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DENTAL NURSING revision dec 7th exam > DN13 > Flashcards

DN13 Flashcards

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1
Q

TWO MAIN PURPOSES OF CARRYING OUT ORAL HEALTH ASSESSMENT ARE:

A
  1. prevention of disease by regular opportunities to reinforce oral health education messages
  2. early detection and diagnosis when disease is already present
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2
Q

EXTRA-ORAL SOFT TISSUE ASSESSMENT:

A
  • EXTERNAL FACIAL SIGNS - checking for SKIN COLOUR, FACIAL SYMMETRY and the ppresence of any blemishes, especially MOLES and ‘COLD SORES’
  • THE LIPS - looking for any CHANGE IN COLOUR OR SIZE, the presence of any blemishes, and palpated for any abnormalities
  • THE LYMPH NODES - lying under the MANDIBLE and in the NECK, these are palpated to detect any swellings or abnormalitties, the presence of which may indicate an infection or a more sinister lesion
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3
Q

INTRA-ORAL SOFT TISSUE ASSESSMENT:

A
  • LABIAL, BUCCAL AND SULCUS MUCOSA - checked for their COLOUR AND TEXTURE, the presence of any WHITE PATCHES and the MOISTURE LEVEL is noted
  • PALATAL MUCOSA - both the HARD and SOFT PALATES, the OROPHARYNX and the tonsils (if present)
  • TOUNGE - checked for COLOUR AND TEXTURE symmetry of SHAPE and MOVEMENT, the LEVEL OF MOBILITY; all surfaces are checked, especially beneath the tounge, as this is one of the commonest sites for oral carcinoma to develop
  • FLOOR OF MOUTH - checked for COLOUR AND TEXTURE, the presence of any WHITE OR RED PATCHES, an the presence of any SWELLING UNDER THE TOUNGE.
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4
Q

WHAT DOES LOW MOISTURE LEVELS IN THE MOUTH INDICATE?

A

this can indicate problems with the functioning of the salivary glands, such as SJÖGREN’S SYNDROME, or XEROSTOMIA (dry mouth) due to age-related changes to the glands or as a side-affect in those taking certain medications.

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5
Q

3 IMPORTANT FUNCTIONS OF SALIVA:

A
  • defence
  • cleansing
  • dental disease initiation
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6
Q

BASIC PERIODONTAL EXAMINATION (BPE)

A

dividing the mouth into sextants and recording the presence of depth of any unnatural spaces down the side of the teeth (PERIODONTAL POCKETS)

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7
Q

SIGNS OF HEALTHY PERIODONTAL TISSUES

A
  • appear pink
  • firmly attached to the necks of the teeth with a gingival crevice no deeper than 3mm
  • do not bleed when touched
  • teeth are firmly held in their sockets by the periodontal supporting tissues
  • no plaque is present on the tooth surfaces
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8
Q

UNIVERSAL CODING SYSTEM FOR PERIODONTAL POCKET PROBING:

A

CODE 0 - healthy gingival tissues with no bleeding on probing
CODE 1 - pocket no more than 3.5mm, bleeding on probing no calculus or other plaque retention factor present
CODE 2- pocket no more than 3.5mm but plaque retention factor detected
CODE 3 - pocket present up to 5.5mm deep
CODE 4 - pocket present deeper that 5.5mm but less than 7mm
CODE * - gingival recession or furcation involvment present, pocket present deeper than 7mm

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9
Q

TOOTH MOBILITY GRADING:

A

GRADE I - side-to-side tooth movement less than 2mm
GRADE II - side-to-side tooth movement more than 2mm
GRADE III - vertical movement present

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10
Q

THREE STYLES OF CHARTING NOTATIONS USED FOR BOTH TEETH AND PERIODONTAL CONDITIONS:

A
  • PALMER NOTATION - for tooth charting
  • INTERNATIONAL DENTAL FEDERATION (FDI) NOTATION - for tooth charting
  • BASIC PERIODONTAL EXAMINATION (BPE) - for periodontal charting
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11
Q

TWO-DIGIT FDI NOTATION:

A
  • UPPER RIGHT- permanent quadrant 1, deciduous quadrant 5
  • UPPER LEFT - permanent quadrant 2, deciduous quadrant 6
  • LOWER LEFT - permanent quadrant 3, deciduous quadrant 7
  • LOWER RIGHT - permanent quadrant 4, deciduous quadrant 8
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12
Q

WHAT IS A HORIZONTAL BITEWING FILM FOR? (intra-oral film)

A

shows the POSTERIOR teeth in occlusion, and is taken to view:

  • INTERPROXIMAL AREAS and to diagnose CARIES in these REGIONS
  • RESTORATION OVERHANGS in these areas
  • RECURRENT CARIES beneath existing restorations
  • OCCLUSAL CARIES
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13
Q

WHAT IS A VERTICAL BITEWING FILM FOR? (intra-oral film)

A

shows an EXTENDED VIEW of the POSTERIOR teeth, from mid-root of the uppers to mid-root of the lowers as a minimum, and are taken to view:

  • PERIODONTAL BONE LEVELS of the POSTERIOR teetg
  • TRUE PERIODONTAL POCKETS
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14
Q

WHAT IS A PERIAPICAL FILM FOR? (intra-oral film)

A

shows ONE or TWO teeth in FULL LENGTH with their surrounding bone, and is taken to view the area and teeth in close detail

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15
Q

WHAT IS A ANTERIOR OCCLUSAL FILM FOR? (intra-oral film)

A

shows a plane view of the ANTERIOR section of either the MANDIBLE or the MAXILLA, and is used especially to view the area for UNERUPTED teeth, SUPER-NUMERARY teeth and CYSTS

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16
Q

WHAT IS THE FUNCTION OF A DENTAL PANORAMIC TOMOGRAPH (DPT)? (extra-oral film)

A

shows BOTH JAWS in full and their SURROUNDING BONY ANATOMY, and is taken for ORTHODONTIC and WISDOM TOOTH assessments, as well as to help DIAGNOSE PATHOLOGY and JAW FRACTURES

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17
Q

WHAT IS THE FUNCTION OF LATERAL OBLIQUE? (extra-oral film)

A

shows the POSTERIOR portion of one side of the mandible, including the RAMUS and ANGLE and the LOWER MOLAR TEETH, and is an alternative to a DPT to view the position of UNERUPTED THIRD MOLAR TEETH.

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18
Q

WHAT IS THE FUNCTION OF LATERAL SKULL RADIOGRAPH? (extra-oral film)

A

this is a view of the side of the head, taken in a specialised machine called a CEPHALOSTAT and is used to monitor JAW GROWTH and determine ORTHODONTIC treatment and determine orthognathic surgery techniques in complicated cases of maloclussion.

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19
Q

USE OF PHOTOGRAPHS:

A
  • to record soft tissue lesions to aid diagnosis
  • to record the extent of injury following trauma
  • to record before and after views of dental treatment
  • to record potentially sinister lesions that can be emailed to specialists immediately, to aid a speedy diagnosis
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20
Q

USE OF STUDY MODELS:

A
  • occlusal analysis in complicated crown or bridge cases
  • orthodontic cases, to determine if extractions are required and which type of appliance is necessary
  • occlusal analysis where full mouth treatment may be necessary, to determine the functioning of the dentition
  • where tooth surface loss is evident, either by erosion from acidic foods and drinks, or by attrition due to tooth grinding, so that the progression of the tooth wear can be monitored and treatment determined
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21
Q

VITALITY TESTS

A

this is sometimes necessary to help in determining whether a tooth is vital (alive) or non-vital (dead), and the tests available are:

  • cold stimulus with ETHYL CHLORIDE
  • hot stimulus with warmed GUTAA-PERCHA
  • electrical test with ELECTRIC PULP TESTER
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22
Q

RESPONSE FOR VITALITY TESTS

A

Normal response - healthy pump
Increased response - early pulpitis present
Reduced response - pulp is dying, or tooth has heavily lined deep restoration present so the voltage cannot be adequately transmitted to the pulp
No response - pulp tissue is dead

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23
Q

MATERIALS USED IN ORAL ASSESSMENTS

A
  • ALGINATE IMPRESSION MATERIAL - consisting of calcium and alginate slats which are mixed with water at room temperature and loaded into trays for insertion into the mouth so that accurate impressions can be taken
    DENTAL STONE - a yellow-coloured, hardened calcium sulphate plaster mixed with water and used to produce a study model cast
    DENTAL PLASTER - a white-coloured, hardened calcium sulphate plaster mixed with water and used to make a base for the dental stone cast
    ETHYL CHLORIDE - a liquid which vaporises easily and produces a cold sensarion on doing so and can be applied to teeth as an aid to detecting dental problems
    GUTTA-PERCHA AS GREENSTICK - a compound which can be heated and applied to a tooth to aid in the detection of dental problems
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24
Q

LEGISLATIONS THAT APPLIES TO ISSUES OF PATIENT HEALTH INFORMATION AND CONFIDENTIALITY:

A
  • data protection act 1998
  • access to health records act 1990
  • freedom of information act
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25
Q

HOW LONG SHOULD DENTAL RECORDS BE HELD FOR?

A

although NHS regulations require dental records to be retained for only 2 years, medico-legally dental records should be kept for 11 years or to the age of 25 with child patients

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26
Q

GDC NINE CORE ETHICAL PRINCIPLE OF PRACTICE

A
  1. put patient’s interests first
  2. communicate effectively with patients
  3. obtain valid consent
  4. maintain and protect patient’s information
  5. have a clear and effective complaints procedure
  6. work with colleaguesin a way that is in patients’ best interests
  7. maintain, develop and work within your proffesional knowledge and skills
  8. raise concerns if patients are at risk
  9. make sure your personal behaviour maintains patient’s confidence in you and the dental profession
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27
Q

THREE KEY PRINCIPLES TO GAINING CONSENT TO PROCEED WITH A DENTAL PROCEDURE:

A

INFORMED - the patient must be given enough information to be able to make a decision, and in issues of treatment options this must include a host of imformation
voluntary decision - the patient alone must make the decision to proceed, without coercion or threat
ABILITY - the patient must actually have the abillty to make an informed decision

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28
Q

INFORMED CONSENT

A

patients must be given full information about the treatment offered to be able to make an informed decision as to whether they wish to proceed or not:
- the nature of the treatment
- the purpose of the treatment
- the risks of the treatment
- the consequences of not having the treatment
- the risks and benefits of any alternative treatment available
- the longevity of success
- the cost of the treatment, whether NHS OR PRIVATE
the information should be given in a way that the patient understands, and this could involve visual aids, an interpreter, or sign language

29
Q

SPECIFIC CONSENT

A

this is the consent gained expressly for each stage of the treatment, and not just consent assumed to be for a full course of treatment without the patient being aware of what is involved at each stage. the patient must be give specific consent for each stage before it is carried out

30
Q

VALID CONSENT

A

for consent to be considered valid, it must be:

  • informed
  • specific
  • given by the patient or their parent or guardian if too young to give informed consent
31
Q

WHO CAN GIVE CONSENT?

A
  • patent or gaurdian of a child to the age of 16
  • “gillick copetent” child to the age of 16 in england and wales
  • scottish equivalent
  • 16 to 18 yar old of sound mind, in england and wales
  • 16 year old in scotland and northern ireland
  • competent adult
  • dentist on behalf of an incompetent, when in the patient’s best interest and with an agreeing second opinion form another proffesional
32
Q

GDC STANDARDS GUIDANCE AND COMPLAINTS HANDLING

A
  • respect the patient’s right to complain
  • checklist to cover the following points:
    • that a complaints procedure is in place and is suitable for purpose
    • that it follows certain regulatory requirements
  • the framework in place identifies who to contact when making a complaint, and that all team members are familiar with the complaints procedure
  • the process to be followed when handling a complaint
  • how to deal with the complaint correctly and constructively
  • try to learn from the complaint
33
Q

IN ORAL ASSESSMENT, THE DENTAL NURSE MUST BE ABLE TO:

A
  • support and reassure the patient throughout the assessment
  • have all the necessary instruments, materials and equipment ready for use
  • make accurate clinical records as required
  • be proficient in the use of:
    • soft tissue record sheets
    • tooth charts
    • periodontal charts
  • complete a full medical history form with the patient
  • assist the dentist as necessary throughout the assessment
34
Q

TYPES OF MALOCCLUSION

A

the basic types of malocclusion are caused by a combination of any of the following:

  • crowding
  • protruding upper incisors
  • prominent lower jaw
35
Q

CROWDING

A

crowding is caused by insufficient room for all teeth to erupt in line and occurs in jaws which are too small to accommodate 32 permanent teeth. the teeth become crooked and overlapping as the permanent dentition erupts and those which are last to erupt cannot take up their proper position in the dental arch as there is insufficient room left.

36
Q

PROTRUDING UPPER INCISORS

A

many children attend for orthodontic treatment becuase their upper front teeth protrude between their lips. this condition usually arises from a jaw relationship in which the upper teeth are too far forward relative to the lowers. it is commonly associated with an open lip posture and is called a CLASS 2 DIVISION 1 MALOCCLUSION. this tends to occur becuase the mandible is too far behind its normal position, and not becuase the maxilla is too far forwards, as may be thought.
when the mandible is not so far posterior to its normal position, so that the jaw relationship is not quite so severe, the upper incisors become trapped behind the tightened lower lip and erupt upright, or even pulled back. this is called a CLASS II DIVISION 2 MALOCCLUSION

37
Q

PROMINENT LOWER JAW

A

this condition, in which the chin is unduly prominent, is caused by a jaw relationship in which the mandible and the lower teeth are too far forward relative to the maxilla and the upper teeth. it usually results in the incisors biting edge to edge; or with the lowers in front of the uppers, instead of behind them. this is called a CLASS 3 MALOCCLUSION

38
Q

ORTHODONTIC APPLIANCES:

A

orthodontic appliances are used to align croocked teeth, so that the patient is able to carry out effective oral hygiene techniques and prevent caries or periodontal disease from developing. the two basic types of appliance are:
FIXED APPLIANCE - composed of individual metal or cermaic components bonded onto each tooth and connected together by an archwire, they cannot be removed from the mouth by the patient
REMOVABLE AND FUNCTIONAL APPLIANCES - composed of an acyrlic base with stainless steel clasps and springs, these can be removed fromt the mouth for cleaning, eating and adjustment

39
Q

EQUIPMENT AND INSTRUMENTS REQUIRED FOR FIXED ORTHODONTIC APPLIANCES

A

ARCHWIRE - flexible nickel titanium or stainless steel wires, to fasten into the brackets or bands
END CUTTERS - right-angled cutter to trim the ends of the archwire after replacement
ALASTIKS - rubber bands to hold the archwire into the slots of each bracket
ALASTIK HOLDERS - ratcheted holders to apply the alastiks to the brackets
BRACKETS - metal or ceramic components to attach to each tooth, if any have been lost since last appointment
BANDS - metal rings to attach to molars especially, although bands are available for all teeth and were the only attachments available before brackets were developed
BRACKET HOLDERS - to hold and position each bracket to the centre of the tooth, if any replacements are required
BRACKET AND BAND REMOVERS - to remove brackets, bands and any residual bond material before replacing, if necessary
BONDING MATERIALS - acid etch and orthodontic resin bond material, to hold brackets onto the tooth
BAND CEMENT - any luting cement material, to hold bands onto the molar teeth

40
Q

PATIENT ADVICE FOR FIXED APPLIANCES:

A
  • careful manual tooth brushing should be carried out after each meal
  • good quality electric toothbrushes, such as sonicare and Oral B, may be safetly used instead
  • use of fluoridated toothpaste
  • daily use of INTERDENTAL BRUSHES to clean around each bracket individually
  • avoidance of sticky foods for the full period of treatment
  • use of FLUORIDE MOUTHWASH daily to minimise the risk of decalcification
  • regular use of DISCLOSING TABLETS to highlight problematic areas where plaque is being retained, in order to minimise the risk of decalcification
41
Q

PATIENT ADVICE FOR REMOVABLE APPLIANCES:

A
  • wear as directed by dentist
  • clean the appliance and teeth after each meal, using a toothbrush and toothpaste
  • avoid cariogenic and acidic foods and drinks, as advised
  • attend all dental appointments for the necessary adjustments
  • contact the surgery immediately if any breakages or loss of the appliance occur
  • expect the appliance to feel tight initially after each adjustment
  • contact the surgery if any prolonged or excessive syptoms occur
  • if the appliance is to be removed for meals, ensure it is placed safely in a rigid container to avoid breakages during mealtimes
42
Q

FUNCTIONAL APPLIANCES

A 
these are a speciallised type of removable orthodontic appliance made of acyrlic and stainless steel components and worn in both arches at the same time, the commonest one currently being a "Twinblock"
they are used to correct skeletal class II discrepancies, where the mandible forwards in the ideal class I position and allowing mandibular growth to occur and correct the malocclusion naturally. as their success depends on the growth of the mandible, they can only be used while the patient is still growing but after the premolars have erupted, so the ideal age is up to 14 years old.
43
Q

ROLE OF THE DENTAL NURSE DURING ORTHODONTIC ASSESSMENT AND TREATMENT:

A
  • have a good understanding of the procedure to be carried out
  • be aware of the position in the dental team for the procedure
  • have all the patients records available, including any blank assessment sheets for the assessment appointment
  • have all the patient records, charts, radiographs, study models, orthodontic appliance and consent forms available for the treatment appointment
  • be aware of the correct equipment, instruments and material to be used, and mix any material accordingly when directed
  • communicate effectively with the patient throughout the procedure, inspiring confidence and trust - this is especially important when impressions are being taken, as many patients find the procedure unpleasant
  • monitor the patient throughout the procedure, ensuring their comfort and well-being, giving assurance as necessary, and assisting them if they are unfortunate enough to vomit during impression taking
  • anticipate an pass instruments etc, to the dentist in the correct order during the procedure
  • record the accurate assessment details into the patient’s records as necessary
  • follow the infection control policy in relation to the safe handling of any impressions taken
  • follow the infection control policy to fully decontaminate the surgery after use, especially in relation to clearing away vomit
  • follow the health and safety policy with regard to hazardous waste disposal
  • ensure that all records, charts and so on are correctly and securely stored for future use after being completed by the cliniciaan, maintaining patient confidentiality at all times
44
Q

DISEASES OF THE ORAL SOFT TISSUES -

RECURRENT ULCERATION -

A

these affect around 20% of the population and are so called because they occur again and agian in the same patient, usually with no diagnosed cause, although they are linked to nutritional deficiences in some patients:
MINOR APHTHOUS ULCERS - small, shallow, painful ulcers that heal within 14 days and cause no scarring
MAJOR APHTOUS ULCERSS - larger, painful ulcers that take weeks or months to heal and cause scarring
HERPETIFORM APHTHOUS ULCERS - very small multiple ulcers that occur sometimes up to 100 at a time

45
Q

DISEASES OF THE ORAL SOFT TISSUES -

ULCERATION DUE TO SYSTEMIC DISEASE -

A

various diseases affecting the digestive system often exhibit oral ulceration, although the patient is likely already to have been diagnosed with the overlying disease before being seen by the dental team, and this should be noted in the medical history:

  • CROHN’S DISEASE
  • ULCERATIVE COLITIS
  • COELIAC DISEASE
  • INFLAMMATORY BOWEL DISEASE
46
Q

DISEASES OF THE ORAL SOFT TISSUES -

ULCERATION DUE TO SKIN DISORDERS -

A

the relevant condition in this category is that of LICHEN PLANUS:

  • an inflammatory skin condition that often causes oral ulceration in sufferers
  • oral lesions are recognised as being PREMALIGNANT - i.e. they can undergo cell mutation and develop into malignant (cancerous) lesions
  • ulcers appear orally with white striae (stipes) around them
47
Q

DISEASES OF THE ORAL SOFT TISSUES - ULCERATION DUE TO VIRAL INFECTION -

A

two viral diseases in particular are associated with, and often diagnosed by, the presence of specific oral ulceration:
HERPES SIMPLEX - as the primary infection of the patient with this virus, causing ulceration of most of the oral soft tissues and recurring throughout later life as herpes labialis (cold sores)
COXSACKIE VIRUS - hand, foot and mouth disease in childhood, with small ulcers present in all these areas at the same time, and specifically on the soft palate and back of the mouth in the oral cavity

48
Q

DISEASES OF THE ORAL SOFT TISSUES -

MALIGANT ULCERATION -

A

SQUAMOUS CELL CARCINOMA is the predominant manifestation of oral cancerand usually develops as an ulceration in the floor of the mouth or on sides of the tounge:

  • painless ulcer with no obvious cause, such as trauma from a sharp tooth, and which does not heal within 2-3 weeks of its first appearance
  • aphtous-like ulcer with a “punched out” floor and rolled edges - this is the classic appearance of an advanced malignancy
  • very usually diagnosed in smokers, users of other tobacco products and heavy drinkers (of alcohol)
49
Q

ORAL WHITE AND RED PATCHES -

ORAL CANDIDIASIS -

A

commonly occurring infection with the fungus ‘candida albicans’, producing a transient white patch which can be wiped off the oral mucosa to leave a raw-looking area beneath:

  • often occurs following the use of broad-spectrum antibiotics, which disturbs the normal microorganism balance in the body and allows the overgrowth of the fungus
  • also occurs in immune-compromised patients and those who are seriously ill with systemic disorders
  • can occur in patients using long-term steroid inhalers, such as asthmatics
50
Q

ORAL WHITE AND RED PATCHES -

LEUKOPLAKIA -

A

a white patch thay has no obvious local casue, such as chronic trauma from a sharp tooth, and cannot be removed from the mucosa by wiping:

  • often appears as white striae on the buccal mucosa or toungue, similar to lichen planus
  • regarded as a potentially PREMALIGANT condition, although it sometimes has no sinister consequenses
  • particularly associated with smoking, and also with heavy alcohol intake
51
Q

ORAL WHITE AND RED PATCHES - ERYTHOPLAKIA -

A

a red patch on the oral mucosa, in isolation or sometimes adjacent to an area of leukoplakia, and regarded as a sinister sign of PERMALIGNANCY of the soft tissues involved

52
Q

INFLAMMATORY DISORDERS -

STOMATITIS -

A

a general inflammatory condition affecting the oral cavity:

  • often occurs in the elderly and in denture wearers
  • mucosa apears red and inflamed and often has a an overlying candida infection present
  • responds well to improved oral and denture hygiene in most cases
  • can be due to general debilitation and malnutriton, especially in the elderly
53
Q

INFLAMMATORY DISORDERS - ANGULAR CHEILITIS -

A

inflammation at the corners (angles) of the mouth:

  • often occurs in the elderly and in denture wearers, as an extension of stomatitis
  • appears as red and inflamed angles, often with cracking of the surface on mouth opening
  • often due to a loss of facial height, which allows saliva pooling in the area
  • wet conditions produced allow infection with common skin microorganisms, such as staphylococcus aureus
54
Q

INFLAMMATORY DISORDERS -

GLOSSITIS -

A

inflammation of the tongue which appears as red and smooth, and in sore:

  • often seen in iron deficiency anaemia
  • also occurs when extensive candida infection is present in debilitated patients
  • may also indicate vitamin B deficiencies
55
Q

INFLAMMATORY DISORDERS -

BURNING MOUTH SYNDROME -

A

usually occurs in elderly women and is described as oral cavity feeling “as though on fire”:

  • usually no physical abnormality is found on examination
  • considered psychogenic in many cases, due to depression, fear of cancer or of other serious disorders
56
Q

EFFECTS OF AGEING ON THE SOFT TISSUES -

SKIN -

A
  • has less underlying fat and elasticity

- this gives increased tissue fragility and the likelihood of soft tissue trauma and bruising postoperatively

57
Q

EFFECTS OF AGEING ON THE SOFT TISSUES -

BONE -

A
  • tends to be more brittle especially in postmenopausal women, who have some degree of osteoporosis present
  • the jaw bones are therefore at increased risk of fracture during extraction
  • in particular, those elderly female patients who take bisphosphonates to counteract the debilitating effects of osteoporosis are likely to require referral for tooth extraction, as the risk of postoperative bone necrosis is high
  • the natural resorption of the jaw bones following tooth extraction makes denture retention more difficult to achieve
58
Q

EFFECTS OF AGEING ON THE SOFT TISSUES -

ORAL MUCOSA:

A
  • is thinner and less elastic
  • it is therefore easier to traumatise during routine treatment
  • the alveolar ridge areas are less tolerant of bearing dentures, with discomfort and ulceration more likely
  • gingival recession will be more pronounced, whcih increases the risk of root caries developing
59
Q

EFFECTS OF AGEING ON THE SOFT TISSUES -

SALIVARY GLANDS -

A
  • undergo an alteration of the salivary components and volume, especially with certain drugs
  • more likely to suffer from a dry mouth (xerostomia)
  • this leads to an increased caries rate, as the self-cleansing action of saliva is reduced
  • it may also cause problems with swallowing, speech and denture retention, as well as an increased incidence of localised periodontal conditions
60
Q

EFFECTS OF AGEING ON THE SOFT TISSUES -

TEETH -

A
  • undergo a gradual darkening in colour, making shade matching of anterior restoratives more difficult to achieve
  • narrowing and sclerosis of the pulp chamber lead to difficulties in gaining access to the root canals suring endodontic treatment
  • have a reduced sensitivity
61
Q

MEDICAL CONDITIONS THAT AFFECT THE ORAL TISSUES -

ORAL CANCER:

A

oral cancer can affect various areas of the moth, the soft tissues, the salivary glands or the jaw bones, ninety per cent of oral cancers affect the oral soft tissues intially, as a lesion called SQUAMOIS CELL CARCINOMA (SCC). the suggested causative factors are as follows:
- TOBACCO HABITS - all tobacco products contain chemicals capable of causing cancer (CARCINOGENS)
- HIGH ALCOHOL CONSUMPTION - alcohol acts as a solvent for the carcinogens and allows them easier entry into the soft tissues
- TOBACCO AND ALCOHOL - smokers who also drink to excess are at most risk of SCC
- SUNLIGHT - in fair-skinned people, sunlight is associated with SCC affecting the lower lip
DIET - research is ongoing into links between SCC and diets high in fats and red meat, or low vitamin A and iron intake
GENETICS - some people are gentically predisposed to developing SCC, as with other types of cancer

62
Q

MEDICAL CONDITIONS THAT AFFECT THE ORAL TISSUES -

HERPES:

A

this group of viruses can affect the oral tissues in three specific disease conditions:

  • HERPES SIMPLEX TYPE 1 - as a primary infection in childhood which takes the form of an acute inflammmation of the oral soft tissues, called gingivostomatitis, and appearing as multiple painful ulcers within the oral cavity.
  • HERPES LABIALIS - the recurrent condition that occurs after the intial primary herpes simplex infection, commonly called a “cold sore” and occuring on the lip
  • HERPES ZOSTER - shingles, which occurs as a re-activation of the cirus in patients previously infected with chickenpox, and can affect the area supplied by the trigeminal nerve, as well as the skin of the torso
63
Q

MEDICAL CONDITIONS THAT AFFECT THE ORAL TISSUES -

HUMAN IMMUNODEFICIENCY VIRUS (HIV):

A

the progressive immune-deficiency conditions that is causes may well present as an oral lesion:
ORAL CANDIDIASIS - usually as an extensive fungal infection of the oral cavity, with heavy coatings of the white “thrush” lesions over the toungue and palate
HERPES ZOSTER - shingles, but typically affecting more than one body area, so the trigeminal nerve region may be affected at the same time as areas of the torso
KAPOSI’S SARCOMA - this is a charecteristic tumour of AIDS sufferers that may occur as a purpilish brown lesion on the palate, as well as the skin
ORAL HAIRY LEUKOPLAKIA - this is an oral white patch that has a distinct microscopic appearance at biopsy, is always associated with HIV infection and is premalignant

64
Q

MEDICAL CONDITIONS THAT AFFECT THE ORAL TISSUES -

HEPATITIS

A

cross-infection following a needlestick injury is a very real occupational hazard for the dental team, but carriers or patients suffering from hepatitis are not likely to be easily identified unless they give a truthful medical history. there are no specific oral lesions associated with the medical condition of hepatitis

65
Q

MEDICAL CONDITIONS THAT AFFECT THE ORAL TISSUES -

DIABETES

A

the effects of the disease on the oral cavity are the same for both types of diabetes:
XEROSTOMIA - some degree of dry mouth is experienced by most patients, so the cleansing and lubricating effects of saliva will be reduced and they are more at risk from developing dental caries
POOR WOUND HEALING - the peripheral blood supply is reduced in all areas of the body, including the oral cavity, and patient tend to heal poorly and be more prone to conditions such as chronic periodontal disease
INFECTION - peripheral vascular disease and peripheral neuropathy result in reduced blood flow and nerve sensation in the oral cavity, so infections are more likely and can often develop more readily into abscesses and more serious conditions in these patients

66
Q

MEDICAL CONDITIONS THAT AFFECT THE ORAL TISSUES -

EPILEPSY

A

this is a condition where the electrical activity in the brain becomes suddenly and temporarily disrupted, resulting in a seizure. the usual drug used to control the occurence of the seizures has the side-effect of causing gingival tissue overgrowth - GINGIVAL HYPERPLASIA. this can make adequate plaque removal difficult for the patient as the overgrown gingival tissue covers it and prevent its routine removal by tooth brushing. the patient may have to undergo regular gingivectomy procedure to remove the worst gingival overgrowths

67
Q

MEDICAL CONDITIONS THAT AFFECT THE ORAL TISSUES -

EATING DISORDERS:

A

bulimia is an emotional disorder in which the sufferer, usually a young adult female, follows bouts of comulsive overeating with periods of self-induced vomiting or fasting, the regular vomiting has the following:
ENAMEL EROSION - often severe pitting and enamel loss are present on many teeth, due to the acidic nature of the stomach contents present in the vomit; the palatal surfaces of the upper anterior teeth are particularly affected
SOFT TISSUE BURNS - the acidic vomit will also cause a burnt, reddened appearance to the oropharynx region at the back of the mouth

68
Q

MEDICAL CONDITIONS THAT AFFECT THE ORAL TISSUES -

DIGESTIVE DISORDERS

A

the oral cavity forms the first part of the digestive system, so it is not suprising that several digestive system disorders manifest with oral lesions:
CROHN’S DISEASE - a chronic imflammatory disease that can affect any part of the gastrointestinal tract, and shows up often as ulceration on the oral cavity
ULCERATIVE COLITIS - a chronic inflammatory disease that affects the colon and rectal areas only of the gastrointestinal tract, and shows orally as aphtous ulcers
COELIAC DISEASE - an absortion disorder of the small intestines, which have an intolerance to the cereal protein gluten; it shows up orally as ulceration, glossitis and stomatitis

DENTAL NURSING revision dec 7th exam (17 decks)

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