dental situations Flashcards
I’m at A&E where a patient comes in with health complications that originate from dental disease. Can you explain how that can happen?
- bacterial infections: bacteria enters bloodstream through mouth- infections in other body parts e.g. lungs, (pneumonia) heart (endocarditis)
- dental diseases e.g. caries, abscess, are painful make chewing difficult-> malnutrition, causes fatigue, muscle weakness, weaker immune system
- periodontitis- gums become inflamed, inflammation in body can cause high blood glucose levels, as cells don’t respond effectively to insulin, hard to regulate blood glucose
- dental abscess- pus build up in teeth, gums due to infection- neck and jaw pain
What is it called when a dental infection spreads to the jaw and neck?
- dental abscess- build up of pus in teeth or gums caused by bacterial infection
- usually occurs when bacteria invades tooth pulp usually through crack or cavity
If a patient collapses in the waiting room, how would you assess them?
- clear space around them, call for help
- give hard shake and ask if they can hear me
- gently tilt head back & lift chin- clears airway
- put face near cheek to hear/ feel breath
- feel for pulse
- if not breathing then start CPR and call ambulance
- use defibrillator if there is one nearby
What are the most common causes of tooth decay?
-bacteria- bacteria in mouth produces acid that erodes tooth enamel
-sugar- feeds the bacteria, more acid production
- poor oral hygiene- not brushing & flossing regularly allows plaque build up
- lack of fluoride- some towns not fluoridated, not enough toothpaste
- frequent snacking- feeds bacteria, keeps acid levels in mouth high
What are some signs and symptoms of a cavity?
- toothache
- sensitivity- hot, cold drinks, sweet foods and drinks
- visible holes
- discolouration- dark spots or stains on tooth surface
- bad breath
How often should you go to the dentist for a check-up?
Every 6 months
Dentist might recommend more frequent visits if higher risk of cavities
Can help prevent cavities and catch issues early on
What are some ways to prevent tooth decay and gum disease?
- brush 2x a day
-fluoride toothpaste, dont rinse - flossing
- eat less sugar
- regular check ups
Can a toothache go away on it’s own or should you always see a dentist?
- see dentist
- may be sign of decay, abscess, gum disease
- if pain stops does not mean infection is gone- nerve could be dead
What are some common causes of bad breath?
- smoking
-poor oral hygiene- plaque build up from not brushing - diet
- ## dry mouth (xeristoma) - saliva cleanses the mouth
What is a dental abscess and how is it treated?
build-up of pus in teeth, gums caused by infection.
- wont go away on own
- swollen face or jaw, toothache, sensitivity
- dentist makes small cut in abscess and drains pus
- could also do root canal
What are some ways to treat and manage tooth sensitivity?
- Desensitizing toothpaste
- soft bristle toothbrush
- avoid acidic food & drink
- add fluoride to daily routine
- consult dentist
Can gum disease be reversed or is it always a chronic condition?
- once passes gingivitus (1st stage) cant be reversed due to bone loss
- bone cant regrow around tooth- lose structural support
How do you properly brush and floss your teeth to maintain good oral health?
- brush 2x a day, fluoride toothpaste, no rinsing, electric
- floss before brush, every night, every tooth
- change brush every 3 months
How does pregnancy affect oral health?
Hormonal changes make gums more sensitive and vulnerable to plaque, leads to inflammation and bleeding gums-pregnancy gingivitis
morning sickness- vomiting exposes teeth to stomach acid, erodes enamel
Changes in diet- cravings for sugary or acidic foods
Hormones can lead to dry mouth which increases risk of cavities and gum disease because salvia cleans the mouth and neutralises acids
some may avoid dental visits during pregnancy
NHS dental care is free during pregnancy and for 1st year after birth of baby.
What is periodontitis and how is it treated?
- inflammation of gums- damages tissue and bone supporting teeth
- red,bleeding,swollen gums
-antibiotics
- Scaling and root planing- deep clean below gumline
What are the symptoms of the temporomandibular joint disorder (TMJD) and how is it diagnosed?
temporomandibular joints found either side of head in front of ears. let us talk, chew and yawn. TMJD caused when one or more joints become inflamed
-Pain in chewing muscles
- Pain that spreads to face or neck.
- Jaw stiffness
- Ringing in ears, hearing loss, dizziness
- dental exam to show if poor bite alignment
- Feeling joints and muscles for tenderness
- Watching, feeling, and listening to the jaw open and shut
- X-rays, CT scan, MRI,
What is fluorosis?
excessive fluoride intake
- cause discoloration, brown spots on enamel
- corrected with cosmetic treatment
What is dry mouth and what are the potential causes?
- salivary glands don’t produce enough saliva- keeps mouth moist
- dehydration- low fluid intake, excess sweating
-side effects of some meds eg antihistamines - anxiety
- cancer treatment (chemo, radiotherapy)
- some medical conditions like Sjogrens syndrome, diabetes
- alcohol and caffeine
- ageing- because you are more likely to take meds when older
What is dental erosion and how can it be prevented?
surface of teeth lost after touching acid. loss of enamel
- good diet, oral hygiene and regular dental care
- limit fizzy drinks
- less acidic foods
- less frequent snacking
- fluoride
What is bruxism and how is it treated?
- teeth grinding- could be stress, sleep,
- wears away enamel,tooth cracks
- custom mouth guard
- muscle relaxants
-meds for anxiety & stress
What is the difference between a bridge and a denture?
- bridge is permanent
- dentures are removable
bridge usually used when less teeth to replace
What is the importance of regular dental check-ups?
- spot caries, decay, gum disease- allows plan for treatment
- easier to treat issues early- less money in future and less appointments
- ensure teeth are healthy
What are the risks of not treating a dental infection?
infection spreads to gum and bone around- abscess
- bacteria enters bloodstream- infections of other body parts
What is the role of fluoride in dental health?
strengthens tooth enamel, makes it more resistant to decay
reduces amount of acid that bacteria on teeth produce.
What is a dental implant?
titanium screw placed directly into jawbone, replacing missing tooth root.
artificial replacements for missing tooth roots
material cant decay like your own tooth
What is the impact of diet on oral health?
- sugary foods- decay, caries
feeds bacteria, produce more acid so more enamel eroded - acidic foods- can erode enamel
What is the difference between a root canal treatment and an extraction?
extraction removes tooth, root canal aims to keep the tooth
extractions take less time
root canal- dentist removes inflamed pulp inside tooth and seals and fills it.
What is the impact of grinding teeth on oral health?
crack or fracture teeth, may require crowns or dental implants. abscess
wear down enamel on teeth, leading to periodontal disease or lost teeth.
headaches,TMJD
What is the connection between oral health and cardiovascular disease?
bacteria that infect gums and cause periodontitis can travel to blood vessels elsewhere in body- cause blood vessel inflammation and damage; blood clots, heart attack and stroke may follow.
Bacterial endocarditis
What are the potential complications of untreated gum disease?
destruction of underlying jawbone, leading to possible tooth loss.
once passes gingivitus and bone loss, cant be reversed
- diabetes, swollen gums, respiratory problems
What is the connection between oral health and respiratory disease?
bacteria can travel through airways and into lungs, lead to infections of lungs e.g. pneumonia.
What do you know about oral cancer?
-cancers of mouth & back of throat.
- risk increases with age
Symptoms include:
- mouth ulcer that lasts 3+ weeks
- red/ white patch inside mouth
- lump inside mouth or on lip
- pain inside mouth
- difficulty swallowing
more likely to get it if:
- smoking
- drink lot of alcohol
- exposed to lots of sunlight, can cause skin cancer affecting the lips
- had cancer before
- weakened immune system e.g. HIV or AIDS
Why do some people underestimate the value of their teeth?
- lack of education- many dont acknowlege the importance of oral health on general health
- dental anxiety- negative exps with dental visits- fear
- cost of care- people prioritise other financial needs
- cultural perceptions- some may not view oral health as a priority
As well as undervaluing their teeth, many can’t access dental care. Why is this?
- cannot afford
- cant leave home- tie to WE and domiciliary
- rural areas
Could you tell me a little more about root canal treatment?
- remove inflamed/infected pulp on inside of tooth, then inside of tooth cleaned & disinfected, shapes inside of root canal, then fills with rubber-like material ‘gutta-percha’ then sealed.
might need a root canal:
- Severe pain when chewing/ biting
- Pimples on gums
- chipped/ cracked tooth
- lingering sensitivity to hot or cold
- Swollen or tender gums
- given local anaesthetic
What do you know about amalgam?
- silver fillings
- alloy of metals, 50% mercury, rest silver, tin, copper
- strong and long-lasting
- ethical debate- mercury bad for health and eco
not used for:
- pregnant or breastfeeding women
- deciduous teeth in U15s
One of the biggest problems to to teeth is smoking. What do you know about this?
- higher risk of oral cancer
- tooth staining
-Smoking tobacco causes lack of O2 in bloodstream, leads to infected gums not being able to heal-> gum disease
Do you think we should ban tobacco in the UK?
yes:
- reduces second-hand smoking,
-nicotine & tar in tobacco settle within the tooth enamel- staining
- chest infections e.g bronchitis
- lung problems
- cancer, heart disease
no:
- takes away people’s freedom
- smoking can help with anxiety
What are the differences between composite and amalgam?
Composite:
- provide a natural appearance
- less durable- may need replacing
amalgam:
- silver looking
- stronger and longer lasting
- can discolour overtime
- uses mercury
What is a crown and what are they made of?
a tooth-shaped cap to restores a decayed, broken or worn-down tooth.
also cover dental implants and root canal-treated teeth.
variety of materials- metal, resin and porcelain,
last between 5 and 15 years with proper care.
porcelain popular because it looks natural
What determines the survival of a tooth?
- health of surrounding gums
- presence of cavities or decay
- effectiveness of oral hygeine practices
What can be done if a tooth has died?
- root canal- most common for dead tooth- dentist removes infected pulp, cleans inside tooth, seals it
- extraction- may be necessary to prevent spread of infection to other teeth
- dental crown- after root canal, dental crown may be placed on tooth to restore its shape, appearance
Do you think the cultural attitude towards dentition has changed?
dentition- the development of teeth & arrangement in mouth
yes- in past, dental health perhaps overlooked, less people educated, less accessed dentists
now greater awareness on oral health, influenced by education (more people in school, more lessons on health), access to dentists (NHS), social media (dentists online)
- cosmetic dentistry more popular to restore aesthetic smiles
How does alcohol affect the oral cavity?
oral cavity AKA mouth
- dry mouth: alcohol leads to dehydration & less saliva made= dry mouth
saliva neutralises acids and washes away food
lack of saliva= cavities, gum disease
-increased acid levels in mouth- tooth erosion
- tooth decay- sugar in sweetened drinks feed bacteria in mouth- plaque build up & cavities
- staining- red wine, can stain teeth
Give risk factors for oral cancer
- tobacco- smoking increases risk
- alcohol- increases risk
- Age- risk increases with age, especially over 50s
- poor oral hygiene- neglecting oral health
-diet- low in fruits & veg increase risk
- weak immune system
Describe how you would tell a patient that their tooth needs to be extracted.
- sit down with them, ensure they’re comfortable
-be empathetic, clear, open to questions
- tell them what we saw wrong with their tooth, why it needs to be extracted
- talk through procedure, ensure they understand, give time to process
- respect autonomy and ensure consent is valid
How do you approach staying up-to-date with the latest dental research and techniques?
- attend conferences & workshops
- engage in discussions w dentists
- read articles
How do you approach evaluating the quality and validity of dental research and techniques?
quality of techniques
- efficiency- if makes process faster
- comfort- if more comfortable for patient
- try on colleagues before patients
- compare to other techniques- easier to use
validity of research
- written by qualified dentists?
- check references- time, date, author
- ask senior dentists, ask for other opinions
Can you describe a time when you had to critically evaluate research or techniques?
- school research project on sedation for special needs patients
- inspired by work experience
- researched techniques of sedation: LA, moderate, GA- weighed up benefits & complications
- important to evaluate research & techniques to stay up to date as dentist & offer efficient treatment
How do you approach understanding the unique dental needs of different patient populations, such as children or older adults?
Can you describe a time when you had to modify your approach to accommodate the unique needs of a patient?
volunteering at care home
- margaret with hearing aids
- raise voice so she could hear
important as dentist to accomodate to others’ needs
How do you approach managing pain and discomfort during dental procedures?
- distractions- puzzles, games, talking to the patient
- sedation- talk about research project
- giving the patient breaks - WE patient with back pain
- family and friend member for support
Can you describe a time when you had to manage unexpected complications?
art club- girl cut finger, bleeding
didn’t stress, dealt with cute, applied pressure
Can you describe a time when you think a dentist would have to make a difficult decision about a patient’s treatment plan?
How do you approach communicating complex dental information to patients in a way that they can understand?
- break down into smaller chunks- process, after care, risks, benefits
- explain fully the procedure
- ask follow up questions, ask them to repeat
- speak calmly and clearly
How would you manage a patient’s anxiety or fear of dental procedures?
- sit down and talk with them- ask why they’re worried, comfort them
- talk about WE- x-ray or special care
- distractions- puzzle, game, fidget toy
- family member/friend for comfort
- sedation
