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1
Q

identify the luxator

A

A

B is coupland’s elevator

C is right cryer’s elevator

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2
Q

which number of forcept woudl you use to extract 11?

a - 74

b - 101

c - 2

d - 73

A

C - 2 (upper straight)

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3
Q

upper straight forceps for

A

maxillary incisors and canines

2

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4
Q

upper universal forceps for

A

maxillary premolars

76

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5
Q

upper molar forceps for

A

maxillary first and second molars

94 (right) and 95 (left)

beak to cheek

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6
Q

upper bayonet forceps for

A

upper third molars

101

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7
Q

lower universal forceps for

A

mandibular incisors, canines and premolars

74 and 74N (roots)

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8
Q

cowhorn forceps for

A

mandibular first and second molars

86

squeeze out

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9
Q

lower molar forceps for

A

mandibular first and second molars

73

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10
Q

extraction movements

A

buccal expansion - single rooted

figure of 8 - multi rooted

apical pressure for all

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11
Q

demonstarte how you would use a luxator on 26 XLA

A

Say you would wash your hands

Turn light on

anaesthetise area - 2 buccal infiltrations and 1 palatal

pt head at level of elbow

place finger and thumb of non-dominant hand on either side of the tooth to be extracted

once in PDL, the luxator is worked down the length of the root with rotation and apical pressure

cuts the PDL fibres and expands the socket

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12
Q

restoring 46

please place rubber dam

A

wash hands, gloves, light on, lower pt

tie floss around the appropriate clamp

place clamp first then rubber dam over with holes punched in (adj for restoration, single tooth for endo)

flick the rubber dam over the wings of the clamp

floss ligatures

wedjets

place the frame - make sure the pt airway not blocked at nose (fold if needed)

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13
Q

demonstrate how to assemble and give an IDB whilst describing the process

A

check expiry date and batch number

Lidocain not articaine for block - neurotoxic

long needle for block

aim 10mm above the occlual plane

  • posterior to internal oblique ridge
  • anterior to pterygomandibular raphe

inject syringe from opposite premolars and advance 2.5-3cm

hit bone and withdraw

aspirate

deposite 2/3 cartride and retract whilst depositing to get lingual nerve

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14
Q

impressions remember

A

adhesive

eval impression - anatomy should be seen

behind for uppers, in front for lower

breather through nose, wiggle toes

lift lip massage to capture anatomy

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15
Q

endo irrigation

A

choose correct irrigant (sodium hypochlorite),

luer lock syringe,

  • side vented,

use index finger to plunge as more sensitive than thumb

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16
Q

describe the appearance

A

1 ulcer present on the right labial mucosa

inflammatory halo around yellow/grey base

oval in shape and sharply defined

17
Q

what Qs to ask when taking this pt’s history

A

about ulcer(s)

  • number
  • location
  • duration
    • minor apthous uclers - shorter than major
    • more than 3 weeks - refer
  • frequency
  • size

about them

  • diet - low in red meat - possible Fe def
  • stress - home, work (predispose ulcers)
  • empathetic Qs - affect eating, sleep, morale
  • Medical history
    • Recurrent aphthous ulcers – crohns, coeliac, Pagets disease, OFG
18
Q

possible causes of uclers

A
  • stress
  • local trauma
  • menstruation
  • sodium lauryl sulphate
  • drugs (NSAID, alendronate and nicorandil)
  • smoking
  • Crohn’s and coaelic disease
  • iron, vit B12 or folate deficiencies
19
Q

managament apparoaches for ulcers

A
  • Difflam mouthwash (benzydamine)
  • topical steroids (hydrocortisone oromucosal tables, betamethasone oral rinses)
  • covering agents (lidocaine ointment)
  • analgesics
  • avoid spicy foods
  • SLS free toothpaste - sensodyne pronamel
  • refer to GP investifate and tx underlying deficiencies or coextisting patholgy
  • refer to oral med if not managed locally or persists >3weeks
20
Q

56yo pt had severe toothache for 4 weeks from upper right first molar which suddenly stopped

tooth was asymptomatic on the day he attended, he reported ‘part of the tooth came off recently’ whilst he was chewing

pt smokes 20/day and is a nocturnal bruxist

takes warfarin for atrial fibrilation

BPEs

2 2 2

2 2 2

A

introduce yourself

check ID

check MH and SH - recognise warfarin as bleeding risk

  • Medical history
    • Diagnoses
    • Medications
  • say quick look through notes seen have X and on Y is this still correct? Any other medical conditions/seeing doctor for?

social history

  • smoking assessment
  • alcohol
  • work

Pick out main bits

  • Tooth
  • Pain
    • SOCRATES
    • How long
    • Type
    • There right now
    • associated factors can be bad taste, foul smell, sinus
21
Q

56yo pt had severe toothache for 4 weeks from upper right first molar which suddenly stopped

tooth was asymptomatic on the day he attended, he reported ‘part of the tooth came off recently’ whilst he was chewing

pt smokes 20/day and is a nocturnal bruxist

takes warfarin for atrial fibrilation

BPEs

2 2 2

2 2 2

FURTHER SPECIAL INVESTIGATIONS?

A
  • radiographs - OPG, periapicals, occlusals, biteweings
  • sensibility testing - ethyl chloride, EPT
  • tenderness to percussion - pulpitic or periodntal pain as info on inflmmation of PDL
  • mobility - grad I, II, III, - assess # if root invlved or not

probing depth - perio disease, #

tooth sleuth - # cusps

test cavity - last resort if unsure on tooth’s vitality status

22
Q

how to explain dx to pt

BPE

2 2 2

2 2 2

A

Large radiolucency – caries

Darkness, shadow that’s the decay/hole in your tooth, gone too far for us to save it as it have reached the nerves inside the tooth

Not sure if be able to restore it as since such a large proportion of it is decayed - empathy

BPE scores – have plaque and calculus in your mouth which can lead to advanced gum disease so need to go through Tx and instructions to help reduce this, smoking will also contribute to this

23
Q

how to explain tx options to pt

A

list all tx options - split into immediate (pain relief), medium term, long term

explain risks and benefits of each option

explain it must be holistic decision taking into account the pt concerns, MH. OH, financial cost and biologic cost (price of the teeth/mouth will have to pay if go ceratin option)

24
Q

56yo pt had severe toothache for 4 weeks from upper right first molar which suddenly stopped

tooth was asymptomatic on the day he attended, he reported ‘part of the tooth came off recently’ whilst he was chewing

pt smokes 20/day and is a nocturnal bruxist

takes warfarin for atrial fibrilation

BPEs

2 2 2

2 2 2

IMMEDIATE MANAGEMENT

A
  • explain INR needs to be checked within 72hrs as pt is high bleeding risk hence unable to extract today
  • stabilise teeth with temp filling material/extirpate (if unrestorable then options are: monitor or XLA)
  • AAA - advise, analgesia, antibiotics (facial swelling or temp/systemically unwell)
  • if XLA then can provide immediate denture if large edentulous space

give cooling period for pt to have time to decide

25
56yo pt had severe toothache for 4 weeks from upper right first molar which suddenly stopped tooth was asymptomatic on the day he attended, he reported 'part of the tooth came off recently' whilst he was chewing pt smokes 20/day and is a nocturnal bruxist takes warfarin for atrial fibrilation BPEs 2 2 2 2 2 2 MEDIUM TERM MANAGEMENT
1. extract tooth under LA with INR checked (may require surgical extraction which involves cutting gum and sutures) * adv: remove risk fo further pain and infection from tooth * disadv: will leave gap which may require management 1. prevention * improvement of OHI and diet investigation before any advcanced cons can be given * smoking cessation * soft splint for bruxism 1. replace denture for a better fitting one if needed whilst waiting for bone levels to stabilise
26
56yo pt had severe toothache for 4 weeks from upper right first molar which suddenly stopped tooth was asymptomatic on the day he attended, he reported 'part of the tooth came off recently' whilst he was chewing pt smokes 20/day and is a nocturnal bruxist takes warfarin for atrial fibrilation BPEs 2 2 2 2 2 2 LONG TERM MANAGEMENT
leave gap denture * can be modified if more teeth lost * good aesthetics * removable so pt may not find them natural at beginning (requires habituation) Bridge * good aeshetics * fixed prosthesis * requires optimum OH * adjacent tooth may require tooth prep (sound enamel loss, 20% chance of pulp damage) - coventional bridge not resin bonded * unaesthetic if recession occurs (likely as smokes 20/day) Implant * good aeshtetics * fixed prosthesis * does not damage adj teeth - low biologic cost * requires optimum OH * contraindicated in smokers (higher chance of peri-implantitis) * expensive - has to be privately funded
27
amy smith, 7 y.o., female lives with mum, parents never married and are not together allergic to penecillin irregular dental attender, first attended GDP in pain a few months ago * had a right sided facial swelling, GDP gave her a couse of antibiotics following which it settled since then has had toothache intermittently from all quadrants of her mouth, kept her awake on a few occassions taking calpol daily to manage the pain attending a new pt clinic with her grandma **explain dx to amy and her grandma**
introduce yourself check ID - check who is accompanying her - who have you brought with you today? why? (mum unable due to time, any time suit her better in future) check MH and SH briefly repeart what you know of pain history - go over SOCRATES to add stuff explain multiple carious teeth thta are unrestorable and need extracted * use pictures, dark areas, Widespread and severe in teeth so likely want to take them out as they’ve been causing her pain for a while and facial swelling grandma cannot conset so mum or dad will need to attend to sign consent forms
28
a my smith, 7 y.o., female lives with mum, parents never married and are not together allergic to penecillin irregular dental attender, first attended GDP in pain a few months ago had a right sided facial swelling, GDP gave her a couse of antibiotics following which it settled since then has had toothache intermittently from all quadrants of her mouth, kept her awake on a few occassions taking calpol daily to manage the pain attending a new pt clinic with her grandma **explain tx modalities to amy and her grandma**
XLA * quick, removes risk of infection * multiple carious teeth so would need multiple visits, a lot to manage for someone with no previous experience of dental tx XLA with IHS (happy air) * reduces anxiet, some analgesic properties, helps densenstise, can be titrated to response, no recovery period so no time off school needed to recover * still requires LA, multiple appointments XGA * all tx dnone in one go, pt will not remember tx after * long waiting list, no desensitisation, fasting needed, extreme/radical approach
29
communication skills
* body language - lean forward, dont cross arms, head tilt and nod * ask open ended non leading qs * describe to me the pain * reapeat a summary of whay they say to check you have gotten the facts correct and show them you are listening * show empathy * I’m really sorry, I know you may not want to hear that you need extractions, but it will get you out of pain and help resolve the infections and we can think of a long term option to replace the tooth if you want * avoid clinical jargon * 'chunk nad checl' - break your information into digestible sections and check if they understand or have any Qs before moving on * refer them to information sources - leaflets, websites, videos
30
antiobiotics 1st line
250mg 2 tablets 4xdaily for 5 days Phenoxymethylpenicillin 500mg 1 capsule 3xdaily for 5 days Amoxicillin 400mg 1 capsule 3xdaily for 5 dyas Metronidazole
31
contraindications for amoxicillin
allergies
32
contraindications for metronidazole
warfarin pregnant no alcohol intake
33
antibiotics 2nd line
150mg 1 capsule 4xdaily for 5 days Clindamycin
34
IDB
Left hand feel for coronoid notch of the mandibular ramus with thumb (greatest depression on anterior ramus, in mouth) and use over fingers to support mandible * 1cm above occlusal plane Needle entry junction of buccal pad of fat/ pterygomandibular raphe Syringe lies over contra lateral 5-6 Advanced to bony contact (1cm of needle visible), do not inject onto retract slightly * If no bony contact reposition syringe mesially * If bony contact too soon, reposition syringe barrel distally Aspirate Inject slowly ¾ cartridge For lingual anaesthesia withdraw 2-4mm then injection of last 1/4 of solution
35
for anaesthetising upper tooth for XLA how much LA buccally and palatally
3/4 buccal 1/4 palatal use handle of mirror on palate to distract
36
rate of LA deposit
30sec/ml whole cartridge will take just over 1min

BDS3 OSCE (6 decks)

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