface angle greater than 90 degrees. angle between prepped and non prepped tooth
Amalgam restoration margin angle greater than 70 degrees. angle between filled/non filled tooth
Overfill to allow scraping away.
Must be at least 2mm deep

56
Q

How do we make amalgam retentive

A

Undercutting is ok for Class 1 and small class 2 however grooves required for larger build ups

57
Q

Why do we no longer use pins in retention

A

Cause damage to the pulp

Can weaken the tooth

58
Q

Amalgam vs composite

A

Amalgam is better when a larger restoration is concerned.
More change of secondary caries with composite.
Longer life span for amalgam

59
Q

Mercury has been blamed for

A 
Neurotoxicity
Birth defects
General health
Oral and intestinal bacterial changes
Kidney disorders
60
Q

Why does care need to be taken with mercury in the environment

A

Mercury in the environment can be transformed by bacteria into methyl mercury in fresh or salt water which is highly poisonous.

61
Q

What do we need for a IO exam looking for caries

A

Good light
Clean dry tooth 3:1
Seps/wedge for interproximals
Loupes if wanted
No probe do not touch any suspected lesion with a probe.
Clinically examine using: visual, radiographs or trans illumination.
The more diagnostic tools we use the better we can detect.
Lesions can be diagnosed at any stage

62
Q

What must a clinician do on finding a lesion

A

Understand the appearance of the lesion and link it to the underlying histological cause to ensure a patient specific care plan

63
Q

What does an arrested lesion look like

A

Black, leathery, Hard,

64
Q

What does an active lesion look like

A

Orange, sticky, soft

65
Q

Which dentition required radiographs for better clinical assessment of interproximal lesions

A

Primary dentition as the contact points are broad, clincially in the permanent dentition clinical assessment is much easier

66
Q

What is transillumination

A

A way of detecting caries when a light is shone onto the tooth the carious lesions pick up less light causing a dark shadow to form indicating a lesion. better light such as a fibre optic needed for the posteriors

67
Q

What does a good journal have?

A 
Clear and easily readable
Justified
Can be repeated
Presents the results accurately
Discusses the results fairly
Draws sensible conclusions
68
Q

What order are scientific papers written in?

A

Intro
Method
Results
Discussion

69
Q

What methodologies should we follow for scientific papers?

A

Data: Quantitative or qualitative
Sampling method: Recruitment/retention, representative, allocations, sample size
Measures: Objective/subjective, are they appropriate, do they incur some confounding variables, are they reliable.

Validity: does the study measure what it intends to
Reliability: could the study be repeated
Results: are they appropriate, significant, omissions
Is it replicable: Setting, collection of data, data collection tools
Discussion: Results presented accurately?,strengths and weaknesses, objectives and results aligned

70
Q

What issues effect good papers

A

Involving the user

Pilot studies

71
Q

What relationships do smoking studies show

A

Smokers have highest bone loss/ CAL
Prev smokers have less
Non smokers have least
Increase risk with number and time spent smoking

72
Q

Clinical appearance of gingiva on a smoker

A 
Rolled fibrotic gingiva
Reduced BOP
Greater stain
Greater calculus deposits
Gingival recession
73
Q

NPD clinical appearance

A 
Punched out papilla
Sore papilla with necrotic ulcers covered in grey slough
Quick to bleed
Lymph nodes may be involved
Possible halitosis
74
Q

What is the overall pathogenesis for Perio in smokers

A

Reduced bleeding
Fibrotic gingiva
Less bleeding due to reduction in vasculature
Impaired wound healing

75
Q

What are the effects of stress

A

Behavioural changes

Chronic inflammation

76
Q

What is biological width?

A

the combined total of connective tissue and junctional epithelial attachment formed adjacent to a tooth and superior to crestal bone

77
Q

What is the mean volume of biological width

A

2.15-2.30

78
Q

Why do restorations effect perio health?

A

PRF: overhangs/ledges, poorly polished surface, poor gingival contacts
Food trapping: open contact points, over/under built contacts, incorrect 3D margins.

79
Q

Why do we have buldge surfaces on teeth

A

To prevent food debris from trapping

80
Q

what are spillways and embrasures for?

A

To prevent food trapping

81
Q

How do we assess someone before a restoration is placed

A 
Always prevention first
Asses periodontal health
Treat any perio issues
Repair any faulty restorations
Place new restorations where necessary
82
Q

What to do if food packing is an issue?

A

Check the patients occlusion:
for plunging teeth into interproximal spaces
open and poor contact points
overbuilt/underbuilt restorations

83
Q

How do we deal with faulty restorations

A 
Repair
Replace
Modify
Extract
Refer to specialist
leave do nothing
84
Q

Where do we get moisture from in dentistry

A 
GCF
Breath
3:1
Saliva
Blood
Dental materials
85
Q

What are the advantages of using a rubber dam

A 
Moisture control
Airway protection
Infection control
Ease of operator/nurse
Protection/retraction of tissues
patient comfort and compliance
86
Q

What are the disadvantages of using a rubber dam

A 
Communication
Clamps uncomfortable
Claustrophobic
Allergy
Matrix placement
Time consuming
87
Q

How to carry out a winged technique

A

floss through to check tight contacts
make a safety line
punch the dam
4 holes large molar 2 for premolar
stretch the wings over and out of the dam
attach the frame
place the assembled dam as a whole onto the tooth

88
Q

Why do we use temporary restorative materials?

A

Time/quadrant stabilisation
Interim dressings between RCT appointments
Sedative effects
Allow time to ensure gingival health before placing a definitive restoration

89
Q

What properties do we look for in temporary restorative materials?

A 
Bulk fill
Easy to identify/remove
Good marginal seal
Antibacterial
Resistant enough to last till permanent restoration goes in
90
Q

What is chemfil rock?

A

A zinc modified GIC.
Used as an interim material
Or to repair cusps temporarily to prevent gingival damage/ damage to opposing teeth.
Choose white shade to easily identify and remove
Bonds to tooth

91
Q

What is Kalzinol

A

ZOE cement with added polymer for strength
not as strong as a GIC but is good temporary
sedative effect on inflamed pulps so used as an interim between endo appointments.
Mix into putty setting time 4 mins, working time 2 mins mixing time 1 min

92
Q

What is Cavit

A 
Temporary material comes as Cavit/G/W
Cavit G is removed in one bulk
Self curing sets under humid conditions
Place into wet cavity
Avoid chewing for 2 hours
93
Q

What is dentine conditioner and why do we use it

A

Dentine conditioner is a 10% polyacrylic acid that needs to be applied before applying a GIC for 20 seconds to remove the dentinal smear layer, and condition the enamel and dentine for the GIC. The dentine conditioner leaves smear plugs in the tubules to prevent any fluid moving out of the tubules disrupting the clean dentinal surface.

94
Q

What is the definition of erosion

A

The progressive loss of tooth tissue due to a chemical reaction involving acid and not bacteria

95
Q

What is the definition of attrition

A

the progressive loss of tooth tissue due to tooth to tooth contact.

96
Q

What is the definition of abrasion

A

the progressive loss of tooth tissue due to mechanical external wear on the tooth.

97
Q

How is toothwear defined

A

aeitiology
distribution
severity

98
Q

What 3 things are a cause of intrinsic erosion

A

Gastro oesophagal reflux
Ruminant eating
Vomiting

99
Q

GOR symptoms

A 
Dysphagia
sore throat
Horse throat
sour taste in mouth
chronic cough
retrosternal discomfort
heartburn
epigastric pain
100
Q

Where do dietary acidic sources come from

A 
Fruit juices
Pickled foods
Alcohol
Fruits
Herbal teas 
Energy and sports sources
Yoghurts
101
Q

Important dietary factors in prevention of erosion

A

frequency
amount
time of consumption
method of consumption

102
Q

What is the clinical presentation of erosion?

A 
Chipped incisal edge
Translucent incisal edge
Proud restorations
Palatal pits
Flattened cusps
darkening in colour
Exposure of pulp
103
Q

What is the difference between erosion and caries

A

in erosion the acid loss causes the demineralisation of tooth surface and the loss of the organic matrix

104
Q

Clinical presentation of attrition

A 
Enamel and dentine wear at same time
Flattened cusps/incisal edges
increased risk of mobility
possible fracture of restorations
possible massetric hypertrophy
Shiny amalgam
Slow process so secondary dentine can be laid down
105
Q

What causes abrasion

A 
toothbrushing
abrasive toothpastes
occupational: wire ripping
piercings
Iatorgenic
habits
106
Q

Clinical presentation of abrasion

A

sharp defined margins
mainly cervical
smooth hard surface

107
Q

abfraction

A

Occlusal forces formed by tensile strength causes microfracture of cervical enamel rods

108
Q

How do we assess the severity of toothwear

A 
Crown height loss
sensitivity
aesthetics
structural integrity compromised
effecting enamel dentine or pulp
109
Q

Initial management of NCTTL

A

Identify presence and severity of tooth wear
Determine aetiology
Monitoring
Prevention

110
Q

How do we assess the aetiology of NCTTL

A

Patients history
clinical appearance
often multifactorial

111
Q

problems with severley worn dentition

A 
Pulpal involvement
not enough tooth left to add a restoration
occlusal change
soft tissue change
aesthetic compromise
112
Q

How do we monitor the progression of NCTTL

A 
Study models
silicone index
measurements with probes
visually
clinical photographs
113
Q

How do we manage NCTTL

A 
Identify severity and aeitology
Apply preventative measures
monitor
operative treatment if required
review
114
Q

Prevention of erosion

A

diet advice
sodium bicarbonate mouthwash
contact GP about reflux/ED
don’t brush for an hour after eating

115
Q

Prevention of attrition

A

Splints
composite build ups
pt education

116
Q

What does a soft splint consist of

A 
Vaccuum formed onto cast model
Upper sodium bicarb/fluoride tray
if pt bites through consider hard splint
usually lower in bruxism cases
full coverage
quick and easy
117
Q

What does a hard splint consist of

A

More time consuming and difficult
Provides ideal occlusion and occlusion guidance
Relaxes muscles and re positions the mandible
Class 1 & 2 upper class 3 lower

118
Q

Prevention of abrasion

A 
Assess brushing hardness
toothbrush bristle hardness
dentifrice abrasiveness
frequency of brushing
pt education and habits

DH&T YR2 (1 decks)

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