Dentistry in a Nutshell Flashcards
what things must you talk to the patient about to ensure you are obtaining valid consent (not AMCUR related)
why treatment necessary
what might happen if treatment is not carried out
treatment options - risks and benefits
recommended option
cost
duration
likely prognosis
whether treatment is guaranteed
what tests can you do quickly when the patient comes in with toothache
visual
air from 3 in 1
palpation
probing
percussion
vitality
mobility
tooth sleuth
apart from the usual endodontic diagnoses for pain, what other reasons may a patient have pain
hypersensitivity
dry socket
TMJ pain
oral ulceration
necrotising gingivitis
sinusitis
orthodontic problem
salivary gland infection
ill/loose fitting dentures
what is the immediate management for adults with dental infections
establish drainage
extirpate if endodontically involved
debride pockets if periodontally involved
prescribe antibiotics if indicated
recommend analgesia
consider extraction
what are the indications for antibiotics
limited mouth opening
facial swelling
systemic infection
immunocompromised patient
elevated temperature >38 degrees
when would you refer to maxfax/a&e
difficulty breathing/likely to obstruct airway
involvement of orbital area/closure of eye
difficulty in swallowing/unable to stick tongue out
swelling rapidly increasing in size
evidence of infection in facial spaces (ludwigs angina)
what is the dose of penicillin for dental infections
phenoxymethylpenicillin 250mg
2 tablets 4x daily for 5 days
what is the dose of metronidazole for periodontal abscesses
metronidazole 400mg
1 tablet three times a day for 5 days
what is the dose of metronidazole for pericoronitis and ANUG
metronidazole 400mg
take one tablet three times day for 3 days
when the patient is complaining of post extraction pain what extra oral exam do you do
pyrexia
lymphadenopathy
bruising
trismus
step deformity
when the patient is complaining of post extraction pain what intra oral exam do you do
visual
tactile
inspect socket for healing status
debris
clot
pus
bone sequestra
necrosis
tender/damaged adjacent tooth
what are the differential diagnoses when a patient is complaining of post extraction pain
dry socket
retained root/bone
infection
LA related trauma
haematoma
MRONJ
OAC
ORN
fractured maxillary tuberosity
step deformity
dislocated/fractured mandible
what symptoms may someone have if they have a cracked tooth
pain on biting
localised pain/sensitivity to cold
what are the signs of a cracked tooth
lymphadenopathy
visible fracture
interferences in occlusion
toothwear
heavily restored dentition
swelling
what are the special investigations for a cracked tooth
sensibility testing
radiographs
percussion
tooth sleuth
before deciding that a patient has a cracked tooth, what other diagnoses must you rule out
periodontal and periapical issues
dentine sensitivity
facial pain
apical pathology
high restoration
if a cracked tooth does not extend to the pulp chamber floor how do you manage it
restore with composite/temp crown with occlusal reduction
assess after 2-3 months
if symptomatic after this time then RCT with crown or extract
if a cracked tooth has cracked subgingivally and there is insufficient coronal tissue what is the treatment
extract as this is hopeless
if a tooth is cracked and it extends to the pulp chamber floor and is restorable what is the treatment
RCT and crown
what are the symptoms of pericoronitis
pain on biting
localised pain
pyrexia
may struggle to open mouth wide
what are the signs of pericoronitis
inflamed operculum
signs of trauma
trauma from opposing tooth
swelling
lymphadenopathy
what is the management of pericoronitis
debride around inflamed tooth
irrigate with saline and instruct patient how to perform OH
consider adjusting traumatic occlusion/extracting upper tooth
antibiotics if spreading infection/trismus
review
what are the signs and symptoms of dry socket
pain 24-48 hours post extraction
inflamed non-healing socket
lost blood clot
trapped food debris or bad taste/odour
what are the risk factors for dry socket
smoking
alcohol
immunocompromised
female
oral contraceptive
mandibular
posterior teeth
previous dry socket
poor compliance with post op instructions
traumatic extraction