Diagnosis, Treatment Options, Consent, Treatment plans and Guidelines Flashcards
where would you look for dental treatment guidelines?
- SDCEP
- British Society of Periodontology •
- Flowchart – print out
- British Endodontic Society
- American Association of Endodontics
- BSSPD
- Guides to standards in prosthetic dentistry – complete and partial dentures
- British society for restorative dentistry
- SIGN
- Mainly medical and largely superseded by SDCEP in dentistry
- British dental association
- Royal colleges: Glasgow, Edinburgh, London and Dublin
refer to source in notes
differential diagnosis is
possible diagnosis before speical investigations
differential diagnosis for: (5)
Background
- 35 year old male who is a new patient and has been an irregular attender at dentists
C/O
- Rough tooth lower LHS
-
Sharp pain ~10 seconds when eating
- address
- Filled hole with temporary filling material from chemist
- Symptomatic pulpitis
- Irreversible pulpitis
- Reversible pulpitis
- Hypersensitivity
- Gross caries
special investigations for: (3)
Background
- 35 year old male who is a new patient and has been an irregular attender at dentists
C/O
- Rough tooth lower LHS
-
Sharp pain ~10 seconds when eating
- address
- Filled hole with temporary filling material from chemist
- Radiographs
- Bitewing and periapical
- Sensibility testing
- 36 and 37
- Ethyl Chloride – reactive
- EPT – positive reaction
- 36 and 37
- TTP – tender to percussion – tap tooth in Q and one behind and in front with mirror
- Biggest response with the one causing the problem
- Tap around to see what normal is to assess normal before problem area
write radiographic report
what teeth, how many etc (7 – type, grade, teeth, restorations, bone levels, apical pathology, coronal pathology) comment on all 7, need to comment on all – legal report – _CLASSIC OSCE STATE ALL_
- Periapical
- Clear and no overlap – Grade 1
- 34, 35, 36, 37
- Bone levels
- Mild bone loss at 34, 35
- Apical pathology/ unusual pathology
- No apical pathology
- Distal 7 widening of lamina dura mild – widening of PDL
- Coronal pathology (start with on bitewings)
- Caries on 36 and 37
- Occlusal into dentine
- Caries on 36 and 37
- Restoration
- Temporary restoration on 36
questions that can be used to enhance dental pain history
based on SOCRATES
closed Qs rather than open so get a definitive answer
- Oral hygiene habits
- Diet diary
- When the pain started, how long it last, one tooth or area (lower harder)
- Anything make it better or worse
- Pain medications – analgesics for it, effect
- Does it keep them awake at night
- Irreversible over reversible pulpitis
- Irreversible – inflammation will go away if treat cause of problem
- Irreversible over reversible pulpitis
reversible pulpitis characteristics
bite, sore, goes away; (not awake at night)
no apical pathology on radiograph;
sensibility tests shows response so not necrotic, vital pulp
inflammation will go away if treat cause of problem
irreversible pulpitis characteritics
OTC doesn’t help, keep them up at night
treatment options for:
Background
- 35 year old male who is a new patient and has been an irregular attender at dentists
C/O
- Rough tooth lower LHS
-
Sharp pain ~10 seconds when eating
- address
- Filled hole with temporary filling material from chemist
Definitive diagnosis
- Reversible pulpitis
- Treat the caries
- Different ways to restore
- Temporary restorations and see if symptoms go away
- Deep caries – close to the pulp
- Stepwise excavation
- Selective removal to firm dentine – partial caries
- to try and save pulp
- Non selective dentine removal
- Deep caries – close to the pulp
- Temporary restorations and see if symptoms go away
- Different ways to restore
In practice remove all, line and restore and explain deep carious lesion
- Extract – want to save pulp primarily
- RCT – want to save pulp primarily
partial caries removal
- Walls first clear to firm dentine, floor soft as caries remain
- Use a slow speed, and hand held excavator
- Easier to remove just right amount and not too much
- Use a slow speed, and hand held excavator
- Stepwise excavation
- Go back and remove remains in 6 months time
liners
- Acidic carious environment
- Want an alkali liner - setting CaOH - Dycal (small drop on deepest layers)
Its so deep - restoration material options
- Amalgam restoration too close to pulp
- RMGI – physical protection, releases F
- Zinc Oxide (ZOE)
pros and cons of
- complete
- partial
- stepwise
caries removal
Complete
- could penetrate the pulp when removing caries, deep restoration,
- tooth may need future treatment – could become irreversible pulpitis or apical periodontitis – nerve become irritated then necrotic and die
Partial
- one visit
- less closely to pulp as small amount of caries left make tertiary dentine to protect pulp
Stepwise
- 2 visits
Stepwise or partial may help save pulp better than complete (need RCT after)
Spontaneous pain – don’t consider stepwise as contraindicated as more pulpal involvement than radiographic indicated
- What are the success rates and advantages and disadvantages of each
non urgent dental care management
- Try analgesics if not already
- Stay away from stimuli – chew on other side
components of caries risk assessment
- Diet
- Frequency of sugar consumption
- Inc sugar in drinks, snacks, fizzy sugar drinks
- Frequency of sugar consumption
- Oral hygiene
- Fluoride
- How often and long they brush
- Mouth wash
- Interdental
when to take plaque and bleeding scores
if BPE 2-4
problem list for:
Background
- 68 year old male – new to you
C/O
- lower teeth worn down and fillings put in by previous dentist keep on failing. No pain. Happy with upper teeth
- Radiographs all fine
- BPE’s all 2s
- Lower teeth NCTSF
possible solutions for
- Lower teeth NCTSF
- Replace fillings
- Likely to fail again
- Crowns
- Lower RPD
- Timely
- Need to adjust to
- Less likely to fail again
